Monday, June 02, 2014
Obama's Conservative Foreign Policy
I pointed out yesterday that Americans are basically isolationists -- believing that the rest of the world should be left to sort out its own problems. Obama's very hands-off foreign policy accords with that -- JR
Conservatives generally agree on a few propositions. The federal government should avoid spending money unnecessarily. It shouldn't exceed its basic constitutional duties. It should encourage self-reliance rather than dependency. It should accept that some problems are beyond its ability to solve.
Barack Obama, they may be surprised to learn, agrees with much of this formula. He just applies it in a realm where conservatives often don't: foreign relations and national security. The Obama doctrine, as outlined in his policies and his speech at West Point Wednesday, is one of comparatively limited government.
Limited government, however, is not something many conservatives champion when it comes to matters military. They may question whether Washington should spend billions to bring prosperity and order to Detroit or New Orleans. But they had no objection to spending billions to bring prosperity and order to Baghdad and Kabul.
In the domestic realm, they believe the federal government's powers are few and mostly modest. Beyond the water's edge, it's a different story. When George W. Bush embarked on an extravagant project to "help the Iraqi people build a lasting democracy in the heart of the Middle East," Republicans granted him all the leeway he could want.
The Constitution says the government should "provide for the common defense." But Bush translated "defense" to mean going to war far from our shores against a country that had not attacked us.
His idea of self-restraint was saying, "The United States will not use force in all cases to preempt emerging threats" (emphasis added). But he insisted that "the United States cannot remain idle while dangers gather." Any potential danger, anywhere, anytime was grounds for an American attack.
A more sensible view is that the U.S. can indeed remain idle while alleged dangers gather, because most of them won't materialize. The immortal philosopher Calvin Coolidge said, "If you see 10 troubles coming down the road, you can be sure that nine will run into the ditch before they reach you." Many conservatives believe in hurrying out to meet all 10 just in case.
Obama noted that in recent decades, "some of our most costly mistakes came not from our restraint but from our willingness to rush into military adventures without thinking through the consequences." Substitute "government programs" for "military adventures," and he could be quoting Paul Ryan.
"I would betray my duty to you, and to the country we love, if I sent you into harm's way simply because I saw a problem somewhere in the world that needed to be fixed," he told the cadets. The attitude he cautions against is one that he and his fellow Democrats do not routinely apply to domestic matters. But it's a sound one.
Critics charge that Obama's foreign policy shows an unwillingness to lead, or weakness, or uncertain purposes. The same complaint, of course, could be made about conservative policies on poverty, health care, urban blight, access to housing and more. "Don't you care?" indignant liberals ask.
But sometimes ambitious government undertakings are too expensive to justify, sometimes they fail to solve problems, and sometimes they make things worse. In those instances, declining to act -- and explaining why -- is the most authentic form of leadership. That's just as true in the international realm as it is in the domestic one.
If Obama has yet to come up with a bumper-sticker slogan for his approach, the elements are fairly clear: Don't use military force until other means are exhausted -- and maybe not then. Don't use ground troops when you can use bombers or drones. Don't act alone when you can enlist allies. Don't take the lead role when someone else will do so.
Don't do for other countries what they could do for themselves. Don't confuse desirable outcomes with vital interests. Keep in mind that very few things are more costly and harmful to American interests than an unnecessary, unsuccessful war.
The president has followed these guidelines with reasonable consistency, which is one reason he could tell the cadets, "You are the first class to graduate since 9/11 who may not be sent into combat in Iraq or Afghanistan" -- and not because they'll be deploying to fight somewhere else.
There will always be people who demand that the U.S. government do more and spend whatever it takes to solve an array of problems without any assurance of accomplishing its goals. Abroad, at least, Obama is not one of them
The VA Health System Is a Tragic Warning Against Government-Run Health Care
Liberals love the now-scandalized veterans health program, but even at its best, it's not worth copying
A damning report released by the Department of Veterans Affairs (VA) Inspector General will likely leave Democrats and their liberal allies clamoring for reforms to the government run health system for those who have served in the military. The report found that workers in the Phoenix VA network systematically manipulated wait time data, leaving thousands of military veterans waiting for medical appointments, and some 1,700 stuck in limbo after being left off the waiting list entirely. According to the report, the average initial wait time for a primary care appointment in the Phoenix VA system was 115 days—a far cry from both the system's 14-day goal and the 24 days Phoenix officials had reported.
Until recently, Democrats have not been particularly shy about expressing their feelings about the VA health care system. For years they have been telling us that it’s great—a model system from which the rest of the nation’s health care systems could learn a thing or two.
In 2011, New York Times columnist Paul Krugman called the program a "huge policy success story, which offers important lessons for future health reform." A few years earlier, he lauded it as a "real live case of impressive cost control." Writing in Slate in 2005, journalist Timothy Noah dubbed the program a "triumph of socialized medicine."
It’s not just liberal advocates. Democratic politicians have made their fondness for the program known as well. In the lead-up to the passage of Obamacare, Sen. Dick Durbin (D-Ill.) praised the Veterans Administration, and all government health care, as a "godsend"—and then mocked a Republican Senator for imagining a future "government [health] plan where care is denied, delayed, and rationed." That future, Durbin said, was "fictitious."
Around the same time, Democratic Sens. Sheldon Whitehouse (R.I.) and Sherrod Brown (Ohio), gave a statement describing the "government health care" provided by the VA as "among the very best health care in the world." In another speech, Sen. Durbin piled on, insisting that veterans reliance on the "quality care" offered by the VA proved critics of government health care wrong. The White House got into the game too, posting a "health insurance reform reality check" declaring veterans’ health care to be "safe and sound."*
The ongoing VA scandal over falsified records, and the deadly long wait times for care that appear to have been the result, seems to suggest otherwise: Veterans are not safe and sound within the fully government-run system, its quality control leaves much to be desired, and its lengthy wait times are not a fictitious prediction but an all-too-grim reality.
In other words, it’s hardly a triumphant, model system. But even if there were no scandal at all, the VA wouldn’t be a system worth emulating.
West Point - The U.S. Military Academy (CC BY-NC-ND 2.0)West Point - The U.S. Military Academy (CC BY-NC-ND 2.0)
When Obamacare passed, we dodged getting a provision that was supposed to emulate the VA. The outbreak of Democratic praise over the program noted above revolved mostly around the possibility of a "public option" in the president’s health care overhaul—a government-run health insurance plan intended to compete with private sector alternatives. The idea was scrapped, and Obamacare became law without it.
So what happens when the federal government actually makes an attempt to take an idea long used by the VA and apply it to the rest of the system? For that, we can look at recent efforts to spur adoption of electronic health records.
In health policy wonk circles, the VA has an electronic records system that is legendarily good. Yes, it’s comparatively expensive, judged against other types of health records systems, but studies have found that the expense pays off with even greater savings. And it helped coordinate better health care too. "The VA’s investment in the Veterans Health Information Systems and Technology Architecture is associated with significant value through reductions in unnecessary and redundant care, process efficiencies, and improvements in care quality," wrote a team of health IT researchers in a 2010 study for Health Affairs.
When the federal government earmarked about $20 billion (to start with) to help encourage health providers to install health IT systems in 2009, as part of the stimulus, it was hoping for a similar payoff. Just a few years earlier, researchers at RAND had published a report estimating that widespread adoption of electronic health records could eventually save $80 billion annually. The stimulus boost was a down payment on the potential for massive future savings.
The stimulus money was sent out to hospitals all over the country, and, with federal funding and a slew of incentives to act, new electronic records systems were rapidly installed. But the hoped-for savings never arrived. In fact, the health IT push may have helped drive federal health spending upwards, by making it easier and more efficient for hospitals to send bigger bills to Medicare.
The system-wide efficiency improvements never appeared either, because too many of the new health records systems couldn’t communicate with each other. The federal government’s health IT investment was supposed to make health care better and cheaper. Instead, it made it more expensive and worse.
The operating theory of most health policy wonks often seems to be that if something works somewhere, it will work everywhere. But the history of health care administration is littered with failed attempts to replicate small successes on a larger scale. All we really know is that if something works somewhere, it will work somewhere.
The point is that even when and where the VA works well it’s not necessarily a system to emulate. That goes for the VA’s vaunted cost control methods too. Paul Krugman is right when he says that the system offers a real-life example of cost control; it really is cheaper than many competitors. But that’s only part of the story. It’s also necessary to account for how the system achieves its savings.
And one of the chief methods the VA uses to control spending is to organize its beneficiaries into eight "priority groups" that determine who gets the most care. The sickest and the poorest are at the top of the list, but everyone else gets shuffled into lower priority groups. And not all types of care are covered, which means veterans in most of the priority groups get the majority of their care outside the system. In 2007, the Congressional Budget Office reported that none of the eight priority groups received more than 50 percent of its care from the program. In 2010, the VA reported that just two of the priority groups—the two groups that have the highest cost per enrollee—had barely crept above 50 percent usage.
It’s not a full-featured system designed to handle the complete health care needs of the population it covers. But it is an example of how government controls costs in health care: through strictly defined prioritization systems and limitations on treatments.
And that's how the system is supposed to work. Add the systematic lies and manipulations that the recent scandal has brought to light, and you have an accurate enough picture of how government health care works in practice.
That’s the government system that Democrats and liberal advocates say they like, and that we should learn from. The scandal shows how bad a government-run system can get, but even the best-case scenario mostly provides lessons in what not to do.
Big Labor's VA Choke Hold
How Democrats put their union allies before the well-being of veterans.
We know with certainty that there is at least one person the Department of Veterans Affairs is serving well. That would be the president of local lodge 1798 of the National Federation of Federal Employees.
The Federal Labor Relations Authority, the agency that mediates federal labor disputes, earlier this month ruled in favor of this union president, in a dispute over whether she need bother to show up at her workplace—the Veterans Affairs Medical Center in Martinsburg, W.Va. According to FLRA documents, this particular VA employee is 100% "official time"—D.C. parlance for federal employees who work every hour of every work day for their union, at the taxpayer's expense.
In April 2012, this, ahem, VA "employee" broke her ankle and declared that she now wanted to do her nonwork for the VA entirely from the comfort of her home. Veterans Affairs attempted a compromise: Perhaps she could, pretty please, come in two days a week? She refused, and complained to the FLRA that the VA was interfering with her right to act as a union official. The VA failed to respond to the complaint in the required time (perhaps too busy caring for actual veterans) and so the union boss summarily won her case.
The VA battle is only just starting, but any real reform inevitably ends with a fight over organized labor. Think of it as the federal version of Wisconsin, Indiana, Michigan and other states where elected officials have attempted to rein in the public-sector unions that have hijacked government agencies for their own purpose. Fixing the VA requires first breaking labor's grip, and the unions are already girding for that fight.
Federal labor unions are generally weak by comparison to state public-sector unions, though the VA might be an exception. The VA boasts one of the largest federal workforces and VA Secretary Eric Shinseki bragged in 2010 that two-thirds of it is unionized. That's a whopping 200,000 union members, represented by the likes of the American Federation of Government Employees and the Service Employees International Union. And this is government-run health care—something unions know a lot about from organizing health workers in the private sector. Compared with most D.C. unions (which organize for better parking spots) the VA houses a serious union shop.
The Bush administration worked to keep federal union excesses in check; Obama administration officials have viewed contract "negotiations" as a way to reward union allies. Federal unions can't bargain for wages or benefits, but the White House has made it up to them.
Manhattan Institute scholar Diana Furchtgott-Roth recently detailed Office of Personnel Management numbers obtained through a Freedom of Information Act request by Rep. Phil Gingrey (R., Ga.). On May 25, Ms. Furchtgott-Roth reported on MarketWatch that the VA in 2012 paid 258 employees to be 100% "full-time," receiving full pay and benefits to do only union work. Seventeen had six-figure salaries, up to $132,000. According to the Office of Personnel Management, the VA paid for 988,000 hours of "official" time in fiscal 2011, a 23% increase from 2010.
Moreover, as Sens. Rob Portman (R., Ohio) and Tom Coburn (R., Okla.) noted in a 2013 letter to Mr. Shinseki, the vast majority of these "official" timers were nurses, instrument technicians pharmacists, dental assistants and therapists, who were being paid to do union work even as the VA tried to fill hundreds of jobs and paid overtime to other staff.
As for patient-case backlogs, the unions have helped in their creation. Contract-negotiated work rules over job classifications and duties and seniorities are central to the "bureaucracy" that fails veterans. More damaging has been the union hostility to any VA attempt to give veterans access to alternative sources of care—which the unions consider a direct job threat. The American Federation of Government Employees puts out regular press releases blasting any "outsourcing" of VA work to non-VA-union members.
The VA scandal is now putting an excruciating spotlight on the most politically sensitive agency in D.C., and the unions are worried about where this is headed. They watched in alarm as an overwhelming 390 House members—including 160 Democrats—voted on May 21 to give the VA more power to fire senior executives, a shot over the rank-and-file's bow. They watched in greater alarm as Mr. Shinseki said the VA would be letting more veterans seek care at private facilities in areas where the department's capacity is limited.
This is a first step toward a reform being drafted by Sens. Coburn, John McCain (R., Ariz.) and Richard Burr (R., N.C.), which would give veterans a card allowing them health services at facilities of their choosing. The union fear is that Democrats, in a tough election year, will be pressured toward reforms that break labor's VA stronghold.
Not surprisingly, Sen. Bernie Sanders (D., Vt.), chairman of the Veterans Affairs Committee, has promised his own "reform." Odds are it will echo the unions' call to simply throw more money at the problem. Any such bill should be viewed as Democrats once again putting the interests of their union allies ahead of veterans.
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Posted by JR at 12:44 AM