Cheney and the GOP criticizing Obama over Crimea

http://news.yahoo.com/cheney-putin-obama-ukraine-171405306.html

I find it ironic (but typical) that Cheney and others in the GOP (except for the Paul family libertarians) would bash Obama for being "weak" in the face of Putin's aggression in Crimea. Politicians have short memories, but I seem to recall that Bush did jack squat against Russia's overt invasion of Georgia in 2008 (and in that war, >700 people died whereas in Crimea one guy got a concussion so far). Diplomacy, not threats or military buildup, eventually led to a Russian withdrawal and UN peacekeeping mission.

Obama said that the US would issue travel restrictions and asset freezes of Russian nationals tied to the Crimea situation (that is already more than Bush did in 2008). We are giving $1B in aid to Ukraine's bankrupt transition gov't. Obama is pulling out of a future G8 summit in Sochi and will likely cut some planned joint military activities. But that's about all he can do for now. If we can't pressure Assad to change course, what do you think we can do against a top energy producer and nuclear arsenal? It remains to be seen if the EU will implement these sanctions too in order to make them more effective, but of course they have more to lose being closer proximity and dependent on Russia for gas and trade.

Previously, I was against Bush's plans to build a missile defense shield in Eastern Europe (ostensibly to counter Iran, but we know who it was meant for). I thought it was provocative to Russia, ineffective, and a handout to Lockheed. Our defense budget is tighter now, but I am reconsidering whether the missile shield would be useful as a strategic deterrent (albeit a pricey one). Russia should abandon their plans to reclaim former Soviet republics, as the West is not going to stand for it as long as the peoples of Eastern Europe are choosing Western values over Putinism.

After the Georgia War:

The [2008 EU] Report claimed that Russian citizenship, conferred to the vast part of Abkhaz and Ossetians may not be considered legally binding under international law. As a result, the interests of these people may not be used as a reason for starting military actions, in defense of Russian citizens living abroad.

A humane and intelligent approach to end-of-life medical care

This interview with physician Sherwin Nuland was very thoughtful and IMO is a prudent approach to the uncomfortable subject of managing end-of-life care decisions. I know medicine and death are very personal and emotional subjects, but I think if we dispassionately put the patient's best interests first and keep expectations reasonable, everyone will end up happier (especially the deceased) and society can save a lot of health care resources.

One issue that the doc didn't cover in the interview was assisted suicide, which has few rational arguments against it, and is becoming more accepted nationwide - similar to legal pot and gay marriage.

-----

Also heard something about end-of-life care on NPR the other day.  There was a particular city that had a big promotion of advanced medical directives.  What they found was that, as a result, medical costs went down quite a bit in their city.  Apparently when people make a positive choice about the type of life they consider worth living it is significantly less expensive than the care legally mandated in the absence of a positive choice.

The major roadblock to those advanced directives is human effort and human emotion.  Understandable and probably not an incredibly high hurdle to overcome.

-----

Agreed. More and more people are preferring to die relatively peacefully at home or hospice rather than "keep fighting" to the end with all the tubes and drugs in them at County General. And the irony is that the former group tends to last longer, and with less grief on themselves and the family, than the latter (obviously at much lower cost too as you said).

There are plenty of war stories where the stubborn commander refused to face reality and sentenced himself and his men to preventable death. Even worse, a stupid, egomaniac dictator doesn't understand opportunity cost, ignores his generals' pleas, and keeps throwing finite resources at an unwinnable battle, which ironically contributes to losing the overall war - see Stalingrad or Guadalcanal. We tend to mock those men and use their folly as teachable moments. So why can't we apply the same logic to medicine? Unfortunately there is such a thing as a no-win scenario, so the sooner we come to terms with that, the better it is for everyone. Would you gamble your life savings on 1 play at 1/1000 odds at the casino? Of course not - so why do we do it at the hospital? Is it because of moral hazard, or the finality/unknown nature of death?

On a personal note, what I really hate to see are relatives pressuring the dying person to "keep fighting" and "not let the disease win". It gives the false impression that the outcome is mostly in the patient's control, and it's a matter of effort/will. The patient has enough to worry about without that guilt. No one wants to be reminded that they are the source of the everyone's sadness, like it's their fault. Families may bring up outliers like Lance Armstrong, but forget that 99.99% of folks like Lance didn't make it. I'm not saying to abandon all hope, but at least don't impose ludicrous expectations. Unfortunately, the next of kin can get pretty selfish and they may not be ready to let go. But during these tough times, the best thing they can do is show as much comfort and compassion as possible for the dying.

But if it's the patient insisting on exhausting every medical possibility no matter the odds or costs, I am not sure how a physician or relative can/should dissuade them respectfully. 

Recent perspectives on income and the wealth gap

Bill Maher: the super rich have an oversized egotistical victim complex. Libertarians and conservatives can cut the crap, because most of the founding fathers commented that concentrated wealth is a danger to democracy (and back then the existence of a billionaire capitalist was less plausible than the Fountain of Youth). 

A caller on KQED: debating the minimum wage is a straw man until America implements more humane labor practices and expectations. Otherwise we're not much different than Tsarist Russia.