Monday, July 25, 2005

Nuclear Conundrum

India and Pakistan have been rivals, if not enemies, throughout the nearly 60 years since their partition established them as separate states. Few things are more inexplicable, or more shameful, than the fact that the U.S. chose to align itself with Pakistan, a dictatorship, against India, the largest democracy in the world. That choice was sustained over several administrations of both parties. Now, in the era of global terrorism, we have no choice but to remain engaged with Pakistan, but we have both practical and moral reasons for engaging with both countries. Thoughtful engagement with India would go a long way toward building a more peaceful world, as well as righting a wrong.

Unfortunately, the Bush administration seems incapable of thoughtful engagement. Bush has now abandoned the Nuclear Non-Proliferation treaty, by breaking a 30-year nuclear technology embargo against non-signatories to that treaty. There are only four sovereign states that are non-signatories: Israel, Pakistan, India and (now) North Korea. Bush has elected to allow sales of sensitive nuclear technology to India, as a way of kissing their butts to win some long-overdue brownie points. Oh, India is a democracy and is committed to peaceful engagement with the rest of the world, so what is the problem?

Simple: Within hours, Pakistan's President Musharraf was on the phone, demanding equal treatment. If he doesn't get it, he will likely turn to China, which might be quite happy to oblige. The temperature on the subcontinent will soar, and Pakistan, already a danger to the world (especially should Musharraf fall) will become even more dangerous.

Isn't anyone in this administration capable of thinking ahead?

Wednesday, July 20, 2005

Whose definition of "conservative"?

Does it mean that you prefer less government in our lives? Which of the following are consistent with “less government”:

Overturning states’ rights in the case of medical marijuana?
Seeking to overturn the popular vote on Right-to-die?
Using the power of Congress to bludgeon Mark Schiavo, who turns out to have been right on every count?
Seeking to overturn laws like Miranda, which protect citizens from government’s abuse of police power?
Using the intelligence agencies to investigate scientists who do research on global warming?
Using police power to arrest and imprison heterosexual couples for practicing sodomy in their own homes?
Compiling “no-fly” lists based on non-disclosed criteria, and without informing those placed on the lists?
Passing a Prescription Drug Act which forces government to pay for drugs without giving it the power to negotiate the terms?
Waging a nationwide campaign for term limits and then reneging once you win a majority?
Forgetting that your party once stood for fiscal responsibility?

If you are, like me, are against heavy-handed government interference in human enterprise, how do you fit the above into your world view?

History: Which president instituted wage and price controls? Which president travelled to Japan to try to bully them into buying more American cars? How many people know that Bush II has killed the SBIC programme, which provided low-cost leverage for startup enterprises, while expanding agricultural subsidies by several times the amount? Does that make sense????

Conversely, which administration ran the last net surpluses? Who was responsible for GATT reform, NAFTA, and WTO? Clinton did more to reduce government’s drag on trade than all the recent Republican administrations combined. (You may hate NAFTA, but that's another story.)

From the time I first heard conservatives rally around the Reagan mantra of small government, I sensed it was a scam. They like big government as much as liberals; the only difference is who gets to bear the weight, and who gets the handouts. The only area where conservatives seem to rise to the occasion is in matters of property rights, as in their dissent to the recent Kelo decision in Connecticut (I was horrified by that decision, as were many, both conservative and liberal). On other issues, "conservatives" are quite happy to let government stomp all over us.

It is not the principle that bothers me. It is the breathtaking disconnect between rhetoric and reality.

Sunday, July 17, 2005


Got back from China, promptly found myself facing a medical hiccup (not related to my travels, but that's another story). Some observations after about 2 weeks in one of the country's top-ranked hospitals:

Undeniable expertise and skills. The doctors and nurses alike are very well-versed in their craft, aggressive in asking questions, and willing and able to use state-of-the art technology. Yet all of that investment in training and expertise, and in technology, is undermined by the failure to do the little things. Orders repeatedly failed to be transmitted down the chain of care. The standard of hygiene doesn't match that of a budget hotel. Equipment was in poor repair, as were basic items such as hospital gowns.

Diagnosis: Our technology-obsessed culture has crowded out the basics. Top hospitals are in an arms race to have the most cutting-edge gadgetry, and to recruit personnel with the fanciest credentials, but I believe they are at the point of zero marginal return on that investment, because they are failing in two basic ways: Internal communication is lousy, and there is no awareness of the importance of the basics.

Prescription: 1) Invest some of the technology budget in electronic patient management, so the nurses don't have to read the minds of the doctors; and, 2) Invest in the basics. Floors, restrooms and the facility in general should be clean; the food should be edible; gowns should not be full of holes. If it takes aggressive retraining of staff, and invesment in a few more staff, it's worth it.

Believe it or not, simple environmental factors have a huge impact, both physically and psychologically, on patients' outcomes. Why doesn't our medical establishment recognize that?