Tag Archives: United States

Cowen calls for evidence in health care options

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Yes, it’s been a little quiet here lately (other than comments about 9/11 being an inside job, and who knows what kind of traffic mentioning that will bring?).  The reasons are twofold:  first, I have been building a new business I started early last year; and second, I just launched a blog that describes my thinking about that business.  I’m very excited about both.

That said, PublicOrgTheory has been my first love for over five years, and I always come back to it.  This meditation by Tyler Cowen on health care caught my attention this morning:

Over at Twitter, Matt Yglesias asks:

Do rightwingers really believe that US health insurance has no mortality-curbing impact?

I don’t speak for “right-wingers,” but I’ll say this:

1. I genuinely don’t know what to believe.  And I often toy with the idea of an “innovation-maximizing” health care policy, so that future coverage is more effective.

2. I am commonly excoriated by people (not Matt) for not supporting government-subsidized universal health insurance, yet few if any of these people grapple seriously with the best evidence.

3. I live in a country where the extension of health insurance is a major issue, and a major budgetary issue, yet much of the discussion is in an evidence-free zone.

There’s more, but it was the evidence-based points that I found most compelling.  While I think coverage for all Americans should make for a healthier nation, an economically stronger nation, and a nation better prepared for its own defense, I have to agree with Cowen that no one–including myself–is offering up evidence that would support the plans being discussed.  There’s an opportunity to be seized here.

National debate seems to be one of the few areas left in American society–management and medicine being two notable others–in which evidence need not be the basis of an argument or action.  “Proving it” is a big deal among people whose lives and livelihoods hang in the balance.  It would be an excellent change to see that kind of urgency to “prove it” in all matters of national interest.

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Terror plot a “cascade of failures”

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A New York Times editorial today reviews what happened in the terror incident two weeks ago on Northwest Airlines Flight 253:

The report implicitly acknowledges all of this, saying that the system failed “to identify, correlate, and fuse into a coherent story all of the discrete pieces of intelligence held by the U.S. government” about both the Al Qaeda group and Mr. Abdulmutallab. It also makes clear that this was not a single failure by one agency but was a cascade of failures across agencies and departments and the bureaucracies that are supposed to coordinate them.

It says that once the government learned of a possible plot in Yemen, the intelligence community failed to devote more analytic resources, and it failed to put one agency or official in charge. John Brennan, the senior official responsible for figuring out what went wrong, said on Thursday that only after the failed plot did the intelligence community recognize that the group, Al Qaeda in the Arabian Peninsula, actually posed a direct threat to the United States. [emphasis added]

This is a fairly straightforward explanation of the problem.  The problem is not individual, but rather systemic.  There are never enough analytic resources to adequately process the overwhelming volume of data collected by the IC, but that is not the primary problem.  The overarching challenge to the IC is that authority, budget, and power are spread across its agencies with no clear leadership or accountability.  Every 8-year-old kid knows what happens when one kid is in charge of building the treehouse and another kid has all the lumber and nails.  If there is to be reform–and it has yet to happen in the past eight years–consolidating budget and accountability is the most powerful lever.

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NCTC likely focus of terror report

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It appears the forthcoming terror report will implicate the young National Counterterrorism Center:

Without naming the agency, he put the National Counterterrorism Center, the new entity formed after 9/11 to do precisely this function, squarely in his crosshairs.

Until the report (to be released today) has been fully dissected and cross-examined, it is impossible to say whether President Obama is pointing his finger at the right culprit. Of all the parts of the complex system and of all of the post-9/11 reforms, I would have considered the NCTC to be one of the better functioning.

I wouldn’t, but Dr. Feaver (great name) will likely know more than I on the matter.  The reasons I wouldn’t expect it to be one of the better functioning organizations in the IC are

  1. The organization is new, and was created in a relative panic;
  2. Its function is merely coordination–admittedly a tough job–without authority; and
  3. The turf-protectiveness of the IC almost guarantees that the NCTC’s analysis would be incomplete.

I harbor a great deal of respect for the many talented individuals who labor within dysfunctional, unnecessarily competitive intel organizations.  Intel reform has clearly not worked–in fact, there really hasn’t been reform.  Adding layers of bureaucracy, especially without real power, is not reform at all.  Pointing fingers and sacking people is often the politically astute path, but it almost guarantees that we’ll have this discussion again.

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