Monday, August 31, 2009
We tend to think of health care as being the same as medical care, but, as Goldhill points out, there are a lot of other aspects of life that are necessary to a healthful life: "nutrition, exercise, education, emotional security, our natural environment and public safety". Yet, we spend an unbelievable amount of money on medical care, "8 times as much as we spend on education, 12 times what is spent on food aid to children and families, 30 times what we spend on law enforcement, 78 times what is spent on land management and conservation, 87 times what is spent on water supply, 830 times what is spent on energy conservation". It is truly scary.
Goldhill looks at medical care as simply an industry. Clearly, looked at through that prism, medical care has some problems. Goldhill feels that the fundamental problem is that the industry is not customer-focused, the customer being you and me; it is focused on who pays the bills, insurance companies and governments. He argues that much of the progress in the world beyond healthcare has come about because of the consumer's interest in the price he pays for goods and services. This is an area that is a grand mystery to just about all of us who consume medical servives Do you know how much your doctor is charging you for your annual physical? Do you question her scheduling of a CAT scan? Do you ask how much the prescription will cost before he writes it? Yet, you look at all the prices in the supermarket. You know to the penny how much you pay in real estate taxes. You make sure that you're getting the beat deal on that new car. Does it not make sense to consider pricing when making medical decisions? His basic argument is that we would all be better off if we directly paid for some of our medical expenses.
Goldhill stresses a fundamental difference between health and other insurance. We expect health insurance to pay for virtually all medical expenses, not only expenses associated with a major problem. Yet, all other forms of insurance cover not the expected daily expenses, but the major catastrophe.
Along the way, Goldhill mentions some interesting factoids: for every two doctors in the U.S. there is one health-insurance employee, Medicare spends twice as much per patient in Dallas as it does in Salem, Oregon, because there are more doctors per resident in Dallas, whether you are insured or uninsured you spend about the same amount of your own money on health care, per capita spending on health care in most Western countries has increased by c. 40% over the past five years.
He does address many of the 'givens' that supposedly have a major impact on the growth of health care costs. The idea that improved technology means higher medical costs flies in the face of the experience of most of us. The computer on which I am writing this is more powerful than the mainframes I worked on in the 1960s and 1970s; those behemoths cost in the millions, I paid $700 for this PC. Goldhill attributes the high cost of emergency rooms more to accounting legerdemain than reality. Goldhill questions the value of the 500 major hospitals we finance. He wonders why the industry won't finance the investment in electronic records as the the roi is close to 60%.
It is probably the most sensible article you will read about how we pay to stay healthy. It demonstrates quite clearly that the current 'debate' about health care is more sound and fury signifying very little. This is an area where change is clearly needed. Instead, as with the world of finance, we're getting patches.
Sunday, August 30, 2009
No, our biggest problem isn't caves; it's credibility. Our messages lack credibility because we haven't invested enough in building trust and relationships, and we haven't always delivered on promises.-----------------------------------------------------------------------------------
The most common questions that I get in Pakistan and Afghanistan are: "Will you really stay with us this time?" "Can we really count on you?" I tell them that we will and that they can, but when it comes to real trust in places such as these, I don't believe we are even in Year Zero yet. There's a very long way to go.
The irony here is that we know better. For all the instant polling, market analysis, and focus groups we employ today, we could learn a lot by looking to our own past. No other people on Earth have proven more capable at establishing trust and credibility in more places than we have. And we've done it primarily through the power of our example.
That's the essence of good communication: having the right intent up front and letting our actions speak for themselves. We shouldn't care if people don't like us; that isn't the goal. The goal is credibility. And we earn that over time.
The Muslim community is a subtle world we don't fully -- and don't always attempt to -- understand. Only through a shared appreciation of the people's culture, needs, and hopes for the future can we hope ourselves to supplant the extremist narrative. We cannot capture hearts and minds. We must engage them; we must listen to them, one heart and one mind at a time -- over time.
He concludes his article, "Strategic Communication: Getting Back to Basics" in the Joint Force Quarterly with these words.
To put it simply, we need to worry a lot less about how to communicate our actions and much more about what our actions communicate.
I also hope we learn to be more humble, to listen more. Because what we are after in the end -- or should be after -- are actions that speak for themselves, that speak for us. What we need more than anything is credibility. And we can't get that in a talking point.
Saturday, August 29, 2009
Quoting Plato: "Only the dead have seen the end of war." That's Lesson No. 1.
Lesson No. 2 is that we Americans don't learn from our mistakes.
Lesson No. 3 is that few of those leaders will ever have to pay the price of their folly.
Lesson No. 4 is that from the Persian Gulf War onward, the quality of soldiers -- and that includes all branches of the service -- has gotten better each year.
Lesson No. 5 is that the same virtues and values I've found in young soldiers can be applied to peacetime problems right here at home.
Another two-sided coin for Lesson No. 6. Take care of our casualties.
Lesson No. 7: Obama is making the same mistake in
Afghanistanthat Bush did in . It's called "the graveyard of empires" for a reason. Iraq
Lesson No. 8 is maybe the easiest to learn. Vote for women and men who understand that war should be the last resort of a democratic republic -- not the first.
Lesson No. 9 is like unto No. 8. Teach your children well. Parents, teachers, coaches, Scout leaders, clerics -- all of you charged with instructing our kids should also talk with them about war.
Finally, Lesson No. 10. I'm done. I'm not leaving my home in
except for vacation. No more will I walk to the sound of guns. This was my last war. I would not trade what I've learned and felt for gold or fame. Covering wars has let me make friends for life. War has shown me the face of evil -- and the heart and soul of courage and loyalty and honor. Merced
Thursday, August 27, 2009
Image via Wikipediam. In the early days of Iraq, the Rendon Group was contracted by the Pentagon to sell the war to the American people. It went so far as to establish the Iraqi National Congress, Ahmad Chalabi's propaganda section. Six years later and with a new administration in Washington the Rendon Group is still taking our money for not exactly honest work. Today's work is vetting journalists who want to be embedded with the military. All right-thinking journalists should pass the test and attain a rating of positive. Those who seem unlikely to pass on the Pentagon's message have lower ratings.
Change you can believe in??
Wednesday, August 26, 2009
The Center asserts that "of the 25 top participants in the program, at least 21 were heavily involved in the subprime lending industry. Most specialized in servicing subprime loans, but several both serviced and originated the loans.Change you can believe in??
Among those on the list:
- At least two firms that earlier settled charges of illegal collection practices brought by federal regulators; another was placed under federal supervision before voluntarily surrendering its bank charter;
- A subprime subsidiary of top-bailout recipient American International Group Inc. (AIG);
- Two former subsidiaries of Merrill Lynch & Co. and one former subsidiary of Lehman Brothers, investment banks that helped underwrite the subprime boom, and;
- A subsidiary of the now-sold, former No. 1 subprime lender in the nation, Countrywide Financial Corp."
“To build a better, freer world, we must first behave in ways that reflect the decency and aspirations of the American people.”But now President Obama is authorizing the practice of rendition to continue. But with the supposedly important proviso that there will be more monitoring. And I have a bridge you can buy!
“This means ending the practices of shipping away prisoners in the dead of night to be tortured in far-off countries, of detaining thousands without charge or trial, of maintaining a network of secret prisons to jail people beyond the reach of the law.”
Change you can believe in?? Ask Maher Arar who was transferred to Syria, where he was tortured.
Change you can believe in??
Monday, August 24, 2009
A good deal of the problem is a function of the initiative system, whereby the populace can enact laws via referendum. But, let's face it, sometimes the populace is not what one would desire. They can be motivated by the belief that being tough on crime will make them safer and will punish the bad guys. Thus, several 'get tough on crime' petitions have been passed over the past twenty years. The problem is that as a result of such measures as defining exactly what the penalty for a specific crime is - and avoiding any discretion on the part of a judge - has resulted in an unbelievable growth in the prison population, growth on the order of eight times what is was 20- 30 years ago. Along with the growth has come a leap in the recidivism rate so that almost 75% of the prisoners return to jail.
Another reason why so much money is spent on prisons is our stupid "War on Drugs". Perhaps half of the prison population is there because of drug-related infractions. Why we have this need to control people's behavior continues to rankle.
And, of course, there are the employees of the correction system, one-tenth of whom earn more than $100,000 a year. Their union has been among the major forces in getting the 'tough on crime' referenda passed.
But, there is a democracy movement that is trying to do something about California's problems. Repair California is using the initiative system to get two measures on the 2010 ballot, one to amend the state constitution via a congress of citizens, the other to call the convention. What is interesting about this initiative is that the delegates to the convention will be chosen randomly. I wonder whether the concept of a random selection is catching on as our system of electing legislators and administrators is showing more and more signs of being a failure.
Thursday, August 20, 2009
Sunday, August 16, 2009
And what will Geithner and company say when the s**t hits the fan again? It will, unless actions are taken now.
If you believe that "God knows where the money is, and he knows how to get the money to you", you may have been in Texas last week listening to preachers of the prosperity gospel. You would not have been alone; thousands were there with you. And the thousands gave the preachers money, lots of it, enough to give Kenneth and Gloria Copeland, the main speakers and organizers of the event, an annual income approaching $100,000,000, much of which is tax-free.
It's a great country, isn't it?
Thursday, August 06, 2009
Counties (see statewide items)
|County Name||Population||Unemployment||Poverty Rate||Total Funding||Per Capita|
I live in Dukes County, which is the island of Martha's Vineyard. We're in the bottom half of the totem pole on a per capita basis. The other island county, Nantucket, is at the top. Were their politicians more effective than ours? Was the fact that the Vineyard has six towns and Nantucket one a factor in seeking these funds?
The Air Force asked for one Gulfstream 550 jet to upgrade their passenger service. The savants in Congress decided that the Air Force really needed three, the additional two being stationed in Maryland ready to ferry Congressmen and other 'leaders' around the world. So, instead of spending $65,000,000 to improve passenger service, the financial geniuses spent $197,000,000. Hey, it's not their money.
Wednesday, August 05, 2009
Tuesday, August 04, 2009
- The medical industry paid for more travel than any other outside interest — more than $10 million for some 8,700 trips, or about 40 percent of all outside sponsored travel. Among the targets: military pharmacists, doctors, and others who administer the Pentagon’s $6 billion-plus annual budget for prescription drugs;
- Foreign governments paid more than $2.6 million for 1,500 trips. The biggest sponsors: U.S. allies Australia, Singapore, and Japan, but the list also includes China, Russia, and the United Arab Emirates;
- Manufacturers of retail goods paid for more than 500 trips, at a cost of about $470,000. Their targets included buyers at on-base retail outlets, which sold more than $12 billion of merchandise in 2007. Among the sponsors: Nike, Skechers, Mattel, and Sony;
- Thousands of the trips were taken to popular vacation spots such as San Diego, Las Vegas, Honolulu, San Remo and Venice, Italy, and Jeju Island, South Korea. Among the guests were spouses, who participated in at least 240 of the trips.
Contrast this with my experience with Sprint. A couple of weeks ago I wrote about the difficulties I had getting Sprint to honor its commitments within a reasonable time frame. In this case I had written to Dan Hesse, Sprint CEO, to get some action with resolving our concerns. I did talk to someone in Executive Services who said we would not have our service stopped because there was a dispute with regards to credits Sprint promised us. Well, yesterday, without warning or any form of notice one of our phones was cut off from service and the man in Executive Services could do nothing about it unless I paid the full bill then and there, even though the full bill did not take into account our credits because Sprint, being a very efficient organization, had yet to post all of the credits to which we were entitled. Clearly, as soon as I can get out of the Sprint contract I will. They made it difficult to reach a responsible party. In effect, they were willing to tell a good customer to take a hike. No one had the courtesy to even acknowledge receipt of my letter.
Which company would you prefer to deal with? Drugstore.com realized that I was paying part of the customer service rep's salary, Sprint did not. I give them another five years or less and there will no longer be the Sprint we know.
Sunday, August 02, 2009
His basic argument is three-fold:
1. We Can No Longer Afford Our Postwar Expansionism
Our financial situation is such that to continue supporting these overseas fortresses will eventually bankrupt us. Johnson notes that the Pentagon budget for next year will, in fact, grow. He quotes Jay Barr, a bankruptcy lawyer, with regard to the absurdity of our position, "Whether liquidating or reorganizing, a debtor who desires bankruptcy protection must provide a list of expenses, which, if considered reasonable, are offset against income to show that only limited funds are available to repay the bankrupted creditors. Now imagine a person filing for bankruptcy claiming that he could not repay his debts because he had the astronomical expense of maintaining at least 737 facilities overseas that provide exactly zero return on the significant investment required to sustain them… He could not qualify for liquidation without turning over many of his assets for the benefit of creditors, including the valuable foreign real estate on which he placed his bases."
2. We Are Going to Lose the War in
“One of our major strategic blunders in
3. We Need to End the Secret Shame of Our Empire of Bases
“In March, New York Times op-ed columnist Bob Herbert noted, "Rape and other forms of sexual assault against women is the great shame of the
armed forces, and there is no evidence that this ghastly problem, kept out of sight as much as possible, is diminishing." He continued: U.S.
"New data released by the Pentagon showed an almost 9 percent increase in the number of sexual assaults -- 2,923 -- and a 25 percent increase in such assaults reported by women serving in Iraq and Afghanistan [over the past year]. Try to imagine how bizarre it is that women in American uniforms who are enduring all the stresses related to serving in a combat zone have to also worry about defending themselves against rapists wearing the same uniform and lining up in formation right beside them."
Johnson does not stop with ‘why’, he also begins to answer the question of ‘how’.
10 Steps Toward Liquidating the Empire
Dismantling the American empire would, of course, involve many steps. Here are ten key places to begin:
1. We need to put a halt to the serious environmental damage done by our bases planet-wide. We also need to stop writing SOFAs that exempt us from any responsibility for cleaning up after ourselves.
2. Liquidating the empire will end the burden of carrying our empire of bases and so of the "opportunity costs" that go with them -- the things we might otherwise do with our talents and resources but can't or won't.
3. As we already know (but often forget), imperialism breeds the use of torture. In the 1960s and 1970s we helped overthrow the elected governments in
Braziland Chileand underwrote regimes of torture that prefigured our own treatment of prisoners in Iraqand . (See, for instance, A.J. Langguth, Hidden Terrors [Pantheon, 1979], on how the U.S. spread torture methods to Brazil and Uruguay.) Dismantling the empire would potentially mean a real end to the modern American record of using torture abroad. Afghanistan
4. We need to cut the ever-lengthening train of camp followers, dependents, civilian employees of the Department of Defense, and hucksters -- along with their expensive medical facilities, housing requirements, swimming pools, clubs, golf courses, and so forth -- that follow our military enclaves around the world.
5. We need to discredit the myth promoted by the military-industrial complex that our military establishment is valuable to us in terms of jobs, scientific research, and defense. These alleged advantages have long been discredited by serious economic research. Ending empire would make this happen.
6. As a self-respecting democratic nation, we need to stop being the world's largest exporter of arms and munitions and quit educating
Third Worldmilitaries in the techniques of torture, military coups, and service as proxies for our imperialism. A prime candidate for immediate closure is the so-called School of the Americas, the U.S. Army's infamous military academy at , for Latin American military officers. (See Chalmers Johnson, The Sorrows of Empire [Metropolitan Books, 2004], pp. 136-40.) Fort Benning, Georgia
7. Given the growing constraints on the federal budget, we should abolish the Reserve Officers' Training Corps and other long-standing programs that promote militarism in our schools.
8. We need to restore discipline and accountability in our armed forces by radically scaling back our reliance on civilian contractors, private military companies, and agents working for the military outside the chain of command and the Uniform Code of Military Justice. (See Jeremy Scahill, Blackwater:The Rise of the World's Most Powerful Mercenary Army [Nation Books, 2007]). Ending empire would make this possible.
9. We need to reduce, not increase, the size of our standing army and deal much more effectively with the wounds our soldiers receive and combat stress they undergo.
10. To repeat the main message of this essay, we must give up our inappropriate reliance on military force as the chief means of attempting to achieve foreign policy objectives.Unfortunately, few empires of the past voluntarily gave up their dominions in order to remain independent, self-governing polities. The two most important recent examples are the British and Soviet empires. If we do not learn from their examples, our declin
Saturday, August 01, 2009
Image via WikipediaEvery issue of Foreign Policy includes a quiz about one aspect of the world in which we live. This month's quiz was about water. I learned some disturbing facts:
- 37 times countries have fought over water rights.
- The Tibetan plateau supplies water to 47% of the world's population.
- It takes 1,000 liters of water to grow a kilogram of wheat and 15,000 liters to produce a kilogram of beef.
- In developing countries the average girl or woman walks 3.7 miles to fetch water.
- 38% of the world's population do not have access to toilets.
- 80% of illnesses in the developing world can be traced to unsafe water.
- In a Peruvian shantytown a cubic meter of water costs $3.22. Rich neighborhoods pay $.45.
- It takes 3 liters of water to produce 1 liter of bottled water.
Walt's second article is a laundry list of concerns about us. Here is a summary:
1. I've never really understood why plenty of smart people think the United States still needs thousands of nuclear weapons (or ever did).
2. I'm still puzzled by why Americans are so willing to spend money on ambitious overseas adventures, and yet so reluctant to pay taxes for roads, bridges, better schools, and health care here in the United States.
3. I don't understand why many people think invoking God is a compelling justification for their particular policy preferences, and why they assume that this move is a trump card that ends all discussion.
4. I'm equally baffled by when someone invokes "history" to justify a territorial claim and assumes that this basis is unchallengeable.
5. I do not understand why Americans are so susceptible to the self-interested testimony of foreigners who want to embroil us in conflicts with some foreign government that they happen to dislike.
6. I certainly don't get the business model that informs the content of the Wall Street Journal's op-ed page. The rest of the newspaper is an excellent news source, with reportage that is often of very high quality. The editorial page, by contrast, is often a parody of right-wing lunacy:
7. A related point: I can't figure out why newspapers aren't hiring more bloggers to write columns for them on a regular basis.
8. In an era where the United States is facing BIG problems at home or abroad, it is both puzzling and disheartening to observe the amount of ink and airspace devoted to the Skip Gates arrest, Michael Jackson's demise, or the "birther" controversy.
9. I don't understand why academics defend the institution of tenure so energetically, and then so rarely use it for its intended purpose (i.e., to permit them to tackle big and/or controversial subjects without worrying about losing their jobs)
10. I'm both amused and annoyed by the highly intrusive security procedures that now exist at airports, which are almost certainly not cost-effective.
F-22 fighter jet — After receiving $2.9 billion this year, the F-22 fighter jet was slated for elimination by Obama. The measure provides $64 million to shut down its production line and $139 million for spare engines for the F-22 and the C-17 cargo jet.
VH-71 presidential helicopter — Obama recommended just $85 million for program termination costs after the troubled helicopter received $835 million this year. The House provided $400 million, drawing a White House veto threat.
Courtesy of AP.
F-35 alternative engine — The House provided $560 million for the alternative engine; Obama proposed "zeroing out" the second engine project and threatens a veto if the final bill would "seriously disrupt" the overall F-35 program.
C-17 cargo jets — Obama wants to kill the program and requested only $91 million to shut down the production line. Congress funded eight planes in this year's war funding bill; the House bill provides $674 million for three more planes.
Kinetic Energy Interceptor — Obama requested no funding for the Kinetic Energy Interceptor, aimed at shooting down enemy ballistic missiles during their boost and early mid-course phases of flight. The House provided $80 million.