U.S. Targets Radical Cleric Anwar al-Awlaki

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by Bobby Ghosh

Pity poor Yemen. Three armed conflicts are being fought in the nation that hugs the southwestern corner of the Arabian Peninsula: there is a separatist insurgency in the south and a fight between the mostly Sunni government forces and Shi'ite rebels in the north, while in the east, home of Osama bin Laden's ancestors, the local affiliate of his network is plotting to undermine the government of President Ali Abdullah Saleh.

So the average resident of Sana'a, Yemen's ancient capital, can be forgiven for regarding Anwar al-Awlaki as just another warmongering imam with a grudge against the West and a deep hatred for the U.S. In fact, until last fall, most Yemenis had never heard of the American-born cleric living in their midst. Those most familiar with him were a small group of Western counterterrorism officials and experts — and even they thought al-Awlaki was of relatively little consequence. (See Muslims encouraging debate, not hate.)

Not anymore they don't. In the past two months, al-Awlaki's anonymity has been replaced by the glare of U.S. government and media attention — and very likely the searching eyes of spy satellites. His connection to both the Nov. 5 massacre at Fort Hood, Texas, and the attempted Christmas Day bombing of a passenger jet over Detroit has persuaded the Obama Administration that al-Awlaki is a big-time bad guy. On Jan. 4, President Obama's top counterterrorism adviser, John Brennan, told CNN, "Al-Awlaki is a problem ... He's not just a cleric. He is in fact trying to instigate terrorism." (See pictures of Umar Farouk Abdulmutallab.)

The Administration is trying to be careful in its assessment of al-Awlaki. Officials recognize that in demonizing a jihadist, they may create a monster they cannot control as the U.S. seemingly did in 2003 when it identified Abu Mousab al-Zarqawi as the top al-Qaeda leader in Iraq at a time when he was little more than a relatively obscure Jordanian terrorist operating north of Baghdad. The notoriety was a bonanza for al-Zarqawi, as mujahedin streamed to join his group. As for al-Awlaki, "the best way to describe him is inspirational rather than operational," says a senior U.S. official. But, as this official points out, "the inspirational element is motivating people to take action. Where do you draw the line?"

Wherever the line between inspiration and operation is drawn, al-Awlaki seems to have come very close to crossing it. White House officials say e-mail exchanges with al-Awlaki may have spurred Major Nidal Malik Hasan to go on a rampage in Fort Hood, killing 13 people. And Umar Farouk Abdulmutallab, the failed Christmas Day bomber, reportedly told the FBI he had met with al-Awlaki in Yemen. Moreover, research into al-Awlaki's past has now revealed that he had been investigated by the FBI for his connections to al-Qaeda as long ago as 1999. He had met three of the 9/11 hijackers, and his sermons and speeches had turned up in the computers of the 2005 London bombers, terrorist plotters in Toronto in 2006 and the six men who planned an attack on Fort Dix, N.J., in 2007. (See the top 10 crime stories of 2009.)

Put all that together, and it explains why, even before the Christmas Day incident, al-Awlaki was of such interest to the U.S. government that it tried to kill him. On Dec. 24, the Yemeni military, pressed by the CIA, fired rockets into his home south of Sana'a. Al-Awlaki was not the principal target — the top leadership of al-Qaeda in the Arabian Peninsula (AQAP) was thought to be meeting there — but U.S. officials were hoping the strike would also take out the cleric. He wasn't home.

Made in the U.S.A.
So who is this man whom U.S. counterterrorism officials would like to see dead? Just like bin Laden, al-Awlaki comes from an influential family: one of his relatives is Prime Minister of Yemen, and his father Nasser al-Awlaki was Agriculture Minister and head of the country's biggest university. Like bin Laden, al-Awlaki is soft-spoken, mild-mannered and austere.

The parallels end there. Although bin Laden saw plenty of Western culture in his youth, he seems to have been profoundly uncomfortable with it. Not so al-Awlaki. Now 38, he has lived in the West for more than half his life, speaks fluent English and peppers his sermons with references to Western places and people. A recent lecture on death, for instance, was informed by an old Michael Jackson interview in which the singer said he wanted to "live forever." Hard to imagine bin Laden referring to the King of Pop in a sermon.

Al-Awlaki was born in 1971 in Las Cruces, N.M., where his father was studying for a master's degree at New Mexico State University. The family spent nearly a decade on American campuses. Anwar was 7 when they returned to Yemen, where they lived in a newish Sana'a neighborhood.

See Muslims encouraging debate, not hate.

See a bin Laden family photo album.

See pictures of a jihadist's journey.

A Yemeni government scholarship allowed Anwar to return to the U.S.; in 1991 he enrolled in Colorado State University's civil-engineering program. Friends remember al-Awlaki as a low-key young man who lived modestly in a one-bedroom apartment and drove around Fort Collins in a beat-up old Buick. He prayed at the Islamic Center of Fort Collins but did not stand out as being especially religious and was not active in CSU's Muslim students association.

When he visited Afghanistan in 1993, a journey that fired thousands of young Muslim men with jihadist zeal, the Soviet occupation had ended, and al-Awlaki was depressed by poverty and hunger in the homes where he stayed. "My impression was that he didn't like it there," says Abdul Belgasem, a fellow student at CSU. "He wouldn't have gone with al-Qaeda. He didn't like the way they lived." But at some point, al-Awlaki must have had something of a spiritual awakening. After graduating in 1994, he set aside civil engineering and applied to be imam of the Denver Islamic Society. He got the job because of his grasp of the Koran and his ability to preach in English. "The people there liked his translations," Belgasem says. Two years later, he moved to San Diego to run the larger al-Ribat al-Islami mosque and enrolled in a master's program in education at San Diego State University. It was in San Diego that he had his first brushes with the law: intelligence officials have told TIME that al-Awlaki was twice detained for soliciting prostitutes. (See the top 10 scandals of 2009.)

San Diego, intelligence officials say, was also where al-Awlaki first made contact with jihadists. He was on the board of a charity run by a Yemeni associate of bin Laden; the FBI has said the charity was a fundraising front for al-Qaeda. Officials also say al-Awlaki met with a close associate of Omar Abdel Rahman, the "Blind Sheik" behind the 1993 attempt to bomb New York City's World Trade Center.

These associations remained hidden from most of al-Awlaki's congregants. Many in San Diego remember him as a likable, articulate preacher with moderate views. Ahmad Ibrahim, president of the Muslim Student Association at the University of California at San Diego in 1999-2000, heard al-Awlaki speak on several occasions and says the cleric only occasionally addressed controversial topics like Palestinian suicide bombers. "He had the opinion that ... their mission was acceptable," Ibrahim says but adds, "I don't believe he ever proposed killing civilians." Another worshipper says the congregation wouldn't have tolerated extremist preaching. "[He wasn't] about speaking out against America or Americans. It was all about becoming a better Muslim," says this worshipper, who asked not to be named. "If anyone in our community had known anything about his leanings, we would have reported it."

The al-Qaeda Connection
But intelligence officials say al-Awlaki was leading a double life. In 2000 he met with Khalid al-Mihdhar and Nawaf al-Hazmi, two of the five men who on Sept. 11, 2001, would hijack American Airlines Flight 77 and fly it into the Pentagon. These sources say that al-Awlaki held several closed-door meetings with the hijackers and that they regularly attended his sermons. But although the FBI investigated al-Awlaki's possible al-Qaeda connections before 9/11, it was unable to make anything stick. (See TIME's photo-essay "Double Agents: A Photo Dossier.")

In early 2001, al-Hazmi would follow al-Awlaki to his next mosque, the Dar al-Hijrah in Falls Church, Va. Again, al-Awlaki paired his new job with an academic interest: he began working on a doctorate at George Washington University in Washington and, for good measure, became the university's Muslim chaplain. The double life continued. As in San Diego, al-Awlaki's sermons at Dar al-Hijrah were largely uncontroversial. Indeed, he spoke out against radicals, prompting the New York Times in October 2001 to label him as one of a "new generation of Muslim leader capable of merging East and West." But at the same time, intelligence officials say, he was steadily drawing closer to al-Qaeda: al-Hazmi introduced him to Hani Hanjour, another of the Flight 77 hijackers.

After 9/11, al-Awlaki swiftly condemned the hijackers. A PBS NewsHour program in October 2001 shows him in a sermon criticizing U.S. foreign policy but arguing that it did not justify killing Americans. On the contrary, he told PBS, "Every nation on the face of the earth has a right to defend itself and to bring the perpetrators to justice."

By this time, however, intelligence agencies were looking closely at al-Awlaki's connections to the hijackers. At the home in Hamburg of Ramzi Binalshibh, a Yemeni who was a leading figure in the 9/11 plot, German authorities found al-Awlaki's phone number. The FBI questioned the cleric but didn't have enough information to arrest him. In March 2002, he left the U.S. for Yemen. He made one final trip to the U.S. in October of that year and was briefly detained at New York City's JFK airport, but the FBI's attempt to arrest him on the charge of giving false information in a passport application came to nothing. After leaving the U.S., he spent nearly two years in London, returning to Yemen in 2004. He taught at a radical university before being arrested by Yemeni authorities and imprisoned for 18 months. The exact reasons are unknown; he was never charged. Al-Awlaki has blamed the U.S. for pressuring the Yemeni government to detain him and claims the FBI interrogated him in prison. (The FBI did not respond to requests for information about al-Awlaki.)

See what happened to the accused 9/11 plotters.

See pictures from the October 2009 suicide bombings in Islamabad.

See Muslims encouraging debate, not hate.

Terrorism Speaks Your Language
There are dozens of "e-imams" who preach hatred toward the West on the Internet, and some have greater clout among the faithful than al-Awlaki. But his books and CDs have become best sellers, and his YouTube sermons are getting hundreds of thousands of hits. The hype reached new heights recently when the Arabic-language news channel al-Arabiya dubbed al-Awlaki "the bin Laden of the Internet."

What distinguishes al-Awlaki is not his record; other preachers have had demonstrably closer links to al-Qaeda and jihad. It is his target audience. Al-Awlaki aims his sermons at young Muslims mostly living in the U.S. and Britain. This is a group he understands better than any other radical preacher. In his fluent English, he has become that rare specimen: the jihadist cleric who can communicate effortlessly with audiences in the West. His tone and his message can appear seductively conciliatory. Most of his sermons have nothing at all to do with radical ideology; they are simple translations from the Koran and stories about the life of the Prophet Muhammad. Al-Awlaki appeals to Muslim immigrants who worry that their English-speaking children are unable to connect to their faith. "He's lived amid such people, and he understands their dilemmas very well," says Jarret Brachman, author of Global Jihadism: Theory and Practice and former director of research at West Point's Combating Terror Center. "He's giving them an option, telling them, 'Here's how to be good Muslims when you don't have an imam to turn to.' " (See pictures of the battle against the Taliban.)

Brachman, who monitors jihadist websites, reckons that al-Awlaki's sermons are "totally harmless nine times out of 10 ... but in the 10th, he starts to breathe a little fire." Much of the brimstone can be found in his blog posts, in which al-Awlaki states baldly that Islam and the West are in conflict and argues that all Muslims should join the holy war. In a how-to guide titled "44 Ways to Support Jihad," he says, "Jihad today is obligatory on every capable Muslim. So as a Muslim who wants to please Allah it is your duty to find ways to practice it and support it."

Most of the "44 ways" involve helping the mujahedin, or holy warriors: giving them money, praying for them, sponsoring their families and encouraging others to join the jihad. Believers are also urged to be physically fit, learn to use arms and spiritually prepare for holy war. Al-Awlaki stops short of telling his readers to go out and fight unbelievers. Instead, he suggests it is enough to have the "right intention" and to pray for "martyrdom." But later in 2009, al-Awlaki's tone grew more strident. "I pray that Allah destroys America and all its allies," he said in a blog post. "And the day that happens, and I assure you it will and sooner than you think, I will be very pleased." If al-Awlaki merely exhorted his audience to jihad, he might have gotten no more than passing attention from Washington. But intelligence officials and counterterrorism experts insist that he is no longer content to preach. His association with AQAP, which may be the terrorist network's most ambitious franchise, has brought al-Awlaki closer to the practice of terrorism. "Over the past several years, he has gone from propagandist to recruiter to operational player," a counterterrorism official tells TIME. "He is clearly moving up the terrorist supply chain."

The exact nature of al-Awlaki's operational role remains in dispute. "There's nothing to suggest that he's sitting down and planning attacks," says Ben Venzke of IntelCenter, a private intelligence contractor. "But his connections to Hasan and Abdulmutallab show that he does more than just make some jihadist literature available online. His role is more important than that." Granted, al-Awlaki lacks combat experience. But Pete Hoekstra, the ranking Republican on the House Intelligence Committee, believes that the cleric has a strong influence on operational issues. "He plays a role in setting a strategic direction for AQAP," he says. "He's telling them, 'Attacking the U.S. homeland should be one of our priorities.' " Is that reason enough for the U.S. to try to take al-Awlaki out? "Absolutely, yes," says Hoekstra. "This is a guy who is encouraging and organizing people to kill Americans." The counterterrorism official agrees: "Taking him off the street would deal a blow to [AQAP]." (See TIME's tribute to people who passed away in 2009.)

That sounds reasonable. But even if the U.S. is right in identifying al-Awlaki as a present danger, getting to him won't be easy. Since the missile strike on his house, the preacher is thought to have gone into hiding among his tribe in Shabwa province. The Yemeni government, already burdened with its three civil wars, is unlikely to start a fourth with the al-Awlakis.

That leaves a U.S. drone strike as the most likely option. There is a precedent for that, but also an unpleasant reminder that al-Awlaki is not the first man brought up in the West — and will surely not be the last — who threw in his lot with jihadists. For in November 2002, one of the first ever drone operations took place in Yemen, killing, among others, Ahmed Hijazi, a suspected al-Qaeda operative. He was an American too.

— With reporting by Mark Thompson, Massimo Calabresi and Caitlin Duke / Washington; Rita Healy / Fort Collins; Teri Figueroa and Jill Underwood / San Diego; and Heather Murdock (GlobalPost) and Catrina Stewart / Sana'a

Hospitals: Radical Cost Surgery

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A hospital that slashes costs—and delivers high-quality care as it innovates? Yes, it exists

By Catherine Arnst

Walk into most hospitals, and you'll see patients scattered about the halls on gurneys or wheelchairs. They're waiting to be moved from intensive care to a standard ward, or to an X-ray room, or to physical therapy. Each journey adds to the patient's discomfort and increases the risk of infections and other complications. Tally up a single patient's migrations over 24 hours, and they may consume as much as half a day of staff time.

Walk into Providence Regional Medical Center, in Everett, Wash., and you will see a hospital trying something different: It brings the equipment to the patient. In 2003, Providence opened one of the few "single stay" wards in the nation. After heart surgery, cardiac patients remain in one room throughout their recovery; only the gear and staff are in motion. As the patient's condition stabilizes, the beeping machines of intensive care are removed and physical therapy equipment is added. Testing gear is wheeled to the patient, not the other way around. Patient satisfaction with the "single stay" ward has soared, and the average length of a hospital stay has dropped by a day or more.

This is just one of many changes—some radical, many quite small—that have enabled Providence Regional to join a special subset of American hospitals: those that do not lose money on Medicare patients.

Almost 60% of U.S. hospitals report losing 20 cents on the dollar for every elderly patient that comes through their doors. They make up the difference by charging the under-65s a far higher fee. But Providence breaks even on the elderly, even though Medicare pays about $1,000 less per enrollee in the hospital's region than the national average. The hospital accomplishes this feat while winning a doctor's satchel full of national awards for top-notch care, placing it among the elite 5% of all U.S. hospitals.

High quality at a low price. Every other industry strives for that combination, but a hospital that does both is all too rare. Providence and its cost-efficient brethren demonstrate that quality care can be delivered at an affordable price, provided hospitals can be persuaded to rethink decades-old practices.

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The crazy world of hospital economics does not offer a lot of incentives to change. Both Medicare and private insurers reimburse on a piecework basis—known as fee-for-service—that encourages hospitals to treat more, prescribe more, and test more. Economists refer to this arrangement as a "value-blind" payment system since no premium is paid for quality.

Consequently, hospitals have no financial motivation to invest in productivity-enhancing computer technology, management experts, or efficiency research—and by and large, they don't. Columbia University economist Frank Lichtenberg calculates that productivity growth for the hospital industry has increased at less than half the rate of the general economy.

There are no proposals in either the House or Senate reform bill to scrap the fee-for-service system. As a result, the Congressional Budget Office expects the legislation to do little to halt the medical inflation that has pushed health-care spending to 16.2% of the gross domestic product. Because hospitals are among the largest employers in many congressional districts, their political clout protects them from reforms that would cause any real financial pain.

But even under a value-blind system, there are ways to "bend the cost curve," an oft-stated goal of President Barack Obama. The nonprofit Institute for Healthcare Improvement last year identified 70 regions around the country, out of a total of 306, where high-quality care is delivered at a reasonable cost. One of those regions is Everett, home of Providence Regional.

Providence is the only hospital in this coastal city of 98,000 people located 20 miles north of Seattle. It is the third-largest hospital in Washington, with two campuses serving 25,000 overnight patients a year, and operates the second-busiest emergency room in the state. It's building a $500 million, 368-bed tower, due to open next year, that will double its capacity.

What sets Providence apart from its peers is not size or location but its ability to operate within a Medicare-designated budget. The majority of U.S. hospitals have the market power to demand higher reimbursements from private insurers to make up for what they see as insufficient payments by Medicare. Because of a wave of consolidation in the 1990s, when more than 900 hospitals merged (including the two medical centers that created Providence Regional), some 90% of the U.S. population that lives in metropolitan areas is now served by just one or two hospital networks. "Hospitals simply don't need to be efficient," says Dr. Robert A. Berenson, a leading health-care economist and member of MedPAC, an independent agency that advises Congress on Medicare. "They are able to get payment differentials from the private sector of 30% to 35% over what Medicare pays." In some markets, it's 50% to 100%, he says.

Providence doesn't have enough private payers to engage in such fee-shifting. Forty percent of its annual revenues come from Medicare, and an additional 13% from Medicaid. Commercial insurers account for only 39%. Dependence on Medicare has forced it to focus on taking costs out of its operation rather than maximizing revenues.

To get those savings, the hospital tries to standardize best practices whenever possible. "There is a tremendous variation in medical delivery that is not quality driven," complains Dr. James Brevig, director of cardiac surgery at Providence. Doctors and nurses are often reluctant to analyze and change their methods because it would mean revamping long-accepted treatments or routines. As a result, says Brevig, "there are no standards in hospitals. Why is that? It's crazy. No other industry is like this."

Providence took a different path after picketing by workers nine years ago reflected a shattered morale. A new administration decided to attack the internal staff divisions and foster collaboration among doctors, nurses, and administrators. Everyone is encouraged to contribute ideas on driving down costs and improving patient outcomes. "I'm eligible for retirement, and under the prior leadership I would have left," says pediatric nurse Kathy Elder, a 34-year veteran of Providence. "They were very hierarchical, very closed. There was a lack of trust all around."

The current CEO, 48-year-old David T. Brooks, a fast-talking Detroit native, took over two years ago. He says the administration is open to suggestions from any and all staffers. "We have scorecards for everything around here, which measure both quality and efficiency. If all we had were great clinical outcomes but costs kept rising, that just wouldn't be good enough."

The staff embraced the challenge to innovate. The nursing team came up with the idea of checking on patients every two hours without waiting for a call button, to see if they need help walking to the bathroom or moving about their rooms. Ten percent of fatal falls by the elderly in the U.S. occur in hospitals. This one change at Providence reduced falls by 25%, according to chief nursing officer Kim Williams. "We believe we'll see more improvement over the next six months."

CONTROVERSIAL PRACTITIONERS

One of the bigger changes at Providence, implemented in 2003, is to place the day-to-day care of almost all its inpatients in the hands of hospitalists, a new type of doctor that has emerged in the last decade. Unlike primary care physicians, who usually visit their patients only early in the morning or late at night, hospitalists are available around the clock, checking that medications are administered properly, chart orders followed, and infection risks minimized. About 37% of Medicare inpatients are attended by hospitalists nationwide, and several studies have associated their use with better outcomes. Providence has also published data showing that infections, lengths of stay, and surgical complications have dropped since starting its own program.

But hospitalists are still controversial in many communities, because primary care physicians are wary of giving up control of their patients, along with their share of inpatient fees. Dr. Joanne C. Roberts, one of the first hospitalists at Providence, has not seen this conflict in Everett, possibly because most of the hospitalists and primary care doctors are associates at one large medical practice, Everett Clinic. That's not true everywhere, she says. "In another community where I worked, independent doctors were pretty hostile. Everyone was trying to grab part of the money. That just doesn't happen here."

The lack of hostility could be because Washington attracts people who appreciate the region's quality of life. The ocean on one side of Everett and the Cascade Mountains on the other are their own kind of bonus. "It helps that most doctors don't move to the Seattle area just to get rich," says Dr. William M. Wisbeck, a radiation oncologist at Providence.

It also helps that Providence has no competition nearby. "We don't have to engage in a medical arms race," says Dr. Lawrence M. Schecter, chief medical officer. Instead, a 20-member Value Analysis Committee consisting of doctors, nurses, and administrators scrutinizes every proposal for a major equipment purchase to determine if it is warranted in terms of patient need, rather than to keep up with the competition or to increase billings.

Providence's savings efforts don't stop at the hospital doors. It offers financial training courses to the 800 independent doctors affiliated with the hospital in an effort to get them thinking about cost efficiencies. That's no easy task, however, since savings don't necessarily flow into their pockets. Cutting back on unnecessary services may be better for the bill payer, but it lowers the income of doctors and hospitals.

Thus there is no national rush to imitate Providence's strategies. The Centers for Medicaid & Medicare Services, which administers Medicare, tries to encourage fiscal restraint through its reimbursement rates, but hospitals consistently argue that these rates are too low. MedPAC estimates seem to support this position—it calculates that hospital Medicare margins were -7.2% in 2009. But overall operating margins are far more robust. Thanks to income from private insurers, the nation's 5,000 nonprofit hospitals had a median operating margin of 8.4% in the second quarter of 2009, according to a Thomson Reuters (TRI) analysis. Health insurers, by comparison, had a median margin of less than 4%.

Brooks says Providence's 2009 operating margins were 6%, despite its heavy dependence on Medicare. Reaching that level is a challenge. As the only major hospital in a fast-growing county, Providence must provide every kind of medical service. Thus its lucrative cardiology unit and high-tech cancer centers are offset by an obstetrics ward that delivers 4,000 babies a year. The hospital loses money on almost every one of those births. Providence also has to absorb some $16 million in unpaid bills each year, more than any other Washington hospital except a public facility in Seattle.

Charity care fulfills a moral mission at Providence that sometimes trumps economics. The hospital is owned by the Sisters of Providence, a Canadian order of Catholic nuns founded in 1843 to minister to the poor. "Everything we do has to uphold our core values," says Brooks. "Our mission doesn't end with our business goals."

DOING PENANCE

But business goals and social mandates do sometimes align. To make life easier for dying patients, Providence opened a hospice in 2003 that offers palliative treatments. Patients tend to express relief when offered the option of hospice over hospital care, says Dr. Roberts, the hospitalist who helped start the program. She recalls one day last fall when the palliative care staff was asked to consult on two patients who, between them, had been admitted 35 times to the hospital within 12 months. "As a result of calm discussions with patients and families regarding their goals for their own care and future, both were referred to hospice," she says. Roberts estimates that Medicare saves an average of $3,120 on patients who choose hospice over drastic interventions.

Providence also seeks to soften contentious encounters among doctors and patients by doing penance for errors. The hospital set up an independent panel to investigate medical mistakes, disclose its findings to the patient, and voluntarily offer a financial award if warranted. As a result, Providence has only two malpractice suits pending, compared with an average of 12 to 14 at other hospitals of similar size.

When Providence can't find standard medical practices, it innovates. That was the case with blood transfusions. Cardiac and orthopedic surgeons realized a few years ago that there was no widely accepted data on the optimal amount of blood to give patients during surgery, despite the $240 cost per bag. Dr. Brevig started looking around and found several studies that correlated greater transfusion volumes with longer patient stays and higher infection rates.

He was particularly surprised that transfusion rates varied greatly from hospital to hospital, regardless of the patient's status. "The variations were related to the culture of the hospital, not the decisions of the doctor," he says. Brevig set out to create a low-transfusion culture at Providence. He got surgeons to slow down because speedy operations cause more blood loss. Settings were changed on heart bypass machines to save blood, and the hospital hired a blood conservation coordinator. In a study of 2,531 operations at Providence, Brevig reported that the incidence of transfusions was reduced to just 18% in 2007, from 43% in 2003, while the average patient stay was reduced by half a day. The changes have saved Providence an estimated $4.5 million.

Brevig has been proselytizing for his plasma practices at medical meetings, but to little avail. Only some 200 U.S. hospitals have a blood conservation program. Since patients are billed the cost of the plasma, doctors aren't motivated to change their habits.

There is also the fear that cutbacks on services will lead to accusations of rationing. Dr. Donald Berwick, president of the Institute for Healthcare Improvement and a longtime campaigner for better, safer hospitals, says this attitude must be revamped. In a recent speech he called on hospitals to reduce costs by 10% over the next three years without harming care. In almost every case, he noted, fewer interventions and adherence to standards lead to better medical outcomes. "Doctors and patients alike need to realize that the best health care is the very least health care that we need," he said. "The best hospital bed is empty, not full."

The Disposable Worker

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Pay is falling, benefits are vanishing, and no one's job is secure. How companies are making the era of the temp more than temporary

By Peter Coy, Michelle Conlin and Moira Herbst

On a recent Tuesday morning, single mom Tammy DePew Smith woke up in her tidy Florida townhouse in time to shuttle her oldest daughter, a high school freshman, to the 6:11 a.m. bus. At 6:40 she was at the desk in her bedroom, starting her first shift of the day with LiveOps, a Santa Clara (Calif.) provider of call-center workers for everyone from Eastman Kodak (EK) and Pizza Hut (YUM) to infomercial behemoth Tristar Products. She's paid by the minute—25 cents—but only for the time she's actually on the phone with customers.

By 7:40, Smith had grossed $15. But there wasn't much time to reflect on her early morning productivity; the next child had to be roused from bed, fed, and put onto the school bus. Somehow she managed to squeeze three more shifts into her day, pausing only to homeschool her 7-year-old son, make dinner, and do the bedtime routine. "I tell my kids, unless somebody is bleeding or dying, don't mess with me."

As an independent agent, Smith has no health insurance, no retirement benefits, no sick days, no vacation, no severance, and no access to unemployment insurance. But in recession-ravaged Ormond Beach, she's considered lucky. She has had more or less steady work since she signed on with LiveOps in October 2006. "LiveOps was a lifesaver for me," she says.

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You know American workers are in bad shape when a low-paying, no-benefits job is considered a sweet deal. Their situation isn't likely to improve soon; some economists predict it will be years, not months, before employees regain any semblance of bargaining power. That's because this recession's unusual ferocity has accelerated trends—including offshoring, automation, the decline of labor unions' influence, new management techniques, and regulatory changes—that already had been eroding workers' economic standing.

The forecast for the next five to 10 years: more of the same, with paltry pay gains, worsening working conditions, and little job security. Right on up to the C-suite, more jobs will be freelance and temporary, and even seemingly permanent positions will be at greater risk. "When I hear people talk about temp vs. permanent jobs, I laugh," says Barry Asin, chief analyst at the Los Altos (Calif.) labor-analysis firm Staffing Industry Analysts. "The idea that any job is permanent has been well proven not to be true." As Kelly Services (KELYA) CEO Carl Camden puts it: "We're all temps now."

Peter Cappelli, director of the Center for Human Resources at the University of Pennsylvania's Wharton School, says the brutal recession has prompted more companies to create just-in-time labor forces that can be turned on and off like a spigot. "Employers are trying to get rid of all fixed costs," Cappelli says. "First they did it with employment benefits. Now they're doing it with the jobs themselves. Everything is variable." That means companies hold all the power, and "all the risks are pushed on to employees."

The era of the disposable worker has big implications both for employees and employers. For workers, research shows that chronic unemployment and underemployment cause lasting damage: Older people who lose jobs are often forced into premature retirement, while the careers of younger people are stunted by their early detachment from the working world. Even 15 years out of school, people who graduated from college in a recession earn 2.5% less than if they had graduated in more prosperous times, research has shown.

Diminishing job security is also widening the gap between the highest- and lowest-paid workers. At the top, people with sought-after skills can earn more by jumping from assignment to assignment than they can by sticking with one company. But for the least educated, who have no special skills to sell, the new deal for labor offers nothing but downside.

Employers prize flexibility, of course. But if they aren't careful they can wind up with an alienated, dispirited workforce. A Conference Board survey released on Jan. 5 found that only 45% of workers surveyed were satisfied with their jobs, the lowest in 22 years of polling. Poor morale can devastate performance. After making deep staff cuts following the subprime implosion, UBS (UBS), Credit Suisse (CS), and American Express (AXP) hired Harvard psychology lecturer Shawn Achor to train their remaining employees in positive thinking. Says Achor: "All the employees had just stopped working."

In a typical downturn, the percentage decline in payrolls is about the same as the percentage decline in gross domestic product. But in the recessions that began in 2001 and 2007, the decline for payrolls was much steeper—1.8 percentage points more during the latest downturn. Worse yet, only about 10% of the layoffs are considered temporary, vs. 20% in the recession of the early 1980s.

PERMA-TEMPS

All that cutting has been good for corporate profits. Earnings rebounded smartly as companies kept payrolls down after the 2001 recession; by 2006 profits had hit a 40-year high as a share of national income, at 10.2%, according to Bureau of Economic Analysis data. The credit bust sent that figure plunging to 5.6% during the final quarter of 2008. But over the past year corporate profits' share has rebounded to 7.4% of national income, equaling the 40-year average.

The trend toward a perma-temp world has been developing for years. Bosses are no longer rewarded based on how many people they supervise, so they have less incentive to hang on to staff. Instead, the increasing use of bonuses tied to short-term profit performance gives managers an incentive to slash labor costs. The Iowa Policy Project, a nonpartisan think tank, estimates that 26% of the U.S. workforce had jobs in 2005 that were in one way or another "nonstandard." That includes independent contractors, temps, part-timers, and freelancers. Of those, 73% had no access to a retirement plan from their employer and 61% had no health insurance from their employer, the Iowa group said.

Temp employment in the U.S. fluctuates wildly, by design. The whole purpose of bringing on workers who are employed by temporary staffing firms such as Manpower (MAN), Adecco (ADO), and Kelly Services is that they're easy to shuck off when unneeded. While the number of temps fell sharply during the recent recession, the ranks of involuntary part-timers soared. The tally of Americans working part-time for economic reasons—that is, because full-time work is unavailable—has doubled since the recession began, to 9.2 million.

Companies that seized on the recession as an opportunity to make drastic organizational changes for greater efficiency and flexibility aren't likely to reverse those changes once the economy begins growing again, says David H. Autor, a labor economist at Massachusetts Institute of Technology. In other words, most of the jobs shipped to China will stay in China. And companies that turned labor into a just-in-time, flexible factor of production won't return to an old-fashioned job-for-life arrangement. "For the last 10 years, I and others have been saying that these trends aren't just for a fringe workforce but increasingly are for the mainstream," says Sara Horowitz, founder and executive director of the Freelancers Union, a 130,000-member advocacy group for contract workers. "This recession has shown us that the future is here."

Boeing (BA) typifies the companies that are taking advantage of flexibility. In 2009, it cut 1,500 contingent workers from its commercial division. Says spokesman Jim Proulx: "The first imperative was to reduce all of the contract and contingent labor that we possibly could to shield our regular employees from those layoffs." Boeing says less than 3% of its workforce is contingent. It has also reduced its dependence on costly permanent staff in the U.S. by making new hires abroad. Last March it announced a research and development center in Bangalore that will "coordinate the work of more than 1,500 technologists, including 100 advanced technology researchers, from across India." Bill Dugovich, a spokesman for Boeing's white-collar union in the U.S., the SPEEA, complains that the Indian workers "are basically contract labor."

For years Microsoft (MSFT) has been an avid user of temporary-staffing firms such as Volt Information Sciences (VOL) for a variety of short-term projects, including writing chunks of software, says Microsoft spokesman Lou Gellos. "Our contingent workforce fluctuates wildly depending on the different projects that are going on," Gellos says. "Somebody does just part of a project. They're experts in it. Boom, boom, they're finished." Temps are especially appealing to companies in cyclical industries. "We have been able to get really good talent. Off the charts," says Jeff Barrett, CEO of Eggrock, a manufacturer of pre-built bathrooms based in Littleton, Mass. It has brought on dozens of plumbers, electricians, and administrative workers through Manpower to handle a spike in orders.

With the economy expanding again, and employers loath to add permanent workers, temp employment is one of the few sectors of the labor market that is growing rapidly. Stock prices for the big temp firms have doubled since last March, while analysts surveyed by Bloomberg expect profits to double in 2010 at Robert Half International (RHI) and to jump about 50% at Manpower. LiveOps is among the biggest beneficiaries of the just-in-time labor trend; its revenues grew by a double-digit percentage in 2009 and the company is planning an initial public offering. "We want to do for the world of work what eBay did for commerce," says LiveOps CEO Maynard Webb, a former chief operating officer of eBay (EBAY). "You have access to the talent you need. And when the need is gone, the talent goes away."

"LEADERSHIP ON DEMAND"

The world of temporary work used to be the domain of sneaker-footed admins. No longer. Last year, Kelly Services placed more than 100 people—including lawyers and scientists—in interim stints that paid more than $250,000 a year. At the forefront of the "leadership on demand" movement in the U.S. is the Business Talent Group, whose roster of 1,000 executives has done jobs at companies like mobile-phone content provider Fox Mobile (NWS), health-care company Healthways (HWAY), and private equity firm Carlyle Group. BTG says its client demand rose 50% in 2009.

Sydney Reiner, of Southern California, has had five assignments in five years as an interim chief marketing officer at companies like Coffee Bean & Tea Leaf and Godiva Chocolatier. "I got a call from Godiva on a Wednesday asking if I could be on a plane to Japan on Saturday," says Reiner. "I was." For the past two months, she's been the interim chief marketing officer at beverage maker POM Wonderful. Reiner prefers the challenge of working in short, adrenaline-packed chunks. But like Smith, the University of Chicago MBA has no access to employer-sponsored health insurance and other benefits. Says Reiner: "To some extent I end up working as hard as a permanent employee, without a lot of the benefits."

Reiner relishes the flexibility of the free-agent lifestyle. While there are others like her, many upscale, white-collar workers aren't contingent laborers by choice. Matthew Bradford, who is 38 and married with three young children, could scarcely believe it when he was laid off in early 2009 by a national law firm in Cleveland. He eventually set up as a one-man "legal professional association" in Akron, handling overflow from other lawyers while he slowly builds up his own practice. Meanwhile he's responsible for his own health insurance and a share of office overhead, things he never considered when he was on track to making partner back in Cleveland. "I never would have thought this would have happened," says Bradford. "I thought, 'Hey, I've got a law degree and an MBA. I'm not going to be out of work.' It's just not the case anymore."

During the boom-time 1990s, employers sold the move away from secure full-time jobs as pure upside for workers—a step toward greater flexibility and freedom. To compete with dot-coms, corporations like IBM (IBM) started replacing some fixed pay with variable compensation: stock options, bonuses, and other cash incentives that have to be renegotiated each year. It was attractive for awhile, but the Great Recession is showing workers the downside of that deal. Employers' unspoken message to employees, says Cornell University labor economist Kevin F. Hallock, is this: "You can absorb more risk, or you're going to lose your job. Which would you prefer?"

At the bottom of the ladder, workers are so powerless that simply getting the minimum wage they're entitled to can be a struggle. A study released in September and financed by the Ford, Joyce, Haynes, and Russell Sage Foundations found that low-wage workers are routinely denied proper overtime pay and are often paid less than the minimum wage. It followed a Government Accountability Office report from March 2009 that found that poor oversight by the Labor Dept.'s Wage & Hour Div. leaves low-wage workers "vulnerable to wage theft." Some companies have been fined for misclassifying employees as freelancers and then denying them benefits. Meanwhile, the George W. Bush Administration made it easier for people earning as little as $23,600 a year not to be covered by overtime-pay rules.

Workers hired for temporary or contract work face a higher risk of developing mental health problems like depression, according to research presented in 2009 by Amélie Quesnel-Vallée of McGill University. A lack of job security and health-care benefits, as well as social ties to the rest of the workforce, increase stress levels for temps and contractors. A survey conducted in September by the National Alliance on Mental Illness found that people who experienced a forced change in their employment during the last year were twice as likely to report symptoms consistent with severe mental illness as individuals who hadn't experienced one.

The situation is especially difficult for young people, many of whom haven't been able to get a first foot on the career ladder. The percentage of people 16 to 24 who have jobs has plummeted by 13 percentage points since the beginning of 2000, while the share of workers 55 and over who have jobs has edged up over the period, despite the recession. Some young people are so desperate to get a start, they're working for free as semi-permanent interns. "Companies that used to use only one or two interns are now asking me for five or six at a time," says Lauren Berger, who runs a company that matches interns with entertainment, marketing, and media companies. Berger also reports a rise in the number of "adult interns," who work for free while trying to break into a new career.

Those internships might look like plum spots in years to come, for the gloomy trends in the labor market show no sign of abating. Consider some statistics. In the 2001 recession cycle, the economy lost 2% of its jobs and took four years to get them back. This time it has lost more than 5% of its jobs. Even after the recession is history, employers are likely to continue to offshore and automate jobs out of existence. If they don't, they'll lose out to competitors that do. In a November update of previous research, Princeton University economist Alan S. Blinder estimated that 22% to 29% of all U.S. jobs will be offshorable within two decades. Of course, even working in a job that's not offshorable—say, landscaping—is no guarantee of job security or decent pay. That's because people in those jobs must compete with the millions of former factory workers and such whose jobs have already been offshored, notes Josh Bivens, an economist at the Economic Policy Institute in Washington.

IBM may strike many people as the quintessential American company, but 71% of its workforce was outside the U.S. at the end of 2008, a figure even higher than the non-U.S. share of its revenue (65%). In 2009 the company reduced its U.S. employment by about 10,000, or 8%. It also announced a program offering certain employees the opportunity to move their jobs to emerging markets; in turn, the company will foot some of the relocation costs.

PAY CUTS

When employment in the U.S. eventually recovers, it's likely to be because American workers swallow hard and accept lower pay. That has been the pattern for decades now: Shockingly, pay for production and nonsupervisory workers—80% of the private workforce—is 9% lower than it was in 1973, adjusted for inflation. Sure, back in the 1950s pillars of the economy such as General Motors paid generously, because they could. Contracts between GM and the United Auto Workers set a pattern for pay throughout the economy, says Harley Shaiken, a professor at the University of California at Berkeley who specializes in labor issues. But while unions covered 36% of private-sector workers in 1953, the figure plunged to less than 8% by 2008. "Today, working conditions are set either by trends in the global economy or by nonunion firms in the U.S.," says Shaiken. He points out that while GM was the largest U.S. employer in the 1950s, "today that role is played by Wal-Mart (WMT), with very different consequences."

The best solution to relieve the pressure on workers would be rapid economic growth sustained over a long period, possibly enabled by some technological breakthrough. The Internet boom pushed unemployment to less than 4% in 2000. But few economists expect such a renaissance anytime soon. That's why labor unions and politically liberal economists argue for New Dealesque public jobs programs and against free-trade pacts like the North American Free Trade Agreement. In 2007, Ralph E. Gomory, former head of IBM's research department and later a senior vice-president at the company, declared before a U.S. House panel: "In this new era of globalization the interests of companies and countries have diverged. In contrast with the past, what is good for America's global corporations is no longer necessarily good for the American people."

Conservative economists, in contrast, say the real problem is too much government intervention in the economy. Employers who might be adding jobs are frozen in place by uncertainty over the impact of pending legislation on health care, global warming, and other big-ticket items, says economist Steven J. Davis of the University of Chicago's Booth School of Business. "I can't think of another time during my professional lifetime when there was so much riding on policy decisions that could get made in the next year or two."

For a glimpse of where things might be headed in the U.S., look at Europe, which makes a lot more use of temporary and part-time workers than U.S. employers do. That's in large part because of Europe's famously rigid labor laws; rather than hiring permanent workers, employers turn to temps and contractors who can be let go more easily during a downturn. In Spain, 85% of recent job losses in this recession were by temps or contractors. One big difference: Most European countries cover temps and part-timers with government health insurance and require that they receive wages and benefits comparable to those for permanent employees doing similar work.

Look far enough into the future and it's possible to see better times ahead for labor. A decade from now the retirement of the baby boom generation could cause labor shortages and hand some bargaining power back to younger workers, says Robert Mellman, a senior economist at JPMorgan Chase Bank (JPM). If that happens, woe unto employers. A survey in 2009 by the benefits consultant now known as Towers Watson found that top-performing employees will be ready to jump ship as soon as a better offer comes along. Says Wharton's Cappelli: "The idea of loyalty—'I will stick with you and you will reward me'—that is effectively gone."

But those are issues for another day. Right now the face of American labor is more like that of Jamila Godfrey, 35, of Seattle. A licensed naturopathic physician, she ran an alternative medicine practice but decided to scoop up another degree, this time in nursing, for greater job security. Though she graduated in June, and health care is the strongest sector in the economy, she hasn't been able to find a job because hospitals can't spare the money for three months of on-the-job training. To support herself and her 12-year-old daughter, the single mother has been working as a temp for the past several months, but that project ends in several weeks. "I'll be jobless again," says Godfrey. "I thought the [RN] qualification would make it easy to find a job, but it's not working out that way."

With Carol Matlack in Paris

Earthquake aftershock in Haiti spurs exodus from Port-au-Prince

Image by United Nations Photo via Flickr

By Manuel Roig-Franzia, Dana Hedgpeth and Theola Labbé-DeBose
Washington Post Staff Writers
Thursday, January 21, 2010; A13

PORT-AU-PRINCE, HAITI -- Haitians pushed and clawed onto rusty boats and dented buses by the thousands Wednesday, hoping to escape a capital city newly unnerved by the strongest aftershock since the Jan. 12 earthquake.

The death toll now stands at 75,000 and is rising, according to President René Préval. A sign that appeared outside an open mass grave at the city's largest cemetery read: "Please. The hole is filled. It can't take more bodies."

About 200,000 people are injured, 1 million are displaced and half the buildings in Port-au-Prince are destroyed, according to the Haitian Directorate for Civic Protection. A new Haitian government estimate says homeless people have congregated in more than 320 fetid encampments across the capital, where pigs and dogs scavenge in the same rotting garbage piles as naked children and their parents.

United Nations officials said an exact toll of the dead and injured may never be known because the powerful earthquake was so widespread and destroyed hospitals and morgues, which traditionally track such figures.

The scale of the tragedy has overwhelmed a country ill-prepared to cope with disaster and outstripped the capacity of international relief agencies, prompting an exodus of poor Haitians, who have no guarantee of finding shelter in the villages and cities outside Port-au-Prince.

Image by United Nations Development Programme via Flickr

At a ferry wharf in Port-au-Prince's Boulva slum, Manie Felix -- a 26-year-old mother of three -- hoped to travel to Haiti's Jeremie region, abounding with fruit trees. But she had no money to pay the inflated passage rate, which was equivalent to $15. "I have all these kids. I have no idea what to do," she said. Felix was asleep at the port when Haiti was shaken by Wednesday's aftershock, which registered at a magnitude of 5.9 and collapsed buildings in the capital.

Outside the U.S. Embassy, Josue Pierre's 4-year-old daughter looked up at him when the earth started shaking and said, "Daddy, Daddy, are we going to die?" The tremor made the 33-year-old Haitian American all the more eager to get permission to fly to Boston to meet his wife. "Something else is going to happen here," he said. "It is just too scary to stay. It is time to go away."

Rayhold Phanore, a pastor, said he saw a roof collapse on two neighbors. "You think everything is done and then it keeps shaking," said Phanore, a Haitian American who is hoping to take his 4-year-old daughter to Orlando, where he has family.

Nearby, in the Cite Soleil slum, where authorities say 3,000 people died and 15,000 were injured, police girded for the reemergence of gangs that held sway there before the quake. Police chief Azistude Rosemond returned to work after losing his wife, daughter and parents in the quake. Now he must cope without 17 of his 67 officers and is worried about escapees from a collapsed jail.

"They were in a tough fight before the earthquake," Lt. Gen. Ken Keen, the top commander of U.S. military forces here, said after touring the slum with Ambassador Kenneth Merten. "The quake is like a kick in the teeth for them."

The city has seen little violence, despite persistent fears that shortages of food, water and shelter will spark unrest. Still, looting remains a problem. Haitian SWAT teams patrolled the government buildings around the National Palace to keep away looters, said police Cmdr. Simon Francois.

"The looters are looking for the government safes, computers, anything that works, and even things that don't," Francois said. "The people are stressed, and that makes it more difficult for us to protect and serve."

Many business owners have refused to reopen because they fear being overrun by desperate quake victims. But several banks opened Wednesday; long lines formed and crowds grew agitated, mirroring the emotions after the morning aftershock.

The aftershock's damage wasn't limited to Port-au-Prince -- the United Nations said that an undetermined number of people were injured and that buildings collapsed in Jacmel, a seaside city known for its international film festival. While crews spread across Jacmel and Port-au-Prince to assess damage, the USNS Comfort arrived but stayed far from shore. Navy and Army divers plunged into the waters beneath the capital's central pier to gauge whether it could withstand cargo and masses of people.

The damaged and sorely inadequate infrastructure is further delaying the arrival of desperately needed relief supplies, and putting more pressure on Port-au-Prince's congested airport, which is now handling 100 landings a day -- four times the normal rate, according to the United Nations.

The air-traffic control tower was damaged in the initial quake, and there is just one runway to handle dozens of relief agency and military flights from around the world. "More people wanted to come in here than there's space, and they wanted to come in quickly," said U.S. Air Force Col. Ben McMullen, deputy commander for the Special Operations unit tasked with improving airport operations. The airport "was running on a first come, first serve" basis initially, he said.

To unload the planes, it was mostly "a bunch of good strong backs," he said. Since then, more forklifts and loaders have arrived, and the military is now requiring flight plans, hoping that will end the hours-long holding patterns imposed early on. A U.N. official said it is unclear when commercial flights might resume.

The Haitian government has signed an agreement giving the United States formal control of the airport, so U.S. officials have had to referee disputes between relief flights. On Saturday, a French plane carrying a portable hospital was diverted because the landing space was full.

"Everybody thinks their plane is a priority," said Maj. Nathan Miller, who helps coordinate air operations. Lionel Isaac, the airport's director, said that crowding has been a problem and that planes need to do a better job of alerting authorities about cargoes and arrival times. "They don't do it," he said. "They just fly in."

Once the planes are on the runway, they are Air Force Tech. Sgt. Adrian Jezierski's problem. "They tell me the size, and I figure out where to park it," said Jezierski, who is among those directing planes. "It's like a jigsaw puzzle."

Staff writers William Booth, Mary Beth Sheridan and Scott Wilson in Port-au-Prince and Colum Lynch at the United Nations contributed to this report.

After Massachusetts loss, Democrats vow to focus on economy, jobs

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By Dan Balz and Paul Kane
Washington Post Staff Writer
Thursday, January 21, 2010; A08

A day after their embarrassing loss in Massachusetts, splintered Democrats pledged to refocus their attention on jobs and the economy, and to draw sharper contrasts with Republicans, as they scramble to find a strategy to quell the populist anger that threatens the party's standing in the November elections.

Elected officials and Democratic strategists found little common ground, however, in the specifics of their response to their party's shellacking in Massachusetts, whether on how to proceed with a health-care bill that has become a political liability or on the elements of a jobs program that can dent the unemployment rate.

But they did agree that voters are prepared to punish them, not only because the economy has not improved faster, but also because they have not delivered on one of the central promises of President Obama's campaign: changing the way Washington does business.

Former Democratic National Committee chairman Howard Dean said the proper course for Democrats now "is exactly the position the president took when he ran," which Dean said was to pledge that special interests would not run the government under his administration. "What voters think, unfortunately, is that they do run Washington," he said.

Pennsylvania Gov. Edward G. Rendell said it was "just wrong" to interpret Republican state Sen. Scott Brown's victory over Democratic state Attorney General Martha Coakley in Massachusetts as a crushing defeat for the president, citing the vagaries of special elections and the difference in the quality of the two campaigns.

But he said Democrats must urgently begin to deliver on their promises in order to head off sizable losses later this year. "Let's give people a reason to turn out and vote for us," Rendell said. "Let's pass a jobs bill. Let's pass a health-care bill. Be a party. Stand up and get things done."

A focus on independents

Sen. Robert Menendez (N.J.), who as chairman of the Democratic Senatorial Campaign Committee helped oversee Coakley's losing bid, said the key political ambition in the next 9 1/2 months is to "make sure we find a way to engage independent voters."

Coakley ran poorly among independents, according to pre-election polls, continuing a trend that surfaced in Virginia's and New Jersey's gubernatorial elections last November, when such voters deserted Democrats and backed Republicans.

But Menendez's House counterpart said focusing primarily on independents is a false choice that could leave the party's left flank demoralized and on the sidelines in November.

Rep. Chris Van Hollen (Md.), chairman of the Democratic Congressional Campaign Committee, said the party must find a way to pass a health-care bill, which would help soothe anger among liberals who feel slighted by the agenda so far, and should push an economic program that appeals to independents concerned about unemployment.

On Capitol Hill, Democrats are focused on the health-care conundrum -- whether they can quickly pass legislation and move on to other issues, principally the economy. "What we don't want to see is that this [health care] is to the exclusion of other things," said Sen. Benjamin L. Cardin (Md.), a leading liberal. "You have to be able to see the finish line. We're now at the last hurdles. You have to have a plan that can win."

Sen. Robert P. Casey Jr. (D-Pa.) said that he favors trying to finish health care but that it must be wrapped up quickly to allow a turn to a new agenda. "It's got to be jobs, almost exclusive of everything else," he said.

If the present climate holds through the fall, Pennsylvania Democrats face the prospect of losing the governor's mansion, a Senate seat and at least six House seats in November.

'It's our problem'

Delaware Gov. Jack Markell, chairman of the Democratic Governors Association, said there is considerable impatience among voters and Democrats must be responsive. "My sense of it is that people in power, whether federal or state, are seen as the people who are responsible," he said. "We have an affirmative responsibility to do so something about these issues."

Markell predicted that once the unemployment rate starts to go down, some of the anger in the electorate will ease. "Until then, it's our problem," he said.

The lack of consensus in the Senate about job creation complicates Democrats' desire to show the public that they are focused on the economy. "The tough part for Democrats is that it is a governance issue, a really substantive problem," said Bill Carrick, a California-based Democratic strategist. "The Republicans don't have to deal with it. All they have to deal with is, 'We don't like what they're doing.' "

South Carolina Democratic Party Chairwoman Carol Fowler said part of the party's problem is that "people voted for change, and change didn't happen the next day. . . . There are lot of people in this country who are miserable, who want something done. Voting people out, whether they've been in office a week or years, seems like the way to get change."

Fowler said Democrats must move more aggressively to hold Republicans accountable for their opposition to the administration's agenda, rather than changing the agenda.

Carrick agreed that drawing sharp contrasts is the key to survival for Democratic candidates this fall. He pointed to the 1994 elections, when Republicans rode anger at Washington and dissatisfaction with the Clinton administration to a landslide takeover of the House and the Senate. "The few that survived at the top of the tickets were campaigns that recognized the situation they were in and moved aggressively to frame the election as a comparative choice," he said.

Looking ahead to this fall, Carrick added, "This is not going to be a campaign where we're going to see people talking in lofty terms about the future of the country."

Americans' bias against Jews, Muslims linked, poll says

Image by Tony the Misfit (taking a break) via Flickr

By Michelle Boorstein
Washington Post Staff Writer
Thursday, January 21, 2010; A03

A poll about Americans' views on Islam concludes that the strongest predictor of prejudice against Muslims is whether a person holds similar feelings about Jews.

The Gallup poll, released Thursday, also finds that people who report going to religious services more than once a week are less likely to harbor bias against Muslims.

The poll, conducted in the fall, is the latest large-scale survey to find a high level of anti-Muslim sentiment in the United States. The Pew Forum on Religion and Public Life released a poll in September showing that Muslims are thought to suffer more discrimination than any other U.S. religious group, by a wide margin. Jews were second.

The Gallup poll asked Americans about their views of Islam, Christianity, Judaism and Buddhism and found that 53 percent see Islam unfavorably.

There is no consistent data over time about Americans' views on Islam or Muslims. Dalia Mogahed, executive director of the Gallup Center for Muslim Studies, said that Americans' attitudes toward Muslims generally seem to be improving but that "changes are not dramatic."

The Pew poll found that Americans' views on whether Islam is more likely than other faiths to encourage violence -- a question Pew first asked after the Sept. 11, 2001, terrorist attacks -- have fluctuated dramatically.

In the Gallup poll, respondents who said they feel "a great deal" of prejudice toward Jews are very likely to report feeling the same level of bias toward Muslims.

Mogahed, who is on a board that advises President Obama on faith-based issues, said the Gallup poll was prompted partly by Obama's outreach to Muslim-majority societies and a desire to understand more about what shapes Americans' views on Islam.

In a note accompanying the poll results, Gallup makes the argument that Americans' prejudice against Muslims is at least partly fueled by misinformed beliefs. For example, people who believe Muslims worldwide oppose equal rights for men and women tend to be much more likely to report prejudice against Muslims.

Data from other Gallup interviews that were not part of the most recent poll show that majorities of Muslims in Iran, Egypt and Saudi Arabia, among other places, say that women and men should have equal legal rights.

Poll results will be available at muslimwestfacts.com at 10 a.m. Thursday.

Yemen to revamp visa procedures in wake of failed Christmas Day airliner bombing

Image by Anduze traveller via Flickr

By Karen DeYoung
Washington Post Staff Writer
Thursday, January 21, 2010; A03

Yemen is changing its visa procedures as a result of the Dec. 25 airline bombing attempt in the United States and will require entry permits to be issued at its embassies abroad rather than granting them on arrival in Yemen, Foreign Minister Abubaker al-Qirbi said Wednesday.

His government has also asked all Arabic-language institutes in Yemen to provide information on foreign students, Qirbi said. Umar Farouk Abdulmutallab, the Nigerian charged with attempting to detonate a bomb aboard the Amsterdam-Detroit flight last month, was a student at such a school in Sanaa, the Yemeni capital, before he allegedly joined the al-Qaeda affiliate there last fall.

Image by Osama Al-Eryani via Flickr

In a wide-ranging interview at the end of a three-day visit here, Qirbi said that counterterrorism cooperation with the United States had improved under the Obama administration, but that U.S. intelligence was still not sharing enough of the kind of information that could prevent attacks like the Christmas Day attempt, which failed because the bomb malfunctioned.

Although Abdulmutallab's father had told the U.S. Embassy in Nigeria that his son was associating with extremists in Yemen, that information was not transmitted to Yemeni security officials. Qirbi said his government had not yet received any information about up to four dozen Americans that a Senate report Wednesday said had converted to Islam and become radicalized before moving to Yemen.

The State Department's top counterterrorism official, Daniel Benjamin, told the Senate Foreign Relations Committee on Wednesday that the presence of such individuals in Yemen is "obviously a major concern for us," although "we can't stop people from going across the ocean."

Overall, both Qirbi and Benjamin -- who testified with Jeffrey D. Feltman, the assistant secretary of state for Near Eastern affairs -- put a positive face on U.S.-Yemeni relations, saying that the countries are working closely together to combat al-Qaeda in the Arabian Peninsula and that U.S. military and development aid is rapidly increasing. Benjamin said Yemen would receive $63 million in aid this year, with additional military funding anticipated.

All three men, who met several times during Qirbi's visit, spoke of a "holistic" approach that would address the "root causes" of radicalization in Yemen, including poverty and unemployment.

But while Benjamin praised what he said was Yemen's recently arrived-at understanding of the threat posed by the al-Qaeda group, Qirbi said it was the United States that had recently awakened to the danger. "We felt that over the last 20 years, since Yemen started its fight against [al-Qaeda], that nobody paid much attention," he said.

In recent weeks, the United States has launched precision-guided missiles against al-Qaeda targets in Yemen, using Yemeni intelligence, according to U.S. military officials. Both countries have refused to comment publicly on the extent of U.S. intervention, with Yemen acknowledging only the assistance of U.S. "firepower."

Although administration officials have acknowledged a rapid increase in intelligence cooperation and military training in Yemen, they have said they are aware that too big an American footprint would exacerbate already strong resentment of a U.S. presence there.

On other matters, Qirbi said there had been little discussion during his visit of nearly 100 Yemeni detainees at the U.S. military prison at Guantanamo Bay, Cuba. An administration review has cleared 45 of them for release, but President Obama suspended their repatriation after the Dec. 25 attack. Qirbi said his government thinks the Obama administration's plans for indefinite detention without trial for some Guantanamo detainees "plays into the hands of al-Qaeda."

Echoing statements by other Yemeni officials, Qirbi said the radical Yemeni American cleric Anwar al-Aulaqi had survived a recent Yemeni airstrike. "He's alive, in one of the remote areas" of the country, Qirbi said. The Obama administration has said that Aulaqi was instrumental in radicalizing Maj. Nidal M. Hasan, the Army psychiatrist charged in the deadly Nov. 5 shootings at Fort Hood, Tex.

Qirbi said his government has asked Aulaqi's father, a former president of Sanaa University, to persuade his son to turn himself in to face "legal action" in Yemen.

Obama blames Massachusetts Senate loss on middle-class economic pain

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By Michael D. Shear
Washington Post Staff Writer
Thursday, January 21, 2010; A01

President Obama on Wednesday blamed the Democrats' stunning loss of their filibuster-proof majority in the Senate on his administration's failure to give voice to the economic frustrations of the middle class, a disconnect that White House aides vowed to quickly address as they continue to work to advance the president's agenda.

Obama said the relentless pursuit of his domestic policies -- and a failure to adequately explain their virtues -- had left Americans with a "feeling of remoteness and detachment" from the flurry of government actions in Washington.

"We were so busy just getting stuff done and dealing with the immediate crises that were in front of us that I think we lost some of that sense of speaking directly to the American people about what their core values are and why we have to make sure those institutions are matching up with those values," he told ABC's George Stephanopoulos.

The admission came as the president's top aides sought to come to terms with political disaster in the aftermath of the GOP's Senate victory in Massachusetts. The surprise outcome -- Republican Scott Brown took the seat of the late Democrat Edward M. Kennedy in the heavily Democratic state -- prompted crowing among GOP leaders and finger-pointing and recrimination among the president's allies.

"The American people, the people of Massachusetts, last night have rejected the arrogance," said Rep. Eric Cantor (R-Va.). "They are tired of being told by Washington how to think and what to do."

Publicly and privately, aides to the president repeatedly stressed that the White House has heard the message from angry voters. But they insisted that they are not backing away from key items on the president's agenda, including health-care reform, energy and bank regulation.

"That anger is now pointed at us because we're in charge, rightly so," press secretary Robert Gibbs told reporters. "I don't believe the president thinks that we should stop fighting for what's important to the middle class, that we should stop fighting for an economic recovery, that we should stop fighting for what we need to do to create an environment for the private sector to hire."

As they huddled behind closed doors in the West Wing, Obama's top aides were glum but undeterred. Several described an atmosphere of resolve not unlike the mood during the toughest moments of the 2008 campaign.

One top adviser insisted that "the White House gets it. We're not oblivious. We're not proceeding ahead as if it didn't happen."

But the early consensus inside the White House, they said, was to pursue a renewed effort to explain the difficult choices Obama has made. They said that the election results will not force a radical rethinking of his agenda and that the White House will attempt to convince Americans that his policies on the economy and jobs will eventually turn things around.

"What the president needs to do is go explain to the people exactly why what has been done is going to get us on a better path for the future," said former Obama White House communications director Anita Dunn, who still regularly provides advice on communications strategy. "What the president is doing now to create jobs, to build a better economic future -- that is something that contrasts very well with the Republicans' refusal to do anything."

The White House had already begun a determined effort to pivot its message to expressions of concern about the economy and jobs as it prepares for congressional midterm elections in November. Tuesday's defeat made that shift in rhetoric even more urgent.

David Axelrod, the president's senior adviser, said on MSNBC that the "main thing" to come out of the election results was a reminder that Obama and his party will be judged by whether people feel economically secure in the weeks and months ahead.

"The main thing that we saw in Massachusetts was the same sense of concern on the part of middle-class folks about the economic situation, about their wages being stagnant, about their jobs being lost," he said. "That's something that we have to pay a great deal of attention to."

While some lawmakers and pundits began predicting a full-scale retreat from the president's health-care reform effort, White House advisers said they are unwilling to accept defeat -- yet. Obama's closest advisers refused to express panic about the issue and vowed to find a way to proceed with some version of health-care reform.

Axelrod called the current health-care system "a real crisis" that is "part of what middle-class people are struggling with." Obama "believes we ought to deal with that crisis," he said. "It's not an option to simply walk away from a problem that's only going to get worse."

The president's aides were quick to accept some blame yesterday for the loss of the Senate seat but also offered a long list of failings by Democratic candidate Martha Coakley and her team, including her decision to vacation during the campaign and a failure to vigorously pursue votes during the final weeks.

White House aides rejected the idea that the Massachusetts election was a referendum on Obama. The Democratic candidate was leading by double digits just weeks ago, an indication, they said, that the political environment set by the president was not dragging her down.

But they struggled to explain how a Democratic Party that found such success in 2008 has now lost three consecutive major races, including contests for governor in New Jersey and Virginia last November.

One senior Democratic strategist said that in conversations he had with party leaders, there seemed to be an unwillingness on the part of the White House to acknowledge the party's new problem with independent voters, who were key to Obama's victory.

"Democrats on the Hill and in the White House don't seem to get that independent voters are upset with them," said the source, who spoke candidly about the president and his team on the condition of anonymity.

Administration officials said the loss of the Massachusetts Senate seat might give upcoming races across the country a jolt, awakening state parties to the perils of fielding weak candidates and giving national Democrats justification to weigh in on problematic campaigns. If there is a silver lining, they said, it is that no Democrats are now unaware of how endangered their power -- and their congressional majority -- is.

Asked whether Obama was having a bad day, Dunn laughed and asked: "Why? Because he's only got 59 votes in the Senate? Can we get a little perspective here, people?"

Staff writers Anne E. Kornblut and Chris Cillizza contributed to this report.

Generation M2: Media in the Lives of 8- to 18-Year-Olds

Image by .mw via Flickr

Generation M²: Media in the Lives of 8- to 18-Year-Olds is the third in a series of large-scale, nationally representative surveys by the Foundation about young people’s media use. The report is based on a survey conducted between October 2008 and May 2009 among a nationally representative sample of 2,002 3rd-12th grade students ages 8-18, including a self-selected subsample of 702 respondents who completed seven-day media use diaries, which were used to calculate multitasking proportions.

Full Report (.pdf)

Toplines:

2009 (.pdf)

2004 (.pdf)

1999 (.pdf)

Image via Wikipedia

Information provided by the Program for the Study of Media and Health
Publication Number: 8010
Publish Date: 2010-01-20