Friday, September 5, 2008

Turning Away From American State Terrorism

Turning Away From American State Terrorism

By: Peter Chamberlin

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“The American people realize this election represents a turning point. In two months they will decide the future direction of our nation. It’s a decision to follow one path or another.” Rudy Giuliani

The choice we face in November is very clear. It is a choice to continue to support the US terror war, or to turn away from this path of unlimited destruction. This lie-based war is all about terrorism – whether America actually fights terrorism or promotes its use. To find the answer to this conundrum all we have to do is turn our gaze to Pakistan.

In Pakistan we find the complete history of the American “war on terrorism,” from its Cold War origins nearly thirty years ago to its present incarnation in the illegal American aggression in Pakistan’s Frontier region (FATA, Federally Administered Tribal Areas) and in American attempts to reignite the Cold War with Russia. The latest cross-border attack against Pakistan in South Waziristan, which involved American helicopters and ground troops, costing 15 villagers their lives, represents the first steps in American attempts to escalate its war into a reasonable facsimile of another world war.

Once again, America claims that its aggression against Pakistan is a legitimate act of self-defense against the “Pakistani Taliban” (TTP,Tehrik-e-Taliban Pakistan), who, it is claimed, are responsible for America’s faltering war effort in Afghanistan. Wednesday’s aggression was another attempt to get TTP leader Baitullah Mehsud (branded “public enemy number one” by the US) or one of his top commanders. Mehsud is the key to understanding America’s true role in the terror war, that of state terrorism planner and facilitator, in order to later assume the role of defender against the terrorism it causes.

Baitullah Mehsud assumed control of the TTP from its founder, his infamous cousin Abdullah Mehsud. Abdullah was a prisoner at Guantanamo before being inexplicably released to return to Pakistan, where he founded the new Taliban splinter group. On his second day in S. Waziristan he instigated the kidnapping of two Chinese engineers from the building of the Gomal Zam Dam, beginning the TTP fight against America’s adversaries in the region.

Setting the pattern for all future American terror attacks, the American media reported that America’s secret allies, the TTP, were “al Qaida linked.” Whenever and wherever the Western media uses the expression “al Qaida linked,” to describe terrorist attacks, they are referring to American terrorism. This is also painfully true about those sinister forces that killed 3,000 American civilians on September 11, 2001. American/“al Qaida” terrorism always targets civilians, even American civilians. Next to the US military, al Qaida is the greatest killer of innocent Muslims in the world.

Now we have American covert forces busily killing Pakistani civilians by the hundreds, in order to justify the planned overwhelming American assault upon Pakistan, which is conveniently situated between the main target Iran and all that juicy fuel located in the “Stans,” the former Soviet satellites where America’s Georgian mercenaries are busily committing acts of genocide to restart the new Cold War.

The American destabilization of nuclear-armed Pakistan has been the key to the planned destruction of Iran and the seizure of the Caspian region oil and gas fields and the pipeline routes for marketing the stolen booty. Targeting American-backed militants, who are using the same terrorist training camps created by the CIA to launch a “jihad” against the Soviets, American interests are seeking to topple the Pakistani government and to seize their nuclear arsenal.

The corporate American government cannot survive the debt-based collapse of its own economy and the world economy without a massive military expansion of its power, gaining control of the world’s energy reserves. America cannot continue bullying the world to have its way without this key asset.

The Republican and Democratic co-conspirators understand the dilemma created by America’s greed and attempts to forge a global empire. This means that no matter who wins the November election will continue this policy of international piracy and terrorism. It is up to the American people to decide whether these policies of state terrorism continue. It is our decision to make, whether we allow America to destroy the world to save itself, or whether we suffer the economic consequences for our actions in the past. By our inaction, or by the wrong action, we allow the evil that our government continually sows. By participating in our farcical “free elections,” casting a vote for either man, we vote to destroy a large portion of the world and its people.

We can no longer give our assent to the crimes against humanity committed against the world by our government on a daily basis. Non-participation in the affairs of this government on any level, will deny it the cover of legitimacy and support it needs to continue on its terror rampage. We must become the “monkey wrench” in the works of government and in American life, in general. We begin by overwhelming the Congress with our righteous anger against governmental plans to unleash hell on earth.

All it will take to do this is a unified signal from the people that we will no longer silently abide its immoral actions. The Congressional parasites who feed at the public trough fear a non-complacent electorate, a united people committed to reclaiming our rightful positions as “watchdogs” of government.

All we have to do to sway a chicken hawk Congress is to convince them that we are now awake. We must focus our antiwar efforts to disrupt the aggression against Pakistan. It is time to join with the democratic antiwar resistance forces in Pakistan, to put an end to the American empire of terror.

Fight the evil that we have become!

U.S. Mortgage Foreclosures, Delinquencies Reach Highs

U.S. Mortgage Foreclosures, Delinquencies Reach Highs

By Kathleen M. Howley

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Foreclosures accelerated to the fastest pace in almost three decades during the second quarter as interest rates increased and home values fell, prompting more Americans to walk away from homes they couldn't refinance or sell.

New foreclosures increased to 1.19 percent, rising above 1 percent for the first time in the survey's 29 years, the Mortgage Bankers Association said in a report today. The total inventory of homes in foreclosure reached 2.75 percent, almost tripling since the five-year housing boom ended in 2005. The share of loans with one or more payments overdue rose to a seasonally adjusted 6.41 percent of all mortgages, an all-time high, from 6.35 percent in the first quarter.

Tumbling home prices are making it difficult for even the most creditworthy owners with adjustable-rate mortgages to sell or get a new loan as their financing costs rise, said Jay Brinkmann, MBA's chief economist. Prime ARMs accounted for 23 percent of new foreclosures and subprime ARMs were 36 percent, he said.

''People chose the lowest payment option to get into some of the very expensive housing markets and now that prices are coming way down, they can't sell and they can't afford the higher payments,'' Brinkmann said in an interview.

The three-year-old housing slump has slowed growth of the world's largest economy, caused more than half a trillion dollars of losses at banks such as Citigroup Inc. and UBS AG, and crimped earnings for companies such as Home Depot Inc. and Lowe's Cos. that rely on home purchases to fuel demand.

Economic Growth

The drop in home sales and values, along with tighter credit conditions and higher energy costs, probably will ''weigh on economic growth over the next few quarters,'' Federal Reserve policy makers said Aug. 5 when they decided to hold their benchmark rate at 2 percent. The central bankers cut the rate seven times in the last year in an attempt to avert a U.S. recession.

The Fed probably will keep the rate level for the next few months, according to the price of Fed funds futures. There's an 81 percent chance of no change at the Sept. 16 meeting and a 75 percent chance of no action at the Oct. 29 meeting, they indicate.

Foreclosures started on prime mortgages rose to 0.67 percent from 0.54 percent and the foreclosure inventory increased to 1.42 percent from 1.22 percent, the report said. The share of seriously delinquent prime mortgages was 2.35 percent, up from 1.99 percent.

Prime Mortgages

The share of new foreclosures on prime ARMs was 1.82 percent, triple the 0.58 percent in the year-earlier quarter, and the total foreclosure inventory was 4.33 percent, up from 1.29 percent, the report said. The share of seriously delinquent prime ARMs was 6.78 percent, rising from 2.02 percent a year ago.

New foreclosures on subprime loans rose to 4.7 percent from 4.06 percent in the first quarter, according to the report. The total foreclosure inventory increased to 11.81 percent from 10.74 percent and the so-called seriously delinquent share of loans that are 90 days or more overdue rose to 17.85 from 16.42 percent.

Existing home sales fell to a 10-year low in the second quarter and the median price for a single-family house dropped 7.6 percent, according to the National Association of Realtors in Chicago.

About 75 percent of U.S. banks surveyed indicated they tightened standards on prime mortgages, up from 60 percent in the previous survey, the Federal Reserve said on Aug. 11.

The Mortgage Bankers report is based on a survey of 45.4 million loans by mortgage companies, commercial banks, thrifts, credit unions and other financial institutions.

U.S. Economy: Payrolls Drop, Unemployment at 5 Year High of 6.1%

U.S. Economy: Payrolls Drop, Unemployment at 6.1%

By Shobhana Chandra

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The U.S. lost more jobs than forecast in August and the unemployment rate climbed to a five- year high of 6.1 percent, a sign that the economic slowdown is worsening two months before Americans elect their next president.

Payrolls fell by 84,000 in August, and revisions added another 58,000 to job losses for the prior two months, the Labor Department said today in Washington. The increase in the jobless rate sent the misery index, which adds unemployment to inflation, to 11.7 percent, the highest level since 1991.

The deteriorating labor market raises the likelihood the Federal Reserve will postpone any increase in interest rates until next year, futures trading shows. Today's figures increase the risk that President George W. Bush will become the first president since Richard Nixon to oversee two recessions, and may hurt fellow Republican John McCain's campaign to succeed him.

‘‘It certainly increases the probability that we really are in a recession,'' William Poole, former president of the Federal Reserve Bank of St. Louis, said in an interview with Bloomberg Television. ‘‘It is a weak number, including the revisions.''

Yields on benchmark 10-year Treasuries rose after dropping earlier to a four-month low of 3.55 percent, and were at 3.65 percent as of 12:03 p.m. in New York. The Standard & Poor's 500 Stock Index fell 0.6 percent to 1,229.86.

Workforce reductions at companies from UAL Corp. to Gannett Co. are adding to the woes of Americans hurt by lower home values, scarcer credit and higher prices. Separate figures today showed that mortgage foreclosures accelerated in the second quarter to the fastest pace since at least 1979.

Election Looms

Today's report is the penultimate look at the job market before the Nov. 4 U.S. election, with McCain vying with Democratic candidate Barack Obama to take the White House. McCain yesterday addressed the Republican Party convention, pledging to ‘‘keep taxes low'' and rein in unnecessary government spending.

‘‘This hurts McCain,'' said Daniel Clifton, head of policy research for New York-based Strategas Research Partners. ‘‘He's going to get a bounce in the polls after the convention, but it could be less because of this,'' he said, referring to the increase in unemployment.

‘‘Americans are hurting and we must act to create jobs,'' McCain said today in a statement. Obama, in a statement, said ‘‘today's jobs report is a reminder of what's at stake in this election.''

Keith Hennessey, Bush's national economic council director, said in an interview with Bloomberg Television that he remained ‘‘an optimist'' about the prospects for growth. ‘‘We hope'' the payroll readings ‘‘will improve going forward,'' he said.

Economists' Forecasts

Payrolls, which have now fallen for eight months, were forecast to drop 75,000 after a previously reported 51,000 decline in July, according to the median estimate of 76 economists surveyed by Bloomberg News. The jobless rate was projected to remain at 5.7 percent.

Factory payrolls dropped 61,000 after decreasing 38,000 in July, with most losses coming in the auto industry.

Today's figures indicate the labor market is deteriorating faster than U.S. central bankers expected. Among Fed governors and district bank presidents, none projected an unemployment rate above 6 percent for the average in the fourth quarter.

Traders see the Federal Open Market Committee keeping the benchmark target rate for overnight loans between banks at 2 percent through year-end, futures show. The chance of a cut in December is 13 percent, up from zero a week ago, with the probability of an increase at just 2 percent, down from 20 percent a week ago and 43 percent in July.

Mortgage Rout

Rising unemployment may make it harder for Americans to keep paying their mortgages. The share of loans with one or more payments overdue rose to a seasonally adjusted 6.41 percent of all mortgages, the Mortgage Bankers Association said in a report today. That's the highest since their data began in 1979.

The Labor Department report also showed the effects of the housing slump and the credit crisis that it triggered. Payrolls at builders fell 8,000 after decreasing 20,000. Financial firms trimmed payrolls by 3,000 for a second consecutive month.

Service industries, which include banks, insurance companies, restaurants and retailers, subtracted 27,000 workers after cutting 12,000 in July. Retail payrolls fell by 19,900 after a drop of 18,100.

‘Clearest' Signal

‘‘We're losing jobs in all kinds of industries now,'' Roger Kubarych, chief U.S. economist at UniCredit Global Research in New York, said in an interview with Bloomberg Radio. ‘‘This is the clearest recessionary signal we've seen.''

Government offices hired 17,000 after an addition of 6,000 in July. That meant private payrolls fell by 101,000 in August.

Today's report brings the total decline in payrolls so far this year to 605,000. The economy created 1.1 million jobs in 2007.

Employment is among the indicators tracked by the National Bureau of Economic Research, the official arbiter of U.S. economic cycles, in calling a recession. The others are sales, incomes, production and gross domestic product.

The group defines a recession as a ‘‘significant'' decrease in activity over a sustained period of time, and usually takes six to 18 months to make a determination.

Consumer spending, which accounts for more than two-thirds of the economy, in July posted the biggest drop in four years after inflation.

Goldman's Forecast

The economy ‘‘is close to stagnating,'' Jan Hatzius, chief U.S. economist at Goldman Sachs Group Inc. in New York, said in an interview with Bloomberg Radio. In part because of continued gains in worker productivity, employers will keep cutting jobs, sending the unemployment rate to 6.75 percent next year, he said.

The average work week remained at 33.7 hours. Average weekly hours worked by production workers fell to 40.9 hours from 41 hours, while overtime decreased to 3.7 hours from 3.8 hours.

Workers' average hourly wages rose 7 cents, or 0.4 percent, to $18.14 from the prior month. Hourly earnings were 3.6 percent higher than August 2007. Economists surveyed by Bloomberg had forecast a 0.3 percent increase from July and a 3.4 percent gain for the 12-month period. Average weekly earnings increased to $611.32 from $608.96.

Productivity rises as US workers see real income cut

Productivity rises as US workers see real income cut

By Jerry White
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Corporations continue to slash tens of thousands of positions while workers still on the job are working harder for less money, according to reports on the US economy released this week.

The job-displacement firm Challenger, Gray & Christmas reported that businesses announced 88,736 job cuts in August, up 12 percent from last year. The total number of layoff announcements in the summer months of May to August rose to the highest level in six years, when the economy was recovering from the 2001 recession.

Friday’s Labor Department unemployment report is expected to show the loss of up to 75,000 jobs in August—the eighth consecutive month of losses. Reports on weekly jobless claims (up 15,000 to 444,000, the highest spike in five weeks) and a widely followed survey of private sector employers by Automatic Data Processing (ADP) bolstered expectations that Friday’s report would show an increase in the official unemployment rate, currently 5.7 percent nationally.

The ADP survey, which generally underestimates actual job losses, reported that private sector employment fell by a total of 33,000 jobs in August. The goods-producing sector cut 78,000 jobs, including 56,000 jobs in manufacturing, which saw its 24th consecutive monthly decline. The generally lower paying service sector added 45,000 positions in August, ADP reported.

Analysts anticipate a continued slowdown in the US economy as corporations confront higher fuel costs, tighter credit restrictions and signs that demand for exports is slowing due to the global character of the recession. In addition, the housing crisis, growth of unemployment and falling purchasing power are undermining consumer spending.

A report released by the US Federal Reserve Wednesday, based on a survey of its 12 district banks, noted that the service sector was “slowing” and the factory sector was “weak.” The real estate sector, it said further, showed no sign of bottoming out and lending activity was weak.

The worsening situation was underscored by reports that Ford Motor Company is having the slowest sales since World War II and Delphi Automotive may be forced to liquidate because the giant parts maker failed to find financial backers to help it out of bankruptcy. In addition, the International Air Transport Association said Wednesday that North American air carriers are expected to lose $5 billion this year, leading to a new wave of bankruptcies, consolidations and mass layoffs.

From the standpoint of corporate America and big Wall Street investors, the only “bright” side of the economic situation remains the fact that workers’ wages remain stagnant even as consumer prices continue to rise and output per worker has sharply increased.

The Labor Department reported Thursday that non-farm business productivity jumped at an annual rate of 4.3 percent in the second quarter, almost double the initial estimate of a 2.2 percent increase. Compared to the second quarter of 2007, productivity rose 3.4 percent, well above the average 2.5 percent rate between 2000 and 2007. This led unit labor costs to fall at an annual rate of 0.5 percent, also faster than expected.

The Wall Street Journal boasted, “Labor costs were up just 0.6 percent from one year ago, an indication that the economic slowdown and weakening jobs market is making it hard for workers to command higher wages.” This meant the Federal Reserve Board—which will meet September 16—“can be patient and hold interest rates steady as they assess economic and inflation risks, since high energy prices aren’t igniting the kind of wage-price spiral that plagued policymakers in the 1970s and early 1980s.”

There is an ongoing debate over whether to increase interest rates because such a move would lead to a further tightening of credit, worsen the position of the dollar and undermine any US economic recovery. Nevertheless the Fed is committed to move swiftly at the first sign of so-called wage inflation.

This has been its policy since the early 1980s, when then-Federal Reserve Chairman Paul Volcker—appointed by the Democratic Carter administration—increased interest rates to 20 percent and deliberately provoked the deepest recession since the 1930s. Plant closings and mass unemployment were used as a battering ram to break the resistance of the working class and roll back wages and living standards.

In 1978, 6 out of 10 labor contracts included cost-of-living adjustments to protect workers from the ravages of inflation. By 1988 that figure fell to 4 out of 10. Today, the unions have abandoned any such demands and the labor bureaucracy has negotiated one contract after another—in auto, telecommunications and other industries—that slashes the real income of their own members.

Airplane manufacturer Boeing, for example, is currently demanding its 27,000 union machinists accept an 11 percent increase in wages over three years, even though the Consumer Price Index rose at a 6.2 percent annual rate in August.

Corporations are also continuing to shift the burden of health care costs and pensions onto the backs of their employees. A survey by the Mercer consulting firm released Thursday said 59 percent of companies intend to keep down rising health care costs in 2009 by raising workers’ deductibles, co-pays or out-of-pocket spending limits.

The corporate assault on workers’ living standards has enjoyed the active support of both big business parties and will continue whether a Democrat or Republican wins the presidential election in November. It is significant that Volcker—who engineered the frontal assault on the working class in the 1980s—is now a prominent adviser to Democratic presidential candidate Barack Obama.

A recent report by the Congressional Research Service (“Globalization, Worker Insecurity, and Policy Approaches,” updated July 31, 2008) noted the results of the decades-long drive to increase the exploitation of American workers.

“While productivity growth or output per worker rose by 71% from 1980 to 2005, the real compensation of non-supervisory workers comprising 80% of the work force grew by 4%. The gap in the manufacturing sector was even greater: productivity rose 131%, while compensation of non-supervisors grew only 7%.”

This has produced a vast transfer of wealth from working people to the richest layers of the population. The report continues, “The share of national income accounted for by the top 1% of earners (as reported on tax returns) reached 21.8% in 2005—a level not seen since 1928. In addition to high labor earnings, income growth at the top is being driven by corporate profits which accrue mainly to those with high labor earnings. In 2006, corporate profits totaled 12.4% of national income, a level not reached in 50 years.”

Making Goliath Walk

Making Goliath Walk

Cheney in Georgia: Gunboat diplomacy in pursuit of oil

Cheney in Georgia: Gunboat diplomacy in pursuit of oil

By Tom Eley
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The US is continuing to ratchet up tensions with Russia in the aftermath of last month’s war in the Caucasus.

On Thursday, US Vice President Dick Cheney appeared in the Georgian capital of Tbilisi. Cheney reiterated US support for Georgia’s incorporation into NATO, while making bellicose denunciations of Russia.

Only a day earlier, Secretary of State Condoleezza Rice proposed the staggering sum of $1 billion in aid to the impoverished Black Sea nation.

During his visit, Cheney made statements tantamount to declaring Georgia an American military protectorate. Georgian President Mikheil Saakashvili, Cheney said, “can count on continued support and assistance from the United States. I assured the president as well of my country’s strong commitment to Georgia’s territorial integrity.”

“Georgia will be in our alliance,” Cheney promised. “NATO is a defensive alliance. It is a threat to no one.”

Georgia has yet to be included in the NATO alliance, with the major continental powers, especially Germany, so far objecting in spite of the Bush administration’s fervent efforts. This may change as a result of the recent war.

The $1 billion aid package the Bush administration is proposing is an enormous increase over last year’s funding, which amounted to $63 million, and would make Georgia the third largest recipient of US foreign aid, trailing only behind Israel and Egypt. About half of the money would be approved by this year’s Congress, while the other half would be approved at the start of the next congressional session.

Rice claimed that the money was not earmarked for rebuilding Georgia’s military, which disintegrated under Russian attack during the war. However, there is little reason to believe the money will not be used for precisely that purpose once in Georgian coffers. A Guardian report stated that Cheney would “discuss Georgia’s long shopping list of military hardware” during the visit.

In a Wednesday editorial headlined “Help for Georgia,” the New York Times, although allowing that it felt “nervous” about Cheney’s trip, nonetheless hailed the proposed appropriation for Georgia and the hard anti-Russian stance assumed by the Bush administration. According to the Times, “Moscow needs to understand that the West will not be intimidated into abandoning a struggling democracy.”

US machinations in the Black Sea have nothing to do with democracy. Instead, two closely related aims animated Rice’s proposal for massive financial assistance to Georgia and Cheney’s nearly simultaneous visit. First, Washington is preparing for war against Russia. Second, it is seeking to secure oil and natural gas pipelines outside of Russia’s orbit.

Cheney’s visit to Georgia came a day before a planned visit to Ukraine, another state hostile to Russia, and only two weeks after Poland agreed to put in place a US missile system designed to shoot down nuclear missiles, clearly directed against Russia.

The same day Cheney arrived in Georgia the US sent yet another warship, the flagship of the Mediterranean fleet, the USS Whitney, into the Black Sea to Georgia, ostensibly on a humanitarian mission.

This is classic gunboat diplomacy. But Washington is also making advanced preparations for war against Russia. This would include a nuclear first strike, which the US political and military elite believe the missile shield will allow them to carry out.

A day before visiting Georgia, Cheney was in Azerbaijan, home to the Baku-Tbilisi-Ceyhan oil and the Baku-Tbilisi-Erzurum gas pipelines, the only non-Russian-dominated routes for Caspian oil and gas bound for the European market. Georgian national security chief Alexander Lomaia said the visits, taken together, are “a very clear sign that alternative energy routes and sources will be secured.”

Azerbaijan, under President Ilham Aliyev, has recently attempted to chart something of a middle course between Washington and Moscow. It has remained largely neutral in its public pronouncements regarding Russia’s standoff with the West over Georgia, and Moscow has been attempting to court the Aliyev government. Azerbaijan has even begun to route some of its oil through a Russian pipeline, citing the instability in Georgia as a reason. Analysts believe that Cheney’s visit was an attempt to cajole Baku back into line.

Cheney also took time during his brief stop in Azerbaijan to hold private talks with the local heads of the BP and Chevron oil companies.

While in Azerbaijan Cheney all but declared that he is seeking to form a military and oil/gas axis in the region. Cheney pointed to the importance for US interests that “energy export routes are diverse and reliable” and that “additional routes for energy exports that ensure the free flow of resources” would be needed, promising to enlist the aid of Turkey in protecting and increasing the number of energy pipelines. The effort is calculated to undermine the basis of Russia’s economic resurgence, its oil exports.

A second purpose for such a coalition would be for preparation of war against Iran. Turkey and Azerbaijan border Iran, while Georgia could be used as a staging ground and base for air operations.

US attack inside Pakistan threatens dangerous new war

US attack inside Pakistan threatens dangerous new war

By Peter Symonds
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A ground assault by US Special Forces troops on a Pakistani village on Wednesday threatens to expand the escalating Afghanistan war into its neighbour. Pakistan is already confronting a virtual civil war in its tribal border regions as the country's military, under pressure from Washington, seeks to crush Islamist militias supporting the anti-occupation insurgency inside Afghanistan.

The attack, which left up to 20 civilians dead, marks a definite escalation of US operations inside Pakistan. While US Predator drones and war planes have been used previously to bomb targets, Wednesday's raid was the first clear case of an assault by American ground troops inside Pakistani territory. The White House and Pentagon have refused to comment on the incident but various unnamed US officials have acknowledged to the media that the raid took place and indicated that there could be more to come.

The attack was unprovoked. US troops landed by helicopter in the village of Jalal Khei in South Waziristan at around 3 a.m. and immediately targetted three houses. The engagement lasted for about 30 minutes and left between 15 and 20 people dead, including women and children.

A US official acknowledged to CNN that there may have been women and children in the immediate vicinity but when the mission began "everyone came out firing from the compound". Even this flimsy justification for a naked act of aggression is probably a lie. "It was very terrible as all of the residents were killed while asleep," a villager Din Mohammad told the Pakistan-based International News.

The newspaper provided details of the dead and injured: nine family members of Faujan Wazir, including four women, two children and three men; Faiz Mohammad Wazir, his wife and two other family members; and Nazar Jan and his mother. Two other members of Nazar Jan's family were seriously wounded.

The US and international media have described the Angoor Adda area around the village as "a known stronghold of the Taliban and Al Qaeda" but offered no evidence to support the claim. A villager, Jabbar Wazir, told the International News: "All of those killed were poor farmers and had nothing to do with the Taliban."

In comments to the International Herald Tribune, a senior Pakistani official branded the raid a "cowboy action" that had failed to capture or kill any senior Al Qaeda or Taliban leader. "If they had gotten anyone big, they would be bragging about it," he commented.

The attack has provoked outrage in Pakistan. Pakistan's Foreign Ministry issued a statement branding the attack as "a gross violation of Pakistan territory" and summoned US ambassador Anne Patterson to provide an explanation. North West Frontier Province (NWFP) governor Owais Ahmed Ghani declared that "the people expect that the armed forces of Pakistan would rise to defend the sovereignty of the country". He put the number killed at 20.

Pakistani military spokesman Major General Athar Abbas said the raid was "completely counterproductive" and risked provoking an uprising even among those tribesmen who have previously supported the army's operations in the border areas.

The International News reported: "Angry villagers later blocked the main road between Pakistan and Afghanistan in Angoor Adda by placing the bodies of their slain tribesmen on the road. They chanted slogans against the US and NATO military authorities for crossing the border without any provocation and killing innocent people."

The US raid has compounded the political crisis inside Pakistan, where the selection of a new president is due to take place tomorrow. The ruling Pakistan Peoples Party (PPP) has been engaged in a delicate balancing act—continuing to support US demands for a crackdown by the Pakistani military along the border with Afghanistan, while trying to defuse widespread anger and fend off accusations that it is a US puppet.

Reaffirming his support for the Bush administration's bogus "war on terror", PPP presidential candidate Asif Ali Zardari declared in a column in yesterday's Washington Post: "We stand with the United States, Britain, Spain and others who have been attacked." Zardari went on to promise that he would ensure that Pakistani territory would not be used to launch raids on US and NATO forces inside Afghanistan.

However, as PPP spokesman Farhatullah Babar explained, the US attack was politically compromising. "We have been very clear that any action on this side of the border must be taken by Pakistani forces themselves," he told the Associated Press. "It is very embarrassing for the government. The people will start blaming the government of Pakistan."

An expanded war

The decision to launch Wednesday's attack was undoubtedly taken at the top levels of the White House and Pentagon. As the New York Times reported in articles earlier this year, a high-level debate has been taking place in Washington over the use of US Special Forces inside Pakistan as well as the intensification of existing CIA operations, which include Predator missile strikes.

A meeting in early January involved Vice President Dick Cheney, Secretary of State Condoleezza Rice, Joint Chiefs of Staff chairman Admiral Mike Mullen and top national security and intelligence officials advisers. According to the New York Times on January 6, options discussed included "loosening restrictions on the CIA to strike selected targets in Pakistan" and operations involving US Special Operations forces, such as the Navy Seals.

The Times reported on January 27 that then Pakistani President Pervez Musharraf rejected proposals put by US Director of National Intelligence Mike McConnell and CIA Director Michael Hayden for an expanded American combat presence in Pakistan, either through covert CIA missions or joint operations with Pakistani security forces. While apparently accepting the refusal, the US intensified pressure on Pakistan to bring its border areas under control.

As the anti-occupation insurgency has expanded in Afghanistan, claiming a growing number of US and NATO casualties, Pakistan has become a convenient scapegoat. Washington has repeatedly accused the Pakistani military of failing to suppress Islamist militia and alleged that Pakistani military intelligence is actively supporting anti-US guerrillas inside Afghanistan.

Admiral Mullen has held five meetings since February with his Pakistani counterpart, army chief General Ashfaq Parvez Kayani, to press for tougher action. The most recent took place last weekend aboard the aircraft carrier USS Abraham Lincoln, stationed in the Arabian Sea. In comments to CNN, a US official "declined to say" whether there were any new agreements for US troops to operate inside Pakistani airspace or on the ground to attack Taliban and Al Qaeda.

Whether the Pakistani military quietly approved Wednesday's attack or not, the Bush administration is making clear that it intends to extend the war into Pakistan. Citing top American officials, the New York Times reported on Wednesday that the raid "could be the opening salvo in a much broader campaign by Special Operations forces against the Taliban and Al Qaeda inside Pakistan, a secret plan that Defence Secretary Robert Gates has been advocating for months within President George W. Bush's war council".

This utterly reckless policy, which risks the eruption of a US war against Pakistan, is bipartisan in character. In fact, Democratic presidential candidate Barack Obama has repeatedly declared his support for broadening the "war on terror" through unilateral US attacks on insurgents based inside Pakistan. His candidacy has been strongly backed by sections of the US establishment that have been critical of the Bush administration's invasion of Iraq for undermining US interests. Far from opposing aggressive US military action, Obama has become the political vehicle for shifting its focus to Afghanistan and Pakistan as the means of advancing US strategic interests in Central Asia and the Indian subcontinent.

The US attack on the village of Jalal Khei is another demonstration that the shift in policy, with all its potentially catastrophic consequences, is already underway.

FBI Wanted Obama Plotters Charged, But A Rove Appointee Said No

FBI Wanted Obama Plotters Charged, But A Rove Appointee Said No

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We noticed last week that it was awfully peculiar that Colorado's U.S. Attorney, Troy Eid, had so airily dismissed conspiracy charges against the three white-supremacist tweakers who were caught planning to assassinate Barack Obama at last week's Democratic National Convention in Denver.

Now it turns out that those suspicions were fully warranted:

KUSA - 9Wants to Know has learned three men in Denver planned to assassinate U.S. Senator Barack Obama during the Democratic National Convention in Denver by sneaking into one of his events and shooting him with a gun hidden inside of a camera, according to federal court records.

Nathan Johnson's girlfriend, whom 9NEWS is not naming because she's a juvenile, said it would have to be a suicide mission.

The plot is similar to that in the 1992 movie "The Bodyguard" starring actors Kevin Costner and Whitney Houston. In the movie, Costner stops an assassination attempt against Houston by spotting a weapon hidden inside a gutted-out TV camera.

Johnson, Shawn Adolf and Tharin Gartrell all thought that Obama had a suite in the third floor of the Hyatt hotel, where they were staying. In fact, the Senator was staying in another Denver Hotel.

The men were doing methamphetamine inside the hotel with two women on Aug. 23 discussing the plot to kill Obama, according to federal records.

Adolf said "it would not matter if he killed Senator Obama because police would simply add a murder charge to his pending charges," according to the records. There were seven outstanding warrants for Adolf's arrest.

The underage woman told law enforcement that Adolf also talked about using "a high-powered rifle 22-250 from a high vantage point" to shoot Senator Obama during his acceptance speech at INVESCO Field at Mile High during the DNC.

Even more significant, beyond the details of the plot, was the fact that, as the Colorado Independent notes, the FBI asked for more serious charges to be filed and were turned down.

When police searched the hotel rooms and cars the men were using, they confiscated meth, needles, laptops, cell phones, a black mask, books indicating check fraud and forgery, bags of new clothes, tactical pants and bar coupons.

Based on the evidence, FBI special agent Robert Sawyer believed there was probable cause to charge the men with conspiracy to kill Senator Obama. However, US Attorney Troy Eid last week said there is insufficient evidence to indicate a true threat, plot or conspiracy against the senator.

Note the language used by Eid in dismissing the gravity of the case: the case isn't serious because they were "more aspirational, perhaps, than operational"? Well, when it was the Liberty Seven -- black Muslim men who were described by the FBI as "aspirational rather than operational" -- there was no hesitation by the Justice Department in bringing charges.

Another funny thing: When a black man in prison sent a threatening letter containing baby powder to John McCain, Troy Eid brought down the full force of the law, complete with press conferences and public declarations that "We won't stand for threats of this kind in Colorado."

But when it's a claque of white men with rifles, disguises, and all the accoutrement of a conspiracy – as well as open admissions to it – Troy Eid isn't worried. After all, they just a bunch of harmless, tweakers, right? … Just like little Timmy McVeigh.

But then, when you're a Karl Rove operative promoted to deliver justice the Republican way, as Troy Eid is, that's the way the scales fall. As Marcy reported at the time, Eid in fact nearly didn't get the Colorado job because of concerns about "improper lobbying."

His failure to take this matter seriously is itself a serious matter. When law-enforcement officials let this stuff slip by, they send a dangerous message to other would-be plotters out there. And next time, they may in fact be more competent.

Soldier suicide rate may set record again

Soldier suicide rate may set record again

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Soldier suicides this year could surpass the record rate of last year, Army officials said Thursday, urging military leaders at all levels to redouble prevention efforts for a force strained by two wars.

So far this year, there are 62 confirmed suicides among active duty soldiers and Guard and Reserve troops called to active duty, officials said. Another 31 deaths appear to be suicides but are still being investigated.

If all are confirmed, that means that the number for 2008 could eclipse the 115 of last year - and the rate per 100,000 could surpass that of the civilian population, Col. Eddie Stephens, deputy director of human resources policy, said at a Pentagon press conference.

"Army leaders are fully aware that repeated deployments have led to increased distress and anxiety for both soldiers and their families," Army Secretary Pete Geren said.

"The Army is committed to ensuring that all soldiers and their families receive the behavioral health care they need," he said in a statement distributed at the press conference.

To try to stem the continuing high number of suicides, the Army continues to increase the number of staff psychiatrists and other mental health staff as well as chaplains, is issuing a new interactive video for troops and will be adding a new program to basic training starting in January, said Brig. Gen. Rhonda L. Cornum, an assistant Army surgeon general.

"There are no simple problems and there are no simple solutions," Cornum said. "There is no program that has been shown to be truly effective at preventing suicides ... Success will be the sum of a number of smaller steps."

Global Realignment: How Bush Inspired a New World Order

Global Realignment: How Bush Inspired a New World Order

By Ramzy Baroud

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The series of unfortunate and costly decisions made during the two terms of the Bush administration, combined with economic decline at home, might devastate the US's world standing much sooner than most analysts predict. What was difficult to foresee was that the weakening of US global dominance, spurred by erratic and unwise foreign policy under Bush, would re-ignite the Cold War, to a degree, over a largely distant and seemingly ethnically-based conflict -- that of Georgia and Russia. Who could have predicted a possible association between Baghdad, Kabul and Tbilisi?

But to date the decline of US global power to the advent of the Bush administration, or even the horrific events of 11 September 2001, is not exactly accurate. The rapid collapse of the Soviet Union and the unravelling of the Warsaw Pact -- especially as former members of that pact hurried to joined NATO in later years -- empowered a new breed of US elite who boasted of the economic viability and moral supremacy of US-styled "Capitalism and Democracy". But a unipolar world presented the US leadership with an immense, if not an insurmountable task.

While 9/11 and a gung-ho president presented a convenient opportunity to reassert US global dominance, action was taken the moment the Soviet Union collapsed. Such efforts, however, were not accentuated until 1997, with the establishment of the Project for the New American Century (PNAC), a think tank from which many neo-conservative policy advisors operated. Their aim was "to promote American global leadership... [which] is both good for America and good for the world." William Kristol and Robert Kagan, PNAC founders, were inspired by the Reaganite policy of "strength and moral clarity". But that supposedly inspiring model was justified on the basis of the Cold War, which no longer existed. Fashioning an enemy was a time-sensitive and essential task to justify the repositioning of US power to reclaim domains that were left vacant with the disappearance of the bipolar international system, which existed since World War II.

Even the PNAC's more recent report, Rebuilding America's Defences: Strategies, Forces, and Resources For a New Century, published in 2000, appeared of little relevance and urgency. It expressed the "belief that America should seek to preserve and extend its position of global leadership by maintaining the pre-eminence of US military forces". The report would have been another neglected document were it not for the terrorist attacks of 9/11, which turned it into a doctrine defining US foreign policies for nearly a decade.

The wars and occupation of Afghanistan and Iraq were aimed at strengthening the US hand in protecting its interests and managing its international affairs. Afghanistan's position was strategic in warding off the growth of the rising powers of Asia -- aside from its military and strategic value, it was hoped to become a major energy supply route -- while Iraq was to provide a permanent US military presence to guard its oil interests in the whole region and to ensure Israeli supremacy over its weaker, but rebellious Arab foes.

The plan worked well for a few weeks following the declaration of "Mission Accomplished" in Iraq. Since then, the US has learned that managing world affairs with a decidedly military approach is a recipe for disaster. Faced with foreign occupation, Iraqis fought back, creating a nightmare scenario and promising US defeat in their country. The US's original plan to exploit the country's fractious ethnic and religious groupings also backfired, as shifting alliances made it impossible for the US to single out a permanent enemy or a long-term ally. In Afghanistan, the picture is even more bleak as the country's unforgivable geography, the corruption of US local allies, resurgence of the Taliban, and the US-led coalition's brutal response to the Taliban's emboldened ascension, has rendered Afghanistan a lost cause by any reasonable military standard.

But the trigger-happy mentality that has governed US foreign policy during the Bush years is no longer dominant and has been since challenged by a more sensible, dialogue-based foreign policy approach, as championed, reluctantly, by Democratic presidential nominee Barack Obama. The change of heart is not entirely moralistic, however, but largely pragmatic. According to a survey conducted jointly by Foreign Policy magazine and the Centre for a New American Security, published 19 February 2008, 88 per cent of present and former US military officers believe that the demands of the Iraq war alone have "stretched the US military dangerously thin". Although not "broken", 80 per cent believe it is "unreasonable to expect the US military to wage another major war successfully at present", as reported by CNN. Such estimation is not too different from similar assessments provided by top US military commanders, most of who found their way to early retirement for similar reasons.

The new military limitations faced by the US in the Middle East have also resulted in the weakening of US political sway and standing. More, its regional allies have also suffered one blow after another: Israel in Lebanon, Georgia in South Ossetia, US allies in Venezuela and other South American countries, etc. Indeed, it is a matter of time before a challenger to US global hegemony arises and tests US resolve under new circumstances. While growing US involvement in Eurasia and its missile defence shield was considered part and parcel of the neo-con plan for "rebuilding America's defences", it was considered by Russia a threat to its national security.

The Georgian invasion of South Ossetia represented a golden opportunity for Moscow to send an unmistakable message to Washington. By crushing the US-Israeli trained Georgian army, Russia declared itself a contender to unchallenged US global dominance, which had lasted for nearly two decades. Countries such as Iran and Syria are quickly warming up to the new Russia, as the latter seeks to rebuild its own alliances and defences.

The nature and the direction of the US-Russian confrontation are yet to be determined with any reasonable preciseness. Internal and external factors for Russia itself (corruption, the oligarchs, and its ability to court a stable alliance) will all prove consequential in the current confrontation. What is clear, however, is that the upcoming US president will find himself face-to-face with a drastically altered world order, one that is defined by military pandemonium, national and global economic decline, and the rise of new powers, all vying to fill a widening, chaotic power vacuum, provided courtesy of the Bush administration.

Police Arrest 200 in March on GOP Convention

Police Arrest 200 in March on GOP Convention

By RYAN J. FOLEY and MARTIGA LOHN

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Police surrounded and arrested about 200 protesters Thursday night after a lengthy series of marches and sit-ins timed to coincide with Sen. John McCain's acceptance of the Republican Party's nomination for president.

Caught up in the clash were several reporters assigned to cover the event, including Amy Forliti and Jon Krawczynski of The Associated Press. Officers ordered them to sit on the pavement on a bridge over Interstate 94 and to keep their hands over their heads as they were led away two at a time.

The arrests came three days after AP photographer Matt Rourke, also on assignment covering the protests, was arrested. He was released without being charged Monday after being held for several hours. Forliti and Krawczynski, who were among at least 19 members of the media detained, were issued citations for unlawful assembly and released.

Ramsey County Sheriff Bob Fletcher said the St. Paul police department and its police chief decided that members of the media would be issued citations and released.

Fletcher said he expected most of the charges would be for unlawful assembly.

"Whoever got arrested was whoever didn't disperse and was still on the bridge," Fletcher said. "The tactic of blocking people on the bridge could very well have prevented a lot of activity later tonight. Clearly there were a number of people with no intention of being law-abiding tonight."

The confrontation resulted in at least 200 arrests, Fletcher said. Protesters had gone ahead with a planned march near the state Capitol even though their permit had expired.

The protest began at 4 p.m. with a rally on the Capitol Mall. When marchers tried an hour later to march from the Capitol to the Xcel Energy Center, where McCain accepted his party's nomination for president, they were stopped by lines of police in gas masks and riot gear.

Police told them their permit to march expired at 5 p.m.

Marchers tried to cross two different bridges leading from the Capitol to the Republican National Convention site but were blocked by the officers backed by snow plows and other vehicles.

A cat-and-mouse game followed as protesters moved around the Capitol area, splintered, and then organized into a marching force again. The size of the crowd varied from a high of about 1,000 down to a hundred and back to around 500.

About three hours into the standoff, about 300 protesters sat down on a major thoroughfare and police closed the four-lane boulevard. Officers then set off smoke bombs and fired seven percussion grenades, causing protesters to scatter.

Some of the scattering protesters entered a residential area north of the Capitol. Later, at least three smoke bombs were discharged in the area of apartments and houses.

About two hours into the standoff, police began arresting people and police were still processing people more than three hours later.

"The important thing is even though we didn't have a permit to march, people have decided they want to keep protesting despite all these riot police," said Meredith Aby, a member of the Anti-War Committee.

Even as protesters were being arrested, the mood was much more relaxed than earlier in the week. It even turned festive at times.

More than 600 people have been arrested in the past week, most on Monday, when violence broke out at the end of another anti-war march.

Americans Who Have Insurance —But Still No Access To Care

Americans Who Have Insurance —But Still No Access To Care

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A friend who lives in Boston complained, not long ago, about not being able to find a physician. In Boston? “Come on,” I said. “This is like claiming you couldn’t find a liquor store.”

“They’re all oncologists and cardiologists,” he grumbled. “Last week I cut my hand badly enough that it needed stitches. I have good insurance. But I couldn’t get an appointment with my family doctor—or any of my friends’ doctors. I didn’t want to spend hours in the ER. So I wound up going to my sister’s house. She sewed it up at her kitchen table.”

His experience is not as unusual as it sounds. Some 56 million Americans do not have a regular source of care according to the National Association of Community Health Centers (NACHC) -- even though many of them do have insurance. The problem is a shortage of primary care physicians (PCPs) in many parts of the country, particularly, but not exclusively, in poorer communities.

Even Docs Have to Call In Favors

Not long ago, Bob Wachter, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco (UCSF) , and author of Wachter’s World warned his readers: “The Long-Awaited Crisis in Primary Care: It’s Heeere.”

Indeed, if you try get an appointment at UCSF’s general medicine practice, you will find that it is “closed” –even if you are an UCSF physician. They just aren’t taking any new patients. “Turns out we’re not alone,” Wachter adds. “Mass General also is not accepting any new primary care patients.”

He calls attention to “to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called ‘The Doctor Can’t See You Now,’ is the best reporting on this looming disaster I’ve heard .

Wachter summarizes highlights: “Getting a ‘regular doctor’ (a PCP) at Mass General now takes the combination of cajoling, pleading, and knowing somebody generally referred to as ‘working the system.’ In other words, the process of finding a primary care doc is now like getting a great table in a trendy restaurant.

“The report also makes clear that providing more ‘access’ through expanded insurance coverage won’t do the trick,” Wachter explains. “Massachusetts, you’ll recall, markedly expanded its coverage a couple of years ago (in legislation proposed by that ex-liberal, Mitt Romney). Scott Jasbon, a 47 year-old contractor/bartender, thought he was all set when he enrolled in one of Massachusetts’ subsidized health plans. He was wrong.

“‘I received a card with my doctor's name on it and I was told that was my primary care physician,' Jasbon recalls. “’I called the office. They told me that they no longer took the insurance. So then I went through every list of doctors in Sandwich, in the book, called each doctor, and each doctor told me the new plan that I received, they, no one took the insurance… I knew that there was something wrong with me, and I was explaining to each doctor actually as I called them, "I'm having problems urinating." Hot flushes, I was hot all the time. I knew something was wrong, and I couldn't get anybody to take care of me.’”

“Jasbon ended up in an ED [emergency department ], where he was diagnosed with diabetes and hypertension. The ED staff helpfully suggested that he should think about getting a PCP. . .”

Readers commenting on Wachter’s post confirmed the story. One wrote: “I’m a physician and we moved to a new city a couple of years ago. I had to twist arms and call in favors to get myself and my wife PCPs--and we have ‘good’ insurance and no significant health problems (yet).”

At the Center of Healthcare Reform: A Medical Home for Every American

In the meantime, health care reformers talk about how, once we have national health insurance, we will create “medical homes” where primary care physicians will, at last, be rewarded for taking the time to co-ordinate patient care.

In a recent issue of the New England Journal of Medicine, for instance, a panel on “The Health of the Nation: Coverage for All Americans,” focused on the need for a “patient-centered home” that would be accountable for overseeing patient care.

The panel began by discussing the difficulties primary care physicians face today. Dr. Arthur Caplan, a professor of bioethics at the University of Pennsylvania, summed up the PCP’s lament: “I don’t have time to talk to anybody . . . . I don’t get reimbursed enough. I’m swamped by paperwork. I don’t have time for anything. And I answer to a bunch of— non-MD folks who are telling me what to do half the time. . . ..”

By contrast, in the brave new world of universal coverage, the panel members agreed, primary care doctors should be rewarded for talking to their patients, “making sure that patients are getting appropriate counseling” and that “they're up to date with their preventive care.” While specialists may see only a single body part, the PCP will have “the big picture.”

Commonwealth Fund president Karen Davis explained how physicians would be compensated: “in addition to fee for service [the practice would receive] a monthly . . . fee for being a medical home. It's a blended system of payment, which has worked very well in Denmark, where people have well-established relationships with primary care and compensation for primary care is on a par [with] or even higher than compensation for specialty care.

Former U.S. Senator Dr. Bill Frist then zeroed in on electronic medical records, describing them as key to helping the primary care doctor keep track of the specialists his patient is seeing, what those doctors are prescribing, and what they are recommending.

Davis agreed: When it comes to healthcare information technology, she noted, “we are way behind. One fourth of American primary care physicians have electronic systems. The Netherlands, New Zealand, Denmark, UK. . . ninety percent of physicians have totally electronic offices. . . What’s different in those countries? The government was willing to set standards on what is an acceptable system. . ..

And “in Denmark,” Davis added, “they found once they got this up and running, they were saving 50 minutes a day. Because it was so much easier to get the information they needed, to order a prescription or authorize a refill of a prescription. It really pays off. . . . But it needs leadership. National leadership...”

Others on the panel jumped into the conversation . . . . Until finally, Dr. Steven Schroeder a professor of health and health care at UCSF, interrupted:

“I think there is an elephant in the living room that we’re not talking about. All these comments presume the persistence of a vibrant primary care system.

“But,” Schroeder observed, “if [as we discussed earlier, doctors are] telling their sons and daughters and nephews not to go into medicine, those that [do] go into medicine know for sure they don’t want to go into primary care. . . . They want to go on what they call now the road to happiness. So this means they want to go into Radiology, Ophthalmology, Anesthesia, Dermatology . . . It’s an old-fashioned road. And why do they want to do that? They want to do that because they’re coming out with huge debts. Because unless we fix the payment system, they’re not gonna get the kind of income that they’d like.”

But the problem isn’t just the relatively low pay that primary care doctors receive. Students are also “more attracted to shift work, so they don’t have to worry about patients after they leave,” Schroeder added. “They want that eight-to-five job. And then finally, they don’t like all the hassles that we’ve been hearing about” in primary care.

“So the electronic medical record by itself isn’t gonna fix that,” Schroeder warned. “And unless we do more fundamental surgery on making primary care a more compelling field...in the future in primary care may will be practiced by [people] other than doctors. And maybe,” Schroeder allowed, “this isn’t a bad thing...”

The discussion swirled forward, as panel discussions do, without really facing up to the implications of Schroeder’s comment. But he was asking exactly the right question about the promise of “a medical home for every American.” Who, exactly, is going to be at home?

Once again, making sure that everyone has health insurance is not synonymous with ensuring that everyone has health care.

A Dearth of Doctors

Because the pay is low, the pace is hectic and the hours are long, fewer and fewer medical students are becoming family doctors or internists. Over the past decade, medical schools have witnessed a 22 percent drop in the share of graduates who choose to become “generalists” rather than specialists. A 2008 NACHC study estimates that to provide services to medically disenfranchised Americans who don’t have a regular source of care, we would need up to 60,000 more primary care professionals.

Instead, the pool is shrinking. Fed up with a broken system, older PCPs are retiring early. And younger PCPs are switching specialties. Wachter points to an “ABIM study [which] found that 10 years after initial board certification, approximately 21% of general internists were no longer in the practice of general medicine [vs. 5% of subspecialists leaving their field].

“The dwindling number of PCPs who remain in practice are being far more discriminating about the patients – and insurance payments – they will accept,” Wachter adds. “With Medicare reimbursement tightening . . . and Medicaid reimbursement near Starbucks barista levels . . . the result is primary care ‘access’ that sounds good in a press conference but is not real.

“You might ask, won’t the existing PCPs need to accept even these low insurance payments? After all, they need to see some patients to generate an income. Well, as it turns out, no,” writes Wachter, answering his own question. “The remaining PCPs are in such demand . . . that they can afford to limit their practice to patients with better paying commercial insurance.”

In the NEJM panel discussion Schroeder suggested that “someone other than doctors” may wind up doing the job. I’m assuming that he’s referring to nurse practitioners. And certainly, nurse-practitioners, working with primary care doctors, pediatricians or geriatricians could screen patients, take care of the least complicated cases, and give the doctor the 30 or 40 minute he needs to talk to—and listen to—patients with more difficult problems.

But as Niko’s post below reveals, we also face a serious shortage of nurses. Indeed, the same 2008 NACHC study says that, in order to staff medical homes, we would need up to 44,500 additional nurses.

Boosting the pay for physicians and nurses willing to co-ordinate patient seeing might draw more young professionals into primary care. But expanding the pool of primary care doctors and nurse is rather like drilling for oil. Even if we raised their fees tomorrow, it would still take many years for students to move through the pipeline, and into the workforce.

Moreover, it is important to keep in mind that it is not just the low salaries that med students find daunting. “Some primary care educators used to say that the problem was that students didn’t have opportunities to see the real practice of primary care docs – if they did, they’d recognize the subtle satisfactions and be more inclined to enter the field,” Wachter notes. “But an upcoming paper by UCSF’s Karen Hauer and others demonstrates that such exposure actually discourages trainees from choosing primary care. Primary care docs are frustrated and demoralized, and most of them are honest enough to share their angst with their students. In other words, It’s The Practice, Stupid.

The Lack of PCPs Creates Holes in the System

In the meantime, as Kevin M.D. pointed out not long ago, the lack of primary care physicians helps explain the number of hospital re-admissions.

Kevin began by pointing to an op-ed in the Boston Globe which urged Medicare to stop paying for patients who are rehospitalized within 30 days after leaving the hospital. “These readmissions are often avoidable,” the op-ed’s author wrote. “And if Congress focuses on reducing the need for rehospitalization in areas where the practice is most common, Medicare could save many billions of dollars.

Kevin took issue: “Not surprisingly, op-eds like these are written by non-physician policy makers, and further puts doctors in increasingly difficult situations. Physicians are pressured by hospitals to discharge patients and keep the turnover high, which increases revenue for the hospital. Now they're taking it from the other end, with this proposal not to pay for readmissions. It would be nice if someone advocated the proper support system be put in place first before acting on these ideas.

“The major reason for readmissions is inappropriate follow-up, which can be directly traced to a lack of primary care access. Solve the primary care shortage, and readmissions will go down.”

This makes sense. Granted, part of the problem is that some hospitals don’t take enough time explaining medications to patients—and making it clear what follow-up treatment they will need. But for proper follow-up, patients do need that “medical home”—a primary care physician who knows that his patient was in the hospital, and why, and what the instructions are for follow-up care. The primary care doctor should have the patient’s hospital records, a list of medications that he is supposed to take, the dosages, and recommendations for physical therapy or other treatments.

But if the patient does not have a primary care doctor, who is going to pick up the slack? The hospital can’t follow him home.

The lack of PCPs also is putting added stress on emergency care. Patients who cannot get an appointment with a primary care doctor are crowding ERS. From 1996 to 2006 Emergency room visits jumped more than 32 percent from 90.3 million according to the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention. And this is not because more Americans lack insurance.

To the contrary, the study found the proportion of emergency visits by the uninsured had not changed substantially between 1992 and 2005, although the number of overall visits went up 28 percent. The survey found that people in the highest income bracket - in excess of 400 percent of the federal poverty level -- accounted for an increasing portion of emergency room visits, while the lowest income brackets remained virtually unchanged.

So much for the theory that illegal immigrants are responsible for the excruciatingly long waits in the nation’s ERs.

Who Suffers

“The state of primary care is not only sad, it is incredibly stupid,” Wachter concludes. “ Mountains of research have demonstrated that primary care-based care is less expensive – without access to primary care doctors, patients get their basic care in emergency rooms, or from subspecialists, or not at all. In any case, care is fragmented, technology over-intensive, and wickedly expensive.”

Yet, “the forces of inertia getting in the way of solving the primary care crisis are so strong that only a very powerful implosion will create the political wherewithal to overcome them. Specialists don’t want to forgo income, medical students will continue to vote with their feet, existing primary care docs have resigned themselves to more of the same and are hunkering down for retirement, and many patients are perfectly happy bypassing primary care docs to get their care from hordes of subspecialists. The patients who take the biggest hit, of course, are poor and middle class folks with chronic diseases – even those with insurance – who can’t find a PCP and can’t afford a VIP doctor, and who therefore live in perpetual fear of the next crisis.”

In Part II of this post, I’ll explore how specialists might become part of the solution. As Dartmouth researchers argue in "Tracking the Care of Patients with Severe Chronic Illnesses: Dartmouth Atlas of HealthCare 2008": “training more primary care physicians alone won’t solve the problem of . . ..the lack of co-ordination in our fragmented health care system.” If we want to contain costs while lifting quality, specialists, too, will need to begin thinking in terms of the “big picture.”