Month: November 2011

Recently a couple of posters took issue with some things that I said about the FDA in the comments section of a Booman post titled Perry’s Gaffe Was Minor. One of them posted “Arthur, you are a moron. The FDA is one of the most important agencies we have.” Another said “Shorter Arthur: sometimes, the FDA allows things to happen that I would allow to happen all the time, so therefore it’s bad. “

Read the article below the fold and weep.

The VIOXX Settlement-Merck Pays a Pittance for Mass Deaths

A little teaser for the undecided:

In recent years the drug industry has surpassed the “defense” industry as the top defrauder of the federal government under the False Claims Act.

Where is zero tolerance when we need it?

Read on.

Q: Who killed more Americans –al Qaeda crashing airplanes into the World Trade Center, or Merck pushing Vioxx?

A: Merck, by a factor of 18.

One of the most downplayed stories of our time ended with a whimper this week.  “Merck has agreed to pay $950 million and has pleaded guilty to a criminal charge over the marketing and sales of the painkiller Vioxx,” the New York Times reported Nov. 23 (in the business section, where important medical news is usually found).  The pharmaceutical giant copped to a misdemeanor: urging MDs to prescribe Vioxx for Rheumatoid Arthritis prior to 2002, when the Food & Drug Administration approved its use for that disorder.

The FDA had initially approved Vioxx (after a hasty “priority review”) in May, 1999 to treat osteoarthritis, acute pain, and menstrual cramps.  By September 30, 2004, when Merck announced its “voluntary recall,” some 25 million Americans had been prescribed the widely hyped drug. Evidence that using Vioxx doubled a patient’s risk of suffering a heart attack or stroke –based on a review of 1.4 million patients’ records– was about to be published in Lancet by David Graham, MD, an FDA investigator.  The FDA director’s office, devoted valet of Big PhRMA, had contacted the Lancet in a futile effort to stop publication of their own scientist’s findings.

Graham’s data indicate that 140,000 Americans suffered Vioxx-induced heart attacks and strokes; 55,000 died, and many more were permanently disabled. The Merck executives’ real crime was conspiracy to commit murder.

Some 3,000 Americans died in the attack on the World Trade Center. The murders perpetrated by Merck executives were not as dramatic, obviously, but were every bit as intentional. An early clinical trial had alerted them to the fact that Vioxx caused coronary damage. Their response was to exclude from future trials anyone with a history of heart trouble!

Once Vioxx was approved, Merck spent more than $100 million a year advertising it.  (You may still remember the tune to “It’s a beautiful morning…”) Merck execs continued to ignore and suppress indications that their new blockbuster was causing strokes and heart attacks. Sales hit $2.5 billion in 2003. And when brave Dr. Graham first presented his irrefragable evidence to an FDA advisory committee in February 2004, Merck argued that the “unique benefits” of Vioxx warranted its remaining on the market. The FDA committee voted 17-15 to keep it available with a black box warning. Ten of the 32 committee members had taken money from Merck, Pfizer or Novartis (which were pushing drugs similar to Vioxx) as consultants.  If these MDs had declared their conflicts of interest, Vioxx would have been pulled from the market by a vote of 14-8. By buying an extra seven and a half months, Merck made an extra billion or two, and killed 6,000 more Americans.

Worldwide, Vioxx was used by 80 million people. Assuming their dosages were similar to the 1.4 million Kaiser Permanente patients whose records Dr. Graham analyzed, the death toll exceeds 420,000.

—snip—

Let the punishment fit the crime

In 2007 Merck paid out $4.85 billion to settle claims by 27,000 Vioxx victims and their survivors. “The reason `so few’ people filed lawsuits,” a physician explains, “is that there is a significant background rate of heart attack. People may not have recognized their event as being related to Vioxx.”  The survivors of people who smoked cigarettes, were overweight or had other risk factors would have been discouraged by lawyers from filing claims, he added, because they’d have a hard time convincing jurors that their loved ones’ heart attacks were brought on by Vioxx use.

“No person was held liable for Merck’s conduct,” Duff Wilson of the Times reported Nov. 23. To be fair-and-balanced in an otherwise Merck-friendly story, he quoted Erik Gordon of the University of Michigan’s Ross School of Business, commenting “It’s just a cost of doing business until a pharmaceutical executive does a perp walk.”

That sounds tough but it isn’t.  Marketing dangerous drugs would still be “just a cost of doing business” to profit-driven corporations if a few individual execs were made to do time at Camp Fed. Why shouldn’t they be charged with conspiracy to commit murder, along with every accessory to the crime that a thorough investigation could identify? (This could provide meaningful work for the currently useless Drug Enforcement Administration.) The Vioxx conspiracy involved researchers who skewed data and sales execs who framed false pitches and government officials who tried to silence whistleblowers and God knows who else… If somebody is killed in a botched robbery at a Seven Eleven, the kid driving the getaway car is charged with homicide. But Merck’s CEO throughout the Vioxx era, Ray Gilmartin, left the company in 2006 with a golden parachute and joined the Harvard Business School faculty. The class he teaches is called “Building and Sustaining Successful Enterprises.”

A more effective way to counter deadly corporate fraud would be for the government to simply stop doing business with entities convicted of major crimes. If MediCare and state Medicaid programs stopped buying Merck or Pfizer drugs for, say, five years, it just might produce the result that we, the people, require.

The day before the Vioxx settlement was reported, the Wall St. Journal ran a story (in the Marketplace section) under the headline “Pfizer Near Settlement on Bribery.”  The corporate boo-boo in this instance involved pay-offs to doctors who purchase drugs for state-owned institutions overseas. Johnson & Johnson recently settled a similar bribery case. Merck, AstraZeneca, Bristol-Myers Squibb, and GlaxoSmithKline are all in settlement negotiations with the government.

On the home front, Pfizer has paid $2.3 billion for violating the federal False Claims Act and bribing institutional purchasers in connection with Bextra, Lipitor, Viagra, Zithromax, Norvasc, Lyrica, Relpax, Celebrex, and Depo-provera.

The systemic corruption is getting worse.  In the 15 years between 1991 and 2005, according to Public Citizen, drug companies paid the government $5 billion in penalties and settlements in connection with kickbacks and false claims. In the five years between 2006 and 2010 the pay out was $14.8 billion.  Four companies accounted for more than half the blood money ($10.3 billion): Glaxo, Pfizer, Eli Lilly, and Schering-Plough.

In recent years the drug industry has surpassed the “defense” industry as the top defrauder of the federal government under the False Claims Act.

Where is zero tolerance when we need it?

Read it and weep.

The entire system is rotted through, folks. It’s just a matter of time before it all comes tumbling down unless something truly radical is done to cleanse this kind of money-driven rot out of the system. Ron Paul is only national candidate who is presenting a viable solution or even acknowledging the scope of the problem…decentralize things so that massive lobbying systems like this Big Pharma scam can no longer buy nationwide get-out-of-jail-free cards under the cover of a huge (and almost impenetrably secretive because of its immense size) federal apparatus.

Wake the fuck up.

Every other candidate is in the pocket of this system. Every one. They are all bought and sold, right on up the line from that asshole Santorum to our OH so glib good cop Preznit Obama.

Wake the fuck up.

They’re killin’ us.

AG

As some of you know, I’m a novelist writing science fiction and fantasy. The first book in my new series launches today. It’s called Broken Blade and it walks the borders between fantasy and detective noir. It also touches on some of the issues of fairness and justice that are important to me as a progressive.

One of the things I’ve noticed as a fantasy author is that with a few notable exceptions like Terry Pratchett, the genre has a tendency toward the glorification of autocratic government of the one true king variety. This bothers me, so when I set out to write my own high fantasy novel, I decided to try something a little bit different.

The Fallen Blade series is built around a sorcerer-assassin who used to work for the Goddess of Justice, dealing with those rulers and nobles that started wars of aggression or oppressed and murdered their people, criminals too rich and powerful for the regular courts to touch. But, when you push a system like that, the system pushes back. Now Aral and his shadow elemental familiar are on the run.

The following is the short plot teaser book one, Broken Blade.

Aral Kingslayer was an assassin once upon a time, perhaps the best in the world, one of the fabled Blades of Namara, goddess of Justice. With his familiar, a living shadow named Triss, at his side, he killed for a cause, never for money. Life was hard but good.

That was before. Before they murdered his goddess and burned her temple to the ground. Before they outlawed his kind. Before the wanted posters and the sentence of death. Before his life fell apart and he crawled into the whiskey bottle.

Now he’s a shadow jack, a free lance problem solver who makes his living out of odd jobs on the wrong side of the law. He doesn’t much like what he’s become, and Triss likes it even less, but Aral doesn’t see any way out. Not until a young woman named Maylien hires him to deliver a secret message.

A simple enough job. Or is it? When Aral delivers the message, he gets the biggest surprise of his new life, and maybe, just maybe, the chance to forge a future where he won’t have to be ashamed of himself.

The three books in the initial series are built around Aral’s struggle to rebuild his life and to come to terms with the idea of justice in a more nuanced and human way as he decides that while much of what his goddess asked him to do was just, it wasn’t always for the right reasons.

At root, what I’m writing is adventure fiction; fast, fun, reads with swordfighting and zombies and magic and lots of special effects, but I’m also trying to layer in deeper issues about the problems of aristocracy and concentrations of wealth and power.

If you’re interested, the opening chapter can be read on my website, and I’ve talked about the launch of the book a bit more in a post there as well.  

I’ll be doing launch events over the next few weeks in the Minneapolis St Paul area, starting tonight with a reading and signing at the Barnes and Noble in the Har Mar Mall in Roseville (St Paul) MN. at 7:00 pm.

I’ll also be signing and chatting with whoever shows up at Uncle Hugo’s science fiction book store in Minneapolis, MN. 1:00 pm Saturday December 3rd. I’ll be signing, maybe reading, and chatting with whoever shows up at Bookends on Main in Menomonie, WI. 5:00 pm Thursday December 8th. Finally, I’ll be signing and chatting with whoever shows up at Dreamhaven Books in Minneapolis, MN. 2:00 pm Saturday December 11th. This will be one of the last events at the book store before they become primarily on online book seller.

The book can be found at all the usual places, Amazon, Barnes and Noble, or Indiebound (various independents) should you be so inclined, but Uncle Hugo’s and DreamHaven are especially close to my heart as local independents. I should probably note here amongst the commercial stuff that Book II, Bared Blade is actually already available for preorder at places like Barnes and Noble and Amazon.

Thanks for reading, I hope some of you find the idea interesting enough to go take a look at the sample chapter.

Also available in orange.

I don’t pay much attention to Ann Coulter because I think she is ridiculous, but I did note with interest that she is enthusiastically endorsing Mitt Romney. I assume this is because she thinks Romney has the best chance to win. But it does present a bit of problem for her because she was so hostile to John McCain four years ago. To hear her talk, she hates John McCain because she thinks John McCain hates conservatives and likes to piss them off for fun. I don’t know if that goes back to McCain dissing the Christian right in 2000 or if it has something to do with policy disagreements over the years, but it strikes me as odd that she’d be so angry with McCain and not hold Romney in the same degree of scorn. It’s true that McCain is better at making enemies than Romney, but they both have perfected the art of bashing conservative ideas until the precise moment that they need conservative votes. I don’t see them as much different in that regard.

I also think it’s probably not the best way to help Romney’s campaign to go on cable television and say that John McCain is a douche bag. I don’t know that this is that helpful either:

“Consistency is not a great thing, and especially someone like John McCain who consistently annoyed conservatives, bragged about annoying conservatives, and would claim he was courageous by attacking conservatives and getting good press in the New York Times.”

She’s be better off pointing out that John McCain wasn’t consistent. In other words, if McCain’s flip-flopping wasn’t disqualifying, why should Romney’s flip-flopping be a problem?

But, instead, she tries to say that being consistent “is not a great thing.” I don’t think she’ll convince anyone of that. But convincing people of that is going to be a full-time job for the Republican establishment if they make Romney the nominee.

If you are looking for signs of demand in the economy, the Thanksgiving weekend provided some hope.

Spurred by aggressive promotions from retailers, American consumers opened their wallets over the holiday weekend in a way they had not since before the recession, setting records in sales and traffic.

The National Retail Federation said Sunday that spending per shopper surged 9.1 percent over last year — the biggest increase since 2006 — to an average of almost $400 a customer. In all, 6.6 percent more shoppers visited stores on the Thanksgiving weekend than last year.

It also looks like the housing collapse is bottoming out. Those are very hopeful signs. It could be that the economy is going to start improving just in time for election season.

So, what better time for Europe to destroy its economy and send the world back into a global recession?

A two-person psychiatric panel has found that Behring Breivik was suffering from paranoid schizophrenia and has done so for several years.

Wiki – 2011 Norway attacks

The panel handed in its report today and due to the enormous interest in its work, some of the findings were presented in a press conference. The report will now be subjected to a quality review by the psychiatric group of the Board of Forensic Medicine.

Norway massacre: Breivik declared insane

Breivik, 32, is due to stand trial on 16 April for a hearing scheduled to last around 10 weeks.

It is unclear if the conclusions of the report – if approved by the panel – will prevent the trial from going ahead in its current form.

It will almost certainly mean that Breivik is detained into psychiatric care rather than receiving a lengthy jail term.

Before the report was made public, a lawyer for the victims said it did not matter what the conclusion was as long as Breivik was not allowed to go free.

“What will happen in the case, no matter what the conclusion, is that he (Breivik) will of course be incarcerated,” John Christian Elden said.

[Mr. Elden is a lawyer for several of the victims.]

Han har en fullstendig manglende empati og ikke i stand til å ta inn over seg ofrenes eller samfunnets perspektiv.

Breivik skal ha blitt gradvis verre i årene forut for terrorangrepet og endt med total funksjonssvikt, sosialt, praktisk og yrkesmessig.

My translation:
He has a totally lacking empathy and is incapable of understanding the perspective of the victims or of society.
Breivik has gradually deteriorated in the years prior to the terror attack and ended up with total functional failiure – socially, practically and professionally.
(from this article

The finding would suggest that a future conviction would not result in a jail sentence. Instead, if found guilty, Behring Breivik would be committed to psychiatric treatment. Persons committed to such treatment will normally have their case reviwed every 3 years to assess whether there is any danger of repeat offenses or to society at large.

Needless to say, the finding, with its consequences for the future trial, has already caused an uproar. English language links are very few at the moment, but headlines in Norwegian online papers this afternoon are quite unanimous. A number of victims and their supporters express disappointment.

– Jeg må si jeg er skuffet. Ut fra hvordan han oppførte seg, virket det ikke slik på meg. Jeg var til stede under fengslingsmøtet og hørte ham erkjenne og innrømme det han har gjort. Jeg vet at han ikke blir en fri mann, men nå blir han bare husket som en mentalt syk mann, og ikke som en som overdrev sin politiske overbevisning, sier Lindhagen Nilssen til Aftenposten.no.
My translation:
I have to say I am disappointed. From the way he acted, it did not seem that way to me. I was present during his arraignment and heard him admit what he had done. I know that he will not be a free man, but now he will simply be recalled as a mentally sick man, and not one who exaggerated his own political convictions, says Lindhagen Nilssen to Aftenposten.no.
(Interview with one of the AUF members present at Utøya during the shooting – Aftenposten article)

Twitter is down in Norway – it is being speculated that these news contributed to that.

 

UPDATE (20.20 CET): Behring Breivik has been informed of the report and its contents tonight. “I feared that this would happen [Jeg fryktet at dette ville skje.]” In his own words, according to a prosecutor.

Han ble fornærmet over diagnosen han i dag fikk i de sakkyndiges rapport, som konkluderer at han lider av paranoid schizofreni, og dermed er strafferettslig utilregnelig. – He was insulted by the diagnosis he received today in the experts’ report which concluded that he suffers from paranoid schizophrenia and, thus, is criminally insane [not accountable to the law].

Link in Norwegian.

The Federal-State Unemployment Insurance Program provides unemployment benefits to eligible workers who are unemployed through no fault of their own. In other words, it gives money to be people who get laid-off. Their job disappeared. They didn’t get fired. And the way this is paid for is by levying a tax on employers. Instead of giving you an extra sixty or seventy bucks a month, they give that money to the state and federal governments, just in case they have to ship your job to India. It’s not really that complicated. People who are out of work through no fault of their own are given a weekly stipend to help them through the transition from joblessness to employment. When times are tough and lots of folks can’t quickly find a new job, the government extends the benefits from six months to a year, or maybe even for a longer period. The point is, people who did nothing wrong and are out of work shouldn’t be ruined financially and left homeless and bankrupt.

But that’s not how people on the right see things. Newt Gingrich, for example, thinks that receiving unemployment insurance payments makes people lazy. He also thinks we should drug test people before they can receive the check that their employers paid for. That’s right. Maybe you didn’t want unemployment insurance. Maybe you would have rather had that extra sixty or seventy bucks in your paycheck. But Newt Gingrich wants you to pee in a cup before you see your own money.

How about if we ask people to pee in a cup before they see any of their 401(k) money or collect disability insurance payments? How about if we require presidential candidates to prove that they don’t have genital warts? Does Newt want to sign up for that?

I didn’t think so.

Newt also thinks we should drug test people before we give them food stamps. So, if you’re an eight-year old and your mom likes to smoke pot, you get to starve.

Here’s my idea. No one can receive any benefit from the government, whether it be a Social Security check or a mortgage deduction or a subsidy for their farm, unless they are registered to vote and have actually voted in one of the last three federal elections (including primaries) in which they were eligible to vote. Forget turning people away because they don’t have a photo ID. Have literally everyone vote, all the time. You can provide waivers for people who are mentally ill or incapacitated. And people can always vote for no one or nothing. Just show up and cast a vote for “don’t care.” The idea is that you can’t expect the government to provide for you if you won’t provide for the government.

The first thing that would happen under this new system is that conservatives like Newt Gingrich would go extinct. And that makes it worthwhile in my book.

Herman Cain denied having a 13-year extramarital affair but his attorney very conspicuously did not deny the charges. That leads me to believe that Herman Cain did in fact have an extended extramarital affair. I also had a red flag go up when Cain said this:

Cain described the woman as an “acquaintance who I thought was a friend” and said his campaign was going to handle the charges “detail by detail, accusation by accusation.”

Now, when he says that he “thought [she] was a friend,” I take it to mean that he thought she’d keep her mouth shut.

Cain’s attorney is taking the position that the accusation isn’t criminal in nature and that it therefore falls outside of the purview of the media’s responsibility to vet candidates.

…this appears to be an accusation of private, alleged consensual conduct between adults – a subject matter which is not a proper subject of inquiry by the media or the public. No individual, whether a private citizen, a candidate for public office or a public official, should be questioned about his or her private sexual life. The public’s right to know and the media’s right to report has boundaries and most certainly those boundaries end outside of one’s bedroom door.

So, is this lawyer saying that the accuser spent time behind Herman Cain’s bedroom door? Because that’s what they seem to be saying to me. And I think people cared about Bill Clinton’s consensual sex-life. At the least, the Republicans certainly cared.

Herman Cain is either the biggest victim alive or he didn’t think very hard about the skeletons in his closet before he launched this book tour.

You see lots of articles about demographics and presidential elections. You see lots of articles about what percentage of what demographic the president needs to win in order to get a second term. I find these articles interesting and they often help inform my analysis of American politics. It’s also helpful to see statistical analysis of past presidential elections. Census data is interesting. But none of it means a thing in a race between President Obama and Newt Gingrich, or President Obama and Herman Cain. There’s an assumption that people will vote one way or the other because that’s the way they voted the last time around. But the last time around Latinos were faced with a Republican candidate who tried and failed to pass comprehensive immigration reform, not one who wants to build an electrified fence along the Mexican border. The last time around, John McCain had a Cap and Trade program on his website, not a delusional plan that assumes that more carbon burning will solve our environmental problems. Some people voted against Obama over fears that never materialized, others for him based on hopes that have been dashed. Obama did poorly in 2008 among uneducated whites. The Democrats did very poorly among uneducated whites in 2010. The assumption is, apparently, that they will do very badly with them in 2012. That could be true. But it could also not be true.

In 1980, how many people do you think predicted that Massachusetts would vote for Reagan in 1984? In 1988, how many people predicted that the Democrats would win Montana and Georgia in 1992?

Here’s the deal. The Democrats aren’t targeting uneducated whites for a simple reason. It’s not because they don’t want their votes. It’s because they’ll have already won a crushing victory by the time they’ve converted uneducated whites. In a matchup between Gingrich and Obama or Cain and Obama, almost every swingable vote in the country will swing to the president. And that includes a lot of uneducated whites. It probably includes most of them. But they’ll be the hardest to convince and the last to make up their minds.

In a matchup against Romney, it should be a more traditional election. But, even there, Obama will clearly outclass his opponent. My point is that statistics and models don’t mean much if one party doesn’t nominate a plausible president.

Economist Paul Krugman writes today in the NY Times that there is no reason that tax rates on the super wealthy shouldn’t go higher than they were during the Clinton era–39%. Certainly, nobody has been wiser or more correct regarding the economy and taxation than Krugman has during the last 4 years.

But let’s assume for a minute that the Occupy Wall Street movement swells into a genuine progressive movement, conservatives are tossed out of control of the House and Senate and Obama stays in the White House. What should we, as progressives, set as our ideal income tax rate on the wealthy? Krugman says it should be higher than 39%.

I suspect most of us here in the Liberal/Progressive blogosphere would like it much higher, perhaps double for those making more than a million dollars a year. But would this really help raise more money or create a fairer society in the long run?

I have my doubts.

Here’ the problem I see with raising taxes beyond 39%: it creates a backlash and permanently aligns the wealthy with the reactionary right, thus funding our enemies.

Let’s talk reality. Sure there are the Warren Buffets, Bill Gates and Bonos who are selfless and eager to pay higher taxes. But most wealthy people, like most people of all economic classes, are selfish and want to keep as much money as they can. At a certain point of taxation, you make rich people feel so burdened that they spend all of their time hating the government and trying to subvert taxes through phony foundations, loopholes, off shore ventures, etc.
When Ronald Reagan got a million dollar a year contract with a movie studio in 1945, the top tax rate was 94%. He reasoned, correctly, that he would only be able to command this kind of a salary for a few years and then his pay would drastically shrink. Since he might only have a few good high income years he grew to hate the government, taxes, and Democrats. He then led a movement to discredit government that we still haven’t recovered from. Imagine if in 1945, Reagan had been able to keep, say 55%, of his earnings. I’d be willing to wager he would have never entered politics and all of us on the liberal side of the isle would be a thousand times better off.

The problem with raising income taxes over a certain level is that it becomes the motivating factor in rich people’s lives. Hence you have wildly wealthy people who are pro-choice, pro-gay rights, pro-progressive on every social issue in the world giving million dollar contributions to the Republican Party so that it can back candidates who are social Neanderthals who happen to favor cutting income taxes.

The other big problem with income tax rates above a certain level is that the really rich simply spend fortunes on smart tax attorneys to dodge the taxes. The problem is that these really rich people who might otherwise be doing productive things with their lives become totally pre-occupied with estate planning because they deduce, sometimes correctly, that if they spend 90% of their time for 7 years rearranging their estate they can decrease their tax burden by, say, $50 million when they die.

Let’s face it; most really rich people aren’t social or religious conservatives. Really rich people, in general, have traveled the world and have been exposed to new ideas, cultures and religions. Sure, they might still be bigots, but they really are not comfortable with the typical religious right Republican. Also, wildly successful entrepreneurs who make hundreds of millions of dollars are usually smart. And since the Republican Party has officially become the “Stupid Party,” most successful entrepreneurs don’t respect the Republican Party–though many support it solely for the issue of marginal tax rates.

It’s true that the second and third generations of the really wealthy are often idiots, but they typically are not conservative idiots. The super wealthy children can indulge themselves in cocaine parties, $500 bottles of champagne or bring an entire bale of marijuana to the first day of college (as one well-heeled dorm mate of mine did). These sorts of activities tend to make one less interested in fundamentalist religious activities or banning abortion nonsense.

No, I’m not buying into the right wing propaganda that we Democrats want to “punish success.” No, I don’t believe that taxes are evil. And I’m not suggesting we buy into the myth that if we raise taxes on the wealthy they will just stop working and making money. I think they will work even harder; it’s just that most of their work hours will go toward tax dodging and attending fundraisers for our enemies.
But at some point, we Liberal/Progressives will come back to power. We will be able to increase the top marginal tax rates. I’m suggesting we come up with a rate that takes into account that most people do have some level of selfishness and that if we raise rates too high, we plant the seeds for future Ronald Reagans to sprout and we needlessly fund social Neanderthals and reactionaries into the next generation.

I think the Clinton era 39% is high enough to increase progressivity, increase actual revenues, and yet not so high as to create numerous unintended political backlashes. What do you think the top tax rate should be? But before you blurt out 94% please think about the consequences of giving  financial aid and comfort to our enemies if the number is too high.

A moderate third-party presidential candidate would be a terribly stupid idea and it seems almost beneath E.J. Dionne to waste his time responding to it. The point Dionne fails to make, however, is that President Obama is already a moderate candidate. In fact, any president who is primarily focused on passing legislation (as opposed to starting foreign wars and gutting regulation) is going to be a moderate. This is a poorly understood fact.

To see why this is the case, we can simply look at the U.S. Senate during Obama’s first two years in office. The president’s party had nominal control of between 56 and 60 seats (depending on the time period and health of the senators). Because the Senate now requires 60 votes to pass anything remotely contentious, the president couldn’t pass anything that didn’t have the support of every single Democrat and (for most of those two years) at least a small handful of Republicans. What this meant was that the most conservative (or moderate or centrist) Democrats had effective veto power over bills and amendments to bills. In most cases, the most progressive (or moderate or centrist) Republicans also had effective veto power. In other words, if Ben Nelson, Joe Lieberman, Susan Collins, and Olympia Snowe didn’t like a provision, it wasn’t going to be included in the bill. And if they didn’t like the bill, it wasn’t going to pass.

The president’s ability to move this centrist coalition to the left was limited. One limitation was created by Mitch McConnell’s strategy of total obstruction. He put enormous pressure on the centrist Republicans not to play ball. And that took away the cover that centrist Democrats like to have when they vote with the party on contentious issues. If Ben Nelson can’t find a couple of Republicans supporting a bill, he pretty much wets his pants. At times, Joe Lieberman appeared to be changing his positions for no other reason than to anger liberals. With dynamics like that, it’s kind of hard to push through liberal legislation.

McConnell’s total obstruction strategy forced Obama farther to the middle, but to a large degree all presidents are forced to work with the middle. Even FDR and LBJ’s huge supermajorities were a little misleading, as they were based on the Democrats’ strength in the conservative South. But those majorities were sufficiently large to create significant liberal legislation.

Ask yourself how the Dodd-Frank bill might have turned out if there had been 70 or 80 Democratic senators. How would the health care bill have turned out under those circumstances? What would we be doing about housing in that alternate reality? Would Gitmo be closed?

Presidential candidates make a lot of promises, but their ability to keep those promises is based on their ability to convince 60% of the U.S. Senate to go along with their agenda. And that guarantees that most presidents will pursue fairly centrist legislative agendas, or they will fail.

George W. Bush didn’t sign a whole lot of legislation. He got his tax cuts (under reconciliation rules, with Dick Cheney casting the tie-breaking vote both times) and his education, Medicare Part D, and Bankruptcy Reform bills, and he was pretty much done. When he tried to push something radical (privatizing Social Security), he got absolutely nowhere.

It’s true that a president can have some far right or far left personal beliefs, but they can’t translate the beliefs into action in the legislative field. If you want really progressive or really conservative outcomes, you need to win a very large supermajority in the Senate and have a president willing to take advantage of that supermajority. Without that kind of power in the Senate, all presidents will produce fairly centrist legislative records.

It still matters where the president stands. It’s especially important when the president’s party loses total control of Congress, because a president might be tempted to start signing the opposing party’s bills and try to take credit for them.

It’s one thing to make tough compromises that water down what you want to do. It’s another to embrace the other party’s agenda and then call it your own.