In Second Look, Few Savings From Digital Health Records

Health insurance companies are increasing premiums on some rates, with Ipsita Smolinski, health care analyst at Capitol Street, and Marc Schupan, Schupan & Sons.

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Health care spending has risen $800 billion since the first report was issued, according to federal figures. The reasons are many, from the aging of the baby boomer population, to the cost of medical advances, to higher usage of medical services over all.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm's acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.

The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems.

"We could be getting much more if we could take the time to do a little more planning and to set more standards," said Marc Probst, chief information officer for Intermountain Healthcare, a large health system in Salt Lake City that developed its own electronic records system and is cited by RAND as an example of how the technology can help improve care and reduce costs.

The RAND researchers pointed to a number of other reasons the expected savings had not materialized. The rate of adoption has been slow, they said, and electronic records do not address the fact that doctors and hospitals reap the benefits of high volumes of care.

Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.

Technology "is only a tool," said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. "Like any tool, it can be used well or poorly."

While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.

Federal officials say they are drafting new rules to address many of the concerns about the current systems.

A handful of lawsuits have been filed over the systems. In the fall of 2010, for example, Girard Medical Center, a small hospital in Crawford County, Kan., hired Cerner Corporation to install an electronic records system. The hospital was hoping to obtain federal financing for it.

But after receiving $1.3 million in payments, Cerner employees failed to get the system up and running in time for the hospital to qualify for federal incentive payments. The company then notified the hospital that it was abandoning the project, according to a lawsuit Girard filed against Cerner last year. The case is in arbitration. A lawyer for Girard and a spokeswoman for Cerner declined to comment.

Late last year, a physician practice in Panama City, Fla., filed a lawsuit against the health care technology firm Allscripts after the company stopped supporting an electronic records system called MyWay that it had sold to 5,000 small-group physicians at a cost of $40,000 per physician.

The lawsuit said that the system had problems and that the physician group was unable to meet the criteria for federal incentive money. A spokeswoman for Allscripts said it would defend itself vigorously.

The 2005 RAND report helped Cerner executives and others sell the new systems, despite criticism at the time that the analysis was too rosy. RAND said that the report was not influenced by its financial backers and that, in fact, it disclosed the corporate sponsorship prominently in the report itself.

The study was harshly criticized by the Congressional Budget Office for overstating expected savings.

The new analysis was not sponsored by any corporations, said Dr. Kellermann, who added that some members of RAND's health advisory board wanted to revisit the earlier analysis.

Dr. David J. Brailer, who was the nation's first health information czar under President George W. Bush, said he still believed tens of billions of dollars could eventually be squeezed out of the health care system through the use of electronic records. In his view, the "colossal strategic error" that occurred was a result of the Obama administration's incentive program.

"The vast sum of stimulus money flowing into health information technology created a 'race to adopt' mentality — buy the systems today to get government handouts, but figure out how to make them work tomorrow," Dr. Brailer said.

View the original article here

As Congress responds to meningitis outbreak: First, do no harm

By B. Douglas Hoey, CEO, National Community Pharmacists Association - 01/11/13 01:45 PM ET

When there is a national crisis, there’s often a notion to pass legislation to try to prevent a recurrence from ever happening again. Now, in the wake of the tragic meningitis outbreak allegedly caused by tainted medications from a rogue drug manufacturer, some in Congress are looking to take action.

While there may be room for a carefully crafted legislative solution, the situation calls to mind the time-tested, medical-school adage: First, do no harm.

In the event of the meningitis outbreak allegedly caused by the New England Compounding Center (NECC), it is important that Congress take targeted action to address the root cause of the problem. Overly broad legislation could have unanticipated consequences for patients and small business community pharmacies. For starters, everyone should recognize that NECC appears to have acted as a small-scale manufacturer of prescription drugs, churning out many thousands of doses and without first obtaining the necessary prescriptions. That’s a far cry from traditional pharmacy compounding.

In comments submitted to both the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy and Commerce Committee in conjunction with their recent hearings, the National Community Pharmacists Association (NCPA) drew clear contrasts between the activities reportedly performed by NECC and the individualized compounding performed by independent community pharmacies.

Independent community pharmacists compound special needs medications for individual patients where a commercial product is not available and in response to a physician’s prescription request. This may include making a liquid form of a medication for patients who have trouble swallowing pills or flavoring a medication for pediatric patients. Compounding also helps alleviate drug shortages on a regular basis. Perhaps most notably, just a few years ago during the nationwide H1N1 flu outbreak, traditional compounding helped alleviate a drug shortage for the liquid form of Tamiflu for children.

As previously evidenced, traditional compounding plays an integral role in the healthcare system. According to a survey of NCPA members, 85% of independent pharmacies perform compounding on behalf of patients and 62% say compounding makes up no more than 5% of their business. While compounding is a small, niche service for most community pharmacies, it is vital to meet specific needs of patients.

Given traditional compounding’s important role in the healthcare system, Congress should carefully consider any legislative changes. Such due diligence should start with an analysis of existing statutes and regulations.

Were existing state and federal laws and regulations properly enforced in the NECC case? Evidence suggests not, judging by congressional hearings and media reports. Had existing authorities been exercised and requirements been enforced, the NECC tragedy could have been greatly mitigated or possibly prevented altogether. In fact, current law allows the Food and Drug Administration (FDA) to identify and stop rogue drug manufacturers as NECC appears to have been.

As Congress moves forward, NCPA stands ready to work with policymakers to ensure that any new legislation or regulations address the critical issue of proper oversight of the manufacturing of prescription drugs and shutting down any outliers like NECC. This balanced approach will ensure that patients maintain access to individualized medications when needed and that independent community pharmacies remain part of the solution to lowering health care costs and alleviating drug shortages when applicable.

Let’s be certain not to throw the baby out with the bathwater.

Hoey is CEO of the National Community Pharmacists Association.

View Comments

View the original article here

Conservative Think Tank Ranks Countries With Government-Run Health Care As The Freest In World

Heritage President Jim DeMint.

Former Senator Jim DeMint, the new president of the conservative Heritage Foundation, has decried Obamacare as “a cancer” that is “is fundamentally inconsistent with liberty.” During the Senate Obamacare fight, DeMint famously declared “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”

But a new report from DeMint’s own organization suggests that, far from being incompatible with freedom, countries with health care systems with as much or significantly more government control over healthcare are the freest countries in the world.

The report in question is Heritage’s Economic Freedom Index, released annually since 1997. The report defines the concept of “economic freedom” in misleading right-wing terms, but even by those standards, it appears that universal health care systems far more expansive than Obamacare aren’t “fundamentally inconsistent with liberty.” In fact, the ten “freest” economies in 2013 by Heritage’s lights range from mandating individuals save a certain amount of money for health care to almost the entire health care system, including hospitals, being owned and operated by the government:

1. Hong Kong: The semi-autonomous city inside China has a universal, publicly run health care system: about 80 percent of Hong Kong hospitals are government owned and operated. While private supplemental insurance is available, it’s more expensive than public services.

2. Singapore: Singapore is often cited as a free-market health care system that works. But one of the centerpieces of the Singaporean model, as conservative David Frum notes, is a government mandate requiring citizens to place a certain percentage of their income in “medical savings accounts” to ensure they can pay for routine health care costs out of pocket (when their income is inadequate to pay, the government pays direct subsidies a la Obamacare’s Medicaid expansion). Hardly seems consistent with DeMint’s point that health care mandates are “slippery slopes” towards the death of freedom.

3. Australia: Australia has a single-payer system in which, like Canada, doctors are privately employed but all Australians are eligible for insurance coverage through a government-run provider called Medicare.

4. New Zealand: The Kiwi government has made most services free or nearly free to all residents; the government covers roughly 80 percent of national health care expenditures and directly owns and operates about half of all health care services in the country.

5. Switzerland: This Swiss system is closer to the American health plan post-Obamacare than most other national systems; Switzerland has both privately owned health care and privately-provided insurance together with an individual mandate to purchase health insurance. Interestingly, Swiss insurers are legally prohibited from profiting on the basic, mandatory insurance package.

6. Canada: Our northern neighbor is, of course, the most famous example of a single payer system in the United States.

7. Chile: Like Singapore, Chile mandates that individuals pay into health savings accounts to cover health care costs and supplements the accounts of poor Chileans. It also has both publicly and privately run health care services.

8. Mauritius: A tiny island nation in the Indian ocean, Mauritius has government-run health services that cover roughly 70 percent of the country’s health expenditures, with private supplemental practices making up the remainder. All government health services are provided free of charge to Mauritian citizens, which has helped the country improve quality of life for its citizens markedly in the past two decades.

9. Denmark: As in Mauritius or the United Kingdom, the Danish government owns and operates the vast majority of the health care system.

Number 10 on the list is, of course, the United States, which will finally join the rest of the top ten “most economically free nations” in providing universal or near-universal health care when Obamacare is fully implemented.

View the original article here

How the US Can Save $500 Billion in Medicare: UnitedHealth

The U.S. could save more than $500 billion in Medicare and Medicaid spending over the next ten years, by more aggressively coordinating medical care for seniors and the poor, according to new research from health insurer UnitedHealth Group.

The report is aimed squarely at Washington, as leaders on Capital Hill wrangle over debt reduction options ahead of automatic budget cuts due to take effect in two months.

"It's either going to be a debate that's purely focused on cutting people's benefits, or it's going to be a debate that's focused on further cuts to doctors and hospitals," said Simon Stevens, UnitedHealth executive vice president, who chairs the insurer's Center for Health Reform & Modernization.

(Read More: Medicare Premium Increase Plan Redefines 'Well-Off')

But in the report, which Simon co-authored, he argues there should be third strategy: to focus on cutting costs, while improving care.

Under the Affordable Care Act, known as Obamacare, the government has begun to align reimbursement rates more on the quality of care for seniors in Medicare, rather than simply paying fees for each procedure.

The UnitedHealth report contends Medicare could save another $200 billion over the next ten years by more aggressively adopting cost-saving managed care initiatives.

Similarly, the report contends the federal government could save an additional $150 billion by integrating managed care for the 9 million low-income seniors and disabled who are enrolled in both Medicare and need-based Medicaid, and who account for a large share of spending in both programs.

Under Obamacare, roughly 2 million of this so-called dual-eligible population will be enrolled in coordinated care programs this year. But Stevens argues the government should expand the program faster, in order to save more.

"All of these options have got a very strong empirical, practical track record behind them," Stevens said. "We've got a sense of what works and what doesn't work."

View the original article here

Obama to award Medal of Honor to Army veteran of Afghanistan war

President Obama will award Army Staff Sgt. Clinton Romesha the Medal of Honor during a ceremony next month, just the fourth living recipient to be awarded the honor for service in Iraq or Afghanistan.

Romesha will be awarded the medal for his actions during the Battle of Kamdesh, one of the bloodiest days for American soldiers during the Afghanistan conflict. During the battle, hundreds of Taliban insurgents swarmed an American combat outpost in Eastern Afghanistan, overwhelming the coalition forces and leaving eight Americans dead and another 22 wounded. According to The New York Times, attackers overran the base, set fire to the barracks and captured the post's ammunition depot.

Romesha and his family will join the president at the White House on Feb. 11.

The Medal of Honor is "awarded to members of the Armed Forces who distinguishe themselves conspicuously by gallantry above and beyond the call of duty," according to the White House. The high honor is only given to service members who display "great personal bravery or self-sacrifice so conspicuous as to clearly distinguish the individual above his or her comrades and must have involved risk of life." The honor was first awarded in 1863, during the American Civil War. The last recipient was a posthumous award to Army Spc. Leslie H. Sabo Jr. for his actions after his platoon was ambushed during the Vietnam war.

The announcement came Friday, as President Obama met with Afghanistan President Hamid Karzai at the White House. According to the White House, during the talks Obama "reaffirmed the United States’ respect for Afghanistan’s sovereignty and reiterated that as Afghanistan takes full responsibility for its security and development, the United States continues to be committed to supporting the Afghan people."

View Comments

View the original article here

ObamaCare Exchanges: State of the States

Last week, the Department of Health and Human Services (HHS) gave seven more states “conditional approval” to operate state-run Obamacare exchanges.

The announcement came two days after the deadline for HHS Secretary Kathleen Sebelius to determine which states will be ready to run their own exchanges in 2014. So it appears HHS was dressing up its numbers by granting conditional approval to more states—including ones that, in the end, will likely prove either unwilling or unable to set up state-run exchanges.

A handy summary table compiled by the Kaiser Foundation shows that exactly half (25) of the states are a firm “no.” As for the other half, HHS has so far granted conditional approval to 19 of the 21 states that submitted a blueprint for creating an exchange. The two others are Illinois and Mississippi. Mississippi’s governor wrote Sebelius on December 28 restating his opposition and informing her that Mississippi’s insurance department does not have legal authority to continue pursuing its plan for setting up an exchange on its own. The remaining four states have expressed some interest but have not yet even submitted blueprints.

These conditional approvals create the perception that states are moving ahead with implementing Obamacare while obfuscating the reality. At least four of the latest seven conditionally approved states are unlikely to have state-run exchanges in place by the end of the year. Specifically:

1)      Idaho, where the legislature seems firmly opposed to the idea, and executive branch activities haven’t gone beyond the initial analysis and planning phase.

2)     Arkansas, where the Democratic governor wants a state-run exchange, but the voters just elected Republican majorities to both houses of the state legislature.

3)     New Mexico, where earlier this year, the Republican governor vetoed the Democratic-controlled legislature’s exchange bill. The state has an existing small business purchasing market that some of the governor’s advisers would like to morph into a Utah-style market-based exchange. However, given disagreements between the governor and legislature, HHS’s inflexibility, and the limited time remaining, it is unlikely that New Mexico will have a state-run Obamacare exchange in place by the end of the year.

4)     Utah, where the state was building its own market-based exchange prior to Obamacare, and has been trying to use it to lever concessions out of HHS but with little apparent success.

As Sebelius noted in all her letters to governors of states granted conditional approval, the approvals are contingent upon their states meeting various conditions, one of which is: “Comply with regulations and expected progress milestones.” If the Secretary continues to take a “my way or the highway” approach with even a state like Utah, which had a pre-Obamacare exchange, she will disabuse even the most credulous of the notion that the Administration will allow state-run Obamacare exchanges to be anything other than branch offices of HHS.

Thus, as it now stands, only 14 to 16 states (plus the District of Columbia) are likely to actually be operating state-run exchanges come October, when open season begins. There may be another two or three states with so-called partnership exchanges, but the feds will be responsible for most of the major functions in those states. Indeed, the final count could be lower as some states trying to set up their own exchanges—faced with significant technical challenges and limited remaining time—give up and default to a federally run exchange.

As it looks now, HHS will need to set up and run federal exchanges in three-fifths to four-fifths of the states. The Obama Administration is about to rediscover the Pottery Barn Rule: “You break it, you own it.”

View the original article here

EXCLUSIVE: 51 Upcoming Gun Shows Ban Loaded Weapons To Promote ‘A Safe Environment’

If “the only thing that stops a bad guy with a gun is a good guy with a gun,” as the NRA proclaimed in its post-Newtown press conference, why do so many gun shows prohibit attendees from carrying loaded firearms?

According to a ThinkProgress analysis, 51 gun shows in January ban attendees from bringing loaded guns onto the premises. In addition, ThinkProgress was unable to identify a single gun show this month that explicitly allowed people, even those with concealed-carry permits, to bring a loaded weapon with them.

For every event, their stated rationale for not permitting loaded weapons in the gun show was simple: safety. Crossroads Gun Show, a touring event across the western United States, explained on their website:

Q: Can I carry a loaded gun in the gun show? I have a Concealed Carry Permit.

A: We respectfully request that you do not bring any loaded firearm into the gun show. Safety is our Number One Priority, and a safe environment in the show can only be maintained if there are no loaded guns in the show.

At most shows, if an attendee brings a personal firearm, he or she must check it at the door and use a tie “so that they cannot be operated, be breached or loaded.”

Some events, like Bill Goodman’s Gun & Knife Shows across Ohio and Tennessee, even threaten prosecution for those who try to enter with a loaded weapon. “Patrons who bring loaded magazines or weapons into the show will be refused entry and may be subject to prosecution,” their website reads.

The widespread prohibition undermines the backbone of the NRA’s case against stronger gun safety laws. The powerful gun lobby argues that the best way to prevent more gun violence is for more people to have guns, supposedly deterring would-be criminals. The organization has succeeded in convincing every state but Illinois to enact laws allowing people to carry concealed weapons and conservative lawmakers are passing legislation to eliminate gun-free zones around schools and hospitals.

A full list of the 51 gun shows that explicitly ban people from carrying loaded firearms is below:

1. Oklahoma City Gun Show (January 11-12)
2. ABBA Shriners Gun & Knife Show (January 12-13)
3. Gibraltar Taylor Gun & Knife Show (January 11-13)
4. Akron Gun Show (January 12-13)
5. Binghamton Gun & Knife Show (January 12-13)
6. Dalton Gun Show (January 12-13)
7. Dayton (Vandalia) Airport Expo (January 12-13)
8. Farmington Gun Show* (January 12-13)
9. Ft. Lauderdale Gun Show (January 12-13)
10. Germantown Gun & Knife Show* (January 12-13)
11. Kansas City Gun Show* (January 12-13)
12. Maitland Gun Show (January 12-13)
13. Mesa Gun Show (January 12-13)
14. Morehead Gun Show* (January 12-13)
15. Nashville Gun Show (January 12-13)
16. San Angelo Gun & Blade Show (January 12-13)
17. San Francisco Gun Show (January 12-13)
18. Wichita Cessna Gun Show* (January 12-13)
19. Las Vegas Shot Show (January 15-18)
20. Ft. Pierce Gun Show (January 19-20)
21. Gonzales Gun Show (January 19-20)
22. Hendersonville Gun Show* (January 19-20)
23. Jackson Gun & Knife Show* (January 19-20)
24. Jacksonville Florida Gun Show (January 19-20)
25. Jefferson Gun Show (January 19-20)
26. Marietta Jim Miller Park Gun Show* (January 19-20)
27. Miami Florida Gun Show (January 19-20)
28. Paducah Gun Show* (January 19-20)
29. Phoenix Gun Show (January 19-20)
30. Springfield Gun Show* (January 19-20)
31. Topeka Gun Show* (January 19-20)
32. Venice Gun and Knife Show (January 19-20)
33. Des Moines Gun Show (January 25-27)
34. Canandaigua Gun Show (January 26-27)
35. Carlsbad Gun & Blade Show (January 26-27)
36. Costa Mesa Gun Show (January 26-27)
37. Fort Myers Gun, Knife, Civil War & Militaria Show (January 26-27)
38. Goodman Dayton Gun & Knife Show (January 26-27)
39. Gun Show in the Smokies* (January 26-27)
40. Kingman Gun, Knife, Coin & Collectibles Show & Sale (January 26-27)
41. Lawrenceville Gun Show* (January 26-27)
42. Macon Gun Show (January 26-27)
43. New Orleans Area Gun & Knife Show (January 26-27)
44. Oklahoma City Gun and Knife Show* (January 26-27)
45. Palmetto Gun Show (January 26-27)
46. Pensacola Florida Gun Show (January 26-27)
47. Sedalia Gun Show* (January 26-27)
48. Tulsa Gun Show* (January 26-27)
49. Watkins Glen Gun & Knife Show (January 26-27)
50. Wichita Coliseum Gun Show* (January 26-27)
51. Wichita Falls Gun & Knife Show (January 26-27)

*- Events sponsored by R.K. Shows Inc confirmed to ThinkProgress by phone that loaded weapons, even for those with concealed carry permits, are prohibited.

View the original article here

Cramer: Don’t Overlook This Biotech

Although the developments were heart-breaking for the medical community – the investment community always looks at price action and the price action was impressive despite the bad news.

Piper Jaffray estimated Biogen spent $75 million to $100 million on the failed trial alone.

"Yet, the stock barely took a hit," said Cramer.

In part that's because Biogen also has a major hemophilia program in the pipeline, one that could potentially generate $3 billion in sales by the second half of the decade.

However, the relative strength in the stock price more likely reflects Biogen's position in n the multiple sclerosis market.

As you may know, MS is it's a life-long, chronic, often disabling disease that attacks the central nervous system. Although there's no cure for MS, there are drugs that can keep the disease at bay by preventing relapses.

"And currently Biogen has two of them on the market, two blockbuster MS drugs, Avonex, which is one of the traditional treatments, and Tysabri, a newer, more effective drug that also has a higher risk of bad side effects," Cramer explained..

Also Biogen's is working on a third multiple sclerosis drug, BG-12, one that can be taken orally rather than injected.

Management has said it would appeal to a very broad patient population. In fact, BG-12 could become the new leading first-line treatment for MS, potentially doing $2.4 billion worth of sales in 2016.

"That's a big deal," said Cramer.

And chatter on the Street suggests the FDA could approve this new drug as soon as late March.

All told, Cramer is bullish.

"Biogen is a classic biotech stock with a bright future and I think it's exactly the kind of thing you should think about buying when we get broad market-wide weakness," he concluded.

Find out more about this company and drugs in the pipeline from Dr. George Scangos, the CEO of Biogen Idec, in the video above.

View the original article here

Joint Statement by President Obama and President Karzai

The White House

Office of the Press Secretary

At the invitation of President Obama, President Karzai and his delegation visited Washington January 8-11, 2013.  President Karzai’s visit comes at an important juncture for both our nations, as we take steps to further strengthen an enduring partnership as sovereign nations, and based upon recognition of our shared interests and shared security.
In their meetings today, President Obama and President Karzai discussed a strategic vision for a secure, stable and prosperous Afghanistan and reaffirmed the U.S.-Afghanistan Enduring Strategic Partnership Agreement signed in May 2012.  Further, the Leaders’ discussion emphasized a convergence of interests and vision.  The two Presidents reviewed the security and economic transitions underway in Afghanistan, election preparations, evolving threats and opportunities in the region, and reaffirmed shared commitments to U.S. and Afghan strategic objectives:  advancing peace, security, reconciliation, and regional cooperation; strengthening Afghanistan’s democratic institutions; and supporting Afghanistan’s long-term economic and social development.

Security Transition
During their meetings, the Presidents welcomed recent improvements in Afghanistan’s security environment.  The Leaders welcomed Afghan security forces’ increasing assumption of lead responsibility, noting the marked progress made in the growth and capabilities of the Afghan National Security Forces (ANSF).  Exceeding initial expectations, Afghan forces began leading the majority of operations in July 2012 and now lead approximately 80% of operations.  In February, in conjunction with the fourth tranche of transition, the ANSF is expected to have the lead in securing nearly 90% of the Afghan population.

Consistent with Afghan priorities, Leaders at the Chicago Summit committed to mark a milestone in mid-2013 when the ISAF mission would shift from combat to support.  President Obama welcomed President Karzai’s desire to mark this milestone this spring, when the ANSF are expected to assume the operational lead across Afghanistan, and ISAF will move into an advisor-support role.  This milestone would coincide with announcing the fifth and final tranche of transition, which would commence implementation in the summer, subject to final NATO and Afghan approval.

At the time of the milestone, most unilateral U.S. combat operations should end, with U.S. forces pulling back their patrols from Afghan villages.  Both Leaders recognized that, as the Afghan security forces take greater responsibility for security, improving the quality of the ANSF, including the accelerated provision of appropriate equipment and enablers, remains a key priority. 

Building upon significant progress in 2012 to transfer responsibility for detentions to the Afghan Government, the Presidents committed to placing Afghan detainees under the sovereignty and control of Afghanistan, while also ensuring that dangerous fighters remain off the battlefield.  President Obama reaffirmed that the United States continues to provide assistance to the Afghan detention system.  The two Presidents also reaffirmed their mutual commitment to the lawful and humane treatment of detainees, and their intention to ensure proper security arrangements for the protection of Afghan, U.S., and coalition forces.

Economic Transition
The Leaders discussed the significant development gains in Afghanistan over the past decade and the need for continued progress on a foundation of sustainable economic growth and fiscal self-reliance from Transition in 2014 and through the Transformation Decade that follows.  Afghanistan's economic strategy is focused on investing in its human capital to lead the country's institutions and to create an enabling environment for inclusive economic growth and investment, to harness the private sector, entrepreneurs, and natural wealth for the creation of a prosperous country.  To this end, the Presidents reaffirmed the commitments made in Bonn, Chicago, and Tokyo, including long-term economic and security assistance in the context of the Tokyo Mutual Accountability Framework. 

President Karzai affirmed his view that the international community’s assistance must be effective, efficient, and sustainable, and he stressed the critical importance of Afghan commitments to build a stable, democratic society, based on the rule of law, respect for the rights of all Afghan citizens, including women, an effective and independent judiciary and good governance, including progress in social development and the shared fight against corruption.

President Obama reiterated the U.S. commitment to support Afghan stability by strengthening Afghanistan’s economic foundations and supporting Afghan reforms to achieve sustainable development and self-sufficiency.  He reaffirmed the conclusions of the Tokyo Conference,  including that the U.S. align 80 percent of aid with Afghan priorities and channel at least 50 percent of development assistance through the national budget of the Afghan Government.

Elections 2014 
During the Leaders’ meetings, President Karzai outlined the Government of Afghanistan’s plans to hold free, fair, inclusive, and democratic elections in 2014.  The Leaders reviewed preparations for the 2014 elections and agreed that independent Afghan institutions are to lead election preparations and implementation, in close consultation with legitimate stakeholders in the democratic process.  President Obama welcomed the Afghan Independent Election Commission’s establishment of April 5, 2014 as the date for presidential and provincial council elections, and he reiterated that the United States’ role is not to support any particular candidate but to support a fair and inclusive electoral process. 

Peace and Reconciliation
The Presidents reaffirmed that Afghan-led peace and reconciliation is the surest way to end violence and ensure lasting stability of Afghanistan and the region. Noting progress in the process of peace and reconciliation, they stressed the importance of accelerating efforts, including by countries in the region that have a role to play in support of the Afghan peace process. Through the High Peace Council, the Afghan Government will intensify its efforts to promote the peace process.  The Leaders said that they would support an office in Doha for the purpose of negotiations between the High Peace Council and the authorized representatives of the Taliban.  In this context, the Leaders called on the armed opposition to join a political process, including by taking those steps necessary to open a Taliban office.  They urged the Government of Qatar to facilitate this effort.  The two Presidents reiterated that the outcomes of peace and reconciliation must respect the historic achievements that Afghanistan has made over the past decade, including protecting the rights that all citizens of Afghanistan, both men and women, guaranteed under the constitution.  As a part of the outcome of any process, the Taliban and other armed opposition groups must end violence, break ties with Al Qaeda, and accept Afghanistan's constitution.

Regional Environment
President Obama and President Karzai recognized the important role of the region in supporting Afghanistan’s progress towards stability and prosperity.  In this context, President Obama expressed support for Afghanistan’s efforts to promote regional cooperation to foster a region that is secure, free from extremism and radicalization and that enjoys greater economic integration.  The Leaders expressed support for Afghanistan’s emerging role as a focal point for trade and economic activity at the Heart of Asia.  The Leaders also reiterated that the goals of the U.S.-Afghanistan partnership are fully consistent with Afghanistan’s vision for building strong and cooperative ties with its neighbors and regional partners.    

Bilateral Security Agreement
As we further develop the U.S.-Afghanistan partnership, the United States and Afghanistan look forward to expanded cooperation under the auspices of the U.S.-Afghanistan Bilateral Commission, through 2014 and beyond.  President Obama and President Karzai committed to conclude the Bilateral Security Agreement as soon as possible, reaffirming that such an agreement is in both countries’ interest.   They discussed the possibility of a post-2014 U.S. presence that is sustainable, that supports a capable and effective Afghan National Security Force, and that continues to pressure the remnants of al-Qa’ida and its affiliates.  The scope and nature of any possible post-2014 U.S. presence, legal protections for U.S. forces, and security cooperation between the two countries is to be specified in the Bilateral Security Agreement.  The U.S. reaffirmed that it does not seek permanent bases in Afghanistan.

Conclusion
President Obama reaffirmed the United States’ respect for Afghanistan’s sovereignty and reiterated that as Afghanistan takes full responsibility for its security and development, the United States continues to be committed to supporting the Afghan people.  Both Presidents paid tribute to the sacrifices made by Afghanistan, the United States, and our international partners in efforts to achieve a stable, prosperous, peaceful, sovereign and democratic future for Afghanistan, as well as security for the international community.  The United States and Afghanistan intend to continue working together to achieve the full promise of our enduring partnership.

We'll soon reach a milestone in Afghanistan -- when Afghan forces take full responsibility for their nation's security and the war draws to a close.

The President asks Jacob Lew -- the current White House chief of staff -- to serve as the next Treasury Secretary.

view all related blog posts

View the original article here

Biden: 'No silver bullet' to stop gun violence

The vice president downplayed harsh criticism the National Rifle Association has made about the administration's gun violence task force.

Vice President Biden said Friday that his task force on gun violence recognized there was "no silver bullet" that would solve the problem and downplayed harsh criticism from the National Rifle Association about the administration's efforts.

"We know that there is no silver bullet," to stop gun violence, Biden said, ahead of a Friday meeting with video game manufacturers and retailers. He did not elaborate further. 

Biden said he believed his Thursday meeting with advocates of gun ownership was "productive," but he refused to comment when asked about criticism levied by the NRA following the conference.

"I thought we had a very straightforward, productive meeting," Biden said.

On Thursday, the NRA said it was "disappointed with how little this meeting had to do with keeping our children safe and how much it had to do with an agenda to attack the Second Amendment."

"We will engage our members," NRA President David Keene told CNN on Thursday, accusing the White House of simply "checking a box" during its meeting with gun activists.

"They were able to say we've met with the NRA, we've met with the people that are strong Second Amendment supporters," Keene said.

Biden did say that he saw differences between the NRA and other groups at the meeting.

"There is actually a difference among them as well," Biden said. "It's not a uniform view."

The meeting Friday with video game manufacturers was the last in packed week for the vice president, who has said he planned to present President Obama a package of potential legislative and executive actions by Tuesday of next week. 

Participants at the meeting included developers Activision and Electronic Arts, along with retailer GameStop.

The Friday conference came after a Thursday evening discussion with film and television executives as Biden's working group at least temporarily shifted focus from the issue of gun control to cultural factors.

Ahead of the meeting, industry organizations issued open letters to the vice president warning that attempts to regulate depictions of violence in video games would likely constitute an infringement on First Amendment rights.

"Governments should not be seeking ways to constrain this emerging medium early in its development by scapegoating video games for societal ills," said Daniel Greenberg, an executive with the International Game Developers Association.

Jennifer Mercurio, a vice president for the Entertainment Consumers Association, argued that "while video game sales have increased, violent crime has been steadily decreasing."

The posturing by the video game representatives largely mirrored a similar statement from executives for film and television groups issued after their meeting with the vice president Thursday night. 

In the statement, Hollywood trade groups said they "look forward to doing our part to seek meaningful solutions" to prevent gun violence while emphasizing that the industry already imposes ratings systems for consumers.

“The entertainment community appreciates being included in the dialogue around the Administration’s efforts to confront the complex challenge of gun violence in America," the statement said. "This industry has a longstanding commitment to provide parents the tools necessary to make the right viewing decisions for their families."

Asked if he believed video games were coarsening American culture, Biden said that he did "not know the answer to that question."

Biden also added  that the range of meetings he had conducted was evidence that the video game industry was "not singled out for help."

On Thursday, Biden outlined a series of proposals that could eventually find their way into the legislative package. He said the federal government would revamp the way it collected data on gun violence, comparing current limits on information gathering with the 1970s-era restrictions on federal research over the causes of traffic fatalities.

The vice president also said many stakeholders had suggested pursuing limits on high-capacity magazines for semiautomatic guns, along with universal background checks that would close the so-called gun-show loopholes.

The Brady Campaign, the nation's most prominent anti-gun group, said Friday that it had suggested making gun trafficking a federal offense and limiting the number of guns that could be purchased in a short period of time.

And the White House on Friday insisted that the president would continue to push for an updated version of the assault weapons ban as part of the legislative package, despite reports that Obama might abandon the effort because it was not likely to garner congressional support.

There were some indications that one change — a  limit on high-capacity magazines — might be able to attract some support across the aisle. The Des Moines Register in Iowa reported Friday that Sen. Chuck Grassley (R-Iowa) said he believes that issue could be regulated without violating the Second Amendment.

Biden himself said Thursday that he believed the administration could accomplish "a great deal" on the issue of gun violence "without in any way imposing on and impinging on the rights of the Second Amendment."

On Friday, Biden did provide one new suggestion, saying that the task force hoped to talk with technology companies about possible gun safety measures.

"A lot could change, for example, if every gun could only be fired by the person who purchased it," Biden said, noting that the gun in the Newtown, Conn., massacre had been purchased by the mother of the shooter.

View Comments

View the original article here

Stock Chart Gorgeous as Mona Lisa: Top Analyst

The key with this pattern is the neckline -- the line that connects the highs from the two shoulders.

When a stock breaks out above that line, it tells someone like Collins that it's time for a big move higher.

Pfizer's neckline is at $25.80, and it crossed over that level just last week.

But that's not all.

Last week, Pfizer broke out above a key level – a ceiling of resistance at $25.50. If the stock closes above that level again this week, Collins believes the stock could resume its long march higher.

In addition to bullish upside patterns – other patterns suggest downside may be limited.

Collins believes Pfizer has a healthy floor of support at $24.60 and even if that breaks, two more key support levels lie in the $23 range.

What's the bottom line?

"It's rare that you get a safe boring, high-yielding drug stock like Pfizer that also has a really hot chart, at least as interpreted by Tim Collins," said Cramer. "For me, that's still one more reason why Pfizer's a buy buy buy."

View the original article here