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Why Oz Is the Doctor Trump Ordered

The Atlantic

www.theatlantic.com › newsletters › archive › 2024 › 11 › why-oz-is-the-doctor-trump-ordered › 680727

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Donald Trump appears to experience the world through the glow of a television screen. He has long placed a premium on those who look the part in front of the camera. Paging Dr. Mehmet Oz.

Trump has picked Oz to lead the Centers for Medicare and Medicaid Services. CMS, as the agency is known, falls under the Department of Health and Human Services (HHS). Last week, Trump nominated Robert F. Kennedy Jr. to serve as HHS secretary. As you may have guessed, Kennedy and Oz are not only friends but kindred spirits. Oz is a global adviser at iHerb, a for-profit company that offers “Earth’s best-curated selection of health and wellness products at the best possible value.” He and Kennedy, two relative outsiders, are now positioned to enjoy a symbiotic relationship within Trump’s chaotic ecosystem.

Oz was last seen running for a Pennsylvania Senate seat in 2022. He lost to John Fetterman, who, despite dealing with the aftereffects of a stroke, carried the state by five points. Throughout that race, Oz struggled to combat the perception that he was a charlatan and carpetbagger who primarily lived in New Jersey. (Fetterman’s team repeatedly tagged Oz as an out-of-touch elitist, trolling him, for example, when he went grocery shopping for crudités and lamented high prices.) After that electoral defeat, Oz’s political dreams seemed all but dashed. But he wisely remained loyal to Trump—a person who has the ability to change trajectories on a whim.

In the pre-Trump era, it might have been a stretch to describe CMS administrator as an overtly political position. But Oz’s objective under Trump couldn’t be clearer. In a statement, Trump, using his reliably perplexing capitalization, telegraphed that Oz will bring a certain ethos to the job—a little MAGA, a little MAHA. Oz, Trump promised, will “cut waste and fraud within our Country’s most expensive Government Agency, which is a third of our Nation’s Healthcare spend, and a quarter of our entire National Budget.” And, because he’s Trump, he mentioned Oz’s nine daytime Emmy Awards.

Some 150 million Americans currently rely on the agency’s insurance programs, including Medicaid, Medicare, and Obamacare. Oz has been a proponent of Medicare Advantage for All. Though that sounds like the Medicare for All initiative championed by progressives such as Senator Bernie Sanders, the two programs are quite different. At its core, Medicare for All would set the U.S. on a path toward nationalizing health care. Trump would never go for that. But Medicare Advantage already exists within America’s patchwork private/public system, and Oz might push to strengthen it. He could also face budgetary pressure to weaken it. Oz’s own health-care views haven’t remained consistent. Though he once praised the mandatory universal models of Germany and Switzerland, as a Republican politician he threw his support behind privatized Medicare.

When asked about Oz’s nomination, Fetterman, his former opponent, told CNN: “As long as he’s willing to protect and preserve Medicaid and Medicare, I’m voting for the dude.” Some people were pissed. Victoria Perrone, who served as the director of operations on Fetterman’s Senate campaign, called out her old boss on social media: “Dr. Oz broke his pledge to ‘do no harm’ when he said red onions prevent ovarian cancer. My sis died of OC in 6/2022. This is a huge personal betrayal to me. We know he won’t protect the Medicaid that paid for her treatments,” Perrone posted on X. “I feel like I’ve been duped and 2 years of working on your campaign was a waste,” she added.

The above argument is illustrative of another reality Trump acknowledged in announcing his pick: “Make America Healthy Again” keeps growing. Oz, Trump declared, “will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake.” He went a step further, promising that Oz will bring “a strong voice to the key pillars of the MAHA Movement.” Oz holds degrees from Harvard and Penn, and he worked as a professor of surgery at Columbia. In spite of that pedigree, Oz has spent years facing credible accusations of medical quackery for his endorsement of dietary supplements. In 2014, he received a dramatic dressing-down on Capitol Hill. Senator Claire McCaskill read three statements that Oz had made on his eponymous show:

“You may think magic is make-believe, but this little bean has scientists saying they’ve found the magic weight-loss cure for every body type: It’s green coffee extract.”

“I’ve got the No. 1 miracle in a bottle to burn your fat: It’s raspberry ketone.”

“Garcinia cambogia: It may be the simple solution you’ve been looking for to bust your body fat for good.”

Oz’s defense that day was that his job was to be a “cheerleader” for the Dr. Oz audience. “I actually do personally believe in the items I talk about in the show. I passionately study them. I recognize oftentimes they don’t have the scientific muster to present as fact, but nevertheless, I would give my audience the advice I give my family,” he testified.

He emerged from that hearing largely unscathed. Two years later, Oz would go on to read what he claimed were Trump’s medical records on that same show. He famously praised Trump’s testosterone levels and supposed all-around health. Four years after that, once Trump was president, Oz sent emails to White House officials, including Trump’s son-in-law Jared Kushner, pushing them to rush patient trials for hydroxychloroquine, an unproven treatment for COVID.

In the next Trump administration, those are the sorts of exchanges Oz could be having with Kennedy—or with Trump himself. How did we get here? Oz landed this gig because he’s good on TV, yes, but also because, when he entered the political arena, he fully aligned himself with Trump. The 47th president rewards loyalty. If there’s one thing that’s become clear from his administration nominations so far, it’s that.

Some of Trump’s appointments will be less consequential than others. Anything involving the health and well-being of tens of millions of Americans is inarguably serious. Oz’s confirmation is not guaranteed, but his selection has already confirmed that nothing about Trump 2.0 is mere bluster.

Related:

Trump is coming for Obamacare again. (From January) Why is Dr. Oz so bad at Twitter? (From 2022)

Here are three new stories from The Atlantic:

Another theory of the Trump movement What the men of the internet are trying to prove Arash Azizi: The problem with boycotting Israel

Today’s News

Republican members of the House Ethics Committee blocked the release of the investigation into the sexual-misconduct and drug-use allegations against former Representative Matt Gaetz. Jose Ibarra, who was found guilty of killing Laken Riley on the University of Georgia campus, was sentenced to life in prison without possibility of parole. Trump tapped former WWE CEO Linda McMahon, who previously led the U.S. Small Business Administration during Trump’s first term, to be the secretary of education.

Dispatches

The Weekly Planet: Drought is an immigration issue, and Trump’s climate policies are designed to ignore that, Zoë Schlanger writes.

Explore all of our newsletters here.

Evening Read

Video by Joanne Imperio / The Atlantic. Sources: Archive Films / Getty; Internet Archive; Prelinger Associates / Getty.

Put Down the Vacuum

By Annie Lowrey

The other night, a friend came over. A dear friend. A friend who has helped me out when I’ve been sick, and who brought over takeout when I had just given birth. Still, before he arrived, I vacuumed.

I thought about this while reading the Gender Equity Policy Institute’s recent report on gender and domestic labor. The study finds that mothers spend twice as much time as fathers “on the essential and unpaid work” of taking care of kids and the home, and that women spend more time on this than men, regardless of parental and relationship status. “Simply being a woman” is the instrumental variable, the study concludes.

Read the full article.

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Stephanie Bai contributed to this newsletter.

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What Did the Democrats Do Wrong?

The Atlantic

www.theatlantic.com › podcasts › archive › 2024 › 11 › democrats-presidential-election-kamala-harris › 680633

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In the aftermath of Donald Trump’s victorious reelection bid, Democrats are searching for an explanation of Kamala Harris’s loss in order to begin rebuilding for the future. So it goes every election cycle—a loss, a scramble for causality, and competing narratives begin to set.

Just one week out from Election Day, there are multiple dissenting and overlapping arguments being made to try to make sense of the results. In 2016, many Democrats believed that Trump’s attack on trade policies was core to his victory. As a result, the Biden-Harris administration pursued Trump-like policies on trade, none of which seem to have made a significant difference in increasing the union vote share, reducing Trump’s likelihood of victory, or stemming the flow of working-class voters out of the Democratic Party.

Now, again, various parts of the Democratic coalition are seeking to define the party’s loss. But what do we actually know about why the Democrats were defeated? There are still theories forming, but on today’s episode of Good on Paper, I talk with the former Republican strategist and current host of The Bulwark Podcast, Tim Miller about the postelection narratives jockeying for power.

“But for those of us who do have a belief that there’s something kind of special about the American system and that have revered America, that understand that America is flawed and has made mistakes, that still is a unique experiment in the world. That “America is an idea” type of thing. The idea is pretty dim at this point,” Miller argued.

The following is a transcript of the episode:

[Music]

Jerusalem Demsas: In the aftermath of a bruising electoral loss, the losing party begins participating in a well-worn democratic tradition: slinging takes about what happened.

This is democracy! When the voters send a dissatisfied response, the messy work of recalibration requires parsing the signal from the noise.

Were voters mad because of a global inflationary environment that no Democrat could dig their way out of? Did they want to see specific breaks between Harris and Biden on policy? Were they frustrated by a candidate they saw as too left on cultural issues?

There are data points in favor of many different theses. Here’s where I’d put my stake in the ground, with the caveat that we still don’t have a complete analysis on subgroup dynamics, or even a final vote count on all the races:

First, incumbents worldwide were facing tough election odds. Electorates were frustrated by the COVID inflationary years and were clearly seeking change. In Australia, Sweden, the Netherlands, France, and beyond, ruling coalitions lost power across the political spectrum.

Second, I don’t think Kamala Harris was ever going to be a great candidate. After Biden’s disastrous debate effort in late June and it seemed he might be pressured to drop out, I wrote an article calling on Democrats not to coronate their vice president, and pointing to key vulnerabilities she displayed and the value of an open democratic process.

Figuring out how much of this is in the campaign’s control—would it really have mattered that much if she’d gone on Joe Rogan’s podcast?—or figuring out what this means for America’s two political parties will take months, if not years. As you’ve heard on this podcast, I’m still arguing about what 2016 really meant on trade and immigration.

My name’s Jerusalem Demsas, I’m a staff writer at The Atlantic, and this is Good on Paper, a policy show that questions what we really know about popular narratives. As a disclaimer, I worked for the Harris primary campaign in 2019 before becoming a journalist, and my guest today, Tim Miller, is a political strategist who was Jeb Bush’s 2016 communications director on his presidential campaign. He’s been an anti-Trump conservative since then and is the host of The Bulwark Podcast.

Today we’re going to talk through some of these inchoate narratives and debate which ones we think are likely to hold water.

[Music]

Demsas: Tim, welcome to the show.

Tim Miller: Hey Jerusalem. What’s happening?

Demsas: Well, we’re recording this six days after Election Day. And—as you have seen on Twitter, and I’m sure in your various interviews—the takes are already coming in very, very hot. And this is a show where we often look at narratives that have already baked, and kind of look at the research and data behind how these narratives formed and what truth is there and what sorts of things have gotten ahead of themselves.

But we’re in an interesting moment right now where we’re seeing very important narrative formation happen in real time. In the aftermath of an election, everyone’s scrambling to define what happened in order to maybe wrest control of the future of the party from an ideological perspective or just a pure power perspective. And so we’re seeing a bunch of people arguing about why Trump won and why Harris lost in a time where there’s a bunch of unknowns. So we’re going to go through a few of these different narratives that are coming up.

But Tim, right off the bat, I wanted to ask you: What’s your perception of why Trump won and Harris lost?

Miller: I’m going to preempt my answer by saying that I think that uncertainty is important in this moment, and that false certainty can lead to some very mistaken and disastrous results. I say this from experience, having worked on the Republican autopsy in 2013, when the conventional wisdom congealed very quickly that Republicans, in order to win again, needed to moderate on immigration and cultural issues to appeal more to Hispanics and women. And not only was that wrong, but the person that became the nominee and then the president used that autopsy for toilet paper and went exactly the opposite direction.

It also always didn’t also work out in Trump’s favor. In 2022, the conventional wisdom was that Trumpism was badly hurt and that Ron DeSantis was ascendant. Right? So anyway, in the week after the election, bad takes abound.

Demsas: [Laughs.]

Miller: That said, my answer is, I’m open to a variety of different things that the Democrats might have to do, among them being maybe nothing and watch Trump self-implode. Might be as simple as that. That said, the one thing that I think is certain that the Democrats need to reflect on when it comes to this question of why Trump won and why Harris lost—it’s that the Democratic message is not landing outside of a particular demographic of middle- to upper-income, college-educated, not particularly religious, urban- and suburban-dwelling white Americans, in addition to Black women, right? Those are the demos that the Democrats are doing well with, that Kamala Harris grew her share with from last time, at least in the case of college-educated women. And I think that the Democrats are doing a very poor job of communicating to people in all of those other demographics.

On what they need to do, I’m very open to various possibilities about whether it’s about affect or vibe or policy or whatever. But I’m certain that there is—fair or unfair, there’s a perception that the Democrats don’t care about these other demographics, particularly working-class demographics, particularly working-class men. And that they did not offer them something that was more appealing than the nostalgia and promises of gold bullion that they got from Donald Trump. And so we can hash through all the different theories about why that was. But I think the fact that what happened—you can’t argue with.

Demsas: Yeah. I think that that’s very descriptively true. But I guess what I would want to know from you is do you feel like there are specific things that Democrats have done that tipped the scales against them? I think that what you’re outlining here is very sound. There’s a difference between why Harris may have lost and what the Democrats need to do going forward to be a more electorally relevant party at the presidential level. And so from your perspective, though, is there something about the Democratic argument around the economy or other issues that you think was particularly relevant this time around?

Miller: I think that, for starters, people were unhappy with the economy. And I don’t think that the Democrats presented a message to them about how they plan to change that for the better. But, again, I’m also not even really ready to concede that, with the exception of inflation being annoying and that broadly hurting people, the Democrats were hurt based on their economic argument. It might simply be cultural. It might be the way that they spoke, and having people feel like they weren’t being heard.

I think the Democrats in particular—I always want to immediately go to, What is the policy prescription that would have appealed? And I’m like, It’s possible that there wasn’t one.

Demsas: Yeah. An important backdrop that I think you’re alluding to here, as well, is that the inflationary environment was really, really bad for incumbents across the world, right? You’re kind of going into an election where the fundamentals are sort of rigged against incumbents because the inflationary episode was just really, really hard for people. I think one narrative that I’m seeing come up a lot is about campaign strategy. And this seems like something that’s going to be hashed out significantly. But I guess the question I have here is whether you think Harris could have won with a campaign run differently, even given the shortened timeline.

Miller: I’m giving another “I don’t know” answer to that question: I don’t know. I think that she, by all accounts, ran a strong campaign that was based on her strengths. And I think she had an undeniably dominating debate performance. They ran a nice convention. Her speeches were good. The messaging pivot, the launch was good. There wasn’t a lot of drama inside the campaign, right? There are other things that she isn’t particularly strong at. I don’t think that she is that great in unscripted moments. Sometimes she’s better than others.

And so then that’s the other thing that people come to, which is like, Oh, she should have done Rogan and all this. And I agree. I think she should have done more of those interviews, but they also weren’t really her strong suit. And I think that this was something that might’ve borne out had there been a longer primary, and maybe somebody else would have emerged. But that said, I don’t think so. I think Kamala Harris was going to emerge from a primary, no matter when Joe Biden dropped out.

And so I’m not saying, Oh, this was inevitable. Just give up. Life is pain. [Laughs.] That’s not really what I’m saying. Any specific thing that people are like, Oh, if this tactic had been different, that would have helped—I don’t really buy that. I mean, I think that broadly speaking, her having the ability to separate herself from the administration would have been helpful, and I think that was very challenging to do given the situation Joe Biden left her in and the time period that was left. And I think that it’s very likely that she might have separated herself from the administration more and still lost, and we would have been here on this podcast with people saying, Why did she distance? [Laughs.] You know what I mean? Why did she break up the Democratic coalition?

Demsas: Yeah. I mean, it’s funny. I think that, on the tactics, I’m sort of with you here. I was looking at some of the data analyses that are coming out now, and it looks like, at this point, given the data we have, while the national average from 2020 to 2024 shifts roughly six points, in battlegrounds, that number is going to end up closer to three points. And that speaks to campaign effects. That speaks to the fact that in battleground states where, again, the majority of the money is going, people are putting ads in battleground states, the campaign is putting rallies there, she’s visiting, they’re really working the press in those places to get her story and message out in a way that you’re not really going to do in a safe, Dem county in Illinois or something.

And so as a result, what they see is that the campaign effects were good on a tactical level. Their ads were persuasive. There’s evidence from Dan Rosenhack at The Economist that it looks like the campaign effects were more effective than Trump’s on things like—indicating things like ads and rallies were better for Harris.

I think on this kind of broader meta question that you kind of raised, right, about Harris as the nominee, I don’t think this is inevitable. I mean, I wrote an article on July 9th arguing that she was unlikely to be a good nominee and the party shouldn’t coronate her, and Nancy Pelosi to The New York Times—I don’t know if you saw this quote, after Harris’s loss—she says that she had expected that if the president were to step aside that there would be an open primary. And that maybe Kamala would have been stronger going forward if she’d gone through a primary and that the president endorsed Kamala Harris immediately, which made it impossible to have a primary at the time. But it sounds like you’re saying that you think that, regardless, this would not have really changed the game that much.

Miller: Yeah, I mean, I think that had Joe Biden followed the—you can argue whether it was a promise or whether it was an indication that he was going to be a one-term [president] and pass the torch. And had there been a two-year process, maybe Kamala Harris does not emerge. But, look, there are three things that I think of when I hear this counterfactual about what would have happened had it been a more open process. The first thing is, the Democrat—one of the things that the Democrats have a lot of baggage around is identity politics. I think it would have been very challenging for a Black woman to be passed over.

Demsas: But the Democratic primary voters did this in 2019, right? There was this argument being made, but they said, no, we care most about electability and they chose Joe Biden.

Miller: Right, that’s true. But Joe Biden had been the vice president in that case. Kamala Harris was the vice president. You already saw this on social media. I saw this on social media, and I was basically for Kamala but also, at the same time, was like, maybe I think it’d be healthy to have an open process. And I guess if you could wave a magic wand, I probably would want Shapiro, Whitmer. Because hopefully that would win two of the three states you need to win the presidency. And that just seems like a safer bet to me. That was my position: It was like pro-Kamala and/but. And I had hundreds of people calling me a racist over that.

So, I think that it would have caused a lot of turmoil within the party.

Now, again, in a longer, two-year process, is that a lot of heat that then just dies out after a while, and you settle on something that’s a little bit more electable and everybody gets behind it except for a few people who have hurt feelings? Maybe.

No. 2, an open process opens up Gaza [as a] wound and rips that apart even wider, and I think creates potentially even greater turmoil than she already was dealing with on that issue. And that’s cost her, frankly. And then No. 3 is then if the theory of the case is a more electable person with someone that could get more distance from the Biden-Harris administration, that assumes that the Democratic voters were looking for somebody to do that.

And that is really where the tension is here, Jerusalem, because if you look at the data, a majority of the Biden-Harris Democrats were basically happy with the administration, right? There were surely big parts of the Democratic coalition, particularly younger voters, particularly working-class Black and Hispanic voters, the types of people that they lost ground with, that were unhappy with the Biden administration. But I think that there was a plurality within the party that was not going to be for somebody—look at the response to Dean Phillips, not exactly the most talented candidate, but total rejection and mockery for somebody who ran trying to get distance from the Biden-Harris administration.

So I think it would have been very challenging to run as a candidate and get distance. So to me, it’s like if we lived in an imaginary world where identity politics wasn’t an issue, Gaza wasn’t an issue, and there was no backlash to distancing yourself from Biden, then certainly the Democrats could have come up with a stronger option.

We don’t live in an imaginary world. And I think that within the world that we live in, within all those constraints, I think it’s very challenging to see a situation where you end up with somebody stronger than Harris.

Demsas: Yeah, I mean, all those points I think are very well taken. And I think I’m seeing a lot of people make that argument of both Harris’s inevitability as the vice president, and also this sort of sense of It would have been a worse candidate. I do think that kind of my general belief is sort of, when you think you’re behind, you run a high-variance play. If you’re gonna lose anyway, you just kind of throw everything you can at the kitchen sink.

And on this kind of inevitability point, right, I think there is this burgeoning sense that Democrats were just repudiated across the board here. You kind of brought this up, this idea that Democrats do not have a good answer on economic issues or on the issues that Americans care about.

But I don’t know, how do you reconcile that with the clear ticket-splitting you see going on here? [Nebraska’s Dan] Osborne ran seven points ahead of the Harris ticket. [Montana Senator Jon] Tester ran seven points ahead of the ticket. Amy Klobuchar ran six points ahead. That’s just in the Senate. And in the House, we see over-performances from everyone from AOC to Jared Golden in Maine, who’s a much more moderate member of the Democratic coalition. Doesn’t that indicate at some level that candidate quality was important here and that there were other candidates that were much more electable?

Miller: For starters, running the presidential race is so far different from running a Senate or House race that it’s almost not even the same sport.

It’s literally like T-ball versus the major leagues. What people expect from their—I mean, nobody’s like, Oh man, does Amy Klobuchar have to go on Joe Rogan? Nobody watches Amy Klobuchar’s debates. Obviously it’s a little different in Montana, where you’re running a competitive race. But again, just the interest in Senate races is different. I think that the Democrats have a coalition that is perfectly durable and able to win nonpresidential elections. I think that this trade in the voters that has happened where the Democrats are picking up more high-trust, more middle- to high-income, more college-educated voters, and the Republicans are picking up more low-trust, more middle- to low-income, and less educated voters. As a trade, that accrues to Democrats benefits in off-year elections and midterms and special elections, just because it’s the type of person that shows up for those types of things, and it accrues to the Republicans benefit in presidential elections. So that’s not good when the Republicans are nominating Donald Trump, and the Republicans’ presidential nominee is an existential threat to the fabric of our republic. And so that’s a problem.

And so I agree that you can’t look at the data and say, oh, the Democratic brand is irreparably harmed. Like, no, the Democrats won. And a lot of these Senate races are going to end up very narrow minorities, in the House and the Senate, that they will probably be able to win back in the midterms, depending on what happens.

But I think that there are two things, which is, No. 1, the Democrats are not well suited to running presidential elections right now, in this media environment, and then No. 2 is that the Democrats have abandoned huge parts of the country where they are not viable. And that’s particularly problematic, given the Senate and Electoral College and the way that’s set up.

So okay, back to No. 1. Democrats are really good at running campaigns that are set pieces. They have professionals that are running these campaigns: the ads, the conventions, the speeches, the going to the editorial-board meetings, the 2004-type campaigns. And that’s how Senate and House campaigns are basically still run in most of the country, and even governor’s races, right? People just don’t care about those races at that deep of a level. But the presidential race is—the media environment around it is so different. I mean, people are consuming information about the presidential race on their TikTok, listening to sports talk, listening to their random podcasts that aren’t about sports at all that are cultural, on women’s blogs, at a school function, people are talking about it casually, you know what I mean?

I’m a parent, and obviously this is a little bit of selection bias since I’m in politics and people know that, but people don’t come up to me and ask me what I think about the House race in my district. Nobody’s mentioned Troy Carter to me at any events,, at any school functions or any of my kids’ sporting events.

Demsas: He’s got to get his name out there. [Laughs.]

Miller: And so the information environment is just a total category difference. And Trump and even J. D. Vance in certain ways were able to take advantage of that by running campaigns that are a little bit more unwieldy, that are better for viral clips, that are also better for sitting down for two hours and broing out with the Theo Von and talking about how you can’t even do coke in this country anymore because the fentanyl is in it, right?

She wasn’t doing any of that. And doing one of those interviews isn’t really the answer, right? It’s like, can you communicate in a way that feels authentic? It might be fake authenticity, but in a way that feels authentic to people in their Instagram Stories, in their TikTok, in their podcasts, whatever.

And Democrats are not producing a lot of candidates who I feel are good at that.

Demsas: But I think there’s also this broad concern that the media ecosystem itself is not producing convincing, progressive-sounding or left-leaning media personalities. There’s a 2017 AER study that I remember being very, very shocking to people when it first came out, right after Trump’s election in 2016. And there are a couple economists, they look at the effect of Fox News, and they find that watching Fox News for an additional 2.5 minutes per week increases the vote share by 0.3 percentage points. But watching MSNBC has essentially no effect, and they see that Fox News is actually able to shift viewers’ attitudes rightward. And they look at 2004 and 2008 and find that Republican presidential candidates’ share of the two-party vote would have been more than three points lower in 2004, and six points lower in 2008 without Fox News.

And so that’s something where I’m just like—there is something to the fact that the media ecosystem does not have that sort of targeted apparatus. But my usual belief about these sorts of things is that we’re discounting the fact that so much of the media is so liberal that Fox News can have this large effect because it I think stands out among a pack of more liberal institutions, but I am kind of surprised at MSNBC.

Miller: Yeah, I mean, as a person on MSNBC, did that study go on before I was a political contributor? I think it did. So we might need to update the study and have them focus on my hits and see if that changes anything.

I guess I want to noodle on that for a little bit. That does surprise me a little bit as well, but I would say this: I think that I’m less concerned. I think there’s a category of person out there, and maybe this is right, that is focused on Republicans have better propaganda outlets than the Democrats do.

Demsas: Yeah.

Miller: And maybe that’s true. I don’t know. So to me, then the question is, okay, what can be done? What is realistic in this media environment? And it goes back to this question of, can the Democrats speak more through using existing outlets or finding a candidate who has a compelling story in their own right, or compelling communication skills to figure out how to speak to people that don’t watch mainstream news?

And that’s just really what it comes down to. The Democrats are very good at talking to people that are high-information, high-engagement, high-education, middle-to-high-income, and offering persuasive arguments. I think that they’re not good at talking to anybody else. And Obama was good at that, and Clinton was good at that. And we’re in a totally different media environment now than we were back then. But I think that there’s still things that can be learned from that.

[Music]

Demsas: After the break, why the abortion-ballot-measure strategy didn’t pan out for the Harris campaign.

[Break]

Demsas: I want to pull us out of this media conversation here, because I think that there’s also this, let’s say things go a little bit differently—and again, the margins here are not very big—and Harris has won.

I think one of the big things we’d be hearing right now is that she won because of abortion, right? And looking at Election Night, you see a lot of wins for abortion. There are 10 states that have referendums on abortion policies, and seven of them win: New York, Maryland, Arizona, Nevada, Colorado, Montana, Missouri. And in Florida, where it loses, the threshold is 60 percent and it earns 57 percent, so it lost, but there’s clearly a majority in favor.

And, going in, I mean, especially after the midterms, there was a real feeling, kind of the big narrative that came out of those midterms was that abortion is the place where Democrats can clearly distinguish and can clearly win over Republican candidates, even in deeply Republican states, and especially in deeply purple states.

And I’m trying to think through this. What explains in your mind the sort of difference between how many voters were saying, Yes, I do have more liberal views on abortion; I’m willing to express those in these ballot measures; but no, I’m not going to then reward Democratic presidential candidate Kamala Harris for it?

Miller: Well, a couple of things. No. 1, this tension has always existed as old as time, and it’s particularly existed as old as time in places like Florida. I did one of these, you know, time is a flat circle—

Demsas: [Laughs.]

Miller: I forget which election it was at this point, but it was like, how did the minimum-wage-increase ballot initiative in Florida pass at the same time that Ron DeSantis won by 18 points or whatever, whichever election that was.

And it’s like, voters are complicated. Voters have complex views. And so you see this as kind of just a common thing in voter habits. In this case, I think that there are a couple of complicating factors in addition. No. 1 was, Donald Trump muddied the waters on his views.

Demsas: Yeah.

Miller: And I think that Donald Trump’s whole brand and vibe—I know we’re getting outside of the data space that you like to be in, Jerusalem, but there’s a certain group of people that are like, Yeah, that guy’s not gonna ban abortion. You know what I mean? And there’s just some percentage of voters out there that that’s just it. He doesn’t come off like Ted Cruz on abortion. He comes off as different, because they assume that he paid for an abortion or whatever, that he doesn’t care about it, and that he’s not gonna—this isn’t gonna be what he’s focused on. There are going to be people that are pro-choice that prioritize their economic views or their nativist views, right?

So that is going to be some of it. I think less so in Florida, but more in Arizona. To me, I think that there is actually a strategic backfiring of having these ballot initiatives on the ballot almost gave some people an out to do both, right? People that did not like Kamala Harris or that were more center-right and said, Oh, okay, great, I can protect abortion in Arizona and also vote for Donald Trump. I can have my cake and eat it, too.

Demsas: Yeah, I mean, I think my read of it is more that when you think about the specific argument being made about abortion, it was largely, he’s to blame for all these horrible things that are happening to women in states that have made abortion inaccessible. And by he, I mean Trump is to blame for that. And also, you know, he appointed these Supreme Court nominees who overturned Roe v. Wade. But as a prescription for the future, I feel like there was not a real clear argument made to voters of how Kamala Harris is going to actually protect abortion.

But again, it all comes back to the overarching question, did voters view this as an abortion election? And it seems clear that they viewed it as an inflation election. That was the core thing that they were focused on. And I think that one thing that I’ve heard a lot is what this means for understanding America, right?

So after 2016, people were just, I think, in shock, and were saying, I can’t believe this is the country I live in. And again here I’m hearing the sort of question of, you know, this is a black mark on the conscience of America, that people would vote for someone who threatened to overturn the results of the 2020 election, who talks with such liberal disdain for women and immigrants.

Something someone said to me in 2016 was really interesting: If your entire perception of America would have shifted if a few hundred thousand people voted differently, maybe don’t completely change everything you believe about everyone. And to me, I think that this framing about Trump’s reelection means something really dark about all the people that voted for him doesn’t really sit well with me because it seems like people are voting based on cost of living. At the same time, too, I think they’re taking their signal from Democrats who, if they’d taken their own warnings about the threat of fascism or the threat to our institutions, I think would have behaved very differently over the past couple of years in trying to win.

Miller: Yeah. It doesn’t change my view of the American people, really, that there are good people and bad people everywhere, that we all have good and bad inside of us. I’ll say that what it does impact for me—and maybe this is wrong and maybe I’m raw and it’s six days out—but for those of us who do have a belief that there’s something kind of special about the American system and that have revered America, that understand that America is flawed and has made mistakes but still is a unique experiment in the world. You know, the “America is an idea” type of thing.

The idea is pretty dim at this point. And, to me, that is the change, having him win again, that I’m having trouble getting over. Mentally, it’s not that it makes me look poorly at my neighbors, but that we just might be at the end of the experiment and the sense that America is something different than Hungary or Switzerland or whatever, any country—you name the country.

It was the old fight with Republicans and Democrats during the Obama years, which is, Obama doesn’t think of America as any different than Belgium. Obama believes in Belgian exceptionalism. And that to me is kind of where I am. I think that we’re about to move into an era where America’s flaws, in addition to all of our existing flaws like gun violence and our history of racism, et cetera—the American system’s flaws look a lot more like what flaws look like in other countries.

There’s going to be oligarchy, kleptocracy, corruption. There’s no special sense that the huddled masses around the world are welcome here any more than they might be welcome anywhere else. They frankly are probably going to be welcome here less than they’re welcome in certain other places.

And so to me, that is what I see differently. I reserve the right to change my mind about that at some point, but that’s where I’m at right now.

Demsas: Yeah. I think in contrast to this large view about the American idea of maybe being different than we believed beforehand is this, I think, really popular take that’s picking up steam, which is about just Democrats need to moderate on cultural issues, whether it’s about immigration, or it’s the issue of trans women and girls in sports. They’re just too left of the median voter, and you don’t actually need to do a bunch else other than accept that people are where they are on those places and not go so far away from it.

The data point that’s kind of in favor of this, particularly on the trans-girls-in-sports one, is Kamala Harris’s leading super PAC, Future Forward, finds that the most effective, or one of the most effective, Trump ads is one of the “Kamala is for they/them, President Trump is for you” ads. They find that it shifted the race 2.7 percentage points in Trump’s favor after people watched it.

How relevant do you think that the Democratic Party’s leftward shift on cultural issues is to Harris’s loss? And I mean, there’s some people who I think are really making the claim that you could just really focus on this and you don’t need to make these kind of larger arguments about strategy or how we’re speaking to America on economic policy.

Miller: I don’t think that this was alone to account for Harris’s loss or even maybe the biggest thing to account for her loss. I think that she didn’t really respond to that ad in particular quite well, and that maybe that was a strategic mistake. I think her campaign—and she didn’t run like an overly “woke,” culturally left campaign. Ao the question is, did the Democratic brand on those issues drag her down? I think possibly.

To me, look, could Kamala Harris have squeaked out a victory this time while holding the same positions on trans issues had inflation been 20 percent better? Maybe. Probably. It was a clear victory for Trump, but it wasn’t, you know, Reagan ’84.

A couple of things changed, and had that one, the cultural stuff stayed static, could she have still won? Clearly. I mean, Biden won in 2020, when all of those issues were more high-salience, I think, than they were this time. Biden, not a Black woman—so maybe there’s something to that as well, that he was able to be a little bit more resilient against attacks on those issues.

So maybe that’s worth thinking about. I would say this, though. If the Democrats want to have 60 senators again ever, then yeah, they got to moderate on cultural issues. You know what I mean? There are two ways to look at this: Can Democrats still win elections by maintaining their views on everything? Yes. Are the Democrats giving away huge swaths of the country by not really even engaging with their concerns about the leftward shift of the party on a wide array of issues? Yeah, they are. I get the land-doesn’t-vote thing, I get it, but look at the map.

Demsas: [Laughs.] We’ve all seen the map.

Miller: The map is still the map, you know what I mean?

And Trump gained in all of those little red counties out there where it’s just land, all right? But he gained. There are a handful of people out there, and he got more of them, in every county. And the Democrats’, I think, choice to just say, Well, we’re just giving up on that and we’re just going to focus on the more dynamic parts of the growing parts of the country and, eventually, demographics are destiny and blah, blah, blah, that looks like a pretty bad bet today.

I’m not out here being like, yeah, you got to throw trans people or migrants under the bus for them to win. But certainly the cultural leftward shift has created a ceiling on Democratic support that I think has a negative effect for the party, but also for progress on a lot of those issues.

Demsas: Yeah. I think it’s obviously very up in the air here, how people are gonna take this mantle of how you should moderate, and I think that there’s bad and good ways that people can take this. And I think that there’s a level to which people—you don’t have to be throwing trans people under the bus. Maybe we need to figure out ways, whether it’s how Democrats responded to this with gay rights, where they talked about federalism a lot and made sure the country moved toward the issue before making it a national issue.

But I think the most important and damning thing that Democrats are clearly responsible for in the choices they have made is about the poor governance in blue cities and states. This is one of my hobbyhorses, but you see massive shifts, as you mentioned, in high-cost-of-living places that are heavily democratic, in New York and in California and in a lot of the Northeast. And I think it’s hard to see that as anything other than just a repudiation of Democratic governance and particularly the cost of living and the cost of housing in these places.

And so, to me, when you talked about the Democratic brand, I mean, when you’re in a cost-of-living election, yes, there are marginal effects on these cultural issues we’re talking about here. Yes, there are things that campaigns can do better. Yes, there are candidate effects. But if people are asking themselves, What does it look like, how does it feel to my pocketbook to live in a Democratically run state versus a Republican one? I feel like they’re being told a very clear story.

Miller: I think that that’s true. I’ve been ruminating on this a lot over the past week. I live in Louisiana, so there is the kind of emotional guttural response I have to this, which is, do you think Louisiana is being governed that well? Because I don’t.

Demsas: Yeah. Well, on cost, though, right? It’s cheaper, obviously, to have a house in Louisiana.

Miller: It’s cheaper to have a house in Louisiana because of the economic destruction of the state over the past couple of decades and the fact that everybody that grows up in parts of the state that’s not this corridor between New Orleans and Baton Rouge leave home. And a lot of people in these places leave home, too, looking for better economic opportunities. And that’s sad for the state.

That is my initial response, which is emotional, which is like, okay, sure. But why does Kamala Harris have to carry the baggage for the place I used to live—Oakland—but Donald Trump doesn’t have to carry the baggage for the hollowing out of big parts of Louisiana? That said, it’s true that it hurt the Democrats, right? And it’s also true that the Democrats have been badly managing these big cities. And if you just look at the numbers, suburban Democrats—and this could be a counterargument. Now, I’m going to really give you a galaxy brain, Jerusalem, to your original data point earlier that the three-point effect in the battleground states versus national speaks to a campaign effect? Maybe.

Maybe it also speaks to the fact that a lot of these battleground states are made up of places that have mixed governance and big suburbs where the Democrats are doing better. Democrats are doing better in suburban America because they know they’re not feeling the acute pain of governing issues that have plagued a lot of the big cities. And surely there are a couple of big cities in those seven swing states, but none of the ones you think of when you think of major disruptions, and that maybe that explains it and that the Republican gains were in a lot more of those places like that, Illinois, New Jersey, California. Anyway, just something to noodle on.

But I think that it is objectively true that Democrats are doing better in places that have not been plagued by some of these bad governing decisions on crime and on housing that we’ve seen for in Democratic cities, and the Democratic mayors and Democratic governors in blue states should fix that.

And it’s the No. 1 thing—the last thing I’ll say on this is—the No. 1 thing that comes to mind when I already hear stupid parlor-game stuff about 2028 and it’s like Gavin Newsom and J. B. Pritzker. And to me, the No. 1 thing Gavin Newsom and J. B. Pritzker need to do if they want to run in 2027 is make Illinois and California run better in the meantime. Otherwise, nothing against either of those two guys, but I think that they’re going to carry this baggage that you’re talking about.

Demsas: Well, I could go on about housing in blue states forever. And there’s an article popping, I think today, listeners, as you’re hearing about this, about why I think this was a big issue for the election.

But Tim, always our last and final question.

Miller: Okay.

Miller: What is something that you once thought was a good idea but ended up only being good on paper?

Miller: Oh, okay. Hold on. I wasn’t prepared for this. I misread the question. I thought it was an idea that was only good on paper that then ended up being not good on paper.

Demsas: Idea could be good.

Miller: No, no, no. I’ll come up with one where I’m wrong. I’m happy to bet where I’m wrong. I was just saying the ideas are endless on those.

Demsas: Oh. Yeah, yeah, yeah. Something that you held, yeah, yeah, yeah.

Miller: An idea that I thought that was good on paper that ended up not being good on paper. Well, I guess I have to give the obvious answer to that question, sadly. I don’t get to rant about daylight savings time as I hoped to—an idea that was certainly good on paper in the 1800s or whenever they came up with it that’s no longer good. Falling back, that is. Permanent daylight saving time: good idea.

Changing times: not good.

Demsas: Four hundred electoral votes for whoever does this.

Miller: Yeah. The idea that I thought that was good on paper that is relevant to this podcast—because I literally put it on paper and wrote it—was the aforementioned 2013 GOP autopsy.

Demsas: Oh, yeah.

Miller: Well, how great! Compassionate conservatism. Republicans can diversify their party by getting softer on cultural issues and reaching out to the suburbs and reaching out to Hispanic voters and Black voters, criminal-justice reform, and that through criminal-justice reform and immigration reform and softening on gays, that Republicans can have a new, diverse electorate, and we can all move into a happy, bipartisan future.

That was a great idea on paper that backfired spectacularly, and now the Republicans have their most diverse electorate that they’ve had ever, I think, voting for Donald Trump after rejecting all of those suggestions that I put on paper. So there you go.

Demsas: As one vote of confidence for younger Tim, there are very many ways that history could have gone. I think that people often forget how contingent things are and how unique of a figure Trump is. And right now we’ve talked through a bunch of different ways that people are reading this moment, but there are a lot of ways that people can go, depending on what candidates do and say and how they catch fire and their charisma and what ends up being relevant in two years and in four years. So a little bit of sympathy for younger Tim.

Miller: I appreciate that. And that is true. Who the hell knows, right?

Demsas: Yeah, exactly.

Miller: Had Donald Trump not run that time and he decided he wanted to do some other scam instead, then maybe Marco Rubio is the nominee and those things do come to pass.

Demsas: [Laughs.] Yeah. If Obama doesn’t make fun of him at the White House Correspondents’ Dinner, we’re not even sitting here on this podcast.

Miller: Great job, Jon Lovett, or whoever wrote that joke.

Demsas: [Laughs.]

Miller: I’m just joking.

Demsas: Yeah. Well, thank you so much, Tim. Thanks for coming on the show.

Miller: Thank you, Jerusalem.

[Music]

Demsas: Good on Paper is produced by Jinae West. It was edited by Claudine Ebeid and engineered by Erica Huang. Our theme music is composed by Rob Smierciak. Claudine Ebeid is the executive producer of Atlantic audio. Andrea Valdez is our managing editor.

And hey, if you like what you’re hearing, please leave us a rating and review on Apple Podcasts.

I’m Jerusalem Demsas, and we’ll see you next week.

Democracy Is Unfortunately Not Essential to Economic Growth

The Atlantic

www.theatlantic.com › ideas › archive › 2024 › 11 › democracy-acemoglu-nobel-prize › 680522

Last month, the 2024 Nobel Prize in economics was awarded to three scholars, Daron Acemoglu, Simon Johnson, and James Robinson, for “studies of how institutions are formed and affect prosperity.” Don’t let the dry language fool you: The award generated more controversy than any other in recent memory. One critic wrote that “it exposes how the economics discipline fails to ask critical questions.” Another called the trio’s work “historically inaccurate, if not ideologized.” I confess to emailing a long rant to colleagues in my department.

Why so much drama? In the work that won the Nobel, Acemoglu, Johnson, and Robinson—three highly respected economists almost universally referred to as “AJR” by their peers—argue that nations with democratic institutions have the most economic growth. It’s an appealing thesis that reaffirms the political systems of Western democracies. The problem—not just for the theory, but for the resilience of those political systems—is that it simply isn’t true.

According to AJR, certain kinds of economic institutions—private property, freedom of contract, a strong and impartial legal system, the freedom to form new businesses—are “inclusive,” meaning they allow most people to freely participate in the economy in a way that makes the best use of their skills. These institutions create modern, wealthy economies that are driven forward by technological innovation, not merely propped up by having won the natural-resources lottery.

Economic institutions do not just drop out of the sky. The laws and systems that make an economy run, such as market regulations, must be created and maintained by governments. AJR therefore argue that political institutions dictate economic outcomes. A nation’s political institutions are what determine who can rule, how these rulers are chosen, and how power is distributed across government. The institutions are enshrined in constitutions, electoral rules, and even traditions. In a dictatorship or monarchy, political power is narrowly distributed and relatively unconstrained. In such cases, AJR argue, a small ruling class will tend to use its power to restrict competition and extract wealth for itself. By contrast, if political power is widely distributed across diverse groups in a society, then their common interest in doing business, and competition among them, will result in prosperity-generating economic institutions.

In the United States, for instance, the oil industry would prefer not to have to compete with alternative energy. Old-stock citizens don’t want to compete with recent immigrants. But if the government is given the power to exclude my rivals, that same power could potentially be used against me. So, according to AJR’s thesis, our common desire to maximize our individual liberties and protect our property prevents us from ceding such power to the government. We’d rather keep the competition than risk getting shut out of the game. And that competition forces us to be ever more efficient.

In the end, AJR claim, decentralized democratic systems such as those found in the U.S., Germany, and Switzerland foster economic prosperity by improving a nation’s ability to innovate. Democracies with more centralized power are less productive. (Think of countries such as France, Portugal, and Greece, which have less separation of powers, fewer checks and balances, and relatively weak state and local governments.) Finally, one-party states and authoritarian regimes—those with even more centralized and less competitive political systems—breed stagnation.

[Gisela Salim-Peyer: Why does anyone care about the Nobel Prize?]

The most common critique of the AJR thesis hinges on methodological objections to the way in which they collected and analyzed the data. But you do not need a degree in economics or statistics to be skeptical of their argument. The real world simply provides too many counterexamples.

On the one hand, there are the nondemocratic systems whose economies have done quite well. To take the most obvious, China’s economy has grown fantastically since the late 1970s even as its political system has remained autocratic and repressive. It is now a global competitor or leader in electric vehicles, solar panels, quantum computing, biotechnology, mobile payment systems, artificial intelligence, 5G cellular, and nuclear-fusion research. South Korea and Taiwan are democracies now, but each grew from an agricultural backwater into a technological powerhouse from the ’60s to the ’90s, while they were relatively authoritarian states. The same goes for Japan. After World War II, Japan’s wealth grew dramatically as the country became a world leader in technology and manufacturing. At the time, it was a one-party state, with heavy government intervention in the economy. Elections were held regularly, but only the Liberal Democratic Party won. The party therefore controlled almost every major political institution throughout the country for nearly four decades, resulting in infamous, widespread corruption. Still, the economy flourished.

On the other hand, examples abound of decentralized democracies that don’t experience the kind of knowledge- and technology-driven growth that AJR celebrate. Canada is a relatively wealthy nation, but over the past several decades, without any change to its institutions, it has fallen into a prolonged productivity slump. AJR consider Australia, another decentralized democracy, to be an example of their theory in action, but its wealth comes overwhelmingly from natural resources; it is not particularly good at cutting-edge science and technology. Nor has decentralized democracy propelled Argentina, Brazil, Mexico, and India into the economic stratosphere. Great Britain was the world’s wealthiest and most technologically advanced high-tech superpower during the 18th and 19th centuries, but it lost that position even as its political institutions became more democratic and distributed.

A particularly revealing example is Spain. Spain has been institutionally transformed since 1975. It went from 40 years of military dictatorship to a market-oriented, decentralized democracy. Despite this revolution, there has been little relative change in Spain’s national innovation rate. Its economic growth per capita has averaged less than 1.5 percent per year since the dictatorship ended. That’s far worse than Ireland (a unitary democracy), Singapore (a “partly free” one-party democracy, according to Freedom House), and Vietnam (a communist dictatorship), each of which leveled up its economic competitiveness during the same time period.

AJR have responded to these critiques, often in point-by-point fashion. They have argued, for example, that China’s growth will be unsustainable in the long term if its political institutions don’t change. India, meanwhile, might be a decentralized democracy, but it is “highly patrimonial,” which “militates against the provision of public goods.” Arguments such as these are unfalsifiable: One can always explain away seemingly inconsistent results by pointing to some overlooked characteristic of a given country. And if a culture of patrimony has defeated otherwise-healthy institutions in India, then maybe institutions aren’t so fundamental after all.

If political institutions don’t explain economic outcomes, what does? My colleagues who study innovation and economic growth point to many possible answers, including culture, ideology, individual leadership, and geography. In my own research, I have found that countries with technology-driven, high-growth economies share one thing in common: a powerful sense of external threat. Some fear invasion; others worry about being cut off from a vital economic input, such as energy, food, and investment capital. Taiwan’s very existence is threatened by China, as was Israel’s after the Arab states began to unite around it. These two countries needed to build high-tech defense industries at home and earn money to purchase advanced weapons systems produced abroad.

Stagnant economies, by contrast, tend to be more focused on internal divisions. They are less concerned about military attacks or imports of essential goods and suffer more from deep conflicts over class, race, geography, or religion. If a nation’s internal threats are perceived to outweigh its external threats, then its people will fear the costs, risks, and redistribution of building a competitive economy. The pie is safe, so they fight over the relative size of their slice. (If I’m right, then Donald Trump’s focus on persecuting “the enemy from within” bodes ill for America’s economic prospects should he be reelected this week.) But if a nation’s sense of external threat is greater than its sense of internal threat, then it tends to invest in innovation. The costs and risks are worth it. The pie is in danger, so people cooperate to defend it.The question of why some countries thrive and others stagnate isn’t just an academic one. In the late 1980s and early ’90s, under pressure from the West, Russia created a parliament and privatized state assets; the West declared victory. The U.S. invaded Iraq in 2003, set up a parliament and a stock market, and then announced “Mission accomplished.” The promised economic miracles never materialized.

[Brian Klaas: The dictator myth that refuses to die]

Western democracies too often assume that setting up the right institutions will bring about the desired outcomes. It doesn’t. A society uses institutions to accomplish its goals. But the goals come first, and they are determined by fights over wealth, power, resources, ideas, identities, culture, history, race, religion, and status.

How did such a demonstrably incorrect thesis win the Nobel Prize? In part, I suspect, because it tells the story that many educated Westerners want to hear about democracy. We want to live in a world where democracy cures all. But if democratic nations overpromise what democracy can achieve, they risk delegitimizing it. In Russia, China, and much of the Middle East, democracy is widely seen as dysfunctional, partly because it has not delivered the promised economic prosperity.

Ambitious politicians recognize that institutions are tools, not causal forces. In different hands, the same tools will achieve different ends. Men such as Hitler and Mussolini understood this. They exploited fundamental political divides to undermine both democracy and markets. These lessons are not lost on modern leaders such as Xi Jinping, Vladimir Putin, Recep Tayyip Erdoğan, Viktor Orbán, Narendra Modi, and even some here in the United States. We therefore ignore the more fundamental political forces at our peril. So do Nobel Prize winners.