Tuesday, April 30, 2013

HCR -- Time is NOW for a National Caregivers Corp

This just appeared at The Health Care Blog. Everyone reading this will  experience dementia in their lifetime, either personally or affecting someone you know.
  • Pay attention. 
  • Get ready.  It may be you. It may be someone you love. 
  • Make a plan. And don't forget an advance directive for medical care. 
  • Waiting for dementia to happen may be too late.
Go to the link and read the comments. Bookmark it or make a comment and leave your email to keep track of the discussion. Unlike other places the comments section of The Health Care Blog are fairly intelligent and civil. Lots of smart people follow the posts at that place. 


The Cost of Dementia: Who Will Pay?
By Michael D. Hurd

Dementia is a chronic disease of aging that robs people of cognitive function, leaving them unable to tend to even the most basic activities of living. But demented persons can live for many years, incurring long-term care bills that can leave surviving spouses impoverished and estates depleted. 
In a study published recently in the New England Journal of Medicine, my colleagues and I reported that the total costs of paying for care for seniors with dementia in the United States are expected to more than double by 2040. Medicaid pays these costs for the poor, and some people have private insurance. But for large numbers of elderly Americans, dementia brings not only human suffering but financial ruin as well. 
Designing and building a program to protect Americans from the cost of dementia care is a daunting and expensive task, one that probably cannot be accomplished without the help of the federal government. The federal government has broad experience in creating health safety nets and has been expressing concern over the state of the nation’s long-term care systems for some time now. If Congress and the administration need a reason to act, our numbers on costs can provide it. 
Currently, some 15 percent of Americans 71 or older have dementia. That is about 3.8 million people; a large number to be sure, but one that will pale by comparison to the 9.1 million expected to be suffering from the disease by 2040. 
Our report, The Monetary Costs of Dementia in the United States, estimated that in 2010 Americans spent $109 billion for dementia care purchased in the market place, like nursing home stays. Factoring in the costs of informal care—provided by family members or others outside of institutional settings—the total cost of caring for dementia patients grew to between $159 billion and $215 billion. 
As the U.S. population ages in the coming decades, we can expect these costs to continue to escalate. Even if we assume that dementia’s prevalence stays at the current rate and the cost of care per person does not go up, our research showed that by 2040 total costs will have soared to between $379 billion and $511 billion as measured in today’s prices. 
We estimated that the average cost per case in 2010 was between $41,000 and $56,000, but this average conceals a great deal of variation from family to family. A large majority of Americans will not face large costs for dementia care. Many patients will have their care covered by Medicaid or private long-term care insurance, or their stays will be short and relatively affordable, or for some other reason they will avoid serious hardship. 
Yet, a minority of families will face financially devastating costs because of very long nursing home stays. This calls for an insurance-style solution, one in which the costs of long-term care could be spread across the entire population rather than being concentrated on the unlucky few.
Insurance companies are probably not going to step into the void because the costs associated with these extreme cases are quite uncertain. But the federal government could take it on and, in fact, has crafted similar solutions in the past. 
For example, in 2006, Medicare Part D was partly enacted to protect seniors from the high out-of-pocket costs of expensive medicines such as exotic prescription drugs for cancer and other diseases. The program was designed to help all seniors, but especially those with prescription drug bills large enough to impoverish them. 
As recently as 2010, the federal government sought to create a long-term care safety net for the aging population. The Community Living Assistance Services and Support Act, the CLASS Act, was enacted as part of President Obama’s health care reform package. The CLASS Act was supposed to do something for seniors by setting up a self-funded and voluntary long-term care insurance program. But, last year, the administration determined that implementing the law would be too expensive and it was abandoned. 
It is time for the government in partnership with industry to return to the drawing board to craft a plan that will provide protection for the more than 9 million people who will need care for dementia by 2040. Until it does, too many Americans will be forced to spend themselves into poverty.

A National Caregiver Corps: What the Administration Could Do
This post in March outlines her excellent idea. 
Again, go there and read the whole post and thoughtful, supportive comments thread. 
What’s a country to do? Launch a Caregiver Corps, a program modeled on similar valuable, successful, and long-lived efforts, such as the Peace Corps, AmeriCorps, VISTA, and Teach for America. Such a program could recruit volunteers from several pools: high school graduates not trained for the workforce; college graduates facing a tough economy and huge undergraduate debt; and older adults, those healthy enough to want to remain in the workforce and contribute to others’ well-being. 
Volunteers could sign up for a year or two. In exchange for their service, they could earn tuition credits to cover the cost of college; they could receive some degree of loan forgiveness, to lessen the burden of debt; they could be paid a stipend that acknowledges the value of their work. They could be assigned to community-based organizations that serve older adults, such as Area Agencies on Aging, non-profit health care institutions, social services agencies, and others. While they could offer enthusiasm, compassion, and insight, they could also learn the kinds of skills required to care for an older adult and his or her family. They could learn about the public policies that affect that care. They could acquire medical and nursing skills—the kind of skills family caregivers use routinely in their daily routine. They could be exposed to older people, and bridge the generational gap that splits our country on this demographic. In the end, they might even be inspired to pursue a career that features caring for one another. 
That, it seems to me, is something Americans have always done best—and will have to do more, as we all reach our own old age. Developing people who have the skills, resources, and motivation to help us in our self-interest. And it is in theirs, too. Millenials face the highest unemployment of any group in the country, and finding ways to become marketable, employable adults is critical to their own security and future.

HCR -- Ignorance Is Reaching Pandemic Levels

Poll: 42 percent of Americans unsure if Obamacare is still law
This headline illustrates how successful opponents of PPACA have been with their relentless negative propaganda. 
If you want to know what a challenge the Obama administration faces in implementing its signature health-care law, this statistic might help: Fewer than six in 10 Americans know that the Obamacare law is still on the books. Seven percent think the Supreme Court struck it down; 12 percent say Congress repealed Obamacare.

This comes from the Kaiser Family Foundation, which is out with a poll Tuesday morning looking at how much Americans know about the health-care overhaul—before a deluge of public outreach, set to begin this summer, kicks off. 
The short answer is: They do not know a lot. Most Americans likely to access new health care programs under the Affordable Care Act—either through subsidized private insurance or the Medicaid expansion—say they don’t have enough information to understand “how it [the health law] will impact you and your family.”

This poll does, however, show greater awareness than separate research conducted last winter by Enroll America, a new non-profit that’s leading much of the outreach effort. It found that 78 percent of Americans likely to gain access to health coverage had no idea that such programs would roll out in 2014. 
The challenge that the Obama administration faces is more complex than just increasing awareness and improving public awareness. It has a lot to do with improving knowledge at the exact right time—not when benefits are way out in the distance, but also not when the public has passed them by.
I have no idea why the administration and others trying to advance healthcare reform have failed to even explain the basics of the legislation. Lord knows, it's not easy. I suspect it has something to do with Congressional shit-tossing. As long as the Tea Party House caucus keeps up the "repeal it all" charade and the Senate refuses to confirm presidential appointees, anything Obama does is politically DOA. Those are not good reasons to ignore the challenge but it's also not smart to waste political capital. 

My suspicion is that the major players -- providers and insurance companies -- are waiting until the last minute for two reasons. 

First, the timeline is still unfolding. Until changes actually become official, early planning may confuse people which would make matters even worse. An unrelated example regards the Congressional passage of "Real ID," Congress passed the REAL ID Act of 2005 in that year and it has been slowly but surely making progress ever since. 

When my wife and I recently went to get our drivers licenses renewed we faced Georgia's new requirements to be in compliance with REAL ID. Each of us had to furnish (in addition to surrendering our expired licenses)
  • Two items proving residence (mail to our address, business statement or employer document with our address. 
  • Social Security card (or something from the SS Administration with the number)
  • Birth certificate (or certified copy) or unexpired Passport. 
The Bureau of Drivers Services was very polite but it was clear that they were charged with following the rules whether or not the public liked it. And the public, from what I saw, was patiently, if grudgingly, in compliance. Discussing our experience with others I know there is a vague awareness that as of this year Georgia is gonna be doing something different with drivers licenses, but the details are of no interest until each person has to deal with it personally. 

Second, it is difficult to predict how many people will respond when the provisions are officially enacted.  Providers very likely fear that they will be overwhelmed as millions of newly-insured people (many with long-neglected medical issues) present for attention. And the insurance industry, salivating for new business from tax-subsidized new customers, will keep their cards close to their vests until the last minute, watching the market and their competition before advertising something not yet ready for prime time.  

It is not surprising that ACA is grinding along so slowly. The majority of Americans have some kind of health care, either from the Veterans Administration, Tri-care (which covers military dependents), employer group plans or private insurance. The working poor live without professional health care, enduring both chronic and acute problems until they rise to the emergency level, and when they present at a hospital ER they are stabilized and dismissed in accordance with EMTALA. And finally, those who qualify for Medicaid receive a range of medical attention according to where they live. (There is a wide range of quality from state to state as well as urban to rural locations.) And fortunately most people are not sick, so until they are confronted with an injury or illness (like people whose drivers licenses are not about to expire) there is no compelling reason to pay attention. 

Meantime, those who care to look can check out this excellent timeline from the Kaiser people. 
Also, most people are already insured. But those who are not may want to check out this chart

Roubini Speaks -- Important Economic Predictions

Nouriel Roubini's latest projection for the next few years is today's most important read about economics.  He's not called Dr. Doom for nothing. He points out many pitfalls. But through a cloud of unknowing he seems optimistic about the distant future. 

Shorter Roubini -- Quantitative Easing is going away and if everyone can learn to behave we won't get into trouble.

As I read this prediction I thought how much the management of economics is like dealing with substance abuse. Credit and debt (two sides of the same coin) are, like alcohol, neither inherently good or bad. However they become problematical when abused.

Anyone who has dealt with alcoholism, either their own or someone else's,  knows there are several ways to deal with it. Quitting altogether is the ultimate goal because the long-term toll is both serious and expensive. Generally speaking there are two approaches:-- "cold turkey" or gradual reduction. Experienced alcoholics and professionals who deal with them know well that stopping all at once is dangerous. Simply stated, abruptly stopping alcohol can kill someone who is seriously drunk.  That approach is not advisable except under the care of medical professionals. The non-medical alternative is to reduce the intake of alcohol over several days as the body adjusts to a diet of food and non-alcoholic liquids, usually enduring delirium tremens (the DT's) on the way to sobriety. It is not a pretty picture.

Quantitative Easing has been the substance of choice for the economy for the last several years and the time has come for the economy to detox.

The Trapdoors at the Fed’s Exit
or "How can we get this drunk back to sobriety without killing him?"
The ongoing weakness of America’s economy – where deleveraging in the private and public sectors continues apace – has led to stubbornly high unemployment and sub-par growth. The effects of fiscal austerity – a sharp rise in taxes and a sharp fall in government spending since the beginning of the year – are undermining economic performance even more. 
Indeed, recent data have effectively silenced hints by some Federal Reserve officials that the Fed should begin exiting from its current third (and indefinite) round of quantitative easing (QE3). Given slow growth, high unemployment (which has fallen only because discouraged workers are leaving the labor force), and inflation well below the Fed’s target, this is no time to start constraining liquidity. 
The problem is that the Fed’s liquidity injections are not creating credit for the real economy, but rather boosting leverage and risk-taking in financial markets. The issuance of risky junk bonds under loose covenants and with excessively low interest rates is increasing; the stock market is reaching new highs, despite the growth slowdown; and money is flowing to high-yielding emerging markets.
In other words, since the problem is bigger than any doctor can manage, we're gonna be doing it the old-fashioned way, detoxing by weaning off the booze a little at a time, hoping that when the DT's come the patient will not lose hope and go back to drinking.

Once again he mentions the difference between the real economy and the financial markets. As those of us in the forty-seven percent know well, the real economy is not called "real" by mistake. The real economy is about having an income to meet everyday expenses of living. Food, shelter and transportation are not optional. Even homeless people must eat, keep out of the elements and be able to walk if they are to avoid facing death. These essentials remain true all the way from negative net worth to zero net worth (all assets minus all debts = zero) which is where nearly half the population now lives.

People in the real economy care not distracted by anything that happens in the financial markets. That is another universe for them. But by some Divine sense of irony, it is the people in the financial markets who control both worlds. Go to the link for Roubini's take on the gory details of what may or may not happen. The old saying is -- It's hard to make predictions, especially about the future.

So he concludes:
The exit from the Fed’s QE and zero-interest-rate policies will be treacherous: Exiting too fast will crash the real economy, while exiting too slowly will first create a huge bubble and then crash the financial system. If the exit cannot be navigated successfully, a dovish Fed is more likely to blow bubbles.
The best hope for the rest of us is that the small number of people controlling the financial markets can find their way out of a drunken stupor to help the real economy recover. 


Am I the only person connecting the huge disparity of wealth between rich and poor with economic uncertainty? It seems to me as long as nearly all new wealth continues to flow to those who are already wealthy the chances of the real economy making a real recovery are seriously reduced. 

Monday, April 29, 2013

HCR -- About Those Insurance Exchanges

I heard a TV talk show host gleefully rattling on one day last week about what he called the Obamacare train wreck, making fun of the complexities of the insurance exchanges because the rules and details were so complicated nobody seems to understand them.

Maggie Mahar's post below points out that consumers will not be tossed into the mix without help. There will be ombudsmen to help them, or as they are being tagged "Navigators." She points out quite sensibly that it is in the interest of the insurance industry to see to it that consumers know and understand what is happening with health insurance, otherwise those failing to do so will not remain competitive.

Anyone who has studied the mouseprint on a standard insurance policy -- not just health insurance, but just about any kind of insurance, from liability to life insurance -- already knows that they are the most complicated documents ever crafted. There is no way that "navigating" any insurance policy is an easy task. The exchanges are being put into place for exactly that reason.

Medicare supplemental plans (also called the alphabet plans) have been standardized for years. The exchanges will do the same ranking of standards for health insurance. In other words, thanks to ACA the rest of the country will finally be able to compare levels of insurance coverage in the same way that Medicare beneficiaries have been doing for years, confident that some hidden charges or fine print will not be used by the insurance company to manipulate coverage in an unexpected way.

Here is a link to Health Insurance 101

  •  The exchanges are NOT insurance plans. 
  • They are definitions of insurance plans. 
  • They spell out what will or will not be covered by plans called bronze, silver, gold and platinum.

Navigators: The Folks Who Will Help You Surf the New Insurance Exchanges
Over at Healthinsurance.org, I’ve addressed some “frequently asked questions” about the “navigators” who will help individuals and small business find the coverage they want in the new Exchanges. 
– Who Will Become Navigators?
– Can Insurance Agents and Brokers Apply to Be Navigators? (Wouldn’t that create a conflict of interest?)
– Just How Will Navigators Help People Sort Out Their Options in the Exchanges?
– How Much Training Will They Receive?
–Finally, many people worry that the “navigators” just won’t be able to handle the heavy traffic. Giving the American public the information it will need about Obamacare is an enormous task. Will these navigators be up to it? 
The answer to that last question is that the navigators will have help. Patient advocacy groups, the states, and county health agencies will pitch in. The federal government also is launching a marketing program, “Enroll America” that will urge mothers to nag their uninsured 20-something and 30-something sons. (Seriously– and I expect that in many cases, this will be effective.) 
Meanwhile insurers will be eager to draw young, healthy customers into the Exchanges. This means that they will invest in marketing campaigns designed to let 20-somethings and 30-somethings know that the vast majority will be eligible for generous government subsidies.
Just one example: Blue Cross and Blue Shield of Illinois already has launched a “Be Covered Illinois” campaign. The campaign is being funded by the insurer, and carried out by various community groups:

Keep in mind that if insurers mislead customers about their offerings, those customers will have an opportunity to pick a different plan a year later. And under the ACA, they will have “navigators” to help them make a better choice. 
Insurers know this. They also are well aware that under the new ACA rules that regulate them, a health insurance company will have to draw—and keep—a large share of the market’s customers in order to survive financially. For that reason, I suspect that savvy insurers will make a major effort to provide information about specific plans that will attract customers who will want to stick with those plans. 
For my answers to the first four questions above, go to Health Insurance.org, click on the question and the answer will pop up.


I must add a couple more comments. 
  • PPACA is not insurance. It is a package of rules and standards that define insurance. 
  • This legislation was crafted by a multitude of Congressional staff guided by lobbies representing private companies and interests -- drugs, insurance, medical devices, durable equipment, professional associations, etc.  The list is endless. 
  • The concept of exchanges has been around for years. Insurance professionals and academic types who specialize in these matters are seeing the concept put into practice for the first time but it is a very old idea. 
  • The name of economist Alain Enthoven has been associated with the concept of exchanges for years. The idea is also tagged "managed competition" and is at the heart of many Conservative ideas (including Paul Ryan's). 
  • Those who speak of "government insurance" and "government health care" revealing embarrassing ignorance. The government is not in the insurance business. But it is correct to speak of government health care because the Veterans Administration, military medical corps, as well as state and community clinics all over the country are, in fact, government health care. Unfortunately, those who speak of PPACA as government health care simply have no idea what they are talking about. 

Multiculturalism -- A First Person Account

Khaled Diab is a freelance journalist, blogger and writer. Until recently based in Jerusalem, he now flits between Geneva and Ghent. He writes for leading publications in Europe, the Middle East and the United States. He is also working on a book that goes beyond the polarised politics of the Middle East to look at the Israeli and Palestinian people and the human face behind the conflict, relates his experiences living in Israel-Palestine, and seeks to crystallise a vision for a better future.

He lives with his beautiful and brilliant wife, Katleen, who works for a leading European NGO.The foursome is completed by the minis: Iskander, their playful, smart, charming, sociable and adorable toddler, and Kuku, the blue-eyed and wise Siamese cat.

Egyptian by birth, Khaled’s life has been divided between the Middle East and Europe. He grew up in Egypt and the UK, and has lived in Belgium for pver a decade. He holds dual Egyptian-Belgian nationality.

Intimate strangers in a splintering world
As Iskander and I enjoy a rare sunny Sunday during this northern European spring that has not yet found its spring, our son quite literally sings the praises of multiculturalism, as he recites nursery rhymes and songs he likes in different languages. 
While I bask in his sonshine, I marvel at how the intricacies of different cultures and identities become, in his tiny hands, quite simply child’s play. 
Not only does he act at home in his two native cultures, Belgium and Egypt, he also took the complexities of the Holy Land, where he spent more than half his short life, in his, at first wobbly, stride. In that sun-kissed, trouble-drenched corner of the world, his blond locks went down a treat on both sides of the bitter divide, as did his nonchalance, charm and tenderness.
When we returned to Belgium recently from our 20-month stint in Israel-Palestine, we were a little concerned about how long it would take him to adjust to life back in Europe, especially the demanding task of starting pre-school. 
But he took to it like a rubber duck to bubbly bathwater. Within a few short weeks, Dutch switched back to being his dominant language after a hybrid Palestinian-Egyptian Arabic had been during most of our time in Jerusalem. 
Multilingualism, as researchers are increasingly discovering, enhances children’s cognitive abilities and helps them to do better in school. As the world continues to shrink, Iskander’s polyglottic childhood should place him in a good position to enjoy an international adulthood. 
Although like any parents we hope that the future is bright for our son, there are a number of clouds on the horizon that trouble me. My wife and I take the benefits of multiculturalism as a given, as do most people in our circles. Not only is the microcosm of our family confirmation of this, but our own experiences back up this conviction. 
For my part, I find that dividing my childhood, youth and adulthood between the Middle East and Europe has been a generally enriching experience, despite certain challenges – I feel both out of place and at home everywhere. My well-heeled Belgian wife developed a keen wanderlust early on which influenced her choice of studies, her extensive travels and her choice of careers. 
Iskander is the next step along this evolutionary line. While both my wife and I grew up in monocultural families, Iskander has been born into diversity, with all its inherent richness and complexities. 
My own personal experiences have taught me that in human interactions personal culture and disposition are more vital factors than collective culture. For example, my wife and I – both secular progressives with an inclusive, humanist outlook – have far more in common with each other than we do with our supposed cultural kin. 
But as the winds of monocultural intolerance swirl evermore-menacingly overhead, not everyone sees the situation this way. A growing number of people (re)subscribe to the notion that there is an innate, cliquey cultural essence which unites a certain group to the exclusion of others. 
This is partly a by-product of the social and economic alienation many people encounter, and the consequent desire to manufacture a sense of belonging. As I get older, I’m growing to understand better the attraction some people feel to having deep roots: the security derived from the familiar, the ability to read the various chapters of your life inscribed on every paving stone for miles around, and the convenience of being in the comforting proximity of family and lifelong friends. 
But you don’t need to belong to a place to have a sense of belonging and you can be a foreigner in your own land. I know people who have lived in the same place their entire lives and feel alienated from their surroundings. I know others who move constantly but settle into each station as if it were their final destination. 
With petty nationalism seemingly on the rise, partly on the back of the crisis afflicting global capitalism, this exclusiveness often manifests itself along nationalistic, even patriotic, lines. Given our aversion to nationalism, we hope that Iskander will grow up to become a proud citizen of the human nation. 
But I appreciate that peer pressure, or rejection, may force him to jettison, or at least to underplay, one of his identities. And so, paradoxically, he may come full circle: returning to one of the monocultural roots of his multicultural parents. 
Although balancing national identities can be done relatively painlessly, especially between societies that are not in conflict, a tougher nut to crack is religion. Of course, Iskander is still too young for religion to be a real issue, but we plan to raise our son to appreciate the beauty of his triple heritage – the secular, non-aligned humanism of his parents, his father’s Muslim and his mother’s Christian heritage – and to choose his faith for himself. 
Even though the millet system, which gave a high degree of autonomy for recognized religious communities, was once an admirable expression of pluralist tolerance in action, its survival in much of what was once the Ottoman empire, including Israel and Palestine, grates against 21st century reality and aspirations. This outdated system defines faith as a birth right, no matter how wrongly or incorrectly this may describe a person’s actual convictions. 
In Egypt, this means that my identity papers say that I am a “Muslim” – which I partly am, in the cultural sense of the word. In addition, given the legal assumption that the son of a Muslim man is also, by default, a Muslim, Iskander, regardless of his actual beliefs, would still be a Muslim in the state’s eye. If Iskander rejects Islam or religion in general, this could result in the surreal situation where two generations of non-believers are still officially defined as Muslim – a situation not unlike that of the historian Shlomo Sand in Israel, who is a third-generation non-believer, but cannot change his ID card to reflect this. 
However, the sands may be slowly shifting: the well-known writer Yoram Kaniuk has won the right in the courts to be registered as “without religion
Our refusal to predefine our son’s convictions have made me so far reluctant to register Iskander’s birth in Egypt, in the hopes that one day the religion field will disappear from birth certificates and IDs, or until I find a legal means to keep it blank. 
However, even if the state becomes more amenable to diversity – which seems unlikely under the current Islamist stewardship but is conceivable under new management given the protection of personal freedoms guaranteed by the new constitution – society as a whole will not necessarily follow suit. 
In Egypt, especially in traditional and conservative circles, the idea that religious identity is inherited runs deep, both among Muslims and Christians, and the traditional model of tolerance is to live as good neighbours and friends but not generally to intermarry. That said, I have met a number of conservative Muslims who accept the rights of other Muslims to convert and even to become atheists. 
More troublingly, the increasing marginalisation of Christians in society and their targeting by Islamic extremists bodes ill if the country fails to rediscover its pluralism. For Iskander, this could be problematic if he decides to pursue his Christian identity or, worst, in the eyes of society, abandons religion altogether. And even if he chooses to become a Muslim, it would cause him to feel shame towards an integral part of his personal heritage. 
But our son’s mixed heritage is not just potentially problematic in the Middle East, it can also cause him difficulty in Europe. Although European society has evolved into a multicultural kaleidoscope which, at its best, is incredibly tolerant and accepting of diversity, there are numerous worrying undercurrents. 
Here in Belgium, the law guarantees equality regardless of background and people possess the legal freedom – both nationally and at the EU level – to choose the belief system that suits them. Moreover, the apparent unceremonious death of organised religion has left questions of faith almost completely in the private and personal sphere. 
But even if Christianity has to a large extent fallen by the wayside, Christian rituals have been secularised, as reflected in the enduring popularity of Catholic sacraments, such as baptism and confirmation. Moreover, for some, old Christian prejudices have combined with secular distrust of religion or old-fashioned racism, to stigmatise Muslims. This manifests itself in the increasing mainstreaming of Islamophobia, as well as xenophobia in general. 
The trouble with the push towards greater monocultural conformity, whether in Europe or the Middle East, is that the rolling boulder of intolerance gathers no nuance as it hurtles down the slippery slope to ever-greater rejection. Today’s “in” could easily become tomorrow’s “other”, as eloquently expressed by pastor Martin Niemöller in his famous “First they came for…” statement. 
This is reflected in how certain salafist groups devolved from the rejection of the non-Muslim other to declaring Muslims who have a different interpretation of Islam to theirs as the enemy within. It can also be seen in how extremist settlers have widened their attacks on Palestinians, to target Jewish-Israeli peace activists and even the Israeli army, as well as the growing segregation between the religious and secular within Israeli society. 
For the sake of my son, and all our children, I hope that multiculturalism prevails. In this, we can take a leaf out of Iskander’s book, who shares his affections indiscriminately, based solely on a person’s individual merit, without regard to nationality, religion, gender, ethnicity or creed.

Sunday, April 28, 2013

Jenan Moussa Photos From Aleppo

Jenan Moussa is a Roving Reporter for Arabic Al Aan TV from Dubai. Lots of photos at the link, I use the Chrome browser so it translates the captions for me but I don't know how to format them for blogging. Good luck with that.  

You will see armed black-clothed women police in Aleppo (in addition to these Kurdish women soldiers) because the religious extremist groups are the ones who are maintaining order. 
I wish our coverage of Syria were not so difficult. and opaque.  As I said, you will see many photos at the link. 

Members of FSA preparing Molotov cocktails in Sheikh Maksoud area Aleppo
Curtains on the streets against snipers

 Female Kurdish fighter before heading to the frontline
Kurdish female fighters posing near to frontline in an abandoned house -

Kurdish fighters posing next to picture of jailed PKK leader Abdullah Ocalan

During lull in fighting, a civilian cuddles a street cat -

Two boys selling sweets; plumes of smoke from airstrike in the background -
 peddling candy while rising plumes of smoke in the background

Girl singing at pro FSA rally - girl sings in a demonstration supporting the free army

Barriers built in the stream so that bodies of executed people will not float further. Tens of corpses have been found in the river according to residents . - Barriers built in the course of the river to stop the bodies. According tp the residents dozens of bodies found here. 

More Twitter Messages -- April 28

I was excused from my evening assignment tonight so here are a few more Twitter links.

I linked this Ezra Klein piece earlier, noting it is a "long read."  It prints out to eight pages but this is highly recommended reading. He looks at a relatively small but impressively effective and cost-effective approach to health care for old people which hay or may not survive not having the continued support of CMS. Hopefully Klein's influence and this article will advance their cause. 


Then there's this. No Twitter message. 
 I just like the infographic.

Hizzoner Brags About Reduced Gun Violence in New York

And he has reason to brag. Audio at the link, but this is a snip:
New Yorkers know better. Here in New York City, we've done everything possible to take illegal guns off the streets. That includes helping to pass the toughest law in the nation against illegal possession of a loaded gun. It also includes smart, pro-active policing that makes it much more likely that if you break our city's gun laws, you'll be caught. The result: Last year, we cut murders and shootings to all-time lows – and so far this year, murders are down another 34 percent, and shootings are also down another 25 percent. There's just no question that our strategy is working, and today the City's Health Department is releasing a new report that makes that even clearer. 
According to the Health Department's new study, between 2000 and 2011, our city's firearms-related murders declined by more than 30 percent – from 524 in 2000 to 366 in 2011. That's in stark contrast to the national trend, which showed no decline over the same period. What's more, the number of New Yorkers who were injured by a firearm in this 11-year period declined, too – by 21 percent. Our success at keeping guns off our streets has meant that our City's overall firearms fatality rate is less than half the rate in the rest of the country, and it's markedly lower than that of other major cities. And when researchers looked at suicide – the tenth-leading cause of death nationally according to the U.S. Centers for Disease Control – our study showed that New York's firearms-related suicide rate is approximately one-ninth the national average, and it ranks the lowest among the nation's 25 most populous cities.

Steny Hoyer on the FAA exception to the Sequester

“While I want to end these delays for passengers in Maryland and across the country, I will oppose this bill because it fails to address the whole impact of sequester. Let me share just a handful of examples of how the sequester will affect Americans.
  • Education: Head Start, 70,000 children will be kicked out of Head Start. 
  • Furloughs to cause delays in processing retirement for disability claims 
  • Four million fewer Meals on Wheels for seniors. 600,000 people dropped off WIC  
  • Housing: 125,000 less HUD rental assistant vouchers 
  • Emergency unemployment insurance cut 11% for two million out-of-work Americans 
  • FDA: 2,100 fewer food safety inspectors, an 18% cut 
  • Longer waits to approve new drugs 
  • Defense and homeland security: furloughs equivalent to 1,000 fewer federal agents, FBI, border, etc., on the job; one third of combat air units are grounded 
  • 89,000 agency-wide furloughs in IRS, up to seven days, including taxpayer assistance centers — nothing in here for them. They serve 89,000 taxpayers trying to find help. [Note: Rep. Hoyer misspoke -- the figure is 97 million taxpayers.]
“We ought not to be mitigating the sequester’s effect on just one segment when children, the sick, our military and many other groups who will be impacted by this irresponsible policy are left unhelped. Instead of dressing this serious wound with a small band-aid, let’s get to work on a real solution, let’s go to conference, let’s get a big deal, let’s deal with all the adverse consequences of sequester, not just those that affect the powerful air travelers of America. We ought to help them, but we ought to help everybody else as well.”

Morning Twitter Messages -- April 28

From the link: 
Departing French Envoy Has Frank Words on Afghanistan
...one of those rare truth-telling moments came at a farewell cocktail party last week hosted by the departing French ambassador to Kabul: Bernard Bajolet, who is leaving to head France’s Direction Génerale de la Sécurité Extérieure, its foreign intelligence service. 
After the white-coated staff passed the third round of hors d’oeuvres, Mr. Bajolet took the lectern and laid out a picture of how France — a country plagued by a slow economy, waning public support for the Afghan endeavor and demands from other foreign conflicts, including Syria and North Africa — looked at Afghanistan. 
While it is certainly easier for France to be a critic from the sidelines than countries whose troops are still fighting in Afghanistan, the country can claim to have done its part. It lost more troops than all but three other countries before withdrawing its last combat forces in the fall.
The room, filled with diplomats, some senior soldiers and a number of Afghan dignitaries, went deadly quiet. When Mr. Bajolet finished, there was restrained applause — and sober expressions. One diplomat raised his eyebrows and nodded slightly; another said, “No holding back there. 
So what did he say? 
That the Afghan project is on thin ice and that, collectively, the West was responsible for a chunk of what went wrong, though much of the rest the Afghans were responsible for. That the West had done a good job of fighting terrorism, but that most of that was done on Pakistani soil, not on the Afghan side of the border. And that without fundamental changes in how Afghanistan did business, the Afghan government, and by extension the West’s investment in it, would come to little. 
His tone was neither shrill nor reproachful. It was matter-of-fact. 
“I still cannot understand how we, the international community, and the Afghan government have managed to arrive at a situation in which everything is coming together in 2014 — elections, new president, economic transition, military transition and all this — whereas the negotiations for the peace process have not really started,” Mr. Bajolet said in his opening comments.
His tone — the sober, troubled observations of a diplomat closing a chapter — could hardly have been more different from that taken by the new shift of American officials charged with making it work in Afghanistan: in particular, with that of Gen. Joseph F. Dunford Jr., the new American commanding general here. This week, General Dunford sent out a news release cheering on Afghanistan’s progress, noting some positive-leaning statistics and praising the Afghan Army’s abilities.
Several diplomats in the room could be seen nodding as he said that drugs caused “more casualties than terrorism” in Russia, Europe and the Balkans and that Western governments would be hard-put to make the case for continued spending on Afghanistan if it remains the world’s largest heroin supplier.
More at the link. 


...In the mid-1970s, the Law Enforcement Assistant Administration's National Advisory Committee on Criminal Justice Standards and Goals classified six types of terrorism, including "non-political terrorism". Both US federal regulation and the FBI define terrorism as "the unlawful use of force or violence … in furtherance of political or social objectives".

This raises a couple of intriguing questions. Why did US officialdom and the media fail to describe Sandy Hook as terrorism and why have American commentators and reporters rushed to assume a political motive for the Boston attacks, even though the older brother and presumed mastermind, Tamerlan, seems to have had plenty of personal issues and private grievances?

It would seem that even if terrorism does not have to be political, the use of this loaded term is often politically motivated. Mass shootings probably don't make it on US society's radar as "terrorism" partly due to the polarised firearms debate. Can you imagine what kind of a stink the gun lobby and people who believe that bearing arms is their constitutional right would whip up if the media or authorities started classing Sandy Hook as a terrorist atrocity?

Video at this next link -- IDF soldier yelling at Palestinian activists. 

Do read this link. 
It is a very bleak assessment of the situation facing the US 
"...Nowhere in rebel-controlled Syria is there a secular fighting force to speak of."

This link will be a long read so I'm stopping here to read it myself.  Scanning through the first time was not enough. 
This is Ezra Klein's description and defense of Health Quality Partners.
Kenneth Thorpe, chairman of the health policy and management school at Emory University, estimates that 95 percent of spending in Medicare goes to patients with one or more chronic conditions — with enrollees suffering five or more chronic conditions accounting for 78 percent of its spending. “This is the Willie Sutton rule,” he says. “If 80 percent of the spending is going to patients with five or more conditions, that’s where our health-care system needs to go.”
Health Quality Partners is all about going there. The program enrolls Medicare patients with at least one chronic illness and one hospitalization in the past year. It then sends a trained nurse to see them every week, or every month, whether they’re healthy or sick. It sounds simple and, in a way, it is. But simple things can be revolutionary. 
Most care-management systems rely on nurses sitting in call centers, checking up on patients over the phone. That model has mostly been a failure. And while many health systems send a nurse regularly in the weeks or months after a serious hospitalization, few send one regularly to even seemingly healthy patients. This a radical redefinition of the health-care system’s role in the lives of the elderly. It redefines being old and chronically ill as a condition requiring professional medical management. 
Health Quality Partners’ results have been extraordinary. According to an independent analysis by the consulting firm Mathematica, HQP has reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent. 
Others in the profession have taken notice. “It’s like they’ve discovered the fountain of youth in Doylestown, Pa.,” marvels Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers. 
Now Medicare is thinking of shutting it off.

Saturday, April 27, 2013

Today's Best Twitter Conversation

Weekend Reading -- April 27

Several links have come to my attention this morning worth reading and reflection. At a glance they seem unrelated but as a collection they represent a serious deficit of understanding where it counts -- in my peers, fellow-citizens and elected representatives whose preoccupation with more immediate challenges prevents them from seeing a larger view of the world. 
Here we go...


North Korea Says Detained American Tourist to Face Trial
Reuters report

North Korea said on Saturday a Korean-American tourist, jailed by the reclusive state since late last year, will face trial for "committing crimes" against the North, a move that could further stoke tensions with the United States. 
The move comes amid a diplomatic standoff between the North and the United States, and as Pyongyang has threatened to attack U.S. military bases in the Pacific and the South.
A number of U.S. citizens of Korean descent have run into trouble in the North over the years, and Pyongyang has tried to use their detention to extract visits by high-profile American figures, most notably former President Bill Clinton. 
In the latest case, Kenneth Bae, 44, has been held by police since arriving in the northeastern city of Rajin on Nov. 3. He was among a group of five tourists. 
"In the process of investigation he admitted that he committed crimes aimed to topple the DPRK with hostility toward it," KCNA state media reported, using the North's official title of the Democratic People's Republic of Korea. 
"His crimes were proved by evidence," it said, adding he would soon be taken to the Supreme Court "to face judgment". It did not provide further details. 
South Korean rights workers said that the North's authorities may have taken issue with some of his photographs, including those of homeless North Korean children. 
A South Korean newspaper published by an evangelical family said he may have been carrying footage of North Korea executing defectors and dissidents. It was impossible to verify this.
They may be calling him an "American tourist" but if my Korean experience is of any value, as soon as I saw that he was of Korean extraction I knew he was seen by the Koreans as a black sheep of the family more than anything else. Free Koreans entering the North are playing with fire. By now they know the risks (or should know) better than anyone.
More at the link.


They may be fighting for Syria, not Assad. They may also be winning: Robert Fisk reports from inside Syria
By Robert Fisk

Fisk is the Middle East journalist for Britain's Independent. He's a couple years younger than I but still turns up in the some of the most dangerous environments in the world. His reporting borders on war porn but no one can doubt his passion. He writes her from Syria, from among Assad's forces -- not from a Rebel perspective, which colors most reports from Syria. This is a powerful piece of writing as the following clips illustrate.
Death stalks the Syrian regime just as it does the rebels. But on the front line of the war, the regime’s army is in no mood to surrender – and claims it doesn’t need chemical weapons 
Clouds hang oppressively low over the Syrian army’s front-line mountain-top in the far north of Syria. 
Rain has only just replaced snow, turning this heavily protected fortress into a swamp of mud and stagnant ponds where soldiers man their lookout posts with the wind in their faces, their elderly T-55 tanks – the old Warsaw Pact battlehorses of the 1950s – dripping under the showers, their tracks in the mud, used now only as artillery pieces. They are “rubbish tanks” – debeba khurda – I say to Colonel Mohamed, commander of the Syrian army’s Special Forces unit across this bleak landscape, and he grins at me. “We use them for static defence,” he says frankly. ‘They do not move.’” 
Before the war – or “the crisis” as President Bashar al-Assad’s soldiers are constrained to call it – Jebel al-Kawaniah was a television transmission station. But when the anti-government rebels captured it, they blew up the towers, cut down the forest of fir trees around it to create a free-fire zone and built ramparts of earth to protect them from government gunfire. The Syrian army fought their way back up the hillsides last October, through the village of Qastal Maaf – which now lies pancaked and broken on the old road to the Turkish border at Kassab – and stormed on to the plateau which is now their front line. 
On their maps, the Syrian army codenamed “Kawaniah Mountain” according to their own military co-ordinates. It became “Point 45” – Point 40 lies east through the mountain gloom – and they spread their troops in tents under the trees of two neighbouring hills. I climb on to one of the T-55s and can see them through the downpour. There are dull explosions across the valley and the occasional “pop” of small arms fire and, rather disconcertingly, Col Mohamed points out that the nearest forest is still in the hands of his enemies, scarcely 800 metres away. The soldier sitting in the tank turret with a heavy machine-gun doesn’t take his eyes off the trees. 
It is always an eerie experience to sit among Bashar al-Assad’s soldiers. These are the “bad guys” of the regime, according to the rest of the world – although in truth the country’s secret police deserve that title – and I’m well aware that these men have been told that a Western journalist is coming to their dug-outs and basement headquarters. They ask me to use only their first names for fear that their families may be killed; they allow me to take any photographs I wish, but not to picture their faces – a rule that the rebels sometimes ask of journalists for the same reason – but every soldier and officer to whom I spoke, including a Brigadier General, gave their full names and IDs to me. 
Many of the soldiers show their wounds; more valuable to them, I suspect, than medals or badges of rank. Besides, the officers have already removed their gold insignia on the front lines – unlike Admiral Nelson, they do not wish to be picked off by the rebels’ early morning snipers. Dawn seems to be the killing time. On a roadway, a second lieutenant shows me his own wounds. There is a bullet’s entry below his left ear. On the other side of his head, a cruel purple scar runs upwards towards his right ear. He was shot right through the neck and survived. He was lucky. 
So were the Special Forces soldiers who patrolled towards a hidden land-mine, an IED in Western parlance. A young Syrian explosives ordnance officer in Qastal Maaf shows me the two iron-cased shells that were buried under the road. One of them is almost too heavy for me to lift. The fuse is labeled in Turkish. An antenna connected to the explosives was strung from the top of an electricity pole for a line-of-sight rebel bomber to detonate. A technical mine-detector – “all our equipment is Russian,” the soldiers boasted – alerted the patrol to the explosives before the soldiers walked over them.  
Colonel Mohamed, who mixes military strategy with politics, says he regards the foreign “plot” against Syria as a repeat version of the Sykes-Picot Agreement of the First World War, when Britain and France secretly decided to divide up the Middle East – including Syria – between them. “Now they want to do the same,” he says. “Britain and France want to give weapons to the terrorists to divide us, but we want to have a united Syria in which all our people live together, democratically, caring not about their religion but living peacefully…” And then came the crunch. “…under the leadership of our champion Dr Bashar al-Assad.” 
But it is not that simple. The word “democracy” and the name of Assad do not blend very well in much of Syria. And I rather think that the soldiers of what is officially called the Syrian Arab Army are fighting for Syria rather than Assad. But fighting they are and maybe, for now, they are winning an unwinnable war. At Beit Fares, I peak over the parapet once more and the mist is rising off the mountains. This could be Bosnia. The country is breathtaking, the grey-green hills rolling into blue velvet mountains. A little heaven. But the fruits along this front line are bitter indeed.


Inside the mind of a Muslim terrorist
By Jamal Khashoggi

I don't trust the reader to follow other links so I have copied the whole column here. This is a very smoothly composed journalistic gem attempting to administer some very bitter medicine to non-Arab, non-Muslim minds which remain mostly indifferent to the subtleties he politely underscores. 

I encourage the reader to follow the link to the general manager's earlier column.  These people are our friends. They are bending over backward to be polite as they tell us as diplomatically as possible that the extremism we have growing in America is every bit as toxic as that which animates the extremism of the young men we call "terrorists."
Dzhohkar Tsarnaev, the Boston Marathon bombing suspect who has serious injuries preventing him from talking and answering investigator questions, is surrounded by investigators who wish they were able to read his mind and search for answers. 
How did a young Muslim man change after he arrived to America as a teenager, fused into the community, became a “U.S. citizen like any one of us” (as one of his friends said), and then turn from a young man who loves life and money (as he wrote on his page on a social networking site) to a terrorist, killing innocent people? 
What mostly frighten security analysts, are the amateur terrorists who are not associated to any organization and who recruit themselves through the internet: analysts cannot consequently find any lines to track them down and expose them before they commit their crime. 
Last week, security officials uncovered two similar cases, one in Canada and the second in France. In both cases, there were young men like the Tsarnaev brothers, the suspects in Boston bombings. This phenomenon can ignite a new wave of Islamophobia. Most probably, someone is now asking in an American right-wing newspaper or TV channel “How can I be sure that my young Muslim neighbor who looks nice and friendly, and is no less American than I am, will not suddenly turn into a terrorist?” 
Despite our uneasiness as Arabs and Muslims regarding this question, it is a legitimate question that recalls the words of Al Arabiya General Manager Abdulrahman al-Rashed, who was brave enough to say that it is a “fact that not all Muslims are terrorists, but it is equally certain, and exceptionally painful, that almost all terrorists are Muslims”; these words pushed some people to harshly criticize him. 
Coming wave of terror? 
I will help security officials and investigators who wish to wander into the mind of Dzhohkar Tsarnaev and convey to them some of what is roving inside the angry Muslim mind in general, even though I know that American and western politicians reject any attempt to answer the causes behind Muslim anger.

They believe it “justifies” terrorism; they know that discussing the reasons will lead to hold them accountable and open some files they want to block out, even though their main goal should be to fight terrorism by treating its causes. American and western politicians also prefer to discuss with the Russian administration issues like promoting security cooperation, rather than to ask President Putin who is responsible for the Chechnya massacres, “what did you do there” and send a Congress committee to investigate his crimes. 
Amid the heightened security efforts that will occupy the attention of the politicians worldwide, they will not anticipate the coming wave of Islamic terrorism, which I expect. The earlier waves launched in the middle of the 1990s were a reaction to the events in Bosnia and Algeria. 
The second millennium wave focused on Iraq, Afghanistan and Chechnya, and will be followed by a third wave that will be provoked by the massacres in Syria, which is now fueling Muslim anger through images of never-ending injustice. They are real images that young angry Muslims can see today on YouTube and WhatsApp and are usually rated 18+. There are videos that news channels cannot broadcast, depicting members of the Syrian regime slowly killing and torturing their victims, and cutting off arms and legs. 
These pictures should be handed to the International Criminal Court and not to social media sites. They are also endorsed by a wave of images coming from Burma, where the world praises its support for Aung San Suu Kyi, Burma's opposition leader and Nobel Peace laureate; while nobody implicitly or explicitly condemned the flagrant human rights violations after the killing, burning and raping of the Muslim minority there. [►See Twitter message below]
Provoking images   
Perhaps Tamerlan Tsarnaev and his younger brother watched some of these videos and images that resounded in their angry minds, which was already accumulated as Chechens. They must have seen a lot of pictures showing Muslims being tortured; they have maybe watched the videos where the Russian officer slays a Chechen fighter with his small Swiss knife – the worst kind of slow murder; the victim wobbles and he gradually bleeds as the Russians laugh about it.
I reiterate that such videos should be sent to the International Criminal Court, but how would that happen if no one was sent to trial. What Bashar al-Assad is doing in Syria today is the same as what Putin did in Chechnya; there are images of the fully destroyed Grozny. The angry Muslim mind is observing again today, that those protecting Bashar and his regime are those who destroyed Grozny and killed more than 100, 000 Chechens. The angry mind does not see any other detail, such as the international scene or the balance of interests; it is a mind that is not able to think. If the Tsarnaev brothers were logically thinking they would not have targeted the Boston Marathon and the compassionate city that nestled them. 
The effect of these videos on the angry Muslim mind is substantial; it stimulates the accumulated feeling of injustice because it sees itself as a targeted minority and that the whole world is against it. It believes that Americans secretly support Bashar, and are keeping mum towards Putin’s crimes and the Burmese leader’s hypocrisy. It believes (and it has the right to) that the ugliest crimes of the last century and today have been committed against Muslims. The only exceptions are the Jews after being tortured by the Nazis, and the Armenians who were tortured by the Ottomans 
This angry mind also perceives that these two communities have gotten the world’s apologies and compensation. The only ones who do not receive apologies are the Muslims; we should not disregard the Palestinian soreness in the Arab Muslim conscience: there have not been a community that was displaced as the Palestinians were, and yet, no one is ready to apologize to them. Who dares to ask for a museum in New York commemorating the exodus? Who dares to ask for an official Russian apology for 1.5 million Chechens who were forcibly displaced from their homes and dispersed on the borders of the Soviet Union, where hundreds of thousands died from diseases and starvation? 
When the Chechens revolted asking for their independence, the Russians waged arbitrary wars against them, and again, the world did not react upon seeing the documented and truthful photos. Many stories are invading the angry Muslim mind in a way that paralyzes its logic and transforms the kindhearted young man into a dangerous terrorist. 
Some will think that in this article, I am trying to find excuses for terrorism, but no, no one can justify terrorism; the only way to eradicate it is to treat its causes. Someone must have the courage to tell the West: your double standards are the reason behind the anger generating terrorism. 
This article was first published in al-Hayat on April 27, 2013.
►One need not look far to find illustrations of Jamal Khashoggi's point. This is what happens in Cairo when Muslim minorities are being abused in Burma.


Syria intervention drawing closer but not because of chemical weapons
By Mahir Zeynalov

Blogging from Turkey, Mahir Zeynalov writes in Today's Zayman ("the most-circulating English-language newspaper in Turkey") that we can expect military intervention in Syria, mostly because the Assad forces seem to be getting an upper hand. See Robert Fisk's piece cited above
Go to the link for excellent supporting maps and infographics.
This guy is not making stuff up. He stands on historic evidence of events that everyone should remember which have happened in our lifetime. 
What's not to understand about the lessons of Iraq and Afghanistan?

As the clock keeps ticking I'm getting a flashback to the days leading up to the TWO wars when the US intervened in Iraq. (We seem to have totally forgotten Desert Storm, no? Papa Bush had one also but was circumspect enough to stop with containment.)
Is the use of chemical weapons that outrageous? Killing innocent people with chemical weapons is definitely a grave war crime, but causing the death of more than 80,000 is definitely a bigger war crime. Why then does the type of weapons used in massacring people determine when to intervene?

US President Barack Obama has said potential use of chemical weapons is “going to be a game changer” in Syria, where repeated calls for intervention fell on deaf ears for more than two years. 
The US and major powers have so far weathered calls for intervention for several reasonable reasons. Except for Turkey, Britain and France, all of whom called for tougher measures against the Syrian regime, those reluctant to intervene cited possible uncertainty after the fall of the Syrian regime, risking emboldening radical groups in Syria and causing more bloodletting if the intervention is mishandled. Are these concerns now mitigated by the use of chemical weapons? If the use of chemical weapons is so deeply immoral that it makes the case for intervention, is the death of tens of thousands of people the tolerable situation? 
The key to figure out the rationale behind this odd move is to understand when states decide to intervene. One thing stands clearer than others: States intervene when they see the military balance on the ground start to change against their favored side. [Ouch! JB]
Two recent examples clearly show that interventions take place when one side starts losing. The first example is the Bosnian War of the early 1990s. For four years, Western powers stood by as atrocities unfolded in Bosnia, including the infamous 1995 massacre of nearly 8,000 civilians in the town of Srebrenica. The intense air campaign against Serb fighters came shortly after this massacre, but it made little, if any, contribution to a wake-up call for NATO.

According to Ivo H. Daalder, the breaking point in the Bosnian War came after a decision by the Bosnian Serb leadership in early March 1995 that they needed to conclude the war by the end of that year. In four bloody years of intense fighting, Serbs were unable to break the impasse and control much of Bosnian land despite unprecedented atrocities not seen in Europe since the end of World War II. 
Daalder argues that the strategy of the Serbs was simple: First, a large-scale attack on the three eastern Muslim enclaves of Srebrenica, Zepa and Gorazde -- each an international “safe” area lightly protected by a token UN presence -- would swiftly capture these Muslim outposts in Serb-controlled Bosnian territory. Next, attention would shift to Bihac -- a fourth, isolated enclave in northwestern Bosnia -- which would be taken over with assistance from Croatian Serb forces. Finally, with the Muslims on the run, Sarajevo would become the grand prize, and its capture by the fall would effectively conclude the war. 
The situation in the Bosnian War was only slightly different from Syria, with Russia then supporting the Serbs. But NATO intervention came shortly after the Serbs began their greater offensive.

Another recent example is the 2011 intervention in Libya, during which Col. Muammar Gaddafi was ousted and eventually brutally killed. In Libya, the entire eastern half of Libya was seized by rebels in less than a month before forces loyal to Col. Gaddafi went on the counteroffensive in early March. One by one, Libyan forces captured rebel-held cities and targeted the largest rebel-held city: Benghazi. 
Hours before an assault on Benghazi -- we popularly call it the “Benghazi moment” -- French-led coalition forces (later NATO) intervened in Libya to tip the balance against the Gaddafi forces. The intervention in Libya would never have happened had the rebels defeated Gaddafi’s forces or been locked in a long and protracted conflict. 
Successful military gains of the Syrian regime forces over the past few weeks have pushed the US and its allies to reconsider intervening in Syria. 
Until now, Western powers, Turkey, Jordan and the Gulf States aided the opposition in any way they could to defeat Assad’s forces. Twenty-five months into the uprising in Syria, opposition fighters are yet to deal a decisive blow to the regime’s forces. For the first time in the fighting, however, they have started to lose. 
In the past few weeks, government forces have launched major offensives in Homs, Idlib, Kurdish-populated areas and in and around Aleppo and the capital Damascus. It is evidently clear that the military balance on the ground is tilting back toward government forces again after a counteroffensive.

Towns near Damascus such as Otaibah were seized by government forces this week, blocking the arms supply for the opposition from Jordan. Another front on the Lebanese border, Qusayir, was recaptured by the regime forces. The Syrian army was also successful in breaking the months-long siege in Homs and Idlib, making it easier to resupply arms to its forces stationed in these areas. If this pace of military advances by the regime forces continues, the opposition will be greatly weakened in a matter of weeks. Washington doubled its aid to the Syrian opposition last week, but the situation on the ground will change by the time the aid package is approved in Congress and reaches the fighters on the ground. 
This change in the military balance made the case for intervention much stronger in Washington and other European capitals. Along with Obama, UK Prime Minister David Cameron and Ankara also voiced concerns over the use of chemical weapons in Syria. Other nations will follow suit in the days to come. 
On Saturday, Turkish EU Minister Egemen Bağış acknowledged that Washington is preparing to intervene in Syria and that the possible use of chemical weapons are not the main drive. Russia believes that claims of chemical weapons use are another ruse by the Western nations to strengthen the case for foreign intervention in Syria. 
Washington says the evidence of chemical weapons use is only “preliminary.” The evidence will get “rock solid” if Damascus wins major battles against the opposition next week. In previous months, there had also been reports of alleged chemical use by the Syrian army. True or not, there is no reason why Assad’s regime would use chemical weapons if it knows that that means inviting Washington to intervene. 
Damascus faces a major dilemma: If it continues with its so far successful offensive, it will make the case bolder for intervention. Western powers don’t want Assad to win and they were expecting opposition forces to finish the fight. If the opposition fails to make any further gains, the West will come to its aid. 
If Damascus is smart enough, it will strengthen its bases in and around the capital to have an upper hand in possible negotiations and offer dialogue to solve the crisis. To realize exactly this, the Syrian regime has launched major assault against opposition fighters in Damascus suburbs. It captured the strategic town of Otaibah and dealt a huge blow to rebels in the Damascus suburb of Jdeidet al-Fadel.

On Friday, government troops pushed into two northern neighborhoods with heavy air and artillery attacks. The fighting was concentrated in the Jobar, Qaboun and Barzeh suburbs of Damascus. After securing his hold around the capital, Assad will likely offer dialogue with the opposition. 
In a nutshell, the use of chemical weapons is not a decisive element to make the case for intervention. It is only an excuse to intervene at a time when military involvement has become more necessary than ever.

A member of the Free Syrian Army holds his weapon as he sits on a sofa in the 
middle of a street in Deir al-Zor, in this April 2, 2013. (Photo: Reuters, Khalil Ashawi)

Apparently the Russians also believe the chemical weapons excuse for intervention is bullshit. This column plus what Steve said yesterday makes me agree. 

If all the tea leaves are being read properly, military intervention in Syria by outside military forces appears inevitable.  The questions now become...

  • Will  the US be moving unilaterally or in concert with other countries?
  • Will the ostensible excuse be the UN, or NATO or some duke's mixture -- yet another coalition of the willing?
  • Better yet, might we get Israel, our proxy in the neighborhood, to do the dirty work? 
  • What responses can be expected from Russia, Iran, European countries, Turkey, Lebanon, Iraq and other identifiably "Arab" or "Muslim" countries (not always the same)?
  • Will China have a dog in this fight?
  • Will the US Congress actually authorize action or keep a safe political distance?
  • And where will the money come from?  (Silly me... I'm actually thinking of how we might pay for it. Is that nutty, or what?)


Under scoring the point that the famous Chemical Weapons Red Line has not likely been crossed, we have this:

The Syrian Regime Tests its Boundaries
How Assad has Adapted to the “Red Line”

As a UN team awaits the Assad government’s go-ahead to conduct a probe into last month’s chemical simulant attacks in Aleppo and Damascus, we are reminded of the Obama Administration’s “red line” and the influences it has had thus far on the Syrian conflict. Though recent Congressional attention (there are three separate Senate committee meetings on Syria this week alone) towards Syria reflects a potential policy shift in the coming months, lawmakers are moving at a pace far slower than the adaptive cruelty of the Syrian regime. The “red line,” many argue, has acted as more of a “green light” to Assad’s military advisors. The March 19th, 2013 attacks on Aleppo and Damascus provide examples. 
Syrian Support Group was the first to receive information from the ground regarding the specifics of the March 19th chemical attacks in Damascus and Aleppo. As our sources reported it, two surface-to-surface missiles were fired from Damascus (one from the Qatifa neighborhood and the second from an unidentified location) towards Aleppo and eastern Damascus, respectively. An area 1km north of the infantry training academy in the Aleppine suburb of Khal al-Asal—a mostly regime-controlled and Assad-supporting area—was the site of impact of the first projectile, while the al-Oteiba neighborhood of eastern Damascus was hit by the second. This information was later revised to state that the projectile that struck Aleppo was delivered by a regime aircraft, and hit a pro-Assad and regime-controlled area due to pilot error. The Free Syrian Army does not have the technology, training, or capability to mix, load, or deploy such weapons. 
Initially, 54 victims of the Khan al-Asal attack were delivered to the regime-controlled Aleppo University Hospital, with 16 more arriving within the next few hours. Of these, 22 died during treatment. The remaining 48 were released after responding well to counteractive drugs such as Atropine. Two medical employees at the hospital reportedly also lost consciousness due to chemical inhalation, but recovered at the scene. There were an estimated 20 victims of the Damascus attack, however we do not yet have updated information about the total number of dead and wounded, nor about the exact type of delivery system. 
Samples taken from bodies Khan al-Asal victims confirmed that the substance used in the attacks was Echothiophate, and organophosphate commonly found in certain pesticides. The effects of Echothiophate on those who inhale the compound are similar to the effects of nerve gasses such as Sarin: muscle spasms and failure, respiratory malfunctions, and, if not treated with proper counteragents in a timely manner, death. 
Though this toxic chemical was intentionally deployed with the goal of killing opposition fighters and supportive Syrian citizens, it does not appear that its use will signal a crossing of the White House’s red line. Echothiophate is not a restricted substance under international chemical weapons treaties. Rather, it is considered a “simulant,” meaning that while its effects on victims are comparable to the effects of officially recognized chemical weapons substances, its use would not legally constitute a chemical weapons attack. A UN investigation, if conducted before the impact sites can be tainted or cleaned, would confirm to the international community the exact compound used in the attacks. If indeed the use of Echothiophate is confirmed, the White House’s red line may not officially have been crossed. 
On Tuesday, however, the Syrian regime refused to grant permission to the UN team waiting in Cyprus for deployment, arguing that such an investigation would be a violation of Syrian sovereignty. It now seems unlikely that an international body will be able to study the impact zones to independently verify the attacks. 
It is not unreasonable to assume that Assad and his military planners calculated the consequences of their choice to use a chemical simulant such as Echothiophate. By avoiding the specifically sanctioned substances outlined by specific international treaties such as the Chemical Weapons Convention, the regime was aware of the unlikelihood of forceful international response. By using its rights of sovereignty to deny access to a UN investigation team, Assad knew that he would remain untouchable. That the news of the March 19th attacks spread so quickly throughout the world was somewhat surprising to the regime, especially in the wake of similar, yet smaller, chemical agent attacks in late 2012. It was confirmed in December by another Syrian-American organization in the United States that Quinuclidinyl Benzilate, or “BZ,” was used in a similar strike last fall. In that attack, victims reportedly experienced nausea, paralysis, labored breathing, and dizziness. We must expect that such attacks may periodically continue to occur as the regime discovers, with each new and unpunished attack, just how much of a green light the red line really is. 
The international community remains, for the time being, unwilling to commit military resources to secure these weapons stockpiles or prevent their unmonitored proliferation to non-state actors, whose intentions may be even more malicious and unrestrained than those of the Assad regime. However, there are known and available products and practices that can be implemented on a wide scale to both reduce the effects of such attacks, and to equip Opposition forces and civilian populations with the necessary tools to save lives. Major General Salim Idris, in a February 4th letter addressed to the United States Government, specifically requested chemical weapons securement training and equipment to allow FSA forces to seek out and contain known chemical weapons stores. Included in this such a package, which the Syrian Support Group possess the resources and connections to implement, is MOPP-4 chemical agent aversion training that can be passed to individual FSA brigades and, more importantly, civilian populations, with ease. It is not too late to provide such training and equipment transfers, and indeed policy motives on The Hill are now moving in a direction that may soon lead to the implementation of these necessary initiatives. The right time to move, however, is now–not after yet another chemical attack that may be looming on the horizon.