Sunday, April 17, 2011

TURKEY AND AFGHANISTAN; BUDGETARY SIMPLICITY VS ACTS OF FAITH

On my oft repeated bias toward a greater role for Muslim Turkey in helping to achieve political stability in the region, Turkey has now said it was willing to host an office in Istanbul for the Taliban to promote peace talks in Afghanistan. Turkey has contributed non-combat troops to the NATO military involvement in Afghanistan.

It is difficult to know where all of this is going, if anywhere, but it is one more possible avenue for getting a political settlement with the Taliban to end the 10-year old war there. Supposedly there are back stage talks already between the Taliban and the government of Afghan President Karzai, with some U.S. involvement. But it is unknown if these are continuing talks and whether any progress has been made. The Turkish offer could add to the negotiation architecture of any peace talks, but there is still a missing major player, at least publicly, in any negotiations that may be going on. That missing player is Pakistan which hosts major elements of the Taliban within Pakistan and which has a history of support of the Taliban.

Turkey's willingness to host a Taliban office might also help determine the power structure of the Taliban itself. It is not a single, hierarchical organization. There are competing factions within Pakistan and the Taliban insurgents within Afghanistan may be operating independently. If the Taliban are to be part of any meaningful political settlement, a necessary first step must be having some confidence that a Taliban office in Turkey has some clout with Taliban factions in both Pakistan and Afghanistan.

There is another advantage of Turkey's offer. Since the governments of Muslim Afghanistan and Pakistan do not trust each other, it puts another Muslim nation in the role of middle man, a nation that already has a growing role in quietly helping in efforts to bring political stability to the region.

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As President Obama and the Republicans attack each other on their competing plans for fiscal 2012, the GOP would seem to have at least one advantage. Despite its meat ax approach to cutting spending and dealing with health care entitlements and its clear bias toward further enriching the wealthy, it does have the advantage of deceptive simplicity. A look at the alternative approaches to deal with the fiscally draining effects of medicare illustrates that simplicity.

The GOP approach to restricting medicare is to convert the current federally funded fee for service approach to a voucher system that would provide federal subsidies to purchase health insurance from the insurance industry. The current medicare funding system is open ended, just submit the bills and the federal government will pay them. The GOP proposes having fixed costs for the program. Aside from the issues of sending huge sums of taxpayer money to the insurance industry and continuing the insurance industry's gate keeper role over accessing needed health care, the general conclusion about the voucher approach is that over time the subsidies to the insurance purchaser will fall behind the increasing costs of the insurance policy. In that regard it certainly is a political risk for the GOP among the growing population of the elderly and its concern for uncertainty about health care and what it will cost them. But it is a seemingly simple solution to cutting the cost and controlling the growing fiscal burden of medicare. And simply cutting costs is central to the agenda of the right wing fiscal hawks.

The Obama approach to cutting the costs of the program is more of an act of faith. The President's plan for cutting costs relies in part on decreasing the cost of medicare through greater efficiency and a crackdown on waste and fraud. But his key to containing costs is having an independent panel which would have the power to slow the cost of medicare by limiting medicare spending if it is growing faster than the growth of the gross domestic product (GDP), plus some wiggle room. If medicare spending rises too much beyond the growth of GDP, the panel would have to come up with ways to keep that growth within the limits of GDP growth. If that isn't complicated enough, the panel's recommendations are then submitted to Congress which can choose to vote or not vote on the recommendations, but politically Congress in effect loses control of its current power to write the rules of the game.

It is a complicated process that challenges any simple understanding except to Congress which realizes how it would limit the role of the lawmakers. The act of faith comes in the willingness to believe that such a panel can deal with all of the complexities involved in determining what health care delivery really costs and then take the steps to cut those costs. Despite the complexity, however, it should be noted that Obama's plan does address the big problem of reducing the growing costs of health care; the GOP plan does not.

So if simplicity has any political advantage, the score is 1-0 GOP. But as stated in the previous post, both Obama's and the GOP's budget plans are just opening bids with "any" final result to be worked out through the traditional process of bargaining and compromise, ugly words to the tea party and its right wing fellow travelers.

7 comments:

  1. Well that sounds like good news. A mediator in the middle east that isn't us. That all sounds like a real positive step forward. I imagine Turkey has an interest in negotiating peace as they are situated right in the middle of everything.

    The wole heatlh care things just confuses me. I don't really understand why we're even going to have to worry about medicare if the new health care law is supposed to cover everybody. I'm sure there is a simple answer but even beyond that the way all these programs work seem very confusing. I was reading an article the other day on the medicare rules and all the parts and it just seemed like a lot to swallow. I do know with all the hoopla about death panels with respect to the new health care law they might not want to refer to an "independent panel". Is all this going to lead the way for yet another czar?

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  2. Carole

    We definitely need an outside mediator. The U.S., Afghanistan, Pakistan, and the Taliban have too much at stake and could use a noninvolved mediator like Turkey. But at the same time, the four stake holders will have to be at the bargaining table and it is not clear at this point whether an outside mediator will be welcome.

    Under Obama's health care reform law, medicare will stay pretty much like it is. The reform is aimed primarily at getting health care for the 40+ million without health insurance and mandating that everyone be insured. The "death panel" thing is, of course, pure fiction from Palin and others of that political persuasion. The panel I referred to about controlling costs would be added to the responsibilities of a 15-person panel already established under the reform law to have an advisory role. Presumably there would not be a czar but getting a 15-member panel to agree on how to actually control costs may not be an easy thing.

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  3. With medicare being in as much trouble as it is and fraught with so much fraud, it is kind of a scarey proposition that the government is also going to be in charge of the new health care regulation especially run by such large panels, or anyh panels. Running the two entirely different programs is going to be incredibly expensive and a lot of bureaucracy.

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  4. Sheila

    As I said, the Obama approach to medicare requires an "act of faith" but I have more faith in a government bureaucracy than in the bureaucracy of the insurance industry which, in seeking to maximize its bottom line, has a bad record when it deals with such things as preconditions and approving treatments for those they insure.

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  5. I don't like the idea of the insurance industry being "in charge" of health care either. It is horrific that they way people are dropped when they need the insurance. It is pretty gross that profit is the only driver. I understand that insurance sales is a business but the product they are offering is insurance and when people are dropped when they actually need it, it is really uncompassionate. I have to admit I'm not sure about the preconditions as people can't buy life insurance when they know they are dying and it seems like the same concept. That is why it is good to have a health care plan that now addresses preconditions.

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  6. Carole

    Believe you have pretty much captured the heart of the question, "Who can you trust"? That's not to say that I have an abundance of confidence in government bureaucracy, but only that on the basis of the track record it seems pretty evident that the insurance bureaucracy can't be entrusted with the job.

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  7. I just saw a news report that Turkey is getting close with Iran. That is disconcerting.

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