“Quote” of the Week” #1: “Not Hard to Imagine” Systemic Change

Our health care system has responded to the COVID pandemic with heroic work by nurses, physicians, hospital employees, and leaders. We will continue to need all of those services in the future. But we also need to redesign our care system. A far better system is not hard to imagine. It would be based in homes and community settings, using hospitals only as a last resort. It would invest heavily both in primary prevention—addressing the true social drivers of illness, injury, and disability—and secondary prevention, helping people with chronic illness anticipate and intercept deterioration. It would focus sharply on what matters to patients. It would assure continuity of care for patients across time and among care settings. The Triple Aim—better care for individuals, better health for populations, and lower per capita cost—can be, and should be, its North Star. That can only be achieved through major changes and improvements in the actual delivery of care, itself, not through financial gaming.

That’s from the Health Affairs Forefront blog, in a September 2021 post entitled “Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2 Building On The ACO Model.” One of the wonkiest things I’ve read, but if you want to, you can read it HERE  And Part One is HERE.

“Quote” of the Week” #2: “Little Cause for Concern”

QOTW #2 is from an article headlined “The Human Toll of America’s Air Wars,” which appeared in The New York Times late last month.

The reporter who wrote those words is Azmat Khan, and the article is the second part of a remarkable two-part series on America’s air wars. I discuss the first part of this series at length in this issue. So this “quote” is a kind of sneak preview, as I won’t be discussing this second article until the next Nygaard Notes, #684.

In recent decades, the United States has fundamentally transformed its approach to war, replacing American troops on the ground with an arsenal of aircraft directed by controllers sitting at computers, often thousands of miles away. This transformation reached full force in the final years of the Obama administration, amid the deepening unpopularity of the forever wars that had claimed the lives of more than 6,000 American service members. Fewer American troops on the ground meant fewer American deaths, which meant fewer congressional hearings about the progress of the wars, or lack thereof. It also meant fewer reporters paying attention to the impacts of the war effort on the local civilian population. If America could precisely target and kill the right people while taking the greatest possible care not to harm the wrong ones, then those on the home front would have little cause for concern.

On December 18th the New York Times published a major story on its front page in which they reported on the contents of “a hidden Pentagon archive of the American air war in the Middle East since 2014.” The Times obtained more than 1,300 reports, “known as credibility assessments — examining airstrikes in Iraq and Syria between September 2014 and January 2018.” There are more, as yet unreleased, reports and “Requests for records from Afghanistan are the subject of a new lawsuit.”

This article was the first part of a two-part series; I’ll report on the second part in the next Nygaard Notes. This first one was headlined “The Civilian Casualty Files: Hidden Pentagon Records Reveal Patterns of Failure in Deadly Airstrikes,” and the reporter is a remarkable journalist named Azmat Khan. I’ll be surprised if she doesn’t win a Pulitzer Prize for this reporting. It’s so remarkable, in fact, that I am going to here publish extensive excerpts of what I consider the most remarkable points in this article that Democracy Now’s Amy Goodman calls “astounding.” I am presenting this series as a case study of something that is increasingly rare in the modern media world. And that “something” is journalism.

Although the byline on the report is Khan’s, my crediting of the following quotations alternates between her and the New York Times, as both the reporter and the publisher deserve credit here.

“A Fundamental Transformation of Warfare”

The report covers a five year period, from the latter years of the Obama administration through the first couple of years of the Trump administration, during which period “American forces would execute more than 50,000 airstrikes in Iraq, Syria and Afghanistan, in accordance with a rigorous approval process that prized being ‘discriminate,’ ‘proportional’ and in compliance with the law of armed conflict. Not only would this be the most precise air campaign ever; it would be the most transparent.” So we were told.

“The air campaign,” says Khan, echoing this week’s “Quote” of the Week, “represents a fundamental transformation of warfare that took shape in the final years of the Obama administration, amid the deepening unpopularity of the forever wars that had claimed more than 6,000 American service members. [The number of non-Americans killed likely numbers in the millions, but that remains un-noted here.] The United States traded many of its boots on the ground for an arsenal of aircraft directed by controllers sitting at computers, often thousands of miles away.” The promise was of a war where only the “bad guys” would be killed. However, as the Times reveals, “The only official accounting of that promise is the hidden Pentagon documents.”

One way to assess that promise is to talk about the people in whose communities the bombs fell. But, “Of the 1,311 assessments from the Pentagon, in only one did [official U.S.] investigators visit the site of a strike. In only two did they interview witnesses or survivors.”

The official reports on the allegations of civilian casualties thus come largely from video footage streamed to those far-away computers: “At times, there was simply no footage for review, which became the basis for rejecting the allegation. That was often because of ‘equipment error,’ because no aircraft had ‘observed or recorded the strike,’ or because the unit could not or would not find the footage or had not preserved it as required.”

This past September, in Nygaard Notes #677, I reported on an August 29th drone strike in Kabul that killed as many as 10 civilians, about which I learned from media reports. Khan mentions that strike, and notes that “The August drone strike in Kabul that killed an Afghan aid worker and nine of his relatives grabbed the world’s attention. But most American airstrikes in Afghanistan took place far from the cities, in remote areas where cameras were not filming, mobile lines were often cut and the internet was nonexistent.”

“President Barack Obama called it ‘the most precise air campaign in history.’ This was the promise: America’s ‘extraordinary technology’ would allow the military to kill the right people while taking the greatest possible care not to harm the wrong ones.” And thus the mythology was constructed of a war with no suffering. Or, more precisely, no suffering of anyone who counts. And why is such mythology needed? The Times puts it simply: “As U.S. combat deaths dwindled, the faraway wars, and their civilian tolls, receded from most Americans’ sights and minds.”

“Tragic Mistakes”? Or Systems of Imperial Violence?

The promise of sanitized war is based in part on the idea that our bombs and drones are “smart,” and only kill people who deserve to die. Indeed, as the Times acknowledges, “America’s precision bombs are indeed precise: They hit their targets with near-unerring accuracy.”

The Times also concedes that “The war of precision did not promise that civilians would not die. But before a strike is approved, the military must undertake elaborate protocols to estimate and avoid civilian harm…”

So, with such precise weapons, and with such “elaborate protocols” in place to assure that those precise weapons are aimed at the right targets, what do the perpetrators say when civilians nonetheless end up being killed? The response typically amounts to something like “It’s a ‘tragic mistake’ that we ‘regret’.”

The Times takes on this “tragedy response” directly. As they reported, “In response to questions from The Times, Capt. Bill Urban, the spokesman for the U.S. Central Command, said that ‘even with the best technology in the world, mistakes do happen, whether based on incomplete information or misinterpretation of the information available. And we try to learn from those mistakes.’ He added: ‘We work diligently to avoid such harm. We investigate each credible instance. And we regret each loss of innocent life.’ Yet [says Khan] what the hidden documents show is that civilians have become the regular collateral casualties of a way of war gone badly wrong.”

Then there’s always the “fog of war” response: “The military spokesman, Captain Urban, pointed out that, “In many combat situations, where targeteers face credible threat streams and do not have the luxury of time, the fog of war can lead to decisions that tragically result in civilian harm.”

“Again and Again”

The “elaborate protocols” are repeatedly called into question by the Times. “The documents, along with The Times’s ground reporting, illustrate the many, often disastrous ways the military’s predictions of the peril to civilians turn out to be wrong. Their lessons rarely learned, these breakdowns of intelligence and surveillance occur again and again.”

Again and again, indeed. “Yet despite this unrelenting toll, the military’s system for examining civilian casualties rarely functions as a tool to teach or assess blame.” Part of the reason is no doubt this: “In many cases, the command that approved a strike was responsible for examining it, too.”

It’s likely that the “fog of war” effect does come into play in specific cases, but Khan points to evidence of a higher-level, systemic tendency to see the air campaign through rose-colored glasses. “American officials had an opportunity to mine the documents for root causes and patterns of error in 2018, when the Joint Chiefs of Staff and the National Defense University undertook a study of civilian deaths. But one of the researchers who sought to analyze the documents in aggregate told The Times that almost all of his findings had been cut from the report.”

That “one researcher” was Lawrence Lewis, who was actually a co-author of the Joint Chiefs’ study. And the study from which he dissented was not the only official study, as Khan tells us: “Another high-level study of the air campaign has never been made public.”

Most systems include mechanisms designed to flag problems or flaws that the designers of the system deem to be important, so that they can be addressed. Do U.S. planners consider the deaths of innocent civilians to be important? Read this and see what you think: “Positive identification of the enemy is one of the pillars of the targeting process, yet ordinary citizens were routinely mistaken for combatants. In a dissenting footnote to the 2018 Joint Chiefs’ study, Mr. Lewis and a colleague cited research showing that misidentification was one of the two leading causes of civilian casualties in American military operations. With few troops on the ground, they wrote, “it is reasonable to expect a systematic undercounting of misidentifications in U.S. military reports.”

“Again and again.” “Routinely mistaken.” “Systematic undercounting.” Why would the Pentagon set up a system of such elaborate protocols and then refuse to admit that they are not working? Well, maybe they ARE working. The Times actually asked Lewis this very question, reporting that he said “Not only does the system provide legitimacy for the military’s actions; it also allows the United States to boast of a process that is a global model of accountability.”

New York Times reporter Azmat Khan spent five years doing the reporting that gives the lie to the official mythology that allows such high-tech killing to go on. And here I’ll once again quote social scientist Harold Lasswell, writing in his 1927 book “Propaganda Technique in the World War.” You may recall his advice to war propagandists of 100 years ago, which appears to still guide war propagandists today: “The justification of war can proceed more smoothly if the hideous aspects of the war business are screened from public gaze.”

The goal of screening the violence that is required to maintain an Empire remains constant, but new technology and the changing nature of the modern information environment has now produced what many call “The New American Way of War.”

Azmat Khan, using “old-fashioned” journalism, has pulled back the screen, at least for a moment, allowing the public gaze to fall upon this new way of war. In the next Nygaard Notes I’ll take a look at the second part of Khan’s two-part series—“The Human Toll of America’s Air Wars”—so we can see how she did it.

Last May, Jennifer Doleac and Anna Harvey, co-directors of the Criminal Justice Expert Panel, wrote a commentary published by the more-or-less libertarian think tank The Niskanen Center, entitled “Policing and Public Safety: What Do the Experts Think?” They started off by noting that “Calls to ‘defund the police’ have become widespread.” No argument there. But what caught my eye was the questions raised by the calls to defund. “At the heart of this conversation,” they said, “is whether police officers are well-suited to improve public safety. Does spending money on police actually make us safer? Or could spending that money on other social services—such as housing, health care, and education—do more good with less harm?”

I decided to look into this, starting with that first question: Does spending more money on police actually make us safer?

One of the most extensive studies I found appeared in The Journal of Experimental Criminology (which I had never heard of). In 2016 they published an article entitled “Conclusions from the History of Research into the Effects of Police Force Size on Crime—1968 Through 2013: A Historical Systematic Review.”

Nygaard Notes likes systematic reviews, and this one is a “meta-analysis,” which simply means that they studied a bunch of studies. This particular systematic review looked at “62 studies and 229 findings of police force size and crime, from 1971 through 2013.”

“No Impact on Crime in General”

They stated their primary conclusion pretty simply in their Introduction: “In the end, there appears to be no impact on crime in general of hiring more police…”

In their summary of “results” they elaborate a bit, saying that “the overall effect … for police force size on crime is negative, small, and not statistically significant.” The fact that they looked at data over 45 years allows them to go further and tell us that “there is extremely little variation in police force size per capita over time, making it difficult to estimate the relationship with reliability.”

In other words, in order to know the effect that increasing or decreasing the number of police has on crime levels, one would need to look at two things. First, you’d need to find cities where there has been a significant increase or decrease in the number of police. Secondly, you’d need to look at crime rates in those cities before the increase/decrease in number of police, and compare it to crime rates before those increases or decreases.

Since the data needed to assess the effect of police force size on crime is not available, the authors conclude that “This line of research has exhausted its utility.” Which is a polite way of saying that it’s a waste of time to keep looking for evidence that spending more on cops improves public safety.

Finally, at the end of their 21-page paper, under “Discussion and Conclusions” they reiterate what they said in their summary of conclusions: “First, the overall effect size of police force size is negative, small, and statistically not significant.” Then they state it even more plainly, saying that after looking at more than four decades of studies in the policing literature, “we conclude that merely increasing police force size does nothing to reduce crime.” And this isn’t really news, as they point out that “the reported effect of police force size on crime has been constant and not significant for more than 40 years.”

The Correlation is Almost Zero

On June 7 2020 (just a couple of weeks after Minneapolis police killed George Floyd), the Washington Post ran a story by national correspondent Philip Bump headlined “Over the past 60 Years, More Spending on Police Hasn’t Necessarily Meant less Crime.” Like the meta-analysis I just discussed, Bump looked at the evidence about the relationship between what cities spend on police and the levels of crime in those cities. And, as in the above meta-analysis, he found that there isn’t any relationship. “If we look at how spending has changed relative to crime in each year since 1960, comparing spending [on police] in 2018 dollars per person to crime rates, we see that there is no correlation between the two. More spending in a year hasn’t significantly correlated to less crime or to more crime. For violent crime, in fact, the correlation between changes in crime rates and spending per person in 2018 dollars is almost zero.”

Bump acknowledges that such a statement might surprise some people. And I think that some of those surprised people may be Nygaard Notes readers. So I’ll offer the following lengthy quotation, with lots of numbers, for which I apologize. I try to stay away from this kind of “sea of numbers” writing, since people’s eyes tend to glaze over when reading such things, but I think these numbers are important. Bump writes:

“Intuitively, one might worry that reducing police spending would lead to a spike in crime. A review of spending on state and local police over the past 60 years, though, shows no correlation nationally between spending and crime rates. In 1960, about $2 billion was spent by state and local governments on police. There were about 1,887 crimes per 100,000 Americans, including 161 violent crimes. By 1980, spending had increased to $14.6 billion — and crime rates had soared to 5,950 crimes per 100,000 Americans and 597 violent crimes. Over the next two decades, those rates thankfully fell, down to about 4,120 crimes per 100,000 people and 507 violent crimes. Spending spiked to more than $67 billion. Eighteen years later — by 2018, the most recent year for which full data are available — crime rates had fallen further to 2,580 crimes per 100,000, including 381 violent crimes. Spending that year topped $137 billion. The figures above aren’t adjusted for inflation. If we make that adjustment, the pattern since 1960 looks like [this]: Crime and spending increasing at a similar pace until the early 1990s, when crime rates began to drop but spending kept soaring.”

Reporter Shaila Dewan, writing in the New York Times a couple of months ago (November 8) said that “In a recent survey of criminal justice experts, about two-thirds agreed that increasing police budgets would improve public safety. But many more of them — 85 percent — said that increasing spending on housing, health and education would do so.”

When she says “criminal justice experts” she’s talking about the Criminal Justice Expert Panel, the co-directors of which I quoted at the very beginning of this essay. The panel is made up of more than 60 academic social scientists from a variety of disciplines. And it’s not just criminal justice experts, but economists, sociologists, public policy wonks, and so forth. Dewan quotes one of them, University of Pennsylvania criminologist Aaron Chalfin, who reminds us that “Crime goes up and down for a million reasons that are completely independent of the police.”

The question with which we started was: Does spending more money on police actually make us safer? The real answer is that we don’t know. But it doesn’t appear to.

So, if we really want to make people safer, what to do? We need to be “smart on crime” rather than “tough on crime.” Adding more police may be tough, but it’s not smart. As Ed Chung of the Center for American Progress reminds us, the “law and order policies” of recent decades “had negligible impacts on public safety but a devastating and destabilizing effect on families and communities, especially those that are African American.”

We need to stop spending so much money arresting people and start investing in things that support people to be their best selves. We need to transform our criminal punishment system into a criminal justice system. And that’s the real meaning of “defund the police.”

In order to better understand those “million reasons” that Chalfin talks about we’ll need to start looking at—and addressing—the conditions that give rise to crime. We’ll need to go to the roots. We’ll need to think justice. We’ll need to think compassion. We’ll need to think systems.