When will we leave Afghanistan?

August 13, 2010 Leave a comment

“…the US army must stay until the Iraqi army is fully ready in 2020.” So says the top US solider in Iraq, Lt. Gen. Babaker Zerbari. He added that the planned withdrawal will create a “problem” and increase instability in Iraq. The US government plans to withdraw its combat troops by the end of August 2010, and to remove all troops by the end of 2011.

This has interesting implications for the US strategy in Afghanistan, where president Obama wants to start troop withdrawal starting July 2011. A year before that deadline, things in the AfPak region are far from stable, unlike in Iraq; this means a slower withdrawal.

Saddam Hussein, undoubtedly, was evil. Nevertheless, Iraq has been a progressive and secular society. It was the only country in the middle-east where one could put up a Christmas tree, and women were not necessitated to don a coverall, not drive or not go to work. While the country was predominantly Muslim, there was a sense of national identity, except for some dissension in the northern province of Kurdistan. Before the US invasion, Iraq had a million-man military, one of the largest in the world at that time.

In contrast, Afghanistan has never really been one nation. Until 1973, when a bloodless coup removed the king Zahir Shah, it was a monarchy. However, this Afghani kingdom only came to be in 1919. Before that it was either a transit for invaders to cross over to India, or was a part of an empire, either Indian or Iranian. During much of the 19th century it was a part of the ‘Great Game‘ between Britain and Russia, which continued even after the Bolshevik Revolution of 1917, ending when they became allies in WWII.

Without a federal authority, there have been several centers of power around the country throughout Afghanistan’s history; all politics is really local here. The populace is used to continual wars as fortunes have shifted. To complicate matters further, there are the majority (about two-thirds) Pashtuns in the east and south, while the minorities of Uzbeks are in the north and those with Persian heritage occupy the west. And they don’t like each other.

When the Soviets invaded, they had almost as much troops (100,000) as we have now (110,000) and were helped by an equal number of Afghan forces. They stayed there about the same time that we have been (almost 10 years), and when they left in 1989, the whole country was in tatters, without any central governance. Today, the situation is no better than it was two decades ago.

In other words, Afghanistan does not have any central command and control, no feeling of national allegiance and no viable armed forces. It does not have the structure or institutions to become a Westphalian nation-state.

If it will take 10 years for us to leave Iraq in toto, we will be in Afghanistan for a long, long time. Gen. David Petraeus, the US commander in Afghanistan, has started to hedge on that deadline, and VP Biden says US troop withdrawal could be limited. Even president Obama stated that “We didn’t say we’d be switching off the lights and closing the door behind us,” in July 2011!

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Medical Tourism?

August 11, 2010 Leave a comment

The rising cost of healthcare in the US has led many an employer to pursue the option of ‘medical tourism‘.

It’s not just countries like Australia, but even developing countries like India are attracting a lot of patients to have everything from eye and dental care, to cosmetic and open-heart surgery. These patients are admitted to top hospitals in major metropolitan areas around the country that use cutting-edge technologies to provide world-class care. Not only are they cheaper by 50%-80% – including all costs: airfare, medical bills and lodging, patients are treated like royalty in luxurious accommodations.

The Internet is teeming with sites to inform you and/or have your business. Googling ‘medical tourism‘ gets about 11 million results; ‘medical tourism in India‘ over a million. To sweeten the pot, you can apply some of your savings to go sightseeing; hundreds of ‘medical-tourist agencies‘ offer thousands of packages from which to choose.

However, recent reports of a drug resistant ‘superbug’ (NDM-1) spreading in British hospitals from patients treated abroad have emerged. Three US cases of NDM-1 have been identified between January and July, according to the Wall Street Journal. The US Centers for Disease Control and Prevention said that patients received recent medical care in India.

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Let the ‘Bush tax-cuts’ expire?

August 8, 2010 Leave a comment

It is interesting that Alan Greenspan wants all of the Bush tax-cuts to be repealed. This puts him, a self-described ‘Republican libertarian’, to the left of President Obama, who wants that those making less than $250,000 should not experience any tax increase.

Ironically, these tax-cuts had his implicit backing as the Chairman of the Federal Reserve then, although Mr. Greenspan justifies that endorsement because there were “surpluses as far as the eye could see” at that time.

One must understand that these budget surpluses were as a result of a modest tax increase under President Clinton, as well as the ‘pay-go’ rules (which require that tax-cuts or new spending should not add to the federal deficit) adopted as part of the 1990 budget deal between President George H.W. Bush and the Democratic-controlled Congress. When Mr. Clinton left office, the budget had been balanced for the first time in four decades, there was a surplus and the DJIA had increased almost five-fold during his presidency to over 10,000.

Eight years of the ‘second’ President Bush took that flourishing economy and landed it in a tailspin. With a balanced budget and a surplus when he assumed office, the state of the economy was at its worst since the Great Depression. What happened?

Firstly, Mr. Bush enacted across the board tax-cuts in 2001 and 2003, and scrapped the ‘pay-go’ rules with a Republican-controlled Congress. He did this despite the need of increased expenditure required by expanding the government (Homeland Security) and conducting two wars. To hide the financial effects of these wars, their expenses were kept off-budget.

While the current state of economic affairs is more complex to simply explain away with the ‘Bush tax-cuts’, the fact is that the revenue so lost is a major part of the current budget deficit. It is rather paradoxical that Republicans (and some Democrats), who want no budget deficits and are opposing things like the Healthcare Reform for its cost to the Treasury, are wanting these cuts to be extended.

On this, I agree with Mr. Greenspan. All the cuts enacted by Mr. Bush in 2001 and 2003 should be repealed. Further, something should be done to collect taxes from the almost 50% of Americans who pay no tax at all. The allegations that this will hurt small business is simply an eyewash. To help those seriously affected by the current conditions, Congress should extend the unemployment benefits for another year or more, until the economy improves.

One just has to look across the pond where the conservative Prime Minister, Mr. Cameron, is including tax-increases to spending cuts to tame Britain’s budget deficit.

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UPDATE 1: In his piece in Newsweek, Fareed Zakaria makes similar arguments. It is a great read.

UPDATE 2: Two Secretaries of the Treasury appeared on ‘Fareed Zakaria GPS‘ program on CNN on 8 August.

  1. Paul O’Neill, the 72nd Secretary of the Treasury in George W. Bush’s first term, was against the tax cuts and was fired for disagreeing with the President. His reasoning was that the war in Afghanistan and the impending war on Iraq (at that time) does not allow the luxury to have this precipitous decrease in revenue that will ensue. He also argued that the entire tax-code should be reformed; $400 billion go uncollected every year, and $300 billion are spent on collecting taxes.
  2. Robert Rubin, the 70th Secretary of Treasury for both terms of Bill Clinton, agreed that the Bush tax-cuts should not be extended, but for the time being, say two years, those making less than $250,000 should be spared. Mr. Zakaria said that this would cost $250 billion of uncollected taxes. Mr. Rubin wants that the estate taxes should be put it place immediately, since they are none right now. He emphasized that letting the Bush tax-cuts expire would only let the taxes go back to what they were when Mr. Bush took office, and not an actual increase.

I tend to agree with all the recommendations above; I wouldn’t mind giving those making less than $250,000 (98% of all Americans) a temporary break until the economy recovers.

There was also a talk of introducing a consumption tax, like the European VAT (Value Added Tax), during the show. Doing so will provide the government with an alternate source of revenue, without having to raise taxes any further than they would be after the ‘Bush tax-cuts’ repeal and would allow people to be more discretionary with their earned income.

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California joins ‘progressive’ Iowa?

August 8, 2010 1 Comment

The Federal District Court in San Francisco has overturned the same-sex marriage ban in California*, deeming it unconstitutional.

However, the chief judge, Vaughn R. Walker, “…immediately stayed his own decision, pending appeals by proponents of Proposition 8, who seem confident that higher courts would hear and favor their position”. Meanwhile, California Governor Arnold Schwarzenegger and Attorney General Jerry Brown have filed briefs to allow such marriages to take place now.

Indeed, this case is destined for the Supreme Court, and it is apparent that Justice Walker has sensed it as well. “…appeals court judges and the justices at the highest court in the land could find themselves boxed in by the careful logic and structure of [his] opinion” according to legal experts. “In his ruling, Judge Walker found that California’s voter-approved ban on same-sex marriage irrationally discriminates against gay men and lesbians”, thus affecting their 14th Amendment rights.

In addition, he wrote “…that the Supreme Court has stated that government cannot enforce moral or religious beliefs without an accompanying secular purpose.” In other words, what a contemporary society may find ‘immoral’ is not necessarily ‘illegal’.

With the current composition of the SCOTUS, it is quite likely that this ruling will be reversed. It could possibly “…turn on the court’s traditional swing vote, Anthony M. Kennedy, who has shaped decisions that struck down laws that discriminated against gay men and lesbians.”

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*Prop 8, that banned such unions, had passed with 52% of the vote. According to a national Gallup poll in May 2010, 53% of Americans felt that “…marriages between same-sex couples should not be recognized by the law as valid, with the same rights as traditional marriages?” 44% felt otherwise and 3% had no opinion.

UPDATE: According to Wikipedia, “Walker’s original nomination to the bench by Ronald Reagan in 1987 stalled in the Senate Judiciary Committee because of controversy over his representation of the United States Olympic Committee in a lawsuit that prohibited the use of the title “Gay Olympics”. Two dozen House Democrats, led by Rep. Nancy Pelosi of San Francisco, opposed his nomination because of his alleged “insensitivity” to gays and the poor. Years later, the San Francisco Chronicle noted the irony of this opposition due to Walker’s sexual orientation.”

He was nominated to the bench, again, by George H.W. Bush. He received a unanimous Senate confirmation this time.

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Quality of medical care by foreign doctors?

August 7, 2010 2 Comments

A new study has summarized the outcome of cases of heart attack and congestive heart failure when treated by American or foreign physicians.

The patients of foreign-born international graduates had the lowest death rate, 5 percent, and the patients of American doctors trained overseas had the highest death rate, 5.8 percent. Patients of the American born-and-trained doctors fell in the middle, with 5.5 percent.

However, when non-US born foreign medical graduates (FMGs) are lumped together with US-born FMGs, there was no difference in outcome when compared to American medical graduates (AMGs).

20% of all FMGs are Americans who had their education in international medical schools, often in the Caribbean. Most foreign-born international graduates come from India and Pakistan, who have completed medical school in their native country. In addition, these foreign-born FMGs often have had additional medical training in these locations abroad, before entering residency training with fresh AMGs.

The authors think that the worse performance of the US-born FMGs as compared to the other two groups could be due to two reasons. For one, Americans choosing to study abroad may have failed to get admission in a US medical school because of their grades, implying that they may be less capable to start with. In addition, it is possible that many foreign schools they attend may have lower standards of education and training.

All FMGs, whether or not born in the US, must take the same series of rigorous examinations given to AMGs, and also complete the same residencies and appear in the same board qualification examinations that AMGs do. Residencies done in non-US hospitals (except for Canada) are not recognized.

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The first author of this study is John J. Norcini, president of the Foundation for Advancement of International Medical Education and Research, in Philadelphia. The study is being published in the August issue of the Journal Health Affairs. Here’s the abstract:

One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality of care provided by doctors educated abroad has been the subject of ongoing concern. Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered medical school had significantly lower mortality rates than patients cared for by doctors who graduated from U.S. medical schools or who were U.S. citizens and received their degrees abroad. The patient population consisted of those with congestive heart failure or acute myocardial infarction. We found no significant mortality difference when comparing all international medical graduates with all U.S. medical school graduates.

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I hope that more studies are conducted on this topic, since it has huge implications. There is an ongoing shortage of doctors in the US, especially in the fields where reimbursement is poor, like Family Practice, Internal Medicine or Pediatrics. This vacuum has traditionally been filled with FMGs who are willing to train and practice in these specialities.

The addition of over 10% of the population (32 million) to those eligible to receive healthcare by the newly passed Healthcare Reform will aggravate this shortage. There are efforts to increase class sizes and open new medical schools in the US, but the number of residency slots remain the same. This raises a few issues:

  1. As the authors caution, schools should not lower their admission standards and accept American applicants who would have had gone to study abroad because of their grades. If they do, medical schools may be churning out many less competent doctors.
  2. Since there will be a gradual increase in the number of AMGs, without a concurrent increase in residency positions, they will have to squeeze out FMGs. If these ‘displacers’ are doctors who would have otherwise been American FMGs, there will be a lowering of the quality of healthcare in the US.
  3. Ultimately, the number of doctors available every year will depend on the number of medical graduates completing their residency programs, whether they are AMGs or FMGs. So there will be no net gain in the number of practicing physicians.

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These matters need to be addressed. The number of post-graduate training positions have to be increased to meet the new influx of healthcare consumers, and the high standards of medical school admissions have to be preserved to maintain the quality of care in the US healthcare system.

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Don’t park your car in the driveway?

August 7, 2010 Leave a comment

Aside from someone breaking in and stealing your radio, police can shoot a dart to plant a GPS unit on to your car.

Fortunately, the US Court of Appeals for the District of Columbia has ruled that the “police cannot surreptitiously stick a GPS unit on your car and track your movements without a warrant”. I see this case heading to the Supreme Court.

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No big deal?

July 15, 2010 1 Comment

Ever since Apple released the iPhone 4 on 24 June, the loss off signal while holding the phone in a certain way has been an issue with only some users, but this has been discussed ad nauseum on the tech blogs, in mainstream media and even on Letterman. However, the “not-recommended” advice from Consumer Reports was a body blow to Apple’s image as a reliable and trustworthy device maker. Despite this “don’t buy” recommendation, Consumer Reports still rated the iPhone 4 as the best smartphone they have yet tested, two points ahead of its closest rivals, the iPhone 3G and the HTC Evo!

The consensus that is developing after about three weeks of launch is that the problem happens only sometimes and only with some people: “The iPhone 4’s innovative antenna-wrapped-around-the-case improves reception. Except when you use the phone in an area with marginal reception, aren’t using a case, and bridge the gap in the lower left-hand corner with your hand. In that situation, it can be deadly”.

For many, the reception is actually better, and they have been able to make/receive calls at places that were dead zones with other phones earlier. Engadget, a premier tech blog, was not able to consistently duplicate the antenna woes. In addition, an electromagnetic engineer asserts that the Consumer Reports’ study was flawed.

Any new device/design can have defects, but since this one is made by Apple, which is the largest tech company in the world on the basis of its market cap, and Steve Jobs is the demon de jour, these cries have reached a new high. Microsoft seems like yesterday’s news anymore, and people seem to forget that they used to have reservations about Google because of its exploitation of our personal data. Further, it has been suggested that hedge fund managers on Wall St. are feeding the frenzy in hopes of AAPL making them money by its slingshot effect.

What is puzzling is that even if there are 5% dissatisfied users – an acceptable number for a new device, why aren’t 85,000 (5% of 1.7 million sold) being returned? After all, Apple has announced a full refund (no restocking fee) on any iPhone 4 within 30 days of purchase.

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Nevertheless, Apple’s reaction to this issue is far from adequate. Steve Jobs telling a user to “calm down” and that “it happens to all phones” in an email reply is very unworthy, as is his dismissal to “just use a case or bumper“. Apple claims that this email exchange was fake, but the Boy Genius Report blog stands by its story and proves that it is real. This generates a bad PR, which worsens when reports are leaked that an Apple engineer had warned Jobs that the iPhone antenna could fail.

Even more disturbing was Apple’s admission that they “…were stunned to find that the formula we use to calculate how many bars of signal strength to display is totally wrong“, and Apple’s software logarithm ‘over’-calculated the signal strength, so that these “high bars were never real in the first place“. No wonder AT&T has “more bars in more places“! Maybe Apple didn’t realize that the gimmick they pulled since the first iPhone on will come back to haunt them. Daring Fireball has a very funny ‘translation’ of the Apple’s explanation to this fiasco.

For its own sake, Apple will hopefully tackle this better than Toyota, although it would have been better if it handled this matter like McNeill did by issuing a nationwide recall when seven people died in Chicago in 1982, after taking Tylenol. Much is riding on the press conference scheduled for tomorrow, although it is possible that Apple has put itself in a lose-lose situation by waiting so long.

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Reap what you sow?

July 6, 2010 Leave a comment

The Pakistani establishment was full of glee in the 1990s, when they were able to deflect the mujahideen, created with the help of money and expertise from the US, which had helped oust the Russians from Afghanistan, to operate in Kashmir. After having lost the war*, which Pakistan declared on India in 1971, the then Prime Minister, Zulfikar Ali Bhutto, declared that it will “bleed India with a thousand cuts”.

Pakistan had deemed that with this ‘proxy’ war it will kill many birds with one stone. It will have deniability of waging a war, and the battle hardened mujahideen will bleed enough of India’s vastly superior armed forces (Pakistan was not yet a nuclear power; it became one in 1998) so they don’t pose a threat to Pakistan. The ensuing mayhem, they felt, would also keep India occupied enough to slow its advance to become a regional superpower. For them, it was a win-win situation.

Pakistan had thought that it could carry on this third-party guerilla warfare forever, or until it is able to wrest Kashmir from India, after having lost three wars it started for this purpose.

However, every action has unintended consequences as well. Nobody foresaw 9/11, and how it would change the whole geo-political dynamic. Pakistan had to make a u-turn in its support for the Afghani Taliban at American behest, and rein it many terrorist outfits that had linkages with al Qaeda and were having international ambitions although they were supposed to operate exclusively in Kashmir.

This created a backlash which progressed rather unchecked. The Pakistani establishment was unable to stem their activities since it had nurtured them for years, and had indoctrinated the population that India is a mortal threat, and that the use of violent methods to achieve goals in the name of Islam are legitimate. Little did they realize that these terrorists will bite the hand that fed them, and create anarchy in the Land of the Pure itself.

There have been reports of another vengeful group emerging in Pakistan, the Ghazi Force. Unlike many other Pakistan-based terror groups, the targets of this band is solely within the country. Suicide bombers have recently attacked a Sufi shrine in Lahore, because these extremists consider the orthodox strain of Islam practiced in Saudi Arabia, Wahabism, as the only true face of the religion. And no surprise, Pakistanis are blaming the US after this shrine attack, because America is “killing muslims” all over the world.


*Mr. Bhutto’s vow was to avenge the re-partition of Pakistan by the creation of Bangladesh. That India’s involvement was mainly because of millions of refugees from ‘East’ Pakistan crossing the border and creating chaos, and that Pakistan had itself declared the war, was summarily forgotten.

It was also overlooked that the one of the  reasons of dissent in that wing of Pakistan was the denial of the ‘West’ Pakistani establishment to honor the election of Mujibur Rehman, an ‘East’ Pakistani whose party had won the majority of seats in the Parliament in the 1971 general election, making him eligible to become the Prime Minister of Pakistan, both ‘East’ and ‘West’.

Another reason was the coercion of the Bengali speaking populace of the ‘East’ to only use Urdu, a North Indian language, as their lingua franca, and systemic assaults of their distinctive culture. The ‘East’ Pakistanis were growing tired of constant intimidation and oppression meted out by the ‘West’.

Apparently, religion (read Islam) was not a strong enough glue to hold them together, as it had been the supposed reason for Partition from India.

These fractures are visible even in the current day Pakistan, where Baluchis and Sindhis rebel against hegemony from Punjabis. One of the four provinces, Punjab is the most populous and dominant, and Punjabis still command the upper echelons of power in the establishment, including the armed forces. These disturbances were ignored until they started happening in Punjab itself, by outfits like the Pakistani Taliban and now the Ghazi Force.

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God’s hint?

July 6, 2010 Leave a comment

I wholeheartedly agree with the Governor of Texas, Rick Perry, that the BP oil spill in the Gulf of Mexico may be an act of God. Maybe, in His Infinite Wisdom, He is giving us a hint to wise up and stop puncturing His creation, Planet Earth.

As we all know, God works in mysterious ways, and we mortals often do not catch the meaning of it all.

God Bless the USA, and Rick Perry.

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Chicago Style?

June 26, 2010 Leave a comment

In a brilliant masterstroke, President Obama replaced Gen. McChrystal with Gen. Petraeus, without opening himself to the criticism of derailing the war effort in Afghanistan. There has been bipartisan, as well as international, praise for this pick.

Another pick Mr. Obama made was similarly lauded. When he picked Mrs. Clinton as the Secretary of State, media pundits opined he was building ‘a team of rivals’, just as Abraham Lincoln did. However, there were some cynics who floated the idea that it was Mr. Obama’s way of sidelining Mrs. Clinton from presidential politics so that she doesn’t mount a challenge to him in 2012.

The cynic in me thinks that it could be the same reason to send Gen. Petraeus over to Afghanistan. It appears that he does harbor political ambitions and his star is rising among many Republicans who seem to be frustrated at the direction their party is taking as they head towards another presidential showdown in the next two years, and the fact that there seems to be no viable name to challenge Mr. Obama in his reelection bid.

Prospective challengers to the President will have to start their campaign sometime in mid 2011 and get in line to battle in their party’s primaries. Latecomers do not stand much chance, as the attempt by Mr. Fred Thompson discovered even though he had an impressive name recognition by playing as a DA in the ubiquitous show, Law & Order.

Mr. Obama has set July 2011 as the date of the drawing down of forces from Afghanistan. However, it does not mean that the war there will come to an end. There will certainly be some withdrawal of forces, a regiment or a brigade or two next July, but we will be in Afghanistan for a long, long time. And so will Gen. Petraeus, at least for another year or two, way past the time he can effectively challenge his current Commander-in-Chief.

I can imagine what a dilemma it would have been for the General when the offer to lead forces in Afghanistan, which, strictly speaking, was a demotion for him since he was heading the Central Command that includes several other countries besides Afghanistan. If he indeed had presidential hopes and had said no, it would have been conveniently ‘leaked’ to the media that the General is putting his political ambitions above his duty to the country. This would have killed his prospects even before they had taken off.

Isn’t this another brilliant masterstroke?

If my thinking is correct, Mr. Obama killed two birds with one stone!

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