Topic: Cato Publications

Gerecht Misses the Mark

Forgive the length, but below is my humble contribution to the debate that is now heating up over at Cato Unbound.

It is odd that Reuel Marc Gerecht criticizes my colleague Ted Galen Carpenter for looking at America’s successes in deterring totalitarian regimes with nuclear weapons for insights on the prospect of deterring the Iranian totalitarian regime, should it get nuclear weapons. Mr. Gerecht offers soliloquies on the (genuine) oddity of twelver Shi’ism (as does Mr. Luttwak, more briefly), but somehow misses the proper starting point for a discussion of US foreign policy: US interests and the costs and benefits of available US policy options. Indeed, Mr. Gerecht does not deign, at any point in this discussion, to evaluate even briefly the prospective costs and benefits of his preferred policy option: preventive war.

Mr. Gerecht points out that “in a pre-9/11 world, Shi’ite and Sunni radical Islamic terrorism should have been one of those things that scared us the most.” He then explains that “to President Clinton’s shame, he couldn’t compel himself into preemptive military action against the rising Sunni menace. Yet it would appear in 2006 such holy warriors scare Mr. Carpenter not much at all. They should.” (my emphasis)

It is a useful rhetorical device for Gerecht to switch back and forth between Sunni al Qaeda terrorists and the Shiite government in Tehran, but the historical record deserves to be corrected as to Carpenter’s concern about terrorism.

To that end, I would humbly point him to Carpenter’s 1995 Handbook for Congress article in which he warned that

Americans have become targets of international terrorism. Unfortunately, that danger is likely to grow rather than recede in the coming years…

Back to Mr. Gerecht’s case for war. Mr. Gerecht implies that there is something inherent in the regime in Tehran—whether theological or political—that is inevitably pushing us toward conflict with Iran. In so doing, he chooses to ignore the decades-long US policy of meddling in Iran’s internal politics and trying to overthrow the government there; one could start with the CIA-backed coup in 1953 and the 1964 SOFA agreement, to the efforts of Gerecht’s colleague Newt Gingrich, then Speaker of the House, to allocate millions of dollars to attempt to overthrow the Tehran government, to the Iran and Libya Sanctions Act of 1996, to…well, to last week’s meeting at the White House between Mr. Gerecht’s other colleague, Richard Perle, and the NSC’s Eliot Abrams, with a host of dissidents whose publicly stated goal is to overthrow Iran’s government. And to think that the Iranians believe that we are trying to overthrow their government!

As for a brief commentary on the prudence of various policy options, I would refer to a useful analogy offered by Mr. Gerecht’s other colleague, Michael Rubin, in referring to our options in dealing with the Islamic republic:

When faced with a hornet’s nest, the choice to destroy it or leave it alone is better than the compromise of lightly tapping it with a stick.

Agreed. For his part, Mr. Rubin did us the courtesy of openly advocating a full-blown regime-change type assault against Iran, but it is not clear whether Mr. Gerecht is advocating destroying the Islamic republic, or just tapping it with a stick. We would do quite well to learn whether Mr. Gerecht is only in favor of striking the nuclear facilities in Iran, or also attacking the locations of the Iranian Revolutionary Guard Corps, the missile sites, the presumed chemical and biological weapons sites, and the Iranian leadership. Of course, this would lead to a discussion of targeting, which would put hundreds, if not thousands of aim points on the table, and we would ultimately be talking (once again) of a preventive war to remove a foreign bogeyman who supposedly poses an intolerable threat to this, the most powerful country in the history of the planet.

Finally, one is hard pressed to imagine how Mr. Gerecht will explain away the reckless and shameful incompetence of the hawk faction in the Bush administration as described by the Washington Post. The Iranians approached the Bush administration directly in 2002 (after the ridiculous “axis of evil” speech!) and proposed cooperating against al Qaeda, informing the US of the identities of 290 members of al Qaeda that Iran had captured and sent back to their countries. The Iranians proposed further cooperation against al Qaeda. The Bush administration’s response?

Representatives of Cheney and Defense Secretary Donald H. Rumsfeld fought back. Any engagement, they argued, would legitimate Iran and other historic state sponsors of terrorism such as Syria… Participants said Bush’s divided national security team was unable to agree on an answer. Some believe important opportunities were lost.

Why would Iran make such overtures? Moreover, even after being rebuffed, Iran cooperated with the US on al Qaeda by transferring some of them to Afghan custody, and provided the US information on more of them. More to the point, why would the Bush administration turn them down, if they were serious about diplomacy?

The sad irony is that there is no good reason that even hawks like Mr. Gerecht should oppose offering a grand bargain to the Iranians. If the issue is indeed the nuclear program, not the regime, then we lose nothing by putting a deal on the table. We offer an irrevocable international inspections regime of Iran’s existing nuclear program, along with all attendant safeguards, in exchange for full diplomatic recognition of the regime in Tehran, lifting of the US sanctions, and a public pledge not to attack Iran unprovoked. If the Iranians turn such a deal down, there is nothing (except prudence) that would prevent us from then attacking Iran. But Mr. Gerecht seems uninterested in serious diplomacy as a matter of principle.

Mr. Gerecht’s original essay, in addition to the lengthy description of the weirdness of the Iranian government, offers little in the way of policy guidance. Gerecht’s preferred policy, for the Bush administration to “begin a crash course in covert and overt Iranian democracy-promotion, firing all those in the bureaucracies who seek to sabotage the mission” is one that he admits “isn’t going to happen.” And that tells us a good deal about its viability. Or does Mr. Gerecht believe that the Bush administration is somehow at peace with the Islamic republic going nuclear? If so, why all the public fuss about it?

So we end up back at what has become the default neoconservative option, preventive war. Gerecht should at the very least answer Carpenter’s worry about how this third US-initiated war against an Islamic country (this one truly unilateral) in the past five years would go over in the Muslim world. Would it have a negative effect, a positive effect, or no effect on the allure of anti-American terrorism for young Muslim males? Would it deflate, or substantiate the arguments of Osama bin Laden about America’s intentions? Would it help, or harm the US mission in Iraq? What would the Iranian response likely be: for America, for Israel, or for Iran’s neighbors? Would another war serve the national interests of the United States more than it harms them?

These are the obvious questions. Unfortunately, Mr. Gerecht provides no answers.

LEAP on Overkill

The terrific group Law Enforcement Against Prohibition (LEAP) issued a statement today on my Overkill paper:

The concern over escalating police paramilitary raids is a valid one, as this tactic takes us farther and farther away from the concept of civilian policing. This is the natural escalation of fighting a war that cannot be won. The answer to every failure in the “War on Drugs” is to escalate, in terms of dollars spent and civil liberties encroached on. Increased use of the more severe tactics by civilian police is just another example of unintended consequences of a failed policy. The only question is: how much more damage must our society and our cherished civil liberties sustain before our political leaders end the destruction of “Drug Prohibition”?

The endorsement was authored by Jerry Cameron. Cameron’s background:

Jerry Cameron spent a considerable part of his seventeen-year law enforcement career in the “war on drugs.” Not only was he chief of two small town departments for a total of eleven years, he is also a graduate of the 150th Session of the FBI National Academy, the DEA Basic Drug Enforcement Course, and two DEA Advanced Drug Enforcement Professional Institutes.

As you might guess, some other law enforcement officers have been less supportive.

Why Wait to Bomb Iran? Find Out at Cato Unbound!

Gene quotes warmongering Bill Kristol below:

We might consider countering this act of Iranian aggression with a military strike against Iranian nuclear facilities. Why wait? Does anyone think a nuclear Iran can be contained? That the current regime will negotiate in good faith? It would be easier to act sooner rather than later.

Why wait to bomb Iran? As it happens, the best discussion of this question anywhere is happening right next door at Cato Unbound.

In his reply to Reuel Marc Gerecht’s Kristol-compatible brief for bombing, Edward Luttwak says he is not averse to an in-and-out quick strike to impede the develop of Iranian nukes, if it comes to that in the three or more years it will take Iran to develop the bomb. But, Luttwak says, it may not come to that, because there is plenty to be done in the meantime. Luttwak’s Center for Strategic and International Studies colleague Anthony Cordesman says diplomacy could work, and we should keep doing what we’re doing. Bombing might not actually keep Iran from getting nukes, and even if the U.S. exhausts all non-military options, we should at least wait until we know where the targets are. Cato’s vice president for defense and foreign policy studies Ted Galen Carpenter says bombing Iran might trigger a “massive regional crisis,” and that “America’s troubles with the Islamic world do not yet constitute a war of civilizations,” but attacks “could well produce that result.”

Why wait? Well, those are a few reasons. And containment? Carpenter, for one, argues that if we successfully contained a nuclear Soviet Union and China, we can contain a nuclear Iran. Don’t miss the detailed discussion about the future of American policy for this hotspot in the volatile Middle East.

Overkill

balko_whitepaper_300x394.jpgToday, my paper on SWAT teams and paramilitary tactics is finally released. It’s been the thrust of my research for nearly a year, now. It offers a history of SWAT teams, legal background, analysis and criticism of their increasingly frequent use and abuse, and an appendix of case studies that documents more than 150 botched raids.

You can download it for free [pdf]. If you want a slick, bound copy, you can order one for $10, and you’ll also get a copy of Gene Healy and Tim Lynch’s paper on the constitutional record of George W. Bush.

We’re also launching an interactive map to accompany the paper. The map plots every botched raid I’ve found in my research, with a description of what happened and a list of sources. You can sort the map by type of incident. So, for example, if you want to see only those raids where an innocent person was killed, it would look like this. If you want to see raids where a nonviolent offender was killed (a recreational gambler or potsmoker, for example), it would look like this. If you want to see all of the “wrong door” raids where no one was killed, it would look like this.

The map is also searchable by year, state, and type of incident.

Cato’s news release on the paper is here.

Premium Medicine vs. Watchful Waiting

In a response to my defense of health savings accounts, Dr. Hébert makes a thoughtful case for the value added by primary care physicians. One way that PCPs add value is through “watchful waiting”:

It used to be that observation was one of the mainstays of medicine. Now everything is scanned, biopsied, and aggressively worked up because specialists find it easier to bill for expensive procedures than for recurring office visits. This shift away from observation towards aggression runs the risk of hurting patients, and is one of the casualties of the microspecialist system.

The (over-) use of such “premium medicine” is one of the main themes of Crisis of Abundance, a new book by Cato adjunct scholar Arnold Kling. As an illustration, Kling writes about a blogger named Quixote who received intensive treatment for her swollen eye:

My guess is that 30 years ago, a patient with similar symptoms would have been treated “empirically,” a term doctors use to describe a situation for which they do not have a precise diagnosis and treatment, so that instead they must use guesswork. A layman’s synonym for treated empirically would be “trial and error.” In this case, the patient might have been sent home with an antibiotic and perhaps a prescription for Prednisone, a steroid used to reduce inflammation. There would have been nothing else to do. In 1975, computerized medical imaging technology was new and exotic, with limited applications.

In contrast, in 2005, over the course of a few days Quixote was given a computed tomography (CT) scan, referred to a specialist, sent to a different hospital, referred to a specialty clinic, seen by a battery of specialists there, and given yet another CT scan. Ultimately, however, she was sent home, as she might have been 30 years ago, with an antibiotic, Prednisone, and no firm diagnosis.

Compared with 30 years ago, Quixote received more services, in the form of specialist consultations and high-tech diagnostics. However, the ultimate treatment and outcome were no different. This does not mean that medicine is no better today than it was a generation ago. The CT scans and specialist consultations could have turned out differently. They might have been critically important, depending on her actual condition. Under some circumstances, treating Quixote empirically with an antibiotic and Prednisone could have been a mistake, perhaps costing some or all of her sight in one eye.

Such is modern medicine in the United States. Doctors are able to take extra precautions. They can use more specialized knowledge and better technology to try to pin down the diagnosis. They can perform tests to rule out improbable but dangerous conditions. But only in a minority of cases does the outcome deviate from what would have been the case 30 years ago.

That’s from chapter one. The remaining chapters wrestle with the question of when we should make use of premium medicine.

(The Cato Institute will host a book forum for Crisis of Abundance from 12-2pm at Cato on Tuesday, August 29. Kling will present, and the Washington Post’s Sebastian Mallaby and NYU’s Jason Furman will comment on the book. Keep watching www.cato.org for more details.)

More on McCloskey’s Bourgeois Virtues

Following up on Radley’s mention of Deirdre McCloskey’s article on bourgeois virtues, here’s what I just posted at the Guardian’s “Comment is free” site: 

At Cato Policy Report the brilliant economist Deirdre McCloskey of the University of Illinois-Chicago and Erasmus University of Amsterdam (formerly the brilliant economist Donald McCloskey) writes about “bourgeois virtues,” the subject of her new book. McCloskey says that in Western civilization we have traditionally recognized two kinds of virtues — the aristocratic virtues such as courage, and the peasant or Christian virtues such as faith, hope, and charity.

But, she argues, these virtues were developed for a pre-capitalist world of defined social classes. In the United States and an increasing part of the world, very few people are aristocrats and no one is condemned to peasant life. Rather, we are all bourgeois now. We live in commercial society, mostly in towns (the root of the word bourgeois). We’re mostly middle class and engaged in business, as entrepreneurs, investors, managers, or employees, and also as customers.

And since the beginning of bourgeois society, the vocabulary of virtues has been used to berate and denounce capitalism. We’re told that business is based on greed, not on virtue. It may be necessary to modern life, but businessmen are still expected to accept their dubious moral standing. Wouldn’t sharing be more virtuous than selling? Isn’t it better to serve society than to produce wealth?

McCloskey points out that the assaults on the alleged vices of capitalism “led, in the 20th century, to some visions of Hell.” Surely capitalism has proven better than the alternative. But she wants to make a stronger case than that: “bourgeois life improves us ethically.” It has led not just to vast increases in material wellbeing but to civility, religious tolerance, cosmopolitanism, and honesty. She examines how the classical virtues apply in a commercial world. “The leading bourgeois virtue is the prudence to buy low and sell high…but it is also the prudence to trade rather than to invade, to calculate the consequences, to pursue the good with competence.”

She goes on to add temperance — to save and accumulate, but also to look for compromise. Justice is private property, along with respecting merit, not privilege, and viewing success without envy. And so on through courage, love, faith, and hope, the old virtues for the modern world.

McCloskey says that her goal is to take the word “bourgeois” back from its enemies, to make it a term of honor, by showing how the virtues inform capitalism and how capitalism encourages the virtues.

Medicare Reform: Just Give Seniors the Cash

Matthew Holt at TheHealthCareBlog.com raises a good question about Medicare’s renewed effort to offer medical savings accounts to beneficiaries:

Those taxpayers who can do basic math might wonder why you’d want to to give healthy Medicare beneficiaries cash for health services that they’re not going to use, while taking that cash away from the pot that pays for the sick beneficiaries that do use said services. But we’ve asked that question so many times before and no one on the free market side dare answer it. And I guess you might say, why not give the taxpayers money straight to the “healthys” instead of laundering it through Medicare Advantage plans as we’re doing it now so that they can hand out free gym memberships to seniors and boost their executives’ stock holdings.

But given that risk adjustment is coming to Medicare Advantage, it may be that that gravy train is ending.

The Medicare MSA concept raises some interesting problems. Fortunately, Holt solves them — though I’m not sure he knows it.

A bit of background: The Medicare Advantage program currently pays private health insurers a flat amount for each senior those plans cover. As Holt notes, that encourages the plans to seek out the seniors whose medical bills will be less than that flat amount. Thus some plans “hand out free gym memberships to seniors” as a way to attract the healthy, profitable ones and avoid the unprofitable sick ones. That can end up costing taxpayers more than if those healthy seniors just stayed in traditional Medicare. 

But as Holt says, Medicare is working on adjusting those payments according to each beneficiary’s health risk. Instead of some flat amount per beneficiary, insurers would receive a payment from Medicare that better reflects each individual enrollee’s expected medical expenses. That way, health plans would have less reason to cater to the healthy or to avoid the sick. 

But once Medicare risk-adjusts those payments, why should the insurance companies get that money? As Holt postulates and Mike Tanner and I discuss in Healthy Competition, why not give it to the beneficiary? Confine it to health care uses, if you like. Healthy people would get smaller payments; sicker seniors would get larger ones. That would enable each to purchase health coverage (high-deductible or whatever) and still have some money left over for their out-of-pocket expenses. Seniors would get more control over their health care and coverage; they would make much smarter cost-benefit decisions than they do now; and Congress could limit the burden that Medicare imposes on taxpayers.

Is the point of the program to help insurers? Or providers? Or seniors? To whom do we want insurers and providers to be responsive?