Iraq’s Curse: A Thirst for Final, Crushing Victory

Edward Wong, writing in the NY Times. Interesting, if depressing, reading.

Listen to Iraqis engaged in the fight, and you realize they are far from exhausted by the war. Many say this is only the beginning.

President Bush, on the other hand, has escalated the American military involvement here on the assumption that the Iraqi factions have tired of armed conflict and are ready to reach a grand accord. Certainly there are Iraqis who have grown weary. But they are not the ones at the country’s helm; many are among some two million who have fled, helping leave the way open for extremists to take control of their homeland.

…

“One day we’ll find that we’ve returned back to 1917,” said Sheik Muhammad Bakr Khamis al-Suhail, a respected Shiite neighborhood leader in Baghdad, referring to the installation here of a Sunni Arab monarchy by the British after World War I. “The pressure of the Arab countries on the American administration might push the Americans to choose the Sunni Arabs.”

Sitting in the cool recesses of his home, the white-robed sheik said he was a moderate, a supporter of democracy. It is for people like him that the Americans have fought this war. But the solution he proposes is not one the Americans would easily embrace.

“In the history of Iraq, more than 7,000 years, there have always been strong leaders,” he said. “We need strong rulers or dictators like Franco, Hitler, even Mubarak. We need a strong dictator, and a fair one at the same time, to kill all extremists, Sunni and Shiite.”

An International Update on the Comparative Performance of American Health Care

An International Update on the Comparative Performance of American Health Care from the Commonwealth Fund:

Overview
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries’ health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.

It would have been nice to have some other countries included (notably France), but it’s informative all the same.

Via Mark Thoma

Comparing Canadian health care

(Cleaning out my closet of health-care pieces.)

Ezra Klein points us to a new study comparing Canadian to US health care outcomes.

Canada vs. America
It’s not that the data shows unbelievable advantages for Canada, to be sure. As the authors conclude, “although Canadian outcomes were more often superior to US outcomes than the reverse, neither the United States nor Canada can claim hegemony in terms of quality of medical care and the resultant patient-important outcomes.” The question raised is slightly different: How can we possibly countenance a system that costs twice as much as the Canadian system but delivers slightly worse care? Even assuming diminishing returns, our expenditures should result in care outcomes at least 20% or 30% better than Canada’s. Instead, they’re about 5% worse, but cost around 187%. Does it sound like we’re getting a good deal?

Phillip Longman: Misdiagnosed

Reviewing Jonathan Cohn’s book, Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price, Phillip Longman suggests that we should be looking to the excellent VA hospital system, described in an earlier Longman piece, as opposed to following Cohn’s proposal of making everyone eligible for Medicare.

The key to the cure is understanding that there is more than enough money already sloshing around the health care system to ensure every American access to quality care. Unfortunately, the current practice of American medicine, whether financed by Medicare, insurance companies, or other sources, is stunningly inefficient, unsafe, unscientific, and getting worse. And that’s why it costs so bloody much.
…
Adopting the VA model, with its salaried doctors and its extensive use of electronic information technology and evidence-based medicine, would cure the American health care crisis. Throwing more money into the current, fragmented, profit-driven system without changing the actual practice of American medicine might ease the problems of the uninsured temporarily, but would also give us more inappropriate, sometimes dangerous, and ever-more-expensive care.

The Belgravia Dispatch: Ankara Watch

Gregory Djerejian of The Belgravia Dispatch posts on the “increasingly alarming situation” between Turkey and the Iraqi Kurds. Quoting the Financial Times:

Recep Tayyip Erdogan, Turkey’s prime minister, and other Turkish leaders have warned repeatedly that the gerrymandering threatens to make a fait accompli of a referendum on Kirkuk’s status later this year that Turkey will not tolerate. Turkey is increasingly identifying with the Turkmen minority in the city, which Ankara believes is being ill treated by the Kurds.

It’s hard to argue with Turkey’s view that the accession of Kirkuk into Iraqi Kurdistan would lead to de facto Kurdish independence. Kurdish Iraq has been the one bright spot since the 2003 invasion (though of course it was effectively insulated from Saddam’s regime well before then).

The FT again:

General Yasar Buyukanit, chief of the general staff, is expected to set out Turkey’s concerns over Iraq when he visits Washington later this month. One possible outcome intended to guard against a unilateral Turkish intervention would be a joint anti-PKK military operation with US and Iraqi forces, says an analyst who asked not to be named.

…making the PKK another branch of the anti-US insurgency. Just what we needed.

Grand Marshal Brownie?

On NPR this morning there was a piece on the ten-year anniversary of the Grand Rapids flood (I come from that neck of the woods, down river from (which is to say north of) Grand Forks, Kittson County MN). The piece is upbeat; Grand Forks and East Grand Forks (on the Minnesota side of the Red River) have largely recovered from the disastrous flooding.

What caught my ear was this:

This week, a series of events is scheduled to mark the 10th anniversary of the flood. James Lee Witt, the former head of FEMA, will be the grand marshal in a parade.

Imagine the ten-year anniversary of Katrina. Picture the parade. Now imagine Witt’s successor, Mike “Heck of a job!” Brown as Grand Marshal….

Sunday Godblogging

Dahlia Lithwik in Slate:

No, the real concern here is that Goodling and her ilk somehow began to conflate God’s work with the president’s. Probably not a lesson she learned in law school. The dream of Regent and its counterparts, like Jerry Falwell’s Liberty University, is to redress perceived wrongs to Christians, to reclaim the public square, and reassert Christian political authority. And while that may have been a part of the Bush/Rove plan, it was, in the end, only a small part. Their real zeal was for earthly power. And Goodling was left holding the earthly bag.

At the end of the day, Goodling and the other young foot soldiers for God may simply have run afoul of the first rule of politics, codified in Psalm 146: “Put no trust in princes, in mere mortals in whom there is no help.”

China, demographics, and the NY Times

Over in the margin, I link to Dean Baker’s Beat the Press, and I hope you all read it religiously. Here’s one reason you should.

More Arithmetic Problems With Demographics at the NYT

The NYT tells us that China is facing a demographic crisis due to the aging of the population and should try to encourage families to have more kids (seriously, read the article).

It’s hard to know where to begin with this one. The articles reports onimously that “The proportion of people 60 and older is growing faster in China than in any other major country, with the number of retirees set to double between 2005 and 2015, when it is expected to reach 200 million.” This means that the share of people over age 60 will rise from about 7.7 percent to 15.4 percent over this decade. Considering that the share of the population over age 60 will be close to 30 percent at that point in the U.S., the Chinese can be forgiven if they are not too worried, as the article claims.

Let’s play with a little arithmetic here. China’s productivity is increasing at a rate close to 8 percent annually. This means that in ten years, workers on average will be producing more than 2.1 times as much per hour as they do today. Let’s say that the average retiree gets 60 percent of the income of the average worker. If the ratio of workers to retirees falls from 5:1 to 3:1 over the next decade (a far more rapid decline than is actually described in the article), then workers could still have 90 percent more income in a decade than they do today, after being taxed to support the growing population of retirees.

(The NYT article goes a step further than most in pushing the retirement scare story. It claims that raising the retirement age won’t help because it has a big problem with unemployment among the young. Okay, the scare story is too many retirees and too few workers, but the workers are unemployed, that sounds like too many workers. I guess China is suffering from too many workers and too few workers. They really have problems there.)

The rich countries have seen a consistent growth in the ratio of retirees to workers and have continued to sustain improvements in living standards for both workers and retirees. The key to rising living standards, which somehow is never mentioned in this article, is higher productivity. If China can sustain a productivity growth rate that is even half its current pace, then it has no reason to fear an aging population. (This doesn’t mean that government pension programs may not need to be adjusted.)

The conclusion of this piece — that China needs more children and a larger population, should be enough to get millions to cancel their subscription to this paper. The world (and China) does not need more people (someone please tell the NYT about global warming).

–Dean Baker

While I’m at it, here’s another on a favorite Baker theme, Social Security, health care, and the budget.

More Budget Scare Stories from NPR

NPR joined the never ending scare campaign this morning, telling listeners that our standard of living will be threatened if we don’t get the deficit under control. Of course the whole story, as always, is the projection of exploding health care costs which, if they prove accurate, will sink the economy regardless of what we do with the budget. If health care costs are contained, as they are in every other rich country, then there would be no plausible story, based on current projections, in which budget deficits would seriously impact our standard of living.

But, NPR would apparently rather beat up on retirees and Social Security than go after the pharmaceutical industry, the insurance industry, and the doctors’ lobby.

–Dean Baker

OpenSTV 1.1

OpenSTV 1.1 has been released.

OpenSTV is a Python-based program with a reasonable GUI for counting elections using a variety of STV and selected other rules. I’ve been participating in the project in a small way as a developer; so far I’ve worked mainly o Mac OS X support. Standalone versions of the program are available for OS X and Windows—no need to install Python, etc.

STV (which stands for “single transferable vote”) is a class of election methods that allow voters to rank their choices, and then produces (in multiple-seat elections) proportional results. The single-winner version of STV is known as instant-runoff voting (IRV) or the alternative vote (AV). STV is also known as ranked-choice or preferential voting.

I’ll be posting more about elections and voting; in the meantime, if you need to count an STV election, download a copy of OpenSTV and go to it.

A bit of Swinburne

Courtesy of Kyril Bonfiglioli, who uses it a a chapter epigraph in Something Nasty in the Woodshed.

  Yea, he is strong, thou say’st,
  A mystery many-faced,
The wild beasts know him and the wild birds flee;
  The blind night sees him, death
  Shrinks beaten at his breath,
And his right hand is heavy on the sea:
  We know he hath made us, and is king;
We know not if he care for anything.

Read all of A C Swinburne’s To Victor Hugo.

Don’t Point That Thing At Me

Don’t Point That Thing At Me is the first book of Kyril Bonfiglioli’s Charlie Mortdecai trilogy (After You with the Pistol and Something Nasty in the Woodshed round it out). Don’t Point dates to 1972 (Bonfiglioli died in 1985), but the books and the author are new to me.

I stumbled on the audio version of Don’t Point That Thing At Me and listened to it while commuting. It was quite wonderful, perhaps as much because of Simon Prebble’s narration as Bonfiglioli’s writing. I won’t bother with a description—you can find plenty of that via Google.

The books are available from Amazon, the audio from the iTunes store. If you have access to the 20 Sept 2004 issue of The New Yorker, you’ll find an appreciative review by Leo Carey which, despite the link from Wikipedia, does not appear to be available online.

Contra CAFE

James Hamilton argues against CAFE and in favor of a gasoline tax.

CAFE standards are based on the premise that auto manufacturers and consumers are making inappropriate decisions about the kind of vehicles that get produced. The clearest way to motivate this from an economic perspective would be to suggest that there are costs to using gasoline beyond those paid directly by consumers, such as a geopolitical cost when the U.S. relies on imported oil or possible consequences for the world climate. But if that is the motivation, an economically more efficient way to accomplish the objective would be to tax the gasoline use itself so that the after-tax price paid by consumers completely reflects whatever these true costs are deemed to be. This has the benefits of providing an incentive not just to purchase more fuel-efficient cars, but also to encourage more fuel conservation in the use of the existing fleet through such measures as driving slower, driving less, or getting more of the existing mileage from the more fuel-efficient vehicles. And it allows consumers and firms the maximum flexibility to figure out how to do this in the least disruptive way.

Hamilton cites research by Stanford economics student Mark Jacobsen.

Overall, Jacobsen estimates that a one-mile-per-gallon increase in the required average corporate fuel efficiency would increase the average fuel-efficiency of all new cars sold by 2.5%. However, since most of the older cars would still be on the road, Jacobsen estimates that during the first year, total U.S. gasoline consumption would decline by only 0.8%. He estimates the costs of this 1 mpg tightening of CAFE would be $20 billion in the first year, with these first-year costs shared about equally between U.S. consumers and producers. For comparison, Jacobsen claims that a gasoline tax could accomplish the same first-year effect at an efficiency cost of significantly less than $1 billion.

Over time, the fuel savings from tightening CAFE would of course increase, but even after 10 years, Jacobsen concludes that that a gasoline tax could accomplish the same thing at 1/6 the cost.

What kind of economy?

The first in a series from The Nation: an article by James K Galbraith, toward a new progressive economic agenda.

In a debate over the Democratic future, no one should confuse the Hamilton Project with the Republican past. Robert Rubin and his associates have invited a broad dialogue on economic inequality and strategic investment, and on many specific policy questions–including education, health, taxes and wages–they will define the high-profile, wholly respectable neo-Clintonian position in the season ahead. There’s nothing wrong with that.

But these advances come at a price, which will be exacted in two areas: the world trading system and domestic fiscal policy. Both of these are far more fundamental to the Hamilton mission than any particular social policy reform. Indeed, one purpose of the Hamilton Project, it seems clear, is to propose just enough creative social advances–such as wage insurance, better teacher pay and healthcare reform–so as to divert discussion from the bedrock commitments to free trade and a balanced budget.

Progressives shouldn’t let this happen. And yet we have our own work to do: Our trade position is obsolete, and there is for now no clear progressive fiscal policy. We need to be talking trade and budgets, not simply because they are too important to bargain away, and not just to contest Rubin’s worldview, but to build one of our own that is realistic, compelling and also serves larger purposes, including environmental survival and social justice.

…

Deficit-fetishism also bolsters the perennial campaign to cut the Social Security system, now taken up by the alarmist David Walker, head of the Government Accountability Office, and by Ben Bernanke, chair of the Federal Reserve System. Here the Hamilton Project strategy document is extremely reticent–it barely mentions Social Security by name. But it is riddled with code words about the long-term “entitlement problem,” which, it avers, can be solved only by a “bipartisan commission” acting on well-known options, behind closed doors. This is not reassuring.

In fact, Social Security is in better financial shape than ever, holding vast stocks of Treasury bonds on which interest can and will be paid. No economic or budget imperative requires that Social Security be cut, now or later. In private discussion Hamilton leaders let on that they understand this. But they are prepared, nevertheless, to include Social Security cuts–pension cuts for America’s elderly, many of whom would otherwise be poor–in some sort of grand deficit bargain. Progressives must be absolutely categorical in rejecting any such deal.

Healthcare costs are a big problem. But they are a problem affecting both public and private healthcare, not Medicare and Medicaid alone. And it’s highly unlikely that the problem of rising healthcare costs will extend to the point projected by Bernanke and Walker, who imply that healthcare will absorb one-third of the GDP within a generation–two or three times as much as in any other country. If that happens, as Dean Baker, co-director of the Center for Economic and Policy Research, has pointed out, we could cost-effectively contract out medical care to the Canadians and the French.