Starting Points

Dec 22, 2009

Nurses Say Senate Bill Entrenches Chokehold of Insurance Giants

by John Nichols

Want to know what's wrong -- really wrong -- with the health-care "reform" bill being pushed through the Senate by Majority Leader Harry Reid?

Ask a nurse.

"It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the health-care crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry," says National Nurses Union co-president Karen Higgins, RN.

"Sadly," adds Higgins, "we have ended up with legislation that fails to meet the test of true health-care reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the choke-hold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations."

The 150,000-member NNU, the largest union and professional organization of registered nurses in the U.S., condemned Reid's bill -- which is expected to gain Senate approval this week -- as a deeply flawed measure that grants too much power to the nation's largest private and for-profit insurers.

Specifically, the union that takes in the powerful California Nurses Association, cited 10 fundamental flaws in the Senate bill:

1. The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.
2. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition.

3. An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.

4. The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they'd pass the higher costs to their employees.

5. Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include:

· Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.

· Insurers are permitted to sell policies "across state lines", exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.

· Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.

· Insurers may continue to rescind policies for "fraud or intentional misrepresentation" – the main pretext insurance companies now use to cancel coverage.

6. Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California's largest insurers have rejected more than one-fifth of all claims since 2002.

7. Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs.

8. New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn't want.

9. Reduced reproductive rights for women.

10. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right.

In fairness to Reid and his fellow Senate Democrats, most of the flaws in their bill are also present in the House bill. And that's the really depressing part.

While members of the Obama administration and key senators claim that the legislation should be enacted because it seeks to expand coverage, places new regulations on insurers and might be improved in the House-Senate conference committee, NNU co-president Deborah Burger, RN, offers a more realistic diagnosis:

"Those wishful statements ignore the reality that much of the expanded coverage is based on forced purchase of private insurance without effective controls on industry pricing practices or real competition and gaping loopholes in the insurance reforms."

For Obama, No Opportunity Too Big To Blow

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Contrary to countless reports, the debacle in Copenhagen was not everyone's fault. It did not happen because human beings are incapable of agreeing, or are inherently self-destructive. Nor was it all was China's fault, or the fault of the hapless UN.

There's plenty of blame to go around, but there was one country that possessed unique power to change the game. It didn't use it. If Barack Obama had come to Copenhagen with a transformative and inspiring commitment to getting the U.S. economy off fossil fuels, all the other major emitters would have stepped up. The EU, Japan, China and India had all indicated that they were willing to increase their levels of commitment, but only if the U.S. took the lead. Instead of leading, Obama arrived with embarrassingly low targets and the heavy emitters of the world took their cue from him.

(The "deal" that was ultimately rammed through was nothing more than a grubby pact between the world's biggest emitters: I'll pretend that you are doing something about climate change if you pretend that I am too. Deal? Deal.)

I understand all the arguments about not promising what he can't deliver, about the dysfunction of the U.S. Senate, about the art of the possible. But spare me the lecture about how little power poor Obama has. No President since FDR has been handed as many opportunities to transform the U.S. into something that doesn't threaten the stability of life on this planet. He has refused to use each and every one of them. Let's look at the big three.

Blown Opportunity Number 1: The Stimulus Package When Obama came to office he had a free hand and a blank check to design a spending package to stimulate the economy. He could have used that power to fashion what many were calling a "Green New Deal" -- to build the best public transit systems and smart grids in the world. Instead, he experimented disastrously with reaching across the aisle to Republicans, low-balling the size of the stimulus and blowing much of it on tax cuts. Sure, he spent some money on weatherization, but public transit was inexplicably short changed while highways that perpetuate car culture won big.

Blown Opportunity Number 2: The Auto Bailouts Speaking of the car culture, when Obama took office he also found himself in charge of two of the big three automakers, and all of the emissions for which they are responsible. A visionary leader committed to the fight against climate chaos would obviously have used that power to dramatically reengineer the failing industry so that its factories could build the infrastructure of the green economy the world desperately needs. Instead Obama saw his role as uninspiring down-sizer in chief, leaving the fundamentals of the industry unchanged.

Blown Opportunity Number 3: The Bank Bailouts Obama, it's worth remembering, also came to office with the big banks on their knees -- it took real effort not to nationalize them. Once again, if Obama had dared to use the power that was handed to him by history, he could have mandated the banks to provide the loans for factories to be retrofitted and new green infrastructure to be built. Instead he declared that the government shouldn't tell the failed banks how to run their businesses. Green businesses report that it's harder than ever to get a loan.

Imagine if these three huge economic engines -- the banks, the auto companies, the stimulus bill -- had been harnessed to a common green vision. If that had happened, demand for a complementary energy bill would have been part of a coherent transformative agenda.

Whether the bill had passed or not, by the time Copenhagen had rolled around, the U.S. would already have been well on its way to dramatically cutting emissions, poised to inspire, rather than disappoint, the rest of the world.

There are very few U.S. Presidents who have squandered as many once-in-a-generation opportunities as Barack Obama. More than anyone else, the Copenhagen failure belongs to him.

Research support for Naomi Klein's reporting from Copenhagen was provided by the Investigative Fund at The Nation Institute.

Al-Shabab Militants Divided over Tactics, Foreign Control

A rising dispute between militants in Somalia may have split the country's al-Qaida-linked al-Shabab group into two factions. Reports say the suicide bombing at a Mogadishu hotel earlier this month deepened divisions between an al-Shabab leader closely aligned with foreigners and another opposed to foreigners dictating the group's agenda.

Alisha Ryu | Nairobi 22 December 2009

Photo: AFP

Somali man is carried away from scene of suicide bomb attack during university student graduation ceremony at a local hotel in Mogadishu, 3 Dec 2009

Reports say a dispute has been simmering for months between the Mogadishu-based ultra-hardline al-Shabab leader Ahmed Abdi Godane, also known as Abu Zubayr, and Muktar Robow Abu Mansour, a leader based in the Bay region, southwest of Mogadishu.

Godane, who came to power after the death of al-Shabab founder Aden Hashi Ayro in a U.S. missile strike in May 2008, is firmly committed to the idea of using al-Qaida-trained foreign fighters to help al-Shabab violently overthrow Somalia's U.N.-backed transitional government and establish an Islamic caliphate in Somalia. Robow is reported to be in favor of engaging in talks with al-Shabab rivals and maintaining a popular backing for the militant group.

International Crisis Group, Horn of Africa analyst Rashid Abdi says al-Shabab has a decentralized leadership structure that has been vulnerable to dissent.

"It has serious trouble in the sense that those who are wedded to the idea of a permanent global jihad with Somalia as a staging post are now in the driver's seat," he said. "Foreign jihadis are the ones who are calling the shots. They are the ones who are behind the waves of suicide bombings, which have caused horrific civilian casualties. And increasingly, they are alienating those people who have a local agenda."

The exact number of foreigners in Somalia is not known. But in June, the president of Somalia's transitional federal government, Sharif Sheik Ahmed, said hundreds had arrived in the country to support al-Shabab. According to VOA sources in Somalia, many foreigners are based at al-Shabab training camps in the towns of Marka, Barawe, and Kismayo, teaching thousands of recruits bomb-making skills and guerrilla fighting tactics.

Officials in Somalia say one of these recruits, a Somali man who had grown up in Denmark, carried out the December 3 suicide bombing at a graduation ceremony for medical students attended by several government ministers. The blast killed four ministers, but also killed and wounded at least 60 bystanders.

Amid a public outcry, al-Shabab's Mogadishu-based spokesman Ali Mohamed Rage denied his group had carried out the bombing. The denial prompted some observers to speculate that foreign al-Shabab commanders may have planned the mission without consulting some of their key Somali counterparts or receiving their endorsement.

Rashid Abdi says the bombing has convinced many ordinary Somalis that al-Shabab is increasingly being controlled by foreign fighters, who have no regard for Somali lives.

Abdi says that public perception could now give Somalia's beleaguered president an opportunity to erase the humiliation his government suffered six months ago, when it was forced to beg for troops from neighboring countries to keep the government from being toppled.

"We have to be cautious. Anger against al-Shabab does not necessarily translate into support for Sharif. But Sharif has to get out there and try to regain the political territory lost to al-Shabab," he added.

On Monday, President Sharif attended the opening session of the Somali transitional parliament in Mogadishu, dressed in a military uniform. He said the time had come to re-take the country from al-Shabab and urged parliament members and Somali citizens to assist the government in efforts to defeat the militants.

New Asia Research Centre Working Papers

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The Asia Research Centre announces 5 working papers from the History of
Marine Animal Populations project. Since 2006, Malcolm Tull of the Asia
Research Centre has been the Project Leader of the Asia module of HMAP,
the historical component of the Census of Marine Life, which "aims to
improve our understanding of ecosystem dynamics, specifically with
regard to long-term changes in stock abundance, the ecological impact of
large-scale harvesting by man, and the role of marine resources in the
historical development of human society".

WP 161, Jo Marie V. Acebes, 'Historical whaling in the Philippines:
origins of 'indigenous subsistence whaling', mapping whaling grounds and
comparison with current known distribution'
(http://wwwarc.murdoch.edu.au/wp/wp161.pdf).

WP 160, Brooke Halkyard, 'Exploiting Green and Hawksbill Turtles in
Western Australia. A Case Study of the Commercial Marine Turtle Fishery,
1869 - 1973' (http://wwwarc.murdoch.edu.au/wp/wp160.pdf).

WP 159, Chen Ta-Yuan, 'The Evolution and Development of the Taiwanese
Offshore Tuna Fishery, 1912- 2005'
(http://wwwarc.murdoch.edu.au/wp/wp159.pdf).

WP 158, Malcolm Tull, 'The History of Shark Fishing in Indonesia'
(http://wwwarc.murdoch.edu.au/wp/wp158.pdf).

WP 157, Joseph Christensen, 'Recreational Fishing and Fisheries
Management' (http://wwwarc.murdoch.edu.au/wp/wp157.pdf).

The Centre also announces the publication of WP 162 by Dr Gerard
Strange, University of Lincoln, UK, titled 'World Order and EU
Regionalism: towards an open approach to New Constitutionalism'
(http://wwwarc.murdoch.edu.au/wp/wp162.pdf).

The working papers are all available from
http://wwwarc.murdoch.edu.au/workingpapers.html

Dr Shahar Hameiri
Editor of the Asia Research Centre Working Paper Series

Asia Research Centre
School of Social Science and Humanities

Murdoch University
Murdoch 6150
Western Australia
Ph: 61-8-9360 6228
Fax: 61-8-93104944
email: S.Hameiri@murdoch.edu.au

Dec 21, 2009

The Virtual Visit May Expand Access to Doctors

By CLAIRE CAIN MILLER

SAN FRANCISCO — Americans could soon be able to see a doctor without getting out of bed, in a modern-day version of the house call that takes place over the Web.

Image by leoncillo sabino via Flickr

OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic, a service that connects patients and doctors using video chat, nationwide next year. It is introducing it state by state, starting with Texas, but not without resistance from state medical associations.

OptumHealth believes NowClinic will improve health care by ameliorating some of the stresses on the system today, like wasted time dealing with appointments and insurance claims, a shortage of primary care physicians and limited access to care for many patients.

But some doctors worry that the quality of care that patients receive will suffer if physicians neglect one of the most basic elements of health care: a physical exam.

“This is a pale imitation of a doctor visit,” said David Himmelstein, a primary care doctor and associate professor at Harvard Medical School. “It’s basically saying, ‘We’re going to give up any pretense of examining the patient and most of the nonverbal clues that doctors use.’ ”

Others, including Rashid Bashshur, director of telemedicine at the University of Michigan Health System, say online medicine is a less expensive way of providing routine care.

Image by Ben Dodson via Flickr

“The argument that you need the ‘laying on of hands’ to practice medicine is an old and tired argument that simply has no credibility,” he said. “There are two constants in medicine: change and resistance to change.”

Christopher Crow, a family physician in Plano, Tex., who used the system during its test period, said, “NowClinic gives you the ability to have that gut feel if something is wrong, in tone or facial expression or body language, that you have when you walk in the door with a patient.”

Many patients who do not have primary care physicians nearby use the emergency room for routine problems. Wait times for patients needing immediate attention have increased 40 percent, in part because of overcrowding, according to a study by Harvard Medical School and Cambridge Health Alliance.

In Texas, 180 counties do not have enough physicians, 70 percent of patients cannot obtain a same-day visit with their primary care doctor, and 79 percent of emergency room visits are for routine problems, according to OptumHealth.

“We are, through this technology, replenishing the pool of physicians and making them available to patients,” said Roy Schoenberg, chief executive of American Well, which created the system that OptumHealth is using.

For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting NowClinic.com. Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available.

The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage.

American Well’s service is also available to patients in Hawaii and Minnesota, through Blue Cross Blue Shield, and to some members of the military seeking mental health care, through TriWest Healthcare Alliance.

Some hospitals and technology companies provide similar services on a smaller scale, including Cisco, the networking equipment maker, which uses its videoconferencing technology to remotely connect employees with doctors. It is working with UnitedHealth Group to offer the service more broadly.

The service has encountered resistance in states where it is already available. Texas law requires that before doctors consult with patients or prescribe medicine online or over the phone, they form a relationship through means like a physical examination.

The Texas Medical Board, which regulates doctors in the state, is evaluating its telemedicine policies in light of new technologies. But Mari Robinson, executive director of the board, said that an online or telephone exam was inadequate if doctors and patients had not met in person and was “not allowed under our rules.”

After American Well’s service began in Hawaii last year, lawmakers passed legislation that allowed doctors and patients to establish a relationship online, though the Hawaii Medical Association opposed the bill.

“From our perspective, we still are a little bit concerned that a relationship can be established online with no prior relationship,” said April Troutman Donahue, the association’s executive director.

American Well and OptumHealth predict that health care professionals will adapt. “This is new technology, so you have a lot of code written that doesn’t take these medical technologies into account,” said Rob Webb, chief executive of OptumHealth Care Solutions.

Many patients seem ready to embrace the new technology. In a recent study, a Harvard research team at Beth Israel Deaconess Medical Center found that patients were comfortable with computers playing a central role in their health care and expected that the Web would substitute for face-to-face doctor visits for routine health problems.

Lebanon Drama Adds Act With Leader’s Trip to Syria

By ROBERT F. WORTH

BEIRUT, Lebanon — In any other part of the world, a new prime minister’s visit to a neighboring country would be a fairly routine event. But Prime Minister Saad Hariri’s trip to Syria over the weekend has been treated here as a kind of Lebanese national drama, the subject of almost endless commentary in newspapers and television shows.

Image via Wikipedia

It is not that anything really happened. Mr. Hariri and President Bashar al-Assad of Syria exchanged some thoroughly forgettable diplomatic banter and posed for photographs.

Instead, the trip epitomized a national story with anguished, almost operatic dimensions: a young leader forced to shake hands with the man who he believes killed his father. And it served as a reminder of this region’s deep attachment to political symbolism.

For many Lebanese, the visit was a measure of Syria’s renewed influence over Lebanon after years of bitterness and struggle since the Syrian military’s withdrawal in 2005. That withdrawal came after Mr. Hariri’s father, former Prime Minister Rafik Hariri, was killed in a car bombing that many here believe to have been ordered by Syria.

The withdrawal was a blow to Syrian prestige, and afterward Saad Hariri seemed to have the entire Western world at his back as he built a movement for greater Lebanese independence and pushed for an international tribunal to try his father’s killers.

But since then, the United States and the West have chosen to engage with Syria, not isolate it. And Saudi Arabia, which has long backed Mr. Hariri and competed with Syria for influence here, reconciled with the Syrians earlier this year, leaving them a freer hand to guide politics in Lebanon as they once did.

Image by Getty Images via Daylife

All this has been known for months, but it was still tremendously important for Mr. Hariri to actually cross the mountains — in his first visit since before his father’s killing — and pay his respects in Damascus.

“The image of Syrian soldiers retreating was a huge blow to them,” said Elias Muhanna, a political analyst and the author of the Lebanese blog Qifa Nabki. “So the image of Hariri coming over the mountains means they’ve come full circle. It demonstrates to all the power centers in Damascus that Bashar has restored Syria’s position of strength vis-à-vis Lebanon.”

The visit also has vivid historical echoes for many Lebanese. In 1977, the Druze leader Walid Jumblatt visited Damascus just weeks after his own father was killed in an attack that is believed to have been arranged by Syria. Like Mr. Hariri, he had little choice: he had to reconcile with Syria if he wanted to continue playing a political role.

“The stability of Lebanon always depends on its environment, and basically this environment is Syria,” Mr. Jumblatt said in an interview on Sunday. “For the sake of Lebanese stability, we have got to put aside personal animosity.”

Image via Wikipedia

It is difficult to say exactly what Mr. Hariri’s visit portends in terms of Lebanese-Syrian relations. By one measure, he has already achieved his most important goals: the Syrian Army is gone, and no one expects it to return. The two countries restored diplomatic relations this year. The international tribunal that was formed in 2005 under United Nations auspices to try the elder Hariri’s killers continues its work here and in the Netherlands, where it is based. It could still indict high-ranking Syrians, although most analysts say that seems less likely than it did four years ago.

But most agree that Syria will once again have a powerful, undisputed voice here on issues ranging from cabinet positions to the militant Shiite movement Hezbollah, which Syria supports. The influence is not likely to be as crude as it was during the 1990s, when Syrian officers strutted through Beirut and were accused of raking profits from Lebanese industries. To some here, that is improvement enough. To others, Mr. Hariri’s trip across the mountains was a tragic concession.

“Whether Saad Hariri admits it or not, it was a severe setback to everything that happened starting in 2005,” said Michael Young, a Lebanese columnist who has long been critical of Syria’s role here. “I think he did it reluctantly, but he never had a choice.”

Egypt's Muslim Brotherhood: widening split between young and old

Egypt's Islamic opposition to autocratic President Hosni Mubarak, the Muslim Brotherhood, faces a split along generational lines as older conservatives' influence is rising.

By Ursula Lindsey Correspondent
posted December 21, 2009 at 1:41 pm EST

Cairo —

Egypt’s main opposition group, the Muslim Brotherhood, is facing a change in leadership that could sideline reformists. That could deprive Islamists of an avenue for participating in Egyptian politics, and some could become radicalized.

Mahdi Mohammed Akef, the general guide of the Egyptian Muslim Brotherhood for the past six years, will step down in January amid a widening split in the organization.

Mr. Akef, who has held together a group that includes moderates and conservatives, young and old, urban and rural, says that the organization’s internal disagreements are one of its strengths. But his blowup with the group’s 15-man Guidance Council when he tried to appoint a younger, reformist member to the elderly and predominantly conservative council has ignited an unprecedented public debate in Egypt.

The goal of the group, which has never been allowed to form a political party, is to make Islam “the sole reference point for ordering the life of the Muslim family, individual, community ... and state.”

But within the Brotherhood there are sharp differences over how to oppose President Hosni Mubarak’s autocratic regime, what rights should be accorded to women, and how strictly Islam should be interpreted.

Old guards and new Brothers

Many of these differences play out along a generational fault line between younger reformists, who seek a more active political role for the banned organization, and older conservatives whose influence is rising.

“Akef is the last of the historical leaders of the group ... the leaders who ... joined the group early on, who have met the founder Hassan Al Banna, who have some sort of historical legitimacy,” says Ibrahim Al Hodaiby, grandson of a former general guide and a writer on Islamist movements.

The Brotherhood’s older members came of age in the 1950s, when the group was at war with the government. It was eventually banned, its members arrested and tortured by the thousands.

This senior group is “directed towards building the organization more than opening up to society,” says Hossam Tammam, editor of the website Islam Online. Their focus is on training new members, proselytizing, and social work.

Image via Wikipedia

The Brothers who came of age in the 1970s after the group formally renounced violence, meanwhile, are something different. These men were active on university campuses and in parliament. Today they are willing to form alliances with other movements and parties and are “more likely to produce reformist ideas,” says Mr. Tammam. But while the reformists are younger, the conservative bloc is in ascendancy.

Akef’s successor, to be chosen in January, is expected to be an old-guard conservative.

That worries Brothers like Abdel-Moneim Mahmoud, a young journalist and blogger. He froze his membership after some of his criticisms were not well received.

“The stage we’re in requires the moderate, the reformist side of the group,” he says. “We need a strong political movement ... to stand against this oppressive regime. This is our duty right now. It’s more important than anything else.”

Image by madmonk via Flickr

Mr. Mahmoud’s ideas were shaped in 2005, when Egypt, under pressure from the United States, experienced a moment of political opening. The Brotherhood, alongside other groups, participated in street protests calling for political reform and an end to the Mubarak regime. Mahmoud was encouraged to form alliances with outside activists and to give his opinion freely.

But subsequent government repression led the Brotherhood to “tak[e] a step backwards,” says Mahmoud, who explains that “whenever there is freedom, reformist ideas [within the group] will predominate; when there’s tyranny, conservative ones will.”

Tammam says government repression is the glue holding the Brotherhood together. If the Egyptian political system opened up, “the internal differences would become apparent in a way that might lead to the existence of more than one Brotherhood.”

But if reformists within the group are being routed, they’re still putting up a fight. The next general guide will almost certainly put an end to this cacophony and perhaps drive members like Mahmoud out for good. But the internal rift is unlikely to disappear.

Passing health reform could be a nightmare for Obama

Image by freestylee via Flickr

By Robert Samuelson
Monday, December 21, 2009; A19

Barack Obama's quest for historic health-care legislation has turned into a parody of leadership. We usually associate presidential leadership with the pursuit of goals that, though initially unpopular, serve America's long-term interests. Obama has reversed this. He's championing increasingly unpopular legislation that threatens the country's long-term interests. "This isn't about me," he likes to say, "I have great health insurance." But of course, it is about him: about the legacy he covets as the president who achieved "universal" health insurance. He'll be disappointed.

Even if Congress passes legislation -- a good bet -- the finished product will fall far short of Obama's extravagant promises. It will not cover everyone. It will not control costs. It will worsen the budget outlook. It will lead to higher taxes. It will disrupt how, or whether, companies provide insurance for their workers. As the real-life (as opposed to rhetorical) consequences unfold, they will rebut Obama's claim that he has "solved" the health-care problem. His reputation will suffer.

It already has. Despite Obama's eloquence and command of the airwaves, public suspicions are rising. In April, 57 percent of Americans approved of his "handling of health care" and 29 percent disapproved, reports the Post-ABC News poll; in the latest survey, 44 percent approved and 53 percent disapproved. About half worried that their care would deteriorate and that health costs would rise.

These fears are well-grounded. The various health-care proposals represent atrocious legislation. To be sure, they would provide insurance to 30 million or more Americans by 2019. People would enjoy more security. But even these gains must be qualified. Some of the newly insured will get healthier, but how many and by how much is unclear. The uninsured now receive 50 to 70 percent as much care as the insured. The administration argues that today's system has massive waste. If so, greater participation in the waste by the newly insured may not make them much better off.

The remaining uninsured may also exceed estimates. Under the Senate bill, they would total 24 million in 2019, reckons Richard Foster, chief actuary of the Centers for Medicare & Medicaid Services. But a wild card is immigration. From 1999 to 2008, about 60 percent of the increase in the uninsured occurred among Hispanics. That was related to immigrants and their children (many American-born). Most illegal immigrants aren't covered by Obama's proposal. If we don't curb immigration of the poor and unskilled -- people who can't afford insurance -- Obama's program will be less effective and more expensive than estimated. Hardly anyone mentions immigrants' impact, because it seems insensitive.

Meanwhile, the health-care proposals would impose substantial costs. Remember: The country already faces huge increases in federal spending and taxes or deficits because an aging population will receive more Social Security and Medicare. Projections the Congressional Budget Office made in 2007 suggested that federal spending might rise almost 50 percent by 2030 as a share of the economy (gross domestic product). Since that estimate, the recession and massive deficits have further bloated the national debt.

Obama's plan might add almost an additional $1 trillion in spending over a decade -- and more later. Even if this is fully covered, as Obama contends, by higher taxes and cuts in Medicare reimbursements, this revenue could have been used to cut the existing deficits. But the odds are that the new spending isn't fully covered, because Congress might reverse some Medicare reductions before they take effect. Projected savings seem "unrealistic," says Foster. Similarly, the legislation creates a voluntary long-term care insurance program that's supposedly paid by private premiums. Foster suspects it's "unsustainable," suggesting a need for big federal subsidies.

Obama's overhaul would also change how private firms insure workers. Perhaps 18 million workers could lose coverage and 16 million gain it, as companies adapt to new regulations and subsidies, estimates the Lewin Group, a consulting firm. Private insurers argue that premiums in the individual and small-group markets, where many workers would end up, might rise an extra 25 to 50 percent over a decade. The administration and the CBO disagree. The dispute underlines the bills' immense uncertainties. As for cost control, even generous estimates have health spending growing faster than the economy. Changing that is the first imperative of sensible policy.

So Obama's plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation's passage. What it's become is an exercise in political symbolism: Obama's self-indulgent crusade to seize the liberal holy grail of "universal coverage." What it's not is leadership.

Iraqi election workers targets for insurgents

Image via Wikipedia

By Michael Hastings
Monday, December 21, 2009; A10

BAGHDAD -- Insurgents have begun targeting Iraqi election workers in an apparent attempt to derail the March parliamentary vote, Iraqi officials said, prompting electoral authorities to restrict the movement of their employees and shelter some at a hotel in the Green Zone.

An election worker was killed in front of his Baghdad home last week, and a worker and the wife and son of another were kidnapped in the past 10 days, according to Faraj al-Haidari, head of the Independent High Electoral Commission.

"It is not a coincidence to have three attacks against our employees," Haidari said. "Our situation is a tragedy. You can see the worry and mental anxiety on the faces of my employees."

Iraqi officials described the attacks as the latest attempt by the Sunni insurgent group al-Qaeda in Iraq to destabilize the government ahead of the elections, scheduled for March 7. U.S. officials hope the elections, which were delayed by nearly two months as a result of political wrangling, will lead to a smooth transition of power and that they will be able to sharply accelerate the withdrawal of troops.

The targeted violence has forced the electoral commission to increase security measures for staff members, of which there are about 500 in Baghdad alone, including limiting their movement during the day and advising their families to relocate until after the elections.

Image via Wikipedia

The commission has requested that the Iraqi government allow it to house workers at Saddam Hussein's old Republican Palace, formerly home to the U.S. Embassy but now vacant. Rooms for higher-ranking officials have been secured at the Rasheed Hotel, a well-protected building in the fortified Green Zone where many Iraqi parliament members and foreign visitors stay.

Haidari said he has discussed the security issue with Prime Minister Nouri al-Maliki and President Jalal Talabani. "We have asked for more security guards," he said. "We are trying to give our employees better protection. We insist to continue our work."

The run-up to the election has been punctuated by bombings that have shaken the confidence of the Iraqi government and have killed more than 400.

Though it is unclear exactly who is responsible for the killing and kidnappings, Iraqi officials say they think al-Qaeda in Iraq and insurgent groups affiliated with the former Baath Party are behind the violence.

The Islamic State of Iraq, an extremist umbrella group, has asserted responsibility for the deadly bombings of government buildings in August, October and, most recently, Dec. 8.

The violence against election workers fits into the insurgents' larger strategy to undermine and destabilize the Iraqi government.

"The electoral process is an important target to the insurgents, because if they break it they will break all the political process in Iraq," Haidari said. "I think all the enemies of democracy in Iraq are behind the bombings, including al-Qaeda."

The details of the election worker's killing indicate a well-coordinated assassination.

Ali Mahmoud, 30, who had worked with the commission for five years, returned home from a friend's wedding last Thursday evening around 7:30 pm. He parked his car in front of his house in Jadriya, considered one of the safest neighborhoods in Baghdad.

An unknown assailant or assailants approached the car and fired two bullets from a gun with a silencer, according to friends of Mahmoud and other election officials. One bullet struck above his nose, another on the left side of his forehead.

The killing, along with the kidnapping of an election worker in Kirkuk 10 days ago and the kidnapping of another election worker's wife and son last week in Baghdad, has had a chilling effect on the commission's work, according to interviews with several people on the commission.

"We are all under threat of assassination," an election official said, requesting anonymity for fear of retribution. "We have a job to do and it will get worse as the election gets closer." Added another worker: "We are worried more than you can imagine."

Hastings is a freelance journalist based in Baghdad. Special correspondent Qais Mizher contributed to this report.

Minority farmers seek redress, claim USDA discrimination

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By Kari Lydersen
Washington Post Staff Writer
Monday, December 21, 2009; A03

In November, the Agriculture Department began negotiations with Native American farmers in a class-action suit alleging systematic discrimination in the agency's farm loan program. About 15,000 black farmers have received almost $1 billion since the settlement of a similar class-action suit, known as the Pigford case.

Hispanic farmers who have filed similar lawsuits hope this means the government may settle with them, too, even though a federal judge has denied them class certification. Female farmers also filed suit but have been denied class certification.

All four groups allege that they were denied farm loans and given loans with impossible conditions because of their race or gender.

Alberto Acosta, a New Mexico chili farmer, sought help a decade ago from the loan program meant as a last resort for farmers who cannot secure private financing. In 1998 and 1999, he was granted $92,000 in loans by the department.

But because Acosta speaks Spanish, a USDA loan officer was required to sign off on every significant expense. That meant he had to drive 260 miles each way to the office whenever he wanted to buy a piece of farm equipment, and he had to pay for and provide his own translator for each visit.

These conditions ultimately proved so taxing that Acosta's home and farm went into foreclosure, he said in a sworn declaration.

"I feel that this discrimination would not have occurred if I were Anglo," Acosta stated.

Since U.S. District Judge James Robertson in the District denied class certification to the Hispanic and female farmers, their cases must proceed through the court system individually. But the federal government could still decide to treat the cases as classes in a settlement.

"Justice dictates that if in fact the government discriminated against a class of people and we recognize that discrimination existed, you don't use legal barriers -- , i.e., opposing class-action status -- to shield the government," said Sen. Robert Menendez (D-N.J.).

Agriculture Department spokesman Caleb Weaver said that "USDA is committed to ending all forms of discrimination and addressing past allegations in a timely and fair manner." He said the department is reviewing civil rights complaints, has launched an external evaluation of services provided and "for the first time since 1997, we will have investigators on staff to do the field work needed to investigate complaints."

Currently, 110 Hispanic farmers in Texas, New Mexico, Arizona, California, Colorado and Washington are suing the department. But lead attorney Stephen Hill said if the case were certified as a class, there would be tens of thousands of Hispanic plaintiffs. He could not estimate the potential damages they might seek.

"The discrimination followed a pretty distinct pattern," he said. "Denying applications, repeatedly discouraging them from submitting applications, refusing to assist the farmer, and if the farmer persisted and filed an application, it would be dragged out for months so they couldn't get the seed in the ground. And often, for the most flimsy excuses like language problems, they put Hispanic farmers in supervised accounts."

Joe Sellers, lead attorney in the Keepseagle case, which was brought by Native Americans, said court proceedings have been put on hold for at least 60 days while they begin settlement negotiations.

"I credit this administration with genuine interest in fixing these problems that have afflicted the USDA for decades," said Sellers. "I don't expect it will be resolved over the next year; but I do believe they are sincere and determined to set in motion the steps to evaluate the shortcomings of the existing system and make appropriate changes."

Support in Senate

On the Senate floor Nov. 18, Menendez and Sen. Michael Bennet (D-Colo.) called for settlement of the Hispanic farmers' cases.

"It is no secret decades of indifference and discrimination in lending practices at the United States Department of Agriculture have made it difficult for minority farmers, specifically Hispanic farmers, to make a living at what they love to do and have done in many cases for generations, leaving many no choice but to leave the farms and ranches they have tended to all of their lives," Menendez said.

Larry and Robert Chavarria were third-generation farmers in California's San Joaquin Valley, who said their family had never sought a loan until 1994 winter storms decimated their crops. They sought USDA loans but were repeatedly denied. They said a local USDA loan officer also froze their subsidy payments at the behest of a neighboring white farmer with whom they had a dispute. They were forced to sell their land and stop farming in 2000. One brother now works in a prison canteen and the other is a self-employed tax preparer.

"It was our livelihood -- we loved it," said Larry Chavarria. "Now I feel empty, I feel like an echo. You ache, you hurt. This shouldn't have happened. We weren't asking for a handout. But they just raked us over the coals."

Problems said to persist

Farmers and their attorneys say diversity and inclusiveness in the farm loan program have improved in recent years, but they allege discrimination still exists.

David Cantu, who raises cattle and grows watermelon, cotton, corn and other crops on 1,100 acres in south Texas, thinks the Hidalgo County farm loan office turned him down for loans in 2005 because he and his father had spoken out about discrimination at a Hispanic farmers conference and an Agriculture Department listening session that year.

Cantu said he received USDA loans and repaid them on schedule every year since 1997, but was denied with no explanation in 2005. He also says loan office staff members would treat Hispanics as "second-class citizens," serving white clients first and inviting whites into their private offices while speaking with Hispanics only in the lobby.

"Hispanic farmers are a piñata to them," said Cantu, 50, a fourth-generation farmer. "They keep beating us and beating us, and then when they hit us down, they still expect us to keep producing and fill their plates."

Radical Islam meets a buffer in West Africa

By Karin Brulliard
Washington Post Foreign Service
Monday, December 21, 2009; A01

TIMBUKTU, MALI -- The Saharan sands stretching north from this fabled outpost have long been a trade route and cultural crossroads, and this past year has brought worrying signs that the desert might also help bring a violent brand of Islam to moderate parts of West Africa.

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An increase in attacks has included the killing of an American teacher and a suicide bombing in Mauritania, the kidnapping of two Canadian diplomats in Niger, and the executions of a British tourist and a Malian colonel in Mali. All were attributed to an al-Qaeda branch made up mostly of Algerians that has ranged southward to hit in urban Mauritania and establish a rear base in the Malian desert.

Mali remains proudly moderate, and most people here dismiss extremist ideology as too foreign and brutal to be accepted. But Mali in some sense has become a test case as its government has accepted tens of millions of dollars in American aid intended to stave off what U.S. officials say could be a growing threat of radicalism in parts of Africa where Muslims make up the majority.

"It does not find a lot of purchase among local people," a State Department official said of the extremist group, known as al-Qaeda in the Islamic Maghreb, or AQIM. But, the official said, "the problem has gotten a lot worse in the past three, last one year. . . . It's one that requires attention."

So far, the desert belt spanning black and Arab Africa has proved less a gateway for the southward spread of militant Islam than a bulwark against it, and some analysts call the threat overblown. In this secular nation, alcohol is served and gambling is common. Images of President Obama are ubiquitous, and anti-American sentiment is rare. Few women wear veils.

"We don't want an Islamic republic," said Mahmoud Dicko, head of the High Islamic Council, an umbrella group of religious organizations in Bamako, the capital. "We don't want sharia, or to cut people's hands off."

A socially conservative but tolerant Sufi strain of Islam dominates, but the ranks of foreign imams are rising, and the government has little handle on what is being preached in mosques, Western diplomats said. A weak army has done little to challenge the extremists, who easily cross invisible desert borders, while frequent U.S. military-led training sessions meant to build up the Malian forces -- part of a five-year, $500 million counterterrorism program in 10 countries of the region -- have been "not very effective," one diplomat in Bamako said.

The region's al-Qaeda-linked group, which grew out of an Algerian nationalist movement, spread into the area under Algerian military pressure and rebranded itself as an al-Qaeda wing in 2007. Security analysts and Western officials say that AQIM's ties to al-Qaeda are mostly rhetorical and that it has little ability to strike outside the region or undermine governments here, though a recent coup in neighboring Mauritania and a sham election in Niger have deepened regional instability.

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Much of the desert insurgency's funding has come from kidnapping Westerners for ransom -- prompting some analysts to deem it more of a profit-seeking gang than an ideological battalion of the jihadist command still based in Algeria.

But by some measures, the group is growing bolder and more ideological. AQIM executed the British tourist in May, for example, after its demand for the release of a Jordanian cleric imprisoned in Britain went unmet.

And after long staying clear of Malian cities -- in what Western officials said was a tacit non-aggression agreement with the government -- AQIM assassinated a military officer in Timbuktu and then killed more than two dozen Malian soldiers and paramilitary forces sent to avenge his death. Last month, the group kidnapped a Frenchman in the northern town of Menaka.

Image by Erwin Bolwidt (El Rabbit) via Flickr

U.S. officials said AQIM is increasingly enlisting fighters in more repressive, Arab-majority Mauritania. There is little evidence that the rebels are actively recruiting in Mali or most neighboring countries, officials said.

Ancient society changes

Timbuktu, a small city where nomadic herders mix with traders and blue-turbaned Tuaregs, prides itself on its history as an ancient hub of Islamic scholarship, and the mention of religious warfare draws baffled looks here. But some leaders worry that poverty and modernization are mixing in unpredictable ways and that extremists' money could hold sway even if their ideology does not.

GPS and satellite phones have made it easier for outsiders to navigate the terrain. The cigarettes long smuggled through the dunes are being displaced by cocaine. Drought has made herding harder. And AQIM rebels are marrying into nomad families, said Col. Mamadou Mangara, governor of the vast area from Timbuktu to the northern border with Algeria.

On Friday, U.S. prosecutors filed charges against three Malians, all men in their 30s who were accused of plotting to ferry cocaine through Islamist-controlled sections of the desert in connection with AQIM associates.

"Working with animals -- young people don't want to do this," said Assarid Ag Imbarcaoune, a vice president of Mali's National Assembly who is from the northern desert. "Young people want villas, AC and big cars."

Resistance to radicals

The shifting social currents inevitably affect faith in the region, scholars say.

"All you have to do is walk . . . anywhere in Mali to see that there is in fact a great diversity of Islam," said Mike McGovern, a Yale University assistant professor and former director of the International Crisis Group's West Africa office. "It's something that's constantly in evolution. To say West African Islam is this -- no, it's not."

That is clear in sun-scorched Bamako. The city's bustle and mostly black African population make it seem a galaxy away from the northern desert. But its urban density, experts say, might make its youths more vulnerable to radicalism, as has been the pattern in Mauritania.

Men filing in to pray at the Grand Mosque pass vendors selling animal skulls and claws believed to have medicinal or magical powers, though Muslim leaders shun them as un-Islamic. Many of the Chinese motorbikes clogging the streets are driven by women wearing everything from tank tops to vibrant but more traditional dress.

"I've got respect for my religion, but I act according to my thoughts," Fily N'Faly Bagayoko, 17, one motorbike rider, said about her decision not to wear a veil.

But this summer, Islamic leaders rallied 50,000 people to demonstrate against a proposed family code that would have, among other things, scrapped a law requiring a woman to obey her husband -- a show of force that underscored the conservatism of Malian Islam and that rattled democracy activists.

Across town at one madrassa, or Islamic school, female teenagers and teachers wore burqas -- a rare sight in Bamako. The school's imam, Mohammed Toure, complained that Western pressure was leading Mali's government to try to suppress Islam. But he said he had no desire for Mali to emulate Saudi Arabia, a nation where he studied and whose government funded his school.

"People have breathing space here," Toure, 39, said in his sunny office. "In Saudi, people are really in prison."

On a recent afternoon in Bamako, Mahmadou Haidara, a pudgy imam in billowy robes, shook his head at the thought of Islamist radicalism taking hold. But as he sat on his breezy roof preparing for a sermon, he pointed into the distance and said he was sure some foreign preachers were teaching "wrong" ideas.

"Real religion would never tell anyone to burn anything or kill others," he said of Islamist extremists. "We condemn them. And we fear them."