Is That the Best You Can Do?

An update from my blog entry on Friday:  The G8 summit has not given any substantive support to the Doha round of trade talks that I can discern. The best the G8 leaders (minus Russia, who failed to convince the US to sign off on their membership application to the WTO) could do apparently was to issue a statement of encouragement to WTO members to keep negotiating, and a permission slip for the WTO Director-General, Pascal Lamy, to consult with members in the hope of promoting “early agreement” (this coming five years into the launch of the Doha round). The leaders gave Mr Lamy until mid-August to report back on his mission. Note that this call to unblock trade talks was from only developed members of the WTO: Brazil and India, the two most powerful developing members in the WTO, will meet with the G8 today and will no doubt have their own perspective.

The G8 leaders’ statement implied they had come to no agreement as to how to break the current stalemate over trade talks, and provides much less momentum than would have been hoped for. For a group calling for “utmost urgency” in concluding a deal, they sure seem reluctant to do any heavy lifting themselves.

“I Don’t Think We’re Losing”

On ABC News’ This Week, George Stephanopoulos played a clip of a question posed to Army Chief of Staff Peter Schoomaker, asking whether or not we are winning in Iraq. (Podcast here, segment begins at 32:30.)

After an exceedingly long pause, Schoomaker responds by saying “I…y’know…I think I would answer that by telling you I don’t think we’re losing.”

If that’s the most affirmative response the Army Chief of Staff can offer, it’s time for a radical recalibration of our strategy. It’s a cliché at this point—but no less true—that for insurgencies to succeed, they don’t have to win; they simply have to avoid losing. And if we’re not winning, they’re not losing.

As a bonus, be sure to check out George Will lashing the neocons on the same broadcast, noting that the “magnificently misnamed neoconservatives are the most radical people in this town,” and that Bill Kristol’s recent plea for US airstrikes against Iran embodies an approach that wonders “why put off to tomorrow when you can have a war today?”

It’s enough to make you consider watching the Sunday morning talk shows. For more of Will’s wisdom, look to the upcoming Cato’s Letter, which features Will’s address at the presentation of the 2006 Friedman Prize.

Entangled in Iraq until 2016?

The Washington Times reports that U.S. military commanders believe American forces will be needed in Iraq until at least 2016.

There often are bad ideas in the arena of foreign policy. Sometimes there are very bad ideas. Occasionally, there are even monumentally bad ideas. Staying in the Iraqi snake pit for another decade belongs in the third category. As Cato scholars explain here, here, here and here, the Bush administration needs to adopt a strategy for a prompt exit from this unnessary and ill-conceived mission.

We need to have our forces out of Iraq in a matter of months, not years. And no reasonable person should want to keep our troops in harm’s way for another decade. Given the casualty rates during the first three years of this war, staying until 2016 would mean another 8,000 dead Americans. At that point, U.S. fatalities in Iraq would exceed the number the Soviet Union suffered during its ill-fated intervention in Afghanistan during the 1980s.

Remaining in Iraq for another decade while the country descends into sectarian civil war is a policy that should appeal only to masochists.

Broadband Bad News Is Good News … but It’s Bad News

Headlines are meant to draw readers in, and this one did me: Broadband’s Double-Digit Growth Coming to an End.

Something’s gone wrong with broadband! Quick! To the BroadbandMobile!

In the next instant, I realized that something had actually gone right. You see, double-digit change in percentage-based figures can’t keep going forever. In fact, it can’t last more than about ten time-periods. (Because then you’d have 110% of something, which only makes sense in rock ‘n’ roll, where the loudest speakers go to 11.)

Adoption of broadband is slowing as people who want it have already got it and people who don’t want it persist in not having it. (Bizarrely to people who live every minute of every day online, some people live no minute of every day online - ever. That is perfectly acceptable.)

There is undoubtedly a tiny margin of poor people who can’t afford broadband. But “can’t afford” is subjective. Many prioritize things other than broadband to buy with their limited resources (which is fine - remember, sans broadband is an acceptable way to live).

But the news report says this is all bad news:

One of the goals of US public policy when it comes to broadband is to ensure all US residents have access to broadband. President Bush said in 2004 that he wanted universal access to broadband in 2007, an achievement that appears unlikely at this point.

But, but … if people who want it are getting it, and people who don’t are not, isn’t that universal access to broadband? Apparently not. Affordability has been added to the metric, moving the goal posts so that federal subsidies for telecommunications seem important once again. Our news report continues:

The Democrats think it’s a great idea too—one plank in their platform for the 2006 mid-term elections is universal access. The telecom law rewrite which may or may not emerge from Congress this year intends to further that goal by funding broadband in areas currently unserved via the Universal Service Fund.

That’s the Universal Service Fund about which Daniel Berninger asks: What have we gotten for our $50 billion dollars?

In the end, this report amounts to an argument that satiation is a basis for subsidy.

Huh.

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.)

“Pelosi Promises Fiscal Restraint If Democrats Win”

That’s the headline House Minority Leader Nancy Pelosi managed to get the Wall Street Journal to run after an exclusive interview. She told the Journal’s reporters that if Democrats take control of the House next year and raise taxes, they would use the money to reduce the federal deficit. And she promised to reduce the use of earmarks: “Personally, myself, I’d get rid of all of them,” she said. “None of them is worth the skepticism, the cynicism the public has… and the fiscal irresponsibility of it.”

If Republicans are going to spend like Democrats, it would be nice to think that Democrats might save like Republicans. But let’s take a reality check.

According to the National Taxpayers Union, in the first seven months of this Congress Nancy Pelosi introduced 22 bills that would increase spending and only one that would cut spending. Admittedly a better record than some Democrats: Rep. Charles Rangel (D-NY), who would be chairman of the Ways and Means Committee in a Pelosi-led Congress, introduced 80 spending bills and three cuts, for a net budget impact of $1.6 trillion. Even the misnamed Rep. Adam Smith (D-WA) introduced 44 spending bills and one cut. Another NTU report showed that Pelosi voted in the interests of taxpayers only 11 percent of the time on tax and budget votes. And her fiscal conservatism has been declining the longer she has been in Congress. In her early years in the House she sometimes voted for taxpayers as much as 25 percent of the time. But not recently.

For taxpayers, it looks like the fall election will be a choice between the devil we know … and another devil we know.