The healthcare disconnect
– Darrell West is vice president and director of governance studies at the Brookings Institution and the author of Digital Medicine: Health Care in the Internet Era. The views expressed are his own. —
It is not the first time Washington has been disconnected from the general public, but recent discussions over healthcare reform reveal a D.C. establishment fixated on arguments not central to the general public.
The air waves are filled with clashing claims over the so-called public option whereby Medicare would be expanded to include more Americans. Proponents claim this is the best way to cover most Americans currently without coverage and drive down costs by creating competition for private insurance companies.
Opponents complain about a “government-run” health system and bureaucrats coming between physicians and patients.
According to pollster Geoffrey Garin, though, voters do not have a big problem with the public option, or employer or individual mandates requiring coverage. A recent New York Times/CBS News survey found that 72 percent of Americans support a “government administered health insurance plan” similar to Medicare and 59 percent believe the government would do a better job than private insurance companies in holding down health care costs.
The problem, from the voter standpoint, is how to pay for reform. With costs estimated to top $1 trillion and federal budget deficits already having sky-rocketed, people want to know who pays and how changes will affect their personal medical care. It matters to them whether the bill for coverage expansion comes in the form of higher taxes on sodas, alcohol, tobacco, or employer benefits or reduced spending on physicians, hospitals, and other health providers. With personal finances under great strain due to the recession, the public is not in a particularly generous mood.
The greatest fear people have, according to public opinion experts, is that their current care will suffer. Seventy-seven percent of Americans are satisfied with the medical coverage they currently receive. While they are interested in expanding coverage, they don’t want to do so if it is really expensive or endangers their own treatment.
What to watch for in Iran’s presidential election
– Dr. Suzanne Maloney is a senior fellow for foreign policy at the Saban Center for Middle East Policy. Maloney, a former U.S. state department policy advisor, recently published the book “Iran’s long reach: Iran as pivotal state in the Muslim world.” The views expressed are her own. —
Iranians go to the polls on June 12 in what is shaping up to be the most contentious ballot in the thirty years since the overthrow of the Pahlavi monarchy and the establishment of the world’s first modern theocracy. The ballot will determine the political fate of Iran’s provocative president, Mahmoud Ahmadinejad, and more broadly will signal the future of the country’s volatile political course and the prospects for improvement in its long-troubled relationship with Washington.
Iranian politics have become intensely personalized, focused for better and for worse around Ahmadinejad, a remarkable development considering his prior inexperience in national politics and the relatively limited authority of Iran’s presidency. By inserting himself in all of Iran’s most contentious debates and by asserting himself both on the domestic and international stage, Ahmadinejad has emerged as the focal point of Iran’s contemporary political landscape. As a result, the vote will serve as a referendum on Ahmadinejad’s notorious personality and policies – a reality underscored by the thinly-veiled vitriol directed at the incumbent in recent weeks.
Coming on the heels of a change in American administrations and a shift in U.S. policy, Iran’s presidential campaign has also featured a remarkably frank discourse about engagement. While no election outcome will single-handedly transform Iran’s relationship with Washington – in part because Iran’s presidency is not its ultimate authority in any case – the conclusion of this week’s election will shape the outlook for diplomacy in ways that are unlikely to be straightforward. A change in leadership would strengthen the Obama Administration’s case for engagement, but could also revive the factional infighting that paralyzed Tehran during the reformist heyday. Conversely, a second Ahmadinejad term might bolster Tehran’s recalcitrance but also intensify the international community’s urgency for dealing with Iran. What to Watch For
Turnout: Iranians actually participate in their electoral process in numbers that are more than respectable by American standards, with at least two-thirds of the eligible electorate turning up to vote in most of the past contests. Historically, Iran’s inchoate opposition has been unable to rally around mass boycotts, but some disaffected voters have stayed away from the polls. The real wild card is turnout in the major cities, where reformists typically have an advantage.
Vote-Splitting and Run-Off: Iran’s political factions are diverse, contentious, and often overlapping. There is little certainty on either side that Iran’s factions will hold together and preclude defections from crucial constituencies. Ahmadinejad’s radicalism may well drive traditional conservatives to embrace former Prime Minister Mirhossein Mousavi, whose long association with the revolution and its founder, Ayatollah Khomeini, give him impeccable revolutionary credentials. Equally possible is the prospect that Mehdi Karoubi, a former parliamentary speaker, could siphon crucial votes and dilute the prospect for a reformist victory. The uncertainties are likely to mean that no candidate wins a plurality of the vote, paving the way for only the second presidential run-off in post-revolutionary history. If however any candidate wins on the first round, it will suggest an unexpectedly strong popular mandate that the next president can use to considerable advantage.
The Future of Reform: Win or lose Iran’s reformists have a lot to prove and a lot to gain in this ballot. Their marginalization in the 2005 election appeared to firmly close the door on the reformists’ particular political strategy, which endeavored to rehabilitate the Islamic Republic by strengthening its representative institutions and guarantees. Today, Iran’s erstwhile reformists see this election as a golden chance to recapture a pivotal political office and revive their public mandate to press more directly for incremental openings in the system. Still, even if Mousavi or Karoubi prevails, it is unclear how they expect to advance their objectives more successfully than former President Mohammad Khatami did.
Why does the USA have to monitor anything “openings on the diplomatic front?”
Things are very simple: lift the unjust US economic sanctions and let the Iranian people determine their own future.
That is where the opening will come from. The sanctions have been there long before Ahmedinejad, so the notion that success for “reformists” will open the door is false.
The source of the fight between Iran and the USA was the refusal of the USA and Britain to allow Iranians to determine their own future and manage their own natural resources, specifically the CIA-led overthrow of a democratically elected Iranian government and the imposition of a britral dictator.
The first step is to lift those sanctions and signal an intention not to interfere.
First 100 days: Grading Obama’s foreign policy
– Michael O’Hanlon is a senior fellow at the Brookings Institution. The views expressed are his own. –
It’s no great surprise in American politics these days, but already a great partisan debate has broken out about President Obama’s foreign policy effectiveness to date. For his enthusiasts, the United States has hit the “reset” button and is reclaiming its place as not only a strong country, but a respected leader among nations. For his detractors, Obama is making the world dangerous by apologizing for America’s alleged misdeeds of the past, naively talking with dictators, and cutting the defense budget.
And as usual, the truth is neither of these polar positions. But as a past critic of Obama, especially during his days of promising a rapid and unconditional exit from Iraq during the presidential campaign, I would nonetheless argue that he has done a good job overall, and that his supporters have the stronger case to date. Still, making too much of provisionally good decisions in the first 100 days verges on playing a silly game of Potomac Jeopardy that only the evening talk shows and political junkies really care about. The bottom line is that Obama is just getting started. But he is off to a more solid start than almost any of his recent predecessors.
Consider the policy towards five key nations. And start with the wars. These are Category A problems. Obama has inherited a more difficult hand than any president since Nixon in terms of active, ongoing conflicts. Already we have lost almost as many American troops in our two wars on Obama’s watch as died in the first year of all of Obama’s predecessors going back to Carter combined.
But that is not a slight on the president, only a reminder of the difficult world that confronts him. And in dealing with these challenges, to date Obama has wisely listened to the counsel of his commanders and other experts on Iraq and Afghanistan. Our drawdown in the former place, while still rapid, will retain up to 50,000 U.S. troops even after it’s over. That is a lot of combat capability, and as such a departure from what Obama promised last year, and a relief to those of us still nervous about Iraq.
In Afghanistan, Obama will roughly double the American troop presence there in his first year in office. That will finally give commanders the wherewithal (or at least most of the wherewithal) to carry out a proper counterinsurgency strategy–with its twin goals of protecting the civilian population and building up Afghan institutions so they can increasingly do the job on their own.
The other crucial set of problems might be described as the nuclear hot spots–Iran, North Korea, Pakistan. On these, Obama’s record is less impressive to date. That is not, however, because he has done anything particularly wrong. Rather, the problems are extremely nettlesome. If Obama deserves any criticism, it is simply that his campaign rhetoric implied these would be far easier problems once George Bush was out of the White House and a new president was ensconced on Pennsylvania Avenue. In fact, the main reason these problems are hard is because of who we are dealing with in each case, and not because of George Bush or any other American leader. Since Obama is the one who raised expectations, he deserves to take a bit of a hit perhaps for not quickly fulfilling them–but otherwise his hand seems rather steady on the tiller.
Obama has made it very clear at the very start that US economy is his number one priority. Hence he picked Hiliary Clinton and Joe Bidden to look after foreign policies for him. Remember Hiliary Clinton had almost half of the Democratic Party’s vote so this is a reasonable arrangement.
Obama would not have enough political capital to change foreign policy dramatically until he proves himself with the US Economy. So if one sees not much change in the 100 days, it is by design.
How will we pay for healthcare over hall?? Get out of Iraqu and stop giving 10 billion dollars a MONTH to Dick Cheney’s companies that are not using any of that money to take care of our soldiers!!!!! Thats how, pretty simple actually!!