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Tear down Walls to Telemedicine

January 27, 2019 in Economics

By Michael F. Cannon

Michael F. Cannon

THE GENERAL ASSEMBLY is considering legislation to expand access
to the nation’s top medical centers and reduce the cost of
health care. Though all Virginians would benefit, the biggest
winners would be patients with low-to-moderate incomes, those who
live in rural areas and those who have rare diseases requiring
highly specialized care.

Unfortunately, special interests are trying to prevent these
patients from seeing anyone but Virginia doctors — even when
the best doctors are out-of-state.

Virginia law allows residents to travel across state lines to
receive treatment at Johns Hopkins University or any other leading
medical center. Anyone who proposed building a wall around the
commonwealth to prevent Virginia patients from seeking care at top
medical centers in other states would be laughed out of Richmond.
Yet Virginia erects a virtual wall that blocks patients from
receiving care from those same doctors via telemedicine.

Telemedicine has made the
cost of accessing care from distant providers plummet. Blocking
telemedicine reduces quality. It’s time for regulation to catch up
with the technology.

Telemedicine allows patients to get care from doctors or nurses
via Skype or other web-based applications. It can improve the
quality of care, such as by connecting patients with rare diseases
to distant specialists, and by reducing delays in the diagnosis and
treatment of strokes, which has the potential to reduce disability
and save lives.

It can also reduce the cost of care. The New England Journal of
Medicine reports, “Numerous organizations, from academic
health centers to startups, now offer low-cost virtual visits (less
than $50 per visit) around the clock for the ‘most common,
most irritating, most inconvenient’ conditions. By contrast,
it takes an average of 20 days to secure a 20-minute appointment
with a physician that with travel and wait time consumes two
hours.”

Economist Shirley Svorny writes that telemedicine can improve
outcomes in “diabetic monitoring and care[,] delivering care
to Parkinson’s patients, mental health services and many
other situations.”

Yet even though it is legal to drive to the Mayo Clinic for
care, in most cases Virginia makes it illegal to receive
telemedicine services from Mayo Clinic doctors.

At a time when patients are buckling under sky-high health care
prices, this virtual wall imposes unnecessary travel, time and
forgone-income costs on patients. Wealthy patients may be able to
shoulder those needless costs. Low- and moderate-income patients
can’t, and those costs are highest for rural patients: Northern
Virginia residents can drive to Johns Hopkins in as little as one
hour, but from Lee County it’s eight hours each way.

Svorny advocates tearing down this virtual wall. The General
Assembly is considering legislation based on her proposal to allow
Virginia patients to receive …read more

Source: OP-EDS

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Facing the Transatlantic Truth: Divergent US and European Security Interests

January 27, 2019 in Economics

By Ted Galen Carpenter

Ted Galen Carpenter

Media reports that President Donald Trump discussed the
possibility of US withdrawal from NATO with other officials on
several occasions in 2018 have produced enhanced anxiety among
Alliance partisans on both sides of the Atlantic. But Trump is
hardly alone in suggesting that a new transatlantic security
relationship may be needed.

NATO’s Cold War mission receded into history more than a quarter
century ago, and there is growing awareness that while America and
Europe have important security interests in common, those interests
are far from being congruent. Not all security problems impact all
portions of the democratic West equally. It is irrational to assume
that disorders in the Balkans, North Africa, or elsewhere on
Europe’s periphery should be as important to the United States as
they are to the European Union countries. Likewise, it is not
reasonable to believe that EU members should be as concerned as the
United States about problems in Central America, the Caribbean, or
Venezuela.

Indeed, expressions of that realization surfaced during the
first post-Cold War decade — and did so at least as much in
Europe as in America. As NATO increasingly pursued “out of
area” missions during the 1990s and early 2000s, some NATO
traditionalists in Europe became very uneasy about the implications
for the Continent. Comments like those of Secretary of State
Madeleine Albright, who suggested that NATO become a force for
peace “from the Middle East to Central Africa,”
strengthened such apprehension. Albright’s former Clinton
administration colleagues Warren Christopher and William Perry
went even further than she did, urging that the
Alliance be an instrument for the projection of force anywhere in
the world the West’s “collective interests” were
threatened.

US leaders should
encourage European ambitions for an independent security
capability, not blindly emulate previous administrations and seek
to sabotage those ambitions.

French Foreign Minister Hubert Vedrine cautioned against that
approach, warning that it ran the risk “of diluting the
alliance”. Without a reasonably tight geographic focus, he
believed, NATO could become a global crusader, endangering European interests in remote
arenas. Spanish Foreign Minister Abel Matutes was even more
specific that Europe did not have a stake in every geopolitical
problem the United States might want to address somewhere else in
the world. He stressed that what happens “8,000 kilometers
from us — in Korea, for example … cannot be considered a
threat to our security.” Vedrine echoed his point, saying
that NATO “is the North Atlantic Treaty Organization, not the
North Pacific”. Such comments indicated a graphic recognition
that American and European interests were distinct and separable,
not identical or even always compatible.

Henry Kissinger, …read more

Source: OP-EDS

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What the Evolution of NATO's Missions Means for the Future

January 27, 2019 in Economics

By Ted Galen Carpenter

Ted Galen Carpenter

Throughout the Cold War, American and European leaders
consistently portrayed NATO as a defensive alliance. They
emphasized the peaceful nature of their cooperation in contrast to
the Kremlin’s record of belligerence and aggression.
Moscow’s brutal suppression of even modest political
deviations within its East European satellite empire helped confirm
the proclaimed difference. Soviet tanks rolled into East Germany in
1953, Hungary in 1956, and Czechoslovakia in 1968 to crush reform
movements. Western insistence that the Soviet Union was a dangerous
aggressor while NATO was a purely defensive association was quite
credible.

Unfortunately, post-Cold War NATO’s image as a collection
of democracies pursuing defensive objectives corresponds less and
less to reality. Robert W. Merry, former editor of
Congressional Quarterly, the National Interest,
and the American Conservative, aptly observes that instead of appreciating
how the end of the Cold War and the demise of the Soviet Union was
a boon to the security of the West, U.S. and NATO leaders
“turned NATO into a territorial aggressor of its own.”
He concludes that NATO today is “a danger, not a guarantor of
peace.”

Washington is pushing the
Alliance to adopt an increasingly offensive focus, and the allies
could be making a major, self-destructive blunder to follow its
lead.

Avoidance of offensive actions and objectives disappeared early
in the post-Cold War era. The interventions in Bosnia and Kosovo
emphatically transformed NATO from a defensive alliance designed to
deter or repel an attack on its members into an organization with
an offensive orientation. In Bosnia, the Alliance used force simply
to prevent a secessionist movement from succeeding; no aggression
against a NATO member had taken place. Four years later, NATO
attacked a sovereign state, Serbia, recognized by the international
community, to detach one of its provinces, Kosovo. Once again, the
target of NATO’s military wrath had not committed the slightest act
of aggression—or even threatened to do so—against any
Alliance member.

The rationale for NATO military action had expanded
dramatically. Citing a security justification for the interventions
in the internecine Balkan conflicts flowing from the breakup of
Yugoslavia required a major stretch of logic. Even most NATO
partisans knew better than to emphasize such a far-fetched
rationale. Instead they focused on the alleged need to prevent a humanitarian tragedy. Even that
justification failed to hold up to any serious scrutiny.

A few NATO traditionalists were decidedly unhappy about the
Alliance’s new missions or expanded geographic focus. Writing
at the time of the Kosovo war, Washington Postcolumnist
Charles Krauthammer was caustic about the increasing focus of the
“new NATO” on out-of-area missions. “What was
wrong with the old NATO?” he asked …read more

Source: OP-EDS

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Time for President Trump to Clean Foreign Policy House

January 27, 2019 in Economics

By Doug Bandow

Doug Bandow

President Donald Trump rediscovered his core foreign policy
beliefs and ordered the withdrawal of U.S. troops from Syria.
Official Washington had a collective mental breakdown.

The president’s decision should have surprised no one. He long
said he wanted U.S. personnel out of Syria. Once the Islamic State
was defeated, he explained, Americans should come home.

However, the “adult” foreign policy advisers the
president surrounded himself with disagreed with him on almost
every issue. Worse, his aides played him at every turn—adding
allies, sending more men and materiel to defend foreign states, and
expanding commitments in the Middle East.

Changing policy in Syria
should merely be the start. He needs to fill his administration
with allies, not adversaries, when it comes to foreign
policy.

Last spring the president talked of leaving Syria “very
soon.” But the American military stayed. Indeed, three months
ago National Security Adviser John Bolton announced an entirely new
mission: “We’re not going to leave as long as Iranian
troops are outside Iranian borders and that includes Iranian
proxies and militias.”

That was chutzpah on a breathtaking scale. The U.S. is entitled
to invade and dismember nations, back aggressive wars begun by
others, and scatter bases and deployments around the world. But
Washington insists on preventing Iran from supporting a long-time
ally under attack by radical Islamists in a multi-sided civil war.
To achieve this objective the U.S. plans to illegally occupy a
third of the war-torn nation indefinitely.

Since Damascus and Tehran have no incentive to cease
cooperating—indeed, America’s presence makes outside
support even more important for the Assad regime—Bolton was
effectively planning a permanent presence. One that could bring
American forces into contact with Russian, Syrian, and Turkish
forces as well as Iranians.

Damacus’ attempt to reclaim territory lost in the civil
war could turn into a major confrontation: Syria is backed by
Russia and might be supported by Ankara, which would prefer to see
the border controlled by Syrian than Kurdish forces. Moreover,
Kurds under threat from Turkey might cut a deal with Assad that
minimizes the Turkish threat.

Apparently his aides’ insubordination came to a head in a
phone call between Trump and Turkish President Recep Tayyip
Erdogan. “Why are you still there?” the latter asked
Trump, who turned to Bolton. The national security adviser could
offer no satisfactory explanation.

Perhaps at that moment the president realized that only a direct
order could enforce his policy. Otherwise his staffers would
continue to pursue their militaristic ends rather than his more
pacific ones.

That determination apparently triggered the long-expected
resignation of Defense Secretary Jim Mattis. Still in place is
Secretary of State Mike Pompeo, who so far has proved to be …read more

Source: OP-EDS