Entries Tagged as 'Congress'

Your Congress at Work

David Frum February 18th, 2011 at 5:11 pm 32 Comments

Government funding for NASCAR: Liberty

Government funding for NPR: Tyranny

Obama Passed His Test, Now Republicans Face Ours

David Frum December 2nd, 2009 at 8:48 am 286 Comments

Reviews of the president’s speech vary from Republican tepid to Democratic anxious.

I disagree.

President Obama’s speech at West Point was not eloquent. Good. What’s needed now are not oratorical flights, but clear plans that give assurance of success. The president presented the details of both plans and purpose, mission and strategy.

In a blogpost last night, I criticized the president for setting a time limit. In the morning, I realized that I made the mistake against which I always warn others: Never listen to an Obama speech until after you have read it first. The man never quite says what you think you just heard. He did not say that the troops would come home after 18 months. He said

After 18 months, our troops will begin to come home.

BEGIN to come home. They will COMPLETE their return home, presumably, either when the job is done – or the war is deemed futile. That decision will be made later.

But here’s a decision that must be made now and renewed continually:

Having urged the president to honor his commitment to the Afghan war, we Republicans must honor our commitment to support him as he fights it. Given the public unenthusiasm for the conflict, there will be political temptations to “go rogue” on the president, if not now, then in the summer of 2010. That will be our test, for us to pass as the president has passed his. I know many Republicans and conservatives will say: “Hey – the Democrats did not give President Bush support when he most needed it.” Correct. They didn’t. And the country suffered for it. The right way to react to that dereliction of duty is not by emulating it, but by repudiating it. “For it before I was against it” has deservedly become an epithet for shameful wavering. Let’s not inflict it upon ourselves.

Politics would not be politics if Republicans did not exact some price for their support. For sure Republican leaders are entitled to close consultation on war policy and the larger national security strategy – and to more attention and respect generally than they have received from this administration to date, and not only Senate leaders, but House leaders too.

At the same time, demanding an extortionate price for support is tantamount to withdrawing support. The war is the war, healthcare is healthcare. Republicans should not take the first policy hostage to gain points on the second. We have to ensure that the political vulnerabilities exposed by this intensified Afghan commitment are protected, not exploited. We’ve said: All in, or all out. The president has gone all in. So now must we – and for the duration.

The Dems’ Afghan War Hypocrisy

December 1st, 2009 at 2:09 pm 23 Comments

Rep. Maurice Hinchey’s claim that President Bush intentionally let Osama Bin Laden escape to justify the war in Iraq is both appalling and ludicrous. The capture of Bin Laden and the overthrow of Saddam were complementary goals, not contradictory.

Hinchey’s conspiracy theory does not make sense even on its own twisted terms.

Would not the successful capture of Bin Laden have signaled a winding down of the Afghan operation and thus free more troops for Iraq?

And surely before a member of Congress hurled such a vile charge, some evidence should be required. I am getting tired of my former president being accused of, in essence, purposefully sacrificing the lives of young men and women in the field (soldiers, sailors and Marines he clearly cared so much about) to forward his own nefarious aims.

It is laughable that Sen. John Kerry of all people should be issuing a report on the Tora Bora operation that is a scathing criticism of the past administration for not committing enough troops in the initial operations in Afghanistan when he himself, was an advocate for restraint and limited commitment from the outset.  Funny, he seemed less Gung-Ho back on December 15, 2001 when he praised the Bush-Rumsfeld strategy, saying: “For the moment what we are doing, I think, is having its impact and it is the best way to protect our troops and sort of minimalize the proximity, if you will.  I think we have been doing this pretty effectively and we should continue to do it that way.”   Today’s Wall Street Journal sums up his position thusly: “Mr. Kerry is now in favor of more troops, after he was against them.”

It was, as the 2001 John Kerry would attest, understandable that Rumsfeld et. al. were very leery of making a massive commitment of men and material to Afghanistan. After all – his fellow Democrats feel exactly the same way today.

The Lockerbie Bomber Story Continues to Unravel

David Frum September 6th, 2009 at 9:31 am 9 Comments

Most of the doctors who examined convicted Lockerbie bomber Abdelbasset al-Megrahi concluded that he had some time to live, up to a year. Scottish Justice Minister Kenny McAskill opted instead to rely on a minority of doctors who estimated Megrahi’s life expectancy at less than three months. This mattered, because under Scottish law only those with less than 3 months to live qualify for compassionate release. Now Britain’s Daily Telegraph reports this:

Medical evidence that helped Megrahi, 57, to be released was paid for by the Libyan government, which encouraged three doctors to say he had only three months to live…

Megrahi is suffering from terminal prostate cancer. Two of the three doctors commissioned by the Libyans provided the required three-month estimates, while the third also indicated that the prisoner had a short time to live.

This contrasted with findings of doctors in June and July who had concluded that Megrahi had up to 10 months to live, which would have prevented his release.

Professor Karol Sikora, one of the examining doctors and the medical director of CancerPartnersUK in London, told The Sunday Telegraph: “The figure of three months was suggested as being helpful [by the Libyans].

“To start with I said it was impossible to do that [give a three-month life expectancy estimate] but, when I looked at it, it looked as though it could be done – you could actually say that.” He said that he and a second doctor, a Libyan, had legitimately then estimated Megrahi’s life expectancy as “about three months”. A third doctor would say only that he had a short time to live.

This weekend it was reported that Megrahi was moved out of an emergency care unit in Tripoli.

Far from an individual act of perhaps misguided compassion by one Scottish minister, the case increasingly looks like a deceitful connivance between the British, the Scots and the Libyans to cut short the imprisonment of a convicted mass murderer for commercial reasons.

The only consolation is that the British press has pressed for the truth and exposed their government’s true role. Meanwhile on this side of the Atlantic, an uncurious American press has accepted the Obama administration’s account at face value. Possibly that story is true. But given the level of lying in London and Edinburgh, it would be unrealistic to put much faith in Washington. What we need now are congressional hearings to discover:

  • When did the Obama administration first hear of London’s desire to see Megrahi released – not formally learn, but actually learn.
  • How did the administration respond? Did it protest? How forcefully?
  • Did the Obama administration have any role in the Libya-U.K. negotiations? Specifically – did the Obama administration agree to downplay its complaints (i.e. Obama’s ultra-mild description of the release as a “mistake”) in exchange for commercial considerations for U.S. firms or interests?
  • What consequences going forward will Britain’s attitude have for U.S.-U.K. relations and especially for U.S.-U.K. criminal justice cooperation?

There are many other questions to ask too as we seek to discover how the man who was convicted for killing 180 Americans was allowed to escape the full sentence for his crimes.

GOP Must Make School Vouchers a Civil Rights Issue

September 2nd, 2009 at 1:54 pm 54 Comments

When one-off events catch public officials flat-footed, the public often shows some understanding.

The start of the school year, however, and the need to schedule classes for students, are as predictable as August.  To have this annual exercise result in chaos and delay for 8,000 high school students in Prince George’s County, Maryland is a scandal and disgrace.

As reported at length by the Washington Post, the year began for 8,000 of the county’s 41,000 high school students without schedules.  Five days, later, 1,300 were still in limbo. It really is difficult to comprehend the scale of this ineptitude.  As one student explained on a Facebook page devoted to the matter:

We basically are going 2 school 4 no point wut so ever…we are wasting time going 2 are fake teachers and fake classes, doing fake work or nothing at all, for nothing at all.

When 20 percent of the county’s high school students are herded into cafeterias and gymnasiums, with teachers engaged in crowd control because students have no classes to attend, the essential functions of local government have broken down.

The greater scandal here is that this failure has almost certainly had an adverse impact on black students.  Prince George’s County may be home to the largest black middle class in the country, but among those high school students who had the start of their high school year ruined by administrative ineptitude, many were minority students who needed those extra few days of instruction and could ill afford thumb twiddling and busy work.

A collapse of governing responsibility, one with civil rights implications, just miles from the nation’s capitol — but will anyone at the federal level propose to do much about it?  We know that Democrats won’t cross the teachers’ unions.  What about Republicans?  Would they use this as an opportunity to promote vouchers for any of these students, betrayed by their school system?

Republicans are supporters of school vouchers as an economic concept. By enhancing parental choice and challenging the unions, they bring competition to the public school monopoly and improve outputs for the parent and child consumers.  And Republicans support state reforms and federal reform in the District of Columbia.

But where are the conservative conviction politicians in Washington who will use this situation to loudly demand justice, and promote school vouchers, for the poor kids in P.G. County?  As many have noted, the lack of access to a quality education is a civil rights issue, one that calls out for vouchers as an emergency measure for kids stuck in failing schools.  For any who doubt this, consider the account of Jessica Pinkney, a Prince George’s County high school junior, who told a Post reporter that two days after the school year began, she was finally moved to the cafeteria from the gym, because the cafeteria had air conditioning.  And then she was given an index card with the number 195 on it — her place in line to receive an academic schedule.  This should not happen in America, and when it does, the citizens under the thumb of the authorities responsible should be liberated from their dependence.

Unfortunately, it is unlikely that Republicans in Congress will take an aggressive stand for these helpless students and against a corrupt and wasteful bureaucracy incapable of executing even the most basic tasks with which it is charged.  Republican commitments to federalism and local authority caution against such a full-throttle embrace of federally funded school vouchers.  Republican orthodoxy on limited government doubts the legitimacy of involvement by Washington in these essentially local matters.  And the Republican understanding of the original Constitution demands a restrictive understanding of fundamental rights.

But as demonstrated in Maryland, vouchers can be an imperative of justice — one consistent with the GOP’s, and the nation’s, historic constitutional commitment to civil rights.

Next week Congress returns from its August recess.  We will hear a great deal from legislators on both sides of the aisle about their admiration for their friend Senator Ted Kennedy.  While not embracing his politics, Republicans should consider the man’s tactics and take on the Prince George’s debacle.  Kennedy spoke loudly and often in the pursuit of justice.  He rarely let an opportunity pass to remind Americans of those in danger of being left behind.  And over time, his moral arguments won adherents and drove the center of the debate in his direction.

Democrats should be ashamed that in the fights over school choice, they take the side of the unions over the little guy — the minority student in a failing school.  And if Republicans spoke on this issue with the frequency and passion that their late colleague devoted to his causes, they might find in a few years that they have achieved some legislative successes on school vouchers, begun to reestablish some trust with the black community, and rebranded the party as one committed to justice and civil rights.

The Coming Doctor Shortage

September 2nd, 2009 at 12:31 am 31 Comments

Let’s say it all works out and we welcome the supposed 45 million or so individuals without healthcare insurance into the fold and they receive the preventive care and primary care that we are told will solve the problems of American healthcare. Based on the assumption that these uninsured people are not receiving healthcare now, we will need about 100,000 more doctors than we have at present (our current physician workforce is about 900,000 physicians). This number is based on our current count of 2.43/1000 population according to the Organization for Economic Cooperation and Development. Let’s be conservative and assume that half of these individuals are receiving some kind of care now, so that we will only need 50,000.

One response to this assumption may be that we already have too many doctors. Perhaps, but the average in the much-admired France, for example, is about 30% higher per 1000 population than in the U.S., so it is likely that we will really need at least that many more doctors to handle the workload.

The reasons for the shortage of physicians in the U.S. are quite complex and, as usual, there is a component of blame attributable to Congress and Medicare.

In order to secure a medical license, one needs to graduate from an accredited medical school and then take at least a one year postgraduate residency position, although the vast majority of graduates, even those entering primary care type practices, pursue an additional 2 to 3 years of training. For some specialties of surgery or medicine, the additional post-graduate training can be 5 to 8 years.

Medicare is the largest single source of funding of graduate medical education, another name for residency training.  The Department of Veterans Affairs also finances the training of about 10% of residents. The costs of graduate medical education are financed by Medicare under two mechanisms: Direct Medical-Education payments to hospitals for a share of residents’ stipends, faculty salaries, administrative expenses, and an overhead allocation to residency programs; and the so-called Indirect Medical-Education adjustment to Medicare payments for each Medicare patient treated at the hospital. The rationale for this indirect education adjustment is the relatively higher costs attributable to the more severe degrees of illness typical of Medicare patients who require specialized services available in teaching hospitals.

In 1997, Medicare’s direct payments for graduate medical education totaled $2.2 billion — 47 percent more than in 1990. Medicare’s indirect medical-education adjustment is based on the number of full-time-equivalent residents who are being trained in the inpatient and outpatient departments of a teaching hospital. Generally, the more residents there are, the greater the payments to a hospital will be. Such payments to teaching hospitals totaled $4.6 billion in 1997 — 84 percent more than in 1990.

In an effort to cut the costs of Medicare, the Balanced Budget Act of 1997 was enacted. Among other effects, it reduced direct payments for Graduate Medical Education by $700 million and trimmed $1.1 billion per year off Medicare’s indirect teaching payments for the subsequent five years. Also, for the first time, Congress imposed a cap on the number of residents the program would support by its direct and indirect teaching payments. The idea was that fewer physicians would mean lower costs.

The impetus to the reduction was, in part, a report by the Institute of Medicine, a prestigious government think tank as an arm of the National Academy of Sciences, that stated, “The Institute of Medicine committee recommends that:

  • No new schools of allopathic or osteopathic medicine be opened, that class sizes in existing schools not be increased, and that public funds not be made available to open new schools or expand class size.
  • The federal government reform policies relating to the funding of graduate medical education, with the aim of bringing support for the total number of first-year residency slots much closer to the current number of graduates of U.S. medical schools.” (Since a large number of new physicians each year are international medical graduates, this proposal represented a huge potential reduction, some 25%)

This was a disastrous error as we now face the aforementioned shortfall in primary care physicians for the proposed newly insured individuals in addition to a universally recognized coming shortage of all types of physicians, both primary care and specialist physicians. In proof, the new 2008 recommendation made by the governing body of the nation’s medical schools (the Association of American Medical Colleges) demands that,” serious efforts must be made to expand the number of health professionals educated to care for a population that continues to grow and whose aging will place unprecedented demands upon the health care system.”

So much for central planning. (See Soviet Union, 1967)

Since it takes 10 years to even begin to expand the pool of American physicians, the misjudgment in 1996 means that we will not even begin to see increased numbers of trained physicians until 2019 at the earliest.

But do not fear. Congress has reacted. We will be able to “recruit” more international medical graduates. In May 2009, Senator Bill Nelson (D-FL) introduced the Resident Physician Shortage Reduction Act of 2009 in the Senate, and Representative Joseph Crowley (D-NY) introduced identical legislation in the House of Representatives. This bill proposes to increase the number of Medicare-supported residency positions across the United States by 15%, or approximately 15,000 positions. The bill also proposes changes in the distribution of currently available positions and encourages the creation of new positions in primary care and general surgery programs.  This program will help correct some maldistribution of positions but mostly it will allow more international medical graduates to earn the right to practice medicine in the United States, as primary care physicians. This is the only type of medical practice that allows foreigners to avoid a 2 year return to their home country prior to qualifying for US work visas.

So in the end, it is possible through mass migration of international medical graduates, creation of increased training positions, and the construction of new medical schools, that by 2020 or so, we will have more primary care physicians. This will certainly help with prevention, screening for disease, and management of routine and most non-life threatening conditions. However, if you need your prostate removed by the latest robotic and tissue sparing technology or you develop a malignancy that requires complex surgery, radiation therapy, and chemotherapy, beware. Another face of rationing is the inability to find a medical or surgical specialist to manage those sorts of life-threatening illnesses. For example, two independent studies have reported that there will be a 50% increase in the demand for the services of cancer specialists over the next decade and that was before any notion of health insurance reform. This will greatly outstrip the supply of cancer specialists given the current number of  approved training positions.

If the argument for a wholesale revamping of American healthcare depends on the large number of uninsured, typically estimated at 45 million (although a New York Times editorial elevated the number of medically uninsured and underinsured to over 100 million), then there had better be some plan that goes along with the reform to find the 25,000 to 50,000 new physicians that will be required. And by the way, since the number of physicians retiring in the next decade will be about 25,000 per year, you can see we have a bit of a problem.

A little preview of physician availability from Massachusetts healthcare reform via the New York Times:

Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months.

“It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”

Obama Losing Bipartisan Support for Afghanistan

September 1st, 2009 at 12:40 pm 11 Comments

In today’s Washington Post, look George Will calls for the United States to dramatically change its policy in Afghanistan.  In effect, Will calls for a pull out:

[F]orces should be substantially reduced to serve a comprehensively revised policy: America should do only what can be done from offshore, using intelligence, drones, cruise missiles, airstrikes and small, potent Special Forces units, concentrating on the porous 1,500-mile border with Pakistan, a nation that actually matters.

That the doves on the left are growing tired of the costly war in Afghanistan should not surprise anyone.  The Obama administration may not be thrilled by this development, but they likely expected the doves to begin to grumble as the war continues to grow more and more costly.  The doves do not threaten the administration’s Afghanistan policy.  However to lose Mr. Will’s support will deeply trouble many administration officials not only because Mr. Will remains one of, if not the most recognized newspaper columnist in America (conservative or Democrat) but also because Mr. Will’s defection indicates that support on the right, particularly amongst realists like Mr. Will (and myself) may not be as reliable as the administration may have originally believed.

President Obama’s handling of the war effort in Afghanistan is one of the few policies where this president has received anything resembling true bipartisan support.  President Obama is a talented politician with a unique ability to appeal directly to the American people, but his administration can hardly afford to lose the support of the realist right at a time when it is fighting heated partisan wars on gargantuan issues like healthcare.  Anything resembling serious opposition to the war effort from moderate Republicans and Democrats alike would require a PR blitz that would quickly suck up much of the administration’s remaining political capital.  The White House knows this, and you can expect them to mount a PR blitz in the coming days aimed at countering Mr. Will’s arguments, and in doing so holding together a portion of the right’s suddenly fragile war support.

What a Difference a Year Makes

September 1st, 2009 at 12:18 pm Comments Off

President Obama

President Obama

A year ago, this man was telling us the surge wouldn’t work, that Iraq was unwinnable, it was distracting us from Afghanistan, which was the right war.

Folding the Flag

Folding the Flag

Now, they’re folding the colors in Iraq, stacking arms, packing up and going home. Mission accomplished.

Meanwhile . . . now Mister Hope-&-Change is saying Afghanistan isn’t winnable . . .

U.S. Soldiers in Combat in Afghanistan

U.S. Soldiers in Combat in Afghanistan

That isn’t how you win wars Mr. President . . . you win wars by KICKING ASS ! ! !

General Patton

General Patton

Any war is winnable… just at the point when either side thinks they’re losing, is when they’re on the verge of winning. Just ask the Vietnamese…

Will’s Exit from Afghanistan

David Frum September 1st, 2009 at 11:42 am 72 Comments

Anybody who does not share George Will’s frustrations with the Afghan mission has not been paying attention.

That does not mean George Will is right in his call for American evacuation and a

comprehensively revised policy: America should do only what can be done from offshore, pills using intelligence, unhealthy drones, cruise missiles, airstrikes and small, potent Special Forces units…

I think that policy answer is wrong. But if we are to reach a better answer, we need to deal with what is right in Will’s analysis of today’s grim and deteriorating Afghan situation.

Will is right about the weakness of the Afghan state. He is right about the endemic corruption of the Afghan government. He is right about the country’s deep backwardness. He is right above all about the Zen unreality of the current mission: to prevent the re-establishment of al Qaeda bases.

The Bush administration’s undeclared strategy in Afghanistan was to invest the minimum necessary to achieve stability – and then refocus on what it regarded as a more important and more winnable theater in Iraq.

Unfortunately, sustaining Afghan stability has proven much more difficult and expensive than imagined back in 2001 and 2002. Then candidate Obama compounded that Bush-era miscalculation with a poorly considered pledge to increase the US commitment in Afghanistan – a pledge that originated much more in the candidate’s political needs than in any strategic calculation. Obama has hugely reinforced the US Army in Afghanistan, with a big “TK” where his counter-insurgency strategy ought to be.

That’s a formula for frustration. What is being said by George Will in public is already being muttered in private by congressional Democrats.

Barack Obama has given Afghanistan men and money. But one vital resource is being withheld: presidential time and commitment. Turning around an unsuccessful war demands intense presidential focus. Everyone around the president must be made to understand that the war is priority 1, and that everything else on the agenda must be subordinated to this supreme imperative. George W. Bush accepted that responsibility in 2006-2008. Barack Obama has not. The results are as we see, in Afghanistan and now in the darkening assessment of as strong-spined an observer as George Will.

Can Obama Save His Presidency?

August 31st, 2009 at 1:48 pm 25 Comments

As cold fear rises in the mainstream media that President Obama may be in over his head, my thoughts go back to a dinner I attended in New York last December. Obama had just been elected and the Right was deeply fearful that he might indeed live up to his hype and be a new FDR. One of the attendees at this dinner happened to be one of the very, very few right-of-center people who can legitimately claim to know Barack Obama well on both the personal and professional levels. (I cannot give his name because his comments were off the record, but I have provided it to the editor of New Majority.) Naturally, we were all curious about his assessment of the new president-elect. He was reluctant to speak to the subject initially, but gave in after some good-natured urging.

“Two observations,” he said. “First, I have never known him to change his mind on any issue of any significance, even when provided with new facts and new information.”

As we digested that rather disturbing bit of information, he added the second.

“And I don’t think he has the foggiest notion of how an economy works.”

When you think about it, though, neither observation ought to be terribly surprising. Unlike Bill Clinton, who had to survive in a culturally conservative state like Arkansas for two decades before becoming president, Barack Obama has lived his entire life in a left-liberal bubble. When he wasn’t living in Indonesia, he was living in Hawaii, the most culturally atypical (and one of the most politically liberal) states in the Union. From everything I’ve read about them, the grandparents who raised him would not have felt out of place at a Communist Party USA meeting. Then there was Columbia and Harvard. He cut his political teeth in Chicago, and there can be little doubt he views the private sector the way any liberal, urban politician views the private sector: as a cow to be milked. He doesn’t want the cow to die, of course. But it’s not the politician’s job to feed the cow, care for the cow, or see to it that the cow is healthy. That is somebody else’s job. All the urban liberal politician wants to hear when he gets up in the morning is that the cow is giving milk, and will give more tomorrow. The mechanics of how that actually gets done is simply not his concern. He was elected to redistribute wealth, not create it. That is what Obama was getting at in his unscripted moment with Joe the Plumber last fall.

So, for those out there who think the president is inclined – or even able – to “pull a Clinton” and tack to the political center, someone who has known him for over a decade doesn’t think it’s in his DNA. And there isn’t much evidence to the contrary. We have a president whose beliefs are rigid and who is ignorant of basic economics. Maybe all this will still work out, but any such belief has to be based more on faith than on evidence.