Obama’s Health-Care Plan

NOTE: For an update on mandates and Paul Krugman’s column of February 4, 2008, see this post.

Yesterday Senator Barack Obama (D., Ill.) unveiled his health-care plan. It was exactly what you would expect from someone who is smarter than any two other presidential candidates combined. It was a tour de force. Anyone who doubts Obama’s presidential qualifications should read his speech carefully.

What’s so brilliant about Obama’s plan? Just about everything. In a relatively short speech, Obama displayed a consummate understanding of realism, politics, economic motivation, economics, actuarial science, quality, transparency, and “customer service.” You won’t find all those words in his talk because he chose simple language that anyone could understand. But he covered all those bases and more, and he covered them well.

Let’s begin with politics and realism. Many Democrats yearn for a “single payer” system, what doctors used to call “socialized medicine.” But powerful forces have made that system politically unattainable in our country.

You have to be of a certain age to understand this point. For decades, the foremost authorities on health care—doctors—have gone ballistic at the mere mention of socialized medicine, however described. Why? They fear that government control of payment will lead to government control of pricing and treatment. For the last two decades, insurers’ bureaucracies and HMOs have forced doctors to work harder, for less pay, under closer supervision than ever before. In that atmosphere doctors are never going to support what they see as yet another huge bureaucracy looking over their shoulders, however well intentioned.

Forget for a moment that insurers, drug companies and most conservatives (even the few remaining moderate ones!) all hate the idea of a “single payer.” Anyone who seeks to pass important health-care legislation over the opposition of the doctors who actually provide health care is pissing into the wind. Obama is much too smart to do that.

Yet as he displayed his firm grasp of political realism by avoiding single payer, Obama also showed us where his heart lies. Toward the end of his talk, he showered praise on our Medicare system, an existing “single payer” plan for seniors. He touched his Democratic bases by lauding Harry Truman, who first conceived the idea, and Lyndon Johnson, who signed it into law. With subtle brilliance, Obama told us, in effect, “Look, folks, I’d like single payer, too. But this problem is urgent and we have to do something that Congress can pass this decade.”

Obama’s realism did not stop there. He wove into his speech an explanation why the stars are all aligned for health care reform in a way they never have been before. He even graciously excused his chief opponent’s earlier failure in health care, referring to the nineties as too early to catch this wave.

The current economic motivations for health-care reform that he cited touch both the left and the right. Several times, he mentioned the 45 million Americans without health care. He began his speech with a story of an Iowa couple, owners of a small Internet business, who had health care but were being driven into bankruptcy by rising premiums as the husband battled cancer.

Obama’s statesmanship lay in what he said next. He did not stop with what steely-eyed business people might call “bleeding heart” stories. He gave all the reasons why business people should (and increasingly do) support sweeping health care-reform. He explained how rising health care costs are ruining American automobile producers. He mentioned the burden on small business. And he noted the disadvantage that huge health-care costs impose on all American businesses as they compete in the global marketplace against firms in Europe and Japan, whose workers enjoy universal, government-sponsored health care.

By invoking reasons why both consumers and business need health-care reform, Obama built a “big tent” for his proposals, all the while explaining how the political stars’ present alignment now makes real reform possible.

Like his substance, Obama’s tone was statesmanlike. He laid out facts showing inefficiency and greed in the health-insurance and drug industries, but he never railed against them. He didn’t promise to “fight” them or exclude them from the legislative process. He merely observed dryly that “it’s time to let the drug and insurance industries know that while they’ll get a seat at the table, they don’t get to buy every chair.” Besides laying out facts to make his points, that was about the strongest thing he said.

But Obama’s realism and statesmanship are only half the story. We have lots of smart politicians in this country, but they don’t seem to have solved any real problems for us in a long time. We desperately need more than clever politics. What we need is substance, i.e., solutions that work. That’s where Obama shines.

The “headlines” on Obama’s plan say nothing terribly new. Like other federal and some state proposals, his rely primarily on the private insurance market. He would reach universal coverage by requiring most businesses (all but “the smallest”) to provide health-care insurance. He would subsidize policies for those who cannot afford them. He would finance his program by letting Bush’s tax cuts for the wealthy expire, by reducing inefficiency and waste, and by requiring greater competition in the insurance, drug, and health-care industries. And he would lower the cost of insurance for everyone by creating bigger insurance pools to spread the risk.

While these proposals are good and should work, they are not really new. In broad outlines, Obama’s program is similar to that which Massachusetts enacted recently and is now implementing. The other Democratic presidential candidates all have similar features in their plans.

What is original—and impressive—is the five subsidiary points of Obama’s plan. They show exactly how thoughtful, creative, non-ideological and practical a leader he is.

Here are the five main “detail” points of his plan, in the order in which he presented them, but in different words:

1. Partial government re-insurance of “catastrophic” claims, such as claims for cancer care and heart surgery.

2. Financial incentives for preventive care.

3. Incentives for quality care through (a) public disclosure of quality “report cards” and (b) direct financial rewards for quality.

4. Taming waste, inefficiency and medical errors through modern electronic record-keeping and transmission systems.

5. Changing the law to require health-care, drug and insurance companies to engage in real competition, with financial penalties if they don’t.

Unfortunately for Obama, you need some background in health care, and more than a little knowledge of economics, to appreciate just how smart these points are.

Take the first point, for example: partial subsidies of insurance company losses from “catastrophic” claims. At first glance, it sounds like a giveaway to insurance companies, right? Wrong. The proposal is brilliant on two levels.

First, take the economic and practical. Imagine that you are a health care insurer trying to price your premiums. You are looking at a horde of Baby Boomers just beginning to retire. Many of them will get expensive diseases like cancer and heart problems. In order to price your premiums well, you have to guess how many will get these expensive diseases and approximately when. You also have to guess how expensive their care will be as medical science progresses and the price tag for therapy keeps going up.

If you guess too low, your premiums won’t cover your losses and you’ll go bankrupt. If you guess too high, your competitors may undercut you; but if they don’t you’ll earn windfall profits. This very real actuarial problem causes most insurers to “overprice” their premiums. It is also one of the chief causes of high inflation in health-care costs.

But now suppose the government offers to subsidize part of your catastrophic losses. The risk of Baby Boomers’ expenses no longer seems so overwhelming. More important, you know that your competitors will be protected as well, so they’ll be likely to set more aggressively low premiums, which you’ll have to match in order to stay in business. Depending on the level of government subsidy and the definition of “catastrophic” expense, Obama’s Point 1 could do much to alleviate the actuarial pressure that is causing health-care costs to skyrocket.

But that’s not all. There’s a political angle, too. Like doctors, the health-insurance industry has steadfastly (you might say fanatically) resisted any government involvement in health care. But suppose the government offers to help you with your biggest problem—increasing and increasingly hard-to-estimate risk. Might you then not budge a little? If single payer wants to get a foot in the insurance industry’s door, helping it with its biggest problem is certainly a good way to do that.

What a brilliant win-win! Health insurers get help with their most difficult problem and an insight that government programs actually may work for them. “We the people” get lower and more stable premiums.

Obama’s second point is financial incentives for preventive care. He is not the first person to make this suggestion, but it is an important one.

We have an epidemic of obesity and diabetes. Nearly a quarter of our population still smokes, although smoking is the single largest cause of preventable disease and death. Study after study shows that people don’t get enough exercise, don’t eat well, and don’t take their medicine—even medicine for potentially life-threatening conditions like diabetes, high cholesterol and high blood pressure. Why?

One answer is that doctors are paid to diagnose disease and do procedures. They are not well paid for preventive care, far less for nagging their patients about unhealthy life styles. Yet study after study also shows that, if doctors did these things, people would be healthier and happier, and health-care costs would drop. The trick is arranging financial incentives for doctors so they are paid more—much more—for keeping people healthy, not just curing them once they are sick.

This idea is not rocket science, but it’s vital for both good public health and cost control. The fact that Obama lists it as his second priority shows he has his priorities right.

Obama’s third point—quality reporting and incentives—is likewise not original. But the way he presents it is. His speech reflects acute awareness of the human suffering, as well as the cost, of medical errors. He specifically notes the high rates of preventable infections in hospitals—a medical scandal just recently revealed. In discussing these inexcusable shortcomings of the medical profession, Obama shows a sensitivity to people—i.e., patients—that all of us want in a leader.

But more than that: Obama already has done something about it. As a state senator in Illinois, he sponsored a bill that required hospitals to disclose their quality “report cards,” including “the ratio of nurses to patients, the number of annual medical errors, and the quality of care [patients] could expect at each hospital.”

For those of us of a certain age, this is manna from heaven. I’ve reached the age when the warranty on my body has expired and it needs frequent repairs. When I need something important done, I want the best doctor and/or hospital within reach.

I’ve worked with computers for over forty years, I can program in HTML, and I love the Web. Without much trouble, I can find out whether a doctor has been disciplined, suspended or “defrocked” for outrageous misconduct, or whether a hospital has lost its accreditation. But I’ve found no way to compare competent docs or decent hospitals and find out which is better. Most of the information I want is locked in the files of a little-known organization called JCAHCO (pronounced “JAY-Co”), the Joint Commission for Accreditation of Health Care Organizations. I can’t get the information I really want without special authorization.

All of us—even doctors when they are patients—want that kind of information. But most doctors and hospitals don’t want to publish it. They’re afraid that market forces will keep their feet to the fire and that “report cards” might judge them unfairly.

Without sounding in the least divisive or contentious, Obama recognizes this as a fight worth fighting. Subjecting health-care providers to market forces will improve quality and cut costs in medicine, just as it has in every other segment of our diverse economy. In the long run, it may be the single best way to improve the quality of health care for all of us.

Obama’s fourth point—dragging health care kicking and screaming into the electronic age—is also not original. But his speech recognizes its importance to both quality and cost. He notes the studies on medical errors. He cites tragic outcomes caused by stupid little things like doctors’ illegible handwriting. He notes the need for automated cross-checking of prescribed medicines against patient’s reported drug allergies.

In this point as in others, Obama has clearly done his homework, understands where the bodies are buried, and has the right priorities. His speech doesn’t say exactly how he would handle this problem, but presumably he would do the obvious: establish reasonable technical standards for electronic records and data transfer, set minimum requirements for doctors, analytical laboratories and hospitals, and create strong financial incentives for moving beyond the minimum requirements as quickly as possible.

So far, so good. But if you want to see what really sets Obama apart, look at his last point: bringing competition back to drug distribution and health insurance. Lots of politicians laud competition; it’s like motherhood and apple pie. But Obama is different. He doesn’t just praise competition. He understands exactly how private firms use business and the law to stifle competition and harm the public.

Obama’s short political speech mentions two methods by which drug and insurance companies distort and avoid competition. One is a series of mergers, reducing competition in a particular market, such as a city, metropolitan area, whole state, or even larger region. The other is a process by which so-called “proprietary” drug companies avoid competing with generic drugs by paying the generic makers to stay out of the market.

These techniques of market control are highly sophisticated and largely invisible to the general public. Under present law, they are sometimes legal, although they do tremendous damage to competition and (through higher prices and reduced consumer choice) to the public. Both the law and the economics involved are complicated. The challenge for any leader is curtailing these practices without doing more harm than good.

To meet that challenge, you have to be smart and well-informed on some pretty esoteric issues. I have watched several congressional hearings on these problems. The average Senator or member of Congress does not appear even to understand what is going on, let alone how to fix it. By mentioning these two points in a brief, general political speech, Obama showed that he understands what is going on and knows its importance. In that respect he is head and shoulders above the average federal legislator and the other candidates for president.

In sum, Obama’s health-care plan reveals the extraordinary brains, understanding and skill that will make him an extraordinary president. He has political realism and statesmanship. He knows that “single payer” will not fly, and he wants to give us the next best thing.

But unlike most politicians, Obama does not shoot for the “easy kill.” He won’t sell us what’s easy to sell and call it a solution. Some of his proposals—like report cards for doctors and hospitals and subsidies for insurance companies’ risks of catastrophic loss—will be hard to sell. They will meet resistance and will require explanation and persuasion. In making these proposals, Obama gives us notice that he will not shrink from the hard work of leading a nation.

Most amazing of all, Obama’s speech shows deep understanding of health-care economics. It recognizes that real solutions to real problems require more than just points on a list. Obama seems to understand the quantitative effect of his proposals—i.e., how much each point will likely improve things—and his priorities reflect that understanding. That fact alone puts him so far ahead of most politicians that he seems to be from another species. It is as if he were Homo sapiens, and the rest Neanderthals.

Unfortunately, the very brilliance of Obama’s plan may hurt him politically. We’ve all become accustomed to bumper-sticker solutions to real and complex problems. Obama’s careful analysis cannot be condensed into a bumper sticker; it requires thought or explanation just to understand why it’s so good.

The most accurate bumper sticker for his health-care plan might read as follows:

Thoughtful, Creative and Effective Solutions by a Very Smart Man Who Does his Homework, Cares About People, and Has Genuine Respect and Empathy for all Points of View.

That’s much too long for a bumper, but it might fit in small letters on the side of a big, gas-guzzling SUV.

And therein lies Obama’s political problem and the paradox of our democracy. Can we even recognize political genius any more when we think collectively in bumper stickers and thirty-second replies in stage-managed presidential debates? Our last, best hope is for Obama to overcome our broken system and corrupted media and drag us all back to respect for governance that works. As brilliant as his plan is, it will take a lot more than a good health-care plan to do that.

Update: the “Cover Everyone” Flap

For an updated discussion comparing Barack Obama’s with Hillary Clinton’s health-care plan, which debunks the canard of failing to “cover everyone,” see this post.

One-Man Rule

We humans like to think we are rational beings. Over millennia we have gained a rudimentary understanding of our physical world and our own biology. In the United States we have a nation founded on Reason. We can fly through the air. We can understand our own molecular genetics. We can diagnose, prevent and cure disease better than ever before.

Our greatest achievements have always been collective. In a much simpler era, it took dozens of wise people to frame American democracy. It takes thousands of experts to build an airplane, tens of thousands to run an airline. Deciphering the human genome was a group project on a massive scale, involving thousands of scientists and laboratory technicians. It is still ongoing. Progress in medicine, in particular, has been slow and steady, requiring the efforts of armies of doctors, scientists and technicians and the cooperation of tens of thousands of patients. Every clinical trial of a new drug is a gigantic exercise in rational collaboration.

Yet even in science—our most conclusive proof that more heads are better than one—we are hierarchical. When we think of physics, we think of the genius of Newton and Einstein; we don’t think of the thousands of scientists now laboring to prepare CERN’s Large Hadron Collider to probe the secrets of the Big Bang. When we think of medicine, we think of Pasteur, Lavoisier, and Fleming, not the incremental progress of thousands of doctors and experimenters, working in clinics and laboratories worldwide over generations. When we think of biology, we visualize Darwin, Crick, and Watson, not all the men and women daily enhancing and re-confirming these visionaries’ work and putting it to practical use.

Our tendency toward hierarchy reaches its nadir in politics and government. It is not limited to extreme cases like Ivan the Terrible, Hitler, Stalin, Mao, Pol Pot or Saddam Hussein. The same trend—to follow the leader, with sometime disastrous consequences—persists to some extent all over the world.

Take Yasser Arafat, for example. He was the Palestinians’ alpha male. What did he bring them? Decades of unrelenting suffering, poverty, oppression, violence and misery. His legacy is playing out in the streets of Gaza today. Yet just as Russians still revere Stalin, who made them slaves and nearly lost their greatest war through incompetence, paranoia, cowardice and stupidity, Palestinians still see Arafat as their savior, if only he could have lived longer. This blindness shows no signs of abating.

Now look at our own country. George W. Bush is our very own Yasser Arafat. Much like Arafat (albeit for a shorter time), he has kept his people suspended in agony between war and peace. Unwilling to support or lead a real war, he has supervised a grinding and degrading exercise in futile, halfhearted violence that threatens to persist at least until he leaves office. Doesn’t that sound a lot like Arafat’s intifada? Yet Bush insists his own failed, half-hearted effort is both necessary and sufficient to avoid a threat to our very survival.

Bush’s position differs from Arafat’s in one important respect. Unlike Arafat, who never had any hope of defeating Israel militarily, Bush could have won his War in Iraq with competent leadership and adequate resources.

We could still “win” it, whatever that word now means. We have nearly fifteen times Iraq’s population, incomparably better technology and industry, and a military infrastructure orders of magnitude richer, stronger, and larger than Iraq’s. If we really wanted to, we could raise and send an army of a million troops—one-third of one percent of our population—fill Iraq’s skies with manned and unmanned spy planes, give every foot soldier the latest body armor and every patrol a well-armored vehicle, and lock Iraq down. We could even annex Iraq as our fifty-first state, and no power on Earth would stop us.

All we would have to do is raise taxes, tighten our collective belts, put our whole nation to work, and spread the sacrifice. Yet instead we throw our brave but hapless small band of troops into a meat grinder of our own making, waiting for the fractious Iraqis to help us.

We think we have a democracy, but we don’t. We have half a democracy. In domestic affairs our democracy functions poorly but perceptibly, at least when it is not in deadlock. (The jury on immigration is still out.) In foreign affairs we have one-man rule.

Our Constitution is partly at fault. It makes the president commander in chief but has no explicit provision for countervailing power or oversight during wartime. All that Congress can do is declare a war and cut off funds for troops in its midst. Congress has some related powers under Article I, Section 8. They include the power to “make Rules” for “Captures on Land and Water” and “the Government and Regulation of the land and naval Forces.”

But let Congress try to enforce these rules or interfere with a president’s prerogatives. As President Andrew Jackson is once reported to have pointed out, the Supreme Court has no way of enforcing its rules, no army, no bureaucracy and no direct contact with the chain of command. The same is true of Congress.

So in wartime, the president rules. Despite millennia of democratic evolution, the Renaissance, the Enlightenment, and the brilliance of our Framers, our structure of government still leaves us like the ancient Romans, under the control of a dictator in time of war.

We don’t use the same word any more, but the word we use still begins with “d.” Bush calls himself “the decider.” When a “war” seems to have no end, as at present, the “decidership” can last a long time. How much at home a Caesar or Crassus would feel in the United States today!

Few question this awesome anachronism. In the twenty-first century, in a nation of 300 million in a world of 6 billion, a single alpha ape decides the fate of all. Given all we know about psychology, sociology, government, law and collective human behavior, nothing could be more irrational. Yet still we soldier on behind our solitary leader.

The more than sixty percent of us who object do not question the system. The system, we think, is OK; we just have a bad leader, a fluke. We don’t consider that Bush made no revolution or coup d’etat. He may have pushed the envelope a bit, but he used our system as it is.

Meanwhile, the beta apes—the likes of Bill O’Reilly, Rush Limbaugh and Senators Cornyn and Kyle—jostle to line up behind the alpha male. Follow the leader, they thunder, or the enemy will soon be climbing over your window sills.

A moment’s thought reveals the absurdity of that claim. There are 1.3 billion Muslims worldwide, and there are terrorist cells in sixty countries, probably including our own. Even a complete “victory” in Iraq (whatever that means) will not stop international terrorism. Nor will a complete “loss” (whatever that means) necessarily bring more terrorists to our homeland. The terrorists’ chief goal is and has always been to create an Islamic Caliphate in as much of the Middle East as possible; we are a secondary and only occasional target.

As for containment strategy, having the best-trained terrorists in a single location may make them more, not less, easy to surveill and control. It would be nice if we could capture or kill them all off in a single place, but we can’t: the Muslim world will provide an unending supply as long as present social, political and economic conditions prevail. We can no more stop terrorism by jailing or killing all terrorists now in Iraq than we can stop illegal immigration by fencing a small part of our border with Mexico.

The simplistic view of the beta males also fails to recognize that we are not alone in this fight. As Iraqis and others taste more of Al Qaeda’s recipe for mayhem and religious tyranny, more of them will join the fight on our side. Iraq’s Sunnis are already moving in that direction.

In the final analysis, the notion that the sky will fall if we Americans don’t get complete control over Iraq is no more valid than the “domino theory” in the Vietnam war. The immediate risks of total civil war in Iraq may be greater than those of our withdrawal from Vietnam. But the exaggerated claims of catastrophe are nothing but a paranoid fantasy. Whatever happens in Iraq, we will still have our increasingly secure borders, the FBI, the CIA, our close cooperation with allies worldwide, our unsurpassed military, our nuclear arsenal, and our growing capability (via satellites and unmanned aircraft) to surveill and destroy terrorists and their weapons anywhere in the world. We don’t have to continue to wage an unnecessary war—far less to wage it halfheartedly—in order to keep our homeland safe.

So why does the nonsense that peddlers of half-hearted war try to sell us have such resonance? The answer is emotion, not reason. The thirty percent who still want to follow Bush over the cliff include the beta males. When a rival tribe threatens, beta males line up behind the alpha male; there is no thought, only instinct. Listening to Cornyn and Kyle spout their patent nonsense in the Senate, you can almost see the beta males screeching behind the alpha male as he beats his chest.

The greatest irony is not how much we all act like apes while some deny our origins. A greater irony is how much the United States is beginning to resemble our erstwhile Communist rivals, China and Russia. All three of these great nations seem to be drifting from their divergent roots, moving toward a common style of government in which one-man rule alternates with collective rule. (Under Alberto Gonzales, we are also beginning to resemble China and Russia in a second respect—converting justice into a matter of politics—but that’s another story.)

In our country this phenomenon may be limited to foreign and military affairs and may be subject to reversal. But if you doubt that it is happening, review the last five years. Every major decision—and every major mistake—of the last five years is traceable to decisions ultimately made by a single man, George W. Bush. He alone decided or approved decisions to invade Iraq, to send too few troops, to short-change our effort in Afghanistan, to neglect the drug and corruption problems there, to abandon our “honest-broker” status in the Israeli-Palestinian conflict in favor of uncritical support for Israel, to alienate our allies in Europe, and (lately) to keep our troops in Iraq in inadequate strength with a pathetically inadequate “surge,” to play “chicken” with the Russians in several respects, and to abandon much of Latin America to demagogues, whom he strengthened with his own demagogic rhetoric. And he made these decisions, in many cases, after ignoring the advice of his own experts, members of his bureaucracy and Congress, allies, and distinguished retired experts. If we have not had one-man rule for the last five years, we have had the next worst thing.

Now consider Russia. Although it has backslid a bit for the last two or three years, it is generally trending in the opposite direction. Stalin was the last true tsar of Russia, and he died in 1953. After he died, the Soviets moved toward a more cautious and bureaucratic form of government. With Stalin’s despotism fresh in their minds, they had no desire to anoint another tsar.

The Soviets’ high council, called the Plenum of the Central Committee, occasionally saw dissent and robust debate. That’s one reason why we all survived the Cuban Missile Crisis and rapprochement and disarmament became possible. Group decision making—even in a small, elite and tightly controlled group like the Soviet Plenum—tends to avoid recklessness and crisis better than one-man rule.

After perestroika and the Soviet Union’s collapse, Russia moved smartly toward democracy. It abolished the gulags, freed the press, and adopted a new constitution, “trying on” parliamentary democracy. Despite the economic hardships that followed, neither the Russian people nor their leaders wanted to resurrect tyranny.

Now, of course, there is a counter-trend. President Vladimir Putin has seized control over the hinterlands by abolishing elections for regional governors. He has cowed, intimidated and bought up most of the press (ironically, using capitalist methods) and much of the Duma. Russia is a far more authoritarian place under Putin than it was under Yeltsin, although it is also far more prosperous.

Yet a return to one-man rule after Putin seems unlikely. Putin himself is a special case. He is the most intelligent, public-spirited, capable, and effective ruler that Russia has seen in over a century. He has done more to improve Russians’ standard of living and reduce poverty in Russia than any leader since Peter the Great. It was natural, although regrettable, for him to try to seize more power in order to accomplish more of the Sisyphean task of reforming and modernizing Russia before his two terms are up.

As Russia diversifies its economy from selling natural resources to competing in international business and industry, Russia’s authoritarian form of state capitalism will probably evolve into more genuine democracy. That sort of evolution has plenty of models, from Spain before and after Franco, to Taiwan, Korea and Mexico. The alternative is likely to be a modified form of bureaucratic state, in which the cabinet (perhaps in cooperation with the security services from which Putin comes) holds real power, while the Duma exercises weak and sporadic oversight.

A return to one-man rule in Russia is unlikely under either scenario. Russians do like a good, strong man (Putin) as leader but don’t want one who is too strong (Stalin). And Putin is far too intelligent and aware of history to knowingly prepare conditions for a return to permanent one-man rule. While many in Russia still revere Stalin, no one wants to bring him back.

China has the most interesting story. Badly burned by Mao’s caprice and destructiveness in his later years, China seems determined to avoid repeating the tragedy of one-man rule. Even China experts have trouble determining what is really happening inside the closed doors of China’s higher leadership. But it appears that Hu Jintao and Wen Jiabao are just the most prominent among a small group of top leaders making important decisions collectively. They seem to recognize that more heads are better than one, and they are generally thoughtful, careful, prudent and conservative.

To assess China’s relative prudence, compare wars. Since the Korean War, China has fought precisely zero wars, while we have fought five, excluding Grenada and Haiti: Vietnam, Gulf I, Kosovo, Afghanistan, and Iraq. Of those five, we have lost one and are rapidly losing the latest.

At the same time as they avoid wars and one-man rule, China’s leaders are transforming the Communist Party into an educated, technocratic elite similar to the old Mandarin bureaucracy under the emperors. If this apparent trend continues, the result could be the world’s most effective government, with well-trained and educated operatives at every level and prudent, collective decision making at the top.

So don’t count China out, whether or not it eventually develops a democracy that looks like ours. China’s old Mandarin bureaucracy was a world-class social innovation. The Japanese copied it, and their MITI and Ministry of Finance helped them achieve their economic miracle. If the Chinese can replicate and improve their old Mandarin bureaucracy under the so-called Communist Party’s aegis, and if they can maintain wise collective leadership at the top, they may have a world-beating combination.

Notwithstanding Francis Fukuyama, history is a long way from over. Whether our species’ future history will be a happy one remains in doubt. Among the most important remaining historical questions is whether humankind can break from its genetic origins and stop following the alpha ape.

To any student of history, the advantages of collective leadership over one-man rule are self-evident. Subjecting a modern, complex, multiethnic, technological nation to the caprice, foibles and limitations of a single individual is folly on a colossal scale. Yet, like the refrain of a bad song, one-man rule recurs again and again.

Democracies may have ameliorated the worst personal vendettas, but they are not immune from the caprice of one-man rule. Witness George W. Bush and Tony Blair, leading their supposedly strong democracies into an unnecessary war, and continuing to wage that war with grossly inadequate forces, convinced that “steadfastness” and “resolve” will overcome both reality and determined enemies.

Viewed from an evolutionary perspective, their “resolve” means following the alpha ape regardless of consequences.

After millions of years of biological evolution and tens of thousands of years of social evolution, we humans are still groping for a stable, durable and effective form of collective government. Far too often, even the best and strongest nations have lapsed into one-man rule, with disastrous consequences, in times of stress. If the last five years have proved anything, they have proved that neither popular elections nor the United States Constitution holds a final solution to the recurring tragedy of one-man rule.

The last five years have seen much backsliding. Most discouraging, the United States and Russia are beginning to resemble each other more than at any time in their history. Both are increasingly characterized by manipulation of public opinion, control or manipulation of the press, impenetrable government secrecy, and the substance, if not the form, of one-man rule.

Yet there are encouraging countertrends. Non-hierarchical social and political structures, mediated by the Internet and modern communication technology, have the potential to create a serious alternative to one-man rule.

The United States’ slow reaction to global warming is the best example. Stubborn as a mule, our presidential alpha ape has persisted for six years in a policy of wishful thinking, ignoring and distorting the truth. Those who want to hear the truth and save our planet as we know it follow a different alpha male, Al Gore. And so we have a weird battle for supremacy of two alpha apes—a sort of ideological replay of the 2000 presidential election.

A similar battle of champions might have played out on the jousting fields of medieval Europe a millennium ago. Not so good for the progress of human social evolution.

But below the level of national politics and policy, another very different phenomenon is emerging. Individuals and smaller groups are “voting” with their minds and acts. Consumers are buying compact fluorescent light bulbs, “tuning up” their cars and homes, buying more efficient cars and appliances, and even planting trees and buying carbon credits. Businesses large and small are doing much the same thing, but on a larger scale. Our several states, with California in the lead, are preparing to take matters into their own hands with various forms of governmental regulation of greenhouse gases. Even evangelical Christians are getting into the act, working to retard global warming based on the notion, derived from Genesis, that we humans are stewards of the Earth.

If these trends continue and spread, they have the potential for replacing stagnant biological evolution with useful social evolution. They might eventually drag us from the social organization of our primate ancestors to a better, more rational form of collective decision making.

More traditional forms of collective government also show encouraging signs. Although sometimes dismissed as a satellite of the United States, Japan has its own, unique form of representative democracy in a culture found nowhere else in the world.

Japan has a world-class, highly educated and elite bureaucracy, built on China’s Mandarin model. That bureaucracy has “guided” its private economy from the ruins of World War II to global supremacy in automobiles, railways and consumer electronics. A single political party with two wings “rules” Japan softly and quietly, relying on a constant search for consensus and harmony that springs from the deepest wells of Japanese culture. While superficially similar in form to our system, Japan is worlds away from the divisiveness and litigiousness that constantly threaten gridlock and are slowly corroding our social institutions (including Congress) from within.

Japan gets far too much scorn and far too little study of its highly effective consensus-seeking, collective form of government. Its industry has reached the pinnacle of quality in cars and electronics, two of the most advanced forms of human collective achievement. Its clean and safe 180 mile-per-hour trains routinely pull into their stations and stop just as the second hand hits the appointed time. Social trust is so high in Japan that people send large amounts of cash through the mails in brightly colored envelopes, trusting each envelope to reach its addressee. It virtually always does.

Japan is the only country in the world in which an inebriated foreigner can stumble along the back alleys of a major city in the wee hours in complete safety and tranquility. It is probably the safest, cleanest, best organized and most orderly society on Earth. With its aging population and puzzling (to Westerners) social-consensus system, Japan is an exemplar of rational collective government.

Alpha apes, as we know them in the West, are rare in Japan. The emperor is now only a figurehead. The prime minister rules, if at all, by consensus or finesse. The myths of John Wayne and Rambo do not loom large in Japanese culture.

So our human experiments in collective self-rule continue. In Japan, in China, in Europe, in Russia, in our own country, in NATO, at the United Nations, and yes, in the Islamic world, humanity is searching for a stable, effective form of collective government—an antidote to one-man rule.

It is now abundantly clear that the United States has found no durable or universal solution. If our species’ ongoing social trials don’t produce some good answers before we blow ourselves up or poison our planet, Francis Fukuyama may end up being right, just a bit later than he expected.

A Tale of Honor and Government by Clique

It is not bad to be proven wrong when the proof provides a germ of hope. A few days ago I wrote that “Not a single act of honor, courage, or personal integrity has diluted the unending flow of disastrous partisan poison” from the Bush Administration. Now we know that I was wrong: there was at least one act of honor and reportedly three.

On Tuesday James B. Comey, the second in command at the Department of Justice during John Aschroft’s tenure as Attorney General, described his own act of honor.

His story, told under oath before the Senate Judiciary Committee, is now widely known. It relates to the president’s ongoing program of secret electronic surveillance of Americans in our own country. The story occurred in 2004, long before the program’s existence was leaked to the press and the public became aware of it.

The Justice Department had authorized the program once, for unexplained reasons, apparently on an emergency basis. Legally required reauthorization was pending. After a thorough review, the Department’s professional staff had concluded that the program was illegal. The reasons for that conclusion are still undisclosed.

Attorney General Ashcroft was in the hospital for emergency gall-bladder surgery, and Comey was Acting Attorney General. Based on the Department’s professional legal review, he refused to reauthorize the program.

A single day remained before the program’s authorization was to expire. Together with Andrew Card (then White House Chief of Staff), then White House Counsel Alberto Gonzales tried to make an end run around Comey. He planned to confront Ashcroft in the hospital, although Ashcroft was still sedated and had been temporarily relieved of duty, and despite Ashcroft’s wife’s insistence that he receive no visitors.

Comey got word of the plan and, with sirens blaring, raced to the hospital where Ashcroft was lying. He arrived minutes before Gonzales and Card and confirmed his previous agreement with a semi-conscious Ashcroft. When confronted, Ashcroft upheld the law and would not bend.

Furious, Card and Gonzales went to the president, who tried to pressure Comey. Comey submitted his resignation. According to Comey, so did Ashcroft and FBI Chief Robert Mueller.

Faced with the threats of three high officials to resign, the president backed down. He modified the secret surveillance program to meet the Justice Department’s objections. Comey, Ashcroft and Mueller had gotten the mule’s attention.

Over two years later, a second standoff with Congress brought the secret surveillance program under a new statutory framework that balanced civil rights and security and made it legal. None of these things would have happened without Comey’s honorable and courageous stand on the night of Ashcroft’s post-operative recovery.

The tale of this “palace revolt” of Justice Department and FBI heads is a wondrous thing to tell. Who would have thought it of John Ashcroft, who did his best to bash a hole through the wall between church and state that has kept us free from pogroms and sectarian tensions for over two centuries? At some level even Ashcroft was a trained and honorable professional who could not abide the president running roughshod over the rule of law.

Yet before we allow this rare story of honor and integrity in the Bush Administration to intoxicate us, we need answers to two questions. First, why did Comey and Ashcroft remain silent for three years?

Robert Mueller is still FBI head, so we can attribute his silence to custom, professional expectations, and putative executive privilege. But Comey and Ashcroft are no longer with the federal government. But for 3,000 votes in Virginia, giving the Democrats control of the Senate by one vote, this encouraging story would have remained secret, certainly until the Bush Administration expired, perhaps for decades.

In late 2005, the public became aware of the secret surveillance program through leaks in the press. The program’s operational details are still secret, as they should be for security’s sake. But once the program’s existence became known and a matter of intense public debate, what reason could there have been to keep secret this tale of honor and steadfastness in defense of the rule of law?

The only credible answer is loyalty, to the president personally and to his political party. While public debate over the program’s legality was hot, Congress and the people should have known what three courageous men had thought of the program initially, and how much they had had to put on the line to keep it legal. Their loyalty kept that knowledge from us.

In the end, the three men kept faith with the rule of law, but not with the principles of democracy. Were it not for change in control of the Senate, “we, the people” might not have known for years how Bush and Alberto Gonzales tried to trample the rule of law and how the best of their colleagues thwarted their destructive impulses.

The second question that needs an answer is what this story reveals about the country’s present chief law-enforcement official, Gonzales himself. Gonzales was White House Counsel, not Bush’s private attorney. His professional obligation was to the office of the president, not the man in it. As a public official paid with public funds, he had a duty to keep an eye on little things like the rule of law, democracy, and history, in addition to the president’s views. No one operating at that level of democratic government should be a lackey.

And what else might you expect? George W. Bush picked Alberto Gonzales out of nowhere in Texas and made him all he is today. Without George W. Bush, Gonzales would be nothing more than a successful partner in an obscure law firm—one of the thousands in our over-lawyered nation.

Under those circumstances, how can anyone expect Gonzales to show the type of independent judgment that every high-level political appointee in a democracy should have? The relationship of mentor to nobody elevates loyalty above all else, undermining democratic government at the highest levels.

Contrast this sorry state of affairs with Abraham Lincoln’s cabinet. To everyone’s surprise, Lincoln appointed his chief political rivals. His reason was not Lyndon Johnson’s rule—better to have them inside the tent pissin’ out than outside the tent pissin’ in. Rather, Lincoln appointed his rivals because, in his words, they were the ablest men available. Each had had a long and distinguished political career, enjoyed great public esteem, and had an independent constituency. Together, they gave Lincoln solid, expert, and independent advice in the runup to our greatest challenge, the Civil War. No lackeys or sycophants for Lincoln.

It is far too late to do anything about the Bush Administration in this regard. Bush seems to like sycophants and to value personal loyalty above all else. He has run the people’s government—our government—like a secret clique, using every excuse to hide our business—and his mistakes—under the veil of executive privilege.

The contrast between men like Comey and men like Gonzales is therefore a cautionary tale. We can—and should—force Gonzales to resign. He has twice demonstrated his lack of the independent judgment that his office requires. But we should not be surprised if Bush appoints another lackey in his place. Already Bush has tried to put one on the Supreme Court.

What we all can do is vet the candidates for 2008 very carefully. It may be too much to ask them to name names. But surely we should press them on their “philosophy” of cabinet appointments. Ultimately, whether a candidate has the vision and strength of character to appoint men and women with their own authority, centers of power and political constituencies may be the most important question we can ask.

permalink

The Demise of Honor

As the rule of law dissolves before our eyes, one of our greatest ironies is blind faith in our Constitution. Like a homeowner quoting words on paper to a crooked contractor, we think our prime document will protect us. We forget that words on paper are only as strong as the honor and integrity of the people sworn to uphold them.

A written constitution provides a false sense of security. England has an unwritten constitution, and its democracy has lasted nearly 800 years. Our Constitution seems stronger for being written down. But at the rate we are going our democracy may not see its 250th birthday, at least in any form we would recognize as such. The reason: people in high places, who should know better, seem to believe that winning the game--or merely staying in it--is more important than playing by the rules.

Nearly thirty-three years ago, the last president to abuse our constitutional system for personal and partisan advantage was driven from office. By today’s standards, Richard Nixon’s transgressions were puny. He did not start his war; he inherited it. He did not lie about the reasons for making war; he only lied about his “secret plan” for peace.

True, Nixon seemed to approve the criminal acts of the “Plumbers,” a group of political and intelligence operatives formed to wage clandestine war against the Democratic party. True, he kept an enemies list of people for the FBI and IRS to persecute for political reasons or personal revenge.

But even Nixon did not seek to turn the entire Department of Justice into a political operation. In those days, doing so would have mimicked the Soviet Union’s Communist Party too much for even hardened Republican partisans to countenance.

In the end, it was not our Constitution that deposed Nixon. It was the acts of courageous and honest people, including many Republicans, at all levels of government. Republican Senators like Howard Baker (R. Tenn.) led the charge to bring Nixon down. Honest, nameless government bureaucrats retarded Nixon’s efforts to persecute the “enemies” on his list.

The Supreme Court refused to let Nixon hide his sins behind a veil of executive privilege. It allowed publication of the Pentagon Papers--a leaked study of misfeasance in the Vietnam War. Eventually, it forced Nixon to give Congress his White House tapes, revealing evidence of his cover up.

When an incriminating eighteen-minute gap appeared in those tapes, Nixon sought to fire Special Prosecutor Archibald Cox, a universally admired jurist and symbol of impartial justice. Elliot Richardson, then Attorney General, reacted with honor. He resigned in protest rather than carry out the order to dismiss Cox. It fell to Robert Bork, then Richardson’s assistant, to salute and obey.

Years later, when President Reagan nominated Bork for the Supreme Court, Bork’s previous blind partisanship and loyalty to Nixon, plus his disloyalty to principles of impartial justice, came back to haunt him. His nomination crashed and burned in a partisan showdown that was the mother of all judicial confirmation battles.

But the victory over Bork was pyrrhic. Nowadays our government is full of Borks.

Throughout all the Bush Administration’s incompetence, misfeasance, malfeasance, and partisan subversion of democratic principles, not one senior official has resigned in protest. Not a single act of honor, courage, or personal integrity has diluted the unending and disastrous flow of partisan poison.

Many were forced on their swords in a vain attempt to preserve Bush’s political power. Among them were honorable men like Andrew Card, Paul O’Neill, and Colin Powell. More recently, there were less honorable ones, like Monica Goodling and Lyle Sampson, pushed overboard to hide self-evident efforts to turn the Department of Justice into a Department of Republican Politics. But none, including the honorable ones, emulated Elliot Richardson and resigned to make a point.

The man who supported or idly tolerated the latest debacle, Alberto Gonzales, wants to stay on to “do his job.” What job is that? Finishing converting our independent prosecutors into partisan lackeys? Making justice in America look more like “justice” in Russia and China? Has he no shame?

Now we have the final ignominy. George Tenet admits in his own hand trying to warn the Administration of the impending threat that became September 11 and the debacle that Iraq has become. Yet not only did he never resign in protest; insofar as he tells us, he never even put his views forcefully to the president when they might have done some good. As his reward for sheepish loyalty to a deeply flawed leader, he accepted the Medal of Freedom. He concludes that he served “honorably,” but where is the honor in that?

Unfortunately, Gonzales and Tenet are not alone. They are just two of a long series of lackeys and sycophants whose dearth of professionalism, honor and integrity allowed the Bush Administration to bring our country low.

The fault is not Bush’s alone. He is what he is. People might have misjudged him initially. But no one with an ounce of good judgment of human character could overestimate his intelligence, honor, integrity or faithfulness to democratic principles after several years. It is almost as if the president’s self-evident lack of good leadership increased his hold over his minions. Or maybe, God help us, awe for the presidential office subverted all sense of right and wrong.

So-called “conservatives” are right about one thing: we live in an age of moral decline. But the deadliest symptoms are not abortions, drugs or violence on TV. Decay always starts at the top.

The moral failings that are potentially most fatal are of people in high places to honor our nation’s most basic principles. Whether to keep their jobs, maintain their lifestyle, advance their political agenda, or show loyalty to a man who respects nothing else, too many people have dropped their honor and our rule of law in the dust. That is a recipe for gang rule, not democracy.

King George is a monarch in all but name, as destructive and capricious as any ancient Chinese or Roman emperor. He remains so because no one close to him has the honor, courage or self-respect to stand against his destructive impulses. If there is any justice left, those who had the chance but lacked the honor will pay dearly at the next election.

Eden or the Fall: for Real This Time

Of all the stories told and retold by humankind, the myth of the Garden of Eden is the most compelling. We lost our Paradise, the myth says, because we made a fateful choice. Our choice drove us from Paradise to wilderness, where we must fend for ourselves without God’s protection.

What makes the myth so compelling is how deeply it probes human nature. A powerful Temptation informed our choice--one which we could not resist. We lost our innocence and forfeited Paradise in exchange for knowledge of good and evil, i.e., free will. God drummed us out of the Garden, and the road has been hard ever since.

The Bible says the fateful Temptation was knowledge. But “knowledge” is a dry and abstract concept. It hardly compels emotional attention. The pictures tell a very different story. The Middle Ages’ transcendently beautiful paintings show a gorgeous Eve, fully nude, accepting a luscious apple from the Serpent of Temptation. You don’t have to have Freud’s knowledge of phallic symbols to understand Temptation as the pleasures of sex.

And so we have the myth’s modern version. Pleasures of the flesh exposed Reason’s weakness and cast us out of Paradise. We exchanged the innocence of childhood for the powerful and dangerous urges of puberty and Reason. And we’ve been fighting a twilight struggle with Evil ever since.

This sexual view of Temptation undergirds much of Western cultural history. From the Catholic Church’s association of sex with shame and guilt (except for procreation) through the negative body fetish of the Puritans and the Victorian Age, the notion of sex as dangerous Temptation leading to a Fall is deeply embedded in Western culture.

It was not always so. The ancient Greeks and Romans had a very different attitude toward sex. They took it at face value and viewed it as part of the natural world’s inherent glory. Countless ancient statues, paintings, murals, and frescoes show human sexuality with accuracy, innocence, humor and tenderness--sometimes even reverence. Archaeologists discover more such works of art every day. It took our Medieval Christians, inspired by the myth of the Garden, to wage a cultural jihad against sex, striking off statues’ genitals, replacing them with fig leaves, and covering our “shame” with strategically draped cloth.

But nothing lasts forever. The Earth turns on its axis. New cultures evolve, and old ones gain supremacy. The century of Asia has begun.

Like the ancient Greeks and Romans, Asians have few sexual hangups. From the hilarious erotic art of Japan’s Edo period, through the concubines of Imperial China, to modern mistresses in Bangkok, Beijing, Hong Kong and Shanghai, Asian cultures accept sex as a natural, inevitable and enjoyable part of human life. If Asian art shows less nudity than did ancient Greece’s and Rome’s, the reason is doubtless that Asia’s main centers of culture were and are in colder climates.

As Asia waxes transcendent, what will become of our culture’s most compelling myth, the myth of Eden? Will it lose its power and become an historical footnote, like Atlas emerging from the ocean with the world on his shoulders?

The myth’s two traditional foci have little relevance to Asia. Asians have never been sexual Puritans and are not so today. As for the “original” version of Original Sin--knowledge--Asians today seek it more avidly than ever before. The vast Asian stampede toward education, science and engineering today hardly portends suspicion of Reason as leading to a Fall.

So is the great myth of Eden destined for oblivion as Asia rises?

Maybe not. Industry and history might conspire to renew it, giving it more power and importance than ever before. The Temptation this time is neither knowledge nor sex, but energy. The Apple of Temptation is no longer pleasures of the flesh or of the mind. It is coal.

Coal is the most dangerous and seductive temptation that humanity collectively has ever faced. It is plentiful. It is cheap. It lies close to the surface and, compared with other minerals, is easy to dig out. Neither Muslims nor Arabs control it. We Americans have enough to meet our energy needs for hundreds of years. China has enough at least to complete its economic transformation, and probably for many more years to come. That is why China is building one new coal-fired power plant per week, and Texas, in its infinite environmental wisdom, until recently seemed not far behind.

There is only one problem: coal will drive us from our Eden as surely as did the biblical hand of God.

We have only one planet. It is our Eden. We evolved here, and so it is just right for us. Even if we “terraform” Mars, it will never be the same. Mars will always be too cold, too dry, and too far from the Sun.

As for other planets that we may find, they’ll be even worse. The recently discovered planet circling Gliese 581, for example, is fourteen times closer to its red dwarf sun, and (because of huge tidal forces) it keeps its same face to its sun all the time. Imagine living on a world in which a dull red sun glowers from a quarter of the sky, without ever setting, and there is no day-night cycle. Men and women trying to live there might go mad.

So there is no place to run. If we succumb to coal’s temptation, we will lose our Eden forever.

Coal is more than half the problem of global warming. It provides more than half our own electric power, and much more than half of China’s and India’s. Coal is the chief source of greenhouse gases worldwide and the primary threat of global warming.

For years fossil fuel junkies derided sober climate scientists as alarmist. But global warming appears to be accelerating faster than anyone expected, even the alarmists. This spring temperatures throughout Europe broke records for days and weeks in a row. If these weather patterns persist, by August we may see heat waves in Europe on a truly biblical scale. Thousands may die.

But global warming is only part of the problem with coal. Coal is the dirtiest fuel known to mankind. In addition to carbon dioxide, which causes global warming, burning coal produces sulfur dioxide, which combines with water to form sulfuric acid (for example, in your lungs). After fifty years of trying, we Americans are just beginning to get a handle on the destruction of our northeast lakes, streams and forests caused by coal-generated sulfur dioxide, so-called "acid rain." The rest of the world hasn’t a clue.

Then there is mercury. Burning coal lifts mercury--a potent and long-lasting nerve toxin--into the air, where it ends up in lakes, rivers, and oceans, poisoning fish and other aquatic wildlife. The recent warnings against pregnant women and other vulnerable people eating too much tuna are largely due to burning coal.

Finally, there is the quality of life. Visit Beijing, Shanghai, or Hong Kong, and breathe deeply. Go to Gary, Indiana. Cruise down the so-called “Mexican Riviera,” and see city after city--Cabo San Lucas, Mazatlan, Puerto Vallarta--hiding its natural and architectural beauty in an orange-grey pall of coal-produced particulates and sulfur dioxide.

For the first time in human history, we have the power to bring the myth of Eden to life. We have temptation, and we have choice. We can have cheap power without much effort and turn our Eden into a kind of earthly purgatory. Or we can tighten our belts, work a little harder, conserve, and rely more on nuclear, solar, ethanol, wind, geothermal, and hydroelectric power and keep our Eden alive.

The Temptation and the Choice are real this time. Purgatory or Eden. Coal or alternatives. The next decade or two will tell whether we can resist Temptation or will suffer the Fall.