David Brooks argues today that a bottoms-up system based on competition has a better chance of reining in Medicare costs than a top-down system based on expert opinion. As part of his argument he dredges up a couple of examples where Medicare experts have been wrong in the past. Fair enough, I guess. Sort of bush league, but a pretty common practice among opinion mongers.
Moreover, if 15 Washington-based experts really can save a system as vast as Medicare through a process of top-down control, then this will be the only realm of human endeavor where that sort of engineering actually works.
I know this is an applause line in certain circles, but really, what possesses people to say stuff like this? Top-down control has never worked in all of human history? Seriously? Is the Catholic Church a successful endeavor? How about the U.S. Army? Or the interstate highway system? Or every corporation in America? Corporations may be embedded within a larger competitive ecosystem, but almost universally they thrive within this system via top-down management structures. If you don't believe me, try working for a corporation.
Look: virtually every real-world instance of human organization works via some combination of top-down planning and bottoms-up competition. The pope is the unquestioned leader of the Catholic church, but in practice there are also lots of competing power centers within the church. Likewise, free market capitalism is primarily a system of aggregating individual preferences, but it works a lot better when there's some top-down planning to regulate the financial system and provide a predictable set of laws and property rights.
Medicare is no different. The basic structure is top-down, but plenty of liberal healthcare wonks favor introducing some aspects of competition. That's never really been the problem with Paul Ryan's Medicare proposal. Allowing beneficiaries to choose between competitive plans has plenty of supporters on both sides of the aisle, but on the liberal side we also want to make sure that funding remains strong enough to guarantee high-quality care that's affordable for everyone. Paul Ryan very decidedly doesn't care about that, and provides little more than handwaving when you ask him how his plan will work. That's what really sets the two sides apart.
The fact is that there's zero evidence from anywhere in the world that simply forcing seniors to pay a way bigger share of their Medicare bills will substantially rein in healthcare costs. (It would certainly rein in Medicare costs, almost by definition, but unless healthcare costs also come down it does it simply by denying care to lots of people.) There is, however, limited evidence that it might put modest downward pressure on costs. Likewise, there's little evidence that better planning and control can have a large and durable impact on healthcare costs, but there is plenty of evidence that it too can put modest downward pressure on costs. Put both together and we'll probably make some progress.1 Pretend dogmatically that either one by itself is a silver bullet and you're almost certainly guaranteeing future failure.
1Though, frankly, probably not all that much. I'm all in favor of attacking healthcare costs on multiple fronts, but I continue to believe that the fundamental reason healthcare costs keep going up all over the world is because that's what people in rich countries want to spend their increasing wealth on. When it gets expensive enough that we collectively don't think it's worth spending more — regardless of whether that collective decision is expressed via the market or the ballot box — costs will start to plateau.
We do not generally praise doctors who help dispatch their terminally ill patients, as Kevorkian repeatedly and unashamedly did. Even when death is inevitable and inevitably painful, it is not considered merciful to prescribe an overdose to a cancer victim against her will, or to gently smother a sleeping Alzheimer’s patient.
The difference, of course, is that Kevorkian’s clients asked for it. That free choice is what separates assisted suicide from murder, his defenders would insist.
What peculiar wording. Douthat makes it sound as if this defense of Kevorkian is some kind of transparently concocted subterfuge. But, yes, the fact that his clients asked for it is what makes assisted suicide different from murder. Even if you don't approve, this is a pretty natural distinction and an easy one to grasp.
So what's the objection to assisted suicide? This is where it gets weird. Douthat argues that it's a slippery slope: if terminally ill patients are allowed to kill themselves, what's to stop anyone else who wants to do it? Nothing, he says, as the example of Dignitas, a Swiss assisted suicide clinic, shows. And technically that's true: about a fifth of Dignitas's clients aren't terminally ill, but merely weary of life. But think about that number: it means that perhaps 200 weary people have used Dignitas's services over the past decade or so. That's something like 20 per year.
In other words, even after a decade in business, Dignitas almost certainly isn't doing anything to spur suicides and it hasn't created a tidal wave of people wanting to die. Like so many other things, it merely provides an additional option for the well off (Dignitas charges about $6,000 to perform an assisted suicide). The less well off simply continue to swallow bottles of aspirin or jump off bridges.
So, again: what's the problem?1 More than anything else, I think this column illustrates the perils of taking a religiously motivated belief and trying to justify it on secular grounds. It just doesn't work. The slippery slope here pretty obviously doesn't amount to much, so you're left with a simple disapproval of people deciding to take their own lives. And what's the argument for that? Douthat doesn't provide one. He simply declares it murder and calls it a day. Without recourse to his underlying religious objections, that's really his only choice.
But of course, that's the real slippery slope. If the state is allowed to prohibit me from killing myself, what else is the state allowed to do? Can it force me to accept medical treatment that will save my life? Can it force me to accept medical treatment that might save my life? If not, why?
I'm a liberal, but I'd just as soon keep the state out of decisions like that. I'd especially like to keep the state out if there's no compelling secular reason for them to get involved. In this case, there sure doesn't appear to be.
1Needless to say, there are practical issues with assisted suicide. You need to make sure the client really wants to die and isn't just reacting to a momentary bout of depression. You need to make sure there's no coercion. You need to make sure the client is of sound mind. But I think all of these things are pretty widely accepted as simple common sense.
On Monday, following the release of shirtless photos by Andrew Breitbart's Big Government, Rep. Anthony Weiner (D–N.Y.) announced that he had sent lewd photos and text messages to six different women in the last three years—all of whom he met online. It was a bizarre scene, made all the more so by the presence of Breitbart, who seized the podium before Weiner's press conference to take questions about his site's coverage of the scandal. But where does it rank on the spectrum of recent political apologies? Here's a quick look:
1. Sen. John Ensign (R–Nev.)
Busted: Had extra-marital affair with the wife of a close friend (and aide). Had his parents pay off the couple to keep them quiet. Used his influence to land the husband of his mistress a job.
Strategy: "Take full responsibility," but don't actually take full responsibility. Ensign says there's nothing to the reports of possible ethics violations.
Did he resign? Yes, last month, when he faced expulsion from the Senate (the first since the Civil War) on ethics charges stemming from his cover-up.
Busted: Sent shirtless photos to a Maryland woman he met on Craigslist.
Strategy: Put out a terse statement, resign immediately.
Did he resign? See above.
3. Sen. John Edwards (D–N.C.)
Busted: Cheated on cancer-stricken wife with campaign videographer Rielle Hunter. The National Enquirer publishes "spy photos" of Edwards holding Hunter's baby.
Strategy: Deny, deny, deny—and then eventually confess to the affair on Nightline: "I became, at least on the outside, something different than that young boy who grew up in a small town in North Carolina." Continue to deny paternity of the child, and then cave on that too.
Did he resign? Out of office. But he might go to prison now.
4. Sen. Larry Craig (R-Idaho)
Busted: Arrested in a sting at the Minneapolis International Airport, Craig pled guilty to soliciting sex from an undercover cop in a men's restroom.
Strategy: Blame the local newspaper, the Idaho Statesman, for pressuring him into confessing even though he did nothing wrong. Blame the confusion over whether or not he was propositioning a cop by tapping his foot on a "wide stance." Oh, and just to be clear: "I am not gay, and I never have been gay."
Did he resign? Nope.
Is there a dramatic reenactment of the arrest that uses the police report as a script?Glad you asked.
5. Gov. Mark Sanford (R-S.C.)
Busted: GOP rising star goes missing for seven days in early 2009, causing the state police to start looking for him. Told staff that he was "hiking the Appalachian Trail," then that he was in Argentina. Conducted long-distance with affair with Argentinian woman.
Strategy: Apologize to more or less everyone he's ever met: "I hurt her. I hurt you all. I hurt my wife. I hurt my boys. I hurt friends like Tom Davis. I hurt a lot of different folks. And all I can say is that I apologize. I —I —I would ask for your — I guess I'm not deserving of indulgence, but indulgence not for me, but for Jenny and the boys."
Did he resign? Resigned chairmanship of the Republican Governors Association, but finished out his term in Columbia.
6. Sen. David Vitter (R-La.)
Busted: Allegedly consorted with prostitutes in DC and New Orleans.
Strategy: Tell media to drop dead. Hold a press conference to apologize for "past failings," and then change the subject to local issues like a water resources bill and I-49 construction projects. Appear with wife at press conference, who says "I am proud to be Wendy Vitter." It's a good thing, too, because she had previously told the Times-Picayune, "I'm a lot more like Lorena Bobbitt than Hillary" and that "If he does something like that, I'm walking away with one thing, and it's not alimony, trust me."
Did he resign? Nope.
Any way things could get worse? Yes. After apologizing once more at a later event, he ran over a stop sign in the parking lot.
7. Gov. Jim McGreevey (D-N.J.)
Busted: Appointed Israeli Defense Forces vet to position as homeland security adviser; had affair with said homeland security adviser.
Strategy: Come clean, come out. "At a point in every person's life one has to look deeply into the mirror of one's soul and decide one's unique truth in the world. Not as we may want to see it, or hope to see it, but as it is. And so my truth is that I am a gay American."
Did he resign? Spectacularly:
8. Rep. Mark Souder (R–In.)
Busted: Affair with a part-time staffer.
Strategy: Blame the "poisonous environment of Washington," apologize to his family, acknowledge sins, improbably attempt to regain the moral high ground: "I'm sick of politicians who drag their spouses in front of the cameras rather than confront the problems that they caused."
Busted: Spent $80,000 on call girls as attorney general and governor.
Strategy: Confess to wrong-doing, keep it short, stand alongside wife.
Did he resign? Yes.
Scandal officially jumped the shark when... Call girl Ashley Dupre launched her own music career.
10. President Bill Clinton (D)
Busted: Had sexual relations with White House intern Monica Lewinsky.
Strategy: Tell American people he did not have sexual relations with Monica Lewinsky, but later come clean while calling on the nation to move on: "Even presidents have private lives. It is time to stop the pusrsuit of personal destruction and the prying into privates lives, and get on with our national life."
Did he resign? Nope—and he survives the impeachment proceeding too.
And? If you have nothing better to do, you can read the Starr Report in its entirety here. The 90s were so weird.
Strategy: No discernible strategy. Intitially fesses up to using "salty language" but denies any wrongdoing. Massa later resigns and goes on a media blitz and accuses a naked White House Chief of Staff Rahm Emmanuel of intimidating him in the Congressional gym. Massa calls Emmanuel the "Devil's spawn," and says the administration forced him out because he didn't vote for the Affordable Care Act.
D-Day for the Sarah Palin email release is Friday.
The state of Alaska has informed media representatives that on this day it will be handing out the 24,000-plus pages of Palin's gubernatorial emails it is releasing in response to a request I initiated in September 2008, shortly after John McCain tapped the first-term Alaska governor to be his running mate. The material will be made available at 9:00 a.m., which will be Friday afternoon on the East Coast, the traditional time for a dump of government documents. But it could have been worse: the state could have opted to release the records on Friday afternoon, Alaska time.
Here's the last update we've posted on this long-running saga:
During the 2008 presidential campaign, I filed a request under Alaska's open records law, for all—yes, all—of Palin's gubernatorial emails. Other journalists and citizen activists later did the same. And after many delays—see here and here—the state is finally preparing to release those emails, probably within the next week or so.
But not all of the emails from Palin's half-term as governor will be made public. In a letter that was recently sent to me and other requesters, the state says it will be disclosing 24,199 pages of records. But it notes, "We withheld and redacted some records that are responsive to your request." Previously the state said that it had located and/or recovered 26,552 pages of emails. This suggests that state of Alaska is withholding 2,353 pages. And there's no telling how heavily the remainder of the emails will be redacted.
President Obama's former top economic adviser is jumping on Friday's weak jobs numbers to make the case that the economy needs a much bigger boost from Washington than it's getting.
....What should Washington be doing? Romer called for additional fiscal stimulus, as part of a package that reduces the deficit over the long term. That spending, she said, should take the form of a cut in the employer side of the payroll tax--an idea with bipartisan appeal--as well as more aid to state and local governments. She also supports infrastructure spending of the kind President Obama has proposed.
We could do this if elite consensus in this country accepted that chronic massive unemployment was a bigger problem than our future federal deficit. But the former affects actual middle class people right now, while the latter — might, possibly — affect the financial fortunes of the well-off in the indefinite future. Looked at that way, it's a no brainer. Deficits it is.
Details on the size or beneficiaries of the projects funded by the MFET are hard to discern from the defense bill's lengthy list of procurements. But armed services committee members on both sides of the aisle have left clues. In the days following the voice vote approving their budget, they pumped out press releases trumpeting the projects they'd scored for their districts. Since the MFET funds came from other cuts in the Pentagon budget, the members could claim their projects would be offset by spending cuts elsewhere. Rep. Allen West (R-Fla.), a tea party freshman who sees himself as a budget hawk, secured $8 million for engines for Army drones, funded by savings from "wasteful DOD offsets." Rep. Chris Gibson (R-N.Y.) bragged that he'd secured a federal study to open a nanotechnology lab on the SUNY-Albany campus in his district, as well as $7 million in funding for additional nanotech research. Rep. Martin Heinrich (D-N.M.), announced $3 million in funding for a nonprofit called the Technology Ventures Corporation, which would "help expand innovation in New Mexico's emerging satellite industry."
Ah, Washington. Not only are these earmarks, despite some laughable attempts to suggest otherwise, but they're stealth earmarks that don't even have to be disclosed. This actually makes them worse than old style pork. It turns out you can take the boy out of the pig sty, but you can never take the pig sty out of the boy.
Mitt Romney capped off the week in which he made the anti-climactic announcement that he is, in fact, running for president with a statement that has drawn considerably more attention: He thinks the planet is actually warming.
"I believe the world is getting warmer, and I believe that humans have contributed to that," he told a crowd of about 200 at a town hall meeting in Manchester, New Hampshire.
"It's important for us to reduce our emissions of pollutants and greenhouse gases that may be significant contributors."
The Reuters story notes that he "broke with Republican orthodoxy" in making this statement. I would point out, however, that the GOP's last presidential nominee, Sen. John McCain (R-Ariz.), came to this not-exactly-earth-shattering conclusion as well. So have others among the 2012 pool: Tim Pawlenty (though he has since apologized), Jon Huntsman, and Newt Gingrich (who has since tried to repent for that by advocating that we abolish the EPA).
Nevertheless, conservatives have declared Romney's statement to be "political suicide."
"His run for President as a Republican is now officially over," declared Charles Johnson over at (the formerly conservative blog) Little Green Footballs. The conservative blog American Thinker declared the statement a "blunder." And over at Hot Air, Allahpundit ponders whether this is a "gaffe" that could cost Romney in the primary, while wagering that Mitt will eventually flip-flop on this in some way: "Many sins can be forgiven in the name of winning, especially if/when Romney inevitably finesses his position here by endorsing 'market solutions' to the problem instead of regulation."
If believing in global warming is going to be a deal-breaker, there won't be many candidates left in the running.
It would begin with a simple and predictable tax system, with a broad base and low rates, free of most of today's deductions and exclusions. The only three worth keeping in the individual tax code are the tax exemption for retirement savings (which are far preferable to universal cash benefits to retirees), a unified child tax credit (to encourage parenthood and to offset the mistreatment of parents in the tax code), and the charitable-giving deduction (since a reduction in government's role in social welfare must be met with an increase in the role of civil society, which should be encouraged). These three exemptions are directed precisely to the needs of a modern society, and to addressing the three broad failings of the social-democratic welfare state.
This really doesn't work. If you think, say, that the mortgage interest deduction is bad policy and we ought to get rid of it, that's fine. Make your case and push to get it repealed. Ditto for all the other tax expenditures in the tax code.
But what you really can't do is argue that deductions are inherently bad and we should get rid of them all — except for these two or three pet ideas that I really truly think are worth making an exception for. You either think that tax expenditures are distortionary and therefore bad policy in general, or you think that it depends on exactly which ones we're talking about and prefer to look at them on a case-by-case basis. After all, every tax expenditure in the current tax code is there because someone thought it encouraged some kind of worthwhile behavior that was directed to the needs of a modern society. If you insist that your three exceptions are worthy ones, then you have to accept that other people are going to find worthy exceptions too.
Personally, I'm in the "case by case" camp. It's always satisfying to take a hard line and demand that the tax code be pure, but human nature just doesn't seem to work that way. Everyone has behavior they believe should be encouraged or discouraged, and sometimes the tax code is the most efficient way of doing it. I'm happy with efforts to scrape barnacles away periodically, but there's no point in pretending that the hull is going to stay clean forever. And there's especially no point in doing it if you yourself have several pet barnacles of your own.
Jon Chait has a good post this morning about a Politico story that simply insists on finding some kind of Democratic counterpart to the gruesome and longstanding efforts of Republicans to make it harder for Democratic-leaning groups to vote. In Politico's defense, their stale attempt at faux evenhandedness only takes up two paragraphs, but the tone of the article throughout suggests that this battle is roughly equivalent on both sides, as if suppressing votes were pretty much the same thing as encouraging votes. You'd think we'd be past that by now, but apparently not.
“I don’t know why everybody’s so puzzled by this,” said Florida state Rep. Dennis Baxley, R-Ocala, sponsor of a controversial election-reform law there....Baxley said the lax address requirement opened the door to abuse, like a city council election he heard about in which the “pro-family” candidate was favored to win until his opponent, “a homosexual activist candidate,” bused in homosexuals from other parts of the state who showed up at the polls and claimed residency at an address occupied by a local Dunkin Donuts.
Chait cautiously says he "strongly" suspects that "the whole story is an exaggeration at best, and a pure fantasy at worst." I think I'll go with pure fantasy myself, even though I have no idea where this story comes from or what urban legend is behind it. This means some enterprising right winger has an opportunity to make me look like a knee-jerk liberal shill who's never willing to concede even the possibility that conservatives might be acting in good faith. All you have to do is find the wellspring of this story and demonstrate that there's something to it.
Anyone can play. I did a bit of desultory googling, but that's about all the time I can afford to spend on this right now. But I really am curious, in an academic sort of way. Has anyone ever heard this story before? Where did it come from? Is there even a remote grain of truth anywhere in it?
I have a story up today on Rep. Michele Bachmann's history of saying absolutely ridiculous things—from the time she opined that Melissa Etheridge's battle with breast cancer was an opportunity for the lesbian songwriter to turn away from her sinful lifestyle, to the time she suggested letting Glenn Beck fix the federal budget deficit. But a reader emailed to let me know I missed his favorite quote. And it is a pretty fantastic one: here is Bachmann, circa 2008, warning against the eight-headed chupacabra of sustainable development:
"This is their agenda. I know it is hard to believe, it's hard to fathom—but this is 'mission accomplished for them': They want Americans to take transit and move to the inner cities. They want Americans to move to the urban core, live in tenements, [and] take light rail to their government jobs. That's their vision for America."
The idea that sustainable development is some sort of nefarious plot actually has pretty deep roots in the tea party movement. MoJo's Stephanie Mencimer reported last spring on concerns, among some on the right, that the United Nations is working in league with progressive activists and politicians to return rural America to nature.
Anyway, if your favorite Bachmann-ism didn't make the cut, feel free to post it in the comments.