Smarter HIV prevention in the UK

Piece for World AIDS Day 2012. Originally appeared here 
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Smarter HIV prevention in the UK

World AIDS Day. For many it will conjure image of young men in the 1980s dying helpless, horrible deaths in hospital wards. Many old enough to have been there will still be able to recall the raw panic that enveloped the early years of the epidemic.

In truth, though, while such imagery unquestionably helps us remember, and to raise money, they are not terribly useful for understanding the reality of HIV in 2012 – or for informing HIV prevention policy. Which is not to say HIV is longer an issue – last year saw the highest number of new HIV diagnoses among gay men in the UK on record. But rather that the epidemic here has moved on. And we desperately need to take heed of this if you’re going to bring down rates of HIV infection.

For one thing, thanks to treatment, if diagnosed early someone with HIV can expect to enjoy a near-normal life expectancy. Second, and most importantly, that treatment can reduce infectiousness by up to 96 per cent – making it extremely unlikely they will pass it on to others.

Quite obviously, though, this is only the case if the individual is diagnosed early. And it’s this which is the great challenge of HIV today. Late diagnosis explains the vast majority of people who die or develop AIDS. What’s more, crucially, it’s the undiagnosed who are now driving our epidemic. Fifty per cent of people with HIV in the UK are diagnosed late (CD4 count of under 350), 20 per cent very late (under 200). Twenty-five per cent of the 100,000 people with HIV don’t know they have it.

Earlier diagnosis through more regular testing thus becomes not only beneficial for personal health, but vital for public health and stopping the spread of the epidemic.

Clearly, conventional HIV prevention such as condom promotion and sex education remain crucial. But they must be coupled with a range of interventions aimed at increasing testing. Just throwing more money at community groups alone will not solve the problem. In short, we need a smarter approach to HIV prevention.

So what are the building blocks of this? Well-funded HIV services and a universal public healthcare system are pivotal. Sadly, both are being undermined by this government.

Beyond that, there are a range of steps the government need to take if they are serious about doing more to reduce rates of HIV. These include:

• Political commitment. The UK has no HIV strategy. The last one, introduced by Labour, expired in 2010, and has not been replaced by this government. This leaves us as one of the few countries in the world without a national HIV strategy.

• More proactive testing by health services. At the moment, testing is conducted on an ‘opt-in’ basis – it requires voluntary commitment by the patient. We need to move towards an ‘opt-out’ system – where your consent to be tested is implied unless you explicitly withdraw it. In high-prevalence areas, all GP surgeries should routinely test all new patients for HIV, while hospitals should do the same for every patient who walks through their doors. The last government commissioned a report which found that this was was feasible, cost-effective and highly successful in reducing rates of undiagnosed HIV. This government has made no real effort to back or implement this.

• In general, testing needs to move outside of just the GUM clinic into GP surgeries, hospitals, communities, saunas and clubs.

• Better HIV partner notification. Telling your recent hook-up when you’ve been diagnosed with HIV is a surefire way of getting them to go for a test. It’s really effective as a means of diagnosing people earlier. But it’s difficult. Services within GUM to support it are patchy at best, and need to be improved.

• An ‘annual testing’ message for Africans living in Britain. It exists for gay men – why shouldn’t it for Africans too? After all, they make up nearly half of the UK’s new HIV diagnoses.

Such steps are not as sexy as high-profile national prevention campaigns. But they would be as effective, if not more so, in stopping the spread of HIV in this country today. So let’s use this World AIDS Day to give money and remember those lost, but also to renew and update our public conversation about HIV and the steps we take to stop what is still, after all this time, a profoundly preventable condition.

The myth of the millionaires' exodus over the 50p tax rate

Blog for HuffPost
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The myth of the millionaires' exodus 

This week the Treasury spin machine went into overdrive in response to Labour's push to highlight the cut in the 50p top rate of tax.

The centrepiece of their case was that the 50p tax had reduced the number of millionaires paying tax in the UK by 10,000 from 16,000 to just 6,000. The Telegraph faithfully reported their argument, informing us that "two thirds of millionaires left the UK to avoid 50p tax". The Mail did likewise, publishing unquestioningly Harriet Baldwin's extrapolation that this cost the UK "£7 billion in lost tax revenue".

This narrative has been accepted by the right - of proof of the age-old maxim that taxing the rich proves counter-productive - and even by the left, as a cause for despair. It's also reached the other side of the Atlantic, giving succour to the Republican blogosphere in their argument against Obama's case on the 'fiscal cliff'.

The trouble is, it isn't true. Or at least there is no credible proof that it is.

The figures used have been worked up on the same basis as the HMRC's report on the 50p tax back in the Spring - and they're disingenuous for that same reason.

As I argued in a piece for LibCon back in March, this report was fatally - and probably intentionally - flawed, seemingly fixed to reach the conclusion George Osborne wanted it to. Primarily, this was done by isolating the top rate tax yield for tax year 2010/2011 - the year the 50p tax was introduced. The report showed a significant drop in top rate revenue for 2010/2011 from 2009/2010, and this was the main basis of the argument that the 50p tax 'raised no money' which justified it's abolition.

A gaping hole in this argument is that by the HMRC's own admission, a great deal of this drop was accounted for by (the non-PAYE paying) super-rich bringing bringing forward their income ('forestalling') and declaring it in 2009/2010 tax year instead, ahead of the pre-announced 50p tax rise. The key point is, by its nature forestalling can only happen once - those who did so could not have kept doing it in the years after; they would have had to have paid up. The 2010/2011 yield was thus artificially deflated; totally anomalous, and unreliable as a baseline. There may have been other more permanent forms of evasion in the mix, but the only way of knowing this - and the true effectiveness of the 50p tax - for sure would have been to wait for 2011/2012 returns. Which is presumably by Osborne avoided doing just that (given there was good evidence it raised a significant sum of money).

And so to yesterday's numbers. They too take 2010 figures, on the number of people declaring an income above £ 1 million, compare it to 2009 and note a drop - leaving the Telegraph and Mail to argue without evidence that they have all moved abroad. But just as with the tax yield, these figures are highly distorted and unreliable, given we know many top rate payers moved their income for 2010 forward to 2009 (this is especially likely to be the case with millionaires, as few would be on PAYE).

Treasury sources go on to state that the number of millionaires is now 10,000 - and shamelessly attribute this to Osborne's announcement of his intention to cut the 50p tax. In reality, it's much more likely that this increase is simply those who forestalled in 2010 returning, as they inevitably have to (a large part of the remaining gap between this figure and the mid-to-late 2000s numbers is likely explained by the financial crisis).

There remains little to no evidence that high earners have, or are planning to, move abroad in response to high tax regimes. For people on the right and left to take such blatantly skewed figures at face value does a real disservice to the level of debate an area as totemic as tax policy should demand. Sadly, I doubt the sleight of hand will stop here. My guess is the next trick will likely come a year before the election. Given the cut in the 50p tax has been pre-announced, it's possible that some income will be delayed being declared until after the cut - some chartered accountants are already advising the super-rich on just that. This will artificially inflate the 45p rate 2013/2014 revenue, allowing Osborne to compare it to 2010/2011 and announce the top rate cut a great success in getting the rich to pay more. If the debate on this issue so far is anything to go by, it's likely he will go unchallenged.

There are evidently parts of the Government intent on fighting a war on behalf of the richest 1% in our society. The first casualty of that war looks to be the truth about the 50p tax.

Post for ShiftingGrounds--

The rise of resentment in America

Three days on from the re-election of President Obama, the hangovers that followed a night of celebration for Democrats have receded. As a nice bonus, the Republicans, by contrast seem to be facing a four-year long headache. The inquisitions and post-mortems have already began. Demographic shifts have altered the political landscape to leave them with a challenge on par in scale with that faced by the UK left in the late 70s and early 80s.

As it turns out, the GOP didn’t understand (or even want to) the nature of the country they so often profess to love. But if the emphatic defeat of Mitt Romney is provoking head-scratching from the US right about America 2012, it should also cause pause for thought among their bedfellows in Britain who – judging from coverage before and in the run up to the election – don’t seem to have updated their view of the country in twenty-odd years.

As Dan Hodges noted of his Telegraph colleague Tim Stanley back in September, these days “the problem isn’t actually with Lefty idealists transposing their dreams on to Obama. It’s Right-wing idealists who transpose their ideological romanticism on to the United States in general.”

In particular, a cornerstone of this is the notion that Americans have no patience for ‘European-style’ attacks on wealth. The story goes that broadsides on those at the top, calls for them to pay more in tax or curb profit-seeking, are resented by ordinary Joe’s who one day think they could be that millionaire chief executive or investor. Money men are always respected, success never resented, we are told. If we “don’t do God”, the Americans don’t do class politics. For years the British right – aghast at their countrymen’s growing resentment of the top 1% – have gazed longingly over the pond and repeated these mantras.

The plutocrats in the US have long spun the same yarn: bashing a billionaire isn’t only just wrong, it’s un-American. One of the stories of this election campaign, though, has been the total unravelling of this narrative.

For those of you raising a sceptical eye-brow, consider this. Romney ran for President on the basis of being a rich man – a successful businessman – and he lost on that same basis. His entire pitch was that as someone who had made it in the private sector, he knew how to create jobs and get the economy going. In times gone by this would have gone largely unquestioned and unparsed.

However, the Obama campaign (in a move straight out of the Rove playbook) turned this supposed strength into a weakness. Those in the Obama camp arguing for an attack on Romney’s record at Bain Capital won out over those preferring to hit the Governor on the safer ground of being a ‘flip flopper’. From early on the campaign sought relentlessly to define Romney in terms of what he actually did to make his money: outsourcing, asset stripping, firing at will, tax dodging. In doing so, they peeled Romney’s supposed ‘experience’ away from ideas of enterprise or wealth creation. And it worked. His reputation never fully recovered. In the home of free-market fundamentalism, Obama’s team were able to pick and win a fight about predatory verses productive capitalism.

This approach was replicated in the furthest reaches of the campaign. Again and again the Obama campaign counter-posed their candidate’s platform “For All”, as the campaign sticker blared, with that of Romney’s. Over and over, the phrase “millionaires and billionaires” tripped from the tongue of Democrats with scorn any time GOP plans were discussed (so much so it upset those poor dears on Wall Street). Tax rises on the very wealthiest also formed a key policy plank for Obama, as he separated the top 1% out from the broader ‘middle class’ in his tax plans.

All this is no small feat, and took some degree of courage when you consider Fox News has spent the past half-a-decade screaming that the President is some sort of Bolshevik. But the space for it was only made possible by a growing anger among swathes of American society at the country’s wealthiest business and financial elites. This comes not just from the financial crisis, but years of declining wages and living standards, as well as Wall Street excess and the saturation – ratcheted up since Citizens United – of US public life with money, SuperPACs and special interests. Romney’s categorical defeat at a time when all the economic indicators suggested he should have won will be remembered as the time that the groundswell of anger at the super-rich that has built up in Europe over recent years reached American shores, and swept the Republican candidate away.

Quite obviously, the US has not suddenly become a socialist nirvana. American society is still beset by huge disparities in wealth and power, and little basis for its transformation exists in a politics where the most progressive US president in forty years has governed as a pretty conventional liberal by UK standards. If taxes on the wealthy do go up as planned, it will only be to where they were under Clinton – far from levels as recent as the 1970s.

But the way in which Romney was defeated is nevertheless important. Fundamentally, it chips away at a notion that has proven vital to the maintenance of the status quo: that the behaviour of the wealthiest is somehow inexorably linked to the public good, and that anyone who is good at money-making must automatically be good at governing or economics, and afforded special status.

It also means that insufferable sirens of the Thatcherite right have one fewer place to point to in the world where their brand of rapacious economic sadism enjoys broad public support. That once-vaunted bond between free-market capitalism and liberal democracy just got weaker still.

Cameron strikes some nice notes, but plays the wrong tune

Post for Shifting Grounds

Cameron strikes some nice notes, but plays the wrong tune

There’s no doubt that David Cameron’s speech to Tory party conference yesterday was one of his better ones since becoming Prime Minister. In some ways it was his most Presidential, not just in the personal touches woven in throughout, but in his attempts to transcend national politics and sketch out a vision of a new frontier – in this case, the new global economy – and place Britain at the heart of it  (sometimes called a ‘moon shot’ in US politics). We are, he said, in a “global race” with new countries on the rise, “sink or swim. Do or decline”.

Cameron also had strong dividing lines on welfare and schools – two issues Labour has no settled position on, but will clearly need to have in the next few years.

But the speech had a fatal weakness. At its core was a diagnosis of a country full of budding businessmen and women and ‘can do’ creatives, being held back by a bloated state and unreformed public services. The solutions that flowed from this were predictable enough – hack back the state, reform welfare, get the deficit down, liberalise school provision. Growth will naturally follow.

But this fundamentally misreads British politics today. Most people won’t become ‘entrepreneurs’, and most don’t want to. They just want to get on, get a good job, earn decent money, provide for their family, and lead happy and fulfilling social lives. The biggest impediment to this in 2012 is not the welfare system or planning laws, but an enormous squeeze in living standards and an economy that only works for those at the top. Wages are stagnating, jobs hollowed out, yet utility bills, rents, train fares, tuition fees and mortgage deposits are all rising (this is the true face of ‘Britain on the rise’ under the Tories). And so are bankers’ bonuses and executive pay, all the while SMEs – a real engine of jobs – can’t get access to finance, and young couples can’t get on the property ladder.

Even those traditionally upwardly mobile parts of the population – at whom the speech was clearly aimed – are suffering from this squeeze. Polling for Southern Discomfort Again showed that between 41%-47% of floating voters in key middle class marginals say they are now not confident they have enough money to make ends meet. As Lord Ashcroft’s polling shows, a key feature of the ‘suspicious strivers’ group he identified is economic insecurity and precariousness.  The squeeze is also having obvious effects on demand and consumer confidence – without which all the “diplomatic showrooms” and ankle flashed to multinationals matters not one jot. Economically and electorally, post-crash Britain is defined more by strugglers than it is by strivers.

To this backdrop, a speech about the ‘global race’ in the new world economy, or unleashing a nation of Steve Jobs style entrepreneurs, is a little arid and far off. It’s not irrelevant, it’s just remote; a bit mid-1990s. On the real day-to-day challenges and anxiety facing people already in work, Cameron had little to say. Bank reform did not feature once in his speech, nor energy companies, or even the words ‘bills’ or ’wages’. The Prime Minister may have struck some nice notes along the way, but he played the wrong tune.

The truth is, most of the obstacles holding back prosperity in the UK and our place in the world come not from an unreformed public sector, but an unreformed private sector. That a Conservative Prime Minister, who came to political maturity in the age of neoliberalism, feels uncomfortable talking to that challenge is not surprising. But it ultimately leaves him unable to connect with the lives of people he needs to reach to win.

It is this divide that Labour needs to put the Tories on the other side of. The party needs to find a consistent line on welfare and schools, but it can’t allow the election be fought on this ground. They need to make 2015 an election about living standards and the squeezed middle; who wants an economy which puts money in the pockets of ordinary people, and who only looks out for the top 1%. Making banks and energy companies work for people, an active industrial strategy, even tax cuts at the bottom or middle paid in part by rises at the top – all, among others, have a role to play. On this divide, the Tories are extremely vulnerable – because they simply don’t grasp Britain’s living standards crisis to begin with. However eloquently delivered, David Cameron’s speech yesterday proved that.

The 'modernisers' of British politics are in retreat

Post for Shifting Grounds. Hopi Sen wrote an interesting response on his blog here.

The 'modernisers' of British politics are in retreat

Since the summer reshuffle, a lot of discussion has been devoted to the right-ward shift of the Conservative party. As Stewart Wood writes, the Tories detoxification strategy seems like a “distant memory”.

But arguably the fading of the Cameron project is just one piece of a broader picture, which is the fall from grace of a sub-sect within the political class which once reigned supreme in all parties: the so-called ‘moderniser’.

It is rarely noted that inside the three three main parties sit a relatively small group of people – advisors, MPs, lobbyists mostly – who have far more in common with one another than their own respective party faithful. Their views are distinguished by a metropolitanism and social liberalism. They are intensely relaxed over gay marriage and women’s rights, but also the filthy rich and the City; supportive of public services but besotted with ‘reform’ defined by marketisation; mildly redistributionist but sharers of a faith that increased tax on higher incomes hits aspiration, that the British middle class starts at sixty-grand a year and the working class has been replaced by an underclass. An unswerving commitment to flexible labour markets is likely to make them uncomfortable with anxiety over immigration, while crime is usually addressed through depoliticized phrases like ‘social exclusion’ or ‘problem families’.

As Julian Astle perceptively notes, in one of the few articles written on them, this group will tend to give different emphasis to these views depending on their respective party’s historical weaknesses. Most importantly of all, though, they position and define themselves by a battle with their own more provincial party base.

And for years they won out. This is what came to capture the essence of ‘Blairism’ and many Blairites within the Labour party by the late 1990s. Success at the polls meant their agenda framed British political debate practically unchallenged. Despite ousting Blair himself, ultimately Brown and the people around him couldn’t carve out an alternative to a zeitgeist still going strong within the party and in media circles.

That Cameron came to pick up the Blairite playbook is well known by now; the huskies, the pledges on public spending and overseas aid, the commitment to gay rights and a more open approach to Europe – all key components of the Cameroon project. What is less appreciated is that in retrospect the ascendency of Clegg and co. at the top of the Liberal Democrats was just another variation on a theme, as he moved his party away from the ‘soft leftism’ of Charles Kennedy towards this more fashionable centre. Out went taxing income to better fund public services and opposition to marketisation, in came greater focus on taxing property and pollution, on free schools and on aridly defined ‘fairness’ within existing budgets. Both Cameron and Clegg kept red meat for their base, but their direction of travel became clear enough.

Now, though, it’s a very different story. The Cameron set are well and truly in retreat, ‘in office but not in power’ as the old saying goes. The resignation of Louise Mensch (a politician quietly liked by trendy triangulating types within the other two parties) and emigration of Steve Hilton comes as the Tories prioritise brutal spending cuts and slash tax for millionaires, all the while stalling on gay marriage and trashing any green credentials they once had. Clegg is more secure – the Lib Dems are less factional than commonly thought – but even he has had to tack back towards proposing higher taxes on the rich, and speculation persists that he’ll be ditched for the more leftish Tim Farron.

Meanwhile, the defeat of David Miliband, the departure of Alan Johnson for Ed Balls and the dominance of the likes of Tom Watson has drastically reduced the influence of Blairites or ‘Third Wayers’ over the direction of Labour. This is the real stupidity of the recent GMB motion to ban Progress. Their formal power within the party has never been weaker. The soft-left totally dominate strategy, policy and often selections. And if we can’t make the most of that ascendency, then we have only ourselves to blame, not nonsense conspiracies about plots or coups.

Indeed, there is an opportunity to forge a new consensus amid the rubble of the old one. The old modernising consensus has fallen from favour in all three parties mostly because its playbook was forged at a time when the basic questions of political economy were settled. In this respect, it was broadly in tune with public opinion. But the financial crash and the decline in living standards has incinerated most of those assumptions, and meant the old agenda satisfies neither party rank and file nor voters. Public opinion is much more volatile and harder to capture than before (increased anger at bankers, the rich and inequality but also – sadly – recipients of welfare). It is this which explains what Rafael Behr laments as “the hollow centre of British politics”.

As both Behr and Wood argue, the Tory right has sensed this gap too. They are pushing on with increasingly bold and frightening agenda to plug it. Unlike Brown, Ed Miliband has proved he can operate effectively outside the old ‘modernising’ formula – he has not pointlessly picked fights with his base nor felt the need to match Tory policy or indulge in huskie style stunts.

But there is still a sense of caution to him at times – he recognises the moment British politics finds itself in, but seems reticent to fully follow through on its implications. For the first time as leader, he and the people around him head into conference this week without any real threat, as a chunk of his critics find themselves in the wilderness or fighting their own internal battles. That space needs to be used to match bold critique with bold policy. There may never be a better chance.

Dover – A chance to put theory into practice…?

Piece for LabourList

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The Labour party has not agreed on much since 2010. Understandably following such a long stint in power, a lot of time has been spent contesting ‘lessons learned’ and ‘where to from now’. One area where there has been broad agreement, though, is on the virtue of Co-ops, mutuals and other community-based models of ownership. This not only formed the bedrock of Blue Labour thinking, but featured in the Red Book, the Purple Book, Compass and Fabian literature. Warm words from cosy seminar rooms are one thing, however – but do we actually believe in this stuff? If so, there is a fight going on, in a tiny corner of England, which offers the chance to turn theory into practice.

The port of Dover a key strategic hub in the region, hosting a number of small and large businesses (mostly ferry companies) and enabling the movement of goods and people across our border. Since 1604 it has been the source of stable and secure employment for thousands of men and women in the local area – from stevedores to electricians - while other industries have deteriorated or declined around it. The dock is deeply embedded in both the local and national economy, facilitating trade, transport and acting as a ‘gateway’ to Britain. It has come to form as integral a part of the community as the famous white cliffs which it neighbours.

Now, though, it is on the verge of privatisation. The Government is gearing up to sell it to the highest bidder, with a number of multinational private equity companies looming. We already have a prelude for what this will mean, as current administrators ‘fatten the pig for market day’. Jobs have been cut, wages slashed, skilled port workers put on zero-hour contracts; all to push down costs with a view to showcase the profits that potential bidders could line their shareholders pockets with.

As well as an affront to years of history, private ownership would likely be a horribly inefficient way to run the port. There is no evidence that it would improve the way it’s operated. That’s why ferry companies are so opposed to privatisation, and 97% of the town voted against it in a referendum last year. From the bidder’s perspective, it is simply about turning a huge profit on a ‘service’ they will have a natural monopoly over (it’s rather hard to ‘marketise’ this industry unless you want to give Dover citizen the right to set up their own shipping port…). For the Government, it is merely about a short-term boost to Treasury coffers – but even that would be lost in the long-term damage on jobs and demand.

Just as there is nothing ‘modernising’ or progressive about this, neither is there anything inevitable about it. The one group standing between a Tory government set on selling off the family silver, and the grateful arms of an overseas corporation, is ’Dover Forever England’. A coalition of groups that includes supporters of state ownership as well as the community-owned Dover People’s Port Trust, they are looking to stage a fight back on a scale we saw around the proposed sale of Britain’s forests.

But the Trust are not just opposing the privatisation of the port, they have come up with a detailed, coherent alternative. They plan to buy it from the government, and run it in partnership withDovercitizens, employees, port users, local businesses and local authorities. In other words, the port would be put in the hands of the people, locked away forever from bean-counters in Whitehall or transnational business elites. Revenue would be spent on jobs and infrastructure, not shareholders.

As well as an alliance of citizens, workers and businesses people, the Trust has teamed up with both Labour and Conservative MPs and councillors to stand against privatisation: the embodiment of the ‘Big Society’ Cameron professes to believe in. Sadly, though, if there’s cross-party consensus pushing for an alternative to the sell-off, there is also an uncomfortable degree of continuity on the other side of the argument. The idea of selling off the port originated under the Brown government, highlighting an instinct among many of our political leaders that most things are better run privately – an assumption that has disfigured much policy on public services, industry and the economy for over thirty years. An alternative to it – and in my view the idea that everything should be controlled bureaucratically, top down from Whitehall– is desperately needed. Though it may appear to be just a local scrap, the fate of the port of Dover is a crucial battle in a much larger war, with huge implications.

That’s why everyone on the left – and groups within Labour who have identified the crucial role community ownership can play in breaking with the past – should give their support to the campaign, do what they can to get involved or spread the word about it. Only this way can the Government be forced to listen, stop the sale – and hopefully hand the port over to the people of Dover.

The Government is set to decide on the port’s fate and whether to put it out to auction in the next few weeks. Ahead of this there is a big campaign meeting tomorrow (8th September), 11am at Pencester Gardens in Dover. If you can’t make it, then you can share articles about the campaign (Patrick Macfarlane at Progress, Tristram Hunt or Julian Baggini are good places to start), sign up to the Facebook group or donate to the Trust through its website, to play a part in the vital effort keep Dover forever England.

Caro shows us the human side of politics

Blog for Huffington Post
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Review: The Lyndon Johnson Years: Volume 4, The Passage of Power by Robert A. Caro

Should you be looking for a window into the lopsided nature of the 'special relationship', you need look no further than the reverence with which political classes on either side of the Atlantic observe the others internal affairs. While most inhabitants of the beltway view our politics with a sort of wry curiosity, wonks of all stripes over here obsess at the labours of American Presidents, campaigns and Congresses throughout history. To this the pride and place of Robert Caro's latest offering on the summer reading lists of Westminster watchers everywhere is just the latest testament.

The equivalent, I suppose, would be shipping a six-hundred page tome covering six years in the life of Harold MacMillan over the other side of the ocean and seeing how it flies. But in the fourth instalment of his monumental life's-work on Lyndon B Johnson, Caro shows us not only why we fall in love with American political life - but what it is that grips us about politics in the first place.

The Passage of Power spans just a portion of Johnson's time in Washington (1958 to 1964). But it is gloriously rich in detail, as Caro brings out the many competing facets that make up the texture of a seismic chapter in US history. Indeed in many ways it is a book defined by contrast and contradiction, even a certain dialectic, personified by Johnson himself.

It begins with LBJ at his peak in the Senate, but quickly descends into a study of his time as JFK's sidelined Vice President - "the man of power who suddenly finds himself short of it", as one journalist described. Johnson wound up there having calamitously misjudged Kennedy - "a whipper-snapper, malnourished, yellow, sickly, sickly" who "never said a word of importance in the Senate, and never did a thing". All of which was true - but none of which was germane to the changing nature of Presidential politics. The telegenic Kennedy glided to the 1960 candidacy, as Johnson tortuously dithered and delayed over whether to enter. This from a man at the height of his powers, famed not only for his ability to read men, and the tides of US politics, but for his decisiveness.

Having been offered the Vice Presidency (in the teeth of opposition from Bobby Kennedy - a passage which Caro relates in intimate detail), Johnson proceeds to make a second error of judgement. He believes he can take an ostensibly ceremonial role and forge a separate political base, as he has always done ("power is where power goes"). But an early power grab falls flat spectacularly, and Johnson is shut-out of the Kennedy White House, starved of influence.

Here the portrait of him offered by Caro is painful. Haunted by premonitions of his own thinly-attended funeral, he skulks around Washington debasing himself in an attempt to get back in the President's good books ("like a cut dog"). The once proud Texas lope is reduced to a slump or a slight kneel in Kennedy's presence, in a sycophantic attempt to hide his height advantage. In a particularly excruciating passage, he even tries to work Kennedy's kids onside ("I want you to call me Uncle Lyndon" he pleads). All to no avail. This period captures Johnson at his most inadequate; shrivelled and pathetic, by turns self-pitying, bitter, jealous, hawkish and corrupt. His greatest fear realised, he was humiliated (humiliation being Washington's answer to the ice pick).

All of which is turned on its head by the crack of a gun in Dallas, and Kennedy's assassination. If it seemed impossible to find a fresh angle on one of the most famous events in human history, Caro achieves it. He vividly puts you right in the back seat of the car - carrying Johnson - that trails the Kennedy motorcade. Better still is his depiction of LBJ in these moments, thrust into the Presidency - a man re-born, reanimated by power. He is sworn in by the same district judge who once symbolised his impotence (Sarah Hayward, whom he had previously failed to personally place on the Federal District Court himself).

The years and pages that follow showcase the better angels of Johnson's nature. His intimate understanding of Washington's "tribal rituals", his ability to see the broader war in an individual skirmish (and face up to it as such), and a razor sharp judgement of character. All were matched with the right dose of idealism and oratory to twist the right arms in the right way, press the right Congressional levers, bring Kennedy's people onside and set an agenda that went where their fallen hero never could - on civil rights, tax and later, poverty. As Caro concludes, Johnson's performance in the aftermath of the assassination was a masterclass in art of power and government. At his best, he was close to a model of Presidential perfection - as majestic as he was once pitiable.

Yet Johnson's weaknesses and fallibility do not totally disappear from sight, they continue to co-exist alongside and jostle with his strengths - the latter just win out in these circumstance. We get a prelude as to how they return in Caro's next volume, in his mendacious attempts to deny Bobby Kennedy an Arlington burial in 1968 (and his dark, impudent delight at news of RFK's demise, "Is he dead? Is he dead yet?"). Even here, they bubble not far from the surface; his needless humiliation of press secretary Salinger, for instance, or his horribly misjudged phone call to Bobby almost immediately after his brother his shot - conducted under the auspices of a constitutional technicality, but clearly in part a taunt at the still grief-stricken attorney-general.

This is the ultimate strength of The Passage of Power: it is not a fairytale. LBJ does not 'overcome' in a way the arc of a Hollywood movie might have it. He is so fascinating precisely because his every move is the product of a tussle between avarice and idealism, guts and pettiness and statesmanship. The enmity between he and Bobby Kennedy may light up the book, but in truth the bigger clash was with the whole Kennedy set, for which Bobby was simply the prefect. Johnson was not urbane or intellectual, born into power - "all social graces" - like Washington's ruling class. He was an outsider who never truly belonged to any tribe. His whole life was spent clawing his way inside, learning the rules, climbing over bodies, and he carried the battle scars as a result: rampant insecurity, paranoia and a fear of mimicking his fathers failings. He was and remained throughout deeply flawed, and deeply human.

In this sense, his successes in this volume are more inspiring than Kennedy's ever were, marshalling as he does his own multitudes and the democratic machinery, itself a bundle of contradictions, towards some good. He showed us the best and worst of what human beings are capable of, and in doing so embodied the best and worst of what politics is capable of.

Like its subject, the book is not perfect; in places it is sloppy and baggy. But it is Caro's ability to tease out and corral the true nature of this complexity - so rarely achieved in popular depictions of politics - that makes Passage of Power such a triumph. As the American author Scott F Fitzgerald famously wrote, "the test of a first rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function." By this marker, and every other, Caro's is a work of pure genius.