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VDH on Iran, and the President Swings and Misses, Again; and “Physics for Future Presidents”

Wednesday, June 17, 2009  |  posted by Hugh Hewitt

Here is the transcript of my interview with Victor Davis Hanson on Iran from yesterday’s broadcast. In it VDH notes the president’s willingness to intercede in affairs of Israel and to push our ally on all sorts of matters but the president’s unwillingness to do anything remotely close to that level of pressure vis-a-vis the gangster regime in Iran. I also asked him the “WWWD?” question: What would “w” do?” His answer:

HH: I asked the question last hour, I’ll ask it of you, what WWWD, what would W. do? What do you think George Bush would have done by now?

VDH: Well, he would have given a statement like he did in Iraq, and like he said about Iran earlier. He would have said our hearts are with people who yearn for universal freedom, and then say it’s not predicated on any particular culture. It’s something we all share. And he would have come out, I think, pretty strongly. But you know, once you’ve apologized to a dictatorship, and you’ve said that we don’t meddle in the affairs of a dictatorship, and we’re sorry for what happened in the past, then you’ve sort of self-censored yourself. And that’s what Obama’s done, that he’s already predicated that he wouldn’t make, exercise moral judgment, and he wouldn’t meddle. He only meddles in democracies. So if it’s a democracy like Iraq, or it’s Uribe in Colombia, or if it’s Israel, then he will meddle and dictate and tell them what he thinks of them, but not an autocracy.

The president’s statement on CNBC yesterday was another missed opportunity to condemn the murder of the dissidents and the rule of the mullahs generally. Here’s what the president said:

Well, I think first of all, it’s important to understand that although there is amazing ferment taking place in Iran, that the difference between Ahmadinejad and Mousavi in terms of their actual policies may not be as great as has been advertised. Either way, we were going to be dealing with an Iranian regime that has historically been hostile to the United States, that has caused some problems in the neighborhood and is pursuing nuclear weapons. And so we’ve got long-term interests in having them not weaponize nuclear power and stop funding organizations like Hezbollah and Hamas. And that would be true whoever came out on top in this election.

The second thing that I think’s important to recognize is that the easiest way for reactionary forces inside Iran to crush reformers is to say it’s the US that is encouraging those reformers. So what I’ve said is, `Look, it’s up to the Iranian people to make a decision. We are not meddling.’ And, you know, ultimately the question that the leadership in Iran has to answer is their own credibility in the eyes of the Iranian people. And when you’ve got 100,000 people who are out on the streets peacefully protesting, and they’re having to be scattered through violence and gunshots, what that tells me is the Iranian people are not convinced of the legitimacy of the election. And my hope is that the regime responds not with violence, but with a recognition that the universal principles of peaceful expression and democracy are ones that should be affirmed. Am I optimistic that that will happen? You know, I take a wait-and-see approach. Either way, it’s important for the United States to engage in the tough diplomacy around those permanent security concerns that we have-nuclear weapons, funding of terrorism. That’s not going to go away, and I think it’s important for us to make sure that we’ve reached out.

The president seems to discount the possibility for real, deep, enduring change in a regime rocked by the sort of turmoil that has shaken Iran for the past five days. This “It doesn’t really matter to us who wins” approach is a deeply disappointing abandonment of the millions who are risking their lives to try and bring about change that doesn’t leave Iran isolated and rushing towards confrontation with the West.

Revolution could still come to Iran, but if it does, it will be no thanks to the thumb-twiddling that has marked the White House’s “actions” since Friday.

I will spend the first hour of today’s program on the latest developments from Iran before turning to a conversation with Berkeley professor and MacArthur Foundation award winner Dr. Richard Muller, author of Physics for Future Presidents. With the climate change bill under consideration in the Congress, everyone needs to read the common sense approach to global warming (and many other science-related public policy issues) treated in the book.

Physics for Future Presidents: The Science Behind the Headlines

The President Misleads, Again, On the “Government Option”

Wednesday, June 17, 2009  |  posted by Hugh Hewitt

The “Government Option,” if part of the radical overhaul of American medicine that is being pushed by the Obama/Pelosi/Reid wing of the Democratic Party, would quickly become the dumping ground for every private sector employer who is tired of paying the health care costs of his employees. I explained this at length in my column this week, and nearly every employer I talk to confirms that the moment a “Government Option” is put into place, they will look at it as a way of offloading the spiraling costs of employee health care.

With that inevitability in mind, read the presiden’ts comments to CNBC yesterday:[# More #]

We’ve said that if you’ve got a plan in the private sector that you’re happy with, you’ve got a doctor you’re happy with, you keep that person. We are not going to be messing with that. What I have said is setting up a public option that would compete with the private sector, but, if it was offering a better product, would give a additional choice to consumers, that’s going to keep insurance companies honest. Now, I understand why insurance companies wouldn’t want it, because if they’re making huge profits and there’s no competition, then why wouldn’t they want to keep that? I understand it, I’m sympathetic. But I think the average American says to themselves, `Why is it that all these members of Congress, including all the Republican members of Congress, they have essentially a public option, they essentially have the ability to look at a menu of choices and exercise those choices; why shouldn’t ordinary Americans have that as well?’ And I think that that kind of approach is sensible. But what I’ve also said is let’s just make sure that, you know, we’re open-minded.

First, the opening statement is simply false. The vast majority of Americans with employer-provided health care don’t pick their insurance plan or at best they pick from aong a limited set of options provided by their employer. Millions of them will be forced into the “Government Option” if it is established, and thus the president’s promise is just flat out untrue.

Second, there is huge competition among health insurance plans right now. Just look at the number and types of plans offered by brokers around the country. There is intense competition between these private firms. Once a “Government Option”exists that private sector competition will be crippled as the subsidized “Government Option” draws huge numbers of employers to it, draining clients from the private plans, pushing them to the brink.

Finally, contrary to what the president said and must know to be false, the “members of Congress” don’t have anything like “essentially a public option.” They have the Federal Employees Health Benefits Plan, which is a subsidized benefit of huge value that allows an annual selection by every federal employee of any of the scores of competing health care plans open to enrollment, regardless of pre-existing condition. What the members of Congress have is a subsidy and a guarantee of acceptance into any plan they want. That’s not the “Government Option” being offered up by Obamacare.

How can you trust the president on anything he says about health care when so short a passage as the one above contains such extraordinary whoppers?

By way of contrast to the president’s froth on this subject, here’s a detailed and sharp analysis of our situation which I received yesterday from Dr. M.E. in North Carolina. The health care delivery system is not efficient, he notes, and for the variety of reasons he details. But the “Government Option” will indeed make it much much worse:

Dear Hugh:

Thank you for the opportunity you have presented over recent weeks for my colleagues and me to express our concerns about the deeply misguided efforts and intentions of our national government in the area of health care. Our jobs are all about balancing risk and cost against potential for benefit, and over time our habits become so ingrained that we apply the same thinking to outward communications. If you want to hear from doctors what they think on an issue you must provide them a low cost, low risk chance of at least a moderate degree of benefit (food helps, too). A note which might help to mold the perspective of such an esteemed and skilled spokesman as yourself, as well as your readers and listeners, is such a chance.

So here I am, a family practice and emergency medicine physician in a small North Carolina town, writing out one doc’s point of view. Like most of my colleagues and co-workers, I am anticipating a turn for the worse should our current national executive and legislative leaders get their hooks further into our health care industry. It seems to me a tremendous fantasy on their part to suggest that the significant problems with which we currently struggle, problems which have been substantially created by government intervention, will somehow be resolved by more intense government intervention. But I suppose that is the essence of the liberal mindset.

We ought to start by considering some common ground. All of us-health care professionals, researchers, hospital administrators, politicians, and the general public-want everyone to get all the quality health care service they may ever need. In addition, we want them to get that service from skilled, intelligent, enthusiastic, visionary and ethical professionals who are diligently committed to the highest standards in all that they do. We want our facilities to be perfectly clean and modern at all times, containing only the latest and best equipment. Record-keeping should be completely accurate and private. Medical research should continue at the maximum possible rate and intensity so as to avoid any delay in the accumulation of our knowledge and refinement of our therapies.

The fact is, however, that we, as a culture, have already made a tacit commitment to these goals and standards without making any plan to pay for the effort. Most of my patients and their families do not only hope for the best possible care regardless of their personal resources-they expect it. As a people, we have little or no tolerance for any behavior by health care professionals which we deem to be even slightly beneath the ideal. I’ve had patients complain about the presence of a fly or spider in the exam room as though such a finding indicates a low standard of cleanliness in our facilities. The complications and near-impossibility of maintaining completely accurate and private medical documentation during ongoing management of a patient’s needs are largely ignored-it must be done!! Any appeal to the expense of high-quality, ethical medical research as an explanation for the cost of drugs or equipment is fruitless-we’re talking about lives and health of real people, not business!!

Regardless of our preferences, rational thinking obliges us to accept limits to what we can provide in this work. We simply cannot afford to fund the ideal system that is our goal. Isn’t that patently obvious? All the players in the current system-patients, their caregivers, facilities, healthcare professionals, government, researchers, etc-want or need more money (a lot more money) to get us closer to the ideal, and the groups paying the bills (employers, insurance purchasers and, of course, American taxpayers) are already spending more than they want to or can afford. As a nation we cannot fund a “right” to unlimited health care for all and our current attempts to do so are, economically and socially, nothing but a big pair of concrete boots.

Such thoughts raise the concept of rationing. No one likes to think about rationing the public support for health care, including doctors, but it has been, is and always will be a necessity. The real point of the debate is not whether to ration, but how to accomplish rationing that gets us as close to the ideal as we are willing to afford and that does so without limiting each individual’s ability to provide for his own needs. Right now we ration by the perverse whim of economic opportunity: Joe qualified for disability years ago and pays no taxes but he gets, on the public dime, an MRI, orthopedic evaluation, replacement of his bad knee and months of rehabilitative therapy so he can maintain his mobility. Fred, on the other hand, works fifty hours weekly on two knees in worse shape than Joe’s, pays a quarter of his income in taxes (in part to fund Joe’s knee replacement) and won’t even see his family doctor for help because his employer provides no meaningful health insurance benefit and he knows he cannot afford anything beyond a primary care office visit. Fred is glad that Joe got the care he needed, but he still can’t walk very well and will likely lose his job eventually when he can’t keep up.

We doctors (and others intimately involved in health care) know that there is a great disparity between the public perception of medical decision-making and its reality. We want to believe that every doctor-patient encounter revolves around some pressing, sincere medical need and that the problem with our current system is a common lack of resources and infrastructure to help the doctor and patient properly address that need. Though I have certainly been involved with many cases in which reasonable patients and their families are struggling to find the means to obtain significant and necessary medical care, it is much more common to be confronted by needy, demanding patients (and their families) who insist on expensive evaluations and therapies which are unlikely to benefit their minor, non-medical problems and for which they will pay nearly nothing. Though it would be difficult to prove by rigorous study, I strongly suspect that the majority of patient visits to Emergency Rooms and primary care offices across our country would not be made if patients had personal control and responsibility for even a quarter of the money involved, even if they could afford the expenditures out of their own pockets. At the same time, those who must pay all of the expenses of their own care due to lack of coverage routinely get by with little or no medical attention until their conditions resolve under their own management or become severe, disabling and even life-threatening.

These messy injustices, which we physicians see constantly, are the predictable product of our national government’s increasing interference over decades in our people’s provision of a basic good for themselves-personal health care. Our current system of health care may not be run by the national government but it certainly is dominated by it, and the inequities and inadequacies of the system can largely be blamed on the regulatory, bureaucratic, legal and financial influences and controls of that entity. We have ample evidence that the government is lousy at distributing our resources toward health care in a reasonable and fair way, and we should not be surprised: Government leaders are highly motivated to give their constituencies what they want, and what they want is more health care. The only way government can attempt to provide this is to spend more money or to require that providers do more for the same money, hence the acceleration of financial outlay and the proliferation of regulations and controls over recent decades. Unfortunately, both these efforts are manifestly incapable of producing what we really need: High-quality, low-cost health care distributed as widely as we can manage and afford.

So, if the government should be extracted from the driver’s seat, who should take its place? If we cannot depend on a “government option” to meet our medical needs, on whom should we depend? What do we do to preserve the good qualities of our health care system while solving the problems?

First, we must reject the sentimental (and unconstitutional) notion that we have a “right” to health care. We should acknowledge that we don’t want to abandon those in need among us, and we should make the best provision for them that we can, but we must stop pretending that we are willing and able to supply whatever it takes to meet whatever needs may develop. We have to decide how much we are willing to spend via the public coffers then spend it as wisely and fairly as we can manage.

Second, we must recognize that no one will ever be in a better position to make health care decisions than the patient with help from his doctor and family. Standards can be set and should be respected based on our best knowledge at the time, but ultimately we must confine the authority and responsibility of medical decision-making to this small circle.

Third, we must never underestimate the importance of a solid connection between the decision-maker and the cost. The worst abuses in medicine take place when those choosing methods of evaluation and treatment are separated financially from those paying the bills. Both patients and providers can be guilty of gross waste in the management of medical problems when they experience no financial consequences for coverage of the options. Indeed, this is one of the principle pitfalls of government involvement: The government frequently formulates programs which sever the link between choosing and paying for a service, typically in the name of a “right” to health care and with an erroneous assumption that patients and their providers will only do what is truly and clearly necessary. Wasteful practices then run amok and the taxpayer is stuck with the bills.

Combining these three requirements would lead to a system in which we, as a people, choose to set aside resources for funding of health care needs at a level commensurate with our ability and willingness, distribute the funds amongst ourselves in some equitable way and then allow individuals and families to spend those funds for health care expenses in whatever manner they deem appropriate. This would allow for public support of health care while preserving a connection between decision-making and financial responsibility as everyone would understand, better than they do now, that the support offered is limited. By this method everyone could have opportunity for basic preventative and illness care, we would encourage individual initiative in the acquisition of additional coverage from the private sector, and politicians would be motivated by pressure from their constituencies to minimize any government interference which increases cost while providing little benefit. Doctors and hospitals would also be incentivized to provide high quality care for low cost as patients would be more discriminating about how they spend their limited public and personal financing. Most importantly, we would all be more inclined toward wise and efficient use of services while at the same time taking better care of ourselves and our loved ones so as to reduce our need for health care.

Many will likely object to all this thinking on the grounds that refusing a “right” to health care and establishing limits for the public contribution to an individual’s medical needs will require us to say “no” to sick people. While such an objection confirms an accurate understanding of the situation, it also serves to illustrate the basic problem we face: We want everyone to have every medical service they might ever need, but our willingness and resources are limited. As wealthy, skilled, knowledgeable and well-intentioned we may be, the American people are not God and we must seek out the most efficient and effective means possible for delivering our limited support. The fact is that we are saying “no” to sick people all the time right now-we’re just doing it in an unreasonable, unjust, frequently accidental and random fashion which helps us to ignore and avoid our responsibility for the situation but prevents us from advancing toward our health care goals as a nation.

These “reforms” described above will ultimately be necessary to get us as close to our ideal as possible. Consider also that these changes will happen eventually: We can either adopt them purposefully now, or we can wait until ever-increasing government intervention and entitlements destroy our healthcare system and bankrupt our country, at which point they will fall quite naturally into place. Purposeful adoption definitely seems wiser, safer and more American to me.

Sincerely, and with appreciation,

Dr. M_____ E_______

Iran On The Brink

Tuesday, June 16, 2009  |  posted by Hugh Hewitt

The BBC’s John Leyne thinks today’s announcement from Iran’s Guardian Council about a recount is “just a political ruse to try and wrong-foot the opposition.” Leyne continues:

They have offered a recount, but they have not said who is going to carry it out. Maybe the same people who did the election count to start with.

In any case, the opposition says there were so many other irregularities, that a recount alone would not satisfy them. For example, many more ballot papers were issued than counted, they say. Some people did not get enough ballot papers so they could not vote in areas loyal to the opposition. Polling stations were closed early, and so on and so forth.

Michael Ledeen has studied and written about Iran’s mullahs and their deeply evil regime for decades. Don’t miss his analysis of where that regime finds itself today. Key graphs:

But the key element is the people. They are only just beginning to understand the reality of their situation. Virtually none of them imagined that they would be in a revolutionary confrontation with the regime just two days after the electoral circus, and few of them can realize, so soon, that they can actually change the world. I think the Mousavis now understand it (they know that they are either going to win or be destroyed). It remains to be seen if they can instruct and inspire the movement.

Much will depend on their ability to communicate. The regime has been waging a cyberwar against the dissidents, shutting down websites, cell phones, Facebook, and the like. As most people have learned, the basic communications tool is Twitter, which somehow continues to function. Bigtime Kudos to Twitter, by the way, for postponing its planned maintenance so that the Iranians can continue to Tweet. Would that Google were so solicitous of freedom.

We don’t know who’s going to win. The Iranian people know that they’re on their own; they aren’t going to get any help from us, or the United Nations, or the Europeans. But paradoxically, this lack of support may strengthen their will. There is no cavalry on the horizon. If they are going to prevail, they and their unlikely leaders will have to gut it out by themselves. God be with them.

Duane has also now posted the transcripts of yesterday’s interviews with Michael Rubin, Michael Totten, Claudia Rosett and John Podhoretz.

The key Twitter search terms remain #iran and #iranelection. The key blogs are, CommentaryMagazine’s Contentions (already strong and then it added Totten), and’s The Corner.

Not every post at every blog is about Iran, nor should they be because the rest of the world hasn’t stopped. (If anything, Team Obama is trying to accelerate the miserable “government option” which would be the ruin of American medicine.)

But the overwhelming focus should be on Iran. It was dispiriting to watch the House of Commons debate last night and see it focus on yet another Iraq War inquiry rather than the savagery of the mullahs’ death squads. We have to hope that the United States Congress acts today to stand with the demonstrators against the killers and in uncompromising terms, and that the president tries to get the message right a third time. (Strike one was the Veep on Meet the Press. Strike two was last night’s incoherent statement about abhorring violence. A blunt condemnation of the killers isn’t that hard to draft.)

As Ledeen notes, the demonstrators cannot look for any cavalry coming over the hill. The amazing site of unarmed protestors charging a Basij compound is a testament to the deep desire for freedom, one that has been seen before in Tienamen Square and around the Berlin Wall, as well as in Ukraine and Lebanon and many other places. Sometimes that deep desire manifests itself in crowds of hundreds of thousands and turns a dictatorship over. Sometimes it is slaughtered. All that the observers in the West can do is pray for, cheer on, and report accurately on that desire for freedom and the incredible courage that supports it.

UPDATE: From the Asia Times:

David Goldman (aka “Spengler”) on Iran’s strategic weakness, and

M. K. Bhadrakumar on the Rafsanjani-Khamenei split that triggered the turmoil which could now swallow them both.

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