April 4, 2011 § Leave a comment
*Fifteen minutes before this post went live, France, under the direction of the U.N., began a campaign “aimed at neutralizing heavy weapons that are used against the civilian population and United Nations personnel in Abidjan,” (From New York Times) in Ivory Coast. So, while the international community can no longer be said to have done nothing in Ivory Coast, action there is still very limited relative to intervention in Libya.
In his most recent post, Arvind asked whether or not international intervention in the conflict in Libya was justified. Since then it has become clear that Libya is not the only country undergoing what could be labeled a civil war: recent events in Ivory Coast suggest that the situation there has degenerated to the point of nationwide conflict as well. Additionally, just as in Libya, reports from Ivory Coast suggest that both sides of the conflict may have participated in mass civilian killings. This raises the question, why did America and the international community mobilize against Qaddafi in Libya, but not Ivory Coast?
Corinne Dufka, in an argument in favor of intervention in Ivory Coast, noted the following about Gbagbo, the incumbent in Ivory Coast whose refusal to leave office sparked protests there:
“In the view of both the African Union and the United Nations, Gbagbo has overseen what probably amounts to crimes against humanity. His security forces and allied militias engage in brutal killings, forced disappearances, politically motivated rape, indiscriminant shelling, and torture in an often-organized campaign of terror against real or perceived supporters of Alassane Ouattara, the internationally recognized winner of last year’s election.”
Since Obama’s speech on March 28, in which he explained the reasoning for intervention in Libya, many have noted the development of what is being called the “Obama Doctrine.” This, in sum, is an argument delineating the correct circumstances for intervening militarily in conflicts in other countries. Here is how Obama phrased it:
“To brush aside America’s responsibility as a leader and -– more profoundly -– our responsibilities to our fellow human beings under such circumstances would have been a betrayal of who we are. Some nations may be able to turn a blind eye to atrocities in other countries. The United States of America is different. And as President, I refused to wait for the images of slaughter and mass graves before taking action.”
As noted in this Foreign Policy article, Obama is essentially describing the “Responsibility to Protect,” a political-philosophical doctrine that argues in favor of protecting civilians in other nations if their government is unable or unwilling to do so, or if the government itself is the source of the harm to civilians. On paper, the situation in Ivory Coast could arguably be placed under the purview of the responsibility to protect, since many reports indicate that Gbagbo, the incumbent who lost the election in late 2010, has ordered the killing of civilian protesters. Assuming this is true, why haven’t Obama or the international community supported intervention in Ivory Coast?
There are two popular strategic rationales for international intervention in Libya, as opposed to other current Middle-Eastern conflicts, one of which I reject and the other I believe may be a significant factor. The first of these is the oil interest in Libya. Some argue that, since Libya has a small but not insignificant percentage of world oil production, the West intervened for the sake of the size and stability of their oil supply, and not for humanitarian reasons. However, as Arvind pointed out to me yesterday, this argument does not make sense. If the west were interested in the stability and size of the oil supply, it would have been more beneficial to ignore Gaddafi’s crimes, allow him to run over the rebels, and get oil production back up and running. Or, if siding with Gaddafi simply was not an option, the West would have sent in ground troops to protect the oil supply and end the conflict quickly. Of course, this may yet happen, but as for now it remains off the table.
The other strategic rationale has to do with Libya’s relative importance to American and international policy in the Middle East, and for the current revolutions there more specifically. Intervening in Libya has two benefits for America and the international community in this regard: we do our part in helping to continue the current populist political movement in the Middle East and in removing an unsavory dictator, while also painting the West and international institutions in a favorable light. Ivory Coast does not fit into this strategic reasoning because it is considered wholly a part of Africa, and not the Middle East, and because democracy has already functioned well there for years, whereas Libya has been ruled by a dictator (Qaddafi) for approximately 40 years.
Beyond strategic reasoning, I believe there are more basic rationales that could explain why intervention in Ivory Coast has not become politically salient while intervention in Libya has: preponderance in force and political framing. While the opposition movement in Libya started as grassroots political protests, the opposition in Ivory Coast had a leader-Alassane Ouattara, the winner of the recent election-and an already organized rebel movement. The opposition movement in Libya would have been severely hampered by Qaddafi’s superior military might and so it needed international assistance, but in Ivory Coast the two sides are more evenly matched.
Qaddafi’s preponderance in force had another effect on the international community’s decision to support intervention. Because Qaddafi had the capability to mass murder civilians and the opposition movement lacked the ability to prevent him from doing so, it was easier to frame conflict there as the beginnings of government sponsored mass-killings. Because Libya was framed in the light of potential moral hazard, governments of the world were compelled to act, or else risk the potential for the situation in Libya to deteriorate into a resemblance of the genocide in Rwanda. Ivory Coast, on the other hand, “looks” more like a civil war, with two sides of approximately equal strength fighting over the politics and society of their nation.
This is not to say that the underlying differences of the conflicts in Ivory Coast and Libya should be reasons to intervene in one and not the other, or even to intervene at all. However, it is useful to understand why some conflicts become the object of interest of the international community (Kosovo, Somalia) while others are either completely ignored or simply left alone (Sri Lanka, Sudan, Rwanda). As this case shows, there are clear distinctions between Libya and Ivory Coast that have compelled international action in one situation and not the other, and understanding these distinctions helps us to understand the actions of our own government along with the norms and morals of the international community.
March 28, 2011 § 2 Comments
I was out of town over the last week doing volunteer work in New Orleans (more about this later) and so I missed much of the news and opinion about Libya as American air strikes began. As I have caught up with events unfolding there, I have had an unusually difficult time deciding whether American intervention there is well-advised. As I discussed the issue with Michael earlier today, I realized that this difficulty is, in large part, caused by the immense uncertainty surrounding the course that events there will take. Normally, when presented with an issue, I decide by attempting to determine the relative harms and benefits involved in each alternative and judging these against my own priorities. In Libya, however, the outcomes resulting from American intervention or non-intervention are not definite facts, they are probabilities whose results lead to yet more questions.
The first question is about the alternatives to a military intervention. The obvious course would have been to do nothing. In the absence of any intervention whatsoever it is not at all clear that there would have been a large scale humanitarian crisis and, in fact, our intervention could easily worsen the situation. Furthermore, it is possible that a combination of negotiations and sanctions would have convinced Gaddafi to stop attacking his own people without the need for military action.
Humanitarian concerns are given some credence by Gaddafi loyalists’ clear disregard for civilians in their attack on the rebel held city of Misrata and their apparent use of rape as a weapon of war, but it is far from clear that mass murder of the Libyan people would have taken place in our absence. Nor is it clear, for that matter, that this humanitarian crisis would have eclipsed the many in which we have not intervened: the Democratic Republic of Congo and Darfur have both experienced demonstrable humanitarian crises of a massive scale without our military taking action.
Assuming that the humanitarian crisis in our absence warrants intervention we must consider the probability of success of the current, limited intervention which involves no (or very limited) ground forces. Though the rebels have made gains in recent days, taking back the strategic oil town of Ajdabiya, their continued success is far from assured. The rebel army consists of only about a thousand trained men and continues to be relatively disorganized. This suggests that, unlike our experience in Afghanistan where we worked closely with the Northern Alliance, the rebel forces on the ground in Libya simply may not have the requisite experience or manpower to defeat Gaddafi, and this, without even considering the much higher degree of our involvement in Afghanistan. Success of this limited intervention, then, is far from assured.
If our current action fails, what comes next? If no further forces are committed, the Libyan people likely would be left worse off than if there had been no intervention at all. The toll of our air strikes and the extensive fighting between rebel forces and Gaddafi loyalists would leave an even larger humanitarian crisis behind with only a Gaddafi led government to provide aid. If the international coalition decides to send in ground troops – and leaving the Libyan people worse off would lend some moral weight to the argument that we ought to – then we are left with the question of American involvement.
Committing American forces to the ground in Libya appears to me to be a bad idea. With two major engagements already in Afghanistan and Iraq (not to mention our many minor commitments around the world) neither the American military nor the American people are ready for another conflict in the Arab world. If the American military refuses to enter, the international coalition may be unable to succeed without them. After all, this is – despite the cheers of international cooperation – the smallest coalition assembled since the First Gulf War. In either case, a more involved intervention may rob the rebels of their legitimacy to govern leading to a long lived insurgent movement as we’ve seen in Iraq and Afghanistan.
In the end, if everything follows the plan and Gaddafi is removed, we have to consider the nature of whatever replaces him. Given the disorganization of the rebel movement, the lack of planning we are able to do with such a movement, and Gaddafi’s creation of a state without many state institutions (all nicely detailed here), Libyan rebels may end up unable to create a functioning government. Out of this anarchic situation we could even imagine a new dictator coming to power or further devolution into a Somalia-like failed state.
Assuming the better case – that a new government is eventually established and that it is a democratic one – it still may not uphold human rights, provide well for its people or be favorably inclined towards the United States. Although, as Michael noted during our discussion, even if the government of Libya is not the best on these counts, democracy may have a liberalizing effect over time leading to an improved situation. We ought to consider, however, that most of the Libyan rebels come from the same parts of the country which sent many insurgents to Iraq.
The commitment of the international community to intervening in Libya seems fraught with uncertainty. It compares favorably in many aspects to Iraq and Afghanistan: the United States has done a fair job forcing other countries to take the lead, the rebel movement is homegrown, and it has already begun to set up an interim government. It also has areas in which it falls short: the size and sophistication of the rebel army, the dearth of state institutions, and the lack of clarity regarding who will control the new government.
This uncertainty suggests that it may have been ill advised to begin an intervention in Libya when a limited commitment would have difficulty succeeding, and when a more involved one may only succeed at the cost of the subsequent government. Given our intervention, however, it now appears as though we must bring it to some degree of resolution. We are now, to borrow a poker term, pot committed: having taken a course of action we are now forced by changing circumstance into further commitments.
What is needed then, is a continual assessment of the cost of our continued presence in Libya against the benefits and harms to the Libyan and American people. For this to work, Obama should lay out clearly what the costs of the war will be, and what our strategy going forward is. While I would oppose the invasion of American ground troops, Obama should continue to pressure coalition members into taking a larger role while providing support for their actions. At least, that is, until more of these questions are resolved and we can more clearly determine whether continued American involvement is helping the cause of Libyan freedom and whether this help comes at too high a cost to the American people.
March 20, 2011 § Leave a comment
Since Arvind is currently working on a series on health care policy in the United States, I would like to provide some background on Capitalism and markets and to show how they can lend to inefficiencies in our health care system. Strangely enough, international reactions to the nuclear crisis in Japan provide just such an opportunity.
There have been some curious reactions to the nuclear meltdown in Japan in neighboring countries. In China, consumers have been buying up large quantities of salt out of fear that radiation from the collapsing nuclear facilities in Japan will carry across the Sea of Japan, the Korean Peninsula and the Yellow Sea and make them ill. The belief in China is that, since their salt is iodized, consumption of a large amount of salt will offer protection from radiation poisoning. Similarly, individuals in California have been purchasing potassium iodide pills for the exact same reason. Why iodine you ask? Nuclear radiation contains cancer-causing chemical isotopes, including iodine-131. For this reason, taking unpolluted iodine will saturate the thyroid gland with safe iodine, thus preventing the body from absorbing any radioactive iodine that could be unknowingly ingested.
The results of these reactions have been shortages of salt in China and of potassium iodide pills in California. The process leading up to these shortages could be summarized as the following: Japan has a nuclear meltdown, speculation occurs about what amount of area the meltdown will negatively affect, individuals possess rudimentary knowledge about the effects of radiation and use this knowledge to speculate about the effect of that radiation on their health, individuals consume products that they believe will mitigate those effects.
All of this seems well and good, except there are a few glaring problems:
1) There is agreement among professionals that the radiation in Japan will not reach Korea, let alone China or the United States. The Chinese National Marine Environmental Forecasting Center released a statement saying that it would be “impossible” for radioactive substances to reach China.
2) Consuming iodized salt will not protect individuals from radiation poisoning. Consuming too many potassium iodide pills can be harmful to the body, as Marc Siegel explains:
“Potassium iodide can interfere with the body’s normal production of thyroid hormone, leading to hypothyroidism, or can provoke an already diseased thyroid gland to make too much of the hormone. The pills can also cause nausea and diarrhea, and you can develop an allergy to them, I said.”
3) Much of the salt buying spree in China is connected to the belief that China’s sea-salt supply will be corrupted. But the CNME Forecasting Center explained that this too would not happen, also in the statement referenced above. Additionally, a large majority of China’s salt supplies are not even at a remote risk of exposure, as “Chinese authorities [explained] that the country has massive reserves and that 80% of its salt sources were on land.” (wording changed for grammatical purposes, quote found here)
The “invisible hand” in capitalism and markets is a widely known term, but in brief it refers to the processes which lead to individuals purchasing demands, corporations supply decisions and the prices of products. The shortages of salt in China and of potassium iodide in California are a result of the “invisible hand”: the economic pressures from reactions to Japan’s meltdown have pushed demand for these products through the roof.
But, as shown above, the increase in demand for these products is completely irrational. Chinese citizens cannot use salt to protect against radiation poisoning and do not need that protection anyway, and Californians similarly have no need to worry about this sickness. Thus, in this example, the “invisible hand” has pushed market forces in a direction that is harmful to individuals by unnecessarily driving up the prices of these goods, creating shortages in them and leading individuals to waste money. Furthermore, these shortages may also negatively affect the supply of potassium iodide available to the Japanese, who are actually at risk of radiation poisoning.
This situation is, of course, not the only instance of irrationalities in capitalist markets. Because individuals possess limited information about the world around them, they will have errors in judgment. Indeed, this is precisely what Arvind is referring to when he notes the following:
“Among the most important drivers of cost in the American health care system is our fee-for-service model of care. Under this model, doctors and hospitals are paid not for outcomes, but for each procedure they perform. As a result, they have little incentive to provide efficient care and, instead, have every incentive to perform unnecessary services. This bias for increasingly expensive procedures affects many aspects of America’s health care system, making us, for example, the world leader in number of CT scans and MRIs administered per capita.”
In this scenario, CT scans and MRIs are taking the place of salt and potassium iodide. The irrationality results because patients do not have perfect knowledge of what treatments they need. Because of this limited knowledge, patients follow their doctor’s judgment, and doctors err on the side that enriches them. Markets will be only as rational as the individuals participating in them, and so we would only see a perfectly “rational” cost of health care if patients were purely rational actors and possessed perfect information of their world.*
And now to my final point. As Arvind continues his series on Accountable Care Organizations and health care reform, and as we debate these ideas, and economies more generally, through politics and media, it is important to remember that the “invisible hand” of our economy will not correct our mistakes for us. We are fortunate to have an economic system that allows for the recognition of such mistakes, but we must then use this information to reform and improve that system. For this reason alone, the Democrats’ effort to improve health care in America makes sense, and maintaining the status quo does not.
*Arvind was a contributor to this paragraph
March 16, 2011 § 2 Comments
Among the most important drivers of cost in the American health care system is our fee-for-service model of care. Under this model, doctors and hospitals are paid not for outcomes, but for each procedure they perform. As a result, they have little incentive to provide efficient care and, instead, have every incentive to perform unnecessary services. This bias for increasingly expensive procedures affects many aspects of America’s health care system, making us, for example, the world leader in number of CT scans and MRIs administered per capita.
The health care reform bill (PPACA) doesn’t attempt to solve the problems in our system with a single approach. Instead, it launches a wide variety of pilot programs and delivery reforms coupled with mechanisms for evaluating what works. A number of these provisions are targeted at encouraging Accountable Care Organizations (ACOs) in the hope that we can reduce costs by changing incentives. In this, the first part of a 3 part series, I am going to explain what an Accountable Care Organization is and how it functions to reduce costs. In later posts I will describe the incentives PPACA provides, both for ACO formation and for cost reduction, and the challenges facing ACOs as these incentives take effect.
At its simplest an Accountable Care Organization is a group of providers who organize together to take responsibility for a patient population across the entire continuum of care. This means that they work together to distribute payments, coordinate the care the patient receives, and reward quality care by implementing performance measures and payment structure reforms. In practice, most ACOs will come to resemble something like Kaiser Permanente – an integrated delivery system in which one organization acts as both insurer and care provider. Under the Kaiser Permanente model, health plan members pay into the non-profit Kaiser Permanent Health Plan which provides investment and infrastructure development for Kaiser hospitals, and directs payments to physician-owned Permanente medical groups. At the end of each year, doctors and hospitals split the excess revenue provided by the health plan.
In an ideal implementation, the distinction between health plan and medical group would be blurred further, essentially combining the two into a single entity. This model has numerous advantages from a cost perspective. Since the insurers and care providers are part of a unified organization, all premiums not spent on care can go towards profit and the lowering of premiums. This incentivizes, for example, providing primary care early in order to prevent costly health problems later on. Furthermore, integration can eliminate many of the overhead costs associated with providers billing insurance companies and with insurance companies deciding whether these bills ought to be paid. This model can also improve quality by allowing doctors to more easily coordinate care among different specialties.
In part two, I will discuss the incentives PPACA provides for the creation of these ACOs and how it envisions ensuring quality, affordable care.
March 15, 2011 § 3 Comments
On Monday, former Ambassador to the United Nations John Bolton criticized Obama for his response to the situation in Libya. According to Bolton, Obama’s policy course has consisted only of “rhetoric combined with studied inaction,” and is too cautious.
Instead, Bolton recommends the following bold steps to assist Libya:
“The steps America can take to protect our key strategic interests are becoming increasingly limited. Options include a no-fly zone (now belatedly endorsed by the Arab League) and possibly a no-drive zone for Gadhafi’s military vehicles, plus recognizing Libya’s opposition as its legitimate government. Whatever we do, however, must be done quickly to have a realistic chance of success. Unfortunately, while the clock ticks and our interests disintegrate, Obama remains essentially passive.”
The situation in Libya is without doubt serious and has the potential to become a protracted civil war. That being said, the notion of a “no-drive zone” is absolutely ridiculous. The only realistic means by which the United States could prevent Gadhafi’s military vehicles from driving through Libya would be military intervention. A no-drive zone, no-fly zone and recognition of the Libyan opposition are also certainly not the only options on the table for the United States. Secretary Clinton has already met with the leaders of the opposition to discuss this very topic, a move which does not seem to suggest inaction on Obama’s part as Bolton has argued.
The slow implementation of a no-fly zone in Libya is also not entirely Obama’s fault. Discussion of the no-fly zone has been held up by China and Russia in the U.N. security council, a tidbit that Bolton probably did not accidentally forget to mention. Prior to being named U.S. Ambassador to the U.N., Bolton was highly critical of the organization.
Bolton’s argument that our government should unilaterally establish a no-fly zone is not surprising, but is the wrong choice. Unilateral American presidential action on foreign policy issues was the favored choice for the Bush administration, and so hearing Bolton echo these ideas should be expected. Fortunately, however, America has moved beyond this strategy. The idea that America can, and should, ignore international institutions and alliances in favor of working alone not only damages relations with other countries, but damages America itself by forcing us to conduct our policy in a less cooperative international environment. Consider that a war lacking strong ally support in Iraq, a war lacking strong ally support in Afghanistan, and the establishment of an indefinite detention facility that tarnishes America’s human rights and legal reputations are some of the results we saw from this approach.
Obama’s foreign policy approach has been cautious and prone to keeping dialogue channels open from the start. Rather than jumping to conclusions like the “Axis of Evil” or “we’re positive Iraq has WMDs,” Obama appears to support a more cerebral policy that focuses on developing understanding and conversation with other governments before acting. In situations like that in Libya, waiting to discuss options certainly leaves a bad taste in our mouths, as we receive daily reports of Gadhafi’s violent repression of anti-government revolts. The trade-off for America, however, is improved international relations, well thought out policy decisions and international respect and perceived legitimacy of American actions, all of which are essential for leadership.
March 14, 2011 § 2 Comments
“The moment we’re living through, the moment our generation is living through, is the largest increase in expressive capability in human history.” -Clay Shirky, talk on How Social Media Can Make History (video below)
Before the last couple of months, the relationship between authoritarian governance and social expression via new media technology would typically be linked to control by the central state. China, for example, has consistently controlled much of what it’s citizens see and hear through the internet. However, following the protests in Tunisia and Egypt, which sparked similar movements in Bahrain, Yemen, Libya, Oman, Mauritania, among other Middle Eastern countries (look here for a good synthesis of events), we are beginning to see a very different story unfold in the life of social media.
Clay Shirky wrote the following in the January/February 2011 edition of Foreign Affairs:
“Disciplined and coordinated groups, whether businesses or governments, have always had an advantage over undisciplined ones: they have an easier time engaging in collective action because they have an orderly way of directing the action of their members. Social media can compensate for the disadvantages of undisciplined groups by reducing the costs of coordination.”
This reduction of coordination costs and increase in communal awareness is what Shirky, borrowing from media theorist Briggs, calls the “conservative dilemma.” The “dilemma” essentially means that autocrats, democratic governments, and business and religious leaders who once monopolized public speech through pure strength in resources are now held accountable by an increasingly coherent and powerful public ire, as previously unorganized individuals and groups can now readily communicate their grievances or ideas via new technology.
Shirky, in his Foreign Affairs article titled “The Political Power of Social Media,” looks to the impeachment of Philippine President Joseph Estrada as a demonstration of social media’s ability to quickly organize mass protests (Estrada, on the verge of being acquitted due to the restriction of key evidence in his impeachment trial, was eventually found guilty after mass protests demonstrated in favor of allowing the evidence). But now events in the Middle East have illustrated the extent to which Shirky’s article speaks true. Civil interactions are now global and instantaneous. The result is that the actions of governments and corporations provoke simultaneous counteractions among individuals that can be instantaneously witnessed and debated by anyone with web access or a cell phone.
“Civil society” is a term used by political scientists to describe interactions among individuals and organizations outside of the government or public sphere, and it is thought to be an important factor in democracy and political dialogue. The rise of new media technologies has caused a profound increase in interactions that fit this label. Indeed, the success of social media has led Shirky to recommend that the United States reorganize its priorities in the State Department’s Internet freedom campaign. Instead of focusing specifically on access to Google or Youtube, Shirky advocates the direct endorsement of civil society by supporting freedom of speech and assembly within repressive governments. He argues that this “environmental” view, rather than “instrumental” view, will be more likely to lead towards the gradual reform of authoritarian governance.
However, I wonder whether this more abstract manner of supporting civil society in authoritarian nations will be sufficient. Shirky seems to advocate a policy which focuses solely on the environmental view, but more instrumental policies, such as establishing proxies to twitter or Facebook when they’re blocked by the government, are also necessary in the short term. It is useful to remember, as Shirky does in his piece, that an important factor in the fall of the Soviet Union was the transmission of American radio broadcasts throughout Eastern Europe. The Internet freedom campaign should continue its short term goals of pursuing unrestricted access to the internet with an eye towards the long term success of global civil society and democracy.