29 September 2009
Are the French Happier?
The fault of Brian Domitrovic’s argument in his op-ed article in the September 29, 2009, Wall Street Journal is his reliance on a relatively easily quantifiable gauge like GDP per capita for measuring economic performance. France’s President Sarkozy would surely not question the statement that the U.S. has experienced 50% higher GDP per capital growth than has France over the last 25 years. But he and Nobel prize winner Joseph Stiglitz, who led the commission that recommended changing how economic performance is measured, would strongly disagree that government policy should be straitjacketed by adherence to such a narrow definition of human progress.
Redefining economic performance doesn’t move the goal posts during a football game. Rather it enlarges the contest into an Olympics of the common good.
The fault of Brian Domitrovic’s argument in his op-ed article in the September 29, 2009, Wall Street Journal is his reliance on a relatively easily quantifiable gauge like GDP per capita for measuring economic performance. France’s President Sarkozy would surely not question the statement that the U.S. has experienced 50% higher GDP per capital growth than has France over the last 25 years. But he and Nobel prize winner Joseph Stiglitz, who led the commission that recommended changing how economic performance is measured, would strongly disagree that government policy should be straitjacketed by adherence to such a narrow definition of human progress.
Redefining economic performance doesn’t move the goal posts during a football game. Rather it enlarges the contest into an Olympics of the common good.
27 September 2009
Alternative to the Iran Attack Plan
By pointing out the ineffectiveness of military actions to alter the nuclear ambitions of the Iranian regime, Anthony H. Cordesman makes a good case in his article on “The Iran Attack Plan” in the September 26-27, Wall Street Journal, for an intense program of economic and even “quality of life” sanctions on Iran. If military actions will not assure that the governing regime in Iran respects international rules of behavior for political states, then the only best solution is to foment domestic revolt. The people of Iran are so inured to oppressive rule by dynastic or religious regimes that they will not easily be convinced of their power to overthrow an order that is harmful to the interests of the world at large and ultimately to their own well being.
A strategy of severe blockade of commercial and humanitarian products and services will have no more devastating an effect on living conditions in Iran than a military attack. Its advantage will be limiting the human cost for the sanctioning powers to those caused by defense against retaliatory actions attempted by the Iranian regime. For this policy to work in Iran, however, it will be necessary to undertake a determined public information program to teach their incipient leaders (a) their responsibility for the good behavior of their government and (b) the most effective methods of non-violent revolution.
This strategy is not likely to be tremendously less expensive than military attack, and it will probably take much more time to achieve regime change. However, it will win wide international support, make fewer human life demands on the sanctioning powers, and leave in its wake an Iran that may forever be governed in accordance with the informed will of its people.
By pointing out the ineffectiveness of military actions to alter the nuclear ambitions of the Iranian regime, Anthony H. Cordesman makes a good case in his article on “The Iran Attack Plan” in the September 26-27, Wall Street Journal, for an intense program of economic and even “quality of life” sanctions on Iran. If military actions will not assure that the governing regime in Iran respects international rules of behavior for political states, then the only best solution is to foment domestic revolt. The people of Iran are so inured to oppressive rule by dynastic or religious regimes that they will not easily be convinced of their power to overthrow an order that is harmful to the interests of the world at large and ultimately to their own well being.
A strategy of severe blockade of commercial and humanitarian products and services will have no more devastating an effect on living conditions in Iran than a military attack. Its advantage will be limiting the human cost for the sanctioning powers to those caused by defense against retaliatory actions attempted by the Iranian regime. For this policy to work in Iran, however, it will be necessary to undertake a determined public information program to teach their incipient leaders (a) their responsibility for the good behavior of their government and (b) the most effective methods of non-violent revolution.
This strategy is not likely to be tremendously less expensive than military attack, and it will probably take much more time to achieve regime change. However, it will win wide international support, make fewer human life demands on the sanctioning powers, and leave in its wake an Iran that may forever be governed in accordance with the informed will of its people.
23 September 2009
Befuddling Afghanistan
President Obama is no more befuddled by the disorder in Afghanistan than is Leslie H. Gelb in his op-ed article in the September 22, 2009 Wall Street Journal. They both take it for granted that using military force defines a war. It takes two states, or at least potential states, to fight a war. What is being fought in Afghanistan is not another state, but a condition of disorder in a land where there is no order to defend.
This war is not a counterinsurgency either. To be one, order must be under attack by a rebellious force. However, Afghanistan has never had much order; its most orderly period may have been when it was ruled by the Taliban. It revels in its exceptionalism—in fact, the people who settled the country’s semi-autonomous regions despise order. Their primary motivation has always only been basic survival and simple flourishment, surrounded by a redoubtably unfriendly terrain.
This is what made Afghanistan a perfect host for Al Qaeda. In today’s technologically flattened world, uncontrolled non-state outlaws have become more dangerous to ordered societies like the U.S. than conventional political regimes. That makes it necessary to define the NATO intervention in Afghanistan as a police action and not a “war.”
Two elements of Mr. Gelb’s strategy will nevertheless help accomplish that objective:
(1) Bribing dissatisfied factions within the Taliban to split away from terrorist sympathizers may help develop an appetite for order in the Afghan national character.
(2) Setting up deterrence capabilities, including diligent surveillance of predators, will be more sustainable for NATO than maintaining an armed force there that only invites violent attacks.
No one has ever succeeded in convincing Afghans that they need a “savior.” Nor will “major help” to the Afghan government ever be a substitute for intervention when it is needed to prevent dangerous operations by opportunistic terrorists. The Obama administration and the U.S. won’t avoid defeat in Afghanistan unless they make a clear definition of what the strategy is. Winning a war should not be the goal. Controlling the no-man’s land there is about the best that can be done. From now on, the U.S. might as well face the fact that in Afghanistan, it may always have to do that.
President Obama is no more befuddled by the disorder in Afghanistan than is Leslie H. Gelb in his op-ed article in the September 22, 2009 Wall Street Journal. They both take it for granted that using military force defines a war. It takes two states, or at least potential states, to fight a war. What is being fought in Afghanistan is not another state, but a condition of disorder in a land where there is no order to defend.
This war is not a counterinsurgency either. To be one, order must be under attack by a rebellious force. However, Afghanistan has never had much order; its most orderly period may have been when it was ruled by the Taliban. It revels in its exceptionalism—in fact, the people who settled the country’s semi-autonomous regions despise order. Their primary motivation has always only been basic survival and simple flourishment, surrounded by a redoubtably unfriendly terrain.
This is what made Afghanistan a perfect host for Al Qaeda. In today’s technologically flattened world, uncontrolled non-state outlaws have become more dangerous to ordered societies like the U.S. than conventional political regimes. That makes it necessary to define the NATO intervention in Afghanistan as a police action and not a “war.”
Two elements of Mr. Gelb’s strategy will nevertheless help accomplish that objective:
(1) Bribing dissatisfied factions within the Taliban to split away from terrorist sympathizers may help develop an appetite for order in the Afghan national character.
(2) Setting up deterrence capabilities, including diligent surveillance of predators, will be more sustainable for NATO than maintaining an armed force there that only invites violent attacks.
No one has ever succeeded in convincing Afghans that they need a “savior.” Nor will “major help” to the Afghan government ever be a substitute for intervention when it is needed to prevent dangerous operations by opportunistic terrorists. The Obama administration and the U.S. won’t avoid defeat in Afghanistan unless they make a clear definition of what the strategy is. Winning a war should not be the goal. Controlling the no-man’s land there is about the best that can be done. From now on, the U.S. might as well face the fact that in Afghanistan, it may always have to do that.
22 September 2009
Heaven Was a Cheap Destination
A sensible approach to resolving America’s health care expense crisis is to promote primary care by reordering the incentives in the health care system in favor of keeping patients well rather than treat their acute and catastrophic illnesses. In order to incentivize health instead of disease care, patients need to be incentivized to lead long lives.
How can this be done? It’s not enough to identify the problem; solutions must be found. Those solutions have to motivate patients to put as high a value on regular fitness maintenance as on contending with interruptions in their physical well-being. Even if patients can be convinced of the effectiveness of that strategy for prolonging life, they will still have to decide that prolonging life is a rational goal.
There are two determinants of that decision:
(1) A long life has to be attractive to the patient, with enjoyable and stimulating activities, and
(2) The cost of living long must be affordable, so it is not a burden on subsequent generations.
Heaven was invented to answer these needs in the past. Now that medical technology has made it possible for individuals to outlive their economic self-sufficiency, we have to pay for heaven on earth.
A sensible approach to resolving America’s health care expense crisis is to promote primary care by reordering the incentives in the health care system in favor of keeping patients well rather than treat their acute and catastrophic illnesses. In order to incentivize health instead of disease care, patients need to be incentivized to lead long lives.
How can this be done? It’s not enough to identify the problem; solutions must be found. Those solutions have to motivate patients to put as high a value on regular fitness maintenance as on contending with interruptions in their physical well-being. Even if patients can be convinced of the effectiveness of that strategy for prolonging life, they will still have to decide that prolonging life is a rational goal.
There are two determinants of that decision:
(1) A long life has to be attractive to the patient, with enjoyable and stimulating activities, and
(2) The cost of living long must be affordable, so it is not a burden on subsequent generations.
Heaven was invented to answer these needs in the past. Now that medical technology has made it possible for individuals to outlive their economic self-sufficiency, we have to pay for heaven on earth.
09 September 2009
Your Health is Everything
My Dad has always said, “Your health is everything.” Apparently, Martin Feldstein has a different idea. In his op-ed article in the September 8, 2009 Wall Street Journal, “ObamaCare’s Crippling Deficits,” he advocates abandoning health care reform in order to save the dollar from inflation and devaluation.
A healthy American economy is not possible if it is built on a largely unhealthy citizenry. The taxes that President Obama suggests will pay for universal health insurance will never be imposed for (dare I say it) less compelling reasons like reducing other projected federal budget deficits. Moreover, a healthier America will be more competitive in world markets and reap richer rewards.
Making health care affordable for everyone will require not only government subsidies but also improvement of its cost-effectiveness by emphasizing and incentivizing general practitioners, as well as by controlling the impact of medical liability suits. The high cost of reforming health care should be understood as an investment in our society’s future. We can pay for it with increased levies on high-income individuals and corporate foreign profits, or with the higher insurance premiums that now cover our inefficient health care system. Both sources are taxes in essence; but if properly structured to transform the behavior of consumers and providers, the former may actually result in reducing the expense of sustaining the nation’s physical well-being.
My Dad has always said, “Your health is everything.” Apparently, Martin Feldstein has a different idea. In his op-ed article in the September 8, 2009 Wall Street Journal, “ObamaCare’s Crippling Deficits,” he advocates abandoning health care reform in order to save the dollar from inflation and devaluation.
A healthy American economy is not possible if it is built on a largely unhealthy citizenry. The taxes that President Obama suggests will pay for universal health insurance will never be imposed for (dare I say it) less compelling reasons like reducing other projected federal budget deficits. Moreover, a healthier America will be more competitive in world markets and reap richer rewards.
Making health care affordable for everyone will require not only government subsidies but also improvement of its cost-effectiveness by emphasizing and incentivizing general practitioners, as well as by controlling the impact of medical liability suits. The high cost of reforming health care should be understood as an investment in our society’s future. We can pay for it with increased levies on high-income individuals and corporate foreign profits, or with the higher insurance premiums that now cover our inefficient health care system. Both sources are taxes in essence; but if properly structured to transform the behavior of consumers and providers, the former may actually result in reducing the expense of sustaining the nation’s physical well-being.
07 September 2009
Health Care, not Insurance, Reform
The problem with the U.S. health care system is not how it pays for medical services but how much it pays for them. The health care insurance system is, admittedly, bureaucratic and aggravating. However, residents of the U.S. pay at least 50% more for keeping their lives going than those of any other country. Somehow those expenses are getting paid for, and the health insurance system is paying for them, however inefficiently.
The cause of excessively costly health care in the U.S. is really that the system provides inefficient medical service to its participants. Legal tort practice is part of the reason, necessitating redundant testing, therapies, hospitalizations, pharmaceuticals, specialists, etc. in order to satisfy jury opinions rather than the judgment of wise physicians. The typical American belief in technology as the ultimate solution to every shortcoming is another source of the country’s dilemma. Why rely on the advice and diagnosis of a generalist, the family doctor, when there is probably a highly-trained and compensated specialist for any ache or pain?
Reforming the country’s health care system will not prevent medical costs from growing. Even those countries that spend less per capita than the U.S. with similar or better outcomes will suffer the fiscal consequences of increasingly long life expectancies—older populations simply require more health care services. But health care expenses will grow less rapidly if the practice and expectations of medicine are reformed to support its ability to guide individuals in leading healthier lives by emphasizing the key role of general practitioners in keeping the public physically sound. This may require government intervention in the way the market compensates primary care doctors so that more competent and imaginative physicians are attracted to field.
Athul Gawande’s recent New Yorker article illustrated how Medicare billings are bloated by careless reliance on overtreatment and specialization in one community when compared to another. It wasn’t the absence of public health insurance that made the difference between them, for the public health insurance provider was forced to pay in both communities. In the long run, devoting the nation’s health care dollar to raising the financial rewards and results-oriented incentives of family doctors will be cheaper than creating another public vehicle to channel insurance funds to health care providers in the same wasteful way.
The problem with the U.S. health care system is not how it pays for medical services but how much it pays for them. The health care insurance system is, admittedly, bureaucratic and aggravating. However, residents of the U.S. pay at least 50% more for keeping their lives going than those of any other country. Somehow those expenses are getting paid for, and the health insurance system is paying for them, however inefficiently.
The cause of excessively costly health care in the U.S. is really that the system provides inefficient medical service to its participants. Legal tort practice is part of the reason, necessitating redundant testing, therapies, hospitalizations, pharmaceuticals, specialists, etc. in order to satisfy jury opinions rather than the judgment of wise physicians. The typical American belief in technology as the ultimate solution to every shortcoming is another source of the country’s dilemma. Why rely on the advice and diagnosis of a generalist, the family doctor, when there is probably a highly-trained and compensated specialist for any ache or pain?
Reforming the country’s health care system will not prevent medical costs from growing. Even those countries that spend less per capita than the U.S. with similar or better outcomes will suffer the fiscal consequences of increasingly long life expectancies—older populations simply require more health care services. But health care expenses will grow less rapidly if the practice and expectations of medicine are reformed to support its ability to guide individuals in leading healthier lives by emphasizing the key role of general practitioners in keeping the public physically sound. This may require government intervention in the way the market compensates primary care doctors so that more competent and imaginative physicians are attracted to field.
Athul Gawande’s recent New Yorker article illustrated how Medicare billings are bloated by careless reliance on overtreatment and specialization in one community when compared to another. It wasn’t the absence of public health insurance that made the difference between them, for the public health insurance provider was forced to pay in both communities. In the long run, devoting the nation’s health care dollar to raising the financial rewards and results-oriented incentives of family doctors will be cheaper than creating another public vehicle to channel insurance funds to health care providers in the same wasteful way.
02 September 2009
Is Health the New Morality?
Improved living conditions and advances in medicine have extended average human lifetimes to previously unimagined lengths. There are even dreams of avoiding death altogether through the use of cryogenic technology. As it becomes more common for people to live into their seventies, eighties and nineties, the medical profession has increasingly bifurcated between getting us there and keeping us there. Crisis and chronic care both have youthful and geriatric divisions.
Has the lengthening of life expectancy, at least for those who can adequately support themselves, contributed to the growth of religious faith among wide swaths of society? In some places, like the U.S., it has; in others, where the state has been crafted as a social welfare provider, the trend seems to be less pronounced. Good health is the key to happiness in that environment, for longevity is a tepid substitute for heavenly reward if it is distressed with physical suffering.
A social system that makes good health its new morality values medical professionals as its priests. In the U.S., doctors are still considered, and compensated, as entrepreneurs. The health care reform that many Americans crave really means changing that social structure so that the trustees of their ability to prolong their physical existence are relieved of the need to provide for their own welfare.
Improved living conditions and advances in medicine have extended average human lifetimes to previously unimagined lengths. There are even dreams of avoiding death altogether through the use of cryogenic technology. As it becomes more common for people to live into their seventies, eighties and nineties, the medical profession has increasingly bifurcated between getting us there and keeping us there. Crisis and chronic care both have youthful and geriatric divisions.
Has the lengthening of life expectancy, at least for those who can adequately support themselves, contributed to the growth of religious faith among wide swaths of society? In some places, like the U.S., it has; in others, where the state has been crafted as a social welfare provider, the trend seems to be less pronounced. Good health is the key to happiness in that environment, for longevity is a tepid substitute for heavenly reward if it is distressed with physical suffering.
A social system that makes good health its new morality values medical professionals as its priests. In the U.S., doctors are still considered, and compensated, as entrepreneurs. The health care reform that many Americans crave really means changing that social structure so that the trustees of their ability to prolong their physical existence are relieved of the need to provide for their own welfare.
