Author: johncla

We’ve seen now both the Republican and Democrat versions of how to do health care reform. What’s to like from either side?

The Democrat version goes like this: draft a hugely transformative bill behind doors, then declare before the vote that “It’s going to be very, very exciting” but you’ll have to “pass the bill so you can find out what’s in it”. Then, ram the bill through both houses of Congress on black-and-white 100% party-line votes.

The Republican version goes like this: vote more than fifty times in the House to repeal or amend Obamacare. Run on ‘repeal and replace’ in the 2018 campaign and win both houses of Congress and the Presidency. Draft a hugely transformative reform bill behind closed doors, fail to get agreement within your own party, and finally give up and withdraw the bill before it comes to a vote.

Which approach do you prefer? I vote ‘none of the above’. Health care is 17% of national GDP and important to every one of us on a very personal level, but both political parties chose to craft solutions behind closed doors and then pass (or try to pass) largely unexamined legislation with no votes from the other party. America deserves better.

We deserve to not have to endure a health care system cobbled together in secret by politicians in an atmosphere of political extremism, whether left or right.

We deserve the chance to look at alternatives. There are national health care systems actually in place and working in places like Japan, Switzerland and France. Identify which features work in these systems and which don’t, and what the actual costs are. Look around at the choices and ‘kick the tires’. There must be at least three or four quality national health care systems already up and running that are worth mining for ideas. Some systems have been in place for decades. Consider the UK: the NHS began operation in 1948. That’s nearly seventy years of experience – the good, the bad, and the ugly. Why re-invent the wheel?

We deserve the chance to see what happens when the largest stakeholders in the US, actual experts – not politicians, sit down together and create a plan. For example imagine that three parties: doctors, insurance companies, and elected officials created a plan they could all agree to. Give them a deadline: six months to sit together, negotiate, and share ideas. They might come up with an interesting and worthwhile proposal.

We deserve the opportunity to examine and react to specific proposals. Imagine if Congress and the President submitted two or three competing proposals to a nationwide debate and referendum. It would not be binding since the Constitution has no provision for initiative and referendum votes; but we deserve the right to look at competing proposals over a reasonable period of time, hear discussion, and make a reasoned choice between alternatives.

The bottom line
Here’s my proposal:
First, hire a management consulting firm, someone like McKinsey & Company, to create a report detailing the principal features, advantages, and disadvantages of the health care systems in Canada, France, and Japan. Almost all of this information is already public and I think you can give them six months and $250,000 to get the work done. (Really, this is work that is probably already done by some college student as their senior thesis. It is not rocket science.) Their report will be public, and it will be analyzed up and down and shredded to bits, but it’s just a starting point by way of clarifying that there’s a wealth of prior examples and experience to draw from.

Then, craft two or three competing proposals. Where do the proposals come from? My suggestion: one from the doctors (the American Medical Association) and one from the insurance companies (Health Insurance Association of America). If that’s too hard for some reason, then ask the Democratic and Republican members of the House create competing proposals. Have the proposals scored by the CBO. Put the proposals out for debate and add an item to the ballot in the next Congressional election – these votes occur every other year. Let people examine the proposals, debate, and choose from the alternatives.

No more hastily-crafted, top secret, politicized, take-it-or-leave-it proposals. We deserve better.

One recent Monday afternoon we were learning all about the upcoming science fair at the neighborhood elementary school and one of the children announced in a delighted and proud voice that ‘all participants get a ribbon!’ Which reminded me of Kanye West and Frank Ocean boycotting the previous evening’s Grammy ceremonies because they expected black artists to be overlooked; a Grammies several years ago when Kanye West rushed the stage because a white artist won an award; and 2009 when Kanye West interrupted Taylor Swift’s acceptance speech because a black artist didn’t win; recent complaints that black artists are insufficiently recognized at the Oscars; and of course I was reminded that Cleopatra, Queen of Egypt was black.

There was a time when African-Americans were the largest minority in the US, but that’s no longer true. According to Wikipedia citing the 2010 census, African-Americans were a mere 12.6% of the population, while Hispanics were 16.3%. African-Americans are also often considered the most abused US minority group, but that status clearly goes to Native Americans. (Think about it. African-Americans suffered slavery in the past and they suffer racism today, but Native Americans experienced genocide through disease and military action, had a continent stolen from them, and adding insult to injury were then defrauded by the Bureau of Indian Affairs.)

Which raises the question of WHY we spend so much time and energy attending to the concerns of African-Americans: there’s African-American History Month (note: it’s this month, February); Martin Luther King gets a national holiday; there’s a new museum in the capitol devoted to African-American history and culture, and also one right here in Seattle. Hispanics are our largest minority, but they get a national history month with little notice, no national holiday, no national historical museum, and of course no museum here in Seattle.

A breakthrough – poverty cut in half
Reams of legislation were passed and billions of dollars spent to end the problems of the African-American community. According to a 2012 essay published by the Cato Institute we were operating 126 Federal anti-poverty programs, and Federal and state spending combined was over a trillion dollars per year in addition to voting rights legislation, constitutional amendments, affirmative action and so on.

Not without progress. There’s good news! According to Census Department data, poverty in the black community declined sharply between 1959 and 2001, down from 55.1% to 22.7%. The current poverty rate is quoted elsewhere as 27%, but that still means the rate was cut in half after 1959.

The remaining issue
The occasion of cutting the poverty rate by half raises the question of what blocks further progress. There is a big chunk of the African-American community that seems uninterested in assimilating — taking on the values and attributes required for success. As an outsider I’m likely to be accused of racism; but the issue here isn’t race, it’s culture and behavior. Culture and behavior are certainly recognized as issues within the African-American community. See the quotes here in order, from Barack Obama, Michelle Obama, and Ta-Nehisi Coates:

Sometimes African Americans, in communities where I’ve worked, there’s been the notion of “acting white” — which sometimes is overstated, but there’s an element of truth to it, where, okay, if boys are reading too much, then, well, why are you doing that? Or why are you speaking so properly?

Today, instead of walking miles every day to school, they’re sitting on couches for hours playing video games, watching TV. Instead of dreaming of being a teacher or a lawyer or a business leader, they’re fantasizing about being a baller or a rapper. Right now, one in three African American students are dropping out of high school. Only one in five African Americans between the ages of 25 and 29 has gotten a college degree.

I think one can safely call that an element of a kind of street culture. It’s also an element which–once one leaves the streets–is a great impediment. “I ain’t no punk” may shield you from neighborhood violence. But it can not shield you from algebra, when your teacher tries to correct you. It can not shield you from losing hours, when your supervisor corrects your work.

There are well-known problems with educational achievement, for example see this chart using Dept. of Education statistics:

There are problems with family structure, for example this chart showing data from the Centers for Disease Control and Prevention:

Finally, note the hypocrisy of the Black Lives Matter movement, which claims it is a “response to the sustained and increasingly visible violence against Black communities in the U.S.” However, it’s not police or white people that are killing African-Americans, it’s other African-Americans. See the FBI murder statistics for 2013: there were 2,491 African-American murder victims in 2013, and in 2,245 cases the offender was African-American. That’s 90%.

In cases where police are involved in shootings, there is a pathology of make-believe. Take the recent Che Taylor case in Seattle. The NAACP called it “cold-blooded murder”. However, the jury at the inquest found that police believed they faced a “threat of death or serious bodily injury.” There is no way to sensibly reconcile those two statements. It’s not police and white people that are the problem.

The bottom line
The economist Milton Friedman (1976 Nobel Prize in economics), wrote (p.33): “Freedom is a tenable objective only for responsible individuals. We do not believe in freedom for madmen or children…Paternalism is inescapable for those whom we designate as not responsible.”

Work cited:
Milton Friedman. Capitalism and Freedom. Chicago: University of Chicago Press, 2002.

America’s first adventure abroad provides an interesting perspective on dealing with our friends and foes today. The Barbary Wars were fought by Presidents Jefferson and Madison to defend free trade against renegade Islamic powers. Pirates based in three Ottoman possessions demanded tribute from merchant vessels. The US fought two wars against the Barbary States with this result, according to Wikipedia: ‘The war brought an end to the American practice of paying tribute to the pirate states and helped mark the beginning of the end of piracy in that region, which had been rampant in the days of Ottoman domination’.

There is a theme here of Presidents (Jefferson and Madison) unafraid to act, dealing with Muslim troublemakers. Free trade was something that needed defending back in 1810, and it is today.

Straying from old allies
President Obama campaigned in 2008 with a promise to remake US foreign policy, and he kept the promise. Unfortunately, we turned away from old friends. Any list of top US allies back then would include Israel, the UK, Egypt and Saudi Arabia.

• Israel has been our most reliable ally in the Middle East. The ill-will between Prime Minister Netanyahu and President Obama was visible for years, and just this week the US failed to veto an anti-Israel resolution in the UN Security Council. A headline in the New York Times two days ago ran thus ‘For Obama and Netanyahu, a Final Clash After Years of Conflict’.
• What can the Egyptians think? The US encouraged the revolt against our long-time client President Mubarak as part of Arab Spring. The result was that two governments fell, thousands died, and Egypt today is back where they started, but poorer and less stable.
• Great Britain has been our partner for nearly a century in a ‘special relationship’, but we elected a President whose grandfather was imprisoned and tortured by the British in Kenya during the Mau Mau rebellion. You might guess President Obama’s affection for Great Britain was limited. Obama moved the Churchill bust out of the oval office, and early in his first term passed British nuclear secrets to the Russians without the permission or knowledge of the British, this in return for Russian signature on an arms treaty.
• Saudi Arabia’s first king sealed a partnership with President Franklin Roosevelt in 1945. The relationship between the US and Saudi Arabia was firm through ten Presidents, but the Saudis now have lingering disagreements with the US on topics like oil prices, Syria, Yemen, and Obama’s romance with Iran. An article published by the Council on Foreign Relations summarized: ‘differences may lead the kingdom to conclude that it can no longer rely on a security arrangement with the United States’.

Who are the new friends to replace relationships that were decades old? Iran?

Syria and Deterrence
US influence dominated the Middle East for 40 years. Today, at least for the moment, we are without much influence. During the 1976 war the threat of US action deterred Russia from supporting an attack on Israel. Then, when a US President threatened consequences he was believed; but Obama’s threats on Syria had no credibility. Obama drew a red line. Russia and Iran were not deterred, and today they control events completely. The US did not participate in the evacuation talks on eastern Aleppo, and as I write this the foreign ministers of Turkey, Russia and Iran are meeting in Moscow to decide the future of Syria, without the US.

Obama owns the tragedy in Syria. He tried to influence events in Syria but was completely out-maneuvered by Russia and Iran. The US encouraged the revolt against Assad but were unwilling to support it effectively. Help that the Syrian rebels needed was never delivered, and as a result there is Aleppo and the agonies of the Greek islands and Angela Merkel. There is Charlie Hebdo. Is the Norwegian Nobel Committee having second thoughts?

Those who hate us must be encouraged. Much of our influence in the Middle East is lost. The Chinese inflict the torture of a thousand cuts on us in the Western Pacific. The Philippines, long faithful allies, thumb their noses at us. Even the Australians hesitate to support us. In the midst of all this, our military is asked to do more with less.

Successes?
There is one success – relations with Cuba are restored. Ironically, that may have helped doom Secretary Clinton’s Presidential campaign, because it annoyed the Cuban exile community in Florida.
The other possible success is the exit from Iraq. Obama promised it in his campaign, and he accomplished it. The problem is that stability was not maintained, and ISIS arrived. Of course, ISIS came in from Syria. Today, US troops are back in growing numbers, helping to re-conquer Mosul. Not a good result.

Bottom Line
My advice: the new President has some good advisors; let’s hope he makes good use of what they tell him.