Inside the charnel house

"Good policy is difficult to make when information is systematically collected in a way that minimizes its discrepancy with policy goals."
—Iraq Study Group report (2006)

Despite predictable but dubious claims that the surge has improved security for ordinary Iraqis, the slaughter of civilians continues at a high level, as most recently demonstrated by the death of more than 500 Yazidis in northern Iraq in concerted bombings that also wounded at least 1,500. During the last two days alone, ten separate incidents involving civilian deaths were reported around the country, including 51 pilgrims at a Shi'ite religious festival in Karbala. Another 247 pilgrims were injured. A million Shi'ite pilgrims were ordered to leave the city to avoid further bloodshed.

There is no reliable data on civilian casualties since the war began, with estimates ranging from 655,000 to 37,000. An accurate total would have to include everything from suicide bombings to "inadvertent" deaths and injuries caused by U.S. air attacks on Iraqi cities and "indirect fire" from artillery.

In an editorial on the Iraqi charnel house, The Economist states:

Faced with what looks from afar like a Hobbesian war of all against all, if not a descent into hell itself, the normal instinct of human beings to exercise their moral faculties grows numb. Often it is replaced by a more craven instinct: to avert the gaze from what has become too painful to look at straight.

The editorial notes that some insurgent groups apparently justify their direct assaults on civilians as part of the "resistance" to the U.S. occupation.

No problems so far: "killing innocents is wrong," as the editorial observes. But the author goes on:

Under all established norms and laws of war (and by most accounts under Islamic law, too) the deliberate targeting of civilians for no direct military purpose is just a crime. [My emphasis.]

When is the "deliberate targeting of civilians" for a "direct military purpose" acceptable? If five insurgents hole up in an apartment complex that houses a hundred civilians, is it morally acceptable (or even lawful) to bomb or shell it even with the absolute certainty that a substantial number of "innocents" will be killed? A "direct military purpose" could arguably be served by such an attack if the deaths of the insurgents would prevent planned attacks on other civilians. [1]

The established practice of the U.S. in Iraq (and the Israelis in Lebanon or Gaza) is to reflexively drop the bombs and then release a prepared statement about "regrettable" civilian casualties. Moral opprobrium is heaped, with some justification, on terrorists who deliberately use civilians as shields by concealing themselves in residential neighborhoods or homes.

Is there a moral distinction between the deliberate targeting of civilians and the "accidental" or "unintentional" killing of civilians in bombings, shellings or other applications of massive firepower?

In a review for New York Times Book Review, the estimable Samantha Power (photo above) argues that "there is a moral difference between setting out to destroy as many civilians as possible and killing civilians unintentionally and reluctantly in pursuit of a military objective..."

There may not be a lot of difference to the affected civilians, but is there a significant moral difference?

Historian Howard Zinn (left), in a letter to the New York Times Book Review last week, gently challenges Power—a person whose work he clearly admires (as do I). Zinn writes:

In countless news briefings, Donald Rumsfeld and Dick Cheney, responding to reporters’ questions about civilian deaths in bombing, would say those deaths were “unintentional” or “inadvertent” or “accidental,” as if that disposed of the problem. In the Vietnam War, the massive deaths of civilians by bombing were justified in the same way by Lyndon Johnson, Hubert Humphrey, Richard Nixon and various generals.

These words are misleading because they assume an action is either “deliberate” or “unintentional.” There is something in between, for which the word is “inevitable.” If you engage in an action, like aerial bombing, in which you cannot possibly distinguish between combatants and civilians (as a former Air Force bombardier, I will attest to that), the deaths of civilians are inevitable, even if not “intentional.” Does that difference exonerate you morally?

The terrorism of the suicide bomber and the terrorism of aerial bombardment are indeed morally equivalent. To say otherwise (as either side might) is to give one moral superiority over the other, and thus serve to perpetuate the horrors of our time.

Still, it's difficult to agree that these actions are "morally equivalent." The legal system here in Oregon, as elsewhere, makes useful distinctions between degrees of homicide, and they provide a rough standard that clarifies some delicate moral distinctions. The deliberate killing of civilians, as in Karbala this week, is clearly a form of aggravated, premeditated murder. The "inadvertent" killing of civilians, by contrast, can be "manslaughter" when it is "committed recklessly under circumstances manifesting extreme indifference to the value of human life" [from Oregon Revised Statutes section 163.118; my emphasis].

Aggravated murder is the more serious crime, but manslaughter isn't to be taken lightly: it's a Class A felony here in Oregon, worth 20 years in the state prison.

Those who lead their country into war, of course, consider themselves exempt from the legal and moral standards that bind the rest of us. But they're not exempt from our judgments.

NOTES

[1] As the U.S. Army's counterinsurgency manual recognizes: "Bombing, even air strikes, should be weighed against the risks, the primary danger being collateral damage that turns the population against the government and provides the insurgents with a major propaganda victory." Some might quibble, of course, that the "primary danger" is deaths and injuries among civilians. A "propaganda victory" would be farther down my list.

PHOTOS: Samantha Power (Swarthmore College) and Howard Zinn (Wikipedia Common)

Ross to Iraqis: "You're grounded!"

Writing in The New Republic, think tanker Dennis Ross proposes yet another opportunity for the U.S. to meddle in the internal politics of Iraq (with thanks to Matthew Yglesias for the link):

...we [!] should set a date for the convening of a national reconciliation conference. Unlike previous such conferences, it should not be permitted to disband until agreement has been reached.

While some of Ross' proposals seem reasonable enough, the irony here seems boundless: after the U.S. overruns their country and precipitates a sectarian civil war, Iraqis have to endure Washington's continuing micromanagement of their politics—possibly including a "national reconciliation conference" that would apparently be held at gunpoint.

A few days ago Prime Minister Nouri al-Maliki criticized certain "American officials" who "consider Iraq as if it were one of their villages." He went on to say: “Iraq is a sovereign country, and we will not allow anyone to talk about it as if it belongs to this country or that.”

Though he was referring to Hillary Clinton and Carl Levin, Maliki's larger point is correct. The same "officials" in the White House who incited chaos in Iraq, and their cheerleaders in the MSM, now have the audacity to make endless demands on Iraqis. Apparently they have the moral right to do this because:

1. The U.S. is so deeply "invested" in Iraq, to the tune of 3,732 lives and $456 billion to date;
2. U.S. politicians and think tankers like Ross know more about the workings of democracy than anyone else, so we can sanctimoniously prescribe what others must do to move toward our level of perfection.
   

But the Iraqis never asked the U.S. to invade and occupy their country. So we don't like what's happening in their country? Let's ground them. Maybe that will "alter their behavior" (as Ross puts it). Send them to a room somewhere to "reconcile." No iPods or Blackberries.

The bipartisan tendency to view Iraqis, Iranians, Venezuelans, the French, the Russians and many others as so many misbehaving children is a major reason why the U.S. is so despised today around the world. There's nothing new about this presumption, but it has become more entrenched than ever under the despicable regime that occupies the White House.

Ross finally admits that there may be limitations on the ability of the U.S. to influence events in Iraq:

Maybe it is too late for such an effort to work. For the Iraqis, perhaps [!] there has been too much brutality, too much displacement, too much disbelief in the intentions of the "other," and too little willingness to accept a political solution with its attendant compromises.

If all else fails, Ross suggests that our "baseline objective should be to make sure that Iraq's problems are contained within Iraq. " Is that the latest, radically-downsized definition of "success" in Iraq?

That may be fine for the realpolitikers on the Potomac. Not fine for the Iraqis.


[A version of this post appears as a comment on Matthew Yglesias' blog]

PHOTO: Nouri Al-Maliki standing in front of what doesn't appear to be an Iraqi flag (Wikipedia Commons).

The resurrection of Allawi: Rove's new gig?

News Item: "Former Interim Prime Minister Ayad Allawi is stepping forward to present himself as the ideal candidate" to replace Nouri al-Maliki as prime minister of Iraq.

The article in question notes that the Maliki coalition government is reeling, yet again, with "the defection of the Iraqi National List, an umbrella faction headed by Allawi's Iraqi National Accord..." This defection "coincided with a lobbying campaign promoting the former prime minister as an alternative to al-Maliki."

Not surprisingly, the Allawi PR offensive is based in Washington rather than Iraq:

Allawi has given several high-profile TV interviews and penned op-ed pieces highly critical of al-Maliki. Allawi also hired the Washington company of Barbour, Griffith & Rogers on a six-month lobbying contract for $300,000, according to papers filed with the U.S. Justice Department.

The company includes Robert Blackwill, President Bush's former envoy to Iraq who helped form the Allawi-led interim government in 2004, and Philip Zelikow, a former adviser to Secretary of State Condoleezza Rice.

So now, after a couple weeks of speculation, we know what Karl Rove's next project might be: the resurrection of Allawi as the latest U.S. surrogate in Baghdad. The outlines of Allawi's career are painfully familiar to many in the U.S., so there's no need to go into all the particulars [see here and here for details]. With two exceptions that are often overlooked: in July 2004, Allawi summarily executed six (or seven by some accounts) insurgents in a Baghdad police station "to send a clear message to the police on how to deal with insurgents." (Maliki, not surprisingly, denies the accusation.) Four U.S. "security men" were alleged to have been present. Then, later that year, he claimed that angry Shi'ites in a Najaf mosque attempted to "assassinate" him by pelting him with shoes.

Allawi's misrule, beginning in the summer of 2004, was so egregious, brutal and corrupt that his political party received only 14% of the vote in the elections of January 2005. As Maliki's support seems to be rapidly eroding, especially in Washington, the resuscitation of Allawi can only be interpreted as a truly desperate attempt to prevent political collapse in Baghdad.

Yet it's difficult to imagine that Allawi, with his long associations with the CIA, would be any more acceptable to Iraqis than he was in 2004-05. Two years before his first regime began, secret British government documents described Allawi (as well as neocon favorite Ahmad Chalabi) as a "western stooge" who "lacked domestic credibility" in Iraq. Surely, at best, his standing in Iraq hasn't gotten any stronger.

So the challenge for Rove, if in fact he's somehow involved in Allawi's resurrection, may be even greater than it was in 2000, when he helped to steal an election that elevated a notorious buffoon to the presidency.

PHOTO: Ayad Allawi (Wikepedia Commons)

Dubya's re-education program

"Whatever your position is on that debate [about Vietnam], one unmistakable legacy of Vietnam is that the price of America's withdrawal was paid by millions of innocent citizens whose agonies would add to our vocabulary new terms like 'boat people,' 're-education camps,' and 'killing fields.'"
—George W. Bush attacking congressional "Defeatocrats" in a speech to the VFW in Kansas City

Where to begin in responding to Dubya's latest display of stupefying ignorance? Whenever he launches into one of his "historical perspectives" on any subject, we can only cringe at what's to follow.

For one thing, Cambodia under Prince Sihanouk was neutral and relatively quiet until 1969. Then, in a futile attempt to interdict the Ho Chi Minh trail, Nixon began a "secret"—to the U.S. public, not the Cambodians—B-52 bombing campaign that killed about 800,000 Cambodian civilians. In 1970, the CIA sponsored a coup during Sihanouk's absence from the country. Lon Nol, the CIA's point man, took power and invited U.S. and ARVN troops into the country in another fruitless attempt to block the Ho Chi Minh trail.

Then Cambodia began to unravel. The U.S.-led coup and invasion provoked a civil war that finally resulted in Lon Nol's expulsion and the establishment of the genocidal Khmer Rouge regime. Estimates of Cambodian dead range from 1.7-3 million.

So Bush's speech should have read:

"the price of America's intervention was paid by millions of innocent citizens, whose agonies would add to our vocabulary new terms like 'boat people,' 're-education camps' and 'killing fields,'..."

Dubya also reiterated familiar claims about the alleged enemy is this endless war:

"The struggle has been called a clash of civilizations. In truth, it's a struggle for civilization. We fight for a free way of life against a new barbarism -- an ideology whose followers have killed thousands on American soil, and seek to kill again on even a greater scale."

A specific ideology seems to animate the relatively small—but apparently growing (thanks in large part to the war in Iraq—number of Iraqis who identify with Al Qaida. But the larger insurgency in Iraq has much deeper roots in nationalist impulses to resist occupation by foreign troops than in any single "Islamist" ideology. In fact, the deep sectarian conflicts between Sunnis and Shi'ites disprove any notion that a unifying ideology motivates them.

The hysterical denunciations of "Islamofascism" and "radical Islamism" (Giuliani's favorite) ring even more hollow than Cold War claims that "international communism" was monolithic. Long ago we began to see the outlines of an updated domino theory based on the notion that the fall of Iraq would lead to radical (and nearly identical) Wassabi or "Islamofascist" regimes in Saudi Arabia, Jordan and elsewhere in the Middle East. Not all hostility to the U.S. in the Middle East countries can be reduced to a fundamentalist religious worldview or "new barbarism."

Nationalism is far too nuanced for those, like Bush, who can only perceive conflict in binary terms founded on ideological and historical distortions.

If there is a valid comparison between Iraq and Cambodia, it would focus on the following observation: heavy-handed U.S. military interventions incited or escalated civil wars that resulted in massive human suffering for no purpose whatsoever.

Dubya should arrange his next vacation, which certainly will come soon, so that he sign up for a couple community-college classes in the reality-based history of southeast Asia and the Middle East.

Lighnin Hopkins: "Lonesome Road"

This video was apparently made in 1960. For another fine Hopkins performance, and more information about the artist, check out "Questionnaire Blues" here.

Geaghan: Saturday snippets

A rainy day here in northwestern Oregon has encouraged me to cancel a camping trip. So I've consoled myself with an extended tour of my bloglist. A few topics du jour:

Leapfrogging into absurdity

Matthew Yglesias writes:

The primary leapfrogging sweepstakes seems to have really taken off now that Michigan's moving to January 15. This means that if New Hampshire and Iowa try to maintain the usual spacing, Iowa's going to wind up in 2007. One can only hope this means the Iowa-Newhampshire-ification of American politics has reached some kind of a breaking point and we won't stick with this farcical nominating process in 2012.

Right now the parties effectively control the nominating process, which has produced the growing absurdity of balkanized campaigns that begin in mid-term.

Other countries manage to regulate campaigns more effectively. In (gasp!) France, for example, there's a cap on total spending (€20 million) and matching public financing of 50% for candidates with more than 5% of the vote. Minor parties, whose candidates received less than 5%, get €800,000 (with €150,000 paid in advance). TV advertising is prohibited, but public TV sets aside ample time for candidates to use. An independent agency supervises elections and public financing. A runoff election takes place if no candidate receives more than 50% of the vote.

Such a rational system of regulating elections would be difficult to import into our chaotic process, but it could produce a better overall result—and end the competition for undue influence by individual states in the nominating process.

Escape Hatch for Rove

Digby at Hullabaloo speculates that Karl Rove's resignation may suggest rapid progress in a Hatch Act investigation that began with a complaint filed against Rove by fired U.S. Attorney David Iglesias in April. She writes:

These Hatch act investigations may end up being more potent than anybody realizes. Remember, Watergate started out as a third rate burglary.

The Office of Special Counsel website describes the meager penalties for violations of the Hatch Act, which would seem to have no application to a federal employee who has already resigned from the government:

An employee who violates the Hatch Act shall be removed from their position, and funds appropriated for the position from which removed thereafter may not be used to pay the employee or individual. However, if the Merit Systems Protection Board finds by unanimous vote that the violation does not warrant removal, a penalty of not less than 30 days' suspension without pay shall be imposed by direction of the Board.

Of course an investigation of Iglesias' allegations could conceivably turn up something more damaging to Rove than Hatch Act violations. The OSC site also points out that "certain political activities may also be criminal offenses under title 18 of the U.S. Code..."

But I don't see any basis to conclude that the OSC even has jurisdiction to investigate former employees under the Hatch Act. So the Iglesias complaint has been rendered moot. Any offenses under title 18 would probably have to be investigated by a grand jury, and none has yet been convened for that purpose.

Even if Congress amends the Hatch Act (as some have suggested) to stiffen the penalties and/or make violations a criminal offense, Rove still walks. A revised Hatch Act couldn't apply retroactively, since Article I, Section 9, of the Constitution prohibits ex post facto laws.

Then there's the small matter of a presidential pardon, which will be instantly available on request.

The Flat Brain Society

Discredited "Middle East expert" Thomas L. Friedman was back on "Charlie Rose" on Thursday, peddling the paperback version of The World is Flat. Now that Friedman's credibility on Iraq has been reduced down near absolute zero, he's shamelessly repositioning himself as an expert on globalization and the vast corporate profits to be had through environmental awareness. But he puts me in such a rage that I couldn't watch more than the first minute.

Atrios provides a link to a Rose interview with Friedman on May 3, 2003—after five weeks of war in Iraq—in which his guest spouts such gems as:

I think it [the invasion of Iraq] was unquestionably worth doing, Charlie.
...
We needed to go over there, basically, um, and um, uh, take out a very big state right in the heart of that world and burst that bubble, and there was only one way to do it.
...
What they needed to see was American boys and girls going house to house, from Basra to Baghdad, um and basically saying, "Which part of this sentence don't you understand?"

You don't think, you know, we care about our open society, you think this bubble fantasy, we're just gonna to let it grow?

Well, Suck. On. This.

Okay.

That Charlie was what this war was about. We could've hit Saudi Arabia, it was part of that bubble. We coulda hit Pakistan. [1] We hit Iraq because we could.

A special niche in hell is reserved for guys like Friedman, who should be forced to spend eternity watching reruns of his many performances as one of the lead pimpmeisters for Bush/Cheney.

And the perfect roommates for Friedman? Christopher Hitchens [2] and Michael Ignatieff [3].

NOTES

[1] The very same Pakistan that has had nuclear weapons since 1998? It's interesting that a realpolitiker like Friedman believes that Pakistan would've politely kept its nukes on the shelf while Bush/Cheney proceeded to overthrow its government.

[2] Hitchens' new book (God Is Not Great: How Religion Poisons Everything), in which he aggressively defends his atheism, might be interpreted as an attempt to reassure himself that he'll never be held accountable for his support of the criminal conspiracy that led to the war in Iraq. He apparently sees no contradiction between his support for Bush/Cheney and the administration's assaults on the Establishment Clause of the U.S. Constitution.

[3] Ignatieff made an unconvincing attempt to repent for his role in pimping for the war, including his express support for torture, in a recent column in the The New York Times Magazine (sorry, but for once I refuse to provide a link—look it up if you want to read it). The Toronto Star simply notes in passing that Ignatieff "supported the Iraq war when it suited him and opposes it when it doesn't."

[Note: Portions of the above were cross-posted as comments on the blogs noted.]

PHOTO: IVotronic voting machine, one of many types used in 2007 French elections (Wikipedia Commons)

Flashback: Cheney on Iraq - April 15, 1994

"Foolish consistency is the hobgoblin of small minds."
—Ralph Waldo Emerson

42nd and counting

The latest comparative study on world life expectancy received a lot of attention this week:

"The U.S. has been slipping for decades in international rankings of life expectancies as other countries are improving health care, nutrition and lifestyles, according to the AP/Daily Star. Countries that rank above the U.S. include Japan, most of Europe, Jordan and the Cayman Islands. A U.S. resident born in 2004 has a life expectancy of 77.9 years, placing the U.S. in 42nd place, down from 11th place two decades ago.

"Researchers say the lower U.S. ranking is attributed to the high uninsured rate among the population, in addition to rising obesity rates and racial disparities in life expectancy. Black U.S. residents have a shorter life span, at 73.3 years, than whites. The U.S. also has a high infant mortality rate compared with other industrialized nations, with 40 countries [including Cuba] having lower infant mortality rates than the U.S. in 2004."

In a long editorial on the subject, the New York Times surveyed the life expectancy study and various findings from other recent comparative analyses:

• "The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care."
• "All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs."
• "The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors."
• "We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world."
• The U.S. performs "poorly in coordinating the care of chronically ill patients, in protecting the safety of patients and in meeting their needs and preferences";
• The U.S. "scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations."
• "In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor."
• "Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada."
• The widespread negative views "may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor."
• "Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines."

The Times concluded:

"With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best."

Another recent study by the Partnership for Prevention reinforces the notion that lack of access to preventive care for the uninsured is a major factor in life expectancy:

Utilization rates remain low for preventive services that are very cost effective and have been recommended for years. Increasing the use of just 5 preventive services would save more than 100,000 lives each year in the United States.

• 45,000 additional lives would be saved each year if we increased to 90 percent the portion of adults who take aspirin daily to prevent heart disease... [Note: Consultation with a doctor is strongly recommended before anyone starts taking maintenance doses of aspirin.]
  
• 42,000 additional lives would be saved each year if we increased to 90 percent the portion of smokers who are advised by a health professional to quit and are offered medication or other assistance. Today, only 28 percent of smokers receive such services.
• 14,000 additional lives would be saved each year if we increased to 90 percent the portion of adults age 50 and older who are up to date with any recommended screening for colorectal cancer. Today, fewer than 50 percent of adults are up to date with screening.
• 12,000 additional lives would be saved each year if we increased to 90 percent the portion of adults age 50 and older immunized against flu annually. Today, 37 percent of adults have had an annual flu vaccination.
• 3,700 additional lives would be saved each year if we increased to 90 percent the portion of women age 40 and older who have been screened for breast cancer in the past 2 years. Today, 67 percent of women have been screened in the past 2 years.

• Breast and cervical cancer screening rates were lower in 2005 compared to five years earlier for every major racial and ethnic group: White, Hispanic, African American and Asian women all experienced declines.

• 30,000 cases of pelvic inflammatory disease would be prevented annually if we increased to 90 percent the portion of sexually active young women who have been screened in the past year for chlamydial infection. Today, 40 percent of young women are being screened annually.

The Partnership for Prevention study found that race and ethnicity are critical variables in access to health care:

In several important areas, use of preventive care among racial and ethnic groups lags behind that of non-Hispanic whites.

Hispanic Americans have lower utilization compared to non-Hispanic whites and African Americans for 10 preventive services.

Hispanic smokers are 55 percent less likely to get assistance to quit smoking from a health professional than white smokers.

Hispanic adults age 50 and older are 39 percent less likely to be up to date on colorectal cancer screening than white adults.

Hispanic adults age 65 and older are 55 percent less likely to have been vaccinated against pneumococcal disease than white adults.

Asian Americans have the lowest utilization of any group for aspirin use as well as breast, cervical and colorectal cancer screening...

Despite higher screening rates among African Americans for colorectal and breast cancer compared to Hispanic and Asian Americans, increasing screening in African Americans would have a bigger impact on their health because they have higher mortality for those conditions.

If the 42 percent of African Americans age 50 and older up-to-date with any recommended screening for colorectal cancer increased to 90 percent, 1,100 additional lives would be saved annually...

The Partnership for Prevention study concludes:

"Low utilization rates for cost-effective preventive services reflect the emphasis that our health care system currently gives to providing acute care. Among the 12 preventive services examined in this report, 7 are being used by about half or less of the people who should be using them. Racial and ethnic minorities are getting even less preventive care than the general U.S. population.

"Expanding the delivery of preventive services of proven value would enable millions of Americans to live longer, healthier, and more fulfilling lives. There is the potential to save 100,000 lives annually by increasing use of just 5 preventive services. It would also lead to more effective use of the nation's resources because the United States would get more value--in terms of premature death and illness avoided--for the dollars it spends on health care services."

Patients often receive "acute care" in hospital emergency rooms because they have no access to preventive care, which is vastly less expensive. A system of effective preventive care would, more importantly, also be more humane.

The Chair of the commission that conducted the Partnership for Prevention study notes that:

"A lot of Americans are not getting live-saving preventive services, particularly racial and ethnic minorities. As a result, too many people are dying prematurely or living with diseases that could have been prevented," said Eduardo Sanchez, MD, MPH, Chair of the National Commission on Prevention Priorities, a blue-ribbon panel convened by Partnership for Prevention to guide the study. "We could get much better value for our health care dollar by focusing upstream on prevention."

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, added:

"This report illustrates that the health benefits would be great if more people took preventive actions... More illnesses would be avoided, fewer lives would be lost, and there would be more efficient use of our limited health care resources. It's important that all of us make a concerted attempt to focus our energies and efforts on preventing disease, not just treating it."

One of the most common objections to proposals for a national health system is that the U.S. "can't afford" it. Yet quite the opposite is true: the U.S. can no longer afford to support a massive insurance bureaucracy whose primary function is to find reasons for denying coverage to patients for medical treatment.

But access to health care is fundamentally a moral issue (as previously discussed here). Failure to address it results in thousands of avoidable deaths each year and suffering on a scale that would be difficult to document.

Maybe the news isn't all bad: the latest findings on life expectancy actually place the U.S. in a slightly higher position than the CIA's earlier estimate for 2007. On their list, the U.S. had dropped to 47th out of 222 countries.

PHOTO: "Health Care Voter" Dave Peter talks to candidate Dennis Kucinich in Nevada (Flickr).

Giuliani: "I'm One of Them"

Turns out Giuliani may have spent more time at the WTC than most of us realized, at least pre-9/11. As Paul Krugman writes in today's NY Times:

Rudy Giuliani has lately been getting some long-overdue criticism for his missteps both before and after 9/11. For example, The Village Voice reports that he insisted that the city’s emergency command center — which included a personal suite with its own elevator that he visited “often, even on weekends, bringing his girlfriend Judi Nathan there long before the relationship surfaced” — be within walking distance of City Hall. This led to the disastrous decision to locate the center in the World Trade Center, an obvious potential terrorist target.

The Village Voice article, "Rudy Giuliani's Five Big Lies About 9/11," is a necessary corrective to various myths that the GOP's leading candidate continues to cultivate about his record.

Grading the surge

There can be little doubt that, officially speaking, the "surge" in Iraq has already been deemed a modest success—more than a month before General David Petraeus is scheduled to submit his formal report. In fact, there's every reason to believe this been a foregone conclusion since the surge began last winter (as described in posts here and here and on many other blogs). More recently:

In an Associated Press interview in late July in his office at the U.S. Embassy, Petraeus betrayed no sign of anxiety, except perhaps a hint of worry that he might tip his hand too early, thus opening himself to challenge from critics before he has fully armed himself with credible arguments for why the buildup is working. Clearly, he believes it is working. But he is not ready to say that too expansively. [My emphasis.]

So the only real issue is how Petraeus can spin the carefully-selected "facts" to confirm the overall success of his own strategies. He's like a probationary employee who gets to write his own six-month evaluation. No doubt there will be self-criticisms and admissions of various deficiencies, especially on the Iraqi political front, but these are necessary if the evaluation is to have any credibility at all. Petraeus will be praised for being "direct," "unsparing" and "candid." You can almost hear Dubya at the Rose Garden press conference: "Heckuva job, Dave."

The criteria that Petraeus will apply in his self-evaluation seem clear enough. Here's my modest preview of the issues it will have to address and its likely conclusions:

1. Casualties among U.S. forces

Depending on how the Pentagon's numbers are parsed, there has been some slight improvement compared to the high levels of April-June, 2007. But July's total of 79 killed is still higher than 10 out of 12 months during 2006, and it's twice as high as last July. The number of wounded declined to 608 in July compared to June's 744, but it was about the same as previous months (but not as low as February's 517). The administration has already concluded, of course, that higher casualties are a measure of more aggressive U.S. tactics, and therefore a perverse measure of "success." So far in August, it appears that the U.S. casualty rate is increasing compared to July.

2. Insurgent attacks and Iraqi casualty rates

There are no reliable figures for Iraqi military or civilian casualties, but the available evidence suggests a continuing high level of both since insurgent attacks began to intensify in July, 2006. Despite monthly fluctuations, the overall civilian casualty rate is significantly higher than it was during 2005 and the first half of 2006. There's no reason to conclude that the security situation has improved nationwide, as insurgents shift their attacks to areas outside the focal points of the surge.

The number of attacks by roadside bombs reached 99 in July, a record level. Deadlier car bombs appear to be producing more deaths and injuries per attack.

3. Military successes or failures

In their now-notorious article ("A War We Just Might Win") for the NY Times, alleged "former war critics" Michael O'Hanlon and Kenneth Pollack of the Brookings Institution argue that co-ordination with "reliable partners" in the Iraqi army has improved to the point that the U.S. "might finally be getting somewhere" in defeating the insurgency.

Some progress has also been claimed in developing a Sunni coalition, armed and financed by the U.S., against Al Qaida cells in Anbar province and elsewhere. This is a risky strategy: the Sunni sheiks may have accepted a temporary alliance of convenience with U.S. forces so they can better arm their militias, eliminate rivals and consolidate their fiefdoms for the coming civil war.

Meanwhile, the Pentagon is predicting that insurgents will attempt a "surge" of their own during the next few weeks in order to demonstrate that Petraeus' strategy isn't working.

4. Training and motivating Iraqi security forces

Iraqi security forces, especially the police, have been so heavily infiltrated that they're widely suspected of being little more than local extensions of the Shia and Sunni militias. While they make claims of tangible progress in a few locations, O'Hanlon and Pollack admit that, "all across the country, the dependability of Iraqi security forces over the long term remains a major question mark."

5. Infrastructure and economy

Progress in reconstructing the economy and basic infrastructure is either scanty or nonexistent, as Iraqis suffer through the summer inferno with little or no electricity, potable water, sanitation or gasoline. If anything, the Iraqi power grid is on the brink of a complete breakdown, with individual provinces hoarding their electricity at the expense of everywhere else. Unemployment continues at up to 70% nationwide. Daily life in Iraq is beyond intolerable, which no doubt generates support for the insurgency and reinforces the perception that the U.S. occupation authority is utterly incompetent—a perception based on overwhelming evidence.

6. Political cohesion and popular support for the government

In any counterinsurgency campaign, these issues are far more important than all the others combined: military success or failure will ultimately be judged by the ability of the Iraqis to sustain a viable government that enjoys a critical mass of popular support and a monopoly on violence—the final test of sovereign authority.

By this standard, Iraq is moving towards a deepening civil war. The political situation is, at best, stagnant. Iraq's parliament is taking a long vacation while Prime Minister Nouri al-Maliki seems in no hurry whatsoever to promote national reconciliation or a compromise on sharing oil revenues. With the resignation of Sunni ministers from the government, it appears that Sunnis have now given up on the political process.

Even the O'Hanlon/Pollack article had to acknowledge the grim political realities in Baghdad:

In the end, the situation in Iraq remains grave. In particular, we still face huge hurdles on the political front. Iraqi politicians of all stripes continue to dawdle and maneuver for position against one another when major steps towards reconciliation — or at least accommodation — are needed.

It's hard to reconcile the upbeat conclusions of O'Hanlon/Pollack with such statements. The only thing that really matters in Iraq is the "political front." If "huge hurdles" exist there, what does it matter if you can cherry-pick a few facts suggesting progress on the "military front?" One would expect a more incisive analysis from so-called "scholars."

Petraeus, a counterinsurgency specialist long before his assignment to Iraq, understands far better than his predecessors and O'Hanlon/Pollack that military strategy must be constantly subordinated to overarching political goals. As Thomas Ricks notes repeatedly in Fiasco, his excellent critique of the war, the administration and the Pentagon reversed these priorities from the very beginning with their obsessive focus on military considerations.

If basic counterinsurgency techniques had been implemented after the seizure of Baghdad, the chances for ultimate "success" under the six criteria listed above may have been greatly improved. Needless to say, though, the Iraq war could never have been redeemed by any strategy: it was an act of aggression, a crime against peace, from the moment it was conceived. Those responsible should be held accountable in a criminal prosecution.

The evaluation of the surge will distract Washington for weeks or months, but it should properly be part of an overall assessment of the entire war. In a Congress that still hasn't bothered to investigate Abu Ghraib, this kind of meta-critique is unlikely to be on any official agendas this year. But if and when such a report is ever written by a future Congress or administration, it would have to consider the political, economic and military effects of the war here in the U.S. It's easy to imagine the list it will have to address:

• The internal deliberations that led the administration to develop a bogus rationale for a war of aggression on a sovereign, if deeply flawed, state;
• The administrative processes that led to catastrophic policy decisions in Iraq, including the failure to control looting and other disorders at the beginning of the war, the "deep de-Baathification" program, brutal and counterproductive applications of force on civilian populations, corruption in civilian contracting, overreliance on private security forces, failure to control weapons stocks and protect Iraqi infrastructure, and a host of related issues.
• The failure of Congress and the media to ask appropriate questions about the war and perform their oversight roles once it began;
  
• The economic effects of a war that has already cost some $500 billion, including the opportunity costs of diverting that sum of money from domestic needs such as a national health-care plan or a program to rebuild crumbling infrastructure;
• The weakening of the U.S. military due to extended tours in Iraq, damaged morale, depleted inventories of vital equipment, lower standards for recruits and failure to meet recruitment goals (1);
  
• The devastating political costs of a conflict that has left the country as polarized as it was at during the Vietnam war; and,
• The long-term effects of U.S. exceptionalism—the widespread assumption in the U.S. that our actions in the world are always guided by the highest moral principles, regardless of the human consequences.
  

The ghosts of this war could haunt U.S. political culture for at least a generation. A thorough and honest assessment, making the perpetrators accountable for their war of aggression and taking steps to prevent similar disasters in the future, would at least begin the exorcism.

NOTES

(1) Leading "war czar" Lt. Gen. Douglas Lute to suggest reinstating the military draft.

PHOTO: Iraqi police on patrol (Wikipedia Commons)

UPDATE (8/14/07): The BBC is conducting a nuanced evaluation of the surge, including its effects on the daily lives of Iraqis.

The presidential recall

"Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security."
—Declaration of Independence (1776)

The Founders had every historical reason to be extreme skeptics about government, especially in the form of the colonial administration of the British colonies in North America. As a counterweight to the tendency of government towards excessive concentrations of power, their Constitution adopted a system of complex checks and balances based on the Enlightenment theories of Locke and Montesquieu.

The U.S. political system is founded on the premise that government is a necessary evil. Contrary to popular opinion, it has five branches, not just three: the executive, congress, judiciary, fifty states and the people. To reduce the risk of tyranny, these branches are placed in constant competition with each other—the capitalist marketplace extended into politics.

After 220 years of stresses and crises, this system has revealed its strengths and weaknesses. While the strengths don't require elaboration at the moment, the weaknesses can be summarized easily enough: it's damned hard to get anything done, at least most of the time. There have been rare times when a single party has acquired enough control of the government to advance its program vigorously: during the New Deal and the early years of the Johnson administration, for example. For much of the last half century, the White House and at least one house of Congress have been under the control of different parties. With few exceptions, those periods of divided government have been notable only for their inaction on pressing national issues.

The Republicans, for the first time in a half century, exercised monolithic control over the entire federal government for two congressional terms starting in 2002. They pursued a catastrophic military adventure in Iraq and a Reaganesque program of tax cuts for the wealthiest 10%, but otherwise accomplished nothing of substance. The current divided government seems incapable of action on critical issues ranging from health care to the war in Iraq.

After the last congressional election barely delivered Congress to the Democrats, the deeply unpopular Bush/Cheney regime has had no incentive to be responsive to anyone. Whether the issue is the war or the future of Alberto Gonzales, Bush has adopted a confrontational in-your-face strategy that scorns compromise. Secure in the knowledge that the Democratic leadership remains uninterested in impeachment, there's no political cost to Bush for his obstinacy (1). With the election more than a year away, panic hasn't yet swept the ranks of Republicans who'll have to run for reelection on the Bush/Cheney record.

So here's the dilemma: the U.S. has an incompetent lame-duck administration that seems blithely determined to tread water for the next year and a half, yet we have no equivalent to the parliamentary "no confidence" motion that might force early elections and the removal of Bush/Cheney. This creates an untenable situation: before the next administration assumes office, another 1,700 or more U.S. troops could be killed in Iraq, tens of thousands of Iraqi civilians could die and millions of Americans could lose their health insurance (2). Bush is clearly determined to prolong the war until his term ends so he and his party can blame the "loss" of Iraq on the next administration.

Even though impeachable offenses have been committed, the Democrats have already proven themselves to be one of the most ineffectual "majorities" in the modern history of Congress.

Could there be a constitutional remedy that might reduce the risk of similar situations developing in the future? Writing in WaPo, Robert Dallek suggests a national recall based on the California model that successfully ended Gray Davis' governorship in 2003:

It's enough to make people think about a constitutional amendment for removing a president other than by impeachment or because of incapacity, as is now provided for under the 25th Amendment.

Such an amendment would need to set a high bar for removal and include a process that would be the greatest possible expression of the popular will. This could best be achieved through a recall procedure beginning in the House and the Senate, where a 60 percent vote would be required in both chambers to initiate a national referendum that would be open to all citizens eligible to vote in state elections. The ballot would simply ask voters to say yes or no to removing the president and vice president from office immediately. Should a majority vote to recall both incumbents, the speaker of the House would succeed to the presidency and, under the provisions of the 25th Amendment, would choose a vice president, who would need to be confirmed by majorities in the House and the Senate.

Even if such an amendment were already in place, of course, an effort to recall Bush/Cheney would likely fail. Neither the House nor the Senate could generate the 60% supermajority needed to initiate the process. Without Republican defections, it's doubtful whether the Democrats could even muster a majority in the current Senate. (The archaic and antidemocratic filibuster rule already imposes a tacit supermajority requirement on nearly every measure that comes before the full Senate.)

The recall model, it seems, would set the bar too high to remedy something like the current situation. It would require just seven votes less than a successful impeachment trial in the Senate. A filibuster could indefinitely prevent a vote on recall.

The better solution, though it's unlikely ever to get any serious consideration here, is the parliamentary "no confidence" vote followed, if necessary, by an election. If such a constitutional amendment were adopted, a simple majority in each house of Congress could force a form of "recall" election. Would that device set the bar too low and create a series of unstable administrations, each subject to removal at the whim of Congress? Or would it create a more responsive government and avoid the lame-duck impasses that we now have to endure?

The British experience, after ten years of Tony Blair's Labour government, lends little support to the fear of instability. In a two-party system like our own, an administration would survive "no confidence" votes as long as strict party discipline remains intact. The administration's party, absent defections, would always prevail.

George Bush would probably survive a "no confidence" vote in the current Senate. Would the threat of such a vote compel him to be more compromising? For a man who apparently receives his political instructions directly from his United Methodist God (3), that seems unlikely. Still, a couple Republican defections might change the political equation dramatically.

Checks and balances, from the presidential veto to the "advise and consent" role of the Senate, tend to make it more difficult to accomplish anything. A "no confidence" amendment, by contrast, could put pressure on an administration to perform and make the federal government more responsive—and therefore more democratic. A "democracy" isn't just a system of elections: in its deepest sense, it demands a government that constantly—and not just every two years—reflects the will of the people and responds to their needs.

The "no confidence" mechanism may never develop roots on this side of the Atlantic, but that doesn't mean it's a bad idea.

NOTES

(1) As the old bumper sticker said, back in the days of AT&T's telecommunications monopoly: "We don't care. We don't have to." This is beyond cynicism, of course. But the strategy seems to be working: Congress is even more unpopular than Bush/Cheney, notwithstanding the fact that the obstructionist R's have prevented the D "majority" from taking action on Iraq or anything else. The administration is guessing that a jaded general public isn't paying serious attention to what's going on: their disgust will extend equally to both parties. Maybe Turd Blossom Rove hasn't lost his touch after all.

(2) The certainty of continuing high casualties in Iraq creates a moral imperative for impeachment that the Democrats seem unwilling to acknowledge, even if they lack the 2/3 majority needed to convict. Would Bush continue to stonewall, even he'd prevail in the Senate? Most likely he would, but there's really no choice (notwithstanding Nancy Pelosi's premature opposition to impeachment last year). Sadly, the Democrats don't presently have the political will or courage to even pass a censure motion. Maybe they need more encouragement (or demands) from the public, which now seems to consider Congress to be even more incompetent than Bush.

(3) In 2004, for example, Bush reportedly said: "I trust God speaks through me. Without that I couldn't do my job." The White House has since denied that story, and similar stories, about Bush's direct communication with the divine.

PAINTING: Benjamin Franklin, John Adams and Thomas Jefferson reviewing a draft of the Declaration of Independence. Painting by J.L.G. Ferris (Wikipedia Commons).

Blues Break: Greg Allman - "Come and Go Blues"

Greg Allman gets in some fine blues licks and vocals during an apparent break (due to "technical problems") in a studio recording session. (Or is it all staged?) The guitar is in open G tuning (DGDGBD).