Help! My Doctor is "Going Boutique"

Not too long ago, my internist "went boutique." What does that mean? A 2002 article in the British Medical Journal described it this way:

Dr Sidney Wolfe, director of consumer organisation Public Citizen's health research group in Washington, DC, said, “Boutique medicine is a predictable consequence of how badly our healthcare system is functioning.”

The American Medical Association has not taken an official position on the issue. But Dr Richard Roberts, chairman of the American Academy of Family Physicians, said, “If you have a substantial portion of America's doctors doing this, who's going to take care of everybody else? We've got over 40 million people in this country without health insurance, and another 20 million who are underinsured. What's wrong with this picture?”"

In my case, I received a letter that informed me unless I paid a thousand dollars a year, on top of what Blue Cross provided for office visits, my doctor would no longer see me.

Instead, I could go see someone from a list of doctors who had agreed to accept his patients for "continuity of care." Well, I thought to myself. If my doctor doesn't want to see me, I don't want to see him. Another doctor told me, "he's good, but he's not that good." So I checked the list. Only one doctor had a medical degree from an American medical school. Some "choice." I called and was accepted as a patient.

Then, a few months later, a new letter arrived, from the new doctor. He was going into a modified boutique system himself, he said, called MDVIP. (The company is owned by Proctor and Gamble, makes of Tide Detergent, by the way.) He would still agree to see me, but only for a short 15-minute appointment. For longer appointments, 30-minutes or more, I would have to pay him an extra fee, as well.

Both of these doctors had invited me to sales seminars at local hotels before they switched to the new system--just the kind of things condo salesmen or hedge fund operators tended to run, before the recent Wall Street collapse.

Well, I talked to yet another doctor, who said that the two-tier practice sounded unethical on its face, that it was wrong to treat patients differently based upon their ability to pay. Apparently, this idea has occured to some lawyers, even Members of Congress, but so far no one has acted upon it. You can find out more about the legal problems with boutique practices, on attorney Steven M. Goldstein's webpage. Apparently, there have been questions from members of Congress:

These practices have not slipped under the radar screen of government officials, as numerous investigations and other efforts to stop this movement have begun. The most visible action was a letter sent in March of this year to the Inspector General for the Department of Health and Human Services by five members of Congress, including Representative Henry Waxman from California and Representative Pete Stark, the author of the Stark self-referral law. In their letter, the Congressmen raise several concerns that the boutique practices are violating federal laws, and they asked the Inspector General to take "rapid action" against these practices. Last year, Senator Bill Nelson of Florida introduced a bill in Congress to prohibit physicians from charging additional fees to Medicare patients. In addition, various state agencies have begun their own investigations. Departments of Insurance in the states of Massachusetts and Florida are reviewing the practice.

Nevertheless, little has been done to stop a questionable practice that results in fewer doctors being available to see patients--at a time of crisis in national health care.

Laura Newman cited the "boutique" phenomenon as a horrifying symptom of a developing American class system in health care, one that harms public health directly by rationing care on the basis of ability to pay in the British Medical Journal:

Charatan points out that the rise of boutique medicine means that more doctors can cream from the top, picking those who pay the most. Unsettling questions remain: are American doctors and insurers in their silence building a system that is eroding the public's health? In the past, doctors' leaders and researchers have waged a successful battle in the United States to allow specialty referrals, taking their battle to the press, Capitol Hill, and state legislatures. But they have become eerily quiet on this issue. It is high time for those claiming interest in the public's health to publicise the situation and document the harm.

I haven't seen too many articles about the phenomenon in the media. My guess is that all too many writers, editors, producers, and the like are happy to pay the extra fees for VIP treatment, and haven't spent much time thinking about the ethical or public health considerations. There's a term for this mentality: "Public be damned."

The thought occurs: Perhaps this discouraging phenomenon might be added to the anti-elitist agenda of the Tea Party Republicans when they enter Congress as part of the effort to "repeal and replace Obamacare?"

WSJ: US Intelligence Budget Over $80 Billion

And what do we get for our money, exactly? Someone please tell me. Oh, you can't because it is a secret? Well, I can tell you that we didn't get Osama bin Laden, dead or alive...So, can we please have our money back? Full AP story here.

WSJ: Bloomberg's FOIA Problem

In today's Wall Street Journal, Bloomberg's Matthew Winkler complains that FOIA isn't helping Bloomberg find out what the US Treasury did with taxpayer money in the 2008 bank bailout--and that government secrecy is bad for business, bad for the economy, and bad for America...

Americans remain bitter about federal bailouts, even after every penny of the $309 billion rescue of banks and insurers was returned at a profit. Why? Because our government refuses to disclose all of the facts and, until it does, every poll will continue to show a lack of confidence in the government and in the companies that finance America.

More than a dozen books have been written about the collapse of the world's biggest credit market and the government's unprecedented steps to protect hundreds of banks from certain ruin. Yet we still don't know: Who made the decisions?

Treasury FOIA Officials Mission: "...withhold information from release to public"

From the Washington Examiner:

Officials at the Treasury Department’s Office of Financial Stability contracted with a small consulting firm that has given nearly $25,000 to Democratic candidates since 2005 (and no money to Republicans) to hire “Freedom of Information Act (FOIA) Analysts to support the Disclosure Services, Privacy and Treasury Records.” The firm is currently advertising a job opening for a FOIA analyst with experience in the “Use of FOIA/PA exemptions to withhold information from release to the public” (emphasis mine, and if that link goes down, The Examiner has kept a copy for its records).

UPDATE: Phacil has changed their job description on their website (without making a note), however here is a link to another job description for the same job that still uses the above as a qualification. They also have not yet returned calls to The Examiner. The side by side comparison of the old and modified versions are at the bottom of this post.

This means that the entire OFS, which is tasked with overseeing the Troubled Asset Relief Program, is trying to hire people who will withhold information from release to the public.

Jerry Brown's Endorsement, from Meg Whitman, on YouTube...

James Taranto on Katie Couric

From the Wall Street Journal's OpinionJournal:

They Have Indoor Plumbing Too
Howard Kurtz, who recently moved from the Washington Post to The Daily Beast, has a report on "CBS Evening News" anchorman Katie Couric, which includes this howler:

That's why Couric has spent recent weeks in Chicago, Philadelphia, Boston and New Brunswick, New Jersey. She is touring what she calls "this great unwashed middle of the country" in an effort to divine the mood of the midterms.

"This great unwashed middle of the country"? Do you think you could be a little more condescending, Katie?

Moreover, although Chicago at least is in the Midwest, in no other sense are any of these cities in the "middle." Politically? All four cities are in counties that went overwhelmingly for Barack Obama, giving him, respectively, 76.2%, 83%, 76.9% and 60.2% of the vote.

A probably apocryphal quote attributed to Lyndon Johnson has it that if he's lost Walter Cronkite, he's lost Middle America. Barack Obama doesn't need to lose Katie Couric. She's lost Middle America all by herself!

William Easterly on the Ivy League v Middle America

From Aidwatchers.com:

There has been a lot of talk this political season about Ivy League Elitism. My own background—of belonging and yet not quite belonging to the elite— makes me very conflicted.

On Monday, I gave a seminar (not for the first time) at my undergraduate alma mater, Bowling Green State University, which is located in my hometown of Bowling Green, Ohio. It was a very good audience, and I enjoyed as always interacting with my old professors, my first mentors in economics, Charles Chittle, John Hoag, and Leo Navin, as well as with one of BGSU’s new generation of star professors, Timothy Fuerst. I also gave a talk at my old high school (BGHS), and was very impressed with the knowledge and smarts of the students (from the Model UN club) and the Social Studies teacher who hosted me, Theresa Dunn, on development topics.

Earlier this year, I attended an awards ceremony where I was one of 100 alumni that were “among the most prominent” of BGSU’s first 100 years, 1910-2010. Some of my friends teased me that getting an award like this was a bit easier at BGSU than it would have been at, say, Harvard, and I played along with maximum self-deprecation. Yet at the awards ceremony, I felt very humbled by how impressive the rest of the 100 were, with high-achieving entrepreneurs, scientists, actors, artists, and athletes.

My Bowling Green experience always reminds me how American economic development is not just built on a bicoastal elite that went to the elite high schools and universities, but on a very broad and deep Middle America (usually dissed as “flyover America”). The bicoastal elite itself is not a fixed hereditary class, but is constantly renewing itself with new recruits from the same vast Middle, of which I am originally one.

The Massive Middle also provides upward mobility to the poorer regions. My family had lived in one of the poorest regions of the US, the Appalachian Mountains of western Virginia and West Virginia for seven generations. My father grew up in southern West Virginia during the Depression, after having lost his own father at age 2 to tuberculosis. Yet thanks to his hard-working mother and his own hard work, he got a Ph.D. at West Virginia University (WVU) and then got a job as a biology professor at BGSU. Government-funded education like WVU, BGSU, and BGHS is also what helped create the Massive Middle.

So after all this, I am a bit conflicted about the Ivy League Elite. I don’t like the anti-intellectual attacks on this elite (from the Middle); I respect very much all the incredibly smart and creative people I know who belong to this elite. Contrary to the perception of the attackers from the Middle, the elite universities do a great job producing world-class ideas and achievements.

At the same time, I don’t like the pretensions of some in the elite who look down on the Middle and who think they are the only ones qualified to contribute to our development.

Having been on both sides, Middle and Elite, it looks to me like BOTH are success stories in themselves and BOTH have played their own important part in America’s Miracle of Development.

Robert Spencer on Juan Williams

From Human Events:

Juan Williams makes the understandable post-9/11 observation that the sight of Muslims on airplanes makes him nervous, and NPR immediately fires him. Bill O’Reilly states the obvious truth that Muslims attacked the United States on 9/11, and Whoopi Goldberg and Joy Behar walk off the set. These incidents and others demonstrate that the Leftists in the mainstream media and their Islamic supremacist allies are wholly intellectually bereft—and so they cannot engage their opponents on the level of ideas, but must instead bludgeon them into silence...

...But by the 1970s and 1980s, the Soviet regime had grown sclerotic, and had lost the assurance that its own people were still terrorized enough to keep silent, or that it could still count on a foreign intelligentsia willfully blind enough to defend the regime. And so instead of mounting flashy show trials, it packed off its opponents to mental hospitals under the cover of darkness. They simply didn’t exist any longer. It was an effective tactic in the short run, as it certainly silenced their opponents of the day; in the long run, it was an expression of exhaustion, an admission of defeat.

NPR used essentially the same tactic on Juan Williams: it declared his opinions beyond the pale of decent people and cast him out of polite society, into the outer darkness inhabited by Fox News, far from the politically correct fold. NPR apparently did not anticipate the fury of the American people at the public station’s bullying and refusal to countenance reality. Goldberg and Behar tried the same tactic with Bill O’Reilly: in stalking off the stage, they were actually banishing him, along with his claim—as obvious to most Americans as it was outrageous to them—that Muslims killed Americans on 9/11. This is likewise what Jeffrey Goldberg and others who have tried to do to Pamela Geller: render her so radioactive through misrepresentation of what she has said that decent people will turn away.

As they practice these tactics, the implicit admission rings louder and clearer all the time: they have no arguments. They can’t really explain why Juan Williams should not be nervous at the sight of Muslims on an airplane. They have no idea how to answer O’Reilly’s follow-up question that if it wasn’t Muslims who killed us on 9/11, then who was it? And they have no comeback to the arguments from reason, decency, common sense and history that Pamela Geller has adduced against the Ground Zero mosque, and so instead of acknowledging these arguments they try to destroy her personally.

The Leftists who control the media and the Islamic supremacists of whom they provide fawning and mendacious coverage cannot defeat their opponents. They are exhausted. They are finished. The only weapons they have left are feigned moral outrage, defamation, and smear.

Seth Lipsky: NPR Bad for High Culture

From "The Real Case for Defunding NPR," in the Wall Street Journal:

My quarrel with government subsidies to NPR—via grants from the federally funded Corporation for Public Broadcasting—is that they cast a chill over the markets in which private entrepreneurs seek to raise capital for what might be called highbrow journalism. It is hard to quantify this. But it is a conclusion that I have reached after more than two decades spent seeking to raise capital for privately-owned publications competing in this arena.

More than once I have been interrupted, while singing the song of quality journalism to a potential investor, to be asked, "Isn't this already being done by public broadcasting?"

In the instances when that or similar questions were put to me, I was not even seeking to raise capital for broadcasting but rather for small newspapers—the Jewish Forward, in the 1990s, and then the New York Sun. And I wasn't entirely hapless. Many millions of dollars were eventually invested in the two newspapers, and any failures they met were not the fault of the government, but were entirely my own.

I have often wondered, though, what effect the government subsidies have on the broader world, in broadcast and print, of quality journalism. I recognize that the percentage of NPR's funds coming from the taxpayers is but 1% or 2%, or between $1.5 million and $3 million. But whatever the scale, seed capital from a credible investor is an enormous help to any effort, and my own experience is that it would have been easier to raise capital had there been no government-funded competition.

These are questions for Congress to explore when it looks into whether to continue funding for NPR. It's been nearly two generations now since President Lyndon Johnson signed the Public Broadcasting Act of 1967. It's not clear to me, incidentally, what constitutionally enumerated power Congress was relying on to pass such an act. But leave that question aside. What has been the impact on the quality of privately funded journalism of the octopus that government funding of broadcasting helped create?

More about NPR from Lipsky in The New York Sun.

Our Readers are Invited to an Exhibition of Paintings By Polly Evans at the Arts Club of Washington on November 5th

Click to print invitation.

Sarah Palin: End Federal Funding for NPR

Has NPR's firing of Juan Williams given Republicans an issue with "curb appeal" to swing voters? First Mike Huckabee, now Sarah Palin, have called for ending federal funding for NPR. Actually, they would need to do more--to strip NPR and CPB of preferential treatment when it comes to subsidy, advertising, payola and plugola, links to partisan political activity, tax exemptions, reserved frequencies of the electromagnetic spectrum, etc. Republican George W. Bush had eight years--but didn't do a thing. Let's hope that Huckabee and Palin would actually do what they say they want to do...From Sarah Palin's Facebook page:

At a time when our country is dangerously in debt and looking for areas of federal spending to cut, I think we’ve found a good candidate for defunding. National Public Radio is a public institution that directly or indirectly exists because the taxpayers fund it. And what do we, the taxpayers, get for this? We get to witness Juan Williams being fired from NPR for merely speaking frankly about the very real threat this country faces from radical Islam.

We have to have an honest discussion about the jihadist threat. Are we not allowed to say that Muslim terrorists have killed thousands of Americans and continue to plot the deaths of thousands more? Are we not allowed to say that there are Muslim states that aid and abet these fanatics? Are we not allowed to even debate the role that radical Islam plays in inciting this violence?

I don’t expect Juan Williams to support me (he’s said some tough things about me in the past) – but I will always support his right and the right of all Americans to speak honestly about the threats this country faces. And for Juan, speaking honestly about these issues isn’t just his right, it’s his job. Up until yesterday, he was doing that job at NPR. Firing him is their loss.

If NPR is unable to tolerate an honest debate about an issue as important as Islamic terrorism, then it’s time for “National Public Radio” to become “National Private Radio.” It’s time for Congress to defund this organization.

NPR says its mission is “to create a more informed public,” but by stifling debate on these issues, NPR is doing exactly the opposite. President Obama should make clear his commitment to free and honest discussion of the jihadist threat in our public debates – and Congress should make clear that unless NPR provides that public service, not one more dime.

Mr. President, what say you?

- Sarah Palin

Here's my idea for Palin's 2012 platform, or Mike Huckabee's: Use NPR's radio frequencies for data transmission channels that expand the speed and availability of the wireless internet instead of broadcasting. This would be truly public radio, where any American citizen is able to Google, Wiki, Blog, Tweet or podcast. The US government has already taken reserved military channels for this purpose, but more are needed--and NPR has abused the channel reservation it enjoys today. With Joan Kroc's 450 million endowment, plus the additional contribution from George Soros, the NPR network could stay in business as an internet broadcaster and via iTunes on a level playing field with everyone else. Existing NPR radio spectrum could be made available for its best and highest use to serve the American public, while NPR listeners could continue to enjoy their channels on their smartphones, netbooks, iPods, and iPads--without federal subsidy.

Juan Williams: NPR Worse Than Nixon

From FoxNews.com:

This all led to NPR demanding that I either agree to let them control my appearances on Fox News and my writings or sign a new contract that removed me from their staff but allowed me to continue working as a news analyst with an office at NPR. The idea was that they would be insulated against anything I said or wrote outside of NPR because they could say that I was not a staff member. What happened is that they immediately began to cut my salary and diminish my on-air role. This week when I pointed out that they had forced me to sign a contract that gave them distance from my commentary outside of NPR I was cut off, ignored and fired.

And now they have used an honest statement of feeling as the basis for a charge of bigotry to create a basis for firing me. Well, now that I no longer work for NPR let me give you my opinion. This is an outrageous violation of journalistic standards and ethics by management that has no use for a diversity of opinion, ideas or a diversity of staff (I was the only black male on the air). This is evidence of one-party rule and one sided thinking at NPR that leads to enforced ideology, speech and writing. It leads to people, especially journalists, being sent to the gulag for raising the wrong questions and displaying independence of thought.

Daniel Schorr, my fellow NPR commentator who died earlier this year, used to talk about the initial shock of finding himself on President Nixon’s enemies list. I can only imagine Dan’s revulsion to realize that today NPR treats a journalist who has worked for them for ten years with less regard, less respect for the value of independence of thought and embrace of real debate across political lines, than Nixon ever displayed.

Jihadwatch: NPR Fired Juan Williams Under CAIR Pressure

Robert Spencer writes:

It turns out that NPR fired Williams after CAIR [Council on American Islamic Relations] sent out a national press release in which CAIR National Executive Director Nihad Awad said this about Williams' statements: "Such irresponsible and inflammatory comments would not be tolerated if they targeted any other racial, ethnic or religious minority, and they should not pass without action by NPR."

And NPR hurried to appease this thuggish Hamas-linked group.

Everyone's favorite stomach-stapled beekeeper, Ibrahim "Honest Ibe" Hooper of CAIR, was just on Fox, defending his takedown of Williams (while denying that CAIR demanded that he be fired), playing the victim card and hectoring Meghan Kelly, demanding to know if she agreed with Williams. (Kelly stood her ground magnificently.) In the course of things he said, "Everyone is accountable for what they say."

Is that so, Ibe? So I guess you're accountable for saying this, eh? "I wouldn't want to create the impression that I wouldn't like the government of the United States to be Islamic sometime in the future."

Anyway, it's bad enough that NPR would with such alacrity do the bidding of a group like CAIR, but it's even worse that Williams' rather commonplace remarks are being represented as some terrible "demonizing" of all Muslims. He said that he gets nervous on a plane when he sees people in Muslim garb. Even though the 9/11 hijackers and others did not wear Muslim garb, there are many other Islamic jihadists who have worn it, and all of the jihadists have explained and justified their actions by reference to Islamic texts and teachings. No Islamic sect or school of jurisprudence worldwide, meanwhile, has renounced the jihad against unbelievers or the imperative to impose Sharia upon them.

Are there Muslims who are not waging jihad against unbelievers? Of course. But the unwillingness of the Islamic community in the U.S. and Europe to back up its protestations of condemnation of terror with real action to root out the jihad ideology from its ranks makes it impossible to determine whether or not any given Muslim is an Islamic supremacist, or a jihadist.

Is this to "demonize" all Muslims? Of course not. But if Honest Ibe Hooper and his ilk are really not wanting Muslims to be demonized, instead of inviting that "demonization" so they can use it to claim victim status and wring more concessions out of a compliant politically correct media establishment, they could have reacted to Juan Williams' by recognizing that if anyone gets nervous when seeing people in Muslim garb, it is the fault of the Muslims who have committed acts of violence in the name of Islam. And they could begin honest, genuine efforts to root out the jihad doctrine and Islamic supremacism from their communities.

More on this, from Elisabeth Meinecke of Townhall.com:

NPR fired Juan Williams this week for saying he was uncomfortable when he sees people in Muslim dress on an airplane that he's riding. I missed Williams' original comments on the The O'Reilly Factor, so I went to YouTube to find the clip.

Guess who had it? CAIR TV's YouTube channel. Thei description had an action item asking people to "Ask NPR to Address Analyst's Remarks on Muslims."

CAIR's website has an action alert asking "American Muslims and other people of conscience to thank The View co-hosts Whoopi Goldberg and Joy Behar for speaking out when their show’s guest, Bill O’Reilly, made anti-Muslim remarks."

However CAIR hides behind a PR blitz, they support terrorism. Even federal prosecutors, during cases in Dallas and Chicago, have introduced proof that CAIR and other conspirators "used deception to conceal from the American public their connections to terrorists" (this is from the Investigative Project on Terrorism).

Still more, from Tim Graham of the Media Research Center:

t shouldn't be shocking that as many NPR stations are conducting pledge drives of their liberal audiences, NPR has found a pretext to fire its longtime analyst Juan Williams for an appearance on Fox News. NPR listeners have complained loud and long that NPR analysts should not dignify that right-wing media outlet with their presence. Williams admitted on The O'Reilly Factor "when I get on the plane, I got to tell you, if I see people who are in Muslim garb and I think, you know, they are identifying themselves first and foremost as Muslims, I get worried. I get nervous."

It should be noted that the Council for American-Islamic Relations (CAIR) sent around a press release on Wednesday afternoon. CAIR National Executive Director Nihad Awad called for action against Williams: "Such irresponsible and inflammatory comments would not be tolerated if they targeted any other racial, ethnic or religious minority, and they should not pass without action by NPR." The New York Times somehow omitted CAIR from its Juan-is-gone story.

Saying that Muslims scare you after 9/11 or the failed Christmas Day bombing over Detroit is apparently "inconsistent" with and intolerable of NPR's editorial standards.

"Tonight we gave Juan Williams notice that we are terminating his contract as a Senior News Analyst for NPR News," NPR said in a statement.

"Juan has been a valuable contributor to NPR and public radio for many years and we did not make this decision lightly or without regret. However, his remarks on The O'Reilly Factor this past Monday were inconsistent with our editorial standards and practices, and undermined his credibility as a news analyst with NPR. """''''''''''''''''''"''

Alicia Shepard, NPR's ombudsman, told the minorities-in-journalism blog Journal-isms by e-mail, "My office spent most of Wednesday fielding phone calls and emails from NPR listeners angry and upset by what Juan Williams said about Muslims. We got at least 60 emails and that was in response to something he said on another network. My job is NPR’s content – not Fox’s. While this must have been a tough decision since Juan joined NPR in 2000, I think NPR’s management made the right call."

I met Alicia Shepard when she covered the PBS funding debate years ago as a journalist, before she became an NPR executive. IMHO she didn't make the right call defending an unjust decision, contrary to freedom of speech, freedom of the press, freedom of conscience...and reality itself.

Juan Williams Fox News clip as posted on CAIR YouTube Channel, here:

My Lunch at Ray's Hell Burger

Today someone I know and yours truly had lunch at Ray's Hell Burger, the nondescript hamburger stand located in a Wilson Boulevard strip mall in Arlington, VA where President Obama lunched with Dmitry Medvedev, the Russian president, this past summer, as shown in the clip above.

To me, it seemed a lot like the Obama administration itself: Disappointing; a lot of filler; cash only--no credit; no hell being raised...although perfectly pleasant.

However, there were a lot of military personnel wearing camouflage, just like when the two presidents visited. They must work in the office buildings nearby, which struck this noncombatant civilian as a bit strange--since they really stood out, in sharp relief, from the other customers.

It was very busy, so plan to arrive early.

CIA or CYA? Panetta Reports on Chapman/Khost Attack Findings

IMHO, After reading this news report, they might as well change the middle initial in the name of America's leading intelligence agency...

The Christian Science Monitor reports:

Of course, the Chapman incident also raises questions about the strength of CIA capabilities, even when working on top of a costly military presence. The CIA did not heed Jordanian intelligence warnings about the double agent, Humam Khalil al Balawi, and security measures at Chapman failed.

Yet, no one will be punished for the failures. Speaking to reporters yesterday in Washington, Mr. Panetta said that internal probes found shortcomings “across several agency components,” meaning that “responsibility cannot be assigned to any particular individual or group.”

And, as reported in Wired's Danger Room Blog:

That led some within the CIA to believe Balawi when he said he could get close to Ayman al-Zawahiri, deputy leader of al Qaeda. The Post reports that CIA briefed the White House and U.S. Central Command on the Balawi operation. Panetta’s letter conspicuously does not mention any pressure from the White House that might have contributed to the insufficient vetting, but that’s a possibility nevertheless.

Officials now believe that Balawi was playing the CIA all along, in order to get close enough to kill operatives, as he ultimately did at Forward Operating Base Chapman in Khost, Afghanistan. Panetta’s letter conceded that Balawi had “not rejected his terrorist roots.” Earlier this year, al Qaeda released a martyrdom tape Balawi made bragging about his imminent attack.

Panetta vowed to continue “the most aggressive counterterrorism operations in our history,” an effort that has brought CIA drone strikes in Pakistan to an all-time high. And it’s worth mentioning that a persistent knock on the CIA, from the 9/11 Commission and others, holds it to be unwilling to take risks for national security. Aversion to risk was clearly not a problem in the Balawi case — something for agency critics to think about.

The CIA’s new inspector general, David B. Buckley, will review the Balawi report. Whether he’ll have more to say about what went wrong — or if the Congressional intelligence committees will inquire further — remains to be seen.

Update: Much more from the New York Times and the Washington Post, which report that a CIA officer in Jordan failed to pass along warnings from a Jordanian intelligence operative that Balawi was in fact an al-Qaeda double agent. (And that December 30, 2009, contrary to what I initially wrote, wasn’t the worst single-day loss of CIA life in the agency’s history; it’s the worst since the 1983 bombing of the U.S. embassy in Beirut.)

You can read Panetta's full statement on the Washingtonian's blog. Here's an excerpt:

...The review is now complete, and I would like to thank those who participated. They did our Agency a great service. It was, to be sure, a difficult task—especially since key insights perished with those we lost. Perfect visibility into all that contributed to the attack is therefore impossible. But based on an exhaustive examination of the available information, we have a firm understanding of what our Agency could have done better. In keeping with past practice, we will provide the Khowst report to the Office of Inspector General.

In highly sensitive, complex counterterrorism operations, our officers must often deal with dangerous people in situations involving a high degree of ambiguity and risk. The task force noted that the Khowst assailant fit the description of someone who could offer us access to some of our most vicious enemies. He had already provided information that was independently verified. The decision to meet him at the Khowst base—with the objective of gaining additional intelligence on high priority terrorist targets—was the product of consultations between Headquarters and the field. He had confirmed access within extremist circles, making a covert relationship with him—if he was acting in good faith—potentially very productive. But he had not rejected his terrorist roots. He was, in fact, a brutal murderer.

Mitigating the risk inherent in intelligence operations, especially the most sensitive ones, is essential to success. In this case, the task force determined that the Khowst assailant was not fully vetted and that sufficient security precautions were not taken. These missteps occurred because of shortcomings across several Agency components in areas including communications, documentation, and management oversight. Coupled with a powerful drive to disrupt al-Qa’ida, these factors contributed to the tragedy at Khowst. Each played an important role; none was more important than the others. Based on the findings of the task force and the independent review, responsibility cannot be assigned to any particular individual or group. Rather, it was the intense determination to accomplish the mission that influenced the judgments that were made.

There are no guarantees in the dangerous work of counterterrorism, but the task force identified six key areas that deserve greater focus as we carry out that vital mission. We will:

Enforce greater discipline in communications, ensuring that key guidance, operational facts, and judgments are conveyed and clearly flagged in formal channels.

Strengthen our attention to counterintelligence concerns while maintaining a wartime footing.

Apply the skills and experience of senior officers more effectively in sensitive cases.

Require greater standardization of security procedures.

More carefully manage information sharing with other intelligence services.

Maintain our high operational tempo against terrorist targets, even as we make adjustments to how we conduct our essential mission...

...We’ve now taken a hard look at what happened and what needed to be done after the tragedy at Khowst. While we cannot eliminate all of the risks involved in fighting a war, we can and will do a better job of protecting our officers. Drawing on the work of the task force and its insights, it’s time to move forward. Nothing in the report can relieve the pain of losing our seven fallen colleagues. By putting their lives on the line to pursue our nation’s terrorist enemies, they taught us what bravery is all about. It is that legacy that we will always remember in our hearts.

Leon E. Panetta

Bottom line, as Mark Twain wrote of the official inquiry into the explosion of the steamboat Amaranth in The Gilded Age: "A jury of inquest was impaneled, and after due deliberation and inquiry they returned the inevitable American verdict which has been so familiar to our ears all the days of our lives—'NOBODY TO BLAME.'"

Fox News: Bush Pentagon Hosted Al Qaeda Mastermind

From Fox News (ht Drudge):

According to the documents, obtained as part of an ongoing investigation by the specials unit "Fox News Reporting," there was a push within the Defense Department to reach out to the Muslim community.

"At that period in time, the secretary of the Army (redacted) was eager to have a presentation from a moderate Muslim."

In addition, Awlaki "was considered to be an 'up and coming' member of the Islamic community. After her vetting, Aulaqi (Awlaki) was invited to and attended a luncheon at the Pentagon in the secretary of the Army's Office of Government Counsel."

Awlaki, a Yemeni-American who was born in Las Cruces, N.M., was interviewed at least four times by the FBI in the first week after the attacks because of his ties to the three hijackers Nawaf al-Hazmi, Khalid al-Mihdhar and Hani Hanjour. The three hijackers were all onboard Flight 77 that slammed into the Pentagon.

Awlaki is now believed to be hiding in Yemen after he was linked to the alleged Ft. Hood shooter Major Nidal Malik Hasan, who e-mailed Awlaki prior to the attack.

Sources told Fox News that Awlaki, who is a former Muslim chaplain at George Washington University, met with the Christmas Day bomber Umar Farouk Abdulmutallab in Yemen and was the middle-man between the young Nigerian and the bombmaker. Awlaki was also said to inspire would-be Times Square bomber Faisal Shahzad.

Then-Army Secretary Thomas White had been an Enron executive prior to government service, and according to Wikipedia, resigned amid a corruption controversy:

While serving as Vice Chairman of Enron Energy Services White had actively pursued military contracts for the company and in 1999 had secured a prototype deal at Fort Hamilton for privatising the power supply of army bases.[2] Enron had been the only bidder for this deal after White had controversially used his government and military contacts to secure key concessions.

In his first speech just “two weeks after he became secretary of the Army, White vowed to speed up the awarding of such contracts”;[3] as the Enron Ft. Hamilton contract, despite the fact that he still held a considerable interest in Enron. A Pentagon spokeswoman responded to suggestions of a possible conflict of interests by saying that “Defense Secretary Donald Rumsfeld sees no conflict and has complete confidence in the Army secretary”.

The Washington Post reported that in late October 2001, White made numerous phone calls to Enron executives including Vice President Jude Rolfes, CFO Jeff Skilling and CEO Ken Lay.[4] Shortly after the calls were made, White unloaded 200,000 Enron shares for $12 million. The L.A. Times reported that White had brief conversations with Rumsfeld in November and Powell in December, the focus of which were "a concern on their part for the impact that the bankruptcy of Enron may have had on my personal well-being. My response in both cases was that I had suffered significant personal losses but that I would persevere."

The New York Times reported that in late January 2002, Rep. Henry Waxman requested a meeting with White regarding the military contracts and the irregularities with the accounting at E.E.S. stating “you are in a unique position because you are the person in government who has the most intimate knowledge of Enron”. Furthermore the Washington Post reported that at this time White still held interests in Enron, including a claim on 50,000 stock options and an annuity paid by the company, despite having promised to divest himself at his confirmation hearing 8 months earlier. This earned him a rebuke from Sens. Carl Levin (D-Mich.) and John Warner (R-Va.) of the Senate Armed Services Committee. He was also accused in the Washington Post of Misuse of Government Property, by allegedly using military jets for personal trips for himself and his wife. In July, following news reports of the company’s involvement in the 2000-2001 California electricity crisis, White denied his involvement under oath before the Senate Commerce Committee.

CIA Sues Former Agent Over Book Charging Corruption

From The Washington Times:

Ishmael Jones, pen name for the 20-year CIA veteran and Arabic speaker who said he sought to expose corruption in the agency, is facing a civil lawsuit over his 2008 book, "The Human Factor: Inside the CIA's Dysfunctional Intelligence Culture."

The book is a detailed account of his career inside the CIA's clandestine service and his work as a "nonofficial cover" operative in the Middle East and Europe.

"The book contains no classified information and I do not profit from it," Mr. Jones told The Washington Times. "CIA censors attack this book because it exposes the CIA as a place to get rich, with billions of taxpayer dollars wasted or stolen in espionage programs that produce nothing."

The CIA said in a statement to The Times that the legal action was filed against the former officer for "breaking his secrecy agreement."

Here's the problem in a nutshell: Established U.S. law does not permit secrecy clauses to be used to hide illegal acts. But courts traditionally defer to the CIA. So, if there were corruption at the CIA, no one would be able to root it out through publicity, because Justice Brandeis' best disinfectant could not be used to do so. If the premise holds, then, a culture of complete secrecy must enable corruption--which in turn must endanger US national security.

Conclusion: Current CIA secrecy policy is a threat to US national security.

You can buy the 2008 book from Amazon.com, here:

US Justice Department, Michigan AG Charge Blue Cross With Price-Fixing

From the Detroit Free Press:

Millions of Michigan consumers have paid higher health insurance premiums over the last three years because Blue Cross Blue Shield of Michigan forced at least 70 hospitals statewide to charge its competitors more, according to a lawsuit filed Monday by the U.S. Justice Department and Michigan Attorney General Mike Cox.

The antitrust lawsuit alleges that Blue Cross -- the state's largest insurer -- used its muscle and size to negotiate deep discounts for itself.

The hospitals include Beaumont Hospitals, St. John Providence Health System and Botsford Hospital. The lawsuit alleges that the practice drove up prices for competitors such as Health Alliance Plan, one of the state's biggest health maintenance organizations, and at-large private insurers such as Aetna and Humana.

In some cases, Blue Cross paid hospitals more than what was proposed to close the deal, the Justice Department alleges. If it prevails, other insurers and their customers might get better deals on hospital prices.

In a statement, Blue Cross spokesman Andrew Hetzel said the insurer's negotiated discounts keep costs reasonable for its members. He said the lawsuit was "without merit."

The Justice Department has won five similar cases since 1994 in Ohio, Rhode Island, Oregon, Washington, D.C., and Arizona.

Suit against Blue Cross could have significant repercussions

Blue Cross Blue Shield of Michigan was so eager to crush the competition that it sometimes paid even more than it proposed if a hospital agreed to charge other insurance companies much higher prices, state and federal attorneys charged Monday in a lawsuit filed in Detroit's federal court.

Beaumont Hospitals, a three-hospital system based in Royal Oak, for example, charged Blue Cross competitors at least 25% more than it charged the Blues. The same happened at all of the Detroit-area hospitals in the St. John Providence Health System and more than 65 others around the state.

Michigan insurance industry leaders say the lawsuit could have a major impact on hospital service pricing.

The lawsuit "clearly identifies an issue that appears to have been impeding other carriers to compete," said Rick Murdock, executive director of the Michigan Association of Health Plans, which represents several dozen health plans in the state. "The association always has stood for creating affordable health care policies and a level playing field."

The U.S. Justice Department and Michigan Attorney General Mike Cox allege Blue Cross has been wielding its influence with more than half of the state's hospitals since 2007, when it started offering most-favored nation clauses, which gives preferential treatment to certain hospitals. They are seeking an injunction.

a link to the Michigan Attorney General's charges in PDF format. More in the Wall Street Journal.

NY Times Reporter to Outraged Reader: "F--- you"

From Jihad Watch:

Jihad Watch reader Mike read this post about a New York Times article in which the author, James C. McKinley, Jr., noted that Fort Hood jihadist Nidal Hasan shouted "Allahu akbar" before he started on his mass-murder spree, and then said, "Yet the gunman and his motive remain an enigma."

McKinley did mention the "Allahu akbar," but McKinley ignored the mountain of evidence indicating that Hasan was a jihadist, including Hasan's own PowerPoint presentation delineating Islam's theology of jihad and warning that Muslims should be allowed to opt out of the U.S. military because adverse consequences could ensue if they were made to fight fellow Muslims, and the fact that he passed out Qur'ans on the morning of his mass murders. So Mike wrote this to McKinley at the Times:

J, "The gunman and his motive remain an enigma."
I'm not sure I've ever seen a better example of cultural rot than this sentence.

We live in a bizarre age when not only to traitors and jihadis get full rights of American citizens, but more bizarrely people like you continue to turn yourself into a human pretzel to avoid connecting the religion of Islam to the violence it inspired in Hasan's own words and deeds.

You're just another ass hat working at a newspaper gainfully employed to keep people confused.

Harsh? Maybe. But right. And in a magnificent example of the media elite's contempt for the people it continues to try to fool, McKinley responded with this:

Fuck you.

BTW, I didn't see this response covered in the NY Times Company's online handbook from 2004, Ethical Journalism: A Handbook of Values and Practices for the News and Editorial Departments.

The Social Network

Saw The Social Network the other day with someone I know. It was enjoyable and unsettling at the same time.

A friend from film school said the film is the Faust story version 2.0. Sean Parker, played by Justin Timberlake, is the Devil, tempting Mark Zuckerberg, played by Jesse Eisenberg, to betray his friends and partners in exchange for wealth, women, and power. He added that it was also about exclusion, and that Zuckerberg is motivated to betray the socially prominent twins who keep him in the bike room of the Porcellian Club and hand him a plastic-wrapped sandwich. Unable to enter the exclusive precincts of the elite, Zuckberger determines to set up his own business with his equally outsider friend, a Brazilian business student named Eduardo Savarin.

It also seems rather like What Makes Sammy Run? version 2.0 (or 1.0 for a movie, since Schulberg's book and play version never made it onto the big screen). That tale of a Jewish screenwriter who backstabbed his way to the top was among the iconic works of 40s and 50s angst and alienation literature. Zuckerberg's sociopathic interpersonal behavior recalls Sammy Glick's.

Perhaps one of the more interesting aspects of Aaron Sorkin's screenplay is the title: THE SOCIAL NETWORK. What does it mean, excactly? Is the network, Facebook--or, as I suspect, the network of exclusive social clubs at Harvard, to which Zuckerberg aspires to be admitted? Interestingly, the only traditional social networking event Zuckerberg attends in the film is at the Jewish fraternity. Despite founding Facebook, he remains unclubbed at the end--even his former friend and partner Eduardo Savarin is hazed by the Phoenix club. Money can't buy you love, and apparently, can't buy you social acceptance, either (as the first scene with his Boston University girlfriend, Ms. Albright, foreshadows, and in a "completion and return" underscores with a final screen shot).

My favorite scene is where the Winklevoss twins go to Harvard president Larry Summers for help, pointing out that Zuckerberg has broken "Harvard law." Summers remains unmoved and unhelpful--merely suggesting that they invent something else...to me, this scene is revelatory of what went wrong with Summers at Harvard--and reminded this viewer of his White House failures in the Obama administration. Not only is Summers depicted as not smart; he's not sensitive, not responsible, and not admirable.

I personally enjoyed how many scenes took place in noisy nightclubs and loud restaurants. Somehow, it captured the emptiness and vulgarity of life before the financial collapse. Looking backwards, hindsight is 20/20.

And then there's the Wizard of Oz angle, perhaps it is all smoke and mirrors, with Ms. Albrecht as Dorothy and Mr. Parker as the Wicked Witch of the West. Of course, it could be noted the film uses the Rashomon-like structure of Citizen Kane to portray Zuckerberg in flashback from a variety of viewpoints. Fun for film students to see the various homages to earlier classics, no doubt.

In any case, I enjoyed the picture. It is a period piece, a depiction of life before bail-outs, only yesterday. Five stars.