Quote of the Day: Robert Musil on Blogging

Or so it's characterized by Herring-Hawker's Cry:

(27 August 1937) The unpleasant thing about an autobiography is taking oneself so seriously, and yet everyone feels the urge to do so. Even this cursing of just about all and sundry is both ugly and indispensable. But if I describe my life as being exemplary, as a life in this age that I want to hand down to later ages, this can be toned down with irony and the objections raised will then fall away. And this epoch deserves to be handed down just as it is (not in the distanced mode of MwQ [Man without Qualities]), but seen in close-up, as a private life. It can have the charm of intimate historical finds. My probing conscience, contemplation of my shortcomings and the like will also find their place here as a reproduction of the times.

Why American Health Care Reform is So Tricky

Cohu, who took a break from eating chocolate isopods (Cymothoa exigua can keep you slim during the holidays by eating your tongue!), practically challenges me to do some good old-fashioned two-fisted Texas policy analysis:

I was hoping you'd have an explanation for the incoherent views of many Americans re: healthcare. Instead you seem to be just as puzzled as I am! I've had the suspicion that Americans tend to think everyone is, prima facie, in charge of their own health, whereas Europeans are more fatalistic and tend to accept everyone will be dependent on others at some point, and conclude there needs to be a system to help them out when they get sick themselves. Or are there any other explanations for the US healthcare dilemma? I realize Americans are much more anti-statist than Europeans, but in this area, their libertarianism simply seems crazy and not at all evidence-based.

Here goes:

  1. America has never had a Socialist party (g) or, for that matter, an explicitly working-class party. These parties have generally been the driving force behind erecting European social welfare states, either by creating them (the UK), or by scaring the powers-that-be into creating them (Germany). Working-class Americans are renowned for their lack of class consciousness, and, with the steady shrinkage of American unions, have only gotten harder to organize on this basis in recent years.
  2. The present American health-insurance system, in which you're expected to get coverage through your job, evolved during World War II as a way to evade wartime salary restrictions. After the war, American unions and employers generally worked together to expand the system to cover most people who had a job. So there's a path-dependence angle to the current situation — it evolved from a somewhat random set of circumstances that then became reified and grew roots in the public consciousness. Plus, it worked just well enough for a couple of decades. That stifled development of alternative models, and prevented the creation of a critical mass of hugely dissatisfied reform-seekers.
  3. The employer-provided model — coupled with Medicaid for the poor and Medicare for the elderly — ensure that the people without health insurance were generally members of the working-class and marginally-employed populations. These people have little organized institutional influence and aren't very politically active. They are crushed by much more powerful lobbies.
  4. Speaking of which, the current American health-care system throws off enormous profits for various branches of the health-care industry, such as pharmaceutical companies, specialty clinics, medical device manufacturers, certain health insurance providers, etc. These are concentrated, extremely sophisticated, well-funded interest groups. Pharmaceutical pricing is probably an instance of regulatory capture. And as we know (.pdf), concentrated, easily-mobilized interest groups have a huge advantage over diffuse interest groups — here, the motley collection of unemployed people, working stiffs, freelancers, and others who aren't well-served by the present system. Of course, strong unions or a social-democratic party could bind these interests together and counterbalance industry, but see #1.
  5. Further, these lobbies know that Americans tend to be suspicious of proposals to increase the size of government, but as soon as the government does create a broad new social welfare benefit that includes the middle class, that program becomes hugely popular and politically untouchable — even in America. Thus, 80% of Americans believe the government has an obligation to ensure that the elderly can live in dignity, a concept embodied in Social Security, the national pension scheme.  Therefore the anti-reform lobby has every reason to throw all of their resources into the fight right now, because any truly ambitious reform scheme may well begin to induce Americans to think of health care as an important government obligation as well.
  6. The nature of the political opposition to health care reform has changed. The U.S. Republican party used to have a moderate, Christian Democrat/Tory wing: they were generally hawkish and fiscally conservative, but still felt an obligation to provide for the social good. Richard Nixon, for instance, expanded many government welfare programs, created the Environmental Protection Agency, and also almost created universal health care in a compromise measure with Senate Democrats in the early 1970s. Since then, the 'moderate', noblesse-oblige tinged wing of the Republican party (Sam Tanenhaus calls it the 'Burkean' wing) has been crushed. The modern Republican party is much more anti-government, and just as closely aligned with corporate interests as ever. Expanding access to health care simply isn't on their agenda, as can be seen by the fact that Republicans dominated all three branches of government for 6 years in the early 2000s, and did nothing about the problem of the uninsured. Today's Republicans are simply flat-out opposing any bill.
  7. The quaint custom of the filibuster means that when your opponents flat-out oppose a bill, you need a 60-vote supermajority in the United States Senate to pass legislation. I'd love to get rid of this stupid custom whenever it impedes legislation I like, but then again, there's a lot of legislation I don't like! And that goes for the parties — nobody can limit or abolish the filibuster without it looking like abject special pleading.

So those are a few of my thoughts on why it's so hard to get health care reform passed. I'm sure commenters will add their two cents, though, so fire away!

Toppling Karzai and Draining Soldiers

The New York Times reports:

As widespread fraud in the Afghanistan presidential election was becoming clear three months ago, the No. 2 United Nations official in the country, the American Peter W. Galbraith, proposed enlisting the White House in a plan to replace the Afghan president, Hamid Karzai, according to two senior United Nations officials.

But remember, parallels with Vietnam are misleading and overblown. That is, unless a modern-day Cable 243 is being prepared as we speak.

And in other news,

Suicides have hit record highs in the Army. Cases of post-traumatic stress disorder (PTSD) and depression, having reached an alarming 300,000 in 2008, according to Invisible Wounds of War, a RAND study, continue to escalate, constituting a mental health crisis for the army.


It's this under-compensated, over-stressed army that we're sending into Afghanistan to accomplish what could only be termed a Herculean task. It's not only supposed to defeat the Taliban insurgency by force of arms – something its troops are, at least, trained for – but build a nation by negotiating a complex "human terrain". That's army jargon for the reality that roughly 80% of so-called nation-building operations basically add up to armed social work. Simultaneously, our troops are being tasked with training an Afghan army that, despite years of effort, exists more on paper than in the field.

By all appearances, that Afghan army is hollow. Making it solid and reliable in a few short years is truly a bridge too far for our trainers.

A Sheepish Convert to ‘Socialized Medicine’

Matt Welch is the editor of Reason magazine, whose motto is 'free minds and free markets'. Reason represents the libertarian trend in American political thought, which has no real counterpart in European polities. Think of it as the FDP on steroids: American libertarians generally call for a radical reduction in the size of the federal government, a 15% flat tax, and believe free markets can supply most public goods (highways, education, mail delivery) better than government bureaucracies. Libertarians come in lots of flavors — some of them pretty preposterous. Others, like Welch, are pretty sharp. For his crowd, Welch's recent article, 'Why I Prefer French Health Care', will be a shocker:

For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.

Need a prescription for muscle relaxers, an anti-fungal cream, or a steroid inhaler for temporary lung trouble? In the U.S. you have to fight to get on the appointment schedule of a doctor within your health insurance network (I’ll conservatively put the average wait time at five days), then have him or her scrawl something unintelligible on a slip of paper, which you take to a drugstore to exchange for your medicine. You might pay the doc $40, but then his office sends you a separate bill for the visit, and for an examination, and those bills also go to your insurance company, which sends you an adjustment sheet weeks after the doctor’s office has sent its third payment notice. By the time it’s all sorted out, you’ve probably paid a few hundred dollars to three different entities, without having a clue about how or why any of the prices were set.

In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and you’re done. If you need a doctor, it’s not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. I’ve had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe €300 for any one procedure.

What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”

What we see here is the difference between someone who's read about European health care systems, and someone who's actually experienced them. The American media are filled with agit-prop scare stories about long waits and missing MRI machines. Welch is an example of someone who came to France expecting one experience, then finding out that reality was something quite different. The better-functioning European healthcare systems (Germany, France, Sweden) aren't bureaucratic monstrosities, and are in fact quite transparent and accessible. Most of the advantages Welch cites for French health care apply equally in Germany. With minor exceptions, everyone gets coverage, you can see a doctor within days, filling prescriptions is simple, and medical procedures cost about 1/3 of what they would in the States.

But here's the kicker: Welch says he doesn't support the current bill working its way through the U.S. Congress (which he calls Obamacare). Hard to blame him for this, there are many reasons to fear this unwieldy legislative kludge. The more straightforward solution would be a simple single-payer system like the one France has. The one Welch says he "prefers." Yet Welch himself says: "It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system." Err, why not? one might ask. Instead, Welch advocates "more capitalism at home" as the solution to America's healthcare dilemma, although (1) he doesn't explain exactly what that means; and (2) he doesn't explain why going in the direction of more government involvement, which has achieved the results he praises in France, would somehow backfire in the U.S.

I mean, come on, Matt baby. We're Americans. We sent people to the friggin' moon. Yet we can't beat the French at their own game? The French?

Oral Roberts on Oral Sex

Oral Roberts, a Pentecostalist preacher and one of the first American 'televangelists', died yesterday at the age of 91.

It's easy to mock these people and their odd beliefs. Perhaps too easy. But it's irresistible. Here's a passage from a real Oral Roberts sermon on sexuality, accompanied by a truly harrowing digitized recreation of how Roberts could have looked while delivering it.

This video may be dangerous to the sane person's psyche. But it's pretty much safe for work, unless you have a problem with loose talk about the 'anus' and 'vagina' and 'orifices'. Don't worry, Roberts never drops the dreaded p-word. Apparently that would have been too much for his audience. Therefore, it's just the 'male organ'.

Surging Into the Quagmire

I'm not going to criticize Obama too harshly for sending more troops to Afghanistan. First, because nobody cares what I think. Second, because I'm not sure he had a choice, politically speaking. During his campaign, he unwisely triangulated himself into a position in which he would face pressure to commit more troops.

Nevertheless, I remain unconvinced by his rationale for sending more people into harm's way. And Nir Rosen, someone whose opinion really does matter, has his doubts. Rosen has an excellent piece in the Boston Review here. He was embedded on several joint Afghan-U.S. missions, and describes them in harrowing detail. The interactions between Afghan forces and their American handlers are just painful to read. Near the end of the piece, Rosen sums up the many problems with the Obama team's reasoning:

[General Stanley] McChrystal proposed more than doubling the size of the Afghan Army, even though his more modest goal of 134,000 had not yet been achieved. He did not explain why results might improve—neither did Obama.

McChrystal’s report correctly portrays the Afghan police as ineffective, but does not show how adding more of them, even with additional training, would solve the problem….

Nor does the assessment question whether ISAF (meaning primarily the United States) has the resources and the will to conduct a decade-long COIN [counterinsurgency]campaign, the length history suggests is required.

McChrystal assumed that creating a centralized, functioning state in Afghanistan, which has never had one, is possible. Past efforts to extend the reach of a deeply unpopular central government in Afghanistan only caused instability. Prior to the recent elections, the legitimacy of President Hamid Karzai’s government faced serious challenges even in areas it controlled. The botched vote makes clear that his government will never gain the authority it needs in order to function. Obama’s unpromising solution is to pressure the Afghans to create a state by announcing his exit strategy before the troops arrive.

For the average Afghan, life remains a miserable struggle for subsistence…. Afghans who have been humiliated or victimized by the Americans and their allies are unlikely to become loyal partners after receiving a bit of aid money, which has also been relatively minimal compared to that provided for projects in Bosnia, Haiti, Rwanda, and East Timor.

The Americans have failed to convince Afghans that they should want them to stay, and Afghans certainly have not been convinced of Karzai’s legitimacy. There are just too many blunders….

Material goods will not outweigh anger over civilian casualties and eight years of humiliation. In Iraq it took the trauma of the civil war to make the Americans look better, yet Iraqis still overwhelmingly want them out. Obama is not Bush, but for Afghans it is the same occupying country—the America of Iraq, Guantánamo, Abu Ghraib; the America seemingly at war with Islam.

Afghanistan should have been easier. Eight years after overthrowing the Taliban—the world’s most detested and backward regime, which provided no service to its people—the United States has restored many brutal warlords the Taliban expelled. The authority the United States established is a failure, corrupt and brutal. Americans and their allies manage to kill innocent civilians, and the Taliban have once again become attractive to many Afghans. A few tens of thousands of troops will not turn things around.

President Obama’s stated goal in Afghanistan is to disrupt, dismantle, and defeat al Qaeda. Why, then, did McChrystal argue for fighting the Taliban and remaking Afghanistan? Why has Obama agreed? Assuming that al Qaeda will set up bases in Afghanistan recalls predictions that Saddam Hussein would give his imaginary weapons of mass destruction to al Qaeda. It assumes that the Taliban are irrational and unaware of their interests. And it rests on much more fundamental assumptions, too: that al Qaeda is a significant threat to the United States and that the best way to reduce the threat is by attacking the movement itself.

Even in this excerpt, there are about 20 very good questions that should be answered before sending more troops into Afghanistan. I haven't seen a really convincing answer to any of them from the Administration.

Obama is now apparently contemplating authorizing drone strikes against Quetta, a Pakistani city of 850,000 near the Afghan border. As Kevin Drum says, "Boy, those comparisons of Afghanistan to Vietnam just get more facile and ridiculous every day, don't they?" For those of you not up on your Vietnam history, he's referring to this – or perhaps this. There's no better time to brush up on your Vietnam war history, since it's beginning to look like a road map for the next few years. Go here if you're not yet convinced.

To lighten up an otherwise gloomy post, some interesting tidbits from the Rosen piece after the jump.

An American sergeant on European ISAF troops:

Dyer [could not] hide his contempt for most of the coalition members. The British, Australians, and Canadians were aggressive, he said, but Americans joke that ISAF, NATO’s International Security Assistance Force, stands for “I see Americans fighting,” or “I suck at fighting,” or “I stay at the FOB” (forward operating base).

And now, the Pashtu Word of the Week:

The sergeant smiled. “Bullshit,” he said, looking at [a translator named] Zahir. “How do you say bullshit in Pashtu?”

Zahir looked at the prisoner and said “kus eh shir,” “a pussy’s poem.”

Government Ride, Un-Pimped

What should I see riding my bicycle through the park a few days ago but this scene:

Dienstfahrrad in Suedpark

The trucks are carrying gravel, which, as you can see, is strewn onto the path. Behind them is a park employee riding one of the crappiest bicycles I've ever seen. The rear mud-guard is bent hopelessly to the right (or is the wheel bent to the left?). The basket was half-crushed, the chain was rusted through, and the badly underinflated tires were so glazed and cracked it was a wonder they still held air. The bicycle sounded like an old box-spring mattress on which sumo wrestlers made love.
But this is no ordinary piece-of-shit bicycle. The sign hanging crookedly from the back reads: Dienstfahrrad: duty bicycle.
Nothing says Old World like a government official on a rundown bike. The New World gets it all wrong — they buy their cops shiny, new mountain bikes. Wrong! The Welsh doctor who cycles from hamlet to coal-darkened hamlet; the Greek policeman wending his way unsteadily among the whitewashed churches of, say, Lesbos; the Italian postman; the Danish dike inspector — do they ride gleaming, fully-pimped BMX? Of course not! Do you have any idea how many forms you'd have to fill out, how many gimlet-eyed bureacrats you'd have to convince, to get yourself a new bicycle issued?
A European government official inherits his Dienstfahrrad from his predecessor, who inherited it from his. It's held together with twine and duct tape. It has only one gear, so the inspector must huff and puff up inclines, gyrating the handlebar to and fro. The brakes must fail regularly, to provide us with those comic scenes in which the inspector plunges into a ditch or hedge, and then re-assembles his wounded dignity in front of tittering village maidens. One of whom, of course, secretly 'funcies 'im' and will take him aside during the next harvest festival for a discreet romp in the hay.
The gravel, by the way, serves an important purpose. It ensures that when you walk in the park, your footsteps generate a satisfying crunching sound. This is the sound that, in American movies, accompanies crusading journalists as they arrange dead-drops with disgrunted government employees during a stroll through Lafayette Park. In European films, it is the soundtrack to the frustrated writer's lonely attempt to escape the crushing absurdity of existence by taking a walk through the denuded winter landscape. In short, it signifies that you're Up To Something Important. This, too, is a vital state service.