Falklands are British, not Argentine
U.S. should back the U.K. as dispute over islands resumes
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.