The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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DealBook: Easing of Rules for Banks Acknowledges Reality

When a global committee of regulators and central bankers agreed to a new set of rules for the banking system a year and a half ago, Jamie Dimon, the chief executive of JPMorgan Chase, told The Financial Times, “I’m very close to thinking the United States shouldn’t be in Basel anymore. I would not have agreed to rules that are blatantly anti-American.”

Over the last weekend, Mr. Dimon finally got what he had wanted: a form of deregulation of sorts. The new international capital requirements for banks, known as Basel III — apologies if your eyes are glazing over — were significantly relaxed by regulators.

Instead of requiring banks to maintain, by 2015, a certain amount of assets that can quickly be turned into cash, the most stringent deadline was pushed to 2019. Perhaps more important, the type of assets that could be counted in a bank’s liquidity requirement was changed to be more flexible, including securities backed by mortgages, for example, instead of simply sovereign debt.

This sounds boring, but it is important stuff. Increasing bank capital and liquidity requirements — think of it as the size of a bank’s rainy day fund — is arguably more significant than all of the new laws in the Dodd-Frank Wall Street Reform and Consumer Protection Act. The more capital a bank is required to hold, the lower the chance it could suffer a run on the bank like Lehman Brothers did in 2008.

Given memories of the financial crisis, the idea that regulators would loosen rules even a smidgen is considered a huge giveaway. The conventional wisdom is that the banks are the big winners and the regulators are, once again, patsies, capitulating under pressure to the all-powerful financial industry. The headlines tell the story: “Banks Win 4-Year Delay as Basel Liquidity Rule Loosened,” Bloomberg declared. The Financial Times splashed, “ ‘Massive Softening’ of Basel Rules.” “Bank Regulators Retreat,” the Huffington Post said. Reuters described the new regulations as a “light touch.”

Mayra Rodríguez Valladares, a managing principal at MRV Associates, a regulatory consulting firm, put it this way, “With every part of Basel III that is gutted, we are increasingly back where we were at the eve of the crisis.” She went on to say, “In today’s financial world, regulators pretend to supervise while banks pretend to be liquid.”

But this is a knee-jerk response.

While there is no question that the original rules would do a better job preventing the next 100-year flood in the banking system, their quick adoption most likely would have created their own drag on the economy because bank lending would most likely have been curtailed.

“If Basel had been implemented this year as written, it almost certainly would have thrown the U.S. and other economies into a recession more than going over the fiscal cliff ever would have,” John Berlau of the Competitive Enterprise Institute, a research organization promoting free markets, wrote. Mr. Berlau, who may have a penchant for hyperbole, had been calling the deadline the Basel cliff. He added, “Basel III has been delayed, and for Main Street growth and financial stability, that is all to the good.”

Mr. Berlau is right. In truth, the reason that regulators ultimately chose to relax the rules was simple practicality: many banks in Europe and some in the United States would have never been able to meet the requirements without significantly reducing the amount of credit they were to extend to Main Street over the next two years, according to people involved in the Basel decision process.

That’s the other side of the regulatory coin that Main Street often forgets about. At the time that the original rules were written in 2010, the consensus among economists was that the global economy would be in much better shape today than it is.

“Nobody set out to make it stronger or weaker, but to make it more realistic,” Mervyn A. King, governor of the Bank of England, explained.

Let’s be clear: high capital requirements are a good thing to do to reduce risk in the system. And there is no question that the banks, especially in the United States, are in a much stronger position than they were. Let’s also stipulate that the Basel committee did a horrible job before the financial crisis in setting and enforcing proper standards. Basel’s loosening of rules before the crisis that worsened the pain of the global banking system.

But the push for stricter rules just as the global economy is trying to nurse itself back to health, simply to satisfy the public, rather to find a solution that balances the risks to the economy and the banking system, would have been a mistake. The chances of a leverage-induced crisis from Wall Street banks right now is quite low.

The challenge for regulators is making sure their memories aren’t so short that they seek to scale back the rules again.

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This post has been revised to reflect the following correction:

Correction: January 8, 2013

An earlier version of this article misstated the affiliation of John Berlau. He is a senior fellow at the Competitive Enterprise Institute, not the Bastiat Institute.

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IHT Rendezvous: IHT Quick Read, Jan. 7

NEWS Sounding defiant, confident and, to critics, out of touch, President Bashar al-Assad of Syria on Sunday used his first public address in six months to justify his crackdown, rally his supporters and leave recent efforts toward a political resolution of the civil war in tatters. Anne Barnard reports from Beirut.

A group of top regulators and central bankers on Sunday gave banks around the world more time to meet new rules aimed at preventing financial crises, saying they wanted to avoid the possibility of damaging the economic recovery. Jack Ewing reports.

Turmoil at a leading newspaper is posing an early challenge for the new Chinese leader, Xi Jinping, pitting pent-up demand for change against the Communist Party’s desire to maintain firm control. Ian Johnson reports from Beijing.

The French technology entrepreneur Xavier Niel has made a career of disrupting the status quo. Now his company, Free, has taken on Google and other Web companies by allowing its estimated 5.2 million Internet-access users in France to block Web advertising. Free is updating users’ software with an ad-blocking feature as the default setting. David Jolly reports from Paris.

John C. Kiriakou, a former C.I.A. officer, says he did not intend to harm national security, and he doesn’t think he did. But in a first, he is set to be sentenced to 30 months in prison for disclosing classified information to a reporter. Scott Shane reports from Washington.

A year after Muscovites took to the streets to protest the government and Vladimir V. Putin’s ongoing rule, the excitement that gripped many of the capital’s young professionals appears to be gone. But in its place is a deepening sense of alienation that poses its own long-term risk to the system. Ellen Barry reports from Moscow.

At first glance the willingness of Al Jazeera, the satellite network owned by Qatar, to pay some $500 million for Current TV, Al Gore’s struggling channel, seems like a vanity project. And it may turn out that way. But Qatar has developed one of the more energetic and sophisticated foreign investment strategies of the Gulf oil and gas producers. Al Jazeera’s expansion plan in the United States can be seen as part of its overall plan to put itself on the map. Stanley Reed reports from London.

A small plane carrying four Italian tourists, including the head of the Missoni fashion business, disappeared off the coast of Venezuela on Friday morning, prompting a sea and air search. Vittorio Missoni, 58, an owner of the family-run label famed for its zigzag knitwear, and his wife were aboard the plane, which was missing after takeoff from the island resort of Los Roques. Eric Wilson reports.

EDUCATION Millions of children in Indonesian elementary schools may no longer have separate science classes if the government approves a curriculum overhaul that would merge science and social studies with other classes so more time can be devoted to religious education. Sara Schonhardt reports from Jakarta.

More Western education institutions are looking to open up in Asia — and U.S. art and design schools are no exception. While the potential for growth is huge, given Asia’s rising creative industries, the actual logistics can be complicated. Kelly Wetherille reports.

ARTS The principal problem with many Web sites is that their designers were neither rigorous nor imaginative enough in planning the way we will navigate them. Alice Rawsthorn on design.

SPORTS The first weekend of the year has its own folklore in England as the time when small clubs can rise and knock the giants out of the F.A. Cup. Rob Hughes on soccer.

On Sunday morning, the long-dormant N.H.L. began stirring to life. The 113-day lockout was over, finished at 5 a.m. after a 16-hour bargaining session at a hotel in Manhattan, and across North America, the game began to awaken from its slumber. Jeff Z. Klein reports.

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Virtual U.: Massive Open Online Courses Prove Popular, if Not Lucrative Yet

Ramin Rahimian for The New York Times

Coursera has 35 employees in Mountain View, Calif. An employee works on a laptop near a new reception area.

MOUNTAIN VIEW, Calif. — In August, four months after Daphne Koller and Andrew Ng started the online education company Coursera, its free college courses had drawn in a million users, a faster launching than either Facebook or Twitter.

The co-founders, computer science professors at Stanford University, watched with amazement as enrollment passed two million last month, with 70,000 new students a week signing up for over 200 courses, including Human-Computer Interaction, Songwriting and Gamification, taught by faculty members at the company’s partners, 33 elite universities.

In less than a year, Coursera has attracted $22 million in venture capital and has created so much buzz that some universities sound a bit defensive about not leaping onto the bandwagon.

Other approaches to online courses are emerging as well. Universities nationwide are increasing their online offerings, hoping to attract students around the world. New ventures like Udemy help individual professors put their courses online. Harvard and the Massachusetts Institute of Technology have each provided $30 million to create edX. Another Stanford spinoff, Udacity, has attracted more than a million students to its menu of massive open online courses, or MOOCs, along with $15 million in financing.

All of this could well add up to the future of higher education — if anyone can figure out how to make money.

Coursera has grown at warp speed to emerge as the current leader of the pack, striving to support its business by creating revenue streams through licensing, certification fees and recruitment data provided to employers, among other efforts. But there is no guarantee that it will keep its position in the exploding education technology marketplace.

“No one’s got the model that’s going to work yet,” said James Grimmelmann, a New York Law School professor who specializes in computer and Internet law. “I expect all the current ventures to fail, because the expectations are too high. People think something will catch on like wildfire. But more likely, it’s maybe a decade later that somebody figures out how to do it and make money.”

For their part, Ms. Koller and Mr. Ng proclaim a desire to keep courses freely available to poor students worldwide. Education, they have said repeatedly, should be a right, not a privilege. And even their venture backers say profits can wait.

“Monetization is not the most important objective for this business at this point,” said Scott Sandell, a Coursera financier who is a general partner at New Enterprise Associates. “What is important is that Coursera is rapidly accumulating a body of high-quality content that could be very attractive to universities that want to license it for their own use. We invest with a very long mind-set, and the gestation period of the very best companies is at least 10 years.”

But with the first trickles of revenue now coming in, Coursera’s university partners expect to see some revenue sooner.

“We’ll make money when Coursera makes money,” said Peter Lange, the provost of Duke University, one of Coursera’s partners. “I don’t think it will be too long down the road. We don’t want to make the mistake the newspaper industry did, of giving our product away free online for too long.”

Right now, the most promising source of revenue for Coursera is the payment of licensing fees from other educational institutions that want to use the Coursera classes, either as a ready-made “course in a box” or as video lectures students can watch before going to class to work with a faculty member.

Ms. Koller has plenty of other ideas, as well. She is planning to charge $20, or maybe $50, for certificates of completion. And her company, like Udacity, has begun to charge corporate employers, including Facebook and Twitter, for access to high-performing students, starting with those studying software engineering.

This fall, Ms. Koller was excited about news she was about to announce: Antioch University’s Los Angeles campus had agreed to offer its students credit for successfully completing two Coursera courses, Modern and Contemporary American Poetry and Greek and Roman Mythology, both taught by professors from the University of Pennsylvania. Antioch would be the first college to pay a licensing fee — Ms. Koller would not say how much — to offer the courses to its students at a tuition lower than any four-year public campus in the state.

“We think this model will spread, helping academic institutions offer their students a better education at a lower price,” she said.

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Alarm in Albuquerque Over Plan to End Methadone for Inmates

Mark Holm for The New York Times

Officials at New Mexico’s largest jail want to end its methadone program. Addicts like Penny Strayer hope otherwise.

ALBUQUERQUE — It has been almost four decades since Betty Jo Lopez started using heroin.

Her face gray and wizened well beyond her 59 years, Ms. Lopez would almost certainly still be addicted, if not for the fact that she is locked away in jail, not to mention the cup of pinkish liquid she downs every morning.

“It’s the only thing that allows me to live a normal life,” Ms. Lopez said of the concoction, which contains methadone, a drug used to treat opiate dependence. “These nurses that give it to me, they’re like my guardian angels.”

For the last six years, the Metropolitan Detention Center, New Mexico’s largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so.

At this vast complex, sprawled out among the mesas west of downtown Albuquerque, any inmate who was enrolled at a methadone clinic just before being arrested can get the drug behind bars. Pregnant inmates addicted to heroin are also eligible.

Here in New Mexico, which has long been plagued by one of the nation’s worst heroin scourges, there is no shortage of participants — hundreds each year — who have gone through the program.

In November, however, the jail’s warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive.

Moreover, Mr. Rustin, a former warden of the Allegheny County Jail in Pennsylvania and a 32-year veteran of corrections work, said he did not believe that the program truly worked.

Of the hundred or so inmates receiving daily methadone doses, he said, there was little evidence of a reduction in recidivism, one of the program’s main selling points.

“My concern is that the courts and other authorities think that jail has become a treatment program, that it has become the community provider,” he said. “But jail is not the answer. Methadone programs belong in the community, not here.”

Mr. Rustin’s public stance has angered many in Albuquerque, where drug addiction has been passed down through generations in impoverished pockets of the city, as it has elsewhere across New Mexico.

Recovery advocates and community members argue that cutting people off from methadone is too dangerous, akin to taking insulin from a diabetic.

The New Mexico office of the Drug Policy Alliance, which promotes an overhaul to drug policy, has implored Mr. Rustin to reconsider his stance, saying in a letter that he did not have the medical expertise to make such a decision.

Last month, the Bernalillo County Commission ordered Mr. Rustin to extend the program, which also relies on about $200,000 in state financing annually, for two months until its results could be studied further.

“Addiction needs to be treated like any other health issue,” said Maggie Hart Stebbins, a county commissioner who supports the program.

“If we can treat addiction at the jail to the point where they stay clean and don’t reoffend, that saves us the cost of reincarcerating that person,” she said.

Hard data, though, is difficult to come by — hence the county’s coming review.

Darren Webb, the director of Recovery Services of New Mexico, a private contractor that runs the methadone program, said inmates were tracked after their release to ensure that they remained enrolled at outside methadone clinics.

While the outcome was never certain, Mr. Webb said, he maintained that providing methadone to inmates would give them a better chance of staying out of jail once they were released. “When they get out, they won’t be committing the same crimes they would if they were using,” he said. “They are functioning adults.”

In a study published in 2009 in The Journal of Substance Abuse Treatment, researchers found that male inmates in Baltimore who were treated with methadone were far more likely to continue their treatment in the community than inmates who received only counseling.

Those who received methadone behind bars were also more likely to be free of opioids and cocaine than those who received only counseling or started methadone treatment after their release.

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Alarm in Albuquerque Over Plan to End Methadone for Inmates

Mark Holm for The New York Times

Officials at New Mexico’s largest jail want to end its methadone program. Addicts like Penny Strayer hope otherwise.

ALBUQUERQUE — It has been almost four decades since Betty Jo Lopez started using heroin.

Her face gray and wizened well beyond her 59 years, Ms. Lopez would almost certainly still be addicted, if not for the fact that she is locked away in jail, not to mention the cup of pinkish liquid she downs every morning.

“It’s the only thing that allows me to live a normal life,” Ms. Lopez said of the concoction, which contains methadone, a drug used to treat opiate dependence. “These nurses that give it to me, they’re like my guardian angels.”

For the last six years, the Metropolitan Detention Center, New Mexico’s largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so.

At this vast complex, sprawled out among the mesas west of downtown Albuquerque, any inmate who was enrolled at a methadone clinic just before being arrested can get the drug behind bars. Pregnant inmates addicted to heroin are also eligible.

Here in New Mexico, which has long been plagued by one of the nation’s worst heroin scourges, there is no shortage of participants — hundreds each year — who have gone through the program.

In November, however, the jail’s warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive.

Moreover, Mr. Rustin, a former warden of the Allegheny County Jail in Pennsylvania and a 32-year veteran of corrections work, said he did not believe that the program truly worked.

Of the hundred or so inmates receiving daily methadone doses, he said, there was little evidence of a reduction in recidivism, one of the program’s main selling points.

“My concern is that the courts and other authorities think that jail has become a treatment program, that it has become the community provider,” he said. “But jail is not the answer. Methadone programs belong in the community, not here.”

Mr. Rustin’s public stance has angered many in Albuquerque, where drug addiction has been passed down through generations in impoverished pockets of the city, as it has elsewhere across New Mexico.

Recovery advocates and community members argue that cutting people off from methadone is too dangerous, akin to taking insulin from a diabetic.

The New Mexico office of the Drug Policy Alliance, which promotes an overhaul to drug policy, has implored Mr. Rustin to reconsider his stance, saying in a letter that he did not have the medical expertise to make such a decision.

Last month, the Bernalillo County Commission ordered Mr. Rustin to extend the program, which also relies on about $200,000 in state financing annually, for two months until its results could be studied further.

“Addiction needs to be treated like any other health issue,” said Maggie Hart Stebbins, a county commissioner who supports the program.

“If we can treat addiction at the jail to the point where they stay clean and don’t reoffend, that saves us the cost of reincarcerating that person,” she said.

Hard data, though, is difficult to come by — hence the county’s coming review.

Darren Webb, the director of Recovery Services of New Mexico, a private contractor that runs the methadone program, said inmates were tracked after their release to ensure that they remained enrolled at outside methadone clinics.

While the outcome was never certain, Mr. Webb said, he maintained that providing methadone to inmates would give them a better chance of staying out of jail once they were released. “When they get out, they won’t be committing the same crimes they would if they were using,” he said. “They are functioning adults.”

In a study published in 2009 in The Journal of Substance Abuse Treatment, researchers found that male inmates in Baltimore who were treated with methadone were far more likely to continue their treatment in the community than inmates who received only counseling.

Those who received methadone behind bars were also more likely to be free of opioids and cocaine than those who received only counseling or started methadone treatment after their release.

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Bill Richardson and Eric Schmidt of Google Visit North Korea

SEOUL, South Korea — Bill Richardson, the former governor of New Mexico, led a private delegation including Eric Schmidt, Google’s executive chairman, to North Korea on Monday, a controversial trip to a country that is among the most hostile to the Internet.

Mr. Richardson, who has visited North Korea several times, called his four-day trip a private humanitarian mission during which he said he would try to meet Kenneth Bae, a South Korea-born American citizen who was arrested on charges of "hostile acts" against North Korea after entering the country as a tourist in early November.

"I heard from his son who lives in Washington State, who asked me to bring him back," Mr. Richardson said in Beijing before boarding a plane bound for Pyongyang. "I doubt we can do it on this trip."

In a one-sentence dispatch, the North's state-run Korean Central News Agency confirmed the American group's arrival in Pyongyang, calling it "a Google delegation."

Mr. Richardson said his delegation planned to meet with North Korean political, economic and military leaders and visit universities.

Mr. Schmidt and Google have kept mum on why he joined the trip, which the State Department called "unhelpful." Mr. Richardson said on Monday that Mr. Schmidt was "interested in some of the economic issues there, the social media aspect," but did not elaborate. Mr. Schmidt is a staunch proponent of Internet connectivity and openness.

Except for a tiny portion of its elite, North Korea’s population is blocked from the Internet. Under its new leader, Kim Jong-un, the country has emphasized science and technology but has also vowed to intensify its war against outside information infiltrating the isolated country — and potentially undermining its totalitarian grip on power.

Although it is engaged in a standoff with the United States over its nuclear weapons and missile programs and habitually criticizes American foreign policy as "imperial," North Korea welcomes high-profile American visits to Pyongyang, billing them as signs of respect for its leadership. It runs a special museum for gifts foreign dignitaries have brought for its leaders.

Washington has never established diplomatic ties with North Korea and the two countries remain technically at war after the 1950-53 Korean War ended in a truce.

But Mr. Richardson’s trip comes at a particularly delicate time for Washington. In the past weeks, it has been trying to muster international support to penalize North Korea for its launch last month of a long-range rocket, which the United States condemned as a violation of United Nations Security Council resolutions banning the country from tests of intercontinental ballistic missile technology.

North Korea has often required the visits by such high-profile Americans as former Presidents Jimmy Carter and Bill Clinton before releasing American citizens held there on criminal charges. Mr. Richardson, who is also a former ambassador to the United Nations, traveled to Pyongyang in 1996 to negotiate the release of Evan Hunziker, who was held for three months on charges of spying after swimming across the river border between China and North Korea.

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Assad Outlines New Syria Peace Plan

BEIRUT (AP) — Syrian President Bashar Assad on Sunday outlined his vision for a road map to end nearly 22 months of violence in Syria but also struck a defiant tone, calling on his countrymen to unite against "murderous criminals" whom he said are carrying out a foreign plot seeking to tear the nation apart.

In a one-hour speech to the nation in which he appeared confident and relaxed, Assad ignored international demands for him to step down and said he is ready to hold a dialogue but only with those "who have not betrayed Syria." He offered a national reconciliation conference, elections and a new constitution but demanded regional and Western countries stop funding and arming rebels trying to overthrow him first.

The proposal, however, is unlikely to win acceptance from Syria's opposition forces, including rebels on the ground, who have repeatedly said they will accept nothing less than the president's departure, dismissing any kind of settlement that leaves him in the picture. On top of that, Assad's new initiative is reminiscent of symbolic changes and concessions that his government made earlier in the uprising, which were rejected at the time as too little too late.

Speaking at the Opera House in central Damascus, Assad told the hall packed with his supporters that "we are in a state of war. We are fighting an external aggression that is more dangerous than any others, because they use us to kill each other."

"It is a war between the nation and its enemies, between the people and the murderous criminals," he added. The audience frequently broke out in cheers and applause.

Assad has rarely spoken since the uprising against his rule began in March 2011, and his speech Sunday was his first since June.

His last public comments were in an interview in November to Russian TV in which he vowed to die in Syria. On Sunday, he seemed equally confident in his troops' ability to crush the rebels fighting his rule, even as they edge in closer than ever to his seat of power, Damascus.

British Foreign Secretary William Hague said Assad's speech was "beyond hypocritical." In a message posted on his official Twitter feed, Hague said "empty promises of reform fool no one."

Wearing a suit and tie, the president spoke before a collage of pictures of what appeared to be Syrians who have been killed since March 2011.

At the end of his speech and as he was leaving the hall, he was mobbed by a group of loyalists shouting: "With our blood and souls we redeem you, Bashar!"

The president in turn waved and blew kisses to the crowd on his way out.

Assad, in his speech, acknowledged the enormous impact of the nation's conflict, which the United Nations recent estimated had killed more than 60,000 people.

"We meet today and suffering is overwhelming Syrian land. There is no place for joy in any corner of the country in the absence of security and stability," he said. "I look at the eyes of Syria's children and I don't see any happiness."

The Internet was cut in many parts of Damascus ahead of the address, apparently for security reasons.

As in previous speeches, Assad said his forces were fighting groups of "murderous criminals" and jihadi elements and denied that there was an uprising against his family's decades-long rule.

He stressed the presence of religious extremists and jihadi elements among those fighting in Syria, calling them "terrorists who carry the ideology of al-Qaeda" and "servants who know nothing but the language of slaughter."

He struck a defiant tone, saying Syria will not take dictates from anyone and urged his countrymen to unite to save the nation.

Outlining his peace initiative, he said: "The first part of a political solution would require regional powers to stop funding and arming (the rebels), an end to terrorism and controlling the borders."

He said this would then be followed by dialogue and a national reconciliation conference and the formation of a wide representative government which would then oversee new elections, a new constitution and general amnesty.

However, Assad made clear his offer to hold a dialogue is not open to those whom he considers extremists or carrying out a foreign agenda.

"We never rejected a political solution ... but with whom should we talk? With those who have extremist ideology who only understand the language of terrorism?" he said.

"Or should we with negotiate puppets whom the West brought? ... We negotiate with the master not with the slave."

As in previous speeches and interviews, he clung to the view that the crisis in Syria was a foreign-backed agenda and said it was not an uprising against his rule.

"Is this a revolution and are these revolutionaries? By God, I say they are a bunch of criminals," he said.

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Michael Cronan, Who Gave TiVo and Kindle Their Names, Dies at 61

Michael Cronan, a San Francisco-based graphic designer and marketing executive who placed his stamp on popular culture when he created the brand names TiVo and Kindle, died on Tuesday in Berkeley, Calif. He was 61.

The cause was colon cancer, said his wife, Karin Hibma, with whom he founded the marketing firm Cronan in the early 1980s.

Mr. Cronan, who studied art in college, had many corporations and cultural institutions as clients, but he was most remembered for the pair of brand names he came up with a decade apart.

In the spring of 1997, he was asked to forge a name and an identity for a new device, a digital video recorder developed by a company called Teleworld that offered more sophisticated television recording choices than the videocassette recorder.

“We reviewed probably 1,600-plus name alternatives, seriously considered over 800 names and presented over 100 strong candidates to the team,” Mr. Cronan told Matt Haughey for his blog PVR (the letters stand for personal video recorder) in 2005.

“We spent the early meetings trying to place a cultural context on the product,” he said. Among the possibilities were Bongo and Lasso, which never got far.

Believing that “we were naming the next TV,” Mr. Cronan recalled, “I thought it should be as close as possible to what people would find familiar, so it must contain T and V.”

“I started looking at letter combinations,” he added, “and pretty quickly settled on TiVo.” (The “Vo” portion, he said, had a connection to the Latin and Italian words for vocal sound and voice.) Then came the search for a mascot that Mr. Cronan hoped “would become as recognizable as the mouse ears are to Disney.” He created a TV-shaped smiley character with the name TiVo inscribed on its face, rabbit ears suggesting an early TV set and large, splayed feet. Teleworld changed its name to TiVo Inc.

When Amazon prepared to introduce its first electronic reader in 2007, it turned to Mr. Cronan, who envisioned imagery reflecting the reading experience as an embryonic but rising technology.

Ms. Hibma said in an interview on Friday that in pondering a brand name, Mr. Cronan “wanted to create something small, humble, with no braggadocio,” while choosing an image that “was about starting something, giving birth to something.” He found the name, she said, by likening use of the new e-reader to “starting a fire.”

Michael Patrick Cronan was born on June 9, 1951, in San Francisco. He studied painting at the California College of Arts and Crafts (now California College of the Arts), where he later taught, and received a degree in art from California State University, Sacramento. He was a founder and past president of the San Francisco branch of AIGA, the professional association for design.

Mr. Cronan and his wife expanded their focus in 1992 to create the Walking Man clothing collection, featuring loose-knit tops and pants. Mr. Cronan also designed a pair of 1999 postage stamps, one commemorating the 50th anniversary of NATO and the other promoting prostate cancer awareness, and painted portraits and watercolors.

In addition to his wife, Mr. Cronan is survived by his sons, Shawn HibmaCronan and Nick Cronan; a brother, Christopher; a sister, Patricia Cronan; and a granddaughter.

For all his devotion to marketing and branding, Mr. Cronan felt that sometimes the demands of commerce went too far, as in the often-changing corporate names attached to sports stadiums and concert halls.

“There was a time in American life where going to a sporting event or a concert was sort of magical, because a lot of these places had these fun names,” he told The Denver Post in 2010. “But these days, with the amount of people craving advertising exposure, the sponsors have found a way to sell everything. They’re selling our nostalgia, and it’s sad.”

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Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

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