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Universal Health Care

Nothing is perfect, and that definitely includes health care. On the 70th anniversary of the first full-coverage national health care system that is ‘free at the point of delivery’, Britain’s National Health Service, English people have been marching in the streets demanding better funding for the NHS, and Donald Trump naturally got the wrong end of the stick again.

Back in February, as part of his war against Barack Obama’s attempt to improve the coverage of the rudimentary US health care system (‘Obamacare’), Trump claimed that the marchers were protesting because the British system is “going broke and not working.”

It’s tough trying to defend the existing US system when every other developed country provides universal health coverage for its citizens, but Trump battled bravely onwards, later tweeting that the Democrats in the United States “want to greatly raise taxes for really bad and non-personal medical care.” Like the British allegedly suffer under the NHS.

In fact, the English National Health Service (Scotland and Northern Ireland have separate but similar systems) is, in former Conservative cabinet member Nigel Lawson’s words, “the closest thing the English have to a religion.” It is almost universally loved, and the protests were about government under-funding of the NHS.

Even the Conservative government that has strictly limited funding increases for the NHS over the past seven years, despite rising demand due to an ageing population, has now been forced to yield to popular demands. Prime Minister Theresa May announced last week that the NHS would get a funding increase of 3.4% per year over the next four years, giving it an extra $27 billion annually by 2023.

But are the English right to love their health-care system – and are the French and Germans and Russians and Japanese and the people of almost every other developed country right to revere their own similar systems? The United States may be the odd country out, but it does spend far more on health care than anybody else.

The United States spends 16% of its entire Gross Domestic Product on health care, almost twice as much as the average (8.2% for Japan, 8.4% for the UK, 8.5% for Australia, 10.4% for Germany). In theory, that ought to mean that Americans are healthier than everybody else and live longer. In practice, it’s just the opposite.

The United States is the only developed country where the average life-span is less than 80. In fact, it’s barely 78 years in the US, whereas everywhere else it’s in 80-82 range. The US also has the highest ‘preventable death’ rate of any developed country, and the highest infant mortality rate by a very wide margin. Americans spend more on health, and get less back, than anybody else.

They also spend far more of their time worrying about health care. The principal cause of personal bankruptcies in the United States is ‘catastrophic’ health emergencies, and all but the very rich have to devote much time to finding affordable medical insurance. Elsewhere in the developed world, nobody really thinks about that. The care will be there when you need it, and nobody goes bankrupt.

The model that was pioneered by Britain’s NHS on July 5, 1948 has been so successful that it is now spreading into many developing countries as well. India is still a poor country, but its National Health Policy 2017 goals include a commitment to “progressively achieve Universal Health Coverage.” China is working to provide affordable basic healthcare to all residents by 2020. And so on.

Attitudes change over time. In the 1930s nobody thought that there was some sort of basic human right to health care. The well-off paid for their own, and the rest depended on charity (which wasn’t very dependable). What changed that attitude was the Second World War, a time of great national solidarity and sacrifice in every country.

It was the worst war in history, but it produced a generation who believed that the people who had shared in the sacrifice (in both the countries that won and those that lost) must not be left behind in the peace that followed. The will was there to do new and great things, and they did them.

It is no coincidence that the same year of 1948 saw the signing of the Universal Declaration of Human Rights, which said (among other things) that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”

The world had turned, and what had been a privilege became a right. One that is still widely abused or neglected, of course, but it has nevertheless spread across the entire planet in the past 70 years. Why did the United States miss out?

The answer is probably a free-market ideology so strong that it enabled the insurance companies and the medical profession (which opposed the idea of a national health system in every country, at least initially) to win the political battle in the US and strangle the idea in its cradle. It keeps coming back even there, but for the moment Americans must go on paying the costs of their ideology.
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To shorten to 725 words, omit paragraphs 5 and 9. (“Even…2023”; and “They…bankrupt”)

Saudi Arabia: A Populist Dictatorship

Joy and pride among Saudi women who are at last allowed to drive. Delight in the car dealerships that anticipate a lot of new business. And dismay in the families of the 1.4 million chauffeurs, almost all from South Asia, who have been earning around $1,000 a month driving Saudi women around. But it will take a lot more than this to change Saudi Arabia.

Just before driving became legal for women, seventeen women activists who have been campaigning for years against the driving ban were arrested. Eight have now been released, but the others are facing possible trial in a counter-terrorism court and long prison sentences for their activism. Does the right hand know what the left is doing?

Yes, it does. Letting women drive is part of Crown Prince Mohammed bin Salman’s project to win popular support by modernising some aspects of daily life. Looking like he is giving in to popular pressure is definitely not part of his programme. The change must look like a free gift from his hand, not a retreat in the face of public protest.

It’s a less dramatic initiative than last winter’s three-month anti-corruption campaign, which detained 56 high-profile royal family members and prominent businessman (in the capital’s best hotel) until they had ‘paid back’ some of their ill-gotten gains.

The exercise allegedly yielded $100 billion to the government, although none of the thieves saw the inside of a courtroom, let alone went to jail. But the message was the same: I’m on the side of ordinary people and I’m doing the right things, but I make the decisions when and as I choose.

The notion that Mohammed bin Salman is liberalising the Saudi system is a fantasy. Having ruthlessly sidelined all rival claimants to the throne – his father, King Salman, is 82 and ailing – he has now centralised power to an unprecedented extent. Saudi Arabia was a traditional, deeply conservative monarchy that always ensured there was a fair degree of consensus among the elite. It is now a dictatorship.

MbS, as he is known, is an impulsive man, and one of his bigger mistakes was to invite the UN’s special rapporteur on anti-terrorism, Ben Emmerson, to visit the country to report on how it was reconciling the need to prevent terrorism with respect for human rights. Emmerson came back in early May. His report was unusually frank for a diplomatic document, and in a subsequent media interview he went well beyond that.

The Saudi anti-terrorism law is written in a way that criminalises all dissent, he told The Guardian. Torture in Saudi jails is commonplace, the guilty officials go unpunished, and Saudi Arabia “is undergoing the most ruthless crackdown on political dissent that the country has experienced in decades.”

“Reports that Saudi Arabia is liberalising are completely wide of the mark,” Emmerson said. “The judiciary has now been brought entirely under the control of the King, and lacks any semblance of independence from the executive. Put simply, there is no separation of power in Saudi Arabia, no freedom of expression, no free press, no effective trade unions, and no functioning civil society.”

Moreover, MbS’s successes in crushing dissent within the country have made him over-confident about his skill in foreign policy. He summoned Lebanese Prime Minister to Riyadh and forced him to resign, only to see Hariri get his job back in alliance with Hezbollah, a Shia Islamist group that MbS utterly detests.

He declared a blockade of Saudi Arabia’s small but wealthy neighbour, Qatar, to force it to close down the Al-Jazeera network, the most influential Arabic-language news service, and to break its ties with Iran, the country that MbS fears most. One year later Al-Jazeera is still alive and kicking, and Qatar has moved closer to Iran.

And in his biggest blunder, he launched a military intervention in the Yemeni civil war to defeat the Houthis, a Shia tribe that has captured most of Yemen and that he believes (wrongly) is controlled and armed by Iran.

Saudi Arabia’s air strikes have killed thousands, its ally the United Arab Emirates has thousands of troops on the ground – and three years later the Houthis still control most of the heavily populated parts of Yemen, including the capital.

It’s not exactly Saudi Arabia’s Vietnam – the Saudis have no troops on the ground, and the Emiratis are mostly using foreign mercenaries – but the Yemeni intervention is very expensive, deeply embarrassing, and probably unwinnable. In the long run, it may be MbS’s undoing.

The wealth has been more widely shared in Saudi Arabia than in most oil-rich countries, and for the non-political majority life is still pretty good. Even for women, things are very gradually getting better: 60 percent of Saudi university graduates are female, and now they can drive too. But the country is now being run by an erratic and over-confident dictator.
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To shorten to 700 words, omit paragraphs 4 and 5. (“it’s…choose)

The Singapore Summit

If the Singapore meeting between Donald Trump and Kim Jong-un had been a zero-sum game, then Trump definitely lost. But maybe it wasn’t.

Kim got a meeting with Trump on terms of strict equality right down to the number of flags on display, which is a huge boost for his regime’s claim to legitimacy. He persuaded Trump to end America’s annual joint military exercises with South Korea (and even got Trump to call them ‘war games’ and say they were ‘provocative’, which no US spokesperson has ever done before).

And he got Trump to accept North Korea’s deliberately vague language about the “denuclearisation of the Korean peninsula”, with no specific reference to North Korea’s nuclear weapons, let alone any talk of dismantling them. In fact, the agreement they signed talked about “re-affirming” North Korea’s denuclearisation pledge, so obviously no progress there.

This is several light-years distant from Secretary of State Mike Pompeo’s pre-summit definition of the US goal as “permanent, verifiable, irreversible dismantling of North Korea’s weapons of mass destruction,” which must happen “without delay.”

There’s no cause for surprise here. Trump is not a great deal-maker; he’s a man who is accomplished at playing the role of a great deal-maker. The reality is more like the contract he signed with Tony Schwartz, who ghost-wrote ‘The Art of the Deal’, the book that made him famous: 50% of the advance, 50% of royalties, and equal billing on the cover. Schwartz was as surprised and pleased then as Kim undoubtedly is now.

If Trump had had a little more time in Singapore, he could have bought a T-shirt saying ‘My president went to Singapore and all I got was this lousy T-shirt’ and taken it home to give to the American people.

He would have needed a bigger apology-gift for the South Korean government, which was blindsided by Trump’s spur-of-the-moment promise to stop the joint military exercises. “We need to find out the exact meaning or intention behind his comments at this point,” Seoul said in an unmistakably sulky tone of voice. (Seoul’s mistake is to assume that Trump himself knew his “exact meaning or intention.”)

But this was not really a negotiation. It was a show, staged for the benefit of the two main participants, and they both got what they came for. They were bound to get it, since they had the power to define the meeting as either a success or a failure. Naturally, they said it was a success – but that doesn’t mean it was actually a failure.

All this zero-sum game nonsense is irrelevant to what is really happening here, or at least could happen in the months to come: the gradual acceptance by the United States that North Korea is irreversibly a nuclear weapons power, although a small one, and the negotiation of some basic rules for this new relationship between two nuclear powers of radically different size.

Diplomatic and military experts have been saying for years that there is no way that North Korea will ever give up its nuclear weapons. The whole country lived on short rations for a generation to get them, and Kim is well aware of what happened to dictators who didn’t have nukes, like Iraq’s Saddam Hussein and Libya’s Muammar Gaddafi.

The experts are right, but they do not see this situation as necessarily a cause for panic. After all, more evenly matched pairs of nuclear powers, like India and Pakistan, or the United States and Russia, have managed to avoid nuclear war for decades. Nuclear deterrence, as Bernard Brodie pointed out more than 70 years ago, works even when there is a huge disparity in the number of weapons possessed by the two sides.

If North Korea has even a marginal ability to destroy one US city with a nuclear weapon, the United States is effectively deterred from using nuclear weapons against it. (Except if the US could count on destroying every one of Kim’s nuclear-tipped missiles in a surprise first strike – but that’s why North Korea will move them around or dig them in deep.)

North Korea is and will remain totally deterred from attacking the United States, because it would be utterly destroyed in a massive American counter-strike. So the deterrence is mutual and relatively stable, barring huge technological surprises or crazy or suicidal leaders.

That is the destination the US-North Korean relationship is heading for, because it is the only one that reality permits. Kim is almost certainly seeking it quite consciously, although it’s unlikely that Trump has ever thought of it in these terms. Indeed, there is some evidence that he is not even clear on the basic concept of deterrence.

No matter. That’s what Trump is heading for, and by the time he gets there he will undoubtedly think that it was his goal all along. There will be more meetings, probably including a Kim visit to the White House, and the two countries will move, slowly and crabwise, towards the mutual deterrence that will define their future relationship.
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To shorten to 700 words, omit paragraphs 5 and 7. (“There’s…now”; and “He would…intention”)

Gwynne Dyer’s new book is ‘Growing Pains: The Future of Democracy (and Work)’.

Trump’s Trade Delusion

Halfway across the Pacific Ocean, Donald Trump heard the closing statements from the G7 summit in Quebec (which he had left early to meet North Korean dictator Kim Jong-un in Singapore).

All the G7 countries had signed up to an anodyne closing communique that papered over the huge gap between the United States and the other six on world trade – but Canada’s Prime Minister Justin Trudeau then said once again that he would answer Trump’s big new tariffs on steel and aluminum imports with new Canadian tariffs hitting US exports just as hard.

He had said it before, including to Trump’s face just the previous day. The other national leaders present in Quebec said exactly the same thing, and none of them had changed their positions before the final communique was agreed. But Trump flew into a rage.

No jumped-up leader of a rinky-dink country like Canada was going to get away with talking to the president of the United States like that. Trump retracted his endorsement of the joint communique, called Trudeau “very dishonest and weak”, and hinted heavily that his next target would be Canada’s car-making industry (which is almost completely integrated with its US counterpart).

No surprises here. The other countries of what used to be called ‘the West’ have grown used to Trump’s tweeted outbursts, and French President Emmanuel Macron restricted himself to saying that “international co-operation cannot be dictated by fits of anger and throwaway remarks.”

True enough, but what also needs to be said loudly and often (but generally isn’t) is that the whole confrontation over trade is irrelevant to Trump’s real political concern, which is vanishing American jobs. He’s not just barking up the wrong tree on this issue; he is baying at the Moon.

Trump’s line is that the very high unemployment rate in the United States (which he is almost alone among American politicians in acknowledging) has been caused by free trade. The evil foreigners took advantage of gullible Americans to make free trade deals, and then lured ruthless American manufacturers to relocate their factories in their low-wage homelands.

This only made sense for American manufacturers if there was more or less free trade between their new base and the United States, so that they could still sell their products back home without tariffs. For Trump, therefore, free trade is the mother of all evils. But while more than a million American jobs did get sent abroad like that in the 1990s, very few have been exported in the past fifteen years.

In the first decade of the 21st century, the United States lost one-third of all its manufacturing jobs, and the vast majority of them were killed by automation. They didn’t ‘go’ anywhere. They just vanished.

It happened first in what became known as the Rust Belt, because that was the main centre of assembly-line industry in the US. Assembly lines, which break a complex task down into a series of simple and highly repetitive actions, are the easiest thing in the world to automate.

Job destruction then slowed down until other new computer-driven technologies matured: self-driving vehicles, on-line shopping, ‘dark’ factories and warehouses. But they are ready now, and the carnage in retail jobs, driving jobs and warehouse jobs is just getting underway. To worry about free trade while this is going on is pure folly.

Not only has the ‘offshoring’ of jobs virtually stopped, but there is a new phenomenon called ‘reshoring’. Some American manufacturers are bringing their factories home, because with full automation you have to hire only one-tenth of the high-paid American workers you used to employ, and by reshoring you get to work in a predictable legal environment in your own language.

Trump can do a lot of damage to employment both elsewhere and in the United States by launching a trade war, but he cannot ‘bring the jobs back’. They are gone for good, and a lot more will follow. Automation may be slowed down here and there for a while, but eventually it will eliminate at least half the existing jobs – and the notion that it will create equivalent numbers of new good jobs is an amiable myth.

So while the leaders of other rich countries will have to divert some attention and effort to coping with the negative impacts of Trump’s trade war, they must not let that become their obsession too. It’s a side issue, though potentially a very expensive one.

In Canada, in France, in Japan, in all the developed countries, the real problem is the same as it is in the US: the inexorable advance of automation and the resulting hemorrhage of jobs. So devote most of your attention to that, and only respond to Trump’s declaration of trade war to the extent that is politically unavoidable.

In the end, you’ll be glad you did.
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To shorten to 700 words, omit paragraphs 10 and 12. (“It happened…automation”; and “Not only…language”)