Iraq's latest Shiite vs Shiite conflict

The new Shiite vs Shiite fighting in Iraq between government forces and Shiite militias is the latest chapter of the post war Iraqi political evolution. There is much discussion about the factions and their leaders but little is being said about the hidden agendas that drive the militia groups to seek political and military domination of the Basra region. It seems to me that the seeds of this conflict can be traced to the partial decentralization of the oil sector in Iraq.

The ill advised decentralization of the previously nationalised oil sector has created an economic incentive for local militias to fight for control of oil rich regions, and to have a vested interest in keeping the central government in Baghdad weak. The central government will never be strong enough to control Iraq as a whole unless it has full control over the oil, thus allowing local politics to be conducted without the hidden oil agendas.

The fight in the oil rich Basra region is not going to be the last fight over oil. As soon as the dust settles the oil rich Kurdish areas could follow, with Arab Iraqis (Sunni and Shiite) fighting to cease control of some or all oil rich Kurdish (Sunni) areas in the north.

The shifting alliances in Iraq is in part due to the desperate attempt of all groups to gain control over all or a portion of the Iraqi oil riches which is now open for local control for the first time in Iraqi history.

In my humble opinion the solutions for much of the simmering internal political and military conflict in Iraq has and will always be the "total re-nationalization" of Iraqi oil industry. It may sound un-American in principle, but it could be the greatest American contribution to the long term security in Iraq.

Romney vs McCain on Immigration

Romney has come a long way to prove himself as the most anti-immigrant among the remaining Republican presidential candidates. True to form, his low blow attacks on McCain’s on the issue came across as slogans and propaganda and lacked real substance.

Senator McCain has nothing to be ashamed of when it comes to his efforts to tackle the extremely unpopular issue of immigration reform. If Romney has it his way then nobody should dare pass any reform and we all should just move south to guard the borders.

Illegal immigrants risk their lives to cross the border only to face exploitation by greedy businesses that pay them a fraction of the minimal wage for the work they do. Their reasons for coming here are no different than the founding colonials. Come to think of those guys didn’t need a visa to come to America either--Their effort to get here was good enough at the time. We all can agree that illegal immigrants are braking the law of the land by crossing the border without a visa but their intentions are as such that calling them criminals is a stretch even in an election season.

Many would agree with the contention that this election is the Democrats’ to lose. The republican nominee for president doesn’t stand a chance in the general election unless he moves to the center. McCain is already there, except on the war.

It is worth mentioning that a growing number of military recruits are now Hispanic immigrants or sons of Hispanic immigrants. The increasing hostile stance by Romney must come as a huge insult to these men and women in uniform. The Hispanic vote is all but guaranteed to be against Romney if he were to clinch the Republican nomination.

McCain should cease the chance to point out that Romney’s only policy on immigration is to build a larger fence then bury his head in the sand, whereas McCain has the courage to at least address the problem head on. There is no clear path to follow on this divisive issue but most politicians recognize that something needs to be done giving the magnitude of the problem.

Tightening the border without immigration reform simply means that the thousands who used to cross the border just to work a few months then return are now having no choice but to stay permanently in the US as they can no longer risk crossing the border back and forth. The anti-immigrant forces are in essence contributing to the increasing number of illegal immigrants permanently residing in the US by their “enforcement only policy”.

Immigration reform would also mean that employers will no longer be able to use the illegal status of their immigrant workers to exploit and underpay them. If Immigrants are paid the same as Americans then the incentive to hire immigrants over Americans would be eliminated.

The many millions who live in the US illegally are likely to remain here no matter what congress decides to do. These immigrants are not going to leave just because the US didn’t pass a law to grant them legal status. Their lives are as such that they have very little choice about where they live. Most are here by necessity and will stay even if their hardships are increased.

It should be clear to most, including Romney, that McCain’s efforts on immigration are honorable and necessary.

The latest attack ads by Romney is further proof that he would do and say anything to be elected. I think he would even switch to the Democratic Party if he thought it would help him get elected.

Turkish attacks in Northern Iraq

The Turkish military was on the brink of initiating a full scale military operation in Northern Iraq back in October but appeared to back down as a result of intense US diplomatic interventions. The visible US concessions to the Turks were that the Armenian genocide resolutions in the US house of representatives was scraped and the US declared the Kurdish enemies of Turkey as enemies of the United States. Aside from the situation in Iraq, the military which represents the secular political power in Turkey was on the brink of yet another military coup to stave off the growing Islamist political power in government. The Europeans applied pressure to prevent that intervention and so the new, ex-Islamist, Turkish president was sworn in despite the objections of the military.

The ex-Islamists in charge of the current Turkish government counted their blessings as the soldiers stayed in their barracks but there is an undeniable sense of urgency on their part to show unconditional support for the military establishment when it comes to attacking the Kurdish rebels. This appeasement phase by the Islamists in Turkey means that the military has a free hand in Northern Iraq as long as they can convince the US to allow operations there.

The recent smaller scale Turkish military operations in Northern Iraq seem to indicate that a deal was struck, back in October, with the US to allow just such operations both for security reasons and to allow the Turkish military to save face and continue to appear relevant in Turkish politics. A show of power by the Turkish military is needed after the events of 2007. Any legitimate oppositions to such operation on the part of the Turkish civilian government would be seen as unpatriotic and give the Turkish seculars an excuse to use the military to oust the Islamists in control of government in Ankara.

We should expect continued Turkish military operations for some time to come but the question now is: how long would can Iraqi politicians turn a blind eye for such operations? The Iraqi military and government view such operations as a violation of Iraqi sovereignty regardless of who is being targeted. The Iraqi Kurds also see these operations as the first indicators that the alliance with the United States has its limits and the Kurds could potentially be sold out if the political and military fortunes change. They are sensitive to this as every Alley they ever had eventually shifted alliance sooner or later through out their history.

The ultimate solution for all would be to come to a political settlement between the Turks and their own Turkish minority (including the rebels). The obstacles to the political settlement include the hard line Kurdish rebels who see independence as the only solution, and on the other side, the Turkish ultra nationalists in the military apparatus who see any negotiations with Kurds as treasonous and a clear threat to the territorial integrity of Turkey.

Below is an excerpt from "Iraq decoded" about the Kurdistan region written in Dec. 2006.(Photos and maps not included here)

Chapter 9. Kurds and Kurdistan

Iraqi Kurds and their politics are probably the most difficult for outsiders to decipher. Most people, including those in the region, know very little about their politics, so Americans can feel better about their less-than-complete understanding of Kurdish issues. Many Americans may be surprised to know that Kurds are mostly Sunni. They are, of course, allied with the Iraqi Shiite Arabs who are, in turn, allied with Iran who is opposed to Kurdish independence or stronger autonomy. The Shiites and the Kurds are unified by their historical suffering under Saddam’s regime, which was supported mostly by the minority Sunni Arab population.

It is important to realize that the Kurds reside in four countries as a significant minority: Iran, Iraq, Turkey, and Syria. This has made it impossible for them to gain autonomous rule or even equal rights in any of them. Such rights in any of these countries are viewed by regional governments as bad precedents which could threaten their territorial integrity. Iran is not only against Kurdish autonomy in Iran, but is also against Kurdish autonomy in Iraq. They consider the latter to be the first step in empowering the Kurds with more rights across the borders. Each of these four countries feels that their own Kurdish minority would demand the same rights afforded the Kurds in the neighboring countries. This has lead to a cycle of interference across borders and a divide-and-concur policy being taken by all sides.

For decades, the Iranians have prevented their resident Kurds from gaining autonomy, while at the same time supporting the Iraqi Kurdish independence movement. This support was not intended to allow the Iraqi Kurds to succeed in gaining their independence but, rather, to destabilize Iraq enough to give Iran a strategic advantage. This same strategy was true of the Iraqi government who supported Iranian Kurds against the Iranian regime. This dynamic preceded Khomeini and Saddam, and is almost a tradition in this part of the world. The cross-border assistance for the Kurdish armed movements resulted in a perpetual state of conflict with no one having an interest in a final settlement. Simultaneously, the Iraqi Kurds were constantly fighting each other as they were divided by their various supporters. The only real friends of the Kurds were the rugged Kurdish mountains. They provided safety against the various attacking armies and allowed them to survive Saddam and others.

The conflict between Saddam and the United States presented a historical breakthrough for the Iraqi Kurds. The establishment of the no-fly zone after the first Gulf war and, later, the alliance with the US during the second Gulf war allowed the Iraqi Kurds to achieve an unprecedented level of independence from the Iraqi central government. In fact, they are now a de facto independent state with their own flag, constitution, and government. This was the only true, unconditional assistance the Kurds received from any country. Kurds in Iraq made the best of this American support and turned their region around economically and politically. This Iraqi Kurdish success story, however, presents a constant threat to all the neighboring countries with a Kurdish minority of their own.

Iran is especially concerned not only because it has a large Kurdish minority sitting at the northwestern border with Iraq, but also because it has other minorities including an Arab minority dominating the oil rich province of Khuzestan (previously known as Arabistan during the Qajar and Safavid Persian dynasties). More Kurdish rights in Iran might embolden the Arabs in Iran to demand more rights in Khuzestan. Such a scenario would threaten Iranian strategic interests in this oil-rich region. Other considerations include Iran’s other minorities, including the Sunni Balouchi minority with strong cross-border ties to Pakistan and Afghanistan and the site of a recent attack (Feb. 2007) on Iranian “Basij” forces, who are considered the Islamic regime’s private army.

The Iraqi Shiites, allied with Iran and jealous of Kurdish control of the northern oil field, are also opposed to Iraqi Kurdish independence. The only reason Iraqi Shiites are going along with the federalism idea now is that, in the short run, they will gain more control of the southern oil fields. They are undoubtedly thinking they can deal with Kurdistan later . . . much later, like when the US is completely out of Iraq. The Sunni Arabs in Iraq are also opposed to Kurdish autonomy. They see the Kurdish oil fields as part of their national treasure; any Kurdish autonomy is considered a first step towards the theft of those resources resulting in further isolating the Sunnis in the poorest region of Iraq. The Sunnis may have the desert, but that desert has much less oil in it than the other regions.

The Sunni Arabs also suspect that the Shiite-dominated central government will do little to explore and develop the small oil fields in the Sunni region. It is no surprise that the first forceful voice against the Iraq study group findings and conclusions was the (Kurdish) Iraqi president Mr. Jalal Talebani. He understood the implications of peace with Iran and the impact of pulling American troops out of Iraq—and along with it the American support to the Kurds.

The Kurds are showing signs of wanting even more than autonomy at this stage. With Saddam’s regime toppled and replaced by a weak central government in Baghdad, it is hard to blame them for becoming politically greedy. They are pushing hard to secure a lion’s share of the oil revenues in their own region, raising the stakes for the other Iraqi factions who are already opposed to Kurdish independence. The Kurds have also pushed to turn the idea of Iraqi Federalism into a de facto declaration of independence, promoting a weak central government in Baghdad. This would leave Kurdistan with significant local powers, including their own independent military power. The Kurds retain in active service Iraq’s best trained and most cohesive forces, in the form of the Kurdish Peshmerga militias. Iraqi Kurdish TV stations broadcast Kurdish news and programs to the Kurds across the border making Iranians and Turks very uneasy. Iran and Turkey can no longer move against their own Kurdish minority without attracting the attention of the Iraqi Kurdish media, who would broadcast the Kurdish point of view to the rest of the world.

Ironically, when we speak of democracy, improved human rights, and minority rights in the region, we forget that if the Iraqi Kurds don’t manage their current gains well, they will put at risk the ambitions for equality of all minorities in the region. The problem is that the Iraqi Kurds can now see an easy path to independence—and they might just take it. In so doing, they would give credence to the argument that if minorities are given more rights, they will use them to gain even more independence and perhaps threaten the countries’ territorial integrity.

When John Kerry and Senator Biden commented in 2006 that all options are on the table, including dividing Iraq up into separate regions, they may have failed to realize the true impact of such policies on the entire region or their impact on the path towards freedom and equality for the many minorities there. If a minority is considered by the rest of the country as a threat to national security and territorial integrity, that minority can expect more persecution. Neighboring countries will tighten their grip and the pursuit of freedom and minority rights will suffer a setback for decades. The US policy should first focus on “do no harm,” when it comes to minorities in Iraq. We should also care, because whatever we do in error, will come back and bite us sooner or later. President Bush may be wrong in thinking that democracy can be exported in a neat package. Yet, he would be right in thinking that US military and political actions in the region can promote civil rights trends that would eventually lead to flourishing homegrown democracies. If the US can prove that granting the Iraqi Kurds more rights won’t
result in the disintegration of Iraq, we would then have succeeded in advancing the pursuit of freedom for all minorities in Iraq and the region.

Americans policies in Iraq, regardless of other agendas, should ensure that any support to Iraq and the regional countries is linked to the rights they afford their people, and especially their minorities. There is no better way to ensure civil and human rights for the entire population than to aim to protect its most vulnerable, the minorities. The US itself offers a perfect example of success in that regard. When the civil rights movement succeeded in passing laws protecting
minorities, they impacted the rights of all Americans of all genders, ages, and races. They even helped to reduce the plight of gay Americans years later.

Democracy takes time to fully blossom in a society. Still it needs to be on the right path, with attention paid to the little, seemingly unrelated issues which could have an impact in the long run. Elections are not all a democracy needs; a commitment to minority rights offers the guarantee for the right to cast votes, the right to freedom of speech, and the right to elect local officials.

Iran has held elections for many years. That criterion alone doesn’t constitute a democracy. In fact, the very existence of elections in Iran provides the Iraqis with the wrong example of a democracy. It is actually an illusion of democracy. People outside Iran don’t realize that, while being able to cast their votes, Iranians lack the right to become candidates unless they are vetted by the central government. Iranians can vote, but they can only choose between cleric
number one and cleric number two. There is not a single city in Iran that can elect its own mayor, because that post is considered a threat to central governmental control. Thus, all mayors are appointed by the government in Tehran. In minority cities, voters don’t even get to choose the city name (changed at will by the central government to water down ethnic identities).

These cities’ appointed mayors often come from elsewhere and from a different sect to insure their detachment from the local population. Obviously, if we allow such “little things” to remain uncontested in Iraq, as in Iran, then we are leading the Middle East on a path away from democracy.

We can protect our interests in Iraq while being the nice guys, which includes being tough on our friends like the Kurds if the need arises. Maybe being the nice guy is the only true way left for us to save the situation in Iraq and be able to complete this mission.

When one looks at the long-term picture for the region, it is apparent that the only spot in the Middle East where there is an incentive to welcome US military bases is Iraqi Kurdistan. Such presence would be welcome on a long-term basis and may be considered a Kurdish national security objective. US presence would provide a way for the Kurds to preserve what they gained in political independence and civil rights over the past 15 years as well as a way to inoculate themselves against future attacks by Iran or Turkey. Despite its desperation for such unconditional bases, the US should not miss this opportunity to set long-term conditions with the Kurds for promoting regional stability and fostering democracy. Such conditions would ultimately serve both US and Kurdish long-term strategic interests. Preserving human rights, curbing corruption, integrating militias with the army, and setting limits on the Kurdish independence ambitions would be objectives to consider.

Arrogant political actions in Iraqi Kurdistan will not be tolerated forever. The Iranians and Turks have time on their side and, before they know it, the Kurds will be back where they started. Under the right conditions, the US can have stable bases in the vicinity while pulling out of hot spots in Iraq. We can accomplish that while promoting, on a long-term basis, human rights issues, the rule of law, and democracy in the region.

All this may all be academic as of now, considering that the January 2007 unilateral US military operation against Iranian officials and diplomatic offices in Iraqi Kurdistan has demonstrated a decision-making process that is short-sighted and focuses only on carrying out security operations without any strategic considerations. To the average Kurd, this kind of unilateral action demonstrates that any US presence in Kurdistan will not constitute an allied presence but instead, one of an overseer. The US must begin acting more like an ally and less like a master in Iraq, including in Kurdistan. We can go after the Iranians in Kurdistan if we must, but need to do so with Kurdish blessing or at least last-minute knowledge.

As the US is working on an exit strategy, the old alliances in Kurdistan are reemerging. Any vacuum left by the Americans will leave doors open for these old alliances to reconsolidate and would likely lead to infighting in Kurdistan. All regional powers would benefit from such infighting, including the central government in Iraq. If we are going to change the political and military dynamics in Kurdistan, we need to cultivate an unbreakable strategic alliance, one that
needs to appear to be a partnership. This partnership would be based on mutual respect and national interests versus a master/subservient relationship that would cease as soon as US interests change or the US forces leave.

In the absence of a US stabilizing presence in Kurdistan, it would only be a matter of time before Turkey began conducting military operations in Kurdistan to pursue Kurdish rebels and separatists fighting in southern Turkey or in pursuit of those who support them in Iraqi Kurdistan. The Iranians would do the same, pursuing Iranian Kurdish nationalists and their supporters in Iraq. Historically, both countries have conducted such operations, though these actions were never large-scale due to the balance of powers in place during Saddam’s regime. With a weak Iraqi government and army, such Turkish or Iranian incursions in Iraq would go unchecked and potentially escalate into a much larger conflict than previously witnessed. The absence of intrinsic or political factors limiting the scope and duration of such operations would destabilize the entire region. Ultimately, if left unchecked, this situation would become unpredictable and could, at the very least, stop the flow of oil from that region.

Politically, this scenario could beget endless infighting and outside political interference from regional powers. Further, the Kurdish people would continue to suffer in Iraq, Iran, and Turkey. Again, it is in the US national best interest to stay in Kurdistan as much as it behooves the Kurdish national interest. Over time, the US presence will encourage dialogue and promote political solutions for the Kurdish problems in all regional countries, as it would eliminate the need for regional military intervention as a means to subdue the Kurds. The people of the Middle East also stand to benefit: policies and laws designed to protect minorities will also protect individual rights for all citizens. Even the Turks can benefit from such a US strategy in Kurdistan; they would be motivated to reach a political settlement with their own Kurdish minority and militias. In doing so, the Turks can improve their human rights record and public image, a first real step towards aEuropean Union membership . . . a goal supported by the United States.

Iraqi refugees returning to Iraq...A sign of success?

The news of Iraqi refugees returning to Iraq from Syria is being reported as a sign of reduced violence and increased public confidence in the Iraqi security forces. There are reasons for optimism in Iraq but I am not sure that the return of the refugees is such a great sign of security success. If the mainstream media were to invest an hour or so researching this topic, they might come across the fact the Syrian government has introduced new visa rules for the Iraqis that make it impossible for them to stay in Syria. With no where to go and no ability to stay the Iraqis are simply choosing to leave before they get deported. The Syrians now require an entry visas for new comers. Those who need their stay permit renewed need to return to Iraq in order to obtain a visa to re-enter Syria.

Like everything else in Iraq, the headlines don't tell the whole story, or even the real story. If we can take a breather from celebrating the refugees' return for a second maybe we can then see the dynamics in play here and start planning for the likely, and imminent, influx of refugees to Turkey, as it is the obvious path of least resistance for Iraqi refugees from this point on.

The return of refugees in such a haste may also result in their segregation by sect for the near future as they are often unable to return to their old neighborhoods due to continued security concerns in most areas. The government of Iraq will also have to manage squatters who took over many of the abandoned homes leaving the refugees with no home to return to. This is but a few of the many refugee issues that demand our attention. Valuable time is being wasted in spinning the news and declaring the refugees' return as an indisputable sign of improved security in Iraq--Improved security in Iraq is but one element in all this. Time will tell if any improvement in security is sustainable enough to prevent more refugees from leaving Baghdad and other hot spots again.

Below is an except from "Iraq decoded" that relate to the refugee issue (written in December of 2006):

Chapter 26. Iraqi refugees,a political gold mine

According to data from the UN’s High Commissioner for Refugees (UNHCR) in 2006_, more than two million Iraqi refugees languish in neighboring countries. This illustrates the fact that the suffering of the Iraqi people extends beyond Iraq itself. Sadly, these refugees are not visible on the radar screens of the policy makers or the US public. Iraqi governmental interest in these refugees is limited to security concerns; it routinely tries to secure the cooperation of neighboring governments to extradite dissidents and insurgence elements or, at least, limit their activities abroad. The US has allowed less than 500 Iraqis to be resettled in the US as of early 2007. The Syrians issue “stay permits” to Iraqis which need to be extended every few months to avoid deportation. The neighboring Arab and Muslim countries don’t seem to care enough to include any assistance for these refugees in their national budgets. This is despite these governments’ frequent expressions of sympathy for the Iraqi people and their stated concerns about the plight of the Iraqi people.
The Syrians are to be given $9,000,000 by UNHCR in 2007 to help with the one million Iraqi refugees there. While nine million dollars may sound like a goodly sum, it amounts to support of a mere $9 per person per year. The Iraqi government cancelled all old Iraqi passports for security reasons, so these Iraqi refugees are struggling to maintain their legal status abroad. Refugees had limited success obtaining new Iraqi passports in order to be able to apply for visas and then move on to Europe or other countries. Even when they attain proper passports, these Iraqis are routinely refused travel visas. It is a life of uncertainty coupled with feelings of abandonment.
This constitutes a humanitarian as well as a social disaster for these Iraqis, mostly middle class, who had the common sense and the ability to extract their families from the daily violence of Iraq. The future and fate of these Iraqis should matter to the US administration. Vulnerable and helpless, whoever comes to their assistance and appears to care, including the US, will be recognized and thanked for years to come—within and outside Iraq. This is a situation where doing the right thing would benefit everyone.
For a smart administration, it constitutes a political goldmine, especially when it relates to the Iraqi refugees in Syria. The US would be able to openly hold public talks and communications with Syria regarding these Iraqi refugees, without having to make any policy changes towards Syria itself. Any US humanitarian assistance would be appreciated by both the Syrians and the common Iraqis. Such assistance would be seen as an act of kindness, one with no immediate ulterior motives or hidden agendas. Provided that such US efforts are public and sincerely meaningful, they would go a long way towards rehabilitating the US image in the region.
A symbolic, low-key meeting behind closed doors to express concern is not what is needed here. A full-scale US bona fide effort focusing on tangible results is what is needed. With US persuasion, the Iraqi government should be encouraged to participate in assisting its citizens in Syria. This could be accomplished by giving the Syrians free oil via its old, unused oil pipe line to
Syria. That may seem to be a waste of desperately needed money, perhaps even an aid to a hostile government, though if done properly, it can have many benefits for the US. It would obviously generate goodwill towards the Iraqi government with the primarily Sunni Iraqi refugees. It would also deter any sabotage against the oil pipeline. To damage that pipeline would be to impair Iraqi refugee assistance efforts; it would serve to assist in shifting Sunni Iraqi public sentiment towards support of more such attacks in the hostile western region of Iraq. Ideally, the Syrians will use this oil to improve care for the Iraqi refugees and would be more likely to cooperate with the Iraqi and US government on future security issues.
The resumption or eventual increase in the flow of oil from Iraq to Syria could become the first step in weaning Syria from its dependence on Iranian oil and assistance. It could help to cultivate closer ties between Syria and Iraq and its US ally. Eventually, this could have the effect of increasing US political and economic influence over Syria.
The US could also come to the aid of Iraqi refugees in Jordan. A fringe benefit of doing so would be the impression it would give the Jordanians and the Palestinians (50% of the population) living in Jordan. Such assistance would be viewed as unexpected acts of kindness, not to be forgotten.
Many of these refugees will eventually return to Iraq. As they do so, they would carry with them a positive image of the US based on their own personal experience. This could be priceless for the US when it comes to repairing its tarnished image in Iraq and maintaining US influence there.
From a humanitarian standpoint, the US should feel a moral obligation to help these refugees, especially as it was US intervention in Iraq that indirectly resulted in the positions these Iraqi families are in today. We can do the right thing and genuinely help the Iraqi refugees, knowing that, politically speaking, no good deed will go unrewarded.

McCain! You're killing me!

I happen to be in the unenviable position of thinking that Senator McCain is the best choice for president of the United States at this juncture. He is probably not going to be president, however, due to, in no Small part, to his own efforts. Everybody know that he needs to pander to the extreme right in order to pass the hurdle of the Republican primary, but he is taking it so far that he is becoming unelectable even in the eyes of right wing Republicans. He looks like he badly needs the presidency, rather than wanting to be president.
His advisers seem oblivious to the fact that both Republicans and Democrats all want an end to the Iraq war in their life time, and so when he the Senator comes across as pro-war no matter what it hurts his electability with both party electorates. Even for supporters, like me, it is becoming worrisome when McCain doesn't distinguish himself from president Bush when it comes to Iraq. There is nothing wrong with qualifying the Senator's support for the war by declaring that he wants the US out of Iraq but he'll do it in a manner that protects US interests and the territorial integrity of Iraq. I personally hope that Mr. McCain doesn't really believe that having 500,000 troops in Iraq would solve the problem; if he does then maybe it's a good thing that he doesn't stand a chance at this point.
If I were the senator's advisor I would advise him to do the following:
-To come to peace with the possibility that he won't be the next president of the United States as it is detrimental to his cause to appear to want the presidency at all cost.
-Support the efforts in Iraq by saying that we he is not in support for immediate withdrawal from Iraq but he does not support turning Iraq into another de facto US territory and is in favor of calculated withdrawal with continued support for our allies in Iraq post withdrawal.
-To continue his anti-torture stance but clearly state that the United States can never guarantee 100% security for its citizens even with torture. The United States, more than ever, needs to make a stance against the forces of hatred and blind revenge within and without. The best chance the US has against terrorism is when it stands for its ideals and principles without giving in to the temptation to hate back and take revenge.
-Declare that the US economic recovery is dependent on US efforts to support peace in the world and mutual peaceful coexistence.
-Talk about how Democratic candidates, if elected, are likely to adopt an aggressive posture in Iraq in order to demonstrate their toughness against terrorism, and that Senator McCain is the best candidate, as a war hero, to make the right decisions in Iraq without worrying about being called a coward if he pulls out of Iraq.
I hope Senator McCain would heed the advice and go on to be the next president of the United States.

Jabbar Fazeli, MD
Author, Iraq Decoded

Better Healthcare for the un-insured. Why forgo simple solutions now in favor of comprehensive reform later?

As a physician and as someone who was once un-insured, I see both sides of the healthcare coverage issue. You would think that being a physician I should have always had health insurance, but in fact I did not have insurance coverage for two years; I could not afford the high premiums and pay for my new private practice at the same time. I also had an eye opening experience when I helped an un-insured niece through a life threatening illness for which I am still paying in excess of $330,000 in medical bills. The cute little thing is worth every penny but her medical bills total would have been no more than a measly $100,000 had she been insured.
It is undeniable that having millions of uninsured Americans is morally unacceptable and financially unsustainable for many Americans. It is regrettable, however, that we are constantly trying to address this problem by waiting for drastic solutions to materialize. We neglect the many smaller scale, less costly, options available to us now. Many of these interventions cost very little when compared to the holy grail of healthcare reform, the “universal healthcare”. Most importantly, we probably could implement many of these simple measures right away and with minimal controversy. Below is an outline of some of these quick and small scale fixes that in my humble opinion deserve more attention and consideration.

• Families spend thousands of dollars on medical bills and health insurance premiums but are often unable to tax deduct these expenses. It would be worth considering removing some of the many restrictions that preclude the tax deduction of health related expenses, knowing that it would deprive the government of highly addictive tax dollars.
  
• Hospitals and doctors, like me, have a peculiar billing system. The first ground rule is that they are not allowed to charge insured patients anything beyond what their insurance dictates by contract. This is in contrast to dentists who can bill patients for whatever the insurance doesn’t cover or underpay; something that makes dental insurance obsolete in my opinion, but that’s another story. You would think that all medical bills sent to the insurance companies would therefore be for the exact amount allowed, but they rarely are. These bills often contain charges that are more (much more in case of Hospitals) than the allowable amount for the medical service rendered. A Hospital that is billing $2,750 for a service that only pays $750 (per the insurer) is only going to get paid $750. The difference between the charges on the bill and the actual money paid is called an adjustment. So why bill higher if they’re only getting a pre-set amount, you may ask. There are many reasons for this billing practice, one of them is that the insurers periodically adjust the allowable payment rates based on actual unadjusted bills, and so Hospitals and physicians try to bill the actual desired amount rather than the allowable amount. For the insured person this is a harmless exercise except for the confusion when he or she reads a copy of the bill. Most patients eventually realize that they are not paying anything beyond what their insurance allows, and so there is no harm done.
  In the case of uninsured patients this harmless billing discrepancy turns into sanctioned over-billing across the board. By law, hospitals and physicians must bill every patient equally for the same services. Therefore they must send uninsured patients the same unadjusted high bill they usually send the insurance companies. There is no adjustment to follow however, as there is no contract in place to mandate such adjustment. Ironically, the law designed to ensure equal billing is mandating inequality in billing for the uninsured. Simply put, in our previous example, the uninsured patient gets the $2,750 bill and has to pay the total amount. In comparison, the insured patient would get the $2,750 bill but the payment is only $750, as determined by the insurance company. Ironically most Americans, including politicians, are unaware of the shocking fact that there is no law on the books to protect the uninsured from this systematic over-billing. In the United States of America un-insured patients are charged much more than their insured counterparts and there is no law against it--shouldn’t this be a headline?
  The only time an adjustment is offered is when the uninsured patient requests it, and if the Hospital feels generous enough to grant it. Physician bills are much smaller compared to hospital bills but the same legal principles apply. Each doctor’s office has a policy on how to deal with bill adjustments and ride-off for the un-insured and many make provisions for such patients, but they are not obligated by law to do so. Clinics with sliding scale payments and some government sponsored partnership programs with hospitals have no such issues of over-billing.
  It would be great if presidential candidates or other politicians and activists were to show interest in tackling this simple issue of equal and fair billing for the uninsured. It would be quite reasonable to pass a law that requires hospitals and doctors not to charge the un-insured anything beyond what they expect from their best paying insurance. That would mean that the hospitals and physicians would still get to bill at the most generous rate available, and the un-insured will be spared the unfair over-billing.
  
• Last but not least, there is the matter of the sky rocketing health insurance premiums. I find myself dealing with high premiums for my own employees, just like any other business. I can’t help but find it wasteful to pay the hefty premiums when most of my employees never end up needing a physician or hospital care. For my personal insurance I have a $5000 deductible insurance that has a premium of under $300 per month. That’s a total of ~$8600 per year, assuming I use up all the money set aside for the deductible. The ~$5000 I am allowed to deposit in my health saving account is totally tax deductible and I use it for my dental care, medial bills, and medication purchases, etc. Any remaining money in the health saving account carries over to the following year and it even earns interest. After depositing $5000 the first year I can either supplement it with smaller amounts the following years or deposit the maximum ~$5000 allowed each year, creating a cushion for future years. This money never goes to waste and can even be inherited.
  I considered the same insurance option for my employees but I realized that there is a constant problem and that is that most people who can not afford the high health insurance premiums can not afford to set aside $5000 for their health saving account to cover the high deductible. Without having this money set aside in reserve in the health saving account they risk having to pay for unexpected medical expenses of up to the maximum $5000 deductible out of pocket. Most employers want to help but can not afford to step in and contribute the full $5000 per employee towards their individual health saving account as that can add up to a large sum of money. This becomes a major barrier for use of this seemingly reasonable healthcare insurance option. If small businesses or businesses in general, were allowed to have a business health saving account to cover employees in lieu of individual health saving accounts then the amount of money that has to be set aside by the employer can be set to be much less and still have a large sum of money on aggregate to be used toward employee high deductibles, and still enjoy the lower premiums offered by the high deductible insurance. Businesses can accumulate money, tax free, in the business heath saving account overtime to be used for various healthcare expenses. This is yet another option that should be considered by politicians and advocates even by those who believe in working towards universal coverage.
  

Being a geriatrician, I deal with the US versions of government sponsored healthcare as most of my patients are insured by Medicare, Medicaid, and the VA. These programs provide universal coverage for select groups, the elderly, the poor, and the veterans. I also had first hand experience with national universal healthcare when I practiced Medicine in Eastern Europe at one point in my life.
The grass is greener on the other side, as they say, but for those involved in the healthcare industry it is no secret that countries with national universal healthcare are moving towards fee for service models to supplement their universal systems. Private healthcare in these countries is readily available and is accessed by the wealthy unsatisfied with the long waits and the inevitable rationing of healthcare resources. Rationing healthcare resources often seem very reasonable to planners and proponents of universal healthcare until these individuals are themselves the ones waiting an extra couple of months for chemotherapy or are denied expensive life saving measures. The wealthy have no such worries as they will always have the option of paying for their healthcare or traveling to wherever the needed medical care is available. They are also more likely to use their influence to improve their access to any universal healthcare system, resulting in even longer waits for the rest of the population. I also worry that expenditures on the elderly will likely be considered a second tier priority, as spending healthcare dollars on children and younger adults will most likely be considered more cost effective. Ultimately, Americans who choose universal healthcare should ask themselves if they believe that Medicaid, Medicare and the VA is the way to go for all Americans. Hopefully any major overhaul of healthcare in the USA will be a result of deliberate analysis and debate, and not just because it’s better than nothing. In the meantime, I think it’s reasonable for all sides of this debate to press forward with what little we can do for the uninsured now, even if it is done piecemeal.

"Giving up in Iraq" or "Giving Iraq up"?

The situation in Iraq is so difficult that even the criticism is becoming chaotic and hard to track. Among the many topics in current events one core issue is worthy of special focus and attention and that is "Iraqi sovereignty" or lack thereof. It maybe easier to control a country that lacks an assertive and independent government, but is keeping Iraq submissive becoming a long term US policy? When the president speaks of not wanting to "give up in Iraq" is he really saying that he doesn't want to "give Iraq up"? There is evidence of this sentiment in recent events, like the blackwater incidents and the political aftermath in both Iraq and the US.

Article 17 of the post-war Iraqi law is a directive by Paul Bremer that gives independent contractors immunity from prosecution. The Iraqi government and parliament, following the recent killing of Iraqis at the hand of security agents, are now working to pass legislation to reverse this legal provision and make all security agents subject to prosecution under Iraqi law. In separate but parallel action, the state department and the Pentagon are fighting over which agency should be supervising the independent contractors for the Iraqis. It was finally decided, according to the New York Times, that the Pentagon will take on that responsibility, implying that perhaps that the uniform code of military justice will be used to prosecute future validations by independent contractors in Iraq.

It is interesting to note the disconnect between what the Iraqis appear to want and what the US is prepared to allow them to have. It is not very hard to predict that tension will likely rise over this issue in the coming months as the Administration fails to satisfy Iraqi government's wish to assert sovereignty--This will likely widen the schism between the USA and Iraq. The question now is what will the administration do when the Iraqis do pass the new law and try to prosecute independent contractors guarding US officials in Iraq, or push for their removal from the country.

The Iraqis are already harassing the independent security contractors using excuses such as non-compliance with weapons licensing laws. It is a popular move with the public and is a way for the Iraqi government to act anti-American without getting in political trouble with the administration. It could be a sign of things to come as Iraq as whole, including its government, is turning anti-American.

One thing is for certain and that is that the administration, by denying the Iraqis authority over independent contractors, is leaving itself with only one option moving forward and that is to weaken the current Iraqi government and reduce its authority to assert sovereignty.

At this point the Iraqi government has officially revoked blackwater's license to work in Iraq but the blackwater company continues to work unimpeded. It is assumed that the US is unable to comply with this, legally non-binding, Iraqi government decree to remove blackwater from Iraq because there is nothing to replace this company with. It is the familiar "all or nothing" choice we seem to end up with in Iraq. The decision makers imply that the US government has only one choice (a bad one) and there are no other options. If all hidden agendas and lobbyists are removed from the equation, the administration maybe surprised to find that is more than capable of coming up with other options vis-à-vis oversight of independent contractors in Iraq.

Looking at the big picture it is not hard to realize that these seemingly little episodes demonstrate a lack on interest in allowing total independence for Iraq and its government. This stance, whether it is based on a hidden agendas or a full fledged policy, dooms the US presence in Iraq and puts the US on a course to becoming an enemy of Iraq and its future governments.Our politicians need to explain to us how they expect the United States to eventually give the Iraqi government full control over Iraq's oil and security forces if we can't even see our way clear to granting the Iraqis the right to prosecute foreign nationals accused of murder on their soil.

One solution to the blackwater situation is to allow the Iraqi government to enforce the revocation of the company's license; the US can then setup a mechanism by which independent contractors can be re-hired by the pentagon. This will most likely result in the bankruptcy of blackwater, despite the lobbying by its billionaire owner, but it would allow the Pentagon to employ ex-blackwater employees under new terms. The Iraqi government having saved face would probably allow the pentagon to assume the role of prosecuting contractors for future infractions. Such action would guarantee independent contractors the ability to work in Iraq while bolstering the Iraqi government's image, rendering it more relevant and legitimate. More importantly, it would set the tone for future US policy when it comes to respecting Iraqi sovereignty and building a lasting alliance based on respect and mutual interests.
Jabbar Fazeli, MD

Author, "Iraq Decoded"