We do not normally concern ourselves with whether posts and comments to this blog may prove abusive, vitriolic or significantly off-topic. While we do not necessarily encourage these sins of being human, all too human, we weigh them as far less repulsive than treating the commentary of our Authors and commenters as collective pastry bag contents to be squeezed and sculpted to predetermined ends of own choosing.

There is, however, that rare exception that threatens even the most enlightened of civilizations and the discourses that sustain them, to whit, the rare possibility that someone, beyond the bounds of all decency and mental order, may suddenly and unpredictably elect to shout “Nie!”.

I am sorry, but as Administrator of this blog I am constrained by my duty to preemptively shut down this thread to prevent just such an abomination from occurring.

Thank you all in advance for your generosity in understanding.

H. M. Stuart

Alexandria

I am very much not the wonkiest person out there, when it comes to knowing either the hairy details of legislative procedure, or exactly what’s behind all the controversies, within Congress, these past few months, about health care reform. There are people you’d be much better off reading than me, and some of you may already know everything I’m going to tell you in this post. Still, on seeing yet another post on what many Americans don’t know about the health insurance reform debate, I figured, on the off chance that some people who could use a little background might be reading me, rather than Ezra Klein (maybe because they’re my friends and not his), I’d do a little summary.

In the post that set me off, Andrew Sullivan quotes Mark Blumenthal

The most important thing to remember is that Americans most likely to be shifting their opinions are those least engaged in news about the ongoing Congressional health care debate. And even though most of the Pew Research News Index surveys in recent months show large majorities who say they are “closely” following the debate, they also find that nearly half of adults (44%) do not know that the “public option” deals with health care, while four-out-of-five cannot pick Max Baucus’ name from a list of four senators as the chair of the Senate Finance committee working on health care.

As it happens, I do know what the “public option” is, and I’ve long known who Max Baucus is. He’s the Democratic Senator from Montana that I tried and failed to get an internship with one summer decades ago (which means he’s as old as dirt). And, of course, also the chair of the Senate Finance committee. Because I never got that intership, way back when, with any of the people I tried, I know way less about legislative procedure than my youngest brother (and he, in turn, was staff of a Senator who had no involvement in health care reform), but I do know enough to describe a few of the players and issues.

The Process and the Players

Any large bill, like the health care reform bill that just passed the House, or the one that’s under consideration in the Senate, is neither fully read nor fully understood by most of the legislators voting on it. This is a normal, rational time allocation decision, and applies both to big bills that happen under Republican administrations and to big bills that happen under Democratic administrations (while the Patriot Act, at 300 pages, falls short of the length of either house’s health care bill, I’d be very much surprised if everyone in Congress read all 300 pages of the thing). Rather, the way things are processed is that

They rely heavily on committee reports that are supposed to accompany all bills coming up for a floor vote. These reports are written by committee staff and are required to faithfully reflect the bill’s intent. They may contain important details, clarifications, data, citations to hearings, and supporting materials, such as a section-by-section analysis, that allow the legislation to be intelligible to non-lawyers and other non-experts.

In addition, both Republicans and Democrats in Congress have organizations that review all bills coming up for a vote, summarize them and offer political perspectives. Here, for example, is the House Republican Conference report on the health bill. If one’s party holds the White House, a member may find the Statement of Administration Policy to be important in understanding a bill and how to vote on it. Here is the SAP on the health bill. The Congressional Budget Office’s analysis may also be important. Here is its report on the health bill….

… In each party there are go-to members who specialize in particular issue areas–health, taxes, banking, energy, agriculture, whatever. In most cases, they are members of the committees with primary jurisdiction and more often than not are the chairman or ranking minority member. It is what these people say is in a bill that really matters for most members.

According to my younger brother, when I asked him by phone a couple of months ago about the state of the health care reform debate in the Senate, and he reported that his Senator wasn’t in the thick of that particular debate, Senators like the guy he worked for rely heavily on the people in their party who are experts on that issue or who serve on the committees actually processing that bill, and then, when it comes to large bills outside their area of expertise, use their staff to check whether the bill has any sections specifically relevant to their state.

The overall process is this: a large bill, like health care reform legislation, gets reviewed by multiple committees. It gets scored by the Congressional Budget Office. There are versions in the House and the Senate, that contradict each other. People on the committees do their bargains and horse trading. Eventually a bill is produced that gets presented to the House, or the Senate, as a whole. There is debate. In the case of the House, you only need a majority vote to pass the bill. In the case of the Senate, you may need a supermajority, 60 votes, to prevent a filibuster. For major legislation like this, the House and Senate versions rarely agree, so after the bill passes each house, a conference committee reconciles the two versions. Then each house has to pass the bill again, and the President has to sign it. You probably knew this part already, but I figured I’d stick it in anyway, as prelude.

So, with this process in mind, let’s get to the players, and other questions.

Q) The Democrats control the House, and have a filibuster proof majority in the Senate. Why, then, have Obama and Senate leadership spent so much time trying for a bipartisan bill, at the expense of the things wanted by the progressive people who actually voted for them?

A) Neither Democrats nor Republicans are a unified group (though they may look that way in many votes once the party whips have done their job of persuading people to vote with their party). The two moderate Republican Senators from Maine, Olympia Snowe and Susan Collins, who have been the focus of much effort at bipartisanship (particularly Snowe), are arguably to the left of some of the Democrats. And there are several swing vote Democrats who’d be much easier to get on board if Snowe and Collins are on board. Similarly, in the House, the reason the bill passed includes a public option but not what’s called a “strong” public option is that not all of the Democrats would stay on board for a “strong” public option (to be defined later). So, no, the time spent wooing Republicans isn’t because Obama’s just too darned nice, and can’t let go of the phantom of bipartisanship. It’s spent because if they can get at least one Republican vote, it makes it easier to hang onto all the Democrats.

Q) So does that mean that progressive Democrats should just accept that their positions need to be bargained away for the bill to pass?

A) Not really, to my mind. To my mind, the way sausage is made, in this particular case, is that everyone bargains heavily for what he or she wants, and if you give up prematurely in the name of compromise, you lose. So, for example, there was a point at which pundits were saying that the public option was dead. It’s still in play (present in the House bill, and Reid’s still working on getting enough votes for it in the Senate) because people didn’t just take the pundits’ word for it, and kept fighting for it. Eventually, you get some monster of a final bill that contains some stuff you don’t like, but until eventually has arrived, if you have strong feelings about the public option, or the size of the subsidies, or the Stupak Amendment, you lobby for those views, even if you’d support a final bill that ignores your wishes (and, obviously, if you see something that’s a deal breaker for you, you lobby even harder).

Q) The late Teddy Kennedy, famously, was a go to person on health care reform legislation for decades, and described it as the cause of his life. So, was health care reform hampered by the fact that he was gravely ill and absent for so much of this process?

A) No. Health care reform passed the committee Kennedy chaired early in the process.

Q) Who is Max Baucus, and why has he been such a major player, here?

A) Max Baucus is the chair of the Finance Committee, and that was the last committee to pass a health care reform bill. The Finance Committee needs to review such legislation, naturally, because it involves spending a whole bunch of money. On a side note, I gather that what happened is not that the same bill made its way through each committee in turn, and got amended in each committee, but that each committee passed its own version of health care reform legislation, and then Harry Reid put together all the committee versions into a version that the Senate votes on as a whole.

Q) Who is Harry Reid, and why is he so important?

A) Harry Reid is the Senate majority leader. Hopefully you already knew that.

Q) Who is Chuck Grassley, and why did Baucus waste so much time trying to win his vote? (Yes, I’m wording this question as if you’re a Democrat; I find that version more fun.)

A) Grassley is the ranking minority member of the Senate Finance Committee, the committee that was the last one (of those required) to pass health care reform legislation.

Q) Why is Olympia Snowe such a big deal?

A) She’s one of the most moderate Republicans, one of the few who seem really willing to deal on anything remotely resembling the health care reform that the Democrats want, and, I gather, possibly the only one who’s willing to vote for any sort of public option. Unfortunately, the version of the public option that she’s willing to vote for is the “triggered public option,” which the Democrats don’t want.

This brings me to the part where I explain all those different versions of the “public option.”

The Issues

Q) What are some of the things the current health care reform legislation will do?

A) It will bar insurance companies from excluding people for preexisting conditions, bar them from rescission (a practice where they sometimes drop people after they get sick), require everyone to buy insurance, and provide exchanges so that people who don’t have their insurance through their employers can get better rates. People below a certain income level will get subsidies to buy insurance.

Q) What is the “public option”?

A) The current health care reform legislation, both in the House version and in the Senate version, sets up exchanges in which health care insurance is sold. A “public option” would be a government run insurance option that competes in these exchanges with private companies, and, like the private companies, finances itself through premiums from the people who buy it.

Q) What are the different kinds of “public option”?

A) There have been several divisions of opinion as to how to implement a public option, if one is implemented at all. The first is whether the public option uses Medicare rates of reimbursement (which tend to be lower than private rates) or market rates. The Medicare rate version is called a “strong” public option. For a while, it looked as if the votes for that might be present in the House (though never in the Senate), but in the end even the House bill didn’t pass a “strong” public option, just one that uses market rates. The second division of opinion is whether you get the public option right away, everywhere, or whether you compromise (of course, from the point of view of progressives, the public option is already a compromise, since they’d prefer single payer). The first compromise proposed, which is supported by Olympia Snowe, is what’s called a “triggered public option.” That means that you don’t get a public option right away, but eventually, if private companies don’t control their rates enough, you might get a public option. Public option supporters in the Democratic Party objected strongly to this version, arguing that it’s easy to structure a triggered public option such that the trigger will never realistically get pulled. Enter the opt in public option proposal, in which states could choose to opt into a public option. This was soon modifed to an opt out public option, in which states would get the public option unless they chose to opt out of it. Harry Reid is now trying to get all Democratic Senators on board to break a filibuster for a bill that contains an opt out public option.

Q) Why care so much about a public option?

A) It’s supposed to provide cost control, by providing the insurance companies with competition.

Q) Speaking of cost control, what about those death panels?

A) There never were any death panels. A Republican Senator added a clause to the bill that would have provided Medicare reimbursement for an appointment in which you discuss with your doctor what end of life care you want. When Grassley complained about this provision, Baucus removed it from the bill.

Q) Isn’t the bill going to cost a humongous amount of money, and lead to worse deficits?

A) According to Ezra Klein, Congress is trying hard to meet a budget target of $900 billion, as scored by the Congressional Budget Office. Here is the CBO’s health page, which includes cost estimates for the legislation that just passed the House, as well as analyses of the subsidies that various version of proposed health care reform legislation would supply.

Because I’m not a wonk like Ezra Klein, rather than analyzing in detail the funding of all this stuff, I do what lots of other people do and pick my favorite experts. Ezra Klein is one of them (though I don’t bind myself to agree with everything he says), and two of my co-bloggers at Alexandria, Steve and Janice, are others, since they’re both doctors who blog a lot about health care reform and who can therefore supply a medical perspective I lack. But when it comes to deficits, the person I always like to check is Alice Rivlin.

I’ve been following Alice Rivlin’s career, loosely, for years, because way back when I was at Stanford I knew her son, and he had a winning way with a Bruce Springsteen song. However, she has merits, even if you never heard her son’s renditions of “I’m on Fire” or “Drive All Night.” Rivlin is the former head of the Congressional Budget Office, and an economist who now works at the Brooking Institute. The reason I like to check her views is that, though she’s a Democrat with the usual Democrat priorities as far as what she’d rather have government spend money on (and, if you check her out in one of those online sites that report campaign donations, with a history of donations to various Democrats and to Emily’s List), she is, more than most Democrats, a deficit hawk. When she wrote about the candidates in the 2008 election, for example, she dinged all of them for not being likely to do enough to restrain the deficit. Now, with a recession on, there are reasons for even deficit hawks to accept a greater level of temporary deficit spending, but health care reform is a long term commitment, and so I care what deficit hawks have to say. And Alice Rivlin is in favor of the current health care reform effort.

Q) What’s the deal with the Stupak Amendment?

A) The Hyde Amendment, for over three decades now, has barred the federal government from funding abortion. So, when health care reform legislation was assembled, it included provisions that: 1) barred federal funds from being used for abortion (but allowed private premiums to be used for that purpose), 2) required at least one plan in each health insurance exchange not to cover abortion, and 3) required at least one plan in each health insurance exchange to cover abortion. This proposal was rejected by groups like the US Catholic Bishops, who argued that, if you have premiums and subsidies paying for the same health insurance plan, that includes abortion, only barring the federal funds from being used for abortion amounts to some sort of accounting shell game. Instead, a last minute deal was cut in which pro-life Democrats in the House would vote for the House bill only if allowed to offer the Stupak Amendment, an amendment that provided that any health insurance plan sold in the exchanges could not cover abortion if it received any federal money in the form of subsidies for people with income low enough to qualify for said subsidies. This, in turn, angered pro-choice Democrats, who argued that it was a sweeping extension of existing restrictions on funding abortion, in that it effectively barred even private premiums from going to plans that cover abortions. Stupak Amendment proponents say that riders, insurance policies that only cover abortion and that use purely private funds, can still be sold in the exchanges; Stupak Amendment opponents say that such riders will never materialize, nor will people actually buy riders for an operation they never expect to have to undergo.

Q) So what’s the next step, with the Stupak Amendment?

A) The Senate will pass a bill that either does or doesn’t contain a similar provision. Senator Ben Nelson, one of the six swing Democrat votes when it comes to defeating a filibuster, is said to be lobbying to introduce a similar amendment to the Senate version. NARAL is urging its members to lobby Reid to keep that amendment out. The Senate is said to have fewer pro-life Democrats than the House, and so may pass legislation without such an amendment. In that case, the conference committee will get to reconcile the two versions, and so the next step will be lobbying regarding who gets put on the conference committee, and what their views on abortion are.

Q) Could this abortion dispute sink health care reform?

A) Darned if I know. There were a whole bunch of Democrats voting for the Stupak Amendment in the House, but the number willing to defect over it may be much smaller. Nate Silver reports that many previously solidly pro-choice Democrats voted for the amendment; it’s hard to imagine that those particular Democrats will defect if the amendment was stripped. Talking Points Memo says the House Majority Whip claims the Stupak Amendment bought the Democrats only ten votes. Meanwhile, forty Democrats in the House are reportedly now saying they’ll vote against the bill if the version coming out of the conference committee retains the Stupak Amendment, but it’s possible that number could shrink considerably under pressure. On the other hand, the margin of victory in the House was so slim, that, for all I know, even losing a modest amount of votes over abortion could sink health care reform. I actually don’t know which option loses the bill more votes in the House at this point, so I’m not going to pretend to know which will look better in political horse race terms. All I know is, if you have strong opinions about this issue, Harry Reid is the guy you’re now supposed to be lobbying.

Spend more but pay less, that has become the conflict which dominates our public policy debates. Doug Elmendorf from the CBO, via Klein sums it up well.

The country faces a fundamental disconnect between the services the people expect the government to provide, particularly in the form of benefits for older Americans, and the tax revenues that people are willing to send to the government to finance those services.

This disconnect led to the heavy deficit spending that occurred since 1980. A bigger military was wanted, but we did not pay for it. Drugs for the elderly, but we did not pay for it. Very popular and it meets the desires of the populace. Getting more and not paying for it. Health care was a major topic in the last presidential election. Poll after poll showed that most Americans wanted health care reform, that it was time to cover nearly everyone (except illegals). This time, it was made clear from the start that the legislation would need to be paid for, not just added to the debt. The result? The closer we get to reform, the less popular it becomes.

With the polarization of the media, this means it becomes almost impossible to raise taxes OR cut spending. California on a national scale. The winners? Those currently benefitting from our economic structure. The status quo wins.

Via Yglesias, Tim Harford notes a study showing that eating healthier foods improves the performance of students in primary schools. Key quotes..

What caught the attention of Michele Belot and Jonathan James, though, was the way Oliver’s project had been implemented. Belot and James – economists at Nuffield College, Oxford, and at the University of Essex respectively – noted that the campaign had created a near-perfect experiment. The chef had convinced Greenwich’s council and schools to change menus to fit his scheme; he mobilised resources, provided equipment and trained dinner ladies. Other London boroughs with similar demographics received none of these advantages – and indeed, because the programme wasn’t broadcast until after the project was well under way, probably knew little about it. The result was a credible pilot project. It wasn’t quite up to the gold standard of a randomised trial, but it wasn’t far off.

Thanks to the UK’s exhaustive school testing regime, Belot and James were able to track pupils’ performance in some detail. They concentrated on primary schools, figuring that secondary school pupils could (and probably would) avoid eating school lunches that were too worthy. (This is surely correct. My own habitual sixth-form lunch was four bars of chocolate – a pound a day well spent.)

Their answer – a provisional one, since they are still refining the research – is that feeding primary school kids less fat, sugar and salt, and more fruit and vegetables, has a surprisingly large effect. Authorised absences, the best available proxy for illness, fell by 15 per cent in Greenwich, relative to schools in similar London boroughs. And relative to other boroughs, the proportion of children reaching Level Four in English rose by four and a half percentage points (more than six per cent), while the proportion of children achieving Level Five in Science rose by six points, or almost 20 per cent. There is some uncertainty about these numbers: they could be substantially smaller or larger. There is not much that can be said with confidence about scores in other subjects, or other achievement levels – although the academic benefits of the Greenwich lunches appear to be positive, if tentatively so, in almost every case.

There are multiple reasons why we should want our kids to eat healthier. School performance aside, the rates of childhood obesity are increasing. Health reasons alone, and the resultant costs should be a motivation. This study gives us another reason to pursue improved diets at school. Maybe we can overcome the false economy of cheaper, high fat, high sugar pre-made foods, fast foods.

Ever so briefly…

In the Annals of Internal Medicine I came upon an article:

Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation

by

• Aaron L. Nelson,
• Joshua T. Cohen,
• Dan Greenberg,
• and David M. Kent

The title was a little off-putting, but the message was sound. In medicine it very rarely happens that we invent technology that is less expensive and almost as good.  In all sorts of other fields we do that.  India invented the Nano, a small, very cheap, very fuel efficient car. Apple created the iPod shuffle. I don’t know who invented the amazingly warm, rock bottom cheap microfiber soft fluffy fabric that my bathrobe is made of, but my hat is off to them. In medicine we keep innovating, and we make these things that are a tiny bit better than the thing before them, and are much more expensive. If cost were of no consequence this would not be an issue. But when we talk about more expensive, the millions of dollars that get spent on these new technologies quickly adds up.

In this article the authors look at some of the rare medical technologies that are less expensive than the pre-existing technologies with which they compete, and come up first with the cardiac angioplasty, or PTCA. In this procedure a blocked artery around the heart is dilated open with a balloon rather than being bypassed surgically.  It is much cheaper to do it that way, but not quite as effective.  But the researchers fail to point out that this procedure also allowed all sorts of people who wouldn’t have been able to tolerate heart surgery to live free of heart pain or heart attacks for years.  So the technologies that are cheaper are, in a way, also sometimes better.

I merely point this out as yet another path toward responsible, successful, human centered medical care.

David Leonhardt has been writing some of the best articles out there on health care. His article on Intermountain Healthcare was superb. The Intermountain system is one of those low cost high quality organizations, maybe the best. Like the Mayo Clinic and Kaiser, it has salaried physicians. The biggest difference is probably its constant efforts to monitor care and encourage the use of protocols.

That leads to his second article on how the current reform bills could be improved. Overall, he sees the Senate bill as much stronger, though needing improvements. One of his recommendations is that we should include in the bill the “easy stuff” that will lower costs and improve care. Key quote……..

THE EASY STUFF Each year, about 100,000 people die from preventable infections they contract in a hospital. When 108 hospitals in Michigan instituted a simple process to prevent some of these infections, it nearly eliminated them.

If Medicare reduced payments for the treatment of such infections, it would give hospitals a huge financial incentive to prevent them. The Senate bill takes a small step in this direction by cutting payments to hospitals with high infection rates by 1 percent. The House bill merely requires hospitals to report their rates publicly. There are also other basic patient safety areas in which the bills can do much better.

This is an area I know well as I have helped implement it at our hospital. This is an area of improvement that would never have occurred without government intervention. There was no money to be made by sponsoring the necessary studies. No individual hospital was big enough to give the meaning necessary to substantiate the findings. The results are pretty eye opening, taking infections that required many days of hospitalization and thousands of dollars of care, down to a nearly zero incidence.

Yet, some hospitals still do not require use of the protocol. The physicians do not want anyone telling them what to do, especially government. Today, working at the smaller hospital which I sometimes cover, I was asked to put in a line by a cardiologist as he expected it to be difficult and it is a procedure I do much more than he. When I explained to the nurses in the Cath lab what equipment I needed, I was told that the doctors here don’t do that. I was shocked. What I asked required 30 seconds of work on their part. I will be making some phone calls tomorrow so this will change, but I think it illustrates the need for some government involvement in improving quality and, sometimes, costs. Unless there is direct profit to be seen, there is inadequate motivation to improve quality.

From a Rolling Stone review of Who’s Next, some familiar admirers’ chuckles:

Obama made some thoughtful and timely remarks on the Fort Hood shooting, but words alone can’t heal a nation’s wounds after such a horrible tragedy. If he wants to do a real service for the lives lost and their families, he should bring all the current troops overseas, who are barred down in unnecessary conflicts, home, and retire America from the empire game. The ultimate gesture to the dead is making sure that nobody else dies in these needless and immoral wars or as a result of them. But that will never happen under Barack Obama because he is not a real leader, just an eloquent sock puppet. Unfortunately, all his acts are dead gestures to an anxious people. But are Americans tired of presidents who only hold up appearances, and who are afraid to address head on the real and difficult choices that the country faces in this century. Only time will tell.

Obama is certainly more attentive to the spell of the moment than Bush was, and his refined nature poured through in the memorial service, but he is also lucky in that he has more gifted speechwriters. For example, his team won’t make an amateurish mistake like putting up a ‘Mission Accompolished’ banner at the beginning of a war. The current administration’s PR is by far better composed for the times. With that said, I think the best part of the President’s speech was his poetic recognition of the greatness that is present in our day:

For history is filled with heroes. You may remember the stories of a grandfather who marched across Europe; an uncle who fought in Vietnam; a sister who served in the Gulf. But as we honor the many generations who have served, I think all of us – every single American – must acknowledge that this generation has more than proved itself the equal of those who have come before.

We need not look to the past for greatness, because it is before our very eyes.

This generation of soldiers, sailors, airmen, Marines and Coast Guardsmen have volunteered in a time of certain danger. They are part of the finest fighting force that the world has ever known. They have served tour after tour of duty in distant, different and difficult places. They have stood watch in blinding deserts and on snowy mountains. They have extended the opportunity of self-government to peoples that have suffered tyranny and war. They are man and woman; white, black, and brown; of all faiths and stations – all Americans, serving together to protect our people, while giving others half a world away the chance to lead a better life.

Sadly, though, the endless sacrifices made by the men and women in the military do not equal true greatness because they are following dreadful and illegal orders. Their participation in these wars have revealed again a deep and ugly truth about the character of the American people, and of their government. The truth is Americans have failed horrendously at being moral crusaders, and they always have, just like other conquering armies in history. Soldiers in the US military have not died for freedom, but tyranny, at home and abroad. But although their cause is not noble, it does not make their bravery less meaningful or their suffering less real.

These men and women have grieved and suffered more than past soldiers because they know they will never receive a hero’s welcome anywhere except amongst their ranks, and in the company of politicians, and their corporate paymasters. To be sure, the public’s devotion to these troops is not a mere formality, but their embrace is tinged with a skeptical appreciation for their services. After all, have they brought peace and liberty to the Middle East, or unjust blood and new cold tyrants? Almost seventy percent of the American people believe the latter. But this is not the military’s stain, but the stain of the criminal leaders who are destroying the country to oblivion. Americans must promise themselves that the deaths of these fighters will not be allowed to go unnoticed and fade into history.

I feel for these fighters, it is an unbelievable weight to know that you played a part in the destruction of villages and homes, after putting trust and faith in your leaders, whose orders came from the darkest of places. The public’s painful reaction upon discovering the corruption of the United States government and the lies of the war on the terror is minuscule compared to a soldier coming across unpleasant truths for the very first time, because their friends, brothers, and sisters, died for these treasonous lies, to which they committed their soul, not just their opinion. In them the tragic lie of 9/11 stings more deeply, because deception is more foreign to them than either the sands of Iraq or Afghanistan.

If these honorable fighters ever want to receive a true and pure hero’s welcome in the future, it will be in Washington, and not in Baghdad, or Kabul. Those places have their own heroes, who have died for a just cause – defending their country against foreign occupiers. Their bodies lay in the ground with passionate blood still running in their veins, unlike American fighters who are killed due to a grave misfortune on the side of the road, and are brought home to be buried in the dark, and who are greeted without any prolonged or dignified acknowledgment by their countrymen for their sustained and noble efforts.

For the freedom fighters of Iraq and Afghanistan, the enemy is not invisible, nor is the enemy an orphan, or a widow. For them, the war is winnable because the enemy of these mischaracterized ‘terrorists’ is clearly marked by what he wears, and who he’s fighting for. As a result his conscience is clear, and his self-defense, even if extremely bloody, is justified in history’s eye. On the other hand, the fate of American fighters is tragically different. They are not George Washington’s patriots, but George Bush’s terrorists.

I pray that more men and women in the military will wake up, and come home to help liberate their own country from oligarchic tyrants. God knows their bravery, skill, and guidance is needed now more than ever in American history. These proud conquerors, if they are true conquerors, will witness that the ‘clash of civilizations’ is but a ploy to establish the new world order’s fate, and consequently, they will turn their swords against the real enemy within. As Albert Camus remarked, “greatness has changed camp,” it no longer belongs to the military general, but to the eternal rebel. “It lies in protest and the blind-alley sacrifice,” Camus said. It lies with Pat Tillman, Matthis Chiroux, Adam Kokesh, Charles Dyer, Mike Prysner, Ehren Watada, and all the winter soldiers, not with David Petraeus, Colin Powell, or Stanley McChrystal.

What America needs at this historical transition are men and women with a soldier’s blood and a rebel’s heart. If freedom is to be reconstituted in America and the rest of the world, the new and true conqueror must walk forth humbly now, without any reservations. If he does, he is guaranteed my salute, and my immortal gratitude.

I commend to all an excellent essay by Gus diZerega, from his blog on Beliefnet: Twelve Things You Probably Didn’t Know About Pagans.

He covers the basics very well. Commentary is welcome here or there.

Bipolar drug market “to plummet from 2011”

The market will be constrained over the next several years by the patent expiries and subsequent generic erosion of a number of key antipsychotic agents including AstraZeneca’s Seroquel (quetiapine fumarate), Eli Lilly’s Zyprexa (olanzapine), Bristol-Myers Squibb/Otsuka’s Abilify (aripiprazole) and Pfizer’s Geodon (ziprasidone), according to the study, from Decision Resources….

Moreover, patent expiries of branded antidepressants that include Wyeth’s – now Pfizer’s – Effexor XR (venlafaxine), Eli Lilly’s Cymbalta/Xeristar (duloxetine) and Forest/Lundbeck’s Lexapro/Cipralex (escitalopram) will further constrain the market, according to the report….

These patent expirations happen at various times between 2011 and 2018.

AllAfrica.com has a briefing on Securing Food Production in Africa, with stories on everything from William Kamkwamba’s homemade windmill to Alliance for a Green Revolution in Africa to agroforestry to genetically modified crops.

Speaking of William Kamkwamba, Win a Copy of William Kamkwamba’s Book!

Robot Contest in Nairobi.

Women in Business: Africa’s Secret Weapon.

Gahaya Links: the story of two Rwandan women who started a business assisting women to manufacture their own goods and sell them internationally.

“…In Lagos, everything is informal…”

Bank lending rates set to fall in Zambia.

Rules for Kenya Internet Trading and Idea Exchange: Local Techies.

Gettin By – Hawking T-Shirts.

Mo Faya in Nairobi and Financial Times Special Report on Kenya.

An African Tech List on Twitter.

An HIV-positive muppet in South Africa’s Sesame Street.

Google Adsense now pays Kenyan bloggers in Kenyan shillings.

Africonline sponsors BarCamp Cameroon.

Banks and Bank Loans in Kenya.

#YouKnowYourKenyanGeek when…

Free marketeers receive a cool reception nowadays but neither is socialism making much of a comeback, unless you count its mention on signs at Tea Parties.  It’s never easy to develop a coherent economic response to a crisis when old ideologies lose relevance.  Pragmatism therefore demands that we employ the best tools of our current system to address its greatest ills; a young real estate advisory and consulting nonprofit I know is a case in point.

Real Estate Advisory and Development Services (READS)  raises funds through arranging real estate deals for budding charter schools as well as through writing grants, the more traditional work of a nonprofit.  The president, Brian Keenan, told me, “Folks ask for reduced rates for our services, which actually are about half the rate of a for-profit.  I tell them, ‘Our time is valuable.  We can discuss when payment is made but we are unwilling to reduce our fee.’”

Keenan is a former banker and doesn’t fear sounding too commercial for the more delicate sentiments of the world of do-gooders.  At the same time, he readily admits that he began his company because his old boss told him that he was “spending too much time helping floundering nonprofits with their real estate problems.”

Keenan’s work is emblematic of a generation of nonprofits not imbued with the anticapitalism of the 1960’s, nor evincing the noblesse oblige of late-nineteenth and early-twentieth century reformers.  The triumph of capitalism is implicit.

Firms such as Keenan’s aim to harness a bit of the tremendous accumulated capital in our country in order to catalyze the full economic participation of underutilized and undertrained social sectors.

The need and the opportunity are identical: Investing in socially marginalized children creates obvious value for the country entire but less obviously does so for particular, for-profit corporations.  By leveraging the goodwill of socially-concerned citizens and, simultaneously, uncovering new profit streams, entrepreneurial-minded nonprofits demonstrate the latent productivity of large segments of the population and, eventually, attract further interest and investment.

Capitalism is excellent at providing opportunities to well-equipped and motivated entrepreneurs.  It is less good at developing the talents, outlook, and networks of those who remained removed from its dynamics.

The wealth of our age gives us the luxury of seeking synergies between these two goals.  Those who uncover such synergies have the potential to do good and to prosper.

I have held off writing about the Fort Hood incident as I do not see that much is gained by speculation. I would prefer to discuss causes and prevention after we know all the facts. However, Marc Lynch has a piece up at Foreign Policy that is too good to pass up. He reminds us, again, what the terrorist groups are trying to accomplish, and what we do to help Al Qaeda and other terrorists. Key quotes…

The grand strategy of al-Qaeda and its affiliated ideologues is, and has always been, to generate a clash of civilizations between Islam and the West which does not currently exist. Their great challenge is that the vast majority of Muslims reject their theology, ideology, strategy and tactics. That’s especially true of American Muslims. They therefore feel the need to change the environment in which Muslims live in order to change their calculations about the appropriateness of extremist identities and ideologies and actions.

Terrorism is a means towards that end. The object is to create a violent, polarized environment in which Muslims are forced to embrace a narrow, extreme version of Muslim identity. They want Muslims to accept a master narrative in which the Islamic umma is existentially threatened by Western aggression, and the only theologically and strategically appropriate individual response is to join the jihad in the path of god (as they have defined it).

They recognize that most Muslims won’t embrace this radical conception of their identity just through messaging, internet rhetoric, or preaching. To make inroads with mainstream Muslim communities, they need to change the context in which they live — to render their status quo unacceptable and to make their narrative resonate. And for that to happen, they need a lot of help — for the targeted governments to take inflammatory measures against their Muslim populations, for the non-Muslim citizens in the targeted countries to discriminate against them, and for the media to fan the flames of hatred and mistrust.

Understanding this strategy points towards some fairly obvious guidelines for judging various responses. Al-Qaeda and its affiliated ideologues don’t just want their targets to overreact with blanket crackdowns on the mainstream Muslim community — they are counting on it. They want to create a homogenous, undifferentiated Islam on whose behalf they speak and a coherent master narrative which justifies and validates their actions. American reactions which feed AQ’s master narrative, lump together disparate Muslim movements, and tar a wide range of Muslims with the AQ brush therefore serve al-Qaeda’s strategy. Responses which disrupt AQ’s narrative, disaggregate the Muslim world and relegate AQ to a marginal fringe frustrate its strategy.

As I have said before, al Qaeda does not pose an existential threat. They count on our overreacting and we do not let them down. It helps if one remembers that terrorism is violence with a political goal. They do not kill just for the sake of killing. There is a political purpose. The message is aimed at Muslims as much or more as towards us. Blanket condemnations of Islam and Muslims in response to any killings aids there effort.

Looked at carefully, we have millions of Muslims living in the U.S. The large majority of Muslims of Eastern descent are people who fled regimes like Saddam’s or the Shah’s or Khomeini’s. They are not running around killing Americans. They have every motivation to want our country to succeed, they chose to come here. A tiny minority have committed a few crimes. On the plus side, if one follows our military actions in Iraq and Afghanistan, it is clear that Muslim Americans have saved many more American lives than they have taken. Their understanding of the language and culture helped us change course. Many Iraqis and Afghans have risked their lives to aid us, that after we invaded their countries.

Once we understand that the jihadists create the same problems in their own countries, worse actually, as in ours, we can remember what a fringe group it is with which we fight. Let’s not help them recruit anymore.

Medecins Sans Frontieres had a story the other day in its Facebook feed on the Central African Republic, reminding me that I’m overdue to post an update on the interlocking set of conflicts surrounding Darfur and its neighbors. For this particular round up, I’m going to focus particularly on what’s being reported by humanitarian groups, although I may link a few other stories.

In fact, there are stories coming out of the Central African Republic that have nothing to do with the humanitarian crisis there. Kenya Airways has launched direct flights to Bangui, the largest city in the Central African Republic. An exiled former president is returning to the CAR to stand in the presidential elections slated for 2010.

The humanitarian situation there, though, continues to be severe. Medecins Sans Frontieres reports

South-western Central African Republic (CAR) currently faces a serious nutritional emergency. The crises in the mining industry, on which many of the region inhabitants depend, has been the last straw for an already highly vulnerable population.

Alerted by the local authorities, the Médecins Sans Frontières (MSF) teams have opened four feeding centres in one month in Carnot, Boda, Nola and Gamboula and implemented a number of outpatient treatment programmes in the area. The first assessments have revealed severe malnutrition rates way over the emergency threshold in some areas….

The UN MINURCAT force stationed in Chad has repaired water pumps in Guereda, and national polio vaccinations have just been carried out.

A three-day nationwide polio vaccination campaign began on 30 October throughout Chad, including in the east where according to the World Health Organization the rate of routine immunizations is among the weakest nationwide.

On 27 October lab results confirmed six new polio cases, bringing the number of confirmed cases in Chad in 2009 to 30. Two regions are newly infected, Wadi Fira in the east and Batha in central Chad….

On a less happy note, an International Committee of the Red Cross staff member was abducted last night in eastern Chad.

Recent Chad stories unrelated to humanitarian aid efforts include a celebration of friendship between the presidents of Chad and neighboring Cameroon and a story about the peacefulness of the border between Chad and Cameroon.

A Douala tabloid a few weeks ago thought it had found the scoop of the year, when it “discovered” that a “Chadian” had been sitting in the Cameroon National Assembly over the years. As the search for the truth continues, it must be emphasized that Cameroonian boundary regions with neighboring countries, from east to west and from north to south abound with ethnic communities that stretch beyond international boundaries.

Chad is no exception. Chad is Cameroon’s northern neighbour with which it shares a boundary of over 500 kilometres. Since Chad’s independence on August 11, 1960 cooperation with Cameroon has been very steady and growing with each passing year….

Top fashion designers are making dolls to fund a vaccination effort in war torn Darfur. Meanwhile, South Sudan has been hit by an outbreak of kala azar (also known as visceral leishmaniasis), a parasitic disease transmitted by the sand fly.

The joint UN-African force has called on one of the major rebel groups in Darfur to stop obstructing its work. Meanwhile, Obama’s Sudan strategy has been hailed by African policy experts.

… The Obama plan calls for a greater dialogue among the United States, international partners and Sudan to end the Khartoum government’s support of attacks in Darfur and spur implementation of the CPA while pressing the Sudanese to get tougher on terrorism. The Obama strategy includes potential sanctions if certain benchmarks to progress that remain classified are not met.

Herman Cohen, former assistant secretary of state for African affairs in the administration of President George H.W. Bush, lauded the strategy, telling America.gov, “The Obama administration is implementing a very pragmatic policy toward Sudan.” …

More links:

ReliefWeb’s latest complex emergency report on Chad.

Reliefweb’s latest complex emergency report on Sudan.

Leading LRA rebel commander Charles Arop surrenders to Ugandan army? (The Lord’s Resistance Army has moved between Uganda, Sudan, the Central African Republic, and the Democratic Republic of Congo, as it engaged in a long standing guerilla war, so, though it formed to fight the Ugandan government, the surrender of an LRA commander would affect other countries as well.)

… but not by me. A friend who came to our meeting from Mormonism reposts an account of his written 3.5 years ago, describing our meeting and how liberal Quakerism compares to Mormonism.

The Guardian today ran a story wherein an unidentified International Energy Agency whistleblower claims “the US has played an influential role in encouraging the watchdog to underplay the rate of decline from existing oil fields while overplaying the chances of finding new reserves.”

This may well be, and we need to alternatives to oil if for no other reason than it allows us to get out of the Mideast.

That said, I’m uncomfortable with a significant source for the story being unidentified. How do we know the person quoted isn’t some nicely compensated shill for an energy trader with a long position in oil, attempting to talk up the price?

This is kind of cool. While listening to Live Ireland radio, I heard familiar words set to an unfamiliar beat. Sean Tyrrell sings Louis MacNeice’s poem, “Bagpipe Music,” under the title, “No-Go,” on his album, Cry of a Dreamer. I suspect some readers here would enjoy “Bagpipe Music,” if you haven’t read it already.

It’s no go the picture palace, it’s no go the stadium,
It’s no go the country cot with a pot of pink geraniums
It’s no go the Government grants, it’s no go the elections
Sit on your arse for fifty years and hang your hat on a pension.

It’s no go my honey love, it’s no go my poppet,
Work your hands from day to day, the winds will blow the profit
The glass is falling hour by hour, the glass will fall forever
But if you break the bloody glass you won’t hold up the weather.

The rest of it here.

When I was just a Sig-twig, a friend and I took it upon ourselves to write what WE considered to be uplifting poetry on the blackboard before our English class started. Being teenagers, we tended toward the cynical and dark. Her father had translated Catullus, so the less overtly sexual bits of that collection made it to the board. “Bagpipe Music” was one of my choices. Every day, the teacher walked briskly to the board and erased our selections, apparently without reading them. I refer you to the great Barry Louis Polisar’s “song,” “The Poetry Lesson.” When you hit the link, scroll down to “Naughty Songs for Boys and Girls” and go to number 15 on the playlist, and you can hear it for yourselves.

SPOILER WARNING-
OPTIMUS PRIME DIES. AND THEN HE IS MAGICALLY RESURRECTED.
I didn’t have any new insights into the healthcare debate, so I thought I’d bitch about the word ‘cheesy’ instead.
“Cheesy.”
I don’t object to all uses of this term, certainly not the ones that are actually listed on dictionary.com:
“–adjective, chees⋅i⋅er, chees⋅i⋅est.
1. of or like cheese: a cheesy aroma; a cheesy taste.
2. Slang. inferior or cheap; chintzy: The movie’s special effects are cheesy and unconvincing. “

Nor do I mind so much when people describe failed melodrama as ‘cheesy.’ I find unsuccessful attempts to move me a lot more uncomfortable than crummy fx. (Like, um…in TRANSFORMERS-REVENGE OF THE FALLEN, the CG was state of the art but Optimus Prime’s touching death scene made me want to throw up and die, because nothing Michael Bay can do will ever make me care about Optimus Prime…I wouldn’t personally use the word ‘cheesy’ for that, I’d probably go with some variation of ‘retarded’ but I don’t think ‘cheesy’ would be totally misapplied either.) What I really dislike is when people apply it to things they ACTUALLY find emotionally affecting.
As in “I love Lord of the Rings even though it’s so cheesy.”
Which, as far as I can tell, means “I am slightly ashamed to admit that I enjoy Lord of the Rings more than The Great Gatsby, even though I know that Gatsby is high art and LOTR is for kids.”
Well, screw that. If you prefer LOTR to Gatsby, don’t make excuses for yourself. You’re right and F. Scott Fitzgerald is wrong.

There were two very interesting articles out on health care this weekend. One of very high quality that everyone interested in reform should know about. The other has some flaws but brings up interesting thoughts.

First, Wilper, et. al. have published in the American Journal of Public Health the best, recent study looking at the association between mortality and the lack of health insurance. The methodology in this study looks very sound in my judgment. While not perfect, for a study of this size, it is surprisingly thorough. (Tell me what you think Janice) The bottom line is that about 45,000 people now die per year as a result of not having adequate insurance so that they can pay for their health care.

The second article, from Bilmes and Day, is based upon the Wilper study. This article attempts to calculate the cost to the economy of lives lost during the working years due to lack of health care. Key quotes…..

The premature death of thousands of Americans can be translated into monetary terms using the economic “value of a statistical life.’’ Government economists use this methodology to help determine whether the cost of new government regulation (stricter pollution controls, for example, or food safety rules) is worth the value of lives saved. Insurance companies also use this approach to help estimate compensation levels for wrongful death. These estimates vary widely, from around $3 million to $12 million.

US government agencies typically use a figure around $7 million to represent the lost economic output from each death. If we conservatively use only half of the government figure, or $3.5 million, it suggests that the annual cost to the US economy of 40,000 deaths is about $140 billion. That adds up to a cost of more than a trillion dollars over a 10-year period – even taking future inflation into account – well above the cost of enacting a health care package.

A second way to estimate the cost of not enacting health care legislation is in terms of life expectancy. US life expectancy – at 78.11 years, ranks around 40th in the world and well below countries with universal health care. If we were to match Canadian life expectancy, for example, that would translate into an extra two years and 1 month of life expectancy for every American.

Putting a value on a life is not easy. Cowen has cited studies showing that people value an extra year of life at about $50,000 to $100,000. How does that translate into an extra 30 or 40 years? Determining what the contribution to the economy might have been is also difficult. How many of those people would have lived with health care, but not been able to work because of their illness?

Then there is the issue of productivity and health, i.e., what happens if health care makes you more functional, lets you work more or better? Key quote….

Less health insurance equates to more premature deaths, and shorter life expectancy. It also impairs the quality of life – and hence the productivity – of those who are living. This is evident in comparing the health of Americans who live in states with high levels of insurance with those who do not. We compared the five US states with the highest levels of health insurance among adults age 18 to 64 (Massachusetts, Hawaii, Minnesota, Wisconsin, and the District of Columbia) with the five states with the lowest levels (Texas, New Mexico, Louisiana, Florida, and California).

In the first group, 90 percent of those 18 to 64 are insured. In the second group the figure is just 73 percent. People living in states with the highest insurance levels have better health indicators, including fewer low birth weight babies, lower infant mortality, and lower death rates from diabetes, heart disease, strokes, Alzheimer’s, and some types of cancer (cervical, colorectal). While expanding health insurance is just one component of a state’s approach to improving health, the data are striking. Moreover, the annual death rate for residents of the states with higher insured populations was lower than for those living in the lowest insurance states. It is tricky to put a precise number on the economic loss from poorer life quality, but we can be sure the economic loss is substant

While I find Bilmes’ and Day’s calculations too crude to be taken at face value, there is enough truth in it to understand that there are real costs to the country incurred by not having health care available. When competing against other countries which do have health care for all, we may be at a disadvantage. So, bookmark the first study, and just think about the second.

Via one of my Quaker Facebook friends, a Dorothy Day documentary: Don’t Call Me a Saint.

Robin M. on Essentials of Quaker Practice?

Obedient to the Light on “Quakers live their principles.” (Friends as a Corrective for Culture, Part 2).

The Friends Committee on National Legislation analyzes the health care reform act that the House just passed. (I already shared this link on Facebook when we were in the last minute lobbying of the House stage, but it can’t hurt to also share it on the blog for those who haven’t seen it already.)

For all of you NaNoWriMo folks out there, how to write a great novel (I forget exactly who I got this from, but it was from another of my Facebook friends, I think from one of the people in my Quaker meeting doing NaNoWriMo).

Get Rich Slowly on How to Get Your Free Credit Report Online: A Step-by-Step Guide and on Knocking Out the Beliefs That Hold You Back.

Brian Solis on The Future of the Social Web.

Google Dashboard: Now You Know What Google Knows About You.

MMWR on abortion statistics (from 2005).

Chris Blattman on The last Cold Warriors: red deer. Also, Does Islamic rule increase women’s education and wages?

It seems so, at least in moderate Turkey.

Adventures in ill-advised medical contrarianism on flu vaccination.

Bruce Schneier on Mossad Hacked Syrian Official’s Computer.

Daisy Deadhead on Woman halts Fort Hood bloodbath.

One of the aspects of the torture program that really bothered me was the amateurs they hired to consult and advise about torture. The lack of any experience with interrogation by the psychologists they hired was well documented in Jane Mayer’s book, The Dark Side and here, by Ackerman. I had assumed that they never even asked the opinions of people with real experience interrogating prisoners, especially Muslim terrorist prisoners. I was wrong. Daphne Eviatar in a Washington Independent article notes that they received an opinion from our most experienced interrogators, they just ignored the advice. Key quotes…….

FBI/CITF agents are well trained, highly experienced and very successful in overcoming suspect resistance in order to obtain valuable information in complex criminal cases, including the investigations of terrorist bombings in East Africa and the USS Cole, etc. FBI/CRT interview strategies are most effective when tailored specifically to suit a suspect’s or detainee’s needs or vulnerabilities. Contrary to popular belief, these vulnerabilities are more likely to reveal themselves through the employment of individually designed and sustained interview strategies rather than through the haphazard use of prescriptive, time-driven approaches. The FBI/CITF strongly believes that the continued use of diametrically opposed interrogation strategies in GTMO will only weaken our efforts to obtain valuable information.

The memo goes on to list the interrogation techniques being used, and then to list which ones are “not permitted by the U.S. Constitution.” Those include: the use of stress positions for more than four hours; hooding; 20-hour interrogation segments; stripping a detainee of all clothing; and exploiting individual phobias, such as fear of dogs, to induce stress. They also include the use of scenarios designed to convince a detainee that death or severe pain is imminent for him or his family; waterboarding (here called “use of wet towel and dripping water to induce the misperception of drowning”); and exposure to cold weather or water.

All of those techniques, we now know, continued to be used by the Defense Department.

The FBI also warned that the use of such techniques would make any evidence derived inadmissible in federal court and if admissible in a military commission, likely to be given “little or no weight.”

The FBI drafters of the memo further explained that most of those techniques, particularly the last four, would also violate the U.S. anti-torture statute. It recommended that they not be used.

At this point, torture fatigue has pretty well settled in. The new administration wants to concentrate on health care, energy and the economy. They have little to gain by pursuing an administration that is out of power. Such an investigation risks exposing Democrats who may also be culpable. Still, I hold out hope for a truth commission of some sort. My hope is that by learning from what happened, we could avoid similar mistakes. If our best interrogators and intelligence people decide sometime in the future that torture is the only way to gain needed intel, I would have to listen to such opinions with some respect. I might be convinced that my ideas are wrong.

But, when I consider that the decision to torture was made by people with no prior direct intelligence, military or interrogation experience, I am appalled. It gets worse when I realize that they rejected the opinions of people with proven success, and chose people with no, zip, nada experience with interrogation of any kind to set up their program. I do not expect government to be perfect, I just don’t expect it to be that bad.

As seen on our cable system on the Francophone Radio-Canada station CKSH.

“During one of his liaison trips to Hanoi, Colonel Harry (Summers) told Tu, “You know, you never beat us on the battlefield,” Colonel Tu responded, “That may be so, but it is also irrelevant.”

George Washington led one of the most famous insurgent campaigns of all time. On paper, it was a total mismatch. British GDP was 100 times that of the colonies. The British army and navy were among the best, if not the best, in the world. However, Washington knew that the British had major commitments in the rest of the world. The cost of empire was high. he also knew that he had time on his side. He needed just an occasional victory to keep up hope. That is what he got and eventually the French aided us in our final push.

The Taliban also know that time is on their side. America has commitments elsewhere and the cost of empire is high. The Taliban also need a few victories of some sort to maintain hope. Dan Green at the Armed Forces Journal documents how they have chosen to obtain their hope generating victories. They are having their big successes off of the battlefield. Key quotes……

The Taliban’s positive political program has at least five aspects: Justice, micropolitics, reconciliation, laissez-faire and democracy. While the Taliban will impose their will on villagers if they have to, and they often do so violently, they also have a positive agenda that seeks to entice supporters to their banner.

In the face of corrupt and/or murderous government officials, a nonfunctioning judiciary, and the perversion or suspension of Pashtunwali traditions, the typical villager has a limited ability to seek justice for the things that bother him most: murder, theft, assault, rape, and land and water disputes. For the Taliban political agent, this vein of discontent is rich and can be mined by appealing to the structures of justice created by Sharia law. While the villager may not be inclined to support Sharia law in its totality, he is likely to do so in the absence of a viable alternative. Because the Taliban agent is sitting in the villager’s home, solicits his grievances and quickly seeks to remedy them, the villager is hard-pressed to support a government that is often distant and abuses its authority.

Along these same lines, the Taliban practice micropolitics to a remarkably high degree of sophistication. The Taliban political agent will find any problem that a village or individual may have and will make it his own. If a village is hoarding water from a stream, causing a down-stream village’s crops to fail, the Taliban will enlist with the aggrieved party. If a tribe has been abused by the Afghan government, the Taliban will join with them to seek justice. This political granularity stands in marked contrast to the sometimes inept, ineffective and insouciant efforts of the Afghan state and the sometimes counterproductive work of the coalition.

The Taliban’s political program is also furthered by their “do no harm” approach to the central drivers of local politics and economies. If a farmer wants to cultivate poppy, the Taliban allow it. If he once worked for or supported the Afghan government, he is allowed to reconcile with the Taliban. If a tribal leader wants his authority respected, they will do so if it furthers their agenda. Additionally, if villagers feel that “their” government does not represent them or has unfairly attacked their interests, then the Taliban preach inclusion, grievance and justice. Against this well-crafted, flexible, dynamic and pervasive program, U.S., coalition, and Afghan efforts lag significantly.

The Taliban are essentially all Pashtuns. They know and understand the local people and culture. They live there. They offer law and justice for the local people. While Sharia law has a bad reputation in the U.S., it is a very large body of law which covers all the areas of law which our civil/common law system covers. It also has the advantage of being faster and more adapted to local customs. Indeed, some of our common law was probably derived from Sharia. Timely justice coupled with micropolitics to counter the inept, corrupt Karzai government gives the Taliban the victories it needs among the Pashtuns.

We face this with a military and civilian effort that is designed to win a war and leave. Our troops rotate into combat zones for about one year at a time (this varies per service and need.) Our State Department workers rotate through for a year and leave. In a state vs state war, this keeps troops fresh. It acknowledges our all volunteer soldiery. It is not a recipe for success in an extended asymmetrical war. If we really want to have success in Afghanistan, the possibility of which I have become increasingly skeptical, we need to commit large numbers of people to stay there for years at a time. We need to understand the people and culture so that we can better compete in the off the battlefield war. Not incidentally, it should also help us to learn the battlefield so that we can fight more efficiently also. Bing West at SWJ has posted on how we are unable to finish firefights. While he laments what he sees as our loss of ability to conduct combined arms maneuver fighting, it also reflects our lack of knowledge about the physical and human terrain.

Do we have the thousands of people necessary who will commit five or more years to, maybe, make things work? That and the $10 billion per month to go with it? If not, we are just another temporary occupying force that can be waited out leaving a trail of dead vehicles and people in our wake.

The other day I received an email from one of my Senators, Sherrod Brown. You may remember him as the senator who claims diabetes makes you more compassionate and fair. The subject line of the email reads, “Health Reform: Ends Industry Discrimination Against Women, Protects Ohio’s Seniors.”

I have my doubts about it protecting seniors but now the discrimination against women part is my focus. First, I wonder if women ever tire of being the perpetual victims. Do women ever tire of being portrayed as helpless and impotent, as needing the constant assistance of men and government to be able to survive day to day life? Apparently not as one of the actions of feminism has been to perpetrate this image and insist on special government programs and laws to benefit the powerless, downtrodden female.

Secondly, how much discrimination do women face from the health care industry? To answer this question, I’ve explored the services available at hospitals in the greater Cincinnati area.

On the home page of the University Hospital of Cincinnati you’ll find links for Women’s Community Health Centers and Women’s Services plus a Lactation Internship Program(??).

At Christ Hospital, where my two youngest children were born, you can click on the “Departments” menu, go down to “Women’s Services” and find: Birthing Center, Breast Health, General Health Information for Women, Prenatal Clinic, Reproductive Services, Women’s Health Today Magazine and Women’s Surgery Center. Bethesda North and Good Samaritan Hospitals have women’s programs that include Maternity Services, Breast Care, Specialized Gynecology Care, Fitness, Programs and Classes and TriHealth Nurse Midwives. The Mercy Hospitals conduct a The Spirit of Women program.

Across the Ohio River in northern Kentucky, St. Luke’s Hospital’s services include Birthing Center, Breast Health Center, Nurse Midwives, Perinatal Centers, Physicians for Women and Women’s Heart Health. St. Elizabeth’s in northern Kentucky provides a Women’s Wellness program. (St. Elizabeth’s and St. Luke’s are affiliated at some level.)

Deaconess Hospital has no obvious special programs for women or men. Jewish Hospital links to a Breast Center.

This is not to say that any of these programs are not legitimate but none of these hospitals has any apparent similar programs for men. No prostate cancer centers or programs, no men’s health centers, etc. If the result of discrimination against women is having the health care industry catering to your every need, we need more of this, not less.

Of course, Sherrod Brown is another mindless liberal parroting the same drivel liberals have repeated since the mid-Sixties. The real issue is that the liberals want to control ever more of our society in every way they can. Freedom means that people, and organizations, can act in ways that liberals don’t approve and we can’t have that. And, do women ever get tired of being treated as helpless little things that can’t possibly make it on their own. The chauvinists of decades ago held women in higher regard than today’s liberals.

Other health care related items courtesy Instapundit:

Unemployment tops 10%, let’s wreck health care

Flu shot favoritism, is this how health care will work?
“Buried in Nancy Pelosi’s health-care bill is a provision that will partially repeal tax indexing for inflation, meaning that as their earnings rise over a lifetime these youngsters can look forward to paying higher rates even if their income gains aren’t real.”

Buy a policy or go to jail.

Can’t remember where I found this one: CBO: Republican health plan would reduce premiums, cut deficit

At the request of our good host H. M. Stuart, I have invited Crustacean from the Crunch Con blog to join us here and consider being a contributor.

I have also taken it upon myself to extend a similar invitation to AnotherBeliever, who I feel would be a fine addition to our group.

This post would be a fine place for either of these two gentlemen to ask questions of our little band, if they so choose.