When government is paying the medical bill, it inevitably has to “ration” care. Choices obviously have to be made by whoever is paying, but there’s good reason not to leave government with the dominant decision-making power, as in Great Britain.

There’s no need to demonize British care. All one has to do is point out how government fiscal objectives so often run against good patient treatment. And how most people have no exit to a better alternative.

Consider this rather amazing story from the Daily Telegraph:

Doctors have launched a campaign on behalf of a war hero who has been told he must go blind in one eye before he can receive NHS treatment and accused Gordon Brown of “incompetence” in managing the health service.

More than 120 doctors have sent £5 cheques to Downing Street, made out to the Prime Minister, in the hope of shaming him into helping former RAF bomber Jack Tagg. The 88-year-old was recently diagnosed with age-related macular degeneration, the leading cause of blindness in Britain, which affects an estimated 500,000 people.

Mr Tagg has the treatable, but most aggressive “wet” form of the disease, which can lead to the loss of central vision in as little as two months.

But he has been told that the NHS will only fund the injections which could save his sight, after he has lost the vision in one eye.

… “They told me there were three choices: let nature take its course and go blind, try to seek funding, or pay for immediate treatment. Time is of the essence, so we opted to pay up and fight for funding.

“This is happening to literally millions of people. It’s appalling and something has got to be done about it.”

The American medical system needs reform. But that should be accomplished by promoting patient-directed care, with individuals and families, rather than government, deciding how best to use scarce resources when it comes to medical treatment.

As the Cash for Clunkers program begins to wind down, I nominate it as the dumbest government program ever. Here is what the program will have accomplished:

• A few billion dollars worth of wealth was destroyed. About 750,000 cars, many of which could have provided consumer value for many years, were thrown in the trash. Suppose each clunker was worth $3,000 at a guess, that would mean that the government destroyed $2.25 billion of value.
• Low-income families, who tend to buy used cars, were harmed because the clunkers program will push up used car prices.
• Taxpayers were ripped off $3 billion. The government took my money to give to people who will buy new cars that are much nicer than mine! 
• The federal bureaucracy has added 1,100 people to handle all the clunker administration. Again, taxpayers are the losers.
• The environment was not helped. See here and here.
• The auto industry received a short-term “sugar high” at the expense of lower future sales when the program is over. The program apparently boosted sales by about 750,000 cars this year, but that probably means that sales over the next few years will be about 750,000 lower. The program probably further damaged the longer-term prospects of auto dealers and automakers by diverting their attention from market fundamentals in the scramble for federal cash. 

Farm subsidies are unjust. Trade restrictions are counter-productive. Energy regulations have done great damage. Housing policies helped cause the financial crisis. But for pure dumbness, Cash for Clunkers takes the cake.

Bernard Finel, a senior fellow at the American Security Project, has an excellent piece on forging an alternative strategy in Afghanistan.

I believe the United States should begin a relative rapid withdrawal of combat forces from Afghanistan. It is not that I don’t think they can be locally effective.  It is just that I question the cost/​benefit calculus of extending the commitment. I think that many supporters of escalation fail to consider the potential consequences if we do fail to achieve our goal of largely defeating the Taliban and pacifying Afghanistan. [Emphasis mine]

Finel brings up a critical point. From former national security adviser Henry Kissinger to Council on Foreign Relations scholar Stephen Biddle, many prominent opinion leaders concede that the war in Afghanistan will be long, expensive, and risky, yet claim it is ultimately worth waging because a withdrawal would boost jihadism globally and make America look weak. But what happens if what we’ve invested in falls apart whether we withdraw tomorrow or 20 years from now? And wouldn’t trying to stay indefinitely — while accomplishing little — appear even worse? Trying to pacify all of Afghanistan, much less hoping to do so on a permanent basis, is a losing strategy.

Mr. Finel goes on to say further down, “we should recommit to doing everything in our power to revolve tensions between India and Pakistan. Pakistan has legitimate security concerns regarding its neighbor and that gives Pakistan mixed motives in dealing with Islamist radicals.”

This too is a crucial recommendation. People in the Beltway have neglected the extent to which leaders in Islamabad fear the rise of an India-leaning government coming to power in Kabul, and thus, their leaders (principally their military) have little incentive to stop allowing their territory to be used as a de facto safe haven for the original Afghan Taliban. Thus, the question must be asked, can Washington offer any number of incentives for their leaders to relinquish support for extremists with whom they have associated for the past 30 years? This question gets lost when people discuss the possibility of talks with the Taliban. The question for U.S. policymakers is not whether the Taliban militants we talk to are “moderate” enough, but whether they will simply lie in wait and reemerge from their cross-border sanctuary after the eventual withdrawal of U.S. and NATO forces.

Unless Washington addresses Pakistan’s existential fear of India, and their military leadership’s continued support for the Taliban in order to counter India’s influence in Afghanistan, U.S. and NATO troops could fight for decades, win every discrete battle, and never come close to eradicating the militancy.

Yesterday, the Rockefeller Institute released a report on state and local government employment since the beginning of the recession. It found:

Private sector employment for the nation as a whole has fallen by 6.9 million jobs between the December 2007 start of the recession and July 2009. Over the same period, state and local government employment has risen by 110 thousand jobs or 0.6 percent, with increases in both state governments and local governments.

With a prolonged recession now forcing state and local governments to actually cut or furlough some employees, it’s important to remember that they were adding government jobs at a time when it was clear to the rest of the country that the air was out of the economic bubble. In other words, taxpayers should have no sympathy for posturing politicians and their apologists warning of Armageddon should taxes not be increased to facilitate the continuance of bloated state and local governments. Also, expect to hear claims that getting rid of government employees will somehow hinder an economic recovery. In fact, getting rid of government employees — and the programs they support — would be good for the long-run health of the economy.

A government employee is inherently parasitic because without the “host” — i.e., taxpayers — their job would not exist. One can debate the degree to which a government employee’s work benefits society, but the fact remains that any benefit comes at a cost to the economy given that productive individuals and businesses are taxed to pay for government jobs. This should be obvious. Unfortunately, it is not uncommon these days to hear intelligent people embrace increasing government employment during a recession to “make up” for job losses in the private sector. One need only spend some time working in government, as I have, to recognize that an economic resurgence will not be fueled by increasing the government employee-to-host ratio.

After months of speculation, the Colombian Senate approved a constitutional amendment that would allow President Alvaro Uribe to run for a second reelection next year. Obstacles remain, however, and the amendment still has to be voted on in the House of Representatives, pass a review process by the Constitutional Court, and be put to a popular referendum — where it’s likely to be approved given Uribe’s high popularity among Colombian voters.

None of these required steps are certain: the final vote in the House of Representatives is not assured; the Constitutional Court might find irregularities during the discussion of the bill in Congress; and time is running out for organizing a national referendum before next year’s election. However, these last-minute efforts to change Colombia’s constitution and Uribe’s blatant interest in running again are troublesome.

I’ve praised Alvaro Uribe’s record before in tackling crime and guiding Colombia out of the abysm it was in at the start of the decade. However, democracy must transcend the virtues of any leader. Just as it is ominous for Venezuela’s democracy that Hugo Chávez plans to perpetuate himself in office, it would be unhealthy for Colombia’s democratic institutions for Uribe to run for a third consecutive term.

The ultimate decision will likely be Alvaro Uribe’s. This is his chance to show the world whether he’s loyal to liberal democracy or to the power he has become accustomed to.

In a discussion on Bloggingheads, David Frum offers his thoughts on the sad state of the GOP these days:

He blames the predicament, in part, on the “conservative entertainment-industrial complex,” a term coined by Andrew Sullivan. In Frum’s telling, this complex has “distorted conservative dialogue to suit the wishes of the Fox audience.” He says that drawing on such a group, “you can get seriously rich out of that, but you can’t govern a country with that kind of voter base, it’s a tiny minority-within-a-minority.”

This is an interesting thesis. Frum was the coauthor of a seemingly successful, widely discussed foreign-policy book titled An End to Evil, which posited that terrorism posed a “threat to the survival of our nation,” and in foreign policy, “there is no middle way for Americans. It is victory or Holocaust.” Are these the sorts of carefully considered judgments on which the GOP is going to ride back into office?

It’s probably true that pushing the American nationalist button over and over from 2002 forward contributed to getting Bush reelected in 2004, but the results after then have been rather less encouraging. John Boehner colorfully remarked recently that the GOP “took it in the shorts with Bush-Cheney, the Iraq War, and by sacrificing fiscal responsibility to hold power.” I’m not sure that my preferred foreign policy is the key to political success, but I’m pretty sure that the zany world view that Frum has traded on isn’t the way forward either.

That’s Dic​tio​nary​.com’s fourth definition of the verb “to ration,” and it is essentially the same as the other three.

Here’s an example of government restricting the consumption of medical care. It comes from a strange, faraway land called “Oregon.”