Monday, February 28, 2011
“People don’t understand the reality they are living in,” Mr. Netanyahu was quoted as telling an assembly of Likud ministers and legislators, as well as some leaders of Jewish settler councils from the West Bank, who then passed on the remarks to the Israeli news media.
“If you don’t live in this world, you can ignore everything, and I suggest that you beware in order to protect the existing construction, because that’s what’s on the agenda, not the new construction,” Mr. Netanyahu said.
The really bizarre thing is that Netanyahu is taking flak for not expanding the settlements but he really isn't getting the benefits of an outright ban, which would be an advancement of the peace process and the acclaim of the international community. Some people are quick to suggest that the peace process would fail anyway, so why should Israel bother? The answer is simple: world public opinion. Anyone who doesn't think that matters over the long term is crazy. Turning world opinion against Israel is the main strategy of anti-Israeli extremists. Expanding settlements only plays into their hands.
Tuesday, February 22, 2011
Politicians who are actually interested in doing the business of the people and not just furthering their own ambitions are a lot less exciting. That is a good thing. Mitch Daniels has demonstrated to Hoosiers that he is a capable, mature, and very serious leader. I wish other Republicans would take note. Mitch has proposed a temporary truce on divisive social issues so we can get our economic house in order, for example. That is a great idea, one that will be rejected by self serving politicians who make careers out of plucking the emotional strings of Americans about these social issues. Mitch proposed a consumption tax as an alternative source of revenue and was crucified for it by the right. Here is Mitch Daniels being a leader again, about union stripping measures, and the subsequent Democratic exodus:
"I'm not sending the state police after anybody. I'm not gonna divert a single trooper from their job of protection the Indiana public. I trust that people's consciences will bring them back to work. ... For reasons I've explained more than once I thought there was a better time and place to have this very important and legitimate issue raised."
A better time and place, indeed. Mitch wants to reform and doesn't want petty squabbles to get in the way of that, and that's because he cares about the people of Indiana more than his own ambitions. Make no mistake, this move will get him criticized by national GOP leaders and certainly won't help him in a Republican presidential primary.
Another great Hoosier Republican is Dick Lugar, who committed the heinous crime of supporting Obama's arms control bill with Russia. Nuclear arms control was a major goal on which he partnered with then Sen Obama before 2008. Sen Lugar is another leader who puts people over politics, the penalty for which will be a primary challenge from the state GOP.
National Republicans should be emulating guys like Daniels and Lugar, not marginalizing them. Republicans are not our problem, and Democrats aren't our problem. Rather, our problem is uncompromising extremist jerks on both sides of the aisle who would rather hurt the other side more than help Americans. People, we need less partisanship, not more, but you don't get less partisanship by demanding more ideological purity at the gate.
Anyway, we were walking into a tea bar (it was my first time going to a tea bar) and I noticed some graffiti on the brick wall outside. I recognized it as being the work of a famous graffiti artist by the name of Banksy, or at least it was a fantastic imitation. In the drawing, there is a man holding a remote control. He is standing in front of a giraffe with a radio collar around its neck, so the man seems to be controlling the giraffe. The giraffe has a paintbrush in its mouth, which it is using to write the word "vandal" on a high part of the wall. The theme is classic Banksy, although like I said it could be an imitation.
In fact, this is not a new phenomenon nor is it a novel observation. Health care resources tend to get concentrated in areas where everyone has access to insurance. The population in those areas tend to get more health care spending than they need, with no demonstrable increase in outcomes at all. Spending elsewhere is suboptimal. The net effect is that distribution of health resources is only tangentially tied to demand, and is certainly inefficient at any rate.
Anyway, sort of related. I got an email from a friend, which is an email that a med student apparently sent to President Obama. The student was on his emergency medicine rotation, which is what I am doing this month, so I figured I'd add it. I end up with a lot of similar sentiments after my shifts in the ED.
Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular musical ringtone.
While glancing over her patient chart, I happened to notice t hat her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.
And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture", a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me".
Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.
STARNER JONES, MD
Saturday, February 19, 2011
President Obama just released his own budget proposal, and Republicans have been lambasting him for a lack of leadership basically because he didn't propose cutting entitlements. I'm not really sure why Republicans are waiting for Obama to make the first move in proposing those cuts. Didn't Americans elect the GOP because they don't trust Obama on spending? And if Obama is as left wing as some purport him to be, why would he ever go along with, let alone propose, entitlement cuts? At any rate it's pretty obvious that Obama will agree to cuts in entitlements. What the Republicans really want, and the reason for the current impasse, is for Obama to help them avoid the political consequences of proposing and enacting entitlement cuts.
While Republicans are dithering about when or if to make the first move on this huge issue, they might do well to look at recent history. Obama poured virtually all of his political capital into his health care reform bill and he did it when he was fresh in office and most popular. If he had waited it never would have happened. The consequence of passing such a huge bill was he suffered politically in the next election. Republicans are now in a similar position. They were swept into office with a mandate to cut entitlements. If they want to make those cuts, they could do it now. Obama would not stop them. But he isn't going to make it *easier* for them. To expect otherwise is to live in a fantasy land. Republicans didn't make it easier for Obama and the Democrats to enact the long-time dream of universal health coverage, they did the opposite. Thats just politics 101.
As I've said before, there is a difference between electoral victory and legislative victory. The former means nothing without the latter. There will be huge resistance to any entitlement reforms - we are seeing a glimpse of it in Madison Wisconsin. The longer the GOP waits to move, the more time the opposition has to sap their momentum and break their will. Republicans may be squandering their only chance for years to do entitlement reform. The GOP needs to stop waiting around for Obama to give them political cover (he won't) and stop diddling around with the small peas of discretionary spending. The real victory is in medicare and social security, if Republicans have the courage to take it.
Naturally, I'm not optimistic about the Republican Party. I think they'll skirt around the real issues and instead focus on PR stunts like shutting down the federal government while whining that Obama won't let them do anything.
Sunday, February 13, 2011
Friday, February 11, 2011
Quick update: I wanted to add some clarification. There are a lot of Republicans who I have a high opinion of. In fact, we have a few of them in Indiana; Mitch Daniels and Richard Lugar in particular have done a great job for our state. Mitch Daniels has a ton of smart ideas, but he has no megaphone with which to talk about them, because Fox is too busy promoting Republicans who obsess over culture war issues, or who are fond of suggesting that Obama is a Muslim. Perfect example: Mitch Daniels wrote an Op-Ed proposing a VAT, and he got crucified for it by the Fox-dominated GOP establishment. Meanwhile, Dick Lugar is facing a major challenge by the Tea Party in the 2012 election. They despise Lugar, and I'll tell you why: he is way too reasonable. He is willing to work with Obama on issues that advance the national interest (securing nuclear materials, START, etc), and that is a crime to many GOP primary voters.
Thursday, February 10, 2011
Since taking the House of Representatives, what have the Republicans focused on? Most of their efforts have been spent redefining what "rape" actually is so they can try to restrict abortion rights for poor women (which is silly anyway, because poor women can still get food stamps or welfare, so money not spent on food and housing can go towards abortions). They've also expended a huge amount of effort trying to put in constitutional amendments to define "marriage" as between a man and a woman. From an economic standpoint, the only thing the GOP has done is promised to cut 32 billion or so in spending this year. That amounts to roughly 0.9 % of our yearly federal budget.
Republicans came to office in November promising to focus on jobs and the economy, to reduce the size of government, to balance the budget. They've done none of these things, and I don't have much hope that they will. They've fallen back on the old battles that the Bush administration focused on while the country melted all around him. My skepticism vis a vis the new libertarian-conservative revival of the Republican Party that we saw last year seems to have been well placed, unfortunately.
Tuesday, February 08, 2011
If some treatments aren't proven, why are physicians still doing them? Well, lets hypothetically say that obstetricians have been doing "x, y, and z" for premature babies for the last two decades, but there is actually no evidence to support z. Are you going to let your premature child be the first in an experimental group that forgoes treatment z? And what kind of malpractice insurance would a physician have to have in order to conduct that sort of experiment?
A New York Times article about a new breast cancer study touches on this challenge. Its pretty easy to convince someone to try something new that is not proven, but getting them to pass on established treatment options in the name of science is another matter. And yet, the physicians who carried out this study on breast cancer did just that. A quote from the article:
The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.
As it turns out, the study proved that axillary dissection in some women provide no benefit. This is a win-win-win. The surgeons can be confident they are providing the best care, the patients are not getting unnecessary treatment with lots of complications, and the health care system is not losing thousands of dollars on a procedure that isn't helpful. A very courageous study, and we need more like it. I don't presume to know all of the barriers that prevent more research studies like this from being executed, but we should all be working to break them down.
Here is Sarah Palin on Egypt. Remember: she was almost VP, and is considered a GOP frontrunner for 2012:
"It's a difficult situation. This is that 3am White House phone call and it seems for many of us trying to get that information from our leader in the White House, it, it seems that that call went right to, um, the answering machine. And, uh, nobody yet has, uh, explained to the American public what they know, and surely they know more than the rest of us know, who it is who will be taking the place of Mubarak. And, um, no, not not real enthused about what it is that is being done on a national level from DC in regards to understanding all the situation there in Egypt and, um, in, in these areas that are so volatile right now, because obviously it's not just Egypt but the other countries too where we are seeing uprisings. Uh, we know that now more than ever, we need strength and sound mind there in the White House. We need to know what it is that America stands for, so we know who it is that America will stand with. And, um, we do not have all that information yet."
Saturday, February 05, 2011
Of course, one of the great drivers of wars in the Middle East is religious extremism. To Americans, the biggest culprits here are groups like Hamas, who refuse to renounce violence or recognize Israel. Unfortunately, there are Israeli religious extremists, too. The Israeli government has refused to confront the settler movement, who continue to build in East Jerusalem and in the West Bank. If the Israelis want to continue to advance settlements, that is one decision. The consequence of that decision is that the peace process is stopped in its tracks and the international community almost universally condemns Israel for the provocations, with the exception of America.
This is all very frustrating to me. I had enormous amount of respect for Binyamin Netanyahu when he took power. Then Obama was elected, an American president who clearly demonstrated a superior understanding of the conflicts in the region and also one who had unprecedented support from Arabs and Muslims in general, by virtue of not being George Bush, having opposed the Iraq war, having a Muslim father, and having lived in a Muslim country as a boy. In this context, I was extremely optimistic about the prospects for peace. I figured the Israelis would be ready to make a move, because the the best time to compromise is when one is in a strong position, and the Israelis clearly were.
Alas, instead of compromising, Israel squandered its time. Binyamin Netanyahu, for all of his military courage, didn't have the political courage to stand up to these irrational religious extremists in the settler movement. When Obama took office, his first move in the Israeli-Palestinian dispute was to call for restraint from both sides, and specifically asked the Israelis to simply halt new settlement construction. Netanyahu humiliated Obama by refusing until Obama bribed him sufficiently, and even then only yielded a temporary freeze which expired soon thereafter. The peace process was stopped dead in its tracks because a bunch of religious extremists believe that Allah or Yahweh promised them the same land. From our end, Republicans have been encouraging this bad behavior on the Israelis' part not because it was in the best interest of Israel, but so they could contribute to Obama's failure.
In fact, just the other week, Mike Huckabee gave a speech commemorating the completion of a new settlement built illegally in the West Bank. Expanding these settlements into the West Bank does not contribute to Israel's security, it gravely undermines it. Yet to Christian evangelicals in the United States and to the Israeli settler movement, these settlements are justified and necessary from a Biblical perspective. At this point we might pause and ask ourselves if the Old Testament is a good guide for American foreign policy in the Middle East. If anyone actually needs an answer to this question, I would refer them to Deuteronomy 20:17 for God's recommendation for dealing with the Palestinian question.
Last week an earthquake struck the Middle East with the epicenter in Cairo. The greatest Arab ally of Israel, and one of the few with a peace treaty, is going to be overthrown. What will come in Mubarak's place? If the new Egyptian government is at all democratic, it will certainly be a government that is far less friendly than Mubarak towards Israel: a recent poll showed that 3% of Egyptians have a positive attitude towards Israel while 91% have a negative attitude. Egyptian animosity towards Israelis will only worsen when Egyptians find out that Netanyahu's government had been frantically lobbying the Obama administration to stand by Mubarak when the crisis hit. Incidentally, I was reading about how some American Jews are struck by the irony of the Jewish Israeli government working to stifle the freedom of oppressed peoples in the lands of Egypt.
What happens from here on out? I do not believe we will see a return to the days of Nasser, where Egypt is actively warmongering and planning to attack Israel. I suspect Egypt will go the way of Turkey lately; relations with Israel will cool, perhaps to the point of animosity, but mutual alliances with the United States should provide enough glue to prevent a severing of relations or outright military confrontation. Still, it is very difficult to imagine that the Egyptians over the long term will continue to enforce the blockade of Hamas in Gaza, which causes great hardship for the 1.5 million Palestinians in the strip. There is no doubt that Hamas and Hezbollah will be emboldened that by far the most populous and important Arab country may become less friendly to Israel.
Nietzsche once said that true courage is having the strength for an attack on one's convictions. Any hard-headed fool can stubbornly cling to his beliefs, no matter how enormous the evidence to the contrary. George W. Bush ignored for almost 3 years the disastrous reality of Donald Rumsfeld's handling of the War in Iraq, and thousands of American soldiers died because of it. George W. Bush is a coward precisely because he did not have the strength for an attack on his convictions. Binyamin Netanyahu is similarly guilty and has let his people down. In retrospect, we will all come to realize the enormous opportunity to make peace over the last two years that the Israelis had. The Netanyahu government wasted this opportunity because it didn't have the political courage to stand up to their religious extremists in the settler movement. Again and again in history, we see that the easy thing for politicians to do is to beat on the drum of nationalism and to prove their mettle by refusing to compromise. It is much harder to offend some of your own in the name of compromise and advancing their interests.
When it comes to Israel and war, there are two questions: one is whether Israel has the right to keep pounding its enemies, and the other is whether it should keep doing so. The first question: Israel certainly has the right to defend itself. No doubt, it feels good to see Israel teach a terrorist group like Hamas a lesson, especially after Hamas provoked the Israeli response. The second question is harder to answer. Israel beat Hamas, but hundreds of innocents died in the process. The international community almost universally condemned Israel. Relations with Turkey in particular melted down to almost nothing. The most important thing to remember is that pounding Hamas did not actually accomplish anything for Israel. Hamas is still in Gaza, it is as radical as ever, and it is still arming. Israel cannot continue to engage in these wars with non-state actors who don't care how many of their own people die so long as they hurt Israel; it's like playing chicken with someone who is suicidal. Weapons and war can only make Israel safe in the short term; the only thing that can make it safe in the long term is compromise, negotiation, and peace.
Thursday, February 03, 2011
When I did an exchange in China last April, I lived in Guangzhou (the capitol) for a month and had the opportunity one weekend to travel to Hong Kong, which is just south of and not included in this proposed mega-city (since Hong Kong is its own special administrative region and not really included in China proper).
The interesting thing about this plan is that this area is already a mega-city. Its not like China is trying to play semantics here for bragging rights. Guangzhou is only about 100 miles from Hong Kong. Furthermore, on the drive (by bus) from Guangzhou to Hong Kong, we passed through the bulk of this proposed mega-city. Between Guangzhou and Shenzen, for example, it's not like we were driving through empty fields and farmland. It was all highly populated. It wasn't as dense as the cities proper, but it was every bit as dense as the bulk of Indianapolis is.
Apparently the impetus to consolidate is to streamline all of the public infrastructure servicing the cities. Under one authority, it is more efficient to organize rail and transit, for example. I am a big fan of China, but I am not as bullish on China as some people in the United States are. Sure, the Chinese economy is going to overtake ours, and relatively soon, but I still think their challenges going forward are larger than a lot of people suggest. That being said, for people who are terrified of China's rise, this is another example of how they are getting a leg-up on us, by smart planning to make their cities and infrastructure more efficient.
There has been a lot of talk lately about how cities and states in the USA are going to all start going bankrupt. Maybe the low population density of American cities has something to do with it? Compare Indianapolis to Amsterdam, which both have about the same population, but Amsterdam is physically only 20% as large as Indy (and Amsterdam feels less crowded for some reason). Which city's infrastructure is more expensive to maintain? The two cities are so different in part to their historic development, but for the last 50 years in America we have guaranteed cheap gas and large abundant roads, whereas in the Netherlands they've taxed gasoline and built public transit with the money. Plus, they have awesome bike lanes which are often physically separated from the roads, leading to things like this: a packed bicycle parking garage next to the central train station.
I don't think it is ever too late to change our development model. The new buzz in Indianapolis is that one of the highways on the upper east side is constantly clogged because the suburb up there is booming. There is so much land in the city proper that is hardly being used, its just a shame these people aren't moving into those areas instead. It seems less efficient to build ever outward when we already aren't using what we have, but I understand schools are a big part of the problem.