No good options: the quandary of military interventions
Military interventionism is back in the news again with the situation in Libya. Let's run through the calculus that would-be interventionists have to go through.
If we go in unilaterally, we may look like we're doing so purely out of self-interest, and are after something (like access to a natural resource, a staging area for other operations, etc.) We will wind up being painted as colonialists, imperialists, and people who don't respect national sovereignty. This tends to inflame those who despise us even more, strengthens their resolve to harm us and drive us out of places, and opens us up to reprisals. It also places all of the (logistical, financial, equipment, and human) burdens on us, ultimately leaving us weaker, and leaving us more vulnerable in the event of a conflict of our own (do we have enough troops? Are they worn out? Is our equipment in tatters?) It's also possible that we can make things worse, either in the short or long term (we empower the wrong group, who turns out worse than the last or winds up our enemy; collateral and infrastructure damage; logistical mistakes that lead to the side we support losing.)
If we try to intervene multilaterally, we have another set of problems. We may spend too much time dithering, discussing the morality, ethics, politics, outcomes, and logistics of the issue, that by the time we get ready to do anything, the facts on the ground have changed (the rebels lose/win, the genocide is complete, etc.) We also have the issue of double standards; we intervene when it comes to smaller, weaker countries (particularly those without nuclear weapons), but when it comes to larger, more powerful (and in some cases more brutal) countries, we all have to play nice. This has undermined the credibility of all sorts of international organizations (the UN human rights org., the Hague, the UN Security Council, etc.) On top of this, many of those on these councils, if we were to judge objectively (in terms of human rights records, etc.), do not deserve to be there. The other perverse effect is that, knowing that intervention is possible pushes countries to get armed with extremely powerful weapons as quickly as possible to prevent being attacked (as we've seen with North Korea and Iran.) Also, just like with a unilateral approach, we may make things worse.
If we do nothing, many may be tortured, imprisoned, or killed. Entire regional populations could be wiped out. The winners of the conflict (if power changes hands) could be even worse than the previous hegemons. It could spill over into surrounding areas, or ignite an even larger conflict (a civil or regional war.) Huge amounts of infrastructure can be destroyed, leaving survivors without clean water, access to transportation, or access to health services, leaving many to die of starvation or disease.
It may seem like an easy choice, regardless of which option you support. In reality, those faced with these decisions have anything but an easy time of it. As we can see from the above, the reality is that there are often no good options.
Earnestly Pursued Oblivion [song]
This song is about America's failed Drug War and its damaging effects on the country. From attacks on entire groups to leading us into sordid alliances with violent organizations who would later call us their enemies, the Drug War continues on, providing a raison d'etre and great profit for many - who have no desire to change the status quo, all while helping to discredit those that continue to support it.
Note: full explanation coming soon. For now, just the lyrics.
Embrace
A permanent war of attrition
Underclass directed
but it can never work
"It is unconscionable in this country to continue to carry out public policy of this magnitude and cost without any way of knowing whether, and to what it extent it is having the desired effect."
The drug war has no interest in its own results
One million every year
You strengthen the thing you try to destroy
We can win, we can win - we can't win
It's a misnomer...wars end.
Monsters of our own creation
When will they learn?
You call it moral midgetry
The greater harm comes from your misguided crusade
"The passing of an unjust law is the suicide of authority."
It's not a war
Wars end
Desires underlying calls for universal health care and some reasons for over-utilization
I think it's important for critics of the idea of universal health care systems/reform (whether it be single payer or any other system more sane than we have now) that what many of us want out of a universal system has much less to do with outcomes, per se, and more to do with freedom and security. Outcomes should be reasonably good (certainly better in the median case than we have now - let's say, outcomes on par with Canada, which isn't perfect), but the main thing is *we want to stop worrying that care will not be there when we need it or that we'll go bankrupt if we have a serious illness or injury.* We want to NOT have to consider "can I change jobs? Can I quit my job and start a business? Can I afford to hire an employee? Can I risk going skydiving? Is it safe to ride my bike? Damn, I can't because I won't be able to afford health insurance/care!"
Many universal care advocates (though my no means all) would live with "smart rationing" if it meant we could get care when we /really/ needed it and not go bankrupt-like when we break our spines or get cancer.
The other things that I think need to be made more obvious to everyone, though they already should be is the following two facts:
1) If people believe that more care (meaning more doctor visits, tests, etc.) means that they are "healthier", then they will over-utilize it. If we had a universal system, we could have doctors say "based on what you tell me, these are the tests/whatever I am going to order. This is included in your tax-funded care. If you want special tests beyond this, you can pay for it out-of-pocket." Then we have a shared database which shows what a patient has complained about, had tested, etc. Then, if they show up at doctor #3 (maybe we allow two opinions to be safe), they are refused further tests or treatment without paying. Also, convince people that what they need is smarter, not more, care. This could be everything from lifestyle education to understanding medical diagnoses better. There's a lot to be done here.
2) Much bigger issue: we only get one life, and we may (rightly) believe that any ache, pain, strange feeling, etc. could *actually* be life threatening, so we go and have everything under the sun tested. This is not a crackable nut with current technology. There are a zillion things which *might* be killing you at any given time, and we are understandably worried about them. What we /really/ need is technology that monitors everything in your body, in real time. You should be able to see not just the basics like blood pressure or heart rate, but real-time cell growth/tumor growth, you should get real-time signaling about *actual* potential problems based on sophisticated, always-on in-body devices that are checking every organ and system to alert you of potential problems. We should be able to see when a pathogen enters our system. We should be able to see *exactly* what nutrients we need. Bottom line is that our technology is very, very far from our health visibility needs. What we have now is the equivalent of trying to diagnose transmission problems by looking at the *outside of the car.* Is it any wonder we're "wasteful"? We grasp at the only things we have to even ATTEMPT to monitor our health (going to a doctor and explaining), pathetic though it may be.
You might have nascent brain cancer right now, but you have no symptoms, and you aren't in a high risk factor group. You never even consider that it might be the case. It never enters your doctor's mind to test for it. Then, a few months later, you die. I'm sure this idea has kept many an over-utilizer up at night, because they HAVE considered it (I've seen this happen with cancer several times - young, seemingly healthy people who go for regular checkups and don't do anything out of the ordinary to endanger their health have just died of cancer very quickly.)
If our cars were as prone to exploding without warning the way our bodies are prone to disease and death without warning, we'd be at the mechanic every day.
To sum up, the current health insurance system doesn't feel like insurance. It feels like a very expensive straitjacket when it should feel like a lifejacket, and
the /real/ visibility into our own health is laughably bad due to the state of our health technology so we turn into over-utilizing fools who don't get better outcomes. We want a health system AND technology that makes us feel free and secure, like any useful safety net. We have neither.
This was originally a comment on this post about improving health care outcomes.
