Here’s Fareed Zakaria on Afghanistan in 2008:

Remember that the United States and its allies have close to 100,000 troops in Afghanistan now. Keeping them there is the right commitment, one that keeps in mind the stakes, but also the costs, and most important, the other vital interests around the world to which U.S. foreign policy must also be attentive.

and here he is in his Washington Post column ten years later in 2018:

And yet, the United States cannot stay in Afghanistan forever. Our presence distorts U.S. foreign policy, tying significant resources to an area of limited national interest. It also creates an inevitable dependency for the fragile Afghan government. The United States is spending $45 billion a year on security and economic aid for Afghanistan. That’s more than double Afghanistan’s entire gross domestic product .

Other than the passage of time and an additional 2,000 American dead what has changed? Are the risks or our interests less now than they were then?

The greater question: why do people whose every prescription is wrong continue to receive some of the most valuable column inches in the United States to give bad advice?

Of all of the many stories that are severely undercovered by the American press, the treatment of non-Han Chinese in China has got to be one of the worst. From Josh Rogin at the Washington Post:

If ethnic cleansing takes place in China and nobody is able to hear it, does it make a sound? That’s what millions of Muslims inside the People’s Republic are asking as they watch the Chinese government expand a network of internment camps and systematic human rights abuses designed to stamp out their peoples’ religion and culture.

Since last year, hundreds of thousands — and perhaps millions — of innocent Uighurs and other ethnic minorities in the Xinjiang region in northwest China have been unjustly arrested and imprisoned in what the Chinese government calls “political re-education camps.” Thousands have disappeared. There are credible reports of torture and death among the prisoners. The government says it is fighting “terrorism” and “religious extremism.” Uighurs say they are resisting a campaign to crush religious and cultural freedom in China. The international community has largely reacted with silence.

Horrific as they are, the camps constitute just one part of Beijing’s effort. The government has destroyed thousands of religious buildings. It has banned long beards and many Muslim names. People are forced to eat pork against their beliefs. The Chinese government’s persecution of innocents continues even after their death. Crematoria are being built to literally extinguish the Uighur funeral tradition, which insists on burials.

And it isn’t limited to the Uighurs. The Sinification of Tibet is all but ignored unless there’s an American celebrity protesting it. The Chinese authorities are not nice people.

And the disproportionate lack of coverage makes you wonder if the coverage of people using impolite words here in the U. S. is more political opportunism than it is genuine concern.

In his Wall Street Journal column about concerns over plastic waste in the ocean James Freeman declaims:

Let’s hear from a few adults. Among the remaining questions: how much of U.S. plastic consumption ends up in the ocean? How much harm does it cause? Are there ways to keep plastic products onshore that are more effective and less costly than banning them? What will it cost to replace plastic? Also, Greenpace says the problem is due in part to the fact that the affected marine species can’t always tell the difference between garbage and food. In the absence of plastic, how much harm will they suffer from eating other objects?

Fantastic media stunts don’t necessarily prove that this is an exaggerated eco-scare, but proponents of plastic bans seem to have done almost everything they can to earn our skepticism.

Can we all agree that throwing large amounts of plastic in the ocean is less than desireable? Then we might be able to agree upon cost-effective ways of dealing with the problem.

As I noted in an earlier post, one of the lessons here is that sending our trash to other countries is no solution. It just puts it out of sight, a very bad habit of ours.

Building upon the points I made in the last post, if “Medicare for All” is a good idea and wouldn’t affect either patient or provider behavior, why isn’t “Medicaid for All” an even better idea? After all Medicaid reimbursement rates are even lower than Medicare reimbursement rates.

Just a modest proposal.

The author of the much ballyhooed Mercatus Center study of the costs of “Medicare for All”, Charles Blahous, takes to the pages of the Wall Street Journal to discuss his study. He clears up an important point near the beginning:

While such large amounts of money are difficult to comprehend, my cost estimate is essentially a lower bound. Medicare for All’s actual price tag would likely be even higher. My projection generously assumes the plan would succeed in lowering prescription-drug costs and that administrative costs would somehow be less than half what they are among private insurers.

IMO that the federal government would do something it has been extremely reluctant to do heretofore, using its monopsony power to bargain for lower prices for pharmaceuticals, is unlikely in the extreme. Let’s put it another way: if the federal government were willing to do that, we might not have the problem we presently do.

How much would M4A reduce administrative costs? Why should we assume that its administrative costs would not only be lower than those of private insurance companies but lower than those for Canada’s plan? A JAMA study of some years ago found that Canada’s administrative costs were around half ours. Using the rule of thumb that everything is more expensive here (we pay more to build a foot of bridge or road than anywhere else in the world), I think that two-thirds of present costs could be achievable. That presents a problem for M4A’s advocates who count on bigger savings to defray the costs of their plan.

He then proceeds to the even greater problem:

Most important, it assumes Medicare for All would successfully cut all health-care provider payments down to Medicare’s reimbursement rates, which are more than 40% lower than private insurance rates—and even below providers’ costs of delivering services. Moreover, it assumes that Medicare for All will somehow do all this without disrupting the availability and quality of health care.

Saying that another way, proponents are either saying that everyone in the health care sector should take about a 20% pay cut or Medicare reimbursement rates should fill in the gap which would increase costs even more.

For me here’s the real sticking point:

Part of the cost increase from Medicare for All would naturally come from covering those who are currently uninsured. But the proposed legislation would also expand coverage of specific benefits such as dental, vision and hearing, and greatly increase demand for health services that are already insured, through its stipulation that “no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual for any benefits.”

The more of a person’s health care is paid by insurance rather than out of pocket, the more health-care services he tends to buy, regardless of quality and effectiveness. Providing first-dollar coverage for a range of health-care services would therefore be a powerful force driving additional health-care spending. Although Medicare for All proponents believe the administrative efficiencies of single-payer insurance would reduce national health-care costs, my research found the opposite—specifically, that the added costs associated with increased coverage far surpass not only the savings attainable from lower administrative costs, but also the savings potentially gained from swapping brand name drugs for generics.

Some have seized on a scenario in my estimates showing a slight decline in projected total public and private health expenditures under Medicare for All. But that decline, relative to current projections, relies on an assumption that Medicare for All would immediately and dramatically cut provider payment rates by roughly 40%. Without such cuts, Medicare for All would drive national health costs further upward, and the federal price tag would be $38 trillion during its first 10 years.

To the best of my knowledge no other plan in the world other than British National Health imposes such a stipulation. In France cost-sharing is about 10%, in Germany 16% (higher than here), and in Switzerland, the country with per capita health care spending closest to our own, about 30%. In other words we would be breaking completely new ground. Throw any assumptions based on the experience with social insurance in other countries out the window. It should also be noted that the costs of a bureaucracy do not scale linearly but more closely to n log n.

I knew you could. At the Washington Post Lawrence Downes complains that an upstart mainland company thinks that the word “aloha” belongs to them:

The Hawaiian dictionary defines “aloha” as “love, affection, compassion, mercy, sympathy, pity, kindness, sentiment, grace, charity.” It is a synonym for “sweetheart” or “loved one,” “hello,” “farewell” and “beloved, loving, kind, compassionate, charitable, lovable.” It is also a verb meaning “to love” or “to show kindness, mercy, pity, charity, affection.”

The word means a lot to those of us with Hawaiian roots. So we were upset to hear that a fast-food chain in Chicago called Aloha Poke Co. has been sending letters ordering companies in Hawaii and elsewhere to stop using “aloha” in their names. Aloha Poke sells food in bowls meant to resemble poke, a Hawaiian dish made of raw fish and seaweed and other seasonings. Nobody in Hawaii told these guys they couldn’t do this to our beloved poke, even though they are making it wrong, or that they couldn’t make commercial use of our greatest word.

The word is free, of course, and is used by us in a spirit that is open and welcoming to those who want to share. The reaction in Hawaii to the cease-and-desist “aloha” letters has been anger and disbelief. But the trouble, the pilikia, is for real. A native-Hawaiian poke-shop owner in Alaska told The Washington Post that after getting the letter she abandoned the name “Aloha Poke Stop” and spent thousands of dollars removing “aloha” from her company’s signs and T-shirts and other materials.

Any claim by Aloha Poke is so obviously a frivolous one I don’t know how anyone could make it with a straight face but it highlights a problem with our legal system. Lawyers send out these “cease and desist” letters in the hope that their targets will back down without fighting back.

In this case it’s just adding fuel to the fire. Some Hawaiians are upset about the Chicago-based company and are suing them. Aloha Poke might have bit off more than they can chew. Next stop: cease and desist letters to the German city of Hamburg.

Disclosure: Aloha Poke has a location two blocks from where I work. Whether it’s actually poke or not, it makes a good lunch for me.

The editors of the Washington Post have come out against the idea of indexing the capital gains tax that has been floated:

We don’t necessarily object, in principle, to indexing capital gains to inflation. During a period of high and persistent inflation, it might be both unfair to investors and bad for the economy to tax, say, stock profits, as if the dollars you sold the stock for were worth the same as the dollars you bought it with. (Ordinary income-tax brackets, after all, are indexed to inflation so as to protect wage earners.) This was a problem in the 1970s when inflation was in the double digits and the maximum rate on long-term capital gains was nearly 40 percent.

Today, though, inflation has been running at 2 percent or below for about a decade, and the maximum capital-gains rate is 23.8 percent. The unfairness to investors, and the distortion to the economy, from failing to levy the tax on only the inflation-adjusted value of the gain are relatively small. Compared with the government’s need for revenue, they are truly trivial. In other words, it may be that current law permits the government to collect a bit more from the wealthy than it could under ideal inflation-proofed conditions — and that’s just fine.

The editors, the Trump Administration, and, I guess, leaders in Washington more generally are treating two distinct problems as though they were one.

The first problem is that the demands for spending are growing very rapidly. The second is that the economy isn’t growing as rapidly as the demands for spending.

The Trump Administration’s and the Republicans’ solution to the second problem is to cut taxes. They believe they can incentivize economic growth to a point at which it exceeds the demands for spending.

The editors’ of the WP and the Democrats’ solution to the first problem is to raise taxes. They apparently believe that our only problem is not enough revenue.

I don’t believe that we can grow out of this problem. We must grow and control spending. Controlling spending means controlling health care costs. Controlling health care costs means reducing consumption and reducing health care sector incomes.

If solving these problems were easy, we’d already have done it.

Yesterday in comments I said my piece about the Democratic Party. Now in fairness I’ll give my assessment of the Republican Party.

The Republican Party is a mess. It can win elections at the local, state, and national level but it has a grave problem with governing, particularly at the national level, because the contradictions in governing well while opposing big government are just too great. Republican governors fare better but not in places where they face concerted, steadfast, and well-funded opposition as is the case in Illinois. The situation in Wisconsin will provide a test case.

Power in the party is divided among three groups: social conservatives, what I would call “Chamber of Commerce Republicans”, i.e. the charred remnants of what used to be the Republican Establishment, and Ayn Rand fans/Tea Party/anarcho-conservatives. Most officeholders don’t represent those factions in a pure form and the precise mixtures varies by region. The only thing they can agree on is that taxes are too high so they always vote for tax cuts.

The party’s problems were never so evident as in the recent campaign for the party’s nomination for president. Trump vanquished the representatives of each of the party’s factions seriatim, simultaneously demonstrating his strength, their weakness, and the fecklessness of the party organization in responding to the challenge he posed.

Trump is a one-man party. He is one of a kind, sui generis. He will build no organization and leave no successors.

I just love these free flights of fancy. In his latest column New York Times column David Brooks longs for a presidential candidate to come along and save us from the two major political parties:

To have a chance, the third-party candidate would have to emerge as the most radical person in the race. That person would have to argue that the Republicans and Democrats are just two sides of a Washington-centric power structure that has ground to a halt. That person would have to promise to radically redistribute power across American society.

As Mike Hais, Doug Ross and Morley Winograd argue in their book, “Healing American Democracy,” the current Washington-centric power structure emerged during the New Deal. In those days and for decades after, the country was pretty homogeneous, trust in big institutions was high and the federal government worked more effectively than state and local governments to build a safety net and break up local economic oligarchies.

But today, the country is diverse, trust in big institutions is low, the federal government is immobilized by partisanship and debt. Now, state and local governments are more effective across many overlapping domains.

The only problem with his proposal is everything in his proposal. Donald Trump, the more radical of the two candidates, is the closest we’ll get to a third party presidential candidate. He ran as a Republican but is closer to being a party of one. Third party candidates have no chance at all in a presidential election. The last time a third party candidate won even a single state was George Wallace in 1968. The last time a third party secured a substantial number of electoral votes was more than a century ago and that third party was the Republican Party (the Progressive candidate received more electoral votes). Americans won’t even vote for Congressional candidates who’ll bring the power back from Washington.