The Tao of Conservative Government, Part 1

"Governing a large state is like boiling a small fish," reads the Lao Tzu, one of the foundational texts of Chinese Taoism. Also known as the Tao Te Ching, it holds (according to D.C. Lau, one of its esteemed translators) that ...

... the state or the empire is a delicate thing that can be ruined by the least handling, or a sacred vessel which must not be tampered with. The empire is as much a part of the natural order as [it is a part of] the world of inanimate objects and, being part of the natural order, will run smoothly so long as everyone follows his own nature. To think that once can improve on nature by one's petty cleverness is profanity. The natural order is delicately balanced. The least interference on the part of the ruler will upset this balance and lead to disorder.

This wisdom from the 4th century B.C., out of a cultural tradition not America's own, resonates with some of us moderns today as we consider what to do about, among other things, our health care financing system that threatens to go bust in coming decades, or Social Security's looming fiscal crisis, or our planet's inability to keep sidestepping the climate change coming from all the carbon we are spewing into the air.

This ancient wisdom, applied to today's political controversies, admittedly seems an apostasy to a political liberal such as oldstyleliberal. We liberals are folks who say show me a problem, and I'll show you a way to have the government fix it.

Health care getting too expensive, with a sixth of the populace uninsured? Fix it by legislation mandating that everybody buy health insurance privately, if they can't get it from their employers. Then set up the government as insurer of last resort and give tax breaks to citizens who can't afford the premiums.

Social Security heading for a fiscal crackup as the burgeoning number of retirees drawing from the kitty overburdens the dwindling number of workers feeding the kitty? Fix the system. How, exactly? That remains unclear, but what seems ultra-clear to most liberals is that privatizing Social Security and subjecting it to the ungoverned vicissitudes of financial markets is out of the question.

Global warming threatening to swamp not only the planet's coastlines but also its sustainable agriculture and its potential for economic growth? Again, bring government power to bear on whatever or whoever is responsible for creating the climate change in the first place. Only problem is, we have met the enemy and he is us. We all have a huge carbon footprint. Even on paper, what could the government fix be for that?

It is beginning to become apparent to oldstyleliberal that, well ... that the old-style, liberal approaches to solving the world's problems have gone bankrupt.


Take, for example, the woes of our health care system today. Primary care physician Kevin Pho writes in an op-ed column in a recent USA Today that a real problem is the acute shortage of doctors who aren't specialists, but rather general practitioners, family doctors, and the like. Medicare and the rest of the health care financing/insuring system pay them much less handsomely when they use "30 minutes to discuss a patient's hypertension, diabetes or heart disease" than if they use the same 30 minutes to perform a procedure or render a tangible service. The incentives are all stacked in favor of primary care docs doing more and discussing less.

Meanwhile, there are the "annual government threats to indiscriminately cut reimbursements despite rising office and malpractice costs, [such that] physicians are faced with no choice but to increase quantity to maintain financial viability." Hence, "primary care physicians who refuse to compromise quality are either driven out of business or to cash-only concierge practices, further contributing to primary care's decline."

Patients naturally respond to the demise of the old-fashioned way of interacting with the family doctor by going directly to specialists who are eager to perform procedures that result in themselves, the specialists, being reimbursed generously. In the old days, the family doc would act as an intermediary and clearinghouse for possible specialist interventions, discouraging those that aren't really going to do the patient much good. Today, though, "studies show that increasing fragmentation of care results in a corresponding rise in cost and medical errors."


How did we get things so messed up?

In the estimation of oldstyleliberal, the culprit may have been the litany of attempts over the past half-century or more to "improve" or "fix" the health care system. They have all had in common that they make the consumers of health care services insensitive to the real relationship of benefits to costs, since "someone else" is paying the costs.

So consumers demand health care services more indiscriminately than they otherwise would ... and the primary care physician whose counsel might help avoid that is out of the loop. Because of the laws of supply and demand, prices go up, and the "someone else" bearing the costs — whether an employer, a private insurer, or the government — tries to impose artificial rules to keep things in check.

But the rules typically rebound. For instance, there was a time not too long ago when experts said "managed care" facilities (HMOs and the like) were the fix we needed. The HMOs, originally benign, soon began imposing all kinds of rules on who may see what doctor when and for what, simply to hold down costs. Massive customer dissatisfaction ensued, followed by an exodus from HMOs.

Again, oldstyleliberal believes the underlying problem with HMOs and the various other "solutions" that have been tried is that they have all been attempts to overrule or undermine the health care marketplace. As columnist George F. Will mentioned in this recent piece about Cuba, a market is "an information-generating mechanism, communism cannot know what things should cost."

Neither can the participants in an American health care financing system that suppresses the ability of consumers to find out, or even care about, what things actually cost.

Now, according to Dr. Pho, "if the Democrats' universal health care proposals come to fruition, the primary care system will be inundated with at least 45 million newly insured patients. As Massachusetts is finding out in its pioneering attempt to provide universal coverage, our system is not ready for this burden."

Dr. Pho's prescription

... starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for spending time with patients, optimally managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked disparity between specialist and primary care physician salaries.

oldstyleliberal is not convinced, though, that these solutions wouldn't rebound in some unexpected way, should they be enacted, because they don't solve the underlying problem: the health care market has been jiggered and re-jiggered so that the "information" it provides suppliers and consumers with is ever more bogus. It doesn't give anyone any real idea of what things should cost. The reason it doesn't is that the level of demand for health services is divorced from what might be termed "cost-benefits reality" whenever "someone else" pays. Then the "someone else" typically tries to impose artificial cost-cutting measures, which always end up cheating somebody even more than purely market-driven forces might do.

In short, government soultions too often end up boiling the proverbial "small fish" into fish paste. There has to be a better way. oldstyleliberal increasingly looks to the so-called conservative initiatives — what this recent editorial in the Baltimore Sun recently lambasted as John McCain's "raft of small-bore policy ideas centered around giving individuals more control over [health care] spending" — that might allow the bottom-up forces of the marketplace to do what the top-down imperatives of government controls have conspicuously failed to do.

2008 Election - SUSA Polling Suggests New Battleground States

Remember 2000? The Democratic candidate, Al Gore, got more of the popular vote than the Republican George W. Bush did, but lost the election in the Electoral College (with the help of the Supreme Court). This year, it looks like another ultra-close general election may be on tap, and it's not unimaginable that it will be the Democrat this time who'll need an electoral-vote edge, after possibly getting fewer popular votes than John McCain. We Democrats need to be prepared for that.

Trouble is, we Democrats are unlikely to know who exactly our 2008 presidential nominee will be until the 796 superdelegates make their individual choices at the Democratic National Convention, August 25-28 in Denver.

The superdelegates are Democratic members of Congress, governors, mayors, and state and national party leaders. Each superdelegate can vote for Barack Obama or Hillary Clinton, as they prefer. Some have already pledged for one, some for the other, and some have not tipped their hand. Once "committed" by announcing their own personal choice, they can still switch candidates at will if they feel the need. There is no rule or law that forces them to cast their vote a certain way.

As of Sunday, March 9, Clinton has a slight edge in committed superdelegates, 242-210, while more than 300 remain uncommitted.

Interesting fact: the identities of only 719 of the 796 superdelegates are presently known. A group of 77 "add-on" superdelegates will be named later by state party leaders. The Obama-Clinton race may wind up in the laps of those 77.

Another interesting fact: if the delegations from Florida and Michigan wind up not being seated at the convention — they've been barred because their states violated party rules and scheduled too-early primaries — neither will Florida and Michigan superdelegates. But if some kind of deal is struck by which those two delegations get seated after all, then an as-yet-undetermined number of superdelegates from those states would be added to the current total of 796 — and their votes could end up picking the nominee.

Unless either Clinton or Obama takes all the remaining primaries/caucuses by large margins, then even in the wake of Clinton's victories in Ohio and Texas on March 4 it looks as if neither candidate can amass enough elected, pledged delegates to sideline the superdelegates at the convention.


How should the superdelegates decide how to vote?

2008 Election - SUSA Polling Suggests New Battleground States gets at what oldstyleliberal thinks the superdelegates ought to be thinking about when they decide. Specifically, they ought collectively to try to vote for the candidate most likely to lick John McCain in the Electoral College in the crucial battleground states.

Says the SUSA (SurveyUSA) pollster, "McCain leads [Obama] in the blue states of Pennsylvania and New Jersey while Obama leads [McCain] in the red states of Virginia, Ohio, North Dakota, Nevada, and Colorado." Meanwhile, "McCain leads [Clinton] in the blue states Washington, Oregon, and Michigan while Clinton leads [McCain] in the red states Florida, Ohio, West Virginia, and Arkansas. McCain leads [Clinton in] two of the three purple states, but trails Clinton in the neighboring purple state of New Mexico."

The "purple states" are the three states that changed parties in 2004's Bush vs. Kerry election, vis-à-vis how they voted in the 2000 Bush-Gore election: New Mexico (which went for Gore in 2000), Iowa (for Gore in 2000), and New Hampshire (Bush in 2000).

If these precise SUSA polling results hold up over time — and no one really sees that as coming about — Obama looks to be the better choice for Democrats concerned about winning Virginia, North Dakota, Nevada, and Colorado in November. Clinton looks to be the better choice if Florida, West Virginia, Arkansas, and New Mexico are held in focus. Both Democrats look like McCain-beaters in 2008 in Ohio. And so on.


Obviously, it's too soon to know for sure how Obama or Clinton would actually do against their Republican foe in all the various states in November. This particular early poll was of too few voters and had too wide a margin of error to be determinative. The point oldstyleliberal would like to make is that, come August, each superdelegate first of all needs to figure whether his or her state will be one of the close-fought ones in November.

If so, then that superdelegate ought to consider how Clinton and Obama will poll against McCain in his or her home state, and vote for the Democrat that can be expected to be most likely to take that state's electoral votes.

That is, each superdelegate from a battleground state should vote for whichever candidate they think has the best likelihood of keeping their own state's electoral votes from going to McCain.

Notice that this is not necessarily the same thing as knowing which candidate, Obama or Clinton, is the more favored by Democrats in the superdelegate's home state. It may be that Democrats in (say) Ohio prefer Clinton, yet Obama might be the better choice as McCain's opponent in Ohio because he could pull more independents, crossovers, and marginal voters into his column in the general election.

Unfortunately for Clinton, there seem to be few if any states where she would be expected to run stronger than Obama with independents, crossovers, and marginal voters such as young adults who typically don't vote, and who might or might not turn out. It is hard to find a state whose primary/caucus voters favored Obama but whose superdelegates ought to back Clinton as the more likely McCain killer.

So unless it somehow becomes clear that the electoral vote in November will turn on one or two swing states where Clinton does in fact stand a better chance than Obama against McCain — if such states exist — then superdelegates in general ought to lean toward Obama.

Accordingly, each superdelegate from a non-battleground state might wish to choose to make an estimate of each candidate's viability in the key battleground states specifically. The Democrat who polls best against McCain in those swing states will likely get more electoral votes in the November election than the other Democratic possibility would receive. Hence, the non-swing-states superdelegates might want to try to throw the nomination to that candidate — who, per the above analysis, is more likely to be Obama than Clinton.


Clearly, it will be pretty hard for any given superdelegate to presume to know how Clinton or Obama will do against McCain in the whole of the Electoral College, once all the people have voted in a close election on November 4. Given the cloudiness of everyone's crystal ball, oldstyleliberal thinks that if a superdelegate is from what will clearly be a battleground state, he or she still ought simply to vote for the Democrat who will be most likely to beat McCain in that state.

As a practical matter the other superdelegates, the ones from states that will probably not be close, might still want to vote for the Democrat who will poll better against McCain in their own states. For instance, the Democratic governor of oldstyleliberal's home state of Maryland, Martin O'Malley, will be a superdelegate. He might opt to vote for whichever candidate, Obama or Clinton, would more certainly prevail in Maryland against McCain, in the unlikely event that huge numbers of Republican voters come out of the woodwork and make the race close in the Old Line State.

That way, O'Malley and the other Maryland superdelegates could avoid having to psych out the likely Electoral College results in the other 49 states, a Herculean task.

So there are several possible alternative strategies open to superdelegates who aim to angle their convention votes in August toward an Electoral College victory in November. oldstyleliberal admits he does not know exactly which micro-strategy for choosing between Clinton and Obama is most likely to pay off in November, given all the clouds in the crystal ball. Still, being ever-mindful of the electoral vote in the general election seems to oldstyleliberal the best way for the superdelegates to carry out their unprecedented duty to actually choose the Democratic nominee.