I have become increasingly convinced that the future of health care delivery will probably be formed outside the United States. Too many people are making too much money here for anything to change. We will increasingly spend everything on pensions and health care until the Gods of the Copybook Headings catch up with us.

At Salon Conor Lynch has just noticed to his dismay that liberal interventionists have more in common with neoconservatives than they do with any other Americans:

Indeed, though he has divided the country, President Trump has been a great unifier of neoliberal Democrats and neoconservative Republicans, who have come to see Russian plots against America at every turn. Neocons like Max Boot, David Frum, Bret Stephens and Bill Kristol are among the top Republican hawks who have become liberal darlings in the Trump era. Frum, the former George W. Bush speechwriter and coiner of the infamous phrase “axis of evil,” has become many liberals’ favorite neocon pundit on social media, while Stephens — a prominent climate-change denier — was hired earlier this year as a full-time columnist for the ostensibly liberal New York Times editorial page (not surprisingly, the Times was forced to issue a correction for his debut column defending climate-change skepticism).

At the center of this alliance is not just a mutual antipathy for President Trump but a hostility towards Russia that recalls the paranoid years of the Cold War. Last week this hawkish alliance was made official when a new “bipartisan” group called Alliance for Securing Democracy was formed. This new advocacy group will be led by Laura Rosenberger, a former State Department official in the Obama administration, and Jamie Fly, a former national security adviser to Sen. Marco Rubio. Top Obama-era officials and Bush-era neocons will sit on the board of directors, including Clinton adviser Jake Sullivan, former ambassador to Russia Mike McFaul, Bush-era Homeland Security Secretary Mike Chertoff and none other than Bill Kristol, America’s leading chicken-hawk (who is known best for how wrong he has been in nearly all of his predictions).

Glenn Greenwald summed up this new Trump era alliance in a recent article on The Intercept, noting that “on the key foreign policy controversies, there is now little to no daylight between leading Democratic Party foreign policy gurus and the Bush-era neocons who had wallowed in disgrace following the debacle of Iraq and the broader abuses of the war on terror.”

The Democratic establishment’s apparent shift to the right on foreign policy, along with its newly formed alliance with Republican hawks, is part of an overall trend that reveals how out of touch the party elite have become with the base. Indeed, while leading Democrats have adopted a Cold Warrior mentality, the party’s base has actually shifted further to the left.

Even though I disagree with it I’m not going to quibble about his diction. The foundation of neoconservatism is in opportunistic Democrats who moved to the Republican Party as the Republican Party gained influence. Since then it has picked up some conservatives and Republican moderates.

If there’s one thing we should have learned over the period of the last 25 years, it is that liberal democratic societies cannot be created at the point of a gun. If we’ve learned two things, the second should be that not everyone wants a liberal democratic society.

Liberal interventionists and neoconservatives have a shared quality: they refuse to learn those two painfully obvious facts.

Harvard prof Jason Furman presents his strategy for patching the Affordable Care Act in his op-ed in the Wall Street Journal:

The administration should ensure that insurance companies continue to be reimbursed for the cost-sharing subsidies they provide for households with incomes up to 250% of the federal poverty line, which is about $60,000 for a family of four. The president should also order his subordinates to continue enforcing the individual mandate and to avoid making large, abrupt changes to the marketplaces.

The “do no harm” principle extends beyond the individual market, where about 1 in 6 Americans get their health care, according to the Census Bureau. To cut cost growth and improve quality, the administration will have to use other tools—many of them bipartisan—that have been created by Congress in recent years. These include delivery-system reforms in Medicare, which shift to payment models that reimburse providers based on outcomes and quality rather than inputs and quantity. A Republican Congress under the leadership of Speaker John Boehner already expanded these reforms after they were originally passed as part of the Affordable Care Act. The “Cadillac tax,” which encourages insurance companies not to offer overly expensive care, should also stay. Neither of these policies requires congressional action. The administration simply has to implement the law as written.

I noticed that he did not mention the increase in the number of counties served by no carrier on the health care exchanges in his op-ed. I will take it on Dr. Furman’s authority that no “death spiral” is taking place. Nonetheless the number of counties served by no carriers or a single carrier is rising, as are premiums and deductibles. Clearly, something is happening.

The editors of the Wall Street Journal are more candid yet about their objectives in Syria:

Does the Trump Administration have a policy in Syria worth the name? If so it isn’t obvious, and its recent decisions suggest that the White House may be willing to accommodate the Russian and Iranian goal of propping up Bashar Assad for the long term.

Last week the Administration disclosed that it has stopped assisting the anti-Assad Sunni Arab fighters whom the CIA has trained, equipped and funded since 2013. U.S. Special Operations Command chief Gen. Raymond Thomas told the Aspen Security Forum Friday that the decision to pull the plug was “based on an assessment of the nature of the program and what we are trying to accomplish and the viability of it going forward.”

That might make sense if anyone knew what the U.S. is trying to accomplish beyond ousting Islamic State from Raqqa in northern Syria. In that fight the Pentagon has resisted Russia and Iran by arming the Kurdish Syrian Democratic Forces and shooting down the Syria aircraft threatening them. Mr. Trump also launched cruise missiles to punish Mr. Assad after the strongman used chemical weapons.

The muddle is what the U.S. wants in Syria after the looming defeat of Islamic State. On that score the Trump Administration seems to want to find some agreement with Russia to stabilize Syria even if that means entrenching Mr. Assad and the Russian and Iranian military presence.

The president does not have the authority to remove the Assad regime as its primary objective in Syria. That is true under President Trump and it was true under President Obama. It is well beyond the enormous scope of the ill-considered Authorization to Use Military Force. It is in direct contradiction to treaties to which the U. S. is signatory. It does not fall under the rubric of exigent circumstances.

If President Obama wanted to pursue that objective, he should have sought approval from the Congress for it. No president, Republican or Democrat, is a despot with unlimited power, even in the sphere in which the president has the most power, the role of commander-in-chief.

The theme here today at The Glittering Eye seems to be our contradictory objectives. In his column at the Washington Post Robert Samuelson correctly points out how contradictory, even perverse, our goals with respect to health care are:

At a gut level, we know why health care defies logical discussion. We personalize it. We assume that what’s good for us as individuals is also good for society. Unfortunately, this is not always true. What we want as individuals (unlimited care) may not be good for the larger society (overspending on health care).\

Our goals are mutually inconsistent. We think that everyone should be covered by insurance for needed care; health care is a right. Doctors and patients should make medical choices, not meddlesome insurance companies or government bureaucrats; they might deny coverage as unneeded or unproven. Finally, soaring health spending should not squeeze wages or divert spending from important government programs.

The trouble is that, in practice, we can’t meet all these worthy goals. If everyone is covered for everything, spending will skyrocket. Controlling costs inevitably requires someone to say no. The inconsistencies are obvious and would exist even if we had a single-payer system.

Here’s the bottom line:

We are left with a system in which medical costs are highly concentrated with the sickest patients. (The top 5 percent account for half of all medical spending.) This creates a massive resource transfer, through insurance and taxes, from the young and middle-aged to the elderly. (Half of all health spending goes to those 55 and over, who represent just over one-quarter of the population).

And yet, we govern this massive health-care sector — representing roughly a third of federal spending and nearly a fifth of the entire economy — only haphazardly, because it responds to a baffling mixture of moral, economic and political imperatives. It will certainly strike future historians as curious that we tied our national fate to spending that is backward-looking, caring for people in their declining years, instead of spending that prepares us for the future.

That is emphatically not the case in the UK, France, or Germany. As I have previously documented here intergenerational health care spending is much more equal elsewhere than here. It’s almost as though the presence of the Medicare subsidy encourages more care than would otherwise be the case.

Here are Mr. Samuelson’s prescriptions:

We need a better allocation of burdens: higher eligibility ages for Social Security and Medicare; lower subsidies for affluent recipients; tougher restrictions on spending. But this future is impossible without a shift in public opinion that legitimizes imposing limits on health spending.

My preferred course would be slightly different. I would change the incentives that lead inexorably to more treatment. The expectations in the health care sector need to change.

Here’s another op-ed with a single, crucial paragraph. In Josh Rogin’s Washington Post op-ed on U. S. policy with respect to Syria, here’s the paragraph:

Last week at the Aspen Security Forum, CIA Director Mike Pompeo laid out what he sees as U.S. interests in Syria. He said the United States has two principal enemies there, the Islamic State and Iran. In addition to stopping Iran from establishing a zone of control that spans the region, the U.S. goal is “providing the conditions to have a more stable Middle East to keep America safe.”

I guess it’s to be expected that a spy chief be less than candid. If those are the U. S. interests they could have been accomplished long ago if the U. S. had assisted the Assad regime rather than arming its adversaries. It seems to me that some goals are missing from that list.

Mr. Pompeo followed that up with this remarkable statement:

“We don’t have the same set of interests” in Syria as Russia, said Pompeo. What are the Russian goals in Syria? “They love a warm-water naval port and they love to stick it to America.”

There seems to be quite a bit missing from that statement as well. It’s all very puzzling. Isn’t it the case that if the U. S. hadn’t armed, trained, and supported Syrian rebels including Al Qaeda in Syria, the Syrian government wouldn’t have needed to summon outside help from Iran and Russia? Didn’t some of the arms we provided fall into DAESH’s hands?

Update

Michael G. Vickers is more candid in his Washington Post op-ed:

Acquiescing to Assad remaining in power, and ending support for the Syrian moderate opposition, would strengthen our adversaries, further convince allies that the Trump administration places Russian interests above our own, enable Iran to consolidate strategic gains, increase the global jihadist threat to the United States — and make a stable Middle East that much harder to achieve.

Abandoning the goal of removing Assad from power will place the United States on the side of not only the barbaric Syrian regime, which has American blood on its hands dating to the early 1980s, but also Iran, Hezbollah and Russia. This is strategic folly.

I believe he has stated the sequence of events incorrectly and, consequently, got his causality reversed. The “Syrian moderate opposition” exists only in the imaginations of people inside the Beltway. The choices have always been between tolerating the truly reprehensible Assad regime and radical Islamist terrorism. We’re on the wrong side.

To my eye the most vital paragraph in Laurel Miller’s New York Times op-ed on negotiating peace in Afghanistan is this one:

The Taliban is violently opposed to the United States military presence on Afghan soil but does not have aspirations beyond Afghanistan. A peace deal could allow the United States to focus its resources on threats from the region that are directed toward the homeland and core American interests.

I can’t help but wonder when Ms. Miller reached that conclusion. From 2013 to 2017 she served the Obama Administration and then the Trump Administration as special envoy for Afghanistan and Pakistan. Did she inform her superiors of that? Did she reach that conclusion only recently?

Hasn’t that always been the case? Didn’t the U. S. invade Afghanistan in the first place because although they had no aspirations of their own beyond Afghanistan, they played host to Al Qaeda which did? Isn’t it reasonable to believe that having expelled the foreign invaders from their borders, as they would undoubtedly see it, they would be willing to host Al Qaeda or DAESH again?

That has always been the problem with the war in Afghanistan. We can’t stay and we can’t leave.

I’ve mentioned before that I had a lot of my dad’s old slides digitized early last year. None of the pictures was indexed and they weren’t organized in any way—chronologically, by subject, nothing. Figuring out what some of them were or when they were taken has taken a certain amount of detective work.

Take the picture I’ve reproduced above, for example. I believe it to be a picture of Wright’s Tavern in Plymouth, Massachusetts, an 18th century tavern where the Concord Minutemen met prior to the Battle of Lexington and Concord in 1775.

But I’m not sure.

If it is Wright’s Tavern, it was probably taken around 70 years ago, when my parents were on their honeymoon or on the New England trip my dad took before my parents were married.

If anyone reading this post can substantiate my guess or can propose an alternative, I’d appreciate it.

Asking the important questions. Here’s an article by Joanne M. Pierce at The Conversation that explains why the Roman Catholic Church bans gluten-free Communion wafers. Kidding aside, it’s estimated that as much as 1% of the population is affected by celiac disease, genuine gluten intolerance. I understand the history behind it but by maintaining its position the Church is cutting some Catholics out of a vital part of being a Catholic.

Most Protestant denominations do not share this prohibition nor do Orthodox churches and their orders are just as valid as ours. To the best of my knowledge it isn’t an issue of dogma but of doctrine and discipline. It’s something that could change.