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The electability debate


Jane, Dara, and Matt debate the idea of pundits trying to guess what the public thinks — plus research on what happens when doctors are patients.

Relevant links:

American Voter Bot (@american__voter)

White paper


Matthew Yglesias (@mattyglesias), Senior correspondent, Vox

Jane Coaston (@cjane87), Senior politics reporter, Vox

Dara Lind (@DLind), Immigration reporter, ProPublica

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Support for this episode, country Clicker lose an average of three hours every day, switching between all our work apps, but you can get them back with click on a flexible platform of the brain. All your essential tools in one place: legal prioritize tasks, collaborate on docks, chat with your team and track comes, It's why companies like Hoover and web use click up is that Mission Control Centre, placing every other aptly we're using before, click up even guarantees to help you save one day a week and get more done. It's completely customizable and it's free forever to dry click up today. It click up a dot com, slash weeds. yeah. This is Marquez, Brownlee, acre mph d, and this is Andrew, Manga, Nellie Movement. Introduce you to our part, cast way formed the nuisance, into the box media pockets network, so I've spent for ten years reviewing tech products and consumer electronics for millions of people on the empty. is to Youtube Channel and now on the way forward.
cast Andrew, and I use that experience to dig even deeper into latest tech for smartphones too. I max to electric cars so Have you gadget your lover or attack head or if you just want to figure out whether the latest gadget is worth your harder in cash? Give us a lesson sacred, fine, formed the empty beefy pike S on your favorite Pakistan. Every Friday see over there. I do and Jane very, very conscious. Apparently, these values Those are also snifty. Next week on sniffle cast hello bottoms, another sort of weeds, only box media Pakistan work. I met your his friend by Jane Coastline and pro public as Darrow Lindh and we When we talk about today, which I met annexed yeah,
the american mind and events to attempts to divide et we're talking about how we think about voters and how some pundits seem to think that they have a very special idea of what voters want- and this was partly inspired big by me, because I know that there are a host of never tromp Republicans or never trump. Conservatives who seem absolute,
They convinced that every Democrat is bad and that they know specifically what voters. What now the aid within me is thinking. If you knew it, voters wanted well, we wouldn't be in this situation. I would we buy this love me too thick you. How exactly do we figure out what voters actually want, because there's been a lot of interesting research on how voter polling is challenging, because voters, when you ask them questions, sometimes say things that they think that you want to hear and so long as we're in the midst of this conversation nationally about democratic candidates from other, not there too, liberal and liberal now for to laughter not left, I'm interested disease How do we know what voters actually want from their elected officials? Yet there are two other threads. I think that make this a particularly interesting times it again to this, because one of them, which I think kind of proceeds and maybe provokes what the state of
mandatory. That you're talking about Jane is that over the course of the debt Had a primary, we ve seen a shift from like colors story. from Iowa and New Hampshire, in which a bunch of voters tell reporters that really really like Elizabeth Warren, but they worry that other voter won't like Elizabeth Warren, she's, not electable, and therefore kind of enthusiasm, not translating into pulling support for her to war, in gaining slowly in the polls, to the point that she is now kind of unquestionably and adopt here of candidates with in a one way to explain that might be voters kind of persuading themselves that it's ok to support the candidate they themselves feel most enthusiastic, slash kind of meeting any doubts in their minds about her elect ability that were what was holding them back earlier in the year and the third strand here, which I think is kind of also provoked.
By the war and rise and maybe itself provoked by the kind of centre right pundit tree about. Oh, you can't when it too liberal Democrat, is a certain panic among the democratic elite. There's a piece in the New York Times that just ran this morning. It's basically A certain number of elite democrats panicking that lake shore there must be better candidate out there who isn't yet in the race, because none of the eleven these six who are who I have been in the rays are really doing everything they believe a candidate could dream of yet so here's, I think, too, to think about some some facts. Right I mean, I think, I think that this sort of biggest way people both like regular people, an professional pundits, tend to make mistakes about these things is It is natural to think of yourself and the people you know as more typical than they really are right. I M just like a natural human inclination Nino to be like everybody.
He thinks that you know ramps are so amazing and they really look forward to the ramps coming out the farmers market, but I don't like them delegates How many people are like weird food is to know about farmers, markets right leg, looked very, very few and thick key facts that I think people always need Jackie. Mind right, filling the sort of validated turn out from the twenty sixteen election is that fifty six percent Electorate was over the age of fifty. Sixty three percent of the electorate had not gone to college right, so I think they'd, like in the kind of circles that I live in and I think all the hosted the show live in and probably most the listener and probably most of most of the listeners. The vast majority of people are under fifty and did the college in the Non College graduates in Washington D C.
overwhelmingly African Americans without smattering of letting immigrants, but in the United States of America those people exist, but there is also a huge pool of white people who didn't College and you don't we'd like sort of now know that from a million like from countries Safari stories. But I think people do sometimes have trouble like grasping in their bones that the electorate is a lot. older and more working class. Then like the takes universe. Is it in that you know I do think it. It matters a lot, not necessarily in terms of like super specific policy opinions but, like general, cultural attitudes like if you see somebody and that person person
You is kind of like old and fuddy Duddy ish and a little out of it like that person is probably closer to the electorate. Then you are like the electorate is itself quite old, but he dead. He is not up on like the latest concepts and ideas, and you know I think it is in fact, like a real issue for Democrats. but you can't because democratic campaign staffers, like weeds, hosts and and weakens listeners tend to. A young city dwelling college graduates and it creates a kind of gravitational pull Oh towards using, like the most advanced, cutting edge thinking about everything in the world relative to an electorate that is largely composed of all people who don't go to college that there is also a second order thing there, which is even if youve accepted that you not the median voter. What does that distance like? How do you attempt to then divine what the medium
but I think that there is it as its they're going to dine. At any rate, there is a certain tendency to engage in either attic dead or just straight up thought experiments right, like David Brookside, a column a couple of weeks ago, in which he said imagined a dialogue between what he imagined as a trump voter in what he imagined. Doesn't urban, elitist, Chuck humor fairly, famously tries to figure out what stances his continue in my constituency, Take on issues by like imagining a middle class white family in New York, that's obviously not valid from a scientific perspective, but also it cuts in the same direction, with both elite Democrats, Emily Republicans kind of defaulting to the idea that this is a centre right nation rightly when David Brooks thinks about these. Of white, lower educated voters. He assumes that they have a certain kind of social concern. Criticism and basic belief in american capitalism that he himself shares when I think a lot of young anxious Democrat
two are in a really traumatized by getting be beaten and twenty sixteen, even if they were on the popular vote, Imagine if they go. Oh, these people are, in some way, fundamentally, unlike me, and so whatever I think is good. They probably think is by also think, though, that it when we say like that, the electorate is older and more likely to be working class. That actually doesn't tell us that much about the real political beliefs, because voters like all of us like everyone on this podcast- are complicated and multi faceted. which is why you, you see a lot of this, especially when people are talking about specific racial groups. So people you're when there is a big push for blacks whatever from the Democratic Party, the art. The argument was like my cache, would become a big big push needs to be, and as I am, I am air, quoting with such power with such power but you're. The argument was basically: will african American tend to be more socially conservative air GAO, but it seemed to be
a leg? Social conservative, social conservatism plus zebra equals report? again anaemic. That's not how any of this works for a multitude of reasons, and I think that you're something that's interesting. There's our peace, national real a couple weeks ago, talking about older voters have such a sway on the electorate that that is a problem for conservatives, because if you want to quote end quote: restrain the welfare state or change what Medicare or Medicaid look like. You really can't do that, because odor voters vote at our not gonna, be into that, but I also think that you'll. I think that we have seen a lot of David Brook sing recently and we see it elected officials who basically do things based on the idea of the voters that they have rather than talking to voters and that's not helped when we see New York Times or other pieces in which they allegedly are talking to like six
in the middle voters and all six of those in the middle voters all happened to be like Republican Party staffers, but I think that there is as yet you have an idea. of what your voters want, and yet here structure or Lindsey. Graham, you ve been in Congress long enough that that I dear for you is more powerful than the actual voters are because the actual voters might be like I oppose Samson marriage, but I also I'm interested in Medicare for all, and I am also interested in getting our troops out of Syria, but I'm still kind of worried about this. Other thing happening in foreign policy, because people are complicated and, regrettably, how our politics works does not really give that much ground for complexity, there's a if you're on twitter I'd. I reckon and following an account called american Voter bought American double underscore voter, all mixer, it's in the show links it pulled out. Individual respondents from public opinion pulling often
giving you know a little bit of demographic information and a few issue positions and then how they ve. In twenty sixteen and often does go down the line, but there definitely Sometimes when you know, there's an issue constellation where I personally go: ok, where they just trolling pollster, and there are also times that is useful to remember that, like ok, some people who are super he perceived were motivated by you. No gun rights didn't vote in the twenty sixteen election or, as some people who you would have expected to have fairly late reported fairly liberal view, then turned around and voted for. President trumpets, it's not you know it's it's easy to over interpret, this data points, which are, after all, data points in a larger aggregate, but it's a little bit useful if you want a kind of get in the habit of assuming texture and the way that Jane was talking about way. What am? I think it's important, though, because you know what would I don't want people to take away from this conversation
is like nihilism like who can say right. One thing you really can tell from the american voter bought, which is which is based on a survey data, is that cross pressured. Voters are very, very common. Right, which is to say if you just take voters, views and I think they do for issues right, it's I can. build, carry something about immigrants thing about health care set minimum wage. It's very a comment for a voter to be give liberal answer on at least one and the conservative answer at least one topic and music. Any credible volume I hear all day and social media activists insisting that, like there are no swing voters and that everything is just about based mobilization and that's like extremely not true. you know like precisely because most people are not that political needs. we common for people to be not like
super geared up into into one of these political sort of tribes, and also when you're talking about mobilizing people who are not necessarily swing, voters but sporadic voters, they themselves, you can see. again in surveys are less consistently liberal or consistently conservative than the people who do vote consistently right and so one thing that you take away from that is that you never gonna have a politician whose policy stances, like everybody agrees with all of them. Right, like politics, doesn't work like that, and so one thing that I think seems clear to be clear. Bad in politics is conveying a sense of super stridency about your attitude towards people who disagree with you about things. Why did that's it? Dangers on partisans frequenting get into any remember. One particular thing, like wit, Perry, are energy secretary who once upon a time really promising presidential candidate in the twenty twelve cycle. Engine
Mitt Romney, who had a million ideological, heterodox ease when, after Perry for just being heterodox on providing in state tuition benefits to undocumented residents of Texas. And so you know this was like a vulnerability for Perry and he had to address it and he addressed in the worst possible way, which is it. He said that if you didn't want to do this, you would be heartless right so very wasn't just like some Republicans would disagree with Perry about this topic. But Perry was saying that if you disagree with Perry, you're a bad person and that's like Hilary in the basket of deplorable it's something that you know. I like something that should always give you the Willy is because, like you're, going to be relying on the votes millions of people who disagree with you about several important topics that the only way to win an election, and it's like its beneficial to see
you mean like, for whatever reason, the kind of person you might want to vote for, like notwithstanding some some levels, disagreement, and I think that's like very clear in that the kind of results there. Yet whenever I think about the cross pressured voter, I just think of that give of Larry David from curbing there's a m. That's like I don't know. I don't know, go like looking at both sides, because that, I think So though I want to get into, I think we probably need to take a break, but then I want to talk about the idea of Elect ability and how much voters are thinking about what whatever I want. Other people. Don't want with a lot of noise between the pings, the dings, the emails labelled urgent. That aren't really that urgent. It's hard to cut through the static zero on the things that really matter just like. We can train our bodies to be better running faster have you, we could train our minds to stay focused to all the noise we live with step. One download head space hits bases and have loaded with guide you meditations designed offer a daily doses.
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Friends, the idea, but I would like to vote for this person, but I also would like to vote for someone who wins, and I think that that's been a lot of the rhetoric that surrounds Joe Biden as the idea of the person who wins verses, say Elizabeth Warrant Bernie Sanders as the idea of the person that you actually want, and you see PETE Buddha judge in some ways attempting the kind of threat the needle tween them as being like what, if you bout, you got both someone who could win and someone who you wanted. It's a fascinating thing to me because it seems to get to this question of flexibility. That's all based on not just past elections, but also our interpretations of past elections. I was reading there's a new book that come out about that night in seventy two election and later elections involving candidates who now we think of as being very far left like Water Mondeo. When in the reading, it turns out that Walter mandate during the general election Tact Fort further to the centre right pray.
seeing Ronald Reagan too. He was competing against for a variety of foreign policy moves and basically attempting to appeal to the centre rather than staying to left. So then you hear a host of kind of lefty twitter talking like a high. This proves that had he stayed towards the left and stay true to the left, leaning ideals that he purportedly held in the primary. He could have beaten, ral rig it. Now we don't know that history is weird, but I think that there is, as I did, of like trying to pursue a lack. Debility is damaging, but also elected. Billowy is important and a kind of leaves me a little confused. Honestly or you don't here's the thing about watermark and the set read, I think these like this in two ways to conceptualize slight, but the centre right policy topics and one is to look at the past. see debate among elite actors right unlike see what positions could be in the centre of that debate and
What kind of ideas? Why didn't he ain't you'd centrist idea, and that common sense is like a carbon tax. Write like that, something that if conservatives had to do something on climate change, it would probably be a carbon tax write. So that's like a centrist idea, but if you look at surveys, carbon taxes are unpopular right and basically any policy that asks the majority of people to pay high, taxes is unpopular, even though a lot of ideas like that have like strong centrist by it and from elites right, then the flip side Some ideas, like Elizabeth, warns idea of a wealth tax law pulls really really well even be considered a far less idea in an elite policy conversation but wealth taxpayer. Well, for the exact same reason, the carbon tax poles portly, which is that wealth taxes proposing that it any tiny tiny minority of people should pay higher taxes to give benefits to most people
right. So in a way it's like, if you forget everything you know about the policy conversation and you just keep in mind that more people would like to get more stuff and would like to pay less likely you can get. I think, a really good guide to what's politically popular in the realm of economic policy and where people trip themselves it is by getting into a sort of dominated policy conversation which cares a lot about bell, budgets and like the efficiency of the tax system and yadda, yadda yadda and all kinds of things that that people don't really care about. But for Democrats, though I still think most, even though we ve had all this dialogue about Medica for on the primary most of the vulnerable points seem to me to be on the kind of social and cultural type issue, quest dense and, like not, coincidentally, that's all conservatives talk about ever right, like if you, if you immersed yourself and conservative dialogue,
You'd have almost no idea that the government like plays any kind of economic policy role at all, except as a sort of symbolic battleground you know, and I and I wonder about somewhere Democrats have gone post twenty. Sixteen on these topics, I mean. I also wonder about these things. But I think that there is a certain for one thing. I think it is important to recognise that the moral purity that has seized the democratic base to a certain extent has also lined up issue positions. in a way that they weren't among the democratic base. Previously rightly, we see continued Increasing awareness among- and you know you ve written about this- not rightly does the so called grey awakening like there's a large segment of the democratic base. That is now substantially more likely both to express progressive opinions on issues of lake, especially Rachel Justice and gun control, than they were ten years ago and to care more about them.
issues, so I do not envy air democratic candidates in their staff, who are currently trying to figure out how to retain the base mobilization that is required to only when a primary but also a general election, because people need to feel You are representing the same vision for America that they have while trying to broaden a base. That is, to a certain extent, convinced that people who disagree with them about who was the right choice and twenty. Sixteen are the reason we're in this problem today, although I mean, if you look at the twenty twenty primary right, if you think about leg, I think the candidates who tried to like q and harnessed almost themes right, whether that's Christian Gill, a brand new anti Castro court, Booker to an extent like those candidates of all sort of fizzled right, unlike Biden Bernie Warren, represent, like contrast,
important ways but, like all do reflect, I think, like differ versions of light chilling out a little bit like. I saw it like the Castro people being Castro who had some tweet. Yes, he was like people told me like not to talk so much about and was like some whole list of like so just as culture war topics but like I did it anyway, but he's like nowhere in the polls like it, it turned out. I think maybe people telling him not to talk about that were given good advice, and I was thinking The funniest things, as happened in contemporary politics, was bug after the Ralph nor Thumb, backface stuff came out and it was like four days of Ike disguise gotta. Go like this is terrible and impose came and it was I d majority of African Americans virginia- Didn'T- want him to resign and I mean I don't know exactly where that left us as a as a country but like
I just feel like even among rank and file. Democrats is actually like less juice in some of these topics, then leg there has been on the internet, so there, of course, also is a ghost about rank and file, Democrats versus primary voters and, in particular, like caucus, stately state voters, where you have to have kind of an added level of dedication to like go out there and sit out, and persuade other people to vote for your candidate right. Like for all of the discussion. That I think sometimes takes place when we're talking about Republicans about how much republican candidates can get pulled Writing primary cycles were the only people voting or die hard Republicans, I do wonder if the kind of public opinion polls Ralph north them or for that matter. The democratic presidential primary are capturing a certain amount of soft support from people who. Just fine with these two quo, or you know Joe Biden or what have you but may not
essentially be motivated enough to go out and vote for them. Well, the polls open, which is kind of the other ghosts that stocking Democrats here right, that's not only to Gosu two thousand and sixteen. It's also the ghost of two thousand and four. When Democrats persuaded themselves a certain candidate, was electable because he seemed unlikely to turn anybody off and then found themselves in the very difficult position of trying to- We mobilise people to vote for that candidate not successfully. It's weird, though, because so much of this is positioning that has taken place. and I say this as a member of the media- but it's so much of this positioning- is largely based on how the media positions candidates so we're having conversations about someone being to something like two far left or too liberal, that based on two too liberal, or to follow.
For whom or on what on what issue, and I think that that something I've been thinking about a lot lately. Em I think about my own writing or how I think about when I talk about politics, is that the idea that there is cut of this centre and what the centre is and the idea that you shouldn't you should attempt to appeal to that enter because going too far in one direction will dissuade interested voters. It really depends on a very specific definition of what the centre is, and so I think that that something everything that alot interest in terms of media coverage of twenty twenty, or even in twenty sixteen there a lot of conversation about kind of a warrant boom lit or now what kind of getting into a Buddha judge Boom lit, and it also has to be based a kind of like this seems to be happening. Or is it actually is it happening, because we're too king about it or is it actually happening? It's really hard to disconnect those two things. I mean yes, it's hard to disconnect these things. It's like it's hot
to get through to reality. And things like that but like there is, I think, discernible difference between a politician who tries to be politically cautious in their commitments, ride tries to stick to thing. Is that Paul? Well tries to sand off the rough edges of their positions, tries to park conversations in the political, safe ground and between politicians who aren't like, great, who stake out unpopular stand, as for whatever reason to to get attention or because they think it's the right thing to do or you know, four for a million kind of of of reasons out there, and I don't think it's like crazy or just media people having their heads up their buds to see that Warren and Sanders are both very much taking that the second leg of that debate,
right and in a way that is even different from Burmese. Twenty sixteen campaign, I would add, is his twenty. Sixteen him pain seem to me to have a heavy dose of, and he was criticised by the clear campaign for this, but I think it reflected a reasonable political calculation that he was going to like d emphasise certain kinds of like woke political struggles and like just talk about getting people free healthcare and college, but he has gone like a true full spectrum left on everything. Warren has you know her own kind of version of this, and you know like it's want to say is good or bad it. But like it's a choice, you know, and like. There is reason to wonder If that is a is a good choice like I think so
many Democrats, I know, are like habituated to elect MID Aughts dynamic where they're telling themselves like we could win every election if it was fought on policy, but like we're losing I'm character and values, and I really Democrats have position. cells. Now, in the opposite way of that that, like they are getting grey, to run on a bunch of issue positions that don't seem super duper popular and they are counting on like character and values, questions to dry tromp down, which they may well at George W Bush did that ran those races to great effect. You know people care about lots of things. Donald Trump does seem. Personally, I can total maniac scumbag get unimpeached, add scandals left and right. You know Shouldn, T lose. Why shouldn't you take bold positions if you want to, but like That's a really discernible difference from somebody who's. gonna be like all: let's do it, twelve down our minimum wage thwarted
extra money does that make small tax go changes like they ve I did. They want to go big, unlike in way is that surveys indicate dont. Have a ton of public support a couple of of kind of loopholes here right? Well, one, maybe less a loophole than like just a calculation going into it is that there a certain belief that some of the trunk voters, even Trump voters who voted Obama, at least in twenty o eight, if not in twenty, eight and twenty twelve are so body and on Donald Trump that actually doesn't matter who's running against him rain, and there is some evidence to bear this out. There is a pull that just came out pretty recently, showing a huge split between Republican, who you know, rely on Fox news for their information and Republicans who don't wear a law a number of Republicans airline. Fox news were saying there was none. Donald Trump could do to lose. Their support were like only a quarter of Republicans he relied on Other media outlets were saying that now is that self sorting to a certain issues? where, if you
are a little bit shaky on trumped you're, probably looking to supplement news, diet, yes, of course, but it does. I think indicate that the kind of swing voter calculus main there's. There is a kind of character and values. Argue going on, but it's not actually about the Dama trumps character and values are bad, but Donald Trump is the person to whom we are pledging fealty. The other thing that I of wonder about. The empirics of here is like we're still a year. Thus away from election day, I ve There are a lot of people who are not paying attention to anything at all and its well known fact that candidates, often after sewing up the primary pit, to the centre for the general now like. On the one hand, you could you that in me, kind of social media age, where everything is immediately accessible. Its harder to. that. On the other hand, you could argue the Lake Donald Trump is totally
Kansas, not a lot of things and no one appears to care, so I'd be interest. in kind of- and I think one The real empirical Tessier is going to be. do we see, If we have a nominee whose Bernie Sanders are Elizabeth weren't, do we see them trying to talk to the centre and does that work with the those who would otherwise be turned off by them. Does it demobilize people who are mobilized for them in the primary yeah? I think that there's been kind of talk among conservatives that their real concern with was with warrant is that she would be able to better tax to the centre using kind of her past is both republic at her past. Can writing those kind of right, ish, leaning
the populist age of twenty nineteen. But I also think one of the challenges that we are thinking about. Twenty sixteen and the way Democrats think about twenty succeed is it. This is some Democrat seem to ascribe to the what I call the trumpets magic theorem. That whatever trump does must be super duper magic, because that's how he one in twenty. Sixteen, your truck one in twenty six June, because, like roughly seventy two, seventy five thousand people in three states didn't vote that, basically it if we have seventy five thousand people vote differently in Wisconsin, Michigan and Pennsylvania, we're in a very different sorrow or proper, but people are probably trying to impeach Hillary Clinton for something. But I think that, through this idea- and you see
that's the kind of anxiety from the democratic establishment. Is this idea not just that these candidates might be too far left for the voting populist, but one that the people who voted for Trump are all trumps base rather than the people you? I knew. No, some people who voted for Trump, but more so in the idea of a kind of, breaks it theorem that I'm voting this work, as I assume other people aren't voting this way, and I just want to make things interesting and now you're here for people like it turns out that interesting isn't always good, but I also think that there is a side dear, that Trump being this super elite genius who Wall Tweet, crazy things and somehow that's that's a brilliant idea, because that's how people think that that's how he wanted twice exchange. I think that's the lending this abundance.
Perhaps surplus of caution to twenty twenty democratic thinkers in a way that I'm not sure is actually based on reality. You don't when you look at the numbers you see and obviously bowling is weird and hard and it is very early because I think that that's the Biden campaigns entire play, is nothing matters until South Carolina, but I do think that there is this idea, like you, Trump isn't very popular and outside of its base. Who is very loud. I think that there is, as I did like, while he won one? Sixteen sixteen by crazy me magic when actually won, because a bunch of people didn't vote because nine their candidate appealed add it turns out a lot of people who didn't like Hillary Clinton voted for tromp because they didn't like tromp either, but they'll hated Hillary Clinton more and you're not probably get us that happened again in twenty twenty. I do think, though you know when you talk about like a leaf level. An straight someone is is about you know, can we be Trump being
where are the others have ye retiring, my Jane and into a lot of it, doesn't make a ton of sense, but something that just about a sense of a loss of control right did the tradition. All steps to winning a presidential primer nomination invisible primary in which you court other. party leaders and the major bundle tours and activists, and what you do we tell politics, and I one New Hampshire, like all of that, seems to be breaking down right- and on the one hand you have a couple left wing candidates who have this small dollar donor base and are not like accountable really to those kinds of traditional gay keepers, then, on the other hand, you have Joe Biden right whose some ways, a very moderate establishment, friendly peg, but who actually a lot of professionals in the party? Don't really think is like a good,
face for mainstream democratic politics. They think he's too undisciplined it in these two old frankly, but he super famous right because he used to the vice President trade, and then you have the mayor of the fourth largest city in Indiana, and it seems like d donors really really like people to judge right I don't know like I like him, because his gun on the weeds twice, but it's not it is not in any way legged nor more candidacy. Righted me in reflects You can see why that will make people anxious like, even if the polls show all four of these people are like beating Trump right, like people like to have control over the situation. They would like it. Be the case that a tradition, all kind of vetting process in which would you it to do was have normal qualifications b. The normal, a trade like we don't have a governor in his fifty's
like anywhere near the top rank of the party wade. guy, like Steve, Bullock, a governor and his fifties. Ass wing stay guy, I'm so of the, like top communications people who worked for Obama Hilary, they were like really impressed by Steve, they have had their eye on him for years. He is like that air in the diners in Iowa, and he's nowhere right and like maybe that's fine like who who cares about Steve Book but, like that's, why people feel anxious about the situation like their understanding of how you select? A nominee is completely breaking down in favour of this much more like media, like mass communication, centric process, by which, whether its trumps tweets or may repeat, unpaid casts or Bernie Sanders doing like little viral video clips of himself or just Joe Biden have being really well known because he was vice. President, like totally dominates. Everything and change is different.
to an end, I think that's like a lot of what's what's going on and evil will probably come up with something it's point, but it like it is a little weird. So how should- We be helping listeners think about all no kind of what's. Is there something that people really really really need to baron. I'm coming out of this as we kind of go into the the primaries in earnest now now Not that I am ceilings. Nine did nothing matter. I mean, I think you know like try to familiarize yourself with the demographic. So the electorate tredah try to try to look things up got go to diners Talkin, random people, brothers anecdotes up into huge things. What more can we do in life? I asked: I also think that their it's worth record a thing for individual listeners that sometimes we do this thing in which our views are complex and enter in other, people's views are ready over simplistic. Exactly.
no other people are also you one how you voted in one particular election or one particular midterm election is not how you will vote for the rest of your life for or it might be kind of how you might shift tell you start to think, moreover, but I also think that there is a set of, like other people, vote for very similar reasons. Why you vote may be they vote? egg down to you straight ticket, because it's easy and your standing there and you have to get back to work. Maybe they vote they particular way they do because there are very interested in one. regular issue, but don't really know that much about a bunch of other issues, or maybe it's neither of those. So I think it's worth recognised for listeners that other people's voting habits are just as interesting. I complexes yours as I agree with that, must take a break with the white paper.
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Mason good enough evidence from positions as patients by Michael Freaks, Jonathan Gruber, an unopened Jenna and it's this is looking at both stepping back. This is like a broad set of ideas that we could make the healthcare system be better if patients were better informed. and that means that, like specifically and is of an idea that will be very, very familiar to eat listeners that, like there are specific things, vat since should be doing that their often not doing, and on the flip side there are lots of healthcare procedures that, like add a lot of costs and don't A lot of value exist so knowing which ones those are is going to make the healthcare system more efficient and you healthier rank as if we could get everyone to adhere to their treatment regimes properly and also not ask for unnecessary healthcare. We could be healthier and spend way less money, and so we'd all be happy
So maybe we need better informed patients, I so what they did was they looked specifically at to sort of get at this sideways they would just like. But what happens when doctors are themselves? Patients swayed because no patient education programme, we're gonna do is gonna make patients as knowledgeable that health care as actual physicians are and they go through it and they find that basically, physicians are really really similar to normal people. They are maybe like slow, least slightly better at at adhering to sort of recommended treatment guidelines but they're, not system we better and they're, not a lot better and the fact that its not consistent when even if the different was small, but you sought across the board. You may well get fair enough, we're like at least clearly moving in the right direction, but it's really not clear that there's like any sort of benefit here at all to the extremely high level of knowledge that that physicians have so you know, I guess we
we're doomed or at least providing more information is not going to significantly solve problems, because changing people's behaviour is challenging. A couple thing, snap, your first of all shout out to the data source here. I which, as we ve listeners, will probably recognise the equipped and the only equivalent we have in the United States, to the excellence of like Nordic Administrative Data is military administrative data and lo and behold here the it is. That used was the military military health data which cloots, both military physicians and you have to compare them to other, like former military officers, cetera, because that's the kind of granite comparison about use of particular procedures. You need also that eliminates any. If confounding variable of o the doctors are paying as much for these procedures are paying more because they their insured in different ways. Cookie payments were pretty low across the board here so that it really was about just
value of having better information, not the interplay of information versus financial cost. The other thing to note here is one of the things the authors looked into is, to the extent that physicians actually are making better healthcare decisions. Is that because they themselves picked doctors who are better or because they are just making the decision in the moment that adheres to best practices and what they found. Particularly I came to syrian sections, which is a pretty well established idea of low value. Of low value care, where, like most of the people who have zairian sections need the minute you no ads risk, etc. What they found was that the literary doctors who were hoop. would have you know who were who were giving birth like could have been eligible for sea sections were. Actually, more likely to pick doctors who issued more see sections, but the military doctors did not in fact end up getting see sections as frequently
which the authors hypothesize means that in a when you're for a doctor, you're looking for someone who's experienced in dealing with kind of all of the past bill it? Isn't you want someone who, if they have to perform a c section, can do it competently, but in the moment, unlike bear in mind in the moon, when you're talking about a person in labour? Is that is not exactly a time when people are going to be expected to make the most rational decision, but they found that there was a small but present difference in How often, in that kind of moment of decision, military doctors were going with yeah, ok screw it give me the c section verses
no. I think it's really important for me to have this birth passionately, yet I thought it was interesting. Also, I've had it especially because this specific issue, as the paper goes into of sea sections, is one. That's that's fascinating, because some tactic as someone I was born vs IE section, because I was quoting quote stuck by. I think that there is very much of a sense of theirs the people who elected to to do that ahead of time and then there's people who elect do that kind of in the midst of labour, but something I was so typically interested in was the idea of how much does the scarcity of available information play into the decisions that one makes air would yo. It would obviously that premise here is that the position
wait. I have more knowledge and Erika make better decisions, but that all really players on the idea of what the best decision might be. I don't know I thought that this paper is interesting, but I also have a lot of questions and I would love to see it in with other specific forms of medical care, especially be it the idea that doctors Yucas I'm thinking about in other forms of medicine, the idea that doctors might actually be more reticent to get specific forms of healthcare or to have specific procedures unless it's in a very specific Rio, I don't know. I thought that this was interesting, but I'd love to see this replicated across different procedures. Yeah I mean, I just think the woods sort of striking about this right is too just remember like how likely dates that the average person will ever be. Remotely as well informed about the health care system as physics right like this is like a real upper bound case for, like the knowledge pathos,
in healthcare, and I do think it fits with legal. I think, if it's with a lot of information we know about, you know Sleeve related topics wide like like like why. Why am I overweight right do. I actually not know that migration eat the eminent comes from the office thing, or is it just like people outside candy? It's good right, and then there's a kind of you know, I I you're, one of context in which we would like to think that if you just provide people with appropriate options and appropriate information that like they will go, make the correct choices and all of our problems will be solved. without any kind of like contentious, You know coercion or heavy handed measures, or just accepting that, like there's gonna, be fuck ups everywhere, and that you know what you mean to see in these situations like it's. Not it's not really true. You know, and I have seen other studies where healthcare knowledge makes
friends, there was one I think we did on the weeds a million years ago, but it was like health care professionals are much less likely to. I name brand over the counter medications right because They know that the generic lcd benefit is literally identical. To advocate, but even in their right is like. Is the policy implication of that that, like the guy, should run around trying to tell everybody about pharmacology, or is it that like we should actually just take steps to lag, get overpriced medicine off the shelves, unlike wicked, If people a lot of money that way- or maybe it doesn't matter right but, like you know, in these situate the just like less choice when things have a right answer, you know, could good idea. One great thing like we do here at vocs media is like brings howdy in to give everybody flew shots like into the office.
since I started working here. I've gotten a flu shot every year and I will tell you like that was not the case previously and it wasn't, as I didn't know that you shouldn't get a flu shot. It's just like somewhere. Sarah cliff is sobbing Yankee. Anything is the convenience of having it in the office is like a literally watching your coworkers get up from their desk to go. Get a flu shot. You like, I really should do that, like that's, let's not be like social engineering makes a big difference. The other thing that this is all housing me to wonder about is: what's the difference in information effect, you're dealing with something that, like you're, probably going to you know you're gonna encounter over the counter medication, both if you're a consumer multiple times over the course of your life and if you're, a physician like regardless of what your special nation is you're gonna be dealing with the kind of generic his name brand medication deferential, whereas some of these procedures are things where Not only are you only gonna probably have them like once or twice like you know
Not most people don't have I surgery tons of times in their life, so Maybe you don't necessarily know whether or not it's a good eye its high value to get a chest examined. Advice, Hence, or you know, maybe you don't remember. Every obviously you'd probably have everything you learned and Med School and if you ve specialised in a different, you know- practice area, maybe that's not something that super familiar to use. I do wonder what we can kind of learning subsequent to this, about whether high degree of specialised knowledge in one area leads. to be more seeking out of expert opinion and less trusting of your own instincts, because you know that, like oh, I so much more than the average person does about like internal medicine or if, conversely, you
just assume that you're an expert and therefore your gut is going to be the same thing as the informed praying. I think personally, and I would love weeds listener to get at us with some data on this. If you happen to know because, as always, I am happy to be wrong- I would argue at guess it would be the latter, because I think that is even if you are an internal medicine specialist, you would have gone through the same basic process to get there that older people and medical profession will have. And so I also I wonder if there is a sense of yo you have this idea like well. I know a lot about this there for I know a lot about my own body and my own understanding of medicine is, I think, more important than seeking out expert opinion, because I think that yet, when I dont know about something and an expert or prepared expert says like this is how the something works. Oh my god. Yes, I got that, however, for these few
was that I know a great deal about when a purported expert says something and I agree? Great with that? Unlike vast just wrong, I am not Whittemore. I am less willing to take that into account, and while that is the most Annick Data of ethnic data, because it's based on trust me I am, I would be curious. I would guess it that might be how other people feel yeah. I think it may be so ok. I agree we could all use of some more information on this EU military about what we do now. I think that's kind of the air, the answer tat to both of today's segments. Absolutely s- humility, always good, but also to keep listening to the weeds to increase or decrease humility as needed. So thanks, Jane and Dara thanks as to our sponsors and tore producer, Jeffrey killed and the weeds will return on accessible, affordable broadband helps community
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Transcript generated on 2021-09-10.