Slipstream: Biometric Data-Gathering Sets Off a Privacy Debate





“PLEASE put your hand on the scanner,” a receptionist at a doctor’s office at New York University Langone Medical Center said to me recently, pointing to a small plastic device on the counter between us. “I need to take a palm scan for your file.”




I balked.


As a reporter who has been covering the growing business of data collection, I know the potential drawbacks — like customer profiling — of giving out my personal details. But the idea of submitting to an infrared scan at a medical center that would take a copy of the unique vein patterns in my palm seemed fraught.


The receptionist said it was for my own good. The medical center, she said, had recently instituted a biometric patient identification system to protect against identity theft.


I reluctantly stuck my hand on the machine. If I demurred, I thought, perhaps I’d be denied medical care.


Next, the receptionist said she needed to take my photo. After the palm scan, that seemed like data-collection overkill. Then an office manager appeared and explained that the scans and pictures were optional. Alas, my palm was already in the system.


No longer the province of security services and science-fiction films, biometric technology is on the march. Facebook uses facial-recognition software so its members can automatically put name tags on friends when they upload their photos. Apple uses voice recognition to power Siri. Some theme parks take digital fingerprints to help recognize season pass holders. Now some hospitals and school districts are using palm vein pattern recognition to identify and efficiently manage their patients or students — in effect, turning your palm into an E-ZPass.


But consumer advocates say that enterprises are increasingly employing biometric data to improve convenience — and that members of the public are paying for that convenience with their privacy.


Fingerprints, facial dimensions and vein patterns are unique, consumer advocates say, and should be treated as carefully as genetic samples. So collecting such information for expediency, they say, could increase the risks of serious identity theft. Yet companies and institutions that compile such data often fail to adequately explain the risks to consumers, they say.


“Let’s say someone makes a fake ID and goes in and has their photo and their palm print taken as you. What are you going to do when you go in?” said Pam Dixon, the executive director of the World Privacy Forum, an advocacy group in San Diego. “Hospitals that are doing this are leaping over profound security issues that they are actually introducing into their systems.”


THE N.Y.U. medical center started researching biometric systems a few years ago in an effort to address several problems, said Kathryn McClellan, its vice president who is in charge of implementing its new electronic health records system. More than a million people in the New York area have the same or similar names, she said, creating a risk that medical personnel might pull up the wrong health record for a patient. Another issue, she said, was that some patients had multiple records from being treated at different affiliates; N.Y.U. wanted an efficient way to consolidate them.


Last year, the medical center adopted photography and palm-scan technology so that each patient would have two unique identifying features. Now, Ms. McClellan said, each arriving patient has his or her palm scanned, allowing the system to automatically pull up the correct file.


“It’s a patient safety initiative,” Ms. McClellan said. “We felt like the value to the patient was huge.”


N.Y.U.’s system, called PatientSecure and marketed by HT Systems of Tampa, has already scanned more than 250,000 patients. In the United States, over five million patients have had the scans, said Charles Yanak, a spokesman for Fujitsu Frontech North America, a division of Fujitsu, the Japanese company that developed the vein palm identification technology.


Yet, unless patients at N.Y.U. seem uncomfortable with the process, Ms. McClellan said, medical registration staff members don’t inform them that they can opt out of photos and scans.


“We don’t have formal consent,” Ms. McClellan said in a phone interview last Tuesday.


That raises red flags for privacy advocates. “If they are not informing patients it is optional,” said Joel Reidenberg, a professor at Fordham University Law School with an expertise in data privacy, “then effectively it is coerced consent.”


He noted that N.Y.U. medical center has had recent incidents in which computers or USB drives containing unencrypted patient data have been lost or stolen, suggesting that the center’s collection of biometric data might increase patients’ risk of identity theft.


Ms. McClellan responded that there was little chance of identity theft because the palm scan system turned the vein measurements into encrypted strings of binary numbers and stored them on an N.Y.U. server that is separate from the one with patients’ health records. Even if there were a breach, she added, the data would be useless to hackers because a unique key is needed to decode the number strings. As for patients’ photos, she said, they are attached to their medical records.


Still, Arthur Caplan, the director of the division of medical ethics at the N.Y.U. center, recommended that hospitals do a better job of explaining biometric ID systems to patients. He himself recently had an appointment at the N.Y.U. center, he recounted, and didn’t learn that the palm scan was optional until he hesitated and asked questions.


“It gave me pause,” Dr. Caplan said. “It would be useful to put up a sign saying ‘We are going to take biometric information which will help us track you through the system. If you don’t want to do this, please see’ ” an office manager.


Other institutions that use PatientSecure, however, have instituted opt-in programs for patients.


At the Duke University Health System, patients receive brochures explaining their options, said Eliana Owens, the health system’s director of patient revenue. The center also trains staff members at registration desks to read patients a script about the opt-in process for the palm scans, she said. (Duke does not take patients’ photos.)


“They say: ‘The enrollment is optional. If you choose not to participate, we will continue to ask you for your photo ID on subsequent visits,’ ” Ms. Owens said.


Consent or not, some leading identity experts see little value in palm scans for patients right now. If medical centers are going to use patients’ biometric data for their own institutional convenience, they argue, the centers should also enhance patient privacy — by, say, permitting lower-echelon medical personnel to look at a person’s medical record only if that patient is present and approves access by having a palm scanned.


Otherwise, “you are enabling another level of danger,” said Joseph Atick, a pioneer in biometric identity systems who consults for governments, “instead of using the technology to enable another level of privacy.”


At my request, N.Y.U. medical center has deleted my palm print.


E-mail: slipstream@nytimes.com.



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Bits Blog: Apple Settles Patent Suit With HTC

Apple and HTC have brought an end to their lawsuits against each other in the first settlement between Apple and a maker of Android smartphones.

In a statement issued Saturday night, the two companies said the settlement includes the dismissal of all current lawsuits and sets up a 10-year license agreement that includes rights to current and future patents held by both parties. Apple and HTC, which is based in Taiwan, said the terms of the deal were confidential.

“We are glad to have reached a settlement with HTC,” Timothy D. Cook, the chief executive of Apple, said in a statement. “We will continue to stay laser-focused on product innovation.”

“HTC is pleased to have resolved its dispute with Apple, so HTC can focus on innovation instead of litigation,” Peter Chou, HTC’s chief executive, said in a statement.

Apple’s battle with HTC had a much lower profile than its legal fight with Samsung, a more significant rival in the smartphone market and the biggest maker of handsets based on Google’s Android operating system. In August, a jury awarded Apple more than $1 billion in damages in its lawsuit with Samsung, though Samsung is challenging the ruling.

The HTC suit, however, was the first one Apple filed against an Android phone maker and a harbinger of future Apple legal challenges aimed at the software. Apple filed patent infringement suits against HTC in March 2010 in federal court in Delaware and before the International Trade Commission.

The suit was the start of what is widely viewed as a proxy war between Apple and Google, the creator of the Android operating system. The week Apple filed the suit against HTC, Steven P. Jobs — then Apple’s chief executive, who died late last year — erupted in fury over Android, in a scene depicted in Walter Isaacson’s biography of him.

“I’m going to destroy Android, because it’s a stolen product,” Mr. Jobs said, according to the book.

Apple sued Samsung in 2011. Another Android maker, Motorola Mobility, sued Apple in late 2010, and Apple subsequently countersued. Google now owns Motorola.

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Changing of the Guard: Chinese Communist Party Faces Calls for Democracy





BEIJING — As the Communist Party’s 18th Congress approached, Li Weidong, a scholar of politics, made plans to observe a historic leadership battle in one of the world’s great nations.




Instead of staying in Beijing to monitor China’s once-a-decade transfer of power, Mr. Li boarded a plane.


“I’m going to the United States to study the elections,” Mr. Li said in a telephone interview during a stopover in Paris. After witnessing the American presidential election on Tuesday, Mr. Li went on the radio for another interview. “I still think China’s politics remain prehistoric,” he said. “I often joke that the Chinese civilization is the last prehistoric civilization left in the world.”


With China at a critical juncture, there is a rising chorus within the elite expressing doubt that the 91-year-old Communist Party’s authoritarian system can deal with the stresses bearing down on the nation and its 1.3 billion people. Policies introduced after 1978 by Deng Xiaoping lifted hundreds of millions out of poverty and transformed the country into the world’s second-largest economy. But the way party leaders have managed decades of growth has created towering problems that critics say can no longer be avoided.


Many of those critics have benefited from China’s stunning economic gains, and their ranks include billionaires, intellectuals and children of the party’s revolutionary founders. But they say the party’s agenda, as it stands today, is not visionary enough to set China on the path to stability. What is needed, they say, is a comprehensive strategy to gradually extricate the Communist Party, which has more than 80 million members, from its heavy-handed control of the economy, the courts, the news media, the military, educational institutions, civic life and just the plain day-to-day affairs of citizens.


Only then, the critics argue, can the government start to address the array of issues facing China, including rampant corruption, environmental degradation, and an aging population whose demographics have been skewed because of the one-child policy.


“In order to build a real market economy, we have to have real political reform,” said Yang Jisheng, a veteran journalist and a leading historian of the Mao era. “In the next years, we should have a constitutional democracy plus a market economy.”


For now, however, party leaders have given no indication that they intend to curb their role in government in a meaningful way.


“We will never copy a Western political system,” Hu Jintao, the departing party chief, said in a speech on Thursday opening the weeklong congress.


The party’s public agenda, which Mr. Hu described in detail in his 100-minute address, was laid out in a 64-page report that is in part intended to highlight priorities for the new leaders, who will be announced later this month. Much of the document had retrograde language that emphasized ideology stretching back to Mao and had little in the way of bold or creative thinking, said Qian Gang, the director of the China Media Project at the University of Hong Kong.


Most telling, there was no language signaling that the incoming Politburo Standing Committee, the group that rules China by consensus, would support major changes in the political system, whose perversions many now say are driving the nation toward crisis.


While Chinese who are critical of the current system generally do not expect a wholesale adoption of a Western model, they do favor at least an openness to bolder experimentation.


“To break one-party rule right now is probably not realistic, but we can have factions within the party made public and legalized, so they can campaign against each other,” said Mr. Yang, who added that there was no other way at the moment to ensure political accountability.


Only in the last few years has the idea of liberalizing the political system gained currency, and urgency, among a broad cross-section of elites. Before that, as the West foundered at the onset of the global financial crisis, many here pointed to the triumph of a “China model” or “Beijing consensus” — a mix of authoritarian politics, a command economy and quasi-market policies.


But the way in which China weathered the crisis — with the injection of $588 billion of stimulus money into the economy and an explosion of lending from state banks — led to a spate of large infrastructure projects that may never justify their cost. As a result, many economists now say that China’s investment-driven, export-oriented economic model is unsustainable and needs to shift toward greater reliance on Chinese consumers.


Constant lip-service is paid to that goal, and on Saturday, Zhang Ping, a senior official, reiterated that stance. But it will not be easy for the new leaders to carry it out. At the root of the current economic model is the political system, in which party officials and state-owned enterprises work closely together, reaping enormous profits from the party’s control of the economy. Under Mr. Hu’s decade-long tenure, these relationships and the dominance of state enterprises have only strengthened.


“What happens in this kind of economy is that wealth concentrates where power is,” said Mr. Yang, the journalist.


The 400 or so incoming members of the party’s Central Committee, Politburo and Politburo Standing Committee, as well as their friends and families, have close ties to the most powerful of China’s 145,000 state-owned enterprises. The growing presence of princelings — the children of notable Communist officials — in the party, the government and corporations could mean an even more closely meshed web of nepotism. It is a system that Xi Jinping, anointed to be the next party chief and president and himself a member of the “red nobility,” would find hard to unravel, even if he wanted to.


Mia Li contributed research.



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Malaria Vaccine Candidate Produces Disappointing Results in Clinical Trial


The latest clinical trial of the world’s leading malaria vaccine candidate produced disappointing results on Friday. The infants it was given to had only about a third fewer infections than a control group.


But researchers said they wanted to press on, assuming they keep getting financial support, because the number of children who die of malaria is so great that even an inefficient vaccine can save thousands of lives.


Three shots of the vaccine, known as RTS, S or Mosquirix and produced by GlaxoSmithKline, gave babies fewer than 12 weeks old 31 percent protection against detectable malaria and 37 percent protection against severe malaria, according to an announcement by the company at a vaccines conference in Cape Town.


Last year, in a trial in children up to 17 months old, the same vaccine gave 55 percent protection against detectable malaria and 47 percent against severe malaria.


The new trial “is less than we’d hoped for,” Moncef Slaoui, chairman of research and development at Glaxo, said in a telephone interview. “But if a million babies were vaccinated, we would prevent 260,000 cases of malaria a year. This is a disease that kills 655,000 babies a year — 31 percent of that is a very large number.”


The company, which has already spent more than $300 million on the vaccine, wants to keep forging ahead, Mr. Slaoui said, “but it is not just our decision.”


It also depends on the PATH Malaria Vaccine Initiative, which has put more than $200 million of its Bill and Melinda Gates Foundation financing into the vaccine, and on the World Health Organization, which has helped talk seven African countries into allowing the vaccine to be tested on their children.


The Gates Foundation declined to say how much money it was ultimately prepared to spend on an imperfect vaccine; this set of trials is set to go into 2014.


“The efficacy came back lower than we had hoped, but developing a vaccine against a parasite is a very hard thing to do,” Bill Gates said in a prepared statement. “The trial is continuing, and we look forward to getting more data to help determine whether and how to deploy this vaccine.”


All the families in the trial were given insecticide-treated mosquito nets and encouraged to use them; 86 percent did, so the vaccine’s results were achieved on top of other anti-malaria measures.


RTS, S contains a protein found on the parasite’s surface that provokes an immune reaction. It was first identified decades ago by two New York University scientists, Ruth and Victor Nussenzweig. The vaccine was developed by Glaxo in Belgium and initially tested on American volunteers by the Walter Reed Army Institute of Research.


When the Gates Foundation began focusing on global health in the early part of this century, it was one of the first projects the foundation adopted. Different ways to make the vaccine more effective, including adding different boosters and giving more shots, are being experimented with. Other vaccines using different ways to provoke an immune reaction exist, but none are as far along in clinical trials.


Like an H.I.V. vaccine, one against malaria has proved an elusive goal. The parasite morphs several times, exhibiting different surface proteins as it goes from mosquito saliva into blood and then into and out of the liver. Also, even the best natural “vaccine” — catching the disease itself — is not very effective. While one bout of measles immunizes a child for life, it usually takes several bouts of malaria to confer even partial immunity. Pregnancy can cause women to stop being immune, and immunity can fade out if someone moves away from a malarial area — presumably because they no longer get “boosters” from repeated mosquito bites.


Read More..

Malaria Vaccine Candidate Produces Disappointing Results in Clinical Trial


The latest clinical trial of the world’s leading malaria vaccine candidate produced disappointing results on Friday. The infants it was given to had only about a third fewer infections than a control group.


But researchers said they wanted to press on, assuming they keep getting financial support, because the number of children who die of malaria is so great that even an inefficient vaccine can save thousands of lives.


Three shots of the vaccine, known as RTS, S or Mosquirix and produced by GlaxoSmithKline, gave babies fewer than 12 weeks old 31 percent protection against detectable malaria and 37 percent protection against severe malaria, according to an announcement by the company at a vaccines conference in Cape Town.


Last year, in a trial in children up to 17 months old, the same vaccine gave 55 percent protection against detectable malaria and 47 percent against severe malaria.


The new trial “is less than we’d hoped for,” Moncef Slaoui, chairman of research and development at Glaxo, said in a telephone interview. “But if a million babies were vaccinated, we would prevent 260,000 cases of malaria a year. This is a disease that kills 655,000 babies a year — 31 percent of that is a very large number.”


The company, which has already spent more than $300 million on the vaccine, wants to keep forging ahead, Mr. Slaoui said, “but it is not just our decision.”


It also depends on the PATH Malaria Vaccine Initiative, which has put more than $200 million of its Bill and Melinda Gates Foundation financing into the vaccine, and on the World Health Organization, which has helped talk seven African countries into allowing the vaccine to be tested on their children.


The Gates Foundation declined to say how much money it was ultimately prepared to spend on an imperfect vaccine; this set of trials is set to go into 2014.


“The efficacy came back lower than we had hoped, but developing a vaccine against a parasite is a very hard thing to do,” Bill Gates said in a prepared statement. “The trial is continuing, and we look forward to getting more data to help determine whether and how to deploy this vaccine.”


All the families in the trial were given insecticide-treated mosquito nets and encouraged to use them; 86 percent did, so the vaccine’s results were achieved on top of other anti-malaria measures.


RTS, S contains a protein found on the parasite’s surface that provokes an immune reaction. It was first identified decades ago by two New York University scientists, Ruth and Victor Nussenzweig. The vaccine was developed by Glaxo in Belgium and initially tested on American volunteers by the Walter Reed Army Institute of Research.


When the Gates Foundation began focusing on global health in the early part of this century, it was one of the first projects the foundation adopted. Different ways to make the vaccine more effective, including adding different boosters and giving more shots, are being experimented with. Other vaccines using different ways to provoke an immune reaction exist, but none are as far along in clinical trials.


Like an H.I.V. vaccine, one against malaria has proved an elusive goal. The parasite morphs several times, exhibiting different surface proteins as it goes from mosquito saliva into blood and then into and out of the liver. Also, even the best natural “vaccine” — catching the disease itself — is not very effective. While one bout of measles immunizes a child for life, it usually takes several bouts of malaria to confer even partial immunity. Pregnancy can cause women to stop being immune, and immunity can fade out if someone moves away from a malarial area — presumably because they no longer get “boosters” from repeated mosquito bites.


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Bits Blog: On Twitter, Steve Jobs Is Immortal

Steve Jobs is gone, but on Twitter his @name lives on. And on.

The chief executive of Apple, who died in 2011, is memorialized on Twitter by about a thousand fans, parodists, traffic seekers, unrepentant haters and crypto-historians, among others. The accounts use his name as either as a title or, with many variations, as an address.

The copycats include @FakeSteveJobs, @FauxSteve and @SteveJobsFalso, a collection of admitted imposters who are following in the footsteps of a parody Web site that was active from 2006 to 2011. Other versions include @RememberSteve, @PulseonJobs and @RealSteveJobs. There are a couple of @BlackSteveJobs, plus Twitter accounts by various articles of clothing and body parts.

Several of the accounts are operated by start-ups hoping to generate attention for themselves. Their tweets contain links to corporate Web pages. Some of the accounts are in languages like Arabic, Thai or Japanese. Many others use Mr. Jobs’s name for the account but have a different address.

Searching the name “Steve Jobs” on Twitter yields about 1,080 accounts, some of which are unrelated to the Apple co-founder; there are people on Twitter who are really named Steve Jobs.

Twitter does not keep score of how many of its 140 million accounts are fakes, but it generally supports the idea of parody accounts. “It’s very helpful for political dissidents, who can’t write under their own name,” said Rachael Horwitz, a company spokeswoman. She also noted that Dick Costolo, Twitter’s chief executive, has a parody account. Jack Dorsey, the chairman of the company’s board, is likewise roasted.

Possibly for his close identification with technology, Mr. Jobs does appear to be the most popular identity on Twitter to leverage. President Obama has about 600 versions of his name, either through the “@” address, or in the name of the account. Given much of the venom of the recent election, several of these accounts are remarkably ugly, certainly worse than the treatment afforded Mr. Jobs. Michelle Obama, who like the president has an official and verified Twitter account, has about 500 copycats.

Bill Gates, Mr. Jobs’s longtime nemesis and eventual frenemey, does better than the president and first lady, with about 840 imitators and parodists. There is also a Klingon version of him, which to date Mr. Jobs’s name does not appear to share. There also appear to be a lot more people on Twitter who are simply named “Bill Gates,” a characteristic that must fill their lives with a lot of predictable humor.

Justin Beiber gets a mere 240 people hoping for a bit of his lustre. John Lennon, Mr. Jobs’ idol, has fewer than 100.

Twitter will take down parody accounts, but usually when it is not clear that they are parodies. That is not a problem in the case of most public figures. “It’s a form of speech,” Ms. Horwitz said. On the Internet, everyone needs a thicker skin. The situation does come up enough that the company has published formal policies on acceptable parody and fan accounts , along with impersonation.

There are parody accounts for Oracle’s chief executive, Larry Ellison; for Larry Page, the chief executive and co-founder of Google; and for Mark Zuckerberg, the chief of Facebook. With so many parody accounts around, some technology chief executives may worry if they are not being parodied.

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Citing Affair, Petraeus Resigns as C.I.A. Director





WASHINGTON — David H. Petraeus, the director of the Central Intelligence Agency and one of America’s most decorated four-star generals, resigned on Friday after an F.B.I. investigation uncovered evidence that he had been involved in an extramarital affair.




Mr. Petraeus issued a statement acknowledging the affair after President Obama accepted his resignation and it was announced by the C.I.A. The disclosure ended a triumphant re-election week for the president with an unfolding scandal.


Government officials said that the F.B.I. began an investigation into a “potential criminal matter” several months ago that was not focused on Mr. Petraeus. In the course of their inquiry into whether a computer used by Mr. Petraeus had been compromised, agents discovered evidence of the relationship as well as other security concerns. About two weeks ago, F.B.I. agents met with Mr. Petraeus to discuss the investigation.


Administration and Congressional officials identified the woman as Paula Broadwell, the co-author of a biography of Mr. Petraeus. Her book, “All In: The Education of General David Petraeus,” was published this year. Ms. Broadwell could not be reached for comment.


Ms. Broadwell, a graduate of the United States Military Academy at West Point, spent 15 years in the military, according to a biography that had appeared on her Web site. She spent extended periods of time with Mr. Petraeus in Afghanistan, interviewing him for her book, which grew out of a two-year research project for her doctoral dissertation and which she promoted on a high-profile tour that included an appearance on “The Daily Show With Jon Stewart.”


Married with two children, she has described Mr. Petraeus as her mentor.


Senior members of Congress were alerted to Mr. Petraeus’s impending resignation by intelligence officials about six hours before the C.I.A. announced it. One Congressional official who was briefed on the matter said that Mr. Petraeus had been encouraged “to get out in front of the issue” and resign, and that he agreed.


As for how the affair came to light, the Congressional official said that “it was portrayed to us that the F.B.I. was investigating something else and came upon him. My impression is that the F.B.I. stumbled across this.”


The Federal Bureau of Investigation did not inform the Senate and House Intelligence Committees about the inquiry until this week, according to Congressional officials, who noted that by law the panels — and especially their chairmen and ranking members — are supposed to be told about significant developments in the intelligence arena. The Senate committee plans to pursue the question of why it was not told, one official said.


The revelation of a secret inquiry into the head of the nation’s premier spy agency raised urgent questions about Mr. Petraeus’s 14-month tenure at the C.I.A. and the decision by Mr. Obama to elevate him to head the agency after leading the country’s war effort in Afghanistan. White House officials said they did not know about the affair until this week, when Mr. Petraeus informed them.


“After being married for over 37 years, I showed extremely poor judgment by engaging in an extramarital affair,” Mr. Petraeus said in his statement, expressing regret for his abrupt departure. “Such behavior is unacceptable, both as a husband and as the leader of an organization such as ours. This afternoon, the president graciously accepted my resignation.”


Mr. Petraeus’s admission and resignation represent a remarkable fall from grace for one of the most prominent figures in America’s modern military and intelligence community, a commander who helped lead the nation’s wartime activities in the decade after the Sept. 11 attacks and was credited with turning around the failing war effort in Iraq.


Mr. Petraeus almost single-handedly forced a profound evolution in the country’s military thinking and doctrine with his philosophy of counterinsurgency, focused more on protecting the civilian population than on killing enemies. More than most of his flag officer peers, he understood how to navigate Washington politics and news media, helping him rise through the ranks and obtain resources he needed, although fellow Army leaders often resented what they saw as a grasping careerism.


 Reporting was contributed by Peter Baker, Helene Cooper, Michael S. Schmidt, Eric Schmitt and Scott Shane.



This article has been revised to reflect the following correction:

Correction: November 9, 2012

An earlier version of this article incorrectly stated that David H. Petraeus was expected to remain in President Obama’s cabinet. The C.I.A. director is not a cabinet member in the Obama administration.



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Debt Ceiling Complicates a Tax Shift





WASHINGTON — Come January, should Congress fail to act, the United States will face more than immense tax increases and spending cuts. It will also run out of room to finance its large running deficits.




The Treasury Department expects the country to hit its debt ceiling, a legal limit on the amount the government is allowed to borrow, close to the end of the year. That would give Congress only a matter of weeks to raise the ceiling, now about $16.4 trillion, before sending financial markets into a panic.


Congressional leaders have made clear that the debt ceiling will be part of the intense negotiations over the so-called fiscal cliff, with many members unwilling to raise the ceiling without a broader deal. That has raised financial analysts’ worries of a financial market panic over the ceiling in addition to the slow bleed of the tax increases and spending cuts.


Congressional action is required to raise the debt limit. The Treasury can jostle payments for a few months. But expenses will eventually overwhelm revenue, putting the administration in the position of choosing which bills to pay. It might stop paying soldiers, for instance, or sending Social Security payments.


In 2011, Congressional Republicans would not raise the debt ceiling without a broader agreement to cut the country’s deficit and set it on a better fiscal path. The impasse over finding spending cuts and tax increases to do that led to the creation of the spending cuts on Jan. 1, the same time the Bush-era tax cuts were set to expire.


The threat that the country might not pay all its bills caused a slump in financial markets and led in August 2011 to the first downgrade of the nation’s credit rating. It left broader economic scars, too. Many economists contend it hurt economic growth and jobs.


A July report by the Government Accountability Office found that the delay in raising the debt limit increased the country’s borrowing costs by about $1.3 billion in the 2011 fiscal year. “However, this does not account for the multiyear effects on increased costs for Treasury securities that will remain outstanding after fiscal year 2011,” the report noted, adding that the debt-limit fight diverted Treasury’s time and resources from other priorities.


This year, Congress will have time to negotiate a broader debt deal before needing to raise the ceiling, even if negotiations spill into January. But the ceiling will be a card in the complex political game that the White House, Senate Democrats and Congressional Republicans are playing.


Much as Democrats see President Obama’s veto threat over an extension of the Bush-era tax cuts for the highest earners as leverage over Republicans, some Republicans see the need to raise the debt ceiling as leverage over the White House, Republican aides said.


Even if the stakes do not get that high, both parties view lifting the debt ceiling as part of the fiscal-cliff negotiations, and they do not expect Congress to raise it outside of a broader deal.


“Resolving the issues surrounding the fiscal cliff, especially the replacement of the sequester, and the next debt limit increase (likely necessary in February) will require that the president get serious about real entitlement reform,” Representative Eric Cantor of Virginia, the House majority leader, said in a letter to conservatives this week, as printed on The Hill Web site.


That has Democrats warning Republicans not to risk the country’s credit rating and broader financial stability again.


“They tried it before: ‘We’re going to shut down the government. We’re not going to raise the debt limit,’ ” Senator Harry Reid of Nevada, the majority leader, told reporters this week. “They want to go through that again? Fine, but we’re not going to be held subject to something that was done as a matter of fact in all previous administrations.”


Economists have warned that the political posturing over the debt ceiling has enormously dangerous economic consequences — even more so than last year, given the threat of huge tax increases and spending cuts hitting households at the same time.


On Wall Street, analysts have tended to use terms like “apocalypse” and “global catastrophe” to describe what might happen should Congress not lift the ceiling.


This week, Fitch, the credit rating agency, threatened a downgrade to the nation’s credit rating if Congress cannot find a timely resolution.


“Failure to reach even a temporary arrangement to prevent the full range of tax increases and spending cuts implied by the fiscal cliff and a repeat of the August 2011 debt ceiling episode would mean that the general election had not resolved the political gridlock in Washington and likely result in a sovereign rating downgrade by Fitch,” analysts at the agency said in a statement on Wednesday.


HSBC analysts this week warned clients of “echoes of 2011” in the uncertainty and market volatility the ceiling might cause.


And economists at the International Monetary Fund cautioned that the unstable situation in the United States might have international ripple effects.


“For now, a lack of political agreement keeps uncertainty about the fiscal road map unresolved,” the fund said in a global risk assessment. “Although bond yields remain low, when contentious political decisions — such as raising the debt ceiling — have come due in the past, uncertainty about the outcome led to unfavorable market reactions.”


But other analysts said they would be surprised if the debate over the ceiling became the debacle it did last year. Many Congressional aides said neither side had any interest in causing market panic for political gain.


“Markets are now starting to become the disciplinarians,” said Diane Swonk, chief economist at Mesirow Financial in Chicago. “C.E.O.’s are finally stepping up to the plate and saying, ‘Excuse me, we can’t do this.’ And that puts political donations and jobs on the line.”


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States Rush to Meet Tight Health Care Deadlines





After nearly three years of legal and political threats that kept President Obama’s health care law in a constant state of uncertainty, his re-election on Tuesday all but guarantees that the historic legislation will survive.




Now comes another big hurdle: making it work.


The election came just 10 days before a critical deadline for states in carrying out the law, and many that were waiting for the outcome must now hustle to comply. Such efforts will coincide with epic negotiations between Mr. Obama and Congress over federal spending and taxes, where the administration will inevitably face pressure to scale back some of the costliest provisions of the law.


Mr. Obama faces crucial choices about strategy that could determine the success of the health care overhaul: Will the administration, for example, try to address the concerns of insurers, employers and some consumer groups who worry that the law’s requirements could increase premiums? Or will it insist on the stringent standards favored by liberal policy advocates inside and outside the government?


But for now — with Democrats retaining control of the Senate and Mitt Romney’s vow to “repeal and replace” the law no longer a threat — supporters are exulting.


“For our district and for our country, the debate on Obamacare is over,” declared Bill Foster, a Democrat elected Tuesday to the House from a suburban Chicago district.


Many supporters feel one of Mr. Obama’s most important tasks will be to step up efforts to promote and explain the law to a public that remains sharply divided and confused about it. In exit polls on Tuesday, nearly half of voters said the law should be either partly or fully repealed.


“There is still a tremendous amount of disinformation out there,” said Jeff Goldsmith, a health industry analyst based in Virginia. “If you actually are going to implement this law, people need to know what’s in it — not just the puppies-and-ice-cream parts, but ‘Here are the broader social changes intended and how they can help you.’ ”


Already, advocacy groups eager for the law to succeed have shifted into a higher gear. One such group, Families USA, held a conference call on Thursday with about 300 advocates around the country to strategize about next steps, said Ronald F. Pollack, the group’s executive director. Enroll America, a sister organization, will hold focus groups next week in Ohio, Pennsylvania and Texas to collect ideas for a public education campaign.


Much depends on the states as they decide in the coming weeks and months whether to build online marketplaces known as insurance exchanges, where individuals and small businesses can shop for health plans, and whether to expand their Medicaid programs to reach many more low-income people.


The clock is ticking on the exchange question in particular: states have until next Friday to decide whether they will build their own exchange or let the federal government run one for them. Some states have asked the administration for more time.


So far, only about 15 states and the District of Columbia have created the framework for exchanges through legislation or executive orders; three others have committed to running exchanges in partnership with the federal government. A number of Republican governors, including those in Arizona, Idaho, New Jersey, Virginia and Tennessee, had said they would decide after the election, giving themselves only a 10-day window before the deadline.


“I would expect that starting today there are a significant number of fascinating conversations going on behind closed doors in state capitols all over America,” said John McDonough, a professor of public health at Harvard who helped draft the law.


With deficit-reduction talks beginning in Washington next week, some observers believe that the law’s most expensive provisions — like federal subsidies to help families with incomes up to 400 percent of the poverty level pay their insurance premiums — could be scaled back in the name of deficit reduction.


“We know folks on the Hill are talking about this already,” said David Smith, an analyst at Leavitt Partners, a consulting firm that advises states on the law. “There are a lot of competing factors, but they have to find the savings and we believe health care will be one of the places where they will go.”


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States Rush to Meet Tight Health Care Deadlines





After nearly three years of legal and political threats that kept President Obama’s health care law in a constant state of uncertainty, his re-election on Tuesday all but guarantees that the historic legislation will survive.




Now comes another big hurdle: making it work.


The election came just 10 days before a critical deadline for states in carrying out the law, and many that were waiting for the outcome must now hustle to comply. Such efforts will coincide with epic negotiations between Mr. Obama and Congress over federal spending and taxes, where the administration will inevitably face pressure to scale back some of the costliest provisions of the law.


Mr. Obama faces crucial choices about strategy that could determine the success of the health care overhaul: Will the administration, for example, try to address the concerns of insurers, employers and some consumer groups who worry that the law’s requirements could increase premiums? Or will it insist on the stringent standards favored by liberal policy advocates inside and outside the government?


But for now — with Democrats retaining control of the Senate and Mitt Romney’s vow to “repeal and replace” the law no longer a threat — supporters are exulting.


“For our district and for our country, the debate on Obamacare is over,” declared Bill Foster, a Democrat elected Tuesday to the House from a suburban Chicago district.


Many supporters feel one of Mr. Obama’s most important tasks will be to step up efforts to promote and explain the law to a public that remains sharply divided and confused about it. In exit polls on Tuesday, nearly half of voters said the law should be either partly or fully repealed.


“There is still a tremendous amount of disinformation out there,” said Jeff Goldsmith, a health industry analyst based in Virginia. “If you actually are going to implement this law, people need to know what’s in it — not just the puppies-and-ice-cream parts, but ‘Here are the broader social changes intended and how they can help you.’ ”


Already, advocacy groups eager for the law to succeed have shifted into a higher gear. One such group, Families USA, held a conference call on Thursday with about 300 advocates around the country to strategize about next steps, said Ronald F. Pollack, the group’s executive director. Enroll America, a sister organization, will hold focus groups next week in Ohio, Pennsylvania and Texas to collect ideas for a public education campaign.


Much depends on the states as they decide in the coming weeks and months whether to build online marketplaces known as insurance exchanges, where individuals and small businesses can shop for health plans, and whether to expand their Medicaid programs to reach many more low-income people.


The clock is ticking on the exchange question in particular: states have until next Friday to decide whether they will build their own exchange or let the federal government run one for them. Some states have asked the administration for more time.


So far, only about 15 states and the District of Columbia have created the framework for exchanges through legislation or executive orders; three others have committed to running exchanges in partnership with the federal government. A number of Republican governors, including those in Arizona, Idaho, New Jersey, Virginia and Tennessee, had said they would decide after the election, giving themselves only a 10-day window before the deadline.


“I would expect that starting today there are a significant number of fascinating conversations going on behind closed doors in state capitols all over America,” said John McDonough, a professor of public health at Harvard who helped draft the law.


With deficit-reduction talks beginning in Washington next week, some observers believe that the law’s most expensive provisions — like federal subsidies to help families with incomes up to 400 percent of the poverty level pay their insurance premiums — could be scaled back in the name of deficit reduction.


“We know folks on the Hill are talking about this already,” said David Smith, an analyst at Leavitt Partners, a consulting firm that advises states on the law. “There are a lot of competing factors, but they have to find the savings and we believe health care will be one of the places where they will go.”


Read More..