Britain in Crisis

Photo by Number 10

On Election Day, May 7, I went to see my doctor, a Polish immigrant. Because he was a legal resident he had the right to vote, and he lost no time (in a very un-English way) in telling me that he was voting Tory. I turned to his nursing assistant, who was also in the room.

“You’d better vote Tory too,” I said, “or you’ll be out of a job.”

“I’m voting Conservative,” she said.

“The Tories the Conservatives,” said the doctor.

“I never knew that,” she said. “I always wondered who they were.”

I was immediately reminded of what Churchill once said: the best argument against democracy is a five-minute conversation with the average voter. How, I wondered, could someone born and bred in this country reach her early twenties and not know that the Tories were the Conservatives? How had she managed not to notice it? But then she said something that redeemed her a little: “I want to keep what we have, you never know with change, do you?”

In any case, she was not alone in her ignorance. It turned out that the pollsters, with nothing else to do but prognosticate, were completely wrong. They had predicted that Labour and the Conservatives would be neck and neck, but the Conservatives polled 6 percent more votes than Labour and won an unexpectedly outright majority in the House of Commons.

Why were the polls so wrong? One possible explanation is that people are reluctant to admit to third parties that they are going to vote Conservative, as if to do so were to admit a secret vice or to being actuated only by the most selfish motives. In other words, their reluctance is an indication of how far the Left has won the battle for the hearts and minds of at least a large section of the population, who do not believe that there can be any respectable arguments for conservatism. Not, of course, that the British Conservatives are genuinely conservative; they are merely less progressive than their opponents. The very term causes a bias against conservatives, for who can be against ? That real progress occurs largely by non-political means is not an idea that can be expressed in a slogan, while supposed progress by political means can easily be reduced to slogans. Moreover, since competitive politics is about the righting of wrongs and the addressing of complaint, any suggestion that some things should remain the same is easily portrayed as unfeeling complacency by the privileged.

In fact, the reelection of David Cameron, which in the past would have been a manifestation of stability, solves nothing of the crisis of political legitimacy in Britain (constitutional legitimacy is something else). With voter turnout of 66 percent and the British party system Balkanized, Cameron won reelection with the suffrage of 24.7 percent of the adult population. Even more startling was the fact that a vote for the Scottish Nationalists weighed nearly 150 times more heavily as far as representation in Parliament was concerned as did a vote for UKIP. (It took 25,974 votes to elect an SNP Member of Parliament, but 3,881,129 to elect a UKIP one.) A vote for the SNP weighed about 25 times more than a vote for the Greens. The SNP won 50 percent of the votes in Scotland but 95 percent of the seats. Clearly, we now live in an unrepresentative democracy.

For the SNP, it was a heads-I-win-tails-you-lose election. If Labour had won more seats than the Conservatives, but not an absolute majority (which was always very unlikely), the SNP would have been able to dictate policy or at least influence it strongly; if the Conservatives won, the SNP could claim that the U.K. government had no mandate or legitimacy in Scotland, and use the vote to emphasize the difference between England and Scotland, and perhaps as a further grievance.

Cameron’s problems are just beginning, and his triumph will be short-lived. He has promised a referendum on membership of the European Union, a promise that would be difficult even for Houdini to escape; and if it goes against membership, the Scots, who are Europhile but anti-English, might declare their independence and try to remain in the European Union (though it is by no means a foregone conclusion that the Union would have them). Nor would independence be without potential for creating deep divisions, bitterness, and conflict within Scotland itself, though the leadership of the SNP speaks the language of unanimity. The potential for chaos both north and south of the border is enormous.

One of Britain’s prevailing assets has been its political stability. But that stability has evaporated, probably for good—with potentially disastrous results for its financial sector, upon which it so strongly (though foolishly) depends. Terrible political problems have been conjured out of nothing except the ambition of politicians, and the country’s deeper problems—its low productivity, its abysmal cultural and educational levels—remain not only unanswered, but unremarked.

City Journal

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Free Speech, No Compromise

Photo via PamelaGeller.com

After the attack in January, some people blamed the victims: the magazine’s artists and editors as well as France itself. By drawing the prophet Mohammed, these critics suggested, the magazine incited violence. France is racist, others charged. It doesn’t integrate its Muslims well or help poor people find jobs. It builds poorly designed low-income houses. And French people are rude. But blaming anyone but terrorists for terrorism is a dangerous game. To see why, look at the rhetoric surrounding the terrorist attack in Garland, Texas, earlier this week.

The assault on the Muhammad Art Exhibit and Contest, a privately sponsored event, could have been another . The only reason jihadists Elton Simpson and Nadir Hamid Soofi wounded one person instead of killing 11—or more—was that a cop shot them dead. You don’t hear too many Americans saying that the reason Simpson and Soofi attacked the exhibit was America’s failure to find them jobs or a place to live. That line of thinking on home turf would be almost too ridiculous—though many supposedly reasonable Americans said or implied those things about the French attacks. But you do hear far too many people—including the editorial board—saying, in effect: “Wasn’t it irresponsible for Pamela Geller, whose anti-Muslim group organized the Muhammad exhibit, to try such a thing?”

We all know by now that many Muslims object to people drawing the prophet—and that a small minority of Muslims objects enough to kill over it. Therefore, the thinking goes, anyone who exhibits drawings of the prophet is asking for it. That’s how columnist Linda Stasi sees it. “We have freedom of speech,” she wrote, “but we also have freedom of religion. Suppose there was a contest to draw God in defiance of Jewish laws. Would that be free speech or hate speech? What about cartoons of Jesus with his genitals up in the air?” Blaming Geller for the attack, Stasi imagined what Geller must be thinking: “Damn the cost in innocent lives.”

The ’s Christopher Knight saw it the same way. Judging that Geller’s exhibit “led to [the] fatal shooting” of the terrorists, he wrote, “there is no one to root for on either side.” Even Fox News’s Bill O’Reilly blamed Geller. “It’s always cause and effect . . . . This is what happens when you light the fuse, you get violence,” he said. And the Daily Kos’s Karen Hedwig Backman wondered, “How many [SWAT] officers did Pamela Geller hire for her little shindig,” leading to the deaths of the two armed terrorists? Indeed, Texas local law enforcement provided armed personnel, for good reason.

This is what passes for rational debate when, in fact, there should be no debate here. Geller has the right to free speech. She has the right to put on an exhibit showcasing Muhammad drawings. Likewise, we all have the right to attend it, to boycott it, to ignore it, or to march around it with protest signs. To answer Stasi’s question: drawing a Jewish God or drawing Jesus’s genitals is also free speech, much as it might offend many of us. The world is complicated, but this issue isn’t. The right to free speech means, too, that Mayor Bill de Blasio as well as most anti-cop demonstrators don’t have “blood on [their] hands” when a terrorist or a criminal shoots a cop. Unless they are inciting violence—telling someone to go out and shoot a cop or a cartoonist—Americans can say what they like.

Speech is speech, and shooting people is shooting people. Everyone who lives in a Western society should understand the distinction.

City Journal

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Libertarians of Convenience

Patrick Allard/REA/Redux
Legalize pot, but stop the vaping.

The rent is too damn high, charges Matthew Yglesias in his recent book bearing that title, and he knows why: government regulations, including zoning, which amount to “draconian central planning.” “High rent is not a fact of nature,” he contends. “It’s the result of bad public policy.” Government red tape limits new supply, drives up rents on the inadequate number of apartments available, and makes building new housing uneconomical for developers. “It all goes back to the question of return on investment,” Yglesias reminds us.

Yglesias wants to see a major rollback of regulation to create a freer market in land use. He admits that “any change is bound to be somewhat discomfiting to some people,” but neighborhood complaints over new construction should be overridden in the name of the greater good of lowering costs. “If people have strong feelings about not wanting to live on the same block as a tall building, they can move,” he says—or pay up to buy out their neighbors’ right to build.

Yglesias must be a hard-core libertarian, right? Well, no. In fact, he’s a left-wing writer and activist who published his book while writing for the very liberal Think Progress. He states unabashedly, “I’m for higher taxes, income redistribution, universal health care, cap and trade, and so on.” Nevertheless, Yglesias says, “here I am, largely making the case for deregulation.”

He isn’t alone. People identifying as urban progressives increasingly find their own goals stymied by laws and regulations, and they’re demanding that these restrictions be overturned or limited. In other areas of city policy, though—typically, when they don’t hold a personal stake—they often push aggressively for ever more regulations and a more intrusive government. Call it a libertarianism of convenience. What these part-time freedom lovers don’t understand is that, absent a wider culture of liberty, calls for selective liberty will probably go unheeded.

Nowhere has the liberal big-government, pro-regulation consensus weakened more noticeably than in housing policy, especially in New York and San Francisco, where housing prices have soared. Zoning—particularly rules limiting density—has become a regular target. Urban analyst Daniel Hertz, a onetime community organizer in Chicago, has struck a strikingly libertarian note on this theme. “In many neighborhoods,” he wrote in the , “zoning laws prevent the construction of low-cost housing by, for example, allowing only single-family homes instead of apartments. . . . Researchers have found overwhelming evidence that restrictive zoning raises housing prices.” Writing in ’s CityLab, and sounding more like Milton Friedman than a traditional left-liberal, Hertz noted that overuse of zoning had produced a pattern of “micro-regulations of the urban space, in which the size, function, number of windows, orientation, number of inhabitants, number of parking spaces, color, lawn space, and a million other details of every single building in the city came to be a legitimate state interest.”

The Washington State–based Sightline Institute, a liberal think tank, echoes Yglesias and Hertz: “This anti-density attitude remains, sad to say, the political reality in most of Cascadia’s single-family zones, and it yields a sort of collective pathology of scratching in the wrong place.” And the Michigan political blog Democracy Tree, in its “Progressive’s Guide to Talking to Tea Party Zealots,” finds an area of agreement with the “zealots”: “Zoning laws are just plain bad. They’ve got to go! They harm communities, create crime-zones, destroy schools, contribute to poverty, and de-humanize our existence.”

Left urbanists also decry zoning that requires city developers or businesses to include a minimum number of parking spaces before moving forward on a building or an opening, rather than leaving that decision to the market. Streetsblog decried parking-space mandates as “absurd.” The Walking Bostonian commented on high minimum parking requirements at, of all places, bars: “It’s almost as if there’s a kind of sickness which seems to get into city planners’ heads whenever the topic of parking comes up, and it causes all common sense to fly out the window.” Greater Greater Washington sarcastically observes that Steve Jobs, by founding Apple in a garage, “broke the law by building computers in required parking spaces.” As liberal urbanist Payton Chung sums up, “A parking minimum demands that the rest of us subsidize one economically infeasible land use above all others.”

Other aspects of housing regulation have also come under scrutiny, including minimum unit size: “The fanaticism of neighborhood groups opposed to microhousing is hard to fathom,” says the, a Seattle alternative weekly. On height limits, “It seems like a no-brainer for D.C. to at least the Height Act to promote growth,” says the Next City website. Even historic districts seem to have gone too far for some liberals, becoming a kind of “neutron bomb zoning—preserving the buildings but driving out the working class communities,” according to MoreNYC.

The urban Left’s sudden love for libertarian ideas goes beyond housing. When hip food establishments run into red tape, progressives and the press jump into gear. For example, the regulatory travails of Chicago’s Logan Square Kitchen attracted a series of articles in the alt-weekly , which observed: “The minutiae of this licensing confusion are mind numbing.” The food industry is ready for deregulation, too, many on the left argue. Covering an alliance between libertarians and city-dwelling foodies, who tend otherwise to be good liberals, to promote “food freedom” and fight bans on raw (unpasteurized) milk, CityLab observed that “it’s the rare bipartisan issue.” Or take meat curing. Writing in the , Mike Sula glowingly profiled members of the “charcuterie resistance,” who flout food-safety laws. Describing Erik and Ehran, proprietors of E & P Meats, Sula writes: “Because they sell meats that aren’t prepared in a licensed commercial facility, Erik and Ehran are operating outside the law. But some laws, they fervently believe, were made to be broken.” Food activist and author Michael Pollan has made kindred arguments. “Today the revival of local food economies is being hobbled by a tangle of regulations originally designed to check abuses by the very largest food producers,” he wrote in the . “Farmers should be able to smoke a ham and sell it to their neighbors without making a huge investment in federally approved facilities.”

Others want the freedom to practice agriculture in the city itself. Covering the battles to open an urban farming-supply store called Cluck, David Dadekian wrote on the Providence website Eat Drink Rhode Island, “I certainly hope this is the last Cluck story I have to write until I can publish a ‘Cluck is now open’ story.” Urban-agriculture enthusiasts are furious that some cities ban backyard chickens. They feel “needlessly henpecked by intolerant neighbors,” as quipped. Urbanist website BeyondDC enthuses: “Urban chickens are really, really great.” So are bees, according to green-advocacy site Treehugger, in a 2009 post. But in New York City, “Urban beekeeping has one significant bump in the road to clear before it joins the ranks of community gardening and CSAs [community supported agriculture organizations]. . . . [I]t just so happens to be illegal.” The city subsequently lifted its ban on bees.

Rules that make food trucks illegal or hard to run—prohibiting them from parking near brick-and-mortar restaurants, say—are yet another irritant. “Many restaurateurs would prefer a downtown free from competitors,” Greater Greater Washington editorialized, “but it makes as much sense to give restaurants input on where food trucks can operate as it does to give food trucks control over prices restaurants can charge.” The complained of that city’s food-truck law: “It doesn’t help start-up food trucks at all, but rather protects the interests of established brick and mortar restaurants.” According to Next City, “More and more cities have come to recognize the mobile kitchen as a small-business model that’s here to stay.”

Examples of this kind of left-libertarianism don’t end there. Much of the new “sharing economy”—made up of firms like AirBnB and Lyft, which facilitate the peer-to-peer rentals of things like apartments or cars that the owners aren’t using—has made regulators uneasy, but progressives have proved more friendly than not to this burgeoning market. (Though they often don’t say kind things about Uber, a sharing-economy firm whose CEO once featured the cover of Ayn Rand’s as his Twitter avatar.) Biking advocates, who tend to be on the left, want laws requiring bicyclists to follow all traffic laws repealed in favor of a looser regulatory regime, modeled on the so-called Idaho stop, which says that they can merely yield at stop signs. Transportation advocates would like to see environmental-review requirements reduced for transit projects, to incentivize building.

Urban progressives’ enthusiasm for deregulation proves to be highly selective, however; indeed, in many policy areas, they’re pushing for greatly expanded regulation. This is often true on the economic front. Advocates have pushed hard for local minimum-wage hikes in cities from Chicago to Seattle, for instance, and they try to block chain retailers from expanding in many neighborhoods. But the regulatory spirit is particularly relentless when it comes to the environment. San Francisco has restricted plastic water bottles and banned single-use plastic bags from stores, prompting the alt-weekly to cheer the city for continuing to “lead the way in the nation’s environmental policy.” New York mayor Bill de Blasio has announced a ban on polystyrene packaging, which will start in July. EVERY CITY NEEDS VANCOUVER’S BAN ON FOOD SCRAPS, a CityLab headline recently declared, lauding that city’s ban on tossing food into the garbage, meant to encourage people to compost.

Their inconsistency can lead liberals to seek more regulations in sectors of city life that they’ve elsewhere said should be deregulated. While they’ve assailed density limits, height restrictions, minimum-unit sizes, and other housing regulations, for example, they have celebrated New York’s access-to-buildings law, which mandates that commercial buildings allow bicycles on freight elevators. Similarly, while car parking minimums have drawn fire, sites like Greater Greater Washington have simultaneously embraced parking minimums in the District of Columbia. When Los Angeles mandated reflective roofing materials, CityLab described the regulation approvingly as banning “heat-sucking” roofs. And progressives’ call for food freedom abruptly reverses itself when trans fats, genetically modified foods, or large sugary drinks are in question—they think all should be banned or strictly regulated. They also support the micromanagement of school lunches and requiring restaurant menus to list calorie counts.

These contortions reach absurdity with smoking policy. On the one hand, the Left champions the legalization of marijuana in states like Colorado, Washington, and Oregon. When the District of Columbia decriminalized pot, Next City wrote that “it’s another example of how smart city policy can one day influence Washington [the federal government].” Legalized pot is variously said to be a great source of tax revenue, jobs, and even a key part of an emerging start-up culture. Yet while smoking weed is encouraged, smoking tobacco remains Public Enemy Number One, with progressive cities piling on further restrictions to this already highly taxed and regulated activity. San Francisco has banned smoking at outdoor events, with such detailed requirements as making promoters include the “no smoking” designation in advertisements, and announcing every two hours during events that smoking isn’t allowed, lest attendees forget. Pot smoking—for “medical” purposes, of course—is exempt from the ban. Portland recently joined a list of cities banning smoking in public parks. As in many cities, the ban covers not just bona fide tobacco cigarettes but also smokeless e-cigarettes. San Francisco was the first city to regulate e-cigarettes like other tobacco products, with New York and others soon following suit.

What explains these contradictions? A charitable explanation is that urban progressives—typically on the younger side—are just beginning to experience how excessive regulations can suffocate life in the city. After getting entangled in bureaucracy in the District of Columbia when he wanted to rent his condo (legally), Yglesias grumbled in Slate that “I’ve been to three offices, filed five forms, spent $200, lost a day of work—and I’m not even close to getting the simple license I need.” Such red tape, he added, is “a large and needless deterrent to the formation of the humble workaday firms that for many people are a path to autonomy and prosperity.” It appears that he’d never before understood what small businesses go through to operate in the District, or in many other American cities.

But it’s hard to avoid thinking, too, that some of the inconsistency reflects elite biases. The things that liberal-minded city residents like and want to do—eat from hip food trucks, smoke dope, and other “bourgeois bohemian” pursuits—should be left as free as possible, consequences be damned (raw-milk advocates downplay the nearly 1,000 cases of illnesses caused by it from 2007 through 2012). Those that they consider déclassé—Big Gulps, Marlboro Lights, McDonalds—should be restricted or even shut down. It’s regulation for thee but not for me.

What the urban Left doesn’t recognize is that the regulatory mind-set is nearly impossible to turn on or off, depending on what you like or don’t like. Many of the bans and rules that progressives impose on cities not only make life difficult for muffler shops, hardware stores, plumbing firms, bodegas, and other unglamorous operations; they also harm the enterprises that they love. San Francisco independent bookstore Borderlands, for instance, announced that it would shutter because of that city’s recent minimum-wage increase. One reason that much-maligned chains now proliferate in American cities is that they’re just about the only ones who can afford to do business there these days. The same impulse that bans food waste in the trash, vaping, and other things disfavored by liberals also makes it hard to start or make profitable a small artisanal food business—or, for that matter, build reasonably priced apartments. It’s no accident that the highest housing prices are found in San Francisco, Boston, and New York, where regulations have metastasized.

In Texas’s cities, by contrast, progressives often share, to some degree, the state’s pro-freedom, pro-market ethos. That’s why Houston, though hardly without restrictions on building, has no zoning per se and a pro-market Democrat, Annise Parker, for mayor. Unsurprisingly, it remains an affordable place to live, as do other low-regulation cities, such as Indianapolis.

At least some on the left appreciate the principle of liberty when it comes to things like free speech: they understand that odious opinions have to be tolerated, or everyone’s liberty is at risk; and that selective free expression isn’t really free. But they fail to see that selective economic freedom brings its own injustices and inequities. Progressives should embrace a broader principle of economic liberty for American cities—not only for the sake of their own pet causes but also because it’s the right thing to do.

City Journal.

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Brilliant and Tormented

Photo by Jackie Lehmann

, by Norah Vincent (Houghton Mifflin Harcourt, 288 pp., $23)

In late March, 1941, Virginia Woolf went for a walk near her Sussex home. Her body was pulled out of the River Ouse three weeks later. She had struggled with mental illness for years, but protected by her husband, publisher Leonard Woolf, and her sister Vanessa, she had managed to produce some of the most original novels of the twentieth century. So what led her to the river’s banks with a heavy stone in her pocket?

In her new novel, , Norah Vincent attempts an answer. Her fictional Woolf is alternately light and dark, laughing with friends and brooding over her prose. Through it all, she grapples with the voices in her head and the personification of her adolescent self, Adeline (Woolf’s given name). In conversation, Woolf and Adeline conjure up painful memories. They also hash out the images that become some of Woolf’s most enduring. This Adeline is “the girl that she once was, the bright Victorian girl shut behind dark paneled doors . . . . She is the girl stopped in time who could not speak or feel at the side of her dead mother’s bed. She keeps the cold, clear information of those days, unclouded by revision or the lies of age. She is there still, communicating, conjured by this strange Virginia, who is the woman she did not become.”

Through various episodes in Woolf’s life, Vincent explores the wonder and terror of this version of the creative process, experienced by someone with a tenuous grip on reality. The fictional Leonard recalls of his wife: “She’d said that perhaps every writer is meant to express only one idea, one mood, one version of what this strange human experience is about, and that he spends his life and work repeating it over and over again. If he is fortunate, once or twice he gets it absolutely right. He delivers his single given message more purely, more uniquely than any other writer ever has or ever will. But the once or twice is usually all he gets.” Over the years, Woolf comes to see that she had this clarity in the middle of her career, the crest of her genius coming with , , and , and that the rest was “just an echo, the congenital compulsion wearing itself out.”

She battles to keep her mental illness in check enough to work, but over time she comes to see her own artistic limitations and wearies of the fight. The larger world starts to fall apart, too. Vincent vividly recreates the dark days of 1941. France had fallen to the Nazis, and London was being bombed nightly. Like many people, the Woolfs assumed a German invasion was imminent. Leonard was Jewish; he and Virginia had discussed plans to commit suicide rather than go to concentration camps.

Of course, discussing suicide with a mentally ill person is a questionable strategy. Woolf elected to go ahead and make her own plans. Vincent imagines what Woolf was thinking in those final moments: that in her late years she was “not a craftsman anymore, but a tradesman,” and that “she had churned out the riskless product in her later years, varnished, hidebound and safe as bloody houses.” Heeding the voice of Adeline, she stuffs the stone in her pocket and wades into the river.

Though Vincent’s prose is sometimes ornate as she tries to imitate Woolf (“She looks up at the facing wall where a lozenge of nacreous light displays the shadow of a breeze-blown branch trembling”), it can also be lyrical. Some moments hit home because they reflect an understanding that one author has for another: Woolf, Vincent writes, likes to pull off the shelf, simply to read those magical words and know that she wrote them. Vincent depicts the characters of the Bloomsbury Group with all their bizarre rivalries and behaviors. The drunken Vivienne Eliot sends Woolf into a tailspin with her insults. Woolf and Lytton Strachey parry back and forth about her dysfunctional sex life. She is deeply in love with Leonard and yet never quite consummates the marriage, though her affair with noblewoman Vita Sackville-West doesn’t come to much, either. She is always betwixt and between, not quite comfortable in this world, which explains her desire to leave it.

Vincent’s desire to hew to the biographical facts of Woolf’s life results in some puzzling choices. Woolf is a compelling character, but she is also a real person, and , like Michael Cunningham’s , tries to borrow some of her literary prestige in paying her homage. It’s not an achievement quite on par with coming up with an original character.

Yet is a moving novel all the same, a portrait of what it means to be brilliant and tormented. Understanding Woolf’s darkness is as difficult as understanding some of her work, but Vincent rises to the challenge, creating something beautiful in the process.

I Know How She Does It: How Successful Women Make the Most of Their TimeFast CompanyUSA Today.

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Free the Nurse Practitioners!

Andrei Malov/iStock/ThinkStock

For medical students around the country, the third Friday of every March is known as “Match Day,” when they find out if, and where, they will begin their residencies. Not everyone finds a match. Every year, thousands of students fail to gain residency positions, the number of which the federal government caps—even as a physician shortage looms in primary-care specialties such as general medicine, internal medicine, and family practice. The Association of American Medical Colleges estimates that the shortage will reach 45,000 by 2025. In some parts of the country, it’s already hard to find a primary-care doctor.

One seemingly obvious solution for the physician shortage is to increase the number of residency slots. Currently, medical residencies are federally funded through Graduate Medical Education (GME) subsidies, which, in turn, are largely subsidized by Medicare. But the 1997 Balanced Budget Act capped the number of Medicare-funded GME slots at individual hospitals, constraining the growth in positions. In 2012, Medicare contributed about $9.7 billion in GME funding to hospitals to support residency slots, while Medicaid, GME’s second-largest funder, provided almost $4 billion. Some scholars argue that Washington should increase Medicare funding for GMEs, though it’s not clear that doing so will create more residencies. After the BBA-imposed funding restrictions, it’s worth noting, the number of residency slots actually rose.

The real issue is geography. As a 2014 Institute of Medicine (IOM) report observed, the numerical shortage is a result of the mismatch of supply and demand for physicians. If doctors avoid certain geographic areas for quality-of-life reasons, or, for that matter, if they aren’t attracted to primary care because of lower income potential, then adding more GME residencies might just result in more doctors flocking to the same big cities to practice highly remunerative specialties.

Fortunately, other options exist to address the regional primary-care physician shortage—which is what we should really be concerned with. The nearly 175,000 nurse practitioners around the country are more than enough to meet our growing primary-care needs, particularly in regions where such care is most needed. These professionals are trained to do just about everything that primary-care physicians do: diagnose illnesses and diseases, determine the proper course of treatment, and facilitate care transitions (for instance, when a hospitalized patient needs to be moved to a nursing home). Moreover, 84 percent of nurse practitioners actively see Medicaid patients—making them crucial players in our health-care system, since, in 2009, half of all physicians either weren’t participating in Medicaid or served fewer than five enrollees.

States often impose tight restrictions on how these medical professionals can practice, requiring “collaborative agreements” with physicians that prevent nurse practitioners from working independently. Physicians’ groups argue that the regulations are necessary, pointing out the 15,000 hours of clinical practice that doctors accrue over seven years of training, compared with the 500 to 700 hours nurse practitioners put in during their graduate training. Yet, a systematic review of 37 studies (including 14 randomized control studies) found no difference in the outcomes of patients treated by nurse practitioners compared with those treated by physicians.

It seems past time, then, to loosen restrictions on the work of nurse practitioners. The IOM should commission an investigation into the long-term effects of replacing physicians with nurse practitioners. And perhaps some of Medicare and Medicaid’s GME funding could be dedicated to providing “bonuses” to hospitals in states that loosen scope-of-practice restrictions. Before Washington throws more money at solving a poorly understood “physician shortage,” it should first understand that a numerical shortage of physicians is not equivalent to a shortage in care.

ForbesForbes

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Professor Tribe’s Transgression

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Columbia law professor Tim Wu smarmily insinuates on the ’s website today that if colleagues like Harvard’s Laurence Tribe are going to speak on behalf of huge corporations like Peabody Energy in its lawsuit against the Environmental Protection Agency, instead of defending “underrepresented” clients whose views otherwise “would not be heard,” then universities ought to rethink their longstanding policy of letting faculty lawyers work for private clients. It is deliciously self-satirical that Wu also directs a Columbia Journalism School First Amendment center as well, for the real purpose of his piece seems less a complaint about the wealth of Tribe’s client than an effort, however anemic, to silence Tribe’s defense of constitutional views that Wu dislikes. Free speech, indeed.

Within the welter of legal complexities surrounding the Peabody case are several luminously clear constitutional issues that Tribe, normally dependably left-of-center, sees in ways that would gladden a limited-government originalist’s heart. First, though Congress refused to pass a law addressing climate change, Tribe points out, the EPA is behaving as if it has the authority Congress refused to give it, wielding the Clean Air Act in ways Congress not only didn’t authorize but also expressly forbade in the Act itself. Moreover, though Tribe doesn’t say so, it is clear that this executive-branch agency is trying to use its non-existent legislative-branch mandate to carry out a highly contentious, highly partisan policy of the Obama administration. As the quotes one anonymous former administration official, “Whether he intended it or not, Tribe has been weaponized by the Republican Party in an orchestrated takedown of the president’s climate plan.” Moreover, Tribe reports himself mystified as to how the EPA has the gall to contravene the federal government’s “promotion of coal as an energy source,” and to envision, in contravention of the Fifth and Tenth Amendments, shutting down not just a major industry, but also the way of life of whole communities and indeed a whole region of the country.

What is most important about Tribe’s involvement in this case is that he lends his considerable professional authority and impeccable liberal credentials to an increasingly loud chorus that questions the constitutionality of the Administrative State that has developed ever since the establishment of the Interstate Commerce Commission in 1887. Unlike the Founding Fathers, Progressive politicians, with Theodore Roosevelt and Woodrow Wilson in the lead, envisioned government not of, by, and for the people, but rather by highly trained, nonpartisan experts who would use the latest scientific knowledge to make better regulations for people than they could make themselves through their elected representatives.

This enterprise was unconstitutional, even un-American, in itself. But as the administrative agencies developed—as they violated the Madisonian principle of separation of powers by merging together executive with legislative power, which the legislature had no constitutional right to delegate, and with judicial power, which the legislature most certainly had no right to delegate—promulgating rules, charging people and corporations with violations of them, and exacting penalties without the benefit of grand or petit juries, in defiance not only of the American Bill of Rights but even of the Magna Carta, they evolved into an utterly unaccountable government that is nothing like the democratic republic the Founders envisioned. What’s more, with lobbyists having so much sway over them and often writing their regulations, the administrative agencies turned into the guarantors of crony capitalism, protecting giant corporations against competition from upstarts, just as the ICC protected the railroad cartel 132 years ago.

To the elites of Harvard and Columbia, Tribe may look like a traitor. But he is a constitutional lawyer in the most literal sense—and Americans owe him a debt of gratitude for attempting to restore popular sovereignty.

City JournalThe Founders at Home.

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De Blasio’s New York

Photo by New York City Mayoral Photography Office

Follow New York politics closely, and you’ll become familiar with the Twitter hashtag #deblasiosnewyork. Political reporters have made a pastime out of slapping the label on all manner of petty, humorous, or weird stories. The initial purpose of this inside joke was to skewer those who think that Mayor Bill de Blasio is taking Gotham back to the “bad old days.” Over the last 14 months, the joke’s boundaries have expanded to suit the absurdist preferences of the city’s press corps. A tweet about coyotes in Riverside Park is as good a candidate for #deblasiosnewyork as is a story about the 16 percent uptick in the city’s murder rate.

The hashtag may be a joke, but OneNYC, a 332-page document released last week to “articulate the goals and long-term agenda of the de Blasio administration,” is not. It’s the real #deblasiosnewyork: a blueprint for the kind of city that the ambitious mayor wants to leave behind when his days in City Hall are over—whenever that might be. OneNYC is a serious and professional document, portraying a city in the hands of efficient and forward-thinking planners. But a closer look reveals an agenda riddled with left-wing pieties and noticeably lacking in humility about the limits of public policy.

Relying heavily on urban buzzwords like “resiliency” and “environmental justice” and drawing fuzzy connections between income inequality and climate change, OneNYC is laundry-list progressivism at its most majestic: “New York City will have an inclusive, equitable economy that offers well-paying jobs and opportunity for all New Yorkers to live with dignity and security.” The goals are pie-in-the-sky: “[If] OneNYC anti-poverty initiatives are implemented, 800,000 New Yorkers would be lifted out of poverty or near poverty by 2025.” The document is larded with language to stir the blood of idealistic graduate students: “Too often, a person’s home address, parents’ income, race, or other demographic traits can weigh on their life outcomes—from educational attainment to future earnings, and even life expectancy. We must change these underlying odds.”

The mechanisms for instituting this progressive utopia are familiar—minimum-wage increases, magically affordable housing, massive infrastructure “investments,” artists-in-residence at public agencies, broadband for all, widespread composting and recycling, and so on. Absent is any explanation of how all of this will be paid for. The mayor promises that those details are forthcoming. “The specific things that cost city money or capital expense money will be accounted for on May 7,” he said at a press conference. Mark your calendar. What are the chances that de Blasio’s funding plan will look a lot like the $3.4 billion in future health-care “savings” that he used to give city teachers retrospective raises last year?

Some elements of the OneNYC program are innocuous—eliminating all landfill waste by 2030, for instance, seems like a noble, if far-fetched, goal. But in the area of “criminal justice reform,” implementing OneNYC could do real harm to the city and reverse the public-safety gains made under Mayors Rudolph Giuliani and Michael Bloomberg.

Throughout his first 16 months in office, de Blasio has consistently voiced support for Broken Windows-style policing. That he has done so in the face of sustained criticism from his left-wing allies is good news, at least to those who understood Broken Windows’ role in reducing New York’s crime rate over the last three decades. This week, after New York police arrested 143 people during a protest related to the Freddie Gray case in Baltimore, the mayor issued a passionate defense of quality-of-life policing, saying that his administration “won’t move away from the strategy because it works.”

By contrast, however, the OneNYC document envisions a city in which “fairness” can be employed as a “crime reduction tool” and in which “cohesive, engaged neighborhoods”—not order maintenance—somehow become the principal agent in crime prevention. OneNYC proposes a rebalancing of the relationship between cop and criminal: “People are more likely to obey the law when they believe those who are enforcing it have the legitimate authority to do so.” The document makes repeated reference to “unnecessary incarceration,” a coinage that necessarily implies frequent wrongdoing on the part of the NYPD. This vision of a chastened and restrained NYPD is more in line with the old de Blasio, who campaigned on reforming the relationship between police and communities.

How are we to interpret, then, the mayor’s increasingly adamant stance that New York needs Broken Windows policing more than ever? Perhaps, after nearly a year and a half as mayor, de Blasio has developed respect for the difficult and often thankless job of policing a city like New York. Or, having been stung by the backlash among the NYPD’s rank-and-file last December, he may have opted for a new strategy of public support and private reform. If so, he’s playing the complicated game of serving two masters. His allies on the anti-cop Left are surely preparing to test de Blasio’s commitment to Broken Windows by escalating their Black Lives Matter street protests.

OneNYC’s hedging on Broken Windows is especially alarming given the city council’s recent moves toward decriminalizing certain “low-level,” quality-of-life offenses such as turnstile jumping and drinking alcohol on the street. De Blasio has thus far said that he opposes these decriminalization efforts. If the council gets its wish, though, and if OneNYC’s criminal-justice reforms come to fruition, New York could become a place where failure to compost is frowned upon but urinating in public is not. Devotees of the #deblasiosnewyork hashtag may call such fears overblown, or they may actually think that living and working in such a city would be an improvement. But for almost everyone else, this is a joke we’ve heard before, and it wasn’t funny the first time.

City Journal.

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