Archive for September, 2007

Health Mess

Monday, September 24th, 2007

The Health Care Mess, Julius B. Richmond M.D., Rashi Fein, Ph.D., 2005

Broken Health Care

Here is a compact look at the U.S. health care mess, its history and prognosis. The book starts with the Flexner Report of 1910 which called for reform in the education and training of doctors. This report and supporting grants from the Rockefeller Foundation from 1910 to 1928 helped to establish better and standardized curriculum for training doctors and for accrediting educational institutions. An unintended consequence of the reform was a sharp reduction in the number of schools and the number of doctors trained dropped by almost one half.

Also coming into prominence early in the Twentieth Century was the American Medical Association (AMA) who from the beginning opposed health insurance for the public (1917 and 1947) and acted more like a guild than a health care advocate interested primarily in restricting membership and maximizing the income of doctors. From the beginning the AMA has remained a conservative, slow to change organization, out of step with the health care needs of the nation.

In 1937, a “Committee of 430” concerned Physicians issued a statement indicating that national public health requires the participation of government. The committee was attacked including personal harassment of individual members by the AMA.

During the depression and WWII, national priorities were elsewhere and doctors incomes were held down by outside events. After the war, the trend toward specialization of training and initiatives to attack certain problems such as the National Heart Institute and National Cancer Institute among others gained momentum. It was now politically possible to funnel government research grants to research universities and institutes. The Natinal Institute of Health (NIH), using a carefully selected board to select among grant applications moved research dollars freely into medical schools and universities, $1.5 billion per year by 1965. The AMA was fairly neutral about this activity.

The Great Depression hit hospitals hard as the public could no longer afford visits. In 1929 a hospital in Dallas came up with the idea of a prepaid group plan (PGP) . The plan was called prepaid to avoid insurance reserve requirements and was sold to entire groups such as employees of a company or teachers to minimize marketing and administrative costs. The idea spread quickly and the AMA threatened to blackball participating physicians, denying them appointments and key memberships. In 1943 the U.S. Supreme Court found the AMA guilty of restraint of trade and in violation of the anti trust act. By 1951, PGPs grew to cover 77 million Americans.

Ironically the very success of the PGPs was used by the AMA to help defeat Truman’s attempt to enact universal health coverage in 1947.

The large number of covered patients getting their primary health care at the hospital had the unintended consequence of requiring the building of ever increasing numbers of expensive hospitals. The research was at the same time resulting in the need to equip these hospitals with ever more and costlier technology. Thus the cost of providing PGP care was climbing fast.

But significant groups were left outside the PGPs. When LBJ won re-election in 1964 and the Democrats won control of both houses, the President pushed for a hospitalization plan to cover retired seniors, a politically powerful group already administered by Social Security. The AMA tried to defeat this plan by proposing an alternate limited plan to cover the very poor. To counter their move, the President and Congress expanded the Medicare Plan A hospitalization plan with an optional Plan B to partically cover physician and outpatient services and additionally created a Medicaid Plan to cover the poor. Both programs were enacted in 1965.

This AMA defeat has to stand as one of the biggest strategic backfires in the history of legislation. The AMAs lack of public concern and consequent isolation of physicians from the public health debate caused Medicare to be located within Social Security and Medicaid to be located in Welfare Administration rather than the more logical U.S. Public Health Service. Membership in AMA fell from 75% in 1975 to 29% in 2005. Along the way, the AMA was sued for breach of contract with Sunbeam over their “Health at Home” products and settled for $9.9 million and they dismissed the 17 year editor of their JAMA over a truthful scientific article the directors disagreed with. All this left the medical care community largely outside of national health care policy decision making. Today, doctors do not have a respected national organization able to represent their views effectively.

Alper Alper

The last major leglislative change in health care was passage of the 1973 Health Maintainance Organization (HMO) act, enabling private companies to build organizations modeled after California’s Kaiser Permanente PGP, although HMOs could contract with physicians and hospitals to provide their care and not own the whole health structure including the hospitals.

Debates over National Health Insurance (NHI) again surfaced in 1974 with Edward Kennedy and Nixon making competing proposals neither of which were passed. Carter tried again in the late 1970s and the Clintons in 1993. With Medicare and Medicaid already in place, the uncovered were largely wage earners not qualified for Medicaid. With this weak constituency, all NHI proprosals failed. The 1993 Clinton effort suffered from fatal problems; noone in Congress least of all Edward Kennedy was consulted nor was Jimmy Carter; Bill Clinton mandated no tax increase; 500 experts developed a plan of nightmare unworkable complexity; the Clintons unlike LBJ knew almost nothing about the workings of Congress. Their proposal didn’t make to the floor of either house of Congress and the Clintons forever abandoned the effort to reform health care.

Attempts were made to weaken Medicare by moving some subscribers to Medicare + Choice HMO programs. Participating HMOs cherry picked only healthy subscribers leaving sicker subscribers to traditional fee-for-service Medicare. With this program, Medicare found itself paying more per subscriber for traditional Medicare and also paying large sums to the HMOs. From 1999 to 2003 enrollment in + Choice HMOs dropped from 6.3 to 4.6 million subscribers. Medicare also limited inflationary increases in payments to HMOs to 2% at a time when costs were rising 12%. Most HMOs felt they needed to drop out. To save the program “reforms” were adopted in 2003 to greatly increase subsidies to HMOs under the program now renamed Medicare Advantage. The result of this meddling has been to drive the subscriber monthly and copayment cost of traditional pay-for-service through the roof. The Part B premium went from 66.60 in 2004 to 77.80 in 2005, an increase of 17.4%. the COLA cost of living adjustment for social security in 2004 was 2.1%. The monthly premium started at $3 in 1966 and remained under $10 until 1981. Premiums will become $93.50 in 2007, more than double the premium in 2000.
medicare advantage

From 1974 forward health care policy debate focused primarily on the runaway costs of health care that grew from 4.5% of GDP in 1945, to 5.7% of GDP in 1960, to 16% today and projected to reach 17% of GDP soon. Debates about NHI focused primarily on the cost controlling potential impact of the various suggested programs. Ironically, Medicare, Medicaid, and the HMOs, meant to control costs, seemed to drive costs ever higher. In an environment of deregulation (Airlines, Telecommunications) started under Carter, deregulation of health care seemed only to spiral costs (and profits) ever higher.

The HMO based system set up a “market” system that “destabilized” health care. In a traditional market system the buyer is the consumer. With HMOs, the buyer is the employer looking for the lowest cost system. The seller, the HMO, in turn, is not the producer. The producer is the physician or hospital. Lost in this equation somewhere is a patient seeking and receiving proper health care. Hence the destabilized market.

In 1985 3/4 of persons enrolled in health care plans were not-for-profit. By 1999 2/3 of persons enrolled were in for-profits. This change resulted in capital drying up for non-profits as for-profits showed potential to make real money. Again, lost in here somewhere is a sick patient looking for help.

Looking at statistical gains in health, the authors attribute 90% of improvements to a better informed public benefiting from research such as the landmark studies linking cigarette smoking to lung cancer. The improvements are largely due to changed behavior (better diet, more excercise, no smoking) on the part of an educated public. In other words, 16% of GDP buys us a 10% improvement in health care.


The book briefly discusses the mess that is malpractice. Modern profit driven HMO medicine gives patients little opportunity to get to know their doctors as caring individuals. This lack of relationship greatly increases the distrust between patient and doctor that can lead to misunderstandings and lawsuits. Doctors are forced to carry malpractive insurance although premiums very widely such as $10,000 a year for a surgeon in Minnesota and $175,000 for a surgeon in Florida. Lawyers specializing in malpractice instigate many suits knowing full well most will be dismissed. If they win before a jury, the damages can make all the failed cases worth while. Insurance companies may settle small cases out of court making the insured doctor look as if he/she is guilty of malpractise. The insurance policy gives them no say in the matter. Very few patients actually experiencing malpractise are compensated under the system. Small but real claims are lost in the system. Most bad doctors go unpunished largely because in an adversarial environment the doctors and hospitals stand together to fight off the lawyers and malpractise continues. The author’s don’t show a way out of this mess but seem to believe that there are reforms possible.

They also briefly discuss the trend toward private support and proprietary development within our universities and other research organizations. Proprietary products and trade secrets is a radical departure from the past when government sponsored research results was freely published and open to all. The authors believe this emphasis on secrets greatly detracts from the educational process and greatly devalues our important educational institutions. They laud the Internet for making research and medical education information universally and instantly available.

Their discussion of options is centered around key debate items. I have added my answers in parentheses.
1. Does the system require a comprehensive overhaul or can it be fixed in icrements? (comprehensive)
2. Do employers belong in the middle as buyers of health care on behalf of employees? ( no)
3. Do private insurance companies have a role providing universal health care? (no)
3b. Should the system support risk adjustment; that is different premiums for different subscribers depending on factors like general health, health history, and age? (no)
4. Should for-profit hospitals nursing homes and other facilities be converted to non-profit? (yes)
5. Should the system offers subscriber choices? The authors admit that offering choices noone understands like the Medicare drug benefit produces sham if not outright fraud. (probably not)


The authors recommend a single payer, universal coverage, non risk adjusted system. This is the only system simple enough to work and yet to cover everyone without discrimination. In interacting with the health care system, (the providers), the system should emphasize regionalization and rationalization of delivery as a way control costs and eliminate waste. Serious consideration should be given to reconverting all hospitals, clinics and nursing homes to not-for-profit.

The authors then ask whether such a system can be realized in the current political climate. They admit that existing for-profit vested interests have enormous political leverage and influence. They also point to the failures from 1974 to today to reform the system. They also point out that the last successful initiative, Medicare, did not have opposition from vested for-profit insurance because by and large social security subscribers had no insurance to displace.

They finish with some creative suggestions for how we might be able to get from here to there in the current political climate. Unknown in this discussion is the state of political will.


Most Americans know the existing system is a mess with marginal access to real care and skyrocketing cost for the insured and large numbers (45-50 million) now left with no coverage at all. Will this translate into pressure on the new President and Congress to undertake a major comprehensive restructuring? Judging from the Democratic candidate’s announced “Health Plans”, little will be done to fix our fundamentally broken system. Maybe only campaign finance reform with government support of candidates and mandated access to media will free our politicians to attack some real problems and not just pander to the special interests which in health care are formidible.

Tin Memories

Thursday, September 20th, 2007

Peeling the Onion, Gunter Grass, 2007

Danzig in 1900 Danzig in 1900

A memoir of his youth, sometimes in the third person, this is an extraordinary exercise in recovering memories of a momentous past, starting in Danzig, an old city that ceased to exist in 1939 and was utterly destroyed by the Russians at the end of the war. Like his city, all documentary evidence to substantiate that this memoir is not a complete fictional work of the imagination is lost to history. Many characters and situations encountered here have found their way into Grass’s fiction. The veracity of his recovered memories really don’t matter much anyway in this compelling work.

Old Danzig Old Danzig

Having grown up in a family that was expelled from house and home, in contrast to writers of my generation who grew up in one place — on Lake Constance, in Nuremberg, in the North German lowlands — and are therefore in full possession of their school records and juvenilia, and having ipso facto no concrete evidence of my early years, I can call only the the most questionable of witnesses to the stand: Lady Memory, a capricious creature prone to migraines and reputed to smile at the highest bidder.

Written with wit and humor, we see the young Gunter Grass at age 11, armed with his mother’s ledger, traveling the neighborhood to collect debts owed the family grocery, earning 5% of debts collected, money that allowed him to see all the movies including Chaplin and Keaton, collecting in turn a lifetime of remembered smells, and learning skills which would later enable him to negotiate and argue with deaf publishers.

During his obligatory youth service we are treated to the Heideggerianisms of the drill Corporal; “You forgetful-of-being dogs, you!” and “We’ll knock the essentiality out of you yet!”. Grass also relates memories of the the very Arian looking blond Jehovah’s Witness (conscientious objector) Wedondothat, who after repeatedly refusing to hold a rifle, is sent to a concentration camp.

Grass laments the limited effects of literature on our lives when, after reading Erich Maria Remarque’s All Quiet on the Western Front about the horrors of WWI, Grass volunteers for the the heroic submarine or tank corps.

He is drafted at age 16 into the Waffen SS and is trained as a Tiger tank gunman. During his training and in the war Grass never sees an actual Tiger tank. His only experience in battle with a tank is hiding underneath an antique alongside his commander as the Russians blow the group apart. His inability to ride a bicycle saves his life, and a wily veteran Pfc tells him to get rid of his Waffen SS jacket before a Russian cuts his throat. Twice he finds himself holding a machine gun he is not trained to use and which he never does.

An American POW in Bad Aibling camp, Grass meets a caraway seed chewing camp mate with whom he throws dice who later becomes the Roman Pope. Shown American photos of the Bergen-Belsen and Ravensbruck concentration camps, the POWs decide they must be American propaganda. Grass is taken on a young Nazi reeducation tour of Dachau and the young Nazis decide that the recent plaster in the showers (gas chambers) must mean the Americans built them.

Of his wartime experience Grass writes:

… the questions I had failed to ask … my petrified faith … the Hitler Youth campfires … my desire to die a hero’s death like Lieutenant Captain Prien of the submarines — and as a volunteer Labor Serviceman we called Wedondothat (the arian Jehovah’s Witness) … how Fate had saved the Fuhrer (from bomb assassination) … the Waffen SS oath of allegiance in the jangling cold: “if Others Prove Untrue, Yet We Shall Steadfast Be” … And the Stalin organ (Soviet rocket) and all the deaths it caused, mostly among the young and unprepared like me … the song I sang out of terror in the woods until an answer came … the Pfc who saved me but lost both legs to a Russian grenade while I was spared … My belief in the final victory to the bitter end … the lightly wounded soldier’s feverish dream of a girl with black braids … the gnawing hunger … a game of dice … the disbelief at the pictures of Bergen-Belsen, at the piles of corpses — look at them, go ahead look at them, don’t turn away, just because — to put it mildly — it is beyond description …

But because so many kept silent, the temptation is great to discount one’s own silence, or to compensate for it by invoking the general guilt, or to speak about oneself all but abstractly, in the third person; he was, saw, had, said, he kept silent…and what’s more, silent within, where there is plenty of room for hide and seek.

On postwar existentialism Grass writes:

The long standing affinity that I and my kind felt for existentialism — or what passed for existentialism at the time — was based on a French import adapted to German rubble conditions and could be worn as a mask becoming to us, the survivors of the “dark years,” as one of the circumlocutions for the period of Nazi hegemony had it: it fostered tragic poses. You saw yourself at a crossroads or before the abyss, according to your mood. All mankind was supposed to see itself in jeopardy. The poet Benn and the philosopher Heidegger furnished quotes for the apocalyptic mood. The background to it all was the thoroughly researched and soon to be expected death by the atom.

An art student in Düsseldorf, Grass plays the washboard in a jazz group performing at a pseudo Hungarian restaurant, one time joined by Louis Armstrong for six or seven minutes. Of the experience Grass writes:

The honor with which it crowned our attempts at entertainment means more to me than all the prizes I later won, including the most prized of all, which having been granted to me in my biblical old age, gave me an ironically distanced pleasure and has since stuck to me like one more job title.

Olivetti Lettera 22
Olivetti Lettera 22

Grass says he marveled at the miracle of language in James Joyce’s Ulysses combined with the Alfred Doblin masterpiece Berlin Alexanderplatz. He received an Olivetti Lettera portable typewriter as a wedding gift with which he has written since and that he calls his most faithful lover. Like all his wives, his faithful Olivetti Lettera had two sisters.

On his novel The Tin Drum, published in 1959, and written in Paris Grass writes:

But it (the German past) stood in the way. It tripped me up. There was no getting around it. As if prescribed for me, it remained impenetrable: here was a lava flow that had barely cooled down, there was a stretch of solid basalt, itself sitting on even older deposits. And layer upon layer had to be carried away, sorted, named. Words were needed.

Nobel Prize for Literature The Tin Drum

And if on the one hand Oskar was clever enough to use me, on the other he had the generosity to leave me the copyright to everything that occurred in his name… Oskar must always be first, Oskar knows all and tells all, Oskar laughs at my porous memory. For him, as is plain for all to read, the onion performs a different function, has a different meaning.

Gunter Grass birth chart

Venice Pieta

Monday, September 17th, 2007

Vivaldi’s Virgins, Barbara Quick, 2007

Set in Venice in the early 18th Century, this novel is based on the well researched lives of the red priest Antonio Vivaldi and his most famous musical student, the foundling, Anna Maria dal Violin for whom Vivaldi composed a number of works, including the Six Violin Concertos for Anna Maria.
vivaldiPierLeoneGhezzi1723. Six Violin Concertos for Anna Maria

The Ospedale della Pieta was a long established Catholic orphanage and school where orphans and foundlings, some the illegitimate children of aristocrats and priests, were sent to be raised in a safe environment. The children’s identity and parentage, if recorded, were closely guarded secrets of the Pieta. Girl children, if they had an aptitude for music, were trained as singers and musicians and they performed in churches throughout Venice. Antonio Vivaldi, a non practicing priest, was retained by the Pieta as a teacher and composer of choral and instrumental works for the students.

Ospedale della Pieta Ospedale della Pieta
Vivaldi Tafel

This novel is largely a coming of age story of Anna Maria who desperately wants to know her parentage and is encouraged to write letters to her unknown mother. She has adventures where she sneaks out to attend Operas and balls, where contemporary luminaries such as the Saxon George Frideric Handel and Italian Giuseppe Domenico Scarlatti perform. Anna Maria’s best outside friend is the gay assistant to the Pieta seamstress, a wise Jewish woman living in the Ghetto. Gives a lot of detail about the decline of the Venice aristocracy, life in Venice and the Pieta, and the music of the period.

Secrets in an Open Society

Monday, September 10th, 2007

Legacy of Ashes, the History of the CIA, Tim Weiner, 2007

A 500 page history using recently released documents and extensive interviews, Weiner concludes that the gross incompetence of the current American intelligence community is not new, they have been incompetent since their beginning in WWII. Our impressions have until now been based on rumor, speculation, and revealed screwups. With this book we have the full history in agonizing, painful detail.

Americans are incurious people, terrible at languages and ignorant of other cultures. For most of our history, America has been staunchly isolationist, wanting nothing to do with foreign intrigues. During WWII America relied heavily on British intelligence. The wartime OSS was largely an adjunct of British intelligence. After the war, a small cadre of mostly Ivy League OSS officers tried to build an American intelligence service. Throughout the CIA’s history they have never been able to find or attract talented agents and the history of intelligence gathering is almost non existent. America had no idea what was happening in the Soviet Union or Communist China. The Russian atomic bomb, the first space rocket, the Chinese invasion of Korea were all total surprises to our intelligence gatherers. When Stalin died in 1953 the CIA was clueless what might happen. On the other hand, foreign powers found easy access to American intelligence, infiltration our service freely and feeding false information at will.

Weiner focuses the early history on three cowboys not much interested in intelligence gathering but keenly interested in covert operations, Frank Wisner, Allen Dulles, and Richard Helms. Their approach was to spend money to buy people and elections, to arm badly trained insurgents and then send them to their deaths in Russia, Eastern Europe, and China. One operative, nationalist general Li Mi, stranded in northern Burma was given money and guns. Li Mi refused to fight the Chinese communists and instead built a heroin drug empire in the area known as the Golden Triangle. The CIA had to start another war twenty years later to wipe out his drug empire.

In 1950, the CIA launched a fifteen year research program originally code named artichoke and later ultra to test heroin, amphetamines, sleeping pills, LSD, and “special interrogation techniques” for mind control. Some subjects were kept in Panama. One army employee test subject jumped out a hotel window in New York. Richard Helms later destroyed all record of these programs.

An early story of the Berlin tunnel reveals the pattern. The CIA committed 350 agents to dig a 1467 foot tunnel from American Berlin into East Berlin and to tap into a cable communications link. The tunnel was completed in 1955 and an army of translators decoded the tens of thousands of voice and telex messages. After 11 months, the tunnel was uncovered and an international uproar ensued. From documents released in 2007 we discovered that the Soviets had learned from a mole about the tunnel before it was even dug and were systematically feeding bad information to the CIA until they decided to create an incident over the tunnel itself. The Americans’ big coup was a disaster from the start.

During WWII the British SOE operations returned three out of four agents sent behind enemy lines to conduct covert operations see. The CIA has lost virtually every agent ever dropped into covert operations. Of these deaths the cavalier, urbane, Allen Dulles said;
Allen W Dulles Allen Dulles

You have got to have a few martyrs. Some people have to get killed.

The agencies first “success“, was the overthrow of the elected Iranian government of Mohammad Mossadeq to preserve British oil rights in Iran. The CIA planned to return the weak willed Mohammad Reza Shah Pahlavi to power but he kept disappearing. In one bizarre coincidence. Allen Dulles ran into Pahlavi checking into the same luxury hotel in Rome. The CIA had lost track of him. The coup that restored the Shah was almost an accident. For the twenty years of Pahlavi’s reign in Iran, he was known throughout the country as the CIA’s Shah.

The CIA’s next “successes“, was the overthrow of the Arbenz government in Guatemala. Cowboy diplomat and CIA associate Jack Peuifoy said of his visit to Guatemala City;

I have come to Guatemala to use the big stick. I am definitely convinced that if the President (Arbenz) is not a communist, he will certainly do until one comes along.

The coup was again almost accidental but the result was forty years of military rule, death squads, and repression. The CIA was also responsible for the assassination of Trujillo in the Dominican Republic in 1961, personally sanctioned by JFK.

Following WWII the CIA was willing to work with anyone anti-Communist. This included former Nazis and Hitler youth throughout Germany and Eastern Europe. These efforts were largely futile as the Nazis were widely hated by everyone.

More successful were the recruitment and support of two Japanese war criminals. Nobusuke Kishi signed the declaration of war against the US in 1941. After his release from prison Kishi masterminded the conservative misnamed Liberal Democratic party that dominated Japanese politics for fifty years. Kishi’s prison cellmate was Yoshio Kodama was a gangster who amassed a personal fortune of $1,750,000 running black markets in occupied China during the war. Together, the war criminal cell mates ran crime and politics in post war Japan. All with the support and financial assistance from the CIA.

The CIA’s record of total failure in intelligence gathering was finally broken when Allen Dulles succeeded in infiltrating, bugging, and planting false information in the offices of Senator Joseph McCarthy who was upset that communists had been so successful in planting spies within the CIA. Dulles succeeded in discrediting McCarthy. Dulles said of his operative, James Angleton, in the McCarthy case; “You have saved the republic.”

In Feb 1956 Nikita Khrushchev delivered a speech to the 20th Congress denouncing Stalin. It took Angleton three months to get a copy of the speech from the Israelis who provided almost all intelligence, however biased, on the Middle East. The CIA immediately began broadcasting the speech via Radio Free Europe but were oblivious and ignorant of the ensuing political crisis in Poland, Hungary, and Egypt. When finally informed, Dulles and the CIA totally misrepresented these events to the President. The CIA knew nothing of Israel’s plan for war against Egypt and of Britain’s plan to use the war as a excuse to seize the Suez canal. Dulles advised the President that the Hungarian uprising meant that Khrushchev’s days were numbered. The CIA had one person in Hungary, Frank Wisner, who had no agents, no Hungarian speakers, no contacts with the rebels, no weapons, no plans, nothing except Radio Free Europe which they used to give the appearance of a full scale revolution. Wisner left Budapest for Vienna. Dulles reported to the President that 80% of the Hungarian army had joined the rebels. He was wrong, the rebels had no arms and the Russians crushed them.

By 1957, the Middle East and it oil became the front line in the cold war. Eisenhower did not believe that those in the Middle East would be able to successfully run free governments. He decided that the best course was to promote the idea of an Islamic Jihad against communism. “We should be everything possible to stress the holy war aspect” (Eisenhower). The CIA would deliver guns, money, and intelligence to King Saud of Saudi Arabia, King Hussein of Jordan, President Chamoun of Lebanon, and President Said of Iraq; “These four mongrels were supposed to be our defense and communism and the extremes of Arab nationalism in the Middle East”. The CIA spent the next decade trying unsuccessfully to overthrow the government of Syria. When the CIA ran into trouble in Iraq they eventually threw support behind the emerging Ba’ath Party where Saddam Hussein would rise to the top.

In 1957, Eisenhower ordered the CIA to overthrow the non aligned Sukarno regime in Indonesia where oil had been discovered, and where the communist party was gaining strenth. The resulting attempt was a total failure with an American bomber pilot captured with full identification and records of his missions. The CIA backed off and Sukarno stayed in power for seven more years while the communist party gained strength. Indonesia, following Hungary drove covert operator Frank Wisner over the edge into insanity and he was committed and subjected to shock treatment.

Frank Wisner Frank Wisner

The CIA’s best analyst, Abbott Smith,wrote in 1958:

We had constructed for ourselves a picture of the USSR, and whatever happened had to be made to fit into that picture. Intelligence estimators can hardly commit a more abominable sin.

The CIA, defense department, and military contractors convinced Eisenhower that the USSR had over five hundred ICBMs pointed at the West. In reality they had four.

Frank Wisner was replaced as head of clandestine operations by Richard Bissell on Jan 1 1959, the same day Fidel Castro came to power in Cuba. In December Bissell was ordered to remove Castro from Cuba. Bissell and his second in command Richard Helms hated one another. The players from the successful Guatemala coup were brought together and the invasion group of chatty Cubans was sent to Guatemala for training. Nixon, facing a touch presidential race, asked them to hold off an invasion until after the election. In the meantime, the CIA backed the overthrow of Patrice Lumemba in the Congo by Joseph Mobutu. He ruled for thirty years, stealing billions and slaughtering thousands to preserve power.

Kennedy won a tight election and was told by his father Joe to retain J Edgar Hoover and Allen Dulles because they knew Kennedy family secrets including a wartime affair of John with a Nazi spy. Kennedy assumed that Eisenhower had approved the Bay of Pigs invasion and Bissel did not tell him otherwise nor that Bissel believed the invasion would fail. The invasion without proper air support was a disaster.

An autopsy of the Bay of Pigs, the Tailor Board heard the following testimony from CIA pioneer General Walter Bedell Smith:

A Democracy cannot wage war. When you go to war, you pass a law giving extraordinary powers to the President. The people … assume when the emergency is over, the rights and powers that were temporarily delegated to the Chief Executive will be returned… When you are at war, cold war if you like, you must have an amoral agency which can operate secretly…

JFK, after the debacle at the Bay of Pigs, moved covert operations to the control of brother Bobby who launched almost as many covert operations in three years as Eisenhower launched in eight years.

When JFK was killed, LBJ, Nixon, Ford, and others including the CIA worried that Fidel Castro was behind the murder. LBJ once said “Kennedy was trying to get Castro, but Castro got to him first.” The Warren Commission that included Gerald Ford was never told that RFK had ordered the assassination of Castro and had made several attempts including poison and a mafia hit man. Castro had a mole in the CIA and presumably knew of all these attempts.

Spy Kim Philby Kim Philby

James Angleton’s old friend and tutor in counterintelligence, Kim Philby, defected to Moscow in 1963. The paranoid Angeton, seeking redemption after Philby, believed that KGB defector Yuri Nosenko knew something about JFK’s murder. Nosenko was imprisoned and tortured for five years until the CIA finally decided he was telling the truth and knew nothing.

Immolated Monk

Among covert CIA operations, Vietnam stands out. The CIA created a government under Catholic Diem who started oppressing the Buddhists more than he fought the communists. The embarrassed CIA, tired of watching images of burning Buddhist monks and nuns on TV and newspapers, arranged for his removal, starting a long succession of CIA puppet governments set up and removed one after the other.

A supposed incident in the Gulf of Tonkin where two American destroyers were attacked was used by LBJ to push through the Gulf of Tonkin Resolution of August 7, 1964 authorizing war in Vietnam. The incident never happened but the lie only came fully to light in 2005. Intelligence about Hanoi during the war was non existent. The CIA estimated enemy troop levels at 500,000 in 1966 but this was reduced under military and diplomatic pressure to 299,000. At 500,000, the actual number, the Americans would never win the war. While pretending to negotiate an end to the war Nixon and Kissinger simply stalled until Americans were forced out in 1975. Neither ever intended to end the war despite Nixon’s campaign promises in 1968 and 1972 to end the war if elected.

Covert operations were taking place in Thailand, where a CIA backed political party, elections, and military government was created in 1965.

The CIA paid an annual subsidy of $180,000 directly to the Dalai Lama and established Tibet Houses in New York and Geneva. Their attempts over twenty years at a cost of millions of dollars to train insurgents to harass the Chinese in Tibet killed numerous insurgence and resulted in capture of a single satchel of Chinese military documents. See the CIA’s secret war.

Covert operations continued in Indonesia, where attempts to overthrow Sukarno were given a boost as the aging Sukarno joined forces with the communists to remove key military leaders in 1965. Five generals were assassinated, The CIA recruited and funded Indonesian diplomat Adam Malik who together with a central Java sultan and army general Suharto and a political movement the Kap-Gestapu, launched a civil war in which 500,000 Indonesians were killed and 1 million arrested, Suharto began his long standing military dictatorship and Malik became foreign minister and eventually President of the UN General Assembly. For forty years the CIA denied involvement in this massacre.

Tony Poe’s Troops
Tony Poe

Covert operations in Laos focused on the Ho Chi Minh Trail through the country, where the CIA coordinated American bombing and headed geurilla forces involving tribal Hmong fighters. Notorious CIA operator Anthony Poshepny known as Tony Poe, was the probable model for Colonel Walter E. Kurtz in the movie Apocalypse Now. Like Kurtz, the CIA believed Poe mad. Like Kurtz, Poe had his fighters cut off the ears of dead enemy combatants. Unlike Kurtz, Poe was left alone to fight as he saw fit.

Tony Poe Tony Poe

In Latin America the CIA was backing the leaders of eleven nations, providing money, weapons, and military training. The CIA sent agents in the hunt for Che Guevara and in 1967 he was found and killed in Bolivia.

Helms and LBJ Helms and LBJ

LBJ finally appointed Richard Helms as Director of the CIA. James Angleton, who the Israelis had given the 1956 Khrushchev speech, now received complete details of the upcoming 6 day war of 1967 when the Israeli military overran the entire area. This intelligence coup was the high point of CIA prestige. They totally missed the 1973 Yom Kipper war because no one told them about it before hand. On balance, Angleton’s paranoia concerning Soviet infiltration of the CIA meant that the CIA remained almost totally blind to Soviet events throughout his tenure at the agency. If Angleton ever learned anything, he often kept it to himself telling no one else.

Helms and Nixon Helms and Nixon

When Nixon came to power Richard Helms formed the Covert Operations Study Group in 1968. Among their findings (secret of course);

Covert operations can rarely achieve an important objective alone…At best, a covert operation can win time, forestall a coup, or otherwise create favorable conditions which will make it possible to use overt means to finally achieve an important objective.
On balance, exposure of clandestine operations costs the U.S. in terms of world opinion. To some, exposure demonstrates the disregard of the U.S. for national rights and human rights; to others it demonstrates only our impotence and ineptness in getting caught…Our credibility and our effectiveness in this role (expanding the international rule of law) is necessarily damaged to the extent that it becomes known that we are secretly intervening in what may be (or appear to be) the internal affairs of others.

Henry Kissinger Henry Kissinger

The only recommendation of the group adopted by Nixon was to appoint Henry Kissinger to direct covert operations. One of Kissinger’s covert successes was the overthrow of democratically elected Salvador Allende in Chile in 1973 after three years of effort. Chile, which had been a democracy since the 1930s was thrown into a violent repressive military dictatorship under Pinochet. In 1976 Pinochet arranged to blow up a car with some enemies only forteen blocks from the White House. Pinochet’s reign of terror lasted seventeen years. Today survivors of Pinochet’s Caravan of Death are pursuing Kissinger in the courts of Chile, Argentina, Spain, and France.

The CIA backed a rogue Greek general Ioannidis who started a Greek Turkish war over Cyprus. The intense Watergate investigation brought light and heat on CIA operations greatly weakening the agency. During this time, the extent of CIA domestic surveillance came out. Seymour Hersh of the New York Times broke the story of CIA domestic spying on anti Vietnam war forces in 1974. During the investigations that followed Angleton said:

Angleton James Angleton

It is inconceivable that a secret arm of the government has to comply with all the overt orders of the government.

From Nixon’s time forward, CIA intelligence was generated (made up) for political purposes and had little to do with reality. This continued into the ridiculous claims about Soviet military power to support the Reagan star wars initiatives. An assessment by John Huizenga in 1971 sums up;

I really do not believe that an intelligence organization in this government is able to deliver an honest analytical product…and have it taken at face value… I think that intelligence has had relatively little impact on the policies that we’ve made over the years. Relatively none. ..The intelligence effort did not alter the premises with which political leadership came to office. They brought their baggage and they more or less carried it along.

Under Carter, the CIA missed the overthrow of the shah of Iran by a fanatic ayatollah and the Soviet invasion of Afghanistan. They not only missed them, they were in denial that these things could happen. The CIA didn’t even know who Khomeini was. In 1979 a group of Iran students and followers of Khomeini stormed the American embassy. CIA agent Daugherty, captured in the raid remembers;

It had been difficult enough for them to accept that the CIA would post an inexperienced officer in their country. But it was beyond insult for that officer not to speak the language or know the customs, culture, and history of their country.

The hostages in Iran were released when Carter left the White House in 1981. Iranians seized other hostages and Reagan indicated his willingness to sell arms to Iran for hostage release. Delirious, Iran seized more hostages. In the most boneheaded scheme in CIA history, the agency spun off money from arms sold to Iran to give to the Nicaragua contras. The complex scheme leaked and the ensuing scandal did more to damage the CIA than Nixon’s Watergate.

Carrying on the grand tradition, the clueless CIA watched the fall of the Berlin wall in 1989 live on CNN along with the rest of us. With the collapse of the Soviet Union, the CIA all but ceased to exist. The fall of the Soviet Union had an impact “analogous to the effect of the meteor strikes on the dinosaurs.” Well said!

Aldrich Hazen Ames Aldrich Hazen Ames

In 1994 Aldrich Hazen Ames, CIA agent since 1967 was arrested. Ames was a Soviet mole since 1985, giving up virtually all agents operating behind the iron curtain. Most were executed. No wonder the CIA had no intelligence on the Eastern Block.

The CIA went on to miss the nuclear tests in India and Pakistan in 1998; and the bombings of three embassies in Africa and the attack on the USS Cole by Al Qaeda. They then provided bad actionable intelligence leading Clinton to bomb a Pharmaceutical plant in the Sudan, the Chinese embassy in Serbia, and an empty Al Qaeda training camp in Afghanistan. The CIA became so gun shy after these debacles that they passed up numerous opportunities to send agents to assassinate Osama Bin Laden in Afghanistan.

The CIA failures to uncover the 9/11 attacks and the false intelligence generated to support war with Iraq were the final straws. Bush sent conservative political hack Porter Goss to dismantle the service. All senior and liberal agents were sacked and replaced by fellow conservative political hacks. Intelligence and covert operations moved to the Defense Dept. and State Dept. and to private beltway bandits who have built a $50 billion intelligence industry out of the ashes.

Personal Conclusions

Eisenhower warned Truman, Kennedy, and Johnson that war cannot be won without good intelligence. In Korea, Vietnam, Iraq, and Afghanistan, we did not and do not have good intelligence. Maybe it is time to admit certain truths. We can start with an admonishment from Richard Helms;

Richard Helms Richard Helms

The only remaining superpower doesn’t have enough interest in what’s going on in the world to organize and run an espionage service.

The following are my personal conclusions after reading this well researched book and should not be confused with Weiner’s own conclusions.

First, democracy and war are incompatible and a President should only be given war powers under very extreme circumstances such as those that existed in WWII and have not existed in the cold war or since. Having war every few years to enhance executive power is dangerous and perhaps fatal to our democracy. All other conflicts should be handled through diplomacy and international organizations.

Second, espionage requires deception and amoral judgments, in addition to language and cultural skills that are basically and perhaps fortunately rare skills hard for Americans to acquire. Those capable of deception are equally capable of deceiving themselves, the American people and the President. Judging from the CIA, they tend to be rogue characters impossible to harness. If possible, Americans should devise ways of acquiring intelligence without relying on espionage.

Third, covert operations should be banned altogether. Most of todays international conflicts find their origins in our own past covert actions and many of the weapons used and trained personnel involved in today’s conflicts were provided and trained under cover of American covert activity. This continues to be true throughout the world including Afghanistan and Iraq. Covert actions during the cold war invariably supported fascist right wing extremists all over the world and the repercussions of their repressions are still felt today and will be felt for some time. Covert operations did more to encourage Islamist Jihadist radical extremists than Middle East oil money supporting extremist madrasas. What goes around comes around.

In summary, An open democratic society is incompatible with a government that operates, even in part, in secret. The government must remain completely transparent throughout all its parts and to its people. A government with secrets is a danger both to itself and to everyone else.

As an aside, some of Barack Obama’s recent remarks about actionable intelligence to capture or kill Osama Bin Laden brings back nightmare images from Clinton’s mis targeted bombings. I hope Obama takes the time to carefully study this book before making further foreign policy pronouncements.

Beirut in Long Sentences

Thursday, September 6th, 2007

DeNiro’s Game, Rawi Hage, 2007

Beirut Beirut

A first novel from Beirut born Montrealite, Rawi Hage, won several Canadian book prizes. De Niro’s Game refers to the Russian roulette scenes from the movie Deer Hunter staring Robert De Niro. After the movie, Russian roulette became a popular game among young boys in Beirut with ready access to guns. The novel is the story of two young Christian Lebanese men growing up in the chaos of war torn Beirut with Syrian fighters, Palestinians joining the communists and other left Lebanese, with Israel threatening to join the conflict, militias recruiting young men as fighters. Random bombings kill the boys’ families; they engage in casino and fake whiskey scams to earn money that might allow them to leave Beirut. The novel is violent yet hopeful. Notable are the long sentences of highly descriptive prose. Samples:

They (impoverished women) washed like meticulous Christian cats that lick their paws under small European car engines that leak corporate oil extracted by exploited Nigerian workers from underneath the earth where devils roam, and worms gnaw on the roots of dead trees that are suffocated by factory fumes and the greedy breath of white-skinned engineers.

War Torn Beirut Beirut War

Little plants sprang from beneath the sidewalks cracks, lived underneath broken arches, shone in front of looted stores, sprang from the bellies of decaying sandbags, and dwelt in deserted governmental buildings that longed for the old days when lazy bureaucrats strolled in long hallways, snoozed on metal desks, dipped their mustaches in thick coffee, paraded their thin ties on hairy, conceited chests, waved their hands to expel flies and welcome bribes and seal endless deals with forged wills, illegal roofs, rebirth certificates, religious divorces, contaminated water pipes, underage driver licenses, expired bank notes, stumbling constrictions, derelict sewers, stained travel documents, and clandestine harvest of hallucinogenic plants that grew in the Bekaa Valley on the stops of Heliopolis, where Fairuz, that whining singer, sang at night under twinkling stars that had guided the three Babylonians from the east and down south into that stable with ruminating cows and the child who extracted milk from the virgin’s round, black nipples.

Time Cover from 1982 Time Beirut

It (the sky) was covered with light signals from faraway planets bursting with gas and the happy bonfires of dead humans singing warrior’s songs in a landscape of burning rocks, and sending Morse code signals to ships steered by alcoholic captains into islands inhabited by sirens who sing in cabarets and offer up their salty sex organs that taste like marinated fish on Sunday’s family gatherings after the families have endured the moralistic discourse of fat priests who douse congregations with incense spilled from the pendulum motion of their jerking hands, a motion that rocks like the swings in parks that are swamped with baby strollers pushed by Filipino nannies on temporary visas and with small paycheques that are transferred at Christmas to faraway families who live in huts by the sea and receive Morse code signals from those old creatures from astral space.

For photos by the author and a reading from this book see.

Afghan Tale

Monday, September 3rd, 2007

A Thousand Splendid Suns, 2007 Khaled Hosseini

This is the second novel by the author of The Kite Runner. Hosseini left Afghanistan as a child in 1980 during the Soviet occupation and is now a U.S. representative on the U.N. Refugee Agency.

This novel follows the lives of two Afghan women through the turbulant years from the 1960’s to the present. The older woman grew up near Herat, the illegitimate daughter of a wealthy merchant and a house maid. She lives with her mother in a small isolated hut and her father teaches her to fish on his occasional visits. A kindly old imman teaches her to read and write a little and to memorize prayers from the Koran. It will be her only education. When her mother dies in 1974, the father arranges for the girl to marry a much older Pashtun widower from Kabul, a cobbler with his own business. The cobbler has a violent temper and his abuse and mistreatment of the girl increases as she is unable to give him a son or any child.

In the meantime the Shah is overthrown and Afghanistan becomes a republic. Communists gain influence and by 1980 the Soviets have occupied the country. The Soviet period in Kabul represents a high water mark for women in Afghanistan with equal opportunities in education and professional careers.

The second girl in the novel grows up during this time. Her father is a professor and she attends a good school where she exels. Her best friend is a boy who lost a leg to a land mine. As they grow their friendship turns to romance. Her much older brothers have joined the Mujahideen to fight the Soviets. Reagan supplies them with Stinger missles and anti-tank weapons. The brothers die but the Soviets leave Afghanistan as their empire self destructs.

The Mujahideen now break into tribal factions fighting each other in the streets of Kabul, their leaders, Sayyaf, the Hazaras, Massoud, Hekmatyar, with the treacherous Uzbek Dostum waiting to choose sides. Civilians die as rockets hit houses and business in Kabul, women and children are raped, and civilians beaten and killed because of their tribal origin.

The one legged boy leaves with his family for Pakistan. A rocket hits the girl’s house killing her parents and wounding her. The cobbler and his wife rescue and take care of her. The cobbler asks the girl to become his second wife. The girl knows she is pregnant by her one legged lover and agrees to the marriage. The cobbler’s business is burned in a rocket attack and the family become destitute. By 1992 the Mujahideen are in control and name Afghanistan an Islamic state. Fighting continues.

The Taliban, led by illiterate Pashtun radicals educated in Saudi financed madrasas in the tribal areas of Pakistan emerge as a unified fighting force, taking city and region one after another. By 1996 they enter Kabul. Among their restrictive rules, girls are no longer allowed to attend school. The Mujahideen retreat to form the Northern alliance in northern Afghanistan. Bin Laden sets up Al-Qaeda training camps in Afghanistan.

The one legged boy returns to Kabul and meets the girl, the cobbler tries to kill her and the first wife kills him. She is arrested by the Taliban and tried for murder while the one legged boy, girl, and children flee to Pakistan.

Bamiyan Buddhas

The Taliban destroy much of the cultural heritage of Afghanistan, and in 2001, they destroyed Bamiyan’s colossal Buddhas which stood for 1,500 years. Al-Qaeda attacks the U.S. and the U.S. declares war in 2002 against Afghanistan and the Taliban and Al-Qaeda. Some refugees, including the one legged boy and the girl, now married, and their children return to Kabul to assist with orphans and other refuges.

For more on the tribal areas of Pakistan, the arbitrary British border between Pakistan and Afghanistan, the Durand line drawn in 1893, and the story of the creation of Pakistan at the start of the cold war see.

A lone American former mountain climber, Greg Mortenson, worried about the absense of educational opportunities in isolated areas of Pakistan, has started a series of secular schools as an alternative to the radical madrasas which trained the Taliban. Mortenson has even negotiated successfully with Afghan drug warlords to be allowed build schools in isolated areas of Afghanistan.