
I am surprised that the Mousavi campaign would yoke these images together, given Khamenei and Ahmadinejad's rhetoric branding the demonstrations as the tool of U.S., Brit and "Zionist" interference.

Mesgari:I think there is still a battle being waged for the hearts and minds of the Revolutionary Guard and Basij. Successful nonviolent movements in other countries have depended on the cooptation of the rank and file in the armed forces; one remembers the moving scenes of Serbian riot police embracing demonstrators...
Iran is not Serbia. The relationship between the people and the revolutionary shock troops is far older and deeper than anything that took root during Milosevic’s relatively brief tenure. By 2000, Milosevic’s fiefdom was rotten to the core; it survived on corruption, the fear of exposure on the part of many criminals and war profiteers, and hostility toward the world. The Islamic Republic, by contrast, was born in a people’s revolution and built on faith in a religion that is deeply held by most Iranians. The state’s ideology is not the hollow construct of political elites, as communism was by the time it collapsed in much of Eastern Europe. Rather, Iranian Islamism was forged over decades, in long struggle with the despotic regime of Mohammad Reza Shah, and from the potent raw materials of Iranian nationalism and Islam. Although the country’s constituency for democracy is vast and growing, the regime has a constituency, too, and it is passionately loyal and heavily armed.
The purpose of the Revolutionary Guard and Basij is the defense of the Islamic Revolution and the Supreme Leader. Rarely have the true believers in the militias been forced to consider the possibility that these two functions might come into conflict. Such a moment may have arrived...
It would seem that the more immediate problem -- with the longer odds -- is the one framed by Secor. But Mesgali's challenge raises the core longer term question. The 1979 revolution got past the Shah and then was hijacked by the most ruthless and autocratic among the contestants for power. Mousavi, as Karim Sadjapour of the Carnegie Endowment for International Peace has pointed out, is no Khomeini -- he's the Gorbachev, the Kerensky, the reformist not the revolutionary. As Secor points out, though, Iran's current power structure is not "rotten to the core" in the sense of having lost all support; it still has the buy-in of at the very least a large minority. A reformer who professes passionate loyalty to the state apparatus he helped found may be the best hope for change Iranians can believe in.Mousavi knows too well how deep the wound is. He also knows that his green bandage is only a first aid cover for this wound and not a cure....
Mousavi knows that not all “this” is for him.
He knows very well, and we also know very well that had there been a “better” candidate than Mousavi with a “lesser evil past” which had chosen yellow colour for his campaign, the nation would have gone yellow and Mousavi would have demoted to Ahmadinejad’s position. …..
Velayat-e Faqih or the “Guardianship of the Islamic Jurists” is the red line which Mousavi has expressed he won’t cross – this red line is now being crossed by those wearing green....
30 years ago, in this country a revolution became victorious in the name of Islam, a revolution for freedom, a revolution for reviving the dignity of men, a revolution for truth and justice. In those times, especially when our enlightened Imam [Khomeini] was alive, large amount of lives and matters were invested to legitimize this foundation and many valuable achievements were attained. An unprecedented enlightenment captured our society, and our people reached a new life where they endured the hardest of hardships with a sweet taste. What this people gained was dignity and freedom and a gift of the life of the pure ones [i.e. 12 Imams of Shiites]. I am certain that those who have seen those days will not be satisfied with anything less. Had we as a people lost certain talents that we were unable to experience that early spirituality? I had come to say that that was not the case. It is not late yet, we are not far from that enlightened space yet.The "enlightened Imam" would be the man who massacred tens of thousands of opponents and crushed all dissent, who prolonged ruinous war with Iraq for six fruitless years after turning back Iraq's initial territorial gains, and in that war sent teens and even preteens in waves of thousands to clear minefields with their bodies (the first Basiji, today's murderous militia); who imprisoned women in the hijab and generally set women's rights back fifty years: who murdered the leaders of the Baha'is and made second-class citizens of the rest; who impoverished the country with his contempt for economic management; who united the people by demonizing the United States (against whom Iranians did have ample cause for resentment) and institutionalizing the murderous Antisemitism that now, adopted in full by Ahmadinejad and Khamenei, threatens the world's stability -- who in short, made Khamenei look like a piker when it comes to crushing human rights and subverting the Republican government Mousavi professes to value.
If the large volume of cheating and vote rigging, which has set fire to the hays of people’s anger, is expressed as the evidence of fairness, the republican nature of the state will be killed and in practice, the ideology that Islam and Republicanism are incompatible will be proven. This outcome will make two groups happy: One, those who since the beginning of revolution stood against Imam and called the Islamic state a dictatorship of the elite who want to take people to heaven by force; and the other, those who in defending the human rights, consider religion and Islam against republicanism. Imam’s fantastic art was to neutralize these dichotomies. I had come to focus on Imam’s approach to neutralize the burgeoning magic of these.He treasures the notion that Islam and Republicanism are compatible. Perhaps they are. But Khomenei united them in demonic form by modeling the Islamic Republic after Plato's Republic -- the oldest blueprint we have for totalitarianism. The Guardian Council that falsified the vote count last week was a real-world enfranchisement of Plato's ruling class of philosopher kings. Khomeini's republicanism like Plato's, is based in absolute faith in the absolute wisdom of an educated elite invested with absolute power.
As I am looking at the scene, I see it set for advancing a new political agenda that spreads beyond the objective of installing [sic] an unwanted government. As a companion who has seen the beauties of your green wave, I will never allow any one’s life endangered because of my actions. At the same time, I remain undeterred on my demand for annulling the election and demanding people’s rights. Despite my limited abilities, I believe that your motivation and creativity can pursue your legitimate demands in new civil manners.Leaders can be transformed by the contract forged with their followers in the crucible of events. Mousavi's pledges to institute the rule of law and respect human rights constitute a religious man's strongest oath to his people, made with the world listening, in mortal political combat with those whom he charges with trampling those rights. Let's hope that if by some miracle he does come into power he will work to fulfill these pledges, whatever his delusions about the blood-soaked Khomeinist past -- and his own role in it.
We advise the authorities, to calm down the streets. Based on article 27 of the constitution, not only provide space for peaceful protest, but also encourage such gatherings. The state TV should stop badmouthing and taking sides. Before voices turn into shouting, let them be heard in reasonable debates. Let the press criticize, and write the news as they happen. In one word, create a free space for people to express their agreements and disagreements. Let those who want, say “takbeer” and don’t consider it opposition. It is clear that in this case, there won’t be a need for security forces on the streets, and we won’t have to face pictures and hear news that break the heart of anyone who loves the country and the revolution.
Despite warnings by Iranian police, protesters have staged an illegal rally in Tehran to cry foul over what they call 'vote-rigging' in Iran's presidential election.While there appears to have been much disgusting Basij violence, it also seems that the government so far has held back from a full-scale Tiananmen crackdown. Videos seem to show that although protesters were kept from massing in major squares, they did manage to fill streets and stay out en masse.
Police used batons and water canons to disperse the protesters who gathered near Tehran's Enqelab Square on Saturday.
Sporadic clashes were reported between security forces and the protesters.
The Council has said it is ready to recount a random 10 percent of the ballot boxes in the last Friday's presidential election.One must assume that the "random" selection would also be rigged. If there were away to verify that it was not, however, the results could be significant. It could even provide a fig leaf for Khamenei to walk back his endorsement of the results.
"Although the Guardian Council is not legally obliged ... we are ready to recount 10 percent of the (ballot) boxes randomly in the presence of representatives of the candidates," the electoral watchdog's spokesman, Abbas-Ali Kadkhodayi said on Saturday.
Iran's Security Council has warned defeated presidential candidate Mir-Hossein Mousavi against 'the consequences' of backing street rallies.
"It is your duty not to incite and invite the public to illegal gatherings; otherwise, you will be responsible for its consequences," Iran's Security Council, a body affiliated with the Interior Ministry replied Mousavi's letter in which he had criticized the law enforcement forces for failing to prevent attacks on protestors during the street rallies.Yup, the Great Satan and the Jews are pulling the strings, manipulating all those millions.
"It is your responsibility to prevent the public from attending such rallies instead of making accusations against the law enforcement," it added.
"We believe this is an organized network which is most probably affiliated to foreign-related groups and deliberately disturbs the peace and security of the public. Of course we have already ordered the law enforcement forces to deal with the issue," read the letter.
As the Shah tentatively cracked down, killing dozens of protesters here and hundreds there, those seeking his overthrow kept coming back for more. Sadjapour suggests that while Khomeini was more ruthless than the Shah, Khamenei may prove more relentless than Mousavi. Rafsanjani is a wild card, though. And the Iranian people have that Shiite reverence for martyrdom. But can any people resist a truly ruthless crackdown? Perhaps only when the soliders in the tanks refuse to roll.The weight of the world now rests on the shoulders of Mir Hossein Mousavi. I expect that Khamenei’s people have privately sent signals to him that they’re ready for a bloodbath, they’re prepared to use overwhelming force to crush this, and is he willing to lead the people in the streets to slaughter?
Mousavi is not Khomeini, and Khamenei is not the Shah. Meaning, Khomeini would not hesitate to lead his followers to “martyrdom”, and the Shah did not have the stomach for mass bloodshed. This time the religious zealots are the ones holding power.
The anger and the rage and sense of injustice people feel will not subside anytime soon, but if Mousavi concedes defeat he will demoralize millions of people. At the moment the demonstrations really have no other leadership. It’s become a symbiotic relationship, Mousavi feeds off people’s support, and the popular support allows Mousavi the political capital to remain defiant. So Mousavi truly has some agonizing decisions to make.
Rafsanjani’s role also remains critical. Can he co-opt disaffected revolutionary elites to undermine Khamenei? As Khamenei said, they’ve known each other for 52 years, when they were young apostles of Ayatollah Khomeini. I expect that Khamenei’s people have told Rafsanjani that if he continues to agitate against Khamenei behind the scenes, he and his family will be either imprisoned or killed, and that the people of Iran are unlikely to weep for the corrupt Rafsanjani family.
That "all four candidates support the regime" -- or did before the vote count -- is not only true, it also taps into the central theme of Mousavi's campaign and of his post-election protest. Back on April 3, the Iranian government vehicle Press TV reported:The competition for the election was very clear. Enemies and dirty Zionists tried to show the election as a contest between the regime and against it. That is not true, all four candidates support the regime." [He lists the government positions of the opposition candidates]. All of the candidates are part of this system and regime. Zionists and the bad Britishradio said it was a challenge to the regime.
"The issue is inside the system. The dispute is not against the revolution. The dispute was among candidates and there was a positive and negative effect. People were able to judge, they felt part of the system. All views were available to the people.
[Mousavi] added that freedom of information should become a basis for both the government and economy, warning that overlooking the Iranian constitution and its contents posed a major challenge to the country.Then, on June 13, Mousavi claimed authority to contest the vote in the name of the Revolution of 1979 and the law established by the revolutionary regime:
"The issue of non-compliance with Iranian rules and regulations is the biggest problem that the country is currently faced with," he said.
I advise all officials to halt this agenda at once before it is too late, return to the rule of law and protect the nation’s vote and know that deviation from law renders them illegitimate. They are aware better than anyone else that this country has been through a grand Islamic revolution and the least message of this revolution is that our nation is alert and will oppose anyone who aims to seize the power against the law.And on June 14, he effectively cast those in control of the vote count as destroyers of the state:
The events that we all have witnessed in the past days were unprecedented in the Islamic Republic. The reason for the fearful concern of the people is due to the extreme sense of danger for the great achievements of the (Islamic) Revolution. Those who after massive cheatings have declared these unbelievable results for the presidential elections are now out to establish these results as undisputed facts and start a new chapter in the history of our country.Now, Khamenei is trying to use this weapon of Mousavi's against him. He has drawn a line and declared that anyone who continues to protest the official election returns is aligned with the "Zionists" and evil western diplomats:
Khamenei has just washed his hands of the blood he's preparing to spill -- and in fact smeared it not only on Mousavi but on Rafsanjani:The guardian council has said that if people have doubts they should prove them. I will not follow false allegations. In all elections some are winners and some are losers. Correct legal procedures should be followed to ensure trust in the process. "The candidates should be careful about what they say and do" [Mousavi doesn't seem to be there]. "Some diplomats from the west are showing their real face and that they are enemies. The worst are the British.
The street is the place of living and trading. Why are you taking to the streets? We have had the election. Street demonstrations are a target for terrorist plots. Who would be responsible if something happened?
"Rumours spread that were not true, and gave a bad image to the previous government. Calling the president a liar is that good? This is against the truth. The 30 years of the revolution was turning black." Khamenei talks about the rumours about Hashemi Rafsanjani. He praises Rafsanjani as "close" to the revolution. "The youth should know that... He was at the service of the revolution. I do have some difference with him, but people should not imagine something else between him and the president.Again, Khamenei is at once asserting that all rivals within the current leadership circle are "part of this system and regime" and warning them not set themselves against it. Rafsanjani, however, is the only rival who might have the constitutional power to in turn cast Khamenei as the one outside the law. Rafsanjani is Chair of the Expediency Council, which according to the Economist in 2005 "was given an undefined 'supervisory authority' over all three branches of government," and head too of the Assembly of Experts, which "can also theoretically dismiss the supreme leader if he fails to meet specific criteria or becomes unable to execute his duties satisfactorily."
Is this really so surprising? No one wants to change a winning game. As long as an autocracy delivers the goods, people are likely to tolerate it. However, these researchers also found thatRegarding transitions to democracy, we find that economic growth has a robust negative effect. This finding, standing in stark contrast to modernization theory, suggests that autocracies with strong economic performance are unlikely to see democracy emerge. Instead, economic contraction causes dictatorships to break down. Also in contrast to modernization theory...the level of GDP per capita does not have a robust relationship with the emergence of democracy (p.2).
We have an interesting finding for economic growth: it makes dictatorships more likely to survive and lowers the chances for democracy to emerge (p. 27).
autocracies with strong economic performance are unlikely to see democracy emerge. Instead, economic contraction causes dictatorships to break down.What happens when rapid economic progress gives way to economic stress? Perhaps that is the danger point for many autocracies.
[Ahmadinejad] broke crockery left and right by associating his opponents with what he claimed was a history of corruption and catastrophic errors dating back to the earliest days of the Islamic Republic. That, of course, is the system that he represents and that he extolls in every public appearance.Indeed, Sick's June 10 post highlights the deep fissure within the Iranian regime that pointed toward a rigged election. Its prescience about the likely rigging -- and Khamenei's likely acquiesence -- lends authority to Sick's conclusion:The 40 million Iranian voters who watched this astonishing spectacle, and who had never heard a serious word of criticism about the Islamic government on national TV, scarcely knew what to think. His accusations, if true, cast doubt on the very legitimacy of the revolutionary state.
Although Ahmadinejad’s barbs were aimed primarily at former president Rafsanjani, whom he suspects of orchestrating the opposition, these charges also apply even more directly to the Leader, Ayatollah Khamene`i, who has had supreme authority over the Islamic Republic since at least 1989. If Iran is this wasteland of corruption, inefficiency and strategic mistakes, what does that say about the wizard who has been guiding this process almost since its inception?
No one in Iran appears to be fully in control of events that have a potential to mark a turning point in the history of the Islamic revolution.Of course, the unlikelihood that the status quo in Iran can be restored does not rule out the possibility that the crisis will produce a more repressive regime.
The point that few commentators are realizing -- Al Giordano is an exception -- is that this story really isn't about the way that the votes were counted. It's about whether Iran is capable at this point of having an election in which the democratic will of its electorate is properly reflected. If Ahmadinejad hired a bunch of thugs to hold every Iranian at gunpoint while they were casting their ballots, it would not have been difficult for him to get 63 percent of the vote -- indeed, he'd probably have wound up with very close to 100 percent. This would be an election -- and there would be no need at all to tamper with the results. But it wouldn't be an expression of democracy. We need to separate out those two concepts. Ahmadinejad, as far as we know, did not go so far as to hold anyone at gunpoint. But the tentacles of fear in Iran run deep.Are good math skills are proxy for experience? Exiled Reza Pahlavi, the 48-year-old son of the last Shah of Iran, needs no numbers crunching to assess the regime that deposed his father. Here's what he told the WSJ:
"We have a major paradigm change right now," he said. "It's a mockery to call any of these theatrics an election process. However, given the limits the Iranian people have, that was the only way to show the whole world they are against the established regime. Now they have gone to questioning the very legitimacy of the regime, and it's unfolding before our very eyes."Of course, Pahlavi is hardly an unbiased observer. Nonetheless, the congruence with Silver's analysis is striking.
Our fiscal future is so dominated by healthcare that if the US can slow the rate of cost growth by just 15 basis points a year (0.15 percentage points), the savings for Medicare and Medicaid would equal the impact from eliminating Social Security’s entire 75-year shortfall.Having framed the imperative to cut healthcare costs, Orzag continues in the FT piece to channel Atul Gawande, as he has at least three times on his blog. Whether or not Gawande has helped to focus Orzag's thinking, there's no question that his tale of two healthcare markets has helped Orzag focus his rhetoric on changing doctors' incentives to prescribe unnecessary care:
The focus on eliminating unnecessary care is in turn helping Orzag -- and Obama -- to draw together two parts of their healthcare pitch: reduce costs, extend coverage. Two weeks ago, Jonathan Cohn noted that Obama seems to find it politically helpful to focus rhetoric on the cost-reduction side of the equation. As Orzag makes clear, however, it's runaway costs that have swelled the ranks of the insured and underinsured -- and runaway costs will make universal coverage impossible if they're not reined in.We must also address the forces making the healthcare system unaffordable and inefficient. The system creates incentives for doctors and hospitals to provide more care, not the best care. A lack of information on what works leads to huge variations in the quality of care and its cost. As Atul Gawande has described in the New Yorker, there are cities such as McAllen, Texas, that spend close to twice the national average on healthcare and do not get better results than lower cost, high-quality cities even in their own state or region.
The US must move towards a higher-quality, lower-cost system in which best practices are universal – rather than concentrated only in some parts of the country. The administration has therefore put forward initiatives such as health IT, research into what works, prevention and wellness, and changes in provider incentives (my emphasis).
"The resistance is religious." And there's an Animal Farm irony to Mousavi's stance: he warns that the original (presumably pure, shining) Islamic Revolution is at risk of giving way to "a new way of political hegemony which is being forced upon us" (June 14). He is now spokesman for the rule of law in the name of an Islamic Republic that from an American perspective never respected it, but that is now sweeping away its inadequate but to some extent functioning channels of response to the popular will. It's as if one of Lenin's original cadre were resisting a less murderous Stalin in the name of the revolution's original ideals.I have submitted my request for canceling the elections to the Guardian Council. I am certain recent reactions are not for me, but it is out of concern for the new political order that is being imposed on our country.
It is important to understand what is going on. There has been a fascist coup after the elections stripped Ahmadinejad of any legitimacy. The resistance is religious as all mass movements in Iran are. The government is fascist. And the regime has split open, leaving the worst elements desperately and brutally trying to restore their control by force.
When asked about protests and complaints, Ahmadinejad said that it was important to ask the opinions of "true Iranians" on the elections. "Like the people you meet at my rallies," he said.Great minds think alike:
"We believe that the best of America is not all in Washington, D.C. We believe" -- here the audience interrupted Palin with applause and cheers -- "We believe that the best of America is in these small towns that we get to visit, and in these wonderful little pockets of what I call the real America, being here with all of you hard working very patriotic, um, very, um, pro-America areas of this great nation.Come to think of it, they're both pretty good at handing out petrodollars, too.
Dear compatriots, I have received numerous reports of unrest and clashes from all over the country. I’m confident these (protests) are not because of my person but due to a growing concern for a new way of political hegemony which is being forced upon us. The events that we all have witnessed in the past days were unprecedented in the Islamic Republic. The reason for the fearful concern of the people is due to the extreme sense of danger for the great achievements of the (Islamic) Revolution. Those who after massive cheatings have declared these unbelievable results for the presidential elections are now out to establish these results as undisputed facts and start a new chapter in the history of our country.Next, more remarkably, Mousavi serially warns those currently in power that the people will not accept a new dictatorship, takes for himself and his supporters the mantle of protectors of the rule of law as established by the Islamic Republic, pledges to work himself within legal channels to have the election results nullified, and calls on his supporters to find peaceful means of resistance:
We respect and abide by the constitution and the laws of the Islamic Republic of Iran and regard our supreme leader as one of the important bases of our regime and (thus) will peruse our political struggle within the structure of the law. We hope that the future events prove the falsehood of our fears (of dictatorship and tyranny), but never the less, we warn that no one who cares and supports the Islamic Revolution (of 1979) will tolerate this (rigging the election), this is after all our national responsibility and patriotic duty that we owe to the thousands who sacrificed their lives for this country. Dear people, Today, I officially asked the guardian council (who oversees the elections in IR) in a letter to nullify the outcome of this election and I regard this (the nullification) as the only possible way for regaining the people’s trust and cooperation with the government. I strongly urge you again to peacefully protest and defend your legal rights civilly and without confrontation and violence all over the country. We have officially asked the authorities to give us the permission for large scale demonstrations in every major city throughout the country for tomorrow, so that people can demonstrate their protest against the way the election was conducted and its results peacefully. I believe that the authority’s compliance with this request is the best way to manage the current outbursts of anxieties.Finally, having urged his supporters to avoid violence, Mousavi appeals directly to law enforcement not to turn on demonstrators, not to forfeit their own legitimacy:
Out of care and respect for our police (law enforcement), I urge them not to use violence against the spontaneous protests so not to let that the people lose their trust in them. These people are your brothers and sisters and have come to the streets in protest to defend theirs and your own rights. The might of our armed forces and the police has been and will always be only due to its unity* with The People. In hope of better days Mir Hossein Mousavi - 24 Khordaad 1388 (14 June 2009) TehranWhat a bold attempt to ride the tiger. Mousavi's letter includes a profession of loyalty to Supreme Leader Khamenei as a "basis of our regime" but also a veiled warning to Khamenei not to abrogate that regime; a call to followers not to accept the election results but also not use violence; and an appeal to the police not to give Iran its Tiananmen Square moment. This is leadership. Mousavi is moving with calm, confidence and courage.
“I don’t use him publicly as a reference point,” said Gov. Mitch Daniels of Indiana, a Republican who lately has emerged as a potential national party leader. Mr. Daniels instead has urged fellow Republicans to “let go” of Mr. Reagan as a contemporary symbol....There's no indication that Daniels has asked himself whether Reagan's policies fit the country's needs today.
Mr. Daniels, too, hails his former boss for “timeless” principles like suspicion of big government and appreciation of the importance of individual freedom and opportunity. As he tackles issues in Indiana — education policy lately is a hot topic — he says he asks himself whether Mr. Reagan would approve.
and drew the conclusion:A glaring example of profligate physician behavior was described by Atul Gawande in the June 1 issue of The New Yorker. (His article has become must reading at the White House.) Dr. Gawande, a Harvard-affiliated surgeon and author, traveled to McAllen, Texas, to find out why Medicare spends more per beneficiary there than in any other city except Miami.
None of the usual rationalizations put forth by doctors held up. The population, though poor, is not sicker than average; the quality of care people get is not superior. Malpractice suits have practically disappeared due to a tough state malpractice law, leaving no rationale for defensive medicine. The reason for McAllen’s soaring costs, some doctors finally admitted, is over-treatment. Doctors perform extra tests, surgeries and other procedures to increase their incomes.
There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients. No doubt a vast majority of doctors strive to do the best for their patients. But many are influenced by fee-for-service financial incentives and some are unabashed profiteers.To be fair, doctors are victims as well as perpatrators of our healthcare system dysfunction. They waste insane amounts of time and resources fighting with insurance companies to get paid. And they're driven by the constant hair-trigger threat of malpractice lawsuits (and malpractice insurance profiteering) to order unnecessary tests and procedures. You might say that defensive medicine, and the "entrepreneurial spirit" that Gawande found infecting some medical communities, are the yin and yang of wasteful healthcare spending in the U.S.
I advise all officials to halt this agenda at once before it is too late, return to the rule of law and protect the nation’s vote and know that deviation from law renders them illegitimate. They are aware better than anyone else that this country has been through a grand Islamic revolution and the least message of this revolution is that our nation is alert and will oppose anyone who aims to seize the power against the law.Indeed, Mousavi's campaign has in large part been about establishing the rule of law. On April 3, a month after entering the Presidential election, he said, ""The issue of non-compliance with Iranian rules and regulations is the biggest problem that the country is currently faced with."
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.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.”
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.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:
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?
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:
Time will tell how "institutionally" Obama thinks about the U.S. Constitution.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.
The president never said a word about me. Or, for that matter, about any of the other 800,000 or so Jews born in the Middle East who fled the Arab and Muslim world or who were summarily expelled for being Jewish in the 20th century. With all his references to the history of Islam and to its (questionable) "proud tradition of tolerance" of other faiths, Mr. Obama never said anything about those Jews whose ancestors had been living in Arab lands long before the advent of Islam but were its first victims once rampant nationalism swept over the Arab world.I have often thought that the single best justification for the State of Israel is the fact that Jews were an oppressed minority throughout the Middle East who had a chance, mainly after the founding of the state of Israel by mainly Ashkenazi Jews, to build a home in a sliver of land carved out from the vast acres of their former oppressors. Yes, European antisemitism was more virulent than the Muslim variety, but Sephardic Jews were very much second-class citizens in Arab lands. It's somewhat as if African Americans got hold of a piece of the Arizona desert and built their own state there.
For example, at the end-of-life, nearly half of all McAllen Medicare patients see 10 or more physicians, significantly more than the national rate of 30 percent (and in Grand Junction, Colorado, it is just 11% – more than four times less than the rate in McAllen). Also, McAllen’s Medicare patients have 50 percent more cardiac surgery procedures as the national average (about 24 per 1000, versus about 16 per 1000), four times the ambulance spending during end-of-life, and eight times the home health care costs. Medicare spending per enrollee in the last two years of life also varies greatly among McAllen and other peer hospitals.This week, Orzag was at it again, converting Gawande's core contrast into a policy mantra:
Obama is singing from the same choir book. As in his June 2 address to senators, so in his June 2 letter to Senators Kennedy and Baucus, he highlighted the Mayo Clinic, replicating Gawande's thesis in the process:It’s certainly true that medical innovation is essential to improving treatment – and thus health outcomes – for us all. And it’s also true that we need to encourage doctors and researchers to explore and experiment in ways that lead to medical advances that save lives and improve their quality. But, today, the American health care system doesn’t always reward the best medical innovations – and one need look no further than McAllen, Texas to see that this is so.Despite having a demographic profile similar to El Paso, Texas, and despite having had similar Medicare expenditures as El Paso as recently as 1992, McAllen’s spending grew about five times faster in the years since than in either El Paso or the United States as a whole. In return, McAllen got more medicine (more tests, more surgeries, more time in waiting rooms), but it didn’t get better health – McAllen scores lower than El Paso (and the U.S. average) in measures of health care quality. McAllen "innovated," and certain doctors and hospitals were financially rewarded, but I think we can all agree that this isn’t the kind of innovation we desire.To get the most from innovation, we need to align incentives toward quality rather than intensity. The Mayo Clinic, synonymous the world over with cutting-edge medicine, has among the country’s lowest Medicare costs per beneficiary. Smaller medical markets, too, have managed to achieve such results: Grand Junction, Colorado is one of the lowest-cost and highest-quality places in the country to be treated. We need to reform the health care system so that it rewards the right kind of innovation – the Mayos, not the McAllens. And the Administration’s proposals aim to do precisely that through bundling of payments, incentives to reduce hospital readmission rates, and (as discussed below) a process through which MedPAC’s recommendations would enjoy fast-track protections in Congress (my emphasis).
We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their success and replicate those best practices across the country (my emphasis).Compare Gawande:
Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next fifty years) would be solved. The difficulty is how to go about it. Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.Among other cost-cutting measures, Obama also called for "'accountable care organizations'" to improve the quality of care for Medicare patients - apparently a bid to create the kind of outcomes-focused peer group Gawande highlighted in the Mayo Clinic.
Here, take this potent herb, and go to the house of Circe, and it shall ward off from thy head the evil day. And I will tell thee all the baneful wiles of Circe. She will mix thee a potion, and cast drugs into the food; but even so she shall not be able to bewitch thee, for the potent herb that I shall give thee will not suffer it. And I will tell thee all. When Circe shall smite thee with her long wand, then do thou draw thy sharp sword from beside thy thigh, and rush upon Circe, as though thou wouldst slay her. And she will be seized with fear, and will bid thee lie with her. Then do not thou thereafter refuse the couch of the goddess, that she may set free thy comrades, and give entertainment to thee. But bid her swear a great oath by the blessed gods, that she will not plot against thee any fresh mischief to thy hurt, lest when she has thee stripped she may render thee a weakling and unmanned.’It was hard for a 20th century eight year-old to grasp how an oath could be a reliable defense against rooted malice. I seem to remember telling myself that extracting an oath would work best on an immortal -- you can't doubt the enforcement power of the gods if you are one. But in Homer, humans also enjoin other humans to swear similar oaths that they will do no harm - for example, the slave Eumaeus recounts how in his childhood his nurse, plotting with a Phoenician merchant to sell him into slavery, made the merchant swear an oath not to harm her before accepting an offer to travel with him to see the house of her parents (from which she had herself been sold into slavery). Plainly, she felt that an oath would have force even from a person with whom she was plotting treachery.
But Bernanke also wants to deliver a message to Congress, a message the White House doesn't want to deliver because it's politically awkward: Congress will have to raise taxes on the wealthy in order to finance universal health care and reduce looming budget deficits. Such tax increases won't slow down the economy because the wealthy don't spend that much anyway (that's what it means to be wealthy -- you've already got most of what you need), but may be necessary, at least to ward off inflation fears.More radical ideas batted around by Matt Yglesias and Nate Silver a couple of months ago: create new tax brackets far above the current top level of $357k -- or make tax brackets "infinitesimal," i.e. ratcheting up proportionately for every extra dollar earned. As Silver pointed out, the current top bracket threshold is anomalously low compared to those of prior eras.
What sort of higher taxes on the wealthy? Bernanke didn't say, of course, but the White House has already floated limits on deductions and seems willing to consider taxing employee-provided health benefits for employees over a certain income. And maybe lifting the cap on Social Security payroll taxes, at least for workers earning over $250,000 a year.
Around the world, the Jewish people were persecuted for centuries, and anti-Semitism in Europe culminated in an unprecedented Holocaust. Tomorrow, I will visit Buchenwald, which was part of a network of camps where Jews were enslaved, tortured, shot and gassed to death by the Third Reich. Six million Jews were killed – more than the entire Jewish population of Israel today. Denying that fact is baseless, ignorant, and hateful. Threatening Israel with destruction – or repeating vile stereotypes about Jews – is deeply wrong, and only serves to evoke in the minds of Israelis this most painful of memories while preventing the peace that the people of this region deserve.There's almost a sleight-of-hand in this passage that sits oddly with its brutal honesty. First, the passive construction "the Jewish people were persecuted for centuries" avoids saying who persecuted them, e.g., perhaps, Muslims as well as Christians. Then comes the statement of Holocaust fact, followed by the assertion that Holocaust denial is poisonous, and then by a claim that Holocaust denial prevents peace -- apparently, Obama seems to imply, by further traumatizing traumatized Israeli minds.
Tarek Hefni
Tarek Hefni, 20, is a student of computer science at Cairo University from Giza, EgyptKholoud Khalifa Kholoud Khalifa, 22, who majored in journalism at the American University in Cairo and describes herself as an “Egyptian-Austrian Muslim,” watched the speech in Mohandesien, Egypt.
I did not feel very comfortable regarding the two state solution and regarding treating the Holocaust as a fact. It is still a debatable issue and should not be taken as granted....
Lede Blog Editor's Note:We asked Tarek to clarify his objection to President Obama’s statement that the Holocaust is a fact in his speech today in Cairo. Here is what he told us:
I admit a genocide has taken place! That’s a fact. However, the numbers are really doubtful. I also don’t see any relevance between people being killed by other nation and building a homeland in a different land. Again the genocide did take place. I just doubt the numbers.
I was troubled by his words regarding the Arab-Israeli conflict and those on democracy. The others were okay, they were expected — violent extremism in all of its forms didn’t really hit a nerve. Iran’s nuclear controversy is just filling white space, but claiming the Holocaust justifies a Jewish homeland and then saying it’s wrong too, what was it? Oh, uttering the same about Jews because it revokes past emotions is atrocious. For 60 years the Palestinians have been displaced, killed and terrorized and it’s disparaging to think of it as a tragic event rather than a genocide. To me, that thought confirms only one thing — his views of Palestinians are no different to those of Zionists.Riham El Houshi
Where Obama really lost us is Palestine. He didn’t beat around the bush, at least, and made it clear right away that the American bond with Israel was unbreakable.It must be said, too, that two of the six students published by The Lede accepted Obama's assertion that a two-state solution is necessary. But still, there's a frightening glimpse here of the depth of hatred for Israel among educated young Arabs. Obama, for his part, should be commended for directly confronting Arab anti-semitism. But he needs to rethink the sequencing of fact, logic and association with which he served up this root of bitterness today.
But he has clearly failed to understand that the problem Muslims have is not seeing both sides of the conflict, but seeing the conflict in historical context. I can safely say that Muslims do not and never will feel responsible for the Holocaust, and do not think it justifies setting up a Jewish state upon Palestinian lands. Lands, which, have shrunk over the decades as settlements have continued to rise and more and more territory has been annexed.
And despite the beauty of the words he used about Jerusalem, it was heavily symbolic talk about a messy issue. Palestinians and Israeli may agree on everything, but they will never relinquish their rights to Jerusalem as the capital of their respective nations.
...in Jordan, Rohile Gharaibeh, deputy secretary general for the Islamic Action Front, the political party of the Muslim Brotherhood, rejected any reference to the Holocaust. “The Holocaust was not the doing of the Muslims, it was the Europeans, and it should not come at the cost of the Palestinian people or the Arabs and Muslims,” he said.More on Obama's speeches:
Around the world, the Jewish people were persecuted for centuries, and anti-Semitism in Europe culminated in an unprecedented Holocaust. Tomorrow, I will visit Buchenwald, which was part of a network of camps where Jews were enslaved, tortured, shot and gassed to death by the Third Reich. Six million Jews were killed – more than the entire Jewish population of Israel today. Denying that fact is baseless, ignorant, and hateful. Threatening Israel with destruction – or repeating vile stereotypes about Jews – is deeply wrong, and only serves to evoke in the minds of Israelis this most painful of memories while preventing the peace that the people of this region deserve.Word count for the first paragraph: 108. For the second: 107. That literally equal allocation was surely not entirely conscious, but parallelism it reflects must be deliberate. Nor is it accidental that grievances are cited for Jews, Muslims and Christians. Evoking the religious groups' suffering picks up on a the speech's central theme: conflicts that go back decades and centuries must be confronted, and that they can be resolved on the basis of values shared by all three religions - and by all civilizations.On the other hand, it is also undeniable that the Palestinian people – Muslims and Christians – have suffered in pursuit of a homeland. For more than sixty years they have endured the pain of dislocation. Many wait in refugee camps in the West Bank, Gaza, and neighboring lands for a life of peace and security that they have never been able to lead. They endure the daily humiliations – large and small – that come with occupation. So let there be no doubt: the situation for the Palestinian people is intolerable. America will not turn our backs on the legitimate Palestinian aspiration for dignity, opportunity, and a state of their own.
At present, the force behind this semantic even-handedness comes from the Obama administration's unequivocal insistence that Israeli settlement growth must stop. That's the new element in the equation. How the emerging confrontation with the Netanyahu government on this issue plays out will go a long way toward determining how this speech will be viewed in retrospect.Palestinians must abandon violence. Resistance through violence and killing is wrong and does not succeed. For centuries, black people in America suffered the lash of the whip as slaves and the humiliation of segregation. But it was not violence that won full and equal rights. It was a peaceful and determined insistence upon the ideals at the center of America's founding. This same story can be told by people from South Africa to South Asia; from Eastern Europe to Indonesia. It's a story with a simple truth: that violence is a dead end. It is a sign of neither courage nor power to shoot rockets at sleeping children, or to blow up old women on a bus. That is not how moral authority is claimed; that is how it is surrendered.
Now is the time for Palestinians to focus on what they can build. The Palestinian Authority must develop its capacity to govern, with institutions that serve the needs of its people. Hamas does have support among some Palestinians, but they also have responsibilities. To play a role in fulfilling Palestinian aspirations, and to unify the Palestinian people, Hamas must put an end to violence, recognize past agreements, and recognize Israel's right to exist.
At the same time, Israelis must acknowledge that just as Israel's right to exist cannot be denied, neither can Palestine's. The United States does not accept the legitimacy of continued Israeli settlements. This construction violates previous agreements and undermines efforts to achieve peace. It is time for these settlements to stop.
Israel must also live up to its obligations to ensure that Palestinians can live, and work, and develop their society. And just as it devastates Palestinian families, the continuing humanitarian crisis in Gaza does not serve Israel's security; neither does the continuing lack of opportunity in the West Bank. Progress in the daily lives of the Palestinian people must be part of a road to peace, and Israel must take concrete steps to enable such progress.
One afternoon in McAllen, I rode down McColl Road with Lester Dyke, the cardiac surgeon, and we passed a series of office plazas that seemed to be nothing but home-health agencies, imaging centers, and medical-equipment stores.
“Medicine has become a pig trough here,” he muttered.
Dyke is among the few vocal critics of what’s happened in McAllen. “We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.
Gawande's Exhibit B is the Mayo Clinic, where those incentives have been neutralized:
The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.
“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.
No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.
Now listen to Obama, addressing Senate Democrats working on healthcare reform (as excerpted by Jonathan Cohn):
I want to just make mention of something that I've talked to many of you privately about. I want to say this publicly. As we move forward on health care reform, it is not sufficient for us simply to add more people to Medicare or Medicaid to increase the rolls, to increase coverage in the absence of cost controls and reform. And let me repeat this principle: If we don't get control over costs, then it is going to be very difficult for us to expand coverage. These two things have to go hand in hand. Another way of putting it is we can't simply put more people into a broken system that doesn't work.
So we've got to reform the underlying system. And this means promoting best practices, not just the most expensive practices. And one of the things I'm going to be discussing with the health and the finance committees is how can we change incentive structures so that, for example, places like Mayo Clinic in Minnesota are able to provide some of the best health care services in the country at half or sometimes even less of the costs than some other areas where the quality is not as good. What we should be--and by the way, that's not just unique to Mayo. The Cleveland Clinic in Ohio, same thing: top-notch quality, lower costs.
Now, the Mayo Clinic's success is not exactly a secret, and Peter Orzag, Obama's budget director, is one of the country's foremost experts on healthcare costs. So maybe this exhortation didn't come straight out of Gawande. But it's hard to shake the impression that the article was in Obama's mind.
UPDATE: Peter Orzag, Obama's healthcare brain, has been all over the Gawande article.
Almost three-quarters of men are obese, compared to fewer than two-thirds of women.Three quarters of men are obese? Well, no. In the chart Penn links to (from the annual report of the Dept. of Health and Human Services) , the category from which his stat is drawn is labelled "Overweight (includes obesity)." "Overweight" is defined as a body mass index at or over 25 kilograms/meter; "obese" is at or over 30. We don't know what proportion of the total are obese -- or in fact whether there may be more obese women than men (and conversely, more merely overweight men than women).
In December 2007, before the economic crisis set in, unemployment rates were roughly equal, but this time it's the guys who have been laid off in greater numbers. The unemployment rate surged from 4.4% to 7.2% for men, but from 4.3% to only 5.9% for women.Those end-point unemployment figures sound a bit low...turns out they're from December 2008. It might make sense to mention that.
More women in the workplace, more female-led families and more sexual equality in general might be expected to cause women to pick up men's bad habits, or be exposed to greater dangers. But for the most part, that hasn't happened.In other words, the number of men incarcerated increased 67% in a decade, while the number of women incarcerated increased 100%. Not exactly a roaring success story for American men. But it does look like women have "picked up men's bad habits" on this front. Their percentage of the overall prison population has risen.
In fact, men continue to outstrip women in most of the downers of life. A record 1.5 million men are in the clink, up 600,000 in the last decade. Only 115,000 women have committed crimes worthy of jail -- and while that's doubled in the last 10 years, more men continue to wind up in jail by a ratio of nearly 15-to-1.