The Geo-Green Alternative

I've always wondered why conservatives who both champion freedom for the Middle East and focus on homeland security are not aggressive on reducing US energy consumption. Thomas Friedman thinks that going green is the best way to promote real reform in the Middle East. Once again, since the NY Times archives are not free, I'll include a long quote from his column.

If Britain, France and Germany, which are spearheading Europe's negotiations with Iran, fail, and if the U.S. use of force in Iraq (even if it succeeds) proves way too messy, expensive and dangerous to be repeated anytime soon, where are we? Is there any other way the West can promote real reform in the Arab-Muslim world?

Yes, there is an alternative to the Euro-wimps and the neocons, and it is the "geo-greens." I am a geo-green. The geo-greens believe that, going forward, if we put all our focus on reducing the price of oil - by conservation, by developing renewable and alternative energies and by expanding nuclear power - we will force more reform than by any other strategy. You give me $18-a-barrel oil and I will give you political and economic reform from Algeria to Iran. All these regimes have huge population bubbles and too few jobs. They make up the gap with oil revenues. Shrink the oil revenue and they will have to open up their economies and their schools and liberate their women so that their people can compete. It is that simple.

By refusing to rein in U.S. energy consumption, the Bush team is not only depriving itself of the most effective lever for promoting internally driven reform in the Middle East, it is also depriving itself of any military option. As Richard Haass, president of the Council on Foreign Relations, points out, given today's tight oil market and current U.S. consumption patterns, any kind of U.S. strike on Iran, one of the world's major oil producers, would send the price of oil through the roof, causing real problems for our economy. "Our own energy policy has tied our hands," Mr. Haass said.

The Bush team's laudable desire to promote sustained reform in the Middle East will never succeed unless it moves from neocon to geo-green.

Pro-Life Pro-Choice?

Andrew Sullivan wrote in The New Republic about Hillary Clinton's recent speech about abortion.

There were two premises to Senator Clinton's argument and they are quite simple: a) the right to legal abortion should remain and b) abortion is always and everywhere a moral tragedy. It seems to me that if we are to reduce abortions to an absolute minimum (and who, exactly, opposes that objective?), then Clinton's formula is the best, practical approach. Her key sentences: "We can all recognize that abortion in many ways represents a sad, even tragic choice to many, many women. The fact is that the best way to reduce the number of abortions is to reduce the number of unwanted pregnancies in the first place."

The conservative Catholic Sullivan praises Clinton for taking what he describes as a "broadly pro-life" position because she acknowledges that abortion is wrong. If more people who support a woman's right to choose agreed with Clinton, then a respectful conversation about the legality of abortion would be more likely (and Democrats might have a better chance of being heard by evangelical and Catholic voters). Not only that, but it might also lead to some progress towards reducing the number of abortions in this countries. A professor from Fuller Theological Seminary (where I am technically a student) writes here about what has happened under Bush in regards to actually reducing abortion rates. His conclusion?

Economic policy and abortion are not separate issues; they form one moral imperative. Rhetoric is hollow, mere tinkling brass, without health care, health insurance, jobs, child care, and a living wage. Pro-life in deed, not merely in word, means we need policies that provide jobs and health insurance and support for prospective mothers.

More on the Inaugural Speech

Newsweek's Fareed Zakaria has a more balanced analysis of the speech. The substance of the speech wasn't bad. The problem is that we have been doing the opposite of championing freedom with regards to Russia, Saudi Arabia, Egypt, Pakistan, Taiwan, Uzbekistan...
Zakaria does not think that the proper way to interact with these countries is a simple matter.

I do not mean to suggest that in all these cases the president should invade or break ranks with or even condemn these leaders. There are understandable reasons why the United States must look after its security, as well as its political and economic concerns. But President Bush has suggested in his speech that there is no conflict between America’s ideals and its interests. The record of his administration—as all previous ones—highlights the opposite.

Dealing with this conflict between ideals and interests is not easy. Our hypocrisy is a major reason the "coalition of the willing" is a joke. It is extremely shortsighted that so much of Europe seems to prefer a US failure in Iraq to helping establish a just and secure Iraqi government, but we are not doing much to make it easier to be joined by France and Germany and Spain and...

While Bush has been visionary in his goals, he has not provided much practical wisdom on how to attain them in a complex world. This lack of attention to the long, hard slog of actually promoting democracy might explain why things have gone so poorly in the most important practical application of the Bush Doctrine so far—Iraq. Convinced that bringing freedom to a country meant simply getting rid of the tyrant, the Bush administration seems to have done virtually no serious postwar planning to keep law and order, let alone to build the institutions of a democratic state. If this sounds like an exaggeration, consider the extraordinary words in the “after-action report” of the most important division of the American Army in Iraq, the Third Infantry Division, quoted in a recent essay by Michael O’Hanlon. It reads: “Higher headquarters did not provide the Third Infantry Division (Mechanized) with a plan for Phase IV [the postwar phase]. As a result, Third Infantry Division transitioned into Phase IV in the absence of guidance.”

...For much of the world, the great challenge today is civil strife, extreme poverty and disease, which overwhelms not only democracy but order itself. It is not that such societies are unconcerned about freedom. Everyone, everywhere, would choose to control his own destiny. But this does not mean as much when the basic order that precedes civilized life is threatened, and disease and death are the most pressing daily concern. Much of Africa is reasonably free, holds elections and is far more open than ever before. The great challenge in, say, Senegal and Namibia is not freedom but an effective state. The author of American liberty, James Madison, wrote in The Federalist papers that “in framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed; and in the next place oblige it to control itself.” Order and then liberty (we might have remembered this in Iraq).

The writing is on the wall. The remaining tyrannies will eventually perish. And the world will move slowly toward greater and greater freedom. The United States is right to push this trend forward. The president is wise to articulate the path ahead. But we should also note the trends toward chaos, plague and poverty, which consume the attentions of much of the world. These are also great evils, and we should propose ways to lead the world in tackling them. That, too, would make for an interesting and important speech.

Inauguration

Juan Cole has a pictorial commentary on Bush's inaugural speech. I had some of the same thoughts. He focused so much on freedom, but his actions over the past four years reveals a limited view of freedom.

Surprisingly, Cole does not deal with the part of the speech that was most troubling to me. Bush declares that the US would stand by those who want to expand freedom and democracy throughout the world. What does that mean for our approach to China and Taiwan? How do we react when Turkey, a democracy, wants to deny US troops access to Iraq through Turkish territory? Why shouldn't the people of the middle east conclude that the US is hypocritical and untrustworthy when they see our relationship with the governments of Saudi Arabia or Egypt? Do we really want a democracy in those countries if a democratic government would be anti-US, at least in the short-term? If a democractic government was established in Saudi Arabia, we would likely see a return to an 1970's style oil crisis. Would we be willing to make that kind of sacrifice?

Again, there is no talk of sacrifice in Bush's speech. What kind of moral values ignores sacrifices?

Bush on Accountability

The Washington Post interviewed the President on Friday and reported the following:

President Bush said the public's decision to reelect him was a ratification of his approach toward Iraq and that there was no reason to hold any administration officials accountable for mistakes or misjudgments in prewar planning or managing the violent aftermath.

"We had an accountability moment, and that's called the 2004 elections," Bush said in an interview with The Washington Post. "The American people listened to different assessments made about what was taking place in Iraq, and they looked at the two candidates, and chose me."

So let me get this straight. There is no reason to hold anyone accountable for their obvious failures because he won the election? So winning trumps accountability? If you win, there is no need to account for mistakes, acknowledge failures? This is quite a departure from a traditional evangelical approach to issues of sin and repentance. How can evangelicals claim that Bush's approach to governing is biblical?!?

Maryland's tort reform

Lawmakers in Maryland overrode the Governor's veto on a medical malpractice reform bill this past week. The bill was supported by trial lawyers, the Maryland Hospital Association (MHA), and the Maryland Medical Society (MedChi). What did it take to get both doctors and lawyers to agree on tort reform?

The bill passed by the Assembly would limit pain and suffering awards in wrongful-death cases at $800,000, require mediation before a malpractice suit could be filed, make a doctor's apology to a patient inadmissible in court and set up stricter standards for expert witnesses.

So, they limited doctors' financial risk from frivolous lawsuits (the real benefit of caps), potentially reduced the expense of dealing with frivolous lawsuits AND reduced expenses for patients who truly are victims of malpractice with mediation, and encouraged a more honest relationships between doctors and patients. It also subjects increases in malpractice insurance premiums to further reviews and even limits. Not a bad plan. An even better plan would combine Maryland's reform with a review board made up of doctors and lawyers that must approve all malpractice cases before they can be filed, automatic sanctions for lawyers after their third case is rejected by this review board, and automatic reviews of medical licenses for doctors after their third malpractice payout (either in a jury award or in a settlement).

Tort Reform

Last week while I was visiting my parents, I came across this article in the Kansas City Star. Doctors in Missouri have been facing tremendous malpractice insurance premium increases and are arguing that the state's cap on non-economic damages should be lowered. They point to Kansas' $250,000 cap per malpractice event as a model, and claim that the cap leads to a difference in premiums.

[T]he average cost for malpractice insurance in Kansas for a general surgeon in 2004 was $31,150. By comparison, general surgeons in Missouri paid $105,563 or more for private malpractice insurance in 2004.

Insurance industry executive Bill Turley says the cap is not the reason for the difference in insurance rates charged in the two states.

Kansas has a Health Care Stabilization Fund, which assumes the major risk of liability for doctors.

It works like this. Private insurers cover the first $200,000 of a doctor's malpractice liability. The Kansas fund assumes up to $800,000 in additional liability. In return, the doctor pays a premium to the private insurer and a surcharge — a percentage of the premium — to the fund...
Part of the reason the stabilization fund can charge less is that its operating costs are only 3 percent of the total it collects annually. It does not have the legal, clerical and marketing costs a for-profit insurance company does, nor does it answer to shareholders. Because all Kansas doctors belong to the fund, they did not face the hassles and higher rates that pummeled Missouri doctors the past two years when some malpractice insurers became insolvent or left the state.

And because private insurers are responsible only for up to $200,000, they can better predict their losses, creating a more stable market that deflects the premium fluctuations that buffet Missouri doctors.

Kansas, being a rural state, only has half the number of med-mal lawsuits as Missouri, but it has stronger regulations for the insurance industry. Before raising rates, an insurance company has to justify the hikes before the state insurance commissioner, while in Missouri the insurance director has no involvement in setting of rates. Like all states, Missouri experiences an "insurance crisis" on a periodic basis. Rates soar when insurance companies lose money in the stock market, insurers claim that caps on awards are the best solution, and when the stock market improves, the crisis goes away.

Turley said reformers look only at short-term fixes and lose interest in more permanent reforms when cyclical malpractice crises wane.

He said Missouri in 1985 considered a joint underwriting association to cover doctors who could not find alternative coverage. The idea was shelved after insurer profits rose and rates fell. There followed a period of price wars that Turley said contributed to the current crisis.

Over the past few years, investments made by insurance companies have not covered their costs. Not only do these companies need to raise their rates to cover their investment losses, but they need to make up for undercharging doctors during the stock market boom of the 1990's. The current crisis provides an opportunity to look at real reform instead of "short-term" fixes.

Are we stingy?

Nicholas Kristof deals with the accusation by a UN official that the wealthiest countries (which everyone understood to primarily mean the US) were "stingy" in their initial response to the tsunami.

Kristof points that while the US contributed generously to the tsunami, malaria kills about the same number of people each month.

But the bottom line is that this month and every month, more people will die of malaria (165,000 or more) and AIDS (240,000) than died in the tsunamis, and almost as many will die because of diarrhea ( 140,000).

Including both official government aid and private charity, American give 21 cents a day per person in development assistance to poor countries. Kristof does note that Bush has been better than Clinton (see, I don't bash Bush all the time!)
More from Kristof:

When I contracted the most lethal form of malaria, in Congo, I was easily cured because I could afford the best medicines. But to save money, African children are given medicines that cost only 5 cents a dose but aren't very effective; the medicine that would actually save their lives is unaffordable, at $1 a dose. Do we really think $1 a dose for medicine to save a child is money down a rathole?

Jeffrey Sachs, the Columbia University economist, estimates that spending $2 billion to $3 billion on malaria might save more than one million lives a year. "This is probably the best bargain on the planet," he said...
With America's image tarnished around the world, one of the most effective steps Mr. Bush could take to revive it would be to lead a global effort to confront an ongoing challenge like malaria. That would also give Mr. Bush more credibility by suggesting that the "culture of life" he talks about embraces not just fetuses, but also African children crying from hunger.

The best response to accusations of stinginess is not to be defensive, but to be generous. And the measure of generosity is not what you offer when the spotlight is upon you, but what you do when the spotlight moves on.

Torture

Alberto Gonzales will begin his hearing before the Senate Judiciary Committee on Thursday to confirm his appointment to be the next Attorney General. It is likely that he will be confirmed, leading one author to say "We Are All Torturers Now."

...what we are unlikely to hear, given the balance of votes in the Senate, are many voices making the obvious argument that with this record, Mr. Gonzales is unfit to serve as attorney general. So let me make it: Mr. Gonzales is unfit because the slow river of litigation is certain to bring before the next attorney general a raft of torture cases that challenge the very policies that he personally helped devise and put into practice. He is unfit because, while the attorney general is charged with upholding the law, the documents show that as White House counsel, Mr. Gonzales, in the matter of torture, helped his client to concoct strategies to circumvent it. And he is unfit, finally, because he has rightly become the symbol of the United States' fateful departure from a body of settled international law and human rights practice for which the country claims to stand.

At least this administration has moral values.

Tort Reform

It looks like the Bush Administration has done something that I agree with in dealing with tort reform. They commissioned a study by the University of Iowa and the Urban Institute to "help state boards of medical examiners in disciplining doctors." The HoustonChronicle.com reports that the finding are that only a small number of doctors have a high proportion of malpractice claim (this is nothing new). State medical boards and underfunded and understaffed while the process of "revoking an incompetent doctor's license can take months or years." Gathering more information is almost always a good idea.

So what is a good response to this information?

Massachusetts has adopted an approach that experts say may provide a model for other states. Without waiting for a complaint to be filed, the Massachusetts Board of Registration in Medicine conducts a clinical review of any doctor who has made three or more malpractice payments to patients, as a result of jury verdicts or settlements. Nancy Achin Audesse, executive director of the board, said: "Three is a magic number. Doctors who have to make three or more payments are also more likely to be named in consumer complaints and to be subject to discipline by hospitals and the medical board."

In Massachusetts during the last 10 years, Audesse said, "one-fourth of 1 percent of all the doctors — 98 of the 37,369 doctors — accounted for more than 13 percent of all the malpractice payments, $134 million of the $1 billion in total payments."

I recently signed a petition for an initiative in the state of Washington calling for a similar process. If, by dealing with only .25% of the doctors in a state, you can reduce malpractice payments by 13%, then surely the Administration (and the insurance industry) would be fully supportive!

President Bush continues to push for limits on jury awards for medical mistakes with a visit today to an Illinois county where the White House says frivolous lawsuits have run amok.

Bush says large malpractice awards have driven up the cost of business so high that doctors have to close their businesses or scale back services...

[Whitehouse spokesman] McClellan on Tuesday brushed aside questions about whether Bush would examine rising malpractice insurance rates. McClellan blamed "unlimited and unpredictable liability awards" for raising the cost of health insurance premiums and making insurance too expensive for some Americans.

Bush says tort reform is a key part of his plan to lower health care costs and help the more than 40 million uninsured Americans obtain coverage. Democrats in Congress say that won't amount to much savings, pointing to a year-old Congressional Budget Office report that said malpractice costs amount to only about 2 percent of overall health care spending.

You wouldn't expect Bush to let little things like research get in the way of his plans, would you?

James Dobson

It seems that James Dobson has left his areas of expertise and is now becoming just another Ralph Reed style political attack dog.

In a letter his aides say is being sent to more than one million of his supporters, Dr. Dobson, the child psychologist and founder of the evangelical organization Focus on the Family, promises "a battle of enormous proportions from sea to shining sea" if President Bush fails to appoint "strict constructionist" jurists or if Democrats filibuster to block conservative nominees.

Another conservative Christian leader who knows a thing or two about politics does not think this is a good idea.

In "an open letter to the Christian church" last month, Charles W. Colson, the born-again Nixon aide and another influential Christian conservative, warned against listing demands of the president or other elected officials.

"To think that way demeans the Christian movement," Mr. Colson wrote with his associate Mark Earley. "We are not anybody's special interest group."

House to Consider Relaxing Its Rules

The Washingtonpost.com: reports on the "moral values" of the Republicans in the House.

War Planning

Another from David Brooks' most important political essays of 2004. The Atlantic published this article last winter about the preparations for Iraq. I have found it interesting that Brooks , and many other conservatives, is now pointing to these criticisms of Rumsfeld and the handling of Iraq. Before the election, of course, these criticisms were unpatriotic.

Abu Ghraib

The conservative NY Times columnist David Brooks recently identified what he considered to be the most important political essays from 2004. One was Seymour Hersh's article in the New Yorker about Abu Ghraib. Hersh is refreshingly nuanced in explaining the relationship between the abuses and the Administration.