The Ultimate Question: Freedom or Power?

Here I was, sick with worry that the questions I hoped to pose to President Obama about his health reform plan would never be answered.  Thank God, Matthew Holt stepped up to the plate.  Or the wicket.  Whatever.

What follows are some of my questions (addressed to the president) and Holt’s responses (in italics).

Mr. President, in your inaugural address and elsewhere, you said you are not interested in ideology, only what works. Economists Helen Levy of the University of Michigan and David Meltzer of the University of Chicago, where you used to teach, have researched what works. They conclude there is “no evidence” that universal health insurance coverage is the best way to improve public health. Before enacting universal coverage, shouldn’t you spend at least some of the $1 billion you dedicated to comparative-effectiveness research to determine whether universal coverage is comparatively effective? Absent such evidence, isn’t pursuing universal coverage by definition an ideological crusade?

Sadly Michael, universal coverage is not about improving public health. If you want to do that, go teach some kids age 1–5 and build some sewage systems. Universal care is about making sure that the costs of health care are fairly distributed. Under the systems you prefer and the one we now have they’re distributed from the poor and sick to the healthy and wealthy—many of whom we both know work in the health care system. But apparently there was NOT ONE MENTION of the uninsured or sick people bankrupted by the system in the whole hour.

Holt’s categorization of my preferred health care “system” and the un-mentioned uninsured aside, he makes my point for me: universal coverage is about ideology, not health.  In fact, Holt demonstrates that the Church of Universal Coverage would be happy to have people die sooner if that would promote its ideo-religious goals.  I really should send him a fruit basket.

A draft congressional report said that comparative-effectiveness research would “yield significant payoffs” because some treatments “will no longer be prescribed.” Who will decide which treatments will get the axe? Since government pays for half of all treatments, is it plausible to suggest that government will not insert itself into medical decisions? Or is it reasonable for patients to fear that government will deny them care?

Why should patients fear it? We know that less intensive care is better, and cheaper primary care is better than more extensive specialty care.

So the government will insert itself into medical decisions.  Gotcha.  Holt is really clearing a lot of things up.

To answer his question, though, the concern is that one size really doesn’t fit all, and that the government’s rules will, shall we say, break my eggs to make his universal-coverage omelette.

You recently said the United States spends “almost 50 percent more per person than the next most costly nation. And yet … the quality of our care is often lower, and we aren’t any healthier.” Achieving universal coverage could require us to spend an additional $2 trillion over the next 10 years. If America already spends too much on health care, why are you asking Americans to spend even more?

Ah we agree. All the money should come from the current system, even if it means reducing the incomes of pundits, bloggers and those who sponsor them, and a few people in the system. Sadly the politics of the US means that apparently Obama can’t say that.

So nice when we can agree.  Now if only there were some way to deny incumbent producers the power to block more efficient ways of doing things … to block “progress,” if you will … hmmmmm

You found $600 billion worth of inefficiencies that you want to cut from Medicare and Medicaid. If government health programs generate that much waste, why do you want to create another?

You’re saying all government programs are the same? That means the US Marine Corps and the Iraqi volunteer EDF (or whatever it’s called) are the same. I could start a government program that saved $600b very easily in Medicare & Medicaid. I might make a few enemies.

Holt is right.  A new program might waste a lot less.  (Or a lot more.)  But the best part of his answer is that leftist impulse: “I could design a better social order if we could just get rid of that whole constitutional democracy thing.”

You and your advisors argue that Medicare creates misaligned financial incentives that discourage preventive care, comparative-effectiveness research, electronic medical records, and efforts to reduce medical errors. Medicare’s payment system is the product of the political process. What gives you faith that the political process can devise less-perverse financial incentives this time?

See my above answer, oh and abolish the Senate.

I refer my right, honorable friend to the answer I gave some moments ago.

You have said there are “legitimate concerns” that the government might give its new health plan an unfair advantage through taxpayer subsidies or by “printing money.” How do you propose to prevent this Congress and future Congresses from creating any unfair advantages?

I don’t know but I’ll make a deal. I’ll promise my health plan won’t have use an unfair advantage if you promise that AHIP’s members will stop lobbying Congress to rip-off the taxpayer.

Again, so helpful of Holt to acknowledge that the playing field between government and private insurers could never be level.

And to keep the insurance industry from ripping off the taxpayers, it seems we will have to give up either (1) the freedom of speech and to petition the government for a redress of grievances, or (2) the power that government currently wields over our health care sector and that the insurance companies’ lobbyists so often bend to their will.

Which brings me to Holt’s byline:

Matthew Holt is a vicious blogger who wouldn’t mind being President for a day or two but not without the ability to break Congress to his will in the first ten minutes.

Doesn’t sound like he would choose freedom over power.

One Year After Heller

One year ago today, the Supreme Court handed down its decision in District of Columbia et al. v. Heller. The decision affirmed the Second Amendment as protecting an individual right to keep and bear arms and invalidated the District of Columbia’s draconian gun control regime.

The case generated a storm of media attention. The Cato Institute filed an amicus brief, one of nearly four dozen in the case.

The Cato Institute held a forum for Brian Doherty’s book chronicling this victory for liberty, Gun Control on Trial: Inside the Supreme Court Battle Over the Second Amendment. The Heller case also figured prominently in Cato multimedia from Robert A. Levy and Clark Neily.

Heller did not settle all of the questions related to the right to keep and bear arms. The incorporation of the Second Amendment against state bans and regulations is currently being litigated across the country. A three-judge panel in the Court of Appeals for the Ninth Circuit held that the Second Amendment is incorporated against the states. The Seventh Circuit and Second Circuit disagreed. Supreme Court nominee Sonia Sotomayor was on the Second Circuit panel that declined to incorporate the Second Amendment, and Roger Pilon notes that this may play into her confirmation hearings. The circuit split on incorporation sets the stage for a further appeal to the Supreme Court, and Alan Gura and the National Rifle Association have both filed petitions for a writ of certiorari. Robert A. Levy discusses this in his recent Cato podcast.

It will be interesting to see what the next year brings for the Second Amendment.

Setting the Record Straight on Health Care Reform

President Obama took to the airwaves Wednesday in an effort to promote his plan for a national government-run health care system. He answered questions on rising costs, taxing benefits, and many other issues during an ABC News special on health care reform called “Questions for the President: Prescription for America.”

After live-blogging the ABC special, Cato scholars Michael D. Tanner and Michael F. Cannon dissect the president’s health care plan point by point.

Institutional Crisis Unfolds in Honduras

A serious institutional crisis is taking place in Honduras as a result of President Manuel Zelaya’s call for a new constitution that would allow for his reelection. Zelaya, a close ally of Hugo Chávez, is barred from pursuing a second term in the general elections in November.

Unfortunately for Zelaya, he doesn’t have the backing of his own party, much less any other major political group. So he has moved unilaterally to call for a referendum on the need for a new constitution. The vote, which is scheduled for this Sunday, has been declared illegal by the Supreme Court and the Electoral Tribunal, and condemned by the Honduran Congress and attorney general (whose office is not part of the cabinet in Honduras).

Despite the widespread institutional opposition to his plans, Zelaya is pushing for the vote. On Wednesday he ordered the Honduran armed forces to start distributing the ballots and other electoral materials throughout the country. The army chief, complying with the Supreme Court ruling, refused to obey the order. Zelaya sacked him, which prompted the resignation of all other leading army officers and the defense minister.

The attorney general is asking Congress to impeach Zelaya for violating the institutional order and abusing his powers. Last night, the Congress discussed removing Zelaya from his office. The president is defiant and has accused the Congress of attempting a coup.

In the meantime, thousands of Zelaya’s supporters are taking to the streets. Yesterday, a mob personally led by Zelaya stormed a Honduran air force base in order to retrieve the electoral materials that the generals refused to distribute. The army is reportedly deploying troops in the capital Tegucigalpa to prevent possible riots.

Zelaya’s mentor, Hugo Chávez, is not staying out of the row. Last night he warned that Venezuela and its allies won’t sit idle while the Honduran “elites” launch a coup d’etat against Zeleya. He threatened to do “whatever it takes” to defend him. It might be more hot air coming from Venezuela’s strongman, but it certainly raises the spectrum of foreign involvement in what constitutes a domestic Honduran crisis.

In an interesting twist, Zelaya has asked the Organization of American States (OAS) to intervene and defend Honduras’ democratic institutions. Most countries in the OAS are client-states of Chávez’s oil largesse. This is why the organization has repeatedly failed to condemn the abuses that Chávez and his Bolivarian friends in Ecuador, Bolivia and Nicaragua have committed against democratic institutions, independent media, the opposition, and so on. More recently, the general assembly of the OAS has lifted the membership suspension imposed on Cuba, despite the country’s blatant violation of the democratic charter of the organization.

So it wouldn’t be surprising for the OAS to come to Zelaya’s rescue with a statement in his favor, despite his efforts to subvert Honduras’ democratic institutions. Mimicking Chávez’s words, the OAS envoy to Honduras has already said that the organization won’t recognize any government that comes out of “a coup.” José Miguel Insulza, the OAS secretary general, gave a confusing and ambiguous statement regarding the sacking of the army chief, saying that “the Armed Forces should obey the constitutional mandate and the constituted authority.” It sounds more like an endorsement of Zelaya’s position. The OAS general assembly is meeting today to discuss the crisis.

It’s clear that Zelaya is deliberately generating an institutional crisis. He can rely on the support of Chávez and his regional allies in the OAS. And he knows that if the armed forces try to remove him, it would look like a “coup d’etat” that would probably be widely condemned all throughout Latin America.

This is a real test for the OAS and its supposed (and tarnished) commitment to democratic republican principles.

Ultimate Dodge: America Plans to Reduce Civilian Casualties in Afghanistan… And???

Gen. Stanley McChrystal, who commanded special operations forces in Iraq and this month became the commander of U.S. military operations in Afghanistan, said he wants to avoid more civilian deaths.

Concern over civilian casualties makes sense in counterinsurgency, since the local population is the strategic center of gravity. I’ll concede that the infusion of 21,000 more troops — which Obama approved within his first 100 days in office — may lead to a reduction in violence in the medium-term. But the elephant in the Pentagon is that the intractable cross-border insurgency will likely outlive the presence of international troops. Honestly, Afghanistan is not a winnable war by any stretch of the imagination.

Certainly in Logar province, where the Taliban have set up a parallel judiciary, I can understand why McChrystal wants to step into voids not filled by the central government. But time and again, Afghans across the political spectrum — including President Hamid Karzai, Finance Minister Anwarulhaq Ahadisaid, Afghan security personnel, and even Afghanistan’s ambassador to Washington — blame the United States for allowing corruption in the Afghan government and repeatedly deny responsibility for their government’s own incompetence. Preventing militants from collecting taxes, enforcing order, and providing basic services means more than simply building up “indigenous capacity” — rather, we, the United States of America, according to those who advocate an indefinite military presence, must spend money we don’t have to be Afghanistan’s perpetual crutch.

McChrystal says he hopes to see an improvement on the ground in another 18 to 24 months. I hope Congress and the president hold him to his word, because if it were up to the military, we would remain in Central Asia for another 12 to 15 years. To win Afghan hearts and minds, America not only has to compete with the Taliban’s shadow government, but also with an amalgamation of mullahs and warlords who have usurped the power of indigenous tribal chiefs in the country’s restive southern and eastern provinces, particularly in Kandahar, the heart of “Taliban country.” Such a strategy is the epitome of social engineering.

Afghanistan’s 33 million people hail from more than 20 diverse cultures, including Uzbek, Tajik, Baloch, Turkman, Pashai, Nuristani, and others. Many of these ethnic groups have different tribal policies. Most Afghans are Sunni, but some, like the Hazara, are Shia. But the Taliban insurgency that we — not the Afghans — are combating, is dominated by the “rulers of the country,” its largest ethnic group, the Pashtuns. In actuality,  ”Pashtun” refers to the more than 50 tribes within the Pashtun people, (including Ghilzai, Durrani, Wazirs, Afridis, and dozens more) concentrated in southern and eastern Afghanistan and along the border in northwest Pakistan. Each Pashtun tribe is divided into various sub-tribes or clans (there are estimated to be 30 clans in the Mehsud tribe alone). Each clan is then divided into sections that split into extended families.

The United States has begun devoting more resources to learning the nuance of various tribes to better understand what groups can be “peeled off” from militants. But better understanding would not necessarily yield the outcomes we want. Afghanistan’s cultural make-up is incredibly complex. And it appears the United States and NATO are backing one side of a civil war.

Durrani Pashtuns [Popalzai, Barakzai (Mohammadzai), Sadozai, Alikazai, and other clans] have been Afghanistan’s traditional political elite. Many Ghilzai Pashtuns in the country’s east (Hotak, Tokhi, Nasr, and Taraki), unlike their Durrani counterparts, tend to be rural, less educated, and were the main foot soldiers of the Taliban. The Afghan government (which we back) alienates some historically marginalized Durrani clans, such as those in the Panjpai Valley and some in Kandahar province (Alizai, Ahmadzai, Noorzai, and Ishaqzai), just as much as some Ghilzai clans in the east, which today only have token representation in the Afghan government.

This war is an unfathomable mess. Afghanistan could fall apart once we withdraw, whether we do so tomorrow or 20 years afterward. We should cut our losses now.

Mourning the Loss of a Great American Capitalist

mjWhile the big news of the day wouldn’t seem to have a public policy angle, Michael Jackson’s death allows us to remember that such phenomenal career achievements can only be possible in an economic system that rewards and harnesses talent.

The King of Pop’s creativity allowed him and his family to make hundreds of millions of dollars, yes, but it also created thousands of jobs in the music and marketing industries and brought joy to fans around the world. Whatever his personal eccentricities — perhaps, in part, as a result of them — Jackson represents a capitalist success story.

No central planner could have invented him, and no government bureaucracy could have transformed pop music in the way he did.

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