In a one-page order, the Supreme Court held that the Texas voter ID law would remain in effect, for the time being that is. Though passed in 2011, the voter ID legislation was implemented only after the Court's holding of Shelby County v. Holder on the Voting Rights Act, and required that one present a government-issued ID (passport, driver's license, state ID card, election identification certificate, US citizenship certificate, US military identification card, or a Texas concealed handgun license) in order to vote in person. The law is considered the strictest in the nation given the particulars as to the types of photo identification that are permitted (e.g., handgun licenses are allowed but student identifications are not). Recent reports have revealed that approximately 500,000 registered Texans lack the identification needed in order to vote. 

The legal challenge to the law will be heard in the Fifth Circuit Court of Appeals in May, and the Supreme Court in its one-page order indicated that should the Fifth Circuit fail to issue a ruling on the matter by July 20 (whether issuing an opinion on the merits of the case or issuing an order to vacate or modify the current stay order), given the time-sensitive nature of the issue in a presidential election year, the groups challenging the law could return to seek relief from the Supreme Court. While those opposing the voter ID law had been concerned that the appellate court would drag its feet and fail to issue a ruling before the November election, the Supreme Court's willingness to step in again regarding the law should prevent such intentional delay from occurring. 

This is not the first time that the Supreme Court has taken on this Texas law. Indeed, in 2014 the Court refused to block the legislation from continuing to be implemented, with Justice Ginsburg dissenting (joined by Justices Kagan and Sotomayor). Justice Ginsburg wrote on the law, "The greatest threat to public confidence in elections in this case is the prospect of enforcing a purposefully discriminatory law, one that likely imposes an unconstitutional poll tax and risks denying the right to vote to hundreds of thousands of eligible voters." 

The Texas law is one of many that have come under scrutiny in recent months, with North Carolina being a hotbed of controversy recently, and many eyes on southern states in the aftermath of Shelby County (with Texas the largest state affected by that holding). While the alleged rationale for these laws is the prevention of voter fraud, few such cases can be found, and the burdens imposed on the electorate are quite consequential.

Consider the following. To obtain a Texas driver's license or state ID card, one must go to the Department of Motor Vehicles, which in many cases is open from 8am to 5pm Monday to Friday and is closed on weekends. Thus, to obtain such identification, many individuals are in the position of needing to take some measure of time away from work, time that could amount to billable hours. Accounts have circulated that in order to obtain a state voting certificate, some voters were forced to travel as much as 250 miles roundtrip, which would be particularly burdensome to those who are lower income. Moreover, the cost of a new driver's license in Texas is $25 and the cost of a state ID card is $16, which could arguably be construed as a poll tax under the Fourteenth and Twenty-Fourth Amendments (an interpretation held by the district court in 2014), though in striking down the law in 2014 (an order that has been stayed), the Fifth Circuit ruled in 2015 that the law did not constitute a poll tax but did discriminate against minorities. 

While there are disputes as to the extent to which such legislation can be properly construed as poll taxes based on the fees associated with obtaining the necessary identification to vote, what does appear to be the case is that there is a substantial burden associated with obtaining the required ID. Whether it is a discriminatory intent versus effect is not crucial to the legal question if there is indeed a disproportionate impact on minorities in hindering their ability to vote, and both the district court in 2014 and the appellate court in 2015 found the legislation to violate Section 2 of the Voting Rights Act in disparately impacting minority voters (or in this case potentially, would-be voters). When poor voters are placed in the position of choosing between their livelihood and exercising their voting rights, remedies must be made. While the Supreme Court did not intervene in its continuation, its imposition of a deadline for the Fifth Circuit to act indicates an inclination to resolve the matter in a timely fashion, hopefully before the upcoming presidential election. 

In the Pennsylvania town hall on April 25, Hillary Clinton was asked about what it means to her to be a feminist, and she delivered a masterful response that disavowed people of the “women’s issue” nature of that which gets lumped in to “feminism.” She spoke of pay equity, which is not always particularly (if at all) egregious early in careers – after all, women are better represented in college and graduate school than men now – but which becomes all too obvious as people stay in their professions and women find themselves earning considerably less than their male counterparts for the same work. And this is not even an issue of income in the current period, as she noted in the context of Lily Ledbetter (side note: my first time attending a congressional hearing was for the Ledbetter Act at the Senate Judiciary Committee… not too shabby). Not only was she being paid less annually, but that had implications for her retirement and 401K, because less money was being put away. This is not an issue easily remedied with a pay raise, given the long-term ramifications of this inequity. This is not a women’s issue. This is an economic issue.
 
What was more noteworthy about Hillary’s response was the fact that she discussed further that beyond being a women’s issue, beyond being an economic issue, it is a human issue. When a woman is being paid less, not only are her retirement prospects down the line more grim, but that also impacts her family. It impacts whether she can afford out-of-pocket medical expenses, and thus her health and welfare. It impacts the financial security of her family. Consider a single, working mother. I was raised by such a person. If she is underpaid for her work, this impacts the neighborhood in which they can afford to live, and in turn likely the quality of the school to which she can send her child, with education quality highly correlated with ability to go on to higher education and to be economically secure. And when the issue of pay equity is hitting on equal rights, education, health care, and economic security, it is no longer a “women’s issue,” but rather speaking to the bread and butter of the Democratic Party platform.
 
For obvious reasons, gender has played heavily into this election cycle. Abortion has been under attack across the nation and pay equity has been discussed frequently, but many issues are dismissed as “women’s issues,” relegated to a niche rather than applying broadly, and many voters dismissed as supporting Clinton on the basis of her gender rather than accepting the fact that her policy proposals are well-reasoned, progressive, and achievable. After all, they couldn't possibly be voting for the candidate who was declared by the New York Times as one of the most broadly and deeply qualified candidates in modern American history. And they couldn't possibly be voting for the candidate who built her career around fighting for women, families, health care, and the economic security of the working class. 
 
We saw this in 2008 as well. People must have been voting for President Obama because of his race. It is an easier argument to make than accepting the fact that one might actually be losing on the grounds of policy substance. But it isn’t simply inaccurate to characterize minorities as voting for Obama on the grounds of race, or women voting for Clinton on the grounds of gender. It is patently offensive, dismissing as women incapable of making reasoned political analysis as opposed to letting their anatomy decide their vote. The Democratic Party (and Sanders supporters in particular) can and should be better than that. 

Following a 16-point loss in New York, a growing number of commentators have noted that Sanders' prospects for the Democratic nomination have gone from "if everything goes right for Sanders, he might have a chance" to "it's not going to be possible for Sanders to overcome Clinton's lead." The question remains, then, Why stay in the race? And perhaps more pertinently for the Democratic Party's November prospects, if staying in the race until the convention as he and his campaign's surrogates have said vociferously that they plan to do, why continue to be on the attack as opposed to shifting the campaign to just be about the (positive) message of combating income inequality?

Politico framed the issue as one of Sanders being in the political trap of being too successful to want to concede months ahead of the convention, and yet not successful enough to win. But the failure to concede or even change strategy has ramifications that extend well beyond his own candidacy for the presidency: "Choosing to back off too soon would anger or disappoint Sanders' millions of loyal supporters, his team worries. But deciding to continue fighting could risk damaging the likely Democratic nominee ahead of the general election, though that’s not a concern that weighs heavily on their thinking."

Such a stubbornness to continue to the convention evokes memories of the 2000 election, with Nader's 4% of the vote ultimately serving as a spoiler in key states, most notably Florida given the historic closeness of the race and its resolution in the Supreme Court. Of course, one can make a number of arguments on the Nader front: the race didn't need to be that narrow if the Democratic Party had a stronger candidate, and we don't know with absolute certainty how (or if) Nader voters would have otherwise voted. But the point is that in a very close election, even just a couple percent of the voting population can make enough of a difference as to swing an election outcome from the Democratic to the Republican Party. And while Sanders is not threatening to run as an independent candidate, his willingness to remain on the attack with respect to Clinton provides enough ammunition for the Republicans to use in the general election, and arguments for Democrats and independents not to trust her leadership, that he risks empowering the interests that he purports to so oppose.So while this is not a wholly analogous case -- we are still talking about the Democratic nomination and not the general -- there is reason to question his motives (policy as he suggests, or ego as his actions imply) and to discuss the potential for his campaign strategy as promoting a spoiler outcome moving forward. 

It is no secret that I am an avid fan of John Oliver (some might say obsessed). I look forward to his show every Sunday, not just because it is hilarious, but because he truly is one of the only people doing true investigative, gutsy journalism these days. As a consequence, I was quite surprised to come across this news story: a New Jersey high school teacher was temporarily forced to resign for showing his students the John Oliver clip on "Make Donald "Drumpf Again." 

There is not a secret as to Oliver's politics. There is an ideological bent to the show, which viewers can take into consideration when evaluating its content and trusting its message. But it also reports a number of stories that are highly salient and deserving of greater public attention, for example:

* Pharmaceutical companies' marketing of drugs to doctors
* Mandatory minimums in sentencing
* Voter suppression tactics and other constraints on voting rights
* DC voting rights
* The limited resources of public defenders
* The "revolving door" in government regulation with the FCC chairman appointee
* Abstinence-only education
* Paid and unpaid family leave
* Televangelists' seed-faith practices
* Sweat shop labor in the fashion industry

I, for one, have shown the clip on the FCC and interest group capture when teaching on the relationship between bureaucracies and interest groups. It is a crisp and recent example of the relationship between the communications industry and the federal government and the implications for effective and responsible regulation of monopolies (and of course, with a healthy dose of humor thrown into the mix).

The teacher's resignation provoked a marked response from the school community and led to him rescinding his resignation and ultimately reclaiming his position. But the broader point is that provided that instructors do not present the show as being an unbiased source of information (indeed, as with any op-ed, it should be a starting point for more, important investigation and discourse), one should hardly be justifiably fired or otherwise pressured to resign for using its political commentary as an instructive tool. 

Last month, I wrote a post on the marked influence of the pharmaceutical industry, both with respect to direct-to-consumer (DTC) advertising as well as marketing to doctors. In today's New York Times, Weill Cornell psychiatrist Richard Friedman provides an op-ed speaking to this very issue. 

With drug makers spending $4.5 billion on DTC advertising, a 30% increase over the spending rate just two years ago, it is incumbent upon us to consider carefully the accuracy of these companies' claims that they are educating the American consumers in their making informed medical decisions about various prescriptions available.

Friedman then compares the effectiveness of comparable anti-depressants, given the ample marketing of the anti-psychotic drug Latuda, which is also used in the treatment of bipolar depression. He examines four different anti-psychotics used to treat bipolar depression (Prozac/Zypreza, Seroquel, Symbyax, Latuda), their monthly cost not factoring in insurance, and the number of people needing treatment in clinical trials for one individual to benefit from the drug. (None of the drugs provide information on the number of successful and unsuccessful clinical trials, so those columns contain only question marks for all four drugs). The number of people requiring treatment in a clinical trial for one to benefit from the drug range from 4 to 6 across the drugs, so there is limited variation on that dimension. However, while Prozac's monthly cost is $21.79, Seroquel ranges from approximately $51-102, and Latuda is $922. And while it is not at all uncommon for one to try different SSRIs and similar drugs to find one that (potentially for idiosyncratic reasons) is most effective and provides fewer side effects (e.g., Prozac vs. Zoloft), when a medication is nearly 42 times more expensive, we expect there to be a large differential in effectiveness. But it is unclear whether that's actually what we're getting here, with many earlier medications apparently functioning the same or similarly and potentially being similarly effective. 

Friedman offers some valuable suggestions for information that would be valuable to consumers in determining which medication to take, and the costs and benefits associated with that decision. Among those recommendations are statistics about the rate at which people taking the drug experience various mild vs. serious side effects (are the cautions we hear on television about seizures or coma just to protect against litigation in a very rare event, or is it a legitimate possibility to consider?), and the results of clinical trials for the drug. He recommends that the FDA provide a universal scorecard for all new drugs to reveal how the drug's cost and effectiveness compare to similar drugs already available, with the scorecard in advertising and pharmacy-provided safety information. Thus, consumers can have not just absolute information (e.g., the cost of this drug and its proper use) but also relative information given the number of similar drugs on the market. 

This is particularly important given the number of comparable medications available to American consumers. However, Friedman notes, "Drug companies have little incentive to make these comparisons. Why? Because a vast majority of 'new' drugs are really not new at all; instead, they are minor tweaks and modifications of older drugs, and therefore unlikely to substantially outperform them. For example, there are seven statins on the market that all lower cholesterol by the same mechanism, and eight antidepressants (selective serotonin reuptake inhibitors) that essentially work the same way." If "new" options for medications are rarely very new but may pose different costs and risks, such a comparative analysis and relativistic way of evaluating drugs will be especially advantageous. The website eHealthMe makes a valuable advance toward such compiling detailed data on patient experiences of particular constellations of side effects with medications as well as with interactions between medications. 

Friedman's additional recommendation that clinical trial information -- both positive and negative -- be provided to consumers speaks to a broader issue in medical research (as well as research in many other fields including political science, though the consequences may be more limited than with respect to the development and distribution of medications to the American public), which is selection bias in publications. Positive clinical trials (those for which the statistical significance is p<0.05) are more likely to be published than are negative ones, though drug companies are required to register all trials. It is not difficult to understand drug companies' incentive to produce positive findings: they are spending marked amounts of money to produce a drug and want to show that it works. And in other contexts, there is an attractiveness to formulating a hypothesis and finding that we were in fact correct in our assessment of the relationship between X and Y. Looking into this matter, the World Health Organization found in surveying various trials and investigations into publication bias that the rate at which clinical trial results are published ranges from 36-93% (striking variation!), that positive findings were more likely to be published than negative or null findings with an odds ratio of 3.90, and that positive findings were more likely to be published sooner. Thus, if a medication is determined to be ineffective, we might not learn about that at all, or if we do, we might not learn this in a timely fashion.

An October 2015 New York Times article evaluated the overstated effects of talk therapy as a consequence of studies with poor results rarely being published in journals and thus peoples' impressions not accounting for the unpublished accounts of limited or null effects. Indeed, when accounting for the selection bias by tracking down the data from 13 unpublished clinical trials, they find that estimated effects of the benefits of talk therapy reduced by approximately a quarter. And while the harm associated with engaging in therapy when it may or may not be helpful is relatively small -- there is a clear financial investment but otherwise may still give someone a venue in which to talk and feel heard, even if not effectively managing the more severe symptoms at hand -- a 25% differential in effectiveness may matter a LOT when considering putting medication in one's body (again, with uncertain clusters of side effects, some serious) and spending hundreds of dollars per month to do so. 

The independent, nonprofit NGO Patient-Centered Outcomes Research Institute (PCORI), created in 2010 as part of the Affordable Care Act ("Obamacare"), has the mission of improving the availability and quality of medical evidence that is made available. Among its programs is Clinical Effectiveness Research (CER), aiming to remedy the incomplete nature of available clinical trial evidence, though clearly there is a long way to go. Increasing the number of venues in which to publish null findings would go a long way toward improving the quality of research in healthcare and beyond. 

On Tuesday, April 19, the Supreme Court heard oral arguments on Universal Health Services v. United States, ex rel Escobar, in which Universal Health Services, Inc. made the argument that providers ought not be held liable for fraud for failing to comply with particular regulations. The outcome of the case will have important implications for the number of False Claims Act suits that are brought against a number of industries but healthcare providers in particular, with two-thirds of whistleblower suits targeting healthcare entities. 

At the heart of the case is the False Claims Act, legislation enacted amid the Civil War and awarding treble damages against government contractors that "knowingly presen[t] . . . false or fraudulent claim[s] for payment.” The majority of cases brought under the Act are by whistleblowers, who can then recover 15-30% of the government's overall recovery. 

Supporting UHS are a number of healthcare groups such as the American Medical Association and the American Hospital Association, which wrote briefs for the case in support of the petitioner's argument that imperfect compliance with the law does not constitute fraud and that the Court should not open the door to meritless lawsuits. Opposing this position are whistleblower groups and mental health advocates, holding that the law is in place to protect patients against being subjected to substandard care, of which Universal Health Services has been frequently accused, with a number of their facilities under Department of Justice investigation, Departments of Children and Family Services refusing to send children to some of their units due to patient conditions (see my previous post on UHS maltreatment), and the Commonwealth of Massachusetts recently requiring that four UHS-managed facilities submit correction plans given patient care and life safety violations. UHS is no stranger to False Claims Act suits across the country, with the company and two subsidiaries settling in 2011 for $6.9 million claims that they had provided substandard psychiatric care to adolescents and had engaged in Medicaid fraud, and with 25 of its behavioral health facilities under federal civil investigation under over alleged violations of the False Claims Act. 

Justices Kagan and Sotomayor appeared during the oral argument to be skeptical of the argument made by UHS, with Justice Sotomayor asking early on, "I always thought that when you asked for payment, you're making a promise: I did what I agreed to do. Pay me, please. That's, to me, what's sort of understood. If I hired you to provide me with doctor services, you ask me for money, I'm assuming you provided me with doctor services. And you know you didn't. Why isn't that a fraud?" Justice Kagan noting that the issue at hand was quite analogous to the type of fraud that the False Claims Act had been meant to address -- namely, contractors' selling to the government non-functioning guns and other materials to the United States during the Civil War -- and she noted, “I would think that this is the exact same --that the contract was for a doctor's medical care, and a doctor's medical care was not provided." Chief Justice Roberts, however, was more sympathetic to UHS's arguments about the harshness of applying the False Claims Act given the complexity and extensiveness of the applicable (thousands of pages of) regulations in challenging cases. Justice Breyer sought to distinguish between garden variety breaches of contract and those violations that could accurately be construed to be outright fraudulent under the FCA. 

How the Court ultimately will come down on the case is ultimately unclear, apart from the quite vocal and pointed Justices Sotomayor (pro-relator) and Roberts (pro-contractor). Should the Court be split 4-4 along party lines with the ninth seat not yet filled, the 1st Circuit's 2015 holding will stand (though it is worth noting that this is an issue of inter-circuit conflict, with the 7th Circuit rejecting the 1st Circuit's argument in a separate case). The 1st Circuit had validated the notion of "implied fraud" -- that is, that even absent actual misrepresentation, claims can be misleading because demands for payment contain an implicit misrepresentation (e.g., the provision of certain medical services that were ultimately deemed substandard). 

While a case of fraudulent claims, at first blush, does not appear the stuff of front page headlines, the implications of the case are vast, with Universal Health Services being the largest provider of inpatient behavioral health services in the United States -- boasting facilities in 37 states, Washington DC, Puerto Rico, the U.S. Virgin Islands, as well as the United Kingdom -- and managing approximately 25% of inpatient care. Touching on so many lives across the country, the company is highly influential in the lives of its patients and their families, but with that power comes the responsibility to adhere to certain standards of care, standards that a number of suits and reports have suggested that they have failed to make. Chances are, we will not know until June how the Supreme Court ultimately will rule on the matter. 

_On Monday, April 25, the Supreme Court will hear oral argument on a seemingly unsexy issue of patent law in Cuozzo Speed Technologies, LLC v. Lee. But don't stop reading. Please don't let the words "patent law" be immediately sleep inducing. Darn, I used those words again. Bear with me.

What the Supreme Court is taking on specifically is a 2011 law, the Leahy–Smith America Invents Act (AIA) (PL 112-29), bipartisan legislation that governs the challenging of patents and which was the most marked development in patent law in decades. Among other things, the law provided for inter partes review, according to which patent challenges may be heard by an appeals board within the United States Patent and Trademark Office, as opposed to through costly and time-consuming litigation. The setting in which patents are challenged is important given the standard of review that is applied, with courts in litigation settings presuming patents to be valid and understood by their "plain and ordinary meaning," while appeals boards under the 2011 AIA interpret patents more broadly. The consequence is that with a specific claim by a patent holder (a condition favoring patent holders), it is more difficult for competitors to argue that the claim isn't novel or important, and there is the general complexity of different standards of review for the same claims in different legal venues, which thus creates uncertainty in the legal environment.

 So what does this have to do with pharmaceutical industry? 

Patent law governs much of the dynamic between the brand prescription drugs that are manufactured and the much cheaper generic versions of drugs that are comparable. It protects drug manufacturers in that they are permitted to exclusively sell their drugs at their chosen price (let's face it, the maximum price that the market will permit) to boost profits and recover research and development expenses before other companies are permitted to market generic versions (for example, marketing Klonopin (brand) vs. clonazepam (generic).  

Should the Supreme Court overturn the Federal Circuit opinion, pharmaceutical companies argue that it will be more difficult for them to recoup expenses for drug manufacturing, research, and development, while health insurers and generic drug companies urge that the lower court ruling be upheld so as to facilitate the introduction of more generic drugs into the market and thus reduce consumers' cost of prescription drugs (for more, see full article at STAT News). 

There is no doubt that drug manufacturing is expensive. Those in favor of patent protections held, "In the twenty-first century, it costs an average of $2.6 billion to develop a new drug... Meaningful patent protection is required to justify that investment." A question raised by insurers and those manufacturing generics, however, is whether drug manufacturers are exploiting those protections to prevent generic competitors from entering the market, given that market competition will lead consumers to opt for the inexpensive (or less expensive) versions. Not surprisingly, the implications for consumers is striking. In 2015 alone, 4,065,175,064 prescriptions were filled in the United States, with those prescriptions yielding retail sales of $286,797,651,607. In 2011 alone, 4.2 billion prescriptions were written, with 34% of American adults taking at least one prescription drug and 11.5% of American adults taking 3 or more prescription drugs. Given these numbers, it is not hard to imagine why the ability to take a generic version of one, and especially of three, prescription drugs every month would aggregate to a large financial difference when it might matter greatly. in fact, 10.5% of those earning under $25,000 annually take four or more prescriptions, compared with 20% of those making $100,000-149,000 annually taking only one prescription. And while generic drugs are required to have the same active ingredients as do brand name drugs (though are not required to have the same inactive ingredients), they are on average 80-85% less expensive than are their brand name counterparts. 

Given that this case implicates not only patent law broadly but a multi-billion dollar industry affecting the majority of American consumers, the case, while at face value not the stuff of landmark holdings, could have monumental implications. And with a continued eight-member bench, should a 4-4 split arise in this instance, the Federal Circuit ruling would hold, favoring the position of insurers and generic companies. 

The New York Times ran an op-ed on April 18 highlighting Sen. Sanders' dismissal of the outcomes of southern states, and the role that they play in the primary race, bringing to light for example the following quotes:

“Secretary Clinton cleaned our clock in the Deep South. No question about it. We got murdered there. That is the most conservative part of this great country. That’s the fact. But you know what? We’re out of the Deep South now. And we’re moving up.” -- Sanders on CNN

“Well, one can argue — people say, Why does Iowa go first? Why does New Hampshire go first? — but I think that having so many Southern states go first kind of distorts reality as well.” -- Sanders on The Nightly Show

There are a couple of problems with this logic, which the author Charles Blow brought to light. For starters, three of these southern states that he lost -- North Carolina, Virginia, and Florida -- are key states in which the Democrats hope to be strong contenders (North Carolina being the most conservative of the three and plagued by voter ID problems, and the other two voting for Obama in both 2008 and 2012). Secondly, in southern states, a large share of the Democratic primary voters are African American, a demographic group with which Sanders continues to struggle. 

Sanders and his supporters have made (especially in the context of discussions about superdelegates) rhetorical flourishes about Sanders' successes in caucus states such as Wisconsin and elsewhere have reflected a surge in support and the "will of the people." It is undeniable that Sanders has vastly outperformed what many expected of him, and for that he should certainly be proud. But given the demographics of the states in which he has been successful (e.g., Wisconsin, New Hampshire, Alaska, Idaho, etc., as opposed to the more diverse states in which Clinton has been successful such as Virginia, Florida, North Carolina, Texas, etc.), it is nevertheless difficult to accurately characterize such outcomes as the will of the people, much less the will of the Democratic Party overall, which relies on the support of the African American community. Moreover, while Sanders touts his average campaign contribution of $27 -- and indeed it is admirable and impressive to have garnered such financial support from so many small contributions -- he has sharply criticized Clinton for taking larger contributions and for benefiting from large fundraisers from such people as George Clooney, despite much of the money going toward not Clinton herself, but to the Democratic Party and down-ticket races, suggesting potentially a broader engagement in the Party and its supporters. 

Part of the reason why we should take Sanders' support with a grain of salt comes down to the nature of the primary system. Much of Sanders' support has come from caucus states, which many have characterized as undemocratic given, for example, the logistical challenges posed for lower-income workers, families without child care, students, and seniors (all demographic groups that he argues that he represents), in addition to the generally haphazard nature in which votes often are cast and counted. Further, and applying to both Clinton and Sanders, not only are primary elections low turnout relative to the general election, but political scientists have noted that primary voters tend to be more ideological than are general election voters. Thus, there is for all states a problem of representativeness. 

With this caveat of less-than-representative subsets of the American electorate determining the Democratic nominee for president, Nate Silver notes that Clinton is doing far stronger in states that more closely resemble the national Democratic Party. Not only do the states in which Clinton boasted victories have large populations of African American and Hispanic voters, both central to the Democratic Party if it will be successful, but Silver argues that North Carolina, Virginia, Florida, and Texas (all supporting Clinton) "are among the most demographically representative of the diverse Obama coalition that Clinton or Sanders will have to rely on in November."

There are demographics in which Sanders has been more successful than Clinton -- notably, young voters and in particular, 18-29 year-old women -- and Clinton will need to ensure that they turn out in November given that young voters tend to be less reliable voters. Sanders has also scored well with independents, which may prove important in an election in which there is so much uncertainty with respect to the Republican Party nominee. However, for Sanders and his supporters to argue that his recent successes represent the "will of the people" or a tidal wave of support that should be noted moving forward to the convention is indeed misleading. Sanders may indeed prove valuable in working to bring new people into the party. But if key demographic groups for the Democrats continue not to "feel the Bern," and if he fails to address this limitation in his mobilization, he will continue to face an uphill battle.

 Much of the debate over Clinton versus Sanders has centered around the question of ideals versus experience. The idea of what should be versus what can be, particularly given the realities of persistent divided government and thus limitations on what the president can himself or herself achieve. Clinton called attention to this in the recent debate in New York, holding that "it's easy to diagnose a problem, it's harder to do something about it," with Sanders' policies being discussed far more in broad strokes than in achievable policy particulars.

But one day ahead of the New York primary, it is also important to consider whether, in the unlikely scenario that he becomes the Democratic nominee, and in the even less likely scenario that his policies are carried into effect as he wishes, would it be good for the country? A number of economists have said no, but I wanted to dig deeper.  

I have not been one to vote my pocketbook. I believe that taxes are an important contribution that we as citizens need to make in order to invest in public schools (from which I benefited, both in secondary school education and in higher education, go bears), roads and public transportation (which I use daily), environmental protection (a global imperative), and the like. But efficiency in those allocations of funds is important (as is one's ability to pay for rent and groceries), and looking between the Democratic candidates, both of whom support those policies, with whom would a middle class person such as myself benefit? 

The focal point of Sanders' campaign has been income inequality. Make the people on Wall Street accountable and protect those on Main Street. Prevent the rich from getting richer, the poor from getting poorer. That's all well and good. This tool can help one to calculate their change in tax liability under the four frontrunners for their party nominations (Trump and Cruz on the right, Clinton and Sanders on the left), given income level, marital status, and number of children. I am single, have no children, and have a current income of $45,000. According to those numbers, I would benefit from a tax perspective under the Republicans, I would pay $40 more with Clinton, but I would pay $4,880 more under Sanders. This is with an income that is incontrovertibly middle class. 

I then looked to see whether the benefits under Sanders would kick in if I were at or around the poverty line, so I entered an income of $15,000 (holding constant marital status and children). Still, I would be paying more under Sanders, with an increase in tax liability of $20 under Clinton and $1,630 under Sanders. Even if earning $15,000 per year with two or more dependents, I would be paying $990 more under Sanders while breaking even with Clinton. Even more absurdly, with a marital status of married and with two or more dependents, one would need to make under $5,000 to benefit under Sanders' tax plan (under $10,000 year if single with two or more dependents). And while it is true that his policies absolutely hold millionaires and billionaires accountable at a higher rate, the fact that those on the middle and lower ends of the income distribution are feeling such a pinch -- in some cases to a debilitating extent --is inconsistent with his rhetoric of concern about the middle class disappearing and the desire to combat income inequality that benefits the wealthy at the expense of the poor. In fact, a recent poll revealed that Sanders supporters are willing to spend only an additional $1,000 more on taxes, vastly exceeding that which his policies would require of them.

It is consistent with the challenge that the Sanders campaign has faced throughout, which is that talking about policies and problems is an easier task than is implementation. Short of careful, deep thought about how to combat these economic and political struggles, he has devised an economic plan whose specifics appear to go against the positions for which he purports to stand. I do not in any way believe that this is the result of any nefarious work on the part of the Sanders economic advisors, but it should give New Yorkers and Americans across the country pause before endorsing these policies. ​

On April 12, 2016, a three-judge panel on the 7th Circuit Court of Appeals ruled that district courts should consider suits being brought by those adversely affected by Wisconsin's photo ID law. The district court will now hear the case by voters who are holding that if for specified reasons they are unable to obtain voter ID, that they be permitted to vote given the provision of an affidavit. Such affidavits will be provided for voters who fall within one of three categories: 1) having a name that does not match that on their birth certificate, such as due to the changing of a last name with marriage (thus requiring more arduous processes associated with obtaining an ID); 2) a voter who is missing the underlying paperwork needed to obtain an ID (e.g., a Social Security card), and 3) a voter whose birth certificate has been lost. Thus, the circumstances to which this applies are highly specific and aimed at those cases that would require an inordinate amount of paperwork and appointments that are disproportionately burdensome for those who are lower-income. 

Judge Easterbrook of the 7th Circuit authored the opinion, writing, "Instead of saying that inconvenience for some voters means that no one needs photo ID, plaintiffs contend that high hurdles for some persons eligible to vote entitle those particular persons to relief. Plaintiffs’ approach is potentially sound if even a single person eligible to vote is unable to get acceptable photo ID with reasonable effort. The right to vote is personal and is not defeated by the fact that 99% of other people can secure the necessary credentials easily. Plaintiffs now accept the propriety of requiring photo ID from persons who already have or can get it with reasonable effort, while endeavoring to protect the voting rights of those who encounter high hurdles."

The judge hearing the case will be Lynn Adelman, who in a 2014 case struck down the voter ID law on the grounds that it discriminated on the basis of race in violation of the Voting Rights Act. Wisconsin ACLU Senior Attorney Karyn Rotker said of the 7th Circuit's holding, "The Appeals Court determined that just because it may be easy for most people to get ID, the state can't take voting rights away from people who have real difficulties getting ID.”

While we rightly see much emphasis on the fact that November will be the first presidential election in the aftermath of Shelby County v. Holder, it is important to note that increasing restrictions on voting is a nationwide strategy being employed, whether in the form of photo ID requirements or the reduction or elimination of early or absentee voting. Such constraints disproportionately impact minorities, poor voters, and students, and in the recent Wisconsin primary resulted in long lines and voters being turned away. 

The right to vote is sacred. Our nation has a long history of battles over obtaining the right to vote in the first place, and later obtaining the right to vote in practice and free of discrimination. While increases in voter turnout do not impact the parties equally, whether one is a Democrat or Republican (and it is worth noting that the 7th Circuit panel was comprised only of Republican appointees), the notion of registered voters (with voter registration alone requiring some evidence of citizenship and residence) being entitled to cast ballots should not be controversial. It is democracy in action.