The Elephant in the Health Insurance Room
The CBO is an imperfect body and should be recognized as such.
JOHN STEELE GORDON 2017-03-16
Washington is all atwitter (a word coined in 1833, but with new meaning in the 21st century) over the Congressional Budget Office scoring of the health bill introduced in the House recently. As has been pointed out, the CBO has a terrible track record when it comes to predicting the future ten years out. It predicted far higher enrollment in Obamacare than came about, so why should we put any faith in its prediction of lost coverage under the new health bill?
When it comes right down to it, of course, ten-year projections aren’t worth the powder to blow them up, as a simple thought experiment shows. Had the CBO existed in 1928, how accurate do you think their ten-year projections made that year would have been?
The CBO also badly missed the mark when it came to Medicare Part D (drug coverage) that started in 2006. The CBO estimated that in the first year there would be 7 million enrollees. There were 24 million. And while the CBO is notorious for underestimating future costs of government programs, it overestimated costs ten years out for Medicare Part D by a whopping 40 percent.
The main reason costs came in much lower than expected is that Medicare Part D allows insurance companies providing the coverage to compete with each other in terms of price. What a concept! That’s why every fall, during the period when people can enroll, drop out, or change providers, television is crawling with insurance company ads trying to entice customers to their Medicare Part D coverage.
When was the last time you saw an ad for regular health insurance? Exactly never. There is no price competition in the health insurance market, which goes a very long way to explaining why medical costs keep ratcheting up. So the elephant in the room of health insurance reform, the elephant that almost everyone in Washington is studiously ignoring, is the lack of price discovery.
As former senator Tom Coburn (a physician by training) explains, as long as the costs of medical procedures are kept secret, no health insurance reform is really possible. Make health care providers post their prices, and those prices, now wildly disparate, will quickly begin to converge towards the low end once customers can find out where they can get a better deal.
The problem, of course, is that insurance companies and hospitals don’t want prices to be public and they are both very powerful lobbies in Washington. Welcome to democracy.
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The Elephant in the Health Insurance Room
Must-Reads from Magazine
The Conscious Act of Forgetting
A false innocence.
Noah Rothman 2018-04-20
Trayon White, the Washington D.C. councilman who earned national scorn last month when he blamed this winter’s persistent snow on the work of a shadowy cabal of Jewish conspirators, is trying to broaden his perspective. His unpublicized attempts at penance have included attending a Passover seder, meeting with local Jewish leaders, and making a sojourn to the U.S. Holocaust Memorial Museum. That last bit went about as well as you might expect.
“Are they protecting her?” White asked his tour guide. He was referring to a 1935 photograph that shows a woman being paraded through the streets by uniformed Sturmabteilung. Around the woman’s neck was a sign that read, “I am a German girl and allowed myself to be defiled by a Jew.” White adhered to his interpretation even after it was explained to him that this was an effort to dehumanize Jews and stigmatize associations with them.
Discomfited by the experience, White apparently snuck out of the tour early. The staffers he left behind were, however, no better educated about one of the 20th Century’s greatest crimes than their boss. When they were confronted by imagery of and a lecture on the Warsaw ghetto—one of many walled enclaves into which Jews were packed and denied food and medicine before they were all eventually sent to the death camps—they seemed perplexed. One asked if this was the Nazi version of a “gated community.”
Though it remains unclear if these experiences convinced White to abandon his prejudices, he did tell reporters that he was grateful to have met a lot of “good Jews.”
As the 20th century’s horrors fade from living memory, columnists and commentators have settled on the word “forgetting” to describe the powerful way in which nostalgia cleanses the memory of trauma. Increasingly, the atrocities of that period and the mock science that justified them exist only on grainy, black-and-white celluloid. But to call it a “forgetting” implies passivity. In White’s case, forgetting appears to be a choice, which isn’t forgetting at all. It’s more like banishment.
Unfortunately, Councilman White—who, at age 33, is representative of a generation with almost no memory of the great ideological struggles of the last century—is in voluminous company. According to the Claims Conference, 40 percent of White’s fellow Millennials could not name a single Nazi extermination camp and 41 percent think the number of Jews who died in the Holocaust has been wildly exaggerated. This is disturbing, in part, because it is the result of a conscious effort.
Absorbing details about the Holocaust isn’t something that can only be accomplished in AP history classes or amid undergraduate seminars dedicated to the topic. These experiences are woven into our shared cultural heritage. To be unable to name Auschwitz, Sobibór, Bergen-Belsen, or Dachau is to have somehow failed to consume or internalize any number of books, films, and graphic novels set at these bleak outposts. Questioning the number of Jews targeted for death in the Holocaust may be the result of consuming conspiratorial and anti-Semitic media outlets. But it’s more likely that responses like these may be an effort on the part of the under-educated to appear sophisticated. After all, centrism and moderation are virtues, and the truth of a contested claim lies somewhere in between two poles. According to such thinking, the truth of the Holocaust is probably some middle ground between no dead Jews and six million killed.
This is laziness in pursuit of a shortcut to erudition, and it is the same phenomenon that has all but successfully rehabilitated the ideology responsible for the greatest horrors of the last century: socialism.
Two years after Senator Bernie Sanders ran a surpassingly competitive campaign for the Democratic Party’s presidential nomination as an unapologetic “Democratic Socialist,” a crop of young office-seekers are attempting to duplicate his success. The New York Times profile of these far-left candidates notes that their supporters, “many of them millennials,” are drawn to the notion that the government should be empowered to “combat income inequality” and rescue them from a competitive job market and its associated costs (student loans, high rent in safe neighborhoods, etc.). These grievances are legitimate, of course. So, too, were the grievances that brought oppressive governments to the fore not just in the Soviet Union and Weimar Germany but in Western Europe (albeit with markedly less bloodshed).
Surveys have routinely found that young adults’ fondness for socialism is directly proportional to their inability to accurately define it. Conceptually, millennials are more predisposed than their elders to oppose government intervention in the private sector, but that concept has to be spelled out before young adult respondents express reservations. Millennials are apt to describe socialism as some form of “togetherness,” “charity,” or simply support for a robust social safety net. These are not jackbooted Tankies eager to defend ethnic cleansings or murderous political purges. These are not the 20th-century intellectuals who convinced themselves of the legitimacy of bloodshed in defense of a new world order. They are, however, the desired product of generations who devoted themselves to scrubbing socialism’s excesses from shared cultural touchstones.
Socialism’s revival is the product of a tireless effort by fellow travelers in the Western intellectual and artistic firmament to wash the blood stains away. Millennials who find themselves attracted to it today are unfamiliar with its legacy, and that is by design. So many of their elders looked away when the last century’s self-described socialists repurposed ancient ethnic grievances as class warfare and, at long last, got their revenge. Today, as the uncompromising logic of “Never Again” presents this generation with a series of unwanted policy dilemmas, the Holocaust is fading from memory, too. That is not the result of a passive process. Forgetting is a choice, and we must treat it like one.
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The ADL Smears Mike Pompeo
Partisan hackery.
Sohrab Ahmari 2018-04-19
When the Anti-Defamation League tapped Jonathan Greenblatt to serve as its CEO in 2015, there were concerns that the Obama White House alumnus would turn the venerable civil-rights group into an arm of the Democratic Party. Alas, those concerns have proved well-founded. Witness Greenblatt’s letter this week opposing Mike Pompeo, President Trump’s choice for America’s next secretary of state, for the flimsiest of reasons.
Running to more than 5,000 words, the letter accuses the CIA director of fanning bigotry with irresponsible statements about radical Islam. Greenblatt goes so far as to suggest that Pompeo’s attitudes are redolent of classic anti-Semitism. That’s a serious charge. It is also utterly baseless. If Pompeo is “Islamophobic,” then so is the ADL. As it turns out, the secretary of state-designate and the ADL have remarkably similar views on the nature of the Islamist threat.
Let’s compare Pompeo’s allegedly culpable statements with the ADL’s long record of public advocacy on radical Islam, the homegrown Islamist threat, and Islamist ideologues and networks operating in the U.S. homeland.
The Silence of American Muslim Organizations
The ADL fulminates against Pompeo for suggesting that some American Muslim organizations don’t go far enough in condemning terrorism and the ideologies that inspire it. Here’s Greenblatt’s letter:
In the aftermath of the 2013 Boston Marathon bombing when responsible leaders were attempting to calm interfaith tensions, Mr. Pompeo did the opposite. . . . Despite the numerous and repeated condemnations of extremism that Muslims and Muslim leaders had voiced, then-Rep. Pompeo said that ‘silence in the face of extremism coming from the best funded Islamic advocacy organizations, and many mosques across America, is absolutely deafening.’
Yet the ADL has also criticized American Muslim organizations for failing to condemn terrorism unequivocally, and in terms that have been as harsh if not harsher than Pompeo’s. Consider the ADL’s profile of the Council on American Islamic Relations, or CAIR, one of the largest and most visible of such groups. “CAIR’s stated commitment to ‘justice and mutual understanding,’” the ADL argued,
. . . is undermined by its anti-Israel agenda. . . . While CAIR has denounced specific acts of terrorism in the U.S. and abroad, for many years it refused to unequivocally condemn Palestinian terror organizations and Hebzollah by name. . . . CAIR’s more recent criticism on Hezbollah began only when the terrorist organization stopped focusing solely on Israel and began engaging in military operations against Sunni Muslim fighters in Syria and Iraq.
In 2010—three years before Pompeo made his speech on the House floor calling on American Muslim organizations to more forcefully condemn terror—the ADL described major Muslim-American organizations’ anti-radicalization efforts as “a sham.” The ADL news release read:
As the number of American Muslim extremists allegedly involved in terror plots in the U.S. and abroad continues to grow, major Muslim-American organizations have publicly acknowledged the existence of a problem in their community and vowed to tackle it head on. But the initial efforts to root out radicalization—announced by a few of these groups in the wake of the arrests in Pakistan of five Muslim-American students from Virginia for allegedly attempting to join a terrorist group—has proven to be a sham and a cover for anti-Semitism and extremism, according to the Anti-Defamation League.
So much for Greenblatt’s claim that Pompeo’s concerns about Muslim organizations made the then-congressman an outlier in the American conversation about Islamism and terror. That is, unless Greenblatt is willing to concede that the ADL, too, was bigoted and out of the mainstream as recently as a few years ago.
Homegrown Radical Islamic Networks
The ADL’s letter also takes Pompeo to task for allegedly promoting a “conspiracy theory that a fifth column of Muslims exists in the United States with the express purpose of undermining the country.” To prove the charge, the ADL quotes from a 2014 interview with Pompeo in which he said:
There are organizations and networks here in the United States tied to radical Islam in deep and fundamental ways, and they’re not just in places like Libya, and Syria, and Iraq, but in places like Coldwater, Kansas and small towns all throughout America. This network is real. The efforts to expand the caliphate are not limited to the physical geography of the Middle East or in the other places where there are large Muslim majorities.
The ADL also quoted from a 2015 speech in which then-Congressman Pompeo said:
I don’t think that you can define the challenge by geography but rather we have a military, political, and diplomatic challenge and a faith-driven challenge to figure out how to contain what is not a small minority inside the Islamic faith that believes in much of what it is we are facing in the Middle East today and the threats that we face here in America as well.
To summarize Pompeo’s views, he believes, first, that there are radical-Islamic networks that operate in the American heartland, and, second, that the Islamist threat is not a geographic one but an ideological and globe-spanning challenge to Western security. Well, the ADL has long suggested the same things, sometimes in nearly identical language.
Here’s a statement from an ADL report marking a decade after 9/11:
The ideologies of extreme intolerance that motivated the 19 hijackers responsible for carrying out the September 11, 2001, terrorist attacks continue to pose a serious threat to the U.S.
While no attacks of that magnitude have been successful on American soil in the ten years since 9/11, one of the most striking elements of today’s terror threat picture is the role that a growing number of American citizens and residents motivated by radical interpretations of Islam have played in criminal plots to attack Americans in the United States and abroad.
Although they do not constitute a fully coherent movement in the U.S., more and more American citizens and residents are being influenced by ideologies that justify and sanction violence commonly propagated by Islamic terrorist movements overseas.
In addition to disagreements with perceived American actions against Muslims around the world, these extremists believe that the West (and America specifically) is at war with Islam and it is the duty of Muslims to defend the global Muslim community through violent means. They come from diverse backgrounds and, as a whole, do not easily fit a specific profile. About one fourth are converts to Islam who embrace the most extreme interpretations of the religion.
Likewise, in a 2013 report on homegrown Islamism that was published in the wake of the Boston Marathon bombings, the ADL noted:
The Boston Marathon bombing in April 2013 served as a tragic reminder of the persistent threat posed to the United States by homegrown extremists motivated by the ideologies and objectives commonly propagated by Islamic terrorist movements overseas. The bombing also underscored the significant influence and impact of online terrorist propaganda on a new generation of homegrown Islamic extremists.
As Internet proficiency and the use of social media grow ever-more universal, so too do the efforts of terrorist groups to exploit new technology in order to make materials that justify and sanction violence more accessible and practical. Terrorist groups are not only using Facebook, Twitter, YouTube, and various other platforms to spread their messages, but also to actively recruit adherents who live in the communities they seek to target. . . .
While the fundamental ideological content of terrorist propaganda has remained consistent for two decades—replete with militant condemnations of perceived American transgressions against Muslims worldwide, appeals for violence and anti-Semitism—terrorists groups are now able to reach, recruit and motivate homegrown extremists more quickly and effectively than ever before by adapting their messages to new technology. One clear indication of the success of these efforts is the number of homegrown extremists that have been found in possession of terrorist propaganda.
Although most homegrown Islamic extremists have lacked the capacity to carry out violent attacks—plots have been foiled by law enforcement at various stages—the Boston bombing showed how two brothers influenced by online terrorist propaganda can terrorize our communities and undermine our security.
The ADL, then, acknowledged the ideological nature of the Islamist threat and its homegrown dimension. What is sauce for the goose is sauce for the gander. If Pompeo’s remarks are beyond the pale, so are the ADL’s positions. Senators weighing Pompeo’s fitness to serve as America’s top diplomat can be forgiven for dismissing this cheap attempt at sliming him. It is the ADL’s donors and supporters who should be asking tough questions—of Greenblatt.
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The Confused and the Confusing
"I don't get confused."
Noah Rothman 2018-04-19
Nikki Haley, America’s ambassador to the United Nations, is not confused. “With all due respect,” she said in a pithy and empowering statement to Fox News anchor Dana Perino, “I don’t get confused.”
She issued this pointed assertion in response to National Economic Council chief Larry Kudlow, who accused Haley of getting “ahead of the curve” and suffering a “momentary confusion” when she announced on Sunday morning that the Trump administration planned more punitive sanctions on Moscow over its support for the murderous Assad regime in Syria. But Haley seems to have been on firm ground when she made those remarks.
Shortly after Donald Trump’s address last Friday night announcing strikes on Syrian targets, the Republican National Committee distributed to its surrogates a set of “White House talking points” previewing a new round of “specific additional sanctions against Russia.” President Donald Trump reportedly intervened as late as Sunday night to put a halt to a policy that was all but in motion. The only person who was confused here seems to have been the president. Kudlow later apologized for his remarks about Haley’s competence.
The bewildering 24-hour period between the coordinated announcement of new Russia sanction and the administration’s retreat from that policy is typical of this administration. The source of the White House’s confusion is not hard to identify.
Before Haley suffered the insults of those dedicated to insulating Donald Trump from the consequences of his indecision and ambiguity, former Secretary of State Rex Tillerson was the man in the barrel. Tillerson surely thought he was representing American diplomatic interests when he revealed last September that the U.S. was “probing” North Korea for an opening that might lead to direct negotiations. “Save your energy, Rex,” the president tweeted. The comment cut the legs out from under his chief diplomat, who he said was “wasting his time” by seeking talks with the Kim regime.
When Tillerson conspicuously continued to lobby the North Korean government for an introductory first meeting “without precondition,” a spokesperson for the president’s National Security Council corrected him. There could be no talks, the NSC spokesman said, until North Korea stops testing missiles and nuclear devices for an unspecified period of time. “The President’s views on North Korea have not changed,” the White House said. But the White House was engaging in back-channel communications with the Kim regime with the goal of a face-to-face encounter between both nations’ principals.
The president’s Northeast Asia policy is about as clear as his Middle East policy. When Trump announced to an Ohio crowd in late March that the U.S. would withdraw its approximately 2,000 troops from Syria “very soon,” to let “the other people take care of it,” it came as a surprise to his administration. State Department spokeswoman Heather Nauert said she was “unaware” of any plan to pull troops out of Syria, and Pentagon officials had spent that same week previewing plans to augment U.S. deployments to Syria. The White House later disclosed that Trump had been convinced of the virtue of maintaining a footprint in Syria indefinitely.
In fact, the president has a bad habit of forcing his staff and allies to clean up after his messes.
When Donald Trump explicitly agreed to a Democratic proposal to make the Deferred Action for Childhood Arrival program permanent without reciprocal border security legislation at an on-camera meeting with legislators, he had to be reminded that his comment did not reflect the GOP’s position. The transcript of the event was initially written to omit the president’s injudicious comments.
In a similar meeting with lawmakers regarding American gun policy, Donald Trump declared his support for legislative measures that would expeditiously strip guns from the hands of potentially dangerous people. Due process rights, he said, were a secondary consideration. The remarks sent Trump’s GOP allies reeling, and White House Press Secretary Sarah Huckabee Sanders quickly dialed the president’s position back to one that was recognizably Republican.
Former Press Secretary Sean Spicer has had to correct the president for misstating the number of Guantanamo Bay detainees released under the Obama administration. In response to Trump’s comments about the value of raciallycharged protests that culminated in violence in Charlottesville, Virginia, last summer, the White House released a statement clarifying that Trump “of course” condemns white supremacists.
The White House has had to walk back Trump’s criticism of German trade policy, his claims about specific terrorist events in Sweden, his support for blanket tariffs on a variety of commodities, his intention to leave three college basketball players in a Chinese prison in response to personal criticism from one of the player’s fathers, and a statement about whether or not the travel ban was (as Trump called it) a “ban.”
The White House corrected the president’s myriad eye-popping assertions made before an audience of Boy Scouts last year, confirming that no one called Trump to congratulate him on “the greatest speech that was ever made” before this audience. They were also compelled to admit that Mexican President Enrique Peña Nieto did not call Trump to confess that the flow of Central American migrants north through Mexico had ebbed to a trickle as a result of Trump’s policies on the border.
Trump has reserved for himself both sides of the issue when it’s come to major U.S. policy initiatives such removing the U.S. from the Paris Climate Accords, corporate tax rates, whether ObamaCare will be stabilized or allowed to “explode,” and almost every aspect of America’s strategic relationship with Russia. Trump has promised to eliminate the carried-interest loophole, reduce individual tax brackets to just three tiers, and create targeted tax credits for working parents with elderly or young dependents—proposals Congress simply ignored.
If there is confusion within the administration as to what Donald Trump’s policy preferences are at any given moment, the president only has himself to blame. Nikki Haley might have been the first administration official to refuse to take the fall for Trump’s lack of clarity, but she is unlikely to be the last.
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Identity Politics in the Hereafter
Grievance even in grieving.
Sohrab Ahmari 2018-04-18
As if the peddlers of identity politics hadn’t done enough to poison Western culture in the here and now, they have now set their sights on the afterlife.
That is the metaphysical meaning of the expression “rest in power,” which has replaced the old “rest in peace” among the woke crowd. When a member of an intersectionally oppressed group passes away, a properly woke mourner offers “rest in power” in condolence, in the solemn hope that the departed might take up in the hereafter the power which was denied him or her (or xir) in this earthly vale of tears.
Thus, when Nelson Mandela’s second wife, Winnie Madikizela-Mandela, passed away earlier this month, the appropriate condolence was “rest in power.” Ditto for Vel Phillips, the African-American judge and Wisconsin secretary of state, who died on Tuesday. Even the late Barbara Bush received a “rest in peace and power” farewell and from none other than the Women’s March, though use of the expression in the former first lady’s case was not without controversy. Many wokesters took to Twitter to object, and they didn’t even need to spell out why: Barbara Bush was white and, worse, a Republican. Better that she rest without power—if at all!
The attempt to carry the struggle beyond the grave is a reminder that liberal identity politics is a quasi-religious or quasi-spiritual movement. On Earth, it makes radical claims for group justice, even as it denies any universal standard of justice. In the realm beyond death, it restages the same old campus and Twitter battles against structures of oppression. Even in the afterlife, we are supposed to check our privileges, unpack our biases, and problematize and dismantle hierarchies. Even the afterlife is the battlefield of race against race, sex against sex, trans against cis, and so on.
Onward to the beyond, then, comrades! Amen, I say to you, today you will be with me in Paradise fighting the patriarchy.
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Pompeo and Circumstance
Podcast: North Korea talks and Trump's legal troubles.
John Podhoretz 2018-04-18On our latest COMMENTARY podcast we wonder at the fact that Democrats are going to vote en masse against Mike Pompeo as secretary of state for no real reason other than that they don’t like Trump—and how this marks the fulfillment of a degradation in the advise-and-consent process that’s been accelerating for the past couple of decades. Also, we talk about Stormy Daniels, alas. Give a listen.
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