The Elephant in the Health Insurance Room
The CBO is an imperfect body and should be recognized as such.
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.
The Elephant in the Health Insurance Room
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The Insufferable Tedium of Media v. White House
The War of the Poses.
Recently, the White House has adopted a habit that seems designed to maximize the frustration of the reporters who cover it. Occasionally, the administration flirts with doing away with the daily press briefing altogether or forcing reporters to submit written questions in advance. When reporters complain, the press briefing returns, but with no cameras allowed.
If the administration is feeling kind, it will allow the audio of the briefing to be recorded. Occasionally, reporters are permitted a still picture or two. This gesture is, however, only offered so as to not be so withholding that the targets of their psychological abuse lose interest in the game. Only when they truly want to hammer home a message will the White House appear to relent to journalists’ complaints and revert to the standard briefing format. Even then, it’s often only to castigate the reporters in attendance.
At Tuesday’s on-camera briefing, there was only one truly pressing subject. No, not the health care reform bill that is stalled in the Senate and could scuttle the president’s legislative agenda if it fails. Media bias was the topic du jour, as it is almost every jour.
Last week, CNN reported that Trump campaign advisor Anthony Scaramucci had ties to a state-run investment fund in Moscow. That story was based on false information and was retracted in its entirety. In a moment of rare professional penance, CNN accepted the resignations of three high-profile reporters and editors.
This display of loose journalistic ethics has become typical of reporting on Trump-Russian connections. The subjects of this smear, both those libeled directly and tangentially, have every right to be frustrated. CNN behaved admirably in facing its failure head-on. Both the president and his spokesperson, Sarah Huckabee Sanders, took the opportunity to be graceless.
Donald Trump responded to the reporters’ dismissal by seeking to maximize his political advantage and declaring all stories related to his campaign’s interactions with Russian officials “fake news!” When she was asked why CNN’s response to their employees’ unprofessional conduct wasn’t good enough for the president, Huckabee Sanders attacked CNN for its serial inaccuracy. She then advised the American public to avail themselves of a video “circulating now” from James O’Keefe’s Project Veritas that purports to show a CNN producer objecting to his network’s ratings-driven obsession with the investigations into Russia and Trump. “Whether it’s accurate or not, I don’t know,” Huckabee Sanders added.
At this point, Sentinel Newspapers’ Brian Karem had had enough. “What you just did is inflammatory to people all over the country who look at it and say, see, once again, the president’s right and everybody else out here is fake media,” Karem averred, “and everybody in this room is only trying to do their job.” The video of his remarks went viral, reporters and conservative pundits flew to their respective corners, and the familiar ritual of public posturing had begun.
Rarely has a perfectly symbiotic relationship been so antagonistic. Or, at least, rarely has that contrivance been so irritating.
Members of this administration might feel legitimately transgressed against when they are accused of conspiring to undermine American sovereignty—particularly if they believe those allegations to be false. And after spending the last 150 plus days being lectured about their corrupt and dishonest employers, friends, and colleagues, members of the press might sometimes put aside professional courtesies and become a little passionate. Those traits are honest and forgivable. Less defensible is the affectation of grievance.
“Does this feel like America?” barked the increasingly hysterical CNN reporter Jim Acosta. “Where the White House takes [questions] from conservatives, then openly trashes the news media in the briefing room?” Adopting the language of the over-caffeinated partisans who make up The Resistance has become a feature of Acosta’s rhetoric since the White House began to draw the curtain over the daily press briefing.
In fact, this is what a traditionally adversarial relationship between reporter and political institution looks like. It is a testament to how compromising the Obama years were for both the press and political professionals that this dynamic is so alien neither side appears to recognize it.
Avoiding Obama’s Mistakes in Syria
A doctrine is taking shape.
With all of Washington consumed by the effort to craft and pass health-care legislation, the Trump White House appeared to catch the country’s political establishment off guard when it announced that the crisis in Syria was again reaching a crescendo.
In a prepared statement, White House Press Secretary Sean Spicer revealed that the Bashar al-Assad regime was engaged in “potential preparations” to execute “another chemical attack” on civilians. “[If] Mr. Assad conducts another mass murder attack using chemical weapons, he and his military will pay a heavy price,” the statement read.
Hours later, the Pentagon expounded upon the nature of the threat. “We have seen activity at Shayrat Airfield,” said Captain Jeff Davis, “associated with chemical weapons.” The Shayrat Air Base outside the city of Homs is the same airfield that was targeted in April with 59 Tomahawk cruise missiles.
For all the frustration over the Trump administration’s failure to craft a coherent strategy to guide American engagement in the Syrian theater, the White House has communicated to the Assad regime a set of clear parameters in which it is expected to operate. That is a marked improvement over the approach taken by Barack Obama’s administration.
When American forces in Syria or those under the American defense umbrella are threatened by the Assad regime or its proxies, American forces will take action. On several occasions, U.S. forces have made kinetic defensive strikes on pro-government militias, and that policy recently expanded to include Syrian regular forces. On June 18, a Syrian Su-22 fighter-bomber was destroyed when it struck American-backed fighters laying siege to the ISIS-held city of Raqqa.
The Trump administration has also telegraphed to Damascus the limited conditions that would lead to offensive operations against regime targets. At the risk of contradicting his campaign-trail promise to scale back American commitments abroad, President Trump was convinced at the urging of his closest advisors and family members following the April 4 chemical attacks to execute strikes on the Assad regime. His administration was quick to communicate that this was a one-time punitive measure, not a campaign. There would be no follow-on action.
That directive may no longer be operative. With the release of this latest statement warning Damascus against renewed chemical strikes on rebel targets, the triggers that led to strikes on regime targets in April are hardening into a doctrine. The United States will act aggressively to maintain a global prohibition on the use of weapons of mass destruction. There is enough consistency and clarity to Trump’s approach that it might amount to deterrence. Even if the Assad regime is not deterred, onlookers may yet be.
This is a doctrine that Barack Obama flirted with, but declined only at the last minute to adopt. “As the ban against these weapons erodes, other tyrants will have no reason to think twice about acquiring poison gas, and using them,” Obama explained to the nation in a primetime address on September 10, 2013. “Over time, our troops would again face the prospect of chemical warfare on the battlefield. And it could be easier for terrorist organizations to obtain these weapons, and to use them to attack civilians.”
This was and remains a prophetic warning. ISIS militants have already deployed chemical munitions against Iraqi troops and their American and Australian advisors. An inauspicious future typified by despots unafraid to unleash indiscriminate and unconventional weapons on the battlefield would surely have come to fruition had the West not eventually made good on Obama’s threats.
Obama framed his about-face as an odd species of consistency. He deferred to Congress in a way he hadn’t before and wouldn’t after while simultaneously empowering Moscow to mediate the conflict. This laid the groundwork for Russian armed intervention in Syria just two years later. In contrast, Donald Trump eschewed the rote dance of coalition-building and public diplomacy. Instead, he ordered the unilateral, punitive strike on a rogue for behaving roguishly. And he’s willing to do it again if need be.
That approach will prove refreshing to America’s Sunni allies who, by the end of the last administration, were entirely disillusioned with the Obama presidency. Obama’s waltz back from his red line undermined the Gulf States and shattered hopes in Syria that the West was prepared to enforce the proscription on mass civilian slaughter. In the week of war drums leading up to the anti-climax of September 10, 2013, a wave of defections from the Syrian Army suggested that a post-Assad future was possible. Today, few think such a prospect is conceivable. And because the insurgency against Assad’s regime will not end with Assad in power, an equal number cannot foresee a stop to the Syrian civil war anytime soon.
These circumstances have led some to criticize the Trump administration. Perhaps the behaviors they’ve resolved to punish are too narrowly defined. Maybe the White House should rethink regime change? It is, after all, not so much a civil war anymore but a great power conflict. American troops—to say nothing of Russian, Turkish, British, French, and a host of others—are already on the ground in Syria in numbers and at cross purposes. Still others contend that even this level of engagement in the Levant is irresponsible. They argue the Syrian quagmire is to be avoided at all costs.
These are all legitimate criticisms, but only now can there be a rational debate over a concrete Syria policy.
For more than three years, Barack Obama tried to have his cake and eat it, too. He presented himself as sagaciously unmoved by the political pressuring of Washington’s pro-war establishment, which salivates over the prospect of lucrative strikes on an alien nation. At the same time, the Obama White House cast itself as a reluctant defender of civilization in the Middle East and elsewhere—perhaps even too quick to deploy men and ordnance. This was only nonsense retrofitted onto Barack Obama’s pursuit of a face-saving way to retreat from his self-set “red line.”
The Trump administration’s policy in Syria is an improvement over Obama’s if only because it deserves to be called a policy. Love it or don’t, at least Americans are no longer being gaslighted into debating the merits of phantasms invented by political strategists in Washington talk shops.
Trump Is Losing the Benefit of the Doubt on Russia
This isn't about politics.
On June 23, the Washington Post ran a comprehensive article reviewing the Russian interference in last year’s presidential election, which involved stealing emails from Democratic Party accounts and releasing them via Wikileaks. The outstanding work of reporters Greg Miller, Ellen Nakashima, and Adam Entous shows that there was a bipartisan, cascading failure to respond adequately to this attack on our democracy. That attack began under President Obama and is continuing under President Trump.
The Post revealed that the CIA had “sourcing deep inside the Russian government” showing that Vladimir Putin had personally tasked his intelligence agencies with “audacious objectives—defeat or at least damage the Democratic nominee, Hillary Clinton, and help elect her opponent, Donald Trump.”
Obama was informed of this while the election was underway, but he did little.
… the Obama administration secretly debated dozens of options for deterring or punishing Russia, including cyberattacks on Russian infrastructure, the release of CIA-gathered material that might embarrass Putin and sanctions that officials said could ‘crater’ the Russian economy.
But in the end, in late December, Obama approved a modest package combining measures that had been drawn up to punish Russia for other issues — expulsions of 35 diplomats and the closure of two Russian compounds — with economic sanctions so narrowly targeted that even those who helped design them describe their impact as largely symbolic.
The article went on to quote “a former senior Obama administration official involved in White House deliberations on Russia” who said: “It is the hardest thing about my entire time in government to defend. I feel like we sort of choked.”
In fairness to Obama, he tried to seek bipartisan support to expose Russia’s machinations and found no interest among the Republican leadership on Capitol Hill, who were plainly more worried about losing an election than about this Russian attack on our democracy. Obama knew that if he had spoken out more forcefully, Trump and his Republican supporters would have hammered him for allegedly trying to “rig” the election for “Crooked Hillary.”
That doesn’t excuse Obama’s failure of leadership. He was the commander-in-chief; it was his responsibility. It does make clear, however, that he was worried not just about the possibility of worsening relations with Russia but also about being charged with a partisan interference in the election.
The failure to react more strongly to the Russian hack extends now into the Trump administration. Trump’s reaction to the Post story is indicative of his troubling mindset. The day before the Post story came out, Trump claimed on Twitter that reports of Russian interference—as unanimously attested to by his own intelligence agencies—are “all a big Dem HOAX!” Following the publication of the Post’s story, he tweeted: “Just out: The Obama Administration knew far in advance of November 8th about election meddling by Russia. Did nothing about it. WHY?”
Given that the Obama administration had publicly called out Russian interference in October, it’s hard to imagine why this would be news to Trump now.
The benefit of the doubt ends there. Trump’s next reaction was purely cynical. “Since the Obama Administration was told way before the 2016 Election that the Russians were meddling, why no action? Focus on them, not T!” So when Trump is accused of collusion with the Russians or other wrong-doing, he claims that the entire Russian operation is a “hoax.” But when he wants to accuse Obama of wrongdoing, then he stipulates that the hacking was real.
For Trump, this is a purely partisan issue. The Democrats are out to get to him, to de-legitimize his election victory, and he will say or do anything to stop them—even if that means denying the reality of the Russian operation one moment and admitting it the next. There is no indication that he has treated this attack with the gravity it deserves, which makes it more likely that the Russians will be up to their old tricks in future elections, just as they have been doing recently in Europe.
Trump is right to castigate Obama for not doing more, but the same criticism now applies to him.
200 Years on the Erie Canal
How the West was dug.
Next Tuesday marks the beginning of the 242nd year of the independence of the United States, and the day will be justly celebrated with parades, picnics, and fireworks from Hawaii to Maine.
But next Tuesday will also mark another anniversary of surpassing historical importance to this country. For it was on July 4th, 1817, 200 years ago, that the first shovelful of dirt was dug and the construction of the Erie Canal began. Finished eight years later (ahead of schedule and under budget) it united the east coast with the fast-growing trans-Appalachian west.
It was a monumental undertaking. At 363 miles, the canal was more than twice as long as any earlier canal. (The Canal du Midi in southern France was 140 miles in length.) Thomas Jefferson thought the project “little short of madness.” But Governor Dewitt Clinton saw the possibilities and went ahead, artfully handling the very considerable political opposition and arranged the financing (much of the money was raised in London).
Clinton was quickly proved right and the Erie Canal can claim to be the most consequential public works project in American history. Before the canal, bulk goods such as grain could reach the east coast population centers only by going down the Mississippi River and out through the port of New Orleans. With the canal, it could travel via the Great Lakes and the canal to the port of New York. Before the canal, it had taken six weeks to move a barrel of flour from Buffalo to New York City, at the cost of $100. With the canal, it took six days and cost $6.00. The result was an economic revolution.
Within a few years, New York City had become, in the words of Oliver Wendell Holmes (the doctor and poet, not his son the Supreme Court justice), “that tongue that is licking up the cream of commerce of a continent.” The city exploded in size, expanding northwards at the rate of about two blocks a year. That may not seem like much, but Manhattan is about two miles wide, and thus the city was adding about ten miles of street front every year, a pace that continued for decades.
The cost of the canal was paid off in only eight years and thereafter became a cash cow for the state. This allowed it to weather the crash of 1837 and the following depression, which bankrupted the state of Pennsylvania and crippled Philadelphia’s banks. New York quickly became the country’s undisputed financial center, which it has been ever since.
And while goods were moving eastwards, people were moving westward through the canal as farmers deserted the thin, stony soils of New England for the rich, deep loams of Ohio and Indiana. This “New England diaspora” moved the political center of the country westwards.
The canal era in this country was a brief one as railroads, beginning in the 1830’s, began to spread. But the Erie Canal continued to function as an artery of commerce until the 1970’s and is still used today for things that, usually for reasons of size, cannot be moved by highway or railroad. And it remains a popular avenue for recreational boating.
So Americans should remember Dewitt Clinton next week just as we remember Washington, Adams, Jefferson, and Franklin. For New Yorkers, that goes double. For it was the Erie Canal that put the “empire” in the Empire State.
David French: The Threat To Free Speech
From the July/August COMMENTARY symposium.
The following is an excerpt from COMMENTARY’s symposium on the threat to free speech:
We’re living in the midst of a troubling paradox. At the exact same time that First Amendment jurisprudence has arguably never been stronger and more protective of free expression, millions of Americans feel they simply can’t speak freely. Indeed, talk to Americans living and working in the deep-blue confines of the academy, Hollywood, and the tech sector, and you’ll get a sense of palpable fear. They’ll explain that they can’t say what they think and keep their jobs, their friends, and sometimes even their families.
The government isn’t cracking down or censoring; instead, Americans are using free speech to destroy free speech. For example, a social-media shaming campaign is an act of free speech. So is an economic boycott. So is turning one’s back on a public speaker. So is a private corporation firing a dissenting employee for purely political reasons. Each of these actions is largely protected from government interference, and each one represents an expression of the speaker’s ideas and values.
The problem, however, is obvious. The goal of each of these kinds of actions isn’t to persuade; it’s to intimidate. The goal isn’t to foster dialogue but to coerce conformity. The result is a marketplace of ideas that has been emptied of all but the approved ideological vendors—at least in those communities that are dominated by online thugs and corporate bullies. Indeed, this mindset has become so prevalent that in places such as Portland, Berkeley, Middlebury, and elsewhere, the bullies and thugs have crossed the line from protected—albeit abusive—speech into outright shout-downs and mob violence.
But there’s something else going on, something that’s insidious in its own way. While politically correct shaming still has great power in deep-blue America, its effect in the rest of the country is to trigger a furious backlash, one characterized less by a desire for dialogue and discourse than by its own rage and scorn. So we’re moving toward two Americas—one that ruthlessly (and occasionally illegally) suppresses dissenting speech and the other that is dangerously close to believing that the opposite of political correctness isn’t a fearless expression of truth but rather the fearless expression of ideas best calculated to enrage your opponents.
The result is a partisan feedback loop where right-wing rage spurs left-wing censorship, which spurs even more right-wing rage. For one side, a true free-speech culture is a threat to feelings, sensitivities, and social justice. The other side waves high the banner of “free speech” to sometimes elevate the worst voices to the highest platforms—not so much to protect the First Amendment as to infuriate the hated “snowflakes” and trigger the most hysterical overreactions.
The culturally sustainable argument for free speech is something else entirely. It reminds the cultural left of its own debt to free speech while reminding the political right that a movement allegedly centered around constitutional values can’t abandon the concept of ordered liberty. The culture of free speech thrives when all sides remember their moral responsibilities—to both protect the right of dissent and to engage in ideological combat with a measure of grace and humility.
Read the entire symposium on the threat to free speech in the July/August issue of COMMENTARY here.