James Audubon
Here's a few Questions I'd like to have answered by particular people
AFGHANISTAN/HEARTS AND MINDS/ THE MISSION/ 911/ SLEEPING SOUNDLY
For President Obama or possibly Linda Winslow, (executive producer or The News Hour): Why do you believe in rabbis to answer questions where "expert" opinion is clearly not expert?
Picture this panel of experts, which, I've read has actually been assembled.
A dinner is thrown at the White House for the President and historians sit around the table as the wise men, the rabbis, and they are asked to expound on the differences between Vietnam and Afghanistan: It snows more in Afghanistan. Afghanies do not speak Vietnamese.
Now I never got a chance to take a single history course in college, but I have listened to the Lyndon Johnson tapes, and I heard LBJ sound very insightful when he was discussing a farm bill, and he sounded pretty resolute about the Civil Rights bill.
And contrary to public perception, he wasn't crassly strong arming the Congressmen and Senators he wanted to vote for his bills; he was any but strong armed.
But when he talked about Vietnam, he was clueless. He would fall back into the posture of, "I'm just a good o' boy. Can't understand the whole thing, but I rely on the bright boys who went to all those big named schools to tell me what to do and they say we got to draw the line in the sand right there in Vietnam--or the whole world will fall to this nefarious, plotting, conniving, mysterious threat to Western civilization thing called communism."
Now President Obama is saying we've got to fight in Afghanistan because those nefarious, plotting, conniving terrorists are all going to gather there and plot and train and connive if we don't find them there and kill them.
So here's the question I never hear the President answer: If we do succeed in driving the terrorists out of Afghanistan, what makes you think they will just give up and stop conniving? Why would they not simply move to Somolia or some other place where there is little or no government?
What is with this concept of a training ground for terrorists?
Oh, we got to clean up those training camps and wipe out all those terrorists. As if you can pull up crabgrass around the tree and flower beds in the front yard and never have to worry about the flower beds in the backyard?
Another way of putting it: What exactly is the mission? How do you know when you've won and can bring home the boys and girls back home?
Richard Holbrooke, seasoned diplomat that he is, had a ready answer for the question of how we define victory in Afghanistan: "We'll know it when we see it."
Oh, that's cute. That means he's clueless, too. Another rabbi without answers.
As I said, I'm no historian, but I had reached the age of reason by the time of the Cuban missile crisis, or at least I'd reached an age at which I could form my own unfounded conclusions and I remember thinking Kennedy's big problem was he was always trying to show he was tougher on Communism than Richard Nixon.
And it was difficult to out tough Nixon when Nixon was accusing people of being pink right down to their underpants.
I really like President Obama. But is he going to try to out tough the Darth Vader of the Bush administration about terrorism?
At least he's abandoned this "War" talk. As if we have a war here. Wars have beginnings and endings. They occur between identifiable enemies, who usually have an identifiable home base. Or, like Ghengis Khan and the Mongol hordes, at least there's an army to defeat. But the wars on crime, cancer, drugs, pornography and terrorism, who's going to come to Appomatox and offer to hand over his sword?
I am unschooled, I admit, when it comes to history, but I did have the good fortune to get in some courses in Anthropology in college and I know from that you are not going to win the hearts and minds of Afghanies with American soldiers who speak no Afgh anie, who look like space invaders and who are, when you come right down to it, infidels.
You might win some hearts and minds with Michael Jackson, Madonna, the Neville Brothers, but not with soldiers.
I'm no history professor, but I was in college during Vietnam and I remember that stuff. It's not history to me. I remember what I saw. And I know what my brother told me when he got back about winning hearts and minds--that sort of thing is just not going to happen.
You cannot win hearts and minds with an army of anthropologists, although you might learn a lot more than you will with the current army.
Anthropologists are, if they are very good, and if they are lucky, and most of all, if they are given enough time, capable of telling you what the Afghanies are thinking, what their values are, how they are willing to live inside and outside those values, but anthropologists do not change a people's mind.
So where was I? Oh, yes, Afghanistan. Here's the question: What is the best outcome you can wish for with those 70,000 American troops?
That's a question for the President. It's a friendly question, really. I'm open minded. Maybe I just don't have enough information. All I know so far is what I read in The New Yorker and what I've heard from a few friends who have recently returned from Afaghanistan.
The Taliban is composed of people we Americans find easy to hate. The Taliban does not place a high value on tolerance. They tend to demonstrate their displeasure by chopping off heads, often in front of helpless children. They are a hard bunch to develop much sympathy for.
Then the follow up question is: Okay, we've captured Osama Bin Laden. We've routed the Taliban, we've got all those farmers in every valley and every mountainside growing wheat and soy and corn and pansies instead of poppy. And we clear out.
Do we think we have prevented the next 911 attack?
Is that the goal?
Do we really believe there are no sleeper crazies in the USA, in Brazil, Argentinia, Bolivia, Somolia, Indonesia, Mali, Palestine, Lebanon, Syria, Iran, North Korea?
So now we are safe again and we can keep our shoes on at the airports?
HEALTHCARE:
President Obama has the right instincts here.
His first instinct was, okay we'll do what the Brits did forty years ago: We'll set up a public system which will cover anyone and we'll allow a private system to run alongside it, where you can get your high priced doctors, your high tread count sheets on the bed in the hospital, but at least everyone will be covered, and we'll get the burden of health insurance off the backs of American industry and we'll likely save money for the US economy in the long run because now all those uninsured are not burdening hospitals and emergency rooms.
But why--here's the question--why do you then back off at the first sign of resistance?
Did you not expect the Republicans to fire a shot? Why do you charge in on the stallion but then retreat when the first shot is fired?
Did you not expect to see Betsy McCoughey with her notebooks with the thousand pages of the bill all highlighted, making some really outlandish, inane and scary pronouncements about how this means pulling the plug on grandma?
(That's what Betsy did with Clinton's healthcare and it make her famous, got her on TV and got her appointed Lt Governor of New York. She claimed to be the only person in America who had actually read the entire Clinton health care proposal, so we was virtually the only authority around.)
And now she sees her big chance for a second act.
Did you have no plan for people like her?
One thing her performance on Jon Stewart did elucidate: The bill she was reading from was horrifyingly detailed. It mandated (on page 432, no less) what the doctor has to discuss with the patient and the family about end of life planning, how it has to be documented. So now the end of life industry has a page in the bill. As far as I know, none of the other industrialized nations with health care systems get into micromanagment to this extreme. Only in America.
Now, suppose every group who has employees making a salary to advocate for vaccinations (a different group for or against each vaccine: Mump) gets a paragraph inserted into the primary care doctor's boilerplate note, where does that leave the doctor? He's got to hire a nurse or a front office person to be sure all thoses paragraphs are signed, dated and so forth and you then have the meet with the auditors who will base your compensation on how pretty your records look.
Do we have better medical care now?
Here's another question for the President: How are we going to pay for the 50 million who are uninsured and the 100 million who are underinsured?
The administration got the CEO of the Cleveland Clinic to appear on the News Hour and give the answer to that one: Well, see, what we are going to do is to get doctors to work with their patients to lose weight and to stop smoking and then everyone will be healthy and we'll not have to pay for their healthcare.
Question for the Cleveland Clinic CEO: Are you serious? Better question: Who put you up to this?
The other answer has come from Atul Gwandi and Peter Orszag, and that is there is lots of waste and overcharging in the system. We'll cut out that fat. They looked at an outlier group of doctors in some town in Texas where the doctors looked at patients as "profit centers" instead of looking at them as patients and they decided this is what all the doctors all over the country are doing--except some at the Mayo and Cleveland clinics.
Here's another problem.
Doctors, in some ways are like auto mechanics. Customer arrives, says there's a squeaking screech every time she hits the brakes. Customer doesn't know what the mechanic knows. He can take some time to figure out the problem. If it's just brake pads, he's got an hour's work, and not much of a charge. Or, he can find it's not just the brake pads she needs but axles,wheel bearings. Now we're talking boat payments for the mechanic.
The incentives are not hard to see. Some mechanics, maybe most, resist the incentives and simply fix the brake pads when that's all that's needed.
We can devise a system, and in fact Medicare has moved in the direction of devising a systems where the doctor is in the same position as the mechanic: He only gets paid a lot if he finds something serious. Before Medicare changed its rules, doctors got paid by the time they spent. They got paid the same, in the end, if the patient turned out to have something simple and non life threatening. But recent rules virtually eliminate the hourly salary effect and install rules which pay hansomely only for the bad stuff. Micromanagment run amuck.
It doesn't have to be this way. Government can do things right, but someone has to be watching.
What is the solution?
Personally, I'd be happy to see doctors on salaries. Then they really do what's in the interest of the patient. They are then "Disinterested" in the sense they've got no stake in a life threatening diagnosis, in doing invasive expensive tests.
But then you've got the arguments about whether you pay the heart surgeon more than the family practitioner.
And here's the question for President Obama: Who are you looking to for the answers?
Are you looking only in the easy places? Someone writes an article for the New Yorker so you listen to him. Someone is the CEO of the Cleveland Clinic, so you visit him? Or are you listening to the answers these visible people propose and asking yourself: Does this really make sense?
President Obama is a smart man. I hope he'll wind up listening to his own inner voice. Amid all those voices clamoring for his attention, hopefully, he'll finally find his own voice.
