A site for those who seek insight, occasional inspiration, a dash of humor, and solid analysis. Welcome to classical liberals, liberal hawks, clear-eyed conservatives, and anyone else who is a genuine friend of democracy, freedom, science, truth, and justice.
Monday, September 30, 2013
Saturday, September 07, 2013
- “the day after and the day after that”
- Removing Assad and installing a decent government
- Securing or destroying chemical weapons in Syria
- Setting up safe, no-fly, no-drive zones for civilians
- Destroying Assad’s air-force, ports, and artillery
- Defanging foreign (al Qaeda, Hezbollah, and Iranian) forces in Syria and supporting the “good guys” (e.g., the Free Syrian Army)
- For decades after the Cold War, we had 2 major allies in the Persian Gulf, and after 9/11, as it was becoming clear we had to vacate Saudi Arabia, it was a real possibility that we had no allies in the Gulf. The War allowed us to leave Saudi Arabia and still maintain primacy in the Gulf until our North American oil revolution took off
- Direct consequences of America’s intimidation of others in the Middle East due to the crushing and apprehension of Saddam included the switching of Qaddafi to being cooperative with the West, which led to the roll-up of Pakistan’s A.Q.Khan “Nukes R Us” network, as well as Syria’s withdrawal from Lebanon.
- Grinding-down of al Qaeda forces which came to Iraq after the war to fight America in a flat desert
- While tens of thousands of Iraqis died due to American mistakes and incompetence post-war, Saddam was killing similar or greater numbers of Iraqis in his rule, a reign of terror which was ended in favor of a decent chance for Iraqis to make their government worthy to serve its people. Certainly the Kurds and Shiites (who together are a sizable majority of Iraqis) are a lot better off.
Monday, August 26, 2013
Wednesday, December 12, 2012
- · Let’s cut taxes on income, saving, and long-term investment (defined as >5 years) to 10%. Remove all deductions except for charity and children. Let’s tighten up the charitable deductions to only organizations that don’t engage in political campaigns and make the child deduction a deduction (not credit) upto $30,000 per child.
- · Let’s eliminate corporate income taxes but also eliminate corporate welfare and subsidies (such as for sugar, corn, and oil companies).
- · Let’s add taxes on sales and imports of 10% (produce and non-processed groceries exempted). This could be paired with foreign policy to reduce or waive these duties when appropriate on a most-favored nation status basis.
- · Let’s also add taxes of 10% on exotic financial transactions (credit default swaps, collateralized debt obligations, derivatives, etc.) and tax short-term investments at 26% (decreasing steadily with each year of investment to 10% after 5 years of holding).
- · End federal incentives to take on debt (e.g., home mortgages, student loans). For the truly needy or meritorious, provide increased grants in the spirit of a hand-up, not hand-out, e.g., scholarships for programs of study that increase long-term economic potential (e.g., science, technology, engineering, business, math, law, health care, English)
- · Let’s raise taxes on alcohol, tobacco, processed foods, high-fructose corn syrup, trans-fats, and marijuana (where it’s been legalized) and start increasing federal gas taxes by a penny a month, indefinitely.
- · Let’s add a 10% tax on lobbying and campaign political ads for corporations, organizations, or entities that don’t pay any taxes. This is not a speech issue, but rather organizations/entities that don’t pay income taxes (and hence don’t vote) should not seek to influence tax policy, or at least should pay a toll to do so. Just as there should be taxation without representation, I do not feel there should be representation without taxation.
- · On the entitlement side, Social Security and Medicare were initiated were longevity was far less than today. We should increase retirement age slowly but steadily, perhaps 1 year every 5 years. Benefits should be means-tested for both these programs as well, while increased opportunities for private retirement and private health accounts (with some matching government contributions) should be developed for younger Americans.
- · Change incentives for primary care practice to encourage more physicians to enter it and focus reimbursement of primary care on keeping patients healthy as opposed to fee-for-service. Physicians could help here by starting a “guild fund” donating 1% of income to ensure medical students would graduate with minimal or no debt, in exchange for new graduates committing to a minimum 2-4 year program of primary care service in underserved areas.
- · Start a health information card for each person as a portable electronic record and get rid of the onerous EMR requirements but have prizes for interoperability and reductions in errors
- · Health savings accounts where federal dollars would match individual savings (to be used for medical expenses over time and every decade, a distribution could be taken as a reward for savings). Over time, this would get insurance companies, government bureaucrats, and lawyers out of the doctor-patient relationship, and let doctors work directly for patients rather than for third-party regulations, documentation, or mindless box-checkers.
- · Allow basic health insurance plans that cover just catastrophic events
- · Increase costs to egregious adverse behaviors (e.g., driving drunk, not vaccinating one’s children, etc.) while incentivizing good behaviors (e.g., by reducing premiums for keeping a healthy weight, quitting smoking, etc.)
- · Give pharmacists the ability substitute in-class (not just same chemical) generic drugs for specific indications unless the doctor specifically wants a brand, and the chance for individuals to buy into Medicare, Medicaid, or private insurance if they so please.
- · Make the patent protection clock for drugs/devices start from FDA approval as that is when they can be marketed. This would allow drug companies a longer period of time to recoup their R&D costs and reduce the immediate price pressures that occur after approval.
- · Let patients know that the longer they wait to buy into health insurance, the higher their premiums would be (much like Australia’s health coverage system or America’s life insurance policies). Also, for specialists, let there be a free market in services.
- · Increase research funding for optimizing patient care and translational/innovative programs geared for bringing new treatments forward.
Sunday, October 21, 2012
The standard defense by Mr. Obama's defenders (and himself) on his dismal economic record is that he inherited a bad situation. Leaving aside that it is unseemly to whine about a bad hand for 4 years and that it is customary for Presidents to take blame or credit for the economy on their watch (as well as their own metrics for success), let's examine Mr. Obama's performance against those of Presidents FDR, Reagan, and Clinton, who also inherited bad economies. Mr. Obama received an unemployment rate of 7.8% in Jan. 2009, which is where it is in Sept. 2012; civil labor-force participation rate fell from 65.7% to 63.5% in that period. Mr. Clinton received an unemployment rate of 7.3% in Jan. 1993 and brought it down to 5.2% by Sept. 1996, while increasing labor-force participation from 66.2% to 66.9%. Mr. Reagan was greeted by 7.5% unemployment in Jan. 1981 which he brought down to 7.3% in Sept. 1984, while increasing labor-force participation from 63.9% to 64.4%. FDR brought the unemployment rate down from 25% in 1933 to 14.3% by the end of his first term. By any standard, Mr. Obama has failed, and should not chalk up his failure to his predecessor.
Friday, September 30, 2011
When do US citizens forfeit their rights?
The US government killed Anwar Al-Awlaki today. This was a premeditated liquidation – Al-Awlaki, a US born citizen turned leader of Al Qaeda of Arabian peninsula, was put on a list for targeted killing last year. I do not mourn for this man – he was a traitor and a terrorist and got what was coming to him. Some people and some ideas in this world, especially the radical Islamic fundamentalists, should be wiped out.
And yet. What was done today, while a significant tactical victory, sets a horrible and dangerous precedent. The US President just ordered and the US military executed an assassination of a US citizen in a foreign country with whom we are not at war. Granted, this man was a bad guy and an enemy of the state, and a threat to America. Yet this killing was not done during the course of a battle nor was any judicial process or congressional oversight involved in the targeting of this US citizen. Citizenship means something. The USA is distinguished from most other nations in how it treats its own citizens. In my humble opinion, how this killing was done is comparable to how Russia killed Alexander Litvinenko in London a few years ago – a targeted assassination of their own citizen who they considered an enemy of the state in a foreign country. It is a very dangerous concept that should not be legitimized.
The justifications given for this killing ring hollow. Some cite the case of Herbert Hans Haupt, a US citizen turned Nazi saboteur who was executed after infiltrating America in 1942. Yet Haupt received a military tribunal hearing prior to his sentence. Some state that a court considered al-Awlaki’s father’s challenge to the placement of his son on the hit list and that the court duly rejected the father’s plea as he had no standing and that the son was free to seek the protection of the court; would you return to a court of a nation whose President has put you on a hit list? This same court said that the government requires a warrant to tap Americans overseas, but extrajudicial killings of Americans are beyond judicial review; such a statement is patently absurd. Others state the 2001 Authorization to Use Military Force gives the President authority to use all necessary force to destroy Al Qaeda and its affiliates, and that the Article II investiture of the Commander-in-Chief powers (including powers to suppress armed insurrection) in the Presidency is beyond question. Yet this a short road to carte blanche murder – do we want to invest one man with the power to designate US citizens at will as enemies of the state as part of the war on Al Qaeda?
With the one caveat that I am not privy to any knowledge of Al-Awlaki’s imminent threat capabilities, I would think that the right way of handling this case would have been to long ago try al-Awlaki in absentia for treason with appropriate counsel for his defense and strip him of his citizenship if conviction resulted. We certainly had the time; this guy was placed on the President's kill list over a year ago. Treason is something we don’t try anymore, and I don’t understand why.
This is qualitatively different than Guantanamo, waterboarding, or collateral damage. Constitutional rights do not extend to foreign citizens (lawful enemy combatants are entitled to Geneva protections, and unlawful enemy combatants aren't; they should receive basic human rights and, like pirates, fall under enemies of humanity rules). But US citizens do not forfeit their rights against the US government when they go abroad. They would forfeit in active combat with the US military, or upon conviction of a crime (and treason is certainly a crime). Law enforcement and the military have the right to self-defense. But the US government doesn't get to do what it wants to a US citizen and throw out the Bill of Rights when it's inconvenient. The President is not an elected king. US citizens at a minimum have the negative rights (what the government should not do to them) enumerated by the Constitution and the Bill of Rights; they are not forfeited by being abroad. They are forfeited by treachery which is established by due process - the American Communists Julius & Ethel Rosenberg were executed after a trial, not by assassination.
The Obama administration has set all kinds of dangerous precedents this year – going to war with Libya without any congressional debate comes to mind. Then it was the Bureau of Alcohol, Tobacco, and Firearms (which reports to the Attorney General) distributing guns to Mexican drug cartels. Now it’s assassination of a US citizen. This goes against the Declaration of Independence, the Constitution, and the Fifth Amendment. This is unbridled executive arrogance. This is wrong. Something wicked this way comes.
Monday, April 25, 2011
Sight for the Sightless
I just got back from an intense week serving on a medical mission through the Sight for the Sightless Initiatve based at KK Eye Institute in Pune, India. This was a very different experience from any of my ORBIS missions or my Zambia mission in many respects. India is fascinating from a medical perspective in that it has first-rate physicians with some centers comparable to those of America but the population has masses of patients who have the health status of Africans. The country is in transition, with medical personnel & infrastructure highly capable yet simply overwhelmed by the sheer number of those in need, as well as hobbled by a lack of top notch equipment, instruments, and supplies.
For background, there are likely 20 million patients with at least one blind eye from cataract in India and about 8 million with corneal blindness. There are only 13,000 ophthalmologists in India, as opposed to 18,000 ophthalmologists in the US (which has only a quarter of the population). From a corneal perspective, donor tissue is much less available in India (unfortunately there is not as yet a well-developed culture of donation on passing away). So my objectives for the week were to do both service in terms of medical and surgical treatment of cornea and complex cataract conditions and skills transfer in advanced techniques and technology.
It was a physically grueling and emotionally exhausting week. With lectures, clinic, and surgery, we got done pretty much at 8 or 9pm each day (starting each day at 8am). Business dinners on future planning and needs followed, so I pretty much was going on 5 hrs of sleep each day. The most poignant moment was clinic on the first day during which we saw about 20 kids from the local blind school. For most of these children, I was a decade late and a dollar short. While I am a bit of a dinosaur in medicine (having finished medical school before the Internet and residency before cell phone), I was confronted by even more ancient demons this past week: children who had scarred corneas following measles infection when they were infants, children with wrecked eyes from Vitamin A deficiency. There are few things more heart-wrenching than telling child after child there is nothing we can do. There were 3 children who we thought we could help so we proceeded with transplantation later in the week.
Over the next several days, we performed (3 of these were children, the rest adults):
• An artificial cornea on a child who had lost one eye, and had a badly scarred cornea (barely able to see motion) in the remaining eye that was not a candidate for a standard transplant
• A combined cornea transplant with cataract extraction
• A partial thickness cornea transplant of the front of the cornea
• Two partial thickness transplants of the back of the cornea (one combined with cataract removal)
• A full thickness cornea transplant
• Several hard cataract cases and some amniotic membrane procedures
By comparison, I usually do 1-2 transplants a month in the US. These were all challenging cases given the complexity of the tissue damage on the eyes and the circumstances of available and (unavailable) equipment. But the best part (in addition to fixing the conditions and hopefully helping the patients) was teaching. I spent a lot of one on one time at the Institute with a very talented surgeon, Dr. Kapoor, and it was very rewarding to see her rapid progress over the course of the week mastering the techniques of chopping cataracts and picking up key elements of cornea transplantation. We also did some live surgery teaching the surgical maneuvers of some complex cataracts and the artificial cornea to a group of local ophthalmologists, and there were several excellent interactive small group sessions, surgeon-to-surgeon.
There were some funny moments during the trip. The hospital had arranged a press conference noting the complex cases being done that week and highlighting the need for corneal donation. During this, one of the reporters, whose first name was Nozia, came up to me and introduced herself as “Hi, my name is nausea.” It was all I could do to not burst out laughing and think of where else that joke could go. Then there were the episodes in the OR with the cotton buds with extra lint (which are a pain during eye surgery) which I nicknamed after the host and MC for live surgery, Ashiyana Nariani, who in turn promised to send me Q-tips for Christmas. Later on, I was trying to tell the patient to look down in broken Hindi, "Kali Baga Baba"; I apparently was not understandable and told Ashiyana my Hindi was worse than hers, and she told me I was actually speaking in Marathi (which I don't know either :( ). And then there was the ophthalmologist attending the live surgery and lecture workshop who requested to share his experience and promptly proceeded to regaling the audience with his life story, including the name of his childhood neighborhood street.
All in all, it was a fantastic trip. It was enabled by several groups and people to whom I owe great thanks and appreciation. The leadership of KK Eye Institute (Renu Wadhwa – CEO, who helped make things possible) and the international NGO Sight for the Sightless (founded by Dr. Ashiyana Nariani), the clinic and operative staff of the local hospital (especially Dr. Kapoor, Mr. Rohit, Ms. Madhu, Sister Pradhan, and Mr. Sachin), my mentor Dr. Claes Dohlman (the inventor of the artificial cornea who donated one for this trip), Sameera Farazdaghi of Tissue Bank International and Kelby Koop of Utah Lions Eye Bank, and my home team from Utah who organized things on this end: Jackie Simonis, Chandler Crane, and Tina Szarek.
I hope my fellow ophthalmologists and those interested in vision care will join the fight against needless blindness by contributing their time to service and teaching and making a difference where both short and long-term impact can be made. I also hope that developing societies as they develop focus resources on preventing needless blindness through awareness, encouraging eye donation, fighting diseases like the measles and malnutrition. Saving and restoring vision is probably one of the most important and cost effective things we in health care and societies as a whole can do. Especially for children, who are all too often neglected in the developing world.