Monday, September 21, 2009
I read Tom Ricks's book Fiasco. I read it in the summer of 2007, while traveling to the Pacific Northwest. It was very critical of the way the Bush administration and the military had handled Iraq to that point. I have also read his more recent book, Gamble. The focus of that book is very different, and it takes a much more favorable view of the U.S. military. In particular, Gamble is very high on General David Petraeus, and it gives much of the credit for the "surge" to General Ray Odierno. In this, it is somewhat at odds with The War Within by Bob Woodward, which attributes much of the impetus for the surge to Stephen Hadley, Mr. Bush's second National Security Advisor.
The perception that Ricks has turned into an admirer of the military, somehow reversing his positions along the way, is, I think, as mistaken as the perception that Woodward turned on the White House and changed from an admirer to a critic of Mr. Bush. To some degree, both men may have been victims of the thinking that recent trends will continue. When Woodward wrote Bush at War, the war in Afghanistan was looking like a success, and Iraq had not yet been invaded. When he wrote Plan of Attack, the situation in Iraq was looking very dicey. When Ricks wrote Fiasco, about the same time that Martha Raddatz published The Long Road Home, and Rajiv Chandrasekaran published Imperial Life in the Emerald City, nobody thought that the war in Iraq was going well. There were differences among observers about why it was going so badly, but it was hard to find an admirer of the Bush strategy in Iraq back in 2006-2007.
The surge actually did turn things around, although it did so in ways that may not be sustainable. For one thing, it appears that the Iraqi government doesn't like the concrete barriers Petraeus ordered erected all over Baghdad, and there have been several recent bombing as a result.
In any event, I would urge you to read Ms. McKelvey's article, and read Gamble, and make up your own mind.
This column should be a sobering reminder to those of us who rely on employer-provided health care programs that change is coming, with or without the reforms being pressed by President Obama and the Democrats in Congress.
Sunday, September 20, 2009
Here's the key paragraph on the political front: "That risk is highest for the political division of the Failure Caucus. The conventional wisdom on the right holds that President Obama and his Democratic allies in Congress are setting themselves up for a big fall through their overreaching. But I'd argue that it's the Republican Party, which was always on the side of greater growth, higher stock prices, and more wealth, that has painted itself into a corner. Many Republicans opposed the initial bailouts because they were conducted by an unpopular Republican president in conjunction with a Democratic Congress. (In Todd Purdum's Vanity Fair article, former Treasury Secretary Henry Paulson conspicuously praises congressional Democrats and conspicuously says little about congressional Republicans.) Then they doubled down with virtually uniform opposition to the Obama stimulus bill, which had been watered down to attract Republican votes. In order for Republicans to be vindicated politically, the bailouts and the stimulus—and the economy at large—must fail. Thus considered, every positive data point, every sign of stabilization in the housing market, every rise in the S&P 500, every TARP repayment, is something of a rebuke. As the clouds part, the historic party of economic sunshine is in the strange position of praying for rain."
I think "failure caucus" is a good name for these self-interested prophets of doom, and I think it particularly appropriate that a picture of John Boehner, the Republican leader in the House of Representatives, is at the top of Gross's column.
Thursday, September 17, 2009
Wednesday, September 16, 2009
Sunday, September 13, 2009
The very title of Michael Ledeen's piece shouts out the author's paranoia, panic, and rampant fear-mongering. The lead (or "lede") for the piece is even more indicative of the author's state of mind. "As a global conspiracy aimed at our destruction grows, not only does Obama fail to respond to the threat, but he actively helps our enemies."
The End of the World.
The Russians are coming, the Russians are coming! Ledeen thinks that there is a conscious, intentional, centrally directed conspiracy of the Russians, the Iranians, the Venezuelans, and the Syrians to bring about the fall of the United States. There are a lot of things I could say about this notion, but here's the main one: So what!
All four of these countries are in economic decline, they have fragile or even self-destructive political leadership, and they are incapable of offering a serious threat to the United States. Sure Hugo Chavez hates us, but he's busy taking the Venezuelan economy into a deep-dive into socialist incapacity. Oil prices are down, and that's hurting both Venezuela and Chavez. Syria is exhausting its minuscule oil supplies. Even Iran has so mismanaged its oil business that it is importing refined gasoline at the same time that it ships natural gas to China at bargain prices.
Mr. Ledeen has mistaken the anti-American rhetoric of political elites who are trying to distract their publics from the messes they've made at home. Of course President Obama isn't making a big deal about this "threat;" it isn't worth his time. If Mr. Ledeen and his fellow "conservatives" had as much faith in the capitalist system as they profess, maybe they, too, could refrain from hysteria.
I watched the speech, and I thought that the president got off to a very good start. The first thing he did was to remind us of two of the main problems with the current system:
- About 45 million people have no health insurance, and many, many people are without coverage from time to time;
- Although most people are satisfied with the coverage they have (and that means about 265 million people), many are concerned that they could either lose their coverage, or that their insurance won't cover what they need it to.
Some time ago, I posted about an article in Commentary in which the authors identified three major problems of the health care system; President Obama dealt with two of them. (The third, the increasing cost of Medicare and Medicaid as the population ages, Mr. Obama, like everyone else, sidestepped. That is a scary subject. I'll refer to that later.)
I agree that these are major problems, and I agree that the "President's plan," which is actually embodied in five - that's five - bills in Congress addresses them to a substantial degree. The plan would provide coverage for many of those 45 million people. It would not guarantee coverage for illegal aliens, of whom there may be 10 million in the country. It would prevent insurance companies from denying coverage to people with pre-existing conditions, it would require many employers to provide health insurance for their workers, it would provide subsidies to help poor people pay for their insurance, and it would even require people who don't want (and would say that they don't need) health insurance to buy it.
These provisions, taken as a whole, also deal with the number two problem: concerns about losing one's coverage. The president's plan does not provide for full portability of health insurance from one employer to another, but it does take steps to ensure that people don't lose coverage when they lose or change their jobs. In particular, the provision about pre-existing conditions should reduce the fear that one could lose insurance coverage by accepting a better job.
Taken by themselves, these provisions are going to cost money: $900 billion over ten years, according to Mr. Obama's figures. If we assume that the average employer's policy on a worker costs about $12,000 per year, and that the 35 million additional people to be covered work out to about ten million households, that would come out to $120,000,000,000 ($120 billion) per year, or about $1.2 trillion over ten years, about 33% more than the president's estimate. The total may be reduced by providing low-ball (low-coverage, high-deductible) policies for a lot of the people who are currently without insurance.
The pre-existing conditions provision means that insurance companies are going to have to cover people they have intentionally avoided in the past. That is going to raise rates for everyone, because it is going to increase the risk the insurance providers are taking on. I'm not sure anyone knows how much the insurance companies are going to want to set aside to cover this increased risk.
One of the more interesting points is that this plan does not impose a government run health care system on the country. The U.S. Government is not nationalizing the health insurance companies or requiring them to transfer their policies to a government insurance agency. The proposed public option would be an insurer of last resort, and would probably have trouble competing with the private insurance firms. What remains unsaid is that a very large part of the health care costs in this country are already covered by U.S. Government agencies, and it is their fiscal problems that are going to break the system.
Some 80% of health care costs, that is, payments to doctors and hospitals, nursing homes and other providers, not insurance premiums, goes to pay for care for people over the age of 75. These people are, by and large, not covered by private insurance, but by a combination of Medicare and Medicaid. (Some of them receive services from the Veterans Administration.) In addition, the government pays for health insurance for its civilian and military employees and runs a system of military hospitals all over the world. So the government is already paying something like 80% of the charges incurred by the health care system, and is a significant provider of health care services. These costs are only going up, and the premiums for Medicare are not rising to meet them. What happens if millions of Americans are told that Medicare won't pay for Mom's bills at the home, and that they're going to have to pay for her care out of their own insurance, or out of pocket? Nice question.
Of course, the real question is which of the various Congressional proposals will make it to a conference committee, and what kind of Frankenstein's monster of a bill will be sent to the president for signature. (Remember that Victor Frankenstein was a doctor!) That's when we'll see how serious these people - both Republicans and Democrats - are about reforming health care.