While We're Talking About Insults Directed at Obama....

Robert Kagan suggests that Obama is being "played" by Iran. The thesis here appears to be that we have three tools to use with Iran: diplomacy, sanctions, and war. And although Kagan is presently directing his insults at Obama, I expect he was equally derisive of Bush's choice of diplomacy. That said, Kagan's argument is silly.

Kagan doesn't believe that diplomacy will work, or in the alternative doesn't believe that a diplomatic solution will prevent Iran from continuing to advance a nuclear weapons program. I suspect that he's correct - that Iran will continue to work to develop nuclear weapons even if slowed by a diplomatic solution. But Kagan is willfully blind to the fact that sanctions could have a more pronounced effect - even if we could convince the rest of the world to go along with them - causing Iran to cast off any pretense that its nuclear program is about peaceful energy generation and to accelerate its nuclear weapons program.

But more to the point, as Kagan concedes, Russia is part of the game. How does Kagan propose that the U.S. could effectively sanction Iran without the cooperation of a permanent member of the U.N. Security Council? Unilaterally? By trying to get other nations to voluntarily team up with us, even as goods continue to flow into Iran through nations that are not cooperating?

Meanwhile, Iran plays an important role in both Afghanistan and Iraq, and as difficult as they can be they can make important contributions to stabilizing or destabilizing our efforts in those nations. If we cast aside diplomacy and unilaterally impose what amount to toothless sanctions, we not only risk making Iran seem tough - unafraid to stand up to the U.S., and unfazed by our sanctions - but we may jeopardize our progress in two major wars.

But really, Kagan is less interested with succeeding with non-military options than he is with forcing military action. He would be profoundly disappointed with a diplomatic success, but he would be ecstatic with a failure of sanctions - a failure that would take our two non-military options off the table. We would then be left with the choice of looking weak - folding our cards and walking away - or bombing Iran. Never mind that few think that bombing Iran will succeed in eliminating its nuclear program - while again allowing it to claim to have stood up to U.S. aggression.

The question is thus much less "Is Obama being played [by Iran]" than it is whether Kagan and friends can successfully play Obama. So far, despite considerable effort, they appear to have failed. I somehow don't think that Obama's so insecure that Kagan's swipe at him will have any effect. And, despite the possibility that Iran will continue to develop nuclear weapons despite the present round of agreements, that's a good thing. (For goodness sake, if this type of attack by the likes of Kagan didn't work on Bush, why would he expect them to work on Obama?)

"Fixing" Afghanistan

Among the many incompetent decisions of the Bush Administration were its decisions to team up with camera-friendly, English-speaking, but exceptionally corrupt leaders whom it hoped would rule over Afghanistan and Iraq. With Iraq overshadowing Afghanistan, not many people paid attention to the regime of Hamid Karzai, until the recent election fraud. Now his corruption, unpopularity, inability to govern outside of Kabul, and familial ties to the drug industry are getting considerable media attention.

We're dealing with similar phenomena in Iraq and Afghanistan - ethnic allegiances that trump the concept of national unity. It seems pretty clear that in both countries the factions that don't feel that they will benefit from "national unity" govenrments, or don't feel that they'll get a suitably proportionate (or disproportionate) share of power, influence and money through a democratic process, are content to wait us out. Years ago, George W. Bush told us that "The Surge" would be a failure if it didn't bring about significant, quantifiable political progress. It has turned into an escalation that certainly has helped segregate warring factions, but the political progress we've been repeatedly promised seems to be at a standstill. Meanwhile, following his seven years of neglect, the situation in Afghanistan is deteriorating - although my guess is that the Karzai family's wealth is now assured for generations, even in exile.

Proponents of continued war in Afghanistan have no suggestions on how to achieve national unity. They have no plan for defeating the Taliban (the Taliban being native to Afghanistan and borne of the numerically dominant Pashtuns, 40% of the nation's population). They have no plans for defeating corruption. Some explicitly eschew the notion of rebuilding (or is it building) the country. They offer little explanation beyond nebulous talk of al-Qaeda getting its safe haven back (one it presently enjoys across the border in the territory of our ally, Pakistan), as to the U.S. foreign policy interest in perpetuating the occupation. Still, they insist, we must fight the war until we "win", whatever that means.

First case in point, David Brooks, who serves up an appeal to anonymous people he contends are authorities on... something:

[The people I consulted but choose not to identify] are not worried about his policy choices. Their concerns are more fundamental. They are worried about his determination.

These people, who follow the war for a living, who spend their days in military circles both here and in Afghanistan, have no idea if President Obama is committed to this effort. They have no idea if he is willing to stick by his decisions, explain the war to the American people and persevere through good times and bad.

There's an inherent tension here: If in fact the military experts trust Obama to make good policy choices, then they trust him to make a good decision as to whether the U.S. should stay in Afghanistan or end the war. That should pretty much end the debate. Instead, Brooks turns it into some sort of test of toughness. Sure, Obama could do the "intellectual, good policy choice" thing and end the war, but then the unnamed, tough-guy military experts would accuse him of wimping out. While I'm sure President Obama is touched by Brooks' concern, somehow I doubt that he's too concerned about sticks and stones from "experts" who don't even have the courage to attach their name to their superciliousness.

Most of them, like most people who have spent a lot of time in Afghanistan, believe this war is winnable. They do not think it will be easy or quick. But they do have a bedrock conviction that the Taliban can be stymied and that the governments in Afghanistan and Pakistan can be strengthened. But they do not know if Obama shares this gut conviction or possesses any gut conviction on this subject at all.

Funny, how every single expert Brooks (supposedly) consulted said exactly the same thing, coincidentally exactly what Brooks believes, and like Brooks offers nothing but empty-headedness when it comes to explaining how a war in Afghanistan might be won, how we would create a stable government for Afghanistan (even if we discard any notion that it be progressive or friendly to the West), or how we would keep a post-occupation government from devolving into the same type of ethnic warfare that followed the end of the Soviet occupation. The various warring factions of Afghanistan know that the occupier always leaves. To a degree, Brooks knows this:

And if these experts do not know the state of President Obama’s resolve, neither do the Afghan villagers. They are now hedging their bets, refusing to inform on Taliban force movements because they are aware that these Taliban fighters would be their masters if the U.S. withdraws.

But doesn't that betray Brooks' fundamental ignorance of Afghanistan? He sees, I guess, a nation of urbanites from Kabul, and "villagers" in other areas. Pasthun, Tajik, Uzbek, Hazara, Turkmen? What's the difference, right? A commentator who knew enough to be discussing this issue might be skeptical that "villagers" who aren't Pashtun, who don't want a return of the Taliban, are afraid to cooperate with the U.S. - if he was truly speaking to experts, it's not like any of this is a secret.

Nor does President Hamid Karzai know. He’s cutting deals with the Afghan warlords he would need if NATO leaves his country.

Get real. Karzai may be corrupt but he's not stupid. If Karzai's government fails, he'll be on the first plane out of the country.

It's wonderful to speak of what we can accomplish for women in Afghanistan, something that seems to be at best an afterthought for people like Brooks, but it's not clear that we're being particularly successful in that goal even now, let alone that improved status and opportunity for women can be sustained in the event of U.S. withdrawal, whenever it occurs. On the other hand, it's useless to talk about Afghanistan as a "safe haven" for al-Qaeda, when they already have a safer haven in Afghanistan.

The simple question for war proponents is thus, "What does victory look like", with the equally simple follow-up, "How do we achieve it?" Brooks has no answer, save perhaps for a blank stare, so he implies that it would be wimpy to withdraw before the undefined concept of victory is magically achieved.

Second case in point, Charles Krauthammer, who is having a major temper tantrum over the fact that G.W.'s many policy failures are being described in accurate terms. Never mind that Bush's incompetent strategy in Afghanistan, and his choice to pursue a war of choice in Iraq led to seven years of neglect and deterioration of military efforts in Afghanistan. Darn it, Krauthammer supported all of that and how dare Obama question Krauth... I mean Bush's competence. Look how he soft-pedals Bush's incompetence, both in Afghanistan and Iraq:

In both places, the deterioration of the military situation was not the result of "drift," but of considered policies that seemed reasonable, cautious and culturally sensitive at the time but that ultimately turned out to be wrong.

I wonder if any of the anonymous "experts" consulted by Brooks would agree with that... that "we'll be greeted as liberators" was sound policy for going into Iraq with insufficient troops to provide even basic post-war security, or that "we need those troops to invade Iraq" was a good reason to neglect the situation in Afghanistan.

The logic of a true counterinsurgency strategy there is that whatever resentment a troop surge might occasion pales in comparison with the continued demoralization of any potential anti-Taliban elements unless they receive serious and immediate protection from U.S.-NATO forces.

Yet, again, we're not going to stamp out the Taliban in Pashtun areas. We may cause it to recede during a period of escalated combat, but Afghanistan is the Taliban's home. It's not going anywhere, and its members will wait us out. So again we have a recipe for endless war and occupation, without any thought toward what a victory will look like or how it will be achieved. We may end up with better segregation of warring ethnic factions, and a sufficiently "stable" governing structure that (assuming we can convince Karzai to stop committing election fraud) could conceivably vote on post-occupation power-sharing. But is there any reason to believe that the government we leave behind will be any more stable, or any more resistant to civil war, than the government left behind by the Soviets?

Seriously, enough with the attacks on Obama. If you advance the continuation or escalation of the war in Afghanistan but can't articulate a strategy for victory, let alone articulate what a victory would look like, you have nothing to contribute to the debate.

Fighing the War on Drugs... With Anecdotes and Bad Reasoning

Although he makes his own view difficult to pin down, George Will seems to endorse the war on drugs, from marijuana to... whatever, quoting Gil Kerlikowske, Director of the Office of National Drug Control Policy, i.e., the "Drug Czar".

Nature made Kerlikowske laconic and experience has made him prudent, so he steers clear of the "L" word, legalization, even regarding marijuana.

Asked whether he thinks that it is a "gateway" drug leading to worse substances, he answers obliquely: "You don't find many heroin users who didn't start with marijuana."

I doubt that you find many heroin users who "didn't start with cigarettes", or "didn't start with alcohol", or "didn't start with"... something else. That people who are inclined to seek out an illegal, highly addictive street drug have previously tried various legal and more easily obtained illegal drugs is anything but a surprise. The question is, does that suddenly transform correlation into causation. Obviously it does not.

But Kerlikoswke also served up this anecdote, offered with a distinct lack of detail:

During his immersion in his new job, Gil Kerlikowske attended a focus group of 7-year-old girls and was mystified by their talk about "farm parties." Then he realized they meant "pharm parties" - sampling pharmaceuticals from their parents' medicine cabinets.

The Post added a short description to Will's piece - a tag line - "Seven-year-olds party with pharmaceuticals they steal from their parents", but that's not what Will wrote. It's not clear from the anecdote whether the girls were asked if they knew about "pharm parties" as opposed to participating or organizing them. Were we to shift back a few decades, I could see Kerlikoswke being similarly surprised that what he thought was a focus group about cooking utensils turned out to be about marijuana. ("I was mystified by their talk about 'pot', but then I realized....")

Note that it's not just older siblings or relatives who could be introducing seven-year-olds to the concept of "pharm parties", but that knowledge can also come from anti-drug education. Consider, for example, DARE:

Statistics have shown that teens believe prescription drugs are safer than illicit drugs, driving the proliferation of such trends as "pharm parties" where teens mix and trade pills with one another to get high, leading to dangerous and sometimes deadly outcomes

At least DARE's not trying to depict this as a new trend for second grade students.

But let's go back to the notion of the gateway drug. Is Kerlikoswke suggesting that these kids are finding Marinol in their parent's medicine cabinet, and that it becomes a "gateway drug" to other medications? Or are the kids heading right to the opiate medication and benzodiazepines? There has been a huge uptick in opiate abuse in our nation, and of other pharmaceutical drugs, and it's not because of "gateway drugs".

Further, one of the problems of depicting a drug as a "gateway drug" that leads kids down a slippery slope into "harder" drugs is that you create a context where a lot of kids will find out that you're lying to them. They'll try marijuana, not get addicted, and may wonder if the anti-drug messages given about "harder" drugs are also overhyped. Tens of millions of Americans have tried marijuana - 42% of the population - including quite a few recent Presidents. While it would be interesting to hear Presents Bush and Obama speak to the notion of marijuana as a gateway drug to cocaine, it should be remembered that the addictions they did develop - Obama's nicotine addiction and Bush's alcoholism - were to legal drugs.

Commenting on legalization, Will also offers the nebulous comment,

Kerlikowske is familiar with Portugal's experience since 2001 with the decriminalization of all drugs, including heroin and cocaine.

What lessons can we draw from that experiment?

Compared to the European Union and the U.S., Portugal's drug use numbers are impressive. Following decriminalization, Portugal had the lowest rate of lifetime marijuana use in people over 15 in the E.U.: 10%. The most comparable figure in America is in people over 12: 39.8%. Proportionally, more Americans have used cocaine than Portuguese have used marijuana.

The Cato paper reports that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well.

Kerlikowske sees that as a policy failure? It would have been interesting to hear his explanation.

Unfortunately, to the extent that it suggests Kerlikowske has a different opinion, when it comes to law enforcement policy Will quotes The Economist and not Kerlikowske:

"There is no correlation between the harshness of drug laws and the incidence of drug-taking: citizens living under tough regimes (notably America but also Britain) take more drugs, not fewer." Do cultural differences explain this? Evidently not: "Even in fairly similar countries tough rules make little difference to the number of addicts: harsh Sweden and more liberal Norway have precisely the same addiction rates."

You might even infer that there's a subset of the population that is predisposed toward addiction and, whether given an "open market" where they can find their drug of choice or a more limited market where they must instead choose a drug they find somewhat less appealing, most will become addicted to something. Talk to some alcoholics and see how hard it is to find one who, following their first exposure to alcohol, thought of little beyond their next opportunity to get drunk.¹ There's no magic answer to eliminating drug abuse and addiction, but the evidence is pretty clear that addiction is better approached as a public health matter than as a criminal matter.²

Update: An editorial takes on the latest version of "reefer madness" (the correlation between marijuana use and psychosis, the notion that marijuana is stronger than it used to be, and that this justifies increasing criminal penalties for possession and use:

The other paradox is that schizophrenia seems to be disappearing (from the general population), even though cannabis use has increased markedly in the last 30 years. So, even though skunk has been around now for 10 years, there has been no upswing in schizophrenia. In fact, where people have looked, they haven't found any evidence linking cannabis use in a population and schizophrenia.

The author expresses concern that criminalization and misinformation make the drug more enticing, and advocates honesty about drugs:

We therefore have to provide more accurate and credible information. We have to tell them the truth, so that they use us as their preferred source of information. If you think that scaring kids will stop them using, you're probably wrong.

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1. It isn't hard.

2. There's an argument that having a criminal law element can be important both to helping some addicts find their "rock bottom" - the point where the cost of addiction exceeds the benefit - although my experience is that few addicts are inspired toward sobriety by an arrest. There's also an argument that the coercive element of probation and possible incarceration can help keep people in treatment; countered by the fact that treatment really only seems to work when the addict wants to get better, and not in the sense of "all I want for Christmas".

"I Hit a Car? I Don't Remember Anything Like That...."

You have to wonder what the excuse sounds like:

Charges have been laid against the 62-year-old woman who became a viral sensation after video of her painfully bad parking job made it onto YouTube.

In the video, captured by a surveillance camera, the woman's black BMW SUV is seen pulling into the parking lot of an Extreme Fitness location in Thornhill, Ont., north of Toronto. The car swings around into a parking spot, then suddenly accelerates, lurching forward and driving up onto the hoods of two parked cars in front of it.

It slowly backs off the crushed cars, pauses, then slinks away out of the camera's view.

In case you haven't seen it:

Sen. Joseph Lieberman (Liebermans for Lieberman, CT)

I'm still not sure why he hasn't been reminded not to let the door connect with his backside on his way out....¹

Update: "At Least Pretend You Know What You're Talking About, Lieberman."? Um... were that to happen, at least on a policy question, wouldn't it be a first?
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1. It has yet to be seen if Lieberman will fold like a cheap suit if in fact he is instructed that the cost of his joining a filibuster will be that he no longer heads any committees.

But What Does "Conservative" Mean?

Bill Kristol is urging the Republican Party to continue its hard tack to the right, pointing to a Gallup poll in which 40% of Americans described themselves as "conservative". Um... as if there's only one definition of conservative, and any person who self-describes as "conservative" lacks even an ounce of moderation? And what does that mean for the future of the Republican Party?

That nominee seems unlikely to be a current officeholder. Right now, the four leading candidates for the GOP nomination are private citizens. In a recent Rasmussen poll, the only candidates with double-digit support among Republicans were Mike Huckabee (at 29 percent), Mitt Romney (24 percent), Sarah Palin (18 percent) and Newt Gingrich (14 percent). These four are running way ahead of various senatorial and gubernatorial possibilities.

I have never been particularly impressed with the concept of Newt Gingrich as a man of ideas - at least if we're limiting the discussion to good ideas. But really, he's running behind Mitt Romney and Sarah Palin, two candidates whose prior national campaigns suggest that if either came up with an idea it would be very, very lonely.¹ As for trying to pick a candidate a couple years in advance of the start of the next Presidential campaign, potential candidates people have heard of do better in the polls than potential candidates most haven't heard of. News to Kristol, perhaps, but no real surprise to anybody who actually pays attention to these things.

Indeed, I suspect that the person most likely to break into this group of front-runners would be a businessman who stands up against President Obama's big-government proposals, a retired general who objects to Obama's foreign policy or a civic activist who rallies the public against some liberal outrage.

Where are Al Haig and Ross Perot when the Republican Party needs them? A civic activist? Surely he's not thinking of Sarah Palin (despite his undying crush) - a "civic activist" sounds like somebody Palin would describe as having no real responsibilities. What might we expect from a Palin candidacy? Angry, bitter, mean-spirited devolution into self-parody, and perhaps an electoral vote count favoring the incumbent that would make Reagan's 1984 landslide look weak by comparison.

On to the next poll:

One reason is that many Republicans lack confidence not just in Congress but even in Republican members of Congress. In last week's Post-ABC News poll, a plurality of respondents disapproved of Obama-type health-care reform. In other words, they agree with the Republicans in Congress. But when asked how much confidence they had in congressional Republicans to make the right decisions for the country's future, only 19 percent of respondents expressed much confidence in the GOP -- well behind the confidence levels in congressional Democrats (34 percent) and Obama (49 percent).

Well, no. Imagine that the Democrats proposed painting the Oval Office blue. And the Republicans angrily insisted not only that the Democrats were going to use green paint, but that it must be painted red. An opinion poll might show that a number of Americans opposed the color choice of blue, and others were confused by the Republican Party's misinformation and were adamantly against the color green. But that doesn't mean that they prefer red or, going back to healthcare, a mysterious, undisclosed Republican alternative to the current healthcare system or reform ideas. (Could Kristol really be so dense as to believe what he's writing?)

The center of gravity, I suspect, will instead lie with individuals such as Palin and Huckabee and Gingrich, media personalities like Glenn Beck and Rush Limbaugh, and activists at town halls and tea parties.

He's comfortable with that?

The lesson activists around the country will take from this is that a vigorous, even if somewhat irritated, conservative/populist message seems to be more effective in revitalizing the Republican Party than an attempt to accommodate the wishes of liberal media elites.

The strange thing is Kristol was able to name two Republican media elites, and cheerlead the angry, often hate-filled rhetoric and misinformation they (and Sarah Palin, another "leader" he again singles out) use to "lead" the Republican Party. But when he drops in a bromide about "liberal media elites" he's unable to name even one - let alone one of any real influence.

If nothing else, he's made clear which party is being run by grown-ups.

Kristol's fantasy of a conservative movement uniting behind a Sarah Palin, or some other "leader"² who represents only one faction of convervatism (religious right conservatives / social conservatives, economic conservatives / free market conservatives, foreign policy conservatives / interventionists / non-interventionists... there are factions within the factions). That's the same sort of foundation upon which Ross Perot built his Reform Party - not so much "vote for us" but "don't vote for them". And when the Palin/Gingrich ticket brings in 19% of the vote....³
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1. I don't want to be unfair to Romney, who was once a successful corporate raider (who now prefers "venture capitalist"), but the image he seemed intend upon presenting during the last campaign was that of an empty head propped on top of a stuffed shirt.

2. Palin has demonstrated little ability to lead those who aren't already in lockstep with her message. While the modicum of leadership she demonstrates by telling her devotees what they want to hear may qualify her as a "leader" in Kristol's book, her failure as an executive both at the state and local level may give others pause.

3. While Kristol was heartened that 40% of Americans deem themselves "conservative", he somehow forgot to mention (or perhaps failed to read) that only half of that number (20%) describe themselves as "Republicans".

Carts, Horses and Healthcare

Tyler Cowen takes a valid premise, and then gallops off in the wrong direction.

The proposals now before Congress would require just about everyone to buy health insurance or to get it through their employers — which would generally result in lower wages. In other words, millions of people would be compelled to spend lots of money on something they previously did not want, at least not at prevailing prices.

That is the unfortunate result of our current "no new taxes" culture. It would be better for the poor, as well as for uninsured and underinsured working Americans, if a sensible tax reform funded basic insurance. People could still choose between plans, but we wouldn't have to worry about subsidies or whether the cost of insurance will be too onerous on people of limited resources. Obviously, forcing people to buy insurance for a price they deem to high - let alone at a cost beyond what they can reasonably afford - could (would) create a lot of resentment.

However, I think his argument that national healthcare amounts to a tax that would discourage the poor from trying to earn more is absurd. First, I don't know of many people who even think that way - "No, boss, I'm turning down that raise because due to its effect on my health insurance subsidy I'll only put half of it in my pocket". (Without digressing into the vagaries of the human mind, there's evidence that earning "more than the next guy" is a much more compelling factor than take-home pay.) Second, people don't always have the luxury of turning down a promotion, even if they want to. Third, people actually do recognize that raises and promotions are incremental - this year's raise may not be as much as you would like, but maybe next year's will be better. Fourth, most people are happy to pocket extra money, even if they would prefer to have more.

But I digress. The argument he offers that I find to be most flawed is this:

We’re often told that America should copy the health care institutions of Western Europe. Yet we’re failing to copy the single most important lesson from those systems — namely, to put cost control first.

Which European nation, in adopting a national healthcare plan, put cost control first? It seems to me to have been quite the opposite - that national healthcare plans were implemented in order to properly serve the needs of the nation's population, and that concerns about cost control arose considerably later. It may well be that, once a nation has implemented a national healthcare plan, cost control becomes a leading consideration, but the plan still comes first. If anything, doesn't Cowen's argument support the idea that the best way to make cost control a priority is to extend insurance to everybody through a nationally managed program?

Medicare vs. Private Plans

Robert Samuelson, whose prior commentary on healthcare reform issues is pretty atrocious, again takes on the subject. A brief response to a couple of his points:

The public plan's low costs would be artificial. Its main advantage would be the congressionally mandated requirement that hospitals and doctors be reimbursed at rates at or near Medicare's. These are as much as 30 percent lower than rates paid by private insurers, says the health-care consulting firm Lewin Group.

You know what I would love to see, and what people like Samuelson would probably hate to see? A full, public disclosure of private insurance company reimbursement rates. You see, Medicare reimbursement rates are public - anybody can access and review them. Health insurance companies keep their reimbursement rates under wraps. I'm really not convinced by the argument that "Medicare rates are 'as much as' 30% lower than our secret rates" - it's easy to cherry pick an outlier to make such an argument. Let's see the real numbers so we can determine for ourselves whether Medicare truly undercompensates the doctors... who voluntarily accept it... or if the insurance industry is again playing games with statistics or "making stuff up" to subvert the debate.

As for administrative expenses, any advantage for the public plan is exaggerated, say critics. Part of the gap between private insurers and Medicare is statistical illusion: Because Medicare recipients have higher average health expenses ($10,003 in 2007) than the under-65 population ($3,946), its administrative costs are a smaller share of total spending.

You see, administrative costs go up when plan members don't get sick and don't make claims. To enjoy cost savings in administration, you need to insure people who get sick a lot, go to lots of different doctors, hospitals, and other treatment facilities, and create an avalanche of claims for reimbursement each time. This is why private insurance companies were so eager to insure the elderly prior to Medicare, and why they complain so bitterly that the government excludes them from that market - or inadequately subsidizes their participation.

Likewise, Medicare has low marketing costs because it's a monopoly. But a non-monopoly public plan would have to sell itself and would incur higher marketing costs.

Medicare Advantage plans don't compete with Medicare? Private prescription plans for seniors don't compete with Medicare? Wow, when you ignore the facts and make stuff up, you can make all sorts of interesting arguments.

Even Hacker concedes that without reimbursement rates close to Medicare's, the public plan would founder. If it had to "negotiate rates directly with providers" -- do what private insurers do -- the public plan could have "a very hard time" making inroads, he writes. Hacker opposes such weakened versions of the public plan.

But wait a minute. Don't a lot of private insurance plans avoid the need for actual negotiation - or even a lot of the difficult, costly work in developing reimbursement rates - by tying the scope of their coverage and their reimbursement rates to Medicare rates? If Samuelson is deferring to Jacob Hacker as an authority on this subject, perhaps he should start by reading what Hacker has to say:

Over the last two decades, moreover, Medicare has increasingly emphasized improved payment methods and rigorous reviews of technology and treatment, and it has made increasing investments in quality monitoring and improvement. Revealingly, private plans generally use the public Medicare plan’s criteria for covering treatments as their standard of medical necessity, and they have adopted many of Medicare’s innovations in payment methods. As Robert Berenson and Bryan Dowd note in a recent Health Affairs article, “Traditional

As for "marketing expenses"....

In one study that assumed widespread eligibility, the Lewin Group estimated that 103 million people - half the number with private insurance - would switch to the public plan.

When half of people with private insurance say, "I don't know how much a public plan will cost or what it will cover, but it has to be better than this ****," why does Samuelson find it so troubling that the industry will face competition?

If We Assume a Slippery Slope....

It's not that Fred Hiatt's editorials are usually good, but he usually hides behind the anonymity of his editorial board when he makes his most inane arguments. So I was a bit surprised when he regurgitated some of his recent anonymous inanity in an editorial to which his name is attached.

From the start, the Obama administration has said that health-care reform has to make health care both more accessible and less costly . If Congress does the first without the second - guarantees a new entitlement without controlling costs - it will bankrupt us, because health-care costs are rising faster than the overall economy is growing.

Hiatt distinguishes the cost of wars from the cost of healthcare, arguing that we can spend ourselves into deficit oblivion over wars "because wars end", but what of the military budget? Even excluding the cost of the wars in Iraq and Afghanistan, Hiatt should be wringing his hands over the inevitability that the military budget will bankrupt us. After all, the same slippery slope argument applies to any category of spending where costs are increasing faster than inflation. I would infer first that Hiatt doesn't recognize that slippery slope reasoning is not logically sound,¹ and second that his concern about deficit spending is based primarily (perhaps exclusively) on whether he supports or opposes the government action at issue.

Hiatt suggests that only two things are needed to eliminate healthcare inflation.

• First, we need to tax the middle class and try to economically pressure employers to diminish the quality of healthcare plans available to their employees. This is the Gingrich model - the idea that if you force employees to pay for their healthcare out of pocket, they will be more selective about what care they obtain and costs will decline. Never mind that there's no evidence that this will work and, with the experience so far with low-coverage, high-deductible plans that costs for healthcare consumers will in fact go up.

• Second, we need to have Congress "cede its power to regulate the minutiae of Medicare coverage" - because, um, it would be better if that were done by magic or something. (Hiatt doesn't explain.) Seriously, healthcare inflation for Medicare is lower than inflation for all other healthcare, yet Hiatt thinks we can solve the world's problems by making some sort of undefined change to "the minutiae of Medicare coverage". Where's his call for private insurers to "cede [their] power to regulate the minutiae of [health insurance] coverage"?

Hiatt continues his silliness by arguing that a public plan won't actually save money over private plans:

If, as advocates sometimes argue, a public plan operates without favoritism, it will be simply one more entrant in the marketplace. Like other companies, it will have marketing and administrative costs. In some markets served by few private plans, it could offer a useful alternative. But it won't radically reduce costs.

People who are truly sick like their Medicare coverage. I know of few people who don't have gold-plated insurance who, following a serious illness, think highly of their private insurance plans. People see value in both having available, and having as a competitor to private insurance, a plan that won't spend huge amounts of money trying to deny coverage it owes under contract. The extraordinary misconduct and, at times, overt fraud committed by insurance carriers should give anybody pause about whether reform could be achieved without a public alternative. Hiatt may be correct that a public plan that competes with private plans doesn't produce much in the way of cost savings, but it could produce a lot in terms of peace of mind. (And if Hiatt were truly in favor of cost savings, he would be looking at various other nations' successful efforts in that regard, rather than throwing up a smokescreen in the defense of our nation's abject failure to control healthcare spending.)

I doubt that a public plan will face much in the way of marketing costs. Everybody will know what it is, where to find it, and what it offers. Besides, how much marketing does Hiatt believe private insurance companies direct at the uninsured and underinsured markets? At least if we're talking about legitimate companies.

If, as advocates argue at other times, the point is to insure sick people whom private companies, despite all regulatory efforts, find ways to shun, the public plan could offer a valuable safety net. But that wouldn't save money.

I've previously pointed out that it is ill-advised to pursue the approach that to be acceptable, any healthcare reform bill must fix every defect of the current system. Here, Hiatt extends that argument to an absurd level, suggesting that it's not enough that the bill fix all problems in the aggregate, but that each and every element of the bill advance all three goals (universality, cost control, and patient choice). At the same time, he does not propose how things would be better in the absence of a public plan - and proposes nothing to pressure private insurance companies or healthcare providers to reign in costs.² If Hiatt believes what he's suggesting, he's an idiot. If he doesn't, yet still expects you to buy his argument, he thinks you're an idiot.
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1. It could be that Hiatt knows his logic is childish and flawed, but that he doesn't care. He later presents another slippery slope argument, whereby a public plan gradually bankrupts every private insurance plan and becomes the only option based upon an entirely speculative set of future events and assumptions. Perhaps he imagines himself as a silver-tongued advocate, whose sophistry and illogic will not be detected by his readers....

2. Granted, this could be because he doesn't care about the inflation caused by the private side of the market, and favors a system in which private insurers maximize their profits even at the expense of the three ostensible goals of healthcare reform.

Budget Mendacity From the Washington Post

Have you ever seen Willie Wonka & The Chocolate Factory? Recall Gene Wilder's "protests" when the various naughty children engaged in acts that he knew would lead to very unpleasant consequences? Somehow Fred Hiatt's gang brought that image to mind with their argument that their acceptance of massive deficit spending for the wars in Iraq and Afghanistan is consistent with their insistence that healthcare reform be revenue neutral.

In principle, all wars should be paid for, just like all other federal spending. We criticized President George W. Bush for sticking with tax cuts rather than calling for national sacrifice after Sept. 11, 2001, and for failing to fund the wars in Iraq and Afghanistan.

So we start with a general statement of principle, with no indication that the Post has any interest in standing behind that principle. Hiatt's editorial board protested, Willie Wonka-style ("Oh! I wouldn't do that... I really wouldn't"), at some point in the past and, having given lip service to their principles, proceeded with full-throated advocacy of the wars and their escalation.

If Mr. Obama were to propose offsetting the cost of additional troops in Afghanistan with a gasoline or carbon tax, we would support it.

But not if he proposed such taxes to fund healthcare reform - for that, Hiatt and his crew want new taxes on the middle class. But take a step back in history to the budget surpluses G.W. inherited and frittered away on tax cuts for the wealthy and a ruinously expensive war of choice in Iraq - why not let some of those tax cuts expire to fund the war? Or to fund healthcare reform?¹

Hiatt and his crew then argue that the budget games they're using to avoid funding the wars in Iraq and Afghanistan are analogous to arguments that future savings in healthcare costs should be considered when calculating the cost of a reform bill. An obvious flaw in this argument is that, at least in any modern western society, the state cannot avoid healthcare costs. It's perfectly appropriate in that context to consider how reforms might bring about savings, and how that will relate to future expenditures. When the government chooses to spend vast amounts of money on a war of choice, the baseline for spending is $0 and (unless you endorse some modern form of loot and plunder) there's no way to achieve "savings" by making that number negative.

Further, the Post combines spending for the wars in Iraq and Afghanistan, suggesting that "savings" that may be achieved from possible troop reductions in Iraq could be applied to the increased budget for the war in Afghanistan, thus bringing about a net "savings". If the Post believes this argument, then it has justified in spades what it deems to be the "creative accounting" behind the healthcare reform bill. Further, money is fungible - why not apply the Post's imagined "savings" from Iraq to healthcare reform, and pass the Post's proposed new taxes to fund the war in Afghanistan? ("Did we just say we opposed sticking with the Bush tax cuts for those wars, so that we wouldn't run up huge deficits? Well, that was so five minutes ago.")

The Post continues with a similar quality of logic:

All this assumes that defense and health care should be treated equally in the national budget. We would argue that they should not be, for two reasons. One is that wars, unlike entitlement programs, eventually come to an end. A guarantee of health care for all, particularly in the context of steadily rising costs, will bankrupt the nation if not matched by a steady stream of revenue.

Sure, wars end... Even the Hundred Years War came to an end. I suspect, though, that the Iraq war would have wrapped up sooner or perhaps not been launched at all if G.W. had told the wealthy, "Sorry, you won't be getting those tax cuts after all, and estate taxes will not be reduced." The Post's tax proposals are consistent with this - they're big on picking the pockets of working Americans, but in relative terms the proposals they're presently endorsing will have a small impact on the wealthy.

Since wars do end, it's reasonable to ask "When will these wars end, and how much will they cost?" The best answer we're likely to get from Hiatt and his boys is probably Jackson Diehl's² "Nothing's anything like Vietnam" argument - a shrug. Who knows, who cares, it's probably best not to even ask - and don't mention long, costly wars we entered with no vision of how we would achieve victory or an exit strategy, because they're nothing like what will soon be our longest war ever with no end in sight."

The Post's slippery slope argument on healthcare costs is amusing, given the Post's strong opposition to the cheapest alternative to the status quo - a robust national healthcare plan, even a single payer plan. I find it childish to suggest that the inevitable consequence of providing health insurance to every U.S. citizen will be that the nation is bankrupted. It's not at the level of "death panels", but it's still a dishonest, fear-based argument.

The point hidden behind the hypocrisy and logical fallacy is actually a good one - when we're committing to an indefinite expenditure we should consider how we are going to pay for it. But the Post's definition of what expenditures are of a limited nature is reminiscent of how the Supreme Court has interpreted the Constitution's provisions on copyright - anything that's less that indefinite in duration is "limited". When there's no end in sight to war spending, and no plan or strategy that will bring an end to that spending, the open-ended nature of the commitment makes it little different than entitlement spending - infinity is not so much different from "infinity minus one".

The Post's last argument is that wars are necessary to defend our nation and its people, while healthcare reform is not. Again we have dubious logic - that any money spent on wars and the military, no matter how spent, is necessary to the defense of the state. Would Fred Hiatt expand that "reasoning", Candian Bacon-style, to a war of choice against Canada? Some wars aren't all that important to our defense. Jackson Diehl just got through suggesting that the wars in Iraq and Afghanistan are less important "in its consequences for the United States" than was the Vietnam War - we ended the war, the North took control of the country, it's still a communist nation, and... Americans can easily and safely visit Vietnam as tourists, and we have normalized diplomatic and trade relations. How would that have been improved by giving the Vietnam War an indefinite³, deficit-funded blank check?

Combining the Hiatt crew's assertion, "the nation's security must be the president's first priority", with Diehl's insistence that our current wars are less important than Vietnam, would the Post endorse a decision to end both the Vietnam and Iraq wars on the ground that they're less important than Vietnam and we did pretty darn well despite having ended that war with an outcome falling far short of victory? Or would we hear Diehl shriek, "Any analogy to Vietnam is imperfect - continue the war forever (less a day) if necessary to win!" With Hiatt chiming in, "At any cost... to the middle class and future generations."

Since we're focusing on the question of what bankrupts a nation, potentially leading to collapse, it seems reasonable to ask this question: In the history of the world, how many nations or empires have collapsed under the weight of healthcare costs (or any other public benefit), and how many have collapsed under the weight of costly wars and imperial overreach? Sometimes wars end because they bankrupt the proponent.

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1. Here, they may be channeling Lionel Hutz. It says we argued "No New Taxes'? They got that all wrong. It's supposed to say 'No! New Taxes!"

2. Jackson Diehl is deputy editorial page editor of The Washington Post.

3. Limited only by the Post's assertion that all wars eventually end.

A New Twist on Learning From History

From what Jackson Diehl has written, it appears that the new lessons of history are:

1. Unless the current event is exactly like the historical event, there's nothing to be learned from history.
2. If somebody has drawn a historic analogy that proves flawed, it conclusively proves that any comparison of the current event to the history event is flawed.
3. If somebody claims that a particular lesson is to be learned from a specific historic event, and you disagree, you can reject the idea that anything can be learned from the historic event.
4. Absent a perfect analogy, anybody who analogizes a current event to a historic event is being unhelpful.

Diehl is offended at the notion that the war in Afghanistan can be compared to the war in Vietnam, arguing "No military mission since Vietnam has come close to that war in the number of casualties, or in its consequences for the United States". Those are the only two measures that are relevant? And when Diehl suggests that the consequences of the war in Afghanistan are significantly less for the United States than the consequences of the Vietnam War, is he making an argument for withdrawal?

George Will is Turning Into Grandpa Simspon

Read his opening two paragraphs. The biggest distinction between George and Abe¹ is that he wraps his rambling digression into his larger point - but one suspect's it's just a matter of time before we're reading "there are too many states nowadays. Please eliminate three".... For that matter, Will's comments on scientific issues are already often as nonsensical as Grandpa Abe's various rambles.

It's a terrific way to bury a decent point (the questionable $250 Social Security bonus checks being sent to seniors) in colorful historical anecdotes and angry fist-waving. Really, Will could have just written, "This type of giveaway will turn Social Security, a program I've always regarded as a welfare program, into a welfare program" - the rest is padding.
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1. While we're sort of on the subject, is it just me or does Dr. Nick bear a striking resemblance to Ross Douthat?

Broder Confuses Budget Decisions With Public Policy Decisions

The use of committees to allow Congress to avoid making tough decisions? Hardly a new idea. Congress has used this method to obtain recommendations on base closures¹ that must be accepted or rejected as a package, in lieu of debating and deciding the issues. It may not be a particularly courageous way to tackle the issue or deal with special interests or the concerns of Members of Congress whose states are affected, but... we're talking about Congress, so you do what you have to do.

But the idea of expanding this concept to the entire budget, eagerly embraced by David Broder, implicates a much broader set of concerns. It's not simply a context where Congress has decided the larger issues, such as recognizing that savings can be obtained and efficiencies realized by consolidating military bases, and the committee is left to work out the details. There are huge public policy decisions involved in setting tax rates, funding various government programs, and cutting or eliminating funding for various programs and initiatives.

The one barely possible benefit from this predictably futile partisan bloodbath is the opportunity it could offer to leverage support for a long-standing bipartisan effort to force Congress to confront the hard steps needed to put the nation on a safer fiscal course.

That chance was highlighted last week when Sen. Evan Bayh of Indiana and nine other moderate Democrats wrote to Senate Majority Leader Harry Reid asking that the debt-ceiling increase be tied to passage of bipartisan legislation creating a deficit-reduction commission whose recommendations would have to be quickly enacted or rejected by the House and Senate as a package.

But this proposal has nothing to do with "hard steps". Sorry, Senator Bayh, but if you were serious about this you could easily team up with your fellow "moderates" and draft up a proposal to balance the budget over a given number of years. Does Broder truly not realize that the reason Senators like Bayh want to delegate that task to a commission, reserving to Congress only an "up or down" vote, is that he doesn't want to be held responsible for either making the tough calls himself or for the consequences of those calls?

It's pretty easy to form a bipartisan commission that understands a mandate to recommend base closures that serve the nation's financial goals without detriment to its military goals. But larger tax and spending issues are much more complex, and have significant policy elements and ramifications. You can almost hear Broder's voice trembling with excitement:

But the odds are against [proponents of the commission]. Because such a commission is likely to propose both cuts in popular entitlement programs and tax increases whenever the country comes out of the current recession, those members on the ballot next November, including Reid and Pelosi, would much rather avoid any discussion of such steps.

Here, Broder highlights two things: First, that he imagines the budget commission will be composed of people who share his own policy goals - apparently focusing on increased taxes for the middle class and the slashing of programs like Medicare, Medicaid and Social Security that significantly benefit the middle class and poor. Second, that politicians shouldn't be held responsible for the consequences of "balancing the budget" by deferring significant policy decisions to what amounts to a black box - they know what goes in, they get to see what comes out, but have no input or control into what happens in the interim.

Were specific members proposed for this committee, Broder would likely either be much more excited ("They really do agree with me!") or horrified ("They want to balance the budget by increasing taxes on capital gains, having a robust estate tax, closing tax loopholes for the rich, a one-time wealth tax on the rich, by taxing corporate profits diverted through offshore companies as if they're domestic, slashing the military budget....") His support anticipates the former - and he's probably correct, that Bayh and friends have an eye on new or increased taxes on the middle class and the slashing of popular entitlement programs, but lack the backbone to simply come out and make those proposals.

Seriously, what if the committee came back and said, "To maintain Social Security and Medicare spending, and to ensure their full funding for the indefinite future, we recommend that the military budget be halved, that funding for the wars in Iraq and Afghanistan be reduced by 1/3 per year until totally eliminated in three years, and that funding for the Army be eliminated with all of its bases and facilities closed," Would Broder still be pretending that this proposal is merely about crunching numbers, and not a delegation of serious policy issues with significant short- and long-term ramifications for the country?

It must be nice to know, in advance, that no matter what Congress does it will always be somebody else's ox that gets gored.

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1. These recommendations come from the bipartisan Defense Base Closure and Realignment Commissions (BRAC).

Everything Old Is New Again

Thomas Friedman brings us some amazing news from the world of legal practice:

A Washington lawyer friend recently told me about layoffs at his firm. I asked him who was getting axed. He said it was interesting: lawyers who were used to just showing up and having work handed to them were the first to go because with the bursting of the credit bubble, that flow of work just isn’t there. But those who have the ability to imagine new services, new opportunities and new ways to recruit work were being retained. They are the new untouchables.

Apparently Friedman believes that in the past law firms have underpaid and undervalued rainmakers, and have shoved them out the door the moment money gets tight.

Friedman also shares this gem about blue collar workers:

Those at the high end of the bottom half — high school grads in construction or manufacturing — have been clobbered by global competition and immigration, added Katz. “But those who have some interpersonal skills — the salesperson who can deal with customers face to face or the home contractor who can help you redesign your kitchen without going to an architect — have done well.”

So... once everybody's a salesperson, the economy will boom? Seriously, we only need so many salespersons in any given industry, and there are only so many kitchens to redesign. And, even assuming unlimited need, there's more to being a good kitchen designer or salesperson than taking a class or two (even if you get "A's").

Friedman's argument is reminiscent of Charles Murray's notion that every blue collar worker can become a "Journeyman Craftsman" and earn six figure incomes remodeling the mansions of millionaires. As for hiring architects for home remodeling? Outside of Friedman's economic circle, who hires an architect to redesign their kitchens?

Those who are waiting for this recession to end so someone can again hand them work could have a long wait. Those with the imagination to make themselves untouchables — to invent smarter ways to do old jobs, energy-saving ways to provide new services, new ways to attract old customers or new ways to combine existing technologies — will thrive. Therefore, we not only need a higher percentage of our kids graduating from high school and college — more education — but we need more of them with the right education.

I would very much favor not only an educational system that was friendlier to nonconformity and entrepreneurship, but also a society that helped support both as major potential factors to the future success of our nation. But it's easy to say things like "we need more [high school and college graduates] with the right education" - what is the right education, and who is going to pay for it - not just for a reinvigorated K-12 education, but for transforming and updating our institutions of higher learning?

It's About... Losing Elections

Although Michael Gerson can't quite bring himself to being explicit in that admission, he does effectively concede that Republican obstreperosity on healthcare reform has its roots in their fear of losing elections.

Critics of all things Republican insist that these objections are merely a cover for politics - that the GOP has decided to defeat Obama, no matter what the content of his health reforms. But concerns about America adopting the fiscal practices of a banana republic are not merely an excuse, they are a wave. And it is not cynical for Republicans to recognize the ideological stakes that Obama has raised. The passage of a massive health entitlement would change the relationship of Americans to their government.

On the evidence of nations such as England, a national health system places a conservative party at a permanent ideological disadvantage. Every proposal for tax reductions is attacked as undermining the eternally hungry public health system. Every failure of that system becomes an excuse for greater spending and government involvement. The tide of government grows, and the ebb weakens, until no one can fight the flood.

This is the main explanation for Republican resistance to Democratic health reform - and the reason that Sen. Snowe is likely to remain a lonely heretic.

While Gerson supposedly fears the slippery slope that will result from an effective national healthcare program, this is the same slippery slope argument Republicans have been making since the dawn of the New Deal. Republicans have repeatedly tried to tear down Social Security, yet somehow they have managed to survive, thrive, and at times dominate the American political culture since that program's passage. The same is true of Medicare. In fact, if Gerson recalls, G.W. Bush massively expanded Medicare, without the same sort of right-wing hand-wringing about budget deficits and transformation of the American way of life.

Gerson, as usual, doesn't know much about his subject. Perhaps he has forgotten Maggie Thatcher, who somehow managed to smash unions, privatize government-controlled entities and public housing, and (get this) lower taxes during her tenure, despite the existence of that nation's National Health Service.

Similarly, his reinvention of himself as a deficit hawk the moment Bush stepped out of office doesn't exactly give credibility to his supposed concern about this nation turning into a Banana Republic. Let's see... the son of a mediocre former President takes over the country, mismanages pretty much everything he touches and runs up huge deficits, but we're at risk of looking like a Banana Republic the moment he leaves office?

But perhaps more to the point, the "deficits" of the Democratic plan could actually be remedied by following a Canadian or European model for a national healthcare plan:

• "First, it will make the average insurance plan more expensive." Here, of course, we are speaking in averages. It follows inexorably that if a pool that once excluded people for pre-existing conditions, and scoured past medical records to disqualify people for benefits based upon "undisclosed" prior conditions (both real and imagined), the cost of insurance within that pool will go up. But for people getting employer-sponsored health insurance, where pre-existing conditions are already covered, it's not likely to have an effect. This could be mitigated or remedied by regulating the insurance industry, requiring health insurance companies to operate as nonprofits, or by having a national healthcare plan that competes with or supplaces private coverage. The Republican "solution", on the other hand, appears to be to allow insurers to continue to deny coverage to people with pre-existing conditions - Gerson's "compassionate conservatism" in action.

• "Second, while Democratic reform does expand health-care access, it does little to address the issue of cost inflation". Well, here's the thing. All indications are that with a national healthcare plan we would experience both cost savings and a reduction in healthcare inflation. Yet Republicans fight tooth-and-nail against even a modest public option to compete with private insurers. Some Republicans do offer a "solution" to healthcare inflation (with no evidence that it would work), by giving everybody much worse health insurance and making people pay for more of their own care out-of-pocket; that might be a hard sell, though, for a party that's propagandized against Democratic healthcare reforms on the premise that most people like their current insurance coverage.

• "Third, the Medicare cuts assumed by the Finance Committee are dishonest." Well, maybe so, but welcome to government. I'm curious - did Gerson try to advance this concern about government honesty when he was writing speeches for President Bush, because.... But seriously, this is one of the perils of trying to have a healthcare bill that's everything to everyone - we shouldn't be trying to address every issue and concern relating to the future of healthcare in a single bill.

If Republicans truly wanted a system that demonstrably would reduce premiums, reduce inflation, reduce the overall cost of healthcare, they would be actively looking to other Western nations and insisting that we adopt a program modeled after the most successful, most competitive national healthcare plans already implemented in other nations. But for all of Gerson's hand-waving, the fact is that to the Republican Party this is all about future elections - and they see an electoral advantage in running for office in a nation where millions of people are uninsured and millions more are underinsured.

Making Airport Security See Reason

Probably not the best way, but this cartoon does highlight the absurdity of the arbitrary, appearance-oriented security rules imposed on air travelers. (I've previously commented on the issue.)

The Worst Columnist in America?

I hardly know what to make of Richard Cohen.

If Obama ends the deepest recession since the Great Depression, if he enacts health-care reform, if he succeeds in Afghanistan, then his presidency will have been remarkable, maybe even great - the triumph of intellect. The man will be his own movement.

But if he fails in all or most of that, it will be because it is not enough to be the smartest person in the room.

Unless he parts the Red Sea, in which case it's all good again? Unless the pharaoh's men make it through, in which case being smart isn't good enough again? Unless he feeds a continent with five loaves and two fish, in which case....

It's not just that this column reads like Cohen phoned it in; it's that all of his columns have the same thinly reasoned, derisive, derivative, uninsightful quality about them.

Update: More from The NonSequitur: "[Cohen i]s talking about a movie about Obama, not Obama the person, but it's not clear to him, or to us, that he's aware of the difference."

But What Does The Poll Result Mean?

Michael Gerson whines that Europeans aren't sufficiently war-like:

A recent transatlantic poll asked whether the use of force can ever be "necessary to obtain justice." Seventy-one percent of Europeans said "no," while 71 percent of American said "yes." In general, Europeans believe that nothing -- not peace, or freedom, or security, or the rights of the weak -- is worth fighting for.

The poll says "inch", and Gerson extrapolates to "mile".

One of the funny things about polls like that is how, when you start describing specific circumstances, the result can change dramatically. "You oppose the death penalty?" "Oh yes, 100%, absolutely." "What about Ted Bundy and Jeff Dahmer." "Well, except for them." The same sort of thing goes on with nebulous questions about war. While 71% of Europeans may well have disagreed with the abstract statement, "Is war sometimes necessary to obtain justice", that does not mean that the same 71% wouldn't endorse a specific war (e.g., WWII) as having done so. Further, there's a matter of interpretation. Europeans from non-English speaking countries (the U.K.'s figures being much closer to those of the U.S.) may have been interpreting that question as "Are there always steps that you can take to achieve justice without going to war?" It's an answer that sees war as one tool in the box, but that recognizes that other tools are available that may be able to achieve the same end, perhaps even with a better outcome.

By way of example, Gerson whinges about Obama's wise decision to abandon an expensive, provocative plan G.W. had to install missile defense technology in Poland and the Czech Republic. Does Gerson think those nations are particularly wise in the necessity of war? If so, then why did 75% of Poles reject the concept of war as necessary to obtain justice, making them significantly more "pacifistic" than "Old Europe"? Also, what happened to Gerson's brand of "compassionate Christianity"? Where in the teachings of his faith can I find similar scorn for pacifism?

Meanwhile, you gotta love Gerson's new anti-popularity test:

It is the combination of American power and credibility that causes other nations to change their behavior in ways favorable to our interests. But power and credibility often attract resentment, not love. President Ronald Reagan was unpopular in Europe while pursuing policies, such as the deployment of medium-range nuclear missiles, that weakened the Soviet Union.

And G.W. was unpopular in Europe while getting the U.S. bogged down in two wars, still no end in sight, and undermining our ability to militarily or diplomatically pressure nations such as Iran and North Korea. Funny, how quickly Gerson forgets the legacy of his lord and master.¹
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1. Gerson does try to slip in a plug for G.W.,

Over the past several decades, certain images of America - the Marshall Plan, the Peace Corps, the President's Emergency Plan for AIDS Relief - have demonstrated that America's conception of its global interests is neither narrow nor selfish.

And the Nobel committee, as much as Gerson tries to pretend otherwise, has recognized American contributions to world peace. In case he missed it, in 1953 they awarded the price to George Cartlett Marshall. Leaving aside his poor diplomatic and military record for the moment, G.W. might have made himself a better candidate had he not coupled U.S. AIDS relief programs with "abstinence only" programs and fought against contraception and family planning.

"Show Me The Money!"

The Washington Post continues its love-in with Michelle Rhee, with this editorial from Richard Whitmire. The editorial points out that with the rise of charter school enrollment (28,000 students) at the expense of public school enrollment (44,000 students), there's danger that Rhee won't be able to "maintain a viable-sized school district". But if charter schools are everything they're cracked up to be, why is that a problem?

The advantages enjoyed by charters, which can pick and choose their staff, are considerable. Among the 1,500 schools in New York City, the top-ranked one on the city's 2007 progress report was Williamsburg Collegiate Charter School. There's just one secret to its success, says Evan Rudall of the Uncommon Schools network, which runs Williamsburg: high-quality teachers. "The best way to find such teachers is by using the latitude granted to charter schools: interviewing hundreds of candidates, both certified and uncertified, to find out if they know their material, are enthusiastic about their subject matter, and can maintain classroom control."

The author also mentions KIPP schools. What goes unmentioned is the sacrifice that some of these teachers make to keep up with the demands of their schools. As EducationSector points out,

The big question is whether the new models can be scaled up to reach the many students who need help. The answer is, not easily. In a decade, education entrepreneurs have created at most a couple hundred very strongly performing schools, serving perhaps 55,000 of the nation's more than eight million urban students. Among the major obstacles to a broader effort: Talented teachers and principals are hard to find and burn out quickly; the schools' longer calendar and other features that are key to their success are expensive; and most of the schools have to pay for their own buildings and often receive less than their full share of state and local education aid. Lacking large infusions of philanthropy, many of the schools would founder financially, and the economic downturn has made the schools' plight even more precarious. The Harlem Children's Zone recently cut staff in the face of diminishing donations.

Talk all you want about "highly qualified teachers" motivation, school quality... but it comes back to this: You're not going to convince teachers unions to give up job security so that their teachers can work more and earn less. It's great that a handful of schools can maintain a sufficient flow of applicants that, as their faculty members wear out and burn out, they can replace them with a new set of motivated teachers. But that model doesn't scale.

Also, let's not forget that this is a model we only propose for the inner cities. I am not aware of any middle or high SES school district that is looking at KIPP and saying, "We should follow that model." Maybe they should be. Maybe they should be looking at alternate modalities such as Waldorf or Montessori and trying to figure out what those approaches do correctly. Maybe they should be looking to offer an array of choices instead of "the same" and "more of the same" (most "school reforms" after all speak of doing the same thing, but "better" or with a longer school day or school year). But interest in "what works", at least with the loudest voices for "reform", seems to be pretty much limited to the retrospective study of standardized tests, and I see little sense that they're really looking for innovation - or that most parents even in "failing schools" are demanding innovation, as opposed to school safety and order in the halls.

For all this talk about top rated schools in the public and charter school systems, let's not forget that we're still not talking about the schools our nation's political and economic elites will choose for their own kids. Before they'll consider such a thing, many will plunk down $30,000+ per year for Sidwell Friends. With diminished private donations for even the best charter schools, and the further erosion of the tax base for public schools, who's going to pay for reform? Talk is cheap in D.C., but the best schools are not.

This Was Funnier When It Was a Cartoon

Remember the Springfield Monorail?

But private prisons are completely different, right? They have to make money!

The Horror....

Although sometimes a bit (probably intentionally) unfair, and not safe for work, regretsy does a pretty good job of highlighting crafting ideas not likely to make Martha Stewart Living.

At Least We're Not Detroit

In keeping with videos on the failure of major cities that are sufficiently and sadly humorous to make it into Michael Moore's new movie,

Bob Herbert sees the pain behind the humor, commenting on Conan O'Brien's jokes about Newark.

Conan was just trying to be funny, but the reality behind his late-night humor is horrifying. In Detroit, the median sale price of a house has hovered around $8,000. Seventy percent of all murders in the Motor City go unsolved. Joblessness is off the charts. The school system is a catastrophe.

* * *

The inner cities have been in a recession for decades. They’re in a depression now. Myriad issues desperately need to be addressed: employment, education, the foreclosure crisis, crime, alcohol and drug abuse, health care (including mental health treatment and counseling), child care for working parents and on and on and on.

Sure, but there are two problems: We're not going to pour the money into the cities that it would take to fix these problems and, even if we were, there's cause to question whether that would be enough. I'm perfectly prepared to take Herbert up on his challenge to "think more seriously about what’s really going on in cities like Newark", but the answers I have (clearing out the dead buildings, consolidating cities like Detroit into areas they can afford to govern, etc.) don't really turn things around - they just make the status quo more sustainable.

Healthcare, Not Health Insurance

It's really simple, but I think this essay identifies the biggest flaw of healthcare reform as it's presently conceived. How can we end hunger?

Providing food to those without is simple, really: we'll just pass a strict law requiring all hungry people to buy some, and if they don't, fine them harshly enough to persuade even the most recalcitrant ones it's in their best interest to eat something once in a while.

Now change "food" to "health insurance," and behold: you have what Congress and President Obama want to inflict upon hapless constituents like me.

Forget health insurance – what sick or struggling Americans need is healthcare. They're not the same thing.

The essay presents an anecdote about a woman who, following reconstructive surgery on her face by volunteer surgeons, complains that the Oregon Health Plan denied payment for the procedure on the ground that it was cosmetic:

I do not want my healthcare decisions made by bureaucrats who think that having a face with a nose you can breathe with is no health issue but a mere matter of vanity.

In fairness she doesn't say "government bureaucrats"; many health insurance companies would make the same determination, if they could not deny her care on the basis that her condition was preexisting. There will be similar denials under any system of health insurance, be it single payer, entirely private, or some form of hybrid.

One of the many hazards of trying to fashion a "one size fits all" bill is that you'll end up with a suit that fits quite poorly on pretty much everybody, but unfortunately that's what our present political culture demands.

"But We're In Two Wars...."

I think Ross Douthat should write a book... perhaps he could call it "The Politics of Resentment in the Post-GW World". He seems to come just short of complaining, "But GW got us into two intractable wars and he didn't get a Nobel Peace Price. Did I mention that it's a stupid, stinky prize anyway?" And of course, there's this:

People have argued that you can’t turn down a Nobel. Please. Of course you can. Obama is a gifted rhetorician with world-class speechwriters. All he would have needed was a simple, graceful statement emphasizing the impossibility of accepting such an honor during his first year in office, with America’s armed forces still deep in two unfinished wars.

Now you'll forgive me, as I did not follow Douthat's blog, but I somehow don't think that Douthat spent the years of Bush's Presidency arguing that the wars in Iraq and Afghanistan were contrary to the larger goal of peace. I'll grant, when Douthat was seven or eight he learned that "peace is the opposite of war", but surely he has come to realize that advancing peace doesn't always mean ending a war (and sometimes it can mean starting or joining one). I'll also grant that GW's concept of preemptive war is scarcely more mature than Douthat's notions of peace, but it's difficult to believe Douthat missed the associated debate.

For that matter, did Douthat whine that Mother Teresa hadn't stopped any wars when she won the Nobel Peace Prize? When he lists various activists, courageous though they may be, whom he believes are deserving of being insulted with this irrelevant honor, who among them can he actually say has stopped a war?¹

The funny part? Had the nod gone to GW, Douthat's friends would be trumpeting it as a vindication of his wars, his "with us or against us" brand of diplomacy, and his rejection of "old Europe".² Not that I want to overuse the term "platitudinous", but...

If Obama goes from strength to strength, then this travesty³ will be remembered as a footnote to his administration, rather than a defining moment.

Figured that out all by yourself, didja?

Now he’s the Nobel laureate who has to choose between escalating a counterinsurgency in Afghanistan or ceding ground to a theocratic mafia. He’s the Nobel laureate who’ll either have to authorize military strikes against Iran or construct an effective, cold-war-style deterrence system for the Middle East. He’s the Nobel laureate who’ll probably fail, like every U.S. president before him, to prod Israelis and Palestinians toward a comprehensive settlement.

Echoes of "math is hard". Yes, Ross, it's easier to start conflicts and to perpetuate conflicts than it is to end them. That's kind of the point. With all of Douthat's talk of "bravery", turning down the award would have been easy.⁴ Living up to it ? That's a challenge.
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1. The standard Douthat seems to be setting for Obama appears to be slightly higher than that set for any prior Nobel Peace Prize laureate, verging on a requirement that Obama end all of the world's armed conflicts.

2. Instead, while presented as an example of how "critics will dismiss his presidency", Douthat brands Obama's predecessor as "Dubya the Incompetent". I've heard the term "incompetent" associated with GW, and I think he was one of the least competent Presidents of modern history; but I've not heard anybody but Douthat use the label "Bush the Incompetent", let alone suggest that it's as resonant as "Slick Willie" or "Tricky Dick". Perhaps Douthat should be pushing a better brand. "Bush The Decider"? "Bush the Misunderestimated"?

3. "Travesty"? I hereby award Douthat the "Drama Queen of the Day" Award. I wonder if he'll try to make the case that he hasn't earned it, and shock me by bravely declining the honor.

4. To me, walking away from the Peace Prize for the reasons Douthat proposes - the possibility of being made fun of by successors to John McCain as a celebrity, or by SNL for not having accomplished his entire agenda in nine months - would at best be shallow, at worst cowardly. Brave? Hardly.

Broke is Broke

In a quality typical of its unsigned editorials addressing budgetary, education, union, or... well, pretty much any issue, the Washington Post argues that complaints about teacher layoffs in the Washington D.C. schools are misplaced:

Washington Teachers' Union President George Parker wrote a letter that appeared on this page Friday saying that his organization has tried to collaborate with Ms. Rhee. There is the suggestion that Ms. Rhee's recent layoff of 229 teachers could dampen the chance of future cooperation.

Let's review the record to examine the plausibility of those charges.

Oh, please, let's.

More than 14 months ago , Ms. Rhee offered a contract to Washington's teachers that was unprecedented in its largess. The proposal would have provided teachers with, at a minimum, a 28 percent pay raise over five years, plus $10,000 in bonuses. They would have had to give up nothing in the way of job security to obtain the raise. All Ms. Rhee asked in return was the freedom to offer, on a voluntary basis, even more money to a subset of teachers, if they would agree to have their compensation linked to performance.

Let's flash back to the offer and it's generous terms that were... kept secret - to the point that Michelle Rhee's dreams of busting the teacher's union are better documented? How in the world could that have created an atmosphere of distrust?

Labor law barred Ms. Rhee from directly explaining to teachers what she had in mind.

How... platitudinous. No, Rhee could not have bypassed the union to directly negotiate with teachers. But that falls considerably short of a mandate that she keep the details of her plan secret. More to the point, she plainly dribbled out the "good parts" to Fred Hiatt and the Washington Post editorial board, so what was her real motive for keeping the rest so tightly under wraps? (And how can Hiatt's board claim to know "all she asked in return" if they're simultaneously asserting that they have no clue what Rhee asked in return?)

But returning to the D.C. Schools budget shortfall, as you would expect, the Post begs the question. If the D.C. Schools are broke and have to lay off teachers despite not giving out those lavish raises, what basis was there to believe that the raises could be delivered in the first place, let alone sustained? Having committed to those raises, Rhee would be in the position of laying off even more teachers this year, next year, the year after.... While the Post cries crocodile tears,

We sympathize with the children whose school year has been disrupted and of course with the teachers who have been fired.

Why won't the Post's editorial board be honest that it endorsed a plan, without knowing the details, that would have caused even greater disruption and numbers of layoffs?

Healthcare Reform is Unfair to Free Riders?

I while back I made a sarcastic proposal of how a health insurance company could serve free riders:

Here's the business model: I charge a premium in the lowest permissible amount (the least expensive plan you can buy to avoid any penalty from the mandate), use that to obtain reinsurance for losses above, say, $50,000, and offer essentially no other coverage. Participants can fund HSA's, if they wish. If a participant gets through a year without making a claim, I refund... let's say 50% of their premiums. The rest goes to the cost of administering reinsurance, administering claims (something I would outsource), and profit. Coverage for pre-existing conditions? Not a problem. Unhealthy people will stay away in droves.

I've also commented on how angry it can make people when they're instructed to buy insurance in which they see no value, or inadequate value. Today, the Wall Street Journal published a letter manifesting that anger, by somebody whose insurance is inadequate under Massachusetts law - due, no doubt, to the free rider problem:

My husband retired from IBM about a decade ago, and as we aren't old enough for Medicare we still buy our health insurance through the company. But IBM, with its typical courtesy, informed us recently that we will be fined by the state.

Why? Because Massachusetts requires every resident to have health insurance, and this year, without informing us directly, the state had changed the rules in a way that made our bare-bones policy no longer acceptable.

Insurance that is adequate is available from IBM at a significant increase in cost. It's also available through state plans at a much lower cost, but of course the complaint is that any increase in cost is too much.

A song dedication for the WSJ: Free Ride.

Update: The other side of the coin:

Industry representatives put Congress and the Obama administration on notice that if health-reform legislation doesn’t send even more new customers the industry’s way or if a windfall profits tax is included, the industry would hit businesses, individuals and the government with higher premiums, effectively defeating one of the initiative’s top goals, reining in ever-rising costs.

* * *

The industry wants more of the estimated 25 million still uninsured – especially healthy, young people – to be compelled to buy policies, too. Without more healthy customers added to the mix, the industry says it will have no choice but to raise rates.

Of course, we probably won't see the WSJ complaining of the insurance industry distorting the debate, impeding any real competition, forcing costly insurance on people who are the least likely to need it, then demanding record profits as the price of their "cooperation".

Peace Is Hard, So Obama Should Give Up

I'm not sure that's what the Nobel Committee had in mind, but it's the gist of the advice of retired IDF general Ephraim Sneh in relation to the Israel-Palestine peace process. You have to love this:

It is because the political constraints of both leaders, the Palestinian Authority's Mahmoud Abbas and Israel's Binyamin Netanyahu, prevent any progress at the negotiation table. Abbas, without substantial achievements, cannot explain to his people why he made substantial concessions to the Israelis. Netanyahu, given the political composition of his government, cannot provide Abbas with such achievements.

So basically, Abbas can't demonstrate progress toward peace without Netanyahu's being willing to negotiate, and since Netanyahu won't negotiate you may as well call the whole thing off. I suspect that Sneh's real fear is that pressure from Obama might make Netanyahu seem unreasonable and obstructionist - despite the fact that Sneh just told us that he and his government are obstructionist.

Save Your Anger For Fictitious People

George Will presents something of an incoherent mumble on anger today, noting that people he assumes are liberal get angry over a shortage of parking at Whole Foods, and that other people get angry about speed bumps. This somehow relates to the perception that healthcare is a right, not a privilege, although Will doesn't do much to explain the connection.

If our vocabulary is composed exclusively of references to rights, a.k.a. entitlements, we are condemned to endless jostling among elbow-throwing individuals irritably determined to protect, or enlarge, the boundaries of their rights. Among such people, all political discourse tends to be distilled to what Mary Ann Glendon of Harvard Law School calls "rights talk."

Witness the inability of people nowadays to recommend this or that health-care policy as merely wise or just. Each proposal must be invested with the dignity of a right. And since not all proposals are compatible, you have not merely differences of opinion but apocalyptic clashes of rights.

Consider, for example, George Will himself. Having decided that corporations, fictitious persons, are entitled to the full panoply of rights granted to real people by the Bill of Rights, he's been sputtering with anger for years over efforts to regulate corporate speech. That, of course, he sees as a perfectly sensible exercise of pique - of his (self-)righteous, conservative anger - whereas it's pure silliness to advocate that real, living, breathing human beings have rights.

Meanwhile, I have to wonder how he came to witness the parking lot anger at Whole Foods. Perhaps after stealing somebody's parking space, while on his way to buy an heirloom tomato on the maid's day off?

Update: Civil rights at work, George Will-style.

Aspirational Awards

You know, I was as surprised as the next guy about President Obama's Nobel Peace Prize, but I'm not sure why some on the political right are so stunned by the idea of awarding a significant, although arguably unearned, prize to a President, in the hope that he'll do something to earn it after-the-fact.

After all, wasn't it the Supreme Court's award of the Presidency to George Bush that inspired him win the election in 2004?

Budget Cuts and the D.C. Schools

A newly hired D.C. teacher describes an unfortunate turn of events in a letter to the Washington Post:

Then, on Friday afternoon, I was laid off. In a last-minute attempt to balance the budget, Rhee and the city opted to cut more than 200 teachers during the most critical period of the academic year - just when students were getting acclimated to their new environments.

My immediate concern was about what would happen to my students, because I was the only third-grade teacher at my school. My principal informed me that my students would be mixed in with the fourth- and second-graders. Yes, these are tough economic times, but does that justify providing a poor educational experience for these children? Simply reassigning them in this way will greatly degrade the educational experience for my third-graders, not to mention those in the classes into which they must be integrated.

There are two obvious problems to this approach to a funding shortage:

• If your goal is to attract motivated, highly qualified graduates to teach in the D.C. schools, laying them off a month into the school year and putting them out of work (or turning them into desperate substitute teachers) for the balance of the year is counter-productive, not just in terms of the new recruits but in terms of whether future graduates fear the same will happen to them.

• If Rhee can't afford the teachers she has, why should they or their union believe that if they give up tenure and job protections they'll be rewarded with lavish raises? If current staff levels aren't sustainable, how can her proposed compensation scheme possibly be sustainable?

I don't hold Michelle Rhee responsible for staffing cuts made necessary by budgetary constraints, but I do think she now owes us an explanation of how her proposed replacement compensation scheme is even slightly viable. If she has donors lined up willing to subsidize such a scheme, why aren't they helping her right now? If they've decided that they have other priorities for their money, or are only interested in funding a scheme that busts the union, it again speaks to the unsustainability of her plan.

Also, I think this highlights what I mentioned the other day, - lip service, including the strong lip service of Fred Hiatt's editorial page, pays for zero teachers. Where's the Post's call for a school funding increase that will allow schools to sustain their present staffiing levels, let alone to improve them and where does it propose that money will come from?

Big Love and FLDS

Within one of the countless articles on Roman Polanski, I came across a criticism of Hollywood not taking child sex abuse seriously, by Professor Marci Hamilton:

First, as I discussed in a prior column, we had Tom Hanks and Rita Wilson producing HBO's "Big Love," which merely winks at the sexual degradation of girls in the Fundamentalist Latter-Day Saints enclaves, but never shows the system in an accurate light that would reveal its true, abhorrent nature. If the pretty fictions were stripped away, the show would be unrelentingly bleak and horrifying: a portrait of a male-dominated society that is inherently inimical to women's rights, progress, and power.

The author in that prior column argues,

Under the "Big Love" scenario, the community needs a three-women-to-one-man ratio. That's distorted enough in comparison to male-female birth rates. In reality, though, many polygamous arrangements involve more than three wives per each man, so more boys have to be discarded.

The distortion of the male-female balance also leads the husbands to seek younger and younger women. The result is that too many girls face abuse: When a girl is secretly "married" before the age of consent, which happens all too often, the marriage's "consummation" is more accurately described as statutory rape.

In other words, polygamy rests, inevitably, on child abuse and neglect.

She takes on a John Tierney column that spoke of polygamy in favorable terms.

Tierney also argues that "[p]olygamy isn't necessarily worse than the current American alternative: serial monogamy." But that's bunk: Divorced couples do not routinely discard their male children on the streets to increase the odds of the father getting the women, or girls, that he wants. And while a divorce may result in one ex-partner (almost always the ex-wife) receiving public assistance, at least the marriage wasn't initially predicated on anyone's receiving public assistance, as the many illegal relationships within many polygamous marriages must be.

I think she both overstates and understates her case. Yes, Big Love is set in a world in which, outside the auspices of its version of FLDS, polygamy is depicted as somehow viable and consensual - what the author describes as "syrupy speculations about how polygamy might be just fine in some possible world". That's the world of entertainment. The show does show some of the dark side of polygamous sects - the casting off of boys, the involuntary marriage of girls, the prophet's control over the lives of the people within the sect, banishment, excommunication, the separation of parent and child, the sect's control of the police departments that supposedly enforce laws on their compounds, violence, tax fraud.... but the focus is on the syrupy world of the main characters who live upper middle class lives outside of the compound. But even with all of that, the show only hints at the darkness.

In fairness to HBO and the show's producers, it's not just their show that diminishes the abusive elements of FLDS-type sects. The 2008 raid on an FLDS compound in Texas, for example, (which in fairness followed an anonymous report of abuse that appears to have been phony) had any number of people demanding the return of the children to their mothers on any number of grounds, none of which involved a good strong look at the abusive environment into which those children were returned. For example, law professor David Bernstein argued,

In the previous thread, some commenters seem to assert that the CPS may take all of the FLDS's children away because (a) there has been documented abuse of children at other FLDS communities; and/or (b) the "culture" of the FLDS is inherently abusive, as it encourages early marriage and leaves its children inherently isolated by homeschooling them and not exposing them to social events, television, and the like. The latter criterion, at least, would place Amish and some of the more insular ultra-Orthodox Jewish communities in jeopardy.

Take a look at some of the literature by former FLDS members, such as Lost Boy. You'll find out about a system of indoctrination and control, and how Rulon Jeffs (Warren's father) pulled the sect away from the secular world, eventually banning not only virtually all television programming, but children's literature (really, pretty much any literature that wasn't FLDS material), imposing sometimes bizarre dress codes and the trademark FLDS hairstyle for women, and how he created a school, run by his son Warren, where children were taught very little conventional educational material, but in which some were reportedly sexually abused by headmaster Warren Jeffs. The FLDS aren't the Amish.

Moreover, the emphasis within the community is on "keeping sweet". Prior to Rulon Jeff's becoming "prophet", young girls were allowed to express some preference in terms of who they married, albeit one attributed to messages delivered to them through prayer. But if you didn't "keep sweet", meaning capitulate to the church and male authority, you could find yourself married off to just about anybody. Call it consensual if you will, but when the prophet tells a teenage girl (or adult woman) "this is your new husband", and he gets to force himself on her, that sounds to me like rape, and not (just or even necessarily) of the statutory sort. (According to the author of Lost Boy, Warren Jeff's nephew Brent, some of the men in the community very much enjoyed that moment.) If you were married and had children but didn't "keep sweet" you could find yourself sent away, separated from your children. Oh, and having the prophet marry you off is a "blessing" - have you guessed yet? If you're keeping sweet, you don't reject a blessing.

On the other side of things, teenage boys could be sent away for not "keeping sweet", in some circumstances to other compounds where it was intended that they learn to capitulate. Girls could become "poofers" - being simultaneously sent away and married off to a man they had never met, with no way of knowing if or when they would see their parents or siblings again. For others, whether for not "keeping sweet" or for being too much of a potential challenge to the prophet, banishment follows - they become the lost boys, separated from their families, without any real world knowledge, and with few other than each other to turn to for support.¹ They come out of a culture of dependence, a world where control is kept in no small part by not letting people think independently - giving people little input into even the mundane decisions of everyday life - which not only leaves them unprepared for the outside world but, as Brent Jeffs describes, can at times inspire a longing to return to that world where you don't have to make decisions.

Brent Jeffs explains how his father came to leave the church. One of Brent's older brothers, who had married, had a baby die of SIDS. Their father allowed him to come home and held a funeral. Brent's father was called in by the prophet, his own father, and was told that for "harboring gentiles" he had a choice: He was to be stripped of his wives, and that his wives and children would be assigned to other husbands, and he could be on probation inside the church, or he could leave the church but his wives would still be assigned to other husbands. Do you think the wedding nights following reassignment would be consensual in any meaningful sense of the word? Does this still, to Professor Bernstein, sound like it could be an ultra-Orthodox Jewish community?

I don't think there can be any doubt that the polygamous sect depicted in Big Love is styled after the FLDS sect headed by Rulon Jeffs (who seems to be the model for the prophet in the show, Roman Grant) and Warren Jeffs (who seems to be the inspiration for the closeted homosexual, patricidal son, Alby, who hungers to take over the role of prophet). So when Professor Hamilton speaks of "the 'Big Love' scenario, the community needs a three-women-to-one-man ratio", she should consider the importance of that number to the FLDS. Under the teachings of that sect, a man must have not less than three lives in order to become the god of his own world after he dies. (No, I'm not making that up.) If a young man does not keep sufficiently sweet, and does not devote himself sufficiently (in the sometimes arbitrary eyes of the prophet) to the church, he won't be promoted through the priesthood, and he won't be awarded the wives he needs to become a god. (Really, I'm not making that up.)² Yes, that number does create the imbalances Professor Hamilton describes, but it's a real-world imbalance, not one confined to an HBO drama.

Watch a movie like Osama³, and consider the Taliban. Take away the burkas and public executions, and for a young woman how much distance is there between life under a Warren Jeffs-style prophet and life under the Taliban?
__________

1. Alcohol and drug abuse appear to be enormous problems for the "lost boys".

2. And fossils? They're not proof of the age of the world, or of past life on Earth, but are parts of other, failed worlds that were recycled to make our world. No, I'm not making that, up, either. FLDS "science" makes those "evolution is just a theory" stickers seem downright scientific.

3. The "Osama" of the film is a young girl, not Osama bin Laden.

More Pay For Less Work!

Who wouldn't want that? That's an admittedly uncharitable interpretation of an argument frequently raised at MedRants in relation to primary care providers. Primary care providers are compensated poorly in comparison to many specialists and, although compensated quite royally in comparison to the average working adult, that's the measure a lot of medical students use when choosing their eventual field of practice. Also, the current insurance compensation scheme pays per service provided, so to maximize income healthcare providers need to cram more patient care into less time. So we're presented with two arguments,

1. It will improve patient care to allow doctors to spend more time with their patients, and thus compensation schemes should be adjusted to compensate doctors for their time as opposed to by service or procedure provided; and

2. To encourage more doctors to enter the field of primary care, where more practitioners are desperately needed, we should increase their compensation to a level that approaches or matches the compensation received by specialists.

On their surface, both of these proposals seem reasonable. The problem is, they would both massively increase the cost of healthcare and would not necessarily provide the anticipated return in the quality of patient care.

The notion of paying per service or procedure appears to come from the idea that a particular action by the doctor could be performed in a set number of minutes, and compensation should be tied to performance and not to time actually spent with a patient. The efficient doctor sees more patients and earns more money. A doctor who is less efficient earns less money. I do have sympathy for a doctor who attempts to improve patient care by spending more time with each patient, sometimes a lot more time, and that doing so often will benefit patients.

The problem is, no insurer or employer will ever completely abandon efficiency measures. Doctors getting paid a salary will be expected to complete the work assigned to them. Those compensating doctors for the services they provide will never approve of a system where a doctor is paid to spend an hour talking to a patient before performing the procedure or service that brought the patient to the doctor. Many patients would like the opportunity to spend more time with their doctors, and concierge practices usually do provide that possibility, but few can afford that luxury.

I will grant that a salaried doctor can negotiate with his employer to have more time to spend with patients, and as the cost of the doctor is fixed the employer will be able to make budget and staffing decisions with that negotiated workload in mind. But for doctors who aren't traditional employees, as soon as you bring efficiency into the equation we're back in the same situation. Whatever the compensation, if it's possible to earn more by cramming more patients into the day, many doctors will do exactly that. And the doctors who choose not to do so will once again complain that they're being undercompensated in relation to their peers because of the time they're spending with their patients. Remember, the issue isn't that doctors can't spend more time with patients even under the current compensation scheme - the issue is that they want to be able to do so while earning the same or more money.

Another approach might be to assign an amount of time to each medical service, such that doctors would be compensated by the service, would have ample time to spend with their patients for each procedure, while capping the number of minutes they could claim for any particular day's work. I don't think it's much of a solution, as even assuming the limits could be policed and enforced, some doctors would invest that time in patient care while others would see it as a mechanism for getting out of the office by noon each day - see patients as quickly as possible, then call it a day. Meanwhile doctors would be able to see fewer patients, exaggerating the already existing shortage of primary care providers. As you can see, I'm having a hard time envisioning a compensation scheme along this line that would actually work.

The proposal to pay primary care physicians more isn't of itself unreasonable, as it does appear that the best way to attract more physicians into primary care is to reduce the differential (or anticipated differential) between primary care earnings and specialist earnings. Another way to tackle the issue might be to reduce compensation for specialist care and use that money to boost primary care compensation, but that would be a complex undertaking and I expect that it would be vehemently resisted by doctors.

But aren't we really just presenting another twist on the concept of "relative poverty" - that poverty shouldn't be measured by what you do or don't have, but by comparing your assets and income to those of your peers? If we were to simply offer an across-the-board increase in the amount provided as compensation for primary care services, how long would it be before specialists were demanding a similar raise? (I don't think the ink would even be dry on the new compensation schedule before those demands came in). And if granted, we're back where we began - with a continued, significant differential between primary and specialist care, with a similar distortion of how medical students choose their areas of practice - but at a significantly higher cost to patients.

Although Dr. Centor links with approval to the argument that medicine should not be about money, and granting that his primary concern is to improve the quality of medical practice and not doctor compensation, the only incentives he points to and the only reforms he proposes revolve around money. There are other approaches to the problems that could be discussed. For example, even though I'm sure Dr. Centor could provide a good argument why doctors would do the job better, patients with more complex health needs could be assigned a case manager, LPN, or physician's assistant to monitor their care and help them better understand their options at a significantly lower cost than assigning those same tasks to a doctor.

I appreciate Dr. Centor's argument that "We must eschew any system that discourages us from spending time with patients", but I unfortunately have yet to hear any explanation of how that can be done except in the context of concierge medicine, or possibly by somehow bringing a Mayo-style (salaried) practice to the rest of the country.

The Poseidon Recovery

Recall the scene from the Poseidon Adventure where the captain sees a tsunami coming toward his giant ocean liner, and orders the ship turned? The ship banks dangerously, but it's much too slow. And, to put it mildly, things don't go well for most on board. The captain can't be blamed for the tsunami, or for trying to avoid having it capsize the ship, but sometimes no matter what you do you are going to be overwhelmed by forces larger than yourself.

President Obama was sworn into office as an economic tsunami hit the nation. After (ahem) bailing out the banks, he proposed a stimulus bill that would arguably help create jobs in an economy that did not appear able to do so. The immediate reaction from the right was either to do nothing, or to cut taxes for the wealthy. Once the stimulus bill passed, many immediately demanded to know why it hadn't worked, even though it hadn't been either funded or implemented. As if the U.S. government, an entity that makes the Poseidon look nimble, can turn on a dime. From the other side, Obama was pressed to do more, and to do it faster - a bigger stimulus bill. But Congress lacked the urgency of the crew of the Poseidon, perhaps because it was primarily other people who needed to be protected from the economic tsunami, and although Obama can be fairly criticized for making a lot of up-front concessions to try to gain Republican support I'm not sure how much more Congress would have given him under any circumstance.

Now we look like we're poised to have, at best, a U-shaped recovery of the employment market. The economy is doing better, but it's still shedding jobs. There are lots of things the government could spend money on, with Bob Herbert (for example) proposing:

A massive long-term campaign to rebuild the nation’s infrastructure - which would put large numbers of people to work establishing the essential industrial platform for a truly 21st-century American economy - has not seriously been considered. Large-scale public-works programs that would reach deep into the inner cities and out to hard-pressed suburban and rural areas have been dismissed as the residue of an ancient, unsophisticated era.

But massive, long-term job creation schemes aren't going to fix things this year or next year. There is a need to improve our nation's infrastructure, and there's little question but that the inner cities can't be physically cleaned up (removing abandoned buildings, environmental clean-up, creating viable brownfields for redevelopment etc.) without a massive investment of government money, Good public policy arguments can be made for that type of investment. But to me it's not clear that it's the best way to create new jobs, let alone to create them quickly.

It's easy to suggest that Obama "needs to do more" about one crisis or another - we have any number of huge crises to deal with. The hard part is figuring out what to do - what will work. (And although I'm skeptical of the motives behind Republican opposition to the stimulus bill, sometimes the answer truly is that "nothing will work", "nothing will work fast enough to matter", or "despite the need, that proposal isn't the best way to use our nation's resources.") I'm a proponent of long-term thinking, and of trying to make our society better and more sustainable for the next generation. But I suspect that to create jobs over the short-term, the ideas proposed by Herbert would have had to have been implemented and funded several years ago.

Wow... Those Are Some Ideas....

Bobby Jindal, a supposed expert on healthcare issues, presents what he contends could be the Republican answer to healthcare reform. His first proposal is straight out of "Hillarycare":

Voluntary purchasing pools: Give individuals and small businesses the opportunities that large businesses and the government have to seek lower insurance costs.

As CNN points out, to date they haven't worked.

Jindal offers up a plate of the usual reform ideas,

• Lawsuit reform - Something it's always fun to talk about, but which now seems to concern the insurance industry so little that it's not a big deal to either party (even if it remains a big concern of doctors). And something that isn't likely to actually bring about cost savings.

• Require coverage of preexisting conditions - Something that only works if there's an insurance mandate. Otherwise the free rider phenomenon makes insurance unaffordable, and you could have the perverse effect of getting healthy people to drop their coverage because they know they'll be able to pick up a plan if they become sick. If Jindal's an expert, he knows that... so why did he leave a mandate off of his list?

• Electronic medical records - Something that may bring about a modest direct cost savings but, if done correctly, could reduce medical error and provide data that could be analyzed to improve healthcare.

• Transparency and payment reform - providing consumers with information about healthcare providers and choices, and making payments "based on outcomes, not volume". The first part, when proposed by Democrats, gets spun by Republicans as "putting bureaucrats between you and your doctor"; I guess this is Jindal's apology? The second part is being tried to some extent with Medicare, although pilot programs haven't done much to reduce costs. The obvious danger of paying based on outcome is that it could lead to doctors turning away high risk patients to maximize their compensation (while also improving their scores on the aforementioned consumer reports on doctor performance).

Okay, Bobby, other than warmed over ideas from the Clinton Administration, ideas that are already being tried, or ideas you've pulled out of of the 2008 candidates' platforms and the Democratic Party's proposed legislation, what do you have?

Tax-free health savings accounts: HSAs have helped reduce costs for employers and consumers. Some businesses have seen their costs decrease by double-digit percentages. But current regulations discourage individuals and small businesses from utilizing HSAs.

As an "expert", Jindal should know that his claim of cost-savings is a half-truth. Sure, costs for businesses providing HSA's along with a catastrophic care-type policy see their costs go down, sometimes quite significantly. But consumers see their costs go up, in part due to how little their insurance actually covers and in part due to the loss of the insurance company as gatekeeper. Is Jindal proposing these plans because he believes in them, or because business lobbyists love them?

Portability: As people change jobs or move across state lines, they change insurance plans. By allowing consumers to "own" their policies, insurers would have incentive to make more investments in prevention and in managing chronic conditions.

There is an obvious problem with that proposal, in that many insurance plans focus on a state or region, and don't have networks of doctors available in other states. But let's assume for the moment that Jindal has a solution to the problem of in-network and out-of-network providers that could make plans work across state lines. There are two things he could be proposing here:

1. Indefinite COBRA - once you're in an insurance plan you can continue to carry the plan with you forever as long as you keep paying the premiums. If you change jobs, your employer could subsidize the new plan. The insurance companies would have to continue plans for anybody who wanted them to continue, even if the original employer dropped the plan.

2. Abolish group plans, and make everybody buy individual plans at vastly higher rates, although perhaps with these fanciful "purchasing pools" negotiating reduced rates for individual plans.

My bet is that Jindal is pushing his party's preference for the latter - abolition of group insurance plans in favor of individual plans that are affordable only by virtue of how little they cover.

Jindal offers a related idea:

Cover young adults: A large portion of the uninsured are people who cannot afford coverage after they have "aged out" of their parents' policies. Permitting young people to stay on their parents' plans longer would reduce the number of uninsured and keep healthy people in insurance risk pools -- helping to lower premiums for everyone.

(Isn't this in the Democratic bills as well?) I guess coverage under the group plans he and his party are so eager to abolish in favor of individual plans are cheaper and better than the plans he hopes will take their place? Because if not, young people would be better off with those new plans, wouldn't they? But seriously, if we're doing this, why not go a step further - let's say we let young people stay on their parents plans, without exception, until the age of 25. Why not 26? Why not 35? Why not... as long as their parent owns the plan? For that matter, why not then allow those young people to participate as full members of their parents' plans, following the "indefinite COBRA" principles previously outlined? Once again, if we're supposed to believe that the Republican alternative plans are going to be at all desirable, even if that right is granted they'll voluntarily drop out of those group plans in favor of the Republican plans, won't they?

Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage)

An idea gleaned from the McCain campaign (and also incorporated in a different way into the current Democratic bills), but watered down into something less than a replacement for employer-sponsored plans? I guess the idea is that the working poor will use tax credits to purchase low-coverage plans accompanied by HSA's they can't afford to fund. Jindal argues that "will help make non-emergency care outside the emergency room affordable for millions and will provide choices of coverage through the private market", but doesn't explain how. Either the tax credits he plans are going to be surprisingly generous, or Jindal expects the poor to somehow get cheap, full coverage policies even as he endorses stripping that type of policy away from working people. Because otherwise, the working poor will still have to get their routine care at the emergency room because, although insured for catastrophe, they won't be insured for that care.

Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy choices or participate in management of their chronic diseases has been shown to reduce costs and improve health.

What does he mean by "healthy choices"? Not smoking? Not drinking? Not using recreational drugs? Not eating too much? Not eating too much fried food, candy, potato chips, etc., whatever your weight? Not being bulimic or anorexic? Not engaging in dangerous recreational activities? Not taking dangerous jobs?

How intrusive will this program be? And who will pay the subsidy? Does Jindal propose mandating that insurance companies offer these rebates, or does he propose that the government will be writing checks to people whom it deems to be making appropriately healthy choices? Will we take people at their word? What will be the consequence of getting caught fibbing? Really, how far does Jindal want the government to insinuate itself into our lives?

On the whole, Jindal's "reforms" largely accord with ideas incorporated into the various Democratic healthcare reform bills. Beyond that, they seem to be intended to let people think that they can keep their plans, and potentially even keep their children on their plans through the end of college or grad school, while producing a stack of incentives to allow and facilitate employers' dropping conventional plans (the ones people like) and replacing them with low-benefit plans and HSA's. McCain's plan meets Newt Gingrich. McCain's reputation for "straight talk" was tarnished in his campaign. (Please note also the prevarications at the beginning of Jindal's editorial.) I guess this is Jindal's roundabout way of saying, "For a Republican, that was straight talk - and then some."

Update: A bit more on why experiments with insurance exchanges have failed:

Texas wasn’t the only state to see its insurance exchange fail. Florida and North Carolina were also unsuccessful. And California, which had the first exchange (established in 1992) and the largest market, shut its doors in 2006. All these state exchanges failed for the same reason: cherry-picking by insurers outside the exchange.

The author's proposed solution, "Insurers have to accept everyone and have to charge everyone the same rates regardless of health status." The former is largely accomplished by eliminating preexisting conditions from the reasons insurance companies can deny coverage. But the latter? Wouldn't that necessarily involve setting one group rate (or schedule of rates) for every person an insurance company insures? If we do that, won't we both eliminate group rates (thus the need for groups) and the need to negotiate discounts (as everybody pays the same rate)? Won't that also encourage insurance companies to try to define their policies to principally benefit people who don't need insurance - their profits becoming primarily dependent upon how few services their insureds require?

The author believes "It would be smarter for Congress to revisit the idea of creating a public plan" than to go with exchanges - if she's correct about the regulatory mess that would be required to make exchanges (maybe) work, that's hard to argue.

Douthat Wants It All (And He Wants It Now!)

No secret, I'm no economist. So when somebody presents an argument premises upon economics that's transparently wrong to me, it's safe to infer that they have no business writing on the subject. Case in point, Ross Douthat. Let's leave aside his political arguments for the moment, and focus on his economic argument. Having noted that there is a massive, growing disparity of wealth in this country, Douthat proposes,

For one thing, the lazy liberal’s cure for income inequality — soaking the wealthy with higher tax rates and cutting taxes for everybody else — simply isn’t going to happen.

Back up, Ross. Wealth and income are not the same thing. Certainly there are many people on the left who argue that higher income taxes on the wealthy can help pay for government, the alternative being a continuation of GW's bloated budget deficits, but I really can't think of any prominent voice who has argued that a higher income tax on the wealthy will significantly affect their wealth. Let's go uber-left, and take a look at Michael Moore's new movie, Capitalism: A Love Story. Moore (making one of the mistakes Douthat also makes, confusing marginal tax rates with effective tax rates) points out that this nation flourished, and many people became fabulously wealthy, under a 90% marginal tax rate. Douthat repeats his mistake with the corporate tax code, noting that the marginal rate "is one of the highest in the West", while ignoring the effective rate.

Second, as Douthat is looking only at pre-tax income inequality, it should be obvious to him that changes in the marginal tax rate do not affect income inequality. If I make $100,000 before taxes, and you make $20,000 before taxes, whether I pay 10% tax or 90% tax our income inequality remains the same. Douthat skips over something near and dear to the hearts of the super-rich - the tax code's beneficial treatment of their primary source of spending money, capital gains.

Third, if Douthat believes that high incomes result from supply and demand, then as effective tax rates go up, so should the income of top earners. That is, it's reasonable to infer that income disparity will increase as high earners get raises to help preserve their standards of living. Their post-tax incomes may be lower than before, but their pre-tax disparity would go up. But perhaps Douthat looks at himself, President Bush, and some of his pundit and editorial page colleagues, thinks of the Peter Principle, and figures that there are ample people who can fill the high-wage jobs such that there would be no pressure to increase their wages to make up for a tax increase.

Leaving aside his confusion over taxes, Douthat's principal argument is a straw man - one he sets up so that he can easily bat it down. First he states,

Liberals, though, have spent decades telling a more simplistic story, in which conservatives bear all the blame for stagnating middle-class wages and skyrocketing upper-class wealth. So it’s fair to say that if a period of Democratic dominance doesn’t close the gap between the rich and the rest of us, it will represent a significant policy failure for contemporary liberalism.

But then he admits,

In part, this is because the Democrats have become as much the party of the rich as the Republicans, and parties rarely overtax their own contributors.

Is Douthat arguing that "liberalism" now means "serving the rich, just like the Republicans"? (He's a self-described Republican - that's how he sees his party's agenda?) He reminds me of his own defense of the Republican Party, that it somehow departed from conservatism and thus shouldn't be held responsible for the ineptitude and destruction wrought by the Bush Administration. He can't have it both ways: If the Democratic party fails to promote equality because it is catering to the rich, its service of its effective base doesn't represent a "failure" of liberalism - it represents the fact that the Democratic Party has abandoned liberalism in favor of serving the wealthy .

Douthat also complains about immigration, arguing,

For instance, inequality is driven in part by low-skilled immigration: it nudges wages downward for native workers, and the immigrants themselves are taking longer to achieve upward mobility than earlier generations did.

Surely Douthat isn't arguing that immigration of low-skilled workers applies downward pressure on the jobs held by the wealthy, or even the bulk of the middle class. He doesn't appear to be adopting John McCain's line, that Americans wouldn't pick lettuce even at $50 per hour, one of the Republican defenses of bringing low-skilled workers into the U.S. He doesn't explain how the effect of a Democratic immigration policy would differ from Bush's idea of bringing in a class of unskilled workers who would never qualify to immigrate, or whether the Democratic alternative would be more stabilizing and help immigrants better establish themselves in the United States.

It does appear that immigration depresses earnings in service fields and the building trades, jobs which historically could provide anything from a decent second income to a decent middle class wage. But in terms of the middle class, isn't the effect of immigration dwarfed by the effects of outsourcing and globalization? Is the problem best addressed by pointing a finger at immigrants and whining, "You're taking our jobs", or by acknowledging that if you want a solid, middle class, upwardly mobile lifestyle in this country, your best bet is to pursue education and to develop specialized job skills?

Douthat brings his social conservatism into play, suggesting that "the collapse of the two-parent household" plays a significant role in inequality, and whining,

But today’s Democratic Party increasingly represents “unmarried America” — the single, the childless, the divorced. This makes it an unlikely vehicle for policies that discriminate, whether through tax code or the welfare state, in favor of the traditional nuclear family.

Okay, we've had Republicans controlling the White House and Congress for much of the past three decades, so remind me: what social engineering feats did they bring about, reducing out-of-wedlock births and strengthening marriage? If the two-parent household continues to collapse after the Reagan "conservative revolution" and after eight years of GW, and we assume that the Republican Party actually cares about strong families, isn't that both a profound indictment of Republican policies and a strong indication that we're not going to stop divorces or reduce out-of-wedlock births through federal social engineering? (Although, as "abstinence only" education shows, we can increase the rate of out-of-wedlock births through ill-considered federal policy.)

Douthat repeats a tired argument on education:

Inequality is perpetuated by our failing education system — and especially by the bloated cartel responsible for educating the nation’s poorest children.

Education is one of those subjects people pretend to care about, but only at the surface level. The Republican "cure" for failing schools is privatization (despite an absence of evidence that it's necessary, will save money, or that it will improve learning, let alone that it's the best approach) and standardized testing. I'm a huge proponent of meaningful improvement of public education at all levels, and I would like to see every inner city child go to school in a safe, orderly, well-maintained facility with quality teachers and administrators. But let's be honest for a moment, and return to Douthat's prior argument against increasing taxes on the wealthy - on their own, "reforms" like "standardized testing", "schools of choice", "vouchers," and "charter schools" don't cut it. If you want to offer quality inner city schools throughout the nation, you need to invest hundreds of millions of dollars in infrastructure, school security, teacher improvement, and wages.

Let's also be honest about the effect of education reform. Let's say that we close the quality gap between schools in the inner cities and those of suburban America, and further close the achievement gap. We would have a bigger than ever pool of high school graduates looking for work. Does Douthat believe that would increase starting wages for high school graduates, or would the effect in fact be similar to that he perceives from immigration? That is, without taking the additional step of helping high school graduates obtain college degrees or obtain specialized job skills, miraculous though our results would be, our efforts should bring about poverty reduction but would continue to fall far short of what it takes to create equal opportunity for inner city youth. We as a nation should be investing in higher education, to make it more accessible and to keep our system (well, arguably at this point, restore it to being) the best in the world. Where's the Republican Party on that?

Douthat suggests that growing government in proportion to the private economy may reduce inequality, and observes that this is "the logic of our current fiscal trajectory: ever-larger government, and ever-slower growth". It's reasonable to note that if you gauge the size of government by comparing total federal spending to the GDP, under Reagan and George H.W. Bush, the ratio was about 22%. The Clinton administration reduced that figure to about 18%. Although G.W. promised to shrink government, under his Presidency the figure bloated back up to about 21%. Douthat closes by arguing that if we end up in an era of greater economic equality, but with larger government and slower growth,

The question is whether Americans will thank [the Democrats] for it.

If in fact the growth of government spending creates "the more egalitarian America that Democrats have long promised to deliver", Douthat has a point - whether or not they like the effect of the growth of government on the nation, it's principally the Republican Party, not the Democratic Party, that people should "thank".

On the whole, Douthat is pushing a familiar canard: that the only policies worth pursuing are those which will bring about overnight change, and if you propose policies that will effect improvement over a longer term, be it a decade, a generation, or a century, that somehow translates into failure. With myopia like that, who can be surprised Douthat's a proud Republican.

So That's What Friedman Meant?

A couple of years ago, Thomas Friedman laid out in explicit detail why he supported the Iraq war:

And what we learned on 9/11, in a gut way, was that [the terrorist] bubble was a fundamental threat to our open society because there is no wall high enough, no INS agent smart enough, no metal detector efficient enough, to protect an open society from people motivated by that bubble and what we needed to do was to go over to that part of the world, I’m afraid, and burst that bubble. We needed to go over here basically and take out a very big stick right in the heart of that world and burst that bubble.

And there was only one way to do it because part of that bubble said, “We’ve got you. This bubble is actually going to level the balance of power between we and you because we don’t care about it. We’re ready to sacrifice and all you care about is your stock options and your Hummers.”

And what they needed to see was American boys and girls going from house to house, from Basra to Baghdad, and basically saying, “Which part of this sentence don’t you understand? You don’t think we care about our open society? You think this bubble fantasy, we’re just going to let it grow? Well, suck on this, okay?”

That, Charlie, was what this war was about. We could have hit Saudi Arabia; it was part of the bubble. Could have hit Pakistan. We hit Baghdad because we could.

If I break that down and try to word it more artfully, Friedman seems to be arguing that:

• A "terrorist bubble" had developed, due to the conception that the U.S. was lazy and greedy, and lacked the force of will to stand up to terrorist attacks.

• We have no real defense against terrorism, as with enough motivation and enough effort eventually a terrorist will be able to get around our defenses.

• We thus must pop the "terrorist bubble" and let the terrorist know that we in fact have that force of will, and that their acts won't weaken our resolve.

• The best way to burst the "terrorist bubble" is to invade a country in the Middle East from which terrorists operate, and demonstrate a willingness to ferret out terrorists even if it means kicking in every door in the country.

• To burst the "terrorist bubble" we could have invaded any country that was part of this terrorist bubble, including Saudi Arabia or Pakistan.

• We chose Iraq over other possible targets "because we could."

Today Friedman rephrases his argument:

Our operation in Afghanistan after 9/11 was, for me, only about “the war on terrorists.” It was about getting bin Laden. Iraq was “the war on terrorism” — trying to build a decent, pluralistic, consensual government in the heart of the Arab-Muslim world. Despite all we’ve paid, the outcome in Iraq remains uncertain. But it was at least encouraging to see last week’s decision by Prime Minister Nuri Kamal al-Maliki to run in the next election with a nonsectarian, multireligious coalition — a rare thing in the Arab world.

Am I missing something, as that doesn't seem entirely consistent with his prior explanation of the war in Iraq - and the omitted element seems larger than what's left behind. ("Suck on this" translates into "nation building"?)

Friedman also argues,

These incidents [involving the recent arrest of suspected terrorists intent on striking U.S. targets] are worth reflecting on. They tell us some important things. First, we may be tired of this “war on terrorism,” but the bad guys are not. They are getting even more "creative."

Thus Friedman is telling us that the "terrorist bubble" didn't burst as a result of the Iraq war, something that surprises few other than Friedman. So that part - the part he argued was the principal reason for invading Iraq (or some other, randomly chosen country in the Middle East) - is conveniently dropped from his present argument.

Friedman also suggests that it is Obama who might transform the war in Afghanistan, described by Friedman as a "war on terrorists" that "was about getting bin Laden", into a "war on terrorism" involving nation-building. Flashing back a few years:

On Wednesday night, [President Bush] celebrated the military's nation-building role, saying that while "the main purpose of our military is to find and defeat the terrorists overseas," members of the armed forces are "also undertaking a less visible, but increasingly important task: helping the people of these nations build civil societies from the rubble of oppression."

Aides to Mr. Bush have said that his change of view began early in his first term, during a visit to Kosovo. But even then, he seemed to draw limits on what kind of nation-building activities he thought were appropriate.

On Wednesday, he celebrated the military's participation in actions that are normally considered civilian.

In Afghanistan, he noted, "Provincial Reconstruction Teams" were "helping the Afghan government to fix schools, dig wells, build roads, repair hospitals, and build confidence in the ability of Afghanistan's elected leaders to deliver real change in people's lives."

Has Friedman been following these issues at all

Taking The Guesswork Out of Psychiatric Medicine

I stumbled across the following:

Researchers with the Centre for Addiction and Mental Health in Toronto said Tuesday they are "months away" from being able to personalize medical treatments for mentally ill patients by using genetics and brain imaging tests.

The project, called the neuroIMAGENE initiative, has been seven years in the making and will involve two evaluations — one that will use DNA testing, the other that will measure brain activity — to determine how a mentally ill patient will react to certain medications and to prescribe the best mix for treatment.

If it pans out, it will be an enormous benefit to recipients of psychotropic drugs, allowing them to avoid numerous trials of various drugs and drug mixtures "to see what works", and potentially allowing the selection of medications that minimize both dose and side effects.

Obama's President of What Nation, Again?

According to Michael Gerson, it's not good enough that the President of the United States evaluate the intelligence provided by U.S. intelligence agencies, consult with U.S. military leaders, and form a U.S. foreign and military policy based upon U.S. goals and interests.

Here is a paradox for President Obama to ponder while traversing the Iranian minefield: If the Israelis were confident that America would act decisively against the Iranian nuclear threat in the greatest extremity, they would be far less likely to act themselves. Lacking that confidence, they may conclude, once again, that delaying the threat is good enough.

No, here's a fact of life. President Obama, like President Bush, is entitled to conclude that a military attack on Iran would not be sufficiently effective to stop a nuclear power program, would not bring about a delay in that program that is significant to justify military intervention, would potentially cause blowback and complication of the U.S. missions in Iraq and Afghanistan (not to mention complicating the situations in Lebanon and the Palestinian territories), and would otherwise be contrary to U.S. foreign policy interests. Israel is a sovereign nation, is entitled to disagree, and is entitled to form its own military policy.

There's no "paradox" on the U.S. side. If Israel chooses to exercise its right as a sovereign nation to attack Iran, despite having been instructed by two consecutive Presidents that the U.S. opposes any such attack, that is their right. We don't owe them a promise that there will be no consequences for such an attack, let alone insinuating that we might carry out an attack so that they "don't have to". Gerson wants to get us into something that could end up like Georgia, round II - a U.S.-backed political leader takes provocative military action in anticipation that the U.S. will back him militarily if that action provokes a strong response. I'll again emphasize, Iran's response could be to complicate or jeopardize the U.S. missions in both Iraq and Afghanistan. Gerson offers this understatement:

If Israeli planes were to fly over Iraq, the reaction against America in that country could get ugly. Palestinian Authority President Mahmoud Abbas would probably be forced to step away from talks with Israel. Iran could escalate the crisis, with missile launches against Israel and attacks from terrorist proxies such as Hezbollah.

Does Gerson have even the slightest idea of what would happen if Iran's border suddenly became porous, whether due to a real or contrived redirection of Iranian military forces to actions other than border defense, enabling hit-and-run attacks against U.S. military supply lines?

If Gerson or certain hawkish Israeli leaders see this, or the Administration's other efforts to advance U.S. military and foreign policy interests in the region, as "inject[ing] considerable suspicion into the American-Israeli relationship", that's really not Obama's problem. Sometimes our goals will conflict with those of even our most reliable allies, and yet we pursue them anyway.

As Gerson admits, his beloved former master, President Bush, held the same position as Obama on military strikes against Iran, and followed "the same basic approach" in dealing with Iran. Moreover, it seemed to be a point of pride for Bush to thumb his nose at the warnings and skepticism of our nation's historic allies. Perhaps Gerson should instead be contemplating how Bush's war of choice in Iraq likely both accelerated nuclear weapons programs in nations like Iran and North Korea, and has painted us into a corner in regard to Iran.

Premature Triumphalism

The Washington Post comments on a study about the performance of charter schools in New York City,

Researchers were careful not to draw conclusions, but they highlighted a correlation to practices such as a longer school day, performance pay for teachers, more time spent on English and effective discipline policies.

That's perfectly reasonable - and hardly surprising. More specifically, the study states,

We are cautious about all of the associations with achievement that we describe above. First, these associations may change as more data are added or more New York City charter schools open. Second, the associations can be difficult to interpret because some policies are routinely found together in packages: an example is the package of a long school year and long school day. It is difficult to disentangle the role played by each part of a package. Third, it is essential to remember that none of the associations we have described is a causal effect. We are not asserting that if a school adopts a certain policy, its achievement effects will rise. One must have causal effects to make such assertions. We cannot tell whether the policies themselves make the difference or whether the policies are merely correlated with factors that do make the difference (great leadership and so on). We strongly discourage readers from treating the associations as though they were causal effects--for instance, by changing a policy based on the estimates shown.

With all these caveats, the positive associations are with a long school year (this is especially strong), the number of minutes spent on English per day, a small rewards/small punishments disciplinary strategy, teacher pay based on performance or duties, and a mission statement that emphasizes academic performance.

None of that's a surprise and, given funding, many of those ideas could be implemented in public schools. So, having acknowledged that the study's authors warn against hasty assumptions or conclusions, how does Fred Hiatt's editorial board respond to these preliminary, and largely intuitive, findings?

Poor children learn. Teachers unions are not pleased.

Um... okay. Well, perhaps that's just a catchy little tagline meant to attract more readers. What else do you have, Fred?

A rigorous new study of charter schools in New York City demolishes the argument that charter schools outperform traditional public schools only because they get the "best students."

You know, the study is worthy of discussion. It introduces an element to the comparison of charter schools and public schools that has been missing from prior studies - an attempt to compare students who have been lotteried in versus those who lost the lotteries and remained in public schools. Not one of the correlations highlighted by the study relate to teaching technique, and not one of the correlations couldn't be implemented in public schools... given increased funding and, in some circumstances (e.g., with increasing the school day or year, or implementing merit pay), following the next union contract. The hardest factor is discipline - charter schools can do things to discipline students and maintain order that public schools cannot - but steps can be taken to improve order in schools and classrooms. It's hardly a surprise that students who are in a distracting, poorly disciplined school or classroom environment fall behind their peers who enjoy calm, orderly learning environments.

What this, the Post's "rigorous new study", highlights is how little research has been done into charter schools, what they contribute, how they compare to public schools, and what techniques can be translated from one set of schools to another. If this is to be taken as proof that underperforming schools should be closed in favor of more charter schools, the Post should be making a perfectly reasonable associated demand: that underperforming charter schools have their charters pulled. I have to tell you, the top performing charter schools posted impressive gains for their students. The Post's case would be much better if they were all performing at that level. We must also remember that we're talking about a school system that's pretty bad; when closing "about 86 percent of the 'Scarsdale-Harlem achievement gap' in math and 66 percent of the achievement gap in English" is trumpeted a great success, you know that the baseline is way below standard.

The study itself is worth reading, and its actual findings are definitely worthy of consideration and additional study. I would go so far as to say, with due respect to the study's caution against "changing a policy based on the estimates shown", underperforming school districts should be contemplating how to implement the factors identified as improving student performance (and newspapers like the Post, if they're going to offer more than words in support of education reform, should back their receiving the necessary funding to do so), and perhaps even implementing them as common sense reforms while we wait for further data. It doesn't seem to me that a whole lot of bad can come out of, for example, a longer school day or school year (assuming infrastructure, compensation and staffing issues are adequately addressed).

Who Wants to Marry Fred Hiatt?

That and other "reality show" alternatives to the Post's "America's Next Great Pundit" contest, from CJR.

The ultimate winner will get the opportunity to write a weekly column that may appear in the print and/or online editions of The Washington Post, paid at a rate of $200 per column, for a total of 13 weeks and $2,600.

Wow. That's really impressive and/or unimpressive.