Kevin Drum

The Rise of Glenn Beck

| Wed Sep. 23, 2009 12:32 PM EDT

From Vinnie Penn, Glenn Beck's partner in the late 90s, when both were Top 40 jocks at KC101 in New Haven, Connecticut:

He always knew how to work people and situations for attention. He could pick the most pointless story in the news that day and find a way to approach it to get phones lit up. That was his strong point — pissing people off. He was very shrewd on both the business and entertainment sides of radio. He's built his empire on very calculated button pushing.

This is from part 3 of Alexander Zaitchik's terrific profile of Beck at Salon.  If you're looking for an antidote to the Beck dreck that Time magazine recently passed off as journalism, this is it. Read part one here and part two here.

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The Real Cost of Medmal

| Wed Sep. 23, 2009 11:41 AM EDT

In his column today, David Leonhardt makes a point about medical malpractice that doesn't get enough attention:

The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.

At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action.

After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim.

This deserves more attention.  We can argue about the costs of defensive medicine forever. But I'm willing to tentatively accept $60 billion as a conversation starter.  It's never going to be possible to get a precise answer anyway since, as Leonhardt says later, virtually every incentive in our medical system is to do more.  Trying to isolate and quantify the blame for each particular unnecessary test just isn't possible.

Still, $60 billion is a reasonable enough guess, and trying to reduce that cost is, as Leonhardt says, a no-brainer.  Unfortunately, the real problem with our medical malpractice system isn't that it costs too much.  The real problem is that it's a lottery.  Some people get money they don't deserve because it's cheaper to settle with them even if their claims are frivolous.  But far more people who are victims of genuine malpractice never sue and never get a dime.  A genuinely fair reform, one that cut frivolous malpractice suits but also did a better job of compensating everyone who was genuinely injured, would almost certainly end up costing us more, not less.

Here's a little-known fact that helps to make this clearer.  If you're injured in a hospital, how do you know if you're the victim of malpractice?  After all, not every surgery has a positive outcome.  If yours didn't work out, that doesn't mean the doctor was negligent.

The answer is: you don't.  Unless you sue.  Most hospitals refuse to release their internal records unless you sue them and force disclosure via discovery or a subpoena.  This means two things.  First, lots of suits that look frivolous (because they're dropped quickly) aren't.  They were merely attempts to see the actual records of a case.  If there were an easier way to do that, the suit would never have been filed in the first place.

Second, despite our famously litigous nature, suing is a lot of work.  Most people don't want to do it just on the chance that there might have been some malpractice.  And most people don't.  Which means that lots of cases of malpractice are never discovered.

We could fix this pretty easily by making it much easier for patients to see the records of their own cases.  If we did, that would cut down on "frivolous" lawsuits and it would increase the number of justified lawsuits.  That would be fairer for everyone, but it probably wouldn't cut medical malpractice costs.  It would increase them.  That's why the medmal warriors never talk about this.  They like the idea of cutting back on frivolous suits, but they're much less keen on admitting that there's also a lot of genuine malpractive that goes completely unnoticed.

Even if we eliminated medmal suits entirely, the cost savings would be pretty modest.  Genuine reform, on the other hand, would likely cost us money.  That's why you never hear much about it.

State Secrets

| Wed Sep. 23, 2009 1:40 AM EDT

The Department of Justice is planning to roll out new standards that would make it tougher for the government to unilaterally throw out lawsuits by asserting the state secrets privilege:

The new policy requires agencies, including the intelligence community and the military, to convince the attorney general and a team of Justice Department lawyers that the release of sensitive information would present significant harm to "national defense or foreign relations." In the past, the claim that state secrets were at risk could be invoked with the approval of one official and by meeting a lower standard of proof that disclosure would be harmful.

...."What we're trying to do is . . . improve public confidence that this privilege is invoked very rarely and only when it's well supported," said a senior department official involved in the review, who spoke on the condition of anonymity because the policy had not yet been unveiled. "By holding ourselves to this higher standard, we're in some way sending a message to the courts. We're not following a 'just trust us' approach."

....The Justice Department officials said Tuesday that their agency would give regular reports on their use of the state secrets privilege to oversight committees on Capitol Hill and that the attorney general would pass along "credible" allegations of wrongdoing by government agencies or officials to watchdogs at the appropriate agencies, even if the administration had decided to invoke the legal privilege in sensitive cases.

I'm all for this, but unless it's backed by the force of law we're still just trusting the government to do the right thing.  Maybe they will, maybe they won't.  Maybe this administration will and the next one won't.  Who knows?  So I hope Pat Leahy keeps beavering away on legislation to codify this stuff.  DOJ can't have any objection to Congress making sure they do what they say they're going to do anyway, can they?

Quote of the Day

| Wed Sep. 23, 2009 12:06 AM EDT

From the reliably hawkish Michael O'Hanlon, suggesting that his fellow hawks ought to cut Barack Obama some slack on Afghanistan:

Here we are less than six months after [the] first strategy review was completed and military commanders are now saying that the exact same strategy they proposed back in March, they need [...] well above and beyond what they thought they needed.  And so Mr. Obama is entitled to think twice about that. He is entitled to wonder just how precise is this military arithmetic? Just how promising is this counter-insurgency strategy anyway?

Let's get clear about something.  Gen. McChrystal, in his leaked assessment, drew a spectacularly grim picture of events on the ground in Afghanistan and made it very plain that more troops alone won't have much effect on that.  Fred Kaplan interprets:

McChrystal's point is that it's not simply "resources," not just U.S. and NATO troops, that will settle the war. It's also whether the Afghan government earns the trust of its people — whether the Afghan president and his entourage of ministers, governors, and warlords are willing — or are willing to be lured — to clean up their act, end their corrupt practices, and truly serve their people.

When Obama says he needs to review the strategy before he decides on troop levels, he almost certainly means that he needs to assess whether a counterinsurgency strategy makes sense if the Afghan government — the entity that our troops would be propping up and aligning themselves with — is viewed by a wide swath of its own people as illegitimate.

So how do we change that?  This is the place where comparisons to Vietnam become hard to avoid.  Diem was never a legitimate leader of South Vietnam, and after his assassination none of his successors were either.  That made the war impossible to win.

Now we're in a different country but the same situation, and there's little reason to believe that we're any better at installing credible puppet governments today than we were 50 years ago.  More troops won't change that, as McChrystal concedes, but it's not at all clear that a change in strategy will either.  Certainly not the relatively modest changes McChrystal favors and certainly not in the timeframe he suggests.  We've screwed up monumentally in Afghanistan, and rearranging the deck chairs just isn't enough to turn things around.

The problem, of course, is that withdrawing from Afghanistan (a) would be a PR victory for the bad guys and (b) might lead to some genuinely dangerous fallout.  Nobody wants to take the blame for that.  It's always a lot safer and a lot easier to keep on fighting, never quite winning but never quite losing either.  The real danger, then, isn't that Obama might spend too much time asking tough questions of the Pentagon (an aspect of being commander-in-chief that Mitt Romney jejunely refers to as playing "Hamlet in the White House"), but that he might succumb to political pressure to "support the generals" too quickly.  Peter Baker and Elisabeth Bumiller in the New York Times today suggest that he gets this:

President Obama is exploring alternatives to a major troop increase in Afghanistan, including a plan advocated by Vice President Joseph R. Biden Jr. to scale back American forces and focus more on rooting out Al Qaeda there and in Pakistan, officials said Tuesday.

....Instead of increasing troops, officials said, Mr. Biden proposed scaling back the overall American military presence. Rather than trying to protect the Afghan population from the Taliban, American forces would concentrate on strikes against Qaeda cells, primarily in Pakistan, using special forces, Predator missile attacks and other surgical tactics.

....A shift from a counterinsurgency strategy to a focus on counterterrorism would turn the administration’s current theory on its head....But the Afghan presidential election, widely marred by allegations of fraud, undermined the administration’s confidence that it had a reliable partner in President Hamid Karzai. Mr. Obama and Mr. Biden already had raised doubts about Mr. Karzai, which were only exacerbated by the fear that even if he emerges from a runoff election, he will have little credibility with his own people.

After eight years, the burden of proof is no longer on the skeptics.  It's now on those who think we can turn things around in Afghanistan.  If McChrystal's team can come up with a genuinely credible plan to make counterinsurgency work, that's fine.  But please: no more wishful thinking and no more demands from knee-jerk hawks that we fight forever no matter what.  It's time for a reality check and some tough decisions.

The Cost of Cultural Imperialism

| Tue Sep. 22, 2009 7:31 PM EDT

Matt Yglesias wants to know why Diet Coke Coca-Cola Light is so expensive in Europe.  Beats me.  But I can say that this has been the case for a very long time.  Back in 1980, after my junior year in college, I spent a few months traveling in Europe with friends and it seemed as if Coke got more expensive with every new country we visited.  As I recall, we finally just stopped drinking the stuff after paying five francs for a can in Paris once and having it finally occur to us just how much that was.  Adjusting for the then-current exchange rate and 30 years of inflation, that can cost me a little over $3.

But expensive though it might still be, fizzy sugar water won't set you back $3 a can these days.  So that's the good news: Coke may still be overpriced in Europe, but not by as much as it used to be.  Progress!

The Murdoch-ization of the Wall Street Journal

| Tue Sep. 22, 2009 6:46 PM EDT

Felix Salmon takes a look at the fire-breathing headlines on the front page of last Friday's Wall Street Journal:

The WSJ is now being edited by a man who cut his teeth in the fiercely competitive Australian and UK markets, where front-page stories drive newsstand sales and newsstand sales drive profits. Sweeping curbs on pay and roiled allies make for great headlines, and mean that readers are that much more likely to shell out $2 for the paper. Unfortunately, they also increase readers' mistrust in the paper — Americans aren't used to the feeling, common in the UK, that the headline massively oversells the story.

The WSJ doesn't need to do this, but Murdoch does: it's in his blood. A Murdoch paper without punchy headlines which grab you by the throat is pretty much a contradiction in terms. Readers of the WSJ will have to get used to trusting the stories more than the headlines, or the implicit news judgment which governs where they're placed. The WSJ's journalism seems to be much less scathed than the headlines have been.

This assessment sounds a bit....how to put this....rosy to me.  Sure, maybe Murdoch will be content to jazz up the Journal's headlines and leave the rest of the journalism alone.  But what are the odds?  It's not as if he's ever been happy with half measures like this before.  Surely it's far more likely that this is merely the first step toward remaking the paper along the lines of his other properties, isn't it?  I figure it's only a matter of time until the WSJ is just a printed word version of Fox News.

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Pet Peeve Watch

| Tue Sep. 22, 2009 5:55 PM EDT

Congressional process wonk Stan Collender discusses one of my minor pet peeves today: the annual idiot-fest over increasing the debt ceiling:

This should be a purely administrative function. After all, in most cases the decisions to do the things that require the additional borrowing have already been made. But it usually turns into a political nightmare, because the party in the minority tries to use the vote to embarrass the White House and the majority by showing they can’t govern, can’t control their own Members, are big spenders, etc. In the meantime, interest rates are affected because Wall Street doesn’t like not knowing whether the government will be able to go ahead with its already-scheduled borrowing.

....There was a time when Congress had to approve each borrowing done by the Treasury. When that proved to be unwieldy, the process was changed so that Congress only had to approve a ceiling and the Treasury was free to manage the debt up to that limit.

But the current debt ceiling no longer serves any meaningful purpose and instead is little more than an excuse for a political food fight....Borrowing decisions actually are made whenever a spending or revenue bill is adopted. So the new debt ceiling should be increased automatically as part of those decisions. Members of Congress who earlier in the year are more than willing to vote in favor of the spending increases or revenue reductions that require Washington to borrow more should not be allowed to vote against the legislation that actually allows the government to do that additional borrowing.

This is just common sense.  We all know perfectly well that the debt ceiling is going to be increased this year and every year after, and we also know perfectly well that our representatives in Washington already have plenty of opportunities to throw faux tantrums for the cameras.  They really don't need another one.  They have better things to do.

Star 6

| Tue Sep. 22, 2009 5:23 PM EDT

The shiny new toy du jour for the conservative movement is the Great NEA Conference Call Scandal.  Unless I'm missing something, here's what happened: a White House flack and an NEA flack arranged a conference call with a bunch of artists and encouraged them to create artwork in support of the president's National Day of Service.  That's, um, about it.  But conservatives are going absolutely ape over it.  Freddie can't take it anymore:

Yes, that’s it. That’s that horrible piece of unAmerican propaganda currently poisoning our government and causing Lady Liberty to weep bitter tears....What’s there is precisely the kind of vague, empty bureaucrat speak that suffuses not only every branch of government, regardless of the party of the sitting president, but also every corporate conference call promoting “synergy” and collective effort for collective goals.

....As SEK from the Edge of the American West blog says, the actual ends that this call is trying to achieve are an increase in community service, such as seeing more young people at blood drives. This is the alleyway the drunken husk of conservatism has crawled into, opposing service to one’s country and community as tantamount to socialism.

Now, that’s what matters — the fact that what was said was absurdly trivial, and that the conservatives screaming and carrying on like they’ve found a dead body in Joe Biden’s trunk are actually completely wrong about what they think the call is about. But, yes, the hypocrisy rankles. It does indeed bother me that the ideology responsible for having people sign written pledges declaring their support for President Bush before they see our elected officials speak now complains about this. It does indeed piss me off that a few short years ago, Republicans were routinely doing things like calling for Howard Dean’s hanging for criticizing the war in Iraq, and yet now they stand enraged over this meaningless conference call.

You know, we saw the same thing happen after conservatives helped expose the forged memos that Dan Rather touted on 60 Minutes.  For about two years after that, conservative bloggers saw forgeries everywhere.  Forged photos.  Forged documents.  Forged pieces of paper from senators' pockets.  They were so intent on recreating their most glorious moment that everything they saw became another potential Rathergate.

This has the same feel.  The ACORN sting was a brilliant piece of political theater.  Not exactly critical to the freedom of the Republic or anything, but certainly something that very entertainingly did some real damage to a liberal group that had been in conservative gunsights for years.  But since nobody really cares all that much about ACORN, the beast needs to be fed again.  And again.  And so they come up with stuff like this: a transcript of a phone call that, at most, suggests a minuscule bit of bad judgment from a couple of low-level flacks.

But there's good news here for liberals: if this is the direction Breitbart and Glenn Beck and the rest of the crew are going, they'll soon be taken about as seriously as Abbie Hoffman and the Yippies.  The first stunt is kind of cool.  The second one, not so much.  The third one is a yawn.  There's just no there there.  Unless there's another shoe to drop on the NEA call, this is a nothingburger.

But this won't be the end of it.  The old admonition to always leave 'em wanting more is good advice for any kind of theater, including political theater, but I don't think the wingers get that.  They should have quit while they were ahead.

Rumsfeld and Bush

| Tue Sep. 22, 2009 4:47 PM EDT

Taegan Goddard explains some of the background behind the kiss-and-tell memoir of the moment:

If you're wondering why Secretary of Defense Donald Rumsfeld comes out unscathed in Matt Latimer's just released tell-all, Speech-less, his old Bush White House boss explains in the Wall Street Journal that it's because he's currently working for Rumsfeld as a ghost writer on his memoirs.

Writes William McGurn: "Not that Mr. Rumsfeld need fear. If this book is any guide, an employer will read how stupid Matt really thought he was only after he's no longer being paid."

There's another possible explanation, of course: Rumsfeld probably knew perfectly well that Latimer was busy slagging the White House in a book of his own and was cheering him on while he did it.  Rumsfeld is likely still pissed off at the way he was treated by Bush, which means that Latimer's behavior toward their old boss might have been a feature, not a bug.

Quote of the Day

| Tue Sep. 22, 2009 1:29 AM EDT

From Bill Clinton, on New York Times columnist Maureen Dowd:

She must live in mortal fear that there's somebody in the world living a healthy and productive life.

More good Clinton stuff at the link from Taylor Branch's upcoming book.