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The Next World War

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This next summer will be 100 years since the fatal August of 1914. We live in a similar era of “history is over and everybody is happy.” See above. In August 1914, Germany’s major trading partners were Britain and France, as well as the US. There were people who believed that democracies that did business with each other never went to war. Sound familiar ?

UPDATE: I am not the only one thinking about this, of course. Here is another version. I worry less about China as a geopolitical rival to the US but a China Japan conflict would not be impossible.

The Telegraph has an excellent piece on the present world situation.

As we look forward to the First World War commemorations, three stark conclusions are hard to refute. First, that in the course of this century we will need a great deal of luck to avoid a nuclear catastrophe. Second, that the Enlightenment has failed. Third, that this can all be traced back to the Great War.

As a result of the Enlightenment and the Industrial Revolution, it seemed that mankind might make a decisive break with the scarcity and oppression that had characterised previous eras. There was, admittedly, one early warning. The French Revolution proved that a radical reconstruction of society on abstract principles was likely to end in tyranny and bloodshed. But after 1815, the 19th century developed into one of the most successful epochs in history. Living standards, life expectancy, productivity, medicine, the rule of law, constitutional government, versions of democracy there was dramatic progress on all fronts, and in the spread of civilisation across the globe.

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Why health care is in trouble.

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Our health care system has been built up over the years in a jury-rigged, ramshackle fashion. Before World War II, there was very little health insurance and what there was often was the product of labor union contracts. The early years were concerned with accident insurance and workers compensation laws.

The American life insurance system was established in the mid-1700s. The earliest forms of health insurance, how ­ever, did not emerge until 1850, when the Franklin Health Assurance Com ­pany of Massachusetts began providing accident insurance, to cover injuries re ­lated to railroad and steamboat travel. From this, sickness insurance covering all kinds of illnesses and injuries soon evolved, but the first modern health insurance plans were not formed until 1930.

The Baylor program for school teachers was the first in 1929.

Medical insurance took stride in 1929 when Dr. Justin Ford Kimball, an administrator at Baylor University Hospital in Dallas, Texas, realized that many schoolteachers were not paying their medical bills. In response to this problem, he developed the Baylor Plan teachers were to pay 50 cents per month in exchange for the guarantee that they could receive medical services for up to 21 days of any one year.

In those days, the concern was lost wages more than hospital care.

In 1939, the American Hospital Association (AHA) first used the name Blue Cross to des ­ignate health care plans that met their standards. These plans merged to form Blue Cross under the AHA in 1960. Considered nonprofit organizations, the Blue Cross plans were exempted from paying taxes, enabling them to maintain low premiums. Pre-paid plans covering physician and surgeon services, includ ­ing the California Physicians’ Service in 1939, also emerged around this time. These physician-sponsored plans com ­bined into Blue Shield in 1946 and Blue Cross and Blue Shield merged into one company in 1971.

The modern insurance plans were very recent in origin. I was there for much of it. The commercial insurers fought the status of Blue Cross, which was not required to have reserves. Blue Cross asserted that it promised hospital care, not payment, so reserves were not necessary.

The 1940s and 1950s also saw the proliferation of employee benefit plans, and the included health insurance pack ­ages became more and more compre ­hensive as strong unions negotiated for additional benefits. During the Second World War, companies competing for labor had limited ability to use wages to attract employees due to wartime wage controls, so they began to compete through health insurance packages. The companies’ healthcare expenses were exempted from income tax, and the resulting trend is largely responsible for the workplace’s present role as the main supplier of health insurance.

The war produced much of this as wage limitations were in force but fringe benefits, like health insurance, were permitted. A lot of this history is contained in Paul Starr’s book The Social Transformation of American Medicine.

From the first, commercial insurers focused on employer plans while Blue Cross and Blue Shield (which was founded by the California Medical Association to pay doctor bills) were individual plans.

In 1954, Social Security coverage included disability benefits for the first time, and in 1965, Medicare and Medicaid pro ­grams were introduced, in part because of the Democratic majority in Congress. In the 1970s and 1980s, more expen ­sive medical technology and flaws in the health care system led to higher costs for health insurance companies. Responding to higher costs, employee benefit plans changed into managed care plans, and Health Maintenance Organizations (HMOs) emerged. Man ­aged care plans are unique in that they involve a particular network of health ­care providers that have been verified for healthcare quality and that have agreements with the insurer about price and related issues. HMOs were originally primarily nonprofit, but they were quickly replaced by commercial interests, and managed care only suc ­ceeded in temporarily slowing the growth of healthcare costs.

Two major changes came in the 1970s. In 1978, the federal government established what were called Professional Standards Review Organizations or PSRO. All doctors had to receive training in how to do these reviews and it was immediately apparent that cost was the only consideration, not quality of care.

I decided to educate myself and took a course from an organization called “The American Board of Quality Assurance and Utilization Review Physicians. I took the exam and passed, then attended the annual meeting. This was about 1986. People I met at that meeting informed me that the exams were graded by throwing them up in the air. Any that landed balancing on one edge were flunked. Nonetheless, the experience was valuable because I could see what was coming.

I was president of the Orange County Medical Association that year and had served for eight years on the Commission on Legislation of the CMA, now called The Council on Legislation. This gave me an opportunity to meet many legislators, many state level and some federal. The impression they made on me was that few knew anything about medicine and most were not very intelligent.

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Freedom, the Village, and the Internet

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I’ve reviewed two books by German writer Hans Fallada: Little Man, What Now?, and Wolf Among Wolves  (the links go to the reviews), both of which were excellent. I recently finished his novel Every Man Dies Alone, which is centered on a couple who become anti-Nazi activists after their son Ottochen is killed in the war…it was inspired by, and is loosely based on, the true story of  a real-life couple who distributed anti-Nazi postcards and were executed for it.

I thought this book was also excellent…the present post, though, is not a book review, but rather a development of some thoughts inspired by a particular passage in the story.

Trudel, who was Ottochen’s fiancee, is a sweet and intelligent girl who is strongly anti-Nazi..and unlike Ottochen’s parents, she became an activist prior to being struck by personal tragedy: she is a member of a resistance cell at the factory where she works.  But she finds that she cannot stand the unending psychological strain of underground work–made even worse by the rigid and doctrinaire man (apparently a Communist) who is leader of the cell–and she drops out. Another member of the cell, who has long been in love with her, also finds that he is not built for such work, and drops out also.

After they marry and Trudel becomes pregnant, they decide to leave the politically hysterical environment of Berlin for a small town where–they believe–life will be freer and calmer.

Like many city dwellers, they’d had the mistaken belief that spying was only really bad in Berlin and that decency still prevailed in small towns. And like many city dwellers, they had made the painful discovery that recrimination, eavesdropping, and informing were ten times worse in small towns than in the big city. In a small town, everyone was fully exposed, you couldn’t ever disappear in the crowd. Personal circumstances were quickly ascertained, conversations with neighbors were practically unavoidable, and the way  such conversations could be twisted was something they had already experienced in their own lives, to their chagrin.

Reading the above passage, I was struck by the thought that if we are now living in an “electronic village”…even a “global village,” as Marshall McLuhan put it several decades ago…then perhaps that also means we are facing some of the unpleasant characteristics that–as Fallada notes–can be a part of village life. And these characteristics aren’t something that appears only in eras of insane totalitarianism such as existed in Germany during the Nazi era. Peter Drucker, in Managing in the Next Society, wrote about the tension between liberty and community:

Rural society has been romanticized for millenia, especially in the West, where rural communities have usually been portrayed as idylic. However, the community in rural society is actually both compulsory and coercive…And that explains why, for millenia, the dream of rural people was to escape into the city.  Stadluft macht frei  (city air frees) says an old German proverb dating back to the eleventy or twelfth century.

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Max von Oppenheim, German counterpart to Lawrence of Arabia

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Max von Oppenheim was a German ancient historian, and archaeologist who also worked as a diplomat and spy for the German Empire during the First World War. In those latter two capacities, he basically tried to incite Jihad against the Entente powers. From Wikipedia:

During World War I, Oppenheim led the Intelligence Bureau for the East and was closely associated with German plans to initiate and support a rebellion in India and in Egypt. In 1915 Henry McMahon reported that Oppenheim had been encouraging the massacre of Armenians in Mosques.[12]
Oppenheim had been called to the Wilhelmstrasse from his Kurfurstendamm flat on 2 August 1914 and given the rank of Minister of Residence. He began establishing Berlin as a centre for pan-Islamic propaganda publishing anti-Entente texts. On August 18 1914 he wrote to Chancellor Bethmann Hollweg to tell him that Germany must arm the Muslim brotherhoods of Libya, Sudan and Yemen and fund Arab exile pretenders like the deposed Egyptian Khedive, Abbas Hilmi. He believed Germany must incite anti-colonial rebellion in French North Africa and Russian Central Asia and incite Habibullah Khan, the Emir of Afghanistan, to invade British India at the head of an Islamic army.[13] Oppenheim’s Exposé Concerning the Revolutionizing of the Islamic territories of our enemies contained holy war propaganda and ‘sketched out a blueprint for a global jihad engulfing hundreds of millions of people’. Armenians and Maronite Christians were dismissed as Entente sympathizers, quite useless to Germany nicht viel nutzen konnen. [14]

Because Germany was not an Islamic power the war on the Entente powers needed to be ‘endorsed with the seal of the Sultan-Caliph’ and on 14 November 1914 in a ceremony at Fatih Mosque the first ever global jihad had been inaugurated. The impetus for this move came from the German government, which subsidized distribution of the Ottoman holy war fetvas, and most of the accompanying commentaries from Muslim jurists, and Oppenheim’s jihad bureau played a significant role. By the end of November 1914 the jihad fetvas had been translated into French, Arabic, Persian and Urdu.[15] Thousands of pamphlets emerged under Oppenheim’s direction in Berlin at this period and his Exposé declared that, “the blood of infidels in the Islamic lands may be shed with impunity”, the “killing of the infidels who rule over the Islamic lands” , meaning British, French, Russian, and possibly Dutch and Italian nationals, had become ” a sacred duty”. And Oppenheim’s instructions, distinct from traditional ‘jihad by campaign’ led by the Caliph, urged the use of ‘individual Jihad’, assassinations of Entente officials with ‘cutting, killing instruments’ and ‘Jihad by bands’,- secret formations in Egypt, India and Central Asia.[16]
“During the First World War, he worked in the Foreign Ministry in Berlin, where he founded the so-called “message Centre for the Middle East”, as well as at the German Embassy in Istanbul. He sought to mobilize the Islamic population of the Middle East against England during the war and can be seen thus almost as a German counterpart to Lawrence of Arabia. The AA pursued a strategy of Islamic revolts in the colonial hinterland of the German enemy. The spiritual father of this double approach, the war first, by troops on the front line and secondly by people’s rebellion “in depth” was by Oppenheim.”[citation needed]
The German adventurer met with very little success in World War I. To this day, the British see him as a “master spy” because he founded the magazine El Jihad in 1914 in an effort to incite the Arabs to wage a holy war against the British and French occupiers in the Middle East. But his adversary Lawrence of Arabia, whom he knew personally, was far more successful at fomenting revolts.[17]

Lawrence of Arabia, aka T. E. Lawrence was successful because he didn’t appeal to religious fervor, but rather to the far more basic sentiment of ethnic solidarity against an oppressor of different ethnic origin. In other words, the Arabs cared far more about their struggle against the Turkish Empire than they did about religion, leave alone jihad.