A friendly reminder to the Pentagon...

War is hell.

Some 15,000 soldiers are heading home to this sprawling base after spending more than a year at war in Iraq and Afghanistan, and military health officials are bracing for a surge in brain injuries and psychological problems among those troops.

Facing prospects that one in five of the 101st Airborne Division soldiers will suffer from stress-related disorders, the base has nearly doubled its psychological health staff. Army leaders are hoping to use the base's experiences to assess the long-term impact of repeated deployments.

"I don't know what to expect. I don't think anybody knows," said Gen. Peter Chiarelli, vice chief of staff of the Army, as he flew back to Washington from a recent tour of the base's medical facilities. "That's why I want to see numbers from the 101st's third deployment."

Why is this happening?

Noting that some soldiers in the 101st Airborne units have been to war four or five times, Chiarelli said he is most worried the military will not be able to find enough health care providers to deal effectively with the troops needing assistance.

Many of the military bases are near small or remote communities that do not have access to the number of health professionals who might be needed as a great many soldiers return home.

More than 63,600 active duty Army soldiers have done three or more tours in Iraq or Afghanistan. That is a nearly 12 percent of the total number of soldiers who have deployed at least once. Roughly four in 10 soldiers who have gone to war have served more than one deployment — and that number is growing steadily

Finally, Army leaders are starting to get their heads out of the sand and deal with the horrible psychological and emotional trauma experienced by multiple-tour Iraq vets.

For the first time, Thomas said, every soldier returning home will have an individual meeting with a behavioral health specialist and then go through a second such session 90 days to 120 days later.

The second one is generally the time when indications of stress surface, after the initial euphoria of the homecoming wears off and sleeplessness, nightmares, and other symptoms show up.

"We're seeing a lot of soldiers with stress related issues," he said. "They're not bipolar or schizophrenic. But they're deploying three and four times and the stress is tremendous. They're having relationship issues, financial issues, marital problems — all stress related."

More than 3,000 of the 15,000 troops returning home, Logan estimated, probably will experience headaches, sleep disorders, irritability, memory loss, relationship strains or other symptoms linked to stress disorder.

And as if that wasn't bad enough:

Medical staff at Fort Campbell say they also worry that there will be a new surge of suicides — an escalating problem in recent years, largely related to the stresses of war.

While soldiers have been routinely deploying for 15-month tours, most Marines serve about seven months and airmen deploy for about four months, although some may serve for tours of six months or longer.

Late this past summer, Pentagon leaders ordered a change, saying any soldier who deployed in August or after would serve 12-month tours. Army leaders say they want to reduce that to nine months, but doing so will be difficult considering the strains of fighting two wars at once.

Logan said that some 85 percent of those soldiers with stress disorder symptoms will recover with the help of some treatment or medication. But the other 15 percent will require more intensive help.

Remember back in the runup to the war, when the neocon cheerleaders, toady TV pundits, Pentagon shills and the 101st Division of Fighting Keyboardists were smugly claiming an invasion of Iraq would pay for itself?

In addition to the myriad other reasons that claim was entirely ridiculous on its face, I'd be willing to bet a nickel that not a single one of these warmongers accounted for the potential PTSD-related mental health care as a potential cost.

Lest we take our eye off of Iraq with so much else going on, I feel it is necessary to ask the Pentagon to please take care of our troops, and not force them into repeated deployment until the point of mental breakdown. If we can't find new men and women willing to fight, it's time to end this war.

Fixing Health Care: Expanding Coverage or Controlling Costs?

I must admit I'm not an expert of any sort in the health care field. But I saw a very interesting panel discussion on Thursday at a work conference, about the challenges and expected priorities of the early Obama Administration, and one panelist named Chris Jennings talked in depth about what meaningful health care reform would look like. Apparently Mr. Jennings has been at the center of the national health care debate for a couple decades now and was a prime architect of the 1993 Clinton plan, so it can be assumed he is well attuned to the political realities of the situation and the potential pitfalls to avoid. His thoughts piqued my interest, so I figured I would share them here.

Here's the crux of his argument:

Health care reform is crucial to rebuilding the economy; without it America is operating at a major disadvantage in the global economy. The guaranteed free health care other countries provide is money employers in those countries don't have to pay for their workers.

The health care crisis has two major components: the massive amounts of uninsured and underinsured individuals unable to get quality care, and the pervasive skyrocketing costs.

Liberals usually focus exclusively on providing universal care while conservatives focus primarily on driving down costs. But it is nearly impossible to fix one problem without making significant headway on the other.

In other words, if we expand coverage to everyone without some mechanism to rein in the exploding cost of adequate care, American health care will face overwhelming financial strain and the system will implode before too long. Likewise, lowering overall costs through "market reforms" while millions of people remain uninsured will result in a massive reverse adverse selection problem - those that really do need quality coverage will be those least able to get it. This structure is also unsustainable in the medium-long run.

Makes sense intuitively. I've always figured an intrinsic advantage of government-provided health care is a much lower overhead cost. Insurance companies now spend something like 30% of their budgets on administrative and marketing costs, around half of that with bureaucratic mazes designed to keep people from getting care the company doesn't want to pay for and the other half telling you to ask your doctor rather suggestively about the LATEST COOL NEW DRUG!!!. Meanwhile, the overhead of Medicare is something like 3%. Between that and the promising potential of negotiating with Big Pharma for lower drug prices, It seems pretty obvious to me which is more economically efficient. Why would we not want a single-payer system based on that?

So.....does anyone who knows more than myself about health care policy want to react to this?

I'm now posting on GW's Policy Hippo blog

http://policyhippo.blogspot.com/

This is the blog started by editors of the GW public policy school journal, Policy Perspectives, of which I now am one. I'll actually be posting there pretty regularly (I mean it this time!) so please check it out and comment freely.

If you pick up RSS feeds, you can subscribe to Policy Hippo here.

I'll still be posting as optimo.

President Obama's Inheritance

No doubt, it feels good to be a progressive these days. Democrats have more control of the federal government than any time since just after the 1964 landslide elections. That was immediately followed by the enactment of Medicare and other key social safety net programs, so it is no surprise that many left-leaning advocates and engaged citizens are expecting big things from the upcoming Obama Administration.

Call me a downer if you want, but I'm not quite so thrilled about the prospects for immediate major advances. I'm certainly feeling an awful lot better walking by the White House these days, but that said, we are about to witness our nation's first black president attempt to maneuver an agenda through perhaps the most dire state of affairs this nation has seen since at least the Great Depression era. The global climate crisis, daunting economic inequality, the Iraq debacle and the threat of Islamic fundamentalism, unsustainable energy consumption, a health care system in absolute shambles. Oh yeah, and there's that whole financial/economic meltdown thing. And that doesn't even bother with a whole host of other important issues that aren't quite as imminently crucial.

We know one thing: governing with be anything but a cakewalk, even with significant Democratic majorities in congress. The constraints on enacting common-sense progressive legislation extend way beyond the impressive ability of Republicans to obstruct. We are plagued by a wide variety of obstacles of all shapes and sizes: a trillion-dollar structural budget deficit ("structural" means it won't go away on its own when the economy gets better), factionalism within the Democratic caucus, loss of credibility around the world, and a continued public aversion to large tax increases. And it's not like most people are aware of these formidable constraints; after all, didn't you hear about Lindsay Lohan's latest drunken escapade?

Really, I'm not trying to be a downer. I just think it's of the utmost importance that highly educated folks like us are realistic in our expectations for the President-elect's job performance. It will take a heroic effort on Mr. Obama's part to:

1. get the economy back on track and create quality jobs,
   
2. shepherd a meaningful climate change initiative through Congress,
   
3. shepherd meaningful health care reform, hopefully providing universal coverage, through Congress,
   
4. get us out of Iraq and restore our standing in the world,
   
5. squash the danger posed by Islamic terrorists and al-Qaeda,
   
6. and get the budget under control.

I'm not sure any president has ever accomplished this much in one term. From everything I've heard in people's expectations, both implicitly and explicitly, Obama will need to accomplish most or maybe even all of these things to be considered a successful president and be re-elected in 2012.

Good luck, Mr. President-elect. You'll need it.

The price of GM's continued existence

I was about to write a spirited rant about the blatant folly of bailing out disgustingly retrograde American car companies, but Lisa beat me to the punch. If you really want to know my thoughts on this, you can find them in a comment on Lisa's post.

But I do want to add one key point. If GM continues to exist and generally suck at making cars, it limits the abilities of more innovative startup companies to grow and gain market share. Companies making cars like the Aptera.


This beauty is actually ready for production, but auto industry regulations essentially written by GM lobbyists are making the producers jump through hoops just to get it on the road. Why does our government hate the car of the future?

Optimo's Official Election Recap

There will be much time to talk about 2009 and the coming Obama presidency, but it feels right to start off with a recap of the election.

Obviously we know Obama won, and decisively so. He definitely has amassed 364 EVs and still could end up with 376 (Missouri and the single Omaha district remain too close to call). He outperformed John Kerry in just about every demographic group you can imagine. Check out the details, they're pretty striking. Obama won the 18-29 age group by an astounding 2-to-1 margin. Regionally, major gains were made in the coastal South, upper Midwest, Northeast and non-Mormon areas of the Mountain West. It's hard to see these gains fading away anytime soon if Democrats manage to deliver on at least some of their promises over the next few years.

In Congress, Republicans actually did a little better than expected. Although a few races in both chambers are still yet to be decided, they lost ground but managed to avoid a major landslide. As of now, the count stands at 22 seats flipping from R to D, 4 '06 D pickups flipping back to R, and eight still yet to be decided. If the eight remaining seats split 4-4, the final count will be 258-177.

The Senate saw at least six Democratic pickups in a very tough year for Republicans, while 3 races involving R incumbents remain too close to call. AK is waiting for all mail-in ballots to be counted, MN will go to a recount, and GA will go to a runoff election. If the D challenger wins in all three (which is very unlikely), then Democrats reach that supposedly magical 60 mark. Georgia would really be a shocker, and both sides will be throwing a ton of resources into the special December 2nd runoff election. My best guess for the final tally is 57-43: Franken wins in Minnesota and Lieberman bolts to the GOP. Again, both houses see non-negligible Dem majorities, but not large enough for the center-left governing coalition within the party to easily get legislation through.

The state level elections produced few surprises and was much more even. Democrats picked up the Missouri governorship which will impact policy there, but all other governor races stayed the same. Democrats picked up 5 state legislative chambers, including the NY Senate (as expected) for the first time in over a century, and Republicans surprisingly picked up both chambers in Tennessee along with 2 other bodies. New Hampshire now has the first majority-female legislative body in the country's history. Ballot initiatives were a very mixed bag. I won't bother with the details, but some nonpartisan review can be found here.

Election predictions

Here is what I expect for tomorrow's election:

Obama wins 53-45 with 1-2% voting for someone else.
He will amass 359 EV's, by winning all the Kerry states and picking up Colorado, Florida, Iowa, Montana, Nevada, New Mexico, North Carolina, North Dakota, Ohio and Virginia.

Three other potential Obama states - Georgia, Indiana and Missouri - will be slight losses due to voting "irregularities". Each of these state governments is dominated by Republicans, and the urban minority areas will be plagued by massive lines, voter intimidation and potential other funny business.

In the Senate, Democrats will pick up eight seats tomorrow: Virginia (Warner), New Mexico (T. Udall), Colorado (M. Udall), Alaska (Begich), New Hampshire (Shaheen), Oregon (Merkley), North Carolina (Hagan), Minnesota (Franken). Georgia's race will go to an early December runoff, and odious incumbent Saxby Chambliss will prevail in a nailbiter. Lieberman will lose his committee chairmanship but will reluctantly decide to remain in the Dem caucus. Thus, Democrats will end up with 59 members, but still be able to break some GOP filibusters by flipping moderates like Snowe, Specter and, yes, the re-re-reinvented McMaverick.

The House is more nebulous (too many damn races to follow), but I expect around 30-35 D pickups and 2-4 R pickups.

Dems pick up the Missouri governorship, and all others remain in current hands. Dems pick up the NY State Senate and prepare to eradicate the state of all Republican congresscritters after the 2010 census.

California's Proposition 8 (gay marriage ban) fails. South Dakota's abortion ban, designed specifically for a Roe v. Wade challenge fails. Affirmative action banning and anti-worker initiatives all fail. Massachusetts' measure eliminating the income tax fails, but marijuana decriminalization passes.

Can you say landslide?

Make your own predictions here.