Nonsense question of the day: "Does Obama have a second-term strategy?"

Sometimes it's hard not to suspect that Politico reporters don't believe their own bullshit when they spin out narratives about who's up, who's down, how A perceives B, what C's prospects are, etc.

Today's nonsense question, posed by Glenn Thrush, is Does President Obama have a second-term strategy? Of course the implied answer is no. But the argument is self-cancelling from the get-go.

The implicit premise is that because Obama said during the campaign that his victory might break the GOP's fever of no-compromise opposition, and that fever has not in fact broken, the president is at loose ends. But that premise must be hedged, because of an inconvenient truth that Thrush acknowledges at the outset: Obam never expected that his reelection would end partisan gridlock:

The WSJ on the ACA, cont.

Early this month, I looked at a couple of Wall Street Journal stories that emphasized the negative in the Affordable Care Act rollout and wondered whether the WSJ healthcare coverage wasn't Foxifying a bit. One emphasized the premium hike for a relatively small subset of people subject to the individual mandate (and without employer-provided insurance), and one aggregated and exaggerated a series of "blows" to the law, most of which were old news.

Healthcare reporter Louise Radnofsky was on both bylines. She's a good reporter. Her coverage over time has been balanced.*

But as the rollout of the ACA exchanges looms, I wonder whether WSJ news editing is tilting the emphasis on ACA coverage generally [ [UPDATE: I have spoken to someone at the Journal, whose word I trust, who assures me that editors area not imposing a political agenda on reporters. I regret speculating about motive without information.].

Today, Project Millennial blogger Mike Miesen flags another questionable WSJ framing of ACA news that had also registered with me this morning:

A Pooh guide to blogging

While I usually avoid talking or even thinking entirely consciously about this, it often strikes me (usually when I don't find anything to blog about) how strange it is that for five-plus years I've managed, FWIW, to come up with a post idea about six days out of seven.  More often than not, this just happens while I'm reading something (something doesn't add up, or reminds me of something else that doesn't seem entirely arbitrary), but sometimes it's a matter of mood, or caffeine: it feels like something is about to catch.

When it's the latter, my repetitive mind -- not so much a lizard brain as a perpetual child brain -- usually throws up a line from Winnie-the-Pooh "he felt singy." Here is that jewel in its setting (House at Pooh Corner, Ch. 6):

One day, when Pooh was walking towards this bridge, he was trying to make up a piece of poetry about fir-cones, because there they were, lying about on each side of him, and he felt singy.

Poem for a hot summer Sunday

In high Buddleia season:

                                                                  Butterflies (a truth to utter)
                                                                  don't look much like flying butter.
                                                                  Why do we say "butterfly"?
                                                                  Babies can't say "flutter by."

"Government-run healthcare," Singapore style

In his long rhetorical war against the Affordable Care Act, Avik Roy likes to hold up Singapore's healthcare system as a shining counter-example. He quite rightly points out that Singapore spends far less on healthcare than the U.S. (4% of GDP vs. 18% for the U.S.), and with better outcomes. How do they do it? Roy -- while acknowledging one aspect of the government's heavy hand --  credits free-market magic:

The key to the Singapore system is mandatory health savings accounts: again, something that libertarians and many conservatives wouldn't like. Matt Miller of the Center for American Progress describes Singapore as "further to the left and further to the right" than the American system--something that could also be said of Switzerland.

Pulping the bully approach to presidential politics, VI

Ezra Klein is replaying that whole paradox of power thing: When Obama comes out for a policy, the GOP will demonize it -- so if Obama wants to get anything done with a GOP House, how can he jump off his shadow?  This time, Klein brings Jon Favreau to bear, affirming the White House's not-at-all-surprising hyper-awareness of this conundrum:

Jonathan Favreau, who in February stepped down as Obama’s chief speechwriter, said that dealing with the Republican Party’s reflexive opposition is a pervasive reality in the White House. “People take a very realistic approach to it,” he said. “They’re not frustrated or upset. It’s more, ‘This is just the way things are and this is how we’ll deal with it.’ The strategy always comes to ‘What gives us the best chance to get something passed?’”

Since you're here, read this

I don't usually post excerpts without comment, but...I feel like Jon Favreau has told basically the whole story of U.S. politics of the last five years with his piece, The GOP is Terrified Obamacare Could be a Success. It lays bare the bad faith, the all-in commitment to misinformation, the callousness and cruelty of today's GOP.  It makes my heart sing, so I'm going to carry my bucket of water to the ocean of Favreau's readership and say: read it:

But here’s my question: if Republicans are so confident Obamacare will end badly, why not just shut up about it? It’s not like they have the votes to repeal the law—a math problem they still haven’t solved after 37 different tries. Their appeal to the Supreme Court ended in defeat at the hands of a conservative chief justice. And now the bulk of the plan will begin to take effect in just a few months.

At this point, why not sit back and wait for this crazy experiment to self-destruct? Why not let President Obama and the Democrats reckon with the millions of angry Americans who will undoubtedly hate their new insurance or their new insurance protections?

Because Republicans are terrified that Obamacare could actually work.

Mistrust among the poor

I am reading Doing the Best I Can: Fatherhood in the Inner City by Kathryn Edin and Timothy J. Nelson, a compulsively readable in-depth account of how poor inner city men view and attempt to fulfill their responsibilities as fathers. The authors lived in Camden, NJ, one of the country's poorest cities, and spoke in depth to some 110 unmarried fathers in Camden and poor black and white neighborhoods of Philadelphia.

The title aptly captures the core idea: the men have shining ideals of fatherhood and marriage but hold themselves to much lower standards in keeping with their earning power and lack of strong ties to their children's mothers. Most beget children as the result of brief and haphazard relationships with women and are much more invested in their relationships with the children than with the children's mothers. Repeatedly, these mostly none-too-trustworthy men express a lack of trust in women.  And one expression of that lack of trust reminded me of a different all-too-common suspicion. Below, a father of three speaks:

Who'll stop the hospital billing machine when you're "covered"?

My family gets its health insurance through my wife's employer, a multi-hospital system. Until this year, we have had in-network coverage only. Last fall, somewhat to my surprise, the hospital-insurer agreed to cover in full an operation out-of-network on grounds that no one in-network was qualified to do it. This was a wake-up call for me, and I insisted that this year we pay more for a plan that provides limited out-of-network coverage.While out-of-network coverage has substantial deductibles and limited co-pays, out-of-pocket expenses are capped at about $11,000 per individual. That strikes me as worthwhile catastrophic insurance if one of us gets seriously ill and needs to tap a top specialist outside the network. But our experience with the covered out-of-network operation we already had raises a question in mind about that out-of-pocket maximum -- for myself and for insured patients in general, particularly those buying on the new healthcare exchanges.

Here's the rub: while our insurer informed us that the operation would be covered in full, they were slow to pay some bills and paid some only in part. We then became targets of "balance billing" -- practices affiliated with the hospital where the operation occurred as well as the hospital itself dunning us for unpaid balances, often under threat of siccing a collections agency on us.

An "introvert" in the White House

Richard Neustadt, author of Presidential Power and Modern Presidents, seems to have been rather a Kennedy worshipper, judging from a chapter on Kennedy written for a later edition of his signature work.  All the more reason that this minor caveat to a portrait of near presidential perfection caught my eye:

.., he was not a "mixer" socially, not, anyway, with most members of Congress and their wives. His manners were impeccable, his charm impelling, but he kept his social life distinct from his official life and congressmen were rarely in his social circle. To know how Congress works but to disdain its joys is an acquired taste for most ex-congressmen downtown, produced by hard experience. Kennedy, however, brought it with him. Many of the difficulties he was to encounter in his day-to-day congressional relations stemmed from that disdain (p. 174, 1990 edition).

How does Roger Cohen know what Egyptians want?

With all due respect to Roger Cohen's long experience as a reporter, how does he know what the Egyptian revolution has been "about"?

He addresses the question with apparent confidence:

The uprising that ended decades of dictatorship and led to Egypt’s first free and fair presidential election last year was about the right to that vote. But at a deeper level it was about personal empowerment, a demand to join the modern world, and live in an open society under the rule of law rather than the rule of despotic whim.

In a Muslim nation, where close to 25 percent of Arabs live, it also demanded of political Islam that it reject religious authoritarianism, respect differences and uphold citizenship based on equal rights for all.

Cohen's sources? Heba Morayef, head of Human Rights Watch in Cairo, and Mohamed ElBaradei, the world famous "liberal modernizer" (Cohen's phrase) who signed onto the generals' coup. That's it -- the sum total of his cited sources for telling us what 80-plus million Egyptians want.

OK, Krugman: How will hypocrisy help us?

Paul Krugman, Jeremiah of galloping income inequality in the United States, today manages a rather half-hearted tribute to the nation's long-term fidelity to its founding ideals. Half-hearted, because seeing those ideals subverted by encroaching oligarchy, he takes rueful solace only in our national hypocrisy:

Of course, our democratic ideal has always been accompanied by enormous hypocrisy, starting with the many founding fathers who espoused the rights of man, then went back to enjoying the fruits of slave labor. Today’s America is a place where everyone claims to support equality of opportunity, yet we are, objectively, the most class-ridden nation in the Western world — the country where children of the wealthy are most likely to inherit their parents’ status. It’s also a place where everyone celebrates the right to vote, yet many politicians work hard to disenfranchise the poor and nonwhite. 

But that very hypocrisy is, in a way, a good sign. The wealthy may defend their privileges, but given the temper of America, they have to pretend that they’re doing no such thing. The block-the-vote people know what they’re doing, but they also know that they mustn’t say it in so many words. In effect, both groups know that the nation will view them as un-American unless they pay at least lip service to democratic ideals — and in that fact lies the hope of redemption. 

So, yes, we are still, in a deep sense, the nation that declared independence and, more important, declared that all men have rights. Let’s all raise our hot dogs in salute.

Left unspoken here is how hypocrisy helps. It's said that hypocrisy is the tribute that vice pays to virtue -- bad conscience with a cover. The question is, how productive will our ethical unease prove? Now that our income distribution (and opportunity distribution) has reverted to roughly where it was before the Great Depression and the New Deal, will this retrogression prove, to borrow a bit of econ-speak, 'secular or cyclical'?  That is, will we readjust, as Obama in '08 argued we must, from a 30-year Reaganite right turn turbo-charging pressure on wages powered by automation and globalization? Will we find means to train our youth to create and fill "good-paying jobs of the future"? Or was the relatively weak American version of the welfare state merely a one-time strategic retreat by elites that have more recently tightened a now unshakable proprietary grip on the means to prosperity?

The "I want the best" quality measure in healthcare

On The Incidental Economist, Bill Gardner rather wearily brushes off claims, based on personal experience, that the U.S. has "the best healthcare in the world." He outsources to Aaron Carroll the marshaling of evidence that "on most important measures, the US has poorer quality of care than comparable countries" and concentrates on a prior question: what do we mean by quality of care? He then offers a breakdown of quality measures which, for policy purposes, may be comprehensive, but which I think misses a dimension that may be in the minds of many who claim "best" status for the U.S. Here are Gardner's "dimensions of health quality*":

• The hotel experience. Some hospitals are nicer places to stay than others. This may seem trivial in the context of life and death, but any hospital manager will tell you that ‘hotel quality’ matters to patients.
• The relationship experience. Did the health care providers treat you with respect? Were they considerate of your religious beliefs? The well-educated readers of this blog may have difficulty imagining that they would not be well-treated by health care providers. But disrespect may be a primary consideration if you are poor, speak a language other than English, live outside the mainstream culture, or are mentally ill.
• The rightness of treatments. By the ‘right’ treatment, I mean the one that was most likely to benefit you.
• Safety. Were you harmed through error or neglect while you were in care?

In response, I posted this comment:

For Egypt, a warning from Aesop

Not to pretend to any expertise about Egypt, but as soon as I read about the military's ultimatum to Morsi, this fable of Aesop's came to mind:

There was once a Horse who used to graze in a meadow which he had all to himself. But one day a Stag came into the meadow, and said he had as good a right to feed there as the Horse, and moreover chose all the best places for himself. The Horse, wishing to be revenged upon his unwelcome visitor, went to a man and asked if he would help him to turn out the Stag. "Yes," said the man, "I will by all means; but I can only do so if you let me put a bridle in your mouth and mount on your back." The Horse agreed to this, and the two together very soon turned the Stag out of the pasture: but when that was done, the Horse found to his dismay that in the man he had got a master for good.

Until Mubarak's deposing, Egypt had been under military rule since 1952.  Do Egyptians really want to toss out their first elected leader, in power for just a year, and take the bit again?

In which Ezra Klein makes Avik Roy acknowledge why U.S. healthcare costs are so high

Avik Roy and Ezra Klein had a long --very long -- conversation about Roy's beefs with the Affordable Care Act. They covered "rate shock,"  minimum coverage standards, and Roy's dreams of a more fundamental system overhaul that would push everyone onto healthcare exchanges by privatizing Medicaid and Medicare and ending the employer tax deduction for health care benefit provision. 

Roy has been a relentless critic of the ACA. Having read some of his writings about it but by no means all, I was surprised to learn, as Klein probed his reaction to feature after feature, that he "do[esn't] have* a problem with standardizing benefits" and that "guaranteed issue [no refusals or cost bumps for preexisting conditions]is fine." His objections really boiled down to three: 1) he objects strenuously to "community rating," i.e., the ACA's limiting of the price differential between the youngest and oldest age cohorts to 3-to-1, as opposed to the roughly 6-to-1 ratio that Roy says the market would dictate.  2) He would like the exchanges to offer plans that cover even less than the lowest cost plans in the current design -- plans covering, say, 40% of a member's average yearly costs rather than the 60% that the exchange's lowest-run "bronze" plans are designed to cover. 3) As mentioned above, he would like more radical reform -- health exchanges for everyone.

As Klein eventually made Roy implicitly acknowledge, though, none of his favored solutions get at the root of the United States' disproportionate healthcare inflation.

WSJ leans into the "rate shock" narrative for Obamacare

[Updated 7/13, per "Blows to Obama's Health-Care Law Pile Up"...]

The WSJ's Louise Radnofsky is an experienced healthcare reporter, and her front-page story today about pending "rate shock" for healthy singles when the ACA takes effect is factually accurate. Since the focus is on the risk that the healthy uninsured will stay out of the ACA's healthcare exchanges, it's arguably fair to focus on the subset -- a minority of those who don't get insurance from an employer or the government -- whose premiums may go up. But nonetheless I find the emphasis and framing misleading in some particulars (e.g., the online home page teaser, "Insurance Rates Could Soar Under New Law"). .

The lede goes for maximum shock effect, setting reader perceptions before multiple caveats qualify the picture:

Children first in the acceptance of same-sex marriage

I may later thicken up this post, which has been stalled by a few reading blocks, but just to get the basic idea down...

When I read Justice Kennedy's reasoning on behalf of the children of gay parents in his opinion striking down section 3 of DOMA in U.S. v. Windsor...

This [federal non-recognition of marriages sanctioned by states] places same-sex couples in an unstable position of being in a second-tier marriage. The differentiation demeans the couple, whose moral and sexual choices the Constitution protects, see Lawrence, 539 U. S. 558, and whose relationship the State has sought to dignify. And it humiliates tens of thousands of children now being raised by same-sex couples. The law in question makes it even more difficult for the children to understand the integrity and closeness of their own family and its concord with other families in their community and in their daily lives...

...I flashed back to Jeffrey Toobin's profile of Ruth Bader Ginsburg, which thanks to dysfunction on the New Yorker website I have not been able to access, subscription notwithstanding. According to Toobin, Ginsburg is at least a bit ambivalent about Roe v. Wade, which she thinks may have brought too much change too quickly. Held up as a counter-example was the low profile manner in which gay would-be parents won adoption rights -- in relatively non-adversarial family court proceedings. I can't recall whether Ginsburg had a hand in this, or simply admired the steady under-the-radar progress.

Civil unions are not marriage "in all but name"

When I read the passage below in Justice Kennedy's decision striking down DOMA today, I thought of a gay friend of mine:

DOMA also brings financial harm to children of same-sex couples. It raises the cost of health care for families by taxing health benefits provided by employers to their workers’ same-sex spouses.

My friend was married to his husband in a New Jersey church a few years ago.  Legally, they are joined in a New Jersey civil union. My friend gets health insurance through his spouse, but thanks to DOMA, the employer does not get the federal tax exemption for providing his health insurance, and the employer passes on the cost to this couple.

When New Jersey passed its law establishing civil unions in 2006, it was billed as marriage in all but name. It was never that, and now its difference from marriage is all the more acute. An ACLU-NJ press release applauding today's decision and exhorting New Jerseyans to push for gay marriage spells this out:

Same-sex couples in civil unions will remain ineligible for the hundreds of benefits that now will be granted to same-sex married couples in other states under the court’s decision.

Will we hear Obama in retrospect?

Greg Sargent very sensibly notes that Obama, in his speech at Georgetown today announcing executive actions to reduce greenhouse gas emissions, "recast the call for climate action as the centrist, common-sense solution." Further developing that idea, he cites Chait:

As Jonathan Chait noted recently, the untold story of the Obama era is his vision of achieving liberal goals as a means for also achieving long-term economic growth:

Fashioning a long-term growth strategy is, and has always been, Obama’s deepest passion. He’s been caught up in an economic crisis and a culture war over the role of government that he wants badly to escape.

I must add that if Obama's vision of enacting liberal policies as a means for achieving long-term growth has been left untold by certain parties, those parties don't include Obama. He has never stopped telling that story: it is the very heart and soul of his pitch to America and always has been. That goes for casting those policies as "common-sense centrism," too. Throughout the 2008 campaign, tracking his speeches, I referred repeatedly to Obama's bid to move the center left. The argument has (and had) these components:

On Neustadt's gold standard for presidential power

I am nearing the end of the chapters comprising the original edition of Richard Neustadt's Presidential Power and the Modern Presidents (originally focused on the presidencies of Truman and Eisenhower, later much expanded).  The original edition is in large part a close study of two failures in presidential decision-making: Truman letting his policy in Korea be shaped by MacArthur's military overreach, and Eisenhower failing to resolve internal splits in his administration over budget policy, and therefore appearing several times over the course of a year to contradict his own prior policies and pronouncements.

The basic premise is that almost nothing happens simply because the president decrees that it should: presidential power depends on convincing a multitude of individuals and constituencies that the president has the ability to help or harm them.  There is a chicken-egg aspect to this: the president convinces people of his power when things that he says will or should happen do in fact happen, and when the results are in line with his stated goals or expectations.  That means being highly alert to the human, interpersonal factors that can undermine both policy decision-making and execution - for example, a rift between budget director and Treasury secretary, or military brass unwilling to cross a legendary general in the field. The requisite alertness can only come from a president developing his own back-channel information network: he (or someday she, as Neustadt enthusiastically adds in a latter-day preface) must constantly be gathering such intelligence from a multitude of sources.

This all seems solid information as far as it goes, derived from Neustadt's personal experience in government as well as by talking to a lot of people in government. And yet, toward the end of the original edition, the thesis is nailed down by means that make a bit wary on structural grounds.

Sweet spot for Obamacare exchanges: some competition, but not too much?

This exchange in a Modern Healthcare interview of Douglas Hough, author of Irrationality in Health Care: What Behavioral Economics Reveals About What We Do and Why, may have some implications for the design of the ACA insurance exchanges:

[Jason] Shafrin: People often perform better, in terms of choosing better when they have fewer choices. Why is that the case? Most economists think that more choice is better.

Hough: What behavioral psychologists and behavioral economists have discovered is that more choice is not necessarily better. The problem is regret bias. If they are shown five things and are asked to choose among them, they can probably choose well. But if they are offered 25 or 50, people end up not choosing at all. This is actually what happened at the beginning of Medicare Part D, when patients were given an extraordinary number of prescription drug plans choices, and a good number of the elderly were paralyzed by having to make that choice. My mother was an incredibly successful business woman, but when at the age of 85 she was faced with the choice of among 45 plans in Virginia for Part D, she just threw up her hands and said, “Well, I don't know which one to pick. Doug, you pick one for me.”

In which Bernstein's "anti-quagmire president" conforms to type

Last week, I noted that in the unfolding of the news that Obama was stepping up aid to the Syrian rebels, it was possible to glimpse Obama pushing back, or holding back, against those trying to promote a more extensive commitment.  There was less to the step-up than meets the eye, the administration seemed to signal.

Last night I watched the Syria segment in Obama's interview with Charlie Rose. And there he made it quite clear that notwithstanding the Sully's fears, Larison's expectations and Marc Lynch's anxieties, he is determined not to get sucked in to another middle east quagmire.  When Rose challenged him on the perception of timidity, this exchange followed:

How now, Politico?

A double dactyl in honor of Politico's  founders, who defiantly dished out their credo to TNR's Isaac Chotiner today:

Higgledy piggledy
Harris and VandeHei
rivet the Capitol:
"Who the day won?"

Beltway CW
retailed quite thrillingly,
gleaned as they willingly
get themselves spun.

Healthcare consolidation perverted by pricing power

Last week, I noted Eduardo Porter's warning that the ACA was spurring hospital consolidation, which increases the hospitals' pricing power. That's the downside of consolidation. Below, that post is updated with a snapshot of the upside of consolidation, realizable when the power to set prices lies elsewhere.
---
Eduardo Porter today spotlights a key factor in healthcare inflation: consolidation among hospitals and other healthcare providers:

What is missing from the stampede of policy innovation is something to tackle one of the best-known causes of high costs in the book: excessive market concentration. 

Two decades ago, there were on average about four rival hospital systems of roughly equal size in each metropolitan area, according to research by Martin S. Gaynor of Carnegie Mellon University and Robert J. Town of the University of Pennsylvania. By 2006, the number of competitors was down to three. 

The share of metropolitan areas with highly concentrated hospital markets, by the standards of antitrust enforcers at the Justice Department and the Federal Trade Commission, rose to 77 percent from 63 percent over the period. 

Did Obama just cross a Rubicreek in Syria?

Just how much of a game changer was the Obama administration's announcement yesterday that it would start providing lethal aid to selected Syrian rebels?  This was one case where the feints and false starts in the news-breaking process suggest that there may have been less of a departure from existing policy than meets the eye. At least, that's what my absorption of the news over an evening and morning suggested to me.

At around 4:45 ET yesterday, a short item in the WSJ Online reported rather ambiguously about a U.S. "proposal" to establish a no-fly zone in a strategic 25-mile sliver of Syria, at the Jordanian border.  The wording immediately raised the question, who was proposing to whom?

1. Daily Intelligencer ‏@intelligencer 19h

   WSJ: U.S. PROPOSES NO-FLY ZONE INSIDE SYRIA http://on.wsj.com/141Fcsv

   
   
2. xpostfactoid ‏@xpostfactoid1 19h

   @intelligencer @lrozen "proposes" to whom? Is this a plan/option or a decided-upon course of action?

   4:47 PM - 13 Jun 13 · Details 

As the WSJ story accrued new paragraphs a few minutes later, it was looking awfully like certain sources were trying to create a reality:

Do past abuses of personal data point toward future abuses of NSA metadata collection?

Stephen Walt spotlights why we worry about metadata collection:

The real risk to our democracy is what this situation does to potential dissenters, whistle-blowers, investigative journalists, and anyone else who thinks that some aspect of government policy might be boneheaded, unethical, or maybe even illegal. If you are one of those people -- even on just a single issue -- and you decide to go public with your concerns, there's a possibility that someone who doesn't like what you are doing will decide to see what they can find out about you. It doesn't have to be the attorney general either; it might just be some anonymous midlevel bureaucrat or overly zealous defense contractor. Or maybe it will be someone who wants to suck up to their superiors by taking down a critic or who wants to have their own 15 minutes of fame. It really doesn't matter: Unless you've lived an absolutely pristine online and cellular life, you might wake up to discover that some regrettable moment from your past is suddenly being plastered all over the blogosphere or discussed in the New York Times. 

 In a way, though, Walt's evidence that we should worry cuts two ways:

Healthcare competition is good. Uniform pricing is better

Eduardo Porter today spotlights a key factor in healthcare inflation: consolidation among hospitals and other healthcare providers:

What is missing from the stampede of policy innovation is something to tackle one of the best-known causes of high costs in the book: excessive market concentration. 

Two decades ago, there were on average about four rival hospital systems of roughly equal size in each metropolitan area, according to research by Martin S. Gaynor of Carnegie Mellon University and Robert J. Town of the University of Pennsylvania. By 2006, the number of competitors was down to three. 

The share of metropolitan areas with highly concentrated hospital markets, by the standards of antitrust enforcers at the Justice Department and the Federal Trade Commission, rose to 77 percent from 63 percent over the period. 

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):

Intelligence's Heisenberg Principle

Two Times articles about the Edward Snowden leaks suggest variants of a kind of Heisenberg Principle of intelligence gathering. First: the better you share information, the more the information will be "shared" in unintended ways, perhaps affecting your ability to gather it:

Some outside experts said the push in recent years to break down barriers between spy agencies and share information across the government had greatly expanded the universe of government employees and outside contractors with access to highly classified intelligence. 

“In past years, someone like Snowden may not have had access to briefings detailing these collection programs,” said Cedric Leighton, a former deputy director of the National Security Agency, “but now with the push from a ‘need to know’ to a ‘need to share’ philosophy, it’s far more likely for an I.T. contractor like him to gain access to such documents.”

Snowden worked for the mega-intelligence services firm Booz Allen, which earns over a billion dollars a year in mostly intelligence-related work for the federal government.  Which suggests the second variant:

What Snowden sees, what Obama sees

Edward Snowden,the whistleblower on the NSA's surveillance programs, is brave, serious-minded, and capable, and was very selective in what he exposed, determined not to endanger individuals. I am glad he revealed what he did, to paraphrase James Fallows, though I'm not yet sure what I think the government ought to refrain from doing in its efforts to thwart terrorist plots. I just want to take a second to try to hold two ideas in the mind at once.

The first is this, from Snowden, in an exchange with Washington Post reporter Barton Gellman (Gellman's debriefing is a  remarkable read, as is a Q&A between Snowden and his contacts at the Guardian). Asked, "Did he impute evil motives to his former colleagues, or the White House?", Snowden responded:

“Analysts (and government in general) aren’t bad guys, and they don’t want to think of themselves as such,” he replied. But he said they labored under a false premise that “if a surveillance program produces information of value, it legitimizes it."

Why would the president say no?

In a ritual that's got to be 50 years old by now, journalists bemoan and ridicule poorly targeted pitches sent by PR people. You're a Bloomberg "healthcare" reporter covering, say, large hospital chains.  You get press releases urging you to inform your readers about a promising new skin cream. What cretin would send you such drek?

Good PR people do constantly hone, refine and update their media contact lists. But they winnow down only to a point.  Those lists are initially generated by media database screening software: you punch in, say, print publications with circulations over 200,000 and reporters covering "healthcare" and get a list of, say, 700 names. You might shrink that list to half its size, but probably not to a point of perfection, because a) the "negative" work of shrinking a list is time-consuming, and b) the cost (to your potential work result) of leaving out someone who might respond is higher than the cost of leaving in people who won't.  The costs to credibility of sending poorly targeted email are incremental and cumulative (unless you're featured in James Fallows "The Glamorous Life of a Journalist" series); the cost of striking someone off of a list who might have responded to your pitch is potentially high.

Dunkin Donuts, Starbucks, and Fish

On Boston.com, Andrew Ba Tran, Scott LaPierre and Alvin Chang interviewed and giffed (is that a verb?) customers of Dunkin Donuts and Starbucks, each about the other place, in search, it would seem, of an obvious class and cultural divide. Customers for the most part didn't disappoint (Starbucks' branding is extraordinary).  One anti-yuppie caught my year, both because she expressed a feeling of mine about Starbucks and because I'd heard her plaint before, in a very different voice. Paula Shay said of Starbucks:

...they're way too expensive, you gotta make it yourself -- it's very inconvenient. I love Dunkin Donuts, they always make it right -- you go to Starbucks, you gotta make it yourself. I feel like it's a yuppieville, urban, like -- it's just not for me. ANd I don't like the coffee, it's way too strong. It's just not for me, Hon.

In sync with Ms. Shay is one of the most erudite of academics, the always argumentative Stanley Fish, who complained in the Times in 2007 that Starbucks confronted the customer with a "coordination problem" akin to the challenges faced by a general deploying an armed force. The struggle climaxes in the combat of the condiments table:

Who might suffer "rate shock" under the Affordable Care Act?

Avik Roy's much-debated screed implying that the launching of the ACA exchanges will trigger widespread "rate shock" among legions of healthy young people who could previously by insurance more cheaply relies on misleading comparisons, as Ezra Klein, Jonathan Cohn and Rick Ungar charged. None deny, though, that the price of the most minimal available insurance will rise for a subset of healthy young adults

In an essay suggesting that rate shock is real, Will WIlkinson recounts that for a brief time a year or so ago he was paying about $100 a month for a catastrophic plan that he found through the Freelancer's Union (presumably a more honest broker than the scammy online broker Roy relied on).

I clicked through and tried the union's plan-finder with random zip codes in the northeast, south and west; it wasn't until  my fifth try that I found a zip code -- 27108, in Winston-Salem, NC -- in which a UnitedHealth quote was available. If I were my 22 year-old son, I could get a plan for $79 a month with a $10,000 deductible and 70% of expenses paid after that, with a total out-of-pocket expense cap of $15,000 (except that if I were my son I couldn't, because he had hip labral surgery this year, which would doubtless jack up his rate if he were searching now -- see Ezra Klein on this.) For $105 per month, I (or 22-me) can get the same deal with a $5,000 deductible and $10,000 annual cap on my out-of-pocket expenses. (Of course, that's a posted plan from just one provider in one market, and comparing ACA offerings to the current individual market is not just comparing apples to oranges, but 50 different fruits to hundreds of other different fruits. But the offering is roughly in line with what Roy found on eHealthInsurance.com)

Submerged state update: Obamacare's gift of the MAGI

[UPDATE, 10/24/13: Per "Freelancer" comment below, there are multiple definitions of MAGI in the tax code, and in the initial post I used the wrong one. Erroneous info marked below. If you got here by search and are simply looking for info about how to calculate MAGI in the ACA, go to Freelancer's post or to this summary sheet of what income to include/exclude]

[UPDATE 2, 12/23/13: Now that actual plans, prices and subsidies can be viewed, I have a series of posts exploring various income/subsidy scenarios. Last in series here. ]

Covered California, the state entity enthusiastically administering the state's health care exchanges, offers not only posted price estimates for the different plans offered in the exchanges, sorted by age and income, but also a personal cost calculator, in which you punch in the number of people in your household, their ages, and your family income to get an estimate of both the cost of a mid-level silver plan and your subsidy.

One fact worth mulling is that the income on which the subsidy is based is the Modified Adjusted Gross Income (MAGI) based on IRS filings. That's a reminder that the premium subsidy is another tax cut (offset in large part by increased taxes on the wealthy, employers, medical device makers and others). The ACA's premium support is one more benefit credited negatively, by lowering the tax bill, the social service mechanism of choice for a tax-averse polity.  Bowing to preferred conservative methods, we've added another subaqueous pillar to the Submerged State.

The "m" in MAGI is important, however, as it modifies the adjusted gross income (AGI) we're all familiar with on our tax forms by adding important deductions back into the total -- e.g., student loan interest, tuition, IRA contributions, and the deduction for half the self-employment tax. The "m" in some measure avoids piling subsidy on subsidy, or augmenting one incentive with another.

The use of MAGI rather than AGI is bad news for the self employed, who I assume make up a large proportion of those who make enough money to qualify for  premium subsidies but who lack access to employer-provided health insurance. But it could be worse.

Ben Bernanke's over-the-cliff notes

No one needs me to add my wonder to that of everyone encountering Ben Bernanke's remarkable commencement speech at Princeton debunking the concept of meritocracy as defined by nearly every politician in America who pays lip service to it. No one needs me either to highlight the implicit rebuke to a party fanatically devoted to preserving low taxes for the rich and benefit cuts for the poor. 

I will only gild the lily so far as to note how thoroughly Bernanke set up the climactic credo from the moment he opened his mouth.  With caustic good humor, he repeatedly struck notes that eventually merged in the climactic chord: Life is unpredictable; merit is a product of chance; you are collectively the luckiest of the lucky; and your only instrument of meaningful control is a determination to do well by others. To wit:

Poor infrastructure breeds its own etiquette

Lamenting the recent rash of pay-to-jump-the-line enticements pushed by amusement parks and ski resorts as well as airlines, "Matthew J.X. Malady" (that's a pseudonym, right?) writes an eloquent tribute to the eroding social achievement of the queue:

This process [of forming lines] may not be fun, but it’s fair. Curse lines all you like, but we would be doomed without them. Unless you’re simultaneously the strongest, smartest, fastest and most universally capable human being on the planet, you should be thankful that lines exist and that, for the most part, people use them in ways that make life less miserable, not more. Which is to say the line is not a persistent social nuisance. It’s one of our most noble collective achievements.

I came to this via Timothy Noah, Jeremiah of inequality, and was led in a Twitter exchange to think about a relative bright spot where the new classism has not yet penetrated: commuter trains. I ride New Jersey Transit into Penn Station in New York, a prime example of inadequate U.S. infrastructure which, on the plus side, has induced regular commuters to develop their own complex, site-specific queuing etiquette.

Take two: Employers want to provide health insurance

Perhaps I buried my lede a bit yesterday in a post about the ACA's employer mandate. So let me try a carve-out.

Josh Barro, taking at face value some bitching about the requirement that employers with more than 50 full-time employees offer health insurance to their employees, recently charged that the mandate is a mistake and that health reform should have pushed health insurance away from the employer-employee relationship.

Defensible as that diagnosis may be in the abstract, voters at large were not the only constituency resistant to weakening the employer-healthcare bond.  Big businesses, and a not inconsiderable number of small businesses, values their role as health insurer, seeing that role as an important part of their bond with employees, as a competitive advantage, and increasingly, as an opportunity to make their workforce more productive  -- not to mention as font of a tax-free form of compensation.

Call them crazy, as Matt Miller did in October 2009 when the National Coalition on Benefits, an association purporting to represent the interests of employers covering 130 million Americans in the health reform process, helped to shoot down Senator Ron Wyden's Free Choice Amendment, which would have enabled all employees to opt out of their employer's health care plan and buy insurance on the insurance exchanges established by what later became the Affordable Care Act. The group's motto: Don't Erode What Works to Fix What's Broken. *

U.S. employers want to provide health insurance

The Wall Street Journal has a good article today, by small business reporters Emily Maltby and Sarah Needleman, about three smallish businesses grappling with the the Affordable Care Act's employer mandate, which charges employers with more than 50 employees $2,000 per employee (excluding the first 30) if they don't offer coverage.  None of the business owners opt not to offer coverage. Here's the head of a small pizza chain with 90 hourly workers:

Next year, Mr. Stark intends to offer a health-insurance plan for the first time to comply with the law. "At the end of the day, if we take care of our team members, they will take care of the guests," he says. "I philosophically believe people having health care, regardless of age, is positive."

A consultant with 93 employees adds:

Love the sin, hate the sinner or whatever

Forty five-odd years ago, a popular poster, sweatshirt etc. showed the Peanuts character Linus (blanket in tow), protesting loudly, "I love mankind -- it's people I can't stand."

That flashed back to me last week when I read Marco Rubio's justification for a fresh round of budget terrorism:

“I have tremendous respect for this institution,” Mr. Rubio said in an interview on Friday. “But I’m not all that interested in the way things have always been done around here.” 

"The way things have always been done" in this case means reconciling House and Senate budgets without tying those negotiations to a threat of national default.

The Times editorial board reminded me of that flashback this morning. Their take on Rubio's comment: it exemplifies the mindset of the latest crop of high profile Republicans, who "want to dismantle government, using whatever crowbar happens to be handy, and they don’t particularly care what traditions of mutual respect get smashed at the same time."

As Peanuts characters used to say from time to time: I'd be foolish to deny it.

Hobson's choices in Syria

Re Syria, the FT's Gideon Rachman is at his best -- teasing out the geopolitical crosscurrents tugging at those countries that fancy themselves able or compelled to try to influence events, and noting the extent to which appearances may be deceptive:

As the world edges towards a peace conference on Syria, three ideas about the west’s role in the conflict are widely accepted. First, that the longer the conflict goes on, the greater the chances of direct or indirect western military intervention. Second, that there is a deep and bitter division between the US and Russia that is making progress much harder. Third, that the Syrian civil war is dominating western thinking on the Middle East. Few people publicly dispute these propositions. And yet they are all distinctly questionable (my emphasis).

Western inhibitions about intervention are driven not just by the debacle in Iraq but by the "success" in Libya:

Hire this woman

I'd have a lot more blog traffic If I could quote myself as enticingly on Twitter as The American Prospect's Jaime Fuller quotes everyone else. Based on my sampling of one, she has a click-through rate of over 50%. Her best tweets are all quote.  A sampling from the last few days (and last few minutes):

"'We’ve come for the poem about the duck,' the cop would say, as I pumped a shell into the chamber." oxfordamerican.org/articles/2013/…
— Jaime Fuller (@j_fuller) May 21, 2013

"A man with a camera mounted on the handlebars of his bicycle lifted up the bike in order to film Weiner walking." capitalnewyork.com/article/politi…
— Jaime Fuller (@j_fuller) May 23, 2013

Another rung down for "Afghan good enough"

If it's possible to define success in Afghanistan down any further, Obama may have done so in his speech seeking an end to perpetual war yesterday:

In Afghanistan, we will complete our transition to Afghan responsibility for that country’s security.  Our troops will come home.  Our combat mission will come to an end.  And we will work with the Afghan government to train security forces, and sustain a counterterrorism force, which ensures that al Qaeda can never again establish a safe haven to launch attacks against us or our allies.

Not, "we'll work with the Afghan government to train security forces to support and sustain a democratic government that serves its people." Not even a force to fend off the Taliban. Keeping al Qaeda out is thesole goal. [5/28 update: I believe I misread this a bit, helped by an ambiguous pronoun. It's the U.S. counterterrorism force that "ensures that al Qaeda can never again establish a safe have." Not clear what the Afghan security forces will "ensure," if anything.]

That went along with a retroactive redefinition of the U.S. mission in Afghanistan in the Obama years:

Obama on counterterrorism: will "redefines" become "unwinds"?

It is true, as Matt Welch avers, that Obama could amend much of what is wrong with the current U.S. response to terror by executive order, without the help of Congress. Also true, by extension, is that much of what is wrong -- excessive use of targeted killings, failure to release those Guantanamo prisoners cleared for release, disproportionate punishment of leakers -- is his responsibility [Update, 5/25: See Joe Nocera today on Obama's responsibility for the continuing hell of Guantanamo].  Also, that while yesterday Obama articulated important intentions -- paring back and ultimately repealing AUMF, closing Guantanamo, finding a way out of the indefinite detention trap -- he was lighter on announced action -- though paring back the drone campaign and transferring it to the military (which he didn't mention, but has signaled clearly through other channels) is certainly significant, as is getting the ball rolling with Yemeni detainees.

And yet, we should not under-emphasize the import -- or the courage required -- in redefining the conflict for the American people, taking us back to the future in our response to terrorism, and warning -- as pointedly as Eisenhower did about the military-industrial complex -- about the dangers of perpetual war.  And in this regard, my response to Obama's rhetoric in his speech redefining U.S. response to the terror threat is, once again, almost Pavlovian. He is so analytical, so precise, so nuanced, and so clear in laying out the threats we face, and the need to balance threats to security and freedom, that I can't help but feel renewed faith in his judgment, and to suspect, with one caveat I'll get to later, that he's balanced his responsibility for U.S. security and for the preservation of our civil liberties and standing in the world reasonably well -- constrained by our divided government, the hysterical existing terms of our national security discourse, an intellectually corrupt opposition, and the institutional machinery of the Pentagon and the security state .

Note the blend of analysis, classification and narrative below, the refusal of triumphalism, the parsing of threats -- Pre-, post- and post-post 9/11; regional vs. U.S.-aimed, terror generally vs. jihad, overseas vs. homegrown:

Kevin Drum's dangerous indulgence

Kevin Drum gave in to temptation this afternoon (and I gather it's kind of Obama's fault):

A couple of hours ago I had a choice to make: spend the next hour writing a reaction to President Obama's big national security speech, or go to lunch. I went to lunch.

Such lapses can put us in danger. So claims Screwtape, C.S. Lewis' devil and master tempter (in Lewis' imagining, each of us is assigned a guardian devil, so to speak, as well as a guardian angel, and they battle it out moment by moment until we die). Read and tremble, midday indulgers:

I once had a patient, a sound atheist, who used to read in the British Museum. One day, as he sat reading, I saw a train of thought in his mind beginning to go the wrong way. The Enemy, of course, was at his elbow in a moment. Before I knew where I was I saw my twenty years' work beginning to totter. If I had lost my head and begun to attempt a defence by argument, I should have been undone. But I was not such a fool. I struck instantly at the part of the man which I had best under my control, and suggested that it was just about time he had some lunch. The Enemy presumably made the counter-suggestion (you know how one can never quite overhear what He says to them?) that this was more important than lunch. At least I think that must have been His line, for when I said, "Quite. In fact much too important to tackle at the end of a morning," the patient brightened up considerably; and by the time I had added "Much better come back after lunch and go into it with a fresh mind," he was already halfway to the door.

Where Obama's Green Lantern lies

Sean Trende offers up a kind of excuse for pundits and centrists who indulge in what political scientist Brendan Nyhan calls Green Lanternism. --lambasting Obama for failures of ill-defined "leadership," i.e., for failing to charm the Republicans out of their scorched-earth opposition or to overcome the extreme constraints the Constitution imposes on presidential power in domestic affairs.   According to Trende, the expectation that Obama would exert magical powers to overcome opposition derives from the campaign Obama ran in 2008:

Many of the president’s supporters thought they were voting for the Green Lantern in 2008.

Remember, the actual policy differences between Obama, Hillary Clinton, and John Edwards were pretty limited. To help distinguish himself from the pack, and to attack Clinton indirectly, Obama all but dressed up in green tights, claiming that his candidacy would enable us to put old arguments behind us, bring people together, and transform the country.

There is an element of truth to this, as there was an element of malarkey in Obama's promise to usher in "a different kind of politics."  But only an element, on both sides of that equation. Obama's core pitch and promise in 2008 was more realistic and tough-minded than "I can melt the opposition."

Does Obama subject African Americans to "targeted scorn"?

Yesterday I put up some thoughts about Obama's commencement speech at Morehouse College, in blithe and admittedly self-imposed ignorance of what others had said about it (I plead lack of time, fatigue and eagerness to get my thoughts down -- and will also cop to not wanting to complicate that quick-stream).  I thought it was an awesome speech, in the pre-colloquial sense of awesome, as in awe-inspiring.

Ta-Nehisi Coates, however, greets the speech (and a parallel commencement address by Michelle) with a powerful indictment. In response to a passage in which Obama admonishes the Morehouse Men, "there's no longer any room for excuses" -- e.g., being held back by racism, Coates writes:

This clearly is a message that only a particular president can offer. Perhaps not the "president of black America," but certainly a president who sees holding African Americans to a standard of individual responsibility as part of his job. This is not a role Barack Obama undertakes with other communities.

Taking the full measure of the Obama presidency thus far, it is hard to avoid the conclusion that this White House has one way of addressing the social ills that afflict black people -- and particularly black youth -- and another way of addressing everyone else. I would have a hard time imagining the president telling the women of Barnard that "there's no longer room for any excuses" -- as though they were in the business of making them. Barack Obama is, indeed, the president of "all America," but he also is singularly the scold of "black America."

There is undoubtedly a lot of truth to this. As Fallows notes in response, though, Obama has to walk a razor-thin tightrope when addressing African Americans directly or matters of race generally -- or, better, as Fallows put it, "a tiny, little rope suspended across a Grand Canyon." By way of additional mitigation, Fallows notes,  "We all take a different tone in setting expectations for "our own."

I would add three further mitigating thoughts. First, in his admonishments throughout the speech, Obama was channeling the historic messages of Morehouse itself -- including in the passage Coates focused on:

Obama gets personal at Morehouse

I have read or listened to several Obama commencement addresses over the years, and his address at Morehouse College yesterday struck me as something of a departure in several ways. While I may have missed or forgotten prior iterations of the parts that struck me, let me set down what I thought was singular.

First off: Morehouse is a men's school, and so Obama addressed men, which gave the talk a retro feel.  He talked about what it means to be a man, rather than simply a responsible adult, and what it means to be a black man in particular.

Addressing black men meant walking a fine line -- as Obama always does when he addresses African American audiences -- between the particular and the universal (in this case, particulars of gender as well as ethnicity).  Obama acknowledged as much in a rather meta moment:

Two takes on Obama from Fallows

In the long hot political summer of 2011, as Obama was sliding down the precipice toward the Budget Control Act (that wonderful deed that gave us the sequester), I was struck by a balance struck between admiration and anxiety about Obama in a note from James Fallows:

"We will hope that the qualities we admire in Obama outweigh the ones that make us nervous."

Today, in a view-from-China at our three scandals, Fallows concentrates on the one that troubles him -- the leak investigation -- and by the way expresses a similar toggle-switch assessment of the president's strengths and weaknesses (in an exception to the long-term rule):

It is one of the rare times I question not his effectiveness or tactics but his judgment. 

Housekeeping note*

A busy work week and a long graduation weekend have put xpostfactoid on unexpected semi-pause for a week. Back soon! - maybe even on the weekend.

We're coming back with this booty -- Sir Walter of the South. Yippee! Painted toenails not included.

* Is "housekeeping note" Bernstein's coinage, or in general bloggy parlance. Apologies to JB if the former.

Are "liberals" learning to love the sequester?

A while back, as the sequester took hold and Obama unfurled his budget, Greg Sargent framed up what he presented as a tough choice for Democrats (on the dubious chance that they would have any choice at all): Stand pat with the sequester in place, Medicare and Social Security left essentially untouched, and no new revenues beyond the $600 billion over ten years enacted in January -- or sign on to a grand bargain that would include entitlement cuts proposed in Obama's 2014 budget, e.g.,  chained-CPI and higher Medicare premiums for wealthier seniors, along with more targeted and gradual discretionary spending cuts than those mandated by the sequester, and some new revenue.

As of today, Sargent seems to have made his choice, or assumed a collective one for "liberals":

The Monica Lewinsky scandal may have helped save Social Security in the late 1990s. Now the scandal fever currently gripping Washington — IRS, Benghazi, Associated Press phone records — may save Social Security and Medicare two decades later.

Liberals who are dreading the scandal-mania that is taking hold should note that it contains a potential upside: It could make a Grand Bargain that includes cuts to Medicare and Social Security benefits even less likely than it already is.

Save Social Security? From Obama's chained-CPI proposal, which by slowing cost-of-living increases would reduce payments from the current baseline by about 0.3% per year, with offsets for the very elderly? Save Medicare? From Obama's $400 billion/10 year grab bag of nips and tucks, little different from those proposed in his 2013 budget, the most notable difference being larger (but still quite incremental) premium hikes for wealthy seniors than those proposed in 2013?

Eloquent omission, Damian Paletta

I approve this messaging from the WSJ reporter on federal budgeting matters:

And while the short-term deficit is shrinking, both parties know it is projected to widen dramatically in coming decades as the U.S. population ages unless changes are made to curb the growth of programs like Medicare.

Conspicuous in its absence from this long-term budget snapshot: Social Security.  Again, later in the article:

Many Democrats have called for a broad budget deal that would reduce the deficit over many years by raising taxes and curbing the growth of Medicare and other entitlement spending.

I get nervous when I read sentences like this, cont.

from Greg Sargent:

And so, in the days ahead, you’ll hear top Democrats continue to amplify the case that the so-called “Boehner Rule” — in which Republicans insist on dollar-for-dollar spending cuts in exchange for the debt limit hike — is a dead letter. You’ll hear them continue to call on Republicans to stop allowing Tea Party intransigence to exert total control over budget strategy. You’ll hear them demand an end to chaos governing. But we’re probably stuck with chaos governing for the foreseeable future. Anyone see any way out of this?

As I've noted before, anticipations by Sargent, Beutler and other progressive close watchers of the budget battles that Democrats won't cave on a particular upcoming sticking point are pretty good indicators that Democrats will, in fact, cave on that particular point. In this case, Sargent does leave the outcome open, merely relaying what we'll hear from Democrats. And it's hard for me, too, to imagine Democrats making any new spending concessions without further tax increases. But still...

Picking at the healthcare Gordian knot

It's no secret that there's a grotesque hierarchy in U.S. healthcare pricing. Medicaid pays the lowest prices, followed by Medicare, then by private insurers.. and then, at the bottom of the totem pole, by uninsured individuals, who, as Steven Brill documented in grotesque detail, may pay three or ten or fifteen times what Medicare pays for a given procedure.

This system is not only grossly unfair, it's the chief reason Americans pay more than twice the OECD average per capita for healthcare than people in other developed countries. Notwithstanding a wide variety of payment systems, countries with universal health insurance -- that is, every other wealthy country in the world -- almost universally empower government to impose uniform pricing. In Japan, for example, where most people get health insurance through private, nonprofit plans provided by their employers (generally with a 30% patient co-pay), the government publishes a uniform price schedule. T.R. Reid, in The Healing of America, describes it:

[the medical price schedule is] published in a thick book--about the size of the Tokyo telephone directory--that anybody can buy. This hefty volume, the Shinryo Tensu Hyakumihyo ("Quick Reference Guide to Medical Treatment Points"), sets forth exactly what a doctor, therapist or hospital will be paid for any treatment or medication. There are tens of thousands of different treatments in the book: "throat swab,", "application of plaster cast, ankle," "sutures, outer arm," "X-ray, simple, neck region, rear," etc., etc. For almost all of these, the price is extremely low...(p. 91).

Vietnam as glimpsed from Camelot

When I was about four or five years old, I was sitting with my mother in our car outside the "Neighborhood House" community center in Riverdale in the Bronx, NY when I must have said something about war.

My mother said, "There are no more wars."  Then she thought about it for a moment and added (as I remember it), "well, there's a little war going on right now. It's not a real war."

I tried to picture a "not real" war. The visual backdrop of our lives was the Palisades, a long run of pristine blue flat-topped cliffs across the mile-wide Hudson River, which our apartment overlooked.*  I imagined Indians falling dead along the cliff line, then getting up again, like kids in a game, because it wasn't a real war.

This evening, as I came across the passage below in Stephen Ambrose's Rise to Globalism, I allowed myself to think that that remembered conversation took place in 1963 (it might have been 1964, but never mind):

Precedent Eisenhower

When justifying his major foreign policy decisions, Obama cites Eisenhower more than any other predecessor -- e.g., in his December 2009 speech announcing his time-limited Afghan surge:

As President, I refuse to set goals that go beyond our responsibility, our means, or our interests. And I must weigh all of the challenges that our nation faces. I don't have the luxury of committing to just one. Indeed, I'm mindful of the words of President Eisenhower, who -- in discussing our national security -- said, "Each proposal must be weighed in the light of a broader consideration: the need to maintain balance in and among national programs."

As calls mount for U.S. intervention in Syria, with exhortations to Obama to uphold U.S. "credibility," I find this summation by Stephen Ambrose in Rise to Globalism*  of Eisenhower's second term instructive:

THE OVERWHELMING FIRST IMPRESSION OF AMERICAN FOREIGN POLICY from 1956 to 1961 was one of unrelieved failure. America’s inability to do anything at all to aid Hungary’s rebels made a mockery of the Republican calls for liberation. Eisenhower and Dulles were unable to contain the Russians, who succeeded in their centuries-old dream of establishing themselves in the Mediterranean and the Middle East. Spectacular Soviet successes in rocketry, beginning with Sputnik, sent the United States into a deep emotional depression. Russia seemed to have won the arms race, and in 1959 it was Khrushchev who played at brinksmanship from a position of strength. After the Suez crisis, the French, British, and Americans could never fully trust each other. In Southeast Asia, Communist guerrillas in South Vietnam and Laos threatened to upset the delicate balance there in favor of the Communists. In Latin America, the Eisenhower administration was helpless in the face of a revolution in Cuba, which soon allowed the Russians to extend their influence to within ninety miles of the United States. 

Surface appearances, however, reveal only surface truths. Eisenhower’s outstanding achievement was to avoid war. However irresponsible Republican emotional appeals to the anti-Communist vote may have been, and despite the Russian shift to the offensive in the Cold War, Eisenhower refused to engage American troops in armed conflict. He was not immune to intervention, nor to provocative rhetoric, nor to nuclear testing, nor to the arms race (within strict limits), but he did set his face against war. It became the Democrats’ turn to complain that the United States was not “going forward,” that it was not “doing enough,” that America was “losing the Cold War.”

Kierkegaard, Julian, Obama

Who knows what governs how a moderately engaged undergraduate makes sense of abstruse philosophic texts? As a sophomore, my mind settled on a basic dichotomy: Hegel bad, Kierkegaard good. This was probably what you might call a gendered thought. Hegel's basic How-Things-Work was to my mind aggressive, imperialist, male: thesis absorbs antithesis in new synthesis. Man slays dragon, eats its heart, becomes (relative) superman. Kierkegaard, by contrast, kept apparently irreconcilable opposites in eternal balance, on an eternal toggle switch whereby they could be seen alternately as part of a unity and eternally distinct.

I can't tell you at this distance whether my abstract caricature is accurate, but it has stayed with me all my life, and I tend to class thinkers on one side or the other of this divide. In retrospect, I'm sure that I placed the subject of my dissertation, the medieval mystic Julian of Norwich (an achoress, i.e. a nun in self-imposed solitary confinement) on the Kierkeaardian side of the ledger, though I never zoomed up the centuries to probe the association. *
 
Julian had a brilliant trick of subordinating the harsh elements of Catholic dogma that she didn't like (the damned are damned forever) to those that she felt by force of direct revelation to be true (all will be well, and all will be well, and all manner of things will be well).  Her basic dynamic was that God-as-man maintains two "cheres," or points of view: the human, limited one, whereby we must see and condemn our own sin, and the "inward, more ghostly" and more strictly divine one, whereby no one does anything except by God's will, and God is delighted with all, and sin is merely an instrument of human self-education.

Intransigence got them the win. Intransigence keeps them from taking it.

Brian Beutler has an intricate and well-sourced account of how the Obama administration scopes out the task of creating a "permission structure" for Republicans to compromise on a budgetary grand bargain. Broadly, it's Gang of Six II, a new attempt to jump off the presidential shadow by staying in the shadows, averting what Ezra Klein called the paradox of power: "If you take a strong position, the other side will immediately take the opposite position."

So once again, as Beutler puts it, "Obama’s putative absence is key to creating the political space Senate Republicans need to negotiate in good faith." But the master hurdle is in the House, where the GOP majority is way more recalcitrant than the five-odd GOP senators who would be needed to get a bill through the Senate.  And there, Beutler's framing caught my eye, because it illustrates a second paradox:

Of consumer cathedrals and Catholic capitalists

Can you love capitalism and hate the forms of commerce that the world's most capitalist economy creates? You can if you're Catholic and acculturated to cathedrals. Like Andrew Sullivan:

The striking paintings of Wal-Marts we featured this morning are not alone. Michelle Muldrow targets, among other supermarkets, Target. She calls these photographs paintings “Cathedrals of Desire.” Cathedrals used to function as a way to transcend desire into love, the worldly into the unworldly. Now these new consumer cathedrals make the worldly sacred and turn desire into a virtue.

I have to say that Target in particular engenders in me an instant version of what some hyper-lefty Germans called Konsumterrorismus: a total panic caused by the option of limitless shopping. (The definition is not undisputed). In my case, this phobia is compounded by the lighting – especially in Target. Aaron took me there once and I could not really get past the doorway. It was just horrifying. If I go to Hell, I will not have my ankles licked by fire. And I will not be lit from below. I will be subjected to giant, constant, overhead fluorescent lighting – what Michael Cunningham once called less lighting than the “banishment of all darkness.”

That gets it right, I think. All darkness must be banished to promote and encourage the purchase of things. This is what a huge amount of our culture now rests upon: the purchase of things. I guess you have to banish the literal darkness to disguise the shallow yet impenetrable darkness our shopping civilization represents.

Serendipity!  Yesterday, Andrew linked to an excellent review (by John Gray) of what sounds like an excellent biography of Karl Marx (by Jonathan Sperber). While unsparing about the harm wrought by Marx's "incoherent mishmash of idealist philosophy, dubious evolutionary speculation, and a positivistic view of history," Gray also credits Marx with an insight into the dynamics of capitalism to which the right is generally blind: