The Economist (2022-01-08)

The Economist January 8th 2022 United States 23

theiremergencyroomsbecauseofstaffing

andbedshortages,saysMartinStallone,

ceoofCayuga MedicalCentreinIthaca,

NewYork.Thenewcdcguidanceallows

critical health­care workers to return

sooner(thoughCayugaMedicalisstillrec­

ommendinga 10­to­14­dayisolation).

Shortages are affecting other indus­

tries,too.Airlineshadtocancelthousands

offlights,oftenbecauseoflackofstaff.Ac­

cordingto thecdc, infectedpeople are

mostcontagiousone­to­twodaysbefore

theonsetofsymptomsandtwo­to­three

daysafter.Afive­dayisolation,plusfive

daysofmasking,letsworkersreturnmore

quickly,minimisingdisruption.

Afternearlytwoyearsofprioritisingin­

dividual risk­mitigationover social dis­

ruption,Americanhealthexpertsarebe­

ginningtolightenup.“Thisisa verydiffer­

entvirusthantheonethatwesawearlier

oninthepandemic,”explainsLeanaWen,

a formerhealth commissioner of Balti­

more.“Therisktomost[vaccinated]indi­

vidualsrightnowofOmicronisverylow.

TheriskthatOmicroniscausingsocietyin

termsofwidespreaddysfunctionisvery

high.”Thepandemicseemstohavehita

turning­point.n

Electoraladministration

Who counts wins

F

ormuchofthepastyear,Democratsin

Congress  have  fitfully  and  unsuccess­

fully  pushed  various  bits  of  voting­rights

legislation.  Whatever  the  merits  of  these

bills, they are an odd first response to the

insurrection  of  January  6th  2021.  Record

numbers of Americans voted in 2020. Long

queues  and  pandemic­driven  confusion

notwithstanding, the problem was not ac­

cess to the ballot, it was the attempted chi­

canery  with  the  counting.  The  Electoral

Count  Act  of  1887  (eca),  which  tries  to  set

guidelines  for  how  Congress  settles  dis­

puted  results  in  presidential  elections,  is

vague,  confusing,  possibly  unconstitu­

tional—and ripe for reform.

To  understand  what  the  eca does,  it

helps  to  understand  America’s  byzantine

method of electing a chief executive. When

Americans  cast  a  vote  for  president,  they

are  actually  voting  for  a  slate  of  electors

who  will  themselves  vote  for  that  candi­

date at the electoral­college meeting. Arti­

cle II of the constitution explains that each

state gets the same number of electors as it

has members of the House and Senate, that

states  send  certified  election  results  to

Congress, and that in a full joint session of

Congress the president of the Senate (who

is also the vice­president) will “open all the

Certificates,  and  the  Votes  shall  then  be

counted”. If no candidate reaches a majori­

ty  of  electoral­college  votes,  then  the

House  chooses  the  president,  with  each

state’s delegation getting a single vote.

The ecawas intended to be a guide for

resolving disputes. It permits legislators to

formally object to individual results or en­

tire states’ slates, provided each objection

is signed by at least one senator and repre­

sentative.  If  majorities  in  both  chambers

uphold the objection, the votes in question

are not counted. It also establishes a “safe

harbour”  deadline,  establishing  that  as

long as states resolve any disputed results

at least six days before the electoral college

votes,  then  those  results  are  “conclusive”

and Congress must count them.

But the ecaleaves much uncertain, in­

cluding the grounds on which members of

Congress  can  object,  the  role  of  courts  in

settling  disputes  and  whether  the  vice­

president  has  any  discretion  in  the  vote­

counting  process.  Worse,  it  lets  Congress

reject valid votes. All that has to happen is

for  states  to  provide  competing  slates  of

electors (as urged by John Eastman, a law­

yer advising Donald Trump in the denoue­

ment of the 2020 election) and for a major­

ity  of  both  chambers  of  Congress  to  back

the  alternative  slates.  Congress,  rather

than  the  American  people,  could  thus  se­

lect  the  president.  The  constitution’s  cre­

ators rejected letting the legislature select

the  executive—but  if  Republicans  control

both chambers of Congress in 2024, as well

as  the  governorships  of  enough  crucial

swing  states,  and  a  scenario  similar  to

2020 emerges again, it would be unwise to

rely on principle and fealty to the founders

prevailing over bare­knuckled realpolitik.

Many  on  the  right  are  also  concerned

about ecaabuse. If Republicans can vote to

reject results they dislike over unfounded

allegations  of  fraud,  Democrats  could  in

theory do the same over concerns about ra­

cially  biased  election  practices.  Some  lib­

ertarian­minded  legal  scholars  argue  that

the ecaitself—specifically, the provisions

that allow Congress to reject slates of vot­

ers—is unconstitutional, because Article II

provides no mechanism for rejection.

By  allowing  federal  legislators  to  im­

pose  their  preferences,  the  ecaweakens

state control over elections, which Repub­

licans have traditionally defended. In 2020

Marco  Rubio,  a  Republican  senator  from

Florida, proposed extending the eca’s safe­

harbour  deadline.  John  Thune  and  Mitch

McConnell,  the  top  two  Republican  sena­

tors,  have  expressed  openness  to  reform­

ing the eca. Some Democrats see this offer

as  a  ruse  to  weaken support  for  voting

rights,  which  itmaybe—but  one  with  a

worthwhile result.n

N EW YORK

Reforming the Electoral Count Act

would help prevent another revolt

Medicaleducationandgender

Identity problems

G

ender dysphoria, the often agonising

feeling  that  one  has  been  born  in  the

wrong body, is listed in the American Psy­

chiatric Association’s “Diagnostic and Sta­

tistical  Manual  of  Mental  Disorders”.  So

Katherine  (not  her  real  name)  was  sur­

prised, in her first week at Louisiana State

University School of Medicine, when a lec­

turer told a class that gender dysphoria was

not a mental illness. It suggested that gen­

der­identity  ideology,  which  holds  that

transgender women are women and trans

men  are  men,  had  influenced  some  of

those who were training her to be a doctor. 

More  evidence  followed.  An  endocri­

nologist told a class that females on testos­

terone had a similar risk of heart attack to

males (they have a much higher risk). De­

bate about all this was apparently off­lim­

its.  How  has  trans  ideology  made  its  way

into medical schools?

Professional  bodies,  including  the

American Academy of Paediatrics, have en­

dorsed  “gender­affirmative”  care,  which

accepts  patients’  self­diagnosis  that  they

are  trans.  This  can  mean  the  prescription

of  puberty  blockers  for  children  as  young

as nine. Trans medicine is not a core part of

medical schools’ curriculums. But an aca­

demic paediatrician (who did not want her

name, institution or state to appear in this

story) says that all medical students under­

stand  that  they  are  expected  to  follow  the

affirmation  model  “uncritically  and  un­

questioningly”.  For  most  doctors  that  will

mean referring a patient to a gender clinic,

some of which prescribe blockers or cross­

WASHINGTON, DC

Trans ideology is distorting the

training of doctors