Watching the Dear Leader

I really, really promised myself that I wouldn't watch the State of the Union address. I can barely stand to listen to Bush for more than a few seconds at a time anyways, and this year Bush is not expected to unveil any major new products (a la war on Iraq, "axis of evil," Social Security, etc.). Yet here I am watching my fuzzy ABC station. I'm such a junkie...

But, as long as I'm here, two things I'd like to share. First, heard on Air America Radio today by a friend of mine at YLS:

Here is what Air America Radio had to say about the coincidence of the State
of the Union and Groundhog Day falling on the same date:

"It is an ironic juxtaposition: one

involves a meaningless ritual in which we look to a creature of little

intelligence for prognostication, and the other involves a groundhog."

Second, the telepundits chronicling this little spectacle for ABC have spent the last few minutes talking about the harsh line Democrats are now taking on Republicans, and bemoaning the partisanship in Washington, and talking about how Bush's speech may attempt to elevate the tone. Which makes me think: they expect this from a President whose chief political advisor said just a few weeks ago that "Republicans have a post-9/11 view of the world, Democrats have a pre-9/11 view"? Whose vice president told a member of the opposition party to "go fuck [him]self?" Really, have journalists learned nothing from the last few years?

The "Fantasy" of Decent Health Care

Robert Samuelson has an astonishingly obtuse column today in the Washington Post. First, he alleges -- without offering any evidence or justification -- that the phrase "fix the health care system" is "completely meaningless" and that critics of our health care system just focus on a few specific flaws. Then he characterizes Bush's yet-unannounced health care plan as mere "tinkering" that won't address the fundamental drivers of increased costs in health care. I'll agree with him that if Bush's plan consists of mere tax deductions and "health savings accounts," as is being reported, it won't solve the fundamental flaws in our system. Then he zooms in, using anecdotal backup, on what he evidently considers the real driver of astronomical health care costs. See, when Samuelson goes to his nice small private family practice, he observes lots of apparently extraneous staff. Doctors hire too many secretaries and nurses and accountants! That's why we spend 16% of our GDP on health care, compared to 6-8% in Europe! Finally, in an argument that sounds downright condescending, he tells Americans that decent and affordable health care is a "fantasy," and -- like a weary parent schooling his kids -- we should all just wake up to the reality that our health care system is the best of all possible worlds. Silly Americans: we expect too much.

I suppose Samuelson's resigned tone of inevitability, so to speak, would be easier to accept if our health care system weren't distinctly costly, inefficient, and inaccessible. Not only do we spend twice as much as most other developed countries relative to the size of our economy, our aggregate health indicators (life expectancy, infant mortality, etc.) are among the worst in the industrialized world. On top of it all, the system leaves close to 50 million Americans uninsured and millions more with high-deductible coverage on narrow terms. No benevolent social planner, given a blank slate, would design the crazy-quilt patchwork of public and private insurance we have now.

That we could do better is anything but a "fantasy," unless, like Samuelson, you are ideologically blinded or completely unwilling to look outside our borders for ideas. Personally, after living in the UK for two years, I think the horror stories we hear about "socialized medicine" are overblown -- their system is the quintessential government-monopolized health care bureaucracy, yet it actually keeps health care costs pretty low relative to already efficient European countries, it offers 100% coverage and is easy to subscribe to (I got into the NHS system just a few weeks after arriving, and kept my coverage for a full two years even though I never paid a cent in British taxes), and the waiting list is not much more severe than you get in our own crowded hospitals and doctors' offices.

And we could actually do much better than the NHS; take, for example, the French health care system, which spends a little more (about 9% of GDP), but as one would expect from the French offers almost all the luxuries one could ask for: every French resident has coverage, there is absolutely free choice of doctors and hospitals, guaranteed access to specialists of your choice without a "gatekeeper" HMO, full drug coverage, even spa therapy. The government and private insurers foot on average 85% of the bill; the poor and the catastrophically sick pay nothing. It's enough even to make a conservative jealous.

But wait: I thought Samuelson said this was all a fantasy?

Receta Para Lomo Saltado

Peruvian cuisine, with its rich blend of Asian, South American and European flavors, is under-appreciated in the States. One of my favorite dishes is lomo saltado, a sauteed savory-sweet mixture of beef, tomatoes, onions and other veggies. Here's a recipe I tried tonight:

Ingredients:

-- 1 pound petit sirloin steak, sliced thin
-- 1 small red onion, sliced thin
-- 2 medium tomatoes, sliced into wedges
-- 1 ají amarillo (a moderately spicy yellow Peruvian chile -- often available at Latin stores, but if not a mixture of sliced yellow bell pepper and serrano chile should serve well)
-- 2 cloves garlic
-- 1 cup white rice
-- 2 small potatoes, sliced thick
-- small bunch parsley, chopped
-- 1/2 lime
-- white cooking wine (1/4 cup) or white wine vinegar (2-3 tbsp)
-- dark soy sauce (or regular soy sauce sweetened with a teaspoon of sugar)
-- salt and pepper
-- vegetable oil (little less than 1/4 cup)

Preparation:

1. In a small pot, mix the rice and 2 cups water with a dash of salt. bring to a boil, cover and simmer for about 15 minutes.
2. fill a small pot about 1 - 2 inches with vegetable oil. put over high heat until the oil is very hot (but not smoking). fry the potatoes until golden, then set to dry over paper towels. season lightly with salt and pepper and set aside.
3. heat the 1/4 cup of vegetable oil in a wok over medium-high heat. add sliced beef and fry, stirring occasionally, until browned and seared. remove the beef from the wok but leave the drippings behind
4. over medium heat, add the sliced onions, garlic, and ají to the leftover drippings and stir gently for 2-3 minutes. add the cooking wine and the soy sauce. stir gently for another few minutes until the sauce thickens, then add tomatoes and fry for another 2-3 minutes.
5. add the fried potatoes and the beef to the mixture and stir well. add the parsley, stir through again.
6. serve the mixture over the white rice and garnish with lime wedges. serves 3 voracious eaters, easily 4 normal individuals.

Enjoy!

The Death of Investigative Journalism, Washington Post Edition

Wow, the credulity of this article is really breathtaking:

GOP Contest Prompts Yawns Outside Beltway

The premise of the article is that the constituents of GOP Congressmen could care less about corruption and those who do care, see it as a bipartisan issue despite all evidence to the contrary. So who does the WP interview to back up this thesis? Why, GOP Congressmen! What kind of answer did the WP expect to get from these "sources"? For crying out loud...

The Government Did Work, Once Upon a Time

Lest you be tempted to regard the troubles plaguing the new Medicare prescription drug benefit as normal "teething," Jon Cohn writing for The New Republic reminds us that the inauguration of Medicare itself was silky smooth:

What Bush could learn from LBJ on Medicare: "The administration's initial response will be familiar to anyone who recalls the early months of the Iraqi insurgency or the first few days after Hurricane Katrina. 'This is going very well,' a spokesman at the Center for Medicare and Medicaid Services (CMS) said on January 4, with apparent seriousness. When the difficulties became too widespread for even the Bush administration to ignore, officials fell back on another well-rehearsed excuse: Glitches were inevitable given the nature of the task. 'We know there are going to be bumps in the road,' another CMS spokesman said. 'It's a new program.'

Most people probably think this makes sense, since most people think that the government always bungles such massive undertakings anyway. But consider what happened when the Johnson administration rolled out Medicare for the first time in July 1966. Back then, the obstacles were even more daunting than they are today. Rather than simply adding a benefit for a relatively narrow class of services (prescription drugs), introducing Medicare meant establishing an entirely new insurance program in just eleven months. There were concerns about hospital capacity: What if seniors held off on medical treatment until the benefit kicked in and then flooded facilities? There were also racial complications: LBJ had insisted that Medicare refuse payments to hospitals that didn't abide by federal civil rights guidelines. Since many Southern hospitals remained segregated, senior citizens there might have had no place to go.

So what happened on the day that this complex program was implemented? Thousands of senior citizens simply went to the hospital and got the health care they needed. 'There were no crises that I remember,' says Yale University political scientist Theodore Marmor, who worked in the office overseeing Medicare implementation and went on to write The Politics of Medicare, the program's definitive history. Newspaper accounts from the '60s back him up. Under the headline 'medicare takes over easily,' a Post writer described the program's first day as 'a smooth transition, undramatic as a bed change.' Three weeks later, the Times affirmed that 'medicare's start has been smooth.'"

Why was it so smooth? No secret ingredients - just administrative simplicity, single-mindedness of purpose, and competent management. The Medicare drug benefit debacle fails on all these counts: the program is maddeningly complex for pharmacists, insurers and especially for seniors; the program is maddeningly complex because it is intended not so much to relieve drug expenses as it is to benefit drug companies and somehow prove the advantages of private markets and choice in healthcare; and the program is run by people with no experience in social insurance programs, supervised by people with an ironclad reputation for holding absolutely no one accountable for even the biggest mistakes (exception that proves the rule: Brownie).

For the last few years I've thought that more government involvement in health care might cause longer waiting lines and some restriction in patient options, but supported it nonetheless because it seems better to have to wait in line than to have no health care insurance at all, which is what a large and growing number of Americans face every day. But after spending two years in the UK and meeting lots of people from countries with real health care systems instead of the crazy-quilt public/private patchwork we have here, I've realized that all those specters the insurance companies and Republican politicians held over our heads are just that: mere shadows. Yes, Virginia, you can run a government health care system that is clean, efficient, and gives patients plenty of choice. It's really not that complicated, but it can only be done when the people in government actually believe in its ability to help individuals -- rather than just treat it as a giant slush fund / goodie bag for well-connected political donors.

But at any rate, whatever you think about this new Medicare benefit or the merits of publicly provided health care, just don't give in to the soft bigotry of low expectations.

D for Dumbass

Chronicles of the Most Incompetent Administration In History (Medicare Episode) -- they can't even carry off a massive giveaway to the pharmaceutical and insurance industries without screwing it up:

Drug Addled - Why Bush's prescription plan is such a fiasco. By Jacob Weisberg: "I refer, of course, to the administration's program to subsidize the cost of prescription drugs for the elderly. This plan, which went into effect on Jan. 1, offers so many baffling options that only 1 million of 21 million eligible Medicare beneficiaries have signed up for it on their own. Many of these early adopters, along with millions of impoverished Medicaid recipients transferred into the new system automatically, have been unable to obtain their prescriptions at the promised discounted price. The specter of citizens going without needed medications has provoked action by several governors, some of whom have invoked emergency powers to pay for drugs. Meanwhile, the estimated cost of this plan that no one likes has already more than doubled and is now projected at more than $1 trillion over the next decade.

It's tempting to conclude that 'Medicare D' has flopped because of Republican disdain for government. And that is indeed part of the problem. It's hard to think of a major federal program or initiative (other than military procurement and domestic espionage) that has thrived under Bush, who tends to tune out such specifics as design and implementation. With the Medicare drug bill, politically attuned but government-detesting conservatives resolved the inherent conflict between the interests of beneficiaries and the affected industries in favor of everyone. Crucial aspects of the plan were characteristically delegated to insurance and pharmaceutical companies, while the senior-citizens' lobby was appeased in various ways."

By the way, did you catch the part about this "benefit" now costing $1 trillion over the next decade? This was a program originally scheduled to cost about $300 billion, then -- after it was approved -- the Administration admitted that the real cost was $450 billion. So, the $1 trillion question: are the Chinese really going to buy all those bonds? And, will this finally cause the public to realize that Republicans are neither the party of fiscal responsibility nor the party of small government nor the party of sound economic management? Or realize that, when you elect as President an idiot who detests government, you'll get government that is stupid and mismanaged?

For failing to take care that the laws be faithfully executed, impeach George W. Bush and impeach Richard Cheney. Now.

The Man Who Should Have Been President

A candle in the darkness. When I saw this on TV, my first thought was, "Where was this Gore in 2000?" And then it occurred to me that we could never have had this speech in 2000, in that innocent era when the most critical issue at stake in the campaign was the "folksiness" of the candidate or the cost of his haircut. Earnestness back then was to be scorned. Only now we realize what we missed, the man who should have been president:

Transcript: Former Vice President Gore's Speech on Constitutional Issues

New Dish - Caldo Tlalpeno

Finally, a non-political and non-policy oriented post. I fell in love with this dish while I was working in Guatemala City a few years ago, and finally figured out a workable recipe that, while probably not truly authentic, hits pretty close to the mark and is pretty easy to make:

Ingredients:

- 1 small onion (red or white), chopped coarsely
- 2 cloves of garlic, minced
- 1 red bell pepper, chopped coarsely
- olive oil
- chicken bouillon cube
- 2 breasts of chicken, cut in small pieces
- 1 cup of rice
- 1 can of chickpeas
- 1 avocado
- bunch of cilantro
- bunch of green onion
- 1 lime
- 1 tsp oregano
- 1 tsp ground cumin
- 1 chile chipotle or 1 tbsp smoked chile paste (I used a brand I found in the local Chinese market, doesn't have an English name that I can tell)
- salt and pepper

Instructions:

Saute the pepper and onions in olive oil over medium heat, in a large pot. Add the minced garlic and the chile paste. Drain the chickpeas and add to the mixture, together with the rice and chicken and 5 cups of water. Add the bouillon cube, and bring the mixture to a boil. Add remaining spices, and salt and pepper to taste. Then cover and simmer for about an hour. Before serving, add the juice from a wedge of lime and garnish with chopped avocado, green onion and cilantro.

Again, probably not an authentic recipe - but pretty close in taste to what I had in Guatemala. Enjoy!

What Exactly Are We Paying For?

Health care is one of those issues I'd like to understand better. Specifically, I'd like to know why this is happening:

Record Share Of Economy Is Spent on Health Care: "Rising health care costs, already threatening many basic industries, now consume 16 percent of the nation's economic output -- the highest proportion ever, the government said yesterday in its latest calculation.

The nation's health care bill continued to grow substantially faster than inflation and wages, increasing by almost 8 percent in 2004, the most recent year with near-final numbers."

And I don't buy the facile conservative explanation that it's all due to abusive trial lawyers -- even accepting that there is a strong link between, for example, the sharp rise in malpractice premiums and malpractice awards (certainly not an ironclad conclusion since the poor investments of insurance firms are also estimated to account for a large share of premium increases), the relative costs of malpractice insurance comnpared to the total health care bill are too small for tort reform to be a sensible approach to health care. Something else is going on here, and I haven't yet seen a good explanation for what it is. But whatever is causing health care inflation, the U.S. now spends more than twice as much as Europe as a share of GDP on health care, while our aggregate public health performance (i.e. infant mortality, life expectancy, etc) consistently ranks among the lowest in the industrialized world. In other words, we pay out the nose for substandard care, and yet Americans seem convinced that we have the best health care system in the world. Maybe more on this to come.

CATO: Cog in the Vast Left Wing Conspiracy?

Read this?

The Cato Institute: News Room: "'President Bush's executive order sanctions warrant-less wiretaps by the National Security Agency of communications from the United States to foreign countries by U.S. persons. Reportedly, the executive order is based on classified legal opinions stating that the president's authority derives from his Commander-in-Chief power and the post-911 congressional authorization for the use of military force against Al Qaeda. That pernicious rationale, carried to its logical extreme, renders the PATRIOT Act unnecessary and trumps any dispute over its reauthorization. Indeed, such a policy makes a mockery of the principle of separation of powers.

'Perhaps the government is justified in taking measures that in less troubled times could be seen as infringements of individual liberties. But if so, the Congress, not the president, is charged with establishing the rules that apply in exigent circumstances. The executive branch cannot unilaterally set the rules and enforce the rules, then eliminate court review of possible civil liberties violations.'"

What a lefty flag-burning Osama-loving thing to say. Must have come from some Marxist professor holed up in a blue state liberal arts college, right?

Why, no -- it came from CATO senior fellow in Constitutional studies Robert A. Levy.

The NSA domestic spying scandal is no longer a partisan issue, if it ever was. Hopefully the media will pick up on this.

And by the way, Happy New Year!