U.S. success internationally is found “by steering those currents in the direction of liberty and justice, so nations thrive by meeting their responsibilities and face consequences when they don’t,” Obama told the cadets, newly commissioned second lieutenants in the U.S. Army. The measure of success is found in that cooperation’s ability to “lessen conflicts around the world.” And in guiding the international order toward it, the approach the U.S. has to take on its own must involve a more equitable distribution of its military and civilian power.

Next week, Obama will release his National Security Strategy, fleshing out the themes here in greater detail and connecting them to the course his foreign policy is already on. Already, much of them have been on display in the Quadrennial Defense Review, Obama’s Oslo speech accepting the Nobel Peace Prize and a recent speech by Jim Jones, his national security adviser.

Some relevant excerpts from the West Point commencement address:

American innovation must be the foundation of American power — because at no time in human history has a nation of diminished economic vitality maintained its military and political primacy. And so that means that the civilians among us, as parents and community leaders, elected officials, business leaders, we have a role to play. We cannot leave it to those in uniform to defend this country — we have to make sure that America is building on its strengths.

As we build these economic sources of our strength, the second thing we must do is build and integrate the capabilities that can advance our interests, and the common interests of human beings around the world. America’s armed forces are adapting to changing times, but your efforts have to be complemented. We will need the renewed engagement of our diplomats, from grand capitals to dangerous outposts. We need development experts who can support Afghan agriculture and help Africans build the capacity to feed themselves. We need intelligence agencies that work seamlessly with their counterparts to unravel plots that run from the mountains of Pakistan to the streets of our cities. We need law enforcement that can strengthen judicial systems abroad, and protect us here at home. And we need first responders who can act swiftly in the event of earthquakes and storms and disease.

The burdens of this century cannot fall on our soldiers alone. It also cannot fall on American shoulders alone. Our adversaries would like to see America sap its strength by overextending our power. And in the past, we’ve always had the foresight to avoid acting alone. We were part of the most powerful wartime coalition in human history through World War II. We stitched together a community of free nations and institutions to endure and ultimately prevail during a Cold War.

Yes, we are clear-eyed about the shortfalls of our international system. But America has not succeeded by stepping out of the currents of cooperation — we have succeeded by steering those currents in the direction of liberty and justice, so nations thrive by meeting their responsibilities and face consequences when they don’t.

There’s also this assertive declaration that American power and American leadership are hardly in decline. Charles Krauthammer of The Washington Post has spent Obama’s presidency hysterically and unconvincingly trying to argue that Obama is a “declinist” in practice, so expect a forthcoming Krauthammer column to explain this away:

We believe, “that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.” And that truth has bound us together, a nation populated by people from around the globe, enduring hardship and achieving greatness as one people. And that belief is as true today as it was 200 years ago. It is a belief that has been claimed by people of every race and religion in every region of the world. Can anybody doubt that this belief will be any less true — any less powerful — two years, two decades, or even two centuries from now?

Republicans began the year in worse shape than they’d been in any time since the 1970s. Conservatives and libertarians, the party’s traditional base, were angry and alienated, swearing that the mistakes of George W. Bush’s failed presidency would never be repeated. By the end of 2009, there had been a massive power shift from the leadership of the movement to its activists, from Washington to places like Watertown, N.Y., and Andrew Breitbart’s Los Angeles basement office.

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Stop back tomorrow for “Ten Conservatives to Watch in 2010.”

Chris Wallace: “Best guess: Will the president end up giving McChrystal the troops he wants, or will he change the war strategy?“

Charles Krauthammer: “I think he doesn‘t and McChrystal resigns.

Krauthammer’s steady criticism of Obama has led to a couple of stumbles like that, but none that have dimmed his influence.

[T]here are no “death panels” in the Democratic health-care bills, and to say that there are is to debase the debate.

With his comments, Krauthammer joins an ever-growing list of conservative commentators and health policy experts who’ve blasted the “death panel” claims as inaccurate, malicious or both.

What the Democrats bill does — and what some Republicans have supported in the past — is to have Medicare pay doctors for late-life decision-making services when patients request such counseling. That means it’s exactly 100 percent voluntary.

Krauthammer doesn’t like the idea, arguing that the effect of the “chats” will be “to gently point the patient” toward choosing death over the expensive treatments that might prolong life for just a few months.

[W]hy get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we’ve nudged you ever so slightly toward letting go.

This is an odd remark, which seems (1) to question the wisdom of the doctors who do this counseling, (2) to toss doctors into the same mythical category of government bureaucrats hell-bent on killing off seniors to save costs, and (3) to doubt the ability of patients to make their own decisions based on the advice they’re given.

Still, Krauthammer, who is a psychiatrist, adds that the proposal is “not an outrage,” and “it’s surely not a death panel.”

It’s safe, at this point, to place those claiming otherwise squarely in the category of folks trying to kill health care reform, rather than debate it.

iStockphoto

Amid the obstructionists’ claims that health care reform is “socialist” or a means of speeding Grandma towards her deathbed, a large focus of the conservative position on health care reform has been that frivolous lawsuits drive up health care costs and require doctors to practice “defensive medicine” that’s costly and wasteful.

In a recent Washington Post op-ed, Charles Krauthammer put “tort reform” on the top of his wish-list for reducing the costs of the health care system. Gov. Rick Perry of Texas in the Washington Examiner boasts that Texas tort reform that capped injured patient’s damages was the answer to his state’s problems. And the American Medical Association has said it won’t support any health reform bill that doesn’t reduce liability for doctors. “If the bill doesn’t have medical liability reform in it, then we don’t see how it is going to be successful in controlling costs,” James Rohack, president-elect of the organization, told Politico in March. “Why spend the political capital and energy in passing a bill if it is not successful?”

Illustration by: Matt Mahurin

So far Republicans have mostly focused on tearing apart any reform with a role for the federal government, portraying it as the government dictating how long old people get to live. But an undercurrent of those complaints is the insistence of doctors, hospitals, insurance companies and ideological conservatives that medical malpractice claims are out of control and a leading cause of rising health care costs.

The health economists and independent legal experts who study the issue, however, don’t believe that’s true. They say that malpractice liability costs are a small fraction of the spiraling costs of the U.S. health care system, and that the medical errors that malpractice liability tries to prevent are themselves a huge cost– both to the injured patients and to the health care system as a whole.

“It’s really just a distraction,” said Tom Baker, a professor at the University of Pennsylvania Law School and author of “The Medical Malpractice Myth.” “If you were to eliminate medical malpractice liability, even forgetting the negative consequences that would have for safety, accountability, and responsiveness, maybe we’d be talking about 1.5 percent of health care costs. So we’re not talking about real money. It’s small relative to the out-of-control cost of health care.”

Insurance costs about $50-$60 billion a year, Baker estimates. As for what’s often called “defensive medicine,” “there’s really no good study that’s been able to put a number on that,” said Baker.

Krauthammer cited a study by the Massachusetts Medical Society that found that five out of six doctors said they ordered additional tests, procedures and referrals to protect themselves from lawsuits. He also relies on a much-criticized study from the libertarian Pacific Research Institute on the civil justice system to conclude that “defensive medicine” wastes more than $200 billion a year.

Baker is skeptical, and makes the point that “defensive medicine” is not the same thing as wasteful medicine. “Like defensive driving, some defensive medicine is good,” he said. “To change behavior. When you drill down those studies, you see that what it means is, doctors are more careful with patient records. They spend more time with the patient. They’re more careful to say hello and goodbye to the patient. That’s good.”

Other health economists agree that “defensive medicine” is not the main driver of costs, and malpractice liability reform is not a panacea.

“If you were to list the top five or ten things that you could do to bring down health care costs that would not be on the list,” said Michelle Mello, a professor of Law and Public Health at Harvard.

Still, that doesn’t mean the medical liability system we now have is a good one. Mello estimates the costs of so-called “defensive medicine” to be far less than Krauthammer does — around $20 billion a year. “So there’s some savings to be had and frankly the health reform package has not come up with a lot of ideas for major savings.”

President Obama at a recent town hall meeting said he wants to reduce doctors’ insurance premiums, but that, based on his conversations with health care experts, “the evidence at least is that that is a very small, maybe not even a measurable factor in the reason that health care costs are going up.”

“He gets it,” said Baker.

Although damage award caps could slightly limit the future growth of liability insurance premiums – about 6 to 13 percent over time, says Mello, “it tends to be oversold as a solution and it’s pretty unfair to patients.”

Annual jury awards and legal settlements involving doctors amounts to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, Amitabh Chandra, another Harvard University economist, recently told Bloomberg News. Chandra estimated the cost of jury awards at about $12 per person in the U.S., or about $3.6 billion. Insurer WellPoint Inc. has also said that liability awards are not what’s driving premiums.

And a 2004 report by the Congressional Budget Office said medical malpractice makes up only 2 percent of U.S. health spending. Even “significant reductions” would do little to curb health-care expenses, it concluded.

A study by Bloomberg also found that the proportion of medical malpractice verdicts among the top jury awards in the U.S. declined over the last 20 years. “Of the top 25 awards so far this year, only one was a malpractice case.” Moreover, at least 30 states now cap damages in medical lawsuits.

The experience of Texas in capping damage awards is a good example. Contrary to Perry’s claims, a recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”

Still, many health policy experts don’t believe the current malpractice liability system is either efficient or fair. Mello and others favor an alternative compensation system that takes the issue away from courts and juries and gives it instead to a panel of independent experts to judge whether malpractice occurred and what compensation should be provided. That’s unlikely to bring about significant cost savings, though, because it would encourage many more claims to be filed. Currently, only about two of every 100 patients injured by malpractice ever receive compensations. “The new system would make it a lot easier to file claims,” said Mello, and would reduce the uncertainty doctors complain about from jury awards.

Such a system implemented at a hospital could mean the hospital pays for malpractice insurance, with premium costs tied to the number of claims. The hospital then has an economic incentive to ensure its doctors are providing good care. Currently, Mello says, most insurance is not “experience-rated”, meaning premiums aren’t tied to the number of claims filed against the doctor.

But Mello, who has advised the Obama administration on malpractice reform, doesn’t expect to see such proposals coming out of Congress or the White House anytime soon. “Trial lawyers don’t embrace proposals that would remove their role in the malpractice system,” she said. And they have a lot of influence with Democrats in Washington.

Ricci’s attorney Karen Torre … appeared on Fox News’ Neil Cavuto with two of the cases other plaintiffs last Friday, but Ricci himself, who declined to comment for this story, was a no-show.

Prior to issuing the statement, Torre told POLITICO that both she and her client felt that print outlets had distorted the facts of the case — though she did not specify which outlets had done so, or when — and that Ricci would not answer questions related to Sotomayor’s nomination.

“We’re not giving interviews regarding anything other than our case, we’re not entertaining questions about anything my client thinks or I think about the nomination,” she said.

This story doesn’t matter quite as much if Torre and Ricci decline Charles Krauthammer’s advice and don’t testify in the Senate hearing against Sotomayor.

You spoke of humanity, Mr. President. Though unto us, in those times, it was human to be inhuman. And now the world has learned, I hope. And of course this hope includes so many of what now would be your vision for the future, Mr. President. A sense of security for Israel, a sense of security for its neighbors, to bring peace in that place. The time must come. It’s enough — enough to go to cemeteries, enough to weep for oceans. It’s enough. There must come a moment — a moment of bringing people together.

Not that either Benjamin Netanyahu or Charles Krauthammer — or these idiots — will pay attention, but it’s still the right sentiment.

President Obama with German Chancellor Angela Merkel and Elie Wiesel at Buchenwald (White House photo)

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Torture of another human being is illegal, unethical and immoral, and I would be duty bound to disobey any such order…

Before deploying to Iraq last year, I explained these things to my troopers. It is difficult to explain to young (practically) kids, with little experience, and poor knowledge of the world…but if you are caring and committed, and repeat yourself often enough they learn and understand. I told them the most important thing they needed to take away from all their preparations was that while it would be terrible to lose one of them or have one of them seriously physically injured, it would be worse to have them come home physically well and mentally broken because they had somehow lost their humanity. Torture destroys our humanity, and any equivocation (feel free to exercise the Kantian absolutist vs utilitarian argument to your heart’s content) on the matter is just bullshit.

If you’ll forgive the harsh language. According to Ricks, Krauthammer, known worldwide as an exemplar of personal courage, hasn’t responded to the letter. (And good for Ricks for going after a columnist for his own newspaper.)

The objective in launching these sorts of parleys with your opponents is two-fold. First, to see if they can be placated, and whether the price of doing so is acceptable. And second, to visibly demonstrate to the broader population that you’ve taken every reasonable step at reaching out to these adversaries — so if they rebuke you and you counterattack, you look like the reasonable party and they look like the rejectionists. It’s generally a sound strategy, and it’s achieved real results.

Am I talking about Iraq? Sure. Afghanistan? I hope so. But the lesson also applies to Barack Obama’s dinner with Bill Kristol, David Brooks, Charles Krauthammer, and George Will.