Israeli soldiers 'used human shields' in Gaza

Image via Wikipedia

Times Online

A group of Israeli soldiers who fought in the recent war in Gaza have testified that the military allowed them to use reckless force.
The 26 soldiers published their anonymous accounts in a booklet compiled by Breaking the Silence, an Israeli soldiers' organisation.
They describe the Israeli army's use of human shields and deliberate targeting of civilian structures.
The soldiers' descriptions confirm information first published by The Times during the offensive that soldiers were given orders to shoot first and ask questions later.
In one typical account, a soldier said that in pre-invasion briefings his officers said it was better to hit an innocent than hesitate to attack an enemy. "If you're not sure, kill. Fire power was insane."
"You felt like a child playing around with a magnifying glass, burning up ants," another Israeli soldier said. "A 20-year-old kid should not be doing such things to people."
Several Israeli soldiers adescribed the use of white phosphorus in Gaza. One soldier described walking on the beach in Gaza and discovering an area covered in glazed sand from a white phosphorous bomb.
He said it was upsetting because "in training you learn that white phosphorus is not used, and you're taught that it's not humane".
A soldier from the Golani brigade said: "Sometimes a force would enter while placing rifle barrels on a civilian's shoulder, advancing into a house and using him as a human shield."
Another soldier related an incident in which he was ordered not to fire warning shots at a man approaching their position from some dozen yards away.
When they asked their commander why he told them not to fire warning shots, he said: "It's night time and this is a terrorist."
Israel has blamed Palestinian militant groups for the high death toll in Gaza, stating that they hid explosives in schools, hospitals, and other civilian structures.
They said that Palestinian militants often dressed as civilians and attempted to get close to forces before launching an attack.
More than 1,400 Palestinians died in the three-week offensive. Gaza health officials say 900 of those killed were civilians but Israel says that figure is closer to 300.
Thirteen Israelis were killed, including three civilians who died from rocket fire.
A military spokesman accused the group of "defaming and slandering the IDF [Israel Defence Forces] and its commanders" but said that he would investigate formal complaints of military misconduct.

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Sotomayor Says Roe v. Wade Is Established Law

The Huffington Post

Judge Sonia Sotomayor declared unequivocally on Tuesday that the right to choose an abortion, as determined by Roe v. Wade, was established as law by the Supreme Court. In the process, the Obama nominee left the clear impression that she would vote to uphold abortion rights should the she be confirmed to the bench.
"The court's decision in Planned Parenthood vs. Casey reaffirmed the court holding of Roe," Sotomayor told the Senate Judiciary Committee. "That is the precedent of the court and settled in terms of the holding of the court."
Earlier in the question and answer session, Sotomayor was pressed to explain her view on the right to privacy, which provides the constitutional basis for the Supreme Court's ruling on abortion rights.
"There is a right of privacy," she replied. " The court has found it in various places in the Constitution.... It is found in the Fourth Amendment's prohibition against unreasonable search and seizures ... It's also found in the 14th Amendment of the Constitution when it is considered in the context of the liberty interests protected by the due process clause of the Constitution.

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Jackson's web of fraud and pill addiction is revealed

Prescription drugs are as popular and as dangerous as crack in the wrong hands.

Michael Jackson via last.fm

AddictionInfo.org

The shocking extent of Michael Jackson's addiction to prescription drugs and the level of the fraud committed to obtain them have been exposed by documents released in California.
His father insisted yesterday that "foul play" had been involved in the singer's death. Joe Jackson made the claim in a US TV interview, but would not give any further details.
Meanwhile, Los Angeles police chief William Bratton refused to rule out any possible cause, including homicide, and said the coroner's report into Jackson's death would be his guide.
Police are looking at his prescription history and trying to talk with his numerous former doctors, Mr Bratton said.
The singer swallowed more than ten Xanax pills every night, with bottles of the powerful anti-anxiety drug among medications prescribed in the names of Jackson's bodyguards and staff found in his room.
Police discovered illegally obtained sedatives, anaesthetics, painkillers and steroids at Jackson's Neverland Ranch in 2003 while investigating child molestation claims against him.
The revelations come in previously sealed papers obtained from the Santa Barbara County sheriff's department, two weeks after the troubled performer died.
The documents, which include transcripts of interviews with bodyguards claiming he was often "out of it and sedated", are the first tangible evidence of his long-term addiction.
The police raid, for instance, found numerous medicines, including several vials of the sedatives Versed and Promethazine; a vial of the hospital-strength anaesthetic Demerol; a bottle of steroid Prednisone; a bottle of the painkiller Percocet; syringes, oxygen tanks and a variety of unidentified loose pills.
In addition, there was a hand-scribbled and badly spelled note found with the drugs, possibly written by Jackson as he spoke to a doctor on the phone.
"Buprenex does the same as demerol, the only difference is you can't become an addict on Buprenex," the writing said.
The note likens the high-strength painkiller, correctly spelled Buprinex, to "synthetic Demeroll. 2 viles. I would feel safe havin it in case of axident."
An investigation by the Los Angeles Police Department into Jackson's death has focused on a number of medical professionals whom he hired privately.
William Bratton, the department's chief, said yesterday that there was a possibility it could become a criminal case.
The Los Angeles County coroner's office, meanwhile, has issued a subpoena for Jackson's medical records from more than a dozen doctors who attended him from 1993 until his death, aged 50, sources say.

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Cheney kept CIA program from Congress, source says

Image by Getty Images via Daylife

CNN.com

The CIA withheld information about a secret counterterrorism program from Congress during the Bush administration on direct orders from then-Vice President Dick Cheney, current CIA director Leon Panetta told members of Congress, a knowledgeable source confirmed to CNN.
The disclosure to the House and Senate intelligence committees about Cheney's involvement by Panetta was first reported in the New York Times. Efforts to contact Cheney for reaction were unsuccessful late Saturday.
The source who spoke to CNN did not want to be identified by name because the matter is classified, and CIA spokesman Paul Gimigliano declined comment on the report.
"It's not agency practice to discuss what may or may not have been said in a classified briefing," Gimigliano said. "When a CIA unit brought this matter to Director Panetta's attention, it was with the recommendation that it be shared with Congress. That was also his view, and he took swift, decisive action to put it into effect."
The fact that Panetta recently briefed lawmakers on an unspecified counterterrorism program was first revealed Wednesday, when a letter from seven House Democrats to Panetta was made public. The June 26 letter characterizes Panetta as testifying that the CIA "concealed significant actions from all members of Congress, and misled members for a number of years from 2001 to this week."
The letter contained no details about what information the CIA officials allegedly concealed or how they purportedly misled members of Congress.
A knowledgeable source familiar with the matter said the counterterrorism program in question was initiated shortly after the September 11, 2001, attacks on New York and Washington.
The program was on-again, off-again and was never fully operational, but was rather, a tool put on the shelf that could have been used, the source said. Panetta has put an end to the program, according to the source.
The disclosures follow a May spat between the spy agency and House Speaker Nancy Pelosi, who accused the CIA of misleading Congress during a secret 2002 briefing on harsh interrogation techniques being used on terrorism suspects. The CIA responded that Pelosi was told about the harsh techniques, including waterboarding, at the briefing.
However, the June 26 letter from the seven House Democrats noted that Panetta told CIA employees in a May 15 letter -- a response to the Pelosi allegation -- that it was not CIA policy to mislead Congress. The letter from the House Democrats asked Panetta to correct his May 15 statement "in light of your testimony."
Asked about the Democrats' letter, CIA spokesman George Little said Panetta "stands by his May 15 statement."
"This agency and this director believe it is vital to keep the Congress fully and currently informed. Director Panetta's actions back that up," Little said in a statement. "As the letter from these ... representatives notes, it was the CIA itself that took the initiative to notify the oversight committees."
The latest revelations come as lawmakers consider expanding the number of House and Senate members privy to the kind of secret briefing that Pelosi received.
The White House opposes a measure that would increase the number of briefing participants from the current eight to 40 members of Congress. A White House memo warned President Obama's senior advisers would recommend a veto of the bill if it contained the expanded briefing provision.

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When is it Economic Slavery?

MN Progressive Project

Imagine a job offered where you were payed in company script, not US dollars, that could only buy company housing and could only be spent in company stores. This is the true history of our Minnesota Iron Range. The owners were absentee owners, where the profit went elsewhere, not invested locally. The owners then went bankrupt, abandoning long term health care and pensions to what the government can provide. And in recessions, the employment dries up. I still listen to this story in awe.

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Presidential Surveillance Program: Spying Went Beyond Warrantless Wiretapping

This is not exactly new news, see here.

George W. Bush via last.fm

Huffingtonpost.com

The Bush administration authorized secret surveillance activities that still have not been made public, according to a new government report that questions the legal basis for the unprecedented anti-terrorism program.
It's unclear how much valuable intelligence was yielded by the surveillance program started after the Sept. 11, 2001, terror attacks, according to the unclassified summary of reports by five inspectors general. The reports mandated by Congress last year were delivered to lawmakers Friday.
President George W. Bush authorized other secret intelligence activities _ which have yet to become public _ even as he was launching the massive warrentless wiretapping program, the summary said. It describes the entire program as the "President's Surveillance Program."
The report describes the program as unprecedented and raises questions about the legal grounding used for its creation. It also says the intelligence agencies' continued retention and use of the information collected under the program should be carefully monitored.
Many senior intelligence officials believe the program filled a gap in intelligence. Others, including FBI, CIA and National Counterterrorism Center analysts, said intelligence gathered by traditional means was often more specific and timely, according to the report.
The Bush White House acknowledged in 2005 that it allowed the National Security Agency to intercept international communications that passed through U.S. cables without court orders.
The inspectors general interviewed more than 200 government officials and private sector personnel, including former CIA and NSA Director Michael Hayden, former Defense Secretary Donald Rumsfeld and former Attorney General Alberto Gonzales.
Five former Bush administration officials refused to be interviewed, including former CIA Director George Tenet and former Attorney General John Ashcroft.
Story continues below
The others: former White House Chief of Staff Andrew Card; former top Cheney aide David Addington; and John Yoo, who served as a deputy assistant attorney general.
The IG report said an unnamed White House official inserted a paragraph into the first threat assessment prepared by the CIA after the Sept. 11 attacks, which was used to justify the extraordinary intelligence measures.
The paragraph said that the "individuals and organizations involved in global terrorism possessed the capability and intention to undertake further terrorist attacks within the United States," according to the report. It also said that the president should authorize the NSA to conduct the surveillance activities.
The memos were revised and renewed thereafter every 45 days. The report said that the president consistently gave that authorization for the surveillance activity, and that both CIA chief Tenet and his successor, Porter Goss, never withheld their signatures from threat assessment memoranda.
The report also questions the legal advice used by President Bush to set up the program, pinpointing omissions and questionable legal memos written by Yoo at the Justice Department.
The report suggests Yoo ignored an explicit provision in the FISA law designed to restrict the government's authority to conduct electronic surveillance during wartime. And it said flaws in Yoo's memos later presented "a serious impediment" to recertifying the program.
Congress required the review of the so-called warrantless wiretapping program last year when it revised the Foreign Intelligence Surveillance Act. FISA is a 30 year-old law that created a secret court to oversee government electronic surveillance.
The inspectors general of the CIA, Justice Department, Defense Department, National Security Agency and Office of the National Intelligence Director also reviewed the Bush-era surveillance program.

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Demonstrators Tear-Gassed, Fired On

Image by Getty Images via Daylife

Informed Comment

Hundreds of protesters braved tear gas and even some live fire to march toward Tehran University on Thursday, commemorating a crushed student protest movement of 1999 a s well as protesting the allegedly stolen elections of June 12. Police intervened to disperse them. A new and significant feature of this demonstration was that simultaneous rallies also occurred in cities all around the country. Although the crowds were relatively small, this national coordination suggests a national underground organization is emerging. The authorities cut off text messaging capabilities on Thursday in a vain attempt to thwart networking.
Nico Pitney is doing his usual superb job of live-blogging today's events in Iran.
Aljazeera English has a backgrounder on today's protests

Pope wants ethical financial order

Image via Wikipedia

The Press Association

Pope Benedict XVI has called for a new world financial order guided by ethics and the search for the common good.
He condemned the profit-at-all-cost mentality and blamed it for bringing about the global financial meltdown.
In the third encyclical of his pontificate, Benedict also pressed for reform of the UN and international economic and financial institutions to give poorer countries more of a say in international policy.
"There is urgent need (for) a true world political authority" that can manage the global economy, guarantee the environment is protected, ensure world peace and bring about food security for the poor, he wrote.
The document, Charity in Truth, was in the works for two years, and its publication was repeatedly delayed to incorporate the fallout from the crisis.
It was released on Tuesday - the day before leaders of the G8 industrialised nations meet to co-ordinate efforts to deal with the global meltdown, signalling a clear Vatican bid to prod leaders for a financially responsible future and what it considers a more socially just society.
"The economy needs ethics in order to function correctly - not any ethics, but an ethics which is people centred," Benedict wrote.
German-born Benedict, 82, has spoken out frequently about the impact of the crisis on the poor, particularly in Africa, which he visited earlier this year.
But the 144-page encyclical, one of the most authoritative documents a pope can issue, marked a new level of church teaching by linking the Vatican's long-standing social doctrine on caring for the poor with current events.
While acknowledging that the globalised economy had "lifted billions of people out of misery", Benedict blamed the unbridled growth of recent years for causing unprecedented problems as well, citing mass migration flows, environmental degradation and a complete loss of trust in the world market.
Copyright © 2009 The Press Association. All rights reserved.

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Image via Wikipedia

The Press Association

Pope Benedict XVI has called for a new world financial order guided by ethics and the search for the common good.
He condemned the profit-at-all-cost mentality and blamed it for bringing about the global financial meltdown.
In the third encyclical of his pontificate, Benedict also pressed for reform of the UN and international economic and financial institutions to give poorer countries more of a say in international policy.
"There is urgent need (for) a true world political authority" that can manage the global economy, guarantee the environment is protected, ensure world peace and bring about food security for the poor, he wrote.
The document, Charity in Truth, was in the works for two years, and its publication was repeatedly delayed to incorporate the fallout from the crisis.
It was released on Tuesday - the day before leaders of the G8 industrialised nations meet to co-ordinate efforts to deal with the global meltdown, signalling a clear Vatican bid to prod leaders for a financially responsible future and what it considers a more socially just society.
"The economy needs ethics in order to function correctly - not any ethics, but an ethics which is people centred," Benedict wrote.
German-born Benedict, 82, has spoken out frequently about the impact of the crisis on the poor, particularly in Africa, which he visited earlier this year.
But the 144-page encyclical, one of the most authoritative documents a pope can issue, marked a new level of church teaching by linking the Vatican's long-standing social doctrine on caring for the poor with current events.
While acknowledging that the globalised economy had "lifted billions of people out of misery", Benedict blamed the unbridled growth of recent years for causing unprecedented problems as well, citing mass migration flows, environmental degradation and a complete loss of trust in the world market.
Copyright © 2009 The Press Association. All rights reserved.

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Ghost of Marx haunts China's riots

Image via Wikipedia

Asia Times Online

The weekend violence that has left 156 people dead and more than 816 injured in Urumqi, capital of northwestern Xinjiang Uyghur Autonomous Region, is the latest example of growing conflicts between China's majority Han ethnic group and ethnic minorities.
At the heart of the escalating problem are China's antiquated policies towards its ethnic minorities - a raft of Marxist measures that are now pleasing neither the ethnic Han, nor the minorities. As China's gargantuan economy has advanced, former leader Mao Zedong's vision of political and economic equality between
Han and non-Han has gradually been undermined.
The end result could be seen on the bloody streets of Urumqi.
On Sunday, more than 300 ethnic Uyghurs - mostly Sunni Muslims - staged a protest in Urumqi's People's Square to demand an investigation into a June 26 brawl at a toy factory in Shaoguan, Guangdong province. Riots began when police began to disperse protesters, soon spreading across the remote city of 2.3 million people.
Groups of rioters broke down guardrails on roads, torched automobiles and beat Han pedestrians. The mob attacked buses and set fire to a hotel near the office building of the Xinjiang Regional Foreign Trade Commission, according to the state-run Xinhua News Agency. Hundreds of cars, shops and homes were smashed and burned during the violence, Xinhua said.
China Central Television on Monday aired images of Uyghur protesters attacking Han men and women, kicking them on the ground and leaving them dazed and bloodied. Images were shown of smoke billowing from vehicles as rioters overturned police cars and smashed buses.
As of Monday evening, at least 156 people were found dead and more than 800 others injured, including armed police officers, the Xinjiang Public Security Department said. More than 50 dead bodies were found in back streets and alleys, officials said, adding grimly that the toll may rise.
Official statistics did not give any breakdowns to show how many Uyghur protesters were killed. A spokesperson for the World Uyghur Congress (WUC), a United States-based organization of pro-independence Uyghurs in exile, told Voice of America that police opened fire on protesters. The Chinese government has blamed the WUC for masterminding the violence,
Xinhua said "the situation was under control" by Monday morning; police had shut down traffic in parts of the city and arrested over 1,000 protesters. Among those detained were at least 10 of the most prominent figures who fanned the unrest on Sunday, the Xinjiang Public Security Department said.
But on Tuesday, over 200 Uyghurs, mostly women, staged a new protest in Urumqi in front of foreign reporters and it was reported that in the afternoon Urumqi Han residents began to counter-attack on Uyghurs. The women demanded the release of their families arrested during Sunday's violence. The foreign reporters had been organized by authorities to visit post-violence scenes, where protesters engaged in a tense stand-off with police, Hong Kong media said.
The Xinjiang government that evening warned that "hostile elements" were plotting to stir up violence in other Xinjiang cities such as Yining and Kashgar.
"We deeply regret the loss of life" in Urumqui, US State Department spokesman Ian Kelly said. "We call on all sides for calm and restraint."
United Nations secretary general Ban Ki-moon also called for restraint. He told a press conference on Monday: "Wherever it is happening or has happened the position of the United Nations and the secretary general has been consistent and clear: that all the differences of opinion, whether domestic or international, must be resolved peacefully through dialogue."
According to Xinhua, a government statement claimed the violence was "a pre-empted, organized violent crime. It is instigated and directed from abroad and carried out by outlaws in the country."
In a televised address on Monday morning, Xinjiang governor Nur Bekri accused the WUC led by Rebiya Kadeer - a former businesswoman now living in the United States - of fomenting the violence via telephone and the Internet. "Rebiya had phone conversations with people in China on July 5 in order to incite ... and the Internet was used to orchestrate the incitement," read the statement.
Kadeer's spokesman, Alim Seytoff, told the Associated Press from Washington that the accusations were baseless.
"It's common practice for the Chinese government to accuse Ms Kadeer for any unrest in East Turkestan and His Holiness the Dalai Lama for any unrest in Tibet," he said. East Turkestan is the name of the state Uyghur pro-independence groups and militants wish to create in Xinjiang.
One the exile groups, the East Turkestan Islamic Movement, is listed by the Chinese government and the UN as a terrorist organization. The WUC denies any connection with the East Turkestan Islamic Movement.
The violence in Urumqi echoed last year's unrest in Tibet. In March 2008, a peaceful demonstration of monks in the capital of Lhasa erupted into riots that spread to surrounding areas, leaving at least 22 dead. The Chinese government accused the Dalai Lama of orchestrating the violence. The Dalai Lama denied the charge.
Whether the riots were instigated by pro-independence activists or not, the fact remains that violent conflicts are easily stirred up by the mutual distrust between the Han people and ethnic minorities. Internet rumors were also involved.
The brawl in the Shaoguan factory on June 26 was started by a post on an Internet website that claimed at least two female Han workers were raped by Uyghur migrant workers, many of whom work at the factory.
In response to the allegation, Han workers stormed into dormitories of the Uyghur workers. In the ensuing battle, two Uyghur were killed and many workers from both sides injured, according to local police. Authorities later arrested a Han worker for uploading the rape rumor to stir up trouble.
The end of class-struggle identity
The increasingly frequent conflicts between Han and other groups indicate the Chinese Communist Party's (CCP's) policy toward ethnic minorities has become ineffective in maintaining harmonious relations between peoples.
For the past 60 years, the stated aim of the CCP's policy has been to maintain national unity and stabilize civil society. The communist government considers all ethnic groups to be Chinese, but encourages all ethnic groups, especially minorities, to keep and develop their traditional cultures. The government has even helped minorities with only a spoken language create their own writing system.
The idea that all people in China belong to the "great family of Chinese" is not the invention of the communists. This attitude began with the founding father of modern China, Dr Sun Yat-sen, and was supported by early Chinese enlightenment thinkers such as Liang Qichao and Hu Shih.
In the era of chairman Mao Zedong, the ethnic policy was dictated by his class-struggle doctrine, by which all Han and non-Han working people shared one common identity - socialist labor. The term "labor" meant they were also the owners of the country - constitutionally and ideologically. Capitalists, land owners, serf owners and other "exploiters" - regardless of their ethnic origins - were the enemies.
This policy successfully surpassed ethnic differences and constructed a shared identity for all working people. To an extent, this policy under Mao united all ethnic groups in the "class struggle" against the "oppressors". It also made the former elites of ethnic minorities diehard enemies of the Chinese Communist Party (CCP).
The working poor of China's ethnic groups gave much support to the CCP government, and accepted their new socialist identity. Han and non-Han people became equal economically and politically, and the idea of ethnicity was gradually faded out by the idea of class.
The concept of a common class, which gave equality to all people in the same class regardless of their ethnicity, surpassed the idea of ethnic identity and forestalled ethnic conflict.
But when the class-struggle doctrine was practiced to the extreme particularly during the Cultural Revolution between 1966 and 1976, it gave the Red Guards - consisting of mostly Hans - the ground to attack China's cultural and historical heritage - Han as well as ethnic - in the name of the revolution. These attacks tremendously hurt the feelings of ethnic minorities.
After the Cultural Revolution, apparently as some form of compensation, the Chinese government began to award some privileges and preferences to ethnic minorities.
For example, the tough one-child policy applies only to Han couples. Accordingly, the birth rate and population proportion of the Han are decreasing, compared to other ethnic groups. Meanwhile, privileges have been granted to ethnic minorities for employment and education opportunities. To boost economic growth, the government in recent years has poured much money into ethnic minority areas.
Many Han are upset at what they see as discrimination. In the aftermath of the Shaoguan brawl, Guangdong party secretary Wang Yang visited and consoled the injured Uyghur workers, but allegedly ignored the injured Han workers. This angered the Han workers and increased their suspicion of the government's policy.
Even as ethnic groups, such as the Uyghurs, complain they are being exploited or discriminated by the Han, many Han accuse the government of doing the same. In the end, as China's economy advances, political and economic equality between Han and non-Han is being undermined.
The wealth gap is expanding between the Han, who in general live in rich areas, and those ethnic minorities who live in relatively poorer areas. The economic inequality between different regions is also a case between Han and non-Hans. Although this imbalance of economic development is due to many factors, it's easy for minorities to feel exploited by the Han.
As the influence of Marxism as the dominant ideology is diminishing in China, the sense of political equality is also abating. Today, common people aren't really considered the owners of the country, and laborers are no longer a respected class. Capitalists have become the government's guests of honor.
In China, political equality based on class equality has collapsed. For the past 60 years, this idea of class equality was a basis on which all common people, including minorities, could maintain an identity as one member of the Chinese political community.
Now, the economic and political marginalization of ethnic minorities is destroying the foundation of some ethnic groups' Chinese identity. At the same time, this marginalization is deeply misunderstood by many of the majority Han ethnic group.
The shared identity of the Chinese - as socialist labor - is gradually falling to pieces. The resulting riots in Urumqi may be just the start of something much, much bigger.
Dr Jian Junbo is assistant professor of the Institute of International Studies at Fudan University, Shanghai, China.
(Copyright 2009 Asia Times Online (Holdings) Ltd. All rights reserved. Please contact us about sales, syndication and republishing.)

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Healthy examples: Plenty of countries get healthcare right

- The Boston Globe

That was Arizona Senator Jon Kyl, speaking last month about healthcare reform. But it could have been virtually any other Republican, not to mention any number of sympathetic interest groups, because that's the party line for many who oppose healthcare reform. If President Obama and his supporters get their way, this argument goes, healthcare in America will start to look like healthcare overseas. Yes, maybe everybody will have insurance. But people will have to wait in long lines. And when they are done waiting in line, the care won't be very good.
Typically the people making these arguments are basing their analysis on one of two countries, Canada and England, where such descriptions hold at least some truth. Although the people in both countries receive pretty good healthcare - their citizens do better than Americans in many important respects - they are also subjected to longer waits for specialty care and tighter limits on some advanced treatments.
But no serious politician is talking about recreating either the British or the Canadian system here. The British have truly "socialized medicine," in which the government directly employs most doctors. The Canadians have one of the world's most centralized "single-payer" systems, in which the government insures everybody directly and private insurance has virtually no role. A better understanding for how universal healthcare might work in America would come from other countries - countries whose insurance architecture and medical cultures more closely resemble the framework we'd likely create here.
Last year, I had the opportunity to spend time researching two of these countries: France and the Netherlands. Neither country gets the attention that Canada and England do. That might be because English isn't their language. Or it might be because they don't fit the negative stereotypes of life in countries where government is more directly involved in medical care.
Over the course of a month, I spoke to just about everybody I could find who might know something about these healthcare systems: Elected officials, industry leaders, scholars - plus, of course, doctors and patients. And sure enough, I heard some complaints. Dutch doctors, for example, thought they had too much paperwork. French public health experts thought patients with chronic disease weren't getting the kind of sustained, coordinated medical care that they needed.
But in the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren't filled with stories of people going bankrupt or skipping medical care because they couldn't afford to pay their bills. And they did all this while paying substantially less, overall, than we do.
The Dutch and the French organize their healthcare differently. In the Netherlands, people buy health insurance from competing private carriers; in France, people get basic insurance from nonprofit sickness funds that effectively operate as extensions of the state, then have the option to purchase supplemental insurance on their own. (It's as if everybody is enrolled in Medicare.) But in both countries virtually all people have insurance that covers virtually all legitimate medical services. In both countries, the government is heavily involved in regulating prices and setting national budgets. And, in both countries, people pay for health insurance through a combination of private payments and what are, by American standards, substantial taxes.
You could be forgiven for assuming, as Kyl and his allies suggest, that so much government control leads to Soviet-style rationing, with people waiting in long lines and clawing their way through mind-numbing bureaucracies every time they have a sore throat. But, in general, both the Dutch and French appear to have easy access to basic medical care - easier access, in fact, than is the American norm.
In both the Netherlands and France, most people have long-standing relationships with their primary care doctors. And when they need to see these doctors, they do so without delay or hassle. In a 2008 survey of adults with chronic disease conducted by the Commonwealth Fund - a foundation which financed my own research abroad - 60 percent of Dutch patients and 42 percent of French patients could get same-day appointments. The figure in the US was just 26 percent.
The contrast with after-hours care is even more striking. If you live in either Amsterdam or Paris, and get sick after your family physician has gone home, a phone call will typically get you an immediate medical consultation - or even, if necessary, a house call. And if you need the sort of attention available only at a formal medical facility, you can get that, too - without the long waits typical in US emergency rooms.
This is particularly true in the Netherlands, thanks to a nationwide network of urgent care centers the government and medical societies have put in place. Not only do these centers provide easily accessible care for people who use them; they leave hospital emergency rooms free to concentrate on the truly serious cases. Tellingly, a Dutch physician I met complained to me that waiting times in her emergency room had been getting "too long" lately. "Too long," she went on to tell me, meant two or three hours. When I told her about documented cases of people waiting a day, or even days, for treatment in some American emergency rooms, she thought I was joking. (In a 2007 Commonwealth Fund survey, just 9 percent of Dutch patients reported waiting more than two hours for care in an ER, compared to 31 percent of Americans.)
Dutch and French patients do wait longer than Americans for specialty care; around a quarter of respondents to the Commonwealth Fund survey reported waiting more than two months to see a specialist, compared to virtually no Americans. But Dutch and French patients were far less likely to avoid seeing a specialist altogether - or forgoing other sorts of medical care - because they couldn't afford it. And there's precious little evidence that the waits for specialty care led to less effective care.
On the contrary, the data suggests that while American healthcare is particularly good at treating some diseases, it's not as good at treating others. (In some studies, the US did pretty well on cardiovascular care, not so well on diabetes, for example.) Overall, the US actually fares poorly on measures like "potential years of lives lost" - statistics compiled by specialists in an effort to measure how well healthcare systems perform. In a 2003 ranking of 20 advanced countries, the US finished 16th when it came to "mortality amenable to healthcare," another statistic that strives to capture the impact of a health system. The Dutch were 11th and the French were fifth. These statistics are necessarily crude; diet, culture, and many other factors inevitably affect the results. But, taken together, they make it awfully hard to argue that care in these countries is somehow inferior. If anything, the opposite would seem to be true.
Critics of health reform frequently point to cancer as proof that American healthcare really is superior. And, it's true, the US has, overall, the world's highest five-year survival rate for cancer. But that's partly a product of the unparalleled amount of government-funded research in the US - something healthcare reform would not diminish. Besides, it's not as if the gap is as large or meaningful as reform critics frequently suggest. France (like a few other European countries) has survival rates that are generally close and, for some cancers, higher. Much of the remaining difference reflects differences in treatment patterns that have nothing to do with insurance arrangements and everything to do with idiosyncratic medical cultures. This is particularly true of prostate cancer, where a staggeringly high survival rate in the US seems to be largely a product of aggressive US treatment - treatment that physicians in other countries, and increasingly many specialists here, consider unnecessary and sometimes harmful.
None of this is to say that either the Dutch or French systems are perfect. Far from it. In both countries, healthcare costs are rising faster than either the public - or the country's business interests - would like. And each country has undertaken reforms in an effort to address these problems. The French have started to introduce some of the managed care techniques familiar to Americans, like charging patients extra if they see specialists without a referral, while developing more evidence-based treatment guidelines in the hope that it will reduce the use of unnecessary but expensive treatments. The Dutch overhauled their insurance arrangements a few years ago, to introduce more market competition and reward healthcare providers - that is, doctors and hospitals - who get good results.
But cost is the one area in which France and the Netherlands are a lot like Canada and England: They all devote significantly less of their economy to healthcare than we do. The French spend around 11 percent of their gross domestic product on healthcare, the Dutch around 10. In the US, we spend around 16 percent. And, unlike in the US, the burden for paying this is distributed across society - to both individuals and businesses - in an even, predictable way.
Of course, reforming health insurance in the US isn't going to turn this country into France or the Netherlands overnight, any more than it would turn the US into Britain and Canada. The truth is that the changes now under consideration in Washington are relatively modest, by international standards. But insofar as countries abroad give us an idea of what could happen, eventually, if we change our health insurance arrangements, the experience of people in Amsterdam and Paris surely matters as much as - if not more than - those in Montreal and London. In those countries, government intervention has created a health system in which people seem to have the best of all worlds: convenience, quality, and affordability. There's no reason to think the same thing couldn't happen here.
Jonathan Cohn is a senior editor of The New Republic, where he writes a blog called "The Treatment." He is also the author of "Sick: The Untold Story of America's Health Care Crisis - and the People Who Pay the Price (HarperCollins, 2007).
© Copyright 2009 The New York Times Company

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Healthy examples: Plenty of countries get healthcare right - The Boston Globe

Plenty of countries get healthcare right.

"I DON'T WANT America to begin rationing care to their citizens in the way these other countries do."
That was Arizona Senator Jon Kyl, speaking last month about healthcare reform. But it could have been virtually any other Republican, not to mention any number of sympathetic interest groups, because that's the party line for many who oppose healthcare reform. If President Obama and his supporters get their way, this argument goes, healthcare in America will start to look like healthcare overseas. Yes, maybe everybody will have insurance. But people will have to wait in long lines. And when they are done waiting in line, the care won't be very good.
Typically the people making these arguments are basing their analysis on one of two countries, Canada and England, where such descriptions hold at least some truth. Although the people in both countries receive pretty good healthcare - their citizens do better than Americans in many important respects - they are also subjected to longer waits for specialty care and tighter limits on some advanced treatments.
But no serious politician is talking about recreating either the British or the Canadian system here. The British have truly "socialized medicine," in which the government directly employs most doctors. The Canadians have one of the world's most centralized "single-payer" systems, in which the government insures everybody directly and private insurance has virtually no role. A better understanding for how universal healthcare might work in America would come from other countries - countries whose insurance architecture and medical cultures more closely resemble the framework we'd likely create here.
Last year, I had the opportunity to spend time researching two of these countries: France and the Netherlands. Neither country gets the attention that Canada and England do. That might be because English isn't their language. Or it might be because they don't fit the negative stereotypes of life in countries where government is more directly involved in medical care.
Over the course of a month, I spoke to just about everybody I could find who might know something about these healthcare systems: Elected officials, industry leaders, scholars - plus, of course, doctors and patients. And sure enough, I heard some complaints. Dutch doctors, for example, thought they had too much paperwork. French public health experts thought patients with chronic disease weren't getting the kind of sustained, coordinated medical care that they needed.
But in the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren't filled with stories of people going bankrupt or skipping medical care because they couldn't afford to pay their bills. And they did all this while paying substantially less, overall, than we do.
The Dutch and the French organize their healthcare differently. In the Netherlands, people buy health insurance from competing private carriers; in France, people get basic insurance from nonprofit sickness funds that effectively operate as extensions of the state, then have the option to purchase supplemental insurance on their own. (It's as if everybody is enrolled in Medicare.) But in both countries virtually all people have insurance that covers virtually all legitimate medical services. In both countries, the government is heavily involved in regulating prices and setting national budgets. And, in both countries, people pay for health insurance through a combination of private payments and what are, by American standards, substantial taxes.
You could be forgiven for assuming, as Kyl and his allies suggest, that so much government control leads to Soviet-style rationing, with people waiting in long lines and clawing their way through mind-numbing bureaucracies every time they have a sore throat. But, in general, both the Dutch and French appear to have easy access to basic medical care - easier access, in fact, than is the American norm.
In both the Netherlands and France, most people have long-standing relationships with their primary care doctors. And when they need to see these doctors, they do so without delay or hassle. In a 2008 survey of adults with chronic disease conducted by the Commonwealth Fund - a foundation which financed my own research abroad - 60 percent of Dutch patients and 42 percent of French patients could get same-day appointments. The figure in the US was just 26 percent.
The contrast with after-hours care is even more striking. If you live in either Amsterdam or Paris, and get sick after your family physician has gone home, a phone call will typically get you an immediate medical consultation - or even, if necessary, a house call. And if you need the sort of attention available only at a formal medical facility, you can get that, too - without the long waits typical in US emergency rooms.
This is particularly true in the Netherlands, thanks to a nationwide network of urgent care centers the government and medical societies have put in place. Not only do these centers provide easily accessible care for people who use them; they leave hospital emergency rooms free to concentrate on the truly serious cases. Tellingly, a Dutch physician I met complained to me that waiting times in her emergency room had been getting "too long" lately. "Too long," she went on to tell me, meant two or three hours. When I told her about documented cases of people waiting a day, or even days, for treatment in some American emergency rooms, she thought I was joking. (In a 2007 Commonwealth Fund survey, just 9 percent of Dutch patients reported waiting more than two hours for care in an ER, compared to 31 percent of Americans.)
Dutch and French patients do wait longer than Americans for specialty care; around a quarter of respondents to the Commonwealth Fund survey reported waiting more than two months to see a specialist, compared to virtually no Americans. But Dutch and French patients were far less likely to avoid seeing a specialist altogether - or forgoing other sorts of medical care - because they couldn't afford it. And there's precious little evidence that the waits for specialty care led to less effective care.
On the contrary, the data suggests that while American healthcare is particularly good at treating some diseases, it's not as good at treating others. (In some studies, the US did pretty well on cardiovascular care, not so well on diabetes, for example.) Overall, the US actually fares poorly on measures like "potential years of lives lost" - statistics compiled by specialists in an effort to measure how well healthcare systems perform. In a 2003 ranking of 20 advanced countries, the US finished 16th when it came to "mortality amenable to healthcare," another statistic that strives to capture the impact of a health system. The Dutch were 11th and the French were fifth. These statistics are necessarily crude; diet, culture, and many other factors inevitably affect the results. But, taken together, they make it awfully hard to argue that care in these countries is somehow inferior. If anything, the opposite would seem to be true.
Critics of health reform frequently point to cancer as proof that American healthcare really is superior. And, it's true, the US has, overall, the world's highest five-year survival rate for cancer. But that's partly a product of the unparalleled amount of government-funded research in the US - something healthcare reform would not diminish. Besides, it's not as if the gap is as large or meaningful as reform critics frequently suggest. France (like a few other European countries) has survival rates that are generally close and, for some cancers, higher. Much of the remaining difference reflects differences in treatment patterns that have nothing to do with insurance arrangements and everything to do with idiosyncratic medical cultures. This is particularly true of prostate cancer, where a staggeringly high survival rate in the US seems to be largely a product of aggressive US treatment - treatment that physicians in other countries, and increasingly many specialists here, consider unnecessary and sometimes harmful.
None of this is to say that either the Dutch or French systems are perfect. Far from it. In both countries, healthcare costs are rising faster than either the public - or the country's business interests - would like. And each country has undertaken reforms in an effort to address these problems. The French have started to introduce some of the managed care techniques familiar to Americans, like charging patients extra if they see specialists without a referral, while developing more evidence-based treatment guidelines in the hope that it will reduce the use of unnecessary but expensive treatments. The Dutch overhauled their insurance arrangements a few years ago, to introduce more market competition and reward healthcare providers - that is, doctors and hospitals - who get good results.
But cost is the one area in which France and the Netherlands are a lot like Canada and England: They all devote significantly less of their economy to healthcare than we do. The French spend around 11 percent of their gross domestic product on healthcare, the Dutch around 10. In the US, we spend around 16 percent. And, unlike in the US, the burden for paying this is distributed across society - to both individuals and businesses - in an even, predictable way.
Of course, reforming health insurance in the US isn't going to turn this country into France or the Netherlands overnight, any more than it would turn the US into Britain and Canada. The truth is that the changes now under consideration in Washington are relatively modest, by international standards. But insofar as countries abroad give us an idea of what could happen, eventually, if we change our health insurance arrangements, the experience of people in Amsterdam and Paris surely matters as much as - if not more than - those in Montreal and London. In those countries, government intervention has created a health system in which people seem to have the best of all worlds: convenience, quality, and affordability. There's no reason to think the same thing couldn't happen here.
Jonathan Cohn is a senior editor of The New Republic, where he writes a blog called "The Treatment." He is also the author of "Sick: The Untold Story of America's Health Care Crisis - and the People Who Pay the Price (HarperCollins, 2007).
© Copyright 2009 The New York Times Company

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Mass arrests over China violence

Image by centralasiatraveler via Flickr

BBC NEWS

Chinese police have arrested 1,434 people over rioting in Xinjiang province, official state media says. Rioting broke out on Sunday in Urumqi - the capital of Xinjiang -leaving 156 people dead and more than 800 injured. The unrest spread to a second city on Monday, with police breaking up fresh protests in Kashgar, dispersing more than 200 "rioters" at its main mosque. Beijing blames ethnic Muslim Uighurs for the violence, but exiled Uighurs say police fired on students.
XINJIANG VIOLENCE
Quentin Somerville, Urumqi Urumqi is under curfew. The city centre is deserted, only armed police and other security personnel stand on the streets. Eyewitnesses have told the BBC that an ethnic battle took place here on Sunday. Muslim Uighurs fought with Han Chinese. People were attacked as they sat on buses, others were dragged from their homes. The authorities say that many died in the back streets around the city centre. This was the bloodiest uprising against Chinese rule in many years, although there is little evidence of it left here on the streets. Burned out cars and buses have been cleared away. Authorities say Urumqi is now back firmly under their control.
Demonstrators said they had been demanding justice for two Uighurs killed last month in a fight with ethnic Han Chinese at a factory in southern China. The bloodshed drew international concern, with the US calling for all sides to "exercise restraint". The official Chinese news agency Xinhua reported on Monday that police believed agitators were "trying to organise more unrest" in other cities in Xinjiang, a mountainous and desert region that borders Central Asia.
About 200 people "trying to gather" at the Id Kah mosque in the centre of Kashgar, on the ancient Silk Road, were dispersed by police early on Monday evening, Xinhua said.
Police also revealed they had information about efforts to organise unrest in the city of Aksu and the Yili prefecture, Xinhua added. Yili is a border region that was hit by ethnic unrest in the late 1990s.
Calm in Urumqi
As relative calm returned to the bloodstained streets of Urumqi, paramilitary police patrolled the main bazaar - a largely Uighur neighbourhood - carrying batons, bamboo poles and slingshots. " Extremist forces inside and outside of China communicated with each other intensively before the incident erupted " Liu Weimin Chinese embassy, London
Mobile phone services were said to be blocked and internet connections cut or slowed down. Witnesses and state media said that rioters overturned barricades, attacked vehicles and houses, and clashed with police in Urumqi on Sunday. State television showed footage of protesters beating and kicking people on the ground. There were graphic images of people who appeared to be ethnic Han Chinese sitting dazed with blood pouring down their faces. Wu Nong, news director for the Xinjiang government, said more than 260 vehicles were attacked and more than 200 shops and houses damaged.
UIGHURS AND XINJIANG
# Uighurs are ethnically Turkic Muslims
# They make up about 45% of the region's population. 40% are Han Chinese
# China re-established control in 1949 after crushing short-lived state of East Turkestan
# Since then, large-scale immigration of Han Chinese
# Uighurs fear erosion of traditional culture
# Sporadic violence since 1991
# Attack on 4 Aug 2008 near Kashgar kills 16 Chinese policemen
A senior communist party official in Xinjiang confirmed on Tuesday that 129 men and 27 women were killed in the clashes in Urumqi. The figure is higher than had been reported on Monday. The police say some bodies were recovered from street corners in the aftermath of the clashes. Others died in hospital. Accounts differ over how the violence happened. The Xinjiang government blamed separatist Uighurs based abroad for orchestrating attacks on Han Chinese. But Uighur groups insisted their protest was peaceful and had fallen victim to state violence, with police firing indiscriminately on protesters in Urumqi.
Liu Weimin, a spokesman at the Chinese Embassy in London, told the BBC's The World Tonight that extremist forces had been involved. "The local government in Xinjiang has evidence that extremist forces inside and outside of China communicated with each other intensively before the incident erupted on Sunday," he said.
Rebiya Kadeer, exiled president of the Uighur American Association, denied claims that she had incited the riots. She said she had learned about the protests from websites and only called her family in China to warn them to stay away from any trouble.
There has been widespread international concern at the clashes, which some analysts say are the most serious in China since Tiananmen Square in 1989. UN Secretary General Ban Ki-moon led the calls for restraint, a sentiment echoed by Britain and the US.
White House spokesman Robert Gibbs said: "We are deeply concerned over reports of many deaths and injuries from violence in Urumqi in western China. We call on all in Xinjiang to exercise restraint."

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Leading Clerics Defy Ayatollah on Disputed Iran Election

Image via Wikipedia

NYTimes.com

An important group of religious leaders in Iran called the disputed presidential election and the new government illegitimate on Saturday, an act of defiance against the country's supreme leader and the most public sign of a major split in the country's clerical establishment.
A statement by the group, the Association of Researchers and Teachers of Qum, represents a significant, if so far symbolic, setback for the government and especially the authority of the supreme leader, Ayatollah Ali Khamenei, whose word is supposed to be final. The government has tried to paint the opposition and its top presidential candidate, Mir Hussein Moussavi, as criminals and traitors, a strategy that now becomes more difficult.
"This crack in the clerical establishment, and the fact they are siding with the people and Moussavi, in my view is the most historic crack in the 30 years of the Islamic republic," said Abbas Milani, director of the Iranian Studies Program at Stanford University. "Remember, they are going against an election verified and sanctified by Khamenei."
The announcement came on a day when Mr. Moussavi released documents detailing a campaign of fraud by the current president's supporters, and as a close associate of the supreme leader called Mr. Moussavi and former President Mohammad Khatami "foreign agents," saying they should be treated as criminals.
The documents, published on Mr. Moussavi's Web site, accused supporters of the president of printing more than 20 million extra ballots before the vote and handing out cash bonuses to voters.
Since the election, the bulk of the clerical establishment in the holy city of Qum, an important religious and political center of power, has remained largely silent, leaving many to wonder when, or if, the nation's senior religious leaders would jump into the controversy that has posed the most significant challenge to the country's leadership since the Islamic Revolution.
With its statement Saturday, the association of clerics came down squarely on the side of the reform movement.

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