David Frum's Slippery Slope

People who are knowledgeable about the world's various national healthcare plans are aware that private insurance plays a significant role in any number of them. Even in Canada, the land from which Frum emigrated, people use supplemental insurance policies - often provided by their employers - to supplement Medicare. And yet....

The Dems are willing to accept that the plan won’t be offered in all states. They are willing to allow private insurance to coexist alongside the government-plan for many years to come. They are willing for the government-plan to retain many features of private insurance – premiums will be based on the allowed risk factors, not on “ability to pay.” They know that all those concessions will gradually erode. The key thing: establish the government-run plan now. Drive private insurers out of the market gradually. Shift only slowly from insurance-like finance to tax finance.

What is it that Frum sees as so special - so especially bad - about the U.S. health insurance system that if the government gets so much as a toe in the door everybody in the nation will recognize the superiority of a national plan and press their legislators to expand the program to allow them to enroll?

Next, he breaks out the crack pipe, arguing that Obama could have easily passed a modest healthcare bill:

“I continue to support the public option personally and will work for it to be established later. For now, my priorities are (1) insurance reform, to outlaw the practices that most offend Americans, and (2) to create exchanges like those created by Gov. Romney in Massachusetts so that individuals and small businesses can buy insurance at the same favorable prices paid by large employers. We’re going to have an individual mandate to buy insurance – and subsidies to help those who can’t. We’re going to shift regulation of health insurance from the states to the federal government, so that we can write a single, predictable set of rules, rather than 50 different rules that allow lobbyists in places like New Jersey to push insurance prices up and up and up.”

Republicans could never have said no to that. He would have pushed his program through in a week.

Okay, let's set aside for the moment the fact that numerous high-ranking Republicans have announced that they want to defeat health reform to hurt President Obama. Let's look instead at what the Republicans call a health reform bill. Let's look first for the biggest of the insurance company "practices that most offend Americans" - denying coverage to people with preexisting conditions, and revoking people's policies when they get sick. Their "plan" creates "high risk pools" but doesn't require that insurance companies insure the sick. For revocation, they offer a nebulous, undefined third party review process.¹ Will the review process be an insurance industry rubber stamp? My cynical side says that if it were intended to be anything but, Boehner would have included some specifics.

The Republicans claim, "The GOP plan prohibits an insurer from canceling a policy unless a person commits fraud or conceals material facts about a health condition." Which is great, except that those are the exact grounds insurance companies assert even when they wrongfully terminate people's health insurance coverage. The Republicans think that the termination letters insurers send out say, "We've decided you cost too much, so we're walking away from our legally binding contract of insurance"?

The Republicans also include their standard "race to the bottom" proposal for "buying insurance across state lines". That's the opposite of Frum's notion of a national set of regulations. As I've previously noted,

There is, of course, no reason that insurance companies cannot enter additional states, offering plans in those states, right now. The impediment is that to set up health coverage you need to create a network of participating doctors, clinics and hospitals who accept your plan.

The Republican proposal isn't about an out-of-state insurer writing new plans in your state - it's about insurers from your state relocating to the states with the least regulation so that they can strip away benefits required by your state's laws and work out of states with minimal regulatory oversight. What does the CBO have to say about the GOP proposal?

By 2019, CBO and JCT estimate, the number of nonelderly people without health insurance would be reduced by about 3 million relative to current law, leaving about 52 million nonelderly residents uninsured. The share of legal nonelderly residents with insurance coverage in 2019 would be about 83 percent, roughly in line with the current share.

Further, "in the large group market, which represents nearly 80 percent of total private premiums, the amendment would lower average insurance premiums in 2016 by zero to 3 percent compared with amounts under current law, according to CBO's estimates." Wow. Almost nobody gets insured, and the cost savings are at best near zero. Did Frum fail to notice that Boehner's bill has no mandate? That it bears no resemblance to Frum's dream bill?

I mean, seriously, if the Republicans could back a sensible set of reforms and pass them within a week, why haven't they written up the Frum Bill (or something similar) instead of Boehner's bill, seemingly designed to reform next to nothing? Further, contrary to Frum's suggestion, Obama has effectively said that he'll sign any healthcare reform bill that gets through Congress, even if it doesn't include a public option. The Republicans can still write up that Frum bill that could supposedly pass in a week - why are they instead declaring a "holy war" against healthcare reform?

Frum appears to live in an alternate universe where he's still a prominent member of the Republican Party. Instead he's shouting from a soapbox, "The Republicans truly are reasonable - and if given a chance they'll agree with me" even as he's been marginalized and excluded. Yet he still hasn't quite embraced honest debate, such that he might gain credibility with anybody else.

A Misguided Prosecution Comes To An End

The government has thrown in the towel and abandoned its appeal of the Lori Drew conviction. As I wrote a year ago,

If the verdict does not stand, and there's a good chance that it will not, the shameless grandstanding by U.S. Attorney Thomas P. O'Brien will have expanded the injustice. It will have given Megan Meier's family the false sense that Lori Drew would go to prison for crimes that should never have been charged. Oh, probably O'Brien will harrumph about how he was right, about how Drew is evil incarnate, and how either the trial court or appellate court has unreasonably second-guessed the good men and women of the jury. Such a reaction would be consistent with what this prosecution is about - the furtherance of Mr. O'Brien's personal and political goals.

So now I await commentary from Mr. O'Brien.

His Master's Voice

Yesterday I commented on the irresponsible "leaders" of the Republican Party. Today, Michael Gerson regurgitates the party memo that, as a commenter in that thread and the Daily Show point out, have transformed Geraldo Rivera into the voice of reason, reinforcing my impression of him as a dim-witted water carrier, slavishly providing an echo chamber for whatever anti-Obama insanity his "leaders" care to spew.

I am so sorry to hear that George W. Bush, Gerson's former lord and master, put the country in peril through the trials of John Walker Lindh, José Padilla, Richard Reid, Zacharias Moussaui.... It's fortunate for us that they made up for it by capturing Osama Bin Laden and the perpetrator of the anthrax attacks, so we could all be safe.

Update: The NonSequitur had me wondering if Gerson deserved a more substantial response to his blather - one that at least pretends he's a serious columnist. Gerson answers for himself with today's regurgitation of the (previously discussed) Republican Party talking points on "dithering" - no, he does not.

Calling Obama the "Undecider"... as contrasted with G.W. whose self-appellation as "a decider" made him the punch line of countless jokes? Telling Obama he's the opposite to the lousy President who put Afghanistan on a back burner so he could pursue a war of choice in Iraq, let things deteriorate until Obama took over and brought marked improvements in the situation, and created a context for the "urgency" - or, more accurately, the possibility of stabilizing the situation - Gerson didn't feel during any of the seven years of Bush Administration neglect? Gerson intends that as an insult?

"As an analogy," says David Kilcullen, an expert on counterinsurgency strategy, "you have a building on fire, and it's got a bunch of firemen inside. There are not enough firemen to put it out. You have to send in more or you have to leave.

The effing place has been on fire for eight years, seven of which passed under the malign neglect of his former lord and master, and Gerson only just noticed? The only thing I can say in Gerson's favor is that he may be the first regurgitator of the memo to use a synonym for "dither", rather than being "that obvious".

The Perils of Democracy

When I watch the Obama Administration forming its policy on Afghanistan, I'm reminded of the Bush Administration (and, well, every administration I've seen in my lifetime) - Push back the date for decisions that may cause blowback such that any negative consequence, that is anything that might hurt the incumbent President in the polls, occurs after reelection (or after his successor takes office).

I suspect that Obama will order an approach that he believes will improve the situation in Afghanistan, but with the idea of wrapping up major military operations by mid-2011. At that time he can safely announce the new policy and begin withdrawing troops without fear of a Najibullah-type collapse of the Karzai government before the election. His Republican opponent will have to decide if he wants to run on a platform of re-escalating and perpetuating the war, or effectively endorsing Obama's policies - and I suspect that in a national election there's a lot more danger to a politician who does the former.

This is hardly unique to the U.S. - there are issues around the globe that could be resolved if elected leaders spent less time worrying about getting reelected and more time worrying about what's truly in the best interest of their country and countrymen. And no, I'm not calling for the abolition of democracy - a cure far worse than the disease. And I would probably be arguing against human nature if I were to ask politicians to treat the public as if it has the knowledge, respect and maturity to accept that it can take years to see the benefits of good policy choices, and that a significant short-term price tag (figurative or literal) can be a small price to pay for those benefits.

Alas, I'm dreaming of a world without lobbyists, and in which people would treat the notion of "Sarah Palin, 2012" as a joke, and where it would be laughable to conceive of people like Rush Limbaugh and Glenn Beck as thought or opinion leaders. I don't mean to single out the political right, but it's difficult to think of a current "thought leader" or "political leader" on the left who offers so little substance yet is taken seriously by the media and the majority of the members of a major political party. People are people, and history tells us that the political left is far from immune from the dubious charms of similar "leaders".

In the Washington Post's tepid "America's Next Great Pundit" contest, a Nobel Prize winning scientist asked why our nation doesn't make an effort to separate science from partisanship, recreating the Office of Technology Assessment to try to "help Congress arrive at a common starting point for complicated legislation". Why not? Because the facts, or scientific consensus, frequently aren't politically convenient. Consider, for example, the British Government's decision to appoint a genuine scientist to advise it on drug issues, only to be embarrassed when he pointed out that much of the hysteria surrounding ecstasy and marijuana were exactly that. So he was fired.

Armed conflicts pose a similar problem, with proponents of war eagerly declaring any action with which they disagree to be a sign of weakness, empowering the enemy. We of course see that in pretty much every pro-war analysis of the War in Afghanistan. And, as Roger Cohen's column on Israel-Palestine implies, it's an argument that can lead to self-destructive behaviors that drag out a problem to the point that the best and easiest solutions may no longer be viable. When things are going well, the politicians respond to the popular sentiment that "Things are going well so why do we need to make any sacrifice," and when things aren't going well they respond to the sentiment, "Why do they deserve anything?" And the problem drags on for years, decades, potentially even for centuries.

As the experience of Britain in the Republic of Ireland indicates, the form of government can change dramatically without any significant impact on how the government responds to a serious issue, problem or conflict. Perhaps it's true that we get the government that we deserve - small-minded, foolish, vengeful, irrational, selfish, short-sighted... just like all of the people some of the time, and some of the people all of the time.

Once Again, Robert Samuelson's Part of the Problem

A while back I commented on Robert Samuelson's mendacity on healthcare reform. No surprise, he's at it again. He is again insisting that reform - the only form of reform he will support - would make the system more expensive. No, once again that doesn't mean he advocates reforms along the lines of those imposed by pretty much every other industrialized nation, which would unquestionably reduce the cost of medical care. It means that he supports the broken status quo, with the highest cost, highest inflation, and a performance record that is on the whole surprisingly poor (even if it's pretty darn good for people with health insurance plans as good as Samuelson's).

He also takes the rather childish tack of branding the House bill, that Obama did not author, as "Obamacare",¹ and insisting that this is "Obama's health-care plan". Last I checked, the Senate hadn't yet ruined the healthcare reform bill passed its own version of the bill, and we were a long way from voting on a bill post-reconciliation. Yet apparently Samuelson was visited by a time traveler who is privy to that final piece of legislation, and who passed along the secret that Obama will personally author it.

Typical of one of Fred Hiatt's crew, Samuelson whines (seemingly endlessly) about how providing healthcare to Americans is a luxury we can't afford - it's better that people be denied care than that we enact a sensible tax policy, reconsider Fred Hiatt's endorsement for endless wars, etc. - the only portion of the budget that can be cut, after all, is that for social services. Never mind that the status quo is failing, and that its failure is accelerating with employers increasingly reducing the health benefits they offer, passing along a greater share of costs to employees, or both. There are endless wars to fight, darnit, and something's gotta give.

But then, remember, this is the same Robert Samuelson who once argued that people only hate Bush because his policies are so darn successful. He doesn't exactly have a track record of sound, objective judgment.

Update: The NonSequitur reminds us of another gem from Samuelson:

A possible war with Iraq raises many unknowns, but “can we afford it?” is not one of them. People inevitably ask that question, forgetting that the United States has become so wealthy it can wage war almost with pocket change. A war with Iraq would probably cost less than 1 percent of national income (gross domestic product). Americans have grown accustomed to fighting with little economic upset and sacrifice.

and, at a later date,

But I am certain — now as then — that budget consequences should occupy a minor spot in our debates. It’s not that the costs are unimportant; it’s simply that they’re overshadowed by other considerations that are so much more important.

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1. I recognize that some supporters of healthcare reform also use the term "Obamacare"... and perhaps the label can be coopted from the propaganda machine that created it, but I personally don't think it's a good term for supporters to use.

Okay, So Where Are The Good Arguments?

I keep reading editorials on Afghanistan, hoping to come across a good argument for why the war should continue. The closest I've come is, "We should stick it out a bit longer so we can truly say we gave it our best shot". Not very compelling. More often, it's a regurgitation of silly, tired arguments like this:

• "The Taliban cannot rely on the support of a nationalist mass-movement.... The locals are wary and weary. They feel as if they have been at war for ever, and they only wish that it would stop.... Most locals are ready to rally to the support of any side which looked as if it could win and thus bring the bloodshed to an end. If it seemed that whatever the cost, Nato was on for the long game, the West would gain a cautious and growing respect. But every time there is a rumour that we might pull out, the locals rush to reinsure themselves with the Taliban."

  All we have to do to "win" is let a population completely weary of war know that we'll stay and perpetuate the war forever, then they'll support us. (Got a problem with that?) Moreover, given a choice between the Taliban, some sort of Sharia-based Islamic government, or the corrupt, western-backed Karzai regime, who says they prefer our version of the end game?

• "Nato tactics are also evolving. There is still a need for more helicopters, better equipment and above all, more men."

  No sh..., er, kidding. And you know what? Next year we will truthfully be able to say the same thing. And the year after, and the year after, and... every year for as long as the war continues.

• "It is part of a wider civilising mission. The Karzai government's difficulties are well-publicised. Corruption is bad; so is ballot-stuffing. But neither is unknown, even in supposedly more advanced countries: think Illinois in 1960."

  If you think that "Illinois in 1960" is a fair comparison to "Afghanistan in 2009", you've pretty much given up any pretense that you're arguing from fact or logic. The author's notion that Karzai's government is the best in Afghanistan's history raises the question, what was the second-best? Najibullah's? Isn't this called "daming Karzai with faint praise"?

  Also, that part about civilizing... is it just Afghanistan? What does that mean? Teaching them that their interpretation of Islam and Sharia law is backward, that they need to treat women as equals, that... seriously? And should we tell them that - "We're here until you behave like civilized people, by our definition"? Because that type of condescension is sure to help our cause....

• "[Soldiers fighting this war] have also made an essential contribution to all our safety. It is not necessary to believe in a relentless clash of civilisations to recognise that there is a problem with Islam. By no means all 1.3 billion Muslims hate the West and they do not all live in failed states. But there is a lot of anger and a lot of failure, especially in Pakistan. Although the West needs effective diplomacy in order to build up alliances with the Muslim world, diplomacy is not enough. The West cannot afford to display weakness. If we let Afghanistan slip through nerveless fingers, we would not only lose it to the terrorists. Pakistan would be in jeopardy and so would our standing throughout the region. The West will only be seen as a reliable friend if it is also a reliable foe."

  That's a jumbled mishmash of thoughts, concluding with a platitudinous attempt at a bon mot. ("You gotta be cruel to be kind, in the right measure, cruel to be kind, it's a very good sign...."

  I don't think we can doubt that the war in Afghanistan has disrupted al-Qaeda activity in Afghanistan, but it can hardly be said that al-Qaeda was defeated in Afghanistan, can't survive without Afghanistan, or can't recruit and flourish in other parts of the region and world. It's also fair to say that they're using the wars in Iraq and Afghanistan as recruiting tools. So once al-Qaeda was displaced from Afghanistan, what part of the war has made us safer? For that matter, were their training camps to return, and for some reason the West decided not to blast them to smithereens, would we in fact be less safe than we are with their present activities in Pakistan or Somalia?

  Who in their right mind thinks that our activities in the region, dating back to our support for ousting the Soviets from Afghanistan, have stabilized that country or warmed its people to the U.S.? Does the author believe that U.S.-Pakistan relations are headed in the right direction?

  Further, hasn't the overblown argument that "our enemy won't respect us unless we fight forever" proved wrong in... pretty much every context? What makes this one special, even if you pretend that ending the war in Afghanistan would mean ending military operations in the region, which of course it does not. Other than staying involved in a permanent war and occupation, the author sees no way to earn respect from Arabs and Muslims?

• "The soldiers I talk to who have served in Afghanistan all know about the cost. They have seen it. But they are unanimous in their belief that it is a price worth paying. The rest of us can make our contribution by demanding that they are given the tools they need to finish the job."

  Let's flash back to something this yutz said earlier in his commentary.... "A majority of the public wants to withdraw from Afghanistan. A majority of the public is wrong.... thank God that we are a representative democracy, not a plebiscitary one" - Unless you take the plebiscite from a subsample, assumed to support your view, in which case how dare you question their wisdom?

Is there anyone presenting a good case for staying in Afghanistan? To me that means (a) a clear statement of what we're capable of achieving, and (b) an explanation of how it will be achieved. Wishful thinking is great, but my mind keeps going back to Burgess Meredith.

A Raw Diehl?

Again cheerleading a significant, long-term escalation of the war in Afghanistan, Jackson Diehl asks,

All that time, no one accused George W. Bush of dithering. So why does Barack Obama keep hearing the taunt as he deliberates about Afghanistan -- and why do even some who sympathize with his dilemma find it hard to shake the feeling that this commander in chief lacks resolve?

If you look at the people who are accusing President Obama of dithering, the answer is self-evident. Is there one among them who is not a staunch advocate of endless war in Afghanistan? They hope that their silly, hypocritical accusations of "dithering" (think Dick Cheney) will somehow embarrass him into doing what they want, and making Obama less likely to impose reasonable demands on Karzai's administration or have a clear end-game in mind before escalating the U.S. presence in Afghanistan.

Diehl shows his cards with this claim,

One part of the answer is easy: Bush was renowned for summoning plenty of resolve, and not enough critical thinking. No one questioned that Bush's heart was in his bid for "victory" in Iraq.

He defines "resolve" as the willingness to make a war last forever if it means avoiding admitting a mistake, but (at least in relation to Bush) not as the resolve to commit the troops or forces necessary to win. Which leads us back to the real Diehl: he wants more troops not because there's a plan for victory, or a reasonable likelihood of victory, but because he favors the perpetuation of the war until his unarticulated fantasy version of "victory" is achieved.

(It would be interesting to read an analysis of how all of the pro-war pundits and commentators miraculously settled on a somewhat unusual word, "dithering", to describe Obama's failure to immediately dispatch tens of thousands of troops to Afghanistan upon the request of General McChrystal, despite the vast improvement his administration has already brought about in Afghanistan following seven years of malignant neglect by Bush and Cheney.)

Human Rights and Withdrawal from Afghanistan

A contrarian view of the human rights impact of continuing the war in Afghanistan, but given the author it's not one to easily dismiss: a woman who "was elected to Afghanistan"s parliament in 2005 and kicked out in 2007 by the warlords".

Eight years ago, women's rights were used as one of the excuses to start this war. But today, Afghanistan is still facing a women's rights catastrophe. Life for most Afghan women resembles a type of hell that is never reflected in the Western mainstream media.

In 2001, the U.S. helped return to power the worst misogynist criminals, such as the Northern Alliance warlords and druglords. These men ought to be considered a photocopy of the Taliban. The only difference is that the Northern Alliance warlords wear suits and ties and cover their faces with the mask of democracy while they occupy government positions. But they are responsible for much of the disaster today in Afghanistan, thanks to the U.S. support they enjoy.

The U.S. and its allies are getting ready to offer power to the medieval Taliban by creating an imaginary category called the "moderate Taliban" and inviting them to join the government. A man who was near the top of the list of most-wanted terrorists eight years ago, Gulbuddin Hekmatyar, has been invited to join the government.

I wish the ideas were better developed, rather than fitting within the @800 word limit of an op/ed column, but if I were to infer why she favors withdrawal it's likely because U.S. policy seems likely to cement in place a corrupt, misogynistic government.