Vote for 9/12

Tom Friedman is a good author (I recommend "The World is Flat"). But I don't often read his NYT OpEd column. Today's however, is worth a read.

Why War is Hell...

I can think of nothing worse than war.  I suppose there is theoretically such a thing as a "just" war, however, even they are "hell" to experience. 

Two of the worst aspects of  war are 1) the senseless killing of civilians and 2) the institutionalized hatred of different races/ethnicities that war creates.

Both of these challenges were brought home by a weekend editorial in the LA Times...Iraq, the vets' view .   In case you don't have time to read this article I will summarize it.  The author interviews vets who served in Iraq from 2004-2006.  One of the basic themes that repeats throughout his interviews is how fear of IEDs, suicide bombers and such leads many US military personnel to distrust and overreact towards Iraqi civilians.  This creates an environment where US soldiers and marines pre-emptively kill civilians of all ages out of fear that they may be a suicide bomber.  The article repeats numerous narratives of entire families gunned down by nervous young soldiers out of fear (or hatred).  Those who support the war may argue that the author selects stories that reinforce his own beliefs.  That may be true, yet the following study from the Pentagon is also telling.

The antipathy toward Iraqis was confirmed in a survey released in May by the Pentagon. Just 47% of soldiers and 38% of Marines agreed that civilians should be treated with dignity and respect. Only 55% of soldiers and 40% of Marines said they would report a unit member who had killed or injured "an innocent noncombatant." (emphasis mine)

That does not sound like a recipe for building allies and destroying "evil" in a sovereign nation.

Today's LAT reports a different, yet related problem...the gradual loss of experienced mid-level officers in the Army.  Given the recruiting problems the Army is having, and the multiple tours-of-duty (some soldiers and reservists have been sent more than four times since the war began!) being assigned to our troops, as well retirements being denied or postponed and the general impact on ones life of being called up, one can hardly blame these officers from leaving the military at their first opportunity.  However, their departure may have grave consequences for our efforts because it leaves a higher ratio of young, scared, inexpensive, and potentially trigger-happy soldiers and marines without the stabilizing effect of mid-level officers.

Despite some of my colleagues' views, I believe it is time to exit Iraq and put a permanent conclusion to the "Bush Doctrine" of pre-emptive war.

Healthcare and Profit

Several times lately I've found myself frustrated by the economic realities of healthcare as an industry. I can think of almost no other industry with such minimal transparency, enormous information asymmetry, and necessity of blind trust in the professionalism of the provider. (Here is an overview of some of the issues from an economic perspective). The financial accounting industry has some similarities, but is less one-sided.

In any event, much like the financial accounting industry (e.g., the Big 4 Accounting Firms), the economic validity of individual healthcare providers is based almost entirely on trust. When patients no longer trust that a physician is pursuing the patient's best interests they will simply choose a new physician.

However, I've increasingly been frustrated over the past few years with the feeling that nearly all of the physicians I've seen have been more concerned about their own self-interest than mine. Now, to be sure, I'm not saying they aren't interested in my health. I believe they are. However, they are equally interested in their own economic self-interests.

This feeling was given more credibility yesterday when I read the following story from the LA Times. I believe this behavior is symptomatic of the larger cultural rush to a "bottom-line" mentality. It is not different than the behavior of CEOs who cancel pension contracts to meet the quarterly figures, private equity groups who privatize public companies only to bring them back for a new IPO and pay minimal capital gains taxes rather than income taxes on the difference (see Robert Reich's opinion here), or Arthur Andersen accountants who cook the books at Enron in order to maximize their own consulting fees without regard for the best-interests of the shareholders.

Let me be clear...I'm not saying that all healthcare providers are crooked, selfish jerks. I'm simply saying the following:

1. There are several structural elements of the healthcare industry that are grossly inefficient and can easily be biased towards the economic self-interests of those who have the information and thus the power in the doctor-patient relationship.


2. As a profession in a free-market structure healthcare is almost completely dependent upon the unforced trust of consumers.


3. As a culture we have become so obsessed with economic performance that we actually believe quarterly financial performance is the right (the only?) measure for almost every arena of life (see my further thoughts on this here). Healthcare providers are not free from this "rush to the bottom line" but because of the nature of their profession a bottom-line mentality can be detrimental to the trust of consumers and their industry as a whole.