As part of Reuters’ coverage of the U.S. healthcare reform, Reuters.com asked Peter J. Pitts, president of the Center for Medicine in the Public Interest and Stephen M. Davidson, a Boston University School of Management professor to discuss the issue. Here are their responses.

Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.

In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what SiCKO concealed was that systems such as those in the United Kingdom and Canada are cost-based rather than patient-centric models. Facts, no matter how inconvenient to one’s argument, must not be ignored.

Citizens of countries with government-run health care systems experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care. For example:

• The five-year survival rate for early diagnosed breast cancer patients in England is just 78 percent, compared to 98 percent in the U.S.

• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.

• The average wait time for bypass surgery in New York is 17 days compared to 72 days in the Netherlands and 59 days in Sweden.

• More than half of Canadian adults (56 percent) sought routine or ongoing care in 2005. Of these, one in six said they have trouble getting routine care.

• Eighty-five percent of doctors in Canada agree private insurance for health services already covered under Medicare would result in shorter wait times.

• Approximately 875,000 Canadians are on waiting lists for medical treatment.

“Congress has an important role to play in healthcare reform” said United States Representative John Shadegg, (R-Arizona), who has introduced healthcare legislation in support of free-market competition. “We can help patient in this country, not by setting up a massive new government bureaucracy, but by empowering individuals to make the best choices for themselves and their families.”

If we’re going to look to other healthcare models for solutions, we must uncover and study their problems. Health care is too important to allow reform by sound bite. “Drugs from Canada” is as much a false promise as “free” healthcare.

Last autumn, my organization the Center for Medicine in the Public Interest interviewed people on the streets of New York City and asked them if they’d prefer “government” healthcare or “universal” healthcare. They overwhelmingly chose “universal” healthcare. But when we asked them to explain the difference between the two, they generally just shrugged their shoulders.

And when we asked them how much more in taxes they’d be willing to pay to support universal healthcare, they shook their heads and said, “No, we want it to be free, like in Europe and Canada.” Such are the fallacies that political rhetoric hath wrought.

Equally as prevalent is the notion of “free” or “low cost” drugs “like in Canada and Europe.” And here too we need to be honest and examine the other side of the coin — that of cost-savings for the payer (often in the guise of healthcare technology assessment programs such as Britain’s National Institute for Health and Clinical Excellence) versus care denied for the patient. What is overlooked is that price controls equals choice controls.

Our national conversation about health care has to go beyond vague concepts of reform and convenient political rhetoric. We must all be part of the solution and suspicious about false choices.

Joshua Foust is an American military analyst. He blogs about Central Asia and Afghanistan at Registan.net . Reuters is not responsible for the content - the views are the author’s alone.

It would be an understatement to call opium cultivation in Afghanistan America's headache. The issue of illegal drug cultivation and smuggling has vexed policymakers for three decades, and led to a multi-billion dollar campaign to combat the phenomenon.

Opium causes all of our problems, so they say—according to a factsheet at the U.S. Embassy in Kabul (pdf), opium creates instability, funds the insurgency, and wreaks havoc on the government. They’re not alone - entire books have been written on the subject.

The blame game on opium, however, ignores a critical - and quite uncomfortable - fact: it misses the point. The reality is, while the cultivation of opium does not help matters from a Western perspective, in Afghanistan it is actually a healthy economic activity. The concerns over its cultivation, too, are overblown: even a brief look at the numbers show it to be at best a trailing indicator of insecurity, insurgency, corruption, and economic malaise. Opium, therefore, is only an indicator of other, more substantial problems.

Consider, for example, what I call The Nangarhar Swing. According to the United Nations Office of Drugs and Crime, in 2005 Nangarhar produced nearly 1/5 of Afghanistan’s opium, but was virtually poppy-free in 2006. 2007 saw a 285 percent increase (pdf) in cultivation, making the province one of the country's top poppy producers. Yet in 2008, it was once again virtually poppy-free (pdf). This shift cannot be tied only to security, as many like to claim: according to the violence statistics compiled by the Long War Journal, even as Nangarhar has stopped the large scale cultivation of opium, it has become steadily more violent. Moreover, there are many other areas of the country, like Khost province along the border with Pakistan, or Kunar province further north, where the insurgency has become worse even as those provinces were emptied of opium.

The discrepancy is really a trick of language: When the UNODC declares a province poppy-free, what they mean is, production there is “negligible”, not non-existent. Whether that is in the context of total production, other provinces, or some sort of absolute number (a percentage of arable land or total worldwide opium production) isn’t really clear. In Nangarhar, several times declared “poppy free” by the UNODC, there remain active opium eradication missions in outlying districts such as Sherzad. What's noteworthy about it is not the presence of some fairly smallish opium farms in southwestern Nangarhar, as most opium farms are small family affairs. What is interesting is the density of the farms. In a single 5 km stretch of the countryside, teams found and destroyed 100 poppy fields. For a supposedly poppy-free province, that is simply stunning.

It also covers up the substantial effect of destroying the opium economy. In many parts of Afghanistan, opium is the economy, and the World Bank estimated in 2008 it accounts for 1/3 of the country’s economy. In opium-adjacent communities, opium funds underpin the entire local economy: especially in the opium “heartland” in the South, the only way for small farmers to get microcredit loans or deal with exporters is through opium traders. Through a system of loans called salaam, they in essence create informal futures markets on crops… but only opium. Cereal crops and fruits, or other licit agriculture, are not included in this system (even though it is possible for other actors, whether the government or NGOs, to provide this service). In fact, the ways these markets have developed in the south is remarkably similar to how informal credit markets formed in rural medieval Europe. It is normal. The West just happens to dislike the crop.

But even in opium “success stories”, there are significant problems to simply removing the crop. In Nangarhar, the wild swings in opium prices and cultivation crashed the rural economy again and again. Most of the microcredit salaam loans farmers take out are not denominated in any currency - they pay in opium. So, when prices crash or an eradication team sweeps through, farmers become trapped in a horrendous debt cycle where the only means of escape is to grow yet more opium. There are even rumors of farmers selling a daughter or son to the traffickers in payment, and many families have fled to either Iran or Pakistan to avoid reprisals for unpaid opium debt.

There is a more fundamental economic problem to growing poppy, however: areas that grow opium actually tend to be the wealthiest. Sherzad District in Nangarhar, where there is still opium cultivation and eradication, actually has relatively high income compared to the rest of Nangarhar. According to the International Monetary Fund (pdf), when Nangarhar province saw a huge drop in opium cultivation in 2005/6, province-wide GDP was about $1.3 billion (which was a big drop from the year before, when there was much more opium). The next year, 2006/7, when opium production spiked 285%, province-level GDP rose to $3.2 billion, only to fall the next year to $1.8 billion as the UNODC declared it poppy-free.

So what is to be done? The Obama administration has wisely recognized that opium eradication is a non-starter, and does far more harm than the marginal good of destroying some opium crops. UNODC Chief Antonio Maria Costa recently agreed, and suggested a “flood of drugs” in its place. Under this plan, somehow the borders of Afghanistan would be sealed so that no drugs can “escape”, in their words, thus crashing the price of opium. Feasible or not, Costa’s idea at least tries to examine other ways of reducing the need for opium cultivation. Looking at opium cultivation as an economic factor, however, leads one to many other conclusions that are inconvenient for a political and military apparatus designed to oppose the very idea of drug cultivation.

If opium is an economic puzzle, and not a political-military one, then there should be an economic (or at least non-military) solution to it. Several years ago, the Afghan Research and Evaluation Unit published a study (pdf) comparing the factors behind the cultivation of opium in adjacent provinces in the “poppy-free” north. Water shortages, soil moisture and salinity, severe socioeconomic inequality driving food insecurity, a poor presence of formal institutions, all have decisive impacts on a household decision whether or not to cultivate opium.

More recently, a team of Norwegian researchers has noted a strong causation between violence and opium cultivation, but not in the way most think: in their research paper (pdf), they assert that opium follows conflict, and not the other way around. In other words, opium cultivation is simply a feature of ungoverned conflict zones, and especially in Afghanistan, something people do as a last resort when other economic activities fail to provide for their families.

Taken together, these studies (and the many others like them—this is a growing field of study) point to a counterintuitive conclusion: do nothing. That is, focusing only on opium misses the point, and doesn’t address the reasons why it is grown. If opium cultivation were an indicator of an ungoverned or contested space, then that would indicate that making that space governed and uncontested would also address the opium.

There are a few examples even within Afghanistan where governance and security came first, and then opium cultivation simply dropped off. Badakhshan province was the only province in the country that was completely Taliban-free in 2001, and as a result was the only one to grow opium in any really measurable amount during the Taliban’s prohibition. Since the American invasion, it has remained mostly quiet, and has seen a growing success in both trade connections to neighboring areas and better governance by multiple levels of officials. As an aid worker active there told me recently, “the price of poppy has fallen fastest in the north (where the poppy has a lower morphine content), and in Badakhshan, farmers can already make more from okra or onions than opium.” Selling vegetables is relatively low risk and carries a good profit margin - something that cannot be said for the majority of Afghanistan’s non-subsistence farmers.

Drug traffickers have taken enormous measures to lower the risk of drug cultivation, but the development community has not taken the time to do so for legal agriculture. It remains prohibitively expensive to ship anything out of Afghanistan, and border politics especially with Pakistan (one worker recently complained that difficulties in crossing the border into Pakistan meant an entire crop of potatoes from Khost province rotted at the border crossing, unsold) keep export-driven agriculture uncertain and extremely risky. By focusing so much of its energies onto eradication or somehow controlling the cultivation of opium, both the International Community and the government of Afghanistan have ignored providing other ways for farmers to make money legally - even when Alternative Livelihood programs exist in an area, they’re poorly administered and often barely make a dent in the local economy.

So why not do nothing? Opium is not Afghanistan’s biggest problem - it is horrendous poverty, bad infrastructure and no security. When it comes to all three problems, Afghanistan faces two major hurdles - underinvestment (money, equipment, education, health, and security) and corruption-driven illegitimacy. Making matters worse, the overwhelming majority of aid in the country flows outside government channels or oversight, which undercuts Kabul’s legitimacy even among the people it helps.

Focusing only on opium, therefore, doesn’t actually focus on the more fundamental problems facing the country. It is an obsession on symptoms, while the causes go unaddressed. The missing piece of governance, and with it the development of the necessary institutions of society and economy, is the critically ignored piece of almost all plans to eliminate opium in Afghanistan. And as examples like Badakhshan have shown, when even moderate progress is made on these fronts, people will voluntarily switch to growing other crops, and they will make enough money to support themselves. It’s enough to make one wonder just why there needs to be a plan in the first place. It’s counterintuitive, but scrapping the West’s counternarcotics policies is surest way to actually achieve the counternarcotics goal of a poppy-free Afghanistan.

(Reuters photos: Opium fields in Farah province/Goran Tomasevic)

- Joshua Foust is a defense consultant who has just spent the last 10 weeks embedded with the U.S. Army in Afghanistan. He also blogs at Registan.net. Any opinions expressed are his own. -

It is a cliché that, in counterinsurgency, one must be among "the people". In Iraq, the U.S. Army did this to great effect under the leadership of General David Petraeus, moving large numbers of soldiers off the enormous bases and into smaller, community-oriented security outposts. As a result, in densely populated urban areas like Baghdad, an active presence of troops played a significant role in calming the worst of the violence. The Western Coalition forces in Afghanistan, however, face an altogether different problem. Kabul is not Baghdad - far less of Afghanistan's population lives there than in Iraq, and the insurgency is concentrated outside the country's largest urban areas. In many urban areas-Herat in the west, Jalalabad in the east, Mazar-i Sharif in the north-a westerner is far safer in the city itself than out in the countryside.

A rural insurgency is a devil's game. It is difficult for a foreign counterinsurgent force to concentrate itself to maximize effectiveness, in part because the insurgency itself is not concentrated. When there are no obvious population clusters, there are no obvious choices for bases. Bagram Air Base, the country's largest military base, is in the middle of nowhere, comparatively speaking - dozens of miles north of Kabul, and a 45-minute drive from Charikar, the nearest city in Parwan Province. FOB Salerno, a large base in Khost Province, is miles away from Khost City, the province's capital-and the road in between is riddled with IEDs.

The many smaller bases strung in between are surrounded by enormous Hesco barriers, concertina wire, and guard towers. No one is allowed on the base without being badged and interviewed by base security, and in many places delivery trucks are forced to wait in the open for 24 hours before completing their trips to the dining halls, clinics, or technology offices.

There are other ways in which Coalition Forces are separated from the people of Afghanistan beyond their heavily fortified bases. Most transit - on patrol, on delivery runs, or on humanitarian missions - is performed through Mine Resistance Ambush Protection, or MRAP vehicles. These enormous trucks, thickly plated with metal blast shields on the bottom with tiny blue-tinted ballistic glass, make it near-impossible to even see the surrounding countryside from another other than the front seat.

On the narrow mountain roads that sometimes collapse under the mutli-ton trucks, soldiers drive, too, in up-armored Humvees, which are similarly coated in thick plates of armor and heavy glass windows they aren't allowed to open.

When soldiers emerge from their imposing vehicles, they are covered from head to groin in various forms of shielding: thick ceramic plates on the torso, the ubiquitous Kevlar helmets, tinted ballistic eye glasses, neck and nape guards, heavy shrapnel-resistant flaps of fabric about the shoulders and groin, and fire-resistant uniforms. A common sentiment among Afghans who see these men and women wandering in their midst is that they look like aliens, or, if they know of them, robots.

There is no doubt that MRAPs, up-armored Humvees, and the seventy pounds or so of bullet and blast shielding has saved the lives of countless soldiers. But counterinsurgency is counterintuitive: in the relentless quest to ensure a casualty-free war, it seems the West has begun to engineer its own defeat.

By separating itself so completely from the population it claims to be trying to win-even at Bagram, where there is almost no combat, ever, it is almost impossible for a soldier or civilian to walk outside the gates to purchase something in the nearby bazaar-there remain precious few opportunities to do the gritty work of actually trying to "win hearts and minds".

The end result is stark: in a war that is desperately short of the troops needed to provide security to increasingly less remote communities, 93% of the soldiers stationed at the Coalition's primary base never walk outside the gates. Instead of a focus on separating the insurgents from the population - another clichéd pillar of counterinsurgency - the focus seems instead to be simply killing as many of the enemy as can be identified.

It is a brutal catch-22. The United States operates an incomprehensibly sophisticated Army - its ability to see things from afar, monitor and decode transmissions, and snoop on anything electronic is unmatched, and quite daunting.

But without strong Human Intelligence, there is little chance to contextualize the many streams of data they receive each day: is that man digging near the road emplacing a bomb, or is he digging up rocks for his fence? When this man identifies the elder from across the valley as a Taliban commander, is he telling the truth or pursuing some decades-old rivalry? Is that firefight the result of Jalaluddin Haqqani's foot soldiers, or are they villagers worried their timber harvest might be impounded?

These are the sorts of questions that cannot be answered while holed up on a large base. Military bases are societies in miniature: they have their own politics, their own players, a separate culture, and even their own language. When focused on themselves, they develop into a so-called "garrison mentality" - a focus on rules, administration, and process, rather than accomplishing any larger strategic objectives.

There are entire swaths of territory that have been ceded to the militants in Afghanistan. In some cases, entire districts are essentially "no go" areas, starved of development and even regular security resources. The abandonment of these areas - at a cost in Afghan lives - has not resulted in any punishments or reprimands of the commanders who did so. Rather, they were praised for reducing their own casualties.

It is a mindset bred into the very framework of the U.S. Army. If a soldier dies in combat, his or her commanding officer is investigated. A "15-6," as they are called, is convened by Court Martial authority, and should any fault be found on the commander's part, his or her career could be destroyed.

"No one has ever gotten a 15-6 for losing a village in Afghanistan," a Lieutenant Colonel who worked at the U.S. Army's headquarters in Afghanistan recently said, "but if he loses a soldier defending that village from the Taliban, he gets investigated."

Under such a threat, can a mid-level Army officer be blamed for taking few risks? The problem is much higher than individual battalion and brigade commanders: a command obsessed over casualties in the short term misses the chance to create an environment that results in fewer casualties over the long term.

In Afghanistan, that process is growing worse by the month: already in January of 2009, casualties were several times higher than they were the previous winter, when fighting is normally at its least intense.

It is that mentality - severe risk aversion, coupled with attention paid to process rather than outcome - that risks ultimately undoing the Western mission in Afghanistan. As an institution, the U.S. Army seems unwilling to make the difficult choices necessary to create the conditions for peace: a population that is adequately protected from the crime, drug, and war lords, and therefore no longer contributing to the desperate regional instability.

It is also a mentality that can be challenged in small doses from below, but demands concerted action from above. Command at the highest levels is vital in changing course, and admitting that war is actually a terrible and ghastly thing that requires your own people dying to win. It is a choice not many at the top seem willing to consider.

(Photos by Joshua Foust: ANP officer in Charikar, Parwan Province; the Nijrab Bazaar in Kapisa Province and FOB Salerno, in Khost Province.)

– James Saft is a Reuters columnist. The opinions expressed are his own

Treasury Secretary Geithner is all but admitting that U.S. banks are suffering not from market failure but self-inflicted collateral damage.

The U.S. Treasury on Monday detailed an up to $1 trillion plan to buy up assets from banks in partnership with private investors, using financing bankrolled by the government, financing that is only secured by the value of the doubtful assets the fund buys.

One portion will be dedicated to buying complex securities from banks employing capital contributed by private investors and the government topped up with funds borrowed from the Federal Reserve. A second portion will buy older securities that are, or were, rated AAA, using, you guessed it, more non-recourse funding.

But most interesting of all is a plan to buy whole loans, dubbed “legacy loans”, from banks but this time the private-public subsidized vehicle will get its leverage courtesy of Federal Deposit Insurance Corporation-guaranteed debt.

Notice that the ground has shifted subtly and the government is now talking not just about “toxic” assets but “legacy” ones. A legacy asset is, more or less, everything real estate related now on bank balance sheets.

These loans are not marked to market they are held to maturity, so no blaming the market here. They are nothing more than doubtful loans in the process of going bad as the economy implodes and the real estate they are collateralized with drops in value.

There is an almighty bust in the U.S. real estate market and it is blowing holes in bank balance sheets having nothing to do with securitizations.

It rather undercuts the argument that was advanced about earlier subsidy plans, that there was a “market failure” leading to hard-to-value complex securities being priced by the market at too little, below their fair “held-to-maturity” value.

The only uncertainty around a whole loan is whether the debtor will pay back the loan and, if not, what the collateral is worth. So there is no more deception about liquidity, market failure or anything else, only a naked subsidy to the banking industry, using the private sector as a pricing mechanism and cutting them in on the deal in exchange.

DEFINITION OF PRIVILEGE
So, will it work, and if it does how will this step influence the way banking functions down the road? Depends on what you mean by work, but it will doubtless take a tranche of lousy assets off of banks.

But as for creating confidence, I can’t see it. Firstly, investors will twig to the idea that the balance sheet issues are deep, and secondly, now that we are talking whole loans I think it’s clear that the $1 trillion is only a down payment.

That means the administration will need Congress to play along and fund another wodge of subsidy. That may be a tough sell, especially considering that the administration has bent over backward to keep Congress out of the funding loop, using the Federal Reserve and FDIC as funding mechanisms and thereby effectively arrogating the funding powers Congress is supposed to hold.

The plan also hugely encourages moral hazard, as it leaves too big and too failed companies, boards and executives in place while providing them with a chance to climb out of the holes they have dug themselves. Not much of a lesson in accountability.

Writing in the Wall Street Journal, Secretary Geithner said the U.S. must strike a balance between promoting public trust and spending taxpayer cash to get the banking system functioning.

“This requires those in the private sector to remember that government assistance is a privilege, not a right. When financial institutions come to us for direct financial assistance, our government has a responsibility to ensure these funds are deployed to expand the flow of credit to the economy, not to enrich executives or shareholders,” he wrote.

It is just astounding that he even sees the need to remind us that free government money is not a right, and reveals much about the balance of power between him and those seeking handouts. And you simply can’t give a subsidy without enriching executives or shareholders, you can only hope not to do it too obviously.

Finally, don’t even begin to believe that concerns about government interference will leave the U.S. with few well qualified asset managers willing to commit their capital to the plan. New York and Connecticut are stuffed to the gills with asset managers who would crawl naked over hot coals to get access to cheap, non-recourse, long-term funding from the government.

That there are suggestions to the contrary is simply an attempt to try and influence the debate about government control over compensation at firms which accept taxpayer largess. A smokescreen within a smokescreen.

– At the time of publication James Saft did not own any direct investments in securities mentioned in this article. He may be an owner indirectly as an investor in a fund –

- Glenda Stone is chief executive and founder of Aurora, a recruitment advertising and market intelligence company, and co-chairs the UK Women's Enterprise Taskforce established by Prime Minister Gordon Brown. The opinions expressed are her own. -

Most venture capital and angel investment tend to go to a specific breed of entrepreneur - innovative, well networked, intelligent, confident ... male. Is this the result of deep-rooted discrimination or is this simply an issue of supply and demand? Women-owned businesses are largely under-capitalised and this leads to inhibited growth.

Access to finance is cited by numerous sources as the greatest barrier to the growth of women's enterprise but "access" is only the consequence and "education" is the cause. More women need to participate in business education addressing business growth, technology, revenue models, and securing correct types of finance.

Globally women-led businesses receive less than 5 percent of venture capital. Women business owners also seek less bank loans and overdraft facilities. Regardless of country, women are more frugal - they do more with less, for less. Is this a flattering positive or is this a naive flaw that perpetuates women's relegation to micro enterprise?

I co-chair a taskforce established by Prime Minister Gordon Brown. We advise on strategy relative to increasing the quantity and scalability of women's enterprise. If women started and grew businesses at the same rate as their male counterparts, the economy would experience greater wealth and job creation and, needless to say, generate further substantial tax revenues for government.

The private sector is keen to encourage emerging markets of women entrepreneurs because this can result in an expanded customer base and vertical cross-selling opportunities. One of the biggest challenges facing the Taskforce is the disproportionate interest in micro versus fast-growth businesses, not so much from the private sector or senior experts in central government, but from business support providers and the actual women themselves. Perhaps the fast-growth female led businesses are simply busy doing business and do not view gender-based networks as relevant.
In addition to government programmes and private sector support typically from finance and technology corporations, thousands of businesswomen's networking groups also exist around the world to encourage and support the rise of female entrepreneurs. Serving an important need, many of these networks provide various training programmes and events but the networks themselves usually lack revenue models and so each month many new networks launch while others simply disappear.

Although recent years have seen an emergence of women's funding networks predominantly in the US, Canada and the UK, most networks tend to focus on micro-enterprise and social networking rather than on formal business education. In addition, media coverage tends to focus on small women-owned businesses in retail that have a good story for high audience appeal rather than on the more scalable and complex business-to-business enterprises that may be of less interest to mainstream media audiences.

Media coverage of women starting their business from the kitchen table in an area they have always enjoyed as a consumer, all while working flexibly caring for children, certainly predominate both online and offline media. Such stereotypes, while important for their inspiration, simply reinforce a narrow concept of women's enterprise. "Women's enterprise" is often acknowledged as one homogenous group with little market segmentation. Is this ignorance or because it is a market not considered to be worth pursuing?

International Women's Day on March 8, celebrated annually since 1911, provides an excellent opportunity for reinforcing the importance of women's equality through economic advancement - and creating wealth through enterprise is key to this. With around 15 per cent increase in the level of International Women's Day activity year on year around the world, there is certainly considerable energy for positive change.

The United States is aiming to send 20,000 to 30,000 extra troops to Afghanistan by the beginning of next summer, according to the chairman of the U.S. Joint Chiefs of Staff.  The plan is not unexpected, and from a military point of view is meant to allow U.S. and NATO troops not just to clear out Taliban insurgents but also to bring enough stability to allow economic development, as highlighted in this analysis by Reuters Kabul correspondent Jon Hemming.

But does it still make sense after the Mumbai attacks -- intentionally or otherwise -- sabotaged the peace process between India and Pakistan?

As discussed many times on this blog, most recently here, a crucial element of President-elect Barack Obama's Afghan strategy was to combine sending extra troops with a new diplomatic approach looking at the Afghanistan-Pakistan-India region as a whole. The argument was that Pakistan would never fully turn its back on Islamist militants as long as it felt threatened by India on its eastern border and by growing Indian influence in Afghanistan on its western border.  India and Pakistan, so the argument went, should therefore be encouraged to make peace over Kashmir, to reduce tensions in Afghanistan and pave the way for a successful operation by the extra U.S. troops.

Where does that plan stand now? India-Pakistan relations are extremely strained and vulnerable to any second militant attack on India. It's hard to imagine the two countries sitting down any time soon for serious peace talks, and certainly not at the United States' behest, given that outside interference on Kashmir has always been anathema to India.

Yet as the Soviet Union discovered during its failed occupation of Afghanistan from 1979 to 1989, no matter how many troops you send in, you can't win there as long as the Islamist mujahideen have sanctuary in Pakistan.  The United States knows this too having backed the mujahideen against the Soviets (this being a war that America has fought on both sides), which is presumably why it had begun to look at Afghanistan in a broader regional context.

So have the Americans reverted to a piecemeal approach with this plan to send in the extra troops? Are they just pushing on regardless and hoping for the best, perhaps thinking they have no other choice? Or should they have gone back to the drawing-board post-Mumbai and come up with a different plan?

In the immediate aftermath of the Mumbai attacks, India's response has been to look to the United States to lean on Pakistan, which it blames for spawning Islamist militancy across the region, rather than launching any military retaliation of its own. So after U.S. Secretary of State Condoleeza Rice's trip to India and Pakistan last week, have the Americans done enough for now?

According to Pakistan's Dawn newspaper, Rice told Pakistan there was "irrefutable evidence" that elements within the country were involved in the Mumbai attacks. And it quotes unnamed sources as saying that behind-the-scenes she “pushed the Pakistani leaders to take care of the perpetrators, otherwise the U.S. will act”.

India's Business Standard said the Indian government was pleased with the U.S. warning. "This is exactly what India wanted," the newspaper said.

The Times of India, however, fretted the U.S. action against Pakistan appeared to be "turning tepid", in public at least. It attributed the U.S. approach to the perceived need to avoid backing the civilian government led by President Asif Ali Zardari into a corner. (India has specifically not accused the Pakistan government of involvement in the Mumbai attacks, pointing instead to militant groups supported by Pakistan's powerful spy agency, the Inter-Services Intelligence, or ISI.) It also said the United States was wary of destabilising a partner on which it depends crucially as a transit route for supplies to Afghanistan, while also being hobbled by the change of administration in Washington.

So which way is the pendulum swinging -- towards firm U.S. action that will allow Indian Prime Minister Manmohan Singh to say he was right to put his faith in American diplomacy, or a lukewarm response that will either force India to act alone or leave its Congress-led government looking on in helpless frustration as it heads into a general election due by next May?

U.S. pressure has succeeded in pulling India and Pakistan back from the brink in the past.  When fighting erupted between the two newly declared nuclear-armed powers in the Kargil war in 1999, U.S. President Bill Clinton persuaded then Pakistan Prime Minister Nawaz Sharif to pull Pakistani troops back. (Sharif paid a high price. Later in the year he was overthrown by then General Pervez Musharraf, a lesson unlikely to be lost on the current civilian government which is seen as wary of making too many concessions to India for fear of alienating the powerful Pakistan Army.)

Then after an attack on India's parliament in December 2001 triggered the mobilisation of close to a million men along the two countries' borders, the United States dived into another round of frantic diplomacy to persuade Pakistan to crack down on Kashmiri militant groups and the Indians to stand down.  Much of that diplomacy went on behind-the-scenes, though for an interesting Pakistani view of how close the two countries came to war in 2002, here is a link to an article written in January that year by the current Pakistan High Commissioner to Britain.

So what are the prospects in the current crisis?

Unlike in previous years, the Americans have become much more forthright about the extent to which they are willing to support Indian assertions that the roots of Islamist militancy lie in Pakistan.  When the Indians blamed the ISI for bombing its embassy in Kabul in July -- a charge Pakistan denied -- the Americans delivered by leaking reports of ISI involvement to U.S. newspapers, as I discussed in an earlier post.

After the Mumbai attacks, the New York Times has brushed off Pakistani denials of involvement with an op-ed boldly headlined The Pakistan Connection.

Bruce Riedel at the Brookings Institution has argued that "the most dangerous terrorist menace (to India) comes from groups with intimate connections to the global jihadist network centered around Osama bin Laden and al Qaeda and its allies in the Pakistani jihadist culture."  Exploring links between the ISI and militant groups he says it nurtured to fight India in Kashmir, he says that Zardari's ability to get control of the ISI "is still very much in doubt."

At the other side of the world, The Australian has challenged what it calls "The dangerous illusion of independent terrorists" -- the misconceived notion, it says, that perpetrators of attacks are non-state actors operating beyond the control of governments. "The radical increase in the lethality, range, political consequence and strategic influence of terrorists comes not from their being non-state actors at all. Instead it comes from their being sponsored by states," it says.  Then in language that could have come straight from the Indian government, it says: "Pakistan has for many years been a significant state sponsor of terrorism."

All that sounds like the kind of response the Indian prime minister was looking for when he said that "We expect the world community to recognise that the territory of the neighbouring country has been used for perpetrating this crime."

But how will it play inside Pakistan, where a weak civilian government is delicately balanced against a powerful army that has run the country for much of its life, and which in turn is battling militants on its border with Afghanistan? And what too will it mean for the ordinary people of Pakistan, caught in the middle?

An attack of the scale and sophistication unleashed on Mumbai would not be possible without months of planning, and yet it completely went below India's intelligence radar.

Indeed, so unaware were the security agencies that even when the attacks began, the first reaction was these were probably gangland shootings that India's financial capital is known for.   So if the agencies have been so clueless about an attack so mammoth in its sweep, the question experts are beginning to ask is how safe are India's vital assets?

The nuclear facilities for instance ? A chilling thought but one that must be answered, says B. Raman, a former top officer at India's Research and Analysis Wing. "I shiver and sweat at the thought of what is waiting to happen tomorrow and where. The mind boggles as one tries to think and figure out how the terrorists could have planned and carried out terrorist strikes of such magnitude, territorial spread and ferocity without our intelligence and police having been able to get scent of it," Raman, one of India's foremost intelligence experts, wrote. "I could not sleep the whole of last night. One question, which kept bothering me again and again was : how safe are our nuclear establishments and material?"

Of course nuclear installations are far more heavily guarded than a public place such as a hotel, hospital or a railway station and Raman probably means to rouse what he thinks is an establishment gone into deep slumber. But after the attacks on Mumbai, no longer can Indian experts be be going around saying Pakistan is unique in not having a grip on the militant threat. After repeated attacks beginning in Varanasi last year to Jaipur, Bangalore, Ahmedabad, Delhi twice this year and finally Mumbai, and still no wiser as to who is behind them,  New Delhi looks as much at sea as its counterpart in Islamabad.

Indian Prime Minister Manmohan Singh has blamed a group with "external linkages" for coordinated attacks which killed more than 100 people in Mumbai. The language was reminiscent of the darker days of India-Pakistan relations when India always saw a Pakistan hand in militant attacks, blaming groups it said were set up by Pakistan's spy agency, the Inter-Services Intelligence, or ISI, to seek revenge for Pakistan's defeat by India in the 1971 war.

An attack on India's parliament in December 2001 triggered a mass mobilisation along the two countries' borders and brought them close to a fourth war.  That attack was blamed by India on the Pakistan-based Kashmiri militant groups Lashkar-e-Taiba and Jaish-e-Mohammed - hardline Islamist groups with links to al Qaeda.  Both have been associated with the kind of "fedayeen" attacks -- in which the attackers, while not necessarily suicide bombers, are willing to fight to the death -- seen in Mumbai.

So does the assault on Mumbai spell the death-knell for what had been gradually warming ties between Pakistan and India?

Pakistan has condemned the attack, just as it did when gunmen attacked the Indian parliament in 2001. And the Pakistani context today is quite different from that of 2001. Then a military ruler, former president Pervez Musharraf was in power, whereas Pakistan is now run by a new civilian president, Asif Ali Zardari, who has made clear he wants peace with India over Kashmir.

But Singh's comments, made in a televised address to the nation, were remarkably strong for the usually mild-mannered prime minister:

“It is evident that the group which carried out these attacks, based outside the country, had come with single-minded determination to create havoc in the commercial capital of the country," he said. “We will take the strongest possible measures to ensure that there is no repetition of such terrorist acts. We are determined to take whatever measures are necessary to ensure the safety and security of our citizens."

The strength of the language may have been fuelled by the scale of the Mumbai attacks, and could refer to either Pakistan or Bangladesh, which has also been accused by India of harbouring militant groups. But it sounded similar in tone to that of Singh's  predecessor, Atal Behari Vajpayee, who following the 2001 parliament attack warned Pakistan that India's patience was wearing thin. And they also contrasted with India's reaction to bombings which killed at least 63 people in the western city of Jaipur earlier this year, when the Indian government notably refrained from pointing a finger at Pakistan.

So was this a deliberate attempt to undermine India-Pakistan relations?  And if so, what will that mean for Pakistan's fragile civilian democracy? Zardari has staked his reputation on making peace with India to improve trade and help lift Pakistan's struggling economy.

Much will depend on how Singh, under pressure to show a firm hand ahead of a national election due in India by May 2009, reacts.

(Rueters photo of Taj Mahal hotel in Mumbai/Punit Paranjpe)