Sunday, February 13, 2022

Fwd: The Morning: The opioid crisis


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From: The New York Times <nytdirect@nytimes.com>
Date: Sun, Feb 13, 2022, 7:43 AM
Subject: The Morning: The opioid crisis
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U.S. overdose deaths keep hitting records year after year.

February 13, 2022

Author Headshot

By German Lopez

Good morning. Overdoses are increasing at a troubling rate.

A service in Pittsburgh for people who died of drug overdoses.Nate Guidry/Pittsburgh Post-Gazette via AP

A rising death toll

Drug overdoses now kill more than 100,000 Americans a year — more than vehicle crash and gun deaths combined.

Sean Blake was among those who died. He overdosed at age 27 in Vermont, from a mix of alcohol and fentanyl, a synthetic opioid. He had struggled to find effective treatment for his addiction and other potential mental health problems, repeatedly relapsing.

"I do love being sober," Blake wrote in 2014, three years before his death. "It's life that gets in the way."

Blake's struggles reflect the combination of problems that have allowed the overdose crisis to fester. First, the supply of opioids surged. Second, Americans have insufficient access to treatment and other programs that can ease the worst damage of drugs.

Experts have a concise, if crude, way to summarize this: If it's easier to get high than to get treatment, people who are addicted will get high. The U.S. has effectively made it easy to get high and hard to get help.

No other advanced nation is dealing with a comparable drug crisis. And over the past two years, it has worsened: Annual overdose deaths spiked 50 percent as fentanyl spread in illegal markets, more people turned to drugs during the pandemic, and treatment facilities and other services shut down.

Chart shows provisional figures. | Source: Centers for Disease Control and Prevention

The path to crisis

In the 1990s, drug companies promoted opioid painkillers as a solution to a problem that remains today: a need for better pain treatment. Purdue Pharma led the charge with OxyContin, claiming it was more effective and less addictive than it was.

Doctors bought into the hype, and they started to more loosely prescribe opioids. Some even operated "pill mills," trading prescriptions for cash.

A growing number of people started to misuse the drugs, crushing or dissolving the pills to inhale or inject them. Many shared, stole and sold opioids more widely.

Policymakers and drug companies were slow to react. It wasn't until 2010 that Purdue introduced a new formulation that made its pills harder to misuse. The C.D.C. didn't publish guidelines calling for tighter prescribing practices until two decades after OxyContin hit the market.

In the meantime, the crisis deepened: Opioid users moved on to more potent drugs, namely heroin. Some were seeking a stronger high, while others were cut off from painkillers and looking for a replacement.

Traffickers met that demand by flooding the U.S. with heroin. Then, in the 2010s, they started to transition to fentanyl, mixing it into heroin and other drugs or selling it on its own.

Drug cartels can more discreetly produce fentanyl in a lab than heroin derived from large, open poppy fields. Fentanyl is also more potent than heroin, so traffickers can smuggle less to sell the same high.

Because of its potency, fentanyl is also more likely to cause an overdose. Since it began to proliferate in the U.S., yearly overdose deaths have more than doubled.

No one has a good answer for how to halt the spread of fentanyl. Synthetic drugs in general remain a major, unsolved question not just in the current opioid epidemic but in dealing with future drug crises as well, Keith Humphreys, a Stanford University drug policy expert, told me.

Other drug crises are looming. In recent years, cocaine and meth deaths have also increased. Humphreys said that historically, stimulant epidemics follow opioid crises.

A needle exchange in Eureka, Calif.Max Whittaker for The New York Times

Neglecting solutions

A robust treatment system could have mitigated the damage from increasing supplies of painkillers, heroin and fentanyl. But the U.S. has never had such a system.

Treatment remains inaccessible for many. Sean Blake's parents, Kim and Tim, drained savings and retirement accounts and college funds to pay for treatment. Like the Blakes, many families spend thousands of dollars to try to get loved ones into care. Health insurers often refuse to pay for treatment; legal requirements for insurance coverage are poorly enforced.

When treatment is available, it's often of low quality. The Blakes frequently found that providers were ill-equipped and overwhelmed. Some seemed to offer no evidence-based care at all.

Across the country, most facilities don't offer effective medications; instead, they often focus on unproven approaches, like wilderness or equine therapy.

Some are just scams. One, called the "Florida shuffle," has in recent years sent patients from facility to facility without offering real treatment — taking advantage of people desperate for help.

Beyond treatment, the U.S. lags behind other countries in approaches like needle exchanges that focus on keeping people alive, ideally until they're ready to stop using drugs. The country also could do more to prevent drug use and address root causes of addiction, a recent report from Stanford University and The Lancet found.

The solutions are costly. A plan that President Biden released on the campaign trail, which experts praised, would total $125 billion over 10 years. That's far more than Congress has committed to the crisis. Lawmakers haven't taken up Biden's plan, and the White House hasn't pushed for it, so far embracing smaller steps.

But inaction carries a price, too. Overdose deaths cost the economy $1 trillion a year in health expenses, reduced productivity and other losses, a new government report concluded — equivalent to nearly half of America's economic growth last year.

For more:

NEWS

The Ukraine Crisis
Ukrainian soldiers on Saturday in the country's east.Tyler Hicks/The New York Times
  • President Biden warned Russian President Vladimir Putin that invading Ukraine would cost Russia dearly.
  • The U.S. has sought to avert bloodshed by trying to beat Putin at his own game: information warfare.
  • Ukrainian businesses are struggling to secure investments and distributing brochures on what to do if war breaks out.
  • Follow our updates for the latest.
Other Big Stories
Trump chocolate bars at the Trump International Hotel in Las Vegas.Josh Edelson/AFP via Getty Images
  • Donald Trump is monetizing his post-presidency by undertaking ventures that trade on his political fame and fan base.
  • The police were outnumbered and unprepared for the convoy of protesters that have descended on Canada's capital.
  • Some in the Super Bowl host city, Inglewood, Calif., fear it is losing its identity as a predominantly Black section of Los Angeles.
  • A couple accused of Bitcoin laundering led strange online lives seemingly at odds with prosecutors' descriptions of sophisticated criminals.
The Week Ahead
Nathan Chen won gold in figure skating.Chang W. Lee/The New York Times

FROM OPINION

James Joyce, in 1938.Hulton Archive/Getty Images

Maureen Dowd: Washington can be as incomprehensible to decipher as James Joyce.

Ross Douthat: The thin line separating professional sports from the gambling industry is disappearing.

Elizabeth Spiers: The firing of Jeff Zucker of CNN reminds us that sex and power are often intertwined.

Jane Coaston: More people should get second chances.

The Sunday question: How well has Biden stood up to Putin?

Biden's aggression — arming Ukraine, rallying NATO and threatening sanctions — has "surprised and discombobulated" Russia, writes Holman W. Jenkins Jr. in The Wall Street Journal. In The Times, Kori Schake faults Biden for ruling out sending troops to Ukraine and failing to gird Americans for any invasion's likely fallout, including higher gas prices.

Through the support of subscribers like you, we've expanded The Morning newsletter to seven days a week. Thank you for being a subscriber and supporting our work.

BOOKS

Rebecca Clarke

An education: Books teach the skills of empathy and compassion, the author Olga Tokarczuk says.

Our editors' picks: "Goliath," by Tochi Onyebuchi, is an ambitious novel of a crumbling future America.

Times best sellers: Daniel H. Pink's "The Power of Regret" can one day look back fondly on this week's hardcover nonfiction best-seller list. See all our lists.

The Book Review podcast: Jessamine Chan's debut novel, "The School for Good Mothers," highlights impossible standards for moms, she says.

THE SUNDAY TIMES MAGAZINE

Photo illustration by Zachary Scott for The New York Times

Bob Odenkirk: What other comedian could play both an oily lawyer on "Better Call Saul" and the beloved patriarch in "Little Women"?

Recommendation: Cheetos Flamin' Hots, the embodiment of artificial excess.

Fashion: Influencers over 50 possess a unique sense of sartorial freedom.

NOW TIME TO PLAY

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52 Across: Acceptance principle of improv comedy.

Take the news quiz to see how well you followed this week's headlines.

If you're in the mood to play more, try today's Spelling Bee or find all our games here.

Thanks for spending part of your weekend with The Times. — German

Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti, Ashley Wu and Sanam Yar contributed to The Morning. You can reach the team at themorning@nytimes.com.

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Friday, February 11, 2022

Paul Krugman: "Folk Economics"


Wonking Out: Very Serious Folk Economics

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A few days ago, Tressie McMillan Cottom published an insightful article in The Times about the power of "folk economics" — which she defined as "the very human impulse to describe complex economic processes in lay terms." Her subject was the widespread enthusiasm for cryptocurrency, but her article sent me down memory lane, recalling the role folk economics has played in past policy debates.

Just to be clear, the "folk" who hold plausible-sounding but wrongheaded views of the economy needn't be members of the working class. They can be, and often are, members of the elite: plutocrats, powerful politicians and influential pundits. In fact, elite embrace of folk economics was a large part of what went wrong in the global response to the 2008 financial crisis. And it's starting to have a destructive effect now.

So, memories: When the 2008 financial crisis struck, economists, believe it or not, had an intellectual framework ready to go, pretty much custom-made for that situation — because it was devised in the 1930s during the Great Depression. The "IS-LM model" was introduced by the British economist John Hicks in 1937 as an attempt to encapsulate the insights of John Maynard Keynes, who had published "The General Theory of Employment, Interest and Money" the previous year. There's endless argument about whether Hicks was true to Keynes's vision — which is irrelevant for my discussion now — because Hicks is what economists brought to the table in 2008.

According to IS-LM (which stands for investment-savings, liquidity-money), public policy normally has two tools it can use to fight an economic slump. Loosely speaking, the Fed can print more money to drive interest rates down, or the Treasury can engage in deficit spending to pump up demand. After a financial crisis, however, the economy gets so depressed that monetary policy hits a limit; interest rates can't go below zero. So, large-scale deficit spending is the appropriate and necessary response.

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But folk economics sees deficits as irresponsible and dangerous; if anything, many people have the instinctive feeling that governments should cut back in hard times, not spend more. And this instinct had a big, adverse effect on policy. True, the Obama administration did respond to the slump with fiscal stimulus, but it was underpowered in part because of unwarranted deficit fears. (This isn't hindsight, and I was tearing my hair out at the time.) And by 2010, influential opinion — the opinion of what I used to call Very Serious People — had shifted around to the view that debt, not mass unemployment, was the most important problem facing the United States and other wealthy nations.

This wasn't what conventional economics said, and there was no hint that investors were losing faith in U.S. debt. But deficit scaremongering came to dominate political and media discussions, and governments turned to austerity policies that slowed recovery from the Great Recession.

Did economists unanimously oppose austerity? Hey, have economists ever unanimously agreed on anything? (There's less disagreement within the profession than legend has it, but still.) Indeed, a handful of prominent economists managed to come up with arguments that seemed to support the folk theory that deficits are always bad — an episode that I always think of when I see demands for new economic thinking. You see, during the last crisis the new ideas that actually influenced policy did indeed go against conventional economics — but in ways that supported, rather than challenged, the prejudices of the powerful.

Two papers in particular had a malign influence. One, by Alberto Alesina and Silvia Ardagna, asserted that cutting spending in a depressed economy was actually expansionary, because it would increase confidence. The other, by Carmen Reinhart and Kenneth Rogoff, declared that government debt had big, negative effects on growth when it crossed a critical threshold, around 90 percent of gross domestic product.

Both papers were widely criticized by other economists as soon as they were circulated, and in fairly short order their empirical claims were pretty much demolished by other researchers. But their arguments were eagerly adopted by influential people who liked their message, and a funny thing happened to the discourse in the media: To a large extent, these speculative (and wrong) arguments for austerity were both accepted as fact and presented as the consensus of the economics profession. Back in 2013, I cited a Washington Post editorial that declared "economists" believed that terrible things happen when debt exceeds 90 percent of G.D.P., when in fact this was very much not what the rest of us were saying.

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And I've been hearing echoes of that misrepresentation in some current debates, as people advocating new economic ideas — or at least what they claim are new ideas — assert that conventional economic thinking was responsible for austerity policies after 2008. Um, no: Fiscal austerity was exactly what conventional economics told us not to do in a depressed economy, and it was only the peddlers of unorthodox economics who gave austerity policies intellectual cover.

Which brings us to our current moment. This time around, fiscal stimulus wasn't underpowered, and there's definitely a case to be made that excessive deficit spending in 2021 was a factor in rising inflation (although we can argue about how big a factor, since inflation is also up a lot in countries that didn't engage in much stimulus). But now what?

As I said, the IS-LM model tells us that policymakers have two tools for managing the overall level of demand: fiscal and monetary policy. When you're trying to boost a deeply depressed economy, monetary policy becomes unavailable, because you can't push interest rates below zero. But if you're trying to cool off an overheated economy, monetary policy is available: Interest rates can't go down, but they can go up.

And because changing monetary policy is easy, conventional analysis says that monetary tightening is the way to go. Indeed, the Fed has made it clear that it intends to do just that. Getting the pace and size of rate hikes right will be tricky, but conceptually it isn't hard.

But the folk economics position — where by "folk," I mainly mean Senator Joe Manchin — is that excessive government spending caused inflation, so now we have to call off any new spending, even if it's more or less paid for with new revenue.

Well, that's not what conventional economics says; on the contrary, the standard model says that the Fed can handle this while we deal with other priorities.

And while conventional economics isn't always right, anyone attacking it now should ask themselves whether they're doing so in a constructive way. In particular, I'm seeing a lot of denigration of monetary policy from people who don't seem to realize that they are, de facto, giving aid and comfort to politicians who don't want to invest in America's children and the fight against climate change.
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Tuesday, February 8, 2022

Matthew Yglesias: Breakdown of the Jan Jobs Report



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The real story behind last week's jobs report

The virus is still driving the economy after all.

The Biden administration spent a couple of weeks lowering expectations in advance of last week's Employment Situation Report from the Bureau of Labor Statistics, warning that after a year of mostly good news on job creation, we would likely see a loss of jobs in January due to Omicron.

In these reports, an entire month is represented by a "reference week," and the survey asks respondents very literally if they worked that week. A "no, I didn't" can be the result of layoffs or the inability of a previously non-employed person to find a job. But not going to work due to a snowstorm, a bad hurricane, or a strike also count as not working, so temporary, non-macroeconomic events like a May 2016 strike at Verizon or the 2012 superstorm Sandy sometimes have a large impact on jobs numbers.

Even among those who were not gravely ill, Omicron seems to have made a large number of people too sick to come to work for at least a few days in January.

Airlines canceled many flights due to shortages of available crews. Some restaurants in my neighborhood had to close or temporarily switch to takeout-only. We saw disrupted deliveries to grocery stores around the country. It seemed like a lot of people missed work at least temporarily, and the January report was expected to reflect this. But then the actual numbers came in:

  • "January Jobs Report Crushes Expectations" [CNN]

  • "Payrolls show surprisingly powerful gain of 467,000 in January despite omicron surge" [CNBC]

  • "U.S. Jobs Surged by 467,000 in January as Economy Weathered Omicron" [WSJ]

  • "How the US economy defied Omicron to add nearly half a million jobs" [New Yorker]

  • "US appears to shake off omicron and adds nearly half a million January jobs" [Guardian]

So what happened? One natural interpretation of these numbers is that the fears of an Omicron impact on the economy were wrong. But this is incorrect. What actually happened is that Omicron had a large negative influence on the economy in January, but the January jobs report included good news about prior months. These revisions not only added to our estimate of how robust the recovery was across 2021, but they also gave us a somewhat different impression of its shape. Altogether, they tell a tale of an economy in which both the virus itself and virus-related fears remain a, if not the, major constraint on growth.

January jobs reports are odd

Today's post relies largely on the work of two other excellent Substackers. Joey Politano and Matt Klein have both done fantastic analyses of this report, and I'd encourage anyone who's consistently interested in labor market data to subscribe to their 'stacks. I'm going to offer a somewhat less technical and somewhat more opinionated account of what happened, but all credit to the two of them for digging into the report to explain what really happened.

It's helpful to know a little about how the monthly jobs report comes together. On the most basic level, it's a combination of two surveys:

  • The establishment survey asks employers how many people work at their facility along with some questions about the nature of the jobs. This gives us the headline number ("X jobs created in Month Y"), plus sector details about how much job creation happened in warehouses versus in hotels, for example.

  • The household survey asks individuals if they worked, whether the work was part-time or full-time, if they wanted a job or more hours, etc.

The establishment survey is generally considered more accurate and is the canonical source of information for the questions that it answers, but to understand the labor market, we also need information that doesn't show up in the establishment survey. Calculating the unemployment rate or more a sophisticated measure like the employment-population ratio, for example, requires knowing how many non-employed people say they're looking for work. Talking to employers doesn't tell you that, so we also need the household survey.

But surveys rely on statistical samples of the population. To go from survey data to a point estimate about the level of employment, you need to make some background assumptions about the population you are surveying. Each month's report is revised the next month and then revised a second time as those assumptions are updated. There is also a seasonal adjustment that is applied to each report to try to extract the macroeconomic signal from the underlying noise.

On top of this, January happens to be the month when the BLS does an annual update of some of its models. As part of this process, they use administrative data from the Unemployment Insurance system to check to see whether their survey-based estimates from a few months ago were accurate. They also use updated census data to change their estimate of how many people there are or what age they are. With updated data, they're able to generate new and better estimates.

The January jobs gains came entirely from these changes.

Population revisions create tons of jobs in January

Near the end of the report, the BLS explains that with new Census data, they now think there are more people in the country but fewer old people than they previously believed. This increases the size of the labor force by a lot, raising the employment-population ratio.

They also specifically say, "Data users are cautioned that these annual population adjustments can affect the comparability of household data series over time." But when we talk about job growth, we are specifically talking about comparisons over time. If you scroll down further to Table C, they show how the altered population estimates change the reported month-of-month change. And it says that if you apply the new population estimate to December 2021, you would have seen a loss of jobs between December 2021 and January 2022. The growth of jobs is purely a reflection of the changed population estimate.

That doesn't mean the jobs aren't real. But they are jobs we had all along. Using consistent household survey data, employment fell in January. And not only did it fall, but it fell for precisely the reason the Biden administration was worried it would fall: lots of people missed work because they were sick.

The economy is a complicated chain of dependencies. Robust labor demand is good for workers, but constraining labor supply is bad, so while some people missed work because they were sick, other people who weren't necessarily sick missed work due to temporary closures induced by other people being sick.

Population estimates don't impact the establishment survey, which did show strong job growth, particularly in the revisions to the November and December numbers. But what normally happens during a period of fast job growth (and certainly what happened consistently in 2021) is that the establishment survey misses a bunch of jobs early on that show up in the household survey. They're then discovered in revisions.

We also need to note another specific piece of January weirdness. Normally a lot of companies add extra staff in the lead-up to Christmas, then lay them off in January. The unadjusted data shows a catastrophic recession every January, but the seasonal adjustment algorithm makes it go away. Every 12 months there's a sharp downward jag in employment, and every January is the worst employment month of the year. Seasonal adjustment takes a January that was better than the average January and calls it job growth.

And

Now to be clear, seasonal adjustment isn't some kind of scam or trick. We want to know how the labor market is doing. And what happens in a strong labor market is you see a below-average number of January layoffs. The official data is telling us what we wanted to know — demand for workers remained robust in January 2022.

But in terms of "labor market data vs. your lying eyes," both surveys are saying the same thing, which is that the economy hit January 2022 with a lot of momentum but there really was an Omicron disruption.

Beyond that, though, the revisions also show us that the pandemic weighed harder than we knew on the labor market all year.

Restaurants are in worse shape than we knew

The pandemic pretty clearly boosted employment in warehouse and logistics work while hurting employment in hotels, bars, and restaurants. I think if you spent all of last year ignoring labor market data, that's what you would have guessed — leisure and hospitality are still pretty depressed, while transportation and warehousing are booming.

That is broadly what the data showed, with a fair amount of nuance. But as Klein's chart here shows, revisions basically eliminated a lot of that nuance; there really was a huge structural shift in demand for workers out of leisure and hospitality and into warehouses. In particular, a collapse in film production and air transportation now seem to have not happened,¹ and the warehouse surge was just enormous.

This doesn't radically alter our understanding of the overall state of the labor market, but it means that the pandemic was weighing more heavily on the economy than the non-revised data showed.

So what's up with restaurants? Well, for eight states (and Ontario), OpenTable can give us information on restaurant bookings now compared to two years ago. And it showed January restaurant demand staying very strong in Florida and kind of strong in Texas and California, but really hurting in New York, Illinois, Pennsylvania, and Massachusetts.

This seems like a mix of blue/red effects and warm/cold effects. We've had unusually harsh weather this January in D.C., and I have seen people braving the outdoor dining scene in freezing temperatures. Common sense is that if we had California's weather, all those outdoor dining structures would've been packed. But a lot of Covid-cautious people stayed home rather than shiver or brave Omicron indoors.

And I think this is going to be a tough policy nut to crack. The restaurants aren't closed in blue America — the cautious people are avoiding them either altogether or during waves. And eating out in restaurants, even though it's something that I personally enjoy a lot, is an extremely discretionary activity. It's not like skipping doctor's appointments or taking your kid out of school. If you don't want to go out to dinner except when the weather is good, you can live that way basically indefinitely.

That being said, as I wrote in my piece on normalcy, I do think Democratic policymakers should consider the interplay between school quarantine rules and other behavior. Saying a kid needs to quarantine for at least 10 days if he gets Covid-19 rather than applying the normal "don't come to school if you feel sick" rule significantly raises the stakes around the virus beyond its actual health impact on children. One point of view is that inducing fully vaccinated families to be more cautious in their behavior is a benefit of these quarantine rules because caution per se is a good idea. But from an economic point of view, it's counterproductive, and it would be helpful to nudge people into dining out if they can.

Good short-term news

My bottom line on all of this is that a correct understanding of the January jobs report should make you more optimistic about the short-term.

There really was a significant Omicron effect on the economy in January, but we can expect that to taper in February. That will be a nice supply-side boost to the economy. And since restaurants in the northeast appear to be a seriously depressed sector, reduced pandemic concerns in February and then better weather come springtime should generate a further economic tailwind.

But beyond the big, obvious questions about inflation, the Fed, the stock market, energy prices, etc., I wonder to an extent how robust American society will prove to be against future waves of the virus. The availability of vaccines and boosters and the accumulated antibodies from prior infections all mean that the virus is becoming less deadly over time. But vaccine protection does wane, the virus seems to keep evolving, and I don't think we'll be able to say this is "over" any time soon.

So I think the Biden administration needs to ponder, not just as a matter of policy but as a matter of rhetoric and signaling, what outcome they are looking for. Unvaccinated people getting vaccinated is clearly good. People getting boosters as needed is clearly good. But if boosted people refrain from travel and indoor dining during Covid-19 waves, is that good? It strikes me as a large economic burden for a minimal public health gain, and among a population that is much more likely to be persuadable by the Biden administration than the hard-core Covid-19 denialists.

As Omicron wanes, it'll be easy for the administration to do some cheerleading. But while there's no guarantee there will be another severe wave, there's a very strong possibility that there will be, and they ought to make a plan for it. Do they want to take a Fauci-led approach that emphasizes the virtue of precaution or do they prefer an economy-focused approach that emphasizes building confidence and the virtues of normalcy? Right now, I think they'd be likely to default toward the former. But they ought to be taking advantage of the opportunity to build up national stockpiles of tests and Paxlovid and preparing a message of "it's good and appropriate to keep traveling and dining with friends and family and living life" because the cost to the economy of doing otherwise is quite real.

1

My best guess is that the rise of streaming services is changing who is employing people in film production just as the shift from business to leisure demand is changing where air transportation workers are. This is the kind of thing you need the administrative data to catch.

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Monday, February 7, 2022

Ezra Klein Show: How Bizarre the Supreme Court Is

Ezra Klein Show: How Bizarre the Supreme Court Is
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Produced by 'The Ezra Klein Show'

"Getting race wrong early has led courts to get everything else wrong since," writes Jamal Greene. But he probably doesn't mean what you think he means.

Greene is a professor at Columbia Law School, and his book "How Rights Went Wrong" is filled with examples of just how bizarre American Supreme Court outcomes have become. An information processing company claims the right to sell its patients' data to drug companies — it wins. A group of San Antonio parents whose children attend a school with no air-conditioning, uncertified teachers and a falling apart school building sue for the right to an equal education — they lose. A man from Long Island claims the right to use his homemade nunchucks to teach the "Shafan Ha Lavan" karate style, which he made up, to his children — he wins.

Greene's argument is that in America, for specific reasons rooted in our ugly past, the way we think about rights has gone terribly awry. We don't do constitutional law the way other countries do it. Rather, we recognize too few rights, and we protect them too strongly. That's created a race to get everything ruled as a right, because once it's a right, it's unassailable. And that's made the stakes of our constitutional conflicts too high. "If only one side can win, it might as well be mine," Greene writes. "Conflict over rights can encourage us to take aim at our political opponents instead of speaking to them. And we shoot to kill."

[You can listen to this episode of "The Ezra Klein Show" on Apple, Spotify, Google or wherever you get your podcasts.]

It's a grim diagnosis. But, for Greene, it's a hopeful one, too. Because it doesn't have to be this way. Supreme Court decisions don't have to feel so existential. Rights like food and shelter and education need not be wholly ignored by the courts. Other countries do things differently, and so can we.

This is a crucial moment for the court. Stephen Breyer is retiring. And in this term alone, the 6-3 conservative court is expected to hand down crucial decisions on some of the most divisive issues in American life: abortion, affirmative action, guns. So this is, in part, a conversation about the court we have and the decisions it is likely to make. But it's also about what a radically different court system could look like.



We discuss the Supreme Court's recent decisions on vaccine mandates, why Greene thinks judicial decision-making is closer to punditry than constitutional interpretation, the stark differences in how the German and American Supreme Courts handled the issue of abortion, Greene's case for appointing nearly 200 justices to the U.S. Supreme Court, why we even have courts in the first place and much more.

You can listen to our whole conversation by following "The Ezra Klein Show" on Apple, Spotify, Google or wherever you get your podcasts. View a list of book recommendations from our guests here.



(A full transcript of the episode is available here.)

I
"The Ezra Klein Show" is produced by Annie Galvin, Jeff Geld and Rogé Karma; fact-checking by Michelle Harris and Kristina Samulewski; original music by Isaac Jones; mixing by Jeff Geld; audience strategy by Shannon Busta. Our executive producer is Irene Noguchi. Special thanks to Kristin Lin.

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