The Slow, Attritional Death of My Molar Enamel

Every public policy scholar has particular arguments in his or her field that seem so empty, or so obviously wrong, that seeing them causes the scholar to grind his or her molars down to the nub.  Seeing my friend Spencer Ackerman’s article on the Army’s new Stability Operations Field Manual gets at one of my policy pet peeves.  (My boss Chris Preble has more on the topic below.)

First, as an aside, Lt. Gen. William Caldwell claims that we need a stability ops manual because the United States exists in an “era of uncertainty and persistent conflict.”  What uncertainty, exactly?  What period in the past century would Caldwell argue has been characterized by “certainty”?  And how is “persistent conflict” measured?  More sharply, from the Army’s vantage point, hasn’t United States national security policy itself over the past 25 years amplified uncertainty and created conflict?

John Nagl, a retired Army lieutenant colonel and now a scholar at the centrist Center for a New American Security also supports the shift toward emphasizing stability operations, arguing, as have dozens before him, that

The greatest threats we face, arguably, will no longer be from states that are too strong, but from states that are too weak.

In one sense, it is (I mean this sincerely) gracious of Nagl to allow that there is a chance that the greatest threats we face might not emerge from weak states.  It is such an article of faith among Beltway security analysts that weak states are the biggest threat that it demonstrates a broad-mindedness on Nagl’s part to consider that they may not be.

But Nagl’s statement on its face, it’s just occurred to me, doesn’t hold any particular analytic value, let alone policy implications.  We would need to know something about the nature of the second-greatest threat(s) we face in order to make any relative claims about the importance of the greatest threats.  If, on the one hand, the second-greatest threat we face is a combined nuclear first-strike from China and Russia, then it’s crystal clear that we ought to really emphasize stability ops.  If, on the other hand, the second-greatest threat we face comes from the Animal Liberation Front, saying that something is the “greatest threat we face” doesn’t tell us too terribly much.

Down with the B.A., and Long Live Education

That could be the rallying cry of Charles Murray in this month’s Cato Unbound. Suppose, he argues, we were to give the job of designing our higher education system to an expert, and that expert gives us the following proposal:

First, we will set up a single goal to represent educational success, which will take four years to achieve no matter what is being taught. We will attach an economic reward to it that often has nothing to do with what has been learned. We will urge large numbers of people who do not possess adequate ability to try to achieve the goal, wait until they have spent a lot of time and money, and then deny it to them. We will stigmatize everyone who doesn’t meet the goal. We will call the goal a “BA.”

Mad, says Murray. A terrible system.

Education should not be made to suffer under a system like this, and neither should those who want to achieve something with their lives. You can read his proposals for education reform in this month’s Cato Unbound. Education economist Pedro Carneiro will have a reply tomorrow, economist Bryan Caplan of George Mason University will reply on Friday, and education policy expert Kevin Carey will have a follow-up on Monday.

Washington Needs Its Own Tribal Awakening

Over the past month, U.S. forces have struck possible terrorist targets in the vast unpoliced region of western Pakistan known as the Federally Administered Tribal Areas, or FATA. Many of the attacks have been conducted with missiles fired from unmanned planes, and at least one with Special Forces ground troops. These strikes followed a string of operations the Pakistani military launched in August under increased U.S. pressure – attacks in FATA’s Bajaur Agency killed almost 70 militants, wounded 60 others, and displaced 200,000 refugees.

While its true that unilateral missile strikes and commando raids can successfully extinguish high-value targets, the collateral damage unleashed by such attacks may only be adding more fuel to violent religious extremism in this nuclear-armed Muslim-majority country.

FATA has long remained a mystery to the outside world. The region’s deep ravines and isolated valleys – much of which can support only foot traffic or pack animals – is inhabited by fiercely independent Pashtun tribes who adhere to the pre-Islamic tribal code of Pashtunwali. Social values include hospitality (melmastiya), loyalty (wafa), and honor (nang). But one other closely held tribal precept is badal, the Pashto word for taking revenge.

During a visit last month to the frontier region, I spoke with local tribesmen from the South Waziristan Agency. They noted that the collateral damage unleashed by U.S. and Pakistani missile strikes has ripple effects throughout tribal society, provoking a backlash that has inflamed local tribes and triggered collective armed action throughout the region.

U.S. policymakers point to the successful killing of top Al Qaeda militants, such as Abu Laith al-Libi last January and chemical weapons expert Abu Khabab al-Masri in July, as effectively vindicating the military approach. But the fallout from U.S. missile strikes proves strategically problematic for three reasons.

First, missile strikes undermine the authority of sitting Pakistani leaders and further strain already shaky U.S.-Pakistan relations. The August 19th resignation of Pervez Musharraf shows how Washington’s embrace can prove a political liability for “war on terror” allies. It’s also one reason why Pakistan’s new president, Asif Ali Zardari, is reviled by many Pakistanis—among other things—for his pro-American stance, while opposition leader Nawaz Sharif, has seen his popularity soar.

Second, military strikes encourage insurgents to lash out against the government of Pakistan, further eroding U.S. standing in the region. Militants routinely attack law enforcement officials, military outposts and political leaders. Suicide bombers were virtually unheard-of in Pakistan before 9/11, but now strike with increasing frequency and in large urban centers, such as Peshawar, Karachi and Islamabad. I spoke with over a dozen Pakistani government officials in Karachi, Lahore and Islamabad, and it is clear they take the insurgent threat seriously. And despite Washington’s repeated accusations of Islamabad’s duplicity in aiding terrorists, the Pakistani army has lost over a thousand soldiers in direct confrontation with insurgents. Further inflaming internal tensions, the South Waziri tribesmen I spoke to perceive that Pakistani action in the tribal areas are being conducted at the behest of Washington. Any plan to contain the spreading insurgency must originate with the civilian leadership in Islamabad.

The final, and most important, reason to be circumspect about escalating military force in the tribal areas is that it will almost certainly fail. The clans of Pashtun tribes straddling the Afghan-Pakistan border have endured thousands of years of foreign invasion. Time and again, Persian, Greek, Turk, Mughal, British and Soviet invaders have learned these peoples to be virtually unconquerable.

It’s clear that the insurgency cannot be eliminated militarily. But Islamabad’s recent course of cutting peace deals with militants has proved equally ineffective. The deals reduced the Pakistani army’s presence in some of the tribal areas, but such moves merely allowed radicals to make further territorial gains.

A better strategy would be to employ low-level “clear and hold” operations, in which small numbers of U.S. Special Forces and Pakistan’s Special Services Group (SSG) perform limited ground and air operations in and around FATA. Although such a limited presence is less than ideal for a region as expansive FATA, an area equivalent in size to Vermont, a heavier combat presence risks provoking a more hostile response. A limited presence with highly trained forces would be better positioned to root out militant safe havens and deny insurgents a base from which to attack U.S.-led NATO operations in neighboring Afghanistan.

Predator-drone attacks and major military campaigns ignore the history, character and ethos of the tribal regions. The struggle for Pakistan’s border is best waged through as light a military footprint as possible. Blunt force is an antidote that will prove worse than the disease.

Is Barack Obama’s Health Plan a Prescription for Socialized Medicine?

Barack Obama’s health plan would enroll more than 50 million Americans in new and existing government health programs, effectively doubling the Medicare rolls.  It would increase taxes on nearly all workers.  It would give the federal government near-total control over health insurance, by letting Washington control prices and dictate the content of every private health plan in the country.  It would create a new government agency whose research would help government and private insurers ration medical care.  Harvard University and Harris Interactive recently polled Americans who claim to know what socialized medicine is, and found:

  • 79 percent believe that universal coverage equals socialized medicine,
  • 73 percent said that socialized medicine exists when “the government pays most of the cost of health care,”
  • 60 percent consider Medicare to be socialized medicine, and
  • 57 percent believe Obama supports socialized medicine.

Obama has repeatedly voiced his support for a single-payer health care system – the type of plan most people have in mind when they use the term socialized medicine.  Many who support Obama’s health plan, such as New York Times columnist Paul Krugman, do so because they believe the Obama plan would lead to socialized, single-payer system. 

So is Obama’s plan a prescription for socialized medicine? 

Somehow, respectable folks at the Urban Institute, The New York Times, The Washington Post, FactChecker.org, and National Public Radio still say no.  Their reasons boil down to these:

  • It’s only socialized medicine if the government employs the doctors and provides health insurance directly.  But that can’t be right.  There is little functional difference between health care system A, a public program through which the government taxes and spends your money on its health care priorities, and health care system B, a completely “private” system in which the government forces you to spend your money on identical priorities.  What matters is not whether health care is nominally “public” or “private,” but who controls the resources.  Even Center for American Progress scholar Jeanne Lambrew acknowledges that a (nominally) private sector is no barrier to socialized medicine: “the government role in socialized medicine systems [can include] public financing of private insurance and providers.”
  • It’s only socialized medicine if there’s government rationing.  But that can’t be right, either.  Barriers to access occur when the government limits spending below what is required to meet patients’ demand for medical care. To say that socialized medicine only exists when there are waiting lists or other access problems is to make the rather curious argument that socialized medicine would disappear if the government wrote bigger checks.

I offer a more reasonable definition:

Socialized medicine exists to the extent that government controls medical resources and socializes the costs.

In a Cato Briefing Paper released today, I use that reasonable definition of socialized medicine to show how America’s health-care sector is already more than half-socialized, and how Obama’s health plan would take us the rest of the way there.

All That and a 30-cent Mojito

This AP story, which ran in the Miami Herald, is an example of some shockingly bad reporting:

A communist experiment is letting average government workers in this eastern city enjoy a few things only foreigners and monied Cubans can usually afford: a good burger, a kicking jazz bar and stiff cocktails.

Across the rest of the island, average monthly government salaries of 408 pesos, about $19.50, don’t cover grocery bills, let alone a night out. But in Bayamo the central government has made a special effort to support peso businesses, giving the lowly currency actual buying power.

Along the stylish pedestrian mall known as Paseo or ”The Boulevard,” six blocks of restaurants, barber shops, ice cream parlors and department stores give Cubans a taste of tourist life at local prices.

Jazz bands jam for free until 2 a.m. at the Piano Bar, where mojitos go for just 5.50 pesos, or 30 U.S. cents. A 1950s-style diner serves up tasty meatball sandwiches for about half a peso – the equivalent of three cents – and four scoops of the richest ice cream in Cuba for about the same price.

”Almost everyone who comes in is surprised at first. The music is good. The cocktails are strong,” said Ernesto Aldana of the Piano Bar, where the Cuba Libre – copious rum pours with ice and splashes of cola and lime – costs 4.80 pesos, the equivalent of less than 25 cents.

The intended first impression, I suspect: Wow, 30-cent mojitos? What an enlightened country!

My actual first impression: You know a country is having problems when a functioning ice cream parlor makes the international news. And, like everything in life, the experiment comes at a price:

Huge government subsidies are needed. Paseo businesses here take in only 1,000 to 1,700 pesos a day, or $50 to $80. And the program only took shape after Bayamo communists asked central government planners for special autonomy and won the right to sell regionally produced items such as rum, seafood, beer, yogurt, beef, ice cream and cheese to local residents, rather than shipping them elsewhere on the island.

”We would see products like powdered milk made here and sold somewhere else and we said, ‘How is this possible? If we make it in Granma, we should be selling it in Granma,”’ Alonso said.

However, rising global commodity prices have made Bayamo’s government subsidies more costly, while hurricanes Gustav and Ike in recent weeks dealt serious blows to Cuban food production.

The government recently ordered all provinces to contribute more food to all parts of the country and reduce Cuba’s dependence on foreign imports, said Humberto Rondon, technical director for production at a state cheese and ice cream factory outside Bayamo. In Granma’s case, officials will now have to ship about 80 percent of its cheese to points elsewhere in Cuba.

Despite the hurricanes and rising food prices, the Bayamo experiment is so successful that the central government in Havana is continuing to devote $10 million this year to reopen some peso businesses and cover operating expenses of those already established, Alonso said.

There are ordinary peso businesses all over Cuba, but the products are shoddy and service is mediocre. Shortages of everything from potatoes to pasta mean most of the dishes listed on peso restaurant menus aren’t available, while peso stores have long lines of customers for mismatched inventory on largely empty shelves.

Think this through: The state supplies the goods, supplies the money to “pay” for them, and supplies the money needed to keep the “shopkeepers” running their make-believe businesses. Generously, the state even deigns to let some privileged people occasionally feed themselves with slightly less supervision than usual. How kind of them!

It then declares a success. In reality, all that this “experiment” proves is that it’s possible to have a really good time on someone else’s money. But all good communists know this already.

What they really want from the “experiment” at Bayamo is not economic reform, but a steady stream of gullible reporters, each thinking that communism somehow magically produces something from nothing, at least once in a while. In that regard, the experiment has been a success: While our intrepid reporter appears to have gathered all the relevant facts, and even to have relayed them accurately, he never bothered to connect them, or to draw the picture as it really is. He reported on a fraud, relayed the facts that show it to be a fraud, and never once declared the thing for what it was.

One thinks of the old adage: Five minutes’ thought would have sufficed to solve this problem. But thinking hurts, and five minutes is a long time.

False or Misleading in Every Particular

Barack Obama currently has the following health-care ad in the field. 

It’s an effort to make Obama’s health plan appear moderate.  That’s quite a trick, considering the plan might give Washington more control over the health-care sector than the Clinton health plan.  So pretty much the only way they could create the appearance of moderation was to write a script that is false or misleading in every particular.

The ad begins:

Health care reform.  Two extremes.  On one end, government-run health care, higher taxes.  On the other, insurance companies, without rules, denying coverage.  Barack Obama says both extremes are wrong. 

Those are not opposing extremes.  In fact, Obama pursues government-run health care, higher taxes, and insurance companies denying coverage, all at once. 

  1. Obama expands government-run health care.  Obama proposes to create a new government-run health care program modeled on Medicare for people under age 65.  One estimate suggests that program would enroll 45 million Americans.  He also proposes to expand Medicaid and the State Children’s Health Insurance Program.  Those expansions would enroll at least another 6 million Americans in government programs.  He also gives government a great deal more control over private-sector health care.  (See below.)
  2. Obama pursues higher taxes.  Funding those government programs will require higher taxes.  Obama admits he would raise taxes on those earning more than $250,000 per year, but that’s just the tip of the iceberg.  Obama would increase taxes on (nearly) all workers.  His proposed “pay or play” employer mandate would take money out of workers’ paychecks before workers even see it.  Finally, Obama would require insurance companies to charge healthy 18-year-olds the same premiums as 55-year-olds with multiple chronic conditions.  That constitutes a further tax on young and healthy workers that would force them to pay far more in premiums than they generate in costs. 
  3. Obama encourages insurers to deny coverage.  If the average 18-year-old makes $1,000 in claims per year, the average 55-year-old makes $20,000 in claims, and each pays a premium of $12,000, whom will insurance companies court, and whom will they avoid?  By requiring insurers to charge everyone the same average premium, Obama guarantees that insurers will avoid and provide lousy care to the sick whenever possible.  That problem already exists in states with community-rating laws and the Medicare program.  It doesn’t even matter if insurers deny care to the sick deliberately or not; Obama would reward them even if they do so unintentionally.  Finally, Obama proposes a new federal agency whose very purpose is to help insurers deny care.

The ad continues:

His plan.  Keep your employer-paid coverage.  Keep your own doctor.

Actually, once Obama gives himself the power to dictate the price and content of every health plan in the nation, his first act would be to eliminate the most affordable 30-50 percent of health plans currently on the market.  At the same time, his National Health Insurance Exchange would set off the ol’ adverse selection death spiral, which numerous studies suggest would eliminate comprehensive health plans from the market.  An awful lot of Americans would have to switch health plans, and would lose their doctors in the process.  Those who go from private to Medicaid coverage are going to have an awful time finding a doctor.

Take on insurance companies to bring down costs.  Cover pre-existing conditions and preventive care.

Nothing in the Obama plan would “take on insurance companies to bring down costs.”  Covering pre-existing conditions would increase costs.  Obama proposes to force insurance companies to spend less on administration and more on claims, but that too would increase costs.  The insurance companies will just game and lobby Congress until Obama’s plan works to their advantage. 

Obama claims he would boost preventive care.  Yet his National Health Insurance Exchange would let people switch plans every year, giving insurers absolutely no incentive to invest in consumers’ long-term health.

Common sense for the change we need. 

Um, yeah.

“I’m Barack Obama, and I approved this message.”

Well, I suppose that part is true.

There is one ray of hope.  The beginning of the ad says that Obama thinks that “government-run health care [and] higher taxes” are “wrong.”  Maybe, with enough persuasion, we can turn him against his own health plan.

A Plan for Nation Building

To some fanfare, the Army has just released a new field manual, FM 3-07, Stability Operations [.pdf, 13.4 MB], which Lt. Gen. William B. Caldwell, IV, the commander of the U.S. Army’s Combined Arms Center, calls “a roadmap from conflict to peace, a practical guidebook” that “institutionalizes the hard-won lessons of the past while charting a path for tomorrow.”

Well.

Don’t get me wrong: it would certainly be a wonderful thing if we could figure out a way to achieve a peaceful world, but thinking that one has “a practical guidebook” to do so strikes me as naive.

I’m even more troubled by the presumptions underlying the new doctrine.  

In the foreword to FM 3-07, Gen. Caldwell writes:

America’s future abroad is unlikely to resemble Afghanistan or Iraq, where we grapple with the burden of nation-building under fire. Instead, we will work through and with the community of nations to defeat insurgency, assist fragile states, and provide vital humanitarian aid to the suffering.

I understand from a political perspective why it is important to differentiate the wars of the future from the wars of the present, especially Iraq. With 60 percent of all Americans believing the Iraq war to have been a mistake, you don’t get off to a good start by telling the public that the new doctrine will make it easier to fight future Iraq wars. Of course, FM 3-07 isn’t addressed to the public at large, or, to the extent that it is, one rationale for it is that had FM 3-07 existed in 2002, we might have avoided some of the mistakes in Iraq. Further, the public remains supportive of the mission in Afghanistan, despite our recent difficulties there, and the authors of FM 3-07 no doubt believe it will be useful there.

But how can we be so sure that future nation-building missions will not be conducted under fire? Are we so confident in the preventive measures set forth in FM 3-07 and elsewhere that we think we’ve discovered the secret to stopping wars before they begin? And with respect to working “through and with the community of nations” to fight common challenges, presumably this is the same community of nations that refuses to fight in Afghanistan, that shrinks by the day in Iraq, and that, generally speaking, has allowed its military capabilities to atrophy? (China and Russia being among the few exceptions). Count me a skeptic on all three counts.

The broader misconception underlying FM 3-07 is even more problematic. The manual asserts as a given that “the greatest threat to our national security comes not in the form of terrorism or ambitious powers, but from fragile states either unable or unwilling to provide for the most basic needs of their people.” Justin Logan and I took aim at this argument nearly three years ago, and again more recently, but the notion is now widely held across the political spectrum.

Notwithstanding the bipartisan enthusiasm for nation building, I stand by our original argument: most failed states do not represent a threat to U.S. security, and some threats emanate from perfectly healthy states. Given this, a blanket supposition that we must fix failed states in order to be more secure is badly mistaken.

Further:

If the costs of successfully administering foreign countries were low and the prospects for success high, the new strategy might make sense. However, a simple look at what it takes to “get nation building right” demonstrates that the costs of making nation building a core object of U.S. foreign policy…would greatly outweigh any benefits.

I returned to that theme last year with Ben Friedman and Harvey Sapolsky, in a paper deconstructing the inordinate faith, also expressed in FM 3-07, that better interagency coordination holds the key to success in nation-building operations. We noted “The trick in politics is not having the right plans; it is having the power to implement them. And in societies our military occupies, the power of the United States is severely circumscribed.” We continued: 

The functioning of a modern state requires the participation of millions of people who show up for work, pay taxes, and so on. People do these things because they believe in a national idea that organizes the state or because they are coerced. In attempting to build foreign nations, the United States is unable to impose a national idea and our liberalism, thankfully, limits our willingness to run foreign states through sheer terror.

If the United States occupies a country where the national identity is intact and simply assists in the management of its institutions and in security, state-building may succeed. But success requires the cooperation of the subject population or a goodly portion of it. That is not something that we can create through planning.

If we are right, first, that security is still necessary (but hardly sufficient) to achieving success in nation building, and second, that even the most well-executed plans for nation building are likely to fail, then we are in danger of merely compounding our past errors: absolving other countries of their primary obligations to provide security for their own people, and placing the burdens squarely on the shoulders of all Americans, but especially on the American military. Meanwhile, we will have signed up for an overarching strategy that will be extraordinarily costly in money and lives, time consuming on the order of decades, not years, and that ultimately depends upon the cooperation of the population within the host nation, cooperation that often will not be forthcoming.

One final point: we have allowed others to free ride on our stated willingness to play the role of global cop, a posture that FM 3-07 accepts as a given. The manual ultimately can’t address that deeper problem, however, because our military’s missions are driven by the policy choices of our civilian leaders. That said, the new doctrine seems to assume too much about the nature of the fights we are in, and that we are likely to be in in the future. If those within the military establishment aren’t willing to sound a cautionary note, then that cries out for dissent from outsiders.