Death with dignity: A physician's perspective.

"And now, the end is near
And so I face the final curtain . . . .
I did it my way"
          "Comme d'habitude," translated into English by Paul Anka, made popular by Frank Sinatra, 1969

Sometimes people have had enough. 

Of almost 4,000 posts over 11 years, the post with the widest distribution was the one where I described helping my friend die.

It was a solemn, emotionally-charged day for me. It was a quiet relief for my friend. I wrote about it from the point of view of the helpful friend who could legally acquire and mix the prescription medicine that would end his life, then hand it to the patient. Bill Southworth read that post. He writes today sharing a physician's perspective on end-of-life care.

Bill Southworth became a licensed physician in Oregon in 1979, then worked and practiced in Ashland, Medford, Yreka and other locations. When he retired 2003, he changed his Oregon license to “active emeritus status” which allows him only pro bono volunteer work. He told me he follows the rules and answers to Oregon law, to the Oregon Health Authority (OHA), and follows best practices and reporting requirements of the Academy of Aid in Dying Medicine.

Guest Post by Bill Southworth, M.D. 

I am now 85 and see only terminally ill patients seeking access to MAID. The term Physician Assisted Suicide is discouraged (I consider it pejorative.) Assisting a suicide by a physician or anyone else is a felony in all U.S. jurisdictions. The cause of death recorded on certificates of patients who have met all eligibility requirements for obtaining and using a legal MAID prescription carry the diagnosis of the underlying disease that allowed them to qualify.

I became exclusively a MAID provider in 2016. Since then I have counseled around 100 patients, and have written prescriptions for 40 or more, around 10 per year. I attend ingestions and deaths when asked or needed. I taught a class at OLLI (Osher Lifelong Learning Institute) on DWD/MAID, which was well attended. This has been the most important and deeply satisfying work I have ever done. It is time-consuming to visit patients in homes or places of care, examining them, reviewing records, seeking a confirming consultation, communicating with family members, to establish eligibility according to the DWDA. Add to that record-keeping and reporting requirements. I’m not held to productivity goals and cannot send bills. I don’t know how I would have fit this into an office schedule. Most of the patients I see are too ill to leave home easily and be transported to an office. I have received more expressions of gratitude from patients and families than I ever did during my previous practice years. I don’t hide what I do. Even a couple of my conservative friends, probably Trump voters, have said MAID is a good thing, consistent with their ideals of freedom of choice.

I learned about caring for dying patients as an internal medicine resident in 1975 during my rotation on hematology-oncology. I learned more in the 1990s as an office-based internist when I referred several terminal patients to hospice programs. I continued to follow them at home or in nursing homes. Hospice agencies have greatly improved since then. MAID and hospice are not either/or choices. I require admission to hospice before issuing a prescription.

I encourage an effective advance directive and sometimes refer to the federally enacted 1990 Patient Self Determination Act (PSDA). In recent years more local community physicians have become comfortable with prescribing for their own dying patients and accepting referrals, no longer afraid of the “doctor death” stigma or attacks from militant moralists. Clinic-based specialty physicians have become more willing to provide the confirming consultation to enable another doc to prescribe, though some groups forbid their member physicians from prescribing.

Other pro bono MAID providers around Oregon believe the option rightfully belongs within the range of services provided by hospice for patients who ask for it. Several already have in Washington and California. Their medical directors can now prescribe MAID drugs. I’ve been told by an unnamed source that two Oregon hospice programs include MAID, but so far none in our part of the state.

I wrote in support of Oregon’s DWDA in 1997 when the initiative was on the ballot. Several respected and sincere colleagues at the time wrote in opposition, citing adherence to the Hippocratic Oath and religious values. When I graduated from UCSF School of Medicine in 1969 my class of 120 was asked to stand and recite the oath in unison. I remained silent. I thought it was a perfunctory exercise, pledging to mythical Greek gods to abide by an archaic ethical code. It was never enforced in modern times anyway. The AMA code of medical ethics still said that lethal medication to end a dying patient’s suffering was incompatible with a physician’s role as healer. That has changed. It’s now a matter of individual conscience, and in a 2017 issue of JAMA (Journal of the American Medical Association) a secular pledge of responsibility to patients was published based on the World Health Organization’s 1948 Articles of Geneva for Health Care Professionals, emphasizing patients’ rights to self-determination and privacy.

All local hospice programs provide professional and compassionate bedside care. The MAID cocktail is not included with hospice comfort medications, nor covered by insurance. Hospice personnel are not expected (in most cases prohibited) to mix or handle the MAID medications, but their continuing bedside support of dying persons and their families following ingestion is essential. Unconscious and in deep coma after 5-10 minutes, 80 percent of deaths occur within two hours after voluntary ingestion, but occasionally it may take several hours. Patients are never left alone.

Bedside support and guidance by trained volunteers is encouraged through End of Life Choices Oregon (EOLCOR), a non-profit agency with local teams based in several regions including in Southern Oregon. They are proficient in finding cooperating physicians (don’t ask for a list) and handling the compounded powder, mixing it at the bedside, relieving family or hospice personnel of that task with steady hands. I’m counting on them to be there should the need arise.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.] 

Medicare for all is mainstream now.

The U.S. healthcare system is expensive, inefficient, and full of gaps. Americans rank 33rd among 35 developed countries in longevity.

U.S. Senator Ron Wyden says it's time to stop trying to repair a flawed system. It's time to reimagine it.

Wyden says we need "Medicare for all."

Wyden was in Medford, Oregon, on Monday finishing up field hearings on health care in America. Health care professionals and patients testified to what was wrong.

-- Hospitals were closing because they couldn't get paid enough to provide the services they offer.

-- Rural areas and small cities couldn't recruit physicians to practice there, forcing people to travel long distances for care.

-- Patients couldn't get insurance approval for life-saving drugs.

-- Mental health care was hard or impossible to access.

-- Uninsured and underinsured people delayed preventive care, leading to higher costs when treatable problems became critical.

-- Health insurance premiums have become unaffordable, made worse by the cuts legislated in the "Big Beautiful Bill."

-- Health care workers are unhappy. We train enough nurses, but we still have shortages, because people leave the profession.

-- Physicians spend their time and energy on billing, coding, and negotiating with insurance companies rather than seeing patients.

Wyden's support for Medicare for all is a shift in the political environment within the Democratic Party. This looks like another iteration of Ernest Hemingway's observation on bankruptcy: it happens gradually, then suddenly. 

In 1993, First Lady Hillary Clinton tried to shape a health care program to provide universal coverage — the Health Security Act, known as "Hillarycare." It faced strong opposition from lobbyists and Republicans, and it contributed to a disastrous 1994 midterm election defeat for Democrats. Barack Obama's 2008 election brought Democratic majorities, which made enactment of the Affordable Care Act possible in 2010. It was a patchwork mixing private health insurance, Medicare, Medicaid, and private insurance bought through exchanges. Joe Biden famously called it a "big fuckin' deal," but the program was new and complicated, and the rollout was ragged. The result was another midterm wipeout for Democrats in 2010. Republicans ran on platforms of "repeal Obamacare."

But the political tides were shifting. Voters, including Republicans, liked the provision that allowed businesses and their uninsured employees to buy health insurance through the exchanges. They liked the provision that required insurers to accept customers with pre-existing conditions — a provision that freed people who had stayed in unsatisfying jobs because if they left they would be uninsurable and at risk of catastrophic medical expenses.

President Trump did not argue that Americans should be self- reliant and take their chances in an unregulated marketplace. He said he supported a bigger, better, cheaper health care program. Trumpcare would be better than Obamacare. Trump is selling wishes, not a program; he has never offered an alternative plan of his own. But Republicans now understand that there needs to be some kind of national program: either the flawed Obamacare they oppose, or some magical better one that they are forever positing.

Bernie Sanders' 2016 campaign moved the ball forward with his call for Medicare for all. It was simple to explain. Medicare already existed, and most participants liked it. Republicans derided it as unaffordable socialism. Democrats were divided. Labor unions, some of which had negotiated excellent health plans, opposed it, because their special paid-for benefit would become available to everyone. Moderate Democrats looked for a middle ground. Pete Buttigieg called for "Medicare for all who want It," and that became the middle-ground position among Democrats. The middle-ground position presumed something inevitably complicated: a mix of private plans, union-based plans, and needs-based plans, with a variety of subsidy formulas designed to keep plans affordable for both taxpayers and the insured.

Wyden: Centered, but ideologically left

Ron Wyden's adoption of the phrase "Medicare for all" signals a shift in what will become commonplace Democratic policy. Wyden is a liberal — by some measures, roughly the 10th-most- liberal U.S. senator — but he has served in the Senate for decades and risen to ranking member of the powerful Senate Finance Committee. Wyden works effectively with Democratic colleagues and Republicans to get legislation through the committee and passed into law. In that sense, Wyden is the establishment: a senator who operates within the group that reflects majority opinion. He isn't an outsider insurgent; he is in, and creates, the majority.

Wyden's move signals a change in the Overton window, that measure of whether an idea is revolutionary, merely edgy, or mainstream. Medicare for All is mainstream for Democrats now. 

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]

Jon Ossoff makes a fool of Trump. The campaign warms up.

Senator Jon Ossoff:

"[President Trump] golfs and trades stocks. See, he doesn't want to do his job. He wants to build his ballroom and travel with Natalie on their apparently defenseless flying palace gifted by the Emir of Qatar."

Ossoff is fleshing out his brand. He's shaping a narrative about the U.S. — a place with a strong, competent military — and contrasting it with a foolish, knavish leader: a Nero-Trump, fiddling with a staff member while the country burns.

Take two minutes and watch the clip. It shows why Trump is reacting so strongly. This is the kind of opposition that is harder to counter than California Governor Gavin Newsom's criticism. Newsom is permanently stained by the "California" brand. Ossoff is still undefined, with a "New! Improved!" quality — some mix of JFK and Barack Obama. He gives Trump more to worry about.

https://www.youtube.com/watch?v=9bSpkFqypbw

The line that caught people's attention referenced the 35-year-old aide, Natalie Harp, whose unusual closeness to Trump was the subject of Regime Change, the book by Maggie Haberman and Jonathan Swan. They reported that the Secret Service was concerned. She leaves love-note-style expressions of devotion for Trump to find. She sticks close by his side; Melania is often absent. She was on the plane back from Turkey when Cabinet members and the media were not. She carries a printer so she can hand Trump articles he'd want to see.

The physical closeness raises eyebrows — Trump has a reputation. Is she a new, younger girlfriend, replacing Melania? Or a personal aide with wipes and fresh underwear, handling the needs of an older man with health issues? Either way, it's an odd arrangement, either naughty or pathetic, and people are asking what the deal is.

Ossoff didn't frame this as an accusation of infidelity, but as evidence of careless inattention to the job. Given the choice between calling Trump foolish or knavish — incompetent or evil — Ossoff chose foolish. That's sound branding. 

Voters seem to want strength more than they want virtue. A corrupt, selfish Trump at least provides leadership, which is more than Congress offers; he'll be cruel to enemies as well as the innocent. Voters decided that overthrowing an election wasn't disqualifying. Biden's feckless handling of the southern border, by contrast, read as weakness and inattention, and voters found that unforgivable.

Besides, painting Trump as a highly-sexed Lothario is a net positive for him and would be a mistake for Ossoff. Trump-as-playboy fits his Hugh Hefner image, a complement to Trump's winner-take-all brand; he is Rambo in the bedroom. Trump likes to say other men settle for less-attractive women, but not Trump; he taunted Ted Cruz with it in 2016.

Trump did it again this week when he taunted Abdul El-Sayed, who won the Democratic primary election in Michigan, with this Truth Social post:

It is astonishingly petty, juvenile behavior, but Republican voters seem to be OK with it. 

Ossoff understands Trump's brand. Trump's access to beautiful women is proof of success, of winning. Ossoff doesn't shame him for it — he turns the attribute into a liability, saying that Trump would rather be distracted by Natalie and golf than do his job. That's why things are a mess.

Trump's team is scrambling to paint Ossoff as small and inconsequential. Trump nicknamed him "Pee Wee Herman," which is unlikely to stick — Ossoff is half a head taller than I am, and had 5-o'clock shadow at noon. He looks strong, not wimpish. 

White House Communications Director Steven Cheung leaned on the same theme, saying "Jackoff Jon is the biggest cuck loser in politics," shockingly strong language from the White House. Jackoff? Cuck? The White House is worried. Ossoff is married with two young children; there's no clear reason to imply he's a sexual loser. But the insult reinforces exactly what Trump considers his own strength: that he's the winner in any contest of sexual conquest.

Trump is missing the point, and digging himself deeper into the hole he is digging for himself. Ossoff isn't contesting Trump's sexual distractions, whatever they may be. He's calling attention to them; meanwhile Rome burns.

My college classmate Sandford Borins, a scholar of political narrative, once described the three-part structure of political campaign branding: fool, knave, and hero. Ossoff has built a campaign narrative around it. He claims the hero spot, of course, with camera angles looking up at his strong jaw and firm neck, the classic "hero shot."  Ossoff positions Trump as the fool: old, bumbling, selfish, distracted by leisure and young women. Meanwhile, the young man addresses the serious work of making voters' lives better. It's a simple, persuasive story. 

In a Democratic primary, Ossoff has a stronger pitch than "California is actually better than you've heard," which is the brand I think Ossoff's most serious competition is stuck defending.

Ossoff may stumble, but he is on the move.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]

Trump's effort to overthrow the election was bad, maybe, but not too bad.

Republican voters like what they like about Trump more than they dislike his attempted coup d' état. 

I wrote last week that I have a litmus test question for Republican candidates: If they cannot dare say aloud that Joe Biden won the 2020 election, it means the candidate will echo a dishonest pretext to stay Trump-compliant. It is a bad sign. It shows they cannot be trusted if he asks them to adopt some other false pretext to do something illegal in the future. 

One commenter to my post said my litmus test was a trap, intended to trip up the candidate. Another commenter said I was demeaning the candidates by suggesting they would cave to Trump's demands. I invite candidates to show my suspicions are unfounded.

I consider my question an opportunity for candidates to break free from the straitjacket of needing to agree with Trump, even when he is plainly wrong and lying. I suspect it would be a significant advantage to their campaigns if they appeared independent of Trump, especially in blue states and districts. I suspect that saying that of course Biden won the 2020 election would do them more good than would spending millions of dollars saying that they are good, upstanding citizens, even while refusing to admit that Trump lost an election. The problem for GOP candidates is that to appear independent they would need be independent.

The candidates' dilemma is not theoretical. It is as current and real as last week's news, in the case of Trump's newly-appointed U.S. Attorney Jeanine Pirro. The Department of Justice had clear evidence that the Reflecting Pool liner was mis-applied and detaching on its own, and that the person they had indicted was innocent of vandalizing it. The DOJ needed to withdraw the case. DOJ lawyers risked sanction for pursuing so meritless a prosecution. Trump had a different idea in mind: The fault simply could not be his or his contractor's; it had to be a vandal, so stick to that pretext. There is truth and there is Trump-truth, the pretext truth. Trump demands the DOJ and Pirro pursue Trump's truth and re-prosecute the guiltless man. Trump criticized Pirro and may replace her, just as he replaced her predecessor.

It must be humiliating for GOP candidates to pretend blindness and recite a dishonest pretext when one knows better. It is the GOP version of Maoist re-education performance. It is the self-abasement GOP candidates endure to achieve their ambitions. 

Trump's threats against non-compliant Republicans have credibility because there is a large body of GOP voters who follow his direction. Trump is their guy, and he gives them the policies they want. They are being practical. This isn’t a test of character and patriotism; it is a choice between a Republican or a Democrat. 

--  Trump is doing something about the openly porous border that Biden failed to address until it was too late. 

--  Trump gives wealthy people lower taxes than Democrats would propose.

--  Trump is anti-woke. Trump shows it is OK to reveal prejudices against other ethnic groups. Trump showed he didn't like Covid-era efforts to enforce social cooperation. He says what is on his mind even when it is rude and crude.

--  Trump appeals to people who think climate-worry is a hoax.

--  Trump appeals to people whose lives involve using natural resources, rather than protecting them from misuse, including farmers, ranchers, miners, loggers, and oil drillers.

--  Trump is more anti-abortion than any Democratic alternative.

--  Trump represents Christian primacy.

My litmus test question points to a delicate point for Republican candidates. Candidates need somehow to accept that Trump making an attempt to overthrow an election isn't disqualifying. His crime can be rationalized and minimized. Democracy is only one thing among other things. Maybe trying to overthrow the election is only a little bit bad, balanced by the things they like. Look at all the good he does. On balance, it isn't about respecting the rules of a democracy, even if we put our hands over our hearts and say the Pledge of Allegiance, respecting the flag and the republic for which it stands -- a republic, where leaders are elected.

Republican voters have taken a long journey from John McCain, who prolonged his stay in a Vietnamese prison out of patriotic duty to other POWS. Trump scoffed at McCain. This is a different era. Look out for number one. Patriotism is for suckers.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]

 

Easy Sunday: "And here's the surprisig part."

Would someone please train large language model artificial intelligence to stop using the same tiresome device?

"Hey! Wake up! Here comes the point."

You have read it. You have heard it in scripts for TikTok, Reels, Instagram, YouTube Shorts. 

--  "Here's why that matters."

--  "But here's the kicker."

--  "Here's what nobody expected."

-- "The result?"

--  "But here's the thing."

--  "But it turns out that what is really important was what no one noticed."

Those are AI giveaways and I see them several times a day. So is the "em-dash," although I have sometimes used an em-dash instead of commas to set off appositive phrases for the 11 years that I have been writing this blog. 

I don't use artificial intelligence to write blog posts, so readers will find fewer examples of the "look-at-this" device in these posts. Since I tend to "write long," and then cut about a third of what I wrote before I push the "Publish" button, those phrases usually get cut.

I think AI offers bullshit in opinion journalism. It creates the equivalent of empty calories. Vague words gloss over knowledge gaps. It is a conflict-avoider in a realm where facts and opinion conflict, and the edges of agreement and disagreement are the point. For example, if I wanted AI's help to describe U.S. policy on Israel, it might say;

Under Biden, America's forward-facing, qualified and guarded support for Israel's military engagement with Gaza contrasts with Trump's more-robust stance, although Trump was restrained by policy constraints imposed by an increasingly-restless public.

I believe the sentence above is  accurate, but every descriptive word is unfalsifiable. Forward-facing, guarded, more-robust, restrained, constraints, and increasingly-restless are words that likely conform to what a well-informed person could agree with, but that person would be filling in the blanks from his or her own existing knowledge base, thinking "Yeah, that is sort-of right." The sentence fills up space; it doesn't inform. It did not require the purported author to state a position about either fact or policy. If I were to write that way, why bother?

So here's the thing: I expect to keep writing the old fashioned, do-it-yourself way.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]

A litmus test for Republican candidates

I have a question for Republican candidates:

 Would they defy their oath of office to please Donald Trump?

The litmus test is whether they dare disagree with his assertion that he won the 2020 election. If they won't risk his wrath now, they will surely cave when it really matters.

Click for Audio and transcript

Phone call between President Donald Trump and Georgia Secretary of State Brad Raffensperger, Saturday, January 2, 2021

Trump:

You know, we won the state. If you took, these are the most minimal numbers, the numbers that I gave you, those are numbers that are certified, your absentee ballots sent to vacant addresses, your out-of-state voters, 4,925. You know when you add them up, it’s many more times, it’s many times the 11,779 number. . . .

 Raffensperger:

Well, Mr. President, the challenge that you have is the data you have is wrong.

Trump:  

I mean, look. Brad. We have a new tape that we’re going to release. It’s devastating. . . .

Raffensperger:

 You’re talking about the State Farm video. And I think it’s extremely unfortunate that Rudy Giuliani or his people, they sliced and diced that video and took it out of context. The next day, we brought in WSB-TV, and we let them show, see the full run of tape, and what you’ll see, the events that transpired are nowhere near what was projected. . . .

Trump:

I won this election by hundreds of thousands of votes. There’s no way I lost Georgia. There’s no way. We won by hundreds of thousands of votes. 

But in Fulton, where they dumped ballots, you will find that you have many that aren’t even signed and you have many that are forgeries.. . . And you will find you will be at 11,779 within minutes because Fulton County is totally corrupt, and so is she totally corrupt.

Ryan Germany, the General Counsel in Raffensperger's office:

 What we’re seeing is not at all what you’re describing. 

Commentary on this hour-long phone call has primarily focused on Trump and his plea that Raffensperger find him 11,780 extra votes. Read in its entirety, one sees how skilled and formidable Trump is as a negotiator. Trump is relentless, unwavering, adamant, and the hard sell goes on for an hour. 

One also gets new respect for Brad Raffensperger. He was under enormous pressure, and he didn't cave. He did his duty.

Trump has a technique that we observe in this conversation and we see repeatedly in his second term of office. He asserts a pretext which is untrue and even implausible on its face that justifies doing something illegal. Invade Venezuela because they are carrying out a "foreign invasion." Impose tariffs on every country because every foreign country is supposedly using slave labor. 

In the conversation with Raffensperger, he was giving a multitude of face-saving pretexts to get the result Trump wanted. Make Trump happy -- or else disappoint him and face the consequences.

The cost of angering Trump is well understood by Republican officeholders and candidates. The list of political roadkill is long: Liz Cheney, Mike Pence, Chris Christie, Jeff Flake, Tom Massie, Bill Cassidy, John Cornyn, and the Indiana state senators. I watched the reaction of Republican activists to Pence in New Hampshire. He was not celebrated as a profile in courage. Quite the opposite.

Pence may get his reward in heaven, but not from Republican voters. I was happy to do a selfie with him at a GOP event. He was standing around friendless.

Friendless Pence

GOP candidates for a state office might want to dismiss Trump and his claims as irrelevant to their office, saying it is a federal matter and about Trump, not them. That isn't the reality. Candidates for state office are subject to being dragooned into Trump's web of dishonesty. It is happening in Oregon right now where Trump claims, despite evidence to the contrary, that our vote-by-mail system allows multitudes of illegally-cast votes. 

If Trump were to telephone a Governor Christine Drazan and demand that she use a pretext of "questionable" votes in Multnomah County, perhaps based on a meritless accusation by a talk show host or Republican precinct committee person, and she received the full-court-press Trump laid on Raffensperger, would she defend Oregon's vote, or would she cave? If the same call were made to the Republican caucus of the Oregon state senate, perhaps a demand that they file a lawsuit claiming that alternative slates of electors be given equal weight to the ones who were actually elected, would Brad Hicks consent? That is not a theoretical idea. Incumbent Republican state senator Kim Thatcher did that in the days prior to the January 6 Capitol invasion, and she was re-elected and remains a senator in good standing.

We are at a moment when Republican candidates can prove up. A candidate who mumbles, distracts, and avoids disagreeing with Trump's insistence that he won the 2020 election in a landslide is showing his or her true colors: They are unwilling to disagree with Trump's pretexts. Willingness to concede a loss is an essential element of democracy. If they won't do it now, they surely won't do it under pressure and when it really counts.

Republican candidates might be "nice people," or have "common sense," or be regular church-goers, but if they cannot disagree with a dishonest attack on democracy, they are unfit for political office in a democracy.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]

 

Yesterday's post: mistake or irrelevant?

 "Peter, yesterday's post was a mistake. It gave Brad Hicks a big advantage. What if he takes your advice? He could win."

And

"Peter, blather on. Whatever. Your so-called advice is irrelevant. You don't understand elections. Denise Krause will win whatever Hicks does."

Photo from his website

Today's post is a followup to yesterday's. Some Democratic readers thought I "gave away the store" when I advised the GOP candidate for state Senate in my local district to give away most of the campaign money pouring into his campaign.

I also got criticism from people who said I should stop fooling myself by thinking that my advice is relevant to winning elections. "Its about party and turnout, period. Not about message." The GOP has no real principles, the argument goes, because Trump changes them on a whim. The only real GOP principle is that he drives Democrats crazy. Republicans follow along out of inertia and party loyalty. Republicans are Republicans. What matters if they vote. But they will vote Republican in any case.

That theory says that Democrats are Democrats. Trump has been a north-star pointing south. Trump wanted to be hateful and he succeeded. Democrats don't have a leader or a clear direction but are united in being infuriated by Trump. This theory says that since Oregon's Senate district number three is majority-Democrat, what Democratic candidate Denise Krause must do is let voters know she is a normal Democrat. Brad Hicks cannot help being who he is, a Republican, and he can spend all the money in the world and nothing will change either that or the vote. The vote is locked in.

In some respects, the two comments converge into a single one. Both say that brand matters. The first worries that Brad Hicks can change his brand from a current Republican into something closer to the kind of nice-guy bipartisan Republican who used to win elections in Oregon. The second comment embeds the idea that those days are gone. Republicans cannot change and they don't want to. They have become Trump-compliant. 

I worked with too many Republican clients over the years to think that every Republican is a mini-Trump, and that they all share his narcissism, racism, dishonesty, misogyny, corruption, and greed. Most of my former clients still vote Republican, so they tolerate those qualities in him, but they don't share them. My advice to Hicks was to do something dramatic and visible to project a different brand from being typecast. From the outside, where I and 99 percent of other voters see campaigns, that is exactly what he is marching lockstep into.  

In my view of politics, candidates have some small ability to adjust their brands beyond party -- if they choose to. They can try to do it with words, but those are mostly ineffective. If they are going to do it, it must be done with big gestures that are unmistakable, even to people barely paying attention. His brand is mostly formed and has been so for decades: He is a good looking, married, Republican man; a Chamber of Commerce CEO; and he is conspicuously very tight with the richest, most powerful businesses locally, statewide, and nationally. It is a powerful brand. His campaign is confirming that brand by where it gets its contributions. 

I think Hicks has a brand problem, especially this cycle. The brand links Hicks tightly to distant, powerful elites at a time when there is bi-partisan suspicion of elite power. Trump has led Republicans to be suspicious of elite universities, elite science, elite expertise in food, medicine, diplomacy, and the Fed. Events have caused all voters to be skeptical of elites running oil companies with windfall profits, pharmaceutical companies with high drug margins, and especially technology companies with data centers. 

Many people are feeling economic stress. Big, powerful, distant businesses and business elites don't come across as the allies of those people. People are skeptical of them, especially now, what with Trump's tight crony relationships with businesses and pay-to-play deals. The aura of corruption is very present. Nevertheless, Hicks  appears to have chosen to ally with the business elites. He is leaning into his brand. It is consistent with his apparent values, politics, and biography. 

I think he has a losing brand, especially this year and especially in this district. I may be wrong. We will see.

[Note: To get daily delivery of this blog by email go to Https://petersage.substack.com. Subscribe. The blog is free and always will be.]