April 18, 2006
The Price of Efficiency?
Kevin Drum links to a revealing piece in the WSJ from Benjamin Brewer, a physician who has 'seen the light' on the absurdity of employer based care and the labyrinthine, inefficient, industry it has created. But there's a telling thorn in the excerpt Drum picks out, where Brewer writes that, compared to the current staff his office has to maintain "I suspect I could go from four people in the paper chase to one with a single-payer system."
In the end, the American health care industry isn't just about the consumer, it is about providing massive numbers of good-paying, high-skills labor, and any significant restructuring or elimination of redundancies in the system is going to have to confront the potential dislocation of those good jobs. Yet, at the same time, it is important to remember that the beauty of health care is precisely that it is such a high growth industry, and that much of this is positive growth rather than bloat, i.e., new technologies that require ever more skilled workers for jobs that can't be outsourced anywhere.
February 13, 2006
Cheney slaughters for fun
Sick. The hunting trip this weekend in which the vice president accidentally bagged a fellow hunter wasn't so much a "hunting" trip as a "slaughtering penned animals" trip. Now, I don't have a problem with regulated hunting. I don't do it myself, but I hardly think the government ought to be able to make it illegal. Hell, as a recovering vegetarian, I think hunters have a lot more right to their burger than I do.
This is a touch different, though. The canned hunt which the VP participated in went like this:
"This wasn't a hunting ground. It was an open-air abattoir, and the vice president should be ashamed to have patronized this operation and then slaughtered so many animals," states Wayne Pacelle, a senior vice president of The Humane Society of the United States. "If the Vice President and his friends wanted to sharpen their shooting skills, they could have shot skeet or clay, not resorted to the slaughter of more than 400 creatures planted right in front of them as animated targets."
It reminds me of nothing so much as the passage in Rebecca West's Black Lamb and Gray Falcon in which she describes the private hunts of Archduke Ferdinand as a symptom of both his own madness and the rotted spiritual core of the Austrian Empire. Ferdinand had a hunting blind set up on the grounds of his private estate, and would sit there alone for days as servants released animal after animal into a small clearing to be shot. Ferdinand became almost addicted to the sadistic sport, to the point where it even horrified fellow royals who were surely no strangers to hunting. In the hour before he is felled by Princip's bullet in Sarajevo, West imagines him confronted by a vision of the accumulated beasts he has slaughtered, smothering him in a crush of ghostly fur and feathers.
Now, Franz Ferdinand's taste for authoritiarianism surely makes Cheney and his transgressions look like Nelson freaking Mandela. But at the same time, one has to wonder what kind of man pretends this is a sport, and what such a man is capable of tolerating.
February 07, 2006
Islamofascism--now with pictures
Greg Djerejian has a great post on the Danish cartoon fracas here. In short, while the actions of the Muslim protesters are obviously heinous and have no place in a free society, he doesn't see much courageous about the Western right's call to "live free or die" and "stand in solidarity" with the cartoons.
I would take that one step further, and note that it betrays the right's fundamental hostility to Islam, the hostility which makes their politics ultimately incompatible with the United States' stated project of strengthening the hand of moderate Muslims and midwifing Muslim nations out of tyranny.
And yet, I understand where the hostility is coming from. The West has a big problem with Islam, and there are legitimate reasons for this, considering that significant sectors of Islamic practice across the globe remain way out of step with Western mores and values.
Unfortunately for the right, the plain truth is that the ONLY way to repair that divide, and to make peace with growing Muslim populations in the West, is to lower alienation and shore up moderate Islam. Clearly, this isn't impossible, as vibrant Muslim communities in the U.S. attest. But it means Western societies must shoot for engaging Muslims as they do other minorities, not engineering pitched culture wars. In the case of a mainstream newspaper publishing blatantly offensive cartoons, that would surely mean widespread repudiation of the images and calls for an apology from both politicians and the public. In the absence of an apology, that newspaper would be marginalized to the fringes of political debate.
I understand why this example doesn't fit the usual pattern of course--the threat of violence from a part of the Muslim population has been duly demonstrated. But the hard fact is that the West must be--and is--the bigger man here. By coming at the situation as the right does, elevating the lashing out of a downtrodden population to a threat on the order of Soviet Russia, we risk falling into the trap of a sort of asymmetrical culture war. The pitfalls are the same as in real asymmetrical warfare--namely, guaranteed failure if you're fighting an enemy you need only subdue with tactics designed for annihilation.
It comes back to the fact that certain conservatives continue to push the idea of a straight line between torching the Danish embassy or protesting with hideous slogans and 9/11. If I were in a less charitable mood, I might note similarities with the lines earlier conservatives drew between garden variety American communists and Kruschev. In any event, its a basic, and wrongheaded conflation of the real national security threat and a long term globo-cultural problem, which cooler heads must ultimately address.
The question is moot
It's fairly clear now that the fallback position for defending the NSA program is that other guys did it too. In the SOTU, we got: "Previous Presidents have used the same constitutional authority I have, and federal courts have approved the use of that authority." The good people over at The Corner can't stop with this line, and now we have Alberto Gonzalez with this gem: "Presidents throughout our history have authorized the warrantless surveillance of the enemy during wartime, and they have done so in ways far more sweeping than the narrowly targeted terrorist surveillance program authorized by President Bush."
As Kevin Drum points out, all this is just plain moot, since the issue here is whether there was transgression of ACTUAL LAWS, and the actual law in this case, the FISA Act was passed in 1978. But of course, the WH playbook dictates the response to every criticism is to ruthlessly exploit the public's natural ignorance about the fine points of complex accusations. I suppose I see how everyone in public office has the right to spin stuff to their best advantage, and that its naive to think public officials would sacrifice political survival to let the other side's points drop where they may. But still...watching this spectacle again and again makes one wonder about the long term effects of so blatantly manhandling the public's knowledge. Will another administration be able to go back to marginally more honest rules? Or are we facing permanent warfare based on who controls the most easily digested interpretation, regardless of whether it blatantly contradicts the facts of the case?
January 31, 2006
Could it be?
Tonight's SOTU is going to be lame, rehashed, cringe-inducing, etc., etc., etc. But one bright spot remains. Recently elected VA governor Tim Kaine is giving the Democratic response, and potentially saving us from the only thing more depressing than Bush's last 5 SOTUs--the rejoinder from Democrats afterwards. At least they now understand that ol' "Robot Eyes" Pelosi is not a good national TV spokesperson for the party. That's admitting you have a problem. The next step is giving Kaine at least a mildly more encouraging background than the empty offices which the recent responses have been broadcast from. The bafflingly low level of TV IQ on display there (message: Bush is the leader of the free world, Democrats are desk jockeys who no one wants to listen to) was not a good sign, to say the least.
Update: Just kidding. That was wretched. What's wrong with his eyebrow?
January 23, 2006
So health savings accounts it is. I have to say, its a bit baffling. On their face, of course, HSA's are a very, very silly idea.
Anyone choosing to participate in them would see a huge leap in their out of pocket costs, unless they got lucky and miraculously gained the ability to prudently save for their medical expenses, a habit which has been utterly bred out of the population by years of health insurance.
The only people who would see it as a good deal are those who are very healthy and have a crazy amount of cash lying around. Think your rich friend's parents who didn't go to the office and actually got a better deal out of just paying cash for medical expenses.
Anyone in this country who feels the mildest amount of financial strain will take two looks at an HSA, gasp "you want me to pay what??" and run back to their managed care. At the same time, those plans will be slowly bled dry of the young and wealthy, eventually collapsing in on themselves amidst much misery and anarchy. Then comes socialism.
Not a pretty picture. Which is why its all kind of a political joke--I mean, he needs something to propose in the state of the union, after all, and apparently his people are tired of coming up with new ideas to watch them smolder away in the rubble of Republican congressional discipline.
But, giving HSA's the benefit of the doubt as a legitimate contribution to the public policy debate...what the hell do they think makes them so attractive? The beauty of the Social Security scheme, which, to anyone who saw it for what it was, was about as good an idea as HSAs, was that it wasn't sold on the merits. Conservatives spent years building up a whole slew of misleading arguments and data by which to sell privatization. The looming Social Security crisis. The fantastical stock returns. The disappearing national debt. This was a carefully planned out strategy of smoke and mirrors wrapped up in a lot of free market, personal choice bunkum that ultimately failed, but not for lack of trying.
So what's the equivalent for HSA's? They can't be planning to sell them on their face, right? The LA Times says more harping on the "ownership society," but its hard to see how that follows in this example. The "ownership" in privatization was attractive because it was tied to "owning more"--the riches that were to flow from stock-market fueled private accounts. The image of toying with a private account during your working life and then getting a bundle at retirement was always the strongest appeal of private accounts, and it was the opposition's ability to portray that as a pipe dream that eventually neutralized a naturally strong attraction.
But with HSAs? There's no "bundle" to be gained except in medical services, something which doesn't really excite the imagination, to say the least. And besides, any chance private accounts had was predicated on selling them to young people with a very foggy idea of retirement. Not so with getting sick. Even among the healthy twenty and thirty somethings, all but the most comfortable are naturally petrified of life without health insurance.
The dirty secret of the ownership society is that what popular attraction it has really lies in promising imaginary wealth, not in an abstract desire for 'choice' and free-market purity. When the veil is lifted, as it seems to be in the unvarnished HSA appeal, the ownership society has just as much 'pain' as any social insurance tax hike.
January 04, 2006
Bogus Analogy Watch
It appears we're in for a round of "Bush is the new Truman." For all the reasons Larry Johnson spins out here, this is grade-A bunkum. Of course it is. Bush's story crafters aren't really after any especially cogent historical comparison. Instead, they come for one thing: a new angle by which to keep the WOT=Cold War fallacy kicking.
While a damn sight better than the "WOT is World War II," the WOT as the Cold War still leaves a lot to be desired, and in some respects, once we start acknolwedging that fact, we'll be better off. In a sense, the War on Terror isn't really a "clash of civilizations" as much as the Cold War was. There, you had two grand logics of development battling for the third world, both presenting very tangible offers of cash and security. Yet no such grand logic animates the appeal of terrorism. Or at least, nothing novel. Humans living under a system of coercion organized by states will always, somewhere have the urge to engage in terrorism as generally defined. There's not much we can do about this.
At the same time, the transnational terrorist networks which we should be worried about have little to offer any but the most fringe elements of society. On this count, liberal arguments about the 'conditions for terrorism' have actually abetted the late stage justifications for the war on terror. The truth is, there are really no macro solutions to terrorism not rooted in a specific local conflict.
And that's the real problem with the "democracy will fix it" security argument used by the administration. While hard for stubborn liberals to admit, the pragmatic side of liberalism knows its true, and knows that putting faith in a strategy of forcing black/white oppositions is a conservative's losing game.
December 22, 2005
Ezra Klein hits the nail on the head here:
Clinton, since entering the Senate, has glommed onto a variety of controversial culture debates, using each one to courageously defy expectations by taking the highest-polling, right-leaning stance. But violent movies, obscene video games, immoral television shows, and flag burning, while good for media coverage, aren't the pressing issues of the day. And on those debates, from Iraq to health care, income inequality to energy strategies, Clinton has been either silent, incoherent, or incrementalist. With her national profile, she could inject grand new ideas into the public debate. Instead, she's contented herself with popularizing poorly conceived culture straddles that supposedly cut against her "liberalism." It's the worst elements of Bill Clinton's second-term policy impulses married to the most contentless aspects of the DLC's political stratagems. Both the Democratic Party and the country deserve better.
I don't necessarily want a Hillary Clinton campaign in '08, but I understand the argument for it, think it has some merit, and would go along if that's how it shakes out. But there's no use denying that she's become far less appealing as a candidate in recent years. And truthfully, after the soul searching of the 2004 campaign, it just doesn't seem likely Democrats are going to line up for a candidate that doesn't move the ball forward.
December 18, 2005
Checks and Balances
With Friday's revelation that Bush, possibly illegally, ordered the NSA to eavesdrop on domestic conversations, its time to add some perspective to what's really at stake in skirmishes over the Patriot Act, civil liberties, torture, etc. After the Patriot Act passed in 2001, there was good reason why people really concerned with American security considered it more of a sideshow than a first priority. After all, a lot of what was included there was necessary, and, if it was passed in an underhanded way, there were at least sunset provisions on the books and the really egregious violations of civil liberties happening at the time had more to do with treatment of immigrants than specific surveillance powers in the Patriot Act.
For most of the past 4 years, that consensus hasn't changed much. There have been sensible calls for more oversight, and, in fact, some progress made on getting it. While the actual uses of the Act have been maddeningly difficult to pin down, this was as much a Washington pissing match as an actual epidemic of liberties violations. No good to be sure, but something we were generally content to let the ACLU and Russ Feingold keep tabs on.
But today, so far down the road from 9/11, I think we're seeing the country, and Congress, waking up to the fact that there's something much more critical at stake here.
The stability of the checks and balances system to prevent abuses of power today relies to some extent on the good faith of the executive branch. Modern presidents generally acknowledge that it is easier to work within the system to achieve their goals, instead of forcing the system to react against overreach. In addition to executive sympathy, abuse of power is further circumscribed by the institutional values of the permanent government, which function as an imposing obstacle to executives stepping out of bounds.
This understanding allows for more effective government, as the complicated business of the modern state is allowed to proceed smoothly without being constantly wracked by partisan warfare. Instead, the executive preserves the broad parameters of its power and respects Congress as the proper venue for political fights.
But just because that's the understanding doesn't mean it's a rule. And it is becoming clearer and clearer that the Bush Administration is an executive branch that does not share this understanding in any way shape or form. It is sincerely committed to using the authority and leeway at its disposal to ensure a sphere of power as broad and as indisputable as possible. Until recently, they have done a reasonably good job of expanding their power out of public scrutiny or sheltered by dubious legal cover. And they have proven that an executive can really get quite far in the absence of restraint.
Now, however, as these transgressions are coming into the light, we are reaching a critical point at which other participants in the system--the judiciary, the Congress, and civil society actors, will have to decide whether they are going to evoke the balance of powers and push back against the Administration, or simply allow them to reconfigure that balance. The conclusion is far from a done deal. Constitutions are only as legitimate as each party's willingness to enforce its part of the bargain against the others. For the moment at least, recent developments have offer some reason to expect that Congress, the media, and others will step up to the plate and curtail the Administration's ambitions.
Hilzoy culls the relevant sections of The Federalist Papers here.
November 10, 2005
A very simple but powerful point from from Kevin Drum: what if all the headline writers and wagging tongues stopped defining "growth" as GDP growth and started focusing on the median wage instead? Surely some not insignificant part of the bizarro upside-down relationship between politics and the pocketbook in this country (a la What's the Matter with Kansas?) has to stem from the simple fact that our broadly shared impressions of the economy are based on indicators that have only a tangential relationship to general prosperity?