Avuncular American

US Health Care: What's So Difficult?

Anyone passing through Brussels and interested in the history of medicine would do well to visit Notre Dame à la Rose in Lessines (photo, left), a town to the west of the city.  Given over to historical tourism since the 1980s, as a "hôtel Dieu" it served to heal the poor for hundreds of years.  You'll be forgiven if you think you're in a cloistered monastery: nuns dispensed treatment for body and soul in a self sufficient complex, replete with its own river and mill, vegetable garden, and farm.

You'll never complain about your doctor again once you've seen the wax image of his 17th century forebear (photo below, right).  Just take a look at his instruments (those were the days of bleeding and trepanation) and count your lucky stars that you only have to say "aahh" on a dry popsicle stick tongue-depressor.

Basic as the care was, it was the best that was on offer at the time, and the nuns, doctors, and other personnel knew that if they didn't care for the sick poor, no one would.  Not only would they care for body and maybe save souls, but they would have the personal satisfaction of salvation, and of doing the right thing.

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Okay, fast forward to the US Congress this week, where Representative Mike Rogers, Republican of Michigan, said this of President Obama's efforts to make health care available to all Americans:

You will have to call a bureaucrat and hope to God his calculator is more compassionate and smarter than your doctor. (NY Times)

Obviously Rogers hasn't checked with his doctor, who may be one of the 450,000 clamoring for health care reform.  Nor has the good Congressman had to deal with an insurance company "gatekeeper" whose job it is to find every conceivable excuse to disallow treatment of patients.  Give me a government bureaucrat any day.

Here's what I can't understand: all the statistics show that the US spends way more than other advanced countries on health care, but gets results that are sub-prime, to say the least.  The same Republicans who decry "government" intervention passed a massive giveaway to private insurers via Medicare during the Bush years.  Their defense of health care appears to exclude dispensing it to anyone save the insurance industry lobbyists who finance their campaigns.

Do they just want to send people to the Poorhouse, that other institution from a bygone era that has gone the way of the hôtel Dieu?

Come on, people, it's not so difficult.  Other countries spend far less, with better results, and it's just not an issue in politics.  It's a human right.  Something that the good nuns and doctors of the hôtel Dieu understood centuries ago.

White House Beer Moment: Let's Rethink Restraints

Here's to President Obama, Professor Gates, and Sergeant Crowley when they meet at the White House for that beer tomorrow.  Cheers!

After oceans of ink analyzing the racial aspects of the unfortunate encounter between Crowley and Gates at the latter's home, I will add my two cents from the vantage point of an American expat.  American cops often inspire the creeps, even among those of us who are the most law-abiding of citizens.  Other than police in totally corrupt places or in what used to be known as "police states," encounters with police in most reasonably stable countries (they don't even have to be full-fledged democracies) tend to be benign, even reassuring.  Many times, police are unarmed.

Consider your typical American cop, decked out with sidearm, nightstick, Taser®, cuffs, mag flashlight, walkie-talkie... the list goes on.  Add the above to an often generous waistline, and you have the stuff of caricature.  Superimposed against a background of racial relationships where "driving while black" (or existing while black) predated post 9/11 instant suspicion of people of color, you have the makings of daily Gates/Crowley-type episodes that pass beneath the radar.  "Contempt of cop," or being insufficiently obsequious to an officer of the law, can, as Prof. Gates' case shows, get you into trouble.  And handcuffs.

Colin Powell ("Don't Argue With Cops"), who knows something about race and power relationships, said this to the NY Daily News:

I would have thought at that point some adult supervision would have stepped in and said, "Okay, look, it is his house. Come on, let's not take this any further. Take the handcuffs off."

Yes, the whole thing did go too far, and President Obama's "brewski diplomacy" (NYDN) is to be commended.  But can we talk about the other aspect mentioned by Powell: the handcuffs?

Cuffing, frog-marching, or otherwise restraining even the most inoffensive of arrestees may be so routine and commonplace in the United States that people think it's a matter of course.  Check out CopQuest.com (above photo: Peerless handcuffs) for the entire panoply of restraints, including one with particularly horrible overtones for African Americans, the "spit mask" or "transport hood," which has been compared to the masks used by 18th century slavers when abducting people for the plantations.  For many people, a black man in handcuffs is not a racially-neutral image.

I refer you to the Human Rights Documentation Centre (HRDC) of India:

Handcuffing for the purpose of humiliating or intimidating individuals violates numerous international conventions, elaborate model standards and resolutions and one of the precepts underlying international human rights law – that the dignity and worth of every individual must be respected.

Humiliation and intimidation...  Put aside Professor Gates and Sergeant Crowley for a moment, and consider Susan McDougal.

In 1996, white, middle-class McDougal, former business partner of then-President Bill Clinton, was jailed in connection with the Whitewater controversy.  Her crime: contempt (not of cop, but of court).  Her treatment: handcuffed and in leg shackles, shuffled out of court in her miniskirt (she was later put in an orange prison jumpsuit) for the press to duly document.  There was absolutely no doubt at the time that the extreme restraints for a wayward businesswoman were for any reason other than humiliation - in this case, hope on the part of the vindictive Special Prosecutor to humiliate both Ms. McDougal and, by association, the Clintons.

So beyond the race relations "teaching moment," let's use the Gates arrest to reconsider the almost automatic use of handcuffs, shackles, or worse for anyone other than violent criminals or suspects.  Their use for people arrested in their own homes for forgetting their keys - and myriad other instances of peaceful confrontation - is the stuff of police states, not the State of Massachusetts.

Global Economic Crisis: Uzbekistan Engages Constructively

A prosperous and democratic Uzbekistan could be an extremely important bridge between the Western and Muslim worlds.

AbduMannob Polat, former chairman of the Human Rights Society of Uzbekistan, writing for the Jamestown Foundation

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Last week I participated in a conference in Tashkent, the capital of post-Soviet Central Asia's most populous country, Uzbekistan.  Hosts were the Uzbekistan Institute for the Study of Civil Society (ISCS), who provided the photos in this post.  Full disclosure: the Brussels-based European Institute of International Relations (IERI, for which I do pro-bono work) was a co-sponsor, as were the OSCE and the National Democratic Institute (NDI), organizations with strong democracy-building and rule of law credentials.

The round table was primarily focused on how Uzbekistan has coped with the international financial crisis.  Rather well, it would appear: the IMF (whose Managing Director Dominique Strauss-Kahn visited Uzbekistan and other Central Asian states last month) forecast 7% GDP growth for the country in 2009, down only slightly from 2008's 9% figure.

Some of Uzbekistan's success in weathering the financial storm is down to its isolation; "double land-locked" among other land-locked Central Asian neighbors, it had already survived the wrenching transition from Soviet central planning after the breakup of the USSR in the '90s.  As one Uzbek banker said, the country's mere 6% of mortgage exposure meant there was "no bubble to burst."  It has also helped that the country's President, Islam Karimov, is an economist by training, and has recently penned a book on the crisis.

Though economic in thrust, the conference's sub theme of political reforms was ever-present.  That picture of me on the right is of a very jet lagged neophyte's first hours in Tashkent, trying to answer the local press' insistent questioning about my opinion on Uzbekistan's upcoming (December) parliamentary and local elections.  "Langue de bois" or diplospeak comes in handy at times, but I was honestly able to plead ignorance based on my almost total lack of information on the question.

Other participants were more forthright, with probably the best line from the NDI director: "democracy is the best defense against extremism."  The extremism is Islamic, and was a reference to Uzbekistan's darkest hour in 2005, when long-simmering tensions came to a head in the city of Andijan.  A bloody confrontation between government forces and opposition elements - over which the jury is still out, though a 2007 Jamestown Foundation report provides dispassionate analysis - resulted in Uzbekistan's sidelining by Western governments and NGOs, which is only now starting to be relaxed.

Part of the thaw is plain power politics: Uzbekistan lies astride a critical supply route leading to Afghanistan, and can be a much-appreciated island of stability in a turbulent region.  As AbduMannob Polat, former chairman of the Human Rights Society of Uzbekistan (and author of the Jamestown study), writes: "A prosperous and democratic Uzbekistan could be an extremely important bridge between the Western and Muslim worlds."  A truism, to be sure.  The conditional tense is crucial: we aren't there yet.  But Uzbek bodies like the Civil Society Institute, with crucial assistance from institutions like the OSCE and NDI (also from the European Union and the Council of Europe), are engaging with the outside world.

As longtime campaigners for the rule of law in Uzbekistan know, the transition from centuries of Czarist then Communist rule does not come overnight.  There are ups, and there are downs.  Dialogue helps, and "constructive engagement" - though dismissed by purists as providing cover and abetting repression - can also be a way of maintaining a positive influence, and has born fruit.  Uzbekistan has an active ombudsman in the person of a respected parliamentary deputy, and the country banned capital punishment in 2008.

I have no illusions that the ways of Uzbek politics are every bit as labyrinthine as those of the Middle East, of which I know enough to know what I don't know, to paraphrase an ex-US Secretary of Defense.  But there is a window opening up, as much for Uzbekistan as for the West.  And it's not just the West: Uzbekistan still must deal gingerly with overtures from its former overlords in Moscow, and President Karimov currently chairs the SCO, the Shanghai Cooperation Organization.

"Great Game" aficionados will put this down to East-West jockeying for influence in a resource-rich, strategically located country, and that cannot be denied.  But that will happen anyway.  Uzbekistan, despite what a NY Times correspondent intimated recently, is not Chechnya.  The question is: are ordinary Uzbek citizens better off with - or without - the presence of Western institutions pressing for rule of law and human rights?  How "righteous" is it to leave them on their own?  Engagement, however problematic and trying on the nerves, can bring results.

Streetcars On the Silk Road: Post From Tashkent

Uzbekistan's capital is the metropolis of Central Asia.  With a population of over 2 million (I heard one guesstimate of 4 million), Tashkent was the Soviet Union's fourth city, just after Kiev.  Its cosmopolitan nature shows, and its people are a kaleidoscope of humanity.

It's a city of wide sidewalks and even wider boulevards, though central planning also endowed it with an impressive public transport system, replete with metro, trams, and buses.  Though the city is marking its 23rd century, you have to look hard to find buildings that predate the devastating 1966 earthquake.

Thanks to a conference colleague from an NGO, a longtime Uzbekistan hand, I was able to see a few of those vestiges, including a madrassa that has been converted into a sort of artisans' colony (lower right).  A taste of what the country has to offer.

I wish I were here longer, maybe fitting in a visit to Samarkand or Bukhara, well-preserved gems on the ancient Silk Road.  Next time, perhaps.  For now, it's conference time - more on that later, when I return to Brussels.

Man Of the 20th Century, Walter Cronkite

When legendary BBC/PBS commentator Alistair Cooke died a few years ago, it was like losing your grandfather, whose wisdom you would now have to do without.  Now we've lost Walter Cronkite, who told us every night "And that's the way it is."  Great was the impact of these authoritative chroniclers of the Twentieth Century.

Cronkite, who hosted a weekly documentary series "The 20th Century" as well as two decades' worth of the evening news for CBS, epitomized the best of broadcast journalism.  His presence was reassuring, even if the news he was relating was of the most jarring sort: war (Vietnam), assassination (the Kennedys, MLK), or revolution (Iran, and the ensuing hostage crisis).

In TPM, David Kurtz provides a touching remembrance of a childhood influenced by this father figure.

The passing of Walter Cronkite also reminds us of the demise of The News, as in "did you see The News last night?"  It was mainly a reference to Cronkite's CBS Evening News, and it invariably included reports from a string of American correspondents positioned across the globe.

Cronkite and his international team are now gone, replaced by pretty boy (or girl) anchors who rely on technicians whose prowess with pixels cannot patch over the lack of depth or analysis.  Cronkite had an amazing team of journalists, reporters like him who had covered World War II with Edward R. Murrow: men like Eric Severeid, who died in 1992, and Richard C. Hottelet, whose work had landed him in a Nazi jail.  Cronkite and his colleagues were literate, homespun, authoritative, and must have been appalled in ensuing years by the downward spiral of TV "journalism" that is embodied by the likes of Fox News.

Readers in the US will be able to watch the CBS tribute, "That's The Way It Was: Remembering Walter Cronkite" (image), tomorrow Sunday 19 July at 7:00 PM EST; for the rest of us, they have put up a nice page of text and video here.

Walter Cronkite, the original "avuncular American."

Planet Earth: The Final Frontier

Yes, yes.  Happy 40th moon landing anniversary, NASA.  There are celebrations galore to mark the event, which I suppose is fine, given the general gloom prevailing.  But let's not get carried away.  There is nothing on the moon - or on Mars - that is nearly as important as there is on Earth.

Listening to all the Apollo nostalgia, you hear lots of stuff about not only exploring Mars, but colonizing it.  And some even see this as the ultimate escape from a dying Earth.  These people, I submit, have watched too many Star Trek episodes.

Even former astronaut Buzz Aldrin has succumbed to the mania, calling in today's Washington Post for "the first homestead in space: an American colony on a new world."  Oh my.

Climate change on a vast scale has reshaped Mars. With Earth in the throes of its own climate evolution, human outposts on Mars could be a virtual laboratory to study these vast planetary changes.

Well, Buzz, the real life laboratory is Earth in the here and now, and the goal has to be keeping Earth green and livable, not studying how Mars became the Red Planet.

Almost every day, there is a new dire report on how bad things have become so quickly, whether it's our seas becoming acidic, our glaciers melting, or the tropics heading north.  Doing the necessary on an urgent basis - drastically reducing greenhouse gases, protecting forests and wetlands, to name only a few priorities - will require effort that will dwarf that of the space program.

Do we want to divert precious resources from the fight to save Earth to mount a quixotic attempt to colonize a planet millions of miles away?  Talk about a distraction from Priority Number One.  Maybe we need a massive "place branding" campaign for the place that can't be replaced - Earth.

I'm no Luddite, and admit that research for space exploration has produced highly useful spinoffs in the battle to save planet Earth.  But we Earthlings cannot entertain notions of trashing our planet and finding refuge on Mars.  We can't just continue to pollute our way to the next pristine wilderness; there aren't any left.  It worked for a while - picture American pioneers heading ever Westward - but the trash builds up, if not in landfills, then in terms of carbon trash in the air and in our oceans.  The atmosphere - the ultimate bubble - holds it all in.

So honor those astronauts, engineers, and scientists who gave us the original Moon Walk, but harbor no illusions about Mars providing a home away from home.  And the next time you hear a politician go on about Mars exploration, bring him down to Earth.

(image: AppleWorks clipart)

Charles Bowden, Chronicler of Mexico's Drug War

"Gunmen Boldly Attack Federal Forces In Mexico," reads the AP article after yesterday's multi-city attacks.  Reminded me of two essential-reading articles by American journalist Charles Bowden.  If you want to learn about Mexican realities, you can't find a better source.

I don't purport to know much about Mexico, other than this: it is the world's most populous Spanish-speaking country, and its 100 million + people share a border with the United States that stretches for more than 3,000 kilometers.

And this: "In 2008, more than 6,000 Mexicans died in the drug violence, a larger loss than the United States has endured during the entire Iraq War."

The quote is from Charles Bowden's article in the July/August issue of Mother Jones, "We Bring Fear."  Nothing tops its portrayal of an honest Mexican journalist who had to flee from the Mexican Army in fear for his life.

Bowden is a master of suspense, of making you care for his subject.  "We Bring Fear" makes the reader share the fear of Emilio Gutiérrez Soto, who has crossed the Army by writing stories about the utter impunity with which it carries out its work.  And the matter of the Army's complicity in the very drug trade that it has been charged to fight.

Read Bowden's article to see if Gutiérrez Soto obtains asylum in the US, and the rest of MoJo for its "Totally Wasted" issue devoted to the never-ending War On Drugs.

For a look inside Mexico's drug cartels, Bowden's "The Sicario: A Juarez Hit Man Speaks" in the May Harper's is riveting reading.

The term sicario goes back to Roman Palestine, where a Jewish sect, the Sicarii, used concealed daggers (sicae) in their murders of Romans and their supporters.

There's nothing "patriotic" in the work of the modern Mexican sicario: just dealing out death, in all of its most horrid forms, to those who fall afoul of the cartel.  Oh yes: Bowden's repentant sicario is a policeman, whose work for the cartel was indistinguishable from that of his day job as a cop.

Bowden's reporting from the field ("Juarez is a death machine") is nothing less than heroic, and he is an acknowledged expert on the war on drugs and undocumented migrants.  He lives in Tucson, Arizona.

With the border - a few miles south of Tucson - as porous as it is, I hope for his sake that he lives in gated community.  Except, as we learned from the Mexican/Uruguayan film La Zona, walls don't afford protection when the barrio is everywhere.

(Map: Mapas-de-Mexico.com)

Obama Challenges Africa's "Big Men"

 

Kente cloth, Ghana

Across Africa, we have seen countless examples of people taking control of their destiny and making change from the bottom up. Make no mistake: history is on the side of these brave Africans and not with those who use coups or change Constitutions to stay in power. Africa doesn't need strongmen, it needs strong institutions.

President Barack Obama, Accra, Ghana, 11 July 2009 (text)

In Chinua Achebe's 1966 novel A Man of the People, "Chief the Honourable M. A. Nanga, M.P." calls the shots, pulls the strings, does everything for His People that a Big Man is supposed to.  All the while helping himself to public money and quashing dissent.  As Somali journalist Abdi Guled recently wrote, confronting the "Big Man Syndrome" in Africa is one of the Obama Administration's major challenges on the continent.  Today's speech was a good step in that direction.

Many Africans might look at Mr. Obama himself as the biggest of Big Men, as a son of Africa who has made it in the West (understatement), and might now be counted on, in time-honored African fashion, to be the Big Benefactor and send more money back "home."  But the President is having none of it:

[T]he true sign of success is not whether we are a source of perpetual aid that helps people scrape by — it is whether we are partners in building the capacity for transformational change.  Aid is not an end in itself. The purpose of foreign assistance must be creating the conditions where it is no longer needed.

Though much anticipated and well-received, the speech appears to be continuation of many programmatic themes of US policy.  Obama gave due credit to George W. Bush's initiatives on health care, though it must be said that even in a country as democratic as Ghana, the best health care is available to elites, and is usually found in the Military Hospital, in capital cities across the continent.

That other Bush initiative - the establishment of AFRICOM - was put in proper perspective, just after diplomacy: "our Africa Command is focused not on establishing a foothold in the continent, but on confronting these common challenges to advance the security of America, Africa and the world."  Obama's mention of "foothold" may be seen by Africans as a reference to Bush Administration frustration in its early attempts to get African support to site AFRICOM headquarters on the continent.

The strength of Obama's "Good Governance" speech, as former Ugandan Foreign Minister Olara Ottunnu said on a BBC program, may come from his "moral authority as a son of an African intellectual."  His reminding African audiences that poor leadership - not colonialism - is responsible for "the destruction of the Zimbabwean economy," for the use of child soldiers, for tribalism, nepotism, or corruption, is made all the more credible because of who he is.

The Big Man in Africa is a reality, and the realist in Obama knows that he will have to continue to work with African Big Men, in presidential palaces and governor's mansions from Cairo to Katanga.  But today's speech mentions Africa's unsung heroes, "these brave Africans" - people from civil society and the civil service who fight injustice and corruption.  Obama's singling out of those courageous people and organizations should provide encouragement to young Africans who hang on his every word.  And make the Big Men feel slightly less comfortable in their plush palaces.

Africa Welcomes Obama

Photo: TouringGhana.com

Barack Obama chose well for the venue of his first sub-Saharan Africa visit as President.  Ghana, as the BBC's Martin Plaut writes, "ticks all the boxes"

Not only is Ghana clearly democratic, but it has some of the African oil on which the US increasingly depends, and there is the symbolic link with slavery, from which so many African-Americans trace their heritage.

Plus Ghanaians deserve to be put forward as a model for other Africans who live in countries not quite as enlightened.  Their country's reputation was not always quite as positive as it has been in recent years.

(Photo, Ghanaian slave "castle" Fort Good Hope, 2005)

The public diplomacy people who helped prepare this inaugural trip had an inspired thought when they invited Africans' comments, which have been pouring in by SMS, email, etc.  Using the best texting shorthand, this is one of my favorites:

Dear Mr President B Obama! Welcome 2 Africa! Congrats 4 ur election! N greetings n blessings 2 ur family! Wat will b ur new foreign policy towards z Islands of SWest of Indian Ocean including Diego Garcia ? Take care ! All z best n God bless!
Mauritius

Actually, I have been wondering the same thing (about Diego Garcia and its exiled inhabitants).

Presidents have very limited time on these foreign trips, and the Obamas are fortunate to be able to visit the Cape Coast Castle, much more spectacular than my little castle here, which has been turned into a very modest hotel (possibly brothel) on a seldom-visited part of Ghana's coast.

Too bad they don't have enough time to make a pilgrimage in Accra to the final resting place of W.E.B. Du Bois, the African-American writer and one of the founders of the NAACP, who decided to settle in the newly-independent Ghana of Kwame Nkrumah in the late 1950s early Sixties.

I will be listening to the President's speech, to be broadcast live on the BBC.  Stay tuned for comment.

Eight Is Not Enough: Turn G8 Into G20

Michael Jackson’s televised funeral turned out to be rather dignified, surprising those who expected the worst from a crowd of fanatical fans. But that doesn’t mean I approve of the time the world's media wasted on this distraction.

So far, the G8 summit in L’Aquila has produced photo ops galore for host Silvio Berlusconi, and we’ve been spared the promised release of compromising photos of the Italian PM with his “Lolita harem.” So far. Is this supposed to make us happy?

I wish the leaders gathered in the ruined Italian city well, and give them credit for saying responsible things concerning climate change. But consensus of eight of the world’s two hundred plus countries, even though they be eight of the richest, is not nearly enough. I’ve said it before: it’s time to can the G8 in favor of the G20.

The members of the G8 know that they are not representative of the world. They keep inviting other countries to add voices from the South - the G5 has weighed in with its own formulations - and Berlusconi himself has been talking of a “G14.“

I have friends who have been intimately involved in the organization of prior G8 summits, and much credit goes to them and other “Sherpas” who do the hard preparatory work which is the essence of these meetings. But just like Nepali Sherpas who do the drudgery of hauling mountain climbers’ loads up to the summit in the Himalayas, once the photos are taken and the ink dries on the summit communique, the Sherpas and their bosses head back home.  And resume preparations for the following G8: 2010 in Huntsville, Ontario, where they will experience “the warm hospitality of Muskokans,” according to Canadian Prime Minister Stephen Harper, in this “jewel in the Canadian Shield.” The PM added that summits (this will be Canada’s fifth as host) are good for the local economy (to the tune of $300 million).

No doubt that consideration was uppermost in Berlusconi’s mind when he switched the venue of this year’s summit to earthquake-striken L’Aquila from the Sardinian town of La Maddalena, but not before spending some €300 million (a stimulus package or “the G8’s legacy to the island”) needlessly on the unused venue.

There is always a tendency in international organizations to create steering groups.  In NATO, the big four of the US, UK, France, and Germany will often meet to set the outlines of Alliance action, and within the EU, similar - if shifting - groupings among the biggest countries try to move the institution.  But with the advent of last April’s London G20 meeting, in the aftermath of the world’s richest countries leading the way to global impoverishment, the G8 met its logical - if unacknowledged - end state.  This unrepresentative group has no credentials with which to “steer” the rest of the world.

So, PM Harper, here’s your chance: make Huntsville the venue for a change-of-command ceremony, the G8 handing over the reins to the G20, and giving the institution a small but permanent secretariat, so that those Sherpas can have a home away from home.

This first appeared in the Euractiv blog Errant European.