Obsidian Wings

Why We Need Universal Health Insurance

by hilzoy

It's not just the people who die because they can't get medical care, or get much sicker than they need to because they can get health care only through emergency rooms, and emergency rooms do not manage long-term, chronic diseases like diabetes. It's not just the people who die or, like Mark Kleiman, come close to dying because of the delays caused by the need to deal with insurance companies. (If you didn't read Kleiman's story when he posted it about a month ago, do it. Right now.) It's the fact that in a system in which all our citizens had health insurance, a system like the one that every other developed country on earth has, this would never happen:

"A husband, financially desperate because of his wife’s medical problems, walked her to the balcony of their fourth-floor Kansas City apartment, kissed her, then threw her to her death, according to court documents filed Wednesday.

Stanley Reimer, 51, was charged Wednesday with second-degree murder for allegedly killing Criste Reimer, 47. Her body was found Tuesday night on the pavement outside the Plaza Point Apartments, 4901 Wornall Road.

Reimer was being held Wednesday night in the Jackson County jail on a $250,000 cash bond. His arraignment is scheduled for today. (...)

When police first questioned Reimer, who was in the apartment when they arrived, he told them “something bad” had happened to his wife, according to the probable-cause statement filed with the charges.

“She didn’t jump,” he said, but didn’t reveal much more.

Detectives said they were suspicious about how Criste Reimer died because her caregiver told them she had numerous health issues and could barely walk. She would have been “physically unable to climb over the railing of the balcony,” the caregiver said, according to the probable-cause statement.

Several hours later, after more questioning, police said they determined Reimer threw his wife from the balcony because he could no longer take care of her medical needs, according to documents.

Criste Reimer had battled numerous medical problems for several years, a fight that drained her physically, according to Jackson County Probate Court records.

Her weight had dropped to 75 pounds, she was partly blind, and she had an extensive history of traumatic brain injury, knee surgeries, neurological disease, hypothyroidism and hydrocephalus. She was also on a host of medications. (...)

Her medical bills ranged from $700 to $800 a week, and she had no health insurance, according to Probate Court records."

This blog has found online guestbook records that indicate that this couple has been married for at least nine years, and probably longer. Mr. Reimer had previously tried to sell what seems to have been their only substantial property to pay for his wife's medical bills; here's what she had left to pay for that $700-800 a week in medical bills: "An inventory of her assets at that time showed she had $200 in her checking account, household goods and furnishings valued at $500, an individual retirement account of $4,000, and real property valued at $2,000. It also showed she was receiving $325 a month in Supplemental Security Income and $400 a month in royalties from the Kaiser-Francis Oil Co." And those royalties seem to have been from the land that was to be sold.

I cannot imagine the pitch of despair to which this situation must have driven Mr. Reimer. I don't mean to endorse what he did, but I think it's the action of someone driven beyond all endurance. Situations like his and his wife's do not exist because of some unalterable necessity. We allow our society to be set up in such a way that they can occur. We should be ashamed.

The Petraeus Report: Update

by hilzoy

The plot thickens:

"Senior congressional aides said yesterday that the White House has proposed limiting the much-anticipated appearance on Capitol Hill next month of Gen. David H. Petraeus and Ambassador Ryan C. Crocker to a private congressional briefing, suggesting instead that the Bush administration's progress report on the Iraq war should be delivered to Congress by the secretaries of state and defense.

White House officials did not deny making the proposal in informal talks with Congress, but they said yesterday that they will not shield the commanding general in Iraq and the senior U.S. diplomat there from public congressional testimony required by the war-funding legislation President Bush signed in May. "The administration plans to follow the requirements of the legislation," National Security Council spokesman Gordon Johndroe said in response to questions yesterday.

The skirmishing is an indication of the rising anxiety on all sides in the remaining few weeks before the presentation of what is widely considered a make-or-break assessment of Bush's war strategy, and one that will come amid rising calls for a drawdown of U.S. forces from Iraq. (...)

White House officials suggested to the Senate Foreign Relations Committee and the House Foreign Affairs Committee last week that Petraeus and Crocker would brief lawmakers in a closed session before the release of the report, congressional aides said. Secretary of State Condoleezza Rice and Defense Secretary Robert M. Gates would provide the only public testimony.

Senate Foreign Relations Committee Chairman Joseph R. Biden Jr. (D-Del.) told the White House that Bush's presentation plan was unacceptable. An aide to Senate Armed Services Committee Chairman Carl M. Levin (D-Mich.) said that "we are in talks with the administration and . . . Senator Levin wants an open hearing" with Petraeus.

Those positions only hardened yesterday with reports that the document would not be written by the Army general but instead would come from the White House, with input from Petraeus, Crocker and other administration officials.

"Americans deserve an even-handed assessment of conditions in Iraq. Sadly, we will only receive a snapshot from the same people who told us the mission was accomplished and the insurgency was in its last throes," warned House Democratic Caucus Chairman Rahm Emanuel (Ill.).

"That's all the more reason why they would need to testify," a senior Foreign Relations Committee aide said of Petraeus and Crocker. "We would want them to say whether they stand by all the information in the report." He spoke on the condition of anonymity because he was not cleared to speak to reporters.

The legislation says that Petraeus and Crocker "will be made available to testify in open and closed sessions before the relevant committees of the Congress" before the delivery of the report. It also clearly states that the president "will prepare the report and submit the report to Congress" after consultation with the secretaries of state and defense and with the top U.S. military commander in Iraq and the U.S. ambassador.

But both the White House and Congress have widely described the assessment as coming from Petraeus. Bush has repeatedly referred to the general as the one who will be delivering the report in September and has implored the public and Republicans in Congress to withhold judgment until then."

That's the trouble with trying to stall for time by pointing to some event in the future and saying: you can't possibly make any big decisions before this happens: eventually the time for this will, in fact, arrive, and what will you do then, having said so often that it is the event on which everything else turns? In the case at hand, there has never been any great mystery about the broad outlines of the reports. There has been some progress in improving security in Iraq, though not enough to bring the violence down to anything like tolerable levels. But the point of improving security was always to allow Iraqi politicians the breathing space they needed to undertake the political reconciliation which alone will bring a lasting end to the violence in Iraq, and without which any improvement in security is just temporary. And there has been no sign whatsoever that any such reconciliation has occurred.

The political "progress" that was claimed in the last report did not involve any actual agreements or legislation or concrete achievement; at best it involved claiming partial progress on such dubious grounds as: that the group which was supposed to consider solutions to a problem had been formed. Since then, no further progress has been made, which is not entirely surprising since large chunks of the cabinet have been boycotting its meetings, and the Parliament is now on vacation.

So the reports will more or less have to say: some limited progress on the military front; none on the political front for whose sake the surge was undertaken. Under the circumstances, the administration might well feel that it has no choice but to take over the writing and presentation of the report. But I think this is a deep mistake: they have no credibility left, precisely because they are so clearly committed to pursuing one course of action regardless of its chances for success, and so consider facts on the ground solely in terms of their usefulness for making a case that that course of action should continue.

It's no way to run a country, and it's certainly no way to run a war.

*** UDATE to the update: BarbinMD at dKos has a nice rundown of Republican Senators explaining hw very important it is to hear from Gen. Petraeus himself. It will be interesting to see whether any of them suddenly change their minds.

Dear God

by hilzoy

I've noticed a horrifying trend in my posts about Iraq over the years. I normally don't post on particular horrible episodes: a suicide bomber, a car bomb, and so forth. This isn't because I don't think they're important: I do. It's just because I couldn't post on all of them, and if I tried, I would hate it: trying to find words over and over for unspeakable things. Every so often, though, something happens that's so completely horrific that I have to try. And during the time I've been posting here, the number of corpses that it takes to make something that kind of event has been rising. I can't check back over my old posts -- searching for something like "Iraq casualties" would produce too many hits, and I have no idea how to narrow it -- but I think I recall, early on in my tenure here, posting about an episode in which twenty whole people were killed. Then, later, sixty. If I posted now every time twenty people were killed in one episode, I'd be writing about it every other day.

But so help me God, I cannot imagine what it would be like for this to become somehow usual:

"Officials said Wednesday that as many as 500 people probably died in a series of coordinated truck bombings that devastated two northern Iraqi villages Tuesday and set a record for mass carnage in war-torn Iraq.

Residents and rescue workers in Tal al Azizziyah and Sheikh Khadar, two villages near the Syrian border in Nineveh province, spent Wednesday pulling the dead and wounded from the rubble of clay homes that had collapsed when the massive bombs exploded.

The confirmed death toll was at least 250 and climbing, officials said. Five hundred more were wounded, many critically. More than 100 one-story homes and shops were destroyed by the blasts. (...)

Official accounts of the blasts varied. Iraqi authorities said four bombs were involved, three at a bus station and a marketplace in Tal al Azizziyah and one in Sheikh Khadar.

American accounts put the number at five, with four striking a bus station in Tal al Azizziyah and the other detonating in a residential area of Sheikh Khadar. (...)

Some accounts said the explosives were concealed in fuel tankers; others said the bombs were hidden underneath haystacks. There was no official estimate of the size of the bombs, and U.S. officials didn't respond to requests for more information."

A few years ago, I couldn't have imagined bombs killing twenty people becoming usual either. I pray that this time, I'm right.

How Seriously Should We Take The Petraeus Report?

by hilzoy

I'd have to think hard about that question if it were actually going to be written by David Petraeus: he strikes me as an honorable person, but the pressure out of this White House would be enormous. Trying to resist it would be like trying to stand straight and tall in the middle of a Category 5 hurricane.

However, deciding how seriously to take his report just got a whole lot easier:

"Despite Bush's repeated statements that the report will reflect evaluations by Petraeus and Ryan Crocker, the U.S. ambassador to Iraq, administration officials said it would actually be written by the White House, with inputs from officials throughout the government."

That settles that.

So Long, Farewell, Auf Wiedersehen, Goodbye

by hilzoy

From the WSJ: Karl Rove is resigning.

"If that quinella pays off, however, Mr. Rove will have to savor it from somewhere other than his West Wing office. He's resigning effective Aug. 31 -- 14 years after he began working with Mr. Bush on his campaign for Texas governor, 10 years after they began planning a White House run, and after 79 months in the political cockpit of a tumultuous presidency.

"I just think it's time," he says, adding that he first floated the idea of leaving to Mr. Bush a year ago. His friends confirm he had been talking about it with others even earlier. But Democrats took Congress, and he didn't want to depart on that sour note. He then thought he'd leave after the State of the Union, but the Iraq and immigration fights beckoned. Finally, Chief of Staff Josh Bolten told senior White House aides that if they stayed past a certain point, they were obliged to remain to Jan. 20, 2009.

"There's always something that can keep you here, and as much as I'd like to be here, I've got to do this for the sake of my family," Mr. Rove says. His son attends college in San Antonio, and he and his wife, Darby, plan to spend much of their time at their home in nearby Ingram, in the Texas Hill Country.

Mr. Rove doesn't say, though others do, that this timing also allows him to leave on his own terms. He has survived a probe by a remorseless special counsel, and lately a subpoena barrage from Democrats for whom he is the great white whale. He shows notable forbearance in declining to comment on prosecutor Patrick Fitzgerald, who dragged him through five grand jury appearances. He won't even disclose his legal bills, except to quip that "every one has been paid" and that "it was worth every penny."

What about those who say he's leaving to avoid Congressional scrutiny? "I know they'll say that," he says, "But I'm not going to stay or leave based on whether it pleases the mob." He also knows he'll continue to be a target, even from afar, since belief in his influence over every Administration decision has become, well, faith-based.

"I'm a myth. There's the Mark of Rove," he says, with a bemused air. "I read about some of the things I'm supposed to have done, and I have to try not to laugh." He says the real target is Mr. Bush, whom many Democrats have never accepted as a legitimate president and "never will.""

Personally, I think that when he's gone, someone should perform an exorcism, and hang garlic all around the White House to prevent his return.

***

UPDATE: What are the odds of publius and I cross-posting on the same story at 6:25/6:26 in the morning? Sorry, publius.

Best Morning Ever

by publius

Rove resigns.

In other news, the Death Star reportedly exploded. Frodo "ring mission" deemed successful. Led Zeppelin reunites. Lily Allen reportedly dating local pseudonymous blogger, citing Obsidian Wings as major artistic inspiration. Residents say hundred dollar bills raining down from sky. Excessive sunshine and mirth reported in area town. Hordes of children playing in the street slowing morning traffic. Mayor Quimby declares today "Fun Day."

Let's Tell The Future

by hilzoy

More bad news about Iraq:

"U.S. troops could withdraw from Iraq within months, but if Iraq's government remains politically deadlocked, it probably would collapse and the nation would descend into chaos, a war game organized by the U.S. Army concluded earlier this month.

The war gamers, following a scenario created by their Army hosts, determined that U.S. troops would secure the exit route to Kuwait through largely Shiite Muslim southern Iraq and face little fighting as they drove their equipment out. Any attacks, the panel judged, would be "harassment attacks," likely by a few Sunni members of al Qaida in Iraq who wanted to attack American troops one last time.

"Why would they stop us? They have been telling us to leave," said one participant who requested anonymity to speak freely about the war game.

Once U.S. troops left, however, the chaos in Iraq would escalate. Shiite militias would drive Baghdad's Sunni population into Iraq's western Anbar province, which is almost exclusively Sunni, the war gamers concluded. There would be a power struggle within Anbar among tribes backed by outside Sunni Arab states, including Saudi Arabia and Syria.

Rival Shiite factions would fight one another to control much of the rest of the country, and Iran presumably would back one side, although the gamers couldn't assess how overt Iranian interference would be. Turkey would consider entering Iraq from the north to thwart the Kurds, who desire independence and claim some of Turkey as part of their homeland.

Iraqi Prime Minister Nouri al Maliki's government would be unable to control the country. Indeed, the gamers concluded, his government could collapse unless Iran threw its support behind it.

"The mess we would leave behind would be awful," the participant said. "The ethnic cleansing is happening now. Once we're gone, absent a political solution that would allow the Iraqi Army to go into action, all of that will be accelerated.""

The main criticisms concern the sole optimistic prediction: that it will be relatively easy to withdraw from Iraq.

Meanwhile:

"The Bush administration is finishing a National Intelligence Estimate on Iraq that paints a sobering picture of a mature civil war unlikely to be snuffed out through political progress, according to officials involved in the report’s preparation.

A late draft of the document warns of the possibility of a spectacular attack in conjunction with a crucial mid-September assessment by Gen. David Petraeus, the U.S. commander in Iraq, and Ryan Crocker, the U.S. ambassador in Iraq.

With the Petraeus-Crocker report looming, some administration officials say they fear a coordinated onslaught like the Tet offensive, a surprise country-wide series of attacks that produced a psychological victory for Vietnamese Communists in 1968."

Two notes: first, it is always worth remembering that all the things we're most worried might happen if we leave are things that would not exist at all had we not invaded: a civil war, a regional war, a terrorist base in Iraq, increased Iranian influence, the possible collapse of the country, and so forth. Second, whenever I read stories like this, I am reminded of all the times supporters of the invasion accused those of us who opposed it of not caring about the sufferings of the Iraqi people. Where, they asked, is your vaunted humanitarianism and your moral foreign policy? Do you want to leave the Iraqis to the tender mercies of Saddam Hussein? Don't you care about Halabja, the rape rooms, the mass graves?

Well: yes, I did care about those things, and no, other things equal, I would rather the Iraqis not be left under Saddam. But as I said a couple of days ago, benefit analysis is no way to make decisions.

Which is one reason why those arguments sound a bit different now, with over half a million dead and counting, death squads roaming around using power drills on human beings, ethnic cleansing well underway, millions in internal and external exile, and warnings that the worst is yet to come.

The Road Not Taken

by hilzoy

This isn't news, though it's still infuriating:

"Statements from the White House, including from the president, in support of Afghanistan were resolute, but behind them was a halting, sometimes reluctant commitment to solving Afghanistan’s myriad problems, according to dozens of interviews in the United States, at NATO headquarters in Brussels and in Kabul, the Afghan capital.

At critical moments in the fight for Afghanistan, the Bush administration diverted scarce intelligence and reconstruction resources to Iraq, including elite C.I.A. teams and Special Forces units involved in the search for terrorists. As sophisticated Predator spy planes rolled off assembly lines in the United States, they were shipped to Iraq, undercutting the search for Taliban and terrorist leaders, according to senior military and intelligence officials.

As defense secretary, Donald H. Rumsfeld claimed credit for toppling the Taliban with light, fast forces. But in a move that foreshadowed America’s trouble in Iraq, he failed to anticipate the need for more forces after the old government was gone, and blocked an early proposal from Colin L. Powell, then the secretary of state, and Mr. Karzai, the administration’s handpicked president, for a large international force. As the situation deteriorated, Mr. Rumsfeld and other administration officials reversed course and cajoled European allies into sending troops.

When it came to reconstruction, big goals were announced, big projects identified. Yet in the year Mr. Bush promised a “Marshall Plan” for Afghanistan, the country received less assistance per capita than did postconflict Bosnia and Kosovo, or even desperately poor Haiti, according to a RAND Corporation study. Washington has spent an average of $3.4 billion a year reconstructing Afghanistan, less than half of what it has spent in Iraq, according to the Congressional Research Service.

The White House contends that the troop level in Afghanistan was increased when needed and that it now stands at 23,500. But a senior American commander said that even as the military force grew last year, he was surprised to discover that “I could count on the fingers of one or two hands the number of U.S. government agricultural experts” in Afghanistan, where 80 percent of the economy is agricultural. A $300 million project authorized by Congress for small businesses was never financed."

I remember hearing those speeches and thinking: oh, thank God. Back in late 2001 and early 2002, I was giving Bush the benefit of the doubt -- I hadn't thought much of him before, but 9/11 did seem to have concentrated his attention, and it truly seemed as though he had changed. (As indeed he had; just not in ways anyone anticipated.) I had supported the invasion of Afghanistan, and I heard those words -- Marshall Plan, we will not repeat the mistakes of the past, we will not abandon Afghanistan -- and thinking: we are really going to do something wonderful.

I think that some of the most inspiring moments in international relations are when serious, long-festering problems are actually decisively solved. When South Africa's apartheid government handed over power peacefully to the ANC, for instance: South Africa still has enormous problems, but the ghastly ever-present nightmare of apartheid had actually gone away. When the conflict in Northern Ireland is finally laid to rest, it will be the same sort of glorious moment. Some problems aren't solved all at once; still, you can see points at which things turn slightly from despair towards hope, and then, if you're lucky, a point at which the process of transforming some problem that has haunted the world for what seems like forever into history starts to look irreversible.

Afghanistan had been one of those problems for decades. We weren't in a position to do much about it earlier -- naively, I believed that you don't just go around invading countries out of the blue, ha ha ha -- but suddenly we actually had a really good reason to invade, and there we were, the Taliban was in flight, the people seemed overjoyed, and I thought: dear God, we are actually going to do try to right by Afghanistan, whose people have suffered so much for so long. And back in that era of lost hopes, what gave me real confidence that we would do our best to actually help Afghanistan to transform itself from a failed state into a normal, functioning society was that for once, making a serious effort to do this wasn't just a wild aspiration. It was feasible, it was the right thing to do, but most importantly, as far as its actually happening was concerned, it was clearly, obviously, overwhelmingly in our interest.

It still breaks my heart just thinking about it. Read the whole article and weep.

Around the Horn - Weekend Edition

by publius

Some quick links/points from around the Internets this weekend:

(1) Over at the always-awesome American Footprints, I asked in the comments whom we should be “rooting” for in the intra-Shiite civil war (they can’t all lose unfortunately). Eric Martin responded with this thoughtful post, which weighs the various pros and cons of each major faction. One of the most interesting points he makes is that this decision first requires figuring out our longer-term policy preferences. For instance, picking (or at least passively favoring) one faction depends entirely on what sort of policies we prefer (e.g., soft partition, respect for territorial integrity).

(2) For now at least, the full-text version of the Atlantic Monthly pieces on Gerson and Rove are up at the Politico. The Rove article hasn’t gotten the same attention yet, but it’s very good. And the Gerson article really is required reading – particularly for the Starbucks story.

(3) The spectrum auction order is finally out. And though I may regret saying this, the Copps/Adelstein/Martin open access language is actually much stronger than I predicted. I hope to write more this weekend.

(4) Although Romney won Buy Some Voters Day (the warm up to the bigger, slightly less fraudulent, infinitely more important one), Tancredo’s support (3rd 4th place) is what jumped out at me on first glance. This guy has about as much money as I do. Must be something else driving his showing.

(5) Iowa rocks. Clearly this state's infinitely legitimate political procedures should determine the nominees for the most important job on the planet.

UPDATE: (6) And Anonymous Liberal (someone to add to your blogroll if you haven't) has been doing an excellent job keeping up with the FISA bill so you don't have to. I've been busy with other things, but hope to weigh back on this too very soon.

Obama's Five Point Plan

In a recent discussion with hilzoy, the subject of Barack Obama's recent speech about GWOT/GSAVE came up, and since I am supposed to be providing some commentary from a nominally right-leaning perspective, I thought I'd provide some analysis here. Yes, I'm late to the party, but I'll beg certain indulgences, as occupied Narn is not always the first place news stops on its voyage around the galaxy so I'm often going to address certain topics after a delay or without necessarily having access to the latest information. I'll put the rest below the fold, so those who are not interested can easily skip on past.