Merry Christmas!!

I’m not a church person, but every year Christmas brings me to a church somewhere. Usually it’s TG’s, where she’ll be singing the messiah with her chorus tonight and we’ll be attending with two of the boys and some dear friends.

Two years ago, we were at Notre Dame in Paris, attending Midnight Mass and wondering at the idea that people have been doing exactly the same thing in exactly the same place for a over thousand years and in the same building for over eight hundred.

So Merry Christmas to everyone here. You don’t have to be religious to embrace the spirit of the day – birth, hope, and renewal.

May your day be merry and your troubles light…
-

Should Healthcare Be A Cathedral Or A Bazaar?

As we’re thinking about the healthcare bill, here’s some useful grist for our mental mills – a statement by Google’s head of product management about what ‘open’ means and why Google is committed to it.

I’m not sure that Google walks their talk 100%, but that’s not the issue here – the issue is the values and value laid out in this manifesto, which is in turn a weaker more instrumental version of ‘The Cathedral and the Bazaar‘ by Eric Raymond.
-

“…Dukakis Without The Administrative Skill.”

Go over and read a great ‘report card’ on Obama at the Huffington Post (can you believe I’m saying that?).

Seriously, writer Drew Westen nails Obama for exactly the things I’m increasingly uncomfortable with (and if you believe the polls, you’re increasingly uncomfortable with as well).

What’s costing the president and courting danger for Democrats in 2010 isn’t a question of left or right, because the president has accomplished the remarkable feat of both demoralizing the base and completely turning off voters in the center. If this were an ideological issue, that would not be the case. He would be holding either the middle or the left, not losing both.

What’s costing the president are three things: a laissez faire style of leadership that appears weak and removed to everyday Americans, a failure to articulate and defend any coherent ideological position on virtually anything, and a widespread perception that he cares more about special interests like bank, credit card, oil and coal, and health and pharmaceutical companies than he does about the people they are shafting.

The problem is not that his record is being distorted. It’s that all three have more than a grain of truth. And I say this not as one of those pesky “leftists.” I say this as someone who has spent much of the last three years studying what moves voters in the middle, the Undecideds who will hear whichever side speaks to them with moral clarity.

He goes on, and it gets better.

My own discomfort with Obama come from two core perspectives…

First, that I’m trying to figure out what happened to that uber-controlled competent campaigner. How did he become Barney Fife?

Next, that the guy who is so good at making speeches seems completely incapable of staying on message and developing themes – of expressing a coherent view of the world, our place in it, and the policies we need to advance to secure and improve that place in the world – see my response to his Afghanistan speech.

Westen goes on:

Like most Americans I talk to, when I see the president on television, I now turn change the channel the same way I did with Bush. With Bush, I couldn’t stand his speeches because I knew he meant what he said. I knew he was going to follow through with one ignorant, dangerous, or misguided policy after another. With Obama, I can’t stand them because I realize he doesn’t mean what he says — or if he does, he just doesn’t have the fire in his belly to follow through. He can’t seem to muster the passion to fight for any of what he believes in, whatever that is. He’d make a great queen — his ceremonial addresses are magnificent — but he prefers to fly Air Force One at 60,000 feet and “stay above the fray.”

It’s the job of the president to be in the fray. It’s his job to lead us out of it, not to run from it. It’s his job to make the tough decisions and draw lines in the sand. But Obama really doesn’t seem to want to get involved in the contentious decisions. They’re so, you know, contentious. He wants us all to get along. Better to leave the fights to the Democrats in Congress since they’re so good at them. He’s like an amateur boxer who got a coupon for a half day of training with Angelo Dundee after being inspired by the tapes of Mohammed Ali. He got “float like a butterfly” in the morning but never made it to “sting like a bee.”

And that’s true. My friends criticized Obama – looking at the trail of bodies in his wake and suggested that he was “just another Chicago politician.” I saw that as a feature, not a bug. I believed that when the chips were down, Obama would fight brutally hard.

Haven’t seen that so much. Instead we get what Westen brutally calls:

He’s increasingly appearing to the public, and particularly to swing voters, like Dukakis without the administrative skill.

I hoped that he’d be the harbinger of a new kind of liberalism, and so far I’m flat wrong about that.

But Fitzgerald was wrong; there often are second acts in American life. Obama has been bloodied. Let’s see what happens now. Will he fold or fight? Will he embrace the bankrupt politics of the SEIU, or will he strike out in new directions and bring the American people with him?
-

I Left My Wallet…In San Francisco

One of the first blog posts I ever did was about ‘Skybox Politics’ (I have it archived, but the Armed Liberal site isn’t up…) – I wrote about a bunch of lefty UC Berkeley student government types who wanted to close a cooperatively-owned bicycle shop in the student union so they could put a small electronics store in instead and raise the rent – so they could fund more progressive activism. I called them ‘Skybox Liberals.’

California is full of them, and we’re seeing the result in the disaster that is our state’s government. Note that to me this isn’t an indictment of liberalism = the folks running the bicycle co-op were admirable liberals of a type we need a lot more of these days. It’s an indictment of a certain mindset.

Well, I ran into a terrific indictment of that mindset – one that boiled it, skinned it, and nails it to the wall – in the SFGate, where Benjamin Wachs and Joe Eskenazi just get out the big hammer and lay into San Francisco’s government. They open:

Despite its good intentions, San Francisco is not leading the country in gay marriage. Despite its good intentions, it is not stopping wars. Despite its spending more money per capita on homelessness than any comparable city, its homeless problem is worse than any comparable city’s. Despite its spending more money per capita, period, than almost any city in the nation, San Francisco has poorly managed, budget-busting capital projects, overlapping social programs no one is certain are working, and a transportation system where the only thing running ahead of schedule is the size of its deficit.

It’s time to face facts: San Francisco is spectacularly mismanaged and arguably the worst-run big city in America. This year’s city budget is an astonishing $6.6 billion – more than twice the budget for the entire state of Idaho – for roughly 800,000 residents. Yet despite that stratospheric amount, San Francisco can’t point to progress on many of the social issues it spends liberally to tackle – and no one is made to answer when the city comes up short.

Because it’s only superficially about good intentions. At root, it’s about power and money. The nomenklatura get the power…

This city is a mecca for people in search of a government handout that they can hand out. According to a 2009 analysis, San Francisco spends around 41 percent of its discretionary budget – about half a billion dollars – on nonprofits, mostly to provide social services for the poor, homeless, elderly, and others.

Many cities contract with nonprofits because it’s cheaper than using city workers. Government is now paying the tab for services that used to be undertaken by families, churches – or, frankly, no one. But a 2009 University of San Francisco study notes that this city is to nonprofits what New York is to big musicals: “Per capita expenditures by operating nonprofits in San Francisco are almost double that of the rest of the Bay Area, and more than twice that found in Los Angeles or [the whole of] California.”

We want the services. We’re willing to pay for them, if they lead to good results. Yet whether our gargantuan investment is paying off is a question no one has an answer to. Hardly anyone even bothers to check. As far as much of the city is concerned, ignorance is bliss.

In 2007, the Department of Children, Youth, and Families (DCYF) held a seminar for the nonprofits vying for a piece of $78 million in funding. Grant seekers were told that in the next funding cycle, they would be required – for the first time – to provide quantifiable proof their programs were accomplishing something.

The room exploded with outrage. This wasn’t fair. “What if we can bring in a family we’ve helped?” one nonprofit asked. Another offered: “We can tell you stories about the good work we do!” Not every organization is capable of demonstrating results, a nonprofit CEO complained. He suggested the city’s funding process should actually penalize nonprofits able to measure results, so as to put everyone on an even footing. Heads nodded: This was a popular idea.

There are two lessons here. First, many San Francisco nonprofits believe they’re entitled to money without having to prove that their programs work. Second, until 2007, the city agreed.

…and the politically omnipotent public sector unions get the money…

The then-president of the Board of Supervisors had proposed sweeping Muni reforms to get the transit system running on time and on budget. National transit experts said Peskin’s proposal was solid; it was later approved by the voters in 2007 as Proposition A. Since then, Muni has slashed services and raised fares, and is facing a bigger budget crisis. That shouldn’t have been a surprise – Muni reform started unraveling on that June day, when dozens of transit union workers “testified” in front of the Rules Committee.

Job protection for even the most obviously unfit Muni workers is among the strongest in the city. Peskin had proposed increasing the percentage of employees who could be fired for incompetence from 1.5 to 10 percent. But if that provision were included in the measure, union reps said, they would flood the “No on A” campaign with money and volunteers. “This is a union town,” one transit worker warned. “And we expect it to stay that way.”

Peskin caved. He had to. This is a union town. You can’t reform the city charter without winning an election; winning an election requires union support; and unions – almost by definition – don’t want major reform. It would be a paradox – but that would contravene a number of union bylaws.

Now what this represents – written small – is the process that’s going on in government throughout the country. We’re looting the money we should be spending on core services – infrastructure, libraries, schools – and spending it on a political class and their dependents.

In 2002, the San Francisco Chronicle revealed that the city had, for decades, been siphoning nearly $700 million from its Hetch Hetchy water system into the San Francisco General Fund instead of maintaining the aging aqueduct. Several mayors and boards of supervisors used that money to fund pet causes, and the Public Utilities Commission didn’t say no. Unfortunately, spending maintenance money elsewhere doesn’t diminish the need for maintenance. By 2002, the water system was in such desperate condition that voters were asked to pass a $3.6 billion bond measure to make overdue fixes. Obligingly, they did – who doesn’t like water? Since then, the projected costs have swelled by $1 billion. So far.

We’ve chronically underfunded maintenance on infrastructure in order to pay exorbitant public-sector salaries, high costs for nonprofits and costs for NGO’s who are great at manipulating funding systems, and possibly less great at actually delivering the services they are contracted for.

Who gets screwed in this?

Well, the taxpayers, obviously. That’s why we’re having tea parties, and why the independent cube-dwelling middle class is so pissed off. The roads are falling apart, the schools are overcrowded and in disrepair, the water systems are failing – and yet the high taxes they pay aren’t ever enough and we need to borrow and tax more.

And – especially galling for me – the poor and dependent, who really should be getting services, who really do need libraries and transit services and good social services.

And that’s what pisses me off. Because what we’re doing is essentially stealing from the defenseless; and worse what we’re doing is discrediting al government spending – making it impossible for even necessary and legitimate government services to argue for funds.

Look, I’m fully aware of “don’t tax you, don’t tax me, let’s tax the fellow over behind the tree” and the problem it presents.

But those of us who argue that government has an important role need – at some point – to break through this and make it clear that government can deliver the goods to those who are supposed to get them – not just to those whose hands they pass through.
-

Krugman On Healthcare and Iraq

Krugman is channeling Monty Python in a particularly silly column up on healthcare today.

His basic claim (echoing Steve Benen) is that the inter-progressive arguments on the healthcare bill have been pretty interesting, while the conservatives haven’t really made any meaningful arguments against it (which kind of makes you wonder why it’s in such danger of not passing, doesn’t it).

I’ve been scanning both sides of the issue for a while, and on one hand, I want to kind of agree with him. The arguments among liberals about how government should increase its footprint in healthcare are more interesting than the arguments by conservatives about why it shouldn’t.

But that’s kind of like why arguments among fans of Bay Area power-pop bands are much more interesting – to other power-pop fans – than listening to someone rail that “Greg Kihn was just crap!” It’s just not very interesting – as above – when you go from argument to disagreement.

And the Republicans are constrained here by three things – first the political Kabuki in which a vote against healthcare is going to be positioned as a vote for putting poor Aunt Molly to death. Reformers (who, by definition, claim to want to extend all possible healthcare to all possible people) are waiting, primed, for some poor redneck Senator to explain that we just won’t spend money on X, whereupon the very real suffers of X will be paraded in Senator Leghorn’s home state as evidence of his or her hardheartedness. Next is the fact that they, too, get a lot of cash from pharma and the payors and really don’t want to be pissing on their own petunias here. Finally, Krugman does have a real point – the GOP hasn’t had a strong ideological core in domestic policy for a long, long time.

Republicans haven’t had a great track record in meaningfully (as opposed to theatrically) arguing for more limited government for a while – that’s because they’re in hock to the rent-seeking class just as deeply as the Democrats – they just have a different set of political investors.

But I’ve got to believe that way back in their hindbrains, they kind of reflexively believe – something. There was something that made them choose to be Republicans back at the beginning of their careers.

Oh, wait. Susan Collins (R-Maine) said something that seemed kind of smart to me:

“I’m very troubled that the Senate bill does not empower consumers more,” Ms. Collins said. “If they’re given information and financial incentives, they’ll make good decisions.”

Oh, yeah. A good argument, made by an opponent of the bill. Gosh.

And his backhand linking opposition to the bill to support of the war in Iraq – well, there’s only one meaningful reply – what if those of us who supported the war were right? History will ultimately make that decision, not Keith Olbermann.
-

Taking The Day off – In Support of CJ Grisham

From Bouhammer:

CJ.jpg

On Wednesday 16 December 2009, many milblogs – including Bouhammer, This Ain’t Hell, From My Position, Blackfive, Miss Ladybug, Boston Maggie, Grim’s Hall, and those participating in the Wednesday Hero program – are going silent for the day. Some are choosing to go silent for a longer period of time. [Winds will be dark for the day – note that our server is set to Zulu time, so we’ll be dark from 0800 on the 16th to 0800 on the 17th.]

The reason for this is two-fold. First, milblogs are facing an increasingly hostile environment from within the military. While senior leadership has embraced blogging and social media, many field grade officers and senior NCOs do not embrace the concept. From general apathy in not wanting to deal with the issue to outright hositility to it, many commands are not only failing to support such activities, but are aggressively acting against active duty milbloggers, milspouses, and others. The number of such incidents appears to be growing, with milbloggers receiving reprimands, verbal and written, not only for their activities but those of spouses and supporters.

The catalyst has been the treatment of milblogger C.J. Grisham of A Soldier’s Perspective. C.J. has earned accolades and respect, from the White House on down for his honest, and sometimes blunt, discussion of issues – particularly PTSD. In the last few months, C.J. has seen an issue with a local school taken to his command who failed to back him, and has even seen his effort to deal with PTSD, and lead his men in same by example, used against him as a part of this. Ultimately, C.J. has had to sell his blog to help raise funds for his defense in this matter.

An excellent story on the situation with C.J. can be found here at Bouhammer: Decorated soldier’s blog attracts loyal following, but he says his bosses are muzzling him.

While there have been new developments, the core problem remains, and C.J. is having to raise funds to cover legal expenses to protect both his good name and his career.

One need only look at the number of blogs by active duty military in combat zones and compare it to just a few years ago to see the chilling effect that is taking place.

Milblogs have been a vital link in getting accurate news and information about the military, and military operations, to the public. They have provided vital context and analysis on issues critical to operations and to the informed electorate critical to the Republic.

On Wednesday 16 December, readers will have the chance to imagine a world without milblogs, and to do something about it. Those participating are urging their readers to contact their elected representatives in Congress, and to let their opinions be known to them and to other leaders in Washington.

Some milblogs will remain silent for several days; some just for the day. All have agreed to keep the post about the silence and C.J. at the top of their blogs until Friday 18 December.
The issues go beyond C.J., and deserve careful consideration and discussion. We hope that you will cover this event, and explore the issues that lie at the heart of the matter. Contact the milbloggers in your area or that you know, and hear the story that lies within.

A Partial List of Participating Blogs:

Bouhammer’s Afghan & Military Blog

This Ain’t Hell

Boston Maggie

Blackfive

Miss Ladybug

Drunken Wisdom

Grim’s Hall

From my position

CDR Salamander

Grisham Legal Fund
c/o Redstone Federal Credit Union
220 Wynn Drive
Huntsville, AL 35893
Please write “Grisham Legal Fund” in the memo line if you use this option.

Milblogs have been a vital link in getting accurate news and information about the military, and military operations, to you. Today, many milblogs are gone and others are under attack from within and without. Today, you have the chance to imagine a world without milblogs, and to do something about it. Make your voice heard by writing your congressional representatives and others, and by making donations as you see fit.

The battle for freedom of speech and the marketplace of ideas is fought on many fronts and in many ways. Without your help, the battle may well be lost.

CJ and his family could use your support, and milblogs – all of them, including, I guess us (it feels odd to be a milblog – I feel like more of a milparentblog) will take the 16th off to show them our public support. See you all on Thursday/

Health 2.0 and Health Policy 0.2

Joe and I are obviously both reading the WSJ this week…

I’ve been watching the health-care debate with depressed fascination. It’s fascinating because this is our government in action, and because I believe that we need to make significant changes to our healthcare system – both for health and for economic reasons. And I’m depressed because what we’re being offered is just such a bad deal.

It’s a bad deal for a large variety of reasons, but the core one is that it intends to control costs through managing health care finance and through centralized regulation (which is also how healthcare finance – your insurer – will be managing your costs).

That model doesn’t have a great track record, here or elsewhere.

The best way to manage costs, I believe, is to engage patients as consumers to better manage their care – a trend which is also deeply embedded in the newest thinking about how to practice medicine. Health 2.0 is, among other things, about empowering patients and embracing the hyperinformed patient as a partner in their treatment.

It turns out I’m not alone.

In today’s WSJ:

The health-care bills moving through Congress contain little to reward consumers for lowering their health costs, an omission prompting some lawmakers to press for more such incentives.

Sen. Ron Wyden (D., Ore.) is proposing amendments to the Senate bill that would give people who are eligible for coverage through their employer the option of buying cheaper coverage from the new insurance exchanges — and pocketing the difference.

A bipartisan coalition including Sens. Ron Wyden (D., Ore.), Evan Bayh (D., Ind.) and Susan Collins (R., Maine) wants to let consumers pocket the difference if they can find a health plan cheaper than the one their employer offers, WSJ’s Janet Adamy reports.

The legislation, without the amendments, opens up the exchanges only to small businesses and to people who don’t have insurance through an employer.

Mr. Wyden’s proposal is garnering support from an unusual mix of lawmakers and interest groups. Maine Republican Susan Collins, whom the White House is courting to support the bill, and Sen. Evan Bayh, an influential moderate Democrat from Indiana, have signed on to the idea.

The National Federation of Independent Business, a small-business group that is opposed to the broader Senate bill, also backs the amendments because they would make insurance more portable, which would help people who wanted to leave their jobs to do something entrepreneurial.

There are virtually no provisions in the Senate or House health bills that directly reward consumers for choosing cost-efficient care or lowering their medical costs through healthy behavior. Instead, the White House and top Democrats who drafted the health bills focused on giving doctors, hospitals and other health-care providers incentives for reducing unnecessary treatments.

Ideas like this seem like nothing but good ones; insurance that makes all medical treatment free to everyone will lead to overconsumption of healthcare, which will in turn lead to rationing through explicit policy or rationing through waiting – as we see in Canada and the UK.

How do we provide government services without letting the Treasury get looted or without intrusive (and expensive) command-and-control bureaucracies?

The idea of giving consumers more “skin in the game” when it comes to health costs has long been popular in some academic circles, especially among those who believe market forces can help solve the U.S. health-spending problem.

From my point of view, we have three healthcare problems in the US – 1) horrible access to healthcare for the poor and uninsured; 2) a structural cost problem caused by rising healthcare costs; and 3) a demographic cost problem as the population ages. Nothing in the current proposals does anything about 2) or 3) which means that while the current bills will broaden coverage, it is highly unlikely they will ‘bend the curve’ and begin to make healthcare more affordable in the overall economy.

Personally, I’d rather directly subsidize HSA’s and empower people to make more – and one hopes better – decisions. Think of it as a ‘negative income tax’ for healthcare…

“I’m very troubled that the Senate bill does not empower consumers more,” Ms. Collins said. “If they’re given information and financial incentives, they’ll make good decisions.”

-