The Washington Post - USA (2022-04-01)

FRIDAY, APRIL 1 , 2022. THE WASHINGTON POST EZ RE A

FRIDAY Opinion

“A

ll wars are fought twice, the

first time on the battlefield,

the second time in memory,”

writes Viet Thanh Nguyen, a

Vietnamese American novelist. In the

case of Russia’s invasion of Ukraine, the

start of the fighting also launched a

battle over the history that caused the

war. It’s worth understanding this intel-

lectual conflict, because it will shed light

on the likely endgame of the actual

conflict.

At the heart of this historical debate is

the question of NATO expansion. Some

have argued that the Western decision to

admit several countries from the former

Soviet empire created a deep and lasting

resentment in Moscow that has morphed

into full-scale aggression. That case has

been made most sharply by University of

Chicago scholar John Mearsheimer as

well as many others over the years.

As it happens, when NATO first start-

ed considering expansion, I was one of

those advocating caution. While I was

not entirely opposed to it, I argued that

even as NATO admitted Poland, the

Czech Republic, Slovakia and Hungary, it

should also begin serious negotiations

with Russia to ensure that any further

expansion was part of a stable security

arrangement that took some of Moscow’s

concerns into account. And I think it is

pretty clear that NATO’s 2008 Bucharest

declaration was a disaster, dangling

NATO membership in front of Ukraine

and Georgia without actually setting

them on a course to get it. It was enough

to enrage Russian leader Vladimir Putin

but not enough to actually protect those

two countries.

And yet, as time has passed, I have

wondered what Europe would look like

with no NATO expansion. The reality is

that the vast majority of the countries

that were part of the Soviet sphere — and

many that were in the Soviet Union itself

— were utterly traumatized by that ex-

perience. It was an even greater trauma

than having been defeated in a war by

Russia. These nations — from Bulgaria

and Hungary to Ukraine and Georgia —

had their entire military, political, eco-

nomic and cultural lives dominated by

Moscow for many decades. They were

desperate to free themselves. To have left

these peoples unmoored and insecure in

a no man’s land between Russia and

Europe would have only heightened the

level of instability in the region, as Russia

would have tried to control them and

they would have resisted.

Moscow’s efforts at control were ac-

tions of a former superpower, humiliated

at its declining fortunes, grasping for

some symbol of greatness. As I argued at

the time, the West should have tried

much harder to aid and rebuild Russia.

(It is worth noting, though, that the

critics sometimes exaggerate the extent

to which the West was guilty of neglect-

ing the country: The United States and

Europe did provide Moscow with huge

aid packages and created a new Group of

Eight forum that gave Moscow a seat at

the table.) But the largest problem might

be that we are viewing the Ukraine crisis

through the prism of great-power politics

when the more appropriate framework

might be imperialism.

The Soviet Union was history’s last

great multinational empire. In the early

1990 s, I participated in discussions at

Harvard, inspired by Samuel Hunting-

ton, on what history taught us about the

collapse of such empires. The answer was

clear: They were always accompanied by

bloody wars as the imperial powers

sought to hold on to their former territo-

ries. The French waged brutal wars in

Algeria and Vietnam, and the British

killed more than 10,000 people in Kenya

during the Mau Mau rebellion. They did

this simply because, in their view, the

idea of being a great power on the world

stage required that they hold on to these

colonial prizes.

Viewed through this prism, Russia’s

actions in Ukraine are perfectly predict-

able. After a period of weakness in the

1990 s (when Russia still waged a bloody

war to keep Chechnya), Moscow has set

itself the goal of retaking its most cher-

ished former colonies. Putin describes

Ukraine as inseparable from Russia in

much the same way France described

Algeria in the 1950s and ’60s. That cause,

keeping Algeria part of France, was

wildly popular and became the definition

of French nationalism.

There was just one problem, then and

now: The Algerians then, like the Ukrai-

nians now, had no desire to continue to

be colonial subjects. This resistance from

the ground is the key piece of the

narrative that we sometimes neglect.

Whatever Washington, London, Berlin

and Moscow may have decided in gilded

meeting rooms, the people in the former

Soviet empire clearly wanted a political,

military, economic and cultural associa-

tion with the West. And they were willing

to do what it took to get it. So when we

tell the story of Russia and the West, let’s

not forget to include in it Ukraine’s desire

— no, its determination — to be free and

independent. The willingness to fight

and die for these aims is probably the real

driver of this story.

FAREED ZAKARIA

Russia

is fighting

to keep

its colonies

BY ELAINE BATCHLOR

M

y mother died recently at the age of 92. Our

experience at the end of her life confirmed

in the most intimate way what I’d already

come to believe: Black lives aren’t equally

valued in the U.S. health-care system.

In her last weeks, Mom became disoriented and

delirious, and I had her admitted to a hospital. They

diagnosed her with a urinary tract infection and gave

her antibiotics. Although her mental status did not

improve, her team of physicians made plans to

discharge her after a few days. When I expressed my

concerns about this, her doctor dismissed them. I

took my reservations to his medical director, but he

did the same. No one seemed to think my views

mattered.

Did I mention I am a Harvard graduate, and an

African American doctor who runs a hospital in Los

Angeles?

Despite my reservations, the doctor discharged her

to a nursing facility for rehab. Two days later, she was

back in the hospital, dehydrated and unresponsive. I

waited for an apology from the doctors. It never came.

Meanwhile, another doctor asked me about Mom’s

advance directive. I said my mother had been clear:

She did not want a “do not resuscitate” (DNR) order

on her chart. “I want every possible treatment,” she’d

told me. “You don’t have to do what she wants,” this

doctor said before I had even finished. “I can easily

give her a DNR. All you have to do is ask.” I was

stunned.

I found myself doubting a doctor who wanted to

allow a Black woman to die without intervention,

contrary to her expressed wishes. His objectivity also

seemed questionable because he and the hospital

were part of an integrated health system that insured

her; I feared that his suggestions might have been

partly based on saving money.

It is difficult to trust Black lives to a medical system

that doesn’t listen to our concerns or seems to value

cost above our expressed wishes.

The reasons for our skepticism aren’t hard to

understand. My mother, who grew up in the worst of

Jim Crow, had known racism all her life. She had good

reason to believe structural racism permeates the

medical system, and so do I: Studies show, for

example, that Black patients are systematically under-

treated for pain, sometimes based on long-debunked

misbeliefs about our insensitivity to pain.

Because of this and other disparities, there is a

deep distrust of the medical system in the Black

community: A 2020 poll found that 7 in 10 Black

Americans think the health-care system treats people

unfairly based on their race. Tragically, the lack of

trust itself often leads to worse care. While about half

of Americans with regular prescriptions don’t take

their medications as prescribed, that is even more

prevalent among Black and Latinx patients, with

medication adherence roughly 7.5 percent lower for

them than for White patients.

Perhaps also because of this lack of trust, only

24 percent of African Americans have advanced

directives stating their wishes about end-of-life care,

compared with 44 percent of White patients. And far

fewer Black families benefit from hospice and other

end-of-life palliative-care systems that focus on miti-

gating pain and providing emotional support.

One of my sons is a pre-med student studying

medical ethics. As I wrestled with my mother’s

situation, he asked me this, “If you did trust Gram-

my’s doctor, what would you do?”

I was able to answer after a new doctor showed up.

From the very first, this doctor listened to my

concerns and responded with kindness. He asked

follow-up questions. After we had thoroughly covered

her condition, he asked me how I’d like to proceed.

“I want her to get all the treatment she needs,” I

said. Then, to my surprise, I heard myself add, “But I

don’t think it would be in my mom’s best interests to

have CPR or be put on a ventilator.”

He said he agreed but wouldn’t have brought it up

himself. It was a relief to be able to respond, “I

brought it up because I trust you.” This doctor’s tone

and attitude were a sea change — and perhaps not

coincidentally, he was a person of color.

Over the next week, the doctors spoke with me

every day. My mother could no longer communicate.

She was no longer able to take in fluids or nutrition,

and her kidneys began to fail. The only treatment left

was to medicate her pain; it was time to let her go.

Still, the decision was incredibly difficult. My family

needed daily conversations to be sure we were not

failing her. We were reassured by the trust we had in

her doctor.

Doctors aren’t omniscient. But we do have the

power to earn our patient’s trust, by listening and

providing compassionate care.

At my own hospital, where 99 percent of our

patients are people of color and 96 percent are on

public health insurance or uninsured, we try to

recruit doctors representative of the people we serve.

The majority of our workforce is made up of people of

color because providers who look like you and

understand you go a long way in overcoming

mistrust.

But my mother’s story isn’t an anomaly; bias is

built into the design of our separate and unequal

health system.

We need an honest conversation about this institu-

tional racism. We must confront the fact that, too

often, Black people do not get the quality of health

care that would allow them to trust the medical

system with their lives. The consequences of their

experiences are cumulative. Patients, their families

and our country all suffer because of it.

The writer is a physician and the chief executive of MLK

Community Healthcare and MLK Community Hospital in

Los Angeles.

When you’re Black, whom do you

trust with your life?

CHELSEA CHARLES FOR THE WASHINGTON POST

are desperately needed in Ukraine. But

all they’ve asked from us is to backfill,”

House Armed Services Committee rank-

ing Republican Mike D. Rogers (Ala.) said

at a hearing Wednesday morning with

top Pentagon officials. “Why is it taking

two weeks?”

Although we don’t know why, Russian

ground troops appear to be regrouping in

some places. Meanwhile, the Russian

military continues to bombard cities all

over Ukraine with hypersonic missiles,

rockets and artillery shells. So far, the

United States and its partners have only

delivered shorter-range missile defense

systems.

“The time to double down is now,”

Rogers said.

Congressional aides told me that the

Pentagon is preparing a proposal for the

Slovakian government on a possible way

to bolster its air defense capability if

Slovakia transfers its S-300 system to

Ukraine. The easiest fix would be to give

Slovakia its own U.S.-made Patriot mis-

sile defense system. Germany and Den-

mark are already sending Patriot systems

to Slovakia on a temporary basis, but

Bratislava wants the comfort of a perma-

nent solution.

To many in Congress, the delay fits a

pattern of the Biden administration bun-

gling a chance to work with NATO allies

on giving Ukraine emergency military

assistance. In February, a similar dynam-

ic played out when the Polish govern-

ment publicly said it was willing to

transfer Russian fighter planes to

M

ore than two weeks have

passed since Defense Secre-

tary Lloyd Austin traveled to

NATO ally Slovakia, where he

discussed transferring that country’s

most advanced air defense system to

Ukraine. But as Russian missiles contin-

ue to rain down on Ukrainian hospitals,

schools and apartment buildings, there’s

no visible progress. As a result, Congress

is losing patience and Ukrainians are

losing their lives.

Standing next to Austin in Bratislava

on March 17, Slovakian Defense Minister

Jaroslav Nad’ said his country was ready

to transfer the Russian-made S-300 mis-

sile defense system, which the Ukraini-

ans know how to operate, “immediately.”

Compared with what Ukrainian forces

have now, the S-300 could cover more

ground and intercept more advanced

incoming aircraft and missiles, poten-

tially saving a lot of civilians. The minis-

ter’s one condition was that the United

States should replace Slovakia’s S-

with another missile defense system at

least as capable. Austin made no firm

commitments, other than to continue

discussions with NATO partners.

Two weeks later, U.S. lawmakers and

Ukrainians are wondering why there’s no

movement. The other two NATO coun-

tries that have S-300 systems, Bulgaria

and Greece, have been cool to the idea of

sending direct military assistance to

Ukraine. Slovakia is ready to go. So,

what’s the holdup?

“Slovakia has offered S-300s, which

Ukraine via a U.S. base in Germany. After

a couple weeks of back-and-forth, the

Biden team declared the idea unwork-

able, claiming that the fighters would

provoke Russian President Vladimir Pu-

tin and wouldn’t have a significant bat-

tlefield impact anyway.

“The transfer of any system is being

closely scrutinized by the White House

and National Security Council as to

whether or not it meets their test of

what’s escalatory and what’s not,” a senior

congressional aide told me. “That’s caus-

ing the system to be constipated.”

Celeste Wallander, the assistant secre-

tary of defense for international security

affairs, testified Wednesday that the

Biden administration was working with

Slovakia to determine exactly what it

needs to replace its S-300 system. She

also said that the Pentagon was already

sourcing parts of the S-300 system from

other countries and sending those parts

to the Ukrainians.

“So, we’ve not simply been waiting for

resolution of that offer, but have been

working on getting the Ukrainians what

they need right now,” she said.

Earlier this month, the Wall Street

Journal reported that the U.S. govern-

ment was sending Ukraine parts of

Soviet-era missile defense systems that

had been acquired over decades as part

of a secret U.S. government program.

Wallander said she would discuss the

details of current efforts only in a classi-

fied setting.

At the hearing, House Armed Services

Committee Chairman Adam Smith (D-

Wash.) said the Biden administration

was trying to “balance between giving

Ukraine the help it needs without

spreading the wider war.”

But Air Force Gen. Tod Wolters, the

head of U.S. European Command, testi-

fied that there’s always risk in whatever

military assistance is provided. The fact

is, Wolters said, Ukrainians will likely be

dealing with incoming Russian missiles

for a long time to come.

“Surface-to-air missiles are very im-

portant,” he said. “They have been effec-

tive in the campaign [against the Rus-

sians], and I predict they will continue to

be effective in the coming months.”

The Biden administration is doing a

lot to arm Ukrainian forces and deserves

credit. At the same time, the bureaucrat-

ic and policy bottlenecks delaying the

S-300 transfer are costing lives each day.

If Austin can’t find one Patriot missile

system to put on a plane and send to

Slovakia, what message does that send

to Ukrainians — or Putin, for that matter

— about our commitment to the fight?

Of course, the United States should be

mindful of needlessly escalating the

crisis. But the best way to prevent the

war from spilling over is to give the

Ukrainians what they need to win. The

more the United States drags its feet on

things such as the S-300, the more

people will die and the longer the

fighting will continue. And if Ukraine

falls, the risk of a greater conflict will

only increase.

JOSH ROGIN

Ukraine needs better air defense systems, not more excuses