Civility is the ability to disagree with others while respecting their sincerity and decency. Civility begins with understanding. We can best understand our political differences by first understanding the moral foundations upon which political views are built. This site features research, resources, and commentary related to the pursuit of Civility through understanding.

Everett

 

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Ross Douthat takes on the income inequality issue in a NY Times op-ed piece.   The issue of income inequality is at the very heart of liberal thought development.  It stems from the early 1800′s, when the excesses of capitalism (long hours, low wages, child labor, etc) demanded reform.  Britain passed the Poor Law to provide subsistence level support for all citizens.  By 1900 the call expanded beyond subsistence to an argument that all members of a just society had a right to a ‘living wage’, and that if the economy did not provide a job with a ‘living wage’ it was by no fault of the worker, and the just state should step in to ”make good” the promise of a living wage.   This was to be provided by taxing the rich; redistribution of income.

The problem was, how much redistribtion was the right amount?  The early writers took no position, and essentially adopted the Utilitarian principle of the ‘greater good’.  Applied, the idea was we should tax the wealthy and redistribute their income until it caused more harm than good.  This cavernous gap in ideology has remained an open question for over 100 years.  How to resolve it?

One of the more popular methods became comparasions of income between the top and bottom tiers.  I have not yet come to the exact argument as to why a widening gap between top and bottom is a de facto social injustice.  Nonetheless, it is widely considered a ‘bad thing’.  But is it?

Mr. Douhat introduces us to factors that effect changes in income inequality:

For instance, inequality is driven in part by low-skilled immigration: it nudges wages downward for native workers, and the immigrants themselves are taking longer to achieve upward mobility than earlier generations did…

Inequality is also driven by the collapse of the two-parent household, which disproportionately affects the poor and working class, depriving them of the social capital they need to rise…

Inequality is perpetuated by our failing education system — and especially by the bloated cartel responsible for educating the nation’s poorest children.

Lacking an objective statement of the ideal income equality, the US is usually compared unfavorably to European countries.  A 1994 paper by Richard Freeman and Lawrence Katz addresses the comparasion:

Why did wage inequality and educational wage differentials rise more in the United States than in other advanced countries?  We attribute the exceptional experience of the United Sates to the way shifts in the supply of and demand for skills work themselves out in the decentralized U.S. labor market, compared with how they operate in other labor markets.  Our explanation has three parts…

The first is that changes in the supply of and demand of labor skills substantially alter wages and employment of different groups of workers in the manner predicted by economists’ supply and demand market-clearing model…We further expect supply and demand to have their largest effect on young or less experienced workers on the active job market as opposed to experienced workers with substantial job tenure…

The second part of our explanation identifies…differences in wage setting and other labor market institutions across countries…The stronger the role of institutions in wage determination, the smaller will be the effect of shifts in supply and demand on relative wages…[E]ducation and training institutions also mediate the effect of market forces…Social insurance and income maintenance institutions also affect labor outcomes…generous income maintenance or unemployment benefits that allow workers to remain unemployed for a long period can reduce their willingness to take low wages to obtain work… 

For the third part of our explanation we turn to institutional changes, such as product market deregulation and changes in unionization…The important institutional changes in the 1980’s were the decline in trade union power, which was exceptional in the United States, and the decentralization of collective bargaining that characterized diverse European countries.  Both of these developments are likely to produce greater earnings differentials. 

To simplify, one explanation for income inequality is that the U.S. labor market is shifting towards higher paying jobs requiring education and away from lower paying jobs.  A bad thing?  Should we ‘fix’ the ‘problem’ by taxing the higher paid?  Mr Douthat concludes:

The European experience suggests that specific policy interventions — the shape of the tax code, the design of the education system — may matter less in the long run than the sheer size of the state. If you funnel enough of a nation’s gross domestic product through a bureaucracy, the gap between the upper class and everybody else usually compresses.  But economic growth often compresses along with it.  This is already the logic of our current fiscal trajectory: ever-larger government, and ever-slower growth.  That combination could eventually create the more egalitarian America that Democrats have long promised to deliver. The question is whether Americans will thank them for it.

 

 

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The man who saw the meltdown coming had another troubling insight: it will happen again.

 

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A specter is haunting Europe — the specter of Socialism’s slow collapse. Full article

 

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David Brooks contributes to the case for obsoleting Left/Right labels. 

When democracy was an infant there was much discussion about the ability of an electorate to self-govern.  Would the voters have sufficient ‘virtue’, in the vernacular of the times, to govern themselves?  Would democracy replace tyrants, or become a new tyranny of the majority?  It depended on the virtue of the electorate.  

Mr. Brooks approaches the call to virtue from an even larger view:

Centuries ago, historians came up with a classic theory to explain the rise and decline of nations. The theory was that great nations start out tough-minded and energetic. Toughness and energy lead to wealth and power. Wealth and power lead to affluence and luxury. Affluence and luxury lead to decadence, corruption and decline.

He puts the contemporary problem nicely:

Our current cultural politics are organized by the obsolete culture war, which has put secular liberals on one side and religious conservatives on the other. But the slide in economic morality afflicted Red and Blue America equally.

If there is to be a movement to restore economic values, it will have to cut across the current taxonomies. Its goal will be to make the U.S. again a producer economy, not a consumer economy. It will champion a return to financial self-restraint, large and small.

It will have to take on what you might call the lobbyist ethos — the righteous conviction held by everybody from AARP to the agribusinesses that their groups are entitled to every possible appropriation, regardless of the larger public cost. It will have to take on the self-indulgent popular demand for low taxes and high spending.

Here here.  Let’s never mind left/right, blue/red.  Perhaps we start by asking of ourselves, what can we afford?

 

 

 

Sep 292009
 

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A look at national health care systems around the world

 

 

 

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Timothy Egan’s article about Gov. John Kitzhaber and his family is touching and well written.  The article intertwines two narratives, death with dignity, and universal healthcare.   The implication is that the two are somehow linked, but are they really?

Can’t we have dignified death without state control of healthcare?   Gov. Kitzhaber and his family were able to make their own choices regarding his parents end of life decisions.   Isn’t that freedom part of the sanctity of life?  Britian’s experience is that state control diminishes individual freedom, with horrifying consequences at end of life.

 

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renocol_ThomasFrankLiberals and Civility      By Thomas Frank

 
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Huffington Post published top 10 wealthiest members of Congress, 8 are Dems, 2 Republican.  Interesting comments from readers include this:

“Capitalism — A brain-power dictatorship
Brains like handsome good looks pass from father to son, those with excessive wealth run things and until we reach the ultimate conclusion of evil they always shall.
For we are all given a different ability to earn income as a test, to see if we pass our excessive wealth down to those less fortunate where it belongs.”

 

This from the WSJ…
 
“Last week, I asked…Congressman James Clyburn…where in the Constitution it authorizes the federal government to regulate the delivery of health care. He replied: “There’s nothing in the Constitution that says that the federal government has anything to do with most of the stuff we do.”  Then he shot back: “How about [you] show me where in the Constitution it prohibits the federal government from doing this?”"  ( http://tinyurl.com/ord3sg )
 
Sigh.  It goes without saying that ignorance of the 9th & 10th amendments and no acknowledgement of constraint on federal power is a problem.       
       
A really big problem. 
 
I’m convinced this is not a partisan issue.  I believe the same attitude prevails amongst Republicans.  A few years ago liberals considered the Patriot Act tyranical, and we’re probably right.  The NYT called “Bush’s tyrannical law” a “low point in American Democracy”.  ( http://tinyurl.com/jxfev )
 
Looking historically, what today is a Democratic position was yesterday a Republican position.  The “progressive movement” was led by Teddy Roosevelt and the Republican party in the early 1900′s.  The progressive movement is largely responsible for the income tax, women’s right to vote, the direct election of senators, and generally argued for increased government to promote social justice.  The last protectionist President was Hoover, a Republican.  Milton Friedman convinced the IRS to withhold wages.  The political parties are more akin to snails that occupy ideological shells according to the political exigencies of the day.  The constitutional checks and balances have been severely weakened, and it should not give any of us comfort if our particular party is the fashion of the day.  It is in their nature to grow government, and there is no better time to increase the scope of government than times of perceived crisis.  
 

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Is the role of government to provide equality of opportunity, or equality of outcome?   They are mutually exclusive.

Equality of opportunity necessarily means inequality of outcome.  People are not born with equal ability, equal circumstances, and equal luck.

Equality of outcome necessarily means individual success must either be prevented or appropriated back to the average, so that others may be lifted.

Which is more fair? Much depends on how fairness is understood.

Fairness is proportionality.  The Left (progressives), who rely on the moral foundations related to Compassion, tend to view proportionality in terms of outcomes, therefore disproportionate wealth accumulation is seen as unfair.  The Right (conservatives), who rely on moral foundations related to both Compassion and social Harmony, tend to view proportionality in terms of effort, so wealth unevenly distributed yet proportionate to effort is fair.

Where the two find common ground is opposing wealth accumulated not by effort, but by cheating, illegallity, gaming of the system, political manipulation, etc..  Wrongful wealth is universally seen as unfair.  Wrongful wealth violates equality of outcomes and equality of opportunity.

Few people would take equality of opportunity so far as to insure that each citizen received exactly the same amount of society’s production.  Most people favor equality of opportunity unless the results become so unbalanced they cross some undefined line representing that person’s perception of fairness.   This line often involves a sense that not only are the have not’s under participating in the nations wealth, but are prevented from rising.  The cure is actions to improve the equality of opportunity.  Affirmative action is an example.

It’s important to note that this equality question is not a social welfare question.  Social welfare refers to a safety net of services a society makes available to individual’s who are not able to care for themselves, either temporarily or permanently.

Much is written today about historical levels of income/wealth inequality.  The root cause is not really income per se, but wealth in the form of stocks, bonds, and real estate; capital assets.   Those individuals who are experiencing large gains in wealth are people who hold capital assets.

Goods and services are produced with labor and capital.  The costs of production are divided between labor and capital in some ratio.   What we are experiencing now is a monumental shift in this ratio.  By example, numbers used to be added up by people (labor) using adding machines.  Now number are added up by computers (capital).  In the adding up business, labor lost income and those who owned stock in the computer companies gained.  Repeat the implementation of technology across the entire economy, and there has to be a huge shift of income from labor toward capital.

The news is now delivered in real time via the internet.  Newspapers, and all the people it takes to print and deliver them, are in trouble.  Should we punish or reward those who invested in the internet?  There were once 2000 commercial ice plants in the U.S., delivered to your home by iconic ice trucks if you put out your “Ice Today” sign.  Home refrigeration ruined the ice business.  We are experiencing some type of this phenomenon across almost all sectors of the economy.

Given the massive shift, we are bound to have a period of excess labor.  This means wages must stagnate (they already have) or even fall.  And it isn’t anyones fault because nothing is wrong.

For many this will feel “unfair”.  After all, it is not their fault the ice business is going away, but it is their fault they can’t pay the mortgage.  In a sense they are the victims of a calamity, not the victims of an injustice.   If society wants to alleviate their circumstances, it is important to understand we would be providing social welfare to unfortunate victims of a calamity, not correcting some fatal flaw in how income is distributed.   With this distinction we can have a civil conversation that honors the Left’s Compassion along with the Right’s interest in Harmony.

 

 

 

 

 

 

Originally, anyway.  It was made legal with the passage of the 16th Amendment in February of 1913.

Upon passage, the new President Wilson immediately called a special session of Congress and the Revenue Act of 1913 passed in May of 1913.  The tax rate was 1-7%.  By 1918 rates were 12-77%, justified by WW I.  A history of income tax in America can be found here.

Inflation since 1913 is 2,180%.   Between 1913 and 1994 government spending grew 13,592%.

Interesting perspective.  Here’s a fun game, ask your friends if they knew the income tax was originally unconstitutional!

 

Well, actually Camille Paglia’s piece is something of a liberal on liberal rant, but it does contain a call to think…

But affluent middle-class Democrats now seem to be complacently servile toward authority and automatically believe everything party leaders tell them. Why? Is it because the new professional class is a glossy product of generically institutionalized learning? Independent thought and logical analysis of argument are no longer taught. Elite education in the U.S. has become a frenetic assembly line of competitive college application to schools where ideological brainwashing is so pandemic that it’s invisible. The top schools, from the Ivy League on down, promote “critical thinking,” which sounds good but is in fact just a style of rote regurgitation of hackneyed approved terms (“racism, sexism, homophobia”) when confronted with any social issue. The Democratic brain has been marinating so long in those clichés that it’s positively pickled.

Ditto that for Republicans.

 

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As proposed in HR3200 we would have a Health Choices Administration, described this way by U.S. News;

Congress proposes a new, independent federal agency called the Health Choices Administration, whose commissioner would create standards for insurance that you and some 285 million Americans (15 million would still not be covered) would be required to have. The commissioner would also qualify plans that meet federal requirements and determine which individuals are eligible for subsidies.

The HCA would be guided by the recommendations of the Health Benefits Advisory Committee, from the same article;

Recommendations for the essential benefits your insurance would cover, which would change with new knowledge and technology, would rest largely with the secretary of health and human services’ Health Benefits Advisory Committee. This group of up to 27, more than half of whom would be appointed by the president, would come up with lists of treatments and services that must be covered and set your copayments for any of the covered services.

In Britain, the National Health Service has what sure sounds like an equivalent to the proposed HBAC, the National Insitute for Health & Clinical Excellence, or NICE.  From the NICE website:

NICE produces guidance in three areas of health:

  • public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
  • clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

You can’t please all the people all the time, but are we prepared for headlines like this, Restrictions on prescription of osteoporosis drug ‘defy belief‘.

 

Hayek

Friedrich August von Hayek CH (8 May 1899 – 23 March 1992), was an Austrian and British economist and philosopher known for his defense of classical liberalism and free-market capitalism against socialist and collectivist thought. He is considered to be one of the most important economists and political philosophers of the twentieth century.  Hayek’s account of how changing prices communicate signals which enable individuals to coordinate their plans is widely regarded as an important achievement in economics. (from wikipedia)

He was also awarded the Nobel Prize in 1974.  He is one of the most important conservative economists of this century (the title probably goes to Milton Friedman, who said he considered Hayek his most important influence, and Ayn Rand had a wider influence).  Hayek’s classic the Road to Serfdom, first published in 1944, remains as topical as ever.

In it, Hayek makes the case against ambiguous legislation.  He argues society is underpinned by the Rule of Law.  “[The Rule of Law] means that government in all its actions is bound by rules fixed and announced beforehand – rules which make it possible to foresee with fair certainty how the authority will use its coercive powers in given circumstances and to plan one’s individual affairs on the basis of knowledge”.

He discusses one way in which the Rule of Law is degraded, “When we have to choose between higher wages for nurses or doctors and more extensive services for the sick…nothing short of a complete system of values in which every want of every person or group has a definite place is necessary to provide an answer…[A]s planning becomes more and more extensive, it becomes regularly necessary to qualify legal provisions increasingly by reference to what is “fair” or “reasonable”; this means that it becomes necessary to leave the decision of the concrete case more and more to the discretion of the judge or authority…One could write a history of the decline of the Rule of Law…in terms of the progressive introduction of these vague formulas into legislation and jurisdiction, and of the increasing arbitrariness and uncertainty of… the law and the judicature, which in these circumstances could not but become an instrument of policy.”

This point is quintessentially non-partisan.  The passage of ambiguous legislation leading to policy decided not by elected representatives but by bureaucrats, or left to judges, would seem to define the last 60 years no matter which party dominated politics.

 

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Does this not ring a bell…

“Schumpeter’s theory is that the success of capitalism will lead to a form of corporatism and a fostering of values hostile to capitalism, especially among intellectuals. The intellectual and social climate needed to allow entrepreneurship to thrive will not exist in advanced capitalism; it will be replaced by socialism in some form. There will not be a revolution, but merely a trend in parliaments to elect social democratic parties of one stripe or another. He argued that capitalism’s collapse from within will come about as democratic majorities vote for the creation of a welfare state and place restrictions upon entrepreneurship that will burden and destroy the capitalist structure. Schumpeter emphasizes throughout this book that he is analyzing trends, not engaging in political advocacy. In his vision, the intellectual class will play an important role in capitalism’s demise. The term “intellectuals” denotes a class of persons in a position to develop critiques of societal matters for which they are not directly responsible and able to stand up for the interests of strata to which they themselves do not belong. One of the great advantages of capitalism, he argues, is that as compared with pre-capitalist periods, when education was a privilege of the few, more and more people acquire (higher) education. The availability of fulfilling work is however limited and this, coupled with the experience of unemployment, produces discontent. The intellectual class is then able to organise protest and develop critical ideas.”

Had he only foreseen the internet!

This from the wikipedia page of economist Joseph Schumpeter.  Here’s the full text of his book Capitalism, Socialism, and Democracy.

 

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End of life care is the subject at the heart of the notorious comments made by she that shall not be named (the original facebook post can be found here).  Though she does not refer to it, it is alleged in the media that she was referring to HR3200‘s section 1233, Advanced Care Planning Consultation.   The reading of the bills is quite involved and I will not try to retrace the path.

Section 1233 provides funding for end of life planning every five years, or more frequently if health changes suddenly.  While such counseling is not itself required, the Act does require “quality” measurements of physicians regarding their end of life care practices and whether or not they are following such guidance.   It also provides for the optional issuance of medical orders resulting from the consultation, subject to the patients approval, including control of nutrition and hydration.   Overall, Section 1233 does not strike me as overtly threatening.

More concerning is the Independent Medicare Advisory Council Act of 2009, endorsed and proposed separately by the administration.   This Act provides for a 5 member commission, appointed by the President and approved by the Senate, to recommend changes to Medicare each year.  Subject to the Presidents approval, the recommendations would automatically become law unless Congress intervenes.  Once enacted, the Councils actions are not reviewable in court, with very narrow exceptions.  The main intent is to control costs, and most of the bill is concerned with the details of payment schedules.  However, the Council may also “…submit, under separate cover, a report containing recommendations for reforms to the Medicare program…”.  There follows a long list of specific regulations the Council may not review.   The Congressional Budget Office’s review essentially concludes the Council is not likely to save much money, if any at all.   To increase the chances of the IMAC effecting real results, the CBO is recommending “Providing clear authority for the council to recommend broad changes in coverage, benefit design, and payment and delivery systems”, and “Expanding the council’s mandate to include making recommendations for changes to the broader health care system”.

And finally, there is the “Health Choices Commissioner“, who would determine, well, our choices.

For many the concerns are intuitive, almost gut felt.  For the rest of us, here’s a presentation of the concerns that these proposal’s may lead us toward:

Step 1.  Advance Care Planning in a compassionate voice. The webpage helping us to understand might look like this…

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Advance Care Planning

Caring for people at the end of their lives is an important role for health and social care professionals. One of the elements to support people at the end of their lives is to find out what their preferences and wishes are in relation to their future care.

Advance Care Planning

Advance Care Planning (ACP) is a voluntary process of discussion between an individual and their care providers irrespective of discipline. If the individual wishes, their family and friends may be included in the discussions. With the individual’s agreement, this discussion should be recorded, regularly reviewed and communicated to key persons involved in their care.

An ACP discussion might include:

  • the individual’s concerns
  • their important values or personal goals for care
  • their understanding about their illness and prognosis
  • preferences for types of care or treatment that may be beneficial in the future and the availability of these

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Step 2.  The development of end-of-life protocols.  Perhaps the webpage would be thus…

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Compassionate Care Pathway

The Compassionate Care Pathway (CCP) for the dying patient has been developed to transfer the hospice model of care into other care settings.

The Ronald McDonald Hospice Care Institute  has pioneered the implementation of the Compassionate Care Pathway for the Dying Patient (CCP). This program is recognised nationally and internationally as leading practice in care of the dying to enable patients to die a dignified death and provide support to their relatives.

The CCP provides a useful template to guide the delivery of care for the dying to complement the skill and expertise of the practitioner using it. Once commenced the goals of care prompt staff to consider the continued need for invasive procedures and whether current medications really are conferring benefit. The health care professional is free to use his or her own clinical judgment in this process.

The use of the CCP does not preclude use of antibiotics or artificial nutrition or hydration but it does ask the professional to consider an appropriate decision for that moment in time and document the reason for decisions made.

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Step 3. Outcomes we didn’t expect.  The headlines might look like these….

Sentenced to Death on CCP

The Compassionate Care Pathway may be the slippery slope to backdoor euthanasia

Terminally ill care crisis

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You just can’t make this stuff up.  Step 1 can be found here,  Step 2 is here, and Step 3 is here and here.

No Healthcare bill has passed, it’s unclear exactly what is proposed and who is supporting it.  But it is difficult to read the hundreds of comments on the Liverpool Care Pathway article and not feel empathy for those whose fates were decided by a distant committee/council/agency/department/commission.   Think what you will about the present proposals, none of us want to be placed on the Liverpool Pathway without our consent.   The sequence of events that led Britain to it’s present circumstance were not carried out by evil men and women, those involved in hospice care may be the most compassionate among us.  But if we are to avoid a similar fate, doesn’t it seem we need to pay attention now?

Update 9/3/2009- See new post on The Danger of Ambiguous Legislation

Update 9/18/2009 – Administrator of Liverpool Care Pathway response to media reports.  Feel better?

Update 9/30/2009 – Wisconsin solves the problem, this will make you feel better…End of Life Care That Works

 

Portrait_of_Robert_Owen_(1771_-_1858)_by_John_Cranch,_1845

Robert Owen (14 May 1771–17 November 1858), born in Newtown, Montgomeryshire, Wales was a social reformer and one of the founders of socialism and the cooperative movement.

Owen’s philosophy was based on three intellectual pillars:

  1. First, no one was responsible for his will and his own actions, because his whole character is formed independently of himself; people are products of their environment, hence his support for education and labour reform, rendering him a pioneer in human capital investment.
  2. Second, all religions are based on the same absurd imagination, that make man a weak, imbecile animal; a furious bigot and fanatic; or a miserable hypocrite; (in dotage, he embraced Spiritualism).
  3. Third, support for the putting-out system instead of the factory system.  (This a reference to outsourcing to contractors)

This is from the opening of his wiki article, check out the full article.   His utopian community at New Lanark mill was circa 1810.   He started two others in 1825 one at  New Harmony, Indiana, and another near Glasgow, Scotland.   So far in this inquiry, these are the earliest dates found in the implementation of western socialist ideas, though “Owen’s new views theoretically belong to a very old system of philosophy, and his originality is to be found only in his benevolent application of them”.  The term socialism was first used by Henri de Saint Simon (1760-1825), and came into popular usage around 1835.   I have also found a book published in 1869, History of American Socialisms,  which sites Owen as the earliest examples of the “movement”.

Owen’s first pillar is particularly interesting in light of modern psychology as we’ve discussed in Are we born Liberal?  Wouldn’t it be fascinating if the difference between liberals and conservatives comes down to one’s opinion of an individuals responsibility for his character?  Is this free will vs determinism?

 
One thing having led to another, we’re interested in understanding the foundations of liberal thinking.  We’re looking for the orignal thinkers, probably late 1700′s to early 1800′s, who laid the intellectual foundation.  Please post your suggestions.
 

“All of us, liberal or conservative, feel as though we’ve reached our political opinions by carefully weighing the evidence and exercising our best judgment. But it could be that all of that careful reasoning is just after-the-fact self-justification” (Klein, 2006)

This from an academic study out of Canada called Why are people liberal?  Provocative as the idea that political ideology is really a nature vs nuture problem, two ideas stood out in particular:

1.  “Need for Change uniquely predicted political liberalism such that greater desire for new experiences and rebellion predicted greater endorsement of political liberalism.”   The Obama campaign may have been MUCH smarter than most of us imagined.

2. “Need for Inclusiveness strongly predicted political liberalism, especially among individuals higher in political knowledge.” 

The study refers to similiar work on political conservatism.  Such ideas set a high bar.  If so, we need to not only think our way through the issues, we need to think our way out of our predispositions.

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