Health-Care Reform

Is universal coverage too expensive?

By Marcia Clemmitt, August 28, 2009

For the first time in 15 years, health-care reform has moved to the top of Washington's agenda. A new Democratic president and Democratic majorities in the House and Senate have declared two major goals: increase coverage to near-universal levels and stop the huge, annual cost increases that are gradually putting health care out of reach for small businesses and low-income families. Most proposals would subsidize insurance for low-income Americans and create new, government-regulated insurance markets for those without employer-provided coverage. One controversial scheme would create a publicly run insurance plan and require individuals to buy coverage. Congressional Republicans and some Democrats argue, however, that the plan would be too expensive and would allow government to meddle too much in health care. And at angry town hall meetings in August, some even charged, incorrectly, that the arrangement would establish “death panels” that would deny treatment to elderly and disabled patients.

The Issues:
* Could a single-payer health-care system work for America?
* Should reform include a publicly run health insurance plan?
* Would universal coverage be too expensive?

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Memories of Covering Sen. Edward M. Kennedy

By Marcia Clemmitt, Staff Writer, CQ Researcher, Aug. 26, 2009.

This morning, as I put the finishing touches on a long piece on health reform (to be published on Aug. 28), the death of Sen. Edward M. Kennedy, D-Mass, calls up many memories of watching “the lion of the Senate” in action.

As a newbie health-care reporter in the mid-1990s, I quickly learned that there was virtually no such thing as a health-related bill that Kennedy and his staff were not closely involved with, whether or not the Democrats controlled the Senate. Over the years, I’ve spent countless hours in committee hearings and back-office briefings led by Kennedy and his impressive staff, on health-related issues ranging from AIDS and the Food and Drug Administration to Medicaid for children with disabilities.

I’m especially struck by Kennedy’s dogged perseverance in the cause of universal coverage. His long career in the Senate – Kennedy served since November 1962 – was marked by an unrelenting focus on, someday, somehow, ensuring that all Americans would have reliable, affordable health insurance.

Just as striking, though, has been his willingness to develop new, ingenious legislative proposals and work across the aisle with various Republican colleagues in pairings that invariably were referred to as “strange bedfellows.” Why the willingness to compromise? Kennedy realized the health-care industry, Congress and, perhaps, much of the public had little stomach for sweeping change.

In the 1960s and early ’70s, Kennedy actively championed universal coverage through a single-payer health-care system. He held hearings around the country and issued a report on “The Health Care Crisis in America,” ultimately proposing his “Health Security Act,” – a universal single-payer plan with a national health budget and no consumer cost-sharing, paid for through a payroll tax.

With Republican President Richard M. Nixon in the White House, however, the times weren't ripe for a European-style single-payer proposal. Nevertheless, Nixon, too, was worried about the number of uninsured Americans, as well as the rapidly rising health-care costs that threatened the coverage of many more. He proposed his own coverage and cost-trimming measures.

Heartened by having Republican leader champion major reforms, Kennedy tried to harness the new, surprising bipartisan interest in coverage expansion.

Realizing that his own single-payer proposal was a step too far for most in Congress, he teamed with Rep. Wilbur Mills, D-Ark., on a more centrist bill with a mandate for employers to contribute to coverage and a requirement that consumers share some of the costs. And, for a while, it seemed that the time for health-care reform might have arrived.

In 1974, however, scandals drove both Nixon and Mills from office, and with Kennedy’s chief House ally out of Congress and one of the few strong Republican voices for health-care reform out of the White House, the campaign went to the back burner.

Kennedy didn’t give up his efforts, however.

Beginning in the late 1970s, he developed a new, much more market-oriented proposal, calling for private insurers to compete for customers who would each be issued an insurance card to get doctor and hospital care. Each American would have the card, employers would contribute to the coverage, and the government would subsidize the cost based on income. Insurers would be paid based on the health risk of their enrollees – a system similar to those in Germany, Switzerland and the Netherlands – and providers would get negotiated fees.

Conservatism was on the rise, however, and along with it a growing public distrust of government regulation and taxes of all kinds. In that climate, Kennedy’s major coverage proposal got nowhere. However, he never stopped his efforts to pass legislation to make Americans’ health coverage more secure and affordable, often reaching across the aisle to work with Republican allies on those proposals.

In 1985, he was a key architect of COBRA – the legislative provision that allows workers to buy into an ex-employer’s health coverage for 18 months after leaving the job, to help people avoid gaps in their insurance coverage.

In 1996, he worked with Republican co-sponsor Sen. Nancy Landon Kassebaum of Kansas to pass HIPAA, the Health Insurance Portability and Accountability Act. Among many other things, HIPAA limits some insurers’ ability to decline people coverage on the basis of their having pre-existing medical conditions, a provision Kennedy and Kassebaum hoped would help more people get insurance.

In 1997, he worked closely with Republican Sen. Orrin Hatch of Utah to enact SCHIP, the State Children’s Health Insurance Program, authorizing states to create coverage programs for the many uninsured children living in low-income working families.

In 2005, after a five-year struggle, Kennedy and Republican co-sponsor Sen. Charles Grassley of Iowa finally pushed through legislation help children with disabilities get and retain Medicaid coverage – which provides people with disabilities many specialized services that don’t exist in private health-care plans – even when their parents’ income rises above the Medicaid cut-off level. Before this provision became law, many parents with disabled children in need of special services like speech or physical therapy were forced to turn down overtime, new jobs and raises to keep their incomes within the Medicaid-eligible limits.

Kennedy’s legislative interests and his bipartisan adventures went far beyond health care, of course. He’s garnered plenty of both praise and blame for his work with President George W. Bush on the 2002 No Child Left Behind Act, for example, and made Republican friends, along with staunch opponents, along the way.

Education has been another of Kennedy’s passions over the years. In January 2008, shortly before his cancer diagnosis, I recruited him to write an “At Issue” essay for a CQ Researcher report on student financial aid. He argued on the need for government to keep up pressure on the student-loan industry to ensure that aid programs provide maximum benefit to students. (see "Student Aid" January 25, 2008)

“Millions of students face staggering tuition bills, and recent graduates juggle an average of about $20,000 in student debt. Congress should do more — not to keep private lenders in the loan business but to help students afford college and deal with debt,” Kennedy wrote. “We should reduce unnecessary subsidies to private lenders and use the savings to increase aid to the neediest students… Each year, 400,000 qualified students are still unable to attend a four-year college because of cost.”

In the piece, Kennedy pledged to continue pushing for improvements in aid programs. “Most important, we'll keep the focus on students, so more can afford college and have a genuine chance at the American dream,” he wrote.

“He Always Seemed to Be Moving Fast”

He generally walked fast, with a bit of a side-to-side shuffle in recent years. In the Senate’s endless marble halls – which look as if they were designed for giants -- or, at least, egos of giant size – he always seemed to be moving as fast as he could to the next place he had to be. You seldom saw him on the Hill without someone – an aide, a reporter, a fellow senator – talking urgently in his ear. Even entering a room, he was usually deep in conversation. He often looked over his glasses or took them off to peer closely at a hearing witness, and his questions were incisive and informed.

Once, at a Medicare hearing, I heard him make a small misstatement of fact, a rare occurrence for Kennedy during an important public deliberation. David Nexon, one of his top health-care staffers for many years, leaned forward from the back row of staff chairs and hissed a correction, and Kennedy quickly amended himself. At the reporters’ table, we exchanged amused, slightly shocked glances, realizing that, yes, a bit of a royal bubble did always seem to surround him, and that we were kind of amazed that Nexon would so easily pierce it.

The Senate is a gentlemen’s – or perhaps, today, a gentlepersons’ – club. Many senators really do have friendly lunches together after hurling bruising indictments at one another across the floor. It seems strange and makes you wonder whether most of the beliefs so passionately espoused are a bit phony. But sometimes the camaraderie leads to alliances that make things happen.

This was never clearer than in 1997, when Kennedy linked up with Republican Sen. Orrin Hatch of Utah to pass the State Children’s Health Insurance Program.
Few legislators could be farther apart philosophically than conservative Hatch and liberal Kennedy. But Kennedy tapped into their friendship and, apparently, Hatch’s memories of growing up without much money and with some serious needs -- including for health care -- and forged the pair into a well-nigh unbeatable lawmaking team that pushed the SCHIP legislation through.

It’s watching that seemingly improbable series of events unfold that I remember most about covering Sen. Kennedy.

Kennedy's Recent CQR Appearances

As an active legislator, and one of the Senate's most long-tenured members, the late Sen. Edward M. Kennedy (who died early this morning at the age of 77) was mentioned and cited frequently in CQ Researcher.
Nearly four years ago, I talked to him briefly about one of his favorite subjects, the federal minimum wage. He was a longtime champion of raising it. At the time we spoke, late 2005, Congress hadn't ordered a raise since 1997. But Kennedy assured me that change was on the way. “We'll get this, I'm convinced, during the next year,” he said with a confident smile after I intercepted him - on an aide's advice - following the screening of an anti-WalMart documentary in a Senate office building.
He was only one year off, which is pretty good, as legislative tea-leaf reading goes.
More recently, Kennedy contributed an "At Issue" essay to a report by my colleague Marcia Clemmitt on financial aid to students. In his 400-word piece, Kennedy argued for congressional action to benefit financially strapped students, as opposed to private lenders.
Kennedy embraced more causes than the minimum wage and student aid, of course. But he didn't take those two casually. His own good luck as heir to a great fortune seemed to goad him to open up opportunities for those who weren't born with his advantages.
No federal program, though, could endow anyone with the personal magnetism that was another of Kennedy's advantages. "Great to see you!," he told me when our brief talk ended - a stock phrase, of course, but delivered with the grin and twinkling eyes of someone who's born to charm.

Former child soldier released from Gitmo

By John Felton, CQ Global Researcher Author
August 25, 2009

The U.S. military has released and returned to Afghanistan one of two young Muslim men who may have been juveniles when they were imprisoned at the Guantánamo Bay detention center in Cuba. Mohammad Jawad, who reportedly was only 16 or 17 years old when he was captured in Afghanistan in December 2002, arrived back in Afghanistan on August 24. Just one day later, he told Reuters news service that he had been tortured and humiliated during the nearly seven years he spent at Guantánamo. "There was a lot of oppression when I was in Guantánamo and these inhumane actions were not for just one day, one week or one month," Reuters quoted him as saying at his family home south of Kabul.

Jawad's case was one of the most troublesome for the Pentagon of all the hundreds of men who have been held at Guantánamo since early 2002. For starters, he probably was under-age when he was captured—a status that led Human Rights Watch, the American Civil Liberties Union, and other organizations to demand that he be considered a child soldier and either be released or transferred to a civilian court. Human rights groups also called for special consideration for Omar Ahmed Khadr, a Canadian citizen who reportedly was only 15 when captured in Afghanistan and sent to Guantánamo.

Both the Jawad and Khadr cases were featured in the July 2008 issue of CQ Global Researcher on the role of child soldiers in modern combat.

There were also many questions about the evidence backing up the charge against Jawad: that he threw a grenade into a vehicle carrying two U.S. soldiers and their Afghan interpreter. Jawad allegedly confessed to Afghan police that he threw the grenade, which wounded the soldiers. Afghan authorities turned him over to the U.S. military, which sent him to Guantánamo early in 2003.

Jawad's lawyers at Guantánamo said the confession had been extracted as the result of torture. On Oct. 28, 2008, a U.S. military judge, Col. Stephen R. Henley, agreed with the lawyers and ordered Jawad's Dec. 12, 2002 confession suppressed on the grounds that it had been elicited by torture: "The Military Commission concludes that the Accused’s statements to the Afghan authorities were obtained by physical intimidation and threats of death which, under the circumstances, constitute torture..." under the rules of evidence for the military commissions.

Jawad's case then moved to a U.S. District Court in Washington, where Judge
Ellen Segal Huvelle on July 16 said the government had "no evidence" against him. The government dropped its charges against Jawad on July 31, and nearly four weeks later put him on a plane to Afghanistan.

Omar Khadr remains at Guantánamo, partly because the Canadian government does not appear to want him back. A Canadian federal appeals court on August 15 ordered the government to seek Khadr's repatriation, but a government spokeswoman said later that the ruling would be appealed because Khadr had been accused of serious crimes, including killing a U.S. soldier.

Accused Terrorist Detainees

The often-furious debate over treatment of U.S. war on terrorists prisoners is back on the front burner, boiling away. Today, the CIA finally released part of a May 7, 2004 report on the agency's interrogation practices. As expected, the report by the agency's inspector general provided new details on methods of forcing information out of men believed to be major figures in jihadist terrorism networks.
In addition to waterboarding, those methods included choking a prisoner until he lost consciousness, threatening the lives of a prisoner's children, staging a mock execution in which a guard dressed as a detainee was posed as if he'd been shot to death - in view of the prisoner being interrogated. And an interrogator menaced a prisoner by "racking" a round into a pistol held next to his head.
As the report - released with major portions blacked out - was making the rounds, Attorney General Eric H. Holder Jr. named a career federal prosecutor to investigate cases outlined in the CIA report and elsewhere.
President Barack Obama has expressed reluctance to review the Bush administration's record on prisoner treatment. But Holder, the nation's chief law-enforcement officer, may have had no choice but to order an investigation. Among the CIA report's disclosures were that interrogators challenged the judgement of officials in the agency's "Counterterrorist Center" who concluded that some prisoners were refusing to tell everything they knew. Those officials weren't always proceeding on the basis of objective assessments or interrogators' reports, but from "presumptions of what the individual [prisoner] might or should know," the report said.
CQ Researcher most recently examined treatment of detainees in 2006. The topic is far from exhausted.
One of the central issues animating the debate is whether the CIA and other agencies obtained any worthwhile information by waterboarding and other techniques that may violate anti-torture law (an issue hotly debated even within the Bush administration). Former Vice President Dick Cheney has consistently said that "enhanced interrogation" produced information that saved American lives. But the inspector general's report concluded: "The effectiveness of particular interrogation techniques in eliciting information that might not otherwise have been obtained cannot be so easily measured."

Armed Politics

When I was reporting a piece on far-right extremism a few months ago, some members of that political sector were hoping that the Obama presidency would provide new recruiting opportunities. And one academic expert noted that a new surge of extremism could take unforseen forms.

That observation came to mind as I read reports of people carrying guns - pistols and assault rifles - to an Obama speech in Phoenix this week. The big political issue these days, after all, is health care, hardly a topic that would make people reach for their weapons. Or so I would have thought.

According to the news site TalkingPointsMemo, which leans liberal while espousing traditional standards of accuracy in reporting, the gun display was organized by a former sympathizer of the "Viper Militia." That group's active members were sentenced to prison terms of 1-6 years in the 1990s on convictions involving the sizeable quantity of firearms and explosives the Vipers had accumulated. TPM also reported that some dismissed the group as big talkers.

That assessment's accuracy aside, the Southern Poverty Law Center has released a new report concluding that militia groups are growing in popularity again. These outfits, which aim to defend citizens against federal intrusion, have often veered into far-right territory. They had faded after a burst of unfriendly publicity following the 1995 Oklahoma City bombing. A conservative political scientist, Carol M. Swain of Vanderbilt University, argues that the Law Center report is sloppy and politically biased. But if militias are on the rise, the trend is as worth noting as the presence of those guns outside a presidential speech.

After all, liberal commentator E.J. Dionne notes in The Washington Post, conservatives wouldn't have reacted casually to the presence of armed leftwingers outside an event featuring President George W. Bush.

Growing Number of Americans Oppose Afghan War

By Thomas J. Billitteri, Aug. 20, 2009

As Afghans went to the polls today amid Taliban violence aimed at disrupting the country’s presidential election, a new survey showed that many Americans — particularly members of President Barack Obama’s own Democratic Party — are turning against the war in Afghanistan.

A Washington Post-ABC News poll found that 51 percent of American adults say the war isn’t worth fighting, up six percentage points in a month and 10 points since March. Among Democrats, 70 percent say the war hasn’t been worth the cost, while the same percentage of Republicans says the war is worth fighting.

The poll results have to be bad news for the Obama administration and military commanders, who see the Afghanistan conflict as crucial to defeating the Taliban, preventing al Qaeda from re-establishing itself in Afghanistan and thwarting further destabilization in neighboring nuclear-armed Pakistan, where Islamist extremists have sown havoc from their mountain redoubts near the Afghan border.

As I noted in our August 7 report, “Afghanistan Dilemma,” Secretary of Defense Robert Gates and other officials are well aware of public impatience with the war, and they have said they have perhaps a year to show progress in bringing the Taliban to heel and restoring a semblance of order to the country. But the public’s weariness with the war, which began nearly eight years ago in the wake of the 2001 terrorist attacks, has surfaced far sooner than they must have hoped. It’s been only five months since Obama announced a new strategy for the Afghanistan-Pakistan region and even less time since Gen. Stanley A. McChrystal, a respected counterinsurgency expert, took over as commander of U.S. and NATO forces in the country.

No doubt the surge of Taliban carnage and rising American casualties leading up to this week’s elections have turned more and more Americans against the war. The opinion poll was conducted late last week and early this week as news of car bombings and other violence hit TV screens and the Internet. What’s more, many Democrats believe the Obama administration should be focusing its attention and budget on domestic issues like health care and global warming, and they fear a long war in Afghanistan will drain both money from the federal budget and political capital from the Democratic Party.

Military officials say the stakes in Afghanistan are enormously high, especially because a defeat there would, they say, embolden extremists in Pakistan and possibly allow them to get their hands on the country’s nuclear arsenal. But whether the American public—and Congress—will sustain support for the Afghan war remains an open, and important, question.

----Thomas J. Billitteri
Staff Writer
CQ Researcher

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Global CQ Researcher: Attacking Piracy

Can the growing global threat be stopped?
By Alan Greenblatt, August 2009

The excerpt below was taken from the "Current Situation" section of the August 2009 CQ Global Researcher on "Attacking Piracy"
~~~~~~~~~~~~~~~~

ORGANIZED GANGS

In the first six months of 2009, Somali pirates have been responsible for more than 60 percent of the world's attacks, 86 percent of the world's maritime hostage-takings and virtually all of the growth in piracy. [Footnote 57]

The pirate gangs come alongside trawlers and merchant ships in fast-moving skiffs and scamper on board using ladders or grappling hooks. They are typically armed with rocket-propelled grenades and AK-47s. “All you need is three guys and a little boat, and the next day you're millionaires,” said Adullahi Omar Qawden, a former captain in Somalia's long-defunct navy. [Footnote 58]

Several pirate gangs operate in Somalia, undoubtedly with connections to politicians and organized criminal gangs. “Believe me, a lot of our money has gone straight into the government's pockets,” Farah Ismail Eid, a captured pirate, told The New York Times.

He said his team typically gave 20 percent to their bosses and 30 percent to government officials, allocating 20 percent for future missions and keeping 30 percent for themselves. [Footnote 59] Abdi Waheed Johar, director general of Puntland's fisheries and ports ministry, acknowledges that some government officials are working with the pirates.

When Somali pirates attacked the MV Faina, a Ukrainian ship carrying tanks and ammunition to Mombasa last September, “they knew the number of crew on board and even some names,” says Somali journalist Arman. “These are illiterate people — they're being given information.”

“Without any form of domestic law and order within Somalia, organized militia groups and pirate gangs have managed to fill this vacuum,” says Sekulich, the Canadian journalist and author. “They have it all — command-and-control structures, logistics people, armories, financiers.”

In a country with an average annual income of $600, pirates now drive the biggest cars, run many businesses and throw the best parties, sometimes with foreign bands brought in for the occasion. “Entire clans and coastal villages now survive off piracy,” The New York Times reported in December, “with women baking bread for pirates, men and boys guarding hostages and others serving as scouts, gunmen, mechanics, accountants and skiff builders.” [Footnote 60]

Pirates are also the best customers for retailers. “They pay $20 for a $5 bottle of perfume,” Leyla Ahmen, a shopkeeper in Xarardheere, a coastal Somali pirate hangout, told the Times.

The huge amounts of cash flooding northeastern Somalia have created serious inflation in the region and corrupts the morals of youths and women in the conservative Muslim society, says Somali presidential chief of staff Abdulkareem Jama. “Young men started paying $100 for a cup of tea and telling the waiter to ‘Keep the change,’” he explained. And some women have left their husbands for rich, young pirates. “These ill-gotten fast riches … are as damaging to the very fabric of the society onshore as it is damaging to international trade offshore.”

While the pirates may move freely on land, their movements at sea are now being curtailed. The massive new international armada has captured dozens of pirates and deterred attacks on vessels carrying food aid. Stephen Mull, U.S. acting assistant secretary of State for political and military affairs, says nearly three times as many pirates were interdicted in the first four months of the year as in all of 2008. Under the new international agreements, many of the prisoners are now being sent to Kenya and other area countries for trial.

But Burnett, author of Dangerous Waters, attributes the southwest monsoon season — which makes the water too rough for small boats — to a temporary reduction in piracy attacks this summer. The pirates will be back in force by October, he predicts.

Meanwhile, the United States recently sent 40 tons of weapons and ammunition to shore up Somalia's Transitional Federal Government (TFG) against the Islamist al-Shabaab rebels who control much of southern Somalia. And the European Union is considering helping to train Somali police and create courts and other legal infrastructures. [Footnote 61]

“We are not being utilized as much as we could be,” Somali Prime Minister Omar Abdirashid Ali Sharmarke told the Los Angeles Times in April. “We need to fight pirates on land. We have information about how they function and who they are. The long-term objective should be to build institutions that will deal with pirates from inside the country.” [Footnote 62]

“The solution is easy if the will-power is there,” says Jama. “If a team of 500 Somali soldiers are given special advanced training in, say, Djibouti or Uganda for three months and are given swift boats equipped with good firepower, GPS tracking and 10 helicopters, piracy can be eliminated or severely curtailed in 6 months.

“Only Somalis can deny pirates the land to use their ill-gotten loot,” he continues. “The international community would be wise to try this solution with little to lose and much to gain. Insurance companies in the UK have offered to help fund a local solution. Other governments would be wise to join.”

However, at the moment Sheikh Ahmed's fledgling government is fighting for its survival against foreign-funded extremists, Jama acknowledged.

The administration of President Sheikh Ahmed is the 16th government that has tried to control the country since the fall of Barre in 1991. And while the moderate cleric is regarded by many as one of the few men whose clan base and political skills might bring peace to the war-ravaged country, many foreign observers are skeptical about the TFG's chances of restoring law and order. Currently, the TFG only controls part of Mogadishu, the capital, and fighting breaks out there frequently.

Moreover, suggests terrorism lecturer Lehr of the University of St. Andrews, the summer lull in piracy due to the monsoon season has stalled momentum toward devising a regional anti-piracy strategy, which had garnered particular interest in nearby countries such as Oman and Saudi Arabia.

A better idea, Lehr says, would be to aid stable provincial governments in Puntland, a semi-autonomous region in northeastern Somalia — home to much of the piracy problem — and neighboring Somaliland, a stable, democratically run state in northwestern Somalia that declared its independence in 1991. Although neither “republic” has received international recognition, they may be more capable of imposing law and order than the fragile central government in Mogadishu.

Puntland President Abdirahman Mohamed Farole may have been complicit in piracy at one time, says piracy author Murphy, of the Center for Strategic and Budgetary Assessments, but he now wants it stopped because the lawlessness and corruption could undermine his regime and make it more vulnerable to insurgencies such as al-Shabaab.

“The piracy is happening in Puntland, not Mogadishu,” Murphy says. “We can't address it in Mogadishu.” Puntland has already begun imposing 15- to 30-year prison sentences for piracy.

Supporting provincial efforts, Lehr says, “would be a much better option in the long run” and “would take the thunder out” of the Islamist movements, which denounce the presence of foreign navies offshore as Western militarism, he says.

“It would be cheaper and would regionalize the issue,” he continues. “They should have a bigger interest in securing their own waters than we have.”

FOOTNOTES
[57] “ICC-IMB Piracy and Armed Robbery Against Ships Report — Second Quarter 2009,” op. cit., p. 11.

[58] Jeffrey Gettleman, “Somali's Pirates Flourish in a Lawless Nation,” The New York Times, Oct. 31, 2008, p. A1, http://www.nytimes.com/2008/10/31/world/africa/31pirates.html.

[59] Ibid.
Footnote:
59. Ibid.

[60] Jeffrey Gettleman, “Pirates in Skiffs Still Outmaneuvering Warships Off Somalia,” The New York Times, Dec. 16, 2008, p. A6, http://www.nytimes.com/2008/12/16/world/africa/16pirate.html.

[61] Mary Beth Sheridan, “U.S. Has Sent 40 Tons of Munitions to Aid Somali Government,” The Washington Post, June 27, 2009, p. A5, http://www.washingtonpost.com/wp-dyn/content/article/2009/06/26/AR2009062604261.html.

[62] Edmund Sanders, “Let Us Handle Pirates, Somalis Say,” Los Angeles Times, April 15, 2009, p. A22, http://articles.latimes.com/2009/apr/15/world/fg-somalia-pirates15.
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MLA Citation Style Update

The Modern Language Association (MLA) citation style has now been updated in the CQ Researcher. The update reflects the latest changes found in the new edition of the MLA Handbook. To view the citation of any CQ Researcher article, click on the "CiteNow!" link located at the top right of the page.The "CiteNow!" box will pop up with options to view the citation format of four popular styles: APA, Bluebook, Chicago, and MLA.

Thanks to those who pointed out the need for the update!

Excerpt from the "Afghanistan Dilemma" report

By Thomas J. Billitteri, August 7, 2009

On the outskirts of Now Zad, a Taliban stronghold in southern Afghanistan's violent Helmand Province, the past, present and future of the war in Afghanistan came together this summer.

The past: After the U.S.-led invasion of Afghanistan in 2001, Now Zad and its surrounding poppy fields and stout compounds were largely tranquil, thanks in part to the clinics and wells that Western money helped to build in the area. But three years ago, when the war in Iraq intensified and the Bush administration shifted attention from Afghanistan to Iraq, insurgents moved in, driving out most of Now Zad's 35,000 residents and foreign aid workers.

The present: This summer U.S. Marines engaged in withering firefights with Taliban militants dug in on the northern fringes of the town and in nearby fields and orchards.

The future: The situation in Now Zad and the surrounding war-torn region of southern Afghanistan is a microcosm of what confronts the Obama administration as it tries to smash the Taliban, defang al Qaeda and stabilize governance in Afghanistan. "In many ways," wrote an Associated Press reporter following the fighting, Now Zad "symbolizes what went wrong in Afghanistan and the enormous challenges facing the United States."

Nearly eight years after U.S.-led forces first entered Afghanistan to pursue al Qaeda and its Taliban allies in the wake of the Sept. 11, 2001, terrorist attacks, the country remains in chaos, and President Barack Obama faces what many consider his biggest foreign-policy challenge: bringing stability and security to Afghanistan and denying Islamist militants a permanent foothold there and in neighboring nuclear-armed Pakistan.

The challenge is heightened by the war's growing casualty figures. July was the deadliest month in Afghanistan for U.S. soldiers since the 2001 invasion began, with 43 killed. Twenty-two British troops also died last month, including eight in a 24-hour period. In nearly eight years of war in Afghanistan, 767 U.S. troops have died there, along with 520 coalition forces, according to the Web site iCasualties.org. Thousands of Afghan civilians also have died.

The Afghanistan-Pakistan conflict –"Af-Pak" in diplomatic parlance – poses a witch's brew of challenges: fanatical Taliban and al Qaeda fighters, rampant corruption within Afghanistan's homegrown police force and other institutions, not enough Afghan National Army forces to help with the fighting and a multibillion-dollar opium economy that supplies revenue to the insurgents.

But those problems pale in comparison with what foreign-policy experts call the ultimate nightmare: Pakistan's nuclear weapons falling into the hands of jihadists and terrorists, a scenario that has become more credible this summer as suicide bombers and Taliban fighters have stepped up attacks in Pakistani cities and rural areas, using Pakistan's lawless western border region as a sanctuary.

"The fact that Pakistan has nuclear weapons and the question of the security of those weapons presses very hard on the minds of American defense planners and on the mind of the president," says Bruce Riedel, who led a 60-day strategic policy review of Afghanistan and Pakistan for the Obama administration. "If you didn't have that angle," adds Riedel, who has since returned to his post as a Brookings Institution senior fellow, "I think this would all be notched down one level of concern."

Pakistan is important to the Afghan conflict for reasons that go beyond its nuclear arsenal. Pakistan has been a breeding ground for much of the radical ideology that has taken root in Afghanistan. A failure of governance in Afghanistan would leave a void that Islamist militants on either side of the border could wind up filling, further destabilizing the entire region.

In March Obama announced what he called a "comprehensive, new strategy" for Afghanistan and Pakistan that rests on a "clear and focused goal" for the region: "to disrupt, dismantle and defeat al Qaeda in Pakistan and Afghanistan, and to prevent their return to either country in the future."

Key to the strategy is winning over the local Afghan population by protecting it from insurgent violence and improving governance, security and economic development.

The effort includes new troop deployments – a total of 21,000 additional U.S. soldiers to fight the insurgency in Afghanistan and train Afghan security forces, plus other strategic resources. By year's end, U.S. troop levels are expected to reach about 68,000. NATO countries and other allies currently are supplying another 32,000 or so, though many are engaged in development and relief work but not offensive combat operations.

An immediate goal is to heighten security in Afghanistan in the run-up to a high-profile presidential election on Aug. 20. None of Afghan President Hamid Karzai's main challengers are expected to beat him flat out, The Washington Post noted, but some observers said other candidates could "do well enough as a group to force a second round of polling, partly because of recent blunders by Karzai and partly because many Afghans are looking for alternative leadership at a time of sustained insurgent violence, economic stagnation and political drift."

Observers say Obama's approach to the Af-Pak conflict represents a middle path between counterterrorism and counterinsurgency – protecting civilians, relying on them for information on the enemy and providing aid to build up a country's social and physical infrastructure and democratic institutions.

Among the most notable features of the new approach is a vow among military officials – beginning with Gen. Stanley A. McChrystal, the newly appointed commander of U.S. and NATO forces in Afghanistan – to avoid civilian casualties. McChrystal pledged to follow a "holistic" approach in which protecting civilians takes precedence over killing militants.

"I expect stiff fighting ahead," McChrystal told the Senate Armed Services Committee at his confirmation hearing. But "the measure of effectiveness will not be the number of enemy killed," he added, "it will be the number of Afghans shielded from violence."

The United Nations said that 1,013 civilians died in the first six months of 2009, up from 818 during the same period last year. The U.N. said 310 deaths were attributed to pro-government forces, with about two-thirds caused by U.S. air strikes.

As part of his strategy, Obama called for a "dramatic" increase in the number of agricultural specialists, educators, engineers and lawyers dispatched to "help the Afghan government serve its people and develop an economy that isn't dominated by illicit drugs." He also supports economic-development aid to Pakistan, including legislation to provide $1.5 billion annually over the next five years. But Obama's approach on Pakistan also reflects long-held Western concerns that the Pakistani government has been at best negligent – and perhaps downright obstructionist – in bringing Taliban and other Islamist extremists to heel. Pakistan, whose situation is complicated by longstanding tensions with nearby India, will get no free pass in exchange for the aid, Obama vowed. "We will not, and cannot, provide a blank check," he said, because Pakistan had shown "years of mixed results" in rooting out terrorism.

As Obama goes after the insurgency, his Af-Pak policy is under the microscope here at home.

Some have demanded that the administration describe its plans for ending military operations in Afghanistan. A measure proposed by Rep. Jim McGovern, D-Mass., requiring a report from the Obama administration by the end of the year on its exit strategy, drew significant support from Democrats but was defeated in the House this summer amid heavy Republican opposition.

And some critics question the validity of Obama's rationale for the fighting in Afghanistan, particularly the assumption that if the Taliban were victorious they would invite al Qaeda to return to Afghanistan and use it as a base for its global jihad. John Mueller, a political science professor at Ohio State University and author of Overblown: How Politicians and the Terrorism Industry Inflate National Security Threats, and Why We Believe Them, contends that al Qaeda does not need Afghanistan as a base. The 2001 terrorist attacks were orchestrated mostly from Hamburg, Germany, he points out.

What's more, he argues, "distinct tensions" exist between al Qaeda and the Taliban. Even if the Taliban were to prevail in Afghanistan, he says, "they would not particularly want al Qaeda back." Nor, he says, is it clear that al Qaeda would again view Afghanistan as a safe haven.

But administration officials disagree. The Taliban are "the frontrunners for al Qaeda," said Richard Holbrooke, Obama's special envoy to Pakistan and Afghanistan. "If they succeed in Afghanistan, without any shadow of a doubt al Qaeda would move back into Afghanistan, set up a larger presence, recruit more people and pursue its objectives against the United States even more aggressively."

The Issues:
* Is the Obama administration pursuing the right course in Afghanistan?
* Are troop levels in Afghanistan adequate?
* Should the United States negotiate with the Taliban?

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Afghanistan Dilemma

Is President Obama pursuing the right course?
By Thomas J. Billitteri, August 7, 2009

Nearly eight years ago, U.S. forces first entered Afghanistan to pursue the al Qaeda terrorists who plotted the Sept. 11 terror attacks. American troops are still there today, along with thousands of NATO forces. Under a new strategy crafted by the Obama administration, military leaders are trying to deny terrorists a permanent foothold in the impoverished Central Asian country and in neighboring, nuclear-armed Pakistan, whose western border region has become a sanctuary for Taliban and al Qaeda forces. The Afghanistan-Pakistan conflict — “Af-Pak” in diplomatic parlance — poses huge challenges ranging from rampant corruption within Afghanistan's police forces to a multibillion-dollar opium economy that funds the insurgency. But those problems pale in comparison with the ultimate nightmare scenario: Pakistan's nuclear weapons falling into the hands of terrorists, which foreign-policy experts say has become a real possibility.

The Issues:
* Is the Obama administration pursuing the right course in Afghanistan?
* Are troop levels in Afghanistan adequate?
* Should the United States negotiate with the Taliban?

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Straining the Safety Net

Is joblessness overwhelming aid programs?
by Peter Katel, July 31, 2009

As unemployment keeps mounting, millions more Americans are being forced to rely on a network of federal and state programs to meet their basic needs. The added pressure on the so-called safety net has prompted increases in unemployment insurance payments and expanded food-stamp and welfare caseloads, authorized under this year's $787 billion stimulus package. Budget crises, however, are forcing some states to cut back on safety-net programs, including health care and meals for disadvantaged children. At the same time critics say welfare reforms enacted in 1996 requiring aid recipients to work don't mesh with the reality of today's job shortage. But supporters of the reforms say the extra spending on benefits shows the system is working. With employment growth unlikely any time soon, a renewed debate on government responsibility to the disadvantaged is gathering force.

The Issues:

* Are safety nets working?
* Are fundamental changes needed in the federal welfare program?
* Is more job training needed?

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Are "safety nets" working?

The following is an excerpt from the CQ Researcher report on "Straining the Safety-Net: Is joblessness overwhelming aid programs?"
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By Peter Katel, July 31, 2009

Many experts gauge safety-net effectiveness in hard times by the level of Temporary Assistance to Needy Families (TANF) payments. The population TANF serves — low-income households almost always headed by a single parent — is especially vulnerable to economic reversals.

Others view food stamps (officially, the Supplemental Nutrition Assistance Program) as a more sensitive indicator. Enrollment in SNAP is relatively simple, and statistics show the program is responding effectively to growing hardship. Nationwide, food stamp enrollment rose 20 percent, to 5 million recipients, during the 12 months ending in April 2009. [10]

Meanwhile, as President Obama put it recently, the recession is clobbering many people traditionally considered outside the target populations for SNAP and TANF. This group includes employees laid off from well-paid jobs that once offered considerable stability — autoworkers are the classic case. As of July, 1.9 million manufacturing jobs had vanished since the recession began in December 2007 — including 335,000 in car and auto-parts factories. [11]

Still another group of laid-off workers includes ex-TANF recipients, or future ones. The low-wage jobs they held provided paycheck-to-paycheck living but little or no cushion to fall back on when the jobs disappeared.

In other ways as well, low-wage workers enjoy less of a safety net than those laid off from better-paying, more stable jobs. A Congressional Research Service expert reported in February that low-wage workers are less likely to receive UI benefits. Some states, for example, bar UI participation by those who earned below a set amount. In any event, as of November 2008, 55 percent of unemployed people weren't receiving unemployment benefits. [12]

The huge economic stimulus bill the Obama administration pushed through Congress in February included a series of measures designed to expand the safety net's coverage.

TANF got an extra $5 billion to be distributed to states according to their needs for cash welfare and work subsidies. [13] The food stamp program received $20 billion to be spent over five years in boosting allotments, for example by $80 a month for a family of four. [14]

And the stimulus bill included a series of provisions to increase unemployment insurance benefits, including a 33-week extension in high-unemployment states, and $7 billion worth of incentives to states that expand UI eligibility to part-time employees and others; by mid-June, half the states had done so. [15]

“Food stamps and TANF have responded as they were intended to do, with the government spending more money,” says Haskins at the Brookings Institution.

He adds that he — unlike some Republicans — supports expansion of TANF caseloads as long as states maintain pressure on recipients to find work. “If you don't have state programs that emphasize work and penalize people who don't look for work, then people stay on the rolls much longer. A lot of people do find jobs, especially in services, during a recession.”

Liberals who opposed the 1996 welfare law argue that the recession has shown the safety net in general, and TANF in particular, to be inadequate, especially by dropping recipients if they're not working or looking for work.

“In general, TANF is too hard to get on, and too many people are being kicked off,” says Georgetown University's Edelman, who resigned as assistant secretary of Health and Human Services when President Bill Clinton signed the 1996 welfare reform law.

Moreover, the entire safety net system is strained far beyond its capacity. Even before the recession, the country was engulfed in a slow-motion socioeconomic disaster created by the expansion of the low-wage economy, Edelman argues. “You have to figure out how you're going to get a decent income to people who are being failed by the labor market,” he says. “The labor market functioning as a ‘free market’ is injuring millions and millions of people who are just playing by the rules.”

But the Heritage Foundation's Rector, a longtime critic of anti-poverty programs, argues that the safety net actually is working in ways that liberals support and that he opposes. Government programs provide “a permanent subsidy to people in the lowest one-third of income distribution.” In a paper in February, he listed some 50 programs aiding people below a certain income threshold, including Pell grants for low-income college students. [16]

As for TANF, Rector argues that the stimulus funds effectively return the welfare system to pre-1996 days, when states got more money as their caseloads expanded. “We are now in the business of paying states to put more people on welfare,” he says, predicting that that provision will be transformed from a one-time measure into a permanent feature of the system.

Zedlewski at the Urban Institute argues that a far bigger issue confronts the entire safety net system. “The great recession shines a light on the somewhat misguided notion that you could just focus on work supports” in revamping the welfare system. “You now have a much larger group of low-income parents who don't have work, and are not getting the Earned-Income Tax Credit because they don't have a job and don't qualify for unemployment insurance. What do you do there?”

Furthermore, Zedlewski argues, the rebuilt welfare system, with its focus on pushing recipients into jobs, has never served people with disabilities that keep them from working but don't qualify them for disability benefits. “I don't think anybody's really come up with a great solution for that group, who account for a large share of our poverty population.”

Footnotes:

[10] “Supplemental Nutritional Assistance Program: Number of Persons Participating,” U.S. Food and Nutrition Service, updated June 30, 2009, www.fns.usda.gov/pd/29SNAPcurrPP.htm.

[11] “Employment Situation Summary,” op. cit.

[12] Gene Falk, “The Potential Role of the Temporary Assistance for Needy Families (TANF) Block Grant in the Recession,” Congressional Research Service, pp. 16–18, http://assets.opencrs.com/rpts/R40157_20090224.pdf.

[13] Ibid., pp. 1,4.

[14] “American Recovery and Reinvestment Act of 2009,” U.S. Food and Nutrition Service, undated, www.fns.usda.gov/fns/recovery/recovery-snap.htm.

[15] Alison M. Shelton, et al., “Unemployment Insurance Provisions in the American Recovery and Reinvestment Act of 2009,” Congressional Research Service, March 4, 2009, http://assets.opencrs.com/rpts/R40368_20090304.pdf; “Federal Stimulus Funding Produces Unprecedented Wave of Unemployment Insurance Reforms,” National Employment Law Project, June 16, 2009, www.nelp.org/page/-/UI/UIMA.Roundup.June.09.pdf?nocdn=.

[16] Robert E. Rector and Katherine Bradley, “Welfare Spendathon: House Stimulus Bill Will Cost Taxpayers $787 Billion in New Welfare Spending,” Heritage Foundation, Feb. 6, 2009, www.heritage.org/research/economy/upload/wm_2276.pdf.

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