I found it gratifying that strategist and international relations thinker Edward Luttwak echoed the views I articulated earlier in his piece at UnHerd:
The foreign busybodies in the State Department, Foreign Office and the French foreign ministry, who are already now pressing for the reconstruction of a unitary Syrian state, should reflect on the country’s history. Syria was never meant to function as a unitary state. Nor under Sunni Arab majority rule, as it is likely to now.
concluding:
Perhaps the Syrians are best left alone to rebuild their state as they see fit. But if benevolent Western officials do intervene, they should not automatically favour a unitary and centralised state — a preference unfortunately shared even by American officials who come from a federal state. A confederal Syria would be a much better alternative.
I wouldn’t be a bit surprised if Syria as it was constructed by the French in the aftermath of World War I ceases to exist. There are signs that the Druze of the Golan Heights would actually prefer to become part of Israel while I wouldn’t be surprised if the Kurds in Syria’s north decided that the fall of Assad’s regime presented a wonderful opportunity to form their own state, a move that the Turks are already moving to prevent.
How the Alawites on the coast will react to developments is anybody’s guess. Might they seek to join with Lebanon? That would leave the Sunni Arab population that is preponderant in the rest of historic Syria in a bad situation.
What I don’t expect is a liberal democratic Syria within its existing boundaries to take form peacefully.
An enormous number of things going on these days remind me of the old wisecrack I’ve heard attributed to Lincoln (which I doubt). It’s about the guy on trial for murdering his parents who appeals for mercy on the grounds that he’s an orphan. Right now that’s a pretty good description of bringing people into the country on H1-B visas because there aren’t enough engineers. To produce enough engineers here in the U. S. there needs to be a career path for engineers in the U. S. That has been narrowing year by year for decades. For EEs there hasn’t been much of a career path for 40 years—since companies like Zenith and Motorola laid off all of their senior engineers in favor of engineers in Japan, South Korea, and now India.
I’m actually in favor of expanding the number of H1-B visas issued but I’m also in favor of strict enforcement and severe punishments for companies that break the rules and hiring foreign workers at wages less than the prevailing wage is against the rules. It’s something that companies like Microsoft and Facebook have been doing for years.
The other thing that I wanted to mention is that things are unfolding much as I have predicted. I’m starting to see demands for a complete suspension of immigration. I think that would be a mistake but it was predictable after our failure to control our southern border. I doubt that President Trump will have the votes to impose something as restrictive as the Immigration Act of 1924.
This happens with me frequently. My interest will be piqued by the caption of an editorial, column, or op-ed and I read it, prepared to disagree vehemently with whatever it has to say. On reading it I find that I agree with most of what the writer has to say. That was the case with David Goldhill’s Washington Post op-ed, “Insurance is what makes U.S. health-care prices so high”:
Consider this: Health insurance is a product so terrible that few Americans voluntarily buy it without receiving a sizable subsidy.
“No one would design a system like the one we have. And no one did,” UnitedHealth Group CEO Andrew Witty wrote this month. “It’s a patchwork built over decades.”
Today, insurers are accused of pushing up prices for medical care and then denying legitimate claims. Their leaders are said to be greedy or incompetent. In reality, we have a more fundamental problem: Health insurance can no longer pay for or manage modern health care, and the patchwork that Witty described is not fixable. It makes no sense to try.
One of the key problems is that what is called “healthcare insurance” in the United States isn’t actually insurance. For a plan to be insurance the insurer must bear risk and premiums must be proportional to risk. What we call “healthcare insurance” isn’t insurance at all. It’s a healthcare maintenance plan paid for by insureds, employers, or the government. Mr. Goldhill actually makes the same point in his piece:
Health insurance was meant to work like other kinds of insurance: When policyholders got sick, they would use the collective financial resources of the healthy to cover their costs. But this model was designed to pay for emergencies such as hospitalizations — not to “share the risk” of erectile dysfunction, weight loss, lifelong management of chronic conditions, or the mental health treatment needed by 1 in 5 Americans. The Centers for Disease Control and Prevention estimates that 90 percent of America’s health-care expenditure goes toward chronic and mental health conditions.
It’s as if homeowners’ policies expanded from insuring against fires and floods to also covering utility bills and property taxes, or even replacing worn-out furniture.
I think the point he’s making here is solid:
When insurers are the primary payers, the marketplace is distorted. So much of what Americans hate about the system — limited networks, paperwork, billing mistakes, terrible customer service, opacity — arises from the way clinicians serve insurers’ business priorities rather than patients’ needs.
The same problems obtain when employers are the actual customers or the federal government is the actual customer:
Policymakers cement the centrality of this model. Medicare, Medicaid and Veterans Affairs health care all have been dressed up as pretend insurance. Americans individually pour hundreds of thousands of dollars into the system through premiums and deductibles, yet they somehow keep believing that someone else is paying for their care.
Here’s his prescription:
To replace its obsolete insurance structure, America has two choices.
One is to emulate other nations and make health care a social utility, with government controlling supply and prices to ensure equal access to care. But this model utterly fails to drive the innovation that’s essential to improving health outcomes. Had the United States copied Britain’s National Health Service when it was established in 1948, Americans might today enjoy the glories of equal access — to roughly 1948-level care.
Instead, America should get the entire industry to compete vigorously for customers — for patients, that is, not insurance companies. Spending power needs to shift from insurers and government subsidies back to individuals, through mechanisms that patients control. Competition among providers for dollars spent directly by prudent consumers would not only bring prices down but also encourage more innovative approaches to packaging care. And this care would be better aligned with patients’ diverse needs.
In such a system, insurance and government would play their traditional functions but no longer act as the industry’s primary customers. Insurance would spread the financial risk of rare and major episodic medical needs. Governments would subsidize vulnerable populations so they could fully participate in the marketplace for ordinary health care.
Sadly, his proposal will not work. There is plenty of scholarship demonstrating that patients do not make decisions about their own healthcare sufficiently prudent to maintain their health and control costs.
Let’s consider the list of stakeholders that have little interest in controlling costs:
Insurance companies
Employers
The federal government
Providers
Patients
It’s little wonder that prices and costs have increased so rapidly over the last 50 years and continue to do so.
It’s a positive feedback system and the behavior of such systems is well understood. They keep going out of control until they collapse. When will that happen? As Adam Smith observed more than two centuries ago there is a great deal of ruin in a nation.
Investors rushing to capitalize on artificial intelligence have focused on the technology—the capabilities of new models, the potential of generative tools, and the scale of processing power to sustain it all. What too many ignore is the evolving legal structure surrounding the technology, which will ultimately shape the economics of AI. The core question is: Who controls the value that AI produces? The answer depends on whether AI companies must compensate rights holders for using their data to train AI models and whether AI creations can themselves enjoy copyright or patent protections.
The current landscape of AI law is rife with uncertainty. The New York Times, Getty Images and individual artists have challenged AI companies over their use of copyrighted material in training data sets. How these cases are decided will determine whether AI developers can harvest publicly available data or must license the content used to train their models. Should courts decide in favor of rights holders, AI companies will face increased costs that could reduce profit margins and put many current valuations into question. Investors shouldn’t underestimate the risks.
Equally significant are the questions surrounding intellectual-property rights for AI-generated creations. Can a novel invented by AI be copyrighted? Can a discovery guided by an AI model be patented? Recent rulings have denied such protections, emphasizing that only human creators can claim IP rights under current laws. This creates ambiguity for companies using AI in creative or inventive processes. Without clarity on whether AI-generated works can be defended as proprietary, what those companies produce may lack the legal protection necessary to secure a competitive advantage, undermining a key element of investor confidence.
I think he’s only scratching the surface. Mr. Harlan writes of the intellectual property claims as something that may impede generative AI in the future. IP claims already impede the use of materials in training generative AI, that will only increase, and the generative AI engines are already running out of materials to use in training. Furthermore, the greater the extent to which generative AI is used to produce “new” content, the more the results will be.
But there’s more. “Intellectual property” is, essentially, meaningless noise to most of the rest of the world, particularly in China. The barrier for China is their tardiness in developing native high density chip technology but that will not persist forever. Too many U. S. companies are staking their very existence on IP and that is incredibly fragile.
Critics of the U.S. health-care system, attempting to capitalize on the fury Americans have expressed toward insurance companies since the targeted killing this month of UnitedHealthcare CEO Brian Thompson, have renewed calls to rethink how the United States pays for care. Some, for example, have returned to the idea of single-payer health care, which would eliminate the need for private insurance.
Such a complete overhaul is not realistic for the foreseeable future. But one idea is worth revisiting: creating models that offer alternatives to for-profit insurers.
This is not a new idea. The original version of the 2010 Affordable Care Act contained a public option — a health plan run by the government — to compete with private insurers. Lobbyists succeeded in getting the provision nixed, though Democrats managed to secure a last-minute compromise: a new nonprofit health insurance entity, called a Consumer Operated and Oriented Plan, or co-op.
Nearly 150 co-ops were opened following passage of the Affordable Care Act. All but three have failed. The explanations for that failure that Dr. Wen considers are:
The funding provided to them under the ACA was insufficient
Onerous regulations including prohibitions against using their government funding for advertising and being blocked from signing up large companies
Low enrollment
Here’s Dr. Wen’s peroration:
So what now? Beilenson, though he has long supported a single-payer system, doesn’t believe abolishing insurance companies is realistic. But he is optimistic that there could be renewed energy to reengage around the public option — or to make another attempt at co-ops, though without all the obstacles that made them near-impossible to operate the first time around.
The idea isn’t new as anyone who has seen Dr. Kildare Goes Home (1940) will realize. The idea for the group set up by Dr. Kildare in his home town is based on Ross-Loos, the first health maintenance organization (HMO). After a series of mergers and acquisitions it eventually transmogrified into Caremark Rx.
I suspect there may be other reasons for the failure of the co-ops including:
Although it is not unethical physicians are disinclined to advertise prices
The incentives do not support cost containment
Such plans interfere with physician autonomy (so does corporate medicine)
I’m open to suggestions of other reasons. The bottom line is that without some external force to change the healthcare system costs will simply not be contained and prices will continue to rise at an unaffordable pace. Don’t look to the federal government to provide that external force. There is a demonstrated lack of will there, cf. SGR.
“Civil asset forfeiture” sounds like a wonky term for some arcane practice in a secluded cranny of the justice system. In fact, it can be a powerful law enforcement tool in the battle against crimes such as drug trafficking — when used correctly. When abused, it can result in innocent people having their property seized, often without criminal charges.
Forfeiture involves officers taking property they suspect is related to a crime, such as cash from a drug transaction, leaving the person from whom they confiscated it with only arduous options to show it is clean and get it back. For years, the Justice Department’s Office of the Inspector General has prodded federal law enforcement agencies to use this tool more responsibly. At the Drug Enforcement Administration, the most persistent abuser of federal forfeiture, those efforts have failed, a recent IG report shows.
The report found that, at mass transportation facilities such as airports, DEA officers defied agency protocols as they harassed passengers and snatched their cash.
As should be needless to say corruption of law enforcement agencies isn’t limited to civil asset forfeiture and it isn’t limited to the DEA. If the FBI is looking for a job they might consider monitoring the federal government’s several dozen armed law enforcement agencies with police powers more closely. Their staffs are humans and as such are fallible. They cannot merely be trusted.
The remaining question is who should monitor the FBI?
I’m getting to it a bit late but Merry Christmas to all!
As you can see they’re pruning trees a bit more narrow this year. That’s a new Moravian star at the top of our tree. Our old star finally died. It was 40 years or so old—you can’t expect these things to last forever. The new star was missing a couple of pieces. I don’t think you can tell.
I took out a home equity loan and got a small (prime) beef roast. A couple of guests joined us for dinner. I also made Basque baked beans (an easy recipe that everybody but vegetarians like) and a green salad. My wife made the birthday cake she’s been making for the last several years for me. Gingerbread cake with ermine frosting. It was the best ever this year.
Probably my favorite present this year was my wife sent some of the ribbons that Kara won to a lady who turns them into beautiful Christmas ornaments.
Can someone please explain to me what is happening in the Congress? In particular how the Democrats benefit from the course of action they’ve selected? The only explanation I have is that they’re doing what they’re doing when your highest priority is “owning” you opponent rather than accomplishing anything.
