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Thursday, November 20, 2014

Rock Stars

My wife sent me a school notice about a meeting regarding "The Future of Life Science Education at La Jolla High School" because she thinks it's good for us to attend such things.  I generally think such things are a waste of time and terribly boring to boot, so I started thinking up excuses about why I couldn't possibly make it that particular evening.

But then, "Guest Speaker: Craig Venter," caught my eye on the meeting notice.  To me, Venter is a rock-star of science, primarily famous for his drive and success in sequencing the Human Genome:
Frustrated with what Venter viewed as the slow pace of progress in the Human Genome project, and unable to get funds for his ideas, he sought funding from the private sector to fund Celera Genomics. The goal of the company was to sequence the entire human genome and release it into the public domain for non-commercial use in much less time and for much less cost than the public human genome project. The company planned to profit from their work by creating a value-added database of genomic data to which users could subscribe for a fee. The goal consequently put pressure on the public genome program and spurred several groups to redouble their efforts to produce the full sequence. DNA from five demographically different individuals was used by Celera to generate the sequence of the human genome; one of the individuals was Venter himself. In 2000, Venter and Francis Collins of the National Institutes of Health and U.S. Public Genome Project jointly made the announcement of the mapping of the human genome, a full three years ahead of the expected end of the Public Genome Program. [emphasis added]
In fact, being the nerd that I am, someone like Craig Venter is more of a draw to me than, say, someone like Mick Jagger, though admittedly, Jagger might possibly be somewhat more entertaining.

So I said to my wife, "Why yes dear, there is nothing I'd like better than attending this school meeting!" She looked at me skeptically with raised eyebrows, to which I replied, "No, really. I'm serious!"  So we went. Or rather, I went.  On the night of the meeting she decided she was too tired and decided not to attend.

There were between 50 and 100 people at the meeting. I was surprised.  After all, if it was Jagger instead of Venter, I think it might've been more crowded.  I was definitely disappointed that someone that I think is so important would only draw that few people.  On the other hand, it was more intimate than if it was a big crowd.

One gentlemen there really stood out.  Or should I say stood up? And up and up. He was 6' 11" which is really, really tall and probably 8 inches taller than the next tallest person in attendance.  It turned out to be retired NBA superstar Bill Walton who happens to be on the board of directors of one of Venter's ventures. In fact, the main event was a conversation with Bill Walton asking Craig Venter various questions about his personal life, genomics, and his views on education.  Two superstars for the price of one!

Some interesting tidbits:

  • On education, the first thing Venter noted was that he had terrible grades and barely graduated from high school and that was only possible because he talked a teacher into giving him a D- instead of an F in a required class.  While I'm not sure that background gives him a lot of credibility to pontificate on how high schools should teach life science, he said that two things they should teach (but don't) are how to take risk, and how to fail (or, more accurately, how to recover from failure).
  • On competitiveness of biotech, he's confident that even though Europe and China are pumping huge amounts of money into this area, the United States will maintain a lead for a long time.  He says that in the United States, a great deal of the funding for biotech comes from an unusual intersection of individual philanthropy and investment (venture) capital which is far more creative, versatile, and nimble than the massive, but blunt and poorly directed funding by the European and Chinese governments.
  • On the direction of biotech in general and the human genome in particular, he feels that huge advances in all aspects of health care will be coming in the next ten years.  He feels that this is a fantastic time to invest in biotech companies.
  • On sequencing human genomes, he feels that the clause in Obamacare that enables everyone to get insurance without regard for pre-existing conditions is critically important because that enables everyone to get their genome sequenced without having to worry about likely genetic based diseased states (a type of pre-existing condition) which could have precluded them from getting affordable insurance. Having everybody's genome sequenced will enable optimal health therapies to be personally designed for each and every person over their entire lifetime, increasing both health and longevity.
Every bit as good as a rock concert!

Monday, November 17, 2014

"That's what I'm afraid of..."

This June, about a month or two before the original Halbig decision,  I was talking with my co-blogger and sharing some of my thoughts on healthcare policy and ACA.  I'm not big on making hard and fast predictions, but exploring various scenarios and thinking about relative probabilities is a common practice.  More about that later.  There were a handful of issues that could have been addressed with targeted pieces of legislation that could have drawn solid bipartisan support.  Instead we got a serious CF that has barely evidenced all of the related problems it will cause.  The political realities make outright repeal very unlikely, however, there is a path forward.  First, let's look at the following historical example of a really lousy piece of legislation which was eventually stripped down to something more manageable.  In an article titled  Let's Taft-Hartley Obamacare by Paul Moreno:

It is increasingly clear that the Affordable Care Act is not going to be either completed or abolished, regardless of what happens in November or in any envisionable future election. It is locked in, but in a peculiarly limited way.

But Obamacare will not be as locked in as, say, Social Security, the Civil Rights Act, or Medicare. As critics have pointed out, those programs were enacted with bipartisan support. Obamacare has enough shortcomings and complications that it will probably track that most accidental of New Deal legislation, the National Labor Relations Act of 1935, which made organized labor the most powerful interest group in America for half a century.
Almost everyone expected the Court to strike down the Wagner Act. Indeed, many liberals wanted the Court to do so, to highlight the conflict between the New Deal and judicial conservatism. Thus the Wagner Act passed the Senate 63 to 12 and passed the House without a recorded vote. The best explanation for the lopsided majority was not consensus in favor of the bill, but the conviction held by many of its opponents that the Court would strike it down — so why incur the enmity of organized labor for nothing?

To nearly everyone’s surprise, the Court upheld the Wagner Act in April 1937, shortly after Roosevelt had threatened to pack it. Suddenly, the country was saddled with an act that might not have passed at all, and certainly not in as radical a form, without the Supreme Court wild card. However, the Democratic majorities were so overwhelming in 1935 (70 to 20 in the Senate) that the NLRA probably would have passed, albeit by smaller margins, had the assumed Supreme Court strikedown not been a factor.

The public was soon put off by the militant tactics — especially the sit-down strikes — employed by the new unions of the Congress of Industrial Organizations (CIO), which had broken away from the more conservative AFL. Roosevelt packed the NLRB with CIO partisans, which alienated both employers and the AFL.

When the Republicans won control of Congress in 1946, for the first time since the beginning of the Depression, they enacted the Labor-Management Relations Act (Taft-Hartley). President Truman vetoed it, calling it a “slave-labor bill,” but Congress overrode the veto. (Many believe that Truman expected and actually wanted his veto overridden. He saw that Taft-Hartley was a much-needed correction to the Wagner Act, and this way he could get it while still keeping the support of the AFL and CIO.)  Taft-Hartley did not go so far as to repeal the Wagner Act. Instead, it maintained its fundamental principles while prohibiting some of the most abusive union practices. Most important, it allowed states to adopt “right-to-work” laws prohibiting compulsory union membership. The nation’s labor markets adjusted to the new regime, until today private-sector union membership is about where it was before the Wagner Act.

When the Roberts Court upheld the Affordable Care Act in 2012, we found ourselves again saddled with an act that probably would not have passed at all, and certainly not in so radical a form, had not the president and Democrats in Congress resorted to every trick in the book to enact it. But the Court left enough openings to significantly curtail it. House Republicans have already taken some small steps, as when they repealed an arbitrary $2,000 cap on deductibles in small-business health-insurance plans.

Some have always been there — like allowing interstate competition in health insurance. (Ironically enough, the liberal New Deal Court invited Congress to do this in 1944, and it declined.) The Court has held that Congress cannot force the states to expand Medicaid, and some Republican governors have taken a stand here. Other provisions, such as the religious-freedom exemptions, also present possibilities. More will open up if and when the Republicans take control of the Senate; outright repeal will be a possibility only if and when they take the presidency, too. But we can still have a Taft-Hartley improvement in the meantime.

So there is historical precedent...

In an article titled  Reforming the Reform Kevin Williamson has some fun which also includes some historical perspective, after which he concludes:

You guys had your shot at this, and you passed the law — but you still managed to blow it. But there are more intelligent, market-based, consumer-driven alternatives, and they are ultimately what’s going to end up getting enacted. We’re here to help — whether you like it or not.

James Capretta and Yuval Levin offer their ideas about a transition to something better.  Their article Getting there: How to transition from Obamacare to real health care reform  begins with the following observations:

Obamacare—or at least the version of it that the president and his advisers currently think they can get away with putting into place—has been upending arrangements and reshuffling the deck in the health system since the beginning of the year. That’s when the new insurance rules, subsidies, and optional state Medicaid expansions went into effect. The law’s defenders say the changes that have been set in motion are irreversible, in large part because several million people are now covered by insurance plans sold through the exchanges, and a few million more are enrolled in Medicaid as a result of Obamacare. President Obama has stated repeatedly that these developments should effectively shut the door on further debate over the matter.

Of course, the president does not get to decide when public debates begin or end, and the public seems to be in no mood to declare the Obamacare case closed. Polling has consistently shown that more Americans oppose the law than support it, and that the opposition is far more intense than the support. The law is built on a foundation of dramatically expanded government power over the nation’s health system, which strikes many voters as a dangerous step toward more bureaucracy, less choice, higher costs, and lower quality care. The beginning of the law’s implementation does not appear to have eased these fears, and in some cases has exacerbated them.

In what is one of the better articles pursuing this theme,  How to Transcend Obamacare Avik Roy begins:

It turns out that repealing Obamacare is not our only hope for reversing the triumph of the entitlement state. Indeed, there may be an even better one.
We can learn two things from Switzerland and Singapore. First, that there are countries out there with freer health-care systems than our own. Second, that it is possible to have one of the freest economies in the world while also ensuring that every citizen has health insurance.

The impressive results of Switzerland and Singapore drive home a powerful message: that health care works best when individuals have more control over their own health spending. The Left can’t bring itself to believe this; there, it’s an article of faith that “disinterested” government experts will make better and more cost-efficient decisions for you than you would make for yourself.

But the examples of Switzerland and Singapore also drive home the problem with focusing solely on Obamacare. If we were to spend all our capital “repealing and replacing” Obamacare, we might not have enough left to tackle the real drivers of unsustainable single-payer health care in America: Medicare and Medicaid.
In short, migrating future retirees and low-income Americans onto exchanges could yield substantial benefits to the quality and cost of subsidized health coverage. But there’s no reason we should accept the Obamacare exchanges as they are.

 Instead of forcing Americans to buy insurance plans that they neither need nor want — the Obamacare way — we should convert the exchanges into real marketplaces, places where people can voluntarily buy coverage that is suited to them. We can do this by repealing Obamacare’s individual and employer mandates, and by rolling back the plethora of new federal regulations and tax hikes that make insurance more costly without improving its quality.
 More than four-fifths of Americans receive federally subsidized health insurance; in Switzerland, only about one-fifth do. That’s the difference between an entitlement leviathan (ours) and a true safety net (theirs).
 The good news is that we can do this. We can solve the problem that conservatives care about more than any other — that America is broke — while actually making the health-care system work better for everyone. The poor and the sick and the elderly will benefit from higher-quality, fiscally sustainable health coverage. And average tax-paying Americans will benefit from affordable insurance, lower long-term tax liabilities, and a consumer-driven health-care system that is centered around them rather than the bureaucracy.
It’s time for conservatives to bring Reagan’s lesson to health reform. Instead of waiting for Obamacare to fail, we should instead devote ourselves to liberating the entire U.S. health-care system from government control. If we do that, and demonstrate the value of our economic principles with tangible results, it won’t matter whether we have formally repealed Obamacare. We will have transcended it, and solved the most important policy problem of our time: that of unsustainable government spending. If we want our children and grandchildren to inherit the country we grew up in, we have no time to waste.

Returning to the conversation mentioned at the beginning of this post -

The main point was that we should probably not be overly gloomy.  After a bunch of struggles healthcare access and affordability will probably be much better 10-20 years hence, despite the law.  More importantly, there are many things happening in the healthcare and life sciences arenas that will allow for the kind of creative destruction that will improve things dramatically.  (To be addressed in a future post.)  I think this is the high probability scenario.  The progressives in their usual clueless manner  will of course think that their law brought this all about.  Then he replied, "that is what I'm afraid of."

Thursday, November 13, 2014

How Much Is Being "Better Off" Worth?

The economist Don Boudreaux notes that Jonathan Gruber admits what many would like to keep hidden:
Obamacare’s chief academic architect, Jonathan Gruber, is caught on camera admitting frankly, and without remorse, that important parts of Obamacare were sold to the public under false pretenses.  Gruber does express regret that voters are afflicted with too much “stupidity” to enable them to see that such legislation is (or so believes Gruber) in their best interest.  But given this regrettable reality of the political process, deception is in order.  Deception and lies and duplicity are proper.
So now I'm allegedly better off regarding my healthcare, but to get there, I had to be held with contempt as being stupid, lied to, and deceived.  Well, guess what?  The negative value to me of being thought stupid, lied to, and deceived by those with violence at their disposal to force me to do what they want far, far, far, far, far, far, far, far exceeds any possible benefits that might accrue from Obamacare, even if those benefits are substantial.

In other words, being made "Better Off" by folks like Gruber has made me worse off.

Boudreaux concludes his Gruber post with:
So Jonathan Gruber simply admits that the very process that people on the left romanticize and celebrate – democratic politics – isn’t what it’s cracked up to be.  Of course, libertarians and public-choice scholars say the same.  The difference between the Jonathan Grubers of the world and the [libertarian scholars such as the] Russ Robertses and Bryan Caplans of the world is that the former believe that politics is still commendable as long as good, smart people (such as Gruber) are performing deceptions necessary to trick voters into supporting policies that good, smart people somehow divine are best for the masses, while the latter believe that the very need to deceive rationally ignorant (indeed, rationally irrational) voters is itself a major flaw in politics – a flaw that makes politics far less reliable and admirable than competitive, private markets.
 The arrogance of the Grubers of the world is what forces me firmly into the libertarian camp.

Wednesday, November 12, 2014

The Narrative, the Narrative, the Narrative

Earlier this year history professor author Fred Siegel released an interesting and surprisingly good book titled,  The Revolt Against the Masses: How Liberalism Has Undermined the Middle Class.  The introduction begins:
This short book rewrites the history of modern American liberalism. It shows that what we think of liberalism today – the top and bottom coalition we associate with President Obama - began not with Progressivism or the New Deal but rather in the wake of the post-WWI disillusionment with American society. In the twenties, the first writers and thinkers to call themselves liberals adopted the hostility to bourgeois life that had long characterized European intellectuals of both the left and the right. The aim of liberalism’s foundational writers and thinkers such as Herbert Croly, Randolph Bourne, H.G. Wells, Sinclair Lewis and H.L Mencken was to create an American aristocracy of sorts, to provide a sense of hierarchy and order associated with European statism.

Like communism, Fabianism, and fascism, modern liberalism, critical of both capitalism and democracy, was born of a new class of politically self-conscious intellectuals. They despised both the individual businessman's pursuit of profit and the conventional individual's pursuit of pleasure, both of which were made possible by the lineaments of the limited nineteenth-century state.
The introduction concludes:

Liberalism, as a search for status, is sufficiently adaptable that even in failure, self-satisfaction trumps self-examination. As the critic Edmund Wilson noted without irony, the liberal (or “progressive reformer,” in his term) has “evolved a psychological mechanism which enables him to turn moral judgments against himself into moral judgments against society.”  This is a book about the inner life of American liberalism over the past ninety years and its love affair with its own ambitions and emotional impulses. Liberals believe that they deserve more power because they act on behalf of people's best interests – even if the darn fools don't know it.   (emphasis mine)
Thanks for demonstrating this so well Mr. Gruber:
“Lack of transparency is a huge political advantage,” says the MIT economist who helped write Obamacare. “And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass.”
Mr. Driscoll concludes:  "The left have displayed enormous condescension to voters in recent years; lying is merely one manifestation of that. And they wonder why they got clobbered last week."

The concluding chapter contains the following passage:
Liberalism, argued Herbert Croly and his heirs, rested on “disinterestedness.”   Experts and intellectuals could be trusted, their theory held, because, unlike the Jeffersonian small-business owners, they weren't motivated by narrow self-interest. But with the expansions of the Great Society and onward, much of the public came to see politicians in general and liberals in particular as engaged in the self-interested business of expanding government expressly to secure policies and privileges for themselves and their supporters. The growing importance of public-sector unions has greatly increased the sense that government has gone into business for itself.

In addition to dealing with increasingly complex and burdensome tax and regulatory regimes economic actors must contend with a bureaucracy and elected officials that have become practically parasitic.  Even when this problem was less pronounced, there were still limits to how much of a positive role the state could play.  As the story is usually told, there is a statist bias with many private actors being unfairly vilified.  Many such examples are in evidence in an old post titled revisiting economic history . (If you haven't seen this post before you might want to give it some attention.) Some of the portrayals are blatantly misleading others are more subtle.  Economic history is not the only area of inquiry  where the conventional wisdom is transmitted through very questionable story-lines. 

Returning to The Revolt Against the Masses, in a chapter titled Three Trials, the author provides the following (excerpts):

No one incident or event contributed more to the self-understanding of liberals or the way they conceived of their political rivals over the past half century than the Scopes “Monkey Trial,” or more precisely the version of the trial rendered in the wake of McCarthyism by the 1955 Broadway hit Inherit the Wind.

Beginning in the 1950s, the play Inherit the Wind and the two film versions of the stage production suffused the liberal imagination.

In the dramatized version of the case, which took considerable liberties with the historical record, the trial was initiated when Scopes, a high school biology teacher, was dragged out of his classroom by a mob and thrown into jail. In reality, as historian Edward Larson showed in his scrupulous rendering of the case based on primary sources, there was no mob, nor was there a jailing. Evolution had long been part of the Tennessee high school curriculum, and there had been no attempt to enforce the symbolic law – the Butler Act – that barred its teaching. In an era when science was seen as wondrous, this law was meant more as a matter of symbolism than substance. It was a period in which eugenics, which had first been introduced by Darwin's cousin Francis Galton, won strong support from liberals who supported both family planning and economic planning. Thirty-five states had enacted laws to restrain the ability of the genetically “unfit” to reproduce themselves.

The case was a contrivance from the outset. The American Civil Liberties Union, founded in the wake of WWI's repression, had initiated the case, which it saw as an opportunity to repeal the Butler Act while also making a name for itself. The ACLU ran newspaper ads across the state looking for a teacher who would be willing to cooperate with them in challenging the state law. They needed a defendant who would agree to be tried for violating the Butler Act. The town fathers of Dayton envisioned the trial as a potential boon that could put them on the map, and they convinced Scopes, a local high school teacher, to intentionally incriminate himself so that he would quality as a defendant and the state's case could go forward. His arrest was a friendly affair arranged by local boosters as a prelude to the show, which would make history by being the first trial broadcast on radio.

Mencken, who wrote about the trial for the Baltimore Sun, gilded the liberal disdain for Bryan by depicting him as a buffoonish bigot and the “idol of morondom.” Mencken, a eugenicist, despised Bryan as a demagogue “animated by the ambition of a common man to get his thumb into their eyes.” He mocked the locals as “Babbits,” “morons,” “peasants,” and “yokels,” which, to be fair, was no less caustic than his usual characterizations of the immigrant masses.

Bryan saw the Scopes trial as in part a matter of self-government. The trial, he wrote, raised the question of “whether the people...have a right to control the educational system which they have created and which they tax themselves to support.” By contrast, Mencken saw the trial, and Bryan in particular, as the living proof of why democracy was a despicable form of government. Mencken's Notes on Democracy (1926) argued that democracy was both impossible and undesirable. Kaiser Wilhelm II, by then dethroned, praised the book highly, but a friend sighed that he wished Mencken hadn't written it, “because it reveals too much about him.” It was a tedious, repetitious performance by an intellectual vaudevillian whose writing never rose above his resentments.

But Bryan, Mencken's avatar of dreadful democracy, was far from a bigoted provincial man. A well-read world traveler, Bryan had read On the Origin of Species in 1905 and had engaged in an ongoing debate about the book with eugenicist Henry Fairfield Osborn, the president of the American Museum of Natural History. The Great Commoner treated his talented wife as a partner and decried the sin of religious prejudice. He roundly criticized his supporters who attributed his 1908 defeat at the hands of William Howard Taft to a Catholic conspiracy, and he would later take Henry Ford publicly to task for publishing The Protocols of the Elders of Zion.

Regardless of what happened in Dayton, the effect of the case was clear: European-like divisions, largely absent thus far in America, opened up between science and revealed religion – it was a chasm never to be closed. Absent the Scopes controversy, some of the fundamentalists might have drifted into the position already adopted by a few of their leaders that evolution was but another name for God's creation.

After Scopes, and the case's revival with Inherit the Wind, fundamentalists were seen by many Americans as not just wrong about evolution, which was clear enough, but so psychologically deranged that they needed to be barred from the public square.

The irony of the Scopes trial, notes historian Michael Kazin, was that it led liberals to tag Bryan, who in many ways was a proto-New Dealer, as a “right-wing authoritarian.” At the same time, it helped position Mencken – the rabidly anti-democratic and sometimes anti-Semitic supporter of eugenics who admired both the Kaiser and 1930s Germany – as “the champion of liberalism.” But this is less of an irony than it appears to Kazin. Modern liberalism, before, during, and since the New Deal, has been based in large measure on Croly's “exceptional fellow countrymen,” the professionals who feel contempt or pity for the unwashed and who are resentful that many business people are better off than they are. Bryan's humiliation became a central event in the liberal story of modern America; it linked together the post-WWI persecutions by rednecks, the execution of Saco and Vanzetti, and Sinclair Lewis's ever-popular It Can't Happen Here, the 1935 novel in which a Bryan-like leader established a dictatorship in America. It's a story whose echoes can still be heard during dinner-table conversations in America's hipper precincts.

I repeatedly hear about "the narrative" from my progressive friends.  My question is, "do you care how much in your story is fiction and how much is non-fiction?"  Even more than what is written in a history book, movies, plays and novels shape the culture.  As Breitbart observed and Lawrence Meyers explains, politics is downstream from culture.

Saturday, November 08, 2014

The new Birchers

Over the last few months on several occasions I have thought about a quote or misquote commonly attributed to Eric Hoffer:

Up to now, America has not been a good milieu for the rise of a mass movement. What starts out here as a mass movement ends up as a racket, a cult, or a corporation.
  • Frequently misquoted as "Every great cause begins as a movement, becomes a business, and eventually degenerates into a racket."
For example: the civil rights movement, feminism and environmentalism all seem to have degenerated from what were once valid approaches to noble goals.

Ed Driscoll has his own take on the matter:

The modern left is built around a trio of laudable principles: protecting the environment is good, racism is bad, and so is demonizing a person over his or her sexual preferences. (In the chapter of his book Intellectuals titled “The Flight from Reason,” Paul Johnson wrote that “At the end of the Second World War, there was a significant change in the predominant aim of secular intellectuals, a shift of emphasis from utopianism to hedonism.” ) But just as the Bircher right began to see communists everywhere, the new Bircher left sees racism, sexism, homophobia, and Koch Brothers everywhere.

They’re lurking around more corners than Gen. Ripper imagined there were commies lurking inside Burpelson Air Force Base. They’re inside your video games! They own NFL teams! They’ll steal your condoms! Disagree with President Obama? Racist! (That goes for you too, Bill, Hillary, and your Democratic supporters.) Not onboard for gender-neutral bathrooms? Not too thrilled with abortion-obsessed candidates like Wendy Davis and “Mark Uterus”? Sexist! Disagree with using global warming as a cudgel to usher in the brave new world of bankrupt coal companies and $10 a gallon gasoline? Climate denier!

And as with the original Birchers, don’t get ‘em started on fluoride.
The original Birchers weren’t bad people, but their Cold War paranoia got the better of them. Similarly, as Charles Krauthammer famously said, “To understand the workings of American politics, you have to understand this fundamental law: Conservatives think liberals are stupid. Liberals think conservatives are evil,” which illustrates how a John Birch-style worldview can cause the modern leftists to take an equally cracked view of his fellow countrymen, to the point of writing off entire states and genders:


The John Birch left? I think it’s a phrase whose time has come...

Seems pretty apt.

Friday, November 07, 2014

Congrats to Republicans, I Guess

The Republicans emerged victorious in the midterm elections, meeting or exceeding expectations at pretty much all levels of government where there was a contest.  The map below depicts the outcome for the House of Representatives.

So, with all my criticisms of Obama and the Democrats, am I thrilled? No, not at all.  My observations of politics is that a Democrat controlled government does a miserable job and is voted out and replaced by Republicans who do a horrendous job who are then voted out and replaced by Democrats and the cycle begins again and repeats over and over.  So now we've just entered a different part of the vicious cycle. Not much reason for hope, with me leaning more towards nope.

It is striking to me, though, just how much land area is controlled by Republicans.  Except for tiny slivers of densely populated areas and a couple rare exceptions, the vast majority of the country by area is Republican dominated. The Democrats call it "fly-over country," but really, it's the country.

I have become more convinced over time that the type of government(s) needed for highly populated areas is simply different from the type of government(s) needed for less densely populated areas.  So it's not that there's something the matter with Kansas, but simply it has different cultural and political needs than New York City because of the variance in population density.  Once again, that points to federalism being potentially beneficial, enabling each area to build its political structure according to its needs.