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,
Hey what do you guys think about the economic speech that he gave today? Do you think it adequately dispells the fears and anxities of the american public?
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!
Dear Friends of Barack Obama,
Please join the AFRICAN IMMIGRANTS MOVEMENT FOR OBAMA at the prestigious NATIONAL PRESS CLUB in Washington DC to celebrate our victory. We all work so hard for the last 22 months to earn the election of Barack H. Obama as the 44th President of the United States of America.
This is an historic moment of our country that we all should be proud of celebrating. January 20, 2009 should a date to remember. Each one of us who strongly beleive on Barack Obama and work hard to make this happen should find a way to keep the Presidential inauguration date alive. The African Immigrants Movement for Obama is therefore inviting you to the "All Africa Inauguration Ball" to celebrate with the African immigrants communities in the united States of America. Our Presidential Inaugural Ball theme is "Renewing the spirit of the Community" which is so fundamental to the African immigrants in the United states, and so dear to President Barack Obama.
The event's location address is: The NATIONAL PRESS CLUB - 52914TH sTREET, NW, 13th floor, Washington DC, 20045. Time: 7:00PM to 1:00 AM
For additional information, please visit our website at: www.aim4obama.org
Contact: Mr. Etienne Takougang - Event Chair - etakougang@hotmail.com, and MS. Fatima Wahab - Coordinating Committee - fatimawahab@yahoo.com
Thanks
Etienne Takougang
Coordinator of African Immigrants Movement for Obama
Obama for America
I'm not a native of the US nation and yet, I never felt so American. I was thinking during the campaign that there was no such thing than talking about issues all the media were discussing about. So, I decided I didn't want to write anything before Barack Obama is elected, cause it was an evidence to me that he was about to win. I spent the summer at Harvard University studying your language through a journalism class and I came up with the idea that if I, a French native african woman, could cross continents to come and live "my" american Dream (attending Harvard at least once), then something bigger could happen there in front of my eyes. And I saw the miracle happened. In cambridge, the spirit of Barack Obama was floating in narrow streets, bakeries, libraries and discussions were pleasant in public places. A conversation on a bench near the Sever Hall building was telling more than all the media together.
Passion was what you felt, passion for change was deeply anchored in hearts and yet, nobody would dare say the magic name: BARACK, like BARAKA (Luck) but, luck has nothing to do with it, for only destiny was in charge here.
And, on November 2008, Obama was elected and I was speechless, voiceless...
So, that's what miracle is all about. You can't move, speak or run. You stay still and witness the will of god.
Once I recovered, shouting and crying at 5 a.m in the morning in my tiny street of my tiny town, was all I was able to do. Brazzaville became too tight and too dark for me. I felt like I went back to Stone age and my President (Sassou Nguesso) was the first to speak on the radio and his tears and emotional voice made me proud because I have lived long enough to see a man teaching all the leaders of the world a lesson of love, hope and history.
And my life changed this day and forever; I'm fearless in my pursuit of happiness...
THANKS MR OBAMA...
Please bloggers, share your opinion about this post to encourage me. Couldn't raise money because didn't enter the category (american citizen, permanent resident), at least let's share...
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)
Please check out the Office of the President Elect transition webpage and make continue to make the difference.
http://www.change.gov/
God bless USA
God bless Obama & Biden
Retrospectively all Americans have come a long way and can evidently identified with the struggles, sacrifices and courage of the black Americans. Today change has indeed come to America and the bitterness of the 60's should be a thing of the past from a pragmatic perspective. This country cannot afford to dwell on the negativity, discrimination, sentimentalism and idealism that forms the focal points of the 1960 United States of America.
These pictures are a reflection of our today, commitment, and desire to truly emulate the fundamental idealism of America; Unity in Diversity, opportunity and democracy.
Barack Obama: 44th U.S. President
President Abraham Lincoln's Emancipation Proclamation ultimately ended slavery in America at the end of the Civil War. In this illustration from 1863, a freed slave, watched by his family, shackles at his feet, kisses the hand of the president.
Despite brief progress for African Americans during Reconstruction, many parts of the nation were systematically segregated. Here, female students sing at a meeting of the African-American sorority Delta Sigma Theta on the campus of the University of Kansas in 1939.
MLB: Jackie Robinson
Brown v. Board of EducationLinda Brown Smith stands in front of the Sumner School in Topeka, Kan., May 8, 1964. The refusal of the public school to admit Brown in 1951, then nine years-old, because she was black, led to the landmark Brown v. Board of Education ruling.
Civil Rights: Rosa Parks
Death of Emmett TillEmmett Till, a black 14-year-old Chicago boy was brutally murdered near Money, Miss., on Aug. 31, 1955, after whistling at a white woman.
'I Have a Dream' Historic March
President Johnson Signs Civil Rights Act
Civil Rights: Malcolm XMalcolm X , also known as El-Hajj Malik El-Shabazz, has been described as one of the most influential African Americans of the 20th century.
First Black Female Elected to CongressIn January 1972 U.S. Rep. Shirley Chisholm of Brooklyn, N.Y., announced her candidacy for the Democratic nomination for the presidency.
Television Series: The Cosby Show"The Cosby Show," starring comedian Bill Cosby, kicked off its long television run in 1984.
Rev. Jesse Jackson: Rainbow Push CoalitionThe Rev. Jesse Jackson holds hands with marchers to show support for U.S. President Bill Clinton during a rally at the Capitol in Washington, D.C. in 1998.
New York City's First Black MayorDemocratic New York City mayoral candidate David Dinkins gestures during an Election Day rally on the steps of Federal Hall on Wall Street in New York. Dinkins served as the city's first black mayor from 1990 to 1993.
First Black Secretary of StateVice President Dick Cheney, left, swears in Secretary of State Colin Powell, the first black American to serve as secretary of state, in 2001, as President George Bush and Powell's wife Alma look on.
http://abcnews.go.com/Politics/Vote2008/popup?id=6183629
Indeed we have all come a long way; Whites, Blacks, Hispanics, and other racial components that form the diversity that America is built upon.
God bless Obama
Nov. 5 (Bloomberg) -- Here is a sampling of the world's reactions to Barack Obama's victory in the U.S. presidential election.
``It's America showing some maturity,'' said Greg Ryan, 38, a financial planner in Sydney, Australia, adding Obama will be a more ``peaceful'' president than George W. Bush. ``America's gone too far down that world policeman thing.''
Obama's victory is a ``generational change'' and he may take global warming more seriously. ``That's the big picture isn't it, the environment. The war over water is going to be bigger than the war over oil in the long run.''
http://www.bloomberg.com/apps/news?pid=20601087&refer=home&sid=aoR_RoR0WGgc
God bless America
In our little ways we have all tried to make the best of our time especially in context of how we all have committed time and energy to make America the abode of haven for humanity.
The rest is in God's hands.
As my mother will tell me, "MY PROBLEM IS THE RECIPE THAT GOD US TO PROVIDE ME WITH PROGRESS AND PROSPERITY", I am also passing this blessed saying across the nation and ask everyone of us to believe, trust and hope for there is nothing impossible for the almighty.
God bless Obama and Biden
Former Massachusetts Gov. Bill Weld Friday joined the growing list of Republican moderates, neo-cons and former aides to President Bush who have announced that they will vote for Democrat Barack Obama.
Gov. Bill Weld
Sen. Obama's conviction is that there is only one United States of America and not the partisanship and inimical divisiveness that classified it into Red states and Blue states.
United we stand and divided we fall.
At a glance one may be tempted into believing that as a result of Sen. McCain’s war experience and coupled with his military background he will be better position to deal with the issue of national security better than Sen. Obama, nevertheless the reality completely suggest a different scenario that may be shocking to many Americans.
Those who argue that the Arizona Senator is better equipped to deal with the issue of terrorism are quick to point at his veteran record and tough talk on the subject matter. However, while acknowledging his vast experience, it suffice to note that in the prevailing conditions in which the country’s economic status is at an anemic and abysmal level and coupled with the inimical conditions of its citizenry, the United States of America need the administration that has as its leader a candidate that is calm, cool, calculated and capable of reversing the trend for the best.
Sen. McCain’s display of temperament and tough talk is not in any way different from those of the incumbent and the results are there for Americans to see and elucidate the realistic conclusion that it has failed the country and hurt its idealism. Unfortunately for those who may think that McCain is best for the national security, his erratic and unstable disposition is a burden that needed to be substantially explained before one can trust his actions, let alone judgment.
I do believe that only Obama has the best solutions for this crisis-if by ignorance, Americans do vote for Mccain this coming November, it is going to be worse. Dear Americans, be wise, and vote with your mind focused on what is going to happen to USA tomorrow, if a republican president is back in the White House. I am telling you, it is time now to put behind those little thinking or excuses, such as Obama is inexperienced! Trust me, he is far away better than MCcain on the Economy. You will not regret your vote. Vote for Obama today, no complaints tomorrow. Vote for MCcain, you will have complaints all your next 8 years, and nobody will listen to you, even me.
Good Election Day!
Retrospectively, sequel to the economic meltdown and the prevailing financial market crisis and coupled with the obvious fact that the McCain campaign has made its intention known to the American people, namely to attempt to denigrate Obama and perpetuate the campaign and propaganda of acrimony, maliciousness and defamation against him, it is pragmatically without doubt that Sen. McCain and his allies have thrown in the towel.
What manner of a presidential candidate that will rather not discuss the issues affecting the people and instead will spend tax payer’s money on tearing his fellow citizen and opponent apart all in the name of satisfying an egocentric mentality and inclination?
How do Sen. McCain how to justify that the money he has been raising on the campaign trail and not to talk about that allocated to him by the federal government is being adequately utilize for the benefit of the Americans and the country at large, if he uses the money and people’s investment in a fashion that fundamentally denigrate the very idealism of the country’s existence as a nation whose virtues and value systems are enshrined in humanity and diplomacy?
The fact that McCain has nothing tangible to say to the American people in the face of two wars and the prevailing socio-economic crisis may as well be taken as his pragmatically or maybe subconscious decision not to continue with his campaign on a holistic fashion and instead focus his attention on dehumanizing Obama.
Nevertheless there is also the downside to this tactics by the McCain camp; Sen. McCain will later come out to apologize to the American people in the same fashion that he seek for pardon for his involvement in trying to deny Dr. Martin Luther King Jr. Holiday and not to talk about his associations with some rogues.
My advice to him is to emulate Sen. Obama by trying to be calm and not be too angry for comfort, after all what goes up must come down in the same fashion that his running mate initially electrified the Republican Party base only to be later exposed as naïve and unfortunately an inconsequential and leprotic arm of the same old same politicians. A pig will still be a pig irrespective of its lipstick, period!
It is time to start working on scheduling, how people who are already registered to vote, couldn't miss voting on that Day!
Nyagatare
