Two of President Obama's senior health care advisers said Wednesday that a proposed tax on high-cost insurance plans and a new commission to control Medicare spending were among "four pillars" essential to major health care legislation.This happens to agree with Obama recommending Ron Brownstein's article in The Atlantic to Rahm Emmanuel, which lauds the Baucus approach, and Emmanuel telling staff it was a "must read." More discussion on that on flavius' TPMCafe thread here.]]>
Their remarks firmly aligned the White House with the Senate on two major disagreements facing Democratic Congressional leaders trying to pass a bill....
In a conference call with reporters Wednesday to highlight cost-containment provisions, the two senior presidential advisers, Peter R. Orszag, White House budget director, and Nancy-Ann DeParle, director of health reform, cited a letter to Mr. Obama by a group of respected economists who strongly endorsed the Medicare commission and the tax on high-priced plans.
The letter also backed the two other pillars of the four embraced by the White House: that the legislation not add to the federal budget deficit and that it promote changes, known as "delivery system reforms," aimed at rewarding high-quality care rather than high-quantity care. "We are in favor of a fiscally responsible reform bill that includes these four pillars," Mr. Orszag said in the conference call...
Tehran denies helping the rebels, and a Saudi source has told AFP there is no evidence of active Iranian involvement.
Syria and Saudi Arabia's partners in the six-nation Gulf Cooperation Council (GCC) -- which groups Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates -- meanwhile voiced support for Riyadh.
"The GCC is always ready to stand alongside Saudi Arabia in the face of dangers and aggressions," Omani Foreign Minister Yussef bin Alawi bin Abdullah said at a GCC ministerial meeting in Doha.
In Damascus, a government official quoted by state-run SANA news agency said: "Syria supports the legitimate right of the kingdom to defend its sovereignty and the integrity of its territory."
In Geneva, the UN refugee agency (UNHCR) said the number of people displaced or affected by fighting between rebels and government forces had climbed to 175,000 since 2004, when the conflict first broke out.
NPR: Walter Reed Officials Asked: Was Hasan Psychotic?
by Daniel Zwerdling
November 11, 2009
Starting in the spring of 2008, key officials from Walter Reed Army Medical Center and the Uniformed Services University of the Health Sciences held a series of meetings and conversations, in part about Maj. Nidal Hasan, the man accused of killing 13 people and wounding dozens of others last week during a shooting spree at Fort Hood. One of the questions they pondered: Was Hasan psychotic?
"Put it this way," says one official familiar with the conversations that took place. "Everybody felt that if you were deployed to Iraq or Afghanistan, you would not want Nidal Hasan in your foxhole."
In documents reviewed by NPR and conversations with medical officials at Walter Reed and USUHS, new details have emerged regarding serious concerns that officials raised about Hasan during his time at both institutions....
Deeply Troubling, Schizoid Behavior....
....Hasan had been a trouble spot on officials' radar since he started training at Walter Reed, six years earlier....
Bureaucratic And Other Obstacles
So why didn't officials act on their concerns and seek to remove Hasan from his duties, or at least order him to receive a mental health evaluation? Interviews with these officials suggest that a chain of unrelated events and factors deterred them.
For one thing, Walter Reed and most medical institutions have a cumbersome and lengthy process for expelling doctors, involving hearings and potential legal battles. As a result, sources say, key decision-makers decided it would be too difficult, if not unfeasible, to put Hasan on probation and possibly expel him from the program.
Second, some of Hasan's supervisors and instructors had told colleagues that they repeatedly bent over backward to support and encourage him, because they didn't have clear evidence that he was unstable, and they worried they might be "discriminating" against Hasan because of his seemingly extremist Islamic beliefs.
Third, the officials involved in deliberations this year reportedly were not aware, as some top Walter Reed officials were, that intelligence analysts had been tracking Hasan's e-mails with at least one suspected Islamic extremist since December 2008.
And finally....
Just thought some people who are interested in the site's policies but aren't in the habit of reading 400-comment-long threads might like to know. (I myself just happened to come across the discussions by looking at his recent comments.)
Feel free to use this thread to discuss the topic, though I probably won't participate, as my position is that I just like to know a publication's actual policy.
]]>"The Hunted"
New York Magazine, October 3, 2009\by Matt McAllester
From Baghdad--frightening reports of gay pogroms, where homosexual men are targeted, tortured, slayed. From New York--a scurry to find those same men before they are killed, and shepherd them to safety.
On a bright afternoon in late March, an 18-year-old named Fadi stood in a friend's clothing store in Baghdad checking out the new merchandise. A worker in a neighboring store walked into the boutique with a newspaper in his hand and shared a story he had just read. It was about "sexual deviants," he said. Gay men's rectums had been glued shut, and they had been force-fed laxatives and water until their insides exploded. They had been found dead on the street....
At minimum what publicity might help is to make people who think the following extreme way pariahs within the Mideast and pariahs within majority Islam--from the story:
"Killing gays is halal," one of the men said, meaning it was permissible under Islamic law. "We'll get points in heaven for it."
And hopefully, shame on the international front about the general attitude of Iraqi society towards gays, which is the main thing that is allowing such extremists to act out their beliefs, might have some gradual effects in changing minds there the way it has elsewhere.
If you read that story, you will find that Human Rights Watch is involved, and contrary to their usual procedure, the situation is so bad that they are intervening to try to save individuals. For more:
]]> An aside: The topic reminded me of the Iraqi war blogger Salam Pax, and I checked up on him. He returned to Baghdad in January 2009. He wrote several articles from there for The Guardian; the last was April 21:Murder, Torture, Sexual Orientation and Gender in Iraq
August 17, 2009, Human Rights Watch
This 67-page report documents a wide-reaching campaign of extrajudicial executions, kidnappings, and torture of gay men that began in early 2009. The killings began in the vast Baghdad neighborhood of Sadr City, a stronghold of Moqtada al-Sadr's Mahdi Army militia, and spread to many cities across Iraq. Mahdi Army spokesmen have promoted fears about the "third sex" and the "feminization" of Iraq men, and suggested that militia action was the remedy. Some people told Human Rights Watch that Iraqi security forces have colluded and joined in the killing.
http://www.guardian.co.uk/profile/salampax
His current blog is here but has not been updated since April 1:
http://salampax.wordpress.com/
His Twitter Feed, however, as of today, had a posting on September 23, and he posted a link to the Human Rights Watch Report on August 17, the day it was published:
]]>]]>"Palestinians Halt Push on War Report"
By Neil MacFarquhar for the October 3, 2009 New York TimesUNITED NATIONS -- In a startling shift, the Palestinian delegation to the United Nations Human Rights Council dropped its efforts to forward a report accusing Israel of possible war crimes to the Security Council, under pressure from the United States, diplomats said Thursday.
The Americans argued that pushing the report now would derail the Middle East peace process that they are trying to revive, diplomats said.
"We don't want to create an obstacle for them," Ibrahim Khraishi, the Palestinian ambassador to the United Nations in Geneva, said by telephone from Geneva, where the Human Rights Council is based. "We want to get a strong resolution to deal with the report in a good manner to get a benefit from it."....
....in a compromise, the body is expected to pass a resolution Friday presented by the bloc of Arab and Muslim states that any action will be delayed until the next meeting in March.
....Michael Posner, the new assistant secretary of state for democracy, human rights and labor, would not comment Thursday about the negotiations.
In a speech to the council this week, however, Mr. Posner called the report "deeply flawed" and criticized the council for what he called a fixation with Israel. But he concluded by saying that fair reviews on both sides would build confidence.....
Mr. Khraishi, the Palestinian ambassador, said that if a resolution were passed now insisting that the General Assembly or the Security Council deal with the matter, as the report itself recommends, it would most likely face an American veto....
"There was a tremendous amount of pressure on all members by the Americans," said an Arab diplomat, who requested anonymity according to diplomatic protocol. "The Americans wanted something to finish it; the compromise is to defer it, which means it is still alive."
...Behind their show of unity about Iran's clandestine efforts to manufacture nuclear fuel...is a continuing debate among American, European and Israeli spies about a separate component of Iran's nuclear program: its clandestine efforts to design a nuclear warhead.
The Israelis, who have delivered veiled threats of a military strike, say they believe that Iran has restarted these "weaponization" efforts, which would mark a final step in building a nuclear weapon. The Germans say they believe that the weapons work was never halted. The French have strongly suggested that independent international inspectors have more information about the weapons work than they have made public.
Meanwhile, in closed-door discussions, American spy agencies have stood firm in their conclusion that while Iran may ultimately want a bomb, the country halted work on weapons design in 2003 and probably has not restarted that effort -- a judgment first made public in a 2007 National Intelligence Estimate....
from
A Nuclear Debate Brews: Is Iran Designing Warheads?
By Wlliam J. Broad, Mark Mazzetti and David E. Sanger for the Sept. 29 New York Times
This is not news to anyone who was reading outside of the blogosphere on the topic for the last 5 or so years, especially European sources that covered IAEA and Iranian diplomatic news. There never was much risk that the USA was going to bomb or invade Iran, and Europe was always a bit more seriously worried about Iran's cat and mouse game. (Unless Bush died and Cheney became president, of course--but then one could visualize him bombing and going to war with nearly everyone, no one would be safe then.)
]]> Especially being in Iraq next door, though, it wasn't to US benefit to advertise and promote the true situation to the general public. (Such concerns were still operative this summer: Odierno also said Iran continues to "interfere" in Iraq, including training insurgents and paying surrogates.)I believe writers like Seymour Hersh or Larry Johnson warning that we were going to war with Iran next month or the month after was just fine with the Bush administration, it projected a helpful hawkish message, kept Iran wary (that's the "keep all options on the table" thing.) I even suspected, as I recall a few others did, that it may have even been the case that those like Hersh were fed that stuff by sources he shouldn't have trusted for that very reason.
Now that Obama has decided to get it all out in the open and talk honestly doesn't mean that he wants to go to war with them or bomb them, either.
Sanctions were always the real stick being waved and they still are, and I think Iran knows that.
In addition, there were probably always covert US activities going on supporting bringing the mullahs down, and this was always known by them, too, hence their paranoia about every western foreigner visiting the country with any ties to another government of even the most innocuous kind.
And of course, Israel could always do something crazy and against US wishes (see "U.S. Rejected Aid for Israeli Raid on Iranian Nuclear Site," regarding 2008, (which also, by the way, mentions those U.S. covert activities.) But even then, after watching how Iran reacted over the years, I always thought chances were high that Iran would react more like Syria did to Israeli bombing in 2007--not react much at all and perhaps start over--than the WWIII that so many in the progressive blogosphere seem to like to imagine.
There is a lot of helpful timeline information on Obama's approach and past tactics towards Iran and how the current U.S./UK/France/ P.R. moves against Iran happened in this September 26 piece:
"Cryptic Iranian Note Ignited an Urgent Nuclear Strategy Debate," by Helene Cooper and Mark Mazzetti,
with the cavaet that the sources are are all anonymous "administration officials," "American allies" and "senior intelligence officials," with their own narratives and agendas to push.
An excerpt for an example, though I highly recommend reading the whole piece and thinking about past news stories in the context of what these sources say:
....the makings of the administration's strategy was hatched months before, when the White House first came to believe that the complex, built into a mountain on property near Qum controlled by Iran's powerful Revolutionary Guards, might be a part of the nuclear program. Over time, the file that intelligence officials accumulated on the facility developed as a cudgel, a way to win over wary allies and test if the Iranians were being truthful in their disclosures.
Senior intelligence officials said Friday that several years ago American intelligence agencies under the administration of George W. Bush discovered the suspicious site. The site was one of Iran's most closely guarded secrets, the officials said, known only by senior members of Iran's nuclear establishment. The officials said that housing the complex on the base gave it an extra layer of security.
Mr. Obama was first told about the existence of the covert site during his transition period in late 2008, White House officials said, after he had been elected but before he was inaugurated. But it was not until earlier this year that American spy agencies detected the movement of sensitive equipment into the facility -- a sign, they believed, that whatever work was involved was nearing its final stages.
American officials said Friday that the facility could have been fully operational by next year, with up to 3,000 centrifuges capable of producing one weapon's worth of highly enriched nuclear material per year.
"Over the course of early this year, the intelligence community and our liaison partners became increasingly confident that the site was indeed a uranium enrichment facility," a senior administration official said....
It is also interesting to reread this June 18 interview with Mohamed ElBaradei in this context.
]]>Dallas sees no relief in health care expenses as competition drives up costs
September 20, 2009, The Dallas Morning News
Medical care in Dallas is delivered in a broken market where doctors, hospitals and other providers shower patients with services of diminishing value but staggering cost.
The spending is rooted in the city's proud entrepreneurial culture. Dallas is home to many competing hospital systems and physician practices. But this competition raises costs rather than lowering them, because it rewards those who do more procedures and tests and offers no incentive to spend less.
Scott & White Healthcare in Temple, by contrast, dominates medical delivery in Central Texas yet provides care for far less money. "Logically, the more competition, the lower the price. It doesn't work that way in health care," said Scott & White president and CEO Alfred Knight. "Competition increases the price."....
]]> Also see:
A New Way to Pay Physicians
By Anne Underwood
September 23, 2009, New York Times Prescriptions BlogDr. John C. Lewin, chief executive of the American College of Cardiology, has met with administration officials and members of Congress about ways to revise pay incentives for doctors. He spoke with a blog contributor, Anne Underwood.
Q.What's wrong with the way physicians' pay is structured now?
A.We have built our system on a payment model that rewards volume. Doctors get rewarded for more tests, more volume, more hospital admissions, more visits. There are no incentives for quality of care or administrative efficiency. That's part of why our system is more expensive than other nations.
The good news -- and the reason why I'm excited about health care reform -- is that the best health care in this country often tends to be very affordable. The whole discussion about bending the cost curve can be resolved by setting new incentives in payment that reward better outcomes with evidence-based medicine....
I plan to use this thread to post any new pieces I see on topic in comments
For those that still haven't read it, here's a link to Atul Gawande's The Cost Conundrum:
What a Texas town can teach us about health care, for the June 1 New Yorker. And for those who don't know it, here's a link Healthbeatblog.org by Maggie Mahar, author of the 2006 book Money Driven Medicine: The Real Reason Health Care Costs So Much.
.
]]>To me it's refreshing to see a president actually use the U.N. (outside rhetoricals on its assembly podium,) rather than treat it as a pain in the butt.
I am expecting an uptick in the foreseeable future in ye olde conspiracy theories about one world orders and black helicopters and such. It's possible some of those left out of the "G-20" will be joining federalist wingers on that front this time.
]]>"We are no longer at the point that it is acceptable to throw things at the wall and see what sticks," said Michael Snow, a lawyer in Seattle who is the chairman of the Wikimedia board. "There was a time probably when the community was more forgiving of things that were inaccurate or fudged in some fashion -- whether simply misunderstood or an author had some ax to grind. There is less tolerance for that sort of problem now."
Wikipedia to Limit Changes to Articles on People
by Noam Cohen for the August 25 New York Times
Hope "the blogosphere" follows the lead.
]]>Lack of Medicare Appointee Puzzles Congress
by Robert Pear for the New York Times, August 18President Obama has made health care his top priority. He says the cost of Medicare and Medicaid is "the biggest threat" to the nation's fiscal future. But to the puzzlement of Congress and health care experts around the country, Mr. Obama has not named anyone to lead the agency that runs the two giant programs.
The agency, the Centers for Medicare and Medicaid Services, is the largest buyer of health care in the United States. Its programs are at the heart of efforts to overhaul the health care system. If it had an administrator, that person would be working with Congress on legislation and could be preparing the agency for a new, expanded role.
"The vacancy stands out like a sore thumb," said Dr. Denis A. Cortese, president of the Mayo Clinic, often cited by the White House as a health care model.
"In effect," Dr. Cortese said, "Medicare is the nation's largest insurance company. The president and Congress function as the board of directors.
"Under a strong administrator, it could take the lead in making major changes in the health care delivery system, so we'd get better outcomes and better service at lower cost."....
Trying to remake the health care system without a Medicare administrator is like fighting a war without a general.
"You need a general," said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the health subcommittee of the Finance Committee. Of the job vacancy, Mr. Rockefeller said: "It's a big problem. I can't explain it.....
That Obama started his health care reform push before even having an appointee suggests to me that the Obama adminstration's health care reform "plan" was always to see what happens with Congress and the public and then go from there. They are waiting to see what reforms are allowed before they even figure out what they want to do about Medicare and Medicaid and who they want to run it. Yes, have their preferences, but don't feel it appropriate to push them too strongly.
Some might call that "fly by the seat of the pants," others might call it "ground up, grass roots, community activist style," others might call it "weak Federal executive theory," but it is certainly not the work of a genius chess player trying to execute a plan. Granted, it might be partly because they see starting with a full-out plan and "war" to support it as repeating the mistakes of the Clinton administration, but that's just more proof that they set out with the idea of dealing with whatever happened with Congressional proposals and public reaction, to just attempt to steer the direction a bit, and not to lead so much.
]]>
Suicide Bomber Rams Truck Into Police Station in Russia, Killing 20
New York Times, August 17
At least 20 people were killed and dozens were wounded when a suicide bomber rammed a truck filled with explosives into a police headquarters in Russia's tumultuous North Caucasus region on Monday...The attack seemed to further undermine the authority of Yunus-Bek Yevkurov, Ingushetia's populist president, who came to power last October vowing a softer approach in dealing with rebel violence than that of Ramzan Kadyrov, the president of neighboring Chechnya....It was the bloodiest single attack to hit Ingushetia in some time, though violence against the police and government officials in this and other North Caucasus republics occurs almost daily...The bombing on Monday comes just days after separate attacks in neighboring Chechnya and Dagestan killed over 20 people...
and thought you had been remiss in keeping up with understanding the situation,
I highly recommend this recent backgrounder piece by Megan K. Stack:
Fear stalks Caucasus amid hidden war
Los Angeles Times, August 15, 2009A campaign of killings and torture has mounted in the Russian republic of Ingushetia, rights groups say. Security forces are said to be involved, and signs reportedly point to Chechnya's leader.
Reporting from Ordzhonikidzevskaya, Russia - This is a place where gangs with masked faces come out of the darkness to take the young men away.
Sometimes the bodies turn up with broken limbs, bruises, torn-away fingernails and burns. Sometimes the captives are placed under arrest officially and end up in jail. Lately, many simply disappear.
Russia's hidden war against anti-government rebels across the Caucasus Mountains has reached a terrible intensity here in the small, mostly Muslim Russian republic of Ingushetia.
Day after day, insurgents attack police and government officials with ambushes and bombings. And day after day, security forces unleash what human rights activists describe as a campaign of killings, abductions and torture in their efforts to force calm upon the land.
Now Ingushetia is struggling under the weight of a new terror, one that seeps over the mountains from Chechnya, a neighboring mostly Muslim Russian republic.
Having brutally squashed dissent in his own restive republic, Chechen President Ramzan Kadyrov.....
not the least of which it tells another one of those cautionary tales of how dealing with terrorist threats the wrong way can bring you nightmare blowback.
]]> Other pieces I read which I found helpful; excuse my not taking the time to format links:
]]>Activists, Reporters Leaving Chechnya
The Moscow Times, August 18
Human rights activists and journalists are leaving Chechnya after a series of murders, saying the danger level in the region has reached the highest level....http://www.moscowtimes.ru/article/600/42/380876.htm
Charity workers' killing shocks Chechnya
Moscow News, August 17
Less than a month after the kidnapping and murder of a Chechen rights activist, a husband and wife team who helped Chechen children were found shot dead....http://www.mnweekly.ru/news/20090818/55385613.html
Clashes Kill Over 20 in Russia Region
New York Times, August 14
More than 20 people were killed in violent clashes in Russia's North Caucasus region in the last two days, including a mysterious attack on seven women in a sauna, underscoring the Kremlin's continued struggles to bring the volatile area under control....http://www.nytimes.com/2009/08/15/world/europe/15russia.html?hpw
Russia: Gunmen Kill Government Official in Ingushetia
New York Times, August 12
Like neighboring Chechnya, Ingushetia has faced violence related to an Islamic insurgency and official corruption. In June, Ingushetia's reformist president....http://www.nytimes.com/2009/08/13/world/europe/13briefs-Russia.html
Gunmen Kill 5 Police Officers in Chechnya
New York Times, August 3
MOSCOW -- Gunmen attacked a police convoy in the Russian republic of Chechnya on Sunday evening, killing at least five officers and ...
http://www.nytimes.com/2009/08/04/world/europe/04chechnya.html
WASHINGTON -- The Obama administration scrambled on Friday to defend major elements of its plan to overhaul the nation's financial regulatory system in the face of significant criticism from lawmakers, the financial services industry, and even senior regulators whose authorities would be eliminated under the proposal.
A turf war among some of the most powerful regulators in Washington, which has played out largely behind the scenes in the last few months, burst into the open at a House hearing. It featured disagreements over two cornerstones of the administration's financial regulation plan -- a new consumer protection agency to take over the functions now performed by the Federal Reserve, and a greater role for the Fed in overseeing large institutions that could pose systemic risks if they become troubled....
continued @ Regulators Spar for Turf in Financial Overhaul,
by Stephen Labaton for the July 25 New York Times.
See also at the New York Times website: Europe Weighs Withdrawing Envoys From Tehran, by Alan Cowell and Stephen Castel, 1:52 PM ET today: Diplomats said that the European Union is considering pulling out all 27 ambassadors in a dispute over Iran's detention of local personnel from the British Embassy. There's conflicting on that, as the Times' The Lede reported at 9:25am that that may have been resolved.
Their primary intended audience is domestic, of course, as they are trying to keep complete control, save their Islamic experiment, or whatever. But it seems they would like some Great Satans to play the game with them and will keep trying.
]]>