Some ideas to guide your thoughts on health care

This post is meant to help my non-economist friends think more clearly about how we pay for health care. I’ll talk about markets, but the truth is that the American system is built of deeply bastardized markets. If our car markets worked like our health markets, most of us would walk to work. I’m trying to focus on the essential logic of the situation which is going to sound Utopian because Congress isn’t going to give us any sort of logical policy any time soon. But we aren’t going to get a logical solution until we as voters understand the logic of health care finance.

I’ve got a few big points to make:

  1. Trying to health insurance also work like charity is bound to end poorly for everyone.
  2. A single-payer system has a lot of nice features for individuals, but a lot of systemic problems.
  3. It’s fundamentally impossible to insure pre-existing conditions. Insurance is about sharing risk, not unavoidable expenses.

(This post is longer than I’d like, so thanks for your patience!)

Markets and Charity

I’ve said it before, and I’ll say it again: we don’t have to ruin markets to do charity.

The essence of markets is that they aggregate knowledge about the relative costs and benefits of different goods based on the preferences of the real people involved in producing and consuming those goods.

The demand side of markets provide information by giving you (as a consumer) a choice between more of something you like and more money to spend on other stuff. On the supply side they give you (as a supplier–probably of your own labor) the choice between providing more of what people are willing to pay for or having less money to buy the stuff you want. Markets crowdsource cost-benefit analysis.

Prices also give suppliers an incentive to produce things that consumers want while trying to save resources (i.e. cut costs). In other words, a price is a signal wrapped up in an incentive.

So what about fairness? The bad news is that markets are a system of “from each according to their ability, to each according to how much other people are willing to pay for the product of their ability.” (Not very catchy!) It’s mostly fair for most of us, but doesn’t do much good for people who are just unlucky (e.g. kids born with genetic defects). Here’s the good news: we can use charity alongside markets.

We can debate how much role government should play in charity some other time. For now, let’s whole-ass one thing instead of half-assing two things. We have to appreciate that interfering with markets interferes with the ability of those markets to function as sources of reliable information. It doesn’t matter how good our intentions are, we face a trade off here… unless we do something to establish a functioning charity system parallel to the health care finance system.

Single Payer

Anecdotes about the merits of a single-payer health care system are powerful because they shed light on the biggest benefit to such a system: individual convenience.

Part of the appeal has to do with the general screwiness of the American system. It’s a cathedral built of band-aids. But even in an idealized market system, a single-payer system has the advantage of not making me go through the work of evaluating which plan best suits my needs.

A single-payer system is, from an individual perspective, about as ideal as having your parents pay for it. But we don’t really  want our parents buying our stuff for us.

Single payer system sacrifice the informational value of markets (probably even more so than America’s current system of quasi-price controls). Innovation would be harder as long as new treatments had to be approved by risk-averse bureaucrats (and again, we already face a version of this with Medicare billing codes and insurance companies).

Essentially, a single payer system creates a common pool problem: each of us gets the individual benefit of being able to be lazy. But then we’re left trusting bureaucrats, special interest groups, and think tanks to keep an eye on things. It could be an improvement over the current American system, but that’s like saying amputation is better than gangrene.

Insurance

Premium = expected cost + overhead

Consider two alternatives. In scenario A you start with $150, flip a coin, and if it comes up tails you lose $100. In scenario B you get $90. The expected value of A is $100, but most of us would still prefer the sure thing.

Here’s how insurance works: You start with $150, give $60 to the insurance company, then flip the coin. If it comes up tails, you lose $100, but the insurance company gives you back $40. You’ve just gotten the sure thing. And by taking on thousands of these bets the insurance company is able to make enough money to pay their employees.

But here’s the thing: the premium they charge is fundamentally tied to that expected value. Change the odds, or the costs (i.e. the claims they have to pay for) and you’ll change the premium.

(BTW, Tim Harford did a nice ~8 minute podcast episode on insurance that’s worth checking out.)

Pre-existing conditions are the equivalent of changing our thought experiment to a 100% chance of flipping tails. No amount of risk sharing that will get you to the $90 outcome you want. You can’t insure your car after you’ve been in an accident and you can’t insure a person against a loss they’ve already realized. If you’re Bill Gates, that’s no big deal, but for many people, this might mean depending on charity. That’s a bummer, but wishful thinking can’t undo that.

If we insist that insurance companies cover pre-existing conditions* the result can only be higher premiums. This is nice for people with these pre-existing conditions, but not so great for (currently) healthy poor people. Again, charity matters needs to be part of the debate, but it needs to be parallel to insurance markets.

Covering more contingencies also affects premiums. The more things a policy covers, the higher the expected cost, and therefore the higher the premium. We each have to decide what things are worth insuring and what risks we’re willing to face ourselves. Politics might not be the best way to navigate those choices.

High deductibles and catastrophic care

Actuaries think about the cost of insuring as a marginal cost. In other words, they know that the odds that you spend $100 in a year are much higher than the odds that you spend $1000. So the cost of insuring the first dollar of coverage is much higher than the cost of insuring the 5000th dollar. This is why high deductible plans are so much cheaper… they only pay out in the unlikely situation where something catastrophically bad happens to you. This is exactly why most of us want insurance. We aren’t afraid of the cost of band-aids and aspirin, we’re afraid of the cost of cancer treatment.

For those of us firmly in the middle class, what we really need is a high-deductible plan plus some money in the bank to cover routine care and smaller emergencies. (Personally, my version of this is a credit card.) Such a plan has the added benefit of encouraging us to be more cost conscious.

A big problem with our current system is that it’s set up like an all-you-can-eat buffet. You pay to get in (your premiums) but once you’re in the hospital, any expenses are the insurance company’s problem (read: everyone else on your health plan). The logic here is the same as with pollution. When I drive my car I get the benefits of a quick and comfortable commute but I also suffer a little bit more pollution. But I don’t have incentive to think about how that pollution affects you so I pollute more than would be ideal. Multiply that by millions of people and we can end up with smog.

tl;dr

If I were trying to put together a politically palatable alternative to our current system, I’d have an individual mandate with insurance vouchers for the poor (it’s not very libertarian, and it’s far from my Utopian ideal, but I think it would be a huge improvement over what we’ve got now). I would also expand the role of market competition by encouraging high deductibles plus flexible health savings accounts.

Reality is complicated, but I’m trying to get at the fundamental logic here. We don’t have a properly functioning market system. To get there we need competition, transparency, and a populace with the mental tools and mathematical literacy necessary to understand what their insurance can and can’t do. That’s a tall order, but it doesn’t mean we shouldn’t keep trying to move in that direction.

To have a fruitful debate we need to understand what we want from our healthcare system: help for the poor (charity), convenience, and efficiency from an individual and social perspective. By trying to lump all these things together we muddy the waters and make it harder to understand one another.


*I don’t know what the deal is with the idea that the AHCA will treat rape as a pre-existing condition. Some webpages give a bunch of random tweets as evidence of this, and others call bullshit. Let’s just leave it at this: in a competitive market this would be considered terrible marketing and savvy companies wouldn’t do it. The lesson then is to keep calling companies on bad marketing, and avoid protecting politically powerful companies from market competition.

Laws regulating cannabis are laws regulating the body

In honor of 4/20, here is a paper I published a couple years ago in my school paper on the science of marijuana consumption. And here’s a few interesting facts about the drug:

  • sea squirts were the first organisms to develop cannabinoid receptors
  • when Tupac Shakur was cremated, members of his musical group Outlawz combined his ashes with marijuana and smoked him
  • the first ever sale on the internet was a small bag of marijuana
  • Carl Sagan, writing under a pseudonym, once wrote an article outlining what he saw as the beneficial effects of smoking it

Combing through the history of drug criminalization in America, it is clear that much of the law arose in response to national or state crises. It’s very obviously too simplistic to say, these drugs became illegal because they are dangerous; it’s also disingenuous to claim criminalization occurs simply to oppress or discriminate against certain groups of people (although, certainly, racism played a role in several criminalization campaigns, definitely including marijuana’s). The attitude has changed toward recreational weed: people think it should be legal because it’s safe and has legitimate medical benefits (instantly making its Schedule I status ridiculous). These things are true, but when progressives rest their drug legalization case on these mild criteria they weaken the case for more dramatic legislation which could produce effects far more progressive. Marijuana should be legal because laws which regulate it are laws which regulate the human body, in ways that only effect the user. The case for legalization is a case for freedom and autonomy, and from it follows the lifting of prohibitions on ketamine, opioids, barbiturates, benzodiazepines, methamphetamine, heroin, lysergic acid diethylamide, psilocybin, ecstasy,cocaine, etc. The economic argument for drug decriminalization is clear; the legal argument (like the iron law of prohibition) is clear; the moral argument is deontological and follows from much of the spirit of new political voices that wonder about government’s role in regulating the body.

The argument, often given by marijuana consumers, that it should be illegal because, were it to become legal, small businesses would get wiped out by larger conglomerates, and lower quality weed would get produced, is partially false and wholly single-minded. Most of the people that get jail time for weed are busted only for possession, not distribution; some people have been charged with life imprisonment for minor acts of growing — some of them retired veterans dealing with mental health issues. Focusing on how potent the weed would be if decriminalized is focusing only on how we, free individuals, will make out; it leaves these people in prison for a minor bump in hedonism. Further, cannabis’ potency has soared over the years since its initial popularity (in truth, a consequence of prohibition). It’s unlikely that it would start to de-escalate, as demand is so high. And weed is available in a multitude of forms now: the experimentation could only grow with laxer drug laws. Also, small businesses are often the ones hardest hit by regulation of products. The massive cartels will suffer most by drying up the black market, and then individuals who want relatively harmless drugs like marijuana can avoid entering a seedy underground (where they are exposed to far worse ails) to obtain it.

Prohibitionists also claim to be concerned about the children: with weed legal, won’t younger people start doing it? Again, the case for drug legalization is a case for autonomy, so this argument is misguided anyway, but to answer it — the best research from Colorado after recreational legalization (see Reason) suggests no statistically significant fluctuation in youth use. Marijuana is already immensely popular with young people; it can’t get much more in-fashion. Also, the recreational measures being introduced propose 21 as a purchase age: if kids are obtaining the drug from their neighborhood dealer now, the new laws would only direct them to buying from older, and probably more responsible people.

Most of the arguments point to decriminalizing weed, and not just because it’s safe and has medical benefits. These arguments also justify the extension of similar opinion to “hard drugs.”

For a more just criminal justice system, and a more free society … legalize it.

Happy 4/20. (And no, by the way, I don’t smoke.)

Would regulation stop the mistakes of rating agencies that contributed to the 2008 crisis?

I remember watching The Big Short and feeling great indignation at the S&P employee who told Steve Carell that rating agencies were pressured into issuing unreasonably high ratings because they were beholden to their customers. If true, this represented an unbelievable moral hazard, which is often cited as the reason for the failures of the ratings agencies–and as a reason for regulating these agencies.

However, more in-depth research and consideration reveals that this answer is incomplete and, in many ways, incorrect. Claire Hill, a law professor at the University of Minnesota Law School and director of the Institute for Law and Rationality, clearly and convincingly critiques this simplistic explanation by recognizing market influences and proposing alternate causes, which also means that if we are looking to avoid a future crisis, we need to look to alternative solutions to the regulatory measures that we currently employ. I don’t think it could be said better than she does in her abstract:

Why did rating agencies do such a bad job rating subprime securities? The conventional answer draws heavily on the fact that ratings are paid for by the issuers: Issuers could, and do, “buy” high ratings from willing sellers, the rating agencies.

The conventional answer cannot be wholly correct or even nearly so. Issuers also pay rating agencies to rate their corporate bond issues, yet very few corporate bond issues are rated AAA. If the rating agencies were selling high ratings, why weren’t high ratings sold for corporate bonds? Moreover, for some types of subprime securities, a particular rating agency’s rating was considered necessary. Where a Standard & Poor’s rating was deemed necessary by the market, why would Standard & Poor’s risk its reputation by giving a rating higher (indeed, much higher) than it knew was warranted?

Finally, and perhaps most importantly, giving AAA ratings to securities of much lower quality is something that can’t be done for long. A rating agency that becomes known for selling its high ratings will soon find that nobody will be paying anything for its ratings, high or low.

In my view, that issuers pay for ratings may have been necessary for the rating agencies to have done as bad a job as they did rating subprime securities, but it was not sufficient. Many other factors contributed, including, importantly, that rating agencies “drank the Kool-Aid.” They convinced themselves that the transaction structures could do what they were touted as being able to do: with only a thin cushion of support, produce a great quantity of high-quality securities. Rating agencies could take comfort, too, or so they thought, in the past – the successful, albeit short, recent history of subprime securitizations, and the longer history of successful mortgage securitizations.

“Issuer pays” did not so much make the rating agencies give higher ratings than they thought were warranted as it gave the agencies a “can do” mindset regarding the task at hand – to achieve the rating the issuers desired, working with them to modify the deal structures as needed. That the issuers were paying motivated the agencies to drink the Kool-Aid; having drunk the Kool-Aid, the agencies gave the ratings they did. My account casts doubt on the efficacy of many of the solutions presently being proposed and suggests some features that more efficacious solutions should have.

I very much recommend reading the full article, which gives more nuance and information about the weaknesses of proposed solutions for rating agency mistakes or malfeasance. This should also be food for thought concerning the general perspective we should have in examining “market failures,” as there are often market feedback systems that mitigate problems, and turning to regulation by reflex can cause unintended harm or even miss the mark entirely.


Reference: Hill, Claire. “Why Did Rating Agencies Do Such a Bad Job Rating Subprime Securities?” University of Pittsburgh Law Review (2010): 10-18. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1582539.

Where is the line between sympathy and paternalism?

In higher-ed news two types of terrifying stories come up pretty frequently: free speech stories, and Title IX stories. You’d think these stories would only be relevant to academics and students, but they’re not. These issues are certainly very important for those of us who hang out in ivory towers. But those towers shape the debate–and unquestioned assumptions–that determine real world policy in board rooms and capitols. This is especially true in a world where a bachelor’s degree is the new GED.

The free speech stories have gotten boring because they all take the following form: group A doesn’t want to let group B talk about opinion b so they act like a bunch of jackasses. Usually this takes place at a school for rich kids. Usually those kids are majoring in something that will give them no marketable skills.

The Title IX stories are Kafkaesque tales where a well-intentioned policy (create a system to protect people in colleges from sexism and sexual aggression) turns into a kangaroo court that allows terrible people to ruin other people’s lives. (I hasten to add, I’m sure Title IX offices do plenty of legitimately great work.)

A great article in the Chronicle gives an inside look at one of these tribunals. For the most part it’s chilling. Peter Ludlow had been accused of sexual assault, but the claims weren’t terribly credible. As far as I can tell (based only on this article) he did some things that should raise some eyebrows, but nothing genuinely against any rules. Nonetheless, the accusations were a potential PR and liability problem for the school so he had to go, regardless of justice.

The glimmer of hope comes with the testimony of Jessica Wilson. She managed to shake them out of their foregone conclusion and got them to consider that women above the age of consent can be active participants in their own lives instead of victims waiting to happen. Yes, bad things happen to women, but that’s not enough to jump to the conclusion that all women are victims and all men are aggressors.

The big question at the root of these types of stories is how much responsibility we ought to take for our lives.

Free speech: Should I be held responsible for saying insensitive (or unpatriotic) things? Who would enforce that obligations? Should I be held responsible for dealing with the insensitive things other people might say? Or should I even be allowed to hear what other people might say because I can’t take responsibility for evaluating it “critically” and coming to the right conclusion.

Title IX: Should women be responsible for their own protection, or is that akin to blaming the victim? We’ve gone from trying to create an environment where everyone can contribute to taking away agency. In doing so we’ve also created a powerful mechanism that can be abused. This is bad because of the harm it does to the falsely accused, but it also has the potential to delegitimize the claims of genuine victims and fractures society. But our forebears weren’t exactly saints when it came to treating each other justly.

Where is the line between helping a group and infantilizing them?

At either end of a spectrum I imagine caricature versions of a teenage libertarian (“your problems are your own, suck it up while I shout dumb things at you”) and a social justice warrior (“it’s everyone else’s fault! Let’s occupy!”). Let’s call those end points Atomistic Responsibility and Social Responsibility. More sarcastically, we could call them Robot and Common Pool Responsibility. Nobody is actually at these extreme ends (I hope), but some people get close.

Either one seems ridiculous to anyone who doesn’t already subscribe to that view, but both have a kernel of truth. Fair or not, you have to take responsibility for your life. But we’re all indelibly shaped by our environment.

Schools have historically adopted a policy towards the atomistic end, but have been trending in the other direction. I don’t think this is universally bad, but I think those values cannot properly coexist within a single organization.

We can imagine some hypothetical proper point on the Responsibility Spectrum, but without a way to objectively measure virtue, the position of that point–the line between sympathy and paternalism–its location is an open question. We need debate to better position and re-position that line. I would argue that Western societies have been doing a pretty good job of moving that line in the right direction over the last 100 years (although I disagree with many of the ways our predecessors have chosen to enforce that line).

But here’s the thing: we can’t move in the right direction without getting real-time feedback from our environments. Without variation in the data, we can’t draw any conclusions. What we need more than a proper split of responsibility, is a range of possibilities being constantly tinkered with and explored.

We need a diversity of approaches. This is why freedom of speech and freedom of association are so essential. In order to get this diversity, we need federalism and polycentricity–stop trying to impose order from the top down on a grand scale (“think globally, act locally“), and let order be created from the bottom up. Let our organizations–businesses, churches, civic associations, local governments and special districts–adapt to their circumstances and the wishes of their stakeholders.

Benefiting from this diversity requires open minds and epistemic humility. We stand on the shore of a vast mysterious ocean. We’ve waded a short distance into the water and learned a lot, but there’s infinitely more to learn!

(Sidenote: Looking for that Carl Sagan quote I came across this gem:

People are not stupid. They believe things for reasons. The last way for skeptics to get the attention of bright, curious, intelligent people is to belittle or condescend or to show arrogance toward their beliefs.

That about sums up my approach to discussing these sorts of issues. We’d all do better to occasionally give our opponents the benefit of the doubt and see what we can learn from them. Being a purist is a great way to structure your thought, but empathy for our opponents is how we make our theories strong.

Does business success make a good statesmen?

Gary Becker made the distinction between two types of on-the-job training: general and specific. The former consist of the skills of wide applicability, which enable the worker to perform satisfactorily different kinds of jobs: to keep one’s commitments, to arrive on time to work, to avoid disturbing behavior, etc.. All of them are moral traits that raise the productivity of the worker whichever his occupation would be. On the other hand, specific on-the-job training only concerns the peculiarities of a given job: to know how many spoons of sugar your boss likes for his coffee or which of your employees is better qualified to deal with the public. The knowledge provided by the on-the-job training is incorporated to the worker, it travels with him when he moves from one company to another. Therefore, while the general on-the-job training increases the worker productivity in every other job he gets, he makes a poor profit from the specific one.

Of course, it is relative to each profession and industry whether the on-the-job training is general or specific. For example, a psychiatrist who works for a general hospital gets specific training about the concrete dynamics of its internal organization. If he later moves to a position in another hospital, his experience dealing with the internal politics of such institutions will count as general on-the-job training. If he then goes freelance instead, that experience will be of little use for his career. Nevertheless, even though the said psychiatrist switches from working for a big general hospital to working on his own, he will carry with him a valuable general on-the-job training: how to look after his patients, how to deal with their relatives, etc.

So, to what extent will on-the-job training gained by a successful businessman enable him to be a good statesman? In the same degree that a successful lawyer, a successful sportsman, a successful writer is enabled to be one. Every successful person carries with him a set of personal traits that are very useful in almost every field of human experience: self confidence, work ethics, constancy, and so on. If you lack any of them, you could hardly be a good politician, so as you rarely could achieve anything in any other field. But these qualities are the typical examples of general on-the-job training and what we are inquiring here is whether the specific on-the-job training of a successful businessman could enable him with a relative advantage to be a better politician -or at least have a better chance of being a good one.

The problem is that there is no such a thing as an a priori successful businessman. We can state that a doctor, an engineer, or a biologist need to have certain qualifications to be a competent professional. But the performance of a businessman depends on a multiplicity of variables that prevents us from elucidating which traits would lead him to success.

Medicine, physics, and biology deal with “simple phenomena”. The limits to the knowledge of such disciplines are relative to the development of the investigations in such fields (see F. A. Hayek, “The Theory of Complex Phenomena”). The more those professionals study, the more they work, the better trained they will be.

On the other hand, the law and the market economy are cases of “complex phenomena” (see F. A. Hayek, Law, Legislation and Liberty). Since the limits to the knowledge of such phenomena are absolute, a discovery process of trial and error applied to concrete cases is the only way to weather such uncertainty. The judge states the solution the law provides to a concrete controversy, but the lawmaker is enabled to state what the law says only in general and abstract terms. In the same sense, the personal strategy of a businessman is successful only under certain circumstances.

So, how does the market economy survive to its own complexity? The market does not need wise businessmen, but lots of purposeful ones, eager to thrive following their stubborn vision of the business. Most of them will be wrong about their perception of the market and subsequently will fail. A few others will prosper, since their plans meet -perhaps by chance- the changing demands of the market. Thus, the personal traits that led a successful businessman to prosperity were not universal, but the right ones for the specific time he carried out his plans.

Having said that, would a purposeful and stubborn politician a good choice for government? After all, Niccolo Macchiavelli had pointed out that initiative was the main virtue of the prince. Then, a good statesman would be the one who handles successfully the changing opportunities of life and politics. Notwithstanding, The Prince was -as Quentin Skinner showed- a parody: opportunistic behaviour is no good to the accomplishment of public duties and the protection of civil liberties.

Nevertheless, there is still a convincing argument for the businessman as a prospect of statesman. If he has to deal with the system of checks and balances -the Congress and the Courts-, the law will act as the selection process of the market. Every time a decision based on expediency collides with fundamental liberties, the latter must withstand the former. A sort of natural selection of political decisions.

Quite obvious, but not so trite. For a stubborn and purposeful politician not to become a menace to individual and public liberties, his initiative must not venture into constitutional design. No bypasses, no exceptions, not even reforms to the legal restraints to the public authority must be allowed, even in the name of emergency. Especially for most of the emergencies often brought about by measures based on expediency.

Coup and Counter Coup VI: Presidential Authoritarianism in Turkey

(Previous posts here, here, here, here and here). The state of emergency proclaimed by President Erdoğan in Turkey on 20th July last year, in response to the coup attempt of five days before, is not a situation that will come to an end in a return to normality. It is the model for the presidential system that Erdoğan has been pushing for since 2007, when he was still admired by many liberal minded people inside Turkey (though not me) and abroad. One of the key provisions of the state of emergency is that the President can issue decrees with the force of law. There are doubts about the constitutionality of this form of ‘law making’ but two members of the Constitutional Court were arrested after the coup attempt and the chances of the court starting up to executive power are now extremely remote. Judges and prosecutors have been demoted and even arrested after making the ‘wrong’ decision during the state of emergency and I do not think Erdoğan and his associates would have any scruples at all about further arrests of judges in the Constitutional Court.

The Presidential system, or one person rule system, which Turks will vote on, will retain the decrees as law powers of the Presidency. There are some limits on the decrees issued, but as the President will control the appointment of most of the senior judiciary there are serious questions about whether the Constitutional Court will put any effective break on these powers to legislate through decree. There is no sign of the state of emergency ending, though at least now everyone can see the deception in the original decision to declare a state of emergency for three months only instead of the six months maximum allowed in the Constitution. The state of emergency is renewed every three months with no debate and no indication of when it will come to an end. Does Erdoğan have any intention of ending the state of emergency before he becomes a President elected with the new powers? In principle these powers should only be implemented after the next presidential election in 2019, coinciding with elections to the National Assembly. Erdoğan may wish to bring these elections forward, particularly for the National Assembly if he loses the referendum. While it may seem outrageous for the Council of Ministers to keep prolonging the state of emergency until 2019, the AKP government has been doing more and more previously outrageous and even unimaginable things now for some years, particularly since the Gezi protests of 2013.

What the state of emergency also means is that suspects can be held without charge and access to lawyers if charged with ‘terrorism’, which is defined in absurdly broad ways to cover any kind of contact with the Gülenists or sympathy for the Kurdish autonomy movement. Torture has been making a return in Turkey after becoming relatively unusual since the PKK terror campaign began again in 2015. The state of emergency conditions have now normalised it completely and though the government denies torture charges, in the normal manner of authoritarian regimes, claiming the charges are terrorist propaganda, you have to wonder how seriously they expect anyone to take the denials. Photographs of the alleged coup plotters immediately after the coup attempt showed they had been badly beaten, though of course this is explained away as the result of ‘resisting arrest’, another time-honoured evasion. Consistent reports suggest prisoners are denied food, placed in stress positions for long periods of time, beaten and sexually assaulted. In the more moderate cases, the prison officials merely restrict prisoners to a diet of bread and bad quality tap water in conditions of psychological abuse. There is amongst everything else in Turkey a growing problem of mental and emotion health problems amongst the survivors of these ordeals, which are of course excluded from the mainstream media.

The rhetoric and abuse used by police ‘special teams’ invading the media and political offices of ‘terrorist’, that is Kurdish autonomy and other leftist groups, involve extreme nationalism and Ottomanism. Kurds are insulted as covert Armenians. Actual Armenians are told that the Ottomans destroyed the Armenians and that Turks are the masters of Armenian. A particularly disgusting reference to the massacre of 1 500 000 Armenians during World War One. These are not aberrations, this behaviour reflects the deep ideology of the AKP, mixing extreme nationalism and Ottomanism, of course ignoring the tensions between these positions. The torture and abuse is legitimated in the minds of perpetrators by a political rhetoric and government measures which present opponents as terrorist and part of international conspiracies against the ‘innocent’ Turks who are so good they are naive. This I am afraid is no exaggeration of the political discourse of the moment.

There is no reason to think the abuse and political extremism will end, though of course we should hope it does. If all Gülenists – real and imagined – and all sympathisers with Kurdish autonomy or the far left are targeted, then there are essentially endless opportunities for authoritarianism, polarising dehumanising rhetoric and abuse. I can only presume the current atmosphere will last indefinitely, as Erdoğan has found it a successful strategy for staying in power and increasing his power.

It is of course not just a question of his own political power. There is the question of how his family occupy places of privilege in large Muslims NGOs (at the same time as non-AKP oriented NGOs come under increasing pressure) with huge budgets and sit on the boards of major companies in Turkey. Erdoğan does not envisage any situation in which these activities are placed under mainstream media examination, and even less legal investigation. The issue of legal immunity is a huge one in Turkish politics. The amended constitution would allow the President to appoint anyone to two vice presidential positions and to the cabinet. Like the President all these people would have lifetime immunity from prosecution for activities undertaken while in office. Though the National Assembly would have the power to send the President to the Constitutional Court, this requires a very high threshold, clearly designed to protect Erdoğan even if the AKP loses a large part of its support.

As mentioned above, there is an expectation that Erdoğan will call an early National Assembly election if he loses the referendum. It seems likely on current polling that two out of the three opposition parties currently in the National Assembly would fail to meet the electoral thresh hold of 10%. This means the National Action Party, which has split over the referendum, and the Kurdish radicals who have lost some of their more moderate support since the revival of PKK violence. In such a National Assembly, the AKP could certainly put any constitutional proposal to referendum and very possibly could have enough votes to amend the constitution without referendum. So even if Erdoğan loses the election, he could get the same measures, or close enough, through other means.

(Last post in the current series, though I will post an appendix on Ottomanist and Atatürkist legacies in Turkey, along with comments on related political thought.)

Coup and Counter Coup IV The Kurdish issue in Turkey

Previous parts here, here and here. As mentioned in the last post, in the immediate post coup atmosphere President Erdoğan appeared to have the support of some significant part of Kemalist (as in Kemal Atatürk who shaped the Turkish republic with reference to secularism, modernisation, national sovereignty and statism) opinion, the more hard core part, seeing shared enemies in both violent Kurdish separatists and Gülenist (members of a religious community, see previous posts) infiltrators into the state apparatus. The return of PKK (the Kurdish acronym for Workers’ Party of Kurdistan) violence against state forces and civilians (the latter largely undertaken by the Freedom Falcons of Kurdistan, TAK in the Kurdish acronym, a product of the PKK) in the summer of 2015 already placed the AKP, hardcore Kemalists, and the Nationalist Action Party (MHP, rooted in a ‘Grey Wolf’ or ‘Idealist’ ideology of absolutist state nationalism and Pan-Turkism) on the same side advocating a militant response including support for the army-led destruction of whole urban areas in PKK strongholds in the southeast. Previously the latter two groups had regarded the AKP as treasonous for holding talks with Abdullah Öcalan, the imprisoned founder-leader of the PKK, fearing a federalised Turkey with a southeast federal region under strong PKK influence. The talks were not at all public, no attempt was made to prepare public opinion for possible evolution in the Turkish state tradition, or to hold any kind of open discussion on the issues at stake.

The talks collapsed with Öcalan returned to strict prison conditions. Despite the MHP and hardcore Kemalist fears about federalisation on PKK terms, it seems likely that Erdoğan never intended more than token concessions to Kurdish identity and autonomy for the southeast, in exchange for operating for the PKK and a party with a common origin as an external support of the AKP. The party which has a common origin with the PKK is DBP (Turkish acronym for Democratic Regions Party) and the umbrella party it formed to accommodate small leftist groups (which don’t have specific Kurdish origins). It appears that the DBP hardcore does not like accommodating non-Kurds so the survival of HDP is not guaranteed. It poses a very happy image to leftist educated Turks, of interest in social liberalism, minority rights and left socialist policies. This reflects a historical feeling of marginalisation, because the CHP (Republican People’s Party: Kemalist/social democratic something like the French Socialist Party in merging Jacobin, social democratic and socialist traditions) is seen as too nationalist and not ‘really’ leftwing.

It tells you something about Turkish politics that there are people who insist that HDP is not leftwing despite its obvious leftwing policies and roots in the Maoist orientation of the PKK. This insistence is rooted in the belief that all left polices must be non-ethnic, that raising ethnic issues is inherently divisive and chauvinistic, reflecting of course a blindness to how some people experience the Turkish state as unaccommodating of, and even hostile to, expressions of identity by those people in Turkey who have a first language, and associated culture, other than Turkish. The Maoist and terrorist origins of the main expressions of Kurdish autonomy politics supports that majoritarian blindness and even chauvinism. Clearly they feed off each other.

The HDP has been turned into an effectively semi-legal party since the summer of 2015, which is not the right state reaction from the point of view of constitutional democracy and individual liberty. However, the HDP has to some degree brought this on itself, because while condemning the acts of terror directed from mountains in Iraq by the current PKK leader Cemil Bayık, it has never rejected the PKK as such, treating Öcalan as the symbolic leader of Kurds in Turkey, and adhering to a political rhetoric of ‘autonomy’ shared with the PKK.

The government has now used the state of emergency to take over the administration of all HDP led local government, that is local government throughout the southeast, appointing ‘trustees’ to run these municipalities. All media with an HDP orientation has been closed down and blocked online if based abroad.

Accusations have been made of the HDP using local government as infrastructure and a source of money for the PKK. This has yet to be proven in court. If it was, we would certainly have to consider the HDP to have taken a very bad path. As things stand, this has not been proven and the persecution of HDP politicians along with the takeover of HDP municipalities is highly premature, serving political power goals and grossly overriding any idea that guilt only exists if and when proven in court, preferably with judges under less political pressure than is the case at present in Turkey.