Monday, May 27, 2013

Obamacare May Bite You At The Vet’s Office

Dog at vet's office. (Source: CBS4)

Dog at vet’s office. (Source: CBS4)

MIAMI (CBSMiami) — Pet owners listen up: You may want to start saving more money for veterinarian care this year. The reason goes all the way back to Washington and an unintended consequence from medical reform.

Dog owner Lori Heiselman was surprised where her veterinarian posted a warning on Facebook.

The notice read: “Because medical equipment and supplies will be going up in cost, that extra expense will have to passed on to the customers.”

So Lori is already tightening her belt to pay for the increase in her dog’s care. Though she doesn’t like it, she’s willing to pay more for her pets.

“They’re very important. They’re members of the family,” said Heiselman.

Why the increase? Its part of a new 2.3-percent federal excise tax on certain medical devices that just went into effect. The tax will help fund the Patient Protection and Affordable Care Act, commonly known as Obamacare, intended for people, not pets. Manufacturers pay the tax, but a recent survey found more than half plan to pass it along.

Some vets say they can’t afford it. Dr. Mike Hatcher is one of them. He explained, “I’m extremely concerned how this is going to be a hidden tax to our consumers that is going to be passed on.”

How does this work? Medical devices used only on animals are exempt. However, items including IV pumps, sterile scalpels and anesthesia equipment, which are medical devices that have a dual use, meaning they can be used on people and animals, will be taxed. Hatcher said, “Putting off an equipment purchase is something that can terribly affect our clients’ ability to have quality care.”

The American Veterinary Medical Association represents 82,000 vets. At this point, they don’t know how much this new tax will indirectly cost them. The organizations members are waiting to hear from more device makers.

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Medicaid Expansion and State Health Exchanges: A Risky Proposition for the States

Recent decisions by the Obama Administration concerning the health care exchanges and Medicaid expansion underscore what a risky proposition the Patient Protection and Affordable Care Act (PPACA) is for the states. Congress presumed in PPACA (Obamacare) that the states would agree to build and run exchanges and could be forced to expand Medicaid. The Supreme Court, however, ruled the Medicaid expansion voluntary, which has made states increasingly concerned over new burdens related to costs, control, and coverage—in both the exchanges and Medicaid.

State Health Care Exchanges

Cost. Proponents deflect attention from the true cost of the exchanges by focusing on the PPACA grants to fund states establishing them. However, unlike past federal-state policy ventures, like Medicaid or even the State Children’s Health Insurance Program (SCHIP), there will be no steady flow of federal dollars to the states. The law specifies that starting in 2015, any state implementing a state exchange must develop its own revenue source to fund the exchange’s annual operations. That puts the long-term costs squarely on the states.

Moreover, the recent announcement by the Department of Health and Human Services (HHS) that it will levy a 3.5 percent administrative fee on coverage sold through the federally run exchanges indicates there are significant costs if a state agrees to run its own exchange.[1]

Just this week a Maryland panel recommended to that state’s governor and legislature new taxes and fees to fund its state exchange.[2] The Maryland report projects annual administrative costs for the state’s exchange of $201 per enrollee in 2015, declining to $152 per enrollee in 2017.

In contrast, applying the 3.5 percent fee set by HHS to the $2,770 national average per-capita premium for all commercial group and individual major medical insurance sold in 2011 yields a projected annual administrative cost for exchanges of $97 per enrollee. The much higher Maryland figures are significant as they reflect thorough and detailed work by the state most committed to implementing a state Obamacare exchange.[3]

Control. Some argue that states should establish exchanges as a means to maintain control of their markets. However, in all matters not otherwise preempted by federal law, the states still regulate insurers (including those participating in the exchanges) regardless of who operates the exchange. States can also regulate exchange “navigators” through state professional licensure statutes to ensure a level playing field with existing insurance agents, regardless of who operates the exchange.

Furthermore, regulations promulgated by HHS allow states no meaningful flexibility or advantage by operating their own exchanges, relative to a federal exchange. Those states would simply be acting as vendors to HHS.

Coverage. Proponents point to the exchange as essential to expanding coverage. However, the law also created a federal default for states declining to establish exchanges. Therefore, the responsibility shifts to the federal government. With more Americans still opposed to the law than supporting it, the innumerable technical challenges to implementation, and large and uncertain future costs, there is a significant risk that the whole law could unravel, or even collapse, before fully taking effect. Given those prospects, states that agree to run exchanges could face significant fallout from failures at the federal level over which they have no control. Instead, a state should focus on creating a viable market for their citizens in the event that the law breaks down.

Medicaid Expansion

Cost. As proponents attempt to convince states that the cost of the Medicaid expansion will be covered by the federal government, the facts remain the same. To start with, the enhanced match is only for the expansion population, not the existing Medicaid population. In addition, it does not apply to administrative costs, which add about 5 percent to benefit payments. Finally, the full 100 percent enhanced match is temporary, with states picking up 10 percent of the new costs in 2020 and thereafter. At a time when Medicaid is already overwhelming current state budgets, it would be counterproductive for states to voluntarily add to those liabilities.

In addition, there are numerous other cost pressures states need to consider when assessing the expansion.[4] First, states will see increased enrollment among the non-expansion population as the law also expands eligibility by changing how income is measured and corrals those eligible, but not enrolled, into the program.

Second, states will face pressure from their hospitals to backfill $18 billion in federal payment cuts for uncompensated care. Third, the PPACA lifts Medicaid reimbursement for primary care physicians to Medicare levels, with federal funding of the difference—but only for two years. Once the federal funding expires, states will face pressure to maintain those levels and to increase payments to other physicians accepting Medicaid.

Moreover, regardless of HHS’s recent claim that it has backed away from previous proposals to shift Medicaid funding to a blended rate, the fiscal challenges facing Medicaid at the state and federal level make future financing adjustments to Medicaid unavoidable.

Control. While the HHS Secretary has touted offering flexibility to the states, the law and HHS regulations offer states no meaningful policy discretion. Specifically, the law extends the maintenance of effort (MOE) restriction from the stimulus law that prevents states from making key changes to their Medicaid programs. Moreover, the recent HHS decision to eliminate any possibility of a state expanding its Medicaid program short of the 138 percent federal poverty level (FPL) further underscores that flexibility was more talk than action. 

Coverage. As with the exchanges, proponents stress the importance of Medicaid in expanding coverage. Unlike the federal default in the exchange, there is no federal default for the Medicaid expansion. However, rather than throwing more people into a broken program, states should focus on improving the current program and developing sustainable alternatives for meeting the needs of the proposed expansion population.

Fighting Back to Minimize the Damage of Bad Decisions

Sometimes opposing bad policy—such as by declining to run exchanges or expand Medicaid— while important, is not enough. In those instances, lawmakers need to work to minimize the impact of bad policies that they are unable to fully reverse. They also need to insist on transparency, accountability, and a level playing field, so as to create public awareness of the true consequences of bad policies and build support for future reforms.

Still a Risky Proposition for the States

Enormous uncertainty still surrounds the health care law. With less than one year remaining before the major provisions of Obamacare take effect, it is no surprise that barely more than one-fifth of states have publically agreed to both establish a state exchange and expand their Medicaid programs. The other states would be wise to decline those risky steps and instead prepare better alternatives for health care reform.

Nina Owcharenko is Director of the Center for Health Policy Studies and Preston A. Wells, Jr., Fellow at The Heritage Foundation. Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.


[3]Author’s calculations using premium and enrollment data from Mark Farrah Associates, http://www.markfarrah.com/. In 2011, U.S. commercial insurers wrote $198,334,667,140 in group and individual major medical premiums covering 71,597,719 individuals.


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Denver Post Defends Front Page Picture Of Gay Speaker Kissing

Photo Credit: Craig F. Walker, The Denver Post

The Denver Post commemorated yesterday’s passage of civil unions in Colorado’s House with a front-page picture of Speaker Mark Ferrandino (D) kissing his partner Greg Wertsch — complete with a bottle of formula on the desk that belongs to their foster child. Anticipating negative reactions from readers, the editors published a defense for running the picture, arguing that it “shows the truth, no matter how objectionable”:

One of the missions as journalists is to take our readers where they can’t go, and the speaker’s office is definitely one of those places. Ferrandino, who is gay, has been fighting to get this bill passed for at least the last three years, and he spoke eloquently on the subject while the bill was being debated. So it made sense to get his perspective. [...]

We have received objections to our photographs of gay couples before, so we all knew there would likely be a negative reaction to running the picture of Ferrandino. The civil unions vote was historic for Colorado and celebrating it was not a surprise. That led one editor to note, “We have no issues showing a straight couple kissing on election night.”

Another detail that made the photo so compelling was the baby bottle on Ferrandino’s desk. It belongs to the foster child he and his partner have; given that the civil unions bill offered protections for children and families, it was another element that gave context.

There is a difference between a picture that people object to and an “objectionable” photo. It’s disappointing that the editorial board thought the decision was “difficult.” Indeed, the one editor’s observation is key: it’s not kissing that people object to — it’s homosexuality . What has proven to be one the most effective ways to shift people’s opinions on gay rights is knowing gay people and learning about their lives and their families. No number of objections changes the reality that the Speaker of the Colorado House is a gay man with a loving partner and child; and reporting on reality is never a difficult decision.


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Bombing of Japan

(Difference between revisions)Why did the US drop the atomic bomb? Historians have debated the issue over the years. On the one hand, Japan was defeated and many civilian leaders wanted to reach conditional surrender terms. After sifting through the records and cross-examining Japanese leaders, the U.S. Strategic Bombing Survey concluded in 1946 that Japan would have surrendered by the end of 1945 because of the devastation wrought by the sea/air blockade, the incessant B-29 and carrier raids. The Survey lends weight to the conclusion, after the war, that the atomic bomb did not have to be used to gain victory. Some "revisionists" have suggested Hiroshima was supposed to be an unmistakable signal to Stalin to play along diplomatically with the Americans who planned to rule the postwar world. Others have wondered whether some sort of demonstration explosion could have been made, in order to frighten Tokyo without killing so many people. The option was considered, but only two bombs were available. Truman decided instead to drop millions of leaflets upon Hiroshima and Nagasaki warning people to leave immediately, and at the Potsdam Conference in mid-July 1945, he explicitly warned Japan it must surrender immediately or be hit with terrible force.Why did the US drop the atomic bomb? Historians have debated the issue over the years. On the one hand, Japan was defeated and many civilian leaders wanted to reach conditional surrender terms. After sifting through the records and cross-examining Japanese leaders, the U.S. Strategic Bombing Survey concluded in 1946 that Japan would have surrendered by the end of 1945 because of the devastation wrought by the sea/air blockade, the incessant B-29 and carrier raids. The Survey lends weight to the conclusion, after the war, that the atomic bomb did not have to be used to gain victory. Some "revisionists" have suggested Hiroshima was supposed to be an unmistakable signal to Stalin to play along diplomatically with the Americans who planned to rule the postwar world. Others have wondered whether some sort of demonstration explosion could have been made, in order to frighten Tokyo without killing so many people. The option was considered, but only two bombs were available. Truman decided instead to drop millions of leaflets upon Hiroshima and Nagasaki warning people to leave immediately, and at the Potsdam Conference in mid-July 1945, he explicitly warned Japan it must surrender immediately or be hit with terrible force.The civilian government in Tokyo wanted peace on conditional terms, but that was impossible because of Roosevelt's policy of "unconditional" surrender, and because the civilians did not control Japan's decisions--the Imperial Army did (in the name of the Emperor). It is often assumed that the atomic bombs caused Japan to finally surrender. However, others point to the declaration of war by the Soviet Union who, invaded Manchuria, and crushed the Japanese Army there. Thus ending Japan's feeble hopes for a negotiated peace. However, in reply, other historians have noted that the Soviet Union did not declare war on Japan until August 8, 1945; two days after the first atomic bomb had been dropped. It was a last-minute grab for the spoils of war. It is known that after Hiroshima and the invasion of Manchuria the army and navy still wanted to fight on, while the civilians wanted to give up. The decisive move was the unprecedented intervention of Emperor Hirohito, who ordered negotiations to be opened after the second atomic bomb had been dropped. Even then a small number of Imperial officers tried to stage a coup by occupying the palace grounds. They planned to not allow the broadcast of Hirohito's order; however, their actions failed. With Roosevelt gone, the Americans redefined "unconditional" to allow continuance of the Emperor. On August 15, 1945, Hirohito then broadcast an order to the nation and its armed forces to surrender, which was obeyed by all but a few who carried out futile last minute suicide attacks which failed. Until that day, the Japanese military leaders were still making their preparations for resisting the expected Allied invasion of the home islands.Wheeler, Keith. "The Fall of Japan" (1983)The civilian government in Tokyo wanted peace on conditional terms, but that was impossible because of Roosevelt's policy of "unconditional" surrender, and because the civilians did not control Japan's decisions--the Imperial Army did (in the name of the Emperor). It is often assumed that the atomic bombs caused Japan to finally surrender. However, others point to the declaration of war by the Soviet Union who, invaded Manchuria, and crushed the Japanese Army there. Thus ending Japan's feeble hopes for a negotiated peace. However, in reply, other historians have noted that the Soviet Union did not declare war on Japan until August 8, 1945; two days after the first atomic bomb had been dropped. Sadao Asada, "The Shock of the Atomic Bomb and Japan's Decision to Surrender: a Reconsideration." ''Pacific Historical Review'' 1998 67(4): 477-512. [http://www.jstor.org/stable/3641184  in Jstor] It was a last-minute grab for the spoils of war. It is known that after Hiroshima and the invasion of Manchuria the army and navy still wanted to fight on, while the civilians wanted to give up. The decisive move was the unprecedented intervention of Emperor Hirohito, who ordered negotiations to be opened after the second atomic bomb had been dropped. Even then a small number of Imperial officers tried to stage a coup by occupying the palace grounds. They planned to not allow the broadcast of Hirohito's order; however, their actions failed. With Roosevelt gone, the Americans redefined "unconditional" to allow continuance of the Emperor. On August 15, 1945, Hirohito then broadcast an order to the nation and its armed forces to surrender, which was obeyed by all but a few who carried out futile last minute suicide attacks which failed. Until that day, the Japanese military leaders were still making their preparations for resisting the expected Allied invasion of the home islands.Wheeler, Keith. "The Fall of Japan" (1983)===Military Opposition to A-Bomb===  ===Military Opposition to A-Bomb===  

The Bombing of Japan by the United States in World War II was a war-winning strategy, but it raises moral issues.

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Army Chief of Staff George C. Marshall explained American strategy three weeks before Pearl Harbor:[1]

"We are preparing for an offensive war against Japan, whereas the Japs believe we are preparing only to defend the Phillipines. ...We have 35 Flying Fortresses already there—the largest concentration anywhere in the world. Twenty more will be added next month, and 60 more in January....If war with the Japanese does come, we'll fight mercilessly. Flying fortresses will be dispatched immediately to set the paper cities of Japan on fire. There wont be any hesitation about bombing civilians—it will be all-out."

When war began the Philippine airbases were quickly lost and the B-17 Flying Fortress lacked the needed range to hit Japan. American strategy then focused on getting forward airbases close enough to Japan to use the very-long-range B-29 bomber, then in development. At first the B-29's were stationed in China and made raids in 1944; the logistics made China an impossible base. Finally, in summer 1944, the U.S. won the Battle of the Philippine Sea and captured islands that were in range.

The flamability of Japan's large cities, and the concentration of munitions production there, made strategic bombing the war-winning weapon. Two months before Pearl Harbor Chinese leader Chiang Kai-shek proposed sending Flying Fortresses over Tokyo and Osaka, "whose paper and bamboo houses would go up in smoke if subjected to bombing raids." Massive efforts (costing $4.5 billion dollars) to establish air bases in China failed. Hundreds of thousands of Chinese peasants broke rocks with little hammers and dug drainage ditches by hand. Shipping supplies around the world to equip the bases was almost impossible, and when some bases were ready in 1944 the Japanese Army simply moved overland and captured them. The Marianas, captured in June 1944, gave a close secure base, and the B-29 gave the Americans the weapon they needed. The B-29 represented the highest achievement of traditional (pre-jet) aeronautics. Its four 2,200 horsepower Wright R-3350 supercharged engines could lift four tons of bombs 3,500 miles at 33,000 feet (high above Japanese flak or fighters). Computerized fire-control mechanisms made its 13 guns exceptionally lethal against fighters. However, the systematic raids that began in June, 1944, were unsatisfactory, because the AAF had learned too much in Europe; it overemphasized self-defense.

Arnold, in personal charge of the campaign (bypassing the theater commanders) brought in a new leader, brilliant, indefatigable, hard-charging General Curtis LeMay. In early 1945, LeMay ordered a radical change in tactics: remove the machine guns and gunners, fly in low at night. (Much fuel was used to get to 30,000 feet; it could now be replaced with more bombs.) The Japanese radar, fighter, and anti-aircraft systems were mostly ineffective in bringing down the bombers. Fires raged through the cities, and millions of civilians fled to the mountains. Tokyo was hit repeatedly, and suffered a fire storm in March 1945 which killed 83,000 people. On June 5, 51,000 buildings in four miles of Kobe were burned out by 473 B-29s; Japanese opposition was fierce, as 11 B-29s went down and 176 were damaged. Osaka, where one-sixth of the Empire's munitions were made, was hit by 1,733 tons of incendiaries dropped by 247 B-29s. A firestorm burned out 8.1 square miles, including 135,000 houses; 4,000 people died. The police reported: Although damage to big factories was slight, approximately one-fourth of some 4,000 lesser factories, which operated hand-in-hand with the big factories, were completely destroyed by fire. Moreover, owing to the rising fear of air attacks, workers in general were reluctant to work in the factories, and the attendance fluctuated as much as 50 percent.

Japan's stocks of guns, shells, explosives, and other military supplies were thoroughly protected in dispersed or underground storage depots, and were not vulnerable to air attack. The bombing did affect long-term factors of production. The Japanese built airplane components in thousands of small shops scattered about their major cities; they did not use their small towns and villages. The U.S. Army Air Force answered the dispersion by burning out entire large cities (while avoiding the small towns and villages). Physical damage to factories, plus decreases due to dispersal forced by the threat of further physical damage, reduced physical productive capacity by roughly the following percentages of pre-attack plant capacity: oil refineries, 83%; aircraft engine plants, 75%; air-frame plants, 60%; electronics and communication equipment plants, 70%; army ordnance plants, 30%; naval ordnance plants, 28%; merchant and naval shipyards, 15%; aluminum, 35%; steel, 15%; and chemicals, 10%.[2]

Munitions output plummeted, and by July, 1945, Japan no longer had an industrial base. The problem was that it still had an army, which was not based in the cities, and was largely undamaged by the raids. The army was short of food and gasoline, but, as Iwo Jima and Okinawa proved, was capable of ferocious resistance. Further, fierce resistance at Okinawa came from the Kamikaze attacks which were flung at the American fleet. The desperate measures used were to make the advances of the U.S. forces a "costly battle of attrition". Japan, now more and more controlled by Emperor Hirohito and the Imperial General Headquarters denied it was losing and refused to surrender. Hirohito's main goal was to keep his throne, no matter how many people died. The Japanese staff officers wanted, " 'all able-bodied Japanese, regardless of sex, ...to engage in battle.' "[3]

The Americans repeatedly warned Japanese civilians to leave the major cities. B-29 bombers dropped a massive number of Japanese-language flyers warning of the devastation coming. It was a psychological success. Most did leave, with only the essential war workers left behind who risked becoming the casualties of the air raids. Japan moved ten million people to the countryside, including two-thirds of the residents of the Tokyo and the five other largest cities. As for morality of bombing innocent civilians, the American position was, and is, that the local government, not the US, is responsible for protecting its civilians. If they are innocent they should be evacuated to the safe countryside.

Total Japanese military fatalities between 1937 and 1945 were 2.1 million, and many more were wounded; most of the deaths came in the last year of the war. Starvation or malnutrition-re­lated illness accounted for roughly 80% of Japanese Army deaths in the Philippines, and 50% of army fatalities in China. The aerial bombing of a total of 65 Japanese cities appears to have taken a minimum of 400,000 and possibly closer to 600,000 civilian lives (over 100,000 in Tokyo alone, over 200,000 in Hiroshima and Nagasaki combined, and 80,000-150,000 civilian deaths in the battle of Okina­wa). Civilian death among settlers who died attempting to re­turn to Japan from Manchuria in the winter of 1945 were probably around 100,000.[4]

Why did the US drop the atomic bomb? Historians have debated the issue over the years. On the one hand, Japan was defeated and many civilian leaders wanted to reach conditional surrender terms. After sifting through the records and cross-examining Japanese leaders, the U.S. Strategic Bombing Survey concluded in 1946 that Japan would have surrendered by the end of 1945 because of the devastation wrought by the sea/air blockade, the incessant B-29 and carrier raids. The Survey lends weight to the conclusion, after the war, that the atomic bomb did not have to be used to gain victory. Some "revisionists" have suggested Hiroshima was supposed to be an unmistakable signal to Stalin to play along diplomatically with the Americans who planned to rule the postwar world. Others have wondered whether some sort of demonstration explosion could have been made, in order to frighten Tokyo without killing so many people. The option was considered, but only two bombs were available. Truman decided instead to drop millions of leaflets upon Hiroshima and Nagasaki warning people to leave immediately, and at the Potsdam Conference in mid-July 1945, he explicitly warned Japan it must surrender immediately or be hit with terrible force.

The civilian government in Tokyo wanted peace on conditional terms, but that was impossible because of Roosevelt's policy of "unconditional" surrender, and because the civilians did not control Japan's decisions--the Imperial Army did (in the name of the Emperor). It is often assumed that the atomic bombs caused Japan to finally surrender. However, others point to the declaration of war by the Soviet Union who, invaded Manchuria, and crushed the Japanese Army there. Thus ending Japan's feeble hopes for a negotiated peace. However, in reply, other historians have noted that the Soviet Union did not declare war on Japan until August 8, 1945; two days after the first atomic bomb had been dropped.[5] It was a last-minute grab for the spoils of war. It is known that after Hiroshima and the invasion of Manchuria the army and navy still wanted to fight on, while the civilians wanted to give up. The decisive move was the unprecedented intervention of Emperor Hirohito, who ordered negotiations to be opened after the second atomic bomb had been dropped. Even then a small number of Imperial officers tried to stage a coup by occupying the palace grounds. They planned to not allow the broadcast of Hirohito's order; however, their actions failed. With Roosevelt gone, the Americans redefined "unconditional" to allow continuance of the Emperor. On August 15, 1945, Hirohito then broadcast an order to the nation and its armed forces to surrender, which was obeyed by all but a few who carried out futile last minute suicide attacks which failed. Until that day, the Japanese military leaders were still making their preparations for resisting the expected Allied invasion of the home islands.[6]

No military ethic in the end supports the use of atomic bombs on Hiroshima and Nagasaki. Both cities were major seaports and had a number of both military and industrial installations, but the military value of those targets was not great. The target committee felt both cities made excellent psychological targets as they had been untouched by earlier bombing raids. The committee recommended the bomb should be used on the Japanese Empire mainland to save American lives and produce maximum shock to try to convince the Japanese to surrender. The civilians made the final call for use of the bombs.

The U.S. Navy had very little to do with the atomic bomb decision. However, having temporarily lost 5 of its 11 big carriers at Okinawa, it did not want to face the Kamikazes again during an invasion of Japan. It argued that the blockade was working well, cutting off nearly all oil, food and troop movements to and from Japan. It expected that the blockade would eventually lead to surrender. Not for several years thereafter were the admirals able to integrate atomic weapons into their Mahanian doctrine.

In July 1945 the AAF saw its doctrine of strategic bombing working. The original plan was to have used B-29 bombers, from high altitude, with greater precision than the B-17 and B-24 bombers used in Europe. Unexpected high-altitude winds proved this was impossible, and Gen. Curtis LeMay, newly commanding the strategic bombers, on his own authority changed to low-altitude incendiary bombing. He had the bombers shed their machine guns and gunners, and the gasoline no longer needed to lift the planes to 30,000 feet. The result was a doubling of the bomb load, and very scared fliers who were greatly relieved to discover their losses were less using the new tactics.[7] From the first raid on March 9, the new tactic was devastating. The B-29 dropping conventional high explosives and incendiaries was the perfect instrument to destroy the infrastructure of Japan's larger cities. The great bombing campaign had just started; it was planned to peak in 1946. The atomic bomb was not part of AAF doctrine; the AAF generals knew very little about the bomb and demanded a direct order from President Truman before they agreed to explode it.

The U.S. Army agreed that the combination of blockade and strategic bombing would eventually destroy every Japanese city, but felt it could not destroy the Japanese Army, which was widely dispersed and dug in. The Japanese military had in fact planned by the end of 1945 to have 2.5 million troops under arms in the Home Islands. To defend Kyushu alone they would have approx. 600,000 to 900,000 troops available by November, 1945. Coastal fortifications were also being built on the islands. Nearly 1/4 of the Japanese population (including women and children) were conscripted or volunteered for local defense.[8]

General Marshall worried that the American people would grow weary of more years of warfare, and might even demand some sort of compromise peace in order to bring the soldiers home. Marshall underestimated the intense determination of nearly all Americans to defeat Imperial Japan. A poll in June 1945, found that 70 percent were in favor of either imprisonment or executing Hirohito. Marshall also objected to dropping the bombs on cities fearing that Japan might become an enemy forever. Most of all, he had a tactical rather than strategic use in mind. Only a handful of bombs were being built, (two to four per month) and MacArthur's invasion forces ought to have all of them. Marshall and his planners concluded that Japan would surrender only after ground troops captured Tokyo. The invasion of Kyushu was scheduled November 1, 1945; all bombs available then (probably seven) should be used there. They would give invading infantry forces enough firepower to destroy defensive ground installations, communications facilities, kill exposed enemy soldiers, and also block the arrival of reinforcements. To waste the precious bombs on irrelevant civilian targets would cause more American casualties in the phased invasion of the home islands. Marshall told Truman that if the invasion of the home islands took place, a minimum of 250,000 U.S. servicemen would be lost.

In mid-1945 the Japanese troops on the home islands of Kyushu and Honshu were overall poorly trained, but resistance was expected to be very heavy. Kamikazes were a great threat with the Japanese having nearly 10,000 planes (about 5,000 for Kamikaze use) and 19,000 pilots with plus gasoline for the purpose.[9]

Unlike Iwo Jima and Okinawa, Kyushu and Honshu were big enough to permit extensive use of tanks and large-scale maneuvering. In fact, the Japanese Army stock-piled at least six tank regiments for the defense of Kyushu and Honshu, alone.[10] In sum, Japanese resistance would have been suicidal, with very heavy losses, but American losses would not been as high, as MacArthur predicted. Stimson and Truman, however, overruled Marshall and decided that the first two bombs would be used on cities in order to demonstrate the power of the Allied forces and bring the war to a swift conclusion.

President Harry S. Truman, who had been completely frozen out of decision making and secret information before he suddenly became President in April, did not know what he wanted to do. He lurched this way then that, depending on who talked to him last.[11] The man who talked to him last about the bomb was Henry Stimson. Stimson rarely participated in strategic planning, but he had one card up his sleeve--the atomic bomb. To build it, Roosevelt, set up the Manhattan Project.

The Manhattan Project was managed by Major General Leslie Groves (Corps of Engineers) with a staff of reservists and many thousands of civilian scientists and engineers. Nominally Groves reported directly to Marshall, but in fact Stimson was in charge. Stimson secured the necessary money and approval from Roosevelt and from Congress, and made sure Manhattan had the highest priorities. He controlled all planning for the use of the bomb. He wanted "Little Boy" (the Hiroshima bomb) dropped within hours of its earliest possible availability. And it was. Stimson wanted Japan to surrender, and thought the Hiroshima bomb on August 6 would provide the final push Tokyo needed. When nothing happened, he recommended to Truman that "Fat Man" be dropped August 9 on Nagasaki. The Japanese offered to surrender on August 10.[12]

In retrospect it seems possible that the impact of continued blockade, relentless conventional bombing, and the Russian invasion of Manchuria would have somehow forced the Japanese Army to surrender sometime in late 1945 or early 1946 even without the atomic bombs. Millions of Japanese would have died.[13] But Stimson saw well beyond the immediate end of the war. He was the only top government official who tried to predict the meaning of the atomic age--he envisioned a new era in human affairs. For a half century he had worked to inject order, science, and moralism into matters of law, of state, and of diplomacy. His views had seemed outdated in the age of total warfare, but now he held what he called "the royal straight flush". The impact of the atom, he foresaw, would go far beyond military concerns to encompass diplomacy and world affairs, as well as business, economics and science. Above all, said Stimson, this "most terrible weapon ever known in human history" opened up "the opportunity to bring the world into a pattern in which the peace of the world and our civilization can be saved." That is, the very destructiveness of the new weaponry would shatter the ages-old belief that wars could be advantageous. It might now be possible to call a halt to the use of destruction as a ready solution to human conflicts. Indeed, society's new control over the most elemental forces of nature finally "caps the climax of the race between man's growing technical power for destructiveness and his psychological power of self-control and group control--his moral power."

In 1931, when Japan invaded Manchuria Stimson, then Secretary of State, proclaimed the famous "Stimson Doctrine." It said no fruits of illegal aggression would ever be recognized by the United States. Japan just laughed. Now the wheels of justice had turned and the "peace-loving" nations (as Stimson called them) had the chance to punish Japan's misdeeds in a manner that would warn aggressor nations never again to invade their neighbors. To validate the new moral order, the atomic bomb had to be used against civilians. Indeed, the Japanese people since 1945 have been intensely anti-militaristic, pointing with anguish to their experience at Hiroshima and Nagasaki. Was Stimson then guilty of a crime (as many Japanese now believe)? Arguably, but it has to be recognized that he moved the issue to a higher plane than one of military ethics. The question was not one of whether soldiers should use this weapon or not. Involved was the simple issue of ending a horrible war, and the more subtle and more important question of the possibility of genuine peace among nations. Stimson's decision involved the fate of mankind, and he posed the problem to the world in such clear and articulate fashion that there was near unanimous agreement mankind had to find a way so that atomic weapons would never be used again. Thanks in great part to Stimson's vision, they never have been used since August of 1945.[14]

During the war prewar pacifists and a few churchmen (especially Catholics troubled over the bombing of Catholic cities like Rome and Cologne) began to question the morality of bombing cities. After Hiroshima the issue focused on the atomic bomb, with much of the discussion echoing the fears of the interwar period about flotillas of enemy bombers dropping poison gas on New York City. This time the technology was capable of mass destruction; everyone had genuine fears of a nuclear war that would kill tens of millions of Americans within minutes. Only the United States had ever used atomic weapons--and in both cases the victims were civilian populations. Many of the top soldiers thought the atomic bomb was unnecessary--that their particular strategy would have won the war, eventually. Each of the alternative strategies, however (such as the Army invasion of Kyushu and Honshu, the Navy's tight blockade, the Air Force's relentless firebombing) would have produced many more American casualties--and far more Japanese killed. Some historians, starting from the assumption that the bomb was "unnecessary" have speculated that it must therefore have been used for some motivation other than military victory. Perhaps the bureaucratic dynamics of the Manhattan Project were such that the bomb had to be dropped to prove the expenditures on it were not wasted? This was highly unlikely, since Truman would not have been blamed for expenditures that took place before he took charge. Other historians suggest that the bomb was dropped in order to influence or frighten the Russians, or perhaps to keep them out of the war. In fact the Pentagon, the State Department and the White House had been wanted the Russians to enter the war, and at no time did Truman ever suggest to Stalin that in fact his entry into the Pacific war was unwanted. As for frightening the Russians, that seems unlikely too. Truman and Stimson knew that Russia had the capability of building their own bomb (after the war it was discovered that Russia had already started working on one themselves which included stealing U.S. technology to do it); unleashing the American weapon was less likely to frighten the dedicated Communists than to divert them from peaceful recovery into a new arms race.

The large cities were prime targets because they contained most of the enemy's munitions factories, railroad yards, government offices and communications centers. According to Air Force doctrine, only a small fraction of the enemy population was targeted for attack--notably the centers of war production, communications, command and control. Civilians were repeatedly warned (by billions of leaflets) to evacuate those cities, or else they would be considered as willing participants in the enemy war effort. Without its cities, an enemy army would lose its munitions supply and its power of movement. As early as 1916, and certainly by the 1930s, it was a well-recognized concept that "civilians" who worked in munitions factories were as much a part of the war effort as soldiers in the front lines, and were legitimate targets. The munitions workers themselves felt that way, as they glanced at posters or listened to speeches from visiting dignitaries telling them how essential they were to the war. They were "non-peaceable" civilians. The efforts of civilian munitions workers in the cities across the globe were largely responsible for deciding who would win the war. Churchill strongly protested Eisenhower's plans to bomb French railroads before D-Day, warning that many Frenchmen would be killed (and therefore France would never trust Britain again.) Eisenhower insisted, and so too did French leader Charles de Gaulle. He wanted his homeland liberated! MacArthur, however, refused to allow bombing of Manila in 1945 because the Filipinos were American subjects.

Primary responsibility for saving the lives of people in the cities was held by the defending government, not by the attacking one according the US Air Force then (and now). Every government did in fact promote civil defense by installing sirens, building bomb shelters, teaching first-aid, assigning fire-fighters and rescue workers, establishing aid stations and support agencies, and training city dwellers on what to do when a raid was imminent.

In World War II, bombing raids were not a sudden and totally annihilating event. Anyone who wanted to be a peaceable civilian and avoid the risk of air attack could and should have left the major cities. The major nations realized this and encouraged evacuation. A year before the Blitz began the British evacuated a million and a half women, children and elderly from London. Japan and Germany evacuated non-essential civilians from their cities, as well. Japan moved ten million people to the countryside, including two-thirds of the residents of the Tokyo and the five other largest cities.

With the coming of hydrogen bombs in the mid 1950s and intercontinental missiles in the early 1960s, cities became defenseless, for they could be annihilated within minutes, with no warning and no chance for evacuation. But that was not the case in World War II. The peaceable civilians had the knowledge and opportunity to get out, and most of them did so. If anyone missed the message from their own government, they could not fail to catch one of the hundreds of millions of leaflets dropped by Allied planes warning them that a real raid was imminent and they should evacuate immediately. In late 1944 American intelligence discovered that in Berlin, "Evacuation has been very thorough and the city now is relatively empty." In peacetime, Berlin had four million population; now it had scarcely one million, many of them foreign forced laborers.

In Japan, total mobilization had been declared as early as 1938 (when Japan was fighting China): "We must mobilize our entire resources, both physical and spiritual; it is not enough merely to provide sufficient munitions."[15] Civilians were more tightly organized on behalf of the state than in any other nation, and American policy makers concluded there were no peaceable civilians in Japan. The AAF policy said that deliberate killing of innocent civilians was immoral, but that in Germany and Japan all workers "voluntary or involuntary" were assisting the enemy and should accept the risks "which must be the lot of any individual who participates directly in the war effort of a belligerent nation.[16]

Revenge played a role in the bombings. The American public demanded revenge for Pearl Harbor, and saw the Japanese as morally corrupt. The British, having watched fifty thousand civilians die from the Blitz, were more than pleased to retaliate. Strategic bombing doctrine had always held with enough pounding, enemy morale would collapse and they would be forced to surrender. That is indeed what happened with Japan. The Germans surrendered only after Berlin was captured, but the ability to resist invasion had been blasted away by the Allied bombings that Germany was helpless to stop. The bottom line regarding strategic bombing in World War II is that it was the only way a total war could be fought and won. The alternatives were compromise with the Nazis and Japanese, or invasions that would have killed far more people in Japan (and did kill far more Germans than the bombings did).[17]

Craven, Wesley Frank and J. L. Cate. The Army Air Forces in World War II (1949), vol 1-5 is the official, very thorough history of strategy and operations in Europe and Pacific online edition Gordin, Michael D. Five Days in August: How World War II Became a Nuclear War (2007) 209 pages excerpt and text search Haulman, Daniel L. Hitting Home: The Air Offensive Against Japan, (1998) online edition Walker, J. Samuel. Prompt and Utter Destruction: Truman and the Use of Atomic Bombs Against Japan (2004) online excerpt Alperowitz, Gar. Atomic Diplomacy: Hiroshima and Potsdam: The Use of the Atomic Bomb and the American Confrontation with Soviet Power. (1995), New Left version hostile to US Allen, Thomas B. and Norman Polmar. Code-Name Downfall: The Secret Plan to Invade Japan-And Why Truman Dropped the Bomb (1995) Arens, Mark P. "Amphibious Corps Planning for Operation Olympic and the Role of Intelligence in Support of Planning." (1996), Marine Corps plans for landing on Kyushu online edition Bernstein, Barton. "Eclipsed by Hiroshima and Nagasaki: Early Thinking About Tactical Nuclear Weapons," International Security (Spring 1991) 149-173 in JSTOR Bernstein, Barton F. "The Atomic Bombings Reconsidered." Foreign Affairs, 74 (Jan-Feb 1995) 135-52. Edoin, Hoito. The Night Tokyo Burned: The Incendiary Campaign against Japan (1988), Japanese viewpoint Gordin, Michael D. Five Days in August: How World War II Became a Nuclear War (2007) 209 pages excerpt and text search Haulman, Daniel L. Hitting Home: The Air Offensive Against Japan, (1998) online edition Holley, I. B. ed. Hiroshima After Forty Years (1992) Jones, Vincent C. Manhattan: The Army and the Bomb (GPO, 1985), official construction history of the bomb Libby, Justin. "The Search for a Negotiated Peace: Japanese Diplomats Attempt to Surrender Japan Prior to the Bombing of Hiroshima and Nagasaki." World Affairs, 156 (Summer 1993): 35-45. Miles, Rufus E. Jr. "Hiroshima: The Strange Myth of a Half Million American Lives Saved" International Security 10 (Fall 1985): 121-40. Pape, Robert A. "Why Japan Surrendered." International Security 18 (Fall 1993): 154-201 in JSTOR Spector, Ronald. Eagle Against the Sun: The American War With Japan (1985) Ralph, William W. "Improvised Destruction: Arnold, LeMay, and the Firebombing of Japan," War in History, Vol. 13, No. 4, 495-522 (2006) online at Sage Rhodes, Richard. The Making of the Atomic Bomb (1986), good overview excerpt and text search Rotter, Andrew J. Hiroshima: The World's Bomb (2008) excerpt and text search Sherry, Michael. The Rise of American Air Power: The Creation of Armageddon (1987), important study 1930s-1960s Skates, John. The Invasion of Japan (1994), excellent military history of the greatest non-battle of all time United States Strategic Bombing Survey. The Campaigns of the Pacific War. (1946) Online edition United States Strategic Bombing Survey. Summary Report: (Pacific War) (1946) online edition key primary source VanderMuelen, Jacob. "Planning for V-J Day by the U.S. Army Air Forces and the Atomic Bomb Controversy." Journal of Strategic Studies 16 (June 1993), 227-39. AAF did not expect quick surrender; bomb was military use Wheeler, Keith. The Fall of Japan (1983) Crane, Conrad C. Bombs, Cities and Civilians: American Airpower Strategy in World War II (1993) Crane, Conrad C. "Evolution of U.S. Strategic Bombing of Urban Areas," Historian 50 (Nov 1987) 14-39, defends AAF Schaffer, Ronald. Wings of Judgment: American Bombing in World War II (1985) Walzer, Michael. Just and Unjust Wars: A Moral Argument with Historical Illustrations (1977), influential philosophical approach from the left Bonnett, John. "Jekyll and Hyde: Henry L. Stimson, Mentalite, and the Decision to Use the Atomic Bomb on Japan." War in History 1997 4(2): 174-212. Issn: 0968-3445 Fulltext: Ebsco Bundy, McGeorge. Danger and Survival: Choices about the Bomb in the First Fifty Years (1988) Feis, Herbert. Japan Subdued: The Atomic Bomb and the End of the War in the Pacific (1961), pro-Truman Malloy, Sean L. Atomic Tragedy: Henry L. Stimson and the Decision to Use the Bomb Against Japan (2008) excerpt and text search Morison, Elting E. Turmoil and Tradition: A Study of the Life and Times of Henry L. Stimson (1960) Newman, Robert P. "Hiroshima and the Trashing of Henry Stimson" The New England Quarterly, Vol. 71, No. 1 (Mar., 1998), pp. 5-32 in JSTOR Walker, J. Samuel. "The Decision to Drop the Bomb: A Historiographical Update," Diplomatic History 14 (1990) 97-114. Especially useful. Walker, J. Samuel. Prompt and Utter Destruction: Truman and the Use of Atomic Bombs Against Japan (2004) online excerpt LeMay, Curtis. Mission with LeMay (1965), autobiography, primary source ? Robert L. Sherrod "Memorandum for David W. Hulburd, Jr." November 15, 1941. The Papers of George Catlett Marshall, ed. Larry I. Bland et al. vol. 2, We Cannot Delay, July 1, 1939-December 6, 1941 (1986), #2-602 pp. 676-681. Marshall made the statement to a secret press conference. For the full text goto and search for "mercilessly". See also Alan Armstrong, Preemptive Strike: The Secret Plan That Would Have Prevented the Attack on Pearl Harbor (2006) excerpt and text search? United States Strategic Bombing Survey, Summary Report: (Pacific War) (1946) online p, 18? Spector, Ronald. Eagle Against the Sun: The American War With Japan (1985)? Dower, John. "Lessons from Iwo Jima," Perspectives (Sept 2007) 45#6 pp 54-56 at [1]? Sadao Asada, "The Shock of the Atomic Bomb and Japan's Decision to Surrender: a Reconsideration." Pacific Historical Review 1998 67(4): 477-512. in Jstor? Wheeler, Keith. "The Fall of Japan" (1983)? Craven and Cate, 5: 608-14; Thomas R. Searle "'It made a lot of sense to kill skilled workers': The firebombing of Tokyo in March 1945," Journal of Military History 103-134 66, no. 1 (Jan 2002): pp. 103-134? Dunnigan & Nofi, The Pacific War Encyclopedia (1998)? Dunnigan & Nofi, The Pacific War Encyclopedia (1998)? Zaloga, Steven J. Japanese Tanks 1939–45 (2007)? J. Samuel Walker, Prompt and Utter Destruction: Truman and the Use of Atomic Bombs against Japan (1997) online edition? Rhodes, Richard. The Making of the Atomic Bomb (1995)? For "revisionists" who reject use of the bomb, see Gar Alperovitz, The Decision to Use the Atomic Bomb (1996) and Barton J. Bernstein, "Seizing the Contested Terrain of Early Nuclear History: Stimson, Conant, and Their Allies Explain the Decision to Use the Atomic Bomb," Diplomatic History 17 (Winter 1993): 35-72? See Sean L. Malloy, Atomic Tragedy: Henry L. Stimson and the Decision to Use the Bomb Against Japan (2008); John Bonnett, "Jekyll and Hyde: Henry L. Stimson, Mentalite, and the Decision to Use the Atomic Bomb on Japan." War in History 1997 4(2): 174-212. Isbn: 0968-3445 Full text: Ebsco; McGeorge Bundy, Danger and Survival: Choices about the Bomb in the First Fifty Years (1988); Elting E. Morison, Turmoil and Tradition: A Study of the Life and Times of Henry L. Stimson (1960); Robert P. Newman, "Hiroshima and the Trashing of Henry Stimson" The New England Quarterly, Vol. 71, No. 1 (Mar., 1998), pp. 5-32 in JSTOR? Quoted in Conrad Totman, History of Japan (2000) online p. 435 ? Crane, Bombs, Cities, and Civilians p. 45 online? Lacking strategic bombers, the Russians relied on their ground forces to capture Berlin in April, 1945. It was the bloodiest battle of the war. Hundreds of thousands of soldiers were killed, along with very large numbers of civilians. Beevor, Antony. The Fall of Berlin 1945 (2003)

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Bill O’Reilly Finally Admits ‘Homosexuality Has Nothing To Do With The Crime Of Pedophilia’

Bill O’Reilly has been campaigning against Colorado House Speaker Mark Ferrandino (D) because he won’t allow a vote on a bill to “Jessica’s Law.” Jessica’s Law imposes excessive penalties on individuals who commit sexual abuse against children, and O’Reilly has repeatedly inferred a connection between the fact Ferrandino is openly gay and not “protecting the kids.” Earlier this week, he responded to criticism over this comparison by doubling down on it. On Tuesday’s broadcast, he finally admitted the connection doesn’t exist, but took no accountability for reinforcing it:

O’REILLY: I have to report the truth here. First truism, homosexuality has nothing to do with the crime of pedophilia. Second, everyone we report on is defined and that guy is proud of his circumstance and promotes it, so we reported it.

Watch it (via Equality Matters):

A “truism” is something so obviously true that it isn’t worth mentioning, and the supposed link between homosexuality and pedophilia hardly fits that description. It’s true that there’s no connection, but it has been made or inferred for decades. More importantly, O’Reilly brazenly made it himself without any subtlety to hide behind just seven months ago. He can’t just shrug it off like everybody knows better when he has a history of miseducating his viewers on the issue.

His admission is also compromised by his description of Ferrandino as having a “circumstance” that he “promotes.” Being gay is not a condition, nor can homosexuality be reinforced in anyone. Under the premise of a campaign to “protect the children,” O’Reilly is only continuing to reinforce stigma against gay people with this kind of rhetoric. If he actually supports civil unions as he claims, he has no grounds for demonizing others for doing the same.

Tonight, Denver Post Opinion Editor Curtis Hubbard, who criticized O’Reilly for his smear campaign against Ferrandino, will appear on his show to confront him in person. Maybe fourth time’s the charm for O’Reilly figuring out how to respect the inherent dignity of an elected official.


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Obama campaign aides' gain is president's pain

President Obama won re-election in what turned out to be a walk. But instead of it clearing the path for progress on his agenda, the path got muddied. The president initially reacted by reverting to campaign war footing, but recently shifted gears and went on a charm offensive when his popularity plummeted. Oh, the tale of woe that is the Obama White House. Has ever a president seemed so lost so fast in a second term?

What went wrong? One need look no further than the heady days after the election, when his cocky campaign aides offered their own beliefs beyond the rout of Romney. Team Obama had a better ground game. Team Obama had better polling. Team Obama understood the shifting electorate better. What was missing? Um, credit to Obama?

That narrative glaringly lacked the premise that Obama won because the public believed in him and his vision for the country. In their haste to promote themselves, some of Obama’s aides turned him into a product that they masterfully marketed. Legacies aren't built around a narrative of great voter databases.

But that's what we got.

“Obama win hinged on ground game, tech,” was the verdict when reporters listened to campaign manager Jim Messina's analysis at the Harvard's Institute of Politics election post-mortem. Well, that certainly makes Mr. Messina look good, doesn’t it?

So while no doubt that narrative made campaign aides brilliant, it also marginalized the president at just the wrong time. It stole his claim for a mandate. Now some of those aides are off making money and he’s inexplicably struggling to rediscover his presidential voice four years into the job. Not good.

You can be sure that President Clinton or President Bush didn’t allow campaign aides to steal their post-election thunder. Harold Ickes and Karl Rove would never have allowed it. Clinton and Bush each had their own second-term blues, some self-inflicted, but post election their teams drove a message that the commander in chief won a second term to complete the mission at hand.

Obama wasn’t as lucky. Now he’s stuck trying to decide whether to be good cop or bad cop. Once again, the president has lost hold of the narrative. Never before has such a brilliant communicator struggled as a story-teller.

Maybe he’ll get lucky and job numbers will continue to improve, which will surely help him get his groove back. And certainly Republicans will bail him out by overreaching, which is in their nature. But in the meantime, President Obama looks like a leader who has lost his way, thanks in part to the same folks he relied on to win re-election.

Galvin is a former political reporter for the New York Daily News who is now CEO of 463 Communications.

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How Food Giant's Hooked Us

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Statement by the Press Secretary on the Visit of Irish Prime Minister Enda Kenny

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For Immediate Release March 12, 2013 Statement by the Press Secretary on the Visit of Irish Prime Minister Enda Kenny

President Obama will welcome Prime Minister (Taoiseach) Enda Kenny of Ireland to the White House on Tuesday, March 19.  The United States and Ireland share a strong bilateral partnership, enduring people-to-people ties, and a commitment to advancing peace, security and prosperity in the world.  In the morning, the President will meet with the Taoiseach in the Oval Office, and subsequently he will attend the traditional St. Patrick’s Day lunch at the U.S. Capitol.  In the evening, the President and the First Lady will host a reception to celebrate their fifth St. Patrick’s Day at the White House.  During the reception, the President and Kenny will participate in the annual Shamrock ceremony started under President Truman.

The President will also greet First Minister Peter Robinson and Deputy First Minister Martin McGuinness of Northern Ireland at the White House on March 19 to discuss their progress toward meeting their shared commitment to a peaceful and prosperous future for the people of Northern Ireland.

Extending Middle Class Tax Cuts

Blog posts on this issue March 13, 2013 4:36 PM EDTThe Economic Case for Commonsense Immigration Reform March 13, 2013 3:49 PM EDTFirst Lady Michelle Obama Challenges America's CEOs To Be Bold in Finding Ways to Hire VeteransFirst Lady Michelle Obama Challenges America's CEOs To Be Bold in Finding Ways to Hire Veterans

The First Lady met today with the Business Roundtable to talk about Joining Forces, her initiative that supports veterans and military families.

March 13, 2013 10:45 AM EDTSunshine Week: In Celebration of Civic EngagementSunshine Week: In Celebration of Civic Engagement

As part of our Sunshine Week series, Macon Phillips discusses We the People.

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Medicaid Expansion Wrong for SC

‘For every problem,” H.L. Mencken wrote, “there is a solution which is simple, clean and wrong.” Enter Obamacare and one of the main ways that it purports to reduce the number of uninsured: putting more people on Medicaid.

S.C. legislators are being pressured to do just that. The House has rejected the idea, and Gov. Nikki Haley has vowed to veto it, but it’s not dead. And if they ultimately sign on to the idea, they’ll find they’ve made a costly mistake and created a long-term fiscal problem.

Specifically, some in the Legislature want to expand Medicaid eligibility to more adults during the three years the federal government covers the expansion population.

But this allegedly good deal will only bring turmoil to the state’s budget in the future. For one thing, Medicaid expansion is not “catch and release” for the states. Once such an expansion has occurred, it is politically difficult if not impossible to roll back enrollment. It becomes a permanent entitlement — and one that is completely unaffordable.

If South Carolina expands Medicaid, taxpayers would be on the hook for millions. According to our research, the expansion would begin costing the state just four years from now and would cost $612 million over the next 10 years — outstripping any purported “savings.”

Already Medicaid is consuming a greater share of the state budget. Expanding Medicaid will make it even larger and harder to pay for other state priorities, including schools and roads, in the future.

This also assumes that federal funding for the Medicaid expansion goes unchanged. Right now, Washington is struggling to get the country’s fiscal house in order. Any serious efforts to address this crisis would have to address real entitlement reform, including Medicaid.

Although administration officials say Medicaid is off the table, it was just last year that the president’s own budget proposed changing Medicaid financing. So these promises are good only until the president needs money to pay for his many other spending priorities.

But affordability isn’t the only issue. Extending coverage via Medicaid doesn’t mean that individuals will, in fact, gain access to the health care they need. Already, it is becoming harder to find a doctor who will accept a new Medicaid patient, primarily due to lower payment rates.

Obamacare tries to temporarily raise Medicaid payment rates for some doctors. But here too it leaves the state holding the bag and ignores the reality that you can’t add millions of people on to a program where there are fewer doctors to see them. Not only will new and existing patients have a harder time finding a doctor, but the doctors will have less time to spend with each patient. The expansion of Medicaid also will displace private insurance and shift more of the cost of health care to the few who still have private insurance.

Who suffers the most if this happens? The needy, of course, including children. Medicaid doesn’t pay for many procedures, and physicians are only able to manage because of their non-Medicaid patients. If more people are dumped into the program, that lack of compensation will only worsen, and the doctors will be forced to do more for even less.

A massive expansion of Medicaid will not meet the needs of those it is intended to reach and will only further exacerbate the challenges of delivering quality care to those currently on it. Medicaid needs reform, not expansion. These reforms can start now with states, like South Carolina, working to develop their own solution for addressing the needs of the uninsured. Ideas that don’t depend on approval or more financing from the federal government.

But as the Hippocratic Oath says, “First do no harm.” S.C. legislators can honor that dictum by not expanding their Medicaid program.

-Former Sen. DeMint is president-elect of the Heritage Foundation.

First appeared in The State.


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New Zealand Poised To Legalize Marriage Equality

MP Louisa Wall

This week, the New Zealand Parliament had its second vote — the most crucial of three — and approved marriage equality with a vote of 77 to 40. Typically the third vote is just a formality, suggesting the country is about to become the 12th on the planet to allow the freedom to marry for same-sex couples. The first vote took place back in August, when equality advanced with a slightly wider margin of 80-40.

The bill’s sponsor, Labour MP Louisa Wall, implored the lawmakers to stand against the prejudice that LGBT people experience, and even quoted hip-hop artist Macklemore:

WALL: The agony and hardship that so many who bravely made submissions have had to face is unreasonable. But what’s totally unacceptable, is the state perpetuating that agony and hardship by not issuing marriage licences to loving, consenting and eligible non-heterosexual couples. [...]

“And I can’t change/ Even if I tried/ Even if I wanted to/ I can’t change…” I hope the House will give a message to all young people. You don’t have to change. You can be who you are and we, as a society, will value who you are.

Prime Minister John Key has promised his support for marriage equality and even participated in a mock gay wedding this past December. In addition, the youth wings of all eight political parties support the freedom to marry.


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Remarks by the First Lady at Business Roundtable Quarterly Meeting

The White House

Office of the First Lady

Business Roundtable Conference Center
Washington D.C.

11:43 A.M. EDT

MRS. OBAMA:  Good morning.  (Applause.)  Thank you so much.

I want to start by thanking Mike for that very kind introduction and for everything that he and Walmart are doing to support our troops, our veterans and the health of our families.  I also want to thank Jim McNerney as well as Governor John Engler for their extraordinary leadership of the Business Roundtable and for inviting me here this morning to be with all of you.

I’d also like to thank the military leaders who are here with us -- Lieutenant General Bill Troy from the Army, and Vice Admiral Bill French from the Navy.  I’d like to recognize the representatives from the administration who have joined us -- you guys wave if you're here -- Fred Vollrath and Frank DiGiovanni from the Department of Defense; John Gingrich from the Department of Veterans Affairs; Keith Kelly from the Department of Labor; and Matthew McGuire from the Department of Commerce.

And finally, I want to thank all of you, the leaders of our nation’s businesses; leaders who care deeply about the future of your businesses and about the future of our country and those who serve it. 

As you know, over the past couple of years, Jill Biden and I have been working to support our nation’s veterans and military families through Joining Forces.  And now that the Iraq War is over and the war in Afghanistan is drawing to a close, we are focused like never before on helping our veterans and military spouses find employment and build their careers. 

Right now, there are hundreds of thousands of veterans and military spouses looking for work.  And in the coming years, we know that over one million more will be hanging up their uniforms and transitioning back to civilian life.  These men and women will be returning to their families, rejoining their communities, and figuring out what’s next in their lives.  And as they do all of that, the one thing that they're going to be thinking about is a job.

They will be trying to figure out how to achieve that sense of financial security and stability for their family, how to find that next mission to accomplish.  And that’s where all of you come in. 

So today, I want to spend a little time just talking to you about who these veterans and military spouses are, what they can do for your businesses, and how they can keep on serving this country in the years ahead.  So let’s start with who they are. 

This current group of veterans –- the 9/11 Generation, as my husband has called them –- holds a special place in our history.  These are the Americans who stepped up and volunteered to serve during wartime knowing full well they would be sent into harm’s way.  They are young -- the majority are between 18 and 34 years old –- and a record number of them are women. 

They’re highly skilled, serving as IT specialists and operations managers, logistics coordinators.  They’ve overseen millions of dollars’ worth of assets, operated complicated machinery, managed dozens –- even hundreds –- of their peers.  On the battlefield, they are the leaders of today’s dynamic modern warfare.  One day they’re handing out humanitarian aid, and the next they’re responding to a firefight, and the next they’re building relationships with local leaders.  And they’re doing all of this on the razor’s edge, when one wrong move could mean the difference between life or death. 

And then back at home, their spouses are serving this country as well.  They’re volunteering in their communities like no one else.  They're taking care of their kids, taking them to soccer; managing their family’s finances alone.  Many are even hitting the books for night class after everyone else is asleep. 

Every couple of years, these spouses are uprooting their lives and restarting their careers as their families are transferred from base to base.  They’re dealing with all the emotions of long, multiple deployments, constantly worried about the danger that lies ahead for their loved one.  And when their spouse comes home, some carrying the seen or unseen wounds of war, they are snapping back to action to care for them.

So these men and women, our veterans and military spouses, have seen it all.  And in the process, they have gained the types of qualities and values that you simply can’t teach anywhere else –- a relentless commitment to excellence, the ability to juggle multiple priorities, the wherewithal to meet deadlines under every circumstance imaginable. 

They know how to develop and execute complex strategic plans, and they don’t give up until their mission is complete.  And when the pressure is highest, that’s when our veterans and military spouses are at their best.

And believe me, my husband and I have seen this firsthand.  We have had the privilege and opportunity to work with military personnel at all levels of the White House, from our policy teams to our military aides to our Navy mess staff.  We have spent countless hours with thousands of our troops and military families at White House events and on military bases throughout the world. 

And let me tell you, they are some of the most nimble and creative and effective people you will ever meet.  And I couldn't recommend them more highly. 

These men and women are exactly the kinds of employees you all are looking for to help you compete in today’s global marketplace, and they’re proving that every single day with their achievements in the private sector.  Let me just share a few stories.

Jenna Dolan was in the Marines for 12 years, including two deployments to Iraq as a fighter pilot.  And today, she’s a program manager at GE where she’s working with outside clients and people from all across the company to help build and sell helicopter engines.  And when she’s not doing that, she’s still serving our country in the Reserves.

There’s Holly Liskey, whose husband has been deployed five times as a Marine in the last 10 years.  While her husband is overseas, Holly serves as a single parent for all five of their children.  And Sam’s Club thought that if she could handle that then she could handle just about anything, so they hired her as an assistant manager.

And then there’s Neil Duncan, a former Army paratrooper with the 173rd airborne.  Neil lost both his legs to an IED in Afghanistan, and since his injury, he’s climbed some of the tallest mountains on Earth –- on prosthetics.  And last summer, at the end of his internship with JPMorgan Chase, Neil’s manager knew they couldn’t let him get away so they hired him for a full-time position as an associate at a bank in Denver where today, he works with clients on their investment portfolios.

And that’s just three of thousands of examples I could give -– a paratrooper in finance, a military wife supervising dozens of employees, and a fighter pilot who’s now a program manager.  These folks are dynamic, resilient, and incredibly loyal.  They are dedicated and hard-working, and they have what it takes to rise all the way to the top of your companies.  And many of you already know this from personal experience.

Right here in this room, we have multiple CEOs who have served in our Armed Forces.  And I want to take a moment to say thank you for your tremendous service to our country.  Thank you so much.

But you don’t have to be a veteran to realize that hiring our troops is the right thing to do for your business, which is why in the last two years, American businesses -- including many represented here today -- have taken up my husband’s challenge to the private sector.  And in the last two years, you’ve hired or trained more than 125,000 veterans and military spouses, and you’ve committed to hire or train 250,000 more by the end of 2014. 

So together, we are making real progress.  And let me just say, I could not be more grateful for those of you who have stepped up and already made commitments.  But I also have to be frank with you as we look ahead at the big picture. 

While we certainly are encouraged that we continue to chip away at the unemployment rate, right now, 9.4 percent of post-9/11 veterans –- about 200,000 people -– are still unemployed.  That’s almost two points higher than the national rate.  And for women veterans, the rate is even higher.  And many young veterans –- those ages 18 to 24 –- more than one out of three are unemployed.  Now, on top of that, we’ve got another 200,000 active duty military spouses currently looking for work. 

And when you combine all those numbers with the one million veterans that we know will be transitioning home over the next few years, it couldn’t be more clear that we still have a lot more work to do.  And that’s why I want to highlight the incredible commitment from Walmart. 

Now, as Mike said, Walmart is projecting that they will hire 100,000 veterans in the next five years, which is truly extraordinary.  But they are not limiting themselves to that number.  They’re making an open-ended commitment to our veterans. 

For every veteran who has served honorably and is in need of a job in the year after they separate from the military, Walmart is telling them that they will hire them.  And they aren’t just looking at annual turnover rates and picking a minimum number they know they can easily hit.  Instead, they are setting the bar high.  They’re saying, no matter what, we’ve got your back. 

Just think about the power of that level of commitment to those veterans.  It's a commitment that carries real weight –- and real risk, I might add.  But Walmart is ready for the challenge.  They’re not just asking themselves, what can we afford to do?  No, they’re asking, what more can we do?

Now, some of you might be saying, sure, Walmart’s in retail.  They’ve got stores in every corner of the country.  They’re hiring for all kinds of different jobs, from customer service to truck drivers to HR.  But while the characteristics of your companies may vary, the character of your commitment to veterans doesn’t have to. 

Whether you’re in finance or technology or the food industry, every single one of you can ask yourselves that same question:  What more can we do?  So today, I want to challenge all the members of the Business Roundtable to answer that question for your businesses. 

Think outside the box.  Take real risks.  And work together to make big, bold commitments to hire our veterans and military spouses and help them reach their full potential within your companies.  Show them that your business is there for them for the long haul.

And if you do that, I know that you can build on the 125,000 folks that we’ve already hired or trained and you can help us bring our veterans unemployment rate down to zero -- yes, zero.  That should be our goal -- in fact, that is our goal.  But it's going to take every one of us doing our part to reach it.

And I want to emphasize that your companies are uniquely poised to make a real, meaningful difference on this issue.  Together, you employ nearly 16 million people.  You represent $7.3 trillion in revenue every single year –- almost half of our nation’s GDP.   So the folks in this room alone have the capacity to end veterans' unemployment in this country. 

Now, of course, I’m not going to try to sell you on exactly who you should hire or how you should train them.  And I do understand that what works for Walmart may not necessarily work for UPS or Motorola.  I mean, you all are the only ones who can figure out the best approach for your businesses. 

But I do want to encourage you to sit down with each other and figure this out together by sharing best practices, pooling resources where it makes sense, and doing everything you can to fully integrate veterans into your businesses.  And as you all are working hard on this issue -- which I know you will -- please know that this administration will be with you every step of the way. 

All the people from across the government that I mentioned at the beginning of my remarks are also working hard on this issue within their agencies, and they will be available to answer your questions right after this meeting and in the weeks and months ahead.

Just last week, we sat down with vice presidents and HR professionals from many of your companies to hear about how we can better help you find the people with the skills and talents that you’re seeking.  And that comes on top of the work that we’ve already done over the past few years, including the tax credits my husband has made available to any business hiring an unemployed veteran or wounded warrior. 

We’re also helping our troops translate their skills into civilian resumes, and matching them with careers that suit their experiences.  We've created an online jobs bank, and we’re connecting your companies to veterans in local communities through our American Job Centers.  And we’re also streamlining the credentialing processes so it’s easier for military truck drivers, welders, machinists and medics to earn the certifications they need in the civilian world.

So believe me, we are in this together with you.  And I also want you to know that folks across this country are in this with you, too.  That’s what I've found to be the beauty of this issue.  Whether folks are in the private or public sectors, whether they’re from big cities or rural areas, everyone is on board when it comes to supporting our military families. 

Just look around this room.  We’ve got competitors like UPS and FedEx, Verizon and AT&T, Viacom and DirecTV all sitting at the same tables ready to take on this issue together.  No matter your differences, you’re here today because you know that hiring veterans is good for your company and good for our country. 

And if you do this, if you direct the full power of your businesses to support our veterans, you will be making progress that lifts up this entire nation.  You’ll be making your businesses more productive, you’ll be helping to lower the unemployment rate, and you’ll be strengthening our economy.  And more than anything else, you’ll be showing these veterans what it means to be a member of America’s military family.

We have the capacity to redefine what it means to be a grateful nation -– that we honor and respect those who serve our country, not just while they’re in uniform, but also when they come home and for the rest of their lives.  And let’s be honest, in previous decades, our country hasn’t always met that responsibility.

But right now, today, we have an opportunity to show this generation of veterans that they’re coming back to a nation that truly appreciates their service, not simply with words, but with real, concrete action -- action that will profoundly impact the direction their lives take long after they leave the military.

We know that finding a job isn’t just about a paycheck.  It’s a pathway to security and stability for these families -- allowing them to save for a home, to send their kids to college, to build the life they’ve always dreamed of. 

But more importantly, a job is a source of pride.  So many of these veterans are just looking for their next mission.  They are ready.  Because for them, the end of their military service doesn't mean the end of their service to this country.  These men and women desperately want to put their training to good use by continuing their service here at home.

They want to play a pivotal role in investing in our communities and rebuilding on this recovery.  They want to deploy their skills and energies to ensure that we remain the greatest nation on Earth.  And we owe it to them to give them that opportunity.

And we only get one chance at this, and we don’t have a moment to waste.  These first few months after our troops transition out of service are pivotal, so we’ve got to act fast.  Now is the time when they’re making decisions that will affect the rest of their lives.  Now is the time when they’re beginning to feel whether or not this country is truly there for them.  So now is the time when we’ve got to spring into action. 

We’ve got to hold ourselves to the same standards of service and patriotism as they've held themselves.  And we’ve got to join forces so that we can truly serve our veterans and military families as well as they have served us. 

So I want to thank you.  I want to thank you all again -- your businesses, the individuals within your companies for everything that you do on this issue.  And thank you for all that you do for this country every single day.  I truly look forward to working with all of you in the months and years ahead.

Thank you so much.

END
12:03 P.M. EDT

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