Falk­lands are Bri­tish, not Ar­gen­tine

U.S. should back the U.K. as dis­pute over is­lands re­sumes

The Washington Times Daily - - Opinion - By Charles G. Curie By Luke Cof­fey

As states rush head­long into man­aged care in the name of “in­te­gra­tion” and cost sav­ings, those most vul­ner­a­ble among us are stand­ing on the side­lines and are most likely to be­come vic­tims of a public-health-pol­icy of­fen­sive.

In these chal­leng­ing eco­nomic times, Ken­tucky, New Hamp­shire, Kansas and Louisiana have moved ag­gres­sively to­ward manda­tory man­aged care within the past six months as a way to ad­dress their ex­pand­ing state Med­i­caid bud­get bur­dens. Other states, in­clud­ing Florida and Ge­or­gia, are poised to move quickly in the same di­rec­tion. Still oth­ers are mak­ing in­cre­men­tal progress to­ward the same end. These dra­matic pol­icy shifts have not been with­out ma­jor con­tro­versy and provider and ser­vice dis­rup­tions.

Some of our na­tion’s most vul­ner­a­ble (and largely voice­less) peo­ple re­ceive their health care through state Med­i­caid and safety-net pro­grams. Pro­posed Med­i­caid re­forms for man­aged care will thrust these peo­ple — in­clud­ing ones with se­ri­ous men­tal ill­nesses, chil­dren in foster care, phys­i­cally and de­vel­op­men­tally dis­abled (in­clud­ing those with autism) and many in nurs­ing homes — into man­aged health care.

While state lead­ers en­deavor to re­form their Med­i­caid sys­tems, the choices to which they are de­fault­ing will place the con­sid­er­a­tion and de­ci­sions for the care of vul­ner­a­ble peo­ple with spe­cial needs in the hands of im­pas­sive mono­lithic health plans. Just as “teach­ing to the me­dian” leaves stu­dents ne­glected at ei­ther end of the tal­ent spec­trum, man­ag­ing health care to the me­dian in tra­di­tional man­aged care leaves these pop­u­la­tions at risk, lack­ing ac­cess to qual­ity health care and health out­comes.

Health care is not easy to man­age, and cer­tainly the chronic care needs of at-risk pop­u­la­tions are not. I know about these complicated chal­lenges af­ter a ca­reer of more than 30 years work­ing in all lev­els of gov­ern­ment men­tal­health and sub­stance-abuse pro­grams. I have seen first­hand how the spe­cial­ized health care needs of just one of those groups, peo­ple with se­ri­ous men­tal ill­ness, have been largely un­met by tra­di­tional man­aged care.

Sadly, sta­tis­tics from the Na­tional Re­search In­sti­tute tell this story best: Peo­ple chal­lenged with a se­ri­ous men­tal ill­ness die 25 years younger than their coun­ter­parts in the gen­eral pop­u­la­tion. This shorter life span is be­cause their be­hav­ioral health is­sues usu­ally are com­pounded by one or more chronic phys­i­cal con­di­tions, such as heart dis­ease, res­pi­ra­tory prob­lems, di­a­betes or stroke.

In my field, we rec­og­nize that there is a com­plex in­ter­play be­tween se­ri­ous men­tal ill­ness and phys­i­cal health con­di­tions. Imag­ine some­one with bipo­lar dis­or­der and di­a­betes whose dis­or­ga­nized think­ing causes dif­fi­culty mon­i­tor­ing his blood sugar lev­els. Symp­toms such as dis­or­ga­nized think­ing (as­so­ci­ated with com­plex be­hav­ioral health is­sues) of­ten in­ter­fere with the ef­fec­tive­ness of pri­mary care. Sys­tems of care founded on pri­mary care leave many of these pop­u­la­tions with com­plex chronic needs pow­er­less, with­out ac­cess to the real “pri­mary” care they need.

Mod­els of in­te­grated health care for peo­ple with se­ri­ous men­tal ill­nesses that bring to­gether care for both men­tal and phys­i­cal health needs in or­der to im­prove health out­comes, as an ex­am­ple, must be dif­fer­ent to be ef­fec­tive. For such peo­ple, the first fo­cus must be on their be­hav­ioral health needs to en­sure suc­cess­ful im­pact of any phys­i­cal health care ther­a­pies on their co-oc­cur­ring med­i­cal con­di­tions. There are mod­els of spe­cialty care that can tran­scend ex­ist­ing prac­tices by giv­ing Med­i­caid ben­e­fi­cia­ries ac­cess to the right com­pre­hen­sive care, all while sta­bi­liz­ing sys­tem costs. The out­come of such mod­els is un­de­ni­able. Penn­syl­va­nia’s Be­hav­ioral Health Choices pro­gram averted $4 bil­lion in pro­jected ex­pen­di­tures through a spe­cialty plan that in­te­grates be­hav­ioral and phys­i­cal health care. New York’s Care Co­or­di­na­tion Project also has been suc­cess­ful with a sim­i­lar com­plex-care-man­age­ment pro­gram that has re­duced Med­i­caid spend­ing by 41 per­cent com­pared to costs in other mu­nic­i­pal­i­ties in the state. Spe­cialty care plans have a proven track record from Ari­zona to Iowa, from Ne­braska to Mas­sachusetts. Aside from im­prove­ments in the qual­ity of care, such plans have yielded an av­er­age sav­ings of 20 per­cent dur­ing their sec­ond year of op­er­a­tion, with up to 15 per­cent pro­jected in fu­ture years.

States have a win­dow of op­por­tu­nity to con­tem­plate new mod­els of care thought­fully for their vul­ner­a­ble pop­u­la­tions. “One size” of man­aged care does not fit all. Gov­er­nors should take this time to think about all of their res­i­dents and to demon­strate their great care.

In 1982, the United King­dom, led by Prime Min­is­ter Mar­garet Thatcher, went to war with Ar­gentina over the Falk­land Is­lands in the South At­lantic.

Un­pro­voked, Ar­gentina had in­vaded and oc­cu­pied the is­lands for two months. Against the odds, Mrs. Thatcher as­sem­bled a naval task force and de­ployed it to the South At­lantic to lib­er­ate the is­lands’ Bri­tish in­hab­i­tants. In a vic­tory for self-de­ter­mi­na­tion, the Bri­tish promptly ex­pelled the Ar­gen­tine in­vaders.

Two decades later, things are heat­ing up once again in the South At­lantic.

Over the past few months, Buenos Aires has be­come more ag­gres­sive over the Falk­land Is­lands. The Ar­gen­tine navy has in­ter­cepted and even boarded Euro­pean fish­ing ves­sels op­er­at­ing un­der li­censes is­sued by the Falk­land Is­lands. At Ar­gentina’s be­hest, more and more South Amer­i­can ports are ban­ning Falk­land-flagged ships. Just last week, two cruise ships were de­nied a port call in Ar­gentina be­cause they pre­vi­ously had vis­ited the Falk­lands.

Ar­gentina also has pub­licly blamed the Bri­tish for the “mil­i­ta­riza­tion of the South At­lantic.” The “mil­i­ta­riza­tion,” how­ever, was merely the rou­tine de­ploy­ment of a Bri­tish war­ship to the South At­lantic and the ar­rival of Prince Wil­liam on the is­lands for duty as a searc­hand-res­cue pi­lot. In this role, he could be res­cu­ing Ar­gen­tines as eas­ily as Falk­lan­ders — hardly provoca­tive.

The United King­dom wants to let the Falk­lan­ders de­cide the sta­tus of the Falk­lands. Un­for­tu­nately, Ar­gentina would like to an­nex and col­o­nize the is­lands. Ex­ac­er­bat­ing the prob­lem, the Obama ad­min­is­tra­tion has stated pub­licly that it would like the United Na­tions to over­see ne­go­ti­a­tions on the fu­ture of the is­lands’ in­hab­i­tants. This pol­icy plays right into the hands of Buenos Aires and makes a mock­ery out of the “spe­cial re­la­tion­ship” be­tween the United States and Great Bri­tain.

So what does his­tory sug­gest re­gard­ing the sta­tus of the Falk­land Is­lands? The first known land­ing there was made in 1690 by a Bri­tish naval cap­tain, John Strong. At that time, the is­lands were named af­ter Vis­count Falk­land, a prom­i­nent Bri­tish law­maker. The Bri­tish, French and Span­ish all had set­tle­ments on the is­lands at var­i­ous points un­til the last Euro­pean set­tle­ment was aban­doned in 1811, leav­ing the Is­lands un­in­hab­ited. In 1833, the Bri­tish re-es­tab­lished a set­tle­ment, which has been there ever since.

The strong­est ar­gu­ment the United King­dom has for its claim on the Falk­land Is­lands is the in­hab­i­tants’ right to self-de­ter­mi­na­tion. The 3,000 res­i­dents over­whelm­ingly want to be Bri­tish and not Ar­gen­tine. Lin­guis­ti­cally, cul­tur­ally and his­tor­i­cally, no­body can deny that they are Bri­tish. The right to self-de­ter­mi­na­tion is guar­an­teed by the United Na­tions Char­ter and the In­ter­na­tional Covenant on Civil and Po­lit­i­cal Rights — and Ar­gentina is a sig­na­tory to both.

Ar­gentina’s claim to the Falk­land Is­lands is based on two points: the prin­ci­ple of uti pos­side­tis ju­ris and the ge­o­graph­i­cal con­ti­gu­ity of the is­lands in re­la­tion to Ar­gentina. Uti pos­side­tis ju­ris is the be­lief that upon be­ing granted in­de­pen­dence, newly formed states should in­herit the same borders that their for­mer colo­nial mas­ters had.

Uti pos­side­tis ju­ris is not a uni­ver­sally ac­cepted prin­ci­ple of in­ter­na­tional law. Even if it were, it would not ap­ply here be­cause at the time Ar­gentina de­clared in­de­pen­dence from the Span­ish Em­pire in 1816, Spain did not have de facto con­trol of the is­lands. The last Span­ish set­tle­ment left the Falk­land Is­lands in 1811.

The ge­o­graph­i­cal con­ti­gu­ity ar­gu­ment is even more ridicu­lous. Based on this ar­gu­ment, Morocco could have a claim over the Ca­nary Is­lands or the United States over Cuba, for ex­am­ple.

For its part, the Obama ad­min­is­tra­tion needs to make it crys­tal-clear that it backs the United King­dom over Ar­gentina re­gard­ing the sta­tus of the Falk­lands. Bri­tain is Amer­ica’s No. 1 ally and con­trib­utes more to global se­cu­rity than Ar­gentina ever will.

The ad­min­is­tra­tion also needs to re­verse its po­si­tion on U.N. me­di­a­tion over the sta­tus of the is­lands. Why should the United States, as a na­tion with a deep-seated tra­di­tion of in­di­vid­ual rights and in­stinc­tive sus­pi­cion of the United Na­tions, want the U.N. to de­cide the fate of the is­lan­ders?

When Pres­i­dent Obama hosts Bri­tish Prime Min­is­ter David Cameron this month, he should of­fer as­sur­ances of U.S. mil­i­tary sup­port for the United King­dom in the event of a cri­sis — at a min­i­mum, on the same level as pro­vided dur­ing the 1982 Falk­lands War.

The Falk­lands are Bri­tish. Pres­i­dent Obama should not for­get this, and Mr. Cameron should be quick to re­mind him.

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