Published in Australian Medicine 19 June 2017 Page 21. http://bit.ly/2rT1xdb
Tuesday, June 20, 2017
The saga of trying to put Medicare on ice
Published in Australian Medicine 19 June 2017 Page 21. http://bit.ly/2rT1xdb
Tuesday, May 23, 2017
Joseph Priestley and a bottle of pop
Published in Australian Medicine 17 April 2017 http://bit.ly/2rRStph
Wednesday, March 29, 2017
The time is now to act on inequalities
Published in Australian Medicine 20 March 2017 http://bit.ly/2od3vHX
Tuesday, March 14, 2017
The Ethics and Practicality of Foreign Aid by Jeffrey Sachs
Jeffrey D. Sachs || March 13,
2017 || Boston Globe
As a lifelong advocate for development aid for the world’s poor, I am angered by the reported plans of the Trump administration to slash US foreign aid. I know how many children will die or grow up without access to education if President Trump’s proposals are adopted. I know that the financial savings for the United States will be trivial, but the costs to millions of impoverished people will be enormous.
Even worse, the cuts in aid are designed to fund an increase in military spending, one that is unnecessary and that should not be funded on the backs of the world’s poorest people. Instead of cutting aid to fund a $54 billion increase in military spending, we should be slashing $54 billion (or more) in defense to increase aid for health, education, renewable energy, and infrastructure, as well as urgently needed spending at home.
Trump’s plan will surely appeal to the racist followers of Stephen Bannon and Breibart News, and perhaps that is their main purpose — to pump up Trump’s base. Yet they will also cause enormous harm to America itself, not only to our nation’s soul and moral standards, but to American national security and jobs as well.
My own support for foreign assistance is based on morality. “Justice, justice shall you pursue,” we are told in the book of Deuteronomy. Those who fail to help the poor cast themselves outside of the moral community. “For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me,” warns Jesus in the Gospel of Matthew.
As a lifelong advocate for development aid for the world’s poor, I am angered by the reported plans of the Trump administration to slash US foreign aid. I know how many children will die or grow up without access to education if President Trump’s proposals are adopted. I know that the financial savings for the United States will be trivial, but the costs to millions of impoverished people will be enormous.
Even worse, the cuts in aid are designed to fund an increase in military spending, one that is unnecessary and that should not be funded on the backs of the world’s poorest people. Instead of cutting aid to fund a $54 billion increase in military spending, we should be slashing $54 billion (or more) in defense to increase aid for health, education, renewable energy, and infrastructure, as well as urgently needed spending at home.
Trump’s plan will surely appeal to the racist followers of Stephen Bannon and Breibart News, and perhaps that is their main purpose — to pump up Trump’s base. Yet they will also cause enormous harm to America itself, not only to our nation’s soul and moral standards, but to American national security and jobs as well.
My own support for foreign assistance is based on morality. “Justice, justice shall you pursue,” we are told in the book of Deuteronomy. Those who fail to help the poor cast themselves outside of the moral community. “For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me,” warns Jesus in the Gospel of Matthew.
Charity (zakat) is a
bedrock of Islam. Compassion is the very core of Buddhism. Indeed, for all
systems of morals, both religious and secular, treating others as we would be
treated is the very essences of morality. If my own children were hungry,
without medicine, or without schooling, I would desperately want them to be
helped. Our responsibility is equally clear. Moreover, I believe, along with
the teachings of the ancient prophets, that a nation built on iniquity cannot
long survive. It will come apart at the seams, as America may be doing today.
I also know, as a development practitioner now for 32 years, that foreign aid works — when we put in the honest effort and thinking to make it work. I am not talking about the kind of US aid that is handed over to warlords, as in Iraq and Afghanistan. I’d cut out that aid in a moment. I’m not talking about aid that is handed out by the US military. I do not believe in the Pentagon and the CIA’s campaigns for “hearts and minds,” designed by people whose real training lies not in providing public health, but in killing. And I’m not talking about the aid delivered largely by American expatriates in somebody else’s country. Almost all local service delivery should be carried out by locals except in exceptional circumstances (e.g., in the immediate aftermath of natural disasters when all hands are needed).
Aid works when its main purpose is to finance supplies such as medicines and solar panels, and the staffing by local workers in public health, agronomy, hydrology, ecology, energy, and transport. US government aid should be pooled with finances from other governments to support critical investments in health, education, agriculture, and infrastructure, based on professional best practices. That’s how the Global Fund to Fight AIDS, Tuberculosis, and Malaria works, as one important example. It’s a model of success.
This kind of aid is not “the White Man’s Burden,” as has been alleged. The responsibility to help the poor is carried by no race for any other race. This is not about whites helping blacks, or about greens helping blues for that matter. It is about the rich doing what they should for the poor. “From everyone to whom much has been given, much will be required,” says Jesus in the Gospel of Luke. Or as John F. Kennedy put it, “If a free society cannot help the many who are poor, it cannot save the few who are rich.”
Nor is good aid about “the poor in the rich countries helping the rich in the poor countries,” as foes of aid have quipped. When aid funds are directed towards the basics — safe childbirth; immunizations; control of diarrheal diseases, malaria, and HIV/AIDS; irrigation for smallholder farmers; information and communications technologies for e-governance, e-finance, e-education, and e-health; ensuring access to schooling; protecting biodiversity; and restoring degraded lands, the beneficiaries will be the poor. And as long as America maintains fairness in the US tax system, the rich will be bearing their fair share. It is true that a politically viable aid program goes hand in hand with a fair tax system.
There is a lot of negative propaganda about foreign aid, since foreign aid is an easy target. There are very few knowledgeable people around to defend it, and the recipients kept alive by it don’t vote in US elections. We certainly hear an earful: Aid is wasted; aid is a huge budgetary burden; aid demeans the recipients; aid is no longer needed in the 21st century. Aid, in short, does not work.
The simple fact is that some aid is wasted and other aid is used brilliantly. The main issue is whether the aid directly supports the work of local professionals saving lives, growing food, installing rural electricity, and teaching children, or whether the aid goes instead to foreign warlords or overpriced American companies. Our responsibility is to fund the aid that works, and when aid has been demonstrated to work, as in public health and education, to expand the assistance as it’s needed by the poorest of the poor.
Aid is a tiny part of our budget, around 1 percent of the Federal Budget, and less than one-fifth of one percent of national income. It is 25 times smaller than the outlays on the military (adding together the Pentagon, intelligence agencies, nuclear weapons programs, veterans’ outlays, and other military-linked spending). And as Trump himself has acknowledged, military spending has squandered many trillions of dollars in Middle East wars that have only exacerbated global threats and US insecurity.
Aid is not demeaning. Aid enables HIV-infected mothers to stay alive and raise their children. Demeaning? Aid enables a child in an impoverished country to escape death or permanent brain damage from malaria, a 100 percent treatable disease. Demeaning? Aid enables a poor child to go to a school fitted with computers, solar power, and wireless connectivity.
Aid is definitely needed still, albeit by a smaller and smaller share of the world. In the 1940s, aid was vital for Europe; hence the Marshall Plan. By the 1950s, Europe had “graduated” from aid; the focus was on Latin America and parts of Asia. Most of those countries too have long since graduated. Aid today should focus on the countries that are still poor — roughly the 1 billion or so people in the low-income countries and the poorest of the middle-income countries. By 2030, with open world markets, improved technologies, and a boost from adequate aid flows for health, education, agriculture, and infrastructure, these remaining countries too could graduate from aid by around 2030.
Another myth is that the United States carries the aid burden while other governments shirk their responsibility. This is plain wrong. The United States spends less as a share of our income than other countries spend as a share of their income. US aid is now just 0.17 percent of US Gross National Income (GNI), roughly $32 billion in aid out of a GNI of $18 trillion. The average aid spending by other donor governments is more than twice the US share, around 0.38 percent.
The best aid giver among our last three presidents was George W. Bush, who created successful US-led efforts to fight AIDS and malaria, and thereby saved millions of lives. By contrast, Bill Clinton and Barrack Obama did very little during their presidencies. Obama’s main contribution was to continue Bush’s programs but without funding the rising needs.
The moral justification of aid, as powerful and adequate as it is, is matched by an equally important case of self-interest. Aid is a matter of US national security and economic interest.
Regarding the links of aid and national security, there is no need to listen to a moralizing economist. Listen directly to the generals. More than 120 retired generals and admirals recently wrote to the congressional leaders of both parties to defend aid as a critical bulwark of national security:
“The State Department, USAID, Millennium Challenge Corporation, Peace Corps, and other development agencies are critical to preventing conflict and reducing the need to put our men and women in uniform in harm’s way. As Secretary James Mattis said while commander of US Central Command, ‘If you don’t fully fund the State Department, then I need to buy more ammunition.’ The military will lead the fight against terrorism on the battlefield, but it needs strong civilian partners in the battle against the drivers of extremism — lack of opportunity, insecurity, injustice, and hopelessness.”
For this reason Senator Lindsay Graham of South Carolina has said of the Trump proposal to slash aid: “It’s dead on arrival, it’s not going to happen, it would be a disaster. This budget destroys soft power, it puts our diplomats at risk, and it’s going nowhere.”
What is especially foolish about the Trump proposal is that the United States would be slashing its own aid precisely when China is ramping up its aid. China is signing and financing major development projects across Southeast Asia, South Asia, Central Asia, Western Asia, and Africa. China may already be the world’s largest aid giver. Trump’s plans would accelerate the transition to China’s preeminence. Who will find diplomatic support in the next global crisis, China or the United States? And whose companies will win the next round of major infrastructure projects?
We must ultimately acknowledge another more radical, and more accurate, perspective: that this is not aid at all, but justice. There are two senses in which “aid” is absolutely the wrong word when it comes to helping the world’s poor. Both the United States and China can and should do their part.
The first returns us to morality. In his wonderful encyclical “Populorum Progressio” (1967), Pope Paul VI noted this of giving to the poor: “As St. Ambrose put it: ‘You are not making a gift of what is yours to the poor man, but you are giving him back what is his. You have been appropriating things that are meant to be for the common use of everyone. The earth belongs to everyone, not to the rich.’ ”
Yet this question of “appropriating things . . . for the common use” is appropriate in a dramatically literal sense as well. The rich countries, including our own, have long robbed and despoiled the planet for our narrow economic gain. Britain, the United States, and other powers have made a career of stealing the oil, gas, and minerals out from under the sands of other nations. Our countries transported millions of African slaves to work the plantations stolen from indigenous populations. Our multinational companies have routinely bribed foreign leaders for land and oil reserves. Our government has launched dozens of coups and wars to secure oil, gas, copper, and banana and sugar plantations and other valuable resources. Our fishing fleets have illegally and recklessly scoured the seas, including the protected economic zones of the poorest countries. And our reckless emissions of greenhouse gases are directly responsible for droughts, floods, and extreme storms around the world, with a president and oil industry too evil even to acknowledge the basic scientific truths.
There is a real question: Who has aided whom over the past centuries? And can we live in morality and peace?
https://www.bostonglobe.com/opinion/2017/03/12/the-ethics-and-practicalities-foreign-aid/lMmOVkMJdIzsByLLOGl0zL/story.html
I also know, as a development practitioner now for 32 years, that foreign aid works — when we put in the honest effort and thinking to make it work. I am not talking about the kind of US aid that is handed over to warlords, as in Iraq and Afghanistan. I’d cut out that aid in a moment. I’m not talking about aid that is handed out by the US military. I do not believe in the Pentagon and the CIA’s campaigns for “hearts and minds,” designed by people whose real training lies not in providing public health, but in killing. And I’m not talking about the aid delivered largely by American expatriates in somebody else’s country. Almost all local service delivery should be carried out by locals except in exceptional circumstances (e.g., in the immediate aftermath of natural disasters when all hands are needed).
Aid works when its main purpose is to finance supplies such as medicines and solar panels, and the staffing by local workers in public health, agronomy, hydrology, ecology, energy, and transport. US government aid should be pooled with finances from other governments to support critical investments in health, education, agriculture, and infrastructure, based on professional best practices. That’s how the Global Fund to Fight AIDS, Tuberculosis, and Malaria works, as one important example. It’s a model of success.
This kind of aid is not “the White Man’s Burden,” as has been alleged. The responsibility to help the poor is carried by no race for any other race. This is not about whites helping blacks, or about greens helping blues for that matter. It is about the rich doing what they should for the poor. “From everyone to whom much has been given, much will be required,” says Jesus in the Gospel of Luke. Or as John F. Kennedy put it, “If a free society cannot help the many who are poor, it cannot save the few who are rich.”
Nor is good aid about “the poor in the rich countries helping the rich in the poor countries,” as foes of aid have quipped. When aid funds are directed towards the basics — safe childbirth; immunizations; control of diarrheal diseases, malaria, and HIV/AIDS; irrigation for smallholder farmers; information and communications technologies for e-governance, e-finance, e-education, and e-health; ensuring access to schooling; protecting biodiversity; and restoring degraded lands, the beneficiaries will be the poor. And as long as America maintains fairness in the US tax system, the rich will be bearing their fair share. It is true that a politically viable aid program goes hand in hand with a fair tax system.
There is a lot of negative propaganda about foreign aid, since foreign aid is an easy target. There are very few knowledgeable people around to defend it, and the recipients kept alive by it don’t vote in US elections. We certainly hear an earful: Aid is wasted; aid is a huge budgetary burden; aid demeans the recipients; aid is no longer needed in the 21st century. Aid, in short, does not work.
The simple fact is that some aid is wasted and other aid is used brilliantly. The main issue is whether the aid directly supports the work of local professionals saving lives, growing food, installing rural electricity, and teaching children, or whether the aid goes instead to foreign warlords or overpriced American companies. Our responsibility is to fund the aid that works, and when aid has been demonstrated to work, as in public health and education, to expand the assistance as it’s needed by the poorest of the poor.
Aid is a tiny part of our budget, around 1 percent of the Federal Budget, and less than one-fifth of one percent of national income. It is 25 times smaller than the outlays on the military (adding together the Pentagon, intelligence agencies, nuclear weapons programs, veterans’ outlays, and other military-linked spending). And as Trump himself has acknowledged, military spending has squandered many trillions of dollars in Middle East wars that have only exacerbated global threats and US insecurity.
Aid is not demeaning. Aid enables HIV-infected mothers to stay alive and raise their children. Demeaning? Aid enables a child in an impoverished country to escape death or permanent brain damage from malaria, a 100 percent treatable disease. Demeaning? Aid enables a poor child to go to a school fitted with computers, solar power, and wireless connectivity.
Aid is definitely needed still, albeit by a smaller and smaller share of the world. In the 1940s, aid was vital for Europe; hence the Marshall Plan. By the 1950s, Europe had “graduated” from aid; the focus was on Latin America and parts of Asia. Most of those countries too have long since graduated. Aid today should focus on the countries that are still poor — roughly the 1 billion or so people in the low-income countries and the poorest of the middle-income countries. By 2030, with open world markets, improved technologies, and a boost from adequate aid flows for health, education, agriculture, and infrastructure, these remaining countries too could graduate from aid by around 2030.
Another myth is that the United States carries the aid burden while other governments shirk their responsibility. This is plain wrong. The United States spends less as a share of our income than other countries spend as a share of their income. US aid is now just 0.17 percent of US Gross National Income (GNI), roughly $32 billion in aid out of a GNI of $18 trillion. The average aid spending by other donor governments is more than twice the US share, around 0.38 percent.
The best aid giver among our last three presidents was George W. Bush, who created successful US-led efforts to fight AIDS and malaria, and thereby saved millions of lives. By contrast, Bill Clinton and Barrack Obama did very little during their presidencies. Obama’s main contribution was to continue Bush’s programs but without funding the rising needs.
The moral justification of aid, as powerful and adequate as it is, is matched by an equally important case of self-interest. Aid is a matter of US national security and economic interest.
Regarding the links of aid and national security, there is no need to listen to a moralizing economist. Listen directly to the generals. More than 120 retired generals and admirals recently wrote to the congressional leaders of both parties to defend aid as a critical bulwark of national security:
“The State Department, USAID, Millennium Challenge Corporation, Peace Corps, and other development agencies are critical to preventing conflict and reducing the need to put our men and women in uniform in harm’s way. As Secretary James Mattis said while commander of US Central Command, ‘If you don’t fully fund the State Department, then I need to buy more ammunition.’ The military will lead the fight against terrorism on the battlefield, but it needs strong civilian partners in the battle against the drivers of extremism — lack of opportunity, insecurity, injustice, and hopelessness.”
For this reason Senator Lindsay Graham of South Carolina has said of the Trump proposal to slash aid: “It’s dead on arrival, it’s not going to happen, it would be a disaster. This budget destroys soft power, it puts our diplomats at risk, and it’s going nowhere.”
What is especially foolish about the Trump proposal is that the United States would be slashing its own aid precisely when China is ramping up its aid. China is signing and financing major development projects across Southeast Asia, South Asia, Central Asia, Western Asia, and Africa. China may already be the world’s largest aid giver. Trump’s plans would accelerate the transition to China’s preeminence. Who will find diplomatic support in the next global crisis, China or the United States? And whose companies will win the next round of major infrastructure projects?
We must ultimately acknowledge another more radical, and more accurate, perspective: that this is not aid at all, but justice. There are two senses in which “aid” is absolutely the wrong word when it comes to helping the world’s poor. Both the United States and China can and should do their part.
The first returns us to morality. In his wonderful encyclical “Populorum Progressio” (1967), Pope Paul VI noted this of giving to the poor: “As St. Ambrose put it: ‘You are not making a gift of what is yours to the poor man, but you are giving him back what is his. You have been appropriating things that are meant to be for the common use of everyone. The earth belongs to everyone, not to the rich.’ ”
Yet this question of “appropriating things . . . for the common use” is appropriate in a dramatically literal sense as well. The rich countries, including our own, have long robbed and despoiled the planet for our narrow economic gain. Britain, the United States, and other powers have made a career of stealing the oil, gas, and minerals out from under the sands of other nations. Our countries transported millions of African slaves to work the plantations stolen from indigenous populations. Our multinational companies have routinely bribed foreign leaders for land and oil reserves. Our government has launched dozens of coups and wars to secure oil, gas, copper, and banana and sugar plantations and other valuable resources. Our fishing fleets have illegally and recklessly scoured the seas, including the protected economic zones of the poorest countries. And our reckless emissions of greenhouse gases are directly responsible for droughts, floods, and extreme storms around the world, with a president and oil industry too evil even to acknowledge the basic scientific truths.
There is a real question: Who has aided whom over the past centuries? And can we live in morality and peace?
https://www.bostonglobe.com/opinion/2017/03/12/the-ethics-and-practicalities-foreign-aid/lMmOVkMJdIzsByLLOGl0zL/story.html
|
Friday, February 3, 2017
Why Millenials Will Reject Trump
Why Millennials Will
Reject Trump
Jeffrey D. Sachs
February 2, 2017
NEW YORK – The key political divide in the United States is not between parties or states; it is between generations. The millennial generation (those aged 18-35) voted heavily against Donald Trump and will form the backbone of resistance to his policies. Older Americans are divided, but Trump’s base lies among those above the age of 45. On issue after issue, younger voters will reject Trump, viewing him as a politician of the past, not the future.
Of course, these are averages, not absolutes. Yet the numbers confirm the generational divide. According to exit polls, Trump received 53% of the votes of those 45 and older, 42% of those 30-44, and just 37% of voters 18-29. In a 2014 survey, 31% of millennials identified as liberals, compared with 21% of baby boomers (aged 50-68 in the survey) and only 18% of the silent generation.
The point is not that today’s young liberals will become tomorrow’s older conservatives. The millennial generation is far more liberal than the baby boomers and silent generation were in their younger years. They are also decidedly less partisan, and will support politicians who address their values and needs, including third-party aspirants.
There are at least three big differences in the politics of the young and old. First, the young are more socially liberal than the older generations. For them, America’s growing racial, religious, and sexual plurality is no big deal. A diverse society of whites, African-Americans, Hispanics, and Asians, and of the native-born and immigrants, is the country they’ve always known, not some dramatic change from the past. They accept sexual and gender categories – lesbian, gay, trans, bi, inter, pan, and others – that were essentially taboo for – or unknown to – their grandparents’ (Trump’s) generation.
Second, the young are facing the unprecedented economic challenges of the information revolution. They are entering the labor market at a time when market returns are rapidly shifting toward capital (robots, artificial intelligence, and smart machines generally) and away from labor. The elderly rich, by contrast, are enjoying a stock market boom caused by the same technological revolution.
Trump is peddling cuts in corporate taxes and estate taxes that would further benefit the elderly rich (who are amply represented in Trump’s cabinet), at the expense of larger budget deficits that further burden the young. Indeed, the young need the opposite policy: higher taxes on the wealth of the older generation in order to finance post-secondary education, job training, renewable-energy infrastructure, and other investments in America’s future.
Third, compared to their parents and grandparents, the young are much more aware of climate change and its threats. While Trump is enticing the older generation with one last fling with fossil fuels, the young will have none of it. They want clean energy and will fight against the destruction of the Earth that they and their own children will inherit.
Part of the generational divide over global warming is due to the sheer ignorance of many older Americans, including Trump, about climate change and its causes. Older Americans didn’t learn about climate change in school. They were never introduced to the basic science of greenhouse gases. That is why they are ready to put their own short-term financial interests ahead of the dire threats to their grandchildren’s generation.
In a June 2015 survey, 60% of 18-29 year-olds said that human activity was causing global warming, compared with just 31% of those 65 and older. A survey released in January found that 38% of American survey respondents 65 and older favored fossil-fuel expansion over renewable energy, compared with only 19% of those 18-29.
Trump’s economic policies are geared to this older, whiter, native-born America. He favors tax cuts for the older rich, which would burden the young with higher debt. He is indifferent to the $1 trillion overhang of student debt. He is reprising the 1990s NAFTA debate over free trade, rather than facing the far more important twenty-first-century jobs challenge posed by robotics and artificial intelligence. And he is obsessed with squeezing a few more years of profit out of America’s coal, oil, and gas reserves at the cost of a future environmental catastrophe.
One might attribute Trump’s backward-looking mindset to his age. At 70, Trump is the oldest person ever to become president (Ronald Reagan was slightly younger when he took office in 1981). Yet age is hardly the sole or even the main factor here. Bernie Sanders, certainly the freshest mind of all the 2016 presidential candidates and the hero of millennial voters, is 75. The young are enchanted with Pope Francis, 80, because he puts their concerns – whether about poverty, employment difficulties, or vulnerability to global warming – within a moral framework, rather than dismissing them with the crass cynicism of Trump and his ilk.
The main issue here is mindset and political orientation, not chronological age. Trump has the shortest time horizon (and attention span) of any president in historical memory. And he is utterly out of touch with the real challenges facing the young generation as they grapple with new technologies, shifting labor markets, and crushing student debt. A trade war with Mexico and China, or a tragically misconceived ban on Muslim migrants, will hardly meet their real needs.
Trump’s political success is a blip, not a turning point. Today’s millennials, with their future-oriented perspective, will soon dominate American politics. America will be multiethnic, socially liberal, climate conscious, and much fairer in sharing the economic benefits of new technology.
Too many observers remain fixated on the traditional party divides in the US Congress, not on the deeper demographic changes that will soon be decisive. Sanders nearly captured the Democratic nomination (and would likely have triumphed in the general election) with a platform appealing powerfully to the millennials. Their time is coming, most likely with a president they support in 2020.
https://www.project-syndicate.org/commentary/america-generational-divide-over-trump-by-jeffrey-d-sachs-2017-02
Jeffrey D. Sachs
February 2, 2017
NEW YORK – The key political divide in the United States is not between parties or states; it is between generations. The millennial generation (those aged 18-35) voted heavily against Donald Trump and will form the backbone of resistance to his policies. Older Americans are divided, but Trump’s base lies among those above the age of 45. On issue after issue, younger voters will reject Trump, viewing him as a politician of the past, not the future.
Of course, these are averages, not absolutes. Yet the numbers confirm the generational divide. According to exit polls, Trump received 53% of the votes of those 45 and older, 42% of those 30-44, and just 37% of voters 18-29. In a 2014 survey, 31% of millennials identified as liberals, compared with 21% of baby boomers (aged 50-68 in the survey) and only 18% of the silent generation.
The point is not that today’s young liberals will become tomorrow’s older conservatives. The millennial generation is far more liberal than the baby boomers and silent generation were in their younger years. They are also decidedly less partisan, and will support politicians who address their values and needs, including third-party aspirants.
There are at least three big differences in the politics of the young and old. First, the young are more socially liberal than the older generations. For them, America’s growing racial, religious, and sexual plurality is no big deal. A diverse society of whites, African-Americans, Hispanics, and Asians, and of the native-born and immigrants, is the country they’ve always known, not some dramatic change from the past. They accept sexual and gender categories – lesbian, gay, trans, bi, inter, pan, and others – that were essentially taboo for – or unknown to – their grandparents’ (Trump’s) generation.
Second, the young are facing the unprecedented economic challenges of the information revolution. They are entering the labor market at a time when market returns are rapidly shifting toward capital (robots, artificial intelligence, and smart machines generally) and away from labor. The elderly rich, by contrast, are enjoying a stock market boom caused by the same technological revolution.
Trump is peddling cuts in corporate taxes and estate taxes that would further benefit the elderly rich (who are amply represented in Trump’s cabinet), at the expense of larger budget deficits that further burden the young. Indeed, the young need the opposite policy: higher taxes on the wealth of the older generation in order to finance post-secondary education, job training, renewable-energy infrastructure, and other investments in America’s future.
Third, compared to their parents and grandparents, the young are much more aware of climate change and its threats. While Trump is enticing the older generation with one last fling with fossil fuels, the young will have none of it. They want clean energy and will fight against the destruction of the Earth that they and their own children will inherit.
Part of the generational divide over global warming is due to the sheer ignorance of many older Americans, including Trump, about climate change and its causes. Older Americans didn’t learn about climate change in school. They were never introduced to the basic science of greenhouse gases. That is why they are ready to put their own short-term financial interests ahead of the dire threats to their grandchildren’s generation.
In a June 2015 survey, 60% of 18-29 year-olds said that human activity was causing global warming, compared with just 31% of those 65 and older. A survey released in January found that 38% of American survey respondents 65 and older favored fossil-fuel expansion over renewable energy, compared with only 19% of those 18-29.
Trump’s economic policies are geared to this older, whiter, native-born America. He favors tax cuts for the older rich, which would burden the young with higher debt. He is indifferent to the $1 trillion overhang of student debt. He is reprising the 1990s NAFTA debate over free trade, rather than facing the far more important twenty-first-century jobs challenge posed by robotics and artificial intelligence. And he is obsessed with squeezing a few more years of profit out of America’s coal, oil, and gas reserves at the cost of a future environmental catastrophe.
One might attribute Trump’s backward-looking mindset to his age. At 70, Trump is the oldest person ever to become president (Ronald Reagan was slightly younger when he took office in 1981). Yet age is hardly the sole or even the main factor here. Bernie Sanders, certainly the freshest mind of all the 2016 presidential candidates and the hero of millennial voters, is 75. The young are enchanted with Pope Francis, 80, because he puts their concerns – whether about poverty, employment difficulties, or vulnerability to global warming – within a moral framework, rather than dismissing them with the crass cynicism of Trump and his ilk.
The main issue here is mindset and political orientation, not chronological age. Trump has the shortest time horizon (and attention span) of any president in historical memory. And he is utterly out of touch with the real challenges facing the young generation as they grapple with new technologies, shifting labor markets, and crushing student debt. A trade war with Mexico and China, or a tragically misconceived ban on Muslim migrants, will hardly meet their real needs.
Trump’s political success is a blip, not a turning point. Today’s millennials, with their future-oriented perspective, will soon dominate American politics. America will be multiethnic, socially liberal, climate conscious, and much fairer in sharing the economic benefits of new technology.
Too many observers remain fixated on the traditional party divides in the US Congress, not on the deeper demographic changes that will soon be decisive. Sanders nearly captured the Democratic nomination (and would likely have triumphed in the general election) with a platform appealing powerfully to the millennials. Their time is coming, most likely with a president they support in 2020.
https://www.project-syndicate.org/commentary/america-generational-divide-over-trump-by-jeffrey-d-sachs-2017-02
|
Tuesday, January 3, 2017
Be clear, precise and don't forget about hope.
Be clear, precise and don’t forget about hope
Collisions between the ethics of private enterprise and medical practice are common, and this is especially so with IVF.
Governments are reluctant to recognise it as an essential — rather than an elective — procedure and to fund it adequately. Consequently IVF clinics are heavily dependent on private provision.
Last month, an ACCC investigation into dozens of fertility clinics criticised some for their misleading advertising of ‘success' rates.
However, the problem of misleading information is not limited to the IVF industry and three lessons from the ACCC's findings can be applied across all specialties.
First, take medical communication and the use of clear language when talking to patients.
Commenting on the ACCC's investigation, Commissioner Sarah Court said: "Some IVF clinics used technical terms understood by industry participants, but which may be misleading to consumers without further clarification or explanation."
The question in IVF is: does the word ‘success' relate to becoming pregnant or giving birth?
Second, analogous to the accuracy of terms, is the use of numbers when making comparisons. Surely, best practice for the IVF industry would be to report the rate of completed pregnancies precisely and accurately?
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However, the report found comparisons were being made, without reliable numbers, between different programs.
Two recent BMJ papers that explored the use of the UK data in predicting IVF success concluded that ‘success rates' should take into account the individual attributes of patients attending different clinics.
This is because social and physical factors, such as obesity, influence the vitality of gametes, and adjustments to predictions of success need to take these factors into account, according to the Robinson Research Institute in Adelaide. This underscores the importance of precision as a principle of all good communication about probability and adverse outcomes.
Numerical estimates of success or adverse outcomes will be interpreted in ways that make sense to individual patients according to their experience of the world. Accurate numbers, rather than terms like ‘usually', ‘frequently' or ‘rarely', are a sound beginning for a clinical conversation.
For example, I am told that the chance of a clinical pregnancy decreases markedly with age — from about 50% per embryo transer for women aged 30 or younger, to 3% for women aged 43 and over.
This information can lead to important discussions and decisions.
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Last but not least, present in many clinical encounters, and strongly represented in relation to IVF, is the need for hope. And it is easy, in the haste of our clinical practice, to overlook the power of this emotion.
If we do not sense a patient's need for hope, vulnerable people will turn elsewhere. We should ask ourselves: "Is there absolutely nothing I can do or say to kindle hope for this patient?" The answer is rarely: "No, nothing."
Counselling need not be fictitious or inappropriate, but focused on possibilities beyond the immediate clinical problems.
When I was managing patients with end-stage respiratory failure, and hope was scarce, I would ask when the moment was right, "What gives your life meaning?"
The answers were often surprising. One man, to my astonishment, said: "Dancing!"
Although not on home oxygen himself, he told me, every week he would visit his neighbour who was receiving home oxygen, "and suck and suck on the oxy and then go to the club and dance until I dropped — and sleep all the next day!"
Together, in a spirit of hope, we explored how this might be made easier.
Distraught, childless couples will be looking for more than just clear words and bald stats. If that's all we offer, then don't blame them if they are attracted to advertisements or clinical conversations of uncertain quality that nevertheless hold out hope.
Exploring their lives in depth, things often come to light where hope might be kindled — that will help them see beyond their current predicament.
Offering hope is much richer and more complex than simply addressing the immediate problem.
We have much to learn from our colleagues in palliative care, who frequently refer to this skill as fundamental in their practice.
When my father was dying in hospital with multiple myeloma, I found him in unexpectedly good spirits one day. His physician had visited and tested his ankle jerks and found them to be in fine form.
The metaphor was powerful: there are things that are good and work well despite the gloom and horror of fatal disease and we need to keep them in view.
Professor Leeder is Emeritus Professor of Public Health at the Menzies Centre for Health Policy, University of Sydney.
Published in Australian Doctor 7 December, 2016. http://bit.ly/2ixxQgC
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