A Wake-up Call for America: We Must Connect with the World

Former U.S. Sen. Russ Feingold, currently the Mimi and Peter E. Haas Distinguished Visitor at Stanford’s Haas Center for Public Service, uses an anecdote in his new book, While America Sleeps: A Wake-up Call for the Post-9/11 Era, to illustrate his concern that Americans have become too insular as a result of the 2001 terrorist attacks. While teaching at Marquette University Law School during the Arab Spring of last year, an undergraduate penned a column lamenting that so many students not only could not find Tunisia on the map – they could spell Kardashian before Kazakhstan.

Feingold writes that he admired this student for his confession about his lack of knowledge on global affairs, then quotes the final thought of the young columnist: “We are connected to the rest of the world in ways few of us can fully fathom, from the shoes we wear and coffee we drink to the cell phones we carry and the tweets we post.”

In a recent interview, CISAC Co-Director Mariano-Florentino Cuéllar and Feingold discuss steps to be taken to ensure that all Americans – young and old, inside the Washington beltway and out on the farm in Wisconsin – take a patriotic stand by engaging with the world to restore our national unity and regain global respect.    

Senator Feingold, what prompted you to write this book now?

Feingold: For me, as for many Americans, 9/11 was a life-changing event, the wake-up call in which we all understood that we no longer could be safe just assuming the world would take care of itself. We got misdirected with things like Iraq and we developed this sort of invade-one-country-at-a-time approach. There was also exploitation of the fears from 9/11 for domestic agendas, from the Patriot Act to the way that Muslims and Arabs are treated in this country. And then, finally, with the rise of the tea party, I feel like we went back to sleep. But there are signals all over the place, of the continued presence of al-Qaida and the continued potency of al-Qaida, not to mention so many other trends from the Chinese influence in Africa to the Iranian influence in Latin America. We aren’t connecting as a government or as a people in a way that I think is commensurate with our place in the 21^st century. I’m trying to issue a warning that we’re going to get fooled or surprised again if we think we can just go back to being just sort of safely over here across the oceans. That’s just not the world anymore.

So how do you wake up Americans and make them realize we cannot, as you say, survive as a nation without being active and aware of global events and trends? 

Feingold: It’s at all levels. I happen to think we have a good president and I think he’s going to be a great president by the end of his second term. And I think he’s started the process of alerting Americans to the need to connect to all places in the world; he’s leading us toward a global vision of the kind that I think we have to have to be safe and to be competitively successful and to be well perceived by the rest of the world. The president and other leaders should call on each of us to try and become citizen diplomats. Three hundred million people should be urged as part of their patriotic duty not just to go to the moon as we once were, but go to the rest of the world. This isn’t Pollyanna; this is about being safe. I don’t think this country is geared up to make that connection and I think it’s a fatal flaw. The Russians, the Chinese and the Iranians, they’re all over the world and they have a plan for what they’re doing. We don’t.

What do you see as the most pressing global security issues today?

Cuéllar:  The United States is confronting a changing world, where countries like India, Brazil, and China are evolving and assuming greater importance. Engaging these countries to address problems like nuclear proliferation will be critical in the years ahead.  The world also faces a persistent problem involving failed or failing states. In places like Somalia, piracy is not only a regional problem in the Gulf of Aden.  The problem is an example of how threats can affect multiple countries and impact flows of commodities, disrupting the rule of law, highlighting the challenges of governing common resources such as international sea lanes. Another challenge is the enormous potential of technology to change people’s lives for the better, coupled with risks that arise which we are only in a very imperfect and incomplete way managing; risks of vulnerabilities in our infrastructure; risks of theft of intellectual property, risks of disruption of organizations.

Feingold: I like this answer because Prof. Cuéllar did not just say, “Well, it’s Russia and Iran and Colombia.” There’s this tendency to just speak of countries. We’re just trained to say, “OK what’s the hot spot and let’s just worry about that.” Like right now it’s Iran; a few months ago it was Yemen. In my book what I’m trying to point out is that you have to look at trends and overall tendencies around the world and somehow we have to have the capacity to deal with more than one thing at a time.

Senator Feingold, you called the Bush Administration’s terrorist surveillance program – the wiretapping and surveillance of emails and financial records without court approval – one of the worst assaults on the Constitution in American history. How does the government protect our constitutional rights to privacy and probable cause while monitoring criminal and terrorist networks in a digital age?

Feingold: The assault on the Constitutional by the administration was not about whether we could do those things, its whether or not the president would basically make up his own laws just because we’re in a crisis. That to me is completely unconstitutional. We understand that a president might have to take emergency action and he may have to come to Congress and say, you know I did this, it may be beyond the law, would you please pass a law to approve it, or I’ll stop doing it. That’s not what Bush did. Bush hid it. Bush hid what he was doing on torture; Bush hid what he was doing on wiretapping. That’s a very dangerous thing that completely saps our strength from within and is completely unnecessary to stop the terrorists.

Cuéllar: The challenge of living up to our constitutional values while we secure the country is always critical. It requires organizations that can learn from their mistakes to be honest with each other enough and recognize when they have overstepped their bounds, that make good use of entities like inspectors-general, that leverage the ability of Congress to do oversight. These are all elements of making our constitutional values relevant. So me the challenge has always been how to you leverage all the information technology and all our ability to make smart, thoughtful, careful decisions – including decisions that do permit appropriate degrees of surveillance and intelligence – in order to avoid superficial reactions against individuals who simply appear threatening.

What key steps should the U.S. government take to improve its counter-terrorism efforts both at home and abroad?

Feingold: The first thing is to recognize the nature of the threat. One of the chapters in the book is called A Game of Risk, where we seem to think the way to counter terrorism is to invade a country and stay there forever and say we have to stay there or the terrorist are going to come back. But this isn’t the nature of al-Qaida or similar organizations. President Bush used to say there were 60 countries where al-Qaida was operating and, of course, one thing that was embarrassing about it was that Iraq wasn’t one of them. But we’re still in this place today. Al-Shabab in Somalia; al-Qaida and the Islamic Maghreb in northern Africa; a group called Boko Haram in Nigeria, which looks very much like an al-Qaida group, has pulled off some 70 attacks in the last year. So this is an international organization that communicates with each other and they’re not done just because Osama bin Laden is gone. So let’s not get caught unawares again.

Senator Feingold, what was your most memorable, defining challenge in Congress and how did that change the way you see yourself and the world around you?

It had to do with recognizing when 9/11 occurred that there really was a group of people out there who would love to kill all of us and, despite the fact that I’m progressive and I voted against most military interventions, just saying to myself: look, there are times when threats are real. And it caused me to actually seek to be on the Intelligence Committee which is something I never wanted to do; I was not sure of the importance of intelligence in the post Cold War era and it was a real change for me. I remember having an emotional response, saying, “You know what? This is real; what these folks did was real and they have intimidated an entire country if not the world.” I wanted to know everything I could about how they came to be and what they were planning next, and to be a person who could try to think ahead for other kinds of threats so we as Americans can get ahead of threats instead of being the people who are reacting.

Recent news from Caixin.net

To illustrate the worst-case scenario for China in the near future, Scott Rozelle pulls up a picture from Mexico. It's a completely barren manufacturing warehouse, abandoned after wages in Mexico rose to more than four dollars per hour.

Following its manufacturing moment in the 1980s, Mexico has been struggling to create jobs in part because 40 percent of its workers lack a high school education, the Stanford University Professor of Economics said.

Contrast this to South Korea, where almost the entire workforce has attained a high school degree. After manufacturing jobs left South Korea in the 1980s, he said, well-educated workers were able to upgrade to technical jobs like chip manufacturing and computer assembly.

The question for China is: South Korea or Mexico? Rozelle said.

With rising labor costs, China is under pressure to upgrade from low-cost manufacturing to high-tech production. But it's still an open question as to whether China's labor force will have the education levels to take on these new roles, or if the jobs will move elsewhere as they did from Mexico in the last few decades.

The odds are stacked against China. In some parts of the country, China's labor force more resembles Mexico's than South Korea's, with about 40 percent of workers in the poorest rural areas (China's 592 "nationally-designated poor counties," as deemed by China's anti-poverty authorities) lacking a high school education, Rozelle said.

Furthermore, the financial hurdles to attaining higher education are the highest in the world, illustrated most recently by a series of studies conducted by the Rural Education Action Project (REAP)—an umbrella group that includes Rozelle's Stanford University, Tsinghua University, the Chinese Academy of Sciences, Peking University and the Xi'an-based Northwest University.

In one REAP study of 62 nations, China claimed the highest tuition price for public rural high schools: $160 per student per semester, not including costs like housing and everyday living expenses. This is nearly three times the world's second-highest tuition in Indonesia, which also fully subsidizes the education costs of children under the poverty line.

It's also a stark contrast to the fact that the vast majority of nations—93 percent of those studied—fully subsidize education, including places like Brazil, India and Kenya.

The high costs of education will become even more problematic, Rozelle said, once China's economy begins to restructure towards higher-value production. If the skill levels of the labor force cannot keep up, China will be caught in a middle-income trap, he said, possibly leading to high unemployment and social strife—not unlike what is plaguing Mexico now, he said.

Even a small subsidy could push thousands of students into high school. In REAP's most recent study, Rozelle and his colleagues took 250 junior high classes in Shaaxi Province and selected the two poorest students from each, providing one with a 1,500 to 2,500 yuan subsidy. The survey revealed that 51 percent of students who had received the subsidy were admitted to high school in the fall of 2010, while only 38 percent without the subsidy enrolled.

To some degree, the Chinese government has recognized the importance of limiting the costs of education. In 2009, officials enacted a policy to reduce high school tuition costs, providing 20 percent of students in central regions and 30 percent in the China's western parts with scholarships ranging between 1,000 and 3,300 yuan annually.

But the policy has proved somewhat illusory: In its 2011 survey of more than 3,000 students in Shaanxi Province, REAP discovered that less than five percent of the targeted students had actually received the subsidies.

As incomes rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.

In China and India – two of the world’s most populous nations with fast-paced economies – the prevalence of diabetes is expected to double by 2025. Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.

But China, India and other developing countries are not fully prepared to deal with the rising trend of diabetes. And a growing number of diabetics aren’t getting the care they need to prevent serious complications, Stanford researchers say.

Even with insurance, many diabetics don’t have essential medications that could help them manage their conditions. In many cases, people are spending a great deal of their household incomes to pay for their treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.

“Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies. “People with insurance aren’t doing markedly better than those who don’t have it. Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.”

Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. The journal article was co-authored by Jay Bhattacharya, an associate professor of medicine and Stanford Health Policy faculty member; and Crystal Smith-Spangler, an instructor at Stanford’s Department of Medicine and an investigator at the Palo Alto VA Health Care System.

Failure to adequately manage diabetes will lead to more severe health problems like blindness, heart disease and kidney failure. It also harms the otherwise healthy, Goldhaber-Fiebert said.

Diabetes often strikes people at an age when they’re taking care of children and elderly parents. To sideline these primary caretakers as dependants will lead to a heavy burden for communities and create an obstacle for economic growth, he added.

Using responses to a global survey conducted by the World Health Organization in 2002 and 2003, Goldhaber-Fiebert and his colleagues examined data from 35 low- and middle-income countries in Asia, Latin America, Africa and Eastern Europe to determine whether diabetics with insurance were more likely to have medication than those without insurance.

They also wanted to know whether insured diabetics have a lower risk of “catastrophic medical spending,” a term the researchers define as spending more than 25 percent of a household income on medical care.

“Surprisingly, diabetics with insurance were no more likely to have the medications they need than uninsured diabetics,” Goldhaber-Fiebert said. “They were also no less likely to suffer catastrophic medical spending.”

There are many reasons why health insurance may not protect diabetics in developing countries against high out-of-pocket spending. In some cases, there’s a lack of sufficient medication – such as insulin – that regulate glucose levels. Without those drugs, there’s a greater risk of complications that often lead to more hospitalizations and more expenses.

In other cases, co-payments and deductibles are too high. Sometimes, drugs and medical services to prevent diabetes complications are not covered. And doctors and hospitals don’t always accept insurance.

“Better policies are needed to provide sufficient protection and care for diabetics in the developing world,” Goldhaber-Fiebert said.

Without medications to manage diabetes and prevent secondary complications, the condition will worsen and the burden of catastrophic spending will increase, he said.

“It’s important to get ahead of the curve and prepare so there’s an infrastructure in place to deal with these health and cost issues,” he said.

While preventing diabetes in the first place would be ideal, programs and policies must be established to care for the many cases that will surely continue to exist.

“There isn’t a single country that’s managed to entirely arrest or reverse the trend of diabetes,” he said. “Programs that focus on primary prevention are extremely important, but the reality is that the developing world faces hundreds of millions of diabetes cases that are unlikely to all be prevented.”