The system is blinking red at Trump

There is as yet no cascade of elected Republican officials disowning Trump -- that is, stating that they won't vote for him or support his campaign to be president. Still, denunciations of him by conservative and (allegedly) nonpartisan partisan establishmentarians are growing ever less inhibited. Below, some remarkable indictments.

First, knee-jerk neocon Charles Krauthammer, who never met a proposed military action he didn't like, but can recognize a personality who will up-end the U.S.-dominated world order:

Of course we all try to protect our own dignity and command respect. But Trump’s hypersensitivity and unedited, untempered Pavlovian responses are, shall we say, unusual in both ferocity and predictability.

This is beyond narcissism. I used to think Trump was an 11-year-old, an undeveloped schoolyard bully. I was off by about 10 years. His needs are more primitive, an infantile hunger for approval and praise, a craving that can never be satisfied. He lives in a cocoon of solipsism where the world outside himself has value — indeed exists — only insofar as it sustains and inflates him.

Next, David Brooks, self-appointed moral arbiter, finding a true north with his often erratic moral compass:

The moral carpet bombing of Edward Snowden has begun

David Brooks vents his prejudices and treats us to pop sociology in search of moral clarity this morning. Nice how some things don't change.

Brooks first reduces Edward Snowden to a social stereotype on flimsy evidence, then condemns him in high moral dudgeon, then undercuts the basis of his condemnation without noticing. For bonus points, he throws in a near-nonsense assertion about the founding fathers' original intent that, insofar as it has any meaning at all, is more false than true.

Brooks' lede intones, "From what we know so far, Edward Snowden appears to be the ultimate unmediated man." That's Brookspeak for 'not a good boy.'  He does not accept the authority and inherent benevolence of Institutions -- in Brooksworld, the repository of all moral value.

Condemning the world's anti-Boy Scouts does not exhaust Brooks' font of indignation. No, the charge must be generational and societal. We are All at Fault, for we are raising a generation of idiots (in the Greek sense of individuals isolated from society):

About that conservative soft spot for means-testing

[reposted from 2/22]

Jonathan Cohn had some fun this afternoon with this tweet and article:

‏@CitizenCohn Huge scoop: White House endorses means-testing for Medicare. http://www.newrepublic.com/article/112506/david-brooks-obama-and-medicare …

--  the joke being that Obama's 2013 budget, released a year ago, proposed modest increases in the already-higher premiums that wealthy seniors pay for Medicare Parts B and D.  Legions apparently retweeted Cohn without pausing to note that the "scoop" was a year old and based on information that the White House publicized.

Cohn's post was prompted by David Brooks lambasting Obama for not offering serious entitlement cuts, such as means-testing, in current negotiations to replace the sequester (see Cohn's post for links).  Which highlights a rather odd fact: means-testing Medicare and Social Security has been a Republican talking point throughout the budget wars. They use it either, I imagine, for cover -- see, we're not just about cutting benefits for the poor -- or as a stalking horse for cutting benefits for everyone else. More on that later.

The funny thing about means-testing is that it's functionally equivalent (if arguably less efficient in some cases) to raising taxes on the wealthy, which is anathema to the GOP.  Another funny thing: people don't realize the extent to which benefits for the elderly are already means-tested -- or, if I'm using that term imprecisely, more expensive for the wealthy (and in one case, available only to the poor).  A few facts, then, about our core elderly benefits:

Breaking: U.S. senior benefits means-tested

Jonathan Cohn had some fun this afternoon with this tweet and article:

‏@CitizenCohn Huge scoop: White House endorses means-testing for Medicare. http://www.newrepublic.com/article/112506/david-brooks-obama-and-medicare …

--  the joke being that Obama's 2013 budget, released a year ago, proposed modest increases in the already-higher premiums that wealthy seniors pay for Medicare Parts B and D.  Legions apparently retweeted Cohn without pausing to note that the "scoop" was a year old and based on information that the White House publicized.

Cohn's post was prompted by David Brooks lambasting Obama for not offering serious entitlement cuts, such as means-testing, in current negotiations to replace the sequester (see Cohn's post for links).  Which highlights a rather odd fact: means-testing Medicare and Social Security has been a Republican talking point throughout the budget wars. They use it either, I imagine, for cover -- see, we're not just about cutting benefits for the poor -- or as a stalking horse for cutting benefits for everyone else. More on that later.

The funny thing about means-testing is that it's functionally equivalent (if arguably less efficient in some cases) to raising taxes on the wealthy, which is anathema to the GOP.  Another funny thing: people don't realize the extent to which benefits for the elderly are already means-tested -- or, if I'm using that term imprecisely, more expensive for the wealthy (and in one case, available only to the poor).  A few facts, then, about our core elderly benefits:

Three professors of false equivalence look at the Obama-Boehner faceoff

The Times' James B. Stewart today interviews three management gurus who think that "getting to yes" in a deficit reduction deal ought to be easy. These men presumably know a good deal about corporate negotiations. But their apparent ignorance of politics -- political dynamics generally, and the battles of the last two years in particular -- is breathtaking.

The three cited experts, William Ury of Harvard, Seth Freeman of Columbia's Stern School, and Daylian Cain of Yale,  collectively assert the following: both sides are taking and have taken maximalist, uncompromising positions; neither allows the other any face-saving outs; and they are not that far apart substantively. Prof. Cain suggests that spending time together socially could make a substantive difference.   All of these assumptions are wrong.

Post-truth political appreciation

For once, I found myself nodding straight through a David Brooks column. Today he pays tribute both to Lincoln and to the new film by that name:

The movie portrays the nobility of politics in exactly the right way.

It shows that you can do more good in politics than in any other sphere. You can end slavery, open opportunity and fight poverty. But you can achieve these things only if you are willing to stain your own character in order to serve others — if you are willing to bamboozle, trim, compromise and be slippery and hypocritical. 

Contrast of conservatives: Brooks vs. Bartlett

By coincidence no doubt, the New York Times today showcases two diametrically opposed conservative approaches to fiscal cliff negotiations (in the parallel online/print universes): that of Bruce Bartlett, a genuine old-school deficit hawk, and of David Brooks, a well-meaning unwitting (if intermittent) sap for the current extremist frauds who dictate GOP policy.

Contemplating what Obama has called a "forcing mechanism" to give him his revenue increase -- the leverage afforded by the expiration of the Bush tax cuts -- Brooks urges a fresh bout of conciliation on the president:

Whither Obama on taxes?

David Weigel notes that he tax stance that served Obama well in his town hall debate with McCain in 2008 will not serve four years later:

Obama had miraculous success in 2008 by promising to raise taxes on the wealthy as a way to be fair and close the deficit. It simply isn't working as well in 2012, when Obama owns four $1 trillion deficits. He can correct plenty of his staging problems in a town hall, compared to a back-and-forth podium debate. But he needs a bigger argument on taxes.

I'm not exactly sure why we should credit this, since Obama has not yet been able to put over his proposed restoration of Clinton era income tax rates on the top 2% and other modest tax increases for the wealthy, and the broad principle of "asking the wealthy to pay a little more" has broad popular support. But allowing that the tax proposals in Obama's proposed ten year deficit reduction plan are a bit lightweight, a few thoughts below about where we are and where we need to head:

True conservatives to the Randians: you're devouring the base

Serendipity.  In today's Times, Cass Sustain showcases a social science finding: the best way to puncture confirmation bias, our tendency to hear only our own side of an argument, is to recruit a "turncoat"from the other side:

People tend to dismiss information that would falsify their convictions. But they may reconsider if the information comes from a source they cannot dismiss. People are most likely to find a source credible if they closely identify with it or begin in essential agreement with it. In such cases, their reaction is not, “how predictable and uninformative that someone like that would think something so evil and foolish,” but instead, “if someone like that disagrees with me, maybe I had better rethink.”

Coincidentally, it strikes me this morning that in the torrent of well-informed criticism of the crude Randianism expressed by Romney in that leaked fundraiser, the best, the most conceptually comprehensive responses have come from thoughtful conservatives.

Obama's tax strait jacket

Last Sunday, when Chuck Schumer defended Obama by denying that middle class tax hikes were on the table, it occurred to me that Obama has not so much shifted to the right on tax hikes vs. spending cuts as remained where he was in 2008:

That unwillingness to tax "the middle class" is a core precept of Obama's. I recall my disappointment during the 2008 campaign when Obama made it clear that he would seek to roll back the Bush tax cuts only for the wealthiest 2%, which accounts for  I believe a quarter of the revenue forgone by those cuts. You simply cannot get to $2 trillion in additional revenue over ten years without taking it out of "the middle class" so broadly defined -- that is, everyone from the 97th percentile on down.  Even with thoroughgoing tax reform, which lowers rates in exchange for reducing tax expenditures, strictly limiting the most popular tax breaks would probably raise net taxes on more than the top 2% of taxpayers.

The moderate Bipartisan Policy Center's plan, for example, radically restructures the tax code, vastly reducing tax expenditures, taxing all capital gains as ordinary income, flattening income tax rates to 15% and 27% and the corporate rate to 27%, and adding a 6.5% national sales tax; it would raise some $2.2 trillion in new revenue by 2020 but also raise net taxes on every income group but the lowest quintile. Obama has never been willing to do that.

I had assumed, as I think others had, that Obama would use tax restructuring -- lowering rates and closing loopholes -- as cover to raise taxes on at least some people making less than $200k (or families under $250k). No dice, apparently.  The strict line that Obama drew in 2008 limiting the tax hikes he is willing to entertain still stands.

The shift of the goalposts to the right thus predates Obama's presidency. Republicans have shifted them by making the Bush rates the status quo and relentlessly demonizing all tax increases, and Obama's half-acquiescence goes back at least to his candidacy.  Those like David Brooks who charged that Obama was putting his agenda in a tax straitjacket back in 2008 were right -- and he is not using tax reform as a cloak to broaden the tax hike pain.

 This basic fact has dawned on a lot of people this week. Ezra Klein noted yesterday:

But we’ve also learned a lot about President Barack Obama. Take taxes. The prevailing theory has been that the Obama administration would seek the largest tax increases it could plausibly pass. Liberals are now dismayed to learn that that notion is false. Instead, the Obama administration wants to take the tax issue off the table as soon as possible; the president is willing to take much less in revenue in exchange for spending less time arguing about taxes.

A quick bet against Brooks

UBER UPDATE 4/26/10:  My copy of Rebound finally arrived, and I was essentially right (as were many commenters): Rose's figures do refer to household income. They're also limited to "prime age" adults. Brooks did not literally misquote, and I shouldn't have inferred that he did without the book in hand. But he missed some key definitions early in the chapter. More here; full review of Rebound here. I have moved prior updates to the bottom, so that everything appears in sequence. 

-------ORIGINAL POST:
Arguing today that America's future is bright, David Brooks retails a stat from Stephen J. Rose: 60 percent of US adults have earned over 100k in at least one of the last ten years..I am willing to bet that "adults' should be 'households.' George Will made a similar error in a Jan. '08 column arguing that all was rosy with the American middle class. I will check this out later today.

UPDATE:  Bingo. Post above was from a Blackberry.  The book by Stephen J. Rose that Brooks references, Rebound: Why Americans Will Emerge Stronger from the Financial Crisis, is not out yet. But in a June 4, 2007 Huffington Post column, Rose wrote (my emphasis): 

Because income swings up tend to be larger than income swings down, the median of multi-year income is higher than median in each of the separate years. Consequently, the median income over ten years ending in 2002 was nearly $75,000 (in 2005 dollars) for prime-age adults and only 20 percent had ten-year average incomes below $40,000.

In addition, half of adults had at least one year in which their total household incomes were greater than $100,000.

Writhing in the budget strait jacket

I have always worried that David Brooks had a point here, back in April '08:

He made a sweeping read-my-lips pledge never to raise taxes on anybody making less than $200,000 to $250,000 a year. That will make it impossible to address entitlement reform any time in an Obama presidency. It will also make it much harder to afford the vast array of middle-class tax breaks, health-care reforms and energy policy Manhattan Projects that he promises to deliver.

Clive Crook, long an advocate for a U.S. VAT,  made a similar point in Feb. '09:

In this "new era of responsibility", as the budget document is called, it would have been better for Obama to signal that huge and desirable initiatives like universal health care will impose at least some costs on all Americans. It is literally impossible to make the rich pay for everything, and telling 95% of voters that they can have all these things at no cost is not good leadership. It has even less to do with shared responsibility.

David Brooks gins up another faux consensus

"It’s easy to get lost in the weeds," David Brooks warns, "when talking about health care reform." So Brooks, that genial guide, kindly leads readers off a cliff.

Declining to explain in any detail why he thinks the robust cost-control measures in the Senate health care bill would fail if enacted, Brooks relies instead on his two old stand-bys: mushy generalizations about values and recourse to faux consensus.

What a society gains in security through social welfare programs, Brooks declares without any evidence, it usually loses in vitality. There's a caveat:

Occasionally, our ancestors found themselves in a sweet spot. They could pass legislation that brought security but without a cost to vitality. But adults know that this situation is rare

Interesting to cast successful social welfare programs as the domain of our "ancestors." That projects such doings into a mythical realm, akin the age of prophecy that rabbis deemed to have ended after the post-exilic prophets. Needless to say, then, health care reform won't reach that state of grace. By enacting it, we will sap our vitality!

Perhaps in his next column Brooks can explain how dozens of wealthy countries that provide health care to all their citizens at half to two-thirds the per capita spending of the U.S. have sacrificed their "vitality." Or how subjecting tens of millions of Americans to subpar care and constant risk of financial ruin magically confers "vitality" on the U.S. -- rather than sapping it by chaining people to their current jobs, assuming they can hold them and that their employers do not scuttle or eviscerate their health plans.

According to Brooks, the great vitality drain will presumably be triggered when an enacted reform bill accelerates rather than controlling health care spending and thus redistributes wealth to the most vulnerable. To make this argument he relies on the device he used three weeks ago to prove that Obama lacked the grit to win in Afghanistan: conjuring consensus out of thin air. Here's how it works this time:

The authors of these bills have tried to foster efficiencies. The Senate bill would initiate several interesting experiments designed to make the system more effective — giving doctors incentives to collaborate, rewarding hospitals that provide quality care at lower cost. It’s possible that some of these experiments will bloom into potent systemic reforms.

But the general view among independent health care economists is that these changes will not fundamentally bend the cost curve. The system after reform will look as it does today, only bigger and more expensive.

As Jeffrey S. Flier, dean of the Harvard Medical School, wrote in The Wall Street Journal last week, “In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it.”

Now, Dr. Flier is indeed a formidable authority. Doubtless he has spoken with many colleagues and experts as he claims. But his assertion of "near unanimity" is just that -- an assertion. Brooks leverages it -- without relaying Flier's substantive argument in any detail -- into "the general view among independent health care economists."

No such "general view" exists. I don't know of any WSJ-style survey of health care economists and experts. But there's good reason to believe that consensus is closer to the opposite view, as Ronald Brownstein suggests in a widely-cited article about expert response to Reid's bill. Here's a centerpiece of the feedback Brownstein reports "from the center to the left":

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end "Cadillac" insurance plans; to pursue "aggressive" tests of payment reforms that will "provide incentives for physicians and hospitals to focus on quality" and provide "care that is better coordinated"; and establish an independent Medicare commission that can continuously develop and implement "new efforts to improve quality and contain costs." Finally, they said the Congressional Budget Office "must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter."

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests.

The Garber letter is signed by 23 leading economists, including two Nobel laureates, Kenneth Arrow of Stanford and Daniel McFadden of Berkeley. A third Nobel Laureate, William F. Sharpe, asked for his name to be added to the list of signers, according to the Harvard Crimson.

Brooks does not bother with the substance of Dr. Flier's argument. That argument boils down to three points: 1) the pending health reform bills are structurally similar to the Massachusetts quasi-universal coverage bill passed in 2006; 2) the Massachusetts bill has not slowed health care inflation, and 3) Massachusetts is just now turning its attention to serious means of controlling costs. Here's where the argument gets curious:

A "Special Commission on the Health Care Payment System" recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving "capitated" payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.

Yet it's entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.

Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation.

So: Massachusetts has not yet worked out the details of serious structural reform. Those details -- and on this point there is something approaching a consensus, which appears to include Dr. Flier -- must be worked out incrementally, by trial and error. That is precisely what the Senate bill -- in contrast to the Massachusetts bill -- aims to do from the outset. Brownstein again, on the bill's measures to seed structural reform:

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led "accountable care organizations" to more comprehensively manage patients' care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of "bundled" payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Dr. Flier plainly does not think much of these measures. He asserts, without any detailed enumeration or assessment of them:

Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction.

Nor does Dr. Flier assess the likely effects of an empowered Medicare commission or of the excise tax on expensive plans. He may have excellent reasons, based on practice experience and discussion with colleagues, to believe that the package of cost control measures won't work. But he's content to merely assert them.

Brownstein relays what appears to me a more balanced, if hardly rapturous assessment:

Former CBO director Robert Reischauer, who signed the November 17 letter, says that's not surprising. "CBO is there to score savings for which we have a high degree of confidence that they will materialize," says Reischauer, now president of the Urban Institute. "There are many promising approaches [in these reform ideas] but you...can't deposit them in the bank." In the long run, Reischauer says, it's likely "that maybe half of them, or a third of them, will prove to be successful. But that would be very important."

And from Mark McClellan, Bush's director of the Center for Medicare and Medicaid Services:

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag's assessment of it. "It has got all four of those elements in it," McClellan said in an interview. "They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go."

Brownstein's article was published three days before Brooks' and has circulated widely. But Brooks does not engage it -- or any other of the formidable health care experts who are voicing support for the Reid bill's cost control measures. Instead, he reverts to the tiredest and most circular of Republican talking points against those measures:

Moreover, the current estimates almost certainly understate the share of the nation’s wealth that will have to be shifted. In these bills, the present Congress pledges that future Congresses will impose painful measures to cut Medicare payments and impose efficiencies. Future Congresses rarely live up to these pledges. Somebody screams “Rationing!” and there is a bipartisan rush to kill even the most tepid cost-saving measure. After all, if the current Congress, with pride of authorship, couldn’t reduce costs, why should we expect that future Congresses will?

Ezra Klein has dealt nicely (and repeatedly) with the embedded logic of such critiques:

More broadly, I'm confused by the budget hawks who that take the line: "This bill needs to cut the deficit, and I don't believe Democrats will cut the deficit, but since the actual provisions of the bill unambiguously cut the deficit, then I guess Congress won't stick to it."

People who want to cut the deficit should support this bill, and support its implementation. The alternative is no bill that cuts the deficit, and thus no hope of cutting the deficit.

Klein has internalized the argument of Harvard's Jonathan Gruber - another signatory of the Garber letter -- who put it this way when he spoke to Klein:

We know we will be closer to bending the curve with this bill than without it. But we can't promise this bill alone will bend the curve. This bill moves us towards that. First is the Cadillac tax. Then comes more research on comparative effectiveness. We need to be able to stop paying for things that don't work. This bill doesn't do that, but it sets us up to have the information to do that. Then there's MedPAC on steroids. You need someone with the political ability to set rates to controls costs. Finally, this bill has pilot programs for a lot of things that we think will control costs, but that haven't been proven. Things like accountable care organizations, bundling and all the rest. We're at the stage where we know in theory what to do. But we don't quite know how to set it up, so we're collecting that evidence.

I think this is as much as you can do politically. It's as much as you can do without sinking the whole bill, which is what happened to every other health-care reform.

Finally, one more advocate of this kind of incremental approach to change is worth listening to:

At this point, I am confident that both the House and the Senate bills will contain what we've been calling MedPAC on steroids, the idea that you continually present new ideas to change incentives, change the delivery system, understanding that because this is such a complex system we're not always going to get it exactly right the first time, and that there have to be a series of modifications over the course of a series of years, and we have to take that out of politics and make sure that an independent board of medical experts and health economists are providing packages that are continually improving the system. So I think there's general consensus that that is one of two very powerful levers to bend the cost curve.

That's a certain Barack Hussein Obama, speaking to Fred Hiatt on July 26. A man whose M.O. is always to move the battleship by a few degrees.

The David Brooks "consensus": Bring back George W. Bush

Reporters are often excoriated for relying on anonymous sources. I can understand why they often have to. But David Brooks takes this to another level. He's hiding behind an anonymous consensus.

Brooks tells us "I’ve called around to several of the smartest military experts I know" to get their take on Obama's deliberations over Afghan policy. These "several" have a mysteriously unified persona. They're very, very smart and experienced. And lo, they all have the same worry. And lo, it looks an awful lot like Brooks's:

They are not worried about his policy choices. Their concerns are more fundamental. They are worried about his determination.

In fact, this Brooks shadow cabinet longs for the return of George W. Bush:

But they do not know if he possesses the trait that is more important than intellectual sophistication and, in fact, stands in tension with it. They do not know if he possesses tenacity, the ability to fixate on a simple conviction and grip it, viscerally and unflinchingly, through complexity and confusion. They do not know if he possesses the obstinacy that guided Lincoln and Churchill, and which must guide all war presidents to some degree.

The unanimous chorus is mysteriously sanguine about the odds of defeating the Taliban:

Most of them, like most people who have spent a lot of time in Afghanistan, believe this war is winnable. They do not think it will be easy or quick. But they do have a bedrock conviction that the Taliban can be stymied and that the governments in Afghanistan and Pakistan can be strengthened.

"Most" of "several" believe this? Right, there's consensus among the informed about staying the course. Funny that Andrew Exum -- who helped prepare General McChrystal's report, who does support the counterinsurgency effort, and who could in fact be one of Brook's sources, writes

I know about 50 really smart people on Afghanistan with lots of time on the ground there, and no two have the same opinion about what U.S. policy should be.

Brooks does voice a set of concerns worth considering:

...if these experts do not know the state of President Obama’s resolve, neither do the Afghan villagers. They are now hedging their bets, refusing to inform on Taliban force movements because they are aware that these Taliban fighters would be their masters if the U.S. withdraws. Nor does President Hamid Karzai know. He’s cutting deals with the Afghan warlords he would need if NATO leaves his country.

On the other hand, as several informed parties, e.g. Matthew Hoh and Rory Stewart, have noted, there's considerable evidence that ramped-up U.S. military presence, far more than presidential deliberations, drives Afghan villagers to support the Taliban. And as Joe Klein has noted, Obama's very public pause is in part calibrated to pressure Karzai, who's been "cutting deals with Afghan warlords" since he was first elected/installed. Indeed, going forward, Exum suggests (in a piece aptly titled Take Your Sweet Time, Obama):

The Obama adminstration has, I believe, some leverage at the moment, which it could use to affect the composition and behavior of the next Afghan government. As long as Afghanistan’s ruling politicians—Hamid Karzai especially—think the United States might reduce its commitment to Afghanistan, they could be willing to accede to U.S. demands on key ministerial and provincial-level appointments....

while countless memoranda and manuals exist instructing U.S. servicemen on how to wage counterinsurgency campaigns at the operational and tactical levels, there is currently little guidance for how U.S. policymakers should use leverage over its Afghan partners. The Obama administration, if it's clever, will try to figure out the best way to use its leverage over Karzai and other Afghan politicians. And in that effort, they deserve time to succeed.

David Brooks purports not to trust the President. I do not trust David Brooks. I think the opinions he "reports" represent 57% of seven people he selectively elected to represent consensus, their musings massaged into unison by Brooks's authoritative editorial "they."

I do not fear that Obama will prove ultimately to lack "conviction" in his search for a policy that works in Afghanistan. I do fear that the powerful institutional forces of U.S. post World War II foreign policy consensus -- forces that shaped the policy of every President from Truman through Clinton, more for good than not -- will work with our latter-day polarized political shriekfest to constrain Obama into a full-blown counterinsurgency effort.

That effort might be the right choice. But politically -- and paradoxically, since public opinion is turning agains the war -- it's hard to see any President really putting on the brakes in mid-course.

Related posts:
Steve Coll vs. Rory Stewart
Obama to Karzai: No marriage no dowry?
David Brooks' lazy free market fantasy

Brooks v. Brooks on the Baucus bill

David Brooks continues to write nonsense about health care.

Professing ambivalence about the Baucus bill, he complains in one breath that it "will retard innovation by using monopoly power to squeeze costs." Two paragraphs later, lauding the bill's "many provisions to make government-run health care more rational," he includes that it "would create a commission to perpetually squeeze costs," also cataloging specific measures favored by health care experts -- bundling payments, encouraging doctors to work in teams, improving IT, measuring comparative effectiveness. He acknowledges that savings from these measures "could be significant."

As for that free market shibboleth that cost controls are always bad: in health care, virtually every industrialized nation has found them necessary. Is Brooks aware that in France, Germany and Japan, three countries that get better health outcomes than the U.S. at half to two-thirds the cost, the central government sets prices for every medical procedure performed in the country, and all insurers are required to pay all bills submitted under that schedule by all providers? That those countries provide universal comprehensive coverage at minimal cost to their citizens? That the fee schedules are completely transparent, posted on doctor's office walls in France, available in a phone book-sized reference in Japan? (For a doctor's- and patient's eye view of these systems, see T.R. Reid's The Healing of America.)

The only "innovation" squeezed by governmental cost controls is the innovation of insurers, ingeniously determining how not to cover procedures or how to wring out maximum premiums by charging different rates for different levels of coverage.

Yes, health care providers in all three countries feel squeezed by government cost controls. Yes, they make much less than doctors in the U.S. They also come out of medical school with zero debt, pay pennies by US standards for malpractice insurance, and spend almost no time or money on administrative costs -- in contrast to American doctors, who have to employ whole staffs to deal with the byzantine billing and claims approval processes of multiple insurers.

Brooks also claims that the Baucus bill (or any set of subsidy levels for people purchasing insurance on exchanges) "will impose huge costs on people as they rise up the income ladder, distorting the whole economy."

Subsidies keyed to income are only relevant to those who do not get insurance from their employer, including the self-employed. Right now, such people suffer "huge costs" indeed -- buying individual insurance on the open market with no subsidy. For many, a rising income will be the result of better employment, which likely means employer-provided health care. For the self-employed or those who work long-term in workplaces that don't provide insurance, it seems perverse to complain that reducing subsidies as their income increases is an imposition of "huge costs."

David Brooks' lazy free market fantasy

Before publishing a disingenuous parable setting up false categories of free-market versus activist government reform, David Brooks should have had a chance to read a cautionary tale of failed health care reform that appeared on the very same Times op-ed page as his own column.

Brooks spins out the reform approaches of "Mr. Bentham" (Obama Democrat) and "Mr. Hume" (free market conservative, vaguely reminiscent of Bush). Presumably these are avatars of nineteenth century reformer Jeremy Bentham and philosopher David Hume, though the affiliations are too tenuous to be worth parsing.

Mr. Bentham is a type AAA superwonk with a solution to everything; Mr. Hume is a lazy skeptic who recognizes his limitations. While Brooks takes a few swipes at "Hume," his sympathies clearly rest with him.

Mr. Bentham comes up with the Baucus bill for health care reform and the Waxman-Markey energy bill; Mr. Hume proposes in both cases to let the market work its magic. Here he is on health care:

“Why don’t we just set up insurance exchanges with, say, 12 different competing policies? We’ll let everybody choose a policy, and we’ll let people keep any money they save. That way they can set off a decentralized cascade of reform, instead of putting all the responsibility on us here.”

Yeah, why don't we just. It's really easy to estblish robust competition benefiting consumers among for-profit health insurers, and every market has twelve competitors ripe for recruitment. That's where column B, an op-ed by the former chairman of the Texas Insurance Purchasing Alliance, Cappy McGarr, offers an appropos reality check.

McGarr chronicles the failure of Texas' effort in the early nineties to establish a health insurance exchange for small businesses--a failure he blames largely on neglect from Governor George W. Bush (the quasi-model, ironically, for Brooks' "Mr. Hume," with imagery borrowed from Maureen Dowd's Boy King columns). The exchange died, according to McGarr, for want of either a public option or strict rules to prevent insurers from cherry-picking small corporate customers outside the exchange:

Most important, though, our exchange failed not because it wasn’t needed, and not because the concept wasn’t sound, but because it never attained a large enough market share to exert significant clout in the Texas insurance market. Private insurance companies, which could offer small-business policies both inside and outside the exchange, cherry-picked relentlessly, signing up all the small businesses with generally healthy employees and offloading the bad risks — companies with older or sicker employees — onto the exchange. For the insurance companies, this made business sense. But as a result, our exchange was overwhelmed with people who had high health care costs, and too few healthy people to share the risk. The premiums we offered rose significantly. Insurance on the exchange was no longer a bargain, and employers began backing away. Insurance companies, too, began leaving the alliance.

The Texas exchange failed, in other words, for want of the very types of provisions that Brooks lampoons in the Baucus bill: "He’d design a set of insurance policy regulations to make sure everybody gets uniform care"( along with various crucial experimental measures to restrict overtreatment and overbilling that Brooks does not criticize in detail).

Brooks recognizes on some level that free market fundamentalism has failed. His Mr. Hume "never could very accurately predict how the market was going to move." But he holds reflexively to his contempt for good-faith efforts to create market conditions in which health insurance competition can flourish. He won't recognize, as Paul Starr has shown, that the Baucus bill -- and indeed, all the Democratic health care bills pending in both chambers -- are comprised entirely of ideas proposed by Republicans over the past four decades. He won't consider, with Jonathan Cohn, whether an exchange minus a public option might work with strict regulation of private insurers. He hasn't engaged the tough questions driving the debate -- for example, whether the Wyden amendment opening the exchanges to all employees might foster real competition, or whether co-ops might work, or how to bend the cost curve if he doesn't like the efforts to do so that he implicitly lampoons in the Baucus bill. He prefers, with his own Mr. Hume, to whine and fantasize easy answers.

David Brooks lambastes Democrats for agreeing with him

Never one for logical rigor, David Brooks ignores himself to a breathtaking degree in today's column.

He begins with an intriguing hypothesis: our latter day Father Coughlins -- Rush Limbaugh, Glenn Beck, Sean Hannity & co. -- command plenty of attention but virtually no votes. His evidence is probably selective, but it's an intriguing hypothesis. They are puffed up by enablers. True enough. But...

They are enabled by cynical Democrats, who love to claim that Rush Limbaugh controls the G.O.P.

Just another politically expedient lie, right? Oh, wait --

And the saddest thing is that even Republican politicians come to believe it [that the shock jocks have real power]. They mistake media for reality. They pre-emptively surrender to armies that don’t exist.

They pay more attention to Rush’s imaginary millions than to the real voters down the street. The Republican Party is unpopular because it’s more interested in pleasing Rush’s ghosts than actual people. The party is leaderless right now because nobody has the guts to step outside the rigid parameters enforced by the radio jocks and create a new party identity. The party is losing because it has adopted a radio entertainer’s niche-building strategy, while abandoning the politician’s coalition-building strategy.

The rise of Beck, Hannity, Bill O’Reilly and the rest has correlated almost perfectly with the decline of the G.O.P. But it’s not because the talk jocks have real power. It’s because they have illusory power, because Republicans hear the media mythology and fall for it every time.

To anyone who believes that democracy can't function without viable choices, it was a sad and shocking spectacle to witness a parade of Republican leaders first calling out and then kow-towing to Rush Limbaugh earlier this year. Democrats would rather have an opposition they can work with; as Paul Starr demonstrated recently, their health care bills are comprised almost entirely of Republican ideas past, but there's no one on the other side negotiating in good faith.

But in David Brooks' still partisan mind, Democrats who agree with him that the Republican party is entirely in the grip of media demagogues are "cynical." And what is Brooks? Pure-minded?

Obama "triggers" a recount of heath care bills' costs

David Brooks would have us believe that Obama's promise in Wednesday night's speech not to sign a health care bill if it "adds one dime to the deficit" "kills the kills the House health care bill," which allegedly would add $220 billion to the deficit over ten years.

But as Ezra Klein highlights for us, Obama's very next sentence indicates an intent to change the CBO scoring that determines each bill's alleged price tag. As several observers including John R. Gabel have pointed out, the CBO has a history of underestimating the savings from various enacted Congressional measures to reduce health care costs; it's difficult for lawmakers to get due credit for cost-cutting measures. Hence this proposal, immediately following the "dime" pledge:

And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize."

Klein, I believe, had already flagged this possibility prior to Obama's speech (it was either him or Cohn). Today, he's all over it:

The idea was recently explained in a paper David Cutler and Judy Feder wrote for the Center for American Progress, so I called Feder today to ask what, exactly, the president was talking about.

How does a fiscal trigger work?

The idea of a trigger is that one establishes in advance a target for savings in the system, agrees on measures that need to be achieved, track that progress as the program is implemented, and if shortfalls are found, then certain actions are automatically triggered in.

What are those actions? What happens when you pull the trigger?

David Cutler and I put forward a range of options and believe a menu should be specified in the legislation. That menu could include further reductions in Medicare or changes in the tax treatment of employer-based efficiency or a strengthening of a public plan to further competition with insurers.

And why do we need this? I thought the plan already had savings in it.

The reason that David Cutler and I have been so supportive of a trigger is that we are firmly behind the cost-saving measures that are in legislative proposals and on which there is enormous agreement to change the health-care delivery system. Payment reform, a value-based purchasing system, moving away from the overprovision of low-value and high-cost procedures, and rewarding providers for better care and management of chronic illness. There's work and experience showing those measures can achieve huge savings systemwide. David Cutler and Rand's Melinda Buntin estimated (pdf) the savings at $2 trillion over the next decade.

But CBO is very cautious about scoring those measures. So it's our belief that for scoring purposes, we can put underneath them a failsafe that guarantees CBO will score the savings.

So the idea is that those savings will appear, but since CBO won't score them, you basically give CBO something it can score that's of similar value?

Exactly.

Presto. That house bill might be scored differently. More importantly, it may really accelerate the imposition of serious cost controls, i.e. changes to the fee-for-service payment structure, which by their nature must be incremental. Read the whole of Klein's interview of Feder.

Human Rights Watch's true-blue conservative

Early this year, David Brooks put on his Big Think cap and counterpoised against our society's alleged individualist shibboleths a communitarian ethos put forward by political scientist Hugh Heclo in a book published last summer, On Thinking Institutionally. As relayed by Brooks:

In this way of living, to borrow an old phrase, we are not defined by what we ask of life. We are defined by what life asks of us. As we go through life, we travel through institutions — first family and school, then the institutions of a profession or a craft.

Each of these institutions comes with certain rules and obligations that tell us how to do what we’re supposed to do. Journalism imposes habits that help reporters keep a mental distance from those they cover. Scientists have obligations to the community of researchers. In the process of absorbing the rules of the institutions we inhabit, we become who we are.

New generations don’t invent institutional practices. These practices are passed down and evolve. So the institutionalist has a deep reverence for those who came before and built up the rules that he has temporarily taken delivery of. “In taking delivery,” Heclo writes, “institutionalists see themselves as debtors who owe something, not creditors to whom something is owed.”

While Brooks never used the word "conservatism" he was plainly holding up this "institutional" ethic as a kind of Platonic conservative ideal. Proud professionals devote their lives to "saving" the honorable essence of institutions that themselves conserve the distilled wisdom of generations.

From this standpoint, Tom Malinowski, Washington Advocacy Director for Human Rights Watch, is a true-blue conservative. Consider his call to trust in the accumulated wisdom of core U.S. institutions in his June 9 testimony before the Senate Judiciary Subcommittee on the Constitution:

Seven years after Guantanamo opened, a stable set of rules for determining who should be detained and with what degree of due process has still not emerged.

Some of these problems are due to the inherent flaws of the system. But many are the inevitable result of creating any new system from scratch, especially one that deviates so much from standards with which US courts are comfortable and American lawyers are familiar. America's civilian criminal justice system, on the other hand, has been around for more than 200 years. The Uniform Code of Military Justice has been around for almost 60. We've had all that time to get the kinks out of the system, to establish stable rules, to train a cadre of lawyers and judges who know those rules, and to develop special procedures for special kinds of cases, including those involving terrorism.

If we try again to create a new system from scratch, if we rely again on trial and error to work out the rules, the result will again likely be more error than trial. Eventually, stable rules may emerge, after all the legal challenges and legislative re-dos are exhausted. But how long should we be prepared to wait to get to that point? Five years? Ten years? Can the United States afford more years of controversy over how to detain suspected terrorists?

To Obama, who has signaled that he wants to revamp rather than scrap the improvisations of the Bush administration - military commissions and preventive detention -- Malinowski points out that there's a kind of infinite regress in trying to reproduce the due process protections of the criminal justice system in a new regime that grants the Federal government powers the whole purpose of which is to short-circuit those protections:

Theoretically, one could design a system of preventive detention that affords detainees such a high level of due process and judicial review that it would not look like Guantanamo, or even Guantanamo-lite. But if you allow protections similar to those already provided by federal courts and courts martial, why go to the trouble of creating a new system at all?

Commentators as diverse as Andrew Sullivan, Martin Wolf and Jack Goldsmith have pointed to a kind of conservatism in Obama -- a propensity to retool rather than radically remake existing institutions, a reform impulse that aims to restore institutions to working order. With regard to treatment of detainees, Obama promises to work within our political institutions, in concert with Congress and the courts, to revamp military commissions and create Constitutional rules for preventive detention. But reforming and "conserving" Bush's radical, ad hoc exercise of this power may simply serve to codify core violations of Constitutional principles as previously understood. As Diane Marie Amann, a law professor at UC Davis, warned in the wake of Obama's May 20, speech on national security:

He signaled a plan by which they — and perhaps other detainees yet to be arrested? — could remain in custody forever without charge. There is no precedent in the American legal tradition for this kind of preventive detention. That is not quite right: precedents do exist, among them the Alien and Sedition Acts of 1798 and the Japanese internment of the 1940s, but they are widely seen as low points in America’s history under the Constitution.

President Obama promised that his “new legal regime” — words identical to those Bush Administration official John Yoo used in 2002 –- will provide an array of “fair procedures.” That ought to be a given, for the Constitution requires due process before liberty may be deprived. But no amount of procedures can justify deprivations that, because of their very nature violate the Constitution’s core guarantee of liberty.

Time will tell how "institutionally" Obama thinks about the U.S. Constitution.

Brooks' assault on reason

Funny that David Brooks dismisses moral philosophy because studying it doesn't seem to increase "proactive moral behavior."

The values that one would think a non-Christianist American conservative would hold most dear are a product of moral philosophy:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed....

Brooks sagely reports that moral judgements are "rapid intuitive decisions" rather than the product of deliberation. Day-to-day, perhaps they are. But millions of Americans were persuaded by watching southern policemen club nonviolent demonstrators that segregation was wrong. Sit-in participants and freedom marchers were demonstrating a very clearly articulated moral philosophy (see Letter from a Birmingham Jail) that changed this country.

Perhaps Brooks finds it comforting to think that morality can be entirely explained by evolutionary biology. Conservatives often find it hard to acknowledge that human ethics advance over time - and to accord judges the authority to incorporate those advances into law.

Over time, however, Americans have been persuaded that slavery is wrong. That women deserve property rights, the vote, equal pay for equal work. That 60-hour work weeks for children are wrong. Now, we're in the process of concluding that marriage for gay people is right.

Those advances in morality were not (are not) "rapid intuitive decisions." They worked through public spectacle, and public discourse, ultimately informed by moral philosophy.

If evolution shapes our values, it shapes them through our reason as much as through emotion. Just as perception and evaluation can't easily be separated, neither can thought and feeling.