Foreign Policy Fiasco?

The lead article in today’s New York Times, “Ending Asia Trip, Obama Defends Foreign Policy,” portrays an increasingly skeptical attitude toward the President’s dealings with other nations as giving an impression of weakness that is leading to disaster.

It’s important to note that the President’s emphasis on avoiding military engagements makes sense after more than a decade of war. His reluctance to getting drawn into the Syrian conflict could have saved us from a quagmire, and there are really no good options for dealing with Russia and Ukraine. Despite the brutal nature of Russian actions, sending a few arms to Ukraine would hardly affect Russia’s considerations towards a country right on their border nor is it wise to get drawn into a shooting match that could end in World War Three.

As to the acrimony at the failure of Middle East peace talks, well, this arena has proven intractable for generations, and getting an agreement would have been a minor miracle. No matter how much Secretary of State Kerry wants it, if the parties are unable to agree, it should not reflect poorly on him or the President. They get points for just trying.

President Obama is pursuing an incremental approach toward foreign policy, agreed, but when you consider the alternatives, it seems like the only prudent thing to do.

Medicare Malfeasance?

The lead article in today’s New York Times, “One Therapist, $4 Million in 2012 Medicare Billing,” attempts to find Medicare fraud in the physical therapy industry but on closer examination is much ado about nothing.

The person investigated, Dr. Wael Bakry — based on the recent release of physician data — has a perfectly understandable explanation for the charges. He has two dozen therapists working for him in four offices, and because he is the physician of record, their services get charged to his account number. Moreover, since his patients are invariably satisfied with his results, they come back to him for more treatments.

The Times is correct in noting the demographic shift in the country to older citizens, but this observation simply underscores why the physician in question, Dr. Bakry, is running such a booming business. The American Medical Association explained how the release of this monetary data could prove misleading, and The Times seems to have proven its case in this article.

Physical therapy is admittedly a grey area where the need for certain procedures could prove hard to sustain. But if patients felt they were receiving too much care or were unsatisfied in any way, they could always vote with their feet. The fact that Dr. Bakry is running a booming business only seems to underscore his case, not that of The New York Times.

European Foot Dragging

The lead article in today’s New York Times, “European Firms Seek to Minimize Russia Sanctions,” reveals the conflict of interest between Russia and European governments politically and economically. Because while the two sides are rapidly moving toward a conflict and crisis over Ukraine, their business sectors want to continue business as usual.

The European public has an especially large stake in resolution of the crisis because they are dependent for about 25 percent of their natural gas from Russia. Russia also serves as a critical export market for European machinery and automotive equipment. All in all, Russia and Europe engaged in $370 billion in trade in 2012 compared to $26 billion for the United States.

That makes it particularly difficult for the European Union to impose sanctions on Russia that really bite because they don’t know how Vladimir Putin will react. His decisions are not totally rational — the annexation of Crimea, for example, had a major deleterious effect on the Russian economy with the value of the ruble falling rapidly, and Standard & Poors downgrading Russian bonds to just above junk status.

President Obama is wise in trying to give Russia a face saving way to extricate itself from the crisis, but they may not want to be extricated. The result would be a global tragedy because Russia would be ostracized at a time when it has so much to contribute.

Net Neutrality?

The lead article in today’s New York Times, “FCC, in a Shift, Backs Fast Lanes for Web Traffic,” may represent the beginning of the end for the Internet as we know it. The Internet has always been somewhat of a wild west in terms of content, with anything and everything available online. The new rules would end that by creating privileged access for content providers who pay more. Companies like Amazon or Netflix could charge more for faster speeds for Internet streaming and then pass that price on to the consumer.

The concept of net neutrality has always encompassed the idea of free, unfettered access for all, with all companies treated the same way. This new rule will set up barriers for higher speed transmissions and could change the Internet into the same thing as all other media, albeit an electronic version.

The proposed rules regarding net neutrality go up for public comment on May 15th, and they are already generating a furor online. One hopes they would be soundly rejected to preserve the Internet as it exists today.

All Internet content should be treated the same way to preserve the unique type of freedom available online that you can’t find anywhere else. Most Internet users have come to appreciate the freedom of this media, both for good and poor content. In the end, the user is king and judges what he will watch or prefer.

Affirmative Action Ruling

The lead article in today’s New York Times, “Justices Back Ban on Race as Factor in College Entry,” once again stirs up the bitterness of racial conflict in a zero-sum area, college admissions in a ruling by the Supreme Court.

College admissions is zero sum because there are a limited number of spaces available for each freshman class, and accepting one applicant inevitably involves denying another. Yet while racial preferences are admittedly a heavy-handed way of making up for previous discrimination, they do serve a role in ensuring diversity and considering factors other than pure academic scores in admissions decisions.

The Supreme Court claims that it is only letting voters decide about these programs, but by explicitly forbidding them, Michigan voters are allowing colleges to consider other extenuating circumstances but not race. That ban is a racial decision in itself because it means that fewer African Americans and Hispanics will be part of the freshman class.

In a perfect world, affirmative action would not be necessary or even desirable, but we live in a society where race continues to play a role in K-12 success rates. Given that situation, affirmative action gives people from underprivileged backgrounds a chance at success and social mobility. Until K-12 becomes a level playing field, colleges should consider multiple factors in their admissions policy.

Crimean Chaos

The lead article in today’s New York Times, “Under Russia, Life in Crimea Grows Chaotic,” shows that while changing your political affiliation may be relatively easy, changing a culture and society is not.

Crimea is now facing a crisis that goes far beyond its annexation and touches every aspect of life. The banks are closed. People are unable to get prescriptions, insurance and residence permits. The court system is frozen — because they need to apply Russian laws, and the lawyers thus have to go back into training.

Even traffic laws can no longer be adequately enforced because the monitors do not know them any more.

Other aspects of Russian society have rapidly asserted themselves including the need to wait for everything. One person was listed as number 4,000 for a relatively routine government function. Even Russian couples who want to boost the Crimean economy by buying a dacha on the sea find themselves stymied.

Perhaps even more important, other aspects of everyday Ukrainian life are no longer the same. Shoppers can no longer find their favorite brands in the supermarket. And Ukrainian Orthodox priests find themselves vilified by their Russian counterparts.

Multinational corporations have fled to avoid possible sanctions. Even MacDonald’s has closed.

It should make East Ukraine pause before doing something that can’t be undone.

Who is that Masked Man?

The lead article in today’s New York Times, “Photos Link Masked Men in East Ukraine to Russia,” shows the hypocrisy of the Russian government as they carry out a “special war” against Ukraine.

A special war avoids the open use of military troops and instead relies on the secret service, subversion and terrorism to gain its goals. Russia used a “special war” against its rebellious province of Chechnya and the recent takeover of Crimea as well.

Now, photographs have surfaced tying the pro-Russia militia in East Ukraine to actively serving Russian troops. This loosely kept secret is now exposed, and it puts Russia on warning to comply with the recent agreement in Geneva to withdraw its forces.

These so-called militia have now taken over government buildings in 10 towns in East Ukraine, and their refusal to back down is clearly in accordance with Russia’s wishes. The Geneva accord is now interpreted solely as Russia buying time to avoid new sanctions.

President Obama must step up the pressure on Russia to comply. Its economy is based almost entirely on the energy sector, so a well-targeted boycott could have a major effect. It would also start to erode Mr. Putin’s popularity as the Russian people realize that their political victories come with a cost as the price of food staples starts to rise inexorably.

Insurgent Intransigeance

The lead article in today’s New York Times, “Insurgents Balk at Pact, Keeping Grip in Ukraine,” shows the delicate nature of the surprise agreement in Geneva between Russia and Ukraine, primarily because the masked militants are refusing to go along with it.

The pro-Russian forces who have seized government buildings in East Ukraine, many believe with tangible support from Vladimir Putin, refused to honor the agreement. This development called into question the whole diplomatic process and made many wonder if it was just a ruse by Russia to avoid sanctions.

Of course, the Russians claim to have no power over these militants, but unless the impasse is broken, Ukraine will move in with its “counter-terrorism” forces to take back its government buildings. If there is resistance, that could spur the Russians to invade like they did in Crimea. And it would probably mean annexation of more of the country.

Mr. Putin, a former KGB agent, is probably working three steps ahead of the rest of us, and the increase in his popularity after the annexation of Crimea cannot bode well for other areas of Ukraine. He is known to want to restore the Soviet empire, and one wonders if he is just getting started.

Suspicions are running high, and the United States is conducting military exercises in eastern Europe to make sure Putin’s ambitions do not extend to any of the new NATO countries.

Take Two Aspirin

The lead article in today’s New York Times, “Treatment Cost Could Influence Doctors’ Advice,” purports to convey a change in doctors’ procedures to evaluate price as well as effectiveness in considering drugs or operations for their patients.

In reality, doctors have been performing this function all along. Growing up in a medical family, I have more exposure to the way things work, and if a patient is in the last year of his life, the doctor will take that into account in prescribing a course of action.

One thing that has changed, however, is the openness with which this process is now being used and recommended. Medical societies are publishing recommendations that include a cost benefit analysis. And insurance companies and others are considering treatment cost per quality-adjusted life year. This statistic includes the long-term effectiveness of a drug so doctors or patients don’t engage in a reckless at-all-costs wild goose chase.

We are all going to pass away eventually, and some patients and doctors need to come to terms with that reality in treating patients as well. Plus, if a patient will be financially ruined after a successful treatment — well, that comes under the imperative of “do no harm.”

Some may consider the process of evaluating medical costs as a form of rationing. But I say that “bedside rationing” has been going on since the beginning of modern medicine.

Russian Economic Troubles

The lead article in today’s New York Times, “Russia Economy Worsens Even Before Sanctions Hit,” provides a realistic assessment of fiscal affairs in the former Soviet Union, as Putin makes fateful political decisions that could rebound against him.

After the annexation of Crimea, President Putin has enjoyed an unprecedented 80+ percent approval ranking among the Russian public, but his numbers could fall sharply as the economic impact spreads.

The Russian stock market is down 10 percent; the ruble is losing its value; and capital is fleeing the country. Russia is undergoing a recalcitrant stagflation, with countervailing troubles that could prove difficult to treat. The labor force is shrunken, and the economy is in danger of recession, arguing for a government stimulus, but the high inflation rate suggests the need for more austerity.

Meanwhile, Russia splurged on the Sochi Olympics, spending $50 billion, and if the price of food and other staples starts to rise, Mr. Putin could quickly lose the gloss of successful imperialism.

Yet Mr. Putin seems more motivated by politics and the desire to restore the fortunes of the Soviet Union than mundane economic matters. However, he will soon find out that one can impact the other, especially if new sanctions are imposed.

Russia’s sole reliance on natural gas and oil prices for economic prosperity will soon be exposed as it makes the nation vulnerable to a focused economic attack by the United States and Europe.