This is the second installment of our new feature: Curbside Consult. For the uninitiated, curbside consults are a venerable medical tradition, whereby a doctor seeks informal advice from an experienced colleague in treating a patient with a complex condition. In covering or understanding complex health and social policies, we need sometimes help too. Today’s interview is with Katherine Swartz, PhD. She is Professor of Health Economics and Policy at the Harvard School of Public Health.
Standish, Michigan It's two p.m. on a workday, and the casino parking lot is completely full. Hundreds of people have come for the $20 gambling coupons offered to those willing to donate blood. Turnout for the drive was "above and beyond" expectations, says Frank Cloutier, a spokesman for the Saginaw Chippewa Indians, who run the 800-slot complex. The nurses are already turning people away two hours before closing, and they will soon run out of blood bags. "We get free money!" one woman tells me, clutching her coupon as her friends nod in agreement.
General Stanley McChrystal's request to send more troops to Afghanistan has induced sticker shock for many Americans--including, apparently, President Obama. The integrated counterinsurgency, or COIN, strategy that McChrystal wants to pursue has many components: protecting Afghan civilians, rapidly expanding the Afghan army and police, reforming government, providing economic development assistance, weaning Taliban fighters and leaders away from Mullah Omar and Osama bin Laden, reconciling them into the new government, and targeting those who refuse.
The Senate Finance Committee has been the focus of so much attention, for so long a time, that it's easy to forget another committee in the Senate passed its own version of reform several months ago. The Health, Education, Labor, and Pensions (HELP) Committee had only partial jurisdiction, of course. It couldn't touch Medicare or Medicaid and it couldn't call for new revenue. But it had the opportunity to design a coverage system, including insurance exchanges, plus it had the chance to introduce some quality incentives. So how good a job did the committee do?
The Wall Street Journal has a terrific piece today about how the recession is accelerating the fraying the post-World War II compact between workers and employers (which has, of course, been fraying for several decades now). Key nugget: Two-thirds of big companies that cut health-care benefits don't plan to restore them to pre-recession levels, they recently told consulting firm Watson Wyatt.
I have to say, I'm underwhelmed by the ideas the company is tossing around so far. Per this morning's Times piece: Goldman said Thursday that it would donate $200 million to its charitable foundation (that figure represents 6 percent of its third-quarter profit, or about six days of earnings). Rumors are swirling on Wall Street that Goldman might donate even more money to charity, perhaps as much as $1 billion, in an effort to defuse public resentment directed at the bank. Mr. Blankfein has even urged his free-spending bankers to be mindful of conspicuous consumption.
Lawrence Lessig's denunciation of runaway transparency is insightful but unduly dour about the potential consequences of the release of accurate information about public officials.
Now, two people will have to choose. The fate of the health care bill is largely in the hands of Barack Obama and Olympia Snowe. The Finance Committee's vote on Tuesday to send its bill to the Senate floor vindicated President Obama's strategy of giving Congress wide latitude to write the early drafts. Major health reform has advanced further than it ever has before. But Obama must now abandon his preference for intervening forcefully only after House and Senate bills go to a conference committee.
How can we snatch victory from the jaws of defeat in Afghanistan? There's one solution that has attracted analysts of all stripes: a "civilian surge," where development and political advisers working for (or contracted by) the State department and the U.S. Agency for International Development flood the country and turn the tide against the insurgents. The logic, at least, is sound: It takes more than military success to defeat insurgents. Insurgency grows where a corrupt and weak government does not provide security, justice, and opportunity.
My introduction to the magazine Caijing came while I was researching this recent piece about our economic relationship with China. It's probably the most influential Chinese business magazine and has become a prominent sign of the regime's tolerance of criticism on the economic front. (See my piece for more on that if you're interested.) Anyway, it sounds like we may be at a bit of a crossroads in the life of the magazine--and also the broader policy of allowing this form of government scrutiny.