I'm like, scratching my head. Barack Obama won the Democratic nomination for president, correct? The nomination will be awarded officially by delegates to the Democratic National Convention, the delegate selection process is over, and the majority of the delegate votes at the convention belong to people who will vote for Obama. Ergo, QED, therefore, ipso facto, a fortiori and you can take it to the bank, Senator Obama will be the nominee.

So Hillary Clinton takes the occasion to announce:

She is the candidate who will be the best president;
She is asking people to continue to donate to her campaign;
She will decide on the future of her campaign in the coming days, based on what the people who voted for her want her to do;
That the voters of South Dakota have had the last word in the primaries, even though the polls in Montana were still open at that very moment;
That more people voted for her than had ever voted for a candidate in a primary -- even though more people voted for Obama than for Hillary Clinton.

SuperTuesday is fast approaching, the closest thing to a national primary we'll likely ever see. It's time to lay down a marker for what we expect from election administrators on Tuesday. No polling place -- not one -- should run out of ballots on Tuesday.

Today's Washington Post has an article that discusses "The Downside of Obama Strategy," i.e., that he actually has the audacity to believe that every Democrat's (and, perhaps, every American's) vote should count equally. The article notes (accurately) that Clinton has done better in large, electoral-vote-rich states than has Obama, which has ostensibly provoked fears about the prospects of his winning in November. It doesn't matter that he has received more popular votes than Clinton in contested elections--which allows us to omit Michigan and Florida--and, of course, that he has won more delegates. All that matters, according to a number of quoted Clinton supporters, is the vote in large states. So what we have is an attempt to apply to the nominating process the Electoral College's effective disenfranchisement of those unlucky enough to live in states where they are the political minority and the insane emphasis on a relatively few "battleground" states . One gather that Clinton will lose to Obama in today's caucuses in Wyoming. But, hey, it doesn't matter what Wyoming Democrats think, because they live in a Republican state.

A Wall Street Journal columnist today suggests that “Obama’s ‘Identity’ Beat Hillary’s ‘Identity.’” His argument is that the Democratic party is dominated by identity politics, and Senator Clinton lost because the race card beat the sex card.

The columnist claims, furthermore, that Obama (influenced by legal theorists at Harvard) sees matters in terms of identity politics, regardless of his professed desire to move beyond it. The columnist writes:
After South Carolina, the campaigns accused each other of playing the race or gender card. Obama deflected this charge. "I don't want to deny the role of race and gender in our society," Obama said. "They're there, and they're powerful. But I don't think it's productive."

I'm not convinced. I think Barack Obama is more inclined to interpret American life in the formal categories of identity politics than is generally thought, or even than would older "conventional liberals" like Al Gore or John Kerry. Legal theorists have been a main source of its ideas; it's hard to imagine that Barack and Michelle Obama didn't hear a lot about "marginalized constituencies" at Harvard Law School. Sen. Obama may not be so conventional after all.

No, not really. It's highly unlikely I'll end up at Disneyland, but I will be in Anaheim next week, arriving Sunday night and staying through the morning of Friday, the 7th. I'll be attending a meeting of the National Child Traumatic Stress Initiative. I hope to have some interesting things to report from there, and if any of my friends are in the area and want to connect, let me know. (E-mail is on the side bar.) Later in March I'll be at the meeting of the International Association of Physicians in AIDS Care in Jersey City, and then at the Joint Meeting on Adolescent Treatment Effectiveness in D.C. What all this will do to blogging is unclear, but I hope it will just make it bigger and better.

And now for a couple of comments about politics. It so happens I worked for Ralph Nader, in a menial capacity, back while my frontal cortex was still undergoing myelination (i.e., in my early 20s for those of you not up on the latest developments in neuroscience). Ralph was the real deal -- he lived ascetically, and plowed the money he made from his books back into the Public Citizen organization. He used to call the office on Saturdays just to see who was there, and I have to confess I answered the phone more than once.

There was a story in the NYT today which repeated an argument Hillary Clinton has been making for awhile -- that only she and John McCain cross the "commander in chief threshold." This argument is meant to stress her experience and readiness for the presidency, but there is a shadow issue that few have noticed although it dogged the first Clinton presidency. That's the relationship between the officer corps and the Democratic party. So far I've noticed one story on this issue in the Washington Times which gave expression to the serious doubts the military has about both Democratic candidates. The conservative and Republican tendencies of the officer corps have been noted but I'm not advancing a Seven Days in May scenario and those tendencies are inherently no more worrisome that the liberal and Democratic tendencies of law professors. The issue is rather whether the gulf between most of the officer corps and Democrats has reached the point where alienation, lack of common ground, and mistrust would lead to unnecessary conflict, misunderstandings, and serious policy mistakes in a Clinton or Obama administration. Remember the opening months of the first Clinton administration -- gays in the military? That conflict featured the military brass drawing on their contacts in Congress to oppose an initiative featured in the presidential election.

Like you, I really don't have a clue what exactly TF Hillary Clinton thinks she's been doing for the past couple of months, or why she's been doing whatever it is, but in any event, no matter what she says tonight, starting right now Barack Obama and the Democratic Party -- with the possible exception of Hillary and 182 fervent supporters who will continue to hold out in caves on some remote Pacific islands -- will start to run against John McCain for the office of prezneh unigh stay, as Sen. McCain pronounces it. That means that if we are very lucky, we just might hvae some conversations about public policy.

So here's my list of public health priorities. It's difficult to put them in order, and I might change my mind five minutes from now, but as of 1:42 pm eastern time they are:

Okay, since the NYT decided to hire Bill Kristol over me, I'll have to restrict my punditication to this space.

You may have noticed that I've had basically squat to say about the presidential campaign. I did point out that of the three Dem contenders, Edwards has the best health care plan, and Obama has the worst, but who cares, really? It's not as if an Edwards presidency -- which seems unlikely at this point anyway -- will result in the legislation he has posted on his web site becoming reality. In the best case, a Democratic president and a somewhat more Democratic congress in 2009 will result in some marginal changes around the edges. Big Pharma and Big Insurance aren't going to get rolled no matter who is elected.

Ralph Nader announced today on Meet the Press that he was running for a third time for the presidency. The reaction so far has been predictable.

Democrats, remembering 2000 and blaming him for the Bush Presidency, are annoyed and a little bit frightened that he is injecting himself into the race. Republicans are secretly delighted, in the hopes that he might swing a few close states like Ohio, or dare one say it, Florida, to the Republican nominee.

I think that Democrats have much less to fear this time. Nader's candidacy means something quite different in 2008 than it does in 2000. In 2000, Nader was one of several factors that put George W. Bush in the White House. And in fairness to him, he was only one factor.

My guess is that there is very little chance that Nader will decide the outcome of the 2008 election; he will probably have very small numbers, as he did in 2004. Third parties who do not quickly displace one of the two major parties (as the Republicans displaced the Whigs in the 1850s) tend not to wear well on repeated attempts.

Over at the Washington Post, Eugene Robinson gets what is at stake in the 2008 election-- a reconstructive presidency:

Obama's candidacy not only threatens to obliterate the dream of a Clinton Restoration. It also fundamentally calls into question Bill Clinton's legacy by making it seem . . . not really such a big deal.

That, I believe, is the unforgivable insult. The Clintons picked up on this slight well before Obama made it explicit with his observation that Ronald Reagan had "changed the trajectory of America in a way that Richard Nixon did not and in a way that Bill Clinton did not."

Yes, another political post. Tomorrow is the Super Tuesday to end all Super Tuesdays, so I don't feel too bad about it. For a political junkie, this has been the most fascinating 6 weeks I've ever seen. Results wildly out of line with the polls, huge lead changes, the death of "momentum" as a meaningful gauge of a candidate's chances, debates more wonkish than I've ever seen, and two candidates I'm super enthusiastic about...

And that's just on the Democratic side. With the Republicans we've got Giuliani's 50 million dollar delegate, Huckabee's shock win in Iowa and all-too-predictable collapse, Romney remembering too late that he had a far better case as a smart business guy than he ever did as the cultural warrior, and the resurgence of McCain (which I'm not enthusiastic about in a strategic sense, but which does make me feel smart for predicting that he would win the nomination way back in November when he looked DOA).

Anyways, I got an e-mail today from a friend in California leaning toward Hillary asking me to make the case for Obama. I ended up with a fairly lengthy response and figured it wouldn't hurt to post it here. Yesterday I made the emotional case. This is the strategic one:

The Democratic Party has just stripped Michigan of its votes at the national convention because, in violation of Party rules, Michigan is holding a primary before February 1. The Party has also done the same to Florida. Under party rules, only Iowa, New Hampshire, Nevada, and South Carolina are allowed to hold primaries before February 1.

Losing both New Hampshire and Iowa can destroy a candidacy. Winning both is a sure path to the nomination.

In explaining John McCain's rise to front runner status, Matthew Yglesias notes that for the past decade and a half, successful Republican presidential campaigns have emphasized issues of character:
In particular, character arguments were central to George W. Bush's critique of Al Gore and John Kerry and, indeed, were about all there was to Bob Dole's 1996 campaign. This has tended to work well as a tactic because the press is a great venue for transmitting character attacks but a terrible venue for transmitting issue attacks because reporters mostly don't understand issues and even when they do they pretend not to.I think that Yglesias's point is essentially correct, but I would lay the blame not with the press per se but rather with the dominant media of political communication that the press uses (along with everyone else).

It appears that John McCain is the anointed (at least by the press) nominee of the Republican Party, not least becasue he carried a number of Northeastern states in which he basically stands no chance of winning in November and because he won 33% of the vote in Missouri and, apparently, 44% of the Republican vote in California. As to the former, the winner-take-all feature had been engineered to slingshot Rudy Giuliani into the lead. Obviously, things changed. (California is not winner-take-all for the Republicans.) Missouri is also a winner-take-all state, which means, by definition, that a candidate rejected by 67% of the relevant electorate can nonetheless "win" because of being first-past-the-post. Perhaps McCain might have won in a run-off or alternative transferrable vote, but there is certainly reason to doubt this in Missouri.

Readers are begging for more about the Massachusetts health care reform legislation. Okay, not begging, but they have expressed mild interest. You can get a one page overview here, and the authority responsible for administering the law, called (weirdly) The Connector, provides links to the actual legislation and associated regulations here.

Unfortunately, in my view, this legislation has become the model for the leading Democratic national proposals. To answer Kathy A.'s question, the law provides sliding scale subsidies for low and moderate income people to purchase insurance. To answer Roger's question, it provides for fairly stiff fines for individuals who don't get insurance, although less than the cost of actually buying it.

As I have said before, I'm not going to be all over the health care proposals of the presidential candidates because whatever they are saying now is not miraculously going to become reality after January 20. It's all going to get processed through the Congressional/K Street/Moronic Corporate Media meat grinder anyway, and who knows what vile offal might emerge?

But, the debate last night has no doubt raised questions in people's minds regarding what that was all about with the mandates and the amputations and what not. Let me say, first of all, that the debate as a whole was extremely heartening. It was largely substantive, we've got two capable candidates who both demonstrated a willingness to submerge their competing personal ambitions for the good of the nation, and it would be absolutely shocking if one of them doesn't become president. Whoever it is will spend the next few years shoveling out a shitpile that makes the Augean stables seem like your cat took a dump on the rug, but maybe they'll get something done on health care.

So, you can go to the respective web sites and read it all for yourselves, but here's my executive summary.

The headlines -- most of them, anyway -- are saying that Senator Clinton beat Senator Obama 51% to 45% in the Nevada caucus contest today. Except that some reports say Senator Obama "won," 13 delegates to 12. What's up? There's a debate going on over at Matt Yglesias's blog (and elsewhere, too, I venture to guess -- especially among the spinners).

Well, there are at least three different metrics by which today's contests could be evaluated.

If there is one thing that is clear about contemporary America, it is that "democracy" scarcely describes our approach to politics. No, I'm not going to do another attack on our Constitution. Instead, I continue to be interested in the widespread belief that the Democratic primary has gone on "too long" and that something needs to be done to wrap it all up (and, in fact, that it should have been wrapped up weeks ago). As a committed Obamaite, I've not been above such thoughts, but as a slightly more detached analyst, I wonder what exactly is wrong about the current imbroglio, at least if one believes in democracy.

Consider the following: Hillary Clinton and Barack Obama actually have had to visit states like Texas, Wyoming, and Mississippi, which they will certainly not do for the general election. They will also find themselves in North Carolina and South Dakota before too very long. This means, among other things, that they are actually forced to become familiar with issues that might matter to people in those states and address them as, gasp, the equal of Democrats in safe states or the fabled swing voters in the few "battleground states." I'm opposed, of course,

The current situation in the Democratic and Republican parties is almost entirely a function of the fact that they operate under two strikingly different election systems. It is "natural experiment" that has much to teach us about institutional design. The Democrats are operating under a classic system of proportional representation. The only real surprise is that it so quickly was reduced to a two-person contest, probably a function of the enormous amounts of money needed to finance a modern campaign. The Republicans, on the other hand, have chosen to operate, in many states, under a classic first-past-the-post winner-take-all system. This means that John McCain was able to get all of Missouri's delegates by getting, I believe, 34% of the total vote in that state. I haven't done the numbers to know what would be happening in the Democratic race if states operated on a first-past-the-post winner take all system. At the very least, Clinton would have hundreds of additional delegates from New York, New Jersey, and California, for starters, not to mention similar possibilities in Texas and Ohio, should she win either by even one vote. If Republicans had adopted a p.r. system similar to the Democrats, then John McCain would by no means have the nomination locked up, and we could all look forward to a circus at the Republican convention in Minneapolis.

As many of you who regularly read my blog know, I'm not big into politics here. (It's a fascinating, but dirty business.) I've written the rare column about it, but I watched the returns on Thursday's Iowa caucuses with some interest, and I thought I'd write something about it, as the 2008 presidential campaigns got officially underway.

As you all know, Barack Obama and Mike Huckabee were the winners on the Democratic and Republican sides, respectively. Obviously both candidates got a huge boost from winning the first major political contest of the 2008 presidential campaign. But I thought some pundits went a little overboard with the pronounciations they were making, especially about Obama.

Unless Barack Obama wins both Texas and Ohio (and adds Pennsylvania a couple of weeks later for good measure), the race will go on, and the controversy about counting delegates from Florida and Michigan will become ever more heated. The Clinton position that the results of the primaries held there in January, in patent defiance of the Democratic National Committee, should be honored, is preposterous. The candidates had pledged to honor the ban by not campaigning there. Obama wasn't even on the ballot in one of those states and certainly didn't campaign. But if Clinton and Obama remain more-or-less tied after the next string of primaries, there will, I suspect, be great pressure to rehold the primaries in a context where both candidates can campaign. This appears fair on the surface, but there is a real paradox in adopting this solution.

Hillary Clinton is evidently running for the Republican nomination for president. Monday, she met with Richard Mellon Scaife -- yes, the very architect and financier of the Vast Rightwing Conspiracy, the man behind the Whitewater hoax, the man who spent millions of dollars promoting the story that Hillary Rodham Clinton had Vince Foster murdered -- now the publisher of a commercially non-viable far right-wing vanity newspaper, and used the occasion to denounce Barack Obama for being a member of Jermiah Wright's church.

Today, I read this in the Washington Post: "[Like John McCain] Sen. Hillary Rodham Clinton's campaign has also started slapping the L-word on Obama, warning that his appeal among moderate voters will diminish as they become more aware of liberal positions he has taken in the past, such as calling for single-payer health care . . . ."

It's not very surprising that a recent poll finds that 28% of Clinton supporters would vote for John McCain if Obama is the nominee, since it has been the Clinton strategy for several weeks now to endorse John McCain over Obama.

Apologies to my hordes of disappointed readers for the lacuna. My Intertubes were blocked on Tuesday -- or, to put it in less technical terms, our ISP had an all-day, city-wide outage. I had the chance to post from elsewhere in the evening but I said to heck with it. Yesterday, the problem was in the wetware. I think I was just so depressed and disgusted by the completely idiotic and repulsive coverage of politics on TV that my neural circuits were sputtering fecklessly. The link is to Glenn Greenwald, writing coherently.

Anyhow, both the ISP and I have rebooted, so before I do a public health post later today, let me just put in my two cents on the presidential campaign. Nothing terribly original, just the same open letter to Hillary Clinton I know you would write as well.

Dear Senator Clinton: You have already made history as the first woman to run a truly credible campaign for the presidency. You have staked out substantive positions on many issues, and your campaign has simultaneously transcended gender and championed gender equality. Good for you. The next woman to run for president will find the way smoothed by your precedent. Chris Matthews has been chastened (to some extent) and it won't be a novelty, it will just be a presidential campaign.

And no free pass for President Obama either. As you know if you've been reading -- because I mentioned it a few days ago -- Obama's health care proposals include requiring insurers to cover preventive services, which he claims will reduce health care costs. Hillary Clinton makes some vaguer claims along the same lines, to the effect that universal coverage will end up saving money because people will get timely preventive care.

Joshua Cohen and colleagues in NEJM consider this proposition. (And you'll be pleased to know that this is one of those articles of broad public interest that the editors have made available to the rabble, so go ahead and read it.)

Alas, as a general proposition it isn't so. Screening and prevention may be worthwhile, but that isn't the same as saving money. Very few procedures actually produce a net cost saving. Cohen et al don't point it out, because it isn't really the focus of their analysis, but the really bad news is that extending people's lives actually costs money. If somebody drops dead of a heart attack, you only have to pay for the funeral. But if they live for 20 years taking beta blockers and ACE inhibitors and statins and getting angioplasties etc., you've prevented a heart attack, but spent a helluva lot of money.

That was the headline I saw on a fellow traveler's newspaper on the subway this morning. I can only say, it would probably be an improvement over the present administration down there. It got me to thinking I should weigh in here on politics. Lately I've been leaving it to others who specialize in that sort of thing, and I still need to deal with the Man and Superman thing, the rest of Stem Cell Century, and current public health news. However, this will be the most critical election for public health in my lifetime, so it requires attention.

This week history was made with Obama winning the Democratic party's nomination!

I love this video of Chris Rock's views on the 2008 Election: Chris Rock's 2008 Election Analysis

Hilary's speech was very interesting. Click here

All of the presidential candidates seem to be picking up Barack Obama's theme of change and portraying themselves as agents of change. If things keep going the way they have been, the 2008 election now looks to be as defining a moment as 1932, 1968 or 1980. (If things keep going, that is. A lot can happen in ten months).

If 2008 turns out to be a pivotal election, defining a new political era, it is important to give credit where credit is due. Two key reasons for the change will be the crackup of the coalition of the dominant party of the era, the Republicans, and the almost complete political failure of George W. Bush and his chief political adviser, Karl Rove. Let me begin with the second feature, and move to the first.

After the criticism leveled at him last week, it is a pleasure to commend David Broder for his extremely interesting article in today's Washington Post on a forthcoming conference at the University of Oklahoma, called by former Sen. and current UO president David Boren, to explore the possibility of a "non-partisan" candidacy for the presidency by New York Mayor Michael Bloomberg.