Take a look at this column by National Journal’s Jonathan Rauch, for me one of the two or three most consistently interesting writers on American public policy:

The Democrats’ postwar narrative was Keynesianism: By managing demand, the government would balance the economy instead of the budget. Reagan’s narrative was supply-side: He would reignite stagnating productivity by reducing tax rates, deregulating, and shrinking a bloated public sector. Bill Clinton preached fiscal responsibility and globalization, a program that succeeded economically but lacked staying power politically, partly because Al Gore seemed to repudiate it.

Bush adopted the supply-side story, but in a primitive form in which tax cuts, deregulation, and smaller government became tax cuts, tax cuts, and tax cuts. The public has responded with something between indifference and contempt, leaving Republicans without a leg to stand on.

As for the Democrats, they have an audience. For the first time since the Great Society era, the public is receptive to a Democratic prosperity narrative, even eager for one. What the party does not have, yet, is the narrative.

Various bits and pieces are in circulation. Fix health care. Improve income security. Restrict trade. Raise taxes on the rich. Democrats hope to speak to middle-class America’s feelings of economic vulnerability, which is probably the right tree to bark up. But while some Democrats strike notes of class resentment, others seem to blame foreigners. No candidate has found a package and a tone that tell a story not primarily about populism or nationalism but about prosperity: raising the tide to lift all boats.

Read the whole column here (the link expires in a week).

My earlier post about Paul Krugman’s attack on Rudy Giuliani’s health-care ad has attracted critical comments that are making similar points. I argued that Giuliani’s numbers were wrong and that his claims were misleading, but that cancer survival rates are indeed higher in the United States (especially for those with health insurance) than for NHS patients in England. Here is one of the comments disagreeing with that post, which states criticisms that others have also made in a fairly clear and comprehensive way.

Mr. Crook’s criticisms of Paul Krugman are not even internally consistent, much less supported by fact.

1. The statement "If you are a man with prostate cancer, it may not matter very much whether your cancer is diagnosed early, or whether you live in Britain or America" implies that the survival rates are very similar.

2.  The further implication is that Mr. Crook knows the true incidence in each country, which are clouded by differences in diagnostic methodology. In reality, there may be real differences in incidence due to differences in the environment, nurture, genetic variation, and so on. Therefore, the true incidence in each country is unknown.

3.  Mr. Crook provides no citations for his assertions, while Mr. Krugman does.

4. The debate over whether PSA antigen testing affects survival is not settled, as a review of recent literature will confirm.

5. Since Mr. Crook asserts that diagnosis is much better in the United States than in the UK, it is disingenuous to shift from overall survival rates to 5-year survival rates. The Ezra Klein reference is clearly to overall mortality.

I was very disappointed by this piece, especially considering the nice promotion this site received from Brad DeLong.

Yes: thank you, Brad, for the nice promotion. Now, as to the criticisms of the post, there is some confusion over terminology here, to which I have no doubt contributed. The standard measure of the effectiveness of cancer treatment is five-year survival rates, often abbreviated in the literature to "survival rates". Whenever I said "survival rates" in my original post, I meant "five-year survival rates".

The five-year survival rate is the proportion of people still alive five years after being diagnosed with cancer. It is a flawed measure, as I tried to explain, and prostate cancer is probably the best example of how it can mislead. Early detection increases the five-year survival rate, but in the case of prostate cancer does not much reduce mortality, because prostate cancer develops so slowly that its victims tend to die of something else first. Mortality rates for that cancer are about the same in both countries. Five-year survival rates are far higher in the United States–so the claim that "survival rates" (ie, five-year survival rates, the usual meaning of that term) are higher for prostate cancer in the US is not "just plain false", as Paul stated. It is in fact true. Misleading, as I tried to explain, but true.

Well then, why not look just at mortality rates? Because mortality rates vary with incidence.  If mortality rates for certain cancers are lower in America, that may be because the incidence of those cancers (driven by factors other than efficacy of treatment) is lower. Changes in mortality rates over time tell you something about a country’s whole cancer-control regime. By themselves, cross-country comparisons of mortality rates say little about the quality of  treatment. Why not look at mortality rates adjusted for incidence? One problem here is that we only have figures for recorded incidence, not actual incidence. The US is good at detecting prostate cancer early.  It records vastly  higher incidence of the disease than Britain. Since the disease has about the same mortality in both countries, you might conclude that US treatment was vastly superior. That would be wrong, because America’s incidence figures are inflated (or you could say that  Britain’s are suppressed) by differences in screening.

Careful assessments of the efficacy of cancer treatment need to take five-year survival rates, mortality, recorded incidence and a host of other complications and confounding influences into account. Reliance on the five-year survival rate alone is rightly criticised–and the case of prostate cancer shows why–but it remains the standard measure. And on that measure, overall US cancer treatment scores better than Britain’s.

Enough metric crunching. I said that the politically salient question is this: if you have cancer, would you rather be an American with health insurance or a Brit without private insurance, forced to rely on the NHS? I said the answer was obvious. If anybody with professional experience of the two systems thinks I’m mistaken about that, I’d love to hear from you.

Paul Krugman has attacked Rudy Giuliani for a dishonest ad on health care–or perhaps an ignorant one, as the case may be. This is a test for the media, as well as a scandal in its own right, Paul says. Will those feckless reporters and editors at The New York Times call Giuliani to account for this? Probably not, seems to be Paul’s opinion:

OK, Rudy Giuliani has just released an ad claiming that the survival rate from prostate cancer is much higher in America than in Britain, thus proving the failure of socialized medicine.

The problem is that his claim is just plain false. In fact, mortality rates from prostate cancer are almost the same in America and Britain.

So, will this get as much attention as, say, the Edwards haircut or the Hillary laugh? Will it get any coverage at all? Bear in mind that health care is the central domestic issue of this election — and Rudy has just showed that he doesn’t know a thing about it.

Giuliani’s claims in the ad are indeed misleading. First, prostate cancer is a very bad example. Worse, in my view, is the implication that his Democratic opponents are proposing "socialised medicine" remotely similar to  Britain’s NHS. That can only be a deliberate deception.

To say that prostate cancer survival rates are much higher in the US than in England is not "just plain false", however. It is just plain true.

(more…)

Much as I agree with the FT’s editorial on Charles Rangel’s new tax bill, one point bears emphasising. If passed (which, as the leader pointed out, it won’t be) the bill would provide a permanent fix for the Alternative Minimum Tax and improve the efficiency of the corporate income tax by broadening its base and lowering its rate. Its distributional implications are modest and, as far as they go, desirable. Which is all well and good. As compared with other ways of fixing the AMT, notably patching it year by year, this is fine.

But remember that the tax cuts of 2001-06 are mostly due to expire by 2010. The Rangel bill, of course, does not forestall that event. As things stand, a significant tax increase is therefore in the pipeline, unless the next administration intervenes to modify the way tax rates reset (which it will). And that is not the end of the uncertainty, because the social-security tax is yet another candidate for an increase. (Barack Obama, for instance, has talked of raising or removing the income cap.)

In short, the Rangel bill does not show that Democrats plan no swingeing increases in income taxes after 2008. It shows only that they see an intelligent way to be rid of the AMT. The "mother of all tax reforms", as Mr Rangel called his bill, is not in any sense a comprehensive reform and leaves a lot of questions unanswered.

Between now and the latter part of December, the US Congress and the White House will revive a much-loved theatrical tradition: the battle of appropriations. Back in February George W. Bush set out his budget request for spending in the fiscal year that started in October. Congress then devised a plan of its own, not that different from the president’s. Spending bills conforming to that scheme have duly been passed by both houses. Mr Bush, accusing Congress of fiscal irresponsibility, says he will veto most of them. There will now be weeks of accusations and counter-accusations, talk of fiscal paralysis and threats of dire consequences. It is no way to run a government but the delays and uncertainty, the preening and posing, the stunts and thrills, at least have a cosy familiarity. It would seem strange to have spending bills passed in an orderly fashion, in time for the fiscal year they relate to, so that no omnibus packages or other routine emergency manoeuvres were required to keep the wheels of government turning – all quite out of the ordinary. This performance is not about good government, after all. It is about making a point. The White House’s point, and I laugh as I write this, is that the Democrats cannot be trusted with the public purse. (more…)

I liked this column by Charles Krauthammer, offering a corrective to the current gloom in Republican circles about the quality of their presidential field.  The party longs for another Reagan, the column points out. Republicans hoped that Fred Thompson might be that man, but what little they have so far seen of Thompson has changed their minds. All the other candidates are gravely flawed in one way or another, or so the party thinks. The column reminds Republican supporters that Reagan was a dozer, a flip-flopper on abortion, a granter of amnesty to illegal immigrants, and that he appointed Sandra Day O’Connor and Anthony Kennedy to the Supreme Court, whose swing votes "upheld and enshrined Roe v. Wade for the past quarter-century".

The point is not to denigrate Reagan but to bring a little realism to the gauzy idol worship that fuels today’s discontent. And to argue that in 2007 we have, by any reasonable historical standard, a fine Republican field: One of the great big-city mayors of the past century; a former governor of extraordinary executive talent; a war hero, highly principled and deeply schooled in national security; and a former senator with impeccable conservative credentials.

The reference to idol worship reminded me of Britain’s Conservative Party after Margaret Thatcher. The perpetual disappointment that resulted from holding each new leader to that false standard has been a large part of their problem. On the other hand,  think of the leaders that followed her: John Major, William Hague, Iain Duncan Smith, Michael Howard, David Cameron. William Hague (I insist) might have been a good prime minister, and I’ll reserve judgment about Cameron. But it was not just "gauzy idol worship" that made the others look bad.   

How depressing–but then, not so surprising–to hear Rudy Giuliani say that waterboarding may not be torture, that it all depends on how it’s done. He insists that the United States is opposed to torture, as though seeking high moral ground on the issue, and then makes a mockery of that position by saying that waterboarding, done right, might fall outside the prohibition. In the case of electrocution, presumably, it all depends on where you put the electrodes.

This is not to say there are no grey areas when it comes to "aggressive questioning" . The line between interrogation and torture is not clear-cut.  But I cannot understand how anybody could doubt which side of that line simulated drowning is on. If anything is torture, simulated drowning is torture. If you need to remind yourself what waterboarding entails, read how the Khmer Rouge did it (thanks to Jim Fallows for the link).

Giuliani and other defenders of such techniques need to probe their residual instinct to oppose "torture". Why do they even feel obliged to say that? What, in their view, is wrong with torture? Why not just say that torture is a useful weapon in the war against terror? If they are repelled by that idea–as they damn well should be–then the revulsion ought surely to extend to practices like waterboarding.  Which principled defence of "aggressive questioning" permits simulated drowning but prohibits thumb-screws or the rack?

The White House’s nominee for attorney-general, Michael Mukasey, told his confirmation hearing recently that  he was unsure whether waterboarding was unconstitutional. If waterboarding is torture, he said firmly, then yes it is unconstitutional–but it may not be torture. "I don’t know what is involved in the technique," he said.  Please. How could he not know? Perhaps he used to know but no longer recalls. If it had slipped his mind, he should have refreshed his memory. That question hardly came as a surprise. 

This mode of thinking–"It may be legal, let me think about it"–reminded me of "The Terror Presidency", an excellent new book by Jack Goldsmith, a former head of the  office of legal counsel in the Department of Justice. Goldsmith shows that this administration has not been lawless in its war on terror, as many critics charge, but almost the opposite. It has been too much preoccupied with deciding what was strictly legal to spend any time wondering what was wise. (My review is here.) Giuliani and Mukasey should read that book, if they haven’t already. An instinct to value legal authority over justice, morality and expediency is a bad enough flaw in an ordinary lawyer, for heaven’s sake. In an attorney general–let alone in a president–it is a calamity.

With apologies for the delay (time waits for no blog, though it is going to have to make an exception in my case) here’s a response to Brad DeLong’s comments on a recent column of mine. My article argued that the debate over fuel-economy standards was not advancing the cause of climate-change mitigation, and it made the case (again) for a carbon tax. Brad’s take on this was:

Clive Crook says: - A stronger CAFE is better than what we have now - A full-fledged gas tax would be better than a stronger CAFE - There is little chance of a full-fledged gas tax - I’m against a stronger CAFE I think I am missing something.

Much as I admire Brad’s writings–what would we bloggers on political economy do without him?–I think this ruthless dissection of my logic leaves a little to be desired. (more…)

Warmest congratulations to Amit Varma, winner of this year’s Bastiat Prize. A libertarian outfit called the International Policy Network gives this annually to a writer who “wittily elucidates the institutions of a free society”. Amit writes a column for Mint, a business paper based in Mumbai, and publishes a blog, India Uncut. He is a champion of the new India, and fits the award’s rubric perfectly. He gives a good impromptu acceptance speech too, as I learned at the award dinner in New York on Wednesday. More power to him. Bastiat is best known, of course for his candlemakers’ petition—a classic satirical assault on arguments for trade protection. I am an admirer, but for the moment at least I’m thinking that satire is best used sparingly. My FT column this week ended with a modest proposal: namely, that the best way to create more equal societies is to slow or stop technological progress. I’d thought people would view that as a patent absurdity in the “let them eat roast babies” class, but more readers than I would have guessed took me seriously. Several wrote in for clarification. And one correspondent who did get the joke drew my attention to this post at The Register. I looked to the comments for consolation but didn’t find much. Some argued solemnly that halting technology was a really bad idea, some that it was an interesting concept but harder to implement than I was letting on, and some that I might in fact be on to something. Resolved: to make my meaning plainer.