Intervention in Libya, Intervention in Congo

A lot of people have questioned why we intervene in Libya and not in places like the Congo, where civil war has resulted in the deaths of millions of people. The answer is that the nature of the threat to civilians in general is completely different. A useful analogy: if you have a gun, you can use it to protect your child from a wolf, but not from disease-carrying mosquitoes.

What is happening in the Congo and in many other failed states is a tragedy, but its very difficult for outsiders to stop the sort of low-tech civil war that goes on in places like that. The only real way to do it is to send massive numbers of US ground troops to impose order, and even then its very difficult and politically risky. There are situations in which it should be done anyway (Rwanda) but its easy to see that building up the political momentum for that kind of a mission might take longer than the conflict lasts.

By contrast, it is very easy for the US to stop civilian deaths if we can focus our efforts on a few targets, IE high-tech military forces like tanks and airplanes. Our military is built to deal with such threats. We can get there really quickly, because we have carriers all over the world. It is also far easier to secure political backing for such sorts of missions, since the risks are far lower.

Anyway, I do think that this effort has a reasonable shot at working. If you break the back of Qaddafi's military forces, and get a stalemate, then its just a war of attrition. If we are serious about getting him out, at that point we just impose an embargo on his oil exports and starve him out. Once his cronies realize the money well has dried up they will turn on him.

It is nice to dream of a world where our interventions are purely based on the gravity of the situation in the affected nation, but the reality is we have to pick our battles. We simply don't have the ground forces or the money to occupy every troubled spot in the world. But we do have an military that is really, really good at blowing up enemy tanks and airplanes. So if those are the weapons that a dictator chooses to use to kill his civilians, why not neutralize them?

In Libya, we send a message to the militaries of autocracies.

The debate over Obama's actions in Libya have been hopelessly muddled by what happened in two other recent situations: what George W. Bush did in Iraq, and what Bill Clinton let happen in Rwanda. We must remember that there is a middle ground between "send 150,000 troops to occupy and nation build" and "let millions of people get massacred while the world watches". While Obama attempts to find that middle ground, critics are hysterical on both sides with claims that he is doing too much ("just like George Bush!") or not enough.

The truth is, our intervention in Libya is likely to be inconsequential more than anything. Our help may come too late to save the rebels. Even if they do hold out, they may not be able to finish the drive to the capitol to remove Qaddafi. Thats OK though, because the consequences of our intervention are similarly modest. We have a UN resolution and support from the Arab league. We aren't sending ground troops. Meanwhile, the Libyan military poses zero threat to us or our allies around the world. At best, we allow a revolution to drive out a dictator; at worst, our actions won't change anything.

There is another very good reason to intervene that I don't see many people talking about. This is an extremely important time in world history, with more revolutions in the Middle East almost certain to come. Our actions in Libya are very important, as they provide a very stark contrast for other militaries to consider. When a dictator in the future orders his military to attack civilians, what should the military do? They can take the example of the Egyptian military, and ignore their dictator's orders to shoot, thereby winning the adoration of their people, the support of the world, and the favors of America. Alternatively, they can follow the example of Libyan military, which followed Qaddafi's evil orders and ended up a smoldering, flaming wreckage as a consequence.

The threat of force won't deter everyone. For geopolitical reasons, we can't intervene in Iran, Syria, Bahrain, or some other potential hot spots. Still, this season of revolution is certain to be unpredictable. The single most important factor for the success of peaceful revolution is whether or not the military attacks the people. The last thing we want to do is send a message that it is OK for an air force or military to start attacking civilians. We would almost be inviting massacres. Even though it would be nice if some other country could deal with things for once, Obama is doing the right thing.

Congestion Pricing

We all know from experience that the severity of a 'traffic jam' is not linearly proportional to the number of cars. Instead, a traffic jam almost seems to be a product of a threshold effect. A given highway can handle any number of cars smoothly up to a certain point. Once that point is reached, additional cars rapidly cause the buildup of a traffic jam. Obviously this does not apply to jams caused by accidents or breakdowns, but most traffic jams aren't caused by those things. Most jams are caused by too many vehicles on too small of an artery.

The implication is that if we were to institute congestion pricing and reduce the overall number of cars by 20%, we may not be reducing the severity of the traffic jam by only 20%. The extra cars that don't show up because of congestion pricing may have been what pushed the highway over the traffic threshold had they been present. By getting rid of that extra 20% of the cars, we could potentially get rid of the majority of the traffic slowdown. This is sound policy on so many levels. Liberals and conservatives should all agree on this, but we don't have this policy yet. Too bad.

Moving Beyond the Automobile: Congestion Pricing from Streetfilms on Vimeo.

First Teachers, then Physicians?

If you view our governmental system as nothing more than a long protracted partisan war, I think the actions of Republicans make a lot of sense. Budgets need to be balanced, so why not make your political enemies foot the bill while letting allies off the hook? Teachers traditionally vote Democratic and their unions are a huge boon to Dem politics, so the GOP has come after them. I worry about this sort of 'trade warfare' as an American and as a future physician. I could be wrong, but my suspicion is that physicians as a group generally vote Republican. What if some hypothetical future extreme Democratic Party comes to power, looks at explosive health costs and deficits, notices that physicians support Republicans, and decide to punish us for it? They could simply block the medicare doc fix, or worse.

I resent the idea that one group should be faced with a disproportionate share of a social burden because they are on the losing side of politics. It is not unreasonable to expect sacrifice from public employees - and it looks like they were prepared to sacrifice in Wisconsin. At the same time, is gutting education spending the best way to secure our nation's long term prosperity? (If it was up to me, we'd cut teacher unions and tenure, but expand benefits and pay such as to make teaching jobs more competitive). There are more millionaires in New Jersey than teachers. There are other forms of public spending, including inefficient subsidies to various industries. There are of course costly entitlements, and the military. These dwarf our education spending in scale.

If Republicans are serious about improving our deficit situation, they need to do more than pay lip service to the notion of shared sacrifice. Focused partisan assaults on a few groups will never be accepted as fair. Any gains will be only temporary, and will simply be undone in the next electoral cycle. To make sustainable changes, changes that are accepted as fair by both political parties and thus not likely to be reversed, Republicans will need to cut government spending in all areas. They may have to injure some political allies in the process. That is the nature of compromise. Without mature leaders who were willing to compromise, our nation wouldn't exist; without them going forward, our nation won't exist.

Holding Our Leaders to a High Standard

Say what you want about the left, but they hold their leaders to standards that the right can only dream of. What is happening to Bradley Manning pales in comparison to what Bush was authorizing on a regular basis to be done to hundreds of captives we had in Iraq, Afghanistan, and Guantanamo.

And yet, the outrage on the left against Obama is orders of magnitude greater than anything we saw from Republicans against their president. Republicans during the Bush era made apologizing and rationalizing their leader's blunders and excesses into an Olympic sport.

This is something conservatives should learn from the left. The next time your "small government" leaders try to expand entitlements, subsidize business with government money, or go on reckless foreign policy adventures, revolt against them!

This advice might be especially prescient given the situation in the Middle East and the fact that every GOP candidate for president apparently thinks we should have intervened militarily in Libya and Iran to help anti-government forces. Have none of them learned anything over the last decade?

Republicans should repeal Medicare Part D

Republicans are obsessed with repealing costly health care bills. Why not start with Medicare Part D? This massive unfunded entitlement expansion was passed by the Bush Administration just before the 2004 elections to buy-off the senior vote. Why not repeal it today?

Something George W. Bush got right

He did a good job, in the aftermath of 9/11, in reminding us that Muslim-Americans are good people and should not be confused with the extremists who attacked us. Its a shame that his supporters seem to have forgotten that.



Imagine that protest was at a synagogue, and its target was Jews. It would be a window into Germany circa 1933.

A republic, if we can keep it.

It was really only a matter of when this sort of thing would happen rather than if, but Fox News was caught lying about the protests in Wisconsin. In this video, which Fox attributes to the pro-union protests in Madison, we see some violent protesters. Also notice there are palm trees in the background: there is no way this footage was from winter in Wisconsin.

Fox News makes "mistakes" like this all of the time. They may accidentally use the wrong footage to make a Tea Party protest look larger than it is, or they may misquote people, or take things out of context. And this is just when they are reporting, don't even get me started about when their pundits come on and start talking. It is hard to believe Fox is just innocently erring when these mistakes happen, because the change always happens to benefit a right-wing narrative. At any rate, the purpose of this post wasn't to point out a lie that Fox News is trying to sell. Thats old news.

An interesting fact that came up when I was reading about this latest lie was that Fox was recently denied access to Canadian television. Canada has a law in place that prohibits misleading or false information from being propagated from television news stations. A lot of people apparently wish we had a similar sort of law here in the states, but I don't. The most indispensable legal right we have in America is the 1st Amendment. That includes the freedom to lie, if that is the agenda of a person or organization. I want no affronts to the freedom of speech, and furthermore I would not want the government to spend effort deciding what is true and what is not (if that was even possible).

Ben Franklin told us after the constitutional convention that we have been given a Republic, if we can keep it. I am confident that when it comes to lies and propaganda, Americans as a group will see through it and will ultimately marginalize the source. I have written before: Fox News undermines conservatism. The phony debates they have on their network cheapens our discourse. The influence conservatives grant to Fox means that they, not we, decide who our party leaders are. Every time the network lies and gets caught, they hand a recruiting tool to the left.

The onus is on conservatives to demand better from Fox News.

(Another) Oil Bubble

Oil prices have been rising lately, probably caused by a multitude of factors. As the economic recovery quickens, demand will increase and so price along with it. Adding to the increases are all of the revolutions going on in the Middle East. Concerns are abound about Iran and Saudi Arabia in particular.

An important point that is often lost on people is that oil producers like Iran are in sort of a catch-22. In the event of an actual geopolitical crisis (a war, for example) with a subsequent disruption of oil supplies, the price of oil would indeed skyrocket. But if Iran isn't selling their oil, they don't benefit from that increased price. Thus it is in Iran's interest to increase tensions and concern of a geopolitical crisis without precipitating one. That way, the price of oil goes up and Iran makes a juicy premium on what it would have exported anyway.

Then you think about what would happen if there was actually a disruption: say a conflict in the Strait of Hormouz or a revolution in Saudi Arabia. The price of oil would skyrocket, possibly to close to 200 dollars a barrel. Consider though that both of those nations are heavily dependent on oil to keep their countries running. In the event of a disruption and subsequent price spike, that nation has a huge economic incentive to get their oil back to market ASAP to take advantage of the high prices. I don't care who takes over Saudi Arabia: you factor in the number of barrels they can export every day times a 200 dollar per barrel price, and its obvious that any disruption will be short lived.

Finally, I think its pretty clear that the demand for oil is pretty plastic. Americans waste a ton of fuel. Dressing warmer in the winter and heating homes less could save a lot. Carpooling, taking a bus, or riding a bike would save more. These are all things that we don't do now because gas is only 3 dollars a gallon; they are things we will do if gas hits 5-6 dollars a gallon. Adding to the flexibility of demand for oil is the fact that there *are* substitutes. Natural gas, nuclear power, and coal for example (the latter two could power cars via batteries).

Commodity speculators were almost certainly behind the spike of oil to 140 dollars per barrel that we saw a couple of years ago. A price at that level was not economically sustainable. With all of the aforementioned variables causing uncertainty in the oil market, the speculators no doubt will be at it again. All things being considered, we will almost certainly see another oil bubble soon. I suspect that prices over 130 dollars per barrel are not sustainable over the long term. If I had some financial assets I'd be ready to short anything above that. You'd have to be crazy to not short anything above $ 160 / barrel, which I wouldn't be surprised to see at some point in the next year or two.

Netanyahu Halting Settlements

The odd thing is that he has really only de-facto halted the settlement construction in the West Bank, and apparently hasn't stopped private expansion. Here is a NY Times article which discusses Netanyahu's recent criticism of fellow right wingers in Israel:

“People don’t understand the reality they are living in,” Mr. Netanyahu was quoted as telling an assembly of Likud ministers and legislators, as well as some leaders of Jewish settler councils from the West Bank, who then passed on the remarks to the Israeli news media.

“If you don’t live in this world, you can ignore everything, and I suggest that you beware in order to protect the existing construction, because that’s what’s on the agenda, not the new construction,” Mr. Netanyahu said.

The really bizarre thing is that Netanyahu is taking flak for not expanding the settlements but he really isn't getting the benefits of an outright ban, which would be an advancement of the peace process and the acclaim of the international community. Some people are quick to suggest that the peace process would fail anyway, so why should Israel bother? The answer is simple: world public opinion. Anyone who doesn't think that matters over the long term is crazy. Turning world opinion against Israel is the main strategy of anti-Israeli extremists. Expanding settlements only plays into their hands.

Grown-up Behavior

Politicians who are actually interested in doing the business of the people and not just furthering their own ambitions are a lot less exciting.  That is a good thing.  Mitch Daniels has demonstrated to Hoosiers that he is a capable, mature, and very serious leader.  I wish other Republicans would take note.  Mitch has proposed a temporary truce on divisive social issues so we can get our economic house in order, for example.  That is a great idea, one that will be rejected by self serving politicians who make careers out of plucking the emotional strings of Americans about these social issues.  Mitch proposed a consumption tax as an alternative source of revenue and was crucified for it by the right. Here is Mitch Daniels being a leader again, about union stripping measures, and the subsequent Democratic exodus:

"I'm not sending the state police after anybody.  I'm not gonna divert a single trooper from their job of protection the Indiana public.  I trust that people's consciences will bring them back to work. ... For reasons I've explained more than once I thought there was a better time and place to have this very important and legitimate issue raised."

A better time and place, indeed.  Mitch wants to reform and doesn't want petty squabbles to get in the way of that, and that's because he cares about the people of Indiana more than his own ambitions.  Make no mistake, this move will get him criticized by national GOP leaders and certainly won't help him in a Republican presidential primary.

Another great Hoosier Republican is Dick Lugar, who committed the heinous crime of supporting Obama's arms control bill with Russia.  Nuclear arms control was a major goal on which he partnered with then Sen Obama before 2008.  Sen Lugar is another leader who puts people over politics, the penalty for which will be a primary challenge from the state GOP.

National Republicans should be emulating guys like Daniels and Lugar, not marginalizing them.  Republicans are not our problem, and Democrats aren't our problem.  Rather, our problem is uncompromising extremist jerks on both sides of the aisle who would rather hurt the other side more than help Americans.  People, we need less partisanship, not more, but you don't get less partisanship by demanding more ideological purity at the gate.

Banksy!

I was living in New York City for a couple of months last summer while doing rotations at Memorial Sloan Kettering. One weekend we went to Williamsburg for dinner, which is in Brooklyn, one subway stop past the East River. Williamsburg is still a developing neighborhood, but is a really cool place. If I was going to move to NYC I'd buy a place in Williamsburg if anywhere. Williamsburg is now what the East Village was like 15-20 years ago.

Anyway, we were walking into a tea bar (it was my first time going to a tea bar) and I noticed some graffiti on the brick wall outside. I recognized it as being the work of a famous graffiti artist by the name of Banksy, or at least it was a fantastic imitation. In the drawing, there is a man holding a remote control. He is standing in front of a giraffe with a radio collar around its neck, so the man seems to be controlling the giraffe. The giraffe has a paintbrush in its mouth, which it is using to write the word "vandal" on a high part of the wall. The theme is classic Banksy, although like I said it could be an imitation.

Bizarro Capitalism in Health Care

Thanks to Tyler Cowen for the link, here is an interesting article where the governor of New Hampshire is basically telling hospitals in his state that they need to stop expanding. A basic principle of macroeconomics is that supply and demand are inversely related.  Only in the health care industry, apparently a world of bizarro capitalism, could increasing supply actually increase demand. 

In fact, this is not a new phenomenon nor is it a novel observation.  Health care resources tend to get concentrated in areas where everyone has access to insurance.  The population in those areas tend to get more health care spending than they need, with no demonstrable increase in outcomes at all.  Spending elsewhere is suboptimal.  The net effect is that distribution of health resources is only tangentially tied to demand, and is certainly inefficient at any rate.

Anyway, sort of related.  I got an email from a friend, which is an email that a med student apparently sent to President Obama.  The student was on his emergency medicine rotation, which is what I am doing this month, so I figured I'd add it.  I end up with a lot of similar sentiments after my shifts in the ED.

----------------------------------------------------------------------------------

Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular musical ringtone.

While glancing over her patient chart, I happened to notice t hat her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture", a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me".

Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully,

STARNER JONES, MD

Act on a mandate, or squander an opportunity?

We keep hearing about this "adult conversation" that our politicians are going to have with us, which is code for cutting entitlements. Entitlements of course represent by far the largest chunk of federal spending, and it is growth in those entitlements, especially medicare, that is the cause of the massive budget shortfall predicted in a few decades. I am fully supportive of having this conversation about entitlement cuts, but all we have right now is a budgetary impasse. Republicans have thus far only had the political courage to target non-defense non-entitlement discretionary spending for their cuts, but Obama doesn't agree that we should gut the EPA, ax R&D, and shut down all of the national parks in order to put a band-aid on our hemorrhaging debt problem.

President Obama just released his own budget proposal, and Republicans have been lambasting him for a lack of leadership basically because he didn't propose cutting entitlements. I'm not really sure why Republicans are waiting for Obama to make the first move in proposing those cuts. Didn't Americans elect the GOP because they don't trust Obama on spending? And if Obama is as left wing as some purport him to be, why would he ever go along with, let alone propose, entitlement cuts? At any rate it's pretty obvious that Obama will agree to cuts in entitlements. What the Republicans really want, and the reason for the current impasse, is for Obama to help them avoid the political consequences of proposing and enacting entitlement cuts.

While Republicans are dithering about when or if to make the first move on this huge issue, they might do well to look at recent history. Obama poured virtually all of his political capital into his health care reform bill and he did it when he was fresh in office and most popular. If he had waited it never would have happened. The consequence of passing such a huge bill was he suffered politically in the next election. Republicans are now in a similar position. They were swept into office with a mandate to cut entitlements. If they want to make those cuts, they could do it now. Obama would not stop them. But he isn't going to make it *easier* for them. To expect otherwise is to live in a fantasy land. Republicans didn't make it easier for Obama and the Democrats to enact the long-time dream of universal health coverage, they did the opposite. Thats just politics 101.

As I've said before, there is a difference between electoral victory and legislative victory. The former means nothing without the latter. There will be huge resistance to any entitlement reforms - we are seeing a glimpse of it in Madison Wisconsin. The longer the GOP waits to move, the more time the opposition has to sap their momentum and break their will. Republicans may be squandering their only chance for years to do entitlement reform. The GOP needs to stop waiting around for Obama to give them political cover (he won't) and stop diddling around with the small peas of discretionary spending. The real victory is in medicare and social security, if Republicans have the courage to take it.

Naturally, I'm not optimistic about the Republican Party. I think they'll skirt around the real issues and instead focus on PR stunts like shutting down the federal government while whining that Obama won't let them do anything.

Worse Than CCTV, continued

Is Fox News worse than China Central Television?  When it comes to the Egyptian protests, CCTV is choosing to simply ignore the issue:  they are not running any footage or stories of the revolution.  Contrast that to Fox News, which is actively cheering for the forces of authoritarianism and repression.  Here is Rachel Maddow taking Fox to task for standing squarely on the wrong side of history, on the wrong side of American ideals, on the wrong side of morality.   

 

http://www.politicususa.com/en/rachel-maddow-fox-mubarak

 

The most confusing thing of all is that, by taking this anti-democracy stance, Fox News is essentially rejecting the Bush administration philosophy towards the mdidle east.  That philosphopy, founded by the neocons, was the reason we invaded Iraq and overthrew Saddam.  Hell, the war itself was called "Operation Iraqi Freedom".  And the march to war in 2003 was supported by Fox News more than any other organization!

Tim Pawlenty's phenomenal idea

I saw T-Paw on a television show the other day, and he had this proposal:  make members of congress do their own taxes.  Furthermore, the law would forbid them from using a lawyer or accountant for help - they have to do it themselves!  This would give members of congress a taste of the awful tax code that they expect the rest of us to grapple with.  Maybe then they'd have more incentive to simplify it. 

 

If it was up to me, I would contract out google to redesign the tax code and develop a system for collecting taxes and distributing returns.

Worse than CCTV?

A year ago, I had the opportunity to live in China for 5 weeks or so.  I had intended to make a comment about CCTV (China Central Television) and its influence on the people...and how those lessons are relevant for the United States.  I basically left China with the impression that CCTV was less harmful to the Chinese than Fox News is to the United States.  And yes, I am being completely serious.

 

To be clear:  the argument I am making is NOT that CCTV lies or propagandizes less than Fox News.  My argument is that CCTV is in net less damaging.  In China, everyone knows that CCTV is state run, is biased, and is propaganda.  Therefore, it seems like most people there take everything they see on CCTV with a great big grain of salt.  Many people might be prone to flat out disbelieve anything the broadcaster says purely because it is on CCTV.

 

Contrast that to Fox News.  While there was a recent poll that demonstrated that Fox was the least trusted name in news, that was mainly by virtue of their large negatives.  There is still a huge segment of this nation that actually thinks Fox News is "fair and balanced".  Fox is very divisive:  the people who watch Fox only trust Fox, and the people who don't watch Fox really tend to distrust it.

 

Some might argue that Fox is no worse than MSNBC, which is obviously baised to the left.  But Fox goes beyond bias.  MSNBC is biased to democrats because they will focus on the stupid things republicans do and not focus on the stupid things democrats do.  Or they will make arguments to support Democrat ideas and ones critical of Republicans ideas.  But the crucial difference between bias and propaganda is that MSNBC rarely is actually dishonest about what they are presenting.

 

Fox News is different.  They do have a routine habit of distorting, of manufacturing and propagating lies, of spreading misinformation generally.  In fact, they've done far worse in my eyes:  in the 2008 presidential primaries, Ron Paul won the straw poll from the first GOP presidential primary debate.  Fox News pundits after sat around and all agreed that Ron Paul actually didn't win the debate, and then later Fox News tried to exclude Ron Paul from the next presidential debate that they were hosting.  It was the single most reprehensible display of utter contempt for the American people that I have ever seen from any person, group, or organization.

 

Anyway, watching this recent clip of routine Fox News BS made me think to write this.

 

http://www.huffingtonpost.com/video/video_2324.html?1271360625

 

The last point I will make is that it is my belief that Fox News hurts America not because they hurt the Democratic Party, but because they hurt the Republican Party.  Fox News almost is doing Democrats a favor at this point:  the young internet-saavy Jon Stewart generation is very aware of the blatant lies and distortion that Fox pulls on a regular basis, even if elderly voters aren't.  Anti-Fox sentiment is a rallying cry for the left.

 

Its the damage that Fox News does to conservative discourse that really hurts America, because we cannot operate as a nation without two viable political parties, and right now we really only have one.  Fox News hurts Republicans because they are essentially the king makers.  Sarah Palin is a force in American politics right now *because* of Fox News' promotion of her. In fact, the only reason she ever was named VP was because John McCain was stupid enough to let the establishment, of which Fox is a part, hand pick her for him.  All of the intellectual hacks that Fox News promotes among the rest of the Republicans who have been named the leadership of the GOP have contributed to the rot of conservatism as a movement, a movement which I predict will prove utterly incapable of capitalizing on the electoral gains yielded by the inevitable backlash to overwhelming Democratic legislative gains seen in Obama's first two years (and a terrible economy).

 

Conservatives in the past used to be unafraid of taking on the left because they were confident in their principles and understood the ideas behind them with an unashamed intellect.  Now they only go in front of friendly journalists like Sean Hannity and hit scripted soft-ball questions.  Many conservatives have read "Atlas Shrugged" by Ayn Rand.  For anyone who doubts if what I am saying here is true, ask yourself this question:  who among today's Fox-anointed Republican leadership would John Galt not be contemptuous of? I can think of only one: Ron Paul. But as Donald Trump said tonight, Paul can't win a general election.

Quick update: I wanted to add some clarification. There are a lot of Republicans who I have a high opinion of. In fact, we have a few of them in Indiana; Mitch Daniels and Richard Lugar in particular have done a great job for our state. Mitch Daniels has a ton of smart ideas, but he has no megaphone with which to talk about them, because Fox is too busy promoting Republicans who obsess over culture war issues, or who are fond of suggesting that Obama is a Muslim. Perfect example: Mitch Daniels wrote an Op-Ed proposing a VAT, and he got crucified for it by the Fox-dominated GOP establishment. Meanwhile, Dick Lugar is facing a major challenge by the Tea Party in the 2012 election. They despise Lugar, and I'll tell you why: he is way too reasonable. He is willing to work with Obama on issues that advance the national interest (securing nuclear materials, START, etc), and that is a crime to many GOP primary voters.

the State of the Republican Party

Mitch Daniels, the effective governor of Indiana, recently wrote an op-ed. He went into detail about how serious the economic situation of America is, and how important it is that we lay a strong foundation for growth in the future while reducing our debts. I think all Americans agree that these are the most important challenges facing our nation, and that sentiment is why the Republican Party won a landslide election in November. To accomplish these challenges, Daniels proposed that we called a temporary truce on contentious issues like abortion, gay marriage, etc so we can focus on the economy. Leave culture warrior issues for another day.

Since taking the House of Representatives, what have the Republicans focused on? Most of their efforts have been spent redefining what "rape" actually is so they can try to restrict abortion rights for poor women (which is silly anyway, because poor women can still get food stamps or welfare, so money not spent on food and housing can go towards abortions). They've also expended a huge amount of effort trying to put in constitutional amendments to define "marriage" as between a man and a woman. From an economic standpoint, the only thing the GOP has done is promised to cut 32 billion or so in spending this year. That amounts to roughly 0.9 % of our yearly federal budget.

Republicans came to office in November promising to focus on jobs and the economy, to reduce the size of government, to balance the budget. They've done none of these things, and I don't have much hope that they will. They've fallen back on the old battles that the Bush administration focused on while the country melted all around him. My skepticism vis a vis the new libertarian-conservative revival of the Republican Party that we saw last year seems to have been well placed, unfortunately.

The importance of evidence based medicine

From my inexperienced vantage point, the greatest internal battle going on in the medical profession is the contest between medical dogma and evidence based medicine. Believe it or not, there are quite a few interventions that physicians utilize on a regular basis that have never been proven to actually benefit patients.

If some treatments aren't proven, why are physicians still doing them? Well, lets hypothetically say that obstetricians have been doing "x, y, and z" for premature babies for the last two decades, but there is actually no evidence to support z. Are you going to let your premature child be the first in an experimental group that forgoes treatment z? And what kind of malpractice insurance would a physician have to have in order to conduct that sort of experiment?

A New York Times article about a new breast cancer study touches on this challenge. Its pretty easy to convince someone to try something new that is not proven, but getting them to pass on established treatment options in the name of science is another matter. And yet, the physicians who carried out this study on breast cancer did just that. A quote from the article:

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

As it turns out, the study proved that axillary dissection in some women provide no benefit. This is a win-win-win. The surgeons can be confident they are providing the best care, the patients are not getting unnecessary treatment with lots of complications, and the health care system is not losing thousands of dollars on a procedure that isn't helpful. A very courageous study, and we need more like it. I don't presume to know all of the barriers that prevent more research studies like this from being executed, but we should all be working to break them down.

One Frail Heartbeat from the Presidency

Here is Sarah Palin on Egypt.  Remember:  she was almost VP, and is considered a GOP frontrunner for 2012:

"It's a difficult situation. This is that 3am White House phone call and it seems for many of us trying to get that information from our leader in the White House, it, it seems that that call went right to, um, the answering machine. And, uh, nobody yet has, uh, explained to the American public what they know, and surely they know more than the rest of us know, who it is who will be taking the place of Mubarak. And, um, no, not not real enthused about what it is that is being done on a national level from DC in regards to understanding all the situation there in Egypt and, um, in, in these areas that are so volatile right now, because obviously it's not just Egypt but the other countries too where we are seeing uprisings. Uh, we know that now more than ever, we need strength and sound mind there in the White House.  We need to know what it is that America stands for, so we know who it is that America will stand with.  And, um, we do not have all that information yet."