Republicans argue that an unemployment rate higher than it has been in more than a quarter of a century is evidence that the Democratic agenda isn't putting Americans back to work. They say the situation will be made worse if Congress and President Obama enact a health care overhaul that will require $1 trillion in tax hikes and entitlement cuts to expand insurance coverage.

"Ten-point-two now makes it hard for the majority to sell their agenda," said Rep. Dave Camp of Michigan, the top Republican on the tax-writing Ways and Means Committee.

"All I know is that Speaker Pelosi is trying to force her members to vote for a bill that the American people have soundly rejected," added House Minority Leader John Boehner (R-Ohio).

Democrats counter that their agenda has kick-started a recovery on Wall Street, even if it hasn't trickled down to the job market yet, and that Republicans are putting what they've begun at risk.

Whoever said that achieved the spectacular feat of making Michael Steele look like a master political strategist.

This was premeditated.  This wasn't VBC again.  That guy snapped, not this one.  He was so damn calm when he was shooting.  Methodical.  And he was moving tactically.  The Army really is diverse and we really do love all our own.  We signed up to be shot at but not at home.  Not unarmed.  No one should ever see what the inside of that medical SRP building looked like.  I suppose that's what VA Tech looked like.  Except they didn't have soldiers coming from everywhere to tourniquet and compress and talk to the wounded while rounds are still coming out.

No one touched him...the shooter that is...other than to treat him.  Though I told the medic (and I'm not proud of this) that was giving him plasma that there better not be anyone else who needed it because he should be the last one to be treated.  But I had just finished holding a soldier who was critical (I counted three entry wounds) and talking to him about his children....  If the shooter had a grievance he should have taken it out on those responsible; he wasn't shooting people he knew (media reports to the contrary).  He was just shooting anybody who happened to be present for SRP medical processing, mainly lower enlisted.

But please, no one use this politically!   The Army is not "broken", PTSD doesn't turn people into killers, most Muslims aren't evil, and whether we should stay or go in Afghanistan has nothing to do with this.  I'm babbling...sorry.

This guy was some form of lunatic or psychopath, and it seems pretty clear to me at this point that he was inspired by terrorists.  But there's no evidence that he was a terrorist--that is, that he was hooked into some organized network.  Lots of people do terrible things in the name of their religion--just ask George Tiller.  Their acts are, as the Catholic Church says, "sins that cry out to heaven for vengeance".  But they are no more indictments of a community than the acts of that Korean kid who went crazy at Virginia Tech.

There is absolutely no political lesson to be learned from this.  Gun control would not have stopped a commissioned officer from obtaining guns.  Barack Obama had no power to stop this.   Infectious PTSD is a lousy theory.  And nations certainly do not--and should not--shape their foreign policy around the possibility that a random psychopath will start shooting up a crowd.  Evil people do evil things.  That's all.

Update  whatever else you think of them, CAIR has issued an admirably forthright condemnation:

(WASHINGTON, D.C., 11/5/09) - A prominent national Muslim civil rights and advocacy group tonight condemned an attack on Fort Hood military base in Texas that left at least 12 people dead.

In a statement, the Washington-based Council on American-Islamic Relations (CAIR) said:

"We condemn this cowardly attack in the strongest terms possible and ask that the perpetrators be punished to the full extent of the law. No religious or political ideology could ever justify or excuse such wanton and indiscriminate violence. The attack was particularly heinous in that it targeted the all-volunteer army that protects our nation. American Muslims stand with our fellow citizens in offering both prayers for the victims and sincere condolences to the families of those killed or injured."

Along with innumerable condemnations of terror, CAIR has in the past launched an online anti-terror petition drive called "Not in the Name of Islam," initiated a television public service announcement (PSA) campaign against religious extremism and coordinated a "fatwa," or Islamic religious ruling, against terrorism and extremism.

Worse, even when strong scientific consensus emerges about appropriate protocols and treatments, the health-care industry is extremely slow to implement them. For example, there is little controversy over the best way to treat diabetes; it starts with keeping close track of a patient's blood sugar levels. Yet if you have diabetes, your chances are only one-out-four that your health care system will actually monitor your blood sugar levels or teach you how to do it. According to a recent RAND Corp. study, this oversight causes an estimated 2,600 diabetics to go blind every year, and anther 29,000 to experience kidney failure.

People with diabetes received only 45 percent of the care they needed. For example, fewer than one-quarter of diabetics had their average blood sugar levels measured regularly. Poor control of blood sugar can lead to kidney failure, blindness, and amputation of limbs.

1. The VHA provides better care because it has centralized records (VistA) to coordinate treatment and reduce errors
2. The VHA provides better care because it will care for a patient their entire life, and therefore has incentives to manage diseases rather than mindlessly do procedures
3. The VHA can reduce costs through administrative efficiency, central procurement, integrated care, and salaried doctors

So what's left? Consider why, ultimately, the veterans health system is such an outlier in its commitment to quality. Partly it's because of timely, charismatic leadership. A quasi-military culture may also facilitate acceptance of new technologies and protocols. But there are also other important, underlying factors.

First, unlike virtually all other health-care systems in the United States, VHA has a near lifetime relationship with its patients. Its customers don't jump from one health plan to the next every few years. They start a relationship with the VHA as early as their teens, and it endures. That means that the VHA actually has an incentive to invest in prevention and more effective disease management. When it does so, it isn't just saving money for somebody else. It's maximizing its own resources.

The system's doctors are salaried, which also makes a difference. Most could make more money doing something else, so their commitment to their profession most often derives from a higher-than-usual dose of idealism. Moreover, because they are not profit maximizers, they have no need to be fearful of new technologies or new protocols that keep people well. Nor do they have an incentive to clamor for high-tech devices that don't improve the system's quality or effectiveness of care.

And, because it is a well-defined system, the VHA can act like one. It can systematically attack patient safety issues. It can systematically manage information using standard platforms and interfaces. It can systematically develop and implement evidence-based standards of care. It can systematically discover where its care needs improvement and take corrective measures. In short, it can do what the rest of the health-care sector can't seem to, which is to pursue quality systematically without threatening its own financial viability.

The analysis is theoretically appealing, but there are a couple of problems for it.  First, on the theory side:  it's not clear what incentives the VA has to become more cost efficient. Finding ways to save money in a government bureaucracy is not generally rewarded.  Finding ways to save money usually means you get your budget cut, while cost growth can provide an argument for a bigger appropriation. And when the VA runs out of money, it can reallocate services between priority levels, cutting some of its customers off in order to cover higher priority patients.

Which brings me to the empirics:  the VA does not, in fact, provide lifetime care for its patients practically from kribbe to grav.  The VHA works on Priority Groups, which categorizes who is eligible for what treatments.  Some of the categories are rather fun:

Veterans in priority group 6 served in World War I or the Mexican Border War, are seeking care solely for disorders associated with exposure in the line of duty to chemical, nuclear, or biological agents (including, for example, Agent Orange), have compensable SCDs [Service Connected Disabilities] rated zero percent disabling¹, or are within a five-year period of special eligibility for recent combat veterans.

The footnote goes on to explain that this covers a handful of vets receiving payments for tuberculosis, "special monthly compensation under 38 U.S.C. 1114(k)" or other disabilities.  And here is 38 USC. 1114(k):

if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs, or one foot, or one hand, or both buttocks, or blindness of one eye, having only light perception, has suffered complete organic aphonia with constant inability to communicate by speech, or deafness of both ears, having absence of air and bone conduction, or, in the case of a woman veteran, has suffered the anatomical loss of 25 percent or more of tissue from a single breast or both breasts in combination (including loss by mastectomy or partial mastectomy) or has received radiation treatment of breast tissue, the rate of compensation therefor shall be $89 per month for each such loss or loss of use independent of any other compensation provided in subsections (a) through (j) or subsection (s) of this section but in no event to exceed $3,075 per month; and in the event the veteran has suffered one or more of the disabilities heretofore specified in this subsection, in addition to the requirement for any of the rates specified in subsections (l) through (n) of this section, the rate of compensation shall be increased by $89 per month for each such loss or loss of use, but in no event to exceed $4,313 per month;

Pardon me for a moment while I meditate on the notion that we must have more government involvement in our health care in order to bring some rational, efficient order to our broken system.

But I digress.  The reason I bring all this up is that none of these groups, according to the CBO, gets as much as 50% of its healthcare through the VA:

Advocates have claimed that because VHA is free from concerns about generating profits from medical services and faces at least part of the long-term costs associated with chronic diseases, the agency has an incentive to invest in preventive care, coordination of services, and quality improvement²⁶.  However, data on the way in which veterans use the system make it clear that most enrollees also rely on other sources of care for a significant portion of their health care needs.

Some proponents of the veterans' health system have suggested that VistA has helped the Veterans Health Administration hold down cost growth when compared with other federal health programs, such as Medicare.  But such comparisons are difficult to make.  The substantial changes in the VHA's structure and in eligibility for care make it particularly difficult to interpret usch metrics as cost per enrollee when enrollment was rising dramatically from 1999 through 2002.  In this assessment, the Congressional Budget Office (CBO) adjusted enrollment data to account for changes in the mix of enrollees adn found that VHA's spending per enrollee was relatively flat from 1999 through 2002, but since that date it has risen about as rapidly as spending per enrollee in the Medicare program.

I have a lot of relatives in NY-23. They are all Republicans, and that affiliation has been passed down through the generations (along with Catholic church membership and a tendency to dress like the pictures in the LL Bean catalog).

And few things get them angrier than how the Republican party has been taken over by "the Texans." This is shorthand for the southern-oriented, Protestant-oriented religious right. They hate that crowd more than any Democrat could. Betrayal by your own side always hurts the worst.

Some of them have even started voting for Democrats as a protest. I don't think they like doing it, but it's the only thing they can think of to smack their party back to its senses. And to its historical roots.

So the question for me is, can the Republicans accomodate a northern wing that is middling conservative, but very different in outlook from its southern wing? Or will they abandon that part of the political spectrum to conservative Democrats? Of course, one could ask the same about the Democrats and their conservative wing as well.

This resonates with me, because my mom's from Western New York.  I remember once noting that until I was in college, I hadn't known any Republicans, to which my mother blinked, and replied "You knew your grandparents."

"But I didn't know they were Republicans."

She blinked again.  "Well, we didn't try to hide it from you."

My grandparents were hard core Republicans.  My grandmother still won't let you say mean things about (either) George Bush in her presence.  They lived in a hard core Republican district--I think Wayne County is the reddest in New York State.  But it's not Republican the way that, say, the Florida panhandle is Republican.  If my family had lived in one of the redder areas of the South, I doubt I could have missed it. 

Social conservatism just isn't the main issue there.  Abortion will be legal no matter what happens on the federal level, and a lot of local Republicans are perfectly fine with that.  Evolution will be taught in the schools.  What animates Republicans in the upstate is a deep economic conservatism.  Their social issues are confined to frowning at drug use, excess drinking, and people who won't work to take care of their families.  (And in rural Western New York, there's no question about who can't work, and who won't . . . it is not an anonymous sort of place.)

Rural areas have a farmer's contempt for welfare, and the entire upstate region knows too well that the taxes and regulations imposed by the rich downstate voters are crippling their economy.  No, this is not libertarian cant; it's obvious to basically anyone who spends any time there.  New York has onerous business taxes, a deeply problematic workman's comp system, and various rules about public sector unions that are slowly destroying the budgets of the local cities.  Combine this with a whole lot of cold weather, and there's no way they can attract new businesses to replace the big industrial plants they've lost. 

I mean, it's quite possible that the economy wouldn't regenerate anyway--but it's 100% sure that it won't as long as the state's tax and regulation levels are so bloated.  But the finance industry throws off enough money that the downstate can afford a costly and often inefficient welfare state (1 in 3 New Yorkers are on Medicaid!).  And New York's major industries, which tend to be information based, are less harmed by corporate regulation. Downstate voters are the majority in the state.  So nothing changes, and the upstate slowly strangles.

As long as social issues dominate the Republican Party, they will continue losing their north--I had a lot of relatives who at least considered voting for Obama.  Ironically, I wonder if the tea parties won't help bring the two wings of the Republican party together:  guns and lower government spending are the two things all members can agree on.  But if the south wants to keep its northern Republicans--and the congressional seats that come with them--it's going to have to back off trying to make the northern party look like a miniature version of itself. 

Not least because northern Republicans share one more feature with their southern brethren--they hate people from some distant city telling them what to do. If you find that hard to understand, just picture how y'all feel when the ACLU starts its annual Nativity Scene Hunt through the town squares of Alabama and Mississippi.

I think there are four obvious lessons to draw from tonight's election returns:

1. For Conservative Republicans: The America people reject Barack Obama and obviously want true conservative leadership. The Governorships of two states have switched to the "R" category, showing a grassroots conservative movement that is alive and well.

2. For Moderate Republicans: The American people obviously want old-fashioned economic conservatives who are moderate on social issues. McDonnell in Virginia and Christie in New Jersey won by downplaying social issues; Hoffman in New York-23 lost because he was too extreme.

3. For Moderate Democrats: The party out of power usually does well in off-year elections like this, and this year was no exception. But obviously there is no sign of any substantial shift in public opinion from the election of 2008.

4. For Liberal Democrats: NY-23 was the race to watch this year, given that right-wing extremists like Palin and Beck threw all their support behind Hoffman. But the district voters rejected the right-wing candidate, sending a Democrat to Congress for the first time in one hundred years. Obviously this shows that the American people reject right-wing extremism.

Obviously.