Health

Not my favorite line from last night's speech, but it still caught my eye....

...the plan I'm proposing will cost around $900 billion over ten years - less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration.

Keep that in mind when your local school district is forced to cut a few more programs or lay off a few more teachers, when your car hits another pothole on a bridge that needs repair, when your public transit system cuts service or raises fares, and when the federal budget deficit continues to rise. Stupid foreign policy decisions don't just cause problems overseas; they undermine our quality of life here at home. And as I said once before, it remains a puzzle why the GOP is eager to tax us to pay for ambitious social engineering projects in faraway lands, yet loathe to fund programs designed to benefit Americans here at home. It's equally puzzling (to me at least), why Americans have gone along with this idea. So far.

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I'm no expert on health care, so I don't have strong views on how to reform the current U.S. system. But watching the lies, chicanery, and sheer wing-nuttery of the "debate" on health care reform (along with the birther controversy, the revelations about "The Family," and various other manifestations of what Richard Hofstader called the "paranoid style" of American politics) led me to wonder about possible foreign policy implications.

Here's my question: What impression do people in other countries get when they observe the divorced-from-reality nature of contemporary American political discourse? American pundits like to talk about how "irrational" our adversaries are (usually when they are trying to scare us into spending more on weapons or launching preventive wars), but do they ever stop to think about how goofy and irrational we appear to be to others? And I don't just mean the buffoons on talk radio and Fox News; I'm talking about Senators, Congresspersons, and other prominent politicos. When I see some of these folks in action, even a realist like me begins to question the validity of the "rational actor" assumption.

The United States doesn't have a monopoly on extremist politicians, of course, but it is a lot more powerful. No wonder unpolarity makes even our allies nervous.

A while back I commented on the two imbalances of power that drive American grand strategy. The first is the gap between the United States and the other major powers, which makes Americans think they are responsible for managing much of the world and convinces them that they can do so with near-impunity. The second imbalance is the strength and political clout of a host of different institutions and interest groups whose common agenda is encouraging greater international activism on the part of the United States. In recent decades, the forces in favor of "doing more" have been better-funded and better-organized than those who favor greater restraint, which is one reason why we spend so much on defense and why we find ourselves entangled in intractable conflicts on several continents.

But when I read some early reports about the Obama administration’s health care plans, I began to wonder if the various forces that favor global activism are going to face stiffer opposition in the future. We are likely to have a sluggish economy for some time to come and the U.S. population is getting older. Virtually everyone agrees that serious health care reform is badly needed but will cost a lot. Plus, Obama's various economic recovery measures are going to saddle us all with record deficit levels. Us baby boomers are not exactly noted for our altruism, and my generation is going to put a lot of pressure on politicians to deliver the entitlements we've been promised. All of this means that budget dollars are going to be very tight, and the Pentagon is going to face tougher scrutiny when it brings in gold-plated requests. The Nation and Mother Jones may not be all that formidable a political opponent, but what about the AARP?

One of the great triumphs of Reagan-era conservatism was to convince Americans that paying taxes so that the government could spend the money at home was foolish and wrong, but paying taxes so that the government could spend the money defending other people around the world was patriotic. Ever since Reagan, in short, neoconservatives supported paying taxes to promote a U.S.-dominated world order, while denouncing anyone who wanted to spend the money on roads, bridges, schools, parks, and health care for Americans as a “tax and spend liberal." But if I'm right about the emerging fiscal environment, that situation may be about to change.

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I'm about to leave town for a conference on civil-military relations sponsored by the Eisenhower Project, so I won't be posting much until next week. But several thoughts occurred to me as I watched the world's nations rally to address the swine flu problem.

Potential pandemics appear to be one of those issue-areas where global cooperation works pretty well. By most accounts the response to SARS back in 2003 did a fairly good job of containing what might have been a much more serious problem. By contrast, the global response to climate change has been much more halting, and collaboration in other areas (the Doha Round, arms reductions, etc.) has been even more disappointing in recent years.

I think there are three features of the pandemic problem that encourage effective international collaboration. First, the dangers are immediate and somewhat indiscriminate, in the sense that lots of countries are likely to be affected and within a relatively short time-horizon. Mishandling a pandemic would not only impose major short term costs, it could also affect the political fortunes of incumbent politicians around the world. So nobody sits around twiddling their thumbs. Global warming, by contrast, is a long-range danger, which makes it easier for today's politicians to waste a lot of time haggling and push the problem off on future generations. 

Second, pandemics are not an issue where "relative gains" loom large. States don't see this as an opportunity to improve their strategic position by getting others to bear all the costs or by trying to free-ride (or god forbid, by trying to encourage the disease to spread to one's rivals). Infectious diseases are too mobile and the world is too interconnected for that approach. If Country A responds vigorously but Country B does not, B is likely to have a more serious problem. But the worse things are for B, the bigger the problem that A might face (think Mexico and the US in this regard). This situation encourages joint efforts, and makes it more likely that each state will do all that it can to contain the danger and mitigate the effects.

Third, public health is a highly professionalized and comparatively de-politicized field, and the relevant international and national institutions (e.g., the World Health Organization) have a lot of prior experience. Many of the responses to these events are based on uncontroversial science and straightforward best practices, which means there is less debate about what measures to take and less time spent trying to devise solutions. One might contrast this with the current economic mess, where different national authorities have rather different ideas about the best way to respond and international coordination has been pretty paltry.

All this is not to say that the global response will be perfect, or that the potential pandemic will be contained as effectively as SARS ultimately was. But it does remind us that global cooperation is possible, and that some global institutions do provide valuable protection. Libertarian neo-isolationists and neoconservative institution-bashers should take note.