Obama’s Afghanistan Plan: Falling Into the Macho Escalation No-Win Trap

The speech has not yet been given, but everyone knows that President Obama plans to escalate the presence of American troops in Afghanistan. All that time spent deliberating and the so-called solution fulfills the deepest, most heart-felt wishes of conservative military hawks. Death and destruction will ensue. American tax payers will pay the bills, at the cost of countless domestic programs that would strengthen our country’s social and economic well-being. American troops will shed more of their own and Afghan blood. All of this will certainly boost the coffers of the military industry and military-support contractors. And after who knows how many more years of war, Afghanistan will still not magically become transformed into a fairy-tale, Western-styled democracy or whatever the goal of this war is supposed to be.

Is this really worth the cost of not supplying fuel for Republicans to have another excuse to screech about the supposed weakness of another Democratic president? Now they can really concentrate on destroying health care reform. And once again hopes are dashed that a U.S. President would do the right thing, instead of doing the thing that he and his advisers think would least affect his chances of re-election. After all, that’s what is really important.

Of what I read so far about this, Bob Herbert’s Op-Ed “A Tragic Mistake” most eloquently outlines the  problems of this decision. Herbert writes,

[…] I suppose we’ll never learn. President Obama will go on TV Tuesday night to announce that he plans to send tens of thousands of additional American troops to Afghanistan to fight in a war that has lasted most of the decade and has long since failed. After going through an extended period of highly ritualized consultations and deliberations, the president has arrived at a decision that never was much in doubt, and that will prove to be a tragic mistake. It was also, for the president, the easier option.

It would have been much more difficult for Mr. Obama to look this troubled nation in the eye and explain why it is in our best interest to begin winding down the permanent state of warfare left to us by the Bush and Cheney regime. It would have taken real courage for the commander in chief to stop feeding our young troops into the relentless meat grinder of Afghanistan, to face up to the terrible toll the war is taking — on the troops themselves and in very insidious ways on the nation as a whole.

More soldiers committed suicide this year than in any year for which we have complete records. But the military is now able to meet its recruitment goals because the young men and women who are signing up can’t find jobs in civilian life. The United States is broken — school systems are deteriorating, the economy is in shambles, homelessness and poverty rates are expanding — yet we’re nation-building in Afghanistan, sending economically distressed young people over there by the tens of thousands at an annual cost of a million dollars each.

I keep hearing that Americans are concerned about gargantuan budget deficits. Well, the idea that you can control mounting deficits while engaged in two wars that you refuse to raise taxes to pay for is a patent absurdity. Small children might believe something along those lines. Rational adults should not. […]

The word is that Mr. Obama will tell the public Tuesday that he is sending another 30,000 or so troops to Afghanistan. And while it is reported that he has some strategy in mind for eventually turning the fight over to the ragtag and less-than-energetic Afghan military, it’s clear that U.S. forces will be engaged for years to come, perhaps many years.

The tougher choice for the president would have been to tell the public that the U.S. is a nation faced with terrible troubles here at home and that it is time to begin winding down a war that veered wildly off track years ago. But that would have taken great political courage. It would have left Mr. Obama vulnerable to the charge of being weak, of cutting and running, of betraying the troops who have already served. The Republicans would have a field day with that scenario.

Lyndon Johnson is heard on the tapes telling Senator Richard Russell, chairman of the Armed Services Committee, about a comment made by a Texas rancher in the days leading up to the buildup in Vietnam. The rancher had told Johnson that the public would forgive the president “for everything except being weak.” Russell said: “Well, there’s a lot in that. There’s a whole lot in that.”

We still haven’t learned to recognize real strength, which is why it so often seems that the easier choice for a president is to keep the troops marching off to war.

Another Pointless, Unwinnable War: Lessons From the Vietnam War Applied to Afghanistan

A couple of weeks ago, I talked with my nine and a half year old daughter about why we bother learning about history. She argued that it’s boring and it’s past. I non-eloquently said that history is interesting and that we can learn a lot from studying it. As would be expected, the conversation drifted off to something else. I remembered this conversation as I read Jonathan Schell’s “The Fifty-Year War” (The Nation 11/11/2009), which relates the lessons of  the Vietnam War to the war in Afghanistan. With a clenched stomach, I realized that we are being led into meaningless war after war by people who have a fourth-grader’s attitude toward the value of history lessons. The difference being that the grown-ups are responsible for sending soldiers off to kill and be killed, causing civilian casualties, fostering hate against us, and, of course, spending billions and trillions of our dollars. As I see it, the only beneficiaries of this endeavor are the military industry and the various firms who snag the lucrative war-support contracts.

Starting with his introduction, here are some of my favorite sections from Schell’s article,

I was about to write that there can be no military solution to the war in Afghanistan, only a political one. But I almost fainted with boredom and had to stop. Who, as President Obama lengthily ponders his decisions regarding the war, wants to repeat a point that’s been made 11,000 times before? Is there anyone on earth who doesn’t know by now that you can’t win a guerrilla war without winning the “hearts and minds” of the people? The American public has known this since the American defeat in Vietnam. The formerly colonized peoples of the Third World, whose hearts and minds were the ones contested, know it. American officialdom knows it. […] Today, even the general in charge in Afghanistan, Stanley McChrystal, now asking for 40,000 or more troops, knows it. He can read all about it in the new Army counterinsurgency manual produced by his boss, Centcom commander Gen. David Petraeus. There he can learn that “political factors have primacy in COIN [counterinsurgency]” and that “arguably, the decisive battle is for the people’s minds.”

But if one has repeated this point anyway (as I have, by a backdoor route), then one must go on to make the rather newer point that there is no political solution that serves the foreign invader either. The problem is structural and fundamental. Like the imperial powers of the past, the United States wants to impose its will on other countries. Yet it is different from those previous powers in at least one respect: it does not aim to rule the countries it invades indefinitely. Conscious that the American public will not support war without end, it means to leave one day. Therefore the art of victory has to be to try to set up a government that can both survive US withdrawal and serve US interests. The circle to be squared is getting the people of a whole country to want what Washington wants. The trouble is that, left to their own devices, other peoples are likely to want what they want, not what we want.

One problem flowing from this dilemma is that the more the United States does to set up such a government, the more the “Afghans themselves” (or the Vietnamese themselves or the Iraqis themselves or the whoevers themselves) are tainted by the association. If the paradox of military engagement in such a conflict is that the more you fight the more you lose, then the paradox of political engagement is that the more you rule the weaker the native component of the government becomes, and the more likely it is to collapse when you leave, as the South Vietnamese government did in 1975. […]

And so, hanging over the scene, still, are the political pressures that go back almost fifty years, to Vietnam, or even sixty years, to the myth that the United States lost China. There is an unmistakable continuity that runs from McCarthy’s attacks on Truman and his administration for “appeasement” and even “treason” clear down to Dick Cheney’s and Karl Rove’s and Glenn Beck’s refrains assailing Obama for opposing the Iraq War, not to speak of Sarah Palin’s charge during the election that he had been “palling around with terrorists.” (The Republicans even call Obama a “socialist,” as if the cold war had never ended.) [..]  it is no secret that Obama’s support for the war in Afghanistan served as protection against charges of weakness over his policy of withdrawing from Iraq. […] In the words of foreign policy old hand Morton Abramowitz to Packer, “Obama…to show he was tough, made Afghanistan his signature issue because he wanted to get out of Iraq.” In short, in strictly political terms, the Vietnam dilemma has been handed down to Obama virtually intact. Now as then, the issue politically is whether the United States is able to fail in a war without coming unhinged. Does the American body politic have a reverse gear? Does it know how to cut losses? Is it capable of learning from experience? Or must it plunge unchecked over every cliff it approaches? And at the heart of these questions is another: must liberals and moderates always bow down before the crazy right when it comes to war and peace? […]

Best Recent Articles on Health Care Reform

Since I am way behind in my intended Blogs, here is a list highlighting recent articles and editorials on the hot topic of health care reform. The list starts with the most recently published, but they are all still quite current. These articles are all from The New York Times. Please send me suggestions for other ones.

• In “Drug Makers Raise Prices in Face of Health Care Reform” (11/15/2009), Duff Wilson wrote, “Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years. In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992. The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year. Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years […].”
• The editorial “Reform and Medical Costs” (11/14/2009) says that “Americans are deeply concerned about the relentless rise in health care costs and health insurance premiums. They need to know if reform will help solve the problem. The answer is that no one has an easy fix for rising medical costs. The fundamental fix — reshaping how care is delivered and how doctors are paid in a wasteful, dysfunctional system — is likely to be achieved only through trial and error and incremental gains. The good news is that the bill just approved by the House and a bill approved by the Senate Finance Committee would implement or test many reforms that should help slow the rise in medical costs over the long term.” The rest of this editorial provides an overview of the “the important proposals in the House and Senate bills.” The following issues are discussed: Cadillac Coverage, Simplified Forms, Electronic Medical Records, Reform of the Delivery System, Independent Commission, Managed Competition, a Public Plan, Comparing Treatments, Negotiating Drug Prices, and Malpractice Reform.
• In “America’s Defining Choice” (11/11/2009) Op-ed columnist Nicholas D. Kristof wrote, “President Obama and Congress will soon make defining choices about health care and troops for Afghanistan. These two choices have something in common — each has a bill of around $100 billion per year. So one question is whether we’re better off spending that money blowing up things in Helmand Province or building up things in America. […] So doesn’t it seem odd to hear hawks say that health reform is fiscally irresponsible, while in the next breath they cheer a larger deployment of troops in Afghanistan? Meanwhile, lack of health insurance kills about 45,000 Americans a year, according to a Harvard study released in September. So which is the greater danger to our homeland security, the Taliban or our dysfunctional insurance system? […] So where’s the best place to spend $100 billion a year? Is it on patrols in Helmand? Or is it to refurbish our health care system so that people like Sue don’t die unnecessarily every 12 minutes?”
• In “Trading Women’s Rights for Political Power”  (11/11/2009) Op-Ed contributors Kate Mitchelman and Frances Kissling wrote, “A GRIM reality sits behind the joyful press statements from Washington Democrats. To secure passage of health care legislation in the House, the party chose a course that risks the well-being of millions of women for generations to come. House Democrats voted to expand the current ban on public financing for abortion and to effectively prohibit women who participate in the proposed health system from obtaining private insurance that covers the full range of reproductive health options. Political calculation aside, the House Democrats reinforced the principle that a minority view on the morality of abortion can determine reproductive health policy for American women. […] The Democratic majority has abandoned its platform and subordinated women’s health to short-term political success. In doing so, these so-called friends of women’s rights have arguably done more to undermine reproductive rights than some of abortion’s staunchest foes. That Senate Democrats are poised to allow similar anti-abortion language in their bill simply underscores the degree of the damage that has been done. […]”
• In “Unhealthy America” (11/4/2009) Nicholas D. Kristof wrote, “The moment of truth for health care is at hand, and the distortion that perhaps gets the most traction is this: ‘We have the greatest health care system in the world. Sure, it has flaws, but it saves lives in ways that other countries can only dream of. Abroad, people sit on waiting lists for months, so why should we squander billions of dollars to mess with a system that is the envy of the world? As Senator Richard Shelby of Alabama puts it, President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.’ That self-aggrandizing delusion may be the single greatest myth in the health care debate. […] The United States ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures. We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the United States is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland.[…]”

Italy Falls Lower in Rankings of Many Global Performance Measures

As a concerned Italian-American I simply could not pass up posting this chart and commentary, “Grading Italy: Berlusconi Blues” from The Economist (Daily Chart 10/22/2009) which shows how unfortunately “Italy is slipping down many global rankings” according to rankings by various organizations.

From Economist.com Daily Chart (10/22/2009)

ON WEDNESDAY October 21st the European Parliament narrowly voted to throw out a resolution expressing concern over media rights in Italy. Silvio Berlusconi, the country’s prime minister, is also owner of Mediaset, one of Europe’s largest media companies. But Italy’s press freedom is a cause for concern according to Reporters Without Borders, an industry lobby group. Italy dropped five places to 49th in its annual world press freedom index, published this week, with only Bulgaria and Romania worst placed among EU countries. Out of the six annual rankings we consider, including corruption perceptions and economic freedom, in only one, the gender gap, has Italy improved.

Poll Shows That Most Virginians Want a Tighter Gun Sales Law

The New York Times 10/21/2009 editorial, “Virginia and Gun Control” tipped me off to the results of a recent political survey conducted in Virginia by the Christopher Newport University (CNU) Judy Ford Wason Center for Public Policy for The Virginian-Pilot, WVEC-TV, and CNU. Results form the survey were reported by Bill Bartel in the article, “Tighten Gun Rules, Most Virginians Say in Poll” (published in The Virginian-Pilot, 10/18/2009). Bartel reports that,

Most Virginians say they want to close the so-called gun show loophole that permits some gun sales without criminal background checks, and they dislike the notion of someone carrying a concealed firearm into a restaurant that serves alcohol, according to a new poll. The survey, conducted by Christopher Newport University’s Judy Ford Wason Center for Public Policy, found that eight of every 10 likely voters interviewed wanted to change a state law that allows someone to buy a firearm from an unlicensed seller at a gun show without first undergoing a criminal background check. If the same sale is between a buyer and a licensed dealer at a show, a background check is required.

Support for closing the loophole was shared by people of all ages and political and ethnic backgrounds – and in all regions of the state, the poll found. Almost 17 percent of those polled said they favor keeping the law as it is. A strong majority of those polled – 68.4 percent – also do not want Virginia to allow people with concealed-weapons permits to bring their firearms into eateries that sell alcohol. More than a quarter of those surveyed – 26.3 percent – disagreed, saying the ban should be lifted.

Earlier this year, the General Assembly passed legislation to legalize the practice but failed to muster the votes to override Gov. Timothy M. Kaine’s veto. In his veto message in March, Kaine noted the objection of law enforcement officials to the bill, saying it “puts the public, the employees and our public safety officers at risk.” […]

As The New York Times editorial concluded, “[…] Those latest newspaper poll results show the people are speaking. Too bad politicians are not listening.”

A Cost-Saving Measure for States: Replace Capital Punishment With Life in Prison Without Parole

Source: Deathpenaltyinfor.org "Smart on Crime: Reconsidering the Death Penanlty in a Time of Economic Crisis

The Death Penalty Information Center (DPIC) report, “Smart on Crime: Reconsidering the Death Penalty in a Time of Economic Crisis” provides an economic rationale for a change in criminal law in States with the death penalty and budget woes. As explained in Warren Richely’s report  “Death Penalty Is too Expensive for States, Study Finds” (The Christian Science Monitor, 10/20/209), the main message from the DPIC reports is that “State and local government facing budget crunches can realize big savings by eliminating the death penalty…”

While Richely’s article reminds readers that in polls more than 50% of American support the death penalty (after all the sense of an eye for an eye justice prevails in our culture), the views of our law enforcement officials are different. In addition to examining the cost of the death penalty process, the DPIC report also summarizes results of a national poll of police chiefs that “…puts capital punishment at bottom of law enforcement priorities.” This chart from the DPIC report summarizes the views of police chiefs on various issues related to the death penalty. According to the DPIC report,

Of various statements about the death penalty, the one with which the police chiefs most identified was: “Philosophically, I support the death penalty, but I don’t think it is an effective law enforcement tool in practice.”

Furthermore, the DPIC report said that “The Police chiefs rejected any suggestion that insufficient use of the death penalty interfered with their work” and “A significant reason why police chiefs do not favor use of the death penalty is that they do not believe it deters murder.”

Here are some excerpts form Richely’s The Christian Science Monitor article,

[…] State and local governments facing dire budget crunches can realize substantial savings by replacing capital punishment with a regime that sentences the worst offenders to life in prison without parole, according to a report released Tuesday by the Death Penalty Information Center (DPIC). The number of death sentences handed down in the United States has dropped from roughly 300 a year in the 1990s to 115 a year more recently. Executions are falling off at the same rate, the report says. In the meantime, some 3,300 inmates remain on death row.

“[T]he death penalty is turning into a very expensive form of life without parole,” said Richard Dieter, DPIC executive director, in a statement. “At a time of budget shortfalls, the death penalty cannot be exempt from reevaluation alongside other wasteful government programs that no longer make sense.” […]

A 2008 study in California found that the state was spending $137 million a year on capital cases. A comparable system that instead sentenced the same offenders to life without parole would cost $11.5 million, says the DPIC report […]. New York spent $170 million over nine years on capital cases before repealing the death penalty. No executions were carried out there. New Jersey spent $253 million over 25 years with no executions. That state also repealed capital punishment.

Some officials may be tempted to try to cut capital-punishment costs, notes the DPIC report, but many of those costs reflect Supreme Court-mandated protections at the trial and appeals-court levels. “The choice today is between a very expensive death penalty and one that risks falling below constitutional standards,” the report says.

Nationwide, the report estimates, at least $2 billion has been spent since 1976 for costs that wouldn’t have been incurred if the severest penalty were life in prison. The figure is based on an estimate in a 1993 North Carolina study that found the average extra cost of a death sentence in this state was $300,000. The average extra cost of capital punishment is significantly higher in several other states like California, Florida, and Maryland, the report says. […]

The DPIC report includes the results of a recent poll of 500 police chiefs nationwide. Fifty-seven percent of the chiefs polled said they agreed with the statement that the death penalty does little to prevent violent crimes because perpetrators rarely consider the consequences when engaged in violence. Thirty-nine percent of police chiefs disagreed with this statement.

The DPIC study concludes that capital punishment is a wasteful, expensive program that no longer makes sense. “The promised benefits from the death penalty have not materialized,” the report says. “If more states choose to end the death penalty, it will hardly be missed, and the economic savings will be significant.”

Wake-Up: Goverment-Subsidized Safety Nets for the Rich Do Nothing for the Rest of Us

I think that a lot of my fellow US citizens walk around with selective blinders and ear mufflers, not seeing and hearing about the things that really affect their lives (for example, issues related to the economy, health care, and education), while suddenly becoming enthralled about inconsequential things like balloon boy or some juicy star-studded sex scandal. You got to wake-up at least once in while friends—nothing will improve if we let ourselves be so easily distracted while the rich get richer and the rest of us pay the bill.

Scaremongering messages are being propagated to make people ridiculously afraid of things like flu-shots, so that somehow they will make a leap that government is bad and thus we can’t have it in charge of health care reform. No—the insidious message implies—we should put our trust in the free-market insurance industry whose job is to make money for investors. Of course, those big businesses will protect the interests and pocketbooks of us ordinary citizens who are not their shareholders? I love fairy tales too, but I have to live in reality. So while the government should not be allowed to restrain greedy businesses, it’s somehow perfectly fine for it to spend billions of our tax payer money to save other big businesses that screwed things up for everybody? The rich get richer and the rest of us don’t, with many falling deeper into the abyss. How is this supposed to help the rest of us?

With  these morose thoughts in my mind I found it refreshing to read Bob Herbert’s,  “Safety Nets for the Rich” (The New York Times Op-Ed, 10/19/2009). Here are some excerpts form Herbet’s Op-Ed (with some bold I added for emphasis),

[…] We’ve spent the last few decades shoveling money at the rich like there was no tomorrow. We abandoned the poor, put an economic stranglehold on the middle class and all but bankrupted the federal government — while giving the banks and megacorporations and the rest of the swells at the top of the economic pyramid just about everything they’ve wanted. And we still don’t seem to have learned the proper lessons. We’ve allowed so many people to fall into the terrible abyss of unemployment that no one […]  has a clue about how to put them back to work.

Meanwhile, Wall Street is living it up. I’m amazed at how passive the population has remained in the face of this sustained outrage. Even as tens of millions of working Americans are struggling to hang onto their jobs and keep a roof over their families’ heads, the wise guys of Wall Street are licking their fat-cat chops over yet another round of obscene multibillion-dollar bonuses — this time thanks to the bailout billions that were sent their way by Uncle Sam, with very little in the way of strings attached. Nevermind that the economy remains deeply troubled. As The Times pointed out on Saturday, much of Wall Street “is minting money.” […] Whether P.T. Barnum actually said it or not, there is a sucker born every minute. American taxpayers might want to take a look in the mirror. If the epithet fits…

We need to make some fundamental changes in the way we do things in this country. The gamblers and con artists of the financial sector, the very same clowns who did so much to bring the economy down in the first place, are howling self-righteously over the prospect of regulations aimed at curbing the worst aspects of their excessively risky behavior and preventing them from causing yet another economic meltdown. We should be going even further. We’ve institutionalized the idea that there are firms that are too big to fail and, therefore, “we, the people” are obliged to see that they don’t — even if that means bankrupting the national treasury and undermining the living standards of ordinary people. What sense does that make?

If some company is too big to fail, then it’s too big to exist. Break it up. Why should the general public have to constantly worry that a misstep by the high-wire artists at Goldman Sachs (to take the most obvious example) would put the entire economy in peril? These financial acrobats get the extraordinary benefits of their outlandish risk-taking — multimillion-dollar paychecks, homes the size of castles — but the public has to be there to absorb the worst of the pain when they take a terrible fall.

Enough! Goldman Sachs is thriving while the combined rates of unemployment and underemployment are creeping toward a mind-boggling 20 percent. Two-thirds of all the income gains from the years 2002 to 2007 — two-thirds! — went to the top 1 percent of Americans.

We cannot continue transferring the nation’s wealth to those at the apex of the economic pyramid — which is what we have been doing for the past three decades or so — while hoping that someday, maybe, the benefits of that transfer will trickle down in the form of steady employment and improved living standards for the many millions of families struggling to make it from day to day. That money is never going to trickle down. It’s a fairy tale. We’re crazy to continue believing it.

A Public Option Must Be Included to Make a Workable HealthCare Reform Bill

A recent journal article and a recent editorial provide good arguments for including a public option in the health care reform. The logic is clear but will Congress and the administration support it or succumb to the lobbying of the health insurance industry and its invested (and well rewarded) defenders? The New York Times editorial “The Public Plan, Continued” (10/17,/2009) states that,

[…] we strongly support inclusion of a public option — the bigger and stronger the better. That is the best way to give consumers more choices, inject more competition into insurance markets, hold down the cost of insurance policies, and save money for the federal budget. Here are some of the basic issues to consider, and the current legislative state of play:

WHO COULD ENROLL? While critics rail against a government takeover of health care, the reality is that the vast majority of Americans — those who have access to health insurance offered by large employers — would not be eligible to enroll in a public plan. […]

DOES IT MAKE INSURANCE MORE AFFORDABLE? Most experts agree that a public plan should be able to provide insurance at a lower cost because it would have no need to earn a profit and could either demand or bargain for lower prices from health care providers. That should spur private insurers, eager to attract millions of new customers on the exchanges, to find ways to hold down their premiums as well, at least on the exchanges. […]

WHAT’S THE STRONGEST PUBLIC PLAN? That is apt to emerge from the House, where the Democrats need only a majority to pass legislation and are constrained only by the need to satisfy conservatives in their own party. […]

A PUBLIC PLAN FOR EVERYBODY? Too often insurance markets are dominated by one or two big companies. We believe that, after a break-in period, the insurance exchanges, with a public option, should be opened to virtually everyone covered by large employer-based plans. That would give the vast majority of Americans a bigger choice of insurance options than they now have at most workplaces — and a greater stake in pushing Congress to approve a strong public plan.

In his piece “Poor Substitutes — Why Cooperatives and Triggers Can’t Achieve the Goals of a Public Option” (The New England Journal of Medicine, 09/23/2009), Jacob S. Hacker writes that,

According to a recent survey, a majority of U.S. physicians support health care reform that includes a new national public health insurance plan, which would compete with private plans. Polls have shown that a substantial majority of Americans support the public option as well.

[…] Senate Finance Committee chairman Max Baucus (D-MT) recently unveiled his draft bill […], which contains no competing public plan. Instead, it substitutes the largely untested idea of providing federal loans and start-up funds to encourage the creation of decentralized, member-run health care “cooperatives.” Another prominent senator on the Finance Committee, Olympia Snowe (R-ME), has indicated that she would support a public plan only in the event that private health plans failed to offer affordable coverage in a particular region, “triggering” the creation of a public option. President Barack Obama — while reiterating his support for a public plan — has said that he could support both these alternatives if they could create accountability and competition for private insurance.

Could they? Both proposals lack adequate specificity to make the answer clear […]. But analysis of existing outlines of both ideas and similar initiatives in prior legislation suggest that they could not.

The “public option” is meant to bring greater competition, choice, accountability, and cost restraint to U.S. health insurance. It would do so by offering the choice of a new national, public, nonprofit insurance plan modeled after Medicare to those who lack employer-sponsored coverage or work for very small firms that decide to buy coverage through a proposed national insurance “exchange.” This plan would be subject to the same rules as private health plans and would be wholly self-financing, with revenues derived entirely from premiums, employer contributions, and the same government subsidy payments for lower-income Americans that would be available to private plans. […]

As envisioned, cooperatives almost certainly could not achieve the key aims of the public plan. Although they might offer a backup option in some regions, they would have little chance of offering the broad choice of providers and portable, standardized, nation-spanning coverage that a national public plan offers. Moreover, as is the case with any private health plan entering a local market, decentralized cooperatives would find it difficult to get off the ground and expand, much less attain the reach or authority required to drive widespread delivery and payment reforms or compete strongly with private insurers. The history of consumer health cooperatives supports this pessimism.[…]

Any new federally authorized health plan must be able to counterbalance the leverage of dominant insurers and providers, in part by constructing its own competitive provider networks. Otherwise, it will have neither the market share nor the bargaining power necessary to become established and serve as a check on those entities. Alas, cooperatives have no real prospect of garnering the requisite market power. The Congressional Budget Office, which has said that the competing public plan could achieve substantial savings if it paid rates linked to Medicare’s payment schedule, has concluded that cooperatives would have “very little effect” on health care spending.^[…]

In short, neither the cooperative nor the trigger represents an acceptable substitute for the immediate creation of a national public plan. Rather than developing fig leaves to provide political cover, congressional leaders and the President should push for a national public plan that competes on a level playing field with private insurance to provide coverage to people who are uninsured and workers in the smallest firms. Such competition is the key to creating greater choice and accountability in increasingly consolidated insurance markets.

Restrictive Abortion Laws Kill Women

A recently released global survey by the Guttmacher Institute reported that while increased use of contraceptives has decreased abortions worldwide, 70,000 women die each year because of unsafe abortions. More than half of the deaths were in Africa, which has the lowest rate of contraceptive use (reported in an AP article, The Philadephia Inquirer, 10/14/2009).

According to the Economist.com Daily Chart (10/14/2009) on the Gutthmacher Institute report, “Abortion: A Woman’s right“, restrictive abortion laws do not prevent abortion, au contraire,

AROUND 40% of women live in countries where abortion is severely restricted by law, a figure that has changed little in a decade. Such laws do not prevent abortion, but they do mean that the procedures are more often unsafe (for example carried out by an unskilled practitioner in unhygienic conditions), according to a report by the Guttmacher Institute, a research group. Some of the highest abortion rates are in Latin America, where abortion is all but outlawed. Nearly all abortions in Africa are unsafe, despite the liberalisation of laws in South Africa in 1997. The most recent data available, for 2003, show that a woman is as likely to have an abortion in regions where it is broadly legal as in regions where it is highly restricted. Globally the abortion rate has fallen since 1995 mainly through a reduction in safe abortions. Unintended pregnancies have also fallen, from 69 per 1,000 women in 1995 to 55 per 1,000 in 2008, as contraception use has increased.

Senate Finance Committee Healthcare Reform Bill Leaves Millions of Americans With No Healthy Future

I read about today’s Senate Finance Committee 14 to 9 vote to pass their version of a so-called healthcare reform bill, grandly called “America’s Healthy Future Act,” in a Medscape Medical News report and an AP report “Health Bill Clears Hurdle With Support from Snowe.” I am disgusted and dismayed about how proud the committee chairman, Senator Max Baucus, seems to be about this bill despite the fact that it has no public option to force  insurance companies into true competition and it would still leave over 25 million nonelderly adults without health insurance. Much of what is wrong with this bill is outlined in John Nichols’ blog,  “Baucus Committee OKs a Health Bill, but not Reform” (The Nation, 10/13/2009). Nichols pointedly wrote,

[…] the Finance Committee bill falls far short of real health care reform. It steers billions of taxpayer dollars into the accounts of insurance companies while failing to provide a realistic, humane or fiscally-responsible alternative to their profiteering.

Of course, that embarrassing omission did not prevent the committee’s chairman, Max Baucus, a Montana Democrat whose campaign accounts are overflowing with insurance-industry contributions, from hailing his “accomplishment.” Baucus has always fancied himself as the man who would define the parameters of reform. On the committee, he set up an elaborate process for achieving bipartisan “buy-in.” He assured everyone that he would get all the warring camps of the Senate Democratic Caucus behind one bill. And he promised that it would be a good bill. Baucus failed on all three counts:

1. He blew deadline after deadline, delaying action for so long that the entire reform initiative was put in jeopardy.[…] Instead of making it possible for the Congress to craft comprehensive legislation before the August break – and giving Americans something real to consider – Baucus delayed for so long and created so much confusion that extremists were able to take advantage of the recess to spin fantasies about “death panels,” “massive tax increases” and “creeping socialism.”

2. He never achieved meaningful consensus – between Democrats and Republicans and even on some issues among Democrats. Comically, the chairman bragged on Tuesday that, “Six Members of the Committee – three Republicans and three Democrats — held 31 meetings to try to come to consensus. We held exhaustive meetings. We met for more than 61 hours. We went the extra mile.” What Baucus did not mention was that the Democrats and Republicans who went through the “exhaustive” and time-consuming exercise did not come to any kind of consensus. (Only Snowe, a regular renegade from the Republican camp, sided with the Democrats on the committee.) In other words, it was a waste of time.

3. He produced a bill that satisfies no one and should infuriate everyone. […] neither side – Republicans who oppose real reform and Democrats who favor it – look kindly on the Baucus bill. There’s been every bit as much criticism of it from the Congressional Progressive Caucus members as from Grassley’s “party of no” colleagues. […]

The problems with the Finance Committee’s proposal extend far beyond the fact that it fails to establish a government-run alternative to compete with the private insurers that will be ridiculously enriched by it. But the lack of a “public option” should make the Baucus bill a nonstarter. As insurance-industry insider turned whistleblower Wendell Potter explained in an advertisement produced by MoveOn.org, the Baucus bill would, if enacted effectively, “kill health reform.”

“Take it from me,” argues Potter [a former health insurance executive], “the Senate Finance bill is a dream come true of the health insurance industry. If there is no public option insurance companies aren’t going to change. The choice of a public health insurance option is the only way to keep insurance companies honest.” […]