Literature, Poetry, and Books
The Hill reports that Paul Ryan's budget committee will propose huge Medicare and Medicaid reforms. The Democratic response is gonna be epic. The fight over public opinion for block granting Medicaid is probably winnable, but even that will take some care. Reformers will have to lead with the present broken condition of Medicaid and present the block granting as a way to let states produce better results with less money. The fight over Medicare will be much harder. Almost everyone is a current or prospective stakeholder in Medicare. Defined contribution Medicare (where the government gives a set amount of money and the recipient uses the money to purchase from a range of health care plans) is a policy proposal that is almost entirely unknown to the public. I would be surprised if one in fifty Americans could accurately describe defined contribution health care. If you were to write down a neutral, one sentence description of a defined contribution version of Medicare, I suspect most respondents would not prefer it to the present system. One of the most important facts in this debate is that most people would keep things going as they are - if they could. They would want Medicare to continue to pay at the projected (pre-Obamacare cuts) level and for the resulting burden to not crush the economy. Well that isn't going to happen. There are going to be limits placed on Medicare spending. The only question is whether those limits will be more of the kind centralized, sudden, and dumb cuts we saw in Obamacare, or whether we will have more market-oriented reforms that increase the productivity of the health care sector and let the elderly pay for the services they want rather than the services some bureaucrat wants them to have. A few pieces of advice from an amateur for Paul Ryan:
1. Defined contribution is a terrible way to describe the conservative version of Medicare. So is is voucherizing and privatizing. It should be called patient-centered Medicare for future retirees. It should be conservative patient-centered health care reform that allows the (future) elderly to purchase the services they want vs. bureaucrat-centered Medicare cuts where some agency just says no. It should be innovation, choice and better health care vs. death panels.
2. Medicare reform is a comparative issue. We are really facing tough choices and those who say otherwise are liars who want to cut your health care. There are two major ways of bringing down Medicare spending to a sustainable level. The Democrats will cut your benefits and leave you with no other options. We see that in Obamacare's plan to reduce provider reimbursements. The Obamacare plan is to pay your doctor less, thereby making it harder to get medical care. Multiply this approach across all your medical needs. And the Democrats are doing this to current retirees. Sometimes the government will just tell you no. More often the government will find sneakier ways to deny you care (creating waiting periods or paying at artificially low rates so that a service becomes unavailable.) They will nickel and dime you to death. This is the future under the Democrats and they have already started building it. Republicans need to explain that patient-centered Medicare will force providers to reorganize to provide better care for the elderly at a lower price, and that this is much better than the Democrat plan to give you less care when and how the government says so.
3. Ryan is articulate, energetic and smart, but he can't be everywhere at once. I assume most Republican members of Congress will be hopeless at explaining this issue past a couple of talking points. Some Republican members of Congress are quite old and have lost something off their fastball. Some are hacks who are just there to be there and aren't about to take on a complicated and controversial issue with enormous political downside risk. They will run for cover after the first AARP blast email. Some have real limited government principles but have demonstrated little ability (and perhaps little interest) in communicating to people who haven't already bought into the conservative narrative. Some congressional Republicans fit into more than one of the above categories.
Ryan needs to get together about twenty congressional Republicans to be the voices of the GOP on this issue (and one of them should be Marco Rubio.) They need to know the facts and the arguments inside and out, and have their responses honed to the second. Then they need to go everywhere and explain, explain, explain. Congress won't pass patient-centered Medicare this year or next. This is a public education effort and those most principled and articulate of Republicans need to be ready. They won't get another chance to make a first impression with the public.
Discover the bright future of conservatism in the latest edition of Counterpoint, the University of Chicago undergrad-edited journal. See Josh Lerner's account of Progressivism, which reconsiders its European origins. Also of note is the thoughtful, social-science focused exchange on same-sex marriage in the letters section. The case against gay marriage has rarely been made more incisively.
The spring issue will contain a symposium on movies, with contributions by conservatives young and old.
I can't find the post, but I remember Reihan Salam writing that repealing and replacing Obamacare might be the work of decades. I hope not. I can hope that, in 24 months, Congress will be well on the way to passing a repeal bill that will be signed by a Republican President. There is an element of chance as to whether the election of 2012 will return results that make Obamacare's repeal possible in the short-run. If James Capretta and Yuval Levin are right that "If the health care debate is lost, then the fight for limited government is lost as well" and Salam is right that the chances for are near-term repeal of Obamacare are questionable, then conservatives will need a health care reform approach that maximizes their odds of prevailing both next year and years down the line.
Conservatives shouldn't waste any opportunity to undo Obamacare, but let's be honest: it's not entirely in our control when that opportunity will come. Some elections are between evenly matched parties, but sometimes circumstance tilts the playing field strongly in favor of one side. The Democrats were smart to nominate candidates like Jim Webb and Jon Tester in 2006 but most of their political advantages in that year came from the Bush administration's mishandling of the Iraq War - absent Bush's epic unpopularity, George Allen probably still wins the Virginia Senate race. Webb also turned out to be the marginal vote for passing Obamacare past the 60 vote hurdle for cloture. Obama didn't earn the financial panic of 2008 (though by not seeming either panicky or overtly demagogic he maximized the political benefits.) In 2010 the Republicans surely benefited from the high unemployment rate and the Democrats' insistence on passing the most liberal bill that could unify their Senate caucus after the maximum application of presidential influence. Opportunity will come when it comes.
But opportunity won't be enough. A public desire to throw out the Democrats might result in a Republican victory, but if the Republicans aren't ready with good policy, who cares? I see no reason to repeat the Schwarzenegger experience of Republican administration of liberal governance. But opportunity and a plan aren't good enough either when the issue is health care. Health care policy is an intensely personal issue that almost everyone has a stake in. The Democrats and their allies and well wishers in the media and other institutions will expend every resource to prevent a repeal of Obamacare and a center-right reform of health care. If conservatives are to retain enough public support to enact their policies, they will need sufficient support from the public. It probably won't have to be an absolute majority but a 40% to 60% split in favor of Democratic policies on such a high salience issue will probably be fatal in the long-term. This is going to be a debate and Capretta and Levin's words should be remembered, "If the health care debate is lost, then the fight for limited government is lost as well" I think that this argues for a multi-track approach to repealing and replacing Obamacare. Some suggestions about what that might look like:
1. Continue to argue for a full near-term repeal. Continue to explain what is wrong with Obamacare and explain strategies for incremental right-leaning reform at the federal level (including block granting Medicaid.) It could work. The Republicans could retain their House majority while a Republican Senate majority and a Republican President are elected. You would almost certainly still have at least forty one Senate Democrats who will filibuster any attempt to repeal Obamacare. You would need at least fifty Republican Senators ready to vote to kill the filibuster in order to pass a repeal. I think it would be worth the trade, but I'm not sure Susan Collins agrees. Anyway, a Republican President could use their discretionary authority to move health care policy in a more market-oriented direction and lay the groundwork for the next stage of right-leaning health care reform.
I don't think it is a good idea to put all of our eggs in this basket. We should do all we can to bring this result about, but for all of our efforts, opportunity might not come just when we wish. The labor market could improve sufficiently to give the President a political boost. A large fraction of the population is already behind him and he does not need many more reinforcements to be well on the way to victory.
2. Focus on state-level health care reforms. Right now. I can't overestate the importance of expanding the social basis of market-oriented health care reform. The best arguments for conservative health care policies won't be found in think tank papers. They will be found in the experiences of people who have benefited from those policies. Republican governors and state legislators should do everything they can to get as many people as possible on HSA/catastrophic coverage plans (especially state and municipal employees.) It would save the government money while increasing the take home pay of the workers. It would make the full implementation of Obamacare harder. Let the Secretary of HHS tell millions and millions of Americans that a health insurance policy they like will now become illegal and that they should now pay more in order to get no better care. Make our day. If the Obama administration blinks, we win and there is an expanded social basis for market-oriented reform down the line. If they don't, then it is an issue for 2014 and 2016. In the meantime, much of the public is now better informed about the benefits of right-leaning reform. It is a win-win-win.
3. Expand public knowledge of the principles and benefits of market-oriented health care reform. This is an enormous challenge. Public awareness (much less public understanding) of right-leaning health care reform policies is abysmally low. I doubt that enough Republican politicians or the populist right-leaning media can reasonably be expected to bear the burden of expanding public understanding in the early stages of a public education effort. It would be worthwhile for some conservative foundation or right-leaning 527 to expend much of its money not in a particular election campaign, but in a campaign to increase understanding of some key issues. Perhaps money spent on the 407th, 408th and 409th 30 second ad for a candidate just before an election might be better spent on a 90 second ad that explains how right-leaning health care reform could save the government money, increase people's take home pay, and maintain people's health care security. This would be about shaping opinion between elections to make it easier for conservative candidates to talk about alternatives to Obamacare and make it harder for liberals to demagogue conservative policies. The ads shouldn't just be on during election seasons and should be on the Rush Limbaugh Show, The O'Reilly Factor, The Daily Show and Sabado Gigante (though the content might vary somewhat depending on the audience.)
"We were in the crowd, just sitting, listening to this guy ask the crowd if anyone knew why the moons going around Mars were potato-shaped and not round," [his mother] recalls. "Jacob raised his hand and said, 'Excuse me, but what are the sizes of the moons around Mars?'"
The lecturer answered, and "Jacob looked at him and said the gravity of the planet...is so large that (the moon's) gravity would not be able to pull it into a round shape."
"That entire building...everyone was just looking at him, like, 'Who is this 3-year-old?'"
Chuck Shumer caught on tape telling his fellow Democrats to cry wolf: "I always use the word extreme," Mr. Schumer said. "That is what the caucus instructed me to use this week."
Crying extremism in defense of Liberalism is not a vice!
Refine & Enlarge
The audio from last Friday's colloquium with Robert Reilly on his book, The Closing of the Muslim Mind: How Intellectual Suicide Created the Modern Islamist Crisis is now available on the Ashbrook site.
I highly recommend that you give it a listen. Bob gave a great talk, very thoughtful, which is to be expected, but also very clear and direct. The students enjoyed it immensely. I literally had to pull him away from a group of them afterward in order to get him to dinner or they would have talked to him for several more hours!
Men and Women
For those who feared foreign extremists would descend upon Egypt in her state of vulnerability, their fear was well founded. According to its founder, ACORN has arrived in Egypt. Not the domestic American ACORN, which died a swift death following revelations that it condoned sex-trafficking in minors, but ACORN International, a resurrected global version of the fraudulent group.
Revealingly, an ACORN International faction which has sprouted up in the Czech Republic is calling itself the "ACORN Comrades Club" and partnering with the communist party. As the Czechs struggle against the residue of communism, ACORN arrives to champion the historic party of corruption and demagoguery. It's the same playbook they used in America.
James Capretta and Yuval Levin write that Republicans need to make major right-leaning health care reform the centerpiece of their campaign in 2012. They estimate the stakes correctly when they write:
For Republicans committed to maintaining a vibrant and free society, there is no choice but to make genuine health care reform the centerpiece of their domestic agenda. If the health care debate is lost, then the fight for limited government is lost as well.
But the obstacles to Republicans enacting, or even running on a right-leaning health care reform agenda are enormous. Part of the problem is with the right. Aside from tort reform and vague calls to get the government out of health care, no particular set of right-leaning health care reform policies are a component of conservative identity. Lower capital gains tax rates, expansion of oil drilling and opposition to socialized medicine are issues that have, for many conservatives, established narratives about growth, opportunity, freedom and justice. Voucherizing Medicaid and giving a flat tax credit towards the purchase of catastrophic health insurance don't. These kinds of connections can be made, but it takes time, effort, and repetition to create familiarity with the benefits of those policies, and the connections of those policies to principles of freedom, markets, and individual empowerment. It could happen. Most conservatives were in favor of greater oil exploration, but it took a combination of circumstances and political activism to make "drill baby drill" a big election issue (until the financial collapse.) For a tangle of commercial and cultural reasons, it is not safe to expect the main outlets of the populist right-leaning media to take the lead in emphasizing particular right-leaning health care reform policies. If those policies seem to be catching on, the populist right-leaning media will follow.
One could hope for evangelical-minded conservative politicians and candidates to expand public understanding of right-leaning health care reform, but it would take a candidate of unusual character to make right-leaning health care reform the "the centerpiece of their domestic agenda." That doesn't mean most conservative politicians won't have a good health care plan on their website (McCain did.) That doesn't mean they won't have a one line or one paragraph nod to health care reform in their stump speech (McCain did.) It means that focusing on right-leaning health care reform at current levels of public understanding and salience will endanger their campaigns. In the Republican presidential primaries, it would make more purely political sense to talk about cuts to the corporate income tax, complain about this week's provocation from liberal-leaning figures, or find some new way (or yell some old way) to express contempt for Obama.
Paul Ryan in one figure who takes right-leaning health care reform seriously. He will get attention for his policy suggestions in the coming months (and not just on health care), but there are many segments of the population that a congressional committee chairman is not going to reach. The politicians who can reach those other segments are Presidents and presidential candidates. Ryan isn't running for President. Newt Gingrich is (probably) running for President. I heard him on the radio talking mostly about tax cuts and oil exploration and making fantasy promises about low unemployment rates and low gas prices. Pawlenty is running for President. His most recent CPAC speech included a vague little paragraph about giving people control of their own health care spending, but saved his energy for a phony and hyperbolic scream about how Obama should stop apologizing for the USA. Gingrich won't be Republican nominee and Pawlenty might, but their behavior closely tracks the political incentives and we probably can't expect better from most other politicians (that is a probabilistic rather than a normative statement.)
It doesn't get better when you get out of the Republican presidential primaries. The issues involved in right-leaning health care reform are complicated. Right-leaning health care reform policies would mean many people switching out of their employer-provided policies. What about the currently uninsured and uninsurable? There are answers (subsidized high risk pools or direct subsidies for those currently without insurance but with a cutoff date for new entrants), but they are complicated. All the time the Democrats will be attacking you saying that you are going to kill grandma and throw people on the street if their kids get sick. Public comprehension of right-leaning health care reform is low on the right, but virtually nonexistent among the potentially persuadable. Health care security is an extremely personal and high salience issue. John McCain was, in one sense, being quite rational in trying to get people outraged by pretending to believe that Obama called Palin a pig. It sure beat having to explain his heath care plan.
But Capretta and Levin are right. Public understanding and support for a patient-centered and market-oriented health care reform will have to be built somehow. It could be a candidate of public relations genius, or a book that catches the imagination of the right-leaning populist media. I hate waiting for one person to do something. What if they get run over by a bus? Also, 2012 might not be the year for Republicans to win (maybe it will, but conservatives should be ready for both eventualities.) Republicans will have the opportunity to govern again, but will they be ready with the right reform program? Even more important, will they have enough public understanding of, and support for their program so that Republicans politicians will be able to enact and sustain their policies in the face of Democratic counterattacks?
I'll try to have some thoughts a little later in the week.
Quote of the Day
Gandhi on Mussolini in Andrew Roberts' review of a new biography of Gandhi:
Gandhi and Mussolini got on well when they met in December 1931, with the Great Soul praising the Duce's "service to the poor, his opposition to super-urbanization, his efforts to bring about a coordination between Capital and Labour, his passionate love for his people."
No enemies on the Left?
Obama has been no friend to religious accommodation - most recently, he opposed conscience clauses exempting medical personnel with religious objections from performing abortions. And Obama's Dept. of Justice has been widely criticized for politicizing the law - from witch-hunts for Bush-era lawyers to the pardoning of the New Black Panthers. The newest twist is the DOJ's championing of a Muslim teacher's right to skip school in order to make a Hajj.
Safoorah Khan had taught middle school math for only nine months in this tiny Chicago suburb when she made an unusual request. She wanted three weeks off for a pilgrimage to Mecca.
The school district, faced with losing its only math lab instructor during the end-of-semester marking period, said no.
The DOJ has asserted that the school violated Kahn's civil rights and "compell[ed] Ms. Khan to choose between her job and her religious observance." The law requires employers to reasonably accommodate workers' religious beliefs, if such imposes no more than a minimal burden on working conditions.
Like his support for the Ground Zero Mosque, Obama's support for this teacher is an attempt to continue his outreach to Muslims. But this is a weak case and the DOJ is an inappropriate forum for sectarian preferences - the administration would never have intervened on behalf of a Christian teacher. Clumsy religious diplomacy in the courts devalues Obama's credibility as an advocate of the rule of law.
Many have wondered how the Egyptian military and the Muslim Brotherhood - former rivals - have managed to become so cozy in so short a time. The ability of the MB to promote order is one factor, but a general alignment of belief is another. For example, the Egyptian army is forcing female protestors to undergo "virginity tests." If they fail (after they are beaten), they may be charged with prostitution. The Muslim Brotherhood needn't be militantly Islamic when it has an Islamic military to do its bidding.
Literature, Poetry, and Books
The rebel forces in Libya have launched their first major offensive since the no-fly zone was instituted, pushing Gaddafi's forces out of the strategic city of Ajdabiya. Meanwhile, civil unrest has spread to Syria and Jordan. Syria has responded with particularly egregious violence.
Events in Egypt and Libya have already assured the current crisis a page in history. But the extent of the rebellion remains to be seen. As I wrote this post, I mentioned aloud that protests in the Arab world had spread to Syria and Jordan, and my lovely lady quite sincerely asked, "How many nations are left?"
On the other hand, the outcome of the rebellion remains to be seen, as well - the entire enterprise could lead to liberal democracies or sectarian tyrannies. One can only hope that, whatever the immediate results, the uprisings mark the beginning of a trend toward liberty and moderation in an oppressed corner of the world.