Re: Implementation

1

I think two things distinguish ACA:

-the lag between passage and implementation and
-the genuine bug-fucking craziness of the Republican Party.

When I was a kid, there was a strong taboo against blowing up the American economy, even among the John Birch types, and certainly among the elites who ran the party.


Posted by: politicalfootball | Link to this comment | 09-19-13 7:37 AM
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Over what time frame did other pieces of major legislation roll out? You can't create Medicaid instantly.


Posted by: heebie-geebie | Link to this comment | 09-19-13 7:40 AM
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The end of Reconstruction and the rise of Jim Crow?


Posted by: Walt Someguy | Link to this comment | 09-19-13 7:43 AM
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The classic case of "massive resistance" involved racial desegregation, first mandated by the Supreme Court in the the 1950's. Several states succeeded in delaying implementation of federal desegregation policies for several decades, and arguably we're not there yet. Sabotage by state officials, rallies in opposition, people calling the policies a failure, etc. The resistance continued long after the major civil rights legislation passed in 1964 and 1965.

Also a significant number of murders. As far as I know, resisters to Obamacare aren't shooting or bombing anyone. Yet.


Posted by: unimaginative | Link to this comment | 09-19-13 7:44 AM
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3: Let's not give people ideas. There's nothing stopping them from changing the skin color of the puppet.


Posted by: Moby Hick | Link to this comment | 09-19-13 7:46 AM
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3/4 Good point.


Posted by: heebie-geebie | Link to this comment | 09-19-13 7:47 AM
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Maybe somebody could tell the Koch brothers about MRSA. That might scare people away from the hospital and could provide useful information.


Posted by: Moby Hick | Link to this comment | 09-19-13 7:52 AM
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4 is right. Conservatives have now turned their sword away from "black people" to a group consisting of "human beings in general". This will probably lose them many votes in 1.5 generations or so.


Posted by: Cryptic ned | Link to this comment | 09-19-13 7:55 AM
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Prohibition spawned a fair amount of illegal activity - not sure that it was obstruction as much as evasion, avoidance, and associated ills like gang wars, local corruption, and, yes Mr. Capone, income tax evasion.


Posted by: bill | Link to this comment | 09-19-13 8:13 AM
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Heh: Ted Cruz Infuriates House GOP By Conceding Defeat On Obamacare Repeal


Posted by: heebie-geebie | Link to this comment | 09-19-13 8:17 AM
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Certainly not Medicare, Medicaid, or Medicare Part D. Medicaid took some time for all states to adopt; Medicare had some scares about provider participation but paid generously enough to keep that from being a problem (at the cost of making hospital spending a near-catastrophe by the late 70's); Part D was merely strengthened when the Democrats came into power the year after it came into effect. The Medicare catastrophic benefit of 1988 was strongly opposed and repealed a few years after passage, but that seems more because of bad design.


Posted by: Minivet | Link to this comment | 09-19-13 8:24 AM
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10 -- It's always a surprise to see people so drunk on their own whiskey. Did anyone but moronic pundits (I repeat myself) think that there would be a bill on the President's desk where he either repeals O-care or shuts down the government? Because that's the only way you'd even have a chance with 'Obama is shutting down the government to save his precious civilization destroying subsidy of poor black people program.' It still wouldn't work, but 'House refuses to pass CR that has passed the Senate' doesn't even have any potential for reflecting on the Pres in that way.

I remain convinced, as noted in the other thread, that maybe the best way to go here is to have the insurance companies advertising their fully ACA compliant plans as 'better than Obamacare' -- which it seems they could do, honestly, if the benefits are even just a tiny bit better than the minimum. Everyone gets covered, insurance companies sell policies, there's no pressure to repeal from people made about their loss of freedom (since they were able to avoid the dreaded Obamacare card.)


Posted by: CharleyCarp | Link to this comment | 09-19-13 8:55 AM
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More directly to one of the OP questions, I don't think it's so much that there was a norm against repealing things after they were passed, but people generally had the wits to count votes and wait until another election had passed, or sometimes agree it might take another generation. (The NYT routinely kept track of wet vs. dry members of Congress all through Prohibition.)


Posted by: Minivet | Link to this comment | 09-19-13 8:55 AM
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+angry


Posted by: CharleyCarp | Link to this comment | 09-19-13 8:56 AM
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Andrew Sullivan suggests that one reason the for the bugfuck crazy opposition of the ACA is that it is a hella effective fundraising tool. You get the bitter-enders riled up so they open their wallets and once the money flows in you're sort of committed, not to mention addicted to the cash. Makes some sense to me. This is the 41st attempt by the House GOP to kill the ACA. They know it will fail, likely at the cost of real harm to the country. But they want that damn money and those crazy-ass motherfucker votes in the primaries and they can't let go.


Posted by: togolosh | Link to this comment | 09-19-13 8:58 AM
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12: The only big difference between on- and off-Exchange plans will be that no subsidies are available outside the Exchange. (There's still minimum essential benefits, no preexisting conditions, community rating, and guaranteed issue.) So this would screw people it fools who were eligible for subsidies, which is a majority of people, and if it results in disproportionately lower-income people using the exchanges, that could unbalance the exchanges' risk pool to the extent that those are unhealthier people (though I'm not the magnitude of that effect).


Posted by: Minivet | Link to this comment | 09-19-13 9:00 AM
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15, Certainly in Ted Cruz's case. If he doesn't get elected president this decade I assume he retires and becomes a full-time con man Ralph Reed-style.


Posted by: Cryptic ned | Link to this comment | 09-19-13 9:01 AM
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17: I like to think that Cruz is sufficiently embedded in the Tea Party that he's un-electable as president. He'd have a hard time doing the etch-a-sketch tack to the center with the amount of wackiness he has on the record. Or maybe I'm wrong and we might have the most interesting administration ever.


Posted by: togolosh | Link to this comment | 09-19-13 9:06 AM
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19

Watch out, laydeez, because Obamacare is going to be all up in your snatch.



Posted by: Kermit Roosevelt, Jr. | Link to this comment | 09-19-13 9:14 AM
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16 -- No, I mean the plans that are being sold the the marketplaces. BETTER THAN OBAMACARE!


Posted by: CharleyCarp | Link to this comment | 09-19-13 9:15 AM
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Want to beat Obamacare? Buy our Silver plan on the Mississippi exchange. Here's the link:


Posted by: CharleyCarp | Link to this comment | 09-19-13 9:16 AM
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I know Brown V Board of Education took a long time to be fully implemented in the South.

In Little Rock, the city literally shut down the schools for a year rather than implement it. (By the next year, all the rich folk had sent their kids to private schools, some of them hastily started.)

And in the suburbs outside of New Orleans, where I came up, it was 1971 before schools stopped segregating by race. I remember the uproar when my school district had to de-segregate.

Plus, there was still fallout into the 80s. For instance, all the public high schools in Jefferson Parish (my parish) were segregated by sex, so white girls wouldn't be going to school with black guys. This meant, in practice, that the boys' schools were funded much better than the girls' schools (we didn't need gyms or calculus teachers), and finally someone sued, I think in 1983?

These are the cases I know about. I'm sure it rolled out much the same in other places.


Posted by: delagar | Link to this comment | 09-19-13 9:17 AM
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$50 off for the first 5,000 customers who turn in their Obamacare Card!


Posted by: CharleyCarp | Link to this comment | 09-19-13 9:18 AM
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19: See, it's the left that's fighting the War on Women!


Posted by: togolosh | Link to this comment | 09-19-13 9:21 AM
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Plus, in fact, schools all over the South are still segregated by class and race.

Here in Fort Smith, we have Northside and Southside High Schools.

Southside is a great school, fully funded, sends kids to wonderful universities on great scholarships all the time, blah, blah, blah.

Northside is falling to pieces, has to hire teachers with very little experience, and can't pay much.

These schools are literally about a mile apart.

I bet you can guess the racial make-up of each.


Posted by: delagar | Link to this comment | 09-19-13 9:21 AM
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20: You've seen the Wonkblog thing about Kynect?


Posted by: Minivet | Link to this comment | 09-19-13 9:21 AM
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The only big difference between on- and off-Exchange plans will be that no subsidies are available outside the Exchange.

This was true of the original design of the ACA, but subsequent regulations have blurred the boundary between the two. A subsidy eligible person will be able to go to an off-exchange channel (like a broker or E-HealthInsurance or a carrier's website) and obtain a subsidized, exchange-qualified health plan.


Posted by: Kermit Roosevelt, Jr. | Link to this comment | 09-19-13 9:22 AM
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A tactful person wouldn't say this, but I will anyway. It has been interesting watching the country be held hostage to crazy Republicans the way California was before the last election. Everyone was all "ho ho, your politics are so crazy and you can't pass a budget and just negotiate with your crazy people." And we were all "We can't. They rightfully fear a challenge from the right in their own districts and nothing matters more to them." And then everyone pointed and laughed at us some more.

My main point is that we never did negotiate successfully. We elected a supermajority and ignore them now, with great results. But we didn't ever find a strategy to work with crazy Republicans.


Posted by: Megan | Link to this comment | 09-19-13 9:24 AM
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Boston didn't implement busing to desegregate schools until 1974 by court order. Exodus and violence followed. PBS says the situation began to stabilize in 1977.


Posted by: ydnew | Link to this comment | 09-19-13 9:27 AM
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28: But California voters inflicted the problems on themselves by passing so many stupid initiatives. That's why we laughed at you.


Posted by: Walt Someguy | Link to this comment | 09-19-13 9:29 AM
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27: Not sure I follow - "on-exchange" doesn't necessarily mean "purchased with the exchange as a middleman", I thought it was always up to the states whether their exchange would be more like a brokerage or a comparison-shop tool. By "on-exchange" I mean approved by an exchange under federal and self-adopted standards, and therefore promotable by the exchange and affiliates (navigators, etc.), subsidy-eligible, and more transparently comparable. Off-exchange plans are still subject to various federal rules, but there's more room for benefit package variation and one fewer layer of oversight, possibly leading to shenanigans.


Posted by: Minivet | Link to this comment | 09-19-13 9:29 AM
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19- I saw that at Yggles and I have no clue what point it's trying to make. Are they saying Obamacare participants will have mandatory snatch exams? Or that all women get their usual snatch exams but that people on Obamacare will have a government bureaucrat present?


Posted by: SP | Link to this comment | 09-19-13 9:31 AM
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33

Well, there is that.


Posted by: Megan | Link to this comment | 09-19-13 9:32 AM
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If this misinformation campaign is successful it will be because there is no countervailing grassroots support for the bill. As it turns out, Heritage healthcare doesn't inspire a lot of progressive enthusiasm.


Posted by: Eggplant | Link to this comment | 09-19-13 9:38 AM
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I mostly thought that California was a leading indicator for the rest of the nation. If I laughed, it was the hysterical, fearful kind of laughter.


Posted by: Eggplant | Link to this comment | 09-19-13 9:41 AM
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32, The message is "You hate the government, right? Everyone hates the government. So watch out, you may think you're going to the doctor, only to find out it's the government instead."


Posted by: cryptic ned | Link to this comment | 09-19-13 9:44 AM
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25, my hometown had East and West High (complete with dividing railroad tracks). Northern US. East was 80% Hispanic, 10% African American, 8% white, 60% graduation rate. West was about 40-40-20 African-American-Hispanic-white, 70% graduation rate. In the late 1990s, a new high school was built. You can imagine the ugliness drawing district lines. East had empty classrooms, West had overflow classes in hallways. The new school is 70% white and 20% Asian with a 99% graduation rate. So, yeah, still a pretty public fight about what should have long been accepted law.


Posted by: ydnew | Link to this comment | 09-19-13 9:45 AM
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No one expects the Government Pap Smear!


Posted by: SP | Link to this comment | 09-19-13 9:57 AM
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Alternate interpretation: "The United States? LOL, we all know the United States can't do anything right. Drop those bozos and get your health insurance from, like, Dow Chemical or something." This might work on some people who happened to have the option of getting health insurance from the United States.


Posted by: cryptic ned | Link to this comment | 09-19-13 10:00 AM
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Another long struggle against implementation is Roe v Wade. Decision in 1973, Hyde Amendment in 1976, state-enacted restrictions imediately, continuing to present.


Posted by: ydnew | Link to this comment | 09-19-13 10:01 AM
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Off-exchange plans are still subject to various federal rules, but there's more room for benefit package variation and one fewer layer of oversight, possibly leading to shenanigans.

I think this is more true in theory than practice. Only a handful of states impose any additional constraints on exchange-qualified plans. The majority of states are on the federally facilitated platform, where HHS has explicitly abdicated any role in qualifying plans: if you're a licensed and accredited health insurance issuer in Alabama and you have an approved product on file with the Alabama DOI, you're welcome to sell it on the federally facilitated exchange, no questions asked.

IMO, the biggest potential for shenanigans will be in the six or so states that have refused to translate the Obamacare insurance market reforms (e.g. guaranteed issue and community rating) into state law. It will be up to HHS to spot violations and initiate enforcement actions. But that has nothing to do with the on-exchange / off-exchange distinction.


Posted by: Kermit Roosevelt, Jr. | Link to this comment | 09-19-13 10:29 AM
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Another long struggle against implementation is Roe v Wade.

Also Engel v. Vitale. Decision in 1962. Some of my school teachers brazenly defied the ban well into the 1970s. Our local legislature tried an end run around it sometime in the 1980s (requiring a daily dose of "silent meditation, reflection or prayer"). Opponents are still a long way from making their peace with it, no small number of them hold public office.



Posted by: knecht ruprecht | Link to this comment | 09-19-13 10:40 AM
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22: In Little Rock Minneapolis, the city literally shut down the poorer schools for a every year rather than implement it fund them. (By the next year, all the rich folk had sent their kids to private charter schools, some of them hastily started.)


Posted by: Natilo Paennim | Link to this comment | 09-19-13 11:03 AM
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42 reminds me just how little I understand conservative thinking. Government involvement in health insurance is bad because Uncle Sam will see your ladybits, but government (a.k.a. public schools) teaching your kids to pray is awesome, because Jesus! So can Uncle Sam look at your ladybits if he prays to Jesus first?


Posted by: MAE | Link to this comment | 09-19-13 11:12 AM
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44, nothing, not even Jesus, cancels the inherent evil of ladybits.


Posted by: ydnew | Link to this comment | 09-19-13 11:17 AM
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42: Oh, yeah. We're still praying in many schools in Arkansas. Just recently my own university (a state university) stopped opening every single event with a Baptist-minister led Jesus prayer.

Plus we had a *big* uproar in a small town near here -- Muldrow, OK, I want to say -- when a student ratted out his high school for having the 10 Commandments posted in every classroom.


Posted by: delagar | Link to this comment | 09-19-13 3:06 PM
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Yes, here:

http://morallowground.com/2013/05/13/oklahoma-teen-gage-pulliam-under-fire-for-effort-to-remove-ten-commandments-from-muldrow-high-school/

The kid is the son of one of my students.

Not that I'm taking any credit for his actions!


Posted by: delagar | Link to this comment | 09-19-13 3:07 PM
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31, 41: Off-exchange plans are still subject to various federal rules, but there's more room for benefit package variation and one fewer layer of oversight, possibly leading to shenanigans.

It was my impression that the primary shenanigans in play for off-exchange plans is simply that they can easily be more expensive than the equivalent on-exchange plan. That may not matter to the citizen taking insurance through his or her employer, if the employer is paying a significant proportion of the monthly premium on the worker's behalf.

In any case, KR at 27: I don't see any blurring of lines between on- and off-exchange plans. Either you sign up for a plan offered through your state's exchange (whether you sign up yourself, or via some mediating navigator/broker), and are then eligible for a subsidy, or you don't - you go with an employer-provided plan, and are not eligible for a subsidy.


Posted by: parsimon | Link to this comment | 09-19-13 6:01 PM
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15: Andrew Sullivan suggests that one reason the for the bugfuck crazy opposition of the ACA is that it is a hella effective fundraising tool.

Certainly it looks like they're cashing in on the defund Obamacare crusade, but I have the impression that's an after-effect: the bugfuck crazy opposition began long before that.

I still haven't been able to figure out why the opposition to the ACA in the first place: just opposition to the individual mandate? A libertarian, anti-government sentiment? They've been dispensing misinformation for 2 years now, and some of the rubes perhaps believe those scary stories, but I doubt the Koch brothers do.


Posted by: parsimon | Link to this comment | 09-19-13 6:39 PM
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32: 19- I saw that at Yggles and I have no clue what point it's trying to make. Are they saying Obamacare participants will have mandatory snatch exams? Or that all women get their usual snatch exams but that people on Obamacare will have a government bureaucrat present?

Forgive me for serially commenting on remarks made hours ago, but the creepy Uncle Sam ads are part of a campaign (Koch-funded), to convince college-age people to 'burn their Obamacare cards', refuse to get health insurance through an exchange. It's called Generation Opportunity.

There's been a rumor going around in conservative realms that if you get insurance through Obamacare, you'll be required to disclose your sexual history -- and might be denied treatment! (or something)

So yeah, the idea of the ads is that if you get insurance, Uncle Sam will call for a mandatory snatch exam.


Posted by: parsimon | Link to this comment | 09-19-13 7:10 PM
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50: I'm hoping the creepy ads go viral--good reminders that enrollment is coming up. And also so crazed* that they help make the whole opposition a laughingstock.

*Like when Bush flew back from vacation for the Terri Schiavo situation. Only the 27% crazies were left in the boat.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 7:36 PM
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Not sure if people caught Chuck "Fuck Dog" Todd confirming the worthlessness of the press. He got a little butt hurt about it on Twitter later that day.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 7:40 PM
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Anyway, this all good news for John McCain.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 7:41 PM
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53: Maybe, but nothing can top getting on Op-Ed published in Pravda.


Posted by: teofilo | Link to this comment | 09-19-13 7:46 PM
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The "wrong" Pravda it turns out.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 7:48 PM
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Before I die I want the rest of the country to join me in an end of Lucky Jim moment directed towards the entire Republican Congressional delegation.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 7:52 PM
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57

People keep saying that, but it's not like there's really a "right" one.


Posted by: teofilo | Link to this comment | 09-19-13 7:54 PM
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58

Oh great. Literature I don't remember the message of.


Posted by: Moby Hick | Link to this comment | 09-19-13 7:55 PM
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I'm so glad I looked that up because apparently it's not by Joseph Conrad and I was thinking something very different.


Posted by: Moby Hick | Link to this comment | 09-19-13 7:58 PM
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Yeah, I don't remember what Lucky Jim is about either. Jeez, Stormcrow.


Posted by: parsimon | Link to this comment | 09-19-13 7:58 PM
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An album I wish I had--Ronald Reagan Speaks Out Against Socialized Medicine . (But it dates from before the bills were passed.)


Posted by: JP Stormcrow | Link to this comment | 09-19-13 7:58 PM
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57: OK, have it your way Nanook, oh mighty pedant of the North.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:00 PM
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LJ is like the ur-postwar-middlebrow English novel. I refuse to gloss it.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:03 PM
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(But hint: it involves ridicule.)


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:03 PM
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Maybe have Chuck "Wart Hog" Todd explain it to you.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:04 PM
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And misogyny! Plenty of misogyny.


Posted by: redfoxtailshrub | Link to this comment | 09-19-13 8:05 PM
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My free-floating hostility, let me show you it.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:05 PM
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Looking to see how much a Kindle copy would cost, I learned that he also wrote The Rachel Papers. I don't remember the plot of that either, but now I feel like looking up Ione Skye for non-crossword puzzle reasons.


Posted by: Moby Hick | Link to this comment | 09-19-13 8:08 PM
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Dear, I did look it up: right, that.

Chuck Todd is in lockstep with David Gregory, who similarly averred some time in the last year that it's not the media's job to, erm, fact check or otherwise express an opinion.


Posted by: parsimon | Link to this comment | 09-19-13 8:11 PM
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66: We lost our old copy so I re-bought and re-read it recently. It really is quite mean and ugly (as we've discussed here before). But funny, too. This edition had a long intro, basically Portrait of the Artists (it was about Amis and Larkin) as Young Assholes.

"Should novelist Kingsley Amis and poet Philip Larkin now be regarded as paedophiles?"


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:11 PM
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Which was sort of a weird thing for David Gregory to say, given that he does at times have at an interviewee, flatly stating, "That's not true, sir." But I think he and his consider that an optional sort of thing.


Posted by: parsimon | Link to this comment | 09-19-13 8:15 PM
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Go to Amazon Look Inside for LJ and search for "rictus" which appears near the end of the paragraph I am stupidly referencing. It will make little sense and seem even stupider out of context. As if I cared.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:21 PM
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62 doesn't even make any sense to me. I tender my apologies to teo.


Posted by: | Link to this comment | 09-19-13 8:23 PM
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73 me


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:25 PM
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I tender my apologies to teo.

Quyana.


Posted by: teofilo | Link to this comment | 09-19-13 8:45 PM
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72: I don't need your charity. I'll either read the novel or the first chapter of it or the wikipedia summary.


Posted by: Moby Hick | Link to this comment | 09-19-13 8:48 PM
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Maybe, but nothing can top getting on Op-Ed published in Pravda.

And it's going to have a great effect on his Zhdanov Number.


Posted by: Cryptic ned | Link to this comment | 09-19-13 8:52 PM
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So, Amis was a huge asshole or what? His wikipedia page never comes out and says it so many words but there are some really big hints.


Posted by: Moby Hick | Link to this comment | 09-19-13 8:54 PM
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76: Charity is for closers.


Posted by: JP Stormcrow | Link to this comment | 09-19-13 8:59 PM
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You get the bitter-enders riled up so they open their wallets and once the money flows in you're sort of committed, not to mention addicted to the cash.

See also the recent glorious moment when the president summoned them to hear a classified briefing on Syria, but some of them wouldn't break off making their money calls long enough to get to a scrambler phone, so nix on the classified briefing and see you next week. And serious people were whining about the House of Commons voting no! (L/aura R/ozen! for example!)


Posted by: Alex | Link to this comment | 09-20-13 1:56 AM
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78: Absolutely. He seems to have turned into a reactionary quite suddenly in about 1967 - J.G. Ballard's memoir dates the moment precisely, and Martin Amis's corroborates, as well as supplying the detail that it was probably about the time he got rich*.

Also, the notion that Ballard was a recluse probably means "he stopped talking to Kingsley Amis because Amis had turned into a fascist and was so drunk he had developed the habit of publishing grossly factually inaccurate reviews of Ballard's friends in the national press**, and to the editor of the Times Literary Supplement as synecdoche for the literary elite, not talking to Kingsley in the 1970s was equivalent to living in a cave on a remote Pacific island".

* he didn't say it in as few words, but he does go on about having achieved a certain status blah blah and quotes him as saying "I think I want a gun. To kill, or otherwise fuck up, anyone who takes my stuff"
**see User's Guide to the Millenium


Posted by: Alex | Link to this comment | 09-20-13 2:06 AM
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Amis used to work in the morning while sober and start drinking at about 2.00, carrying right on through. I had this first hand from a man who used to have four hour lunches with him in the Garrick several times a week.


Posted by: chris y | Link to this comment | 09-20-13 2:36 AM
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re: 81

Aye, if I recall, Ballard was leading a perfectly happy normal domestic life in the suburbs, rather than living as a recluse. Although I suppose being a largely-stay-at-home single father did make him a freakish outlier in the literary community at the time.


Posted by: nattarGcM ttaM | Link to this comment | 09-20-13 3:05 AM
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that said, there's pretty much nothing more Ballardian than the notion that normality is the weirdest trip going.


Posted by: Alex | Link to this comment | 09-20-13 3:08 AM
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82: I couldn't last a week like that, even assuming I had nothing that I needed to do after 2:00.


Posted by: Moby Hick | Link to this comment | 09-20-13 5:15 AM
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