How "direct to consumer" marketing inflates health care costs

http://www.npr.org/templates/story/story.php?storyId=113675737

CorrectionThe audio and a previous Web version of this story mistakenly said that between 1992 and 2008 the average number of prescriptions that Americans get increased by 58 percent. The actual increase was 71 percent.

Part 1: Doctor Decisions All Things Considered, Oct. 8

In the mid-1970s, an unconventional health researcher named Jack Wennberg discovered an unusually high rate of hysterectomies in a small town in Maine. If the rate continued, nearly 70 percent of Lewiston women would be without their wombs by age 70. That was just one of a series of studies conducted by Wennberg that led him to a very surprising conclusion about health care: A large portion of the medical care Americans get is unnecessary, and the structure of the health care system is the reason why. The system can push doctors to prescribe care that doesn't improve patient health.Read this story.

Part 2: Patient Behavior Morning Edition, Oct. 12

The behavior of patients in the U.S. health system has changed dramatically over the past couple of decades. We've been transformed from passive patients who almost blindly follow doctors' orders into active and aggressive consumers of health services. A look at how that change came about, and how it affects the behavior of doctors. Read this story.

Part 3: Marketing Sickness Morning Edition, Oct. 13

Prescription drug spending is the third most expensive cost in the U.S. health care system. The average American gets 12 prescriptions a year, and this number only seems to grow larger. There are more medicines on the market today than in 1992, with Americans now spending $175 billion more per year. A look behind these numbers and what drove the increase in prescription drug consumption in America.


October 13, 2009

David Couper went to his doctor after watching a small green creature jump up and down on the nail of an infected toe.
For Anne Nissan, a 17-year-old in Prescott, Ariz., the image that stayed with her was of a party. Women were on a roof in a city, pimple-free and laughing, utterly unbothered by the cramps that immobilized her once a month.
And then there is Samantha Saveri, a transportation planner in Baltimore. She remembers bunnies and the promise of digestive regularity.
Three different people in three different places were all driven to contact their doctors after watching an ad for a prescription medication on television. Each walked into a doctor's office with a specific request, and walked out with a prescription for exactly the medication he or she desired.

The Rise Of Prescription Drugs In America
Prescription drug spending is the third most expensive cost in our health care system. And spending seems to grow larger every year. Just last year, the average American got 12 prescriptions a year, as compared with 1992, when Americans got an average of seven prescriptions. In a decade and a half, the use of prescription medication went up 71 percent. This has added about $180 billion to our medical spending.
While there are more medicines on the market today than in 1992, researchers estimate that around 20 percent of the $180 billion increase has absolutely nothing to do with the number of medications available, or increases in the cost of that medication.
To understand this change, one place to look is Wilder, Vt. There, in a tasteful housing complex on the side of a mountain, is the home of Joe Davis.
Davis is retired now, but in his speech and manner it's easy to hear the breezy salesmanship that made him so successful. Davis was an adman: "I was trained — or I was toilet-trained as we like to say — in packaged goods," Davis says. "General Foods, Procter & Gamble — that kind of thing."
Until the 1980s, the kind of people who sold stuff like packaged goods were completely different from the kind of people who sold stuff like prescription drugs. In those days, drugs ads were for doctors, not the public. They were designed by people who worked at these small, technically minded medical advertising companies and targeted this small, technically minded audience.
"Nobody had ever thought that these drugs should be or could be advertised to the patients. It was just outside of people's brains," Davis says. "They thought that only doctors could understand the products. They're technical products. They're scientific products."
But it was more than that. There was a fear — shared by doctors and drug companies alike — that advertising drugs directly to consumers could be harmful. Both the drug companies and the doctors worried that even though consumers couldn't really evaluate whether or not a drug was appropriate, they might become convinced by an ad, and pressure their doctor to prescribe it.
Not only might doctors end up passing out inappropriate medications, but also, drug ads could disrupt the doctor-patient relationship — a relationship that, at the time, was mostly a one-way street. Davis tells this story about his own mother, a sophisticated woman whom he found fumbling with a bottle of pills one day. When he asked what she was taking:
" 'Well,' she said, 'I take a yellow pill, a green pill and a white pill.' I said, 'That's great. What are they for?' "
His mother had no idea what they were for, Davis says. All she knew was that her doctor had told her to take them.
"It was very passive from the patient standpoint," Davis says. "The patient just took whatever orders were given by the doctor."
An Advertising Revolution
It used to work like this: Doctors decided what to prescribe. Drug companies — through medical advertisers — tried to influence doctors. Patients did what they were told.
The only problem, says Davis, was that the system wasn't working out for the drug companies. For them, the system was much too slow.
Because doctors exclusively held the keys to the kingdom, drug companies spent enormous amounts of time and money trying to get their attention. To give you a sense, the average doctor got around 3,000 pieces of mail a year from the drug industry, and to break through this noise often took years.
And so Davis, who had previously only sold packaged goods, approached William Castagnoli, the then-president of a large medical advertising company. The two came up with a solution: They would advertise directly to the patient. They'd get the patient to go in and ask the doctor for the drug. "Pull the drug through the system," Davis says with a certain amount of glee.
There was only one small problem with this solution: It was almost impossible to do.
In the early 1980s, FDA regulations required that drug ads include both the name of a drug and its purpose, as well as information about all the side effects. But side-effect information often took two or three magazine pages of mouse print to catalog, and this wouldn't do for a major television campaign. As Castagnoli says, "We couldn't scroll the whole disclosure information over the television screen — OK?"
But then, in 1986, while designing an ad for a new allergy medication called Seldane, Davis hit on a way around the fine print. He checked with the Food and Drug Administration to see if it would be OK.
"We didn't give the drug's name, Seldane," he says. "All we said was: 'Your doctor now has treatment which won't make you drowsy. See your doctor.' "
This was one of the very first national direct-to-consumer television ad campaigns. The results were nothing short of astounding. Before the ads, Davis says, Seldane made about $34 million in sales a year, which at the time was considered pretty good.
"Our goal was maybe to get this drug up to $100 million in sales. But we went through $100 million," Davis says. "And we said, 'Holy smokes.' And then it went through $300 million. Then $400 million. Then $500 million. $600 [million]! It was unbelievable. We were flabbergasted. And eventually it went to $800 million."
Pharmaceutical companies took note.
Today, drug companies spend $4 billion a year on ads to consumers. In 1997, the FDA rules governing pharmaceutical advertising changed, and now companies can name both the drug and what it's for, while only naming the most significant potential side effects. Then, the number of ads really exploded. The Nielsen Co. estimates that there's an average of 80 drug ads every hour of every day on American television. And those ads clearly produce results:
"Something like a third of consumers who've seen a drug ad have talked to their doctor about it," says Julie Donohue, a professor of public health at the University of Pittsburgh who is considered a leading expert on this subject.
"About two-thirds of those have asked for a prescription. And the majority of people who ask for a prescription have that request honored."
Whether the increase in the number of prescription drugs taken is good or bad for patient health is an open question. There's evidence on both sides. What's not up for debate is this: By taking their case to patients instead of doctors, drug companies increased the amount of money we spend on medicine in America.

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So yeah, totally buy that brand-name pills are a huge source of unnecessary cost. There's certainly value in making drug research profitable so people have an incentive to do it, but it's well beyond that.

The two things I thought were most interesting from this bit: First, the average American has twelve prescriptions per year? Holy hell. I can't even fathom that. I assume that's probably inflated by short-duration prescriptions (docs don't like giving you a prescription for more than a couple weeks of Vicodin at a time), but still. Twelve is the *average*?

The second was the comment about drug ads "disrupting the doctor-patient relationship". The relationship they describe, where the woman takes the pills with nfi what they're for, sounds pretty dysfunctional. For really common, obvious medical cases maybe that's fine, but if your medical situation is even slightly complicated, the only way you're going to get good care is by talking with the doctor and understanding your situation.

Ultimately it seems like you need to get the doctors properly incentivized so when someone comes in asking for a drug, the doc can explain why it is/n't appropriate, what the options are, and all that. We're obviously not going to get that in a broad systematic way from this administration, but at least encouraging people to ask their doctors questions is a step in the right direction.

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Yeah the numbers are pretty scary. As you said, 12 Rx/year on average? Damn. So for all the reasonably healthy people out there with 1-3 Rx per year, they're cancelled out by the hypochondriacs with 20 Rx/year. Probably many of the culprits are the obese, the depressed, and seniors. They take pill A for some disease, but they need pill B for pill A's side effect, and then pill C for pill B's side effect, and pill D enhances the efficacy of pill C, and so on. I guess that's why in Holland and probably other universal health care nations, doctors are actually given cash bonuses for prescribing cheaper generics when available. If a generic is 10 Euros and brand-name is 15, the doctor can pocket like half of the difference. People need to remember that pain is part of life. Your body can't feel perfect all the time. Don't they say "just tough it out" and "whatever doesn't kill you makes you stronger"?

Especially for seniors who complain about every little discomfort - it's irresponsible and maybe even harmful to them (drugs may help but cause side effects, long-term addiction, reduced efficacy over time, etc.). Some seniors have a huge pill case like a tackle box full of daily meds, and some have doctor's appointments like 3x/week! The psychiatric drugs really concern me. Sometimes you're sad, and sometimes your kid is hyper at school. That doesn't mean you have clinical depression and your kid is ADHD. Yet they get medicated all the same, every day, at huge cost. I know some people have legitimate mental conditions where drugs really improve their quality of life, but most of us would believe without data that such drugs are over-prescribed in America.

Apart from the short-term drugs, I think some of the big money-sinks are the "daily until you die" drugs like Lipitor. These "lifestyle" drugs are shortcuts for healthy living. I know some people have legitimate cholesterol issues and need statins to be healthier. But for the elderly or lazy folks who don't want to exercise and eat right, popping a statin will make up in part for your bad habits. Lipitor cleared nearly $7B in the US in 2004, which is more than the GDPs of many nations. And 66% of Lipitor's worldwide sales are to Americans, even though we're only 5% of the world's population. I know Americans are more obese on average, but come on.

The other top-selling drugs are here: http://www.forbes.com/technology/2004/03/16/cx_mh_0316bestselling.html

As you can see, they are mostly "dailies" for chronic diseases like depression, asthma, ulcers, circulatory issues. I think the penis drugs make a lot of money too, though not sure if they are covered by insurance. Viagra topped $1.6B in 2005.

http://money.cnn.com/2006/01/05/news/companies/sexdysfunction/index.htm

Obviously DTC ads play right into this problem. You have a discomfort or are not feeling right about some aspect of your body. Then the TV says a magic pill just makes it all better and you will be like the happy, pretty people in the commercials. But people haven't done the research about side effects, which patient sub-population would benefit most, cheaper alternatives, etc. And doctors may not have time to discuss in detail (15 min per patient at Kaiser, or so the rumor goes), or don't want to say no because they worry about angering customers and losing them to competitors who will prescribe anything they want. Jeez - 2/3 of patient-requested Rx's get honored? I guess 2/3 of people deserve honorary MD or PharmD degrees. As you said, marketeers get in the way of the doctor-patient relationship. People become consumers instead of patients, and we all know Americans don't consume very responsibly. As you said, the doctor is ultimately responsible because he or she signs the Rx. So if we can incent or threaten them to be more austere with Rx's, maybe it will get better. Like if we chart doc Rx habits and see that some are several standard deviations above the mean, then they get a fine or whatnot. And we can combine that data with patient outcome metrics to see which drugs deliver the most bang for the buck, and which docs are managing resources most efficiently. Some of this is already going on behind the scenes, and now our data collection, stats, and computing power align for more thorough analyses. So if we can build on that, and reward the docs who use drugs most effectively for their patients, then maybe some behavioral changes can happen. Because obviously we can't count on the patient to make the right choices, just as we can't trust children to own a gun or drive a vehicle.

No Olympics for Chicago

http://sports.yahoo.com/olympics/news?slug=reu-riosponsors&prov=reuters&type=lgns

Man, Rio gets the 2014 W Cup AND the 2016 Olympics? Not that I wanted Chicago to get it; that city sucks. All the tourists will get mugged. I guess there has never been an Olympics in South America, so they are playing affirmative action. And I think all the hoopla over the Obamas going over to Denmark to lobby was BS. The IOC is so damn corrupt anyway. If we wanted the Olympics so bad, Obama should just buy the IOC with our tax dollars and have them pick Chicago (why not, add them to the stable with AIG and GM!).

Anyone who loves where they live doesn't get out enough. Like would any of us want the Olympics in SF? Of course not because we know it sucks. Most cities suck. How the hell can you love the city you live in? Unless your'e rich like Michelle Obama I guess, only going to eat at Spago and shopping at Bloomie's. Plus the belief that Olympics make money for the host city is actually false (except if you include increases in international trade following the games):

http://www.pbs.org/newshour/updates/business/july-dec09/olympics_10-01.html

It took one city 30 years to pay off its Olympics debt, and that was during pre-9/11 security cheaper times! Chicago can't even figure out its train and traffic problems, how can it handle a Games?

http://www.npr.org/templates/story/story.php?storyId=92633264

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my coworker said the RIO is worse in terms of crime versus chicago against visitors. this is unsubstantiated but I thought I'd share it. did you read all the articles on China after the Olympics and how the Bird's nest stadium is being remodeled into a shopping center?

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OMG so typical for China. Where will they hold their big sporting events then? In the rice fields out back?

Yeah true about Rio. A lot of drug violence and slums too (ever seen "City of God"?). If they wanted no crime they shoulda picked Tokyo or Stockholm or something. But if I'm gonna get jacked by a gang, I'd rather it be down in Rio with beaches, honeys, and Carnival!

The FUBAR Afghan election

http://www.pbs.org/newshour/bb/asia/july-dec09/afghanistan_10-01.html
http://www.nybooks.com/articles/23113#

These links tell a scary story of how the recent Afghan presidential election was, instead of a victory for democracy against the Taliban menace, actually a major setback undermining that nation and the West's hopes for its improvement. It seems that once the Obama administration took power and Richard Holbrooke was appointed as special envoy, corrupt and paranoid President Karzai was convinced that America sought to replace him. So he plotted for months to stack the upcoming election in his favor. The UN assistance mission to Afghanistan (UNAMA), desperate for some milestones of success amidst major security deterioration and stalled development under their watch, craved a "successful election". In order to demonstrate political progress, they turned over the reins to the Afghan government, instead of running and monitoring the process directly, as they did during the last election in 2004. So that is basically a recipe for disaster. And as in America, unfortunately the preparations for election caused governmental tunnel-vision and forced all other pressing Afghan issues to the back burner (education, infrastructure, justice, armed forces training, counter-narcotics, etc.). Security was concentrated on the polling stations instead of hunting Taliban, and it showed with several brazen Taliban attacks and bombings in "secure" urban areas like downtown Kabul. NATO deaths in the summer months leading up to the election were the highest in the war's 8-year history.

As one would expect, Karzai stacked the "independent election commission" with members partial to him, including foreigners to feign impartiality. All the warning signs of major fraud were obvious prior to the election. An American diplomat and deputy special rep to the UN Afghan mission, Peter Galbraith (son of the economist John Galbraith) raised these concerns to UNAMA, and was summarily ignored by chief Kai Eide. Galbraith's investigations had shown that the Afghan election commission set up many voting stations in Taliban-controlled regions where less than 10% of the populace was expected to turn out (due to poor security and threats to their lives). Those stations were located in areas too remote or dangerous for monitoring, and probably only existed on paper. Yet after the election, thousands of pro-Karzai votes came streaming in from those locations. Karzai eventually and improbably netted 54% of the overall vote, and his leading challenger, Abdullah Abdullah has challenged the legitimacy.

Galbraith's office had collected evidence of this, and he feels that his boss deliberately suppressed it. Their professional relationship deteriorated to the point where Eide complained to Secretary-General Ban Ki Moon and had Galbraith removed. Ban chose appearances over the truth. The UN and the West were so desperate to pronounce the election a success as a propaganda blow to the Taliban that they covered up fraud. But as presidential challenger Abdullah said, the Taliban are obviously the biggest threat to Afghanistan's future, but an illegitimate, corrupt government is second. The UN doesn't seem to care. Somehow Karzai has convinced them to back him, maybe through bribery. Of course the UN's official excuse is that it has no "right" to interfere in the elections of a sovereign state, and we should be patient and let the Afghans sort it out. They do admit that fraud took place, but do not concede that the fraud was preventable, and overwhelmingly in Karzai's favor. The Obama administration and Holbrooke have been fairly quiet on the issue as well, even moreso than the disputed Iranian elections and Honduras coup d'etat.

If America, NATO, and the UN came to Afghanistan to help the people, show them good governance, and bring them into the 21st Century, then how can we tolerate this result? We toppled the "illegitimate" regime of the Taliban in 2001, but now we sit on the sidelines while a corrupt, inept political parasite (of course appointed by the Bushies) hijacks a nation that is vital to our security interests in the region. The only worse result would be if Osama won the election, legitimately (and by now I'm sure he is more popular among Afghans than Karzai). No wonder no one trusts or respects us and the Smurfs. We screw up Yugoslavia, Congo, Haiti, Rwanda, East Timor, Iraq, Afghanistan, and pretty much every other warzone we go.

Growing up

Regarding aging, it's too bad that people on the post-graduate education route need to devote so many years (and money) towards that cause, while not really being able to set down roots due to student loan repayments, less-than-secure employment, high cost of housing, etc. So when all is said and done, people are almost "starting adult life" at 30, when a generation ago they would have 2 kids and the white picket fence by then. And for those who want a family these days (I'm still on the fence, but my wife wants kids, so I guess it would be selfish of me to deprive her of that), they have to navigate that social maze while also working long hours as a junior-level employee hoping to advance. There just doesn't seem to be enough time for all the stuff that adults said we were entitiled to growing up. And like your friend working for the foreign service in Asia, I think there are many really interesting, rewarding international jobs out there where one could learn a lot and grow as a person, but it seems fairly incompatible with relationships/family. Plus our parents are getting older and we may need to support them more and more with our time and resources.

So I guess I am feeling some trepidation about the future after all, and how to balance these various commitments and choices. After visiting some friends in France/Holland recently, and seeing how their way of life is becoming more and more "American" (i.e. competitive, stressful, hurried, individualistic, unhealthy), I can't help but feel a bit sad. Their postwar governments and companies made strong efforts to maintain a decent quality of life for people (immigrants and the poor still falling through the cracks of course) through universal health care, generous unemployment insurance, free or heavily subsidized child care and university, as well as the 35-hour week and 5 weeks vacation. Maybe such a paradigm is foolish and unsustainable in the cost-cutting globalized economy, but I respect them for trying. It's not like Europe is Utopia, but their health and happiness metrics are higher than ours, even though they are less rich by some measures.

All the young American parents I know are stressed as hell. I am not sure if your relatives and circle of friends are the same. I know they say their kids give them so much joy (would any parent admit that they regret having kids though?), but they're always running around, behind on work, mostly eating fast food, and getting ill more often. They don't follow the news much and seem "out of touch". I know it's just qualitative and anecdotal, but their bodies look worn and their lives seem to revolve around kid stuff (like they don't do their hobbies anymore, and if they are lucky enough to have a night out to the cinema, it's to see "Finding Nemo"). I think parents should spend a lot of time with their kids of course, but maybe more balance is healthier? Of course if we had to work less, and wasted less time in traffic or at the mall, there would be more time for recreation and self-maintenance. And then there are those freaky "super-parents" who run 5 miles a day, have great, well-behaved kids, and kick butt at their jobs. Maybe it's the cocaine! But seriously, it's a sad reflection on our society that moms are a surprisingly prominent demographic for meth use. There's just too much for them to do to be "good moms", trying to live up to the impossible expectations that the jerks in media, marketing, etc. place on women.

I don't know. There are many ways to live life happily, and it's not required for everyone to have kids (actually if we did, it would be really bad for the Earth). Many people find great satisfaction with their spouses, jobs, or life callings and that seems to be enough. I just know that I will never love my job on my current path, and probably jobs I could love are now out of reach due to my life choices. Lauren and I just adopted a dog, and I think my plate is plenty full with taking care of the dog, condo, and trying to be a good husband/son. I am sure you, Mark, and most everyone else feels pressed for time too. I guess I am mostly content with my life at present, but I am not thrilled with the possible paths ahead of me.

Obama's "world without nuclear weapons"

He wants a world without nuclear weapons? Then with a stroke of a pen he could reduce the world's nuclear arsenal by 20%. The US has 2,600 active warheads, plus another 6,800 inactive and/or obsolete. There are roughly 24,000 nukes on the planet now. Why not decommission 4,800 of our inactive weapons as a gesture of good faith and much-needed trust-building? It makes no sense to hold onto them. Even if Russia doesn't reciprocate, it's not like we're defenseless. We just got rid of the nukes that are basically billion-dollar paperweights, collecting dust somewhere in Livermore or Wyoming. Otherwise he is just spouting off the same empty talk.

Obama: "Iran is breaking rules that all* nations must follow."
* Except Israel and the Security Council Big 5

Obama wants a world where no new players develop nuclear weapons. The "responsible" nations can keep their bloated and obscene stockpiles. Yes Iran is skirting the rules and misbehaving on the nuclear issue. We would to the exact same in their shoes. Ideally we should work with other nations to persuade/pressure them to open up for inspections and negotiations. Of course they will stall, play games, and be difficult, just like North Korea. But of all people, General Khadafi raised a good point at the recent UN meeting (Libya is a temporary member of the Security Council now). If Iran has to open up its nuclear activities, shouldn't Israel be held to the same standards? Ambiguity surrounds Israel's nuclear capabilities, although a 1968 CIA report concluded that Israel had developed nukes (and produced as many as 100-200 warheads, which is 10X more than India and Pakistan's arsenals), we only concretely know of Israel's program because an employee at a facility, Mordechai Vanunu, went public with photos in the 1980s. After that, he was captured by Mossad and is currently rotting in solitary confinement, labeled by Tel Aviv as a traitor. Since Israel never signed the NPT (why wouldn't they if they are such a peace-loving nation?), they are not required to disclose any nuclear activities. But officially their government has declared, "Israel will not be the first to introduce nuclear weapons into the Middle East".

So we have no proof that Iran is weaponizing nuclear material, but we want to further sanction them out of suspicion. We have caught Israel in a bold-faced lie about its nuclear weapons, and we tolerate it.

http://news.yahoo.com/s/ap/20090925/ap_on_go_pr_wh/g20_summit_obama_iran
http://news.bbc.co.uk/2/hi/middle_east/3340639.stm
http://en.wikipedia.org/wiki/List_of_states_with_nuclear_weapons

Health Care

http://www.npr.org/templates/story/story.php?storyId=112687935

I'm overseas and missed Obama's speech, but I was surprised to see the "You lie!" outburst on CNN this morning. The look on Pelosi's face was priceless - she would make a good boarding school headmistress if she ever tires of being 3rd in line to the presidency. Do you think much of America watched the speech and could be swayed, or are their minds mostly made up? Well, maybe it was mostly meant as a jolt for Congress and rebutting right-wing media's attacks.

Plus that Rep. got worked up over something so ridiculous. Although it would be humane to give some medical assistance to illegals, even if they don't want to, the costs of minimally covering that population are miniscule in the grand scale of the reform plan ($880B over 10 years at least).

I wish Obama would just come out and say, "Why are you imagining all these evil motives for our health reform? Do you think I ran for president so I could institute death panels and put insurance companies out of business? Believe it or not, we actually want to make your lives better and our country stronger, and health reform is an integral part of that. I understand that people can be distrustful of expanding government and new regulations, but at least be equally skeptical to my opponents like right-wing media and the insurance and medical lobbies. What about their ulterior motives and conspiracy theories? Maybe then you'll see I'm not so bad."

But again, Obama seems to be light on details in his big speeches. He spent a lot of time reassuring America about the things his health plan won't do. I know the bill is enormous and many details have yet to be ironed out, but at least give us a 30-second overview of how the plan will make us better. The Dems say 80% of the legislation is worked out; ok so tell us then. Unfortunately I think a lot of America still doesn't understand what he is trying to do (most Americans don't even understand what health coverage they have, nor how the industry works at present), so of course the fear-mongers fill that vacuum with a lot of rubbish.

And unfortunately I think Obama still wants to hide some of the costs of his plan from us, so as to avoid more lost support. But sooner or later he has to level with us that any meaningful health reform will cost something. We won't get by just by trimming waste and taxing the rich more. To cover more people, we will have to spend more, and to reduce per-capita costs, then we'll have to reduce some services. The CBO concluded that Obama's numbers are wishful thinking, and a zero-debt health reform is either impossible or insignificant. But those sacrifices could reap huge rewards, since so much social and economic productivity is lost due to complications from uninsured sick people and unequal employer-based insurance. Plus we could theoretically recoup some funds by capping malpractice settlements which would lower premiums (not so popular with the Dems) and taxing health-poor products, such as fatty junk foods and alcohol, to promote healthier living as we've already done for cigarettes (wishful thinking though).

I don't think it's realistic for Americans to expect that their health coverage (or any service in fact) to be immune to change with the times. Maybe some of us have "great coverage" now or in the past, but in the future we won't, or we'll have to pay ridiculous sums for it. The nature of group coverage and health policy is communal, so unless we're super-rich, we can't hope to remain on our individual islands, detached from the less fortunate among us, enjoying access to all the best treatments. Maybe our taxes will have to go up slightly, and maybe Medicare benefits will decrease a bit. Call it "socialist" and "rationing" if you want, but what do you think your HMO is doing to you now? The healthy pay for the sick. Try getting an MRI for a bruised knee, or an exotic, expensive drug when generic alternatives are available, and see how accommodating they are. And they have the luxury of denying service to cost-negative individuals, which Medicare of course can't do. Obama wants to cover the uninsured and hold insurers/medical providers accountable to provide more bang for the buck. How can that be bad for America? The Dems have to do a better job clarifying the issue. Of couse if Obama's plan calls for too many sacrifices in order to cover the uninsured, then it doesn't make sense (except morally). If that price is too high to pay, then we can stick with the feudal health care system we currently have.

National security news

1) Obama scrapping Bush's Eastern Europe missile defense shield.

http://news.yahoo.com/s/ap/20090917/ap_on_re_eu/eu_eastern_europe_missile_defense

Way to go, Big O. Now hopefully Russia will reciprocate and increase cooperation on anti-terrorism, curbing weapons proliferation, energy, and dealing with states that are not so friendly with us. If our 2 nations can show a united front against Iran's nuclear activities, then maybe there will be enough leverage to get them to change course. Hopefully this will reduce tensions in the former Soviet nations. Well not everyone is happy. The anti-Russian nationalists in Czech and Poland are miffed, but oh well. Go find some oil in your country and then we'll talk.

2) Is the assumption that a pullout in Afghanistan would create/resume a "terrorist safe haven" for Al Qaeda to plot new, deadlier attacks against the West even valid?

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/15/AR2009091502977.html

After all, most of the preparations for 9/11 took place semi-autonomously in Europe and the US, not in some cave in Afghanistan. Currently, the 2001-era Qaeda leadership (what's left of it) is contained in Pakistan and mostly serving a propaganda/ideological inspiration function, not actually plotting or capable of harming against us again. In this modern electronic age, a physical base is not as crucial to international terrorists. So even if we invest the huge resources needed to stabilize Afghanistan, incur the political/moral costs of increased bloodshed and propping up a corrupt government, and are lucky/smart enough to pull it off halfway decently, how much will that even increase our security vs. Qaeda-symathetic cells that are already in the West? Plus, it's not like a "stable" Afghanistan still won't have terrorists lurking. Terrorists exist in highly secure nations like the US and UK as we speak.

And what about new havens in Somalia, tribal belt Pakistan, Iraq, Algeria, and such? If the hawks say havens are so crucial, why just send troops to Afghanistan? Don't we need to clear out those other places too? "Better fight them over there than at home." Or maybe while we're exhausting ourselves trying to fight an elusive enemy (or the wrong enemy, such as the Taelban or Ba'athists) overseas, while the terrorists who are the real threats to attack the US are still out there. Just imagine if we invested half the war resources of Iraq/Afghanistan to actual homeland DEFENSE, intel, and surgical counter-terrorism, maybe we wouldn't need the color threat level or "harsh interrogations" anymore.
Who's Afraid of A Terrorist Haven?
By Paul R. Pillar
Wednesday, September 16, 2009

Rationales for maintaining the counterinsurgency in Afghanistan are varied and complex, but they all center on one key tenet: that Afghanistan must not be allowed to again become a haven for terrorist groups, especially al-Qaeda. Debate about Afghanistan has raised reasons to question that tenet, one of which is that the top al-Qaeda leadership is not even in Afghanistan, having decamped to Pakistan years ago. Another is that terrorists intent on establishing a haven can choose among several unstable countries besides Afghanistan, and U.S. forces cannot secure them all.

The debate has largely overlooked a more basic question: How important to terrorist groups is any physical haven? More to the point: How much does a haven affect the danger of terrorist attacks against U.S. interests, especially the U.S. homeland? The answer to the second question is: not nearly as much as unstated assumptions underlying the current debate seem to suppose. When a group has a haven, it will use it for such purposes as basic training of recruits. But the operations most important to future terrorist attacks do not need such a home, and few recruits are required for even very deadly terrorism. Consider: The preparations most important to the Sept. 11, 2001, attacks took place not in training camps in Afghanistan but, rather, in apartments in Germany, hotel rooms in Spain and flight schools in the United States.

In the past couple of decades, international terrorist groups have thrived by exploiting globalization and information technology, which has lessened their dependence on physical havens.

By utilizing networks such as the Internet, terrorists' organizations have become more network-like, not beholden to any one headquarters. A significant jihadist terrorist threat to the United States persists, but that does not mean it will consist of attacks instigated and commanded from a South Asian haven, or that it will require a haven at all. Al-Qaeda's role in that threat is now less one of commander than of ideological lodestar, and for that role a haven is almost meaningless.

These trends have been familiar to counterterrorist cognoscenti for years but have gone mostly unmentioned in discussion of Afghanistan. This is probably because the intervention there in late 2001 was unquestionably a response to Sept. 11 -- the "good war," in contrast with the misguided expedition to Iraq, where the only connection to the 2001 attacks was in the Bush administration's contorted selling of that invasion. The U.S. entry into the Afghan civil war succeeded in ousting the Taliban from power and rousting its al-Qaeda allies, and the intervention would have occurred regardless of whether the occupant of the White House was named Bush or Gore.

The issue today does not concern what was worth disrupting eight years ago. And it is not whether a haven in Afghanistan would be of any use to a terrorist group -- it would.

Instead, the issue is whether preventing such a haven would reduce the terrorist threat to the United States enough from what it otherwise would be to offset the required expenditure of blood and treasure and the barriers to success in Afghanistan, including an ineffective regime and sagging support from the population. Thwarting the creation of a physical haven also would have to offset any boost to anti-U.S. terrorism stemming from perceptions that the United States had become an occupier rather than a defender of Afghanistan.

Among the many parallels being offered between Afghanistan and the Vietnam War, one of the most disturbing concerns inadequate examination of core assumptions. The Johnson administration was just as meticulous as the Obama administration is being in examining counterinsurgent strategies and the forces required to execute them. But most American discourse about Vietnam in the early and mid-1960s took for granted the key -- and flawed -- assumptions underlying the whole effort: that a loss of Vietnam would mean that other Asian countries would fall like dominoes to communism, and that a retreat from the commitment to Vietnam would gravely harm U.S. credibility.

The Obama administration and other participants in the debate about expanding the counterinsurgency effort in Afghanistan can still avoid comparable error. But this would require not merely invoking Sept. 11 and taking for granted that a haven in Afghanistan would mean the difference between repeating and not repeating that horror. It would instead mean presenting a convincing case about how such a haven would significantly increase the terrorist danger to the United States. That case has not yet been made.

The writer was deputy chief of the counterterrorist center at the CIA from 1997 to 1999. He is director of graduate studies at Georgetown University's Security Studies Program.

I tire of the "green-minded company" propaganda

I thought the gen 3 Prius commercials were bad, but maybe this is rock bottom:

http://www.youtube.com/watch?v=puh-vBXQy8M

"Americans are always finding ways to be more responsible" must be the most laughable brown-nosing lie I can possibly think of. You Americans are so awesome... pleeeaaase buy more of our $70K vehicles to rescue our sinking profits! Because when I think of America, I think of responsibility (trillions of dollars of government and consumer debt, Wall Street bailout, housing bubble, #2 polluter behind China, #1 energy user, #2 arms exporter behind Russia, #2 nuclear arsenal behind Russia, etc. etc.). And when I think of BMW, I think environmentally conscious. Heck just producing that inane ad probably cost us all a ton of CO2.

http://www.bloomberg.com/apps/news?pid=20601100&sid=a18vUVMqC77c&refer=germany

They brag about their vehicles that get 28 MPG highway in "simulated driving". If BMW really cared about the environment, they would shutter all operations and invest their assets in green tech. Because every car BMW sends to the showroom and every minute their business operations run causes pollution. And the same can be said of most companies of course. You can't have your cake and eat it too. These rich assholes want to justify their lavish, wasteful spending as eco-conscious? Please. Just accept that you are killing the Earth for your own consumerist pleasure and don't sugar-coat the truth. Or if you really care, spend the $70K differently: buy a $16K Civic, a $200 bike, and donate the rest of the money to environmental projects. I would rather the BMW ads just cut the crap and say, "BMW: We make fancy, expensive cars that burn a lot of gas so you can drive fast to try to impress chicks. Just make sure you keep up with your payments and sorry for our poor reliability record."

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Why do I still think there's a BMW in your distant future?

= )

PS: Honda Civics are also cars and thus also destroy the environment... and NGOs might not be as efficient in saving the environment as coordinated government action...

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Put this in writing... I'll NEVER purchase an automobile that costs more than $30K (inflation-adjusted). It's not a priority for me and I can think of better ways to use the cash, plus currently my savings rate is like zero due to being mortgage poor. I suck at picking stocks and my job has very little upward mobility, so I doubt BMW is in my future haha. I prefer Japanese cars (since I'm a racist), but for Euro models, currently my "dream car" is probably a VW TDI.

Sure it would be fun to tool around in a M6, and I guess it would be nice if one of you got me one for my b-day (hint, hint), but it's just decadent. I am trying to be one of those "responsible Americans" that the ugly marketing guy in the commercial spoke of. Well, regardless of what vehicle we choose to buy and drive, my point was I don't endorse the "green consciousness" fad that somehow exonerates us of our unsustainable, polluting habits of our Western lifestyle just because we buy a few CFLs and some locally-grown produce (which in some cases, is more polluting than more efficently-grown imported foods: http://www.boston.com/news/globe/ideas/articles/2007/07/22/the_localvores_dilemma/). I accept the truth that my life choices are killing the planet and I don't care enough to change. Humans and our industrialized mass commerce-consumption (nuclear weapons being a part of it) is the biggest threat to Earthly life since the dinosaur's meteor. We may not destroy the planet overnight, but we're surely not helping any. Even though I believe that, I try not to be defeatist about it, and seek to reduce my harm by conserving resources and buying less-polluting products. But still I'm in the negative overall because I am addicted to electricity, driving, and meat. I just wish ad campaigns wouldn't try to make us feel good about doing bad. Buying a BMW or even a Prius doesn't make you a champion of the environment under any circumstances, but I guess it might make you feel better about yourself.

Yes it's true that any car hurts the environment, but a Civic does less harm than a BMW. I guess it's a trade-off. Unless you go tribal, you probably need a vehicle to get you places. For those people who want to be "carbon neutral" (impossible, but a nice gesture), they can drive a minimally-polluting auto and maybe invest in environment-positive ventures on the side. Surely NGOs are not as efficient as large governments when it comes to environmentalism (scale, resources, laws), but at least NGOs can take action faster and not get bogged down in politics. How likely do you think "cap and trade" is of passing this year? We still have a third of Congress that doesn't believe global warming has a human cause (we still have a contingent of Congress that believes the Earth is 6,000 years old). Plus the environmental savings of Obama's plan is questionable since no one really knows what is an "acceptable" level of carbon output to cap the US economy at, nor how to price and distribute credits fairly. We'll see if that big summit in Denmark coming up bears any fruits.

But forget all this sustainable living crap, we have more important things to talk about: KanYe at the VMAs... OMG OMG, Twitter about it!!!!

Health care overhaul

1) The compensation that the White House negotiated with Big Pharma ($80B in cost savings over a decade) may not be actual savings for us at all:

http://www.huffingtonpost.com/2009/08/13/internal-memo-confirms-bi_n_258285.html

A memo leaked describing a deal that if the Pharmaceutical Researchers and Manufacturers Association (PhRMA) made $80B in concessions over 10 years for Medicare drug reimbursements, Uncle Sam won't try to drive a harder bargain for future drug prices, won't import cheaper Canadian drugs, and won't move some drugs from Medicare Part B to Part D (thereby reducing reimbursements). But wasn't the whole point to save patients and the government money on exorbitant drug costs? Obviously an industry trade group wouldn't agree to a cost restructuring deal unless it benefited them in the long run. While they may have to give up $80B now to help make Obamacare appear to be paid for, that is a drop in the bucket considering the windfall sales they will reap as the pill-popping Baby Boomers get older. Just for perspective, the 2 biggest pharmas in terms of revenue are Novartis and Pfizer, who combined cleared $100B in revenue in just a single year, 2008. When the memo first broke, both the White House and PhRMA denied it's authenticity, but later probes by the LA and NY Times quoted administration officials confirming that such a deal occurred. Some in Congress were irate that the White House would cut a secret deal without their involvement, and wanted to tighten the screws on Big Pharma to get more for the taxpayers. Not surprisingly, the White House opposed them and said that generous PhRMA has promised enough. Well, according to OpenSecrets, Obama received over $19M in campaign contributions from the health care sector (over double what McCain got, despite Obama having tougher rhetoric on health care reform and reducing drug prices), of which pharma is a big chunk.

2) Is the "outrage" at health care town halls actually a manifestation of blue collar white America lashing out at their impotence in a changing American cultural and economic landscape?

http://www.npr.org/templates/story/story.php?storyId=111922780&ft=1&f=2
http://www.theroot.com/views/birthers-and-jim-crow-20

And of course right-wing radio and the GOP (the stupid wing of the GOP led by Palin at least) are stoking the fires, claiming ridiculous things like Obama's reforms are actually reparations in disguise, Obama is not actually a US citizen (everyone knows he's secretly a Muslim of course), and you and your relatives may have to justify their existence to "death panels" that determine whether you deserve to receive medical care - if the Dems get what they want. And moderate Republican Congressmen are scared stiff of angering the demagogues and populist mob if they make health care reform concessions too. I guess poor white America doesn't feel like America is theirs anymore (as if it ever was), and their "values" are being trampled on with change after change for the worse. What is their place in this unstable, changing world? I am sure current events are scaring college-educated, connected people like us, so one can only imagine how the anger and frustration is boiling over in the Rust Belt or Appalachians. Immigration, gay marriage, bailouts, soft power foreign policy, reforms, climate change, and such fly in the face of what they want America to be - even though the fantasy America they envision for themselves where everyone is free to prosper, no big government meddling in your life, and we are never wrong, has never and will never exist.

One of the Dems major political weaknesses since the Bush years is an inability to reach rural, white, lower income voters (the Dixiecrat voters and such from the JFK/LBJ years that they took for granted). They have tried with outreach by humble-roots white politicians like Biden and Webb, but haven't really had much success. Obama's white support mostly came from educated and higher-income people (UC System, Stanford, Harvard, and Columbia were all top-20 donors to his campaign). It's sad and ironic, because many of the Dems' social initiatives would really benefit poor whites, but conservative media and dogma have persuaded those people to hate the Dems who they think are selling this country down the river. And yet the GOP policies of deregulation, deficit spending, and low taxes contributed to their jobs being outsourced, cost of living rising well ahead of wages, and defaulting on their ARM. Remember the Howard Dean comment that his party has to connect with the voters who drive pickups with the Confederate flag bumper stickers? He got a lot of heat for that (especially from his rivals like Southerner John Edwards), and maybe it cost him the Dem nomination, but his underlying argument was sound, if very awkwardly worded. Though Obama and the Dems seem more scared to tackle the poor white issue than the black-white issue. If the Dems can successfully reach out to that demographic (I highly doubt it after so many years and a widening political gulf), then they would deplete the GOP to what it really is - a party for extremist Christians and rich champions of the military-industrial complex.

3) So much for a public insurance option:

http://news.yahoo.com/s/ap/us_health_care_overhaul

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Thought this was amusing and on-topic:

http://www.hulu.com/watch/89817/the-daily-show-with-jon-stewart-glenn-becks-operation

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LOL thanks M! He just has to be outraged about someting, even both sides of the same issue. I didn't realize Beck changed networks (not that I watch either). I would love to see a Battle Royale between Beck, Hannity, Rush, Savage, and Poppa Bear to see who is the biggest conservative propagandist prick alive. Oh, almost forgot to include Malkin vs. Coulter for the undercard.... jello wrestling.


If Beck thinks we have the "best health care" in the world, he must be taking too much oxycontin after his ass surgery (it was a complex procedure to make him an even bigger asshole).

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The WHO last ranked national health systems in 2000, and probably won't again because the metrics are getting too complex, but here were the rankings for those who haven't seen:

http://www.photius.com/rankings/who_world_health_ranks.html

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba
40 Brunei


Life expectancy from 1997-99 (and it's much lower for African-Americans and the poor):

Rank Overall life expectancy

1 Japan 74.5
2 Australia 73.2
3 France 73.1
4 Sweden 73.0
5 Spain 72.8
6 Italy 72.7
7 Greece 72.5
8 Switzerland 72.5
9 Monaco 72.4
10 Andorra 72.3
11 San Marino 72.3
12 Canada 72.0
13 Netherlands 72.0
14 United Kingdom 71.7
15 Norway 71.7
16 Belgium 71.6
17 Austria 71.6
18 Luxembourg 71.1
19 Iceland 70.8
20 Finland 70.5
21 Malta 70.5
22 Germany 70.4
23 Israel 70.4
24 United States 70.0

Rank Country or territory Infant mortality rate
(deaths/1,000 live births) Under-five mortality rate
(deaths/1,000 live births)
1 Iceland2.93.9
2 Singapore3.04.1
3 Japan3.24.2
4 Sweden3.24.0
5 Norway3.34.4
6 Hong Kong3.74.7
7 Finland3.74.7
8 Czech Republic3.84.8
9 Switzerland4.15.1
10 South Korea4.14.8
11 Belgium4.25.3
12 France4.25.2
13 Spain4.25.3
14 Germany4.35.4
15 Denmark4.45.8
16 Austria4.45.4
17 Australia4.45.6
18 Luxembourg4.56.6
19 Netherlands4.75.9
20 Israel4.75.7
21 Slovenia4.86.4
22 United Kingdom4.86.0
23 Canada4.85.9
24 Ireland4.96.2
25 Italy5.06.1
26 Portugal5.06.6
27 New Zealand5.06.4
28 Cuba5.16.5
29Channel Islands ( Jersey and Guernsey)5.26.2
30 Brunei5.56.7
31 Cyprus5.96.9
32 New Caledonia6.18.7
33 United States6.37.8


Total health expenditures as %GDP, 2000-05:

Rank Location 2000 2001 2002 2003 2004 2005

1 Marshall Islands 22 19.1 18.4 16.3 13.2 15.4
2 United States of America 13.2 13.9 14.7 15.1 15.2 15.2
3 Niue 8 38.1 11.1 12.5 15.5 14.5
4 Timor-Leste 8.8 8.6 8.5 9.2 10.3 13.7
5 Micronesia (Fed. States of) 9 9.8 9.1 10.7 11.7 13.5
6 Kiribati 11.6 12.3 12.6 13.7 13.7 12.7
7 Maldives 6.8 6.8 6.6 7.2 7.8 12.4
8 Malawi 6.1 7.8 10 12.8 12.8 12.2
9 Switzerland 10.3 10.7 11 11.4 11.4 11.4
10 France 9.6 9.7 10 10.9 11 11.2
11 Germany 10.3 10.4 10.6 10.8 10.6 10.7
12 Jordan 9.4 9.6 9.3 9.3 10.1 10.5
13 Nauru 11 10.8 10.6 10.3 10.4 10.3
14 Argentina 8.9 9.5 8.9 8.3 9.6 10.2
15 Austria 10 10 10.1 10.2 10.3 10.2
16 Portugal 8.8 8.8 9 9.7 10 10.2
17 Greece 9.3 9.8 9.7 10 9.6 10.1
18 Canada 8.8 9.3 9.6 9.8 9.8 9.8
19 Sao Tome and Principe 6.3 9.1 8.6 11.9 12.1 9.8
20 Belgium 9.1 9.3 9.5 9.5 9.7 9.6

Health expenditures per capita, OECD nations 2000:

Rank Countries Amount
# 1 United States:$4,631.00 per capita
# 2 Switzerland:$3,222.00 per capita
# 3 Germany:$2,748.00 per capita
# 4 Iceland:$2,608.00 per capita
# 5 Canada:$2,535.00 per capita
# 6 Denmark:$2,420.00 per capita
# 7 France:$2,349.00 per capita
= 8 Belgium:$2,268.00 per capita
= 8 Norway:$2,268.00 per capita
# 10 Netherlands:$2,246.00 per capita
# 11 Australia:$2,211.00 per capita
# 12 Austria:$2,162.00 per capita
# 13 Italy:$2,032.00 per capita
# 14 Japan:$2,011.00 per capita
# 15 Ireland:$1,953.00 per capita
# 16 United Kingdom:$1,764.00 per capita
# 17 Finland:$1,664.00 per capita
# 18 New Zealand:$1,623.00 per capita
# 19 Spain:$1,556.00 per capita
# 20 Portugal:$1,439.00 per capita
# 21 Greece:$1,399.00 per capita
# 22 Czech Republic:$1,031.00 per capita
# 23 Hungary:$842.00 per capita
# 24 Slovakia:$690.00 per capita
# 25 Mexico:$491.00 per capita


Putting that all together, we see that we are paying a ton for health care and health outcomes that far lag behind those evil socialized medicine nations in Western Europe, Asia, and Canada. Maybe one can argue that America's lower life expectancy is also due to lifestyle (overeating, stress) and culture (guns, car accidents), not just health care. While that may be true, our smoking and binge drinking rates are much lower than most of Europe, yet many of those nations outlive us. But the biggest, most shameful metric is infant mortality. That is pretty much an even playing field to judge. Unless American mothers are prone to pregnancy complications and unhealthy parenting (no strong data to support that), it's the responsibility of the health care providers to monitor fetuses, birth those children, and make sure they have a good chance to reach adulthood. Our I.M. rate is 50% higher than France and double Japan's. Unacceptable. Especially when you consider that we commit 15% GDP to health care vs. 11% for France, or $4.6k per capita vs. France's $2.4k. Maybe that's not fair since France is ranked #1 by the WHO. But still, look at the other nations that devote >12% GDP to health care. They're either small or poor, which means they don't have much GDP to spread around anyway. We have the largest GDP, so we're wasting incredible amounts of money on sub-prime care.

Critics of Obamacare are not allowed to say that he is tampering with a great system, because the evidence is just not there. They can criticize Obama reform for cost, scale, rules, and planning, but even Mitch McConnell said that the GOP knows our health system needs some sort of reform too, it just depends on what shape it takes. So only a cretin (no offense to Greeks from Crete) would think that we're doing fine on the national level. Sure Ted Kennedy and Patrick Swayze are getting the "best health care in the world", and best care will still be available (even under a single-payer system) to those who can pay for it out of pocket, but on average the US has a long way to go before we can crown our asses (Dennis Green-ism).

The nightmare of CA's prison system

http://www.npr.org/templates/story/story.php?storyId=111843426

A must-read/hear, and I don't say that much.

Those of us who have the misfortune of living in dysfunctional CA already know some of this, but it's really sick how the prison guard's union has really capitalized on human misery to gain money, numbers, and power. The people claiming to hold the line between the dangerous criminals and the vulnerably citizenry are the ones making the crime problem worse. Like the pharma-medical industries, they partially exist to help people, but mainly exist to help themselves. Currently 10% of state corrections employees make six figures. There's more money in treatments than cures. Repeatedly locking up people instead of educating and rehabilitating them may increase the prison guards' job security, but it bankrupts the state and makes our streets actually less safe.

And then there were the grandstanding GOP politicians like ex-governor Pete Wilson seeking to "get tough on crime". Yes the crack epidemic promoted terrible gang problems and violence in urban centers. Something had to be done, but instead of increasing drug treatment and education programs, they just made sentencing tougher. People who show a total disrespect for the law and public safety should be punished accordingly, but a nonviolent pot smoker doesn't pose the same criminal threat as Pablo Escobar. Wilson and company wanted to make California's streets safe for Joe Blow suburbanite consumer, so of course that meant locking up Jose and Mookie of the underclasses (and in dozens of cases, giving them lethal injection too). And middle-to-upper class CA supported it. What kind of society is that where we incarcerate people we don't feel comfortable with? And it's not like those same suburbanites weren't snorting blow, hiring illegal immigrant nannies, or cheating on their taxes either.

Out of sight, out of mind. Using a marketing campaign of extreme examples of extreme criminality, con men like Wilson and Reagan (remember the Willie Horton ad?) scared us silly, to the point where we would gladly cancel indeterminate sentencing in favor of mandatory (so forget the hope of early release for good behavior), and imprison someone for their entire life for stealing a TV three times, or being in the same car while a kidnapping was taking place. Missing one parole meeting would send you back to the slammer. Since Wilson's time, CA's prison population rose from 20,000 to 167,000. Yet the number of violent, maximum security convicts has remained relatively stable. The difference is the "petty offenders", who only get nastier in the racist, inhumane confines of prison instead of rehabilitated. And some depraved prison guards even derive entertainment from that tragedy. CA has set inmates up for failure, and the 75% recidivism rate proves it. Despite all these extra people locked away, CA is not really a safer place now than 1980. Some cities even suggest the contrary. Overall US crime and CA crime did drop a lot in the 1990s, but rates have rebounded in this decade. Yet the prison population has only risen steadily, so there isn't a correlation. Those politicians, prison guard's union, and apathetic, intolerant suburban voters (yes that's us), have hurt the state far worse than a million Crips ever could.

Well our bigotry and overzeal of the past have now come home to roost. Apart from the obvious challenges to our budget ($10B a year to keep the "prison industrial complex" running, on par with our entire "bloated" education budget), we have to live with the moral stain that Californians chose the path of apartheid - and I don't say that lightly. Conditions in our prisons are so horrible that we are probably in violation of the Constitution, and I'm not even talking about the assaults, rapes, and riots. Inadequate health care causes hundreds to die each year of treatable conditions, and the court-appointed receiver for prison health reform believes we would need to spend at least $2.5B in construction and $0.48B annually just to provide the legal minimum service. We've created a monster who is eating us out of house and home. The prisoners are not the monsters; it's the system and those who gain from its existence.

http://www.lao.ca.gov/2007/cj_primer/cj_primer_013107.aspx
http://www.facts1.com/general/Casey.htm

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Folsom Embodies California's Prison Blues

by Laura Sullivan


August 13, 2009

In January 1968, Johnny Cash set up his band on a makeshift stage in the cafeteria at Folsom State Prison in California.

"Hello, I'm Johnny Cash," he said in his deep baritone to thunderous applause. Song after song, the inmates thumped their fists and cheered from the same steel benches now bolted to the floor.

The morning that Cash played may have been the high-water mark for Folsom — and for the California Department of Corrections and Rehabilitation.

The men in the cafeteria lived alone in their own prison cells. Almost every one of them was in school or learning a professional trade. The cost of housing them barely registered on the state budget. And when these men walked out of Folsom free, the majority of them never returned to prison.

It was a record no other state could match.

Things have changed. California's prisons are all in a state of crisis. And nowhere is this more visible than at Folsom today.

Overcrowded, Underfunded
A Look at Folsom Prison

Credit: Amy Walters and Laura Sullivan/NPR

Folsom was built to hold 1,800 inmates. It now houses 4,427.

It's once-vaunted education and work programs have been cut to just a few classes, with waiting lists more than 1,000 inmates long.

Officers are on furlough. Its medical facility is under federal receivership. And like every other prison in the state, 75 percent of the inmates who are released from Folsom today will be back behind bars within three years.

California's prison system costs $10 billion a year. Its crumbling, overcrowded facilities are home to the highest recidivism rate in the country. And the state that was once was the national model in corrections has become the model every state is now trying to avoid.

'Kind Of Like A Pressure Cooker'

Lt. Anthony Gentile, spokesman for Folsom, stands in the prison's empty cafeteria, beneath chipping paint, rusting pipes and razor wire.

"There's drug activity, gang activity," Gentile says. "It's kind of like a pressure cooker."

Where a photographer stood 40 years ago and captured Cash's famous concert, an officer now stands in a metal cage. He's armed with three guns and pepper spray.

When they're confined in this environment, the problems tend to simmer and stay there. It creates somewhat of the mob mentality.

- Lt. Anthony Gentile, spokesman for Folsom

There are now 15 to 20 assaults a week here at Folsom. And while inmates used to mix with one another, Folsom today is entirely segregated by race — in the cafeteria, on the yard and in the cell blocks.

"When they're confined in this environment," Gentile says, "the problems tend to simmer and stay there. It creates somewhat of the mob mentality."

To figure out how California could have gotten to such a place, you have to start in Sacramento.

Jeanne Woodford is one of four secretaries that the Department of Corrections and Rehabilitation has had in the past five years. She spent 30 years in the department. As secretary, she lasted two months.

"Honestly, I was very hopeful when I went up there," Woodford said about Sacramento. "I thought it was all about the right policy and the right principle. It's really about the money."

And lots of it. California can't afford its prisons. Taxpayers spend as much money locking people up as they do on the state's entire education system.

How Did Things Get So Bad?

Experts agree that the problem started when Californians voted for a series of get-tough-on-crime laws in the 1980s. The state's prison population exploded immediately. It jumped from 20,000 inmates, where it had held steady throughout the 1960s, 1970s and early 1980s. Today there are 167,000 inmates in the system.

Jeanne Woodford was warden of San Quentin during the prison population boom.

"The violence just went out of control," she remembers. "And then the programs started going away. I was there during an 18-month lockdown. It was just unbelievably horrific."

California wasn't the only state to toughen laws in the throes of the 1980s crack wars. But Californians took it to a new level.

Voters increased parole sanctions and gave prison time to nonviolent drug offenders. They eliminated indeterminate sentencing, removing any leeway to let inmates out early for good behavior. Then came the "Three Strikes You're Out" law in 1994. Offenders who had committed even a minor third felony — like shoplifting — got life sentences.
Derrick Poole is enrolled in Folsom's mill and cabinetry program.
Enlarge Laura Sullivan/NPR

Derrick Poole is enrolled in Folsom's mill and cabinetry program. Due to the high prison population and budget problems, Poole is one of only 10 percent of Folsom inmates who can participate in the prison's vocational programs.

Voters at the time were inundated with television ads, pamphlets and press conferences from Gov. Pete Wilson. "Three strikes is the most important victory yet in the fight to take back our streets," Wilson told crowds.

But behind these efforts to get voters to approve these laws was one major player: the correctional officers union.

A Prison Guard Union With Political Muscle

In three decades, the California Correctional Peace Officers Association has become one of the most powerful political forces in California. The union has contributed millions of dollars to support "three strikes" and other laws that lengthen sentences and increase parole sanctions. It donated $1 million to Wilson after he backed the three strikes law.

And the result for the union has been dramatic. Since the laws went into effect and the inmate population boomed, the union grew from 2,600 officers to 45,000 officers. Salaries jumped: In 1980, the average officer earned $15,000 a year; today, one in every 10 officers makes more than $100,000 a year.

Lance Corcoran, spokesman for the union, says it does what is best for its members.

"We have advocated successfully for our members," he said.

But he disputes that the union has purposefully tried to increase the prison population.

"The notion that we are some prison industrial complex, or that we are recruiting felons or trying to change laws, is a misnomer," he said.

Money And Influence

I think that prisons should be a place where an individual has the opportunity to change if they choose to and we move forward from there.

- Fulsom Warden Michael Evans

Campaign records, however, show much of the funding to promote and push for the passage of the laws came from a political action committee the union created. It is run out of a group called Crime Victims United of California.

Its director, Harriet Salarno, says the committee is independent from the union. But a review of the PAC's financial records shows the PAC has not received a donation from another group besides the union since 2004.

Corcoran does not deny that the two are closely connected.

"We support a number of victims' rights groups," he said.

When asked why the correctional officers union is involved in victims' rights at all, Corcoran said: "There are people that think that there's some sort of ulterior motive, but the reality is we simply want to make sure [the victims'] voices are heard."

But Corcoran acknowledges that the union has benefited from the increase in the prison population after these laws passed.

"We've had the opportunity to grow," Corcoran says, "and that has brought with it both success and criticism."

Secret Dealings With The Governor

Woodford says she stepped down as secretary of the corrections department when she found out that the union had been going on behind her back to negotiate directly with the governor's office.

"The union is incredibly powerful," Woodford says.

Former Secretary Roderick Hickman resigned for the same reason in February 2006.

"The biggest problem that I had was the relationship that I had with the union," Hickman says.

Hickman says the union was able to control the department's policy decisions, including undermining efforts to divert offenders from prison and reduce the prison population.

"Maybe I was just impatient," he says, "or it wasn't going to go fast enough, but [the department] is still in the same place I left it, with an over $8 billion budget. Now it's over $10 billion."

Today, 70 percent of that budget goes to pay salaries and benefits to the union and staff. Just 5 percent of the budget goes to education and vocational programs — the kind of programs that study after study in the past 10 years has found will keep inmates from returning to prison.

Shop Talk: A Chance To Cross Race Lines

From the instant you walk through the metal doors of the mill and cabinetry workshop at Folsom, you get a different feeling from other parts of the prison. In the shop on a recent day, a group of black, white and Latino inmates are bent over a table, talking to each other, discussing measurements for a conference table.

"When we're down here, we put all the politics to the side," says inmate Derrick Poole as he works on the table's legs. "It gives us a place to go where we can we can get out of the prison politics gang, where we don't get along, where we don't socialize outside our race. We socialize outside our race here."

Poole is spending nine years at Folsom for drug possession with intent to sell. In his life, he has been released from prison at least six times that he can remember. It hasn't worked out well.

"When I got out, you kind of lose your social skills," Poole said. "You get used to segregating yourself. You already weren't learned on the street. Then you come in here and you're not learning, and now your mind is more hollow, more empty."

Poole got very lucky this time, beating out hundreds of others to land a spot among just 27 inmates in the cabinetry program. When he's done, Poole will be an accredited woodworker with his GED.

Most of the men in Folsom won't be so fortunate. Just across from the cabinetry shop, program administrator and school Principal Jean Bracy sits in her makeshift office next to the welding class. She knows the statistics by heart.

"I have 1,797 inmates who read below the 9th grade level; 394 of those read below the 4th grade level," Bracy says. "When we put them back out on the streets, they're not employable."

And back on the streets is where 85 percent of all California's inmates are going one day when their sentences run out, regardless of whether they spent their time in prison dealing drugs and running a gang or learning how to weld.

Bracy only has a handful of vocational programs left, enough to reach less than 10 percent of Folsom's inmates — and the state plans to cut even that in half in the next few weeks.

"I think this is the worst I've ever seen it," Bracy says.

'A Merry-Go-Round'

It only costs her about $100,000 to run these programs — not even a blip in a $10 billion-a-year prison budget. But, says Bracy, the programs are always the first to go. Sometimes she almost feels like giving up.

"It's just not cost-effective to throw men and women in prison and then do nothing with them," she said. "And shame on us for thinking that's safety. It's not public safety. You lock them up and do nothing with them. They go out not even equal to what they came in but worse."

The numbers bear that out, with 90,000 inmates returning to California's prisons every year.

But compare that to the Braille program here at Folsom. Inmates are learning to translate books for the blind. In 20 years, not a single inmate who has been part of the program has ever returned to prison. This year, the program has been cut back to 19 inmates.

Out on the prison yard, one of the oldtimers, an inmate named Ed Steward — or "Lefty" — sits in old chair in the only bit of shade on the dusty dirt field. He watches the inmates stand in groups by their race and shakes his head.

"Nowadays, you know, the kids are just coming through this like it's a merry-go-round," he said. "Like there's nothing to it."

Most of these inmates here on this yard aren't here for serious or violent crimes. The number of inmates incarcerated in California's prisons for murder, assault or rape has been relatively unchanged in two decades. The difference is this yard is now packed with drug dealers and drug users, car thieves and shoplifters who stole something worth more than $500.

What Used To Be

But all across this prison are signs of what this place once was — when administrators came from New York and Texas to find out how Folsom kept its violence so low and its inmates from coming back.

There's the deserted shop where inmates used to train to be butchers; it was closed when the prison couldn't afford to remove the asbestos.

Its thriving medical facility was shuttered when it couldn't keep up with thousands of new inmates.

And hovering above the prison is China Hill, a now-barren field where inmates once trained to become landscapers. The prison can't afford to pay the teacher.

Warden Michael Evans can see China Hill just outside his office. Its meaning is not lost on him.

"If I have a dog and I put him in a cage and I beat [him] regularly, ultimately [it] will bite me when I open that door," he said.

After three decades working in corrections, Evans says he has come to one conclusion.

"I think that prisons should be a place where an individual has the opportunity to change if they choose to," he said, "and we move forward from there."

For now, California is at a standstill, unable to find the money to move forward with a different strategy, unable to move backward to a time when it didn't need one.

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In addition to being rife with typos and grammatical errors this article is disheartening from a topical perspective as well... There's a reason why it's possible to hear of a prison colloquially referred to as "Crime University" and it's a shame that we continue to push in the same direction with respect to criminal justice rather than stopping to consider whether an alternative approach might be feasible (e.g. Vipassana)...

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the three strikes prgrm works fine, it is the overwhelming number of prisoners in the jail system that is the problem which is the obvious problem...we simply need to reintroduce the death penalty to separate the "strikers" from the true "strikers" - i watched a documentary that showed an overwhelming ratio of inmate to guard in the prison system in the california system - it was something like 15 to 1 that is what they are dealing with...fights, riots, etc are occuring on a daily basis and this will continue to happen with our economy as it is - the prison system is a low priority - obama does not have that on the top of his list...

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What are we going to do? Kill people for possession of pot? Stealing a bike? There are a number of 3 strikers in jail along with drug possession criminals filling the cells in CA. My suggestions?
1. the state needs to take ownership of the prison system. They're privatized at this point and full beds means more income for these investors. Who's one of the biggest investors in the private CA prison system? Bar Bush. The private prisons get 50K per inmate per year. Hell, what if we gave these people 35K a year to live on their own? Oh, I'm sorry that would be welfare, giving people money for nothing. What's prison? Maybe we should do like they did in a prison in Tennesee? They were starving the inmates so the management could pocket the extra money.
2. legalize drugs, let all people out of jail immediately that are there for drug arrests, period.
3. Assess risk to the population based upon violence and keep those that are violent out of the general population. Unfortunately, soon all of them will be dangerous to the general population b/c they're being tortured in jail. They use sleep deprivation, bright lights and isolation in these systems. I know someone who'd been there and saw it firsthand.
4. Lock up the real violent criminals-Rumsfeld, Cheney, John Yoo, Alberto Gonzalez and Karl Rove. Let them share a 6X10 cell with a toilet in the corner.

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Some of what you proposed may happen anyway, due to economic forces. Because of prison overcrowding, they are releasing hundreds, if not thousands, of elderly or minor-offense convicts early. Drug legalization always seems to be on the table (at the back of the table), but now with CA's deficit it seems like a reasonable price to pay for the extra revenue. Amsterdam did not deteriorate into Gomorrah, and it is much better than most, if not all, US cities.

If the prison guards treated the inmates better and tried to forge a respectful relationship, then there would be less violence. In other prisons around the world (maybe not in the US, but definitely in the past), guards don't even carry weapons. There is no lock down and solitary confinement. If you want people to treat you right, start by treating them right. And for how much we want to forget, inmates are still human beings.

I do not know how many of our life-sentence inmates are there for Three Strikes, but it is not an effective program. As I said, overall US and CA crime did drop precipitously in the 1990s. But that would have happened with or without Three Strikes. If you've read Freakanomics, the author has a very controversial theory on the reason behind US crime reduction (he cites the legalization of abortion in the 1960s putting fewer poor, desperate, crime-prone people on the streets by the 1990s, but also increases in law enforcement budget/personnel, reduced crack use, and prosperous economic conditions). We have to use data and predictions to estimate how much worse crime would have been without Three Strikes. Since it's installment of 1994, a GWU study charted its enforcement county-by-county. Since different CA counties enforced Three Strikes more or less strictly, if the program worked, you would expect crime rates to have decreased the most in counties where the enforcement was strictest. But there was no correlation, despite Sacramento's assurances that the program "drastically" reduced crime. So we're spending a lot of extra money and ruining more lives for very little social benefit.

The punishment is not proportional. Yes it's terrible if you are convicted for a felony three times in your life, but it does not warrant losing your freedom forever. Violent crime is another matter, and usually the sentencing for those offenses become de facto life terms anyway. Actually reading up on Three Strikes, it seems that the first two strikes have to be "serious" felonies, and the third can be any felony (auto theft, burglary, property theft >$500, even if no one is hurt). The second strike mandates 2X length of normal sentencing, and the third strike you are in prison for 25 to life. Good behavior rewards are reduced from 50 to 20% of sentence. And even for non-violent, non-escape-risk inmates, they are not permitted to serve their time in county jails, probation, or house arrest (as they used to do in the past) - further bloating the prison population. I was not in the state at the time, but in 2004 there was a Proposition 66 that would have toned down Three Strikes at a savings of several hundred million dollars per year to the state. It was narrowly voted down (53% to 47%), so that shows nearly as many Californians disapprove of Three Strikes as approve.

http://www.lao.ca.gov/2005/3_Strikes/3_strikes_102005.htm
http://www.rand.org/pubs/research_briefs/RB4009/index1.html

Or maybe the better solution is prevention. As L said, why spend $50k per prisoner when you can spend a fraction of that on social programs and urban outreach? Attack the seeds of crime before they grow. Poverty and low education are heavily correlated with criminality. But again, that would reduce job security for cops and prison guards, so no-go. They would rather spend millions on GPS parolee tracking, Tazers, Kevlar, assault rifles, and faster cars. You can't get rid of 100% of crime, but the whole point is getting the most bang for your buck, and hopefully doing it humanely. Yeah the private prisons idea is terrible. Just another way to fleece the gov't, like defense contracts. But it's the gov'ts fault too for shirking their responsibility on this serious issue, and passing it off to the for-profit "private sector" that is supposedly more efficient.

Sotomayor confirmation

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/04/AR2009080401691.html?wprss=rss_nation
http://www.azcentral.com/news/articles/2009/05/24/20090524obama-court0524.html

"Latinos see [Sotomayor] as a symbol of Hispanic leadership in America," said Lionel Sosa, a Latino political strategist who has advised several presidential candidates on Hispanic outreach, including McCain. "If they vote against Sotomayor, it's a vote against Hispanic leadership in America. That's the way Latino voters will see it."

Well if they see it that way, then they are idiots.

It's not good for the country if symbolism and identity take too prominent a role in politics. Just because you oppose a public official doesn't mean you oppose their entire ethnic group's involvement in politics. It's like how AIPAC and other groups blanketly label any Israel critics as anti-Semitic. That is a sad reflection on our country and our political culture if some Latino-American politicians and activists threaten to punish any GOP "no" votes during the next election cycle. What does that say about their community if they feel the need to bully and blackmail opponents into agreement? The NRA and right-wing radio are doing the same thing for any Republicans who confirm Sotomayor, so what are they to do? I hope the Latino-American political machine doesn't want to lower itself to the level of the NRA and Limbaugh. I know it's not like they're in the streets with torches and pitchforks, but still I would hope for more restraint. If Sotomayor truly is the most worthy nominee in the eyes of the Latino community (and I doubt many even bothered to read up on her beyond the sound bites, or share much in common with her beyond speaking Spanish), then they should trust that the public, media, and Senate will come to the same conclusion. And if some don't, well you can't please everyone. Let the political process, which they seek greater visibility in, work.

Sotomayor probably well exceeds qualifications for the job. But it's not like she is the overwhelming obvious choice. Other names floating around were Kagan, Wood, Granholm, Wardlaw, and Napolitano (all white women), and their records are similarly impressive. Obama is playing politics too, and it would be a great boost to the Democrats for them to take credit for her historic nomination, considering that Latino swing votes may become more influential in future elections. It shouldn't be so consequential, but that is reality. And there's no need to play affirmate action with our High Court. Yes it would be nice if the Nine represent their country's demographics and were also the top judicators in the land, but it's not like we need quotas for various minorities. We are supposed to pick the most qualified, blindly. At least Sotomayor knocks off two categories: female and Latina. But if America worries about quotas and representation, then why nominate another Catholic when 5 of 8 justices are already Catholics?

After all, she will surely be confirmed despite 28 or so GOP nays. So what is the point of all their fussing? Maybe it's just media overexposure, but still this should really be a non-issue. I guess they wanted to hit a home run with nay votes in the teens or fewer, to send a positive message for Obama and the Latino community. And to put things in perspective, she is but one vote out of nine, and not even a swing vote. The court still leans conservative. Probably LA Mayor Villeraigosa is a more influential Latino leader, and he was elected directly by the people, unlike the undemocratic Senate-decided life term of a justice. Latino-Americans vote majority Democrat, so I don't remember them threatening Democrat senators over no-votes for Alberto Gonzales' nomination by Bush to AG a few years ago. He was a "historic" first Latino to that position too. Lastly, I don't recall the black community threatening the opposition party for refusing to support Thurgood Marshall, Eric Holder, or even Barack Obama - all three being the first African-Americans to their respective positions. I guess the GOP figured it was a moot point, since blacks vote over 90% Democrat anyway (even if the candidate isn't black), so very few additional votes to lose. But maybe it matters more with Latinos, who are projected to occupy a much larger slice of the American population in the coming decades vs. other minorities.

Pro-Sotomayor Republicans say that they are disappointed with their party for placing ideology concerns over professional qualifications over the Sotomayor confirmation. Well unfortunately for a Supreme Court nominee, ideology is part of your qualifications. Maybe that is true for most jobs in Washington (remember the attorney firings during the Bush years?). But probably they have little to worry about, since Sotomayor was rumored to be under consideration by right-winger Bush for the Supreme Court opening that Alito eventually took. Liberals would do the same thing against nominees who may want to overturn Roe-v-Wade, prohibit gay marriage, or other sensitive liberal issues. Of course nominees are smart enough to keep mum about their personal views during the long-winded confirmation hearings, and will come up with all sorts of confusing excuses to explain their past controversial comments, because they want the job so badly - and I guess we all do the same at job interviews.

I only have one thing to add about the "wise Latina" comments. She can say whatever she wants as a private citizen off duty, and that has nothing to do with her professional performance. But anyone who declares herself as "wise" demonstrates the contrary. The truly wise don't have to announce it to anyone, and Pascal said, "Do you wish people to think well of you? Don't speak well of yourself. " Gandhi followed with, "It is unwise to be too sure of one's own wisdom. It is healthy to be reminded that the strongest might weaken and the wisest might err." That comes from two of the wisest humans in history. She wasn't wise enough to maintain her marriage, and has no children (and nothing edifies a person like having kids). So by missing out on those "life experiences", can she empathize as well as the other justices with families? She's very bright and a geek of the law. She's wise in the courtroom, but probably not on the streets. That's no better or worse than the other justices, so she and the public should stop trying to claim that she's something more. I don't mean to be so harsh on her, but suffering through her boooooring confirmation hearings on NPR for a week made me bitter! I think Sir Oscar Wilde summed up the Senate confirmation hearings process well ahead of his time: "In examinations, the foolish ask questions the wise cannot answer.”

She says that her background will help her empathize and understand more cases/people than a white male justice. But Sotomayor does not think, act, and live like a typical Latino-American now and for many years. She is rich and powerful, and actually lives more like an upper class white. Although much "poorer" than recent millionaire nominees Roberts and Alito, her net worth is over $770k plus full judge salary pension after she turns 65, according to NYT. The Pew Hispanic Center cited the median net worth of Latino American households at $7,900 in 2002, and I doubt it's much better now. So how much does she have in common with people who are 100X poorer? I am sure she is well versed in Latino issues from books and colleagues, but it has been decades since she was a poor Puerto Rican from the Bronx. It's just like the Obamas - what kind of personal/social connection do they have with the African Americans in Oakland or Alabama? Yet those communities love and embrace them as if they are a product of their neighborhood. I guess that is the "cult of personality". We love and vote for people who we identify with (in our minds at least), which is sadly no better than the fragmented Afghans and sectarian Iraqis.

Problems with our Afghanistan approach

http://www.lrb.co.uk/v31/n13/stew01_.html

I found these 3 quotes from the author to be most telling:

-Counter-insurgency is neither a necessary nor a sufficient condition for state-building.
-Americans are particularly unwilling to believe that problems are insoluble.
-The new UK strategy for Afghanistan is... not a plan; it is a description of what we have not got.

From Rory Stewart, Kennedy School of Government, Afghanistan expert. NATO may find it a lot harder to achieve Iraq-level "success" in Afghanistan (how disheartening is that?). A troop surge may buy time for government to fill the Taleban void, reconcile the hostile groups, and improve the rule of law/human services, except that this is the Afghan government we're talking about - completely incapable of doing any of that. It's not necessarily their fault, since Afghanistan is one of the 10 poorest nations on Earth, very remote/harsh, with a very under-educated populace, and recovering from decades of war and social turmoil. In addition, there are no marginalized, deal-making Sunnis to "awaken" to our side, and Afghanistan is geographically larger than Iraq yet we've devoted 38% fewer troops: 146,000 for Iraq vs. 90,000 for Afghanistan (that is including the less motivated, experienced, risk-taking non-US forces, as well as the upper estimate of Obama's 2009 surge request). But of course military models recommend a force of at least 500,000 to properly stabilize a nation like Afghanistan. That is impossible, and so is this: the Pentagon seeks to train and deploy a combined Afghan security force of approx. 450,000 men to take over as we draw down (assuming Surge part 2 succeeds). But supporting such a force would require 500% of Afghanistan's current budget (narco-commerce not included).

This is what Obama recently said of the Afghanistan challenge:

[The Afghan gov't] is undermined by corruption and has difficulty delivering basic services to its people. The economy is undercut by a booming narcotics trade that encourages criminality and funds the insurgency . . . If the Afghan government falls to the Taliban – or allows al-Qaida to go unchallenged – that country will again be a base for terrorists who want to kill as many of our people as they possibly can . . . For the Afghan people, a return to Taliban rule would condemn their country to brutal governance, international isolation, a paralysed economy, and the denial of basic human rights to the Afghan people – especially women and girls. The return in force of al-Qaida terrorists who would accompany the core Taliban leadership would cast Afghanistan under the shadow of perpetual violence.

‘There can be only one winner: democracy and a strong Afghan state,’ Gordon Brown predicted in his most recent speech on the subject.

Well that leaves very little room for error, doesn't it? Isn't this the same problem Bush/Blair had justifying/selling the Iraq quagmire? I guess Democrats can do fear-mongering too, like LBJ in Vietnam. Just as it was ludicrous to fear that Saddam would equip terrorists with WMD to strike America, it's unrealistic to think that Western inaction will lead to Taleban/Qaeda takeover of 2 failed states and Pakistan's nuclear arsenal. And it's not a foregone conclusion that those 2 groups will even be able to cooperate in the future, as they have poor track records and clearly different objectives.

And Stewart continues: It misleads us in several respects simultaneously: minimising differences between cultures, exaggerating our fears, aggrandising our ambitions, inflating a sense of moral obligations and power, and confusing our goals. All these attitudes are aspects of a single worldview and create an almost irresistible illusion. It conjures nightmares of ‘failed states’ and ‘global extremism’, offers the remedies of ‘state-building’ and ‘counter-insurgency’, and promises a final dream of ‘legitimate, accountable governance’. The path is broad ... general ... and almost too abstract to be defined or refuted. It papers over the weakness of the international community: our lack of knowledge, power and legitimacy. It conceals the conflicts between our interests: between giving aid to Afghans and killing terrorists. It assumes that Afghanistan is predictable. It makes our policy seem a moral obligation, makes failure unacceptable, and alternatives inconceivable. It does this so well that a more moderate, minimalist approach becomes almost impossible to articulate.

Sounds like a blast from the past. New administration but same ignorance, hubris, and vague/misplaced goals. Yes it's true that the stakes are great and Afghanistan is a critical foreign policy priority, but framing the discussion in this manner is not helpful or responsible. In other words, we can't approach Afghanistan as a test of wills or a holy war. That is how our opponents think (or so some say), and that is what they want from us. Yet strangely everyone and their mother are on board for Obama's plan (the UN, aid groups, NATO, our Muslim allies, and even Afghans). It's just because they hate/fear the oppressive Taleban so much, and are terribly war-weary and desperate. We all hope that an increase in troops will magically fix Afghanistan, but we have to remember history and consider the objective data.

Stewart suggests a sleeker approach with less of a Western footprint on Afghanistan. Nation-building must be an Afghan-driven process, and nothing that we implement will work well or last. Our special forces operations to cripple Qaeda have been effective since 2001, so let's continue that instead of clogging the battlefield and Afghan communities with our regular troops that weren't built or trained for this delicate, difficult purpose. Careful air strikes and 20,000 special forces are enough for surgical missions that will place fewer civilians at risk. If we truly want to increase the rule of law, government functionality, and development over there, then we should stop pretending and actually seriously fund/equip those projects to the level that is required. So we need more boots on the ground for sure, just not boots toting rifles.

Cash for clunkers

http://www.cars.gov/
http://www.kbb.com/kbb/cash-for-clunkers/list.aspx
http://www.npr.org/templates/story/story.php?storyId=111456626&ft=1&f=1006

I question the necessity and execution of this program. Yes it appears to be a success when the $1B CARS fund has nearly depleted after a week of enrollment, and the House quickly passed another $2B replenishment. Assuming that the average rebate is $4,000, that means 250,000 new car sales were subsidized by CARS (assuming no overhead and clunker junking costs). But what is the purpose of the program? A) to get surplus new vehicles off dealer lots, B) to make America's auto fleet less polluting, and/or C) to help consumers fight the recession with increased spending and enjoy the quality-of-life benefits of a new car? And shouldn't this program accomplish those goals fairly and efficiently?

Well let's look at goal A. If Uncle Sam wanted to incentivize Americans to buy more cars (and more fuel-efficient cars... tie-in to goal B), why not just give a tax rebate for buying high-MPG vehicles? Hybrids already have a tax credit, and under the Bush admin. they even gave polluting mega-trucks and SUVs up to a $12k tax break if the vehicle was used for a small business (an easily abused condition). Efficient vehicles are already cheaper than gas-guzzlers, and it's easier to get a great deal for a new car these days, but maybe another $1-2k off the sticker price would help consumers do the right thing. Because if the Feds are essentially rewarding consumers for making poor decisions in the past, that is no different than the bank and mortgage bailouts to irresponsible lenders/borrowers.

So for goal B - will this program make America's auto fleet a bit less polluting? Hard to say but doubtful. There are over 140M autos in the US (1 car for ever 2.5 people, so even if CARS facilitates 500k trade-ins, that will raise our overall fleet MPG under 0.1%). To qualify for the program, clunkers must achieve 10 MPG (or 4 MPG for "work trucks") according to Kelly Blue Book. And to get a full rebate, you must buy a new car that is 10 MPG more efficient. So if I trade in a guzzler 9 MPG Suburban, that means I can buy another medium-sized SUV that gets 19 MPG, and Uncle Sam takes $4,500 off my bill. Why? We know that SUVs not only consume more fuel, but their emissions are dirtier and some studies suggest they are more accident-prone (maybe more a function of the SUV-driver demographic than the actual vehicle class, but still). SUVs may hurt Americans more than cigarettes, yet we tax the hell out of the latter and subsidize the former? So this program hardly discourages the purchase of low-MPG vehicles, which is why the Senate may re-think the weak MPG rules attached to the addition $2B in funding that the House passed. One may still buy a new car that is only 3-5 MPG better than the trade-in clunker and receive $3,500 credit, which is 78% of the maximum rebate. So I can trade in my old Suburban for a slightly smaller Suburban, and somehow that makes me worthy of $3,500 from the taxpayers?

It doesn't make sense. If anything, you should receive a smaller rebate proportional to how low your trade-in vehicle MPG is. If one trades in an efficient but old Civic for a new Civic, that is the "model consumer" the government should reward, not the person trading in an old truck for a new one. And in order to achieve the maximum effect, the trade-in vehicle should be the person's primary or secondary car. If many of these clunkers are a family's "forgotten" fifth car that sits in the driveway and maybe gets 1,000 miles a year, then by removing it from circulation we haven't really helped fight the CO2 problem, because even badly polluting vehicles don't pollute much if they're not driven. So again, the government is subsidizing a family's poor consumer decision and giving them a free pass to the junkyard. And speaking of junking these clunkers - it's not cheap to safely dispose of a junked car. Parts must be salvaged, toxic components must be safely disposed of, and the bulk metal must be compressed or shredded. Or they'll just end up in a Third World nation with laxed environmental laws, like much of the West's consumer trash.

And lastly for goal C - how will this program stimulate the economy? If anything, it looks like another cash infusion to auto companies. Why not just cut a check to the Big 3 and call it even? Because the administrative costs of running this program are not trivial either. "Cash for appliances" seems just as appropriate to meet goals A-C, if not moreso since appliances are cheaper so we can reach more people. As far as I know, there are no income eligibility requirements for CARS. So Warren Buffet and I are equal in the program's eyes. I know it's too early, but I would like to see some demographic data for those who used the CARS program. I highly doubt many of them are "needy" in this recession. Was there even an effort to spread awareness of this program to lower-income or non-English speaking communities? I know CARS is not a charity (it seems DC is mainly interested in helping the rich and irresponsible during this recession), but still. Why not cap eligibility at $150k household income? Otherwise we are giving people who were going to buy a new car anyway a pointless subsidy. Or you have the "cheapskate rich" who are financially able to buy a new car any time they want, but are just waititng for an opportunity like this for Uncle Sam to save them money. Other Americans who unfortunately must rely on their clunker to get to work and pick up the kids from school every day may not be able to afford a newer, better, more efficient vehicle, even with an extra $4,500.

So is this program fair, effective, green, and edifying for America? Possibly but I have my doubts.