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A Lesson on End of Life Care for Our Cat Joey, by David Henderson

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As the health economist with President Reagan’s Council of Economic Advisers from 1982 to 1984, I was upset when I learned that a large percent of spending under Medicare is for people in their last 6 months of life. I understood even then that going in you can’t always know that it’s the last 6 months of life. Still, it made sense to me, assuming we’re stuck with socialized health insurance for the elderly, for the government to give the elderly who are clearly terminal a choice: If the cost of treatment is x, you can get treated at the government’s expense or the government will give you 0.5x and you don’t get treated at government expense. That would give people an incentive to husband those dollars. They could go without government treatment and spend the money on other things, including a bequest to heirs, or they could try to find cheaper treatment, possibly in places like India. People who took the money would gain and the government would say taxpayers’ money.

That still makes sense to me.

But something in my thinking has changed. It’s not that the proposal above doesn’t make sense. What’s changed is my view on the percent of people who would likely take the money rather than the government expenditure on their health care. I used to think it was high. Now I think it’s lower than I thought. I can’t easily put numbers on it, but it’s lower.

And what led to it has been my wife’s and my experience in the last few weeks with our cat Joey. That’s his picture above. He was the sweetest cat and he was more like a human in his interaction with us than any other cat we’ve had–and we have had a lot of very good cats.

A little over 2 years ago, we found out that Joey had small-cell lymphoma and that he had probably had it for at least the previous half year. We put him on chemotherapy; I posted about it here. The chemo seemed to work–and then didn’t. So our vet put him on a different chemo. It seemed to work and then stopped working about 8 months ago. We should have been aggressive and gone to a cat oncologist–yes there are such people–for a third kind of chemo that, we learned too late, did exist. We started him on it about a month or two ago, but lost about 6 months of valuable time.

Even with the chemo not working and Joey’s weight having dropped from over 16 pounds before his disease to under 9 pounds recently, Joey seemed to be Joey. We agreed that we wouldn’t keep him alive just for us if we thought he was miserable. But we saw enough signs that he wasn’t miserable.

Last Tuesday, though, we thought we had seen enough to take him to the vet and euthanize him. But the vet did enough checks on him that we still held out hope that he would live maybe a few weeks more with a reasonable quality of life. At each stage that day when they did tests, they asked our approval and gave us the price tag in advance. We left there with some hope–and a bill of just a hair under $1,000.

Yesterday, it was clear that Joey was miserable and so we took him to our regular vet to be euthanized.

Do I regret spending that $1,000? Yes. But that’s because I know now that he lasted only 2 extra days and was miserable for almost the whole 48 hours. If I had thought that Joey could have a quality life for an extra 2 weeks, would I have regretted spending that $1,000? No.

And that’s my new insight. The value of keeping Joey alive for a few extra weeks–and remember that he’s a cat, not a person–was at least $1,000.

So now I’ve altered my prior view of the value of keeping a human alive for a few extra weeks or months.

Of course, the issue is: value to whom? In the case of our cat, the value to us. For a human, the value to the human and to those around him or her. I’m not arguing for government subsidies. I’m saying simply that the value is likely higher than I had expected.

Two additional points.

First, the late Gary Becker and co-authors Kevin Murphy and Tomas Philipson have written on this issue for humans and come up with high numbers based on different considerations.

Second, when bloggers discuss health care, they often point to Robin Hanson’s claim that people spend so much on health care because they want to show that they care. The slogan might be “health care shows I care.” That’s not what’s going on here. We weren’t tying to demonstrate anything to Joey and I’m pretty confident my wife and I were on the same page and not trying to impress each other. We simply badly wanted another few weeks with this precious, precious cat.

 

 

(15 COMMENTS)
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zippy72
3 days ago
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The value of human life is higher than expected. That’s the huge elephant-in-the-room problem with economics right there.
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freeAgent
9 days ago
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Also, the simple formula of treating someone or giving them .5x in dollars is short-sighted as it would encourage people to have the most expensive end-of-life medical conditions possible. Just sayin'.
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Taiwan’s indigenous people remind Xi Jinping that it has “never belonged to China”

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With much of the world’s attention on Taiwan colored by its decades-long enmity with China, it can be easy to forget that centuries of history preceded the arrival of ethnic Chinese on the island.

In response to a recent speech by Xi Jinping in which he warned he would not rule out military means to force the unification of Taiwan with China, the island’s indigenous people issued an open letter addressed to the Chinese president to challenge Beijing’s claims.

Published yesterday (Jan. 8) in Chinese (link in Chinese) and translated here into English, the letter asserts that the various indigenous tribes of Taiwan, which have inhabited the land for 6,000 years, do not belong to the “so-called ‘Chinese nation,'” a reference to the oft-used rhetoric by Beijing that Taiwan is an inalienable part of China, and that it is a “historical conclusion” that Taiwan and China should be one country.

After the end of the Chinese Civil War in 1949, the defeated Nationalist forces fled to Taiwan and established a competing Chinese government there, while the Communist Party ruled from Beijing. Since then, Taiwan has governed itself and holds democratic elections, while Beijing has never relinquished its claims over the island. Forced to choose between the governments in Beijing and Taipei, almost all countries in the world have diplomatic relations with China, and only maintain quasi-diplomatic ties with Taiwan.

Lost amid all the military conflicts and great-power tussles of the 20th century, however, is the voice and history of Taiwan’s indigenous people, who today number over 500,000, or 2% of the country’s population. Like indigenous peoples in other countries in the world, they’ve experienced hundreds of years of exploitation and colonization from a series of conquerors. “We… have witnessed the deeds and words of those who came to this island, including the Spanish, the Dutch, the Koxinga Kingdom, the Qing Kingdom, the Japanese, and the Republic of China,” the letter says. Koxinga refers to the Japanese-born Chinese conqueror who fled Ming dynasty China to establish a government in Taiwan in 1661, then under Dutch control. Koxinga himself is claimed as a national hero (paywall) by Japan, Taiwan, and China, underscoring the complex history and notions of identity in that part of the world.

“We do not share the monoculturalism, unification, and hegemony promoted by you, Mr. Xi,” the letter asserts. “It is by far not a path to greatness.” It also noted the violations of human rights going on in parts of China such as Xinjiang, Tibet, and Hong Kong, and derided Xi’s offer of a “One Country, Two Systems” model for unification on those grounds.

The authors of the letter, representatives of two dozen of Taiwan’s indigenous tribes, also criticized the modern state of Taiwan as one that was built upon their “motherland” and said they have “have never given up [their] rightful claim to the sovereignty of Taiwan,” but acknowledged that since the election of president Tsai Ing-wen in 2016 the country has started recognizing the ethnic and cultural diversity of Taiwan.

Tsai was the first Taiwanese leader to apologize to the country’s indigenous people, and has pledged to bring about transitional justice to the population, which includes promoting historically accurate accounts of violations committed against indigenous people, and reparations for their suffering. She has also sought to play up (paywall) Taiwan’s ethnic diversity, in contrast to Xi’s promotion of ethnic Han culture over China’s ethnic and religious groups. However, many indigenous people believe that the Tsai government has reneged on its promises, for example by continuing to allow large corporations to build on their land—just the latest in the centuries-long struggle for indigenous rights in Taiwan.

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zippy72
3 days ago
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freeAgent
11 days ago
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Introducing GDPR.eu, a new site to help businesses achieve GDPR compliance

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The General Data Protection Regulation is the world’s toughest data privacy law, threatening enormous fines to violators. Yet businesses have few good resources to help them comply. GDPR.eu is here to change that.

The European Union created the GDPR to help individuals achieve a greater degree of privacy and data security online. It was meant to curb data breaches, which drain billions from the economy each year and expose citizens’ sensitive information to hackers. And it gives individuals more control over how companies use their data.

While the GDPR is great for people, it hasn’t been so easy on businesses. Last year, we asked 101 business leaders about their GDPR compliance and discovered that even six months after the law went into effect, a majority of businesses are not fully compliant. And it’s not for lack of effort. They have invested thousands (and sometimes hundreds of thousands) of dollars on GDPR compliance, and most say they still don’t fully understand the law.

The main problem is the lack of quality resources. Inadequate understanding of the law remains the greatest obstacle to compliance for small- and medium-sized businesses. Despite an overwhelming number of articles about the GDPR on the Internet, few are actually straightforward and relevant. Owners and managers of small businesses told us they wanted clear guidance on how to achieve proper GDPR compliance. Businesses want practical information they can actually use. As one manager of a retail company in London told us, “GDPR is a lot harder in practice than in theory.”

Solving this problem is why we created GDPR.eu.

What is GDPR.eu?

GDPR.eu is meant to be the definitive resource on GDPR compliance topics. The information is not the high-level overviews that you might find on some corporate blogs, or the hard-to-understand jargon put out by some law firms. Instead, it is an easy-to-understand, comprehensive, and practical guide written by people who have gone through the actual process of making a business fully compliant with the GDPR.

GDPR.eu does not only contain news and information about the EU’s General Data Protection Regulation. It includes a GDPR compliance checklist and the full text of the GDPR itself, which is easily searchable so you can find any passage using keywords. This is one of the only fully searchable online copies of the law, and if you have ever tried to find something in the GDPR law itself, you will have a better appreciation for this.

The site also contains detailed guides on specific topics, such as how to comply with the “right to be forgotten,” what is a Data Protection Officer(and who needs one), and how GDPR fines are determined.

Finally, we have also published examples of a number of GDPR forms that are essential for businesses to comply with the GDPR. Some of the sample forms available for download include a GDPR-compliant privacy notice, a sample GDPR Data Processing Agreement, and a sample GDPR right to erasure request form. Unlike other samples you might find online, these are actually used in business and have been vetted.

Going forward, we will continue to update the site with more guides, as well as news and analysis as EU regulators begin to interpret and enforce the law. We will also conduct original research to make sure we’re answering questions about the GDPR that you actually want answered, while gaining deeper insight into GDPR compliance.

Why is ProtonMail working on GDPR.eu?

As the world’s largest encrypted email service with millions of customers worldwide, complying with the GDPR was essential for us, given that nearly 40% of our customers come from the EU. Even as a Swiss company, we are not exempt from compliance (in fact, nobody is exempt if you have EU customers). For this reason, over the course of 2018, we expended significant effort ensuring that ProtonMail and ProtonVPN would be fully compliant with the GDPR.

GDPR.eu is the culmination of the lessons we learned during our own GDPR compliance process. We want the research we have done to not only be a resource for ourselves but a resource for the whole world, so we can collectively move toward a more private and secure Internet.

This is also fitting considering that in 2018, Proton Technologies AG was co-funded by the Horizon 2020 Framework Programme of the European Union, which was created to stimulate entrepreneurial research and innovation. One important area of focus is cybersecurity and privacy, and we believe the GDPR and similar regulations are an essential step toward creating a safer Internet.

The GDPR.eu project is part of our mission to raise awareness about data security and expand the use of cryptographic tools. Whether it is working with journalistseducating the public, or partnering with civil society organizations, a more secure and private Internet is only possible by combining technology development with educational initiatives.

Businesses—and especially small businesses—have always been particularly vulnerable to information security challenges and stand the most to gain by implementing data protection standards required under the GDPR, such as encryption. We believe data protection principles should be easy to implement and should not come at the cost of business growth. It’s our mission with GDPR.eu to help business leaders find such solutions.

Please feel free to share your feedback with us at contact@gdpr.eu or on our social media pages below:

Twitter: https://twitter.com/ProtonMail
Reddit: https://reddit.com/r/ProtonMail
Facebook: https://facebook.com/ProtonMail

Best Regards,
The ProtonMail Team

——————————————————————————————-

You can get a free secure email account from ProtonMail here.

We also provide a free VPN service to protect your privacy.

ProtonMail and ProtonVPN are funded by community contributions. If you would like to support our development efforts, you can upgrade to a paid plan or donate. Thank you for your support!

The post Introducing GDPR.eu, a new site to help businesses achieve GDPR compliance appeared first on ProtonMail Blog.

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freeAgent
12 days ago
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Nice work.
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zippy72
5 days ago
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Why First-Mover Advantage in a New Industry Isn't Always An Advantage

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I have written in the context of both the new marijuana stocks (e.g. Tilray or Canopy) and Tesla in EV's that the market is putting a whole lot of value -- in some cases 90+% of their current market value -- on these companies being first movers in potentially large and lucrative new industries.

It is hard to predict early on where in an industry's value chain the profits will be, or if the industry will be profitable at all.  Who will make money in marijuana -- the growers?  the retailers?  the folks that package the raw material into consumer products?  The early marijuana entrants are focusing on cultivation, but in tobacco do the cultivators or the cigarette makers who buy from them make the most money?  And as anyone at Myspace could tell you, being first is not always a guarantee of success, and in some ways can be a disadvantage.  Second movers can avoid all the first-movers costly mistakes.

I though of all this seeing the infographic below on changing leaders in the Internet world.  Almost all the top 20 companies in the first year are largely irrelevant today -- AOL and Yahoo are technically still in business but only because they have been bought up by Verizon in a group of other dogs they seem intent on collecting.

 

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freeAgent
14 days ago
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Shared for the chart. I don't know how accurate it is or what the criteria are that define "biggest", but it's interesting nonetheless.
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zippy72
5 days ago
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You Might Not Get Your Tax Refund If the Government Stays Shut Down

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|||Bigapplestock/Dreamstime.comMost Americans have been shielded from the effects of the so-called government shutdown. Post offices continue to run; the federal drug war rages on; the regulatory state thrives. If the shutdown continues through tax season, though, it could have a very serious impact indeed.

Though the government continues to dip its hand into Americans' hard-earned funds, The Wall Street Journal reports that early filers will likely not see their refunds so long as the government remains shut down. But fear not! While the Internal Revenue Service currently lacks the funds to process refunds, it is fully prepared to process tax returns that include payments to the government.

In other words, you can still pay the government, but the government won't be returning anything it took in excess.

While this is less of a concern to later filers, the report notes that lower-income households often rely on early refunds to pay debts or make larger purchases. Indeed, many retailers count on people to spend more money in February.

The partial shutdown began in the days leading up to Christmas, thanks to President Donald Trump's insistence on adding $5 billion for a border wall to a congressional spending package. Trump will have an even harder time pursuing funding for his wall in 2019, now that the House is under Democratic control.

In the meantime, we're stuck with a "shutdown" that fails to shut down the parts of the government that take people's money.

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zippy72
16 days ago
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freeAgent
18 days ago
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Britain is on the brink of an historic strategic decision

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What happens in the next three months, perhaps even the next couple of weeks, is going to shape the fate of the country for decades. If Brexit goes ahead, in any form, it will enact a profound misreading of the nature of the contemporary political and economic world and represent an unprecedented failure of British statecraft. Before the next round of political theatre begins, it’s worth standing back to consider just why that is so.

It has become commonplace to see Brexit as a backlash against globalization and/or to bemoan it for failing to accept globalization. In fact, it would be better to see it as a failure to understand the regionalization of economics and the multi-polar nature of international relations.

Brexit as a failure of economic strategy

Economic regionalization is most obvious in relation to trade, although trade is only one of its manifestations. On the one hand, and there is nothing new about this, countries tend to trade more with their closest neighbours than with those that are more distant (the so-called ‘gravity model’ of trade). Dominic Raab recently tweeted a strange comment to the effect that the difference between remainers and leavers is that the former believe UK prosperity to be dependent on its location, whereas the latter believe that it is dependent on our character. It’s an absurd notion. There are obvious cost and logistic reasons for location to matter in terms of goods trade, but it also applies to trade in services. National ‘character’, whatever that may mean, doesn’t enter into it.

On the other hand, and which is newer, that basic reality has been institutionalised via the creation of regional trade blocs of various sorts – MERCOSUR, AEC, CPTTP, NAFTA and so on. The European single market is not only one example of this, but is an example of a particular sort. Being a single market rather than simply a free trade bloc or area entails a far more extensive deepening of economic integration.

Amongst other things, this accounts for the fact that there is far greater services trade liberalisation in the single market than in any of the other regional blocs. It also accounts for the highly integrated supply chains running across national borders, and for the fairly integrated labour market by virtue of freedom of movement.

These facts, taken together, mean that alongside the general propensity of trade to be geographically skewed to close neighbours, UK services and also its most advanced manufacturing industries are very deeply embedded in the European market. It is not necessary to make or accept economic forecasts, only to understand basic institutional realities, to see that detaching a country from its regional bloc and then seeking to re-attach it on unknown, but by definition worse, terms to that same bloc, in an unknown time frame, is going to have adverse consequences for businesses and trade, and hence for employment and tax revenues.

The limitations of globalization and the naivety of Brexiters

However, the deeper issue about regionalization is that although it is not the reason for the foundation of the EU it has emerged as one of its key functions because of the failures and limitations of globalization. This is most obvious in the way that the WTO has made relatively little progress in providing a comprehensive architecture for global trade in, especially, services and agriculture. The stasis that has been evident since the ‘Doha round’ can only be exacerbated by Trump’s anti-WTO positions. In this way, regionalization makes a mockery of both the globalist and the nationalist cases for Brexit.

The naivety of globalist Brexiters

The naivety of the globalists is evident in their repeated call for Britain to trade on WTO terms as if these provided anything other than the most basic and limited participation in global trade. By exiting not only the regional single market but also the EU as a gateway to preferential trade deals around the world, the Global Britain agenda is, as a Foreign Affairs Select Committee report put it, a meaningless one. Indeed, its irony is very obvious in Liam Fox’s recent delighted announcement of the value to Britain of the new EU-Japan trade deal – a deal which Britain is due to fall out of once Brexit is completed.

The naivety of nationalist Brexiters

No less naïve are nationalist Brexiters of various hues, both right and left wing. For they fail to recognize that whilst the WTO doesn’t provide a comprehensive and deeply-developed trade system of the sort found in the single market, nor does it allow the pure ‘sovereignty’ of national self-determination. Thus it makes no sense at all for right-wing nationalist proponents of such sovereignty to be so enthusiastic about being bound by WTO rules over which Britain will have far less say than, as a member, it has over EU rules.

Equally, ‘Lexiters’ who imagine that Brexit will bring, or is required to allow, freedom from state aid rules are entirely wrong, as competition law expert George Peretz QC explained in a recent article. More generally, the Lexiter vision of ‘socialism in one country’, which seems to inform Corbyn’s approach to Brexit, is rooted in pre-regionalization economic thinking: national economies are no longer discrete, bounded entities and could only be made so by mass immiseration.

In short, different kinds of Brexiter share a fundamental misunderstanding of the nature of the contemporary economic world. The globalists don’t understand that globalization has taken the form of a series of regionalizations. There’s no realistic way of being global without also being regional. The nationalists don’t understand that nationalism has been embedded within regionalism. There’s no realistic way of being national without also being regional.

It’s no good Brexiters saying ‘but Britain managed perfectly well before’: even if that were true, which is highly questionable, Brexit isn’t a time machine. The world that existed in 1973 has disappeared. In this sense, Brexit represents a profound strategic error for the British economy: if the most basic feature of a national (like an organizational) strategy is its fit with the realities of its environment then Brexit is certainto have a poor outcome because it is incompatible with the realities of regionalization.

Brexit as a failure of geo-political strategy

But the strategic error goes well beyond trade and economics. It is also based on a complete misunderstanding of contemporary geo-politics and international relations. In the aftermath of the collapse of the Soviet Union there was a brief period when the idea of the ‘end of history’ gained ground. Western capitalism and liberal democracy had ‘won’ and were now the only game in town. That analysis was bound up with the idea of economic globalization, but it also implied a uni-polar geo-politics and a trend to ideological homogeneity. In Britain, that analysis was most obvious in the politics of New Labour.

Thirty years on from the fall of the Berlin Wall, and we can see how, again, naïve that analysis looks in almost every respect. The world is not uni-polar, nor is it any longer bi-polar in the way it arguably was during the Cold War, but multi-polar. One aspect of that, in part because of the impact of end of history type-thinking on reshaping the post-Soviet space, is that Russian nationalism is resurgent, of which more shortly. The rise of Chinese global capitalism – China joined the WTO in 2001 - has not been accompanied by liberal democracy and in many respects, most obviously state involvement in private enterprises, is completely different to the neo-liberal model of capitalism that had supposedly triumphed.

At all events, there are now three military superpowers (the US, China and Russia) and three economic superpowers (the US, China and the EU). And of course there is also a string of regional power brokers – India and Iran being examples, albeit of very different sorts.

This would always have been a complex and unstable world within which Britain had to operate, made far more so by a US administration so radically different to those we have been used to. Adding to that by fundamentally shifting geo-political positioning – not for strategic reasons or with any planned or desired end-state in mind, but simply by the series of political accidents and miscalculations that led to the Brexit vote – is folly of the highest order.

Russia and Brexit

That is true both in a general sense but in at least two more specific ways. First because it entails repositioning Britain within an international order which almost universally sees Brexit as incomprehensible, if not downright crazy. And second because about the only international player who gains from Brexit is Russia, a country currently routinely hostile to the rules-based international order in general, and to Britain in particular.

Indeed, it is extraordinary that Brexiters should see ECJ rulings as a threat to British sovereignty when there are regular aggressive Russian incursions into British airspace and watersand when the Russian state “almost certainly” made a chemicals weapon attack on British soil in Salisbury.

It is not necessary to believe that Russia directly or decisively interfered in the 2016 referendum – although there is evidence for this - to see how destabilising both Britain and the EU is firmly in the interests of Putin’s Russia. And the flip side of that is the way that – as the Salisbury attack showed – Britain relies on the EU as one part of its diplomatic defences in relation to Russia in that case, but also more generally.

At all events, Putin’s recent statements about Brexit are abundantly clear. The 2016 Referendum, he opined, expressed the will of the people and a further vote would be a betrayal. That is, ironically, precisely the line that Theresa May is taking. It is obviously also a gloating taunt, mocking Britain, and more especially Brexiters could they but see it.

Brexit is a huge victory for Putin. It damages Britain, it damages the EU, and it presents possibilities for Russia in the Baltic and Balkan states. If Brexit is a strategic disaster for Britain, it’s a triumph for Russia.

The abandonment of strategy

As with economic regionalization, the lesson of multi-polar geo-politics is that few countries, and certainly not Britain, can operate outside of power blocs. It doesn’t matter if a country is the fifth (or sixth, or seventh) biggest economy in the world, or one with, relative to many countries, considerable military, security, and soft power assets. Outside of the big three or four economic and/or political blocs is a chilly place to put yourself by choice rather than necessity.

Current attempts to retro-fit a geo-political strategy to Brexit, notably Jeremy Hunt’s notion of an Asian pivot, underscore this. Not only is it incoherent in its own terms, not least for being predicated in part on Britain having a close relationship with the EU, it also contains nothing that could not be done, and done more effectively, whilst remaining an EU member. The exception to that might be the idea of adopting the ‘Singapore model’, but not only has this been debunked by the PM of Singapore as a non-starter it is also completely incompatible with maintaining a close relationship with the EU (for whom it would be an evident act of economic hostility) and, needless to say, is nothing remotely like what leave voters were promised.

The reality is that Brexit was never conceived of as a strategic project, still less a strategically desirable one. It was always a protest campaign not a plan. Now, it has really come down to just two justifications: to end freedom of movement and to honour the result of the referendum. Without even discussing, yet again, whether or not these are good political justifications for Brexit, the point to make is that whatever else they are, they are not a strategic basis for Brexit.

So if Brexit goes ahead it will mark not just a failure of economic and geo-political strategy – and, after all, such failures are common enough – but something much more unusual: the abandonment of any serious attempt to have such strategy. The difference between May’s deal and no deal in this respect is only one of how quickly and how dramatically the effects of that are felt. If MPs vote against May’s deal, then that will be the first step away from the brink – not enough in itself, but a necessary pre-condition for avoiding disaster, as well, of course, as risking the even greater one of no deal.

However, if it were then to come about that - by virtue of a referendum or some other route – Brexit is abandoned it will be vital to understand and make a case for that not on the basis of returning to 2016 but as a long-term strategic decision about Britain’s future, mediated by its regional position and recognizing the fraught complexities of a multi-polar world.
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zippy72
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expatpaul
18 days ago
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Belgium
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