David Brooks: Let the bullies win

New York Times columnist David Brooks penned a remarkable column this week in which he makes the case for Romney as the vessel of bipartisan reform.  In the piece, he makes a reasonable set of assertions:

1.  Obama will pursue what Brooks calls "a moderate and sensible agenda", including re-creating the "Grand Bargain", immigration reform, corporate tax reform, infrastructure and such.
2.  Republicans will fight him tooth and nail on everything, as they have done for the whole first term.
3.  Were Romney in the White House, Democrats would be more likely to work with him than Republicans have been to work with Obama.

He goes on to imagine a scenario where Romney would offer to increase taxes on the wealthy, give up chunks of the Ryan budget cuts, and decrease the size of his tax cuts in order to get the Democrat-controlled Senate to go along with his plans to shift the government to the right.  Republicans would, according to Brooks, vote for these things because they don't want to make a Republican president look bad.

Brooks' faith in the ability of Republicans to learn compromise is absurd on its face.  The Republican Party has spent the last 30 years whipping its base into an anti-tax frenzy.  The Republicans Brooks expects to vote for Romney's tax-raising compromise with Senate Democrats would be decimated in the GOP primaries next time around.  Almost every Republican in Congress signed Grover Norquist's pledge to never ever raise taxes ever, and those broken pledges would end lots of careers.

So I'm not as optimistic as Brooks about the chances of bipartisan solutions under a President Romney.  In the spirit of his article, however, I'd like to imagine a scenario where an Obama victory leads to bipartisan cooperation:

Obama wins re-election and pursues his "moderate and sensible" agenda.  Republicans know that the economy will likely add 12 million jobs during his second term even if Obama is prevented from passing anything.  Given their failure, in this scenario, to win the White House in 2012 with a bad economy, they are leery of their prospects of defeating the incumbent party in 2016 when things are (probably) much improved.  They also know, as things stand, that they are on the wrong side of the nation's evolving demographics.  If they continue to pursue policies that result in their candidate losing Latinos 73-21, they will go the way of the Whigs.  These short- and long-term realities will bring Republicans to the table, correctly recognizing that their obstructionist tactics are a path to irrelevance.

A boy can dream.

Don't be fooled about Roe v Wade

Former Minnesota Senator and current Romney surrogate was speaking in Beachwood, Ohio today.  The above video is his claim that Roe v Wade would not be endangered under a Romney presidency.  To support his claim, he says "President Bush was president eight years, Roe v. Wade wasn't reversed. He had two Supreme Court picks, Roe v. Wade wasn't reversed. It's not going to be reversed."

This is, of course, pure bullshit.  For starters, Romney's website says that "he believes that the right next step is for the Supreme Court to overturn Roe v. Wade".  It's also important to consider the make-up of the Court.  Bush's two Supreme Court picks were to replace Rehnquist, who was on the Court when Roe v Wade was decided and wrote a dissent, and to replace O'connor, which made for four justices who are for eliminating Roe.  Those four (Scalia, Thomas, Roberts, Alito) are of course still on the bench.  So it would only take one more for Roe to be overturned.  As previously discussed, there's a pretty good chance, given the ages and health of the justices, particularly Ginsburg and Kennedy, that there will be another nomination to make in the next four years.  If Romney's in office, which way do you think it's going to go?

This is something that moderate/undecided voters need to think about.  It's fine to vote for Romney as a way to push for lower taxes or less regulation or whatever.  But you can't separate his views/policies.  If you vote for his tax plan, you also vote for his abortion plan and his views on other social issues.

How not to help hurricane victims

Romney held a "storm relief event" in Ohio today (at the site of a "canceled' campaign event) at which his campaign collected canned food and such to be sent to areas affected by Hurricane Sandy.

From the Red Cross website:

The American Red Cross does not accept or solicit small quantities of individual donations of items for emergency relief purposes. Items such as collections of food, used clothing, and shoes often must be cleaned, sorted, and repackaged which impedes the valuable resources of money, time, and personnel that are needed for other aspects of our relief operation. 

The Red Cross, in partnership with other agencies, suggests that the best use for those types of donations is to support needy agencies within donors' local communities.
The best way to help a disaster victim is through a financial donation to the Red Cross. Financial contributions allow the Red Cross to purchase exactly what is needed for the disaster relief operation. Monetary donations also enable the Red Cross to purchase relief supplies close to the disaster site which avoids delays and transportation costs in getting basic necessities to disaster victims. Because the affected area has generally experienced significant economic loss, purchasing relief supplies in or close to the disaster site also helps to stimulate the weakened local economy.

Rather than model the sort of approach that would actually best help victims, Romney decided to go for what looks better.  A picture of Romney sorting canned goods looks better than just asking people to write a check.

Why oh why are we not spending on infrastructure?

Our nation has:

1. Millions of people looking for work

2. Hundreds of billions and/or trillions of dollars desperate for some way to be spent (as evidenced by the historically low rate of return on bonds)

3. Cities with inadequate flood protections, bridges we all drive on which aren't up to code, and slower internet than much of the developed world.

Romney says he's for infrastructure spending, but given the massive challenges he'll face to pay for his tax rate cuts, increased military spending, and pay down the deficit, it's seems likely that plans to increase domestic discretionary spending will be first on the chopping block.

This is one of the many reasons why Romney's vagueness is so frustrating.  It allows him to say "sure, I'm for infrastructure spending!" without showing where he'd get the money from.  It deprives voters of a chance at real discussion.  Everybody's for giving citizens benefits if there doesn't have to be discussion of costs.  It's figuring out the balance between competing possibilities that requires debate and leadership.  Romney provides neither.

Romney releases brilliant/cynical ad

Obama's auto bailout, which saved lots of jobs in Ohio, is a big reason for his lead in the crucial state.  Knowing he needs to win the state to win the White House, Romney released an ad which makes a number of attacks on Obama which are technically true but are quite misleading.

He attacks Obama for taking Chrysler and GM through bankruptcy, which Romney supported.  Obama's approach to bankruptcy was objectively better than Romney's as Obama's would actually work; Romney said it should have been funded by private capital, which, like all of Romney's proposals, sounds great in theory but doesn't work out in reality, since no private group was willing to lend the companies besides the government.

Romney boasts of being supported by former Chrysler CEO Lee Iacocca and the Detroit News.  So a rich guy and a conservative paper support him.  That's nice.  But they are associated with Detroit, and if they like him, that must mean he's good for the auto industry, or something.

The ad also implies that Chrysler is moving Jeep production to China, when in fact they are adding new production to build Jeeps in China to be sold in China.

It pains me to admit, but it's a great ad.  While the main points of the ad fall apart on close inspection, most voters aren't going to give it any sort of inspection.  At this stage of the game, it's tough to refute these sorts of "not technically false but definitely misleading" attacks.  When the candidates are debating and sitting for interviews and such, these things can be picked apart.  At this point, it's easy for such things to slide by without being challenged.

Borrowing from China to oppose China

Romney says his main criterion for spending is to ask " is it so important, so critical, that it is worth borrowing money from China to pay for it?"  Romney also plans to boost spending on the defense spending by $2 trillion beyond what the Pentagon asks for.  Who else might we realistically need more nuclear attack subs to oppose, if not China?  It would be one thing if Romney were proposing spending a shitload on Navy SEAL teams and counter-terrorism technology, but he specifically mentions tanks and Navy vessels, increases of which would only be needed for conflicts with a major enemy like China.

Ohio unbelievably important

Over at the FiveThirtyEight blog, which is far and away the best prediction/polling analysis resource in existence, Nate Silver (co-author of the "1 in 60 million" study (.pdf) referenced yesterday) calculates what he calls the "tipping point" state, which is the state that pushes the winner over 270 electoral votes if you start counting with the overall winner's most lopsided state win and keep adding in closer and closer races.  Silver runs thousands of simulations every day, every time ranking the states from biggest wins to smallest, finding the tipping point each time.  He projects that Ohio has a 49% chance of being the crucial tipping point.  This is due to Ohio's position as a relatively close, relatively elector-rich state.  If Romney loses Ohio, he's probably screwed.  If he wins it, he's probably our next president.  Since most of my readership is in Ohio, seemed important to mention.

FYI, based on all kind of data including polls, past elections and economic indicators like unemployment, Silver currently gives Obama a 76% chance of winning Ohio.

Examining my options, part 2

Yesterday, I looked at the various options for alternative people to vote for besides Obama.  Today, let's consider some reasons for not voting.

-"The candidates are the same"
While it's true that plurality voting pushes the candidates to have similar views in the grand scheme of things (neither is a communist, anarchist, autocratic dictator, etc.), there are still huge areas of disagreement.  Romney would spend about $2 trillion more on national defense in the next decade than Obama.  Obamacare would mean health insurance for about 45 million more Americans than Romney's plan.  That's a shitload of difference.  I'll grant it's not as much difference as there'd be if Gary Johnson or Jill Stein were in the equation, but it's not insignificant.

-"My vote doesn't matter.  How likely is it that one or the other will win by a single vote?"
A study (.pdf) before the 2008 election calculated a 1 in 10 million chance that a single vote would affect the outcome in one of a few toss-up states, and 1 in 60 million that it would decide the presidency. While there are plenty of people who would buy a lottery ticket at those odds, I think it's pretty unlikely that such a tiny sliver of a chance of affecting the outcome is the primary motivating force for most voters.

The satisfaction I gain from voting comes from my sense of identity, as well as social pressures.  As you might have guessed, I have lots of opinions about politics and enjoy sharing and discussing them with others.  Election Day for me is first and foremost a time when we come together and tell each other what kind of country/state/county/municipality we want to live in.  It's a time when we share our opinions with each other on a grand scale.  To skip the opportunity to participate would make all my musings, reading and discussions of politics ring hollow.  Unless I thought that...

-"Voting, or any involvement in government, is coercive/evil."
Our government is above all things an instrument of violence and coercion.  Everything the government does is backed up with the threat of dudes with guns breaking down doors and making it happen.  Voting necessarily involves a plurality making decisions that not everyone would agree with.  Any participation in voting, then, might be viewed as a coercive act and something to be avoided.

One of the beauties of our voting system is that there is no limit to what one can work toward within the system.  Constitutions can be amended, laws can be changed, anyone can be elected to any position, and positions can be created and eliminated as needed.  While the government as currently formulated involves a plurality forcing obligations on others (taxes, imprisonment, etc.), one is not obliged to vote for the continuation of such acts.  Were one so motivated, one could vote for candidates and issues which would dismantle any and all structures of government.

This could be viewed as a form of coercion itself, as it might prevent people who want things like Medicare and national defense from having them.  But eliminating government wouldn't do that.  Anyone who wanted could enter into private agreements to provide these benefits to each other.  They just would not be given the power to force others to be involved through involuntary taxation.

-"Voting's just not worth my time."
Given that an individual's decision to vote or not only has a 1 in 60 million chance of actually affecting the outcome, there's no moral obligation for anyone to vote.  Not everyone has the same values as me.  Their own self-identity might not involve placing the same importance on politics/government.  They might have views which are out of the mainstream to the degree that other voters would never accept them.  Maybe they have something better to do on November 6th.

Examining my options, part 1

As discussed yesterday, there are life-and-death issues where I find Obama's stance terrible.  Like, "killing innocent people" terrible.  So, what is a boy to do?  Let's investigate my options for whom to vote:

-Vote for Green Party nominee Jill Stein
As previously discussed, when it comes to the issues, Stein is my ideal candidate.  She's a tax-raising, welfare-loving enviro-peacenik.  She also has no chance of winning.  It's true that more votes for her would help similar candidates in future elections and to some tiny degree move our politics more in my direction.  The power of the president and the bully pulpit, however, have a much greater ability to change the future.  Assuming there's sufficient difference between the major nominees, which I believe there is (more on this later) at least this time around, whatever minuscule benefits gained by Stein as a result of a few thousand more votes aren't worth the risk of those votes changing the winner of the election.  It would be great if our voting system were capable of registering my preference for Stein's policies while also letting me help decide the winner, but as it stands, I have to do one or the other.

-Vote for another third-party candidate
If I'm not going to vote for Stein, I can't think of any good reason to vote for another inevitable loser with whom I agree less.

-Vote for Romney
Agrees with Obama on the areas where I have issues with Obama, disagrees with Obama and I on the issues where we agree.

Of course, I don't have to vote for anyone at all.  More on that option tomorrow.

Obama saved by question order

In last night's debate, Bob Schieffer asked the candidates about the use of drones to eliminate people the administration says are terrorists.  It was Romney's question to answer first, so he gave a brief statement of support for Obama's approach and then used the rest of his time to make another point.  Obama then responded to the rest of Romney's answer but didn't say anything at all about the drone attacks.  I'm fairly certain that Obama will not be sitting for any interviews between now and Election Day where he'll be asked about killing people with robots.  We therefore lost our chance to hear the guy who's running a secret "kill list" in our name try to defend his actions.

Whatever one thinks about the morality of targeted killing, or the practical effects of lobbing missiles into villages, it's something that should have been discussed at some point during a year-long campaign.

Tomorrow, I'll discuss how I sleep at night despite supporting the "kill list" guy.

Debate response

... Will be after midnight, as I watched the debate away from home.  Stay tuned

EDIT:
It was an interesting debate, with each contender clearly pursuing a different, correct strategy.  Romney needed to go 90 minutes on a stage with the Commander-in-Chief and emerge with some modicum of respectability, so he tried to be non-confrontational and agreed with the meat of just about everything Obama said.  Obama had to make sure Romney failed, and he came out swinging from the get-go.   It's also next-to-impossible for a Republican to move to the right of Obama, who expanded the war in Afghanistan, attacked Libya and has a secret list of people he intends to kill with drones.

As Romney's demonstrated throughout these debates, he's willing to abandon previously stated positions if he thinks it's politically expedient.  He was quick to agree with Obama on several issues, forcing Obama to point out the differences between what Romney was saying and what he'd said before.  Romney tried to portray Obama as only criticizing Romney, not putting forth his own agenda.  But Obama has been carrying out his agenda for the past four years, and Romney agreed with huge swaths of it.

There was a fascinating exchange about military spending which illustrated the weaknesses of both men.  Obama rightly attacked Romney's ridiculous claim that our navy now having fewer ships than we had in 1916 is evidence of a deteriorating military, pointing out that changes in tactics, strategy and technology have allowed a smaller number of ships to do the job more effectively.  "You mentioned the Navy, for example, and that we have fewer ships than we did in 1916. Well, Governor, we also have fewer horses and bayonets, because the nature of our military's changed."

Obama should have stopped there, or perhaps gone on to discuss the inconsistency of arguing for massive military spending while claiming we don't have the money to continue Medicare or fix bridges.  But he instead patronized Romney, saying "We have these things called aircraft carriers, where planes land on them. We have these ships that go underwater, nuclear submarines."  Like his "you're likable enough, Hillary" mistake from '08, Obama came off looking smug and condescending.  It weakened what could have been a critical attack.

Romney had a strange moments, like his claim that Iran's "only route to the sea" is Syria.  Iran doesn't border Syria; Iraq's in between.  Also, and slightly more importantly vis-a-vis Romney's claim, Iran itself borders the sea.  Candidates have brain-farts occasionally, but I have no idea what Romney might have been thinking on this one.

Ultimately, I think Obama did enough damage to win the night.  I wonder if there are still enough undecided voters out there to make a difference in the polls.  Or the outcome.  Just 14 days to go!

Debate preview

As discussed yesterday, there is agreement between Obama and Romney on many areas of foreign policy.  But it would be a boring debate if they just talked about how much they agreed about things, so let's take a look at where they differ.

-Under current law/projections, military spending is slated to fall to 2.4% of GDP by 2022.  Romney proposes to put in a floor for military spending of 4%.  1.6% of today's economy is about $240 billion, which is a shitload of money.  I'll be very interested to hear Romney try to argue for such massive spending without lapsing into either military Keynesianism or General Turgidson levels of parody.

-Romney seems to buy the conservative talking point that the problem with Obama's foreign policy is that he doesn't accept that we're in some sort of death struggle with radical Islamofascism, or whatever.  This is the context behind Romney's failed attack at the last debate about Obama supposedly not calling the Benghazi attack "terrorism" for a couple weeks.  It turns out of course that the CIA was in fact telling the administration that the attack was related to anger over the anti-Islam video, but it fits the conservative narrative better if Obama was making excuses for his Muslim brothers.  Romney will hopefully have the maturity to acknowledge that his attack was wrong, but I wouldn't hold my breath.

-There is a clear contrast on how Romney and Obama react to unexpected events.  Former counter-terrorism chief Richard Clarke discusses how it's often impossible to know exactly what happened right after a chaotic event like a terrorist attack.  He points out several examples like the explosion of TWA Flight 800 or the attack on the USS Cole, where the true story wasn't known for weeks.  Romney, in his press release dispatched before we knew that Ambassador Stevens was killed, much less why/how he was killed, launched right into an anti-Obama attack.  He couldn't fathom that Obama wouldn't yet know what had really happened, so linking the attack to the anti-Islam video must have been, to Romney's mind, a callow political move by the White House.  He had stated in his secretly-recorded fundraiser comments (the same event as the 47% gem) that he would be ready to "take advantage" of a foreign policy crisis.  His entire approach to foreign policy reeks of crass opportunism, lashing out at Obama before any facts are known.

Plurality voting stifles true debate

As NWest pointed out a few days ago, Romney and Obama actually agree on a lot when it comes to foreign policy.  Both propose to leave Afghanistan by 2014.  They're for drone strikes and having "all the options on the table" with Iran.  Gitmo will stay open under either man.  There are still some very important differences between them (to be discussed tomorrow in preparation for the debate), but there are undoubtedly broad areas of agreement.  We are therefore denied a national debate on these issues where they agree.

A race between two candidates arguing similar, "moderate" positions is an unavoidable result of our plurality voting system.  In a system where 50.1% wins and voters are conditioned to support the "lesser of two evils" by voting for the major candidate closer to their views, both candidates try to appeal to the middle, since they can, at least to a degree, count on the base/flanks to come along.  Moving away from the middle cedes ground/voters to the opposition.  If a candidate doesn't think 50.1% of voters agree with a position, he won't adopt it.  In some areas, both sides will come to the conclusion that one particular position is the majority's view and adopt it, and we don't get to actually discuss it.

Differences in underlying philosophy, polling/focus group research and marketing strategy result in slightly different positions on issues, but both sides are essentially targeting the same voters.  It's no surprise then that the range of ideas addressed by the candidates is narrow.

By having a system that pushes candidates to the middle, voters are denied a real chance to express their views, unless they are willing to "throw their votes away" by voting third party.  Different voting systems like approval voting or instant runoff voting can accommodate a wider range of views, because they elicit more information from voters.  Freeing voters to support more candidates means more candidates can be involved in the campaign, each bringing their own views.  The presence of Jill Stein or Gary Johnson on Monday night would allow for exploration of the multitude of areas where Romney and Obama agree.

GOP Rep. Walsh demonstrably wrong on abortion

Rep. Joe Walsh (R-Ill) claimed during a debate yesterday, when asked if he thinks it is never medically necessary to perform an abortion to save the life of the mother, "Absolutely.  With modern technology and science, you can't find one instance.  There is no such exception as life of the mother, and as far as health of the mother, same thing.”

This is demonstrably false.  Just in my own experience in pediatrics, where such things are of course less common, I know of one abortion which was performed on a patient with severe cystic fibrosis because there was no way she would have survived a pregnancy.  Several patients with congenital heart disease were told to never get pregnant, and would need an abortion if they did, because their hearts couldn't handle the increased work of pregnancy.

It is utterly unacceptable for leaders like Walsh and Todd Akin (the "legitimate rape" guy) to talk about these life and death issues from a position of ignorance.  We can agree or disagree on the moral implications of the issues, but they are not allowed to make up their own facts.  That such candidates still find support in the Republican Party is a stain on the party, and undecided voters should take notice.

Tax Policy Center devastates Romney again

From the folks who brought you the study (.pdf) which showed that Romney's 20% income tax cut could never ever possibly work even if you eliminate all deductions comes a new study which shows that Romney's 20% income tax cut doesn't work if you allow deductions up to $17,000.

Shocking.

It's nice to see the numbers officially crunched, though.  The Tax Policy Center concludes that capping deductions at $17,000 would raise about $1.7 trillion of the $5 trillion needed to pay for Romney's other cuts.  Eliminating deductions altogether leaves a gap of $3 trillion.  It appears Romney's plan to make up that $3 trillion is a combination of telling China they're naughty and supply-side pixie dust that didn't work when George Bush tried it.

Why I'm excited for next week's debate

From last night's debate, a terrific moment of real, personal emotion from Obama.  It's a sneak peek at the monumental task Romney has before him in the foreign policy debate next week.  Obama has an indisputable record of foreign policy accomplishments (killing bin Laden, deposing Qaddafi for a thousandth of what we spent in dollars and American lives to depose Saddam), and Romney is pretty much proposing a return to Bush-era foreign policy.  As previously discussed, Obama has plenty of material to work with.

Much left uncovered in debates

With the final debate limited to matters of foreign policy and defense, we can close the book on direct discussion of health care policy.  Pretty much all we got was a brief discussion of Medicaid in the first debate, a line about the Obamacare "cut" of $716 billion, and a line tonight about George Bush not proposing to replace Medicare with a voucher.  These issues affect how millions of us will leave the world (about two thirds of Medicaid spending pays for the elderly and/or disabled).  But we were deprived of detailed explorations of the topic so we could spend more time with the candidates trying to talk over the moderator or discuss who loves their wives more.

Overall a good night for Obama, though no big punches either way.  Obama's best moment was when he asked Romney if he would support a business deal which wouldn't share the details about how it would work until after approval for the deal was given.  Obama probably continues to gain a bit of the ground he lost after the first debate.

Krugman understates Romney ER debacle

Paul Krugman weighs in on Romney's claim that ERs can be someone's only doctor without potentially leading to their death.  Krugman seems to think that Romney is just ignorant of the negative effects of leaving the uninsured to get their health care from ERs.  But we know, based on his 2006 comments, that he knows better.  He knows that primary care doctors (full disclosure: I'm a primary care doctor) are better at primary care than ER doctors.  And yet, he chooses to put forth this blatant lie affecting the health of millions of Americans and the lives of thousands annually, so that he might not present any facts which would challenge Republican dogma.

Fox News calls out Romney's "studies", misses the point

In an interview with Romney surrogate Ed Gillespie, Chris Wallace of Fox News questions the reliability of the studies.  He says the studies should be doubted since some are op-eds and blog posts, and they are from right-leaning sources.  Analysis from potentially-biased sources should of course be taken with a grain of salt.  But these studies are not merely to be doubted because of their authors and their possible biases.  They are to be ignored because each is based on different assumptions than Romney's plan and/or they are just plain wrong.  Wallace deserves credit for casting a skeptical eye on the studies.  He errs, however, because he casts the issue as right/left, not right/wrong.

Romney on ERs in 2006

In 2006, when Romney was still governor, he said “There ought to be enough money to help people get insurance because an insured individual has a better chance of having an excellent medical experience than the one who has not. An insured individual is more likely to go to a primary care physician or a clinic to get evaluated for their conditions and to get early treatment, to get pharmaceutical treatment, as opposed to showing up in the emergency room where the treatment is more expensive and less effective than if they got preventive and primary care.”

Compare that with his previously-discussed statement extolling the use of ERs to provide health care to the uninsured.

About those six studies

During yesterday's debate, Paul Ryan pointed to six "studies" which supposedly validated Romney's math on tax cuts.  This analysis by Josh Barro at Bloomberg shows that all six do nothing of the sort.  One miscounts the effect of eliminating the deduction for municipal bonds.  Another makes similar arguments and also suggests that a lower top income limit to still be "middle class".  Two more differ from Romney's proposal by including people making between $100,000 and $200,000, a group of people making 24% of all adjusted gross income, in the group to lose deductions and pay for tax cuts for everyone else.  The fifth makes an error in calculating the effect of Romney's plan to eliminate the estate tax.  The last one ignores revenue lost by Romney's proposal to elminate the estate tax and the Alternative Minimum Tax and makes unlikely assumptions on economic growth.

The strongest part of Barro's analysis is the conclusion:

Finally, I would note one item that the Romney campaign does not cite in support of its tax plan: Any analysis actually prepared for the campaign in preparation for announcing the plan in February. You would expect that, in advance of announcing a tax plan, the campaign would commission an analysis to make sure that all of its planks can coexist. Releasing that analysis now would be to the campaign's advantage, helping them put down claims like mine that their math doesn't add up. 

Why don't they release that analysis? My guess is because the analysis doesn't exist, and the 20 percent rate cut figure was plucked out of thin air for political reasons without regard to whether it was feasible.

Romney indifferent/ignorant of suffering of the uninsured

In my very first clinical rotation in med school, I encountered a 50-something woman who presented with changes to her right breast.  She had noticed a weird patch of skin a couple years prior.  Not having health insurance, and unable to afford to take days off work from her job as a hairdresser to have it checked, she decided to just hope it would go away on its own.  By the time I saw her, much of her breast was necrotic.  We diagnosed her with stage IV breast cancer, and she died a few months later.

Another patient, who I encountered on my internal medicine rotation, was admitted to the ICU with a massive stroke.  He was in his late 40's and had a history of high blood pressure.  He'd lost his job and with it his insurance, so he stopped following with his doctor and taking his medications.  Now (or, well, 5 years ago, at least), he's bedridden, non-verbal, and gets lots of expensive treatments paid for by you and me.

A Harvard study from 2009 estimated that 45,000 Americans die every year due to lack of health insurance.  The estimate should be taken with a grain of salt, as it was authored by advocates for single-payer health care, but simple medical knowledge, and my own experience, indicate that the number of Americans who die from lack of insurance certainly isn't zero.

Most of us probably know people without insurance who deal with untreated chronic illnesses, or who aren't able to afford a doctor's visit for a nagging cough or to pay for the medicines the doctor would prescribe if they were seen.  Their quality of life, and the quality of work they provide, are damaged due to preventable causes.

So I was dismayed today to read that Mitt Romney said “We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack... No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

Romney seems to be completely unaware of the fact that emergency rooms don't provide a whole myriad of services one might need to go on living, like chemo, regular dialysis, mammograms and blood pressure medications.  They aren't capable of long-term management of obesity and cholesterol, which would prevent heart attacks from happening in the first place.  ERs also don't provide end-of-life care like hospices provide.

This is an incredibly important issue which affects far more Americans than terrorism, against which we spend literally trillions, and is far more amenable to a government solution.  For Romney to say something so ignorant is truly shocking.

How is this "simpler"?

It makes a fair degree of intuitive sense that eliminating some number of tax credits/deductions would make the tax code simpler.  If Romney were to eliminate, say, the the mortgage interest deduction and the charitable contribution deduction, the tax code is of course simpler, since all the laws pertaining to those deductions could be wiped off the books, leaving a shorter, simpler set of laws.

But what of Romney's idea to limit the overall value of deductions to $17,000 (or $25,000-$50,000)?  Such a change doesn't make anything simpler, and in fact adds another layer of complexity.  Actually, Romney aides have since expanded on the idea by suggesting that the $17,000 cap is in fact only one of three caps, along with a cap on personal exemptions and another on health insurance.

Well that's not any simpler at all.  Far from it.  We'd still have all the same complexities we have now, plus three different caps to deal with.

In defense of (some) tax loopholes

Romney, Obama, the Simpson-Bowles Commission and an increasingly-large share of Congress all agree that we need to "simplify the tax code" by reducing or eliminating tax expenditures.  I agree that punitive damages from civil lawsuits probably shouldn't be tax deductible, and that encouraging home ownership through the tax code probably isn't worth the cost.  But there's lots of stuff that's tax deductible that seems totally reasonable to me.

Deductions for charitable giving are a smart way for government to encourage people to provide public services so the government doesn't have to.  Giving a tax break in exchange for donating money (by definition more money than the tax break costs) to a hospital or a scholarship fund might save the government more money that they cost through decreased costs for Medicare or Pell Grants.  I'm sure there are examples of ridiculous 501(c)(3) corporations out there which don't benefit the public enough to justify the cost of the tax breaks, so I'd be all for tightening the qualifications to earn tax-exempt status.  But taking a hatchet to the charitable giving deduction seems a poor plan.

Incentives for decreasing pollution make sense.  If my kid has asthma, I have an interest in encouraging people to not drive gas guzzlers.  The tax code provides a way to put a number on the true costs of polluting behavior.

The whole economy benefits from a more educated workforce, so tax incentives for education should probably stick around.  I'd be happy to discuss the proper level of such incentives and where the societal cost/benefit balance point is, but I imagine one would have a pretty hard time arguing the best level is $0.

This is an area where Democrats play into the Republicans' hands by how they approach the issue. Both parties suggest that there's plenty of money to be had if we'd just eliminate silly loopholes like deductions for corporate jets or donations from viewers like you.  Neither side wants to be the voice for those expenditures which are actually worthwhile, so we're left with the current and ongoing march toward "simplifying the tax code".

Romney's foreign policy speech

Mitt Romney delivered a major foreign policy speech today at the Virginia Military Institute.  Romney put forth several proposals which are, frankly, just awful.

I will put the leaders of Iran on notice that the United States and our friends and allies will prevent them from acquiring nuclear weapons capability. I will not hesitate to impose new sanctions on Iran, and will tighten the sanctions we currently have. I will restore the permanent presence of aircraft carrier task forces in both the Eastern Mediterranean and the Gulf region—and work with Israel to increase our military assistance and coordination.  For the sake of peace, we must make clear to Iran through actions—not just words—that their nuclear pursuit will not be tolerated.

Apparently Romney thinks that we don't have enough forces near Tehran.  Here's a map that shows the US bases in the vicinity of Iran:

(source)

Note: The map appears to be slightly out of date, as we've handed over the bases in Iraq when our last soldiers left the country last year.  But still, that's a shitload of bases, not to mention that we can send stealth bombers from Missouri anywhere in the world, as well as lots of other ways to project our power across the globe.  And the 75,000 American soldiers permanently deployed in Europe.  But yeah, we need two more carrier groups.  Then they'll know we're serious.

Romney continues:

The size of our Navy is at levels not seen since 1916. I will restore our Navy to the size needed to fulfill our missions by building 15 ships per year, including three submarines.

If there's one thing that'll make terrorists huddled in caves or hiding in major cities shake in fear, it's a nuclear attack sub at $2 billion a pop.

In Syria, I will work with our partners to identify and organize those members of the opposition who share our values and ensure they obtain the arms they need to defeat Assad’s tanks, helicopters, and fighter jets.

What could possibly go wrong?

And in Afghanistan, I will pursue a real and successful transition to Afghan security forces by the end of 2014.  President Obama would have you believe that anyone who disagrees with his decisions in Afghanistan is arguing for endless war. But the route to more war – and to potential attacks here at home – is a politically timed retreat that abandons the Afghan people to the same extremists who ravaged their country and used it to launch the attacks of 9/11.  I will evaluate conditions on the ground and weigh the best advice of our military commanders. And I will affirm that my duty is not to my political prospects, but to the security of the nation.

Allow me to paraphrase what he just said.  "I agree that getting out by the end of 2014 is a good idea.  I'm not sure exactly what I'd do that's any different, but Obama must be wrong somehow.  After I win, I'll talk to the generals and have them tell me what to do."

Finally, I will recommit America to the goal of a democratic, prosperous Palestinian state living side by side in peace and security with the Jewish state of Israel.  On this vital issue, the President has failed, and what should be a negotiation process has devolved into a series of heated disputes at the United Nations. In this old conflict, as in every challenge we face in the Middle East, only a new President will bring the chance to begin anew.

As you may recall, Romney had something rather different to say about the possibility of Palestinian statehood at that secretly-taped fundraiser from a few months back (when he talked about his disdain for the 47%):

One is the one which I've had for some time, which is that the Palestinians have no interest whatsoever in establishing peace, and that the pathway to peace is almost unthinkable to accomplish.

The final debate of the season, on October 22, concerns foreign policy.  Hopefully, Obama will find the time to do his homework and be ready to take down Romney, who gave him lots of ammo today.

Cartoon of the day

(source)

Reference, from the raid on bin Laden's compound

"Which Romney will voters get?"

Ezra Klein has a tremendous article which tries to divine what kind of president Mitt Romney would be.  Given the contrasts among the positions Romney held in 1994 when running against Ted Kennedy, in 2002 when he was elected governor, in the 2012 primaries, and at the debate, it's a valid question.  Romney has presented himself to the left of Kennedy and the right of Rick Santorum on various issues at various times, so how can anyone know for sure how he would lead?

The ultimate conclusion Klein reaches is that Romney will be shaped by his circumstances, just like he always has.  Klein writes:

"One thing Romney emphasized over and again was the need to hammer out his policy agenda through negotiations with Congress. And that, I think, provides the answer. If Romney is facing a Democratic Congress that demands compromise in return for votes — the same situation he faced in Massachusetts — he’ll be more like the Massachusetts moderate he presented as last night. If he’s facing a Republican Congress that’s pulling him to the right and threatening to reject his proposals and force him into a primary in 2016, he’ll be more like the candidate we saw in this year’s  primaries and throughout much of this campaign."

Deductions, charity and shredding the safety net

At a time that GOP dogma requires massive cuts to social programs like Medicaid and food stamps, Romney is advocating essentially eliminating the tax deduction for charitable donations.  A limit on deductions of $17,000 would squeeze lots of people who itemize, as the average total deduction for itemizers is $26,000.  If someone who currently deducts $26,000, including charity along with mortgage interest, health care costs and state/local taxes, no longer has an incentive to engage in tax-advantaged behaviors after they hit $17,000, it stands to reason that some number of people will do less of those behaviors.  As health care costs, mortgage interest and state/local taxes are somewhat difficult to change, it stands to reason that charitable contributions might be in line for a big hit.  Charity organizations would be less able to handle the increased demand for their services that would arise from the proposed cuts to the safety net.

Romney promises to off Big Bird for pocket change

One of the few specific policy proposals Romney made last night included his promise to stop federal funding of PBS, saying "I’m sorry, Jim, I’m going to stop the subsidy to PBS.  I like PBS, I love Big Bird... But I’m not going to -- I’m not going to keep on spending money on things to borrow money from China to pay for it."

China owns $1.149 trillion of our debt.  Our total debt is around $16.149 trillion, meaning China holds about 7% of it.  PBS's annual subsidy is $450 million.  7% of that is $31.5 million, which is less than Romney made in 2010 and 2011 while running for President.  It's a trivial amount of money (in government terms), but apparently Romney thinks being willing to off Big Bird will earn him credibility as a fiscal guardian.  If voters don't bother to actually look at the numbers, he might get away with it.  Of course, he has good reason to think most people won't look at the numbers, since voters' knowledge on important matters is so often hugely wrong.

Bad night for Obama

Mitt Romney gave a tremendous performance tonight.  On each topic, he had a numbered list of things to say, and he had (relatively, for him) specific things to say.  Obama, on the other hand, had a more general approach.  For example, he mentioned the Tax Policy Center study (.pdf) which shows Romney's tax promises are impossible, but he wasn't able to specifically say that the cost of the plan would be $4.8 trillion, and that part of those cuts would be paid for by something like $800 billion in increases on lower-income people.  He failed to call out Romney for citing six studies which supposedly support Romney's tax math, but each of those studies made fundamentally different assumptions from Romney's statements.

Obama appeared to try to play a safe, non-combative game, giving ground to avoid a big moment.  To his credit, there was not one particular moment that would be memorable.  But Romney was so consistently sharper and more polished that he'll probably pick up a few days of positive press coverage.  We'll see what happens with the polls.

Romney gets ever so slightly more specific

Today, Romney suggested a way to pay for his 20% income tax cut.  He floated a limit of $17,000 on the total amount of tax deductions which are allowable in a given year.  Since lots of people, particularly the wealthy, claim much more than that in deductions each year, lots of people's taxable incomes will go up, since their deductions are limited.

I've been trying to find enough info online to do some calculations on the feasibility of Romney's proposal, but honestly I'm not having much luck.  So I'm afraid we'll have to do with just some impressions for the evening.  It seems unlikely that there would be enough savings from limiting deductions to pay for the rate cuts and other cuts.  Consider the effect on the 70% of us who take the standard deduction (that is, who don't itemize) plus people who itemize with total deductions that don't add up to $17,000.  Romney's proposal would seem to be a huge net win for these people, since they'd get the 20% cut without really giving up anything, since they are already under Romney's limit.  Even a good number of people with deductions over $17,000 will come out ahead if the 20% cut in their rates is greater than the amount they lose because they're over Romney's limit.

Where does the money come from to offset these cuts for non-itemizers and low-itemizers?  Of course some money would come from high-itemizers (who are, generally, the wealthy); however, the savings from limiting high-itemizers' deductions would first be applied to offsetting the high-itemizers' own 20% rate cuts.  If there is any additional revenue gained from limiting high-itemizers' deductions, those would, ipso facto, be net tax increases on the wealthy.  I'm perfectly willing to keep an open mind until I see Romney's numbers, but I don't think this will be the actual end result of the proposal.

So if we assume that Romney wouldn't raise rich folks' taxes, and the money for non- and low-itemizers rate cuts has to come from somewhere, we'd be left once again with the idea that tax cuts paying for themselves through increased economic growth.  It's the same thing Republicans have been selling for decades.

Wheels coming off?

A loud chorus of conservative pundits and politicians declare that the murder of four diplomatic staff in Libya means the "wheels are coming off" Obama's foreign policy, or that it's "unraveling" as Paul Ryan called it.  Each one of those four deaths is a terrible tragedy, and the incident will hopefully provoke changes in how we defend our embassies.

Given recent history, however, it seems a stretch to suggest that this is some sort of hugely significant landmark event that should change how America views Obama's foreign policy.  In the last 11 years, over 6,000 American soldiers have died in Afghanistan and Iraq.  2,977 Americans were killed on 9/11.  I understand that the Romney campaign is searching for a game-changing moment, but the attacks in Benghazi, though horrible, are not that moment.

This is by no means to suggest that Obama's foreign policy is without flaw.  It would be healthy for us to discuss the 2,000th American death in Afghanistan, or our use of drones, or Obama's policy of labeling any young man killed in a strike zone a "militant".  The Republican Party isn't presenting an alternative on those issues, however, so we don't get to have that discussion.