While my attention remains on the resurgent conflict in eastern Ukraine, two separate articles by the BBC in December paint a rather persuasive portrait of the radical, ultra-nationalist character of partisan, paramilitary contingents on both the pro-Russian and pro-Ukrainian sides engaged in Donetsk and Lugansk. See:
Tim Whewell, "The Russians fighting a 'holy war' in Ukraine," on BBC News Magazine (17 Dec 2014), at: http://www.bbc.com/news/magazine-30518054
David Stern, "Ukraine underplays role of far right in conflict,"on BBC News Magazine (13 Dec 2014), at: http://www.bbc.com/news/world-europe-30414955
These separate reports reinforce a number of conclusions concerning the conflict over Donetsk and Lugansk:
1. Over the course of 2014, right-wing, ethnic and monarchical nationalists and supporters of the reconstitution of Russian imperial space, inclusive of Ukraine, backed at least to some degree by the Putin government and United Russia, hijacked the legitimate cultural and economic concerns of residents and Ukrainian citizens in Donetsk and Lugansk in order to transform local demands for greater autonomy into a movement for secession and unification with the Russian Federation.
In this respect, I think it is fully impossible to discern the actual aspirations of the local populations in Donetsk and Lugansk relative to the political, economic, and cultural future of their country (i.e. Ukraine) as a whole and their particular oblasts for the simple reason that these aspirations were taken up as foder for political manipulation by the Putin government, which further incited non-governmental "volunteers" from the Russian far-right to transform local discontent arising from the overthrow of the Yanukovych government in ways that, at least potentially, distorted the original intentions of Ukrainian citizens in these oblasts. That is to say, I doubt that the average Ukrainian citizen in these oblasts, no matter their ethnic origin (i.e. Ukrainian, Russian, or other) or degree of sympathy for the Russian Federation under Putin's leadership, actually would have opted for secession and unification with Russia. Furthermore, it is one thing to fear the possibilities of a decisive turn of the Ukrainian economy toward the EU in a region that has traditionally prospered from its orientation toward Eurasian markets (Russia and the former Soviet Caucasus and Central Asian republics) and to fear that a partisan revolution in Kiev might elevate the stature of intolerant, right-wing Ukrainian cultural bigots relative to movements more sensitive to the traditional linkages between these oblasts and Russia. It is another thing entirely to comprehend a conflict over eastern Ukraine as a struggle for the integrity of a Nineteenth century conception of Russia, in which the defense of pre-Soviet geographic boundaries, the spiritual and social-moralistic domination of Russian Orthodoxy, and aspirations for the return to a tsarist autocracy for all Russians are all served by the defense of Donetsk as the frontline and bastion of imperial Russia against the impinging West and their ignorant dupes in Kiev! Again, something is missing here - actual democratic expression of the wishes of residents in these oblasts with regard to the future economic wellbeing of their children and continuity of their cultural, linguistic, and religious lineages on the soil and in the cities where they and their ancestors may have resided for hundreds of years. I have previously argued on this blog that the sham elections and referendum perpetrated by the People's Republics of Donetsk and Lugansk failed to approximate such a democratic assertion of the wishes of these populations if only because differential control of the region by rebel groups and the central government disrupted the possibility of hearing from all citizens in the two oblasts through an open and fair referendum process. In the end, the unbridgeable divide between the legitimate sources of a conflict between Ukrainian citizens and their post-revolutionary government in Kiev and the current wellsprings of right-wing Russian nationalist support for secession and incorporation of these oblasts into the Russian Federation/Empire demonstrates why the government in Kiev needs to embark on new efforts to forge a middle ground with residents of Donetsk and Lugansk, respecting the economic and cultural uniqueness of the Don basin and isolating the outside influence of Russian nationalist fanatics.
2. To date, Putin and United Russia have succeeded in stoking right-wing nationalist support for pro-Russian groups in Donetsk and Lugansk by painting the efforts of the post-revolutionary government in Kiev to forge a new, Westward course for the Ukrainian economy as a product of infiltration by European and American governments seeking to further politically/militarily and economically isolate Russia and restrict Russia's efforts to pursue its historically destined domination of Eurasian space. In this respect, the intervention of the U.S. and EU against Russia in regard tp Ukraine have, however inadvertently, played into Putin's hands and nurtured a dynamic through which the conflict in eastern Ukraine becomes, within the mind of Russian nationalists, a crusade against the Western heathen.
My conclusion here does not seek to argue that the U.S. and EU should avoid further actions to dissuade or otherwise punish the Russian Federation, its government, and key economic and political agents in response to Russian intervention in eastern Ukraine. Emphatically, it is preceisely this behavior by the Putin government that should be counteracted by aggressive economic measures intended to isolate Russia and make it more difficult for Russia to actively intervene in the conflict between local, pro-Russian groups in the Don basin and the Poroshenko government. On the other hand, Western governments need to keep in mind that what is at stake in this conflict in this conflict is an internal matter within Ukraine, concerning a legitimate divergence of economic and cultural interests between different regions of the country. Moreover, they need to realize that whatever they do to compel Russia to stay out of the domestic politics of Ukraine will unintentionally play into the larger Nineteenth Slavophile narrative of imperial Russia, defender of Christian civilization and morality, against the decadent, liberal West.
In the near term, there may be no way for Western governments to avoid a perception, within the Russian media, that Western intervention against Russia over the conflict in Ukraine has supported a purely offensive agenda intending to isolate Russia and diminish both its geographic sphere of influence and its capacity to employ military force to pursue legitimate national security policies within that sphere. In the long run, Western policies vis-à-vis the Russian Federation need to respect a broader goal of liberalizing Russia and bringing it into the European fold, a goal at which the U.S. and other NATO states have been miserable failures in promoting since the breakup of the Soviet Union thanks to residual veins of Russophobia within Western foreign policy communities. Such an agenda would explicitly seek to marginalize right-wing nationalist voices within the Russian political spectrum and amplify the visions of liberalizers in their efforts to reform Russian political oligarchy to promote more pluralistic democratic institutions and restructure the Russian economy to expand entrepreneurial opportunities and more broadly distribute the gains for economic development, diversify export sectors, and support deepened market integration with the West beyond energy markets.
Having made the point that Western governmental strategies for dealing with Russian intervention in Ukraine inadvertently play into the hands of Putin to paint Ukraine as a battlefield on which to save Russia's place in the world against Western domination, Western governments also need to recall that the conflict within Ukraine is prefigured on legitimate internal grievances that have characterized the evolution of Ukrainian domestic politics since the breakup of the Soviet Union. In this sense, neither the U.S. nor the EU nor the Russian Federation have any business dictating a particular resolution to internal political, cultural, and economic issues within Ukraine. That is to say, the best that we can accomplish in Ukraine is to convince the Poroshenko government to actually engage local, pro-Russian groups in the eastern oblasts in discussions on the economic and cultural future of the country without any predetermined conditionalities in economic development and nationwide cultural and/or linguistic homogenization. As such, in attacking one (Russian) right-wing nationalist agenda, the West needs to sensitively pursue the marginalization of its Ukrainian, right-wing nationalist counterpart, which has similarly shaped the course of the current conflict in the Don basin and, in my understanding, reinforced the unwillingness of the Poroshenko government to palpably address the divergent interests of Ukrainian citizens in the eastern oblasts to the extent that the pursuit of such interests might offend the Ukrainian right-wing.
3. The presence and influence of the Ukrainian nationalist far-right, as the intolerant other to imperialist Russian nationalism, both constitutes a legitimate basis for the fears of Ukrainian citizens in Donetsk and Lugansk that their cultural distinctiveness in relation to their own countrymen will be, at best, ignored and, at worst, crushed in the name of cultural homogenization and ethnic purity and shapes the particular hard-line nature of the Poroshenko government's approach to dealing with pro-Russian sentiments in the eastern oblasts.
If, on the one hand, it seems unlikely that the Ukrainian far-right played a significant role in the Euromaidan revolution against the Yanukovych government, it appears, on the other hand, that Ukrainian nationalists have constituted a small but disproportionately influential political bloc impacting security policy by the Poroshenko government. As suggested both in Stern's article and commentary by Volodymyr Ishchenko in The Guardian (see "Ukraine has ignored the far right for too long - it must wake up to the danger," (13 November 2014), at: http://www.theguardian.com/commentisfree/2014/nov/13/ukraine-far-right-fascism-mps), the presence of an energetic and well organized ultra-nationalist movement across Ukraine has effectively shifted Ukrainian political discourse to the right and dictated a more aggressive and militaristic response by Kiev to pro-Russian dissent in the eastern oblasts in the aftermath of Yanukovych's overthrow. Moreover, as both again suggest, the willingness of the Poroshenko government and other centrist and/or liberal political actors in Kiev to turn a blind eye to right-wing extremism (if not outright neo-nazism) and the compliant ignorance of Ukrainian media toward the far-right reflect a consensus that acknowledgement of the scale and influence of the far-right can only play into the hands of Putin and United Russia, exacerbating the fears of ethnic Russians in the eastern oblasts that they will face discrimination and violence at the hands of nationalist vigilantes. Finally, the existence and engagement of such organizations as the Patriot of Ukraine and its Azov Battalion in actual fighting against pro-Russian groups in the Don basin ensures that the continuity of a militant strategy by the Poroshenko government against pro-Russian groups in the eastern oblasts can only strengthen and legitimize the far-right in the eyes of the majority of Ukrainian citizens.
With these issues in mind, it is, again, critical that the U.S. and EU recognize the integral role played by right-wing nationalism in Ukraine and demand from the Poroshenko government, as a condition of Western material assistance and support, a tangible and significant effort to both acknowledge and marginalize ethnically intolerant and racist groups in government and in the execution of security policy in the eastern oblasts. It cannot be enough for the West to acknowledge the play of Russian ultra-nationalism in the Don basin without also recognizing that there is something to criticisms of fascism in Kiev leveled by the Russian media.
Friday, January 30, 2015
Wednesday, January 28, 2015
The War in Donetsk: More of the Same
Having avoided making any significant comments on the conflict between the Poroshenko government in Kiev and pro-Russian forces in Donetsk and Lugansk for some time, I truly lack any meaningful new reflections on the fighting that seems to be resuming, given the apparent failure of the cease-fire agreement signed in Minsk last year. Pro-Russian forces, apparently supported by Russian military "volunteers" are now moving on the port of Mariupol to move in the direction of securing a land linkage to Crimea. Acknowledging how little I actually know about the strategic and tactical details on the ground, I am assuming that Ukrainian government forces will be able to divert sufficient forces to repel rebel attacks on Mariupol, barring the possibility that the Russian Federation unambiguously commits heavy artillery assets and/or SPETNAZ detachments in coordination with Donetsk People's Republic militias to seize key objectives around the city.
My principal comments with regard to this struggle remain the same. First, the Russian Federation cannot be allowed to intervene in the internal politics of Ukraine without punitive repercussions. The resumption of the pro-Russian offensive toward Mariupol should be met by new economic sanctions by the U.S. and EU against the Russian Federation if it can be reliably ascertained that Russian-supplied artillery/rockets were responsible for the attack on central Mariupol on Saturday morning that killed at least thirty civilians. If Western governments continue to apply economic pressure against the Putin government, then it seems at least conceivable that the Russian Federation will seek some way to save face in the war of Donetsk and Lugansk rather than accept a continuation of sanctions, reinforcing the negative effects of declining crude oil prices on the Russian economy. On the other hand, I hold to the view that there needs to be some leeway on the part of the Poroshenko government in order for such a strategy to work - Putin doesn't get to look like he accomplished something for the pro-Russian populations of Donetsk and Lugansk if Russia withdraws its material support for the Donetsk and Lugansk People's Republics and the latter are immediately and decisively crushed by Kiev. Further, there needs to be something more than another cease-fire. All sides in the conflict need to come to some sort of a consensus that eastern Ukraine is economically and culturally distinct from Ukraine to the west of the Dnieper and that if the country is to remain whole, individual oblasts need to be conferred some degree of autonomy in economic and cultural matters relative to the central government in Kiev. That does not mean conceding to pro-Russian groups in Donetsk and Lugansk a right to secede, but I think it does imply that the central government in Kiev should concede that a single unitary, pro-European economic developmental vision may not be implemented across the Ukrainian economy in the near future without some significant effort to persuade residents in the Don basin that they have more to gain by looking west.
Lastly, I have to concede at least some level of ignorance on the demographics of Mariupol. In an oblast that has a significant share of ethnic Russians and ethnic Ukrainians for whom Russian is the native tongue, I am personally curious as to whether the civilians killed by pro-Russian rebels on Saturday might have, in life, been at least nominally supportive of pro-Russian groups or, at least, ambivalent toward the Euromaiden revolution and the Poroshenko government. Again, in view of the regional differences that appear self-evident in the culture and economy of Ukraine, it seems that local, democratic self-governance is somehow getting short-shrift in what, for all intents and purposes, appears to be a conflict between Russia and the West being waged between Ukrainian surrogates. To the extent that this is the case, the story of Ukraine at this moment in its history is degenerating into an abject tragedy, irredeemable with regard to the possibilities for economic growth through progressive European integration if, in the process, a brighter future for the people of Donetsk and Lugansk is forced onto them at the end of a gun. With this in mind, I hold to the view that the Poroshenko government needs to revise its strategies for bringing Donetsk and Lugansk back into the fold.
My principal comments with regard to this struggle remain the same. First, the Russian Federation cannot be allowed to intervene in the internal politics of Ukraine without punitive repercussions. The resumption of the pro-Russian offensive toward Mariupol should be met by new economic sanctions by the U.S. and EU against the Russian Federation if it can be reliably ascertained that Russian-supplied artillery/rockets were responsible for the attack on central Mariupol on Saturday morning that killed at least thirty civilians. If Western governments continue to apply economic pressure against the Putin government, then it seems at least conceivable that the Russian Federation will seek some way to save face in the war of Donetsk and Lugansk rather than accept a continuation of sanctions, reinforcing the negative effects of declining crude oil prices on the Russian economy. On the other hand, I hold to the view that there needs to be some leeway on the part of the Poroshenko government in order for such a strategy to work - Putin doesn't get to look like he accomplished something for the pro-Russian populations of Donetsk and Lugansk if Russia withdraws its material support for the Donetsk and Lugansk People's Republics and the latter are immediately and decisively crushed by Kiev. Further, there needs to be something more than another cease-fire. All sides in the conflict need to come to some sort of a consensus that eastern Ukraine is economically and culturally distinct from Ukraine to the west of the Dnieper and that if the country is to remain whole, individual oblasts need to be conferred some degree of autonomy in economic and cultural matters relative to the central government in Kiev. That does not mean conceding to pro-Russian groups in Donetsk and Lugansk a right to secede, but I think it does imply that the central government in Kiev should concede that a single unitary, pro-European economic developmental vision may not be implemented across the Ukrainian economy in the near future without some significant effort to persuade residents in the Don basin that they have more to gain by looking west.
Lastly, I have to concede at least some level of ignorance on the demographics of Mariupol. In an oblast that has a significant share of ethnic Russians and ethnic Ukrainians for whom Russian is the native tongue, I am personally curious as to whether the civilians killed by pro-Russian rebels on Saturday might have, in life, been at least nominally supportive of pro-Russian groups or, at least, ambivalent toward the Euromaiden revolution and the Poroshenko government. Again, in view of the regional differences that appear self-evident in the culture and economy of Ukraine, it seems that local, democratic self-governance is somehow getting short-shrift in what, for all intents and purposes, appears to be a conflict between Russia and the West being waged between Ukrainian surrogates. To the extent that this is the case, the story of Ukraine at this moment in its history is degenerating into an abject tragedy, irredeemable with regard to the possibilities for economic growth through progressive European integration if, in the process, a brighter future for the people of Donetsk and Lugansk is forced onto them at the end of a gun. With this in mind, I hold to the view that the Poroshenko government needs to revise its strategies for bringing Donetsk and Lugansk back into the fold.
Against the Euro: Awaiting the Showdown over Greece
At the outset, I want to say that I have mixed feelings about Syriza's victory in Greek parliamentary elections. On the one hand, I am innately sympathetic with the goals of any left-wing party/coalition and the determination of such parties to address disparities in wealth and income and to improve or expand the availability of public services and rewarding employment opportunities to lower and middle income populations. Of course, I am glad that Syriza will be challenging the German-mandated, quasi-punitive fiscal austerity measures enforced on Greece as a condition of EC/ECB assistance to avoid sovereign debt default. In this manner, I adamantly reject the notion that the principal sources of Greece's sovereign debt crisis are located in the expansion of social spending by the Greek government in the 1980s and lingering expectations by the Greek populace for generous public employment and social services and relatively high private sector wages. On the other hand, I want to argue that there is at least something to the critique that Greece needs to foster a more flexible and entrepreneurial private sector to develop, initially, in Jacobs' terminology, more aggressive import replacement and, subsequently, over the long term, the generation of new export commodities corresponding to evolving patterns of comparative advantage with a changing array of trading partners. It is one thing to say, like Krugman and many other macroeconomic policy analysts on the Keynesian left, that austerity measures in the face of short run declining output and national income are not policies favorable to the stimulation of aggregate demand and, thus, exuberant private investment in new productive capacity. Austerity, as a fiscal policy regime, has been an unmitigated disaster for Greece that will not be reversed by imposing still more austerity measures or by allowing Greece to go into sovereign debt default. However, if aggressive public spending is to be undertaken in an economy like that of Greece to stimulate short run aggregate demand and begin to address the country's massive unemployment problem (25 percent of the available labor force!), the state needs to fully consider how its expenditures will impact the long term growth of the private sector, particularly in targeted industries.
Emphatically, how will Syriza's decision not to permit the sale of the port facility of Piraeus to China's Cosco Group aid the Greek state to develop a more ambitious and long term policy of transportation and logistical infrastructure development in support of export-oriented business growth? Will Syriza's efforts to halt the privatization of government shares in the Public Power Corporation of Greece enable it to undertake investment decisions that will reduce aggregate energy expenditures by Greek industries in the long term, or will these efforts simply constitute an additional budgetary loadstone that the state will have to overcome in order to avoid debt default? At what point can national pride and the aspiration for democratic self-determination of fiscal policies by the Greek electorate against demands for austerity by Germany and the international financial community impede the articulation of a clear vision by the Tsipras government for a new post-austerity Greek fiscal policy that might actually benefit private sector economic development over the long term? In view of the initially steps being undertaken in fulfillment of campaign promises by Syriza, I perceive very real problems for the Greek economy to turn a corner, even if the ECB and other financial sector agents confer a substantial forgiveness of sovereign debt.
Having stated my misgivings over the perceived direction being taken by Syriza at its arrival in power, I want to reinforce my larger argument that the single largest problem facing Greece and, for that matter, Spain, Ireland, Portugal, as well as parts of the Italian and French economies is not profligate public spending but monetary union. Contrary to those corners of professional economic analysis who insist with monetarist zeal that money is neuter with respect to real economic development, I insist, on Jacobsean lines, that the expansion of a monetary zone to incorporate diverse and heterogeneous internal economies can only manifest a continuous pro-cyclical effect on private investment, favoring aggressive economic development in already strong internal economies and virtual abandonment of weaker internal economies. In the absence of a full-blown European fiscal union, incorporating explicit transfers of income from Germany and other stronger Euro-zone economies to the weaker end economies, not simply in the form of debt relief but more emphatically as a continuous constitutional commitment to share the benefits of incommensurable German global competitiveness under the Euro, the European monetary union is doomed to fail, perhaps within the next five to seven years.
Beyond this point, I would argue that the end of the Euro would be a better outcome for all of the Euro-zone economies than the imposition of a fiscal union that would, in any case, impose on the entire zone a new and expensive governmental regime, organized to deprive each member state of its sovereign democratic capacities for self-government over a steadily expanding range of domestic policy issues. I do not think that, for all that Syriza stood for and against in its march to victory in Greece, the Greeks would want to confer power on a unified European fiscal authority to determine internal tax rates on Greek citizens from, say, Brussels. I am quite certain, as well, that the majority of German citizens would sooner secede from Europe than allow themselves to be taxed at exorbitantly high rates to cover budget deficits in Spain or Italy manifest through differential social service needs and demands at the national level. In the end, the overwhelming majority of Euro-zone states would be better off returning to their former national currencies or developing new, special-purpose regional currencies that might be more conducive to counter-cyclical monetary policy management across a European free-trading community.
Concluding this relatively short commentary on the coming crisis over Syriza's policies in Greece and their incompatibility with the fiscal austerity preferences of the net lending states of the Euro-zone, I think that a sovereign debt default is almost inevitable this year for Greece. The Tsipras government is not going to convince the troika (ECB, EC, and IMF) that it should write off significant quantities of Greek debt as a measure to restore European economic stability on a stronger, growth-oriented footing. Under the dominant influence of net lending states like Germany, these institutions will sooner allow Greece to default on its sovereign debt than acknowledge that the very monetary union that reinforced the dominant economic standing of these states led them to the point where their junior partner and debt peon, Greece, was marched off the cliff for failing to pay. When this happens, maybe Syriza will continue to exercise the mandate of the Greek people to exit the Euro-zone and make a go of the new economic landscape with its own currency and prohibitively high international lending rates to service its overly aggressive and, perhaps, somewhat ill-conceived ideas on social spending. In sum, I do not think that the powers that be in the troika are as yet quite willing to admit that they cannot allow the sovereign states of Europe to become prisoners to the prerogatives of international finance.
Emphatically, how will Syriza's decision not to permit the sale of the port facility of Piraeus to China's Cosco Group aid the Greek state to develop a more ambitious and long term policy of transportation and logistical infrastructure development in support of export-oriented business growth? Will Syriza's efforts to halt the privatization of government shares in the Public Power Corporation of Greece enable it to undertake investment decisions that will reduce aggregate energy expenditures by Greek industries in the long term, or will these efforts simply constitute an additional budgetary loadstone that the state will have to overcome in order to avoid debt default? At what point can national pride and the aspiration for democratic self-determination of fiscal policies by the Greek electorate against demands for austerity by Germany and the international financial community impede the articulation of a clear vision by the Tsipras government for a new post-austerity Greek fiscal policy that might actually benefit private sector economic development over the long term? In view of the initially steps being undertaken in fulfillment of campaign promises by Syriza, I perceive very real problems for the Greek economy to turn a corner, even if the ECB and other financial sector agents confer a substantial forgiveness of sovereign debt.
Having stated my misgivings over the perceived direction being taken by Syriza at its arrival in power, I want to reinforce my larger argument that the single largest problem facing Greece and, for that matter, Spain, Ireland, Portugal, as well as parts of the Italian and French economies is not profligate public spending but monetary union. Contrary to those corners of professional economic analysis who insist with monetarist zeal that money is neuter with respect to real economic development, I insist, on Jacobsean lines, that the expansion of a monetary zone to incorporate diverse and heterogeneous internal economies can only manifest a continuous pro-cyclical effect on private investment, favoring aggressive economic development in already strong internal economies and virtual abandonment of weaker internal economies. In the absence of a full-blown European fiscal union, incorporating explicit transfers of income from Germany and other stronger Euro-zone economies to the weaker end economies, not simply in the form of debt relief but more emphatically as a continuous constitutional commitment to share the benefits of incommensurable German global competitiveness under the Euro, the European monetary union is doomed to fail, perhaps within the next five to seven years.
Beyond this point, I would argue that the end of the Euro would be a better outcome for all of the Euro-zone economies than the imposition of a fiscal union that would, in any case, impose on the entire zone a new and expensive governmental regime, organized to deprive each member state of its sovereign democratic capacities for self-government over a steadily expanding range of domestic policy issues. I do not think that, for all that Syriza stood for and against in its march to victory in Greece, the Greeks would want to confer power on a unified European fiscal authority to determine internal tax rates on Greek citizens from, say, Brussels. I am quite certain, as well, that the majority of German citizens would sooner secede from Europe than allow themselves to be taxed at exorbitantly high rates to cover budget deficits in Spain or Italy manifest through differential social service needs and demands at the national level. In the end, the overwhelming majority of Euro-zone states would be better off returning to their former national currencies or developing new, special-purpose regional currencies that might be more conducive to counter-cyclical monetary policy management across a European free-trading community.
Concluding this relatively short commentary on the coming crisis over Syriza's policies in Greece and their incompatibility with the fiscal austerity preferences of the net lending states of the Euro-zone, I think that a sovereign debt default is almost inevitable this year for Greece. The Tsipras government is not going to convince the troika (ECB, EC, and IMF) that it should write off significant quantities of Greek debt as a measure to restore European economic stability on a stronger, growth-oriented footing. Under the dominant influence of net lending states like Germany, these institutions will sooner allow Greece to default on its sovereign debt than acknowledge that the very monetary union that reinforced the dominant economic standing of these states led them to the point where their junior partner and debt peon, Greece, was marched off the cliff for failing to pay. When this happens, maybe Syriza will continue to exercise the mandate of the Greek people to exit the Euro-zone and make a go of the new economic landscape with its own currency and prohibitively high international lending rates to service its overly aggressive and, perhaps, somewhat ill-conceived ideas on social spending. In sum, I do not think that the powers that be in the troika are as yet quite willing to admit that they cannot allow the sovereign states of Europe to become prisoners to the prerogatives of international finance.
Friday, January 23, 2015
Reflecting on Black Ice and Forced Vacations
The past 8 days have been unexpectedly difficult ones for me. I spent the balance of them, until Tuesday morning, with a bandaged splint on my right arm, extending up to my elbow. Cutting through the mostly dry and well sanded parking lot of Northampton High School, just down Milton Street from my apartment in the Baystate neighborhood of Florence, while pondering abstractly on the nature of my rejection of the Christian doctrine of the Trinity and my opposition to the idea of Divine intervention in the material universe, the worn heel of one of my old Air Force desert flightline boots suddenly hit a lone patch of black ice, crystallized near the opening to Milton Street from the day's snow melt at the lot's edges. Before I could realize what was happening, I landed flat on my butt on the concrete. Fortunately or unfortunately, I reflexively laid out my open palms in the split second in which I fell, to break the fall and spare my spinal cord the full shock of hitting the cold hard concrete. That shock was largely absorbed by my right hand, and, as I pulled myself quickly off the surface of the parking lot, I immediately realized that this hand had sustained a relevant injury that I could feel as I attempted to bend my fingers and clinch my fist.
It turned out that I had sustained a non-displaced distal fracture of my right radius, the anatomical term for a broken wrist. It has been the most peculiar injury, even to the extent that I have had no previous experience, at age 40, with broken bones. On the night that I fell, the pain gravitated from my wrist up my arm to my elbow, a throbbing that drove me to pop down two Ibuprofen tablets and hope that I'd be able to sleep. By morning, the pain had subsided, and there was no obvious bruise and only a minimal amount of swelling with one slight but obvious and painful lump on the underside of my hand near my thumb. I held out hope at the urgent care certain where I was treated that it would only be a slight sprain. An x-ray revealed, however, that I had a clean crack right across the radial head where the radius meets the ulna and the carpals of the hand (i.e. the wrist joint). The urgent care clinic splinted my injury and referred me to an orthopedic practice for casting.
Acknowledging that the whole purpose of my splint was to immobilize the bone and the wrist joint per se to avoid further injury, my initial inclination, in view of the fact that I could still clinch my fist and hold a knife, was that I would continue to work at least until that injury was cast. In fact, I missed an hour and a half last Wednesday, not so much because of my injury as because the accumulation of ice on my street made it unsafe for me to leave my apartment as normally at 6:30 in the morning. I worked almost forty hours wearing my splint, during which time I continued to perform almost all of the duties I normally perform down at the meat store where I work, short of using a mallet with my right hand (it was an interesting experience learning how to pound chicken cutlets with my left hand). I even found myself delivering groceries to the vehicles of customers with my injured hand. This coming Tuesday, when I consult my orthopedic practitioner for my first follow-up x-ray, I will, of course, discover the extent to which my exuberant efforts to continue to lead a normal working life in the week after my fall may have intensified my injury.
The most peculiar thing about the week between my fall and getting casted was the fact that I rarely experienced any pain, however much stress I placed on my arm. The physician who had initially evaluated me at the urgent care clinic suggested that I should not use Ibuprofen to address pain from the injury but instead use Acetaminophen (i.e. Tylenol) and even offered twice to prescribe something stronger (e.g. Acetaminophen with codeine or Oxycontin). I politely declined to accept her offer on the grounds that my injury really didn't hurt very badly. My inclination, moreover, had been that, if anything I was doing might result in the intensification or dislocation of the injured bone, then it probably would have resonated as an instance of severe pain!
At this point, a few comments on the nature of the medical process, the complications arising from dependency on labor income, and the subordinate matter of civil liability for both personal injuries and medical malpractice are in order. First, I am not sure that the way that I decided to deal with my injury was perfectly ideal in terms of the use of medical resources. A little under two years ago, I suffered an abscess in my back arising from an infected sebaceous cist. At the time I was insured through the University of Massachusetts where I was a graduate student. The insurance plan operated as a health maintenance organization (HMO), where all meidcal problems were to treated under one roof or referred for subsequent treatment outside of the health clinic. After an initial consultation and prescription of antibiotics for treatment of my cist failed to yield any improvement, I showed up in the clinic with a heavily swollen patch of skin on my back. The physician who evaluated me took one look at it and concluded that he would have to operate at that moment. Following the operation, I underwent an extended series of post-operative visits to change dressings and evaluate the progress of the wound. If I remember correctly, neither the surgery nor any of these visits inflicted on me any expenses more costly than a $20 co-payment per visit. I am not sure that the practice was acting, to some degree, in an overly zealous manner by compelling me to disrupt my work routine in order to show up two to three times a week over a month after my surgery, but the most significant personal expense arising from the entire process concerned only my lack of paid sick leave and lost wages from the disruption of my schedule, motivations that eventually prompted me to cut the post-operative treatments short and "wing it" with my recovering wound. By and large, whether this represented an efficient use of medical resources, at least with respect to my own needs, I was very satisfied by the organization of my health insurance plan and its responsiveness to my need for medical care.
Presently, I have a health insurance plan sponsored and paid in full by my employer. All things considered, it is a fairly good plan at mitigating expenses from treatments, even to the extent that I encounter higher co-payments for treatment than under my former UMASS plan. To a somewhat greater degree, the organization of the plan relies on my efforts to manage my own health care needs through a single primary care physician. I had such a physician briefly at UMASS but was unable to retain him when I left the university. Now, by contrast, I have come to rely on urgent care clinics for all of my acute medical needs. Obviously, the isolated treatment by an urgent care clinic for a single broken wrist is not an overwhelming problem. On the other hand, reliance on urgent care facilities is not a good way to manage long term care on problems like hypertension (i.e. high blood pressure), which I fear that I may have to deal with in the near term! While my health insurance provider, thus, seems to be reasonably good at organizing medical resources to reduce either urgent care or emergency room visits as a recurring phenomena for individual patients, it is more than a health insurer can be expected to do ensure that patients take the adequate steps to organize their own long term health care issues in the most cost effective manner. Ultimately, this is a responsibility of the patient, the effects of which will be manifest across a broader health insurance network if individual patients, in the aggregate, do not follow through in ways that will ensure cost savings in the long run for the insurer. That is to say, I may not bear a significant responsibility for seeking out medical attention for my wrist from someone other than the primary care physician that I have listed with my insurer (who I have yet to actually meet a year after I selected him), but I do bear responsibility for not treating the medical process as an ongoing, preventitive endeavor.
Beyond my concerns about the organization of health care processes, one subordinate issue in my treatment, alluded to above, struck me as I was writing this post. Notably, it is significant that, even though I was not reporting any pain at the time when I visited the urgent care facility, the physician who treated me volunteered to prescribe high powered pain medications to me. At the present time, the Commonwealth of Massachusetts is dealing with a widespread public health crisis in the abuse of prescription pain medications, leading, at least in some circumstances, to abuse of and addiction to heroine. To be clear, I am not seeking to impose blame on my treating physician for the prescription medication abuse problem in Massachusetts, but it seems clear that medical professionals are confronted with a quandry in the treatment of conditions inducing pain that can be readily addressed with pharmaceuticals and I am not certain that it is entirely safe for the profession to err on the side of progressive treatment in such circumstances. Certainly, physicians enjoy a much greater range of available pharmaceutical preparations to deal with the discomforts of patients suffering from broken bones, infections, and chronic conditions (e.g. cancer-related pain). Perhaps at some point in the near future, physicians in Massachusetts will be able to prescribe marijuana for certain chronic conditions, if state legislators and regulators finally get around to obeying the expressed mandate of the Massachusetts electorate on this issue (i.e. we approved medical marijuana by ballot initiative 2 years ago). Moreover, the administration of medications to reduce the pain experienced by patients is a relevant component in the business of treating diagnosed medical conditions. However, given wide variations in the strength and addictive nature of certain pain medications, it probably makes more sense for medical professionals to allow patients, in most circumstances, to self-medicate using over-the-counter (OTC) analgesics, particularly Ibuprofen and Acetaminophen-based products, subject to the appropriate use instructions on OTC labels, and reserve prescription medications for circumstances involving chronic conditions and, more generally, acute conditions requiring hospitalization or other significant measures. In any case, insofar as I had indicated experiencing little to no pain from my breakage, I do not think it was entirely appropriate to be offered vicodin for the taking just because it might make me feel a little better than an extra-strength Tylenol.
This leads me to a legal question. Notably, under what circumstances might physicians and medical practices become civilly liable for the prescription or failure to prescribe pain medications? In the former circumstance, the evolving corpus of medical malpractice law seems to indicate that there is some basis for physicians to be held liable for the prescription of pain medications leading to patient addiction when an accepted standard for medical care of particular conditions is transgressed by an individual physician. In my view of this, I am still somewhat spell bound why physicians would be tempted to err on the side of prescribing pain medications for particular conditions even when a patient is not reporting significant pain. There is, of course, the recourse to compassion as the motivation for physicians to go above and beyond in treating patients with broken bones, nasty lacerations, and severe infections, but, maybe by virtue of a certain lacking of emotional sensitivity on my part, I just do not comprehend how physicians could open themselves up to possible malpractice litigation out of sympathy for the real or perceived suffering of a patient. Rather, from my standpoint as an economist, I am inclined to interrogate the market motivations for the over-prescription of pain medications. That is to say, I find it at least plausible that physicians over-prescribe pain medications because they perceive that the failure to offer pain medications to patients experiencing potentially painful conditions must impact the ability of the physician to retain or otherwise attract new patients, even at the level of a medical practice with multiple physicians. Such a situation might be patterned in some game-theoretic manner, incorporating the expected risk of addiction from given medications and the expected risk of diminished long run compensation to physicians failing to offer pain medications, especially in circumstances when a patient within a demographic where the probability of abuse is very high actually asks the physician to prescribe a pain medication.
One last thought on the medical profession in the U.S, derived from my present experience and from past experiences of treatment for acute but relatively significant medical conditions: there are few professions in the U.S. where economic myopia is at least tolerated if not rewarded as it is in the provision of health care. In making this observation, I do not mean to argue that the physicians who treated me, either at the urgent care clinic that I went to initially or to the orthopedic practice that cast my injured wrist a few days ago, proceeded with a cavelier indifference toward the costs my medical condition would inflict on me. In some degree, a condition like a broken wrist is probably somewhat technologically simpler that numerous other conditions (e.g. cancer care) where new, state of the art medical procedures and technologies are now available to be offered to patients. My point is, however, that, given the market structure of American health care, the medical profession needs to be more attentive to the costs of given treatment regimes relative to the income level of patients and the potential effect that a prolonged medical disability is likely to have on the patient's income.
Again, the problem here may have much less to do with the medical profession itself than with the institutional environment of labor markets in the U.S. against which it is situated. For my part, a short incapacitation from a broken wrist is unlikely to bankrupt me. The actual treatment costs will be largely borne by my insurer. Moreover, I can accept the fact that my condition is going to demand follow-on orthopedic care, including more x-rays - I am actually quite enthusiastic about this insofar as I really do want my wrist to heal as rapidly as possible and without complications. On the other hand, I would be much more likely to obey a strict regime restricting the use of my right hand and right arm if I enjoyed some form of compensation to ensure that I remain out of work and not over-stressing my arm. The more painful point is that I will end up sinking my federal and state tax returns to pay for monthly living expenses rather than contributing to my long term savings. Clearly, I am going to lose a good amount of labor income and potential savings, and possibly a week of paid vacation time, as a result of this injury. If, in the end, this comment devolved into an advertisement for short term occupational disability insurance, I did not actually mean for it to do so, but my level of frustration with my combined physical and financial inability to do all the things I want to do right now and my inability to rationally attribute blame to someone else prompted this result in exasperation!
Closing on the point of attributing blame, I still have the issue of that one little patch of black ice at the end of the Northampton High School parking lot. In theory, I guess I could secure an attorney and sue the Northampton School Department for negligence in failing to maintain an ice free driveway or, in the very least, failing to put up any signs warning of icy surfaces or prohibiting use of the parking lot as a means to traverse the distance between Elm Street/Route 9 and Milton Street. On the other hand, in that event, I used the parking lot to get where I was going for one simple reason - it was the most ice-free space available in a year in which we have had, until now, very little snow but a profusion of freezing rain/ice events! The sidewalk maintained by the School Department skirting the outside of the High School property was a proverbial ice-skating rink, as was the road surface at the beginning of Milton Street. All things considered, the School Department deserves at least some credit for maintaining the parking as dry and well sanded as it is and as it was on the night I fell. No one can absolutely ensure that all surfaces will be ice free in a winter like the one we are having. Moreover, my inability to provide any witnesses on a night in which I fell in total isolation from any other human beings in a fairly isolated suburban corner of town would make it difficult for me to corroborate any claims that I fell on school property and that the school was responsible. In the end, all that I can say is that, notwithstanding my best efforts to stay on dry ground and avoid ice, accidents are accidents and I will have to simply deal with this one.
It turned out that I had sustained a non-displaced distal fracture of my right radius, the anatomical term for a broken wrist. It has been the most peculiar injury, even to the extent that I have had no previous experience, at age 40, with broken bones. On the night that I fell, the pain gravitated from my wrist up my arm to my elbow, a throbbing that drove me to pop down two Ibuprofen tablets and hope that I'd be able to sleep. By morning, the pain had subsided, and there was no obvious bruise and only a minimal amount of swelling with one slight but obvious and painful lump on the underside of my hand near my thumb. I held out hope at the urgent care certain where I was treated that it would only be a slight sprain. An x-ray revealed, however, that I had a clean crack right across the radial head where the radius meets the ulna and the carpals of the hand (i.e. the wrist joint). The urgent care clinic splinted my injury and referred me to an orthopedic practice for casting.
Acknowledging that the whole purpose of my splint was to immobilize the bone and the wrist joint per se to avoid further injury, my initial inclination, in view of the fact that I could still clinch my fist and hold a knife, was that I would continue to work at least until that injury was cast. In fact, I missed an hour and a half last Wednesday, not so much because of my injury as because the accumulation of ice on my street made it unsafe for me to leave my apartment as normally at 6:30 in the morning. I worked almost forty hours wearing my splint, during which time I continued to perform almost all of the duties I normally perform down at the meat store where I work, short of using a mallet with my right hand (it was an interesting experience learning how to pound chicken cutlets with my left hand). I even found myself delivering groceries to the vehicles of customers with my injured hand. This coming Tuesday, when I consult my orthopedic practitioner for my first follow-up x-ray, I will, of course, discover the extent to which my exuberant efforts to continue to lead a normal working life in the week after my fall may have intensified my injury.
The most peculiar thing about the week between my fall and getting casted was the fact that I rarely experienced any pain, however much stress I placed on my arm. The physician who had initially evaluated me at the urgent care clinic suggested that I should not use Ibuprofen to address pain from the injury but instead use Acetaminophen (i.e. Tylenol) and even offered twice to prescribe something stronger (e.g. Acetaminophen with codeine or Oxycontin). I politely declined to accept her offer on the grounds that my injury really didn't hurt very badly. My inclination, moreover, had been that, if anything I was doing might result in the intensification or dislocation of the injured bone, then it probably would have resonated as an instance of severe pain!
At this point, a few comments on the nature of the medical process, the complications arising from dependency on labor income, and the subordinate matter of civil liability for both personal injuries and medical malpractice are in order. First, I am not sure that the way that I decided to deal with my injury was perfectly ideal in terms of the use of medical resources. A little under two years ago, I suffered an abscess in my back arising from an infected sebaceous cist. At the time I was insured through the University of Massachusetts where I was a graduate student. The insurance plan operated as a health maintenance organization (HMO), where all meidcal problems were to treated under one roof or referred for subsequent treatment outside of the health clinic. After an initial consultation and prescription of antibiotics for treatment of my cist failed to yield any improvement, I showed up in the clinic with a heavily swollen patch of skin on my back. The physician who evaluated me took one look at it and concluded that he would have to operate at that moment. Following the operation, I underwent an extended series of post-operative visits to change dressings and evaluate the progress of the wound. If I remember correctly, neither the surgery nor any of these visits inflicted on me any expenses more costly than a $20 co-payment per visit. I am not sure that the practice was acting, to some degree, in an overly zealous manner by compelling me to disrupt my work routine in order to show up two to three times a week over a month after my surgery, but the most significant personal expense arising from the entire process concerned only my lack of paid sick leave and lost wages from the disruption of my schedule, motivations that eventually prompted me to cut the post-operative treatments short and "wing it" with my recovering wound. By and large, whether this represented an efficient use of medical resources, at least with respect to my own needs, I was very satisfied by the organization of my health insurance plan and its responsiveness to my need for medical care.
Presently, I have a health insurance plan sponsored and paid in full by my employer. All things considered, it is a fairly good plan at mitigating expenses from treatments, even to the extent that I encounter higher co-payments for treatment than under my former UMASS plan. To a somewhat greater degree, the organization of the plan relies on my efforts to manage my own health care needs through a single primary care physician. I had such a physician briefly at UMASS but was unable to retain him when I left the university. Now, by contrast, I have come to rely on urgent care clinics for all of my acute medical needs. Obviously, the isolated treatment by an urgent care clinic for a single broken wrist is not an overwhelming problem. On the other hand, reliance on urgent care facilities is not a good way to manage long term care on problems like hypertension (i.e. high blood pressure), which I fear that I may have to deal with in the near term! While my health insurance provider, thus, seems to be reasonably good at organizing medical resources to reduce either urgent care or emergency room visits as a recurring phenomena for individual patients, it is more than a health insurer can be expected to do ensure that patients take the adequate steps to organize their own long term health care issues in the most cost effective manner. Ultimately, this is a responsibility of the patient, the effects of which will be manifest across a broader health insurance network if individual patients, in the aggregate, do not follow through in ways that will ensure cost savings in the long run for the insurer. That is to say, I may not bear a significant responsibility for seeking out medical attention for my wrist from someone other than the primary care physician that I have listed with my insurer (who I have yet to actually meet a year after I selected him), but I do bear responsibility for not treating the medical process as an ongoing, preventitive endeavor.
Beyond my concerns about the organization of health care processes, one subordinate issue in my treatment, alluded to above, struck me as I was writing this post. Notably, it is significant that, even though I was not reporting any pain at the time when I visited the urgent care facility, the physician who treated me volunteered to prescribe high powered pain medications to me. At the present time, the Commonwealth of Massachusetts is dealing with a widespread public health crisis in the abuse of prescription pain medications, leading, at least in some circumstances, to abuse of and addiction to heroine. To be clear, I am not seeking to impose blame on my treating physician for the prescription medication abuse problem in Massachusetts, but it seems clear that medical professionals are confronted with a quandry in the treatment of conditions inducing pain that can be readily addressed with pharmaceuticals and I am not certain that it is entirely safe for the profession to err on the side of progressive treatment in such circumstances. Certainly, physicians enjoy a much greater range of available pharmaceutical preparations to deal with the discomforts of patients suffering from broken bones, infections, and chronic conditions (e.g. cancer-related pain). Perhaps at some point in the near future, physicians in Massachusetts will be able to prescribe marijuana for certain chronic conditions, if state legislators and regulators finally get around to obeying the expressed mandate of the Massachusetts electorate on this issue (i.e. we approved medical marijuana by ballot initiative 2 years ago). Moreover, the administration of medications to reduce the pain experienced by patients is a relevant component in the business of treating diagnosed medical conditions. However, given wide variations in the strength and addictive nature of certain pain medications, it probably makes more sense for medical professionals to allow patients, in most circumstances, to self-medicate using over-the-counter (OTC) analgesics, particularly Ibuprofen and Acetaminophen-based products, subject to the appropriate use instructions on OTC labels, and reserve prescription medications for circumstances involving chronic conditions and, more generally, acute conditions requiring hospitalization or other significant measures. In any case, insofar as I had indicated experiencing little to no pain from my breakage, I do not think it was entirely appropriate to be offered vicodin for the taking just because it might make me feel a little better than an extra-strength Tylenol.
This leads me to a legal question. Notably, under what circumstances might physicians and medical practices become civilly liable for the prescription or failure to prescribe pain medications? In the former circumstance, the evolving corpus of medical malpractice law seems to indicate that there is some basis for physicians to be held liable for the prescription of pain medications leading to patient addiction when an accepted standard for medical care of particular conditions is transgressed by an individual physician. In my view of this, I am still somewhat spell bound why physicians would be tempted to err on the side of prescribing pain medications for particular conditions even when a patient is not reporting significant pain. There is, of course, the recourse to compassion as the motivation for physicians to go above and beyond in treating patients with broken bones, nasty lacerations, and severe infections, but, maybe by virtue of a certain lacking of emotional sensitivity on my part, I just do not comprehend how physicians could open themselves up to possible malpractice litigation out of sympathy for the real or perceived suffering of a patient. Rather, from my standpoint as an economist, I am inclined to interrogate the market motivations for the over-prescription of pain medications. That is to say, I find it at least plausible that physicians over-prescribe pain medications because they perceive that the failure to offer pain medications to patients experiencing potentially painful conditions must impact the ability of the physician to retain or otherwise attract new patients, even at the level of a medical practice with multiple physicians. Such a situation might be patterned in some game-theoretic manner, incorporating the expected risk of addiction from given medications and the expected risk of diminished long run compensation to physicians failing to offer pain medications, especially in circumstances when a patient within a demographic where the probability of abuse is very high actually asks the physician to prescribe a pain medication.
One last thought on the medical profession in the U.S, derived from my present experience and from past experiences of treatment for acute but relatively significant medical conditions: there are few professions in the U.S. where economic myopia is at least tolerated if not rewarded as it is in the provision of health care. In making this observation, I do not mean to argue that the physicians who treated me, either at the urgent care clinic that I went to initially or to the orthopedic practice that cast my injured wrist a few days ago, proceeded with a cavelier indifference toward the costs my medical condition would inflict on me. In some degree, a condition like a broken wrist is probably somewhat technologically simpler that numerous other conditions (e.g. cancer care) where new, state of the art medical procedures and technologies are now available to be offered to patients. My point is, however, that, given the market structure of American health care, the medical profession needs to be more attentive to the costs of given treatment regimes relative to the income level of patients and the potential effect that a prolonged medical disability is likely to have on the patient's income.
Again, the problem here may have much less to do with the medical profession itself than with the institutional environment of labor markets in the U.S. against which it is situated. For my part, a short incapacitation from a broken wrist is unlikely to bankrupt me. The actual treatment costs will be largely borne by my insurer. Moreover, I can accept the fact that my condition is going to demand follow-on orthopedic care, including more x-rays - I am actually quite enthusiastic about this insofar as I really do want my wrist to heal as rapidly as possible and without complications. On the other hand, I would be much more likely to obey a strict regime restricting the use of my right hand and right arm if I enjoyed some form of compensation to ensure that I remain out of work and not over-stressing my arm. The more painful point is that I will end up sinking my federal and state tax returns to pay for monthly living expenses rather than contributing to my long term savings. Clearly, I am going to lose a good amount of labor income and potential savings, and possibly a week of paid vacation time, as a result of this injury. If, in the end, this comment devolved into an advertisement for short term occupational disability insurance, I did not actually mean for it to do so, but my level of frustration with my combined physical and financial inability to do all the things I want to do right now and my inability to rationally attribute blame to someone else prompted this result in exasperation!
Closing on the point of attributing blame, I still have the issue of that one little patch of black ice at the end of the Northampton High School parking lot. In theory, I guess I could secure an attorney and sue the Northampton School Department for negligence in failing to maintain an ice free driveway or, in the very least, failing to put up any signs warning of icy surfaces or prohibiting use of the parking lot as a means to traverse the distance between Elm Street/Route 9 and Milton Street. On the other hand, in that event, I used the parking lot to get where I was going for one simple reason - it was the most ice-free space available in a year in which we have had, until now, very little snow but a profusion of freezing rain/ice events! The sidewalk maintained by the School Department skirting the outside of the High School property was a proverbial ice-skating rink, as was the road surface at the beginning of Milton Street. All things considered, the School Department deserves at least some credit for maintaining the parking as dry and well sanded as it is and as it was on the night I fell. No one can absolutely ensure that all surfaces will be ice free in a winter like the one we are having. Moreover, my inability to provide any witnesses on a night in which I fell in total isolation from any other human beings in a fairly isolated suburban corner of town would make it difficult for me to corroborate any claims that I fell on school property and that the school was responsible. In the end, all that I can say is that, notwithstanding my best efforts to stay on dry ground and avoid ice, accidents are accidents and I will have to simply deal with this one.
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