Come home America!

 

I have been sitting down to try to seek, understand, list and express what seem to me to be our core American values. I know I am not alone in feeling real fear and foreboding that our great nation, this great experiment in democracy, liberty and justice is precarious, that it is in danger.

America, we must come home.

We must find common ground. Remember our shared values. Reconnect with some unity of purpose.

Yes, I know. These are cliches. Shibboleths. Everyone says them. “All men are created equal”. “Life, liberty and the pursuit of happiness”. “To form a more perfect Union”. These words once possessed near religious meaning. The were enough to create a nation. But what do they mean now? Too often empty expressions. Catch slogans. Blah blahs.

I have tried to discover, for myself, what do I believe are our common values. What binds us together as a people, a culture, a nation, an idea. If in fact, anything does. If we articulate what are our values, those ideals and principles we all really share, then maybe we can determine if we are being true to them, and if not, how might we be.

I started by listing for myself as many of what I believed were truly core American values as I could. Then I looked through my somewhat chaotic list of values several times, trying to find common threads, to group them, to make coherent what looked almost random.

I found that, in broad strokes, our American values, for me, fall into seven basic categories and principles.

1) We value a general respect for fairness.
Not that everybody’s lot be equal, but that the system is fair for everyone.
That the rules are developed in a manner which we can see and understand.
That the rules are applied evenly.
That everyone has the opportunity to make of themselves as much as their ability and effort can take them.
That we give each other a fair shake.
That each of us is expected to play by the rules.

2) We value a rule of law which is consistent, impartial, evenly distributed and upheld.

That the law for one person is the same as the law for another.
That justice is separate from politics, that leaders don’t use the judicial arm of the state to enforce their political purposes.
That there is a consistent and agreed upon set of constructs, principles and norms which govern every person fairly and impartially.
That every man and woman has “their day in court”.
That the courts are fair and honest.
That justice is, as they call it, “blind”.

3) We value a reliability, trustworthiness, dependability of our respect for tradition, our adherence to precedent, and to principle.

That our word is our bond, and that we are as ‘good as our word’, both at home and abroad.
That when we give our word, that when we make an agreement we can be expected to keep it.
We respect that value in individuals, calling it by names like integrity, and we value it as a nation.
We expect that our allies can count on us.
We expect that we will keep up our end of a bargain, that we will hold fast, not blindly, but whenever we can, to our end of the bargain to our word, to our principles, to our ideals, our norms and traditions.

4) We value truth, and honesty.
And also intellectual honesty. We don’t like it when politicians, scientists, public servants, the press, or anyone bends, slants or compromises facts, and the truth to fit their own private opinions and agendas.
We may not all agree on what is true, but we value the honest pursuit of truth.
We value a free exchange of ideas in a fair, open and available intellectual public square.

5) We value respect for the dignity and the rights of individuals.
Ideally of all individuals. Of all races, colors, genders, creeds, nationalities, it is in our DNA to do so.
We believe that individuals have intrinsic worth as human beings. Well meaning Americans may differ on whether that dignity and intrinsic worth of an individual automatically guarantees them, say, entrance to the country, for example, or government assistance – and those are fair policy disagreements to have, but as Americans we value individual rights and dignity. That includes those rights enshrined in our Constitution and Bill of Rights, of course, such as the right to peaceable assembly and a free press, but it also means a respect for certain traditional norms and standards. Although some may tolerate it to achieve other goals, I can’t really believe that taunts, slurs, insults, and ridicule are not what Americans wish to emulate in leaders.

6) We value in general a certain decency, a certain dignity, a decorum, standards, civility.
A certain willingness to respectfully listen to one another.
We may for a time decry “political correctness”, but we don’t really value in the long run public servants or leaders who speak like street toughs and ‘hooligans’, who are ill mannered, ill tempered, crude.

7) We value the ideal of progress, opportunity, a chance to succeed.
We cherish that each individual have a chance to have that mythical American Dream.
We value the ideal that each generation leaves the nation better than they found it.
We value the belief that we continue to improve and that the lives our our children will be filled with more opportunities and a better world than we had.
We value the notion that humanity can get better. We may not believe it, but we value it.

Of course there are so more things we value, our lives and our families and our safety, security, shelter, and the like, but those are common to all mankind. And I am sure there are values which I have either left out or expressed differently than others would have them, but the categories of values expressed above capture, I hope, a good deal of what it means to be an American.

And, America, we have to come home. Come home to American values. Come home to ourselves. To who we really are.

Now, I don’t wish to be too coy, or devious, or to make out as if this is part of mystery novel with an unexpected ending. This is at heart the beginning of a political statement, a series of political statements. The thesis of these statements will be that in the coming election the only way to come home and to honor our values as Americans is to vote democratic.

Note please, note well that I am not claiming that this will always be the case. There could well arise in future elections candidates who are conservatives, republicans for whom one could vote and still be upholding in every respect those values we cherish as Americans.

But not this time.

In future writings, and very soon I hope, I intend to show specifically why, based on these above stated values and on the actions of the current president and administration, to come home, to be America again, means to reject Donald Trump.

For the moment, and this is The Moment, I would respectfully beg the reader to consider these values, to ask if these are really fairly called American values, and if so, to ask how well they are being represented in the current administration and the environment they have created.

Then we well talk again soon.

Dear Bernie, Don’t 2016 -ize 2020. Please.

Dear Bernie,

I am asking you as a democrat and someone who wants both a chance to regain the decency of winning the election, and having a chance of accomplishing our shared goals.

Not to drop out. Your ideas are worth hearing. No question.

But to stop running your campaign against other democrats in such a way as to try to make them out to be the enemy.

That’s what you did when you undermined the trustworthiness of Hillary Clinton in 2016. You succeeded in creating questions about her honesty. Congratulations. She didn’t win.

Let me be clear. If you win the nomination, I will vote for you, and actively support you. But I don’t think you will win. Because, as honest, and caring as you are, as much as your heart is in the right place, the Republicans will not run against you.

They will run against Socialism. And they will win. They will not even mention Bernie Sanders. They will run against Nicolas Maduro. They will run against Fidel Castro, Joseph Stalin, and Mao Tse Tung. They will run against Kim Jung Un. And they will win.

Please look at my “Why I am not feeling the Bern” from 2016. I think the arguments are just as good today.

None of this is to say you shouldn’t run. You feel you have something to say. The things you say are important. If your arguments prevail, and you win the nomination, I will support you.

But please, for the present, please stop trying to attack other democrats who are at least just as likely to be the nominee. It undermines them. Makes it much less likely they can beat a sitting president in a time of relative prosperity.

I heard your speech.

It might have been gracious to have congratulated Joe Biden on some remarkable victories. But okay, let that go.

It’s one thing to race against the Greed of Wall street, drug companies, and the fossil fuel industry.

It is, perhaps not as helpful, at least to the chances for a Democratic victory, to attack someone who has statistically at least a fifty percent chance of being the nominee as having “voted for the war in Iraq”, imply he voted for cuts in Social security and Medicare, voted for ‘disastrous trade bills’, representing the credit card companies, and implying he is in the pocket of all those demonic Billionaires.

Just as a fact check, he didn’t vote “for the war in Iraq”, he voted to authorize the President to use the threat of force to compel compliance with UN mandates. He was wrong, and has admitted it. Bush had another agenda. History has shown that, and several of us, yes, myself included, thought it at the time. But let’s be honest, the measure passed overwhelming, it was supported by a large majority of democrats, including some well respected and prominent, such as two of our last three nominees, both of Obama’s secretaries of state, and our current senate minority leader. It was not the vote of a war profiteering war monger, and you should stop pretending it was a decision out of keeping with the majority of the members of our party. It wasn’t.

This attempt to cast your “establishment” opponent in morally questionable light is exactly what you did in 2016, when you joined with the Republican talking points to cast doubts on Clinton’s honesty, it is partially what kept her vulnerable to aspersions on her sincerity and trustworthiness, which reinforced Trumps ability to take advantage of the perceived weakness, and it is one good reason why President Trump won then. And, face it, he probably why he will win again. Even with a fully united front it is difficult to defeat an incumbent president in a time of relative peace and unquestioned prosperity.

A united, progressive, but still inclusive and consensus building party of decency, competency, rule of law and respect for national and international norms can win. But not if you continue to undercut the basis of trust. Hillary didn’t release transcripts of her talks to private banks. You hounded her on that until you succeeded in undermining trust for her. Congratulations, Bernie, Hillary didn’t win.

So if you go ahead and undermine Joe Biden, Trump can win re-election.

And, you know something. A re-elected, emboldened and legitimated Donald Trump might not be as kind, decent, truthful, law abiding and compassionate as he has been these four years. His phone calls, as “perfect” as they were already, might get even more “perfect”.

Perhaps you are playing the “long game”. Perhaps you think that if a moderate democrat gets trounced, democrats will wise up and turn to socialism.

I don’t think that is true.

What is more likely is that if socialists make it impossible for democrats to win, then centrist democrats will have to seriously consider becoming moderate republicans.

Not asking you to stand down. That would not be right.

Perhaps though if you could “tone it down”, and look for some mutual respect and consensus, we could run a democratic ticket with some chance in hell of winning.

Let us have (another) real discussion about Health Care. Finding common questions if not always common answers.

Bernie Sanders has called for “Medicare for All”. Joe Biden rolled out this week a plan, and argued that “Medicare for All” would end Obamacare – which is what Donald Trump wants. Pete Buttigieg suggests “Medicare for all – who want it”. Kamala Harris wants a single payer system. Kirsten Gillebrand wants a transition period. And, in the first Democratic presidential debate, there was a clear divide between who would raise their hands to eliminate private insurance.

How to provide and pay for health care is one of the most central points of contention, debate and difference between the Democratic candidates for president. It is one of the most salient points of difference and contention between the Democratic and Republican parties as a whole. And it is one of the major issues of genuine and shared interests to all who live in our country. And has been so for at least half a century.

Just about anything that can be said about health care has been said, however everything said has been said in fragmented, multiple, diverse, and separate ways. This issue continues as perhaps the greatest key flash point in our national dialogue and division. The arguments remain every bit as heated as they were in 2010 when the ACA was being debated, as they were in 2001 when Hillary embarked on her famously ill fated attempt to reconsider our health care delivery system, and, truth be known, as they were 60 years ago when Medicare was first being proposed and derided. But with all the heat, I am not sure we have one candle power more light.

I am a physician who has provided front line care to patients for forty years, four decades when concern over health care costs and delivery have done nothing but soar. I have also been an interested witness of the system. From time to time I have tried to comment, albeit with little success. My first attempt at a cost containment article, (unpublished, not for lack of trying) was written in the early 1980s. My first play featured, perhaps of minimal interest to the audience, admittedly too much talk on the subject. (One LA Times reviewer called it ‘more like a surprisingly candid panel discussion than a play’) At the time I first tried to comment it was feared that costs could reach 100 billion a year. Now over two trillion and climbing.

With now half a century of arguement, it is not clear to me that the issue has been presented broadly enough, or comprehensively enough, for the majority of our citizenry to really come together and find common ground. We still lack the common language necessary to weigh and assess the issues and arguments. We still do not articulate what really separates either the voices in the democratic debates, or the difference between the general left and right about the issue. Shibboleths like “socialized medicine”, and “health care for all” get thrown around at each other, continuing to generate anger and resentment, but not enough understanding. The heat, again, generates little light.

We still have left well over a year before the 2020 elections. It is my hope that in that time, through the multiple debates, discussions and diatribes which will ensue, we can find a way to understand together enough of the basic issues to make some reasonable and common analysis of why we are were we are and what are some options going forward.

I hope to reframe a view of the basic issues behind the unsustainable growth of health care costs. I also hope to make the point that the calls to allow so called “market forces” to regulate health care costs as based on a false assumption, and that health costs can never be subject to market forces. I hope to show how any large restructuring process, such as the ACA was, and such as are being proposed now, while not perfect, have roots in the purpose of addressing those issues. I hope to show where other efforts will continue to be needed if we are to succeed in bringing both costs, service and their balance into line.

    Let me propose that for the moment we entertain the following premises:

1. There is more than enough blame, lack of communication, partisan bickering, special interest, and lack of understanding to go around in the health care debate. It is almost impossible to find a single clear comprehensive statement about the nature of the problem. The sound byte culture has not allowed anyone to offer a vision or conceptualization clear enough or accessible enough for the expert to find it valid, for all stakeholders to find it fair, and for the average citizen to claim to understand it.

2. The costs of the system are the key to defying a ready solution. Although most of us wish there were no one without health care, the moral issues regarding the uninsured are not the only concern for the majority of the American public. The need for reform has to be framed both in terms of fairness, but also in terms of the unsustainable costs to our society and our future. The system which President Obama sought to fix was not out of control just because insurance companies denied people for pre-existing conditions. Insurance companies denied people for pre-existing conditions partially because the costs of the system were out of control. We don’t spend a fortune on health care because we have millions without coverage, we have millions without coverage because we have to spend a fortune on health care.

3. Our nation includes those who hold widely divergent philosophies about the role of government in the common welfare of its citizens. We encompass very different views of the nature of health care, whether it is a ‘right or a privilege’, a market service or a commodity. There is a vast difference in the personal financial impact both for those working in the healthcare ‘industry’, and all other participants in the economy as a whole. There are vast differences to all citizens, and residents, of this nation depending on how we approach health care reform. There will be widely differing political consequences for the two parties depending on whether and how the health care conundrum is solved. These wide divergences of view, philosophy, financial impact and political consequences would make it extraordinarily challenging to ‘fix health care’, even if we all agrees that it has to be fixed.

4. Finally, even if we were to compact together to try to overcome the blame, lack of communication, bickering; even if we were all incredibly motivated to save the money we waste, even if we were willing to try to bridge the gaps in our philosophies, views, financial impacts and political consequences, still we would have a difficult time reeling in such a massive, complex, multiple player, multi-layer, multi-trillion dollar system which effects everyone at the most vulnerable moments of their lives. Given the very best of intentions, even if there were the commonality which we lack of vision and purpose, still the very complexity of the issues involved would make solution near impossibly difficult.

Let us then, for the moment, accept these premises and still try to move forward in framing the issues and difficulties.

What are the real costs of health care?

The figure is often quoted that we spend a much larger percentage of our dollars on health care than do other industrialized nations. Specifically, we spend almost 18% of GDP on health care, versus the average of 9% in the OECD (Organization of Economic Cooperation and Development) states, which is comprised of 30 democratic market economy countries, all first world, including such countries as the major European democracies, Canada, the USA, Japan, Australia and New Zealand. We hear the percentages, but rarely has it been articulated what this really means. Let’s “do the numbers”.

In 2009 the US GDP was 14.2 trillion dollars. The percentage of that GDP which was spent on health care is 2.34 trillion dollars. If we spent on health care what the average OECD country spends (8.9%), we would be spending 8.9% of 14.2 trillion, or 1.26 trillion. That is 1.08 trillion dollars less per year than what we now spend.

In other words, as a nation, we are spending one trillion dollars more a year on health care than we would be spending if we spent at the same rate as the average OECD country.

For perhaps a specific example. There is wide variation among OECD states and perhaps we don’t want to compare ourselves to Turkey or Slovakia., Let’s take Germany as more comparable. Germany spends 10.9 percent of its GDP on health care. If the USA spent the same percentage of its GDP on health care as does Germany, we would spend 10.9% of 14.2 trillion dollars, or 1.54 trillion dollars. That would still be 800 billion dollars a year less than we spend now.

(This figure, derived here from primary data, is the same figure I heard President Clinton cite in the only discussion of the concept I have ever heard publicly expressed, so I think we can take the 800 billion or so as reasonably accurate.)

So let’s examine what we could get for that 800 billion dollars every year. The size of the US National Debt is currently about 22 trillion dollars. (It was 11 trillion at the beginning of the Obama presidency, it was 19 trillion at the beginning of the current administration, so rising by about a trillion a year in both administrations, perhaps a shade faster now.) If the amount saved in health care each year by spending the same percentage of our GDP as does Germany were applied directly to the principal of the debt, the debt would change as shown in the attached graph, and we as a nation would be debt free for the next generation. (This graph was constructed in 2012 when debt was smaller and growth of debt per year smaller, so it would now be somewhat later, since since this calculation doesn’t account for the interest).

Fig 1.

This would be a very valuable use, I think most would agree, for any savings which could be realized if we could somehow bring our spending on health care to the level of a comparable country like Germany,

How about if we didn’t use the savings to pay down the national debt? How about if we used it to build things? Well, at about 25 million dollars for a hospital, that would be 32,000 new hospitals a year. Schools? About 53,000 new schools a year.

Let’s say we are military minded? Many of the detractors of Obama care and any current proposal have a strong belief in the importance of national security, as do we all. If we spent the same percentage of our GDP on health care that Germany does and devoted the rest to our military, it would easily more than double our defense budget. For the extra money spent on health care we could buy about 178 new Nimitz class aircraft carriers a year! We could put about 5031 new F-22 raptor fighters on them a year! We could pay for another two wars like Iraq and Afghanistan each 18 months -we could, well, you get the picture. (I am NOT advocating that as the best use of the money! But some might. At least we’d then have the money to argue about!)

To consider how we could save the money difference between what we spend and other industrial nations spend, we need to ask why is our care so expensive. In other words, what ‘drives’ our health care costs so much?

What are the Real ‘Drivers’, or ‘Driving Principles’ of Health Care Costs?

One reason that it is difficult, even without the dramatics, just to intellectually discern a way forward is that it is difficult to dissect the drivers of health care costs.

Table I lists a comprehensive, but by no means exhaustive list of those factors which have been cited as ‘drivers’ by various commentators on the health care crisis.

Table 1
List of Drivers….

The sources I used to compile this list of drivers ranged from university based, presumably objective scholarly treatises to short admittedly and obviously biased blogs, and they range from progressive to conservative commentators, but even a quick glance can show that dozens of factors can be implicated as causal in the nation’s “out of control” health spending. Those factors which any one analyst indicates as a driver of health care costs often depends on which side of the issue one stands on.

Providers may target administrative and legislative costs. Insurance executives complain of the rising prices of care given. Payors focus attention cite demographics, the aging population, obesity and point out the high costs incurred in the care of ‘outliers’, i.e., that relative small proportion of very ill and complicated patients who use the bulk of health care costs.

More liberal analysts will indict the lack of a comprehensive national system while those on the right more blame restraint and regulation of competition.

And everyone implicates increasing technology, except that new technology has the benefit often of years of useful life associated with it, and improvements in technology allow shorter more focused stays in hospitals.

I would propose we step back from the ‘trees’, and try to look at the ‘forest’ from a more comprehensive perspective.

I propose that we can frame the real “drivers” of health care costs as being subsumed into the following four (what I will call) Overriding Driving Principles of health care costs. We may not be able to alter these drivers, and some might argue we should not, but, in my opinion, until we address them explicitly all attempts to move forward will be filled with the kind of anger, frustration, misunderstanding and bickering that have characterized the debate so far.

The “OVERRIDING DRIVING PRINCIPLES” of health care costs

1. The Multiple Layers of Profit Motive.
2. The Incentive Structure of Health Care Reimbursement.
3. The Expectations of the American Patient.
4. The difficulty for patients of maintain our own health, alcohol, tobacco, weight, drugs, firearms, chronic disease.
5. The Concurrence of Fear of Litigation with Fear of Patient Dissatisfaction and profit motive ALL compel practitioners to do more.

And it must be recognized that each of these ‘Overriding driving principles’ move the cost of health care in the same direction – towards more expensive care, not less.

DRIVER # 1: Multiple Layers of Profit Motive

One the one hand, the right to fair compensation, commensurate with an individual’s abilities and efforts, for work performed, risks taken and value discovered and added is an essential feature in our capitalist system. It is a central tenet which has contributed to the development in our society of a growing, inventive and effective economy, and one which has provided a high standard of living for the majority of its citizens. The capitalist incentive has also given rise to technological progress and advancement in almost every area.

It is also true that there are areas within our society where the motive and ability to make a profit are simply not part of the service rendered. There are services which the society simply requires so reliably that the ability to generate profit and gain compensation are subjected, in the notion of a greater good, to other considerations, and the profit motive is controlled and regulated.

In plainer terms, the society offers some essential services to its citizens at a nominal fee, and some public servants are not expected or even permitted to use their role in rendering service to maximize their own individual financial well being. Clear examples abound. Our fire departments, police departments, postal services, public education, public utilities, parks and recreation services, for example, are all provided almost free of charge to all citizens as a right of citizenship, or even of residency. The same is partially true of the military, which, while it has several arms manufacturers which may make exorbitant profits, is as an overall societal effort meant to be paid for essentially by taxes. Individual citizens are not expected to pay private insurance to make certain their personal homes are not invaded by enemies. We don’t pay separately for “missile strike insurance.” Protection from foreign enemies is a service provided to all who live within our borders by the government as part of its responsibility to maintain the state.

I am not suggesting here that the medical system should copy law enforcement, the postal services or the military as a model. Nor am I attempting to demonize those who profit from the provision of health care. I am simply pointing out that while the profit motive is a key part of our society; it is not the only model by which essential services are provided in our country.

We may realize that there are broad philosophical differences between our views of the role of private enterprise in the provision of medical services to our populace. However, broader philosophical issues aside, what is practical and necessary to notice in the instance of health care is that profit motive exists separately at every layer and level in the healthcare industry.

That means profit, on top of profit, on top of profit, on top of profit. Follow the chain. The physician wants and deserves a decent living. So do the nurse, technician and aide. Fair enough. The hospital where they practice wants to make a profit. Or at least make enough to support its administrative expenses and capital expenditures. Many hospitals are designed and run specifically to make a profit, and those publicly owned for profit chains have a legal duty to maximize their profits to their shareholders. Fair enough. The pharmaceutical and medical device industry needs to make profit, enough to justify its continued expenditure and risk, so it says, but also, as many if not most drug companies are publicly traded, have a first duty to maximize profits to their shareholders. Fair enough. (?) The whole system of care delivery is generally paid for with insurance dollars. Insurance companies need to make enough above their expenditures for care to support their administrative structures. And, as many or most are publicly traded, have a primary duty to their shareholders to make a profit. Fair enough?

These multiple levels and layers of profit making thus insures that the providing of profit for each of the various players becomes in itself one major, perhaps the primary cause of expenditure. When I buy insurance for example, the premiums I have to pay are high, in part, yes, because if I get sick I will need expensive services. They are high also because my premium has to be called upon to supply a profit to the insurance company, the drug company, the hospital company, the hospital, and the professional actually providing my care. And many of the players in that long chain, as corporations, have a legal primary duty to their shareholders to maximize that profit.

One’s view of the ultimate moral place of profit making aside, one cannot deny that profit making at every level is at least one major class of drivers for our health costs, costs which, again, which run about $800 billion (170 Nimitz air craft carriers a year) more than other industrialized nations.

One essential plank of any serious attempt to reign in costs would have to be directed to mitigating this particular “driver/driving principle”, that of the multiple layers of profit. The ACA, “Obama care”, through its exchange mechanism tried to enhance competitive pressures on the insurance industry by forcing insurance companies to be more transparent and more competitive. The plan sought in that way to cause insurance companies to lower their prices. That was meant to moderate profits. Not eliminate them. But lower them. By forcing insurance companies to cover the sick, not just the profitable, that would take some of the profit out. Not all, but some. In turn, insurance companies would have (in order to maintain any profit) to lower what they will pay hospitals and doctors. Hospitals will then have (to maintain any profit) to lower what they will pay for drugs and devices, and this will lower some of the profit to those entities.

In essence, through the device of forcing the payer furthest upstream, the insurance company, to become more competitive and less selective in picking out the healthy patients and denying the sick, the Obamacare idea was designed to have the effect of gradually moderating some (but not all) of the profits out of the system all the way down the line. It is a very slow and gentle way of doing it.

The present administration encouraged tremendous antipathy and has sought first to eliminate then to provide obstacles to Obama’s plan. Remember this was, essentially a plan in which private insurance remained the primary payor but with enhanced regulation and facilitated competition, transparency and more universal delivery. Now, Obamacare, the “affordable care act” with its emphasis on mitigating the profits of private insurance, weakened, threatened and compromised, there is arising among the more progressive democratic wing an increasingly insistent demand for either a single payer, or a public option added to the existence of private insurance.

Those on the further progressive wing insist that the single player plan, so called “medicare for all”, would be much more effective, in providing care and controlling costs. Others, more centrist argue both that such a change it is not in keeping with the capitalist approach of the rest of our society, and that any sudden attempt to effect such a change would be much more disruptive. They have argued for either adding a public option to the already existing ACA (Medicare for all who want it), taking a gradual path in transitioning toward a single payer, or just improving the current ACA, making more effective its reliance on improved regulation and competition among private insurance carriers. Each of these seeks to make the Payor (government or regulated insurance” pay less, and thus control costs by slowing payment.

I believe that the difference among these positions can not be effectively resolved without making more explicit the goal that either, or any, of these approaches is seeking to achieve. I believe all candidates need to explicitly state that:

“To lower the costs of healthcare, we must modify some portion (perhaps not all, but some) of the multiple layers of profit existing within the current system, and to start off by putting some downward pressure on the insurance companies is one effective but gentle way to do it”. To eliminate insurance companies altogether would be a much more drastic attempt to achieve the same global goal”.

Once the goal has been stated explicitly, and the reason for this goal made explicit, reasonable thinkers could then weigh and balance the risks and benefits of various methods to achieve that goal.

DRIVER # 2: The Incentive Structure of Health Care Payment

This issue has been mentioned every time health care economists say that they want a system to pay doctors for better outcomes and not for each procedure they do. The most common method of reimbursement in the current payment for health care is called “fee for service”. The doctor, or hospital, are paid separately for each service they perform.

The drawback is well known, namely that “fee for service” may have the incentive and result that more reimbursed services will be performed and then billed for. Of course no one expects physicians to do unnecessary procedures just for the billing. But it is considered to be possible that when there is no great scientific evidence for one course of action over the other, there may be an incentivized proclivity in a fee for service system to opt for the more billable course of action. Not saying it happens – just saying it is possible.

Far more cost effective ways of reimbursing providers are known. These more cost effective ways served as the essence of the Managed Care companies who became the villains of the nineties. These are the companies, which, by the way, squeezed so much from the cost of health care that their profits from the savings became legendary. If those profits had been uniformly returned to the society and not given to CEO bonuses, we might have remembered with a far more generous attitude these organizations, intended to lower costs, than we have done.

It is not my intention to review all the devices of managing care, but it is worth using one example to make the point, and I’d like to contrast ‘fee for service’ reimbursement with what was called ‘capitation’ – not to further exhaust a subject which is well known within the industry but to illustrate for the general reader the essence of some ideas which underpin some of the current dialogue.

In the “fee for service” model, as we have said, the provider and hospital are paid for every service they provide. Let’s provide an example. Let’s say a patient comes to the emergency department. They get a fee for using the hospital (a ‘facility fee’) as well as a fee for the physician’s services (the ‘professional fee’) From the hospital, they get billed for every lab test ordered, every intravenous line started, every medication given, every x-ray taken. Again, for the x-ray, they get a bill for the x-ray itself, and a separate fee for the professional radiologist reading the x-ray. Now, again, to be clear, I am not suggesting that the hospital or the doctors do more tests because they have a financial incentive to do so. However they have no financial incentive to refrain from doing so.

If pure “fee for service” gives the most incentives to spend more, then pure “capitation” was perhaps the most effective cost containment tool in the armamentarium of the managed care companies because it provided the strictest incentives to limit expenditure. Capitation, in essence, provides a total lump sum for the care of a specific number of persons, and leaves it up to the health care providing system how they chose to spend that money. That system was designed so that it was now in the provider’s financial interests to spend as little as they need to. If, say, a million dollars is to be divided between a thousand persons, then spending the whole million on two patients would leave nothing more for the rest. The company would have to pay for that extra care from its savings, or profits. It therefore gave the incentive to restrict care to that which is really necessary. That would, hopefully lead providers to spend fewer dollars over the year for their thousand patients than they were allotted, and then save or distribute the rest. Using capitation, however companies drove costs way down, and, sometimes by denying what many thought was necessary care. Some, as we all know, pocketed the huge profits made…or saved, depending on how you look at it.

Since the insurance companies already know from observing their managed care competitors over decades that the best ways to lower the cost of care involve managing care (with incentive structures akin to capitation), it is expected that when forced to cut medical outlays to maintain some profit, the insurers will have to reintroduce, perhaps gradually at first, the principles of managed care of provider incentives, because they know the principle:

To lower costs, we need to change the incentive structure by which costs are paid.

Now, why didn’t managed care, with its very effective, scientifically designed and empirically demonstrated ability to cut costs continue? Because in its own desire to maximize profits, since companies were not being rewarded but rather financially penalized for spending resources on tests and procedures, they limited and restricted the tests and procedures in such a way that the patients covered began to feel, sense and realize the the managed care system was limiting their care – and often in such a way that it seemed not in the patient’s best interests. It felt like the managed care industry was putting profits in front of patients, and, thus it ran smack into the third driver/driving principle of health care cost increases – the strongest and most intransigent driver of them all.

DRIVER # 3 – Patient Expectations

I saved this area for later in the discussion for two reasons. First is for lasting emphasis. The question underlies every discussion, yet is never explicitly isolated as a cost driver. We are constantly reminded that the kind of care which is found in Canada, the United Kingdom, France, Germany, and most of the industrialized first world would not be acceptable here – that the level of care provided to virtually every other modern state would not satisfy the expectations of the American patient. We never ask, however whether perhaps those expectations may be realistic or sustainable. Or, perhaps to frame the question more palatably, we don’t ask whether it is worth it, to satisfy those expectations, to forego the $800,000,000,000 every year we spend to try to meet them.

I finish with the question also for a second reason. It is unpopular, perhaps politically impossible, and for some offensive to discuss anything that has the faintest whiff of “rationing” care. I don’t think we should ration care – but why can’t we rational-ize it?

It is pointless to put that question first, because we would run into such resistance. But perhaps after viewing the vast difference in our nation’s expenditure on health care, examining the role of layer upon layer of profit motive, and examining the inherently cost increasing effect of the most common current incentive structure, and suggesting how these can be changed, we can now dare point out there are efforts individuals might make in examining their own expectations which could have some effect on viewing how we delivery health care.

As an emergency physician with board certification and experience in internal medicine and critical care as well, with former teaching posts at both Harvard and Yale, and also decades of experience in urban and suburban emergency departments, I have seen first hand for thirty years that many American patients expect to be able to come to the emergency department for events which are, perhaps, not really emegencies – colds, bumps and bruises. It is also true that many American patients expect that every sniffle needs a chest x-ray, every bump on the noggin a CT scan.

More costly, but also more morally challenging are the issues on the other end. I have seen many times situations where, no matter how hopeless the prognosis nor how (apparently) limited the quality of life, any family can demand a virtually unlimited amount of resources enormously costly and often futile intensive care in the last few weeks and months of life.

And it is not always clear to the patient or even the physician which bump on the noggin needs a CT scan, or which apparently hopeless person may, in fact, get out of the ICU for another few months, so we are, as physicians inclined, by our nature, culture and training to support expectations of patients no matter how superficially unrealistic, with the traditional “full court press”.

It was precisely this wall which managed care ran into. There does exist, albeit in development, ways to minimize expenditure on both unnecessary and futile care. The managed care industry had developed effective (and truth be told, not so dangerous) ways to limit expenditures. But many of them limited access beyond what Americans expected and believe they deserve. Patients who want to be able to just go straight to the Emergency Department were told, instead, that they had to access 24 hour demand management telephone triage systems, whereby a specially trained nurse or other health care provider, using computerized decision support systems would tell the patient whether they could go to the ED or not. Primary care physicians, “gatekeepers” told patients when they could and could not go to specialists. Managed care companies, employing physicians (whose primary duty was to contain costs) decided who needed procedures like hip replacements, and when. And no one wants to be told, when they believe they have a health urgency, emergency or necessity, that it is not to be had.

This is precisely the limitation that Americans seem to find so odious about the more public care systems of other advanced nations. We have not been accustomed to delay or limit our expectations for the most advanced and immediate technology. And no one has really articulated the case why we should not have it.

The massive expenditures mentioned above, those on the other end of life are a related issue, and emotionally charged issue. Care at end of life is a deeply emotional issue, but one which needs to be discussed carefully both on an individual and societal level. Opponents, when the very notion was originally broached, called such discussions “death-panels”, perhaps in the effort to further make insoluble already difficult questions. However, in the long run, the difficulties in dealing with end of life care, and related questions such as whether nonagenarians should receive dialysis, fall within the rubric of patient expectations. There is no question that with increasing technology, we can offer patients who would otherwise die extra weeks, often months of life, spending the time, technology and money necessary to do so. Whether it is morally appropriate in all cases to do so is a worthwhile discussion. And one which we should have. Is there a balance between one the one hand, an individual’s perceived right to have if they wish access to a veritably unlimited expenditure on sometimes futile intensive care, and on the other hand the need for a society to use its resources in an effective and efficient manner?

This driver, the driving principle of the need to meet our American public’s patient expectations will be the most intransigent, and will not yield easily. It didn’t fade before the clearly demonstrated effectiveness and efficiency of managed care. But with work, time and education, it could be tempered. However, it first has to be explicitly and honestly identified as a driver! To make any change in health care lasting and satisfactory will require a long, careful and systematic process of national reflection about our demands and expectations, so that we can look specifically at what our expectations are, and weigh whether those are supportable or not.

Perhaps I have not listened enough, but to my knowledge no one has expressly addressed the role of overly unrealistic expectations about care. Perhaps no one else believes they exist. Perhaps eveyone knows that it is a politically impossibly tough sell. In either case, I think the American people know, instinctively, that you can’t lower what we spend on health care without lowering a little what we expect and demand, and to address this conundrum more explicitly and more honestly would, I believe, be helpful.

DRIVER #4 – The difficulty we have as patients maintaining our own health.

Addiction, whether it be to food, alcohol, tobacco, drugs, violence, and difficulty in doing the hard work of monitoring and maintaining our own health in chronic diseases such as COPD, heart failure, diabetes, asthma are neither simple, straightforward nor unique to our society. And it is by no means clear that any change in health care financing will have an effect on any of those issues, at least over the short run. At present, doctors struggle on an individual basis to counsel their own patients, often to little or no avail.

It is also true that with our present form of health care delivery, the is little or no national level stake in the population’s overall maintenance of its health. No single accountable, overriding agency stands to lose when too many people smoke, drink, overeat, take drugs or fail to take their heart failure medication. True, as part of the ACA, Medicare placed some incentives, there are becoming more demands, for instance, to have patients with chronic heart failure better manage themselves at home. In many cases, now, repeat hospital admissions within a short period of time are not compensated or penalized. We can ask though what overall entity is at risk, though, when too many people engage in non-health protective efforts.

In the days of the 1990s when HMOs were in ascendency, some made increased and active efforts to develop preventative health programs. To do so on a nationwide and effective scale would probably take a very long and concerted effort. Look at how many decades it has taken, more than half a century, to bring down the rates of smoking. Still, if we treated alcohol, obesity, smoking, drugs, and firearm violence as health emergencies causing damage to the whole economy, we might find ways to begin to address them.

This argument does not mandate any particular solution, but I propose that when we recognize self destructive behavior as well as the inability to maintain good health maintenance preventative care as a primary DRIVER of health care expenditure, we will perhaps be in a better position to start to manage it.

DRIVER #5 – The Concurrence of Fear of Litigation with other drivers

Both physicians, and opponents of health care reform in general have both emphasized the role of so called defensive medicine. Proponents of tort reform identify it as the primary and preferred method of cost control, while those who have studied its effects say the defensive medicine adds a very small fraction of the costs of healthcare. What can be said, I believe, as a practitioner is that fear of litigation is in itself a minor factor but one which combines with all the other drivers to move in the same direction.

Let us say that I were a physician practicing in a hospital which, using fee for service, makes a profit on CT scans, and also say that my community’s patients expect that they will get one when the hit their head. Let us further guess that my patients might write to my chairman if they are dissatisfied, or at least give me a bad score on a patient satisfaction survey. And let us further notice that my department takes patient satisfaction, that is, specifically, the satisfaction of patient expectations, seriously. And now add to that my awareness that in the hopefully very unlikely chance that I send home a patient with a normal neurologic exam after not doing the CT and they end up with the very rare occurrence of having something bad happen, I may get sued.

The fact is, if I’ve documented well, and avoided a really egregious error in judgment, I will probably win the suit. I don’t do the CT specifically to avoid litigation, but, and this is the key point, since I am paid by a hospital which profits from the CT, and my patients expect the CT, and they will make my life less pleasant if I disappoint them, and they might sue me if I don’t and miss something – I DO THE CT.

And that’s the point. Every single driver in our multilayer, multiplayer, multi-trillion dollar juggernaut of a health care system works together to drive us to spend more.

Having looked, I hope, explicitly at the Overriding Drivers, let us look at one oft touted but I believe unreliable solution.

The ‘Myth’ of the Role of Market Forces on Health Care Costs.

Those who generally oppose any central government role in the regulation of health care point to the market, to ‘market forces’ as a solution to the issue. The notion of “consumer driven health care” has received considerable attention especially in conservative leaning publications. It is suggested that when consumers (patients) are spending their own money, which they have been encouraged to save through tax advantaged specific health savings accounts, they will be more frugal than they are when third parties, i.e., insurance companies pay. Fewer unnecessary tests will be done, lower cost providers will be sought out, and the market will act as it is supposed to do to lower costs. Examples in which this has occurred, such as in plastic surgery, are cited. It is held that insurance should not be used for routine visits, but only for true catastrophes.

There is one major fallacy in the market theory of health control. With other goods or services the consumer’s informed choices determine the price of the goods or service both by putting suppliers into competition with each other, and by buying only when the value of the good or service purchased seems worthwhile for the price demanded. With the case of health care, much of the time, no real option exists to decline to use the service. Oh, yes, of course, you can put off elective preventative care for years (how many of us put our colonoscopies off as long as possible!?) However, in the face of severe pain or loss of function, especially to a child or loved one, there is simply no option other than to go to the doctor, and do what one is told. Shopping around for the lowest cost provider when you or your child is writhing in pain, or afraid for your life, is a non-option.

Furthermore, current internet empowerment notwithstanding, the patient is simply in no position to say what is appropriate to do. Physicians don’t always agree. The patient simply does not fulfill those criteria of ability to make an informed choice to choose or decline an expensive service, especially in a moment of extreme pain, fear or disability. The criteria which are necessary to make market forces a real controller of a market simply do not exist. Healthcare costs can not be controlled by “market forces”. It is an illusion.

Suggested Principles which might inform a comprehensive health care debate.

Now, I have reviewed and detailed what I believe are the real Overriding Drivers of HealthCare Costs. How can we begin to address them? I can’t claim to have the definitive answers, and I am not going to take specific sides at this juncture between Bernie, Joe, Kamala, Pete and Kirsten! I am going to seriously hope that they will find a way to elevated this discussion from a sound byte contest to a serious a joint and mutual consideration of these important aspects.

It is my wish that those candidates running for office would make the effort to articulate then discuss from the point of a common understanding of some of the issues what might be able to be done. I believe that would lead to a more fruitful evolution of thought, and ability to choose our candidates, then the current hand raising to single dimension questions.

Here are some suggestions of ( what I might call ) ‘Guidepoint Concepts’ which might help focus such a discussion.

1) Some efforts are large enough, complex enough, and demanding enough to require that the primary controller be governmental. That was true of the second world war, the development of the atomic bomb and the trip to the moon. The needed role of government as a provider of health care was clearly and explicitly acknowledged in the creation of Medicare. Those who think that if we just step back and let “the market” work are at least 60 years behind the times. The government is already ‘up to its ass in alligators’ in health care. Let’s discuss how best to make it work.

2) Personal resources and savings cannot be relied upon to pay for health care. Some form of insurance is needed. It is a pipe dream to believe that personal resources or “health savings accounts” can pay for health care. Perhaps most upper middle class people can afford the occasional few thousand for an ER visit, or maybe even to have your gallbladder out. But very few could come up with a few hundred thousand for a coronary bypass, and almost no one for the potential millions of dollars plus of a truly catastrophic illness or injury, stroke, paralysis, birth injury which happen every minute to someone across the country. Just can’t be done.

3) The larger the risk pool, the greater the number of covered persons, the safer, more stable and more resilient the insurer is. If three of us in a room decide to pitch in, say, five thousand dollars a year to cover each other, and one person gets a million dollar injury, we cannot cover it. If three hundred of us do it, we are a little better. If thirty thousand, then there is enough to cover most contingencies. If all three hundred and fifty million of us throw in a few thousand, we get closer to being able to cover the whole. The larger the contributing pool, the less likely any risk is to take down the system.

4) Fee for service is not the most cost effective way to pay for medical care. There exist and have been developed and researched and put into practice multiple more effective methods. While the “capitation” model caused much dissatisfaction to patients and providers, much of that could be mollified if the purpose of capitation were not to generate profit. And fair compensation could still be found for all health care professionals, albeit probably not at the upper levels now found in some specialities. Another longer discussion.

5) The competition among insurers, and the multiple layers of approval, fee setting, price comparison, network policing, to say nothing of shareholder distribution, marketing and the like mean that huge proportions of money available are spent by private industry over what a governmental system would provide. This is not to say that there is no role for private industry, just that costs inevitably go up.

6) We may be compelled to accept, in some manner, a multiple tiered health system, as much as that may be anathema to some. We have mandated as a society that no one should starve, and we provide necessary food to all who live here. That does not mean the the best restaurant in New York accepts food stamps. There will always be some disparity between the services received in any sector by the richest and the poorest. The difference, however, may be in amenities, it should not be in necessities. If the nation creates a system whereby all who live here receive all the care necessary at a reasonably cost effective manner, then it should not be impossible for those who can afford it to have, additionally, private access to ‘luxury’ services. I don’t object to the existence of the so called “cadillac health plan” if there exists no one in the country without reliable, safe, decent and affordable access to a clean, comfortable and punctual bus. (Maybe not the best analogy but hope it makes the point!)

7) A broad governed system, even if it evolves to an ultimate single payer type plan could still experiment with the optimal ways to regulate and distribute care. Perhaps Managed care plans and captivated plans are best for some, more specific isolated and partially self insured plans may work for others. There have been “demonstration projects” and, I believe, under the rubric of a more centrally planned system there still may be room to experiment with a variety of different such projects.

8) Finally, whatever comes to be the best, final, optimal solution, it will of necessity take some time to transition. That is not to say big big changes cannot be made, but there will be some evolution period needed. This is not only due to patient expectations, and the strength of the financial industry as it currently exists, but because for major change to occur, those who have spent their lives working in the industry will need to participate in its evolution as well. I think the vast majority of physicians will tolerate evolution of health care such that some element of autonomy, and profitability has to be sacrificed to a longer and more wide ranging good. I think, perhaps naively, that as a system changes to make health care less of a profit maker and more of a universal service, most if not all of the executives who run the systems will either change their own expectations, or enter other more appropriately profit driven industries. But these changes will not happen immediately, any more than it could happen immediately for patients to learn that they have to call a telephone triage demand management system before going to an ER or the doctor. Any major effort to really bring our nation to the point when we both have that extra 800 billion dollars a year, and a safe and satisfied populace, will take us time. And education. We need to be aware of this, and factor it into our own expectations for change.

BOTTOM LINE IS IT TAKES REAL DISCUSSION AND KNOWLEDGE, not sound bytes and one liners.

I would call upon those running for office, especially on the democratic side (but if republicans want to join, I mean really join in the discussion why not have them) to reject single line answers and hand raises, simple sound bytes and emotional appeals. I hope and call upon the field jointly, together, in the process of the debates and discussions to follow, start to expose, examine, analyze and then put together a serious and complete proposal.

In that manner, perhaps only in that manner, can they expose the bankruptcy of the “repeal and replace” simplicity of the current administration, draw a meaningful distinction and prepare to take back governance.

I hope that the issues pointed out in this article are relevant to evaluating the current arguments. I wish that out of the “everything that has been said”, these things had been said more clearly. I hope that those running for office can find a more focused way to address than is allowed by raising your hand to a simple yes/no question.

If these arguments were more explicitly framed, the American people would then be better able to ask and answer what may be the best ways forward.

How would that hurt?

Sometimes she makes us cringe, but she always makes us think. What is a “concentration camp”? Are we on the wrong road?

When Donald Trump was called out in his first presidential debate for using language offensive to some, he replied that “there is too much political correctness” in this country. Well Alexandria Ocasio-Cortez’s description of the facilities along our border as “concentration camps” was certainly not politically correct.

That does not mean it was not without merit.

Yes, we could quibble about the fact that the term “concentration camp” had been used many times before its infamous use in the second world war, originally in the Boer War. We could point out, as some historians have done, that the generic term “concentration camp”, as a large collection of detainees held without conviction by a judicial proceeding together and away from the general population is by historical definition a concentration camp, and, strictly speaking, our detention facilities are therefore accurately called concentration camps.

But that would be semantics, and, like patriotism as been called, a refuge for scoundrels. Let us assume and allow that AOC called the facilities “concentration camps” intending to invoke the image, and the moral opprobrium of the Nazi “konzentrationslager”, the concentration camps.

It is conceivable that this choice of words could mean that she was unable intellectually or morally to discriminate between that which is happening on our border and that which finally came to pass in Nazi held territory, Auschwitz and Treblinka, vast systematic factories of death and torture. But anyone who has listened to AOC knows she is often brilliant, direct and courageous, and always purposeful, so perhaps she is making another point. Perhaps she is intentionally “calling us out” for being on a trajectory which leads no where good.

Origins and codification of antisemitism in Germany.

Adolf Hitler was elected Chancellor of Germany and assumed power in January of 1933. The Nazis established the first concentration camps, starting with Dachau, later that year. However they were initially used for political prisoners, communists, social Democrat’s, critics of the regime. It was not until after 1938, Kristallnacht, that Dachau and other concentration camps started to be used for Jews.

The first official steps toward the systematic deprivation of basic rights to Jews had first codified as the Nuremberg Laws, which took effect in September of 1935. We are not as far into the Trump administration yet as was Germany into the administration of the Nazis when anti Jewish laws were first passed.

The idea of “extermination”, while it appears sporadically in Hitlers thoughts, does not become policy until 1941/1942. Prior to that, and as late as 1940, Hitler was still considering mass deportation of Europe’s Jews. There are some in our country not so shy, or politically correct, not to call for the same.

The first Extermination camps were started in 1941/1942, after the war was well under way, and after Hitler’s decision to kill Europe’s Jews. That decision, its planning and putting into practice was finalized at the end of 1942, and is well expressed in the film The Wannsee Conference”. In other words, those camps whose horrors we have rightfully come to consider the apogee of human evil, and with who nothing since can compare, did not begin until 9 years after Hitler came to power, more than the equivalence of two presidential terms.

When Hitler had been in power the same amount of time that Trump has, Jews were still legal citizens of Germany, and concentration camps were political prisons, not instruments, yet, of extermination.

The growing and increasingly inhumane collections of men, women and children we are constructing within our country now are also not intended as extermination facilities, and therefore cannot be compared to the final endpoint of the Nazi terror, the extermination camps of Auschwitz, Treblinka and the like. However, already upwards of 20 people are reported to have died in our overcrowded custody. (I can’t verify those figures personally, but I have not heard them denied.) If you just compare the time line, we have gone some distance toward competing with the third Reich regarding the systematic deprivation of human rights compared per unit time. We view that period, the Nazi period, now through the scope of its ultimate outcome. Perhaps we should apply that scope, where the trends could lead, when we look at our present.

Perhaps, when AOC says that we have built ‘concentration camps’, she is not saying that borders camps equal Auschwitz. Not saying that the trajectory has gone all the way to the level of an Auschwitz, which was built about 9 years after the Nazi administration began.

Perhaps she is observing that we seem to be starting on such a trajectory. It is, I think, a very fair question to raise. The current occupant of the oval office dehumanizes immigrants, calls them animals, he uses the vermin analogy of infestation. People are held in at best questionable conditions without trials, some of them die, and he still talks of the deportation of millions.

Vast numbers of people who are not criminals, many of whom are perfectly within their legal rights to seek asylum, are being forcibly detained in very questionable conditions. Their families are being separated, children taken from their mothers arms. They are not criminals. Those who are convicted criminals are kept in prisons, when they are convicted. These people are, in large measure, asylum seekers. The people our statue of liberty told us we were to welcome.

Alexandria Ocasio- Cortez is calling out the non-judicial collection (concentration) of large numbers of ethnically similar non – criminal families in conditions which no real American could possibly avoid being ashamed of. She is calling it by a name which is, although this is semantics, factual accurate. But she is using an image as a warning that we have started down a path which is disturbing. She finds it very disturbing. Disturbing enough to use rhetoric more inflammatory than some of us might prefer, but still, the facts are very disturbing.

Perhaps we should be applauding her courage, not denigrating her choice of words.

I also find what has happened in this country, what is happening in the name of our country, both rhetorically and actually, quite disturbing.

Don’t you?

An American Goes to Iran – Is it time to reconsider the relationship?

I have recently returned from a tour of the Islamic Republic of Iran. I had a remarkable, exciting and eye opening experience. But more interesting, surprising, even shocking, was that the Iranian people I met, also surprised and shocked to see an American, were very happy for my being there. It seemed quite genuine, and the impression was widespread, virtually universal. “Thank you for being here, thank you for coming. We know that your press has nothing but bad things to say about us. Thank you for taking the chance on us. Thank you for coming to Iran.” Such a response would be predictable if it were only coming from hotel and restaurant staff, those who needed the most, lacking business from the sanctions. It is not predictable when it comes as a consistent message from people on the street.

Welcome scenes in Iran

One little boy was typical. He asked where I was from, and when I told him he said, “I love New York”, and opened his jacket to show me his New York tee shirt. I opened my jacket to show him mine. “America is beautiful. Thank you for coming to Iran”. I can remember warm welcoming people all over the world, but none more welcoming than the Iranians. I told one young man that I would bring the message home to my friends that Iran is a lovely place to visit, and he said, “Please, write to Mr. President Trump, tell him we are nice people”.

Iranian school children visiting a famous Mosque

Of course, even Secretary of State Mike Pompeo says that we have no argument with the people, only the government. Here our Secretary echoes another frequent theme I heard from many many people who, when they found I was American and enjoying the time, said “Governments can be enemies but people like each other.” So, if a visit to Iran was one of the most interesting, exciting and pleasant vacations I have ever had, and it was, and if the people are among the most warm and welcoming people I have met, and they were, then perhaps it might be reasonable, as an American, to try to take a fresher look at the whole relationship between our two countries. I had previously in these pages written in support of our government approving the nuclear deal with Iran, but that was more out of my overall support for diplomacy, and my belief that a stable and verifiable nuclear agreement was in our nation’s best long term strategic interests. I still believe that, but now I wish to try to determine whether one person’s pleasure in visiting Iran can be reconciled with so many decades of distrust and antipathy at the level of our two governments.

Twenty years ago the then Secretary of State, Madeline Albright, argued that reformist currents in the then newly elected Iranian government should be welcomed. While announcing a modification in a sanctions program which had been directed against the country, she called Iran “one of the world’s oldest continuing civilizations and one of the globe’s richest and most diverse cultures” and said she hoped that “both in Iran and the United States, we can plant the seeds for a new and better relationship in years to come”. She referred to a strong “common ground between our two peoples”, saying “both are idealistic, proud, family-oriented, spiritually aware, and “ – perhaps most importantly for the understanding of some Iranian rhetoric – “fiercely opposed to foreign domination”.

Another foreign policy expert on Iran observes that “with a disproportionately young and well-educated population, situated at the wellspring of the world’s petroleum supplies and at the crossroads of Asia’s emerging democracies, Iran is uniquely positioned to enhance the interest of the United States and its allies in a peaceful and economically vibrant future -or, alternatively, to sow greater chaos and instability”. My visit and my conclusions must be timely, as this same very week I publish this, the same foreign policy expert on Iran is also asking that our relationship be reconsidered.

This is not just the the naive plea that we all get along. Before reviewing what I will call a historical balance of grievances, it is important to note that this is not just a plea to revisit the past, but to look toward a possible and mutually beneficial future. There is much opportunity for our own nation as well as a stable order for us to effect a repair of our relationship. Consider the possibilities going forward. Iran is mostly a desert land just waiting to be developed, roads to be built, cities and towns to grow.

Someone is going to partner with Iran to do those things. Iran is at one major hub of exchange from East to West, from North to South, one of the central nodes of the ancient and enduring “Silk Road”. Iran has always been part of the commercial traffic of civilization. One has to wonder if it is our own best interests to continue to attempt to isolate them, and thereby ultimately isolate ourselves from this hub.

Iran has prided itself on its previous good connections with the rest of the world. We were taken to a palace where gifts from other countries to prior governments are displayed. The plates below are from China and Japan. The table, we were proudly told, was a gift from Napoleon.

Not everyone is avoiding engagement with Iran. Russia has not held off in taking economic advantage of the opportunities. The Wall Street Journal has in fact called Russia the winner in our return to the sanctions regime.

Russia and Iran shake hands. Image from Breitbart.

China has pumped vast sums into the Iranian economy as Western interests have retreated, or suspended their advance in the face of US renewed sanctions and withdrawal from its international agreements.

China and Iran are not avoiding each other

China’s new Silk Road goes right through Tehran

China will likely become a major consumer of Iranian Oil, sanctions non-withstanding, and Iran provides an important ‘linchpin’ in China’s Belt and Road Initiative, its reframing of the classic Silk Road. Iran is increasingly “having to rely on China to offset the Western-induced isolation, predominately championed by the United States”. Chinese care makers are prepared to fill the gap “left by French automakers who closed their Iranian operations” due to US sanctions. I would ask the question whether it is in the best interests of the United States to allow such focused and strategic investment in time and relationship by Russia and by China with Iran go unanswered?

The damage, from President Trumps withdrawal from the agreement, to the perceived value of America’s word, the validity of its signature on an international agreement are naturally painful, disappointing and embarrassing to me as an American, but not really the point I am trying to make. The point is that in weighing the balance of grievances. With the USA unilaterally withdrawing from an agreement which we ourselves forced on Iran, and which was approved by almost every other major world power, and which was approved by both our Senate and the United Nations, it is difficult to avoid the conclusion that the balance of grievance has shifted, vis a vis the United States, in favor of Iran.

There is one important but subtle point, and one not always appreciated point regarding the effects to us of our withdrawal. Benjamin Becker, a close friend from Germany with some experience in things economic, made the following additional and very relevant observations regarding the long term effects, detrimental to ourselves, that the withdrawal from the agreement and the reimposition of sanctions is likely to have:

“The renewed sanctions are doing lasting harm, harm that will continue to be felt even if future U.S. administrations are wiser than the current one and return to the nuclear agreement. That has to do with path dependencies in international trade that span years and decades. Germany discovered that after the sanctions ended following the nuclear agreement. At the time we thought that our exporting industries would face fantastic prospects in Iran. After all, Iran pre-sanctions had been a reliant importer of German goods and products. In reality, exports remained far behind expectations. The reason was that in the meantime, China had pretty much filled the gap, and re-taking market share against them proved an almost impossible task. It makes sense when you think about it – one purchase decision can influence a multitude of follow-up decisions which favor the company or country you first did business with. Whether it’s compatibility, industrial standards, replacements, service deals, interpersonal connection, trust, name recognition – once trading and consumption patterns are established, they’re extremely hard to break up, and even more so if you face a formidable competitor like China who itself keeps on innovating. So when we allow ourselves the luxury of suspending trade for a few years at the whim of a certain president, we don’t only lose these few years, we lose so much more for such a long time to come – and many opportunities for business, trade, and by extension opportunities for peaceful interaction as well as cultural and political influence, may be lost forever. That makes re-establishing peaceful relations with Iran an even more pressing task than it already is.”

So, having proposed the benefits of renewed relationship, we need to clear the air, or try to, of what has clouded and destroyed what was once a good connection. In what follows I wish to construct a ‘balance sheet of grievances’ between our two countries.

It is not hard for those who remember the transition from the days before the revolution in Iran, who remember the days of the Shah, to trace back the antipathy which grew and continued. While in the USA it is taken as axiomatic that the Iranian government are the aggressors and our intractable adversaries, I have come to believe that a balanced assessment of the grievances each side has against the other may make room for another, more even handed view. A view which will allow some progress forward out of what has become, especially over the last year, an unnecessarily adverse situation. True, Iran and the USA have a number of serious grievances, each against the other. I will try to look at each grievance as fairly as I can. As a guide for this, I have presented below a table of US grievances against Iran, and Iranian grievances against the United States. In what follows we can look at some merits to each’s claim against the other.

A caveat is in order. There are many people, patriots, so called, who feel that any recognition of fault in our own country is unseemly. Any such inquiry constitutes an “apology”. It compromises our ‘exceptionalism’ to admit fault. If one starts a conversation about our relations with other countries by admitting error or fault, one is automatically not to be listened to. President Obama was accused of having an “apology tour” when he sought to place world events in a reasonable and balanced manner. One could consider the relationship between the USA and Iran with some openness to the complaints of each. However if the reader is already of the opinion that any recognition of fault on the part of the US, or that any moral comparison is heresy, then perhaps that person will remain unconvinced by my arguments. It is not my intention in this essay to ‘apologize’ for the United States, but rather to place the grievances which the US and Iran hold against each other in such a context as to consider whether maybe it is time for each of us to stop demonizing the other, and move on towards an eventual rapprochement, or reconciliation. Consider, then, the table, and the arguments which follow.

The Embassy takeover. Americans have for four decades viewed Iran primarily through the lens of the US Embassy takeover in 1979. I do not in any way wish to whitewash that attack, or to pretend that it was acceptable. The armed assault on any nation’s embassy is an act of war and a violation of the most basic of those international norms without which we cannot have an orderly connection between nations. An embassy is the symbol of diplomacy and without diplomacy there is war. Had President Carter at that time opted for a military option I could have supported it. I still think it might have been a justified, if not necessarily optimally prudent response. One cannot pretend that the armed take over of the American Embassy was Iran’s finest hour.

Still, it might be helpful in going forward to try to frame that event, as reprehensible as it was, within the context of the the history of modern American – Iranian relationships. If not to condone, it would be fair to try to understand the event through the eyes of the other. One aspect is that the embassy takeover, and the Ayatollah’s reaction to it were part of an internal power struggle, but that would offer no excuse. There is another aspect to be considered.

Iran claimed at the time, and still does, that the Embassy was not acting in good faith as a diplomatic outpost. They assert that it was rather a center of espionage designed to subvert the establishment of the new government. They still keep the former Embassy site open as a museum. They call it a “Den of Spies”. They insist that the people who worked there, and the purpose they served was not one of genuine diplomacy, but that it was espionage. If, the Iranian argument goes, the embassy staff were not diplomats but rather spies, then detaining them would have different significance within international norms than the detention of diplomats. To weigh whether that assertion should have any impact on our lingering antipathy requires that we ask whether there is any reasonable basis for this accusation that the embassy was a center of intelligence gathering rather than the more universally accepted purpose of an embassy.

I did not visit the museum when I was in Tehran. Ours was a cultural tour, mostly ancient archeologic sites.

The tomb of Cyrus the Great, with Iranian tourists.
Ancient Fortress

Ancient Persian Bust in Tehran Museum, dating from third millennium BC

But others have visited the site, and some Western observers have listed, for example, the existence of “soundproof dens, spying equipment and machinery and pieced together shredded documents.” Certainly the Iranian students were able to piece together shredded documents which suggested some CIA attempts to make contact with non-government Iranians during the period immediately after the revolution. In fact, some documentary support exists for a CIA attempt to recruit and pay a leading figure in the Iranian post-revolutionary government.

There may be no “smoking gun” to demonstrate that in 1979 the American Embassy existed primarily as an intelligence gathering outpost. One does wonder, however. A balanced view would have to admit that Iran might have cause for concern over the intelligence operations of the Embassy, even if not sufficient evidence to have justified occupation.

Why should Iran be so specifically concerned to see CIA covert influence as a threat to its vital interests. After all, we suspect that all embassies have some intelligence gathering role. Why the big deal? Here the Iranian grievance has some precedent to consider.

Elements of Iranian historical architecture


The CIA coup. In 1951 Iran elected a secular democrat, Mohammad Mosaddegh, as prime minister, a progressive who introduced a number of measures including land reform and social security. He was seen as a champion of anticolonialism, one who supported a modern democratic and freer Iran within the context of a constitutional monarchy. But he ran afoul of British and American sensibilities when he moved to nationalize Iran’s Oil industry. Britain had acquired all rights to Iranian oil reserves for less than a fifth of net profits, and even after several years of negotiations and ultimatums, new agreements gave less than a fifth of profits to Iran. Peter Frankopan, in his excellent The Silk Roads, reviews the post WWII situation in Iran very incisively, points out that the the Anglo-Iranian oil arrangement was “particularly odious”, “given the huge imbalance in the amounts paid to the British exchequer compared with royalties disbursed to Iran”. He goes on to paint a cogent picture of why Britain felt it so necessary, its empire crumbling, to elicit American help in counteracting the Iranian attempt to gain greater control of its resources.

The call for nationalization arose, as Mossadegh attempted to negotiate a complex settlement which was rejected by the British. The British then took a number of retaliatory countermeasures, including threats to other European companies for doing business in Iran, as well as intercepting ships carrying oil from Iran. At one point Mossadegh reached out to Washington for help in resolving the economic distress rendered by the boycotts, but was told he needed to settle with Britain.

The CIA’s participation in the coup which removed Mossadegh from power is not denied, however, the effectiveness of the CIA in its role in the coup has been questioned, and the significance of its role has also been disputed. The argument has been made that many parties were implicated in the removal of the legitimately elected Mossadegh from power. It has been argued that the Islamic Republic’s version of the story is an oversimplification. Calling it a legitimate leader being toppled exclusively by a malign CIA may ignore a more widely spread dissatisfaction with the direction that government was going. Nonetheless internal CIA documents revealed in 2013 are quoted as saying that the coup “was carried out under CIA direction as an act of US foreign policy, conceived and approved at the highest levels of government”.

It remains fair to agree on a very basic truth. Western interests, and specifically economic (what some might call ‘colonial’) interests threatened, American and British intelligence worked together to weaken, undermine and ultimately replace the legitimate leader minister of a Sovereign Iran with a government far more amenable to those western interests. If Iranians were overly concerned that in the 1979 takeover, the US embassy was being used to foment a similar weakening of the new Islamic Republic, then that position would be, if not necessarily accurate, then at least not without precedent. This does not justify the use of force to detain diplomats, but it puts the perception of diplomats as spies in a broader context. Western spies had, in fact, subverted the government before.

The 1953 coup, regardless of whether one sees it as CIA instituted or just CIA assisted brought back to direct control of the government the Shah of Iran. Where Mossadegh had been widely regarded as progressive, egalitarian, and committed to social justice, the regime of the Shah was characterized as one “which has created an atmosphere of fear…conveying a picture of extreme political repression”. While the early days after the revolution saw trials and executions by the Islamic Republic, “…the great majority of those who were tried and executed ( that is, in many cases, members of the Shah’s army and secret police) were charged with terrible violations of the most elemental human rights; and the testimony of the accused, so rich in detail and so internally consistent as to be credible tends to confirm the worse charges against the Shah’s regime”. Estimates for the number of deaths the Shah’s regime was responsible for and accusations vary, of course. It appears that the Ayatollah’s original revolutionary accusation that the Shah had murdered 60,000 is exaggerated perhaps 10 fold. But it is clear that thousands, though probably not tens of thousands died under the Shah’s rule from imprisonment, torture and use of deadly force against protest. Many of us may remember (if we remember college in the seventies!) that our campuses were replete with Iranian students carrying pictures of prisoners tortured by SAVAK.

Mike Pompeo, Secretary of State, has stated in a recent op.ed piece that the current regime of the Islamic Republic of Iran was responsible for thousands of deaths. And, to be fair, regarding deaths attributed to the Shah, perhaps a similar number were killed in similar manner during the first three years after the revolution. Iran did not greet the Shah’s secret police with “truth and reconciliation” committees. Things have changed from those days. When I was in Iran I heard talk of things having been “terrible” during the early days of the revolution, but better now. I was told that for the most part people were now free to do and say as they pleased – although perhaps, in a somewhat lowered voice, and some of it only in their own home or private place. According to some modern Iranian scholars “notions of democracy and human rights have taken root among the Iranian people”, and “Liberal notions of human rights are almost hegemonic in Iran today”. This corresponds to my experience in Iran, that people seemed to feel that, while the government had done many good things, no one thought it was perfect – nor did they seem at all afraid to say so. I did not in the least have the feeling, which I had expected to have, that people thought they could be tortured for saying the wrong thing. Perhaps they can be, but the sense of an “atmosphere of fear” which is reported to have existed under the Shah, was not, at least to my admittedly limited excursion, palpable.

The fact that Secretary Pompeo, use his defense of the US Saudi partnership to accuse Iran of being responsible for “thousands of American deaths”, is ironic, considering the literature regarding the role of Saudis, such as Osama bin Laden, in the 911 attack. As far as Irans attacks on US live, he is not only grossly exaggerating the figures but neglecting to mention that Americans killed by Iranian combatants were, for the most part, soldiers in Iraq, a country which we attacked with, at best, very minimal if any provocation. If Iran, bordering Iraq, had sent aid to protect Shia Militias from an invading army, it is not really, in my mind, quite fair to be condemning them as if they had murdered Americans without provocation. Al-Quida is not Iran. ISIS is not Iran. How that argument sits might depend on the readers view of the legitimacy of the Iraq War. A similar question will be asked, further in this discussion, regarding the legitimacy of a target when we discuss the Marine Barracks destruction in Lebanon. For the present, I have yet to see evidence of Iran involved in ‘thousands of American deaths.’

Before continuing to get too far ‘into the weeds’ let me frame again where I am going with this. Our national antipathy towards Iran takes as a given, as a bedrock principle, that Iran has been a ‘bad actor’ towards our nation and our allies. The main question in public discourse has never questioned this axiom, but always been how to deal with this misbehavior. I am attempting to examine whether the balance of grievances might not be more equal than we in the West have been lead to view. I will now move on to a prior Iraq war which has, I think, more significance in our understanding of the balance of grievances and the state of our current relationships.

The Iran Iraq War – The issue of Poison Gas. Many readers will not be old enough to remember the war between Iran and Iraq, which lasted from 1981 until 1989. Iraq, under Saddam Hussein, started that war with an unprovoked attack on Iran. This war may not be commonly remembered by the average American, so before examining whether Iran may have any grievance with us over Iraq’s conduct of that war, and whether the US could be said to have any role in it, it is useful to review the magnitude of the war, and what it might have meant to Iran.

The war between Iran and Iraq lasted one month shy of 8 years, or 95 months. By way of comparison, the involvement of the US in WWII lasted from Dec 7, 1941 through mid-September 1945, or 3 months less than 4 years. So the Iran – Iraq war lasted twice as long as the second world war did for us. Estimates vary, but it would appear that Iran lost upwards of 200,000 dead many times more injured. The population of Iran at that time was estimated to be about 40 million, so Iran lost 0.5% of its population. During the Second World War, the US lost about 400,000 out of a population of 138 million, or 0.3%. Therefore, both in terms of time at war, and percentage of the population lost, the Iran Iraq war had roughly twice the impact on Iran that the second world war had on the US. It was a BIG WAR, a big event, and every where we went, even tiny desert eco-camps there were prominently displayed posters of the war dead. They are called “the martyrs”. Pictures of young men who died in that war are literally everywhere you look, on buildings, along roads, in displays in airports.

Portraits of Iranian victims of the Iran-Iraq war, displays on buildings and in airports

Of course, that means nothing to our consideration of the balance of grievances if there is no US involvement or responsibility for the slaughter. No matter how bloody the slaughter, how could Iran hold a grievance if we had nothing to do with it? So, did we?

Peter Frankopan, in the comprehensive work The Silk Roads cited above, points out that while both the Ayatollah and the Prime Minister Badr of Iran stated at the time that they believed the US had engineered Iraq’s invasion, there is no hard evidence for that. There is, in fact, considerable evidence that Saddam Hussein devised the invasion on his own. However, the US, he points out, without officially claiming to be on one side, strongly supported Iraq, despite the fact that they had started the war with an unprovoked attack. He shows that after removing Iraq from the list of state sponsors of terrorism, the United States acted to help prop up the economy, allowed Saddam to buy “dual – use” technology, boost Iraqi oil exports, and impede sales of weapons and spare parts to Iran.

One might counter that the US in fact also helped Iran. Reagan’s “Iran-Contra” scandal involved selling anti tank missiles to Iran. However it is widely believed that this move was actually both to secure the release of American hostages and transferring funds to the rebels in Central America, rather than to help Iran. Kissinger is famously said to have observed that American interest in the war was that “both sides lose”, but the preponderance of evidence shows active US support for the aggressor, Iraq.

Our Iranian guide stated that no one had helped Iran during its war. (He either did not know, neglected or choose not to mention well documented Israeli arms sales to Iran from the outset.) However, he also mentioned that others had helped Iraq attack Iran with chemical weapons, with poison gas attacks. Daryoosh was polite enough and familiar enough with the customs of hospitality not to verbally implicate the US while I, his American guest was standing there, however there is a widely suspected belief that the United States facilitated, abetted or at least permitted Saddam Hussein to use chemical weapons against large numbers of Iranians. Can this accusation be verified, or is it anti-Western propaganda?

There exists substantial evidence that the US officials were very aware of and in fact facilitated Saddam’s use of poison gas against Iranian soldiers as early as 1983, and that it suppressed the evidence for this Iraqi violation of international law from public view. A Google search of the terms “evidence of US complicity in Iraqi gas attacks on Iran” yields 505,000 entries. It is not clear that the US directly supplied the chemical weaponry, but perhaps American companies supplied precursors. However, it is well documented that with full knowledge of Iraqi chemical capabilities and proclivities, the US provided Iraq with satellite photos of Iranian troop concentrations. What is also known is that the US did not condemn Iraq at the time for its use of chemical weapons, and prevented blame from being assessed to Iraq for these actions. Iraqi poison gas attacks are estimated to have caused 50 – 100,000 casualties.

I would submit that if we are really willing to weigh in a fair, impartial, just and moral manner, a ‘balance of grievance’, then the scales would include 52 hostages held 444 days and released unharmed on one side, but should also include complicity and facilitation of 50-100,000 poison gas casualties on the other.

The Beirut Marine Barracks bombing. In October of 1983 a suicide bomber using a truck bomb destroyed the barracks of the US Marines in Beirut, causing the largest single day casualties since the second world war.Although responsibility for the attack was claimed by a shadowy group calling themselves “Islamic Jihad”, much popular wisdom at the time and still today attributes the bombing to Iran. The suicide bomber was an Iranian national, and Iran was ultimately sued in US courts. When the government of Iran did not file a response the the claims, default verdicts were entered, over $2.5 billon dollars were awarded to the plaintiffs.

Iran has consistently denied involvement in the Marine Barracks attack. The US did not retaliate against Iran, and, most telling, Caspar Weinberger, then US Secretary of Defense stated that the reason there was no direct retaliation against Iran was that it was never really known if Iran was really responsible for the bombing. Finally, it needs to be remembered that the American Marines had strayed from what had initially been conceived of as a peace keeping mission. At the time of the attack the US had begun to take the role of an active participant in the civil war. The Marine commander noted at the time that Americans given up their neutrality in that conflict, and “were going to pay in blood for that decision”. We can call it terrorism, but I wonder if we really want to label with the pejorative “terrorism” every lethal attack on a military unit involved in combat. That might be a difficult precedent for our forces going forward to so define “terrorism”.

The Downing of the Civilian Jet-Liner.
In 1988 and Iranian commercial jet liner, Iran Air Flight 655 from Tehran to Dubai was shot down by an American missile fired form the Naval cruiser USS Vincennes. 290 people including 66 children were killed on the Airbus 300. The jet was hit while within Iranian airspace while on a routine flight path. The Vincennes, on the other hand, had entered Iranian territorial waters.

It was an accident. No American commander would ever shoot down a passenger jet intentionally. And this is not sarcastic, I believe it as one of my own bedrock beliefs. No American commander would ever shoot down a civilian jet intentionally. But that was not how it was seen by Iran. They noted that the commander had been involved in close calls with Iranian vessels before, and this incident was seen even by some American commanders as a result of the commanding officers known “aggressiveness”. Still, it was an accident. But the United States never formally apologized. 8 years later in settlement of a suit brought in international court the US paid $61.8 million dollars to the compensate the victims families, or approximately $213,000 per person. The average compensation to passenger families in airline deaths in 1988 was cited to be about $356,000 so this was somewhat low, but not out of the range of normal. (Although this is a little like ‘apples and oranges’ to compare an act of aggression which is suspected but not proven, with a clear accident, but it is interesting to note that the penalty applied by American courts for Iran’s supposed attack on the Marine Barracks, a combat force, was $ 2.6 Billion, fifty times per person the penalty assessed against the US for killing a larger number of civilians, albeit by accident.)

Perhaps an apology would have been appropriate. We generally apologize for simple mistakes. While then Vice President Bush’s statement one month later that he would never apologize for the United States, no matter what the facts were was said in a different context, it was seen by Iran as referring to this event. But, again, of course it was an accident. An interesting thought experiment – how gracious would we be if an Iranian warship operating in American territorial waters accidentally shot down an American civilian jet liner on its routine flight within the United States?

In any relationship between two nations in which there has been enmity, posturing, events and accusations and counter-accusations, it is difficult to equally weigh and assess blame. I would submit though that any assessment which tries to be even moderately fair and just, which weighs each grievance, weighs the embassy takeover, the CIA backed coup, chants of ‘Death to America” versus “axis of evil”, which includes US complicity in gas attacks, the accused Marine Barracks attack and civilian airliners, one would have to conclude that – in the battle of ‘good guy versus bad guy’, we are at the very best, “even-steven”. If you don’t believe that, then show me where Iran’s actual injury to the United States outweighs Western injury to Iran.

So, taking at least for, for the sake of argument, the assertion that Iran and the US are on a comparable moral high, or comparably low ground going into the nuclear negotiations of the last decade, let us proceed.

The Iran Nuclear Deal. Let us leave aside as too snarky the question of what business has the country which invented nuclear weapons and used them, together with the only country in the Middle East which (is rumored to) have them in demanding that a country which has pledged not to develop them stop even from producing nuclear fuel for peaceful purposes. For the present I will ‘stipulate’ that, perhaps, as one of the world’s only countries powerful enough to do so, we have the right and duty to prevent the proliferation of the weapons throughout a notoriously volatile region and one whose (relative) stability is of such importance to virtually every other nation.

Stipulating to that right and duty, that is exactly what our efforts accomplished. I have already argued this point in these pages. Pulling out from the deal, even though all observers agreed that Iran was complying with its requirements has had a large fall out.And could be “disastrous for the Middle East”, causing friction between the US and its allies, driving Iran nearer to Russia and China and perhaps permanently damaging US credibility as a negotiator or diplomatic partner. It has even been said that the partnership with America had a long and fruitful life — but Europe is ready to start over. Officials in the EU have asked: ‘With friends like Trump, who needs enemies?” In the words of one Rand Corporation researcher “The U.S. withdrawal was unnecessary and strategically harmful, and undermines both transatlantic trust and the ability of the U.S. to negotiate future multilateral agreements.”

The decision gave rise to general anger, even fury, leading Europeans to conclude that the US is no longer a country which “keeps its word and values its allies”. With this one action, America has, in the words of one commentator, “made a mockery of the value of its signature on an international agreement” Iran was understandably outraged. After all, Iran was universally found to be in compliance with the agreement.Even Secretary Pompeo testified that Iran was in compliance,and Secretary of Defense Mattis recommended preserving the agreement. Withdrawal has been clearly damaging to the Iranian economy and its prospects.While some have stated the effects will be minimal,there is a clear harm done, at least in exchange rates. My own experience was to arrive in Tehran the Saturday after the sanctions were reimposed on Monday, and I was able to exchange $100 for 150,000 Rial at an official exchange, an almost 2 fold collapse since prior to the reinstitution of sanctions. It was good for me, but it is not hard to understand Iranian anger.

The Islamic Republic of Iran and the Jewish State of Israel
There is one further, and perhaps most vexing issue. Iran’s continually expressed antipathy towards Israel, not just its policy but its legitimacy and right to existence, along with the allegations of antisemitism and, worse, Holocaust denial, should be concerning not only to Jews, to Jewish Americans, but to fair minded people everywhere. Certainly criticisms of the policies of nations is fair game for anyone, but the continued public, primary and often threatening stance toward Israel’s very existance is an issue I have had to try to confront, and anyone should address in seeking for a possible reconciliation with Iran. This was a particularly vexing issue for me, being Jewish, as shortly after my arrival home last month, I wanted to send warm and effusive greetings to my Iranian hosts, and was stopped in my tracks by fresh reports of the Iranian President calling Israel a “cancerous tumor”. Still I think it is possible to address, in some measure, these issues, and if not erase the concern, at least point out where another approach by both the USA and Israel could conceivably result in a different kind of relationship between the countries, albeit perhaps not soon or easily.

I would ask, for reflection, whether Israeli long run safety and security is enhanced more by Iran’s long term (and, if you really read the document, not certain sound bytes of it), permanent abandonment of nuclear arms exchanged for a re-integration into the world economic order, or by a very public abandonment of an international agreement, invoking broad and deep resentment, actively and publicly encouraged and facilitated by an Israeli leader.

The first question to begin this approach involves raw antisemitism, which is, unfortunately, not so rarely expressed anywhere anymore. However, as far as personal or individual antisemitism in Iran, although I wouldn’t have previously believed it possible, I attended Shabbat evening services in a Synagogue in Esfahan, Iran.

Shabbat Services in Esfahan, Iran

There are still 10-15,000 Jews in Iran, living generally comfortable middle class lives, free to stay or leave as they please. The president of Iran and its foreign minister have sent Rosh Hashanah greetings to the world’s Jews, and a poll commissioned by the Anti-Defamation league, no less, concluded that Iranians are the least antisemitic people in the Middle East and North Africa.

The current enmity between Iran and Israel did not always seem inevitable. Some have argued comparatively recently that reconciliation is not inconceivable even now. Our guide, perhaps because he knew I was Jewish, made a frequent mention of the collective memory that Cyrus the Great had freed the Jews, a source of pride in Iran. The two countries had good relations for decades before the revolution, including military cooperation and early de facto as well as official recognition, long before that from any other Muslim country. As geopolitical and religious ties drew Iran closer to front line Arab confrontational states such as Egypt and Syria, the strategic advantages to Iran of a relationship to Israel waned. As the Ayatollah Khomeini returned, he strengthened his own pan Islamic credentials in severing ties with Israel, and throwing his full weight behind the Palestinian cause, going so far as to turn the evacuated Israeli embassy over to the Palestinian Liberation Organization. Khomeini continued to embrace the identity of primary resistance to the Israeli presence in the Middle East, not only rhetorically but in support of powerful military non-state actors such as Hezbollah in their resistance to what they call an “occupation” – i.e., Israel’s existence.

Some commentators, who admit to viewing Iran as “theologically committed to the destruction of Israel” tend to see in the Iranian stance against Israel the specter of the Nazis overarching goal to physically eliminate the Jewish people, and are able to articulate a very long list of anti-Israeli statements made by Iran leaders. Citing, primarily, the Jerusalem Center for Public Affairs report on Iran leaders anti-Israeli rhetoric, it is argued that a wide swath of Iranian leadership has called for the specific elimination of the Israeli state, as opposed to a statement about the historical inevitability of same, and that these calls for destruction are made without being tied to specific acts of retaliation for any threading actions which Israel may or may not do to Iran. The document compiles quite a list of vitriolic and threatening statements against the existence of Israel, and some of those statements clearly relish the notion of Israeli deaths.

True, some of the statements are taken in the context of the funeral of militia leaders assassinated by Israel, and some of the threats come directly after events blamed on Israel and the West and in response to what are perceived as military threats. And also true, Israeli leaders were no less antagonistic in their rhetoric, although I think be any measure less dehumanizing, calling Iran a “dark murderous regime, worse than Hitler”.

For the present, low level and proxy antagonism continues, and baring a true sea change, is unlikely to change in the immediately foreseeable future. Iran and Israel are likely to remain, primarily in rhetoric but with some real damage from each side to the other – witness Netanyahu’s effect on the current state of the JPOC agreement. Any call for reconciliation between the West and Iran, especially by a Jewish American, must come to terms with this enmity. Is this possible? To attempt it would entail, I believe addressing the following primary questions:

1)Does Iran deny the Holocaust?

2)Does the Islamic Republic of Iran constitute an existential threat to nation of Israel and the Jews who live there?

3) Does Iranian support of Hezbollah constitute an aggressive or existential threat to Israel and its citizens?

4) Are there circumstances under which Iran and Israeli governments would accept the lasting legitimacy of the other, or at least be willing to pledge a mutual non-interference with the conduct of each others affairs?

5) Is it in Israel’s best interests to continue to make efforts, and be seen as making efforts to prevent Iran from reintegrating into the worlds political and economic order?

The first question, whether Iran denies the Holocaust is of importance both for moral reasons and in the spirit of “those who are ignorant of history are doomed to repeat it”. Considering the both the magnitude and moral horror of the Nazi’s systematic destruction of the Jews, it would be hard to warm to anyone who denies it. Therefore, for moral as well as practical reasons it is worth examining what Iran’s position on this question actually is.

The issue surfaced under the presidency of Mahmoud Ahmadinejad. Ahmadinejad, who was President of Iran from 2005 to 2013, came into office as a hard liner, reversing previous reform candidates. He gained worldwide notoriety for his hostile and vitriolic comments regarding Israel, the US and Saudi Arabia. Under his presidency, Iran’s openings to the world plummeted. Our tour guide related to us that during Ahmadinejad’s administration he had to stop guiding tours because tourism dried up completely. Ahmadinejad’s election to a second term caused widespread protests within Iran, and he was prevented from running a third time.

What Ahmadinejad is actually quoted as having said is as follows: “Some European countries insist on saying that during World War II, Hitler burned millions of Jews and put them in concentration camps. Any historian, commentator or scientist who doubts that is taken to prison or gets condemned. Although we don’t accept this claim, if we suppose it is true, if the Europeans are honest they should give some of their provinces in Europe, – like in Germany, Austria or other countries, to the Zionists and the Zionists can establish their state in Europe. You offer part of Europe and we will support it”. He later went on to say, “In the second World War, over 60 million people lost their lives. They were all human beings. Why is it that only a select group of those who were killed have become so prominent and important?” And, finally, “And the third question that I raised in this regard, assuming that this happened, where did it happen? Did the Palestinian people have anything to do with it? Why should the Palestinians pay for it now?….You might argue that the Jews have the right to have a government. We’re not against that. But where – at a place where their people were”. Although reading the actual quotes might be seen to show some nuance, still it is hard to argue that Holocaust Denial deserves much nuance to be allowed it. He was universally condemned, and rightly so. What does the current government of Iran have to say about the Holocaust, and about Ahmaninejad’s 2005 statements?

The current president of Iran, Hassan Rouhani, has made efforts to straighten the record. “I can tell you that any crime that happens in history, including the crime the Nazis created towards the Jews, as well as non-Jews, is reprehensible and condemnable.” On another occasion he said “The Nazis carried out a massacre that cannot be denied, especially against the Jewish People….The massacre by the Nazis was condemnable. We never want to sit by side with the Nazis. They committed a crime against Jews – which is a crime against Christians, against Muslim, against all of humanity”. While some have argued me may not have gone far enough, leaving himself some wiggle room regarding the actual magnitude of the massacre, it seems clear that the current government of Iran admits and condemns the Holocaust.

This brings up the next question. Does the Iranian government constitute an existential threat to Israel, specially to the people of Israel? Is it their intention to destroy Israel? Do they have, or could they have the capacity to do so? Again, looking back at the rhetoric of Ahmadinejad from 2005, in which he was widely accused of saying that Iran would “wipe Israel off the map”. There has been a great deal of parsing and interpreting his meaning. Looking at his statements actual translation, Persian language specialists have translated a speech by the Ayatollah as saying “This occupation regime over Jerusalem must finish from the arena of time”. However, the phrase “wipe off the map not only persists but has been displayed prominently in English signs in Iran. Again, the Jerusalem Center for Public affairs have argued that the context of the statements indicate the intent by Ahmadinejad to incite military violence and physical extermination of Israel, using original Farsi wording and translation and arguing, “Iranian leaders are also not talking about a non-directed historical process that will end with Israel’s demise. Rather they are actively advocating Israel’s destruction and have made it clear that they have the it has been maintained, they are advocating for the destruction of Israel and have the will and capacity to effect it. How accurate is this assessment? As to the intention, it is hard to be sure. There remains, however, considerable threatening and vitriolic rhetoric, and even the most progressive attempt to reconcile with Iran can’t ignore that. As far as capacity the issue is clearer.

Fear of a direct war was raised early in 2018 when an Iranian drone crossed into Israeli airspace. Shooting down the jet, Israel also struck agains the Iranian military presence in Syria. As Israeli jets were returning to their bases, one F-16 was shot down, causing the pilot to parachute, and precipitating a large Israeli counterattack, the largest air operation over Syria by Israel in over thirty years. The rapidity and intensity of the escalation lead to widespread media speculation of an impending war. However, as that threat has receded, the possibility of escalation in the near future seems less likely. First of all, a direct Iranian attack on Israel is thought to be very unlikely because not only would it raise the spectre of the massive casualties of the Iran Iraq war, but Iran aircraft and missiles are extremely unlikely to inflict damage on Israel and emerge remotely intact.

Further analysis suggested the the ferocity of Israel’s response to this single drone incursion, called “disproportionate” was intended to decrease the risk of further exchanges by making it clear that any any significant, direct or sustained attack by Iran or Iranian proxies, while inflicting significant pain on Israel, would likely result in “unbearable” damage to Iran, proxies such as Hezbollah, and the civilian populations in which they reside. And while Tehran issued an expected condemnation , unless one believes the Iranian leadership to be completely irrational, not the position of American military leaders, Iran would not wish to escalate conflict with Israel.

Certainly there are voices of concern, much from what we call the political right. The Heritage Foundation, known for its Conservative stance and of some influence in the Trump transition team, views Iranian presence in Syria as an increasingly direct threat to Israel, viewing Iran’s presence both in Syria and Lebanon as part of an overall approach to “the liberation of Jerusalem” and sees Iran trying to build proxy forces in Syria to replicate its strategy of support for Hezbollah in Lebanon. From this point of view, “Iran remains determined to incorporate Syria into its sphere of influence. Iran has deployed a significant fighting force to Syria consisting of Iranian conventional forces and Iran directed coaltions of Shia Militias from Lebanon (Hezbollah), Iraq and Afghanistan’s strategic interests are argued to coincide with Russia’s in making extending jointly needed influence in maintaining relative freedom of movement and extension of influence.

Israeli Defense views this coalition as a single front directed against the state of Israel, and has warned that they will not tolerate Iranian establishment of a military presence in Syria.They have warned against the transfer of “game changing arms”, including accurate missiles into the hands of Hezbollah or Iranian proxies in Syria. However clashes are unlikely to escalate into war. Iran and Israel do not share any border, so a direct ground war between the two is not feasible. Of course, Iran could employ forces of Hezbollah, but it is neither in Hezbollah’s current interests, given its successes in becoming a political force within Lebanon, nor in those of any other of the major parties, neither Israels, Irans, Russias or Syrias. It is true that Hezbollah continues to try to improve their military position, with tunnels and excursions. It should simply be clear to all that Israel retains the right and capability to counter any such activities with military means when necessary.

How can we conclude this train of reasoning? Well, while no one can know the future, and the specter of the 1930s must be of concern not only to Israelis and Jews everywhere, but to any sentient human, still I believe, and I hope these arguments can be seen to demonstrate that:

The Iranian people are not by culture antisemitic.

The current and official position of the Iran is not Holocaust denial.

The Iranian military does not pose, at least in the near and medium term an existential threat, certainly not by capability, to Israel.

Iranian proxies such as Hezbollah could undeniably inflict significant suffering on an Israeli population should it come to war. However there are enough impediments to institution of such a threat that, unless Hezbollah is so self destructively irrational as to bring a certain end to themselves for minimal and unclear consequences, they would not be likely to initiate an aggressive war on Israel, at least not in the short to medium term.

This train of arguments by no means dismisses the antipathy between present day Iran and Israel. Perhaps nothing will. But I think it does make it seem, at least not morally impossible, for a reconciliation to begin between the west and Iran. I asked my Iranian guide, as we were walking together towards my Shabbat evening in Iran, whether there was any possibility of a reconciliation in the future. He replied that Israel and Iran had been allies under the Shah, that Iranian Jews freely travel to Israel, and that while the governments currently view each other as “enemies”, “in the future, who knows, anything is possible”.

As Americans, we have a traditional relationship with the State of Israel for many reasons, and I think most would see it as a moral and historical imperative to be guarantors of Israel’s existence and safety. That does not, in my opinion, mean that we cannot have any relationship whatsoever with those whose rhetoric is anti Israeli. In fact, I believe that an open exchange could improve the safety and decrease than chance of military action against Israel. An Iran situated to mutual benefit within ordered relation of nations, to the reciprocal benefit of each, would be a safer and more stable situation for all, certainly including for Israel. We should, we must be clear and that in any military attack upon Israel we would do whatever was necessary to defend it. This doesn’t mean that our relationships with every other country need be exclusively determined by whether that country supports Israel. I would ask, for reflection, whether the current Israeli government’s very public position subverting the anti-nuclear agreement with Iran, and its re-integration into a global society has more potential to help, or to harm Israel’s long term interests?

Now it is time to consider our own.

Review, Conclusion and Recommendations

Although my personal experience in Iran was as welcoming as it was, I would probably not take such an effort, or presume such a capability to argue for a renewed engagement with Iran if I had not support from published sources by recognized experts. Peter Frankopan, in the work cited above, argues cogently that Iran is a “fulcrum” of economic and military trade and transit not only through the middle east, but across the vast extent of Euro-Asia. At the end of the war, and perhaps still, Russia wanted controlling influence in Iran, not only for its vast oil reserves, he argues, but because of its naval bases, outlet to the sea, and the (then and conceivably again) “location in the middle of a web of international air routes”.

Flynt Leverett, and Hillary Mann Leverett, with prior experience in the National Security Council, the State Department, and the CIA are even more direct and insistent. In their bold and comprehensive Going to Tehran, they have argued that our antipathy towards the revolution in Iran stems from an American desire to act in an imperious fashion. They see our policies as designed to remake the middle east rather than to deal “soberly and effectively with the region’s complex political and security dynamics”. They argue that the effort has been damaging to American standing and interests. (I would cite the Iraq war as an example) They argue that the US has systematically “demonized” would be challengers to its primacy in the region. Finally, they suggest that America’s determination to “keep Iran in a subordinate position has become the biggest single risk to the secure and adequate flow of oil and gas exports from the Persian gulf”. I would argue that our failure to live up to our agreements made regarding the Iran nuclear agreement constitutes one of recent history’s biggest single threats to the use of diplomacy and the standing of the US as a dependable partner in the region. Time will, I fear, make that abundantly clear and to our detriment.

Current Iranian thought regards the region through twin lenses of cooperation and deterrence, in which Iranian political analysts emphasize the “tendency” of Iran toward regional cooperation, but recognize that they are now increasingly “required” to be capable of deterring threats.

Iranian Cooperation in the Region, is it a good thing to be left out of?

Although skeptics would certainly reject the sincerity of an Iranian intellectual, still in a very public and international forum the analysis has been that Iran seeks not to become the dominant military force in the region (see associated image for a comparison of regional arms imports), but rather to become an integrated part of a strong region.

Comparison of regional arms imports – is Iran the country seeking military dominance?

It is argued in this recent public forum , “Iran has explicitly announced that it has no interest in establishing permanent military bases in Syria, for expanding its regional influence, opening up even a so-called “second front” against Israel, as recently discussed by some analysts or the Israeli regime. Iran is well aware of the U.S. obsession to Israel’s security and wants no possible military engagement of the U.S. in Syria that could change the Syrian political scene in favor of the opposition forces.”

Of course one wouldn’t take the word of one Iranian political scientist regarding Iran’s position in the Middle East. There was a recent Al-Jazerra/Johns Hopkins symposium in which experts from various countries were asked to comment on the coming changes in the balance of power in the middle east. “Balance of power…is shifting in the Middle East, where post-cold war American domination is giving way….Russia and China are asserting themselves, even as Iran re-emerges, Turkey engages, and Saudi Arabia displaces Egypt as the Arab center of gravity”. “The “linear” power model of the cold war is over, and power in the region is a a hybrid of relational alliances.” Another panelist pointed out that the weakening of an Arab center owing, to the a schism between Saudi Arabia, Bahrain and the UAE against Qatar, Oman and Kuwait was “debilitating”. Turkey, it was argued, is concerned primarily with containment of its Kurdish population and diversification of its international relationships with Nato and with Russia. This put a relatively resurgent Iran, with its “success in making and keeping strategic partnerships, even with non-state actors” increasingly on the map of power centers. In this authors mind, these would be arguments for more engagement with Iran, not less.

The last section of this essay has been my attempt to argue for the strategic benefits of active American re-engagement with Iran, but that argument is, at least as far as my formal training is concerned, ‘above my pay grade’. I am a doctor, not a professional political scientist. Let me return to the basic points I have made in this argument to conclude.

Iranian Palace Garden

Interior of Shia Mosque

1) My recent visit to Iran showed me that the Iranian people on the street were warm, welcoming, friendly, very much appreciative of an American coming to visit, and hoping for a reengagement with the west. They had been lead to believe it was coming with the international nuclear agreement, were surprised, shocked and saddened when we reneged on that UN sanctioned agreement, but that hasn’t stopped them from wearing New York tee shirts on the streets.

2) I have attempted to review the long history of what I believe are legitimate American grievances against the Islamic Republic of Iran, not to deny their legitimacy. I have also tried to place those grievances within the context of what I believe are also legitimate Iranian grievances with the US and Western alliances. I have argued that there is enough blame to go around, and that a fair and balanced review would bring us, credibly, to a start over point.

3) I have argued then that if the balance of blame is equal, then the JCPOA, the “Iran nuclear deal”, is a fair, balanced, enforceable agreement between Iran, the worlds major powers and the United Nations, and that our withdrawal from that deal, Iran’s compliance with which is disputed with evidence by no one, places the onus to repair the situation squarely on us.

4) Although no American and certainly no Jewish American denies that the antipathy, the rhetoric, the vitriol and threat to our close friend and ally Israel is reprehensible and deserves condemnation, still, I believe and hope that these pages successfully argue, the worst but much trumpeted accusations against Iran, that of Holocaust denial, and “Holocaust preparation” are not supported by a real review of the data. Baring suicidal lunacy from Iran or its regional allies, there is neither an actual existential threat to Israel nor capacity to complete such a threat were there one. Finally, and perhaps as importantly, I would ask the question. Did our withdrawal from the arms agreement and our exclusion of dialogue with Iran, so very publicly making both ourselves and Israel to blame for it, improve either our security or Israel’s?

5) Finally, using recent published sources of thought and discussion, I have argued that the balance of power, and perhaps as importantly the balance of opportunity in the middle east is shifting, Iran’s role remains central, other international competitors have taken advantage of that, and we stand the risk of giving up an important political, diplomatic, economic and military opening which we lose to our detriment, and which we won’t get back.

I would suggest if anyone in a position of authority were to listen that we take three simple, initial steps. which would, I believe, go worlds in transforming a mutually dangerous and detrimental situation towards one of real possibilities:

1) Reengage in the international agreement we already signed, rejoin the JCPOA, and drop the sanctions against Iran.

2) Offer a good faith agreement to Iran for each government to simply suspend negative public statements about the other for a, say, two year moratorium. Encourage the leaders of both Iran and Israel to make the same good faith public negative statement moratorium. Offer to refer to Iran by its official name as “the Islamic Republic of Iran” in exchange for Iran referring to us as ‘The United States of America” and to Israel as “the state of Israel”.

3) Reaffirm, although nothing in these actions should cause it to be doubted, that in any military attack on Israel in which hostilities were instituted against Israel, we would provide whatever military assistance required to defend it. That should not mean we refrain from active dialogue with Iran. It might make it all the more essential.

More active steps, such as formal culture exchanges, People to People ambassador type visits, could await further political developments.

I asked someone why, if there is such interest in reconciliation with the rest of the world, why there still remained “Death to America” rhetoric. I was told that most of this comes from hard liners, that you do not hear it from the average person and that generally, (but not always) the current leaders are more moderate. He also said that they can’t change so publicly because “then they’d have to admit that for thirty years, they have been wrong, and no one wants to do that!” Well our leadership doesn’t seem like the type to want to do that either. The Leverett’s conclude their comprehensive and persuasive book with a simple line, “It’s time for an American president to go to Tehran”.

Well this American citizen has gone to Tehran.

I would suggest perhaps it is time for other Americans to open up minds to doing the same.

You might be very pleasantly surprised.

( The author wishes to thank Sam McManus of YellowWood Adventures, and both Daryoosh Minoui and Ms. Maryam Tayarani of Iran Doostan Tours, without whom this visit to Iran would not have been possible. At the present time, an American cannot travel in Iran except on a formal tour. )

Dr Rick Nierenberg is an emergency physician. Although not formally trained in political science, he has a long history of interest in politics, history, travel, and diplomacy.

Consider, Senator McConnell, the damage you are about to do to the Rule of Law.

Dear Senator McConnell,

It would be a bad bargain to gain a conservative majority while losing the nation’s shared respect for the legitimacy of the Court and the Rule of Law. That would not be a “good deal”. Senator McConnell, when you do something as patently and obviously outside of the bounds of fairness, equality, and lawfulness as denying a hearing to one president for reason of proximity to an election, then turn around and grant the same hearing to another of your party, you erode, degrade and will ultimately destroy our nation’s sacred basis, that we are united in being governed by consent and the rule law.

The Rule of Law has been defined as “a principle of governance in which all persons, institutions and entities, public and private, including the state itself, are accountable to laws that are publicly promulgated, equally enforced and independently adjudicated…”

Let me tell you what the “rule of law” has meant to me. It has meant that my parents taught me, and I taught my child, that the police are our friends. That when I choose charities, I include national and local police. That when, as an emergency physician, a police officer comes to see me that I take them, sometimes out of line, as quickly and effectively as possible in recognition for the service. That on those times I have served as a juror I have, whether rightly or wrongly, taken the sworn testimony of a police officer as having more weight than the accused against whom the officer is testifying, and convinced others to do so. That in general I offer respect and gratitude to the officers of the court and of the law, and finally – and most importantly – that I obey the law, do not attempt to skirt it, even on my taxes, even when I think I could do so.

Your party has been trumpeting on about the “illegal” entry of persons into this country, but you yourself have, and are, undermining, compromising, and ultimately destroying the very respect for law you insist on. I suspect this is not only true for me, but true as well for tens of millions like me.

President Obama had the legal right and duty, when a vacancy came up on the Supreme Court, over a year before the end of his legal tenure in office, to name a replacement. You were derelict, and intentionally so, in your sworn duty and legal obligation to advise and consent. That in itself compromised my respect for the rule of law. And by extension those charged with supporting it. It left my respect for institution severely damaged. But you would have a chance to shore it up. If you do not you will leave it hanging by a last thread if at all.

The precedent of not considering the legitimate nominee of a sitting President was at best questionable. However, if you were to apply that very same standard now to a President of your own party, it might serve at least temporarily, to shore up some shred of belief and respect for that, we would like to believe, impartial and legitimate institution of our courts and laws.The issue could then be, as it should be, impartially adjudicated at a later time.

If, however, you go ahead in what even to you must clearly be a hypocritical and obvious deviation from the notion of the law applying equally to all, then you will, for me at least and I suspect for millions of others, permanently compromise, subvert, and leave in taters what has for me been, up to now, a heartfelt respect for the institution of law in our nation. If the Supreme Court is compromised, the Law is compromised. If the law is compromised, respect for its enforcement is also compromised.

In such a case, I myself, for example, a hitherto very compliant and law abiding citizen would no longer feel it incumbent to support the institutions of the law. Those should be based on equality, impartiality, and fairness. But if, when in power, you don’t support them, then why should I?. Not that I would start undertaking ‘criminal acts’, I wouldn’t. I would no long feel inclined to count law enforcement as a primary target for my charity, nor feel it necessary to automatically give the ‘benefit of the doubt’ to the police in a court of law. As representatives of a system whose integrity is, at least meant to be, above question and above politics, I have done so. In the future, I am not so sure.

I hope that you could find your long term duty, and the best interests of this nation, to stand, politics and personal preferences, and servility to your party aside, for the fair, impartial, and equal application of the rule of law. Then I would also continue to struggle to do so. If, however, you will not, and you just do what you have the temporary power to do, then why should I stand for the law, for fairness? I think that the overall diminution of respect for our legal structure and norms is not a legacy you want to leave. That would be a bad trade for your conservative justice. A bad deal.

I know the chances of you every reading a word of this are close to zero but I hope you do, and I hope you consider as you rush toward trying to cram a conservative enough candidate through a deeply divided senate to please a clearly divisive president, what the long term implications will be. Your conservative justice will, last for decades as is well known.

But the lack of a common and shared notion of legitimacy, the lack of respect for the institutions of our nation, the lack of regard which your actions will create for the notion of the rule of law and those who enforce and adjudicate it will last far, far longer.

Consider it, Mr. Senator. Consider the real duty is, of those sworn to uphold our constitution and the rule of law in our nation.

With respect,

A citizen who has traditionally loved and supported our nation for its sincere attempts to govern itself through the rule of law and the principles of democracy.

Some Closing Arguments for the Election of Hillary Clinton

Clinton image

I. Hillary Clinton is widely acknowledged to have the edge on intellect, reasoning, foreign and domestic policy experience.

A. On Tuesday a letter was signed by 370 economists, including 19 Nobel Prize winners, saying that HRC’s economies would be better for the nations, Today the respected journal The Economist endorsed her

The position held by these 300+ economists is clearly echoed by foreign policy experts , a prominent group of GOP experts in foreign policy, Even Republican foreign policy experts have cautioned that Donald Trump would be dangerous to the nation’s security.

The prestigious journal Foreign Policy, hitherto bipartisan academic journal has broken its long-standing tradition and endorsed Hillary Clinton, as has the Atlantic Monthly. In fact, over 186 major newspapers, including NYT, LA Times, Washington Post, and just recently The Economist have backed HRC. Many of these are traditionally Republican.

B. Yes, six papers have endorsed Mr. Trump, about one thirtieth of those endorsing Clinton. They are the St. Joseph News-Press, the Santa Barbara News Press, the Waxahachie Daily Light, The Hillsboro Ohio Times-Gazette and the Las Vegas Review Journal.

Few reasonable persons would argue that HRC is not clearly more experienced, capable, intelligent and competent than Mr. Trump. Still many oppose her because they believe she is so ethically flawed and criminal that they can’t vote for her. Which brings us to the next argument.

II. The long standing drumbeat of accusation and innuendo, including the FBIs recent suggestion that they are looking at new emails, without knowing if they are pertinent, fits into a long standing pattern of suggesting that HRC, and President Clinton are engaged in some sort of ‘vast criminal conspiracy’ and they suggest her ‘crimes’ range from theft to perjury to murder. In fact, she has NEVER been charged with a crime, any NONE of the dozens and dozens of investigations uniformly by Republican investigators have ever found evidence of crime, or wrong doing.

One cannot document this argument nearly as well as I’d like here, but an earlier argument on this same site details a rebuttal to these accusations, and one hopes that if there is anyone who really knows in their heart that HRC is the more capable but somehow cannot abide the idea of her ethical challenges, one might suggest they please take the time to see that rebuttal of the innuendo.

III. Mr. Trump has challenged and subverted those very things that actually make America great.
Our most fundamental liberties are the liberty of speech, press and religion. He has said he would exclude people on the basis of their religion, he has thrown reporters out of his rallies for disagreeing with him, he has repeatedly advocated for violence against protesters exercising their right of free speech. He has called for torture. He has called for the killing of the families of adversaries. He has called for jailing his political opponents. “Lock her up”, when she hasn’t been convicted or even arraigned for a crime? I think they call that kidnapping, so he advocates what might be a capital offense in some states. He has suggested that gun rights advocates could might be able to prevent HRC doing what they like…you know the implications. He has stiffed his employees, probably cheated on his taxes or at best bent the rules but he will not release his taxes for us to know, and his statements about the reason are not, shall we say, true. As a matter of fact people keep lists of his statements which, to put it politely, are not correct.

IV. Our children look to our leaders as role models. HRC may not be the angel her supporters feel she is, but the argument that he is a better role model is so false as to be, well, insulting.
Even if you assume the worse, that HRC was so sloppy as to leave a confidential memo on an unsecured source how would that ‘crime’ stack up against Mr. Trump’s demeanor in this election? He started by saying Mexican immigrants were rapists, all but “some whom, he assumed, were nice people”. He went on to infer an native born American judge couldn’t be fair because of who his parents were, inferred that a respected female right wing new-caster couldn’t be fair because she had “blood coming out of her…what-ever”. He has insulted, and perhaps assaulted woman, on tape!

V. The potential downsides of Trump presidency outweigh the potential downsides of a Clinton presidency by a large margin.
Markets are in the business of assessing risk. Here is an image of the Dow Jones industrial average since Friday October 28, when the FBI announced it was looking at the possibility of other emails. Until that announcement, an HRC presidency was considered by most to be inevitable. Here is what happened since that announcement:slide-in-market

Moody’s Analytics has analyzed a Trump presidency and found it likely to lead to very negative consequences for the American economy. They predicted, in contrast, a large positive effect for a Clinton election.

The Economist, another respected journal, listed a Trump presidency as one of the top ten global risks and just today endorsed HRC.

Mr Trump endorsed a Brexit vote, calling it “taking their country back”, and compared his victory to the unexpected Brexit victory. Let’s look at the effect of Brexit on the British economy. The following is a graph of projected British growth pre and post Brexit:bexit

The data projections, from reliable sources such as the Bank of England, Thomas Reuters show a clearly decrement in estimates of GDP and growth.

This parallels very closely what could be expected, America Great rhetoric aside, from a Trump presidency. Or at least so say Moodys, the Economist, and several hundred prominent experts including numerous Nobel Prize Winners.

VII. In summary, HRC represents a better political philosophy, one which addresses better the concerns voiced by the supporters of her opponent than his would. She is more capable, more experienced, supported by far more economists, foreign policy experts and incomparable more and better editorial boards. Her temperament is vastly better for the position, and the objections to her have been, (pun intended) trumped up, exaggerated innuendoes and implications, none of which have ever been shown meritorious.

The arguments above are passionate, but they are logical and supported.

An election is a time to make an intelligent and informed decision, not a time to vent anger. I know the decisions I have made when I have been angry. They are not always the best decisions.

If someone is asking you to make your decisions out of anger and resentment for the system, you might not be making the best decisions.

Think it over.

Principle over Personality, Part II. The case for a liberal approach to the issues of globalization, trade and immigration.

trade-policy-review-photoclintontrumpimage This is Part II, the second article in which my hope is to frame the election not as a contest of personalities, but rather with recourse to the differing political philosophies, progressive versus conservative, which underlie the platform and vision of the two parties and candidates.

Between these two personalities of the candidates, and the baggage that each brings, from the constant reminders of email controversies, allegations of sexual predation, the inflammatory rhetoric and insults, discussions of temperament and the like, so much attention has been directed at two individuals and the issues of their personae, that almost completely lost has been any awareness of the two governing principles being contrasted. Ultimately, while the personal peccadillos of the candidate are of key importance, no less so is their approach to governance.

In Part One of this article I argued that a progressive, “liberal”, center left approach to government, at the present time, was most likely to solve the overall threats to our society, and world.

In this, Part Two, I would like to drill down to the issues which seems (when any issues are discussed at all) to get the most attention. That is globalization, trade, immigration – basically our relationship to the outside world and how it effects our overall economy, our employment picture, and how the benefits of the last seven years of recovery have been distributed, or rather not distributed throughout our society.

I will try to research the benefits and detriments of so-called globalization, whether it is inherently harmful to our overall economy and also to the middle and working class, and whether the damage done, if any, can be corrected by different trade policies and barriers to illegal immigration. It is worth considering whether, regardless of the personalities involved, liberal policies would be more helpful in alleviating and addressing the distress caused by globalization, or whether conservative policies would be better. I will argue for the former.

I am aware that at this stage of the game, the election may come down primarily to personality, whether the number of people who view Hillary as a cheat and liar outnumbers those who think Donald is a megalomaniacal fascist and sexual predator. Perhaps that is the nature of elections in this day. Still I think some consideration of the political principles which ultimately inform the two camps is worthwhile, and I hope I can draw distinctions which a reader might find useful.

Globalization and the differential effects on different segments of the work force

It would be pointless to argue that “globalization” has been of universal benefit. It has been of mixed blessing and detriment. Even experts who have advocated for increased globalization argue, that globalization has failed to live up to its potential” to bring benefits to both the developing and developed world.

On one hand, economic analysis shows a beneficial effect of globalization on overall growth.

Some economists have a positive outlook regarding the net effects of globalization on economic growth, citing variables such as trade, flow of capital, GDP per capita and direct investment. However the largest effect has been in the transfer of wealth to well-educated and technically skilled segments of the economy. For those not at the top, however, the benefits have been considerably less. It has been noted that

“as labor-intensive industries move to developing nations, demand for labor in the United States decreases, thus reducing wages for non-college educated workers. At the same time, globalization increases demand in the United States for professionals, skilled labor and capital, thereby increasing incomes for college-educated workers and widening the gap between the rich and poor.”

The need to compete with workers in poor countries leads to decreased wages for non-college educated workers. Certain domestic industries, ranging from consumer electronics to textiles are “endangered due to comparative advantages of other countries” Further, growth in competition which inevitably follows growth in trade leads to domestic companies having to down-size to improve efficiency and increase profits. (Labourec

It is interesting that globalization has also lead to a worsening of the position of unskilled relative to skilled labor in developing markets.

Stiglitz, an economist known for his concern over growing inequality, argues that this is because special interests have constructed the rules to benefit themselves and that has lead to the detriments to those not so happily connected. He was referring primarily to the growing imbalance between rich and poor, industrialized north versus developing southern global economies, however the success of Donald Trump’s candidacy in bringing out real passion, real anger over this issue is clear evidence that such disparities exist in out developed country as well.

Donald Trump’s answer to the adverse affects of globalization on lower economic sector wages is to institute a form of trade protectionism. While this may have short-term benefits, in the long run it lowers general competitiveness and weakens overall world growth, as it was said to do in the great depression and lead up to the Second World War. At that time short term and temporary gains in local employment were ultimately followed by longer-term decrements in trade, productivity, and prolongation of depression. Isolation of American products from international competition has not been shown to increase, in the long run, the competitiveness of American industry, as was demonstrated by the growth of Japanese presence in the car industry at a time when American’s rested on an increasingly non-competitive standard.

There are real questions about whether, for example, NAFTA had a net benefit or gain. One recent Wharton school of business analysis concludes that, while there have been a net loss of some jobs, automotive jobs, for example, from the United States there are certainly gains for North America, and that had there not been a NAFTA, most of the jobs that have gone to Mexico would have gone to China. Interestingly enough, the author also concludes that the NAFTA facilitated improvement in the employment situation in Mexico has brought migration of Mexicans into the US to a virtual standstill. That is not what we would hear from Mr. Trump.

There is not one single “liberal / progressive” view on whether to increase globalization, and many well remember that in the primaries the more progressive wing of the Democratic party looked with great suspicion on a process which enriches the upper echelons to the detriment of the workers. However I believe a center left position would look, rather than to kill trade with protectionist policies, to help workers retrain and retool for growing industries. That is, at least, Secretary Clinton’s position.

The effect of immigration on American workers

The effect of immigration on American work force and wages is complicated. Some reports have suggested that rather than lowering economic opportunity for native born Americans, immigrants actually increase the opportunities for American jobs and incomes. This is because of a concept called “complimentarity”, which essentially says that if a low paid, less skilled worker can help a higher skilled person to get their job done (the person who builds what the architect designs), then both benefit. Providing services that the higher skilled work might otherwise have to take the time to do, house keeping, gardening, home care and the like, frees them to do more productive jobs.

“Not so fast” argues GW Bush speech writer, David Frum . He argues that the positive effect proposed for native American workers will obtain only if the presence of the lower skilled newly arrived worker can allow and facilitate the transfer of the native to a higher paying job. In his examples,

“The immigrant groundskeeper can’t speak English very well, so the lawn service hires a bilingual Mexican-American to supervise him. The rising numbers of immigrant nannies call forth specialized payroll firms that hire native-born workers to process checks and pay taxes.”

Frum goes on to argue that any positive effect of immigration might not really occur. It is not so easy for, essentially blue collar workers to move from less to more skilled jobs. “Up-skilling” as he calls it, requires time, effort, money, flexibility and it can “force older workers to begin again at a time in their lives when they felt settled to risk failure at a time in life when risk is not appreciated”.

Given these challenges, which are admittedly very real, it is not such a stretch to see why an apparently simple and straightforward solution such as Donald Trump suggests is appealing, and not so easy to demean or laugh off. The fact that these concerns are real, persistent and vocal on the part of Trump and his supporters, it is incumbent on a liberal, progressive and Democratic candidate to say how she would address the concerns.

How might a progressive approach the threats to worker well being from Globalization and Immigration?

The effect of Education. Globalization is surely not without its detrimental effects, however there are opportunities created for those with more competitive educations. Unfortunately for the US, the presence of a globalized increase in competition for lower skilled jobs, and an increase in the value of jobs that require improved education is occurring just at the time when the position of US education with respect to other countries has decreased. Due to increased international educational efforts, especially in emerging economies such as China and India, the US has fallen from 1st to 8th nation in the world in the percentage of students finishing high school.

Our competitiveness in advanced educational skills has fallen even more dramatically. In a compendium of recent studies we have fallen to 14th in reading skills, 17th in science, and a whopping 25th place in math! In other words, “the results from the world’s global education report cards show that American students are not well prepared to compete in today’s knowledge economy. A host of developed nations are surpassing us in education”.

The Effect of Health Care Costs on American competitiveness

It has been long known and well documented that the high cost of health care, relative to other developed countries, and the fact that it falls mostly on employers can have adverse effects on the global competitiveness of our industries. Put simply, if an American corporation has to factor the costs of health care for its workers into the price of a product, especially when that cost is high and growing, it forces the product to be more expensive and therefore less competitive.

Asking workers to forego healthcare in their contracts is well known to be a non-starter, but any system in which some of the burden is shifted from employers, and some of the costs increases of health care are mitigated would tend to increase our competitiveness.

Analysts of the effect of the Affordable Care Act have concluded that, while it is too early to know for sure, (and there are clearly some fixes needed), there is a real possibility that the provision of near universal care, care whose cost is rising more slowly, and care which can be separated from the burden to the employer may make our industries more competitive. Certainly a liberal progressive agenda would seek to improve on the promise of more universal and less expensive health care, something which the conservative surely would not.

So what could a more progressive, or center left administration do to address the damage to the American worker which globalization and immigration have created, and why would these responses come more likely from a democratic administration? Here are some possible answers.

1) Investment in American infrastructure would create jobs and opportunities for workers which are much harder to “out-source” to other countries. I have previously argued (see Part I of this article) that such a massive investment in infrastructure would require public private partnerships, debt assumption which only the full faith and credit of the government in partnership with industry could accomplish, and some element of public planning. All of these are more likely with a progressive administration.

2) Public investment in education, both at the primary level, but more to the current point at the retraining level would help make American workers more competitive compared to workers in emerging economies where educational advancement is occurring more rapidly.

3) Public efforts both improve the economics of health care delivery could relieve a tremendous burden from American export industries. Thousands of dollars are added to American cars, for example, decreasing their international competitiveness. Although the “public option” is currently too progressive by far to take hold, certainly public efforts to reign in spending are needed for us to remain competitive, and a return to an unregulated fee for service, such as might occur with the repeal of the Affordable Care Act runs the risk of putting the competitiveness of our products even further back.

In conclusion, I have tried to analyze how a liberal, or progressive agenda might approach one of the most glaring issues of the day, compared with how a conservative might do the same thing. I have tried to do so without a single reference to either candidate’s personality, temperament or trustworthiness. Certainly those issues are not without their importance, but I believe we, as an electorate, would be better served by far to try to debate the issues from the standpoint of principle over personality.

My conclusion continues to be that while there is not easy fix, a liberal, progressive, center left agenda continues to be the one with the most chance of addressing both the longer global issues (see Part I) and the more current issue of globalization, trade and immigration.

Beyond the Personalities, A Case for Progressive over Conservative Polices, Irrespective of the Candidates

conservativeclintontrumpimage

The present election cycle has focused almost exclusively on the personalities, temperament, idiosyncrasies and supposed inadequacies of the two individuals running for the presidency. Lost, in large measure, has been a serious discussion of the most important issues, and lost completely is a discussion of the underlying principles which would inform a discussion of the two parties and the two approaches to government.

I believe that we are losing, in this personal slugfest, an opportunity to engage in the investigation of those underlying principles. Were we to bring the basic concepts, reasoning behind, arguments for and against, and implications of the progressive platform versus the conservative one, we could at least, as a nation, take steps forward more guided by an underlying conceptual structure, than the present teetering between issues and personalities of the day.

I hope to make a plausible argument here that a central, liberal, “progressive or left” leaning conceptualization for the role of government and its efforts is better for this nation right now than the conservative “right” leaning approach. I think that argument can be made even were we to have two equally capable and equally untarnished candidates. I will leave untouched for this article whether that happens to be the case or not.

I will make this argument with the points which follow.

Questioning the Basis for the Moral argument for conservatism.

I assert that the romantically imagined ‘rugged individualist’ argument for a moral basis for conservatism is a flawed argument. The argument, stated quite articulately and compellingly by Ayn Rand and F.A. Hayek, holds that when an individual alone, by dint of their own personal capacities, talents, efforts, courage, willingness to take risks, to work tirelessly, suffer mightily and bear any hardship to create something in the world, they should be able to reap, unencumbered and unfettered, the benefits which result from the fruition or success of their labors.

This argument is further extended by the assertion that the way in which the less gifted and accomplished majority surrounding that productive individual can share in the benefits produced by that individual is only through the coercive power of the state, either implicit or explicit, to compel the individual to give away from what is rightfully theirs to those who did not share in its production. This has been called a “Road to Serfdom”.

The argument finally extends to state that it is human nature to work for one’s own wellbeing, and that of one’s family, but once a productive individual finds the fruits of his or her labor being ‘redistributed’ more an more widely one’s motivation to work will crumble, and everyone will sit around waiting for others to do the work (after all, why should they do anything) and the productivity of the society will collapse.
This is, as I can see it, the clear principles which underlie the right, the conservatives, in their conception of national policy and finance. All of the concern about ‘redistribution’, tax structure, the size of government and regulations obtain from this underlying structure of thought, that the individual creates and produces, and the government has no right to interfere.

The argument is flawed for two basic reasons.

First, although there are exceptions, the vast majority of those who ‘produce’ do not achieve what they achieve in a vacuum. Most people who “make it” do so within the context of considerably enhanced opportunity compared to less fortunately endowed. They are born into more successful families, endowed often with more intellectually favorable genes, but more to the point with more achievement oriented influence, they are held on the lap and read to from infancy, shown to recognize and reproduce letters almost from the time their little eyes can discriminate shapes. They get pre-school, nursery school, and, even when not enrolled in a better or private schools, they are usually lead to know from Day 1 that school is special, important to be taken seriously and exceled at. They are generally well supervised, often well tutored, usually well travelled and culturally enriched. Those meant to be successful go to summer camps, get riding lessons, learn a musical instrument and are expected to compete and succeed in literary, artistic and musical endeavors. They are, in a word, groomed. Not everyone who succeeds, but the vast majority. To assert that the world is like a race in which we all are given an equal start and is therefore somehow fair is simply not true. If a race were run where some started halfway to the finish line on bicycles and the others started behind carrying bags of cement, we would not call it fair. This is an exaggerated image, of course, but not completely off the mark. The underlying “fairness” argument for the conservative approach to government is, rugged individuals aside, not really fair.

Second, to the extent that the productive individual’s talent and effort are translated into a deliverable and reward-able product or service, still the vast infrastructure which was needed to allow its production and distribution do not belong to the individual, but are the produce of a vast history and society. The roads along which the products travel to market were made by hundreds who came before, on land which was settled by thousands in decades and centuries passed, defended by the blood, sweat, and tears of millions who died preserving the right to build into the future. The hedge fund hero or the dot com maven owe most, of course, to their own efforts, but a significant contribution to their success was made as well by the unknown communist comrade who fell at Stalingrad, or the son of an immigrant dying in the sands of Iwo Jima. “You didn’t build it someone else made it happen” was a line that earned President Obama a firestorm of criticism, but the speech articulated this argument quite to the point.

The rugged individualist, Man on his Own, is not really on his own. It is a romantic notion, I admit, and few adolescents can escape the thrill of Atlas Shrugged, but a fair and, I believe mature understanding of the way the world works will call into question the claim of the conservative rugged individualist that no one else has a share in their success. The claim is not accurate.

Notice I am not claiming, here, a moral superiority to the progressive view that we are “all in this together”. Most religious teachings argue a mandate to share with the poor. But I will not make this argument here. I only assert that the moral argument for conservatism is at best questionable, and if the moral arguments for the right and the left are, at least, equal, then we should look to what is most effective a way to run a society.

The “straw man” of socialism.

For the record, not even the so called socialists call for a system in which individuals are not rewarded for their individual efforts. While it is always popular to attack progressive agenda by calling it socialist and Stalinist, implying that the productive will work and the others will lounge, that is simply no one’s position. The progressive agenda admits the right of individual achievement and private property, but calls for broader distribution of opportunity and a more comprehensive safety net. It also calls for some segments of the economy which are traditionally private and profit motivated to transition to being viewed as societal and universal. As we progress now into the main points of the argument, it is at least dispensing with the view that the left is socialist and will lead to sloth. It is not, and will not.

Four Pillars of Arguments for a more liberal leaning worldview.

1. The enormous and growing disparity of wealth, income, power and opportunity

, but within the nation and internationally are inherently destabilizing and are the largest cause of increasing conflict and war. Although some argue that inequality has mixed benefits and threats, most view the level of increased inequality in the world as a threat. Certainly the majority of conflicts have some major discrepancy in opportunity as part of what might appear an otherwise sectarian struggle. Although no single point of view has a monopoly of concern over this growing threat, I believe it is clear enough not to need specific citation to know that liberals and progressives view wealth inequality as threat to the nation and world stability, while conservatives tend to favor policies which only promote that inequality.

2.
Those challenges which must be met to bring our nation and the world further into the next century will demand investment and coordination

of resources which can only be done with a national, somewhat centralized public private and planned approach. The needed investment in urban infrastructure and the creation of world class city regions, investment in the complete overhaul, modernization and maintenance of local, regional national and international transportation infrastructure for both people and goods, the massive development of information infrastructure, health infrastructure and so on will require, most likely, tens if not hundreds of trillions of dollars world wide over the next decades. It will require intelligent planning and coordination on a scale unimaginable for a single private enterprise.

Private entities could not have put a man on the moon, nor could they have won the Second World War. There is a time for a coordinated, public and national response. I would assert that time is now. A progressive and liberal government could see that. A conservative outlook will not. Partially that is because:

3.
The next step in our national evolution will require a very long-term vision,clintontrumpimage

conservative

one that sees our development in the context of technological and social changes extending into the next several decades. It is highly likely that the national “balance sheets” would have to be ‘in the red’ for several decades before this generation’s investment pays off for our children and grandchildren. Corporations report to their constituencies on a quarter-to-quarter basis. A government informed primarily by a corporate mentality simply is less likely and less able to respond to the longer view.

4.

    The majority of issues of the conflict in the world

can be easily framed in a black and white, us versus them, good guys versus bad guys, we win means you lose motif. And, sometimes, that is true. But more often, to really get a longer term, difficult problem solved requires extensive cooperation, negotiation for mutual benefit, give and take, willingness to hear another’s view points, and a willingness to come out of an argument having achieved some but not all of what one wanted. Efforts by recent conservative administrations to impose unilateral and non-consensual solutions by unilateral force, for example in Iraq, have been, I think most observers would agree, been less than successful. The effort to achieve a fair, sustainable, if not total solution in Iran used a different, consensus building approach.

The rhetoric of the guys with the white hats sallying forth to confront evil is very appealing, but rarely, not never, but rarely works. At least not without broad consensus building and compromise. A liberal and progressive agenda tends to look for compromise, consensus, and diplomacy, using military intervention sparingly and as a tool of diplomacy. That is sometimes, but, I would assert, less often the approach of a conservative government.

I could go on to list specific issues, climate change, our relationship with our super-power rivals, our approach to regional conflicts, tax policy and the like, and view review them in the context of these pillars of difference. I will not do so at this point, only to reiterate that from the standpoint of what can clearly be argued as our greatest threats and challenges, a left of center government, sustained over a several election cycle will be much more effective in address those threats and challenges than any but the most moderate center right.

The specific threats to the American electorate in terms of globalization and automation are real. In the next part of this article I will attempt to address those within a more liberal leaning framework, which is, I believe, much more likely to succeed than one steeped in conservatism, nationalism and xenophobia.

Notice I have not considered the persona characteristics of the two candidates for office in this article. I have attempted to argue for voting liberal rather than conservative in any situation in which the two candidates are of equal capacity, leadership qualities, character and temperament. I suppose, if there were a situation in which the candidate of the Republican or conservative faction were clearly superior, I would consider for one election voting for that candidate.

I do not believe that to be the case in this election, so will continue to vote for the candidate I believe best represents the more liberal leaning, center left approach to governing. I hope I have demonstrated it to be more effective, and at least as well morally grounded.

The Case Against “The Case Against” Hillary Clinton

Clinton imageIt is my purpose of this article to “unpack”, “debunk” or “deconstruct” the constant and pervasive litany of accusations and insinuations against Hillary Clinton. It has become a well known mantra and fundamental to all the Republican attacks in this campaign that the ‘American People do not trust Hillary’.

Few attacks are made against her policy vision, almost all against what she has or has not been transparent about in the past. This distrust has lead to the fact that a candidate with as questionable qualifications as her opponent has has drawn dead even in the polls as of Labor Day. A Google search of “Hillary Clinton Lies” easily reveals multiple sites dedicated to simply listing and cataloguing the “lies” she has supposedly told the American people. The drum beat of accusation and insinuation is constant and unflagging, and is meant to establish by repetition an aura of credibility and non-deniability about these constant accusations. Individual ‘new’ revelations, for example that she may not remember a specific discussion about email confidentiality are framed within this over arching narrative of supposed Clinton dishonesty. This is meant to have the effect of giving the new “revelations” more traction that the single event itself might have, as it is framed as part of a story, a collection of instances and innuendos.

Although the constant drum beat of suggestion and innuendo has undoubtedly taken its toll, I believe that a systematic review of the accusations will show that although long and oft repeated, they really have little or no merit in assessing the overall trustworthiness, veracity, intention and capabilities of Mrs. Clinton. They are a story concocted to imply something about the candidate which, I believe, genuine and fair assessment will find vastly exaggerated if not down right untrue.

Personal disclaimer in order. I believe that given the difference in the positions, visions, the morality, the experience and capability, and, yes, the temperament of the two candidates, I personally believe that the case could be made to vote for Clinton even if she has lied or exaggerated about, say, the circumstances of her landing in Bosnia, whether one or all of her grandparents were immigrants and even exactly how consistently she characterized the motivations of the attackers of our consulate in Benghazi during the first hours and days, pr even her email server. However I understand that the implications of dishonesty and untrustworthiness have stuck, so I think it worth the time to try, through my reading of publicly available sources (the only ones I have access to), and my own reasoning to debunk or at least place into context the vast attempt which has been made to, in my judgement, recycle a collection of old accusations to try to make some case where, really, there is none.

There is no lack of availability to the collections of accusations.

1. She reported landing on the tarmac in Bosnia under sniper fire, when in fact the video proves her landing was completely peaceful.

2. She left the White House “dead broke” when in fact she and President Clinton had resources and were soon very wealthy.

3. She claimed that her grandparents were all immigrants when in fact only one was an immigrant.

4. She was named for Sir Edmund Hillary when in fact she was born before he climbed Everest.(Sounds like something her mother might have told her when she was a little girl to motivate her, but it is hard to ascertain that now)

5. She claimed she tried to join the Marines when it appears that at the most she considered joining the Army.

6. She accused Trump of making “all” his products overseas, when in fact he makes some products in the US.( Fair enough, he makes “many or most” of his products overseas.)

7. She stated that whites are three times as likely to get a mortgage as non-whites. (The truth is that African -Americans are almost three times more likely to be rejected for a mortgage, but that is mathematically not exactly the same, since whites are only about 10% ‘more likely’ to get a mortgage.)

8. She claimed that under the Affordable Care Act health care costs are lower than they have been in fifty years. (In fact, the GROWTH of health care costs is the lowest it has been in fifty years, but the increase is still there)

9. She said “Mike Pence “slashed” education funds for his state. (Fair enough, he didn’t slash them. He cut the INCREASE in education funding in half from what it’s previous ten year average had been, making Indiana the 35th state of the union in education spending. “Slash” was an exaggeration.)

10. She exaggerated her role in the Northern Ireland peace talks, saying she was instrumental when the actual negotiators described her as peripheral.

11. In the Whitewater scandal from the early 1980s, several people were indicted and served probation and time for a shady real estate deal. The Clintons lost money in that deal, but were accused by some of using their political influence to gain financial advantages for some of the players. The Clintons were never charged with a crime but the implication has many times been made they should have been.

12. Finally, the two largest accusations. Benghazi, the accusation being that Hillary was responsible for grossly negligent mismanagement of a deteriorating security situation and later lied to the families of the fallen and the American people about it. (will treat in some depth below), and

13. She maintained her private email server illegally and compromised national security by doing so.

There are few really trivial ones which can find combing the email lists, (She apparently expressed she had concerns that Chelsea had been riding her bike on September 11 when she knew she was safe at home), but the twelve accusations and innuendos above are the main stuff of attack.

Of the Baker’s dozen listed above, again, all taken from prominent sites seeking to defame Clinton, several are, in my opinion, trivial enough to dismiss. Does it really matter if she says she was named after Sir Edmund Hillary? One can easily imagine she heard that somewhere as a child, can’t one? Parents tell their children things like that to motivate them. I don’t think this makes Hillary a liar, really, do you?

Is it really a deal breaker if when she speaks of her grandparent’s immigrant experience, only one was an actual immigrant, the others being children of immigrants?
Does it really matter that she said whites were three times as likely to get a mortgage when she really meant, correctly, that blacks are three times as likely to be refused one? Other “lies” listed on these most prominent sites are, admittedly, not completely accurate, but are they really lies? Pence didn’t “slash” education, true. He cut its growth in half. Fair enough. Trump doesn’t make “all” his products abroad, perhaps just most of them. The Affordable Care Act decreased the rate of growth of health care spending more than any time in fifty years, but health care costs still grow. Do these make her the great liar she is purported to be?
I think not.

So, given that the litany of “7, 10, 12 or 20 major lies” is clearly nonsense, still there are some serious concerns with things she has said which might not bear intense scrutiny. I will focus on attempting to “Debunk, unpack or deconstruct” the four most often cited and potentially concerning accused or suggested lies. The accusations, and my response follow.

#1. The Arrival in Tuzla. In her 2008 campaign against then Senator Barack Obama, Hillary Clinton attempted to draw a distinction in her record of service by citing her experience in travel to troubled areas and said that she had “landed in Bosnia” under sniper fire. Review of the video and memories of others shows that she actually landed in peaceful situation and was greeted by a child with flowers. She later had to apologize for this miss-statement. Donald Trump has cited this episode several times as an example of her being a “world class liar”.
Let’s see if we can shed some light and perspective on this episode.

Review of the reports from the time and the statements made demonstrates the following:

Hillary Clinton made a trip to Bosnia in 1996. From the Washington Post story of the time, we see that one of the speech writers on the flight with her reported (in her words):

“I was on the plane with then First Lady Hillary Clinton for the trip from Germany into Bosnia in 1996. We were put on a C-17 — a plane capable of steep ascents and descents — precisely because we were flying into what was considered a combat zone. We were issued flak jackets for the final leg because of possible sniper fire near Tuzla. As an additional precaution, the First Lady and Chelsea were moved to the armored cockpit for the descent into Tuzla. We were told that a welcoming ceremony on the tarmac might be canceled because of sniper fire in the hills surrounding the air strip. From Tuzla, Hillary flew to two outposts in Bosnia with gunships escorting her helicopter”

Another witness, a diplomat experienced in Bosnia at the time reported a briefing that the then First Lady received as follows.

“I found myself almost rolling my eyes as the briefer went on and on about the possibility of snipers and what the plan of action would be (essentially, making a beeline to the armored vehicles parked nearby). As the briefing continued for what seemed like half an hour, one of the journalists, a little worried, asked me if it was going to be that dangerous. I explained I was not going to contradict the briefer, but, whispering, I told him I seriously doubted we would encounter any such threat. For heaven’s sake, I explained, it was a U.S. military base with thousands of troops, where there had not been a single such incident in the three months they had set up camp. He was relieved, but those more attentively listening to the briefer were not, as they contemplated that soon they could be running for their lives across an open tarmac a la “sniper alley” in Sarajevo.

Thus, we have two witnesses who reported at the time that Hillary Clinton and her party were briefed at some length regarding the possibility and presence of snipers active in the area and that they were kept in an armored cockpit and issued flak jackets. As it turned out, threats of snipers were clearly exaggerated, and the arrival was safe and welcoming.

Now, when she recalled the episode some twelve years later, in 2008, Hillary Clinton at first recalled that she had “landed under sniper fire”. Video shows she didn’t and she is thus labelled a ‘world class liar’.

Isn’t it rather possible, just possible, that she may have remembered what was by several reports a threat taken seriously enough to prompt an extended briefing about sniper fire? Isn’t it possible that this threat, probably not routine for anyone, even a First Lady, took a higher place in her memory, twelve years later, than perhaps the subsequent events might have justified? Especially given that her only child was with her? Isn’t that explanation possible?

Hillary Clinton landed in Tuzla in 1996 after being briefed extensively about the possibility of sniper fire. This is confirmed by more than one concurrent witness. She remembered, when recalling the incident twelve years later, the sniper, even though the warned of fire had never actually materialized. A memory reported with a little exaggeration of the danger, to her own advantage. Yes, perhaps. A “world class liar”? Ask yourself. Being fair.

2. The Whitewater Scandal. The accusation is that in participating in a complicated land deal, the Clintons and several co-investors were involved with some shady and mysterious transactions, and that Bill Clinton used his political clout as Governor to obtain favorable financing for some of the investors.

I am not sure it is worth the time to attempt to disentangle and go through a point by point rebuttal. Even at the time few could really figure out what the issue was. This is so long ago, so obtuse and, since there was never an indictment made despite several investigations that it really shouldn’t even count as innuendo, but for those who want the details, there is a long account available.

For the sake of the present discussion, I would just observe the following two points.

One, the Clintons themselves were never prosecuted, after three separate inquiries found insufficient evidence linking them with the criminal conduct of others related to the land deal, and,

Secondly, on April 22, 1994, Hillary Clinton gave an unusual press conference under a portrait of Abraham Lincoln in the State Dining Room of the White House, to address questions on both Whitewater and the cattle futures controversy; it was broadcast live on several networks. In it, she claimed that the Clintons had a passive role in the Whitewater venture and had committed no wrongdoing, but admitted that her explanations had been vague. She said that she no longer opposed appointing a special prosecutor to investigate the matter. Afterwards, she won media praise for the manner in which she conducted herself during the press conference. Time called her “open, candid, but above all unflappable…the real message was her attitude and her poise. The confiding tone and relaxed body language…immediately drew approving reviews”.

Considering the multiplicity of the deals, bankruptcies and suits which Mr. Trump is a part of, this issue should not be even considered in the equation. It should be noted, however, that the innuendo continues to be that the Clintons must have pulled off some nefarious criminal activity that they ‘got away with’. This implication colors all future stories. Perhaps as people who say they respect the rule of law, the fact that innocent until proven guilty should apply at least to the extent of innocent until EVEN CHARGED!

Let’s get to the ONLY two ‘real’ issues.

#3. Benghazi. The accusation is that the consulate in Benghazi was left woefully underdefended, given the deteriorating security situation in the region, that repeated calls for help were ignored and unheeded, that when the event occurred the response was incompetent and inadequate, but more to the point of Hillary’s trustworthiness, the accusation is that she attempted to cover up the true nature of the event, declined to call it terrorism, blamed it, deviously, on an an-Islamic video and “lied” to families about the true nature of the attack. She is accused of callousness and playing politics with American lives. Let us examine the event.

The circumstances surrounding these events, the placement, position, construction and defense of the Consulate in Benghazi, was well as its role and its relationship with the Embassy in Tripoli; the reasons we were in Libya in the first place, and the circumstances of Gaddafi’s fall; the intelligence assessments and responses to the now obviously fluid and deteriorating security of the Benghazi outpost, the distribution of security assets, relationships with local militias charged with defense and our contingency planning regarding possible risks are have all been investigated several times . Nine times, as a matter of fact. The connection if any between the apparently planned September 11 assault and a concurrent international furor over a video released that day, the details of what, when and by whom reports were made to the American people and what Secretary Clinton said to the families of the fallen have been investigated, debated and questioned both privately and publicly, officially and informally, now for nearly four years. They are complex and I don’t know that they can be completely disentangled in a few paragraphs here.

One point, however, deserves making. This point was made by Clinton at the beginning of her several hours of testimony, but bears, in my mind, repeating and elaborating here. The four Americans who died in the attack in Benghazi were not the first Americans to die by terrorist assault. Two hundred and forty Marines died in a truck bombing in Beirut under President Reagan ; and three thousand died in the Twin Towers under President Bush. Dozens died in the bombings in Tanzania and Kenya, nineteen in the Khobar towers , seventeen in the bombing of the Cole .

But while this was by no means the first, and certainly by no means the largest loss of life in terrorist attacks, it is to my memory the first time it has become used as a political attack. People asked whether the security of the Marine compounds appeared to be lax.Some publically wondered whether the Bush administration responded enough to the message that Al Qaeda planned an attack on US soil or that there were pilots who just wanted to learn to fly, not to land. Recommendations were later made, and put into place to address the fact that, as was said in the passive voice the “dots were not connected”. Unless I missed it, however, there were not eight investigations during which the security apparatus and intelligence community and national political leaders were publicly grilled to find and demonstrate fault. Not for 9/11, not for Beirut, not for the Embassies, the Khobar Towers, or the Cole. So, while it is certainly reasonable, and in fact necessary to dissect the event of Benghazi, to conduct the operational analyses and learn the lessons, it should be noted that the “review” of the events of Benghazi is unique both in its political targeting, and its vitriol, in any investigation in my memory. That is true, even though the casualties of this tragic event, in number, remain fewer than 1/10th of one percent of the number of casualties in other events which received non-personal and non-political scrutiny.

That being said, let us examine the record.

The most recent, most comprehensive, and, arguably, most politically motivated investigation was recently chaired by Trey Gowdy, not a noted Clinton supporter. The conclusions of this Republican, and admitted politically motivated committee regarding culpability, were summarized on page one of the 800 page report with the following key points:

1)Both the President and the Secretary of Defense ordered the deployment of military assets.

2)A White House meeting was convened but apparently split focus with the reactions to the YouTube Video. Despite there being “no mention’ and “virtually no discussion” of the video by those actually on the ground, half of the action items developed at the meeting referred to the video. This may not have seemed so out of place, of such low yield, or so politically motivated at the time as seems to be seen through the eyes of critics today. From a few sections further in this, again, Republican lead committee report,

“On September 10, 2012, the day Stevens arrived in Benghazi, American military forces were reminded to “do everything possible to protect the American people, both at home and abroad.” That day the President conducted a conference call with key national security principals to discuss the steps taken to protect U.S. persons and facilities abroad and force protection.

Leon E. Panetta, Secretary of Defense, one of the conference call participants acknowledged they were already tracking an inflammatory anti-Muslim video that was circulating on the Internet and inciting anger across the Middle East against the United States” and that they braced for demonstrations in Cairo and elsewhere across the region.” (These facts, I remind you, are from the report of Trey Gowdy’s Republican lead committee)
Due to the Arab Spring, it was a time of heightened concern for that region in general. In particular, the discussion focused on several areas including Cairo, Tripoli, Tunis, Khartoum, and Sana’a, due to intelligence indicating potential demonstrations could erupt in those areas.
Based on the September 10 conference call with national security principals and the President, the Defense Department placed its forces on“higher” alert because of the potential for what could happen.” Yet, the intelligence and the call for a “heightened alert” did not cause any actual adjustment in its posture for assets that could respond to a crisis in North Africa. Some assets were in the middle of training exercises, and others were in the middle of inspections. No fighter jets or tankers were placed on a “heightened alert” status.

SEPTEMBER 11, 2012

In the hours preceding the attacks in Benghazi , a protest of approximately 2,000 demonstrators assembled outside the U.S. Embassy in Cairo, Egypt.
Cairo is some 600 miles east of Benghazi. Plans for a demonstration in Cairo first began to ocoalesce in late August 2012 with the designated terrorist organization, Jamaa Islamiya, calling upon its supporters to protest the continued incarceration of its leader, Sheikh Omaar abdel Rahman, also known as the “Blind Sheik.”
Rahman is serving a life prison sentence for his role in the 1993 World Trade Center bombing.Additionally, in the days preceding the September 11 demonstration in Cairo, an Arabic version of a trailer for a little known anti-Islamic film, produced in the United States , was posted on YouTube.

We can wonder now, why a clearer differentiation was not made at the time between a pre-planned attack on the Benghazi compound and the more spontaneous outbreaks of region wide protest over the film, however it is not inconceivable that the conflation of the two was not political but really had to do with the so called Fog of War.
In any event, the committee’s report goes on to analyze the White House meeting.

3)Troop deployment was made contingent upon Libyan state agreement and direction to either Tripoli or Benghazi.

4) Further, despite the early recommendation to be at highest alert, the entire security apparatus was not present at the meeting due to the Vice Chairman of the Joint Chiefs of Staff being at a diplomatic dinner.

5) Military assets did not meet timelines, in some cases sitting ready to go for hours without orders.

6) Libyan forces with whom the CIA and State Department had developed relationships did not come to the rescue of the compound.

Further review of the Benghazi committee reports show that over both the long run and in the weeks, days and hours leading up to the attack, there are several areas in which complex events negatively impacted the security situation. The conclusions of the report discuss a failure of intelligence. One indication of the lack of real time intelligence is the fact that Ambassador Stevens, upon receiving a security briefing after having arrived in Benghazi was seen as ‘surprised at how far the security situation had deteriorated’, according to one of the briefers. Other examples include the fact that security which at been provided by one Libyan militia up until two days before Ambassador Steven’s return to Benghazi was suddenly withdrawn over criticism of the US government regarding a candidate which the militia thought was being supported in national elections. Another example is that security had been decreased in Tripoli, the capital of Libya where the actual American Embassy stands, so there were no extra agents to send to the smaller consulate in Benghazi.

I will not further detail my selection of portions of this report, it is readily available on line. I will just observe that despite a strong political motivation to do so, the committee specifically could not find culpability or bad faith in the way the Secretary of State handled the event.

As far as what the Secretary told the American people, here is the official GOP conclusion.

“Immediately after the attack, intelligence about who carried it out and why was contradictory, the report found. That led Susan Rice, then U.S. ambassador to the United Nations, to inaccurately assert that the attack had evolved from a protest, when in fact there had been no protest.
“But it was intelligence analysts, not political appointees, who made the wrong call, the committee found. The report did not conclude that Rice or any other government official acted in bad faith or intentionally misled the American people.”

As far as Clintons supposed mischaracterization of the event as not being a terrorist event,
“She never said that that Benghazi attacks were due to the video. Clinton has criticized terrorism. Clinton has criticized the video. Clinton has criticized protests and violence against US embassies due to the video. She never said the Benghazi attack was due to the film. She mentions the film and Benghazi in the same speech, but doesn’t blame one on the other.”

The results of our clearly, admittedly inadequate military preparation for the growing security threat in Benghazi, and failure to respond effectively in real time are a real tragedy, and one which we can all as Americans hope never occurs again. One would hope, that with the 9 investigations into the event, enough has been learned to try to assure such does not occur again. What is also clear is that the attempt to politicize this event is both unprecedented, and ineffective. Secretary Clinton’s role in Benghazi has been investigated intensively many times, some of which demonstrably with an agenda to take her down. There has never been a conclusion made in any of the official reports that she was in any way culpable.

Would Republican heroes, Bush and Reagan withstand the same level of scrutiny were, say, the wisdom of the placement of Marines in Beirut, or the addressing of the threat by Ben Laden, or the planning for a post invasion Iraq subjected to eight investigations from a hostile Congress? One wonders. It is said politics ends at the shores. I wonder how much our current Republican congress has embraced that notion.

4. The Email ‘Scandal’. Certainly, this is the accusation which has the most traction, and in large measure because there is the semblance of a “there” there.

To be fair, even the most dyed in the wool Hillary Clinton supporter has to concede that,

(1) the choice of a personal email address for government business is on its face problematic,

(2) that the use of such a server for classified or sensitive information puts that information at more risk, perhaps than a government server would.

(I say perhaps because there are now multiple instances in which the state department itself, a major political party, and even major industry servers have been hacked. It may well be, ironically, that secrets were just as safe or safer in Hillary’s basement than they would be on a government server, but then at least she would not be to blame!),

(3) when the use of such a server came to light she was not as prescient about the risks to her campaign and reputation as she should have been, and that she did not get out in front of the story quickly enough or transparently enough, and finally

(4) she has consistently attempted to minimize, belittle, dismiss and rationalize criticism of her actions with regard to the server.

These are all grievous faults. And “grievously has Caesar paid for them”! Were there to have been no Clinton email server controversy, the likelihood is that Republicans would be struggling to prevent a 50 state sweep, not being ‘dead even’ on Labor Day. It is a problem, it is a wound, it is a concern.

But before addressing this concern, though, please take at least take a moment an review my arguments that the Context of supposed Clinton Dishonesty into which this event has been placed is, upon scrutiny as outlined above, not really fair, and not really accurate. Then let’s proceed.

Secretary Clinton has many times acknowledged that his was an error, and that she would not make a similar error again.

James Comey, originally appointed to the Justice Department as Deputy attorney general by George W. Bush, appointed FBI director by President Obama. He was, at least until he disagree with the desired Republican outcome widely perceived to be fair.

Taking all into consideration, and with his reasons clearly articulated, the highest law enforcement official in the land put his reputation on the line to state that there was no basis for a criminal prosecution of the
Secretary. To fair minded Americans, it seems to me, that has to mean something. This even considering the number of ‘I do not recalls’.

It is completely valid to wonder, and pains even those of us who are Clinton supporters, to realize that having a private Email invited unwanted scrutiny and showed less than stellar judgment. It was, one has to agree, in Director Comey’s words, “careless’, perhaps even “extremely careless”, at least with regard to threat assessment. That is a concern for a US president, even the most die-hard Clinton supporter has to concede. And perfectly fair, then, to ask the American voter, taking each part of the public record available for both candidates, to consider their history of judgment.

Still, the fact remains, that in the judgment of the top law enforcement officer in the land, one respected enough to have been appointed by both democratic and republican presidents to the highest offices in law enforcement, Hillary Clinton is not a criminal.

It remains ironic that those who claim to be most in favor of “law and order” are happy to ignore law and order when they don’t agree with it. “Lock her up”, was the most often articulated platform of the Republican party. What is it called when you “lock up” someone who has never been charged, much less convicted of a crime? It is called kidnapping. That is a felony and in some states, I believe, was a capital offense. If the party of ‘law and order’ is calling for felonious assault on the freedom of someone who has never been charged or indicted, what does that tell you about the sincerity of their wish for real law and real order?
There continues to this day to be attempts to find some hidden ‘smoking gun’, close to a year and well over 30,000 emails later. There appears, at least after a year of intense scrutiny, to be none.

So finally, those of us who passionately support Hillary Clinton, and who wish to ask those who don’t to at least take a long, hard look again at the two candidates are left with four questions.

(1) Why is it that Hillary Clinton cannot consistently represent herself with the transparency, and capacity to accept responsibility for fault, which would lead others to see her as honest, trustworthy, and likely to learn from rather than repeat mistakes regarding transparency.

(2) Do those instances in which Clinton has either misperceived a threat, or presented herself or her decisions in such a way as to minimize her own culpability really constitute threats to her ability to govern effectively?

I cannot answer these first two concerns definitively. I would observe that taking responsibility for one’s errors, and public mea culpas tend not to be the stock in trade of most politicians, perhaps doubting oneself publicly is not a good survival tactile for them.I would also make one additional observation, based on my experience as a physician and that is this. As physicians, we do sometimes make errors, and errors which hurt people. If we could not, in front of our peers and teachers, admit and dissect our mistakes, we could not become better. This is the culture of the medical “mortality and morbidity rounds”. However, for the longest segment of our history, we have known that if we make these admissions of error too publicly, or to the wrong ears, we are likely to be sued. It is a dilemma. How do we privately learn from our errors without giving fodder to those waiting to take advantage, sometimes unfair advantage, of our honesty.

My guess, and it is just a guess, perhaps just something I wish to believe, is that Secretary Clinton has dissected every step in the error of her email saga, just as I am sure she has with the run up to the attacks on the compound in Benghazi. The current political climate, I think a fair person may agree, is not conducive to airing one’s errors in public. Still, even as in medicine, where the public stance has now shifting to early public acknowledgement and apology for error, it may have been a better time for the Secretary to have clearly and unequivocally acknowledged poor judgment, ‘confessed’ the error, and taken her chances with the sympathies of the press and public. Should she lose this election for failing to do so, it will be a sad irony for someone who worked hard on the Watergate hearings, where an otherwise remarkably skilled leader compromised his legacy for failure to quickly admit error and wrong doing. I hope that does not become the case, and would ask the reader to indulge be a few more moments of time in review of the next two finishing concerns we must ask ourselves.

(3) How do Hillary Clinton’s supposed ‘lies or concealments’ stack up against those of prior leaders? How does “email gate” stack up against Johnson’s Gulf of Tonkin Watergate, or IranContra, or the the run up to the war in Iraq? Or even the Monica Lewinsky scandal, which she handled, I think with real dignity? Even if she has mischaracterized her mis-remembered that “C” meant classified on at least three documents, where does this place her in the hierarchy of presidential dishonesty?

(4) Finally, this is, as we keep hearing a “Binary” election. I suppose, if Hillary Clinton were running against liberal Giants of the past, Clinton versus Roosevelt, Clinton versus Kennedy, Clinton versus Carter, or even against Clinton 42, Obama, or even Gore, Biden or Kerry, we might consider how important these, in my view, if not white, then fairly pale “lies” are. Even if she were running against a frighteningly practical, philosophically open, and central leaning Republican, one could at least ask the question. But running against Donald Trump?

I would ask the reader, please, in the name, not just of our future as a nation, but in the name of our tradition of giving people a fair and decent hearing, perhaps one of our best American values. Please examine the innuendos, the dark suggestions, the implications, the drum beat supposed accusation of fraud, lying, dishonest, “crookedness”, examine them in the light of the real data. I think for all the reasons outlined above, a fair consideration of the record will show that Hillary Clinton is honest enough and trustworthy enough that she should be considered, with respect to her opponent, not on this continued drum beat of suggestion, but rather on the merits of their positions, visions and arguments, and capabilities.

Because, in the long run, that is what our elections are supposed to be about.

Respectfully proposed,

Dr. Richard Nierenberg