Arrias on Politics: China and North Korea
China, that is, the ruling elite in Beijing, isn’t helping things. Talking heads can be heard opining that the only way to solve the mess in North Korea is with China’s help. But, the truth is a bit more complicated.
Beijing wants to carve out a larger piece of the pie (the world). How big is a good question, but as Cicero was fond of saying: “Deeds, not words.” Despite regular words of peace, they’re engaged in a rapid expansion on all fronts, seeking to stake out a real, and dominant, presence across the globe. They’re staking out control of the South China Sea, are flexing their muscles in the East China Sea (over Japanese islands), and are working on establishing a real presence in Central Asia and the Horn of Africa.
And North Korea can play a role in that global endeavor.
China is far and away the largest trading partner of the North Koreans, counting on China for the overwhelming majority of the oil it consumes, as well as filling annual shortfalls in food production.
So, why can’t China do something about the North Korean nuclear weapon and missile development programs?
As has been widely reported, North Korea is engaged in an aggressive program– what’s known in the US as “RDT&E,” Research, Development, Test and Evaluation – of missiles, weapons, and associated gear. (Just this past week there was press speculation that a new tactical missile launcher for a North Korean missile is a Chinese made truck, a possible violation of international agreements.) In the last several years the number of tests conducted by the North has increased, one public estimate being that during his 5 years in office Kim Jong Un has conducted 4 or 5 times as many missiles launches as his father conducted in 17 years as dictator.
The nuclear weapon development program continues as well, and the UN has reported that North Korea is now producing Lithium-6, a radioactive isotope of lithium that, per numerous defense experts, is a necessary material in the manufacturing of tritium, a key component of a hydrogen (fusion) bomb.
Here’s the thing: this is expensive. With a GDP of less than $30 billion, more than a million people in their army, perennially facing food and energy crises, where does Pyongyang find the money, and the technology, to pursue these weapons and systems? While we can speculate that Iran, flush with cash following the easing of sanctions, is a partial source, it’s simply not credible that this activity would be taking place without the explicit knowledge and at least implicit agreement of the leadership in Beijing.
Imagine South Korea, or Japan, were known to be developing a nuclear weapon. Beijing would be apoplectic; we could expect a continuous stream of invective from their leadership, and loud and aggressive military posturing, tied to vociferous demands in the UN for draconian sanctions. But, while Beijing will occasionally call for North Korea to end testing, and will announce it intends to adhere to existing sanctions, in fact it continues to trade with Pyongyang.
The reality is this activity by North Korea suits Beijing. Beijing may not particularly revel in the idea that Kim Jong Un will someday soon have nuclear weapons, but it doesn’t worry them; Beijing knows those weapons will never be used against Beijing. Further, there’s no desire in Beijing, no matter what they might say, for a unified Korea. Such a Korea would be, even under the rule of Pyongyang, a thorn in China’s side. Under the rule of Seoul, it would mean a US ally with a common border to China, an unacceptable situation; a unified Korea is simply not something Beijing wants to see.
But the continued rule of Kim Jong Un? Prolonged crisis just short of war? That represents problems, and costs, to the US, the ROK, and to Japan. And increased US commitments of forces into Korea means forces not available elsewhere. All that benefits Beijing. China will talk a good game, but there’s nothing that China has done in the recent past, nor anything it is now doing, that suggests Beijing will in any way work to resolve the situation in North Korea. In fact, Beijing likes it just as it’s developing. Solutions might be found working with the Republic of Korea and Japan.
But China is not on our side.
Copyright 2017 Arrias
Arrias on Politics: North Korea’s Kim Jong Un and the Nuclear Threat
While the nightly news and the major newspapers stir themselves into a frenzy over mostly trivia, real problems continue to fester:
North Korea has nuclear weapons.
Three administrations (Clinton, Bush, Obama) believed that negotiations and agreements would change the minds of the government in Pyongyang. They were wrong.
The leader of North Korea, Kim Jung Un, third member of the Kim dynasty, ruling North Korea since 1948, is a demonstrably vicious ruler who uses execution and assassination to solidify control. He isn’t, however, “crazy.” Evil and without any morals, yes. But, coldly rational. On 13 February he had his half-brother assassinated using a nerve agent. This sends an interesting signal: he has VX, and he demonstrated an ability to move it surreptitiously into another country (Malaysia).
Further, Kim views nuclear weapons as key to survival. He won’t surrender them.
The only acceptable long-term solution is unification, the entire peninsula transforming into a greater Republic of Korea. The Kim regime’s despotic rule over the north must end. But getting there is the problem. There are few options: the regime collapses from its own internal problems; a coup, country-wide collapse, or revolt by some force external to the regime but internal to the country; or war.
Obviously, we need to prevent war. A second Korean War would be catastrophic, even without the use of nuclear weapons. We must arrive at some situation where the Kim regime is gone, and the ROK can manage an orderly transition into a unified, free republic encompassing all of Korea. But how?
The standard responses (for multiple administrations) has been along two lines: 1) impose sanctions, and 2) work with China, China can control them. Two thoughts occur: 1) Clearly, the sanctions haven’t worked. North Korea is testing missiles at a furious rate, and the nuclear weapons program grinds forward. 2) China either can’t or won’t control them; (presumably, it’s a little of both.) Beyond that, China really doesn’t want a unified Korea. So, why would Beijing do something that trends in that direction? China wants the Kim regime in power, but hopes to keep them on some sort of leash, even a long and badly frayed leash.
Meanwhile, Kim has conducted multiple nuclear tests, and there are indications (publicly available satellite imagery) that he’s preparing another such test.
North Korea has also been engaged in an aggressive missile development and testing program. They may not have an intercontinental missile – yet (the missile and warhead need further testing), but they have operational missiles that can strike South Korea, Japan, and Guam. Public estimates are that they either have or will have within the next year or so a handful of nuclear weapons that will fit on these missiles.
Which leaves the current administration where?
First, several initiatives are moving forward. While there are a host of sanctions against North Korea already, they’re not necessarily well enforced. The US can insist that others, allies and trading partners, not only refuse to deal with North Korea, but also seize any ships that attempt to trade in certain goods. The US can use its political and economic “weight” to insist countries strictly honor the sanctions.
However, the North is very good at working through loopholes, small and large. Sanctions are important, but sanctions alone are not going to stop the North.
US military posture in Korea, and in the Western Pacific (especially Japan) has been strengthened under the Trump administration, particularly in our missile defense posture, with the deployment of the THAAD (Terminal High Altitude Area Defense) anti-ballistic missile system.
The US has repeatedly made it clear that we will not tolerate an attack on the South and statements from the new administration (including from the President), as well as Secretary of Defense Mattis’s visit to Korea and Japan, help convey that message.
Against the backdrop of a corruption scandal in Seoul and the impeachment of President Park, the real question is: how to separate Kim from power without a war or a paroxysm of destruction?
Strengthen the alliance, buttress sanctions, work with the new president, hold fast against North Korea’s demands; all that sort of thing is appropriate.
But in the end, Kim needs to go.
We must work with the ROK, we need to penetrate the north, irrespective of risk, make contact with possible replacements, destroy the Kim regime internally, and move northern Korea out of the 19th century and into the 21st. It will be painful and there will be setbacks. But, there are really no other acceptable options.
Copyright 2017 Arrias
Arrias on Politics: A 350-Ship Navy
The President wants to add $54 billion to the DOD budget next year, and expand the Navy to 350 ships; and expand the Army, Air Force and Marines.
Several retired admirals and generals opined that it won’t really work, and that once Washington DC reality sets in, there’ll be universal recognition of that “fact” and this talk will end.
Concerning “sage” commentary from the retired 4-stars; there are 3 assumptions that form the foundation of their commentary:
1) There’ll be no real economic growth. Real growth – the economy producing more, hence, there’s more to tax and there’s more real revenue – is needed for increased spending. The US averaged just under 4% real growth for 230 years; the last 8 years more like 2%.
Is 2% all the US is capable of?
2) There’s no improving the efficiency or effectiveness of the federal government. Efforts to eliminate waste or redundancy will produce no meaningful savings.
But: a 10% cut in the non-uniformed federal workforce would mean 200,000 fewer government workers; that’s $22 billion per year.
3) There will be no substantive change in federal budget priorities. National security currently consumes 4.5% of the gross national product and 22% of federal spending.
The “Sages” believe Congress will not act, and the people will not tolerate, an increase in those numbers.
Frankly, my bet is on the American worker, and on President Trump providing the necessary stimulus and incentives to American enterprise; there’ll be real growth, we can find real efficiencies in the bureaucracies, and the citizenry recognize the need to changing our priorities.
Some critics chided the President, noting that the US already spends more on defense than the next half dozen countries combined.
But US defense spending reflects living in the US.
Our military personnel are paid well (and should be); substantially more than soldiers in China or Russia. DOD pay and benefits account for more than 40% of the budget (up to 50% in some years). That’s what you’d expect in an all-volunteer military in the world’s wealthiest country. Elsewhere? A colonel in the Chinese Army is paid about 15% of his US counterpart.
The US pays more for weapons because that’s the nature of our economy; an aircraft made in the US means paying US wages, not Russian wages. And the US still makes the best aircraft in the world.
The US defends its interests around the world. Broad generalizations comparing US spending with that of other nations are misleading. US interests include defending others, such as South Korea, necessitating having forces available to conduct combat operations in Korea. Some forces are stationed in Korea permanently, other forces need to get there, and be sustained while they are in Korea. And more forces are needed to continue protecting US interests elsewhere while forces are in Korea. A potential enemy, such as North Korea, doesn’t need to move its forces anywhere, or save forces for another potential crisis.
This “tyranny of geography” necessitates that the US have an Army – Air Force – Navy that is larger and more capable than one tasked simply to “defend the US.”
That said, expanding the military isn’t easy.
The Army has 32 Brigade Combat Team (BCTs, the basic combat element) in the regular force, 28 in the National Guard. (Marines have 11 Regimental Combat Teams – roughly equivalent, plus 3 reserve RCTs). A BCT, about 4,500 soldiers, can operate as a complete, integrated, unit; very capable, very flexible, but very complex.
At any moment half the Army is not in a BCT, but in a training command, a support command, on a staff, etc. Expanding the Army means adding a BCT plus the support personnel necessary to train, equip and sustain it. So, to add 1 BCT means adding perhaps 10,000 soldiers, plus gear, plus training, etc.
Adding ships and airplanes is similar: more personnel, more support, etc., “more tail with more tooth;” you can’t simply “buy another airplane.”
Which leads where?
To some wisdom: deterring a war is far cheaper than fighting one. The goal isn’t to defeat anyone in battle; the goal is to never need to fight that battle in the first place. Ronald Reagan once observed that no one was ever attacked for being too strong. President Trump is right to want an Army, Navy, Air Force and Marines strong enough to fight and win any war.
And a nuclear arsenal to match.
In an increasingly dangerous world, such a force is the surest guarantee we won’t need to fight a major war. That would makes this endeavor very inexpensive…
Copyright 2017 Arrias
Arrias on Politics: Hobbes and the Deep State
Years ago, I listened to a man discussing how to rescue troubled organizations. Among other things, he said real change was never easy, and it was never accepted by most of the people — even in organizations that were failing badly, and the only way to make change “stick” was to make it fast and radical. Incremental change didn’t work, and in particular, slow change didn’t work. And if you went into an organization and took 3 to 6 months ‘studying the problem’ you’d be co-opted by the system and end up accomplishing little.
There’s an interesting political philosophy that explains that wisdom, a book written during the English civil war, by a rather dour individual – Thomas Hobbes: Leviathan. In it, Hobbes describes how governments work to bring order.
But, it’s in the details where Hobbes really gets interesting, because while the system and process Hobbes was discussing was that of an all-powerful government, the essence of his argument applies to any organization; the larger the organization, the better the fit.
In any organization, those who obey the rules are treated well by the organization; those who break the rules are viewed as a threat. Those who aid the organization are rewarded by it; the more they aid it, the more the reward. Conversely, those who do anything that threatens the organization are the enemy. The larger or more powerful the organization, the more extreme are both rewards and punishments. This is particularly true in regards to government, and specifically, to the federal bureaucracy. Loyalty flows not to some amorphous “nation,” but to your specific organization, to the bureaucracy; it’s the bureaucracy that’s protecting you and providing for you.
Virtually every organization acts this way: you join a club or group of some sort, you provide it support, and the more you help it, the higher you go in the club; maybe you become the club president. A company is much the same: you join, you adopt the rules of the company (always wear green shirts, smile at the customers, sell more widgets, etc.) and you get promoted.
But large government bureaucracies are, of course, what Hobbes was talking about: join the Navy, become a “Navy Man,” do Navy things in a Navy way: the Navy promotes you. Loyalty to the Navy is “expected.”
But where does your real loyalty lie? Is it with the company? The club? The Navy? Or is it to your families and to the Constitution (which in the case of the Navy, is what you swore to protect – not the Navy)? To Hobbes (a strong monarchist), the monarch, and his bureaucracy, was the state.
Modern nations, in particular the United States, have a different perspective: the bureaucracy is a servant and a tool of a nation. Power technically resides in the citizenry. But in fact, power flows increasingly into the bureaucracy, pulled out of the hands of the citizens; bureaucracy becomes the master, the people the servants.
Given enough time, organizations become very protective; they develop rules and language that protect them from outsiders. Consider the rise of the Mandarins in Imperial China, who built a bureaucratic structure – to enforce the Emperor’s laws – that was so complex, and used such arcane language, that no one could understand it, except them. Their power and position was therefore protected. Anyone who’s watched the budget process in the DOD will begin to get an idea of this sort of “insider language.”
The “Mandarins” become the leaders of their “Deep State.” Every bureaucracy will, in fact, strive for that. Every bureaucracy will use the tools at hand: the ability to craft rules and regulations and processes, both in the budget process and in the hiring and firing process, that seek to ensure that only those internal to the bureaucracy itself can effect change. And anyone outside the bureaucracy who tries to change things, who “threatens” the organization, is the real enemy. The bureaucracy will burrow in and fight for survival; it’s needs being far more important than the needs of any such amorphous thing as “the nation.”
Which leaves us where?
The federal bureaucracy is huge, complex, and committed to itself. Mr. Trump wants to change it. The bureaucracy is fighting back. Many members of the bureaucracy are committed to their organization, fully convinced they’re doing the right thing. For them, as members of the bureaucracy, the rest of the nation simply is wrong. Call them mandarins, or the “deep state;” call them what you will. But Hobbes understood them. And they are real.
Copyright 2017 Arrias
Arrias on Politics: Why Don’t We Win?
Secretary Mattis: everyone seems to hope he’ll bring some sanity to national security. Perhaps he can even win these seemingly interminable wars. Maybe. But consider Hannibal:
He was, perhaps, the greatest tactician in history. For 14 years he ravaged the Italian countryside; despite being outnumbered, he defeated every army put against him (in one 6 hour battle his 50,000 man army destroyed a 120,000 man Roman army, killing perhaps 80,000); in the end Rome only defeated him in battle after his key ally was paid off and switched sides – hours before battle.
There’s much to learn from the Second Punic War, but the most important lesson is at the root of the most dire question:
Why doesn’t the US win wars?
To be clear: the US (like Hannibal) is consistently, decisively successful on the battlefield. Why doesn’t that translate into final victory?
That question is asked again and again by various experts and their answers are legion: but most answers suggest that political machinations – often termed “policy” – have replaced real strategy for most decision-makers.
But there’s another – much more significant – problem.
As noted, we’re superb tactically; we don’t lose in combat. We haven’t lost a battalion sized operation or larger (a battalion is about 500 men), since 1953.
Therein lies the first truth: wars are NOT about technology, or tactics or doctrine; they’re not about organizations or training plans or operational plans or leadership councils. And they certainly aren’t about diversity or inclusiveness. Wars are about will.
Victory means your will prevails; the enemy yields.
If you want victory you must have the will to expend the energy, and commit the assets. But most importantly you must have the will to commit to whatever violence is necessary to impose your will on the enemy. If you don’t, he will impose his will on you. You break his will, or he breaks your will; his will or yours must prevail.
At that point, the war ends. One side decides it’s “spent” enough, one side refuses to yield. Rome understood this – with amazing clarity – for more than 1,000 years.
One way to achieve that clarity is make certain you never go to war unless you absolutely need to. The subsequent point is: but if you do need to, then you fight to win. That was based on a simple concept: belief that preservation of our society was of greater importance than the preservation of any other society.
But, most of the news media, a significant slice of our political leadership, and much of our academic “leadership” believe in “globalism,” in the equal value of all cultures, in the idea that nothing about our nation warrants placing it ahead of any others. If so, there’s no point in sustaining our society over theirs; there’s no reason to fight for victory. If one society, one view of the world, is no better than another, why fight to impose that view on someone else? Philosophical ambivalence cannot produce the will to fight and endure. In practical terms this translates into a requirement that warfare be as antiseptic as possible; we aren’t trying to make the people of country “X” change, we’re only trying to defeat the particular force facing us.
But defeating armies doesn’t win wars; ask Hannibal. We consistently defeat every army we face. But if we haven’t defeated the people, if we haven’t broken their will, or at a minimum the will of their leadership, than all the tactical success in the world will not suffice.
Thus, guidance from policy experts that suggests that we must strive to make war antiseptic may make it impossible to win. The enemy can still win, because they aren’t playing by the same rules we are. But we can’t, the rules won’t let us reach that point where the enemy population and leadership is convinced that continuing the war is worse than surrendering.
Clausewitz, the German field marshal, noted that: “…war is such a dangerous business that the mistakes which come from kindness are the very worst…”
What that means is this: Before going off to war, the nation must be all in or not in at all. So, hold a debate, write and pass a clearly worded declaration of war. Then go and fight for victory – no matter the cost. Or don’t go at all.
Until Congress and the media and academia understand that, it will matter little how hard Secretary Mattis or President Trump work to produce victory. Victory is a product of our national will.
Copyright 2017 Arrias
Arrias on Politics: Watchers at the Gate
Presidents are charged to defend the Constitution. Virtually all of them have stated at one time or another that their prime duty, which comes before all others, is to defend the nation. But defending the nation begins with recognition of threats, and then an acceptance of certain risks. For each president the acceptable level of risk will vary. Accordingly, the security policies of two presidents may vary widely, even though they may see the world in a similar light. Two presidents with substantially different views of the nation and the world, and different views of acceptable levels of risk, will develop substantially different security policies.
Which is another way of saying: President Trump’s immigration policies are going to be different than President Obama’s. To not accept that is to deny reality. We can debate the process, and ask whether specific adjustments are legal, but to suggest that one president is “right” and the other “wrong” solely based on their stated concerns about immigration from a particular country is nonsensical. One sees it one way, one see it another; each will guard the “gate” differently; that shouldn’t surprise us.
That said, the law itself seems pretty clear:
“Whenever the President finds that the entry of any aliens or of any class of aliens into the United States would be detrimental to the interests of the United States, he may by proclamation, and for such period as he shall deem necessary, suspend the entry of all aliens or any class of aliens as immigrants or non-immigrants, or impose on the entry of aliens any restrictions he may deem to be appropriate.” (8 USC 1182 para f)
Well, what about the specifics of immigration? What is fair? Are these fair questions to ask of someone wishing to enter the US?
What is your name?
How old are you?
Are you married or single?
What is your occupation?
Are you able to read and write?
What country are you from?
What is your race?
Have you been in a prison, almshouse, or institution for care of the insane?
Are you a polygamist?
Are you an anarchist?
Are you deformed or crippled?
If they can’t answer the questions, or if certain information can’t be confirmed, or if they are clearly ill, is it fair to deny them entry? Perhaps hold them in quarantine, or turn them around and send them back to their country of origin?
Consider what two previous presidents said about immigration:
“[T]here are those in the immigrants’ rights community who have argued passionately that we should simply provide those who are [here] illegally with legal status, or at least ignore the laws on the books and put an end to deportation until we have better laws. … I believe such an indiscriminate approach would be both unwise and unfair. It would suggest to those thinking about coming here illegally that there will be no repercussions for such a decision. And this could lead to a surge in more illegal immigration. And it would also ignore the millions of people around the world who are waiting in line to come here legally. Ultimately, our nation, like all nations, has the right and obligation to control its borders and set laws for residency and citizenship. And no matter how decent they are, no matter their reasons, the 11 million who broke these laws should be held accountable.”
“After years of neglect, this administration has taken a strong stand to stiffen the protection of our borders. We are increasing border controls by 50 percent. We are increasing inspections to prevent the hiring of illegal immigrants. And tonight, I announce I will sign an executive order to deny federal contracts to businesses that hire illegal immigrants.”
The questions above are from the standard questions asked of the 12 million people who entered the US through Ellis Island. The same questions were also asked of the quarter million who were stopped and sent back.
And the quotes? The first is from President Obama (2010), the second from President Clinton (1996).
Amidst all this seething anger it might be worth remembering that there are millions of people who want to come here, including citizens from the 3 largest Muslim populations: Indonesia, Pakistan, and India (none of whom were included in the 90 day suspension)). If you have a few minutes, do a little research on the internet and find how many people are waiting to move to those countries…
Copyright 2017 Arrias
Arrias on Bismarck and East Asia
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 the 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.
Copyright 2017 Arrias
Arrias on Healing Health Care
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.
Copyright 2017 Arrias
Syria, China and the Trump Administration
If you haven’t paid attention to the civil war in Syria (entering its 6th year in March), the Assad – Russia coalition has moved deep into the city of Aleppo, and now controls all but part of eastern Aleppo. This means that Assad and the Russians are winning the war. It may take another year or two, but short of some untoward event, Assad has survived. It’s now only a matter of time before he regains the rest of Syria.
4500 miles away, about 50 miles off the coast of the Philippines, another event took place last week that may have as great a significance to the United States (and President-Elect Trump): a Chinese Navy ship seized an instrumented drone being used by the USNS Bowditch (T-AGS-52), which was engaged in conducting bottom surveys well outside of not only Chinese claimed waters, but also China’s Exclusive Economic Zone (EEZ).
Although seemingly unrelated, these two events offer Mr. Trump an opportunity to reset US policy.
First, it’s necessary to understand how the US finds itself in this situation. In 2011, in the wake of the “Arab Spring,” the Obama administration supported uprisings that were, in fact, backed by militant Islamic organizations in Egypt and in Syria. The US also chose to overthrow the unpleasant, but finally cooperative, Col. Qaddafi in Libya. The result of these choices was violence in Egypt (which led to a counter-revolution), the “conversion” of Libya into a failed state, and fueling of the civil war in Syria. Long-time regional US allies (Saudi Arabia, Kuwait, Bahrain, Qatar, the UAE, Oman, Egypt, Jordan) began to wonder whether the US was a dependable ally. The “nuclear deal” with Iran further undermined their confidence in the US.
Into this ambiguity stepped Russia and Iran. Russia, using high-tech forces, Russian special operations personnel, and Iranian army units to support their client (President Assad of Syria), established a de facto “Damascus Pact,” stretching from the Mediterranean Sea to Afghanistan.
Meanwhile, in East Asia, despite US promises of the “Asia Pivot,” China began to flex its “muscles,” with a substantial build-up of naval forces, intending to establish hegemony over first, the entire South China Sea, and more recently the East China Sea and all relevant island archipelagos. The US response has been at times tepid, and at times ambiguous; with the US Navy conducting operations in and through Chinese claimed waters, but doing little to support claims by friends and allies to islands now occupied by China.
The Chinese have capitalized on this confusion and have continued to expand their presence in and around these various islands and over the entire South China Sea. This increasingly muscular China, and an increasingly disinterested State Department, has led to once certain US allies and friends – the Philippines, Thailand, Malaysia, et al, consciously distancing themselves from Washington and seeking to cozy up to Beijing.
With this latest act of seizing the US bottom-survey sensor, the Chinese have changed, once again, the strategic equation in the South China Sea, making it clear that they will set the bench mark for what is and isn’t acceptable behavior.
Which leads to the obvious question: What should the Trump administration do once in office in less than 5 weeks?
First, the US needs to reaffirm that it will support US interests, not the interests of the amorphous global community, or in the interests of an effete elite in Brussels or the ivory towers of academe. This will come as a relief to many of our allies and friends, who understand that their interests and US interests are very much in common.
Second, the US needs to communicate in private to both Moscow and Beijing that there is a new administration in Washington and that what was acceptable before, is no longer acceptable. We will defend US interests. This must be backed up by clear commitment of assets supporting friends and allies both in East Asia and the Middle East. Demonstration of intent now will prevent these situations from further deteriorating, a condition that would certainly involve serious – and costly – damage to US interests.
Third, the US needs to commit the necessary funding to increase the size and capability of US naval and air forces, allowing us to maintain the security of US and allied interests in the regions. Doing so will not only provide future administrations with the wherewithal to defend US interests, it will send the clearest possible signal of the seriousness of the Trump administration.
Copyright 2017 Arrias
Arrias on Politics: We the People
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 are safeguarded by the Constitution.
The Constitution, and its integral role in the culture and the 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.
Copyright 2017 Arrias