In today’s Cato Daily Podcast, Foreign Policy Analyst Malou Innocent discusses foreign policy challenges the Obama administration will face and how the new president should approach Afghanistan and Pakistan in 2009.

Prominent health economist Victor Fuchs has an article in this week’s New England Journal of Medicine that all who care about freedom and health care reform should read. He discusses the array of forces that could be — and in my view, should be — employed to stop health care reform this year:

First, many organizations and individuals prefer the status quo. This category includes health insurance companies; manufacturers of drugs, medical devices, and medical equipment; companies that employ mostly young, healthy workers and therefore have lower health care costs than they would if required to help subsidize care for the poor and the sick; high-income employees, whose health insurance is heavily subsidized through a tax exemption for the portion of their compensation spent on health insurance; business leaders and others who are ideologically opposed to a larger role of government; highly paid physicians in some surgical and medical specialties; and workers who mistakenly believe that their employment-based insurance is a gift from their employer rather than an offset to their potential take-home pay. These individuals and organizations do not account for a majority of voters, but they probably have disproportionate influence on public policy, especially when their task is simply to block change.

Second, as Niccoló Machiavelli presciently wrote in 1513, “There is nothing more difficult to manage, more dubious to accomplish, nor more doubtful of success … than to initiate a new order of things. The reformer has enemies in all those who profit from the old order and only lukewarm defenders in all those who would profit from the new order.” This keenly observed dynamic, known as the “Law of Reform,” suggests that a determined and concentrated minority fighting to preserve the status quo has a considerable advantage over a more diffuse majority who favor reform but have varying degrees of willingness to fight for a promised but uncertain benefit.

Third, our country’s political system renders Machiavelli’s Law of Reform particularly relevant in the United States, where many potential “choke points” offer opportunities to stifle change. The problem starts in the primary elections in so-called safe congressional districts, where special-interest money can exert a great deal of influence because of low voter turnout. The fact that Congress has two houses increases the difficulty of passing complex legislation, especially when several committees may claim jurisdiction over portions of a bill. Also, a supermajority of 60% may be needed to force a vote in the filibuster-prone Senate.

Fourth, reformers have failed to unite behind a single approach. Disagreement among reformers has been a major obstacle to substantial reform since early in the last century. According to historian Daniel Hirshfield, “Some saw health insurance primarily as an educational and public health measure, while others argued that it was an economic device to precipitate a needed reorganization of medical practice.… Some saw it as a device to save money for all concerned, while others felt sure that it would increase expenditures significantly.” These differences in objectives persist to this day.

That last item speaks to a divide among left-leaning health care reformers that was discussed by Drew Altman in a column at the Kaiser Family Foundation web site:

We could be headed for a new schism in the debate about health reform. Not the familiar gulf between advocates of the market and government, or the predictable one between deficit hawks and spenders, but a new one that crosses traditional partisan and ideological lines between advocates of long-term reform of the health care delivery system, and immediate help for the uninsured and insured struggling with health care costs. This new rift is most likely to develop if tight money and a crowded agenda force the focus to shift from comprehensive to incremental reform and choices need to be made about what goes into a smaller, cheaper legislative package. It’s a rift that could stand in the way of progress on health reform if care is not taken to avoid it.

For one group, I will call them the “Delivery System Reformers,” true health reform lies in making the actual delivery of care more cost effective over the long term. Delivery System Reformers champion health IT, comparative effectiveness research, practice guidelines, and payment incentives to encourage more cost-effective care such as pay for performance .… Indeed some delivery reformers believe it would be a mistake to put more money into the current system through expanded coverage until more fundamental changes in the system are made.

The other group, I will call them the “Financing Reformers,” is focused on an entirely different set of problems. Its major concern is the problem of the 46 million Americans without health insurance coverage and the serious problems all Americans are having today paying for health care and health insurance .…

The health reform field is like a Venn diagram with circles that intersect (though not by a lot).

As an example of those conflicting priorities, Fuchs himself writes, “If the current health care reform initiative is limited to questions of coverage, without serious attention to cost control and coordination of care, the ‘crisis’ in health care will continue to plague us for years to come.” (Almost sounds like something a member of the Anti-Universal Coverage Club would say.) I would add that conflicts between delivery-system reforms and financing reforms (e.g., covering the uninsured) only arise when dealing with command-and-control approaches to reform.

Neither Fuchs nor Altman intended their articles to be used as a guide to block health care reform. But since Messrs. Obama, Baucus, Daschle, and Wyden have already given us a fairly clear picture of the shape their proposed reforms will take, free-market advocates should scour both articles in their entirety for useful tips on how to beat back the next great leap toward socialized medicine.

USA Today reports on Obama DOE nominee Steven Chu:

The Nobel Prize winner nominated to head the Energy Department said Tuesday that he would focus the agency in part on global warming, a sharp departure from the agency’s priorities during the Bush administration.

Citing new evidence in the debate over the legitimacy of global warming, Senior Fellow in Environmental Studies Patrick J. Michaels explains scientific bias in his new book, Climate of Extremes: Global Warming Science They Don’t Want You to Know.

Watch Michaels discuss the possibility of a carbon tax on Fox Business and global warming on CNN’s Lou Dobbs.

Senior Fellows Jerry Taylor and Peter Van Doren examine the true cost of climate change and defend the case against government support for alternative energy.

The Forest Service, Bureau of Land Management, National Park Service, and Fish and Wildlife Service collectively manage well over a quarter of the land in the United States. Several Cato Institute studies have called for privatization of these public lands, but this idea is strongly resisted by environmentalists, recreationists, and others. A new paper from Cato scholar Randal O’Toole suggests an alternative policy: turn them into fiduciary trusts. Under this proposal, the U.S. would retain title to the lands, but the rules under which they would be governed would be very different.

• “A Matter of Trust: Why Congress Should Turn Federal Lands into Fiduciary Trusts,” by Randal O’Toole

Two recent items in the “Cultwatch” category:

NPR has audio of an Atlanta student chorus that will be singing at the inaugural festivities. “Dear Obama hear us sing/​we’re ready for the change that you will bring…” (hat tip: David Boaz)

And here’s video of some 800 Chicago elementary school students whose teachers had them form a 150-foot human portrait of the president-elect’s face:

(hat tip: Matt Welch)

New York Times: “Chávez Lets West Make Oil Bids as Prices Plunge”

No wonder. According to a study by the Deutsche BanK, Venezuela needs the barrel of oil to stay above $97 in order to pay for government expenditures. It is currently traded at below $40 per barrel.

Today, the Senate Judiciary Committee is holding a confirmation hearing for Eric Holder, Obama’s nominee for Attorney General. Here are some questions for Mr. Holder:

1. You admit you made mistakes with respect to how you handled the pardon for Mark Rich. Why do you think he was pardoned? You are a former prosecutor and investigator–do you believe there was a corrupt bargain of some kind?

2. You and Attorney General Janet Reno approved the violent raid by federal agents to take custody of Elian Gonzales. Did you know in advance that agents waited until the judge familiar with the case left the courthouse for the day and then applied for a warrant from the evening magistrate, who was not as familiar with the circumstances of the case? Did you know that federal agents used tear gas against peaceful protestors outside the home of Elian’s relatives?

3. You have testified in favor of federal hate crimes legislation. Where in the Constitution do you find authority for Congress to enact such legislation? What is your view of the Tenth Amendment? What federal criminal laws (enacted or proposed) fall outside of the purview of the limited and enumerated powers of Congress?

4. In 2000, the Department of Justice maintained that the Second Amendment to the Constitution does not really guarantee the right of citizens to keep and bear arms. The government can, in its discretion, take guns away from the citizenry. Is that your view? You did sign on to an amicus brief in the Heller case that defended the draconian gun control regulations of Washington, D.C.

5. If a federal law enforcement agent for the FBI or DEA is involved in a questionable shooting and local prosecutors come to the conclusion that the law was broken and bring murder or manslaughter charges, will your department argue for blanket immunity from prosecution? During the Clinton years, the Justice Department argued that federal agents “are privileged to do what would otherwise be unlawful if done by a private citizen.” Do you think federal agents are immune from murder statutes?

6. In Mahoney v. Babbitt, 105 F.3d 1452 (1997), you signed a brief that took a bizzare view of free speech rights. You argued that people who support Bill Clinton could bring signs along the inaugural parade route, but that people who disliked Bill Clinton could be denied permits to bring signs to express their point of view. Where did you get that from? You say that as attorney general you would follow not only the letter but the spirit of the law, but your record does not support that.