Via Brad DeLong, one of Peter Orszag’s health care slides is a scatterplot of state per patient Medicare spending and state Medicare quality:

As you can see, we’re having some serious problems with getting good value for our money in health care spending. The standard account of this, that I have no reason to disbelieve, is that geographical areas with a high supply of health care services — especially specialist MDs — wind up recommending to patients a lot of useless or even harmful additional treatments. And this occurs at the same time as restrictions on the supply of general practitioners and on the permitted scope of activities by non-doctors (nurse-practitioners, etc.) artificially raises the cost of the sort of very basic health care that really would be useful to people.

Long story short, substantial progress on the health care costs problem will probably require the crushing of the doctor’s lobby. Reforming to the method of financing health care can shift the fiscal burden off financially struggling people in a helpful way in the short- or medium-term but absent some kind of doctor-crushing initiative to change the system of health care delivery the fiscal burden will soon enough drown whoever’s tasked with the responsibility of paying for it.

Fred Hiatt calls out a friend of mine in the WaPo‘s lead editorial, and I expect he’ll have something to say about it. But let me just note this:

In essence, Mr. Obama promises an improved version of the Bush administration’s three-year-old strategy of offering, in conjunction with European allies and Russia, economic and political favors to Iran in exchange for an end to its nuclear program and threatening it with sanctions if it refuses.

All this proves is that if you describe policy ideas at a sufficient level of abstraction, then everything is identical. But the difference here is pretty clear. Obama would like to work, in good faith, for a diplomatic agreement that would achieve America’s key security goal (verifiable Iranian disarmament) in exchange for us offering some kind of concessions to Iran. Bush and McCain, by contrast, come from a school of thought which regards it as essentially impossible to reach stable agreements with “bad guy” regimes.

Thus, their diplomatic approach to Iran amounts to repeatedly shaking their fists at Iran and demanding that they capitulate, followed by stern proclamations about how “unacceptable” a nuclear-armed Iran would be. It’s not clear if the Bush-McCain policy is going to lead to war (as a literal read of their rhetoric would suggest) or to Iran possessing nuclear weapons (if they flinch from launching a war) but what it’s not going to do is produce a diplomatic agreement to achieve verifiable nuclear disarmament in Iran. Obama, by contrast, wants to pursue good-faith negotiations aimed at achieving that goal. That’s the difference and it’s a huge difference — to brush it all away because both candidates agendas involve “Europe,” “Russia,” and “Iran” is silly, especially given that both McCain and Obama say they believe they’re disagreeing it ought to take compelling evidence before anyone concludes otherwise.

[The less said about Hiatt's concluding pitch for endless war in Iraq, the better]

Ace reporter Spencer Ackerman tells me over IM that he’s experiencing “extreme fog” delays at Dulles Airport this morning. Yesterday at National they told us a flight was delayed because of fog. The thing of it was that you could look outside and there was clearly no fog. I attempted to vent about this to a fellow passenger, but he sheep-like took the view that if they say there’s fog there must be fog. I tried to gesture to the numerous large windows, but to no avail.

The experience put me in the mind of Michael Frayn’s “Fog-Like Sensations”.

“I consider all American constitution” evil, [Khalid Sheikh Mohammed] said, because it permits “same-sexual marriage and many other things that are very bad.”

I’m sure Hamid Karzai has some problem, but it strikes me as intuitively a bit absurd to hold him personally responsible as being “not up to addressing Afghanistan’s many troubles.” It’s not, after all, as if Afghanistan has some long record of troubles being well-addressed and everything going smoothly until Karzai showed up. Meanwhile, neither the United States nor the Europeans have done as much as they/we should or even said we would to help out. Shifting the blame onto Karzai is just a low blow.