Everybody thinks Donald Trump will lose the general election in November. If that's true, what should Republicans do about the Supreme Court?

  1. Go ahead and confirm Merrick Garland. He's about as good as they're likely to get from a Democrat.
  2. Continue their holdout and let Hillary Clinton nominate someone even more liberal next year.

Decisions, decisions. But it's a live question. Garland is now officially a pretty serious dilemma for Republicans.

Chart of the Day: Cheap Pot!

It's now been three years since Washington State legalized the sale of marijuana. So what happened? Answer: it got cheaper. The price of pot has fallen from $25 per gram to about $9 per gram, and it's still dropping. Keith Humphreys comments:

Falling pot prices create winners and losers. Because state taxes are based on a percentage of the sales price, declining prices mean each sale puts less money in the public purse. On the other hand, bargain-basement prices undercut the black market, bringing the public reduced law enforcement costs, both in terms of tax dollars spent on jail and the damage done to individuals who are arrested.

For consumers who enjoy pot occasionally while suffering no adverse effects from it, low prices will be a welcome but minor benefit....On the downside, young people tend to be price-sensitive consumers, and their use of inexpensive pot may rise over time, as might that of problematic marijuana users.

Are falling prices in Washington due to legalization? That seems like a reasonable guess. On the other hand, if the folks at priceofweed.com have things right, $9 per gram is roughly the market rate everywhere west of the Rockies. So there might be something else going on. Maybe legalization in Washington and Colorado have affected the entire regional market. Or maybe there's been a bumper crop of pot in Mendocino County. It's a little hard to say without more data.

How Smart Is Donald Trump?

Donald Trump is now officially the presumptive Republican nominee for president. But what kind of chance does he have of winning in November?

I'd guess "pretty slim," but it depends on a couple of things. First, does anything horrible happen between now and the election—say, a terrorist attack, a financial crash, or Hillary Clinton being indicted for her email woes? Any of those could sweep him into office, but since they're entirely unpredictable there's not much point in worrying about them.

Second, just how smart is Trump? Here's what worries me: in retrospect, we can see that Trump played the rest of the GOP field like a Stradivarius. He somehow managed to get his strongest competitors, Jeb Bush and Scott Walker, out of the running early. He didn't waste much energy on obvious losers like Ben Carson and Carly Fiorina. Then he zeroed in on Marco Rubio. In the end, he was left only with Ted Cruz, possibly the most disliked man on the planet.

Was this deliberate? The entire Republican Party would have rallied around Rubio if he'd been the last man standing, and that could very well have turned things around. But Cruz was never much of a threat to Trump. He's got a smarmy personality that doesn't appeal to the public, and a contemptuous disposition that has made virtually every Republican politician on Capitol Hill into a sworn enemy. Even faced with a Trump freight train bearing down on them, they couldn't bring themselves to circle the wagons and work for a Cruz victory.

So: Did Trump actively try to make sure that Cruz would be his final opponent? Is he that smart and that proficient at executing a long-term strategy? Or did he just get lucky? The answer to that question might determine what happens in November.

Cancer drugs are expensive. No surprise there. But Carolyn Johnson reports on a study showing that they've become spectacularly more expensive over time:

The [study] examined 32 cancer medications given in pill form and found that their initial launch list prices have steadily increased over the years — even after adjusting for inflation. The average monthly amount insurers and patients paid for a new cancer drug was less than $2,000 in the year 2000 but soared to $11,325 in 2014.

Shazam! That makes the rise of university tuition seem like peanuts. Still, at least prices should go down as time goes by and competing medications come to market. Right? No siree:

A study published Monday in Health Affairs examined what happened to the prices of two dozen cancer drugs after launch and found that pharmaceutical companies on average increased prices 5 percent above inflation each year. That inflation dwarfed ameliorating effects from competing drugs being introduced, which resulted in an average discount of about 2 percent. And the biggest hikes — of about 10 percent — coincided with the drugs receiving approval for other conditions. In other words, when a drug became useful to a larger number of patients, the price shot up.

The findings highlight the often mind-boggling ways that drug prices behave. Launch prices for cancer drugs have soared over time; after launch, those prices also increase steadily, despite competition from other treatments and even as the drugs are used by more patients.

Off the top of my head, I can think of a couple of ways this makes sense. First, pharma companies might well price new cancer drugs moderately in order to get them on formularies and build up market share. Then, once they've been approved and doctors start to get familiar with them, they raise the price a bit each year. No one's going to remove a drug from their approved formulary just because of a measly little 5 percent price increase, after all.

Second, cancer drugs can legitimately become more valuable over time. It's one thing to have the original clinical studies, but the true efficacy of a new drug is still a bit iffy until oncologists start prescribing it in large quantities and get personal experience with it. Once that happens—assuming the results are good—demand for the drug goes up and the market will bear a higher price. When doctors find a drug that produces good results with acceptable side effects, they quite reasonably get attached to it.

That said, I'm guessing that the main driver of these price increases is because they can. Without these drugs, you die. That makes it pretty tough for an insurance company to say no regardless of what the price is.

As soon as the California primary is over, Donald Trump will be facing a barrage of attack ads:

A series of ads painting [Trump] as an unserious, unready, and unscrupulous businessman who also happens to disparage women and minorities is to start airing June 8, the day after the final primaries in which Trump is likely to clinch the Republican presidential nomination.

“That’s a good day to start,” said Justin Barasky with Priorities USA Action, a super PAC backing Democrat Hillary Clinton. “We’re not going to the make the same mistake Republicans did in waiting too long [to go on the offensive].”

That sounds fine. But why announce it in advance? Doesn't that just give your opposition time to plan a counteroffensive? Or am I missing something?

Last year I wrote about a paper that looked at the relationship between childhood lead poisoning and violent crime rates in a whole new way. James Feigenbaum and Christopher Muller compared cities from the early 20th century that installed lead water pipes with those that installed iron pipes, and found that cities with lead pipes had higher homicide rates. Today, Josh Marshall alerts me to the fact that Feigenbaum and Muller have now published a final draft of their paper. The basic results are below:

As you can see, the effect is consistently positive. "Based on the lowest and highest point estimates," the authors conclude, "cities that used lead pipes had between 14 and 36 percent higher homicide rates than cities that did not." They present further versions of this chart with various controls added, but the results are largely the same. Overall, they estimate that cities with lead pipes had homicide rates 24 percent higher than cities with iron pipes.

As a check, they also examine the data to see if lead pipes are associated with higher death rates from cirrhosis and infant diarrhea, both of which have been linked with lead poisoning:

As expected, we observe large, positive, and statistically significant relationships between a city's use of lead pipes and its rates of death from cirrhosis and infant diarrhea. Unexpectedly, we find that cities that used lead water pipes had higher rates of death from scarlet fever and influenza. Cities that used iron pipes, in contrast, had higher rates of death from circulatory disease, cancer, and cerebral hemorrhage. We know of no scientific literature to motivate these latter relationships.

So it looks like lead really is the culprit, and it really is associated with higher crime rates.

Click on my post from last year to get more details about both the strengths and weaknesses of this paper. As with any retrospective study like this, there are reasons to be cautious about the results. However, the main strength of this study is unquestionably important: it verifies the lead-crime link in an environment completely different from all the other studies done to date, which examine gasoline lead exposure from 1960-2010. It's yet more evidence that lead really did play a role in the great crime wave—and the subsequent crime decline—of the second half of the 20th century.

UPDATE: The original version of this post used the wrong chart. It's now been corrected.

Weekly Flint Water Report: April 23-29

Here is this week's Flint water report. As usual, I've eliminated outlier readings above 2,000 parts per billion, since there are very few of them and they can affect the averages in misleading ways. During the week, DEQ took 450 samples. The average for the past week was 5.50.

What's the Best Way to Talk About Racism?

Over at Vox, we're having a battle of the charts. Matt Yglesias says this is the one chart you need to understand Donald Trump's popularity in the Republican Party:

But no! Dara Lind says this is the one chart you need:

Needless to say, there's no real disagreement here. Both writers are suggesting that Trump is winning because he appeals to a Republican Party base that thinks white people are getting screwed and doesn't much like all the non-white people they think are doing the screwing. So they're all pretty happy about Trump's wall and his proposed Muslim ban and his endless griping about "political correctness." At its core, Trump's appeal is fundamentally racist.

I think it's safe to say that nearly all liberals believe this. There's voluminous evidence beyond just these two charts, after all. But here's my question: what should we do about it? This has been bugging me for a while.

If we attack it head on—"Republicans are racists!"—it accomplishes nothing. Or worse than nothing: it pisses off our targets so badly that they'll never hear another word we say. Besides, it's all but impossible to prove that racism is at the core of any particular belief, and doubly impossible to do so in the case of any particular person. It's also really easy to go overboard on charges of racism once you get started.

Alternatively, knowing that this is a political loser, we can skirt the direct charges of racism and focus instead on tangentially related topics. The upside is that we have at least a chance of winning over some voters who aren't too far gone. The downside, obviously, is that we're avoiding the elephant in the room. How do you fight racism if you're not willing to talk directly about it?

I don't have a good answer. Accusing people of racism is the fastest way to shut down a conversation and ensure implacable opposition. Avoiding racism is the fastest way to make sure nothing serious ever gets done about it. So what's the right approach?

Donald Trump Accuses...Someone of Something

A few days ago I was checking out at the supermarket and saw the cover of the National Enquirer telling me that Ted Cruz's father was linked in some way with the assassination of JFK. I briefly wondered whether this would help or hurt Cruz with the tea party crowd and then forgot about it. But Donald Trump is on it:

“His father was with Lee Harvey Oswald prior to Oswald's being — you know, shot. I mean, the whole thing is ridiculous,” Trump said Tuesday during a phone interview with Fox News. “What is this, right prior to his being shot, and nobody even brings it up. They don't even talk about that. That was reported, and nobody talks about it.”

“I mean, what was he doing — what was he doing with Lee Harvey Oswald shortly before the death? Before the shooting?” Trump continued. “It’s horrible.”

Very presidential, no? But it reminds me of a New York Times piece this weekend headlined "Experts Warn of Backlash in Donald Trump’s China Trade Policies." Gee, no kidding. I'm glad the Times was on this.

And yet, what are reporters supposed to do? Trump tosses out absurdities on a daily basis, and we can either ignore them or we can give them more oxygen by writing earnest explanations of why he's wrong. It's a lose-lose proposition. Tomorrow he'll declare that teaching arithmetic in grade school is a waste of time since we all have calculators on our cell phones. Mobs of Trump supporters will start carrying around signs saying "No More Times Tables!!!" and a week later, when no one cares anymore, we'll get a barrage of op-eds laying out in gruesome detail all the academic research explaining why kids should still learn arithmetic these days. I imagine this is going to happen approximately weekly from now until the first week of November.

Strange days.

There's not much more to say about the Republican primary. The polls now show Donald Trump with a commanding lead in tomorrow's primary in Indiana, and he's got a big lead in California too. It's all over but the shouting.