Summer Davos in Tianjin: The US & China in a Messy Century?

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Watch live streaming video from worldeconomicforum at livestream.com

For those interested in an interesting discussion about America’s bleak course, China’s rise, and global uncertainties — with some modest moments of optimism here and there — please enjoy this video segment from the Summer Davos meeting yesterday in Tianjin, China.
I moderated a session with Chinese Institute on Contemporary International Relations President Cui Liru, New York Times foreign affairs columnist Thomas Friedman, Japan Liberal Democratic Party Acting Secretary General Taro Kono, Yonsei University political science professor Moon Chung-in, East West Center Director Charles E. Morrison, and US State Department APEC official Kurt Tong.
I will write more about these World Economic Forum meetings — which were tremendous on many levels, but disturbing when the general take on US prospects are measured — when I get the first chance.
Now on my way to London to discuss US foreign policy with Princeton’s G. John Ikenberry, the LSE’s Michael Cox, and others at the Royal United Services Institute. The Afghanistan Study Group report and Obama’s foreign policy will be the guts of my talk.
More soon.
– Steve Clemons

Comments

34 comments on “Summer Davos in Tianjin: The US & China in a Messy Century?

  1. questions says:

    From WaPo/Marcus:
    “It’s easy to forget, amid the angry clamor of the Tea Partyers and the carping of the disappointed left, that Obama’s approval ratings remain relatively strong; they are higher at this point than Bill Clinton’s and Ronald Reagan’s were at the same point in their presidencies. If the focus groups are a guide, Obama has some time to prove himself to these voters. They are less enraged than unconvinced. “It’s hard to trust him,” one woman in St. Louis said, but it turned out that what she meant was not that Obama wasn’t trustworthy — it was that she was uncertain that matters would improve. “A lot of things have happened since he’s been in office, so we tend to blame him,” she said. “And things haven’t turned around very quickly, so what is going to happen next? You don’t know.” ”
    http://www.washingtonpost.com/wp-dyn/content/article/2010/09/21/AR2010092104638.html?hpid=opinionsbox1
    Bunch o’ Walmart moms/shoppers on video — mostly patient w/Obama given what he inherited, mostly disgusted with Congress….
    I think it’s kind of interesting that people can sympathize with the chief as he is one dude, but CONGRESS is a monstrosity rather than a set of individual MCs in a system they can’t quite control.
    And yet, individual MCs are really in the same position as Obama — individuals in a system they didn’t really make and they can’t quite control.
    ALSO –
    Am 1/3 or so of the way through BROKE USA — about the poverty industry in the US. REALLY REALLY good detailed view of the genesis of the subprime market, the good work some have done to extend credit, the abuses that are really hideous, the “poverty tax”, the terms of some of these mortgages and rent to own places and paycheck loans….
    Also, one very very interesting anecdote about Phil Gramm — he grew up poor, his mom got a subprime mortgage and that mortgage made a huge difference in her life. It’s a thing to remember that credit at the lower end of the econ. scale is really important — but it should not be usurious credit — and this is a structural problem. You can’t engorge a subprime credit system without usury, and the industry does seem to want to be engorged.
    I’d put in a bid for “market failure” here, and I’d suggest that we need some kind of national credit system that doesn’t try to make outsized profits to feed shareholders.
    *****
    Also, Dana Milbank nails Hoyer for all them damned post office namings!!!!!!!!!!!!
    It’s an important constituent service, to be sure, but so is DADT repeal, and a bunch of other worthies.
    Congress really is disliked!

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  2. questions says:

    And on the generic congressional ballot, Nate the Great notes that there are a bunch of caveats that make it look a little better for the dems perhaps.
    http://fivethirtyeight.blogs.nytimes.com/2010/09/21/why-the-generic-ballot-may-underestimate-democrats/#more-1261
    This falls into the “I will vote to retain my MC, but in general it would be fine if the other party won some seats” kind of thinking.
    If Obama can sustain energy between now and Nov, if a few more good legislative things happen, if a little more Tea Party-induced oddity and corruption stuff hits the headlines, I would be a very happy drug-free camper!
    And if indeed Israel finds a way to sustain the settlement stoppage (they seem to be looking for politically acceptable ways to do this — some NYT headline regarding Pollard I saw in passing), then there’s another feather in the cap.
    Obama needs some serious plumage. Hope they have a checklist in mind. Hope they can get around some of the pubs. Hope they have the timing right!
    Hope the pubs peaked too early and now their dates have gone home frustrated!

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  3. questions says:

    SORRY! DELAWARE!! Oops!

    Reply

  4. questions says:

    Useful items in no particular order, from TPM and other places:
    Coons WAY ahead of O’Donnell. The good people of New Hampshire are good people.
    Mark Kirk admits to having a high income district and so not really knowing much about unemployment.
    Housing starts are up a bit.
    Feingold is not in good shape. Time to get serious about Wisconsin. Go big cheese or whatever one says there. Kos has polling data.
    Fox has Angle 1 point up on Reid — does this mean Reid is 10 points up on Angle?
    Mickey Mouskie is running for Alaska Sen as a write-in!
    The recession did indeed end in June of ’09. Looks like Roubini’s original claim that the recovery wouldn’t feel much like a recovery is true. Bonddad (Hale Stewart) has a good piece up at Kos with lots of charts and graphs. Might also be at 538 dot NYT (ugh). But I haven’t checked.
    Dems ahead by a point in Gallup congr. poll.
    I get the feeling there is mild turnaround space, and this is without my habitual nadine-inspired drug infusion!
    And from Huff Po, the rich don’t feel rich, which of course makes sense. Income distribution is relative, there’s always someone on your map who makes more than you, and you always look upward. Of course, if you make 35 grand, someone who makes 250 grand looks pretty rich. But subtract the bigger mortgage, private school tuition, large and expensive new cars, property taxes, pension contributions, nice clothing, trips to the opera and theater (opera tix can easily run 400 a pop)… and suddenly there’s not a lot of money left. Amazing fact of life. Whatever you have, it’s not enough. You spend what you have. People make sure there’s a way to spend what there is. Can’t afford those taxes anymore…..
    Obama needs to show some sympathy across the income lines. This is hard to do, because 35k doesn’t get private schools and nice cars…and is broke. But 200k spends it all too.
    Odd fact of human psyches.

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  5. questions says:

    Some great reading from around the web:
    First on the list, knocking down the “US has drifted to the right” meme in data rich fashion:
    http://www.dailykos.com/storyonly/2010/9/19/903199/-Before-you-say-the-country-is-moving-to-the-right
    And second, the fate of internally displaced Iraqi refugees and exiled refugees. It’s not a pretty picture:
    http://www.dailykos.com/storyonly/2010/9/19/903375/-Iraqi-exiles-remain-in-dire-straits
    There will be more, especially if the site actually performs properly. It’s been a little weird today, as has my internet service….

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  6. questions says:

    Really interesting article from Washington Monthly:
    http://www.washingtonmonthly.com/features/2010/1003.lynn-longman.html
    Authors from NAF.
    Also there’s some article floating around about syringes and hospital acquisition. The issue comes up in here tangentially, but is definitely worth following up on. B and D makes a not so great syringe, another company came up with a retractable syringe that causes significantly fewer accidental needle sticks and so significantly fewer transmissions of HIV and hepatitis. B and D has the protected market share…..
    Aging, entrenched, monopolistic, non-agile industries are more interested in buying up other companies and squelching competition. The supply chain and the acquisition chain and the relations between people who know each other or who pay each other off or who take kickbacks keep the non-agility going.
    We end up with too little R and D investment. We also get “efficiency” in that we don’t have multiple companies chasing similar things, but that very efficiency seems to be paid for by a lack of imagination and creativity. Perhaps inefficiency is far more efficient than we realize.
    It’s a high price we pay for corporate freedom.

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  7. questions says:

    Murkowski must hand out pens with her name on the caps and on the barrel.
    Can these be brought into the polling booths?
    How about dry transfers? Or stickers?

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  8. Dan Kervick says:

    David, I agree with much of what you say.
    Certainly we cannot expect to find the national will and trust in 2010 that is needed to empower the US government to participate in the building of global collective security arrangements. The institutions that were built in the late 40s were built by leaders who had just won a global war, successfully concluding the most massive and complex military operation in the world’s history. Popular trust in those leaders’ capabilities and competence was surely at a very high ebb, and cannot be conjured up in the cynical and dispirited times in which we currently live.
    But the big ideas I am hoping for fall more into the realm of economics, infrastructure and environment than global security.
    And how about just some relatively middle-sized ideas? For example, we could set a national goal to increase the number of proficient American speakers of Chinese 10-fold by 2020, along with similar increases in the knowledge of other Asian langauges. It could be done.
    The US appears to be in one of those classic, “Who will tell the people” moments? Politicians across the spectrum are terrified of leveling with Americans about the new world they live in. The American people themselves seem more interested in throwing a variety of temper tantrums and repeating comfortable fables to themselves than addressing their own long-term self interest with major initiatives of any kind.
    But the tidal wave of stupid that is scouring the American landscape is not just an accident of history or a mere emotional reaction. It is the consequence of decades of educational failure, a failure that has left us with an ignorant citizenry increasingly incapable of interpreting the events that are shaping their world; increasingly incapable of thinking critically about those events; increasingly incapable of choosing intelligent and competent leaders; and increasingly incapable of governing themselves. Instead of acquiring the knowledge they need to function as a viable democratic citizenry, they gorge themselves on news for toddlers and info-porn that is easy to digest and pleasantly titillates the organs of political pleasure, but leaves them just about as stupid as they were before they consumed it.

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  9. questions says:

    Murkowski’s first ad should just be a black marker SPELLING HER NAME correctly, by hand and then filling in the bubble.
    M-U-R-K-O-W-S-K-I
    !!!!!!!!!!!!!!!!!
    Voice over — Murkowski, spell it, write it, fill it in!
    All done in animation.
    She has the name recognition already. Just not the spelling recognition.
    And she can’t use the R-word.
    Maybe she’ll caucus with the dems!!!!!!!!!!!!!
    (Murkowski — think “cow”!)
    (Murkowski — think “murk” think “ow” think “ski”)
    Can Alaskans do it?

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  10. questions says:

    Murkowski as a write in?? A big announcement is apparently coming….
    http://www.dailykos.com/story/2010/9/17/902838/-UPDATE:-AK-SEN:-Looks-like-Murkowski-is-going-for-a-write-in-campaign-after-all!
    Quick, bring a bucket of popcorn!
    And, I guess, a bag of tea!

    Reply

  11. questions says:

    Kervick writes,
    “highly likely to cause the very desirable outcome Y and much less likely to cause”
    YUP! Absolutely. And how often do we get highly likely and much less likely all in the same policy paradigm?
    When it’s clear cut, even an idiot like I can see it’s clear cut.
    Afgh. is not clear cut.
    The very specifics of health care are not clear cut even if the broad outlines are.
    Energy is not clear cut, though clearcutting is pretty unfortunate.
    Torture prosecutions are pretty damned murky too. Especially when the issue of future governance and future care is tied to deeply wicked past action that we maybe cannot actually bring to justice.
    Oh, wait, I’m getting all nuancy and jumpy-topicky and ungammatically again. Damn! I hate when that happens!

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  12. questions says:

    Kervick writes:
    “If someone argues that we should do X because it is highly likely to cause the very desirable outcome Y and much less likely to cause the undesirable outcome Z, it is worthwhile to consider criticisms of the proposal that come in the form of claims of *better* estimates of the likely outcomes of X. But it is not really worthwhile spending time wringing our hands over the blanket skeptical possibility that we are just hopelessly wrong about everything and unable to estimate consequences altogether. That global possibility is always out there, but it produces no rational considerations on one side or another.”
    Kind of depends on where in the policy process you are…..
    I’m not a decider. I don’t have a job in which it is my responsibility to say, Hey Mr. President, DO THIS NOW! If I had that job, I would probably say, Hey, dude, do this now. In a nice way.
    To the extent that anyone ever reads anything I ever type here and makes use of it (a dubious notion, admittedly), I would think that my “job” is to wring my hands. To show problems, possibilities, alternative interpretations, to bring what I know to bear on whatever issue there is, to link to fun things like Dude, you HAVE no Qu’ran — a beautiful moment we should all enjoy.
    It is perhaps your job and POA’s job to bring your very own self-certainty to bear on the important issues of the day and to say to the prez, Hey, Prez, DO THIS NOW. After all, you know so much more than I do about what happens when we craft policy, and you know precisely the right policy to advocate for. You’re just in a different part of the process from me.

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  13. questions says:

    Handwringing is exactly what policy analysis does. It’s amazing how many twists and turns really good analysis does to try to see what the impact of some proposed rule change or other might do. Increase this a bit, and we get that…. change this protocol and OH SHIT. Make these be the reporting requirements, and the industry will rebel and we’ll get less than we have now….
    All of this analysis has to be fed into a machine that includes industry interests, activists, MCs, the media….
    No, not only is it not easy to come up with brave new policy, it’s often counterproductive in some amazing ways.
    We do have choices regarding policy, by the way. We can opt for the status quo until a change is so overdetermined that it happens almost by itself. The end of DADT is likely to be an instance of this kind.
    As for my intellectual capacity to write essays rather than flighty stream of consciousness internet postings — yup! I’m am a dumbfuck! And you have probably read way way way way way way way more health care policy analysis and quantitative work than I. It’s a good thing that I don’t drive the policy debate in the universe for I have nothing to add at all save childish ramblings about disconnected stuff.
    OR, I’m typing stuff in a little box on the screen and not composing what I think of as my magnum opus. I do this on the fly in between other tasks like counting the monkeys flying out of my….wait that’s a POA style insult! Not bad Kervick!
    Oh, and to jump in childish manner to another topic (I’m just scrolling up and down between the little box I’m typing in and the bigger box where your previous post is) — the Afgh. war has proven itself to be about as muddled a mess as my brain is. Funny, that. Steve Coll thinks it’s more necessary than Steve Clemons seems to (if I heard all of this correctly.) There’s actually debate about the importance of the war, of our military presence there, of some kind of US presence there, of what we can hope, of the position of women in that society and so on. If I reflect this external debate internally, this is a problem? If I am not sure how to weigh duty which is absolute against cost which is relative, I’m suddenly intellectually impoverished? Hmmm.
    My typings here are just that, typings. I do not pretend to essayistic or literary flow in this medium. I don’t compose in Word and paste into the little box on the screen and I don’t spend hours laboring over every word. I have this other thing called my life to live. This is a place I go to to think out loud, occasionally to get some feedback, to stay humble as I make mildly public predictions that turn out badly (I was so sure about Crist, dammit!!!). It’s a place that pushes me to read in an area I don’t typically bother with. It’s amusing and frustrating by turns. I learn a little. Not a bad deal.
    And Dan, if it’s so awful for you to read my unpolished ramblings, just don’t read them as they are unpolished ramblings with generally exquisite grammar if I may say so myself. ‘cept when I use sentence fragments. Or typos.
    If my ideas are banal, then so be it. I’m sure your brilliance will shine through and ensure that at least a dull light shines upon me in reflected glory!

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  14. questions says:

    Not sure I’d limit it to “large sacrifices demand large benefits”, but interesting post nonetheless.
    Part of our problem is that we really do have an aged systemic entrenched set of agents who want huge benefits and no sacrifice at all. Somewhere between assurance problems and future discount and a thorough lack of agility on the part of existing structures, there’s a huge incentive for no one to move anywhere at all. After all, corporate profits are doing well, and even in a death spiral, it takes some time to burn through profitability and end up collapsing. Far better to take those profits now and let the next generation cope with the mess!!
    Some small practices can be instituted that do small things — handwashing in hospitals, or bar coding things to avoid medical errors of one sort or another. Many medium sized fixes like better technology or new suppliers for medical devices are harder to get through the system as innovation disrupts supplier-buyer relationships.
    And as new imaging technologies and the like don’t come with ready-made standards of good use. We don’t actually know what many test results mean in terms of mortality. But we have lots of tests!
    The biggest savings of all would be not just disease prevention but prevention without a substitution of some other disease, OR simply denial of care.
    The former isn’t going to happen. For all the disease x we manage, we’ll simply substitute a later disease y. No money savings here over the long term.
    And the latter we’re not likely to do either. We really don’t like denial of care as a social policy. Though in fact, the bulk of our previous cost savings has really been a kind of systemic denial of care, and yet costs have spiraled anyway.
    Thinking big in terms of any domain, medicine, global warming, energy policy, industrial policy, housing policy…all of this big thinking requires endless analysis of what any change will bring about, of what the actual goals are, of what offsetting behaviors will ensue, of what substitute behaviors will ensue. We might never get from here to there, or we might think we’re headed there and end up here all over again.
    Policy is funny stuff. Interventions in the way people live don’t generally go quite the way we think they should. But I’m too much of a childish non-adult not living in adultworld to appreciate the importance of ignoring this issue.

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  15. Dan Kervick says:

    “In grown up policy world, actual policy makers are actually responsible for figuring out what policy trade offs are actually worth making, what policy trade offs are even possible politically, and what we get or lose with trade offs.”
    Of course they are. You constantly reiterate these banalities as though they were important discoveries that just occurred to you, and that you must now spread to the world. Let’s remember that when several of us in the past have tried to get you to consider policy choices in terms of estimated costs and benefits, you are the one who has balked, and have suggested that the world is just too fuzzy and iffy and unfathomable and unpredictable to be amenable to such utilitarian considerations. We once had a long discussion of the Afghanistan war as a national security policy choice, and you rebelled strongly against the very idea that we should base our decisions about the war on how much it costs, on whether the expected value of the war was commensurate with those costs, and on whether there were important opportunity costs incurred by spending the resources on the war rather than something else.
    You frequently avert to the mere possibility that when we make estimates of the likelihoods and costs of various outcomes we *might* get the estimates wrong as a blanket excuse for avoiding making these estimates altogether.
    “If we’re not going to divert resources away from health care, then we’re going to have to dump huge amounts of resources into health care as we broaden access.”
    No, not necessarily. You seem unwilling to consider the possibility that our current system is grossly inefficient and wasteful, and that we might be able to get more and better and broader health care for less money. And if that is the case, the alternatives to pouring resources into the system are not exhausted by embracing shocking outcomes like letting people die. Since the claim of systemic inefficiency has been defended by health care policy researchers reflecting a very broad spectrum of political and economic orientations, I’ll leave it to you to look them up and return to the issue when you have something concrete to say about it.
    “I suppose I could turn it around and say you are too childlike in finding easy ways to carry out policy.”
    Perhaps you could point out the places where I indicated that any of the things I recommend are “easy”.
    “how you can just say, GEEZE, decisions are risky and analysis is practically worthless (or whatever you seem to be saying about analysis) strikes me as, oh, I don’t know, childish?”
    Where in the world do you find me claiming that such analysis is worthless? I would be willing to bet that I have read far more analyses of health care economics over the years than you have.
    As I said before, it is you who have been utterly resistant in the past to the arguments of people who apply analytic or quantitative techniques to policy-making. You have usually confined your criticisms of any proposals made by others to a series of lame and unconvincing “what ifs” in which “What if insurers cover the costs of their new legal requirements by raising deductibles?” exists on the same intellectual plane as “What if monkeys fly out of our butts?” or “What if our ability to anticipate the consequences of our actions is so cosmically inadequate that all policy analysis is effectively worthless and unavailing?”. You flood your mind with all sorts of paralyzing pyrrhonian possibilities, but you seem to make no intellectual distinctions among these possibilities by organizing them into different grades of probability. You now pretend to extol detailed policy analysis, but you have shown you have no interest previously in actually considering any of it. Frankly, given your general disinclination toward organizing your flighty, stream-of-consciousness, text-messagy thinking into mature and thoughtfully organized paragraphs, and your preference for staccato, emotional ejaculations expressed in incomplete sentences, I doubt you have the intellectual capacity or discipline for such analysis.
    “Modeling the real world is complex. Policy depends on modeling. Policy is complex. People engage in offsetting behavior. People undermine the best intentions of policymkers. Unintended consequences rule. Systems bite us in the butt when we intervene… This stuff is so basic to policy analysis that I can’t even begin to understand how anyone disputes it.”
    Nobody does dispute it. We all learned about these obvious problems early in life. However, we have no choice but to make decisions anyway, and to incorporate the best information we can get our hands on. You, on the other hand, never argue on the basis of any of the actual analysis you pretend to extol, but fly from the responsibility of offering concrete policy suggestions on one issue after another by begging the universal privilege of confusion and intolerable complexity.
    ” … that it’s easy to figure out what kind of vaccine to use, that once a policy maker decides something, the world will respond in exactly the right way.”
    No, it’s usually not *easy* at all. It is just *necessary* that we make decisions under conditions of uncertainty, and necessary that we therefore make some estimates of the probabilities of the many possible outcomes we can consider.
    If someone argues that we should do X because it is highly likely to cause the very desirable outcome Y and much less likely to cause the undesirable outcome Z, it is worthwhile to consider criticisms of the proposal that come in the form of claims of *better* estimates of the likely outcomes of X. But it is not really worthwhile spending time wringing our hands over the blanket skeptical possibility that we are just hopelessly wrong about everything and unable to estimate consequences altogether. That global possibility is always out there, but it produces no rational considerations on one side or another.

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  16. David Billington says:

    “In my view, several kinds of inefficiency, wasteful profiteering,
    protected rackets and restraints on effective competition are giving us
    a health care system which is failing to deliver the greatest achievable
    value at the lowest possible cost. ” (Dan Kervick)
    There are really two questions about health care here. One is whether
    the system could be more efficient in the ways that you urge. The
    other is whether American health care is sustainable even if it is
    efficient in these ways.
    “Right now, there is a deplorable failure in American political culture to
    think big and innovative ideas about the US future and position in the
    global order, and even less will to implement any such ideas.”
    I don’t think it is true that denizens of the policy world have been
    unable or unwilling to think big; otherwise we would have no debate
    right now over things like climate change, health care, financial
    regulation, industrial policy, and other major issues that have been
    neglected for many years. I wouldn’t blame the deadlock all on an
    unwillingness to implement big ideas; much of the difficulty reflects
    constitutional and procedural hurdles that protect minority views. The
    virtues of these hurdles may soon be appreciated by the other side if
    tea party conservatives set the agenda next year.
    The problem I see is that large sacrifices demand large benefits, and we
    haven’t had big ideas in which the benefits have been perceived to be
    proportional to the sacrifices or risks. Domestically, the objections to
    the stimulus do not rest on principled objections to deficit spending as
    much as on practical objections to spending so much to so little
    immediate effect.
    In the wider world we have a similar problem. We do not want an
    unlimited American interventionism, nor a retreat to full isolationism.
    But in trying to navigate between these extremes we define our choices
    within broadly familiar contours. The reservations of an increasing
    number of Americans have to do with whether the costs of staying
    within these contours are worth the benefits to those who have to pay
    for them. If this alienation becomes the view of a larger majority, the
    contours themselves will need to be rethought.
    On big ideas in foreign policy, I would argue that it has been possible
    to debate fundamental departures that do not default either to
    isolationism or unilateralism. In the late 1940s, for example, new
    peacetime ties in the North Atlantic were debated in terms of two
    competing definitions of closer union. One was outright political
    federation, an elected assembly of North Atlantic democracies having
    limited but sovereign powers over defense and trade. The other was
    the NATO military alliance that in fact came into existence in 1949,
    followed by the economic union of Europe, splitting defense and trade
    between two organizations with America belonging only to one,
    although anchoring the world economic order in other ways.
    The alternative of North Atlantic federalism has been banished from
    our memory of the late 1940s, on the grounds that it was unrealistic
    and that the path we took was the only alternative to isolationism,
    forgetting that in 1939 both postwar paths would have been wildly
    utopian. In the sixty years since 1949, we have taxed ourselves to
    provide the services of world government. Whether or not this was ever
    a realistic basis for world order, it was accepted as such, and there was
    certainly a case for some form of it during the Cold War. We are not
    going to police the world for very much longer, though, and as a result
    the multipolar tension that existed before 1945 will return in the next
    20-30 years.
    The moment for integrating Europe and North America, if it was ever
    possible, may be long past and I don’t think any larger sharing of
    sovereignty will occur worldwide unless and until there is a catastrophe
    of global proportions to prompt it. But in the aftermath of past
    disasters, America has been able to put forward big ideas. Woodrow
    Wilson’s League of Nations misfired, but NATO, the Marshall Plan, and
    Bretton Woods were successful. We may not again have the power to
    implement big ideas with so much clout but we are certainly still
    capable of thinking big. Those who can anticipate big change will have
    the best chance of helping the country get through it.

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  17. questions says:

    In grown up policy world, actual policy makers are actually responsible for figuring out what policy trade offs are actually worth making, what policy trade offs are even possible politically, and what we get or lose with trade offs.
    Sorry if it makes your head spin, or seems childish to try to calculate gains and losses with change, but that indeed is necessary.
    The point about Asclepius is that real savings in health care may actually only come through giving up on treating sick people which is not an outcome we’d necessarily welcome, but is one that Plato seems to recommend.
    If we’re not going to divert resources away from health care, then we’re going to have to dump huge amounts of resources into health care as we broaden access.
    It’s a huge system and it’s not easily given over to rationalization. So intervention in the system will either lead to way more resources’ being dumped in, or a whole bunch of what will be seen as shocking side effects of attempts at rationalization.
    And indeed, the whole idea of “rationalization” for something as broadly non-specific as medical care is problematic. There are too many sources for demands, too many places where rage at not getting certain tests or treatments will be intolerable for rationalization to take hold.
    Health care isn’t an area given over to easy truths, money-saving practices, or other changes that come in nice easy fun packages like “let’s do” or “what we need.”
    So basically, if you think I’m ridiculously non-adult in my finding complexity, I suppose I could turn it around and say you are too childlike in finding easy ways to carry out policy.
    ********
    Which reminds me of another analogy you probably won’t understand cuz it’s just too complex.
    OPV — oral polio vaccine is the sugar cube thing you might have sucked on when you were a kid. It’s a live virus vaccine. It sometimes causes polio. Indeed, I think it was the major cause of polio for a while. The vaccine caused polio.
    Then someone came up with a killed-virus vaccine. This one is an actual injection. You can’t get polio from a killed virus injection. Seems like a no-brainer to do the killed virus version. BUT, parents don’t like shots for their kids as much, so public health specialists worry that moving to the injection from the sugar cube might cause polio indirectly through lack of vaccine.
    The current practice is to give the killed virus shot for the first round and then use the sugar cube if the parents prefer after that. It’s not a perfect compromise. Giving the shots is best at this point. But you can’t always do what’s best.
    So if something as simple as a sugar cube or a shot can be so complicated and need so much study to figure out how people respond, and in the process some group of people or other will get polio because of the decisions by public health people, how you can just say, GEEZE, decisions are risky and analysis is practically worthless (or whatever you seem to be saying about analysis) strikes me as, oh, I don’t know, childish?
    Modeling the real world is complex. Policy depends on modeling. Policy is complex. People engage in offsetting behavior. People undermine the best intentions of policymkers. Unintended consequences rule. Systems bite us in the butt when we intervene.
    This stuff is so basic to policy analysis that I can’t even begin to understand how anyone disputes it. It’s not a matter of “grow the fuck up and DO SOMETHING”. It’s a matter of a basic set of analytic tools that simply have to be brought to bear on policy shifts.
    This is really 101-style thinking. But go ahead and insist that I’m just talking to myself in some sort of arcane language of paralysis, that it’s easy to figure out what kind of vaccine to use, that once a policy maker decides something, the world will respond in exactly the right way.
    And then try to explain why, say, Microsoft hasn’t given up on backwards compatibility despite the mess that Windows has become.

    Reply

  18. Dan Kervick says:

    Questions, I suppose I really should leave you to go back to talking with yourself. But I would like to mention that I didn’t endorse single payer, although I would be perfectly happy to entertain the suggestion. I endorsed public components, and suggested an approach to public policy decisions that will alter the way the private health care market functions.
    Obviously key stake-holders in an existing system will fight to preserve it. That is always true; its a fact of political life. Why do think that is particularly an important topic to bring up?
    If the kinds of changes I support were enacted, I suspect we would see overall job gain in the health care industry, not job loss. In my view, several kinds of inefficiency, wasteful profiteering, protected rackets and restraints on effective competition are giving us a health care system which is failing to deliver the greatest achievable value at the lowest possible cost. As a result, there is unmet demand for health care, and protected costly, inefficient provision is keeping less costly, higher value provision out of the market. When an industry increases productivity and efficiency in a market in which demand is effectively unlimited, the productivity gains usually produce higher employment in the same industry, not job flow out of that industry.
    Now maybe I’m wrong. If you have any concrete reasons for thinking so, or alternative approaches to reform, present them. But your usual amorphous cloud of “mights” and lecturings on sophomoric truisms don’t advance the discussion.
    I have only the slightest idea what relevance the Asclepius example has for you, but obviously any major decisions on social and economic policy require best estimates of the overall impact of those decisions. As usual, your attitude seems to be that decisions are hard and scary and complicated and risky, and their expected costs and benefits are hard to estimate because there are oodles and boodles of interconnections, and *ever* so many complicating factors and *ever* so many potential pitfalls. And so what? Maybe we should avoid making public policy decisions altogether?
    What can I say? Decisions are risky. Welcome to grown-up world.

    Reply

  19. questions says:

    Dan, you’re quite welcome for the commonplaces! Happy to oblige.
    And of course now that you’ve noted that these are commonplaces, why not add in that those who benefit from the current system will fight hard to keep the current system, so it’s not just a matter of changing voila! In fact, when you try to change incentive systems away from some current group, you find that they have a strong incentive to fight you right back.
    And if you think the dislocations of altering any very broad system are trivial or minor, think again. Job loss by one sector of the economy may help another sector, but it’s still a transfer, not an addition. That is, if you don’t quite see the point, taking my low end clerical position away from me and giving it to you doesn’t alter the social good, it only moves my job to you.
    So yes, you, or whoever, benefits, but the social good itself doesn’t improve.
    Improving the social good is a far cry from simply changing payment options, and requires something far more significant than “single payer” in my view. And what a third rail/don’t touch the American way of death is!
    Read that little thing in the Republic about Asclepius as statesman — he knows who should live and die, what kind of treatment people really desreve, and how quickly they should die. I don’t think we actually want to go there, and we certainly don’t want to talk about it.
    So for now, the mild transfers we’ve managed are about all we’re going to get, and asking for more may not give you what you want.
    ****
    As for software, of course there are huge issues. If MS changes its backwards compatibility, we all lose the ability to access all of our data via Windows-based systems. It’s a massive loss that we won’t put up with, and because we won’t put up with it, we’re stuck with this bizarre patchwork of a mess that Windows has become.
    Changing entire systems is a huge undertaking, and it’s not merely some dumbass commonplace what-a-stupid-issue-questions-brings-up-yet-again-wish-I’d-not-bothered-reading… set of problems.
    In fact, it’s a central problem in concocting public policy, and to ignore the systemic read is to encourage truly bad public policy.
    As I’ve noted before here, one of the interesting problems with, say, energy conservation through turning off lights or whatever — the money you save is more likely to be spent on some other energy-consuming activity. So lowering your electric bill doesn’t change a fucking thing unless you don’t substitute activities. You have to do less. So much for easy greening. But how many people think they’ve made a difference simply by turning out a light somewhere!?!
    The system needs to be thought through systematically.

    Reply

  20. Dan Kervick says:

    “Trying to rationalize the medical system means changing a flow of money, altering individual behavior patterns and individual thoughts and habits and a social sense of the value of life.”
    Yes, questions, obviously. Thanks for more of your “everything is hard, because everything is connected” and “change causes dislocation” commonplaces.
    Software re-design doesn’t seem like a good analogy to me. I don’t see any single layer of the health care system that corresponds to an industry-standard operating system, but instead see a large, flexible and complex network of interacting business components. If we use the power of law to force a lot more price pressure and competition for doctors, medical supplies and insurance into the system, we aren’t going to get some massive systemic backward-compatibility problem as a result. We will instead see rapid adaptation and innovation in the system as the current suppliers adjust their business models to adapt to the new rules, and as newer, more entrepreneurial suppliers rush into the market to pick up the balls dropped by old-schoolers who refuse to change.
    Some people will lose their jobs no doubt. But the competent among them will quickly land on their feet in the re-organization, and the number of jobs overall will increase as a result of productivity gains. The demand for medical care is very great and far from being met, the population is aging, and the overall amount of work to be done in a more productive and efficient system will continue to grow. So I wouldn’t worry to much about the damage from temporary dislocations.
    There might be some negative effect in the market for high-end consumer goods. But instead of paying one person a fortune that he then uses to buy pleasure boats and a third home, we can be paying the same amount to three people who will use the income to buy first homes and second cars.

    Reply

  21. questions says:

    Dan, the stuff you point to is a mark of an aging system. It’s structural, and it isn’t an easy thing to take on or it would have been done. It’s not even without consequences to take it on.
    People set up their lives and livelihoods in response to incentives even in the medical industrial complex. All that overcharging and all the lack of smart innovation and all the emphasis on baldness cures instead of on basic handwashing and labeling of tubes and use of retractable syringes (just read something about this one the other day) — all of this is part of a flow of money that a group of people count on.
    If you alter the flow of money, those who are cut off will suffer. We don’t get to go back to zero and start a whole new system that is actually rational.
    Trying to rationalize the medical system means changing a flow of money, altering individual behavior patterns and individual thoughts and habits and a social sense of the value of life.
    This kind of intervention is far harder than you seem to give credit to, and the effects of changing things at this level spiral out broadly from the epicenter.
    I think the best analogy is probably to software design. If MS were to make Windows spare, lean, fast, cheaper, easier to use, it would have to do away with backwards compatibility, alter all of our computer habits, make inaccessible huge amounts of currently owned software, put out of business many many people, alter the relationships between executive support groups and the people they support…..
    It makes sense on one level to make the leap, and on another level, not so doable a deed.
    So, yes, interventions must happen, and no, they can’t entirely.
    And it is precisely this mess that the HCR bill ran into, and we will be patching it up much as MS patches Windows and IE and the rest of its product line.

    Reply

  22. PissedOffAmerican says:

    NONE OF THIS MATTERS IF WE DON’T HAVE A VOICE.
    http://www.blackboxvoting.org/
    Thursday Sept. 16 8:04 am MEMPHIS: Shelby County Aug. 2010 election
    Full report, with photos, can be viewed and discussed here:
    http://www.bbvforums.org/forums/messages/8/81178.html
    INSPECTION TEAM FINDS 3,221 “PHANTOM VOTES” (MORE VOTES THAN VOTERS)
    Five phantom vote locations uploaded from voting machines day before election
    Cordova precinct reports 599 more votes than voters; Gemantown, Collierville, more?
    Consultants examining the Aug. 5 Shelby County election found 3,221 more votes than voters on documents provided by Shelby County elections officials pursuant to a court order.
    Most voterless votes were found in large Republican precincts, a non-random distribution.
    The inspection team sought and obtained documents in connection with a lawsuit filed by ten defeated candidates over irregularities in the election. Detailed PDF format report also available at above link.
    Four kinds of information are needed to authenticate an election:
    - Who can vote (the voter list)
    - Who did vote (the list of participating voters)
    - Were votes cast the real ones (chain of custody)
    - Was the counting accurate (public verification of the count)
    - Shelby County admitted that they installed an invalid voter list in Election Day electronic poll books, altering #1 (WHO CAN VOTE). The list said thousands of people could not vote because they had already voted, even though they had not voted.
    - Shelby County withheld the list of WHO DID VOTE (#2 ) until ordered by the court to produce it. When consultants analyzed the list of who did vote, they found names missing for 3,221 votes counted in the final certified results.
    Shelby County computer logs show uploaded invisible data from 16 polling places the day before the polls opened. The premature uploads were done out of public view, and no testing procedure or work order record matches documents the uploads of invisible votes into the central tally machine, raising questions on WHETHER VOTES COUNTED WERE THE REAL ONES (#3).
    - #4, COUNTING OF THE VOTE: Shelby County declined to provide precinct results after the election and even after they certified the results; Elections Administrator Richard Holden stated in front of a court reporter on Aug. 16 that it was not possible to produce them, a misrepresentation to the court, but the inspection team discovered copies of precinct results reports sitting on Shelby County computers. The results had been there since Aug. 6. Shelby County precinct results (“Statement of Votes Cast” or “SOVC”) do not match the list of participating voters.
    ===========
    A meeting is being held tonight, Thursday Sept. 16, for all citizens and the media to hear details on the evidence. Shelby County Voter Protection meeting: 6:00 pm at Morning Star Holiness Church – 3161 Park Ave Memphis TN 38111-3043
    ===========
    Shelby County’s certified “SOVC” results show 85,290 votes cast at polls (not early votes, or absentee votes, but Election Day polling place votes. But Shelby County’s Participating Voter List shows only 82,069 voters who cast votes at polls.
    Also, in at least five locations containing phantom votes — votes without voters — Shelby County had performed secret uploads from voting machines the day before the election.
    PRECINCT: COR09
    The heavily Republican COR09 precinct, location HOPE PRESBYTERIAN CHURCH shows just 20 people who voted at the polling place, but the certified “SOVC” results counted 619 votes. This is a discrepancy of 599 votes.
    PHOTOS: PHANTOM VOTES IN CORDOVA
    Can be viewed at link above
    The pictures above show the Shelby County Participating Voter list, with 10 absentee votes and 20 At Polls votes. Superimposed over this is a photo of Shelby County’s certified results, which show 619 At Polls votes.
    Poster logs from Shelby County — obtained only after a representative of the court appeared at Shelby County elections to order compliance, which was refused (causing the court to seal and sequester the logs “in the bosom of the court”) — when eventually released, show two voting machine uploads on August 4 from the COR09 precinct.
    continues……….

    Reply

  23. Dan Kervick says:

    We are definitely going to have to do more work on health care. Obamacare Phase One is going to help a lot with the equity, portability and care distribution issues. But at some point this country is going to have to get very serious about the roots of the cost equation. That’s an issue the Obama administration was terrified of touching in any deep way.
    A large part of the cost problem is rooted in the fact that the health care system in the US is a leaky, wasteful racket in which many systemic parasites siphon away value in the form of exorbitant profits and extravagant compensation in amounts that are far in excess of the value these individuals actually create, and in ways that are shielded from both effective market competition and effective downward public cost pressure.
    The Democratic Party better step up to offer solutions, fast. Because if the middle class gets stuck with an increased bill for the recent health reform – higher prices, higher deductibles and poorer employer health benefits – to pay for insuring the poor, the chronically sick and the old; while at the same time the rich, the doctors, the pharmaceutical kingpins, the trade-restraining professional organizations, the unnecessary middle men, the advertisers, and all of the other hucksters and blood-suckers who drive the cost of American health care through the roof are not brought to heel, then Democrats are going to end up paying a huge political cost.
    Along these lines, there are millions of brilliant young Chinese and Indian brains on the other side of the world who will happily learn the trades and skills of medicine, biomedical technology and engineering and pharmaceutical research, learn them well, and then come here to produce value equal or better than we are getting now for a fraction of the salaries and profits. As long as this country is so big on outsourcing, let’s open up the system to more strenuous competition for efficiency, and bring hungrier and less complacent folk over here to do these jobs. Either that, or we are just going to end up buying all our drugs and medical equipment abroad anyway. And people will increasingly go abroad for medical tourism to get better deals where they can be had – while those who can’t afford such travel will pay premium stay-at-home costs.
    And for Pete’s sake, let’s create some more public insurance and provider options to establish a lean low-cost baseline that private entities have to compete with to stay viable. The name of the game is efficiency: re-engineering a health care system that produces more quality at better value.
    And perhaps we should get businesses out of the business of providing health care for their employees altogether. It’s a sub-optimal system that keeps people indentured to their employers, throttles the flow of skills and opportunity in the economy, and shields the rackets from consumer decision-making and competition.
    This country can no longer afford $10 million dollar health care CEO’s and yacht-sailing, mansion-dwelling pharmaceutical and medical fat cats – not any more than we can afford the cruise-ship-in-the-sky air travel of yesteryear.

    Reply

  24. Don Bacon says:

    The problem isn’t the American people, it’s their leaders. But not to worry, the Democrats have a new logo and a new motto — “change that matters”
    DNC Chairman Tim Kaine trumpeted the party’s accomplishments during the first years of the Obama administration, including a massive economic stimulus program and the passage of landmark health care reforms.
    “We’ll be talking about that as a signature achievement for generations to come,” he said about the health care overhaul that was passed in March.
    Why wait? The Dems are talking about Obamacare now, but not as a signature achievement. Politico: “Democratic candidates are spending three times more advertising against the health reform law than they are in support of it. Since the beginning of Congress

    Reply

  25. samuelburke says:

    the american participants will probably be judged to have been in
    denial, while the asian participants were being humble in their asian
    sort of way.
    it’s enlightening to see what goes for diplomacy nowadays.

    Reply

  26. Dan Kervick says:

    I only watched about 2/3rds of the video, but I didn

    Reply

  27. questions says:

    Chris Coons is taking donations…..
    http://www.chriscoons.com/action/actioncenter
    Just figured I’d paste it in in case anyone feels inclined.
    Assuming the goal is to keep O’Donnell out of the Senate, and all….

    Reply

  28. questions says:

    Don’t know how long it will last, or if it’ll fly at all, but:
    http://blog.538refugees.com/
    This is for all the 538 commenters who don’t want to be moderated and who do want to say FUCK once in a while (or all the fuckin’ time).
    I guess if Steve ever kicks us all out, we could reassemble at our very own TWNREFUGEES.WTF or whatever!

    Reply

  29. Kathleen says:

    some reason for hope
    Obama To Nominate Elizabeth Warren To Temporary Position
    http://www.huffingtonpost.com/

    Reply

  30. questions says:

    Come to think of it,
    How about a GI bill that covers education (to prop up state universities which are pretty major hiring centers for a wide range of people from a wide range of classes) — the employees that would be hired would all get tuition benefits for family members — what a way to deal with spiraling college costs for the working class — employ huge numbers of people as campus workers to help the GIs from Iraq and Afghanistan — and provide tuition to all those dependents as well.
    State universities are often in small towns, are regional, rural, important centers of commerce and research, will keep many many people busy while the economy sputters into recovery.
    The institutions exist, it’s easy enough to convert space to classrooms and dorms, hire temp faculty as needed, and hire huge numbers of people from the communities.
    Every state has vets, every state has one or two systems, every lower tier system has campuses in smaller towns.
    Get hiring! One of the places everyone has space for doing something new in is in their brains. And branch campus state u tuition is already pretty cheap.
    *****
    There are probably other kinds of services that creative people could design that would tie together social need to already existing institutions in places where the economy lags significantly. Tie all of this to patriotic themes and you have a winner!
    Corridors of dreams to go with the DREAM Act. Innovate, excellence, buzzwords of all sorts should be flowing out of DC right about now.
    It’s a good time to be peaking.

    Reply

  31. questions says:

    No need for links….
    Yes, Elizabeth Warren.
    Yes, Christine O’Donnell.
    Yes, Rove melts down.
    Yes, the smarter pubs are nailing the rest.
    Yes, the racism will cost.
    Yes, even Chris Christie fucked up a 400 million dollar deal!
    Yes, Sharron Angle makes Harry Fuckin’ Reid look good (of course, I kinda like Reid!)
    Yes, the conservative fringe wing of the Republican party has taken over and will hurt the party’s chances in Nov.
    Inchoate and poorly directed anger, poor candidate recruitment, no actual interest in governance, fealty to tax cuts without realizing that the service cuts will debilitate those who both need the services and want the cuts…all of this comes together to make the dems look pretty good just in time for Nov.
    No early peaking, no need for political viagra to keep it up, well-timed, one or two or three more reasonable successes, some kind of extension of tax breaks for the working class, a promise to tax the billionaires, a deal or two on the international scene, a little more in-fighting on the right of the right of the right where O’Donnell and her odd notions of sexuality and biblicality collide with the way the rest of us live, and we should be fine.
    Unless, of course, the dems fuck it up.
    So Dems, don’t fuck it up.
    Find some connection issues for business people, for the non-racists out there who quietly are just decent people, for teachers (look at Fenty, you Duncan-idiots you!), for regular people who feel like they’re on the edge. Give them something that lets them feel decently respected and decently treated and adult and intelligent.
    Thanks.

    Reply

  32. Don Bacon says:

    Nearly forty percent of private sector employment is in small business. As larger corporations increase their productivity by shucking employees, through mechanization and computerization, and by outsourcing, the small business sector becomes more important.
    The days of devoting a mindless career to a paternalistic large corporation are over, and more people are recognizing it.

    Reply

  33. questions says:

    On US job creation via Ruth Marcus, confirmation of the kinds of numbers I’ve seen elsewhere over time….
    “It is taken as gospel among politicians of both parties that small business is the engine of job creation. “We’re starting with small businesses because that’s where most of the new jobs do,” President Obama said this year. “Small businesses are the job generator of America,” echoed Arizona Republican Sen. John McCain.
    They’re in good company. George W. Bush, John Kerry, Bill Clinton and Ronald Reagan have all made that claim. Only one problem: These assertions are overblown and simplistic. Take it from a reliable source — the chief economist for the Small Business Administration. “It’s not true,” Zoltan Acs told me when I asked about whether small business is, in fact, the engine of job creation. “It’s half the story.”
    Small businesses are job creators; they are also job destroyers, as firms fail. Most start-ups do: About 40 percent of jobs created by start-ups are eliminated in the first five years. Meanwhile, established small businesses — your neighborhood dry cleaners — don’t generate many new jobs.
    The chief source of small-business job creation comes from a mere handful of firms — the “gazelles,” in the evocative term of economist David Birch — that start small and prosper. The difficulty is that the gazelles among the herd can been seen only in the rearview mirror. ”
    http://www.washingtonpost.com/wp-dyn/content/article/2010/09/14/AR2010091405459.html?hpid=opinionsbox1
    **********
    It always helps to know what the problem is before we try for a solution. Sometimes problem-definition lags way behind our need to act. Then we really fuck up!
    (See Rachel Maddow on Bill Clinton as the nation’s best Republican pres in a long long time. Wrong problem-definition. Big consequences. Republican-lite.)

    Reply

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