Rajiv Shah cries wolf

Posted By Kori Schake Thursday, April 7, 2011 - 12:00 PM

Imagine the chairman of the Joint Chiefs of Staff testifying that if defense funding were reduced, seven hundred thousand people in Libya would die, and tens of millions elsewhere in the world. It would be considered fear-mongering of the most repulsive kind. In fact, it would be considered a threat to the integrity of our civilian-led military to attempt such a blackmail of the Congress.

But that's exactly the approach USAID Director Rajiv Shah took last week testifying before the House Appropriations State and Foreign Operations subcommittee. He said that if proposed reductions to USAID's budget go into effect 70,000 children will die. He added that he considered that a very conservative estimate, and that among other effects, another 800,000 recipients of our international disaster assistance in Darfur would be at risk.

Shah testified that 30,000 deaths would come specifically from scaling back anti-malaria programs, 24,000 from lack of immunization, and 18,000 lack of skilled attendants at births. All this from cutting 16 percent of the Obama administration's international affairs budget request.

Hard to say which is more offensive, Shah threatening Congress will have blood on its hands unless it continues to fund USAID programs, or the bureaucratic and cultural mindset that considers increased spending the only solution to a multivariate problem.

USAID was created as an entity separate from the State Department (and military assistance) in 1961, in order to remove from development assistance the taint of being provided in order to advance America's interests. USAID's official history rather unselfconsciously states that "It was thought that to renew support for foreign assistance at existing or higher levels, to address the widely known shortcomings of the previous assistance structure, and to achieve a new mandate for assistance to developing countries, the entire program had to be 'new.'"

The whiff of sanctimony pervades USAID still, which is part of why it is so unpopular on Capitol Hill, where elected representatives often find unpersuasive that the spending of their constituents money abroad should have no connection to our national interests.

Providing money through the Agency for International Development is by no means the only -- or even the most effective -- way to alleviate disease and poverty in the world. Case in point: funding for AID was dramatically cut in the 1990s, and yet that decade saw nearly a billion people lifted out of poverty by actual economic development. USAID's funding has been increased by 150 percent in the past decade -- most of that coming with the advocacy of a Republican president and his secretaries of state.

There are many ways USAID could compensate for reduced government spending:

USAID could build coalitions of like-minded governments to share the burden of funding.
USAID could reach out into American society for private-sector partners to fund programs.
USAID could use its power as a convener and facilitator of non-governmental organization involvement in programs.
USAID could develop performance metrics that ensure it is using what money is available to greatest effect.
USAID could prioritize its own activity to close down programs of lesser immediate importance.
USAID could discontinue development projects in countries like China and Brazil that, as a result of their own economic development, are now providers of development assistance to others.

In fact, USAID's Quadrennial Diplomacy and Development Review champions all these approaches. USAID just doesn't practice them.

TIM SLOAN/AFP/Getty Images

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EXPLORE:NORTH AMERICA, DEVELOPMENT, FOREIGN AID, HEALTH, OBAMA ADMINISTRATION, PUBLIC HEALTH, STATE DEPARTMENT, U.S. CONGRESS, U.S. FOREIGN POLICY

Congress should heed Gates and chiefs on defense health

Posted By Dov Zakheim Tuesday, November 30, 2010 - 3:52 PM

Nearly five years ago, testifying alongside and in support of my former Pentagon colleague, then-Under Secretary of Defense David Chu, I pleaded with the House Armed Services Committee to do something, anything, about spiraling defense health care costs. At the time the Defense Health Program exceeded $40 billion, more than the entire defense budgets of most of our allies -- and of many of them combined. The program had more than doubled over the previous five years, spurred by two major Congressional decisions that took effect on Oct. 1, 2001, just as the war in Afghanistan was about to commence.

The first of these decisions was to create TRICARE for Life, a program to supplement Medicare benefits for military retirees; the second eliminated co-pays for active duty personnel. The Joint Chiefs had lobbied hard for both programs, arguing that it was imperative that military personnel and their families be fully cared for. Until Sept. 30, 2001, Medicare-eligible retirees were accepted only on a space-available basis at military treatment facilities. As a result, the plan was not that attractive to many military retirees. Overnight, however, TRICARE became one of America's top premium health insurance plans: TRICARE for Life meant that TRICARE was now the supplemental health insurer for all Medicare eligible retirees, and also covered costs that were not provided by Medicare.

But congressional action did not stop there. In Fiscal Year 2003, Congress expanded the TRICARE Prime Remote program, which covered military families that lived more than fifty miles, or an hour's drive, from the facility where the military member was stationed. Congress also expanded TRICARE eligibility for reserves, who were playing an increasingly arduous and critical role in the wars in Afghanistan and Iraq, by offering continuous benefits to those called to active duty since 9/11.

With pharmaceutical costs increasing more than five-fold over the past decade, with medical care outpacing inflation by four percent annually, and with co-pays remaining frozen at mid-1990s levels, more and more military members and their families have come to realize just what a good deal TRICARE really was. They have signed up accordingly, even as more people have become eligible for TRICARE coverage. On Oct. 1, 2001, there were 1.5 million persons eligible for TRICARE for Life; five years later that number was 1.8 million. Today it exceeds two million, and continues to climb. Spending on beneficiaries under the age of 65 has also grown: from 33 percent in 2006 to about 39 percent, or a ten percent increase projected, for the current fiscal year. Meanwhile the Congress, egged on by veterans' organizations, has absolutely refused to increase co-pays even by the minuscule rate of inflation nor to increase TRICARE's annual fees, which amount to only $460 for TRICARE Prime, the most popular insurance option that closely resembles an H.M.O.

Civilian employers, as well as at least a half-dozen state governments, have also come to recognize what a great deal TRICARE offers their military retiree employees -- many of whom join private industry as soon as they retire from the military, some as young as age 38. Recognizing that they would be contributing to health care plans for as long as three decades, employers naturally encourage military retirees to sign up for TRICARE. Since TRICARE costs are generally so much more economical than what most employers' plans offer, it takes little encouragement to get retirees to sign up.

Veterans' organizations argue loudly that retirees deserve all they get; and in a sense that is true. But by expanding the number of those eligible for benefits and minimizing the cost to receive those benefits, Congress is short-changing other elements of the defense budget, whether operations -- including training, procurement or research and development programs, that are equally crucial for the troops. During the earlier part of this decade, many Democrats otherwise opposed to defense spending, supported health benefits; if procurement had to be reduced, that did not worry them. Republicans went along, despite pleas from Bush administration officials, and other analysts who recognized that defense health had evolved into nothing other than an entitlement program, akin to Social Security or Medicare. As a result, the long range prospects for meeting even shrunken defense requirements are gloomy, with budget deficits likely to eat away at the defense top line.

The secretary of defense has engaged the deficit commission on the defense health issue. And the joint chiefs have finally come to realize that health care is devouring the rest of the defense budget, and has been doing so for a decade. They too now concede that it is not too much to ask those on active duty to increase their co-pays by the minimal amount that an inflation-based increase would represent. Nor is it outrageous to ask that the family free for TRICARE Prime, be raised from its current minimal level.

It is time that the Congress, and the veterans' organizations that egg it on, take note of the other needs of those who are in active service today, and those who will serve tomorrow. A defense budget that does not begin to rein in defense health costs will overwhelm our ability to buy the guns of today, develop those of tomorrow and furnish the means to operate and maintain them. And that will do neither our troops nor our nation any good now or in the days to come.

AFP/Getty Images

COMMENTS (2)

EXPLORE:HEALTH, MILITARY, U.S. CONGRESS

What the Afghan policy rollout tells us about Obama's domestic agenda

Posted By Peter Feaver Thursday, December 3, 2009 - 10:52 PM

By Peter Feaver

The post-Afghan-announcement spin has been almost as interesting as the announcement itself. Over on our sister blog, Tom Ricks raps my knuckles for finding fault with Obama's rhetoric and assures us that the speech was likely effective with its intended audience: Obama supporters.

Color me "still not persuaded." Mind you, I agree that Obama aimed the speech at his supporters, especially his supporters who like to think that all of Obama's problems can be blamed on his predecessor (supporters like Tom, for instance). I further agree that the policy compromise, particularly the promise to begin the withdrawal in 18 months, was aimed at his supporters. I just don't think the speech was effective at doing so. Mine is not a partisan observation, since folks who have drunk far more Kool-Aid than Tom, folks like Chris Matthews, for instance, also found the speech ineffective.

But what matters is not the relative artfulness vs. artlessness of the speech. What will have lingering impact is the 3-month review, not the 30-some minute speech. And here I believe, the case is fairly dispositive. Despite the spin coming out of the White House, this review, and its general untidiness, almost certainly did more damage to public/political support for the war than it helped. Several dedicated Obama supporters have tried to persuade me that Obama has been masterful throughout this process and their case just does not withstand careful scrutiny.

To make the case that this was masterful, one has to make a far-fetched counterfactual argument that the (declining) support we see today is somehow stronger (and much, much stronger) than it would have been in early September if the president had made the decision in a timely manner. Further, one must argue that going forward the president is better poised to keep that support shored up despite all of the other damage (such as to our NATO and regional allies) that has been done in the intervening 3 months.

But Obama did not use the three month interval to shore up domestic support for the war and, on the contrary, it is likely that domestic support for his policy is lower today than it would have been had he conducted the review in a less clumsy fashion. Instead of spending the time reassuring wobbly Democrats, the team spent their time doing a near-Diem on Karzai, upbraiding the military brass, and, of course, complaining about how the previous team never ever asked any hard questions. This gave both time and material to strengthen the anti-war sentiment at home (to be sure it is not a juggernaut, but it is undeniably stronger on Dec. 3 than it was on Sept. 3, as the three month slide in poll numbers makes clear), to re-cement in Pakistan's mind that the United States is an unreliable ally, to undermine the utility of the two principal civilian players in the Afghan mission (Holbrooke and Eikenberry), to convince the major NATO allies that they were right to start edging to the door, and to sow all sorts of doubts in the minds of the U.S. military.

Now the policy compromise itself is indeed intended to shore up that support (buying Dem acquiescence with an arbitrary commitment to give a "mission accomplished" speech in July 2011) while doing the least amount of damage to the actual policy (give McChrystal close to what he asked for, give himself enough wiggle room to keep waging the war after his 2011 "mission accomplished speech"). But it did not take him 3 months of painstaking review to find that that compromise. It was available to him all along. So far, the Obama team has not leaked any evidence to suggest that the arbitrary date was derived from careful analysis of what is actually doable on the ground in Afghanistan: eg. How fast can we really stand up the ANA or how fast can we really strike a mortal blow at the Taliban. In the absence of that sort of analysis, it is more likely that the target date was arrived at by analysis of two other fixed calendars -- calendars that were known long ago: the troop PERSTEMPO schedule and the 2012 presidential primary calendar. If so, that Solomonic compromise was fully discernible from the beginning and Obama could have announced it to roughly the same level of cheers and jeers in early September.

So the long review was not really about buying time to shore up public or political support for the war. That does not mean that the delay served no political purpose. It may be that the long delayed review served two other political goals, one successfully and the other less so.

First, the delay bought time and freed up legislative/political bandwidth to pass Obamacare. Had Obama announced the Afghanistan decision in September, he would have greatly complicated the politics of health care. Having angered his left-wing base on Afghanistan, he might have felt obliged to tilt even further to the left (and sooner) on health care. As it is, he still faces a fight in the Senate, but health care looks to be in far better shape today than it did in early September. In that respect, this is a very close analog to President Johnson's 1964-1965 strategic calculation: dither on national security policy long enough to get the higher priority domestic programs through.

Second, the delay bought time and freed up political space to do a full-court press to mobilize base turnout in the off-year elections. This domestic objective was not successfully reached, but it was not for lack of trying on the part of the White House who deployed Obama to an extraordinary degree in an effort to win both New Jersey and Virginia. Given how desperate both candidates were for a strong turn-out of the left-wing base in the election, it would be only natural for the political advisors who played such an integral role in Obama's Afghan Strategy Review 2.0 to want to delay any policy decision that would anger the base until after the election.

Mind you, I am not sure that these domestic political calculations were the primary factors dictating the pace of the review. It may very well be the case that the dithering was largely due to Obama's own discomfort with the decision. However, I am pretty sure that the delay was not primarily or even secondarily about doing the ground work necessary to reassure Obama supporters that the president had done due diligence before ordering an escalation for a war that only a few months earlier all of those people were championing as the good and necessary war.

There is one final way in which the 3-month delay might linger. One theme emerged fairly consistently from all of the leaking and sniping: Please give Obama credit for doing the kind of serious analysis and question-asking and military-request-heeding that you-know-who never did. This was a natural extension of the permanent political campaign and, while tiresome, might at least be defensible if it were true and well-aimed. But it has been neither. The key charges have been shown to be false (for instance, see here and here).

But perhaps worse than repeatedly leveling false charges, the attacks are poorly aimed: whether intended or not, the folks hit by these attacks are members of Obama's own Afghanistan security team. The people who "failed" to do the serious analysis, question-asking, and military-request-heeding, as the president's spokesman Gibbs makes clear, were the folks in charge throughout 2008. The problem is that they happen to include some of the same people on whom Obama now relies, including his Secretary of Defense Robert Gates and his White House Afghan war czar General Doug Lute. One could argue that since the attacks are false to begin with, there is no damage done and the people hit with those attacks are not going to get upset. Yet, when Secretary Gates goes to some lengths to explain that what the president said last night about deadlines was really not much of a deadline, one cannot help but wonder whether he is showing that he can dish it out as well as take it. And when the White House hits back within the same news cycle one cannot help but wonder whether we are heading into a stormy patch personnel-wise on national security.

JIM WATSON/AFP/Getty Images

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EXPLORE:AFGHANISTAN, BUSH ADMINISTRATION, HEALTH, MEDIA, MILITARY, OBAMA ADMINISTRATION, POLITICS

A foreign policy must-have: an ambassador for children

Posted By Jean M. Geran Tuesday, November 24, 2009 - 5:38 PM

By Jean M. Geran

This past week marked yet another of 2009's 20th anniversaries highlighting the challenges we face to protect the world's afflicted. The UN Convention on the Rights of the Child (CRC), passed in 1989, has now been ratified by 193 countries -- except the United States and Somalia. Its 20th anniversary prompted the usual round of calls on the United States to ratify it, but ratification would not necessarily improve the lives of the world's children. The Obama administration says it is reviewing the CRC, but the reality is that like some other human rights treaties, the technicalities of U.S. law and problems with some aspects of the CRC make ratification anytime soon unlikely.

Vulnerable children are a common denominator in many foreign policy challenges today -- whether an orphan who needs to be adopted, a child soldier or trafficking victim who needs to be reunited, an unaccompanied minor refugee who needs to go home, or a poor child whose family needs support to stay together. Instead of the CRC, a far more productive focus for child advocates would be to urge Secretary Clinton to fix the broken U.S. policy and aid apparatus on global children's issues. A good start would be to designate someone at the State Department, ambassador-level or higher, to coordinate all child protection issues across the U.S. government.

International children's issues currently fall afoul of the U.S. government's dysfunctional foreign aid system. There is bipartisan consensus that the system is broken. Secretary Rice attempted foreign assistance reform through transformational diplomacy, and the Obama administration has its State-led Quadrennial Diplomacy and Development Review (QDDR) and pending legislation on the Hill. But I doubt change is imminent. For the foreseeable future, gaps will remain in culture, approach, and purpose between State, USAID, and other U.S. agencies with international programs -- and vulnerable children around the world will continue to fall through the cracks.

Every child's right to a family, their best protection against abuse, is enshrined in the CRC. But protecting that right requires finding permanent solutions for each orphan, abandoned or separated child. From a U.S. policy perspective, responsibility for each category of children as well as the solutions available to them are spread across numerous offices and departments from State, to USAID, to the Department of Health and Human Services (HHS) and others. The divisions run wide and deep, but the issue where American foreign policy interests come together around children -- or more often collide -- is over inter-country adoption.

Americans adopt more children from abroad than any other nation and international adoptions have more than doubled since 1989. Adoption is not right for every child without a family nor is it the full solution to the orphan crisis brought on by HIV/AIDS. But for many needy children adoption is the only way to have a permanent family. Yet adoptions must be done right. Unfortunately, weak laws and regulations in developing countries, preferences for infants over older children, and the money involved can lead to inappropriate adoptions and, in extreme cases, baby selling. Such problems have forced the State Department's Office of Children's Issues to stop adoptions from specific countries like Cambodia and Guatemala until officials could ensure that they were legitimate -- a necessary but tragic outcome for families and children caught in the pipeline.

As a member of the Policy Planning Staff under Secretary Rice, I developed an initiative that would have improved interagency coordination and created bilateral partnerships and a trust fund at UNICEF to help countries strengthen their own child protection systems. Though there was wide support including from the Secretary herself, the initiative was derailed by petty turf issues, scarce resources and resistance to new approaches -- all common bureaucratic dysfunctions. Opposition to international adoption also played a role. A USAID officer told me that he maintains a firm wall between international adoptions and any assistance he oversees for orphans to keep it from being "tainted." The problem is that the same authorities in developing countries in charge of adoptions are also in charge of other vulnerable children. The bureaucratic wall helps no one -- not the abandoned child languishing in an institution even though a family is willing to adopt him or the government official trying to stop bad adoptions and place children safely into families in her own country. It needs to come down.

It will take a mandate from the top to push the bureaucracy past these problems and Secretary Clinton is perfectly placed to direct it. As a former Senator and long-time child advocate, she knows of the strong bipartisan support in Congress for adoption and orphan issues. The secretary can task someone on her staff, possibly an existing assistant secretary, with the mandate to implement a comprehensive strategy to protect children globally. An "ambassador for children" could chair a senior policy coordinating group to include HHS and others to oversee strategic diplomacy, technical assistance, exchanges, and public-private partnerships to help developing countries improve child protection systems and provide better oversight of all adoptions. An effective coordinating mechanism could unlock significant resources from Congress, the private sector, faith-based groups, and other international partners.

Assisting countries that want to improve their own governance is the best way to reduce the abuse, exploitation and neglect of orphans and vulnerable children anywhere. It doesn't require ratifying a new treaty, just some leadership and more effective cooperation.

JAY DIRECTO/AFP/Getty Images

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EXPLORE:HEALTH, OBAMA ADMINISTRATION, STATE DEPARTMENT, U.S. FOREIGN POLICY, UNITED NATIONS

Where's Obama's resolve on Afghanistan?

Posted By Peter Feaver Thursday, September 10, 2009 - 4:25 PM

By Peter Feaver

The eyes, mouths, and digits of the punditocracy are understandably focused on the fate of Obamacare. Over here in Shadow Government, we serve the country best by focusing on most everything else.

In that spirit, I was struck by Jane Harman's op-ed, "It's the Corruption, Stupid," in today's Washington Times. Congresswoman Harman is a moderate Democrat on foreign policy and fairly hawkish on national security questions (full disclosure: she is also a friend and fellow Aspen Strategy Group member). She was part of a group of Democrats that the Bush administration considered to be critics especially worth consulting. They were sharply critical of our Iraq, Afghanistan, GWOT, or what-have-you policy, but having enough expertise to be able to offer constructive suggections and sharing enough common ground with us to be willing to do so.

Bottom line: if you were going to build a bulwark within the Democratic House in support of General McChrystal's request for a ramped up military effort, you would probably begin with Congresswoman Harman.

She may still be part of that bulwark, but I interpret her op-ed as signaling something very different, something very ominous for the Obama Administration. Her argument is that neither increasing nor decreasing coalition troops in Afghanistan makes sense until we have fixed the endemic problem of government corruption. In case you miss the implication, the Washington Times editors spell it out with their subtitle: "Raising U.S. Troop Levels is the Wrong Move." That subtitle might be slightly misleading since, as I read the op-ed, Harman caveats that recommendation with a proviso: "unless or until you fix corruption in Afghanistan."

However, fixing corruption in Afghanistan is the work of a generation, if not more. Indeed, one could argue that you cannot fix corruption in Afghanistan until you have fixed every other problem including ending the drug trade, raising literacy and health standards, ending the influence of tribes, etc., etc. There are vast armies of well-paid bureaucrats in the World Bank and elsewhere who have cushy life-time employment working on corruption issues in societies with far rosier horizons than Afghanistan.

The stipulation that we can not and must not raise troop levels in Afghanistan until we have fixed corruption is tantamount to a stipulation that we can not and must not raise troop levels in Afghanistan, ever. Indeed, that does seem to be Harman's basic argument because she goes on to note, correctly, that once the corruption problem is fixed then it is likely that the Afghan government itself can provide all the additional forces they might need.

That is a principled position, of course, but it is not the one you want in the floor leader defending an urgent Obama administration request for more troops now.

As I understand it, the recommendation coming from Generals Petraeus and McChrystal involve increased troop levels concurrent with increased efforts aimed at corruption and all the other Afghan problems. Congresswoman Harman appears to be giving that recommendation a clear thumbs-down.

If I am right about this, then President Obama's political problem on Afghanistan is much more thorny than I thought even a few weeks ago.

One final point: in the last couple weeks I have had numerous conversations with journalists all writing some variant of the "Obama administration and national security in wartime" story. I have asked each of them the same question: "Based on your reporting and access to the White House, what do you think is President Obama's gut-level resolve on Afghanistan?" The answer I have gotten back from every one of them, including journalists who are famous for their favorable coverage of Obama, is "I have no idea." That, I believe, may turn out to be one of the most consequential differences between this Commander-in-Chief and his predecessor.

How the administration responds to the signals sent by Congresswoman Harman and others will help clarify this question.

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EXPLORE:AFGHANISTAN, HEALTH, MILITARY, OBAMA ADMINISTRATION

America's crazy health care debate goes global

Posted By Phil Levy Wednesday, August 19, 2009 - 8:07 PM

By Phil Levy

America's fevered health care debate has begun to spread around the world like a virulent pathogen. Some critics of President Obama's health proposals loudly warned that the United States could end up afflicted by its own version of the U.K.'s National Health Service. They meant that as a bad thing. The British were not amused.

Of course, plaudits have been flying across the ocean as well. Paul Krugman managed to discern that the Obama plan would render us just like Switzerland. This was a remarkable conclusion, since there currently is no Obama plan, just an amalgamation of three House plans, one Senate plan, and a Senate proposal to be named later. Apparently, though, when the dust clears, we'll look like the Swiss. And he meant that as a good thing. Soon enough, though, we'll have critics poking holes in the Swiss approach, raining scorn on the Dutch, and hip-checking the Canadians.

Is it really necessary to go global with our uncivil health debate? Necessary or not, it's natural. In a sense, all of the major developed countries are trying to solve the same puzzle: how to construct a system that meets their population's health needs. If another country has found the answer, it's reasonable to ask whether that solution might work here as well.

To decide whether we've found our answer, though, we first need a good grip on the question. What are a population's health needs? This is where it gets tricky. It's exceedingly difficult to distinguish health ‘needs' from health ‘wants.' No matter where we draw the line between basic health care and deluxe treatment, there will be someone whose ailment puts them just on the far side, whose life may depend on access to the latest and costliest treatment available. The plot thickens when we allow for treatments that are not available today, but might be available tomorrow with sufficient investment and innovation.

In this sense, the demand for health care is boundless while the resources to meet that demand are emphatically not. This is the textbook definition of an economic problem: how to meet unlimited demand in a world of limited resources. The problem is many feel a philosophical revulsion at treating health care as just another product; they see it as a right.

No matter how strongly that belief is held, however, it doesn't get rid of the budget constraint. That, in turn, leads to the rationing debate. One way of rationing scarce health resources is to have private insurance companies offer policies that meet some, but not all, demands for health services. That will lead to two types of horror stories: those who have coverage but have claims denied; and those who do not have coverage. The United States has a system of this type, albeit a dysfunctional one, since it is generally employers, not consumers, who contract with the insurance companies.

A second way of rationing scarce health resources is to have a government determine who receives which treatments and when. This will lead to horror stories about interminable waits for care or advanced procedures that are unavailable. Some form of public provision of health care is more common in the rest of the world.

Much of the debate over different countries' approaches devolves into just such an exchange of contemporary horror stories. That still neglects tomorrow's horror stories, which are necessarily more difficult to observe. What if policy caps on payments stifle innovation so that tomorrow's cure is never brought to market?

If we are to compare how different countries solve this health dilemma, we first need to set up our criteria for a solution. At a minimum, a system must be financially viable for the longer run. No points for paying on credit today and worrying about the bill tomorrow. Given the combined challenges of government borrowing, population aging, and rising medical costs, this criterion narrows the crowd of potential solutions dramatically.

Even if we do find an answer abroad, there are reasons to wonder how readily such an answer can be ported over to the United States. Across a range of safety net programs, such as unemployment benefits, we have seen that homogeneous populations have an easier time reaching a consensus than heterogeneous ones. The United States marks the far end of the heterogeneous scale. What happens when one region of the country chooses to indulge in deep-fried Twinkies and another doesn't? That can certainly have health cost implications.

So as we scour the globe for a magic health care elixir, one that lets us meet those unlimited wants at bargain rates, we can expect to keep holding our fellow countries up to scrutiny, finding them wanting, and denouncing them. To soothe hurt feelings, by way of compensation, perhaps our congressional leaders could offer their parliamentary counterparts abroad some guidance in how to ignore criticism.

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Shadow Government is a blog about U.S. foreign policy under the Obama administration, written by experienced policy makers from the loyal opposition and curated by Peter D. Feaver and William Inboden.