Control uncontrolled healthcare costs through Trubamacare

Controlling uncontrolled Heathcare Costs: Trubamacare (Trump-Obama Care)

The Republican controlled house has finally delivered on its promise to ‘repeal and replace’ the Affordable Care Act, aka Obamacare. They have ramrodded the American Health Care Act, (let’s call it Trumpcare, a counterpoint to Obamacare) through the House and it now sits as a steaming, smelly pile on the Senate’s polished, antique table. A lot has been said and written comparing the two plans. In this post I will concentrate on the following two salient points which tend to get lost in the punditry:

  1. Both deal with how the costs are shared among the different categories of recipients, e.g. the young, the old and the ones with preexisting conditions.
  2. Neither of them deal with the fundamental problem facing our health care system: the uncontrolled burgeoning of health care costs.

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International hotspots under Trump

A Survey of International Hotspots under President Trump

The Trump presidency in fast approaching its 100 day mark. It is time for a quick appraisal of its performance in office. Trump ran on his appeal as a ‘take charge, decisive CEO’ who would rapidly solve all or most of our problems. He started with a travel ban from certain countries followed by ‘repeal and replace Obamacare”. Those did not turn out as expected. But soon international events, some unexpected, overtook domestic policies. I will group the hotspots into two main theaters based on their geography.

Russia, Syria, ISIS and the Middle East

It seemed that under President Trump, a gradual rapprochement with Russia was underway. It would become our partner in combating ISIS. Sadly, that dream went up in smoke as cruise missiles slammed into an airfield in Syria and the FBI continues its investigation into possible collusion of Trump’s election team with Russia during the election of 2016. The chemical attack by President Assad on civilians was ghastly, horrific and contrary to all norms of civilized conduct, in 2013, 2017 and on all the other occasions. Perhaps Trump was genuinely moved by pictures of children gasping for breath or dead babies seemingly asleep, cradled in their father’s arms in Khan Shaykun. Perhaps he wanted to differentiate himself from Obama as a decisive leader who would not hesitate to act if someone crossed a red line. So, he put Assad, Russia, North Korea and the whole world on notice with the missile barrage on Shayrat airbase in Syria. An opening gambit.

But, a salvo does not a strategy make. What is the next step? What are the plans for Syria, for dealing with ISIS and the entire Middle East? The Russians were warned before the attack and this time they quietly stood aside, but they won’t the next time. Relationship with Russia, a nuclear armed power, is at an all-time low since after the cold war and it continues to bolster Assad and his grip on power. This is to Russia’s advantage. Assad gives Russia a secure footprint in the region, airfields, a warm water port in the Mediterranean and a steady stream of refugees that continue to destabilize Europe and NATO, Putin’s dream.

It is not clear if there is a coherent plan for Syria, ISIS and the Middle East in general. We need clarity on:

  1. Can there be a peaceful solution for Syria with Assad in power? If he is displaced, what are the plans for managing the aftermath? Remember Iraq after Saddam Hussain!
  2. What are the plans post ISIS? Once they are driven from Raqqa and other strongholds, what are the plans for a peaceful, inclusive civilian government and who is responsible for ensuring that those places do not degenerate into sectarian violence. The lessons of Iraq and Afghanistan are still fresh in our minds.
  3. Is the US getting gradually sucked into a Middle East quagmire again? We hear of more and more boots being sent to Syria and of our (not so well advertised) involvement in Yemen, a country at the other end of the peninsula. In Afghanistan, next door to Iran, the war is in its 16th year. There, we just dropped a MOAB, the largest non-nuclear bomb in the world. This bomb has been in our arsenal for quite a while but Presidents before Trump had carefully avoided using it. So, what was the reason for using it now?

The USA should not and cannot afford to be the policeman of the world. This is the platform Trump ran on in 2016. This is still true. But history has taught us that unexpected events do happen. Sometimes, after diplomacy and all other options have been thoroughly exhausted, we may have to take extreme measures when our security or those of our allies are directly threatened. But a military solution should not become a reflexive habit just because we have an overwhelming military capability. War should always be the very last resort.

China and North Korea

China is the second largest economy (after the US) and these two economies are inextricably linked. During the election Trump had repeated incessantly that China would be labeled a ‘currency manipulator’ and China would be taken to task for stealing jobs from the US. Now, after dinner with President Xi at Mar-A-Lago, President Trump has reversed his opinion regarding currency manipulation. He now needs China’s help to restrain North Korea’s nuclear ambitions.

North Korea is perhaps the most acute problem in Trump’s inbox but unfortunately with very few solutions, all bad ones. North Korea is rapidly building up its nuclear arsenal and rockets including solid fuel ICBMs that can theoretically reach the United States. That is indeed alarming. However, threatening a volatile, insecure, young dictator like Kim Jong Un with an aircraft career strike force may not be a good idea. He could retaliate unpredictably and preemptively. Seoul is just 35 miles away, within range of his conventional artillery and his huge army is poised just across the DMZ.

China shares a land border with North Korea, is its biggest trading partner and the only country that has the best chance of persuading North Korea to change course. Here again, instead of saber rattling, a diplomatic solution with all the regional powers, China being the predominant one, is needed.

President Trump is clearly learning on the job. That is not necessarily a bad thing. What is disquieting is how diametrically opposite some of his current views are from what he said during the election. What were those statements based on? That is a fair question. And what would his ardent, vociferous supporters who cheered him then, think now? I am just curious.

The Corniche skyline Doha

In Transit: A delightful Day in Doha

The intercom hummed into life and I sat up with a start, the eye mask still wrapped incongruously around my face. “Ladies and gentlemen, we are beginning our descent to Hamad International airport…”.  I had fallen fast asleep. I buzzed the stewardess for a wake-me-up cup of tea as the large Airbus turned and settled into its long descent towards Doha. The sun was just beginning to peep over the horizon.

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Suu Kyi, Rohingya plight and three steps to a solution

Aung San Suu Kyi, the Nobel Peace Prize and the Plight of the Rohingyas.

The problem

On rare occasions, the Nobel Peace Prize is given to someone with an eye to the future in the hope that he or she will live up to its lofty expectations. In 1991 it was given to Aung San Suu Kyi, a young, well-spoken, charismatic politician from Myanmar, for her “non-violent struggle for democracy and human rights”. She led and pitted her party against the established military junta and won. Myanmar, under her stewardship was poised to come out from military repression and join the world community as a budding democracy. It was an auspicious beginning. But, how soon perceptions change when faced with real events on the ground.

A little history

Myanmar, once known as Burma, is a country of 53 million. It is a tropical paradise of dense forests, wide rivers and golden pagodas. The vast majority of its population is Buddhist. It became part of the British Empire when the British subjugated the Arakan and adjoining kingdoms. From the 17th century, the Empire had imported laborers from Bengal (now Bangladesh) bordering the Rakhine province of Myanmar to work in the fields, forests and ports of Rakhine. Many came voluntarily and settled in Rakhine because there was work to be had. Their descendants and others are the Rohingyas, Muslim by religion and now over 1 million in number.

The Rohingyas are possibly the world’s most persecuted minority and the largest single group of stateless people. They are not accepted as citizens of Myanmar even though many have lived there for generations. They are considered outsiders, interlopers, ‘Bengalis’ who came from Bangladesh. Unfortunately, Bangladesh does not consider them its citizens either and so not its problem.

Myanmar has over 100 official ethnic groups but ‘Rohingya’ is not one of them. Consequently, Rohingyas have very few rights. Myanmar law does not protect non-citizens (read Rohingyas). They live on the fringes of society often without access to education or health care. In 2012 tensions boiled over and communal riots broke out between the Buddhist Rakhines and Muslim Rohingyas. There were charges of ethnic cleansing and genocide as close to 140,000 Rohingyas were forced to flee and now live in squalid refugee camps around Cox Bazar in Bangladesh. Over 25,000 fled by boat to Indonesia, Thailand and Malaysia with the inevitable human trafficking and exploitation that accompanies the exodus of desperate humans. Hundreds drowned in the process. Militant Rohingyas retaliated against Myanmar border guards and this was followed by the inevitable, heavy handed crack down by the army. There were credible reports of gutting of villages, killings and rape by the army.  The sad story continues, but the goal of this article is not to chronicle them but to explore avenues for a solution. Here are three points worth considering.

Three steps towards a solution.

  1. Aung San Suu Kyi should speak out more forcefully on the Rohingya issue, but she avoids using the term ‘Rohingya’ because it is “controversial”, not ‘official”. She was awarded the Nobel Peace Prize for her work on human rights. She now has to prove she deserved the honor. To do this, she has to use some political capital and stand up to the army and the ethnic Rakhines. This is politically unpopular, she knows that she needs the army’s blessing to stay in power. But sometimes one has to choose what is right over what is expedient. Rohingyas who have lived in Myanmar for generations do have a right to citizenship. She has to speak up, her silence is deafening. The good news is that talks between Myanmar and Bangladesh have begun, a first, welcome step. But they cover only 65000 Rohingyas while over 500,000 have fled to Bangladesh.
  1. The international community should exert pressure on the Myanmar government to find a solution to the Rohingya problem. The international press has been woefully negligent. Only when the bright light of the press is focused on the problem and international condemnation is brought to bear will the ruling party in Myanmar agree to address this issue. Only when Syrian refugees started to trek into Europe did the Western press start reporting on it. Only then did it become a big refugee crisis with discussions in the UN with plans and resources to combat it. World news in the US and Europe show Asian refugees being rescued in the Mediterranean and UN refugee camps in Lesvos, Greece. That is good. The Rohingya problem is as severe if not more but receives a fraction of the press coverage. President Obama has visited Myanmar, Miss Suu Kyi was fêted in the White House and sanctions were lifted. Perhaps that was premature.
  1. A solution to a problem of this magnitude requires copious funds. The UN and rich Gulf States should chip in. It is time Gulf States showed solidarity with their Muslim brethren. Proper tents, food, water, medicine and sanitation are urgently required for the thousands of displaced Rohingyas who have lost everything. As a first step, the United Nations Refugee agency, UNHCR should open and supervise more refugee camps for the Rohingyas in Myanmar and Bangladesh.

Lady, speak up

Solving the problem of the stateless Rohingyas will not be easy; similar problems persist throughout the globe e.g Palestinian refugees and Middle Eastern refugees in Europe. But world attention is focused on these problems and there are slow, halting steps towards mitigation. There is very little focus on the Rohingyas.

Is Miss Su Kyi willing to spend the political capital necessary to take on the army, the native Rakhines, and the militant Buddhist monks to find a solution? She may be tempted to kick the can down the road rather than take a principled stand that may lower her popularity in Myanmar.

The carrot and the stick.

This could have unintended consequences. The large number of young, poorly educated Rohingyas with no jobs and no future could turn to Jihadism. Their cause could attract Islamic militants from across the globe. So far that has not been the case but that could change. It is best that Miss Su Kyi address this problem expediently and the world community keep the pressure on her and the Myanmar army. If not, economic sanctions should follow and development aid should be linked to concrete progress on granting statehood to the Rohingyas. A carrot and stick policy often yields results.

 

This article, in abridged form first appeared as a Commentary in the Philadelphia Inquirer, January 25, 2017.

Tiger Tiger!

 

Tyger, tyger, burning bright
In the forests of the night,
What immortal hand or eye
Could frame thy fearful symmetry?

A few years back, I had written an article on our family trip to Ranthambhore, India, in the hope of seeing a tiger. I decided to write this post on the same topic but with a different emphasis. Recently I came across data on the alarming decline in the tiger population in India, mainly from poaching. This is fueled by the insatiable demand for tiger body parts, mainly in China. Can we sit back and allow this magnificent beast immortalized in the famous poem by William Blake, the first verse of which is quoted above, to simply disappear from the earth? Certainly not. In this post I describe the awe and joy I felt coming face to face with a tiger in the wild.

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Bye 2016 Hello 2017

A unique New Year Resolution: on Cellphones and Sex

It is the end of December. I look outside and the lawn and trees are covered with a fresh dusting of snow. It is quiet and peaceful. I fancy I am a tracker from the time when hominids clad in animal skins would  hunt grasping nothing more lethal than a flint topped spear or axe. I go out looking for deer, rabbit and fox tracks in the snow.

Nah. Who are we kidding?

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Happier Holidays with Less

Happier Holidays, with Less

The Holiday Season is upon us.

The walls are decked with holly, the houses and rooftops are aglow with lights, jovial Santa is smiling benignly and Rudolf the reindeer is prancing on the lawn. The malls are packed, parking is at a premium and of course the mad rush of shopping for presents continues unabated. I find people slumped on benches and chairs in the mall, exhausted by long hours of hunting for bargains and presents.

Which begs the question, why.

Tired from shopping

Tired from shopping

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