By Ron Leach
My medical colleagues will recognize the title – A Rude Unhinging – derived from Dr. Samuel Gross’ 1862 description of a rapidly deteriorating physiological state of the human body now known as shock; “the rude unhinging of the machinery of life.” They will also recognize the term homeostasis; the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes, necessary for health and long-term survival of the biologic organism. Just as the biologic body – human or other living organism, and the interconnected ecosystem – requires a state of equilibrium within narrow metabolic norms, our “body politic” requires homeostasis, or a balance within certain ranges of normal if the essential core functions of that body shall persist and serve us appropriately.
Just as our bodies have normal criterion ranges on exam resulting in optimal outcomes, our body politic operates most effectively and for the good of the body as a whole – i.e. all of us – within a narrow range of healthy norms. The current political vital signs and behaviors point to trouble. On exam I see an abnormal temperature in our political temperament – ideological extremes. I see multiple Behavior Health concerns such as paranoia, schizophrenia, and depression. I see a substance abuse disorder manifested in the ever growing influence of money used more frequently even once the damage is readily apparent – (yet I am sure every politician will insist that they don’t have a problem, and can quit any time).
In human medicine, seriously concerning values or significant behaviors abnormalities require immediate attention. Measurable quantifiable lab values, when significantly outside of normal, are referred to as “critical values” and require immediate reporting to and acknowledgement by the treating provider. I am reporting the critical values and out of range behaviors I am seeing in our democracy or Body Politic. We – all of us – as the care takers of our own democracy must acknowledge these critical values and formulate a treatment plan.
A Febrile Body Politic – Ideological extremes and hyperpolarization: Whereas the human body has a vital sign of temperature, our politics has a measurable vital sign in temperament. The current polarization within our politics exceeding normal values on both the left and right, has stricken our democracy and wrought a paralysis rendering our body politic unable to appropriately address the most significant and growing challenges of our nation. What is a “normal” range/value for political vital signs? Biologic normal values are often derived from a reference range defined as the set of values for which 95 percent of the normal population falls within. So, what would be a normal range for political polarization and what would indicate a body politic with a polarization and partisanship that exceeds a “normal” healthy range and potentially a critical value? By what measure can I definitively state that our politics is no longer in homeostasis and is in a life threatening state of imbalance? First, I will point to the quantifiable and measurably growing polarization within the walls of our US Congress. From post WWII through the early nineties, 40 percent of US Congressional members where rated as moderates based on their votes and positions. These moderates carried, nearly equally, the label of Democrats or Republicans. Within the ranks of Democrats and Republicans there existed a degree of common ground on many issues and room for mutual respect and compromise. Now the number of moderates has dropped to 10 percent, with a growing absence of bridge builders and coalition builders on both sides of the isle. Another way to examine this shifting vital sign of our democracy would be to look at the shrinking number of US House and Senate members who fall between the most liberal Republican member and the most conservative Democratic members within their respective legislative bodies as discussed in Chris Cillizza’s The Ideological Middle is Dead in Congress – Really Dead, 10 April 2014, Washington Post. A few graphics from that article to make the point:
It is no coincidence that this trend has coincided with more frequent ideological showdowns while our US Government is frequently taken to the brink of shutdown or default, sequestration in lieu of responsible budgets, and CR (continuing resolution) after CR; no actual budget passed from 2009 until just recently while on the brink of a fiscal cliff once again.
Polarized Congress Only Getting More Split– Now Proven by Math by Seth Augenstein, Digital Reporter 04/22/2015 reaches the same conclusion.
The US Legislature is temporarily playing nice. In October 2015 a budget was finally passed and the US House passed a deal to finally fund the Highway Trust Fund for more than a few months at a time (although riddled with financing gimmicks/ smoke and mirrors rather than a clean straightforward adjustment in the federal gas tax that has remained unchanged for about two decades now – has lost inflation adjusted value of 63% since last raised and is further diminished measured by revenue per mile driven due to successes in increased fuel efficiency – a double whammy that has repeatedly depleted the fund). As we get into the swing of another election year the perceived ability to actually govern is becoming a key issue in voter’s minds. Legislators are attempting to imitate actual governing. But the near insurmountable ideological divide remains and is growing, and the failure to make pragmatic and realistic deals is the result. This mounting and ongoing failure is reflected in the electorate’s declining congressional job approval ratings:
Signs of Depression within our Body Politics: Anhedonia– “the loss of interest or pleasure in activities one normally engaged in” is a key indicator of depression for which we strive to screen for at each patient encounter. Anhedonia, while a subjective measure when evaluating our human patients, is a measurable and objective vital sign of our politics. A key normal activity in a democracy is voting. Yet, in the US, generally the rate for Presidential elections is around 50% participation, around 40% or less in midterm elections, and as witnessed in Kentucky’s Governor’s race last Tuesday, can be as low as 1 in 3 eligible voter or lower. Just like our individual patient dealing with depression, our body politic expresses feelings of hopelessness and futility. In addition to a voluntary lack of participation, we must add the millions in America who are disenfranchised by law – prior convictions of non-violent crimes for which they have paid their debt, or discouraged often intentionally by politicians seeking to choose the electorate, rather than trusting the electorate to choose them.
Schizophrenia – “a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.” –Or more simply – (in general use) “a mentality or approach characterized by inconsistent or contradictory elements.”
Is the electorate – the global cognitive functioning of our body politic – exhibiting signs of schizophrenia? YES, absolutely! Let’s look at Boyle County KY exit polling from the now only 10 days past Kentucky Governor’s race. While not a perfect picture of the state as a whole, it is close. (According to the Secretary of State’s website, 54.7% of Boyle County voters voted for Bevin, 40.1%, Conway, and 4.6% for Curtis, while Kentucky as a whole went 52.5% Bevin, 43.8% Conway, and 3.7% Curtis). According to exit polling, 64.3 percent AGREE on raising the minimum wage to $10.10/hour – a position aligned with the Democrat that they rejected. The electorate agree on EPA regulation of the coal industry at 56.2% – Yet Bevin has been quoted as saying he will ignore the EPA and that the EPA can “go pound sand.” The electorate agrees with outgoing Democratic Gov. Beshear’s Medicaid expansion decision at 61.9% and support, Gov. Beshear’s implementation of KYNECT insurance exchange (Kentucky’s successful state run insurance exchange) 55.2%. Yet Governor elect Matt Bevin – while waffling from immediate repeal to “scale back” and shift current insured onto the federal exchange (so much for that libertarian “the states can do it better” mantra) is opposed to this position. On the issue of support for Rowen County Clerk Kim Davis’ refusal to issue marriage licenses, only 32.6% support her and Governor Bevin’s position. Yet these same voters gave Matt Bevin 54.7% of their vote (a 14.6% margin of victory over Democrat Jack Conway). Of the six exit polled questions, the only exit question in which the electorate sided with the candidate for which the majority gave their vote was on the issue of random drug testing for recipients of public benefits. So, yes, the electorate reflects a degree of inconsistency, i.e. “a mentality or approach characterized by inconsistent or contradictory elements.”
Substance abuse disorder– Substance use/abuse disorder, also known as drug use disorder, “is a condition in which the use of one or more substances leads to a clinically significant impairment or distress.” The abused substance/ the substance for which our body politic has developed a disabling and unhealthy dependence is money. “Money is not the root of all evil in politics, In fact, money is the lifeblood of politics” former House Majority Leader Tom DeLay once said. Majority Leader DeLay was later indicted for election law violations asserting undue corporate money influence (later acquitted – because that same corporate money can buy whatever “justice” is sought). How do we decide when there is a substance abuse disorder vs a harmless and responsible use? For alcohol the long used screening “CAGE” questionnaire asks the following:
• Have you ever felt you should Cut down on your drinking?
For our Body Politics we could ask equivalently have you ever felt you should cut down on the amount of time you spend fund raising and spend more time actually governing?
• Have people annoyed you by criticizing your drinking?
For our legislators clearly under the influence, we could ask “have your constituents, those you are elected to represent, ever suggested that you fund raise too much and have no time for them or their concerns?”
• Have you ever felt bad or Guilty about your drinking?
We could ask “have you ever felt guilty with the company you keep to supply your insatiable need for money? Have you ever done things/made votes you are ashamed of because you needed another fundraising fix?”
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
Have you ever missed a vote or a constituent meeting for a fund raiser? How soon after the previous election (how many hours later) do you feel the need to do just a little more fund raising?
Item responses on the CAGE are scored 0 or 1, with a higher score indicating alcohol problems. A total score of 2 or greater is considered clinically significant. I feel we can safely assume that the vast majority of our elected “representatives” would, if honest, produce a max score of 4 indicating a significant dependency impairment.
Oppositional Defiant Disorder is a condition in which a child (Member of Congress) displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority (the electorate/ E Pluribus Unum –the idea that we are all in this together and stronger as one). The child’s (insert the US House “Freedom Caucus”) behavior often disrupts the child’s (Legislators) normal daily activities, including activities within the family and at school (insert US Congress). Are there any questions on validity of this observed pathology exhibited by a 40 US House member minority and a smaller handful of US Senators that has hijacked and rendered our US Congress dysfunctional? Enough said.
Are we now witnessing our body politic spiraling rapidly to the rude unhinging of the machinery of life, towards a point of no return? A traumatized or ill body has compensatory mechanisms that can for a short duration stave off shock – an increased heart rate, peripheral vascular constriction to restore blood pressure and direct blood and oxygen to core functions of the heart, brain, and other vital organs; but at the expense of other less immediate needs. We are witnessing this compensatory state within our body politics. Core functions, while compromised and maintained in a clunky inefficient and short term myopic fashion, are continuing. But the non-standard/ outside of “regular order” methods – Continuing Resolutions in the absence of responsible and deliberate budgeting, sequestration that fails to distinguish between vital and non-vital investments, discharge petitions to force votes on popular bills with wide spread bipartisan support etc., employed to sustain minimal core functions are not without costs. The less immediately vital, but in the long-term essential, functions required to maintain our nation’s growth and health are starved and will deplete and weaken our nation over time. A healthy Body Politic has the mental and cognitive strength to constrain excesses, plan for the next generation rather than pander for the next election, and give due diligence to all that ails us, not just blunder forward aimlessly.
Just as the human body’s ability to compensate eventually fails and is followed rapidly by the rude unhinging of the machinery of life, with rapidly diminishing likelihood of recovery in the absence of timely and aggressive life support, our body politic is approaching the point of decompensating and a precipitous decline towards a point of no return. In the early stages of shock, as core immediate body functions are prioritized and less immediate needs are neglected, the damage begins almost immediately as areas deprived of normal oxygenation and blood supply begin anaerobic metabolism resulting in acidosis, lactic acid production, and an accumulation of metabolic toxins that even if full reperfusion is restored, will wreak havoc and harm to the body as a whole. We see this same toxic buildup in our body politics today – an acidic political environment, atrophy of our public institutions and the public’s confidence in these institutions, a steady spiral towards the point of no return, towards a rude unhinging that is eventually irreversible.
What interventions are required?
Prescription/plan: Regular Exercise – Exercise our Vote! And as with all healthy exercise programs, we need voters to “exercise smartly”, and able to make informed and healthy exercise routines.
(1) Automatic voter registration for every citizen at age 18.
(2) A National Election Holliday on our traditional Tuesday federal election day as well as open polls the Saturday and Monday prior.
(3) Mandatory public debates that will force incumbents to face and engage opponents and defend their record and ensure a more informed electorate able to exorcise there vote more effectively. Debates are a vital part of democracy often dodged by incumbents calculating that they have everything to lose and nothing to gain – as my opponent demonstrated in Kentucky’s 2nd US Congressional District race in 2014. P.S. –Debates should be over public airwaves and accessible to all, not only for those with the right cable package!
Substance Dependency Treatment
(1) End Citizens United, END ALL Corporate funding and Super PACS, make public all money spent to achieve political outcomes – i.e. buying legislation. Enforce moderation with enforceable caps on contributions for any perceivable purpose of influencing the electorate.
(2) Consider lengthening and staggering US House terms to mitigate the polar swings election cycle to election cycle and the member’s perceived need for endless fundraising due to the always near term next election.
(3) Voice of the Represented Only – Ban contributions from outside the district for which the candidate seeks election – only allow contributions from the State for which a US Senator seeks election or re-election, the multiple counties of the district for which a US Representative seeks election, the few counties that a state representative or state Senator seeks to represent. In doing so, election results will be determined by those represented, not by millions of dollars in outside contribution. This would greatly level the playing field upon which incumbents currently have a near insurmountable advantage. Elections would less likely be won through saturating the airwaves with biased and carefully crafted TV ads, but rather be won by good old fashion shoe leather, local organizing, public debates and engaging with the electorate directly.
Antipyretics – Fever reduction. Address the temperament –hyperpartisanship – that is destroying our body politic.
(1) End Gerrymandering. All state and federal legislative districts created by an independent non-partisan means (several sophisticated computer programs/applications do a very fine job while eliminating any potential human bias or partisanship).
(2) End “straight ticket voting” here in Kentucky and the remaining other nine US Sates that allow it. Straight Ticket voting only exacerbates polarization. Parties are NOT candidates. Voting straight ticket without making individual choices from top to bottom of the ballot is not actually voting for actual candidates on their merits at each level/race, and unless the voter can actually name each and every candidate on the ballot for which he or she is indicating a vote (for or effectively against) by choosing straight ticket, the basis of an informed vote is not truly exercised and they have not actually cast a vote for or against any actual candidate. Independents are disenfranchised/ disadvantaged – there is no Independent slate “straight ticket” choice, therefore they are not equally represented in the process. In the case of severely polarized electorate (most electoral districts in Kentucky) the down ticket major party candidates are also disadvantaged having their fate severely skewed by the electorate’s response to the “top of the ticket” exacerbated by “straight ticket” voting option.
(3) Eliminate the (D), (R), (I) and other party designations next to the names on the ballot. This overlaps with the aforementioned elimination of straight ticket voting, but takes it one step farther in seeking to ensure voters are selecting people rather than parties.
(4) Runoff elections: Consider voting that allows the electorate to rank candidates when three or more candidates seek the same elective office. Might also consider adding “none of the above” as a standard choice. If no one candidate reaches a greater than 50 percent threshold as the electorate’s “1st Choice”, then there would be a runoff election for the top two finishers two weeks following the first round elections. In the case where the Independent or third party candidates rank high as the second choice for a majority of Democrats and Republicans, they would be more likely to move forward in the runoff rather than be eliminated because of the “spoiler effect” and “least of two evils” fear during a one off election. This technique may very well have resulted in a Bevin vs Curtis runoff election here in Kentucky and the possibility of a non-partisan and pragmatic outcome for our Great Commonwealth of Kentucky which would have better served us all. (See data confirming Independent Drew Curtis support less partisan/more moderate).
You may note that I did not list term limits. Why? Because without many of the above and other measures, I fear that term limits could inadvertently bring about greater polarization. How? Consider a “wave” election year (landslide left or right) in which a relatively centrist legislator who would otherwise likely be reelected cannot seek reelection due to term limits. His or her potential moderating influence would be lost and likely replaced by a more ideological newcomer. Additionally, unless you cutoff the immense influence of PACs, Super PACs and other special interest monetary advantage, these entities will simply swoop into every race now an open race (no incumbent) due to term limits and install the candidate of their choice – i.e. he or she most compliant or willfully sponsored by them. I do not completely reject the idea of term limits and am sympathetic to the argument, but fear the result may not be as intended if not implemented in conjunction with other systemic reforms.
This is not an all-inclusive list of the measures I would suggest to restore the health and functionality of our American democracy, and I do not suggest that I have all the answers. I welcome your thoughts and suggestions – second opinions or the assessment of specialists so to speak. The bottom line is our Body Politic is severely ill, and further delay of our intervention will only result in a continuing deteriorating state with diminishing chances of recovery. Some of what I have suggested may have untoward side effects and may not be the right answer. In medicine every intervention if followed by a reevaluation and adjustment of the treatment plan as indicated. The same will need to be the case as we attempt an aggressive resuscitation of our democracy. But doing nothing would equate to malpractice. We are the care takers of our own democracy. We must acknowledge the current deteriorating status and actively and aggressively intervene now.