Tuesday, August 26, 2008

Veterans' Battle Within

The battle within

Soldiers who struggle with pained bodies or troubled minds still get deployed, sometimes on crutches or antidepressants, by an Army pressed to fill the ranks in Iraq and Afghanistan.

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CHUCK CLAMON | With a mix of medication prescribed after suffering head and spine injuries in Iraq, the sergeant first class says, I feel helpless. I could care less about actually leaving the house now.

In the weeks before Christmas last year, a brigade of battle-bruised soldiers left Colorado's Fort Carson for its third round of war in Iraq.

Sgt. Colin Barton was getting Botox shots in his forehead to kill the relentless pain from a brain injury. Army doctors said he should not wear a helmet — a safety requirement for the flight to Iraq. The Army sent him anyway.

Sgt. Joshua Rackley, recovering from his eighth knee surgery, was classified as permanently injured. The Army sent him anyway.

Master Sgt. Denny Nelson and Sgt. Joseph Smith didn't have time to recover from predeployment surgeries. Nelson hobbled with crutches; Smith wore a post-surgical boot. Sgt. Tim Graham brought a sleep-apnea machine. Sgt. 1st Class Walter Overton had a shoulder injury and couldn't lift his gear. Spec. Joseph Leon was popping morphine pills to dull the nerve damage to his groin.

The Army sent them too.

Five years into the war in Iraq and six years after the invasion of Afghanistan, the Army is sending soldiers with physical and mental injuries back to war, at times overruling physicians' classifications of soldiers as "nondeployable."

Facing demands unprecedented in the history of the all-volunteer force, the Army has deployed soldiers with slings and crutches and some who need machines to help keep them alive through the night. Thousands are taking pain, sleep or antidepressant medication, with sometimes deadly consequences.

The pressure to send marginal soldiers grew with the "surge" of troops to Iraq in January 2007, an effort that Army leaders say has succeeded in stabilizing the nation's government and reducing sectarian violence.

Yet from the onset of the Iraq war, deployment pressures have been evident. An Armed Forces Health Surveillance Center analysis shows that 43,000 service members — two-thirds of them in the Army or Army Reserve — were classified as nondeployable for medical reasons three months before they deployed Army spokesman Paul Boyce said many had minor medical needs that could be resolved in a day.

"Our medical personnel know from experience that service members are ruled medically nondeployable for reasons such as requisitioning a second pair of eyeglasses, bringing dental records up to date and filling dental cavities," he said. A Denver Post examination of deployment records, internal e-mails and medical files provided by soldiers from one Army brigade — Fort Carson's 3rd Brigade Combat Team of the 4th Infantry Division — shows that more than 130 soldiers were sent to Iraq last fall despite being classified with medical limitations just before deployment.

In many cases, those limitations went well beyond cavities or missing eyeglasses.

At least 25 of the brigade's soldiers — including Barton, Nelson, Rackley and Smith — were still suffering from serious and unresolved medical problems as they boarded transport planes bound for Kuwait and then Iraq.

In interviews, soldiers or their relatives described how they worked in constant pain, sought physical therapy in vain and were ordered to perform tasks that violated duty restrictions in what are known as their "medical profiles."

Army commanders have final authority to decide who goes to war and who doesn't. The commander considers doctors' opinions but can take a soldier to a war zone even if a doctor says the soldier should not be deployed.

Army officials say thosewith medical conditions are assigned to jobs in the war zone suited to their physical limitations. They also say many of the problems that caused soldiers to be classified medically as "no-go" were minor.

"Were there some mistakes made? Yes. Some soldiers should not have gone and did," said Maj. Gen. Mark Graham, who became the commanding general of Fort Carson just before the 3rd Brigade departed. "My understanding is the majority of the soldiers, not all of them, once they got over there and realized they couldn't give them the care they needed, they were sent home."

Multiple tours take their toll

Some soldiers who discussed their cases with The Post requested anonymity, fearing retribution, but their accounts were corroborated through Army records, interviews, observations or medical records that they or their families provided.

One soldier said he walked with a cane to relieve the relentless knee pain that kept him awake at night. Another said he isn't supposed to stand more than 15 minutes a day, but stands 12 hours at a time as a gunner. Another left his medication at home — Zoloft and Klonopin for combat stress, and Tramadol for degenerative disc pain in his back — because, his wife said, he feared they would interfere with his job as a sniper who must lie still for hours at a time.

"I have a herniated disc in my neck, and the Army docs said I was fine," wrote one Fort Carson soldier, who said he was sent to Iraq with two buddies who had broken bones in their hands and couldn't fire their weapons. "I know they sent us over here hurt so they could keep the numbers up."

Of the 1.6 million active-duty service members, reservists and National Guard members sent to Iraq and Afghanistan, 34 percent have served at least two tours. With each deployment, the chances of injury increase. With multiple deployments and shortened downtime, the chances of being sent back while still nursing physical or psychological injuries also increase, veterans advocates argue.

"We'll have some units, entire units, that have served four tours over there," said Tom Berger, senior analyst for veterans' benefits and mental-health issues for Vietnam Veterans of America. "Those are the kinds of things that at least scare me, and they should be scaring mental-health professionals and the (Department of Veterans Affairs) and the (Department of Defense). And it should be scaring the American public because we don't know what's going to happen. We really don't know the impacts of multiple deployments.

"We do know, at least from the research that has been done, the more a person is exposed to those traumatic events and for longer periods of time, there are real problems. But we don't really know. . . .

"This is the first time we've really had to deal with that."

In Vietnam, soldiers served 12-month tours and Marines served 13-month tours. Those who wanted to go back for a second tour signed up. Those who didn't left. When the Army needed soldiers, it drafted more. From 1965 to 1973, 3.4 million Americans were sent to war in Southeast Asia, 2.6 million within Vietnam.

In the current conflicts, the Army, which is doing most of the fighting, has relied on a relatively small core of soldiers.

Through May, about 206,000 soldiers, plus about 63,000 in the Army National Guard and Reserve, had gone to Iraq or Afghanistan at least twice, Army data show.

At the same time, 174,241 active-duty soldiers in the Army as of Feb. 29 had never been deployed overseas. Some are ineligible because they are in basic training, they are physically disabled or they hold jobs — such as recruiters, drill sergeants and some medical occupations — that tend to exclude them from overseas combat. But the Army has identified 37,000 eligible soldiers who were not deployed once while others were ordered to return to war with injuries.

The Army also is examining the cumulative length of soldiers' deployments in an effort to make calls to combat more equitable. Recently, it reduced future deployments from 15 months to 12 months.

"(Equitability) is so keen and essential to making sure we're taking care of our force," said Louis Henkel, deputy director of the Army's enlisted personnel management directorate.

In June, after complaints from soldiers and Congress, the U.S. Government Accountability Office reviewed Army records and reported that "the increasing need for able warfighters has meant longer and multiple deployments for its soldiers."

In a survey of 685 soldiers at Fort Benning and Fort Stewart in Georgia and Fort Drum in New York, the GAO estimated that 14 percent had "medical conditions that could require duty limitations," including herniated discs, back pain, chronic knee pain, Type 2 diabetes and asthma. About two-thirds of them were deployed anyway. The agency could not determine how carefully those limitations were respected once soldiers arrived in a war zone.

But dozens of family members and soldiers who were deployed with medical issues said in interviews with The Post that once in Iraq, commanders sometimes ignored medical limitations set by doctors.

Five minutes of helmet too much

After too many blasts from nearby explosive devices in two deployments to Iraq, Barton had incurable headaches. Sometimes they left him dizzy; sometimes he flew into a rage.

An Air Force doctor had begun an experimental treatment, injecting Botox into Barton's forehead to relieve pressure before his third deployment. He was scheduled for a follow-up treatment in January, but he was deployed in December with a medical profile instructing him not to wear a helmet.

"In any military plane, you're supposed to be wearing your Kevlar (helmet). They told me, they're like, 'Oh, we got a waiver, you can just wear it when you get on the plane,' " he said. "I had it on once for like five minutes and Sgt. Jason Knierim was diagnosed with delayed post-traumatic stress disorder and chronic depression in July 2007 and was given an antidepressant but had no therapy between August 2007 and Nov. 30, when he was ordered to a third tour in Iraq.

At the soldier-readiness processing site, his mental illness was flagged, but a major cleared him for combat duty anyway. "I went into her office, she said, 'You're good to go.' She stamped the paperwork," he said.

Since his first deployment, Knierim had been haunted by memories of killing a 7-year-old boy who pointed a toy gun at him. When he arrived in Kuwait to prepare for his third tour of duty, he had a mental breakdown. His superiors took his gun away and put him on a 24-hour suicide watch.

Even after that, "the chain of command wanted to send me to Iraq to get my treatment there. They thought I could get enough treatment in theater," he said. "They told me to get ready to go — they were getting ready to give my weapon back to me."

He said soldiers such as him become a burden to other soldiers.

"We're unstable," he said. "We can't be relied upon to do our job. We're taking up someone else's time, watching us, to make sure we're OK. Someone has to do that when they could be doing something else."

Rackley had a long history of knee troubles. He had to go through basic training twice just to get into the Army. At 25, he had undergone eight knee surgeries and was listed as nondeployable last year.

When his brigade deployed, Fort Carson's soldier-readiness processing center insisted, "Look, this soldier's not going to Iraq. There's no way," he said.

Yet two days before Christmas, he was asked whether he could leave Christmas Day for Iraq. He was told the rear detachment at Fort Carson had received an urgent call for more soldiers.

"They need people, is what was told to rear detachment. 'Send me people...'," he said. "They needed numbers."

In Iraq, Rackley tried not to violate his medical profile, which instructed him not to carry more than 50 pounds. When he needed to wear armor, "I had to take out all my plates but two," he said. "No ammunition, no water. I had other people carrying my gear for me. Soldiers, we help each other out."

Even carrying a machine gun posed a weight problem. "My first sergeant gave up his own 9mm (pistol) so I wouldn't be breaking a profile," he said.

Rackley said others in Iraq are in worse shape. "I know of five other people deployed right now" with more painful injuries, he said. "Mostly back injuries. One with a shoulder injury."

Eight months after Fort Carson deployed the 3rd Brigade, Knierim has been discharged from the Army and is seeking disability benefits from the VA. Leon returned to Fort Carson after doctors decided his groin injury couldn't be treated in a war zone. Barton came back to Colorado to help his wife cope with multiple sclerosis. Rackley went to South Carolina to train for a noncombat job.

Stories repeat across the country

Fort Carson is not the only base that has deployed soldiers with serious health problems.

Recently, the Army flew Sgt. 1st Class Jason Dene, the nephew of actress Mia Farrow, from Iraq to Dover Air Force Base in Delaware for surgery.

"He was released from the hospital into the loving arms of the government, who sent him directly back to Iraq," his uncle Patrick Farrow wrote in a letter to the Rutland (Vt.) Herald. "He was put on active duty while he was still on a liquid diet, unable to eat solid food because of a throat hemorrhage due to a botched surgery at a military hospital."

Dene, 37, of Castleton, Vt., died of a drug overdose in his bunk in Iraq on May 25.

At Fort Hood in Texas, a doctor recently recommended deploying a soldier with eosinophilic granuloma, a rare disease that causes growths in his lungs.

The soldier, Cameron Atkin, declined to comment publicly. But his wife, Britney, and a soldiers' advocate, Carissa Picard, questioned why the Army would deploy any soldier who struggles to breathe whenever he tries to wear body armor.

"Basically the only gear he can wear out of his combat gear is his helmet," his wife said. If he puts on a flak vest, "after a couple of minutes it feels like a 100-pound weight on his chest. He can't breathe."

She said her husband passed out twice doing push-ups and was unable to train for deployment or even fire a gun because he was being treated for the newly diagnosed lung disease.

Among her husband's friends already in Afghanistan, she said, one failed his last four hearing tests, one has a worsening case of glaucoma, one rarely wears body armor because of a slipped back disc, and one has undergone three surgeries on the same ankle.

"They're trying to fill their quotas. They don't care about lives; they care about bodies," she said.

This month, she said, a second Army doctor examined her husband and found him undeployable. There is still a chance his commander could overrule that recommendation.

Scrambling to grow the ranks

Five years into the Iraq war, the Army has established Warrior Transition Units to help manage a growing number of soldiers with physical and mental-health problems.

But for every soldier assigned to a WTU brigade, another must be sent to Iraq in his or her place.

The Army is managing to enlist about 80,000 new soldiers each year. But to do so, it raised enlistment bonuses by an average of 37 percent last year. In three years, it nearly doubled the number of waivers for recruits with criminal-arrest records, a history of drug or alcohol abuse, or medical problems such as poor hearing or eyesight, asthma and high blood pressure.

And it is taking fewer high school graduates — down to 79 percent last year from 94 percent in 2003 — despite Defense Department and Army standards that say "no less than 90 percent" of soldiers must have high school degrees.

Fort Carson's 3rd Brigade was originally set to deploy in March. But last fall, with the 30,000-soldier surge showing some signs of success, the date was moved up, "to the left" in Army parlance, to get the brigade into the fight.

When that order came, Fort Carson had transferred 225 brigade soldiers to its WTU, where injured soldiers go to concentrate on recovery, and 368 others were deemed nondeployable.

"So when they got moved to the left, were there problems getting them? Yes, there were, because the system never caught up," said Maj. Harvinder Singh, the rear-detachment commander for the brigade.

Singh said that every unit has a goal to send a certain percentage of the brigade, usually about 3,500 soldiers at full strength. "Our goal was 95 percent; we went through with 87," he said.

Singh said that once in Iraq, the brigade slowly added soldiers sent from other units.

"As the Army starts backfilling everyone else, over the last six months, we have received over 500 soldiers. Again, it's just a goal that commanders have. If you don't reach it, you don't reach it," Singh said.

Changes to clearing a "no-go"

E-mails from Capt. Scot Tebo, the brigade surgeon, written Jan. 3 just after the brigade deployed, show the brigade was struggling to find enough healthy soldiers.

"We have been having issues with reaching deployable strength and thus have been taking along some borderline soldiers who we would otherwise have left behind for continued treatment," Tebo wrote to Maj. Thomas Schymanski.

One of those soldiers he evaluated was Nelson, a 19-year Army veteran who is a Bronze Star recipient.

Nelson had fractured a foot while jumping on his daughter's trampoline. He was sent to Kuwait on crutches.

"They're sending units so rapidly, they're having trouble getting them healthy," Nelson said.

After The Post in January reported on the deployment of some injured soldiers with the brigade, Maj. Gen. Graham ordered the post's inspector general to investigate.

The inspector general found "no initial indication that the units deliberately deployed medically unfit soldiers against explicit medical advice," nor that the unit systematically changed medical profiles to deploy more soldiers.

The inspector general did find the brigade sent 36 soldiers "who were rendered nondeployable" by a "medical no-go" and recommended a more rigorous reporting system to ensure that unfit soldiers are not sent to war.

The inspector general's report also suggested limiting the use of "no-go" to describe soldiers with "potential deployability constraints" that a commander must consider. "The term 'medical no-go' is unclear and, as witnessed by recent public media interest, can easily be misunderstood," it reported.

Graham said the Army has "very good, competent commanders that I think are doing a tremendous job, and they work closely with the medical care providers. And I'll tell you, I don't think there is any evil here. These are America's sons and daughters, and we don't put people in command who don't take that responsibility quite seriously."

Still, after the inspector general's report, Graham ordered brigade commanders not to send no-go soldiers until he had reviewed their cases and signed off on them personally. Another brigade is due to deploy from Fort Carson in the coming weeks, the first test of Graham's new policy.

And he acknowledges the hardships that come with multiple deployments.

"This is hard, this is hard," Graham said. "War is hard. And there is no doubt you can see the Army is working hard to get back to 12-month deployments from 15 months because we know this is tough on our soldiers and families too. It is very hard."

"They just need the numbers"

For Michelle Graham, the wife of Sgt. Tim Graham, a mechanic serving in Iraq, the level of desperation in the Army is no more apparent than in her husband's case.

Graham — no relation to Maj. Gen. Graham — has a permanent profile for severe sleep apnea.

"With his profile, he was not supposed to go. He stops breathing," Michelle Graham said. "He has a machine that goes over his face to help him breathe at night. If his machine breaks down, they have to send it back to the States to fix it. He does have a backup, but how long is that going to last?"

She said she does not sleep at night because she worries about her husband. The Army recently changed its regulations, deciding soldiers on sleep machines could deploy safely.

"Tim has a profile that says he's not supposed to go, but his first sergeant and his commander said, 'You're going anyway.' It's numbers, that's all it is. They don't care who goes out there; they don't care what's wrong with them. They just need the numbers. It's really frustrating."

The Housing Bubble Villains Deny Responsibility

The Housing Bubble Villains Deny Responsibility

Dean Baker

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The central bankers of the world gathered last weekend for their annual meeting at Jackson Hole, Wyoming. This was an opportunity to talk about the major issues confronting the world economy, as well as an opportunity to spend some time in a very beautiful vacation spot.

When they met in Jackson Hole in 2005, the meetings were devoted to an Alan Greenspan retrospective, honoring his 18-year tenure as Federal Reserve Board chairman, which was due to end the following January. A number of papers were presented analyzing his record at the Fed, including one that raised the question of whether Mr. Greenspan was the greatest central banker of all time.

The elite Jackson Hole crew did not debate whether Greenspan was the greatest central banker of all time this year. The world is now facing the most serious financial crisis since the Great Depression. At least, that is the assessment of Alan Greenspan. With house prices plunging, unemployment and inflation rates rising and banks failures mounting, Greenspan has a pretty good argument.

How did we get here? The centerpiece in this story is the United States allowed an $8 trillion housing bubble to grow unchecked. Between 1996 and 2006, house prices rose by more than 70 percent, after adjusting for inflation. In the previous century, from 1896 to 1996, house prices had just kept even with the overall rate of inflation.

When there is suddenly a sharp divergence from a long-term trend like this, it is reasonable to look for an explanation. Was there some fundamental factor on either the supply or demand side that was suddenly causing house prices to skyrocket?

A quick investigation revealed no obvious suspects. On the supply side, there were no major new constraints that were impeding construction. In fact, housing starts were at near record levels over the years 2002 to 2006, so there was no reason to believe any developments on the supply side could explain skyrocketing house prices.

The demand side also didn't feature any obvious culprits. The rate of population growth and household formation had slowed sharply. If demographics could explain a sharp rise in house prices, then we should have seen the surge in the 70s and 80s. That was when the huge baby boom cohort was first forming their own households. In the current decade, the baby boomers are preparing for retirement.

There also was no plausible income story. Income grew at a healthy but not extraordinary rate in the years from 1996 to 2000, but income growth has been very weak throughout the current decade.

Finally, if the run-up in house prices could be explained by the fundamentals of the housing market, then we should expect to see a comparable increase in rents. But there was no unusual run-up in rents. They did slightly outpace inflation in the late 90s, but they actually were falling behind inflation by the early years of this decade.

If the run-up in house prices could not be explained by the fundamentals, then it was a bubble, which would burst. This was easy to see for anyone who cared to look, but Greenspan and his sycophants could not be bothered. Greenspan insisted everything was fine - there was no housing bubble - and virtually the whole economics profession, including his fellow central bankers, acted an enablers touting Mr. Greenspan's wisdom.

While the exact timing and path of the housing market's collapse and the resulting turmoil in financial markets could not be predicted, the basic course of this tsunami was entirely foreseeable. The collapse of the bubble will destroy in the neighborhood of $8 trillion of housing wealth. Most of these losses will be absorbed by homeowners ($8 trillion comes to $110,000 per homeowner), but if just ten percent of the loss ends up on bank financial sheets, the losses will be $800 billion.

That is enough to put many banks under. Losses of this magnitude were virtually certain to sink Fannie Mae and Freddie Mac, the two huge government-sponsored enterprises that created the secondary mortgage market in the United States. The current financial crisis was, therefore, an inevitable follow-on to the collapse of the housing bubble and will almost certainly amplify its negative impact on the US economy.

This all seemed painfully obvious from even a quick look at the housing data back in 2005 when the central bankers were honoring Alan Greenspan. In fact, it should have been obvious at least three years sooner.

But the Jackson Hole economists were convinced everything was just fine. Now, they are all saying no one could have foreseen the current crisis. And they say no one, at least among the Jackson Hole crowd, saw any problems coming.

The really tragic part of this story is there are no consequences. The same group of economists that led the economy into this catastrophe still has its hands on the wheel. Holding them accountable for their disastrous performance is simply not on the agenda.

Central bankers are not like dishwashers and custodians. They don't get fired when they mess up on the job. They don't even get a pay cut.

So, lets all hope the Jackson Hole crew had a good time at their summer retreat. We've paid a big price for it.

Wall Street fears the worst as US housing sales continue to fall

Wall Street fears the worst as US housing sales continue to fall

By Simon Evans

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Wall Street will this week brace itself for further disappointing figures from the US housing arena when numbers for sales of existing and new homes are released on Monday and Tuesday.

After economic data last week showing the UK on the brink of recession, attention will be on the US, with minutes from the Federal Reserve's interest rate-setting committee and GDP numbers also due to be released.

Worse than expected figures are likely to rein in the US dollar, which has soared against the pound recently. Economists predict that sales of new homes in the US will have once again fallen back in July to around 525,000, a further fall from June.

On Friday, the Federal Reserve chairman, Ben Bernanke, gave a much-needed fillip to Wall Street when he claimed that the threat of inflation in the world's biggest economy had receded. A combination of lower growth, lower oil and commodity prices and a strong dollar had, he said, all contributed to reducing the threat of spiralling prices.

His comments came as speculation grew that the US Treasury, led by the Treasury Secretary, Hank Paulson, is set to bail out the failing mortgage giants Freddie Mac and Fannie Mae, with a further package that most believe to be quasi-nationalisation. The investment guru Warren Buffett said "the game was now over", since the government's blank cheque had encouraged riskier lending, meaning that investors in the groups were likely to lose all their money.

Talk of a bailout for Freddie and Fannie came alongside rumours that the ailing investment bank Lehman Brothers could be bought by the Korea Development Bank.

Meanwhile, in the UK, figures from the Office for National Statistics showed zero economic growth in July. The statistics suggest that Britain's economy is teetering towards the official definition of a recession – two quarters of negative growth. The downward revision brought to an end a 16-year run of growth in the UK and prompted a further weakening of sterling to its lowest levels against the euro for 12 years.

Economists warned that stagnation had made a cut in the cost of borrowing, currently at 5 per cent, more likely. The Bank of England's Monetary Policy Committee meets on 4 September to decide the direction of rates.

US continues to ratchet up tensions with Russia

US continues to ratchet up tensions with Russia

By Barry Grey
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The United States has continued to intensify its confrontation with Russia in the wake of Moscow’s withdrawal of troops from most of the Georgian territory it held following the five-day war provoked by the invasion of the breakaway province of South Ossetia by the US-backed government of Georgian President Mikheil Saakashvili.

On Sunday, the US guided missile destroyer USS McFaul docked at the Georgian port of Batumi as part of what President Bush and the Pentagon have called a “military humanitarian mission” to aid the former Soviet republic in the southern Caucasus.

The McFaul, an Arleigh Burke-class destroyer, is outfitted with an array of weapons, including Tomahawk cruise missiles, which can carry either conventional or nuclear warheads, and a sophisticated radar system. According to US Defense Department spokesman Bryan Whitman, the US Coast Guard cutter Dallas has also been dispatched to the Georgian coast, while a third vessel, the Navy command ship USS Mount Whitney, is being loaded in Italy.

Russian military officials on Monday denounced the US-led naval buildup, and hours later Russia’s flagship cruiser re-entered the Black Sea, ostensibly for weapons tests. Anatoly Nogovitsyn, the deputy chief of the Russian military’s general staff, said, “The fact that there are nine Western warships in the Black Sea cannot but be cause for concern. They include two US warships, one each from Spain and Poland, and four from Turkey.”

Reuters cited unnamed sources in Russian military intelligence as saying the NATO ships in the Black Sea are carrying more than 100 Tomahawk cruise missiles, with more than 50 onboard the USS McFaul alone that could hit ground targets.

On the ground, the Georgian military has concentrated equipment and forces along the border with South Ossetia, near Russian troops that have set up checkpoints in a five-mile buffer zone around the pro-Russian enclave. The Georgian parliament voted on Saturday to prolong the official “state of war” with Russia until September 8.

Russian military officials this weekend vowed to boost their forces in the breakaway provinces of South Ossetia and Abkhazia in direct proportion to American military spending to rebuild the Georgian army.

In addition to its provocative military moves, Washington is stepping up its political and diplomatic offensive against Moscow. American officials continue to charge Russia with violating the terms of the cease-fire agreement brokered two weeks ago by French President Nokolas Sarkozy, acting in behalf of the European Union. Sarkozy currently holds the rotating presidency of the 27-member European alliance.

The Bush administration moreover announced that Vice President Dick Cheney would visit the Georgian capital of Tbilisi next week as part of a tour of former Soviet republics and Warsaw Pact nations that are now allied to the US and ruled by virulently nationalistic and anti-Russian governments. Cheney heads a faction within the Bush administration that has long pushed for an even more belligerent and aggressive policy toward Russia than that carried out by Secretary of State Condoleezza Rice.

Early in the five-day Georgia-Russia war, while Bush was still attending the Olympics in Beijing and issuing relatively muted statements on the conflict, Cheney telephoned Saakashvili and placed the blame for the fighting squarely on Moscow. His office issued a statement saying that Russian “aggression ... must not go unpunished.” His visit to the -region indicates that his faction has gained the upper hand within the administration.

On Sunday, Sarkozy announced that he was calling an emergency EU summit for September 1 to consider the European Union’s relations with Russia and the provision of aid to Georgia. Sarkozy, who said he was calling the meeting at the request of “some EU governments,” last week threatened to call such a summit and warned of “serious consequences” if Russia failed to adhere to the cease-fire terms. He, along with German Chancellor Angela Merkel and British Foreign Minister David Milibank, are echoing US charges that Moscow continues to defy the agreement.

Russia on Friday withdrew almost all of the forces it had sent into Georgia to repel the attack on the South Ossetian capital of Tskhinvali, which, Moscow contends, killed over 2,000 civilians and leveled 70 percent of the buildings in the city. However, it is retaining over 500 troops within the borders of South Ossetia and Abkhazia and has established military checkpoints in what it calls a “security zone” around the two provinces.

Moscow insists that it is in compliance with the cease-fire, which includes a point allowing Russia to take unspecified “additional security measures” besides keeping peacekeepers in the disputed territories. Russia has maintained peacekeeping troops in the provinces since they ended effective control by Tbilisi in fighting that followed the breakup of the Soviet Union in 1991. A subsequent agreement between Moscow and Tbilisi sanctioned the presence of Russian peacekeepers in the breakaway republics.

In a telephone conversation with Russian President Dimitry Medvedev over the weekend, Sarkozy said the agreement allowed Russian peacekeepers to “patrol” areas near the borders of the two republics, but not to set up checkpoints. He also demanded that Russia remove military checkpoints near the Georgian port of Poti and the air base at Senaki, which are outside the five-mile buffer zone around Abkhazia.

From the moment the cease-fire agreement was announced, Washington began accusing Russia of violating its terms. Both Georgia and the US have refused, in practice, to acknowledge the point allowing Russia leeway to station some forces beyond the borders of the disputed provinces.

The Financial Times reported Monday that “US diplomats have voiced their frustration at the terms of the subsequent ceasefire deal brokered by Nicolas Sarkozy, France’s president, which they consider too vague and too favourable to the Kremlin.” In a separate article based on an interview it conducted over the weekend with Saakashvili, the newspaper reported that “Saakashvili put the blame on the ‘vague’ ceasefire agreement.”

Divisions within the EU over how closely to adhere to the extremely provocative line of the US and how far to take the confrontation with Russia were reflected in a statement by French Foreign Minister Bernard Kouchner, who ruled out EU sanctions against Russia at the upcoming summit.

However, Sarkozy’s announcement of the meeting reiterated the US mantra of support for the “independence and territorial integrity” of Georgia, a formula for rejecting demands of separatists in the two breakaway provinces, broadly supported by the local populations in the wake of the Georgian assault on South Ossetia, for independence from Georgia.

The question of independence for South Ossetia and Abkhazia is becoming the flashpoint for further conflict. On Monday, both houses of the Russian parliament—the upper Federation Council and the lower State Duma—voted unanimously in favor of a non-binding resolution calling on Medvedev to recognize the independence of the provinces.

The Russian parliament and the governments of South Ossetia and Abkhazia have cited as precedent American and European recognition of Kosovo, which last February, over vehement objections from Russia, declared itself independent of Serbia, a traditional ally of Moscow.

Intensifying the conflict, Abkhaz President Sergei Bagapsh called on Monday for a military cooperation agreement between an independent Abkhazia and Russia.

Russian Deputy Foreign Minister Grigory Karasin in an interview with Spiegel Online on Sunday attacked the US for its “deceitful role” and pointed out: “American was arming Georgia for five years, and Georgia tripled its military budget.”

Of Washington’s intense lobbying for Georgian admission to NATO, he said, “That would be very dangerous ... It is a decision by all of NATO, a decision on what relations it wants with Russia in the future.”

The Russian government is incapable of responding to the aggressive and provocative policy of the US except by counterposing to Washington’s drive for hegemony in the Caucasus and the Eurasian continent its own Russian nationalism and militarism.

Resting as it does on the dominant factions of the new bourgeoisie that enriched itself from the plundering of the nationalized economy of the former Soviet Union, the Russian regime is incapable of making any appeal to the masses of former Soviet republics such as Georgia and Ukraine which are being lined up against it.

On Sunday, Ukraine held a large military parade in Kiev to mark the 17th anniversary of independence from the Soviet Union. Ukrainian President Viktor Yushchenko gave a televised address in which he declared that only NATO membership and military rearmament could protect Ukraine from Russian domination.

Yushchenko published an op-ed column in Monday’s Washington Post in which he reiterated earlier threats to limit Russian naval access to the Black Sea port of Sevastopol. Russia and Ukraine agreed in 1997 to a 20-year renewable lease for the Russian naval base in the Crimean port.

Yushchenko went on to declare his support for the “territorial integrity” of Georgia and insist on Ukraine’s admission to NATO.

Indicative of the bipartisan support for the Bush administration’s reckless and belligerent policy toward Russia, with its ominous implications of a potential military clash between nuclear armed powers, is an interview with Saakashvili reported in Monday’s New York Times. The article notes that the Georgian president is convinced of unqualified US support for his drive to reassert control over South Ossetia and Abkhazia, saying he “spoke by phone with the presumptive Republican nominee for president, Senator John McCain, as often as twice a day, and that he was in regular contact with Senator Joseph R. Biden Jr., who has been picked to run for vice president on the Democratic ticket.”

Democrats convene in Denver amid police state security and a sea of corporate cash

Democrats convene in Denver amid police state security and a sea of corporate cash

By Bill Van Auken
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Nothing could more graphically expose the political fraud of the “change you can believe in” mantra promoted by the Democrats and their presidential candidate Barack Obama than the reactionary atmosphere surrounding the party’s national convention, which kicked off Monday in Denver, Colorado.

The more than 4,000 Democratic delegates—covered by an army of some 15,000 members of the press—are convening in what amounts to a political bubble surrounded by security measures consistent with those of a police state. The convention itself, not to mention the lavish parties being thrown for the delegates—many of them elected officials—is being paid for largely by major corporations looking to buy political influence.

The media has focused the bulk of its attention on the convention’s first day on speculating as to whether lingering “bitterness” on the part of Obama’s principal rival for the nomination, Senator Hillary Clinton, and her supporters will detract from the unity message that is meant to predominate. Most of this coverage is cast entirely in terms of personal frictions and identity politics, without a hint of any substantive political issues involved.

This is in keeping with the general tenor of the convention itself, which is packaged as a $60 million, four-day infomercial, with no question of a debate over policy breaking out on the floor of Denver’s Pepsi Center, where the delegates are assembled. The media, with very few exceptions, functions as an uncritical conduit for this process, accepting its narrow parameters as given.

It has been more than three decades since such a convention was an arena for any form of political debate, and where the outcome was not preordained. The ritualistic character of these events is a function of the widening gulf separating the official politics of the US two-party system—controlled lock, stock and barrel by the banks, corporations and a narrow financial elite—from the vast mass of the American people.

A stark illustration of this same divide is to be found in the extraordinary security measures that have been put into place in Denver. The Democratic Party, the ostensible political opposition to the Bush administration, is meeting under what amounts to a state of siege, justified in the name of the “war on terror” and the assumed need to exert iron-fisted control over any expression of political dissent in the streets.

The actual scale of protest in Denver is decidedly limited. On Sunday, barely 1,200 people participated in an antiwar demonstration led by Ron Kovic, the paralyzed Vietnam War veteran and author of the book Born on the Fourth of July, and Cindy Sheehan, the mother of a soldier killed in Iraq. The leaderships of the major antiwar protest groups are part of the effort to divert anger against the wars in Iraq and Afghanistan into support for a political party that has funded and will continue both US interventions.

Nonetheless, demonstrators have been confronted with overwhelming police force. The ranks of Denver’s police have been doubled by the influx of cops from throughout the surrounding area.

As Denver’s Rocky Mountain News reported, “Hundreds of heavily armed officers, some clad in riot gear or hanging off SUVs, are saturating Denver’s streets in unprecedented numbers, quickly isolating any hint of trouble that could tarnish the city’s reputation under the limelight of the Democratic National Convention.

“The officers—on foot, horseback, bicycles and motorcycles—are armed with black batons and pepperball guns that resemble assault rifles. And they were quick to move Sunday when hundreds of rowdy protesters took to the streets of downtown.”

Police have distributed pamphlets to would-be protesters warning them that they will be subject to arrest if they refuse orders to disperse, even if they have broken no laws. To deal with potential mass arrests, the city has opened a temporary detention center—a warehouse divided into chain-link cells. Critics of the security crackdown have dubbed the site “Gitmo on the Platte,” after Denver’s South Platte River.

The authorities have also attempted to restrict protesters to a so-called “free speech zone,” the Orwellian term they have given to an isolated patch of a parking lot ringed by two layers of black steel security fencing, giving it the appearance of a detention camp.

The force of 1,500 officers brought in from 52 police agencies in nearby areas does not include a huge federal contingent that has been mobilized for the event.

The Department of Homeland Security has declared the conventions of both the Democratic and Republican parties—the latter to be held next week in St. Paul, Minnesota—”National Special Security Events.” This designation places the department and the Secret Service in charge of overall security and brings in an array of national police, military and intelligence agencies.

Some $50 million in federal funding has been allotted for security measures at each of the conventions. In Denver, a portion of this money has gone to equip police with body armor and shields as well as to purchase an armored vehicle.

Federal and local police agents have established a secret headquarters, dubbed the Multi-Agency Command Center, or MACC, from which they are monitoring every movement in the city via hundreds of security cameras that are trained on the convention center, protest sites and the entire surrounding area.

In a chilling indication that the police surveillance is far wider and more intrusive than has been reported by the media, protest leader Cindy Sheehan reported returning to her Denver hotel room Monday to find a man in her room using a screwdriver on the telephone.

The US Customs and Border Protection agency has been brought in to inspect vehicles in the city, while agents of the Transportation Security Administration are being deployed to screen those entering the convention center.

The military has also been deployed in Denver for the convention. In addition to the activation of over 1,000 National Guard troops, elements of the US Coast Guard have been placed in charge of intelligence operations in designated areas, while the North American Aerospace Defense Command and the Northern Command, based at Peterson Air Force Base in Colorado Springs, are also participating. The Pentagon refused to supply any details on the precise role of these commands, but some of the media reported that they were providing the convention with “air cover.”

The convention’s business: bribery and influence-peddling

Behind these rings of steel and phalanxes of police, the real business of the convention is being conducted in a series of activities and events that amount to organized and officially sanctioned bribery and influence-peddling.

Speaking last Saturday in Springfield, Illinois, in his announcement of Delaware Senator Joseph Biden as his running mate, Obama claimed that his campaign was based on “a simple belief: that the American people were better than their government in Washington—a government that has fallen prey to special interests and policies that have left working people behind.”

Yet in Denver this week, he is presiding over a convention that is being paid for by these same special interests, with the clear understanding that their money will secure favors from Democratic politicians and, potentially, a Democratic administration headed by Obama himself.

While posturing as the party of “the people,” the Democrats have auctioned off access to US corporations, selling aptly named “presidential sponsor” packages for a million dollars each. The money buys companies private access to Obama’s advisors, tickets to exclusive parties attended by Democratic elected officials and luxury skybox seats to hear Obama’s acceptance speech Thursday in Denver’s Mile High Stadium.

The party had billed the stadium event as a sign of its openness and desire to include the people in its deliberations. But the auctioning off of skyboxes to the highest corporate bidders clearly expresses the Democrats’ real role as an essential prop of social inequality and the rule of big business.

An array of major corporations has sponsored parties, dinners and other events, using loopholes in new ethics rules touted by Obama and the Democrats, to stage lavish events for and contribute amply to Democratic politicians. While the rules limit individual donations to candidates to $2,300, and bar direct contributions from corporations and unions, their provisions do not extend to the party conventions.

AT&T, which has refused to disclose how much it has given to the convention, held such an event Sunday night from which it barred the media, calling the police against a few reporters who attempted to interview those attending. The bash was given for the Democratic Leadership Council.

AT&T was one of the principal beneficiaries of legislation passed by Congress last month—with Obama voting in favor—which vastly expanded government domestic surveillance powers while granting blanket retroactive immunity to telecommunications firms that collaborated in the Bush administration’s illegal domestic spying program.

Another telecom, Qwest Communications, has donated $6 million to the convention—the largest known contribution.

As the Los Angeles Times pointed out Monday, “The largest donors frequently have some of the largest business issues pending before state and federal agencies at the time lawmakers ask them to donate.”

Qwest has a case pending before the Federal Communications Commission (FCC) that would grant it regulatory relief. The newspaper reported that a member of the convention’s fundraising committee, Rep. Diana DeGette of Colorado, also sits on the congressional committee that oversees the FCC and wrote a letter to the agency on the company’s behalf.

Other major corporate convention donors with issues before Congress that have significant implications for their bottom line include Comcast Corp., Xcel Energy Inc., UnitedHealth Inc., Eli Lilly and other big pharmaceutical firms, and Kraft Foods.

One major donor worth noting is Lockheed Martin, the huge military contractor. “Lockheed Martin strongly supports our nation’s political process and candidates that support in general national defense, homeland security, high technology and educational initiatives,” a company spokesman said of the convention funding. Clearly, it is confident that the US war machine will provide it with profitable conditions under an Obama presidency.

Among the events scheduled at the convention is a poker night for delegates at Coors Field, sponsored by a business alliance that is lobbying Congress not to place restrictions on Internet gambling.

Even the government-backed mortgage finance giants Fannie Mae and Freddie Mac had been slated to host events and contribute to the convention’s cost, until the idea was scrapped out of fear that it would trigger outrage because of the recent government move to bail out the firms.

Behind the media glitz and meticulously staged spectacle, the Denver convention’s reality of corruption, elitism and repression is the real face of the Democratic Party and the Obama campaign.

No less than the Republicans and their candidate John McCain, the Democrats defend the interests of the corporate and financial ruling elite. The thoroughly anti-democratic two-party system excludes any expression of the genuine interests of working people.

We Tilt at Windmills as World War Looms

We Tilt at Windmills as World War Looms

By Simon Jenkins

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Is the world drifting towards a new global war? From this week the dominant super-power, America, will for three months pass through the valley of the shadow of democracy, a presidential election. This is always a moment of self-absorption and paranoia. Barack Obama and John McCain will not act as statesmen but as politicians. They will grandstand and look over their shoulders. Their eye will stray from the ball.

Meanwhile, along history’s fault line of conflict from Russia’s European border to the Caucasus and on to Iran, Afghanistan and Pakistan, diplomats are shifting uneasily in their seats, drums are sounding and harsh words are spoken. The world is now run by a generation of leaders who have never known global war. Has this dulled their senses?

Dan McNeill, an American general, was recently interviewed in Kabul on how to beat the Taliban. He was not the first to conclude that this could not be done militarily but only by “winning hearts and minds”. The problem, he said, lay in the answer to the question, “Whose hearts and minds?” Was it those of the Afghan people or was it rather those of the American Congress and voters?

Both Obama and McCain have claimed that the war in Iraq has been allowed to distract attention from the war in Afghanistan. This is different from the neoconservatives, who felt the war in Afghanistan was a distraction from the more important war in Iraq.

America now thinks it has won in Baghdad and must return to Kabul - and possibly even Tehran. At the same time it must face the possibility that these conflicts may in turn be a distraction from the reemergence as world powers of Russia and China, who are already gaining the initiative in Iran and Africa. Moscow is also precipitating a nationalist resurgence in eastern Europe and among Russian minorities in the Caucasus.

The question is critical. Has the West misjudged the fault line of an impending conflict? Its global strategy under George Bush, Tony Blair and a ham-fisted Nato has declared the threat to world peace as coming from nonstate organisations, specifically Al-Qaeda, and the nations that give them either bases or tacit support. Western generals and securocrats have elevated these anarchist fanatics to the status of nuclear powers. Policing crime has become “waging war”, so as to justify soaring budgets and influence over policy, much as did America’s military-industrial complex during the cold war.

Might it be that a raging seven-year obsession with Osama Bin Laden and his tiny Al-Qaeda organisation has blinded strategists to the old verities? Wars are rarely “clashes of civilisation”, but rather clashes of interest. They are usually the result of careless policy, of misread signals and of mission creep closing options for peace.

Terrorists, wherever located and trained, can certainly capture headlines and cause overnight mayhem, but they cannot project power. They cannot conquer countries or peoples, only manipulate democratic regimes into espousing illiberal policies, as in America and Britain. By grossly overstating the significance of terrorism, western leaders have distracted foreign policy from what should be its prime concern: securing world peace by holding a balance of interest - and pride - among the great powers.

To any who lived through the cold war, recent events along Russia’s western and southern borders are deeply ominous. Moscow initially spent the 17 years since the fall of the Soviet Union flirting with the West. It had been defeated and had good reason for disarming and putting out feelers to join Nato and the European Union. It took part in such proto-capitalist entities as the G8.

In the case of Nato and the EU it was arrogantly rebuffed, while its former Warsaw Pact allies were accepted. Moscow was told it would be foolish to worry about encirclement. A nation that had never enjoyed democracy should content itself with basking in its delights. Russians in the Baltic states and in Ukraine should make their peace with emerging governments. The political clutter of the cold war should be decontaminated.

Suddenly this has not worked. The world is showing alarming parallels with the 1930s. Lights are turning to red as the world again approaches depression. The credit crunch and the collapse of world trade talks are making nations introverted. Meanwhile, the defeated power of the last war, Russia, is flexing its muscles and finding them in good working order.

On Thursday Gordon Brown told his troops in Afghanistan that “what you are doing here prevents terrorism coming to the streets of Britain”. He cannot believe this any more than do his generals. Afghanistan poses no military threat to Britain. Rather it is Britain’s occupation and the response in neighbouring Pakistan that fosters antiwestern militancy in the region. Like the impoverishment of Germany between the wars, the stirring of antiwestern and antiChristian sentiment in the Muslim world can only be dangerous and counter-productive. Yet we do it.

The Taliban are fighting an old-fashioned insurgent war against a foreign invader and recruiting Pakistanis and antiwestern fanatics to help. They have succeeded in tormenting Washington and London with visions of a destabilised nuclear Pakistan, a blood-drenched Middle East and an Iran whose leaders may yet turn to jihad. For Brown - or the American presidential candidates - to imply that these conflicts with the Muslim world are making the world “safer” is manifestly untrue.

Worse, it distorts policy. Rather than calming other foes so the West can concentrate on the conflicts in hand, it is pointlessly stirring Russian expansionism to life.

There is no strategic justification for siting American missile systems in Poland and the Czech Republic. It is nothing but right-wing provocation. Nato’s welcome to Georgia and Ukraine, for no good reason but at risk of having to come to their aid, has served only to incite Georgia to realise that risk while also infuriating Moscow.

Russia is well able to respond recklessly to a snub without such encouragement, so why encourage it? The more powerful state - America - surely has an obligation to show the greater caution. Any strategic decision, such as the goading of Moscow, must plan for its response. Nato’s bureaucracy, lacking coherence and leadership, has been searching for a role since the end of the cold war. That role is apparently now to play with fire.

Western strategy is dealing with a resurgent, rich and potent Russia. It has played fast and loose with Moscow’s age-old sensitivity and forgotten the message of George Kennan, the American statesman: that Russia must be understood and contained rather than confronted. The naive remarks welcoming Georgia to Nato by David Miliband, the foreign secretary, show a West far detached from such analytical truths.

Any student of McCain or Obama, of Russia’s Vladimir Putin and Dmitry Medvedev, or of the leaders of Britain, France and Germany, might conclude that these are not people likely to go to war. They are surely the children of peace. Yet history shows that “going to war” is never an intention. It is rather the result of weak, shortsighted leaders entrapped by a series of mistakes. For the West’s leaders at present, mistake has become second nature.

The Pinched Middle Class Is Ditching Target for Wal-Mart

The Pinched Middle Class Is Ditching Target for Wal-Mart

By Marie Cocco
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The one certainty I have about the economy is that I did not cause Target's profits to slide. Quite the opposite. I've been dedicating time for trips to the discount retailer to save a few bucks that would otherwise have been spent thoughtlessly buying, say, paper towels at the grocery store, where you never know if they'll be on sale.

But it turns out that consumers more pinched than I am are switching to Wal-Mart, so that discounter has been posting sales increases while Target is slumping. With wholesale inflation for July just reported at a 27-year high, consumer prices in the coming months will likely have at least some of this summer's painful energy costs factored in, so we probably haven't seen the worst of inflation.

Even Saks, the luxury department store, is suffering a slide in sales and profits. The economic pain is trickling up, a perversely welcome change from the immunity the Saks class has enjoyed for too many years to count.

This week's bad news is almost sure to be followed by more next week, when the Census Bureau reports on 2007 trends in income, poverty and the number of Americans without health insurance. This consistently alarming number is likely to climb again. Employers were dumping insurance coverage to pare costs even before they started dumping significant numbers of jobs altogether. And since insurance coverage is usually tied to jobs, the logic is inescapable. "I expect a significant increase in the number of the uninsured," says Jared Bernstein, a senior economist at the Economic Policy Institute.

The surge in inflation comes after years during which wages have been mostly flat, another trend likely to be confirmed by the Census. The economic expansion that began after the 2001 recession could be the first on record in which real median family income actually will be lower at the end of the "recovery" than it was at the last business peak in 2000, Bernstein believes.

It is no overstatement to call this a crisis. The thoroughly disheartening twist is that it seems not to have sparked a political uprising, even in the midst of a presidential campaign.

With economic conditions about as bad as they've been since the early 1980s, the most pressing political stories of the past week have been entirely -- and exhaustively -- beside the point. One involved whether Republican John McCain or Democrat Barack Obama was more effective in groveling before the famous pastor of an evangelical Christian megachurch. When the two candidates were not maneuvering their way through the religious thicket, they were calibrating their strategies for announcing their choices for vice president. Never mind that there's precious little historical evidence that this choice matters very much in an election's outcome. The way the candidates stage-manage the selection is now supposedly the significant and revealing event.

You are left to wonder what any of this has to do with the price of milk, which, like the price of most food, has gotten completely out of hand. I have never been one to hold politicians accountable for not knowing the answer to those silly questions such as how much a gallon of milk or a loaf of bread costs. This particular game of gotcha is unfair to politicians running for president since they really do live in a cocoon imposed partly by contemporary security needs and partly by their fear of giving a thoroughly embarrassing answer.

Still, the price of milk -- rather, the broader, complicated, awful economic circumstances we confront that have helped lead to the mind-boggling price of milk -- should be the most talked-about political issue right now.

Yet other than the drill-or-not-to-drill-for-offshore-oil debate, no economic issue has made it into the core campaign message of either candidate.

You can't blame McCain. He is closely tied to the Bush administration's failures on the economy and even flip-flopped to say he would continue the exorbitant tax breaks for the rich that he first wisely opposed. But where is the outrage from Obama? It has turned up, finally, in television ads that, in part, use McCain's own statements on the economy to depict the Arizona senator as clueless.

Amid this blur, I long for a candidate who would "focus like a laser beam" on the economy. That's what voters are doing as they see their paychecks shrink from inflation, their jobs threatened and their middle-class dreams diminished.

U.S. CENTCOM Conducts Fla. Training for 'Continuity of Operations'

U.S. Central Command Conducts Training

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The United States Central Command has deployed approximately 200 personnel from Tampa to Central Command Forward Headquarters in the Middle East to conduct training on the Continuity of Operations Plan (COOP).

The training includes the emergency deployment of the USCENTCOM headquarters in Tampa to an alternate location forward in the CENTCOM area of responsibility (AOR). The alternate command post will provide the Commander of US Central Command the ability to maintain situational awareness and command and control of contingency operations throughout the USCENTCOM AOR as well as Headquarters, USCENTCOM during a natural disaster.

The COOP was last exercised during November 2006, and is a long-planned, routine training event.

There are no media opportunities scheduled during this training.

Insurance gap leads some elderly to forgo medicine

Insurance gap leads some elderly to forgo medicine


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Many people in Medicare with diabetes, high blood pressure and other chronic conditions stop taking their medicine when faced with picking up the entire cost of their prescriptions, researchers say.

About 3.4 million older and disabled people hit a gap, known as the doughnut hole, in their Medicare drug coverage in 2007. When that happened, they had to pay the entire costs of their medicine until they spent $3,850 out of pocket. Then, insurance coverage would kick in again.

About 15 percent of those hitting the coverage gap stopped their treatment regimen. That rate varied depending upon illness. For example, about 10 percent of diabetes patients stopped buying the medicine, as did 16 percent of patients with high blood pressure and 18 percent of patients with osteoporosis.

The drug benefit, which began in 2006, has come in under budget. Most participants report they are satisfied with the program. But many lawmakers and health analysts say improvements could be made.

"If a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions," said Drew Altman, the chief executive officer and president of the Kaiser Family Foundation. The foundation conducted the study with researchers at Georgetown University and the University of Chicago.

The Republican-led Congress in 2003 crafted the doughnut hole as a way to make the drug benefit more affordable for the federal government.

The researchers based their findings on pharmacy claims data provided by IMS Health, a company specializing in collecting health care data. They excluded people who get extra help in paying for their drug coverage because of their income; they do not pay the full cost of medicine even when in the doughnut hole.

When looking at spending by people who did not receive the extra help, researchers could determine when they hit the coverage gap, which began at $2,400 in total drug spending. They also could determine when they passed through the gap and catastrophic coverage kicked in.

The researchers focused their analysis on eight categories of drugs. Those least likely to stop taking their medicine were Alzheimer's patients, at 8 percent. Those most likely, at 20 percent, were patients taking medicine for heartburn, ulcers and acid reflux disease, 20 percent.

Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the coverage gap kicks in after participants have saved about $1,600 on their drug costs, on average. He also noted that many plans offer some coverage when beneficiaries hit the doughnut hole. Those plans cost at little as $28.70 a month, and are available in every state for less than $50 a month.

"We urge beneficiaries to choose wisely when selecting their drug coverage," Nelligan said. "Again, we emphasize that any changes to the coverage gap would need to come from Congress."

The share of Medicare recipients who reached the doughnut hole varied widely by region. About one-third in Arkansas and seven states in the Northern Plains hit the coverage gap in 2007, but only 12 percent in Nevada did.

Researchers said such regional differences may occur because of physicians' prescribing patterns as well as overall health of the population. A separate factor may be enrollment in Medicare Advantage plans. Such plans offer comprehensive health coverage on top of the drug benefit. Regions where Medicare Advantage plans were most prevalent had fewer enrollees hit the coverage gap, which could reflect stronger management of drug use.

Democratic lawmakers have led efforts to let the government use its purchasing power to negotiate cheaper drug prices. They say the savings could be used to reduce the coverage gap, though the Congressional Budget Office projected that the legislation would not lead to any significant savings.

About 5 percent of the people who hit the Medicare coverage gap switched to another medication, most often a generic drug, while 1 percent reduced the number of medications they were taking in a particular class of drugs, the report said.


On the Net:

Kaiser Family Foundation: http://www.kff.org