I’ve been delayed this morning by debating with a commenter in a comments thread at WSJ. The commenter believes that Medicare and Medicaid should be abolished and a free market be established for healthcare in the U. S.

Whatever your political or economic views, you should understand there is no prospect whatever for that happening. It’s politically impossible for one thing. It could not get enough votes.

We have not had a free market healthcare system in the U. S. for 120 years and maybe not even then. Government at all levels is so embedded into healthcare that if federal support were withdrawn the entire system would collapse.

I recognize that such realities trigger anarcho-capitalists but that is the nature of the world in which we live.

That is not to say that our present system is beyond reform. It is in serious and substantial need of reform but the reform will need to be from within the system and gradual rather than radical. I believe it will reform because events will force it to reform. It’s like Winston Chruchill’s wisecrack: “The Americans can always be trusted to do the right thing, once all other possibilities have been exhausted.”

I got to this article at Politico by David Lim, Adam Cancryn, and Lauren Gardner fourth hand, that is I was pointed to it by an article which pointed to another article which pointed to the Politico article which is about the difficulty that Robert Califf is facing being confirmed as commissioner of the Food and Drug Administration. You’d think he’d be a shoe-in. Cardiologist, highly-published, former FDA commissioner (confirmed 89-4), we’re in the middle of a pandemic, he’s been appointed to head an agency key dealing with the pandemic. What’s the hold-up?

• It isn’t due to Republican intransigence—he actually received support from some of the Republicans in committee
• He’s stalled due to lack of support from Senate Democrats. When Bernie Sanders and Joe Manchin link arms in opposition to a nomination, there’s a problem.
• The White House isn’t doing much to promote his nomination
• He’s made millions in pharmaceutical stocks

The article caught my attention because it highlights so many of the things that are wrong with our government and our politics. Portraying this as a partisan issue is a distortion of the facts.

Dr. Califf has no actual formal credentials ever to have led the FDA other than an MD. We are a very different society than we were 50 years ago. Specializations are much narrower. There are now advanced degrees in health administration, public health administration, public policy, and on down the list.

He’s very clearly a staunch member of the public health-industrial complex or maybe I should say the public health-education-industrial complex, bopping back and forth among higher education, the federal government, and the private sector. Dr. Califf is practically a poster child for regulatory capture between outsized consulting fees from pharmaceutical companies trading in pharmaceutical company stock.

And why isn’t the White House managing his nomination? Can’t anybody here play this game?

The editors of the Washington Post urge us to start thinking seriously about the next pandemic. Here’s what they would like done:

A high priority is to build the equivalent of national early warning radar for disease. Genomic sequencing makes it feasible to rapidly identify pathogens and send up a flare, as South Africa did with the emergence of omicron. A viral and bacterial surveillance network will provide a clear picture of threats and more time to respond properly.

Next, we must invest in people. Even before the pandemic, turnover was high among state public health officials, and once the crisis set in, state and local workforces became exhausted and burned out. Dr. Walensky said the workforce needs more than just money: “We need to train it. We need to make public health an attractive workforce to enter.” Public health workers have been at the front line of bitter political debates about vaccine and mask mandates, too often subject to toxic public threats and political interference. At the same time, they must redouble efforts to earn the public’s trust with clear, transparent communications and overcome the deleterious impact of misinformation and disinformation. The CDC needs to get out of its ivory tower and play a more direct and urgent role in addressing the public.

Data is the lifeblood of public health. The CDC and states have suffered for years with antiquated systems. In an unpredictable pandemic, this is a serious liability to decision-making. Dr. Walensky promised to make upgrades a priority. “The pipes have to connect,” she said.

I wish they would connect the dots for me. I don’t see how any of those measures, whether in isolation or together, would mitigate the risk of a future pandemic. COVID-19 was completely sequenced by the Chinese no later than January 10, 2020. Since then the virus has spread from China to every country in the world and killed more than 5 million people. In the case they cite sequencing the omicron variant did exactly nothing to halt its spread.

Invest in people? We’ve been investing in people for a half century or more. I suspect that issue is more that we’re investing in the wrong people. In most states public health officials are required to be medical doctors. As has been pointed out “thinking like doctors” is part of the problem rather than the solution. My experience has been that medical doctors are peculiarly unsuited to manage groups consisting of varied professionals. They’re not trained for it and the motivations that lead to med school generally don’t include a desire or the personal skills to manage physicians let alone non-physicians. Managing professionals is generally understood to be a tricky matter and med school doesn’t prepare you for it.

And then there’s data. Government organizations are peculiarly unsuited to applying cutting edge information technology. For one thing they are almost always standards-based and standards are inherently retrospective. You only need consider the federal government’s many information technology debacles of the last dozen years to recognize that.

I don’t have any advice for dealing with the next pandemic. All I can suggest is that the editors try again.

Before we jump into Josh Rogin’s musings on Russian President Putin’s thought processes in his Washington Post column, I’d like to point out three things:

1. Russia is not the Soviet Union. It’s no liberal democracy along the lines of, say, Denmark but it’s significantly more democratic than the Soviet Union, it’s not as totalitarian as the Soviet Union was, and it is not bent on world domination as the Soviet Union was.
2. Putin’s approval rating in Russia is twice as high as President Biden’s is here.
3. For the last 150 years or more Russia’s priorities have been (in descending order of importance):
   • Russians
   • Orthodox Slavs
   • Slavs
   • Orthodox
   • Pretty much anybody else

Josh Rogin exhibits a certain amount of surprise that President Putin “doesn’t think like we do”:

In March 2011, I was in the room during a meeting between then-Vice President Joe Biden and Vladimir Putin (who was then serving as Russia’s prime minister until he returned to the presidency not long thereafter). At one point, Putin told Biden (and I’m paraphrasing from memory), “You look at us and you see our skin and then assume we think like you. But we don’t.” To emphasize his point, Putin slid his index finger down his white cheek.

He then launches into what is to my eye a completely mistaken description of foreign policy realism, concluding with:

Those deploying this model to explain Russia’s behavior today (not Putin’s because individuals don’t matter to realists) also offer several prescriptions for how to defuse the current Russia-Ukraine crisis: Freeze NATO expansion and Russia will be content. Offer face-saving concessions that give Russia tangible gains and the threat of war will subside. Don’t arm Ukraine because that will fuel escalation and trigger a Russian invasion.

If Putin thought like us, maybe some of these proposals might work. But Putin does not think like us. He has his own analytic framework, his own ideas and his own ideology — only some of which comport with Western rational realism.

Foreign policy realism merely means that other countries have interests of their own and pursue them.

Here’s his analysis of Putin:

Three tenets from Putinism are particularly important to grasp. First, Putin believes that the West unfairly dictated the terms of peace at the Cold War’s end. In Putin’s view, the West imposed liberal restructuring inside Russia, compelled Moscow to sign lopsided arms control treaties, expanded NATO with no regard for Russia’s interests, and — the greatest sin of all — divided the Slavic peoples of the Soviet Union into separate countries and then “systematically and consistently pushed Ukraine to curtail and limit economic cooperation with Russia.” (Actually, it was the leaders of the three Slavic Soviet republics who signed the agreement dissolving the U.S.S.R. in December 1991, not leaders from Washington, London, or Brussels.) Now that Russia is powerful again, Putin is prepared to risk a lot to revise this so-called American imperial order, especially in Europe. He sees this mission as his sacred destiny.

Preventing Ukraine from becoming a member of NATO is therefore only one dimension of Putin’s revisionist agenda. Even if Biden and his NATO allies wanted to offer that concession, Putin won’t be satiated. He will press on to undo the liberal international order for as long as he remains in power. Normalizing annexation, denying sovereignty to neighbors, undermining liberal ideas and democratic societies, and dissolving NATO are future goals.

Second, unlike realists, Putin does not view countries as unitary actors; he looks within countries to distinguish between dictatorships and democracies. Not without reason, Putin believes that U.S. support for democracy abroad threatens his autocratic rule. During Putin’s reign, most crises in relations with the United States have been triggered not by NATO expansion, but by democratic mobilizations — Putin calls them “color revolutions” — within countries, be it Georgia in 2003, Ukraine in 2004, the Arab Spring in 2011, Russia in 2011 and Ukraine in 2014.

On this contentious issue, there is no deal to be had between the United States and Russia as long as Putin is in power. U.S. leaders cannot command other societies to stop wanting democracy. Putin will always fear mass protests and feel threatened by democracies, especially successful ones on his border with a shared history and culture such as Ukraine.

Putin expressed a third idea of his worldview that day in March 2011 with Biden when he proclaimed that “we” think differently. He should have said “I.” All Russians do not think alike, and their ideas and values about domestic and foreign policy have changed over time. Western analysts who treat “Russia” as a unitary actor or who equate Putinism with all Russians are making a mistake. Even today it would be wrong to assume all Russians support war with Ukraine to preempt some fictitious, future threat of NATO expansion. In 2021 Levada polls, most Russians expressed positive attitudes toward the Ukrainian people, and only 17 percent of respondents support unification between the two countries.

Which model of Putin’s behavior comports better with events, Mr. Rogin’s or mine? I think mine and, sadly, for the last 25 years U. S. policy has been variously aggressive and dismissive of Russia. I think that Mr. Putin is far more of a foreign policy realist than Mr. Rogin. That Mr. Putin’s and Russia’s interests are different from ours does not diminish that realism.

There is one question I wish Mr. Rogin had addressed: why have we pushed to expand NATO in ways that did not increase the strength of the alliance but actually weakened it? I don’t believe that can be explained in realist terms.

I also found this analysis of COVID-19 testing by James Bovard at USA Today interesting:

At the start of the COVID-19 pandemic in March 2020, President Donald Trump ludicrously proclaimed that “anybody that wants a test can get a test.” That was baloney then and, unfortunately, despite a barrage of political promises in the meantime, it is still malarkey today.

So, if two presidents have both, shall we say, underperformed, where does the real blame reside?

The Centers for Disease Control and Prevention, the Food and Drug Administration and the Trump administration policymakers blocked the speedy development and deployment of private testing that could have provided Americans with far better awareness to the perils they faced. Instead, the CDC sent out poorly designed, contaminated tests to health departments that gave false readings. (Trump boasted those tests were “perfect.”)

and

The Centers for Disease Control and Prevention, the Food and Drug Administration and the Trump administration policymakers blocked the speedy development and deployment of private testing that could have provided Americans with far better awareness to the perils they faced. Instead, the CDC sent out poorly designed, contaminated tests to health departments that gave false readings. (Trump boasted those tests were “perfect.”)

and

Scott Lincicome, a Duke Law School lecturer, recently noted in Barron’s that the latest “fix” is “is actually the president’s sixth promise to subsidize and plan our way to testing abundance.” Germany permits sales of more than 60 rapid COVID-19 tests, “including several made in the United States for export only.” Germans can easily buy tests for a dollar while many Americans can’t find and purchase a test at any price.

The FDA has “never been enthusiastic about letting people test themselves,” ProPublica reports. “In the 1980s, the FDA banned home tests for HIV on the grounds that people who tested positive might do harm to themselves if they did not receive simultaneous counseling. In the 2010s, the agency cracked down on home genetic testing kits, concerned that people might make rash medical decisions as a result.”

David Kessler, who is Biden’s chief science officer for COVID-19 response, epitomized this mindset with his declaration in 1992 when he was FDA commissioner: “If members of our society were empowered to make their own decisions … then the whole rationale for the (FDA) would cease to exist.”

Unfortunately, few Americans recognize the FDA fingerprints on the COVID-19 testing debacle. Federal health agencies have had more blunders than practically anyone expected during this pandemic. The least that Uncle Sam can do is get out of the way of private efforts to help Americans recognize the risks in their own lives.

in which you will hear more than a slight echo of points I have made here repeatedly. Don’t expect the political leadership to deliver things that the federal agencies tasked with public health will not provide on a timely basis.

We need major government and, especially, civil service reform.

I think that the failure of, first, President Trump and now President Biden to reorganize and reform the CDC and FDA is a fair complaint. However, blaming the failures of these agencies on them is only fair in a “buck stops here” sense.

I thought you might be interested in this survey of coverage of the Ukraine situation by Russian state media at The Moscow Times. As may not surprise you it is considerably different from what we are hearing here. So, for example on state-run television Channel One:

“We see that our Western colleagues are, without any doubt, in a state of some warmongering frenzy,” the channel showed Russian Foreign Minister Sergei Lavrov telling State Duma lawmakers. “We have never attacked anyone, it is us who have always been attacked. And everyone who did it has always got what they deserved.”

Channel One’s coverage continued to focus on Ukraine, quoting ruling United Russia party lawmakers calling for the government to provide the separatist regions of Luhansk and Donetsk with the weapons “they need to contain Kyiv’s aggression.”

Or from TASS:

State-run TASS news agency: “Ukrainian Armed Forces Commander Will Soon Arrive in Donbas to Prepare for a Possible Ukrainian Main Offensive, Luhansk People’s Republic Claims”

Read the whole thing. It’s brief.

The editors of the Wall Street Journal lament the retirement of Justice Breyer:

Appointed by Bill Clinton in 1994, the 83-year-old Justice Breyer is the second-longest serving member of the Court after Justice Clarence Thomas. Like many liberals of his generation, he is an institutionalist who believes in the promise of the Constitution and incremental social improvement.

That has been reflected in his jurisprudence, where he has been the most pragmatic of the Court’s liberal bloc, which is now down to three Justices. He is the least hostile to business, bringing a law-and-economics view of antitrust in opinions on the First Circuit Court of Appeals and later to the High Court. While a staunch opponent of the death penalty, the Justice is also known to be sympathetic to law enforcement on due-process issues—sometimes to the “right” of originalist Justices Antonin Scalia and Neil Gorsuch on searches and Justice Breyer’s openness to opposing views will be felt in deliberations, not least by Chief Justice John Roberts. Yet on the cases that most divide the Court and the country—those touching on race, sex, religious liberty and executive power—Justice Breyer has been a reliable vote for the politically progressive interpretation of the Constitution.

concluding:

The President would be wise to pick a liberal in the mold of Justices Breyer or Elena Kagan, rather than Sonia Sotomayor, who seems more interested in fiery dissents than persuading colleagues and shaping the law. As the President’s first year has shown, chasing the sugar-high of activist praise can lead to a political slump.

with which I am in material agreement. fulfilling his campaign pledge, meeting the standard the editors suggest above, and pacifying activists all at the same time will be a chore. Further, the pool of experienced, qualified jurists who meet the necessary demographic requirements and are young enough to serve for an extended period is not large. One of those frequently mentioned is Ketanji Brown Jackson who apparently clerked for Justice Breyer. We might ask his opinion.

The news getting much of the buzz today is the announced retirement of Supreme Court Associate Justice Stephen Breyer. The retirement presents President Biden with the opportunity to appoint a new justice. Whomever he appoints is likely to exercise influence for decades—it’s an important decision for the president presuming he has at least one eye on his legacy.

During the campaign he promised to appoint a black woman. Whomever the president appoints I hope it is an experienced and qualified jurist, committed to following the law and the principles of law and providing opinions on the cases brought before him or her on that basis.

I also hope that the Senate Republicans will take this opportunity to heed Sam Clemens’s advice:

Always do right. This will gratify some people, and astonish the rest.

In this case “right” is confirming President Biden’s appointment expeditiously if the designate is qualified which I presume will be the case and is supported by Senate Democrats which I have no reason to doubt. There is some reason to believe that might actually happen, as Meridith McGrawe and Hailey Fuchs report at Politico:

Top officials at conservative judicial groups said they viewed the current landscape as less than conducive to a successful bare-knuckled confirmation fight. A Breyer retirement was long expected, Republicans do not control the Senate and, most importantly, a new justice would not shift the court’s ideological balance, let alone its majority.

“The stakes just aren’t quite as urgent — the left or the right” compared to the fight to replace the late Justice Ginsburg, said Josh Blackman, a law professor and a legal expert with the conservative Federalist Society and an adjunct scholar at the Cato Institute.

Alternatively, either President Biden or Senate Republicans or both can take this appointment as an opportunity to energize their respective bases for the upcoming midterm elections. That’s not the statesmanlike thing to do but it is consistent with recent experience. And round and round until we can’t stand it any more. I hope that’s not the case but I suspect it will be.

You may be interested in some of Ruy Teixeira’s takes on today’s Demmocratic Party from an interview of him by Blake Hounshell (formerly blogger of the lamented blog American Power) and Leah Askarinam in the New York Times. If you’re not familiar with the name Mr. Teixeira, along with John Judis, wrote the book The Emerging Democratic Majority which has been canonical among progressives for some time. I criticized it at the time—in short Mr. Teixeira has come around pretty close to my way of thinking. Some telling quotes:

Demographic change was inevitably shifting the political terrain. It did not make it inevitable that Democrats would benefit.

And even on this raw demographic basis, it’s not crazy that there’s a natural popular-vote Democratic majority in the country. However, that does not translate into political power. We very specifically said — and this is widely ignored — that for this majority to attain and exercise political power, you have to retain a significant fraction of the white working class. The country was changing, but it wasn’t changing that fast.

Damage control.

The second thing we didn’t anticipate was the eventual effect of professional-class hegemony in the Democratic Party — that it would tilt the Democrats so far to the left on sociocultural issues that it would actually make the Democratic Party significantly unattractive to working-class voters.

It’s a huge liability for the Democrats, because the people who staff the party, the people who staff the think tanks, the advocacy groups, the foundations, the staffers, they’re all singing from the same hymnal to some extent. They live in this liberal cultural bubble, particularly the younger members.

Almost two-thirds of the top 1% of income earners, mostly the “professional class”, are Democrats and 60% of the ultra-wealthy, are Democrats.

And the extent to which this is completely ignored by the dominant liberal Democratic discourse, to me, is completely astonishing. Do they really believe that the Black voters who formed the base of the Democratic Party think like Ibram X. Kendi, or the leaders of BLM? Are they crazy? I mean, how can they not understand there’s enormous sort of diversity among the worldviews of people within the Black community? They vary by class, they vary by age, they vary in all kinds of ways. And the idea that they are sort of all on board with this crusade against the superficial aspects of so-called systemic racism, that that’s really what they care about, is fanciful, really.

So, either a preponderance of the Democratic donor base are, to use Mr. Teixeira’s diction, “crazy” or something else is afoot. I’ve provided one possible explanation: vanguardism. Here’s another: think “The Walrus and the Carpenter”. It’s hard to believe they’re simply mistaken.

Here’s his prescription:

Well, it won’t be easy. You try to be productive, you try to get the Electoral Count Act and associated reforms done. You try to get some sort of Build Back Better thing through Congress with Joe Manchin’s support, or you break it up into pieces that are popular and try to get them through. These are the kinds of things you have to do to convince people you’re effective, and you can govern.

The second thing is, whatever you haven’t done to try to get the country back to normal, do it. We’re fast approaching the end of this pandemic. A Democrat should be ready to reopen the country. You’ve just got to send the message that what you want is for people to be happy and for things to be back to normal.

A third thing here that’s related to any elections: They’ve got to try to lift the ceiling on their support levels, which I think will necessitate some drawing of lines within the party, where you say, “No, no, we believe in being tough on crime. We think it is an absolutely atrocious idea to defund the police.”

He’s right. It won’t be easy. I can’t imagine the Marcusist progressives that form such a large proportion of the Democratic leadership doing any of those things.