Posted on 11/18/2002 7:57:30 AM PST by governsleastgovernsbest
NOV. 18, 2002: DISSING THE ALAMO Powell Disses the Alamo: Colin Powell should have been fired yesterday – literally. The Washington Post yesterday posted its first excerpt from Bob Woodward’s new book, Bush at War. Like Woodward’s book on the Gulf War, The Commanders, Bush at War is essentially an edited transcript of Powell leaks, all of them calculated to injure this administration and undermine its policies on the very eve of military action against Iraq.
For more than a year, we’ve been reading nasty little stories in the papers about Karl Rove, Paul Wolfowitz, and Donald Rumsfeld and condescending stories about President Bush, Vice President Cheney, and Condoleezza Rice. Careful readers have understood that these stories emanated from the State Department – but until now, Powell has taken care to protect his personal deniability. Now he has abandoned that polite pretense.
In the Woodward piece, Powell scorns the president for his “Texas, Alamo macho.” (I guess Powell thinks Col. Travis should have negotiated.) Powell complains with Senate Democrats that acting against Iraq “would suck the oxygen” out of the anti-terror campaign. He denigrates Rice, snidely observing that “she had had difficulties” keeping up with what Bush was doing. When the president over-rules him, Powell complains that he thought he had a “deal” – as if cabinet members bargain with their president rather than taking orders from him. Powell repeatedly praises himself or repeats the praise of others: We learn from him about a personal call from Rice in which she compliments one of his presentations as “terrific,” and we hear via Woodward that Powell is “smooth, upbeat ... eloquent.” Amazingly, Powell even manages to insert into this long uncontrolled soliloquy of accusation against his colleagues a complaint that they sometimes leak against him!
“[Deputy Secretary of State Richard Armitage] had heard from reliable media contacts that a barrage was being unloaded on Powell. ... The White House was going to trim Powell’s sails; he was going to fail. Armitage said he couldn’t verify who was leaking this, but he had names of senior people in Defense and in Cheney’s office. ‘That’s unbelievable!’ Powell said.”
There is no sin in a cabinet officer dissenting from the policies of his president. Nor is it necessarily wrong for him to take his dissent to the country. But before he makes his dissent public, he should resign – and if he won’t resign, he should be sacked. Instead of representing the United States to the world, Powell sees his job as representing the world to the United States. It’s time for him to go.
Homeland Security: My wife and I took the Acela train from Washington to New York City on Sunday morning. My wife, who is not quite so convinced of her personal invulnerability as I am, was more than a little disturbed by the total absence of any security procedures. The conductors barely glanced at our tickets; they never asked for any ID – this on the very first weekend after the FBI announced the threat of massive imminent attacks on American transportation network and national symbols.
But then, maybe the Amtrack conducts knew what they were doing. Whatever country Amtrak is a symbol of – it ain’t America. Brazil maybe.
Single Payer, Part Deux: Friday’s post on the merits and demerits of single-payer health systems like Canada’s provoked an avalanche of e-mail – far too many to respond to each individually. I’m truly sorry about that. I’m sorry too about the typographical errors in the post, which concerned a number of the e-mailers: I write these diary entries very late at night or very early in the morning, and my fingers do sometimes stumble.
Let me try here to reply to the main criticisms I received.
1. My friends over at the New Republic point out that Canada spends only about 9% of its GDP on healthcare as against America’s 14%. The long delays in treatment that Canadians suffer can therefore be blamed – not on the system itself – but on Canada’s failure to fund the system adequately.
This line of defense is often heard in Canada itself. I sometimes think that the words, “We need more government funding,” should appear on Canada’s coins in the spot where the words “E Pluribus Unum” appear on America’s. Here’s the answer.
a) The gap between America’s spending on patient treatment and Canada’s is not as big as the raw percentages might suggest. For example, America’s 14% figure includes the cost of the vast American medical research program. The budget of the National Institutes of Health alone - $27 billion in fiscal 2003 – is larger than the total healthcare expenditures of the provinces of Ontario and Quebec combined. (The provinces are the main funders of Canadian healthcare; Ontario and Quebec are the two biggest provinces, home between them to more than half of Canada’s population.) Canada does little medical research. In healthcare as in defense, Canada piggybacks for free on America’s costly efforts.
b) Much of the differential between the cost of the Canadian and American systems is achieved by the brutal squeezing of the incomes of doctors and nurses. While this may have some impact on staff morale and may contribute to a reduction in the skill level of medical staff, it has little relevance to the issue of waiting times.
c) The Canadian population is demographically different from America’s in important ways. The average age of the Canadian population is lower than that of the United States. There is less obesity in Canada, fewer premature births, fewer victims of assault and attempted homicide. Canadians also drive fewer miles per year than Americans. These differences impose costs on the United States that the Canadian system does not bear. Even under exactly identical health-care policy regimes, one would expect health-care expenditure in the United States to be significantly higher than in Canada.
d) Advocates of single payer often cite Canada’s lower expenditure on healthcare as an argument in favor of the Canadian system. Then, when confronted with the evidence of the Canadian system’s failure, they admit that America’s 14% is not all frittered away on advertising and obscene HMO profits – that it does indeed buy superior care. But if the American system is not riddled with waste that single-payer will squeeze out, then extending a single-payer system to cover the entire U.S. population will be just as hugely expensive as conservative critics fear.
2. Many readers have pointed to Canada’s high average life expectancy as proof that its healthcare system can’t be all bad. But (see point c above) there’s much more to public health than a healthcare system. Hike cigarette taxes and life expectancy will rise, no matter how lousy the hospitals are. The test of a healthcare system is not life expectancy of the population as a whole – it’s the life expectancy of people once they get sick. Here Canada’s record is not so good.
3. Some cosmopolitan readers note that other single-payer systems, Germany’s usually, deliver more satisfactory results than do Canada’s and Britain’s. That’s true – precisely because the German system is much more decentralized and offers more choice (and demands more responsibility) than do Canadian Medicare or Britain’s NHS. Some socialized healthcare systems are more socialized than others, and the more socialized they are, the worse they do.
4. Yes, yes, yes, America’s healthcare system is flawed. It’s overly litigious, it discourages people from changing jobs, it is often wasteful, and it abandons too many people to charity medicine. Yes, yes, yes, America’s healthcare system – which probably should not be called a “system” at all – is in need of reform. The question is not, “Is America perfect?” The question is, “Would single-payer be an improvement?” And the answer to that question – despite Al Gore – is no, no, no.
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