Is it over for Obama and the Democrats?

It might just be too soon to write off the president and his party.

It's not about him -- it's what he stands for. Two thirds of Americans don't have an issue with President Obama as a person -- it's not that they really think he's aloof, or too remote, or any of the other stuff which is supposed to be behind his fall in the polls.

It's just that the vast numbers of middle-of-the-road voters across the country are proving more centre-right than centre-left. Health care was one thing - but what's not going down well, it seems, is the President's handling of the economy - from the banking bail out to the still-rising numbers out of work.

When the economy is doing badly - history shows people tend to blame the party in power. And the latest survey show just one third of Americans think Barack Obama has been a "very good" or a "good" president: the rest consider him merely average, or downright "poor".

It's useful ammunition for the GOP, of course: House minority leader John Boehner is making his first major speech of the campaign in Ohio, where he'll focus on jobs: as an aide put it - "the November election will be a referendum on President Obama and Washington Democrats' job killing record." And RNC chairman Michael Steele bashed out an instant response to the jobless figures: "President Obama and his left wing allies on Capitol Hill have spent trillions of taxpayer dollars with nothing to show for it but a mountain of crippling debt and chronic joblessness."

So just over three weeks before the midterms - how should the Democrats fight back? The good news for the party is that barely anyone (just 22%, apparently) - thinks Sarah Palin would make an effective president.

And key election strategist David Plouffe, who's back running Obama's "Organising for America" campaign, has insisted voters are still open to the arguments - claiming large numbers are being put off the Republicans by the success of Tea party candidates.

President Obama himself - and the First Lady, Michelle (now officially the "World's Most Powerful Woman"...whey-hey...) - are out there whipping up enthusiasm on the campaign trail. Even Joe Biden's been sent out on the road, campaigning for 18 candidates in 23 cities across the country - with 18 more events in his busy diary before election day.

And there's a decidely populist tone coming from many Democrats - a direct pitch to working families - hitting Republicans by bashing corporate America, outsourcing of jobs, and the minimum wage.

Yesterday President Obama used his veto to block a bill that sneaked through Congress last week - which critics say would have made it easier for lenders to evict people who missed their mortgage payments. There are legal moves going on in at least ten states to extend a voluntary freeze on foreclosures - with calls for a moratorium across the country.

Union officials from the AFL-CIO have put out literature in Illinois, Oregon and Minnesota, accusing Republican gubernatorial candidates of opposing an increase in the minimum wage - while highlighting other Republican candidates who've proposed doing away with federal minimum wage regulations altogether.

And Democrats in many districts are pushing the message that they're on the side of ordinary workers - a message that pollsters say has been going down well with focus groups. In at least six close-fought Senatorial contests, like California and Indiana - they're putting out campaign ads attacking the Republicans over their record on outsourcing - like this, from Barbara Boxer: "Carly Fiorina laid off 30,000 workers. Fiorina shipped jobs to China."

Not that the Republicans are taking this quietly: a collection of lobbyists from big business called Club Fox Growth is splurging millions on ads in toss-up states which depict Democrats as "out of touch with the financial plight of average Americans." Look at the level of campaign spending, in fact, and you'd be forgiven for thinking the recession never happened...television spending by outside interest groups, says the New York Times, has more than doubled the amount spent at this stage in the 2006 midterms.

But is any of this - from hard cash to populist ads - galvanising people to the polls, and overcoming that much-documented 'enthusisasm gap' among those voters who so optimistically swept Barack Obama into power?

The most recent survey by Pew Research at first looks alarmist - under its banner headline 'Lagging Youth Enthusiasm Could Hurt Democrats in 2010'. But read a little closer - and the numbers are rather more hopeful for the party. Younger voters, it says, are far more supportive of the President than any other age group. 58% of the so called 'Millennial' generation still approve of how he's doing. Of course optimism is the preserve of the young. And three weeks isn't long to turn things around. But still - it might just be too soon to write off Obama - and those "left wing allies on Capitol Hill" - just yet.

Felicity Spector is chief writer and American politics expert for Channel 4 News.

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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage