| Apr 30 | Law And Medicine: Sweden |
| Apr 29 | Friday Chinchilla Blogging & Shuffle |
| Apr 28 | Absotively |
| Apr 27 | In Which I, Nick Beaudrot, Claim to Have All the Answers |
| Apr 24 | Offense Wins Championships |
| Apr 23 | Law and Medicine: Japan |
| Apr 21 | Law and Medicine: Germany |
| Apr 21 | Law and Medicine: Canada |
| Apr 20 | Law and Medicine: United Kingdom |
| Apr 20 | Medical Malpractice Policy: France |
| Apr 17 | Yeah, That's About Right |
| Apr 16 | The Electoral Math of Social Security, or, Karl Rove's fuzzy math, part #870 |
Well, Ezra's packed it in on health care, but I wanted to talk at some length about the Scandinavian system for medical malpractice. Sweden, Norway, Denmark, Finland, and New Zealand all have "no-fault" systems of malpractice compensation that radically alter the relationship between doctors, patients, and the legal system [Yes, I realize that New Zealand is not in Scandinavia. But they have the same kind of system].
How does it work? You fill out a form. Really, that's it. All clinics and hospitals are required to provide patients with a form they can fill out to describe what happened to them in the event of malpractice -- it's generally better to have a lawyer help you fill out the form, but in theory it's simple enough that anyone could do it. The form then goes to an government-appointed review board, which includes three representatives from the health care unions and five elected officials. Roughly 40% of all claims that are filed result in an award to the patient, a much higher rate than US civil law produces. Non-economic losses are determined by a pre-set formula -- losing your eye is worth 75,000 Euro, losing a hand is worth 150,000 Euro, etc. (I'm making these numbers up) -- and not subject to appeal. Maximum damages are set at 880,000 Euro ($1.2 million).
Patients who are unhappy with their initial settlement can appeal their award to an arbitration board, which is used rarely but is available to the patient at no cost. In many cases the entire appeal is handled by mail. What's more, payouts from trials brought under the Patient Torts Act are generally lower than those paid out through the Compensation Fund. Total awards for cases that go to trial are capped at $730,000.
A seperate Medical Responsibility Board is responsible for reviewing claims of malpractice bad enough to warrant disciplinary action against health care providers.. The Medical Review Board takes its job seriously, and has the intestinal fortitude to discipline doctors. Roughly 20% of all malpractice claims result in a warning or admonishment that's placed on the doctor's (or nurse's) permanent record, and in 1% of all cases go so far as to revoke the doctor's (or nurse's) license to practice.
Who pays? Counties use local tax revenue to fill the government's Patient Insurance Compensation Fund, which then makes payments for malpractice claims. Doctors are also required to purchase liability insurance separately to cover those cases which go to trial.
How effective is it? Because the system is so easy to navigate and doesn't require hiring a lawyer, Sweden has three times as many patients who apply for malpractice compensation (10.5 per 10,000 people) as the United States (3.1 per 10,000). However, over 50% of all claims are ruled frivolous by administrative staff, so the effective rate of is closer to 4.2 per 10,000 citizens. The average payout is approximately $10,000, which is roughly 30 times lower than the average settlement or jury award here. This puts payouts at a level far lower than in the US, accounting for .015% of GDP and .16% of all health care spending, compared to .2% and 3% respectively for malpractice claims in the US. Administrative overhead is approximately 18%, and there are no contingency fees, so the overall overhead is probably much lower.
Because of it's status as a quasi-trial court, the Swedish compensation system has come under criticism as possibly violating Article 6 of the European Convention on Human Rights, which claims that every European has the right to a public hearing by an impartial court. If you ask me, calling that a fundamental Human Right seems like a stretch, but to each his own.
Sources: The Swedish Compensation System: A viable alternative to the U.S. tort system? EU Study on National Liability Systems [1, 2], Studdert et. al, "Can the United States Afford a 'No-Fault' System of Compensation for Medical Injury?"
Coming Next: I'll put together a wrap-up of what I think the US could do to control malpractice costs, speed the processing of claims, and still be fair to wronged patients, all at the same time.
I believe the leader of this pack is Roxanne, but I could be mistaken.
You may now mock me mercilessly for owning music by Korn and/or Avril Lavigne. Other than that it's hip-hop day on the dial.
Also, it's snack time:
At last, we discover that JimmyJeff GannonGuckert is the product of cross breeding between Miss Piggy and Beaker.
In related news, conservative bioethicists have called on the Bush administration to oppose the further creation of muppet hybrids.
Today has seen a new attempt be the center-left blogosphere to answer the eternal question "how do you fit liberalism on a bumper sticker?" Yglesias, Klein, Kos, Digby, and Drum have all chimed in at one point or another. The consensus seems to be that it's important to have both (a) sufficiently specific statements that the opposition can't simply say "well, I'm for that too!" and (b) specifics that conservatives must inherently reject. I usually don't have much to offer to bumper-sticker discussion, but somehow today I find myself with slightly better command of the English language than usual.
During The American Prospect's 30 word competition, I submitted this entry:
Liberalism represents a new set of freedoms: freedom from poverty for all who work; from bankruptcy cause by sickness; from intolerance and hatred; and from the fear of nuclear proliferation.
It's a weak attempt to riff on Roosevelt's "Four Freedoms" concept. Roosevelt's freedoms were speech, worship, want, and fear, but that doesn't make for a very good campaign slogan, so I ended up picking a different set of four freedoms. I found the exercise helpful, but the results were slightly dissatisfying -- a slightly higher word limit wouldn't even have been enough to get the sentiment right. What's more, this phrasing still doesn't have the same punch as the conservative bumper sticker of "smaller government and lower taxes, family traditional values, and a strong national defense". It's not even in the same ballpark.
But today, over at Ezra Klein's, I was inspired by Digby's suggestion:
fair taxes, a secure safety net, personal privacy, civil rights, and responsible global leadership.
Which I modified to look like this:
A stronger safety net, responsible budgeting, a fairer playing field for businesses, and global leadership.
But I would now like to revise again to look like this
A stronger safety net, responsible budgets, family privacy, better citizenship from business, and responsible global leadership.
Contra Digby, claims that liberals are for fair taxes and conservatives are not simply won't work. After all, the addle-brained House members who support flat taxation (whose numbers include both the Republican1 Speaker and the Majority Leader) have a bill they call the "Fair Tax Act". Has the press called them on this game yet? Who in the world is going to say they're for unfair taxation? That's like saying you're running for President on a platform opposing job growth. The same goes for civil rights -- remember that discrimination has was always been couched in the language of "preserving liberty of private citizens", which, in theory, is a civil right in and of itself.
Conservative government clearly involves a weak safety net: witness the bankruptcy bill, the wretchedly executed Medicare bill, attempts to dismantle social security, a punitive notion of welfare reform rather than honest assessments of what's needed to get welfare recipients back to work, the Freedom to Farm Act, and so on. Empirically, the conservative notion of "budgeting" is fundamentally irresponsible; of the 20 years of Republican rule, we will likely have structural deficits for 18 years (the exception being the last 2 years under George HW Bush). My hunch is that "family privacy" probably focus-groups better than "personal privacy" and covers family planning, gay rights, end-of-life issues, and religious freedom. In all these cases, the Republican party would rather have the government intervene just for grins. As for global leadership, well, you're not a leader if no one follows. Business citizenship encompasses environmental protections, workplace safety regulations, the minimum wage, and hits universal health care again. Finally, between our abandoned treaties and the rapidly disintegrating Coalition of the Willing, there aren't too many folks out there who are following.
It's not perfect. For one, it's still a hair too long: it's sixteen words, and they're all a bit heftier than words in the twelve-word Republican bumper sticker. It uses the word "responsible" twice, which I'm not thrilled by. And it still feels a bit like a laundry list. Perhaps the "stronger safety net" could go. Still, I think this is a reasonable starting point for the elusive Liberal Bumper Sticker. It avoids policy specifics like "universal health care", traps like "fair taxation", and potentially divisive statements about abortion or gays.
Revisions are more than welcome.
Update: More suggestions from Article 19, Political Interest, CapitalistImperialistPig [sic], and Daniel Starr. I think Starr's bumper sticker is pretty good, too.
1Remember to remind everyone who controls Congress whenever they have bad ideas.
Matt's right that John Hollinger has pulled a bit of a bait-and-switch by discussing offensive efficiency versus the pace of play when trying to determine if the old adage "defense wins championships" is true. But then Matt pulls the trick himself:
The best way to score tons of points is to play really, really fast. But teams who rely on this strategy seem to underperform in the playoffs. Be that as it may, I have mixed feelings about the Suns. My personal preference is for slower, defense oriented basketball à la Detroit. But I think the conventional wisdom that success for the run-and-gun Suns would help "save the NBA" from its relative unpopularity has something to it. Certainly most people seem to prefer the basketball fast and sloppy.
Fun-n-gun teams seem to underperform in the playoffs because they're aren't enough of them. Really, there have only been two such teams in the last five years: Dallas and Sacramento (well, some of the Antoine Walker-Paul Pierce Celtics teams might fit the bill). Considering the Kings were one Robert Horry three-pointer away from making the NBA finals, I'd say they're not doing terribly. What's more, there's no reason to think that playing fast implies playing sloppy. To the contrary, the Phoenix Suns are second in field goal shooting and in the middle of the pack on turnover per game. Dallas, one of the other supposedly banal "fast and sloppy" teams, ranks fifth in field goals and has the fifth fewest turnovers per game. Sacramento is seventh in shooting and third in fewest turnovers per game. Considering the fun-n-gun teams hold more possessions per game than the average team, it's likely that they're actually more careful with the rock on a per-possession basis than, say, the Heat, which rank just below Phoenix in turnovers per game
The best slow and precise defensive team on the market is probably Minnesota, which ranked fourth in shooting, had the fewest turnovers per game, and ranked seventh in holding down opponents' field goal percentage. You could ask Kevin Garnett how well this style of play works, but busy he's making tee times, so that might not work. Detroit, with its plays-the-way-old-people-make-whoopee* style of basketball, ranks 17th in shooting and seventh in turnovers per game (they make up for this performance by ranking 5th in defensive field goal percentage). I suspect if faced with a legitimate high-octane team (either Phoenix or Dallas) from the Western Conference this mediocrity will shine through. But it won't happen, because the Spurs will go all the way this year.
Speaking of Garnett, Matt is probably right that the marginal value of a superstar simply isn't as great as everyone thinks. To wit, based on Hollinger's top 50 PER ratings, the difference between the worst viable MVP candidate (Dwayne Wade), and the worst best player on any non-Chicago playoff team --Marcus Camby of the Denver Nuggets--is only about 6 points of PER, which I think translates into three wins over a full season. That's simply not enough to make an appreciable difference in a team's overall talent level. Further, the presence of three basically superstar-less teams in the playoffs--Denver, Detroit, and Chicago--suggests that there is more than one way to build a high-quality team.
Meanwhile, in more interesting sports, the wrestling of three slightly-above-average teams continues in the NL East, but it's too early to draw any conclusions based on anyone's record or Pythagorean Projection.
* slow and sloppy. $1 to George Carlin
We're off to Japan, to discover the wonders of its medicolegal system:
How does it work? In several semi-connected pieces.
The largest group of doctors is the Japanese Medical Association (JMA). All members of the JMA -- which accounts for 43.5% of all doctors -- have a collective insurance pool with a $8930 (1 million yen) deductible per claim and a maximum payout of $893,000 (100 million yen). Private doctors and employees of large hospitals can buy insurance on the private market, though they are not required to by law as in the United States. In general, individual doctors get better insurance terms than they would under the JMA, but large medical institutions get less favorable turms. So this form of insurance is a form of wealth redistribution from Big Hospital to the family doc.
Both groups of doctors have the option of sending to a form of semi-binding mediation through a local review board made up of plaintiffs' lawyers and medical experts. Patients can receive compensation via remediation without time and financial commitment that a full-fledged lawsuit would require. The terms of the review board's mediation are binding, but if the patient is dissatisfied she may sue in civil court. The deck is stacked in favor of the doctor in two ways. First, it is the doctor's choice whether to go through mediation or to bypass mediation and go to court, giving them the opportunity to forum shop for the audience most likely to accept their side of the story. Second, the review board is stacked with a number of medical experts. Patients' rights advocates claim the system is biased in favor of physicians and tends to award damages that are within the payout range of their insurance policies; however publicly available data show that 54% of all mediated claims result in some settlement, though the largest claim ever was for $1.3M, which is much lower than the largest malpractice award in the US.
In the event of malpractice, the doctor is entitled to a form of non-binding arbitration, after which a patient who wants a better settlement may still sue.
In addition to the mediation barriers, the short supply of lawyers in Japan also limits a patient's ability to sue. What's more, plaintiffs are expected to pay their lawyer a retainer and fork over a contingency fee should they win the case. When combined with the generally smaller payouts in Japanese malpractice cases, the prospects for bringing suit are slim.
There are also significant cultural barriers to bringing malpractice suits in Japan. As a side effect of the cold doctor-patient relationship Ezra describes, medical advice is given without any explanation or meaningful "informed consent"; drugs are given out by doctors without labels, for instance, and patients are unlikely to seek second opinions and do not expect to question their doctor, even if they fail to provide adequate care. Recent public outcry over a seemingly large number of incorrect surgeries at a large hospital has brought enough politcal pressure to enact reforms which ease the patient's ability to recover damages. In addition, the Ministry of Health and Welfare has begun to suspend physicans' licenses for repeated negligence, a power it always had but rarely exercised.
How effective is it? It's certainly more effective at controlling liability costs than the American system, but it's not clear how effective. Malpractice suits are filed are incredibly low rate (.2 per 10,000 compared to 3.1 per 10,000 in the US), and of those that reach trial, half are settled before a verdict is rendered. Also, as mentioned above, the overall level of payouts is lower in Japan, though not quite as low as it is in Europe. However, the actual number of claims is hard to determine. Insurers settle an undisclosed number of claims before the patient brings suit, and both the JMA and domestic private insurers are very careful not to publicize this information. Insurance for the average doctor has an annual cost of less than $500, which is pocket change compared to the sometimes five-figure insurance premiums American doctors pay. Still, premiums are on the rise, having risen 75% in inflation adjusted terms since 1990.
Sources: Medical Malpractice and Legal Resolution Systems in Japan, Journal of the AMA, "Medical Errors Outrage in Japan".
And now, if you'll excuse me, I have to go download as many archived volumes of the Journal of the American Medical Association as I can in the next 24 hours.
Previous Entries: France, England
Now Playing: Jadakiss / Kiss of Death / Bring You Down
Ezra now has us traveling to Germany to inspect the wonders of their health care system and medical malpractice policy.
How does it work? Initial claims are referred to mediation boards and expert panels set up by the Physicians' guild. This both speeds the processing of malpractice claims and reduces overall payouts. Patients may reject the result of mediation and take their case to court, where they will encounter a system that looks a lot like our system in the United States. Patients have a slightly lower burden of proof than in the US; specifically, in cases of grave error or failure to provide care equivalent to an "ordinary" doctor, the link of causation between error and injury may be assumed rather than proven. Recent changes in German law have made it easier for patients to win suits by placing burdens of proof upon the doctor rather than the patient.
Who pays? As in the UK and France, the plaintiffs' bar receives no contingency fees and the civil tort system is a "loser pays" system, discouraging malpractice claims. Insurance is presumably purchased by doctors and hospital chains on the private market.
What's the result? The German government has some published studies on malpractice claims, but I don't speak German. You're welcome to take a crack at them if you like. Overall spending on the tort system (which includes general product and service liability, not just medical malpractice) in Germany is roughly 33% lower than in the US when measured by GDP (1.9% versus 1.3%) and over 50% lower when measured by raw dollars per capita ($800 versus $350); however, in isolation this number is not necessarily informative. In the US, the tort system theoretically serves the dual purpose of punishing bad actors and compensating those they harm; in EU countries with strong social safety nets, workers compensation funds or other social insurance schemes fill the second role. So if a doctor performs the wrong operation and accidentally amputates your arm, there's no need to sue the hospital to recover your future income. This artificially lowers the cost of the German tort system when compared to the US system which doubles as a form of workers' comp.
Source: Look Who's Behind 'Tort Reform', The Nation 10/2004, EU Study on National Liability Systems [1, 2]. CBO study on tort reform.
Previous entries: France
Now Playing: Shakira / Piez Descalzos / Estoy Aqui
Ezra's covered how the Brits handle medicine, but how do our friends across the pond handle the problem of negligent doctors? It turns out that like the US, the UK relies on the court system to settle patient complaints. Julie Saltman's research has beaten me to the punch in many cases, but her documents a bit out of date.
How does it work? Public-sector doctors, which in the United Kingdom make up 90% of all doctors, are insured by the NHS. So you can think of the NHS as one giant hospital chain that handles all the legal and business aspects of medicine. Doctors are not personally liable for malpractice claims, nor must they purchase malpractice insurance on their own. Private-sector doctors must buy their own insurance, however. With the caveat that jury trials are less common, the actual legal handling of malpractice claims looks exactly like it does in the United States. You sue the doctor and the hospital, you go to court, and if you win, they show you the money.
The plaintiffs' bar in the UK does not take cases on a contingent-fee basis. Worse, the UK legal system is a "loser pays" system, so patients who bring tort claims to court and lose owe the NHS for their legal fees. Unsurprisingly this discourages malpractice claims.
Recently the UK has begun experimenting with a Swedish system of payouts for ophthalmologists and ob-gyns, and also require them to write apologies to their patients explaining what happened. The payment terms for injured infants are very generous, presumably because it makes for good politics to give financial help mothers who suddenly must rearrange their life for a permanently injured child (Michael Howard: tough on babies, soft on bad doctors. I'm Tony Blair and I approved this message).
Who pays? Funds for the NHS indemnity come from the governments general fund, so that big fat VAT, the income tax, and other government revenue streams are the main sources. Your tax dollars at work.
What is the result? There are 40% as fewer malpractice claims made, let alone settled, in the UK (1.8 per 10,000 people) compared to the United States (3.1 per 10,000). According to this Eurotimes article, the average malpractice settlement is about 57,000 pounds, or a shade under $100,000, compared to an average settlement of $250,000 or court award of $500,000 in the US. Malpractice payouts compromise .05% of GDP and .7% of overall health care spending, compared .2% and 3% (!) respectively for the US. The average time to push a case through the court system and receive a claim is measured in years. Years. Therefore almost half of all claims are settled out of court.
The UK system is less than perfect, and much stingier towards wronged patients. But it is an order of magnitude cheaper.
Sources: "Regulatory Matters", Eurotimes 2003 ; EU Study 2004 [1, 2]; National Association of Insurance Commissioners; NHS Indemnity
Ezra Klein has been doing yeoman's work summarizing the health care policy of the rest of the developed world. He's focused mostly on payment structures and quality of care, which are in the grand scheme of things far more important than handling the small number of medical errors (estimates are that in the US roughly .4% of all visits to a physician result in some form of malpractice). But I think it's important to recognize that a country's treatment of medical malpractice makes some difference in its ability to deliver health care to everyone. After all, if the cost of malpractice insurance is too high, the profession of medicine will be off limits to all but very wealthy private practitioners or to very large hospital chains, and neither of those groups is really interested in working in rural areas.
I want to emphasize that this is not an endorsement for GOP-style "tort reform", which is simply a facade for eliminating the right to bring tort claims of any sort. Real tort reform would probably look something like what Mark Kleiman has proposed in the margins of his thoughts: you have to get doctors, lawyers, and patients to sit at the table, and each group has to give up a little bit of ground. Medical boards need to have the power and gumption to discipline error-prone doctors, there should be a system for keeping real nuisance suits out of the courts and disciplining those lawyers who continuously bring them, and patients would have to accept smaller payouts--though perhaps more patients would get those payouts. Also, for reasons I don't yet understand, the current system really puts the screws to ob-gyns, so it is worth investigating policy that might help reduce their liability in cases where the fault really lies with the pre-natal caregivers (or worse, with the patient herself for not getting adequate pre-natal care).
Anyhow, back to the question of how France deals with malpractice:
How does it work? It turns out that that's changing. Up until 2002, France's malpractice system looked more or less like the United States'. Patients brought their cases to court and then either settled with the doctor/hospital/malpractice insurance company, or received an award. There were two main differences. First, France had no caps on malpractice awards -- if the judge or jury thought you deserved 600 million Euro because your child had cerebral palsy, you could get it [you probably weren't, because most of those jackpot awards come from jury trials, and your right to a trial by jury is not as great in Europe as it is here]. Second, there are several small differences that made it slightly harder for patients to win a case -- the plaintiff's burden of proof is slightly higher, the standard of care that doctors were required to provide was slightly lower, and statute of limitations on tort claims was shorter. There were also no review boards, arbitration panels, or mediation panels, which some states have established to try and act as gatekeepers to lessen the case load on civil courts and remove truly nuisance claims. But the actual legal system looked much like ours.
But this is no longer the way things work. In response to rising malpractice premiums, France has moved to a Scandinavian compensation system (I'll explain why it's called "Scandinavian" whenever Ezra covers the Swedish health care system). Under the French implementation of the Scandinavian system, wronged patients bring claims before their regions' government-appointed review board which is responsible for determining if compensation is in order and, if so, how much. For a patient to get paid, the board does not have to find the doctor at fault, or that medical negligence caused whatever pain and suffering the patient is experiencing. Money for patient relief comes from a national compensation fund, which presumably gets its cash either from a dedicated tax insurance premium placed on doctors and hospitals, or from general fund revenues. The closest analogy to this sort of system in the United States would be workers' compensation funds that many states run. The goal of such systems is not to find fault or establish causation as much as it is to provide a bit of compensation to workers who are injured on the job.
You can see how it would be easy for the doctor-hospital-insurance complex to game the system under a Scandinavian-style regime. Just as energy lobbyists try to get appointments to the rate-setting boards, and agribusiness interests attempt to hold the office of Agriculture Commissioner, the medical profession would probably try to get its backers onto the review boards. Even so, because the burden of proof is much lower than it is in the US, the processing time is shorter, and there patient needs to commit less time to the process, the number of claims is generally much, much higher, though payouts are smaller. Since you don't have to go through the agony of dealing with the legal system, you get a bit of money for your trouble and then get sent on your way.
Who pays? See above. It's not entirely clear what the revenue source is (a dedicated tax versus general funds), but there's a pool of taxpayer money used to pay out settlements. Hey, look! It's your government actually working for you! Take that, libertarians!
How effective is it? It's too early to tell. Finding data on the number of tort claims per capita average payout amounts has been like finding a date at a Microsoft party. On top of that, France has only used the Scandinavian system for two years, so there's not a lot of data on the subject. I have a gofer at Google AnswersTM working on this for me, so hopefully I'll be able to post the results soon. As for how successful the Scandinavian system is in ... well, Scandinavia ... let's wait until Ezra covers one of those countries.
Sources: "Regulatory Matters", Eurotimes; "Comparative Analysis of National Liability Systems For Remedying Damage Caused by Defective Consumer Services", European Union Study [1, 2]; Insurance Issues in Europe; National Association of Insurance Commissioners
Your Linguistic Profile: |
| 50% General American English |
| 35% Dixie |
| 10% Yankee |
| 5% Upper Midwestern |
| 0% Midwestern |
That makes good sense for someone who was raised in the South and later picked up a few Northernisms while at college. The only reason the 5% Upper Midwestern shows up is that I know that October 30th is Devil's Night. Thank you, Brandon Lee.
And Big Media Matt is right, this really doesn't do enough to expose regional word choices outside of the South. It doesn't try to settle the on line/in line controversy or the sub/hoagie/grinder kerfuffle. You need to go to the Harvard Dialect Survey for a more complete set of results. Also curious is the apparent lack of any sort of West Coast dialect. "Hella", anyone?
After many weeks of slacking, I've finally managed to draw meaningful crosstabs out of the 2004 exit polls. My hope was to find a useful way of exploiting Bush's "plan" for Social Security unreform to win seats in the House and Senate for the 2006 midterms. It appears there are no real surprises: the best potential Republican voters for Democrats to woo to their side are older voters, particularly older women.
Before looking for new voters, I want to touch briefly on those voters that may abandon Democrats because they support Bush's "plan". The first group is voters under 30. This group is in a unique position, since their approval of the President is the lowest of any age group, but they are also the group most open to privatization. Therefore I think the most effective critique to target at young voters would try to "bleed" Bush's poor favorable ratings into the Social Security debate. Something like this: "Social Security might need fixing, but you can't trust Bush to get it right." The second core Democratic constituency that Bush has tried to target is African-Americans, but Bush's fraudulent claims that Social Security is a bad deal for blacks based on his inability to interpret statistics (if you're feeling generous), or his willful misrepresentation of them (if you're not) ... well, let's just say that no one's buying it.
Now let's move on to the more interesting question: where should Democrats look for Republican voters that will be sympathetic to the Democratic goal of preserving Social Security? I'll start trying to answer this question by looking at results from the 2004 election broken down by both age and race. The number in parentheses is the percentage of voters that this demographic makes up, which is followed by Kerry's vote totals, followed by Bush's:
| Age/Race | All | White | Black | Hispanic | Asian | Other | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 18-29 | (17.9) | 55.7 | 44.3 | (12.1) | 45.8 | 54.2 | (2.6) | 89.1 | 10.9 | (2.3) | 64.7 | 35.3 | (0.4) | 60.6 | 39.4 | (0.6) | 69.4 | 30.6 |
| 30-44 | (28.2) | 45.9 | 54.1 | (20.9) | 37.2 | 62.8 | (3.6) | 85.5 | 14.5 | (2.3) | 56.8 | 43.2 | (0.6) | 61.6 | 38.4 | (0.9) | 54.5 | 45.5 |
| 45-59 | (29.5) | 47.7 | 52.3 | (23.4) | 41.3 | 58.7 | (3.0) | 86.5 | 13.5 | (1.8) | 59.7 | 40.3 | (0.4) | 56.6 | 43.4 | (1.0) | 57.0 | 43.0 |
| 60+ | (21.7) | 47.3 | 52.7 | (18.5) | 43.5 | 56.5 | (1.5) | 87.8 | 12.2 | (0.8) | 52.5 | 47.5 | (0.2) | 57.7 | 42.3 | (0.8) | 49.2 | 50.8 |
| Total | 48.6 | 51.4 | (75.2) | 41.5 | 58.5 | (10.7) | 87.0 | 13.0 | (7.1) | 59.5 | 40.5 | (1.6) | 61.3 | 38.7 | (3.3) | 56.5 | 43.5 | |
[Source: National Election Pool 2004 Exit Polls]
From this table two things become clear. First, there are few new votes to be had by persuading the small number of African-Americans who supported Bush to change their mind. Second, the traditional Democratic advantage among seniors is gone. Take a look at the historical results for voters age 60 and up:
| Year/Race | DEM | GOP | +/- |
|---|---|---|---|
| 1996 | 48 | 44 | 4 |
| 2000 | 51 | 47 | 4 |
| 2004 | 47 | 52 | -5 |
[Sources: CNN 1996 Exit Polls, ABC News 2000 Exit Polls]
In 1996 Clinton won voters age 45-59 by a 48-41 margin, so the problem is not that a huge number of fifty-something Republicans are moving into the 60+ age bracket. This suggests that the over-60 voters can be brought back into the fold with relative ease. Recent polling data supports this hypothesis; recent polls show that even though seniors are aware that Bush's "plan" does not affect their Social Security check, they are still strong opposed to privatization. It's also worth mentioning that voters close to age 55, but not yet there, ought to be sympathetic to Democrats as well. These folks would be taken to the cleaners under Bush's Social security unreform; they pre-funded their retirement under the Greenspan reforms, but would see a large cut in guaranteed benefits.
Now that we've taken a look at the effect of race and age on voting patterns, let's examine at gender as well.
| Age/Gender | All | Men | Women | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 18-29 | (17.9) | 55.7 | 44.3 | (8.3) | 54.0 | 46.0 | (9.5) | 57.2 | 42.8 |
| 30-44 | (28.2) | 45.9 | 54.1 | (13.2) | 43.3 | 56.7 | (15.0) | 48.2 | 51.8 |
| 45-59 | (29.5) | 47.7 | 52.3 | (13.4) | 45.5 | 54.5 | (16.0) | 49.4 | 50.5 |
| 60+ | (21.7) | 47.3 | 52.7 | (9.9) | 44.5 | 55.5 | (11.5) | 49.7 | 50.3 |
| Total | 48.6 | 51.4 | (45.1) | 46.2 | 53.8 | (52.6) | 50.6 | 49.4 | |
Note that the gender gap is almost perfectly consistent across all races, with the exception of elderly Hispanics, though it's quite possible that this is due to sampling error. But what is interesting is that the 4-point gender spread in the last election is small by historical standards. How did this happen? Well, in part it is due to Kerry's ability to pull in almost all male Nader voters (or a number of voters that's roughly the same). But it's also due to Bush's impressive showing among women in 2004:
| Year/Gender | Men | Women | Gender+/- |
|---|---|---|---|
| 1996 | 38-49 | 48-43 | 8 |
| 2000 | 42-54 | 54-43 | 12 |
| 2004 | 46-54 | 50-50 | 4(!) |
And there, folks, are your security moms: the four or five percent of women who voted for Gore in 2000 but moved to Bush in 2004. As with seniors, these voters who recently defected from the Democrats will probably be the voters that can be brought back to the fold most easily. Thankfully, most polling shows that women are more sympathetic to building a strong social safety net than men are, so this should help as well.
At this point, the most promising demographics to target look something like this:
We've done a decent job of narrowing the universe of target voters already, but I think we can do better. Coming next, I'll try to refine the results further by looking at income, education, and church attendance.
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updated by Nicholas Beaudrot on 06:16 20 September 2005
