Michael Goldfarb serves as a GlobalPost correspondent in the United Kingdom, where this article first appeared.

In America, the health care debate is about to come to a boil. President Barack Obama has put pressure on both houses of Congress to pass versions of his flagship domestic legislative program prior to their August recess.

Good luck.

Opponents are filling the airwaves with the usual litany of lies, damned lies and statistics about socialized medicine and the twin nightmare of bureaucratically rationed health care and high taxes amongst allies like Britain, France and Germany. So here is a brief overview of health care in some of Europe’s biggest economies: Britain’s National Health Service is paid for out of a social security tax. Services are free at the point of provision. No co-pay, no reimbursement. The budget last year was 90 billion pounds (about $148 billion). That makes the average cost per person about 1,500 pounds ($2,463).

The NHS is big — huge, in fact. With 1.5 million employees it is one of the largest employers in the world. Only China’s People’s Liberation Army, India’s state railways and good old Wal-Mart employ more folks. Sixty percent of the NHS budget goes toward salaries.

The French system is run on a compulsory purchase of insurance through the workplace. The insurance cost is based on how much a worker earns. Low-income workers pay nothing. The average contribution per person is about $4,000. The government sets fees for services and negotiates the price of drugs with pharmaceutical companies. (See related GlobalPost story “Why French doctors still make house calls.”)

Service is not free at the point of provision. But reimbursement for costs is swift and in the case of catastrophic illness all fees are waived. People are free to purchase supplementary insurance from private companies.

With a compulsory insurance plan, as in France, German care is universal and equitable. Germans pay approximately 14.3 percent of their earnings to buy this insurance. As in France, people are free to buy supplementary private health insurance. Each system is unique (as are all the systems around Europe) but they have two things in common that make them different from the United States: Coverage is universal and the cost of care as a percentage of GDP is significantly less.

For Europeans — even those who would label themselves conservatives — American attitudes to setting up a universal health care system with strong state participation and management seem bizarre. The peace of mind that comes from knowing that in an emergency you will be taken care of and you won’t be financially ruined has no price. Why resist it?

Beccy Ashton, policy adviser at health care think tank The King’s Fund, worked for more than half a decade in the U.S. She explains the difference this way: “In Europe healthcare is regarded as a human right. In America, people think of it as a commodity that you buy.” If you look at how the Big Three’s health systems came into being you realize changing American attitudes may be difficult.

Britain and France created their systems out of the rubble of World War II. Pushed from below, the leaders of both nations sought to bring greater social equality to their societies. Social security systems were set up with equal access to health care given pride of place.

This wasn’t done without facing down doctors and insurance companies, but politicians are never so bold as when the public will for something is clear. In 1945 in both Britain and France, there was no going back to the status quo before the war started. Germany’s system has the weight of history behind it. Its origins can be traced back to the first era of German unification when Chancellor Otto von Bismarck created the First Reich. In the 1880s he set up a system of compulsory health insurance by workers and employers and other forms of social security. He did not invent the system out of nothing. There had been a tradition among the German guilds going back to the Middle Ages of members making compulsory contributions to help their brothers in old age or if a colleague had to stop working because of injury.

Clearly, America at this moment in time has not recently experienced an epoch-shattering historical event like a World War and despite Obama’s comparative popularity, he doesn’t have the clout of an Iron Chancellor to simply decree what he wants and know that Congress will rubber stamp it.
Beccy Ashton points out, “The President must be aware of the fine line he has to walk. If he goes forward with a radical agenda, he knows you’ve lost before you’ve started.”

So people in Europe continue to watch with bemusement as American legislators grapple with reforming a system that basically needs to be junked. Professionals like Ashton answer calls from reporters and try to refute right-wing misinformation that floats around the debate. Those damned lies and statistics.

The only statistics on health care systems that really matter are life expectancy and infant mortality. Both speak to accessibility and affordability. If you want to know how the U.S., the wealthiest nation on earth, stacks up, here you go:

In life expectancy, the U.S. ranks 38th or 45th depending on whether one uses the United Nation’s statistics or those compiled by the CIA. (In both cases, life expectancy in Cuba is higher!) According to the CIA World Factbook, the U.S. has many more infant deaths than its EU counterparts or northern socialist (to right-wing ideologues) neighbor, Canada. While the U.S. has 6.26 deaths per live births, Canada had 5.04. Britain, France and Germany? 4.85, 3.33 and 3.99, respectively.

Other health links from GlobalPost:

Winter in the time of swine flu

Coming home from school with strawberry condoms

(Pictured above: Healthcare reform supporters rally outside U.S. Senator Sam Brownback’s office in Overland Park, Kansas, July 9, 2009. REUTERS/Carey Gillam)

– 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. –

When it comes to healthcare reform, as Aldous Huxley said, “Facts do not cease to exist because they are ignored.”

Three of the most common “urban myths” of American healthcare are that:
1. The lower life expectancy in the U.S. “proves” the total inadequacy of our system;
2. There are 47 million uninsured Americans — proving the inequity of our system; and
3. We spend “too much” on health care — proving the wastefulness of our system.

As the Ol Perfessor used to say, “Let’s look at the numbers.”

1. Lower Life Expectancy: According to N. Gregory Mankiw, Professor of Economics at Harvard University, “The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.”

This fact, according to Mankiw, is often taken as evidence for the inadequacy of the U.S. health system. But a recent study by June and Dave O’Neill, economists at Baruch College, from whom these numbers come, shows that the difference in health outcomes has more to do with broader social forces.

Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, and the O’Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach nothing about the U.S. system of health care.

Americans are also more likely to be obese, leading to heart disease and other medical problems. Among Americans, 31 percent of men and 33 percent of women have a body mass index of at least 30, the dividing line between overweight and obese, versus 17 percent of men and 19 percent of women in Canada. Research by the Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro concludes that the growing obesity problem in the United States is largely attributable to its ability to supply high-calorie foods inexpensively.

Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight, which is correlated with teenage motherhood. Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youths.

2. 47 Million Uninsured: This number from the Census Bureau is regularly cited by President Obama and almost every proponent of “universal healthcare” as evidence that the health system is failing for many families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.

The 47 million includes about 10 million illegal immigrants. And all the current legislation being considered in Congress specifically excludes illegal immigrants from government healthcare. The “Big Number” also includes millions of the poor who are eligible for Medicaid but have not yet applied. They could be insured, on the government’s dime, tomorrow. And about a quarter of the uninsured have been offered employer-provided insurance but declined coverage, often because of cost. The solution to this isn’t Uncle Sam, MD, but smarter insurance regulation.

A new study by University of Minnesota economists Stephen Parente and Roer Feldman shows that Congress could boost by more than 12 million the number of people who have health insurance without spending taxpayer dollars. The change required is to allow people to buy health insurance across state lines, so they can shop for less expensive policies. For example, a typical health-insurance policy in heavily regulated New York costs more than three times as much as in less regulated Iowa ($388 a month versus $98 a month for the same coverage).

3. We Spend “Too Much” on Healthcare : In 1950, Americans spent about 5 percent of their income on health care. Today the share is about 16 percent. According to Harvard’s Mankiw, “many pundits take the increasing cost as evidence that the system is too expensive. But increasing expenditures could just as well be a symptom of success.”

And he hits a homerun with a clear, concise, and common sense explanation. “The reason Americans spend more than their grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Medical science has consistently found new ways to extend and improve lives. Wonderful as they are, they do not come cheap.”

Consider the question posed by economists Charles Jones of the University of California and Robert Hall of Stanford: “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing - or an extra year of life?”

As the old saying goes, everything you read in the newspaper is true, except for those things you know about personally. Healthcare reform is too important (and too complicated) to permit reform by sound bite.

–- Diana Furchtgott-Roth, former chief economist at the U.S. Department of Labor, is a senior fellow at the Hudson Institute. The views expressed are her own. –-

President Barack Obama has repeatedly said “First of all, if you’ve got health insurance, you like your doctors, you like your plan, you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you.”

But America’s Affordable Health Choices Act of 2009, the bill under discussion in the House of Representatives, would result in the demise of private health insurance in America.

The 1,018-page bill would result in unprecedented regulation of America’s health sector. Among other provisions, it includes an 8 percent tax on employers who do not offer health insurance to employees, a mandate for everyone to have insurance, and requirements on whom insurers must cover, what benefits must be provided, the extent of variation in premiums, and how much profit is permitted—with excess profits returned to enrollees.

This would solidify government control of all health care in America, force most private insurance companies out of business, and lead to a single payer health system, like Britain or France.

The bill’s focus is to drive people to the new public health-care plan or to Medicaid, the federal-state plan for low-income people. It would motivate many employers to drop insurance and pay the 8 percent tax, effectively steering employees to the new public plan.

The bill would create a new Health Insurance Exchange, where “qualified health benefit plans” are allowed to advertise their health insurance plans to individuals and firms. Only qualified health benefit plans are permitted to participate. In order to achieve the status of a qualified plan, an insurance company has to offer a certain package of benefits, meet guidelines on who can sign up, and agree to limits on profitability. It is unlikely that insurance companies can meet these requirements and stay in business.

The basic benefit plan for insurance companies who want to participate in the Exchange comprises inpatient and outpatient hospital services, as well as physician services and equipment and supplies used for treatment. In addition, it includes services that can by no means be considered basic, such as dental, vision, and hearing care for children, and mental health and substance abuse services.

Men would have to pay for maternity services and baby and child visits even if they are single and childless. People who do not abuse drugs would have to pay for substance abuse. This basic plan is like making everyone pay for a Cadillac when they would be glad to drive a used Ford.

Insurers would be required to accept all applicants, no matter how sick, and would be always required to renew coverage. With the exception of age, everyone, no matter how sick or healthy, would be charged the same premiums. When pricing by age, the highest premiums could not be more than twice as high as the lowest.

This means that in order to stay in business the prices charged by insurers would necessarily have to be very high. Companies would be required to cover a broad range of services, to accept anyone who applies without regard to sickness or health, and to keep premiums within a narrow range.

In addition, if companies were to make more than a certain level profit in a particular year, they need to return funds as rebates to enrollees. This prevents insurance companies from building up a reserve in some years to guard against losses in other years.

This pricing mechanism would quickly force private plans in the Health Exchange out of business—and leave consumers with the public plan.

In order to prevent insurance companies from offering plans outside the Health Exchange, Americans who receive financial help in paying for insurance would be required to buy plans in the Exchange. They could not select “bare bones” or catastrophic insurance plans sold on the open market.

Some Americans would be given “affordability credits,” credits to lower the price of their insurance, to be spent only within the Health Exchange. Individuals would be eligible if they earn too much to qualify for Medicaid—over 133% of the poverty line, now $29,000 for a family of four—but less than 400% of the poverty line, now $88,000.

Hence, health insurance assistance would be extended well above the median income for American households, now $55,000. These individuals would be forced to join plans in the Exchange in order to take advantage of government assistance.

Employers are also driven towards the Exchange. Beginning five years after passage of the bill, they would either have to offer health insurance comparable to plans in the exchange, or pay an 8 percent tax specifically designated towards subsidizing coverage in the Exchange.

Although President Obama repeatedly says that Americans who are happy with their medical insurance plans will be able to keep them, the House bill will make these plans disappear. Then, it’s a short step to a single payer system. Is America ready?

– James Pethokoukis is a Reuters columnist. The views expressed are his own —

You have to admire the confidence. “Don’t bet against us,” said President Barack Obama on Monday about the chances for healthcare reform. “We are going to get it done.” Not only that, Obama repeated his pledge that his plan “will not add to the deficit over the next decade.”

Sunny optimism may reign at the White House, but things are a bit gloomier over on Capitol Hill. An August deadline to get a bill passed looks likely to be broken. More delays mean lost momentum and rising odds that debate over the bill could linger into the tumult of the 2010 congressional election year.

What’s the hold-up? Money, of course.

At least half the plan — say, $500 billion or so over 10 years — will need to be paid for through higher taxes. But there have been few takers in Congress for either a) reducing the value of tax deductions for wealthier Americans or b) taxing employer-provided healthcare benefits.

The latest unloved plan is a surtax on high incomes, suggested by Representative Charles Rangel, chairman of the House Ways and Means Committee. But influential Democrats in the Senate quickly hint they are cool to the idea.

So anybody got a spare $500 billion?

“I could name you 20 different ways to pay for healthcare reform in 30 seconds, but they have all been ruled out by key members of Congress,” says Len Berman, a budget expert with the Urban Institute. What drives Berman nuts is that after talking to people in the White House and on Capitol Hill, he is sure they all understand the importance of getting healthcare costs under control and making sure any reform doesn’t make the deficit worse.

Then again, there’s nothing new in that. Despite full knowledge of the scary future budget numbers, Congress in 2003 passed a prescription drug benefit for the elderly without putting in a mechanism to pay for it. Experts now project that program has a bigger long-term liability than Social Security.

Berman thinks pulling a fiscal stunt like that again could sink the American government bond market. In any case, there are doubts that centrist “blue dog” Democrats would vote for healthcare reform that clearly makes the already huge budget deficit worse.

Another option would be to put healthcare on hold and wait until the economy improves. The public might be less skittish about higher taxes then and the Obamacrats — having successfully “fixed” the economy — might have more political capital to spend on new programs.

But such a delay would surely enrage party liberals who think the slow progress is all-too reminiscent of Bill Clinton’s failure to reform healthcare in 1994. “Imagine if the Republicans were in power with 60 votes and a wildly popular president and couldn’t pass tax cuts,” says Ryan Ellis of Americans for Tax Reform. “Democrats have their own base to worry about.”

If Obama wants some sort of reform bill to sign by year end, it may be a more minimalist package of greater healthcare benefits for children and perhaps a move toward some of his information technology, cost control and medical procedure evaluation goals. He can call it a “down payment.” Realistically, that’s about all he can really be confident of these days.

– James Pethokoukis is a Reuters columnist. The views expressed are his own —

The playbook is getting pretty thin for the Obama White House and congressional Democrats. One big idea they had to pay for healthcare reform was by capping itemized tax deductions for upper-income taxpayers. But the charities and nonprofits who benefit from these deductions screamed to Capitol Hill, so that approach was shelved. Time for Plan B.

Then congressional Democrats considered removing or capping the tax-advantaged status of job-based healthcare benefits. These untaxed benefits mean workers pay very little of their healthcare expenses out of their own pockets, which, in turn, means they aren’t motivated to act like true, cost-conscious consumers.

Whatever else its merits, this change would have been a step toward signaling to workers the true cost of their job-based healthcare plan by reminding them that their income funds the purchase of those health benefits. Higher benefits means lower wages.

But it turns out that this idea isn’t very popular with voters who are being asked to give up money today for the promise of lower healthcare costs tomorrow.

So how to pay for a plan that could cost $1.5 trillion over the next decade? Time for Plan C.

Now congressional Democrats are floating the idea of a surtax on wealthier Americans. Actually, this would kind of be a second surtax. During the presidential campaign, Barack Obama said that some of the revenue gained by letting the 2001 and 2003 Bush tax cuts expire for those folks at the end of 2010 would help pay for healthcare reform.

So on top of that $500 billion (over ten years), you can tack on, perhaps, another $300 billion. While this might make the tax system more progressive, it leaves in place the free-lunch illusion surrounding worker healthcare benefits (though they do play premiums, of course.)

In addition, it is a de facto further hike in marginal tax rates during an economic downturn that is far worse than Team Obama expected. That comes in addition to plans to raise investment taxes, corporate taxes, and energy taxes. And, of course, some of the so-called wealthier Americans are small business owners. While most owners would be not affected, the majority of small business profits would face the higher marginal rate.

The weak economy is making the American public rightfully more skittish about paying higher taxes, whether for reforming healthcare or dealing with climate change. And if unemployment keeps rising, calls for a pricey second stimulus package might might make healthcare seem like an expensive indulgence that can wait until 2010 or beyond.

At least that will give the Obamacrats more time to think about how to come up with that $1.5 trillion.

– Darrell West is vice president and director of governance studies at the Brookings Institution and the author of Digital Medicine: Health Care in the Internet Era. The views expressed are his own. —

It is not the first time Washington has been disconnected from the general public, but recent discussions over healthcare reform reveal a D.C. establishment fixated on arguments not central to the general public.

The air waves are filled with clashing claims over the so-called public option whereby Medicare would be expanded to include more Americans. Proponents claim this is the best way to cover most Americans currently without coverage and drive down costs by creating competition for private insurance companies.

Opponents complain about a “government-run” health system and bureaucrats coming between physicians and patients.

According to pollster Geoffrey Garin, though, voters do not have a big problem with the public option, or employer or individual mandates requiring coverage. A recent New York Times/CBS News survey found that 72 percent of Americans support a “government administered health insurance plan” similar to Medicare and 59 percent believe the government would do a better job than private insurance companies in holding down health care costs.

The problem, from the voter standpoint, is how to pay for reform. With costs estimated to top $1 trillion and federal budget deficits already having sky-rocketed, people want to know who pays and how changes will affect their personal medical care. It matters to them whether the bill for coverage expansion comes in the form of higher taxes on sodas, alcohol, tobacco, or employer benefits or reduced spending on physicians, hospitals, and other health providers. With personal finances under great strain due to the recession, the public is not in a particularly generous mood.

The greatest fear people have, according to public opinion experts, is that their current care will suffer. Seventy-seven percent of Americans are satisfied with the medical coverage they currently receive. While they are interested in expanding coverage, they don’t want to do so if it is really expensive or endangers their own treatment.

The best thing President Barack Obama can do is remind people that if they like their current care, they get to keep it. No one will be forced into a public plan. People can keep physicians they like. If they worry about government-run health care, they can stick with private insurance.

The biggest change from 15 years ago, when the Clinton administration attempted health care reform, is that now people worry as much about mistreatment from private insurance companies as government-sponsored health plans. The bureaucrat they fear is not just a government employee making policy decisions affecting health care, but the commercial insurer that denies claims, demands extensive paperwork and removes people from coverage due to pre-existing conditions. From the voter’s perspective, the playing field between the public and private sectors is more level than in earlier reform efforts.

New technologies furthermore give consumers greater control over medical information and treatment. Regardless of what policy decisions Washington makes, America is moving towards “consumer-directed” health care that will transform the practice of medicine. The monopoly over medical treatment held by physicians and hospitals is eroding. In the future, people will use remote sensors to monitor glucose levels and blood pressure; electronic medical records will be utilized for storing information. Information technology will produce the real long-term revolution in health care.

-Arvind Ganesan is the Director of the Business and Human Rights Program at Human Rights Watch. The opinions expressed are his own.-

Equatorial Guinea is a tiny country of about half a million people on the west coast of Africa, but is the fourth-largest oil producer in sub-Saharan Africa.

Most of the investment in the country’s multi-billion dollar oil industry comes from the United States. ExxonMobil, Hess and Marathon are all there. Right now, the U.S. imports up to 100,000 barrels of oil a day from Equatorial Guinea, or about a quarter of the country’s oil production.

Oil money gives the country the means to be a model for development and human rights. The economy is nearly 130 times as big as it was when oil was discovered in 1995. But as a report released by Human Rights Watch today details, the government has squandered or stolen much of the money at the expense of its people.

It is a sad contrast, since the country has a per capita income comparable to Spain’s or Italy’s and development indicators more like Afghanistan’s. For just one sad example, infant and child mortality actually has increased -- from an already-dismal 103 deaths per thousand in 1990 to 124 per thousand in 2007. Similarly, under-5 mortality rates increased from 170 per thousand in 1990 to 206 per thousand in 2007.

The president and his family are doing just fine, though. They lead lavish lifestyles while most people live in crushing poverty.

A series of corruption scandals involving government officials and their families will give you some idea of how bad it is.

In 2004, a U.S. Senate investigation into the country’s dealings with the now-defunct Riggs Bank detailed how President Teodoro Obiang Nguema Mbasogo used the country’s oil wealth to finance numerous personal transactions, including spending $3.8 million to buy two mansions in a suburb of Washington, D.C. That investigation led to one of the largest fines against a bank in U.S. history, and ultimately the bank’s takeover.

Obiang’s eldest son, Teodorin, bought a $35 million property in California in 2006. In 2004, he spent about $8.45 million for mansions and luxury cars in South Africa. His only known income was a $4,000 monthly salary as a government minister. His $43.45 million in spending on his lavish lifestyle from 2004 to 2006 was more than the $43 million the government spent on education in 2005.

The people of Equatorial Guinea have no way to hold their government accountable. Obiang has been in power since 1979, when he deposed his uncle in a coup. The government severely curtails press freedom and independent civil society, and the political opposition is weak and faces constant government harassment, intimidation, and arrests. In the most recent parliamentary elections in May 2008, Obiang and his allies won 99 out of 100 seats.

The government has joined the Extractive Industries Transparency Initiative (EITI), an effort to make natural resources benefit everyone by setting a global standard for openness in oil, gas, and mining. However, the government has been very slow to implement the initiative’s standards. The danger is that EITI may give the government a veneer of legitimacy even while it stifles its critics and opposes real scrutiny.

Perhaps the best prospect for reform lies with the Obama administration since most of the investment in Equatorial Guinea’s oil comes the US. There are in fact things the administration can do now to break the cycle of corruption in a place like Equatorial Guinea. It should hold the government accountable for human rights and insist that it rigorously enforce anti-corruption laws. Under the Bush administration, that did not happen.

The same month in 2006 that Obiang’s son bought a $35 million Malibu mansion, Secretary of State Condoleezza Rice met with Obiang in Washington and called him “a good friend” at a news conference.

Unless the Obama administration makes it clear to Equatorial Guinea’s leaders that they must share the oil wealth with the country’s people , the human cost of the oil that the US imports from that country will continue to be staggering.

–- Diana Furchtgott-Roth, former chief economist at the U.S. Department of Labor, is a senior fellow at the Hudson Institute. The views expressed are her own. –-

The Obama administration is considering a proposal to use federal regulations to expand women’s participation beyond college athletics to the selection of courses, especially in mathematics, science and engineering.

The proposal to apply so-called Title IX gender-equality to selection of courses and majors was discussed at a White House conference on June 23, and endorsed by Valerie Jarrett, senior adviser and assistant to the president, and Russlynn Ali, assistant secretary of education for civil rights.

Title IX, passed in 1972 as an amendment to the 1964 Civil Rights Act, has been interpreted to mean that universities which accept federal funds cannot have more male athletes than female, even though more men than women generally want to play sports. Hence, many collegiate men have not been able to participate in intercollegiate athletics, and men’s sports teams have been terminated all over the country.

Title IX was intended to protect against sex discrimination, but not to allow the use of quotas. Indeed, it specifically prohibited arbitrary leveling of student numbers by gender. Yet the courts have required universities to adopt a proportionality standard for college sports if they wished to avoid lawsuits. If 52 percent of the students are female, then 52 percent of sports slots have to go to women.

In a telephone conversation yesterday Ali told me that although the administration will extend Title IX to math and science, it does not intend to argue for proportionality. Instead, the administration will make sure that secondary schools and universities do not discriminate against girls and women when it comes to selection of courses and majors, citing anecdotal evidence that some girls and women are counseled against taking courses in math and science.

Since Title IX is already law, congressional approval is unnecessary. The new initiative will not require new formal regulations, just a change in enforcement.

Ali explained that college athletics were a special case because male and female programs were segregated, whereas math and science classes are open to all, so gender parity—the same number of women as men in a physics class, for example—is not the goal “at this point.”

The question is, of course, at what point, if ever, the administration will decide that gender parity is the goal. Is the administration’s initiative the first step down a slippery slope that will eventually lead to men being shut out of physics classes the way that they are shut out of swimming and diving at the University of California at Los Angeles? Or will the administration be content to monitor discrimination without resorting to quotas?

Measuring discrimination is tough, because differences in outcomes are not necessarily evidence of discrimination. In 2006 women earned 20 percent of all bachelor’s degrees in engineering and 27 percent in math and computer science. But there’s no evidence that women who wanted to major in science were turned away—or are now.

The Education Department’s prospective focus on counseling sidesteps the issue of what constitutes constructive advice. Is it permissible for a girl who gets Cs in math and science to be counseled not to major in these subjects in college? Or is that evidence of discrimination? What if schools and colleges never counsel females to stay away from science—and women fail courses, then taking longer to get degrees? How is the Department of Education going to measure discriminatory counseling, and how are schools and colleges going to defend themselves against lawsuits?

Students from around the world go to great lengths to come to American universities to study. Let’s hope that universities will not be discouraged from accepting male scientists, because it distorts the gender balance. Would Albert Einstein have been able to come to America under Title IX?

American universities have long hailed academic freedom for both students and faculty as the hallmarks not only of education but of American society. Applying Title IX to students’ majors and courses could be the beginning of the end.

- Bernd Debusmann is a Reuters columnist. The opinions expressed are his own -

Spare a thought for Hugo Chavez, the larger-than-life Venezuelan leader who flourished in the role of Latin America’s defender against an evil empire led by a devil who smelt of sulphur and was named George W. Bush.

Those were the easy days for Chavez. Now he has become a dragon-slayer without a dragon, an actor on a stage without the most important prop. It was one thing to rally the Latin masses against the widely-detested Bush, it is another to deal with Barack Obama, “the first (U.S.) president who looks like us,” in the words of Brazilian President Luiz Inacio Lula da Silva.

“The devil, the devil himself, is right in the house, ” Chavez said, to laughter and applause, in his infamous 2006 anti-Bush speech to the United Nations General Assembly. “And the devil came here yesterday. Yesterday, the devil came here. Right here. And it smells of sulphur still today.”

Chavez’s reaction to the bizarre coup that ousted Honduran president Manuel Zelaya was evidence that the Venezuelan knows the rules of the game he played for years no longer apply. In his weekly television show, he said he did not think Obama was behind the plot.

Claiming otherwise would have been difficult even for a president given to surreal conspiracy theories. Within hours of the coup against Zelaya, a Chavez ally, Obama condemned the action, as did the Organization of American States and the European Union, which promptly withdrew its ambassadors from Tegucigalpa, the Honduran capital.

Contrast Washington’s reaction to the way it greeted a short-lived coup against Chavez and you might well come to the conclusion that he owes a debt of gratitude to the Bush administration.

On April 12, 2002, the White House greeted with barely concealed glee news that a coup had ousted Chavez, an elected president. He had created the conditions that led to his ouster, according to then White House spokesman Ari Fleischer. In other words, he only had to blame himself.

Washington looked forward, Fleischer said, to working with Venezuelan democratic forces (a euphemism for the plotters) to “restore the essential elements of democracy.” As it turned out, that wasn’t necessary. Chavez was back in power within 48 hours and has portrayed himself as a victim and a target of CIA plots ever since.

The role of victim will be more difficult to play in future, barring big missteps on the Latin American scene by the Obama team. So far, there have been none. Commenting on the Honduras coup during a visit to Moscow, Obama said policy differences were no reason to abandon democratic principles. During the abortive coup against Chavez, the Bush team seemed eager to do just that.

U.S. ANTAGONISM BOOSTED CHAVEZ

Chavez’s political fortunes have been boosted considerably by confrontational U.S. moves, and not only during the eight years of George W. Bush. In 1998, when Chavez campaigned for the Venezuelan presidency, the Clinton administration denied him a visa to visit the United States. At the time, polls put his support at between three and five percent.

Those numbers shot up when Chavez incorporated the visa denial into his campaign. Holding aloft a visa credit card, he would tell cheering crowds that “this is the only visa I need,” not the visa the U.S. denied him. He won the election.

Since then, Chavez has emerged as a role model for Latin American leaders who want to perpetuate themselves in power by way of changing their countries’ constitutions. After narrowly losing a referendum on term limits in 2007, he tried again this year and won. He now can run for re-election as often as he wants.The opposition saw it as a move towards a lifetime presidency.

In January, Chavez’s left-wing ally Evo Morales won a referendum that allows him to run for a second five-year term. Last September, another Chavez ally, Ecuador’s Rafael Correa, won a referendum on a new constitution that vastly expanded his powers and allowed him to hold office for two additional four-year terms.

Another leftist, Nicaragua’s Daniel Ortega, has begun pushing for changes to let him stay on after his present term expires in 2011. (The urge to perpetuate themselves in power is not restricted to Chavez’s leftist allies: In Colombia, President Alvaro Uribe is mulling ways to run for a third time, after having the constitution changed to give him a second term).

In Honduras, Zelaya tried and failed to follow the Chavez script. Soldiers stormed into his residence and bundled him onto an Air Force plane, still in his pyjamas, bound for Costa Rica, after days of tension over his attempt to gauge public support for a referendum on term limits.

And for once, Chavez does not have an American president to blame.

Poor Hugo.

(You can contact the author at Debusmann@Reuters.com.)

– John Simon was recently U.S. Ambassador to the African Union and former Executive Vice President of the Overseas Private Investment Corporation.  He is currently a Visiting Fellow at the Center for Global Development in Washington DC. The views expressed are his own. —

President Obama’s trip to Ghana highlights one of Africa’s leading success stories - a country that has held five consecutive democratic elections, recently transferring power peacefully to the opposition after it won a razor thin victory.

Ghana is not alone. Sub-Saharan countries made tremendous progress in the past decade. Freedom House ranks seven out of ten of Sub-Saharan countries as free or partly free. Through 2007, Africa experienced 10 years of uninterrupted economic growth, the last five at rates above 5 percent. Foreign capital inflows increased from only $7 billion in 2002 to $53 billion in 2007.

Yet continued progress is not inevitable.  If Africa is to realize its potential, the hard work Africans have exerted over the past decade to improve the continent’s governance and economic policies must continue, and despite the myriad of pressing issues elsewhere, engagement by the international community in general, and the United States in particular, cannot flag.

Supporting Africa’s progress is not just about providing additional aid.  Aid is an important element for financing Africa’s development, but aid flows to Sub-Saharan Africa have nearly tripled since 2000 and will quadruple by 2010 if donor commitments made at the Gleneagles G-8 Summit are met.  More important now are efforts to help Africa increase its trade, solidify democratic norms through its own institutions, and resolve its remaining conflicts.

The United States can lead the world to provide an immediate benefit to Africa through trade.  The stalling of the Doha Development Round of trade talks is a missed opportunity that would have been worth billions of dollars for Africa.  Yet all is not lost - the United States could agree to implement those aspects of the Doha package that will benefit Africa now without waiting for a final deal with all WTO members.

This means eliminating domestic agricultural subsidies. The U.S. has held out on conceding these economically unjustifiable programs for a comprehensive deal, which would offer our farmers greater access to emerging markets like China and India.  But with deficits exceeding $1 trillion, we can no longer afford these $20 billion programs that mostly benefit fewer than 200,000 large farms at the expense of millions of poor farmers across the globe.  Acting now will counter the impact on Africa of the global financial crisis, which threatens to stop Africa’s economic progress in its tracks, and give us standing to insist the EU follow by opening up its massive market to African agricultural products.

Now is a critical time for African democracy as well.  In 2009, sixteen African countries went or will go to the polls for presidential or parliamentary elections.  The African Union (AU) intends to monitor them all.  Ensuring the AU has the resources and staff to not only validate the results on election day, but to do the pre-election assessments that encourage a level playing field will raise the standards for democracy on the continent and make likely more examples of the peaceful transfer of power most recently witnessed in Ghana.

Finally, the U.S. needs to use its voice in the United Nations to increase support for peacekeeping on the continent.  Done right, peacekeeping can lead to dramatic successes, as has been the case in Liberia and Sierra Leone.  Liberia initially had 17,000 peacekeepers for a population of 3 million people, giving the peacekeepers enough firepower to dissuade any “spoilers.” 

Compare that to the Democratic Republic of Congo, where a similar number of peacekeepers are seeking to stabilize a country of 66 million people 21 times the land area of Liberia; or Somalia, which currently only has slightly more than 4,000 peacekeepers for a country of more than 7 million. In such instances, spoilers can outgun the peacekeepers and gain prestige by attacking them. Many will argue that peacekeeping budgets are limited, which is true, but the cost of new funding for peacekeeping pales beside the cost of failing to keep the peace.

Africa has achieved much in the last ten years.  If this decade is to be a precursor of sustained development success in the future instead of a temporary hiatus from the steady decline of the past, its friends need to act now to support Africa’s leaders and institutions in establishing peace and security, raising democratic standards, and integrating the continent into the global economy.