Sarah Palin's Death Panels are Back...

The Wall Street Journal published an op-ed today by Sarah Palin on the report released by the National Commission on Fiscal Responsibility.  And once again, she has invoked the notion of government-sponsored “death panels.” 

She writes that the findings of the Commission:

“[…] implicitly endorses the use of "death panel"-like rationing by way of the new Independent Payments Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare.”

The controversy over these alleged “death panels” raged during the summer of 2009 as our nation fought to come to a consensus on healthcare reform.  

At the center of the controversy was the following statement made by Ms. Palin on her Facebook page:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

These “death panels” were actually proposed funding for consultations between physicians and patients in order to discuss issues concerning end-of-life care.  Palin’s statements were later voted the biggest lie of 2009 by the non-partisan website, Politifact.com.

So what’s the harm in categorizing end of life discussions as “death panels?”  For one, you’re putting physicians in the role of the executioner.  Conversations regarding a patient’s wishes at end-of-life, including the transition to palliative care, are an integral part of a patient’s treatment.  These conversations respect and promote patient autonomy, by allowing patients to obtain information from their physician regarding their prognosis and treatment options in order to make informed decisions concerning the course of their healthcare.  In many terminally ill patients, this includes conversations on death and dying. 

Accepting death is probably one of the most difficult, and intimate, decisions an individual will ever face.  And this week we said goodbye to a woman who did so bravely, Elizabeth Edwards.   I’m afraid that Ms. Palin’s continued reference to “death panels” undermines the difficult decision that many persons with cancer have to make – the acknowledgement that the fight is over and the preparation for what lies ahead.  At the recommendation of her physician, Elizabeth Edwards made the decision to discontinue treatment and spend the remainder of her time in this world at home surrounded by her loved ones.  Many similarly situated patients choose to continue treatment and endure the harsh side effects of aggressive cancer treatment. 

When a particular cancer treatment has not produced the desired results, the promise or possibility of a new treatment or experimental drug gives a great deal of hope to the patient.  Especially when proposed by the patient’s oncologist.  The possibility of offering additional therapy can also be therapeutic for the oncologist, who is in the role of “fighting” the disease.  But there is a point, a point that Mrs. Edwards also faced, when treatment does become futile.  And this is an objective conversation that should be had between the patient and the physician. 

In her article, Palin refers to Independent Payments Advisory Boards, which would recommend proposals to reduce Medicare spending.  I would argue that reducing healthcare spending and seeking cost-effective medicine is not evil, Ms. Palin.  Even in a perfect world – with limitless resources and talented oncologists– we simply do not have the ability to cure every patient.  And just because we have the means of continuing treatment, doesn’t mean that we should – especially when it comes at the expense of the quality of one’s life. 

It is unfortunate that Ms. Palin continues to reference death panels and demonizes the initiation of end-of-life discussion with terminally ill patients.  These discussions are an important tool for patients in making decisions regarding their healthcare, often prevent unnecessary treatment and procedures, and accelerate the transition to palliative care.

There is a great deal of trust in the relationship between the patient and his oncologist.  I think there is something to be said about the subject of palliative care being introduced by the physician, rather than initiated by the patient.  No person with cancer, especially one who is a provider of a family, wants to feel like they are giving up on their fight against cancer by electing to embrace palliative care.  And I am certain that many members of the medical community do not appreciate the association with “death panels.”

Are FBI Stings on High Risk Individuals Really Combating Terrorism?

The recent arrest of Somali-born, Oregon teenager, Mohamed Osman Mohamud, is the latest in a trend of sting operations utilized by the FBI, which seeks to target Americans who are considered to be a high risk of carrying out violent acts on American soil.  The arrest of Mohamed Osman Mohamud came after a year long investigation leading to an eventual sting operation, foiling what Mohamud perceived to be a plan to detonate a bomb at an Oregon Christmas tree lighting ceremony.  The problem is, there was no bomb in the first place.  In fact, the public was never in any immediate danger of being harmed.  Despite what senior FBI Agent Arthur Balizan describes as "a very real threat,"  Mohamud, who believed he was in contact with Al Qaeda operatives who were helping him plan an attack, was actually speaking with FBI agents the entire time and at no time was he in contact with the terror organization.

Whether people consider these sting operations entrapment , or whether they consider them just, there are a few things that need to be considered.


One, it is fair to say that these types of operations are at best not helping American-Muslim relations, and at worst are helping to destroy them.  Shortly after the arrest of Mohamud, the Mosque that he frequented was set ablaze in what local authorities are calling arson.  It is quite the snowball effect when it comes to American-Muslim relations. A possible outcome is this:  Man is caught in alleged terror plot. Targeted members of community become enraged and set fire to Mosque that most likely had nothing to do with Mohamud's radical behavior.  This in turn leads to resentment and anger from the Muslim community as well as making it just that much easier for militant groups to recruit by spinning the whole operation as propaganda for a "American War on Islam".


Second, the resources, money, and man power needed for a year long operation is not cheap.  At minimum this is hundred of thousands of dollars that are being spent on setting up a local youth who is, with the FBI's help, becoming a radicalized militant.  Not to mention the man power it takes to conduct such an operation.  Every one person working to set up a high risk individual is one less person working to combat people who actually have the means to carry out such an attack.


Lastly, while The FBI celebrates this sting operation, and arrest, as a victory, I am left only with the idea that with the hundred of thousands, if not millions of dollars being spent on setting up high risk individuals, and hundred of agents and analysts it takes to carry out such an operation. Is this money and man power well spent? Or could it possibly be spent in better places, such as stopping actual terrorist attacks like the one that almost happened in May.

Article Review - "Islamic Revivalism and the crisis of the Secular State in the Arab World: An Historical Appraisal" - Dr. Khoury

        Dr. Khoury’s article - Islamic Revivalism and the crisis of the Secular State in the Arab World: An Historical Appraisal - examines the social injustices, economical disproportionalities, domestic governmental shortfalls and the international antagonizing influences that fostered the reactionary revivalism of Islamic Fundamentalism. Dr. Khoury’s empirical perspective sheds light on this misunderstood religious evolution. Islamic revivalism, within Arab nations, is not a theologocentric cultural phenomenon, as depicted by “western media.” This orientalistic, cultural miss-interpretation is a product of the Fundamental Attribution Error (FAE). American media portrays angry Arab populations in juxtaposition with acts of violence. The western perception is that Islamic Fundamentalism and the “violence” that is associated with it is a result of fundamental Arab cultural predispositions for religious extremist. This perception belays the western cultural ignorance. According to Dr. Khoury (pg. 217) the defining voice for the Arab states in the 20th century was secular nationalism, not religious extremism. The Islamic Fundamentalist revival that has taken place within the Middle East North African (MENA) region is a reaction of Arab state exhaustion. Since the post-colonial period after WWII, Arab states have failed at modernizing their populations. Modern Arab secular states were depleted of their civil-society capabilities, they did not adequately provide social services, employment opportunities, social-economic mobility, skilled labor markets and proportional wealth distribution for their populations.

        The disenfranchising of Arab nationalism was due to several situational catalysts, the massive urbanization's that drew the uneducated, agriculture working class “peasants” into over-crowded metropolitans; western investments in finite resources that created rentier[1] authoritarian states; the developments of class systems that fostered dissent and radicalization in the lower and middle economic classes; and the reliance on traditional religious values by the lower classes to mitigate the oppressive natures of authoritarian regimes. Islamic Fundamentalists did not gain radicalized support within modern Arab secular nation states until the 1970s. This revival was due to the failure of the Arab secular movements of national growth; the Arab communist governments failed to establish social equality, the secular governments failed to include the uneducated masses, Pan-Arab nationalist movements failed to represent the diverse region and democracy never gained a foothold. Subsequently, Arab national top-tier elites can abuse their bureaucratic positions, while not being held accountable for their political cronyism and their structural corruption.

            The scarcity of an effective Arab nationalistic model has left the working-lower- middle class with one answer, Islamic Fundamentalism. This religious mantra manifests itself into a Political Islamic movement. Arab authoritarian regimes and their bureaucrats have to respect the political movement and adopt the religious tenets, or risk becoming targets of political violence. Every religion is capable of justifying violence; this is not unique to Islam and the region. However, Islamic Fundamentalism was revived not because Arabs need to become beholden to a faith but specifically it is an political identity that the populace can rally behind. Arab women wear Islamic traditional clothing out of western-protest more so than out of piety. The suicide bomber declaring that god is great before he blows himself him up is acting as a human without a future not as a religious warrior. This reactionary effect of Islamic Fundamentalism is vital to the MENA-regional stability conversation because radicalized Islam is the political vehicle that drives the sectarian violence. However, targeting this vehicle with theologian centric criticisms only embeds the extremist more with legitimacy. Arab moderate nationalist need to address the lack of basic functions that their exhausted governments cannot sustain. The needed moderation evolution involves a culturally conceptual shift, from the current practices, to address the motivational drivers for Islamic Fundamentalist’s extremist.        

            Dr. Khoury attributes the “main force” (pg. 227) behind the Islamic Fundamentalism revival to the “urban lower-middle class(es)”, which form the “class(es) caught in between.” The middle-tier leaders, the store owners, merchants, community bureaucrats, preachers, and college students are the populations that are caught in between the desire for a strong political voice or limiting their societal-growth within oppressive, failing, rentier Arab nation states. These states are typically made of authoritarian regimes that conduct structural violence with corruption and severe capital punishments for suspected dissent. The adoption of Islamic Fundamentalism by these classes has allowed the revival to influence all aspects of the Arab human landscape. Islamic Fundamentalism’s footprints can be found in legal systems with a “reestablishment of the shari’a” (pg.231); within education systems there is an adoption of Islamic teaching; culturally “non-elite” women are dressing traditionally; and politically Arab states are starting to impose moral laws with the “prohibition of alcohol, drugs, prostitution, gambling.” Historical people define themselves with religion when tranquility in the “afterlife” is more promising than their tumultuous realities.

        Dr. Khoury presents Islamic Fundamentalism as means for authoritarian states within the Arab world to legitimize their oppressive methods and placating their classes by adopting political Islam and by incorporating the tenets of Islamic Fundamentalism within the states policies. “The (Arab) state’s accommodation is itself an admission of revivalism’s potential for destabilizing current regimes, it is also, however, a way of reasserting a regimes legitimacy” (pg. 233) I ascertain from this quote and this article that western powers have a vetted interest in a moderate secular movement within the MENA region. In addition, the Islamic political revolution is vulnerable to a moderation evolution if the social factors that led the regions populace to become radicalized can be addressed. Islamic Fundamentalism is a reactionary symptom of a religious political identity that the disenfranchised forgotten classes of the Arab states.

-jfoxwell

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[1] Rentier states refers to nations that base their economic stability on finite resources. The consistent unskilled wealth financially supports authoritarian states. One reason for this is typically renter states do not tax their citizens; so the populations are satisfied with less than democratic and corrupt conditions. Subsequently the state is not held accountable to its populations…

News Aggregation:

TOP STORY IN THE IDEA LOBBy 

THE IDEA LOBBY

Hey TSA, Racial Profiling Doesn’t Work

Looking at the math behind profiling meant to nab terrorists, computer scientist William Press 

realized it may be less effective than purely random sampling.

By Emily Badger - November 30, 2010


This is an interesting and timely examination of the TSA's security methods and America's approach to national security.
-jfoxwell

Is "Terrorist" the new "Communist" ?

Whistleblowing site WikiLeaks' latest leak of hundreds of thousands of classified documents has led to immense condemnation from American law makers on both sides of the aisle.  One congressman, Rep. Peter T. King (Rep-NY) even went as far as to send a formal letter to Secretary of State Hillary Clinton.  In his letter Rep. King states his case in hopes of having Wikileaks.com labeled a Foreign Terrorist Organization.  He asserts,

   
  "From these acts, WikiLeaks appears to meet the legal criteria for FTO designation as a (1) a foreign organization; (2) engaging in terrorist activity or terrorism which (3) threatens the security of U.S. nationals or the national security of the United States. Specifically, pursuant to Section 212 (a)(3)(B) of INA (8 U.S.C. § 1182(a)(3)(B)) WikiLeaks engaged in terrorist activity by committing acts that it knew, or reasonably should have known, would afford material support for the commission of terrorist activity."

Is Wikileaks a terrorist organization as defined by the legal definition of FTO's?

Yes.... and no.  Breaking down the answer we see that in order to be classified as a FTO, the suspect in question must fulfill a criteria including three characteristics. First, is it a foreign organization? By the sites own emission it is.

"Wikileaks was founded by Chinese dissidents, journalists, mathematicians and startup company technologists, from the US, Taiwan, Europe, Australia and South Africa." 

The second characteristic it must fulfill in order to be classified a FTO is, does the group engage in terrorist activity or terrorism?


This is where the things start to get hazy.  What is terrorism?


The League of Nations defined terrorism in 1937 as "criminal acts directed against a State and intended or calculated to create a state of terror in the minds of particular persons or a group of persons or the general public"

The dictator led National Reorganization Process of late 1970's Argentina definied terrorism as "not only who sets bombs and carry guns, but also those who spread ideas opposite to christian and western civilization"

India's Supreme Court defined terrorism in 2003 as "peacetime equivalents of war crimes."

 Our own government has had an equally difficult time defining the term as illustrated by the fact that it is written in to multiple laws.


U.S.C. Title 22, Chapter 38 defines it as "the term 'terrorism' means premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents;"

U.S.C. Title 18 says, "involve violent acts or acts dangerous to human life that are a violation of the criminal laws of the United States or of any State, or that would be a criminal violation if committed within the jurisdiction of the United States or of any State; [and] appear to be intended . . . to intimidate or coerce a civilian population"

These are just a few of the many definitions offered up by organizations and states who over the years have struggled to define such a complex act.  The reason it is so difficult to define is because no two acts of terrorism are committed in the same way or for the same reasons.  This is why there is no cookie cutter definition just as there is no single way to combat it.  It is ever changing and as a result our definitions of the horrific acts of terrorism have continued to change. The term has become so loaded that it is reminiscent of how the word "Communist" was thrown around during the 1950's.  We can now look back and say that while there were agents with a goal of spreading Communism in The United States, most of the people labeled as "Communist" were only done so because they were disliked or seen as a threat, regardless of where their political ideologies laid.  Is Julian Assange and Wikileaks an enemy of The United States Government? Absolutely, and probably could be convicted on behalf of the Espionage Act. But to label Wikileaks a terrorist organization is to skew the already loaded word and possibly even make it more difficult to define and ultimately combat true terrorism.   Is Wikileaks a terrorist organization?  Whatever your opinion, I'm sure there is a definition out there to support your position.

4th Wave on the W.M.D. Proliferation Horizon...

In the first decade of the 21^st century, United States (U.S.) national security has had to evolve to react to the international and domestic threat of non-state actors (N.S.A.).  The new breed of N.S.A.’s are globally positioned anti-American insurgents, and they represent the world’s fourth wave of weapons of mass destruction (W.M.D.) and nuclear proliferation.  These loosely structured N.S.A. factions have declared that W.M.D. proliferation is a permanent goal of their strategy. The global decline of first-rate nation-states has forced American conventional warfare to reinvent itself to deal with an asymmetrical threat that has no borders and no need for treaties.  Such insurgencies span the globe, from Afghanistan and Indo-China to America’s doorstep, they are not going away, and it is inevitable that they will procure W.M.D’s.  America’s only recourse is to embrace this threat as a reality and transform our security tactics to deal with it.

America’s preemptive response to non-state actors in the first decade of the 21^st century has given rise to some very strange bedfellows: Iran and Hamas; Al Qaeda and Iraqi Sunni tribes; North Korea, Iran and Syria.  The majority of these blocs are fueled by Middle Eastern policies that have inspired hatred for everything American; this hatred, in turn, acts like insurgent superglue. Our enemies are no longer nation-states that understand the concept of M.A.D. that defined the Cold War balancing act for forty years.  Instead, America’s national security is today under siege by groups that do not wage war to spread national politics but to spread ideals. The U.S. has to comprehend the mentality of suicide bombers who value American death over their own lives and the cultures that give birth to this mentality.  U.S. security tactics must adapt to better defend against asymmetrical terrorism, and American diplomatic policies must transform to anticipate the societies that will breed the 21^st-century insurgents.

Mutually assured destruction (M.A.D.) is the most important concept to grasp in understanding the dire situation created by this fourth wave of N.S.A.’s.  At the height of the Cold War, nuclear weapon systems were developed to be as deadly as possible, ensuring that first-tier nations would never use them.  According to the game theory discussed in The Evolution of Nuclear Strategy, the two superpowers of the world, the U.S.A. and the U.S.S.R., found success in the stalemate of mutually assured destruction. After these two world superpowers first established the concept of M.A.D., the world watched the rise of second- and third-wave nation-states develop nuclear warfare for political ends.  Treaties were developed. Nations like China, Israel, Pakistan, India and North Korea, once obscure locations on the globe, now had political bargaining power and were major players.  India and Pakistan were not a part of the original Nuclear Non-proliferation Treaty (NNPT), but they were still nations that would understand the notion of M.A.D.  When North Korea backed out of the N.N.P.T. in 2003, the first-wave nations took ineffective reactionary steps with UN sanctions.  But it was M.A.D. that has kept North Korea’s nuclear arsenal at bay.

By doing a survey of the worlds’ nuclear powers in 2010, we can see an alarming trend of nuclear arms in destabilized regions.  Pakistan is a safe haven for Al-Qaeda operatives.  India, even though it has a stable marketplace, has unstable undercurrents of religious tensions.  North Korea’s nuclear arms are on auction to the highest bidder. According to Professor Tadie, in my International Securities class, North Korea was providing the technology for a suspected nuclear fissile materials refinement factory in Syria that was funded by Iran.  Right now, the world is a global marketplace for insurgents and religious zealots who have nuclear armament as a goal. These N.S.A.’s are the 4th wave of nuclear proliferation, and they have no concern for M.A.D.

American national security cannot afford to negotiate with non-state actors, and they will not go away.  When we kill them, they become martyrs; when we put them in prisons, they inspire recruiting propaganda; and when we attempt to utilize them for intelligence, we open up our defenses to the type of double-agent betrayal recently experienced in Afghanistan.  The enemy’s determination to get WMD's and nuclear weapons is stronger than our power to stop them. 

In the 1950’s, the U.S. accepted that a Soviet nuclear arsenal was inevitable.  America is at the same crossroads sixty years later: We have an enemy that will obtain these weapons, we just do not know when. What we do know is that, unlike the Soviets, this enemy will have no respect for M.A.D.  This enemy harvests and arms suicide bombers – what do they care about mutually assured destruction?
America is facing enemies that have no borders, no centralized government and no national economy. They have a multi-national web of safe havens in which to hide and recruit others.  America needs to attack the life-source of this enemy, its ability to reproduce its anti-American ideology in the hearts and minds of future insurgents.  We need to understand the scope of the American footprint in the Middle East and Indo-China.  I believe this decade’s security focus should be upon the endgame policies in Iraq and Afghanistan.  If we screw this up, we will enable the N. S.A.’s to proliferate nuclear arms and we will sew the seeds of hatred for our enemies to reap.  We could expect a century of asymmetrical warfare, not just in some proxy location, but also on our doorstep.

- jfoxwell

Works Cited:

Freedman, Lawrence. (2003) The Evolution of Nuclear Strategy

(3^rd edition) Palgrave, Macmillan, Great Britian,

Tadie, Eugene and Smith, John, International Security, George Mason    University (2010).

Human Terrain: The Center-of-Gravity for Counterinsurgencies

         In the first decade of the 21^st century, America’s military has had to evolve to fight unconventional wars in foreign locations, and we have become a global-stabilization force. Our most pressing threats have come from non-state actors who survive in loosely affiliated international networks. With the advent of the Internet and the global economy, our enemies have fluid tactics and irregular weapons. The weapon of choice, the improvised explosive device (IED), has been developed by a global collaboration of different technological markets and by experts from chemists to electrical engineers. The power of these insurgency (IN) networks is illustrated perfectly with the Nigerian Christmas Day suicide bomber. This jihadist was trained in Yemen by al-Qaida, a Saudi Arabian-created insurgency group whose current power seat is located in the shadowy Afghanistan-Pakistan border region. America is confronting the real and present danger of al-Qaida on four continents. The human terrain is the demographical landscape of any civilization. Major General Flynn, U.S. Army (2010), a top commander in Afghanistan, recently noted that  winning this terrain on a regional scale is essential for our success against a global anti-American insurgency.

            The human terrain is a survey of the individual life experiences within a region or a culture. There are several population-centric questions that need to be addressed before a foreign counter-insurgency (COIN) force (America) can be successful. What are the region’s primary economic resources, and how can we protect these markets? What are the cultural differences within the subgroups of the region, and how can we dissolve any civil injustices?  If a community must be displaced because its village has been destroyed, where can we place the population without developing a volatile region? Where are the civil engineering hubs of the region, and how do we ensure an electric grid’s operational integrity?  What (IN) forces will we be facing, and what actionable intelligence do we have about them? Dr. O’Neil (2005) explains the strengths and weaknesses of nine categories of insurgencies. He stresses that, regardless of the insurgents’ type, motive, inception or tactics, COIN forces must understand the local population if we are to defeat the insurgents. The majority of IN are motivated by a civil rights struggle, racial discrimination, religious oppression, or a sociological/economic caste system that holds a subpopulation below another. Dissolving these civil struggles is a key to our stabilizations efforts. The repercussions of not stabilizing the human terrain are illustrated with macabre accuracy in the Iraq and Afghanistan conflicts.

            In 2002, General Wilson (USA) was given the task of combating al-Qaida in the Philippines. He implemented his COIN Diamond Model, a strategy that focuses on developing the human terrain. He had overwhelming, time-tested success with his strategy. His small force of 1,300 specially trained American soldiers was able to build a native population COIN force. He understood the human terrain and he immersed his forces in it. He used foreign-aid specialists to assess humanitarian needs. He deployed civil-engineering specialists to help sustain a quality of life and to train the native population in job skills. Regional demographic experts and language-dialect specialists were utilized to explore and translate cultural diversity. The military’s mission was to train the native military into a native COIN force. 

         By applying this population-centric philosophy, Gen. Wilson gained the native population’s trust. He was able to right civil injustices so that foreign insurgents could not recruit locally. Comparing the Basilan, Philippines “Diamond Model” with the U.S. strategy in Iraq and Afghanistan, the value of the native human terrain becomes staggeringly clear. A strategy similar to the Diamond Model was utilized in the Sunni Awakening operations that took place in western Iraq in 2007. We were able to stabilize this al-Qaida safe haven by training a native security force so that it could defend against foreign insurgents and oust all active and passive support for al-Qaida from local communities.

            America has to embrace this population-centric mantra so that we can take away the insurgents’ active and passive support structures. An individual actively supports an IN if they take up arms with it or if they promote the dissent by actively recruiting, offering finical support, or refuge.  Active support is easier for the U.S. to target because it takes the form of deliberate actions.  We can close bank accounts that support IN, we can monitor Internet chat rooms that target recruits, and we can track businesses that sell IED components. Passive support stems from a community distrusting the U.S. COIN forces. Because of its subversive nature, it is much harder to prevent. America must reach out to the local civilian who notices a stranger in her village but says nothing to the American soldier on patrol, and the local merchant who supplies the terrorist out of fear or sympathy.

            From Chairman Mao of the Chinese revolution to Osama Bin Laden, successful insurgency leaders have understood that their success lies in their ability to capture the human terrain of the region in which they are fighting.  America’s COIN forces are at a constant strategic disadvantage because the native populations are foreign to us. For IN to be successful, all they have to do is survive to outlast us.  To remove all the shadows and safe havens from our enemies we must develop the native human terrains.

- jfoxwell

Works Cited:

 Flynn, M. Major General U.S.A. (Jan. 2010) Voices from the Field, Fixing Intel: A blueprint for making     Intelligence relevant in Afghanistan Washington, D.C. Center for a New American Security

 O’Neill (2005) Insurgency & Terrorism: From revolution to Apocalypse (2^nd ed.)  Dulles, VA. Potomac Books

Tadie, Eugene (PHD) (Jan – May 2010) International Security, Government-347,

George Mason University (2010)

 Wlison, G. Major General (USA) (2006) Anatomy of a successful COIN operation: OEF-Philippines and indirect approach Military Review (Nov-Dec 2006)             http:/findarticles.com/p/articles/mi_m0PBZ/is_6_86/ai_n27084049/