The "fire shower of nuclear retaliation", and North Korean strategy.

A recent statement in North Korea's main newspaper Rodong Sinmun is potentially interesting for what it reveals about their nuclear strategy.

The north Koreans were responding, in typically bellicose fashion, to the US announcement that it was extending its 'nuclear umbrella' to cover South Korea. Short exempts of the North Korean article can be found all over the web, but when scanning the news on the subject quickly, one relatively short article I found
from a fairly obscure source included enough of the North Korean statement to potentially reveal something interesting about their nuclear strategy. Virtually everyone mentioned the "fire shower of nuclear retaliation", but what most of the articles leave out the following words "all over South Korea."

This statement is a fairly strong indication that nuclear weapon targeting in North Korea definitely includes South Korea of course, but this may well indicate that their nuclear targeting may be focused MOSTLY on South Korea, rather than on South Korean allies like the US or Japan.

Fireball from Minor Scale test immediately after detonation. This was a conventional (non-nuclear) test using only high explosives, and it was above, rather than below ground, but the scale is similar to the latest (2009) North Korean test (yield estemated by the Bulletin of the Atomic Scientists). Note the F-4 Phantom aircraft in the foreground for scale.

We have to realize that North Korea targeting the South cannot be regarded as a completely foregone conclusion, because the North regards the South as part of their own nation, and fallout from any such strike would most certainly affect them.

Now the North Korean military and government are composed of very hard men, and it is unsurprising that they would be willing to accept the damage, but they are also a nation with a strong propaganda focus as well, and the possibility of being nuked by the North certainly has the possibility of alienating otherwise sympathetic South Koreans.

The sword of propaganda is double-edged in this case, because the possibility of nuclear war also might encourage South Koreans to make additional concessions to the North, but even so, it is doubtful that the North would risk the negative consequences unless they meant what they said. The North Korean ideology is more patriotic and focused on uniting the nation than it is communist and committed to international socialism, and such a strategy would not fit well with an idle threat to nuke your "own" people and land.

North Koria's Ballistic missiles "RODONG"(=NODONG), "TAEPODONG-1" and "TAEPODONG-2"

The REASON that this strategy would be adopted is most likely, technical. Even though North Korea has nuclear weapons, it most likely lacks the ability to place them on ICBM's (missiles). Considering the level (technical or numerical) of North Korean air-power, they could not rely on bomber delivery to far off locations, as the US Strategic Air Command did in the 1950's. It is fairly likely however, that a bomb could be dropped on the South, right across the border.

While technical limitations are likely to have been the most decisive, it is also likely the strategy is based in no small part on the idea that a limited, rather than total, nuclear war scenario is the most desirable. Communist nuclear thinking around the globe never truly embraced mutually assured destruction, and it would not seem especially wise for North Korea to be an exception, at least so long as North Korea lacks nuclear parity (technically unlikely). In the event of a war breaking out on the Korean peninsula, were the North to be pushed to use a nuke locally, the chances that international intervention (especially by China or Russia) would force a truce, would logically be higher, than if San Diego, Maui, or Tokyo were to be vitrified.

Thus the most likely scenario is that North Korean weapons are first, last-ditch solutions to a lost war, and also coming a close second, a deterrent to nuclear attack, which would be most likely to occur if North Korea was WINNING a war with the South, and looked likely to take over the entire nation.

To some degree, this should be reassuring to Americans, Japanese, or other US allies, but it is also very clear that reducing hostilities with North Korea is desirable. Long-extended hostilities will tend to tilt North Korean nuclear strategy further and further towards retaliation; bringing the war TO hated enemies, rather than resorting to targeting that nearly attacks oneself.

If you never had it in the first place..........

Megan McArdle at the Atlantic has written an interesting post on the developing (or perhaps ossifying) dogma in the Democratic party that holds that good and universal health care will not only be good for the people that have it, but will also be cheaper. This "have your cake and eat it too" notion may be, as she points out, reasonably compared to the notorious "Voodoo economics" of the Laffer curve. There is one way that medical costs might well (unfortunately) end up being controlled however.

A very large percentage of these national health care systems around the globe (and most developed-world health care systems are substantially nationalized) negotiate low costs for medications because drug companies take cost-of-additional-production + profit as a basis for pricing drugs sold to national systems. Cost of research and development is commonly not included in the price or at least is not included fully, and national health systems are able to enforce this preferential pricing, which externalizes the cost of developing medicines, by not making available all of the medicines on the market.

The structural reluctance of a national health care system to add new drugs to the national formulary is countered by observation of the success of a given medicine ELSEWHERE. It is difficult to deny medication and treatments that are well demonstrated to be useful and effective in another nation, but such a system naturally tends towards stasis, and is quite dependent on external benchmarking of medical quality for PARTICULAR treatments. Low-cost but high-quality treatment in unitary health care systems is thus quite dependent on non-unitary health care elsewhere.

The United States has been, for many years the non-unitary market of choice, and indeed is the market of choice for drugs and medical devices altogether. Medical research and development efforts around the globe, including in unitary markets, will generally take for granted that any drug or medical device that is effective and improved is likely to repay its research costs if it is approved in the US. Comparisons between the US and a unitary health care system will naturally cause American health care to seem thoroughly overpriced, because a unitary system that takes the natural and obvious steps to control drug costs becomes a free rider on the research, development, and effectiveness evaluation of other nations. The US, due to lack of comprehensive coverage, is not a great standard bearer for quality medicine when all the people who lack coverage (or who lack good coverage) are included, but the role of the US medical system in determining which TREATMENTS work, is vital.

If something changes in the US to interfere with the new-medicine introduction cycle however, then everything changes everywhere. Where in the world, if not in the US, will new, and likely expensive medications or treatments be offered the chance to demonstrate their effectiveness?

The nightmare scenario would thus be that the US would adopt an 'off the rack' national health care model that would seek out preferential pricing, and which would not allow new drugs into the national formulary until they had a well established record on the market. This scenario would create a sort of 'lockout' with the formulary systems of the world excluding all or most new drug introductions, and preventing new medications from proving themselves.

In fact, a Canadian or British unitary and single-payer system is not required to squelch medical development however. Even if EVERY new drug were allowed, but allowed with a delay, then drugmakers would have less time when they would be able to recoup their costs (which includes costs for drug development that did not pan out) before the opportunity to do so was truncated by patent expiration. A limited trial period when drugs would see a limited introduction would likewise slice into the period when a drugmaker is protected by patent monopoly.

For most national health systems, a delay in introducing a drug to the national formulary causes injury to the extent that such patients as are denied the medication suffer its lack for a few years. This can be lethal to the affected individuals, but their numbers are limited. Due to the crucial role of the US in the global drug market however, the effects of a delay or other market alteration are likely to be more lasting, and could eliminate new treatments altogether.

The Obama administration has put a good deal of emphasis on the creation of an agency that would evaluate the "effectiveness" of particular drugs and treatments, and an agency of this sort could easily provide the justification for excluding new medications, whether it is a government program or private insurance that would actually pull the trigger. If new medical treatments are introduced less and less often, then the costs associated with new medical treatments will drop. It will be hard for people to miss treatments that did not ever exist in the first place.