Bismarck and East Asia

February 5th, 2017

The other day I heard someone opine that it’s a crime that the US hadn’t (and wasn’t considering) going into Syria to take down President Assad.

Well, consider this:

While the focus of the US, and much of the rest of the world, has been squarely on the US elections, and ISIS, things have continued at quite a pace in East Asia. In the last 5 years China has moved aggressively into the South China Sea (through which passes some 20% of all international trade), claiming it as their own. Meanwhile, China continues expanding its army, navy and air force.

Elsewhere, Thailand, the Philippines, Malaysia, and Indonesia have drifted away from the US and towards China, a result of both neglect on the part of the US during the same 5 years, and the muscular foreign policy of China.

And, North Korea appears to be on the verge of producing both an intercontinental ballistic missile and a nuclear weapon to fit atop that missile.

A rising, expansive power, with a centralized government and few of the restraints found in a western democracy, has been extending its reach, and a new nuclear power has emerged, while the US has been focused elsewhere.

The question is: What next?

Almost to a certainty there will be confrontations between the US (and certain key allies, Japan and the Republic of Korea) and China. And North Korea. Whether those confrontations are violent, and whether they escalate, is the real question. Our goal, quite obviously, is to keep these confrontations as peaceful as possible and where that isn’t possible, to limit the escalation. And to make sure that, in the end, US aims are achieved.

But in getting there, we need to remember something…

Despite how morally superior we might want to sound, it’s critical in the nuclear age that we recognize that every nation will, and must, weigh the cost of survival against the cost of its other interests.

Any planning must first be bounded by the knowledge that potential enemies have nuclear weapons. It’s for that reason that our nuclear force must be modernized and kept ready, to ensure that any possible enemy understands that our nuclear forces are credible and that they can’t resort to the use of nuclear weapons without paying too high a price. A modern, ready nuclear force therefore acts as a bar to crossing that nuclear threshold.

But long before we get to any nuclear threshold, we as a nation need to consider other thresholds.

Ask yourself this “simple” question: how many American lives would you be willing to trade for peace in Syria? 400,000 Syrians have now died in their civil war. Would you be willing to send in the Marines to bring peace to that country? If so, how many dead Marines would be too many?

That’s not an easy question, and there are no easy answers.

Otto von Bismarck, the foreign minister of Prussia 1862 - 1890 (and chancellor of Germany 1871 - 1890) is reputed to have said, as to the question of Germany getting involved in the Balkans: "the whole of the Balkans is not worth the bones of a single Pomeranian grenadier."

Bismarck had orchestrated the War of German Unification, the Austro-Prussian War and the Franco-Prussian War. He was an exceptional strategist, probably the best in two centuries, and he understood costs and national interests. He was willing to expend assets – and lives – in defense of those interests. But only in defense of those interests. He understood Germany’s national interests, and he knew where those interests ended.

It’s in this sense that the US must be judicious in where it applies effort, where it commits forces, where it draws “red lines,” and where it lets others do what they will.

SecDef Mattis understands this calculus, he understands US interests, and he understands our approach to China needs to be well thought out and deliberate. 

But there seem to be a fair number of folks who think the US should be rushing here, there and everywhere to defend some other set of interests, the “common interests of mankind” or some such thing. They need to ask themselves exactly what price they’re willing to pay, particularly with other peoples’ lives.

Healing Health Care

January 29th, 2017

The President is looking at unraveling the Affordable Care Act (the ACA, commonly referred to as Obamacare) and replacing it with something that is less expensive and at the same time giving citizens more options in their health care.

Less expensive is key. Since the ACA was passed in 2011, health insurance costs have soared and are heading higher still. As of last November premiums were set to rise an average of 25% in 2017, in the 39 states served by the federal market.

While many will receive subsidies to help pay that increase, subsidies will mean that the taxpayer will ultimately foot the bill. And you can be certain that some of the bill we be dropped into next year by raising the deficit.

Before going any further, it might help to consider a few simple concepts.

When this began, there were some 250 million Americans covered by some form of health insurance. When the ACA was passed, that number jumped. The goal was to reach 280 million, leaving about 10% of the citizens uninsured. Without going into whether ordering people to buy health insurance is Constitutional or ethical, someone should have seen a problem.

The problem is this: if you have a health care system providing care to 250 million, and you add 30 million to it, you have less health care per person when you are done. It doesn’t matter how you get there, you have less per person.

How bad? While the overall ratio of doctors to citizens is staying roughly the same, that trend line appears to be in part due to doctors remaining in practice longer, with more doctors practicing medicine well past age 65. However, there is a trend of more doctors entering into specialized healthcare and fewer into general practice. That translates into fewer doctors providing basic healthcare, meaning more “rationing” of doctors, and higher costs – to be met with higher insurance rates.

Perhaps this shortage can be met by expanding the role of nurses in primary health care?

Certainly, except for one minor point: the shortage of nurses is expected to reach roughly 1 million in the next 5 years, with roughly 2 million nurses in practice in the US  (the need is for roughly 3 million, measured in ‘Full Time Equivalents.’)

In short, no matter what’s happening with the efforts to unravel the mess caused by the ACA, and no matter what steps are taken to address health insurance pricing, none of that is going to matter unless we address the question of supply: the United States needs to expand the “supply” of doctors and nurses.

Practically speaking, that can’t be done in the short term except by “robbing” from someone else. Even as we sit and debate the rules for immigration, the US will need to find ways to attract more doctors and nurses to this country over the next 5 years. Options to provide incentives seem limited: a special tax category perhaps for a medical professional who moves to the US.

To address the long-term problem, any health care program needs to provide some mechanism to expand the “production” of doctors and nurses. What that means is more graduates from medical and nursing schools, but that really translates into more medical and nursing schools. Simply putting more students in any class will in the end dilute the “product.” The real solution requires more schools.

But it doesn’t end there. The other shortage is in residency programs. The residency programs need to be expanded now if we are to meet the needs of a population that will reach 400 to 450 million by 2050. The government needs to identify both incentives for new and expanded medical and nursing schools, and new residency programs, as well as eliminating institutional roadblocks to expansion. And these programs should include planning and sizing to meet the need for that future population growth so that we don’t repeat this problem in another 30 years.

Government planning and interference in health care has been at least partly responsible for the increase in costs over the past decade. The government now has an opportunity to take another look at the health care industry, and working with the industry, academia and the citizenry, chart a different course, one that actually steers us around the problems generated by previous administrations.

We the People

January 23rd, 2017

The transfer of power, per the Constitution, has taken place. President Obama peacefully and gracefully ceded power to President Trump. Huzzah! Three Cheers for the United States of America!

It’s worth noting that while Mr. Obama was passing power to Mr. Trump, troops from Senegal and Nigeria were moving to Ghana, preparing to remove the obdurate President Yahyeh Jammah of “the Gambia;” who had refused to leave office; (he left the country 24 hours later.) That’s how transfers of power often happened, until George Washington – per the Constitution – reset the standard by calmly handing power to John Adams in 1797. (Washington actually handed over power gleefully; Washington had to be cajoled into not resigning more than once during his 8 years in office, dearly wishing to shed his office and return to his beloved Mt. Vernon.) 

If you listened to President Trump's speech you noticed the key point Mr. Trump made: this is really a transfer of power from the Washington DC political establishment back to the people. It's a nice tag line, but the difference is Mr. Trump means it. Not that it's original to him. After all, it's right there in the nation’s instruction manual, the Constitution, which begins: “We the People…”

What will that translate into?

The obvious things certainly; everything promised repeatedly during the campaign, and mentioned again Friday: not simply a government responsive to the citizenry, but also spending less; fixing healthcare and unraveling “Obamacare;” securing the border; and in a grand sense, putting America first in all things.

The media seem to enjoy pointing out that Mr. Trump is just a man, he's not perfect. True. Nor should we expect him to be perfect. None of us are, not even the media who vilify him.

But that's why what he said is so important. By making the point that power comes from and belongs to the people, Mr. Trump has made the simple but vital point that the real effort, the real work, the real America isn't the President, it isn't Congress, and it isn’t the far from perfect federal bureaucracy; America is the people, to include the 95 million Americans of working age who can't find a job, and who in the last 8 years were no longer even recognized by the Department of Labor.

There’s also a subtle point here, one the mainstream media misses, one the mainstream media would suggest the average American is incapable of understanding –one that Mr. Trump clearly understands: the underpinnings of Western Civilization safeguarded by the Constitution.

The Constitution, and its integral role in the culture and society it creates, is at one and the same time straightforward and subtle. Unfortunately, the Constitution has been turned in on itself like a pretzel by judges who felt free to interpret the Constitution in any manner comfortable to them, at odds with the equally valid understanding by the majority of the citizenry (after all, it is our document), and thereby altering, sometimes dramatically, the society desired by the citizenry, and stripping power from the citizenry and shifting it to the bureaucracy.

Yet, despite the portrayal by many in the media of the average citizen of 'flyover country' as an uncivilized rube, the ‘flyover citizens’ understand this complicated relationship between the Constitution and the society and culture around them, and the impact of “pretzel making” by federal judges.

For many, perhaps most, of those who voted for Trump, this issue of “judicial legerdemain” became the critical issue. They understood that selection of the next Supreme Court Justice, and selection of more than 100 other federal judges, will change many subtle but vitally important facets of our nation. Not only facets of our economy and politics and various regulations, but also, and more importantly, facets of the culture and society that define the United States, and Western Civilization as a whole.

It is, I would suggest, why they elected Mr. Trump, because they saw that he understood this relationship as well, and understood the need to protect our society and culture with the right judges. It’s why, perhaps more than any other single point, Mr. Trump is now president. It’s why, as Mr. Trump so eloquently pointed out, that he is transferring power to “We the People.”

God Bless Mr. Trump as he begins this monumental effort, and God Bless the United States of America.