Sunday, July 29, 2007

The World's Greatest Nation has the World's Greatest Health System

Joke, haha!

Michael Moore is a target for the wingnuts who, understandably, have a need to claim that he's always factually challenged. (Well, they're experts in distortion, dementia and paralogic....)

So, the factsheet on "Sicko". Hint: even if a couple shots miss, everyone knows he's pretty much right on target.
'SiCKO' Factual Backup

SiCKO: There are nearly 50 million Americans without health insurance.

The Centers for Disease Control and Prevention actually reported that 54.5 million people were uninsured for at least part of the year. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2006. Centers for Disease Control. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200706.pdf
The amount of uninsured is rising every year, as premiums continue to skyrocket and wages stagnate. From 2004 to 2005 the number of uninsured rose 1.3 million, and rose up nearly 6 million from 2001-2005. Leighton Ku, "Census Revises Estimates Of The Number Of Uninsured People," Center on Budget and Policy Priorities, April 5, 2007 http://www.cbpp.org/4-5-07health.htm. With 44.8 uninsured in 2005, in 2007 the number will be much higher. Professors Todd Gilmer and Richard Kronick, in "It's The Premiums, Stupid: Projections Of The Uninsured Through 2013," Health Affairs, 10.1377/hlthaff.w5.143, "project that the number of non-elderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013." According to these authors, by now the number of non-elderly uninsured by this date clearly would be nearly 50 million.
SiCKO: 18,000 Americans will die this year simply because they're uninsured.

According to the Institute of Medicine, "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage." Insuring America's Health: Principles and Recommendations, Institute of Medicine, January 2004.
http://www.iom.edu/?id=19175
SiCKO: Richard Nixon and John Ehrlichman are heard discussing the concept of a health maintenance organization in Oval Office Recordings.

On February 17, 1971, Richard Nixon met with John Ehrlichman to discuss the Vice President's position on health maintenance organizations, as heard in the film. The Miller Center of Public Affairs has this audio recording (conversation number 450-23. "Richard Nixon - Oval Office Recordings,"
http://millercenter.virginia.edu/scripps/digitalarchive/presidentialrecordings
/nixon/oval?PHPSESSID=b813e56b3017d097cd176720bc10fc74
The next day, Nixon called for a "new national health strategy" that had four points for expanding the proliferation of health maintenance organizations, or HMOs. "Special Message to the Congress Proposing a National Health Strategy," February 18th, 1971, http://www.presidency.ucsb.edu/ws/index.php?pid=3311
The term "health maintenance organization" was coined by Nixon advisor Paul Ellwood. Patricia Bauman, "The Formulation and Evolution of the Health Maintenance Organization Policy, 1970-1973, Social Science & Medicine, vol. 10. 1976. After Congress passed Nixon's HMO Act in 1973, HMOs in America increased nine-fold in just ten years. N. R. Kleinfield, "The King of the HMO Mountain," New York Times, July 31, 1983.
SiCKO: The American Medical Association distributed a record featuring Ronald Reagan discussing the evils of socialized medicine.

Ronald Reagan's recording was widely available in the 1960s, and was a part of the American Medical Association's "Operation Coffee Cup," a coordinated rebuttal to Democrats' push for Medicare. Max Skidmore, "Ronald Reagan and Operation Coffee Cup: A Hidden Episode in American Political History," Journal of American Culture, vol. 12. 1989.
SiCKO: $100 million spent to defeat Hillary's health care plan.

"Even before debate began in Congress, a powerful coalition had been cobbled together to fight Clintoncare, as opponents labeled it - congressional Republicans, the insurance industry, the pharmaceutical industry, the National Federation of Independent Businesses, the Business Roundtable, the Christian Coalition, the conservative radio talk show network. Those groups spent between $100 million and $ 300 million to defeat it. And the battle was fought like a presidential campaign - with a TV advertising campaign, a network of field operatives and public relations experts to lobby members of Congress back in their districts." Rob Christensen, "Who killed health care reform? Answer: Everyone," News & Observer, June 19, 1996.
"In 1993-94, the Health Insurance Association of America, a trade group, spent about $15 million on advertising to defeat Clinton's proposed overhaul of the nation's health care system." John MacDonald, "Proponents, Opponents Join Battle Over Drug Price Limits," Hartford Courant, June 21, 2000.
"'We spent $1.4 million to fight President Clinton's plan,' [Mike Russell of the Christian Coalition] says." Harold Cox, "Business will spearhead Health Reform II ; Old enemies of Clinton's plan in lead," Washington Times, December 27, 1994.
"A study by Citizen Action, a consumer group, reports that doctors, hospitals, insurance companies and other providers of medical services made campaign contributions of $ 79 million during the 1993-1994 election cycle. The insurance industry passed out $16 million. The American Medical Association, which objects to cost-control measures, contributed $ 3 million." Froma Harrop, "The big lie about health reform," Rocky Mountain News, August 20, 1995.
"According to [Citizens for a Sound Economy] spokesman Brent Bahler, the group has not bought any airtime for commercials but has 'tentative plans' for a grassroots advocacy effort that would include an advertising component. Last year, Bahler said, the CSE spent more than $2 million on print, radio and television advertising to defeat Clinton's health care reform plan." James A. Barnes, "RNC Turns To TV Ads On Budget," National Journal, 5.16.95.
SiCKO: The United States is ranked #37 as a health system by the World Health Organization.

"The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds." "World Health Organization Assesses The World's Health Systems," Press Release, WHO/44, June 21, 2000. http://www.who.int/inf-pr-2000/en/pr2000-44.html
SiCKO: Health industry companies accused of wrongdoing in Sicko.

Aetna: "Aetna Inc. … settled with the plaintiffs, which include the medical associations of California and Texas. Aetna agreed to pay the plaintiffs $120 million." Milt Freudenheim, "Class-Action Status Is Upheld for Doctors Suing Insurers," New York Times, September 2, 2004. See also, Susan Beck, "HMO Postmortem," American Lawyer, October 10, 2003. Settlement Agreement, http://www.aetna.com/provider/agreement_with_physicians.html
Blue Cross/Blue Shield: "Sixty-seven Blue Cross/Blue Shield companies across the nation have paid the United States a total of $117 million to settle government claims that Medicare made primary payments for health care services that should have been paid by the Blue Cross/Blue Shield private insurance companies, the Department of Justice announced today." "Blue Cross/Blue Shield Companies Settle Medicare Claims, Pay United States $117 Million, Agree To Share Information," Department of Justice News Release, October 25, 1995.
http://www.usdoj.gov/opa/pr/Pre_96/October95/551.txt.html
Cigna: "Cigna Corporation, [has] settled with the plaintiffs, which include the medical associations of California and Texas. … Cigna agreed to pay $85 million." Milt Freudenheim, "Class-Action Status Is Upheld for Doctors Suing Insurers," New York Times, September 2, 2004.
"HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today. … Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation." "Largest Health Care Fraud Case In U.S. History Settled; HCA Investigation Nets Record Total Of $1.7 Billion," Department of Justice News Release, June 26, 2003.
http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm
SiCKO: Executive Compensation

Michael B McAllister earned $3.33 million in compensation as CEO of Humana. "Forbes 2006 Executive Pay list," April 20, 2006.
http://www.forbes.com/lists/2006/12/AG0Q.html.
John W Rowe earned $22.2 million in compensation as CEO of Aetna. Rowe has since left Aetna. "Forbes 2004 Executive Pay list," April 21, 2005.
http://www.forbes.com/static/execpay2005/LIRS5NI.html?passListId=12
&passYear=2005&passListType=Person&uniqueId=S5NI&datatype=Person
Bill McGuire has stock options worth $1.6 billion at the end of 2005, as CEO of UnitedHealth Group. Robert Simison, "SEC Investigates UnitedHealth Over Stock-Options Practices," Bloomberg News, December 27, 2006; Michael Regan, "Business 2006: Who Won, Who Lost," Associated Press,December 26, 2006.
SiCKO: There are four times as many health care lobbyists as there are members of Congress.

According to the Center for Responsive Politics (www.opensecrets.org), in 2005 there were 2,084 health care lobbyists registered with the federal government. With 535 members of Congress, that's 3.895 lobbyists per member.
SiCKO: Hillary Clinton became the second largest recipient in the Senate of health care industry contributions.

"As she runs for re-election to the Senate from New York this year and lays the groundwork for a possible presidential bid in 2008, Mrs. Clinton is receiving hundreds of thousands of dollars in campaign contributions from doctors, hospitals, drug manufacturers and insurers. Nationwide, she is the No. 2 recipient of donations from the industry, trailing only Senator Rick Santorum of Pennsylvania, a member of the Republican leadership." Raymond Hernandez and Robert Pear, "Once an Enemy, Health Industry Warms to Clinton," New York Times, July 12, 2006.
SiCKO: Drug industry money to members of Congress, and the president, who led the effort to pass the Medicare Part D prescription drug plan.

"The health industry gave $14 million total to the eleven elected officials largely credited with negotiating the bill. Pharmaceutical company PACs, employees, and their families gave more than $3 million in campaign contributions to (those) eleven elected officials." Buying A Law: Big Pharma's Big Money and the Bush Medicare Plan, Campaign Money Watch, January 2004.
http://www.ourfuture.org/docUploads/donnelly$_1-15-04.pdf
SiCKO: The Medicare Part D plan will hand over $800 billion of our tax dollars to the drug and health insurance industry.

According to the Congressional Budget Office, for the ten-year period, 2006 through 2016, the projected spending is $848 billion. "The Budget and Economic Outlook: Fiscal Years 2008 to 2017," Congressional Budget Office, January 2007. http://www.cbo.gov/ftpdocs/77xx/doc7731/01-24-BudgetOutlook.pdf
SiCKO: The elderly could end up paying more for their prescription drugs than they did before under Part D - and a majority of senior citizens could still pay over $2000 a year.

"For all patients, Medicare covers 75 percent of the first $2,250 worth of drugs. But after that, coverage drops to zero - and doesn't resume until the patient hits $5,100 in expenses. Then Medicare kicks in again, paying 95 percent of costs. But it's this gap - of almost $3,000 - that many sick and disabled seniors call unaffordable." Medicare's 'Donut Hole,' CBS News, July 26, 2006.
http://www.cbsnews.com/stories/2006/07/26/eveningnews/main1839288.shtml
"Nearly 7 million seniors and individuals with disabilities who purchased stand-alone prescription drug coverage are now at risk of falling into the 'doughnut hole.' According to a report released today by Senior Democrats on the House Ways and Means Committee… nearly 88 percent of new drug plan enrollees, roughly 7 million individuals, are at risk of losing coverage for their medications while they continue to pay monthly premiums to their insurers. The report further details how few individuals have enrolled in plans without doughnut holes, presumably because of the prohibitive cost of such plans." "88% Of New Medicare Drug Program Enrollees At Risk Of Falling Into The 'Doughnut Hole,'" Joint News Release From Representative Charles B. Rangel, Ranking Democrat, Committee On Ways And Means, Representative Pete Stark, Ranking Democrat, Subcommittee On Health, Committee On Ways And Means, Representative Sander M. Levin, Ranking Democrat, Subcommittee On Social Security, Committee On Ways And Means, September 21, 2006.
http://www.house.gov/list/press/wm31_democrats/060921_88
_of_new_medicare_drug_program_enrollees_at_risk_of_falling
_into_the_doughnut_hole.html
"Over the past year, Part D drug prices have increased several times faster than the rate of inflation. Families USA analyzed the prices for 15 of the drugs most frequently prescribed to seniors. We examined prices for each of the plans offered by the largest Part D insurers, which together cover about two-thirds of all Part D beneficiaries. We then compared the lowest available Part D price for each drug in April 2006 with the lowest available price for the same drug in April 2007. The lowest price for every one of the top 15 drugs prescribed to seniors increased, and the median increase was 9.2 percent." Medicare Part D Prices Are Climbing Quickly, FamiliesUSA, April 2007.
http://www.familiesusa.org/assets/pdfs/medicare-part-d-drug-prices.PDF
SiCKO: Fourteen Congressional aides went to work for the industry; Billy Tauzin left Congress to become CEO of PhRMA for a $2 million annual salary.

See, e.g., The Medicare Drug War: An Army of Nearly 1,000 Lobbyists Pushes a Medicare Law that Puts Drug Company and HMO Profits Ahead of Patients and Taxpayers, Public Citizen Congress Watch, June 2004,
http://www.citizen.org/documents/Medicare_Drug_War%20_Report_2004.pdf
"Retiring Rep. Billy Tauzin, R-La., who stepped down earlier this year as chairman of the House committee that regulates the pharmaceutical industry, will become the new president and CEO of the drug industry's top lobbying group…Public Citizen, a non-profit consumer advocacy group, called Tauzin's hiring 'yet another example of how public service is leading to private riches.' Tauzin gets a pay package reportedly worth at least $2 million a year, making him one of the highest-paid lobbyists in Washington." "Tauzin switches sides from drug industry overseer to lobbyist," USA Today, December 15, 2004.. http://www.usatoday.com/money/industries/health/drugs/2004-12-
15-drugs-usat_x.htm
SiCKO: Canadians live three years longer than we do.

The 2006 United Nations Human Development Report's human development index states the life expectancy in the United States is 77.5, and the life expectancy in Canada is 80.2. Human Development Report 2006, United Nations Development Programme, 2006 at 283.
http://hdr.undp.org/hdr2006/pdfs/report/HDR06-complete.pdf.
SiCKO: Tommy Douglas, who pioneered Canada's health care system, was heralded as the nation's singular most important person.

"In November 2004, Canadians voted Tommy Douglas the Greatest Canadian of all time following a nationwide contest. Over 1.2 million votes were cast in a frenzy of voting that took place over six weeks as each of 10 advocates made their case for the Top 10 nominees in special feature programs on CBC Television… . From his first foray into public office politics in 1934 to his post-retirement years in the 1970s, Canada's 'father of Medicare' stayed true to his socialist beliefs -- often at the cost of his own political fortune -- and earned himself the respect of millions of Canadians in the process." "The Greatest Canadian," CBC, 2004. http://www.cbc.ca/greatest
SiCKO: Canadian "wait times" not nearly as long as some try to allege.

According to Statistics Canada, the official government statistical agency, "In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests. Nationally, median waiting times remained stable between 2003 and 2005 - but there were some differences at the provincial level for selected specialized services.… 70 to 80 percent of Canadians find their waiting times acceptable" "Access to health care services in Canada, Waiting times for specialized services (January to December 2005)," Statistics Canada, http://www.statcan.ca/english/freepub/82-575-XIE/82-575-
XIE2006002.htm
A recent study of emergency care in Ontario found that overall, "50% of patients triaged as CTAS I [most acute] were seen by a physician within 6 minutes and 86% were seen within 30 minutes of arriving at the [Emergency Department]. In contrast, the 50% of patients triaged as CTAS IV or V who were seen most quickly waited an hour or less, while 1 in 10 waited three hours or more. Understanding Emergency Department Wait Times: How Long Do People Spend in Emergency Departments in Ontario? Canadian Institute for Health Information, January 2007.
http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=reports_
wait_times_bulletins_e
"Gerard Anderson, a Johns Hopkins health policy professor who has spent his career examining the world's healthcare, said there are delays, but not as many as conservatives state. In Canada, the United Kingdom and France, 'three percent of hospital discharges had delays in treatment,' Anderson told The Miami Herald. 'That's a relatively small number, and they're all elective surgeries, such as hip and knee replacement.' John Dorschner, "'Sicko' film is set to spark debate; Reformers are gearing up for 'Sicko,' the first major movie to examine America's often maligned healthcare system," Miami Herald, June 29, 2007.
SiCKO: Drugs in England only cost $10.

For much of 2006, the standard charge for a prescription was £6.65. "The cost of an NHS prescription in England is to rise by 15p to £6.65 from the start of April." "Prescription charge to rise 15p," BBC News, March 13 2006.
From April 1 2007 to present, the charge is £6.85. "There are many unacceptable inequities and anomalies in the present system. Although around four out of five prescriptions are exempt (see below for list of exempt categories), the price of a prescription (£6.85 from 1 April 2007) often hits those who cannot afford such charges. There are many people with chronic conditions who are not exempt and those on low incomes find it very difficult to pay. This causes a disproportionate levy on a limited section of the population." British Medical Association, "Funding - Prescription Changes," March 2007. http://www.bma.org.uk/ap.nsf/Content/FundingPrescriptionCharges
SiCKO: After losing 42,000 civilians in eight months during a vicious bombing campaign during World War II, Britain pulled together and instituted a National Health Insurance program in 1948.

"The Blitz was September 7, 1940 through May 11 1941. "42,000 civilians are estimated to have died during the campaign, with over 50,000 injured, and around 130,000 houses destroyed." See, "Remembering the Blitz,"
http://www.museumoflondon.org.uk/archive/exhibits/blitz/intro.html; "Living With War; Air Raids," The Discovery Channel,
http://www.discoverychannel.co.uk/ww2_home/ww2_living_with
_war/index.shtml
"The NHS was set up in 1948 and is now the largest organisation in Europe. It is recognised as one of the best health services in the world by the World Health Organisation but there need to be improvements to cope with the demands of the 21st century." "About the NHS," NHA website,
http://www.nhs.uk/Aboutnhs/howthenhsworks/Pages/
HowtheNHSworks.aspx
SiCKO: In a study of older Americans and Brits, the Brits had less of almost every major disease. Even the poorest Brit can expect to live longer than the richest American.

"The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences… Level differences between countries are sufficiently large that individuals in the top of the education and income strata in the United States have comparable rates of diabetes and heart disease as those in the bottom of the income and education strata in England." (See also Table 1 - for example, prevalence of diabetes among high-income Americans is 8.2 per thousand, while it's 7.3 among low-income Brits.) Banks, Marmot et al., "Disease and Disadvantage in the United States and in England," Journal of the American Medical Association, 2006;295:2037-2045.
SiCKO: A baby born in El Salvador has a better chance of surviving than a baby born in Detroit.

According to the United Nations Statistics Division, Population and Vital Statistics Report, the rate of infant deaths per thousand in El Salvador is 10.5. "Table 3, Live births, deaths, and infant deaths, latest available year, June 15, 2007." http://unstats.un.org/unsd/demographic/products/vitstats/serATab3.pdf
According to the Michigan Department of Community Health, the rate of infant deaths for Detroit is 15.9 per thousand. "Number of Infant Deaths, Live Births and Infant Death Rates for Selected Cities of Residence, 2005 and 2001 - 2005 Average," Michigan Department of Community Health Web Site, http://www.mdch.state.mi.us/pha/osr/InDxMain/Tab4.asp.
SiCKO: Around 65 percent of young Americans can't find Britain on a map.

"About 11 percent of young citizens of the U.S. couldn't even locate the U.S. on a map. The Pacific Ocean's location was a mystery to 29 percent; Japan, to 58 percent; France, to 65 percent; and the United Kingdom, to 69 percent." "Survey Reveals Geographic Illiteracy," National Geographic Today, November 20, 2002. http://news.nationalgeographic.com/news/2002/11/1126_021120_
TVGeoRoperSurvey.html.
SiCKO: Companies that no longer offer pensions to new employees.

These can be found on a list prepared by the Center for Retirement Research at Boston College. Pension Change Fact Sheets, http://www.bc.edu/centers/crr/PFFS.shtml In addition, the Pension Rights Center has also compiled a near-comprehensive list. Companies That Have Changed Their Defined Benefit Pension Plans, http://www.pensionrights.org/pubs/facts/company_list.html
SiCKO: Like Canadians and Brits, the French live longer than we do.

The 2006 United Nations Human Development Report's human development index states the life expectancy in the United States is 77.5, the United Kingdom is 78.5, France is 79.6, and Canada is 80.2. Human Development Report 2006, United Nations Development Programme, 2006 at 283.
http://hdr.undp.org/hdr2006/pdfs/report/HDR06-complete.pdf.
SiCKO: The productivity rate per hour in France is higher than in America.

According to the Organisation for Economic Co-operation and Development, France has a higher labor productivity (GDP per hour worked) than the United States. "OECD in Figures 2005, 2005/Supplement 1 at 84.
http://213.253.134.29/oecd/pdfs/browseit/0105061E.PDF
"Britain has yet to catch up with its rivals on productivity. Gordon Brown, the chancellor, has long wished to close Britain's productivity gap with other countries. It is proving a long haul. In 2004, output per hour worked was 19% higher in France, 15% higher in America and 5% higher in Germany than it was in Britain." "Poor show; International comparisons," The Economist, January 21, 2006.
SiCKO: French policy on childcare and household assistance for new parents.

According to the French-American Foundation comprehensive review of child care, "For non-working parents or parents who work part-time, haltes garderies (drop-in centers) provide part-time, occasional, and drop-in care. Haltes garderies are also subsidized (by municipality and the National Family Allowance Fund), with parents paying a portion of the costs based on a sliding scale (parents pay an average of $1 per hour). … For working parents [there are] licensed family day care providers (assistants maternelles), licensed babysitters at home (social security costs and salaries subsidized by the National Family Allowance Fund)." Peer, Shanny., "The French Early Education System," French-American Foundation, November 13, 2003.,
www.eoionline.org/ELC/Presentations/Peer4.pdf
SiCKO: There is a company in France, SOS Medecins, which will perform doctor house calls at any time.

SOS Medecins has an English website, viewable here: http://www.sosmedecins-france.fr/en/smf_en_present.htm.
SiCKO: The government initially refused to pay for the health care of 9/11 volunteers, because they were not on the government payroll. It remains difficult for the volunteers to access the $50 million fund that has been appropriated for their care.

The Department of Defense and Emergency Supplemental Appropriations for Recovery From and Response to Terrorist Attacks on the United States Act provided a total of $175 million for workers compensation programs - $125 million to NYS Workers Compensation Review Board, and an additional $50 million to reimburse the NYS Uninsured Employers Fund, including for benefits paid to volunteers. However, there have been major delays in getting money to volunteers. See. e.g. "Statement of Robert E. Robertson, Director, Education, Workforce, and Income Security Issues," "September 11, Federal Assistance for New York Workers' Compensation Costs," United States Government Accountability Office, (GAO-04-1068T) September 8, 2004.
"With strong advocacy from New York's Congressional Delegation and labor leaders, a portion - about $52 million - of the $125 million in federal funding that had been allocated for administering workers compensation claims was re-allocated to provide some funding for medical treatment programs, but it will only meet a fraction of the need. Congress approved the legislation authorizing this funding in late December 2005." Devlin Barrett, "Congress Gives New Life to 9/11 Programs," Newsday, December 22, 2005.

A $52 million fund for volunteers was eventually established, but experts agree it's inadequate. The New York Times reported on September 6, 2006 that "Dr. John Howard, who was named the federal 9/11 health coordinator in February, has already said that the $52 million the federal government has appropriated for treatment late last year is inadequate. He said in an interview yesterday that the new study will very likely mean that the gap between funds and the need for them is going to grow." Anthony DePalma, "Illness Persisting in 9/11 Workers, Big Study Finds," New York Times, September 6, 2006.
SiCKO: American officials claim that detainees at Guantanamo Bay receive excellent health care.

"There is still acute care 24 hours a day, in which surgical procedures, everything, can be performed right there in the detainee camps, but as those wounds healed and as the detainees got further and further away from acute injuries, there has been increasing emphasis on preventative care. Indeed, the immunization rate there is higher than in the United States of America…. Things such as screening for cancer have taken place there. Colonoscopies--a procedure which, as we all know, is used commonly in this country to screen for colon cancer--are performed there on a routine basis. The health personnel-to-detainee ratio is 1 to 4--remarkably high. That is all health personnel who are there. And I guess, as I left this briefing and the opportunity to talk to the doctors and the nurses and the psychologists and the psychiatrists, I left with an impression that health care there is clearly better than they received at home and as good as many people receive in the United States of America." Sen. Bill Frist (R-TN), remarks on Guantanamo Bay, U.S. Senate, September 12, 2006.
"They go out, they do sick call on the blocks three times per week, care for them there, if they can… We have diabetes. We have high blood pressure, high cholesterol. Those detainees -- we've created a population health database so that we can track those detainees to make sure we're seeing them frequently, monitoring their labs and their overall health." Statement of Navy Commander Cary Ostergaard. "Hearing Of The House Armed Services Committee Subject: Detainee Operations At Guantanamo Bay," June 29, 2005.
"Detainees receive medical, dental, psychiatric, and optometric care at U.S. taxpayers' expense. In 2005, there were 35 teeth cleanings, 91 cavities filled, and 174 pairs of glasses issued." "Ten Facts About Guantanamo," Department of Defense, September 14, 2006. http://www.defenselink.mil/home/dodupdate/For-the-record/documents/
GuantanamoBay_Top10_ATTACHMENT2.doc.
SiCKO: Cuba is one of the most generous countries in providing doctors to the third world.

"WHO statistics show that the incidence of AIDS in Cuba is the lowest in this hemisphere, and there are now more than 800 Cuban doctors in Haiti alone working to control the AIDS epidemic. President Castro has offered an almost unlimited number to be sent to Africa, to be paid by the Cuban government with only a small stipend from the host countries." "President Carter's Cuba Trip Report By Jimmy Carter," May 21, 2002.
http://www.cartercenter.org/news/documents/doc528.html
"The close friendship between Cuban leader Fidel Castro and Venezuelan President Hugo Chavez has netted Venezuela a loan of 20,000 Cuban health workers -- including 14,000 doctors, according to the Venezuelan government -- who work in poor barrios and rural outposts for stipends seven times higher on average than their salaries at home. Castro has vowed to send Chavez as many as 10,000 additional medical workers by year's end." "As Cuba Loans Doctors Abroad, Some Patients Object at Home," Boston Globe, August 25, 2005.
"President Evo Morales on Friday heeded the wishes of six visiting U.S. senators by acknowledging the positive effects of American aid in his country - but added that Cuban doctors had had a greater impact on Bolivia than their U.S. counterparts… [I]n a Friday interview with Bolivian radio network Fides, Morales said the assistance of Cuban leader Fidel Castro - who has sent Bolivia some 1,700 doctors and paramedics this year alone, setting up free hospitals and eye clinics throughout Bolivia -- outshines the United States' own medical aid." "Morales Says Cuban Doctors top U.S. Medical Aid," Boston Globe, December 29, 2006.
SiCKO: In the U.S., health care costs run nearly $7,000 per person. But in Cuba, they spend around $251 per person.

United States health spending per capita is $6,697 per person according to Catlin, A, C. Cowan, S. Heffler, et al, "National Health Spending in 2005." Health Affairs 26:1 (2006). As with the number of uninsured, the number continues to increase and is projected to be $7,092 per capita in 2006, $7,498 per capita in 2007 and reaching $12,782 by 2016, according the Department of Health and Human Services Center for Medicare and Medicaid Expenditures, National Health Expenditures Projections 2006-2016,
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2006.pdf
The 2006 United Nations Human Development Report says Cuba spends $251 per capita on health care. (Human Development Report 2006, United Nations Development Programme, 2006. http://hdr.undp.org/hdr2006/statistics/indicators/52.html)
SiCKO: In Cuba, access to health care is universal.

"Cuban dissatisfaction with their personal lives does not mean they are negative about the revolutionary government's achievements in health care and education. A near unanimous 96 percent of respondents say that health care in Cuba is accessible to everyone. Gallup polls in other Latin American cities have found that on average only 42 percent believe health care is accessible." Gallup/ Consultoría Interdisciplinaria en Desarrollo, "Cubans Show Little Satisfaction with Opportunities and Individual Freedom Rare Independent Survey Finds Large Majorities Are Still Proud of Island's Health Care and Education," January 10, 2007.
http://www.worldpublicopinion.org/pipa/articles/brlatinamericara/
300.php?nid=&id=&pnt=300&lb=brla
SiCKO: Cuba has a lower infant mortality rate and a longer average lifespan than the United States.

The 2006 United Nations Human Development Report's human development index states the life expectancy in the United States is 77.5, and is 77.6 in Cuba. Human Development Report 2006, United Nations Development Programme, 2006 at 283. http://hdr.undp.org/hdr2006/pdfs/report/HDR06-complete.pdf.
According to the United Nations Statistics Division, Population and Vital Statistics Report, the rate of infant deaths per thousand in Cuba is 6.2 per thousand, and in the United States is 6.8. "Table 3, Live births, deaths, and infant deaths, latest available year, June 15, 2007."
http://unstats.un.org/unsd/demographic/products/vitstats/serATab3.pdf

Saturday, July 28, 2007

Meet Our Allies: Why Our Leaders' Middle East Policies are Doomed

The GOP have always had a hard-on for the Saudis, beyond just all the oil. IIRC, the Saudis take really good ($$$) care of the Republican sycophants....

‘US angry over Saudi role in Iraq’

* Report accuses Saudi Arabia of trying to undermine the Baghdad government

WASHINGTON: The US administration is deeply frustrated with Saudi Arabia over its role in Iraq, accusing the Saudis of trying to undermine the Baghdad government and failing to stem the flow of volunteers joining the insurgency there, the New York Times reported on Friday.

The Saudis view Iraq’s Shiite prime minister, Nuri al-Maliki, as an agent of Iran and appear to have stepped up efforts to weaken his government, providing funding for Sunni groups, the Times wrote, citing senior US officials who spoke on condition of anonymity.

One official told the paper that there was evidence Saudi Arabia was supplying money to Maliki’s opponents but declined to say if that funding was going to Sunni insurgents.

“That would get into disagreements over who is an insurgent and who is not,” the official said.

Officials in President George W Bush’s administration also say that of an estimated 60 to 80 foreign fighters who enter Iraq every month, nearly half come from Saudi Arabia and the Saudi leadership has not done enough to counter the influx.

Secretary of State Condoleezza Rice and Defence Secretary Robert Gates planned to raise Washington’s concerns in a visit next week to Saudi Arabia, the paper said. The Bush administration has refrained from publicly criticizing its long-time ally over Iraq and has instead blamed Iran and Syria for fomenting violence and sectarian divisions.

But the officials spoke to the Times with the clear intention of sending a signal to the Saudis after previous private appeals failed to produce results, the newspaper said.

US-Saudi relations have been increasingly strained since the US-led invasion of Iraq in 2003. In March, King Abdullah slammed the “illegitimate foreign occupation” of Iraq. afp
Link.
U.S.-Saudi Tensions To Increase In 2008
Oxford Analytica 07.27.07, 6:00 AM ET

U.S. Secretary of State Condoleezza Rice and Defense Secretary Robert Gates will visit Saudi Arabia's capital Riyadh on July 31. As the United States looks to regional actors for support on Iraq, Iran and Israeli-Palestinian issues, it will find that Riyadh is not going to play its assigned role. While President George W. Bush's administration faces long odds on these issues already, the Saudi position makes the prospect for success even less likely.

On the major regional questions, the United States and Saudi Arabia are in agreement to a greater extent than at almost any time in their relationship. They each:

--worry about increasing Iranian regional influence and the Iranian nuclear program;

--see the Israeli-Palestinian conflict as a wound that needs to be healed;

--worry about the spill-over effect of Iraqi violence; and

--vigorously oppose al-Qaida and its regional affiliates.

However, they have very different tactical approaches, which will become more salient as Washington puts forward new initiatives to move the Arab-Israeli peace process forward, salvage something from Iraq and isolate Iran.

Bush announced on July 16 a high-profile diplomatic effort to move Israel and the Fatah-led Palestinian National Authority (PNA) toward a political settlement. Saudi Arabia quickly voiced its support, but Washington and Riyadh have very different visions of how to approach the issue. The Bush administration seeks to isolate Hamas diplomatically and choke off the economy in Gaza. Meanwhile, it hopes to encourage economic growth and political progress in the Fatah-controlled West Bank, showing Palestinians that their best choice is to abandon Hamas and support PNA President Mahmoud Abbas. Riyadh is pushing for a renewal of Fatah-Hamas dialogue and a return to the Mecca Agreement on power-sharing, which the Saudis brokered earlier in the year.

In Iraq, the Bush administration needs to show tangible progress to fend off congressional pressures to begin troop withdrawals. To that end, it has opened direct (if low-level) talks with Iran and encouraged greater regional involvement to support the Iraqi government, symbolized by the May Sharm al-Sheikh summit. While Saudi Arabia attended that summit and agreed to forgive the bulk of Iraqi Saddam-era debt, it has made clear that it is not willing to take other steps to support the government of Prime Minister Nuri al-Maliki, which it sees as an extension of Iranian influence in Iraq.

Indeed, Saudi Arabia is supporting efforts by Maliki's opponents (including former prime minister Iyad Allawi, various Sunni political factions and Maliki's Shia opponents) to form a political front to challenge the government's parliamentary majority. Saudi King Abdallah also very publicly refused to receive Maliki on the latter's regional trip preceding the summit. With Riyadh facing the likelihood of a reduced U.S. role in Iraq, it is less likely to follow the U.S. lead there and more willing to forge its own alliances with Iraqi players and factions.

Both Washington and Riyadh want to limit Iranian regional influence and discourage Iranian nuclear plans. As long as the United States continues using diplomatic pressure, multilateral and United Nations sanctions and indirect military threats to push Iran away from the nuclear path, it will have Saudi support. However, if the Bush administration pursues a military option, this will change. The Saudi leadership is pursuing a subtle policy of both engaging and containing Iran. It does not want to return to the 1980s, when the two states were directly confronting each other and Tehran was actively encouraging domestic opposition to the Saudi regime. Moreover, it knows that it will be on the front line of any Iranian retaliation for a U.S. military strike.

Such tensions are a normal feature of the Saudi-U.S. relationship and do not necessarily herald a crisis in the making. However, while core relations will not be affected, they will add to the tensions likely to emerge between the countries on Middle East issues and make for an uncomfortable few months in bilateral relations in 2008.

Link. See this too. And this too, if you're registered with the Times.

US tracks Saudi bank favoured by extremists

Daily Times Monitor

LAHORE: In the 1940s, two Bedouin farm boys from the desert began changing money for the trickle of traders and religious pilgrims in this then-remote and barren kingdom. It was a business built on faith and trust, Sulaiman Al Rajhi once told an interviewer, and for many years he would hand gold bars to strangers boarding flights in Jidda and ask them to give the gold to his brother on their arrival in Riyadh, according to a report published in The Wall Street Journal on Friday.

Today, Mr Al Rajhi is a reclusive octogenarian whose fortune is estimated at $12 billion. And Al Rajhi Bank grew into the kingdom’s largest Islamic bank, with 500 branches in Saudi Arabia and more spread across the Muslim world.

Following the Sept 11, 2001, attacks, the bank also set off an intense debate within the US government over whether to take strong action against its alleged role in extremist finance. Confidential reports by the Central Intelligence Agency and other US agencies, reviewed by The Wall Street Journal, detail for the first time how much the US learned about the use of Al Rajhi Bank by alleged extremists, and how US officials agonized over what to do about it.

After 9/11, the Saudi monarchy pledged its full support in the fight against global terrorism. And following violent attacks inside the kingdom in the next two years, the Saudis did launch major strikes against militants operating on their soil. But the Saudi government has been far been less willing to tackle the financial infrastructure essential to terrorism. US intelligence reports state that Islamic banks, while mostly doing ordinary commerce, also are institutions that extremism relies upon in its global spread.

As a result, the Bush administration repeatedly debated proposals for taking strong action itself against Al Rajhi Bank, in particular, according to former US officials and previously undisclosed government documents. Ultimately, the US always chose instead to lobby Saudi officialdom quietly about its concerns.

The US intelligence reports, heretofore secret, describe how Al Rajhi Bank has maintained accounts and accepted donations for Saudi charities that the US and other nations have formally designated as fronts for Al Qaeda or other terrorist groups.

Al Rajhi Bank and the Al Rajhi family deny any role in financing extremists. They have denounced terrorist acts as un-Islamic. The bank declined to address specific allegations made in American intelligence and law-enforcement records, citing client confidentiality.

Two years earlier, federal agents raided the Virginia offices of a network of charities funded by Sulaiman Al Rajhi that worked closely with the IIRO and that - according to Justice Department court filings - provided funds to Palestinian terrorists. No charges have been filed.

A year after the 9/11 attacks, US authorities began to lament the lack of Saudi action in taking down terrorists’ financial infrastructure. A November 2002 CIA report said the Saudi government “has made little independent effort to uncover terrorist financiers, investigate individual donors, and tighten the regulation of Islamic charities,” largely because of “domestic political considerations.”

The US began to rethink that approach after an Al Qaeda attack in Riyadh in May 2003 that killed 26 people, including nine Americans. Deputies from the National Security Council, CIA, Treasury and State departments debated a proposal for legal and political action against Al Rajhi Bank, including the possibility of covert operations such as interfering with the bank’s internal operations, according to Bush administration documents and former US officials.

One idea kicked around was “listing or threatening to list” Al Rajhi Bank as a supporter of terrorism. Such a listing can be done if recommended by a committee representing the Treasury, State and Defense departments and the CIA and NSC, and signed by the president. The designation bars US companies from doing business with the named entity. A US designation also normally is forwarded to the U.N., and if that body puts the name on its own terrorist-supporter list, all member states are obliged to freeze the entity’s assets.

Other ideas US officials discussed included enlisting friendly countries to step up scrutiny and regulatory action against the Al Rajhis. The CIA report said that “a successful effort against the Al Rajhis would encourage efforts against other donors, or at a minimum, would discourage private funding of Al Qaeda”.

Ultimately, the Bush administration again chose merely to continue privately exerting pressure on the Saudis to stiffen their oversight.

Link.

Speaking of the Genius of Our Leaders....

While I agree that we had the wrong plan for three years, we now have the right one, and the right man to lead it. The proper conclusion to be drawn from the N.I.E. findings is that Congress and the American people must remain vigilant and committed to the war on terror and its central front in Iraq.

(Senator) Kit Bond
Washington, July 19, 2007
The writer is vice chairman of the Senate Select Committee on Intelligence.
Link.

So many question from a sentence or two, albeit one written by (or attributed to) a politico-hack....

How and why did we have the wrong plan for three plus years? What exactly was the wrong plan? The invasion itself was a good idea and incorporated a right plan? What harm has been done with three years of a wrong plan? And is the senator correct for that matter that there has only been one plan?

And what were the senator's enabling contributions to this "wrong plan"?

And can the senator offer us just a little humility and contrition for his contribution to the "wrong plan"?

And is "Kit" really his real name?

The Genius of Rudy

Republican presidential candidate Rudy Giuliani called Democrats "the party of losers" for demanding a scheduled pullout of U.S. troops from Iraq.

"Democrats have already declared we've lost," the former New York mayor said during a campaign stop in Texas.

***

"I'm for victory," Giuliani said. Democrats, he added, are "living in a world where they refuse to admit the existence of Islamic terrorism."
Link.

The amazing thing about the Iraq fandango is that it's such a litmus test. It is so wrong what we did in invading and the follow-up has been really breath-takingly inept. The cluelessness shown by our leaders is mind-boggling, both in invading in the first place and then in all the post-invasion aspects. Our leaders have absolutely no clue about the Middle East or Iraq.

Th question of the moment then involves the vox populi: Are all of us sick of the war because it's taking so long to resolve (actually, it'll take generations unless, um, we install a dictator that can control the place -- like our ex-BFF, Saddam) or because it's just so damn wrong?

So when someone running for office brainlessly parrots our leaders' dementia, or in Perfect Rudy's case, gives the hopped up version of the party line, well, it's scary....

Friday, July 27, 2007

Our Leader is Lying about the Threat of Al-Qaida in Iraq: Some Proof

President Bush makes fallacious connections between Al Qaeda in Iraq and the Al Qaeda who attacked the US on 9/11. "Some say that Iraq is not a part of the broader war on terror. They claim that the organization called al Qaeda in Iraq is an Iraqi phenomenon -- that it's independent of Osama bin Laden and it's not interested in attacking America. That would be news to Osama bin Laden. I presented intelligence that clearly establishes this connection. The facts are that al Qaeda terrorists killed Americans on 9/11, they're fighting us in Iraq and across the world, and they're plotting to kill Americans here at home again." [CNN, 7/24/07 ]

The nation's 16 intelligence agencies agree that Al Qaeda has regenerated its ability to strike at the United States through its bases on the Afghan-Pakistan Border. "We assess the group has protected or regenerated key elements of its Homeland attack capability, including: a safe haven in the Pakistan Federally Administered Tribal Areas (FATA), operational lieutenants, and its top leadership." [National Intelligence Estimate, 7/07 ]


Former Secretary of State Colin Powell said that Al-Qaeda "was only 10% of the problem in Iraq and Nouri al-Maliki, its prime minister, lacked the political will to establish an effective government." He went on to say that even even if the military surge has been a partial success in areas such as Anbar province, where Sunni tribes have turned on Al-Qaeda, it has not been accompanied by the vital political and economic "surge" and reconciliation process promised by the Iraqi government. [The London Sunday Times, 7/8/07 ]

Al Qaeda in Iraq is not the same as Al Qaeda in Afghanistan. Some of the extremists in Iraq have chosen to call themselves "Al Qaeda in Iraq," and they are in fact inspired by Osama Bin Laden's extremist ideology. While there is some level of cooperation and exchange of information, these groups did not exist in Iraq prior to the invasion in 2003.

President Bush argues that "Al Qaeda is public enemy number one in Iraq. Al Qaeda is public enemy number one for the Iraqi people. Al Qaeda is public -- public enemy number one for the American people." [President Bush, 7/24/07 ]

Al Qaeda in Iraq accounts for 15% of the violence in Iraq. "Anthony Cordesman, a security analyst at the Center for Strategic and International studies says, the U.S. military estimates that al-Qaeda in Iraq, a group thought to number several thousand, accounts for only about 15% of the attacks in Iraq." [Time, 7/30/07 ]

Foreign Jihadist fighters make up less than 10% of the insurgency. Most intelligence estimates still state that the vast majority of Sunni insurgents are Iraqi. They are not driven by a pan-Islamic ideology of destroying the West and creating a caliphate. Instead, they are fighting either against American forces or against other ethnic groups in Iraq. [Center for American Progress, 6/25/07 ]



The Al Qaeda Threat: Myth vs. Reality

The National Intelligence Estimate reaffirmed that the Bush Administration has made Americans less secure by taking its focus off the real danger in Afghanistan and Pakistan and instead invading Iraq. Almost six years since 9/11, Al Qaeda has established a new safe haven on the Afghanistan-Pakistan border and has taken advantage of the operational space afforded by a poorly conceived truce between the Pakistani government and tribal leaders. Meanwhile the invasion of Iraq has fed the Al Qaeda narrative and created a new focal point for the recruitment, fundraising, training and indoctrination of Al Qaeda operatives. Unfortunately, the Administration's response to all of these problems is to continue to pour more troops and funds into Iraq, even as military strategists have concluded that sectarian violence and civil war - not Al Qaeda - are the greatest dangers in the war torn country.

Al Qaeda is Growing Stronger in Pakistan and Afghanistan

The nation's 16 intelligence agencies agree that Al Qaeda has regenerated its ability to strike at the United States through its bases on the Afghan-Pakistan Border. "We assess the group has protected or regenerated key elements of its Homeland attack capability, including: a safe haven in the Pakistan Federally Administered Tribal Areas (FATA), operational lieutenants, and its top leadership." [National Intelligence Estimate, 7/07 ]

Al Qaeda took advantage of an ill-conceived truce with Pakistani tribal leaders to gain strength. The truce has now broken apart. In the fall of 2006, the Pakistani government brokered an agreement with tribal and Taliban leaders on the Afghanistan-Pakistan border. The agreement allowed Al Qaeda and the Taliban to continue to operate freely as long as they did not spill over into Afghanistan or other parts of Pakistan. The deal was criticized at the time, and has given Al Qaeda and the Taliban a 10 month rest period to gather strength and increase the frequency of their attacks in Afghanistan and Pakistan. The agreement is now officially off. [Washington Post, 7/16/07 ]

John Kringen, who heads the CIA's analysis directorate, agrees that Al Qaeda has been getting stronger. "They seem to be fairly well settled into the safe haven and the ungoverned spaces of Pakistan," Kringen testified in front of the House Armed Services Committee. "We see more training. We see more money. We see more communications. We see that activity rising." [NPR, 7/15/07 ]


In its new safe haven, Al Qaeda has had more flexibility to train terrorists and produce propaganda videos. "While the northern area of Pakistan, much of which is controlled by local tribes, has always been a stronghold of the Taliban, it's now also home to a resurgent al Qaeda. New training camps have sprung up in the mountainous terrain, and the ease with which militants operate in the region even affords them time to produce the relatively high-quality training and propaganda videos frequently released by jihadist groups. Even the generals are fed up with the situation. "Even after five years of operations, what has been achieved? Osama bin Laden is still there, al Qaeda is still there, in fact it is spreading," Lt. General Ali Jan Mohammed Aurakzai (Ret.) said in February. Aurakzai is the governor of the Northwest Frontier Province. [CBS, 7/17/07 ]


Pakistan bombings raise fears of Taliban, al Qaeda resurgence. "A series of bombings in recent days in northwestern Pakistan have killed at least 79 people and are spreading fears that the Taliban and al Qaeda have made a comeback. Militants linked to the Taliban in the area near the Afghan border say a truce reached with the Pakistani government last September is off. That deal has been blamed for an increase in attacks on U.S. troops over the border in Afghanistan, as Taliban fighters were able to prepare, train, and reconstitute weapons supplies without interference from the Pakistani government. Tensions in the region had been simmering for months, and recent events at Islamabad's Red Mosque triggered the fresh wave of violence." [CNN, 7/16/07 ]

The Invasion of Iraq has Strengthened Al Qaeda's Hand


The invasion of Iraq has created a new focal point for recruitment, fundraising, training and indoctrination of terrorists. The Nation's 16 intelligence agencies agree: "We assess that al-Qa'ida will probably seek to leverage the contacts and capabilities of al-Qa'ida in Iraq (AQI), its most visible and capable affiliate and the only one known to have expressed a desire to attack the Homeland. In addition, we assess that its association with AQI helps al-Qa'ida to energize the broader Sunni extremist community, raise resources, and to recruit and indoctrinate operatives, including for Homeland attacks." [National Intelligence Estimate, 7/07 ]


Last year, the nation's 16 intelligence agencies concurred that Iraq is fueling global terrorism. "We assess that the Iraq jihad is shaping a new generation of terrorist leaders and operatives; perceived jihadist success there would inspire more fighters to continue the struggle elsewhere. The Iraq conflict has become the 'cause celebre' for jihadists, breeding a deep resentment of U.S. involvement in the Muslim world and cultivating supporters for the global jihadist movement. Should jihadists leaving Iraq perceive themselves, and be perceived, to have failed, we judge fewer fighters will be inspired to carry on the fight." [National Intelligence Estimate, 4/06 ]

Al Qaeda had no significant foothold in Iraq before the invasion. The US presence in Iraq has provided al Qaeda new base camps, new recruits and new prestige. Pentagon resources have been diverted from Afghanistan; where the military had a real chance to hunt down al Qaeda's leadership. It alienated essential allies in the war against terrorism and drained the strength and readiness of American troops. [NY Times, 7/8/07 ]


Iraq is a failing state, which is more likely to become a terrorist safe haven. Foreign Policy magazine ranked Iraq as the second most unstable country in the world in its recently released Failed State Index. Only Sudan is considered more unstable. [Foreign Policy, July/August 2007 ]

Terrorist attacks around the rest of the Middle East have risen significantly since the U.S. invasion of Iraq. As of September 2006 there had been 37 attacks in Arab countries outside of Iraq since the invasion, while there were only 3 in the period between 9/11 and March 2003. The rate of attacks in Arab countries jumped by 445 percent since the Iraq invasion, while the rate of killings rose by 783 percent. [Mother Jones ]


Al Qaeda in Iraq would likely be one of the biggest losers if American forces were drawn down. The majority of Iraqis have already turned against Al Qaeda in Iraq. The Shi'a are the most powerful group in the country and would undoubtedly attempt to wipe out an Al Qaeda presence that has been perpetrating violence against them. Moreover, many of Al Qaeda's Sunni allies have also turned against it and without an American presence in Iraq it will be much harder for Al Qaeda to continue recruiting foreign fighters. [Center for American Progress, 6/25/07 ]


The real problem in Iraq is not Al Qaeda but multiple civil wars. Shi'a are fighting Sunnis all over the country and in Baghdad. Shi'a are fighting each other in the South. Sunnis are fighting Sunnis in Anbar and Diyala. Sunnis are fighting Kurds in the North around Kirkuk and Mosul. [CSIS, 6/20/07 ]
Link.

And even his Pentagon says he's lying
:
Supporters of the war in Iraq -- including President George W. Bush -- claim that a withdrawal of US forces would lead to an al Qaeda takeover of Iraq. Yet according to Pentagon war games, this scenario is highly unlikely.

On Wednesday's Countdown Keith Olbermann interviewed Washington Post correspondent Thomas Ricks who discussed his article on Pentagon war gaming for a post-US Iraq.

Pentagon simulations on US withdrawal find the most likely scenario would be a three-way split of the country between Kurds, Shias, and Sunnis. Ricks warns while the breakup would be "very ugly," with possibly "tens of thousands of people dying," an al Qaeda takeover of Iraq would not be possible by "any stretch of the imagination."

In addition, the war games also found Iran would not benefit from US withdrawal, and in fact would be sucked in to the same kind of destabilizing sectarian conflict the US finds itself embroiled in.

Olbermann asked Ricks whether it is fair to draw the conclusion that the best way to stop Iran from interfering in Iraq is to leave, to which Ricks responded, that while there are no "good answers" left in Iraq, leaving would make it significantly easier to deal with Iran.

Ricks noted that while these lessons appear to be taken to heart by members of the military, it is ultimately up to them to convince the White House come September, when this war will become "General Petraeus' war" just as much as it is Bush's.

Our Beloved Leader's Grandfather: A Fascist who Hated America Enough to Try to Overthrow the Government

Blood and breeding don't really change....

The BBC has a report
. Read about it here.

And an excerpt is here.

Fake Medical Malpractice Crisis in New York

For some reason -- well, a giveback to supporters -- our (New York's) tarnished governor feels there's enough of a crisis to warrant a 14% increase in premiums.

But the facts don't support it
.

And here's the background for those of us who are reality-based:

A basic primer is here
. A national overview is here. (However, as a N.Y. tort litigator, I only care about my state :)

How much of a crisis is there? None, really. See this. And this. And this. And this:
The oft-repeated political argument for restricting patients’ legal rights is that undeserving patients are overburdening the system with too many “frivolous” medical malpractice lawsuits.1 However, on May 11, 2006, the New England Journal of Medicine published a definitive study that debunks this myth once and for all.2
As summed up in Harvard’s release accompanying the article, “the new study by researchers from the Harvard School of Public Health and Brigham and Women’s Hospital challenges the view that frivolous litigation is rampant and expensive.”

Among the study's findings:

“Portraits of a malpractice system that is stricken with frivolous litigation are overblown.”

Most injuries that result in claims are caused by medical error. Sixty-three percent of the injuries were judged to be the result of error and most of those claims received compensation; on the other hand, most individuals whose claims did not involve errors or injuries received nothing.
Claims typically involve injuries that are severe. Eighty percent of claims involved injuries that caused significant or major disability or death.
Even though the large majority of claims (63 percent) involve error, those that do not involve error are not “frivolous.” As noted by the authors, “The profile of non-error claims we observed does not square with the notion of opportunistic trial lawyers pursuing questionable lawsuits in circumstances in which their chances of winning are reasonable and prospective returns in the event of a win are high. Rather, our findings underscore how difficult it may be for plaintiffs and their attorneys to discern what has happened before the initiation of a claim and the acquisition of knowledge that comes from the investigations, consultation with experts, and sharing of information that litigation triggers.”
The vast majority of resources go toward resolving and paying claims that involve errors. “Disputing and paying for errors account for the lion’s share of malpractice costs.”

Most instances of medical malpractice do not result in a lawsuit. “Previous research has established that the great majority of patients who sustain a medical injury as a result of negligence do not sue. … [F]ailure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims.”

Few claims result in court trial and with regard to those that do, juries are conservative.

Only fifteen percent of the claims were decided by trial verdict.

Patients “rarely won damages at trial, prevailing in only 21 percent of verdicts as compared with 61 percent of claims resolved out of court.”
And then there's this:
Litigation Against Hospitals Improves Patient Safety


On May 11, 2006, the New England Journal of Medicine published a breakthrough article arguing that litigation against hospitals improves the quality of care for patients.1 The article also confirmed that removing the threat of litigation would do nothing to improve the reporting of errors since fear of litigation is not main reason doctors do not report errors. Highlights of this article include:
“In the absence of a comprehensive social insurance system, the patient’s right to safety can be enforced only by a legal claim against the hospital. … [M]ore liability suits against hospitals may be necessary to motivate hospital boards to take patient safety more seriously.”
“The major safety-related reasons for which hospitals have been successfully sued are inadequate nursing staff and inadequate facilities.” For example, the Illinois Supreme Court found that a hospital was at fault for failing to provide enough qualified nurses “to monitor a patient, whose leg had to be amputated because his cast had been put on too tight.”
In a 1991 Pennsylvania Supreme Court case, the court listed four areas from which hospital safety obligations should flow: “the maintenance of safe and adequate facilities and equipment, the selection and retention of competent physicians, the oversight of medical practice within the hospital, and the adoption and enforcement of adequate rules and policies to ensure the quality of care for patients.”
Anesthesiologists were motivated by litigation to improve patient safety. As a result, this profession implemented 25-years-ago, “a program to make anesthesia safer for patients” and as a result, “the risk of death from anesthesia dropped from 1 in 5000 to about 1 in 250,000.”
Only one quarter of doctors disclosed errors to their patients, but “the result was not that much different in New Zealand, a country that has had no-fault malpractice insurance” [i.e., no litigation against doctors] for decades. In other words, “There are many reasons why physicians do not report errors, including a general reluctance to communicate with patients and a fear of disciplinary action or a loss of position or privileges.”
“[B]y working with patients (and their lawyers) to establish a patient’s right to safety, and by proposing and supporting patient-safety initiatives, physicians can help pressure hospitals to change their operating systems to provide a safer environment for the benefit of all patients.”
Link.

And here's the famous Harvard study (well, the short version) -- never really disputed.

Resources for doing what Eliot Spitzer cannot or doesn't care to can be found here.

And if you don't want to click on a link, here:
THE TRUTH ABOUT MEDICAL MALPRACTICE LITIGATION

MEDICAL MALPRACTICE CASES REPRESENT A TINY PERCENTAGE OF TORT CASES FILED EACH YEAR. In 2004, medical malpractice cases accounted for an average of only four percent of tort cases in 13 states reporting.1

CONTRARY TO POPULAR MYTH, FEW INJURED PATIENTS FILE LAWSUITS.
Between 44,000 and 98,000 Americans die each year (and 300,000 are injured) due to medical errors in hospitals alone. Yet eight times as many patients are injured as ever file a claim; 16 times as many suffer injuries as receive any compensation.2
At the highest level, the estimated number of medical injuries (in hospitals and otherwise) is more than one million per year; approximately 85,000 malpractice suits are filed annually. “With about ten times as many injuries as malpractice claims, the only conclusion possible is that injured patients rarely file lawsuits.”3
FAR FROM BEING “BROKEN,” THE CURRENT MEDICAL MALPRACTICE SYSTEM WORKS WELL. The Harvard School of Public Health recently found that the current system works: legitimate claims are being paid, non-legitimate claims are generally not being paid, and “portraits of a malpractice system that is stricken with frivolous litigation are overblown.”4 The authors found:
Sixty-three percent of the injuries were judged to be the result of error and most of those claims received compensation; on the other hand, most individuals whose claims did not involve errors or injuries received nothing.
Eighty percent of claims involved injuries that caused significant or major disability or death.
“The profile of non-error claims we observed does not square with the notion of opportunistic trial lawyers pursuing questionable lawsuits in circumstances in which their chances of winning are reasonable and prospective returns in the event of a win are high. Rather, our findings underscore how difficult it may be for plaintiffs and their attorneys to discern what has happened before the initiation of a claim and the acquisition of knowledge that comes from the investigations, consultation with experts, and sharing of information that litigation triggers.”
“Disputing and paying for errors account for the lion’s share of malpractice costs.”
“Previous research has established that the great majority of patients who sustain a medical injury as a result of negligence do not sue. … [F]ailure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims.”
THE VAST MAJORITY OF TRUE MEDICAL MALPRACTICE CASES SETTLE; “FRIVOLOUS” CASES DO NOT SETTLE.
In the Harvard closed claims study, only fifteen percent of claims were decided by trial verdict.5 Other research shows that 90 percent of cases are settled without jury trial, with some estimates indicating that the figure is as high as 97 percent.6
• According to a Bureau of Justice report that examined medical malpractice insurance claims in seven states, between 2000 and 2004, about 95 percent of medical malpractice insurance claims settled prior to trial. 7
As Duke Law professor Neil Vidmar, who has extensively studied medical malpractice litigation, recently testified in the U.S. Senate, “Research on why insurers actually settle cases indicates that the driving force in most instances is whether the insurance company and their lawyers conclude, on the basis of their own internal review, that the medical provider was negligent.….An earlier study by Rosenblatt and Hurst examined 54 obstetric malpractice claims for negligence. For cases in which settlement payments were made there was general consensus among insurance company staff, medical experts and defense attorneys that some lapse in the standard of care had occurred. No payments were made in the cases in which these various reviewers decided there was no lapse in the standard of care.”8
Vidmar testified, “In interviews with liability insurers that I undertook in North Carolina and other states, the most consistent theme from them was: ‘We do not settle frivolous cases!’ The insurers indicated that there are minor exceptions, but their policy on frivolous cases was based on the belief that if they ever begin to settle cases just to make them go away, their credibility will be destroyed and this will encourage more litigation.”9
Vidmar further testified, “Without question the threat of a jury trial is what forces parties to settle cases. The presence of the jury as an ultimate arbiter provides the incentive to settle but the effects are more subtle than just negotiating around a figure. The threat causes defense lawyers and the liability insurers to focus on the acts that led to the claims of negligence.10
THE NUMBER OF MEDICAL MALPRACTICE PAYMENTS IS DECLINING.
According to Public Citizen’s analysis of National Practitioner Data Bank (NPDB) data, between 1991 and 2005, the total number of malpractice payments made on behalf of doctors declined 15.4 percent (with judgments and settlements).11
Public Citizen’s analysis also found that between 1991 and 2005, the number of malpractice payments per 100,000 Americans dropped more than ten percent.12
MEDICAL MALPRACTICE PAYOUTS ARE FAR SMALLER THAN COMMONLY BELIEVED AND COMPENSATE FOR SERIOUS INJURIES.
Verdicts and Payouts.
In 2001, the latest year studied by the U.S. Department of Justice, median awards in medical malpractice cases (jury and bench trials) was $422,000.13 In jury trials, the median was $431,000.14
According to Public Citizen’s analysis of National Practitioner Data Bank (NPDB) data, “the annual average payment for a medical malpractice verdict has not exceeded $1 million in real dollars since the beginning of the NPDB. The average payment for a medical malpractice verdict in 1991 was $284,896. In 2005, the average was $461,524. Adjusting for inflation, however, shows that the average is actually declining. The 2005 average adjusted for inflation is only $260,890 — a decline of 8 percent since 1991.”15
Public Citizen also found that the total number of malpractice payments made on behalf of doctors, including judgments and settlements, declined 15.4 percent from 2001-2005 (from 16,588 in 2001 to 14,033 in 2005) and “the number of payments per 100,000 people in the U.S. also fell since 2001 – from 5.82 to 4.73 – a decline of 18.6 percent. Since 1991, the number of payments per 100,000 people declined more than 10 percent.”16
According to a Bureau of Justice report that examined medical malpractice insurance claims in seven states between 2000 and 2004, most medical malpractice claims were closed without any compensation provided to those claiming a medical injury.17
Vidmar testified “research evidence indicates that outlier verdicts seldom withstand post verdict proceedings.… Post-trial reductions have been documented in a number of studies. I and two colleagues found that some of the largest malpractice awards in New York ultimately resulted in settlements between five and ten percent of the original jury verdict. A study that I conducted on medical malpractice awards in Pennsylvania and a study of Texas verdicts found similar reductions. … My recent research on medical malpractice verdicts in Illinois found that, on average, final payments to plaintiffs were substantially lower than the jury verdicts. This does not mean that the original verdict was too high. Rather, needing money immediately and wanting to avoid a possibly lengthy appeal process the plaintiffs settled for the health providers’ insurance policy limit. Generally speaking, the larger the award, the greater the reduction in the settlement following trial.18
Total Payouts. Total medical malpractice payouts, for injuries and deaths caused by medical negligence in the nation, have recently hovered between $5 billion and $6 billion annually.19 This is less than half of what Americans pay for dog and cat food each year.20
Severity of injuries.
Public Citizen’s analysis of NPDB statistics shows that patients do not win large jury awards for insignificant claims and that payments usually correspond with injury severity. In 2005, more than 64 percent of payments involved death or significant injury, less than one-third were for insignificant injury, and less than three percent were for million-dollar verdicts.21
According to Duke University Law Professor Neil Vidmar, “the magnitude of jury awards in medical malpractice tort cases positively correlated with the severity of the plaintiffs’ injuries, except that injuries resulting in death tended to result in awards substantially lower than injuries resulting in severe permanent injury, such as quadriplegia. I and two colleagues conducted a study of malpractice verdicts in New York, Florida, and California. We also found that jury awards of prevailing plaintiffs in malpractice cases were correlated with the severity of the injury.”22
Punitive damages.
In medical malpractice cases in 2001, the most recent year studied by the U.S. Department of Justice, punitive damages were awarded in only 4.9 percent of cases with plaintiff winners.23
In medical malpractice cases between 1963 and 1993 studied by professors Koenig and Rustad, punitive verdicts were largely proportional to compensatory awards, with the median ratio of punitive damages to compensatory damages awarded at trial 1.21 to 1.24 They also found that punitive damages were only levied in instances of outrageous behavior.25 In addition, judges changed 42 percent of punitive verdicts after trial. Nearly ten percent (26 out of 270) of cases involving punitive damages were reversed by appellate courts.26 Moreover, the “vast majority of punitive dollars were uncollectible due to post-trial reversals, settlements, and defendant insolvency.”27
CONTRARY TO POPULAR NOTIONS, IT IS DIFFICULT FOR PATIENTS TO WIN MEDICAL MALPRACTICE CASES BEFORE JURIES.
In 2001, the latest year studied by the U.S. Department of Justice, patients won before judges 50 percent of the time, while only winning 26.3 percent of cases before juries, dropping from 30.5 percent in 1992.28
According to the Harvard School of Public Health, patients “rarely won damages at trial, prevailing in only 21 percent of verdicts as compared with 61 percent of claims resolved out of court.”29
Duke University Law professor Neil Vidmar testified before Congress, “Interviews with North Carolina jurors who decided medical malpractice cases showed that jurors viewed the plaintiffs’ claims with great skepticism. Jurors expressed their attitudes in two main themes: first, too many people want to get something for nothing, and second, most doctors try to do a good job and should not be blamed for a simple human misjudgment. This does not mean that in every case jurors held these views. Sometimes, evidence of the doctor’s behavior caused jurors to be angry about the negligence. However, even in these latter cases the interviews indicated that the jurors had approached the case with open minds. ”30
JURIES ARE COMPETENT AND ABLE TO HANDLE MEDICAL MALPRACTICE CASES. Consistent empirical studies show juries to be competent, effective, and fair decision makers able to handle complex cases.31

LITIGATION IMPROVES PATIENT SAFETY. The New England Journal of Medicine confirmed in a breakthrough article by George J. Annas, J.D., M.P.H., that litigation against hospitals improves the quality of care for patients.32 The author wrote, “In the absence of a comprehensive social insurance system, the patient’s right to safety can be enforced only by a legal claim against the hospital. … [M]ore liability suits against hospitals may be necessary to motivate hospital boards to take patient safety more seriously.… Anesthesiologists were motivated by litigation to improve patient safety. As a result, this profession implemented 25-years-ago a program to make anesthesia safer for patients and as a result, the risk of death from anesthesia dropped from 1 in 5000 to about 1 in 250,000.”

A SMALL PERCENTAGE OF DOCTORS ARE RESPONSIBLE FOR MOST MALPRACTICE PAYMENTS.
From 1991 to 2005, only 5.9 percent of doctors were responsible for 57.8 percent of malpractice payments. Each of those doctors made at least two payments.33
Since the creation of the National Practitioner Data Bank in 1990, the large majority of doctors – 82 percent – never made a malpractice payment.34
FEAR OF LITIGATION IS NOT THE MAIN REASON DOCTORS DO NOT REPORT ERRORS.
According to a recent study by Dr. Thomas Gallagher, a University of Washington internal-medicine physician and co-author of two studies published in the Archives of Internal Medicine, “Comparisons of how Canadian and U.S. doctors disclose mistakes point to a ‘culture of medicine,’ not lawyers, for their behavior.” 35 In Canada, there are no juries, non-economic awards are severely capped and “if patients lose their lawsuits, they have to pay the doctors' legal bills… yet “doctors are just as reluctant to fess up to mistakes.” Moreover, “doctors' thoughts on how likely they were to be sued didn't affect their decisions to disclose errors.” The authors believe “the main culprit is a ‘culture of medicine,’ which starts in medical school and instills a ‘culture of perfectionism’ that doesn't train doctors to talk about mistakes.”36
Research by George J. Annas, J.D., M.P.H. “found that only one quarter of doctors disclosed errors to their patients, but “the result was not that much different in New Zealand, a country that has had no-fault malpractice insurance” [i.e., no litigation against doctors] for decades. In other words, “There are many reasons why physicians do not report errors, including a general reluctance to communicate with patients and a fear of disciplinary action or a loss of position or privileges.”37
MEDICAL MALPRACTICE CLAIMS AND PREMIUMS ARE A TINY PERCENTAGE OF THE TOTAL COSTS OF HEALTH CARE IN THIS COUNTRY.
Medical malpractice payouts are less than one percent of total U.S. health care costs. All “losses” (verdicts, settlements, legal fees, etc.) have stayed under one percent for the last 18 years. Moreover, medical malpractice premiums are less than one percent of total U.S. health care costs as well. Dropping for nearly two decades, malpractice premiums have stayed below one percent of health care costs.38
The Congressional Budget Office found that “Malpractice costs account for less than 2 percent of [health care] spending,” and that all the provisions of the federal medical malpractice bill, including a $250,000 cap on non-economic damages, “would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small.”39
January 2007

NOTES
1 Examining the Work of State Courts, 2005, A National Perspective from the Court Statistics Project (2006) at 29.
2 National Academy of Sciences Institute of Medicine, “To Err is Human” (1999); Harvard Medical Practice Study (1990). In 2004, HealthGrades, Inc., which rates hospitals for insurers and health plans, concluded, from a study of Medicare records for all fifty states from 2000-2002, that the Institute of Medicine’s high figure of 98,000 was too low and that a figure of 195,000 annual deaths was more accurate. (Testimony of Neil Vidmar of Duke Law School before The Senate Committee on Health, Education, Labor and Pensions, Hearing on “Medical Liability: New Ideas for Making the System Work Better for Patients,” June 22, 2006 at 5.)
3 David A. Hyman and Charles Silver, “Medical Malpractice Litigation and Tort Reform: It's the Incentives, Stupid,”59 Vand. L. Rev. 1085, 1089 (May 2006) (citing Brian Ostrom, Neal Kauder & Neil LaFontain, Examining the Work of State Courts (2003) at 23).
4 David M. Studdert, Michelle Mello, et al., “Claims, Errors, and Compensation Payments in Medical Malpractice Litigation,” New England Journal of Medicine, May 11, 2006.
5 David M. Studdert, Michelle Mello, et al., “Claims, Errors, and Compensation Payments in Medical Malpractice Litigation,” New England Journal of Medicine, May 11, 2006.
6 Testimony of Neil Vidmar, Russell M. Robinson, II Professor of Law, Duke Law School before The Senate Committee on Health, Education, Labor and Pensions, “Hearing on Medical Liability: New Ideas for Making the System Work Better for Patients,” June 22, 2006 at 17. (citations omitted).
7 Bureau of Justice Statistics, U.S. Department of Justice, “Medical Malpractice Insurance Claims in Seven States, 2000-2004,” NCJ 216339 (Mar. 2007) at 7.
8 Ibid. at 17-18, 22.
9 Ibid. at 23.
10 Ibid. at 21.
11 Public Citizen, Congress Watch, The Great Medical Malpractice Hoax: NPDB Data Continue to Show Medical Liability System Produces Rational Outcomes, (January 2007) at 2. (This report analyzes data in the National Practitioner Data Bank Public Use File, dated 31 December 2005.)
12 Ibid. at 4.
13 “Tort Trials and Verdicts in Large Counties, 2001,” U.S. Department of Justice, Bureau of Justice Statistics, 206240 (November 2004), at 4.
14 “Tort Trials and Verdicts in Large Counties, 2001,” U.S. Department of Justice, Bureau of Justice Statistics, 206240 (November 2004), at 7.
15 Public Citizen, Congress Watch, The Great Medical Malpractice Hoax: NPDB Data Continue to Show Medical Liability System Produces Rational Outcomes, (January 2007) at 5, 9. (This report analyzes data in the National Practitioner Data Bank Public Use File, dated 31 December 2005.)
16 Ibid. at 2-5.
17 Bureau of Justice Statistics, U.S. Department of Justice, “Medical Malpractice Insurance Claims in Seven States, 2000-2004,” NCJ 216339 (Mar. 2007) at 1.
18 Testimony of Neil Vidmar, Russell M. Robinson, II Professor of Law, Duke Law School before The Senate Committee on Health, Education, Labor and Pensions, “Hearing on Medical Liability: New Ideas for Making the System Work Better for Patients,” June 22, 2006 at 13.
19 See, Americans for Insurance Reform, Stable Losses/Unstable Rates, 2004, http://www.insurance-reform.org/StableLosses04.pdf.
20 The Pet Food Institute puts these figures at $13 to $14 billion annually over the past few years. See, http://www.petfoodinstitute.org/reference_pet_data.cfm
21 Public Citizen, Congress Watch, The Great Medical Malpractice Hoax: NPDB Data Continue to Show Medical Liability System Produces Rational Outcomes, (January 2007) at 2.
22 Testimony of Neil Vidmar, Russell M. Robinson, II Professor of Law, Duke Law School before The Senate Committee on Health, Education, Labor and Pensions, “Hearing on Medical Liability: New Ideas for Making the System Work Better for Patients,” June 22, 2006 at 10.
23 Bureau of Justice Statistics, U. S. Department of Justice, “Selected Findings, Civil Justice Survey of State Courts, 2001, Punitive Damage Awards in Large Counties, 2001,” NCJ 208445 (March 2005) at 3.
24 Thomas Koenig & Michael Rustad, “Reconceptualizing Punitive Damages in Medical Malpractice: Targeting Amoral Corporations, Not ‘Moral Monsters,’” 47 Rutgers L. Rev. 975, 1009 (1995).
25 Ibid. at 15, 50-51.
26 Ibid. at15, 24, 43.
27 Ibid. at 15, 43.
28 Bureau of Justice Statistics, U.S. Department of Justice, “Tort Trials and Verdicts in Large Counties, 2001,” NCJ 206240 (Nov. 2004) at 4, 7.
29 David M. Studdert, Michelle Mello, et al., “Claims, Errors, and Compensation Payments in Medical Malpractice Litigation,” New England Journal of Medicine, May 11, 2006.
30 Testimony of Neil Vidmar, Russell M. Robinson, II Professor of Law, Duke Law School before The Senate Committee on Health, Education, Labor and Pensions, “Hearing on Medical Liability: New Ideas for Making the System Work Better for Patients,” June 22, 2006 at 8.
31 For an extensive list of studies demonstrating the competence of juries, see, e.g., Testimony of Neil Vidmar, Russell M. Robinson, II Professor of Law, Duke Law School before The Senate Committee on Health, Education, Labor and Pensions, “Hearing on Medical Liability: New Ideas for Making the System Work Better for Patients,” June 22, 2006 at 10 (“The overwhelming number of the judges gave the civil jury high marks for competence, diligence, and seriousness, even in complex cases …Systematic studies of jury responses to experts lead to the conclusion that jurors do not automatically defer to experts and that jurors have a basic understanding of the evidence in malpractice and other cases. Jurors understand that the adversary system produces experts espousing opinions consistent with the side that called them to testify. Moreover, jurors carefully scrutinize and compare the testimony of opposing experts. They make their decisions through collective discussions about the evidence.… We also found that jury awards of prevailing plaintiffs in malpractice cases were correlated with the severity of the injury.”)(citations omitted); Peters Jr., Philip G., “Doctors & Juries,” U of Missouri-Columbia School of Law Legal Studies Research Paper No. 2006-33 Available at SSRN: http://ssrn.com/abstract=929474 (“Four important findings emerge from the data. First, negligence matters. Plaintiffs rarely win weak cases. They have more success in toss-up cases, and fare best in cases with strong evidence of medical negligence. Second, jury verdicts are most likely to square with the opinions of experts hired to evaluate the jury's performance when the evidence of provider negligence is weak. This is the very set of cases that most worries critics of malpractice litigation. Juries agree with expert reviewers in 80 to 90 percent of these cases - a better agreement rate than physicians typically have with each other. Third, jury verdicts are much more likely to deviate from the opinion of an expert reviewer when there is strong evidence of negligence. Doctors consistently win about 50 percent of the cases which experts believe the plaintiffs should win. Fourth, the poor success of malpractice plaintiffs in these cases strongly suggests the presence of factors that systematically favor medical defendants in the courtroom. The most promising explanations for that advantage are the defendant's superior resources, the social standing of physicians, social norms against ‘profiting’ from an injury, and the jury's willingness to give physicians the "benefit of the doubt" when the evidence of negligence is conflicting.”) See also, Marc Galanter, “Real World Torts: An Antidote to Anecdote,” 55 Md. L. Rev.1093, 1109, note 45 (1996), citing Michael J. Saks, Small-Group Decision Making and Complex Information Tasks (1981); Robert MacCoun, “Inside the Black Box: What Empirical Research Tells Us About Decisionmaking by Civil Juries,” in Verdict: Assessing the Civil Jury System 137 (Brookings Institution, Robert E. Litan ed., 1993); Christy A. Visher, “Juror Decision Making: The Importance of Evidence,” 11 Law & Hum. Behav. 1 (1987); Richard O. Lempert, “Civil Juries and Complex Cases: Let’s Not Rush to Judgment,” 80 Mich. L. Rev. 68 (1981).
32 George J. Annas, J.D., M.P.H., “The Patient’s Right to Safety – Improving the Quality of Care through Litigation against Hospitals,” New England Journal of Medicine, May 11, 2006.
33 Public Citizen, The Great Medical Malpractice Hoax, at 12.
34 Ibid.
35 Carol M. Ostrom, “Lawsuit fears aren't reason for docs' silence, studies say,” Seattle Times, August 17, 2006 , citing from Thomas Gallagher, M.D., et al, “Choosing your Words Carefully: How Physicians Would Disclose Harmful Medical Errors to Patients,” Archives of Internal Medicine, Aug. 14, 2006.
36 Ibid.
37 George J. Annas, J.D., M.P.H., “The Patient’s Right to Safety – Improving the Quality of Care through Litigation against Hospitals,” New England Journal of Medicine, May 11, 2006.
38 See, Americans for Insurance Reform, “Think Malpractice is Driving Up Health Care Costs? Think Again,” http://www.insurance-reform.org/pr/AIRhealthcosts.pdf
39 Congressional Budget Office, Limiting Tort Liability for Medical Malpractice 1, 6 (Jan. 8, 2004).
Link.

Thursday, July 26, 2007

Iraq for Dummies

Well, I mean, an accurate precis as opposed to the version offered by the dummy who is Our Beloved Leader.
Misperceptions of the 'War' in Iraq
An NBC News correspondent—with longtime experience in Iraq—describes many other visions of the war now being fought.

By Richard Engel

The war in Iraq is not what it seems. In fact, there is no "war" in Iraq—there are many wars, some centuries old, playing out on this ancient land. But this is not what Americans are often led to believe. The perception portrayed by the White House and Iraqi government in Baghdad—and commonly reflected in the news media—is that the violence in Iraq is a fundamental struggle between two opposing teams: Freedom Lovers and Freedom Haters.

In this Manichaean and simplistic view of the fighting here, the tale of the tape is:
The Freedom Lovers: The 12 million Iraqis who plunged their fingers into purple ink on Election Day in December 2005, choosing freedom, democracy and to shut forever the door on Saddam Hussein's dictatorship. Their team captains are the Iraqi government, the White House, the U.S.-trained Iraq security services, and the roughly 150,000 American troops in Iraq.

The Freedom Haters: Iraqi radicals, foreign jihadists, former Ba'ath Party members, and criminals supported by al-Qaeda, Syria and Iran, who have formed an alliance of convenience to reject the democratization of Iraq, each for its own motivation. The team's captains are al-Qaeda in Iraq and other Sunni militant groups, Iranian and Syrian agents and, but not always, radical Shi'ite cleric Moktada al-Sadr's Mahdi Army.
While there are certainly elements of truth to this narrative, the reality in this fractured country is much more complex.

The Other Wars

During a break in a diplomatic meeting in Baghdad in March, I was sitting in a smoke-filled waiting room of the foreign ministry watching Iraqiya, the state-sponsored television station. It was the final day of the Shi'ite festival of Ashura, and several hundred thousand, perhaps as many as two million, Shi'ite pilgrims were gathered in the holy city of Karbala, south of Baghdad. The television images showed the Shi'ite devotees flagellating their backs with zangeel (bundles of chains) and cutting their heads with swords to mourn the seventh century martyr Hussein and punish themselves for not having done more to save his life during a battle in Karbala in one of Islam's early civil wars.

The pictures showed a man dressed as Hussein in ancient Islamic battle dress, with a sword, flowing headdress, and a colorful cape, reenacting the battle by single-handedly fighting off a crowd of attackers until he was overwhelmed and heroically slain. Hussein's martyrdom, many Shi'ites claim at the hands of early Sunnis, is one of the central themes of Shi'ite Islam in Iraq and establishes a basic premise that Hussein, the Prophet Muhammad's grandson, and his Shi'ite descendants are the true heirs to Islam but were defeated by Sunni "usurpers."

But the footage on Iraqi state TV during Ashura didn't stop there. Interwoven with the images of Hussein's struggle and the mourning rituals was current news footage of the aftermath of car bombings in Baghdad, the

Shi'ite al-Askari mosque in Samara destroyed by al-Qaeda militants in February 2006, and wounded Iraqi women and children. The message was clear: the attacks on markets, Shi'ite mosques, restaurants and university campuses, mostly carried out by Sunni radicals, are a continuation of Hussein's battle centuries ago.

As pilgrims marched by our Baghdad bureau on their way to Karbala, I could hear them chant: "Kul yom Ashura! Kul ard Karbala!" or "Every day is Ashura! All land is Karbala!" Simply put, they were saying, everyday and everywhere in Iraq, Shi'ites are reliving Hussein's battles in Karbala. There was no talk of democracy or the Ba'ath Party, Saddam Hussein or the U.S. troop "surge," or other subjects that dominate the Iraq debate in the United States. Instead, it is apparent that many of Iraq's Shi'ites believe they are fighting a different war from the one many in the United States see their troops engaged in here, and for different reasons.

Many Sunni groups in Iraq are also fighting a war that seems to have little in common with the official U.S. and Iraqi characterization of the conflict. Al-Qaeda in Iraq and its allies recently formed an umbrella group they call Dowlit al-Islam, or the Islamic State in Iraq. After the group claimed responsibility for bombing the Iraqi parliament building in Baghdad's Green Zone in April, the group issued an Internet statement explaining its motivation. The group said the suicide bomber who attacked parliament's cafeteria and killed one lawmaker was motivated to kill "the traitors and collaborators" who had sold out to a "Zionist-Persian" conspiracy to control Iraq. From what they wrote, they seem to believe they are fighting Israel, Iran and their agents, not the U.S. mission to bring democracy to Iraq.

These visions of war are just two of the competing power struggles that U.S. troops in Iraq are trying to quell; the reality is there are many wars within the war. Others include:
Moktada al-Sadr: The radical Shi'ite leader and commander of the Mahdi Army who wants to equal or surpass the influence of his father, one of Iraq's most revered Shi'ite leaders. Based primarily on his family's reputation, Sadr has tapped into the frustrations of Iraq's poor, uneducated and unemployed Shi'ite community, increasingly fed up with the continued presence of U.S. troops.

The Kurds: Iraqi Kurds want independence and control of the oil rich city of Kirkuk. Thankful that U.S. troops rid them of Saddam's oppression, they now want to capitalize on their new freedom by establishing what they have been denied for centuries, an autonomous, prosperous oil-rich state. For Kurds, the fighting in Iraq is not about democracy, but self-determination.

Abdul Aziz al-Hakim: He is the leader of the Supreme Council for Islamic Revolution in Iraq [now the Supreme Islamic Iraqi Council] who wants to control southern Iraq and carve out a ministate allied with Iran. His party would rule this emirate, containing both the rich oil fields in Basra and access to the Persian Gulf. Al-Hakim's Iranian-backed militia, the Badr Brigade, renamed the Badr Organization in an attempt to make it seem more mainstream, has gained control of many of the local councils and police stations across southern Iraq.

Ayad Allawi: The former prime minister and ex-Ba'ath Party member and western intelligence "asset," he wants to return to power, overthrow Prime Minister Nuri al-Maliki, unite Sunnis and Shi'ites under his secular rule, and bring back divisions of the Iraqi army dissolved by then U.S. administrator Paul Bremer.

Nuri al-Maliki: Prime Minister Maliki's goals are unclear. At times he sounds as though he is reading talking points from the White House, but he has been reluctant to stop Shi'ite militia groups and has overseen a Shi'ite-led government often accused of pursuing a sectarian agenda.
U.S. politicians and military commanders often complain that the Iraqi government "won't step up and do its job." The impression they give is that Iraqi officials are sitting around smoking hooka pipes and refusing to pull themselves up by their bootstraps, while U.S. troops are fighting and dying to "get the job done." Perhaps the question should be, "Which job?" American soldiers often ask me when the Iraqis will "step up and fight for their own country." They are already fighting for their country. Iraqi officials, religious leaders, militia groups, Syria, Iran and al-Qaeda are struggling and dying to get a "job done" in Iraq, though it does not appear to be the job the White House would like them to be doing.

U.S. Defense Secretary Robert Gates warned during his April visit to Iraq that America's "patience is running out." If he's waiting for Iraqis and the wider Middle East to start fighting the war of Freedom Lovers against Freedom Haters, Americans might need to have considerably more patience in the years ahead.
Link.

Wednesday, July 25, 2007

Our Leaders Lead Us Another Giant Step Backwards

In a July 23 letter, UCS and OMB Watch urged Committee on Homeland Security and Governmental Affairs Chair Joseph Lieberman (I-Conn.) to question the nominee on his opinion of Bush administration Executive Order 13422, which goes into effect today. The executive order bans any regulation from moving forward without the approval of an agency's regulatory policy officer, who would be a political appointee. UCS urged the Senate committee to ask Mr. Nussle how he would ensure that political appointees would not interfere with the work of agency scientists.

"We have a corps of highly trained scientists in federal agencies. Why would we want to undermine their expertise and authority?" said Francesca Grifo, director of UCS's Scientific Integrity Program. "This executive order greatly expands the power of the White House to weaken the ability of federal agencies to protect public health and safety. We have the right to know where Mr. Nussle stands."
Link.

And then there's the genius of Mitt. (Yes, I know he was successful in business because of connections, not intelligence or anything....) My God, hat a bunch of mental cases -- Election 2008 is becoming really scary....