An anesthesiologist slash right-wing crank who happens to share the name Ronald Dworkin with an important legal and political theorist has taken the august op-ed pages of the The Wall Street Journal to (a) whine about the fact that he, personally, might earn a lower income under a national health care system, and also that we should (b) “Expect a two-tier medical system and needless ER deaths if Congress and the White House have their way.”

It’s probably true that universal health care systems have a tendency to lead in a two-tier direction, as people with the means necessary to purchase additional services above the publicly provided “floor” wind up with somewhat more lavish care, though not necessarily better basic treatment for illness. That said, from this complaint you’d think that we were currently living in some Communist utopia in which health care is provided “to each according to his needs.” Even among Medicare recipients we have a two-tiered system according to whether or not you’re prosperous enough to afford “Medigap” coverage. Then there’s the tier separating people with really generous health care plans from those stuck in lower tiers that severely constrain your choice of doctor and access to specialists. And of course there’s the tier for people with catastrophic-only coverage and the tier for poor people on Medicaid and the tier for people with no insurance whatsoever. Probably more tiers than that, too. Our current system is clearly, obviously, and by design less egalitarian than all the major alternatives. That’s the whole point.

One question is why, with income inequality reaching unprecedented levels, we shouldn’t act to redress that inequity in our health care system? Dworkin appears to concede that inequity is bad, describing the residual inequity of a universal health care system as a great evil. But surely it’s progress relative to where we are.

When I saw yesterday’s poll indicating that a majority of Americans don’t think the war in Afghanistan is worth fighting my mind turned immediately to the fact that I don’t have a yes or no answer to that question. Whether or not something is “worth” doing depends on both how much resources you’re expending, and also on what you’re hoping to accomplish. At the moment, both the objectives of our campaign and the resources we’re willing to expend on it seem to be in flux.

Even in terms of the issue of whether we should be trying to “beat” the Taliban, there’s a kind of basic ambiguity in what that would mean.

This is a map of Afghanistan’s main ethnic groups that abstracts away from the reality that actual populations aren’t homogeneous. The biggest ethnic group is the Pashto. The Taliban is also an overwhelmingly Pashto-based movement. Historically, Afghanistan’s Uzbeks and its small Turkmen community have been very hostile to the Taliban. What’s more, the Hazara are Shiites so they don’t really have any choice but to be anti-Taliban. The Tajiks aren’t necessarily as hostile, but pro-Taliban sentiment is relatively rare among Tajiks, and since the Tajiks are the second-largest group the main leaders of the anti-Taliban coalition in Afghanistan have generally been Tajik.

All of which is to say that waging war against the Taliban means something quite different in the brown-colored Pashto belt than it does in the rainbow of non-Pashto areas. “Beating the Taliban” could mean something very ambitious like helping the central government in Kabul to essentially reconquer the entire Pashto belt. It could also mean something relatively unambitious like trying to build a central government in Kabul that’s strong enough to prevent the Taliban from overrunning major cities and non-Pashto areas without continuing direct American military involvement. I think it’s plausible to imagine accomplishing that second set of goals with one or two years of continued military presence followed by a longer period of financial assistance. The hope would then be that a well-run government in Kabul ought, over time, to be able to expand its control into more and more of the Pashto countryside but we wouldn’t be defining victory as requiring that. The first set of goals, however, sounds like a decade-long commitment to combat in Afghanistan.

Of course you could look at the whole situation with even more nuance and possible outcomes. But the point is that these two things would be quite different wars, and I don’t really know at this point which one the administration is going to propose committing ourselves to.

Since there seems to be some persistent confusion about this, I thought I should just lay it out:

— If there were no constraints whatsoever, I would organize the health care system this way which is more-or-less what they do in Singapore.

— As an equally unrealistic idea, I think the National Health Service model from the UK has a lot going for it.

— Getting less unrealistic, I think a program of Universal Medicare would be excellent.

— In terms of the present-day political debate, I think mandate-regulate-subsidize plus a public option would be a major improvement over the status quo.

— But even though mandate-regulate-subsidize without a public option wouldn’t be as good, I still think it would be an improvement over the status quo.

— I don’t think reform advocates should “drop” the public option; I think they should fight for it and try to bring practical pressure to bear on members of the Senate to vote for one.

— But if in the final standoff we get a choice between mandate-regulate-subsidize and the status quo, I would prefer to take mandate-regulate-subsidize.

I don’t personally think that this set of views makes me a closet Blue Dog or an agent of the for-profit health insurance industry. Readers are, however, free to draw their own conclusions. But I don’t like to see my views mischaracterized.

Undersecretary of State for Public Affairs Judith McHale (official photo)

The administration has some pretty exciting ideas about increasing American assistance to Pakistan and rebalancing much more toward the civilian side of things and away from our traditional reliance on military strongmen as our key friends over there. I think it’s a good idea and on a number of levels it seems to hold a lot of promise. What’s more, the strategic goal strikes me as fairly clear—a legitimate, effective Pakistani state would serve our interests, and the costs involved in even a “big” aid program are pretty low in the scheme of things.

My one doubt about this all is, however, a pretty serious one. By all anecdotal accounts I’ve ever heard from Pakistanis or Pakistani-Americans, the United States is really really hated in Pakistan. And the polling from Pew and others bears that out. Helene Cooper has a good piece about this in The New York Times:

Judith A. McHale was expecting a contentious session with Ansar Abbasi, a Pakistani journalist known for his harsh criticism of American foreign policy, when she sat down for a one-on-one meeting with him in a hotel conference room in Islamabad on Monday. She got that, and a little bit more. [...] “‘You should know that we hate all Americans,’” Ms. McHale said Mr. Abbasi told her. “‘From the bottom of our souls, we hate you.’”

Beyond the continuation of the battle against militants along the Pakistani-Afghan border, a big part of President Obama’s strategy for the region involves trying to broaden America’s involvement in the country to include nonmilitary areas like infrastructure development, trade, energy, schools and jobs — all aimed at convincing the Pakistani people that the United States is their friend. But as Ms. McHale and other American officials discovered this week, during a visit by Richard C. Holbrooke, the special representative to Pakistan and Afghanistan, making that case was not going to be easy.

On the one hand, this could be said to underscore the vital need for a big reboot of US commitment to Pakistan. On the other hand, how effective can anything we try to do to help Pakistan be under situations where people really don’t seem to want our help? It’s also noteworthy that if you look around the countries where we’re most disliked tend to be our “friends” like Pakistan and Egypt while in countries we don’t “help” like Iran we’re see much more positively.