Sinaloa*

Nobody lives here anymore.  Whole towns, completely abandoned.  The only sounds: creaking doors, padlocked, when the wind surfs through, a few birds that hover and then abscond, the silence of a dreary sun peering through indolent clouds. 

The families have left.  The violence was too much.  Bodies mutilated, decapitated, gunned down in busy streets at midday, floating in rivers, stinking behind garages, flapping in the breeze slumped over car window ledges (the windows were up, before, but are now smashed, the remaining glass jagged, and delicately placed in bloody fragments).

This would be hell.  Except it's empty.

Elections were this past Sunday.  No one was allowed to drink, because election day is a dry day.  Everything was closed so the citizens of tomorrow could put on their Sunday best, and head to the polls.

Except here.  Here, there were no polls.  This is one of ten communities in the south of the northern Mexican state of Sinaloa that did not vote on Sunday.  Mostly because there are hardly any people left.  And also because those who have stayed are too afraid to vote anyway. 

Voting, like walking down the street to buy a bag of maize flour, might get you killed.

Welcome to democracy, narco style.  Where the gangs rule, and the citizens cower.  Where the police and the military are authorized to keep the peace, and everyone else is authorized to try their best not to get caught in the middle.

Good luck.

Sinaloa is not the poorest state in Mexico.  Indeed, it has only 60 percent as many people as Chiapas, but its economy is about a sixth larger.   It is a middling state when it comes to development, compared to Chiapas or Oaxaca, which are in last place.  If you can stay away from the narcos, it is not such a bad place to live.

Good luck.  

Oaxaca 

Violence is only one way to kill a democracy.  There are many others.  In Oaxaca, there is plenty of violence to go around.  But there are smoother tricks too.  Oaxacans voted last week, for their mayors.  It is alleged that most of the opposition candidates were selected and financed by the governor.  In other words: vote for whoever you want, it won't make any difference.  We're all friends here.  Or enemies, as the case may be.

Oaxaca is a good reminder of what the old PRI was like.  Except this is 2007, and the PRI still runs the state just like it used to run the federal government.  It buys votes, or non-votes, depending on which is more efficient.  Last week, voters reported that they were offered a variety of goods and services- from food to televisions- in exchange for their voting cards.  In Mexico, you can't vote without a voter identification.  If you are willing to hand yours over for about a week, just until the day after the elections, you could win the lottery.

This is actually quite a sophisticated operation. In the old days, you had to worry that if you gave someone a television, they might still vote for the other party.  The nuisance of secret ballots and all.  This is a much safer system.  Of course, it means that the turnout rate can fall to abysmal levels.  But, what, after all, does democracy have to do with turnout?  And even if you think you can answer that, what does Oaxaca have to do with democracy?

When voters don't want to sell their votes, there is always ballot stuffing, ballot stealing, and, if all else really does fail, a little violence around the edges.  But the other tools usually work: so well that the average difference between the winner and runner up in elections in 2003 in Oaxaca was about 30 percentage points. 

It is not all mayhem and corruption in Oaxaca, though.  The state is actually the only in the republic to have created a substantial parallel electoral system for indigenous communities where major political parties do not participate.  Instead, since 1995, voters choose their mayors according to traditional, customary practice.  Oaxaca, which has over a fifth of the country's 2500 municipalities, still has more municipalities electing mayors from the traditional parties than most states.  But over 400 municipalities follow this "customary" practice.

The creation of "customary" municipalities has been controversial, and with good reason.  In many municipalities following this practice, less than 20 percent of the population is indigenous.  It is unclear how "customary" practice affects the interests of the majority in these areas.  Then there is the problem that customary practice does not always accord well with modern ideas about democracy.  For example, in 18 percent of these 400 plus districts, women are not allowed to vote, by "custom."  Thus the usual controversy arises: is it fair to sacrifice the rights of individuals to preserve the rights of a group, particularly one that may be ill-defined and not even constitute a majority?

But on the other hand, the creation of these districts must be seen as a triumph of peaceful indigenous negotiation with the state.  After all, the alternative has shown its face elsewhere, and it is not pretty.  Power from the barrel of a gun.  Just ask the chiapanecos and the guerrerenses.

Guerrero

It would be generous to call the capital city of Guerrero, Chilpancingo, non-descript.  Hard to believe, then, that this city under a hill was once, if for less than the time it takes to say the name Chilpancingo, the capital, or declared capital, of independent Mexico.  But so it was in 1813, when one of the few Catholic priests in world history to regularly sport a bandana, José María Morelos, declared Mexico free from Spain.  Morelos was later killed by the Spaniards, and it was not until over a decade letter that Mexico did become a free state.  By then, it was clear that the capital would not be in the backwater city of Chilpancingo at all, but a bit more than a half-day away by horseback, in Mexico City.   

Lonely Planet calls Chilpancingo a university town, but this is also laughable.  In the first place, half of the university is not even in the city.  Important schools, like the school of medicine (and funnily enough, the school of political science) are in Acapulco.  In the second place, although students can be seen in Chilpancingo, it is one of the deadest university towns I have ever seen.  On a Friday night at 10 PM, the downtown area around the plaza was empty. 

Chilpancingo, being the capital, is probably best described as a government town.  And, oh, what a government.  Now, it is true that in 2005, the opposition PRD won the governor's race for the first time.  This makes Guerrero about a thousand times more democratic than Oaxaca. 

But let's not push it.  Guerrero is also one of the country's most violent states; by some indicators, it is Mexico's most violent state.  In 2006, for example, Guerrero had far and away the highest percentage of homicide cases (as a proportion of all crime) in Mexico, with a rate over two times the national average.  In 2005, one in every 7 people who died in Guerrero was murdered.  In Mexico City, which does not have a reputation for being particularly safe, the figure was half that.

During the last century, violence in Guerrero has been perpetrated by landlords, the police, the military, the guerillas, and the narcos.  In 1995, the police mowed down rural protestors in Aguas Blancas.  In 1996, the EPR, the guerilla movement which has been blowing up oil installations around Mexico this year, was formed in response.

The poorest municipality in all of Mexico (out of 2500) is also in Guerrero.  Outside of Acapulco, there has been little economic growth in the state, and the tourism industry is probably the only thing keeping the state from being in worse shape than its neighbors, Chiapas and Oaxaca.  As I pointed out last week, the health system also faces a number of serious challenges. 

Political alternation is a good thing, and the PRD has been growing stronger in the state since the 1980s.  But the party is also divided, and the current governor is not a party loyalist.  Nor is he very representative of the party base: he is a centrist, business-oriented civic activist from Acapulco.  He has been in nearly constant conflict with the party's left-wing base since he took office.  Therefore, it is not clear how much things are really changing in Guerrero, in spite of the end of PRI rule in the state.

All is not gloom and doom in Guerrero either, though.  In addition to being the home of the poorest municipality in the country, Guerrero is also the home of innovative attempts to invest in agricultural technology and keep young people from migrating north to the United States.  It is estimated that over 70,000 young people from Guerrero flee to the United States every year seeking greener pastures.  But recently, some young people have been borrowing from the government, investing in tractors, and growing tomatoes.  They recently won Mexico's National Youth Prize for their efforts to stay back and improve life at home.

Tomatoes are not going to be enough to bring prosperity to Guerrero.  But what is inspiring about these kids is that, in spite of the violence and the dysfunctional nature of state politics, they are actively working together to improve their communities against the odds.  Ultimately, that is the spirit that will make Guerrero a place young and old people alike are proud to live.

Something less than democracy

Things are getting better in Mexico. But political scientists often ignore the ground realities at the local level when they talk about "democracy." My old boss, Seymour Martin Lipset, and by implication, myself, were as guilty of this as anyone, focusing almost exclusively on the big picture at the national level.

This is not totally misguided.  Anyone who knows the history of places like Argentina, which were ruled at the national level by the military, and subjected to years of repression and state-sponsored massacres, knows that national regimes matter a lot.  But they are not the only thing that matters.  And for many, many people, a change in government at the national level will not save them from military, guerrilla, narco, or police brutality at the local level.

Nor does an institute which guarantees a free and fair vote at the national level help citizens when they vote for governor or mayor.  In fact, the national regime often leaves these local issues aside as a cost of insuring that things work okay at the national level.  Local elites agree to help the national government in exchange for a hands-off policy when it comes to their own adventures in violence, vote-buying, and voter intimidation.

So here's to Mexican democracy.  May it keep getting better.  But in the meantime, let's not forget the poor folks back home.  At least those that haven't fled for their lives.  They are still waiting for democratization at the local level.  The national government isn't going to give it to them; they are going to have to take it, just as national opposition and civil society leaders did at the national level.  They need the support of human rights activists and democrats around the world. 

*The section related to Sinaloa draws on in-depth reporting by Mexican daily, El Universal, in advance of elections there.

What defines an election in Uttar Pradesh, India's biggest state, and, were it to be its own country, one of the world's largest democracies? Polls in UP are primarily about two things: crime and punishment.  Most of the crimes are real, but the punishment is largely imaginary.  To the extent that there is any accountability in UP, it is not exercised by voters, but by bandits, mafia dons and politicians themselves.  And no- in case you were wondering-, there is no one guarding the guardians. 

The Chief Minister of UP campaigns for reelection on few substantive slogans.  One of the more memorable of these, however, is that if he is not reelected, he will almost certainly go to jail.  Ergo, voters should vote to protect him.  This slogan is curious in a hundred ways, but at a minimum, it demonstrates the perverse nature of politics in UP.  Where else does a politician campaign by asking voters to help him with his problems, rather than promising voters help with their own?

Meanwhile, the CM's leading opponent, Mayawati, India's most powerful untouchable leader, has made putting the CM behind bars an important element of her own sloganeering.  This is again rather bizarre.  In transitional elections as Latin American countries democratized in the 1980s, prosecution of former dictators for human rights abuses was sometimes a campaign issue.  But in what democracy does prosecution of democratically elected politicians who have no immunity in the first place constitute a serious campaign issue?  Only one in which the criminal justice system is dysfunctional.

Mayawati has not promised to clean up politics, a claim she would at any rate have trouble pitching, given that she, like the CM, is under criminal investigation by the Indian equivalent of the FBI.  (And given that her party, the BSP, like the CM's, has given a large number of tickets to known criminals in the current election cycle.)  Instead, her appeal is intensely personal.  She is going to arrest the CM, not all the criminals in UP, not even all the criminals in the ruling party.  Just Mulayam Singh Yadav and his number two, Amar Singh. 

This is not, after all, particularly surprising, because politics in UP is intensely personal.  Political parties are not organizationally sophisticated institutions.  Indeed, they have little structure to speak of; they are instead teeming, pyramid-like monsters, composed of blood relatives and sycophants, and a few Brutuses waiting for their moment to spring.  UP politics is still, even after the decline of the Congress Party's hegemony, a family affair.  In UP today, Rahul Gandhi, scion of India's first family, is leading the campaigning for the Congress.  But the personalistic nature of UP politics is revealed not only by the cult of Gandhi; all of the major political parties are afflicted with a severe case of tribalism.  Many of the ruling Samajwadi Party's top leaders are blood relatives of the CM. 

If politics in UP is personal, it is also criminal.  All three frontrunners for the post of CM are under criminal investigation, but a substantial number of ticket holders across all parties in this election also have criminal records.  In fact, according to Election Commission records, between 15-30 percent of each major party's candidates in any given round of this election have criminal antecedents.  Major mafiosi are also well represented across the parties.  UP is the state that brought the world the Bandit Queen, Phoolan Devi, who was an MP from Bundelkhand.  Today, this part of the state is still represented by bandits. 

Politicians sometimes deny that their respective parties are engaged in patronizing criminals.  One campaigner from the BSP, Mayawati's party, told me that there were absolutely no criminals running under the party's name.  The newspaper reports to the contrary, he claimed, were written by reporters stationed in Delhi who know nothing about UP.  The overall claim is unsustainable; high-profile criminals whose names even a Delhiite would recognize are absolutely running on the party's tickets.  Still, the campaigner had a point.  In UP, anyone who wants to can charge anybody else with a crime.  Because the system is dysfunctional, perfectly innocent people might be charge-sheeted for crimes by people with political vendettas against them.  When corruption and crime is so rampant that a little bakshish will buy you a criminal charge against anyone, it becomes difficult to know who the real criminals are.  Under these circumstances, having a criminal record is simply an indicator of having been in politics long enough to acquire enemies.

The crimes of political leaders do not dominate UP elections as much as the crimes of partisans, however.  That is, elections are dominated by the crimes of those who want to stuff ballot boxes, engage in "booth-capturing," or otherwise intimidate voters into voting the way they want them to.  How much security does it take to run a fair election in a state as lawless as UP?  The Election Commission thinks it needs, in total, about a half million paramilitary troops.  Because this many troops are not available to conduct polls in the state, the EC has divided the election into 7 phases, for which it is deploying around 70,000 troops during each phase.  Even this number is considered to be too low by some.

More astonishing still is how much the EC thinks law and order have deteriorated since 2002 Assembly polls.  Then, the EC used barely one sixth the number of troops to protect the vote.  In some parts of the state, the EC is deploying around nine times as many troops this time.  The EC's writ extends beyond the deployment of troops.  Indeed, election time means that the EC assumes the mantel of an alternative government.  No new programs may be started, or new phases of old programs rolled out, once the EC has called elections.  The government may no longer transfer officials to new posts; instead, the EC itself has engaged in massive transfers.  The ostensible purpose of these transfers is to remove partisan bureaucrats from sensitive positions and to replace them with officials that have reputations for greater integrity.  Many top civil servants with control over the machinery of intimidation, such as the principle secretary in the Home Ministry, which controls the state police, have been moved.

The speed and power with which the EC rules almost makes you wish the body ran the state the rest of the time as well.  Ultimately, though, the EC has arbitrary powers not befitting a legitimate institution in a democratic system.  It is the dysfunctionality of that system which makes the EC a hero.  The prevalence of crime, the impunity of the criminals, the corruption of the state bureaucracy, the partiality in delivery of basic government services-- these have all led to an increasingly muscular Election Commission exercising greater and greater authority through fiat. 

This is not something to celebrate; it is something to fear.  When the exercise of the franchise becomes largely an exercise in crime and punishment, democracy is failing.

Posted January 26, 2007

I do not know why, but many Indian-Americans I have spoken to think that caste is dead in India today.  They believe, and maybe their parents believe, that caste has gone the way of dial-up internet connections.  Interestingly, I have not heard them make the same claim about religion, a claim which would be equally difficult to substantiate.  Or, to put it less mildly, a claim that would be equally preposterous.  For the notion that caste is dead in India today is just silly.

Caste is a hard concept for Americans to wrap their minds around, because it is not quite the kind of hierarchical concept- like class or race- that we are accustomed to.  Since caste is neither class nor race, there is a nagging concern that maybe it does not really exist. 

But no serious analyst of India would ever doubt the salience of caste.  Caste, and the caste system, are very much alive in India today.  Recent polls indicate that even among relatively affluent, educated, urban Indians, a majority would not be willing to marry a member of a lower caste.  At the national level, over 70 percent of Indians oppose inter-caste marriage.  In UP, the two biggest parties in state level politics are the Samajwadi Party and the Bahujan Samaj Party, both of which have a virtual lock on the caste groups they represent (OBCs and SCs, respectively, but more on that below).  Politics in the state, and consequently a large number of policy outputs, job offers, and goods and services are controlled by caste groups who actively discriminate on the basis of caste.

I am not competent to provide a history of the caste system, or to explain how or why it persists.  But I have always been dissatisfied with even basic explanations of caste that I have seen in the West.  So consider this a primer. 

A caste is a social category.  It may be thought of as akin to ethnicity, in that people of a similar caste share similar names, speak in similar ways, and tend to marry amongst themselves.  It may be thought of as akin to class because castes have traditionally been associated with particular activities, such as priests (brahmins), warriors (kshatriyas), merchants (vaishyas), cowherders (yadavs), leathermakers (chamars), toilet cleaners (bhangis) and so on. It may be thought of as analogous, finally, to religion, since the basis for the caste system is the religious concept of the varna, and contact with the untouchables (technically outside the system) leaves "caste Hindus" in need of purification. 

Then again, caste subverts some of these categories.  Indian Muslims, according to the link between Hinduism and caste, should not have castes among them, but they do.  People of the same caste may work in very different occupations in modern India, may be rich or poor, and may have more or less social power. 

If that basically clarifies (or confuses!) what a caste is, what is the caste system? 

The caste system can be thought of in two ways.  First, there is the traditional caste system. This is the informal system as it evolved prior to Indian independence. There is a great deal of debate about how "traditional" the caste system really is and to what extent the British made it worse or better.  This is more than we need to know for present purposes.  Whatever the case, the caste system has had a certain tenor that predates independence.  When Gandhi protested against the exclusion of the untouchables from Hindu temples because of their impure status, he was protesting against this traditional caste system.  Note that, as per an earlier blog on this very page, such struggles continue today.  Only a few months ago in the state of Orissa, a major standoff ensued over untouchable (now known as "dalit") access to a Hindu temple.  In the traditional caste system, your caste has a very large effect on your social standing and economic welfare. 

The second way to think about the caste system is the evolution of that system since independence as a direct result of government affirmative action policies.  In India, there has been affirmative action, known here as reservation, for dalits since independence.  This has created a new dynamic in India in which many dalits have been able to enter into politics and government, previously the domain of the upper caste Hindus, and exercise power disproportionate with their position in the first caste system (the traditional one).  

If we return to the first caste system, the traditional one, we need to recognize the immense complexity and heterogeneity of that system.  Each of the castes with which we are familiar has many sub-castes.  Each of these varies by state and region in India.  In North India and South India, for example, the caste systems have evolved in different ways.  In Uttar Pradesh (UP), India's largest state, there are over 60 divisions within the "dalit" group of untouchables.  Altogether, UP probably has hundreds of different castes. These castes are, again, identifiable by name, community, speech, job, and social position.

If we turn to the second caste system, it tends toward a less complex and more readily ordered set of categories.  India, according to this second system, may be thought of as divided up between: Upper castes, Middle-upper castes (or Intermediary castes), Other Backward Classes/Castes (OBCs), More Backward Castes, Most Backward Castes, and, finally, the Dalits, or what are also known as Scheduled Castes.  The upper castes are the Brahmins, the Kshatriyas and so on.  The Middle-upper or intermediate castes are debatable.  One caste which is sometimes thought of as an upper caste and sometimes as an OBC are the Jats, a farmer caste in North India. 

This second caste system is fluid, and is bolstered by the existence of state policies which are targeted to each caste subset.  For example, there has always been reservation for Scheduled Castes at the central level in India, but there has not always been reservation for OBCs.  The current Congress-led government has legislated reservation for the OBCs at the central educational level; 27 percent of spots in government-supported educational institutions must go to this caste-group.  Although the federal policy is new, many states have long had reservations at the state level for OBCs. 

One issue which has come up in the reservations debate is whether OBCs should be divided into regular OBCs and the "creamy layer," the amusing term for those OBCs who are economically well off.  The creamy layer concept further complicates the meaning of caste by overlaying it with a class component.  This invites a variety of questions about fairness.  For example, one rarely hears talk about the "creamy layer" of Scheduled Castes, but reservations have actually created an elite class among this group in terms of economic and social power.  Is a non-creamy layer OBC better off than a creamy layer SC?  While such mental gymnastics, replete with cute phrases and a plethora of acronyms, may seem hilarious to an outsider, the issues are deadly serious. And they are not dissimilar from those which societies like America's, Brazil's or South Africa's must confront when applying race versus class affirmative action policy.

Contemporary politics in India, and the evolution of the national reservations policy, suggest that the importance of caste is, if anything, on the rise in India, rather than the decline.  Whether this is a good thing or not is debatable; at a minimum, it gives non-Indians more time to figure out the caste system before it is a thing of the past.    

Some years back, during the roaring nineties, Singapore's authoritarian Prime Minister, Lee Kuan Yew, extolling "Asian values," attributed the lack of democratization in his own country, as well as its spectacular economic success, to the persistence of Confucianism.  Other pundits commenting on the then highly successful economies of the Asian tigers agreed with this nebulous "Asian values" hypothesis: the unique combination of acquisitiveness and communitarianism, familial love and harsh discipline, was behind the triumph of a hybrid breed of capitalism and a less repressive kind of authoritarian rule. 

This values debate was muted after the Asian economies came down with a terrible flu in the late 1990s.  But the mystique of "values" continues to puzzle observers of developing countries.  At times, they are inscrutable and unchanging; at others, they seem to adapt with incredible rapidity.  While Lee Kuan Yew reified unchanging values in his ideology of communitarian-authoritarian-developmentalism, he also recognized that values were not static.  He was acutely aware, for example, of the meteoric rise of Christianity in South Korea, arguing that economic development led to a desire for new belief systems as populations outgrew their old traditions. 

When American academics first began to focus on the political economy of development in the aftermath of World War II, they tried to attribute some of the difference between developing and developed countries to values.  Developed nations tended to subscribe to values like "meritocracy" and "efficiency" while developing countries tended to privilege "ascription" and "familism."  Put in modern parlance, and in relative terms, developed countries seemed to have functional institutions which rewarded productivity, while developing countries seemed to be mired in nepotism, corruption, and inefficiency. 

While the descriptive differences between developing and developed countries were accepted by many scholars, there was never a consensus around the direction of causality: did values cause development, or did development cause value change?  Many thought that with development, secularism and modernity would triumph.  Others, following the logic if not the letter of Max Weber's argument in The Spirit of Capitalism, thought that modern value systems were a prerequisite for development.

For the most part, this theorizing has turned out to have been a fool's errand.  A half century later, we understand spectacularly little about either values or development.  What we know today is that values may sometimes impinge development, and development may sometimes alter values, but we hardly know how either thing is likely to occur or when.  The South Korean embrace of Christianity is a good example.  Once upon a time, a country developing rapidly like Korea would have been expected to embrace secularism.  Driven by a recognition that the United States, one of the most developed countries in the world, is also one of the most religious, most scholars now recognize that development does not impede religious ties, and may even occasionally stimulate them.  But few countries have followed Korea's path: widespread adoption of a new religion alongside development.  And few could tell us when to expect a poor country to look more like secular Europe, persistently religious America, or transformatively religious Korea, after it develops.    

2. Tradition

One thing that is certainly true, however, is that when societies seem to be changing rapidly, social analysts are almost always surprised about the parts that persist.  I was not surprised, then, to see that the Hindustan Times was surprised about the surprising resilience of arranged marriage in India today. 

Some readers may object that marriage is not a particularly surprising place to find enduring traditions.  True: marriage is one of those social institutions that seem to persist through a great deal of social upheaval.  One need only consider how few supposedly "modern" countries will permit homosexuals to marry to see what great weight tradition carries in the minds of most people when it comes to marriage.  A less weighty confirmation can come in the form of watching liberal, progressive friends with grand views of social change fall into petty disputes about the "appropriate" wedding invitation, number of months in advance of the wedding to send the "save-the-date" card, the right place to register, and how many of their parents' friends to resist inviting.  We all end up getting a little moist around the eyes when it comes to marriage, except for the Europeans, who have largely stopped doing it.  But note: failing to marry is not a strategy which attacks the traditions surrounding the institution.  It implicitly recognizes the weight and responsibility of that tradition, and opts out.

The persistence of arranged marriage is still surprising to the Hindustan Times, and well it should be.  HT is not surprised to find that rural India still believes in and practices arranged marriages.  Nor is it surprised that urban India still practices arranged marriage.  No, the source of its surprise is that young people in India, or as it affectionately refers to them, Gen Now, still desire arranged marriages.  In fact, a recent survey by the paper found that over 90 percent of urbanites between 17 and 25 years old approve of arranged marriages.  Numerous interviews seem to confirm the view that arranged marriages are at least as acceptable as love marriages, and maybe more so.  It is not just that young people are okay with arranged marriages; they seem to prefer them in many cases.

The paper explores a number of hypotheses about the sources of this curious affection for tradition: young people are lazy and want help getting married from their parents, young people are insecure and want guidance from their parents in making tough decisions, young people are deferential and believe their parents know best.  But the most interesting hypothesis is the one which gives the credit for the persistence of arranged marriage to the institution itself.

Rather than young people remaining the same in the face of change, it is arranged marriage which has changed to suit them.  Gone are the days of forced marriages between people who have never met, at least in urban India.  Arranged marriages today involve choice, contact, and communication.  Indeed, the most remarkable shifts in the arranged marriage market are caused by the availability of social networking technology.  According to HT, 60 percent of women's marriage profiles posted on internet marriage and dating sites are posted by their families, not by the women themselves.  But then the families often stand back and let the power of the web guide the "arranging."  Families in this scenario take the first step- putting their kids on the market using a particular set of socially acceptable criteria- and the last step- approval- but they let the kids work out the details themselves.  In this respect, arranged marriages for young Indians are like match.com for young Americans: just another part of the portfolio of activities we undertake to meet new people and find a partner. Why not have your parents working for you to supplement your normal efforts?  Internet dating sites do the same thing, and probably less well.

Actually, all the hypotheses in HT point in the same direction: a recognition among young people that looking for a partner is hard, time-consuming and risky, and a search by these young people for outside help.  Indians have a tradition of arranged marriage which they can rely on as one among many tools to provide this help.  And relying on this seemingly useful tradition is exactly what they appear to be doing.

In the end, there is little to be surprised about.  Traditions tend to persist when they continue to serve a purpose.  Every once and a while, we adapt to them, persisting in behaviors that do not serve us well only because our parents did so.  Usually, however, they adapt to us.  As even Lee Kuan Yew recognized, traditions operate in a marketplace where they are faced with constant competition.  Only those that serve their customers can survive that kind of competition. 
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Unless, of course, they are forced down customers' throats by repressive political regimes.  But take note, Lee Kuan Yew: those "traditional" authoritarian regimes usually don't last forever either.  In Asia, or anywhere else.    

Posted January 9, 2007

Yesterday, Mexican President Felipe Calderón inaugurated the so-called "Medical Insurance for a New Generation" program in the state of Morelos. With this, he put into effect one of his campaign promises, to provide universal health coverage for children born in Mexico after his presidency began, that is, children born after December 1, 2006.  The President announced that, with the increase in affiliation to this new insurance for children, as well as growth in affiliation to Seguro Popular, and the new Women's Hospital opened yesterday, infant mortality would fall to one third of its present level by 2015.

The confluence of the introduction of this new insurance modality and a new hospital opening is promising.  A major criticism of the Seguro Popular (SP) has been that the program provides a package of insured services, but does not adequately address the fact that Mexico lacks the infrastructure to provide covered services to the entire population.  This has been a source of tension from the early days of SP, with health analysts arguing over the relative proportion of funding which should go to infrastructure versus expanding the package of covered services.  Undoubtedly, Mexico needs both high quality health infrastructure and a robust health insurance package. 

What Mexico does not need is yet more health programs with new names that are difficult to comprehend for the average citizen, and lack transparency for even the seasoned analyst.  So there is some concern about how exactly this Medical Insurance for a New Generation is going to work, how people are being signed up for it, and where the money is coming from.  Does the program simply tack on new benefits to SP or does it create a separate bureaucracy with its own resources? Are children signed up while their parents are denied services?  As far as I can tell, this information is not yet in the public domain.  It should be placed there as soon as possible.  Mexicans have a right to health care, as the president acknowledges, but they also ought to have a right to know who is providing it and how.

An interesting twist to the introduction of this new Medical Insurance for a New Generation is that the Secretary of Health appears poised to try to use it to push forward health service contracting.  This part of the Seguro Popular has been largely a dead letter.  The 2003 health reform was supposed to open the public system up to both internal and external contracting for health services.  Put another way, the 2003 reform was supposed to create a true insurance scheme, in which Mexicans could use multiple providers with the same publicly provided insurance.  This has not happened.  However, in his speech at the opening of the Women's Hospital, Health Secretary José Ángel Córdova Villalobos said that he was in the process of finalizing contracts with all public sector and some NGO providers to offer the services covered by the new insurance for children. 

If that is true, then maybe this Medical Insurance for a New Generation will really live up to its name.  And then, Mexicans, accustomed to a long history of monopoly service provision, will finally have some choices about providers. 

January 4, 2007

Marty wrote about everything.  He wrote like he ate: voraciously, maddeningly, with fragments of juicy bites flying in all directions, covering his face, his hands, and those of others.  Marty was interested in almost everything, too.  He would eat anything, and he would talk or think about anything.

I suppose it is not an uncommon experience to read an obituary about someone who has been in the public eye, but who you knew personally, and to think: this is so incomplete, so unidimensional.  But, since I do not know many people in the public eye personally, reading Marty's obituaries in the New York Times and the Washington Post was my first exposure to this kind of lonely disappointment.  Not that these reviews made any major errors, or were poorly written.  They just didn't capture Marty, the Marty I knew.

Marty used to bark.  When I first went to work for Marty in 1999, at the Woodrow Wilson Center in Washington, D.C., I remember that he would bark at me from his office when he needed something.  I found this curiously rude at first, but ultimately endearing.  I think because, after he barked, he would warm up quickly, as if to soothe over any frayed nerves.  That was the thing about Marty, he was excitable in the extreme, but a moment later, would be asleep while talking, or have switched from arguing vociferously about socialism to plotting lunch.

I worked for Marty for about 2 years.  We labored together for a year and a half on a book project, and then he had a stroke.  He suffered the debilitating consequences of that stroke from 2001 until New Year's Eve of this past year, when he passed away. 

For a year and a half, I had one of the best jobs I will probably ever have.  I spent my time reading the literature on democratization and learning about political science in long car rides from Arlington to Fairfax, Virginia, where Marty taught.  I used Marty's spacious desk at the Wilson Center when he wasn't there, and got to hear people like Gorbachev and Newt Gingrich speak, then talk about their speeches with him.  I spent hours at Marty's house in Arlington, where his doting wife, Sydnee, introduced me to rustic cooking, fine cheeses and olives.  Those were warm and glowing days, full of light and knowledge.

After the stroke, things changed.  Sydnee and I ate together still, but mostly in Baltimore, often in Greektown, which was down the street from the Bayview Geriatric Center, where Marty partially recovered from his stroke.  There were a few happy moments then too, days when Marty would remember something remarkable from the past, smile or joke about something we did not realize he had understood, or perk up when old friends came to visit.  But these were dark days.  I spent a lot of time on the train traveling back and forth to Baltimore, and a lot of time seeking advice from other scholars about how best to finish the work Marty and I had started.  People who knew Marty well, like Larry Diamond and Don Kash, generously offered me advice.  But mostly, I had to figure out what to do with this book we had spent so much time on, now by myself.

Our book is out now, and it has even been translated into Serbian.  It is nice to have a book under your name, but for me, the best part is that, while very few people understand the kind of relationship I developed with Marty and Sydnee, the book is a live testament to the fact that, to turn one of Marty's favored phrases, it happened here.  People understand books, even if they haven't read them, as some kind of offering, some kind of giving of oneself, and a melding of authors' ideas and personalities.  That is true, if incomplete.

Much can and has been said about Marty as an intellectual.  I do not want to add a great deal to this.  Marty's intellectualism, as I experienced it, was a daily phenomenon, over coffee or rugelach, and not so much the well-developed arguments in his oft-cited books.  One book which I think deserves mention, however, is Union Democracy.  This is still my favorite work.  Union Democracy was written years before the explosion of interest in civil society and social capital.  It was a book about a seemingly trivial topic: the internal politics of a typographical union.  It used unsophisticated cross-tabulations to make its points.  And, since the great decline in American unionism, it has often seemed to be of little significance today.

But Union Democracy is a masterpiece.  To me, it is the fullest manifestation of the Lipset style.  It combines the personal, the political, and the academic.  Marty's father was a typographical unionist, Marty's personal politics at the time emphasized social democracy and union power, and the book moves in a dramatically escalating aria from table to table, creating a far more powerful impression of how things really worked at the union local than much of modern, "sophisticated" political science. 

It is ironic that Marty carried forth the torch of quantitative political science, given that today, the crude quantitative analysis in his early work can appear overly simplistic, even wrong.  But he did.  He emphasized the need for measurement, and the multivariate character of politics long before that had become the norm in political science.  Those were the lessons he imbibed, however primitively by today's standards, from the Columbia school of sociology.   

But Marty never forgot his roots, roots which were not in math, but in politics, argument, and detailed knowledge of the world. Even as he pushed toward the large-N quantitative study which has become so popular in political science today, he continued to emphasize the need to know cases, and to build grand theory, two parts of the discipline that have become less important over time.  That is what makes Union Democracy so incredible today.  I do not know how many tables are in that book, but they do nothing to obscure the fact that he (and Martin Trow and James Coleman, his co-authors), knew that union inside out, not only through numbers, but through personal connections, interviews, time spent observing and talking to people.  And it may appear to be a book about a union, but it is actually a book about the fundamental question of the relationship, so much discussed today, between civil society and democracy.  Remarkably, this obscure book, which was written in 1956, is cited by 83 books currently sold by Amazon a half century later.

There are, of course, many stories to tell about Marty, but I will tell only one more, one that, for me, sums it all up.  Marty used to make a mess when he ate, as I said before.  One day, in the morning, he came into the office as dapper as I had seen him, with a fancy pair of suspenders, a tie, and a starched shirt.  His jacket was over his shoulder. 

Why are you so dressed up, I asked.  He replied that he had an important lecture to give at 4 that day, I no longer remember where it was.  Satisfied with this reply, I set about my work down the hall.  At 11, he summoned me.  He was going to eat lunch early today, he said, so he could go home and change before the lecture.  But why would you go home, I queried him, if you are already dressed for the lecture? He said that Sydnee had insisted that he come home before the lecture to change, because she knew he would make a mess of himself at lunch.  Fair enough, I responded, but then why get dressed at all. 

Ah, Marty said, leaning back in his chair, well…there is always hope.

Indeed.  To Marty Lipset, who taught me almost everything I ever really needed to know about political science, and to the things he valued: empirical evidence, deep knowledge of cases, and grand theories.  Onwards and upwards, then.

4.5 million cadavers.  That is my estimate of the number of people who have died due to violent conflict in Africa in the last decade.  The number is easy to calculate.  About 4 million from the great Congolese conflagration (see below), plus somewhere between 200 and 300,000 in Darfur, and you are almost there.  Add in tens of thousands of deaths from each of a number of other long-standing conflicts, many of which came to an end in this period: Northern Uganda's 20-year conflict, conflicts in Liberia and Sierra Leone, civil war in Angola, the North-South conflict in Sudan and so on, and you are pretty close to the 4.5 million mark.  This number does not include the 800,000 who died during the Rwandan genocide in 1994.  

This post is called Hanging Chad.  The play on words relates to a country that almost no American knows anything about, but which is now being dragged into the genocide/civil war on its border with Sudan.  The conflict in Darfur is one of the few in the region that has achieved some international notoriety.  The Bush administration, to its credit, has termed it genocide and used tough language with the Sudanese government.  To its discredit, it has done little else.  Today, thousands of Darfuris fled their burning villages, sure to further inflate the growing numbers, now estimated at 4 million, who rely on international humanitarian aid to survive.

While we do nothing about the Darfuris, whose plight ought to be motive enough to act, we also allow this conflict to roil the rest of the region.  Hanging Chad Out to Dry. That is what the title refers to.  But it may as well refer to the continent as a whole.

This is not a post about a great African crisis that, if ignored, will suddenly explode into a conflagration we will wish we had paid attention to before.  No, not at all.  The crisis, unlike headline-seizing natural disasters of the past few years (the tsunami, Katrina), is ongoing, the conflagration is already here, and almost nothing will happen if we continue to ignore it.  Nothing will happen to us, anyway.  Basic human decency, however, suggests that we should care about the Africans themselves. 

So here is a quick rundown.

The following countries, at a minimum, are engaged in some form of conflict, ranging from isolated violence in a marginal region of the country, to full-scale international war: Somalia, Ethiopia, Sudan, Chad, Central African Republic and Congo.  Note that these countries share borders in the central and eastern part of Africa.  As is usual, the deaths involved in all of these conflicts are largely from sickness and malnutrition rather than violent attack.

The Sudanese case is well known, and Chad's problems are associated with that conflict, though there are additional internal factors at work.  The same can be said of Central African Republic, which has experienced scores of coups in the past decade, but which now finds itself destabilized by overflow from Darfur.  Somalia is engaged in a civil war in which Ethiopia and the US have backed a transitional government against Islamic rebels.  Typically, the Union of Islamist Courts had brought relative peace to Mogadishu as it ran out the transitional government, but at a price: more restrictions on personal freedom under Islamized rule.  Now, however, the peace is gone.  Today, Ethiopians and Somalis marched toward Mogadishu for a showdown with the UIC.  The UN worries that the conflict will spiral out of control once the warring parties meet in the capital.

Not all of these conflict-prone countries are at the high-point of their conflicts.  In Congo, for example, recent elections and demoblizations have marked a partial return to peace in a country where international conflict claimed some 4 million lives in the last 8 years.  Nonetheless, rebel leader Laurent Nkunda, a rather unsavory rebel leader, continues to terrorize the locals and send refugees pouring into Uganda. 

Nor is the center-east the only part of Africa that is burning.  Recent attacks on oil companies in Nigeria have escalated a long-simmering conflict over oil rights there. Cote d'Ivoire is effectively cut in two, with a UN force in the middle guarding an uneasy standoff which was to end its own civil war in 2002. Burkina Faso is experiencing a low-grade conflict between the police and military with the potential for more violence. Zimbabwe is suffering the dying pangs of a cruel dictatorship that has destroyed the country's economy and led to a sharp escalation in torture and rape (see earlier post below).

And of course, cruel violence is not the only problem facing Africans today.  Cruel poverty is as great of a threat to many.  Consider that in Zambia, doctors worry that even with cheap ARVs for HIV patients available, victims of the disease are so poor that they are unable to eat when they consume these partially toxic medications.  As a result, they often become even sicker.  The world has poured new money into disease prevention, and treatment, in poor countries in recent years (see earlier post below on HIV).  But Zambia is a reminder that controlling disease must be part of an integrated approach to human welfare.

Okay. Guns and Disease. You've heard all of this before. So now what? What can be done about all of this? In the next post, I will look at what the world has done in recent years to aid Africa, and what could be done better.

Posted December 25, 2006

It's Christmas.  Today is a day to be with family, to say thanks to friends and to celebrate plenty by giving generously.  Generally, we give most generously to those who are close to us: children, lovers, friends. 

I am not a Christian, but I accept that today is a good day to engage in all of these activities.  Everything is closed, so there is plenty of time and space to be together, to be thankful, and to be generous.  As a non-Christian, I feel no obligation to celebrate the holiday in traditional ways, however.  So let me make a different kind of offering.  This is an offering not to my close friends, but to people I hardly know at all.  This is an offering to Africa.

I am not an expert on Africa, but I hold it, all fifty plus countries and hundreds of millions of people, close to my heart.  I spent nine months in Africa nearly a decade ago, about half of it in Kenya, and half in Zimbabwe.  I passed by overland bus through much of the East and South.  I interviewed ex-freedom fighters in Kenya, suffered a concussion in a traffic accident in Tanzania, lost my bladder in Malawi, interned for an independent magazine in Zimbabwe, and drank beer in Soweto.  I am not an expert on Africa, but I hold it close to my heart.

So today, I want to write of Africa, because that is where many of today's great tragedies are occurring, and very few people are paying any attention.

Many people ask why we should care about Africa.  It is not geo-strategically important, few people live there relative to poor countries like China or India, and, as a perpetual basket-case, even if we wanted to care about it, it seems nearly impossible to understand Africa's savagery and instability. 

In responding to this logic, well-intentioned Western leaders too frequently resort to claims about how Africa actually does affect us.  It is argued that instability in Africa creates conditions for Islamic terrorism to flourish, or for disease to propagate.  Sometimes, we are told, pursuing a different tack, that we must care about Africa because our actions, through our consumption of diamonds, oil, or pharmaceuticals, actually impact on African lives. 

The problem with these arguments is not that they are false.  They are not.  The problem is that they elide an inspiring moral vision in exchange for a cold, rational calculus which is ultimately unpersuasive to most Americans.  In the first place, the notion that it is in our self-interest to care about Africa seems implausible.  What evidence can be brought to bear in defense of this claim?  We have little exposure to Africa in military or commercial terms, relative to other parts of the world, so why should self-interest raise the profile of the continent? 

In the second place, it may be true that our consumption patterns create some link between us and Africans, but it is problematic to assert that trade with Africa is largely a losing proposition for Africans.  If our consumption of diamonds, oil, or pharmaceuticals (or textiles or coffee or other primary goods) makes us responsible for events in Africa, it seems likely that these markets impact in both positive and negative ways on Africans.  Why should we assume that, on net, we are doing more harm than good? We don't worry about the effect of our trade with other partners, like Europe, with whom we trade infinitely more, on their societies.  That is for them to figure out.  On balance, if trade is not in their interests, they can decide not to do it. 

So, in my view, the case for Africa must rest elsewhere.  The case for Africa must rest with the fact that Africa, more than any other region of the world, exemplifies the limits of the American dream.  In Africa, a smart, well-meaning, industrious child, who does her best to play by the rules and get ahead, has a very high chance of failing to thrive, or even survive.  That should bother us. Period.  America's ideology is founded on the belief that if people work hard, try hard, and play by the rules, they should be able to get ahead.  Not everyone is smart enough, talented enough or lucky enough to be a Fortune 500 executive, the president, a movie star.  But everyone can have a comfortable life if they put their minds to it, and their hearts in it.

This belief is based on the notion that America is an "opportunity" society.  John Locke once wrote that in the beginning, all of the world was America.  He meant by this that all of the world was open space, with boundless opportunities for individuals who were willing to labor.  Locke understood, however, as did all of the "social contract" theorists of government, and America's founding fathers, that labor could only yield progress when there were institutions which protected property and rewarded diligence.  These institutions were not the creation of individuals, but of communities.  Therefore, the edifice upon which the American dream is founded presupposes the existence of institutions which reward work, investment, and creativity.  No man is an island, and no man's accomplishments are his alone.  He owes society a great debt for creating conditions which allow him to prosper.

Peter Singer made a similar argument in his recent piece on the proper levels of charity which private citizens ought to render to the poor.  He wrote:

"People can earn large amounts only when they live under favorable social circumstances, and… they don't create those circumstances by themselves. I could have quoted Warren Buffett's acknowledgment that society is responsible for much of his wealth. "If you stick me down in the middle of Bangladesh or Peru," he said, "you'll find out how much this talent is going to produce in the wrong kind of soil." The Nobel Prize-winning economist and social scientist Herbert Simon estimated that "social capital" is responsible for at least 90 percent of what people earn in wealthy societies like those of the United States or northwestern Europe. By social capital Simon meant not only natural resources but, more important, the technology and organizational skills in the community, and the presence of good government. These are the foundation on which the rich can begin their work. "On moral grounds," Simon added, "we could argue for a flat income tax of 90 percent." Simon was not, of course, advocating so steep a rate of tax, for he was well aware of disincentive effects. But his estimate does undermine the argument that the rich are entitled to keep their wealth because it is all a result of their hard work. If Simon is right, that is true of at most 10 percent of it."

As always, one may quibble with the details of Singer's argument (i.e., maybe Simon's estimate is too high), but the core is sound.  If Buffet is correct, and I think he is, we should be disturbed when a large region of the world does not provide opportunities for people who wish to excel.  Of course, self-interest tells us that we all lose when talented people die young or are unable to contribute to society because of their circumstances.  But we don't need self-interest to tell us that we should be upset and angry when this happens.  We should be upset simply because it is unfair, regardless of whether it affects us directly or not.

And so we should be upset about Africa.  In the second part of this post, I will explore recent events on the continent, events which should make us angry, concerned and active. 

Posted December 19, 2006

*A shorter version of this post appears on the New Vision blog, Foresight.

During the 2004 presidential campaign, John Kerry made reinsurance a cornerstone of his health care reform plan. Now, Harvard School of Public Health Professor Katherine Swartz has published a new book, Reinsuring Health: Why More Middle Class People Are Uninsured and What Government Can Do, which is clearly designed to put reinsurance back on the political agenda in time for the 2008 elections.  Swartz's book offers a deft analysis of the problem of the uninsured in America today, and proposes an incremental but important solution.  It's not perfect, as I will argue below, but it would go a long way toward helping to slim the ranks of the uninsured.

At the most basic level, reinsurance is exactly as unglamorous as it sounds; it means, literally, "insuring again." If "insuring again" doesn't sound like a great way to help people with no insurance in the first place, consider the basic logic.  Reinsurance is insurance which is purchased by insurers themselves, rather than individuals.  Why do insurers want more insurance?  The insurance business is predicated on the idea that a certain number of people will get very sick each year on average, and it sets premiums for care based on the probability of that event occurring.  But, while these expectations are right on average, some years will be very bad, and a few extra people will get very sick. 

The result is that the insurer may not be able to afford the costs of care in that particular year, which ultimately means that one bad year is enough to bankrupt an insurer, even if they have properly calculated their average annual risk.  This is where reinsurance steps in.  If a "reinsurer" covers the risk of bad years for a large number of insurers, then it can prevent any single insurer from going bankrupt in a bad year, and its own expenditure should be relatively smooth, since the probability of all insurers having a bad year in the same year is relatively low.

Okay, so if you have followed me until now, you may be thinking: reinsurance sounds like a good idea, but how is it going to help the problem of the 46 million uninsured in America? This is where Swartz's book makes a key contribution.  That contribution is to redefine our understanding of the uninsured.

The first part of her book demonstrates what I will call the problem of the "missing middle."  The missing middle is both the middle-class, and the middle demographic range, adults between 25 and 44 years old.  Swartz documents an important trend in the demographic profile of the uninsured: the precipitous decline in the percentage of the uninsured who are children (under 19) and the rise in the proportion of 25-44 year olds without insurance.  The likelihood of being uninsured has risen for all age groups since 1979 except for children and the elderly.  In other words, while government programs like the 1997 Children's Health Insurance Program (CHIP) and Medicaid/Medicare have expanded to cover the poor, the young, and the elderly, it is the middle-aged, middle class that represents a growing fraction of the uninsured. 

America has always assumed that this demographic would get coverage from its employers, or purchase it on their own.  But, as Swartz demonstrates, the decline of traditional unionized work and the rise of contracting for services means that employers are much less likely to provide such care, and the costs of purchasing it in the individual market have been rising very fast.  Middle-aged, middle class workers cannot afford health care at current prices.

Since the labor market is not going to change anytime soon, the main solution to the problem of the uninsured is to reduce the costs of purchasing health insurance in the private market for individuals.  According to Swartz, the way to do this is to reduce the fears of insurers that the individuals who are purchasing their insurance products are those that are likely to be sickest and costliest for them.  This problem is known as adverse selection: when insurance coverage is voluntary, there is a tendency for those who think they are most likely to use the insurance to be willing to pay for it, while the healthiest will stay away.  Fears of adverse selection lead insurers to do everything they can to avoid covering the sickest, which means those who most need coverage may end up without it.  Adverse selection also leads to rising premiums.  If insurers take on costlier patients on average, then they end up having to charge higher premiums to cover their care.  But this makes healthier patients even less inclined to purchase insurance, which further biases the insurer's risk pool towards the sick, which makes providing coverage even costlier, which can lead to a spiral of increasing premiums.

Here, finally, is where reinsurance connects to the problem of the uninsured.  If the federal government reinsures private insurers for their costliest patients, insurers no longer have to fear adverse selection, because they are insured against it.  Swartz's preferred reinsurance plan would cover the costs of any insured individual's care once it exceeded a certain threshold.  As a result, two things would happen which should reduce health care costs for the missing middle.  First, there would no longer be a need to jack up premiums because of fears of adverse selection.  Second, insurers would no longer spend administrative resources trying to target the best risks and avoid the worst risks. This saves them money, savings which should also result in lower premiums.  These lower premiums, in turn, would encourage the missing middle to sign up for insurance in the first place.

Swartz's plan is not a panacea.  She also calls for further expansions of government programs to deal with the poor and young which would not be helped by her scheme.  But her core argument is that reinsurance will help the problem of the missing middle, which now makes up a substantial fraction of the uninsured.

So will it work?  Reinsurance is not a new idea.  It was first proposed by the Eisenhower administration in 1954, but never enacted.  More recently, in 2001, New York state introduced the Healthy New York program, which is a health insurance option for individuals and small employers.  The program, which uses state reinsurance to cover expensive care, has been credited with substantially reducing premiums relative to the individual market.

Reinsurance suffers from four problems.  First, it will not eliminate the adverse selection problem entirely, because insurers still have incentives to seek out the cheapest patients (insurers still make more money on cheap patients), which means that savings on the administrative side will be relatively small.  Second, it will not affect one of the biggest cost drivers in the American health system, technological innovation, which is not a shock to individual insurers, but causes premiums to rise across the board.  Third, reinsurance assumes that the only reason people do not sign up for insurance is cost, but there are low risk individuals who will not sign up at any price unless they are forced to.  Swartz has nothing to say about making insurance compulsory, but universal coverage will ultimately necessitate some kind of mandate.

But perhaps the idea's greatest weakness is political: reinsurance is not exactly an inspiring concept.  It does not elicit passionate support the way that an improbable reform like national health insurance does.  Since the estimated cost of such a program is between $5 and $20 billion per year, some political commitment is needed to pass funded legislation.  Does reinsurance have the sex appeal to generate excitement on the campaign trail?

Perhaps the right way to sell reinsurance is not simply as a mechanism for achieving universal coverage, but as a way of reducing premiums for everyone, even those who have coverage already.  Robert Blendon, an expert on American opinion about health issues, argues in a recent Health Affairs article that the rising cost of coverage is as important to most Americans as the uninsured.  An October Kaiser Family Foundation poll found nearly half of voters were concerned about rising health care costs. Rising costs are undoubtedly at least as important to businesses as well. And we know from the Clintoncare debacle that if insured Americans are afraid of losing coverage or seeing their premiums rocket, they become far less inclined to support increased coverage for others.

America's attempts to provide expanded health insurance coverage have come in two flavors.  There are, first, the soaring, idealistic big bang plans to reform the system and cover everyone at a go, such as Clintoncare, which have engendered great expectations, and uniformly resulted in great failures.  And then there are the incremental plans which slowly augment the ranks of the insured, such as the Children's Health Insurance Program, which have quietly succeeded at far less ambitious tasks.  Approximately 6 million children have been covered by CHIP, according to the latest government figures.   

If reinsurance isn't a sexy idea, it is squarely in the camp of the incremental policies which have succeeded in America in the past.  The beauty of the reinsurance solution is how little change it requires in the nature of the American health system.  The private insurance market remains the primary insurer for the middle class, the system remains voluntary, choice of insurer is preserved, and the federal role is no greater than in the catastrophe reinsurance or secondary mortgage market.  It may not elicit passionate support, then, but is unlikely to elicit passionate opposition either.  And the historical record suggests that avoiding passionate opposition may be more important than exciting passionate, but ultimately impotent, support. The greatest weakness of reinsurance may also be its greatest strength.

December 16, 2006

Today's news contains a bit of good news from the U.S., some bad news from America and India, and a couple very ugly tidbits from India.

The good.  The Census reports that Americans now drink more bottled water than beer, while the National Cancer Institute reports that breast cancer rates have declined sharply in recent years.

The bad. The Census also reports that Americans spend about 1/6 of the year, 64 days per annum, watching television. Around the globe in India, less than 6 months after U.S. embassy warnings over the summer of potential bomb attacks in Delhi surrounding India's celebration of independence, the Israeli embassy now warns that Goa is a potential target over the New Year's holiday.  The tourist destination in southwest India is popular with Israelis.

The ugly. The Hindustan Times reports that the speaker of India's parliament argued against the notion that the body was "dominated" by criminal elements because only  40 of 545 MPs in the body have serious criminal cases against them.  The paper notes that if minor offences are counted, however, the number rises to 140.  Meanwhile, in the Indian state of Orissa, a standoff has developed over the entrance of Dalits (formerly known as Untouchables) into a temple from which they had been banned for 300 years.  On December 5, the Supreme Court ordered that they be allowed to enter the temple, which they did a couple days ago.  Now, the temple has been closed, and upper-caste Hindus are threatening a hunger strike.

Here's hoping things improve tomorrow.