Tufts Roundtable, Volume 2, Issue 1 September 2009

Contact Information Jonathan M. Tisch College of Citizenship and Public Service Lincoln Filene Hall Tufts University Medford, Massachusetts 02155 www.tuftsroundtable.org [email protected]

FE ATUR ES

No Miracle Cure by Jonathan Danzig Page 10

The Trouble With Compromise by Tim Lesinski Page 13

LOC AL AN D C AM PUS ISSUES 4

What Could Have Been

John Peter Kaytrosh

NATIO NAL 5

Whole Right to Healthcare?

Alexa Rosenthall

6

A Felon’s Right to Vote

Chelsea Ongaro

7

Nameless Victims of Bush-Era Lawlessness

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The Issue of Healthcare Reform (Tuftscope)

Michael Steinberg Michael Shusterman

INTE R NATIO NAL AFFAIR S 16

Tamiil Troubles

17

Why We’re in Afghanistan

18

Where is Central Asia?

Asad Budruddin

19

Missile Defense and Russia

Edmund Gallese

Chris Walczyszyn Chas Morrison

October 2009

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The Picture of Health What Congress Has in Mind for Healthcare Reform

Senate Health Committee Bill “Affordable Health Choices Act”

House Tri-Committee’s “America’s Affordable Health Choices Act of 2009”

• Individual mandate for insurance • Individual mandate for insurance • Individuals without qualifying health insurance • Individuals without qualifying health insurance must pay a penalty of 2.5 percent of their adjusted must pay a minimum penalty of $750 per year gross income

Senate Finance Committee “America’s Healthy Future Act” • Requires most citizens and legal residents to have health insurance • Individuals without qualifying health insurance must pay a penalty of $750 per year for incomes between 100 and 300 percent of the poverty line, $950 for larger incomes

• State-based American Health Gateways for individuals and small businesses to purchase health insurance • Government subsidies available for individuals whose income is less than four times the poverty line

• Health Insurance Exchange for individuals and small businesses to purchase health insurance • Premium and cost-sharing subsidies available for individuals whose income is less than four times the poverty line • Provide health insurance credits for small businesses offering health insurance to their employees

• State-based health insurance exchanges for individuals to purchase health insurance • Premium and cost-sharing subsidies available for individuals whose incomes are up to four times above the poverty line • Separate health insurance exchanges for small businesses • Requires all private insurers to participate in the exchange

• Creation of a community health insurance option offered through the Gateway that is of the same quality as the private plans • All insurers participating in the Gateway must meet certain requirements

• Creation of a public health insurance plan that is offered through the Health Insurance Exchange that is the same quality as the private plans

• Creation of a Consumer Operated and Oriented Plan (CO-OP) to allow for the creation of nonprofit consumer run health insurance companies in each state

$615 billion over 10 years. Funding must be ap- $1.042 trillion over 10 years, financed by cutting spending on $774 billion over 10 years, financed by cutting spending proved by the Senate Finance Committe. Medicaid and Medicare and instituting new taxes on higher on Medicaid and Medicare and instituting new taxes on incomes. high-cost insurance.

“The time has come to take on this daunting task. The time has come to reform America’s health care.” Sen. Max Baucus (D-MT), author of the Senate Finance Committee Bill Contributed by Chelsea Ongaro

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from the executives

tufts roundtable

Nearly one year ago, the Tufts Roundtable set out to create a media forum that would make it vastly easier for individuals and groups within the Tufts community to share their thoughts, passions and ideas with each other. The idea was simple: by mastering 21st century media and making it available to the general community, we could create one large, centralized showcase of university-based content. Such a forum would make it easier for community to do what it already does, and to help it expand to do more. For those groups and individuals who already produce content, this platform will make that process significantly easier, more streamlined and refined. For those who have not produced content in the past, this platform will allow for the easy but rapid, constant and consistent sharing of thoughts and ideas. This platform will allow all persons involved, whether it’s an individual or a major organization, to access a broader market and viewership base through a central, professional venue. In order to fulfill the mission that we have laid out, we will primarily utilize three platforms: Journal of Debate and Ideas: Tufts first open, professional, and nonpartisan magazine. The Journal of Debate and Ideas accepts submissions from all members of the Tufts community and is actively looking for submissions for the next issue. Tufts Roundable Live: Television and radio can often be inaccessible to many members of the community. Tufts Roundtable Live strives to make it easier for members of the community to take full advantage of these resources, on a professional platform. This team will coordinate a variety of different types of programming, from panel discussions to faculty interviews to recording live events. It will also work to coordinate special events that include collaboration with students and groups, for example the healthcare debate we are hosting. TuftsRoundtable.org: TuftsRoundtable.org is the vehicle through which we will bring together all of the parts of our organization. An umbrella community of independent bloggers and organizations, TuftsRoundtable.org provides an open an accessible forum to any member of the community who might want to contribute. This issue of the magazine is an example of the type of collaboration we wish to foster. As Congress debates healthcare reform, we are thrilled to have Tuftscope, a prominent student group on campus, provide analysis on the reform effort. In a similar effort we are hosting a debate between the Tufts Democrats and Tufts Republicans, which will be moderated by Tuftscope and will focus on healthcare. Tufts is truly at the forefront of media, making it an exciting time to be on the Hill. As this project is still very much in the startup phase, we are still very much looking for people to get involved, at all levels. Whether you’re looking to take on a leadership role on the staff, or just looking to submit articles, blog, or share content, there is a seat for you at the Tufts Roundtable.

Editor-in-Chief

Charlotte Harrison

Managing Production Daniel Rosenblum Director Managing Content Editor

John Peter Kaytrosh

Managing Copy Editor

Brian Kato

Editing Staff

Chelsea Ongaro

Business Manager

Michael Graifman

Executive Web Manager

Richard Mondello

Contributors

Asad Budruddin Jonathan Danzig Edmund Gallese Tim Lesinski Alexa Rosenthall Michael Shusterman Michael Steinberg Chris Walczyszyn



Samuel Wallis, Shabazz Stuart, Chas Morrison Charlotte Harrison, Richard Mondello, Faris Islam, Michael Graifman

Presidents Shabazz Stuart Samuel Wallis Chas Morrison IOPC Student Board Members Adam Weldai, Dean Ladin

—Brian Kato

October 2009

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What Could Have Been John Peter Kaytrosh The death of Senator Ted Kennedy (D-MA) immediately turned the nation’s collective thought to the idea of the “Kennedy legacy.” The concept of such a legacy is, at the very least, a misnomer. First of all, there are still Kennedys involved in public life. More to the point, though, when the “Kennedy legacy” is discussed, it is, more than anything, a masked call for national introspection to raise awareness of the challenges that we face, and an examination of the sort of leadership and solutions we will need to meet them. When that conversation arises, we often do as one of the Kennedy titans would have. Sen. Kennedy’s death called us once more to look to that legacy for inspiration, but Massachusetts political leadership took the easy way out. In 2004, the General Court amended the standing Senate vacancy law to remove the governor’s power to appoint a temporary successor, leaving instead a five-month gap between the vacancy and a special election to fill the seat. However, Ted Kennedy gave us advice earlier this year, foreseeing the untimely demise which came this past August. In a letter to Governor Deval Patrick (D-MA) and prominent legislative leaders, Kennedy deplored the possibility of leaving Massachusetts half-represented in the Senate and recommended amending the 2004 statute to return appointment power to the governor. Opponents of the 2004 change alleged then that it was nothing more than a partisan move to ensure that then-Gov. Mitt Romney (R-MA) would not be able to make a Republican appointment should Sen. John Kerry (D-MA) have won the presidency, and opposed Kennedy’s plan, seeing it as a hypocritical Democratic power grab. As to whether or not Kennedy’s solution was a suitable one, I make no judgment. What we can admire is the late senator’s unabashed willingness to change the system and unapologetically try to ensure “the continuity of representation for Massachusetts should a Senate vacancy occur.” It is true that Senator Kennedy expressed what he wanted— representation—but, as much as his friendships crossed partisan lines, so too did his willingness to engage in the practice of legislation. We should have let Kennedy’s actions speak, and the General Court should have found a compromise. Instead, Beacon Hill Democrats forced through a bill in September 2009 that undid the legislature’s actions of 2004, allowing Gov. Patrick to appoint, with no strings attached, now-Sen. Paul Kirk, a longtime Kennedy friend and aide. A myriad of plausible compromises which would have allowed

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Democrats to maintain some political and moral high ground existed. One such compromise includes allowing gubernatorial appointments now and in the future—with the consent of a supermajority of the legislature. Changing the process itself would allow this debate to be framed as something more than a partisan power grab. Another possibility would have been to allow Patrick to make an appointment—with the consent of leaders of both the Democratic and Republican parties. This would require a bipartisan, good faith effort to do nothing more than ensure the continuity of representation for the Commonwealth. A third solution that comes to mind was used with some success in Wyoming in 2007 to fill the seat of former Sen. Craig Thomas (R-WY), now occupied by Republican Sen. John Barrasso. It allows the party that held the seat prior to the vacancy to submit three names to the governor, of which one must be chosen for the temporary appointment. If the Republicans should someday gain a seat in Massachusetts, this policy would apply equally to them. These are only a few of the possible solutions at the disposal of Massachusetts legislators. Most assuredly, more legally brilliant minds than my own inhabit the halls of the State House, but does the political will exist? Senator Kennedy’s ability to write and vote for bills that were the products of compromise was forged by decades of conservative—not even necessarily Republican—control of the Senate. Democratic Massachusetts legislators generally revel in the comparative luxury of their safe seats and even safer control of the House of Representatives and Senate. When a difficult political question like this one threatens their security in a real way, a compromise not only makes ethical sense, it makes political sense and reminds the voters that the Legislature can be entrusted to their party. A healthy debate has already begun for the special election set to take place this January. Republican and Democratic candidates are both appealing, and the race is still open for any and all comers to forge a path to victory. This is a race that could produce a successor worthy of Ted Kennedy’s seat. Though Kennedy’s seat has already been filled until January, the process for filling vacancies still needs change, and it’s not too late to bring it. Let us, as a Commonwealth, take up that “fallen standard” that Ted once took up himself, and ascribe to Kennedy’s legacy an appointment process worthy of this Commonwealth, enacting it just as brilliantly and wisely as he would have. •

National Section: Whole Right to Healthcare? p. 5 A Felon’s Right to Vote p. 6 Nameless Victims of Bush-Era Lawlessness p. 7 The Issue of Healthcare Reform p. 8

Whole Right to Healthcare? Alexa Rosenthall To say the least, this past year in American less-educated societies will have the opportunity to succeed politics has been exciting and controversial. while those who do not succeed will succumb to natural selecWe have elected a black man to the presi- tion. Although this is an apathetic viewpoint, it does not condency, blasted billions of dollars into ailing tradict the dogma of the United States government. All citizens firms, and caused raucous debates in town can speak, act, and write freely, but they are not assured health halls. While the former two events are like- care. wise important, the outcome of the current health care debate After Mackey wrote this editorial on August 11, 2009, he will have the most direct effect on all United States citizens. received furious backlash. Numerous Obama supporters across Health care reforms have the potential to better or worsen the the country began a boycott against Mackey’s brainchild, Whole quality of care for Americans across all socioeconomic levels. Foods. The supermarket mecca for wealthy liberals suddenly The news of this past summer was flooded with health became a manifestation of conservative politics. As a result of care legislation and negotiations between heavy-hitting sena- Mackey’s editorial, a simple expression of personal sentiment, tors. It was not rare to see daily editorials Whole Foods has been stigmatized by on health care. The American populace While Obama’s election and the many Americans. quickly became numb to health care upvilifying a supermarket is abeconomic bailouts are visible, no one surd,While dates. However, after months of debating this action illustrates the current this volatile topic, the CEO of Whole can live in the pursuit of happiness unease. After months of debate and frusFoods, John Mackey, bluntly stated in without good health. tration as medical legislation is continuthe Wall Street Journal that health care is ously rewritten, Americans are worried. not an inherent right of a human being. Quality of personal health is important. Specifically, Mackey likened health care to other luxuries that It has an immediate consequence on every citizen’s life. The are desired but not guaranteed. “Health care is a service that we health of an individual dictates whether he can engage in soall need, but like food and shelter it is best provided through ciety, generate a salary, enjoy life, and see grandchildren mavoluntary and mutually beneficial market exchanges. A careful ture. While Obama’s election and the economic bailout are visreading of the Declaration of Independence and the Constitu- ible, no one can live in the pursuit of happiness without good tion will not reveal any intrinsic right to health care, food, or health. shelter.” Without a doubt, the United States needs health care reIn the wake of this article was left the question: do Amer- form. Medical treatment has become ridiculously costly from icans have an equal claim to good health care? In addition, unnecessary examinations and inefficient practices. But unishould it be the government’s responsibility to provide every versal health care is unfeasible. Instead of condemning Whole citizen with adequate care, even for those who cannot afford Foods, Mackey, and non-supporters of universal health care, it? Perhaps access to health care is simply an extravagance that the American government and populace should solely focus on comes with a decent salary and education. Those who work a viable plan for health care reform. Reform is cost-effective hard will reap the benefits. Those who are born into poorer, and practical. It’s time for Congress to debate a new issue. •

October 2009

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A Felon’s Right to Vote Chelsea Ongaro While the rest of us were considering whether to cast our ballots for Obama or McCain, a group of Washington state voters had no ballot to cast at all: convicted felons. As in 47 other states, felons in the State of Washington were denied the right to vote in the election this past November, as they have been in every other federal and local election. The United States Supreme Court has long upheld the constitutionality of felon disenfranchisement, giving individual states the power to decide the terms under which felons may, or may not, vote. Though few states go as far as to ban felons from ever voting again, Vermont and Maine are so progressive as to offer prisoners ballots while incarcerated. With a recent change in voting policy that was enacted on July 7, Washington felons were able to cast a ballot in the local elections that August, provided that they were no longer incarcerated and were current with their payment of fines. This bold action has given voice to a segment of the population kept silent for far too long based on racial and monetary grounds. The traditional argument for preventing felons from voting portrays them as having lost the trust of society; therefore, they should not have the privilege of electing officials or helping in the creation of laws that they themselves do not intend to follow. But is it really fair to continue to punish a lawbreaker after they’ve served their time? Voting is not a privilege; it is a right allowed all citizens

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of the United States. Felons are citizens that have made a mistake, but are citizens all the same. The issue with felon disenfranchisement, however, runs deeper than the human right to vote: it is racially discriminatory. A disproportionate number of felons come from minority groups, making disenfranchisement laws for felons a way to target sectors of the population for racial discrimination. In Washington, AfricanAmericans make up 22 percent of the felon population but a mere three percent of the general population. Clearly, these laws are not unlike the poll taxes and Jim Crow laws of old, designed to bar African-Americans from voting, at least in practice if not in purpose. In some states, including Washington prior to the enactment of its new law, felons are barred from voting only until they have served all their time and paid their fines. Can a felon be denied a ballot based on his wealth? It is not in the power of most individuals who have been recently released from prison to pay their fines in their entirety so they may regain their right to vote. So, felons aren’t being given their right to vote because they belong to a less wealthy class of citizens. A clear violation of the Constitution’s equal protection clause, this is wholly wrong and has long been considered so. A felon’s lack of the right to vote also affects voting neighborhoods and legislative districts where a large number of voters are convicted felons. The officials in these areas are not being chosen by a representative sample of their constituents, resulting in a skewed view of the needs of voters and also preventing them from receiving the funding for programs they need to improve their neighborhoods and reduce crime. Without intervention, a vicious cycle is created, only creating more felons. Enfranchisement of felons also has political consequences, especially for the Republican Party. As a vast majority of AfricanAmericans vote Democratic, and because a large number of felons are African-Americans, an implication is that Republicans oppose enfranchising felons because it will hurt their numbers. A citizen’s right to vote cannot be denied based on the vote he will cast; it is a human issue, not a political one. A felon should have his voting rights restored upon release from the prison system regardless of fines and fees owed. This is not only a right based on citizenship, but also one that should not be denied on the grounds of wealth or race. We should embrace the idea that prison is a correctional facility meant to better the criminal. If his rights are denied to him upon his release, what incentive does he have to improve himself during his stay? People can change, felons can too. Even more than that, that’s what prison is for. Under such laws, felons become members of society who have lost their voices forever. Other states should follow the example of Washington and enfranchise felons, which would help to end discrimination based on race, wealth, and criminal history in the voting process and to give voice to a long-silenced group of voters. •

N ational

Nameless Victims of Bush-Era Lawlessness Michael Steinberg

In early 2003, Abdullah alKidd was standing at a ticket counter at Dulles Airport in Washington, D.C., when he suddenly found himself engulfed by a team of federal agents. An American citizen and convert to Islam, al-Kidd was on his way to Saudi Arabia, where he hoped to study Islamic law and Arabic. Abdullah al-Kidd, once known by his erstwhile, Americanized name, Lavoni Kidd, has to this day never been charged with a crime. He was confined in a high-security prison cell lit 24 hours a day, repeatedly stripsearched and physically abused, and, most horrendously to imagine, transported in shackles across three different states for sixteen days straight. Even after a judge ordered his release, al-Kidd was remanded to live with his in-laws in Nevada for the next fifteen months, unable to travel and required to report to a probation officer. Subsequently, this prisoner, still never having been charged with a crime, lost his job with a government contractor after being denied security clearance. The arrest and its aftermath ruined his marriage, and he and his wife separated. The emotional trauma of that time, now more than six years past, even today impedes his ability to hold a steady job or function properly in society. As tragic as the story of Abdullah al-Kidd may seem, it is not unique. In the wake of 9/11 and the advent of the Bush Administration’s “War on Terror,” dozens of American citizens have been detained in such a manner by the federal government. And how, one may ask, was it at all possible for the Feds to detain these people without accusing a single one of them of a crime?

After all, an American citizen has the right to be confronted by his accusers, and the Fourth Amendment expressly forbids unlawful seizures. The answer lies in the Machiavellian legal framework of the Bush adminsitration. After 9/11, federal agents began to detain individuals deemed potentially dangerous, but against whom not even enough evidence existed to constitute probable cause for an arrest, as “material witnesses” to the 9/11 attacks. Of the 54 individuals that were detained by the government under the euphemistic Orwellian guise of “material witnesses,” 53 were of Muslim faith. This was not simply Bush’s people engaging in an illicit campaign of detention in an attempt to circumvent the law and human rights, but a means of executing a deliberate, full-throttled attack on American Muslims. It is highly spurious to suggest that al-Kidd, a Kansas-born Muslim convert, husband, and father of two, had any material connections to the crimes of 9/11. Al-Kidd was en route to Saudi Arabia at the time of his arrest, but had no known connections to that country or any other to implicate him. Al-Kidd, according to law enforcement, professed on a website an interest in jihad—an Islamic theological term whose interpretation has been misconstrued in the West to indicate a belief in terrorism as a means of combating religious opponents. However, I was heartened to hear of the decision earlier this month of the Ninth Circuit Court of Appeals in the case against John Ashcroft filed by al-Kidd. The three judge panel denied Ashcroft the immunity from prosecution that he sought due to his prosecutorial capacity in the Bush Administration. The court opined that the government’s illegal detention of material witnesses following 9/11 was “repugnant to the Constitution and a painful reminder of some

of the most ignominious chapters of our national history.” The judges went on to find that Ashcroft’s own public statements on the importance of detaining material witnesses meant that a compelling case could be made for his liability in al-Kidd’s treatment. It remains unclear to what extent al-Kidd’s legal team will ultimately be able to tie Ashcroft directly to the abuses al-Kidd suffered. Still, the fact that an American court finally opened the gates to even the possibility of some closure and redemption for al-Kidd, a man whose only crime was his faith, is edifying. Of course, government officials engaging with national security matters of the utmost confidentiality are rightly granted legal immunity for their actions—to routinely expose such individuals to highly-publicized legal battles would undermine the ability of our government to keep us safe. However, it is not outlandish to suggest that when government officials treat the legal underpinnings of our constitutional democracy with such contempt, and in doing so, they inflict harm upon their fellow citizens, they must be held accountable. It is easy to dismiss the opinion of the Ninth Circuit as that of a reliably liberal, San Franciscobased court that is out of touch with mainstream views. That is why the composition of the three judge panel that ruled on the Ashcroft case is so salient. Two of the judges were appointed by former President George W. Bush, and the third was a Reagan appointee. Indeed, adherence to the rule of law is neither a Democratic issue nor a Republican issue, but one essential to our society. It is not much of a leap to say, then, that the Bush Administration, in denigrating the rule of law, conducted itself in a manner that was unAmerican. •

October 2009

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N AT I O N A L | T uftscope Partner P iece

The Issue of Healthcare Reform Michael Shusterman, Tuftscope Are death panels going to euthanize Grandma? Why is the government touching my Medicare? Would Stephen Hawking survive the British National Health Service? (He seems to think he would.) These have been the burning questions driving the healthcare debate in the United States this past summer. The concerns of millions of un- or under-insured, the ability of health insurers to rescind policies, the primary care shortage, or even the 16 percent of our GDP that healthcare currently consumes have all been relegated to the sidelines. Protestors stormed town hall meetings to shout down members of Congress, talking heads on cable declared the simultaneous arrival of socialism and fascism, and misinformation spread like wildfire. In the midst of this bacchanal of inanity, the lobbying arms of healthcare interest groups poured millions of dollars into shaping reform in their own likeness, while agreeing to superficial cuts in the name of cooperation. For the last hundred years from Presidents Theodore Roosevelt to Barack Obama, the question of healthcare reform has percolated up from the depths of the national consciousness. In every administration and era, opponents of reform have tried to use fear, half-truths, distortion of the issues, and fallacious myths, assisted by the intrinsic complexity of the topic. It is essentially far easier to discuss ‘death panels’ than administrative costs, regional disparities in medical overuse, the benefits and detriments of health savings accounts, and so forth. Even policies traditionally espoused by the Republican Party, such as medical tort reform, are lost in the noise and backed further into a corner by interest groups, in this case the powerful trial lawyers lobby. Special interests exploit the vacuum of rational dialogue by running vast advertisement campaigns, often riddled with inaccuracies and outright lies. And to be fair, both pro- and anti-reform efforts have distributed their fair share of inaccurate multimedia paraphernalia, though the most egregious abuses come from the anti-reform side. In the end, many (if not most)

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Americans have found themselves without credible sources of information in the media to counter the dishonesty. This perspective seeks to briefly explore two key concepts: insurance coverage and healthcare costs. Health Insurance Polls have repeatedly shown that while the majority of Americans are dissatisfied with the overall costs of the healthcare system, they are as a group largely content with the current health insurance plan they have now. Some 70 percent of the non-elderly (below the age of 65) have private healthcare insurance and of those, more than 90 percent receive coverage from their employers. Group coverage to employees through employer-sponsored insurance provides not only an added job benefit, but also offers protections from the private market. Group coverage provides the safety of insurance without the threat of increased premiums or canceled policies for preexisting conditions. On the private market a policy can be rescinded if the insurance company finds that the subscriber did not mention all previous health conditions (e.g., acne or a bone broken at twelve years of age). Current laws allow health insurers to cherrypick consumers and arbitrarily cancel policies. And like most businesses, insurance companies have no interest in self-regulation, as recent Congressional hearings on recession demonstrate. And when it comes to a consumer focus, healthcare policies read like credit card agreements, poorly worded and confusing for many buyers. Logically, many Americans are afraid of losing the protective safety net of group coverage for the dangers of the private insurance market. But the current recession and the nature of the market have ensured that it has become relatively easy to lose your employer coverage. Every sixth individual with employer-sponsored coverage in 2006 ended up losing that coverage in 2008. Most of those who lost their coverage would not buy it again on the private market, but waited to receive coverage through their new employers.

N ational | T uftscope partner piece But what about the uninsured and under-insured? There are between 45 and 47 million uninsured in the United States. This group is comprised of the working poor, young adults, those already eligible for programs like Medicaid or S-CHIP (but are not signed up), those who can afford coverage (but do not buy it), and some six million illegal aliens (who will not be covered under any legislation being discussed today). Then there are an additional 25 million under-insured, who have high deductable policies that lead them to forgo routine care or would consume a significant share of their income if they became ill. No matter how you add up the numbers, there are millions of Americans who either cannot afford health insurance or have poorly designed and overly expensive policies. Bending the Cost Curve The second half of the equation is cost. Today the US spends $2.5 trillion each year on various areas of healthcare. Much of this spending (52 percent) is driven by provider and hospital costs. A variety of additional factors contribute including systemic inefficiencies, overconsumption of healthcare, new technologies, administrative costs, prescription drugs, and an aging population. Pharmaceutical costs having been growing especially rapidly, in part due to the passage of Medicare Part D through the 2003 Medicare Modernization Act. Since the Act forbids the federal government from negotiating drug prices with pharmaceutical companies, the combination of an aging population and unfettered drug costs may well prove to be a significant cost problem. Researchers at the Dartmouth Atlas of Healthcare have pointed to another significant contributor to costs, the wide discrepancies in costs between regions. Using Medicare spending data, the researchers have pointed out over more than twenty years that provider overuse of services that is not necessarily correlated with evidence-based practices is rampant in certain areas of the country. In a well-distributed article, Atul Gawande of Harvard University told the story of McAllen, Texas, where Medicare spends nearly twice the national average per patient. Meanwhile, nearby El Paso, Texas, with a nearly identical pop-

ulation, spends two times less. The reason for the increased spending may be the entrepreneurial drive by McAllen physicians to run their own hospitals and practices and therefore to consciously (or unconsciously) overuse procedures and tests. Unless we would like to spend increasingly greater portions of the federal budget paying for healthcare, this spending spree will eventually make Medicare an unsustainable program. For those with appropriate coverage, the healthcare system provides the latest in medical procedures, scanning technologies and aggressive end-of-life care. Despite such innovations, a considerable number of major medical centers, and costs per person that are nearly twice those of other nations, the returns on quality of care is quite poor compared to other developed nations. We receive poor care for our money and if we are to continue to consume more and more healthcare (chronic diseases now lead to 70 percent of all US deaths), the system will be inevitably faced with questions regarding rationing, cost control mechanisms, and other unpleasant discussions. Concluding Thoughts Until recently, politicians would not touch the question of regulatory reform of health insurance companies because so many members of Congress were (and still are) indebted to insurance agencies for campaign funding. Costs are an even more sensitive topic, since every dollar cut is a dollar lost from someone’s salary. Considering the nature of previous efforts to reform the healthcare system, it seems likely that any legislation passed will be incremental in scope and will not effectively hold down costs over the long term. And yet even some change to the current perverse incentives that permeated the current system would surely be beneficial for millions of Americans. • Michael Shusterman is a senior majoring in biology and history. He is Editor -in-Chief of TuftScope: The Interdisciplinary Journal of Health, Ethics, & Policy. TuftScope provides commentary on health policy, bioethics, and public health topics at http://tuftscope.blogspot.com and www.twitter.com/tuftscope.

October 2009

9

No Miracle Cure

BY JONATHAN DANZIG

Barack Obama has vowed to be the last president to deal with healthcare reform. Fair enough. He has also vowed to work with Republicans, which is great, because everyone likes cooperation. Political compromise requires careful consideration of a number of factors: the urgency of the situation, the popularity of the governing party, the gap between partisan interests, and acknowledgment of both political and outside realities. Whether President Obama will fulfill his vow depends on his, and the Democratic Party’s, ability to come to terms with these dynamics. Compromise in Theory If you ask a pundit or politician why Washington is so crippled by partisan gridlock, he or she will answer with some variation of the following: elected officials are choosing to be as partisan as possible— why, in the good old days, everyone had a ‘can-do’ attitude, and they just wanted to work together to find solutions. Nowadays, we hear, they’re too busy trying to

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prevent opposition victories, instead of serving their country. And they’re being rude about it, too. This is basically nonsense. Disagreement is an essential part of multi-party politics; if we wanted total consensus, we would establish a one-party state. But even Massachusetts elects Republican governors. Politicians are partisan because they are elected to stand for something; cynics may deride them as opportunists, sell-outs, and frauds, but they still probably believe in something. As a group, politicians disagree on issues, and therefore vote divergently on legislation. Every four years, Ralph Nader runs for president and dramatically declares that Republicans and Democrats are the same party. If he were right, America would already have a healthcare compromise. We are still waiting. What Everyone Wants There are three basic considerations in healthcare policy: cost, quality, and coverage. Those seeking consensus can look at these issues and find complete, meaningless agreement: every single politician wants lower healthcare costs, higher qual-

ity, and expanded coverage. As I wrote in a previous article, nobody is against everyone having healthcare coverage; people just disagree on the proper role of government in assuring it. True believers within the Democratic Party want single-payer health insurance: government-run, government-administered, taxpayer-funded healthcare (theoretically) for all. The Congressional Progressive Caucus, the main bastion of liberal strength in Congress, supports it. The most liberal Senators, including Russ Feingold (D-WI) and Bernie Sanders (I-VT), a self-proclaimed socialist, support it. And President Obama, before he had to face political realities, told the AFL-CIO in 2003 that he “happen[s] to be a proponent of a single-payer, universal healthcare plan.” If they could push it through, they would. Republicans, of course, almost uniformly oppose single-payer healthcare, but unlike with Democrats, there is no single phrase (like ‘single-payer healthcare’) to describe their ultimate goals. Roughly, they want healthcare policies that will allow personal freedom and competition, with

N ational a minimal amount of government interference. To paint with a wide brush, the issue is not that the government does not do enough. To Republicans, government does too much: by restricting choice and implementing faulty policies in various areas of healthcare, government involvement drives up costs for everyone, rich and poor. One party’s true believers want a government takeover, and the other’s true believers want the government to back off. Compromise is difficult. Single-Payer vs. Political Reality One could write a book on the costs and benefits of single-payer healthcare, but Republicans and Democrats can agree that regardless of its merits, it will not pass in the immediate future. Not enough people support it. Politics is the art of the possible, as the phrase goes, so healthcare-minded Democrats look for a solution. They thought they had found it in the ‘public option,’ a proposal to allow Americans to buy health insurance directly from the government. It seems a brilliant compromise: it does not nationalize healthcare, nor does it create an individual mandate to buy health insurance. As one of its leading proponents, Rep. Anthony Weiner (D-NY), says on his website, “The public option must be included if we want to control costs, improve healthcare services, create competition and turn around our ailing healthcare system.” Of course, this is the same Anthony Weiner who is a co-sponsor of HR 676, the single-payer House bill. It is difficult to believe that he simultaneously wants to increase competition through the public option and eliminate competition through single-payer. He cannot

have it both ways. The ‘public option’ is the 2007 brainchild of Jacob Hacker, a political science professor at Yale University. He recognized that single-payer was politically unfeasible and developed a compromise. Some accused him of creating a Trojan horse for single-payer. His response: “Well, it’s not a Trojan horse, right? It’s right there! We’re gonna get there [to single-payer] over time.” Numerous Democrats are on record confirming that the public option is the road to single-payer, government-run healthcare.

Healthcare policy wonks understand why the public option will lead to single-payer. Simply put, it would offer above-market coverage at below-market value, subsidized by American tax dollars, leading to the gradual siphoning of people off of private insurance and onto a ‘cheaper’ government plan (which they are paying for anyway), and eventually to the necessary political environment for a near-total government takeover of American healthcare. For Democratic party faithful, that is fine. For Republicans, that strategy is proof that Democrats are not really interested in compromise; rather, they are interested in a politically-safe version of

politically-unfeasible single-payer. Awareness of an ‘incrementalist’ strategy makes Republicans justifiably wary of anything presented as a compromise. Sen. Kent Conrad’s (D-ND) proposal for healthcare cooperatives has potential: successful cooperatives, where people band together to pool risk, exist and work well, mostly throughout the Midwest. There is little doubt that Conrad is sincere in his desire to find a compromise, but the difference between proposed co-ops and current co-ops is that the proposed ones would be created by and initially funded by the government, whereas current ones are not. If actual coops (rather than political government entities) were so feasible, they would not need government intervention in order to come into mass existence. The last reform that liberals might be willing to accept is the so-called ‘public option trigger,’ without the direct establishment of a public option. The trigger would give the insurance companies a ‘final chance,’ they say, to provide affordable, quality care to all Americans. And if they do not pass an arbitrary benchmark, the public option will automatically come into existence on a state-by-state basis. But, as former Speaker of the House Newt Gingrich said on Fox News Sunday, “If you say to the government bureaucracy, ‘As long as you find it has failed, you get to build a brand-new bureaucracy,’ you have a guarantee the trigger’s going to go into effect.” This is another backdoor to single-payer that will not pass. Indeed, as long as single-payer is used as a starting point for ‘compromise,’ the nation, acting through its elected officials, will not accept it.

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F eature All Facts Considered An actual compromise must be based on reality, because compromise remains impossible so long as each side comes to the table with different facts. As former Sen. Edward Kennedy (D-MA) said back in 1978, “The problems of our economy have occurred not as an outgrowth of laissez-faire, unbridled competition. They have occurred under the guidance of federal agencies, and under the umbrella of federal regulations.” Of course, he was talking about the trucking industry, but it applies to healthcare, too. America’s healthcare system may be profit-motivated, but it is not a free market. Free market skeptics claim that insurance companies make record profits by price gouging, neglecting to concede that each state places a plethora of mandates on insurance companies regarding minimum coverage, and federal regulations prevent consumers from buying across state lines. They criticize employer-based health insurance, neglecting to mention that such a faulty system exists because of Democratimplemented tax laws that favor employerprovided insurance while taxing individually-bought insurance—a regressive tax on the poor and unemployed. They complain about high premiums while refusing to recognize that frivolous malpractice suits drive doctors’ insurance rates up, forcing them to charge much more. To his credit, President Obama made some mention of this in his address to Congress, but it has yet to appear in proposed healthcare bills. Of course the free market cannot solve these problems. The free market did not create these problems. Many Democrats seeking compromise cannot even acknowledge that government played a role in the many high costs and inefficiencies of American healthcare, and this prevents a resolution. The disparity between Republican and Democratic understanding occurs because the left wing of the Democratic Party wants a single-payer revolution, while most Americans just want healthcare to be cheaper and more accessible. For any Republicans to sign on to a Democratic proposal, it must recognize their concerns as more than a novelty.

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Compromise as Necessity The standard line goes that the Republicans are the ‘Party of No,’ that they are responsible for shooting down every Democratic proposal, no matter how generous to them. Sen. George Voinovich (R-OH) admitted a few months ago that it’s “probably 50/50” regarding how much of the

For any Republican to sign on to a Democratic proposal, it must recognize their concerns as more than a novelty. opposition to Obama’s healthcare vision is just for political points. That statement was a gaffe, only in the sense that he spoke the truth: of course Republicans want to score political points running against a proposal that, according to Rasmussen, has 55% disapproval and 42% approval (9/15/09). And Democrats scored political points running against President Bush’s social security reform, against President Bush’s tax cuts, and against the Iraq War that the majority of them voted for. If Republicans, like Democrats opposing Bush, think something is bad, and they think people do not like it, they really have no motivation to work with a president pushing an unpopular policy. As President Obama seeks Republican support for his

proposals, he will not convince anyone by vowing not to “waste time with those who have made the calculation that it’s better politics to kill this plan than improve it,” as he said in his address to Congress. Nobody should forget the actual reason Obama needs Republican support: Democrats are abandoning him. The Democrats have a filibuster-proof majority in the Senate and an overwhelming majority in the House, and therefore do not need Republicans to pass anything. Obama is not ‘reaching out’ because he believes in bipartisanship; he is reaching out because his own party is not getting in line behind him. Reality-Based Solutions Republicans have proposed many individual market-based reforms that could achieve the goal of near-total coverage without increasing government control. They brought them to President Obama’s address to Congress, and held them up when he said that his “door is open” to any “serious” proposals. Political reality dictates that such reforms will never pass under a Democratic Congress and President. That’s fine. Elections have consequences. But for Democrats to craft a compromise that is acceptable to any Republicans, they cannot include anything that could be manipulated into a Trojan horse for government-run healthcare. There are plenty of alternatives on the table. •

The Trouble With Compromise

BY TIM LESINSKI

The debate on healthcare poses an interesting dilemma for liberals. On the one hand, we want to see bipartisanship and a viable compromise, which helps us by reducing the chance of Republican gains in the 2010 midterm elections. On the other hand, we want to pass a bill that accomplishes all our goals, which include reducing overall cost, ending discrimination against those who are sick or have preexisting conditions, and, most notably, securing universal coverage. The prevailing opinion among most liberals is that any compromise without a public option would not achieve those goals. So, what is a politician to do? Compromise or None? Health reform cannot wait. The system is profoundly broken, because the insurance companies are driven to do whatever is necessary to make a profit, even if it means denying coverage to people who are deemed unprofitable to them or raising costs at an unreasonable rate. The increase in the cost of medical care has greatly out-

paced the increase in wages. From the perspective of a member of Congress of either party, it should be clear that almost any passed bill is better than no bill at all. Unfortunately, this isn’t the case. In both chambers, the Republicans have been shooting down every compromise, regardless of how watered-down. They typically even reject cooperatives, a proposal that wouldn’t increase the size of government at all. Then, in the House of Representatives, we have a large group of progressive Democrats who have decided to reject any bill that doesn’t have a public option—a policy that stops compromise in its tracks. While their determination is to be admired, the 60-odd progressive Democrats should look to the results of the final bill, rather than the mechanism that it uses to achieve them. A bill must pass, and it must pass soon. Unfortunately, making compromises isn’t easy. On the right, we have the so-called “deathers,” who believe that Obama’s plan for health reform includes “death panels” that will deny coverage to the elderly and disabled—a malicious rumor given publicity by former Governor

Sarah Palin (R-AK), among others. There are several Republicans who have pledged to vote against a bipartisan healthcare bill, no matter what the content. As Republican Senator George Voinovich of Ohio said a few months ago, regarding how much of the opposition to Obama’s health care plan is about scoring political points against Obama: “I think it’s probably 50/50.” A recent incident demonstrates well what Sen. Voinovich was talking about. During Pres. Barack Obama’s address to a joint session of Congress on health care, Representative Joe Wilson (R-SC) shouted out “You lie!” when Pres. Obama said that health reform would not cover illegal immigrants. Since the incident, he has raised $1.7 million. Was he scoring political points? I’ll let you be the judge. On the left, there are those who still fight for a single-payer system, although it has no chance of passage, and there are the House progressives, who will vote against anything without a public option. Unfortunately, many liberals are beginning to think that health care reform isn’t worth doing if it doesn’t involve a public option. That kind of thinking gets us nowhere.

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F eature Nature of the Bills and Compromises Not all bills are created equal. Some will inherently be better than others. Some aspects of a compromise work better, but will be less likely to get Republican support; others aren’t as good, but will win over a great number of Republicans. The willingness of both parties to compromise will determine the final nature of the bill. Here are some aspects of a compromise that will actually increase the number of the insured, while still standing a chance of reaching the President’s desk: a trigger for a public option, tort reform, and abortion and deficit neutrality. It seems that the trigger will be the key portion of this compromise. A trigger for a public option—the proposal of White House Chief of Staff Rahm Emanuel and Maine Sen. Olympia Snowe, the most likely Republican vote for a compromise bill—sets a deadline for insurance companies to comply with certain criteria within a set amount of time, such as making affordable coverage accessible to 95 percent of Americans in each state; if this deadline is not met, a public option will be triggered in that state. This compromise gives market-

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based reform a final chance to prove itself, but in case market-based reform fails, a more progressive solution can step in, pleasing both

Not all bills are created equal. Some will inherently be better than others. camps. Since it only requires that affordable coverage be accessible, not that everyone be covered, it does not punish insurance companies for not providing health insurance to people who can afford it but choose not to purchase it. This compromise works to achieve the goals of progressives, while limiting “unnecessary” government intervention, as conservatives want. It also distinguishes among states and preserves the federal system, as it is enacted on a state-by-state basis, something that also pleases Republicans. Tort reform is an element of healthcare reform that Republicans have proposed. It involves making it harder to sue frivolously for malpractice, since frivolous lawsuits cause a portion of healthcare cost increases. Tort reform alone, without more fundamental

structural changes, is a terrible idea. Those on the left doubt it will accomplish much towards reducing costs; it is, however, worth including, since it placates Republicans and does nothing bad. Progressives seem to be getting the message; they are slowly getting on board with it, in spite of their doubts, if only to get Republican votes. Obama has seen the need for tort reform in a compromise, too, and has started to speak out for it. Another of the rumors swirling around health reform is that abortions will be funded under a public plan, or even that private insurance companies will be forced to pay for abortion. While this may or may not be true, it has caused much outrage among both the pro-life and pro-choice camps. After all, who wants their money going to someone else’s abortion? It is clear that there must be a strong provision in the final bill that specifically bans any government funding from the bill going to provide abortion-on-demand. Elective abortion is not healthcare, and taxpayer money should not fund it. Doing so would encourage abortions, at a time when they clearly need to be discouraged. The inclusion of a provision banning funding

feature of abortion would send preventative care meaclearly the crucial messures, and ensuring the sage that abortion should universality of affordable truly be a last resort. quality healthcare to virDeficit neutrality is tually all US residents. another key component However, some Reof a compromise. If we publicans are opposed • Mandates that individuals have insurance by 2013. pass a major bill like this, even to these provisions. • Employers with under 50 employees would be under no we have to pay for it. They believe that it will obligation to provide or pay for insurance. We cannot simply pass hinder insurance com• Creates state-based, nonprofit cooperatives. along the debt to future panies’ ability to provide • Prohibits the use of federal funds for abortion. generations, which often coverage, requiring them was the case with bills to deny coverage to some • Income comes from $13 billion in new fees, and a new passed by the George in order to maintain a tax on insurance plans. W. Bush administration. profitable business mod• Total Cost: $774 billion Deficit neutrality will be el. This only strengthens achieved in several ways. the argument for a pubThere will be some monlic option. be motivated to change their ways, insurance ey saved from ending In the homeowners subsidies to insurance companies, and from companies must have the threat of a public insurance industry (at least in Massachudigitzing medical records, but it is clear that option hanging over their heads. setts), some homes, most of which are on the The Baucus bill deserves credit for one storm-prone coast, are insured by the FAIR that will not be enough. We do, unfortunately, need to raise taxes on the wealthy to thing at least: it has a stronger, more robust (Fair Access to Insurance Requirements) pay for this. It may sound harsh, but it is health insurance exchange than the other Plan. It charges premiums like a normal the fiscally responsible thing to do. Unfor- plans. Under the Baucus plan, companies insurance company, but its rates are detertunately, there has been such a fear of raising with 50 or fewer employees have access to mined by the state Insurance Commissioner. taxes that the tax rate hasn’t been increased the health exchange; under other plans, this The profits and losses for the plan are dinumber is only twenty. This plan also allows vided among the insurance companies. The since the early 1990s. Also, provided there is some form of for businesses of any size to join the health model works for uninsurable homeowners; public plan, a good portion of the funding insurance exchange in a decade or so, al- shouldn’t something like this be done to enwill come from premiums on the plan, thus lowing more choice for employer coverage. sure healthcare to those the health insurance enabling it to be self-sufficient. (The public Additionally, it is paid for by penalties and companies don’t wish to insure? This is why, option is, despite what some may say, not a taxing insurers, leading to a reduction in the at the very least, liberals call for an insurance handout. It may be cheaper than a private deficit. However, there are disadvantages. exchange that works like the FAIR plan, or a plan, but it isn’t free.) This will also place With certain changes including a trigger for public option trigger. private insurance companies’ offerings on a a public option and an employer mandate to The final compromise will probably look more level footing with the public plan, pre- increase the possibility of universal coverage, something like this: a public option with a venting the insurance companies from going this will be an effective bill. trigger that also includes provisions ending

The Baucus Bill

out of business, as well as pushing for better coverage from private plans.

The Other Compromise A different sort of compromise, however, is gaining traction. That is the Finance Committee’s attempt at a bipartisan bill, or “The Baucus Bill,” or even “BaucusCare,” named for Senate Finance Committee chairman Max Baucus (D-MT). A central portion of this is not the public option, but rather nonprofit health care cooperatives, which attempt to create a collective bargaining advantage for consumers in a similar way to how federal employees get cheaper healthcare. While this may work, there are doubts that prices will be lowered and discriminatory practices will end simply because of co-ops. In order to

We cannot simply pass along the debt to future generations, which often was the case with bills passed by the George W. Bush administration. The Non-Negotiables There are several other provisions that reform proponents must fight to include in the final bill. These include preventing insurance companies from discriminating against those whom it is unprofitable to insure, ending lifetime or annual caps on spending, ensuring that healthcare costs are reduced, increasing

lifetime caps, consolidation of medical records, tort reform, and abortion neutrality. It will include some tax hikes, likely on the wealthy, rather than on the insurance companies themselves; it will thus be deficit neutral. This seems to be the type of bill that will most likely win over Sen. Snowe, and thus convince moderate Democrats such as Sen. Ben Nelson of Nebraska. It will also hopefully be approved by the House progressives, as it provides the possibility of a public option if market based reform fails. Navigating the roadmap of reform is tricky, and only a few possible solutions could secure passage, but reform can, will, and must be passed this year. •

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International Section: Tamil Troubles, p. 16 Why We’re in Afghanistan, p. 17 Where is Central Asia? p. 18 Missile Defense and Russia, p. 19

Tamil Troubles Chris Walczyszyn On May 18, 2009, the world witnessed the conclusion of a war many thought would never end. For twenty-five long years, the Sri Lankan government has refused to accept the Tamil demand for autonomy and has sought to quell their rebellion. As the United Nations lauded the Sri Lankan government for bringing an end to the conflict, Human Rights Watch reported that approximately 300,000 Tamils displaced by the fighting were being held in internment camps. Furthermore, reporters have not been allowed full access to the detention centers because the government fears having a bad image abroad. They must instead, go through military channels to enter the camps. The Guardian’s Nick Paton Walsh was deported from the island nation after smuggling a camera into an internment camp and recording accusations of rapes, deaths, kidnappings, and a lack of respect for the bodies of the dead. As he put it, “The government is intolerant of a critical press; the line we crossed was at passport control.” Quite frankly, the current Sri Lankan government is on a power trip. They crushed the Tamil Tigers and their liberation movement, thereby ending a threat that previous administrations had failed to eliminate, doing so quite suddenly. They deserve praise for their accomplishment. While the government may have deemed it a necessary precaution to intern Tamils to reduce the threat of Tigers rejoining the fight, there simply is no moral or practical justification for interning hundreds of thousands of civilians to contain a few. It would behoove the government to, at the very least, improve conditions in the camps and allow reporters to come in and report on the situation inside. Now that the government has won the war and brought a sense of stability to the island, further progress must be made. International focus has inevitably shifted to the continued existence of the internment camps. Afraid of jeopardizing its victory, the Sri Lankan government has prevented interned Sri Lankans from leaving the camps.

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This fear, though reasonable, must be overcome if the government is to ever make true peace with the Tamil people. Longterm stability cannot be attained when hundreds of thousands of civilians are held hostage, even though they have had no direct involvement in the war. The road to progress will be a long one. The Tamils feel that they are a defeated people. Members of the Tamil Diaspora have staged protests around the world in an effort to increase international pressure on the Sri Lankan government and to express their disappointment that there will not be an independent Tamil state on the island. Unfortunately, the sad reality is that few people, and more importantly, few governments care. Many are blissfully unaware of the situation on the island and the harsh realities of life inside of an internment camp. Though international pressure on Sri Lanka is mounting, with the BBC reporting that the UN’s Undersecretary General for Political Affairs, Lynn Pascoe, has visited several camps on the island, he is expected to accomplish no more than speeding up the process of liberating the Tamils. The stark divisions between the communities will take time to heal. Future generations of Sri Lankan Tamils will be able to cite the internment of their people after the war as a sign of abuse and mistreatment at the hands of what they will term a ‘brutal regime.’ Clearly, not enough pressure has been placed on the current Sri Lankan government. If the international community wants to see human rights restored in Sri Lanka, more pressure needs to be placed on the government by prominent members of the international community. While the UN can foster dialogue, history has proven it to be highly ineffective in forcing governments to comply with its wishes. Until serious international pressure mounts, pity the Sri Lankan Tamils. They will be in camps for some time to come. •

international affairs

Why We’re in Afghanistan Chas Morrison There’s been a lot written lately on the strategic rationale for the continued presence of American troops in Afghanistan. Afghanistan is an ancient land that has never been kind to foreign armies. The rugged passes of the Hindu Kush sweep down into deeply impoverished valleys that are inhabited by tribesmen whose sense of honor often dictates that they resist foreign occupation. Most of the men we are spending so much blood and treasure to kill have no use for a global jihad and harbor no love for al Qaeda and its ideology. For every al Qaeda diehard who really does want to kill Americans, there are a hundred Pashtun tribesmen who fight simply because it’s the thing to do. Unfortunately, the American public has no idea of the enormity of the effort that will be required for us to achieve victory. Any army can destroy, but we have the far more difficult task of building. Building democratic processes, establishing the rule of law, and enforcing accountability—even at the local level—is the only long term path to defeating the Talibanled insurgency. Is it really worth thousands of more American lives and billions of dollars to engage in an imperial project of society-building in a forgotten and impossible corner of the earth? Yes, but not for the reasons most people think. Properly understood, Afghanistan isn’t about terrorism so much as it is a great power competition; much of this great game over the course of the 21st century will play out at sea, in the shipping lanes of East Asia and the new trade routes through the Arctic, but the war, the real war, would be fought over Central Asia, the last true frontier. The region holds vast oil and gas reserves, which are only just beginning to be exploited. If there is ever to be another apocalyptic war, it will be fought here, at the end of the world, over the sinews of power: oil. It is in Central Asia where the great civilizations meet, and will ultimately clash. To the north lies Russia, feebled yet dangerous. To Russia, Central Asia is the near abroad; most of the current governments in the region are simply Soviet-era apparatchiks wearing nationalist hats. Russian thinking and strategy has left an indelible impact in the region and the Kremlin fundamentally understands the leaders in Tashkent and Dushanbe. Moscow wants and needs friendly governments in its near

abroad to offset fears of growing impotence and decrepitude. Georgia last summer was but a preview of what may be to come if Russia continues to feel the need to reassert its authority on a regular basis and maintain its influence in what it regards as its backyard. To the east is China. China cared so much about putting down the Uighur protests over the summer because it desperately needs Xinjiang province as a gateway to Central Asia. To fuel its unquenchable appetite for natural resources, China has embarked upon a steady campaign of soft expansion, cultivating ties with governments around the world, and especially in Africa. However, oil from Africa won’t be enough when China is putting tens of thousands of cars on the road each day. No, China will look westward at the vast expanse of the steppes and see power for the taking. And that leaves the Americans. Unlike the Chinese and the Russians, we don’t have a natural gateway to the region. Our closest true ally nearby is India, but the Indians have their own problems and in any case, the subcontinent is too isolated by the Hindu Kush to serve as an effective staging area for projecting power inland. Pakistan is rocked by turmoil and a large American presence would only further destabilize the country. And then there’s Afghanistan. If—and this is a huge ‘if’— America can put down the Taliban insurgency, craft a measure of stability, and turn Afghanistan into a sphere of influence from which it can project power into Central Asia, it will be in position to protect its energy interests long into the future. While there’s a small chance that the superpowers would ever come to blows over Central Asia, it is virtually certain that there will be an intense competition over the region’s resources. Like the Great Game that once played out between the British lion and the Russian bear so many years ago, a new great game is emerging in which a tripartite competition for resources will have the potential to bring the world into a new era of conflict. It’s imperative that when the day comes and Middle Eastern oil has dried up, and the world turns toward the last energy frontier, America is ready and prepared to protect its access to the energy which powers its civilization. The war in Afghanistan, then, for all its difficulties, is a good start toward that end. •

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I nternational affairs

Where is Central Asia? Asad Budruddin Can anyone who is not from Central Asia actually name more than three or four countries over there? Do you know anything about the bunch of countries on the map above Afghanistan? I ask this not to mock the Tufts student populace or those of us who might be from Central Asia. I ask this because I myself couldn’t name them before writing this article. The New York Times ran a story on Kazakhstan on September 4 about the arrest of human rights activist Yevgeny Zhovtis, but you don’t usually hear about the area’s politics, or, for example, why many terrorist organizations draw members from that region. This is a region of about 55 million people, where many of the countries are currently ignored by traditional media outlets and will probably continue to be ignored until they get embroiled by the next big wave of controversy that is usually associated with their Middle Eastern neighbors. To be fair to the press, some of the Central Asian governments have tried to isolate their populations from the rest of the world, but that should not be an excuse for ignoring this region. Central Asia is a blend of different peoples. It has Soviet communist influences, Afghan and Pakhtun tribal links, and Iranian mixtures that make up a complicated and diverse landscape. It hosts refugees and displaced persons from civil wars and other conflicts, and has high birth rates, low mobility, and water shortages caused by the area being landlocked. In fact, much of our interaction with Central Asia probably comes from Borat, a film that might have been funny, but was also truly insulting to people in Kazakhstan who had no idea what they did to deserve to be portrayed the way they were. Subsequently, the government of Kazakhstan rebuked and protested Sacha Baron Cohen’s portrayal of their people. Unfortunately there has not been much attempt to look beyond the stereotypes and understand this region, because it is not deemed important enough right now. Chas Morrison, on his Tufts Roundtable blog entry about Afghanistan, spoke about the strategic importance of Central Asia. Although I disagree with some of the conclusions he makes, I agree with his contention that Central Asia is bound to be the focus of a lot of attention soon, especially because of its yet untapped energy resources. In fact, Morrison goes on to to say that part of the incentive for the United States to stay in Afghanistan is so that it can easily access energy-rich Central Asia in the future. China’s problem with its Uighur

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Muslim community recently got some attention after riots erupted in Xinjiang Province in the summer of 2009. It reflects the ethnic tensions this entire region is subject to, and which complicates the formation of fully representative democracies. During the heyday of the Soviet Union, people of many ethnicities were “exported” to the Central Asian region; this relocation drastically changed a formerly ethnically uniform region into a melting pot. As the Uighur riots have shown, these countries are finding it difficult to harmonize their ethnic diversity. Due to the Soviet religious suppression, there is a general lack of religious intellectual activity, especially within the Islamic community that is the dominant religion in the region. This can make the region a dangerous and fertile ground for demagogues to abuse religion. Major powers have been playing a game of silent chess in this region. Russia, China, and the United States have been trying to establish military bases and missile systems aimed at each other. It is unfortunate that all these countries, instead of strengthening their ties with the people of Central Asia and relying on international norms of economic cooperation and political negotiation, are rather relying on missiles to build up their influence here. While all three countries have genuine and pressing security concerns in Central Asia, they should probably use diplomatic means to come to some sort of understanding with each other to ensure future political and economic progress and success. While President Obama has set a good precedent by halting the Eastern European weapons program, which was causing friction with Russia, more work remains. Hopefully, Central Asia will get the attention it deserves before it becomes a global hotbed and the world’s next liability. •

international affairs

Missile Defense and Russia Edmund Gallese In a recently-published article in the New York Times, Secretary of Defense Robert M. Gates outlined his support for President Obama’s September 17 decision to scrap plans to build interceptor missile and radar sites in Poland and the Czech Republic, supposedly aimed at countering Iranian ballistic missiles. When considering whether or not the choice was affected by Russia, which has strongly opposed the sites since plans to build them were first made in 2007, Gates affirmed, “Russia’s attitude and possible reaction played no part in my recommendation to the President on this issue.” Of course, there is no denying that the President’s decision was influenced by several other factors, not the least of which is the fact that the administration’s new, lower-profile, missile defense plan in Europe is both easier on the defense budget and can be implemented much sooner. Nevertheless, given Russia’s staunch opposition to the old plan, as well as the administration’s need for Russian support, it is impossible to completely divorce its cancellation from Russian considerations. It seems clear that Russia’s real problem with the old plan was not so much its ability to counter Russian missiles but rather its placement. After all, the administration’s new defense plan, as Gates points out, will be just as capable of destroying missiles, albeit not those of the intercontinental variety that make up much of the Russian arsenal. However, Gates also said they may be later upgraded with such capabilities. More importantly, though, the new proposal will place interceptors on warships and in Turkey rather than the Czech Republic and Poland. This is crucial considering Moscow’s history of complaints regarding Western meddling in its ‘privileged sphere of influence,’ which mainly includes former communist states in Eastern Europe. Russia has appeared to recognize this shift in policy. Russian President Dmitry Medvedev recently stated, “The fact that they are listening to us is an obvious signal that we should also attentively listen to our partners, our American partners.” As tension has brewed between the United States and Russia over various topics ranging from the missile defense plan to Russia’s invasion of Georgia last August, the Obama administration could definitely use this moment as Russia’s “American partners” to advance its foreign policy interests. To begin with, the administration still needs to update its Strategic Arms Reduction Treaty (START) with Russia for the concerns of a post-Soviet world. Perhaps more importantly, though, the United

States needs Moscow’s help in pressing Iran to cease its nuclear enrichment program. Securing this help would not only reduce the need to develop European missile defense but also send a message to other states who might think of acquiring nuclear weapons in violation of the Nuclear Non-Proliferation Treaty. In this area, Russia has been resistant to the idea of supporting more sanctions on Iran, instead maintaining that Iran has a right to a civilian nuclear program. However, it is unlikely that the United States’ recent action will cause Russia to make a U-turn on its position regarding Iran, as Russian and American officials alike emphasize that it was neither given nor will be taken as a concession to Russia. How, then, is it possible to get Moscow behind placing more sanctions on Iran? The answer is that the Obama administration must continue to part with the previous Bush policy in Eastern Europe that did little more than antagonize Russia. Indeed, Russia has seen the United States’ backing of both Ukraine and Georgia for NATO membership as more meddling in their backyard. This stance, which the current administration still supports, as is evidenced by Vice President Joe Biden’s visit to both countries in the summer, should be dropped. Neither country has proven itself to have the responsibility to be a member of the alliance. Georgian President Mikheil Saakashvili has demonstrated himself to be both repressive, limiting media freedom in his country, and reckless, provoking Russian invasion of his country last summer by attacking South Ossetia. Meanwhile, Ukraine, having been especially affected by the global economic crisis, has a disintegrating economy, while infighting between its leaders has not only left its government impotent but also made it into something of a political laughingstock. While detractors of the Obama administration will cite such a measure as a failure to keep promises to each country, the fact is that both Georgia and Ukraine would prove to be only liabilities to NATO. Furthermore, such acquiescence to Russia’s wishes could not be ignored and would greatly improve the United States’ chances of getting Moscow to help in achieving its policy goals. Scrapping the original missile defense program was the right move on the current administration’s part with consideration to Russia. Now it must continue the trend if it wants to get Russia behind it and confront Iran. •

October 2009

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Greg Beach, Things that are Cool “I’m not dead!”: Debunking the Public Option The mainstream media sees these divisions within Congress and, like any good business, chooses to exploit them for financial gain. They have framed the issue of the public option as an issue of left vs. right, of a government intrusion into the health care industry, and as a potential source of Congressional compromise to gain a few Republican/Blue Dog votes for health care reform. They also have misinterpreted the President’s position of “It is only one part of my plan” as meaning he is caving on an issue much of his base holds dear to their heart. Reputable news sources such as the New York Times and the Washington Post have declared the public option to be dead, trampled to death by the stampede of insanity that is our national health care debate. Well, unless I’m missing something here, almost everyone seems to be wrong... Why anyone confuses Obama’s strategy of playing it safe with an abandonment of the public option is beyond me. The media has painted the public option as a nutty, liberal thing; if the President becomes as hard lined as Pelosi and others, he risks the loss of valuable political capital and leaves himself vulnerable to attack. If Obama has thought this all through (and I assume he has), he knows the public option will be included in the final bill; he knows the smartest move is to let Congress handle the battle over the P.O. and once Armistice Day arrives, sign the bill. A recent study by the New England Journal of Medicine reported that 73% of doctors support a public insurance option. The New York Times/ABC News reported in a recent survey that 65 percent of Americans support the pubic insurance option and, depending on the wording of the polling question, the support may be even higher. Hell, even Bill O’Reilly supports the public option. This is not a liberal vs. conservative issue and it shouldn’t be. The public option has been and continues to be the most effective proposed method to control exploding health care costs, hold health insurance companies accountable, and increase coverage to uninsured Americans. At last, we will live in a country where fellow citizens do not go bankrupt because of medical costs and every American is guaranteed an affordable health insurance option. Victory is near, friends.

Christopher Snyder, The Quad Tufts Daily to News Media: Stop “Selling Out” over ResLife Sex Policy Yes, roommates should have a frank discussion about sharing a room, including sexual activity, starting at move-in day. But circumstances change, roommates do things they didn’t think they would do, etc. It’s much harder to have a conversation in November about something than in September (even though it wasn’t a problem in September). It’s far easier for a disconcerted roommate to point to a ResLife policy (“See, you have to let me live in my own room, ResLife says so!”) than to try and stand up for oneself sometimes (“Well, it’s really annoying, but I guess it’s part of what college is like, you know, some people just have bad roommates, that’s part of college culture too, and there’s nothing I can do, I don’t want to be a stick in the mud...”). The policy, as written, is certainly not in the right place in Habitats. Sexiling doesn’t just happen when overnight guests are involved. Perhaps there should be a section which elaborates on the Residents’ Bill of Rights (which is located on the inside cover of Habitats). Or maybe it should just be in a part of the guest policy that doesn’t say “overnight.” But let the news media gawk. Many policy restrictions are targeted at only a few people (such as “Panic Buttons ARE NOT used to alert TUPD if you are locked out of your room,” p. 27 of Habitats, or “defecating and urinating in student rooms is strictly prohibited,” p. 40). This is just one of those policies -- a common-sense policy that sadly must be spelled out for an inconsiderate few.

20 Tufts Roundtable