Shadow Government

The worst case scenario for the Afghan election

By Christian Brose

August is always the worst month for surprises, which often take the form of wars: World War I, the Gulf War, and more recently, the Lebanon War and the Russia-Georgia War. For fear of jinxing a good thing, I shudder to say that we're halfway through August, and so far so good. But there is that business of tomorrow's election in Afghanistan. The worst case scenario for it may be improbable, but it's not impossible. And it certainly could rise to the level of nasty "August crisis." So what might that look like?

One worst case outcome is the Iran scenario -- a disputed election result, allegations of fraud, and a drawn-out political fight laced with street protests and sporadic violence. This could be set off by either a narrow Karzai win or a suspicious Karzai blow-out (Ahmadinejad style). One could imagine days, even weeks, of protests by the losing candidates' supporters demanding a recount, or a revote if none is declared, ultimately leading to an unpopular Karzai dispatching the U.S.-backed Afghan security forces to do battle with his political opponents under the banner law and order.

This scenario is bad enough, but it could get even worse. What if the Iran scenario turns into what might be called the Samarra scenario? That is, a single, shocking blow to the political body that exacerbates already fraught ethnic and sectarian tensions, sparks a paroxysm of violence and revenge killings, pushes the state to the brink of failure or beyond it, and pitches Afghan society into full-scale civil war -- similar to what Al-Qaeda's bombing of the Golden Mosque in Samarra did to Iraq in early 2006, when the resulting Sunni-Shia violence nearly sent the country over the cliff?

Again, this scenario may be improbable, but it's not impossible. Civil conflict between the major ethnic groups is nothing new in Afghanistan, and the post-2001 political order has delicately balanced these competing interests. But it has by no means resolved them. Nor has it created durable political institutions that could ensure the peaceful resolution of differences in the event of a major system meltdown. Afghanistan's new institutions are still so weak and fragile that they would likely be overwhelmed if hit by a resurgent wave of civil unrest and ethnic violence, similar to what Afghanistan experienced in the 1990s or what peaked in Iraq in 2006. And considering the discontent with Karzai in Afghanistan, it's not hard, with a little fatalistic imagination, to envision the whole thing going violently off the rails if there is a widespread perception of injustice and wrong-doing on the part of a weak and unpopular Pashtun leader.

In this scenario, the center would not hold, and Afghanistan's warring groups would take their fight out of the halls of politics and into the streets and neighborhoods of their enemies. And heaven knows these factions still retain the weapons and warriors, not to mention plenty of old grievances to go around, that would make this an awfully bloody affair. The incentive for meddling neighbors to become even more meddlesome would be huge and irresistible -- especially for Pakistan, but also for Iran and India. And all the while, U.S. and NATO forces would be standing in the middle of this raging civil conflict. Or perhaps worse, they would be perceived as not in the middle of it, but instead seen as foreign occupiers who are forcibly propping up an illegitimate Karzai government that is violently thwarting the will of the people. The Taliban would be licking their chops, but even that might be the least of our problems.

This is the kind of low-probability/high-impact event that governments need to ponder and plan for, and I hope someone in the Obama administration is doing just that. My hunch is they are, and this might help to explain why Secretary Gates and Admiral Mullen recently summoned General McChrystal to Brussels and told him to take a few more weeks with his strategic assessment and not to include any additional troop requests when he does submit it. The last thing the administration would want is for its commanding general in Afghanistan to lay out new strategic recommendations for the war and to have even more new forces streaming into a situation that has turned overnight from countering an insurgency to containing a civil war -- in which the current Afghan leadership is taking sides in the fight, if it hasn't dissolved entirely. In short, the Samarra situation would render the entire U.S. policy in Afghanistan O.B.E: overtaken by events.

Will this scenario unfold? Probably not. Could it? Yes, and I hope we're ready for even the most extreme possibilities. August has always been the meanest of months for unwelcome surprises, and this one's not over yet.

Shadow Government

America's crazy health care debate goes global

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.