June 21, 2013 by The Sumter Item

OPINION THE ITEM

FRIDAY, JUNE 21, 2013 To submit a letter to the editor, e-mail letters@theitem.com

COMMENTARY

America sidelined, barely relevant

ASHINGTON — The war in Syria, started by locals, is now a regional conflict, the meeting ground of two warring blocs. On one side, the radical Shiite bloc led by Iran, which overflies Iraq to supply Bashar al-Assad and sends Hezbollah to fight for him. Behind them lies Russia, which has stationed ships offshore, provided the regime with tons of weaponry and essentially claimed Syria as a Russian protectorate. And on the other side are the Sunni Gulf states terrified of Iranian hegemony (territorial and soon nuclear); non-Arab Turkey, Charles now conKRAUTHAMMER vulsed by an internal uprising; and fragile Jordan, dragged in by geography. And behind them? No one. It’s the Spanish Civil War except that only one side — the fascists — showed up. The natural ally of what began as a spontaneous, secular, liberationist uprising in Syria was the United States. For two years, it did nothing. President Obama’s dodge was his chemicalweapons red line. In a conflict requiring serious statecraft, Obama chose to practice forensics instead, earnestly agonizing over whether reported poison gas attacks reached the evidentiary standards of “CSI: Miami.” Obama talked “chain of custody,” while Iran and Russia, hardly believing their luck, reached for regional hegemony — the ayatollahs solidifying their “Shiite crescent,” Vladimir Putin seizing the opportunity to dislodge America as regional hegemon, a position the U.S. achieved four decades ago under Henry Kissinger. And when finally forced to admit that his red line had been crossed — a “game changer,” Obama had gravely warned — what did he do? Promise the rebels small arms and ammunition. That’s it? It’s meaningless: The rebels are already receiving small arms from the Gulf states. Compounding the halfheartedness, Obama transmitted his new “calculus” through his deputy national security adviser. Deputy, mind you. Obama gave 39 (or was it 42?) speeches on health care reform. How many on the regional war in Syria, in which he has now involved the United States, however uselessly? Zero. Serious policymaking would dictate that we either do something that will alter the course of the war, or do nothing. Instead, Obama has chosen to do just enough to give the appearance of having done something. But it gets worse. De-

spite his commitment to steadfast inaction, Obama has been forced by events to send F-16s, Patriot missiles and a headquarters unit of the 1st Armored Division (indicating preparation for a possible “larger force,” explains The Washington Post) — to Jordan. America’s most reliable Arab ally needs protection. It is threatened not just by a flood of refugees but by the rise of Iran’s radical Shiite bloc with ambitions far beyond Syria, beyond even Jordan and Lebanon to Yemen, where, it was reported just Wednesday, Iran is arming and training separatists. Obama has thus been forced back into the very vacuum he created — but at a distinct disadvantage. We are now scrambling to put together some kind of presence in Jordan as a defensive counterweight to the Iran-HezbollahRussia bloc. The tragedy is that we once had a counterweight and Obama threw it away. Obama still thinks the total evacuation of Iraq is a foreign policy triumph. In fact, his inability — unwillingness? — to negotiate a Status of Forces Agreement that would have left behind a small but powerful residual force in Iraq is precisely what compels him today to re-create in Jordan a pale facsimile of that regional presence. Whatever the wisdom of the Iraq War in the first place, when Obama came to office in January 2009 the war was won. Al-Qaeda in Iraq had been routed. Nouri al-Maliki’s Shiite government had taken down the Sadr Shiite extremists from Basra all the way north to Baghdad. Casualties were at a wartime low, the civil war essentially over. We had a golden opportunity to reap the rewards of this too-bloody war by establishing a strategic relationship with an Iraq that was still under American sway. Iraqi airspace, for example, was under U.S. control as we prepared to advise and rebuild Iraq’s nonexistent air force. With our evacuation, however, Iraqi airspace today effectively belongs to Iran — over which it is flying weapons, troops and advisers to turn the tide in Syria. The U.S. air bases, the vast military equipment, the intelligence sources available in Iraq were all abandoned. Gratis. Now we’re trying to hold the line in Jordan. Obama is learning very late that, for a superpower, inaction is a form of action. You can abdicate, but you really can’t hide. History will find you. It has now found Obama.

COMMENTARY

Does health insurance improve health?

oes having health insurance make people healthier? It’s widely assumed that it does. Obamacare advocates repeatedly said that its expansion of Medicaid would save thousands of lives a year. Obamacare critics seldom challenged the idea that increased insurance coverage would improve at least some people’s health. Now, out of Oregon, comes a study that casts doubt on the premise that insurance improves health. In 2008, Oregon state government had enough Medicaid money to extend the program to 10,000 people but many more were eligible. So the state set up a lottery to determine who would get coverage. That created a randomized control trial (RCT), to compare the health outcomes of about 6,000 people who won the lottery with a similar number who lost. RCTs are the best way to test the effects of public policies, as Jim Manzi argues in his recent book “Uncontrolled: The Surprising Payoff of Trial-and-Error for Business, Politics and Society.” Other studies compare the effect of policies on populations that may differ in significant ways — apples and oranges. RCTs compare apples and apples. The only previous RCT on health care policies was conducted by the RAND Corporation between 1971 and 1982. It found no statistically significant difference in health outcomes from having more insurance. But health care has changed a lot since then. The Oregon Health Study, published last month in the New England Journal of Medicine, found much the same thing. Comparing three important measures — blood sugar levels, blood pressure and cholesterol levels — It found no significant differ-

ence after two years between those on Medicaid and those who were uninsured. It did find lower levels of reported depression among the group on Medicaid. And it found, unsurprisingly, that they did save significant money. Those findings may not be unrelated. The findings have serious implications for Obamacare. Half of its predicted increase in insurance coverage comes Michael from expansion BARONE of Medicaid. Obamacare supporters have assumed that those eligible for Medicaid — poorer, sicker and less steadier in habits than the general population — would have great difficulty getting health care without insurance. The Oregon Health Study is evidence that at least in that state Medicaid-eligible people without insurance — a “pretty sick” population, one state official said — nevertheless managed somehow to get care that produced results about as good as those who won the lottery. It may just be that ordinary people, even those with significant problems, are more capable of navigating the seas of American life than elites, either liberal or conservative, tend to assume. These results run contrary to the predictions of many Obamacare fans, who expected to see more positive effects from Medicaid coverage. It undermines at least a little the case for Obamacare’s vast expansion of Medicaid. Some Obamacare backers, and others as well, point out that the study did not measure all possible health care outcomes. It couldn’t because it covered only two years; and Oregon, with more Medicaid money, ended the lottery experiment, so there won’t be any more RCT results.

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In particular, in a two-year period you aren’t going to have too many cases of catastrophic illness among a population of 12,000. There’s no way you can measure outcomes in those with long-running ailments like cancer, Parkinson’s disease or Alzheimer’s. Blood sugar levels, blood pressure and cholesterol levels can be treated with relatively inexpensive generic drugs. Medicaid coverage may result in more people getting heart bypass surgery and needing expensive drugs for rare ailments. But that is another way of saying that health insurance as we know it may not do much to improve the treatment of common health problems. Most U.S. health insurance today, thanks to the tax preference for employer-provided insurance, is not real insurance at all. Real insurance pays for rare, expensive and unwelcome events, like your house burning down. It doesn’t make sense to insure for routine expenses, like repainting your living room. The Oregon Health Study suggests that insurance isn’t necessary for people to get what are now, for people of a certain age, routine measures like blood pressure medicine. Maybe government should help poor people pay for them, but they manage to get them nevertheless. Americans have come to expect health insurance to pay for routine treatments. Obamacare reinforces that in its requirements for coverage and makes it more difficult for many to insure against catastrophic health care expenses. That’s not likely to make people healthier.

H.D. OSTEEN 1904-1987 The Item

MARGARET W. OSTEEN 1908-1996 The Item

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