State and federal lawmakers are focusing increasingly on health care reform, and a growing number are expressing serious interest in "patient-focused" or "consumer-centered" approaches. This is certainly a positive development. Lawmakers of both parties are now more inclined to advocate making the patient the focus of America's health care system.
However, the vocabulary of health care policy is often elastic, and different people use the same terms to express significantly different concepts. This elasticity adds to the general confusion among the public and policymakers that seems to plague this area of public policy and often results in legislators and taxpayers talking at cross-purposes or past one another.
Consequently, clarifying the rationale, objectives, and principles of consumer-centered health care reform is important so that participants in the discussions, particularly the taxpayers, accurately comprehend the concepts and implications of this approach and are better equipped to evaluate the various proposed reforms at the federal and state levels.
Key Principles
The fundamental objective of a patient-centered health care system is to maximize value for individuals and families so that they receive more benefit and better results for their health care dollars, both as patients and as consumers buying health insurance. Only when individuals choose and own their own health insurance will the other actors in the system—health plans and providers—have the right incentives to deliver better value in the form of improved results at lower prices.
If policymakers are serious about real patient-centered, consumer-driven health care reform, they should ensure that their legislative proposals embody six key principles:
The Key Tests of Reform
Notall health care reform legislation that is labeled consumer-oriented is equally effective or significant. The key test is whether or not it puts in place structural changes that maximize the ability of a large number of individuals to make basic choices about their own health insurance coverage and medical care.
Individuals are both consumers and patients. In a consumer-centered health system, individuals directly control the flow of dollars, buy and own their own health plans, pick the kinds of coverage that they want, and determine which plans offer them the best value.
In such a system, consumers expect transparent prices, and consumer choice stimulates competition among plans and providers to offer better value for money. That competition, in turn, drives innovation in both clinical practice and plan design. For individuals as patients and consumers, value for money is judged in terms of results: better medical outcomes, improvements in their health condition or status, cost-effective treatments, and health plans that save them money by helping them stay well and, when they do need care, by identifying the providers that offer the best results at the best price for their particular condition.
Thus, true consumer-centered health reform is system-focused reform, not product-focused reform. Its objective is to improve performance and results by changing the basic structure and incentives of health care markets so as to maximize value for money in health insurance and medical care. It is not simply an exercise in legislating new product designs or trying to plug gaps in coverage by crafting new programs for targeted subpopulations. Instead, true consumer-centered health reform focuses on making fundamental structural changes in the system, as opposed to merely expanding the existing system or micromanaging insurance plan designs or provider reimbursement methodologies.
Policymakers need to step out of the conventional mindset that accepts the basic structure of the present system as a given and attempts only to modify it around the edges. For example, legislative proposals to promote certain product types— e.g., health maintenance organizations (HMOs) and health savings accounts (HSAs)—may well have beneficial effects, but they do not fundamentally change how the system functions as long as someone else picks the health plan for the individual. Similarly, no amount of regulatory tinkering with provider reimbursement rates or payment methodologies can create more than marginal improvements in value as long as the system vests control over key decisions with employer and government "payers" who are not the ones receiving the medical care or using the health insurance policy.
Rather, consumer-centered health reform challenges policymakers to redesign the basic rules of the health care market to create new incentives for all of the actors in the system to put the interests of consumers and patients first.
Properly designed structural reforms will also produce a better framework and new incentives for addressing the current system's failings in cost, access, and quality more effectively. If responding to consumer needs and preferences is made the organizing principle of the system, then insurers and providers will have the right incentives to develop innovative ways to deliver better value to consumers and patients in the form of lower costs and improved outcomes.
In a reformed market, competition will produce new and better plan designs, clinical practices, and provider payment arrangements without lawmakers needing to micromanage the process. At the same time, it will generate new opportunities for lawmakers to focus public assistance more effectively to ensure that all Americans have access to the benefits of a system that offers better value.
The fundamental problem with the current system is that it encourages all participants (payers, insurers, providers, and patients) to engage in a giant game of cost-shifting, with each party trying to stick one or more of the others with a bigger share of the bill. Thus, while there may be plenty of competition in the present system, much of it is a zero-sum competition in which there is a loser for every winner. What America's health care system desperately needs are structural changes that create positive-sum competition in which all participants can "win" by working, often collaboratively, to improve the health care value proposition.[1]
The Consumer As Key Decision Maker
The place to start examining any economic or social system is with its basic organizing principle, which is identified by asking "Who is the key decision maker in the system?" In any economic or social system, the key decision maker is the one who sets the parameters for the other participants in the system. The other participants must act in response to the needs or preferences of the key decision makers.
Political science clarifies this process. For example, in a democratic system of representative government, the organizing principle is popular sovereignty, identified by the fact that voters are the key decision makers. Other participants (e.g., office holders, public employees, lobbyists, and interest groups) operate within the framework of the preferences periodically expressed by voters in elections. To advance his or her interests successfully, another participant must ultimately persuade voters either that they already want what the participant is proposing or that they should want it.
This creates a cascading chain of incentives throughout the system. For example, the most successful way for a lobbyist to persuade a politician to vote for what the lobbyist wants is to show the politician how such a vote would be popular with voters.
Other political systems (e.g., monarchies, aristocracies, and dictatorships) have different organizing principles, each of which can be determined by identifying the key decision makers in these systems.
The same holds true in economics. Most market economic systems are "consumer-driven" because the individual customer is the key decision maker. The other participants (e.g., producers, shippers, wholesalers, and retailers) must operate within the framework of the consumers' preferences as expressed through their purchases. To advance their own interests successfully, the other players must find ways to persuade customers either that they are offering what the customers already want or that the customers should want what they are offering.
Again, the result is a cascading chain of incentives. Thus, the surest way for a shipper to get a producer's business is to demonstrate that it can deliver goods to retailers or consumers more quickly and at less cost.
As in politics, alternative economic system designs can be recognized by identifying the key decision makers and, thus, the systems' organizing principles.
For example, the organizing principle of a monopoly is that the economic sector is "producer-driven." A monopoly exists (whether by accident or by design) when only one producer provides a particular product, thus making that producer the key decision maker. With no alternative producers available, other participants in the sector (e.g., consumers and retailers) are constrained by what the sole producer decides to produce and its quantity, timing, and price.
Likewise, when suppliers collude, such as through a guild or cartel, the resulting market can be described as "supplier-driven," reflecting the fact that suppliers hold the key decision-making power in that particular sector.
The Health Care Sector Anomaly
In health care, on the supply side of the supply and demand equation are physicians, hospitals, and other health care professionals and institutions. Collectively, they are commonly referred to as health care providers. On the demand side are the patients who are seeking or receiving medical treatment. The broader term "consumer" encompasses not only patients, but also individuals who, while not actively seeking or receiving medical care, purchase related products and services, most notably health insurance.
In the U.S. and many other countries, health care differs from most other economic sectors because government policies have sponsored, promoted, and maintained an anomaly in the sector—an additional set of participants known as third-party payers. While individuals always ultimately pay the costs of any health system, governments have instituted policies that effectively divert a portion of their incomes into the hands of others (the payers), who then make the basic or key decisions on how to spend the money on behalf of patients.
The simplest variant of this arrangement is the single-payer system, in which the government taxes its citizens and then pays medical providers for treating them. The U.S. and some other countries have developed multipayer variants of the same basic model.
In multipayer health systems, the government is almost always one of the payers, but its role is more limited than in single-payer systems, typically operating tax-funded medical care payment programs only for certain subgroups of the population. For example, in the U.S., the federal government runs a tax-funded single-payer system for the elderly called Medicare, while the state governments run a similar system for the poor called Medicaid.
However, for the majority of individuals in countries operating multipayer health systems, the relevant third-party payers are private entities such as employers, unions, or associations. These private payers divert a portion of their workers' or members' income either to buy health insurance or to pay medical bills directly on behalf of their employees or members. These arrangements can be either mandatory, as in Germany, or voluntary, as in the U.S.[2]
Yet, in a voluntary third-party payment system, individuals are unlikely to hand over large chunks of their income and the authority to spend it without something that makes the arrangement significantly more advantageous to them than buying the services directly. That is particularly true for something as personal and important as health insurance and medical care.
In the U.S., these arrangements exist largely because employee compensation that is diverted through employers to buy the employees' health insurance is exempt from federal income and payroll taxes. In contrast, if workers wanted their employers to divert part of their compensation for other purposes—such as buying groceries, paying for their housing, or leasing cars for their personal use—they would find that tax law treats such arrangements as income and taxes the workers accordingly. While the law does not prevent employers and workers from entering into third-party payment arrangements for food, housing, transportation, or anything else, such arrangements are uncommon because they offer no clear advantage (tax or otherwise) to workers over receiving their compensation in cash and then paying directly for the goods or services of their choice.
The Evolution of the Health Care System
Current health care systems are a relatively recent phenomenon. They evolved in response to advances in biology, chemistry, and physics since the end of the 19th century that transformed medicine into a scientific discipline and an expanding economic sector. Even though the purpose of medicine is to better the lives and health of patients, the health care financing arrangements that evolved over the past century have never been truly consumer-centered.
Through at least the first half of the 20th century, health systems were essentially provider-centered. Patients were expected to defer to the judgment of medical professionals and to pay what was charged. It was considered highly unprofessional for physicians to engage in explicit price competition. Hospitals granted admitting privileges to physicians, and physicians referred patients to the hospitals where they had such privileges. Thus, a hospital's real customers were the doctors who controlled the flow of paying patients, not the patients themselves.
This basic structure persisted even as third-party payers, whether governments or employers, were introduced into the equation. Third-party payers were expected to pay the usual and customary charges billed by physicians and hospitals for their services, but not to question the benefits, quality, or value of these services. This provider-centered focus can be seen in early health insurance arrangements. For example, in the 1930s, hospitals organized Blue Cross and doctors organized Blue Shield to guarantee providers steady, predictable income streams by having patients—and later, their employers—effectively prepay for medical care on a subscription basis.
However, the resulting growth in the cost of medical care eventually spurred payers to start questioning the bills, beginning in the 1970s. At first, the focus was on the prices charged by providers. Payers, both government programs and private insurers working for the employers who were their customers, imposed payment limits on provider charges. Over time, those initial limits evolved into complex and comprehensive payer-imposed provider fee schedules.
However, as the payers soon discovered, prices constituted only half of the cost equation. Costs were still climbing thanks to steady increases in the volume and intensity of the medical care being provided. In recent decades, payers have tried to tackle this other half of the cost equation with a variety of restrictions on patient access to specific treatments or technologies.
The result is that today's health care financing systems, whether at home or abroad, are functionally payer-centered, with third-party payers having displaced providers as the key decision makers in the system.
In this specific sense, there is no qualitative difference between a single-payer system and a multipayer system. Both systems are payer-centered. Consequently, both systems generate the same incentives for other participants to respond to payers' demands and preferences rather than those of providers or patients. In a single-payer or a multipayer system, the payers decide whether or not to contract out to private insurers all or part of their role in managing the system, and they determine the terms and extent of such contracts. Private insurers therefore first serve the interests of the third-party payers who are their customers.
Thus, the relevant question is "For whom do the private insurers work?" not "Are private insurers part of the system?"
The Alternative: A Patient-Centered, Consumer-Based System
The obvious shortcoming of a provider-centered system is that it distorts the system in the direction of providing more, regardless of cost. The natural tendency of providers is to assume that increasing the volume and intensity of medical services will generate more benefit. Of course, this assumption is not consistently true. Depending on the circumstances, a particular test or therapy can be unnecessary or ineffective. Indeed, many medical interventions entail significant risks to the patient and can cause more harm than good. At other times, the modest benefits are not worth the costs.
In contrast, the shortcoming of a payer-centered system is that it distorts the system in the opposite direction by focusing on the cost side of the equation to the detriment of the benefit side. The most obvious, most effective, and simplest way to limit costs is by not spending money, but simply paying less or refusing to pay at all does not inherently produce more benefit or better value for the patient.
Furthermore, both a provider-centered system and a payer-centered system have an inherent bias to favor short-term considerations over long-term considerations. In a provider-centered system, the incentive is to do more now without adequately considering the possibility that such a course of action could produce a worse result later. In a payer-centered system, the incentive is to save money today without adequately considering the possibility that this could increase future costs.
Neither a provider-centered system nor a payer-centered system has the requisite incentives to maximize value systematically and consistently. Only consumers have a natural interest in a system that reduces costs while simultaneously improving results over the long term.
For any economic system to be value-maximizing, it must consistently and broadly reward consumers with lower cost and greater benefits if they seek the best value and must reward producers and suppliers with more business and higher incomes if they offer a better value than their competitors.
Thus, the foundational insight behind consumer-centered health care reform is that the only way to achieve better value in health care is to make the consumer the key decision maker in the system. Only when users and payers are the same will the incentives in the health care system properly align to seek and generate better value. Since third-party payers are never the users of the system—after all, doctors and hospitals treat people, they don't treat governments or companies—the only way to align the incentives to produce better value is to give those who use the system (patients and consumers) control over the funding and the associated spending decision. No other alternative arrangement can systematically and consistently produce more for less and secure value for the patient.
The Objectives of Patient-Centered, Consumer-Based Reform
The overarching objective of consumer-centered health care reform is to transform the health care market into one that maximizes value, meaning that the system's operational dynamic is competition among participants to produce better results at lower cost for patients and consumers. Once delivering better value to consumers becomes what enables other participants (e.g., doctors, hospitals, insurers, drug makers, and insurance agents) to "win" within the system, many of the current problems start to solve themselves. A consumer-centered system begins to control costs because it creates increased pressure to justify costs better in terms of demonstrated benefit. At the same time, a consumer-centered system generates pressure to improve results by demanding data showing that anticipated benefits are commensurate with expected costs.
Consumer choice also creates stronger incentives for measuring and reporting quality and performance because consumers need that information to make better decisions, thus producing improvements in those areas as well. Even a portion of the access problem begins to solve itself. When health insurance attaches to the person instead of to the job, fewer people encounter circumstances in which they lose their health insurance coverage, and the size of the uninsured population is commensurately reduced.
A secondary objective is to provide lawmakers with a better foundation on which to build complementary public policies that more effectively address those access issues that competitive markets alone cannot solve. For example, the existence of a consumer-centered market for food makes it easier for policymakers to assist those who need help beyond what the market can provide through such means as subsidies in the form of food stamps or targeted incentives for grocery stores to operate in economically or geographically marginal, underserved areas. In a similar fashion, the presence of a consumer-centered, value-maximizing health system would allow lawmakers to focus tax dollars on helping those individuals who are financially or geographically disadvantaged to "buy into" a well-functioning system.
Another secondary objective is to encourage greater innovation. In this regard, health system innovation encompasses not only medical innovation to produce new and better treatments and therapies, but also innovation in organization and financing such as developing better clinical practices for treating patients, better provider payment arrangements, and better insurance plan designs.
This last point is particularly important. By putting the interests of patients and consumers first, a consumer-centered system forces other participants, particularly insurers and providers, to rethink their relationships and interactions. The current confrontational dynamic, in which providers try to force payers to spend more and payers try to force providers to charge less and do less, becomes an unproductive strategy for both sides because it does not produce the better value that consumers want. Instead, in a consumer-centered market, providers and insurers would find that they can both win (gain market share and increase income) if they collaborate to deliver better value (more benefits for less costs) to patients and consumers. This forces them to think more creatively and urgently about how providers can improve their quality, results, and efficiency and how insurers can restructure provider payment and contracting arrangements to capture newly created value and pass the savings and benefits on to their customers.[3]
The Key Principles of Real Reform
Lawmakers looking to design the right policy framework for enabling a consumer-centered, value-maximizing health system need to start with six key principles.
PRINCIPLE #1: Individual consumers are the key decision makers in the system.
In a consumer-centered health care system, individuals are the key decision makers with respect to medical treatments and health insurance. The current payers in the system (governments and employers) will still play an important role, but in a different fashion. They will no longer manage the details of the system, but will instead play supporting roles in assisting consumers, who become the system's primary decision makers. The role of employer will center on providing their employees as consumers with financial engineering and decision-support services.
The financial engineering aspect encompasses various employer strategies to help workers participate in the system more efficiently. For example, the workplace is a convenient location for distributing information and handling administrative tasks, such as workers choosing coverage from a menu of options during an annual open season. Similarly, employer participation in an automatic payroll deduction system for insurance premiums is an administrative efficiency that benefits workers at very little cost to employers.
Most important, as long as federal tax policy treats worker compensation for health care as tax-free to the worker if it is passed through the employer's hands, employers can leverage the tax code to ensure that their employees' spending on health insurance and medical care takes advantage of that favorable tax treatment. Doing so effectively lowers the cost of health insurance and medical care to workers by 15 percent to 50 percent because workers do not pay taxes on this compensation.[4]
Employers can also play a decision-support role by assisting their employees with information and guidance in making health care choices. Most often, this will take the form of the employer or an insurance broker under contract with the employer helping individual workers pick the insurance plans that best suit their personal circumstances and preferences. Employers can also offer their employees a range of related services, such as workplace clinics; health promotion programs; information on the costs, risks, and benefits of common treatments; and comparative data on the quality and results of health care providers. Employers inclined in this direction will find that numerous vendors already exist who are willing and able to bring these and similar programs into the workplace.
For governments, their role in a consumer-centered system shifts to financial assistance. Ultimately, the goal should be for the government to stop trying to design and operate public health insurance plans and instead focus on providing disadvantaged individuals with the necessary funds to buy into the same consumer-centered system that everyone else uses.
This will primarily take the form of steps to shift public assistance from a defined-benefit model to a premium-support model. In the current defined-benefit model, the government operates separate public health insurance plans for specified subsets of the population—something that government is poorly equipped to do competently. In a premium-support model, the government would operate programs to supplement the incomes of those who do not have sufficient funds to buy adequate health insurance and medical care in the market, just as the government now does with food stamps to help the poor buy groceries.
In some places, such as rural areas or economically distressed locations, governments might also provide assistance in the form of targeted subsidies or incentives to ensure that essential health services are available—for example, by funding clinics or offering inducements to health professionals to practice in those areas.
PRINCIPLE #2: Individuals buy and own their own health insurance coverage.
For a health system to be consumer-driven, health insurance coverage must be purchased and owned by individual consumers. In other words, the coverage contract must be an agreement between the insurer and the individual consumer. If the contract is between the insurer and some other party, such as an employer or a government, then the other party, not the individual consumer, is the insurer's real customer.
While at one level a coverage contract is a legal arrangement, it is primarily an economic arrangement. The legal aspects of the contract simply define the specifics of the underlying economic arrangement between the insurer as the supplier and the counterparty as the customer. As a supplier, the insurer is legally obligated and economically motivated to work in the interest of its customers. However, when the counterparty is an employer or government, that entity becomes the insurer's customer, and the counterparty's interests may differ from or be contrary to the individual's interests, even if the coverage is ostensibly purchased for the individual.
A simple analogy illustrates this key point. When a parent purchases breakfast cereal for a child, the customer is the parent, not the child. The parent and the child may have different opinions as to the best cereal to purchase. Indeed, these different opinions likely result from differences between the interests and preferences of the parent and the child. For example, the child likely prefers flavor over nutrition, while the parent will likely view nutrition as more important than flavor. Of course, the child's preferences likely influence, at least partially, the parent's decision, and cereal makers may even try to exploit this by pitching advertising to the child in the hope that he will influence his parents.
Ultimately, the buying decision rests with the parent, who is therefore the cereal maker's true customer. For the child to be the customer, the child must make the purchasing decision, using either his own money or money given him by a parent. Absent such a shift in decision-making authority, to sell more cereal, the cereal maker must first make its products attractive to the parents who will buy them, regardless of how attractive it makes the cereals to the children who will eat them. This means that the cereal maker must focus on the aspects that matter most to parents, such as nutritional content or pricing that gives them good value for their money.
While parents letting their children choose which breakfast cereal to buy is probably not a good idea, having individual consumers—not their employers or the government—choose their own health insurance plans is a good idea.
PRINCIPLE #3: Individual consumers choose their own health insurance coverage.
Individual ownership of coverage is an essential criterion for a consumer-driven market, but it is not the only criterion. A market characterized by individuals purchasing the product is still not a consumer-driven market if only one product is available, if there is only one supplier, or if the suppliers are organized in a cartel.
In such monopolistic circumstances, the lack of meaningful choice for consumers means that the key decision-making power still resides on the supply side of the economic equation. For the market-shaping power of the key decision maker to shift from the supply side to the demand side, consumers must have a choice of competing products and suppliers. Only then must suppliers respond to consumers instead of the other way around.
The linchpin of a consumer-centered health care market is the opportunity for individuals to choose the health insurance coverage that best suits their own preferences. While choice of health care providers is certainly essential to a well-functioning, consumer-centered market, the ability to choose among a diverse array of competing health insurance plans is the most important feature. This is true for two reasons.
First,health insurance is the principal mechanism for financing medical care. Indeed, this is true even when consumers opt for high-deductible plans and purchase much of their routine medical care directly from providers. For a health system to be truly consumer-centered, individual consumers must ultimately decide how the money in the system is spent. Thus, the first and most basic decision that consumers must be allowed to make is which health insurance plan to purchase.
Second,the choice of a health insurance plan of necessity incorporates a whole set of other implicit choices, such as what the plan will pay for versus what the consumer will purchase directly from providers, how and from whom the consumer will receive care, and how the plan will assist consumers in deciding among competing providers and treatment options. This last consideration is particularly important. Even the most sophisticated consumer may not have all of the relevant information available or have sufficient time to gather and analyze it when deciding among providers and treatments. However, health plans have—or should have—the information and expertise to assist consumers in making these decisions.
What consumers want is good value—meaning the best medical care at the best price. In a competitive market in which consumers choose their own health insurance, insurers succeed and prosper by offering consumers a better value proposition than their competitors offer. In other words, they apply their data and expertise to finding their customers the best medical care at the best price or, better yet, to finding ways to help their customers minimize their medical spending by staying or becoming healthy.
Thus, when individual consumers decide which insurance plan to purchase, insurers become the consumers' expert agents, helping them to navigate the health care system and obtain the best results at the lowest cost.
PRINCIPLE #4: Individuals have a wide range of coverage choices.
In any truly consumer-centered market, multiple suppliers compete to offer consumers better products at better prices. Yet for market competition to produce better value consistently—that is, by simultaneously increasing benefits while decreasing costs—consumers must be free to choose from a range of different options, and suppliers must have wide latitude to innovate in meeting consumer demands and preferences with new and better products. Thus, a precondition to any well-functioning, consumer-centered market is that lawmakers avoid unduly restricting either the options available to consumers or the scope for supplier innovation.
Government does need to set some basic rules for any well-functioning market. Much like establishing product safety standards or a uniform system of weights and measures, government can establish rules that facilitate well-functioning markets without unduly restricting supplier innovation or consumer choice. However, for a competitive market to function optimally, the basic rules need to permit wide scope for suppliers to innovate in developing new and better products and features to meet consumer needs and preferences.
Furthermore, lawmakers need to recognize that not all consumers have the same needs, preferences, or priorities. Suppliers must be free to innovate in offering different products to different subsets of consumers, targeting their different needs and preferences. This is particularly important in the health care sector where constantly expanding scientific knowledge and the resulting innovations in medical treatment force continual reassessment of what is "best" for individual patients and specific medical conditions.
For example, in health care, it is appropriate for government to limit the practice of medicine to those who demonstrate adequate knowledge and skill, but lawmakers should avoid inappropriately restricting provider competition with rules beyond those necessary to ensure basic provider competence and patient safety. Likewise, lawmakers should also take care to avoid imposing regulations that needlessly micromanage providers, stifle innovation in clinical practices, or favor one set of providers over another.[5]
In the same fashion, lawmakers need to set basic standards and rules for health insurance products and the companies that offer them. Yet they need to resist the temptation to substitute their judgment for the consumers' judgment.
In setting health insurance market rules, lawmakers should focus on establishing the broad market parameters and allow market competition to work out the details. For example, in setting coverage standards, lawmakers should limit themselves to specifying basic coverage categories, such as physician services, hospital services, and prescription drugs. They should avoid micromanaging the market by, among other things, imposing coverage mandates for specific conditions or treatments or by stipulating how plans must contract with providers.
Similarly, lawmakers should not enact measures that favor one particular plan design over others. Government policy should treat all plan designs (e.g., HMO, preferred provider organization (PPO), indemnity insurance, and HSA with high-deductible insurance) equally. Such an approach not only permits beneficial competition and innovation, but just as importantly respects and accommodates differing personal preferences among consumers.
PRINCIPLE #5: Prices are transparent to consumers.
The same holds true in establishing rules for the price side of the price/benefit equation. In all cases, lawmakers should avoid direct "price setting" because such interventions inevitably distort the market in ways that end up harming both suppliers and consumers.
Yet government does play a legitimate role in ensuring that a market functions fairly and smoothly by establishing basic pricing rules, which enable consumers to comparison shop effectively by clearly informing them up front about the price of each option. For example, government requires grocers to include the unit price on the label of products sold by weight or volume and requires lenders to disclose the effective annual percentage rate (APR) of a loan when offering financing to prospective borrowers.
In a similar fashion, lawmakers will need to reach agreement with stakeholders on the appropriate standards for calculating and communicating prices to consumers in the health system. While enhanced price transparency at the provider level will certainly improve the functioning of the health system, the bigger issue will be the rules for how insurers price their health plan offerings.
Because insurance premiums can be calculated in a number of different ways, lawmakers need to establish rules for reporting those prices so that consumers can comparison shop among the different offerings. In other words, which factors and parameters will be used in reporting prices? Will prices (premiums) be reported on an age-adjusted basis? If so, will the competing plans produce rate tables priced in one-year age increments, or will five-year age increments be sufficient for insurers and simpler for consumers? Lawmakers will need to address similar questions about other possible rating factors, such as geography and family status.
Regardless of the specifics, lawmakers need to establish some set of basic rules on reporting premiums. Otherwise, if competing insurers priced their plans in different ways, or if insurers customized the premium charged to each individual customer, it would be difficult or even impossible for consumers to comparison shop among plans. Without some agreed convention on reporting prices, the balance of power in the market shifts back to the supplier because the answer to the consumer's question "What is the price?" becomes "It depends." This makes it difficult for consumers to weigh the relative costs and benefits of competing options accurately and makes the market supplier-driven instead of consumer-driven.
The specifics of the pricing convention are less important than making certain that some standard pricing convention is used. For example, for many years the standard convention on the New York Stock Exchange was to price stocks in eighths of a U.S. dollar, while the London Stock Exchange used hundredths of a British pound. Although they used different pricing conventions, both markets worked equally smoothly. Indeed, when U.S. stock markets switched to using hundredths of a U.S. dollar, some market participants fared marginally better or worse than they had fared under the previous convention, but the markets continued to function smoothly. In contrast, a stock market would become less transparent and less efficient if each company was listed using its own choice of currency and fractional system.
In setting these and other market parameters, lawmakers should focus on ensuring that the resulting rules are transparent and equitable to consumers and that they provide insurers with a level playing field while accommodating their legitimate business concerns.
PRINCIPLE #6: Consumers have regular opportunities to make coverage choices on predictable terms.
For a market to be truly consumer-centered, individuals must be able, at least periodically, to reconsider past purchasing decisions and make different ones. A market that restricts consumer choice by unreasonably locking consumers into past decisions also has the effect of shifting the balance of power in the market back to suppliers.
For example, if a market rule locked consumers into buying new cars only from the manufacturers of their first cars, this would clearly shift market power from consumers back to suppliers and reduce producer competition and its resulting benefits. With much of its customer base locked into its product line, each producer would have significantly less incentive to respond to consumer demands for better products, more innovative features, and lower prices.
For the health insurance market to be truly consumer-driven, a clear set of rules must establish when and under what terms consumers can choose among competing options. Otherwise, adverse selection or constant churning could undermine the stability and viability of these markets. Nonetheless, these rules need to ensure that the market puts the interests of consumers firmly ahead of the interests of suppliers (the insurers) while still accommodating the legitimate business concerns of the suppliers.
This feature of consumer-centered health reform will likely be the most unsettling to many insurers because it will require them to adjust their business practices to accommodate a new market dynamic in which the customer picks the supplier. In the current dynamic, the supplier picks its customers through various strategies that focus on selling to some potential customers but not to others.
In setting this portion of the market rules for a consumer-centered system, lawmakers need to start from a clear understanding of both the product in question and the needs and behavior of consumers.
A significant portion of any health insurance plan is not insurance in the classic sense of financial protection against unpredictable risks or costs. All health insurance plans still retain some element of this protection, but it is no longer their primary feature. Rather, a large share of health insurance today consists of prepayment for medical care of varying cost and predictability. While the concept of using health insurance to pay for a full range of possible medical care was originally developed decades ago to serve the providers' interest in having more predictable income, that concept has since superseded its original intent.
Today, health insurance plans are a way for consumers to manage their need to finance medical care of varying predictability. In recent decades, advances in medical science have steadily made more medical services more predictable for more patients. Furthermore, the current trends in scientific discoveries and their practical applications in the clinical setting will make even more medical care more predictable for more patients in the future. This is an irreversible dynamic that is driven by steadily expanding knowledge in the basic sciences of biology, chemistry, and physics, closely followed by constant practical innovation in applying that knowledge to the development of new tests and therapies.
This ongoing scientific evolution has several practical implications for health insurance and health insurance markets.
First,it is no longer practical or desirable for policymakers to attempt to fight the rising tide of scientific knowledge by trying to restrict health insurance plans to paying only for the limited and ever-shrinking share of medical care that is genuinely unpredictable. Even the more consumer-directed plan designs that limit coverage by requiring subscribers to pay directly for more of their routine care will need to evolve to accommodate this new reality—for example, through mechanisms to ensure that incentives are properly aligned between the care that subscribers purchase directly and the care paid for by the plan—so that the totality of treatment is integrated and produces optimal results. While such plans will continue to attract a share of consumers, they will need to demonstrate in a competitive market that the total proposition offered—the combination of services paid directly by the consumer and services reimbursed by the plan—is a good value compared to other plan designs and produces a combined outcome for the consumer that is as good as or better than that offered by alternative, competing arrangements.
Second,plans will need to become more of the consumer's "expert agent" who works to identify for customers the best providers and treatment options available at the best prices. Some current business practices, such as negotiating provider contracts based mainly on price and then steering patients to those providers, will not compete adequately in a value-maximizing market.[6] Instead, plans will need to develop new strategies. For example, they might cover all providers in a given market but vary patient co-pays according to an analysis, which the plan makes available to its subscribers, of which providers offer the best results at the best prices. Pharmacy benefit managers have already pioneered such a business strategy in the form of tiered co-pays for different competing drugs.
Third,a consumer-centered system will need to curtail some current insurer underwriting practices that exclude, limit, or charge above-standard rates for coverage for certain individuals or certain medical conditions. While these traditional practices will need to be retained in a limited form as penalties against those who wait until they are sick to buy coverage, they cannot be applied when individuals with coverage choose a different plan if the new market is truly consumer-centered. One of the important incentives for purchasing health insurance when an individual is healthy must be the assurance that future changes in health status will not disadvantage the individual when retaining existing coverage or choosing new coverage.[7]
Fourth,as science increasingly makes more medical care more predictable, health plans must recognize that they are increasingly less in the business of cross-subsidizing unpredictable risks and more in the business of cross-subsidizing health status. In this regard, cross-subsidizing health status is not only a horizontal exercise—commonly understood as the healthy paying for the sick—but also a longitudinal one in which a healthy person today will probably be in poorer health at some point in the future or even vice versa.
A competitive, consumer-centered system will force insurers to rethink some of their business practices in this area as well. For example, insurers might experiment with offering features such as multi-year contracting, premium discounts for participation in wellness or disease management programs, or cash rebates to subscribers who successfully meet agreed-upon health improvement goals. These and other novel plan designs can create powerful new incentives for consumers, providers, and insurers to work together to achieve better value by keeping or making consumers healthier at a lower cost.
Fifth,lawmakers must ensure that the market rules in this regard are fair to consumers, while also accommodating the legitimate business concerns of insurers. For example, if consumers are to be able to choose coverage at standard rates regardless of health status, it will be necessary to limit when consumers can make these choices to avoid confusion in the market. For instance, consumers could be limited to choosing or changing coverage only during an annual open season, or for some other fixed period of time, with exceptions for special circumstances such as loss of employment or loss of coverage under a spouse's plan.
Similarly, lawmakers will need to work closely and cooperatively with insurers to devise risk-adjustment mechanisms to give insurers incentives not to avoid subscribers with health problems, but rather to help them get better outcomes at better prices or even to specialize in identifying and organizing cost-effective treatments for patients with specific conditions, such as diabetes, cancer, and heart disease. The market will need risk-adjustment mechanisms that allow each insurer to accept all customers regardless of their individual health status and that permit all insurers to aggregate a portion of their large claims and equitably redistribute these costs across all consumers in the market.[8]
Conclusion
The current debate over health care reform is usually framed in terms of addressing cost and access problems, accompanied by occasional discussions about the need to improve quality and outcomes in the system. Yet those issues are all manifestations of a more fundamental dissatisfaction with the status quo. Implicitly, both policymakers and the public are motivated by a sense that health care today is not living up to their expectations for value at either the individual level or the societal level.
While America's current health system has clear strengths, it also has significant weaknesses. For all the benefits that it provides in helping people to live longer and healthier lives, America's health care system seems too costly, confusing, inefficient, and uneven in its results, and it leaves too many people without adequate access to its benefits. Fundamentally, Americans as individuals and as a society intuitively recognize that the present health system could do a much better job of delivering value.
Put simply, Americans rightly sense that either they are paying too much for their present health system or the system should be delivering better results given what they are already paying.
The solution and the challenge for policymakers is to undertake the reforms needed to transform the present system into one that does a much better job of rewarding the seeking and creation of better value. As the experience of other economic sectors shows, health care need not be a zero-sum game in which costs can be controlled only by limiting benefits and benefits can be expanded only by increasing costs. Rather, a value-maximizing system will simultaneously demand and reward continuous improvements in benefits while continuously reducing costs.
Such a value-maximizing result can be achieved in health care only if the system is restructured to make the consumer the key decision maker. When individual consumers decide how the money is spent, either directly for medical care or indirectly through their health insurance choices, the incentives will be aligned throughout the system to generate better value—in other words, to produce more for less.
All Americans should be able to agree with the goal of creating a value-maximizing health care system. Consumer-centered health care marketreforms are the only effective means for achieving that goal.
Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.
[1] For a concise discussion of why structural change is needed and how to refocus competition on value maximization, see Michael E. Porter and Elizabeth Olmsted Teisberg, "Redefining Competition in Health Care," Harvard Business Review, June 2004. For a longer discussion, see Michael E. Porter and Elizabeth Olmsted Teisberg, Redefining Health Care: Creating Value-Based Competition on Results (Boston, Mass.: Harvard Business School Press, 2006). See also Regina E. Herzlinger, Who Killed Health Care? America's $2 Trillion Medical Problem—and the Consumer-Driven Cure (New York, N.Y.: McGraw-Hill, 2007).
[2] For a concise overview of the German health system, see David G. Green, Ben Irvine, and Ben Cackett, "Health Care in Germany," Civitas, 2005, at www.civitas.org.uk/nhs/germany.php (April 15, 2008).
[3] See Porter and Teisberg, "Redefining Competition in Health Care" and Redefining Health Care: Creating Value-Based Competition on Results.
[4] The value to a worker of the tax exclusion for employer-sponsored health insurance is equal to the combined marginal income and payroll tax rates that would be imposed if the compensation were instead paid to the worker as taxable cash income. For a low-wage worker with no federal income tax liability, the tax exclusion is worth 15.3 cents per dollar of health benefits, reflecting the combined employee and employer payroll (FICA) tax rate. Thus, the value of the tax exclusion for that worker is effectively a 15 percent discount on the cost of buying health insurance. For a worker in the 28 percent income tax bracket, the value of the tax exclusion is 43 percent (15 percent payroll tax plus 28 percent federal income tax) and, depending on the applicable state income tax rate, can approach 50 percent when avoidance of state taxes is included.
[5] Examples of such counterproductive regulations include certificate-of-need laws that restrict the availability of medical facilities, technologies, or services; insurance benefit laws that dictate how plans are to pay certain favored health care providers; and laws that unreasonably restrict competition among providers, such as ones that bar the creation of specialty hospitals. For further discussions of these various regulations, see Michael J. New, "The Effect of State Regulations on Health Insurance Premiums: A Revised Analysis," Heritage Foundation Center for Data Analysis Report No. CDA06–04, July 25, 2006, at www.heritage.org/Research/HealthCare/cda06-04.cfm; Ashok Roy, "How Congress Is Killing Competition: The Future of Specialty Hospitals," Heritage Foundation WebMemo No. 1740, December 13, 2007, at www.heritage.org/Research/HealthCare/wm1740.cfm; U.S. Federal Trade Commission and U.S. Department of Justice, Improving Health Care: A Dose of Competition, July 2004, at www.justice.gov/atr/public/health_care/204694.htm (April 15, 2008); and Patrick A. Rivers, Myron D. Fottler, and Mustafa Zeedan Younis, "Does Certificate of Need Really Contain Hospital Costs in the United States?" Health Education Journal, Vol. 66, No. 3 (September 2007), pp. 229–244.
[6] See Porter and Teisberg, "Redefining Competition in Health Care" and Redefining Health Care: Creating Value-Based Competition on Results.
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Your Excellency President Barrack Obama,
I am very grateful for your speech delivered in the Ghana’s parliament on July 11, 2009 addressing not only the population of Ghana but also all the people of the African continent in general.
As an American of Rwandan origin, I would particularly like to bring to your attention my opinion on the current governance in Rwanda.
In Rwanda there is a vague law outlawing "genocide ideology". This law is written so broadly that it can encompass even the most innocuous comments. As many Rwandans have discovered, disagreeing with the government or making unpopular statements could easily be portrayed as genocide ideology, punishable by sentences of 10 to 25 years. That leaves little political space for dissent.
In Rwanda, there is no meaningful opposition in Rwanda. The press is cowed. Nongovernmental organizations are under attack. When parliamentary elections held last September produced a whopping 92% victory for Kagame's ruling party, evidence collected by the European Union and Rwandan monitors suggested that the government actually inflated the percentage of opposition votes so as to avoid the appearance of an embarrassing Soviet-style acclamation.
Kagame and his western supporters claim that Tutsis and Hutus have been united as “Rwandans” by Kagame which absolutely is not true. Although the Rwandan people are terrorized and severely oppressed they cannot speak up because soldiers and local defense militia are everywhere, on each hill, with a specific mission to silence and/or physically eliminate any potential opponent.
In Rwanda, the monopoly system has made it possibble that most of the wealth be concentrated into a small group of individuals that rule the country, to the expenses of the mass.
In Rwanda, one instrument of repression in Rwanda is the gacaca courts -- informal tribunals run without trained lawyers or judges -- which the government established at the community level to try alleged perpetrators of the genocide. The original impetus was understandable: Rwandan prisons were overpopulated with tens of thousands of alleged genocidaires and no prospect of the country's regular courts trying them within any reasonable time. The gacaca courts provided a quick, if informal, way to resolve these cases. In theory, members of the community would know who had or had not been involved in the genocide, but in reality the lack of involvement by legal professionals has left the proceedings open to manipulation.
Another powerful tool of repression is free and forced labor (modern slavery) that has been institutionalized under the umbrella of TIG works (from a French acronym TIG: Travaux d’Intérêts Généraux or Works of General Interests) which began in 2005 along with the Gacaca courts system. Both Gacaca courts and TIG works together constitute a powerful tool of public repression that went unnoticed by the International Community mostly due to a powerful network composed of some renowned western ideologues that advise Kagame in the commercialization of the Rwandan genocide.
Kagame is often given credit for apparent economic growth in Rwanda. People who blindly give such false statements in order to maintain Kagame on Power should do their homework before making such misleading statements that do neither serve the American interests in region nor genocide survivor’s interests in Rwanda. Poverty is wide spread nationwide and Rwanda’s economic growth per capita has not reached its 1994 level before the Rwandan genocide.
Here is an excerpt from the UNDP, 2008 report on Rwanda: “Although the Rwandan economy depends mainly on agriculture, which supports 80% of the workforce and produces 42% of the GDP, the agricultural sector receives a mere 3% of the national budget, a far cry from the 10% threshold recommended by the United Nations Food and Agriculture Organization (FAO). Government spending in Rwanda is clearly oriented away from the majority and toward those who will help the government maintain its power”.
Thank you for your understanding and cooperation.Sincerely,
I noticed that the more we go deep in President Obama agenda, the more we do encounter a stronger resistance, not only from pure Republican machine, but also from some Democrats who still not understand the message of change. We should fight and achieve our objectives in Healthcare, Education, Energy, and keep the economy going. The more we demonstrate our focus, all our opponents will finally believe in our commitment, and it will be difficult to continue their resistance movement.
Nyagatare
This is critical,
Please let help him pass this budget! He needs our help! Washington DC seems to luck that support. Petition letters or talk to our representantives.
Good luck everybody!
The Senate is holding up the budget. Anybody want to work on this? Then join the Citizen Strategy Think Tank. We will be dividing up the budget, studying it, and making talking points to get this thing passed. Then we will be contacting our Representatives and helping to make it happen. Pass it on...see you there. Look for a thread that says Project Four and jump in. http://my.barackobama.com/page/group/CitizenStrategyThinkTank And please be respectful and helpful. Thank you to all those who are gonna join this work team.
Lisa Lindo National USA.CAN Group Administrator (Community Action Networks) Associate Producer Vote For Change Campaign -- http://obeygiant.com/voteforchange/ You Tube: You Made Me Love You, Obama! Economic URL: IfTheBuckStopsHereShootIt.com Twitter: lisalindo http://My.BarackObama.com/page/group/CaliforniaCAN http://My.BarackObama.com/page/group/USACAN http://my.barackobama.com/page/group/hawaiiCAN
AP
WASHINGTON – A typical American family would get a tax cut under President Barack Obama's budget proposal, and their low-income neighbor would fare even better.
Their wealthier counterparts, however, would face some steep tax increases, starting in 2011.
Families making as much as $50,000 would owe no federal income taxes, as long as they have at least two children, according to an analysis by Deloitte Tax LLP. Others making as much as $150,000 would see big tax cuts, especially if they have children in college.
The budget outline unveiled Thursday continues Obama's policy of targeting tax cuts for middle- and low-income families. In the presidential campaign, Obama promised tax cuts for the middle class, and he delivered some temporary relief in the economic stimulus package enacted this month.
Most of the tax cuts for individuals in the stimulus package would be made permanent in Obama's budget proposal. They would be offset by tax increases on businesses and on couples making more than $250,000. Single filers making more than $200,000 would also be hit with a tax increase.
At the other end of the spectrum, millions of Americans who don't make enough money to pay federal income taxes would receive government payments at tax time through refundable tax credits.
A typical family of four making $50,000 a year would receive a payment of $40, according to the Deloitte analysis. Before the stimulus package was enacted, that same family would have owed $760 in federal income taxes.
A similar family making $35,000 a year would get a payment of $4,100, an increase of $1,200. The median household income was $50,233 in 2007, according to the Census Bureau.
The stimulus package provided most working couples with a new tax credit of up to $800 for 2009 and 2010 — single filers get up to $400. Obama's budget proposal would make the credit permanent for families making less than $190,000 and individuals making less than $95,000.
An expanded $1,000 child tax credit would be made permanent, as would an expanded $2,500 tax credit for college expenses. Families making up to $160,000 a year would be eligible for the full college credit.
Obama "did what he said he would do in the campaign," said Clint Stretch, Deloitte's managing principal of tax policy. "And he had a surprise hit for those on the high end."
Obama promised during the presidential campaign to eliminate tax cuts for the wealthiest Americans, which was enacted under former President George W. Bush. Obama's budget proposal would allow them to expire in 2011, increasing the top income tax rate for couples making more than $250,000 from 35 percent to 39.6 percent.
The budget proposal also would enact new limits on itemized tax deductions for those same couples, including deductions for charitable donations, mortgage interest and state and local taxes. The tax increases would be delayed until 2011, when the economy will presumably be improved.
The deductions are valuable to millions of Americans — even more so to people in high tax brackets. Without the new limits, a taxpayer in the proposed 39.6 percent tax bracket could save $396 in taxes from a $1,000 reduction in taxable income. Obama wants to limit deductions to the 28 percent bracket, meaning the same taxpayer would save only $280, said Timothy Speiss, a partner at the New York-based accounting firm of Eisner LLP.
Homebuilders and charitable groups have come out against the proposed limits, and even some Democrats in Congress have raised concerns.
Speiss noted that the limits would apply only to high-income families.
"The argument is going to be that it's not terribly dramatic because we're only talking about the top 5 percent of earners," Speiss said.
Under Obama's budget proposal, a typical family of four making $300,000 a year would see their federal income taxes increase by $1,100, while a similar family making $500,000 would get an $11,300 increase, according to the Deloitte analysis. Single filers with no children would be hit with even bigger tax increases.
The analysis took into account typical deductions for families with high incomes, Stretch said.
Obama's budget proposal would provide a long-term fix for the Alternative Minimum Tax, sparing more than 20 million taxpayers from significant tax increases. The tax was enacted 40 years ago to make sure wealthy taxpayers pay at least some tax. But it was never indexed to inflation, so it would hit many middle-income taxpayers without an annual fix by Congress.
Obama's proposal would spare Congress from dealing with it each year, but most taxpayers won't notice the change.
Alison des Forges
ARUSHA (AFP) — The court trying alleged perpetrators of the Rwandan genocide was stunned Saturday at the death in an air crash of the top expert on the 1994 massacres, Alison Des Forges.
Des Forges, 66, an expert advisor to the International Criminal Tribunal for Rwanda and human rights groups, was among the 50 victims of Thursday's plane crash near Buffalo, New York.
"It is with deep shock that the tribunal has learned of the tragic disappearance of Alison des Forges, "a spokesman for the UN tribunal based in Arusha, Tanzania, told AFP.
"It is a great loss for the world of human rights, international justice and all humanity," Roland Amoussouga said.
"Alison was not only an expert but also a very committed militant," he added." It is a great loss for the world of human rights, international justice and the whole of humanity," he said.
Des Forges appeared as an expert witness in 11 trials for genocide at the ICTR, three trials in Belgium, and at trials in Switzerland, the Netherlands, and Canada.
Her book "No Witness Must Survive" is regarded as the reference work on the Rwandan genocide.
"She was one of the topmost authorities on the history and politics of Rwanda," ICTR prosecutor Hassan Bubacar Jallow said in a statement.
"As a world renowned expert in this field, her knowledge, professionalism and commitment to justice assisted the ICTR and indeed the world at large tremendously -- through her writings, her expert reports and her oral testimony spanning several trials before the tribunal -- acquire a better understanding of the genesis and course of the tragedy of the Rwanda genocide of 1994."
He added, "Dr Des Forges has made an indelible contribution to the cause of international criminal justice and to the cause of human rights."
Des Forges was also a senior adviser to Human Rights Watch, whose boss Kenneth Roth called her "truly wonderful, the epitome of the human rights activist - principled, dispassionate, committed to the truth and to using that truth to protect ordinary people."
"She was among the first to highlight the ethnic tensions that led to the genocide, and when it happened and the world stood by and watched, Alison did everything humanly possible to save people," Roth added.
Text of President Barack Obama's inaugural address on Tuesday, as prepared for delivery and released by the Presidential Inaugural Committee.
OBAMA: My fellow citizens:
I stand here today humbled by the task before us, grateful for the trust you have bestowed, mindful of the sacrifices borne by our ancestors. I thank President Bush for his service to our nation, as well as the generosity and cooperation he has shown throughout this transition.
Forty-four Americans have now taken the presidential oath. The words have been spoken during rising tides of prosperity and the still waters of peace. Yet, every so often the oath is taken amidst gathering clouds and raging storms. At these moments, America has carried on not simply because of the skill or vision of those in high office, but because we the people have remained faithful to the ideals of our forebears, and true to our founding documents.
So it has been. So it must be with this generation of Americans.
That we are in the midst of crisis is now well understood. Our nation is at war, against a far-reaching network of violence and hatred. Our economy is badly weakened, a consequence of greed and irresponsibility on the part of some, but also our collective failure to make hard choices and prepare the nation for a new age. Homes have been lost; jobs shed; businesses shuttered. Our health care is too costly; our schools fail too many; and each day brings further evidence that the ways we use energy strengthen our adversaries and threaten our planet.
These are the indicators of crisis, subject to data and statistics. Less measurable but no less profound is a sapping of confidence across our land — a nagging fear that America's decline is inevitable, and that the next generation must lower its sights.
Today I say to you that the challenges we face are real. They are serious and they are many. They will not be met easily or in a short span of time. But know this, America — they will be met.
On this day, we gather because we have chosen hope over fear, unity of purpose over conflict and discord.
On this day, we come to proclaim an end to the petty grievances and false promises, the recriminations and worn out dogmas, that for far too long have strangled our politics.
We remain a young nation, but in the words of scripture, the time has come to set aside childish things. The time has come to reaffirm our enduring spirit; to choose our better history; to carry forward that precious gift, that noble idea, passed on from generation to generation: the God-given promise that all are equal, all are free and all deserve a chance to pursue their full measure of happiness.
In reaffirming the greatness of our nation, we understand that greatness is never a given. It must be earned. Our journey has never been one of shortcuts or settling for less. It has not been the path for the faint-hearted — for those who prefer leisure over work, or seek only the pleasures of riches and fame. Rather, it has been the risk-takers, the doers, the makers of things — some celebrated but more often men and women obscure in their labor, who have carried us up the long, rugged path towards prosperity and freedom.
For us, they packed up their few worldly possessions and traveled across oceans in search of a new life.
For us, they toiled in sweatshops and settled the West; endured the lash of the whip and plowed the hard earth.
For us, they fought and died, in places like Concord and Gettysburg; Normandy and Khe Sahn.
Time and again these men and women struggled and sacrificed and worked till their hands were raw so that we might live a better life. They saw America as bigger than the sum of our individual ambitions; greater than all the differences of birth or wealth or faction.
This is the journey we continue today. We remain the most prosperous, powerful nation on Earth. Our workers are no less productive than when this crisis began. Our minds are no less inventive, our goods and services no less needed than they were last week or last month or last year. Our capacity remains undiminished. But our time of standing pat, of protecting narrow interests and putting off unpleasant decisions — that time has surely passed. Starting today, we must pick ourselves up, dust ourselves off, and begin again the work of remaking America.
For everywhere we look, there is work to be done. The state of the economy calls for action, bold and swift, and we will act — not only to create new jobs, but to lay a new foundation for growth. We will build the roads and bridges, the electric grids and digital lines that feed our commerce and bind us together. We will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost. We will harness the sun and the winds and the soil to fuel our cars and run our factories. And we will transform our schools and colleges and universities to meet the demands of a new age. All this we can do. And all this we will do.
Now, there are some who question the scale of our ambitions — who suggest that our system cannot tolerate too many big plans. Their memories are short. For they have forgotten what this country has already done; what free men and women can achieve when imagination is joined to common purpose, and necessity to courage.
What the cynics fail to understand is that the ground has shifted beneath them — that the stale political arguments that have consumed us for so long no longer apply. The question we ask today is not whether our government is too big or too small, but whether it works — whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end. And those of us who manage the public's dollars will be held to account — to spend wisely, reform bad habits, and do our business in the light of day — because only then can we restore the vital trust between a people and their government.
Nor is the question before us whether the market is a force for good or ill. Its power to generate wealth and expand freedom is unmatched, but this crisis has reminded us that without a watchful eye, the market can spin out of control — and that a nation cannot prosper long when it favors only the prosperous. The success of our economy has always depended not just on the size of our gross domestic product, but on the reach of our prosperity; on our ability to extend opportunity to every willing heart — not out of charity, but because it is the surest route to our common good.
As for our common defense, we reject as false the choice between our safety and our ideals. Our founding fathers, faced with perils we can scarcely imagine, drafted a charter to assure the rule of law and the rights of man, a charter expanded by the blood of generations. Those ideals still light the world, and we will not give them up for expedience's sake. And so to all other peoples and governments who are watching today, from the grandest capitals to the small village where my father was born: know that America is a friend of each nation and every man, woman, and child who seeks a future of peace and dignity, and that we are ready to lead once more.
Recall that earlier generations faced down fascism and communism not just with missiles and tanks, but with sturdy alliances and enduring convictions. They understood that our power alone cannot protect us, nor does it entitle us to do as we please. Instead, they knew that our power grows through its prudent use; our security emanates from the justness of our cause, the force of our example, the tempering qualities of humility and restraint.
We are the keepers of this legacy. Guided by these principles once more, we can meet those new threats that demand even greater effort — even greater cooperation and understanding between nations. We will begin to responsibly leave Iraq to its people, and forge a hard-earned peace in Afghanistan. With old friends and former foes, we will work tirelessly to lessen the nuclear threat, and roll back the specter of a warming planet. We will not apologize for our way of life, nor will we waver in its defense, and for those who seek to advance their aims by inducing terror and slaughtering innocents, we say to you now that our spirit is stronger and cannot be broken; you cannot outlast us, and we will defeat you.
For we know that our patchwork heritage is a strength, not a weakness. We are a nation of Christians and Muslims, Jews and Hindus — and non-believers. We are shaped by every language and culture, drawn from every end of this Earth; and because we have tasted the bitter swill of civil war and segregation, and emerged from that dark chapter stronger and more united, we cannot help but believe that the old hatreds shall someday pass; that the lines of tribe shall soon dissolve; that as the world grows smaller, our common humanity shall reveal itself; and that America must play its role in ushering in a new era of peace.
To the Muslim world, we seek a new way forward, based on mutual interest and mutual respect. To those leaders around the globe who seek to sow conflict, or blame their society's ills on the West — know that your people will judge you on what you can build, not what you destroy. To those who cling to power through corruption and deceit and the silencing of dissent, know that you are on the wrong side of history; but that we will extend a hand if you are willing to unclench your fist.
To the people of poor nations, we pledge to work alongside you to make your farms flourish and let clean waters flow; to nourish starved bodies and feed hungry minds. And to those nations like ours that enjoy relative plenty, we say we can no longer afford indifference to suffering outside our borders; nor can we consume the world's resources without regard to effect. For the world has changed, and we must change with it.
As we consider the road that unfolds before us, we remember with humble gratitude those brave Americans who, at this very hour, patrol far-off deserts and distant mountains. They have something to tell us today, just as the fallen heroes who lie in Arlington whisper through the ages. We honor them not only because they are guardians of our liberty, but because they embody the spirit of service; a willingness to find meaning in something greater than themselves. And yet, at this moment — a moment that will define a generation — it is precisely this spirit that must inhabit us all.
For as much as government can do and must do, it is ultimately the faith and determination of the American people upon which this nation relies. It is the kindness to take in a stranger when the levees break, the selflessness of workers who would rather cut their hours than see a friend lose their job which sees us through our darkest hours. It is the firefighter's courage to storm a stairway filled with smoke, but also a parent's willingness to nurture a child, that finally decides our fate.
Our challenges may be new. The instruments with which we meet them may be new. But those values upon which our success depends — hard work and honesty, courage and fair play, tolerance and curiosity, loyalty and patriotism — these things are old. These things are true. They have been the quiet force of progress throughout our history. What is demanded then is a return to these truths. What is required of us now is a new era of responsibility — a recognition, on the part of every American, that we have duties to ourselves, our nation, and the world, duties that we do not grudgingly accept but rather seize gladly, firm in the knowledge that there is nothing so satisfying to the spirit, so defining of our character, than giving our all to a difficult task.
This is the price and the promise of citizenship.
This is the source of our confidence — the knowledge that God calls on us to shape an uncertain destiny.
This is the meaning of our liberty and our creed — why men and women and children of every race and every faith can join in celebration across this magnificent mall, and why a man whose father less than sixty years ago might not have been served at a local restaurant can now stand before you to take a most sacred oath.
So let us mark this day with remembrance, of who we are and how far we have traveled. In the year of America's birth, in the coldest of months, a small band of patriots huddled by dying campfires on the shores of an icy river. The capital was abandoned. The enemy was advancing. The snow was stained with blood. At a moment when the outcome of our revolution was most in doubt, the father of our nation ordered these words be read to the people:
"Let it be told to the future world ... that in the depth of winter, when nothing but hope and virtue could survive...that the city and the country, alarmed at one common danger, came forth to meet (it)."
America, in the face of our common dangers, in this winter of our hardship, let us remember these timeless words. With hope and virtue, let us brave once more the icy currents, and endure what storms may come. Let it be said by our children's children that when we were tested we refused to let this journey end, that we did not turn back nor did we falter; and with eyes fixed on the horizon and God's grace upon us, we carried forth that great gift of freedom and delivered it safely to future generations.
Washington, DC—The Joint Congressional Committee on Inaugural Ceremonies today announced the details for the 2009 Inaugural Luncheon, which will follow the swearing-in of President-elect Barack Obama and Vice President-elect Joe Biden.
The luncheon, hosted by the members of the Joint Congressional Committee on Inaugural Ceremonies, has been a tradition for more than a century. Approximately 200 guests including the new President, Vice President, members of their families, the Supreme Court, Cabinet designees, and members of Congressional leadership will attend the event in Statuary Hall. The details of the luncheon have been designed to reflect the theme of the 2009 Inaugural ceremonies, "A New Birth of Freedom," which celebrates the bicentennial of the birth of President Abraham Lincoln.
The menu, created by Design Cuisine, a catering company based in Arlington, Virginia, draws on historic ties to the Presidency of Abraham Lincoln. Growing up in the frontier regions of Kentucky and Indiana, the sixteenth President favored simple foods including root vegetables and wild game. As his tastes matured, he became fond of stewed and scalloped oysters. For dessert or a snack, nothing pleased him more than a fresh apple or an apple cake.
The wines to be served during the luncheon were produced by some of the finest winemakers in California, the home state of Senator Dianne Feinstein, the Chairman of the Joint Congressional Committee on Inaugural Ceremonies. Each wine was selected to complement the flavors of the luncheon ingredients.
The first course will be served on replicas of the china from the Lincoln Presidency, which was selected by Mary Todd Lincoln at the beginning of her husband's term in office. The china features the American bald eagle standing above the U.S. Coat of Arms, surrounded by a wide border of "solferino," a purple-red hue popular among the fashionable hosts of the day.
The floral arrangements, designed by JLB Floral of Alexandria, Virginia, will feature hydrangeas in shades of purple and blue, Hot Mojolica spray roses, bright Red Charlotte roses and light blue Delphinium in a footed brass compote. After the luncheon, the floral arrangements will be given to the Walter Reed Army Medical Center.
The backdrop for the luncheon will be a painting, chosen for occasion, and borrowed from the New-York Historical Society. The painting, "View of the Yosemite Valley," by Thomas Hill, reflects the majestic landscape of the American West and the dawn of a new era. The subject of the painting, Yosemite Valley, represents an important but often overlooked event from Lincoln's presidency -- his signing of the 1864 Yosemite Grant, which set aside Yosemite Valley and the Mariposa Grove of Giant Sequoias as a public reserve.
During the Inaugural Luncheon it is traditional for the President and Vice President to be presented with gifts by the Congress on behalf of the American people. The President and Vice President will each be presented with a framed official photograph taken of their swearing-in ceremony by a Senate photographer, as well as flags flown over the U.S. Capitol during the inaugural ceremonies.
The President and Vice President will also receive one-of-a-kind engraved crystal bowls, created by the Lenox Company of Bristol, Pennsylvania. President Obama will receive a bowl depicting the White House on a crystal base inscribed with “Barack H. Obama, The Presidential Inauguration, January 20, 2009.” Vice President Biden will receive a bowl depicting the United States Capitol, on a crystal base inscribed with “Joseph R. Biden Jr. , The Vice Presidential Inauguration, January 20, 2009.” The bowls were designed by Timothy Carder and hand-cut by master glass-cutter Peter O’Rourke.
Each guest at the Inaugural Luncheon will receive a crystal vase etched with a depiction of the U.S. Capitol, designed by Paula Skene, an artist in Emeryville, California, and handcrafted by Evergreen Crystal of Montrose, Colorado.
The Smithsonian Chamber Players, who are artists in residence at the Smithsonian National Museum of American History, will provide music for the Inaugural Luncheon. The ensemble, directed by cellist Kenneth Slowik, is renowned for its performances of period music on the musical instruments in the Smithsonian’s collection.
Members of the Joint Congressional Committee on Inaugural Ceremonies are Senator Dianne Feinstein, Chairman; Ranking Member of the Senate Rules Committee Bob Bennett; Senate Majority Leader Harry Reid; Speaker of the House Nancy Pelosi; House Majority Leader Steny Hoyer; and House Minority Leader John Boehner.
For more information on the Inaugural Luncheon, including recipes for the luncheon menu, and images of the painting "View of the Yosemite Valley," the Lincoln Presidential china, the floral arrangements and the official gifts, visit http://www.inaugural.senate.gov/luncheon.
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Typical questions asked by Rwandan Americans
Hirondelle News Agency (Lausanne)
Rwanda: Kigali Admits to Have Barred Human Rights Champion Dr. Des Forges From Entering
The Rwandan government has admitted to have barred Human Rights Watch's Senior Adviser on Africa, Dr Alison Des Forges, from entering Rwanda as " an individual case", but did not state categorically for what reasons.
The pro-government Rwanda Times quoted Rwanda's Director of Immigration and Emigration, Mr Anaclet Kalibata, as saying that Dr Des Forges case was "personal problem" and that it was different from making her organization's human right's work in Rwanda difficult. "It is true that we have barred her from entering, but it is an immigration issue... it has nothing to do with human rights, it is an individual case" claimed Mr Kalibata.
Kalibata added that Human Rights Watch has an office in Kigali that was still operating, which was a testimony that Rwanda has no problem with the organization's activities.
The Human Rights Watch last week called on the Rwandan government to reverse its decision over Dr Des Forges.
"Des Forges, who has been working to promote human rights in Rwanda for 17 years, won the prestigious MacArthur Award for her reporting on1994 genocide" wrote HRW. Dr Des Forges was author of a book titled: "Leave None to Tell the Story".
"A nation like Rwanda, which has seen such deadly violations of human rights, should show the world that it welcomes review of its record," said Kenneth Roth, Executive Director of Human Rights Watch.
"We've asked Rwandan authorities why they have excluded this highly respected human rights advocate but haven't gotten any official response. Unofficially the only explanation we have been given is that they don't like our criticism."
The Rwandan government first refused Dr Des Forges entry at a border crossing with Burundi on September 4, 2008. She was refused a second time on December 2, when she flew to Rwanda to attend an international conference on legal aid for poor. On that occasion, Rwandan officials prevented her from leaving the plane and which forced her to return to Belgium.
On December 3, the Rwandan authorities delayed for a day another Human Rights Watch staff member at Goma, Democratic Republic of Congo (DRC), border crossing. However, finally she received permission to enter Rwanda in the evening.
In addition to monitoring human rights, the US-based body has worked to see justice delivered on behalf of victims of 1994 genocide and of war crimes and crimes against humanity, which according to UN estimates ,claimed lives of about 800,000 ethnic Tutsis and moderate Hutus.
Dr Des Forges has provided expert testimony in 11 genocide trials before the Arusha-based International Criminal Tribunal for Rwanda (ICTR), including that of Col. Theoneste Bagosora and two others found guilty on December 18. She has testified also in genocide trials in Belgium, Switzerland, the Netherlands and Canada.
On several occasions, most recently on December 12, Human Rights Watch called on ICTR Prosecutor to ensure it carried out its full mandate by examining alleged cases against the Rwandan Patriotic Front (RPF), dominant force in the current Rwandan government.
In the past, staff members of other international organizations, journalists, and academic specialists thought to be critical of the government, have also been refused permission to enter or work in Rwanda.
by Ann Wright
Travelling to Iran as a Citizen Diplomat for Peace
Just a month ago, while Israeli Prime Minister Olmert and U.S. President Bush met for the last time as heads of state in late November, 2008 in Washington and continued their relentless bellicose rhetoric toward Iran, I and three activists from the United States were in Iran as citizen diplomats talking with Iranians on their views of a new American presidential administration and their hopes for their country.
We went to Iran with no illusions. We knew well the history of United States involvement in Iran. We knew of Iranian support for organizations U.S. administrations have labeled as "terrorist" groups. And we were very familiar with international concerns about Iran's nuclear enrichment program and human rights record.
We wanted to talk with members of the Iranian government as well as with ordinary Iranians. We ended up meeting with officials in the President's office and the Ministry of Foreign Affairs and with two women members of the Iranian Parliament (Majles). We also spoke with businesspersons, members of nongovernmental organizations, writers, filmmakers and university students and faculty.
Writing about the concerns of the Iranians we met leaves one open to comments of being one-sided, not speaking with enough Iranians to provide the "real" voices and of picking and choosing voices to record. I acknowledge the possible criticism in advance, but believe our discussions are worthy of presentation to those who have not been so fortunate to have travelled to Iran to see and hear for themselves. So here goes.
Iranians Want Peace Not War
Codepink Women for Peace co-founders Jodie Evans and Medea Benjamin, Fellowship of Reconciliation Iran program director Laila Zand and I were reminded in virtually every conversation that Iranians want peace with the United States, not war. Not one person in Iran told us that first, she believed her country would begin a war with the United States, or any other country to include Israel, and second, that if the United States initiated military actions against Iran, that those actions would resolve problems in Iran or with the United States.
They reminded us that, unlike the United States that has invaded and occupied Iran's neighbors Iraq and Afghanistan, Iran has not attacked any country in the last 200 years. They reminded us that Iran was the victim of an eight year war in the 1980s when Iraq invaded Iran and in which the United States and European countries provided Iraq with military equipment, intelligence and chemical weapons that were used at least 50 times against Iranian civilians and military forces. We learned that during the eight year war the Revolution's Supreme Leader Ayatollah Khomeini had mandated that it would be against Islamic precepts to bomb Iraqi cities or use chemical or unconventional weapons on Iraq-and Iranian military forces complied-even though the Iraqi military bombed Iranian cities including Tehran and used chemical weapons on Iranians.
Most Iranians Have Issues With Their Government, As Most Americans Have Issues With Theirs
Iran is a county with a population of about 70 million (two and one-half times as many people as Iraq) and a geographic area about the size of Alaska (four times as large as Iraq). Tehran, the Iranian capital, has 7.5 million people in the urban area and 15 million in surrounding areas. It is a modern city, with a beautiful subway, cosmopolitan shops, as well as a huge traditional bazaar and an incredible number of cars, trucks and motorcycles. Tehran and Iran have recovered from the Iraq war that ended 20 years ago and are holding up remarkably well to U.S. and international sanctions.
Most Iranians with whom we talked openly said they have issues with many aspects of their government. Many said the Iranian people share a common dislike with Americans--dislike of their governments, noting that President Bush's and the U.S. Congress's approval ratings with the American people are extremely low, as is Iranian President Ahmadinejad's ratings, particularly in urban areas. But, they strongly said they do not want outside interference in the internal political events of their country and definitely do not want a political system and government installed by invasion and occupation. Their democracy, even with its flaws, is better than a U.S. enforced democracy, they said.
America's best policy would be to treat Iran with respect and not with threats of military action. Any attempt to overthrow the Iranian government would be met with stiff opposition, even from those who don't like the government, they repeated. "Regime change" will come in due time and in an Iranian manner.
U.S. Interference in Iran's Internal Affairs
Several reminded us that in January, 1981 the United States signed the Algiers Accord, in which the U.S. agreed "not to intervene directly or indirectly, politically or militarily, in the Iran's internal affairs." The Algiers Accord was the agreement signed by the United States and Iran to end the 444 day US Embassy hostage crisis. (www.parstimes.com/history/algiers_accords.pdf)
However, this Accord has been violated numerous times by the United States. Investigative journalist Seymour Hersh wrote that, in late 2007, President Bush requested and received from Democratic Congressional leadership $400 million reprogrammed from previous authorizations to fund a Presidential Finding that substantially increased covert activities designed to destabilize Iran's religious leadership. These covert actions involved support for the Ahwazi Arab and Baluchi groups and other dissident organizations. Hersh also revealed that United States Special Operations Forces had been conducting cross-border operations from southern Iraq, with Presidential authorization, since 2007, including seizing members of Al Quds, the commando arm of the Iranian Revolutionary Guard and taking them to Iraq for interrogation, and the pursuit of "high-value targets" who could be captured or killed. Hersh said operations by the Central Intelligence Agency and the Joint Special Operations Command (JSOC) were significantly expanded in 2007 by this authorization. (http://www.newyorker.com/reporting/2008/07/07/080707fa_fact_hersh).
Iran's Nuclear Program
Iran has had a nuclear program for almost 50 years, having purchased a research reactor from the United States in 1959, during the Shah's reign. The Iranian government states that its nuclear energy program will allow increased electricity generation to reduce consumption of gas and oil to allow export of more of its fossil fuels. The U.S. National Intelligence Estimate (NIE) made public December 3, 2007 concluded with "high confidence" that the military-run Iranian nuclear weapons program had been shut down in 2003, but that Iran's enrichment program could still provide enough enriched uranium to produce a nuclear weapon by the middle of the next decade, a timeframe unchanged from previous estimates. (http://www.nytimes.com/2007/12/03/world/middleeast/03cnd-iran.html?hp)
Virtually everyone with whom we spoke said they believe that their country has a right to have a nuclear enrichment program and to produce nuclear energy. Many questioned why Iran would ever need a nuclear weapons program, unless as leverage against the United States' 30 year antagonism toward their country. They reminded us that Iran is a member of the Non-Proliferation Treaty (unlike nuclear-states Israel, India and Pakistan that refused to join the NPT and developed nuclear weapons purposefully outside the treaty.) Additionally, they insist that Iran is in compliance with the IAEA standards according to the November, 2008 IAEA report, despite the interpretations of the report by the United States and Israel.
Some reminded us that on August 9, 2005, at the IAEA meeting in Vienna, 60 years after the US atomic bombing of Japan, Iran's Supreme Leader Ayatollah Khamenei announced that he had issued a fatwa, or religious mandate, forbidding the production, stockpiling and use of nuclear weapons. Importantly, the Supreme Leader controls the Iranian military and the nuclear program of Iran, not the President of the country, Mr. Ahmadinejad. (http://www.mathaba.net/0_index.shtml?x=302258)
Iran, Israel and the United States
Iran, Israel and United States have had a disturbing, but fascinating, history over the past 30 years. Iran's current relationship with Israel and Western countries seems to be defined by President Ahmadinejad's October, 2005 widely reported, but tragically and dangerously mistranslated and misinterpreted, statement that "Israel should be wiped off the face of the earth." According to highly respected Middle Eastern scholar Juan Coles, Ahmadinejad was "not making a threat, but was quoting a saying of Ayatollah Khomeini that urged pro-Palestinian activists in Iran not give up hope-- that the occupation of Jerusalem was no more a continued inevitability than had been the hegemony of the Shah's government. Whatever this quotation from a decades-old speech of Khomeini may have meant, Ahmadinejad did not say that "Israel must be wiped off the map" with the implication that phrase has of Nazi-style extermination of a people." (http://www.themiddleeastnow.com/wipedoffthemap.html)
But the history of Iranian-Israeli relationships is more than just Ahmadinejad's misinterpreted statement. Israel, like the United States, had a long history of selling arms to the Shah, which Iran's revolutionary government was willing to exploit secretly, despite its public animosity toward the state of Israel. In the early years (1980-82) of the Iranian Revolution and during the war with Iraq, Ayatollah Khomeini's government sold oil to Israel in exchange for weapons and spare parts. Even during the American hostage crisis (1979-1981) in which 52 U.S. diplomats were held for 444 days, Israel made weapons deals with Iran. Ronald Reagan's Secretary of State Alexander Haig gave permission to Israel to sell U.S.-made military spare parts for fighter planes to Iran in early 1981.
In another remarkable relationship known as the Iran-Contra affair, funds from the sale to Iran of U.S. weapons by Israel in 1985-1986 were used by U.S. Defense Secretary Caspar Weinberger, National Security Advisor Admiral John Poindexter, National Security Advisor Robert McFarlane (President Reagan's first NSA) and National Security Council staffer U.S. Marine Lieutenant Colonel Oliver North to fund the Contras' war against the revolutionary government in Nicaragua. This was in violation of a Congressional ban on funding the Contras and took place during the Iraq-Iran war when the U.S. was also providing military equipment including chemical weapons to Iraq, Iran's opponent in the war. Iranians remember that those convicted for their actions including Weinberger, Poindexter, McFarlane and North, were pardoned by President George H.W. Bush who was Vice-President during the period of criminal actions conducted by government officials during the illegal Contra Affair.
Iranian Support for Hamas and Hezbollah
When asked about one of the most contentious points in U.S.-Israeli-Iranian relationships, the Iranian government's support for Hamas in Palestine and Hezbollah in southern Lebanon, Iranians pointed out that the U.S. has consistently and heavily funded Israel during its 62-year existence (U.S. provides about $4 billion per year to the Israeli government and the Israeli Defense Forces.) Many Iranians suggested that Palestinians who have lived in refugee camps during those 62 years must be provided assistance. Hezbollah began in 1982 as a small militia fighting against the Israeli invasion of Lebanon, and is now not only a military group but a political organization that won seats in the Lebanese government, has a radio and satellite television-station and provides social development and humanitarian assistance for much of southern Lebanon. Iranians strongly felt that Hamas, the elected (and they emphasize elected) government of Gaza, needs financial support, particularly now in current extraordinary humanitarian crisis due to the lengthy Israeli blockade of foods and services into Gaza.
Iraq
On the question of Iraq, many Iranians who lived in the border regions with Iraq during the eight year war, said they personally knew the agony of deaths, injuries, destruction and other costs of war and do not wish that on their former enemies. They talked of the irony of the political outcome of the U.S. invasion and occupation of Iraq in which many Shi'a Iraqis, who lived in exile in Iran during Saddam's regime and have long standing ties to the Iranian government, are now in leadership positions in the new U.S. backed Iraqi government.
Afghanistan
Other Iranians reminded us of Iran's help to the U.S. in 2001 and 2002 in the early days of the U.S. military action in Afghanistan. When we asked about recent United States intelligence analysis that indicated Iranian support for the Taliban, we were met with laughs. The Taliban are of the Sunni branch of Islam while the Iranians are of the Shi'a branch. They reminded us that in 1998 the Taliban murdered 11 Iranian diplomats and one Iranian newsperson at the Iranian consulate in Afghan northern city of Mazar-i-Sharif, an incident which Iranians have not forgotten. The Iranians consider the Taliban their adversaries and feel that a Taliban government in Afghanistan would make the region more unstable.
Sanctions are Drying Up Lines of Credit for Businesses
We found that Iranians are proud of their creativity to outwit the 29 years of various sanctions the U.S. has placed on their country. They say the U.S. has only isolated itself commercially by its sanctions as Iran trades with many other nations. The Europeans, Chinese, Russians and Indians have had flourishing businesses with Iran. However, the recent international sanctions clampdown on lines of credit for Iranian banks has had a rippling effect into the business community, where money for loans to Iranian businesses for purchase of materials is drying up. Oil dollars that paid for an incredible amount of imports are drying up with the downturn in oil prices, and the government is beginning to reevaluate the large subsidizes given to the population for food, gasoline and services.
We spoke with four businesswomen (an architect, a chemist, a business consultant and an agricultural professional) who said each of their businesses had been affected negatively with the shrinking of money available for purchase of materials from outside the country and for continuation of current levels of operation or expansion of their business.
One of the most of incredible stories we heard about the effect of the sanctions was on the alternative energy sector. Since there is so much rhetoric in the U.S. about the dangers of the Iranian nuclear program, we decided to see if there were alternative energy companies in the country. On the aircraft flying into Iran, we met a European businessman who said he would put us in touch with the director of a wind energy company. He introduced us by telephone to the director of Saba Niroo, an Iranian company that makes wind turbines and is the largest regional wind power manufacturer (http://www.sabaniroo.co.ir/eng/index.asp). We met with the director and staff at the modern, state of the art, factory, in south Tehran. Saba Niroo has installed some of the 143 wind turbines planned for the wind farm in Manjil, Guillan province and the 43 wind turbines planned for the Binalood wind farm in Khorasan Razavi province. They have installed 4 wind turbines in the Pushkin Pass wind farm in Armenia.
However, the director told us that because of U.S. sanctions pressure, Vestas, a Danish wind energy company (http://www.vestas.com/) with whom the Iranian company has had a contractual relationship, has now refused to honor its 15 year contract to furnish critical parts for the wind turbines.
As a result, Saba Niroo has 50 huge, 70 foot long wind blades and corresponding chassis and installation towers lying useless in its warehouse and warehouse yard. Saba Niroo may go bankrupt in six months if it is unable to complete and sell the wind turbines-all because of U.S. sanctions and pressure.
As a part of citizen diplomacy, we decided to defy sanctions and show our support of alternative energy programs, by purchasing shares in Saba Niroo. We have also decided to purchase shares in the Danish company Vestas, which has a big U.S. headquarters in Portland, Oregon. As shareholders, we could put shareholder pressure on Vestas to honor its contract with the Iranian company.
Join the campaign "Winds for Change" to support for alternative energy and for sanctions breaking and purchase a shares with us. (http://www.commondreams.org/newswire/2008/12/12-5)
Human Rights in Iran
On the question of human rights in Iran, executions, political prisoners, rights of gays and lesbians, many Iranians strongly want changes in their government's policies. In response to a question in September, 24, 2007 from an audience at Columbia University in New York, President Ahmadinejad drew widespread criticism when his answer was translated as "In Iran, we don't have homosexuals in our country , we do not have this phenomenon. I don't know who told you that we have it." In October, 2007, one of Ahmadinejad's media advisor's said that the President had meant that "compared to American society, we don't have many homosexuals--In Iran, we don't have homosexuals like in your country." http://www.nytimes.com/2007/10/11/world/middleeast/11iran.html?_r=1
Homosexual acts are punishable by law: sodomy (defined as "sexual intercourse with a male) is punishable by execution and punishment for "lesbian acts" is 100 lashes. However, conviction takes the testimony of four witnesses and if the accused recants before witnesses testify, the reportedly accused will not be punished. The discussion of human rights of youth and gay youth combined in the much publicized 2005 execution by hanging of two young men in Iran. Some say they were executed because they were solely because they were gay and others say the two young men, minors, were convicted and hanged because they criminally sexually assaulted another youth. http://www.washingtonpost.com/wp-dyn/content/article/2006/07/19/AR2006071902061.html)
Interestingly, sex change is legal in Iran and there are more sex change operations in Iran than any other country except Thailand. The Iranian government provides grants up to $4500 for the operation and further funding for hormone therapy on the theory that persons wanting a sex change have a "treatable disorder."
Iranians want change to come from within their society, not imposed by another government, especially one, as we were reminded, that has its own human rights issues, including incarceration of the highest percentage of its citizenry of any country in the world, high rates of execution (Texas in particular), state-sponsored kidnapping from other countries (known in the Bush administration as extraordinary rendition) , imprisonment without due process, extrajudicial courts and a military and an intelligence agency that are notorious for torture.
Women's Issues
When thinking of women in Iran, many in the West immediately respond with comments about the clothing women must wear. Few realize that 70% of all university students are women, 30% of doctors in Iran are women, 80% of women are literate (88% of men can read), women receive 90 days of maternity leave at 2/3rd pay and right to return to her job, and the number of children per woman has declined from 7 in 1979 to 1.7 now. Abortions are illegal in Iran, but it's the only country I know of were couples must take a class on modern contraception before being issued a marriage license. It has the only state-supported condom factory in the Middle East and it produces 45 million condoms a year in 30 different colors, shapes and flavors.
In one of the most successful instances of women's grassroots organizational pressure on the government, in September, 2008, over 100 advocates for women's rights successfully lobbied against proposed changes to marriage laws which were detrimental to women and forced the Iranian Parliament to drop the regressive amendments.
Clothing Restrictions
Yes, there are mandatory clothing rules for women, including wearing a scarf and clothing that covers the arms to the wrists and legs to the ankles, and they are cited by Western women as a form of human rights concern. In fact, as our aircraft arrived at the Tehran International Airport terminal, the aircraft crew announced "By the law of the country of Iran, women cannot leave the aircraft without a scarf on their heads-and there will be an Iranian official outside the aircraft to return women who are not properly covered." While some Iranian women say wearing the scarf is burdensome, others are comfortable with the dress code. In any case, clothing restrictions are not the main focus of women's rights advocates. Rights to custody of children and property after divorce, right to education and health care are more important than mandatory wearing of a scarf.
In the Month Since Our Visit
Sparks Fly Over Iranian President's BBC Christmas message-- "Jesus Christ Would Stand Up to Bullying, Ill-Tempered and Expansionist Powers"
In what they surely knew would be a very controversial request, the British Broadcasting Company (BBC) asked Iranian President Ahmadinejad to deliver the BBC channel 4's traditional "alternative Christmas message" to the Queen's Christmas address.
The head of BBC News and Current Affairs said the decision to ask President Ahmadinejad was because "As the leader of one of the most powerful states in the Middle East, President Ahmadinejad's views are enormously influential. As we approach a critical time in international relations, we are offering our viewers an insight into an alternative world view. Channel 4's role is to allow viewers to hear directly from people of world importance with sufficient context to enable them to make up their own minds." (http://news.bbc.co.uk/2/hi/entertainment/7799652.stm)
It turned out that Ahmadinejad's short, 36 second message in Farsi with English subtitles broadcast on Christmas Day, 2008, probably resonated with much of the world, but predictably provoked a British government hornet's nest with his comment that if Jesus Christ lived today he would stand up against bullying powers. "If Christ were on earth today, undoubtedly he would stand with the people in opposition to bullying, ill-tempered and expansionist powers." Ahmadinejad, a devout Muslim, criticized the "indifference of some governments and powers" towards the teachings of the "divine prophets, including Jesus Christ" and said that "the general will of nations" was for a return to "human values". "The crises in society, the family, morality, politics, security and the economy ... have come about because the prophets have been forgotten, the Almighty has been forgotten and some leaders are estranged from God."
Ahmadinejad's remarks received very little media coverage in the United States, miniscule when compared to the news story of the month-- President Bush's encounter with the Iraq shoe thrower. However, a spokeswoman for the UK's Foreign and Commonwealth Office in predicting anticipated Bush administration displeasure said: "President Ahmadinejad has during his time in office made a series of appalling anti-Semitic statements. The British media are rightly free to make their own editorial choices, but this invitation will cause offence and bemusement not just at home but amongst friendly countries abroad."
Labor Member of Parliament (MP) Louise Ellman, chairwoman of the Labor Jewish Movement, said: "I condemn Channel 4's decision to give an unchallenged platform to a dangerous fanatic who denies the Holocaust, while preparing for another, and claims homosexuality does not exist while his regime hangs gay young men from cranes in the street. Conservative MP Mark Pritchard, a member of the Commons all-party media group, said: "Channel 4 has given a platform to a man who wants to annihilate Israel and continues to persecute Christians at Christmas time. "
Media Relations Not a Strong Suit of the Iranian Government
It's almost as if the Iranian President Ahmadinejad, who is up for election in the summer, 2009, has hired lame-ducks U.S. Vice-President Dick Cheney and Israeli Prime Minister Olmert as his foreign policy, national security and media consultants. How else could the Iranian government have come up with so many incidents in the past weeks that give ammunition to those in the United States and Israel who do not want dialogue with Iran on nuclear and regional security issues, who want human rights issues to publicize and who wish ill to the Iranian government and people?
For example, on December 22, 2008, the Iranian government closed down two human rights organizations headed by 2005 Nobel Peace Prize winner Shirin Ebadi. The government accused the organization of carrying out illegal activities, such as publishing statements, writing letters to international organizations, and holding news conferences. The Center for Participation in Clearing Mine Areas helps victims of landmines in Iran and Defenders of Human Rights Center reports human rights violations in Iran, defends political prisoners, and supports families of those prisoners. Ebadi was also taken into police custody briefly following the raids.
And the first week in December, 2008, in a campaign against Western cultural influence in Iran, Qaemshahr city police arrested 49 people during a crackdown on "satanic" fashions and unsuitable clothing and closed five barbershops for "promoting Western hairstyles." (http://www.telegraph.co.uk/news/worldnews/middleeast/iran/3548370/Iran-arrests-49-for-wearing-satanic-clothing.html)
And now, there is the predictable increased international criticism about the Russian government providing the Iranian government with S300s, anti-aircraft and anti-missile defense systems, triggered by the Bush administration's decision to put a "missile shield" in Poland and the Czech Republic. On December 23, 2008 United Press International (UPI) reported that the Russian government had begun delivery to the Iranian government of some of its most modern anti-aircraft and anti-missile defense systems, the S-300s. These missile systems can shoot down ballistic missiles and aircraft at low and high altitudes as far away as 100 miles. Iran conducted well-publicized air force and ballistic missile defense exercises in September, 2008.
The Bush administration's ballistic poke in the eye of Russia and Iran by the deployment of ballistic missiles in Poland and a radar in the Czech Republic "to protect against attacks from rogue states" (http://www.globalsecurity.org/space/library/news/2008/space-081115-rianovosti01.htm is perceived by many Iranians as a strategy to ensure that tensions in the region continue to escalate. The United States is planning to deploy 10 Ground-based Mid-course Interceptors in Poland and batteries of shorter-range Patriot PAC-3 anti-ballistic missiles to protect the Interceptors.
Iranians Not Optimistic About Future Relations with the United States Under an Obama Administration
Despite President-elect Obama's comments during the Presidential campaign that he would have dialogue with the Iranian government without preconditions, many Iranians with whom we spoke are not optimistic that there will be meaningful change in U.S. policy during an Obama administration. Citing appointments of former Israeli Defense Force member and US Congressman Rahm Emanuel, as Chief of Staff, Hillary Clinton, who during the summer campaign said she would "obliterate" Iran if Iran used nuclear weapons against Israel (a statement that Iranians find incomprehensible since it is Israel that has nuclear weapons, not Iran, and Israel continues to threaten Iran), and Dennis Ross, the Middle East negotiator during the Clinton and Bush administrations, Iranians said they hoped the AIPAC lobby in the United States had not already determined Obama's agenda toward Iran.
Iranians Want Peace
To emphasize again, the overwhelming comment from Iranians during our visit was that they want peace with the United States. They hope that the new President of the United States will talk with their government to resolve issues, instead of resorting to the threat, much less, the use of military action.
Our Future with Iran - A Hope for Diplomacy Not Military Action
As we have seen from the American invasion and occupation of Afghanistan and Iraq, the use of our military to resolve security issues kills and injures innocent civilians, destroys cities and villages, creates more people who dislike/hate our country and who may be willing to use violence against us, and jeopardizes, not enhances, the security of the United States.
As a retired US Army Colonel and a former US diplomat, I hope that the Obama administration will throw away the old template of 30 years of crisis, threats of military action, vindictiveness and retaliation and look to diplomacy to develop a peaceful future with Iran!
Ann Wright is a 29 year US Army/Army Reserves veteran who retired as a Colonel and a former US diplomat who resigned in March, 2003 in opposition to the war on Iraq. She served in Nicaragua, Grenada, Somalia, Uzbekistan, Kyrgyzstan, Sierra Leone, Micronesia and Mongolia. In December, 2001 she was on the small team that reopened the US Embassy in Kabul, Afghanistan. She is the co-author of the book "Dissent: Voices of Conscience." (www.voicesofconscience.com)
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http://www.massviolence.org/Rwanda-The-State-of-Research?artpage=8-12
by Thalif Deen
UNITED NATIONS - The United Nations Wednesday commemorated the 60th anniversary of the landmark Universal Declaration of Human Rights (UDHR) against the backdrop of widespread political repression -- most notably in Zimbabwe, Sudan, Burma (Myanmar), Iraq, Afghanistan and in the Israeli-occupied territories of West Bank and Gaza.
But a sharply divided Security Council has remained politically impotent against continued atrocities worldwide, in violation of humanitarian law and international conventions, including the UDHR.
Andrew Hudson, a senior associate with the Human Rights Defenders Programme at Human Rights First, singled out U.N. member states, primarily Security Council members, "who have frequently failed to prevent or address gross violations of the UDHR."
The United Nations, he said, should redouble its efforts to demonstrate that the human rights contained in the UDHR are universal and allow for translation into specific local contexts.
"The new Universal Periodic Review mechanism at the Human Rights Council demonstrates that the UDHR applies universally to all states," he stressed.
The U.N. human rights system should engage in objective, impartial and universal evaluation of the human rights records of all states, Hudson told IPS.
More recently, at a political level, the Security Council has remained deadlocked because of the partisan role of the five veto-wielding permanent members.
The United States, France and Britain have continued to protect Israel, Iraq and Afghanistan while Russia and China continue to shield Zimbabwe, Sudan and Burma (Myanmar) against any strictures or sanctions for human rights violations.
Article 1 of the UDHR, which was adopted by the General Assembly on Dec. 10, 1948, states that "all human beings are born free and equal in dignity and rights."
But in reality human rights abuses are increasingly becoming the norm in most developing nations. And in developed countries, including the United States and Britain, violations are being justified in the name of fighting terrorism.
Speaking at a ceremony to mark the 60th anniversary of the UDHR on Wednesday, Secretary-General Ban Ki-moon said: "We see human trafficking, the exploitation of children, and a host of other ills plaguing millions of people," he added.
The "host of other ills", according to human rights organisations, includes torture, disappearances, extra-judicial killings, arbitrary detention, surveillance, defamation and administrative and judicial harassment. The victims also include journalists and human rights defenders.
Navi Pillay, the U.N. High Commissioner for Human Rights, told reporters that tens of millions of people around the world are still unaware that they have rights that they can demand, and that their governments are accountable to them, to a wide-ranging body of rights-based national and international law.
"Despite all our efforts over the past 60 years, this anniversary will pass many people by, and it is essential that we keep up the momentum, thereby enabling more and more people to stand up and claim their rights," she added.
Anuradha Mittal, executive director of the San Francisco-based Oakland Institute, pointed out the failure of nation states and governments in fulfilling their obligation to ensure human rights for all.
For instance, she said, in the United States, where homelessness, hunger and poverty -- particularly among children and seniors -- abound, it is the failure of the government to fulfill its obligation to its people.
"The United Nations could have done more in terms of emphasising the relevance of human rights treaties, insisting on these treaties taking precedence over, say, trade agreements or other social economic policies that might conflict with human rights of people," Mittal told IPS.
Asked where the United Nations has succeeded or failed in helping implement the UDHR, Julie Gromellon of the International Federation for Human Rights (FIDH) told IPS the objective of the founders of the U.N. to add a human dimension to international law through the UDHR has become a reality.
She said international law, and especially the UDHR, has become an important tool to promote respect for and observance of human rights.
The Universal Declaration has also served as a starting point for further standard-setting activities through eight core human rights conventions, whose implementation is monitored by so-called treaty bodies, a more advanced system of supervision.
In this framework, the United Nations has contributed to the recognition of the accountability of all states for compliance with their human rights obligations as laid down in the UDHR, she added.
But important lacunae need to be filled to implement the UDHR. States should be continuously urged by the U.N. to ratify all relevant international human rights treaties and to accept and implement the supervisory procedures.
In particular, they should be urged to ratify the relevant individual complaint procedures, Gromellon added.
She also said the crucial role of non-governmental organisations (NGOs) should be recognised by the U.N. "They have contributed in a most significant way to the development and enforcement of the international human rights system," she noted.
And such organisations should also be given a consultative status with other organisations, including the international financial institutions and the World Trade Organisation.
Rob Wheeler of the World Alliance for Transforming the U.N. said the United Nations, in failing to ensure that all people's rights are met, is actually violating several articles of its own founding Charter.
"We thus urge the United Nations to organise and hold a U.N. Charter Review Conference, under Article 109 of the Charter, in order to determine what can and must be done to ensure that the charter is upheld and that all people's most basic human rights are indeed provided and met," he said.
Unfortunately, he said, most of the provisions included in the Universal Declaration have still not been met even after 60 years -- 830 million people still do not have enough food to eat, 1.1 billion lack access to clean water, 2.6 billion to basic sanitation, and 2.0 billion to essential drugs.
Hudson of Human Rights First said that the United Nations, especially the High Commissioner for Human Rights, has played a critical role in education, outreach and awareness-raising about the universality of the UDHR.
"However, U.N. member states fail to implement aspects of the UDHR by suggesting that human rights do not acknowledge cultural difference -- a specious argument used to avoid human rights scrutiny," Hudson told IPS.
A Question of Ethics
Doing business online brings into sharp focus ethical questions about privacy, employee monitoring, and sharing data in supply chains. Are IT professionals prepared to respond?
By Clinton Wilder (cwilder@cmp.com) and John Soat (jsoat@cmp.com)
ne afternoon last fall, Lockheed Martin corp. senior financial analyst Susan Watershoot opened an E-mail attachment and knew immediately that she was looking at information she wasn't supposed to see. In a template from a Lockheed Martin competitor that should have been blank, the competitor had mistakenly included proprietary rate calculations for a federal government contract on which Lockheed Martin was a subcontractor.
Waterschoot, who also acts as database administrator in the company's radar systems unit in Syracuse, N.Y., immediately alerted her boss and the unit's legal counsel. But there was one other department that had to be notified--and fast. Waterschoot knew that if the document was still on the company's Microsoft Mail server after 5 p.m., it would be backed up overnight and archived on tape, making it potentially recoverable by other employees. Furthermore, the server is shared by the prime contractor, Lockheed Martin, and other subcontractors, exposing the confidential data to even more potential competitors. Waterschoot and the legal counsel worked with their colleagues in IT to remove the document from the server and back it up onto a diskette, which they returned to the competitor. "I just tried to do the right thing," she says.
As E-business moves more and more business processes and transactions online, Waterschoot's experience is a telling example of how information technology, and the people who manage it, are at the forefront of decisions with ethical implications. The debate over ethical standards in business isn't new. What is new, or at least more apparent than ever, is IT's central role in some of the most important business-ethic issues of the day: privacy, the ownership of personal data, and the obligations created by extended E-business partnerships. How have these controversies affected IT managers and others involved with technology? What ethical issues, if any, are business executives grappling with in connection with cutting-edge IT? And where do IT people go for guidance on ethically ambiguous situations? Far from self-evident, the answers may be critical to the development of the trust and integrity needed to succeed at E-commerce and online business.
Changes in technology and business processes can outpace companies' ability to consider their ethical implications or to train employees to deal with them. Few companies have formal programs like Lockheed Martin's, which requires its 140,000 employees to complete one hour of ethics training every year. "It's traditionally been seen as an add-on--'ethics is nice, but let's get back to work,'" says David Gebler, a principal at the Working Values Group in Boston, a consulting firm that's developed ethics training programs for Chase Manhattan Bank, Procter & Gamble, Prudential, Raytheon, and other companies. "You have to bring ethics into your business context. And E-business raises ethical issues that may have existed before, but not in such stark reality."
One IT manager considers the quality of his work to have ethical implications. "The impact of the decisions I make on our company is scary," says Frank Gillman, director of technology at Allen Matkins Leck Gamble & Mallory LLP, a large law firm in Los Angeles. Gillman says his decisions on anything from an outsourcing partner to a WAN vendor could be critical to the firm's ability to operate and compete effectively. And that's an ethical burden in itself. "IT people need professional training on more than just how to work on computers," Gillman says. "We don't do enough in that area. I wish we could do more."
Many IT and business managers seem to take their cues about ethical conduct from the companies they work for. In an InformationWeek Research survey of 250 IT and business professionals, only 54% say they have a personal code for evaluating the ethical and moral implications of business decisions. Of those who do, 67% say it's based on their company's code of conduct; only personal experience polled higher (70%). An eye-opening 93% of all respondents say they agree with all aspects of their company's ethical code, and 96% say their company adheres to its code.
"I'm pretty shielded from those [ethical] questions by our human-resources department," says James Underwood, manager of IS at Canon Information Systems Inc. He's alluding to collecting Internet firewall log data that reveals which Web sites employees visit. The HR department "is responsible for what's ethical and legal as far as what they do with that information, and I'm happy to let them do that," Underwood says. "The question of whether they use it in an ethical manner is up to them."
A pragmatic view, to be sure, but is it a sound one? "IT people are the ones responsible for configuring technologies and systems that have ethical implications," says R. Edward Freeman, business administration professor and director of the Olsson Center for Applied Ethics at the University of Virginia's Darden School of Business, and co-editor of the Blackwell Encyclopedic Dictionary Of Business Ethics (Blackwell, 1998). "They have to be more than the mechanics who keep it running. They need to understand that ethics is at the center of what they do."
At a law firm where Frank Gillman formerly worked, one IT employee clearly didn't understand that. The worker sold company-owned disk drives for money to support his cocaine habit. Theft and drug use are bad enough, but that's not what horrified Gillman. To cover his tracks, the employee seriously compromised the firm's IT integrity by removing the system's data-mirroring capability, giving the system the appearance of having the added memory provided by the missing drives. "Can you imagine what would have happened if the system crashed?" Gillman says.
In large part to address potential IT-related liabilities, both inside and outside a company, a growing number of businesses have high-level ethics executives or chief privacy officers to enforce company standards. "Our goal is to raise awareness, to be proactive and preventive rather than punitive," says Tracy Carter Dougherty, Lockheed Martin's director of ethics communication and training, part of a corporate-level office of ethics and business conduct that reports to the chief operating officer and CEO. Lockheed Martin recently disciplined an employee who E-mailed a chain letter to friends in the company--and brought down a server that affected an entire business area. "When you hit that 'Send' key, there's no getting it back," says Dougherty. "You always have to be very mindful of the risks, and we depend on IT to tell us where the new risks are likely to be."
One new area of risk has to do with the use of handheld devices such as cell phones or personal digital assistants while driving, which has been cited as a factor in a growing number of traffic accidents. Mike Vleisides, senior manager of application development at Aventis Pharmaceuticals Inc. in Parsippany, N.J., spearheaded a "pull-off-the-highway" policy for the company's 3,500 field sales reps seeking to download data while in their vehicles--which Vleisides says constitutes about 90% of their working hours. "Our company would rather have our sales people pull over and spend 30 seconds using the devices safely than risk accident, injury, or worse using them while attempting to drive,'' he says.
Another area of risk, perhaps the riskiest, has to do with collecting personal data. In the InformationWeek Research survey, 80% of respondents say their companies collect customer data. Yet only 60% say their companies have a publicly displayed policy on the privacy of customer data they collect. Just 6% of those surveyed say their companies sell data to third parties, though the percentage jumps to 11% among companies with revenue of $1 billion or more. Health-care companies, which collect what may be the most sensitive customer data, have the highest percentage (9%) of companies selling data among five industries surveyed. Overall, 95% of respondents say their companies always adhere to their privacy policies, and virtually everyone says their customers know when specific types of data are being collected.
"We will treat customer information in a way that our customers expect it to be treated," says Robert Beason, outgoing CIO of the Southern Co., a $23 billion gas and utility holding company in Atlanta. Beason says the company has turned down third-party offers to buy some of the data within its 7-terabyte data warehouse of information on 4 million customers. "It's for our internal use, and we're not going to sell information in the open marketplace without written approval from customers," he says. "There has to be a business ethic that goes along with that."
But what role should IT people play in determining that ethic? Like scientists, IT professionals are often accused of being more interested in results than ramifications. "When your job is building the best-performing database you can, you don't always think about the ethical implications of how that data will be used," says Ed Altman, a former CIO at Metro-Goldwyn-Mayer Studios Inc. and now director of business development at integrator and staffing firm Metro Information Services. "The very people helping to create the [data privacy] problem don't realize how bad it is."
Yes they do, says Kathy Komer, president-elect of the International DB2 User Group, a worldwide organization of users of IBM's enterprise relational database. Or at least they're aware of the controversy. "I don't see anyone who takes managing databases lightly," says Komer, a database administrator for a large Northeastern company. But the user group has no written ethical policy concerning data collection, nor does it advise companies on ethical considerations in dealing with personal data, Komer says.
For consumers, the line between well-targeted marketing and privacy invasion has always been a fine one. Some argue the consumer privacy issue, when compared with the actual capabilities of online marketing technology today, is overblown. It's rarely possible and almost never cost-effective to segment customer data to the individual level. In the InformationWeek survey, 65% respondents say they segment customer data by product line, 46% by region, 41% by frequency of purchases, and 33% by profitability. "All this fuss about privacy policies is the political correctness of the 21st century," says admitted contrarian Peter Fader, professor of marketing at the University of Pennsylvania's Wharton School of Business. "Let the market dictate what's good and bad. As technology advances, consumers also get smarter and more skeptical."
Most everyone in E-business agrees that questionable ethical moves that compromise customer privacy for short-term marketing gain are bad for business in the long run. "Online business is entering a more mature phase, and the issue of who the customer trusts becomes more of a competitive differentiator," says IBM chief privacy officer Harriet Pearson.
Lands' End Inc. believes that its renowned customer loyalty depends heavily on trust, and the apparel retailer has one of the industry's strictest online privacy policies. The company doesn't send E-mail promotions to its customers except by request and never sells or trades online customer data.
Lands' End's security audits include not only hacking tests on its firewalls, but ethical tests of IT and business employees in situations where data security could be compromised. "We test to make sure they make data available only to those who should see it," says Linda Severson, director of business systems. "You have to have tests that continually challenge your security and privacy processes. Ethics has to become more of a way of life, not a one-time policy posting."
Trust between workers and employers is another key issue putting IT managers in the midst of ethical decisions. Most companies forbid employees using company computers to access Web sites with material that is pornographic, violent, or hate-related. Dow Chemical Corp. fired 50 employees last year at a Freeport, Texas, facility for violating that rule. In the InformationWeek survey, more than half of the companies monitor their employees' use of the Web (62%) and E-mail (54%). Among companies larger than $1 billion, those figures jump to 77% and 70%. And consistent with respondents' overwhelming agreement with their corporate policies, most IT people believe such monitoring is ethical.
"Speaking for myself, I think employees' Web-usage logs should be available," says Dave Austin, human-resources IS specialist at manufacturer Leggett & Platt Inc. in Carthage, Mo. "If an employee is doing a poor job and the manager can see that person has visited eBay 85 times in the past week, the manager should be able to say that's not acceptable and must stop. And that should be explained to every employee up front." But Austin also says reasonable personal use of the Net should be allowed, given the fact that many devote long hours and weekend time to their jobs.
Another question is, who should this data be available to? Canon Information Systems' Underwood says he's been approached by department managers seeking a peek at the Web-surfing habits of certain employees. "I said, 'We have the information but you need to go to HR to get it.'"
When accounting firm Clifton Gunderson LLP in Peoria, Ill., started generating monthly reports on Web-site usage for its HR department, chief technology officer Matthew Camden, who studied business ethics while in graduate school at Loyola University, says he realized the technology manager producing the reports might be tempted to warn people whose names appeared on the list. "I said, 'You may see people on the list who sit next to you, but you can't do anything about it,'" Camden recalls. IT people need help in determining the proper ethical responses to ambiguous situations, he says, and IT and business managers need to provide that guidance. "It's not enough to have a rule; you have to do what you can to make people follow it."
Because of IT professionals' access to sensitive data, they must often do more than ensure compliance with company policy. At the Allen Matkins law firm, an IT employee cleaning up logs in the firm's contact-management application noticed something amiss. In a space for comments and notes usually left blank, one attorney, unaware it was a shared application, had keyed in two credit-card numbers, a savings-account personal ID number, and the access code for his home security system. Director of technology Gillman told the employee to notify the attorney immediately.
Call it CYA ethics. "Whenever there's a leak of information, one of the fingers of suspicion will be pointed at IT," Gillman says. "The more you act like you can be trusted, the less you'll be targeted."
Guarding data privacy takes on even more significance when supply-chain partners share information online outside company walls, as Lockheed Martin's Waterschoot knows. In industries such as automotive, high-tech manufacturing, aerospace and defense, and many others, collaborators on one project can often be competitors on another. "You need to make darn sure that the information being exchanged online is the right information," says ethics director Dougherty.
More suppliers are designing key components for competitors and sharing those designs online, says Michael Bauer, a partner in CSC Consulting's manufacturing practice and co-author of E-Supply Chain (Berrett-Koehler Publishers, 2000). "I hear a lot of emphasis on shortening cycle times and finding tools for security, but I haven't seen a lot of awareness or programs about the responsibilities of partners in an electronic supply chain," Bauer says. "The problem is human beings--not because they're malicious, but because they can be careless or ignorant about ethical implications."
That may be the key: Most IT managers and executives agree there needs to be more training in ethics, especially now that IT has taken a central role in doing business. Indeed, thinking of business and ethics, or IT and ethics, as opposing forces may be a false dichotomy. "The whole idea of positioning ethics and profits as a trade-off is like asking me if I want a heart or a lung," says University of Virginia's Freeman. "Well, I'm partial to both of them." --with Bob Wallace
by Peter Erlinder
November 2008 was the 100-year anniversary of the Congo's conversion from the personal property of Belgian King Leopold II to a colonial possession of Belgium, itself. The King's brutal rule, documented in Leopold's Ghost, embarrassed the Belgians into switching "landlords" in 1908, but did little to ease the colonial burden on the Congolese people.
Between the European powers Berlin meeting that divided up Africa in 1885 and 1908, Belgium's Leopold II accumulated spectacular wealth for himself while an estimated 10-million Congolese died. Even more died before Congo finally got its independence on June 30, 1960. But, real independence has never arrived in the Congo, and foreign military and economic powers still control its destiny today! In 2008, Leopold's "Ghost" has been replaced by the United States and the United Kingdom, and surrogate-armies led by Rwanda's Paul Kagame and Uganda's Yoweri Musveni, as documented by reports commissioned by the UN Security Council more than 5 years ago....that the U.S. press has studiously ignored.
U.S. neo-colonial influence in Congo can be traced to the years just after nominal "independence," when Patrice Lumumba, its first democratically-elected prime minister, was assassinated by a western-backed "anti-communist" coup on January 17, 1961. Belgium apologized for its role in 2002 , but despite exposés like A Legacy of Ashes, the CIA history published last year that documents CIA crimes in the Congo, and elsewhere, the U.S. still downplays its role in assassinating Lumumba, and backing the "anti-communist" dictator-criminal Mobutu Sese Seko for more than 3 decades...until he was overthrown in 1997 by a U.S./U.K. sponsored invasion from Rwanda and Uganda, after the Soviet Union's collapse made him expendable.
During a lull in the fighting in the Congo, the UN Security Council commissioned detailed reports in 2001, 2002 and 2003 that document how the 1996 Ugandan/Rwandan military-invasion overthrew of Mobutu, put Laurent Kabila in power in 1997 and unleashed an ongoing resource war, when Kabila tried to reclaim the resource-rich eastern Congo from his erstwhile "allies." That war eventually brought Angola, Zimbabwe and other nations to the defense of the Congo's territory in what became known the First "World War of Africa." Since the 1996 invasion, the Congo has lost an estimated 6 million men, women and children, and the Rwanda/Uganda sponsored war continues today.
As central Africa teeters on the edge of another conflagration that threatens to touch off a Second "World War of Africa" even the New York Times is reporting that the increasing violence is based in a grab for resources. But, what has not been reported is that, more than 5 years ago, at least 3 UN Security Council-commissioned reports submitted over 3 separate years, identified the resource-grab by Rwandan and Ugandan elites as the main source of violence and death in the Congo. Each nation's capital has become the largest trading centers for riches that don't exist in either country, but exist in great plenty in the eastern Congo.
The UN reports describe how elites, related to government and military leaders in Rwanda and Uganda, are gorging themselves on the riches stolen from the areas under the control or their armies or their surrogates. For example, according to the UN reports Rwanda controls an area of the Congo more than 15-times its national territory.
The map of central Africa shows Rwanda and Uganda as smallish "bumps" on the backside of the Congo, a country the size of Western Europe. Uganda's population is only about 35 million and Rwanda's no more than about 8 million...but they have both managed to sustain a 12-year war of occupation in vast areas of the eastern Congo, and have threatened to take control of the entire country.
The Iraq and Afghanistan wars have taught the American people just how expensive wars of aggression and occupation really are. The occupation of the Congo has lasted nearly twice as long as George Bush's wars, which means that either the wars are very, very profitable, or the Ugandan and Rwandan militaries are getting support from outside central Africa...or both.
The 2001-03 UN-commissioned reports document just how lucrative the Congo invasion and occupation has been for its Rwandan and Ugandan sponsors....but it also helps to know, as reported by the U.K. Telegraph, that Uganda is one of the largest recipients of U.K military and economic aid on the African continent. And, Rwandan President Kagame was trained by the U.S. Army at Ft. Leavenworth and that Rwanda has been Africa's largest per capita recipient of U.S. military and economic aid. The Rwandan army has grown from 7,000 troops when Kagame invaded Rwanda from Uganda in 1990 to between 70,000 to 100,000 troops today. Rwandan and Ugandan troops and private military contractors are in Darfur, Somalia and part of the 180,000 "civilians" assisting the U.S. military in Iraq.
Only the United States and United Kingdom (not the UN or the "international community") have the power to stop the killing in the Congo by removing support for the military and economic crimes of their allies. But, in addition to direct governmental support, as we know from the movie "Blood Diamonds," cutting off the private capital that also fuels Africa's wars is also necessary. But, if the well-documented governmental and private Anglo-American interests in central Africa stop turning a blind-eye to the crimes being committed by their surrogates....that supply "blood"-coltan for cellphones, "blood"-gold, diamonds, tin and bauxite to North American and European markets, and proxy-troops in Africa and Iraq, the "puppet-combatants" would be unable to continue a large-scale war for very long.
Europe had its own 100-year war, and the Congo has already experienced an African variation with a century of European assistance. But, at the dawn of the 21st Century, the British and Americans can prevent what promises to be a 200-year genocide in the Congo and central Africa....but only if they choose to admit their complicity, and end it!
President Obama has many difficult challenges indeed....but his capacity for deeper understanding of neo-colonial manipulations in Africa than any U.S. president before him presents the possibility that he could emerge as a peacemaker in Africa on a scale that could even exceed the contributions of Nelson Mandela, and ensure Obama's place in world history. The question is whether he will have the wisdom, strength and courage to finally put Leopold's neo-colonial "Ghost" in its well-deserved grave....and, whether the Pentagon and U.S. economic interests will permit him to bury U.S. neo-colonialism in Africa, once and for all.
