Listen to Elisabeth Rosenthal on NPR’s Fresh Air

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How U.S. Healthcare Became Big Business

“We’ve trusted a lot of our health care to for-profit businesses and it’s their job, frankly, to make profit,” Rosenthal says. “You can’t expect them to act like Mother Teresas.”

Below is the full transcript of the show, for those of you who would like to read it.

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TERRY GROSS, HOST: 
This is FRESH AIR. I’m Terry Gross. Have you ever looked at a hospital bill and been aghast at how expensive and incomprehensible it was, or tried to figure out which health care plan to choose and played the odds about whether you should go for the high deductible plan or not? Patients are told to be good consumers, but we’re navigating a system that isn’t exactly user friendly.

The new book “An American Sickness” explains how health care became big business and how the pricing and billing of medical services, devices and prescription drugs became so complicated even a lot of doctors don’t understand it. My guest is the author, Elisabeth Rosenthal. She’s the editor-in-chief of Kaiser Health News. Before that, she was a reporter at The New York Times. When she was covering health care for the Times, she wrote a series called “Paying Till It Hurts.” Before becoming a journalist, she was a physician.

Elisabeth Rosenthal, welcome back to FRESH AIR. Let’s start with some of your economic rules of the dysfunctional medical market. You say more competition doesn’t mean better prices. In fact, it can drive prices up. That’s a very interesting thing to say considering how much we’ve been hearing that if we repeal and replace Obamacare and make the market more competitive, it will be more favorable in terms of price for medical consumers. So why do you say that more competition can actually drive prices up?

ELISABETH ROSENTHAL: Well, what we see in health care is not like what we see in any other economic market. I mean, it’s sad. It’s amusing. It’s baffling, which is partly why I undertook this book. But basically if you look at drug prices, for example, there was a miraculous drug called Gleevec which really changed cancer patient’s lives when it came out maybe 10, 15 years ago.

Now there are many, many kind of copycat versions of Gleevec. We call them in the profession sons of Gleevec. And they’re all four or five times more expensive than Gleevec was when it came out. So if you were looking at a world where an economic market worked, you would think, wow, there are 10 of these now so the price should have come down – it hasn’t.

GROSS: Why not?

ROSENTHAL: Well, because the standard in health care has been usual and customary. So that kind of doesn’t let the market work. You may have seen that on your insurance bills, or you may have seen that when your insurer is saying this is how much we’re going to pay. It’s the usual and customary in your area. Well, what happens if everyone is charging five times as much as is reasonable? Well, then five times as much becomes usual and customary.

And it’s a very inflationary concept over time. So what you see because of usual and customary is that maybe a gallbladder operation will cost $50,000 in Nassau County on Long Island, but it might cost $10,000 five miles away in Queens. And that’s because the usual and customary in those two geozips are very different.

GROSS: So you’re saying prices rise to whatever the market will bear?

ROSENTHAL: Well, that’s the ultimate lesson of much of American health care is that prices rise to whatever the market will bear. And another concept that I think is unique to medicine is what economists call sticky pricing, which is a wonderful term. It basically means – and you see this over and over again in the drug sphere and also in the hospital chargemaster sphere – once one drug maker, one hospital, one doctor says hey, we could charge 10,000 for that procedure or that medicine. Maybe it was 5,000 two months ago, but once everyone sees that someone’s getting away with charging 10,000, the prices all go up to that sticky ceiling.

Maybe they come just a little bit below. What you see often now is when generic drugs come out, so there’s lots of competition, the price doesn’t go down to 20 percent of the branded price, it maybe goes down to 90 percent of the branded price. So we’re not getting what we should get from a really competitive market where we, the consumers, are making those choices.

GROSS: But the premise of the competitive market is that we’ll be shopping for the hospital or the doctor that does the procedure for the cheaper cost and that will bring prices down. Apparently things aren’t working that way.

ROSENTHAL: Well, this concept makes me a little nuts frankly because we’re told over and over again – and this is part of why I’m so obsessed with this – we’re told over and over again, oh, you should be a good consumer of health care. OK, right. What do you need to be a good consumer? You need to know a price. OK. I need – say my doctor tells me you need to get that wrist X-rayed after you fell. I may call 10 X-ray centers. No one’s going to tell me the price. They’re all going to say it depends on your insurance or we don’t know.

So how can I shop around? Even in that kind of elective situation, I can’t really shop because I don’t know the prices. And P.S., a lot of medicine isn’t so elective. Your doctor says hey, you need to have your hip replaced. Or your doctor says, I’m going to fill out a requisition for this blood test. Here’s the lab I’m sending it to. You don’t have a lot of choice.

Now, part of what I’m saying is you should ask for that choice. So if your doctor says, I’m going to order this blood test and here’s the lab you should go to, it’s beholden on us now to say hey, which labs are in my network? I’m going to go to one in my network because I don’t want to be hit with an out-of-pocket cost for that test.

GROSS: OK. I’m going to name another one of your economic rules of the dysfunctional medical market. And that rule is a lifetime of treatment is preferable to a cure. Preferable for who?

ROSENTHAL: Well, you know, you’ve got to look at every medical problem from two sides – what’s right for health care and what’s good for business. And you have to remember, we’ve trusted a lot of our health care to for-profit businesses. And it’s their job, frankly, to make profit. Much as that makes me uncomfortable and I might not like it, you can’t expect them to act like Mother Teresa’s – they’re not.

So if you’re a pharmaceutical manufacturer and you have a problem like diabetes, for example, if I invented a pill tomorrow that would cure diabetes, that would kill a multi-billion dollar business market. It’s far better to have treatments. And, you know, sometimes really great treatments, very effective treatments, so that’s good. But you kind of want the treatment to go on for life. That’s much better than something that will make the disease go away overnight.

Now, one expert in the book joked to me – kind of tongue-in-cheek, of course, because no one would think of this as a good outcome – that if we relied on the current medical market to deal with polio, we would never have a polio vaccine. Instead, we would have iron lungs in seven colors with iPhone apps.

GROSS: If you’re just joining us, my guest is Elisabeth Rosenthal, author of the new book “An American Sickness: How Healthcare Became Big Business And How You Can Take It Back.” One of the things I’ve been noticing is the consolidation of hospitals, where one entity will buy up a bunch of hospitals in the region. And the hospitals maintain their name, but they’re all under a larger entity. What’s that about? Why is that happening?

ROSENTHAL: Well, that’s a complicated question. It started happening because in many cases it’s not very efficient to have a huge number of hospitals scattered in every little town. You know, if you’re – if you need open-heart surgery, maybe you should go to a center that does lots of open-heart surgery. And in the beginning – and this is – so much of this book starts in the beginning because we’ve seen these things evolve over time. And in the beginning, this was a good idea.

Hospitals came together to share efficiencies. You didn’t need every hospital ordering bed sheets. You didn’t need every hospital doing every procedure. You could share records of patients. So the patient could go to the medical center that was most appropriate. Now that consolidation trend has kind of snowballed and skyrocketed so to a point now in many parts of the country, major cities only have one, maybe two hospital systems.

And what you see with that level of consolidation is, you know, it’s kind of a mini-monopoly. And what happens, of course, when you have a mini-monopoly is you have an enormous sway over price. And so what we see in research over and over again is that the cities that have the most hospital consolidation tend to have the highest prices for health care without any benefit for patient results.

GROSS: There are so many shopping plazas now that have a dialysis center and an imaging center. You’d never see that in a shopping center in the past. What’s going on there? Why are there so many kind of standalone medical centers like that – medical specialty centers?

ROSENTHAL: Yeah. Again, what we see over and over in health care is something that started maybe 20, 30 years ago as a good idea and a positive thing, has kind of morphed into something that’s far more ambiguous in its utility. I mean, the idea was in the ’80s and ’90s that a lot of things that used to be done in hospitals, could be done as outpatients.

You know, that’s far more convenient for patients. If you need dialysis, you don’t have to go into a hospital. If you need minor surgery, you don’t have to go into the hospital. So there was a movement of a lot of things to outpatient status. Also anesthesia got better. We could do much more under local. It was a good idea in the beginning. And it still is for a number of things.

But what’s happened is it became a revenue source. So a lot of these outpatient clinics became owned by doctors who were doing the surgeries. So there was a kind of mixed motivation in do you need the surgery? And I’m making money from this surgery. So when your doctor says, OK, you need a colonoscopy. We can do it on either Tuesday – I’m doing it at my surgicenter – or Thursday, where I do them in the hospital.

For patients, that can mean the difference between an outpatient procedure, which may cost you $5,000 and a hospital outpatient procedure, which will be billed perhaps at twice as much because you’re paying for hospital O.R. time. So, you know, there’s a huge price implication for patients. And often, patients aren’t told that. So you may just say, oh, I’ll have it done on Thursday. That’s my day off and – not knowing that it’s going to cost you twice as much. But…

GROSS: So the hospitals are likely to cost more than the outpatient procedure in a surgical center?

ROSENTHAL: Yeah. Yeah. It almost always will because you’re paying a hospital fee. On the other hand, I think, you know, there’s an upside and a downside. If you’re having a serious medical procedure in a surgicenter, maybe it can’t handle emergencies that a hospital could handle. So, you know, there are things that need to be done in the hospital. And there are things that can be done in surgicenters.

And that decision, I think, sadly, now is often made as the result of a trade war between those two entities, rather than really what’s best for a patient. There’s a big push to do more and more as an outpatient. And there’s a big debate in the medical community about whether we’re trying to do too much in the outpatient setting now. But more…

GROSS: Why is there a push to do more in the outpatient settings? The push coming from the people who run the outpatient centers or from the hospitals or from the health insurance companies?

ROSENTHAL: (Laughter) There’s a new twist in this. But let me – the push is partly from the health insurance companies because it’s lower cost. It’s driven largely, though, by the people who own the outpatient surgery centers, of course – the ones you see advertising on TV and in shopping malls because they want the revenue.

So the hospitals as a whole don’t like it. But in the latest twist of this ongoing consolidation of financial power, many of the hospitals have decided to end this trade war with the outpatient surgery centers and are just buying them up. So the thing in your shopping mall that looks like an outpatient surgery center that may be owned by some investors or some physicians, is now actually rebranded as being the hospital.

Even though it’s the same surgicenter in the same shopping mall, they’ll just say, oh, it’s now part of our hospital network. So now that same surgery center will charge hospital prices. So in some ways, the consumer/patient can’t win.

GROSS: If you’re just joining us, my guest is Elisabeth Rosenthal, author of the new book “An American Sickness: How Healthcare Became Big Business And How You Can Take It Back.” She’s editor-in-chief of Kaiser Health News. And before that, she was at The New York Times – there as a reporter for a long time and ended up covering health care there. We’re going to take a short break, and then we’ll be right back. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. And if you’re just joining us, my guest is Elisabeth Rosenthal, author of the new book “An American sickness: How Health Care Became Big Business And How You Can Take It Back.” She’s editor-in-chief of Kaiser Health News. Before that, she was a longtime correspondent at The New York Times where she ended up covering health care and wrote a series about health care called Paying Till It Hurts.

So, you know, there’s a big conflict now between people who want to save Obamacare and people who want to replace and repeal it. We know what happened the first time around. The repeal and replace attempt failed before it got to the floor. There are still a lot of proponents of single payer.

ROSENTHAL: Yeah.

GROSS: Are you one of them?

ROSENTHAL: Well, I’m still a journalist. So I can’t endorse one solution or another. Single payer has certainly worked in many other countries. But I’d like to point out if Americans really want something that’s more market-based, other countries have used market-based solutions or more market-based solutions and have gotten really good health care, too.

If you look at Switzerland, they have a largely market-based system. But – and this is a really important but – all the countries that have working marketplace-based systems have some form of control over pricing. It’s not kind of the Wild West open market. They’ll say this is the ceiling you can charge for that procedure. They’ll say this is a bandwidth in which you can charge. And you can compete all you want below that ceiling or within that band.

But you can’t just drive up prices to whatever the market will bear because – I think one of the legitimate analogies is if water or electricity was a totally free market, imagine what prices would be like.

GROSS: I want to ask you about coding. And this is, like, the letters and the numbers that are used in the doctor’s office to codify, for billing purposes, what procedure you’ve done, what diagnosis you’ve been given, what kind of examination you’ve had. And, you know, it’s usually part of your bill that you’re handed, like, when you walk out of the doctor’s office. You get this, like, big, say, pink sheet with a grid (laughter) of all the things the doctors could possibly bill for with these codes on them. And it’s, of course, indecipherable if you’re a patient. But I think it’s indecipherable for a lot of doctors, too. I mean, it’s really complicated. Why does this kind of coding – and that’s C-O-D-I-N-G – why does this kind of coding system exist?

ROSENTHAL: Well, again, it evolved from a good idea and got perverted into something that is really kind of toxic if you think of health care as a market, I think. You know, it originally – the coding systems originally evolved during the bubonic plague in order to classify diseases. And, you know, there were a lot of people dying in different countries, and you wanted to be able to track disease epidemiologically.

Now in the U.S. – and I believe only in the U.S. – these coding systems became the bedrock of medical billing. So you were billed according to what the ICD code was for your disease. And at some level, you know, you say – yeah, that makes sense. You know, rather than write out pulmonary hypertension with grade 3 blah, blah, blah, you just put 107.2 – that’s not the actual code for that. But – so yeah, at some – first pass you can say, yeah, OK. That made sense.

What happened over time once that coding performed a bedrock financial function – like all the rules on Wall Street for markets, people learned to manipulate it, and other codes developed because, hey, those codes were kind of vague. You know, they just said what disease you have. But if I’m a doctor, I do a lot of different kinds of things for different diseases that I want to bill for. So then you need a coding system for what doctors do, which is called the CPT code. And those CPT codes, by the way, are owned by the American Medical Association. So there’s a little bit of a conflict of interest there.

OK. So you have the CPT codes for doctors. Well, you know, what about when you’re in the hospital? You need a different kind of code for all the stuff that’s done there because, hey, in the U.S., we don’t bill by you have this disease, so we’re going to bill you X amount. We say – and particularly not now – everything is billed item by item in the hospital for most commercially insured patients. So it will be – and you’ve seen it if you’ve looked at these 60-page hospital bills – they’ll be oxygen, you know, per 15 minutes, $100; recovery room time per 15 minutes, $500; Tylenol – you know, every little thing that’s done to you is barcoded and charged and has a code.

GROSS: So before the doctor does anything, what questions should you ask to avoid billing problems down the line?

ROSENTHAL: Yeah, I think you should start every conversation with a doctor’s office by asking – is there a concierge fee? Are they affiliated with a hospital? Which hospital are they affiliated with? Is the office considered part of a hospital? – in which case you’re going to be facing hospital fees in addition to your doctor’s office fees. You ask your doctor always – as I do mine, I’ve really learned a lot from covering this topic – if I need a lab test, if I need an X-ray, will you send me to an in-network provider so I don’t get hit by out-of-network fees?

You know, our insurers have deals with certain laboratories and certain X-ray chains. And if you stay within that chain, you’ll be largely protected from costs. If you go out of it, you can be hit with big costs. And often, that will be a little hard for your doctor because they may have to fill out a different requisition. But it’s worth asking. And any doctor who won’t help you in that way, I think, isn’t attuned to the financial costs that we’re bearing today.

I think also when your doctor suggests – why don’t we just get this test? You can ask – well, why? How will it change my care? Because often – I’ve been a physician – doctors are ticking off boxes on a long checklist of tests, and maybe they’re not thinking, do I really need that one? Often, a bunch of them come together. And maybe these days with electronic medical records, a lot of them are automatically checked off. The doctor may have to uncheck tests. So help your doctor be more attuned to your financial needs.

GROSS: My guest is Elisabeth Rosenthal, author of the new book “An American Sickness.” After a break, she’ll explain why, if you’re in the hospital, it’s really important to know whether you are officially under observation or you’re being admitted as an inpatient. That’s after a break. I’m Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. I’m Terry Gross, back with Elisabeth Rosenthal, author of the new book “An American Sickness.” It’s about how health care became big business, and it has plenty of advice about how to navigate your way through the health care system and what questions to ask. Rosenthal is the editor-in-chief of Kaiser Health News. Before that, she was a reporter at The New York Times and covered several beats, including health care. And before becoming a journalist, she was a physician.

You suggest that if you’re in the hospital for any reason, you need to ask whether you are officially under observation or whether you are being handled as an inpatient. So what’s the difference, and why do you need to ask that?

ROSENTHAL: Well, the difference between inpatient admission and under observation status is huge in terms of the finances. It’s not any different in terms of what you see as a patient, and that’s why you’re so at-risk because you’ll be moved to a hospital bed. You’ll see the same doctor. You’ll get the same tests. But technically, you’re not admitted to the hospital.

And that has a huge implication for what you’re expected to pay because observation status is technically, for financial purposes, outpatient care, which means the terms of your outpatient insurance applies. That means you’re responsible for co-payments that may be up to 20 percent. And two days in a hospital, 20 percent co-payment, you’re easily into the thousands if not tens of thousands of dollars. Also, if you’re a Medicare patient, Medicare will cover your nursing home care if you’re transferred out of a hospital after admission. If you’re under observation status, they’ll say, you don’t really need nursing home care. You were never really in the hospital. So you always have to ask. When my mom was admitted to a hospital in New York a couple of months ago, after – is she OK? – the next question was she’s not under observation care, is she? She’s admitted – because I know the vulnerabilities of that.

GROSS: So you should have the presence of mind to say I want to be admitted. I don’t want to be under observation.

ROSENTHAL: Well, that’s the problem, you know. If you’re a person who’s really sick, what’s on – and that’s the problem with our health system. If you’re a person who’s really sick, you’re not thinking – oh, am I going to be able to pay this in two months? You’re just thinking, I feel awful. I want to get better. Am I going to die? So it’s always helpful to have someone who can serve as an advocate for you in the hospital while you’re there. But I think it’s kind of a sad reflection of our system that that’s necessary.

GROSS: Another question you suggest that patients ask, especially if they’re in the hospital – because this will have an impact on your billing – is, who else will be involved in my treatment, and will I be getting a separate bill from another provider? So what’s behind that question?

ROSENTHAL: (Laughter) Well, there’s been a lot of talk lately about surprise medical bills. And I’m really glad that one of the articles in The New York Times series helped ignite that discussion. That article, which is one of my favorite, was about a young man who went in for neck surgery at a hospital in New York and ended up being billed $117,000 by an assistant surgeon who he’d never met, and it was out of his insurance network. I mean, he was asleep in the OR, so he had no idea this guy was in the OR. When he got the bill, he flipped out and, thankfully, called me at The New York Times then to talk about it.

So I think we are all vulnerable to surprise medical bills. You go to an emergency room; you think everything’s covered because it’s in your network. But guess what – the doctor there may not be part of your network. He might call in a dermatologist who’s not in your network ’cause he just wants the dermatologist to look at a funny rash on your shoulder, you know, little things like that. And so you have to ask – who’s going to be involved in my care that you’re not telling me about?

And you have to insist that they be in your insurance network because, otherwise, you can be on the hook for those really, really huge out-of-network charges. And to me, logically, you go to an in-network hospital, you go to an in-network emergency room, everything should be covered in-network. But that’s not how the system currently works, so you’ve got to watch your back.

GROSS: You said that when you’re in the hospital, that nice doctor who you don’t know who stops by every morning and says, how you doing? – might end up charging you, like, $700 for each time he stops by. And you don’t know about that. You don’t know why the doctor’s there. It’s not, like, your doctor. Right?

ROSENTHAL: Right.

GROSS: So you call that drive-by doctors.

ROSENTHAL: (Laughter) Yeah.

GROSS: Is that your expression? I’ve never heard that before. But what do you mean by that? How are they – why are they there?

ROSENTHAL: Well, you know, sometimes they’re there because your primary doctor asked them to be there. And so they’re doing a kind of drive-by ’cause your primary doctor said, oh, you know, she looks like she could use some advice about nutrition, you know. And your primary doctor probably isn’t thinking, that’s going to be a big bill for my patient. They’re just thinking – well, she’s in the hospital anyway. It will be useful. But a consult in the hospital is going to be really, really, really expensive. And there’s a good chance you’re going to be paying for it or your insurer’s going to be paying for it, and we’ll all pay.

So in other times, it may be the hospital who’s assigned that person to come by. You know, there are hospitals now – I would say some of this is motivated by billing, perhaps not all – who say, every patient before discharge has to have a physical therapy consult. What I hear from patients over and over again, the kind of obsessive patients I love who look at their bills, who say, wait – that physical therapy consult – that was just someone who came by and, like, walked with me down the hall. That wasn’t a consult. That was five minutes, and there’s no way that was worth 600 bucks.

But so you do have to say – who are you, who called you, and am I going to be billed for this? And it’s – again, it’s tragic that, in recovery, people have to think in this kind of keep-on-your-guard, somewhat adversarial way. But I think if we don’t push back against the system and the way it bills, we’re complicit in allowing it to continue.

GROSS: You know, but at the same time, I’m not sure patients are in the best position, even if they’re alert, to evaluate what care they need and what care they don’t. Like, maybe you really need that physical…

ROSENTHAL: Right.

GROSS: …Therapy consult before you leave the hospital, especially if you’ve become a little deconditioned from lying…

ROSENTHAL: Right.

GROSS: …In bed several days. So I’m not sure what advice you’re actually giving on that because I’m not sure how much power – like – and if you don’t need that physical therapy consult, can you send away the physical therapist and say sorry, I have unilaterally decided I don’t really need to have your consult? Thank you very much. Go away.

ROSENTHAL: Well, obviously, it depends on the situation and your condition. Right? In places where it’s just mandatory for discharge, I’ve gotten complaints from doctors – from heart surgeons who say, I know when my patient needs a physical therapy consult, and I’ll order it if they need one. I don’t want it to be the kind of automatic check box for everyone. It’s just not necessary. You know, everything is context, and health care is individual, obviously. And so you have to be a good consumer and say, if what the physical therapy consult is going to involve is walking you to the bathroom, you can say – oh, thanks, but I’ve already done that. And I’m fine.

GROSS: So something that you can’t really do when you go to the hospital say how much is this going to cost me? Because…

ROSENTHAL: Right.

GROSS: …You’ll be told I don’t know, it’s – it depends on how it goes, right? You say in Australia doctors have to obtain informed financial consent as well as medical consent from patients.

ROSENTHAL: Yeah.

GROSS: What’s entailed in that informed financial consent and what do you think America might be able to learn from that?

ROSENTHAL: Well, I think what America could learn from it is it is possible, right? It’s not like breaking a law of the universe. This is something that doctors do in other countries. It may be harder in our highly compartmentalized medical system, although more and more we’re seeing procedures bundled, meaning having a flat all-in fee for everything you might need.

Hospitals say, oh, how can we do this because every patient is different? Well, yes, but on average they know about what they have to spend, so they could give you a pretty good ballpark. I know one patient when she asked about the costs of pregnancy that she was paying out of pocket, got an estimate of between 5,000 and 45,000. Sure, those…

GROSS: That’s not really helpful is it? (Laughter).

ROSENTHAL: It’s not very helpful. If we’re supposed to be a consumer, I don’t know how you can act on that. But also, yes, there are extremes, but they know pretty much what the ballpark is. And more and more maybe we should be asking them to pay that bundled fixed fee that’s the ballpark, and it’s their problem that some go way over in some go under.

That’s what Medicare does for hospital payments, and it’s worked pretty well for Medicare. It can be done. It’s just that we have not put pressure on our hospitals, our providers and on our insurers to think that way.

GROSS: If you’re just joining us my guest is journalist Elisabeth Rosenthal. Her new book is called “An American Sickness,” and it’s about how health care became big business. We’re going to take a short break and then be back. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR, and if you’re just joining us, my guest is Elisabeth Rosenthal author of the new book “An American Sickness.” It’s about how health care became big business. She’s also editor-in-chief of Kaiser Health News. Before that, she was a longtime reporter at The New York Times where one of her beats was covering health care. And as part of that beat, she wrote a series called Pain Till It Hurts.

So let’s talk about hospital bills. What advice can you give us about how to read a hospital bill and what to look for?

ROSENTHAL: Well, the first piece of advice I give people is it’s overwhelming, but you can figure out a lot with the right tools. First of all, don’t be alarmed by the prompt payment discount. Go back to the hospital and say I want a fully itemized bill. I want to know what I’m paying for. Some of it will be in codes, some of it will be in medical abbreviations.

I’ve discovered you can Google those codes and find out what you’re being charged for often, and most importantly you might find you’re being charged for stuff that obviously you know you didn’t have. I mean, Wanda Wickaser (ph) who was the subject of a section of the book – she discovered that in her $356,000 bill for her surgery which was inpatient. I mean, she came into the hospital unconscious and was in the intensive care unit. There was something like 70,000 billed for outpatient surgery. She was never an outpatient. So that kind of thing you can pick up pretty easily.

If your son didn’t have a circumcision, you know that. Many bills have errors, and you’ll find things that will save you money. Even more than that, if we all start asking to see those bills – I mean, I’ve seen patients who’ve got bills that just said $76,000 you pay and no explanation of what it is you’re paying for. I mean, if I went to the supermarket and shopped and nothing had prices on it and then went home and a month later I got a bill saying $2,000, I, as a consumer and every consumer, would be ballistic.

GROSS: So I want to ask you about Obamacare. There are several insurance companies that have pulled out of the ACA marketplace exchanges. What’s your understanding about why they pulled out and what that says about how the ACA has been functioning?

ROSENTHAL: Well, I think the first thing you have to start with is to say the ACA did some incredibly important things, whatever flaws you can point out, and there are flaws. It guaranteed health insurance to people with pre-existing conditions. Before the ACA, I heard from patients who had a history of mild depression or used an asthma inhaler And as a result couldn’t get insurance. It also removed lifetime caps which was really important to people with chronic diseases who might have maxed out their insurance coverage.

And it also, I think, in a very important way established health care and health insurance, I should say, as a right that we should all care about as a nation, and it insured 20 million more people. So that being said, the ACA had – and has because it’s still the law – its flaws. One of those is that the marketplaces are highly uneven in how well they function. Some have function fantastically. Some have been beset by huge premium increases. Others have been beset by insurers pulling out and saying we can’t make money doing this.

Well, I would note overall insurers are doing just fine. I think that’s one of the lessons, so it was going to take some learning. Some people that dove in were going to say, you know, this just doesn’t work for us. Others were going to say it’s working great. A lot of patients were pretty happy with it. Some patients found that their premiums went way, way up, and they weren’t happy with it. So I think to say the ACA as one thing wasn’t working is disingenuous. It’s working very well in some places and in some aspects, but not working well in some others.

Another thing to point out, I think, which I point out in the book, is that the ACA struggled to become law and is less than the Obama administration had hoped it would be. So part of the distress we’re seeing is that Congress did not come through for the ACA in the way that had been initially anticipated, meaning some of the money that had been promised to support the exchanges didn’t arrive. It never was approved.

So, you know, yes, some of the exchanges are having trouble. Some insurers are pulling out. But in essence, these marketplaces were trying to work often with kind of one hand tied behind their back.

GROSS: So one more question – you started off as a physician and became a journalist instead. Why did you leave medicine?

ROSENTHAL: Well, oddly, I feel like I’m circling back to the same place. I always loved writing, and I was always writing freelance on the side. And in 1994, I was working in an emergency room in New York City. And I saw a lot of problems with our health care system. And if we remember what was going on in ’93, ’94, Hillary Clinton was proposing a health care reform plan.

And so I initially converted to journalism at the invitation of some editors at the Times to cover the Clinton health reform. And I honestly always thought – OK, I’ll do this. I’ll cover medicine. I’ll cover health care reform, and it will be done. And then I’ll go back and be an ER doctor, and I’ll be happy. And I guess I got distracted. And of course, the Clinton health reform didn’t pass. And here we are, you know, more than 20 years later talking about the same issues, only more so. And I think that’s what drew me back to health care reporting, was I saw all the same issues but in such an exaggerated form.

And I think – you know, when I was drawn to journalism, to write about health care reform in the ’90s – at that point in time, health care was still pretty much working for the upper-middle-class people who were insured for physicians. I mean, it was OK. It wasn’t working for the people I was seeing in the emergency room, people with HIV/AIDS, people who were poor. When I came back to the U.S. after years as a foreign correspondent, my kind of aha, eureka moment was – hey, this system isn’t working for anyone now.

GROSS: Elisabeth Rosenthal, thank you so much for talking with us.

ROSENTHAL: Thank you for having me here.

GROSS: Elisabeth Rosenthal is the author of the new book “An American Sickness” and is editor-in-chief of Kaiser Health News. The new season of the “Breaking Bad” spin-off “Better Call Saul” starts tonight on AMC. Our TV critic David Bianculli has the review after this short break. This is FRESH AIR.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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David Daley on NPR’s Fresh Air

POLITICS

Understanding Congressional Gerrymandering: ‘It’s Moneyball Applied To Politics’

June 15, 2016    1:36 PM ET

Ratf**ked author David Daley says that Republicans targeted key state legislative races in 2010 in an effort to control state houses, and, eventually, Congressional redistricting. Radio Show Image

https://www.npr.org/player/embed/482150951/482182856

Below is the full transcript of the show, for those of you who would like to read it.

*Reminder*

Conference Call with David Daley

Author of RATF**KED

Sunday, June 4th at 7 pm EST

Call: 641-715-3605
Pass code: 767775#

 

DAVE DAVIES, HOST: This is FRESH AIR. I’m Dave Davies in for Terry Gross, who’s off this week. Our guest today, Salon’s editor-in-chief David Daley, has a new book that he says began with a simple question. When President Obama won re-election in 2012 and a Democratic tide gave the party a big majority in the Senate, why did the House of Representatives remain firmly in Republican hands? The result was even more striking since voters cast 1.3 million more ballots for Democratic House candidates than Republican ones.

The answer, Daley decided, was effective gerrymandering of House districts following the 2010 census. And it’s state legislatures that draw most of the congressional boundaries across the country. The result of Daley’s research is his new book, which details an effort by Republican strategists to put money and campaign resources into targeted state legislative races in key states in 2010, so Republicans could control the statehouses and control congressional redistricting. Daley’s book has a title I can’t say on the radio. It refers to a crude term for a political dirty deed done cheaply. I’ll approximate the title as “Rat-bleeped: The True Story Behind The Secret Plan To Steal America’s Democracy” [Actual book title is “Rat-F*****: The True Story Behind The Secret Plan To Steal America’s Democracy.”]

Well, David Daley, welcome to FRESH AIR. You know, it’s interesting that Republican control of Congress kind of feels like an ironclad reality of politics these days. But, you know, you remind us that in the election of 2008, when Barack Obama took the White House, the congressional picture was very different. Remind us of that election and where the Republican Party stood not so long ago.

DAVID DALEY: If you go back and watch the tapes from election night, the smartest minds in the Republican Party are despairing on television. They are trying to understand where all the Republican voters went. The Republicans realized that they were staring down a demographic tidal wave, that the nature of the electorate was changing and the Democrats were talking about a coalition of the ascendant and looking at a decade of changing politics. The Democrats took a super majority in the Senate – we forget – and how quickly it all changed.

DAVIES: Right. The Democrats then had a 60-plus-seat majority in the House of Representatives. And you write about a Republican strategist named Chris Jankowski. Tell us about him and what he saw as a way back.

DALEY: Chris Jankowski is one of the brightest strategists in the Republican Party. And what he saw was how the Republicans could make their way back state-by-state. Jankowski runs something called the Republican State Leadership Committee. And he has a eureka moment in 2009 when he realizes that the following year is a year that ends in zero and that elections at the end of a decade reverberate across the course of the next decade because of the redistricting which follows every census.

And Jankowski has got connections in statehouses across the country. And he realizes that if they can raise enough money that they can go in state-by-state and do battle – not on the presidential level but in specific statehouse and state Senate districts around the country – redo the maps in the following year if they’re able to win, and they’ve built themselves a firewall for the next 10 years.

DAVIES: And the critical link here, of course, is that in most states, it’s the state legislature that draws the congressional boundaries. They do the redistricting after each census. So he’s getting at Congress by going to statehouse and state Senate seats often little-known to voters. This was called Operation RedMap. Explain the idea.

DALEY: The idea was that you could take a state like Ohio, for example. In 2008, the Democrats held a majority in the statehouse of 53-46. What RedMap does is they identify and target six specific statehouse seats. They spend $1 million on these races, which is an unheard of amount of money coming into a statehouse race. Republicans win five of these. They take control of the Statehouse in Ohio – also, the state Senate that year. And it gives them, essentially, a veto-proof run of the entire re-districting in the state.

So in 2012, when Barack Obama wins again and he wins Ohio again, and Sherrod Brown is re-elected to the Senate by 325,000 votes, the Democrats get more votes in statehouse races than the Republicans. But the lines were drawn so perfectly that the Republicans held a 60-39 supermajority in the House of Representatives, despite having fewer votes.

DAVIES: That’s a 60-39 majority in the Ohio Statehouse.

DALEY: In the Ohio Statehouse that is drawing these lines. And the congressional delegation – Ohio has a 16-seat congressional delegation – 12-4 Republicans. So I began to unravel how this had happened – how the House stays in Republican hands after 2012 because all of these blue and purple states are sending delegations to Congress that are 12-4 Republican or in the case of Pennsylvania, 13-5 Republican, even though these are blue states that voted for Barack Obama and that often voted for more Democratic candidates in the aggregate than Republicans.

DAVIES: All right. Well, let’s talk about the efforts in statehouse races. Now, the idea of representative democracy and state legislatures is that state representatives and state senators are chosen by local voters to represent their interest and generally funded by local interests or, in some cases, state party interests. This is a little different, isn’t it, in bringing lots of national money to statehouse races? Describe the impact of national money coming into a statehouse race.

DALEY: It is more money than these races usually see. It can be a hundred percent of the budget that these candidates thought they were going to have to spend or imagined that they would face from an opponent. What Jankowski and his team did is they spent almost two thirds of this money in the last six weeks of the 2010 campaign. So these candidates not only never saw it coming, they didn’t have time to respond. Suddenly, every day in these small races in Wisconsin and Pennsylvania and Ohio, national Republican dollars are targeting state legislators. And they are pulling out four, six, eight-page, full-color mailers out of their mailboxes every day for the last three weeks of this campaign, and they couldn’t believe what hit them and they had no means of responding to it.

DAVIES: Right, and these are mailers from a national Republican organization, and they’re not making the case that, hey, we need to have a Republican legislature so we can have a Republican Congress. They are very localized attacks on the Democrats. And you write about – I think the first specific case you write about is a guy in Pennsylvania, 20-year Democratic legislator named Dave Levdansky. Tell us his story.

DALEY: He represents a district out of Elizabeth, Pa., which is a steel-working community not far outside of Pittsburgh, very small town. He grew up there. His family had been there for years. He’d been re-elected every year since 1984. Had risen to a pretty authoritative position in Harrisburg, the state capital on finance issues. And I went to meet him, and he pulled out his folder of all of these mailers. And he just looked at me and said, I wouldn’t have voted for myself either if I was getting all of this stuff. And they were brutal attacks and misleading attacks. And they were deeply poll-tested and focus grouped in order to try to find the silver bullet that would take out these small-town guys.

What people don’t understand is that control of the Pennsylvania House was very, very tight that year. The Democrats had it by a nose. So if you could go in and spend just enough money to take out four or five guys, which was the goal, you could flip this for a song. This isn’t just brilliant politics. It’s Moneyball applied to politics because they got a bargain here.

DAVIES: Do you recall some of the mailings that were aimed at Dave Levdansky and, you know, what they said about him?

DALEY: The silver bullet that they found – and when I sat down with Jankowski, he remembered it really well – was something called the Arlen Specter Library. Arlen Specter was a senator of Pennsylvania, a longtime senator who had been a Republican and in recent years had just – I believe right after the 2008 election, he switches parties, becomes a Democrat. He was not the most popular politician in the state of Pennsylvania at that point in time, especially in the western part of the state, as he was from the Philadelphia area.

So there was a capital budget of about $600 million that the Pennsylvania House passes. What Jankowski and the RSLC did – and they – focus grouped and looked and looked trying to find the exact issue that would take out Levdansky. And when they told people that he had spent $600 million on a library for Arlen Specter, it outraged voters. And this was a difficult economic year. The recovery had still not come back around entirely. The small towns around Pittsburgh were hard hit, and they didn’t like the idea that their state legislator had authorized $600 million for an Arlen Specter Library.

And these mailers made it out to be this big marble monstrosity. And in reality, about $2 million of that entire capital budget was actually allocated for a Specter Library. And it was, you know, on a college campus to house his papers. And this was a significant, you know, player in the state’s political history. This was an educational institution grant, but it was turned into something that when Levdansky would walk into homes, people who he had known for years would say, I’m sorry, Dave, but I can’t vote for you this year because of the Arlen Specter Library.

DAVIES: So this was a legislator’s routine vote on a budget that included many, many, many, many things, and they pick out this one. Have to say, you see this a lot in political campaigns. But was…

DALEY: You do.

DAVIES: Yeah, but very effective in this case.

DALEY: Very effective.

DAVIES: So Dave Levdan – the – this national Republican group, the Republican State Leadership Committee, spends a couple-hundred thousand dollars, a dozen mailers or so and Levdansky loses by how much to a relatively unknown Republican?

DALEY: He loses by about 140 votes. It’s that close. And those mailers and that money made the difference. The Republicans take control of the Pennsylvania House. They take control of the Senate. They elect a Republican governor in Corbett that year and they own all three legs of the redistricting process. So as a result, you come back in 2012 and Obama wins the state by 310,000. There are a hundred-thousand more votes for Democratic House candidates than there are for Republicans.

DAVIES: That’s Congressional House candidates, yeah.

DALEY: Yes. Republicans take the delegation 13-5. And that means 51 percent of the vote turns out to 28 percent of the seats. That’s a real problem for a participatory democracy.

DAVIES: Chris Jankowski did not dodge your phone calls. He was proud to talk about this, wasn’t he?

DALEY: It’s the greatest political achievement in modern times. It’s the greatest political bargain, I think, that they are very proud of what they managed to do. I think if you’re a Republican, you look at this and say, boy, this was effective, it was efficient and we won. We played by the rules. We changed the rules, but we still played by the law and the game. And if the Democrats weren’t smart enough to figure this out themselves, well, see you in 2020, boys.

DAVIES: We’re speaking with David Daley. He is editor-in-chief of Salon. He has a new book about Republican efforts in the 2010 election to target state legislative seats, giving the party an advantage in Congressional redistricting. We’ll continue our conversation after a short break. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: This is FRESH AIR, and we’re speaking with David Daley. He is editor-in-chief of Salon. He has a new book about Republican efforts in the 2010 election to target state legislative seats and thereby gain a huge advantage in congressional redistricting, which he says made a big difference in Republican representation in Congress. So we’ve been talking about this effort by this group, the Republican State Leadership Committee, to put not huge amounts of money, but enough money to make a difference in a few dozen state legislative races, hoping that Republicans could then control statehouses, and after the 2010 census draw the new congressional lines. OK, so take us inside this. Pick a state and talk about the redistricting process and how this made a difference.

DALEY: There are two prongs of this effort. The first prong, of course, is winning these races in 2010. Then in 2011, you have to be ready to redraw the maps. And what the Republicans were able to do in states like Ohio and Pennsylvania and North Carolina, and Michigan and Florida and Wisconsin was move the redistricting process deep behind closed doors and use redistricting as a blunt force partisan weapon in a way that it had not been all the way back to the first gerrymander in 1790.

So in Wisconsin, the operatives working on redistricting barricaded themselves into a law firm across the street from the Capitol and tried to claim attorney-client privilege for all of the negotiations and mapmaking that were going on. And they even made Republican members of the legislature there sign a nondisclosure agreement if they wanted access to the room. In North Carolina, they bring in a master mapmaker named Tom Hofeller, who is probably better at jiggering and rejiggering district lines than anybody. And they draw maps in North Carolina that give Republicans a 10-3 advantage on the congressional side.

And Hofeller has a presentation that he gives when he goes to talk to state legislatures, and it is all about secrecy and privacy. You do not fire the staff until you are completely sure that redistricting is done. You do not walk away from your computer and leave anything showing on it ever. You remember exactly what kind of legal hell one false email can put you in. It is as if he is training master spies in espionage and not, you know, drawing the lines that make up the fundamental building blocks of our democracy.

DAVIES: Right. And of course, we want to remind people the reason people are drawing congressional boundaries in hotel rooms and in secret is because typically, the lines are done by acts of state legislatures. And a lot of state legislation is drafted privately before it’s voted on. So in the end, you know, lawmakers do cast a vote, the votes are recorded, it’s signed by the governor. It’s a bill that conforms to rules of legislative procedure. But the real stuff gets done privately?

DALEY: Exactly.

DAVIES: Now, you know, gerrymandering isn’t new. And I don’t think politicians before 2010 were, like, totally benign in their use of…

DALEY: They certainly were not.

DAVIES: …Of this subject. So why was it so much more effective or aggressive in 2010? Is part of it technology?

DALEY: I think technology is almost all of it. Citizens United and the money that comes into the system is a piece of it. The really ingenious plan that Jankowski devises is part of it. But it’s the technology that makes these lines so precise and impregnable right now.

There’s a program called Maptitude that is used by lawmakers and operatives in just about every state who are working on redistricting. And I had someone who was involved in the redistricting in Arizona show me how it works. And there is more information available through Maptitude that – when you look at a congressional map and you say, boy, the shape of that is very strange. There is a reason behind each and every one of those curves. Every little jut and turn that on a map you say, I don’t know why that could possibly be there, a mapmaker knows why it’s there.

With Maptitude, it is fully loaded with just about every census information, with economic information, with every precinct-by-precinct results of elections all the way down ballot going back for years. And you can draw these lines with complete knowledge of how they will respond now. And the difference, frankly, between 2000 and 2010 – I mean, think of the way we texted in 2000. We didn’t have a keyboard on our phones. We used a number pad essentially to, you know, find a letter. Redistricting in 1990 and 2000, it was still horse and buggy. It becomes a rocket ship in 2010, thanks to computing power.

DAVIES: When this is done, when you look at some of these districts on a map, what do the shapes look like?

DALEY: They are incredibly strange. There’s a district in Michigan that I went out and drove every turn of between Detroit and Pontiac. It’s Michigan’s 14th. And it goes about 135 miles, and it takes you all day to, you know, go turn by turn. What you see first is that this is a district designed to connect the poorest neighborhoods in Detroit with the poorest neighborhoods in Pontiac so that you can put as many African-American voters into one district, make it a district that elects a Democrat with about 75 or 80 percent of the vote. And then all of the neighboring suburban districts as a result are more Republican. And as you take these turns, time and again over the course of the day, I would look at the map and say boy, there’s an interesting turn right here. There’s an interesting notch here. And every single time, there was a reason.

DAVIES: And the reason was to pack all the Democrats in that district so they wouldn’t weaken Republicans in surrounding districts.

DALEY: Yes.

DAVIES: David Daley has a new book about the 2010 elections and redistricting. After a break, he’ll assess the Democrats’ efforts in that election. Also, Maureen Corrigan will tell us about Susan Faludi’s new memoir. And jazz critic Kevin Whitehead reviews drummer Matt Wilson’s new album. I’m Dave Davies, and this is FRESH AIR.

(SOUNDBITE OF MUSIC)

DAVIES: This is FRESH AIR. I’m Dave Davies in for Terry Gross, who’s off this week. We are speaking with Salon’s editor-in-chief David Daley. His new book focuses on Republican efforts to win key state legislative races in the 2010 elections so they could control statehouses that would redraw congressional boundaries. The result, Daley argues, was gerrymandering, which kept Republicans in control of the House of Representatives.

Now, Democrats aren’t stupid, and they’ve been involved in redistricting for a long, long time. Where were the Democrats when all this was happening, when the Republicans were targeting these state legislative seats? Did they – were they just…

DALEY: They fell asleep at the wheel. This was a catastrophic strategic failure by the Democratic Party. Chris Jankowski tells me that throughout the fall of 2010, he’s out in the field and he can’t believe that the Democrats aren’t out there spending any money. The Democrats never saw this coming, and it’s political malpractice because the Republican Party announced their plans in big bright flashing neon lights.

In an op-ed piece in March 2010 in The Wall Street Journal, Karl Rove says we are going to use redistricting this year to take back the Congress. It was announced. It was not hidden. I don’t know if the Democratic leadership simply doesn’t read The Wall Street Journal, but it was right there. Steve Israel, who led the Democratic Congressional Campaign Committee after the debacle of 2010 for Democratic Party, tells me that the Democratic National Committee simply whistled past the graveyard.

DAVIES: And in states where Democrats did control the statehouse – Maryland, Illinois – when redistricting occurred, did they do the same things? Did they gerrymander the lines so as to benefit their party?

DALEY: There are two examples of where Democrats did effectively gerrymander after 2010, and it is in Maryland and it’s in Illinois. And what the Republicans were able to do which is a little bit different is they were able to take states that were blue or purple and make them bright red. And that to me seems to be the difference. You can look at Maryland and say that there’s probably one or maybe two more seats that the Democrats control that they wouldn’t have had if you apportion seats based on the popular vote. But it’s certainly not as egregious as a state like Pennsylvania, where you have a majority of voters ending up with, you know, fewer than 30 percent of the seats.

DAVIES: You go around the country and look at what’s happening on this issue, and it seems you find some encouraging developments, people taking another look at redistricting methods. What do you see?

DALEY: I think that members of both parties want our votes to counts, and we want the system to work. And we’re aware that things aren’t quite working. And when you look at the kind of referendums that have passed on redistricting in red states and in blue states – in Florida, in Arizona, in California, in Ohio – it’s a sign that people understand that our democracy isn’t working. When you put a referendum about nonpartisan redistricting on the ballot, it wins. People fundamentally understand questions of fairness.

DAVIES: And in those states where they have passed, how have things changed?

DALEY: Well, commissions sometimes work and sometimes don’t work.

DAVIES: That is to say taking redistricting out of the legislature and putting it in the hands of an appointed commission, is that what that means?

DALEY: That’s exactly right. You can look at Arizona, which is a case that went to the Supreme Court. And that commission was upheld, its constitutionality. But it’s basic functioning – there’s a lot of questions about whether the partisanship simply seeped back in a secret, hidden way and whether the politicians simply found another way to game that system. Once it was taken out of the legislators’ hands, it stayed in the hands of the operatives.

In Florida, certainly, what you saw was an effort by Republican strategists in the state to conduct a shadow redistricting process in violation of the fair districts referendum. But the beauty of that was that because the referendum had been passed, good government groups in Florida were able to file a lawsuit, and in the discovery process unearthed a trove of emails showing exactly what had happened. And a number of those districts have had to be redrawn.

DAVIES: You know, the Supreme Court has pretty much ruled out interveening to reverse cases of partisan gerrymandering, where it’s simply about benefiting a political party. It’s been different for racial gerrymandering, and there are active cases. And I wonder if in effect the Voting Rights Act and other statutes that affect racial gerrymandering are the real arena for these fights. There are several active cases now, some in Virginia, I think, that deal with racial gerrymandering. What are we looking at?

DALEY: Well, I think that again is exactly right. Most of these cases really have their roots in what was called the unholy alliance between African-Americans in the South, Democrats who wanted to increase their representation and Republicans who wanted to turn the South into the solid South. And these efforts began in the late 1980s and the early 1990s. And that was the redistricting battle in those days. It was about a deal between African-Americans to increase their ranks in Congress and Republicans who wanted to increase their numbers as well. And it worked very well for both sides in that you grew the largest Congressional Black Caucus since the days of Reconstruction. But at the same time, Republicans took over all the rest of those states.

DAVIES: And the reason that alliance benefited both sides was that they drew the boundaries so that black voters were packed into a small number of districts, almost certain to elect black representatives.

DALEY: They could elect their own leaders. And if you are an African-American leader in the South, then you have been a key part of the Democratic constituency. But the constituency in Congress is all essentially white Democrats. It makes an awful lot of sense to try to find a way to increase representation. That came at a cost to the party.

DAVIES: And why would that be? Why would creating largely black districts cost the party congressional seats?

DALEY: Because it packed all of the Democrats into a handful of majority-minority districts. So what you see in North Carolina, for example, is after these new districts went into play in the early 1990s, the delegation suddenly shifts from 8-4 Democrats to 8-4 Republicans. And that happened across the South, and it essentially led to the extinction of the white Democratic Congressman in the South. There’s only a handful left these days.

DAVIES: And so then lawsuits now are aimed at re-crafting those boundaries.

DALEY: Exactly.

DAVIES: Let me play devil’s advocate on the Operation RedMap argument here. This was about the 2010 elections. And you note that while Operation RedMap targeted, you know, a few dozen congressional seats in efforts to flip statehouses, it was a big Republican tide that year in that they gained almost 700 state legislative seats nationwide. And if you look specifically at Pennsylvania, for example, going into that election, the Democrats had a narrow majority in the statehouse – five or six seats – and that Operation RedMap, this national Republican effort, targeted three, put money in, won all three. And that would’ve been enough to flip the statehouse from Democrat to Republican.

But there was such a Republican tide that after that election, the Republicans ended up with a 21-seat majority in the Pennsylvania Statehouse. If those three seats targeted by the national Republican effort had stayed Democrat, it would still have been a 15-seat Republican majority. I guess what I’m wondering is however smart and effective Chris Jankowski and these national Republicans were, there was a Republican tide here, and a lot of this would’ve happened anyway, wouldn’t it?

DALEY: There was a huge Republican wave election in 2010, and that is an important piece of this. But the other important piece of Redmap is what they did to lock in those lines the following year. And it’s the mapping efforts that were made and the precise strategies that were launched in 2011 to sustain those gains, even in Democratic years, which is what makes RedMap so effective and successful.

DAVIES: You know, when I looked at the book, it struck me that what Chris Jankowski and these national Republican strategists was sort of staring us in the face, right? I mean, everybody knew that congressional redistricting mattered. Everybody knew that they were largely done by state legislatures. It wasn’t a big leap to figure out that it might be worth some national effort to win state legislative seats. Are the Democrats more focused on this now than they were before?

DALEY: The Democrats have finally realized that they need a plan. They are doing what seems to me to be all the wrong things. They’re fighting the last war, and they’re trying to replicate the plan that the Republicans had in 2010. The problem is they’re going to have to win on Republican maps with less money and no elements of surprise. Seems to…

DAVIES: When you say Republican maps, you’re talking about Republican state legislative maps, not congressional maps.

DALEY: Yes.

DAVIES: Right, right.

DALEY: This is what we need to understand – there are so many different locks on the system right now that undoing this is going to take years and really concentrated efforts state by state, chamber by chamber. There is no one simple solution to this. And it’s going to take the Democratic Party a lot of time, possibly even a generation to undo what happened in 2010 and 2011.

DAVIES: What’s interesting to me about that is in 2010 – you focus on how after the Republicans took control of statehouses, they redo congressional maps so as to enormously strengthen the Republican’s hold on Congress. But the state legislative maps, were they also gerrymandered so that they…

DALEY: They were, so that’s what matters.

DAVIES: So in…

DALEY: Yes.

DAVIES: …2020 when you’re electing the legislatures that will do the next congressional redistricting, those races will occur in districts redone in 2010?

DALEY: There could be – there could be a huge Democratic wave nationally in 2020 that elects or reelects a Democratic president that year. However, if the Democrats can’t make a difference and some headway in changing control of the Ohio House or the Michigan Senate or the Wisconsin House or the Florida House, they will still have Republicans drawing these lines in 2021. And they will be locked in for another decade.

DAVIES: Unless there are movements to take redistricting out of the hands of legislatures.

DALEY: That will take some time.

DAVIES: You don’t think that’s going to happen in a lot of places anytime soon.

DALEY: I do not think that this is a problem that can be solved quickly or easily. And it seems to me that we are going to have Republican control at this level for a long time.

DAVIES: David Daley, thanks so much for speaking with us.

DALEY: Thanks so much for having me.

DAVIES: Dave Daley is editor-in-chief of Salon. His book about the 2010 election and redistricting has a title we can’t say on the radio. I’ll approximate it as “Rat(Bleeped): The True Story Behind The Secret Plan To Steal America’s Democracy.” Coming up, Maureen Corrigan reviews Susan Faludi’s new memoir. This is FRESH AIR.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Conference Call with David Daley

Author of RATF**KED

Sunday, June 4th at 7 pm EST

Call: 641-715-3605
Pass code: 767775#

Radio Interview with Ellen Feldman

Planned Parenthood Founder Gets Novel Treatment

Ellen Feldman’s “Terrible Virtue” Brings Margaret Sanger To Life

March 10, 2016 on NPR’s To The Best of Our Knowledge

 

Ellen Feldman appeared on “To The Best of Our Knowledge” shortly after Terrible Virtue was released.  I think you will enjoy listening to the show in anticipation of our conference call with Ellen on Sunday, January 22nd.

In the interview, Ellen talks about what drew her to writing a novel about Margaret Sanger,

Ever since I was a kid, I geuss, I thought she was the most amazing woman who wrought an amazing revolution….

…I think the history of what this country was like before she started her work.  Contraception was illegal in this country. It could only be prescribed by doctors and only to men and only to prevent disease.  And [Margaret] fought long and hard and went to jail repeatedly to make birth control legal and to improve women’s lives and children’s lives….She really changed the landscape of our country, the sexual landscape, the political landscape and the social landscape certainly.”

The interview runs about 11 minutes and is a far ranging conversation about Margaret’s controversiality, her relationship to the African American community, her history with eugenics, and her radical political roots in socialism and anarchism.

Hedrick Smith on Yellowstone Public Radio

 

Yellowstone Public Radio logo

Journalist Hedrick Smith

On The Historic 2016 Campaign Season

  May 6, 2016

(If you do not see audio file, you can listen here.)

Journalist and author Hedrick Smith recently delivered a President’s lecture at the University of Montana about the widespread political disaffection in America. Smith won the Pulitzer prize for international reporting while covering Russia and Eastern Europe for the New York Times. After his newspaper career, he went on to win Emmys for his work on the award-winning PBS Frontline series.

Smith talked with Sally Mauk at MTPR studios to give his take on this historic campaign season.

Copyright 2016 KUFM-FM. To see more, visit KUFM-FM.

 

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Reminder: Politics for the People

Conference Call With Hedrick Smith

Sunday, June 19th @ 7 pm EST

(641) 715-3605   Code 767775#

 

Radio Boston Interviews Lisa McGirr

On November 9th, 2015, WBUR’s Radio Boston host Meghna Chakrabarti interviewed Lisa McGirr on The War On Alcohol: Prohibition and the Rise of the American State.  I think you will really enjoy listening to the show.

Lisa McGirr

(If the audio link does not appear, you can listen to the show here.)

Here are some of my favorite moments in their conversation.

Meghna asked Lisa to share how she came to write the book. Here is part of her response:

I love doing history from the bottom up and this was an effort to get to the experiences, for example, of working class immigrant ethnic men and women, different groups, African Americans in the cities and in the countryside, to understand the wide implications of Prohibition for all Americans across the board. And the differential implications by race, by class and by gender.”

 They discussed how the FBI expanded its activities during Prohibition.
This is the first time there is a massive expansion of the Federal government in crime control,  in 1919 through the 18th Amendment.  And it’s the first time that crime is really identified as a national problem and that has all sorts of ramifications for the expansion of the state toward policing and serveillance through Prohibition and throu the war on alcohol and its collateral effects of course.  Prohibition generated a national obsession over crime and criminality….This was a moment when the prison system was expanded, was reorganized….”
Meghna Chakrabarti asked whether we had learned the lessons from Prohibition that we needed to.  Lisa responded:
…neglecting and not understanding the history of Prohibition accurately–the ways in which it contributed to Penal state building–we have failed to see the way that we are continuing essentially along those same paths and the flaws that are inherent in any crusade against these recreational substances.  I mean, addiction is a huge problem…however the solution is not these kind of prohibitionary measures.  That was proved in the 1920’s, by 1933 there’s a wide consensus.  Hopefully now we’re getting to a place where there’s a little bit of opening to break the consensus that has developed on the war on drugs, because the implications have been, I think, even far more devastating on a domestic and global scale.”

Police from Boston's Division 9 with casks seized during Prohibition, circa 1930. (Boston Public Library/flickr)

Police from Boston’s Division 9 with casks seized during Prohibition, circa 1930. (Boston Public Library/flickr)

 

P4P Conference Call

with Lisa McGirr

Sunday, April 3rd at 7 pm EST

Call in number (641) 715-3605

Access code 767775#

With Her Camera, MacArthur ‘Genius’ Tells An African American Rust Belt Story

Below is an NPR interview with LaToya Ruby Fraizer from September 29th, 2015 on All Things Considered.

 

(If the audio does not appear in your email, either come on over to the blog or you can listen to the interview through this link.)

Grandma Ruby on Her Recliner, 2002

Frazier’s grandmother grew up in Braddock in the 1930s and ’40s, when “it was prosperous and a melting pot,” Frazier says. Here is what Frazier shared with NPR host Ari Shapiro about making this photograph:

It was just one of those powerful, stoic, transcending moments. My grandmother Ruby was a woman of very few words, was very serious, didn’t like to talk about the past. … So I’m leaning over her, she’s in her recliner. She really didn’t like me to make photographs, she only cooperated on maybe five or six, and this was one of them. And so it’s a Saturday afternoon where I’m leaning over her with my 35 mm camera and we just pause and she actually looks into the lens, but she’s really looking, gazing through the lens directly at me, almost like she’s transferring some type of history without speaking a word. And as she looks at me intensely with that pensive stare, I clicked the shutter.

The selection of photos below from The Notion of Family were those chosen for viewing on the NPR website alongside the interview.

  • LaToya Ruby Frazier has been taking pictures of her hometown and family for two decades. Pictured here: Huxtables, Mom and Me, 2008.
    LaToya Ruby Frazier has been taking pictures of her hometown and family for two decades. Pictured here: Huxtables, Mom and Me, 2008.
  • Grandma Ruby And Me, 2005.
    Grandma Ruby And Me, 2005.
  • Aunt Midgie And Grandma Ruby, 2007.
    Aunt Midgie And Grandma Ruby, 2007.
  • Gramps On His Bed, 2003.
    Gramps On His Bed, 2003.
  • Grandma Ruby's Installation, 2002.
    Grandma Ruby’s Installation, 2002.
  • Mom Relaxing My Hair, 2005.
    Mom Relaxing My Hair, 2005.
  • Mom's Friend Mr. Yerby, 2005.
    Mom’s Friend Mr. Yerby, 2005.
  • Momme (Shadow), 2008.
    Momme (Shadow), 2008.
  • Mr. Jim Kidd, 2011.
    Mr. Jim Kidd, 2011.
  • Rally To Protest UPMC East, July 2, 2012.
    Rally To Protest UPMC East, July 2, 2012.
  • United States Steel Mon Valley Works Edgar Thomson Plant, 2013.
    United States Steel Mon Valley Works Edgar Thomson Plant, 2013.
    Courtesy of artist LaToya Ruby Frazier

 

Politics for the People Conference Call

With LaToya Ruby Frazier

Sunday, December 6th at 7 pm EST

 CALL IN NUMBER

641 715-3605

Code 767775#

Reader’s Forum–Harriet Hoffman

I recently saw an announcement that New York City will publicly acknowledge for the first time that it sanctioned a huge slave market on Wall Street from 1711 to 1762, and that a memorial marker will be erected on the site.  This made me curious so I decided to do a little research on the Internet.  While I knew that slavery had once flourished in New York (at one time 40% of residents owned slaves) I quickly learned that the city did not just tolerate the buying and selling of slaves, it actually organized the market!  The City received tax revenue from every slave sold and itself used slave labor for infrastructure work for many years, including, it is said, the building of City Hall.  I also read that thousands of Africans who passed through the Wall Street slave market contributed to the prosperity of companies like Aetna, New York Life and JPMorgan Chase, to name a few (WNYC FM Radio, 4/14/15).  So it is no wonder that the Underground Railroad needed to keep moving escaping slaves north, out of New York City where even freed slaves were not safe.  I probably would have paid less attention to the timely acknowledgement of NYC’s slave market had I not been immersed in the wonderful stories of courage told in Eric Foner’s Gateway to Freedom.  I’m so glad this wonderful book is available now.

You can listen to Jim O’Grady’s report for WYNC radio, “City to Acknowledge It Operated a Slave Market for More Than 50 Years.”

//www.wnyc.org/widgets/ondemand_player/wnyc/#file=%2Faudio%2Fxspf%2F444286%2F

 

Harper’s Magazine illustration of the New York City slave market in 1643. (Harper’s/Wikipedia Commons)

Harriet Hoffman is a consultant specializing in grant writing and helping people maximize their Medicare and social security benefits.  She is the volunteer coordinator for the NYC Independence Clubs.

P4P Conference Call

With Eric Foner

 Sunday, April 19th, 7 pm EST

Call In Number: 805 399-1200 

Access Code 767775#

Through the Mind of a Novelist

Here is an interview Jerome Charyn did with NPR books last year.

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 Through The Mind Of A Novelist,

Lincoln Shares His Life Story 


npr BOOKS Weekend Edition
February 15, 2014 8:00 AM ET
 

 

[NOTE: If the interview does not appear in your browser, you can listen to it here.]

Interview Highlights

On how he decided to add to the crowded field of books about Lincoln
Well, I was having lunch with a critic, Brenda Wineapple, and she made a very startling statement. She said, “The two greatest poets of the 19th century were Emily Dickinson and Abraham Lincoln,” and that confounded me. So I went and started reading Lincoln, and when I read about his depression, that made me feel that I could enter into his world, because yes, there’s been so much written about him, but never in his voice. Only a crazy man would write a novel in Lincoln’s voice.

Jerome Charyn, Photo: Nina Subin

On the constraints of history in fictionalizing Lincoln’s life
Well, the history’s a kind of frame and a straightjacket at the same time. You know, you have to deal with the Civil War, you have to deal with … the love for Mary, and the Emancipation Proclamation, which for me was the most important American document ever written. So you have to stretch that straightjacket and push the fiction inside it. Then you have a kind of explosion, and that’s what I wanted to do.

On what brought Abe and Mary Lincoln together
Sex! Very few historians have been willing to see them as sexual creatures, and that’s one of the things that was important to me, to really try to explore what was the attraction between this very tall man and this very short woman. Well, you know, she was a kind of a foxy lady. She was quite attractive, and she fell in love with him, and he jilted her, and she waited, and she waited, and she waited, and he came back. That’s a great love story.

On the sadness of Mary Lincoln
We have to remember the limits that were imposed on women in the 19th century. She was an educated woman, and what could she do? She could be a school teacher, she could be a housewife, she could be a nurse, or an old maid. And women at that time really were treated like educated cows. They didn’t really have a persona of their own, so to my mind, she was a very brave woman.

On Lincoln’s ambivalence about slavery and abolitionists
He was frightened of the abolitionists because they caused riots and a great deal of clamor. On the other hand, he wanted to send the slaves to Liberia, but when he realized that this was not possible, great change was with the Emancipation Proclamation. Once he conceived that, and he conceives that alone, without his cabinet — his cabinet didn’t want him to present this document — but once he conceives the Emancipation Proclamation, he really is the great artisan of the Civil War, as far as I’m concerned. It’s not really necessarily fought on the battlefield, it’s fought in Lincoln’s mind.

On why we’ll never again have a successful politician with depression
…It would come out, there would be some kind of great drama that he’s seeing a psychiatrist or whatever it is, but I think this man of eternal sadness could view the world in a way that most of us can’t, and I think that allowed him to write what he did and to behave the way he did towards other people. I mean, he was human in a way that most other people aren’t … We will not see the likes of Lincoln again.

P4P Conference Call

With Jerome Charyn

 Sunday, February 15th at 7 pm EST

Radio Boston Interview with Alex Myers

This Sunday, we will have the opportunity to talk with Alex Myers from 7-8 pm EST on our next Politics for the People Book Club conference call.  I know that many of us have questions we are eager to ask Alex.  The call in number for the conference call is 805 399-1200 and the access code is 767775#.  

Anthony Brooks from Radio Boston did a great interview with Alex in January, a nice prelude to our conversation.  Hope you will put Revolutionary down for a moment and give a listen:

America’s First Female Soldier

                                                                   Deborah Sampson (Credit: Wikipedia)
“Alex Myers‘ new novel, Revolutionary, tells the story of 22 year-old weaver who yearns for something more. She feels trapped in 18th Century Massachusetts, and tells her closest friend, “There is a world out there, beyond weaving, beyond housework.” So she cuts her hair, disguises herself as a man, and fights heroically in the Continental Army. The gripping novel is based on the true story of Deborah Sampson  – recognized as a true hero in America’s war for independence. In 1983, the Massachusetts legislature named her the official state heroine and declared May 23rd Deborah Sampson Day. That her story inspired author Alex Myers is understandable. Myers is a female-to-male transgender person, was the first openly transgender student at Harvard, and over the years, has campaigned for transgender rights. His unique perspective reminds us that conversations around gender identity are hardly modern….”

Politics for the People Takes to the Airwaves

Tomorrow afternoon, Thursday, I will be interviewed on the national radio show, Fairness Radio with Chuck and Patrick at 2:15pm ET.  Co-hosts Chuck Morse and Patrick O’Heffernan will be talking with me about our new Independent book club and trends in writing about, for and by independents.  In addition, tune in at 1:15 pm ET, when Chuck and Patrick will be talking with IndependentVoting.org President, Jackie Salit.  Jackie is a monthly guest on Fairness radio and has a book that will be out in early August, Independents Rising.  A book I can’t wait for us to read here at Politics for the People.

You can tune in online at http://www.cyberstationlive.com – click on “Listen Live”.  You can call in at 617-328-8700.  You can also email questions live to be read on the air, or  post a comment on the program’s  Facebook Page or Twitter feed.

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