Health Care Now–Paul Krugman, NYT. A Reply

If you are a regular reader of Extreme Thinkover (here’s a shoutout to Eddie and Micki, two of my colleagues), you know one of my passions is health care reform and universal health care insurance.  We need it and we need it now!

This week Paul Krugman, who writes for the New York Times published, in his January 29th column, “Health Care Now.”

It’s a good piece, not only because he agrees with me, but that he presents a concise description of what is holding up getting started on the health care reform legislation in the new Obama administration, and then gives a Nobel-winning prize economist’s perspective why sooner is really necessary.

There is a bit of a mystery, though.  When the column was published over 350 people, including me, posted a reply.  After so many hours, the comment section was closed, which is standard NYT practice.  But then by the evening of the next day, the comments link was taken off-line.  Nothing from Krugman or the NYT as to why.  However, since I back up all my posts, and planned to put it on Extreme Thinkover, what follows is my reply to Dr. Krugman’s column.

^^^^^^^^^^

Paul–For some of us in the medical industry, the tsunami you call the looming health care disaster has already crested.  The hospital I work for, part of a Catholic health care system, incurred $66 million in uncompensated care last year (FY08).  That’s not waste or bad management.  That’s the amount of money we spent to treat every person who came to us, for which we could not recover a single dollar.  There are no golden parachutes or corporate jets in our health system.  And the administration says we are already $3 million ahead of last year.

Our mission is to treat the sick.  Anyone who thinks that not having access to health insurance or basic health care is overblown rhetoric or too expensive just needs to spend one day with me.

I cannot urge the Obama administration strongly enough to initiate their health reform legislation.  Nothing short of universal health care will work in the short or long run.  During the election I studied the various plans being touted (AARP, AMA, both candidates, the Catholic Health Association), as well as the legislation being introduced by various politicians.  I support the plan by Sen. Max Baucus (D-MT). Be assured, I have written him several times, urging him to act quickly.

I know the financial crisis needs immediate attention, but there is no reason for the groundwork not to be laid now to push hard for health care reform and universal health insurance in Congress as soon as possible.

We need it now.  We needed it for all those patients who came to us last year, requiring  immediate medical care, but who had no way to pay for what collectively amounted to $66 million to just one hospital.  They got the care they needed, anyway.  That’s what can happen when you believe that health care is a human right.  It would just be nice for those people to have insurance so they are not prohibited from exercising that right.  It wouldn’t be bad to get compensated for that care either.

Bush’s Surge: The Arsonist Calls 911

Peter Beinhart, a senior fellow in the Council for Foreign Relations, a so-called conservative think-tank, published an op-ed column in the Washington Post on January 18, titled “Admit It: The Surge Worked.”  The column was printed in my home town newspaper, The Register Guard, today, in the Commentary Section.  The RG’s title was “Admit it: Bush was right, and courageous.”

I beg to differ.

Beinhart opens with the following thesis statement:

It’s no longer a close call: President Bush was right about the surge. According to Michael O’Hanlon and Jason Campbell of the Brookings Institution, the number of Iraqi war dead was 500 in November of 2008, compared with 3,475 in November of 2006. That same month, 69 Americans died in Iraq; in November 2008, 12 did.

All right, assuming O’Hanlon and Campbell of the Brookings Institution got the numbers right, one could agree that the dramatic drop in deaths of both Iraqis and Americans is a good thing.  Whereas we can all probably concur that if no one had been killed in one month would have been best, in a nation where a war is being waged, a low casualty count is encouraging news.

Beinhart goes on to acknowledge that the post-surge improvements are fragile:

Is the surge solely responsible for the turnaround? Of course not. Al-Qaeda alienated the Sunni tribes; Moqtada al-Sadr’s Mahdi Army decided to stand down; the United States assassinated key insurgent and militia leaders, all of which mattered as much if not more than the increase in U.S. troops. And the decline in violence isn’t necessarily permanent. Iraq watchers warn that communal distrust remains high; if someone strikes a match, civil war could again rage out of control.

To a reasonable person, who has been following the progress of the war in Iraq, this statement makes sense.  One phrase, however, is disconcerting:

the United States assassinated key insurgent and militia leaders, all of which mattered as much if not more than the increase in U.S. troops.

Beinhart appears to directly contradict himself, here.  He seems to imply that a strategy of assassinating the key insurgent leaders would have had the same effect as adding the 30,000 plus troops on the ground (although his punctuation use might be including the impact of  Qaeda on the Sunnis and al-Sadr’s holding back his Mahdi Army also contributed).  So, which factor should be considered the basis for the dramatic decline in deaths, the assassinations or the troops?  To what degree did the one depend on the other for that decline?  Finally, can Bush be credited for the success, especially, as Beinhart insists, making a courageous decision?

Beinhart believes so:

But if Iraq overall represents a massive stain on Bush’s record, his decision to increase America’s troop presence in late 2006 now looks like his finest hour.

This statement, questionable as it is on so many levels given the now historical context of the Bush presidency, is only the prelude to Mr. Beinhart’s fatal flaw in his whole argument:

Politically, Bush took the path of most resistance. He endured an avalanche of scorn, and now he has been vindicated. He was not only right; he was courageous.

As my grandfather used to say, this is about as “cock-eyed” an interpretation as you could possibly get.  Here’s why: Beinhart ignores his own half-hearted attempts to describe the events and outcomes of the Surge within the context of historical reality and how George W. Bush’s decisions set those events and outcomes in motion.  Beinhart believes his own set of assumptions crafted from his political ideology and draws a conclusion that any sophomore college student taking Introduction to Logic could poke holes in after binge-drinking the night before.

Here’s my analogy.

Two gangs from opposite sides of town have been feuding for many years.  One gang, known as the Bushies, whose leader is called Decider, has grown very large and powerful.  None of the gangs on the other side of town, known collectively as the Easties, are as big or as powerful, but they supply the Bushies with “bling” and the Bushies use lots of it, need lots of it, and know that the biggest source of bling is across town.  The gangs have been feuding for a long time, but the rumbles have never been very long and the casualties limited.  The bling has continued to flow to the Bushies pretty much uninterrupted.

One day, Decider decides the time has come to have the ultimate rumble and take down the Easties for good.  He decides to take down the Baghdaddies first.  The Bushies hit the Baghdaddies hard, setting their neighborhood on fire and seem to get the upper hand pretty fast.  But the gangs in the surrounding neighborhoods feel threatened, and though they know they can’t take on the Bushies directly, they send their gang members to infiltrate the rumble.  Sometimes they help the Baghdaddies fight back; sometimes they set more of the neighborhood on fire, hoping to prevent their own turf from being torched.

The Bushies are taking a lot of casualties, even though the Baghdaddies are being killed in droves.  The burning neighborhood grows and grows, killing more gang members from both sides than the gangs themselves.

Decider doesn’t waver in his decisions.  Keep going.  Finish the feud once and for all with the Bushies on top.  The bling must flow.

Flash point.  The burning neighborhood erupts into a firestorm.  Decider’s gang lieutenants surround him and deliver an ultimatum.  The firestorm will destroy them all.  They must have help to put out the fire.

Decider, against every fiber of his being, relents.  He dials 911 and calls for the fire fighters.  The flames are soon extinguished.  Decider and his supporters trumpet the success of the rumble, and praise Decider for his courage to call 911 as the finest moment of his time as gang leader.

^^^^^^^^^^^

There is a research principle that says when interpreting data, the most likely solution will be both simple and elegant.  It will be simple in that no other interpretation agrees so closely with the data, and elegant because it when applied it creates a satisfying unification with the other data in the theory.

And so, there is a conclusion that fits the evidence both simply and elegantly: The arsonist who first set the fire and then was forced to call 911 to save himself and an entire nation from being destroyed by those flames, Mr. Beinhart, was neither right nor courageous.