Tom Corbett to PA's Working Poor: "Drop Dead!"

Part 3. What Medicaid Expansion Would Mean to Pennsylvania

On Tuesday, PA Governor Tom Corbett stated that at this time he cannot recommend accepting $38 billion in federal funding to expand Medicaid, thereby denying medical assistance to more than 700,000 Pennsylvanians. This series of posts will consider the implications of that decision. My first post presented evidence that Medicaid improves health and saves lives. The second examined the costs and benefits of Medicaid expansion under the Affordable Care Act (ACA). This time, I'll look at how these costs and benefits apply to Pennsylvania.

I attended a webinar on Corbett's budget sponsored by the Pennsylvania Budget and Policy Center on February 6. Some of the figures in this post come from that discussion. If it becomes available on the web, I will add a reference to it.

First of all, let's look at the 719,000 Pennsylvanians who will be denied coverage. Pennsylvania is one of the least generous states in the country when it comes to providing Medicaid coverage for adults. To qualify for coverage you must make 46% of the federal poverty level or less. For a family of three, that's less than $8781 per year. (You'll recall that children under six are covered up to 133% of the poverty line, and older children up to 100%.) If the governor had agreed to Medicaid expansion, all adults (and children) would have been eligible for Medicaid if they made up to 133% of the poverty level—$25,390 for a family of three.

This is where it gets complicated. Under the ACA, people who make between 100% of the poverty level ($19,090 for a family of three) and 138% are eligible for subsidized health insurance purchased through the federal exchange. (Pennsylvanians will be using the federal exchange because Corbett has refused to implement a state exchange.) This subsidy should, in theory, reduce the cost of private insurance to approximately what they would pay in Medicaid premiums and co-payments. However, this leaves a huge coverage gap for Pennsylvanians making between 46% and 100% of the federal poverty level. They will not be eligible for either Medicaid or subsidized private insurance.

These are the 719,000 adult Pennsylvanians who will be denied health care coverage as a result of Corbett's decision. In effect, Corbett has created a new “doughnut hole” for Pennsylvanians making between 46% and 100% of the poverty level. Most of them fall into the category of the working poor. These are the people who work at Walmart or McDonald's. The graph below illustrates this problem. You can click on it to expand it.

The Kaiser Family Foundation has estimated that Medicaid expansion is worth $37.8 billion in health care coverage for Pennsylvanians to be paid by the federal government between 2014 and 2022. The governor gave as his main reason for refusing the coverage that it will cost Pennsylvania $4.1 billion to implement the program between now and 2022. Most of this is backloaded, when the state is required to cover 5% (in 2017) or 10% (in 2020) of Medicaid costs. This $4.1 billion figure is contested. Kaiser puts it at $2.8 billion. The governor has not realeased any data to show how he arrived at his figure. However, even if it turns out to be accurate, the governor is turning down $38 billion in order to save $4 billion.

Furthermore, this neglects other costs to Pennsylvania if it rejects Medicaid expansion. For example, it is estimated that, if Medicaid is not expanded, Pennsylvania hospitals will be faced with $1 billion per year in uncompensated costs for the care of uninsured people. Some of these costs are shifted to people with insurance through higher premiums, or are paid for by state and local taxes.

In Governor Corbett's letter to Health and Human Services Secretary Kathleen Sibelius, he gives two other reasons for rejecting Medicaid expansion in addition to the alleged $4.1 billion cost.

He refers to the current Medicare as a “broken system” plagued by waste and fraud, and states that it makes no sense to expand such a system. He claims that in 2009, $43 billion “could not be traced directly back to Medicaid beneficiaries.” He does not cite a source and I'm unable to evaluate this claim.

He also calls for granting states greater flexibility “to successfully reform and build a system that works for them.” He calls for aligning benefits “to meet individual needs and closer (sic) resemble coverage provided by employers.” He calls for a Medicaid program that “promotes personal responsibility” and provides “appropriate incentives for participants to seek and retain employment.” This is vague, but bear in mind that Pennsylvania is already one of the country's stingiest Medicaid states. It appears that Corbett wants the flexibility to reduce coverage below the amounts specified in the ACA, or to place some time limit on Medicaid enrollment.

Next time, I'll speculate a bit about the politics of Medicaid expansion in Pennsylvania, and what health care activists can (and cannot) do to persuade the governor to change his mind.

You may also be interested in reading:

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 1)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 2)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 4)

His Master's Voice

The banner headline in yesterday's Pittsburgh Post-Gazette proclaims, “County, Consol strike $500M gas drilling deal.” Allegheny County Executive Rich Fitzgerald announced the terms of a contract that will allow Consol Energy to frack on county land—the 9,236 acres surrounding Pittsburgh International Airport. The $500 million figure is pure speculation. The county gets $50 million up front, but whether we get the remaining $450 million depends on how much gas is found and the future price of natural gas. But buried deep into this story is the most interesting part—when and where Fitzgerald chose to make this announcement: At a public hearing on proposed legislation to allow fracking at the Pittsburgh Airport. Fitzgerald's statement no doubt was a surprise to most of the overflow crowd of 300 citizens attending the meeting, especially to the 77 who registered to speak. It was particularly shocking to members of Marcellus Protest, a local anti-fracking group that showed up in force for the meeting. Guess what, citizens? Nobody cares what you have to say.

The article reminded me of an experiment.  Unfortunately, I've previously written about it, but it's particularly a propos here. Let me explain.

Social psychologists study two types of justice norms. Distributive justice refers to the fair allocation of social outcomes (rewards and punishments). Procedural justice refers to the fairness of the processes for arriving at those outcomes. For example, in a classroom, the distributive justice question is whether the grades fair. Procedural justice refers to questions like whether the tests are relevant to the course, or whether the teacher is free of bias. Even a good decision doesn't feel right if it was not arrived at by fair procedures.

One variable that influences people's procedural justice judgements is voice—the opportunity to express yourself or present your views. People who have some input into the decision process are more satisfied with a decision than others in the same circumstances who are not given a voice. This is especially true when the outcome goes against their self-interest. But this raises the possibility that authorities will attempt to manipulate citizens' satisfaction with a decision by trying to convince them that they have more influence than they actually do.

 All rights reserved by BBurnie82

How often have you heard this scenario? The county (or city, or state, or federal) government is about to make an important decision affecting all of our lives. But before they decide, they will travel around and hold several public hearings on the issue. Citizens who have an opinion on the question are invited to attend one of the meetings and present their views. The question of course is this: Are the decision-makers really listening to your views, or have they already made up their minds, and are they simply going through the motions of soliciting public input? Maybe public hearings are just another way of “cooling the mark out.” The right to be heard is, after all, not the right to be heeded.

Social psychologists Allan Lind and Tom Tyler have found that voice makes a difference in satisfaction even when it's objectively unlikely that the speakers will have much influence on the decision. To test the limits of this “voice effect,” Lind, Kanfer and Earley did a study in 1990 in which student participants were allowed to present evidence to a decision maker. For some of them, their presentation was delivered before authorities had decided what to do—the usual situation. But other participants were told that the decision had already been made, and then invited to present their views. A third group was given no voice. The results showed that people who got to speak before the decision were more satisfied than those who didn't speak until after the decision. But even under the absurd circumstance of presenting evidence after it was too late, participants with voice were more satisfied with the decision than those who were not given an opportunity to express their views. The authors had speculated that there might be a frustration effect leading to more dissatisfaction with the decision in the after condition, but there was not.

Before this study, the accepted explanation for the voice effect was that people optimistically believed they might persuade decision makers to accept their point of view. The Lind study suggests that people also value voice for self-expressive reasons. Maybe getting to present your views is an indication that you are respected by the community, although you might think that self-respect would be reduced by the knowledge that the intended audience is not paying any attention. Are people really that easily fooled by manipulations of voice? Maybe all authorities have to do is pretend to listen to our views and we are more satisfied with their decisions.

Even a casual newspaper reader can't help but notice that the timing of this announcement was a rude and arrogant gesture on Fitzgerald's part. His statement was followed by pro-fracking speeches by three Consol executives and a parade of elected officials. I'm told that those people who came to present the case against fracking were furious. To their credit, they resisted the impulse to fling feces at Fitzgerald. Even though it took more than an hour before the first citizen got to speak, they politely played their part in this theatre of the absurd, delivering their prepared speeches even though it was futile. This can be partially justified by the fact that the county council has not yet ratified the decision, although approval is almost certain.

I don't mean to imply that the members of Marcellus Protest were ever naïve enough to think they could convince the county not to drill on airport land. I also don't mean to suggest that they are in any way “satisfied” with the decision. These are well-informed, committed activists, whose views are not going to be turned around by one incident. They are more likely to show a frustration effect than Lind's participants. In fact, I'd be surprised if this experience doesn't have some effect on their cynicism about government and their willingness to participate in future public hearings.

Judging from my email box, the Pittsburgh area is awash in public hearings. Does all of this activity translate into more democratic decision-making? One way of looking Thursday's events is that Rich Fitzgerald let his side down—his side being his fellow politicians. He has laid bare their guilty secret for everyone to see. Public hearings are a sham. They are just a way of keeping the suckers occupied, while the real decisions are made behind closed doors.

Tom Corbett to PA's Working Poor: "Drop Dead!"

Part 2. Medicaid Expansion is a Huge Bargain for the States

On Tuesday, PA Governor Tom Corbett stated that at this time he cannot recommend accepting $38 billion in federal funding to expand Medicaid under the Affordable Care Act, thereby denying medical assistance to more than 700,000 Pennsylvanians. This series of posts will consider the implications of that decision. Yesterday, I wrote about the evidence that Medicaid is effective in improving health and saving lives. Today, I will look at Medicaid's costs.

I have previously discussed the circumstances which caused Medicaid expansion to become a political issue. To summarize: Medicaid expansion is a critical part of the Affordable Care Act (ACA). Of the approximately 30 million people who were scheduled to be insured for the first time under the ACA, fully half of them—the poorest half—were going to be insured through Medicaid expansion.

Traditional Medicaid is jointly administered by the state and federal governments. Federal law requires that all children be covered if their family makes less than the federal poverty level. Children under six are covered up to 133% of the poverty line. The eligibility rules for adults are determined by the states. In most states, adults without children don't qualify for Medicaid no matter how poor they are. The income level at which parents with dependent children qualify for Medicaid varies from state to state. In the least generous states, parents only qualify if they make less than 40% of the federal poverty level—$4850 a year for two parents with a single child. The most generous states cover all adults making up to 133% of the poverty level. But on the whole, Medicaid is not much of a safety net for the poor. Right now the federal government pays on average 57% of the cost of traditional Medicaid—between 50% and 75% depending on state eligibility rules.

The ACA expands Medicaid by making everyone—children and adults—eligible for Medicaid if their family income is 138% of the poverty level or less. This is expensive, so the Feds agreed to pay most of the cost. In 2014, they will pay 100%. This drops to 95% in 2017, and 90% in 2020. States whose current Medicaid eligibility rules are relatively stingy stand to gain more money per capita from Medicaid expansion than states whose current eligibility rules are more generous.

The ACA required states to implement the Medicaid expansion. If they refused, the federal government threatened to withhold its contribution to traditional Medicare. The Supreme Court, in National Federation of Independent Business v. Sebelius, ruled that this was coercive, and that states may opt out of Medicaid expansion. The numbers change every day, but as of this writing 21 states have announced that they will expand Medicaid, 11 states have decided not to, and 18 are undecided. To the extent that states refuse to expand Medicaid, they will frustrate the intent of the ACA and deny medical care to many Americans who need it most.

How expensive is Medicaid? The average annual cost of Medicaid expansion for adults is $6000 per year, although the ACA hopes to implement some cost savings. Recall that the Sommers, et al study I referred to yesterday estimated that one life is saved per year for every 176 people added to the Medicaid rolls. From this we can calculate that the average cost per life saved is 176 x $6000, or slightly over $1 million. This sounds like a lot, but is actually well below what society is ordinarily willing to pay to save a life.

Most health care policy experts point out that Medicaid expansion is a huge financial windfall for the states, and that the logic of expanding Medicaid should be strong enough to overcome any resistance due to ideology. The states that do not expand Medicaid will be turning down “free money.” They will have to explain to their citizens why they can't have health care that is fully paid for by the federal government. The citizens of those states will be paying to expand Medicaid anyway through their federal taxes, their money will go to the states that have accepted the deal.

Uninsured citizens in the non-expanding states will continue to show up at hospital emergency rooms. Their care will be paid for through cost shifting. Costs are shifted in three ways.

1. Some of the cost is paid by those who have health insurance. Their premiums are higher to cover the cost of treating people without health insurance.
2. Part of the cost is paid by federal, state and local taxes, which provide emergency health care for the poor. The Urban Institute estimated that in 2008, state and local governments spent $10.6 billion providing emergency care for the uninsured. But beginning in 2014, the federal government will no longer subsidize emergency care, so the burden will fall even more heavily on state and local government. If they expand Medicare, state and local governments will have to spend very little on emergency care. This cost savings alone could be greater than the cost to states even when they are paying 10% of the cost of Medicaid expansion.
3. Finally, part of the cost is shifted to hospitals through what is called “forced charity”—uncompensated medical care for the uninsured.

Whatever Medicaid costs the federal government—and our best estimate is $6000 per recipient—this money will be added to the economies of the accepting states. Initially, it will go primarily to doctors, hospitals, pharmaceutical companies and other health care providers. Doctors and hospitals have already agreed to reduce their reimbursement rates under the ACA, in anticipation of having many more customers due to Medicaid expansion. They are also not happy about forced charity. They can be expected to lobby heavily for Medicaid expansion.

These advantages must be balanced against the costs to the states of Medicaid expansion.

1. The 5% (in 2017) to 10% (2020 and thereafter) of the cost of Medicaid expansion is not exactly pocket change. Some states also claim to be worried that the Feds will play a “bait and switch” game on them and increase their financial obligation in the future.
2. States also claim to be worried about the “woodwork effect.” Many Americans who are eligible for Medicaid in their state don't apply for it. However, the publicity surrounding the ACA and the threat of a fine for violating the individual mandate may persuade more eligible people to sign up. The states will then be responsible for whatever part of the cost they would have had to cover under traditional Medicare. However, the woodwork effect will occur anyway, even if the states do not expand Medicaid.

Health care experts such as Aaron Carroll and Austin Frakt argue that, leaving all humane considerations aside, it's in the overwhelming financial interest of states to implement Medicaid expansion. In the next part, I'll look at how these financial contigencies affect Pennsylvania and attempt to evaluate Governor Corbett's stated rationale for refusing Medicaid expansion.

You may also be interested in reading:

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 1)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 3)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 4)

On Queue

As I've previously written, one of the most effective ways to suppress voter turnout is to create long waiting lines at the polling place so that many potential voters will leave in frustration. This method has long been used to discourage voting in minority areas and around college campuses. It can be done by not having enough polling places or voting machines in heavily populated areas, or by creating procedural delays, such as requiring I.D. checks, but not having enough poll workers to carry out these operations efficiently.

This method of voter suppression is insidous for a couple of reasons. First, unlike other voter suppression efforts, it leaves no traces. There is no way to accurately count the number of discouraged voters. Secondly, the public often blames the victim and argues that if discouraged voters had only been more patient, there would have been no problem. Needless to say, this ignores the fact that many people have other obligations, such as work and child care, and cannot afford to spend hours in line at the polling place.

This problem is finally receiving some of the attention it deserves. The New York Times reports the results of a survey by political scientist Charles Stewart showing that blacks and Hispanics wait longer in line than whites. The survey was conducted over the internet by YouGov/Polimetrix. They contacted 10,200 people, 200 from each state and the District of Columbia, for a survey on “the quality of the voting experience.” The average self-reported wait time was 14 minutes. Here are the differences by race:

Race	Waiting time
White	12.7 minutes
Hispanic	20.2 minutes
Black	20.2 minutes

They also found significant differences by size of county, with people from larger counties—that is, urban areas—waiting longer. There were large differences by state, with Vermont having the shortest average wait time (2 minutes) and Florida the longest (45 minutes).

Is this a representative sample? YouGov/Polimetrix is a polling organization that is increasingly popular with social scientists. They provide opt-in internet survey panels. People volunteer to participate in internet surveys. They are notified by email when their participation is requested. For each completed survey, they receive points exchangeable for prizes such as movie tickets and gift cards. A recent study suggests that their results are as valid as more expensive telephone surveys, primarily because of recent declines in public willingness to participate in telephone surveys. While you might think that their volunteers would be higher in political interest than the average person, YouGov/Polimetrix actively recruits low interest respondents and can statistically weight its results to correct for this and other types of unrepresentativeness.

Another response to this survey might be, “They are lying.” That is, critics might speculate that African- and Hispanic-Americans deliberately exaggerate their wait times in order to claim the status of victims of discrimination. I doubt whether the wait time issue is sufficiently politicized to produce this type of bias, but if it is, you could claim that whites might also exaggerate their wait times in order to deny that they are beneficiaries of discrimination.

The Stewart study focuses attention of Florida, whose average wait time was 11 minutes longer than the second worst location, D. C. The Orlando Sentinal recently commissioned an engineering professor, Ted Allen, to estimate the number of Floridians who left without voting on Election Day, 2012. Dr. Allen has developed a mathematical model which predicts turnout suppression from parameters such as number of registered voters, number of voting machines, ballot length, etc. It was originally developed to measure voter suppression near the Ohio State campus in 2004. Although the model is too mathematically complex for me to understand, it is published in peer-reviewed journals.

One of Allen's more important discoveries is that you can predict turnout suppression from the number of hours the polls have to stay open after closing time. For each additional hour the polls stay open, turnout is suppressed by about 4.8%. This allows you to estimate the number of discouraged voters in each precinct. If you then assume that the discouraged voters would have voted for the candidates in the same proportion as those who actually voted at that location, you can estimate the number of votes lost by each candidate.

Based on the sample of precincts he analyzed, Allen estimated that 201,000 Floridians left in frustration on Election Day, which is 2.3% of the number of votes cast. He predicts that 108,000 of these votes would have gone to Obama and 93,000 to Romney, so Obama's margin of victory would have been 15,000 votes greater had these people voted. Obama carried the state by 74,309 votes.

There are many remedies for long waiting lines, including making Election Day a holiday, expanding early voting times, and ensuring that the number of polling places is proportional to the population. It is outrageous that, in many states, one party controls voting procedures and manipulates them to serve their interests. There is speculation that President Obama will call for voting reform in the State of the Union address. However, as long as Republicans continue to benefit from voter suppression, it is unlikely that reform legislation will get through our gridlocked Congress.

Tom Corbett to PA's Working Poor: "Drop Dead!"

Part 1. Medicaid Improves Health and Saves Lives

On Tuesday, PA Governor Tom Corbett stated that at this time he cannot recommend accepting $38 billion in federal funding to expand Medicaid under the Affordable Care Act, thereby denying medical assistance to more than 700,000 Pennsylvanians. This series of posts will consider the implications of that decision.

It is difficult to arrange a definitive test of whether a social policy such as Medicaid is effective in achieving its goal of better health. In order to demonstrate causality, you must run an experiment with a randomized control group design, in which some people are randomly assigned to receive Medicaid (the experimental group), while others are randomly assigned to not receive it (the control group). Random assignment is critical. You can't compare Medicaid recipients to all non-recipients because to be eligible for Medicaid, you must be poor, and poor people have worse health outcomes. Since Medicaid is voluntary, you can't compare people who sign up and receive Medicaid to other eligible people who don't sign up, because people seek out health insurance when they are ill. While these flaws may seem obvious, you should be careful. Opponents of government health insurance will sometimes cite these flawed comparisons to convince people that Medicaid is counterproductive.

Assuming that a randomized control group design is not possible, there are two general ways to evaluate a social reform such as Medicaid expansion. In a time series design, you measure the outcomes of a group of people from before to after the change is implemented. The main problem with this design is that other events may occur at the same time as the reform, and they may serve as alternative explanations for the results. In a comparison group design, you compare the outcomes of a group of people who receive the treatment to a comparison group that does not receive it. Outcomes are measured at the same time. The problem with this design is that the two groups may not have been equivalent at the beginning of the study. Any irrelevant difference between the two groups can be an alternative explanation for the results. It is possible to combine the good features of both these designs in a time series design with a comparison group. However, it is still possible that some outside event that coincides with the treatment is affecting one group more than the other.

 All rights reserved by forwardstl

I will discuss two studies, both published in 2012, that evaluate Medicaid outcomes. Since these two studies are superior to any that have gone before, previous studies are basically irrelevant. A study by Benjamin Sommers and others, published in the New England Journal of Medicine, utilized a time series design with comparison groups. One of its strengths is that it used three experimental groups and four comparison groups. In 2001 and 2002, three states, New York, Maine and Arizona, substantially expanded Medicaid by relaxing their eligibility requirements. For example, in New York, you could previously apply for Medicaid if you were below the federal poverty level. In 2001, people were allowed to sign up if their income was at or below 150% of the poverty level. For each of these states, they selected geographically close and demographically similar comparison states that did not expand Medicaid access. New York's comparison state was Pennsylvania, Maine's was New Hampshire, and Arizona's were Nevada and New Mexico. Since they were interested in whether Medicaid saved lives, the primary outcome measure was the mortality rate, which in this country is reported at the county level. All the outcomes were measured from five years before the change until five years after.

The results showed that prior to Medicaid expansion, there were no significant differences in mortality between the expansion and comparison states. After they implemented the expansion, these states showed a 6.1% reduction in mortality relative to the comparison states. Additional analyses showed that, as you might expect, the decline in mortality was greatest among the poor, minorities and older adults. Survey data showed that Medicaid expansion was associated with a 24.7% increase in Medicaid coverage, a 21.3% decrease in the rate of delayed care due to cost, and a 3.4% increase in number of people saying their health was “excellent” or “very good.” The authors calculated that one life per year was saved for every 176 adults that were added to the Medicaid rolls.

As impressive as these results are, they do not prove that Medicaid caused these health improvements.  A critic might argue that these three states—especially New York, which showed the greatest drop in the death rate—are not typical of the rest of the country, and thus the study exaggerates the benefits of Medicaid. Fortunately, circumstances have given us a randomized control group design with which to evaluate the effects of Medicaid. This is the “gold standard” for social policy research. In 2008, Oregon attempted to expand its Medicaid program, but didn't have enough money. They invited people who were eligible to apply. Ninety thousand people applied, and 10,000 of them were randomly selected to receive Medicaid in a lottery. Amy Finkelstein and her colleagues are conducting an ongoing survey comparing the lucky winners to those who applied but were turned away. They reported some preliminary results last year.

The main finding is that the Medicaid group is 25% more likely than the control group to report themselves in “good” or “excellent” health, as opposed to “fair” or “poor” health. More importantly, 40% fewer people in the experimental group reported a decline in their health over the last six months. (The reason this difference is so much greater than in the Sommers study is that Finkelstein only compared Medicaid recipients to those who were turned away, while Sommers' data estimated the health of everyone in these states regardless of whether they were enrolled in Medicaid.) As you would expect, the Medicaid group reported more doctor and hospital visits, more preventive care, and fewer unpaid medical bills.

The number of people in the Oregon study is too small to detect meaningful differences in mortality. Nevertheless, the two studies converge to give us the best evidence we have ever had that Medicaid improves its recipients' health and saves some of their lives. In the next post in this series, I will look at cost considerations.

You may also be interested in reading:

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 2)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 3)

Tom Corbett to PA's Working Poor:  "Drop Dead!" (Part 4)

The Pain of Paying

This is an easy post.  I'd like to call your attention to an interesting video by social psychologist Dan Ariely about "the pain of paying."  The pain is greater when you must pay cash, and when you pay at the time of consumption.  It can influence your decisions about what to buy and your enjoyment of the product.

What's the most socially significant innovation intended to reduce the pain of paying?  I nominate the credit card.

Why This? Why Now?

At the top of the front page of this morning's Pittsburgh Post-Gazette is a reprint of a Washington Post article by Craig Whitlock (“Missteps by U. S. in Africa revealed”) reporting that in 2003, the U. S. had an opportunity to assassinate Mokhtar Belmokhtar, alleged mastermind of last month's attack on an Algerian natural gas facility in which 38 hostages were killed. The attack was “vetoed” by the U. S. ambassador to Mali, Vicki Huddleston.

“I'm really frustrated right now because I think we blew it,” said retired Air Force General Charles Wald, exhibiting perfect 20/20 hindsight. If you read far enough into the article, you find that Ms. Huddleston gave three reasons for blocking the proposed air strike: (1) Belmokhtar had never attacked Americans; (2) ten years ago, he was considered only a “minor figure;” and (3) it was “unclear” whether he was actually in the proposed target area. I'm not a terrorism expert, but those sound like three very good reasons not to bomb somebody. The article, however, presents this as a huge blunder by Ms. Huddleston.

The first thing to note about this article is that it is unlikely to have resulted from an independent investigation by the Post reporter. It is there because somebody leaked it. The Pentagon is proposing to expand American strikes into Africa by unmanned aircraft (drones). The article implies that our only mistake is not doing targeted assassinations of Africans soon enough. This story is a public relations triumph for the Pentagon under any circumstances, but it appears in the context of several recent developments related to American military policy.

• A memo giving a “legal defense” of the American policy of assassinating U.S. citizens suspected of terrorism has been leaked to NBC reporter Michael Isikoff. The defense can be charitably described as inadequate, and raises more questions than it answers. Here is Rachel Maddow interviewing Isikoff. It is well worth watching.
  
  
  
  
• President Obama has claimed the right to unilaterally engage in acts of cyberwarfare (computer sabotage) against American enemies, including the right to carry out preemptive cyberstrikes.
  
  
• The Senate will hold a confirmation hearing Thursday on the President's appointment of John Brennan to head the CIA. Brennan is strongly identified with support for drone strikes against enemy targets. He will almost certainly be questioned about the policy—but probably not very aggressively.

This Just In . . .

The British government has just awarded a $31 million contract to Prox Dynamics of Norway for development of a nano-drone, to be used for surveillance in Afghanistan. The miniature helicopter is four inches long and weighs 16 grams. It is part of a trend toward ever smaller drones.

Use of a nano-drone for surveillance is outrageous enough, but equipping them with powerful nano-bombs is said to be only months away. How long will it be possible to keep these devices out of the hands of private citizens? Will a future U. S. president be assassinated by a nano-drone?