Sunday, January 15, 2006

On preemption

It goes without saying that I'm pretty down on the Bush preemption plan. I don't think it works and I don't think it makes sense.

But I do think preemption makes sense. Just not in the sense that Bush takes it.

Let's talk health care, for a second.

In 2000, Congress passed a law requiring hospitals to provide emergency medical care to anyone who came through the door, regardless of ability to pay. This makes all sorts of sense, since a person with a medical emergency shouldn't be tossed onto the street to die.

But it poses a problem, because ER time is expensive. People without the ability to pay for ER care also can't pay for a doctor's appointment, so the ER is more likely to be a source of primary care for the indigent, and the hospital has to pass on the cost of that care to patients who can pay. Unintended consequences, yada, yada.

The problem is not that people can't pay for emergency care (though that's a problem, too). The problem is that people can't pay for medical care. Simple prophylaxis is expensive for a lot of people (even if they have insurance, co-pays leave a disincentive to regular checkups and other inexpensive prophylactic care). By prophylaxis, I'm talking about getting a sore throat checked before it an entire workplace comes down with strep, or keeping immunizations up to date, not to mention regular cancer screening for the at risk, or diabetes screening, or heart disease checks. Catching any of these early can save time and money in long-term treatment.

So it would be better to pre-empt someone being rushed to the ER with a heart attack by ensuring that people get regular checkups.

Similar arguments are easy to make for geopolitics. Bombing a house and killing a bunch of children is bad, especially if you illegally invade another country's airspace to do it. Killing Zawahiri would be good (it might even justify those deaths), but we missed. We pissed off a lot of people, and didn't kill

It would be better to prevent Zawahiri's from developing. On 9/11, the cancer of fundamentalist terrorism metastasized and took this nation to the ER. Now, we're trying to respond. But it would be better to have caught the problem early. (See Against All Enemies by Richard A. Clarke for more on that topic.)

I want to switch gears and talk about Rwanda for a moment, because Shake Hands with the Devil : The Failure of Humanity in Rwanda by Roméo Dallaire offers some compelling insights on this problem.

Dallaire was the general in charge of the UN peacekeeping force in Rwanda when the genocide started. But the book isn't about the genocide. During the slaughter, he was largely confined to a small area under U.N. control. But he was there for 2 years before the slaughter, and that time was critical. He wrote numerous reports showing that more equipment and personnel, as well as a broader mandate would prevent the outbreak of violence. He discovered arms caches which could have been seized, preventing the slaughter, but he was held back. Part of the problem was that the genocidaires had a seat on the Security Council at that time, but more of the problem was based on the fact that the great nations didn't want to commit to Rwanda, a tiny country where nothing was happening. Why send functioning APCs or a battalion of Marines to police a nation that was at peace (for the moment)?

So his warnings were ignored, he was denied the power to act preemptively, prophylactically.

And when the genocide started, there weren't enough resources to do anything, nor did new resources arrive for months, and when they arrived, they weren't put under the command of someone experienced in the area, but a distrusted former colonial power.

A little prophylaxis, maybe involving some gunfights to secure weapons caches, maybe even some dead soldiers, would have prevented what may have been the fastest slaughter of humans in world history.

Now, the fighting there is over. In the epilogue, Dallaire describes a more recent trip to Africa:

I conducted a field visit to Sierra Leone to get first-hand information on the demobilization and reintegration of child soldiers and bush wives – children who had been abducted from their families and had then fought for several years as part of the once powerful rebel force.… Sitting down with a group of the boys, all around thirteen years of age, we were soon discussing tactics, bush life and the brutality of civil war. They were only a few days into the retraining process, and they fervently hoped – now that they were permitted to hope – that they had a promising future in a country that could sustain peace. But, talking to them, it became clear that if things did not work out in the camp, they would return to the free and violent life of terrorism in the bush, where they would carry on taking what they wanted by force. The rehabilitation and reintegration period was scheduled to last at best three months, and they wanted to know what would happen next. Who would pick up the ball? Certainly not their families or communities, who had yet to accept them back, nor their devastated country in which teachers and other educated persons and potential leaders had been a favourite assassination target.

Abducted at nine or even younger, a number of these boys had become RUF platoon commanders, and in terms of experience, they were thirteen going on twenty-five; if laying down their arms meant they had no future except to join thousands of others in displaced and refugee camps that dotted the countryside, they would not countenance it. … If these combat-tested leaders were not specifically targeted for advanced education and social development programs, they would surely lead the children back into the bush.…

Even worse off were the girls, who were much shyer about coming forward for help. Many had serious medical problems caused by rape, early child-bearing and unassisted births. … In time, the boys were generally accepted back into the community, but the girls were often shunned and abandoned.… Some of the girls had fought or held considerable responsibilities in the rebel formations; if properly supported, there was a chance they could become leaders – the forerunners of change on the gender-equality front. The demobilization and reintegration camps were their best chance, which was nearly no chance at all, especially if the aid community didn't get behind them and help.

…These disordered, violent and throwaway young lives – and the consequences of the waste of these lives on their homelands, and inevitably on the rest of the world – are the best argument to vigorously act to prevent future Rwandas.
If you think Africa doesn't matter, I remind you that al Qaeda's first major strike at America was not on 9/11, but on August 7, 1998, when two American embassies were blown up in East Africa, and that Sudan sheltered Osama bin Laden for many years. Bringing peace to Africa is not just a moral imperative, it's a prophylactic against future world instability. Those child soldiers will be leaders, one way or another. If Osama bin Laden reaches out to them, supports them trains them, they'll follow him. If Americans reach out, they will come to us. The EU, Canada, Japan, all have opportunities to bring the chaos of Africa to an end and to close off these traumatized populations from terrorist recruiting.

More on this topic later.