SoCal Minds

What succeeds in counterinsurgency operations?

From RAND

With the United States mired in a seemingly intractable battle that has become one of its longest overseas incursions ever, policy-makers may wish to take heed of new research from Santa Monica that examines what works and doesn't in counterinsurgency operations. Experts scrutinized more than 20 distinct approaches tested in various global hot spots over three recent decades, including in Turkey, Croatia, Somalia, Burundi, Tajikistan and Kosovo. Some key take-aways: Trying just one approach won't get it -- indeed, successful counterinsurgency operations employed multiple options; escalating repression, relocation of populations and increasing support of insurgents 'have the weight of evidence against them' and their prospects for success. Outsiders -- like the U.S. in Afghanistan and Iraq -- must gauge carefully their prospects for prevailing in a conflict by understanding deeply and carefully, the researchers say, both the popular support that local insurgents enjoy, and, more important, the tangible support (food, supplies, intelligence, cover) that they receive. A bad, undependable or shaky on-scene partner or government in a counterinsurgency? That's a grim indicator for counterinsurgency failure, something that might give U.S. policy-makers much greater pause, both in the past Bush administration and on to the Obama folks, about President Hamid Karzai and his regime in Afghanistan.

Successful campaigns found to tap multiple approaches, awareness of insurgents' support

Click here to get full RAND study, 'Victory Has a Thousand Fathers'

What's U.S. role in Persian Gulf after Iraq drawdown?

From RAND

With a flailing U.S. policy in Afghanistan commanding glum headlines, the American presence in Iraq somehow manages to slip ever so slowly from public view and deep, necessary consideration. Which, taking in account the nation's investment of blood and treasury there, could be a big problem. Still, as the experts in Santa Monica make clear, figuring the American role in Iraq after the planned Obama Administration major troop draw-down there turns the incursion there into a daunting, complex regional balancing of threats, alliances and interests. These include the right response by the U.S. and its allies to Iran, the Israeli-Palestinian conflict, with Turkey and what to do about restive religious, ethnic, nationalistic and insurgent movements (from Islamic fundamentalists to Kurdish nationalists). And, of course, what, including oil, are America's real, long-term interests and at what depth in the troubled area, Baghdad included? Got a headache yet?

Even with lesser role in Baghdad, U.S., allies urged to redefine a complex regional policy approach

Teaching hospitals urged to communicate more on last choices

From RAND & UCLA

Because desperately ill patients often don't get a choice about where they will spend their last days, it's good to know that, according to researchers in Santa Monica, teaching hospitals provide high-quality medical care to those at the end of their lives. Terminal patients, especially seniors, received appropriate care 70% of the time when measured against benchmarks -- a better performance than recorded in other studies of treatment of the ailing old. But better communications also need to be put in place between care-givers and patients' families as to expectations about treatment goals, the researchers found after analyzing almost 500 cases of critically ill folks hospitalized in the big, aggressive treating Bruin hospital on the Westside. Caregivers in Westwood already have taken steps to address concerns raised by the research on end-of-life patients, particularly in getting doctors and patient families to talk early and often about sustaining measures such as dialysis, ventilators and defibrillators and when they should be shut off so the old and critically ill can be allowed to die. Americans' reluctance to tackle the tough talk about the last days of loved ones, of course, dominated moments of the national debate on health care and health insurance reform; 10% to 12% of all health care costs nationally and a quarter of Medicare's expenditures go to patients in the last year of their lives.

Care-givers urged to consult more with patients' familes on end-of-life treatments, expecations

• And by the way, for those who didn't get enough of the topic during a year's national debates, two policy experts will tackle the recently enacted health care and health insurance reform, asking whether it is a 'government takeover' or 'corporate welfare.' The free session, for which space is limited and reservations are required, will be at 7 Wednesday night on the Westside.

A dissection on whether health care reform is 'government takeover' or 'corporate welfare' 

For U.S. policy-makers, troubling critiques on South Asia

From RAND

With the top U.S. general in Afghanistan apologizing for flip remarks about his civilian bosses, it's hardly  good news that the Obama Administration's Pakistan policies also come under criticism by researchers in Santa Monica, even as a noted writer on South Asia visits the Southland for a free, public conversation. The broadside at key elements of the American 'Af-Pak' strategy finds that too much attention has gone to short-term, immediate military moves by Pakistan, with U.S. aid and encouragement, against militant groups that have surged within its borders and poured into Afghanistan, too, often with the support of the Pakistani intelligence services and military. Yes, the U.S. drone strikes and Pakistani military sweeps in lawless border areas have achieved some key gains. This approach, however, has undercut tougher, long-term strategies that need to be developed and put in place if terrorist organizations like Al Qaeda really are to be put down, researchers say. They say these steps would include Pakistan creating real rule of law, building up local police and courts, providing for greater economic development and aid to the combat displaced. Meantime, William Dalrymple, a noted journalist who earlier this year penned a disturbing Op-Ed that reminded about how fast things can go south for foreign forces in Afghanistan, will be on the Westside talking about his well-received new tome and the 'Nine Lives' and more that he found in his treks across India.

An unfavorable critique of long-, short-term U.S. policy in Pakistan

Click here for the full RAND report on Pakistan

Searching for sacred in 21st Century India

For Uncle Sam's crew, deep doubts about military contractors

From RAND

It's all couched in the delicate demurrers preferred by the striped-pants crowd. And, of course, these were employees talking about their employers' big, official policies and major course of action. Still, researchers in Santa Monica say that U.S. diplomatic workers and government employees express significant doubt about this country's decisions, chiefly in the Bush administration era, to ramp up the employ of armed private security contractors. While those who serve this country in official capacity, in the diplomatic corps, the military or as government workers, didn't always see negative conduct in places like Iraq, they heard, witnessed and knew enough about incidents on the margins of their own experience or widely reported really bad acts to give the outsiders a mixed report card. The contractors' employ reached unprecedented levels, especially in Iraq, where armed contractors grew from around 10,000 in 2000 to 30,000 in 2007, falling back to 10,422 in 2009. 'Disconcertingly high' numbers of surveyed State Department employees denounced the armed contractors for their ignorance and flouting of international and local law, as well as their insensitivity to the culture, customs and local practices of Iraqis; government employees, especially those in the military, expressed discomfort if not resentment at the significantly higher pay that the outsiders collect. 

Mixed marks for outsiders who provide high-cost armed security in Iraq, elsewhere

Click here to get the full RAND study on armed military contactors

U.S. found to keep up fighting forces by boosting bonuses

From RAND

The long, brutal battles in Iraq and Afghanistan have taken a major toll on the U.S. military but the armed services have hit on a key way to maintain their recruiting and retention of fighting forces, researchers in Santa Monica say. What has worked for our armed forces? Money, of course. The Defense Department almost has doubled its budget for enlistment and reenlistment bonuses, which went up as a line item from $625 million in 2000 to $1.4 billion in 2008 and, in the Army's case, went on average from $5,600 to $18,000 per soldier. Bonuses boosted reenlistment in the Army, Marines and Navy but proved less effective with the Air Force. The one-time payments, however, proved more alluring and cost-effective than hikes in base pay, housing and subsistence allowances or tax breaks for various types of military compensation, researchers say. The costs of reenlistment bonuses varies by position and branch of service, though researchers called for more study about their effectiveness regarding productivity and caps, as well as greater inquiry as to how the extra money moves personnel to enlist for key positions. As the Iraqi and Afghan conflicts and commitments drag on and questions increase as to the U.S. roles in the two hot spots, of course, more lawmakers and taxpayers are raising issues with military spending, including the allocations for bonuses.

Cash for enlistment, reenlistment helping to offset brutal toll of Afghan, Iraq wars

Alternatives considered, a nod for health reform, as approved

From RAND

Now that the screaming and voting has ended, the recently approved national health care and health insurance reform, researchers in Santa Monica say, provided coverage to the largest number of Americans while keeping federal costs as 'reasonably low' as possible. The researchers plugged more than 2,000 policy scenarios into their computer models to reach their conclusions about the health care and health insurance package that Congress passed earlier this year and which they estimate will add health coverage for 28 million Americans by 2016. Yes, the data crunching showed that some proposed measures might have curbed costs more at the federal level. But these alternatives -- substantially higher penalties for those who don't comply with mandates, lower government subsidies and less-generous Medicaid expansion -- the researchers deemed 'politically untenable.'

Health package found to offer largest numbers coverage at best option on costs

An HIV-AIDS fighting role for faithful in Latin America

From RAND

Churches and religious relief- and development-groups can play a crucial role in responding to HIV-AIDS in Latin America, especially if they focus on people and a disease -- not on theological points of dispute, say experts in Santa Monica who have researched what the Samaritans could do in three countries in the region most afflicted by the virus (Belize, Honduras and Guatemala). They say that faith-based groups could make a major difference in the course of the disease and how it affects lives if they helped those with HIV-AIDS with nutrition and support programs. If the religious also would take up the message of testing and treatment, especially sustaining the sometimes difficult drug regimens called for in the care of those with the virus, they could use their considerable sway to keep public perception on HIV-AIDS as a disease. The problem, of course, is that the virus often spreads through sex -- between men and via sex workers; an effective preventative method also relies on prophylactics, which are anathema to some faithful. 

Faithful urged to use huge sway, focus on helping the afflicted, caring for those with a disease

Click here for full RAND report on faith-based groups, HIV-AIDS in Latin America

New U.S. policies urged for problematic Pakistan

From RAND

Pakistan will continue to pose giant foreign policy challenges for the United States, which must shift its approach toward the South Asian nation, recognizing that it, not Afghanistan, is the central concern in what also must become a regional strategy that also takes into account relations with India, researchers in Santa Monica say. They have produced a new book that asks whether the U.S. can help secure the insecure nation, based on interviews with elites and research on polling, demographic, economic and other data. At best, they say, the deeply riven nation will muddle along, neither collapsing into religious and ethnic strife that could engulf the region nor becoming a theocracy nor a militarily controlled state. To see any progress, however, Washington must keep its focus on aiding and building civilian rule in Pakistan and recognize that its size, resources, influence, population and power make it more key to regional and U.S. interests than Afghanistan; the U.S. must help the Pakistanis and Indians resolve their long enmities; Washington cannot keep throwing money and other aid at Islamabad, particularly its military, without greater accountability and transparency about where those sums end up. And the U.S. Air Force may have a particularly important part it can play in influencing the Pakistani military, the researchers say.

Click here for summary, full RAND report on Pakistan

A cautionary call on profiling doctors by costs

From RAND

Here's another prescription for caveat emptor for patients and physicians as they both try to keep track of a proposed cost-saving measure by health insurers. The firms have sought to apply different kinds of methods to create profiles of doctors and their charges, with the hopes of getting patients to traffic docs with lower costs, particularly when they must see multiple care-givers. But details about how the insurers attribute charges to docs can be devilish, creating huge disparities in their assignment to a low-cost and insurer-preferred pool. Do the companies, for example, weight their criteria so docs who see the most patients get attributed with more charges? Or do they tag docs whose charges make up the bulk of the cost of patients' total care? Based on a  dozen shifting standards and a study of four Massachusetts health plans with more than 1 million adults in them, researchers said they could see as few as 17% and as many as 61% of insurer profiled physicians moving into different low- or high-cost categories. They say the insurers must be clear, fair and open about how they create profiles, including patients and docs in the process and allowing for outside review of their actions.   

Are insurers' methods fair, clear, open as they dub docs low- or high-cost?