Islamophobia isn't pretty

WASHINGTON - A Muslim group is asking Virginia Republican Rep. Virgil Goode Jr. to apologize after he told hundreds of his constituents that more Muslims will follow Rep.-elect Keith Ellison, D-Minn., to Congress if strict immigration laws aren't passed.

"The Muslim representative from Minnesota was elected by the voters of that district and if American citizens don't wake up and adopt the Virgil Goode position on immigration there will likely be many more Muslims elected to office and demanding the use of the Koran," Goode wrote.

The letter was written to constituents who contacted Goode after Ellison said he planned to bring his Quran, the Muslim holy book, with him when he takes the oath of office on Jan. 4.

In his letter, Goode said: "When I raise my hand to take the oath on Swearing In Day, I will have the Bible in my other hand. I do not subscribe to using the Koran in any way."

Goode, an attorney and former state senator who was first elected to Congress in 1996, said he wants to "stop illegal immigration totally and reduce legal immigration and end the diversity visas policy pushed hard by President Clinton and allowing many persons from the Middle East to come to this country."

"I fear that in the next century we will have many more Muslims in the United States if we do not adopt the strict immigration policies that I believe are necessary to preserve the values and beliefs traditional to the United States of America and to prevent our resources from being swamped," Goode wrote.

Newsweek-WorldTop100Univ-2006

We evaluated schools on some of the measures used in well-known rankings published by Shanghai Jiaotong University and the Times of London Higher Education Survey. Fifty percent of the score came from equal parts of three measures used by Shanghai Jiatong: the number of highly-cited researchers in various academic fields, the number of articles published in Nature and Science, and the number of articles listed in the ISI Social Sciences and Arts & Humanities indices. Another 40 percent of the score came from equal parts of four measures used by the Times: the percentage of international faculty, the percentage of international students, citations per faculty member (using ISI data), and the ratio of faculty to students. The final 10 percent came from library holdings (number of volumes).

Here is our ranking:

1. Harvard University
2. Stanford University
3. Yale University
4. California Institute of Technology
5. University of California at Berkeley
6. University of Cambridge
7. Massachusetts Institute Technology
8. Oxford University
9. University of California at San Francisco
10. Columbia University
11. University of Michigan at Ann Arbor
12. University of California at Los Angeles
13. University of Pennsylvania
14. Duke University
15. Princeton Universitty
16. Tokyo University
17. Imperial College London
18. University of Toronto
19. Cornell University
20. University of Chicago
21. Swiss Federal Institute of Technology in Zurich
22. University of Washington at Seattle
23. University of California at San Diego
24. Johns Hopkins University
25. University College London
26. Swiss Federal Institute of Technology in Lausanne
27. University Texas at Austin
28. University of Wisconsin at Madison
29. Kyoto University
30. University of Minnesota Twin Cities
31. University of British Columbia
32. University of Geneva
33. Washington University in St. Louis
34. London School of Economics
35. Northwestern University
36. National University of Singapore
37. University of Pittsburgh
38. Australian National University
39. New York University
40. Pennsylvania State University
41. University of North Carolina at Chapel Hill
42. McGill University
43. Ecole Polytechnique
44. University of Basel
45. University of Maryland
46. University of Zurich
47. University of Edinburgh
48. University of Illinois at Urbana Champaign
49. University of Bristol
50. University of Sydney
51. University of Colorado at Boulder
52. Utrecht University
53. University of Melbourne
54. University of Southern California
55. University of Alberta
56. Brown University
57. Osaka University
58. University of Manchester
59. University of California at Santa Barbara
60. Hong Kong University of Science and Technology
61. Wageningen University
62. Michigan State University
63. University of Munich
64. University of New South Wales
65. Boston University
66. Vanderbilt University
67. University of Rochester
68. Tohoku University
69. University of Hong Kong
70. University of Sheffield
71. Nanyang Technological University
72. University of Vienna
73. Monash University
74. University of Nottingham
75. Carnegie Mellon University
76. Lund University
77. Texas A&M University
78. University of Western Australia
79. Ecole Normale Super Paris
80. University of Virginia
81. Technical University of Munich
82. Hebrew University of Jerusalem
83. Leiden University
84. University of Waterloo
85. King's College London
86. Purdue University
87. University of Birmingham
88. Uppsala University
89. University of Amsterdam
90. University of Heidelberg
91. University of Queensland
92. University of Leuven
93. Emory University
94. Nagoya University
95. Case Western Reserve University
96. Chinese University of Hong Kong
97. University of Newcastle
98. Innsbruck University
99. University of Massachusetts at Amherst
100. Sussex University


http://www.msnbc.msn.com/id/14321230/site/newsweek/

Liberal Pledge

To:  Conservatives and Republicans

I, and my fellow signatories, hereby make these promises to you:



1. We will always respect you for your conservative beliefs. We will never,
ever, call you "unpatriotic" simply because you disagree with us. In fact,
we encourage you to dissent and disagree with us.



2. We will let you marry whomever you want, even when some of us consider
your behavior to be "different" or "immoral." Who you marry is none of our
business. Love and be in love -- it's a wonderful gift.



3. We will not spend your grandchildren's money on our personal whims or to
enrich our friends. It's your checkbook, too, and we will balance it for
you.



4. When we soon bring our sons and daughters home from Iraq, we will bring
your sons and daughters home, too. They deserve to live. We promise
never to send your kids off to war based on either a mistake or a lie.



5. When we make America the last Western democracy to have universal health
coverage, and all Americans are able to get help when they fall ill, we
promise that you, too, will be able to see a doctor, regardless of your
ability to pay. And when stem cell research delivers treatments and cures
for diseases that affect you and your loved ones, we'll make sure those
advances are available to you and your family, too.



6. Even though you have opposed environmental regulation, when we clean up
our air and water, we, the Democratic majority, will let you, too, breathe
the cleaner air and drink the purer water.



7. Should a mass murderer ever kill 3,000 people on our soil, we will devote
every single resource to tracking him down and bringing him to justice.
Immediately. We will protect you.



8. We will never stick our nose in your bedroom or your womb. What you do
there as consenting adults is your business. We will continue to count your
age from the moment you were born, not the moment you were conceived.



9. We will not take away your hunting guns. If you need an automatic weapon
or a handgun to kill a bird or a deer, then you really aren't much of a
hunter and you should, perhaps, pick up another sport. We will make our
streets and schools as free as we can from these weapons and we will protect
your children just as we would protect ours.



10. When we raise the minimum wage, we will pay you -- and your employees --
that new wage, too. When women are finally paid what men make, we will pay
conservative women that wage, too.



11. We will respect your religious beliefs, even when you don't put those
beliefs into practice. In fact, we will actively seek to promote your most
radical religious beliefs ("Blessed are the poor," "Blessed are the
peacemakers," "Love your enemies," "It is easier for a camel to go through
the eye of a needle than for a rich man to enter the kingdom of God," and
"Whatever you did for one of the least of these brothers of mine, you did
for me."). We will let people in other countries know that God doesn't just
bless America, he blesses everyone. We will discourage religious intolerance
and fanaticism -- starting with the fanaticism here at home, thus setting a
good example for the rest of the world.



12. We will not tolerate politicians who are corrupt and who are bought and
paid for by the rich. We will go after any elected leader who puts him or
herself ahead of the people. And we promise you we will go after the corrupt
politicians on our side FIRST. If we fail to do this, we need you to call us
on it. Simply because we are in power does not give us the right to turn our
heads the other way when our party goes astray. Please perform this
important duty as the loyal opposition.



I promise all of the above to you because this is your country, too. You are
every bit as American as we are. We are all in this together. We sink or
swim as one. Thank you for your years of service to this country and for
giving us the opportunity to see if we can make things a bit better for our
300 million fellow Americans -- and for the rest of the world.

Financial Times Business News: Harvard study paints bleak picture of ethnic diversity - MSN Money

Financial Times Business News: Harvard study paints bleak picture of ethnic diversity - MSN Money: "Harvard study paints bleak picture of ethnic diversity

A bleak picture of the corrosive effects of ethnic diversity has been revealed in research by Harvard University's Robert Putnam, one of the world's most influential political scientists.
His research shows that the more diverse a community is, the less likely its inhabitants are to trust anyone -- from their next-door neighbour to the mayor.

This is a contentious finding in the current climate of concern about the benefits of immigration. Professor Putnam told the Financial Times he had delayed publishing his research until he could develop proposals to compensate for the negative effects of diversity, saying it 'would have been irresponsible to publish without that'.

The core message of the research was that, 'in the presence of diversity, we hunker down', he said. 'We act like turtles. The effect of diversity is worse than had been imagined. And it's not just that we don't trust people who are not like us. In diverse communities, we don't trust people who do look like us.'

Prof Putnam found trust was lowest in Los Angeles, 'the most diverse human habitation in human history', but his findings also held for rural South Dakota, where "diversity means inviting Swedes to a Norwegians' picnic".

When the data were adjusted for class, income and other factors, they showed that the more people of different races lived in the same community, the greater the loss of trust. "They don't trust the local mayor, they don't trust the local paper, they don't trust other people and they don't trust institutions," said Prof Putnam. "The only thing there's more of is protest marches and TV watching."

British Home Office research has pointed in the same direction and Prof Putnam, now working with social scientists at Manchester University, said other European countries would be likely to have similar trends.

His 2000 book, Bowling Alone, on the increasing atomisation of contemporary society, made him an academic celebrity. Though some scholars questioned how well its findings applied outside the US, policymakers were impressed and he was invited to speak at Camp David, Downing Street and Buckingham Palace.

Prof Putnam stressed, however, that immigration materially benefited both the "importing" and "exporting" societies, and that trends "have been socially constructed, and can be socially reconstructed".

In an oblique criticism of Jack Straw, leader of the House of Commons, who revealed last week he prefers Muslim women not to wear a full veil, Prof Putnam said: "What we shouldn't do is to say that they [immigrants] should be more like us. We should construct a new us."

Copyright 2006 Financial Times

Sam Harris Blasts Head-in-the-Sand Liberals

http://www.latimes.com/news/opinion/la-oe-harris18sep18,0,1897169.story?coll=la-opinion-rightrail

Head-in-the-Sand Liberals
Western civilization really is at risk from Muslim extremists.
By Sam Harris
SAM HARRIS is the author of "The End of Faith: Religion, Terror and the Future of Reason." His next book, "Letter to a Christian Nation," will be published this week by Knopf. samharris.org.

September 18, 2006

TWO YEARS AGO I published a book highly critical of religion, "The End of Faith." In it, I argued that the world's major religions are genuinely incompatible, inevitably cause conflict and now prevent the emergence of a viable, global civilization. In response, I have received many thousands of letters and e-mails from priests, journalists, scientists, politicians, soldiers, rabbis, actors, aid workers, students — from people young and old who occupy every point on the spectrum of belief and nonbelief.

This has offered me a special opportunity to see how people of all creeds and political persuasions react when religion is criticized. I am here to report that liberals and conservatives respond very differently to the notion that religion can be a direct cause of human conflict.

This difference does not bode well for the future of liberalism.

Perhaps I should establish my liberal bone fides at the outset. I'd like to see taxes raised on the wealthy, drugs decriminalized and homosexuals free to marry. I also think that the Bush administration deserves most of the criticism it has received in the last six years — especially with respect to its waging of the war in Iraq, its scuttling of science and its fiscal irresponsibility.

But my correspondence with liberals has convinced me that liberalism has grown dangerously out of touch with the realities of our world — specifically with what devout Muslims actually believe about the West, about paradise and about the ultimate ascendance of their faith.

On questions of national security, I am now as wary of my fellow liberals as I am of the religious demagogues on the Christian right.

This may seem like frank acquiescence to the charge that "liberals are soft on terrorism." It is, and they are.

A cult of death is forming in the Muslim world — for reasons that are perfectly explicable in terms of the Islamic doctrines of martyrdom and jihad. The truth is that we are not fighting a "war on terror." We are fighting a pestilential theology and a longing for paradise.

This is not to say that we are at war with all Muslims. But we are absolutely at war with those who believe that death in defense of the faith is the highest possible good, that cartoonists should be killed for caricaturing the prophet and that any Muslim who loses his faith should be butchered for apostasy.

Unfortunately, such religious extremism is not as fringe a phenomenon as we might hope. Numerous studies have found that the most radicalized Muslims tend to have better-than-average educations and economic opportunities.

Given the degree to which religious ideas are still sheltered from criticism in every society, it is actually possible for a person to have the economic and intellectual resources to build a nuclear bomb — and to believe that he will get 72 virgins in paradise. And yet, despite abundant evidence to the contrary, liberals continue to imagine that Muslim terrorism springs from economic despair, lack of education and American militarism.

At its most extreme, liberal denial has found expression in a growing subculture of conspiracy theorists who believe that the atrocities of 9/11 were orchestrated by our own government. A nationwide poll conducted by the Scripps Survey Research Center at Ohio University found that more than a third of Americans suspect that the federal government "assisted in the 9/11 terrorist attacks or took no action to stop them so the United States could go to war in the Middle East;" 16% believe that the twin towers collapsed not because fully-fueled passenger jets smashed into them but because agents of the Bush administration had secretly rigged them to explode.

Such an astonishing eruption of masochistic unreason could well mark the decline of liberalism, if not the decline of Western civilization. There are books, films and conferences organized around this phantasmagoria, and they offer an unusually clear view of the debilitating dogma that lurks at the heart of liberalism: Western power is utterly malevolent, while the powerless people of the Earth can be counted on to embrace reason and tolerance, if only given sufficient economic opportunities.

I don't know how many more engineers and architects need to blow themselves up, fly planes into buildings or saw the heads off of journalists before this fantasy will dissipate. The truth is that there is every reason to believe that a terrifying number of the world's Muslims now view all political and moral questions in terms of their affiliation with Islam. This leads them to rally to the cause of other Muslims no matter how sociopathic their behavior. This benighted religious solidarity may be the greatest problem facing civilization and yet it is regularly misconstrued, ignored or obfuscated by liberals.

Given the mendacity and shocking incompetence of the Bush administration — especially its mishandling of the war in Iraq — liberals can find much to lament in the conservative approach to fighting the war on terror. Unfortunately, liberals hate the current administration with such fury that they regularly fail to acknowledge just how dangerous and depraved our enemies in the Muslim world are.

Recent condemnations of the Bush administration's use of the phrase "Islamic fascism" are a case in point. There is no question that the phrase is imprecise — Islamists are not technically fascists, and the term ignores a variety of schisms that exist even among Islamists — but it is by no means an example of wartime propaganda, as has been repeatedly alleged by liberals.

In their analyses of U.S. and Israeli foreign policy, liberals can be relied on to overlook the most basic moral distinctions. For instance, they ignore the fact that Muslims intentionally murder noncombatants, while we and the Israelis (as a rule) seek to avoid doing so. Muslims routinely use human shields, and this accounts for much of the collateral damage we and the Israelis cause; the political discourse throughout much of the Muslim world, especially with respect to Jews, is explicitly and unabashedly genocidal.

Given these distinctions, there is no question that the Israelis now hold the moral high ground in their conflict with Hamas and Hezbollah. And yet liberals in the United States and Europe often speak as though the truth were otherwise.

We are entering an age of unchecked nuclear proliferation and, it seems likely, nuclear terrorism. There is, therefore, no future in which aspiring martyrs will make good neighbors for us. Unless liberals realize that there are tens of millions of people in the Muslim world who are far scarier than Dick Cheney, they will be unable to protect civilization from its genuine enemies.

Increasingly, Americans will come to believe that the only people hard-headed enough to fight the religious lunatics of the Muslim world are the religious lunatics of the West. Indeed, it is telling that the people who speak with the greatest moral clarity about the current wars in the Middle East are members of the Christian right, whose infatuation with biblical prophecy is nearly as troubling as the ideology of our enemies. Religious dogmatism is now playing both sides of the board in a very dangerous game.

While liberals should be the ones pointing the way beyond this Iron Age madness, they are rendering themselves increasingly irrelevant. Being generally reasonable and tolerant of diversity, liberals should be especially sensitive to the dangers of religious literalism. But they aren't.

The same failure of liberalism is evident in Western Europe, where the dogma of multiculturalism has left a secular Europe very slow to address the looming problem of religious extremism among its immigrants. The people who speak most sensibly about the threat that Islam poses to Europe are actually fascists.

To say that this does not bode well for liberalism is an understatement: It does not bode well for the future of civilization.

Amazing how subsequent events have colored their view of history...



OTTAWA -- Half of Canadians blame American foreign policy for the Sept. 11, 2001, terrorist attacks, showing a hardening of opinions since the one-year anniversary of the disaster, when people in this country were less inclined to attribute the bombings to U.S. meddling in certain parts of the world.

A poll conducted for Canwest News Service indicates that 53 per cent of Canadians believe the attacks were "a very specific violent reaction to foreign policies of the U.S. government."

Only 36 per cent reported that the terrorist bombings signalled an attack against "all western-style, affluent democracies because they hate their ideas and values, symbolized most by the United States."

The telephone survey of 887 adults, conducted by the polling firm Ipsos-Reid on Sept. 6 and 7, is considered accurate within 3.5 percentage points, 19 times in 20.

The results show that Canadians are more firm in their blame since the first anniversary of Sept. 11, in 2002, when only 15 per cent said that U.S. foreign policy was responsible for the attacks and another 69 per cent suspected it was somewhat responsible, said John Wright, Ipsos-Reid's senior vice-president.

"People have defined their views. They've looked at not just 9/11, but what's happened since then. They're looking at Iraq. And they're saying the foreign policy of the United States has become -- or is, or was -- the root cause of this issue," Wright said.

Young Canadians under 35 were most likely to blame U.S. foreign policy (58 per cent).

The five-year anniversary poll indicates that a significant number of Canadians continue to be affected by the attacks.

More than one in four people -- 28 per cent -- reported that in comparison to everything else that has taken place in their lives, the attacks were "life-altering" and they've "never been the same since."

One in four are afraid to fly outside Canada because of fears of terrorism. One in three say they are "personally more suspicious of people who are from the Middle East or Southeast Asia."

Almost one in five people -- 17 per cent -- said they can't watch television or movie recounts of the event because "the recall has a traumatizing effect on me."

Despite the lasting effect on many, the survey also reveals that 77 per cent of Canadians have moved on since the attacks, reporting that while they were affected at the time, their "outlook and activities are now almost exactly the way they were before the attacks took place."

In a bizarre finding, the polling firm reported that 22 per cent of Canadians believe in a conspiracy theory in which the terrorist attacks were orchestrated by a "group of highly influential Americans and others" rather than by supporters of Osama bin Laden and his al-Qaeda terrorist network.
The theory that the U.S. pulled off an inside job to ultimately justify going to war for Iraqi oil persists in Canada and in the United States, fuelled by a few books and a compelling Internet documentary called Loose Change, created by two young Americans, which has been viewed by millions and is particularly popular on university campuses and in Internet chat rooms. One of its assertions is that the Pentagon was hit by a cruise missile fired by the military as an excuse to go to war.

"It does have resonance," said Wright. "I call them neighbourhood rumours. There are a good number of people who believe it could have been perpetrated by people in the United States."

The poll shows young adults aged 18 to 34 are most likely to believe in the conspiracy theory (26 per cent).

Another key finding was that only 18 per cent of those polled believe that the Canadian government and police have gone too far in fighting terrorism at the expense of civil liberties. Another 43 per cent believe that a proper balance has been struck, while 33 per cent believe police and government should give themselves more powers.

All questions in the poll, with the exception of the one dealing with U.S. blame, were asked of 1,000 adults on Aug. 29 to 31. The results have a margin of error of plus or minus 3.1 percentage points.

© Times Colonist (Victoria) 2006

http://www.canada.com/victoriatimescolonist/news/story.html?id=1853b27d-781d-41c4-807e-3c662c401039&k=24965&p=2

Webb Storms for Senate in Va

If this guy doesn't win, just throw in the towel ...

Fight to the Finish
Bring It On: Can the Dems exploit public worry about the war and retake Capitol Hill? A case study in Virginia.
By Jonathan Darman and Evan Thomas
Newsweek
Sept. 18, 2006 issue - Candidates for the November elections usually campaign flat-out in the week after Labor Day. Jim Webb, Democratic nominee for the U.S. Senate from Virginia, took off to hang out with a bunch of 20-year-olds on a Marine base in North Carolina, to drink beer, make small talk and wait. He was not on holiday: one of the young men was Webb's son, Jimmy, 24, a lance corporal in the Marines who was about to ship out to Iraq. "I had to clear my schedule and clear my head," says Webb. "I just wanted to be with my son."

Webb is not a normal politician. He is a warrior, with the medals (a Navy Cross, a Silver Star, two Bronze Stars) and the wounds (shrapnel in his head, back, left arm, kidney and left leg) to show for it. He comes from a family that has fought in America's wars back to the Revolution. An ancestor rode with Nathan Bedford Forrest in the Civil War; Webb's father was an Air Force pilot in World War II. Webb has been preparing his own son for war since childhood. The two have walked battlefields from Antietam to Shiloh to Verdun to Webb's own "fields of fire" in Vietnam. Webb hates the Iraq war and is now running against it, but he taught his son the family code: soldiers do their duty, regardless of whether the politicians who lead them into wars are right or wrong. Jimmy understands, says Webb, "because he's part of a continuum. My family has always done this."

Webb's decision to become a politician could be an answered prayer for the Democratic Party. Ever since Vietnam, Democrats have been bedeviled by charges that they are "soft" on national security. GOP operatives now jeer at the Democrats as "Defeatocrats." And last week, as President George W. Bush delivered a flurry of speeches staking out security as the centerpiece of the fall campaign, the Republican National Committee launched a Web site called America Weakly, aimed at undermining voters' confidence in the opposition party. But with polls showing some of the highest levels of antiwar sentiment since Vietnam—with roughly three out of five Americans saying that they disapprove of President Bush's handling of the Iraq war—the Democrats have a chance to recapture Congress, if only they can overcome the perception that they are somehow weak. The war may dominate the 2008 election as well: voters overwhelmingly cite Iraq over the economy as the No. 1 priority for the next president.


John Kerry was a genuine war hero, but in 2004 he was pilloried for growing his hair long and attending peace rallies with the likes of Jane Fonda. No one is going to "Swift Boat" Jim Webb. During Vietnam, he scorned antiwar protesters with the same contempt he shows today for so-called chicken hawks, the neocons who never served in the military but were all for invading Iraq. Webb refuses to speak of sending "forces" into combat. To Webb, they are soldiers who have lives and families to live for. Webb's opponent, incumbent GOP Sen. George Allen Jr., plays the good-ole-boy superpatriot. With his cowboy boots and swagger, he is a reasonable facsimile of George W. Bush. But next to a hardened combat veteran like Webb, he can seem like a tough-guy wanna-be.


Webb's electoral chances went from long shot to medium shot a month ago after his opponent blundered by referring to one of Webb's supporters, an Indian-American college student, as a "macaca," a racially offensive term that refers to a genus of monkey. But Webb must contend with some serious liabilities. As with most other Democratic candidates, he has yet to find a way to express his opposition to the Iraq war that does not sound as if he is either (a) advocating a policy of "cut and run," or (b) complaining and criticizing but offering no clear way out. Stiffly refusing to pander on the stump, Webb tends to ramble on, describing nuances and complexities. "He's never run for office before, and you can tell," says Larry Sabato, director of the Center for Politics at the University of Virginia. "He doesn't know how to give a speech. He seems incapable of comparison campaigning, much less negative campaigning." Way behind Allen in fund-raising, Webb lacks Allen's common touch. Walking around a street fair in Salem, Va., last Saturday, Webb had to be formally introduced to each voter.

In his brooding intensity, he can seem haunted. In Vietnam, 56 members of the platoon Webb commanded were killed or wounded. Webb threw himself in front of a grenade to save one soldier (his badly infected wound finally forced him to resign from the Marines). Webb seethed when he returned to civilian life, and never forgot those veterans who had turned against the war. In 1984, Webb was working with a group involved in building the Vietnam Veterans Memorial. Webb met with sculptor Frederick Hart, who had been an antiwar protester. As Hart walked into what was supposed to be a friendly session, Webb sneered, "Welcome to the other side of the picket line, motherf---er." (Webb says he was joking with Hart, a close friend, about a conflict over the design of the memorial.) Webb has mellowed, sort of. He won't overtly criticize men, like Allen, who didn't serve in Vietnam. (Allen had a student deferment.)

But it was Allen's obtuseness about the Iraq war that drew Webb into politics. Webb was an early opponent of invading Iraq. He had opposed the 1991 gulf war because, he said at the time, he was worried that American troops could get bogged down in a long occupation if they pushed on to Baghdad. In a speech at a Naval Institute conference in 2002, he warned that invading Iraq would be a "strategic blunder," a distraction from the war on terror and a potential quagmire for U.S. soldiers. At about that time, Webb met with Allen to press his senator to oppose an invasion. According to Webb, Allen responded, "I feel like you're asking me to be disloyal to my president." (Allen's office confirmed the meeting but declined to comment on a private conversation.)

Webb began thinking about opposing Allen's 2006 re-election bid. At the time, he was writing a book about the warrior tradition of his kinsmen, the Scots-Irish who settled Appalachia and have been disproportionately represented in America's bloodiest battles. Their hero was Andrew Jackson, and Webb regarded Old Hickory as a soldier-statesman role model.

Webb had been a Democrat until, as he puts it, "Jimmy Carter made me a Republican" by appearing weak on foreign policy. Webb went back into government service in the Reagan administration, first as an assistant secretary of Defense for reserve affairs, then as secretary of the Navy. Among his causes was stripping away combat decorations from veterans who had not demonstrably earned them. He quit the Pentagon after two years rather than going along with a diminution in the size of the 600-ship Navy.


Webb was already a cult figure at his alma mater, the U.S. Naval Academy. He charged that academy officials were promoting academics over physical toughness and wrote a defiant Washingtonian magazine article, "Women Can't Fight," after the Academy went coed in the late 1970s. Friends say Webb can seem a little defensive when he launches into a long explanation of why he lost the Academy boxing championship to a fellow midshipman, a mauler named Oliver North, back in 1967.

Webb is something of a literary figure as well as a Hollywood screenwriter. His Vietnam roman ? clef, "Fields of Fire," was widely praised; among his books is a brilliant historical novel, "The Emperor's General," about Gen. Douglas MacArthur's running of postwar Japan. Now Allen is trying to portray Webb as a dilettante. "Are we going to choose someone who's spent the last 20 years in service to the state of Virginia as governor and senator? Or do we choose someone whose priority has been writing novels and hanging around Hollywood?" Allen asks.

The GOP's overall strategy to preserve its majorities in the House and Senate is to morph all Democratic candidates into the mold of Senate Minority Leader Harry Reid and House Minority Leader Nancy Pelosi. But the Democrats have had unusual success at fielding candidates like Webb who hardly fit the "San Francisco Democrat" template. Tammy Duckworth, a female helicopter pilot who lost both legs in combat in Iraq in 2004, is running a close race to win an open House seat long held by the GOP in Illinois, and Vice Adm. Joe Sestak, who oversaw combat operations in Afghanistan and Iraq, has a shot at unseating veteran Republican Rep. Curt Weldon in Pennsylvania. GOP candidates like Weldon are showing signs of nervousness. The No. 2 member of the House Armed Services Committee, Weldon is introducing a resolution to give ground commanders more say in deciding troop levels in Iraq. "I'm not trying to undermine the president," protests Weldon. "I am just asking for a clear plan."

A clear plan is not what voters will hear from Jim Webb, however. Webb takes his cue from another soldier-politician, Dwight Eisenhower, whose approach to the Korean stalemate in 1952 was to argue, somewhat vaguely, that America's foreign policy was in shambles and that voters needed a different set of eyes on the problem. Webb avoids any timetables for getting out of Iraq, preferring to rely on "American ingenuity."


Webb does not strongly stir voters. Last Friday night, at a rally of some 200 people in western Virginia, the ex-Marine did take a shot at Allen. He explained that he had driven that day 300 miles from Camp Lejeune, N.C. "I was thinking that if I was George Allen, I'd have been in a helicopter. But then if I was George Allen I'd have $20 to $30 million and I'd be bought and paid for." Biting words, but Webb spoke in a harsh monotone, like a drill sergeant. He seemed weary. He had arisen at 3 a.m. to see off his son, Jimmy, whose Marine battalion left for Iraq that morning at 5.

With Andrew Romano, Lee Hudson Teslik, Holly Bailey and Richard Wolffe

URL: http://www.msnbc.msn.com/id/14757418/site/newsweek/from/ET/


--------------------------------------------------------------------------------

© 2006 MSNBC.com

Some facts about the insurgency in Iraq...

Some facts about the insurgency in Iraq...
from Rep. Murtha:

"FACT: Since the last week in February 2006, sectarian violence and death has reached new heights. In the past few weeks alone, over a thousand Iraqi civilians have been killed in the violence.

FACT: Electricity production remains below pre-war levels. Baghdad received an average of 6.4 hours of electricity per day. Oil production was at 1.77 million barrels per day, some 30% below pre-war production rates. [Iraq Weekly Status Report of March 1, 2006 from the U.S. State Department]

FACT: The number of incidents per week have tripled since one year ago [summary of classified information provided by the Central Intelligence Agency]

FACT: Unemployment ranges from 30-60% nation-wide. In Anbar Province -- the epicenter of the insurgency -- unemployment reaches 90%. [summary of estimates by the State Department and U.S. intelligence agencies]"

http://www.huffingtonpost.com/rep-john-murtha/claims-and-facts-the-war_b_17311.html



... How's that working for ya?

In 2003, U.S. Spurned Iran's Offer of Dialogue
Some Officials Lament Lost Opportunity

By Glenn Kessler
Washington Post Staff Writer
Sunday, June 18, 2006; A16



Just after the lightning takeover of Baghdad by U.S. forces three years ago, an unusual two-page document spewed out of a fax machine at the Near East bureau of the State Department. It was a proposal from Iran for a broad dialogue with the United States, and the fax suggested everything was on the table -- including full cooperation on nuclear programs, acceptance of Israel and the termination of Iranian support for Palestinian militant groups.

But top Bush administration officials, convinced the Iranian government was on the verge of collapse, belittled the initiative. Instead, they formally complained to the Swiss ambassador who had sent the fax with a cover letter certifying it as a genuine proposal supported by key power centers in Iran, former administration officials said.

Last month, the Bush administration abruptly shifted policy and agreed to join talks previously led by European countries over Iran's nuclear program. But several former administration officials say the United States missed an opportunity in 2003 at a time when American strength seemed at its height -- and Iran did not have a functioning nuclear program or a gusher of oil revenue from soaring energy demand.

"At the time, the Iranians were not spinning centrifuges, they were not enriching uranium," said Flynt Leverett, who was a senior director on the National Security Council staff then and saw the Iranian proposal. He described it as "a serious effort, a respectable effort to lay out a comprehensive agenda for U.S.-Iranian rapprochement."

While the Iranian approach has been previously reported, the actual document making the offer has surfaced only in recent weeks. Trita Parsi, a Middle East expert at the Carnegie Endowment for International Peace, said he obtained it from Iranian sources. The Washington Post confirmed its authenticity with Iranian and former U.S. officials.

Parsi said the U.S. victory in Iraq frightened the Iranians because U.S. forces had routed in three weeks an army that Iran had failed to defeat during a bloody eight-year war.

The document lists a series of Iranian aims for the talks, such as ending sanctions, full access to peaceful nuclear technology and a recognition of its "legitimate security interests." Iran agreed to put a series of U.S. aims on the agenda, including full cooperation on nuclear safeguards, "decisive action" against terrorists, coordination in Iraq, ending "material support" for Palestinian militias and accepting the Saudi initiative for a two-state solution in the Israeli-Palestinian conflict. The document also laid out an agenda for negotiations, with possible steps to be achieved at a first meeting and the development of negotiating road maps on disarmament, terrorism and economic cooperation.
Newsday has previously reported that the document was primarily the work of Sadegh Kharazi, Iran's ambassador to France and nephew of Iranian Foreign Minister Kamal Kharazi and passed on by the Swiss ambassador to Tehran, Tim Guldimann. The Swiss government is a diplomatic channel for communications between Tehran and Washington because the two countries broke off relations after the 1979 seizure of U.S. embassy personnel.

Leverett said Guldimann included a cover letter that it was an authoritative initiative that had the support of then-President Mohammad Khatami and supreme religious leader Ali Khamenei.

Secretary of State Condoleezza Rice has stressed that the U.S. decision to join the nuclear talks was not an effort to strike a "grand bargain" with Iran. Earlier this month, she made the first official confirmation of the Iranian proposal in an interview with National Public Radio.

"What the Iranians wanted earlier was to be one-on-one with the United States so that this could be about the United States and Iran," said Rice, who was Bush's national security adviser when the fax was received. "Now it is Iran and the international community, and Iran has to answer to the international community. I think that's the strongest possible position to be in."

Current White House and State Department officials declined to comment further on the Iranian offer.

Paul R. Pillar, former national intelligence officer for the Near East and South Asia, said that it is true "there is less daylight between the United States and Europe, thanks in part to Rice's energetic diplomacy." But he said that only partially offsets the fact that the U.S. position is "inherently weaker now" because of Iraq. He described the Iranian approach as part of a series of efforts by Iran to engage with the Bush administration. "I think there have been a lot of lost opportunities," he said, citing as one example a failure to build on the useful cooperation Iran provided in Afghanistan.

Richard N. Haass, head of policy planning at the State Department at the time and now president of the Council on Foreign Relations, said the Iranian approach was swiftly rejected because in the administration "the bias was toward a policy of regime change." He said it is difficult to know whether the proposal was fully supported by the "multiple governments" that run Iran, but he felt it was worth exploring.

"To use an oil analogy, we could have drilled a dry hole," he said. "But I didn't see what we had to lose. I did not share the assessment of many in the administration that the Iranian regime was on the brink."

Parsi said that based on his conversations with the Iranian officials, he believes the failure of the United States to even respond to the offer had an impact on the government. Parsi, who is writing a book on Iran-Israeli relations, said he believes the Iranians were ready to dramatically soften their stance on Israel, essentially taking the position of other Islamic countries such as Malaysia. Instead, Iranian officials decided that the United States cared not about Iranian policies but about Iranian power.

The incident "strengthened the hands of those in Iran who believe the only way to compel the United States to talk or deal with Iran is not by sending peace offers but by being a nuisance," Parsi said.

© 2006 The Washington Post Company









... How's that working for ya?

Christians Fleeing Lebanon Denounce Hezbollah

Christians Fleeing Lebanon Denounce Hezbollah

Well, they're pretty pissed at Israel too...

Christians Fleeing Lebanon Denounce Hezbollah
By SABRINA TAVERNISE
TYRE, Lebanon, July 27 — The refugees from southern Lebanon spilled out of packed cars into the dark street here Thursday evening, gulping bottles of water and squinting in the glare of the headlights to find family members and friends. Many had not eaten in days. Most had not had clean drinking water for some time. There were wounded swathed in makeshift dressings, and a baby just 16 days old.

But for some of the Christians who had made it out in this convoy, it was not just privations they wanted to talk about, but their ordeal at the hands of Hezbollah — a contrast to the Shiites, who make up a vast majority of the population in southern Lebanon and broadly support the militia.

“Hezbollah came to Ain Ebel to shoot its rockets,” said Fayad Hanna Amar, a young Christian man, referring to his village. “They are shooting from between our houses.”

“Please,’’ he added, “write that in your newspaper.”

The evacuation — more than 100 cars that followed an International Committee for the Red Cross rescue convoy to Tyre — included Lebanese from several Christian villages. In past wars, Christian militias were close to Israelis, and animosity between Christians and Shiites lingers.

Throngs of refugees are now common in this southern coastal town, the gateway to the war that is booming just miles away. The United Nations has estimated that 700,000 Lebanese, mostly from the southern third of the country, have been displaced by the war.

But thousands of people have been left behind, residents and the Red Cross say.

What has prevented many from fleeing is a critical shortage of fuel. Roland Huguenin-Benjamin, a spokesman for the Red Cross who accompanied the convoy to Tyre, said Red Cross officials had offered to lead out any people who wanted to drive behind, but many did not have enough gasoline for the trip.

Those who did get out were visibly upset. Some carried sick children. A number broke down it tears when they emerged from their cars here.

“People are dying under bombs and crushed under houses,” Nahab Aman said, sobbing and hugging her young son. “We’re not dogs! Why aren’t they taking the people out?”

Many Christians from Ramesh and Ain Ebel considered Hezbollah’s fighting methods as much of an outrage as the Israeli strikes. Mr. Amar said Hezbollah fighters in groups of two and three had come into Ain Ebel, less than a mile from Bint Jbail, where most of the fighting has occurred. They were using it as a base to shoot rockets, he said, and the Israelis fired back.

One woman, who would not give her name because she had a government job and feared retribution, said Hezbollah fighters had killed a man who was trying to leave Bint Jbail.

“This is what’s happening, but no one wants to say it” for fear of Hezbollah, she said.

American citizens remain in some southern villages. Mohamed Elreda, a father of three from New Jersey, was visiting relatives in Yaroun with his family when two missiles narrowly missed his car, while he was parking it in front of his family’s house. His 16-year-old son was sprayed with shrapnel and is now in a hospital in Tyre.

“I have never seen anything like this in my life,” said Mr. Elreda, who arrived here on Thursday morning. “They see civilians, they bomb them,” he said, referring to the Israelis.

“We had to move underground like raccoons.”

He said a person affiliated with the United States Embassy arrived in Yaroun and shouted for everyone to join a convoy that the Israelis had promised safe passage.

He left in such haste, he said, that he had pulled on his wife’s sweatpants (they had a pink stripe running down the length of each leg). His son’s blood still stained his shoes.

He said Yaroun had been without electricity and clean water for more than a week, and he had stirred dirty clothes in a pail of water and bleach to make bandages for his son’s wounds.

The village is largely Christian, but has Muslim pockets, and Mr. Elreda said he walked at night among houses to the Christian section, where a friend risked his life to drive his son to Tyre, while Mr. Elreda stayed with the rest of the family.

On Thursday he joined his son at the hospital.

“He’s my son,” he said, standing at the foot of the boy’s bed. “I just can’t see him like this.”





Copyright 2006 The New York Times Company

Armchair's Links (in need of weeding)

s.f. bayarea forums - craigslist: "Even Ted Kennedy-hatin' conservatives agree.
2006-07-21 16:09:33

Bushsheep are fascist scum.

http://www.opednews.com/articles/opedne_thepen_051112_senator_graham_pulls.htm

http://www.commondreams.org/views05/1114-22.htm

http://www.smirkingchimp.com/article.php?sid=23494

http://www.buzzflash.com/hartmann/05/11/har05011.html

http://www.capitolhillblue.com/artman/publish/article_7624.shtml

http://www.opendemocracy.net/globalization-village/torture_2938.jsp

http://www.informationclearinghouse.info/article10710.htm

http://www.smirkingchimp.com/article.php?sid=23363

http://kos.dailykos.com/story/2005/10/21/15231/469

http://www.wsws.org/articles/2005/oct2005/flu-o07.shtml

http://www.commondreams.org/views05/1015-23.htm

http://onlineathens.com/stories/101505/opi_20051015032.shtml

http://dissidentvoice.org/Oct05/Goldsmith1010.htm

http://www.commondreams.org/views05/1017-28.htm

http://www.antiwar.com/roberts/?articleid=7556

http://www.smirkingchimp.com/article.php?sid=23061

http://www.smirkingchimp.com/article.php?sid=23062

http://tabletalk.salon.com/webx?7@@.6853034b/5658

http://www.commondreams.org/views05/0930-25.htm

http://fairuse.100webcustomers.com/fairenough/latimes023.html

http://www.lewrockwell.com/gregory/gregory108.html


Even Ted Kennedy-hating conservatives (at least the smart ones) agree.
http://www.lewrock"

Another Day in the Empire

Another Day in the Empire: " Alexandrovna to task on AlterNet?s forums, accusing her of sedition for simply reporting the story.
Meanwhile, the Associated Press reports this morning that Sen. Robert Menendez and Sen. Charles Schumer are using the hyped story of distant and untrained terrorists to ?offer legislative proposals to increase funding for mass transit security? in New York. ?The proposals would add $200 million to the $150 million already in the bill for subway and bus system security measures across the country; add $50 million for research and development of protective and warning systems; and add another $50 million to help local governments pay overtime to law enforcement agencies during terrorist threat-related emergencies.?
In short, the senators are exploiting the story to get more Ministry of Homeland Security largess for their district, thus demonstrating terrorism?or vastly overstated threats of terrorism, as the supposed perpetrator in the New York transit case was slapped in a Lebanese jail three months ago?may serve as a way to get cuts in the gravy train line.
Of course, with baseless and hyped terrorism stories making the rounds in the corporate media on a regular basis, ?terrorist threat-related emergencies? will become a regular and mundane occurrence, thus conditioning the public to accept more police state intrusions. Never mind the government is unable to apprehend real ?al-Qaeda? terrorists and instead depends on the FBI to entrap and frame patsies.
?One year and countless searches later, the practice [of random searches of New York subway commuters] once thought of as a temporary imposition with potential to trample civil rights remains firmly in place while barely causing a stir. The city?s top law enforcement official still insists the measure helps deter terrorism?and has no plans to halt it,? reports the Bu"

Pierre Rehov's Middle East Documentaries

Pierre Rehov's Middle East Documentaries: "The Counterterrorism Blog Interview with Pierre Rehov, documentary filmmaker, on psychology behind suicide bombings.


On July 15, I appeared on MSNBC's 'Connected' program to discuss the 7/7 London attacks (you can see video of the segment on the linked page). One of my fellow guests was Pierre Rehov, a French filmmaker who has filmed six documentaries on the intifada by going undercover in the Palestinian areas. Pierre's upcoming film, 'Suicide Killers,' is based on interviews that he conducted with the families of suicide bombers and would-be bombers in an attempt to find out why they do it. Pierre agreed to my request for a Q&A interview here about his work on the new film. Many thanks to Dean Draznin and Arlyn Riskind for helping to arrange this special interview.

What inspired you to produce 'Suicide Killers,' your seventh film?
I started working with victims of suicide attacks to make a film on PTSD (Post Traumatic Stress Disorder) when I became fascinated with the personalities of those who had committed those crimes, as they were described again and again by their victims. Especially the fact that suicide bombers are all smiling one second before they blow themselves up.

Why is this film especially important?
People don't understand the devastating culture behind this unbelievable phenomenon. My film is not politically correct because it addresses"

Why We Don't Get No Respect by Fareed Zakaria

Why We Don't Get No Respect by Fareed Zakaria: "July 3-10, 2006

Why We Don't Get No Respect
'It's not a real conversion,' remarks one senior European politician. 'It's a product of failure.'
By Fareed Zakaria

"The Bush administration must wonder these days if it has a Rodney Dangerfield problem. No matter what it does, it can't seem to get any respect. Secretary of State Condoleezza Rice has engineered a broad shift in American diplomacy over the last year, moving policy toward greater multilateralism, cooperation and common sense on Iran, North Korea and Iraq, and several other issues. And yet it hasn't produced a change in attitudes toward the United States. The recent Pew global survey documents a further drop in America's poor image abroad. President Bush tried to be conciliatory while visiting Europe last week but confronted an angry public. A poll published in the Financial Times on the eve of his visit showed that across the continent, the United States was considered a greater threat to world peace than Iran or North Korea.
Why aren't people noticing the new, improved Bush foreign policy? First, the changes coming out of Washington have been very recent. Perhaps more important, they remain incremental and incomplete. This is probably because they are still contested within the administration. Almost all of those officials who embody the administration's crude and clumsy policies of the first term-led by Donald Rumsfeld and Dick Cheney-remain in office. They merely appear to be lying low, for now. So there's a limit to how much things can change. What appears like a revolution in Bush policy the administration is now finally thinking that maybe, possibly, Guantanamo should be shut down often is just the belated arrival of common sense. "


... In other words, if you set the bar low enough, the American public might applaud you but don't expect the rest of the world to stand up and cheer just because you've improved your performance from Terrible to Merely Mediocre.

Krugman on Health Care

http://www.nybooks.com/articles/18802


The Health Care Crisis and What to Do About It
By Paul Krugman, Robin Wells

Thirteen years ago Bill Clinton became president partly because he promised to do something about rising health care costs. Although Clinton's chances of reforming the US health care system looked quite good at first, the effort soon ran aground. Since then a combination of factors—the unwillingness of other politicians to confront the insurance and other lobbies that so successfully frustrated the Clinton effort, a temporary remission in the growth of health care spending as HMOs briefly managed to limit cost increases, and the general distraction of a nation focused first on the gloriousness of getting rich, then on terrorism—have kept health care off the top of the agenda.

But medical costs are once again rising rapidly, forcing health care back into political prominence. Indeed, the problem of medical costs is so pervasive that it underlies three quite different policy crises. First is the increasingly rapid unraveling of employer- based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attack. Third is the long-term problem of the federal government's solvency, which is, as we'll explain, largely a problem of health care costs.
Save $30 on gift subscriptions

The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.

Before we talk about reform, however, let's talk about the current state of the US health care system. Let us begin by asking a seemingly naive question: What's wrong with spending ever more on health care?
1.
Is health care spending a problem?

In 1960 the United States spent only 5.2 percent of GDP on health care. By 2004 that number had risen to 16 percent. At this point America spends more on health care than it does on food. But what's wrong with that?

The starting point for any discussion of rising health care costs has to be the realization that these rising costs are, in an important sense, a sign of progress. Here's how the Congressional Budget Office puts it, in the latest edition of its annual publication The Long-Term Budget Outlook:

Growth in health care spending has outstripped economic growth regardless of the source of its funding.... The major factor associated with that growth has been the development and increasing use of new medical technology.... In the health care field, unlike in many sectors of the economy, technological advances have generally raised costs rather than lowered them.

Notice the three points in that quote. First, health care spending is rising rapidly "regardless of the source of its funding." Translation: although much health care is paid for by the government, this isn't a simple case of runaway government spending, because private spending is rising at a comparably fast clip. "Comparing common benefits," says the Kaiser Family Foundation,

changes in Medicare spending in the last three decades has largely tracked the growth rate in private health insurance premiums. Typically, Medicare increases have been lower than those of private health insurance.

Second, "new medical technology" is the major factor in rising spending: we spend more on medicine because there's more that medicine can do. Third, in medical care, "technological advances have generally raised costs rather than lowered them": although new technology surely produces cost savings in medicine, as elsewhere, the additional spending that takes place as a result of the expansion of medical possibilities outweighs those savings.

So far, this sounds like a happy story. We've found new ways to help people, and are spending more to take advantage of the opportunity. Why not view rising medical spending, like rising spending on, say, home entertainment systems, simply as a rational response to expanded choice? We would suggest two answers.

The first is that the US health care system is extremely inefficient, and this inefficiency becomes more costly as the health care sector becomes a larger fraction of the economy. Suppose, for example, that we believe that 30 percent of US health care spending is wasted, and always has been. In 1960, when health care was only 5.2 percent of GDP, that meant waste equal to only 1.5 percent of GDP. Now that the share of health care in the economy has more than tripled, so has the waste.

This inefficiency is a bad thing in itself. What makes it literally fatal to thousands of Americans each year is that the inefficiency of our health care system exacerbates a second problem: our health care system often makes irrational choices, and rising costs exacerbate those irrationalities. Specifically, American health care tends to divide the population into insiders and outsiders. Insiders, who have good insurance, receive everything modern medicine can provide, no matter how expensive. Outsiders, who have poor insurance or none at all, receive very little. To take just one example, one study found that among Americans diagnosed with colorectal cancer, those without insurance were 70 percent more likely than those with insurance to die over the next three years.

In response to new medical technology, the system spends even more on insiders. But it compensates for higher spending on insiders, in part, by consigning more people to outsider status—robbing Peter of basic care in order to pay for Paul's state-of-the-art treatment. Thus we have the cruel paradox that medical progress is bad for many Americans' health.

This description of our health care problems may sound abstract. But we can make it concrete by looking at the crisis now afflicting employer-based health insurance.
2.
The unraveling of employer-based insurance

In 2003 only 16 percent of health care spending consisted of out-of-pocket expenditures by consumers. The rest was paid for by insurance, public or private. As we'll see, this heavy reliance on insurance disturbs some economists, who believe that doctors and patients fail to make rational decisions about spending because third parties bear the costs of medical treatment. But it's no use wishing that health care were sold like ordinary consumer goods, with individuals paying out of pocket for what they need. By its very nature, most health spending must be covered by insurance.

The reason is simple: in any given year, most people have small medical bills, while a few people have very large bills. In 2003, health spending roughly followed the "80–20 rule": 20 percent of the population accounted for 80 percent of expenses. Half the population had virtually no medical expenses; a mere 1 percent of the population accounted for 22 percent of expenses.

Here's how Henry Aaron and his coauthors summarize the implication of these numbers in their book Can We Say No?: "Most health costs are incurred by a small proportion of the population whose expenses greatly exceed plausible limits on out-of-pocket spending." In other words, if people had to pay for medical care the way they pay for groceries, they would have to forego most of what modern medicine has to offer, because they would quickly run out of funds in the face of medical emergencies.

So the only way modern medical care can be made available to anyone other than the very rich is through health insurance. Yet it's very difficult for the private sector to provide such insurance, because health insurance suffers from a particularly acute case of a well-known economic problem known as adverse selection. Here's how it works: imagine an insurer who offered policies to anyone, with the annual premium set to cover the average person's health care expenses, plus the administrative costs of running the insurance company. Who would sign up? The answer, unfortunately, is that the insurer's customers wouldn't be a representative sample of the population. Healthy people, with little reason to expect high medical bills, would probably shun policies priced to reflect the average person's health costs. On the other hand, unhealthy people would find the policies very attractive.

You can see where this is going. The insurance company would quickly find that because its clientele was tilted toward those with high medical costs, its actual costs per customer were much higher than those of the average member of the population. So it would have to raise premiums to cover those higher costs. However, this would disproportionately drive off its healthier customers, leaving it with an even less healthy customer base, requiring a further rise in premiums, and so on.

Insurance companies deal with these problems, to some extent, by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums. But such screening is itself expensive. Furthermore, it tends to screen out exactly those who most need insurance.

Most advanced countries have dealt with the defects of private health insurance in a straightforward way, by making health insurance a government service. Through Medicare, the United States has in effect done the same thing for its seniors. We also have Medicaid, a means-tested program that provides health insurance to many of the poor and near poor. But nonelderly, nonpoor Americans are on their own. In practice, only a tiny fraction of nonelderly Americans (5.3 percent in 2003) buy private insurance for themselves. The rest of those not covered by Medicare or Medicaid get insurance, if at all, through their employers.

Employer-based insurance is a peculiarly American institution. As Julius Richmond and Rashi Fein tell us in The Health Care Mess, the dominant role of such insurance is the result of historical accident rather than deliberate policy. World War II caused a labor shortage, but employers were subject to controls that prevented them from attracting workers by offering higher wages. Health benefits, however, weren't controlled, and so became a way for employers to compete for workers. Once employers began offering medical benefits, they also realized that it was a form of compensation workers valued highly because it protected them from risk. Moreover, the tax law favored employer-based insurance, because employers' contributions weren't considered part of workers' taxable income. Today, the value of the tax subsidy for employer-based insurance is estimated at around $150 billion a year.

Employer-based insurance has historically offered a partial solution to the problem of adverse selection. In principle, adverse selection can still occur even if health insurance comes with a job rather than as a stand-alone policy. This would occur if workers with health problems flocked to companies that offered health insurance, while healthy workers took jobs at companies that didn't offer insurance and offered higher wages instead. But until recently health insurance was a sufficiently small consideration in job choice that large corporations offering good health benefits, like General Motors, could safely assume that the health status of their employees was representative of the population at large and that adverse selection wasn't inflating the cost of health insurance.

In 2004, according to census estimates, 63.1 percent of Americans under sixty-five received health insurance through their employers or family members' employers. Given the inherent difficulties of providing health insurance through the private sector, that's an impressive number. But it left more than a third of nonelderly Americans out of the system. Moreover, the number of outsiders is growing: the share of nonelderly Americans with employment-based health insurance was 67.7 percent as recently as 2000. And this trend seems certain to continue, even accelerate, because the whole system of employer-based health care is under severe strain.

We can identify several reasons for that strain, but mainly it comes down to the issue of costs. Providing health insurance looked like a good way for employers to reward their employees when it was a small part of the pay package. Today, however, the annual cost of coverage for a family of four is estimated by the Kaiser Family Foundation at more than $10,000. One way to look at it is to say that that's roughly what a worker earning minimum wage and working full time earns in a year. It's more than half the annual earnings of the average Wal-Mart employee.

Health care costs at current levels override the incentives that have historically supported employer-based health insurance. Now that health costs loom so large, companies that provide generous benefits are in effect paying some of their workers much more than the going wage—or, more to the point, more than competitors pay similar workers. Inevitably, this creates pressure to reduce or eliminate health benefits. And companies that can't cut benefits enough to stay competitive—such as GM—find their very existence at risk.

Rising health costs have also ended the ability of employer-based insurance plans to avoid the problem of adverse selection. Anecdotal evidence suggests that workers who know they have health problems actively seek out jobs with companies that still offer generous benefits. On the other side, employers are starting to make hiring decisions based on likely health costs. For example, an internal Wal-Mart memo, reported by The New York Times in October, suggested adding tasks requiring physical exertion to jobs that don't really require it as a way to screen out individuals with potential health risks.

So rising health care costs are undermining the institution of employer-based coverage. We'd suggest that the drop in the number of insured so far only hints at the scale of the problem: we may well be seeing the whole institution unraveling.

Notice that this unraveling is the byproduct of what should be a good thing: advances in medical technology, which lead doctors to spend more on their patients. This leads to higher insurance costs, which causes employers to stop providing health coverage. The result is that many people are thrown into the world of the uninsured, where even basic care is often hard to get. As we said, we rob Peter of basic care in order to provide Paul with state-of-the-art treatment.

Fortunately, some of the adverse consequences of the decline in employer-based coverage have been muted by a crucial government program, Medicaid. But Medicaid is facing its own pressures.
3.
Medicaid and Medicare

The US health care system is more privatized than that of any other advanced country, but nearly half of total health care spending nonetheless comes from the government. Most of this government spending is accounted for by two great social insurance programs, Medicare and Medicaid. Although Medicare gets most of the public attention, let's focus first on Medicaid, which is a far more important program than most middle-class Americans realize.

In The Health Care Mess Richmond and Fein tell us that Medicaid, like employer-based health insurance, came into existence through a sort of historical accident. As Lyndon Johnson made his big push to create Medicare, the American Medical Association, in a last-ditch effort to block so-called "socialized medicine" (actually only the insurance is socialized; the medical care is provided by the private sector), began disparaging Johnson's plan by claiming that it would do nothing to help the truly needy. In a masterful piece of political jujitsu, Johnson responded by adding a second program, Medicaid, targeted specifically at helping the poor and near poor.

Today, Medicaid is a crucial part of the American safety net. In 2004 Medicaid covered almost as many people as its senior partner, Medicare—37.5 million versus 39.7 million.

Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. Between 2000 and 2004 the number of Americans covered by Medicaid rose by a remarkable eight million. Over the same period the ranks of the uninsured rose by six million. So without the growth of Medicaid, the uninsured population would have exploded, and we'd be facing a severe crisis in medical care.

But Medicaid, even as it becomes increasingly essential to tens of millions of Americans, is also becoming increasingly vulnerable to political attack. To some extent this reflects the political weakness of any means-tested program serving the poor and near poor. As the British welfare scholar Richard Titmuss said, "Programs for the poor are poor programs." Unlike Medicare's clients—the feared senior group—Medicaid recipients aren't a potent political constituency: they are, on average, poor and poorly educated, with low voter participation. As a result, funding for Medicaid depends on politicians' sense of decency, always a fragile foundation for policy.

The complex structure of Medicaid also makes it vulnerable. Unlike Medicare, which is a purely federal program, Medicaid is a federal-state matching program, in which states provide on average about 40 percent of the funds. Since state governments, unlike the federal government, can't engage in open-ended deficit financing, this dependence on state funds exposes Medicaid to pressure whenever state budgets are hard-pressed. And state budgets are hard-pressed these days for a variety of reasons, not least the rapidly rising cost of Medicaid itself.

The result is that, like employer-based health insurance, Medicaid faces a possible unraveling in the face of rising health costs. An example of how that unraveling might take place is South Carolina's request for a waiver of federal rules to allow it to restructure the state's Medicaid program into a system of private accounts. We'll discuss later in this essay the strange persistence, in the teeth of all available evidence, of the belief that the private sector can provide health insurance more efficiently than the government. The main point for now is that South Carolina's proposed reform would seriously weaken the medical safety net: recipients would be given a voucher to purchase health insurance, but many would find the voucher inadequate, and would end up being denied care. And if South Carolina gets its waiver, other states will probably follow its lead.

Medicare's situation is very different. Unlike employer-based insurance or Medicaid, Medicare faces no imminent threat of large cuts. Although the federal government is deep in deficit, it's not currently having any difficulty borrowing, largely from abroad, to cover the gap. Also, the political constituency behind Medicare remains extremely powerful. Yet federal deficits can't go on forever; even the US government must eventually find a way to pay its bills. And the long-term outlook for federal finances is dire, mainly because of Medicare and Medicaid.

The chart in figure 1 illustrates the centrality of health care costs to America's long-term budget problems. The chart shows the Congressional Budget Office's baseline projection of spending over the next twenty-five years on the three big entitlement programs, Social Security, Medicare, and Medicaid, measured as a percentage of GDP. Not long ago advocates of Social Security privatization tried to use projections like this one to foster a sense of crisis about the retirement system. As was pointed out last year in these pages,[1] however, there is no program called Socialsecuritymedicareandmedicaid. In fact, as the chart shows, Social Security, whose costs will rise solely because of the aging of the population, represents only a small part of the problem. Most of the problem comes from the two health care programs, whose spending is rising mainly because of the general rise in medical costs.

To be fair, there is a demographic component to Medicare and Medicaid spending too—Medicare because it only serves Americans over sixty-five, Medicaid because the elderly, although a minority of the program's beneficiaries, account for most of its spending. Still, the principal factor in both programs' rising costs is what the CBO calls "excess cost growth"—the persistent tendency of health care spending per beneficiary to grow faster than per capita income, owing to advancing medical technology. Without this excess cost growth, the CBO estimates that entitlement spending would rise by only 3.7 percent of GDP over the next twenty-five years. That's a significant rise, but not overwhelming, and could be addressed with moderate tax increases and possibly benefit cuts. But because of excess cost growth the projected rise in spending is a crushing burden—about 10 percent of GDP over the next twenty-five years, and even more thereafter.

Rising health care spending, then, is driving a triple crisis. The fastest-moving piece of that crisis is the unraveling of employer-based coverage. There's a gradually building crisis in Medicaid. And there's a long-term federal budget crisis driven mainly by rising health care spending.

So what are we going to do about health care?
4.
The "consumer-directed" diversion

As we pointed out at the beginning of this essay, one of the two big reasons to be concerned about rising spending on health care is that as the health care sector grows, its inefficiency becomes increasingly important. And almost everyone agrees that the US health care system is extremely inefficient. But there are wide disagreements about the nature of that inefficiency. And the analysts who have the ear of the Bush administration are committed, for ideological reasons, to a view that is clearly wrong.

We've already alluded to the underlying view behind the Bush administration's health care proposals: it's the view that insurance leads people to consume too much health care. The 2004 Economic Report of the President, which devoted a chapter to health care, illustrated the alleged problem with a parable about the clothing industry:

Suppose, for example, that an individual could purchase a clothing insurance policy with a "coinsurance" rate of 20 percent, meaning that after paying the insurance premium, the holder of the insurance policy would have to pay only 20 cents on the dollar for all clothing purchases. An individual with such a policy would be expected to spend substantially more on clothes—due to larger quantity and higher quality purchases—with the 80 percent discount than he would at the full price.... The clothing insurance example suggests an inherent inefficiency in the use of insurance to pay for things that have little intrinsic risk or uncertainty.

The report then asserts that "inefficiencies of this sort are pervasive in the US health care system"—although, tellingly, it fails to match the parable about clothing with any real examples from health care.

The view that Americans consume too much health care because insurers pay the bills leads to what is currently being called the "consumer-directed" approach to health care reform. The virtues of such an approach are the theme of John Cogan, Glenn Hubbard, and Daniel Kessler's Healthy, Wealthy, and Wise. The main idea is that people should pay more of their medical expenses out of pocket. And the way to reduce public reliance on insurance, reformers from the right wing believe, is to remove the tax advantages that currently favor health insurance over out-of-pocket spending. Indeed, last year Bush's tax reform commission proposed taxing some employment-based health benefits. The administration, recognizing how politically explosive such a move would be, rejected the proposal. Instead of raising taxes on health insurance, the administration has decided to cut taxes on out-of-pocket spending.

Cogan, Hubbard, and Kessler call for making all out-of-pocket medical spending tax-deductible, although tax experts from both parties say that this would present an enforcement nightmare. (Douglas Holtz-Eakin, the former head of the Congressional Budget Office, put it this way: "If you want to have a personal relationship with the IRS do that [i.e., make all medical spending tax deductible] because we are going to have to investigate everybody's home to see if their running shoes are a medical expense.") The administration's proposals so far are more limited, focusing on an expanded system of tax-advantaged health savings accounts. Individuals can shelter part of their income from taxes by depositing it in such accounts, then withdraw money from these accounts to pay medical bills.

What's wrong with consumer-directed health care? One immediate disadvantage is that health savings accounts, whatever their ostensible goals, are yet another tax break for the wealthy, who have already been showered with tax breaks under Bush. The right to pay medical expenses with pre-tax income is worth a lot to high-income individuals who face a marginal income tax rate of 35 percent, but little or nothing to lower-income Americans who face a marginal tax rate of 10 percent or less, and lack the ability to place the maximum allowed amount in their savings accounts.

A deeper disadvantage is that such accounts tend to undermine employment-based health care, because they encourage adverse selection: health savings accounts are attractive to healthier individuals, who will be tempted to opt out of company plans, leaving less healthy individuals behind.

Yet another problem with consumer-directed care is that the evidence says that people don't, in fact, make wise decisions when paying for medical care out of pocket. A classic study by the Rand Corporation found that when people pay medical expenses themselves rather than relying on insurance, they do cut back on their consumption of health care—but that they cut back on valuable as well as questionable medical procedures, showing no ability to set sensible priorities.

But perhaps the biggest objection to consumer-directed health reform is that its advocates have misdiagnosed the problem. They believe that Americans have too much health insurance; the 2004 Economic Report of the President condemned the fact that insurance currently pays for "many events that have little uncertainty, such as routine dental care, annual medical exams, and vaccinations," and for "relatively low-expense items, such as an office visit to the doctor for a sore throat." The implication is that health costs are too high because people who don't pay their own medical bills consume too much routine dental care and are too ready to visit the doctor about a sore throat. And that argument is all wrong. Excessive consumption of routine care, or small-expense items, can't be a major source of health care inefficiency, because such items don't account for a major share of medical costs.

Remember the 80–20 rule: the great bulk of medical expenses are accounted for by a small number of people requiring very expensive treatment. When you think of the problem of health care costs, you shouldn't envision visits to the family physician to talk about a sore throat; you should think about coronary bypass operations, dialysis, and chemotherapy. Nobody is proposing a consumer-directed health care plan that would force individuals to pay a large share of extreme medical expenses, such as the costs of chemotherapy, out of pocket. And that means that consumer-directed health care can't promote savings on the treatments that account for most of what we spend on health care.

The administration's plans for consumer-directed health care, then, are a diversion from meaningful health care reform, and will actually worsen our health care problems. In fact, some reformers privately hope that George W. Bush manages to get his health care plans passed, because they believe that they will hasten the collapse of employment-based coverage and pave the way for real reform. (The suffering along the way would be huge.)

But what would real reform look like?
5.
Single-payer and beyond

How do we know that the US health care system is highly inefficient? An important part of the evidence takes the form of international comparisons. Table 1 compares US health care with the systems of three other advanced countries. It's clear from the table that the United States has achieved something remarkable. We spend far more on health care than other advanced countries—almost twice as much per capita as France, almost two and a half times as much as Britain. Yet we do considerably worse even than the British on basic measures of health performance, such as life expectancy and infant mortality.

One might argue that the US health care system actually provides better care than foreign systems, but that the effects of this superior care are more than offset by unhealthy US lifestyles. Ezra Klein of The American Prospect calls this the "well-we-eat-more-cheeseburgers" argument. But a variety of evidence refutes this argument. The data in Table 1 show that the United States does not stand out in the quantity of care, as measured by such indicators as the number of physicians, nurses, and hospital beds per capita. Nor does the US stand out in terms of the quality of care: a recent study published in Health Affairs that compared quality of care across advanced countries found no US advantage. On the contrary, "the United States often stands out for inefficient care and errors and is an outlier on access/cost barriers."[2] That is, our health care system makes more mistakes than those of other countries, and is unique in denying necessary care to people who lack insurance and can't pay cash. The frequent claim that the United States pays high medical prices to avoid long waiting lists for care also fails to hold up in the face of the evidence: there are long waiting lists for elective surgery in some non-US systems, but not all, and the procedures for which these waiting lists exist account for only 3 percent of US health care spending.[3]

So why does US health care cost so much? Part of the answer is that doctors, like other highly skilled workers, are paid much more in the United States than in other advanced countries. But the main source of high US costs is probably the unique degree to which the US system relies on private rather than public health insurance, reflected in the uniquely high US share of private spending in total health care expenditure.

Over the years since the failure of the Clinton health plan, a great deal of evidence has accumulated on the relative merits of private and public health insurance. As far as we have been able to ascertain, all of that evidence indicates that public insurance of the kind available in several European countries and others such as Taiwan achieves equal or better results at much lower cost. This conclusion applies to comparisons within the United States as well as across countries. For example, a study conducted by researchers at the Urban Institute found that

per capita spending for an adult Medicaid beneficiary in poor health would rise from $9,615 to $14,785 if the person were insured privately and received services consistent with private utilization levels and private provider payment rates.[4]

The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting adverse selection, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.

At the same time, the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers.

The second source of savings in a system of public health insurance is the ability to bargain with suppliers, especially drug companies, for lower prices. Residents of the United States notoriously pay much higher prices for prescription drugs than residents of other advanced countries, including Canada. What is less known is that both Medicaid and, to an even greater extent, the Veterans' Administration, get discounts similar to or greater than those received by the Canadian health system.

We're talking about large cost savings. Indeed, the available evidence suggests that if the United States were to replace its current complex mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall. That's what happened in Taiwan, which adopted a single-payer system in 1995: the percentage of the population with health insurance soared from 57 percent to 97 percent, yet health care costs actually grew more slowly than one would have predicted from trends before the change in system.

If US politicians could be persuaded of the advantages of a public health insurance system, the next step would be to convince them of the virtues, in at least some cases, of honest-to-God socialized medicine, in which government employees provide the care as well as the money. Exhibit A for the advantages of government provision is the Veterans' Administration, which runs its own hospitals and clinics, and provides some of the best-quality health care in America at far lower cost than the private sector. How does the VA do it? It turns out that there are many advantages to having a single health care organization provide individuals with what amounts to lifetime care. For example, the VA has taken the lead in introducing electronic medical records, which it can do far more easily than a private hospital chain because its patients stay with it for decades. The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.

In summary, then, the obvious way to make the US health care system more efficient is to make it more like the systems of other advanced countries, and more like the most efficient parts of our own system. That means a shift from private insurance to public insurance, and greater government involvement in the provision of health care—if not publicly run hospitals and clinics, at least a much larger government role in creating integrated record-keeping and quality control. Such a system would probably allow individuals to purchase additional medical care, as they can in Britain (although not in Canada). But the core of the system would be government insurance—"Medicare for all," as Ted Kennedy puts it.

Unfortunately, the US political system seems unready to do what is both obvious and humane. The 2003 legislation that added drug coverage to Medicare illustrates some of the political difficulties. Although it's rarely described this way, Medicare is a single-payer system covering many of the health costs of older Americans. (Canada's universal single-payer system is, in fact, also called Medicare.) And it has some though not all the advantages of broader single-payer systems, notably low administrative costs.

But in adding a drug benefit to Medicare, the Bush administration and its allies in Congress were driven both by a desire to appease the insurance and pharmaceutical lobbies and by an ideology that insists on the superiority of the private sector even when the public sector has demonstrably lower costs. So they devised a plan that works very differently from traditional Medicare. In fact, Medicare Part D, the drug benefit, isn't a program in which the government provides drug insurance. It's a program in which private insurance companies receive subsidies to offer insurance—and seniors aren't allowed to deal directly with Medicare.

The insertion of private intermediaries into the program has several unfortunate consequences. First, as millions of seniors have discovered, it makes the system extremely complex and obscure. It's virtually impossible for most people to figure out which of the many drug plans now on offer is best. This complexity, coupled with the Katrina-like obliviousness of administration officials to a widely predicted disaster, also led to the program's catastrophic initial failure to manage the problem of "dual eligibles," i.e., older Medicaid recipients whose drug coverage was supposed to be transferred to Medicare. When the program started up in January, hundreds of thousands of these dual eligibles found that they had fallen through the cracks, that their old coverage had been canceled but their new coverage had not been put into effect.

Second, the private intermediaries add substantial administrative costs to the program. It's reasonably certain that if seniors had been offered the choice of receiving a straightforward drug benefit directly from Medicare, the vast majority would have chosen to pass up the private drug plans, which wouldn't have been able to offer comparable benefits because of their administrative expenses. But the drug bill avoided that embarrassing outcome by denying seniors that choice.

Finally, by fragmenting the purchase of drugs among many private plans, the administration denied Medicare the ability to bargain for lower prices from the drug companies. And the legislation, reflecting pressures from those companies, included a provision specifically prohibiting Medicare from intervening to help the private plans get lower prices.

In short, ideology and interest groups led the Bush administration to set up a new, costly Medicare benefit in such a way as to systematically forfeit all the advantages of public health insurance.
6.
Beyond reform: How much health care should we have?

Imagine, for a moment, that some future US administration were to push through a fundamental reform of health care that covered all the uninsured, replaced private insurance with a single-payer system, and took heed of the VA's lessons about the advantages of integrated health care. Would our health care problems be solved?

No. Although real reform would bring great improvement in our situation, continuing technological progress in health care still poses a deep dilemma: How much of what we can do should we do?

The medical profession, understandably, has a bias toward doing whatever will bring medical benefit. If that means performing an expensive surgical procedure on an elderly patient who probably has only a few years to live, so be it. But as medical technology advances, it becomes possible to spend ever larger sums on medically useful care. Indeed, at some point it will become possible to spend the entire GDP on health care. Obviously, we won't do this. But how will we make choices about what not to do?

In a classic 1984 book, Painful Prescription: Rationing Hospital Care, Henry Aaron and William Schwartz studied the medical choices made by the British system, which has long operated under tight budget limits that force it to make hard choices in a way that US medical care does not. Can We Say No? is an update of that work. It's a valuable survey of the real medical issues involved in British rationing, and gives a taste of the dilemmas the US system will eventually face.

The operative word, however, is "eventually." Reading Can We Say No?, one might come away with the impression that the problem of how to ration care is the central issue in current health care policy. This impression is reinforced by Aaron and his co-authors' decision to compare the US system only with that of Britain, which spends far less on health care than other advanced countries, and correspondingly is forced to do a lot of rationing. A comparison with, say, France, which spends far less than the United States but considerably more than Britain, would give a very different impression: in many respects France consumes more, not less, health care than the United States, but it can do so at lower cost because our system is so inefficient.

The result of Aaron et al.'s single-minded focus on the problem of rationing is a somewhat skewed perspective on current policy issues. Most notably, they argue that the reason we need universal health coverage is that a universal system can ration care in a way that private insurance can't. This seems to miss the two main immediate arguments for universal care —that it would cover those now uninsured, and that it would be cheaper than our current system. A national health care system will also be better at rationing when the time comes, but that hardly seems like the prime argument for adopting such a system today.

Our Princeton colleague Uwe Reinhardt, a leading economic expert on health care, put it this way: our focus right now should be on eliminating the gross inefficiencies we know exist in the US health care system. If we do that, we will be able to cover the uninsured while spending less than we do now. Only then should we address the issue of what not to do; that's tomorrow's issue, not today's.
7.
Can we fix health care?

Health policy experts know a lot more about the economics of health care now than they did when Bill Clinton tried to remake the US health care system. And there's overwhelming evidence that the United States could get better health care at lower cost if we were willing to put that knowledge into practice. But the political obstacles remain daunting.

A mere shift of power from Republicans to Democrats would not, in itself, be enough to give us sensible health care reform. While Democrats would have written a less perverse drug bill, it's not clear that they are ready to embrace a single-payer system. Even liberal economists and scholars at progressive think tanks tend to shy away from proposing a straightforward system of national health insurance. Instead, they propose fairly complex compromise plans. Typically, such plans try to achieve universal coverage by requiring everyone to buy health insurance, the way everyone is forced to buy car insurance, and deal with those who can't afford to purchase insurance through a system of subsidies. Proponents of such plans make a few arguments for their superiority to a single-payer system, mainly the (dubious) claim that single-payer would reduce medical innovation. But the main reason for not proposing single-payer is political fear: reformers believe that private insurers are too powerful to cut out of the loop, and that a single-payer plan would be too easily demonized by business and political propagandists as "big government."

These are the same political calculations that led Bill Clinton to reject a single-payer system in 1993, even though his advisers believed that a single-payer system would be the least expensive way to provide universal coverage. Instead, he proposed a complex plan designed to preserve a role for private health insurers. But the plan backfired. The insurers opposed it anyway, most famously with their "Harry and Louise" ads. And the plan's complexity left the public baffled.

We believe that the compromise plans being proposed by the cautious reformers would run into the same political problems, and that it would be politically smarter as well as economically superior to go for broke: to propose a straightforward single-payer system, and try to sell voters on the huge advantages such a sys-tem would bring. But this would mean taking on the drug and insur-ance companies rather than trying to co-opt them, and even progressive policy wonks, let alone Democratic politicians, still seem too timid to do that.

So what will really happen to American health care? Many people in this field believe that in the end America will end up with national health insurance, and perhaps with a lot of direct government provision of health care, simply because nothing else works. But things may have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology.

—February 22, 2006
Notes

[1] "America's Senior Moment," The New York Review, March 10, 2005.

[2] Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordon Peugh, and Karen Davis, "Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries," Health Affairs Web exclusive, November 3, 2005.

[3] Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters, "Health Spending in the United States and the Rest of the Industrialized World," Health Affairs, Vol. 24, No. 4 (July/August 2005), pp. 903–914.

[4] "Medicaid: A Lower-Cost Approach to Serving a High-Cost Population," policy brief by the Kaiser Commission on Medicaid and the Uninsured, March 2004.