Kevin Drum

A Tribal Strategy for Afghanistan

| Mon Nov. 23, 2009 9:04 PM EST

A couple of weeks ago Fred Kaplan speculated that President Obama might be planning to pursue a tribe-centered counterinsurgency strategy in Afghanistan rather than one centered on the central government in Kabul.  Today, after reading Dexter Filkins' piece in the New York Times that describes an effort already underway to co-opt local militias, Kaplan doubles down:

The interest, even excitement, in this development stems from two sources. First, it is reminiscent of the Anbar Awakening in 2006-07, when Sunni tribal leaders in western Iraq formed alliances with U.S. forces — whom the Sunnis had been shooting just months earlier — to beat back the bigger threat of al-Qaida.

Second, it has drawn high-level attention to a 45-page paper by Army Maj. Jim Gant, the former team leader of a special-ops detachment stationed in Konar province. The paper, called "One Tribe at a Time: A Strategy for Success in Afghanistan," recounts his experiences with organizing "tribal engagement teams" to help local fighters beat back the Taliban — and it spells out a plan to replicate these teams across the country.

....There are signs that Obama has been mulling over something like Gant's strategy. At one of the seven meetings Obama has held with his national security advisers (the ninth, and perhaps final, session takes place tonight), he asked for a breakdown of which Afghan provinces could provide their own defense, which need our help, and to what degree.

....Obama is likely to announce his decision — on a strategy and on how many, if any, more troops it will require — soon after Thanksgiving. A key question to ask, in examining this mix, is how prominently it features the tribes.

I first heard about Gant's paper via email from Wagster, who wrote about it in a post earlier this month:

Gant goes on to describe how he developed close relations with the village chieftain, whom he affectionately called "Sitting Bull." He was audacious enough to arm and supply the village's fighters, probably breaking many rules but winning their trust and allegiance and gaining access to valuable intelligence. It is this approach — a tribal engagement strategy — that he advocates for the country as a whole. He calls the fighters Arbakai, a tribal militia that would protect their neighbors from Taliban intimidation. These could be the Afghani equivalent of the “Sons of Iraq,” grass-roots warriors defending their own tribal interests, with the U.S. as their ally — not imposing a central government on them, but giving them what they want: security, their tribal traditions, and the right to be let alone.

I will go farther than Gant does. Instead of envisioning an end state where Kabul dominates all of Afghanistan, we should be striving for Kabul + Largely Autonomous Tribe Lands. The Karzai government would control the heavily populated areas in the east of the country, and as best they could the border areas with Pakistan. They would have nominal sovereignty over their country, as previous Afghani governments have. The Pashtuns would be empowered to defend themselves from the Taliban, but they would largely be free of Kabul too. Provincial government structures would have to be developed in order to resolve inter-tribal conflicts and law-and-order issues, but largely, governance would come from nearby.

Kaplan says flatly that if Obama's eventual strategy doesn't look a lot like Gant's, "it is almost certain to fail."  And even if it does, it might still fail.  But at this point, the tribes are pretty much our only hope.

I am, as I've said before, skeptical about deepening our engagement in Afghanistan at all.  But the absolute minimum requirement is a strategy that's notably different from the one we've been following for the past seven years, a strategy that's done little except pour ever more troops into the country while simultaneously losing ever more control.  This might be the one. We'll probably know in another week or so.

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On to Copenhagen

| Mon Nov. 23, 2009 2:59 PM EST

The latest news from the White House:

The US will announce a target for reducing greenhouse gas emissions before next month's UN climate summit, according to a White House official.

The target is expected to be in line with figures contained in legislation before the Senate — a reduction of about 17-20% from 2005 levels by 2020.

This is no big surprise: 17% is the figure in Waxman-Markey and it's close to the figure in the various Senate bills.  Overall, it's a pretty modest target, but Obama could hardly pledge anything more under the circumstances.  At least it's something.

(I think this is going to be my motto for the next four years: "At least it's something."  Kinda sad, isn't it?  But at the moment we're still pretty plainly not willing to face up to reality on a whole bunch of different fronts.  So we do what we can.)

Quote of the Day

| Mon Nov. 23, 2009 1:03 PM EST

From Ezra Klein, on the likely course of healthcare reform:

I once heard an activist say that leadership is the process of managing your constituency's disappointment. If that's accurate, then the next few months are going to offer ample opportunities for leadership.

Yep.  The opt-out public option is almost certainly toast, and we'll end up instead with something closer to Olympia Snowe's trigger idea — assuming we even end up with that much.  And there's no telling what other amendments are going to get tacked on and then make it through the final conference report.  Whatever happens, though, it's not going to be pretty.  Watching sausage getting manufactured never is.

Mass Production Heart Surgery

| Mon Nov. 23, 2009 12:40 PM EST

Over the weekend, the Wall Street Journal had an interesting piece about Devi Shetty, an Indian heart surgeon who is revolutionizing the practice of heart surgery:

Dr. Shetty, who entered the limelight in the early 1990s as Mother Teresa's cardiac surgeon, offers cutting-edge medical care in India at a fraction of what it costs elsewhere in the world. His flagship heart hospital charges $2,000, on average, for open-heart surgery, compared with hospitals in the U.S. that are paid between $20,000 and $100,000, depending on the complexity of the surgery.

....Then there are the Cayman Islands, where he plans to build and run a 2,000-bed general hospital an hour's plane ride from Miami. Procedures, both elective and necessary, will be priced at least 50% lower than what they cost in the U.S., says Dr. Shetty, who hopes to draw Americans who are uninsured or need surgery their plans don't cover.

A few notes: Shetty runs a for-profit business, not a charity.  He makes money at these prices.  And although a big part of his lower prices has to do with the generally low cost of living in India, his mass-production techniques have reduced prices more than 50% even compared to other Indian hospitals.

But although this may be cheap medicine, there's nothing cheap about his results: outcomes at his hospitals are at least as good as they are at the best American clinics, and probably even better.  It's the kind of thing someone ought to be trying here.  The whole story is worth a read.

Weatherizing Your House

| Mon Nov. 23, 2009 12:17 PM EST

"Using energy more efficiently in buildings may be the fastest, cheapest way to substantially reduce carbon emissions in the short-term," says David Roberts, and I think my only quibble there would be with the word may.  But how do we get people to do it?  Most people don't bother with this stuff even if it already makes economic sense, so putting a price on carbon and raising the price of energy will probably have only a minor impact on getting people off their butts to weatherize their houses and buildings:

Evidence indicates that the elasticity of energy demand is weirdly low.  The price signals that already exist aren’t getting a rational response. People can already save lots of money by investing in efficiency, but they aren’t doing it. They absorb a lot of price pain before they adjust their behavior....Which raises the question: why should price-based policies be our exclusive focus? Why not instead, or in tandem, try to increase elasticity of demand? If the federal government wants to get good job and economic results from its stimulus investments—and it surely does—it should not only spend the money, it should start attending seriously to the project of meliorating the market and behavioral failures in efficiency markets.

How do we remove the barriers? It turns out we know a decent amount about them but comparatively little about how to overcome them.....We’ve had three decades of cheap energy, so there’s been little reason to focus on accelerating efficiency; our know-how froze in the 1970s.

What’s clear is that getting the most out of efficiency will not only mean federal policy but state and local policy,  public-private partnerships, new financing models, new models of information sharing, and much more creative thinking. Because we know so little, there’s a lot we can learn quickly with an all-hands-on-deck effort.

Part of the problem here is simple: inertia.  Or call it laziness if you like.  It's like the difference between opt-in and opt-out: people are far more likely to accept the status quo, whatever it is, than they are to actively seek change.  Look at me: I accidentally ordered a bunch of extra channels from my cable company a couple of months ago, but I still haven't gotten around to cancelling them.  Maybe I never will.  Inertia is powerful.

But we also know that financing is a big part of the problem too.  Most of us don't have $10,000 to get our homes up to snuff, and if we finance the improvements via a loan, the payments need to be low enough that we see a net savings each month.  That might require government help.  Most of us also aren't willing to bother with this stuff if we think we might be selling our house in the next few years.  Creative financing that stays with the house, not the homeowner, can help here too.

But pure marketing is also part of the answer.  Many of us, I suspect, don't really believe all the claims about energy audits.  Even I don't.  Several years we bought a new refrigerator, and the energy savings on the model were plastered all over it.  What's more, the Energy Star program has gotten lots of publicity over the past decade.  And yet, I was still sort of surprised when we got the next month's electricity bill and it was about $20 lower than before.  In my heart, I guess I hadn't ever really believed that all the hype was true.  But the fact is that it really has paid for itself over the past five years.

So yes, this is low-hanging fruit from an economic point of view.  But to get the most out of it, we need a lot more work on quantifying the benefits, on marketing, on behavioral prods, and on financial programs.  Plus we need whatever stuff David is promising to share in a followup post tomorrow.  It'll probably be worth reading.

Dog Food Explained!

| Mon Nov. 23, 2009 11:04 AM EST

So how did the Senate's provision forcing members of Congress to buy health insurance through the exchange end up in the final bill?  A reader emails to explain:

The provision in the health care bill was added by Sen. Chuck Grassley. He originally wanted it to cover all federal workers — not just the Congressional ones — and obviously that created a bit of a stir. Baucus tried to placate him by adding language to say that federal employees may enter the exchanges, but that didn't work. So then Grassley offered his amendment saying, members of Congress and their staffs must use the exchanges. Perhaps he thought this would lead to an embarrasing fight, but Baucus said, "fine," and then that was that. As far as I know, the House version just says, members of Congress may enter the exchanges if they want to.

So there you have it.  More here.

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Eating Their Own Dog Food

| Sun Nov. 22, 2009 5:53 PM EST

Last week I found myself talking about healthcare for a few minutes with a friend I hadn't seen in a while, and at one point she remarked sarcastically that if healthcare reform was such a great idea, why didn't Congress give itself whatever deal it was foisting on the rest of us?  I mumbled some kind of lame reply, but little did I know that the Senate bill actually does this.  Joe Klein explains:

My favorite provision requires that all members of Congress give up their federally-funded health care benefits and join the health care exchanges that will be set up by this bill. This is brilliant politics, addressing the tide of populist anger and fears of incipient socialism. But it also makes an important substantive point. The future of health care reform in this country will depend on how effectively the exchanges — health insurance super-stores — are working. If members of Congress have to participate in this system, you can bet they'll insist on a array of choices, similar to the system they currently use, the Federal Employees Health Benefits Plan.

There are actually a couple of ways you can look at this, and the pessimistic way is that if you make Congress buy insurance from the exchange then we'll never get any cost controls in place — because members of congress will never approve of anything that might infringe on their own perks of office.

But even I'm not quite that pessimistic.  I think Klein is right: if this survives the conference report, and gets the publicity it deserves (why is this the first time I'm hearing about it?), it will actually go a long way toward assuaging public cynicism about both Congress and healthcare reform.

(And hey — why is this the first time I've heard about this?  It's not as if I don't follow this stuff pretty closely.  Was it added in by Harry Reid at the last second?  Or what?)

UPDATE: Answer here!

Tricked Out

| Sun Nov. 22, 2009 1:46 PM EST

Compare and contrast.  Here is a math teacher describing a technique in algebra:

The trick to deriving the quadratic equation is remembering to complete the square.

You probably remember that from junior high school.  Now, here is climate scientist Phil Jones describing a statistical technique in an email to another climate scientist that was recently hacked and stolen from the University of East Anglia webmail server:

I've just completed Mike's Nature trick of adding in the real temps to each series for the last 20 years (ie from 1981 onwards) and from 1961 for Keith's to hide the decline.

Climate skeptics have gone gaga over this, of course, insisting that the word "trick" means something nefarious designed to pull the wool over the eyes of the world.  But it's not.  RealClimate explains:

The paper in question is the Mann, Bradley and Hughes (1998) Nature paper on the original multiproxy temperature reconstruction, and the ‘trick’ is just to plot the instrumental records along with reconstruction so that the context of the recent warming is clear. Scientists often use the term “trick” to refer to a “a good way to deal with a problem”, rather than something that is “secret”, and so there is nothing problematic in this at all. As for the ‘decline’, it is well known that Keith Briffa’s maximum latewood tree ring density proxy diverges from the temperature records after 1960 (this is more commonly known as the “divergence problem”–see e.g. the recent discussion in this paper) and has been discussed in the literature since Briffa et al in Nature in 1998 (Nature, 391, 678-682). Those authors have always recommend not using the post 1960 part of their reconstruction, and so while ‘hiding’ is probably a poor choice of words (since it is ‘hidden’ in plain sight), not using the data in the plot is completely appropriate, as is further research to understand why this happens.

This won't slow down the skeptics for a millisecond, of course, but there you have it.  The rest of the email stash contains plenty of examples of scientists being annoyed with skeptics and wishing them ill, but that's about it.  For the record, though, I also find skeptics annoying and wish them ill, so the only surprise to me is that the scientists managed to restrain themselves so well even in private.  I don't think I could have kept things so civil.

Dissent of the Day

| Sat Nov. 21, 2009 5:26 PM EST

A regular reader emails to tell me to wake up and smell the mooseburgers:

It's easy as hell to laugh at Palin but I think Democrats are making a big mistake if they don't start taking her much more seriously as a credible challenger to Obama. People are in a sour-as-hell mood and if the economy doesn't pick up dramatically by 2012, Obama is going to be toast. Heaven help our Congressional majority next year.

Yes, Palin speaks in trite, childish platitudes but so do most Americans. Face it, the vast majority of our voters are not exactly rocket scientists and for many of them she will be a perfectly fine alternative to Obama.

Listen, I'm the guy who was convinced the American people would never choose the "amiable dunce" Reagan or the stupendously stupid Bush over Democrats who had IQ scores that couldn't possibly be any less than 30 or 40 points above their opponents'.

Given the state of today's Republican Party, I'd say Palin has an excellent shot at the nomination and if our economy still sucks in 2012 she'll have an excellent shot at beating Obama. So, let's take her for the more serious threat that she actually is and not as some poor joke. Remember, the dullest knife in the drawer is often the quickest to cut us.

I'm pretty sure I disagree.  But let's open up the floor for discussion.  Sarah Palin: joke or serious threat?  Vote in comments.

Reining in Healthcare Costs

| Sat Nov. 21, 2009 3:22 PM EST

Ronald Brownstein on the cost-control measures in the Senate healthcare reform bill:

[Jonathan] Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won't succeed unless it "bends the curve" in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

....In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform....[Mark] McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag's assessment of it. "It has got all four of those elements in it," McClellan said in an interview. "They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go."

McClellan is being honest here: it would be nice if more could be done to rein in costs (it would always be nice if more could be done, wouldn't it?), but the Senate bill is still pretty good.  It includes all the primary elements of healthcare cost control and gets us moving in the right direction.

It's noteworthy how much support healthcare reform has from retired Republicans compared to the zero support it has from active Republicans.  The Senate measure is basically a pretty good bill considering the political environment it's being built in, and lots of Republicans who aren't running for office see that.  But Republicans who are running for office aren't allowed to admit any of this.  Not because the bill is bad, but because their political careers would be ruined by taking any of this stuff seriously.  Sad.

Via Ezra.  As he says, it's a very good, detailed column.  Worth a full read if you want to understand more about how the Senate bill gets the ball rolling on healthcare cost control.