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Friday, November 11, 2005

The Deadly Doughnut by PAUL KRUGMAN

November 11, 2005
Op-Ed Columnist
The Deadly Doughnut
By PAUL KRUGMAN

Registration for Medicare's new prescription drug benefit starts next week. Soon millions of Americans will learn that doughnuts are bad for your health. And if we're lucky, Americans will also learn a bigger lesson: politicians who don't believe in a positive role for government shouldn't be allowed to design new government programs.

Before we turn to the larger issue, let's look at how the Medicare drug benefit will work over the course of next year.

At first, the benefit will look like a normal insurance plan, with a deductible and co-payments.

But if your cumulative drug expenses reach $2,250, a very strange thing will happen: you'll suddenly be on your own. The Medicare benefit won't kick in again unless your costs reach $5,100. This gap in coverage has come to be known as the "doughnut hole." (Did you think I was talking about Krispy Kremes?)

One way to see the bizarre effect of this hole is to notice that if you are a retiree and spend $2,000 on drugs next year, Medicare will cover 66 percent of your expenses. But if you spend $5,000 - which means that you're much more likely to need help paying those expenses - Medicare will cover only 30 percent of your bills.

A study in the July/August issue of Health Affairs points out that this will place many retirees on a financial "roller coaster."

People with high drug costs will have relatively low out-of-pocket expenses for part of the year - say, until next summer. Then, suddenly, they'll enter the doughnut hole, and their personal expenses will soar. And because the same people tend to have high drug costs year after year, the roller-coaster ride will repeat in 2007.

How will people respond when their out-of-pocket costs surge? The Health Affairs article argues, based on experience from H.M.O. plans with caps on drug benefits, that it's likely "some beneficiaries will cut back even essential medications while in the doughnut hole." In other words, this doughnut will make some people sick, and for some people it will be deadly.

The smart thing to do, for those who could afford it, would be to buy supplemental insurance that would cover the doughnut hole. But guess what: the bill that established the drug benefit specifically prohibits you from buying insurance to cover the gap. That's why many retirees who already have prescription drug insurance are being advised not to sign up for the Medicare benefit.

If all of this makes the drug bill sound like a disaster, bear in mind that I've touched on only one of the bill's awful features. There are many others, like the clause that prohibits Medicare from using its clout to negotiate lower drug prices. Why is this bill so bad?

The probable answer is that the Republican Congressional leaders who rammed the bill through in 2003 weren't actually trying to protect retired Americans against the risk of high drug expenses. In fact, they're fundamentally hostile to the idea of social insurance, of public programs that reduce private risk.

Their purpose was purely political: to be able to say that President Bush had honored his 2000 campaign promise to provide prescription drug coverage by passing a drug bill, any drug bill.

Once you recognize that the drug benefit is a purely political exercise that wasn't supposed to serve its ostensible purpose, the absurdities in the program make sense. For example, the bill offers generous coverage to people with low drug costs, who have the least need for help, so lots of people will get small checks in the mail and think they're being treated well.

Meanwhile, the people who are actually likely to need a lot of help paying their drug expenses were deliberately offered a very poor benefit. According to a report issued along with the final version of the bill, people are prohibited from buying supplemental insurance to cover the doughnut hole to keep beneficiaries from becoming "insensitive to costs" - that is, buying too much medicine because they don't pay the price.

A more likely motive is that Congressional leaders didn't want a drug bill that really worked for middle-class retirees.

Can the drug bill be fixed? Yes, but not by current management. It's hard to believe that either the current Congressional leadership or the Mayberry Machiavellis in the White House would do any better on a second pass. We won't have a drug benefit that works until we have politicians who want it to work.

Thursday, November 10, 2005

An Army Ready to Snap By BOB HERBERT

November 10, 2005
Op-Ed Columnist
An Army Ready to Snap
By BOB HERBERT

Have you heard what's been happening to the military?

Most people have heard that more than 2,000 American G.I.'s have been killed in the nonstop meat grinder of Iraq. There was a flurry of stories about that grim milestone in the last week of October. (Since then the official number of American deaths has jumped to at least 2,055, and it continues to climb steadily.)

More than 15,000 have been wounded in action.

But the problems of the military go far beyond the casualty figures coming out of the war zone. The Army, for example, has been stretched so taut since the Sept. 11 attacks, especially by the fiasco in Iraq, that it's become like a rubber band that may snap at any moment.

President Bush and Donald Rumsfeld convinced themselves that they could win the war in Iraq on the cheap. They never sent enough troops to do the job. Now the burden of trying to fight a long and bitter war with too few troops is taking a terrible toll on the men and women in uniform.

Last December, the top general in the Army Reserve warned that his organization was "rapidly degenerating into a 'broken' force" because of the Pentagon's "dysfunctional" policies and demands placed on the Reserve by the Iraq and Afghanistan wars.

As one of my colleagues at The Times, David Unger of the editorial board, wrote, "The Army's commitments have dangerously and rapidly expanded, while recruitment has plunged."

Soldiers are being sent into the crucible of Iraq for three and even four tours, a form of Russian roulette that is unconscionable.

"They feel like they're the only ones sacrificing," said Paul Rieckhoff, a former Army lieutenant who served in Iraq and is now the executive director of Operation Truth, an advocacy group for service members and veterans.

"They're starting to look around and say, 'You know, it's me and my buddies over and over again, and everybody else is living life uninterrupted.' "

When I asked Mr. Rieckhoff what he thought was happening with the Army, he replied, "The wheels are coming off."

The Washington Post, in a lengthy article last week, noted:

"As sustained combat in Iraq makes it harder than ever to fill the ranks of the all-volunteer force, newly released Pentagon demographic data show that the military is leaning heavily for recruits on economically depressed, rural areas where youths' need for jobs may outweigh the risks of going to war."

For those already in the Army, the price being paid - apart from the physical toll of the killed and wounded - is high indeed.

Divorce rates have gone way up, nearly doubling over the past four years. Long deployments - and, especially, repeated deployments - can take a vicious toll on personal relationships.

Chaplains, psychologists and others have long been aware of the many dangerous factors that accompany wartime deployment: loneliness, financial problems, drug or alcohol abuse, depression, post-traumatic stress disorder, the problems faced by the parent left at home to care for children, the enormous problem of adjusting to the devastation of wartime injuries, and so on.

The Army is not just fighting a ruthless insurgency in Iraq. It's fighting a rear-guard action against these noncombat, guerrilla-like conditions that threaten its own viability.

There are reasons why parents all across America are telling their children to run the other way when military recruiters come to call. There are reasons why so many lieutenants and captains, fine young men and women, are heading toward the exit doors at the first opportunity.

A captain who is on active duty, and therefore asked not to be identified by name, told me yesterday:

"The only reason I stayed in the Army was because one colonel convinced me to do it. Other than that, I would have walked. Basically, these guys who are leaving have their high-powered educations. Some are from West Point. They've done their five years. Why should they stay and go back to Iraq and die in a war that's just going to keep on going?"

Beyond that, he said, "Guys are not going to stay in the Army when their wives are leaving them."

From the perspective of the troops, he said, the situation in Iraq is perverse.

He could find no upside. "You go to war," he said, "and you could lose your heart, your mind, your arms, your legs - but you cannot win. The soldiers don't win."

Wednesday, November 09, 2005

A War in Paris by Marjane Satrapi

A War in Paris






Tuesday, November 08, 2005

The Rosa Parks for the 21st Century By NICHOLAS D. KRISTOF

November 8, 2005
Op-Ed Columnist
The Rosa Parks for the 21st Century
By NICHOLAS D. KRISTOF

She may be the bravest woman in the world, but Mukhtaran Bibi was finally looking intimidated.

Mukhtaran is the Pakistani peasant woman who was gang-raped on the order of a local council, and then forced to walk home nearly naked before a jeering crowd. Instead of killing herself, as rape victims routinely do in such places, she prosecuted her attackers and became a women's rights leader in Pakistan.

But last week, she was confronted by something she found pretty scary: Midtown Manhattan.

Glamour magazine is honoring Mukhtaran as a "woman of the year." It flew her from Pakistan - first-class - to the U.S., where she met senior officials in the White House, the State Department and Congress.

At the Glamour banquet at Lincoln Center, Brooke Shields introduced Mukhtaran as a woman who "showed the world the real meaning of the word honor." Mukhtaran (who also goes by the name Mukhtar Mai) seemed a little stunned to receive two standing ovations from a huge crowd of whooping Americans.

Mukhtaran is, of course, an unlikely star of Glamour. She's a peasant living in a remote village who doesn't know her age (her mom says she was born in the winter, but no one knows what year). She is a devout Muslim who wears a head scarf, and while her photos adorn Glamour's December issue, her clothing-to-skin ratio may set an all-time high for the magazine.

While Mukhtaran is being feted here, it's easy to think that her problems are over. But they aren't. President Pervez Musharraf allowed her to make this visit, after blocking a trip by her in June and then kidnapping her when she protested, but Pakistani intelligence agents still follow her everywhere. Agents open or confiscate her mail and spread lies about her in the Pakistani press, and she is reported to be on a death list. At some point, her luck may run out - and her fame won't stop a knife or a bullet.

"I'm still very scared," she said. "I feel threatened."

Yet what sets Mukhtaran apart is not her suffering, but her effectiveness in bringing hope, education and new attitudes to rural Pakistan. Laura Bush got it just right in an eloquent video tribute to Mukhtaran at the banquet: "Please don't assume that it's only a tale of heartbreak. Mukhtaran ... proves that one woman really can change the world."

After prosecuting the rapists, Mukhtaran used the compensation money of $8,300 to start schools in her village because she thinks that education is the best way to overcome feudal attitudes. Girls from surrounding areas hike up to two hours each way to attend the school.

When I first met Mukhtaran, in her village, she was running out of money to keep the schools operating, her enemies were biding their time to murder her, and she was lonely and frightened - and unwavering.

Times readers responded with a torrent of contributions, more than $130,000, and Mukhtaran has used the money to improve the schools and "endow" them by buying cows, which will generate income to pay expenses. She has also bought an ambulance for the area and built a police station that provides security, and now she's preparing to build the first high school in the area, along with a clinic and a women's shelter. (If you want to help, please don't send money to me; contributions can be sent to either of these Web sites: www.4anaa.org and www.mercycorps.org.)

Not surprisingly, filmmakers are jostling to make a movie of her story. Mukhtaran turned a tale of gang rape into something that is actually inspiring.

The world lost Rosa Parks last month, but Mukhtaran is a Rosa Parks for the new century: a woman simultaneously ordinary and extraordinary, who transcended her role and started a broad movement for justice. The most pressing moral challenge today is to overcome the brutality and inequality faced by women and girls in the developing world, and Mukhtaran has become a leader of that struggle. I hope that we'll follow her, and that the U.S. will align itself with real Pakistani leaders like her.

Mukhtaran was in the fourth grade in her own school when I met her. So on this visit I asked her over pizza on West 43rd Street what grade she's in now.

"I've been too busy to go to school much," she said, embarrassed. "So I'm still in the same grade. ... But I do hope that eventually I'll get to high school."

Never mind. This is one fourth grader who can be a teacher for us all.

Monday, November 07, 2005

What did we learn today?

Questions for . . .Maureen Dowd

November 4, 2005
Questions for . . .
Maureen Dowd

Following an essay by Maureen Dowd in The Times Magazine, which was adapted from her new book, "Are Men Necessary: When Sexes Collide," the author and Op-Ed columnist answers reader questions on the past and future of feminism.

Q. I was fortunate, at quite a young age — 23— to marry a man who was rather liberated and we stumbled along, figuring out the money, power, housework, jobs, sex, parenting and family stuff together. Our daughter is in college now, and the boys she meets seem terrified of the strong, opinionated and funny young woman she has become. She is discouraged and worries that she won't be able to secure a relationship like ours. After reading your article on modern relationships, I don't know whether to advise her to hold out for the last liberated guy. Or tell her that she may need to settle for less, and tone down her style a bit, too. And it would break my heart to do that. What would you recommend?
— Deborah Frandsen, Missoula, Mont.

A. I think when you settle for less than you deserve, you get less than you settled for. Your daughter clearly has high standards because she's had remarkable role models in you and your husband, and you've clearly created someone enchanting. She should not tone anything down. She should look for guys who celebrate and appreciate who she is, and not waste a lot of time on guys who don't. Just because a lot of men seem to prefer women who are awed by them, rather than ones who provide snap and crackle, doesn't mean there aren't plenty of men who like the snap and crackle, too. You just have to hunt for them.

Q. Doesn't it seem curious that this resurgence of the girlie girl and sex kitten seems to be running parallel to the great religious and political conservative movement engulfing us today? What are we doing wrong in letting the lessons some of us learned in that period go quietly by? Whether by folklore, story-telling, or by virtue of your upcoming book, shouldn't more be done to show the risky effects of insular dependence on the man in your life?
— Barbara P. Hageman, Brewster, Mass.

A. I recommend reading Ariel Levy's new book, "Female Chauvinist Pigs: Women and the Rise of Raunch Culture." It has a lot of interesting material linking the red state surge and the self-actualized sex kitten surge.

In my book, I make the point that we live in a society that is so derangingly sexualized, it's not a sexy society. You can't think about sex clearly if all you're thinking about is sex, whether it's an obsession over celibacy or nymphomania. America has always been conflicted about sex, its puritanical side clashing with its prurient side. But now, with the ascendance of the prudish religious right and the numbing oversexualization of commerce and culture, America seems positively bipolar about sex.

As Amazon.com began selling sex toys, a public radio station in Kentucky briefly canceled the venerable Garrison Keillor's show "The Writer's Almanac" a few months ago because he read a poem with the word "breast" in it. An art dealer in New York captured the schizoid insanity of the moment perfectly, confiding that he gets calls from wealthy private collectors in places like Texas saying that they don't want Rubens or Monet nudes because they have small children at home. They'd rather stick with impressionist landscapes and old Dutch masters. I agree that young women, like the Ivy Leaguers interviewed in a recent front-page story, may correctly assess that it was a grind for baby boomer women trying to have it all. But they seem oblivious to the perils of insular dependence on a man.

Q. Are the problems you describe more about the shallowness of the culture and its immature, narcissistic elements, and less about the role of men and women?
— Norman Chaleff, West Orange, N.J.

A. I would say both. I think baby boomers were a very narcissistic bunch compared to the self-deprecating and not so self-regarding Greatest Generation. And I think narcissism has trumped feminism. But I also think that men and women at the start of the sexual revolution envisioned a lot easier road, and more utopian world of equality, than this world of ours. Relations between the sexes are more muddled than ever.

Q. Do women ever marry down much?
— William G. O'Connell, Minneapolis

A. A lot of high-powered, high-earning women end up with men who put less focus on earning and ambition, and that makes for a happier, alpha-beta balance. But it's harder for women to duplicate the "staff siren" syndrome I write about, where men like to get involved with the young girls who are paid to revolve around them and make their lives easier. I've had fantastically smart and cute young male assistants, but never entertained any notion of marrying them.

Q. At the close of your piece, you imagine a 2030 where all of today's young women who've opted for hearth and home will wake up and find themselves deserted by husbands for younger babes. Is your opinion of men really this jaundiced? Have you not run across any men in your world devoted to their wives and their marriages? Have you ever considered the possibility that just maybe you're traveling in the wrong circles and hanging out with the wrong people? I'm not writing from a farm in the Midwest. I grew up in New York City and married a professional woman I look forward to being married to for the rest of my life.
— Peter McFadden, Cold Spring, N.Y.

A. Yes, all the men in my family are devoted to their strong, professional wives and happily married, and many of my male friends. I was merely speculating on the possible perils for a pampered class of young women who yearn to go back to total economic and emotional dependence on men. It was just a nightmare fantasy of what could happen if women someday boomerang so far away from feminism, that they start totally revolving around men again, and give up all their own independence. A Philip K. Dick scenario.

Q. Why blame feminism for the fact that ignorant men prefer women who aren't as smart and successful? Why not blame the ignorant men? And why perpetuate this sad stereotype of single women waiting passively — and desperately — for men to pay attention to them?
— Ajitha Reddy, Chicago

A. You have to read the whole book. I don't think men who prefer women who aren't smart and successful are ignorant. A lot of men think it works better to hook up with women who want to revolve around them, and I can't argue with that. It's probably easier in many ways. I know plenty of single women who are having a great time.

Q. When your wife renounces books for catalogues, when she begins to idolize Blanche Dubois and starts going to Mass again . . . when your grad-school daughter says her mother is letting her mind go to waste, what is a husband to do? You build a modest career by avoiding the twin pitfalls of being boss and being bossed, then one day you look in the mirror and see Mike Doonesbury. Are we going back to the future or forward to the past?
Chandler Thompson, Las Cruces, N.M.

A. That is my question exactly! I love your e-mail. Please read the whole book and get back to me with your thoughts.

Q. There are women in African countries who risk HIV/AIDS on a daily basis because they HAVE to have sex with their husbands, or else. There are women in Eastern Europe who see their tickets outta there on a train to work in a brothel in the West. And there are women in India who are burned to death in kitchen fires for letting down the in-laws. The point is, these women have still not gone through our 60's — they have not had a wave of feminism which would allow them to claim some very basic rights, much less the right to be C.E.O.

Maybe women in North America are moving on, and back to a place we aren't very comfortable with. But while that happens, from our positions of comfort, I think we owe women in other countries a voice.


Christine McNab, Geneva, Switzerland

A. I agree.

Q. Who would you identify as positive role models today for women looking to stand on the shoulders of our feminist foremothers and build from that place rather than reject it? In other words, if you had your way, who would you like to see on the cover of magazines instead of Jessica Simpson?
Amy Selwyn, London

A. I introduced Mary Robinson, the former president of Ireland and former U.N. commissioner for human rights, the other night at a Glamour Magazine Awards dinner. She was very impressive. She got 90 percent approval ratings in Ireland and led with moral authority in a country dominated by men, reflecting feminine grace and macho tenacity, always trying to unite society and heal divisions, reaching out to her political rivals, and reaching out to help the poor and suffering, and working for women's legal and reproductive rights. Mrs. Robinson is now running an international organization called Realizing Rights, trying to end extreme poverty and to move women's health to the top of the international agenda, to try to stop the gap between rich and poor, powerless and powerful, from getting bigger. It's fine to have beautiful women on the covers of magazines, but there are many ways to be beautiful, and I worry that America has lost a sense of that. Women used to demand equality; now they just demand Botox.

We need more covers like the Time Persons of the Year in 2002, featuring a trio of brave truthtellers — Sherron Watkins, who blew the whistle on the creeps at Enron; Coleen Rowley, who blew the whistle at the F.B.I. incompetence; and Cynthia Cooper, who blew the whistle on the Worldcom n'er do wells. Three grown-up Nancy Drews with guts.

Q. How hopeful are you that America will be an example of innovation and forward-thinking once again?
Steven Henry, Miami, Fla.

A. We're in a dark ages now, with the government pulling science backward, and suffocating research on stem cells, and encouraging the idea that Intelligent Design is a legitimate alternative to evolution studies. This is a long way from JFK's New Frontier attitude. But I think most Americans like to be on the cutting edge of culture and science, and will want that reflected, sooner or later, in our leaders.

And The War Goes On by BOB HERBERT

And The War Goes On by BOB HERBERT

The coalition of the clueless that launched the tragically misguided war in Iraq is in complete disarray.

Dick Cheney is simultaneously running from questions about his role in the Valerie Wilson affair and fighting like mad to block any measure that would outlaw torture by the C.I.A. His former top aide, Scooter Libby, one of the original Iraq war zealots, is now an accused felon who is seldom seen in public unaccompanied by defense counsel.

Donald Rumsfeld, the high-strutting, high-profile defense secretary who was supposed to win this war in a walk, is suddenly on the down-low. There are people in the witness protection program who are easier to find than Rummy.

As for the president, he went all the way to South America to get away from the Washington heat. But even within the luxurious confines of Air Force One, Mr. Bush found that he couldn’t escape the increasingly corrosive effect of the fiascos plaguing his administration.

The ominous news of the president’s plummeting approval ratings followed him like a dark cloud. A Washington Post-ABC News poll found that Mr. Bush has never been less popular with the public. On nearly every important measure of character and performance, he was given lower marks than ever before. For the first time, according to the poll, a majority of Americans even questioned the president’s integrity. And fully 55 percent of respondents to a new USA Today/CNN/Gallup poll said they believe the Bush administration has been a failure.

The fact that Mr. Bush is struggling in his own political purgatory (for the sin of incompetence) is bad news for the soldiers in Iraq, where the suffering and dying continues unabated. The administration that was so anxious to throw scores of thousands of healthy young Americans into the flames of war now has no idea how to get them out.

Troops are being sent into Iraq for two, three, even four combat tours by an administration in which clowns like Scooter Libby and Karl Rove were playing games with the identity of a C.I.A. agent, and the vice president has been obsessed with his twisted protect-the-torturers campaign.

Now the Bush crew, which should be focused like a laser on what to do about the war, is consumed with damage control – pumping up the poll numbers, defending its handling of prewar intelligence, fending off further indictments and staying out of prison.

The war? There’s no plan for the war. The architects of this war had no idea what they were getting into, and they are just as clueless now. The war just goes on and on, which is not just tragic – it’s criminal.

Opposition to the war may be mounting. But the reality of the war, especially the toll of American dead and wounded, fades in and out of the public’s consciousness.

There was a rush of articles a couple of weeks ago when the number of deaths of Americans serving in Iraq reached 2,000. But those stories were quickly superseded by Harriet Miers’s withdrawal of her nomination to the Supreme Court; President Bush’s selection of Samuel Alito to take her place; the indictment of Mr. Libby; the president’s address to the nation on the possibility of a bird flu pandemic and so on.

The killing of G.I.’s in Iraq once again took its place as a relatively minor story, meriting in most cases just a brief mention on the inside pages of the major newspapers, and the most cursory coverage on television newscasts.

The death toll has now reached at least 2,035 and, of course, it is climbing. More than 15,000 G.I.’s have been wounded in action. Limbs have been lost. Men and women have been permanently paralyzed, horribly burned, or blinded. Thousands more have been injured in nonhostile incidents, such as accidents, and many have fallen ill.

If the American public could see the carnage in Iraq the way television viewers saw the agony of New Orleans in the aftermath of Hurricane Katrina, this war would be over. A solution would be found. Imagine watching a couple of soldiers in flames, screaming, as they attempt to escape the burning wreckage of a vehicle hit by a roadside bomb or a rocket-propelled grenade.

For all the talk, neither the administration nor the public has taken the reality of this war seriously enough to do something about it. If the sons and daughters of the privileged were fighting it, we’d be out of Iraq soon enough. But they’re not fighting it.

So the war goes on and on.

[thx tblib]

PRIDE, PREJUDICE & INSURANCE By PAUL KRUGMAN

PRIDE, PREJUDICE & INSURANCE By PAUL KRUGMAN

General Motors is reducing retirees' medical benefits. Delphi has declared bankruptcy, and will probably reduce workers' benefits as well as their wages.

An internal Wal-Mart memo describes plans to cut health costs by hiring temporary workers, who aren't entitled to health insurance, and screening out employees likely to have high medical bills.

These aren't isolated anecdotes. Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid, but it's an institution in decline.

Between 2000 and 2004 the number of Americans under 65 rose by 10 million. Yet the number of nonelderly Americans covered by employment-based insurance fell by 4.9 million.

The funny thing is that the solution - national health insurance, available to everyone - is obvious.

But to see the obvious we'll have to overcome pride - the unwarranted belief that America has nothing to learn from other countries - and prejudice - the equally unwarranted belief, driven by ideology, that private insurance is more efficient than public insurance.

Let's start with the fact that America's health care system spends more, for worse results, than that of any other advanced country.

In 2002 the United States spent $5,267 per person on health care. Canada spent $2,931; Germany spent $2,817; Britain spent only $2,160. Yet the United States has lower life expectancy and higher infant mortality than any of these countries.

But don't people in other countries sometimes find it hard to get medical treatment? Yes, sometimes - but so do Americans. No, Virginia, many Americans can't count on ready access to high-quality medical care.

The journal Health Affairs recently published the results of a survey of the medical experience of "sicker adults" in six countries, including Canada, Britain, Germany and the United States.

The responses don't support claims about superior service from the U.S. system. It's true that Americans generally have shorter waits for elective surgery than Canadians or Britons, although German waits are even shorter.

But Americans do worse by some important measures: we find it harder than citizens of other advanced countries to see a doctor when we need one, and our system is more, not less, rife with medical errors.

Above all, Americans are far more likely than others to forgo treatment because they can't afford it. Forty percent of the Americans surveyed failed to fill a prescription because of cost.

A third were deterred by cost from seeing a doctor when sick or from getting recommended tests or follow-up.

Why does American medicine cost so much yet achieve so little? Unlike other advanced countries, we treat access to health care as a privilege rather than a right. And this attitude turns out to be inefficient as well as cruel.

The U.S. system is much more bureaucratic, with much higher administrative costs, than those of other countries, because private insurers and other players work hard at trying not to pay for medical care. And our fragmented system is unable to bargain with drug companies and other suppliers for lower prices.

Taiwan, which moved 10 years ago from a U.S.-style system to a Canadian-style single-payer system, offers an object lesson in the economic advantages of universal coverage.

In 1995 less than 60 percent of Taiwan's residents had health insurance; by 2001 the number was 97 percent.

Yet according to a careful study published in Health Affairs two years ago, this huge expansion in coverage came virtually free: it led to little if any increase in overall health care spending beyond normal growth due to rising population and incomes.

Before you dismiss Taiwan as a faraway place of which we know nothing, remember Chile-mania: just a few months ago, during the Bush administration's failed attempt to privatize Social Security, commentators across the country - independent thinkers all, I'm sure - joined in a chorus of ill-informed praise for Chile's private retirement accounts. (It turns out that Chile's system has a lot of problems.)

Taiwan has more people and a much bigger economy than Chile, and its experience is a lot more relevant to America's real problems.

The economic and moral case for health care reform in America, reform that would make us less different from other advanced countries, is overwhelming.

One of these days we'll realize that our semiprivatized system isn't just unfair, it's far less efficient than a straightforward system of guaranteed health insurance.

[thx ed s.]

Sunday, November 06, 2005

The Mysterious Death of Pat Tillman By FRANK RICH

From The New York Times, 11/6/05:
http://select.nytimes.com/2005/11/06/opinion/06rich.html?hp

The Mysterious Death of Pat Tillman

By FRANK RICH

IT would be a compelling story," Patrick Fitzgerald said of the
narrative Scooter Libby used to allegedly mislead investigators in the
Valerie Wilson leak case, "if only it were true."

"Compelling" is higher praise than any Mr. Libby received for his one
work of published fiction, a 1996 novel of "murder, passion and
heart-stopping chases through the snow" called "The Apprentice."

If you read the indictment, you'll see why he merits the critical
upgrade.

The intricate tale he told the F.B.I. and the grand jury - with its
endlessly clever contradictions of his White House colleagues'
testimony - is compelling even without the sex and the snow.

The medium is the message.

This administration just loves to beguile us with a rollicking good
story, truth be damned.

The propagandistic fable exposed by the leak case - the apocalyptic
imminence of Saddam's mushroom clouds - was only the first of its
genre.

Given that potboiler's huge success at selling the war, its authors
couldn't resist providing sequels once we were in Iraq.

As the American casualty toll surges past 2,000 and Veterans Day
approaches, we need to remember and unmask those scenarios as well.

Our troops and their families have too often made the ultimate
sacrifice for the official fictions that have corrupted every stage of
this war.

If there's a tragic example that can serve as representative of the
rest, it is surely that of Pat Tillman, the Arizona Cardinals
defensive back who famously volunteered for the Army in the spring
after 9/11, giving up a $3.6 million N.F.L. contract extension.

Tillman wanted to pay something back to his country by pursuing the
enemy that actually attacked it, Osama bin Laden and Al Qaeda.

Instead he was sent to fight a war in Iraq that he didn't see coming
when he enlisted because the administration was still hatching it in
secret.

Only on a second tour of duty was he finally sent into Taliban
strongholds in Afghanistan, where, on April 22, 2004, he was killed.

On April 30, an official Army press release announcing his Silver Star
citation filled in vivid details of his last battle.

Tillman, it said, was storming a hill to take out the enemy, even as
he "personally provided suppressive fire with an M-249 Squad Automatic
Weapon machine gun."

It would be a compelling story, if only it were true.

Five weeks after Tillman's death, the Army acknowledged abruptly,
without providing details, that he had "probably" died from friendly
fire.

Many months after that, investigative journalists at The Washington
Post and The Los Angeles Times reported that the Army's initial
portrayal of his death had been not only bogus but also possibly a
cover-up of something darker.

"The records show that Tillman fought bravely and honorably until his
last breath," Steve Coll wrote in The Post in December 2004.

"They also show that his superiors exaggerated his actions and
invented details as they burnished his legend in public, at the same
time suppressing details that might tarnish Tillman's commanders."

This fall The San Francisco Chronicle uncovered still more details
with the help of Tillman's divorced parents, who have each reluctantly
gone public after receiving conflicting and heavily censored official
reports on three Army investigations that only added to the mysteries
surrounding their son's death.

(Yet another inquiry is under way.)

"The administration clearly was using this case for its own political
reasons," said Patrick Tillman, Pat Tillman's father, who discovered
that crucial evidence in the case, including his son's uniform and
gear, had been destroyed almost immediately.

"This cover-up started within minutes of Pat's death, and it started
at high levels."

His accusations are far from wild.

The Chronicle found that Gen. John Abizaid, the top American officer
in Iraq, and others in his command had learned by April 29, 2004, that
friendly fire had killed their star recruit.

That was the day before the Army released its fictitious press release
of Tillman's hillside firefight and four days before a nationally
televised memorial service back home enshrined the fake account of his
death.

Yet Tillman's parents, his widow, his brother (who served in the same
platoon) and politicians like John McCain (who spoke at Tillman's
memorial) were not told the truth for another month.

Why?

It's here where we find a repeat of the same pattern that drove the
Valerie Wilson leak a year earlier.

Faced with unwelcome news - from the front, from whistle-blowers, from
scandal - this administration will always push back with
change-the-subject stunts (like specious terror alerts), fake news or,
as with Joseph Wilson, smear campaigns.

Much as the White House was out to bring down Mr. Wilson because he
threatened to expose its prewar hype of Saddam's supposed nuclear
prowess, so the Pentagon might have been out to delay or rewrite a
story that could be trouble when public opinion on the war itself was
just starting to plummet.

It was an election year besides.

Tillman's death came after a month of solid bad news for America and
the Bush-Cheney re-election campaign alike:

the publication of Richard Clarke's book about pre-9/11 administration
counterterrorism fecklessness,

the savage stringing up of the remains of American contractors in
Falluja,

the eruption of Sunni and Shiite insurgencies in six Iraqi cities,

the first publication of illicit photos of flag-draped coffins.

In the days just after Tillman's death, "60 Minutes II" first
broadcast the Abu Ghraib photos, Ted Koppel read the names of the
war's fallen on "Nightline," and the Pentagon's No. 2, the Iraqi war
architect Paul Wolfowitz, understated by more than 200 the number of
American casualties to date (722) in an embarrassing televised
appearance before Congress.

Against this backdrop, it would not do to have it known that the most
famous volunteer of the war might have been a victim of gross
negligence or fratricide.

Though Tillman himself was so idealistic that he refused publicity of
any kind when in the Army, he was exploited by the war's cheerleaders
as a recruitment lure and was needed to continue in that role after
his death.

(Even though he was adamantly against the Iraq war, according to
friends and relatives interviewed by The Chronicle.)

"They blew up their poster boy," Patrick Tillman told The Post; he is
convinced that "all the people in positions of authority went out of
their way to script" the fake narrative (or, as he puts it, "outright
lies") that followed.

Pat Tillman's mother, Mary Tillman, was offended to discover that even
President Bush wanted a cameo role in this screenplay:

she told The Post that he had offered to tape a memorial to her son
for a Cardinals game that would be televised shortly before Election
Day. (She said no.)

In an interview with The Arizona Republic, Mary Tillman added:

"They could have told us upfront that they were suspicious that it was
a fratricide but they didn't. They wanted to use him for their
purposes. It was good for the administration. It was before the
elections. It was during the prison scandal. They needed something
that looked good, and it was appalling that they would use him like
that."

Appalling but consistent.

The Pentagon has often failed to give the troops what they need to
fight the war in Iraq, from proper support in manpower and planning at
the invasion's outset to effective armor for battle to adequately
financed health care for those who make it home.

But when it comes to using troops in the duplicitous manner that Mary
Tillman describes, the sky's the limit.

Pat Tillman's case is itself a replay of the fake "Rambo" escapades
ascribed to Pfc. Jessica Lynch a year earlier, just when Operation
Iraqi Freedom showed the first tentative signs of trouble and the
Pentagon needed a feel-good distraction.

As if to echo Mary Tillman, Ms. Lynch told Time magazine this year, "I
was used as a symbol."

But the troops aren't just used as symbols for the commander in
chief's political purposes.

They are also drafted to serve as photo-op props and extras, whether
in an extravaganza like "Mission Accomplished" or a throwaway
dog-and-pony show like the recent teleconference in which the
president held a "conversation" with soldiers who sounded as
spontaneous as the brainwashed G.I.'s in "The Manchurian Candidate."

As Mr. Bush's approval rating crashes into the 30's, he and the vice
president are so desperate to wrap themselves in khaki that on the day
of the Libby indictment, they took separate day trips to mouth the
usual stay-the-course platitudes before military audiences.

If this was a ploy to split the focus of cable news networks and the
public, it failed.

Perhaps Scooter Libby is hoping that a so-called faulty-memory defense
will save him from jail, but too many other Americans are now
refreshing their memories of what went down in the plotting and
execution of the war in Iraq.

What they find are harsh truths and buried secrets that even the most
compelling administration scenarios can no longer disguise.


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[thx Harry at googlegroups]