The Rationing Canard

Ezra Klein takes a bat to Charles Krauthammer's claim that national healthcare inevitably leads to rationing:

A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent....There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The problem, of course, is that the U.S. rations by denying healthcare to poor people, and the Krauthammers of the world don't really care much about that.  What's more, for all that we like to think of ourselves as nice people, most middle class Americans don't care much about it either.

In any case, Krauthammer also violates two of my standard rules for figuring out when someone is completely full of it when they talk about healthcare.  #1: the old hip replacement canard.  Run for the hills when you hear it.  Krauthammer, as Ezra points out, is implicitly talking about elective surgeries like hip replacements, but there's a reason these procedures are called "elective": it's because these are the procedures that can be most effectively triaged.  We do the same thing in emergency rooms all the time, and we do it every time you have to wait a few weeks for a doctor's appointment because you're not keeling over on the street.  Every system triages something, and in some countries that something is hip replacements that can be easily monitored and scheduled.  In others — like ours — it's things like basic dental care.

#2: Krauthammer is careful to name check only Britain and Canada, which have more problems than most other national healthcare systems — and are conveniently English-speaking, which makes it easy to lazily Google complaints about care.  But he couldn't make his rationing statement at all if he'd chosen France and Germany (or Sweden or Japan) instead.  The plain fact is that universal care doesn't inevitably mean longer waits for care than in the U.S.  As any honest observer knows, plenty of actual, existing countries have proven just that.  We should emulate them.

Af/Pak Dominos

According to Mike Crowley, Bruce Riedel said this at a Brookings event earlier this week:

The triumph of jihadism or the jihadism of Al Qaeda and the Taliban in driving NATO out of Afghanistan would resonate throughout the Islamic World. This would be a victory on par with the destruction of the Soviet Union in the 1990s. And, those moderates in the Islamic World who would say, no, we have to be moderate, we have to engage, would find themselves facing a real example. No, we just need to kill them, and we will drive them out. So I think the stakes are enormous.

Riedel was chair of a White House team that reviewed U.S. policy on Afghanistan and Pakistan earlier this year, so his opinion isn't one you can easily dismiss.

But how reasonable is it?  It's probably true that Pakistani moderates are skeptical about our willingness to stick things out for the long haul, so they often hedge their bets by trying to stay on our good side while they strike deals with the Taliban on the side.  After all, Americans are a wee bit unpopular in Pakistan these days, so why not?  What's more, it's a pretty safe game since these same moderates know perfectly well that we don't have enough leverage to ever really call them out on this tap dancing.

At the same time, neither Pakistani moderates nor, more importantly, the Pakistani army, would ever put up with any serious effort by the Taliban to mount a coup.  The army plays a sometimes dangerous game, trying to use these terrorist groups as useful foot soldiers in its forever war with India, but other than that they've never had any real use for them.  The more important question, then, is what would happen if Islamist elements in the Pakistani army gained more control than they have now and started cooperating with Islamist groups more seriously?  If the U.S. withdrew from the region and radicals claimed victory, would all this stop being a game and start becoming all too real?

Nothing is impossible, but at its core this is just a sophisticated version of the same domino theory that dominated U.S. thinking in Southeast Asia in the 50s and 60s.  That led us into a disastrous war then, and it could do the same now if the Obama administration starts getting too wrapped up in febrile thinking like this.  After all, if you assume enough dominos, you can come to just about any conclusion you want.  I sure hope they're not taking this more seriously than it deserves.

More in the same vein from Michael Cohen here.

Headline of the Day

From the Los Angeles Times this morning:

L.A. Targets Illegal Cheese

It's all about unpasteurized Mexican cheese, of course, which is "spirited into the country in suitcases and is then sold door to door to residents or restaurants and at open air markets out of coolers."  The foodies love it:

Many people know its provenance is illegal but think it tastes better. Jonathan Gold, the Pulitzer Prize-winning L.A. Weekly food critic, said he prefers it.  "I will admit that there are some groceries . . . where you do kind of buy cheese under the table, and it tastes better," Gold said. "If you're the sort of person who believes milk has a soul to it, which I guess I am, then pasteurizing is taking something away." As for the potential danger posed by unpasteurized cheese, Gold added: "Life is filled with risks."

I guess the LAT's own food critic wasn't willing to own up to buying illegal cheese under the table.  Coward.

The GOP seems to have no end of nutty criticism of the Democrats’ health care plans. First they had the entirely fictional “death panels.” Now, they're claiming that a reformed health care system might discriminate against Republicans. Last week, the ever-entertaining Michael Steele, chairman of the Republican National Committee, mailed out a push-poll disguised as a health care "survey." Among the questions on the survey was this one:

"It has been suggested that the government could use voter registration to determine a person's political affiliation, prompting fears that GOP voters might be discriminated against for medical treatment in a Democrat-imposed health care rationing system. Does this possibility concern you?"

While it's hard to imagine that Steele will get much traction with this sort of thing, in this climate, it seems Republicans are banking on the public’s willingness to believe just about any conspiracy theory they put out there to kill off health care reform. Again.

Sgt. Daniel Smith, an amphibious assault vehicle crewman, maintains security during a census patrol in Helmand province, Afghanistan, Aug. 18. Delta Company, 2nd Amphibious Assault Battalion and civil affairs group Marines, deployed with 2nd Marine Expeditionary Brigade, are talking with the local populace in order to understand their conditions and concerns and identify possible reconstruction and development projects. US Marine corps photo by Sgt. Pete Thibodeau.

Happy Friday. Here's a sampling of what's happening in the realms of environment, health, and science, here at motherjones.com and in the rest of the wide world:

No chains during birth: New York's Gov. David Paterson has signed a bill banning the shackling of incarcerated pregnant women during labor and recovery.

Remembering Cash for Clunkers: The program was wildly popular, provided a modest but noticeable amount of economic stimulus, and helps reduce US oil consumption. Not bad for $3 billion.

SODIS skeptics: There's a simple way to disinfect water in areas where lots of kids get sick and die from bad water. So why is it so hard to get people to do it?

Stimulus for stoves: The US government will spend $300 in stimulus money to reward consumers who choose energy-efficient appliances.

Africa, sans animals: Could poaching and encroaching kill of Africa's great herds for good?

Need To Read: August 28, 2009

White House photo.White House photo.Today's five must-reads know the dream never dies:

Like most bloggers, I also use twitter. I mostly use it to send out links to interesting web content like the stuff above. You can follow me, of course. David Corn, Mother Jones' DC bureau chief, is also on twitter. So are my colleagues Daniel Schulman and Rachel Morris and our editors-in-chief, Clara Jeffery and Monika Bauerlein. Follow them, too! (The magazine's main account is @motherjones.)

Today we get some bad news on the executive power front:

The Obama administration will largely preserve Bush-era procedures allowing the government to search — without suspicion of wrongdoing — the contents of a traveler's laptop computer, cellphone or other electronic device, although officials said new policies would expand oversight of such inspections.

...."It's a disappointing ratification of the suspicionless search policy put in place by the Bush administration," said Catherine Crump, staff attorney for the American Civil Liberties Union. "It provides a lot of procedural safeguards, but it doesn't deal with the fundamental problem, which is that under the policy, government officials are free to search people's laptops and cellphones for any reason whatsoever."

And also a bit of good news, from a ruling in a lawsuit brought against the CIA by a DEA agent, Richard Horn, and his lawyer, Brian Leighton:

In a highly unusual legal step, a federal judge has ordered the government to grant an attorney a security clearance so he can represent a disgruntled former narcotics officer in a lawsuit against a former CIA officer...."The deference generally granted the executive branch in matters of classification and national security must yield when the executive attempts to exert control over the courtroom," U.S. District Judge Royce Lamberth wrote in an order issued late Wednesday.

...."It is fabulous for many reasons, not the least of which is the judge doesn't believe anything the government is saying," Leighton said Thursday of the new ruling.

....In his July ruling, Lamberth denounced certain CIA and Justice Department officials for having "handcuffed the court" with delay tactics and inaccurate statements. His latest ruling similarly chastises Justice Department attorneys for "continued obstinance" and "diminished credibility."

The Horn/Leighton lawsuit has been going on since 1994.

As long as I'm writing about British sporting clubs today, how about some cricket blogging?  A few weeks ago I was emailing with Alex Massie about something or other, and along the way suggested that he should write more about cricket.  "I'm pretty much agog," I wrote "at the idea that you have a sport that frequently ends in a draw even though it takes five days to play."

That's not the only reason I find myself intermittently bewitched by cricket, of course.  All sports have their own weird jargon, but cricket writing is so deliciously, Britishly impenetrable that it's mesmerizing, sort of like those contests to write parody pomo paragraphs.  Like this: "Ian Bell, back at No3 and under the microscope, survived a torrid start to make 72 good runs, worth more than they appear, before dragging his first ball after the tea interval on to his off-stump, while Andrew Strauss batted superbly, hitting 11 fours in his 55, on the way protecting Bell from a Mitchell Johnson bombardment while he settled in."

And the rules!  Every year or two, when some big test series comes along, I read up on the rules again and then immediately forget them.  It's sort of like quantum mechanics: no matter how often I read about it, my brain refuses to accept that anything so eccentric can possibly be true, and promptly expels it.

So there's that.  But back to the five-day draws.  I wrote that email to Alex after England had, via some pact with the devil or something, managed to force a draw in the first test of the Ashes last month even though Australia was clearly the better team by several light years.  But Alex says it's the draw that makes the game what it is:

This is [] an aspect of cricket that mystifies many people, by no means all of them American. But of the three most common results — a win, a loss and a draw — it is not an overstatement to say that the draw is the most important. Because it is the draw, or more accurately the possibility of the draw, that gives the game its texture and much of its near-endless variety.

Then he starts quoting Clausewitz.  Someday, I suppose, I need to actually go watch some cricket in person with a knowledgable fan.  Only then, like Schrödinger's cat, will I truly understand what it's all about.