Physicians’ Responsibility to Consider Cost

Physicians have a responsibility to patients – and to society, who shares the cost – to factor cost into treatment decisions. Medicine does not operate in a vacuum. Allocating dollars, in a family budget as in a state or federal budget, means making trade-offs. American medicine often ignores this reality. As a result, we spend more money per capita on healthcare than any other country but have little to show for it (see below). We’ve got to wise up. Physicians and other healthcare professionals – those who’ve chosen to care for society – should be leading this charge, not dragging their feet behind it. Some are, but too many are not. Continue reading

Tragedy in Afghanistan – The Personal Impact of Long Wars on our Military Leadership

I woke to the sound of my cell phone ringing early on a Saturday morning. I rubbed the sleep from my eyes and braced myself for what I knew would be bad news on the other end of that line. I didn’t know yet, but this time there was nothing I could do to be ready. A fellow SEAL officer and close friend of 25 years responded to my “hello?” and got right to business. “Jamie, I’m sorry to be the one telling you this, but Job died last night in Afghanistan.”  I felt the breath rush out of my chest and the tears well in my eyes – “how?” I asked. “There will be an investigation, but right now it appears that Job died from a self-inflicted gunshot wound to the head,” he responded, his voice faltering.  For several minutes, the silence on the phone line hid the currents of emotion running through our minds.  My friend broke the silence, “Will you notify his parents? They are in Pennsylvania. I need you there right away.” Continue reading

What’s the Big [Trade] Deal? The Significance of the Bali Ministerial for the WTO


By Caroline M. Kirby

The Ninth Ministerial Conference of the World Trade Organisation (WTO), held in Bali, Indonesia from December 3 – 6, 2013, brought out the best, and worst, in the World Trade Organisation and its 159 [bickering] Member States. While the achievement of an estimated $1 trillion agreement on trade facilitation (TF) is laudable—the first multilateral agreement in the Organisation’s twelve-year history—the slow rate of progress on the rest of the Doha round is lamentable.

Perhaps this lethargy can be explained, if not understood. Inherent in the multilateral trading system are stark differences from bilateral and regional frameworks, to which Member States are still adjusting. In lieu of protecting invested interests, countries must often accept vulnerabilities (i.e. restrictions on agricultural subsidies) for the sake of broad consensus. This lack of comfort and specificity makes multilateral agreements all too unappealing.

In addition, multilateral agreements can result in the exploitation of least developing countries (LDCs), who may defer to their region‘s consensus for political or other reasons. Some argue LDCs would derive more benefits from trade by engaging bilaterally and regionally instead of multilaterally.

Nevertheless, despite these and other recent criticisms of the relevence and effectiveness of the WTO, the institution remains essential to the stability of an increasingly globalized world.

Even considering the short-term economic benefits of bilaterial and regional trade agreements, the comparative advantage remains with the WTO. In the long-term, countries would be forced to expose national sensitivites for the sake of increasing trade partners.

While richer countries can indeed exploit the interests of developing countries, they can also work to protect them. The WTO is the only place where countries can address national sensitivities in a multilateral context.

The Office of the United States Trade Representative (USTR) can lead the effort in the WTO to expand gainful trade opportunities for emerging economies. As Ambassador Michael Froman has said on numerous occasions, for those countries willing to engage in earnest and who see the benefits of trade for themselves, the USTR will work to help them.

Already, USTR has demonstrated an unparalelled commitment to the WTO through its active role in securing consensus in Bali.

Let’s hope the TF deal in Bali is not a one hit wonder for the WTO. With renewed optimism for its mandate, the Organisation and its Member States, spurred on by Azevedo, can realize concrete deliverables throughout the continuation of the Doha round.

Caroline M. Kirby (@carolinemkirby) has interned with both the U.S. Mission to the United Nations and Other International Organizations in Geneva and the United Nations Development Programme in Geneva, Switzerland.