Archive for July, 2023

How Medicare’s Drug Prices Could Have Been Half What They Are

Thursday, July 20th, 2023

In yesterday’s Letter I described the torturous path taken by the Biden Administration to get to the point where Medicare would be allowed to negotiate the prices it pays for the drugs it provides to its beneficiaries. I wrote that pharmaceuticals now cost Medicare about a quarter of its entire spend for the 64 million people it insures.

The Inflation Reduction Act was the vehicle that finally ushered in negotiations, which are scheduled to begin next month, negotiations that will center on ten of the highest cost drugs and should result in lower prices beginning in 2026. In succeeding years, more negotiations will focus on more and more drugs. Given the huge dollars Pharma contributes to Washington’s politicians, stretching everything out as far as possible was a necessary compromise the President’s team made.

But Pharma, the US Chamber of Commerce and two big drugmakers, Bristol Myers Squibb and Merck, haven’t given up, not by a long shot. Within the last two weeks they have filed four lawsuits. They’re throwing everything they have up against the wall to see if anything sticks. If they succeed in derailing the train to lower prices, they will, with great big smiles, sit comfortably back in plush seats on board the gravy train they’ve come to know so well.

But while all of that plays out, I want to suggest a better result that could have happened long ago if only lawmakers had treated drugmakers differently.

There is another government health care organization that has never had a prohibition with respect to negotiating drug prices. It is the Department of Veterans Affairs. The VA.

In January, 2021, the Government Accountability Office released a study that concluded:

“the Department of Veterans Affairs (VA) paid, on average, 54 percent less per unit for a sample of 399 brand-name and generic prescription drugs in 2017 as did Medicare Part D, even after accounting for applicable rebates and price concessions in the Part D program.”

This means what the VA pays is in line with the other 32 OECD countries I mentioned yesterday whose cost are half those of the US for Medicare.

Moreover, the GAO found that 233 of the 399 drugs in the sample were at least 50% cheaper in the VA than in Medicare, and 106 drugs were at least 75% cheaper. Only 43 drugs were cheaper in Medicare than in the VA.

What are the operational differences between the two organizations?

For one thing, the programs pay for drugs differently. Medicare reimburses the Part D plan sponsors to pay pharmacies through the middlemen―Pharmacy benefit Managers, but the VA buys drugs directly from manufacturers. It cuts out the middlemen. The VA can get lower prices because it can:

  • Negotiate as a single health system with a unified list of covered drugs; and,
  • Use discounts defined by law that Medicare doesn’t have.

As an aside, I’ve always thought that one of the primary causes of high costs in both Medicare and group health insurance is the presence of Pharmacy Benefit Managers, the middlemen. But that’s a topic for another day.

As in everything political, all of this comes down to economics. The VA, with only nine million health care beneficiaries, as opposed to Medicare’s 64 million, could fly under the political radar and avoid congressional restraint. It was able to keep the congressional camel’s nose and, more to the point, its sticky fingers, out of its tent.

Medicare is so big, it couldn’t do that.

And here we are.

Where Does The Medicare Drug Price Negotiation War Stand Now?

Wednesday, July 19th, 2023

Medicare Part D, a prescription drug benefit plan for Medicare beneficiaries, became law on 1 January 2006 under the George W. Bush administration and a Republican controlled Congress. The legislation was enacted with no funding provisions whatsoever. Since then, Washington politicians have been arguing over whether this government program should be allowed to negotiate with pharmaceutical companies the prices it pays for drugs its members need. Medicare beneficiaries, all 64 million of them, and the public at large, have overwhelmingly supported such a move. Over the years, pharmaceutical companies have spent a king’s ransom donating to politicians to secure―should we say “buy?”―their votes in opposition.

What’s been the result?

  • study published recently in the Journal of the American Medical Association concluded more than a quarter (27.2%) of Medicare spending is now for prescription drugs;
  • That would be $180 billion, as reported by the Medicare Payment Advisory Commission for 2020;
  • According to the Kaiser Family Foundation, the total we in the US spent on prescription drugs in 2017 was $333 billion; and,
  • The Rand Corporation studied and compared US prices to 32 other OECD countries (The Organization for Economic Cooperation and Development – the most developed nations) and reported our prices are “nearly twice those of other countries after adjusting U.S. prices downward to account for rebates and other discounts paid by drug companies.

And now, perhaps the gravy train may be slowing.

In August 2022, Congress finally passed―without a single Republican vote―and President Biden signed, the Inflation Reduction Act, which, among other things, allows Medicare to move forward with drug price negotiations―sort of. Right about now, you may be asking what prevented Medicare from doing that all along since 2006 as a normal part of its drug-purchasing process?

As the Kaiser Family Foundation explains:

Under the Medicare Part D program, which covers retail prescription drugs, Medicare contracts with private plan sponsors to provide a prescription drug benefit. The law that established the Part D benefit included a provision known as the “noninterference” clause, which stipulates that the HHS Secretary “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP [prescription drug plan] sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”

In other words, although Medicare is buying drugs for its members, all 64 million of them, it has not been allowed to even hint that a lower price might be more fair and appropriate for the government to pay. That is the very definition of a “sweet deal” for drug manufacturers.

Giving the negotiation contrarians the benefit of a doubt they more than likely don’t deserve, their argument in opposition hangs on the slim thread that negotiations will lower the income of drug manufacturers, and that will, in turn, reduce the amount of money the companies invest in research and development to discover new life-saving drugs. My own opinion is that this argument is chock full of what makes the grass grow green and tall. And, by the way, the Congressional Budget Office agrees with me, although their analysists said it with a bit more eloquence.

And what does the aforementioned Inflation Reduction Act do, anyway?

It does a number of things, one of which is to lay down new rules for price negotiations. These are its major health care provisions, leaving out, for the moment, the negotiation issue. It will:

  • Require drug companies to pay rebates to Medicare if prices rise faster than inflation for drugs used by Medicare beneficiaries, beginning in 2023;
  • Cap out-of-pocket spending for Medicare Part D enrollees and make other Part D benefit design changes, beginning in 2024;
  • Limit monthly cost sharing for insulin to $35 for people with Medicare, beginning in 2023. This might be the most far reaching and important item in the entire legislation.
  • Eliminate cost sharing for adult vaccines covered under Medicare Part D and improve access to adult vaccines in Medicaid and CHIP, beginning in 2023;
  • Expand eligibility for full benefits under the Medicare Part D Low-Income Subsidy Program, beginning in 2024; and,
  • Further delay implementation of the Trump Administration’s drug rebate rule, beginning in 2027.

Notice the years in which these provisions take effect. In most cases, it’s 2023. Which is now.

The negotiation provision of the Inflation Reduction Act:

  • Requires the federal government to negotiate prices for some drugs (emphasis added) covered under Medicare Part D and Part B* with the highest total spending, beginning in 2026. Note the year.

This provision targets the most expensive drugs. Here’s how.

Under the new Drug Price Negotiation Program, Medicare will negotiate the price of 10 Part D drugs for 2026, another 15 for 2027, another 15 for 2028, and another 20 for 2029 and later years. The drugs to be chosen for negotiation will be selected from among the 50 drugs with the highest total Medicare spending. The number of drugs with negotiable prices  will accumulate over time.

So, beginning three years from now, the law goes after the most expensive Medicare drugs — ever so slowly.

There are debatable reasons for delaying implementation until 2026, all dealing with operational processes. The period of negotiation between the Secretary of Health and Human Services and manufacturers of the selected drugs will occur between 1 October 2023 and 1 August 2024, and the negotiated “maximum fair prices” will be published no later than 1 September 2024 and will go into effect 1 January 2026.

This has always seemed to me a rather long and drawn out negotiation process, but it is, after all, a political compromise, and a rather elegant one, at that.

But now, into that elegant compromise has stepped the pharmaceutical industry and a bunch of high-powered allies. They lost in the fight that brought the compromise within the Inflation Reduction Act, but they’re now back with lawsuits to derail the process before it gets going this year.

Just this month, four lawsuits have been filed in four different court venues, amounting to a legal blitz in the span of just over two weeks. The complaints include a range of legal arguments, some of which overlap.

“If you find one judge or one panel, that’s all it takes. When you’re thinking of savvy and sophisticated litigants, that is the way that they try and challenge major policies at this stage,” said Zachary Baron, an associate director of the Health Policy and the Law Initiative at Georgetown’s O’Neill Institute.

The lawsuit filed by PhRMA (Pharmaceutical Research and Manufacturers of America) and two other plaintiffs alleges the drug negotiation program is unconstitutional for three main reasons. First, the groups contend Congress shouldn’t have delegated such broad authority to the federal health department; second, the program denies manufacturers their due process rights: and third, it imposes a “staggering” tax for noncompliance.

Another lawsuit from the U.S. Chamber of Commerce and local business groups made similar arguments, though they also included other claims in their quest to bring down the program.

Finally, the Jones Day law firm has brought suit on behalf of drug manufacturers Bristol Myers Squibb and Merck. Their arguments assert that the rules force the drugmakers to agree to the price HHS sets and thus violate their free speech rights.

“Force the drugmakers to agree to the price HHS sets…” Except — What the Inflation Reduction Act imposed on drugmakers was a negotiation, not a drug price mandate.

One person who spoke with a Washington Post reporter suggested the lawsuits were just the first move in a complicated chess match the drugmakers were hoping would wind up in a  sympathetically conservative Supreme Court.

No one ever said this was going to be easy.

Tomorrow — A better way to lower prescription drug costs for Americans.


The March To The Sea

Friday, July 14th, 2023

I was all set to write one of these Letters about Alabama Senator Tommy Tuberville. Really. I was. Tuberville, the man who singlehandedly, by Senatorial “Hold,” has stopped Senate confirmation of more than 270 senior field grade officers, generals and admirals whom the Department of Defense would like to promote to mostly replace retiring DOD senior officers. These include members of the Joint Chiefs of Staff, including Chairman Mark Milley, who is set to retire at the end of September.  If Tuberville’s intransigence continues we may find ourselves without a Chair of the Joint Chiefs. Already, Tuberville has left the Marine Corps leaderless for the first time in 164 years. Doesn’t matter to him.

Why has Tuberville created this mess? Because the DOD, although none of its medical facilities conduct abortions, in compliance with the Hyde Amendment of 1976, has authorized women soldiers and sailors living and working in states that severely restricted access to abortions following the Dobbs decision to travel at government expense to states where abortion is legal and obtain one at their own expense.

Until now, Tuberville’s claim to fame has been a career as a relatively successful college football coach after earning a degree in Physical Education from Southern Arkansas University. Following a 21-year career coaching college football, most notably at Auburn University, where only 53% of his players actually graduated, well below the national average, he somehow convinced Alabama voters that they should make him one of their two US Senators. And they did, by a wide margin. Of course, it helped that he jumped on Donald Trump’s back and was then carried over the goal line by the MAGA Man in Chief. In case you’re wondering, Tuberville was one of the speakers at Trump’s rally on the Ellipse on the 6th of January 2022, and, later that day, actually after midnight, was one of the Senators who refused to certify Joe Biden’s election.

Two things bother me above all else in this matter. First, I have a deep affinity for and loyalty to the US Army. Although I hated everything the Vietnam War stood for, I found myself in the thick of it and did the best I could to keep my guys alive. I suppose I could have gone to Canada or petitioned for a deferment due to bone spurs, but when a few friends came home in their own olive green shrouds, I couldn’t help myself. Second, Tuberville’s ignorance and flat-out stupidity demonstrate a sorry excuse for a United States Senator. Our founders thought Senators would be the wisest of men (sorry ladies) and the epitome of probity and thoughtfulness. Hasn’t always worked out that way. 2023’s Exhibit #1: Tommy Tuberville.

Of course, Tuberville tells his legions of critics that if they want to confirm these people he has “held,” they can do it, just one at a time, not all at once as is the usual process. And wouldn’t that be fun? I can just see some Senators wanting to discuss the pros and cons of confirming Generals Tom, Dick and Harry ad nauseam. People, it’s embarrassing.

As I said, I was all set to write about terrible Tuberville, but I won’t. Instead, because he did get me thinking about my service in the Army, and because I was once acquainted with another kind of “hold,” I’m going to tell you the story of The March To The Sea.

Orders arrive

It was a beautiful late summer day, and I and my 28-man Platoon, including Rusty the scout dog and his handler, PFC Snyder, having recently concluded one of our personally rewarding occasional encounters with some of North Vietnam’s finest, were sunning ourselves on top of what passed for a mountain in northern South Vietnam, when Bobcat called.

Bobcat, who preceded Bulldog of The Nuts and Calendar fame, was Colonel Robert Stillingworth, “Still” to his friends, Bobcat to me. And don’t worry. It’s alright to name him. Bobcat has long since become one with the universe.

Anyway, Bobcat called, and the ultimate, sub-rosa reason he called was because in his tenth month of a 13-month Vietnam tour, Bobcat had yet to win his Silver Star, which he figured was essential to becoming a 1-star general. Of course, I did not know that at the time. Why should I? But afterwards it explained everything.

As soon as I heard his voice, I knew siesta-time was over.  “Go to the secure freq. I have orders for you,” he said. I switched to our secure frequency. He said, “You are to proceed to the sea.” Then he gave me a couple of coordinates, which by deduction worthy of Sherlock Holmes I presumed to be on the coast of the South China Sea somewhere. “You are to be there no later than 0100 hours. You will receive further orders upon arrival. Any questions?”

Well, no. Seemed simple enough. Then I heard, “Bobcat out.” The man had a way with words.

I pulled out my map and saw that our upcoming little stroll would cover about 24 kilometers, we called them “clicks”, or roughly 15 miles. Twenty-four clicks in less than eight hours and, since we had just been resupplied with rations, ammo and what not a couple of hours earlier, we’d be bebopping along with about 85 pounds on our backs.

The good news was we wouldn’t have to bebop through much jungle. After we made it down from the mountain, we’d be just about one click from Highway 1, the only paved road north of Saigon. We’d take that north, and it would lead us right to where we were supposed to go. Simple. As long as we didn’t stumble into any of the bad guys.

So, we gathered up our stuff and off we went. About an hour later, we were on Highway 1. That’s when the rain began. It rained all the way to the sea.

We arrive

In the gloom of a rainy night, about one click from where we were supposed to wind up, we took a right off the highway onto a dirt path and saw the lights from a village up ahead. As we got nearer we could hear voices, a lot of them. But before we got there we smelled the bread.

In our haste to make the deadline, we hadn’t stopped to eat, just kept slogging up Highway 1 in the rain. Now, dead ahead of us, a sorry group of cold and wet-to-the-core soldiers, was an old woman, smiling from ear to ear, standing behind a table in front of a tiny building that appeared to be the village bakery. She had two hanging oil lamps, one on each side of her, and spread out on her table were loaf after loaf of newly baked bread. The lady knew we were coming.

Ravenous as we were, we bought every loaf, making her instantly wealthy, and wolfed them all down. If you ignored all the sand still in the bread it was the best we ever tasted.

Then we moved on to our rally point, where all the voices were coming from. We found ourselves in a little harbor, really little. And in it were a few small boats, not much more than Sampans, really, but they had engines.

Orders are delivered

Standing on a small pier hanging out over the water was the Intelligence Officer of our Brigade, LTC Barnacle. He gave me written orders and told me the boats behind him belonged to the South Vietnamese Navy. “Excuse me, Colonel, South Vietnam has a Navy?” I asked. “Yup, and you’re lookin’ at it.” He then said, “Your orders are to board that ship over there with your men and, ah, the dog, I see you have a dog. The ship will ferry you up the coast to just south of the DMZ (Demilitarized Zone), where you will conduct an amphibious assault and secure the beach.”

I just looked at the man and said, “Sir, this is a joke, right?” “No joke,” he said. “Get ready to board, cause you’re leaving in 15 minutes.” “But sir,” I said, “Are you going to brief me on the resistance my men and I will likely encounter when we do this crazy thing?”

The Colonel draped his arm over my shoulder and pulled me aside. “Lieutenant,” he said. “Believe me when I tell you it is highly unlikely you and your men will encounter much resistance, if any.”

“Is this just an exercise?” I asked. “Sort of,” he said. “But it’s kind of secret. Now get your ass on the boat.”

On the boat with Rusty

So, we did. Rusty, PFC Snyder, and the rest of us loaded ourselves into the hold on the deck of the first boat. The hold, about 20 by 20 feet, sloped from the middle out to the sides. At the middle it was about three and a half or four feet high. At the sides it was down to about 2 feet. We crammed ourselves in. It would have been a lot less uncomfortable if it weren’t for all the 85-pound rucksacks and weaponry. We pushed off from the dock, and the put-putting engine sent us all slowly into the South China Sea.

About ten minutes later my big mistake reared its shaggy head, because that was when PFC Snyder, stuck way back in the left corner, yelled over to me, “Lieutenant, the dog’s gotta go.” The mistake had been loading Rusty and Snyder in first. They always led after our Point man in the jungle. Why not here? Well, this was why not.

There was nothing we could do, no way to get him anywhere else, so Rusty did his thing, a four-plopper according to Snyder, and the rest of our trip along the coast up the South China Sea was redolent with an aroma only a dog can make.

The assault

At 0815 hours in the morning we were at the assault point. Of course, the genius who designed the “plan” didn’t allow for low tide, so we hit the water for the big battle about a quarter mile from shore.

Not a shot was fired. Heads up, we casually waded ashore, walked up the beach, and found rectangular table after table along about 100 feet of beach, behind which, with smiles to light up the sky, stood about 25 women of the American Red Cross handing out cans of Coca Cola. To the guys in the field, they were known as “Doughnut Dollies.”

Having not died in the second coming of D-Day, we occupied the beach for the next three weeks, never encountering a single moment of stress from an enemy that must have had other things on its mind.

During the time on the beach I developed an infection from a small cut I got opening a can of Bud. So, I hopped a chopper and flew back to base camp for some antibiotic. While there I met up with the Brigade Adjutant, a friend. It was he who told me the story of how Bobcat had led the charge in an amphibious assault on a tightly held enemy location on the South China Seacoast, and, .45 calibers in each hand, had led his men to victory.

At least, that’s what the citation for his Silver Star said.

The story of Reginald Lee

Tuesday, July 11th, 2023

Let me ask you a question: What is the single most dangerous challenge facing America right now?

There are lots of possible answers, aren’t there? In no particular order, we face political and cultural hyper-partisanship, an ever-widening gap between the very rich and the very poor, the never-ending threat of Donald Trump and his MAGA-cult followers, the continuing decline in our human replacement rate, the accelerating rise in health care costs, the fate of Europe as the Ukraine/Russia war continues beyond 500 days… and the list goes on.

I’m sure we all have our various answers to the question of our most dangerous challenge. To get to mine, let me tell you the story of Reginald Lee.

In the early 20th century, Clark University in Worcester, Massachusetts, played an unexpected role in the aftermath of the tragic sinking of the RMS Titanic. While the connection may not be widely known, it highlights the far-reaching impact of this historic event.

One of the survivors of the Titanic disaster was a young man named Reginald Lee. Born in Worcester in 1891, Lee was a gifted student who excelled in academics. He had an insatiable curiosity and a deep interest in scientific research. It was this passion that led him to pursue a higher education at Clark University.

Lee arrived at Clark in 1910, where he studied physics and immersed himself in the scientific community. His time at the university proved instrumental in shaping his future and setting him on a path that would intersect with the Titanic tragedy.

During his studies at Clark, Lee became fascinated with wireless telegraphy, a burgeoning field of communication technology at the time. He was particularly captivated by the work of Guglielmo Marconi, the Italian inventor who had made significant advancements in wireless communication.

In 1912, as Lee neared the end of his studies at Clark, he received an incredible opportunity. The Marconi International Marine Communication Company, a leading wireless telegraphy company, offered him a position as a junior wireless operator aboard the RMS Titanic. This was an exciting opportunity for Lee to work with the latest wireless technology while traveling on the world’s most luxurious ocean liner.

On April 10, 1912, the Titanic set sail from Southampton, England, bound for New York City. Lee took up his duties as the junior wireless operator, working alongside senior wireless operator Jack Phillips. Their task was to maintain constant communication with other ships and relay messages to and from passengers.

Tragically, on the night of April 14, 1912, the Titanic struck an iceberg in the North Atlantic Ocean and began to sink. As chaos ensued, Lee and Phillips stayed at their posts, sending out distress signals to nearby ships. Their heroic efforts were instrumental in alerting the RMS Carpathia, which ultimately rescued over 700 survivors.

Lee survived the disaster and returned to Worcester, deeply affected by the tragedy. He continued his studies at Clark University, where he received support and guidance from his professors, who recognized the extraordinary experiences he had endured.

After completing his studies, Lee dedicated his career to wireless telegraphy and radio communication. He went on to work for various companies, advancing the field of wireless technology and contributing to its rapid development. His expertise and experiences aboard the Titanic shaped his understanding of the importance of effective communication and safety at sea.

Reginald Lee’s story serves as a poignant reminder of the enduring legacy of the Titanic sinking. It also highlights the often unexpected connections that exist between historical events and educational institutions like Clark University.

Quite a story, isn’t it? Except everything you just read about Reginald Lee is a lie. He never existed. Didn’t go to Clark University, didn’t work for Marconi and didn’t serve as Junior Wireless Operator on the Titanic. That duty fell to real-life Harold Bride, who, working alongside Jack Phillips, stayed at his post, repeatedly sending SOS messages, and was swept overboard, but made it to a life boat, and lived until 1956. Phillips did not survive the sinking.

The fictional account was written by ChatGPT, an Artificial Intelligence (AI) program, and was sent to me by my daughter, who is the Senior Writer & Content Editor for Clark University. She saw it on Instagram and, unlike most people who would see it, did a bit of research, because it concerned her University.

It turns out the Instagram Post came from a Clark University alum, who “asked (ChatGPT) a simple question about writing a historical story about the connectivity between Clark University and the Titanic.” The answer came back as a total fabrication.

The alum cautioned, “Be careful with ChatGPT.”

Be careful, indeed. Just think of the possibilities. If used wisely, it seems obvious that AI programs like ChatGPT can be powerful engines for good. But what if they aren’t? The story of Reginald Lee shows convincingly how these programs — that are learning all the time, every second of the day — can create potent disinformation, harmful disinformation.

In another example, a reporter asked ChatGPT for information about the Belgian chemist and philosopher, Antoine de Machelet, who is fictitious and has as much reality as a Harry Potter Unicorn. Without pause, the program replied with a cogent, well-organized biography populated entirely with imaginary facts. Compared to the demonic potential of ChatGPT, George Santos has the credibility of Pope Francis.

It’s important to know there are two kinds of artificial intelligence. The first, the one we’re experiencing right now is Narrow AI. Narrow AI is AI that deals with one, narrowly defined task, or a small set of related tasks. Think of the programs that now read Xrays, and do that far better than humans can. Or, think of the algorithms now reading the Resumé you just submitted and worked so hard to make stand out. Or, think of the story of Reginald Lee, which you probably would have believed if I hadn’t told you it was a complete fabrication.

The second kind of AI is Artificial General Intelligence (AGI). General AI programs are systems that demonstrate intelligent behavior across a range of cognitive tasks. It is self-aware. Think of the two Blade Runner movies, or the Terminator movies, or the whole premise behind Battlestar Gallactica. Experts think we are more than a decade away from anything even remotely resembling an embryonic General AI. We might never get to it.

But right now, Narrow AI is scary enough. It has the quality of deep-learning, which is a massive advance of technology. In traditional learning, humans, in one form or another, teach other humans how to perform a task. But Narrow AI, like ChatGPT, requires minimal instruction and instantly accesses a massive amount of data, and then learns by itself constantly.

The problem is not that Narrow AI is really smart, which it is, but that it is incredibly stupid in unpredictable ways: In one case, when New York Times technology reporter Kevin Roose was testing Microsoft’s Bing Chatbot code-named “Sydney,” Sydney tried to get him to leave his wife and marry it! Subsequently, Microsoft explained Sydney could become “confused, causing it to have disturbing and bizarre exchanges with users.” Right.

There is monumental good that will come from Narrow AI programs like ChatGPT. But I’m thinking of our current political landscape and our upcoming 2024 elections. The potential for disinformation is enormous, disinformation that comes at you like a Gatling gun and is entirely believable. Without any regulation, political, moral or ethical, an unsuspecting and unaware public can be moved from one position to another and never know it happened.

As everyone knows, disinformation has been happening on social media platforms for the last few years, but that has been human driven in mostly traditional ways. Narrow AI has the potential to explode disinformation’s impact in never-before-seen ways.

ChatGPT and other programs like it are two-edged swords, and each edge is exceedingly sharp.

Nazi Propaganda Minister Joseph Goebbels would have loved these programs.

How Putin, misreading the past, has gone horribly wrong

Friday, July 7th, 2023

In his misguided attack on Ukraine, Vladimir Putin, who seems to have learned nothing from history, is making all the mistakes tyrants have made in the past. He’s in great company — Kaiser Wilhelm and Adolph Hitler come to mind. Let me explain.

In August 1914, in a war that never should have been, but was, nonetheless, inevitable, the Russian Imperial Army, poorly trained cannon fodder, lacking modern equipment, and insufficiently armed — not much artillery and fewer bullets — significantly influenced the outcome of World War I in spite of the Czar’s  apparent indifference. Here’s how it happened.

In 1870, Germany had defeated France in the  Franco-Prussian War. Germany’s overly greedy and needlessly cruel terms of surrender were excruciating for France and from that point on both countries, each of whom knew they would meet again on the battlefield, prepared for the rematch that would become World War I.

To that end, Germany’s Chief of the General Staff, Count Alfred von Schlieffen, devoted his entire tenure (1891 to 1906) to creating what would become the German Plan of Attack. The plan called for a huge, lightning-like strike through Belgium, which would result in the capture of Paris in nearly six weeks, 40 days. But there was a problem: Belgium neutrality and safety, which had been officially guaranteed in 1831 in London at an international conference of European powers — which included Russia.

The Kaiser and his generals decided to ignore Belgian neutrality and proceed with the Schlieffen plan, which was exact in every detail, a model of precision, and it factored in every possible contingency.

The only thing it lacked was flexibility. That is, what to do if something went wrong. And many things did. As that great American philosopher Mike Tyson put it, “All your plans go out the window the first time someone punches you in the mouth.”

The Germans invaded Belgium on their way to Paris on 4 August 1914. In addition to misjudging the determination of the French to defend themselves, they believed Britain would either stay out completely or join the battle late. They underestimated the valor of the Belgians, who refused to roll over and play dead. And they failed to appreciate that Russia, a signatory to the treaty for defending Belgium, would mobilize, join the war, and, with 800,000 soldiers — poorly equipped and insufficiently armed — engage with and delay the German army weeks before Schlieffen’s plan anticipated. Russia’s actions upset the Schlieffen timetable, and, rather than champagne in Paris after 40 days, the Germans settled in for four years of trench warfare and a defeat that would lay the ground for Hitler’s rise and another war that should never have been, but was, once again, inevitable.

And so it was that, after taking power in January 1933, Nazifying all of Germany in the next  seven years, conquering Poland nearly overnight in 1939, leading to the deaths of more than three million Poles, 1.4 million of them Jews, Hitler launched Operation Barbarossa on 22 June 1941 and invaded the Soviet Union.

The German invasion went according to plan in the first six weeks as its troops tore into Ukraine¹ and Russia at breakneck speed. Early in the campaign they took more than three million prisoners. Stalin panicked, retreating to his Dacha not knowing what to do. But over a weekend he recovered his nerve, assembled his generals, and got to work fighting the invaders.

Like Schlieffen before him, Hitler had mistakenly thought his war with the Soviet Union would be brief, perhaps a couple of months, but as Stalin’s forces regrouped and continued to pour soldiers into battle from what seemed a nearly limitless human arsenal, — the number would eventually reach 14 million, more than half of them Ukrainians — everything slowed down. Summer and autumn turned into winter, the coldest ever recorded, once reaching -49° Fahrenheit, for which the Germans were nearly completely unprepared. With little food, overstretched supply lines, equipment that wouldn’t work in the cold, and soldiers who were, literally, freezing, they soon found themselves, just as they had 27 years earlier, in a four-year slog of a war they could never win. The eastern front was where Hitler lost World War II. The Russians don’t call it the Great Patriotic War for nothing.

And so, in both the first and second World Wars, Russians and soldiers from regions occupied by Russia (the vast majority being Ukrainians) saved Europe from German domination. More than 12 million of them died in the process (again, more than half were Ukrainian). Despite the brutality of Czars and  the cruelty of Communists, made manifest in Joseph Stalin’s malign and barbaric Ukrainian genocide by starvation², these patriots fought with heroism and profound self-sacrifice.

Today, Vladimir Putin is making precisely the same mistakes made by Schlieffen, Kaiser Wilhelm, and Hitler. Like them, he thought he could capture a docile country in less than a month, putting it back where he was sure it belonged, that would be in his pocket. His army — and mercenaries — have committed documented crimes against humanity, atrocities similar to those perpetrated by Hitler’s SS.

In his “Special Military Operation,” he has gravely miscalculated everything. He has completely underestimated the determination, and skill, of Ukrainians and their leaders to successfully resist his monstrous invasion. He has misjudged the continuing unity of NATO in providing the arsenal Ukraine needs to defend itself. In effect, he has created a unified NATO to an extent no one ever thought possible. He has weakened his position as Russia’s leader, and, despite sending Prigozhin and his 25,000 Wagner mercenaries packing off to Belarus³, he has opened the door to the carping of his critics and wanna-be successors. Rather than smashing him down like a tiny bug, he has raised Ukraine’s President Zelenskyy to superstar Churchillian status. He has been forced to buy weaponry, mostly drones, from Iran and grovel for more from China, which has been smart enough not to give any, not that we know of, anyway.

But what strikes me above all else is that in his manic drive to be seen as the second coming of Peter the Great, he has viciously and barbarically attacked the very country that, more than any other, saved his country, Russia, from defeat at the hands of the German Goliath in World War II. There’s gratitude for you.

Now, having dug himself and his country into the deepest of holes, he has yet to find anything better to do other than to keep digging.

It is only a matter of time before all the dirt he has shoveled out falls back in and buries him. Like Hitler after Operation Barbarossa, his days are numbered.


¹ In a terrible twist, in addition to millions of Ukrainians fighting with the Red Army, a significant number in the western part of the country joined forces with the Germans when the invasion came.

² In 1932 and 1933, more than 3.9 million Ukrainians were starved by man-made famine as Stalin sought to tamp down Ukrainian nationalism. In acknowledgement of its scale, the famine is often called the Holodomor, a term derived from the Ukrainian words for hunger (holod) and extermination (mor).

³ Although reports from yesterday suggest Prigozhin may have left Belarus. To go where? We don’t know.