Liberal Dem, Conservative Doc

As a front-page blogger at Daily Kos and creator of the site's popular Daily Pundit Roundup, Dr. Greg Dworkin (f.k.a.DemFromCT, now blogging under his real name) is a high-profile political liberal.  On Twitter, he is an enthusiastic if scrupulously evidence-based proponent of the Affordable Care Act, defending the efforts it embodies to extend access, control costs and improve quality in healthcare delivery.

As a pediatric pulmonary physician with nearly 25 years in private practice, however, Dr. Dworkin spontaneously describes his approach to systemic change in the medical delivery system as "conservative."  He is not hostile to concepts such as coordinated care, bundled payments or risk-based payment -- in fact he has adapted to many changes along these lines over the course of years. He just sees innovations on this front as incremental and experimental -- and to be judged on the basis of evidence that's not in yet.

Dr. Dworkin's thinking about healthcare reform is also, to a degree, conservative in a more political sense. While he sees no clear benefit as yet from reforms in the way doctors and hospitals are paid, he does witness patients growing ever more cost-conscious as health plan deductibles rise and prescription drug coverage grows more restrictive. In a recent discussion of what healthcare reform looks like from the physician's point of view, he placed more emphasis on the effect of newfound cost-consciousness in patients than on changing incentives for doctors.

As with bundled payments, he said, the advent of consumer cost-consciousness is "a process that's been happening for a long time -- it predates and goes in parallel with the Affordable Care Act."

A Post-Atwater election?

Back in October, I wondered here whether the U.S. had become a post-democratic society. That is, a society in which marketing techniques have grown so successful that they overwhelm democratic discourse, so that even the most thoughtful, able and public interest-minded elected officials cannot develop good policy and legislation and cannot speak anything approaching the truth as they see it if they have any hope of being elected.

Sometimes now, with a little audacious hope, I wonder if we're coming out the opposite end -- that is, whether our democracy isn't developing some effective defenses to the consumer manipulations developed over the last forty years. Kos Diarist 2501 set me thinking this again with an interesting footnote to an Obama ad running in Ohio:

At the end, it does not just give Obama's web site and campaign phone number, but it also gives the correct date and times for voting in that state. I am sure that Obama's campaign knows that a prime vote suppression technique (especially often used against african-americans in poor neighborhoods) is to spread misinformation about the time and date of the election. While this is something that can help bring out more of Obama's (likely) voters in the primary, it is also a smart strategy to help get more Dem-likely voters out in the general election.

I'd like to think that we have seen this often enough--the push polling, the fake robocalling, the ugly last-minute smears-- that our candidates would know that developing pre-emptive strategies against such tactics would be a smart move. I'd like to see if we could start a discussion about this, collecting known past techniques, and also collecting ideas for smart ways to counter them. I think this Obama ad shows a very simple but smart way of combating one.

This call for "pre-emptive" strategies makes me think again that maybe this is the first 'post-Atwater,' or post-consumer or post-media election. In various ways, we may be developing antibodies against manipulative techniques that have worked for 2-4 decades: negative advertising, big-donor money, manipulation of mainstream media (there are so many voices, watchdogs and counter-watchdogs now), Penn-style microtargeting, to name a few. Not that these forces will go away or lose their power overnight, but there are new means of resistance -- and maybe a healthy scepticism and media saturation in the electorate.

Part of Obama's promise is to turn us past spin. On one level, that can't be any more true than that he'll end lobbying or partisanship. He's a skillful message masseuse himself. But note how he's stopped the Clinton smears in their tracks, at least for a brief spell. And how he's managed to dissect Hillary's limitations with a minimum of distortion. It's not past reason to hope that he could push through legislation to curb lobbying, and help discredit Rovian techniques, and dial down partisanship, which has historically ebbed and flowed.