Search

Begin New Search Topic Government Political Geography United States Content Type Journal Article Publication Year within 25 Years

81. The Idea of a Strategist's Education

Author:
Steven Anthony Pomeroy
Publication Date:
01-2011
Content Type:
Journal Article
Journal:
Journal of Military and Strategic Studies
Institution:
Centre for Military, Security and Strategic Studies
Abstract:
This essay adopted from “Ancient Alexandria, Alexander, and History: The Relevance of Humanistic Thought in the Contemporary Strategic Environment,” a talk the author gave on December 28, 2009, Broadmoor Hotel, Colorado Springs, Colorado. The comments herein are those of the author and do not reflect the official policy or position of the Unites States Air Force Academy, the Air Force, the Department of Defense, or the U.S. government. The author wishes to thank the following professors: Colonel (Dr.) Thomas A. Drohan, Dr. James R. Titus, and Dr. John Farquhar of the Military and Strategic Studies Department at the United States Air Force Academy. The comments herein are those of the author and do not reflect the official policy or position of the United States Air Force Academy, the Air Force, the Department of Defense, or the U.S. government. Bernard Brodie, Strategy in the Missile Age (Princeton, NJ: Princeton University Press, 1959), 406. Contending that nuclear weapons had fundamentally changed the character, if not the nature, of warfare, Brodie emphasized the importance of rigor and a scientific approach to strategic problem solving in the nuclear era.
Topic:
Climate Change, Education, Government, and Nuclear Weapons
Political Geography:
United States and Colorado

82. Quarterly Update on Conflict and Diplomacy

Author:
Michele K. Esposito
Publication Date:
05-2011
Content Type:
Journal Article
Journal:
Journal of Palestine Studies
Institution:
Institute for Palestine Studies
Abstract:
The Quarterly Update is a summary of bilateral, multilateral, regional, and international events affecting the Palestinians and the future of the peace process. More than 100 print, wire, television, and online sources providing U.S., Israeli, Arab, and international independent and government coverage of unfolding events are surveyed to compile the Quarterly Update. The most relevant sources are cited in JPS's Chronology section, which tracks events day by day. 16 November 2010–15 February 2011
Topic:
Diplomacy and Government
Political Geography:
United States, Israel, Palestine, and Arabia

83. International Visitor Leadership Program: A Valuable Tool in the Public Diplomacy Kit

Author:
Jinnie Lee
Publication Date:
04-2011
Content Type:
Journal Article
Institution:
Council of American Ambassadors
Abstract:
Celebrating its 70th anniversary this year, the International Visitor Leadership Program (IVLP) is the State Department's flagship citizen exchange program. The IVLP is a professional exchange program that seeks to build mutual understanding between the United States and other nations through carefully designed short-term visits to the United States. These visits to the United States reflect the International Visitors' professional interests and support the foreign policy goals of the United States. The participants are current and emerging foreign leaders in government, politics, journalism, education, arts, business, and other key fields identified as such by officers serving in US embassies. Almost 200,000 individuals have participated in the International Visitor Leadership Program, including more than 300 current and former chiefs of state and heads of government, and thousands of leaders from the public and private sectors.
Topic:
Education, Government, and Politics
Political Geography:
United States

84. The Impact of Ohio's EdChoice on Traditional Public School Performance

Author:
Matthew Carr
Publication Date:
06-2011
Content Type:
Journal Article
Journal:
The Cato Journal
Institution:
The Cato Institute
Abstract:
Over the course of the last 35 years, traditional public school student achievement in the United States has been stagnant, despite myriad reform efforts and a doubling in total expenditures on K–12 education (Ravitch 2000, Hanushek 1986, Greene 2005). The ramifications of this academic achievement plateau on human capital development and thus the country's global economic standing are of paramount importance (Heckman and Masterov 2007). Thus, one of the most important public policy questions that government and society faces is how to improve the academic performance and quality of the nation's public education system.
Topic:
Government
Political Geography:
United States

85. Immigrants and America's Future

Author:
Hilda L. Solis
Publication Date:
06-2011
Content Type:
Journal Article
Journal:
Americas Quarterly
Institution:
Council of the Americas
Abstract:
The U.S. labor secretary offers a blueprint for immigration reform.
Topic:
Government, Immigration, and Reform
Political Geography:
United States and America

86. The Americas Go Glocal

Author:
Saskia Sassen
Publication Date:
06-2011
Content Type:
Journal Article
Journal:
Americas Quarterly
Institution:
Council of the Americas
Abstract:
There is little doubt that the North-South axis remains dominant for Latin America's geopolitical positioning. But new relations are emerging and deepening at subnational levels, in turn creating new intercity geographies and challenging that geopolitical notion. These relations are a direct product of economic and cultural globalization. Some examples are the shift of migration from Ecuador and Colombia toward Spain rather than the U.S., the growing economic relations between Chinese businesses and organizations and São Paulo and Rio de Janeiro, and the emergent relations between these cities and Johannesburg, South Africa. The Internet has allowed a rapidly growing number of people to become a part of diverse networks that crisscross the world. And nongovernmental organizations (NGOs) from various parts of the world are establishing active connections over social struggles in Latin America. In other words, beneath the still-dominant North-South geopolitics, transversal geographies are growing in bits and pieces. One trend is the formation of intercity geographies as the number of global cities has expanded since the 1990s. These subnational circuits cut across the world in many directions. A second trend is the growth of civil society organizations and individuals who are connecting around the world in ways that, again, often do not follow the patterns of traditional geopolitics. The New, Multiple Circuits There is no such entity as the global economy. It is more correct to say there are global formations, such as electronic financial markets and firms that operate globally. But what defines the current era is the creation of numerous, highly particular, global circuits—some specialized and some not—interlacing across the world and connecting specific areas, most of which are cities. While many of these global circuits have long existed, they began to proliferate and establish increasingly complex organizational and financial foundations in the 1980s. These emergent intercity geographies function as an infrastructure for globalization, and have led to the increased urbanization of global networks. Different circuits contain different groups of countries and cities. For instance, Mumbai today is part of a global circuit for real estate development that includes investors from cities as diverse as London and Bogotá. Coffee is mostly produced in Brazil, Kenya and Indonesia, but the main place for trading its future is on Wall Street. The specialized circuits in gold, coffee, oil and other commodities each involve particular countries and cities, which will vary depending on whether they are production, trading or financial circuits. If, for example, we track the global circuits of gold as a financial instrument, it is London, New York, Chicago, and Zurich that dominate. But the wholesale trade in the metal brings São Paulo, Johannesburg and Sydney into the circuit, while trade in the commodity, much of it aimed at the retail level, adds Mumbai and Dubai. And then there are the types of circuits a firm such as Wal-Mart needs to outsource the production of vast amounts of goods—circuits that include manufacturing, trading, and financial and insurance services. The 250,000 multinationals in the world, together with their over 1 million affiliates and partnership arrangements worldwide, have created a new pattern of relations that combine global dispersal with the spatial concentration of certain functions often while retaining headquarters in their home countries. The same is true of the 100 top global advanced-services firms that together have operations in 350 cities outside their home base. While financial services can be bought everywhere electronically, the headquarters of leading global financial services firms tend to be concentrated in a limited number of cities. Each of these financial centers specializes in specific segments of global finance, even as they engage in routine types of transactions executed by all financial centers. It's not just global economic forces that feed this proliferation of circuits. Forces such as migration and cultural exchange, along with civil society struggles to protect human rights, preserve the environment and promote social justice, which also contribute to circuit formation and development. NGOs fighting for the protection of the rainforest function in circuits that include Brazil and Indonesia as homes of the major rainforests, the global media centers of New York and London, and the places where the key forestry companies selling and buying wood are headquartered—notably Oslo, London and Tokyo. There are even music circuits that connect specific areas of India with London, New York, Chicago, and Johannesburg. Adopting the perspective of one of these cities reveals the diversity and specificity of its location on some or many of these circuits, which is determined by its unique capabilities. Ultimately, being a global firm or market means entering the specificities and particularities of national economies. This explains why global firms and markets need more and more global cities as they expand their operations across the world. While there is competition among cities, there is far less of it than is usually assumed. A global firm does not want one global city, but many. Moreover, given the variable level of specialization of globalized firms, their preferred cities will vary. Firms thrive on the specialized differences of cities, and it is those differences that give a city its particular advantage in the global economy. Thus, the economic history of a place matters for the type of knowledge economy that a city or city-region ends up developing. This goes against the common view that globalization homogenizes economies. Globalization homogenizes standards—for managing, accounting, building state-of-the-art office districts, and so on. But it needs diverse specialized economic capabilities. Latin America on the Circuit This allows many of Latin America's cities to become part of global circuits. Some, such as São Paulo and Buenos Aires, are located on hundreds of such circuits, others just on a few. Regardless of the case, these cities are not necessarily competing with one other. The growing number of global cities, each specialized, signals a shift to a multipolar world. Clearly, the major Latin American cities have circuits that connect them directly to destinations across the world. What is perhaps most surprising is the intensity of connections with Asia and Europe. Traditional geopolitics would lead one to think that Latin America connects, above all, with North America. There is a strong tendency for global money flows to generate partial geographies. This becomes clear, for example, when we consider foreign direct investment (FDI) in Latin America, a disproportionate share of which goes to a handful of countries. In 2008, for example (a relative peak of FDI), FDI flows into Latin America were topped by Brazil at $45.1 billion, followed at a distance by Mexico at $23.7 billion, Chile at $15.2 billion, and Argentina with $9.7 billion. On average, between 1991–1996 and 2003–2008, FDI in Brazil increased more than five-fold while tripling in Chile and Mexico. Among the countries in the Latin American and Caribbean region receiving the lowest levels of foreign investment in 2008 were Haiti, at $30 million; Guyana, at $178 million; and Paraguay, at $109 million. Globalization and the new information and communication technologies have enabled a variety of local activists and organizations to enter international arenas that were once the exclusive domain of national states. Going global has also been partly facilitated and conditioned by the infrastructure of the global economy…
Topic:
Economics, Government, and Non-Governmental Organization
Political Geography:
United States, New York, America, South Africa, London, Colombia, Latin America, Mumbai, Sydney, Ecuador, Dubai, and Chicago

87. Leftist Governments in Latin America: Successes and Shortcomings edited by Kurt Weyland, Raúl L. Madrid and Wendy Hunter

Author:
Eduardo Silva
Publication Date:
06-2011
Content Type:
Journal Article
Journal:
Americas Quarterly
Institution:
Council of the Americas
Abstract:
At the turn of the twenty-first century, the Latin American Left experienced an extraordinary revival, especially in South America. By 2009, eight South American countries and two Central American nations had elected left-wing governments. Is this revival a harbinger of a progressive renaissance or a throwback to failed experiments? Leftist Governments in Latin America: Successes and Shortcomings attempts to answer this question by analyzing the extent to which these governments have improved the livelihoods of their citizens. The seven essays that make up the volume, written by distinguished U.S. and Brazil-based scholars, provide a sharp, scholarly comparison of the outcomes achieved by governments of the moderate left and what coeditor Kurt Weyland of the University of Texas at Austin calls the “contestatory” or more radical left, in an introduction that lays out the theoretical framework. This book, which was also edited by Raúl L. Madrid and Wendy Hunter of the University of Texas, fills a critical gap in the burgeoning literature on the subject.
Topic:
Government
Political Geography:
United States, Brazil, and Latin America

88. The Government's Assault on Private-Sector Colleges and Universities

Author:
Craig Biddle
Publication Date:
06-2011
Content Type:
Journal Article
Journal:
The Objective Standard
Institution:
The Objective Standard
Abstract:
Private-sector colleges and universities, also known as career colleges or for-profit colleges, educate more than three million people annually in the United States. These colleges—which include the University of Phoenix, ITT Technical Institutes, Kaplan University, Strayer University, Capella University, and Monroe College—provide vital services to Americans seeking to improve their lives. Programs in career colleges range from information technology and business administration, to commercial art and interior design, to allied health care and nursing, to accounting and finance, to criminal justice and law. These highly focused, career-specific programs enable people to achieve their occupational goals and to become productive, self-supporting, prosperous, and happy. These colleges are, for many people, pathways to the American dream. Unfortunately, certain individuals and agencies in the U.S. government are seeking to cripple and destroy these schools via an assault that includes fraud, collusion, and defamation. Before turning to the details of this assault, however, let us take a closer look at the enormous life-serving value provided by career colleges.
Topic:
Government
Political Geography:
United States and America

89. Exceptionalism of a kind: the political historiography of US foreign relations

Author:
Michael Dunne
Publication Date:
01-2011
Content Type:
Journal Article
Institution:
Chatham House
Abstract:
The recent US mid-term elections have not only dented President Obama's image at home and abroad, they have seen the return to 'divided government' whereby one party controls the Executive and the other controls either the Senate or the House of Representatives or both. Such divided government has been quite frequent since the Second World War; but the situation is often portrayed by political scientists as dysfunctional, even as they acknowledge that the Founders of the Republic deliberately created a federal system which would minimize concentrations of political power. Yet divided government is only one complaint among many levelled by American commentators at their political system. This article examines such criticisms both theoretically and historically, and also develops a historical approach which discusses American attitudes to the past, particularly US foreign relations. Here the emphasis is upon the ideologies that have powered American expansion, first across the North American continent and then overseas. A peculiar, even 'exceptional' aspect of this expansion has been its rhetorical form, in particular the invocation of past presidents to justify contemporary actions and the creation of a doctrinal canon (classically expressed in the Monroe doctrine). While these two lines of enquiry (emphasizing history and political science) are the methodological double core of the article, they are not treated discretely; rather the focus is on the interplay between the two.
Topic:
Government
Political Geography:
United States and America

90. An Unfinished Revolution

Author:
Shadi Hamid
Publication Date:
09-2011
Content Type:
Journal Article
Journal:
Georgetown Journal of International Affairs
Institution:
Georgetown Journal of International Affairs
Abstract:
On 25 January 2011, the first day of Egypt's uprising, U.S. Secretary of State Hillary Clinton affirmed: "our assessment is that the Egyptian government is stable." Eighteen days later, Egypt had a revolution, which concluded when the Egyptian military forced President Hosni Mubarak to step down from his position. After this remarkable turn of events, the Egyptian regime was simultaneously thought to be both more ruthless and more unified. After several years of impressive economic growth, the regime had the support of a powerful emerging business elite. It also had the United States as its primary benefactor. None of that was enough.
Topic:
Economics and Government
Political Geography:
United States and Egypt

91. Editor's Note

Author:
Michael McKeon and Imani Tate
Publication Date:
02-2011
Content Type:
Journal Article
Journal:
Georgetown Journal of International Affairs
Institution:
Georgetown Journal of International Affairs
Abstract:
Espionage and intelligence-gathering activities have evolved significantly since the end of the Cold War. State governments are no longer the only actors to make use of these practices, and information collection methods range from covert surveillance activities to monitoring financial transactions. Espionage plays an ever-greater role in the operations of states, non-state actors, and corporations, and has, as a result, created a host of new challenges to U.S. interests. The authors in this issue's Forum provide a glimpse into the ubiquity and complexity of espionage and intelligence-gathering, and offer insight into the implications of their use in finance, industry, and national security. Other contributions to this issue include articles about the end of the Comprehensive Peace Agreement in Sudan, constitutional reform in Burma, anti-human trafficking policies, and power politics in Kenya's Mau Forest Complex. We are proud to remain a source of information on a wide range of topics, and to give voice to leading academics, policy experts, and practitioners in the field of international affairs. We thank our staff, advisers, supporters, and the School of Foreign Service for their tireless work and dedication to this publication.
Topic:
Cold War and Government
Political Geography:
Kenya, United States, and Burma

92. Introduction

Author:
Catherine Lotrionte
Publication Date:
02-2011
Content Type:
Journal Article
Journal:
Georgetown Journal of International Affairs
Institution:
Georgetown Journal of International Affairs
Abstract:
Espionage and intelligence-gathering activities have evolved significantly since the end of the Cold War. State governments are no longer the only actors to make use of these practices, and information collection methods range from covert surveillance activities to monitoring financial transactions. Espionage plays an ever-greater role in the operations of states, non-state actors, and corporations, and has, as a result, created a host of new challenges to U.S. interests. The Forum of this issue addresses the changing threat of espionage after the Cold War, some of the new consumers of intelligence, and the unique and effective ways that actors have begun to use these practices.
Topic:
Cold War, Government, and Intelligence
Political Geography:
United States

93. Peace Before Freedom: Diplomacy and Repression in Sadat's Egypt

Author:
Jason Brownlee
Publication Date:
10-2011
Content Type:
Journal Article
Journal:
Political Science Quarterly
Institution:
Academy of Political Science
Abstract:
The Egyptian – Israeli Peace Treaty of April 1979 capped four major wars and inaugurated a new U.S. – Egyptian relationship. Henceforth, U.S. presidents would regard the Egyptian – Israeli treaty as a cornerstone of American interests and values in the region. In 2003, President George W. Bush recognized Egypt as a trailblazer of peace and urged the country to “ show the way toward democracy in the Middle East. ” 1 The remark spoke to Washington ʼ s success reconciling historic adversaries and its ostensible hope for political reform in Cairo. Between the U.S. and Egyptian governments, though, peace and democracy had been at odds since the treaty ʼ s drafting. The autocratic prerogatives of President Anwar Sadat (r. 1970 – 1981) were a sine qua non of successful bargaining. Negotiators on all sides presupposed tight policing within Egypt. At this crossroads of diplomacy and domestic poli- tics, Sadat fused international peace and internal repression.
Topic:
Government
Political Geography:
United States, America, Middle East, and Egypt

94. The Political Power of Social Media

Author:
Clay Shirky
Publication Date:
01-2011
Content Type:
Journal Article
Journal:
Foreign Affairs
Institution:
Council on Foreign Relations
Abstract:
Discussion of the political impact of social media has focused on the power of mass protests to topple governments. In fact, social media's real potential lies in supporting civil society and the public sphere -- which will produce change over years and decades, not weeks or months
Topic:
Government
Political Geography:
United States

95. Letter to the Editor: Legalize It

Author:
Terry Nelson
Publication Date:
01-2011
Content Type:
Journal Article
Journal:
Foreign Affairs
Institution:
Council on Foreign Relations
Abstract:
Robert Bonner writes that "destroying the drug cartels is not an impossible task" ("The New Cocaine Cowboys," July/ August 2010). But he really should have written, "Destroying some drug cartels is not an impossible task."
Topic:
Security, Government, and War on Drugs
Political Geography:
United States

96. Adjusting to Stabilization and Reconstruction Operations

Author:
Robert Hoekstra and Charles Tucker Jr.
Publication Date:
03-2010
Content Type:
Journal Article
Journal:
PRISM
Institution:
Institute for National Strategic Studies (INSS), National Defense University
Abstract:
Drawing on the lessons learned from coalition interventions in Bosnia and Herzegovina, Kosovo, Afghanistan, Iraq, and elsewhere, by mid-2004, a consensus developed within the executive branch, Congress, and among independent experts that the U.S. Government required a more robust capacity to prevent conflict (when possible) and (when necessary) to manage “Stabilization and Reconstruction Operations [SROs] in countries emerging from conflict or civil strife.”
Topic:
Conflict Resolution and Government
Political Geography:
Afghanistan, United States, Iraq, Bosnia, Herzegovina, and Kosovo

97. Organized Crime in Iraq: Strategic Surprise and Lessons for Future Contingencies

Author:
Phil Williams
Publication Date:
03-2010
Content Type:
Journal Article
Journal:
PRISM
Institution:
Institute for National Strategic Studies (INSS), National Defense University
Abstract:
After the invasion of Iraq in March 2003, the United States encountered a series of strategic surprises, including the hostility to the occupation, the fragility of Iraq's infrastructure, and the fractious nature of Iraqi politics. One of the least spectacular but most significant of these surprises was the rise of organized crime and its emergence as a postconflict spoiler. This development was simply not anticipated. Organized crime in Iraq in the months and years after March 2003 emerged as a major destabilizing influence, increasing the sense of lawlessness and public insecurity, undermining the efforts to regenerate the economy, and financing the violent opposition to the occupation forces. In 2003, the theft of copper from downed electric pylons made the restoration of power to the national grid much more difficult. In 2008, the capacity to generate funds through criminal activities enabled al Qaeda in Iraq (AQI) to continue resisting both the U.S. military and the Iraqi government. Moreover, with the planned U.S. withdrawal from Iraq, organized crime in the country will continue to flourish by maintaining well established crime-corruption networks. It might also expand by exploiting the continued weakness of the Iraqi state.
Topic:
Economics, Government, and Politics
Political Geography:
United States and Iraq

98. India's Rise, America's Interest: The Fate of the U.S.-Indian Partnership

Author:
Evan A. Feigenbaum
Publication Date:
03-2010
Content Type:
Journal Article
Journal:
Foreign Affairs
Institution:
Council on Foreign Relations
Abstract:
Until the late 1990s, the United States often ignored India, treating it as a regional power in South Asia with little global weight. India's weak and protected economy gave it little influence in global markets, and its nonaligned foreign policy caused periodic tension with Washington. When the United States did concentrate on India, it too often fixated on India's military rivalry with Pakistan. Today, however, India is dynamic and transforming. Starting in 1991, leaders in New Delhi -- including Manmohan Singh, then India's finance minister and now its prime minister -- pursued policies of economic liberalization that opened the country to foreign investment and yielded rapid growth. India is now an important economic power, on track (according to Goldman Sachs and others) to become a top-five global economy by 2030. It is a player in global economic decisions as part of both the G-20 and the G-8 + 5 (the G-8 plus the five leading emerging economies) and may ultimately attain a permanent seat on the United Nations Security Council. India's trajectory has diverged sharply from that of Pakistan. With economic growth, India acquired the capacity to act on issues of primary strategic and economic concern to the United States. The United States, in turn, has developed a growing stake in continued Indian reform and success -- especially as they contribute to global growth, promote market-based economic policies, help secure the global commons, and maintain a mutually favorable balance of power in Asia. For its part, New Delhi seeks a United States that will help facilitate India's rise as a major power. Two successive Indian governments have pursued a strategic partnership with the United States that would have been unthinkable in the era of the Cold War and nonalignment. This turnaround in relations culminated in 2008, when the two countries signed a civil nuclear agreement. That deal helped end India's nuclear isolation by permitting the conduct of civil nuclear trade with New Delhi, even though India is not a party to the Nuclear Nonproliferation Treaty. Important as the agreement was, however, the U.S.-Indian relationship remains constrained. For example, although U.S. officials hold standing dialogues about nearly every region of the world with their counterparts from Beijing, Brussels, and Tokyo, no such arrangements exist with New Delhi.
Topic:
Government
Political Geography:
United States, Washington, India, and New Delhi

99. Letters and Replies

Publication Date:
04-2010
Content Type:
Journal Article
Journal:
The Objective Standard
Institution:
The Objective Standard
Abstract:
Thank you for publishing Paul Beard's excellent article regarding the California Coastal Commission. Perhaps it was intended to be implied, but nowhere in the article was it stated that Pacific Legal Foundation, whose Coastal Land Rights Project Mr. Beard now heads, has represented the property owners in all of the cases he described.
Topic:
Government
Political Geography:
United States

100. Government-Run Health Care vs. the Hippocratic Oath

Author:
Paul Hsieh
Publication Date:
04-2010
Content Type:
Journal Article
Journal:
The Objective Standard
Institution:
The Objective Standard
Abstract:
When medical students graduate from medical school, they take an oath-the Hippocratic oath-in which they solemnly swear, above all, to use their best judgment in treating their patients. Doctors hold this oath as sacrosanct; they regard upholding it as morally mandatory, and violating it as out of the question. But in order to uphold this oath, in order to practice medicine in accordance with their best judgment, doctors must be free to practice in accordance with their best judgment. Unfortunately, U.S. politicians are working feverishly to prevent doctors from upholding the Hippocratic oath. How so? By implementing government-run health care. Politicians' efforts to impose government-run health care include their goal of "guaranteeing" health care to everyone. But whenever the government attempts to "guarantee" health care, it must also control the costs of that service-which means, it must dictate how doctors may and may not practice. Toward this end, as Harvard professor Martin Feldstein notes, advocates of government-run health care call for "comparative effectiveness" practice guidelines. Quoting the White House Council of Economic Advisers, Feldstein points out that these guidelines are designed to ration health care and reduce spending by "implementing a set of performance measures that all providers would adopt" and by "directly targeting individual providers . . . (and other) high-end outliers."1 ("High-end outliers" is government-speak for "physicians who order more tests or perform more procedures than the government deems appropriate.") An example of such "effectiveness" guidelines is the new federal recommendations for screening mammography. The U.S. Preventive Services Task Force (USPSTF) recently recommended restricting mammogram screening to women over age fifty, despite the fact that medical organizations such as the American Cancer Society and the American College of Radiology-whose conclusions are based on years of peer-reviewed scientific research-have long recommended that women begin routine mammography at age forty.2 The USPSTF argues that eliminating mammograms for women between ages forty and forty-nine would result in only one additional cancer death per nineteen hundred women screened-an increase in death that they evidently consider acceptable.3 The announcement of these new guidelines caused so much public controversy that Secretary of Health and Human Services Kathleen Sibelius quickly backpedaled and stated that these particular USPSTF recommendations would be "nonbinding."4 But what does "nonbinding" mean when it refers to the guidelines of a government agency? The government is an agent of force. Any government "recommendations" come with at least the implicit threat that recalcitrant doctors may face negative consequences. Not surprisingly, government medical agencies have already adopted the new guidelines. The California state government has begun using the USPSTF guidelines to determine which services patients in the Medi-Cal program may and may not receive.5 (Medi-Cal is the California equivalent of Medicaid in other states.) Government-funded health programs in New York and Ohio have already begun turning away women under fifty seeking mammograms.6 And, Sibelius's reassurances notwithstanding, Congress is considering giving the USPSTF legal authority to determine which screening tests will or will not be covered for patients with private health insurance.7 How are American physicians responding to these developments? Fortunately, many have chosen to ignore the guidelines, to continue practicing according to their best medical judgment, and to order mammograms on their female patients between ages forty and fifty as they see fit.8 But bear in mind that the White House Council of Economic Advisers has already pejoratively labeled such physicians "high-end outliers." If the government decided to enforce its "comparative effectiveness" guidelines, such doctors could be punished at any moment. And bear in mind what the punishment would be for: upholding their Hippocratic oath, their promise to practice according to their best judgment for the best interests of their patients.
Topic:
Government
Political Geography:
United States