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Showing posts with label Health care. Show all posts
Showing posts with label Health care. Show all posts

Monday, July 07, 2025

The Drug Crisis Through a Demand and Supply Lens: What America Must Learn and Do



The Drug Crisis Through a Demand and Supply Lens: What America Must Learn and Do

The fentanyl crisis, the broader opioid epidemic, and the ballooning overdose problem in America are not merely criminal justice issues. They are symptoms of a deep and systemic social failure. When approached through the demand and supply lens — the same lens used to understand any market — a more honest picture emerges. It is time America looks in the mirror and asks: Why is demand for numbing substances so high?

The Demand Side: Why So Many Are Numbing Themselves

When people turn to fentanyl, heroin, or prescription opioids, they are not just chasing a high — they are often running from pain, emptiness, or despair. Here are the key demand-side drivers fueling the crisis:

1. Gross Economic Inequality

When the top 1% owns more wealth than the bottom 90%, and tens of millions of Americans are one medical bill away from bankruptcy, the stress, hopelessness, and social disconnection that follow create fertile ground for drug use. Despair thrives when people see no pathway upward.

2. Homelessness

Without stable shelter, even the most basic human needs become a daily struggle. Many unhoused individuals turn to drugs to endure trauma, weather conditions, and constant fear. Substance use becomes both an escape and a coping mechanism.

3. Poverty and Job Insecurity

Living paycheck to paycheck — or not at all — frays mental health. People stuck in poverty often lack access to health care, education, and even hope. In such an environment, drugs provide an illusion of control.

4. Food Deserts and Health Neglect

Malnutrition doesn’t just stunt physical development — it also damages mental health. When whole communities have easier access to processed sugar and liquor than to fresh produce, we’re creating an environment where long-term well-being is structurally out of reach.

5. Mental Health Crisis

Undiagnosed, untreated, or stigmatized mental illness often underlies substance use. But America has chronically underfunded mental health programs and allowed care to be a privilege for the wealthy.

6. Social Isolation and Fractured Communities

The erosion of community institutions — from churches and unions to neighborhood centers — has left millions without support networks. Loneliness has become a public health issue.

The Supply Side: A Broken System Enabling Exploitation

Yes, drug cartels flood fentanyl into the U.S. market. Yes, pharmaceutical companies knowingly oversupplied addictive painkillers. And yes, pill mills and corrupt distribution networks facilitated mass dependency. But the reason supply thrives is because demand is insatiable.

What fuels supply:

  • Weak regulations and oversight

  • A fragmented health care system

  • Overreliance on for-profit pharmaceutical models

  • Corruption and lobbying that silence reform

Solutions: Healing the Demand Side

Solving the crisis requires bold, system-level interventions — not more jail cells. Here are the social programs and policy frameworks that can actually reduce the demand for drugs:

1. Progressive Taxation to Fund Safety Nets

America remained capitalist even when the top tax rate was 90% during the Eisenhower era. A 70% marginal tax on net worths exceeding $10 million isn't socialism — it's survival. Use the revenue to invest in:

  • Universal health care (including mental health and addiction treatment)

  • Free and quality education

  • Affordable housing and housing-first models for the homeless

  • Guaranteed nutrition through universal basic food access

2. Decriminalization and Treatment-First Policies

Countries like Portugal radically decriminalized drug possession in 2001 and invested in public health, not punishment. The result? Overdose deaths plummeted, HIV infections fell, and recovery rates improved. Treat addiction as a health issue, not a moral failing.

3. Community-Based Solutions

In Iceland, youth substance use dropped dramatically when the country invested in after-school programs, family support, sports, and community bonding. The key? Replacing disconnection with belonging.

4. Economic Dignity

Job creation programs, a federal jobs guarantee, and robust unemployment and disability benefits give people back a sense of purpose. Countries like Sweden and Germany show that strong social safety nets do not hinder economic productivity — they strengthen it.

5. Legal Access to Services

Just as health care should be universal, so should access to legal aid and protection. Poverty should not mean powerlessness. Many drug users are also victims of exploitation, abuse, or systemic neglect that goes unchallenged without legal support.

The Moral Imperative

If we truly care about "doing right by families," we must ensure that every child, regardless of zip code, grows up in an environment where trauma is addressed, opportunity is available, and healthcare is a right — not a luxury.

Drug overdoses are now the leading cause of death for Americans under 50. This is not a fringe issue. This is the collapse of a social contract.

Final Thoughts

We don’t need to reinvent the wheel — we need the political courage to copy what works, tax what hoards, and heal what hurts. The fentanyl crisis is not about bad people doing bad things. It’s about broken systems producing broken lives — and then punishing them.

There is no quick fix, but there is a clear path forward. It starts with investing in people, not prisons. In communities, not corporations. And in hope, not punishment.

If we want to reduce drug deaths, we have to reduce despair. It's time America wages a war not on drugs, but on hopelessness.



मांग और आपूर्ति के दृष्टिकोण से ड्रग संकट: अमेरिका को क्या सीखना और करना चाहिए

फेंटानिल संकट, व्यापक ओपिओइड महामारी, और बढ़ता ओवरडोज़ संकट केवल आपराधिक न्याय प्रणाली के मुद्दे नहीं हैं। ये अमेरिका की गहराई से विफल हो चुकी सामाजिक व्यवस्था के लक्षण हैं। जब हम इन्हें मांग और आपूर्ति के लेंस से देखते हैं — जैसे किसी भी बाजार को देखा जाता है — तो एक अधिक ईमानदार तस्वीर सामने आती है। अब समय आ गया है कि अमेरिका आईना देखे और खुद से पूछे: इतनी बड़ी संख्या में लोग दर्द से छुटकारा पाने के लिए नशीली दवाओं की ओर क्यों जा रहे हैं?


मांग पक्ष: लोग इतनी बड़ी संख्या में नशा क्यों कर रहे हैं?

जब लोग फेंटानिल, हेरोइन या ओपिओइड की ओर जाते हैं, तो वे अक्सर केवल "नशे" के लिए नहीं, बल्कि अपने दर्द, खालीपन या निराशा से भागने के लिए ऐसा करते हैं। मांग को बढ़ाने वाले मुख्य कारक ये हैं:

1. अत्यधिक आर्थिक असमानता

जब टॉप 1% के पास नीचे के 90% से अधिक संपत्ति हो और लाखों लोग एक मेडिकल बिल की दूरी पर दिवालिया हो सकते हों, तो तनाव, निराशा और सामाजिक अलगाव गहराते हैं। ऐसे माहौल में नशा एक आसान रास्ता लगता है।

2. बेघरपन (होमलेसनेस)

जब लोगों के पास सिर छुपाने की जगह नहीं होती, तो रोजमर्रा की जिंदगी ही संघर्ष बन जाती है। बेघर लोग अक्सर दर्द और डर से निपटने के लिए नशीली दवाओं का सहारा लेते हैं।

3. गरीबी और नौकरी की अनिश्चितता

पेचेक-टू-पेचेक जिंदगी या बेरोजगारी मानसिक स्वास्थ्य को नष्ट करती है। गरीबों के पास स्वास्थ्य सेवा, शिक्षा और अवसरों की भारी कमी होती है। नशा तब एकमात्र बचाव बन जाता है।

4. भोजन की कमी और पोषणहीनता

जब पूरी बस्ती में जंक फूड और शराब तो मिलती है, लेकिन ताजे फल-सब्जियाँ नहीं, तो स्वास्थ्य और मनोबल दोनों गिरते हैं। ये हालात भी नशे को जन्म देते हैं।

5. मानसिक स्वास्थ्य संकट

अनदेखी, अनउपचारित या कलंकित मानसिक बीमारियाँ अक्सर नशे के पीछे होती हैं। लेकिन अमेरिका ने मानसिक स्वास्थ्य सेवाओं में लगातार कटौती की है और इन्हें केवल अमीरों की सुविधा बना दिया है।

6. सामाजिक अलगाव और टूटते समुदाय

कलीसियाओं, यूनियनों और सामुदायिक केंद्रों जैसी संस्थाओं के कमजोर होने से लोग अकेले पड़ गए हैं। अकेलापन अब एक सार्वजनिक स्वास्थ्य संकट बन गया है।


आपूर्ति पक्ष: एक टूटी हुई प्रणाली जो शोषण को बढ़ावा देती है

हाँ, ड्रग कार्टेल फेंटानिल जैसे पदार्थ अमेरिका में ला रहे हैं। हाँ, फार्मा कंपनियों ने जानबूझकर ओपिओइड्स का अत्यधिक वितरण किया। लेकिन आपूर्ति तभी बढ़ती है जब मांग अत्यधिक हो।

आपूर्ति को बढ़ावा देने वाले कारक:

  • कमजोर नियमन और नियंत्रण

  • बिखरी हुई स्वास्थ्य प्रणाली

  • मुनाफा-प्रेरित दवा मॉडल

  • भ्रष्टाचार और लॉबिंग


समाधान: मांग पक्ष को ठीक करना

इस संकट का समाधान जेल नहीं, बल्कि नीतिगत बदलाव है। नीचे वे कदम हैं जो मांग को घटा सकते हैं:

1. प्रगतिशील कर प्रणाली से मजबूत सामाजिक ढांचा

अमेरिका तब भी पूंजीवादी था जब शीर्ष आय कर दर 90% थी। 10 मिलियन डॉलर से ऊपर की संपत्ति पर 70% कर लगाना समाजवाद नहीं है — यह सामाजिक स्थिरता की बुनियाद है।

इन करों से प्राप्त धन का उपयोग करें:

  • सार्वभौमिक स्वास्थ्य देखभाल (मानसिक स्वास्थ्य और नशा उपचार सहित)

  • मुफ्त और गुणवत्तापूर्ण शिक्षा

  • सस्ती और सुरक्षित आवास योजनाएँ

  • पोषण सुरक्षा और खाद्य अधिकार

2. डिक्रिमिनलाइजेशन और स्वास्थ्य-आधारित नीतियाँ

पुर्तगाल ने 2001 में ड्रग उपयोग को अपराध की बजाय सार्वजनिक स्वास्थ्य समस्या के रूप में माना और नतीजतन:

  • ओवरडोज़ मौतों में भारी गिरावट

  • HIV संक्रमणों में कमी

  • बेहतर रिकवरी दरें

3. सामुदायिक समाधान

आइसलैंड में युवाओं में नशा घटाने के लिए खेल, कला, और पारिवारिक कार्यक्रमों पर निवेश किया गया। नतीजा? उल्लेखनीय सफलता।

4. आर्थिक गरिमा और नौकरी

फेडरल रोजगार गारंटी, अच्छी बेरोजगारी योजनाएँ और उद्यमशीलता समर्थन कार्यक्रम लोगों को उद्देश्य और आत्म-सम्मान देते हैं। स्वीडन और जर्मनी जैसी जगहें यह दिखाती हैं कि मजबूत सामाजिक सुरक्षा उत्पादकता बढ़ा सकती है।

5. कानूनी सेवाओं तक सार्वभौमिक पहुँच

स्वास्थ्य सेवाओं की तरह, कानूनी सहायता भी सभी के लिए उपलब्ध होनी चाहिए। गरीब अक्सर अन्याय के शिकार होते हैं, लेकिन उनके पास कानूनी संरक्षण नहीं होता।


नैतिक ज़िम्मेदारी

अगर हम वास्तव में परिवारों के लिए कुछ करना चाहते हैं, तो हमें यह सुनिश्चित करना होगा कि हर बच्चा, चाहे वह किसी भी क्षेत्र में पैदा हो, शिक्षा, स्वास्थ्य और सुरक्षा के साथ बड़ा हो।

ड्रग ओवरडोज़ अब अमेरिका में 50 वर्ष से कम उम्र के लोगों की मृत्यु का सबसे बड़ा कारण बन चुका है। यह कोई मामूली संकट नहीं — यह सामाजिक अनुबंध की विफलता है।


निष्कर्ष: अमेरिका को किस पर युद्ध छेड़ना चाहिए?

हमें नया आविष्कार नहीं करना — बस यह देखना है कि क्या काम करता है और उसे ईमानदारी से अपनाना है।

ड्रग संकट बुरे लोगों का नहीं, बल्कि एक टूटी हुई व्यवस्था का नतीजा है जो टूटे हुए जीवन को पैदा करती है — और फिर उन्हें सजा देती है।

संकट का समाधान जेल नहीं, बल्कि न्याय है। उपचार नहीं, बल्कि पुनर्स्थापन। नफरत नहीं, बल्कि करुणा।

अगर हम ड्रग की मौतें कम करना चाहते हैं, तो हमें निराशा को कम करना होगा।
अब समय है कि अमेरिका ड्रग्स पर नहीं, बल्कि निराशा पर युद्ध छेड़े।





Wednesday, May 07, 2025

How to Fix Health Care in America: Lower Costs and Cover Everyone


How to Fix Health Care in America: Lower Costs and Cover Everyone

Health care in the United States is both the most expensive in the world and among the least efficient when it comes to covering everyone. Despite spending nearly 18% of GDP—more than any other country—tens of millions remain uninsured or underinsured, and medical bankruptcies are a uniquely American tragedy. The system is fragmented, profit-driven, and bureaucratically complex. But reform is not impossible. Many countries around the world provide universal health care at far lower costs while achieving better or comparable outcomes. It's time America learns from them.


🏥 The Two Goals: Lower Costs, Universal Coverage

To reform American health care effectively, two fundamental goals must be pursued in tandem:

  1. Dramatically reduce costs

  2. Provide universal health care to all Americans

Achieving both requires systemic changes that go far beyond tinkering around the edges with insurance subsidies or provider networks.


💡 Five Core Reforms America Needs

1. Universal Public Insurance or Regulated Nonprofit System

  • Either implement a single-payer system (like Canada or Taiwan) or tightly regulate a network of nonprofit insurers (like Germany, France, and the Netherlands).

  • Eliminate or restrict for-profit insurance companies, which currently absorb billions in overhead and marketing.

2. Standardized Pricing for Services and Drugs

  • Introduce national or regional fee schedules to eliminate wild variations in pricing.

  • Use bulk purchasing (as other countries do) to drastically reduce prescription drug prices.

3. Administrative Simplification

  • The U.S. spends 4 to 5 times more on health care administration than peer countries.

  • Streamlining billing, coding, and insurance verification can save hundreds of billions annually.

4. Preventive and Primary Care Focus

  • Shift investment from expensive emergency and specialist care to primary care, preventive services, and public health.

  • Incentivize value-based care instead of fee-for-service.

5. End Employer-Based Insurance

  • Decouple health care from employment to increase labor mobility, entrepreneurship, and equity.

  • Replace it with publicly financed insurance funded via progressive taxes and employer contributions (as seen in Japan and Germany).


🌍 Which Countries Are Doing It Better?

Several nations provide excellent health care at half or less of the U.S. cost:

Country % of GDP on Health Universal? Key Features
🇹🇼 Taiwan ~6.7% Yes Single-payer, smart card system, low overhead
🇩🇪 Germany ~11.7% Yes Multiple nonprofit insurers, employer/employee-funded
🇫🇷 France ~11.2% Yes Public insurance with supplemental private plans
🇸🇪 Sweden ~10.9% Yes Tax-funded regional health care system
🇯🇵 Japan ~10.7% Yes Employer-based with strong government regulation
🇬🇧 UK ~11.3% Yes NHS: government-funded and operated

These countries differ in structure but share common traits:

  • Universal coverage

  • Government-negotiated prices

  • High public satisfaction

  • Lower administrative costs

  • Focus on primary care and public health


🔍 What the U.S. Can Learn

From Taiwan: Adopt a smart card system that centralizes medical records and billing. Use global budgeting to control total system costs.

From Germany and France: Allow pluralistic insurance models—but strictly regulated, nonprofit, and universally accessible.

From the UK and Sweden: Invest in public infrastructure and staff, especially in rural and underserved areas.

From Japan: Use price controls without stifling innovation, and support healthy lifestyle education as a core policy tool.


🔚 Conclusion: A Healthier America is Possible

America’s health care crisis is not a failure of medicine or technology—it is a failure of political will and economic justice. The solutions are not secrets. They exist, and they work in dozens of countries today. By prioritizing health over profit, simplifying administration, and ensuring universal access, the U.S. can finally achieve what every other advanced country already has: health care as a human right, not a privilege.

The question is not how to fix American health care. The question is when the political courage will catch up to the moral urgency.



Friday, August 02, 2019

The US Health Care Mess

And when I say mess, don't get me wrong, I am not saying there is an ebola epidemic in the US. I mean that in an organizational chart sense. When it comes to health care in the US as a whole, I think it is a scenario of the left hand does not know what the right hand is doing.

Describe to me how the system works right now. You can't. It is not like the curry on the plate was made with this one recipe, and now you are going to use a different recipe tomorrow.

You can't just throw more money at the problem. You can't just 100% privatize. You can't just 100% nationalize.

It is the biggest chunk of the economy. If you think about it, social security and medicare are such big parts of the US economy, as is defense, and you have health care, and is America not already a socialist country? The government in the US is bigger than it is acknowledged.

Good luck figuring it out.



Thursday, July 11, 2019

Bernie Is The John McCain Of The Left

Bernie Sanders is a maverick. More so than John McCain. Today anybody can be a Socialist. But Bernie was a Socialist during the Cold War! Imagine that. That's a maverick.

John McCain ran for president. Twice. He did not win. But he did build stature. He was in the Senate, but he was not just another Senator. I see the same thing happening to Bernie. He will not become Majority Leader. But his megaphone will be big. He will have a loud voice.

I don't see him winning the nomination. He lacks nuance. He stays blind to orchestrated targets. The moneyed interests send the media guys after him. He stays uninformed. He does not respond.

If the entire gamut of Democratic candidates is today talking about Medicare For All, it is because Bernie hammered the point in 2016. That's to his credit. That Bernie did so well in 2016 gave a lot of people confidence that perhaps Obamacare was just a stepping stone to Medicare For All. And there is broad public support. The idea is popular among Republicans.


Saturday, April 27, 2019

US Health Care: A Perspective





Thursday, January 19, 2017

Donald Trump: Health Care For Everyone

Donald Trump said something about health care for everyone a few days back.

He took on the Republican establishment during the primary season and came on top. Democracy is like capitalism. There is creative destruction involved. In Manhattan, where Trump is from, since every square inch of space is already taken, when you have to erect a new building, you demolish an old one. When you want to preserve the exterior of an old building, you gut it from inside. This is all real estate language, familiar to Trump.

If Trump sticks by his pledge of health care for everyone, he ends up ideologically gutting the Republican Party. The brand name stays, but the party is fundamentally changed from inside.

I was, of course, rooting for Hillary 2016. You can dig into this blog's archives and see. But it did not escape my attention that Trump absolutely ate 16 otherwise stellar Republican candidates for lunch without spending much money at all. More noteworthy than lack of funds was the fact he did not have much in the name of a political operation. He was his own political consultant, for the most part. His approach to the whole endeavor was entrepreneurial. Never underestimate a man with a Twitter account, I guess.

If he can end the Cold War with Russia once and for all, that would be a good thing.

Sticking by the mantra of health care for everyone is the only way he can honor many of the people who voted for him.

I think it is possible. The US government is the largest customer of the biggest pharmaceutical companies. There is room to bargain and bring down the prices on drugs.

If Trump will stick to the health care for everyone pledge, I will take a second look at him.

Trump's Stealth Health Plan Could Be 'Medicare For All'

Wednesday, November 09, 2016

The Trump Recession Can't Be More Than Two Years Away

Trump's trade and immigration policies lead straight to recession. That can't be more than two years away.

A whole bunch of people would be crying hoarse next year when they lose their health care. But most of them did not even bother to vote. And many of them voted for Trump. They are white and poor.

Ah, democracy. 

Friday, October 21, 2016

Improve Obamacare

Barack Obama Offers Blistering Takedown Of GOP Obstructionism In Pitch For Health Care Law 

First is for the 19 states that have refused to take up Obamacare’s Medicaid expansion to do so, in the process covering millions more poor adults. Second is to beef up the subsidies provided to people who get their coverage from the law’s health insurance exchanges. And third is to set up a government-run public option program ― which Obama called a “public plan fallback” ― in geographic areas with the highest prices and least competition.

Sunday, February 21, 2016

Bernie And Blacks


  • Bernie should talk more about his Jewish experience. And, like I suspect, if he does not have too much of it, he should talk about his father's Jewish experience. Black folks think they have some kind of a patent on victimhood. They got nothing on Jews
  • Blacks wrongly think they were/are victimized because they had nothing. The opposite is true, just like for Jews. Jews have a tradition of knowledge. The rest of the world has had to wait for a 21st century knowledge economy to get the message. 
  • Black folks need the Bernie message more than any other group. Bernie is not trying to dismantle Obamacare, that would be Donald Trump. He is trying to expand upon it. College is the new high school. Bernie is right. Taking money out of politics only makes sense. It makes everything else possible. 



Wednesday, June 03, 2015

100 Smart Cities, 100 World Class Universities



Modi talked of "100 Smart Cities" on the campaign trail in 2014. In 2019 he should perhaps talk of 100 World Class Universities. A world class university is one where people from all over the world come to study. He should also talk of 100 World Class Hospitals doing cutting edge work that caters not only to domestic needs but also to medical tourism.

India is a big, diverse, rich-poor country where you have to come from the low end, but also from the high end. It has to build toilets, but also missions to Mars. It has to wipe out poverty but also think of creating the industries of tomorrow at the same time. And you can not create the industries of tomorrow without having a stable of world class universities.

A world class university of today will be built around all that is available and possible online. MOOCs will be at the core of it. All journals will be available. Guest lectures will be the norm.

You get NRIs to contribute to the endowment.

India's Goal: $50 Trillion

Monday, September 20, 2010

Pelosi Should Pass Election Reform To Keep Job

The Huffington Post: Election Reform As A Way To Put Republicans On The Spot: pass the Fair Elections Now Act, which likely to be voted out of committee next Thursday .... 165 co-sponsors and at least 40 more supporters, would give matching money to candidates who agreed to raise only small donations. It even has three Republican co-sponsors. ...... So far in this election cycle, House and Senate candidates have raised $1.2 billion dollars, and the money arms-race only grows. ..... Under the proposed Act, a candidate who raised small donations from at least 1,500 small donors contributing no more than $100 each for a total of at least $50,000 could get matching money, at a 4-to-1 ratio ..... As much as $3 million in public financing would be available -- enough to be competitive on most House races. The money wouldn't come from tax dollars, but from a special levy on the auctioning of broadcast spectrum
Of all things Pelosi could do between now and the November date, this would top the list. This is smaller than immigration reform and bigger than doing nothing. This is just the right size thing to do.

And with Charlie Rangel sleep walking to jail time after Bill Clinton sent out a robocall on his behalf right before the September 14 primary, the Dems badly need something that shows they stand on the side of politically clean. This bill would be it.

Pelosi can't do the stump speech thing that Obama does. That we should leave to Obama. But this House thing is Pelosi territory. She can get this done just like she got health care reform done and she got finance reform done.

The Dems need this bad.

The fear is not that the Tea Party might out think Obama. They have no plans to out think. Their plan is to numb the American people to not think anything. Their plan is to use racially coded language and imagery to get the American people to think that perhaps the guy in the Oval Office is not one of us.

If the Dems can turn this into an election about ideas and the future, that will lead to victory.

Obama does not need a victory in November. The Dems losing in November puts him in a better situation to win reelection in 2012. It is the American people who need Obama to win, who need Pelosi to be able to keep her job. And this election bill will help.
The Huffington Post: Obama Challenges Tea Party: 'Specifically, What Would You Do?': Obama, in no uncertain terms, accused the movement's members of refusing to talk in specifics. ..... We had two tax cuts that weren't paid for, two wars that weren't paid for. We've got a population that's getting older. We're all demanding services, but our taxes have actually substantially gone down." ..... What you can't do, which is what I've been hearing a lot from the other side, is we're going to control government spending, we're going to propose $4 trillion of additional tax cuts .... Obama does seem to operate at his best when facing inherently adversarial questions (recall the positive coverage he received for going to a Republican conference in Baltimore during the height of the health care debate).


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Tuesday, September 07, 2010

JFK, Primaries, Social Media, DirectConnect


JFK invented the primary system we know of today. Before him it was the party bosses in smoke-filled rooms who decided on the party nominee. It was party bosses who decided on FDR. It was party bosses who decided on Lincoln.

Barack Obama's massive use of social media took JFK's invention to a whole new level. Take away all that technology and Obama was toast. All prominent blacks in the country were lined up in the opposite camp. Pretty much all elected officials were lined up in the opposite camp. All the labor unions were lined up behind Hillary pretty much. There was no doubting her credentials. And there was something historic about the idea of the first woman president too.

At some level I was torn having had to choose between the idea of the first black president and the first woman president, and I am on record at this blog rooting for an eventual Barack-Hillary ticket. But at the end of the day it was not about the first black president. It really was about Barack Obama the person, it was about this particular individual. It was about moving on past the Clinton generation. It was about Obama's emphasis on getting people to meet in person, it was about his use of the newest in technology.

JFK took a big step in the direction of what I call DirectConnect, the idea that there ought to be nothing and nobody between the candidate and the voter. Barack took another big step in the direction of DirectConnect.

Endorsements and political clubs and the status quo will matter less and less going into the future. 2010 is the year of the insurgency. But it is not an insurgency of throwing one party out for another. The insurgency has been about throwing the bums out in both parties. Suddenly primaries matter like they always needed to. A lot of incumbents across the country are facing real contests. Many have faced them and lost them. More will.

The good news is primaries matter, and DirectConnect is more possible than ever before.
You want people to get engaged and stay engaged. But that is not to say polls have substituted the need for leadership. The need for leadership is acute as ever. If we did not need leaders, we would not need elections. But we do.

We have a president who has been wading FDR waters since the passage of health care reform. The recession is not over yet. It will be over finally when the unemployment is down to five per cent. And there leadership matters big time. The guy at the top has many decisions to make, and I believe he will.



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