The Washington Post National Weekly - October 7, 2018

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5 Myths Capitalism 23

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OPINIONS

To moderate politics, we need stronger parties DAVID VON DREHLE is a Washington Post opinion columnist.

Given the extreme polarization in the Senate during the fi­ nal days of the Kavanaugh confirmation drama, one might conclude that political parties have never been stronger.

George Washington’s words in his farewell address strike a ringing chord in these bitter times. Warning against “the baneful effects of the spirit of party” (which, Washington admitted, “unfortunately, is inseparable from our nature”), the Father of his Country listed the bad effects of faction: It “serves always to distract the public councils and enfeeble the public administration. It agitates the community with ill founded jealousies and false alarms, kindles the animosity of one part against another, foments occasionally riot and insurrection.” It even “opens the door to foreign influence and corruption,” Washington added presciently — centuries before Paul Manafort laundered his first Ukrainian hryvnia.

Yet could it be that we need stronger political parties rather than weaker ones? Political scientist Joseph Postell makes the case in an intriguing essay written for the Heritage Foundation.

Today’s gridlocked Congress and imperial presidency are the sour fruits of party decline, writes Postell, an assistant professor at the Colorado Springs campus of the University of Colorado. “The history of political parties reveals that they are the critical mediating institutions that make the American Constitution function well.”

Postell contrasts Washington’s lament with James Madison’s gradual realization that the constitutional system of checks and balances he created can’t operate without strong parties.

Broad national coalitions force narrow factions and special-

interest groups to moderate their demands and learn to compromise. Madison figured out that he and his fellow architects of the American government had been so frightened of mob rule in a democracy that they built a machine that would not go — and thus, paradoxically, a machine too weak to resist the tyranny of whichever small faction got its hands on executive power. Large national parties “would take the bite out of factions by incorporating them into broader movements,” Postell writes of what he calls “the Madisonian cure for the Madisonian disease.”

Robust political parties “translate majority will into public policy by focusing elections on policies rather than personalities,” Postell maintains.

Today’s weakling parties, by contrast, are liable to be hijacked by celebrities, as any dismayed pre-Trump Republican conservative will attest. The president’s approach to alliances, trade and spending all fly in the face of traditional GOP values, but the party establishment was too weak in 2016 to enforce even a shred of discipline.

You won’t read about President Trump in Postell’s paper — but you will find a nuanced discussion of Trump’s favorite precursor, Andrew Jackson. Like the current

TIMOTHY A. CLARY/AGENCE FRANCE-PRESSE/GETTY IMAGES

A mirror image of a delegate on the first day of the 2016 Republican National Convention in Cleveland on July 18, 2016.

president, Jackson was a huge personality with a direct connection to his populist supporters. The flamboyant general rose to power in an era of weak parties and bitter divisions.

Enter Martin Van Buren, the hero of Postell’s paper. As a U.S. senator from New York, Van Buren eyed Jackson with alarm.

“If Jackson were to win based on his personality, he would have considerable personal power once he attained office,” Postell writes. But if the maverick could be lassoed into Van Buren’s Democratic Party as its presidential nominee, “he would have to accommodate the different views of people within the party once in office.”

After Van Buren, the nation entered an 80-year period in which — with the notable exception of the Lincoln administration — presidents were weak, Congress was strong and the American political parties were at their zenith.

Generations of Americans have been taught to revile the corrupt political machines that ruled the land from San Francisco to New York. But Postell reminds us of the good that was accomplished in the smoke-filled rooms: The bosses were pragmatic, and they knew how to make a deal. They knew how to get things done.

Strong parties “moderate politics by encouraging elected

officials to bargain and compromise instead of engaging in endless conflict,” Postell maintains. “They reinforce the separation of powers by strengthening the legislative branch and checking the accumulation of power in the executive.”

Left unanswered, though, is the looming question: Having hollowed out the parties, how would we start to rebuild them?

If anything, the trend today is toward weaker parties, not stronger ones. As Trump demonstrated in 2016, the power of social media allows candidates to connect directly with voters — especially famous candidates with big personalities. The Republican Party establishment was no match for a candidate with a direct line to the voters; GOP leaders have had no choice but to hop aboard the personality bus or be flattened beneath its wheels.

“Great parties make American politics more accountable by letting the people decide between competing visions of good government rather than individual candidates and their personalities,” Postell concludes.

There’s something attractive in these crazy times about the idea of more vision and less personality. But as the song says: You don’t know what you’ve got till it’s gone. n

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POLITICS

e would be, in the words of his prep school’s motto, a man for others. At an age when most young people struggle to figure out their path forward, he knew he would devote his life to public service.

Brett M. Kavanaugh was destined for something big.

The people around him knew it, too. Through the years, Kavanaugh, 53, a federal appellate judge since 2006, has been rich in friends, loyal and true. Teachers, parents, classmates, colleagues — they made it their business to buff and defend Kavanaugh’s reputation. They cheered him on as he climbed the ladder of legal success. And they rallied around him when he tripped on the way up.

That turned out to be a job that extended over four decades because as bright and kind and wise as friends say Kavanaugh is, he has also left behind a trail of people who say that his reckless behavior raises serious questions about his judgment and veracity.

The story of President Trump’s embattled choice for the Supreme Court is a classic Washington tale of a young man who grew up surrounded by people in high places, keenly aware of protecting his image. He told a friend in college that he didn’t plan to buy stocks as an adult because he had to avoid conflicts if he wanted to follow in his mother’s footsteps as a judge.

Kavanaugh’s story is also one of the power and insularity of wealth. He grew up in an idyll of country clubs and beach retreats, private schools and public prominence. The only child of a lobbyist and a judge, he had parents who pushed him hard, teachers who assured him that he faced no limits, and friends whose families knew the art of making problems go away quietly.

That Kavanaugh would achieve greatness seemed certain. Some of his classmates called him “The Genius.” They liked him because he was smart and fun. Women found him thoughtful and empathetic.

Men said he was a guy’s guy — a walking encyclopedia of sports, a good pal, always up for a beer.

But again and again as he rose to the pinnacle of official Washington, Kavanaugh has given those charged with examining his life and character reason to pause and dig deeper.

The rise and the reckoning Inside Brett Kavanaugh’s circles of influence BY

M ARC F ISHER, A NN E . M ARIMOW AND M ICHAEL K RANISH

COURTESY OF MARTHA KAVANAUGH

As he faced a Senate vote that would determine whether he will spend the rest of his working life at the apex of American democracy or in permanent disgrace, he was up against devastating allegations that he was a nasty, belligerent drinker who, according to his chief accuser, Christine Blasey Ford, pinned her to a bed and held his hand over her mouth when she tried to stop his sexual assault when they were in high school.

Once again, schoolmates, friends, family members and coworkers rushed to his defense.

“After law school, Brett started on a path of high-profile jobs, and we were rooting for him all along,” said Tom Kane, a Georgetown Prep classmate and friend. “Between 1998 and 2004, I lost my father, my mother and my sister, and he was always there for me.

He has a fricking conscience and a soul unlike what people say.”

This story about Kavanaugh’s rise — and how his upbringing at the pinnacle of Washington’s political and social elite has helped protect him from his missteps — is based on dozens of interviews with friends, classmates, co-workers and mentors, including some who think he has been grievously wronged in the confirmation process and others who think he is unfit to serve.

When the American Bar Association first considered Kavanaugh’s nomination to a judgeship, the committee assigned to check him out ended up talking to more than twice as many lawyers and judges as many investigations required.

Some of those who spoke to the ABA in 2006 raised concerns about Kavanaugh’s lack of experience. Some warned about his temperament. He was “dissembled,” one lawyer said. He was

Brett Kavanaugh, bottom right, is pictured in 1992 on his first trip with a group of friends who lived together while attending Yale Law School. The group has gone away together every year since.

described as “insulated,” “immovable,” “very stubborn and frustrating to deal with.”

Kavanaugh pushed back, bolstered by his tight network. Supporters were always offering his name when sterling positions opened up, singing his praises to those making decisions about clerkships, law firm jobs, White House appointments and judgeships.

When it came time for Kavanaugh to marry, it was the president of the United States who encouraged him to do so. Kavanaugh, like fellow Yale alumnus George W. Bush, settled down with a strong woman from a modest West Texas background.

Bush, who held a sit-down dinner for the couple in the Rose Garden, called their marriage “the first lifetime appointment I arranged for Brett.”

Fourteen years later, Bush would get on the phone to rally senators to try to save Kavanaugh’s troubled nomination.

Now, as Kavanaugh’s suitability to serve on the nation’s highest court was being considered by the Senate, the judge faced the most severe test of what looks to outsiders like a charmed life.

This moment — an excruciating mix of careful inquiry into his legal opinions and voracious inspection of his adolescent behavior, all taking place amid a searing national struggle involving truth, trust, political polarization and sexual mores — has left Kavanaugh’s community deeply, perhaps irrevocably, divided.

Some have fixed on hazy but painful recollections of ugly nights in the 1980s — a bar fight, groping attempts to get somewhere with women, perhaps worse. Others slot those same stories into memories of a debauched but too-common scene of cloistered young men learning how far was too far, even as they prepared to run the world.

No one who hung out with Kavanaugh during Beach Week on the Delaware shore or at Demery’s bar in New Haven, Conn., knew their partying would become the stuff of congressional debates and national polls, or that the president would conclude that their friend “did have difficulty as a young man with drink.”

Any definitive version of what happened between Kavanaugh and Ford 36 years ago seems lost to history.

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POLITICS More than most people, by virtue of where and how he grew up, Kavanaugh knew he would someday be called to account for himself. He did not, however, expect to be asked to answer for the ways and mores of the place and time that shaped him, as he has described the most recent inquiry to friends. Yet here he was, in a humiliatingly intimate and public job interview that has turned into a historic reckoning, for Kavanaugh and for his country.

‘We had something to prove’ There are many automatic advantages that come from attending the 229-year-old Georgetown Preparatory School in North Bethesda, Md. There is the intimacy of small classes and the lesson drummed in by Jesuits at the Catholic school that the boys are expected to excel and to serve. There is the continuing pride in single-sex education, the unfashionable idea that wisdom and power are unlocked by channeling adolescent energy into studies.

The boys, in the 1980s perhaps even more than in decades before and after, believed that their hard work bought them enough slack that they could get away with hard partying.

“We did everything to the max,” said one of Kavanaugh’s classmates, who, like many of his peers, spoke on the condition of anonymity because, as he put it, “Brett doesn’t want us putting ourselves out there right now.”

Many of the boys at Prep came from families accustomed to gaining and holding influence. Kavanaugh’s father, Edward Kavanaugh, was president of what was then the Cosmetic, Toiletry and Fragrance Association, the kind of Washington job in which building connections to powerful people justified the $4.57 million in compensation he earned in 2005, according to tax returns.

His mother, Martha Kavanaugh, was a prosecutor who became a circuit judge in Montgomery County.

Perhaps the greatest privilege the boys gained at Prep was one another. Some graduates came to view the school as a troubled, morally questionable symbol of a snobby elite; others cherish the place as a foundry for men of character and achievement. But

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such a way that others heard “masturbator” — the kind of schoolyard teasing that brought easy laughs, but also humiliated the recipient.

“The whole group there did not treat me well,” Fishburne said.

“Brett was a jerk.”

GABRIELLA DEMCZUK/POOL/REUTERS

most bonded over the idea that they were the elect who owed one another a permanent duty.

Many also shared a sense that they were looked down upon.

Even as much of the outside world viewed them as part of a narcissistic elite, they grew up hearing that theirs was a lesser private school, academically no match against other nearby schools: St. Albans, Sidwell Friends or St. Anselm’s.

“We had something to prove,” said one of Kavanaugh’s classmates said. “We were supposedly the dumb jocks, the party guys.”

Since graduation, the men of the Class of 1983 have supported those among them who have faced difficulties. They took classmate Mark Judge to his cancer treatments and helped him when he had other problems, several classmates said. They assisted another classmate who fell behind with mortgage payments.

Since Kavanaugh was nominated, members of the class — some from his inner circle, some who’d never been close — have created a support network that has fended off reporters, offered guidance to favored journalists and batted down false rumors, all with frequent consultation with their former schoolmate.

They had done this before.

Judge, a good friend of Kavanaugh’s in high school, became a freelance writer and in his books, which include two memoirs, he described an alcohol-saturated adolescence. A central char-

acter in Judge’s account was named “Bart O’Kavanaugh.” Kavanaugh was nicknamed Bart in high school.

Years before his Supreme Court nomination, Kavanaugh’s supporters pressed Judge to limit or mask his revelations of bad behavior, three Prep classmates said.

At Prep, as at almost every stage of his life, the impressions people formed of Kavanaugh were consistently inconsistent.

Kavanaugh and other football players were at the center of Prep’s social universe. Matt Brown, a classmate who was decidedly not part of the in crowd, remembered Kavanaugh standing out among the popular boys because he was so nice.

Many football players let their gridiron celebrity “get to their heads and they wouldn’t really interact with you,” said Brown, now an alcohol and drug counselor in Portland, Maine. Not Kavanaugh: “He was a guy who would still talk to you in the hallways and would acknowledge your existence.”

Classmate William Fishburne recalled Kavanaugh as an academic standout, a popular jock.

But he also recalled a different side of Kavanaugh.

Fishburne was short and heard more than his share of short jokes on campus. He was also a star in high school debate, and he said Kavanaugh “liked to call me a master debater,” but he’d say it in

Sen. Patrick Leahy (D-Vt.) points to a page from Brett Kavanaugh’s high school yearbook during a Senate Judiciary Committee hearing on Sept. 27 regarding sexual assault allegations against the Supreme Court nominee.

At Prep, the impressions people formed of Kavanaugh were consistently inconsistent.

A consistent conservative At Yale College and Yale Law School, as at Prep, there are classmates who say Kavanaugh was a big drinker who became nasty and belligerent when he got drunk and classmates who say he drank heavily but never seemed out of control.

The two portraits seem irreconcilable, yet both could be true.

“Brett was a sloppy drunk, and I know because I drank with him,” said Elizabeth M. Swisher, a friend who is now a professor of gynecologic oncology at the University of Washington School of Medicine. “He’d end up slurring his words, stumbling. . . . It’s not credible for him to say that he has had no memory lapses in the nights that he drank to excess.”

But Chris Dudley, a close friend who played basketball at Yale and later in the National Basketball Association, painted an opposite picture. “I went out with him all the time. He never blacked out,” Dudley said. “Brett drank and I drank. Did he get inebriated sometimes? Yes. Did I? Yes. Just like every other college kid in America.”

Just as there are women who say Kavanaugh was clumsy or rough when he made drunken passes at them, there are women who say he was charmingly awkward and reticent in such moments.

Even as classmates remain divided over his behavior when drinking, they agree that he was a consistent conservative on a liberal campus.

As a first-year law student in 1987, Kavanaugh aligned himself with Chief Justice William H. Rehnquist, a conservative who moved the Supreme Court to the right.

“In class after class, I stood with Rehnquist. That often meant . . . that I stood alone,” Kavanaugh said in a speech last year. “Some things don’t change.”

Kavanaugh soon joined the Federalist Society, a Washingtonbased group that has played a key role in recruiting, grooming and

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supporting strongly conservative judges — including Kavanaugh.

As Kavanaugh became active in the society’s Yale chapter, Leonard Leo got involved with the group at Cornell. The two soon formed a bond that would prove powerfully important.

In Washington, Leo, who emerged as a leader of the Federalist Society, became the keeper of a list of influential conservative judges from which Republican presidents have chosen court nominees. Leo was also one of Kavanaugh’s most avid boosters.

A Starr protege After law school, Kavanaugh clerked for two federal judges, lining himself up for a coveted clerkship at the Supreme Court.

But before Justice Anthony M. Kennedy hired him, Kavanaugh caught the eye of another prominent conservative who would prove to be a vital mentor.

Like Kavanaugh, Ken Starr was a staunch conservative who would be accused of excessive partisanship in a job that required a fair and neutral temperament. But what drew Starr, an independent counsel appointed to investigate allegations against President Bill Clinton in 1994, to hire Kavanaugh three times was the same mix of attributes that had attracted so many people before him: He considered the young lawyer an unusually likable guy who was brilliant and closely aligned with Starr’s philosophy.

In 1992, when Starr was U.S. solicitor general, the federal government’s lawyer in the Supreme Court, he interviewed Kavanaugh and hired him as a fellow in his office. From there, Starr lent a hand as Kavanaugh sought the Kennedy clerkship.

Starr kept a close eye on his protege and a few years later recruited him to join the independent counsel’s office, first to investigate the death of White House deputy counsel Vincent Foster and later, after Kavanaugh had left the office, to come back and lay out the reasons the president should be impeached for lying about his affair with White House intern Monica S. Lewinsky.

As Starr and his deputies discussed how to handle the questioning of the president, some wondered whether Clinton should be cut some slack out of respect for his office.

Colleen Roh Sinzdak, a 2010 graduate, said Kavanaugh helped her get a Supreme Court clerkship even though she has been a lifelong Democrat.

After the court upheld Trump’s travel ban earlier this year, Sinzdak felt crushed. She was surprised that night to receive a sympathetic email from Kavanaugh, who probably disagreed with her on the issue, encouraging her to keep her chin up. “That meant a lot,” she said.

PABLO MARTINEZ MONSIVAIS/ASSOCIATED PRESS

President George W. Bush watches the 2006 swearing-in of Brett Kavanaugh as a judge on the U.S. Court of Appeals for the D.C. Circuit by Supreme Court Justice Anthony M. Kennedy. Holding the Bible is Kavanaugh’s wife, Ashley.

The news brought “tears to my eyes.

Tears of joy.”

Ken Starr, on hearing the news of Brett Kavanaugh being nominated to the Supreme Court

On the night of Aug. 15, 1998, Kavanaugh answered with an impassioned memo: “I am strongly opposed to giving the President any ‘break’ in the questioning. . . .

The President has disgraced his Office, the legal system, and the American people by having sex with a 22-year-old intern and turning her life into a shambles.”

Kavanaugh offered 10 questions to ask the president, including: “If Monica Lewinsky says that you inserted a cigar into her vagina while you were in the Oval Office area, would she be lying?”

The next morning, said Robert J. Bittman, then Starr’s deputy, Kavanaugh expressed remorse about some of the tone of his assessment of Clinton, but not about the questions.

The bond between Kavanaugh and Starr was mutual. Starr had been bitter about being passed over by President George H.W. Bush for a Supreme Court nomination, but when he heard that Trump had nominated his protege for the high court, Starr said it brought “tears to my eyes. Tears of joy.”

A network of supporters Kavanaugh’s rise was swift and deliberate. At every step, his friends pitched in. Starr, Leo and others recommended him, spread the word, helped knock down critics.

In 2003, when Alberto R. Gonzales, then the U.S. attorney general, advanced Kavanaugh’s name

to the White House for nomination as a judge on the U.S. Court of Appeals for the D.C. Circuit, it was Kyle Sampson, Gonzales’s chief of staff, who initially recommended the move.

“I thought — correctly! — that Brett would make a great judge, given his A+ level smarts, collegial demeanor, commitment to public service, compassion,” Sampson said in an email. The chain of connections was typical Washington: Kavanaugh and Sampson had worked together on the nomination of another judge, John Bates, and Kavanaugh and Bates had worked together in the independent counsel’s office.

When the American Bar Association knocked down its rating of Kavanaugh from “well qualified” to merely “qualified,” and Democrats blocked his nomination to the D.C. Circuit, his friends rallied once more. More than two years after he was first chosen, he won a spot on the bench by a nearly party-line vote in the Senate.

On the bench, Kavanaugh extended his network. Other judges began to cite his rulings frequently. He is among the top appellate judges nationally to send his law clerks on to clerkships in the chambers of Supreme Court justices.

At Harvard Law School, where Kavanaugh taught for a decade before last week’s announcement that his class has been canceled, he invited students to dinners and encouraged them to stay in touch.

‘A tough process’ On the day before the Senate Judiciary Committee hearing about the allegations against him, Kavanaugh spent hours behind closed doors in his courthouse office, writing an angry, emotional defense of who he is. He struggled to deliver the speech even in practice runs, according to a person familiar with the sessions.

His opening remarks were searing, partisan and accusatory; his delivery, by turns outraged, weepy and righteous.

When Sen. Amy Klobuchar (DMinn.) questioned Kavanaugh, the judge initially came across as courteous and diplomatic. But when she asked whether he had ever blacked out after a night of heavy drinking, Kavanaugh pounced with his own question.

“I don’t know,” he snapped.

“Have you?”

During breaks in his testimony, Kavanaugh regularly huddled with White House counsel Donald McGahn and other advisers in a small meeting space behind the hearing room.

But after the heated exchange with Klobuchar, Kavanaugh took a moment by himself. His people were out there in the hearing room. But now, with everything on the line, he was on his own.

Just before the hearing resumed, he told his advisers he wanted to apologize to the senator, according to a person familiar with the discussion.

“Sorry I did that,” he told Klobuchar when the hearing resumed. “This is a tough process.”

That night, Kavanaugh, emotionally spent, his future very much up in the air, retreated to safe ground. He spent the evening with those who would understand, the ones who had been there at every step, including, of course, his buddies from Prep. n ©The Washington Post

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Hopes may be too high on trade deal

BY D AVID J . L YNCH AND H EATHER L ONG

P

resident Trump casts his new North American trade agreement as “the biggest trade deal in the United States’ history” — one that would return lost manufacturing jobs to American shores, discourage future outsourcing of factory work, and “send cash and jobs pouring into the United States.”

But many economists and trade experts say the president’s forecast may prove overly optimistic, given the limited changes that are envisioned and the powerful economic forces that already have reshaped regional commerce.

While some industries and regions would fare better than others, the sheer size of the $20 trillion U.S. economy will probably swamp those specific effects.

The accord, which the president has christened the U.S.-Mexico-Canada Agreement, would require automobiles to include more North American parts to qualify for duty-free treatment, pry open a sliver of Canada’s dairy market and update trading rules for the Internet economy.

All that earned the administration wary praise last week from business groups, farmers, investors and even some Democratic lawmakers. But the president’s ebullience about “high-quality American jobs” ushering in “a new dawn for the American auto industry” stood in contrast to the relatively muted assessments of professional economists.

“This isn’t a revolutionary deal.

It’s a modification of a deal already in place,” said Eric Winograd, senior U.S. economist at AllianceBernstein, an investment and research firm. “The total economic impact will be very small. I do not expect it to boost the U.S. economy.”

To the degree that it could drive growth, the deal would do so by removing the cloud of uncertainty that Trump has created by unsettling global trade, some economists said. That climate of doubt may have held back investments — so the new deal could perhaps add

JABIN BOTSFORD/THE WASHINGTON POST

Trump touts new pact as biggest in U.S. history, but analysts say gains are expected to be small a tenth of a percentage point to the economy’s growth rate next year, said Chris Rupkey, chief financial economist at MUFG Union Bank.

Trump celebrated the new agreement with a White House Rose Garden ceremony Monday in which he said the deal included stronger labor protections and would make it easier for American farmers to sell to Canadian customers.

Other provisions would refresh regional trading rules for a 21stcentury economy, providing important clarity for e-commerce retailers as well as data-rich industries such as financial services.

Even some left-leaning economists gave the president credit for bettering the trade bargain.

“I’d argue this deal is an improvement, though enforcement will make or break that impression,” said Jared Bernstein, former economic adviser to Vice President Joe Biden.

The administration will prob-

ably confront a tough fight for congressional approval next year, when the House of Representatives may be controlled by Democrats. Touting large potential gains from a new trade deal — as President Bill Clinton did in 1993 when he was promoting the North American Free Trade Agreement — will be a central part of the White House campaign.

As economists and trade analysts sorted through the 1,800plus pages of the new accord, they saw few signs of major change.

Lorenzo Caliendo, an economics professor at Yale University’s School of Management who co-authored a NAFTA study published in 2015 that concluded each American had gained about $45 a year from that treaty, said the new agreement would “clearly not” return significant numbers of manufacturing jobs to the United States.

The limited differences between the new and old treaties, coupled with changes in the U.S.

From center left, U.S. Trade Representative Robert E. Lighthizer, President Trump and White House senior adviser Jared Kushner during an announcement on the United StatesMexico-Canada agreement in the Rose Garden at the White House on Monday.

labor force over the past quarter-century, would minimize the economic benefits, Caliendo said. Much of the work that has moved to Mexico since 1994, when the original deal took effect, would be ill-suited for the higher-skilled contemporary U.S. labor force, according to Caliendo.

“I expect very small aggregate effects,” he wrote in an email.

Some of the gains may be important for individual industries or farmers but may not make much of a difference in the overall economy. The president has been especially critical of Canada’s dairy management system, which limits imports to protect domestic farmers’ incomes and has been a particular irritant for U.S. producers in states such as Wisconsin.

As one of the final issues to be resolved, Canada agreed to open roughly 3.5 percent of its dairy market to U.S. farmers.

The auto industry would face some of the biggest adjustments, illustrating how the deal would create winners and losers. The new agreement is widely expected to raise vehicle costs and create more onerous paperwork requirements, especially for the Tier 1 and Tier 2 suppliers that feed major automakers such as General Motors and Ford.

The Trump administration aims to return auto industry jobs to the United States. To encourage that, the new deal stipulates that at least 75 percent of a vehicle — vs.

62.5 percent today — must be produced in the NAFTA region to qualify for duty-free treatment.

Another new provision requires at least 40 percent of each automobile to be made by workers earning $16 an hour, far higher than Mexico’s average factory wage.

“The new deal makes it harder to assemble a car in Mexico and export it to the United States and meet the requirements,” said Chad Bown, a senior fellow at the Peterson Institute for International Economics.

At the same time, he said, “carmakers are also less able to buy cheaper parts from European or Asian suppliers. n ©The Washington Post

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ACA provision poses threat to GOP T RACY J AN in St. Louis BY

I

n February, Missouri Attorney General Josh Hawley joined a Republican lawsuit to overturn the Affordable Care Act, and with it protections for Americans suffering from preexisting medical conditions that previously could be excluded from insurance coverage.

Now, running to unseat Democrat Claire McCaskill in one of the nation’s most competitive U.S. Senate races, Hawley is airing a sympathetic ad using the affliction of his 5-year-old son, diagnosed this year with a rare bone disease.

“A preexisting condition. We know what that’s like,” he says in the ad. “I support forcing insurance companies to cover all preexisting conditions.”

After being a drag on Democratic candidates for several election cycles, President Barack Obama’s 2010 health-care law is now threatening Republicans who have spent years railing against it and seeking its repeal.

Hawley is one of many Republicans in key races scrambling to square their opposition to the health-care overhaul with voters’ strong support for one of its most popular provisions.

In Ohio and Michigan, candidates for governor are being forced to answer for their antiObamacare moves as attorneys general. In other states, Republicans are trying to tailor new responses to voters questioning their intentions.

President Trump, who has long pushed for the repeal of Obamacare, has begun defending coverage of preexisting conditions, although like most of the Republicans, he has not been specific about how he would make that happen.

Denny Enloe, an independent voter who listened to Hawley’s campaign remarks, said he agrees with Hawley on issues such as guns, abortion and promoting work over welfare. But he was skeptical of Hawley’s support for coverage of preexisting conditions, noting the federal lawsuit

NICK SCHNELLE FOR THE WASHINGTON POST

Coverage of preexisting conditions has become a key voting factor to dismantle the health-care law.

The suit argues that the law — which expanded health insurance to millions of low-income Americans but also included a controversial mandate that nearly everyone purchase insurance — is no longer constitutional because Congress last year repealed a tax penalty for those forgoing insurance. Hawley said Monday that he does not regret joining the lawsuit and said preexisting conditions can be protected in ways apart from the health-care law.

“How are you going to tell me you’re going to fix it when you’re on a lawsuit to invalidate the Affordable Care Act?” said Enloe, who has end-stage chronic ob-

structive pulmonary disease and watched Hawley’s Facebook video from his living-room couch in the conservative, rural and working-class town of Union.

Democrats have launched a barrage of ads attacking Republicans on the issue, a reflection of the strong voter sentiment in favor of preexisting condition coverage and the issue’s rise in importance this election year.

Three-quarters of Americans say it is “very important” that protections for people with preexisting conditions remain law, according to the most recent Kaiser Family Foundation poll released in September. A July Kaiser poll found that a candidate’s position on preexisting

Cort VanOstran, center, talks to a voter last month in the St. Louis suburb of Glendale, Mo. The Democrat is making coverage of preexisting conditions a central issue in his campaign for Congress.

conditions to be the top healthcare issue for voters, especially among Democrats, independents and those living in battleground areas. Half of Republicans said it was either the most important factor or a very important factor in their vote.

“Preexisting conditions is the ideal issue for Democrats in red states or purple states who are trying to reach independents,” said Drew Altman, president and chief executive of the Henry J. Kaiser Family Foundation, a nonpartisan nonprofit headquartered in San Francisco. “It’s a third-rail issue that’s incredibly resonant with the public.”

In Ohio, Republican gubernatorial candidate Mike DeWine,

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POLITICS who as state attorney general had challenged the constitutionality of the ACA in court, notably has not joined Hawley and the coalition of Republican governors and attorneys general in 20 states on the lawsuit.

DeWine said during a September debate with Democratic candidate Richard Cordray that he has “always been for the coverage of preexisting illnesses.” Yet he has not signed on with Democrats to save the mandate that preexisting conditions remain covered.

Michigan Attorney General Bill Schuette, a Republican running for governor, is straddling a similar line and has not picked a side in the federal lawsuit, even as the Democratic Governors Association released an ad saying he would deny health coverage to Michiganders with lymphoma, cerebral palsy, asthma and multiple sclerosis. Schuette has dismissed such suggestions as a “scare tactic” but has not said precisely how he would protect such patients.

In August, Senate Republicans up for reelection — Dean Heller in Nevada, Roger Wicker in Mississippi and John Barrasso in Wyoming — introduced a bill to require insurers to continue selling plans to people with preexisting conditions should Republicans prevail in the lawsuit. But health policy analysts have said the legislation does not prevent insurers from excluding specific health conditions from coverage.

Republican Senate candidates in Florida, North Dakota and Montana also have penned opeds and released statements pledging to protect treatment of preexisting conditions.

Republican strategist Doug Heye said candidates need to spell out how exactly they will do so.

“One of the criticisms Republicans have gotten the last two cycles is only talking about what we’re against, not what we’re for,” said Heye, former spokesman for the Republican National Committee. “This issue is picking up throughout the country, and it behooves Republicans to demonstrate some kind of plan for what they will actually do.”

Policy analysts say it would be financially unrealistic to force insurers to cover preexisting conditions without mandating that

JEFF ROBERSON/ASSOCIATED PRESS

everyone, including healthy people, buy insurance. That was the argument Democrats made in approving the mandate.

Nationally, more than a quarter of working-age adults have health conditions that could have left them uninsurable before the ACA, according to Kaiser.

In Missouri — a state where nearly a third of non-elderly residents have health conditions that could have resulted in insurance denial, according to Kaiser — McCaskill has taken to asking voters who attend her town halls to stand if they have a preexisting condition. The first time she did it during a state Democratic fundraising dinner in June, few in the ballroom remained in their seats.

McCaskill, whose campaign is highlighting the stories of voters with preexisting conditions, has attacked Hawley for signing on to the lawsuit.

“Josh Hawley’s lawsuit will take away every protection that Missourians have against overreach by insurance companies, including preexisting conditions,” McCaskill said in a September debate. “He wants the whole thing thrown out, and he knows there is nothing there to back it up.”

President Trump, who won Missouri by more than 18 points in 2016, said in September while stumping for Hawley in Springfield that he and Hawley “will always protect preexisting conditions.” The president, whose administration argued in a court brief filed in June that ACA protections for preexisting conditions should be ruled unconstitutional, did not say how.

As health-care worries continue to percolate through the conservative suburban enclaves surrounding St. Louis, a Democratic challenger in the state’s 2nd Congressional District is reaping the reward.

When Cort VanOstran canvassed a leafy neighborhood in upper-middle-class Glendale a few weeks ago in his increasingly competitive bid to unseat threeterm Republican Rep. Ann Wagner, several conservative-leaning independent and Republican voters said they would consider backing a Democrat because of the issue.

“You can’t go into a booth blind and say I’m going all Republican,” said Ken Clarke, a 72-year-old Republican who voted for Trump and Wagner in 2016. His daughter-in-law has multiple sclerosis, and in recent years, he said, he

Missouri Attorney General Josh Hawley (R) speaks to supporters during a stop on his campaign for U.S. Senate last month in St. Charles, Mo.

KLMNO WEEKLY

has begun to support the concept of universal health care.

“I wish America would somehow get across-the-board insurance for everyone — like Canada,” Clarke said. “Social medicine has got to be the future.”

Walking door to door, VanOstran, a 30-year-old lawyer, highlighted Wagner’s 2017 vote to repeal the ACA. “When she made that vote, I felt like it was a vote against me and my family,” VanOstran told Sherry Ingram, a 63-year-old grandmother who retired from her job as a Monsanto accounts manager.

Wagner’s vote, he said, prompted him to run for office.

His mother, who died of breast cancer two years ago, had health coverage through a plan sold under the ACA in the final years of her life, VanOstran said.

“I really think that most Republicans don’t want people with preexisting conditions to lose their care,” Ingram said, stepping onto the porch as her daughter’s goldendoodle peered through the glass door.

Wagner last year co-sponsored a House Republican bill to offer insurance to patients with preexisting conditions. But health analysts say the legislation does not bar insurers from charging higher rates based on health factors.

Ingram, an independent voter who considers herself conservative on economic issues but liberal on social issues, said she has yet to settle on either a House or Senate candidate and is open to the Democratic and Republican nominees in both races.

“It’s very important to make sure preexisting conditions are taken care of fairly,” Ingram said.

Hawley, too, faces questions from voters who typically would be open to siding with a Republican.

“Can you tell me your plan to fix health care?” Peggy Vangorder, who described herself as an independent who often votes Republican, typed on Hawley’s Facebook page after watching his 8-minute speech outlining the stakes of next month’s election.

“This scares people who are sick,” another woman wrote, urging him to clarify by getting “some ads out letting people know you do support preexisting conditions.” n ©The Washington Post

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Arctic lake’s dangers rise to the surface Researchers worry about climatic effects of its methane bubbles C HRIS M OONEY above the Arctic Circle, Alaska BY

K

atey Walter Anthony has studied some 300 lakes across the tundras of the Arctic. But sitting on the mucky shore of her latest discovery, the Arctic expert said she’d never seen a lake like this one.

Set against the austere peaks of the Western Brooks Range, the lake, about 20 football fields in size, looked as if it were boiling. Its waters hissed, bubbled and popped as a powerful greenhouse gas escaped from the lake bed. Some bubbles grew as big as grapefruits, visibly lifting the water’s surface several inches and carrying up bits of mud from below.

This was methane.

As the permafrost thaws across the fast-warming Arctic, it releases carbon dioxide, the top planet-warming greenhouse gas, from the soil into the air.

Sometimes, that thaw spurs the growth of lakes in the soft, sunken ground, and these deep-thawing bodies of water tend to unleash the harder-hitting methane gas.

But not this much of it. This lake, which Walter Anthony dubbed Esieh Lake, looked different. And the volume of gas wafting from it could deliver the climate system another blow if lakes like this turn out to be widespread.

The first time Walter Anthony saw Esieh Lake, she was afraid it might explode — and she is no stranger to the danger, or the theatrics, of methane. In 2010, the University of Alaska at Fairbanks posted a video of the media-savvy ecologist standing on the frozen surface of an Arctic lake, then lighting a methane stream on fire to create a tower of flame as tall as she is. It got nearly half a million views on YouTube.

So now, in the Arctic’s August warmth, she had come back to this isolated spot

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with a small research team, along with her husband and two young sons, to see what secrets Esieh Lake might yield. Was it simply a bizarre anomaly? Or was it a sign that the thawing Arctic had begun to release an ancient source of methane that could worsen climate change?

One thing she was sure of: If the warming Arctic releases more planetwarming methane, that could lead to. . . more warming. Scientists call this a feedback loop.

“These lakes speed up permafrost thaw,” Walter Anthony said. “It’s an acceleration.”

There was only so much the team would learn from the instruments they had hauled here. To get a firsthand look, they would have to get in.

Arctic lakes that don’t freeze Walter Anthony, who grew up close to Lake Tahoe, was captivated by Arctic lakes at 19, when she spent a summer at Siberia’s picturesque Lake Baikal.

“I love the solitude of remote lakes and the mystery of what lies beneath the water surface.”

Two decades and several academic degrees later, she was asked by a Native Alaskan group, the NANA Regional Corporation, to search for methane seeps in northwest Alaska, since the gas, despite its climate downsides, could provide a fuel source for remote communities.

How do you find a lake in Alaska that leaks methane? Well, there’s one telltale sign: They don’t fully freeze over.

In April 2017, Walter Anthony put out

PHOTOS BY JONATHAN NEWTON/THE WASHINGTON POST

Katey Walter Anthony and her son Jorgen, 6, collect gas samples at Esieh Lake in Alaska.

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word among residents of Kotzebue, Alaska, that she was looking for weird lakes. An email that month from a pilot led her to the Noatak region, not far above the Arctic Circle. Last September, she made her first visit to the lake — set against sloping hills covered with rust-colored mosses and blueberry bushes. She brought her family and a graduate student to the spot, so remote it required several days of camping and was completely off the grid.

At first, the sheer volume of gases at Esieh Lake was slightly terrifying, but as Walter Anthony grew accustomed to the lake’s constant spluttering, her fear gave way to wonder.

Her sounding devices picked up huge holes in the bottom of the lake. Pockmarks, she called them, “unlike anything I’ve ever seen in any Arctic lake.”

Most of Esieh is quite shallow, averaging only a little more than three feet deep. But where the gas bubbles cluster, the floor drops suddenly, a plunge marked by the vanishing of all visible plant life.

Measurements showed that the lake dips to about 50 feet deep in one area and nearly 15 feet in another. When they first studied them, Walter Anthony and her graduate student Janelle Sharp named these two seep clusters W1 and W2, short for “Wow 1” and “Wow 2.”

The next discovery came from the lab.

When the scientists examined samples of the gases, they found the chemical signature of a “geologic” origin. In other words, the methane venting from the lake seemed to be emerging not from the direct thawing of frozen Arctic soil, or permafrost, but rather from a reservoir of far older fossil fuels.

If that were happening all over the Arctic, Walter Anthony figured — if fossil fuels that had been buried for millennia were now being exposed to the atmosphere — the planet could be in even deeper peril.

‘Hotspot’ For the second trip, Walter Anthony had brought a larger team of researchers, more equipment and her family — her husband, Peter Anthony, and sons, Jorgen, 6, and Anders, 3.

The team brought instruments

ABOVE: Research technician Philip Hanke moves a measuring chamber that records greenhouse gas fluctuations.

LEFT: Methane gas released from the depths roils the surface of Esieh Lake.

for sampling gases, four inflatable boats, large crates of food, eight tents, a satellite phone for emergencies and two shotguns.

As with much of the Alaskan wilderness, the lake is frequented by grizzly bears, and the bear scat around the camp kept everyone keenly aware of their surroundings.

A week before the trip, Walter Anthony had published a major study delivering worrisome news about Arctic lakes in general. Her husband, Peter — also a scientist at the University of Alaska at Fairbanks — was a co-author.

The research tackled the central question now animating scientists who study permafrost soils, which can reach depths of nearly 5,000 feet and were laid down over tens of thousands of years or more as generations of plants died and sank beneath the

surface. Because of the cold, those carbon-rich remains never fully decomposed, and the soil preserves them in an icy purgatory.

Now, though, as the Arctic warms, decomposition is starting up — and it gives off greenhouse gases.

Scientists know the permafrost contains an enormous amount of carbon — enough to catastrophically warm the planet if it were all released into the atmosphere. But they don’t know how fast it can come out and whether changes will be gradual or rapid.

That’s where Walter Anthony’s work came in.

The authors examined the prevalence of thermokarst lakes, which form when the wedges of ice within permafrost melt and create voids that then fill with water. And they found that the continuing growth of these lakes

— many of which have already formed in the tundra — could more than double the greenhouse gas emissions coming from the Arctic’s soils by 2100. That’s despite the fact that the lakes would cover less than 6 percent of the total Arctic land surface.

Scientists have been puzzling over a dramatic spike in atmospheric methane levels, which since 2006 have averaged 25 million tons more of the gas per year. Walter Anthony’s study found that Arctic lakes could more than double this increase as well.

Overall, if Walter Anthony’s findings are correct, the total impact from thawing permafrost could be similar to adding a couple of large fossil-fuel-emitting economies — say, two more Germanys — to the planet. And that does not take into account the possibility of more lakes like Esieh, which appears to be a different phenomenon from thermokarst lakes, emitting gases faster.

The landscape around Esieh Lake itself bears the mark of rapid permafrost thaw.

Along the shore, a large section of the hillside had collapsed, a change that, according to two members of the team, had occurred just since May, when they were last here.

This “thaw slump” was a textbook example of fast-moving permafrost thaw. It had left behind an exposed wall of muddy ice and small islands of peat and mosses.

The NASA Arctic-Boreal Vulnerability Experiment, or ABoVe, partly supports Walter Anthony’s work and has been using aircraft to study Arctic methane emissions. It found that the land surrounding Esieh Lake is an emissions “hotspot.”

“We think that the permafrost thawing processes at work in the lake are also at work in the neighboring landscape,” said Charles Miller, the deputy science lead for the project.

‘It’s kind of freaky’ If it weren’t for the bubbles, the large patches of silty water they create and the slightly unsettling fact that you could light the emerging gases on fire (at one point, Walter Anthony did just that), Esieh Lake might be an idyllic scene. But these features, combined with the fact that it

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appears to be frequented by grizzly bears, render it more alien than bucolic.

But Walter Anthony and research technician Philip Hanke, 25, were determined to explore it from within. On the second day of the trip, they donned wet suits and snorkels and plunged into the cold water, which was below 60 degrees.

They wanted to see the methane seeps up close and learn what they could by swimming among the bubbles.

Hanke went first, venturing into the more vigorous bubble site, Wow 2. There was very little visibility. But, groping in the darkness, Hanke could feel the shape of things.

“It’s kind of freaky,” he reported after he surfaced. “Right where the hole goes in, it slopes, and it’s flattened out, and it coned back down, and that was where some really loose sediment was, and I could stick my hands into it.”

“So there’s different ledges, you’re saying?” Walter Anthony asked.

“Yeah, it was a ledge.”

The second, much deeper site was less murky, more peaceful.

Walter Anthony was still in awe when she came up for air.

“You’re just looking down into this stream of bubbles coming up

right into your face, and they’re so soft they go all around you,” she said. “And the sunlight’s on them. It’s like out of this world but under this world.”

Another scientist, Frederic Thalasso, had traveled from Mexico City and spent days taking gas measurements around the lake.

His initial results: Emissions from Esieh were very high — and clearly had something to do with fossil fuels.

The lakes where he had witnessed similar bubbling activity were in the tropics and polluted — ideal conditions for the production of methane, said Thalasso, a scientist with the Center for Research and Advanced Studies at the National Polytechnic Institute in Mexico.

But those lakes have gas flows that are “probably 100 times lower than in this lake,” he said.

His instruments also detected ethane, butane and propane — classic signatures of a fossil origin.

Later, after processing his data, he produced an initial estimate that the lake was producing two tons of methane gas every day — the equivalent of the methane gas emissions from about 6,000 dairy cows (one of the globe’s biggest methane sources). That’s not enough to be a big climate problem on its own, but if there are

many more lakes like this one — well, that’s another story.

A troubling hybrid After four nights of camping, the team packed up to make the two-hour boat trip to Kotzebue, Alaska, the first leg on the journey home. Walter Anthony wouldn’t have all the new data processed for a while, but she did have a pretty good hypothesis about what is happening at Esieh Lake.

Permafrost contains a lot of carbon — but in some locations, permafrost soil, and its characteristic wedges of embedded ice, also sits atop ancient reserves of fossil fuels, including methane gas. So as the Arctic warms — which it is doing twice as fast as the rest of Earth — these gases could be liberated into the atmosphere.

The holes in the bottom of Esieh Lake could therefore be an underwater cousin of odd craters that have appeared in the Siberian tundra in recent years, suspected to have been caused by underground gas explosions.

If this is right, then Esieh Lake becomes a kind of hybrid — and a worrying one.

It’s not a pure thermokarst lake, though some thermokarst appears to be forming around the lake’s expanding edges, tipping

A rainbow shines over Esieh Lake, with the seep field of methane gas visible in the center.

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shoreline trees as the ice in the permafrost melts and the ground destabilizes. But the thawing of permafrost at the lake bed might also have unleashed older fossil gases from a reserve that had been sealed — creating another kind of worrisome lake.

“This is an additional source,” Walter Anthony said.

Carolyn Ruppel, who leads the Gas Hydrates Project at the U.S. Geological Survey, said Walter Anthony’s theory makes sense.

Permafrost thawing could indeed release ancient fossil fuels in areas where they intersect.

But it would take more study to prove that this phenomenon is leading to widespread emissions across the Arctic, she said. Nobody knows how long ago the seeps started bubbling or what the trigger was.

The fact that these lakes are emitting methane rather than carbon dioxide engages a thorny debate over which of the two quite different gases is worse.

Methane is often described as being more powerful than carbon dioxide, but it’s not quite that simple. Methane hits the atmosphere hard and fast and then mostly dissipates after a decade or two (leaving behind carbon dioxide).

Carbon dioxide, meanwhile, is less immediately potent but lingers for centuries or even millennia. One warms the planet rapidly in the short term; the other, steadily in the long term.

Meanwhile, some scientists say they’re not sure yet how bad Arctic lakes will be for the climate or whether they will indeed cause emissions from permafrost to double.

“It’s not the final number,” said Vladimir Romanovsky, one of Walter Anthony’s colleagues at the University of Alaska at Fairbanks and a noted permafrost expert.

At this point, it would be premature to call Esieh Lake a sign of climate doom. It is a strange and dramatic site, but its message remains partly veiled.

The coming years will probably reveal what’s behind Esieh and whether it has many cousins across the top of the world.

By then, we may also see whether the Arctic’s great thaw will have thwarted attempts to stop global warming. n ©The Washington Post

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FIVE MYTHS

Capitalism BY

S TEVEN P EARLSTEIN

Thirty years ago, in the face of a serious economic challenge from Japan and Europe, the United States embraced a form of free­mar­ ket capitalism that was less regulated, less equal, and more prone to booms and busts. Driving that shift was a set of useful myths about motivation, fairness and economic growth that helped restore American competitiveness. Over time, however, the most radical versions of these ideas have polarized our politics, threatened our prosperity and undermined the moral legitimacy of our system. (A recent survey found that only 42 percent of millennials support cap­ italism.) Here are five of the most persistent ones.

MYTH NO. 1 Greed, a natural human instinct, makes markets work.

Adam Smith, the father of economics, first pointed out in his most famous work, “The Wealth of Nations,” that in vigorously pursuing our own selfish interests in a market system, we are led “as if by an invisible hand” to promote the prosperity of others.

Smith, however, was never the prophet of greed that freemarket cheerleaders have made him out to be. In other passages from “The Wealth of Nations,” and in his earlier work, “The Theory of Moral Sentiments,” Smith makes clear that for capitalism to succeed, selfishness must be tempered by an equally powerful inclination toward cooperation, empathy and trust.

These insights have now been confirmed by brain researchers, behavioral economists, evolutionary biologists and social psychologists.

MYTH NO. 2 Corporations must maximize value for shareholders.

In fact, corporations are free to balance the interests of shareholders with those of customers, workers or the public, as they did routinely before the 1980s, when companies were loath to boost profits if it meant

laying off workers or cutting their benefits. Legally, corporations can be formed for any purpose. Executives and directors owe their fiduciary duty to the corporation, which is not owned by shareholders, as widely believed, but owns itself (in the same way that nobody “owns” you or me). The only time a corporation is obligated to maximize its share price is when it puts itself up for sale.

MYTH NO. 3 Pay is an objective measure of economic contribution.

The theory of “marginal productivity” holds that a worker’s wage or salary reflects the “amount of output the worker can produce,” according to Harvard’s Greg Mankiw, author of a best-selling economics textbook.

In reality, however, the pay set by markets is also subjective, reflecting the laws and social norms under which markets operate. The incomes earned by workers who planted tobacco — and those who owned tobacco plantations — changed considerably after slavery was abolished, and again after laws protecting sharecroppers were enacted, and again when minimum-wage laws were passed, and again when farmworkers won the right to unionize.

BRYAN R. SMITH/AGENCE FRANCE-PRESSE/GETTY IMAGES

Some argue that greed is what makes free-market capitalism work, but cooperation, empathy and trust are also needed to drive the system.

MYTH NO. 4 Equality of opportunity is all people need to gain wealth.

While the United States has made great strides in removing legal barriers to equal opportunity, at least half the difference in income between any two people is determined by their parents, either through inherited traits such as intelligence, good looks, ambition and reliability (nature), or through the quality and circumstances of their upbringing and education (nurture). As our society has become more meritocratic, we’ve simply replaced an aristocracy based on title, class, race and gender with a new and equally persistent aristocracy based on genes, education and parenting.

MYTH NO. 5 A fairer economy would be smaller and less prosperous.

Economists have long believed that there is an unavoidable trade-off between equality and growth — having more of one means having less of the other.

Arthur Okun’s book, “Equality and Efficiency: The Big Tradeoff,” remains a classic. The implosion of communism and the decisions

of socialist countries like Sweden to reduce taxes and welfare are widely seen as acknowledgments of the failure of overly egalitarian systems to produce adequate economic growth.

But evidence suggests that there is also a point at which high levels of inequality begin to deliver less economic growth, not more — and that the United States has passed that point, according to research by the International Monetary Fund.

That’s partly because moreunequal economies tend to have oversize and overcompensated financial sectors that are more prone to booms and busts. Other researchers have found that worker productivity suffers when economic gains are not widely shared.

A further reason may be that rising income inequality erodes the trust people have in one another and their willingness to cooperate. Countries with more social capital tend to be healthier, happier and richer. n Pearlstein, a Washington Post economics columnist and the Robinson professor of public affairs at George Mason University, is the author of “Can American Capitalism Survive?”

15 SUNDAY, OCTOBER 7, 2018

SUNDAY, Month, Day, Year 18

KLMNO WEEKLY

BOOKS

How a pain pill led to a national crisis N ONFICTION

• REVIEWED BY

S USAN O KIE

D DOPESICK Dealers, Doctors, and the Drug Company That Addicted America

By Beth Macy Little, Brown. 376 pp. $28

rug overdoses killed a record 72,000 Americans last year — more than the peak annual totals from HIV, guns or automobile crashes.

As a journalist, I recall writing a commentary almost a decade ago about the rapid increase in overdose deaths from prescription pain pills. As a physician, I’ve been the recipient of conflicting messages about the optimal use of opioids.

But until I read “Dopesick” by journalist Beth Macy, I didn’t grasp all of the factors that have produced the present crisis. They include unscrupulous prescription drug promoters, greedy or gullible physicians, inadequate action by the Food and Drug Administration, and prescription opioids’ role in opening up new geographic markets for heroin, a cheaper but more dangerous alternative for the addicted.

A Roanoke-based reporter, Macy had a front-row seat for the pain pill epidemic’s march through rural and small-town western Virginia. In the late 1990s, soon after Purdue Pharma began an aggressive national marketing campaign for its new, long-acting painkiller, OxyContin, patients hooked on that drug began showing up in clinics and emergency rooms in rural America. Overdose deaths began to rise.

Purdue sales representatives were urging physicians to prescribe OxyContin for patients with arthritis, low-back injuries and other common causes of chronic pain, not just for those suffering from intractable cancer.

The company wooed doctors with free meals and gifts, assuring them that the risk of addiction with OxyContin was one-half of 1 percent. The actual risk may be as high as 56 percent, according to a 2007 medical review article cited

by Macy.

Users seeking a high quickly figured out how to remove the pill’s outer coating and crush the inner pearl of opioid into a pow-

LITTLE, BROWN

The OxyContin push in the ’90s helped ignite the pain pill epidemic.

der that could be snorted or injected. “Oxy” also commanded a high street price: In a household strapped for cash, it could pay the rent.

Often prescribed in too-large quantities, leftover pain pills in bathroom cabinets became targets for thieves or bounty that a teenager could swipe to pass around at a pill party. Within a few years, high school football stars and college-bound students from upscale neighborhoods were joining the ranks of the addicted.

The stunned, grieving parents of some of the teenagers who died of OxyContin overdoses became impassioned activists. Their voices are among the most powerful in Macy’s book. Ed Bisch and Lee Nuss, who each lost a son, founded a nonprofit organization, Rela-

tives Against Purdue Pharma, whose members lobbied legislators, sponsored school workshops and demonstrated with posters of their dead children outside the company’s corporate headquarters. In 2007, John L. Brownlee, a young U.S. attorney, settled a landmark federal case against Purdue in a plea agreement under which the company admitted to fraudulently marketing OxyContin for six years. It had even falsified scientific charts to buttress that claim. Three top executives pleaded guilty to misdemeanors, and Purdue paid $600 million in fines.

But by then, the multi-year promotion and supplying of OxyContin and other prescription opiates to pharmacies all over America had ignited the pain pill epidemic, and there was no stopping it.

In Roanoke and other Virginia towns, as Macy learned, pain pill addicts readily switched to heroin as a cheaper alternative, and teenagers who had used the pills were easily persuaded to try it. “I did my first bag of heroin before I drank my first bottle of beer,” recalled Spencer Mumpower, who, as a young addict and heroin dealer, went to jail after selling a friend the drug that caused his overdose death. Local “mules” would make day trips to Baltimore or Hagerstown, Md., to bring back a supply of heroin to sell. Eventually, scenting an untapped market, more-experienced dealers moved into rural Virginia from big cities in the Northeast, set up sales networks and began underselling the competition.

This exhaustively reported book includes many heartbreaking examples of young lives lost to drugs. Although Macy’s stories are set in Virginia, they could happen anywhere in the United States. Most compelling are the characters she was able to follow over time, such as Mumpower, who recovered from addiction in prison and a halfway house, trained himself in mixed martial arts, and was clean at the time of the book’s publication. Another subject, high school athlete and honor student Tess Henry, became addicted to pills and then heroin, was jailed for dealing, and took heroin or Suboxone (a synthetic opioid used to treat addiction) throughout a pregnancy.

Born healthy, her son was taken from her, and Tess’s struggles to stay off drugs and become a fit mother provide a moving counterpoint to Macy’s discussion of the controversies that roil our national debate over addiction treatment. n Okie is a doctor and a former medical reporter and science editor for The Washington Post. Her debut poetry collection, “Let You Fly,” was published this year.

16

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