November 22, 2009
By DAVID M. HERSZENHORN and ROBERT PEAR

WASHINGTON — The Senate voted on Saturday to begin full debate on major health care legislation, propelling President Obama’s top domestic initiative over a crucial, preliminary hurdle in a formidable display of muscle-flexing by the Democratic majority.

“Tonight we have the opportunity, the historic opportunity to reform health care once and for all,” said Senator Max Baucus, Democrat of Montana, and a chief architect of the legislation. “History is knocking on the door. Let’s open it. Let’s begin the debate.”

The 60-to-39 vote, along party lines, clears the way for weeks of rowdy floor proceedings that will begin after Thanksgiving and last through much of December.

The Senate bill seeks to extend health benefits to roughly 31 million Americans who are now uninsured, at a cost of $848 billion over 10 years.

The House earlier this month approved its health care bill by 220 to 215, with just one Republican voting in favor. That measure is broadly similar to the Senate legislation, but there are some major differences that would have to be resolved before a bill could reach Mr. Obama, and that would almost surely push the process into next year.

As the Democrats succeeded Saturday in uniting their caucus by winning over the last two holdouts, big disagreements remained, making final approval of the bill far from certain.

Two reluctant Democratic senators, Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas, warned that their support for a motion to open debate did not guarantee that they would ultimately vote for the bill. Their remarks echoed previous comments by several other senators, including Ben Nelson, Democrat of Nebraska, and Joseph I. Lieberman, independent of Connecticut.

Those comments made clear that more horse-trading lies ahead and that major changes might be required if the bill is to be approved. And it suggested that the Senate majority leader, Harry Reid of Nevada, who relied only on members aligned with his party to bring the bill to the floor, may yet have to sway one or more Republicans to his side to get the bill adopted.

The Senate Republican leader, Mitch McConnell of Kentucky, said his party’s opposition would persist. “The battle has just begun,” he said.

In a rare ceremonial gesture reserved for major votes, senators cast their yeas and nays from their desks in the chamber, each one rising to voice his or her position. Senator George V. Voinovich, Republican of Ohio, was not present and did not vote.

After the vote, Mr. Reid said he understood that Ms. Landrieu was already working with two other Democratic senators, Thomas R. Carper of Delaware and Charles E. Schumer of New York, to see if they could devise a public insurance plan with broad appeal.

The White House issued a statement praising the vote. “The President is gratified that the Senate has acted to begin consideration of health insurance reform legislation,” his press secretary, Robert Gibbs, said, adding that President Obama “looks forward to a thorough and productive debate.”

Mrs. Lincoln, who faces a tough re-election campaign next year and has in recent weeks been the target of millions of dollars in television advertising by both sides in the health care fight, said pointedly that she would not vote for the measure if it retained a government-run health insurance plan, known as the public option, to compete with private insurers. “Although I don’t agree with everything in this bill, I believe it is more important that we begin debate on how to improve the health care system for all Americans,” said Mrs. Lincoln, who was the last uncommitted Democrat, and whose speech, at about 2:30 p.m. Saturday, lifted a cloud of suspense that had hovered around the Capitol.

She added: “But let me be perfectly clear. I am opposed to a new government-administered health care plan as a part of comprehensive health insurance reform, and I will not vote in favor of the proposal that has been introduced by leader Reid as it is written.” But Senator Lieberman, who voted to take up the health care bill, said he was still staunchly opposed to a government-run plan. It is “a terrible idea,” he said.

Ms. Landrieu, whose support came after she won a provision that could be worth more than $100 million in additional federal aid for her financially troubled state, said, “I have decided there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done.”

A parade of Democrats and Republicans spent Saturday laying out their arguments for and against the bill in floor speeches.

Mr. Reid, in a rousing closing speech given at his customary volume, which is barely audible, likened the health care bill to some of the most profound issues confronted by the Senate across history.

“Imagine if instead of debating either of the historic G.I. Bills — legislation that has given so many brave Americans the chance to brave college — if this body had stood silent,” Mr. Reid said. “Imagine if instead of debating the bills that created Social Security or Medicare, the Senate’s voices had been stilled. Imagine if instead of debating whether to abolish slavery, instead of debating whether giving women and minorities a right to vote, those who disagreed were muted, discussion was killed.”

With the Democrats nominally controlling 60 votes — the precise number needed to overcome the Republican attempt to stop the bill — the vote on Saturday evening was the biggest test yet of the Democrats’ resolve and of Mr. Reid’s ability to unite his fragile caucus. Mr. Reid faces a tough re-election fight next year.

The bill would expand health benefits by broadly expanding Medicaid, the federal-state insurance program for low-income people, and by providing subsidies to help moderate-income people buy either private insurance or coverage under a new government-run plan, the public option. And it would impose a requirement that nearly all Americans obtain insurance or pay monetary penalties for failing to do so.

According to the Congressional Budget Office, the cost of the legislation would be more than offset by new taxes and fees and reductions in government spending, so that the bill would reduce future federal budget deficits by $130 billion through 2019.

Mr. Reid accused Republicans who opposed the legislation of “living in a different world.” He and several other Democrats also used their speeches to assail perceived abuses by private insurers. “The health insurance industry has an insatiable appetite for more profit,” Mr. Reid said.

Senate Republicans countered with an impassioned denunciation of the measure as an ill-conceived budget-busting expansion of government and a threat to the health and economic security of all Americans, especially the elderly.

The Republicans sought to portray the vote on Saturday — on whether to end debate on a motion to bring up the health bill — as tantamount to a vote on the bill itself, and to shake the confidence of Democrats who had wavered in recent days.

In his closing argument, just ahead of the vote, Mr. McConnell implored at least a single Democrat to vote no. “If we don’t stop this bill tonight,” he said, “the only debate we’ll be having is about higher premiums, not savings for the American people, higher taxes instead of lower costs, and cuts to Medicare rather than improving seniors’ care.”

“The American people are looking at the Senate tonight; they’re hoping we say no to this bill,” Mr. McConnell added moments later, holding up a single index finger. “All it would take,” he said, “is just one member of the other side of the aisle, just one, to give us an opportunity not to end the debate but to change the debate in the direction the American people would like us to go.”

Mr. McConnell warned of the political consequences for senators who voted to move ahead. “Senators who support this bill have a lot of explaining to do,” he said. “Americans know that a vote to proceed on this bill, to get on this bill, is a vote for higher premiums, higher taxes and massive cuts to Medicare.”

Republicans also said that the vote was a proxy for a larger dispute over abortion, because they said the bill did not sufficiently restrict the use of federal money for insurance covering abortions. Senator Mike Johanns, Republican of Nebraska, described the vote as “the key vote on abortion in the health care debate.”

Saturday night’s vote was required because Senate rules and precedent have long granted a right of virtually unlimited debate, or filibuster, to the minority that can be curtailed only by a supermajority vote of 60 senators to move ahead. Currently, there are 58 Democrats in the Senate and two independents who routinely align with them. If the Democrats had lost the vote, they could have tried again, presumably after changing the bill to try to attract more votes.

Senator Patrick J. Leahy, Democrat of Vermont assailed the Republicans as obstructionists on Saturday morning. “I will vote today to end the filibuster so the Senate can begin the historic debate to improve and reform our nation’s health insurance system,” he said. “Let’s not duck the debate, let the debate begin. Let’s not hide from the votes.”

While Democrats generally agree on the broad goals of the legislation, to cover the uninsured and to slow the growth in health care spending, there are potentially serious disagreements over any number of provisions that could sink the bill.

Ms. Landrieu, in her speech, methodically cataloged provisions of the bill that she liked and those that she said needed improvement.

Under the bill, she said, owners of small businesses would no longer face “volatile costs” for health insurance. In addition, she said, the bill would “encourage employers to move away from high-cost benefit plans” and shift some compensation to wages.

But more needed to be done to improve the bill, she argued, particularly to help small businesses and the self-employed. And she issued a stern warning about the public option, one of the most contentious features of the sweeping health care legislation.

Carl Hulse contributed reporting.

By Chris Jordan
November 18, 2009

As a liberal, and an avid news consumer, there is no cable news channel that warms my heart more than MSNBC.

Why do I find MSNBC so appealing? The network made a business decision in recent years that it was good for ratings to move to the political left. With a few exceptions, strong liberal commentators like Keith Olbermann, Rachel Maddow, Ed Schultz, and Chris Matthews have become the face of MSNBC.

The same trend is taking place on the opposite side of the cable divide. We’ve known for years that Fox News’ “Fair and Balanced” act was a charade, but since Obama’s election, they’ve taken it to a whole new level.

Fox was instrumental in relentlessly promoting the right-wing “tea parties,” even going so far as to inform its viewers of their times and locations. Former Republican presidential candidate Mike Huckabee has been given his own talk show. Glenn Beck has also joined Fox and has seen his ratings skyrocket after labeling the president a racist.

While Fox and MSNBC have shifted further away from the center, CNN has largely stuck to simply covering the news.

Anchors Larry King, Wolf Blitzer, and Anderson Cooper rarely promote a politically slanted agenda on their shows. What’s been their reward? Declining ratings.

The trend toward more partisan news is clear. Cable stations are transitioning to more and more commentary, less and less hard news.

I’m not trying to argue that opinions are bad. Heck, I’d be out of a job if we didn’t have opinions in the media. But this trend seems to indicate that news stations are increasingly going to have to “pick sides” or suffer lower ratings, and citizens are getting more news from one-sided sources.

Simultaneously, high-profile stories of late have demonstrated the mainstream media’s obsession with the political angle over substantive discussion and debate.

A perfect example is coverage of the health care issue. Until several weeks ago, the phrase, “the public option is dead” was spouted on cable news, oh, about 10,231 times, by my count. We’ve seen endless stories about the “fate” of this proposal, but it’s hard to remember if there was even a serious and thorough discussion of its merits.

While partisan news sources are on the rise, we are seeing less and less debate of key issues. News channels obsess over the politics of health care — Will it pass? Are there enough votes? Obama’s approval rating is down! — without paying much attention to the actual components of reform.

It’s no wonder then, that less than half of Americans, 47 percent, say they are very or somewhat familiar with the details of the health-care legislation, according to a recent Washington Post survey. While Congress is on the verge of passing the most important reform in decades, most people don’t even know what is in the bill.

Thanks a lot, news media.

As we strive to be informed citizens, it is important that we make extra effort to get a range of perspectives instead of merely “picking a team.” One-sided news is becoming increasingly prevalent. So next time you’re watching MSNBC, consider switching over to Fox during the commercial break (I know it’s painful) just to see what they’re saying, or seek out conservative opinions elsewhere. The same idea applies if Fox News is the channel that warms your heart: Seek out other views.

As far as a robust debate in the news media goes, we can only hope that the recent trend reverses itself and consumers start to reward those programs that go truly in depth on the issues.

Reach columnist Chris Jordan at opinion@dailyuw.com.

GOP and liberals put pressure on Democrat as Senate vote nears

By Shailagh Murray
Washington Post Staff Writer
Tuesday, November 17, 2009

When the Senate begins floor debate on a health-care reform package this week, the outcome is almost certain to rest on decisions made by a handful of moderate Democrats.

None of those Democrats is feeling the heat as intensely as Sen. Blanche Lincoln (Ark.), who has become emblematic of the improbable distance that health-care reform has traveled, and how far it still must go before becoming law.

Her vote and that of two other Democrats expressing serious reservations about the legislation — Sens. Ben Nelson (Neb.) and Mary Landrieu (La.) — will determine whether it will garner the 60 needed to break an all-but-certain Republican filibuster.

There are 60 members of the Democratic caucus but one, independent Sen. Joseph I. Lieberman (Conn.), has threatened to join a GOP filibuster if the final bill contains a government insurance plan, or “public option.” With only a single Republican, Sen. Olympia J. Snowe of Maine, even considering backing the final product on the floor, the trio of Democratic centrists could make or break the reform effort.

And of those three, only Lincoln must face voters next year.

Hundreds of thousands of Lincoln’s constituents are low-income and lack insurance, the very kind of voters expected to benefit under the Senate bill. Lincoln, a second-term senator, helped write some of the legislation’s key provisions as a member of the Finance Committee, and her sometimes uncomfortable role near the center of the debate could cost her in culturally conservative Arkansas. Despite the potential benefits for many in her state, polls show her support weakening, and constituents are expressing doubts about the proposed overhaul.

The low-profile centrist is being pressed by both sides. Democratic activists are incensed that she has turned against the public option, an idea she once supported. Republicans are casting her cautious approach to the health-care debate in starkly political terms, saying that she is unwilling to put local interests above those of a president who lost the state by a resounding 20 percentage points.

“I want to be a check and balance on Barack Obama’s extreme agenda,” state Sen. Gilbert Baker, a front-runner for the GOP nomination, told reporters last week.

An Arkansas Poll published Nov. 5 found that Lincoln’s job-approval rating had dropped to 43 percent, from 54 percent a year ago. At least seven Republicans are vying to challenge her bid for a third term; Baker raised $500,000 in his first month as a candidate. And if she does not embrace the party line on the health issue, Lincoln could also face a Democratic primary challenger, along with a Green Party opponent in the general election.

“In some ways, there’s not a good vote on this,” said Sen. Mark Pryor (D), Arkansas’s junior senator, who coasted to reelection last year. “You’re going to have detractors on either side, no matter what you do. So I think in the end you have to what you think is right. And I think that’s what we’re all going to have to do.”

The first test for Lincoln could come as early as Friday, when the Senate will vote on whether to bring the bill to the floor. Lincoln told party leaders she would study the final product before committing either way.

“What people want is for us to take our time and not rush into something that we haven’t thought completely through,” she said, shrugging off the pressure as she hurried back to her office after a Senate vote last week.

Although Pryor supports the reform effort, another prominent Arkansan, Rep. Mike Ross (D), voted against the House bill.

“Most people support the need for health-insurance reform; they just think we can do it for less,” Ross said. “They really, as I do, support more choices. They’re just skeptical of a bill that takes 2,000 pages to accomplish that.”

Ross was reluctant to offer Lincoln advice, but acknowledged her predicament. “She represents the whole state. I just represent one-fourth of the state. I’d just be guessing.” But he added: “I think people fear the unintended consequences in a bill this massive.”

Democratic leaders expect Lincoln to stick with them on key procedural votes, but are less confident about winning her support on critical amendments — particularly on the contentious public option.

Lincoln’s record on a government insurance plan has drawn detractors on both sides. In July, she wrote in the Arkansas Democrat-Gazette: “Individuals should be able to choose from a range of quality health insurance plans. Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan.”

By Sept. 1, she had changed her mind. “I would not support a solely government-funded public option,” Lincoln said at an event in Little Rock. “We can’t afford that.”

In recent weeks, she also has raised concerns about both potential compromise approaches — one that would allow states to “opt out” of a public plan that Senate Majority Leader Harry M. Reid (D-Nev.) is expected to include in the Senate bill, and a proposal by Snowe, the only Republican still at the negotiating table, to create a public option as a fallback if private insurers do not offer reasonable rates.

In the process, Lincoln has riled liberal groups including MoveOn.org, which is targeting her with radio ads, direct mail and rallies outside two of her Arkansas offices. Perhaps more ominously, MoveOn — working with the liberal group Democracy for America — has amassed $3.5 million in pledges to fund primary challenges against any Democratic senator who sides with Republicans to block an up-or-down vote on a bill with a public option.

“We think it’s really important for her to see there are negative political consequences to being on the wrong side of this issue,” said Ilyse Hogue, MoveOn’s campaign director. “There’s no arguing she’s in a conservative state, but she’s going to face a tough election no matter what, and she can’t do it without the base. These are the activists, the people who knock on doors, and she is really running the risk of alienating them.”

The National Republican Senatorial Committee is also documenting each of Lincoln’s comments on health care to build a case against her. The Republican National Committee released a Web video this week that compares her public-option remarks to Sen. John F. Kerry’s “I actually voted for it before I voted against it” line about Iraq war funding.

For GOP leaders, the best strategy for defeating the Senate bill is to sow doubts among vulnerable Democrats, convincing them that Reid is leading them off a political cliff.

“There’s a great effort under way here to convince their members to ignore public opinion” on health-care reform, Minority Leader Mitch McConnell (R-Ky.) told reporters last week. “I hope it will not be lost on our Democratic friends where the public is, how the public feels about this measure. They’re speaking increasingly loudly that they do not think it ought to pass.”

Recent polls suggest that reform is a difficult sell in Lincoln’s home state. The Arkansas Poll, conducted in mid-October by the University of Arkansas’s Survey Research Center, found that 39 percent of voters support a public option and 48 percent oppose the idea. And respondents split about evenly on the question of whether reform would improve or hurt their quality of care.

“It’s hard to draw firm conclusions,” said Arkansas Poll Director Janine Parry. “People are dissatisfied, but they haven’t signed on with an alternative.” Lincoln, said Parry, appears to be “right with her constituents — convinced that we need to do something, and not convinced it’s this.”

Senior Senate aides said Lincoln helped to shape measures aimed at reducing the cost of such procedures as MRIs and at better coordinating care among doctors, hospitals and nursing homes. And she was the primary sponsor, along with Snowe, of a provision aimed at giving small businesses more health-care choices for employees.

According to the Kaiser Family Foundation, of the nearly 473,000 Arkansas residents who lacked coverage as of 2008, virtually all would be eligible for federal assistance under the Senate bill — either through Medicaid or through tax credits that would subsidize the purchase of private plans.

“There’s a lot in the bill that will be good for Arkansas,” Pryor said. “But there are a lot of people in our state who are against this bill. Some have very legitimate concerns and ask very good questions. But also some is based on bad information. We have to try to talk to those people.”

If Lincoln supports the Senate bill, she will have to sell it to constituents before they see many of the legislation’s benefits. But she says she is well aware of the challenge. “I have no doubt that I’ll be held accountable on this,” she said. “We’re going to be held accountable on a lot of things.”

But poll finds support for key provisions of reform effort

By Dan Balz and Jon Cohen
Washington Post Staff Writers
Tuesday, November 17, 2009

As the Senate prepares to take up legislation aimed at overhauling the nation’s health-care system, President Obama and the Democrats are still struggling to win the battle for public opinion. A new Washington Post-ABC News poll shows Americans deeply divided over the proposals under consideration and majorities predicting higher costs ahead.

But Republican opponents have done little better in rallying the public opposition to kill the reform effort. Americans continue to support key elements of the legislation, including a mandate that employers provide health insurance to their workers and access to a government-sponsored insurance plan for those people without insurance.

Over the past few months, public opinion has solidified, leaving Obama and the Democrats with the political challenge of enacting one of the most ambitious pieces of domestic legislation in decades in the face of a nation split over the wisdom of doing so. In the new poll, 48 percent say they support the proposed changes; 49 percent are opposed.

With the bill through the House, Senate Democrats are now looking for the votes to enact their version of the legislation and keep the reform effort moving forward. Whatever the outcome of the health-care debate, it will have a powerful influence in shaping the political climate for next year’s midterm elections.

The House bill contains a highly controversial provision prohibiting abortion coverage for those insured under a new public insurance plan as well as those who received federal subsidies to purchase private insurance. In the poll, 61 percent say they support barring coverage for abortions for those receiving public subsidies, but if private funds were used to pay for abortion expenses, the numbers flipped. With segregated private money used to cover abortion procedures, 56 percent say insurance offered to those using government assistance should be able to include such coverage.

The new poll provides ammunition for both advocates and opponents of reform. For opponents, a clear area of public concern centers on cost — 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result.

Few see clear benefits in exchange for higher expenses. Rather, there has been a small but significant increase in the number (now 37 percent) who anticipate their care deteriorating under a revamped system, putting that number in line with opinion in July 1994, just before President Bill Clinton’s health-care reform efforts fizzled.

Among those with insurance, three times as many continue to see worse rather than better coverage options ahead (39 to 13 percent), and fewer than half of those who lack insurance see better options under a changed system. Six in 10 see it as “very” or “somewhat” likely that many private insurers would be forced out of business by a government-sponsored insurance plan, a potential result that GOP leaders frequently warn about.

But reform proponents have other findings to bolster their case. Two-thirds of those surveyed support one of the basic tenets of the reform plan, a new requirement that all employers with payrolls of $500,000 or more provide health insurance coverage for their employees or face fines.

As in previous polls, a majority supports a government-sponsored heath insurance plan to compete with private insurers, although the percentage supporting the general idea has slipped slightly over the past month to 53 percent. Support for the scheme jumps to 72 percent when the public plan is limited to those who lack access to coverage through an employer or the Medicare or Medicaid systems.

While Americans overall are divided on reform legislation, the Democrats have made some progress among at least one key group. Support among senior citizens, while still broadly negative, is up 13 points since September to 44 percent.

Seniors have also tilted back toward Obama when matched head to head with congressional Republicans on dealing with health-care reform, helping the president to a 13-point advantage over the GOP on this issue.

Republicans appear to be hampered by a widespread perception that they have not offered clear choices: 61 percent of those polled say the GOP is “mainly criticizing” without presenting alternatives to Democratic proposals.

Looking toward next year’s midterm elections, 25 percent say they more apt to back a candidate who supports the proposed health-care changes; 29 percent are less likely to do so. More, 45 percent, say the vote will not make much of a difference. Independents are nearly twice as likely to be swayed away from rather than toward a candidate who supports the changes (31 percent to 17 percent).

Beyond health care, Obama continues to garner broadly positive ratings from the public. His overall approval rating stands at 56 percent, holding steady in Post-ABC polls since the late summer. More, 61 percent, say they have an overall favorable impression of him, and a slim majority continues to see him as “about right” ideologically (four in 10 consider him “too liberal.”

The president, who is on a 10-day visit to Asia, gets his top mark on handling international affairs, and also picks up majority approval on dealing with the threat of terrorism. But Americans are more divided over his performance on other key issues, with nearly even splits in satisfaction with his work on health care, the economy and the situation in Afghanistan. On each of these three issues, intensity runs against the president, with significantly higher numbers expressing “strong” disapproval as strident approval. Obama receives generally negative reviews on his handling of the federal budget deficit, with 53 percent disapproving of his actions on that front.

Obama continues to be lifted by weakness in the opposition. In addition to his double-digit lead over congressional Republicans on health care, the president has a 15-point advantage on handling the nation’s still-struggling economy. More broadly, Democrats continue to have the edge as the party more trusted to deal with the country’s main problems over the next few years and when it comes to being more empathetic and more in tune with people’s values.

But there are also evident signs of an anti-incumbent mood in the new survey, which would disproportionately hurt the majority Democrats next fall should they hold. Most see the country as headed pretty seriously off on the wrong track and half of all Americans say they are inclined to look around for someone new to support for Congress; just 38 percent are inclined to reelect their member of Congress. These numbers are similar to those from November 1993, one year before Republicans took back control of the House and Senate and close to those from May 2006, six months before Democrats re-captured the Congress.

Among independents, nearly two-thirds say they are inclined to seek new representatives. Independents also about evenly divided over which party better represents their personal values and give Democrats a narrow advantage on being more in tune with “needs of people like you.” More than a quarter of independents do not trust either party to adequately deal with the country’s primary concerns in the coming years.

The poll was conducted Nov. 12-15 by conventional and cellular telephone among a random national sample of 1,001 adults. The margin of sampling error is plus or minus three percentage points.

Polling analyst Jennifer Agiesta contributed to this report.

House liberals threaten to vote against final version of health overhaul
by James Oliphant And Kim Geiger
Tribune Washington Bureau

WASHINGTON – Furious liberals on Monday threatened to derail the massive health care overhaul bill to protest a last-minute deal over insurance coverage of abortions that had secured passage of the legislation in the House.

At least 40 House members pledged not to vote for a final health care bill if the abortion provision survives – endangering the exceptionally fragile Democratic coalition that has kept the bill afloat.

At issue are the insurance policies offered in a new “exchange,” or insurance marketplace, that the legislation would create to help consumers purchase health plans, many using newly created federal subsidies.

The House measure says the federal subsidies cannot be used to buy health policies that cover elective abortion. But abortion rights supporters say this would affect a broad set of consumers, because insurers would likely abandon abortion coverage in all policies offered in the exchange.

The provision “represents an unprecedented and unacceptable restriction on women’s ability to access the full range of reproductive health services to which they are lawfully entitled,” the House members wrote to House Speaker Nancy Pelosi.

It was a tougher line than they had adopted less than 48 hours earlier, when they had, almost to a member, voted to pass the health legislation. The bill cleared the chamber late Saturday night by a mere five votes.

The tumult over abortion now travels to the Senate, where it promises to cause headaches for Democrats still wrestling with fundamental issues of cost, coverage and revenues in its version of the health legislation.

Legislation before the Senate contains looser restrictions on abortion coverage than was approved by the House. But, already, at least one Senate Democrat, Ben Nelson of Nebraska, appears willing to work with abortion rights opponents on language similar to that from the House.

President Barack Obama suggested Monday the House measure might be altered as the legislation moves through Congress, though he did not say he would push for changes himself.

Obama told ABC News the bill should uphold the principle that federal money may not be used to subsidize abortions.

“And I want to make sure that the provision that emerges meets that test – that we are not in some way sneaking in funding for abortions, but, on the other hand, that we’re not restricting women’s insurance choices,” he said. “Because one of the pledges I made in that same speech was to say that if you’re happy and satisfied with the insurance that you have, that it’s not going to change.”

The House amendment would allow people buying insurance in the exchange to purchase separate “riders” that would cover abortions. Abortion-rights advocates say few would do so, because few women anticipate an unplanned pregnancy and few insurers are likely to offer such a separate service.

“No one counts on getting an abortion,” said Rachel Laser, a lawyer with Third Way, a Washington think tank that advocates centrist policies.

In 2001, 13 percent of abortions were billed directly to insurance companies, according to the Guttmacher Institute, which studies reproductive health. That figure, however, may understate insurance payments for abortion, because it does not include cases where women paid for the procedure out of pocket and later asked for reimbursement from their insurers.

Dr. Willie Parker, a board member at Physicians for Reproductive Choice and Health, said the amendment could have the greatest impact on women whose underlying health conditions require hospitalization in order for a safe abortion to be performed.

Parker cited an example of a woman with a pregnancy that involves abnormal attachment of the placenta. While a standard abortion may cost just $350, the cost in that situation would range between $3,000 and $4,000.

Change dropping abortion coverage may have helped sway vote
by David Lightman
McClatchy

WASHINGTON – The House of Representatives on Saturday passed, by a 220-215 vote, historic health care overhaul legislation that would require nearly all Americans to obtain health insurance and create a government-run health insurance plan to help them do so.

If passed by the Senate, the bill would bring about the most sweeping changes in the American health care system since Medicare was created 44 years ago.

Supporters of the measure burst into cheers and applause on the House floor as it became clear the measure had won, but the vote was excruciatingly close, passing by just two votes more than the bare minimum needed. One Republican, Joseph Cao of Louisiana, voted for the bill; 39 Democrats, including Idaho’s Walt Minnick, voted against.

President Barack Obama made a personal plea for passage before the all-day debate began.

“Now is the time to finish the job,” Obama said in brief remarks in the White House Rose Garden after meeting with House Democrats.

The job is far from finished. The Senate hopes to act by the end of the year, and if successful, the two Houses would then craft a compromise that would need approval of each chamber.

The House vote came with a warning: Getting enough votes later this year or early in 2010 will not be easy. Thirty-nine Democrats, most from conservative districts or freshmen who narrowly won their 2008 elections, voted against the House bill, joining 176 Republicans. In the Senate, eight to 12 moderates have expressed reservations about that chamber’s proposal.

In addition to creating the public option government-run insurance program, the House-passed bill would bar insurers from denying people coverage because of pre-existing conditions and set up health care “exchanges,” or marketplaces, where consumers could easily shop for coverage.

The changes are expected to mean that by 2019, 96 percent of eligible Americans would have health insurance, up from the current 83 percent.

During his half-hour appearance on Capitol Hill, Obama took no questions from lawmakers, but his presence was a vivid reminder that the president has put health care overhaul at the top of his domestic agenda – a change that has eluded presidents for nearly a century.

“He came here to say, ‘This is what we said we would do in the campaign. Let’s do it,’ ” said House Majority Leader Steny Hoyer, D-Md.

On the House floor, Democratic leaders appealed to members’ sense of history, reminding them this was one of the most significant votes, short of war, that they were likely to take.

“There are few moments when we have the opportunity to do so much good with one vote. This is one of those moments,” said Hoyer.

Republicans countered with arguments that the health care plan did little to improve coverage or affordability.

“Astoundingly, Democrats are bringing to the floor a bill today that will not reduce the costs of health insurance; it will grow the size of government,” said GOP Conference Chairman Mike Pence, R-Ind.

The bill may have gotten a boost from a deal to bar coverage by government-subsidized insurance policies of elective abortions.

As originally written, the measure would have required insurers to separate public and private money, so that only private funds could be used for elective abortions. Abortion opponents were concerned that such a policy would effectively expand the government’s role in improving access to abortion, and as many as 40 Democrats threatened to withhold support from the health care bill unless changes were made.

After tense negotiations Friday night – with White House officials and representatives of the U.S. Conference of Catholic Bishops as well as key Democratic members of Congress – House Democratic leaders agreed to allow a vote Saturday on sweeping changes to the abortion provision.

The measure was approved, 240-194, as 64 Democrats joined 176 Republicans to back the change.

The change would permit abortion coverage for people receiving federal aid for their insurance only in the case of rape or incest or when the mother’s life is endangered, consistent with a 1970s-era federal law governing public funding of abortion. Under the new provision, only people buying private insurance with their own funds would have an elective abortion covered.

Many abortion rights advocates were angry, and the brief debate often pitted Democrat against Democrat. “This amendment is government interference in the decision between a woman and her physician,” said Rep. Lois Capps, D-Calif. “Unnecessary and reprehensible,” added Rep. Nita Lowey, D-N.Y.

“Today we’re on the brink of passing health care reform that honors and respects life in every state,” countered Rep. Brad Ellsworth, D-Ind.

Republicans tried throughout the day to create more doubt and delay, shouting objections to routine parliamentary requests by objecting when Democratic women tried to discuss their concerns on the House floor.

GOP members then pushed their own plan, which would make it easier for small businesses to band together to purchase competitively priced coverage, allow consumers to buy policies across state lines, and effect strong medical malpractice reforms.

It was easily defeated on a largely party line vote, 258-176.

In the Senate, where moderates’ concerns have stalled progress, Democratic leaders are hoping for a debate and vote before the end of the year.

“My vote is not an endorsement of all the provisions of the bill, because I find much of the bill to be deeply flawed,” said Rep. Jim Cooper, D-Tenn., a Blue Dog who backed the measure. “My reason for voting ‘yes’ is to advance the cause … by forcing the Senate to act.”

10 ways the House bill would change health care

1 Creates a government-run “public option” to offer coverage.

2 Sets up insurance “exchanges” where consumers can easily compare plans.

3 Requires nearly everyone to obtain health insurance by 2013.

4 Requires health plans to allow children to remain on parents’ policies until their 27th birthday.

5 Provides federal financial help for lower- and middle-income consumers to obtain coverage.

6 Bars insurers from denying or limiting coverage because of pre-existing conditions.

7 Bars insurers from imposing lifetime limits on coverage.

8 Expands Medicaid coverage.

9 Imposes 5.4 percent surcharge on adjusted gross incomes of more than $500,000 for individuals and $1 million for joint filers.

10 Imposes penalties on people and businesses who fail to comply.

McClatchy-Tribune

by Cal Thomas
The Spokesman-Review

Does the U.S. Constitution stand for anything in an era of government excess? Can that founding document, which is supposed to restrain the power and reach of a centralized federal government, slow down the juggernaut of czars, health insurance overhaul and anything else this administration and Congress wish to do that is not in the Constitution?

The Framers created a limited government, thus ensuring individuals would have the opportunity to become all that their talents and persistence would allow. The Left has put aside the original Constitution in favor of a “living document” that they believe allows them to do whatever they want and demand more tax dollars with which to do it.

Can they be stopped? Some constitutional scholars think the Tenth Amendment offers the best opportunity. The Tenth Amendment states: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

In 1939, the Supreme Court began to dilute constitutional language so that it became open to broader interpretation. Rob Natelson, professor of Constitutional Law and Legal History at the University of Montana, has written that even before Franklin Roosevelt’s court-packing scheme, it was changing the way the Constitution was interpreted, especially “how the commerce and taxing powers were turned upside-down, the necessary and proper clauses and incidental powers, the false claim that the Supreme Court is conservative, how bad precedent leads to more bad court rulings, state elections as critical for constitutional activists, and more.”

While during the past seven decades the court has tolerated the federal welfare state, Natelson says it has never, except in wartime, “authorized an expansion of the federal scope quite as large as what is being proposed now. And in recent years, both the Court and individual justices – even ‘liberal’ justices – have said repeatedly that there are boundaries beyond which Congress may not go.” … “Chief Justice John Marshall once wrote that if Congress were to use its legitimate powers as a ‘pretext’ for assuming an unauthorized power, ‘it would become the painful duty’ of the Court ‘to say that such an act was not the law of the land.’ ”

It would be nice to know now what those boundaries are and whether Congress is exceeding its powers as it prepares to alter one-sixth of our economy and change how we access health insurance and health care.

Natelson makes a fascinating argument in his essay, “Is ObamaCare Constitutional?” (www.tenthamend mentcenter.com/2009/08/18/is-obama care-constitutional), using the court’s Roe v. Wade ruling in 1973. In Roe, he writes, the court struck down state abortion laws that “intruded into the doctor-patient relationship. But the intrusion invalidated in Roe was insignificant compared to the massive intervention contemplated by schemes such as HB3200. ‘Global budgeting’ and ‘single-payer’ plans go even further, and seem clearly to violate the Supreme Court’s Substantive Due Process rules.”

Constitutional attorney John Whitehead, president of the Rutherford Institute, tells me, “Although the states surrendered many of their powers to the new federal government, they retained a residuary and inviolable sovereignty that is reflected throughout the Constitution’s text. The Framers rejected the concept of a central government that would act upon and through the states, and instead designed a system in which the state and federal governments would exercise concurrent authority over the people. The court’s jurisprudence makes clear that the federal government may not compel the states to enact or administer a federal regulatory program.”

Lawyers are busy writing language only they can understand that seeks to circumvent the intentions of the Founders. But it will be difficult to circumvent the last four words of the Tenth Amendment, which state unambiguously where ultimate power lies: “… or to the people.”

Americans who believe their government should not be a giant ATM, dispensing money and benefits to people who have not earned them, and who want their country returned to its founding principles, must now exercise that power before it is taken from them. The Tenth Amendment is one place to begin. The streets are another. It worked for the Left.

Cal Thomas is a columnist for Tribune Media Services.

Boehner says House version based on four principles
by David Lightman
McClatchy

WASHINGTON – Small businesses would have an easier time banding together to offer insurance to employees. Consumers could cross state lines to buy coverage. There’d be no big government expansion.

Those are among the ideas that Republicans in the House of Representatives plan to push later this week, as lawmakers expect to begin debating how to overhaul the nation’s health care system.

One longtime favorite Republican proposal apparently will be absent: The Republican plan will contain no tax incentives for consumers who buy insurance individually, said House Minority Leader John Boehner, R-Ohio.

“Cost,” he said, was the reason for the omission.

Chances are that little or none of the Republican plan will become law, since the House has 177 Republicans and 256 Democrats and Democrats control 60 of the Senate’s 100 seats.

The Republican strategy has two missions: Illustrate what the party stands for, and try to demonize and defeat Democratic initiatives.

House Democrats have proposed a 1,990-page bill that includes a government-run insurance plan, or “public option,” that would compete with private insurers. Savings in Medicare and a tax on the wealthy largely would pay for the legislation, which has been estimated to cost a net $894 billion over 10 years. The tax surcharge would apply to adjusted gross incomes of more than $500,000 for individuals and $1 million for joint filers.

Debate on that plan could begin late this week, with final votes late this week or early next week. The Republican plan would be offered as an alternative.

In the House, Republican leaders began mounting an offensive last week built around four key principles, as Boehner outlined Monday:

•Giving states more flexibility to “create their own innovative reforms.”

•Making it easier for employers, individuals and small businesses to set up risk pools.

Under one scenario, a small business that operates in different states could draw customers – and thus pool risks – from all states where it conducts business. Currently, such pools are subject to the rules and regulations of each state, which critics see as burdensome.

Researchers study three decades worth of data
by Lindsey Tanner
Associated Press

CHICAGO – Nearly half of all U.S. children and 90 percent of black youngsters will be on food stamps at some point during childhood, and fallout from the current recession could push those numbers even higher, researchers say.

The estimate comes from an analysis of 30 years of national data, and it bolsters other recent evidence on the pervasiveness of youngsters at economic risk. It suggests that almost everyone knows a family who has received food stamps, or will in the future, said lead author Mark Rank, a sociologist at Washington University in St. Louis.

“Your neighbor may be using some of these programs, but it’s not the kind of thing people want to talk about,” Rank said.

The analysis was released Monday in the November issue of Archives of Pediatrics and Adolescent Medicine. The authors say it’s a medical issue pediatricians need to be aware of because children on food stamps are at risk for malnutrition and other ills linked with poverty.

“This is a real danger sign that we as a society need to do a lot more to protect children,” Rank said.

Food stamps are a Department of Agriculture program for low-income individuals and families, covering most foods although not prepared hot foods or alcohol. For a family of four to be eligible, their annual take-home pay can’t exceed about $22,000.

According to a USDA report released last month, 28.4 million Americans received food stamps in an average month in 2008, and about half were younger than age 18. The average monthly benefit per household totaled $222.

Rank and Cornell University sociologist Thomas Hirschl studied data from a nationally representative survey of 4,800 American households interviewed annually from 1968 through 1997 by the University of Michigan. About 18,000 adults and children were involved.

Overall, about 49 percent of all children were on food stamps at some point by the age of 20, the analysis found. That includes 90 percent of black children and 37 percent of whites. The analysis didn’t include other ethnic groups.

The time span included typical economic ups and downs, including the early 1980s recession. That means similar portions of children now and in the future will live in families receiving food stamps, although ongoing economic turmoil may increase the numbers, Rank said.

An editorial in the medical journal agreed.

“The current recession is likely to generate for children in the United States the greatest level of material deprivation that we will see in our professional lifetimes,” Stanford pediatrician Dr. Paul Wise wrote.

Wise said the Archives study estimate is believable.

“I find it terribly sad, but not surprising,” Wise said.

James Weill, president of Food Research and Action Center, a Washington-based advocacy group, said the analysis underscores that “there are just very large numbers of people who rely on this program for a month, six months, a year.”

“What I hope comes out of this study is an understanding that food stamp beneficiaries aren’t them – they’re us,” Weill said.

The analysis is in line with other recent research suggesting that more than 40 percent of U.S. children will live in poverty or near-poverty by age 17; and that half will live at some point in a single-parent family. Also, other researchers have estimated that slightly more than half of adults will use food stamps at some point by age 65.

by Associated Press

WASHINGTON (AP) — President Barack Obama declared the swine flu outbreak a national emergency and empowered his health secretary to suspend federal requirements and speed treatment for thousands of infected people.

The declaration that Obama signed late Friday authorized Health and Human Services Secretary Kathleen Sebelius to bypass federal rules so health officials can respond more quickly to the outbreak, which has killed more than 1,000 people in the United States.

The goal is to remove bureaucratic roadblocks and make it easier for sick people to seek treatment and medical providers to provide it immediately. That could mean fewer hurdles involving Medicare, Medicaid or health privacy regulations.

“As a nation, we have prepared at all levels of government, and as individuals and communities, taking unprecedented steps to counter the emerging pandemic,” Obama wrote in the declaration, which the White House announced Saturday.

He said the pandemic keeps evolving, the rates of illness are rising rapidly in many areas and there’s a potential “to overburden health care resources.”

Because of vaccine production delays, the government has backed off initial, optimistic estimates that as many as 120 million doses would be available by mid-October. As of Wednesday, only 11 million doses had been shipped to health departments, doctor’s offices and other providers, according to the Centers for Disease Control and Prevention officials said.

The government now hopes to have about 50 million doses of swine flu vaccine out by mid-November and 150 million in December.

The flu virus has to be grown in chicken eggs, and the yield hasn’t been as high as was initially hoped, officials explained.

Swine flu is more widespread now than it’s ever been. Health authorities say almost 100 children have died from the flu, known as H1N1, and 46 states now have widespread flu activity.

Worldwide, more than 5,000 people have reportedly died from swine flu since it emerged this year and developed into a global epidemic, the World Health Organization said Friday. Since most countries have stopped counting individual swine flu cases, the figure is considered an underestimate.

by Cal Thomas
The Spokesman-Review

“That’s just the way it is. Some things will never change …” (Bruce Hornsby song lyric)

The Washington Post headline sounds as if a comedy writer, or someone fluent in George Orwell’s “Newspeak” wrote it: “Record-High Deficit May Dash Big Plans,” it said.

As if a contributing factor to the projected record-high deficit of $1.4 trillion has nothing to do with big spending by this and previous administrations. Is there no end? Will we ever reach a limit where government says, “no more, we’ve done enough; you’re on your own now”? Apparently not. The “greatest generation” mostly lived within their means. They knew what it meant to go without all but essentials. Today, we think the sky is the limit when it comes to spending and that if we can conceive it, then we are entitled to it.

This is partly because of how dysfunctional Washington has become and partly due to our own sense of “what we are owed.” Government can spend, tax and do whatever it wishes. If you oppose what it does, you are a selfish, greedy, rich elitist who cares nothing about people less fortunate than yourself. But wait. Did we have fewer poor people before government stepped in to “cure” poverty? Do we have fewer now? We aren’t sure if the war in Afghanistan can be won, but we know the war on poverty was lost. Once, the prospect of an empty stomach motivated most people to get up and start chasing opportunity. Today, people can do whatever they want and government will bail them out with a welfare check (for the poor) or a corporate welfare check (for the rich). Bad decisions? No problem. Failure is no longer an option.

Thomas, you are such a racist and an uncaring person. You’ve been lucky and should have to pony up for the less fortunate.

How about showing the “less fortunate” the way to become fortunate? Does anyone hear a politician in either party encouraging people to do for themselves, instead of relying on government? And that goes for big corporations, too.

People who play by the rules, stay in school, refuse to take drugs, marry before having children, and stay married, are no longer considered worthy role models by government, which has no intention of making them the norm. These norms have disappeared in a cloud of diversity and political correctness. Government now proposes to transform health insurance and tax responsible citizens at increased rates to pay for the votes, uh, benefits of others who are more content to take slices of other people’s pies rather than learn to bake their own.

If you have been an honest businessperson and give money to your church and charities to help others who want to succeed but are having difficulty doing so through no fault of their own, that no longer matters. In fact, government proposes to reduce the deductibility of your charitable giving because government sees itself as more capable of charity than you.

That’s what the Obama administration’s proposal to send a $250 check to every senior citizen is about. Seniors won’t get a cost of living adjustment in their Social Security checks next year because the cost of living hasn’t gone up. But because seniors have become accustomed to an annual raise, the president apparently thinks by giving it to them anyway, he can buy their support for health care legislation that is not in their interest.

Washington’s attitude toward those who make right decisions for themselves so as not to become a burden to government seems to be, “Good for you, but because you made all those right decisions (‘right’ being a relative term, so the government will say they were right FOR YOU), we will penalize your decisions and your success and take the money you earned and give it to others who didn’t earn it because we want their votes so we can preserve our political careers.”

“Well they passed a law in ’64,

To give those who ain’t got a little more,

But it only goes so far.”

For government, it’s never far enough.

Cal Thomas is a columnist for Tribune Media Services.
Get more news and information at Spokesman.com

CLEAR MAJORITY NOW BACKS PLAN
Americans still divided on overall packages

By Dan Balz and Jon Cohen
Washington Post Staff Writer
Tuesday, October 20, 2009

A new Washington Post-ABC News poll shows that support for a government-run health-care plan to compete with private insurers has rebounded from its summertime lows and wins clear majority support from the public.

Americans remain sharply divided about the overall packages moving closer to votes in Congress and President Obama’s leadership on the issue, reflecting the partisan battle that has raged for months over the administration’s top legislative priority. But sizable majorities back two key and controversial provisions: both the so-called public option and a new mandate that would require all Americans to carry health insurance.

Independents and senior citizens, two groups crucial to the debate, have warmed to the idea of a public option, and are particularly supportive if it would be administered by the states and limited to those without access to affordable private coverage.

But in a sign of the fragile coalition politics that influence the negotiations in Congress, Obama’s approval ratings on health-care reform are slipping among his fellow Democrats even as they are solidifying among independents and seniors. Among Democrats, strong approval of his handling of the issue has dropped 15 percentage points since mid-September.

These numbers underscore the challenges ahead for the president and Democratic leaders in Congress as they attempt to maintain support among liberals and moderates in their own party while continuing to win over at least a few Republican lawmakers.

Overall, 45 percent of Americans favor the broad outlines of the proposals now moving in Congress, while 48 percent are opposed, about the same division that existed in August, at the height of angry town hall meetings over health-care reform. Seven in 10 Democrats back the plan, while almost nine in 10 Republicans oppose it. Independents divide 52 percent against, 42 percent in favor of the legislation.

There are also deep splits in the new poll over whether the proposed changes would go too far or not far enough in expanding coverage and controlling costs. Twice as many see the plan as leaning toward too much government involvement, but since last month there has been a nine-point increase in the number who say government should be more involved.

On the issue that has been perhaps the most pronounced flash point in the national debate, 57 percent of all Americans now favor a public insurance option, while 40 percent oppose it. Support has risen since mid-August, when a bare majority, 52 percent, said they favored it. (In a June Post-ABC poll, support was 62 percent.)

If a public plan were run by the states and available only to those who lack affordable private options, support for it jumps to 76 percent. Under those circumstances, even a majority of Republicans, 56 percent, would be in favor of it, about double their level of support without such a limitation.

Fifty-six percent of those polled back a provision mandating that all Americans buy insurance, either through their employers or on their own or through Medicare or Medicaid. That number rises to 71 percent if the government were to provide subsidies for many lower-income Americans to help them buy coverage. With those qualifiers, a majority of Republicans say they support the mandate.
The public option

Faced with a basic choice that soon may confront the administration and Democratic congressional leaders, a slim majority of Americans, 51 percent, would prefer a plan that included some form of government insurance for people who cannot get affordable private coverage even if it had no GOP support in Congress. Thirty-seven percent would rather have a bipartisan plan that did not feature a public option. Republicans and Democrats are on opposite sides of this question, while independents prefer a bill that includes a public option but does not have Republican support, by 52 percent to 35 percent.

But if there is clear majority support for the public option and the mandate, there is broad opposition to one of the major mechanisms proposed to pay for the bill. The Senate Finance Committee suggested taxing the most costly private insurance plans to help offset the costs of extending coverage to millions more people. Sixty-one percent oppose the idea, while 35 percent favor it.

Nearly seven in 10 say they think that any health-care measure would increase the federal budget deficit, a possible concern for Obama. But nearly half of those who see the legislation as growing the deficit also say the increase would be “worth it.”

Concerns about the implications for Medicare continue to cloud the debate. More than twice as many Americans (43 percent to 18 percent) say they think the legislation would weaken Medicare. Despite the dip in opposition to a health-care overhaul among seniors, most, 51 percent, still think reform would hurt the popular program.

Overall, 57 percent approve of the way Obama is handling his job as president and 40 percent disapprove. While those numbers have moved only marginally over the past few months, here, too, are fresh signs of restiveness among the party faithful: “Strong approval” among liberal Democrats is down 16 percentage points over the past month.

On the economy, 50 percent approve of Obama’s efforts, while 48 percent disapprove.

The president receives better marks from all Americans for his handling of international affairs and his performance as commander in chief (57 percent approval on each). Slim majorities also approve of how he is dealing the situation with Iran and his winning of the Nobel Peace Prize. A majority disapprove of his work on the federal budget deficit.
Partisan divide

Despite those mixed reviews on domestic priorities, Obama continues to hold a big political advantage over Republicans.

Poll respondents are evenly divided when asked whether they have confidence in Obama to make the right decisions for the country’s future, but just 19 percent express confidence in the Republicans in Congress to do so. Even among Republicans, only 40 percent express confidence in the GOP congressional leadership to make good choices.

Only 20 percent of adults identify themselves as Republicans, little changed in recent months, but still the lowest single number in Post-ABC polls since 1983. Political independents continue to make up the largest group, at 42 percent of respondents; 33 percent call themselves Democrats.

The wide gap in partisan leanings and the lack of confidence in the GOP carries into early assessments of the November 2010 midterm elections: Fifty-one percent say they would back the Democratic candidate in their congressional district if the elections were held now, while 39 percent would vote for the Republican. Independents split 45 percent for the Democrat, 41 percent for the Republican.

The poll was conducted by conventional and cellular telephone from Oct. 15 to 19 among a random sample of 1,004 adults. The margin of sampling error for the full poll is plus or minus three percentage points.

Attorney general says prosecuting such cases ‘will not be a priority’

By Carrie Johnson
Washington Post Staff Writer
Tuesday, October 20, 2009

Attorney General Eric H. Holder Jr. directed federal prosecutors Monday to back away from pursuing cases against medical marijuana patients, signaling a broad policy shift that drug reform advocates interpret as the first step toward legalization of the drug.

The government’s top lawyer said that in 14 states with some provisions for medical marijuana use, federal prosecutors should focus only on cases involving higher-level drug traffickers, money launderers or people who use the state laws as a cover.

The Justice Department’s action came days after the Senate’s second-highest-ranking Democrat introduced a bill that would eradicate a two-decade-old sentencing disparity for people caught with cocaine in rock form instead of powder form. Taken together, experts say, the moves represent an approach favored by President Obama and Vice President Biden to put new emphasis on violent crime and the sale of illicit drugs to children. Legislation that would cover a third administration commitment, to support federal funding of needle exchanges, is moving through the House.

The announcement set off waves of support from advocacy groups that have long sought to relax the enforcement of marijuana laws. But some local police and Republican lawmakers criticized the change, saying it could exacerbate the flow of drug money to Mexican cartels, whose violence has spilled over the Southwestern border.

In a statement, Holder asserted that drug traffickers and people who use firearms will continue to be direct targets of federal prosecutors, but that, on his watch, “it will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers who are complying with state laws on medical marijuana.”

The turnaround could pave the way for Rhode Island, New Mexico and Michigan to put together marijuana-distribution systems for residents of those states, according to Graham Boyd, director of the Drug Law Reform Project at the American Civil Liberties Union. Advocates say marijuana use can help alleviate pain and stimulate appetite in patients suffering from cancer, HIV-AIDS and other ailments. But the American Medical Association since 2001 has held firm to a policy opposing marijuana for medical purposes.

Under the Controlled Substances Act, which is more than three decades old, marijuana remains within the category of drugs most tightly restricted by the government. Donna Lambert, who is awaiting criminal trial in San Diego County Superior Court for allegedly providing medical marijuana to another patient, injected a note of skepticism into Holder’s announcement. In an interview, Lambert noted that senior administration officials had made public comments this year in line with the Justice Department policy, only to have law enforcement agents, including the Drug Enforcement Administration, take part in raids soon afterward.

Ethan Nadelmann, executive director of the Drug Policy Alliance, said he and other advocates will watch closely whether federal agents refuse to participate in raids or send other signals to district attorneys in the states that allow some medical use of marijuana.

Americans for Safe Access, which supports medical marijuana programs nationwide, estimated that during the Bush administration federal authorities conducted 200 raids in California alone. A 2005 U.S. Supreme Court case made clear that the federal government has the discretion to enforce federal drug laws even in states that had approved some relaxation of marijuana statutes for sick patients.

White House press secretary Robert Gibbs, at a daily briefing in Washington, declined to address “what states should do” in response to the Justice Department guidance. But Gibbs said that the president since January had outlined his medical marijuana policy and that the Justice Department memo, signed by Deputy Attorney General David W. Ogden, helped to fill in the details.

The administration stopped far short Monday of endorsing wholesale marijuana legalization, frustrating some activists. At the libertarian Cato Institute, official Tim Lynch described the war on drugs as a “grand failure.” He exhorted the White House to take “much bolder steps to stop the criminalization of drug use more generally.”

In the three-page memo, Ogden made clear that the department is not creating a new legal defense for people who may have violated the Controlled Substances Act. Instead, the memo is intended to guide prosecutors on where to train their scarce investigative resources.

The International Association of Chiefs of Police “strongly believes that the federal government must continue to play a central role in the investigation and prosecution of . . . traffickers, dispensary operators, and growers,” said Meredith Mays, a spokeswoman for the group.

Rep. Lamar Smith (Tex.), the top Republican on the House Judiciary Committee, said the Justice Department guidelines “fly in the face of Supreme Court precedent and undermine federal laws that prohibit the distribution and use of marijuana.”

He added: “We cannot hope to eradicate the drug trade if we do not first address the cash cow for most drug-trafficking organizations — marijuana.”

The cocaine bill is still pending in the Senate, although advocates say its prospects are stronger now than over the past decade. The sponsor, Sen. Richard J. Durbin (D-Ill.), said in an interview last week that he was working to enlist GOP co-sponsors to ease the bill’s passage.

by Gary Crooks
The Spokesman-Review

While heading into work on Friday, I saw a small group on the corner of Second Avenue and Lincoln Street waving signs in opposition to Referendum 71, which would give voter approval to the “everything but marriage” law that was adopted by the Legislature last spring. The law grants to registered same-sex couples the same rights and benefits accorded married couples under state statutes.

Normally, I wouldn’t mind such a political display, but among those holding “Protect Children” placards were children themselves. Do you suppose the kids independently researched the topic before deciding they’d be imperiled if discrimination against same-sex couples were brought to an end? More likely, adults shoved the signs into their hands for emotional appeal. Must be that indoctrination I’ve been hearing about.

The use of children in politics has always bugged me, whether it’s the serene family photos on glossy brochures or those oh-so-cute appearances at political rallies. Then there’s the positioning of children near the lectern to dissuade questions about why politicians were sleeping around. But the anti-Referendum 71 example strikes me as particularly odious, because the signs make it seem like the issue is about child predators and one side is all for them.

The logical leap is that a household with a man and a woman is better for child-rearing. There is no firm empirical evidence of this, but even if there were, there are many socioeconomic factors that determine outcomes for children. Divorce and single parenthood matter. So do income, educational level and the age at which people marry.

So where are the campaigns to prohibit marriage (and the rights that go with it) for those who have low incomes or are under 25 years old or don’t have college degrees? Where are the signs protesting the impending marriages of those who tried it before and failed? There aren’t any, and I wonder why. Isn’t this about the kids?

Mixed message. Speaking of protecting children, a justice of the peace in Hammond, La., is making headlines for refusing to sign a marriage license because the couple is biracial. That’s right, Keith Barnwell turned away the couple because of his concern for their yet-to-be-born children. For one thing, he says, mixed-race couples are more apt to get divorced.

Barnwell says he’s not racist, because he has officiated at many marriages involving African-American men and women. But why would he do that when those couples have an above-average divorce rate? Don’t those kids matter?

Maybe we need to pass a law that prohibits adults from using children as an excuse for their bigotry.

You don’t say. It’s interesting how many arguments against gay marriage were first used to defend state laws that barred mixed-race nuptials. Here’s one:

“We aren’t bigoted,” said the backers of anti-miscegenation laws. “We just worry, what will happen to the children? They’ll be taunted and teased.”

It’s like telling a shoe salesman that size matters. Minorities don’t need a heads-up on the possibilities of bigotry. Neither do gays and lesbians. It’s a truth that’s self-evident.

Follow the balloon. A nation is transfixed. What is it? What keeps it aloft? How high will it go? What if it crashes? What if there’s too much inflation or sudden deflation? What if rescuers can’t get there in time? What if there’s no way to bail out? Who built it? Who approved it? Who could think it would ever be safe?

But enough about the economy, how about that balloon boy?

Smart Bombs is written by Associate Editor Gary Crooks and appears Wednesdays and Sundays on the Opinion page. Crooks can be reached at garyc@spokesman.com or at (509) 459-5026.

By ROBERT PEAR and DAVID M. HERSZENHORN

WASHINGTON — After months of relentless courting and suspense, Senator Olympia J. Snowe, Republican of Maine, cast her vote with Democrats on Tuesday as the Senate Finance Committee approved legislation to remake the health care system and provide coverage to millions of the uninsured.

With Ms. Snowe’s support, the committee backed the $829 billion measure on a vote of 14 to 9, with all the other Republicans opposed.

“Is this bill all that I would want?” Ms. Snowe said. “Far from it. Is it all that it can be? No. But when history calls, history calls. And I happen to think that the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.”

Ms. Snowe’s remarks silenced the packed committee room, riveted colleagues and thrilled the White House. President Obama had sought her vote, hoping that she would break with Republican leaders and provide at least a veneer of bipartisanship to the bill, which he has declared his top domestic priority.

Mr. Obama, speaking in the Rose Garden, described the committee’s action as “a critical milestone” and declared, “We are now closer than ever before to passing health reform.” But he added: “Now is not the time to pat ourselves on the back. Now is not the time to offer ourselves congratulations. Now is the time to dig in and work even harder to get this done.”

With its vote Tuesday, the Finance Committee became the fifth — and final — Congressional panel to approve a sweeping health care bill. The action will now move to the floors of the House and the Senate, where the health care measures still face significant hurdles.

Aside from Ms. Snowe, no Republicans in Congress have publicly endorsed the bills in their current form. And Republican leaders are strongly opposed, saying the bills cost too much, raise taxes, cut Medicare and dangerously expand federal power.

Pressure from lobbyists is sure to grow in the coming weeks. And many more lawmakers will get involved in what promise to be impassioned and highly politicized debates in the Senate and the House.

After the Finance Committee vote, the chief architect of the bill, Senator Max Baucus, Democrat of Montana and chairman of the committee, declared: “It’s clear that health care reform will pass this year. Our action today provides terrific momentum.”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, said the bill put the nation on “a slippery slope toward more and more government control of health care.”

Ms. Snowe helped write the Finance Committee bill, in months of bipartisan negotiations, but had not committed to vote for it. She said Tuesday that she shared many of her Republican colleagues’ reservations about the legislation, and pointedly warned Democrats that they could lose her support later in the legislative process.

“My vote today is my vote today,” she said. “It doesn’t forecast what my vote will be tomorrow.” And she observed, “There are many, many miles to go in this legislative journey.”

Ms. Snowe gave no clue how she would vote in the first few hours of committee deliberations Tuesday and she did not alert the White House to her plans.

While colleagues spoke, she kept her head buried in papers, fidgeted and spoke occasionally with aides. When Mr. Baucus stepped over to speak to her, a small army of photographers snapped pictures, with cameras clicking like a chorus of chirping crickets.

The Congressional Budget Office said the bill would cost $829 billion over 10 years. The costs include $345 billion for the expansion of Medicaid and $461 billion for subsidies to help lower-income people buy insurance.

The budget office said the costs would be completely offset by new fees and taxes and by cutbacks in Medicare, so federal budget deficits in the next 10 years would be $81 billion lower than now projected.

But Douglas W. Elmendorf, director of the Congressional Budget Office, said his agency had not estimated the impact of the bill on overall national health spending, public and private, and could not say whether it would “bend the cost curve,” as Mr. Obama and lawmakers want.

Likewise, Mr. Elmendorf said he did not know for sure how the bill would affect premiums.

Several senators said they would fight for changes on the Senate floor.

Liberal Democrats, like Senator John D. Rockefeller IV of West Virginia, said they would push for a public insurance plan. Senators Ron Wyden of Oregon and Robert Menendez of New Jersey, both Democrats, said they would seek changes to make insurance more affordable to middle-income families. And Senator John Kerry of Massachusetts said he wanted to require employers to provide insurance to their employees.

The bill does not include such an employer mandate. But employers with more than 50 workers would have to reimburse the government for some or all of the cost of federal subsidies provided to employees who buy insurance on their own.

Ms. Snowe said she liked the Finance Committee bill because it would prohibit insurance companies from discriminating against people on account of health status or sex and would create a network of insurance exchanges where individuals, families and small businesses could shop for coverage, with subsidies from the federal government.

At the same time, Ms. Snowe said she shared Republican “concerns about vast governmental bureaucracies and governmental intrusions.” That, she said, is why she had opposed amendments to create a government insurance plan and would continue to do so.

Ms. Snowe said she was open to a compromise under which a public plan could be “triggered” in states where people could not otherwise find affordable insurance. She said her “paramount concern” was that insurance might be too expensive for some people, even with government subsidies.

The Congressional Budget Office said the Finance Committee bill would provide coverage to 29 million people, but still leave 25 million uninsured in 2019. Of those left uncovered, about a third would be illegal immigrants.

David Stout contributed reporting.

By Chris Jordan
October 7, 2009

Prepare yourself for the shocker of the century…

I am not a fan of George W. Bush.

I know what you’re thinking: Oh, how original. But first, let me explain.

One of the things I remember most vividly about the Bush years was feeling like the United States’ global influence was fading rapidly. We were becoming the hated bully of the world.

Instead of building partnerships and working with our allies, we were essentially alone. Instead of displaying leadership on pressing global issues like climate change, we were constantly at odds with the world.

So far, President Obama has put us on a good path towards progress. He has re-engaged with allies, reached out to Muslims around the world, and made real progress on nuclear arms control.

But the greatest challenge is yet to come. Forging a new global framework for climate-change mitigation will be the goal of the upcoming U.N. Climate Conference in Copenhagen, Denmark.

The Kyoto Protocol is the existing treaty aimed at global greenhouse gas reductions, and it was signed and ratified by every nation on Earth with the exceptions of Iraq, Afghanistan, Somalia, the United States and a tiny handful of others. It is set to expire in 2012. This Copenhagen Conference, set to occur in December, is the next step for humanity in dealing with climate change.

British Prime Minister Gordon Brown recently warned that, “the [Copenhagen] negotiations are proceeding so slowly that a deal is in grave danger.”

Part of the reason behind this stall is the political situation in Washington, D.C.

While world leaders had planned to build on the framework of Kyoto for the new agreement, the United States wants to weaken and change the treaty so it might have a shot at ratification in the U.S. Senate.

According to The Guardian, European leaders worry, “it could take several years to negotiate a replacement framework.”

So why is the Obama administration so uncomfortable with the old Kyoto Protocol?

First of all, in 1997 the Senate passed a bill 95-0 that stated that the United States should not be a signatory to any protocol that did not include binding targets and timetables for developing nations. Democratic climate change legislation passed in the U.S. House of Representatives earlier this year, but only by a tiny margin of 219-212. On the Senate side, where it takes 60 votes to break a filibuster and pass any bill these days, the odds of a bill passing are in serious doubt.

What happens in the United States over the next several months will directly affect the success or failure of world leaders at Copenhagen, and the United States’ global role for years to come.

Without the passage of a climate-change bill in Congress, the United States will never credibly lead the world on this issue, and we will never be able to reduce our national greenhouse gas emissions. Without significant public support at home, the new Copenhagen treaty, if it emerges at all, will never be ratified in the Senate.

The United States has a golden opportunity to restore our global leadership on the most important issue of our time. We cannot let partisanship and division in Washington stand in the way of that opportunity.

So consider this column a call to action. If you’ve ever cared about the environment, now is the most critical time to make your voice heard. Talk to your friends. Tell your representatives to support climate change legislation.

The opportunity presented by climate change is about more than just saving the trees and polar bears. It’s about restoring our economy by creating new green industries. It’s about securing the future for coming generations. And to me, it’s fundamentally about the ability of our country to accomplish great things and be a leader in the world once again.

Reach columnist Chris Jordan at opinion@dailyuw.com.

by David S. Broder

Barack Obama has reached the moment of truth for answering the persistent question about his core beliefs and political priorities. The coming votes in the House and Senate on his signature health care reform effort will tell us more about the president than anything so far in his White House tenure.

The challenge is not one he invited. All during last year’s campaign, Obama skillfully skirted the question of whether he was a moderate, consensus-seeking pragmatist, as his words suggested, or a faithful adherent to the liberal agenda, as his voting record demonstrated.

In stylistic terms, he cultivated the pragmatic image. On issues, he was alternately one or the other – lining up with the liberals on Iraq and civil liberties, for example, but joining the hard-liners on Afghanistan and the budget.

In the campaign, he took the moderate side of the health care debate – disagreeing with Hillary Clinton on the necessity for an individual mandate to buy health insurance and suggesting he would be satisfied with incremental progress toward covering all the uninsured.

But now, a number of factors have combined to strip him of the camouflage he once enjoyed when it comes to health care policy.

His effort to craft a bipartisan package with significant Republican support has failed, as GOP leaders in Congress have chosen to take their chances on handing him a costly defeat rather than opting to claim a share of the credit for success. With Sen. Olympia Snowe of Maine apparently the only Republican who might vote for the evolving legislation, Obama will have to find virtually all the votes he needs among his fellow Democrats.

Also, the debates inside the five House and Senate committees that have shared in drafting the bills have dramatized the deep ideological splits on the Democratic side of the aisle. The symbolic issue has been the public option – the proposal for a Medicare-like insurance plan competing with those offered by private companies.

Four of the five committees have included that proposal; the fifth, the Senate Finance Committee, has explicitly rejected it.

Beyond that much-hyped dispute are multiple disagreements on the cost and financing of the overall reform, with no consensus between the more conservative Democratic Blue Dogs and the more numerous liberals, especially in the House.

The first imperative for House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid is to find a formula that will produce 218 Democratic votes in the House and 59 of the needed 60 votes in the Senate.

Obama will have to be an active player in that process. But in addition, he will have to negotiate something that will be workable in the real world. As he contemplates a re-election race in 2012, he needs at least three years when his most important domestic initiative has not blown up in his face.

What are his chances of pulling it off? It will not be easy. In the House, Pelosi and a clear majority of the Democratic caucus members want a liberal bill, including the public option. They may have to offer some cosmetic concessions to the Blue Dogs, but they are unlikely to yield on the main points.

In the Senate, on the other hand, while the liberals may prevail on floor amendments to install the public option, they cannot by themselves deliver 60 votes for passage. At this point, the leverage swings to the handful of more conservative, small-state Democratic senators who, with the Republicans, may be able to force substantive changes.

As this plays out – finally, in a House-Senate conference committee – the political cost of the Republican decision to be simply a blocking force will become clear. Had the GOP furnished even a few votes in return for seeing some of their concerns addressed, chances are Obama and the Democratic congressional leaders would not have felt the necessity to keep all the liberals in line. This would have given the president more room to maneuver.

As it is, his main leverage point is the realization among nearly all Democrats that nothing would be as costly to them, in their individual 2010 races, as the failure of this Congress, with its heavy Democratic majorities, to pass a substantive health reform bill.

That may be enough in the end for Obama to succeed. But the task of getting there will really test him – and expose his core values.

David S. Broder is a columnist for the Washington Post. His e-mail address is davidbroder@washpost.com.

October 4, 2009

By ROBERT PEAR and DAVID M. HERSZENHORN

WASHINGTON — With the Senate Finance Committee set to approve its health care bill this week, Democrats are tantalizingly close to bringing legislation that would make sweeping changes in the nation’s health care system to the floor of both houses of Congress.

Party leaders still face immense political and policy challenges as they combine rival proposals — two bills in the Senate and three in the House. But the broad contours of the legislation are in place: millions of uninsured Americans would get subsidized health benefits, and the government would move to slow the growth of health spending.

Senior Democrats said they were increasingly confident that a bill would pass this year. “I am Scandinavian, and we don’t like to overstate anything,” said Senator Kent Conrad, Democrat of North Dakota and an architect of the Finance Committee bill. “But I have a solid feeling about the direction of events.”

President Obama, in his weekly address on Saturday, noted Friday’s dismal unemployment numbers and said the health care overhaul would bolster small businesses and create jobs.

Mr. Obama called the overhaul “a critical step in rebuilding our economy” and said he was working with his economic advisers “to explore additional options to promote job creation.”

Step by difficult step, the legislative process is lurching forward. Proponents say they see some momentum — more than they saw in Congress 15 years ago, when President Bill Clinton’s plan for universal health coverage collapsed.

As Senate Democrats try to secure the 60 votes needed to overcome a possible Republican filibuster, intricate details and big hurdles stand in their way. Republicans have said they will fight the legislation at every turn.

The policy challenges are also daunting. In the space of one year, the Democrats are trying to restructure one-sixth of the economy, writing a bill that will affect almost every American, every business and every doctor and hospital in the country.

Three House committees approved health care bills in July, as did the Senate health panel. After hearing from constituents in August — some furious, some pleading for change — many Democrats returned to the Capitol determined to plow ahead. They were also emboldened by Mr. Obama’s speech to Congress on Sept. 9 that cast the legislation as a moral and political imperative.

The Finance Committee is expected to approve its bill this week, after receiving cost estimates from the Congressional Budget Office. And while the panel made numerous changes over seven days of public debate, the core components of its more centrist proposal, developed in months of bipartisan talks, are still intact.

After the committee votes, a new, potentially more perilous phase will begin as party leaders put together the final proposals they will take to the floor of the Senate and the House.

These are some of the huge issues that remain:

¶The major House and Senate bills would require most Americans to carry insurance. This individual mandate could touch off an angry public reaction, especially if the penalties for violations are taxes collected by the Internal Revenue Service. Many lawmakers want to minimize the penalties.

¶Whether the government should require employers to provide health benefits to their employees, or pay a penalty, is still an open question. Liberal Democrats say yes. Moderate Democrats are unsure. Republicans are generally opposed.

¶Lawmakers have not decided how to pay for the legislation, expected to cost about $900 billion over 10 years, though they insist that it will not add to the deficit. The House has proposed a surtax on high-income people, while the Senate proposed an excise tax on high-cost insurance plans.

¶Democrats are divided over whether to create a government insurance company to compete with private insurers. The more liberal House will probably not pass a health care bill without such a public insurance option, while the Senate appears unlikely to pass one with it.

¶Lawmakers are looking for ways to provide more generous subsidies to help low- and middle-income people buy insurance. Many Democrats and some Republicans, like Senator Olympia J. Snowe of Maine, insist that insurance must be affordable if people are required to buy it.

¶While Congressional leaders say they want to curb the explosive growth of health costs, it is unclear whether the final bill will make a serious effort to do so. Every proposal meets resistance from health care providers who fear a loss of income, even as they stand to gain millions of paying customers if nearly everyone has insurance.

Mr. Conrad said that even some Republicans seemed to recognize the likelihood that Congress would pass major health care legislation this year. “I thought there was an air of resignation that settled over our colleagues on the other side of the aisle,” he said.

But Senator Lamar Alexander of Tennessee, the No. 3 Republican in the Senate, predicted that opposition would grow. “It would be very difficult for a bill like the Finance Committee bill to pass the Senate,” he said. “There is nothing inevitable about such a bill. There is nothing predictable about the Senate floor.”

Republicans are not waiting for the finished product and have unleashed a barrage of criticism. In addition to expanding government and raising taxes, they say, the Democratic plans will hurt older Americans by cutting Medicare, intrude on personal freedom by forcing people to buy insurance and impose new costs on states by expanding Medicaid.

Democrats said that once the Finance Committee acts this week, they will be closer than ever to carrying out a major overhaul of the health care system — a goal that has eluded presidents and Congress for more than a half-century.

By Chris Jordan
October 1, 2009

As UW students flock back to school this week, their representatives in Congress will have recently flocked back to their D.C. offices after an August recess marked by angry town halls and endless health-care ad wars.

President Barack Obama’s signature domestic agenda item has faced a tough road, and no doubt his own strategy and execution is partly to blame. By failing to explain what health-care reform means to those who already possess insurance, the President left a vague plan open to attack.

Such Republican scare tactics and outright lies (see “death panels”) have unfortunately had an impact. They’ve inflamed the passions of anti-Obama activists on the right and sewn doubt in the minds of many Americans about health insurance reform.

The key sticking point in this debate has been the inclusion of a government run “public option” that would compete with private health insurance. While support has declined for the Democratic plan in general, a CBS poll in September showed support for a public option strong at 68 percent. Another poll published in September found that 73 percent of doctors support the public option.

Republicans have used confusion over this proposal to paint the entire reform effort as a “government takeover.” They have constantly claimed that Americans will be forced from their private insurance into a “big government plan.”

I find this to be a strange argument because, as I understand it, you can’t be forced into something that is by definition an option.

The public option is intended to provide competition to private insurance by giving Americans more choices. If people choose to abandon their private insurance for a public option, it’ll be because they make the decision that they can get better care at a lower cost with that plan. It won’t be because the evil, socialist government forced them to do it.

We can all agree that the goals of health reform should be to lower overall costs and increase the quality of care. We can also agree on the general principle that more choice for consumers and competition in the marketplace leads to both lower costs and an increased quality of the product being sold. That’s what the public plan will do; provide another choice to consumers and force private insurers to compete.

For those who suggest that the public option would drive private insurers out of business, the Congressional Budget Office estimates that only 11 to 12 million people will sign up for it. Not to mention the fact that reform will require everyone to have insurance, similar to the way everyone is required to have auto insurance. With roughly 45 million Americans currently lacking any plan, private insurance companies will be signing up new customers faster than they can take them.

And for those who suggest that the public option would be too costly, the President has said that it must be self-sustaining and funded by those who pay to use it.

We should set up a health-care system that is uniquely American; one that combines the best aspects of our own system (high quality care, innovation) with the best of other systems (universal coverage, lower cost). That’s why Obama is not proposing a government takeover, he’s proposing a government option that will pay for itself and provide more health insurance choices, and thus competition.

If the public option does not survive into the final bill, we will have lost a great tool for controlling health-care costs.

Reach columnist Chris Jordan at opinion@dailyuw.com.

Charles Krauthammer is a columnist for the Washington Post Writers Group. His e-mail address is letters@charleskrauthammer.com.

My mother wanted to die, but the doctors wouldn’t let her. At least that’s the way it seemed to me as I stood by her bed in an intensive-care unit at a hospital in Hilton Head, S.C., five years ago. My mother was 79, a longtime smoker who was dying of emphysema. She knew that her quality of life was increasingly tethered to an oxygen tank, that she was losing her ability to get about, and that she was slowly drowning. The doctors at her bedside were recommending various tests and procedures to keep her alive, but my mother, with a certain firmness I recognized, said no. She seemed puzzled and a bit frustrated that she had to be so insistent on her own demise.

The hospital at my mother’s assisted-living facility was sustained by Medicare, which pays by the procedure. I don’t think the doctors were trying to be greedy by pushing more treatments on my mother. That’s just the way the system works. The doctors were responding to the expectations of almost all patients. As a doctor friend of mine puts it, “Americans want the best, they want the latest, and they want it now.” We expect doctors to make heroic efforts—especially to save our lives and the lives of our loved ones.

Compared with other Western countries, the United States has more health care—but, generally speaking, not better health care. There is no way we can get control of costs, which have grown by nearly 50 percent in the past decade, without finding a way to stop overtreating patients. In his address to Congress, President Obama spoke airily about reducing inefficiency, but he slid past the hard choices that will have to be made to stop health care from devouring ever-larger slices of the economy and tax dollar. A significant portion of the savings will have to come from the money we spend on seniors at the end of life because, as Willie Sutton explained about why he robbed banks, that’s where the money is.

As President Obama said, most of the uncontrolled growth in federal spending and the deficit comes from Medicare; nothing else comes close. Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life. This might seem obvious—of course the costs come at the end, when patients are the sickest. But that can’t explain what researchers at Dartmouth have discovered: Medicare spends twice as much on similar patients in some parts of the country as in others. The average cost of a Medicare patient in Miami is $16,351; the average in Honolulu is $5,311. In the Bronx, N.Y., it’s $12,543. In Fargo, N.D., $5,738. The average Medicare patient undergoing end-of-life treatment spends 21.9 days in a Manhattan hospital. In Mason City, Iowa, he or she spends only 6.1 days.

Maybe it’s unsurprising that treatment in rural towns costs less than in big cities, with all their high prices, varied populations, and urban woes. But there are also significant disparities in towns that are otherwise very similar. How do you explain the fact, for instance, that in Boulder, Colo., the average cost of Medicare treatment is $9,103, whereas an hour away in Fort Collins, Colo., the cost is $6,448?

The answer, the Dartmouth researchers found, is that in some places doctors are just more likely to order more tests and procedures. More specialists are involved. There is very little reason for them not to order more tests and treatments. By training and inclination, doctors want to do all they can to cure ailments. And since Medicare pays by procedure, test, and hospital stay—though less and less each year as the cost squeeze tightens—there is an incentive to do more and more. To make a good living, doctors must see more patients, and order more tests.

All this treatment does not necessarily buy better care. In fact, the Dartmouth studies have found worse outcomes in many states and cities where there is more health care. Why? Because just going into the hospital has risks—of infection, or error, or other unforeseen complications. Some studies estimate that Americans are overtreated by roughly 30 percent. “It’s not about rationing care—that’s always the bogeyman people use to block reform,” says Dr. Elliott Fisher, a professor at Dartmouth Medical School. “The real problem is unnecessary and unwanted care.”

But how do you decide which treatments to cut out? How do you choose between the necessary and the unnecessary? There has been talk among experts and lawmakers of giving more power to a panel of government experts to decide—Britain has one, called the National Institute for Health and Clinical Excellence (known by the somewhat ironic acronym NICE). But no one wants the horror stories of denied care and long waits that are said to plague state-run national health-care systems. (The criticism is unfair: patients wait longer to see primary-care physicians in the United States than in Britain.) After the summer of angry town halls, no politician is going to get anywhere near something that could be called a “death panel.”

There’s no question that reining in the lawyers would help cut costs. Fearing medical-malpractice suits, doctors engage in defensive medicine, ordering procedures that may not be strictly necessary—but why take the risk? According to various studies, defensive medicine adds perhaps 2 percent to the overall bill—a not-insignificant number when more than $2 trillion is at stake. A number of states have managed to institute some kind of so-called tort reform, limiting the size of damage awards by juries in medical-malpractice cases. But the trial lawyers—big donors to the Democratic Party—have stopped Congress from even considering reforms. That’s why it was significant that President Obama even raised the subject in his speech last week, even if he was vague about just what he’d do. (Best idea: create medical courts run by experts to rule on malpractice claims, with no punitive damages.)

But the biggest cost booster is the way doctors are paid under most insurance systems, including Medicare. It’s called fee-for-service, and it means just that. So why not just put doctors on salary? Some medical groups that do, like the Mayo Clinic, have reduced costs while producing better results. Unfortunately, putting doctors on salary requires that they work for someone, and most American physicians are self-employed or work in small group practices. The alternative—paying them a flat rate for each patient they care for—turned out to be at least a partial bust. HMOs that paid doctors a flat fee in the 1990s faced a backlash as patients bridled at long waits and denied service.

Ever-rising health-care spending now consumes about 17 percent of the economy (versus about 10 percent in Europe). At the current rate of increase, it will devour a fifth of GDP by 2018. We cannot afford to sustain a productive economy with so much money going to health care. Over time, economic reality may force us to adopt a national health-care system like Britain’s or Canada’s. But before that day arrives, there are steps we can take to reduce costs without totally turning the system inside out.

One place to start is to consider the psychological aspect of health care. Most people are at least minor hypochondriacs (I know I am). They use doctors to make themselves feel better, even if the doctor is not doing much to physically heal what ails them. (In ancient times, doctors often made people sicker with quack cures like bleeding.) The desire to see a physician is often pronounced in assisted-living facilities. Old people, far from their families in our mobile, atomized society, depend on their doctors for care and reassurance. I noticed that in my mother’s retirement home, the talk in the dining room was often about illness; people built their day around doctor’s visits, partly, it seemed to me, to combat loneliness.

Physicians at Massachusetts General Hospital are experimenting with innovative approaches to care for their most ill patients without necessarily sending them to the doctor. Three years ago, Massachusetts enacted universal care—just as Congress and the Obama administration are attempting to do now. The state quickly found it could not afford to meet everyone’s health-care demands, so it’s scrambling for solutions. The Mass General program assigned nurses to the hospital’s 2,600 sickest—and costliest—Medicare patients. These nurses provide basic care, making sure the patients take their medications and so forth, and act as gatekeepers—they decide if a visit to the doctor is really necessary. It’s not a perfect system—people will still demand to see their doctors when it’s unnecessary—but the Mass General program cut costs by 5 percent while providing the elderly what they want and need most: caring human contact.

Other initiatives ensure that the elderly get counseling about end-of-life issues. Although demagogued as a “death panel,” a program in Wisconsin to get patients to talk to their doctors about how they want to deal with death was actually a resounding success. A study by the Archives of Internal Medicine shows that such conversations between doctors and patients can decrease costs by about 35 percent—while improving the quality of life at the end. Patients should be encouraged to draft living wills to make their end-of-life desires known. Unfortunately, such paper can be useless if there is a family member at the bedside demanding heroic measures. “A lot of the time guilt is playing a role,” says Dr. David Torchiana, a surgeon and CEO of the Massachusetts General Physicians Organization. Doctors can feel guilty, too—about overtreating patients. Torchiana recalls his unease over operating to treat a severe heart infection in a woman with two forms of metastatic cancer who was already comatose. The family insisted.

Studies show that about 70 percent of people want to die at home—but that about half die in hospitals. There has been an important increase in hospice or palliative care—keeping patients with incurable diseases as comfortable as possible while they live out the remainder of their lives. Hospice services are generally intended for the terminally ill in the last six months of life, but as a practical matter, many people receive hospice care for only a few weeks.

Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim and degrading. The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what’s called for.

That’s what my mother wanted. After convincing the doctors that she meant it—that she really was ready to die—she was transferred from the ICU to a hospice, where, five days later, she passed away. In the ICU, as they removed all the monitors and pulled out all the tubes and wires, she made a fluttery motion with her hands. She seemed to be signaling goodbye to all that—I’m free to go in peace.

With Pat Wingert, Suzanne Smalley, and Claudia Kalb in Washington

Well, we survived August, which is good news. It was not a month that will be recorded in the Enlightened Discourse Hall of Fame. In fact, it was a national embarrassment — not just the steady stream of misinformation about the nature of President Obama’s health-care proposals, but the racism — both overt and opaque — the death threats, the imprecations (calling someone a Nazi is evidence of the evil of banality), the idiots bearing assault rifles at presidential events. As the lunatics took over the asylum, the President’s poll ratings dropped, and the chances for a truly bipartisan health-care-reform effort vanished, if they existed in the first place. Consequently, we have had a back-to-school fusillade of advice for the President from my columnizing peers — and an effusion of premature crowing from conservatives about the collapse of the Obama presidency.

The drop in the President’s poll numbers represents a natural political process. When politicians talk about spending their political capital, they are talking about their poll numbers — and the cliché is somewhat misleading. They are actually investing their political capital, hoping for a greater return if their gamble succeeds. George W. Bush invested his capital in privatizing Social Security, and the stock tanked. Barack Obama is investing in health-care reform. We are at the point of the legislative process where all seems hopeless, but Obama should be heartened by the fact that most of his Republican adversaries oppose the bill for crass political rather than ideological reasons. They assume that if it passes, his investment of political capital will result in higher poll numbers — which means they assume the public will like the changes he is proposing. (See TIME’s photo-essay “The Health-Care Debate Turns Angry.”)

And, I fearlessly predict, the public will. If insurance companies can no longer deny coverage for pre-existing conditions, or drop people who get too sick, the public will love it. If health-care exchanges give individuals and small businesses the power to negotiate lower premiums from the insurance companies, people will love that too. Making health care available to everyone, even if some people — young, healthy people — who are not buying in now are told they have to join up, will also be well received. The odds are better than even that a bill containing those provisions will pass in Congress this fall.

But even if most of the noise about Obama is nonsense, there is one area of concern that could affect the ultimate success of his presidency. It is his tendency to overlearn the lessons of past presidencies, especially when those lessons enable him to avoid taking responsibility for tough decisions. It has been widely observed that Obama overlearned the lesson of the Clinton health-care effort by deferring to Congress to write the legislation. It has been less widely observed that the President overlearned the lesson of Bush’s hyperpoliticized Justice Department by leaving to Attorney General Eric Holder the decision about whether to investigate the CIA for torture abuses.

What should the President have done? Well, there’s a path between the 1,300-page Clinton health-care plan and the 1,000-page Henry Waxman plan that will be voted on in the House. The President could have laid out a set of principles and said, “I will veto any bill that doesn’t contain the following …” (Indeed, he still could do so.) They should be clear, simple, popular and achievable. My list would include insurance reform, health-care exchanges, near universal coverage and tort reform. (Obama’s position on tort reform is another abdication of responsibility: he says he’s open to it, knowing the congressional Democrats are closed to it.) (See “Understanding the Health-Care Debate: Your Indispensable Guide.”)

The President’s deferral of responsibility for the CIA investigation is more serious than his health-care meanderings. This is a matter of national security that will directly affect the morale and behavior of our clandestine services. The President can’t say he wants to look forward, not backward, then allow his Attorney General to look backward. The most egregious practices, like waterboarding, were (outrageously) declared legal by the Bush Justice Department. How can you prosecute one interrogator for threatening a prisoner with an electric drill and let others who waterboarded a prisoner 83 times off the hook? Is it right for the interrogators to be prosecuted and the real miscreants — people, like former Vice President Dick Cheney, who ordered, and still approve of, the torture — to escape unpunished? Most legal experts believe that such cases would be difficult to prosecute. But whether you favor an investigation or not, this is a presidential decision the President avoided.

In the great sweep of history, this presidency has barely begun. The mistakes Obama has made are rookie mistakes that can be corrected. And the general tendency of his Administration — toward civility, as opposed to the ugliness we’ve seen in the past month — is the right one. But he can’t allow his desire for civility to neuter the requirements of leadership. He has to lead, clearly and decisively, starting right now.

Froma Harrop is a columnist for the Providence Journal.

Dr. Robert Golden is a urologist in Spokane.

Government program endorsed, not required

WASHINGTON – President Barack Obama on Wednesday laid out a series of compromises he’s willing to make to get a health care overhaul through a nervous Congress this year, including diluting his vision for a new public insurance program and embracing ideas floated by Republicans.

In an address to a joint session of Congress, Obama tried to seize control of the Democratic Party’s highest domestic priority after months of party disarray and raucous public debate across the country. The president said that he’d require all individuals to have health insurance and would provide tax credits to people and small businesses that couldn’t afford it.

“Well, the time for bickering is over. The time for games has passed. Now is the season for action,” Obama said.

At one point, a South Carolina Republican congressman shouted, “You lie” when Obama characterized reports that he’d insure illegal immigrants as false.

On perhaps the most controversial single plank in his program, Obama endorsed creating a “public option” government program to compete against private insurers, but he didn’t insist that it be included.

Instead, he left room for alternatives that liberal Democrats in Congress are resisting. Those include creating nonprofit health care cooperatives; a “trigger” mechanism for a public option to kick in later if private insurers fail to meet benchmarks of coverage; or perhaps simply tightening regulations on private insurers.

He pledged that any “public option” wouldn’t weaken coverage for those in Medicare or insured through their employers. He promised them “more security and stability.”

In turn, Obama made it clear that he intends to work with congressional Democrats to push some health care plan through Congress this year – on a bare partisan majority if necessary.

“I am not the first president to take up this cause, but I am determined to be the last,” Obama said in remarks that he hoped would breathe new life into Democrats’ push to expand coverage to many of the roughly 46 million in the U.S. who now lack health insurance.

“We are the only advanced democracy on Earth, the only nation, that allows such hardships for millions of people,” he said. “Now is the season for action.”

Such an expansion is a goal that’s eluded presidents since Harry Truman, and, most recently, Bill Clinton 15 years ago.

Obama said that his plan would cost about $900 billion over a decade. He said it could be paid for mostly by eliminating “waste and abuse” from the existing health care system, but he wasn’t specific. In addition, he’d charge insurance companies “a fee for their most expensive policies” to fund his plan. Beyond that, he failed to specify how his proposals would slow rising health costs.

Three House of Representatives committees have written legislation that would create a public option, raise taxes on the wealthy to help pay for the plan and mandate coverage for most people. The House is expected to combine three pending Democratic bills into one piece of legislation and attempt to pass it this month.

The Senate outlook is cloudier and likely to take longer. Even if both chambers pass versions of the legislation, they’re all but certain to differ, requiring a House-Senate conference to draft a compromise version that each house then must pass. How that will happen or what final terms it may contain aren’t clear.

Fleshing out a framework that he’s been advocating for months now, Obama called for creating a government health insurance exchange, or marketplace, to take effect by 2013. Through it many Americans could obtain lower-cost private coverage – or possibly coverage through some variation of a public plan if Congress creates one.

Until the exchange would take effect, Obama would borrow from a plan that his 2008 Republican rival, Arizona Sen. John McCain, proposed last year – to provide catastrophic coverage for those with pre-existing conditions.

In another olive branch to Republicans, Obama indicated that he’d support some “demonstration projects” to try setting experimental limits on medical malpractice lawsuits – long a Republican goal that Democrats typically oppose.

Obama also called for new regulations on private insurers to protect patients. He told Americans that any plan he signs will:

•Ban insurance companies from denying coverage because of pre-existing conditions.

•Prevent insurers from dropping or watering down coverage during illness.

•End arbitrary annual or lifetime coverage caps.

•Limit out-of-pocket expenses.

•Require insurers to cover routine checkups, mammograms and colonoscopies.

Judge rejects challenge to Referendum 71

Derrick Skaug (former MSHS AP GO PO Student)

The Daily Evergreen

Published: 08/31/2009 6:49pm

Being called a liberal used to be an insult, but after eight years of former President George W. Bush, being a liberal is not only acceptable, it is preferable. Now that conservatives have realized tarring someone as a liberal is not an effective election strategy, dirtier words are being slung.

President Barack Obama’s economic policies are being labeled as socialism, communism and even fascism. I will not speak for the legitimacy of communism or fascism because both systems are, at best, ineffective and, at worst, dangerous. Socialism, on the other hand, should not be considered an insult or something to be feared because we are all socialists.

It’s true. No matter what Rush Limbaugh, Sean Hannity or Glenn Beck say, the U.S. has been a socialist state for a very long time. Not one country on earth operates under a true laissez-faire economy.

Every single student at WSU is supporting a socialist program – public schools. A socialist education system still offers choice unlike communist systems. Parents can pay to have their children attend a private school, or they can send their kids to a taxpayer-supported public school.

The shipping and mail industry is the same way. When I buy products off of Ebay or Amazon, some of my products are delivered by FedEx. On the other hand, the U.S. Postal Service, which is an independent government agency, which provides jobs for Americans, delivers the rest of my mail.

The U.S Constitution actually gives Congress the right to set up post offices. Apparently, that dreaded socialism even managed to taint our sacred constitution.

Another government-funded segment of society interfering with the free market nature of raging wildfires is the fire department. A scene in Martin Scorsese’s film “Gangs of New York” depicted two private firefighting companies grappling over who would get to put out a raging inferno that was destroying an entire city block. This was not drawn out of thin air. A vast multitude of private fire companies did exist. Thankfully, very few still do. A true, free market supporter should find the closest private firefighting company and put that number on speed dial.

It’s ironic that the only socialist program that conservatives like to support is the military, which tends to have a monopoly on national defense. Most Americans seem to prefer the military rather than their private sector counterpart, Blackwater. And there seems to be no private sector competitors to the police, except maybe bodyguards.

The question boils down to how conservatives can support so many socialist programs, including the bailouts of entire industries, but not a public health care option.

Medicare, Medicaid and SCHIP are all popular socialist health care programs that conservatives would never tamper with. Yet these programs let many Americans fall through the cracks – those with preexisting conditions, the lower-middle class and many others. Most Americans just want to be able to make their own choice between a public or a private option when it comes health care.

Supporters of a public option are socialists, but then again, aren’t we all?

By Michael Barone

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Dr. Donald F. Condon is a physician in Spokane.

Charles Krauthammer is a columnist for the Washington Post Writers Group. His e-mail address is letters@charleskrauthammer.com.

Insurance companies would face benchmarks

‘Everything but marriage’ referendum, still facing court hurdle, would come in November

David S. Broder is a columnist for the Washington Post. His e-mail address is davidbroder@washpost.com.

Froma Harrop is a columnist for the Providence Journal.

Charles Krauthammer

Charles Krauthammer is a columnist for the Washington Post Writers Group. His e-mail address is letters@charleskrauthammer.com.

By JONAH GOLDBERG

August 29, 2009 –IF you read the papers or watch the news, you’ll encounter a long list of accomplishments by the late Sen. Edward M. Kennedy. You’re less likely to hear, however, that in his death Kennedy proved Rush Limbaugh right.

In March, the talk-show host and bete noir of progressives everywhere said that the health-care bill wending its way through Congress would eventually be dubbed “the Ted Kennedy Memorial Health Care Bill.” At the time, the official position of the Democratic Party was outrage and disgust. The Democratic Congressional Campaign Committee initiated a petition drive demanding that the Republican Party formally denounce Limbaugh for his “reprehensible” and “truly outrageous” comments.

Fast-forward to a few hours after the announcement of Kennedy’s death. Suddenly, naming the bill after Kennedy would be a moving tribute.

ABC News reports that “the idea of naming the legislation for Kennedy has been quietly circulating for months” but was kicked into overdrive by Sen. Robert Byrd, the Democratic Party’s eldest statesman.

Intriguingly, this suggests that either Democrats already had the idea when Limbaugh floated it, which would mean their protests were just so much opportunistic and cynical posturing — or they actually got the idea from Limbaugh himself, which would be too ironic for a Tom Wolfe novel.

But that Kennedy’s death should be marked by cynicism, opportunism and irony is not shocking, given that these qualities are now the hallmarks of the party he largely defined.

The Democratic Party’s determination to exploit his death for political gain puts the commentator who doesn’t wish to speak ill of the dead in something of a bind. So let us be clear that there’s no evidence whatsoever that Kennedy himself — or any Kennedy — would object to such a ploy.

Whether one calls it exploitation or heroic perseverance, the Kennedy dynasty’s longevity is best understood as a response to fatal tragedies. Shortly after her husband’s murder, Jacqueline Kennedy lamented Lee Harvey Oswald’s inconvenient political views: “It had to be some silly little Communist.”

Fortunately, her husband’s handlers had things well in hand, orchestrating with a compliant media the grand fiction that Kennedy had somehow been a martyr to civil rights, taken out by right-wing “hate.”

The real JFK, who cut capital-gains taxes and only reluctantly supported Martin Luther King Jr.’s March on Washington, had never been nearly as liberal as the posthumous legend created to give new life to liberalism — and the Kennedy name.

According to the mythmakers, JFK would have pulled us out of Vietnam. Meanwhile, the real JFK boasted (mere hours before his murder) that he’d massively boosted defense spending and ordered a 600 percent increase on counterinsurgency special forces in Vietnam. The prior March, he’d asked Congress to spend 50 cents out of every dollar on defense.

Hence one of the great ironies of Ted Kennedy’s career: He was the chief beneficiary of an inheritance from a brother whose views he didn’t share.

Such contradictions never bothered Ted Kennedy, nor his fellow Democrats, when he was alive — so why should there be compunction now?

After all, the Kennedys and the Democrats have mythologized and exploited the deaths of three brothers (and minimized the deaths of Mary Jo Kopechne and Martha Moxley) in order to protect the Kennedy brand. Naming a massive expansion of the federal government after Ted Kennedy, particularly when it was indeed his life’s cause, seems entirely fitting and fair.

My only objection is the notion that somehow anyone but partisan Democrats should be expected to cave in to the “Do it for Teddy” bullying.

Conservatives should surrender to something that violates their fundamental principles out of deference to the very man liberals celebrate for never abandoning his fundamental principles? No one expected Ted Kennedy to become a champion of free markets out of deference to Ronald Reagan’s memory.

Now, if liberals want to rally their own troops by putting Kennedy’s name on the bill, that’s their right, even if it will likely result in an even more unpopular bill than the ones now under consideration.

I suspect that they’ll be disappointed to discover that the currency of the Kennedy name purchases far less than it once did — thanks in large part to what Ted Kennedy did with it.

JonahsColumn@aol.com

(Extension:  When the history books are written and the Ted Kennedy section comes to light, what will be stated?  Do  a little research and enlighten us as to the accomplishments and/or failure of the “Lion of Liberalism”?)

Leonard Pitts Jr.

Leonard Pitts Jr. is a columnist for the Miami Herald. His e-mail address is lpitts@miamiherald.com.

Kathleen Parker is a columnist for the Washington Post Writers Group. Her e-mail address is kathleenparker@ washpost.com.

by Chris Jordan – Former AP GO PO Student
I’m watching Fox News right now and it’s really tough to do.

Sean Hannity is on covering the “Universal Nightmare” and every time
he talks about Obama’s healthcare plan, computerized blood flashes
across the screen. Classy…

He just had some “expert” on his show explaining why the Public Option
that we’ve heard so much about is a horrible idea. This is exactly
what he said…

“When President Obama says ‘If you like your current plan, you can
keep it,’ he’s not telling the truth. Millions of Americans will be
forced from their current insurance because the government run plan
will be able to come in at a lower cost.” And then he went on with all
the usual stuff about how horrible government-run healthcare is.

First of all, it is absolutely impossible for anyone to be FORCED from
their current plan into something called a Public OPTION that you can
only enter into by choice. The government run OPTION is intended to
provide competition to private insurance. If millions of people CHOOSE
to abandon their private insurance for a public option, it’s because
they’ve made the decision that they could get better care for a lower
cost with that plan. It won’t be because the evil government FORCED
them into a government plan. People will choose what is best for their
families, and if that so happens to be a government plan, so be it!

If conservatives and whoever else really believe that private
insurance is superior, and that government run healthcare is really so
horrible and low quality, then the only way to find out is to have
them compete. If we can set it up in a way so that the competition is
fair, shouldn’t everyone want private insurance if it’s really so
awesome?

We should set up a healthcare system that is uniquely American – one
that combines the best aspects of our own system (high quality care,
innovation) with the best aspects of other systems (universal
coverage, lower cost). That’s why Obama is not proposing a government
takeover (much to my dismay)– he’s proposing introducing a public
OPTION that people can choose to go into if they don’t like their
current insurance. People will choose whatever plan is best for them,
public or private.

I agree that choice and competition will lower prices. And that’s why
I support the public option – because it’s one more choice Americans
will have as THEY decide the insurance that is best for them.

May the best plan win!

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on more than 750 stations in North America. Denis Moynihan contributed research to this column.

Cal Thomas is a columnist for Tribune Media Services.

HHS Pick Built Connections Over Decades

By Ceci Connolly
Washington Post Staff Writer
Tuesday, February 3, 2009

As he battles this week to save his nomination to be secretary of health and human services, one thing is certain: No one in Washington has a better-positioned network of allies in the Obama administration than Thomas A. Daschle.

Over three decades on Capitol Hill, including 10 years as the Senate Democratic leader, Daschle has nurtured one of the largest, most experienced talent pools in the city. His charges guided Barack Obama from his first days in the Senate, through the presidential race and into the White House. Daschle’s tentacles, moreover, stretch far beyond the agency Obama picked him to lead, reaching across the entire administration from the upper echelons of the White House to mid-level departmental positions to Obama’s kitchen cabinet.

The network is being tapped this week as Daschle and his allies scramble to explain why he did not pay more than $100,000 in back taxes, primarily for the use of a car and driver for three years. After a 75-minute closed-door meeting yesterday with the Senate Finance Committee, he emerged ashen-faced and apologetic. His confirmation vote has been postponed until at least the middle of next week.

Republicans remained noncommittal yesterday, weighing the costs and benefits of perhaps killing the nomination of a former colleague and close personal friend of the president. Democrats rose to Daschle’s defense, including, most notably, the man who would be without much of his top staff were it not for Daschle.

Asked yesterday morning whether he stands by Daschle, Obama said firmly: “Absolutely.”

If he weathers the tax controversy, Daschle is likely to be one of the best-connected Cabinet secretaries in the administration, if not history.

At least a dozen Daschle alumni are stepping into the highest positions of the federal government. Already, Obama and Vice President Biden have tapped Daschle veterans to manage their staffs, guide foreign policy and craft public relations strategy. In addition to the new HHS chief of staff, the chiefs of staff to Biden, the National Security Council and Treasury Secretary Timothy F. Geithner all worked for Daschle. His allies oversaw Obama’s transition team — including vetting Daschle himself — and one serves as the president’s personal lawyer.

“This is notable for the breadth and scope and number,” said Chris Jennings, who was the Clinton administration point man on health care and knows the challenges of navigating the White House bureaucracy.

As news broke over the weekend that Daschle had made several tax errors, many of those former colleagues and aides helped mount a defense, praising his integrity on talk shows, in news releases and in whispered asides. Not a single lawmaker has called for him to withdraw.

But the real potency of the network will come if Daschle is confirmed, said Ross K. Baker, a political scientist at Rutgers University. With such well-placed, trusted advisers, he would be in a position to promote his priorities and shape policy well beyond the contours of his department.

“The fact that he has eyes and ears in the White House, rather than way down in the HHS bureaucracy, is really an advantage,” Baker said. He likened Daschle’s sphere of influence to the broad power that Henry Kissinger held as secretary of state in the Nixon administration.

“Geography is determinant of influence,” he said. “To have people proximate to the president is a real advantage.”

Like Daschle, Secretary of State Hillary Rodham Clinton can lay claim to an impressive network of insiders, developed during her husband’s eight years in the Oval Office and her eight in the Senate. Many have worked for Daschle as well. But the Clinton coalition has become fractured and she carries the lingering scars of a contentious fight with Obama in the Democratic presidential primaries.

By contrast, Daschle and Obama share an uncommon bond, forged during the 2004 campaign. Many — including aides to Daschle — had expected him to seek the White House. But the South Dakotan lost a nasty reelection fight, and the young Illinois legislator burst onto the national scene and into the U.S. Senate.

“Tom was the first guy to go with Obama” in the pre-presidential campaign season, said Frederick H. Graefe, a Washington lobbyist and one of Daschle’s oldest friends. “He told him, ‘Run now, don’t wait, don’t make the mistake I made. I’ll give you everybody I have — the campaign team, the personal staff, leadership staff, fundraising lists — lock, stock and barrel.’ ”

“It was a ready-made team,” Graefe added.

As a Senate leader with authority over not just his personal staff but several policy and campaign committees as well, Daschle employed more than 100 people at any given time. From 1994 to 2005, even more than the Clinton White House, “the University of Daschle” was the place to learn the inner workings of governing, Baker said.

More than half a dozen Daschle veterans hold high-ranking White House positions, most notably Pete Rouse, who was his chief of staff and is now senior adviser to the president, and Phil Schiliro, Obama’s legislative liaison.

Daschle-ites are also taking positions at the Agriculture Department and the Democratic National Committee. Some of his closest allies are among Obama’s most trusted outside advisers, a select group whose influence comes not from a title but from a personal bond. They include John D. Podesta, the Center for American Progress president who masterminded Obama’s transition; lawyer Robert Bauer; and political consultant Anita Dunn.

“The spokes of the wheel all lead to Pete Rouse,” said Dunn, who has deep ties to both men. “When Pete went to work for Barack, what Barack got — and I don’t think he realized it — was the only network in Democratic circles that from both a policy and political perspective came close to the Clinton network.”

Rouse got his start in Washington in the early 1970s when he and Daschle were young aides to then-Sen. James Abourezk (D-S.D.). In 1986, he began an 18-year stint with Daschle.

When Daschle lost in 2004, he encouraged his team to sign on with Obama. Rouse agreed and eventually recruited many of Obama’s top aides, including Schiliro and the husband-and-wife team Dan Pfeiffer and Sarah Feinberg.

If confirmed, Daschle will be “HHS secretary plus,” said Dunn, referring to the additional role as head of the new White House Office of Health Reform, which has a small but well-situated office in the basement of the West Wing.

If Daschle were working at HHS headquarters, his “embeds,” as Dunn calls them, could provide “an extraordinary level of information and access that most Cabinet secretaries don’t have.”

“It’s a matter of him not having to go in and forge relationships,” she said. “Daschle gets to deal directly with people he knows and is comfortable with.”

If as HHS secretary he wanted to tweak health tax policy, his longtime chief of staff, Mark Childress, would need only pick up the phone and call former colleague Mark Patterson, Geithner’s chief of staff. If there were an international health issue to resolve, Childress could contact Daschle alums Mark Lippert at the NSC and Denis McDonough on the White House staff.

And if Daschle needed assistance from Biden, he could turn to Ron Klain, the vice president’s chief of staff, who oversaw the Senate Democratic Leadership Committee for Daschle in 1995. Biden was making calls on Daschle’s behalf yesterday.

The Daschle hires that Obama has made are the “cream of the crop” of the Democratic establishment, Jennings said.

“People outside the Daschle orbit recognize his friendship with and influence with President Obama,” he said. “It’s the cumulative perceptions of his respect and influence within the administration and his former staff. Whether it’s an accurate perception or not, perception is reality in Washington.”

Staff writers Paul Kane and Joe Stephens and research editor Alice Crites contributed to this report.

UPDATE

Daschle Ends Bid for Post; Obama Concedes Mistake

WASHINGTON — Tom Daschle withdrew his nomination as secretary of health and human services on Tuesday after weathering four days of scrutiny over unpaid taxes, prompting President Obama to concede having “screwed up” in undermining his own ethical standards by pushing the appointment.

“I’ve got to own up to my mistake, which is that ultimately it’s important for this administration to send a message that there aren’t two sets of rules,” Mr. Obama said in an interview with NBC News. “You know, one for prominent people and one for ordinary folks who have to pay their taxes.”

Mr. Daschle, a closer confidant to Mr. Obama than any other cabinet nominee, had offered to step down over the weekend, but officials close to both men said Mr. Obama had urged him to fight for confirmation.

Mr. Daschle went to Capitol Hill on Monday to keep his confirmation on track, but by Tuesday morning, with the pressure showing no signs of easing, he told the president that he believed he had become a distraction and too wounded to be effective.

It was the rockiest day yet for the new White House. Two hours before Mr. Daschle withdrew, Mr. Obama’s nominee to be the chief White House performance officer, Nancy Killefer, pulled her name from consideration because of unpaid payroll taxes for a household employee.

The developments distracted attention from Mr. Obama’s effort to push his economic stimulus plan through the Senate and complicated the initiative that Mr. Daschle was to have led, his plan for overhauling the health care system.

The nominees’ tax problems also gave Republicans a new argument against Mr. Obama and his party as the economic debate proceeds: that Democrats are cavalier about taxing other people because they do not abide by the tax laws themselves.

In evening interviews on broadcast and cable television networks, Mr. Obama said he took responsibility for the errors. “And so I’m frustrated with myself, with our team,” he told NBC, “but ultimately my job is to get this thing back on track because what we need to focus on is a deteriorating economy and getting people back to work.”

He added, “I’m here on television saying I screwed up and that’s part of the era of responsibility.”

Mr. Daschle delivered the news in a call on Tuesday morning to Mr. Obama, who was in his study, just off the Oval Office. He also stepped down from his position as White House heath czar, a job with a West Wing office.

Mr. Daschle said Monday that his failure to pay $128,000 in taxes for the use of a friend’s chauffer and car service was “completely inadvertent.”

Declining an interview request on Tuesday afternoon, Mr. Daschle said in a brief statement distributed by the White House that he would not have been able to lead an overhaul of the nation’s health care system “with the full faith of the Congress and the American people.”

“I am not that leader,” Mr. Daschle said, “and will not be a distraction.”

The withdrawals by the two advisers represent the highest-level political casualties of the young administration and raised fresh questions about the vetting procedures for officials already selected and scores of positions that remain open.

Senate Republicans signaled their intention to step up scrutiny of all appointees. Treasury Secretary Timothy F. Geithner was confirmed last week after apologizing and weathering weeks of criticism for late payment of $34,000 in income taxes.

Both Mr. Daschle and Ms. Killefer pulled out on their own accord, officials said, after their tax returns were scrutinized by the Senate Finance Committee. On the campaign trail, Mr. Obama often expressed frustration to aides about the practice of cutting loose advisers at the first sign of political trouble.

“They both decided and recognized that their nominations would distract from the important goals and the critical agenda that the president put forward,” Robert Gibbs, the White House press secretary, said Tuesday.

Asked repeatedly whether the White House had quietly urged Mr. Daschle to step aside to quell the controversy, Mr. Gibbs said, “He did not get a signal.”

Among the people mentioned as possible candidates for the job of health secretary are Gov. Kathleen Sebelius of Kansas, a former state insurance commissioner; former Gov. John A. Kitzhaber of Oregon, a doctor; and Gov. Jennifer M. Granholm of Michigan. All are Democrats.

In the Senate, Democrats were caught by surprise by Mr. Daschle’s decision, particularly after his appearance at the Finance Committee on Monday, as well as several indications that he could win confirmation.

But Republicans were intensifying their criticism of his tax failings, and Senator Harry Reid of Nevada, the majority leader, said Mr. Daschle told him in a phone call on Tuesday morning that he believed the nomination was getting too much attention.

Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate, said Mr. Daschle, the former Senate majority leader, had done “the honorable thing to spare his family, the president and his colleagues in the Senate from a tough political battle that would lie ahead.”

Mr. Durbin added, “I think he would have prevailed in the end, but it would have taken a while, and there would have been some suffering.”

The day had been scripted by advisers to turn the page on the tax controversy and refocus on the economy. In a rare move, television anchors for five broadcast and cable networks had been invited to interview Mr. Obama about the urgency of passing the economic recovery plan, a decision that magnified the troubles at the White House by giving them increased prominence on the evening news.

He delivered almost precisely the same mea culpa to each of the anchors as they cycled through the Oval Office.

Hours earlier, as his advisers huddled in the West Wing to shape a strategy for responding to the dizzying turn of events, Mr. Obama and his wife, Michelle, made an unscheduled stop at a public school not far away.

“We were just tired of being in the White House,” Mr. Obama told second graders at Capital City Public Charter School.

Senator John Kerry, Democrat of Massachusetts, who sits on the Finance Committee, said he believed Mr. Daschle should not have withdrawn his name.

“I believe that when the smoke clears and the frenzy has ended, no one will believe that this unwitting mistake should have erased 30 years of selfless public service and remarkable legislative skill and expertise on health care,” Mr. Kerry said.

In the case of Ms. Killefer, administration officials said she had failed to pay more than a year’s worth of unemployment taxes on household help.

The District of Columbia filed a $946.69 tax lien on her home in 2005 for failure to pay the tax. That was disclosed to the Senate Finance Committee, but officials said her tax records were being further scrutinized.

“I recognize that your agenda and the duties facing your chief performance officer are urgent,” Ms. Killefer wrote in a letter to Mr. Obama on Tuesday.

“I have also come to realize in the current environment that my personal tax issue of D.C. unemployment tax could be used to create exactly the kind of distraction and delay those duties must avoid.”

Ms. Killefer, head of the Washington office of the consulting firm McKinsey & Company, was named to the new position on Jan. 7. In the announcement, Mr. Obama said she would help “restore the American people’s confidence in their government.”

He said at the time that her role would be to scour the budget for wasteful or inefficient spending.

Robert Pear and Carl Hulse contributing reporting.

NASHVILLE — Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.

For those in poor urban neighborhoods and isolated rural areas, including Indian reservations, the clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases.

As a crucial component of the health safety net, they are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care.

Despite the clinics’ unprecedented growth, wide swaths of the country remain without access to affordable primary care. The recession has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs.

In response, Democrats on Capitol Hill are proposing even more significant increases, making the centers a likely feature of any health care deal struck by Congress and the Obama administration.

In Nashville, United Neighborhood Health Services, a 32-year-old community health center, has seen its federal financing rise to $4.2 million, from $1.8 million in 2001. That has allowed the organization to add eight clinics to its base of six, and to increase its pool of patients to nearly 25,000 from 10,000.

Still, says Mary Bufwack, the center’s chief executive, the clinics satisfy only a third of the demand in Nashville’s pockets of urban poverty and immigrant need.

One of the group’s recent grants helped open the Southside Family Clinic, which moved last year from a pair of public housing apartments to a gleaming new building on a once derelict corner.

As she completed a breathing treatment one recent afternoon, Willie Mai Ridley, a 68-year-old beautician, said she would have sought care for her bronchitis in a hospital emergency room were it not for the new clinic. Instead, she took a short drive, waited 15 minutes without an appointment and left without paying a dime; the clinic would bill her later for her Medicare co-payment of $18.88.

Ms. Ridley said she appreciated both the dignity and the affordability of her care. “This place is really very, very important to me,” she said, “because you can go and feel like you’re being treated like a person and get the same medical care you would get somewhere else and have to pay $200 to $300.”

As governor of Texas, Mr. Bush came to admire the missionary zeal and cost-efficiency of the not-for-profit community health centers, which qualify for federal operating grants by being located in designated underserved areas and treating patients regardless of their ability to pay. He pledged support for the program while campaigning for president in 2000 on a platform of “compassionate conservatism.”

In Mr. Bush’s first year in office, he proposed to open or expand 1,200 clinics over five years (mission accomplished) and to double the number of patients served (the increase has ended up closer to 60 percent). With the health centers now serving more than 16 million patients at 7,354 sites, the expansion has been the largest since the program’s origins in President Lyndon B. Johnson’s war on poverty, federal officials said.

“They’re an integral part of a health care system because they provide care for the low-income, for the newly arrived, and they take the pressure off of our hospital emergency rooms,” Mr. Bush said last year while touring a clinic in Omaha.

With federal encouragement, the centers have made a major push this decade to expand dental and mental health services, open on-site pharmacies, extend hours to nights and weekends and accommodate recent immigrants — legal and otherwise — by employing bilingual staff. More than a third of patients are now Hispanic, according to the National Association of Community Health Centers.

The centers now serve one of every three people who live in poverty and one of every eight without insurance. But a study released in August by the Government Accountability Office found that 43 percent of the country’s medically underserved areas lack a health center site. The National Association of Community Health Centers and the American Academy of Family Physicians estimated last year that 56 million people were “medically disenfranchised” because they lived in areas with inadequate primary care.

President-elect Barack Obama has said little about how the centers may fit into his plans to remake American health care. But he was a sponsor of a Senate bill in August that would quadruple federal spending on the program — to $8 billion from $2.1 billion — and increase incentives for medical students to choose primary care. His wife, Michelle, worked closely with health centers in Chicago as vice president for community and external relations at the University of Chicago Medical Center.

And Mr. Obama’s choice to become secretary of health and human services, former Senator Tom Daschle of South Dakota, argues in his recent book on health care that financing should be increased, describing the health centers as “a godsend.”

The federal program, which was first championed in Congress by Senator Edward M. Kennedy, Democrat of Massachusetts, has earned considerable bipartisan support. Leading advocates, like Senator Bernie Sanders, independent of Vermont, and Representative James E. Clyburn, Democrat of South Carolina, the House majority whip, argue that any success Mr. Obama has in reducing the number of uninsured will be meaningless if the newly insured cannot find medical homes. In Massachusetts, health centers have seen increased demand since the state began mandating health coverage two years ago.

At $8 billion, the Senate measure may be considered a relative bargain compared with the more than $100 billion needed for Mr. Obama’s proposal to subsidize coverage for the uninsured. If his plan runs into fiscal obstacles, a vast expansion of community health centers may again serve as a stopgap while universal coverage waits for flusher times.

Recent job losses, meanwhile, are stoking demand for the clinics’ services, often from first-time users. The United Neighborhood Health Services clinics in Nashville have seen a 35 percent increase in patients this year, with much of the growth from the newly jobless.

“I’m seeing a lot of professionals that no longer have their insurance or they’re laid off from their jobs,” said Dr. Marshelya D. Wilson, a physician at the center’s Cayce clinic. “So they come here and get their health care.”

Studies have generally shown that the health centers — which must be governed by patient-dominated boards — are effective at reducing racial and ethnic disparities in medical treatment and save substantial sums by keeping patients out of hospitals. Their trade association estimates that they save the health care system $17.6 billion a year, and that an equivalent amount could be saved if avoidable emergency room visits were diverted to clinics. Some centers, including here in Nashville, have brokered agreements with hospitals to do exactly that.

Many centers are finding that federal support is not keeping pace with the growing cost of treating the uninsured. Government grants now account for 19 percent of community health center revenues, compared with 22 percent in 2001, according to the Health Resources and Services Administration, which oversees the program. The largest revenue sources are public insurance plans like Medicaid, Medicare and the State Children’s Health Insurance Program, making the centers vulnerable to government belt-tightening.

The centers are known for their efficiency. Though United Neighborhood Health Services has more than doubled in size this decade, Ms. Bufwack, its chief executive, manages to run five neighborhood clinics, five school clinics, a homeless clinic, two mobile clinics and a rural clinic, with 24,391 patients, on a budget of $8.1 million. Starting pay for her doctors is $120,000. Patients are charged on an income-based sliding scale, and the uninsured are expected to pay at least $20 for an office visit. One clinic is housed in a double-wide trailer.

Because of a nationwide shortage of primary care physicians, the clinics rely on federal programs like the National Health Service Corps that entice medical students with grants and loan write-offs in exchange for agreements to practice as generalists in underserved areas. Of the 16 doctors working for United Neighborhood, seven are current or former participants.

Dr. LaTonya D. Knott, 37, who treated Ms. Ridley for her bronchitis, is among them. Born to a 15-year-old mother in south Nashville, she herself had been a regular childhood patient at one of the center’s clinics. After graduating as her high school’s valedictorian, she went to college on scholarships and then to medical school on government grants, with an obligation to serve for two years.

She said she now felt a responsibility to be a role model. “I do a whole lot of social work,” she said, noting that it was not uncommon for children to drop by the clinic for help with homework, or for a peanut butter sandwich. “It’s not just that we provide the medical care. I’m trying to provide you with a future.”

Despite such commitment, national staffing shortages have reinforced concerns about the quality of care at health centers, notably the management of chronic diseases. This year, the government started collecting data at the centers on performance measures like cervical cancer screening and diabetes control.

“The question is not just, ‘Are you going to have more community health centers?’ ” said Dr. H. Jack Geiger, founder of the health centers movement and a professor emeritus at the City University of New York. “It’s, ‘Are you going to have adequate services?’ ”

A deeper frustration for health centers concerns their difficulty in securing follow-up appointments with specialists for patients who are uninsured or have Medicaid. All too often, said Ms. Bufwack, medical care ends at the clinic door, reinforcing the need to expand both primary care and health insurance coverage.

“That’s when our doctors feel they’re practicing third world medicine,” she said. “You will die if you have cancer or a heart condition or bad asthma or horrible diabetes. If you need a specialist and specialty tests and specialty meds and specialty surgery, those things are totally out of your reach.”

December 22, 2008

By Ed Gillespie

As the year draws to an end and President Bush enters his final month in office, there is much commentary about the Administration’s record over the past eight years. Unsurprisingly, many of these stories assail and distort the President’s record and recycle myths and unfounded allegations that have been leveled for the better part of his two terms. Historical accuracy requires a response to the litany of attacks leveled against President Bush, and while there’s not enough space to respond to all of them, here are five of the most egregious:

Myth 1: The last eight years were awful for most Americans economically and President Bush’s deregulatory policies caused the current financial crisis.

Reality:

President Bush’s time in office is ending as it began, with our economy under stress. The recession President Bush inherited as he entered office ran through the attacks of September 11, 2001, but during the recovery that followed, and due in no small part to the tax relief President Bush worked with Congress to provide, this country experienced its longest run of uninterrupted job growth – 52 straight months, with 8.3 million jobs created.

This reflected six consecutive years of economic growth from the Fourth Quarter of 2001 until the Fourth Quarter of 2007. From 2000 to 2007, real GDP grew by more than 17 percent, a remarkable gain of nearly 2.1 trillion dollars. This growth was driven in part by increased labor productivity gains that have averaged 2.5 percent annually since 2001, a rate that exceeds the averages of the 1970s, ’80s, and ’90s. In the same period, real after-tax income per capita increased by more than 11 percent, and there was a 4.7 percent increase in the number of new businesses formed. The current economic challenges, which the President and his Administration have responded to aggressively, threaten to reverse some of these gains – but the gains cannot be denied.

As for the current crisis, the President and his economic team have taken unprecedented actions to stabilize the financial sector and avert a collapse. While there are a number of causes of the housing and credit crises that are at the root of our current economic troubles, deregulation by the Bush Administration is simply not one of them. In fact, one of the circumstances that contributed to the crisis was the failure of the government sponsored enterprises (GSEs) Fannie Mae and Freddie Mac, which President Bush long tried to subject to greater regulation. In April 2001, three months after taking office, the President warned in his first budget that the size of the two GSEs were a “potential problem” that “could cause strong repercussions in financial markets, affecting Federally insured entities and economic activity.” In 2003, the Administration began calling for a new GSE regulator, and over the next five years, the Administration continued to call for GSE reform only to be accused by Democrats in Congress of creating artificial fears and advocating for ill-advised proposals. By the time Congress finally acted in 2008 to provide the oversight the President requested, it was too late to prevent systemic consequences. Had the Administration’s initial reform proposals been adopted, some of today’s turmoil in our financial markets may have been averted.

Myth 2: President Bush’s tax cuts only benefitted the wealthy and were paid for by sacrificing investments in health care and education.

Reality:

There are not 116 million “wealthy Americans,” but that’s how many taxpayers benefited from the President’s tax relief. The across-the-board tax cuts provided tax relief to every American who pays income taxes, created a new bottom 10 percent bracket rate, doubled the child tax credit to $1,000, and actually increased the share of the Federal income tax burden paid by the top 10 percent of individual earners from 67 percent in 2000 to 70 percent in 2005. Furthermore, this Administration removed 13 million low-income earners from the income tax rolls completely.

The economic growth spurred by tax relief also spurred growth in Federal tax receipts. In fact, the Federal Treasury realized the largest three-year increase of revenue in 26 years, and tax receipts grew more than $542 billion between 2000 and 2007. And yes, much of that money went to investments in health care and education.

President Bush provided more than 40 million Americans with better access to prescription drugs by creating the market-based Medicare Prescription Drug Benefit. And it is one of the rare government programs that actually costs less than expected. Projected overall program spending between 2004 and 2013 is approximately $240 billion lower, nearly 38 percent, than originally estimated, thanks to the market-oriented principles included at President Bush’s insistence.

Despite the heated rhetoric over children’s health insurance (S-CHIP) legislation last year, estimates from a 2007 Federal survey show that the number of uninsured children under the age of 18 actually declined by 800,000 from 2001 to 2007. From 2007 to 2008, the number of people covered by affordable and portable Health Savings Account-eligible plans increased 35 percent. Additionally, since President Bush took office, more than 1,200 community health centers have opened or expanded nationwide, which has helped provide treatment to nearly 17 million people.

Federal spending on education has increased nearly 40 percent under President Bush. Additionally, Pell Grant funding nearly doubled during the Administration, which is expected to help more than 5.5 million students attend college in the 2008-09 school year, 1.2 million more students than were assisted by Pell Grants in the 2001-02 school year. This financial aid assistance also helps account for the fact that 66 percent of high school graduates from the class of 2006 enrolled in colleges, compared to 63 percent in 2000.

Perhaps more importantly, the President’s No Child Left Behind Act has delivered tangible results to students. Since the law was enacted, fourth-grade students have achieved their highest reading and math scores on record, eighth-grade students have achieved their highest math scores on record, and African-American and Hispanic students have posted all-time high scores in a number of categories, narrowing the gap between minority students and white students.

Myth 3: The President’s “go it alone” foreign policy ruined America’s standing in the world.

Reality:

Rarely can one see revisionist history occurring in the present, but this charge is nothing short of that. The United States acted with a multilateral coalition of partner nations to remove Saddam Hussein from power in Iraq after he failed to comply with the will of the international community, including numerous United Nations Security Council Resolutions. To ignore this fact is not only a distortion of history, but it is also an insult to the service members of our coalition partners who sacrificed their lives to contribute to the success we are now witnessing in Iraq. And in Afghanistan, approximately forty countries are currently deployed with American forces, including every one of our NATO allies.

The President also created a worldwide coalition of more than 90 nations to combat terrorist networks by sharing information, drying up their financing, and bringing their leaders to justice. To date, we have captured or killed hundreds of al-Qaeda leaders and operatives with the help of partner nations. Furthermore, the Administration established the Proliferation Security Initiative, which now includes more than 90 nations, and other multilateral coalitions to stop the proliferation of weapons of mass destruction.

The President successfully pushed for expanding NATO membership, generated international pressure on Iran to stop it from developing nuclear weapons, and organized the Six-Party Talks, which have resulted in North Korea committing to give up its nuclear weapons and abandon its nuclear programs. Verifying North Korea’s commitment will be a challenge, but at the most recent Six-Party Talks meeting, there was strong consensus among the five parties that North Korea must submit to a comprehensive verification regime that accords with international standards.

U.S. ties in Asia have been strengthened over the past eight years, and the Administration has built strong relationships with China, Japan, and South Korea, among others. We have signed an historic civilian nuclear power agreement with India, reflecting a fundamental change in our relationship. Pro-American leaders have been elected in Germany, France, and Italy. Eastern European countries such as Georgia, Ukraine, and Kosovo treasure their relationships with the United States, and no president has done more to improve health and security in the nations of Africa. We have also strengthened cooperation with Latin America, including initiatives with Brazil on biofuels and with Mexico and Central America on fighting organized crime. Finally, when the President took office, America had trade agreements in force with only three countries, versus 14 today – with three additional agreements approved by Congress but not yet in force and agreements with three countries that are awaiting Congressional approval.

Myth 4: The war in Iraq caused us to “take our eye off the ball” in Afghanistan and with al Qaeda.

Reality:

Iraq and Afghanistan are two fronts in the same war, and while the success of the surge in Iraq has been visible, we have also had a quiet surge in Afghanistan. The U.S. has continuously and aggressively fought side-by-side with Afghans and our allies to defeat the Taliban and al Qaeda in Afghanistan. The United States has provided nearly $32 billion for security, political, and economic development assistance and the international community has provided more than $55 billion to Afghanistan since 2001.

An additional U.S. Marine battalion deployed to Afghanistan in November and they will be followed by an Army combat brigade of about 3,400 troops in early 2009. U.S. forces now total approximately 31,000, and are joined by nearly as many coalition troops. The United States and our allies are working with Afghanistan to help it nearly double the size of the Afghan National Army over the next five years, from 79,000 now trained to 134,000 in 2014.

We have also deployed Provincial Reconstruction Teams to ensure security gains are followed by real improvements in daily life, and we have helped local communities strengthen their economies and create jobs, deliver basic services, improve governance and fight corruption, and build or repair key infrastructure such as roads, bridges, hospitals, and schools. More than six million children, approximately two million of them girls, are now in Afghan schools, compared to fewer than one million in 2001.

In this Global War on Terror, we do not have the luxury to fight on one battlefront at a time. To defeat the terrorists, we must fight them overseas so we don’t have to fight them here at home. Since 9/11, we have successfully captured or killed dozens of al-Qaeda’s senior leadership and hundreds of al-Qaeda operatives in two dozen countries, removed al-Qaeda’s safe-haven in Afghanistan and crippled al-Qaeda in Iraq, and disrupted numerous al Qaeda terrorist plots against the U.S., including a 2006 plot to blow up passenger planes traveling from London.

Myth 5: This Administration has been bad for the environment and ignored the problem of global warming.

Reality:

Given the liberal media’s failure to acknowledge this Administration’s true record on alternative energy, conservation, and climate change, it’s not surprising this charge has stuck. But here are some irrefutable data points: From 2001 to 2007, air pollution decreased by 12 percent, and fine particulate matter pollution is down 17 percent since 2001. Ethanol production quadrupled from 1.6 billion gallons in 2000 to 6.5 billion gallons in 2007, wind energy production has increased by more than 400 percent, and solar energy capacity has doubled. In 2007, solar installations increased more than 32 percent and the U.S. produced 96 percent more biodiesel (490 million gallons) than in 2006. The Administration also provided nearly $18 billion to research, develop, and promote alternative and more efficient energy technologies such as biofuels, solar, wind, clean coal, nuclear, and hydrogen.

This Administration has improved and protected the health of more than 27 million acres of Federal forest and grasslands, protected, restored, and improved more than three million acres of wetlands, and established the Papahānaumokuākea Marine National Monument, the world’s largest fully protected marine conservation area (nearly 140,000 square miles).

Much of the misperception about the President’s environmental record is born out of the President’s withdrawing the United States from the Kyoto Protocol, which did not include the effective participation of major developing countries such as India and China. Instead, the President worked to address climate change by launching the Major Economies Process, which convened the leaders of the world’s major economies, both developed and developing, to work on ways to further reduce greenhouse gas emissions and improve energy security without harming our economies or giving any nation a free ride. Finally, the President set the country on course to stop the growth of greenhouse gas emissions below projected levels by 2025 and invested more than $44 billion in climate change-related programs.

Some other items that are infrequently mentioned about the real record of the Bush Administration but are worth noting: Teenage drug use has declined 25 percent; in 2007, the violent crime rate was 43 percent lower than the rate in 1998; between 2005 and 2007, the chronically homeless population decreased approximately 30 percent; funding for veterans’ medical care has increased more than 115 percent; and as of 2005, the most recent abortion rate is at its lowest since 1974.

And one last fact: Our homeland has not suffered another terrorist attack since September 11, 2001. That, too, is part of the real Bush record.

More on RCP: Gas Prices Shouldn’t Set Our Energy Policy

Page Printed from: http://www.realclearpolitics.com/articles/2008/12/myths_and_facts_about_the_real.html at December 22, 2008 – 04:44:29 AM

You probably sat in a fancier conference room the last time you refinanced or heard a pitch about life insurance. There’s a table, some off-brand mesh office chairs, a bookcase that looks as if it had been put together with an Allen wrench and instructions in Swedish.

To reach this room, you pass through a cubicle farm lightly populated by quiet young people. Either they have just arrived or they are just leaving, because their desks are almost bare. The place has a vaguely familiar feel to it, this air of transient shabbiness and nondescriptitude. You can’t quite put your finger on it …

“It’s like the set of The Office,” someone offers.

Bingo.

It is here that we find Barack Obama one soul-freezingly cold December day, mentally unpacking the crate of crushing problems — some old, some new, all ugly — that he is about to inherit as the 44th President of the United States. Most of his hours inside the presidential-transition office are spent in this bland and bare-bones room. You would think the President-elect — a guy who draws 100,000 people to a speech in St. Louis, Mo., who raises three-quarters of a billion dollars, who is facing the toughest first year since Franklin Roosevelt’s — might merit a leather chair. Maybe a credenza? A hutch?

But he doesn’t seem to notice. Obama is cheerfully showing his visitors around, gripping the souvenir basketball he received from Hall of Famer Lenny Wilkens, explaining a snapshot taken the day he played pickup with the University of North Carolina hoops team. (”They are so big and so fast and so strong, you know.”) Then, since those two items basically exhaust the room’s décor, Obama sits down on one of the mesh chairs and launches into a spoken tour of his world of woes. It’s a mind-boggling journey, although he shows no signs of being boggled — unless you count the increasingly prevalent salt in his salt-and-pepper hair. By now we are all accustomed to that Obi-Wan Kenobi calm, though we may never entirely understand it. In a soothing monotone, he highlights the scariest hairpin turns on his itinerary, the ones that combine difficulty with danger plus a jolt of existential risk. (See pictures of the Civil Rights movement from Emmett Till to Barack Obama.)

“It is not clear that the economy’s bottomed out,” he begins, understatedly. (The morning newspaper trumpets the worst unemployment spike in more than 30 years.) “And so even if we take a whole host of the right steps in terms of the economy, two years from now it may not have fully recovered.” That worries him. Also Afghanistan: “We’re going to have to make a series of not just military but also diplomatic moves that fully enlist Pakistan as an ally in that region, that lessen tensions between India and Pakistan, and then get everybody focused on rooting out militancy in a terrain, a territory, that is very tough — and in an enormous country that is one of the poorest and least developed in the world. So that, I think, is going to be a very tough situation.

“And then the third thing that keeps me up at night is the issue of nuclear proliferation,” Obama continues, sailing on through the horribles. “And then the final thing, just to round out my Happy List, is climate change. All the indicators are that this is happening faster than even the most pessimistic scientists were anticipating a couple of years ago.”

Score that as follows: one imploding economy, one deteriorating war in an impossible region and two versions of Armageddon — the bang of loose nukes and the whimper of environmental collapse. That’s just for starters; we’ll hear the unabridged version shortly.

But first, there is a bit of business to be dealt with, having to do with why you are reading this story in this magazine at this time of the year. It’s unlikely that you were surprised to see Obama’s face on the cover. He has come to dominate the public sphere so completely that it beggars belief to recall that half the people in America had never heard of him two years ago — that even his campaign manager, at the outset, wasn’t sure Obama had what it would take to win the election. He hit the American scene like a thunderclap, upended our politics, shattered decades of conventional wisdom and overcame centuries of the social pecking order. Understandably, you may be thinking Obama is on the cover for these big and flashy reasons: for ushering the country across a momentous symbolic line, for infusing our democracy with a new intensity of participation, for showing the world and ourselves that our most cherished myth — the one about boundless opportunity — has plenty of juice left in it.

See pictures of Obama’s nation of hope.

See pictures of Obama’s college years.

But crisis has a way of ushering even great events into the past. As Obama has moved with unprecedented speed to build an Administration that would bolster the confidence of a shaken world, his flash and dazzle have faded into the background. In the waning days of his extraordinary year and on the cusp of his presidency, what now seems most salient about Obama is the opposite of flashy, the antithesis of rhetoric: he gets things done. He is a man about his business — a Mr. Fix It going to Washington. That’s why he’s here and why he doesn’t care about the furniture. We’ve heard fine speechmakers before and read compelling personal narratives. We’ve observed candidates who somehow latch on to just the right issue at just the right moment. Obama was all these when he started his campaign: a talented speaker who had opposed the Iraq war and lived a biography that was all things to all people. But while events undermined those pillars of his candidacy, making Iraq seem less urgent and biography less relevant, Obama has kept on rising. He possesses a rare ability to read the imperatives and possibilities of each new moment and organize himself and others to anticipate change and translate it into opportunity. (See pictures of Obama’s nation of hope.)

The real story of Obama’s year is the steady march of seemingly impossible accomplishments: beating the Clinton machine, organizing previously marginal voters, harnessing the new technologies of democratic engagement, shattering fundraising records, turning previously red states blue — and then waking up the day after his victory to reinvent the presidential-transition process in the face of a potentially dangerous vacuum of leadership. “We always did our best up on the high wire,” says his campaign manager, David Plouffe.

Obama’s competence fills him with a genuine self-confidence. “I’ve got a pretty healthy ego,” he allows. That’s clear when he offers a checklist for voters to use in judging his performance two years from now. It’s quite an agenda. Listen: “Have we helped this economy recover from what is the worst financial crisis since the Great Depression? Have we instituted financial regulations and rules of the road that assure this kind of crisis doesn’t occur again? Have we created jobs that pay well and allow families to support themselves? Have we made significant progress on reducing the cost of health care and expanding coverage? Have we begun what will probably be a decade-long project to shift America to a new energy economy? Have we begun what may be an even longer project of revitalizing our public-school systems?”

There’s more: “Have we closed down Guantánamo in a responsible way, put a clear end to torture and restored a balance between the demands of our security and our Constitution? Have we rebuilt alliances around the world effectively? Have I drawn down U.S. troops out of Iraq, and have we strengthened our approach in Afghanistan — not just militarily but also diplomatically and in terms of development? And have we been able to reinvigorate international institutions to deal with transnational threats, like climate change, that we can’t solve on our own?”

And: “Outside of specific policy measures, two years from now, I want the American people to be able to say, ‘Government’s not perfect; there are some things Obama does that get on my nerves. But you know what? I feel like the government’s working for me. I feel like it’s accountable. I feel like it’s transparent. I feel that I am well informed about what government actions are being taken. I feel that this is a President and an Administration that admits when it makes mistakes and adapts itself to new information.’”

Can he really achieve all that? Plenty of voters will be happy if he aces only Item 1 on his list. But the essence of both Obama’s strength and his promise is that, according to a recent poll, a strong majority of Americans believe he will accomplish most of what he aims to do. For having the confidence to sketch that kind of future in this gloomy hour and for showing the competence that makes Americans hopeful that he will pull it off, Barack Obama is Time’s Person of the Year for 2008.

I. Simple Competence
In some tellings, Obama’s journey to the white house started with his little-noticed but carefully nuanced speech against the Iraq war in 2002. In other versions, it began with his electrifying address to the Democratic Convention in 2004. Those moments blazed with potential, true, but something more was necessary: a certain appetite among the electorate. The country had to be hungry for the menu he offered, and in that sense, his path’s true beginning lay in the drowned precincts of New Orleans in the sweltering, desperate late summer of 2005.

Hurricane Katrina blew away the last gauzy veil from an ugly specter of executive incompetence in American politics. When the people of New Orleans needed leadership, the Republican Administration in Washington proved useless. The Democratic governor and mayor were pitiful. At long last, our government was united — but under an appalling banner of fecklessness. The moral bankruptcy of the spin doctors was laid bare: no soul remained gullible enough to believe that Brownie was doing a heckuva job.

After Katrina, demand collapsed for the very qualities that Obama lacked as a candidate: empty boasts, finger-pointing, backstabbing and years of experience inside a government that couldn’t deliver bottled water to the stranded citizens of a major U.S. city. Spare us the dead-or-alive bravado, the gates-of-hell bluster, the melodrama of the 3 a.m. phone call. A door swung open for a candidate who would merely stand and deliver. Simple competence — although there’s nothing simple about it, not in today’s intricate, interdependent, interwoven, intensely dangerous world.

See pictures of Barack Obama’s campaign behind the scenes.

See pictures of Obama on Flickr.

His official theme was change, but a specific kind of change: the nuts-and-bolts kind you can see and measure. Voters were invited to believe because Obama kept delivering the goods. Certainly he made mistakes and gave up on some ideas while doubling back on others — his promise to stick to the existing campaign-finance system, for example. On the whole, though, he was a doer. Obama told people that a black man could win white votes. In Iowa he proved it. He said a broad-gauge campaign could win in GOP strongholds; along came Indiana and Virginia and North Carolina. He declared that a new approach to politics would topple the old Clinton-Bush seesaw, and topple it he did. He sank the three-pointer with the cameras rolling. Made a speech in a football stadium feel intimate. Some might say these are not exactly Churchillian achievements, but in the land of the hapless, the competent man is king. In the end, his campaign e-mail list numbered some 13 million people, of whom more than 3.5 million put actual skin in the game — money, volunteer hours or both. Obama’s most formidable opponent, Hillary Clinton, tried to convince voters that he was all talk and no action, a vessel empty but for intoxicating fumes. Yet he was the one whose campaign ran like clockwork, while hers was a fratricidal mess. And by Nov. 4, the strongest party in the U.S. was no longer the Republican Party or the Democratic Party; it was the Obama Party.

II. Filling the Vacuum
“A presidential campaign is like an MRI of the soul,” says David Axelrod, Obama’s chief strategist. “And one of the great revelations of this process, certainly the most thrilling revelation to me, was to learn what a great manager this guy is. We had no way of knowing that when we started. When he decided to run, we had no political infrastructure at all. There was just a handful of us, and we were setting off to challenge the greatest political operation in the Democratic Party.”

Keep in mind that Obama, as Rudy Giuliani put it at the Republican Convention in September, had “never led anything, nothing, nada” — certainly not a sprawling organization spread from coast to coast. But he did have a philosophy of leadership, which he explains like this: “I don’t think there’s some magic trick here. I think I’ve got a good nose for talent, so I hire really good people. And I’ve got a pretty healthy ego, so I’m not scared of hiring the smartest people, even when they’re smarter than me. And I have a low tolerance of nonsense and turf battles and game-playing, and I send that message very clearly. And so over time, I think, people start trusting each other, and they stay focused on mission, as opposed to personal ambition or grievance. If you’ve got really smart people who are all focused on the same mission, then usually you can get some things done.”

Stop and look back at those last few words, because they are a telltale sign of Obama’s pragmatism. A persistent question during the campaign — it became the heart of John McCain’s message in the closing weeks — was whether Obama was some kind of radical, a terrorist-befriending socialist masquerading as Steady Freddy. As he builds his Administration, though, he is emerging as a leader who just wants to “get some things done.” (Read “The New Liberal Order.”)

Obama is a businesslike boss. He prefers briefing papers tightly written and shows up for meetings fully prepared. He expects people to challenge him when they think he is wrong and to back up their ideas with facts. He’s not a shouter — “Hollering at people isn’t usually that effective,” he explains — but if he thinks you’ve let him down, you’ll know it. “What was always effective with me as a kid — and Michelle and I find it effective with our kids — is just making people feel really guilty,” he says. “Like ‘Boy, I am disappointed in you. I expected so much more.’ And I think people generally want to do the right thing, and if you’re clear to them about what that right thing is, and if they see you doing the right thing, then that gives you some leverage.”

Again, take a second to reread, this time the bit where he says “people generally want to do the right thing.” Trust of this kind has been in short supply for many years in American politics, where the dominant attitude is that every disagreement is a sign of bad faith and every opponent is assumed to be malevolent. Obama’s attitude was ridiculed as kumbaya naiveté during the campaign, but trust proved to be essential to his victory. His campaign entrusted millions of volunteers with unprecedented authority to download information about prospective voters, to assign themselves to make phone calls and canvass their own neighborhoods and apartment buildings, and to keep the campaign abreast of their progress. A typical presidential effort is top-down, intensely protective of its data and strategies. Obama’s approach seemed to court mischief or even chaos. “There was a lot of snickering among the political pros,” says Plouffe. “They couldn’t believe that we were giving people we didn’t know access to our data and trusting them to handle it honestly. But it was enormously important because it made people feel that much more accountable: ‘These are my three blocks, and everyone’s counting on me.’”

See pictures of Obama on Flickr.

See the Six Degrees of Barack Obama.

Yes, Obama could talk — like nobody’s business — but talk didn’t win the election. According to the daily tracking polls, the tumblers clicked into place precisely at the moment the financial hurricane hit, when the wizards of Wall Street proved as incompetent as Oz and neither the President nor the leaders of Congress nor the Treasury boss nor Senator McCain could deliver a rescue package. When this group failure provoked a stock-market crash in early October, Americans asked, “Can’t anybody here play this game?” Astounding as it would have seemed scant months before, their gaze fell on the one fixed point in the widening gyre: a guy named Barack Hussein Obama. (See pictures of Barack Obama’s family tree.)

III. Fear Itself
As White House Chief of Staff during the final years of the Clinton Administration, John Podesta became accustomed to short nights and emotional roller coasters. Still, he found it a bit strange to be headed to the airport in the predawn darkness of Nov. 5 — just a few hours after the election of a Democratic President. Was Obama really going to chair a major strategy session the morning after winning the longest and most grueling campaign on record? How about a day off?

Long before Election Day, Obama decided that an ordinary transition wouldn’t do. Given the shaky economy and two wars, he knew that the winner of the election — whoever it turned out to be — would face instant and daunting challenges. He wanted to be ready. “What I was absolutely convinced of was that, whether it was me or John McCain, the next President-elect was going to have to move swiftly,” Obama recalls. He deployed Podesta in midsummer to lead an unusually elaborate preparation for a possible Obama presidency. McCain accused him of overconfidence and vanity, of measuring the Oval Office drapes. To Obama, it was simply a matter of prudence. (See pictures from the historic Election Day.)

Podesta had long been planning the return of a Democrat to the White House, and his think tank, the Center for American Progress, was already preparing detailed briefings on conditions in the various departments of government. As the financial system went into free fall in September, Podesta’s team pressed the FBI to work overtime on security screenings of potential Obama nominees. Now, as he boarded a 6 a.m. flight to Chicago, Podesta carried a list of more than 100 candidates who had passed their background investigations and were ready for confirmation on Day One. Instead of taking a day off, the new President-elect celebrated his victory with a five-hour meeting.

Obama had been pondering whether he should step to center stage or wait in the wings as the turbulent last months of the Bush Administration played out. His aides were all over the map. Some advised him to go quietly about his business in Chicago and insist that America has just one President at a time. For Obama to succeed, they argued, the country needed to see his Inauguration as a clean break, a new sunrise. Others floated the idea of immediately starting the First Hundred Days, perhaps asking George W. Bush to appoint Obama’s choices to key offices so that they could get to work by late November.

Obama was leery of appearing to shoulder responsibility for problems before he had any real authority to fix them. Bush’s bank of political capital was busted, and Obama wasn’t about to take ownership of the toxic assets. On the other hand, he didn’t want to repeat the dysfunctional transition of power from Herbert Hoover to Roosevelt in the dark hours of the Great Depression. F.D.R.’s silence between his election and his Inauguration may have deepened the crisis. By 5 p.m. on Nov. 5, when Podesta walked out of that meeting — not 24 hours after the polls closed — Obama was far ahead of the normal transition process, having homed in on finalists for many of his key staff and Cabinet positions. But he hadn’t yet decided how public to be about it.

Within two days, however, events forced his hand. On Friday, Nov. 7, Obama convened a meeting of his economic advisers in Chicago, and the tone of their comments was chilling. The stock market was plunging; credit remained tight; fresh unemployment numbers were shocking. “There was just a very dramatic deterioration” in the days after the election, says Timothy Geithner, Obama’s choice for Treasury Secretary. On previous occasions when the group had gathered, someone could always be counted on to find potential upsides in dismal forecasts, while Paul Volcker, the 81-year-old former chairman of the Federal Reserve, reliably closed each meeting with a gloomy soliloquy. On this day, though, there was no positive scenario for Volcker to deflate. Everyone in the room was grim.

See pictures of the global financial crisis.

See pictures of Obama’s nation of hope.

Obama opened the meeting by reflecting on his dilemma: act now or wait until January? By the end of the session, he had concluded that, like it or not, he must “accelerate all of our timetables,” as he put it, “in appointments not just on the Cabinet but also our White House team, in structuring economic plans so that we can start getting them to Congress and hopefully begin work — even before I’m sworn in — on some of our key priorities around the economy, on laying the groundwork for a national-security team that can take the baton in a wartime transition.” There was no time for the “traditional postelection holiday.” Vacations would have to wait until Christmas.

Transition is such a gentle word. We make the transition from youth to adulthood or from the dinner table to the den. For Obama, though, the concept was freighted with danger. “He was very focused on the basic perils of the gap between the election and the Inauguration, at a time when the economy was clearly deteriorating and the markets were very fragile,” Geithner explains. In certain powerful respects, Obama felt compelled to begin his presidency immediately. Markets needed to size up his economic team and hear what he planned to do. Congressional leaders, contemplating a colossal economic-stimulus package, needed to know where he was headed. Military leaders, key allies and opportunistic enemies were all keen to know just how dovish the anti-Iraq-war President intended to be. Obama concluded that hanging back would create a dangerous leadership void in the short-term and compound his troubles come January. And nothing that has happened since that Nov. 7 decision — the crisis at Citigroup, the drama of the automakers or the assault on Mumbai — has made the transfer of power look any less perilous.

He could not have predicted when he set out to become President that he would face such circumstances. The distance from the birth of his campaign to these first days of his fledgling presidency could be counted in months but measured in light-years. When he announced his candidacy on a frigid morning in Springfield, Ill., in 2007, Iraq was a disaster, and the Dow was still headed upward past 14,000. So this moment was a test not only of his speed but also of his flexibility. Obama proved lithe, indeed, persuading Robert Gates, Bush’s Secretary of Defense, to remain in his post and asking Clinton, a constant critic of Obama’s foreign policy views during their primary battle, to be his Secretary of State. Priority 1 was the economic team, however. There his task was to find a mix of people familiar enough to signal stability but fresh enough to promise change, and to design a stimulus strategy dramatic enough to inspire markets to swallow their panic. (See pictures of Obama’s White House team.)

In the days leading up to Thanksgiving, Obama delivered. Having promised to govern from the middle, he rolled out a bright purple team of economic advisers, neither red nor blue. Geithner had served in various posts under both Bush and Bill Clinton. As president of the New York Fed, he was well known to Wall Street but relatively unknown on Main Street — just the blend of experience and newness that Obama was seeking. His budget director, Peter Orszag, had fans across the political spectrum, and his in-house oracle, Volcker, was a Democrat who fought inflation alongside Ronald Reagan. Larry Summers, named to run the economics team from the White House, was a Clinton stalwart.

Unveiling these and other picks at a series of daily press conferences, Obama assured the public that he wanted to move fast, so fast that trainloads of money might be ready for him to dispatch across the country with a stroke of his pen on Inauguration Day. The idea of another wave of spending horrifies America’s surviving conservatives, but most economists support it — some with enthusiasm, some with resignation. Obama realized that the stimulus package could be a vehicle for launching his broad domestic agenda. His ambitious campaign promises — to reform health care, cut taxes for low- and moderate-income earners and steer the U.S. toward a new energy economy — had seemed doomed by the yawning budget deficit (some $200 billion a month, according to the latest projections). But call these projects “stimulus,” and suddenly a ship headed for the reef of economic disaster might sail through Congress flying the flag of economic recovery. With even Republican economists talking about hundreds of billions in new spending, the sky’s the limit. A dream of health-care reformers — electronic medical records — is now economic stimulus because Obama will pour money into hospitals for computers and clerical workers. His tax cut is stimulus because it puts spending money in the pockets of working Americans. His pledge to repair the nation’s infrastructure is a stimulus plan for construction workers, while his energy strategy is stimulus for the people who will modernize government buildings, update public schools and improve the electrical grid.

See pictures of Obama’s nation of hope.

See pictures of Obama’s college years.

Of course, the bullet points are easy to list; far harder is the task of spending vast sums — perhaps $1 trillion over two years — efficiently, effectively and quickly enough to spur the economy. Washington’s three goblins — waste, fraud and abuse — are watching with hungry eyes. Obama has cast Orszag as a flinty keeper of the purse strings, but he has no intention of letting his opportunity go by. “I don’t think that Americans want hubris from their next President,” Obama says, noting that McCain received nearly 47% of the vote last month. However, “I do think that we received a strong mandate for change. And I know that people have said, ‘Well, what does this change word mean? You know that it’s sort of ill defined.’ Actually, we defined it pretty precisely during the campaign, and I’m trying to define it further for people during this transition,” he says. “It means a government that is not ideologically driven. It means a government that is competent. It means a government, most importantly, that is focused day in, day out on the needs and struggles, the hopes and dreams of ordinary people.”

IV. Into the Breach
More than 75 years ago, a new president took the oath of office amid economic catastrophe and admonished the nation that “the only thing we have to fear is fear itself.” Today generations of Americans are experiencing a harsh tutorial in the true meaning of that resonant diagnosis. Fear is kryptonite to the economy, which cannot operate efficiently without broad and well-founded confidence — that wise investments will gain value, that balance sheets mean what they say, that contracts will be honored and bills paid.

The events of the past autumn produced the sharpest drop in consumer confidence ever recorded, and a similar wave of fear cratered credit markets. Obama notes the very real structural flaws in the economy, but he is also aware of the role that fear plays. “Nobody trusts other people’s books anymore. And people decide, ‘Well, I’m just going to hold on to my cash for a while,’” he explains. “And that compounds the crisis. And all that results in a contraction in lending, in consumer spending, which then has a real impact on Main Street. And so what starts off as psychological is now very real.”

Just like our banks and our carmakers, America’s shattered confidence is in serious need of a bailout. And the thing about competence is that it nourishes fresh confidence. “Yes, we can” is both an affirmation of optimism and the essential claim of the competent. When the slogan is rooted in a record of accomplishment — when tomorrow’s yes-we-can is backed up by yesterday’s yes-we-did — confidence and competence begin to feed on each other. This virtuous cycle of possibility isn’t the whole of leadership, but it is an important part and perhaps the element most needed in today’s sea of troubles. (See pictures of Obama’s nation of hope.)

After the election, veteran Democratic pollster Peter Hart convened one last focus group to ask Virginia voters why a state that gave Bush an 8-point victory four years ago chose Obama by 6 points this time. Their responses clustered around the crucial connection between competence and confidence. They told Hart they were drawn to Obama’s self-assured and calming personality. They felt he was “honest,” a “straight shooter” — in other words, a person who does what he says he will do. Their confidence in Obama wasn’t starry-eyed; they hadn’t been swept away by his stadium speeches. They saw a man who can get some things done, at a time when so many of their leaders, from Pennsylvania Avenue to Wall Street, cannot. He made moderates feel hopeful, and even among many core Republicans who did not ultimately vote for him, Obama inspired admiration. Viewing these comments through the results of his national surveys, Hart discerned a surge of good feeling that he had not seen in a generation: “a sense of real hope,” he says, “and the kind of broad bipartisan support that has not been in evidence since the 1980 Reagan election.”

Obama has begun to turn his thoughts to his Inaugural Address. According to strategist Axelrod, he is looking for the right mixture of bracing and boost in a speech that will be “both sober and hopeful.” He may signal a new day by announcing a plan to stem the foreclosure crisis, which aides say is in the works. As the gray Chicago sky frowns outside his conference-room window, Obama rehearses his message. Americans “should anticipate that 2009 is going to be a tough year,” he says. Then he adds, “If we make some good choices, I’m confident that we can limit some of the damage in 2009. And that in 2010 we can start seeing an upward trajectory on the economy.”

A few days after this interview, Illinois Governor Rod Blagojevich reminded the country that some aspects of politics will never change. Government is a human enterprise, after all, and Obama, like everyone else, is bound by its limits and subject to human frailty. Nevertheless, if he has shown anything this year, Obama has made it clear that he knows how to write new playbooks and do things in new ways. Which is a compelling quality right now. His arrival on the scene feels like a step into the next century — his genome is global, his mind is innovative, his world is networked, and his spirit is democratic. Perhaps it takes a new face to see the promise in a future that now looks dark. What’s in store for Obama’s America? “I don’t have a crystal ball,” he says. But the measure of his success in menacing times can be found in the number and variety of people who consider the question with eagerness alongside their dread.

—David Von Drehle with reporting by Massimo Calabresi and Michael Duffy / Washington

See pictures of Obama’s college years.

See pictures of the Civil Rights movement from Emmett Till to Barack Obama.

Senator John McCain used the final debate of the presidential election on Wednesday night to raise persistent and pointed questions about Senator Barack Obama’s character, judgment and policy prescriptions in a session that was by far the most spirited and combative of their encounters this fall.

At times showing anger and at others a methodical determination to make all his points, Mr. McCain pressed his Democratic rival on taxes, spending, the tone of the campaign and his association with the former Weather Underground leader William Ayers, using nearly every argument at his disposal in an effort to alter the course of a contest that has increasingly gone Mr. Obama’s way.

But Mr. Obama maintained a placid and at times bemused demeanor — if at times appearing to work at it — as he parried the attacks and pressed his consistent line that Mr. McCain would represent a continuation of President Bush’s unpopular policies, especially on the economy.

That set the backdrop for one of the sharpest exchanges of the evening, when, in response to Mr. Obama’s statement that Mr. McCain had repeatedly supported Mr. Bush’s economic policies, Mr. McCain fairly leaped out of his chair to say: “Senator Obama, I am not President Bush. If you wanted to run against President Bush, you should have run four years ago.”

Acknowledging Mr. McCain had his differences with Mr. Bush, Mr. Obama replied, “The fact of the matter is that if I occasionally mistake your policies for George Bush’s policies, it’s because on the core economic issues that matter to the American people — on tax policy, on energy policy, on spending priorities — you have been a vigorous supporter of President Bush.”

The debate touched on a wide variety of issues, including abortion, judicial appointments, trade and climate change as well as the economy, with the candidates often making clear the deep differences between them.

But it also put on display the two very different temperaments of the candidates with less than three weeks until Election Day. The lasting image of the night could be the split screen of Mr. Obama, doing his best to maintain his unflappable demeanor under a sometimes withering attack, and Mr. McCain looking coiled, occasionally breathing deeply, apparently in an expression of impatience.

Sitting side by side with only the host, Bob Schieffer of CBS News, between them on the stage at Hofstra University, Mr. McCain made clear from the start that he was going to follow the prescriptions of many of his supporters — among them his running mate, Gov. Sarah Palin of Alaska — and try to put Mr. Obama on the defensive and shake him from his steady debate style.

Seizing on an encounter in Ohio this week with a voter — Joe Wurzelbacher, a plumber — who told Mr. Obama that he feared that his tax policies would punish him as a small-business owner, Mr. McCain pressed his attack on Mr. Obama as a tax-and-spend liberal. Mr. Obama’s plan would raise taxes on filers earning more than $250,000 a year, a category that includes some small businesses, but would cut taxes on households earning less than $200,000 a year.

Seeking to suggest that Mr. Obama would hurt the economy and many entrepreneurs, Mr. McCain said, “The whole premise behind Senator Obama’s plans are class warfare — let’s spread the wealth around,” repeating a phrase Mr. Obama had used to Mr. Wurzelbacher in explaining the rationale for his upper-income tax increase.

“Why would you want to do that — anyone, anyone in America — when we have such a tough time, when these small-business people like Joe the Plumber are going to create jobs unless you take that money from him and spread the wealth around,” Mr. McCain said.

The plumber came up directly or indirectly 24 times during the debate, an Everyman symbol of the divide between the candidates on how best to address the economy.

As he has done in previous encounters, Mr. Obama looked into the camera and repeated his plan: “Now, the conversation I had with Joe the Plumber, what I essentially said to him was, five years ago, when you weren’t in the position to buy your business, you needed a tax cut then. And what I want to do is to make sure that the plumber, the nurse, the firefighter, the teacher, the young entrepreneur who doesn’t yet have money, I want to give them a tax break now.”

Coming on a day that the Dow Jones average had one of its worst drops in history, Mr. Schieffer tried something other moderators had failed to do this fall: get the two candidates to enumerate which proposals they would specifically have to postpone or cut in the face of an economic environment that has changed drastically since they first drew up their plans.

Neither man went very far, though Mr. McCain perhaps offered a more detailed list. Repeating his pledge of an across-the-board spending cut, he said, “Well, one of them would be the marketing assistance program. Another one would be a number of subsidies for ethanol.”

Mr. Obama, for his part, specifically cited the “$15 billion a year on subsidies to insurance companies,” a component of the Medicare program. But, he said more generally, “we need to eliminate a whole host of programs that don’t work, and I want to go through the federal budget line by line, page by page. Programs that don’t work, we should cut.”

Still, though the winner of this election will inherit the most sweeping federal intervention in financial markets in at least three generations, the debate, while not short of policy discussions, was at least as much about the styles of the two men as they engaged one another.

In the days before the debate, Mr. Obama had appeared to have goaded Mr. McCain, saying in an interview with ABC News that he did not know why Mr. McCain had not personally made an issue of Mr. Obama’s association with Mr. Ayers, with whom he worked with on two nonprofit boards, in their last debate considering that Mr. McCain’s campaign had done so repeatedly in recent weeks.

And there was some degree of anticipation over whether Mr. McCain would do so this time. He did, though only after a bit of prompting from Mr. Schieffer, who, in a question about the tone of the campaign directed at both men, asked Mr. McCain specifically, “Your running mate said he palled around with terrorists.”

Mr. McCain initially did not address that point directly.

But as Mr. Schieffer seemed prepared to move to another topic, Mr. McCain returned to Mr. Ayers on his own. Mr. McCain seemed most agitated in that moment, saying: “I don’t care about an old, washed-up terrorist. But as Senator Clinton said in her debates with you, we need to know the full extent of that relationship. We need to know the full extent of Senator Obama’s relationship with Acorn, who is now on the verge of maybe perpetrating one of the greatest frauds in voter history in this country, maybe destroying the fabric of democracy.”

He was referring to a community activist group that focuses on housing issues and has been running voter registration efforts in many states that have drawn accusations of fraud.

Mr. Obama’s aides said during the day that he was preparing for the Ayers question.

“Bill Ayers is a professor of education in Chicago. Forty years ago, when I was 8 years old, he engaged in despicable acts with a radical domestic group. I have roundly condemned those acts,” Mr. Obama said. “Ten years ago, he served and I served on a board that was funded by one of Ronald Reagan’s former ambassadors and close friends, Mr. Annenberg.”

On Acorn, Mr. Obama said, “Apparently what they have done is they were paying people to go out and register folks. And apparently some of the people who were out there didn’t really register people, they just filled out a bunch of names. Had nothing to do with us. We were not involved.”

Speaking of his involvement with the group, he said, “The only involvement I’ve had with Acorn was I represented them alongside the U.S. Justice Department in making Illinois implement a motor voter law that helped people register at D.M.V.’s.” Mr. Obama’s campaign made some payments to an affiliate of Acorn.

Mr. Obama said sternly as Mr. McCain bristled, “And I think the fact that this has become such an important part of your campaign, Senator McCain, says more about your campaign than it says about me.”

In a Florida Retirement Community, Residents Are Uncharacteristically Split

By Anne Hull
Washington Post Staff Writer
Wednesday, October 15, 2008; A01

SUN CITY CENTER, Fla. — The sign over the woodworking shop says “Sawdust Engineers,” and there was a time when the men now bent over the tools used to put on ties or make sales calls, building their pensions so they could one day leave the rat race for this warm world of unbroken sunshine.

“Retirement is the best!” says Jerry Decker, 73, one of the Sawdust Engineers tinkering in the wood shop at this over-55 retirement community of 19,000 residents outside Tampa.

But the tranquillity of palm trees and wine gatherings that sustained Decker’s dreams all those years in the snow has been upended by the financial crisis. Even here in paradise, nothing is for sure anymore.

“Who isn’t afraid of getting a ‘Dear John’ letter from GM saying your pension is in danger?” he asks. “You look at all these companies and what they are doing. We worked so hard to put them first, and it’s just not right for them to be reneging.”

The other men share the outrage, spitting out the names of corporations and their golden parachutes and lavish indulgences.

“I wasn’t invited to the AIG spa weekend, were you?” one asks aloud. “You didn’t get the manicure?” another asks.

“If we ran a household like they ran their company, you’d be bankrupt in five months.”

The Sawdust Engineers should be an easy sweep for Republican presidential nominee John McCain. All five are Korean War veterans and registered Republicans. George W. Bush nailed every one of their votes. But three weeks before the election, only three of them are supporting McCain.

Sun City Center is in the hard-fought electoral quadrant in Florida known as the I-4 corridor, home to 43 percent of the state’s voters. The Republican Party has always counted on the retirees here to deliver in bulk, but this year a more severe calculation is at play. To win Florida, McCain needs to capture a bigger slice of older voters than President Bush won in 2004 to offset the high numbers of young voters supporting Democratic Sen. Barack Obama.

“I’m ready for a change,” says Ed Bearer, a retired public school teacher from Delaware who recently received a letter saying his wife’s medical expenses may no longer be covered under his pension plan. “McCain turns me off. I can’t explain it,” he says. He’s voting for Obama.

That leaves Jerry Decker. Last week, during the second presidential debate, Decker kept waiting for McCain to come out swinging. “What he should have said was ‘We’re going to prosecute AIG to the fullest extent,’ ” Decker says. Instead, only vague promises to clean up corruption.

It’s easy to see why Decker wants more heat from a candidate when his own steady discipline is compared with the reckless indulgence of Wall Street. For years, Decker brown-bagged his lunch, even when he went over to the corporate tower as a director of human resources for Formica Corp. His wife, Jeannie, was his barber. The Deckers had one son and the family lived fully but frugally: They were the ones on the side of the ski mountain with their lunch and cans of soda packed from home. Jeannie watched the budget, and for more than two decades she gave her husband $25 each Friday for his weekly spending money.

“It wasn’t a sacrifice,” Decker says. “We had a game plan to spend our retirement together.”

But the game plan for many of the couple’s friends at Sun City Center has been jeopardized by the financial meltdown. Decker hears the stories in the wood shop. Guys who took their company’s advice and converted their pensions to 401(k) plans only to watch their holdings diminish by half when the market plunged. Jeannie tells him that some of the women are skipping their weekly trips to the beauty parlor and letting their hair go gray. More people their age are bagging groceries at the nearby Publix supermarket, and foreclosure signs, once unthinkable, are popping up in the trim Bermuda grass.

“I still believe in our country,” Decker says. “But Jeannie and I don’t have time to rebound. When you are 72 and 73, you don’t have time to recoup.”

‘A Nice Legacy for Our Kids?’

The storefronts at the strip plazas serving Sun City Center say it all: pulmonary clinics, laser surgery, Beltone hearing aids, oxygen tank rentals, a Bob Evans and numerous pharmacies. Retirees zip around in golf carts, many of them outlandishly customized, including one that looks like a giant sombrero, complete with fringe. But spare these folks the Florida retiree jokes — they’ve heard them all. Giving a tour of the aquatic facility, information director John Bowker mentions that four seniors have died in the Jacuzzi. “The most common sound around here is an ambulance,” he says.

Once a solid hub of conservative retirees from the Midwest, Sun City Center has in recent years been set upon by newcomers who make for a less cohesive voting group — “liberal Northeasterners,” says Dee Williams, president of the Sun City Center Republican Club since 1991. In other words, blue-staters.

The influx of Democrats and McCain’s tepid style of campaigning have Williams concerned enough to shoot off SOS e-mails to the Florida Republican Party warning that her turf cannot be taken for granted. “McCain is not bringing passion,” says Williams, 80, sitting in her living room of blue sofas. “He has to convey to the public that what we are doing with the bailout, we had to do.”

In her Missouri twang, Williams makes a direct appeal to her candidate: “You better get off your duff and show some fire. Send Sarah [Palin] and her husband to Michigan. If you are going to give up Michigan and you lose Florida, you lose.”

The same morning Jerry Decker and the Sawdust Engineers are tinkering in their wood shop, a group of women called the Weavers are at their looms elsewhere in the activities center expressing ambivalence about McCain.

“He’s flat, he’s old, he doesn’t seem enthused,” says Jane Bolder, 69, a registered independent who twice voted for Bush because of his tax policies. Voting for McCain, she says, would be a no-brainer if he had picked Sen. Joseph I. Lieberman as a running mate instead of Alaska’s Gov. Palin. “I can’t imagine sending Palin, with her cliches, et cetera, to negotiate or meet with leaders of other countries,” she says.

Obama has struggled to capture older white voters, and Bolder epitomizes their hesitance about him. “He has pizazz, but he has a lot of plans to spend a lot of money,” she says. “The health plan is more geared toward government control. He wants to raise capital gains taxes. Where is the money going to come from to pay for health care?”

Outside, the aqua aerobics class is full tilt with women in water wings dancing to Abba’s “Mamma Mia” while golf carts are nosed up to the state-of-the-art gym. The computer room is packed. Bridge starts at 2. To write off this population as a monolithic voting bloc is a mistake: Ages here range from 55 (known as the “babies”) to 95. They TiVo, they download, and most important, they are inveterate consumers of information.

The one common experience that sears the majority here is the Great Depression. The tanked economy has transcended their usual single-issue focus on health care or Social Security. They are worried, even mournful, about the country that is being passed on to their children and grandchildren. The surface anger is directed at reckless corporations and lack of oversight, but the deeper emotions eventually come out.

“Our debt is in the trillions,” Decker says. “Is this a nice legacy for our kids? We’re worried about our granddaughter, the kind of medical care she’ll have. Will there be a Social Security for her? Will there be pensions?”

It’s 4:30 in the afternoon, and the Deckers are having their ritual glass of wine when Jerry leaps up from a chair in the living room and points out the sliding glass door. “Look at that gator!” he shouts. “He’s on the sixth fairway!” A 10-foot alligator is walking toward the lake.

The couple steps outside. “Oh, look, he’s gonna stop and see Betty,” Jeannie says.

The alligator pauses at lake’s edge next to a white bird. “Isn’t that majestic?” Jerry says, in awe.

The Deckers find everything about Sun City Center pretty majestic. They moved here from Delaware in 2005, and it was a long time coming. After they married in 1960, they put a plan together: save as much as possible so they could enjoy retirement. Jeannie was a registered nurse and Jerry worked for various corporations. Now they swim, fish in the Gulf of Mexico, line-dance, hit the Ringling Museum of Art and even ride the log flume at Busch Gardens.

Both voted for Bush but felt somewhat duped when no weapons of mass destruction were found in Iraq. “Being an old Army guy, I remember saying to Jeannie, ‘I hope he’s right, but we gotta support him 100 percent,’ ” Decker says. “Turns out the weapons weren’t so mass after all.”

The Deckers favor abortion rights and stem cell research, but restoring financial solvency is what matters most to them.

“McCain has that built-in integrity because of what he went through as a POW,” Jerry says. “But I wish he would have gotten on the bandwagon on the other issues — the golden parachutes — and come out swinging.”

And yet he is not ready to commit to Obama.

“First of all, his presence and rhetoric are marvelous,” Jerry says. “But once you get beyond that, what is there? I’m concerned with his associations in the past, the minister and ACORN.” Decker is referring to Obama’s former pastor, the Rev. Jeremiah A. Wright Jr., who cursed the nation from the pulpit, and the candidate’s work with the Association of Community Organizations for Reform Now that critics say pressured banks into lending money to unqualified low-income home buyers.

Meanwhile, a widow friend of the Deckers just learned that her husband’s benefits plan with a Big Three automaker is dropping her medical coverage.

“Doggone it, this was the agreement at the start, that we’ll take care of you,” Jerry says. “You didn’t mind working for 35, 40 years because you say to your wife, ‘Honey, we are gonna get all of these things in retirement.’ ”

The Deckers are better positioned than most. Eighteen months ago, when Jerry noticed the country’s debt shooting up and the glut of overpriced houses, he pulled their money from the stock market and invested in certificates of deposit and long-term annuities, a move that preserved their retirement savings.

Their glass of wine finished, they watch “NASCAR Now” as they do every weekday at 5 and then “Pardon the Interruption.” Jeannie makes a shrimp salad for dinner while the Florida sky turns pink.

By 6:30 the next morning they are headed out for their three-mile walk. The moon bounces off campaign signs in the cool grass. Back home they eat breakfast and Jerry becomes engrossed in an article in the morning paper about Hobson’s choice and the 2008 presidential election. “It means you have a choice between two undesirable options,” Jerry tells Jeannie. “That defines our dilemma perfectly.”

It’s ‘Scary What’s Going On’

As the Deckers clear away their breakfast dishes, Dee Williams is in another part of Sun City Center preparing to canvass for McCain. Armed with printouts of addresses of registered Republicans, the president of the local Republican Club hops in her golf cart and hits the gas.

“If Obama becomes president, I’m scared of the march down the road to socialism,” Williams says. Not that she has been that thrilled with Bush. “He didn’t know what a veto pen was. He didn’t have the guts to stop the spending habits.”

McCain is the only hope. She parks the golf cart in front of a peach-colored house with flamingos carved into the burglar bars. “I just love cul-de-sacs,” Williams says. A woman tentatively opens the door.

“I’m Dee Williams, your precinct chairman,” she says, handing the woman a McCain-Palin packet.

“It’s kinda scary what’s going on,” the woman says.

Williams offers encouragement. “Yes, we have to get out the vote,” she says.

Back in the golf cart, she recounts McCain’s appearance the night before at a campaign stop in Minnesota where he reassured a voter that Obama is not an Arab and that there is no reason to fear him.

“Why didn’t he say, ‘There’s no reason to be scared of him, but be scared of his policies’? ” Williams says. “My daughter Kim called and said, ‘I think this man is going into dementia.’ ”

Williams is disappointed that Palin bypassed Sun City Center on a recent swing through the Tampa Bay area for a rally at a public park in a neighboring county.

“Our people are too old to show up at some park and sit on the ground,” Williams says. “You can’t take our vote for granted. These people here are darned independent.”

She rings the bell of a house with a Jaguar in the garage and flowering jasmine wrapped around a lamppost. The woman who answers the door makes a grave forecast for the Republican Party:

“I’m for these guys, but I don’t think they’ll win.”

Trying to Decide

With his $25 allowance in his wallet, Jerry Decker takes the golf cart up to Home Depot. He whirs along the smooth roads, waving to friends, adjusting his baseball cap. Retirees used to move to Sun City Center and pay cash for their houses. Now mortgages are common; more than two dozen homes are in foreclosure.

When Jerry was a boy in the 1930s, his father told him that the bank had come for their furniture because of a missed payment of $2.50, and the lesson stuck with him: Don’t rely on the government and don’t rely on credit.

What he wants is a commander who will address the country and talk honestly. He and his wife will watch the third and final presidential debate and try to make up their minds. More pieces of the puzzle.

“Jeannie said it best,” Jerry says. “She said, ‘No one has stood up and said: I made a mistake.’ ”

He parks the golf cart outside Home Depot and inside he grabs some weedkiller before catching sight of a display of Eco-Smart light bulbs on sale. He looks at the box and checks the sign. “Six forty-five, that’s a pretty good price,” he says.

At the register, he greets the cashier. “Hello, young lady, can you keep me under $10?”

She smiles. “No, it’s $12.97.”

When he gets home, Jeanne is setting out their Saturday lunch: half a tuna sandwich each and sliced peaches. “Honey, I brought you a present,” he calls, coming through the garage door. “And these were on sale.”

Jeannie studies the light bulbs.

The purchase leaves Jerry with $12.03 for the week, but that’s his business. “I’ll make it,” he says. “Oh, sure.”

Staff researcher Julie Tate in Washington contributed to this report.

Speed of heart extractions raises ethical questions

Rob Stein
Washington Post
August 14, 2008

WASHINGTON – Surgeons in Denver are publishing their first account of a controversial procedure in which they remove the hearts of severely brain-damaged newborns less than two minutes after the babies are disconnected from life support, and their hearts stop beating, so the organs can be transplanted into infants who would otherwise die.

A detailed description of the transplants in today’s issue of the New England Journal of Medicine immediately ignited an intense debate about whether the first-of-their-kind procedures are pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds.

The doctors who performed the operations as part of a federally funded research project defended the practice, and some advocates for organ donation praised the operations as offering the first clear evidence that the procedures could provide desperately needed hearts for terminally ill babies.

Critics, however, are questioning the propriety of removing hearts from patients, especially babies, who are not brain dead and are asking whether the Denver doctors wait long enough to make sure the infants met either of the long-accepted definitions of death – complete, irreversible cessation of brain function or of heart and lung function. Some even said the operations are tantamount to murder.

“This bold experiment is pushing the boundaries and raising many questions,” said James Bernat, a Dartmouth medical professor who wrote one of four commentaries that the journal published with the report – an unusual step that anticipated the firestorm of reaction the procedures would cause. The journal posted them on its Web site with a videotaped debate among three prominent bioethicists.

“This clearly shows the feasibility of doing this,” Bernat said. “The question is: Should this be done?”  This is the issue I would like you to focus on for this post – Kautzman

The operations are occurring as transplant advocates have become increasingly aggressive in trying to bridge the gap between the number of available livers, kidneys, hearts and other organs and the number of Americans on the waiting list for transplants.

Since the 1970s, most organs have been removed only after doctors declared a patient brain dead. But in the hopes of obtaining more organs, federal health officials, transplant surgeons and organ banks have been intensely promoting “donation after cardiac death,” or DCD. DCD usually involves patients who have devastating and irreversible brain damage but are not actually brain dead. Their families consent to removing life support, and their organs are removed minutes after the patients’ hearts stop beating.

While the procedure has become increasingly common in adults, it remains highly controversial. Critics say it endangers the care of dying patients – a California surgeon is facing criminal charges that he tried to hasten the death of a potential DCD donor in 2006 – and has raised questions about whether the donors are truly dead.

To address such concerns, hospitals follow strict guidelines, including requiring a clear division between doctors caring for the patients and those removing and transplanting the organs. Most also require surgeons to wait at least two minutes – and usually five – after a heart stops to make sure it does not spontaneously start beating again on its own, which has occurred in rare cases.

The Washington Post reported last year that doctors at the Denver Children’s Hospital had started removing hearts from babies, sometimes waiting only 75 seconds to increase the chances that the organs would be viable. The new report marks the first time the doctors have described their efforts in a medical journal.

The report details three cases between 2004 and 2007 involving babies who experienced severe brain damage from oxygen deprivation during birth. Their parents decided to discontinue life support several days following their birth after doctors told them there was no hope. The surgeons waited three minutes before removing the first baby’s heart, but just 75 seconds for the second and third after an ethics panel monitoring the research decided that would be sufficient.

Surgeons transplanted the hearts into three babies 1 to 4 months old who were dying of heart problems. Six months later, all three recipients were alive.

“We’re very pleased with the lives we saved,” said Mark Boucek, who led the team before moving to the Joe DiMaggio Children’s Hospital in Hollywood, Fla. “We’re trying to deal with a very difficult situation where children die waiting for transplant and parents of other children want to donate.”

James Burdick of the Health and Human Services Department, which funded the study, agreed.

“In a very important way, it’s a wonderful story. You had three situations with hopeless medical problems who would have otherwise died but got this gift of life,” he said. “It’s an important demonstration of what is possible.”

But critics questioned whether the donor babies were truly dead when their hearts were removed. In those cases, the hearts were restarted in another child’s body, meaning cessation was not irreversible, they argued.

“This practice cannot be ethically justified,” said George Annas, a Boston University bioethicist. “The donors are not dead. I understand that they would like us to change the definition of death, but they can’t do that by themselves. It’s very problematic to start treating a baby as an organ donor before it’s dead.”

Robert Veatch, a Georgetown University bioethicist, went further, saying the deaths were equivalent to murder.

“The whole issue is whether the infants from whom the hearts were taken were dead. It seems very clear to me that they were not,” he said. “I think it’s illegal, and if it’s illegal, what we’re talking about is the physicians causing the death of the three patients, and that would be homicide. It’s immoral. I think it should be stopped.”

Boucek, the cardiologist, argued that the hearts were incapable of functioning in the newborns from whom they were removed, satisfying the criteria for pronouncing the babies dead.

“At the end of the day, we feel we are on very firm ground,” he said. “There is no question these all met the criteria that one would establish for death.”

by Glenn Beck

Editor’s note: Glenn Beck is on CNN Headline News nightly at 7 and 9 ET and also hosts a conservative national radio talk show.

NEW YORK (CNN) — A few days before the Fourth of July, I read a column in The Philadelphia Inquirer that said America didn’t deserve to celebrate its independence this year.

It claimed that all of our so-called atrocities have shamed the memory of our founding fathers and, as a result, we should cancel our parades, put away our fireworks and all sit quietly while we atone for our sins.

I guess that was one way to go.

Another way to go would be to fire up the grills, bring the kids to the beach,and gather the family on a blanket to watch as your tax dollars ignite into colorful bursts.

I’m guessing that most of us chose the second option.

But just because I had fun with friends and family doesn’t mean that I believe America is perfect. It just means that, for one day, I chose to celebrate the fact that America is still closer to perfect than any other country in the history of the world.

For 364 days a year we talk about high gas prices, crooked politicians, and how much people from one political party allegedly hate everyone from the other. But for 24 hours we get to put it all aside and marvel at how a few brave men risked their lives to stand up for what they believed in. Of course, I would prefer we celebrate that every day, but for now, or at least until that Inquirer columnist gets elected president and bans it, I’ll take the one.

As someone who works in the media in New York City, I’ll admit that I am part of the chorus of people who talk about our problems. But there’s nothing wrong with that, so long as you also occasionally take the time to talk about the other side. And that’s what I want to do now by asking the question that never seems to be of interest to the mainstream media: What’s right with America?

Let’s start with our much maligned economy. I’m not trying to sugarcoat it, times are definitely tough for an awful lot of families right now. But you know what? We’ve made it through a depression; we’ve made it through wars, oil shocks, and major terrorist attacks and we’re still standing. In fact, we’re not just standing, we’re towering over the rest of the world.

Our economy is almost as big as the next four largest economies on Earth (Japan, Germany, China and Great Britain) combined. The state of California alone has an economy as large as the entire country of France. Illinois has the same GDP as all of Mexico. New York matches the entire GDP of Brazil. Florida’s economy is as large as South Korea’s. Texas has a GDP roughly equal to Canada’s. Michigan’s economy is as large as the entire country of Argentina.

It takes a lot longer to turn around an aircraft carrier than it does a dinghy, but the problem we have is with our ship’s captain — the pea-brains in Washington — not her crew.

What’s right with America? How about the way we educate our children. Sure, I complain a lot about left-wing professors and how some wealthy private universities hoard their billions while charging obscene amounts for tuition, but the truth is that our universities are always ranked among the best in the world.

Students aren’t fleeing America to go to college in Japan, India, or China — it’s the other way around. We open our colleges and universities to more than 80,000 foreign professors, scholars and educators a year and we have more students in college right now than those three countries combined.

What’s right with America? Our world-class universities don’t require you to have an elite family name or Rockefeller-type wealth to get in. We don’t care about your race, gender or nationality. You just have to be smart enough and work hard for it. What a concept, huh?

What’s right with America? How about the way we treat the less fortunate? With no help from our government, Americans gave a record $306 billion to charities last year alone. We give twice as much as the next closest country and, relative to the size of our economies, we give 1,000 percent more than the French.

What’s right with America? It’s not just the wealthy who are generous. Two-thirds of American families making under $100,000 a year give to charity. Compassion is ingrained in our culture like no other.

What’s right with America? How about our supposedly third-world health care system? We spend more on health care per person than Switzerland, Germany, Canada, or any other country you can think of. Do we still have problems? Absolutely, but don’t fall for “the grass is greener” crowd; every country has health care problems.

What’s right with America? We love our country. World Values Survey found that 77 percent of Americans are very proud of their nationality. That puts us in a first place tie with the Irish. Australia was next and no one else was really even close.

I could go on and on, but my point is that we don’t need the so often wished for “change” in this country, we just need perspective.

While most of us inherently know that we’ve won the lottery by living here, we don’t often think about the reasons why.

So, for at least that one day, let’s just remember that America still leads the world in the principles that matter most: The rule of law, freedom of religion, equal rights, freedom from an oppressive government and, fortunately for the Philadelphia Inquirer, freedom of speech.

This article was suggested by R. Damiano

Washington Post
July 20, 2008

PIERRE, S.D. – In a victory for antiabortion forces, doctors in South Dakota are now required to tell a woman seeking an abortion that the procedure “will terminate the life of a whole, separate, unique living human being.”

The U.S. Court of Appeals for the 8th Circuit last week lifted a preliminary injunction that prevented the language from taking effect. A spokesman for Planned Parenthood, which runs the state’s only abortion clinic, said doctors will begin reciting the script to patients as early as this week.

On another front, South Dakota voters will be asked in a Nov. 4 referendum to consider broad limits on abortion for the second time since 2006. The ballot measure includes exceptions for rape, incest and the woman’s health that were not part of the 2006 wording rejected by voters.

Antiabortion forces in South Dakota have been trying for years to halt the procedure and to build a winnable challenge to Roe v. Wade, the 1973 Supreme Court decision legalizing abortion nationwide.

A law that took effect July 1 requires doctors to ask a woman seeking an abortion if she wants to see a sonogram of the fetus. About 700 abortions are performed in South Dakota each year.

The doctors’ script that officially took effect Friday has been tied up in court since 2005, when Planned Parenthood challenged a law that instructed physicians what to tell abortion patients. Under the law, doctors must say that the woman has “an existing relationship” with the fetus that is protected by the U.S. Constitution and that “her existing constitutional rights with regards to that relationship will be terminated.” Also, the doctor is required to say that “abortion increases the risk of suicide ideation and suicide.”

The message must be delivered no earlier than two hours before the procedure. The woman must say in writing that she understands.

Karen Heller
The Philadelphia Inquirer
July 8, 2008

When did teen pregnancy become entertaining?

You know, the stuff of a break-out summer comedy, an Oscar-winning independent film, and now the ABC Family series “The Secret Life of the American Teenager.” Nothing quite says “a new kind of family” – the network’s slogan – like a 15-year-old’s unplanned pregnancy.

It’s only a matter of time before some artist makes “Large Times at Gloucester High.”

Apparently, pregnancy provides a better plot device than abortion, especially since the procedure has become one of culture’s dirty words. In “Knocked Up,” one pothead slacker is so uncomfortable he calls it schmabortion, putting a lie to Hollywood’s leftist tendencies.

Teen pregnancy is on the rise for the first time after a 14-year downturn. In real life, misguided teens think pregnancy is a wondrous adventure – that is, until they have to care for a baby on a daily basis.

“A teenage pregnancy immediately turns the odds against mother and baby,” says Dayle Steinberg, president of Planned Parenthood of Southeastern Pennsylvania.

Teens believe they’re superheroes when it comes to birth control and health care. Young expectant mothers, the poor ones not depicted in “Juno” or on ABC Family, are more likely to risk unhealthy behavior (smoking, drinking) and less likely to receive prenatal care, putting mother and child at risk.

A baby proves a powerful hindrance to schooling, while tethering young mothers to government services and financial dependency. Education, not family income or background, is the great indicator of economic success. Teen pregnancy stagnates education, obstructs future career choices and clogs income.

“Hollywood entertains and Planned Parenthood prevents,” Steinberg says. “Responsible behaviors aren’t promoted enough.”

Studies show teenagers aren’t receiving adequate information at home or in the classroom about sex and reproductive health. Abstinence-only sex education, granted substantial federal funding in recent years, teaches the fallibility of contraception and inaccurate information about abortion, according to a congressional investigation.

The lessons have had no effect on curtailing teenage sexual activity, which nearly half of 15- to 19-year-olds experience. Meanwhile, one in four teenagers contracts a sexually transmitted infection. They represent a fourth of the sexually active population, but half of the people with sexually transmitted infections, suggesting a laxity when it comes to prevention. Last year, an 80 percent increase of gonorrhea cases occurred in Delaware County, Pa., for example, more than a quarter among teenagers.

But that doesn’t exactly make for entertainment, does it?

“Secret Life” offered a public-service announcement on teens talking to adults, though the show seems more likely to boost pregnancy-test sales. Scenes from future episodes suggest that the heroine will continue school and get help from her mother.

If only. Teenagers come to Philadelphia’s Women’s Medical Fund when life doesn’t work out like that.

“These are teens who can’t tell their parents, and they don’t have any money and don’t have access to help,” says executive director Susan Schewel.

Recently, the Women’s Medical Fund helped a 16-year-old obtain an abortion. She felt she couldn’t tell her mother – her father isn’t in the picture, and the father of her child isn’t, either.

“By making my decision,” the girl wrote to the fund with her $25 contribution, “I am now able to move forward in my life and continue my schooling, knowing I can still reach for the stars.”

There’s a secret life of an American teenager you don’t tend to see in movies or on television.

Stephanie Desmon
Baltimore Sun
March 12, 2008

About 1 in 4 teenage girls in the United States – and nearly half of black girls – has at least one sexually transmitted disease, according to a study released Tuesday, providing the first national snapshot of infection rates among this age group.

Those numbers translate into an estimated 3.2 million adolescent females infected with one of the four most common STDs – many of whom may not even know they have a disease or that they are passing it to their sex partners.

“What we found is alarming,” said Dr. Sara Forhan, a researcher with the Centers for Disease Control and Prevention and the study’s lead author. “This means that far too many young women are at risk for the serious health effects of untreated STDs, including infertility and cervical cancer.”

The study’s authors analyzed data on 838 girls between ages 14 and 19 who participated in the 2003-04 National Health and Nutrition Examination Survey, an annual study that assesses a broad range of health issues. For the analysis, the teens were tested for human papillomavirus (HPV), chlamydia, trichomoniasis and herpes. By far, the most common sexually transmitted disease was HPV. Of those infected, 15 percent had more than one STD.

“It shows that what people have always suspected is true,” said Dr. Emily J. Erbelding, an infectious-diseases specialist at Johns Hopkins Bayview Medical Center. “Sexually transmitted infections have been called a hidden epidemic, because a lot of these conditions are going to be asymptotic when they’re diagnosed, but they’re highly common.”

The overall figures could be slightly higher, because other sexually transmitted diseases – syphilis, HIV and gonorrhea – were not included in the study, although experts say the prevalence is low for those infections among adolescents. The study did not include teenage boys.

Forhan said she was surprised to see how readily the risk to young women appears. Of those in the study who said they had one sexual partner in their lifetime, the prevalence of STDs was 20 percent, she said.

While parents may be surprised by the study, it’s a reflection of what doctors have been seeing in their practices in recent years, said Dr. Ligia Peralta, chief of the Division of Adolescent and Young Adult Medicine at the University of Maryland Hospital for Children in Baltimore. In a small study done among girls at in her university clinic in 2000, primarily black teens, 90 percent of the sexually active teens had HPV.

She called the CDC study “critical information for parents” and encouraged them to use this knowledge to be sure their daughters are being properly screened and taught about protection and prevention. She said parents need to know that the average age of a girl’s first sexual intercourse is 15.

Cal Thomas
January 19, 2008

Thirty-five years after the Supreme Court unilaterally struck down state laws restricting abortion, the cost of that decision continues to increase our moral deficit, which will have far greater (and eternal) consequences than the impact from economic challenges during a possible recession.

Depending on how one counts the number of abortions per year since 1973, more than 50 million people who might have been are not. These were people who, regardless of the circumstances of the women who carried them, had the potential to contribute to the country and to the world. But now they cannot, because they are not. Would we be fighting the battle over immigration had we not rid ourselves of a generation of humans who likely would have done the work for which we are now importing illegal aliens? Actions have consequences.

Roe and its companion case, Doe v. Bolton, took the question of endowment of life by “our Creator” and placed it in the hands of individuals. History has shown what happens when humanity seizes such power for itself: political dictatorships, eugenics and scientific experiments unrestrained by any moorings to a moral code. Each becomes her and his own god; each becomes a taker of life, rather than a giver, inverting the creation model into one of destruction and transforming the pregnant woman from life-giver to life-taker.

The social restructuring unleashed by the judicial fiat that was Roe created a cultural fissure that remains today. We moved quickly from acknowledgement of a right to live, to assertions of a right to die. In her essay “The Women of Roe v. Wade,” Harvard professor Mary Ann Glendon calls to mind the novelist Walker Percy who prophesied two years before Roe that “Qualitarian Centers” would spring up, “where, as one of Percy’s characters explained, doctors would respect ‘the right of an unwanted child not to have to endure a life of suffering.’ ” State governments, Percy suggested, might eventually recognize a right to die. Arrangements would be made for the sick and elderly to push a button that would transport them to a “happy death” in Michigan, a “joyful exitus” in New York, or a “luanalu-hai” in Hawaii. Percy’s fiction increasingly resembles fact.

Abortion on demand cannot be seen in isolation from social breakdown. In 1973, near the end of the Vietnam War and the approaching resignation of President Nixon two years later, the focus on self, pleasure and convenience by Baby Boomers was at its height. Marriages easily dissolved as “no fault” divorce laws were passed; cohabitation and out-of-wedlock births were on the rise; “unwanted babies” (who were labeled “products of conception” to make it easier to deny the obvious) became an impediment to the pursuit of pleasure and material gain.

Abortion was not a cause, but a reflection of our decadence and deviancy. One does not begin to kill babies until other dominoes have fallen. And once they have fallen, it becomes difficult to set them aright because to do so would require an admission of something so horrible that those responsible for this fetal holocaust would have to acknowledge their sin and repent of it. Such a thing is not a character trait of this most pampered generation.

In recent years there have been signs that things may be – if not turning around – then moderating. According to the Centers for Disease Control and Prevention, abortion numbers have declined steadily since 1990, from a high of 1.2 million annually to fewer than 900,000. This is due, I believe, to the unrelenting commitment of the pro-life movement through pregnancy help centers, information by Internet, marches and what appears to be a growing pro-life consensus among many women who reject the cavalier attitudes about life displayed by their mothers’ feminist generation.

Hollywood has infused a pro-life subplot into films such as “Juno” and “Knocked Up.” Might the “old-fashioned” become the new fashion?

Politicians and judges could help bury Roe by requiring that pregnant women receive complete information about the nature of the life within them, including being required to view sonograms before electing abortion. This would follow truth-in-labeling and truth-in-lending laws by fully informing and empowering women. Such an approach would satisfy the liberal demand to keep abortion “safe and legal” and the pro-life desire to make them rare.

After 35 years of slaughtering our young, isn’t it time to stop? That child born in 1973 could be a parent now. There are children who could have been born today. Thirty-five years of killing has diminished and corrupted us all. Let’s summon the moral courage to stop it for our sake … and for theirs.

Number of terminated pregnancies plummets; more opt for the pill

Stephanie Simon
Los Angeles Times
January 17, 2008

The most comprehensive study in years of abortion in America underscores a striking change in the landscape, with ever-fewer women choosing abortion and those who do increasingly opting to avoid surgical clinics.

The number of abortions has plunged to 1.2 million a year, down 25 percent since peaking in 1990, according to a report released Thursday – days before the 35th anniversary of Roe v. Wade, the Supreme Court ruling that legalized abortion.

In the early 1980s, nearly one in three pregnant women chose abortion. The most recent data show that proportion is closer to one in five.

“That’s a significant drop, and it’s encouraging,” said Randall K. O’Bannon, director of education and research for the anti-abortion group National Right to Life.

Women looking to end early pregnancies are gravitating to medication abortions, in which they take two pills under a doctor’s supervision to induce miscarriage. This approach lets them avoid surgery – and the protesters who often picket clinics – and expel the embryo in the privacy of their homes. The Food and Drug Administration approved the pills in 2000 for use through the seventh week of pregnancy.

By 2005, the most recent year covered by the report, the pills accounted for 13 percent of all abortions.

The research was conducted by the Guttmacher Institute, a New York-based nonprofit that focuses on reproductive issues. The institute supports abortion rights and has received funding in the past from Planned Parenthood. Abortion opponents, however, generally view its statistics as reliable.

The Guttmacher report came to no conclusions about why the abortion landscape has changed. But that didn’t stop activists on both sides from speculating — and using the data to press their political agendas.

Abortion-rights advocates suggested women may not be terminating as often because they’re avoiding unwanted pregnancies, thanks in part to emergency contraception, known as the morning-after pill, which is sold without a prescription to women 18 and older.

Led by Planned Parenthood, activists have pledged to spend much of 2008 lobbying for laws to make all forms of birth control cheaper and more widely accessible. They also plan to push states to require sex-education classes that teach contraception.

A political tactics manual recently developed for Planned Parenthood asserts that voters respond well to such issues especially when they’re framed with buzzwords like “prevention,” “protection” and “personal responsibility.”

Keeping the focus on abortion is exactly what opponents want.

They contend that the more women learn about the procedure, the less likely they are to choose it. The falling abortion rate, they say, may be the result of laws mandating counseling before an abortion.

More than 30 states have such laws. Some of the material given to women is false or misleading – for example, warnings that abortion raises the risk of breast cancer or causes post-traumatic stress disorder. Brochures often use photos of fetal development through nine months, though 90 percent of abortions take place in the first trimester. North Dakota’s packet informs women that the term fetus comes from the Latin for “young one.”

Abortion opponents view such material as a vital tool; they plan to lobby to expand this type of counseling.

Some of the biggest drops in the abortion rate, however, have come in states that do not impose tight restrictions.

Oregon, for instance, was rated this week by Americans United for Life as the nation’s “least pro-life state,” yet its abortion rate dropped 25 percent from 2000 to 2005 – more than any state except Wyoming.

The data suggest that the decline in abortions may be due not to legal restrictions, but to a shift in “socio-cultural mores” – in other words, women’s attitudes, said John Seery, a professor at Pomona College who studies the politics of abortion.

The Guttmacher report offered the first comprehensive census of abortion providers since 2000.

The number of abortion clinics nationwide was down 15 percent, a net loss of four dozen surgical clinics. But other women’s health centers and doctors in private practice filled the gap by offering medical abortions.

That trend may have political implications.

Abortion clinics have been besieged by “an escalation of pickets and protests,” said Cecile Richards, president of Planned Parenthood Federation of America. It’s much harder for protesters to identify a physician in private practice.

“Increasing reliance on nonsurgical abortions is a problem for the anti-abortion movement,” said Alan Abramowitz, a political scientist at Emory University. “There is little popular support for restricting such abortions.”

On the other hand, the trend isn’t a clear victory for abortion-rights advocates. “It’s harder for protesters to target these physicians, but it’s also harder for women to find them,” said Rachel K. Jones, a senior research associate at Guttmacher.

Reality Check on an Embryonic Debate

By Sharon Begley

NEWSWEEK

Updated: 12:46 PM ET Nov 24, 2007

When President George W. Bush vetoed Congress’s latest stem-cell bill in June, he tried to soften the blow and minimize the political damage by arguing science, not politics. Sources of stem cells other than days-old human embryos, he said, offered just as much promise for understanding and treating disease. Bush, it turns out, was well briefed. Earlier this year scientists in Kyoto had announced a feat of biological legerdemain that promised to obviate the long and bitter stem-cell debate, which has pitted the moral status of days-old human embryos against the moral duty of biomedical researchers and society to seek cures for devastating diseases. The Kyoto University team had taken skin cells from adult mice and “reprogrammed” them, turning back the biological calendar so the adult cells could, like embryonic cells, turn into any kind of cell in the body. Bush knew from his advisers that labs were close to accomplishing that with human cells, too.

Now the Kyoto scientists and a team from the University of Wisconsin-Madison have in fact done it. The groups independently announced last week that they had taken a quartet of human genes, slipped them into adult skin cells, and thereby reprogrammed the cells to become stem cells. But although the feat is being hailed as eliminating the need to produce—let alone destroy—embryos as a source of stem cells, it doesn’t. And the attention the discovery is receiving obscures an important change in stem-cell science. While the research was once hailed as leading directly to cures—by turning stem cells into neuronal cells that could be implanted in patients with Parkinson’s disease, say—it now looks like something much more mundane: another laboratory tool to study different diseases, yielding insights that would launch the slow, years-long search for new therapies. “It’s likely that studying human disease is on a faster track than using stem cells for transplant therapy,” says Fred Gage of the Salk Institute. For that purpose, having the new method for creating stem cells is unlikely to lead to treatments and cures any sooner than having only the old one.

The magic of embryonic stem cells comes from the fact that, like a newborn baby, no life path has been closed to them. They can mature into a muscle cell or a liver cell or any other. Although adult cells contain the same genes as embryonic cells, most of their genes have been silenced. One way to make all the genes sing again is to inject them into an egg. Something in the goopy ovoid returns the genes to their embryonic state, allowing the egg to develop into a ball of stem cells. This approach has worked in mice and monkeys, but not humans. The Kyoto and Wisconsin scientists discovered another way to produce human stem cells: use a virus to ferry four human genes into an adult cell. The quartet reprograms the cell back to its embryonic state of unlimited potential.

If this recipe works reliably, notes the journal Science, which published the Wisconsin study, we “would not need human embryos or [eggs] to generate patient-specific stem cells—and therefore could bypass the ethical and political debates that have surrounded the field.” But that’s a big “if.” For one thing, the virus used to carry the four genes has a bad habit of plunking itself into spots on a cell’s chromosomes where it can trigger cancer. Also, one of the four genes is itself a cancer-causing gene. Malignant cells are unlikely to be very useful for either basic research or as transplants, says Konrad Hochedlinger of Massachusetts General Hospital.

But that’s not why Kyoto’s Shinya Yamanaka and colleagues call the claim that reprogrammed stem cells eliminate the need for embryonic stem cells “a serious mistake.” For one thing, it will be years before scientists understand reprogrammed stem cells—how to get them to mature into different tissues, for instance. Also, embryonic stem cells will be needed as a benchmark, something to compare to the power of reprogrammed stem cells to treat disease (which embryonic stem cells have done in lab animals). “Applications of stem-cell science would be indefensibly delayed if [research on reprogrammed stem cells] is pursued at the expense of further human embryonic stem-cell research,” Yamanaka and colleagues wrote last month.

To a public for whom stem cells equal cure, the real blow will be the realization that the simplistic picture—take a patient’s genes, slip them into an egg, let the egg grow and divide into stem cells that are perfect genetic matches for the patient and transplant those cells to treat diabetes, Parkinson’s, Alzheimer’s—is more fiction than fact. “Creating cell lines for transplant is unlikely to come down the pike any time soon,” Paul Nurse, president of Rockefeller University and a Nobelist in medicine, told the New York Stem Cell Foundation conference last month. “Opponents [of embryonic stem-cell research] recognized that this was an overselling of the technology.” Instead of yielding cures directly, stem cells— reprogrammed and embryonic alike—will take their place alongside other lab systems for studying disease. They will reveal hitherto-unknown causes and pathways of illness, even pointing the way to new drugs. The typical time between such a discovery and a new drug is at least 15 years.

URL: http://www.newsweek.com/id/72054

Leonard Pitts Jr.
Miami Herald
November 4, 2007

You might want to wash your hands after reading this.

After all, many other folks touched this paper (or screen, as the case may be) before you, and you don’t know where their hands have been.

For all you know, the last person to touch the paper was carrying Entamoeba histolyca, a parasite that causes amebiasis. You could end up with stomach cramps, bloody stools and an abscess on your liver. And that’s assuming the disease doesn’t spread to your lungs and brain.

Or maybe the last person to use the computer recently came into contact with African green monkeys. You could contract Marburg hemorrhagic fever. It brings rash, vomiting, chills, chest pain, sore throat, fever and diarrhea. And jaundice, pancreatic inflammation and severe weight loss. And delirium and shock. And liver failure and multi-organ dysfunction. And then you might die.

You think I’m trying to scare you? You’re right. Why should I be the only journalist in America who isn’t?

Consider what happened about two weeks back when every news organization in the country suddenly, simultaneously, discovered that staph infections kill people.

You could not turn on the television or pick up any publication this side of TV Guide without encountering alarmist stories about Staphylococcus aureus. Like flocks of birds that turn in the same direction at the same time in response to some invisible stimulus, it was as if every news editor in the country got the same memo at the same time: this is staph week.

Most of the stories were about MRSA, i.e., Methicillin Resistant Staphylococcus aureus, a staph strain that does not respond to common antibiotics. This made the so-called “super-bug” a headline magnet.

You know how many times staph was mentioned in U.S. newspapers in the first two weeks of October? According to a computer search: 155. Know how many times it was mentioned between the 15th and the 31st? 1,650.

So did staph somehow become deadlier in the last two weeks than it was before? No.

“Staph is not new,” says Nicole Coffin, a spokeswoman for the Centers for Disease Control and Prevention in Atlanta. “Even MRSA is not new. In the hospitals it’s been around for 30 years. In the general population, it’s been around for at least 10 years.”

According to Coffin, the media’s staph infection stemmed from a story in the Journal of the American Medical Association nearly a month ago. JAMA reported on a study that found there were 19,000 fatal MRSA infections in 2005.

The number was higher than researchers had expected. But even that comes with a caveat: researchers cautioned that the methodology they used was significantly different than that of earlier studies, so direct comparisons with earlier data are dicey.

Am I making light of staph? Far from it: One of my family had a serious bout with the infection just this year. So I’m not diminishing staph. I am, however, ridiculing media.

As in the people who bring us shark attacks! Poison gases in your home! Bacteria lurking in hotel sheets! The pedophile next door!

We live evermore in the United States of Fear. We are entertained by it. Titillated by it. Distracted by it.

And we have learned to move as media move, together like birds in a flock, attention changing constantly and for no apparent reason. Already, fear of staph is fading. Tomorrow there will be fear of something else.

Meanwhile, in other news, 47 million Americans have no health insurance, the number of hate groups in this country has risen by 40 percent in seven years, and the wars in Iraq and Afghanistan are projected to cost $2.4 trillion over the next 10 years.

Thanks for reading. Don’t forget to wash your hands.

Froma Harrop
Providence Journal
October 17, 2007

Whether Graeme Frost has an affluent father or lives in a $400,000 house with granite counters is of no consequence to me. But such details have led a right-wing attack on the Democrats’ poster family for expanding the State Children’s Health Insurance Program, which President Bush vetoed.

These charges happen to be untrue. The Frost family income is $45,000. Their Baltimore house, bought 17 years ago for $55,000, is now worth about $250,000, and the kitchen counters are concrete.

But even if the counters were gold, I wouldn’t care. America needs a universal health care plan that puts the rich and poor, young and old, sick and well into one big insurance pool.

And whether the Frosts could sell their house and use the money to obtain health coverage is irrelevant. They tried to buy a policy, but insurers wouldn’t sell them one because of pre-existing medical conditions. Graeme and his sister suffer brain injuries from a car crash.

The right does these issues on automatic pilot – and the left knows how to hit back – but the center feels conflicted. Megan McArdle, a blogger for the Atlantic magazine’s Web site, worries about forcing families to sell assets to qualify for public health care benefits. “On the other hand,” she writes, “many people, including me, don’t want to pay for the health care of someone so that they can stay in their Park Avenue mansion.”

Honey, you already do.

The taxpayers are footing the medical bills of many a Park Avenue swell over 65. There’s little means testing in Medicare, yet Bush pushed a drug benefit on top of the program’s already generous coverage. It will cost many times the price of SCHIP, even were it to cover the likes of Graeme Frost.

So let’s discuss what the panic is really about. Republicans know that once government health coverage seeps up into the middle class, there’s no stopping it.

Note how Bush does this big “compassionate conservative” thing about very much wanting SCHIP for poor people. Programs for the poor are fine, because you can always cut the living daylights out of them. Politicians who mess with middle class benefits find their heads in the return mail.

The happiest campers in American health care today are the people in Medicare, a government-run program that sets prices. Middle-class families who taste similar fruits will not say: “Please, oh, please. Send my health coverage back into the exciting free market.” And their neighbors will ask, “Where can I get some?”

As last stands go, issuing cries of injustice that an insured family making $40,000 might be asked to subsidize the health care of an uninsured family making $60,000 is neither heroic nor smart.

The more rational response would be to let the folks making $40,000 also join the program – and require employers to raise their paychecks by the amount previously taken out for health coverage. Both the family and the bosses would come out ahead.

Really, how did American workers become the last people in any industrialized democracy to be subject to such anxiety about paying for medical care? They already fund the health care of retirees, the poor, the disabled, convicts and government employees, including members of Congress. Their taxes pay for everyone’s health care except their own.

Republicans can’t possibly believe that today’s expensive and chaotic mess of a health care “system” is a “conservative” approach. They see their former business allies running into the arms of Democrats for deliverance from the unpredictable costs of insuring workers.

Right-wingers, give it up! You’re fighting a battle you shouldn’t want to win. A country without universal coverage isn’t conservative. It’s primitive.