Blog Mix

Noam Unger: Beyond How Many Troops

Thu, 02 Jul 2009 17:38 GMT

Yesterday's Washington Post featured a front page article by Bob Woodward with the headline "Key in Afghanistan: Economy, Not Military." The article focused mostly on discussions National Security Adviser James L. Jones has been having with, well, our military on the ground in Afghanistan, and it did not include a single quote from a government official or outside expert focused on economic development. Today's Post featured a front page article by Rajiv Chandrasekaran about the launch of a mission in Afghanistan's Helmand Province, the Marines' biggest operation since their invasion of Fallujah, Iraq, in 2004. The activities and fates of our dedicated troops should be top news in a time of war. Their service is invaluable. Sustainable security in Afghanistan and our own national security depend on much more than our military, however. If the key in Afghanistan is the economy and not the military, then the public should be demanding, and key news outlets like the Post should be providing, deeper coverage of U.S. policy and strategy related to economic development.

To his credit, Chandrasekaran did write a lengthy and well-researched June 19th article headlined "U.S. Pursues a New Way To Rebuild in Afghanistan," but most of the story was really about past blunders and how not to support much needed agricultural development. The part about Richard C. Holbrooke's forward-looking plan to revamp reconstruction efforts is a story in and of itself.

Journalists should find no shortage of potential leads on the economic development front of U.S. engagement in Afghanistan and neighboring Pakistan. For better or worse, Afghanistan and Pakistan will be the crucibles of U.S. foreign assistance reform. The high stakes of these different but connected national security challenges may provide the impetus for long-needed changes to our overall aid system. On the other hand, picking the Af-Pak border region as a place to ensure and measure fundamentally more effective assistance may be like picking the middle of the Atlantic as a good place to stay dry. That same spotlight of public and policy attention is less likely to tolerate the risks associated with experimental approaches to development. Additionally, few experts are optimistic about the prospects for large-scale investments that must be executed by a foreign assistance bureaucracy that is politically weak, incoherent, and fragmented to the point at which it is far less effective than it could be in supporting strategic goals.

In keeping with my Washington Post theme, today's edition also ran a story by Ann Scott Tyson about Gen. Stanley A. McChrystal's 60-day assessment of the Afghanistan campaign. She notes that McChrystal "has been advised to tell Mullen, Defense Secretary Robert M. Gates and President Obama, 'Here's what I need.'" We should all be reading more stories about how U.S Ambassador to Afghanistan, Karl Eikenberry, and specifically U.S. Agency for International Development (USAID) Mission Director in Afghanistan, William Frej, have been advised to tell the USAID Administrator, Holbrooke, Secretary of State Hillary Clinton, and President Obama, "Here's what we need," because hopefully that is what is happening.

The fact that the president has not yet nominated political leadership at the helm of USAID poses yet another set of challenges when trying to execute an approach to national security built on the 3 D's: diplomacy, development and defense. Clinton and her deputy, Jacob Lew, have both consistently made it a point to emphasize global development efforts, and Holbrooke is surely trying to stay on top of reconstruction and development issues in Afghanistan and Pakistan, specifically, but such policy leaders are not focused on development in the same way and to the same extent as the head of USAID (or yet-to-be confirmed policy makers at Treasury and the Millennium Challenge Corporation, for that matter). In the case of Afghanistan policy, there may be a silver lining to this dark cloud in that Acting USAID Administrator Alonzo Fulgham has on-the-ground experience serving as the Agency's Mission Director in Kabul.

Beyond More Civilian Personnel

As Chandrasekaran's article on the Marines' operation makes clear, the State Department and USAID are not yet capable of bringing their expertise to bear in Helmand through the deployment of personnel. The issue of human capital constraints among U.S. diplomatic and development professionals is certainly highlighted in non-permissive environments like Helmand, but staffing problems cut across all contexts, not just conflict settings. Certainly State needs more diplomats. USAID needs more development professionals. The Administration seems to be working on those issues through the budget process with Congress and no less than eight former Secretaries of State spoke up just last week to support more robust funding and resources. More technical experts at USAID, for example, could help to reduce that agency's over-reliance on contracting, especially mega-contracts with insufficient monitoring and evaluation.

Ultimately, however, if instability stemming from economic turmoil is the top security concern for our country, and that is what Director of National Intelligence Dennis Blair believes, then our government should be looking to solutions that extend beyond beefing up personnel. In the near-term, for example:

President Obama should quickly name a highly qualified USAID Administrator and enable that person to represent development policy considerations within the National Security Council;

The Administration should craft a formative interagency National Strategy for Global Development to bring coherence to U.S. global development policies across aid, trade, debt and other areas; and

The Administration and Congress should work together to clarify the relationship between key development assistance bodies of the government including USAID, the Millennium Challenge Corporation, and those in the State Department (eg. the Global AIDS Coordinator) as well as key objectives of U.S. foreign assistance.

Thinking Really Big

Perhaps, after his assessment in Afghanistan, McChrystal will explain that what he really needs in addition to more Afghan security and governance counterparts is enhanced U.S. civilian capabilities to carry out responsive and responsible development programs in partnership with local communities. To get there, he may point out that "[t]he way to institutionalize these capabilities is probably not to recreate or repopulate institutions of the past such as AID.... just adding more people to existing government departments such as Agriculture, Treasury, Commerce, Justice and so on is not a sufficient answer either - even if they were to be more deployable overseas. New institutions are needed for the 21st century, new organizations with a 21st century mind-set." If he did so, he would be quoting a 2007 speech delivered by his boss, Secretary Gates.

As foreign assistance challenges from Afghanistan and Pakistan to Sudan, Palestine, Nigeria, Honduras and more arise in the news, the American public and media must take a close look at relevant policies, strategies and planning processes. We may have a tendency to do so more thoroughly when the military is involved, but whether they are or not, the non-military side of U.S. "smart power" matters at least as much.

Kurtz: Objectivity Impossible for Black Women?

Thu, 02 Jul 2009 16:30 GMT

Shorter Howard Kurtz: Well, ok, so none of the African American women who are reporters on the Michelle Obama beat have gotten interviews with her since the inauguration. And ok, so "no one raises questions when an Irish American male reporter covers a pol named Murphy." But all these African American women are still probably going too easy on Michelle Obama. Because she's black! And they're black! And she's a woman! And they're women!

As Adam Serwer says:

More importantly, you would never ever see a media critic like Kurtz questioning the ability of white men to cover other white men objectively, or for that matter the ability of white men to cover women or people of color, despite the fact that if newsroom coverage were to be affected, it would be by the prevailing cultural biases of the better represented population in the newsroom.

But why would Kurtz question white men? After all, he's a white man, and he's never had the appearance of being sympathetic to a white male candidate. Cold, clear-eyed assessment, that's him:

After McCain held a media barbecue at his cabin near Sedona, Columbia Journalism Review seems to have developed indigestion, especially since it was on the record but political questions were discouraged:

"Such ground rules must go down easier with a tour of the grounds and a plateful of McCain-made ribs. (While, apparently, 'objectivity prohibits a good reporter' like Reuters' Jeff Mason from telling readers how tasty McCain's ribs were, CBS's Dante Higgins 'is confident in reporting they were succulent and flavorful').

"In return for dropping 'political talk,' reporters got their candidate-cooked meal. And a tire swing. And Frank Sinatra tunes on the deck.

"And McCain, in return, got press coverage depicting a relaxed, confident, regular-like-you-and-me-but-also-very-much-in-charge guy holding court at what could well be, as so many reporters noted, the future Western White House. (Could rib-grilling be the new brush-clearing? Just as manly -- and sticks to reporters' ribs!)"

There might be a morsel of a complaint here if journalists didn't get much chance to ask McCain serious questions. But he's the most accessible presidential candidate in modern history. Hillary had one dinner with her press corps, but it was off the record. And my sources say she didn't cook.

In fact, Kurtz had a lot to say about McCain's accessibility to reporters...like Howard Kurtz.

In conclusion: It's unreasonable to suggest impropriety when John McCain has reporters over to his house and cooks for them. It is reasonable, however, to wonder if the beat reporters who slog along behind Michelle Obama waiting outside the closed doors of her events are favoring her because of shared race and gender.

That, my friends (McCain shout-out!), is Village logic.

KEN SILVERSTEIN—The Clinton Foundation: It depends on how you define “is”

Thu, 02 Jul 2009 08:22 GMT

When Barack Obama nominated Hillary Clinton’s as secretary of state, he made her appointment contingent on her husband revealing the contributors to his foundation in order to avoid any questions about potential conflicts of interest. The foundation subsequently disclosed its donors — after refusing to list them for a decade — and it turned out they included many “governments, corporations and billionaires with their own interests in U.S. foreign policy”. . . .

Palin's Story Divides Republicans

Wed, 01 Jul 2009 14:26 GMT

[Guest post by DRJ]

Politico headlines this week's GOP feud featuring Weekly Standard editor Bill Kristol and former McCain campaign chairman Steve Schmidt:

“Rival factions close to the McCain campaign have been feuding since last fall over Palin, usually waging the battle in the shadows with anonymous quotes. Now, however, some of the most well-known names in Republican politics are going on-the-record with personal attacks and blame-casting.

William Kristol, the editor of The Weekly Standard and at times an informal adviser to Sen. John McCain, touched off the latest back-and-forth Tuesday morning with a post on his magazine’s blog criticizing the Todd Purdum-authored Palin story and pointing a finger at Steve Schmidt, McCain’s campaign manager.”

Kristol, with support from former McCain advisor Randy Scheunemann, believe Schmidt was responsible for rumors that Palin's behavior was caused by post-partum depression. I guess PPD is today's version of the Eagleton situation, but Politico does a good job summing up the real issue:

“Was Palin a fresh talent whose debut was mishandled by self-serving campaign insiders, or an eccentric “diva” who had no business on the national stage? Going forward, does she offer a conservative and charismatic face for a demoralized and star-less party? Or is she a loose cannon who should be consigned to the tabloids where she can reside in perpetuity with other flash-in-the-pan sensations?”

I think Palin should be Palin but IMO she has two choices: First, get a good campaign staff and manager and bet it all on being herself. With luck and good timing, she may be able to do what Obama did — especially with so many problems in unemployment and the economy.

Alternatively, she could run a Hillary-type campaign that focuses on gravitas and bland steadiness. This approach probably won't win a primary, let alone a general election, but it could position Palin for a Senate run or a position in a future Republican Administration.

– DRJ

Democratis primaries: In NY, Rep. Maloney will challenge Sen. Gillibrand. In PA, Rep. Sestak will challenge Sen. Specter.

Wed, 01 Jul 2009 12:26 GMT

Two of the newest Democratic Senators, New York's Kirsten Gillibrand, who was appointed by Governor Paterson to take Hillary Clinton's vacant seat, and Pennsylvania's Arlen Specter, who switched parties, will be facing primary challengers.

Via The Hill:

An adviser to Rep. Carolyn Maloney (D-N.Y.) confirmed Wednesday that the congresswoman will enter the state’s Senate primary against appointed Sen. Kirsten Gillibrand (D-N.Y.).

Paul Blank, who works with Democratic consultant Joe Trippi’s firm, said Maloney is officially in the race. Blank is set to serve as a top adviser for her Senate campaign.

"Congresswoman Maloney has made her decision,” Blank said. “She believes times are too tough and our challenges too important for politics as usual.

He added: “Congresswoman Maloney is putting together a campaign team and will make her announcement in two weeks."

And, The Hill again:

Rep. Joe Sestak (Pa.) said Wednesday he will challenge Sen. Arlen Specter (Pa.), becoming the second House Democrat in the past few hours seeking to unseat an incumbent Senate Democrat.

“I am going to get into the race against Arlen Specter in the Democratic race for senator,” Sestak told the Wayne Independent on Wednesday morning.

This is good for the process. Senate seats aren't inherited or bestowed upon people, although many in the Senate seem to think that's the case. Also, opportunities to run for the Senate don't happen very often.

"Political realities": Translation: Don't piss off the Blue Dogs because they're so mean we can't control them

Wed, 01 Jul 2009 11:35 GMT

In case you had any doubts that Washington DC was one giant hackocracy full of venal, greedy bastards from both parties who just want to shovel as much corporate cash into their pockets, and listen not one whit to the American people, here's your proof:

All was well within the Democratic Party, which had finally received that elusive 60th caucus member. The Republican filibuster would be no longer be a threat.

Or maybe not.

Franken is expected to come to Washington after the July 4th recess. But not everyone is convinced that his presence will make a huge political difference. The reality, which few in the Democratic Party are willing to talk about openly, is that there are really only 58 caucusing members. Sen. Ted Kennedy, D-MA, has been out for nearly all of the current Congress on medical leave. Sen. Robert Byrd, D-WV, while released from the hospital on Tuesday morning, continues to face health issues of his own. Meanwhile, moderate Democrats like Mary Landrieu, D-La, and Ben Nelson, D-Neb., have made it almost a point of pride in not allowing their votes to be taken for granted. And on specific issues, the party has proven strikingly allergic to philosophical unison.

"It is good news for the Democrats and it is bad news for the Republicans. That is a simple fact," said Mo Elleithee, a Democratic strategist who has worked on Hillary Clinton and Terry McAuliffe's campaigns. "Having said that, you don't want to get too far ahead of yourself here. It is not like the caucus is unanimous on every issue."

Talking on condition of anonymity, some Democratic strategists were even blunter. "Sixty is an imaginary number," said one operative. "You are always going to lose the Ben Nelsons and all the centrists. This is why 2010 proves to be so important because it can set a buffer for that 60 threshold."

The threshhold for a filibuster-proof majority is now exactly one more than the number of Democrats you have.

Useless sacks of shit.

Isn't it funny how Republicans never thought like this? They had 51 seats, they were king of the fucking world. But Harry Reid is folded in a fetal position in the corner, lest Ben Nelson and Evan Bayh and the other corporatist suckup say mean things.

Can we please vote these weasels out of office and get some Democrats with some stones in there? It's things that make me miss Paul Wellstone more every fucking day. And even though Al Franken has finally taken back that seat from the people who murdered Sen. Wellstone, I'm not convinced he's going to be significantly more progressive than the blue dogs.

I am hoping he'll surprise me.

FIGHT! FIGHT! FIGHT!

Wed, 01 Jul 2009 03:50 GMT

The Vanity Fair article on the Queen of Wasilla has the shivs going in the front for a change. And I have to say Steve Schmidt demonstrates once again defeating Bill Kristol in a battle of wits is only a few neurons tougher than vanquishing Jonah Goldberg or Dick Morris.

After Kristol accuses Schmidt of impugning the competency of the Palin, who Kristol thought adding to the ticket would be awesome beforehand, the firing back commenced:

Asked about the accusation, Schmidt fired back in an e-mail: “I'm sure John McCain would be president today if only Bill Kristol had been in charge of the campaign.”

“After all, his management of [former Vice President] Dan Quayle’s public image as his chief of staff is still something that takes your breath away,” Schmidt continued. “His attack on me is categorically false.”

That's some awesome smack, the best part being Schmidt is unquestionably accurate and it is also something rarely pointed out as being completely Kristol's doing (or undoing). When it comes to bringing GOP elected officials to the very laughable and representational reflection of the Peter Principle no one has done better than Bill Kristol.

...as early as June 29th, two months before McCain chose her, Kristol predicted on “Fox News Sunday” that “McCain’s going to put Sarah Palin, the governor of Alaska, on the ticket.” He described her as “fantastic,” saying that she could go one-on-one against Obama in basketball, and possibly siphon off Hillary Clinton’s supporters. He pointed out that she was a “mother of five” and a reformer. “Go for the gold here with Sarah Palin,” he said. The moderator, Chris Wallace, finally had to ask Kristol, “Can we please get off Sarah Palin?”

The next day, however, Kristol was still talking about Palin on Fox. “She could be both an effective Vice-Presidential candidate and an effective President,” he said. “She’s young, energetic.” On a subsequent “Fox News Sunday,” Kristol again pushed Palin when asked whom McCain should pick: “Sarah Palin, whom I’ve only met once but I was awfully impressed by—a genuine reformer, defeated the establishment up there. It would be pretty wild to pick a young female Alaska governor, and I think, you know, McCain might as well go for it.”

On July 22nd, again on Fox, Kristol referred to Palin as “my heartthrob.” He declared, “I don’t know if I can make it through the next three months without her on the ticket.”

Dan Quayle & Sarah Palin, heckuva job Bill.

Deep Bench

Tue, 30 Jun 2009 06:22 GMT

Barack Obama is a truly gifted politician, though -- as ever a triangulating one [one commonality I always saw between he and Hillary Clinton]. But all-in-all an adroit one, who reaches the great majority of Americans -- and with luck will continue to do so.

But even if he doesn't, the Republicans remain truly his best ally on the road to a second term.

Who are the GOP contenders? Williard Romney, Newt Gingrich, and the Crazy Queen of Alaska.

In the aftermath of the November election, the conventional wisdom among Palin’s supporters in the Republican establishment was that she should go home, keep her head down, show that she could govern effectively, and quietly educate herself about foreign and domestic policy with the help of a cadre of experienced advisers. She has done none of this.

And though the disaster of Sarah Palin is ultimately as much, if not more, McCain's fault that any other (in an election he'd probably have lost anyway in only slightly less of a defeat) there is a moment when you feel some humanity for McCain...

Election Night brought what McCain aides saw as the final indignity. Palin decided she would make her own speech at the ticket’s farewell to the faithful, at the Arizona Biltmore, in Phoenix. When aides went to load McCain’s concession speech into the teleprompter, they found a concession speech for Palin—written by Bush speechwriter Matthew Scully, who had also been the principal drafter of her convention speech—already on the system. Schmidt and Salter told Palin that there was no tradition of Election Night speeches by running mates, and that she wouldn’t be giving one. Palin was insistent. “Are those John’s wishes?” she asked. They were, she was told. But Palin took the issue to McCain himself, raising it on the walk from his suite to the outdoor rally. Again the answer was no.

Here's a guy who's dreams of being President (and face it, he'd had that dream for about the whole length of the Republic's history) have been forever dashed and the Queen of Wasilla wants to kick off 2012 over his benediction.

I do have to say this is my favorite part:

More than once in my travels in Alaska, people brought up, without prompting, the question of Palin’s extravagant self-regard. Several told me, independently of one another, that they had consulted the definition of “narcissistic personality disorder” in the Diagnostic and Statistical Manual of Mental Disorders—“a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy”—and thought it fit her perfectly. When Trig was born, Palin wrote an e-mail letter to friends and relatives, describing the belated news of her pregnancy and detailing Trig’s condition; she wrote the e-mail not in her own name but in God’s, and signed it “Trig’s Creator, Your Heavenly Father.”

(pic via Something Awful)

UUs go ‘beyond gender’ (by Suzie)

Sun, 28 Jun 2009 19:53 GMT

I’m experiencing post-traumatic stress over the election of the Rev. Peter Morales as the eighth president of the Unitarian Universalist Association. He will be our first Hispanic president, following the Rev. William Sinkford, our first black president. Morales defeated the Rev. Laurel Hallman, who would have been our first female president.

Like many churches, the majority of our members are women. Unlike many, the majority of our ministers are women, too. But even when female candidates have more experience, we elect men to the top job because we find them so inspiring.

In an earlier forum, Margot Adler asked the candidates about patriarchy. Hallman talked about “the centrality of male images” in the church, women who have been wounded by patriarchy, and a holistic approach to theology that went beyond the intellectual.

Morales responded that he wanted to go “beyond gender” and look at privilege and class. He said:

… the situation of women who are Black and Latina is very different from the position of women from the dominant culture. … if we focus only on gender, we will miss powerful dynamics of inequality that need to be addressed.

This is the meme that white women (like Hallman) are not really oppressed. Why? Because gender is insufficient reason to be oppressed. Gender must be coupled with other oppressions, such as race or class or disability or sexuality, etc.

Much earlier in the campaign, the candidates had been asked about “anti-racism and anti-oppression.” Morales didn’t say that he wanted to move beyond race and talk about class and privilege.

Morales' father was second-generation Spanish-American, his mother was Mexican-American, and I don’t know when/if* her family immigrated. When he was 4, he said, his parents bought a home in an English-speaking neighborhood so that their children would not speak with a heavy Spanish accent. He won a scholarship to college and ended up getting three master’s degrees.

He has many more privileges than Latinos with less education and less income whose family came to the United States more recently. He has more privileges than a Latina. I’m not faulting him for being a well-educated middle-class man who speaks flawless English, whose skin is lighter than my father’s, and who married a guera. But if we need to talk about class and privilege when it comes to gender, shouldn’t we do the same when it comes to race?

While we’re talking about class and privilege, maybe the UUA can reform its voting rules. Some people who voted on the presidency at the General Assembly followed the wishes of their congregation. Churches like mine, which don’t pay travel expenses for people going to GA, may have no say in how their "delegates" vote. Obviously, this skews in favor of people who have the time, money and inclination to go.

Sinkford has said that electing a person of color is not a shortcut for attracting more members of color. (For links, please see my previous post on the election.) Nevertheless, some UUs wanted Morales because the Latino population is growing in the U.S., and they want more Hispanics to become UUs. We don’t need a female president, however, because women will show up anyway.

At GA, Princeton professor Melissa Harris-Lacewell gave the prestigious Ware Lecture, discussing “a litany of the bleak realities in the United States today — the rights not yet held by black, brown, immigrant, gay, and poor Americans.” In the coverage of the speech, I don’t see any mention of gender.

I blogged about Harris-Lacewell before, when she suggested that Hillary Clinton was acting like Scarlett O’Hara, wanting black women to serve her like a Mammy.

I feel like the Chalice Chick who “hasn't forgotten what it was like to be a Hillary supporter early last year when Hillary was 'just more of the same' while Obama was made of kittens and fairy dust and was going to change politics forever and ever.” In the next post, she talks about how some supporters of Morales called him the “Prophet of the Possible.” Sound familiar?

I’m sure I’ll calm down eventually. But right now, I’d say that the UUA can go to hell – except I don’t believe in hell.
--------
*Some Mexican-Americans in San Antonio, where he was born, trace their ancestry to the time when Texas was part of Mexico.

The Rationing Scare

Sat, 27 Jun 2009 10:35 GMT

The opposition to real health reform boils down to two lines of attack: 1) the government will spend too much money and bankrupt us or 2) the government will spend too little money and ration our care. To the extent I can find people who make the first point while also opposing the many recent tax giveaways to the very wealthy, I'll try to engage them. The rationing point is more interesting, but needs to compare reform proposals to the status quo--not some big rock candy mountain of free and fabulous care for all.

As Christopher Beam at Slate has helpfully pointed out, in the US, there "already is rationing—it's just rationing by income instead of by efficiency." In a devastating commentary on Scott Gottlieb's Wall St. Journal opinion piece describing reform as rationing, Nathan Cortez, a professor of health law at SMU, describes the many misconceptions behind the recent rationing scares:

[Gottlieb] warns that rationing is “a European import,” as if no health insurer in the United States has ever had to draw the line somewhere and decide what not to pay for. . . . [Moreover,] we’re not exactly strangers to these organizations in the United States. Gottlieb . . . [ignores] our home grown organizations, like the Agency for Healthcare Research and Quality (AHRQ), which makes new technology assessments for Gottlieb’s old agency, CMS, and supports comparative effectiveness research. Or the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), which also performs new technology assessments.

In fact, it’s no secret in Washington that Medicare has long considered some amalgam of cost effectiveness and comparative effectiveness in its coverage decisions, even if nothing in the Medicare statute explicitly allows it to do so. (CMS has long stretched the definition of “reasonable and necessary” in section 1862(a)(1)(A) of the Social Security Act to fit its fiscal realities, even if CMS or its precursor, HCFA, haven’t been successful in cementing cost effectiveness as a formal criterion, as evidenced through failed rulemaking in 1989 (54 Fed. Reg. 4,302) and 2000 (65 Fed. Reg. 31,124)). And just as importantly, private insurers make cost and comparative effectiveness determinations too[.]

As I've described before, private insurers' cost-effectiveness determinations can be a valuable service. However, Wendell Potter's recent testimony on Capitol Hill indicated that such determinations are often eclipsed by a more profitable strategy: dropping unprofitable customers.

[E]xecutives of three of the nation’s largest health insurers [have] refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending. The Energy and Commerce Committee’s investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.

They also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether. . . . The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association.

My colleague John Jacobi sheds light on another aspect of private insurer rationing--running away from covering the chronically ill.

We ought not rely on self-interested market participants and expect them, all else being equal, to act contrary to their own self-interest. . . . [Purely] private markets for health coverage might make sense if health costs were homogeneously spread, or even if high costs occurred unpredictably. In a world where a large number of Americans are predictably poor bargains for insurers due to known chronic conditions, we need, as an option, an entity whose sustainable, reliable mission is to provide good, economical coverage for those who most need care, and who incidentally represent a substantial portion of our health care budget.

Health reform that does not address "rationing as risk selection"--and that does not encourage evidence-based medicine based on cost-effectiveness analysis--is no health reform at all. I just hope the blogosphere can help us avert the "triumph of misinformation" that derailed reform during the Clinton administration.

McCaughey back with more misinformation

Thu, 18 Jun 2009 09:19 GMT

Deja vu alert: Betsy McCaughey is pushing misinformation about health care legislation in Congress again.

Back in 1994, McCaughey wrote a New Republic article that popularized the false claim that people would not be able to purchase health care services outside the Clinton administration's proposed system of managed competition. The conceit of her article was that she had read the entire 1300+ page bill and discovered this coercive requirement, but she failed to mention the provision stating that "Nothing in this Act shall be construed as prohibiting ... [a]n individual from purchasing any health care services." (Incredibly, her article won a National Magazine Award and she went on to become lieutenant governor of New York.)

It's hard to understate the damage that McCaughey's article inflicted on the Clinton health care plan. The next week, former TNR editor Michael Kinsley slammed McCaughey's piece in his own column in the magazine, and subsequent reporting by James Fallows and Mickey Kaus showed it to be riddled with a number of false and misleading claims. By then, however, her claims had been repeated and disseminated throughout the national media. Hendrik Hertzberg, a former TNR editor now at The New Yorker, told me in previous reporting that "No Exit" was "the low point in the magazine's history since it stopped being sympathetic to the Soviet Union" and Fallows recently nominated her for "Most destructive effect on public discourse by a single person" during the 1990s.

For all of these reasons, it's disturbing to see McCaughey being given airtime on CNBC to promote new misinformation about the Democratic health care plan being developed in Congress. In this case, as Media Matters reports, she's falsely claiming that "the Democratic legislation pushes Americans into low-budget plans." And again, she's using the gimmick of pushing strained interpretations of specific provisions in the legislation ("That's Section 3101") while ignoring other provisions that directly undercut her arguments ("No individual shall be compelled to enroll in a qualified health plan or to participate in a Gateway").

Earlier this year, McCaughey tried the same close-reading gimmick with the stimulus bill, falsely claiming to have discovered that it will create "[a] new bureaucracy, the National Coordinator of Health Information Technology [that] will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective," leading to "rationing" for seniors.

How many times will we let McCaughey get away with this? It's time to cast her out of public discourse and shame anyone who gives attention to her claims.

Someone keep Fleet Street away from Bill Clinton

Tue, 03 Jun 2008 22:29 GMT

So by now everyone knows that Bill Clinton thinks the American press corps is in the bag for Barack Obama. Indeed, I suspect that in their heart of hearts, more pundits and reporters like Obama than Clinton (though, as Chris Matthews pointed out a few weeks ago, what they really like is a never-ending horse race). Still, despite the possible bias on these shores, I can&os;t imagine any major American newspaper having the following lede for their story: Seventeen months after she sat regally in her New York living room and calmly declared: Im in and Im in to win, Hillary Clinton stands on a stage in a stifling hot shed in South Dakota, coughing and spluttering, as her daughter, Chelsea, grabs the microphone from her hand to take over the show. A long campaign, the former First Lady chokes out between sips of water. Her husband, red-faced and exhausted and having just apologised for another angry outburst in front of reporters looks on wistfully at the final rally of his wifes presidential bid, an endeavour that has been transformed from an inevitable juggernaut into a costly train wreck. So,for those of you interested in Bill Clinton&os;s continued good health, I&os;d recommend not showing him any of the Fleet Street covers tomorrow AM....