Monthly Archive for December, 2011

Constitutional Contempt 2012

The authoritarian impulse is alive and well in your modern GOP. The party which in other contexts implores us to hew to the mythical “original” meaning of the constitution, has shown itself during the primary campaign to be utterly contemptuous of that document when it comes to nuisances like the rule of law or separation of powers. To wit:

Newt Gingrich is continuing his outrageous campaign to subvert one of the most sacred and revolutionary democratic principles, that of the independent judiciary:

Republican presidential candidate Newt Gingrich is doubling down from Thursday’s Fox News debate on his vow to abolish federal courts if he disagreed with their decision.

According to The Hill, in a conference call with reporters, Gingrich indicated that it was in the president’s power as commander-in-chief to deem any Supreme Court ruling irrelevant if he or she in the White House disagreed. […]

Gingrich also backed his position to subpoena judges or abolish courts entirely if he thought their final rulings were wrong.

At the last Republican debate he repeated this bold plan to transform the U.S. into a banana republic by making the rule of law subservient to executive caprice.

Ron Paul, god bless him, was the only candidate to challenge him on it. The recent polling suggests that Gingrich will likely be slithering back into his private life as an influence peddler soon enough. But I find it outrageous that the recent front-runner for the Republican nomination could express such overt constitutional contempt without opprobrium of any kind.

The next item is a more general critique but I think recognizable to us all. In the recent debates the most popular refrain from the candidates when asked about military or security policy has been that they would “listen to the commanders on the ground.” This sort of language serves as a very easy way for politicians to signal to military fetishists that they are tough and like tough things such as men with epaulets. And to be fair, one hears this tiresome deference to the “commanders on the ground” from both parties. But I think it can be fairly said that it’s the liberty-loving GOP most enthralled with the idea of civilians “listening to the generals”—rather than the other way round—in the conduct of war policy.

Just yesterday there was a very important corrective to this inversion from the Chairman of the Joint Chiefs, Martin Dempsey. General Dempsey was asked if his advice on extended troop presence in Afghanistan after 2014 will be heeded in Washington. His surprising and brilliant response:

I’ll probably make news with this but I find some of those articles about divergence or control of the generals to be kind of offensive to me. And here’s why. One of the things that makes us as a military profession in a democracy is civilian rule. Our civilian leaders are under no obligation to accept our advice; and that’s what it is. Its advice. It’s military judgments, it’s alternatives, it’s options. And at the end of the day, our system is built on the fact that it will be our civilian leaders who make that decision and I don’t find that in any way to challenge my manhood, nor my position. In fact, if it were the opposite, I think we should all be concerned.”

Here is one case in which listening to the generals would be wise indeed.

This might all be dismissed as campaign nonsense. However, in a week in which we’ve lost the great Czech champion of human freedom and democracy, as well as his ghoulish diametric opposite in North Korea; and as we watch Egypt descend into violent martial law, with the heroes of Tahrir Square beaten and shot and gassed by generals who do not recognize the legitimacy of civilian rule; and as the rule of law remains nothing more than the morality of the strong in so many parts of the world; we should shame from public life such demagogues as Mr. Gingrich, who seek applause lines from credulous voters by selling them a subversion of the very principles they claim to venerate.

Patients Are Not Consumers

Reason #10,000 why health care is not and never will be a "market" in the free-enterprise sense:

Sarah Kliff cites a study that shows people spend far more time researching an appliance or car purchase than they do researching their choice of doctor.

image

Kliff notes that this is superficially surprising considering health care makes up such a large share of our annual household spending ($10,944 on premiums for a family of four). And aside from price, you’d think the stakes for doctor selection are much higher than the stakes for dishwasher selection. If you mess up your dishwasher choice, you either live with a mediocre dishwasher or you return it and get another one. But if you blow your doctor choice you can theoretically end up with Dr. Nick.

The survey finds that people don’t research their doctors because they don’t think shopping around would reduce their ultimate costs or lead them to a better doctor. They basically perceive no competition in price or quality. Which is a difficult clay from which to mold a free market. As Kliff notes, "Shopping for a doctor is a lot harder than shopping for a dishwasher. There’s no price tag for what you’ll pay, or a Consumer Report to reference on quality."

So is this all about price transparency and clear quality standards? Is there a savvy health care consumer buried in all of us, just waiting for the wonders of free market competition to be unleashed in order to drive down costs systemwide? I am skeptical.

The thing that is unique about a lot of health care consumption is it is done under conditions of emotional and physical distress. Finding a doctor for your yearly physical is probably relatively stress free, as is the physical itself; but in terms of system costs, this isn’t where the money is. Treatment for chronic disease and hospital bills is where most of the cost damage is done in this country. And these are precisely the times when people are most vulnerable and afraid and least able to make informed dispassionate choices. Patients are not consumers. If your dishwasher breaks you can wash by hand until you get around to looking for a new one. If you have a heart attack and need an emergency bypass you’re not going online to read surgeon reviews. Or just before they lay the defibrillator on you, you are unlikely to ask where everybody in the room did their residency. And you don’t really have the option of threatening to walk out if the anaesthesiologist won’t come down in price.

Various elective surgeries, and non-emergency but serious diagnoses like cancer admit of some opportunity to shop around. But only very affluent people can fly around to Boston or Houston to receive top cancer care. And cancer treatment is very expensive no matter where you go. But even if there were huge price disparities that you could theoretically take advantage of, it’s unclear that "cheapo cancer treatment" would be a big selling point to anyone.

This is where comparisons between health care and normal consumer markets really fail. If I needed a new dishwasher I’d very likely choose one in a middle price point in the good-but-nothing-special category. If I heard about amazing luxury dishwashers being produced and sold only in Boston and Houston, I wouldn’t have any inclination to travel to Boston or Houston to buy one. I’d say most consumers share my dishwasher preferences, which is why there is robust price competition and a plethora of choice in the good-but-nothing-special category. And you can find a good-but-nothing- special class of goods in pretty much every normal consumer market. This category doesn’t really exist in health care, and even if it did it’s not clear that people are very interested in it. 

But the main point is that even after you’ve somehow managed to do diligent research and find your dream doctor while actively bleeding from your eyes and ears, it turns out you are in no condition to calmly adjudicate between different complex treatment options. You just want to stop the bleeding! You defer! In no way whatsoever does this scene resemble you kicking the tires on a showroom floor.

And if we throw in the fact that a large majority of expensive health care is performed on old people near the end of their lives, the shopping around/free market theory really falls apart. I’m not sure who the Republicans have in mind when they suggest that 80-year olds should get vouchers so they can shop around on price and quality. I don’t know these 80-year olds. We’ve all had infirmed elderly relatives go to an important specialist appointment only to come out unable to recall most of what the specialist said. It’s a nightmare. You want them burdened with negotiating prices also? And thoughtfully weighing various treatment value propositions? Please.

The asymmetry of information and authority will always be profound between doctors and patients. Even clear-headed, smart, stoic sick people prefer to just defer to a doctor’s expertise. A disoriented, suffering, afraid sick person will always defer. That’s ok, it’s why society venerates doctors and pays them extremely well. But it makes any analogy to "consumers" or "free markets" disingenuous and extremely unhelpful.

Hamas, Hezbollah Unsure What "Resistance" Even Means Anymore

There are plenty of reasons of morality and justice for Americans to hope for the swift demise of the Syrian regime, and for its smug, chinless leader to be escorted to the dock, followed by a lifelong retirement in prison.

But virtues and values notwithstanding, it’s national interests that all the realist kids want to hear about these days. So let’s talk interests.

The main U.S. strategic interest in the ongoing Syrian uprising is Syria’s star role in the regional “Resistance Bloc” consisting also of Iran, Hezbollah, and Hamas. What are they “resisting?” Well they would say they’re resisting the big bad U.S-Israeli axis of imperialism; colloquially known as the Great Satan and the Little Satan. Of all their resistance activities, none is undertaken with as much ardor as their often violent, mostly rhetorical opposition to the legitimacy of the Jewish state.

That the regimes in Iran and Syria maintain their power only through coercive repression always left it an open question as to exactly in whose name they were “resisting”. They have a very old game of deflecting blame for all domestic ills on hidden foreign plots and conspiracies, and they claim legitimacy by arguing that they alone can win justice for Palestinians and dignity for Muslims.

With the Arab Spring in late bloom, it has been interesting to see if and how the resistance bloc coalition might fray, as its members are forced to choose between support for regimes or for the people demanding the end of the regimes. Any result that weakens this coalition would be a tremendous boon to U.S. interests in the region.

This choice is particularly acute for Hamas and Hezbollah. Both are grassroots movements with mass popular support and experience in coalition government. They are far more attuned to their respective local constituencies, and are credible because they are seen as taking seriously the importance of democratic legitimacy and accountability. But with their main arms and cash conduit in Damascus under threat of being toppled, who will they stand with?

Hamas, whose senior leadership is based in Damascus, is nothing if not politically astute, and has calculated (correctly) that it better not be caught clinging to its erstwhile sponsor at the expense of the very people on whose behalf it claims to be “resisting.”

Haaretz has learned that Hamas has made a decision to abandon Damascus without letting the Syrian authorities know. The decision was made by the organization’s senior leadership in the wake of the harsh criticism voiced against top Hamas officials in Gaza and abroad because of their ties with the Syrian regime. […]

The Arab League’s decision to suspend Syria from membership of the organization and impose economic sanctions on Damascus tipped the scales, with Hamas finally deciding to covertly evacuate all its activists from Syria and leave behind only the organization’s highest-ranking officials so as to preserve a low profile of activity there.

Iran, which hasn’t wavered in its support for Assad, is not happy with Hamas’ abandonment of Damascus:

Iran had applied intense pressure to Hamas in an effort to persuade it not to leave Damascus, threatening even to cut off funds to the organization if it did so, Palestinian sources have told Haaretz.

The Iranian pressure also included an unprecedented ultimatum – namely, an explicit threat to stop supplying Hamas with arms and suspend the training of its military activists.

And how about Hezbollah? For now Hezbollah seems to have chosen to stick with old team. Regarding Assad, Hezbollah chief Hasan Nasrallah told a large crowd in Beirut that he would “stand by a regime that has stood by the resistance for a long time.”

His invocation of Syria’s support for “the resistance” sounds a little discordant when the “resistance” most people think of today is that which is bravely battling and dying out on the streets against the Assad regime.

Understandably, the opposition forces in Syria are not happy with the prospect of anyone taking the side of the regime, and they have warned the old resistance bloc superfriends that they are watching closely:

Burhan Ghalioun, the chairman of the Syrian National Council, told CNN in an interview airing Tuesday that Iran is “participating in suppressing the Syrian people” by backing al-Assad. […]

“I hope that Iranians realize the importance of not compromising the Syrian-Iranian relationship by defending a regime whose own people clearly reject it and has become a regime of torture to its own people,” Ghalioun said. Tehran must understand “that this is the last chance to avoid an unwanted fate to the Syrian-Iranian relationship,” he said.

As for Hezbollah…Ghalioun said, “The Syrian people stood completely by Hezbollah once. But today, they are surprised that Hezbollah did not return the favor and support the Syrian’s people struggle for freedom.”

You notice the chairman is not exactly burning bridges here. This is for the unsettling but banal reason that most Syrians, including opposition members, strongly dislike Israel, are deeply distrustful of the U.S., and agree broadly with the military and political goals of Hezbollah, Hamas, and Iran. It’s likely that a more representative government in Damascus would not be any more amenable to coexistence with Israel than Assad is.

The Syrian National Council is basically offering to keep the old resistance bloc intact, if only they all agree to disavow Assad. Hamas is on board. I don’t know why Iran and Hezbollah don’t take the deal, unless they are so sure that Assad will survive this.

But from a U.S. perspective, this in-fighting is great. It will be a fine day if and when Assad finally tumbles, but it will be extra special if a new government is seated that feels scorned by the old alliances and distrustful of the motives of Iran. Disrupting this four-headed supply chain of reactionary hate and violence would be a major strategic victory for the United States and reform-minded allies in the region.

UPDATE: Forget my assessment on what the Syrian opposition thinks of Iran and Hezbollah. Instead, read this interview with the head of the Syrian opposition, Burhan Ghalioun (quoted above), transcript here. It seems I misrepresented his position.

On Iran:

The current relationship between Syria and Iran is abnormal. It is unprecedented in Syria’s foreign policy history. [...]

Our relations with Iran will be revisited as any of the countries in the region, based on the exchange of economic and diplomatic interests, in the context of improving stability in the region and not that of a special relationship. There will be no special relationship with Iran.

This is the core issue—the military alliance. Breaking the exceptional relationship means breaking the strategic military alliance. We do not mind economic relations.

On Hezbollah:

As our relations with Iran change, so too will our relationship with Hezbollah. Hezbollah after the fall of the Syrian regime will not be the same. Lebanon should not be used as it was used in the Assad era as an arena to settle political scores.

How much of these positions actually make their way into a new post-Assad representative government remains to be seen. But wow, these are truly transformative policies; let’s hope he speaks for many, many of his countrymen.

Foreign Policy Succumbs to the Culture War

One undeniable political trend over the past fifteen years or so is the way in which every policy issue eventually seems to get vaccumed up by the culture war. And once an issue enters the realm of the culture war, it really never escapes, and will likely never be considered on the merits ever again. The environment, immigration, welfare, the deficit, health care, energy, transportation, monetary policy: it’s all been sucked up and ruined by identity politics. People now know the answers to these complex policy questions not by appealing to data or to a conception of the social good, but merely by making a reflexive in-group, out-group assessment. And once a person fuses their conception of their identity with any particular policy outcome, it’s near impossible to dislodge it. I cannot think of an issue that, once recruited into the culture war, was later set free and reverted back to a “normal” issue.  (If you can, please leave it in the comments)

The culture war is as old as the Republic; or rather, even the founding itself has been absorbed into the culture war, and the poor Founders are regularly exhumed and drafted in support of belligerents on both sides. The Civil War provided the cultural-geographic template which in many ways we’re still saddled with today; and with the consolidation of the two-party system, it’s been a steady process of electorate-sorting based on various group affiliations.

In Ken Burns’ recent documentary on Prohibition, I was interested to learn about the identity coalitions that formed on either side of the issue. A dominant dynamic was City (wets) vs. Country (drys). The city was mostly poor Catholic European immigrants and Jews. The country was buttoned-up white Protestant. Liquor became a proxy for a rural WASP population to stick it to the unwashed urban immigrants who were in the process of changing the face and culture of American life forever. (In answer to my question above, I guess alcohol is one culture issue that has been defused almost completely over time. But it’s also been defused as a policy issue altogether.)

One area that’s always been resistant to culture war enlistment is foreign policy. Yet, as Noah Millman writes at the American Scene, that may be over with. Millman thinks the GOP has finally succeeded in culture war-izing foreign policy.

Sure, the “anything tough is Republican” theme has been crystallizing for a long while; I’d say its iconic modern moment was maybe, “Tear down this wall.” But the process has really accelerated since 9/11, and Millman writes that this GOP primary campaign has put it over the top:

It’s in the last two elections that the trend of foreign policy being treated as part of the culture war – at least by the GOP – has become dominant. Mitt Romney is the exemplar in this regard; his entire foreign policy argument consists of saying that he knows America is exceptional and President Obama does not, and that Obama has been making too many concessions to America’s enemies (without any clear explanation of what those concessions might be).

You can watch Romney spin his main theme here.

Millman notes that there just isn’t any objective substance with which to attack Obama on foreign policy:

[Obama has been] a competent and fairly successful steward of America’s position as he inherited it. America has suffered no meaningful foreign policy setbacks during his tenure, and has had some notable successes. The contrast to the economic situation could not be more stark. Why on earth would anyone on the other side spend their time demagoguing on foreign policy? […]

The reason has everything to do with the culture war.

Millman goes on to outline the psychological mechanism at work:

Identity politics on the GOP side of the aisle involves stoking an emotional identification between their core demographic groups, the Republican Party, and the national identity. The white working class is the backbone of the American military. Stoking an identification between the white working class and the military, and between the military and national purpose, provides the emotional fuel for political mobilization. It imbues identity with purpose and connects that purpose to politics.

There’s some truth to this, but I think it’s a bit needlessly complex. I think part of the Republicans’ insistence on attacking Obama on foreign policy is the simple Rovian innovation of going after your opponent where he’s strongest. Absent any arguments to make on the merits, the only way to get at it is through culture, which necessitates demagoguery.

The left is certainly not immune to identity politics or reflexive cultural affiliation. But I think the Republicans’ sense of grievance and resentment is today a far more fundamental mobilizing force for the right than whatever its analogue would be on the left. The 2012 America Is So Awesome Tour that we’re currently seeing on the Republican side is an outgrowth of that cultural anxiety and grievance. This sort of overt triumphalism always has such a sad “doth protest too much” quality to it. But as Millman says, this dynamic is probably not going anywhere for a while. Just add foreign policy to the ever-growing list of American team sports.