The Dish

Fujiya & Miyagi 'Ankle Injuries' from Tom Lindsay on Vimeo.

Atul Gawande compares controlling health care costs to controlling food costs at the start of the 20th century. The parallel is, by nature, inexact but this paragraph leapt out at me: 

Much like farming, medicine involves hundreds of thousands of local entities across the country—hospitals, clinics, pharmacies, home-health agencies, drug and device suppliers. They provide complex services for the thousands of diseases, conditions, and injuries that afflict us. They want to provide good care, but they also measure their success by the amount of revenue they take in, and, as each pursues its individual interests, the net result has been disastrous.

Our fee-for-service system, doling out separate payments for everything and everyone involved in a patient’s care, has all the wrong incentives: it rewards doing more over doing right, it increases paperwork and the duplication of efforts, and it discourages clinicians from working together for the best possible results. Knowledge diffuses too slowly. Our information systems are primitive. The malpractice system is wasteful and counterproductive. And the best way to fix all this is—well, plenty of people have plenty of ideas. It’s just that nobody knows for sure.

The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front. Government has a crucial role to play here—not running the system but guiding it, by looking for the best strategies and practices and finding ways to get them adopted, county by county.

(Hat tip: 3QD)

Marc Lynch worries that the new Af-Pak strategy places too much emphasis on Al Quada Central and not enough on the broader network of loosely affiliated terrorist organizations:

For Bruce Hoffmann and other "Centralists," al Qaeda Central continues to play an extremely important role in guiding, shaping, arming, and directing the seemingly inchoate network of jihadists. They point to evidence of contacts between the perpetrators of well-known cases and AQC affiliated people in Pakistan or elsewhere. They point to the deluge of AQ propaganda still pouring out of al-Sahab and other jihadist media outlets. On the other side, Marc Sageman and other "bunch of guys" analysts see the threat as primarily one of a very loosely affiliated network of like-minded individuals and organizations who neither need nor want direction from AQC. If AQC was needed as a spark to light the fire, it is no longer needed to keep the fires burning or new fires from breaking out when local conditions come together.

Lynch fears that our current strategy "could end up strengthening the strategic threat of violent extremism even if it weakens al Qaeda Central."

Portland, Maine, 9.30 am

Weigel tires of Matt Continetti's pro-Palin spin:

It’s true that strong candidates can turn around negative numbers–in 1980, Ronald Reagan overcame many polls that found Republicans were worried about his age–but this is getting silly. In 2005, polls found majorities of all voters, and huge majorities of Democrats, ready to back a Hillary Rodham Clinton candidacy in 2008. In 2009, Palin defenders are left arguing, as Continetti does here, that the fact that 47 percent of Republicans think she’s up to the job of president is fantastic news for her.

EIT exposes one of the lesser known battles of the culture war:

A reader writes:

I have been following your discussion of cap and trade versus carbon tax, and I participated in the development of the RGGI cap and trade scheme.  I think there are some unintended consequences no one has discussed.

As some of your commenters have alluded, the logical place to measure and price carbon (whether a tax or C&T scheme) is at the point where it is extracted.  This is particularly true if an international agreement is to be completed.  That would seem to give producing countries (say Venezuela or Iran or Saudi Arabia) a huge tax windfall at the expense of consuming countries, but maybe not.  Crude oil prices are not set in a market; they are set by OPEC (really Saudi Arabia) to maximize its wealth.  That requires prices low enough to avoid economic catastrophe.  OPEC "prices" will only decline by the amount of the tax.  Whether you call a payment a "price" or a "tax" is irrelevant if it is paid to a socialist government.

On the other hand, US domestic natural gas producers will pay that tax (or whatever pricing regime is developed).  The result is that natural gas (the lowest carbon fossil fuel) will be disadvantaged relative to oil.  That's the worst case of all.  It makes us MORE dependent on foreign oil, and ADDS carbon to the atmosphere (unless of course it shrinks the economy as GW deniers fear).

The better, simpler, maybe even unilateralist alternative is an increasing tax on oil imports.  It does not directly address carbon from all sources, but it reduces the value of foreign oil, makes domestic production (including renewable sources) more profitable, cannot easily be gamed, and may have more real effect on carbon than the scheme currently being negotiated.  And it would make the Saudi Arabians piss their pants.

Ironically, a Pigovian tax on carbon is impossible in the US, but a tax on oil imports might be get the support of anti-free-trade protectionists for all the wrong reasons.

A reader passes along video of what is said to be police slamming into a cyclist in the city of Yazd (east-central Iran):

A translation of the audio and text would be much appreciated. A reader translates:

Did you see? Did you see? Look! Look at this. Look at this. This is the Islamic Republic. This is the Islamic Republic. Oh my, poor bikers. Look at what they did to his motorbike. I swear to god my body is shaking.

A reader writes:

DiA took issue with your use of the label "evil" by noting that the bomber appears to be a rational actor. But doesn't his very rationality make him more evil? For me, that's the very difference between one who commits bad acts and one who is truly evil.

If one commits bad acts because of mental instability, we still punish him, but we might have sympathy for him and offer him medical help. If one reluctantly commits bad acts because of extenuating circumstances, we recognize those circumstances, especially if he shows remorse. But if one commits murder because he believes it is the rationally correct decision, if that person believes murder of children is morally permissible, that's evil. DiA's point was about the deep roots of these beliefs and the difficulty of dealing with them. I certainly agree, and we should do everything we can to understand their thought processes. But watching this video, if that's not evil, I don't know what is.

Things seem to have settled down a bit in Iran today, but Enduring America has a few updates:

1330 GMT:  Peykeiran is reporting that several hundred students are protesting at Tehran University. The demonstration is occurring despite a warning from universities’ authorities that any protesters would be “dealt with”.
…
0920 GMT: Students, Don’t Even Think About It. Fars News reports that Tehran University authorities have declared that any student gathering today is “illegal” and “will be dealt with”.

The video above is evidently from Sharif University today.