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Border Walls and the High Cost of Healthcare

May 12, 2011 2 comments

President Obama’s signature legislative achievement goes a long way toward improving America’s healthcare insurance system – now he’s calling on congress to fix our defective immigration rules. But healthcare costs still pose significant problems and America continues to overpay for medical services compared to other nations. So the president might as well aggravate the anti-immigrantion Right further and break down the wall separating these two issues. The GOP keeps saying they want more free market solutions for healthcare, President Obama should offer one.

The administration should seek an international agreement to recognize foreign medical accreditation, increase visas for qualified doctors, and encourage insurance companies to finance patient travel. Fred Hansen in an Institute of Public Affairs article writes,

Although up from 500,000 in 2006 to 750,000 in 2007, the number of Americans traveling abroad for healthcare is tipped to increase to 6 million by 2010.

Unfortunately I can’t find more up-to-date numbers, but it is clear that medical tourism will continue to grow. Of course, many people naturally fear the idea of foreign medicine, but if importing medical services or traveling abroad for them lowers prices or provides access to otherwise unavailable higher quality care to a suffering patient that xenophobia can be an expensive and dangerous delusion.

In 1993, the trade economist Jagdish Bhagwati wrote a piece for the Journal of Commerce advocating that Hillary Clinton’s healthcare task force open the borders for medicine and doctors.

The entry of more foreign doctors wouldn’t require anything as formidable as easing immigration restrictions. Temporary visas for providers of professional services can be made available readily to qualified doctors from abroad.

[…]

Economic research strongly suggests that the AMA makes [foreign medical] examination tougher when doctors’ earnings are under pressure, thereby reducing the pool of eligible applicants for visas. Limiting entry eases competition among doctors and keeps their earnings-and the cost of health care-higher than it might otherwise be.

As the healthcare cost graph (linked above) shows, Americans spend $64 billion in excess costs because of overpriced healthcare workers. As President Obama goes around the country to push for immigration reform he might think about how he can build on his previous success by tearing down a few walls.

The Most Important Lesson For Elected Officials

October 27, 2010 Leave a comment

In Ezra Klein’s recent post juxtaposing David Brooks from 2005 with David Brooks now is worth a read, but Klein writes 2 sentences that every politician should have tattooed to the inside of their eye lids (one on each?).

You don’t win elections in order to win more elections. You win elections in order to solve problems and make the country better.

Most people probably think that is self-evident, but it seems most politicians easily lose sight of that. Here’s Mitch McConnell forgetting,

The single most important thing we want to achieve is for President Obama to be a one-term president.

Don’t think Democrats don’t forget as well. Yglesias reminds Democrats that if they focused on governing better they wouldn’t be losing elections. Even if you’re self-interested enough and want your main goal to be reelection that shouldn’t prevent you from governing better – you just can’t be so myopic.

Speaking to The New York Times‘ Peter Baker for a profile published last week, Obama said his administration “probably spent much more time trying to get the policy right than trying to get the politics right” and drew the lesson that “you can’t be neglectful of marketing and P.R. and public opinion.”

Marketing and public relations are nice, but opinion is fundamentally driven by results. And on this, Obama has it backward.

[…]

The issue is not so much that the administration needed to be more or less moderate, rather that it needed to be more effective in boosting the economy and more mindful of the central role it plays in politics. This matters because, to point out the obvious, the economic outlook is still bleak. Enhanced post-election focus on marketing and PR won’t turn that around. In other words, all the marketing and PR in the world won’t succeed in moving public opinion, meaning Democrats could easily have another round of election losses to look forward to.

Martin Wolf feels similarly,

The president’s willingness to ask for too little was, it turns out, a huge strategic error. It allows his opponents to argue that the Democrats had what they wanted, which then failed. If the president had failed to get what he demanded, he could argue that the outcome was not his fault. With a political stalemate expected, further action will now be blocked. A lost decade seems quite likely. That would be a calamity for the US – and the world.

Every time an elected official compromises what he thinks will be best for the economy for political purposes he’s sowing the seeds of his own defeat. Certainly certain compromises might be necessary to pass a particular bill, but as Wolf points out, when you make it seem like you got what you wanted you’ve trapped yourself. Not only that, but Democrats willingness to give up the rhetorical fight for stronger stimulus (or for any stimulus) weakens them for the future. If they aren’t willing to defend the idea of stimulus (assuming they still actually think it can be productive) how do they think they can gain support for using fiscal policy in the future?

I really don’t understand the long-term strategy of not making the case for the policies you want. Obviously if you want them you think they are the best policies; by undercutting the case for those things you’re just making it harder to get what you want. President Obama continues to make policy compromises that weaken policy only to get no Republican votes, no acknowledgment of compromise, no positive electoral gains, and…. compromised and weakened policy. Here’s my advice.

Stop looking at the next election, close your eyes and recognize why you’re in office.

The Wisdom of Silence

August 24, 2010 12 comments

Better to remain silent and be thought a fool than to speak out and remove all doubt. 

      Mark Twain 

When Twain made this remark he probably didn’t have American presidents in mind, but it captures an important lesson in an unintended way. Of course, Twain meant that if you’re a fool and you speak, your intellect will be more obvious to others than if you kept your mouth shut. Presidents often aren’t fools (yes, I did just write that) but speaking out even with wise words may be a foolish move. 

Over at The Economist’s “Democracy in America” blog, the writer, while staking out an odd position on gay marriage (one I happen to disagree with), observes that “for presidents, words are political actions.”

What would have been the actual political consequences of a decision by Barack Obama to come out in favour of gay marriage in the past year and a half? I don’t think there can be any doubt that such a move would have re-politicised an issue that, remarkably, has become steadily less partisan in recent years. Presidents can’t simply speak their minds. For presidents, words are political actions. A president who voices an opinion without considering the political consequences is acting irresponsibly. Presidents’ voiced opinions about social justice are very sharply constrained by whether voicing those opinions is likely to advance their visions of social justice at that political moment. And that means that presidents’ spoken views on such questions may lag far behind the pace of progressive opinion, and may become much less progressive when they are in power than they were before they were elected.

I happen to believe that Obama speaking out in favor of gay marriage would be beneficial to the cause (and would certainly put him on the right side of history), but it’s not preposterous to think that the opposite effect would result. There is no question that it would further politicize the issue just when a majority of Americans now believe in full marriage rights for gays and lesbians. 

On August 11th Matthew Yglesias wrote a post arguing that often presidential leadership can be counterproductive. He was talking about immigration, but this clearly applies to all issues. He was piggybacking off of Ezra Klein’s post on Francis Lee’s book Beyond Ideology which argues that “presidential positions” increase the partisanship on issues.

[The] American people — and the media — expect a lot of bully pulpit leadership. But that bully pulpit leadership polarizes the other party against the initiative, even when the messaging is effective.

Grasping this dynamic is key to understanding the wisdom of President Obama in not offering his full opinion of the Islamic center near Ground Zero. If anyone has any doubts of the effect, notice how the issue became more polarized when he just commented on the constitutionality of it. This isn’t to say that presidents shouldn’t ever speak out on controversial issues; it is to only notice that “A president who voices an opinion without considering the political consequences is acting irresponsibly.”

Given that, I think it’s unfair for writers on the left, right, and center to blast President Obama for being cowardly for not commenting on the wisdom of the choice or to give his personal opinion. Clive Crook’s latest FT column is a perfect illustration of this. This expands on his previous blog post on what Crook thinks Obama should have said. Of course, all this presumes Obama is, in fact, in favor of the mosque and thinks it is wise. If he thinks it is unwise and insensitive, does Crook still think it’d be unifying? Lee’s research suggests that had Obama spoken out by praising the wisdom of the mosque it would have made the polarization of the issue even worse. If he strongly argued that equating this mosque and Sufi Islam with the Islamic fanatics that attacked the US is completely irrational he would have been skewered for being insensitive to the 9/11 families. 

Presidents’ words also have effects diplomatically. Had Obama given too much sympathy for the sentiments of the 9/11 families by saying that it isn’t completely irrational to feel disgust at putting a mosque so close to the site of a horrendous attack by Islamic terrorists, how would that have played with our Muslim allies? To not consider the unintended consequences would be ill-advised. 

None of this is to argue that presidents shouldn’t take politically unpopular or politically dangerous stands if strong principles are at stake. Commentators just need to recognize the possible effects of a president’s words; after all, a president speaking out may be counterproductive to justice or diplomatic goals and these effects aren’t necessarily going to run in the same direction. Crook or Krauthammer or whoever can plausibly argue that the president should take a stand that they agree with because it is the right thing to do, but to argue that it is cowardly not to or that it would be “unifying” if he did is disingenuous or foolish – on this they’d be better off remaining silent. 



(image: abc news)

Religious Freedom Trumps Our Feelings, ctd

August 16, 2010 17 comments

In my previous post on this topic, I laid out my argument and others’ for allowing the proposed mosque to be built. President Obama courageously and dutifully addressed the nation and also supported the religious freedom of Muslims to build a mosque on private property.

I completely agree when the President says,

As a citizen, and as President, I believe that Muslims have the same right to practice their religion as everyone else in this country.  And that includes the right to build a place of worship and a community center on private property in Lower Manhattan, in accordance with local laws and ordinances. This is America.  And our commitment to religious freedom must be unshakeable.  The principle that people of all faiths are welcome in this country and that they will not be treated differently by their government is essential to who we are.  The writ of the Founders must endure.

He or I did not, however, comment on what he calls “the wisdom of making the decision to put a mosque there.”

Well Sam Harris tries to thread the needle by distancing himself from “many who oppose the construction of this mosque [that] embody all that is terrifyingly askew in conservative America—“birthers,” those sincerely awaiting the Rapture, opportunistic Republican politicians, and utter lunatics who yearn to see Sarah Palin become the next president of the United States (note that Palin herself probably falls into several of these categories). These people are wrong about almost everything under the sun.” He’s attempting to jab his carefully threaded needle into the wisdom without puncturing the liberal values of America’s founding and its citizens’ constitutional rights. Outside the piece he explains that he wrote this article before President Obama gave the speech – the editors wrote the title and lead in. Within his essay, I do think he bursts President Obama’s diplomatic statement that “Al Qaeda’s cause is not Islam -– it’s a gross distortion of Islam.  These are not religious leaders -– they’re terrorists who murder innocent men and women and children.” I do worry that careless readers with fall into the trap of thinking Harris is too easily grouping moderates and extremists; failing to discriminate. Further in however Harris’s thread comes close to falling out.

And the erection of a mosque upon the ashes of this atrocity will also be viewed by many millions of Muslims as a victory—and as a sign that the liberal values of the West are synonymous with decadence and cowardice. This may not be reason enough for the supporters of this mosque to reconsider their project. And perhaps they shouldn’t. Perhaps there is some form of Islam that could issue from this site that would be better, all things considered, than simply not building another mosque in the first place. But this leads me to a somewhat paradoxical conclusion: American Muslims should be absolutely free to build a mosque two blocks from ground zero; but the ones who should do it probably wouldn’t want to.

Harris might be right that it is unfortunate that these peaceful American Muslims would want to build their mosque so close to Ground Zero if they are actually interested in easing tensions between communities (clearly that isn’t working yet), but I’m not sure he’s right that it shows that “liberal values of the West are synonymous with decadence and cowardice.” Even if some terrorists overseas view it that way, in my mind it highlights the strength of our values to withstand even what a majority of our citizens find “offensive.” I don’t want to be held hostage to whatever religious terrorists may think about our decisions or values. Furthermore, allowing the construction stands in stark contrast to how many in the Muslim world treat things they find offensive. Christopher Hitchens spotlights that gambit.

A widespread cultural cringe impels many people to the half-belief that it’s better to accommodate “moderates” like Rauf as a means of diluting the challenge of the real thing. So for the sake of peace and quiet, why not have Comedy Central censor itself or the entire U.S. press refuse to show the Danish cartoons?

This kind of capitulation needs to be fought consistently. But here is exactly how not to resist it. Take, for example, the widely publicized opinion of Abraham Foxman, national director of the Anti-Defamation League. Supporting those relatives of the 9/11 victims who have opposed Cordoba House, he drew a crass analogy with the Final Solution and said that, like Holocaust survivors, “their anguish entitles them to positions that others would categorize as irrational or bigoted.” This cracked tune has been taken up by Newt Gingrich and Sarah Palin, who additionally claim to be ventriloquizing the emotions of millions of Americans who did notsuffer bereavement. It has also infected the editorial pages of the normally tougher-minded Weekly Standard, which called on President Obama to denounce the Cordoba House on the grounds that a 3-to-1 majority of Americans allegedly find it “offensive.”

Where to start with this part-pathetic and part-sinister appeal to demagogy? To begin with, it borrows straight from the playbook of Muslim cultural blackmail. Claim that something is “offensive,” and it is as if the assertion itself has automatically become an argument. You are even allowed to admit, as does Foxman, that the ground for taking offense is “irrational and bigoted.” But, hey—why think when you can just feel?

I have to admit, when I first heard that they were building a “Ground Zero Mosque” I assumed it was going to be in the new Twin Towers. Viscerally and immediately I opposed that; but once I learned it was being built on private property and off the site of the Twin Towers, I couldn’t find any reason for restricting the freedom of fellow Americans. Now I still don’t think I’d argue in favor of putting a mosque there if I was making the decision (fortunately in America we don’t allow the opinion of random citizens to decide such questions), and I can’t help but understand the emotional appeal of people like this 9/11 firefighter in opposing the mosque’s construction (which I watched as I sat in the ER). I don’t agree with all his arguments but I can empathize with his perspective. This puts me in a difficult place. How can I on the one hand give his argument from offense weight while actively instigating offense in campaigns like “Draw Mohammed Day” (e.g. here and here)? Well to me it illustrates the essential difference in supporting freedom in practice to just giving it lip service. Conor Friedersdorf puts the opposition to the test.

Imagine a suburban street where three kids in a single family were molested by a Catholic priest, who was subsequently transferred by the archbishop to a faraway parish, and never prosecuted. Nine years later, a devout Catholic woman who lives five or six doors down decides that she’s going to start a prayer group for orthodox Catholics — they’ll meet once a week in her living room, and occasionally a local priest, recently graduated from a far away seminary, will attend.

Even if we believe that it is irrational for the mother of the molested kids to be upset by this prayer group on her street, it’s easy enough to understand her reaction. Had she joined an activist group critical of the Catholic Church in the aftermath of the molestation, it’s easy to imagine that group backing the mother. As evident is the fact that the devout Catholic woman isn’t culpable for molestations in the Catholic church — in fact, even though we understand why her prayer group upsets the neighbor, it is perfectly plausible that the prayer group organizers never imagined that their plan would be upsetting or controversial. In their minds (and in fact), they’re as opposed to child molestation as anyone, and it’s easy to see why they’d be offended by any implication to the contrary.

Presented with that situation, how should the other people on the street react? Should they try to get city officials to prevent the prayer meetings from happening because they perhaps violate some technicality in the neighborhood zoning laws? Should they hold press conferences denouncing the devout woman? Should they investigate the priest who plans to attend? What if he once said, “Child molestation is a terrible sin, it is always wrong, and I am working to prevent it from ever happening again. I feel compelled to add that America’s over-sexualized culture is an accessory to this crime.” Does that change anything?

I’d certainly side with the woman who wants to hold the prayer group, and her fellow orthodox Catholics.

Does anyone think any of those talk-radio hosts opposing the mosque would similarly oppose the Christian prayer group? What about Gingrich or Palin? Certainly, the mosque case is more extreme in degree, but I fail to see any difference in principle.


I still believe that once tensions simmer down, America will be stronger for allowing this construction. As I argued before, we’re not so fragile that we can’t live with this. We must remember that even if it is unadvisable or unwise for these Americans to build their mosque here, they aren’t responsible for 9/11. Feelings aren’t permanent, freedom should be. And, hey, we can always support building a gay bar next to it.

Crook-ed Logic

I’m a big fan of Clive Crook, his policy instincts and analysis are usually spot on, but his political barometer may be malfunctioning. In his latest Financial Times column he makes the classic pundit mistake of mapping his feelings onto the electorate. Crook wasn’t happy with the way Obama sold his policies. He argues President Obama “should have chosen centrism unreservedly – as many voters believed he had promised during his election campaign. Then he could have championed, as opposed to meekly accepting, centrist bills.” Although Crook acknowledges that the economy is largely to blame for falling approval ratings (political scientists have repeatedly found this to be the case), he thinks Obama’s political loss with independents and centrists is due to his insufficient zeal in talking like a centrist. After all, Crook believes the policies themselves are centrist.


First of all it is not at all clear that independents are moving that fast away from the President. Here is my previous post on the recent steadiness in their support. 

And when you look at more polling from pollster.com any drop in approval coincides with the dismal economic growth, not his legislative battles or perceived non-centrist speeches.

The healthcare bill, which Crook uses as an example, passed in March. Yet, from around the time debate started on the bill to its passage to now, Obama’s approval ratings among independents have moved rather modestly. And who is to say that any of that movement is even attributable to the healthcare bill at all? Polling on the healthcare bill specifically has actually gone up slightly.Trend: Reaction to Congress' Passage of Healthcare Reform Bill
It is also interesting to note that it is actually centrist Democrats who are more likely to lose their seats than more progressive Dems. I’m not sure how that fits into Crook’s picture. What is clear is that the electorate blames whoever is in power for the state of the economy which – except at the margins – is the only thing that really matters. 


Curiously, Crook also believes in further stimulus yet believes listening to the progressive wing (who wanted more and bigger stimulus) would have been a mistake.

The fiscal stimulus, too, was a centrist initiative. It was smaller than the left wanted, and included temporary tax cuts as well as increases in spending. 

[…] 

If Mr Obama had followed the advice of the party’s progressive wing, he would have killed his administration’s electoral prospects – and his own hopes of a second term – stone dead.

It should be obvious by now that if a bigger stimulus had resulted in a better economy, Obama’s and the Democrat’s electoral fortunes would be better right now. If anything capitulation to the centrists has been self-defeating. 


Most people don’t pay enough attention to how politicians sell their plans for it really to affect their votes and when they do most just rationalize it to their bias anyway. Crook should remember voters are irrational and the economy matters more than political salesmanship. He should have stopped writing his column here:

The economy is much to blame, of course. The political effects are direct and indirect. Voters are unhappy, which hurts the party in power. The electorate understands that George W. Bush bequeathed the recession, but if 18 months of remedial action have failed to work as hoped, blame begins to migrate.

Obama and Independents

I don’t usually cover pure political material but I’ve heard so much about Obama’s approval ratings with independents from pundits, friends, and colleagues I need to set the record straight. Over at The Monkey Cage, a blog devoted to political science, readers get a dose of reality. Here’s a graph of Obama’s souring approval rating with independents. 

Quite a roller coaster ride, eh? Yes, ladies and gentlemen, watch in amazement as independents “sour” on Obama during the health care debate. The percent who approved of him at the beginning of September 2009 was 46%. During the week he signed the bill it was…45%!

And how about that oil spill? Since the oil spill, Obama’s approval among independents is down by a whopping 4 points. Sour, indeed!

I recommend The Monkey Cage for sane and empirical coverage of politics. The overall message: most of political analysis and reporting is utter b.s.

Kaplan Nukes Romney’s "Rant"

Fred Kaplan:

In 35 years of following debates over nuclear arms control, I have never seen anything quite as shabby, misleading and—let’s not mince words—thoroughly ignorant as Mitt Romney’s attack on the New START treaty in the July 6 Washington Post.

[…] 

[By] all indications, Romney has been badly advised. Next time he speaks out on nuclear weapons, he should read up a little bit. At the very least, he should learn the difference between an ICBM and a bomber. 

Oh just read it all for the details. My summery: Romney has no idea what he’s talking about. 

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