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GovInsights: Do You Have a “Duty to Die”?

This interview marks the third of a brand new series on GovLoop called “GovInsights” where we are interviewing and highlighting the thoughts and perspectives of professors at colleges and universities who are teaching, researching and writing about government issues.

This time, we talked to Dr. James Keagle, Director of the Transforming National Security at the Center for Technology and National Security Policy at the National Defense University. He served prior as the Deputy Director at the Office of the Secretary of Defense and is teaching Global Defense and Security in international Affairs.

Julia: What are the 3 biggest challenges that government faces today?

Dr. Kaegle: Each of the challenges have enormous resource and policy implications. And in my business, which is national security and defense, if we don’t get these right or close to right, people die. I think that raises the stakes significantly.

1. Information Revolution: As all of us know, there is a significant revolution in information technology. That particularly translates into the Business of National Defense and Security, into what we now call asymmetrical warfare. We have the possibility of spreading viruses and contaminating information that we need to rely on to make accurate and informed decisions. This could be from what we know Bootnez, through social networking, or through cloud computing. These are the three areas with particular problems, especially as challenges to information assurance.

2. Energy: Our reliance on fossil fuel, generally as the means to generate energy could lead to fights over scarce resources, challenges to the stability of existing governments, to natural disasters, rising sea levels, displaced persons and, ultimately, these kinds of instabilities could lead to conflict, causing the defense establishments around the world to make difficult decisions.

3. Health Care: I think the World, the Western World and particularly the United States is plagued with enormous expenses with health care. In my profession, we are spending far too much of our resources. That might sound cold and cruel but we are spending far too much of our resources on health care and not enough on actually equipping the fighting force to do what it is paid to do. This is sometimes referred to as the “tail to tooth ratio.” The amount of resources you spend on the fighting force compared to the amount of resources you spend to support some kind of functions — and I would put health care in that category of support.

I say health care because we have larger dependent populations, we have larger retiree populations, we have higher expectations in regard to healthcare in terms of entitlements of particular services that we were previously not paying for because we did not have the technology to do it. And we have again, in my profession specifically, higher survivor rates on the battlefield and new kinds of injuries for which the kinds of care and health care that are expected at location and recreation facilities are enormous. And I am talking more specifically about traumatic brain injuries and post-traumatic stress disorders. Sometimes the more visual pictures we get with regard to battle injuries that are survivable are the ones that are treated with prosthetics, but I think the far larger cost involved in treating the returning veterans are going to be these brain injuries, psychologically and physiologically.

Julia: What are your proposed solutions?

Dr. Kaegle:

1. Information Revolution: I hope your audience finds this interesting and useful. I believe that the fundamental challenge is to create an environment, a cultural work place environment that can attract the kinds of folks that are more likely looking for jobs at Google and other private sector businesses. In the national security establishment we don’t have the kind of environment that tolerates those who come to work in flip-flops, would prefer to work at home, don’t want to wear a suit and tie, don’t understand what time cards and 8-5 duty days are. All of that culture of the military establishment is a significant inhibitor to attracting the kind of workforce that we need, the kind of talent that we need. So create that new environment for hiring the right people.

2. Energy: The challenge, of course, is to reduce our dependency on fossil fuels. This will require a major challenge to the existing power elites in all of our cultures who have risen to power through the enormous profits that have been involved in the existing fossil fuel resources bases they have been investing in. Any change to a future that will have us less dependent on fossil fuels is going to have to take on this existing power structure that benefit from the way things are rather from the way things need to be in the future. So what that requires is finding that individual or those individuals that have the leadership skills to take us in large steps not in small steps because there are transformational kind of steps to be taken. It will require leadership and it will require an acceptance on the part of the larger populations to take some risks associated with the leader who is going to challenge existing power leads.

3. Health Care: The cost of health care in many Western societies, particularly North America and the United States, have gone from less then 10% 10 years ago to the 16-18% of our GDP that we spend today on our health care. The trend continues to project that in the next 9 to 10 years it will be 20% or more of our GDP. That’s an unaffordable, an unsustainable cost.

We have to figure out ways to reduce that cost. Again, an enormous culture change is required. If you look on how we spend money on health care, the fast disproportioned percentage of healthcare dollars are spend in the last 6-12 months on life. Research suggests that anywhere from 40 to 45% of all the dollars spent on health care are in the last 6-12 months of a person’s life. That suggests if we really want to attack the costs of health care we have to figure out what to do with that last 6-12 months. Twenty five years ago, people referred to this in another phrase that was somewhat cruel, not a “dignified death” but “a duty to die,” that people have a duty to die. That may be a conversation that we have to revisit. At some point, the health profession and the society more broadly have to recognize that it is time to die at an individual level and the individual needs to make that choice and WE have to be comfortable with those individual choices. We may need to move to a culture that can facilitate and take those individual choices. This is not about having “death commissions,” but rather facilitating the individual to make that choice.

Julia: What kind of progress have you seen that has been implemented effectively by


Dr. Kaegle:

On Energy the government has made some significant progress. All of our services — the Army, Navy and the Marine corps — are making significant strides in changing the fuels that they use. They are looking for ways to come up with greener fuels like fuel mixtures. But they are also trying to come up with alternatives, non-fossil fuel based, to power themselves in the combat environments in which they operate. Outside the combat environment, the Air Force is particularly interested in developing what they call ”facility studies” and looking for ways to reduce the cost for maintaining the infrastructure. That can be through lowering the thermostats in the winter and raising the thermostats again but just the initial construction and other sorts of steps that you can take to control the costs of maintaining the infrastructure.

I guess in a word hybrid fuels and hybrid vehicles are much more common place now then they were 15 years ago. All of the services are looking for ways to reduce the need to burn fossil fuels. And this is not because they are so green conscious. I should caveat this to say, don’t think that the military services in the United States are simply green conscious. They have been driven by practical realties, which is to operate in combat environments which are often far away it is very costly to get the fuel to the combat environments. And often times a lot of the casualties occurring by the supply chains, the supply lines that are delivering the material to the combat environment and the larger the delivery load is actually fuel then it is munitions or food or anything else, that is also part of the logistic lines. The largest single element in the logistic line is fuel itself. It’s like 150 years ago when mobility was based on the horse and the horses pulled a lot around. Well, a lot of what they pulled around was the food for the horse.

Related Posts

Previous GovInsights:

– Harvard’s Dr. Ganz: GovInsights: We Need a Major Social Movement

– George Washington’s Dr. Langenbacher: GovInsights: What We Need Right Now — Spending Cuts, Higher Taxes and Closer Friends

Dr. James M. Keagle is the Director of the Transforming National Security seminar series at the Center for Technology and National Security Policy at the National Defense University. Prior to this position, Dr. Keagle served for nine years as the National Defense University’s Provost (effective 2004) and Vice President for Academic Affairs (effective 1999). Prior to these positions, he served as a professor of National Security Strategy at NDU. In that role Dr. Keagle worked as a research faculty member assisting with NDU’s modeling and simulation and work with interagency education and training. Accepting an appointment to the U.S. Air Force Academy, he graduated 2nd academically in his class in June 1974. Following graduation, he went to the University of Pittsburgh to complete his Master’s of Arts degree in political science and earned a graduate certificate in Latin American studies (1975). After a tour as a munitions maintenance officer, Dr. Keagle went on to become an assistant professor of political science at the U.S. Air Force Academy. In 1980, he went on to Princeton University where he completed both a Master’s of Arts degree(1981) and Ph.D. (1982) in politics. He proudly notes his honorary Ph.D from the Military Technical Academy of Romania–the only United States citizen so honored. Following his extensive education, Dr. Keagle’s next six tours were political-military assignment that included direct access and interaction with Cabinet-level government officials on national security related matters. These assignments included work for two Combatant Commanders as a senior strategist; for the Office of Secretary of Defense pertaining to Cuba; Deputy Director, Office of the Secretary of Defense Bosnian Task Force; and for the Deputy Under Secretary of the Air Force in International Affairs as Senior Strategist. Military. For the last two years he has led multiple NATO and Defense Education Enhancement Teams to Georgia, Azerbaijan, and Montenegro. Medals include the Defense Superior Service Award, the Legion of Merit, and the Purple Heart. Since leaving military service, Dr. Keagle has held the position of adjunct professor at a number of institutions to include: Syracuse University, American University, Central Michigan University, Catholic University, University of Colorado, and Lake Superior State College. He also holds an honorary professorships with Transilvania University in Brasov, Romania, as well as the Mongolian Defense University–again, the only American so honored. Dr. Keagle and wife Kay are the proud parents of three adult children.

Disclaimer: The views and opinions here represent Dr. James M. Keagle’s own and not the ones of his employer or affiliated associations and institutions.

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Love the take on “information revolution” and the need to provide a world-class culture that appeals to the top individuals in the field

Andrew Krzmarzick

1 – Information revolution. I think most folks would agree here, so no issues.

2 – Energy. Again, both sides of the aisle seem to acknowledge that we have to reduce reliance on old energy sources.

3 – Health Care. Now here’s where it gets controversial. I totally disagree with cuts to health care for the sake of expanding the military. While I understand the need to have a strong military capable of protecting us, I would advocate MORE for seeking cuts in military spending by using innovative technology that (a) creates significant cost savings and (b) creates the possibility of reducing force size. I know this means significant investments in R&D, but I think the aim should be lowering the defense budget so that we can do more to strengthen our civilian workforce – that’s where the real wars are going to be fought: economics and industry! So we need smarter, healthier people!

Also, the notion of “a duty to die” really, really bothers me. Once we make the decision that human life is nothing more than a commodity that has little value once it’s ceased being productive or has becomes a burden beyond remedy, our entire civilization will have lost its soul and we might as well be nothing more than a planet of machines!

Henry Brown

1. Information Revolution: Would offer it probably will not be implemented at least for a generation and probably longer, especially in the DOD/US Military.

2. Energy: Agree that both sides agree that reliance on foreign energy sources, However IMO there is going to be BATTLE ROYALE on the NEED to reduce reliance on old energy sources (Global warming issues)

3. Health Care:
I believe that there could be SIGNIFICANT cuts in health care costs WITHOUT the creation of “death panels”. These savings should/could be discussed on where they should be applied.

As far as death panels, PROBABLY a big waste of time. What does work is an outstanding relationship between patient and doctor. A SIGNIFICANT number of people have already implemented a “living will”. My Mother, who died of cancer, in concert with her doctor and my father drew the line in the sand as to what treatment would be tried to save her life. This line moved forward and backwards depending on the discussion(s) with all involved.

Peter Sperry

1. Information revolution — Agree on the technology but there will need to be some give from BOTH sides on the culture issues. Yes there are many advantages to a looser, more free wheeling work environment but when peoples lives are on the line, discipline is not a bad thing.

2. Energy — Enormous potential for improvements once we break through the resistence to nukes. Meanwhile, many of us have little patience with the criticism of traditional energy sources from organizations that have opposed such progress for 40 years.

3. Health Care — The most difficult dillema and surrounded by a great deal of very bad research. Much of the “excessive costs in final 6 months of life” research comes out of a few Dartmouth studies which worked backwards from time of death to examine costs and were refuted by UCLA Medical Center which looked forward from time of diagnosis. Bottom line, death is expensive but UCLA produced clear results showing that agressive treatments administered quickly when serious conditions are first diagnosed reduces mortality significantly and extends life expectancy. Personal note on this. When my mother was diagnosed with Lymphoma 3 years ago, the hospice coordinators were all over her like white on rice to discuss “the next six months”. They almost had her convinced and we had to put on quite a sales job to convince her to fight the desease rather than give in. Two years later, I took her to Paris for her 80th birthday and at her last exam, the doctor gave her better than even odds of living another 15 years. Others may feel a “duty to die”, I’ll excercise my right to life.

Al Fullbright

Information technology – Isn’t it time for free Broadband and busting up these Cable Company Darth Vaders.

Energy How about a Carbon Tax and put the money toward incentives for Clean Energy. Ethanol is expanding because the farmers are driving it, but it leaves a huge carbon footprint. We need Wind and Nuclear. New Nuclear Tech is a whole new ball game from the big old reactors of the past.

Health Care The expense of Health Care has more to do with the profiteers. Every Hospital today resembles a palace. So much for the good samaritan. We have a finite number of people to care for. We can and must care for them. The health bill was not about making people well; its about who can charge whatever they want (practically without limits) and who must pay.

Education Seems people don’t think of this but we are bringing doctors and scientists from other countries but our brightest kids cant seem to get an education unless they have some money and connections. This country should be ashamed of the way we’ve neglected our free education system; especially High Schools and University System .

The only thing that does seem to be alive and well in this country is the profiteers.
Maybe we need to penalize the profiteers and reward those who come up with cost saving techniques. We need to have some competition to drive theses enormous costs down.

When are we going to end these wars of “Dominance” over other cultures. What is going on has absolutely nothing to do with 911.

Janis Heim

I am more interested in the right to live being cut short by penny-pinching bureaucrats and greedy “health professionals”. Most of my family had no problem dying when they wanted to; it was getting help to live that was in short supply. Keeping semi-conscious people alive indefinitely depends on hope of recovery, and should not be exploited for anyone’s greed. Convincing fully conscious people they have a duty to die for the good of others can be very good in the military but criminal in civilian life, and I would prefer to keep it that way.

Lewis Gutman

I don’t have much to say about energy and health care. These are national issues and require national solutions, though there are productive point solutions being pursued within DoD. Regarding IT: I have worked at a DoD lab in IT for 26 years, have a masters degree in computer science, and know many IT professionals both inside and outside of the defense sector. Unfortunately, I don’t think that Dr. Keagle has a good view of the situation on the ground here. DoD is moving its gov’t engineers away from hands-on involvement in IT. Most of its engineers are moving into contracting and oversight roles and most of the new hires are being placed in these sort of positions immediately upon arrival. This is partly a natural effect of the commoditization of IT and the need for DoD to manage costs. But it is also an effect of the DoD commitment to outsource engineering and development. Outcomes include raiding DoD IT research & development budgets to pay for things such as program documentation requirements and movement of government computer and engineering professionals into disciplines such as acquisition, systems engineering, and logistics. There are of course exceptions, possibly at organizations like USCYBERCOM (which I don’t know a lot about) and NSA, but this represents a drop in the bucket across DoD. Coupled with the prospect of government employee salary and benefit reductions, it hardly seems likely that a large number of high-powered and motivated IT professionals will come to DoD in the near term. It’s not enough to offer flexible working hours and a relaxed dress code. Exciting work opportunities and competitive benefits are what attract talented engineers and scientists.