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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?


To: Dale Baker who wrote (119320)8/23/2009 8:54:18 PM
From: Dale Baker  Respond to of 542957
 
This is so familiar and still so depressing; I left Bosnia eight years ago and hardly anything has changed. This could have been written in 2001 with minor variations.

It's a likely scenario for the future of Iraq, too, except no outside power has a monopoly of force or last-resort authority any longer. So the hardliners can kill lots of people while staking out their turf.

The details may seem tedious but the same issues will pop up, almost guaranteed. Bas steta.

Old Troubles Threaten Again in Bosnia
14 Years After War, Leaders Suggest U.S. Should Step In to Rewrite Treaty

By Craig Whitlock
Washington Post Foreign Service
Sunday, August 23, 2009

SARAJEVO, Bosnia -- Fourteen years after the United States and NATO intervened to stop war and ethnic cleansing in Bosnia, the old divisions and hatreds are again gripping this Balkan country.

In June, the international envoy who oversees the rebuilding of Bosnia invoked emergency powers that he said were necessary to hold the country together. Although U.S. and European officials have been trying to get Bosnia to stand on its own feet for years, many Bosnian leaders say the only thing that can permanently fix their gridlocked government is for Washington to intervene -- again -- and rewrite the treaty that ended the war in 1995.

The economy is in tatters, with unemployment exceeding 40 percent. Serbs are talking openly of secession. Croats are leaving the country in droves. Religious schisms are widening. In December, street protests erupted after Bosnian Muslim school officials in Sarajevo tried to ban "Santa Claus" from delivering gifts to kindergartens.

The national government answers to three presidents, who agree on one thing: Corruption, political infighting and bureaucratic dysfunction are paralyzing the country. In May, Vice President Biden visited Sarajevo and lectured Bosnian leaders to put aside their differences. But the squabbling has only worsened since then.

Zeljko Komsic, a Croat and chairman of Bosnia's tripartite rotating presidency, said the country has increasingly hardened along ethnic lines. Even as Bosnia dreams of integrating into NATO and the European Union, its population has become more segregated than ever.

Many Bosnian Muslim and Croat students, Komsic noted, attend school together but are separated in the classroom so they can learn different lessons about history, geography, religion and language, based on their ethnicity.

"What kind of message are we giving to these children?" he said. "As an individual, you almost don't exist in this society. You are just a member of a certain ethnic group."

The European Union, the United States and other donors have spent billions of dollars trying to rebuild Bosnia since the 1995 signing of the Dayton peace accords, brokered largely by U.S. diplomats. An estimated 100,000 people were killed during the war, which erupted in 1992 after Bosnia declared independence from the former Yugoslavia.

Serb and Croat nationalists, supported by leaders in next-door Yugoslavia and Croatia, tried to carve up the country along ethnic lines. Nearly half of Bosnia's prewar population of 4.3 million either fled the country or were forced from their homes.
A 'Dependency Syndrome'

On the surface, Bosnia's wartime scars appear healed. Sarajevo's Old City, which was bombarded for three years by Serbian forces, bustles with smiling families snacking on cevapcici, a minced-meat kebab venerated as the national dish. Thousands of damaged houses, churches and mosques in the hilly countryside have been rebuilt with foreign aid. Ethnic violence is relatively rare.

But the international campaign to transform Bosnia into a pluralistic democracy is still limping along with no end in sight. The struggle serves as a cautionary example for U.S.-led efforts to rebuild much larger nations hamstrung by ethnic and religious factions, such as Iraq and Afghanistan.

Bosnia is still overseen by an international viceroy, known as the high representative, who holds unchecked authority to dismiss local officials and set policy if deemed necessary for the welfare of the country.

The Peace Implementation Council, a group of 55 nations and agencies that oversees the Dayton accords and appoints the viceroy, has been trying for years to abolish the position and restore full sovereignty to Bosnia. But foreign diplomats say they are not confident that Bosnia is ready to govern itself.

Valentin Inzko, an Austrian official who serves as the high representative, said Bosnia suffers from a "dependency syndrome" that dates back centuries, to when it was part of the Ottoman Empire.

He cited an ongoing political dispute that has left Mostar, a city evenly divided between Bosnian Muslims and Croats, without a budget or a functioning government. A delegation of firefighters and municipal workers visited Inzko in Sarajevo recently to plead with him to do something because they have gone unpaid for several months.

"I can easily intervene. I can declare a budget because people are desperate, they are hungry," Inzko said. "It's easy to do it, but to do it contributes to this dependency syndrome."
Challenges From Serbs

Under the Dayton accords, Bosnia was divided into two autonomous zones, each with its regional parliament. One zone is the Republika Srpska, or the Serb Republic; the other is known as the Federation, and it consists mostly of Bosnian Muslims and Croats.

Muslims represent about half of Bosnia's population, with Serbs accounting for about a third and Croats making up much of the rest. Nobody knows precise numbers, however, because the last census was taken in 1991.

In June, Inzko defused a much bigger crisis after lawmakers in the Serb Republic approved legislation challenging the authority of the national government in several areas, such as customs and law enforcement. Inzko nullified the legislation, ruling that it would undermine the Dayton accords, the legal framework that holds the country together.

Serb Republic lawmakers have tried to block the national government from consolidating power while effectively creating a separate state in their autonomous zone.

Milorad Dodik, the prime minister of the Serb Republic, has hinted that it might try to secede. He has also tangled with prosecutors and diplomats who have served under the high representative, saying they are biased against Serbs.

Raffi Gregorian, an American who serves as the deputy high representative, said the political mood in Bosnia began to sour three years ago after Dodik's party took power in the Serb Republic. Since then, he said, many politicians have tried to win votes by fanning ethnic fears and suspicions.

"Thank God there have been no physically violent incidents," he said. "But the rhetoric, according to people who have been here, is as bad as it's been since 1991."

In interviews, officials in Banja Luka, the city that serves as the capital of the Serb Republic, said they have no intention of seceding. They defended their efforts to prevent the national government from consolidating power.

"To impose a centralized federal model on this country means only one thing: domination by one group," said Gordan Milosevic, a political adviser to Dodik. "People do not feel comfortable living on a territory where they are a minority unless they have safeguards."

Igor Radojicic, speaker of the Serb Republic's National Assembly, said it is time to end the international oversight of Bosnia and force the country's political factions to work things out on their own.

"The international community is losing patience," he said. "It's even boring to have to explain to them the problems of Bosnia-Herzegovina. It's an old story for many of them, and they are tired of it."

Meanwhile, Bosnia is becoming even more polarized, as Serbs, Croats and Muslims migrate to places where their ethnic groups are in the majority.

Franjo Komarica, the Roman Catholic bishop of Banja Luka, said his predominantly Croat diocese had lost 90 percent of its prewar population.

Komarica estimated that he presides over 50 funerals for every baptism. "It's not so nice to contemplate, but I think we'll become like a group of exotic animals at the zoo," he said.

Sulejman Tihic, president of the Party for Democratic Action, a Muslim political bloc, said he worries that the recent hot rhetoric could easily lapse into violence.

"If we look at the history of this country, we have to keep control and we must not let things fall apart," he said. "I passed through five Serb [concentration] camps during the war. I never want to see that era repeated again."



To: Dale Baker who wrote (119320)8/23/2009 9:00:30 PM
From: JohnM  Read Replies (2) | Respond to of 542957
 
5 Myths About Health Care Around the World

By T.R. Reid


Just a terrific piece. Well worth a very careful read.



To: Dale Baker who wrote (119320)8/23/2009 11:44:41 PM
From: Ron  Read Replies (1) | Respond to of 542957
 
excellent article, thanks. That one made the email list.



To: Dale Baker who wrote (119320)8/24/2009 5:01:15 PM
From: JohnM  Read Replies (1) | Respond to of 542957
 
The tag line on this essay, 5 Myths about Health Care Around the World by T. R. Reid, is that Reid has a book published today.

Barnes and Nobles has an elegant set of reviews of the book: by Ezra Klein, Jacob Weisberg at Newsweek, Timonth Noah at Slate, and so on.

Klein's review is special. I'm going to post it here even though it's rather long. I don't recall reading as good a review as this one. Not at least, one that is as short as this.
------------------------------
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by T.R. Reid

The Barnes & Noble Review

There can be, in book reviews, a distressing tendency to bury the actual recommendation beneath the scintillating thoughts of the reviewer. (I have fallen prey to this myself. My thoughts are very scintillating.) Let's not make that mistake here. You should buy this book. It is the clearest and most useful contribution to the ongoing health care reform debate I've read. And, unlike most books that are described as a "useful contribution," it's a good read, too.

The book's clarity comes from its thesis: The way America does things is not the only way things can be done. That simple refusal to remain inside the strictures of America's political debate -- where the argument is over how best to cover everyone while offending no one and changing nothing -- allows T. R. Reid to elegantly demonstrate how unnecessarily complex and inefficient and expensive and cruel our health care system really is.

Unlike so many other commentators, Reid does not do this by exhaustively explaining the mechanics of the American health care system and wagging his finger at its many mistakes. He does it by offering insight into other health care systems. In particular, he examines the French, Canadian, German, Japanese, and British systems, alongside the pushes for reform that recently gave Sweden and Taiwan brand-new health care systems. The result is a sort of health policy travelogue: Reid flies around the world, investigating the workings of these systems and asking doctors in each to recommend a course of treatment for the chronic pain in his shoulder. This latter effort could be gimmicky, but it actually proves helpful: It allows Reid to view the various arrangements from both the high altitude favored by wonks and the ground level experienced by patients.

Reid's reporting results in two important contributions to the debate we're having here at home. First, the national health care systems enjoyed by residents of every other developed country are superior to the fractured health care industry that serves Americans. They are cheaper, they cover everyone, and there is no evidence that they produce worse outcomes. Second, these national health care systems are all different. Some are socialized and some are not. Some are single-payer and some are not. Some are private and some are not.

This first fact is a particularly hard one to swallow. We're America. We have the most highly trained doctors, the most astonishing medical equipment, that guy from House (although we imported the actor who plays him from Britain). We even spend the most, which is, in many areas of life, a sure sign of achievement. How can our medical system not be the envy of the world? This leads to a lot of strange rationalizations for the fact that we get less and spend more than every other country. But it shouldn't. If there were two stores in your town, and one was twice as expensive as the other and tended to be out of things that 15 percent of the people needed to buy, you wouldn't spend a lot of time concocting elaborate explanations for the superiority of the store that cost too much and couldn't provide everyone with the goods and services they required. You'd go to the other store.

But it's not just one other store. There are a variety of other business plans we could try. Reid groups the possibilities into four models. The Bismarck model, named for Germany's Otto von Bismarck, is a private system in which the government shapes the rules of the market to make certain that everyone is covered and that basic rules of decency and consumer protection are followed. The Beveridge model, named for England's William Beveridge, is a socialized system in which the governments owns the hospitals and employs the doctors and basically runs the whole thing. The National Health Insurance model is what's traditionally known as single-payer, and it's what we see in Canada: the government is the insurer, but the doctors and hospitals are private. And then the Out-of-Pocket model is what you have in developing countries: health services are available to those able to afford them.

None of these systems should be particularly alien to Americans. The Bismarck model is pretty close to what those of us with solid employer-based insurance experience. The Beveridge model is what our veterans enjoy in the Veteran's Health Administration. The National Health Insurance Model is Medicare. And the Out-of-Pocket model is what the uninsured and self-employed face. But unlike other countries that have chosen a single system and worked to make it run smoothly, America has a confusing patchwork of different arrangements and models. We don't so much have a store as a vast bazaar. And there's a good reason that the bazaar model has given way to Target.

Choosing a system, however, is only the first step. You also have to implement it. Savings will not emerge as if by magic. In other countries, health care providers make less money. Doctors have lower salaries. Pharmaceutical companies see less in profits. Those will be tough political fights. Similarly, other systems sometimes -- though not always -- furnish patients with less in the way of treatments. That, too, is a choice. A system can be biased toward more treatment, less treatment, or neither. Our system is currently biased toward more treatment: Doctors make money every time they do something to you. Britain's system is biased toward less treatment: Doctors lose money every time they do something to you. Other systems are somewhere in the middle. But Americans tend to believe that more medical care is better, even if the evidence doesn't quite back that up, and they don't like facing down the possibility that a new system would mean doctors might be more reticent with a pill or a surgery.

There are, in other words, hard decisions to be made. But they are decisions. Toward the beginning of the book, Reid says something quite radical: Letting people die or go bankrupt because they happen to be sick and happen to not have health insurance "is a fundamental moral decision America has made." That is not, in general, how we see it. The more traditional view is that health care is a problem we simply haven't solved. Not mustering the will or energy to solve that problem anytime during the 21st century is, however, a choice. A decision. It is to our discredit to fail. But it is in our power to change it. Others, as we can see, already have.

-- Ezra Klein

Ezra Klein writes on economic and domestic policy for The Washington Post, at voices.washingtonpost.com. He has been an associate editor at The American Prospect and contributes to the group food blog the Internet Food Association.