Political India: Engaging America

Labels: Keystone XL pipeline, Obama

From The Hindu

In a relatively rare Gulf of Mexico oil spill update coming directly from the White House, President Obama said “the new cap is good news” — a reference to the “capping stack” installed earlier this week, which has thus far improved the odds of a total mop-up.

In a statement, the President explained that scientists and external experts who “met through the night and continue this morning to analyse the data from the well integrity test” were seeking to determine whether they could safely shut in the well using the new cap without creating new problems, including further oil leaks in the sea floor.

Mr. Obama noted, “Either we will be able to stop the flow, or we will be able to use it to capture almost all of the oil until the relief well is done. But we’re not going to know for certain which approach makes sense until additional data is in.”

Touching upon the positive aspect of the latest development, the President added that even if a shut-in were not possible, the new cap and the additional equipment being placed in the Gulf would be able to contain up to 80,000 barrels a day “which should allow us to capture nearly all the oil until the well is killed”.

However, Mr. Obama also cautioned that “when the oil stops gushing, everybody feels like we’re done — and we’re not”. He said that the final solution to the problem was going to be the relief wells and getting that completed “but there’s no doubt that we have made progress as a consequence of this new cap fitting on, and that even if it turns out that we can’t keep the containment cap on to completely stop the oil, it’s going to allow us to capture much more oil and we’ll see less oil flowing into the Gulf”.

He added that there was still “a big job to do” in terms of skimming surface oil and better coordination on the ground along the shorelines. “There’s still going to be an enormous cleanup job to do, and there’s still going to be the whole set of issues surrounding making sure people are compensated properly, that the $20 billion fund is set up and is acting expeditiously,” Mr. Obama said.

Labels: BP oil spill, Gulf oil spill, Obama

From The Hindu

No decision has been made on the question of whether India will have direct access to David Coleman Headley, the Assistant Secretary of State for South and Central Asia, Robert Blake, said today.

Discussing some of the highlights of his recent trip to the region with journalists Mr. Blake said, “We understand that there is a lot of information that Mr. Headley has, which is of great interest to India, particularly because he was scouting out some possible sites.” In turn the United States had great interest in sharing as much information as it could on that, Mr. Blake added.

Yet he cautioned that although the U.S. Department of Justice was working with the Government of India to discuss the modalities for cooperation on the Headley case, “no decision has been made on that.”

Broader LeT threat

On the other hand in Pakistan Mr. Blake said that among the most important messages that he had conveyed was his view that India was seeking two things: first the “continued prosecution of suspects in custody for the Mumbai bombings”; and second, “progress to curtail cross-border infiltration that is taking place from Pakistan into India.”

Mr. Blake also said that he had urged Pakistan to take action against the Punjab-based groups, such as Lashkar-i-Taiba (LeT), “not only because that is important to India but it is important to the U.S.”

He explained that the LeT now had growing ambition and scope in its activity as shown by the David Headley case. “So we think it is very much in the interest of Pakistan as well to take action against the LeT,” he added, implying that the global nature of the LeT threat may endanger Pakistan’s interests.

The Assistant Secretary further argued that the it was important for Pakistan not to allow any terrorist groups to use Pakistan as a base from which to attack India or any other country. “I made that point not only publicly but also privately with my friends in Pakistan,” he said.

Mr. Blake praised Pakistan for its military action along the Afghan border. “I think an enormous amount has happened in Pakistan, first in Swat, then in South Waziristan, and then the more recent arrests of several senior Taliban leaders.” A lot of important progress has been made, he added, however qualifying that with the statement that there has not been any recent progress with the trials of the Mumbai attacks accused in Pakistan.

Liability and the civil nuclear deal

Reacting to suggestions that India may not pass legislation for absolute liability in line with Committee on Supplementary Compensation Mr. Blake said, “I do not see it as a sticking point. In all of our conversations with the Government of India, they have consistently said they remain committed to fulfilling this commitment under the civilian nuclear deal, to pass the civil liability legislation.”

He admitted that the opposition in India has recently expressed its objections to aspects of that legislation but said that it would be up to the Government of India to figure out how to move forward on this.

India-Iran pipeline project

Regarding the proposed Iran-Pakistan-India oil pipeline proposal Mr. Blake sought to dissuade India and Pakistan from engaging with Iran in this area. “This is a very sensitive time with negotiations with Iran and we would prefer that all countries not conduct such transactions with Iran at this time,” he said.

He said that the reason for this would be that the U.S. view of Iran was that it appeared to be unwilling to uphold its international responsibilities in terms of its alleged nuclear development programme.

Labels: 26/11 Mumbai attacks, David Headley, India, Obama, Robert Blake, US

From The Hindui

The 24/7 news cycle and the intense glare of a thousand cameras has made all politicians wary of every word escaping their lips.

The media, in turn, has turned into a ravenous, sound-byte-hungry beast that hangs on every such word.

Yet for all the frenzy it is sometimes that unintended whisper caught on tape that reveals more than a thousand prepared lines.

On Tuesday, in the aftermath of the historic passage of the healthcare reform bill, President Obama held a ceremony for signing the bill into law in the East Room of the White House.

The signing was witnessed by an august gathering, including Vicki Kennedy, widow Senator Edward Kennedy, who fought fiercely for healthcare until his death last year; and 11-year-old Marcelas Owens, who lost his mother to illness because she lacked medical care, and yet he had become one of Mr. Obama's favourite ambassador's for reform.

When the President and the Vice-President entered the room they did so to thunderous applause and chants of “Yes We Can!”

But before the President addressed the crowd, who should step up to introduce him but Vice President Joseph Biden, a man with a less-than-perfect record on social faux pas.

He began with aplomb, saying “Mr. President, your passion to make the lives of ordinary Americans better has been on display.

And the principles that guided your public service, beginning when you were a community organiser, have led this nation to this moment... Ladies and gentlemen, the President of the United States of America, Barack Obama…”

And then it happened.

The Vice-President leaned over his boss' shoulder to whisper something in his ear. Sadly he didn't lean far enough to be out of earshot of the microphones.

So the many millions watching their national leaders on stage heard him say to Mr. Obama: “This is a big [expletive] deal.”

News of Mr. Biden's gaffe has since travelled, viral-style and like wildfire, across the global media — as a testimony not only to the breadth of his vocabulary, but more importantly to how much healthcare reform has meant to this White House.

Labels: Biden, controversy, healthcare Bill, Obama

Labels: economic policy, environment, Obama

From The Hindu

The U.S. healthcare reform drama is moving towards a resolution. The House of Representatives narrowly passed a version of the reform bill that scaled down the public option while retaining some landmark elements of the original Obama reform. Most importantly, the bill extends healthcare cover to 36 million uninsured Americans, bringing 96 per cent of the eligible population under the insurance umbrella. With the Senate voting last week to take up the debate in December, the risk of delaying tactics, especially a filibuster by Senate Republicans, has diminished. Now all that stands between President Barack Obama and unprecedented success in reforming a bloated and fundamentally inequitable healthcare system is a Senate vote on and for the bill and, after that, a final vote on a House-reconciled version of it.

The real threat to the U.S. President’s Senate support comes not from three vacillating Democratic Senators but from a potentially ruinous failure to convince the American public that his reform proposals will create a system that is more equitable in its delivery and deficit-neutral in its cost. The recent fall in Mr. Obama’s approval ratings to below 50 per cent for the first time reflects a failure to come with a bold political initiative to engage with, and enthuse, the American public. To put this in perspective, one needs only to recall how his brilliant campaign for the presidency was powered by broad-based and innovative grassroots appeal — among other things, through the use of the social media, rousing speeches that somehow managed to strike the right social balances, and genuinely democratic internet-based fundraising. Candidate Obama had charisma but, more importantly, demonstrated a gift for inspiring ordinary people with his inclusive promise of leadership. This left the Republican campaign floundering amidst confused and bitter sound bytes. But given the highly polarised nature of American politics and with the White House team performing below par, the Republicans, and especially their right wing, have recovered some ground. Specifically on healthcare reform, until the recent upturn in its fortunes, the administration seemed to be retreating into a cocoon of policy analytics. President Obama may well be banking on regaining his touch, and the political advantage, on the strength of his adroit technical manoeuvres and Congressional victories. Paradoxically, the prospects of his most ambitious reform project hinge on whether he has the capability to persuade millions of ordinary Americans — many of whom suffer from poor healthcare by developed country standards and debilitating unemployment — of its vital necessity.

Labels: approval ratings, Democrats, Healthcare reform, Obama, Republicans

Labels: budget deficit, financial reforms, Goldman Sachs, Obama, U.S.

(This article is reproduced from The Hindu)

Success will depend on the government’s ability to get service providers such as doctors and insurance companies as well as patients to break with conventional thinking in at least four areas.

With the oratory that has now become the Obama signature, the U.S. President recently addressed the American Medical Association (click here to read Obama's speech) (AMA) on one of the thorniest issues his country faces: reform of the U.S. healthcare system. Barack Obama’s persuasive powers were further challenged by the composition of his audience. A powerful lobby representing the medical profession, it has often in the past sided with the Republican view in debates on healthcare reform.

As with the other challenges Mr. Obama faces domestically and internationally, actions will matter more than words. Both the AMA and his detractors elsewhere in America will be waiting to see what concrete policies emerge to back his promise to expand medical insurance to the 50 million Americans who are uninsured and face uncertain prospects should a health problem or crisis emerge. What is more, virtually all Americans now have a vested interest in how reform pans out: the country faces a public finance crisis given the Wall Street bailouts and the deep recession. Costly healthcare reform, if mishandled, could be the sledgehammer that breaks the camel’s back. Critics of Mr. Obama will point to two aspects of the proposed reform that are ambiguous: first, the numbers and, secondly, the attitudinal or paradigm shifts needed to get this reform working on the ground.

The numbers thus far do not ring in Mr. Obama’s favour. Democratic Senators Edward Kennedy and Christopher Dodd, responsible for the proposal for healthcare reform, have produced a draft version that suggests, according to Congressional Budget Office calculations (click here to read the document), that reforms would cost $1 trillion over 10 years, increase the number of insured Americans by 16 million, and yet leave 36 million Americans uninsured, even by 2017. Hardly an easy case for pushing through one of the most complex and embattled cases for reform?

Wrong, answered Mr. Obama, who contended that “one essential step” on the American journey towards prosperity was to “control the spiralling costs of healthcare in America... and in order to do that we are going to need the help of the AMA.” Recent estimates suggest that the U.S. spends close to $700 billion a year on healthcare and almost 50 per cent more per person than the next most costly nation. According to Peter Orszag of the Office of Management and Budget: “For families, after adjusting for inflation, health insurance premiums have increased 58 per cent while wages have risen only 3 per cent since 2000.” Similarly the states face burgeoning healthcare costs and resultant budget squeezes, which lead to cuts in essential services and tax rises.

So where, in the parched wastelands of the U.S. economy is the President going to find $1 trillion? A major portion will come from what Mr. Obama calls the Health Reserve Fund — $635bn set aside over 10 years. Half of this massive saving will be financed by limiting the itemised deduction rate for the wealthiest Americans to what it was when Ronald Reagan was President (an implicit allusion to Republican provenance); the other half from ending overpayments to Medicaid and Medicare Advantage plans (a system of private companies offering care under Medicare and essentially a subsidy to insurance companies). A further $313bn will be wrested by reducing payments to hospitals that cater to uninsured Americans — the logic being that the number of such Americans should decline if the overall insurance coverage is expanded, as the Kennedy-Dodd proposal hopes it will be.

While these proposed savings, assuming they are possible, puts the Obama administration “in a good position to fully fund health reform in a deficit neutral way,” the real bite of the reform will depend on the government’s ability to get service providers such as doctors and insurance companies as well as patients to break with conventional thinking in at least four areas.

First, doctors must be incentivised to provide the best care rather than simply more care. For this to happen there would not only have to be changes in the system of doctor remuneration, for example, rewarding doctors for good patient health outcomes rather than for treatments prescribed. Doctors would also need to be provided better information on patient histories and the relative effectiveness of different treatments. President Obama spoke of both issues to the AMA, asserting that a switchover to an electronic records system would help restore doctors to their traditional role of healers instead of being “bean-counters” and “paper-pushers”. Further the system’s ability to inform doctors about the most effective treatments available will be honed. Currently less than 1 per cent of healthcare spending goes into determining which treatments are most effective. However, Mr. Obama said, initial investments towards improving electronically available information to doctors have already been undertaken as part of the economic recovery programme.

Secondly, patients will have to invest much more in preventive care so as to “avoid illness and disease in the first place,” Mr. Obama demanded. The American struggle with obesity and sedentary and harmful lifestyles is well known, the stuff of movies like “Supersize Me” and numerous newspaper columns. But if there is to be any real hope of long-term cost reductions in healthcare, this message must be spread with unprecedented emphasis and effect. Mr. Obama seems to agree. He now faces the task of convincing America.

Thirdly, insurance companies will have to yield to the growing clamour of voices seeking greater competition in the industry. For decades, health insurance giants such as Cigna and Humana have enjoyed a relatively unrestricted ability to set insurance premiums and in many cases deny payouts to sick patients on the basis of controversial ‘prior conditions.’ This status quo may be significantly altered under Mr. Obama’s plan to introduce an “insurance exchange” or a system of publicly provided, lower-cost insurance policies for the uninsured. The AMA has already signalled its opposition to this single payer public-funded insurance plan. The path of persuasion Mr. Obama has chosen may be longer than he hopes.

Fourthly, and this is being hailed as a benefit of Mr. Obama’s revolutionary campaign tactics, is his gentle hint to the AMA that medical malpractice reform, anathema thus far to Democrats and very much a Republican agenda item, may be necessary. If the 44th President really hopes for a cost-effective healthcare system where doctors can prescribe treatments based on evidence and evidence-based guidelines, it does imply a shift away from excessive treatments, leading to a potential increase in medical malpractice suits. Under other Democratic administrations, including Bill Clinton’s, the President’s ability (setting aside the question of willingness) to tackle the increasingly obese white elephant of malpractice suits has been circumscribed by the fact that the Democrats have had an entrenched relationship with the trial lawyers interest group. The latter, the prime beneficiaries of the litigious circumstances that have trapped the U.S. healthcare system, have fiercely resisted challenges to this source of their ascendancy. Yet Mr. Obama has, given his grassroots approach to campaigning and campaign financing, been able to sidestep the influence of this lobby, perhaps by sheer luck — or perhaps not.

Beset by massive financing and paradigm-shift challenges, President Obama is likely to sleep lightly over the coming months. However, his conciliatory approach combined with a no-nonsense speaking of truth to power might turn out to be the best chance of transforming the ailing healthcare system that any President could ask for.

Labels: healthcare, insurance, Obama, reform, U.S.