Triage

The practice of triage in dealing with medical patients especially under emergency conditions was first formalized by French doctors during World War I. Patients are divided (hence, trier, to separate or sort) into one of three categories:

  • patients who are likely to live, regardless of whether they receive immediate treatment
  • patients who are likely to die, even if they receive immediate treatment
  • patients for whom immediate treatment can improve their likelihood of recovery

I’m sure my physician readers will correct my diction.

The practice of triage requires two related skills: you’ve got to be able to assess a patient’s condition quickly and accurately and you’ve got to be able to assess realistically and accurately the effects of likely treatment.

In his column this morning Bob Herbert takes note of the Obama Administration’s problems in determining the relative importance of their priorities:

If I were a close adviser of President Obama’s, I would say to him, “Mr. President, you have two urgent and overwhelming tasks in front of you: to put Americans trapped in this terrible employment crisis back to work and to put the brakes on your potentially disastrous plan to escalate the war in Afghanistan.”

While I may not agree with Mr. Herbert’s prescriptions, I agree with his priorities. But I think that the Administration has a problem with triage.

I have sympathy for their predicament. They have an enormous number of very grave problems on their plate. They’re eager to blame their immediate predecessors for many of them but I think that in fact many of the problems, e.g. the financial crisis, the looming crisis in healthcare, global warming, and so on, have their roots in bad policy decisions made over a period of twenty, thirty, or more years by Republican presidents and Democratic presidents, under Republican Congresses and Democratic Congresses. Additionally, I think that it’s fairly retorted that President Obama sought these challenges.

The economy is the fundamental problem of problems. Need I repeat “It’s the economy, stupid!”? If the economy continues to weaken over the next three years as it has done for the first year of President Obama’s term, he will have no second term in which to tackle the pressing problems. That what the Administration can do may be very limited or even counter-productive does not absolve President Obama from the appearance of taking determined action. If the economy does not recover at least somewhat during his administration, his successor may have the luxury of blaming his predecessor for the country’s economic woes while taking credit for an inevitable recovery.

While Afghanistan has no strategic importance (so long as Al Qaeda isn’t there), what we do there does. If our allies leave due to flagging American support, it will place the future of NATO in serious doubt and with it the heart of our foreign policy. If we simply leave Afghanistan, it will provide more evidence to our enemies that America is a weak foe and a worse friend. If we escalate our efforts in Afghanistan, we run the risk of sinking vast sums, lives, and energies into the potentially hopeless task of making a nation out of a group of none too friendly tribes.

They say that impending doom does wonders to concentrate the mind. So far that doesn’t seem to be the case with the Obama Administration. From that I speculate that either they don’t see these conditions as being as serious as I do (and Bob Herbert does) or they don’t have the ability to establish relative priorities.

Whether they have the ability to assess the effects of their prescriptions realistically and accurately is the subject of another post.

11 comments… add one
  • The top three priorities when Obama was sworn in were rescue the financial system from imminent collapse, (more or less done,) keep Afghanistan from collapsing (he rushed a first round up troops to the theater, appointed a new general and began looking at strategy,) and yes, stem growing unemployment.

    This last he dealt with — ineffectively, obviously — with the half-assed stimulus he was able to get through Congress. I don’t know whether a larger or better-designed stimulus would have done the trick. I think it’s hard to deny that temporarily keeping GM afloat probably saved some jobs. But I don’t think long-term job growth probably has much to do with government action one way or the other.

    It seems to me as very much a naif when it comes to economics that we built an economy on guys moving money from one pocket to another, guys betting that housing prices would go up forever, and guys selling $5 coffees to the first two groups.

  • The top three priorities when Obama was sworn in were rescue the financial system from imminent collapse, (more or less done,) keep Afghanistan from collapsing (he rushed a first round up troops to the theater, appointed a new general and began looking at strategy,) and yes, stem growing unemployment.

    I don’t know much about military matters or foreign policy really, at least not enough to speak intellgently on them.

    However, regarding our financial system I’d give Obama a C-. He has basically pursued the Bush policies of injecting money into zombie banks. He is keeping alive a system that needs a fundamental overhaul. Further, his Administration has been all over the place in regards to policy increasing uncertainty in the markets and if anything likely making the situation worse. Note that this too is a continuation of the Bush Administration.

    As for unemployment Obama and his Administration have failed spectacularly, grade F. Not only has unemployment not dropped it has grown at unprecedented rates. Could part fo the problem be related to the uncertainty noted above? Are firms less certain of what will happen to their investments and thus postponing them till they are more certain? The stimulus spending does not appear to be working, and is possible adding to the uncertainty of the whole situation.

    How will the massive increases in debt be handled? Taxes? Inflation? Cut backs in other spending? The last is unlikely given health care “reform” and other legislation…which again adds to the uncertainty. You want to build a new plant. What kind of issues are you going to have with impending global warming legislation?

    While I’ve made the case often that Presidents don’t have good control over the economy, the current track record is pretty bad. It isn’t helping, it is hurting. Health care reform should probably be put off till the economy recovers somewhat. Same with the global warming legislation. Another round of stimulus probably wont help. What might help would be dealing with our financial system and getting it back on sound footing. Finding the zombie banks and shooting them in the head (hey, I’m staying with the genre). Sweden did something along these lines. Unfortunately we are going down the road the Japanese went down.

  • steve

    “As for unemployment Obama and his Administration have failed spectacularly, grade F. Not only has unemployment not dropped it has grown at unprecedented rates”

    How long after a recession does it take unemployment to drop? Are there reasons why it make take longer to recover this time, like a record high in consumer borrowing or low levels of savings? You should know this.

    http://economistsview.typepad.com/economistsview/2009/10/the-weakest-recovery-in-modern-memory.html

    Steve

  • PD Shaw

    Obama did the triage on Afghanistan. Obama promised that on the first day of office he would direct a review of U.S. policy in Afghanistan and issue a directive in 60 days. He did it, he executed it, but the results being reported from the referring surgeon are causing him to rethink and worry.

    I’m not sure what the medical analogy here is. There are obviously some benefits of continuing a course of treatment to see if it works. There is also merit in evaluating the situation kinetically and responding to developments. I only really complain that indecision is not an art that the medic practices for the benefit of the patient.

  • steve

    The medical analogy? We decide to do a CABG (COIN ). While waiting for all the tests to finish, the patient develops pneumonia ( Karzai’s election). We now need to decide if it makes sense to go ahead with the CABG or fix the pneumonia first.

    Steve

  • PD Shaw

    And of course some of us on the sidelines are wondering if the patient really has developed pneumonia or if the new physician is just performing a CYA in case the patient goes into shock under his care. Some of the new doc’s treatments seem to be a bit on the pricey side.

  • How long after a recession does it take unemployment to drop?

    The last recession took quite awhile, at least a year, but to be more certain I’d have to check the data. However, keep in mind that Obama pushed the stimulus package as reducing unemployment pretty quick after passage. Looking at some of the econ-blogs you can see the graph or actual unemployment, unemployment with no stimulus and unemployment with stimulus. The graph has unemployment with and without stimulus as being very much lower than our actual unemployment.

    Now, yes, President’s have imprecise control of the economy at best. And normally blaming Obama probably isn’t very fair. But he took this assignment. He stood up and said, “Pass this legislation I’m having my pet congress people put forward and the employment situation will get better.” He took the assignment and he failed. So he gets an F.

    And on top of it he is doing things to make the labor situation worse, not better. If you are a smaller business would you hire people right now knowing that employment costs might skyrocket with the recent passage in the House of the health care expansion legislation? What about all the globla warming legislation? Will you have to start buying carbon credits to stay in business? Will you have to pay a new tax? Will there be a mandatory reduction with fines for failure and how much does technology to reduce GHG emissions costs? Can you use carbon offsetts and how much does that cost?

    Seriously…you’d hire more people in this environment? You’d expand your business and take these unknown risks? Would you start your own company right now?

  • Hello….thump thump thump this thing on…?

    I guess we’ll take that as a “No” that you wouldn’t hire people in this business environment.

    Thanks for playing.

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