Tuesday, September 30, 2008

Which Candidate's Health Plan Would Do the Most for Ordinary Americans?


By Trudy Lieberman , Columbia Journalism Review. Posted September 29, 2008.


Neither candidate is talking much about the people who fall through gaps in our public safety net. And neither plan is truly universal.
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This is the third in a series examining how the candidates' health care proposals will affect ordinary people who live in Helena, Arkansas, and how the press could cover that angle. Part I is archived here, and Part II is here.

Annette Murph

Annette Murph, age 54, finds herself in a classic bind: medical problems prevent her from working. When they can't work, disabled people lose health insurance from their jobs and seek help from public programs, often enduring long waiting periods and a lot of red tape. What irony! The American way of health care forces those with serious medical problems to battle an inhospitable system that, at times, seems designed to keep them from getting care rather than meeting their medical needs.

Healthwise, Murph has been unlucky. She got high blood pressure and arthritis when she was 28 -- from her mother and grandmother, she says. Nine years ago, doctors diagnosed diabetes -- her parents, cousins, and uncles all had the disease. Her thyroid gland is abnormal, and she has had two heart attacks; two first cousins died young from heart attacks. Two years ago she underwent knee replacement surgery, after which she could no longer work as a buffet attendant at one of the casinos that line the Mississippi River not far from her home.

As a kid she picked and hoed cotton, as did so many in the Delta, and then repackaged pesticides and herbicides for a local chemical company. Until her knee surgery, Murph had worked at the casino for twelve years and had health insurance that covered her heart attacks. It also allowed her to regularly see her cardiologist and internist, who checked her thyroid and monitored her diabetes. After the surgery, her knee would no longer bend; it continues to hurt and swell, making it impossible to stand for long periods or move about easily. She could hardly work as a buffet attendant. The unsuccessful surgery, plus her other ailments, qualified her for Social Security disability payments.

After a remarkably short five-month period (the wait averages around two and a half years), she got her first monthly check of $758. That check, and thirty-seven dollars worth of food stamps is her entire income. More than one-third goes for rent on her tiny house, its living room decorated with pictures of relatives and Dr. Martin Luther King. She has little left for food, gasoline to power her nine-year old car, utility bills, and prescription drugs (she takes fourteen). Sometimes she gets help from drug company prescription assistance plans. If she can't, she goes without.

Right now she is without one of her four blood pressure medicines and one of her four diabetes medications. Without the diabetes medicine, her blood sugars rise into the 300 range -- too high. Since she left her job, she has accumulated over $15,000 in unpaid medical bills. Half were for care she needed from the local hospital in 2007; half reflect the care she needed this spring from cardiologists in Little Rock. On her income, she cannot pay them. "This is really frustrating. I'm not supposed to be upset because of my heart condition," Murph says. "I'm trying to stay calm, but I can't because of this system."

The system to which she refers is Medicare and Medicaid, believed by most people to be a safety net for the millions of Americans who become disabled, many by the time they turn fifty. Sometimes, the net is riddled with holes. "I thought when you are disabled, you automatically get covered," Murph says. "I've never been on government assistance before since I have always worked. When I couldn't go back to work is when this nightmare started."

Although Social Security disability payments qualify her for Medicare, there is a two-year wait for coverage, and she still has six months to go. She couldn't get continuous coverage under Medicaid because her $758 monthly income is too high. In Arkansas, a single person can make no more than $108.33 a month to qualify for that program.


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Most Results of Drug Studies Never Published


By Maggie Mahar, Health Beat. Posted September 29, 2008.


The results of over half of all clinical trials on drug safety and effectiveness are not published within five years of the drug going on the market.
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Last week, the Guardian UK published a story that should be shocking -- but isn't: "More than Half of U.S. Drug Studies Never See the Light of Day." This serves as further proof -- if we needed it -- that pharmaceutical companies should not be allowed to control what doctors and patients know, and don't know, about new drugs.

The story follows below.

More than half of US drug safety studies never see the light of day
Only 43 percent of the evidence of safety and efficacy that the US Food and Drug Administration uses to approve drugs is published in scientific journals. The authors of the survey say this amounts to "scientific misconduct."

James Randerson, guardian.co.uk,Tuesday September 23 2008 10:46 BST

The results of more than half of all clinical trials that demonstrate the safety and effectiveness of new drugs are not published within five years of the drug going on the market, according to an analysis of 90 drugs approved by US regulators between 1998 and 2000.

The researchers, who traced the publication or otherwise of 909 separate clinical trials in the scientific literature, wrote that the failure of drug companies to publish the evidence relating to new medicines amounted to "scientific misconduct". They said it "harms the public good" by preventing informed decisions by doctors and patients about new medicines and by hampering future scientific work.

Sir Iain Chalmers, who is director of the James Lind Library in Oxford and a founder of the Cochrane Collaboration, a respected organization that reviews medical evidence, said that it was vital that all data on new medicines be made public.

"Patients may otherwise suffer or die unnecessarily," said Chalmers, who was not involved in the work. "The people who participate in a trial have a right to expect that their participation and their data will be made available publicly so that people can take whatever decisions seem appropriate in the light of that information."

The US researchers who carried out the study searched the academic literature for publication of the trials that drug companies relied on to convince the US Food and Drug Administration that their new products were safe and effective and so worthy of market approval.

Information that is used to convince the regulators is not necessarily subsequently published for public and scientific scrutiny, but the scale of the missing information was found to be vast.

Five years after each of the 90 drugs was first available for patients, only 43 percent of the studies supporting the drugs' use had been published, with most publication happening in the first one or two years. In the case of one product -- an antibiotic -- the researchers could not find a single supporting trial in the scientific literature, while five trials were published twice and one was published three times.

The team also found evidence for a "publication bias." Trials with statistically significant results were more likely to be published than those with non-significant results, as were those with larger sample sizes.

"In the years immediately following FDA approval that are most relevant to public health, there exists incomplete and selective publication of trials supporting approved new drugs," Prof Ida Sim and her colleagues at the University of California, San Francisco, wrote in the journal PLoS Medicine.

One possible explanation for the scientific data not being published is that drug companies hold back publication of the results that are least flattering to their new drugs. Another possibility is that academic journal editors are less inclined to publish papers on trials that have negative or ambiguous results.

"Regardless of the cause, publication bias harms the public good by impairing the ability of clinicians and patients to make informed clinical decisions, and the ability of scientists to design safer and more efficient trials based on past findings," the authors wrote. "Publication bias can thus be considered a form of scientific misconduct."

The reporting of clinical trial results should have improved since the period analysed by the researchers, because the 2007 FDA Amendments Act mandated basic results reporting for all trials supporting FDA-approved drugs and devices. However, the researchers said it remained to be seen whether clinical reporting would improve.

The new law could even have the opposite effect. "Might sponsors feel less compelled to publish equivocal trials because the basic results will already be in the public domain?" they speculated.

Liked this story? Find more health news at Health Beat.

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Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

Medical Bills Stack Up, Americans Pack Up


Posted by Ella Hushagen, Stand Up for Health Care at 12:52 PM on September 29, 2008.


Medical debt is closely tied to the mortgage crisis that's pushing working families out of their homes and our economy to the brink of collapse.

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We all know that working families in America are squeezed in the current economic recession, plagued by skyrocketing health care costs and rampant home foreclosures. But how much does one have to do with the other? The answer is: A lot.

It turns out that medical debt is closely tied to the mortgage crisis that's pushing working families out of their homes and pushing our economy to the brink of collapse. One recent study found that medical crises contribute to half of all home foreclosure filings, with 23 percent attributable to medical bills.

A report by the Center for Studying Health System Change found,

The percentage of Americans in families with problems pay°©ing medical bills increased from 15.1 percent in 2003 to 19.4 percent in 2007... That translates to more than 57 million Americans of all ages in families in 2007 reporting problems paying medical bills in the previous 12 months-an increase of more than 14 million people since 2003.

According to the authors, the number of families struggling to pay medical bills increased at all income levels, and about 10 percent of respondents were burdened by more than $12,000 in medical debt. About 62 percent of families were contacted by a collection agency, and more than half borrowed money to pay medical bills. What's worse, one in five people with medical bill problems considered filing for bankruptcy.

The findings of both reports are consistent with finds from our December 2007 report, Too Great a Burden: America's Families at Risk. We found that nearly one out of four non-elderly Americans-61.million-is in a family that will spend more than 10 percent of its pre-tax income on health care costs in 2008. Some 17.8 million Americans are in families that will spend more than 25 percent of their pre-tax income on health care costs in 2008.

As Congress discusses how to pull Wall Street back from the edge of catastrophe, they must bear in mind the daily struggles of working Americans who cannot afford to pay their medical bills-a burden that has already thrown many off the cliff into financial ruin. While families struggle to make ends meet, it is imperative that Congress and the next President take action on this immediately.

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Fueling the Fire of Real Change

Fueling the Fire of Real Change

by Chris Hedges

Turn your back on Wall Street. Walk a few blocks up from the gleaming and soulless towers of disintegrating capitalism to the shabby, brick Catholic Worker house at 55 E. Third St. Sit, as I did recently, in one of the chairs in the basement dining room with its cracked linoleum and steel utility tables.

"Works of mercy and contact with the destitute sustain the spark in the ashes," William Griffin, who has been with the Catholic Worker for 34 years and writes for the newspaper, told me. "It is with the poor and the indigent that you sense the imbalance and injustice. It is this imbalance that inspires action. Generations come in waves. One generation is inspired by these sparks, as Martin Luther King was during the civil rights movement. These fires often fall away and smolder until another generation."

The coals of radical social change smolder here among the poor, the homeless and the destitute. As the numbers of disenfranchised dramatically increase, our hope, our only hope, is to connect intimately with the daily injustices visited upon them. Out of this contact we can resurrect, from the ground up, a social ethic, a new movement. Hand out bowls of soup. Coax the homeless into a shower. Make sure those who are mentally ill, cruelly cast out on city sidewalks, take their medications. Put your muscle behind organizing service workers. Go back into America's resegregated schools. Protest. Live simply. It is in the tangible, mundane and difficult work of forming groups and communities to care for others and defy authority that we will kindle the outrage and the moral vision to fight back. It is not Treasury Secretary Henry Paulson who will save us. It is Dorothy Day.

Day, who died in 1980, founded the Catholic Worker in the midst of the Great Depression with Peter Maurin. The two Catholic anarchists published the first issue of the Catholic Worker newspaper in 1933. They handed out 2,500 copies in Union Square for a penny a copy. The price remains unchanged. Two Catholic Worker houses of hospitality in the Lower East Side soon followed. Day and Maurin preached a radical ethic that included an unwavering pacifism as well as a hatred of unfettered capitalism. They condemned private and state capitalism for its unjust distribution of wealth. They branded the profit motive as immoral. They were fervent supporters of the labor movement, the civil rights movement and all anti-war movements. They called on followers to take up lives of voluntary poverty. The Catholic Worker refused to identify itself as a not-for-profit organization and has never accepted grants. It does not pay taxes. It operates its soup kitchen in New York without a city permit. The food it provides to the homeless is donated by people in the neighborhood. There are some 150 Catholic Worker houses around the country and abroad, although there is no central authority. Some houses are run by Buddhists, others by Presbyterians. Religious and denominational lines mean little.

Day cautioned that none of these radical stances, which she said came out of the Gospels, ensured temporal success. She wrote that sacrifice and suffering were an expected part of the religious life. Success as the world judges it should never be the final criterion for the religious and moral life. Spirituality, she said, was rooted in the constant struggle to fight for justice and be compassionate, especially to those in need. And that commitment was hard enough without worrying about its ultimate effect. One was saved in the end by faith, faith that acts of compassion and justice had intrinsic worth.

Many of the old stalwarts of the movement do not place their hopes in Barack Obama or the Democratic Party. They see their task as sustaining the embers of social and religious radicalism. They hope that this radical ethic can once again ignite a generation shunted aside by a bankrupt capitalism.

"If you lived through the civil rights movement as I did, you would want very much to vote for Obama," said Tom Cornell, who first came to the Worker in 1953, "but I don't think I will be able to, given Obama's foreign policy and his failure to promote a health care system for all Americans. I can't vote for someone who leaves an attack on Iran on the table."

Those within the Worker, however, worry that the looming economic dislocation will empower right-wing, nationalist movements and the apocalyptic fringe of the Christian right. This time around, they say, the country does not have the networks of labor unions, independent press, community groups and church and social organizations that supported them when Day and Maurin began the movement. They note that there are fewer and fewer young volunteers at the Worker. The two houses on the Lower East Side depend as much on men and women in their 50s and 60s as they do on recent college graduates.

"Our society is more brutal than it was," said Martha Hennessy, Day's granddaughter. "The heartlessness was introduced by Reagan. Clinton put it into place. The ruthlessness is backed up by technology. Americans have retreated into collective narcissism. They are disconnected from themselves and others. If we face economic collapse there are many factors that could see the wrong response. There are more elements of fascism in place than there were in the 1930s. We not only lack community, we lack information."

I do not know if our hope lies with the Catholic Worker. Institutions, even good ones, ossify. They can become trapped in the deification of their own past and the rigid canonization of the views of those who began the movements. But as our society begins to feel the disastrous ripple effects from the looting of our financial system, the unraveling of our empire and the accelerated rape of the working and middle class by our corporate state, hope will come only through direct contact with the destitute. The ethic born out of this contact will be grounded in the real and the possible. This ethic will, because it forces us to witness suffering and pain, be uncompromising in its commitment to the sanctity of life.

"There are several families with us, destitute families, destitute to an unbelievable extent, and there, too, is nothing to do but to love," Day wrote of those she had taken into the Catholic Worker House. "What I mean is that there is no chance of rehabilitation, no chance, so far as we see, of changing them; certainly no chance of adjusting them to this abominable world about them-and who wants them adjusted, anyway?

"What we would like to do is change the world-make it a little simpler for people to feed, clothe, and shelter themselves as God intended them to do. And to a certain extent, by fighting for better conditions, by crying out unceasingly for the rights of the workers, of the poor, of the destitute-the rights of the worthy and the unworthy poor, in other words-we can to a certain extent change the world; we can work for the oasis, the little cell of joy and peace in a harried world."

Chris Hedges, who graduated from seminary at Harvard Divinity School, is the author of "American Fascists: The Christian Right and the War on America."

Wrecking, Wrecking, Wrecked

Wrecking, Wrecking, Wrecked

by Thomas Frank

The great fear that hung over the business community in the 1970s was death by regulation, and the great goal of the conservative movement, as it rose to triumph in the 1980s, was to remove that threat--to keep OSHA, the EPA, and the FTC from choking off entrepreneurship with their infernal meddling in the marketplace.

Defunding those agencies was one way to stop the killer bureaucrats; another was to stuff them full of business-friendly personnel who would go easy on regulated. The signature conservative regulatory idea became "voluntary enforcement", because everyone now knew that efficient markets regulated themselves. Bad practices or tainted products drove away consumers; therefore firms had an incentive to behave, an incentive far more powerful than some top-down scheme in which big brother told them what to do.

Whether people ever truly believed this nonsense or not, its application over the years makes up the basic story of conservative governance as I tell it in my book, The Wrecking Crew. This is the philosophy by which conservatives gutted the EPA and the Labor Department, turned over the Interior Department and the FDA to the industries they were supposed to regulate, let the CEO of Enron advise the vice president on energy policy, and generally came to regard business, not the public, as government's "customer" (a word that crops up with disturbing frequency in conservative regulatory history).

But it is only now, as we watch the financial system crumble around us, that we can really see the devastating consequences of this folly. It turns out the Securities and Exchange Commission (SEC), which was responsible for regulating investment banks, did a significant part of its job through a voluntary program which firms could participate in or not as they saw fit. As the New York Times told the story on Saturday, this system had--of course--been pushed for by the investment banks themselves, who wanted it in order to avoid the stricter rules from European governments that they would otherwise have had to obey.

And now, as a consequence, the SEC has almost no industry left to regulate. Bear Stearns, Merrill Lynch, Lehman Brothers, Goldman Sachs, Morgan Stanley: All of them are gone or restructured. At business's urging, business was left up to its own devices; its own devices turned out to be precisely the things that our grandparents set up regulatory agencies to guard against: euphoria that leads to panic; perverse incentives that lead to fraud; boom that leads to bust.

As you watch the world crumble, try taking your Armageddon with this sprinkling of irony: Over the last three decades, business has got virtually everything it wanted, and its doomsday scenario from the 1970s has come true because of it. The regulators have indeed killed the regulated--not by intrusive meddling but by doing nothing, by taking a nap while the financial sector puffed up the bubble and blew itself to pieces.

We Have the Money

We Have the Money

If Only We Didn't Waste It on the Defense Budget

by Chalmers Johnson

There has been much moaning, air-sucking, and outrage about the $700 billion that the U.S. government is thinking of throwing away on rich New York bankers who have been ripping us off for the past few years and then letting greed drive their businesses into a variety of ditches. In fact, we dole out similar amounts of money every year in the form of payoffs to the armed services, the military-industrial complex, and powerful senators and representatives allied with the Pentagon.

On Wednesday, September 24th, right in the middle of the fight over billions of taxpayer dollars slated to bail out Wall Street, the House of Representatives passed a $612 billion defense authorization bill for 2009 without a murmur of public protest or any meaningful press comment at all. (The New York Times gave the matter only three short paragraphs buried in a story about another appropriations measure.)

The defense bill includes $68.6 billion to pursue the wars in Iraq and Afghanistan, which is only a down-payment on the full yearly cost of these wars. (The rest will be raised through future supplementary bills.) It also included a 3.9% pay raise for military personnel, and $5 billion in pork-barrel projects not even requested by the administration or the secretary of defense. It also fully funds the Pentagon's request for a radar site in the Czech Republic, a hare-brained scheme sure to infuriate the Russians just as much as a Russian missile base in Cuba once infuriated us. The whole bill passed by a vote of 392-39 and will fly through the Senate, where a similar bill has already been approved. And no one will even think to mention it in the same breath with the discussion of bailout funds for dying investment banks and the like.

This is pure waste. Our annual spending on "national security" -- meaning the defense budget plus all military expenditures hidden in the budgets for the departments of Energy, State, Treasury, Veterans Affairs, the CIA, and numerous other places in the executive branch -- already exceeds a trillion dollars, an amount larger than that of all other national defense budgets combined. Not only was there no significant media coverage of this latest appropriation, there have been no signs of even the slightest urge to inquire into the relationship between our bloated military, our staggering weapons expenditures, our extravagantly expensive failed wars abroad, and the financial catastrophe on Wall Street.

The only Congressional "commentary" on the size of our military outlay was the usual pompous drivel about how a failure to vote for the defense authorization bill would betray our troops. The aged Senator John Warner (R-Va), former chairman of the Senate Armed Services Committee, implored his Republican colleagues to vote for the bill "out of respect for military personnel." He seems to be unaware that these troops are actually volunteers, not draftees, and that they joined the armed forces as a matter of career choice, rather than because the nation demanded such a sacrifice from them.

We would better respect our armed forces by bringing the futile and misbegotten wars in Iraq and Afghanistan to an end. A relative degree of peace and order has returned to Iraq not because of President Bush's belated reinforcement of our expeditionary army there (the so-called surge), but thanks to shifting internal dynamics within Iraq and in the Middle East region generally. Such shifts include a growing awareness among Iraq's Sunni population of the need to restore law and order, a growing confidence among Iraqi Shiites of their nearly unassailable position of political influence in the country, and a growing awareness among Sunni nations that the ill-informed war of aggression the Bush administration waged against Iraq has vastly increased the influence of Shiism and Iran in the region.

The continued presence of American troops and their heavily reinforced bases in Iraq threaten this return to relative stability. The refusal of the Shia government of Iraq to agree to an American Status of Forces Agreement -- much desired by the Bush administration -- that would exempt off-duty American troops from Iraqi law is actually a good sign for the future of Iraq.

In Afghanistan, our historically deaf generals and civilian strategists do not seem to understand that our defeat by the Afghan insurgents is inevitable. Since the time of Alexander the Great, no foreign intruder has ever prevailed over Afghan guerrillas defending their home turf. The first Anglo-Afghan War (1838-1842) marked a particularly humiliating defeat of British imperialism at the very height of English military power in the Victorian era. The Soviet-Afghan War (1979-1989) resulted in a Russian defeat so demoralizing that it contributed significantly to the disintegration of the former Soviet Union in 1991. We are now on track to repeat virtually all the errors committed by previous invaders of Afghanistan over the centuries.

In the past year, perhaps most disastrously, we have carried our Afghan war into Pakistan, a relatively wealthy and sophisticated nuclear power that has long cooperated with us militarily. Our recent bungling brutality along the Afghan-Pakistan border threatens to radicalize the Pashtuns in both countries and advance the interests of radical Islam throughout the region. The United States is now identified in each country mainly with Hellfire missiles, unmanned drones, special operations raids, and repeated incidents of the killing of innocent bystanders.

The brutal bombing of the Marriott Hotel in Pakistan's capital, Islamabad, on September 20, 2008, was a powerful indicator of the spreading strength of virulent anti-American sentiment in the area. The hotel was a well-known watering hole for American Marines, Special Forces troops, and CIA agents. Our military activities in Pakistan have been as misguided as the Nixon-Kissinger invasion of Cambodia in 1970. The end result will almost surely be the same.

We should begin our disengagement from Afghanistan at once. We dislike the Taliban's fundamentalist religious values, but the Afghan public, with its desperate desire for a return of law and order and the curbing of corruption, knows that the Taliban is the only political force in the country that has ever brought the opium trade under control. The Pakistanis and their effective army can defend their country from Taliban domination so long as we abandon the activities that are causing both Afghans and Pakistanis to see the Taliban as a lesser evil.

One of America's greatest authorities on the defense budget, Winslow Wheeler, worked for 31 years for Republican members of the Senate and for the General Accounting Office on military expenditures. His conclusion, when it comes to the fiscal sanity of our military spending, is devastating:

"America's defense budget is now larger in inflation-adjusted dollars than at any point since the end of World War II, and yet our Army has fewer combat brigades than at any point in that period; our Navy has fewer combat ships; and the Air Force has fewer combat aircraft. Our major equipment inventories for these major forces are older on average than any point since 1946 -- or in some cases, in our entire history."

This in itself is a national disgrace. Spending hundreds of billions of dollars on present and future wars that have nothing to do with our national security is simply obscene. And yet Congress has been corrupted by the military-industrial complex into believing that, by voting for more defense spending, they are supplying "jobs" for the economy. In fact, they are only diverting scarce resources from the desperately needed rebuilding of the American infrastructure and other crucial spending necessities into utterly wasteful munitions. If we cannot cut back our longstanding, ever increasing military spending in a major way, then the bankruptcy of the United States is inevitable. As the current Wall Street meltdown has demonstrated, that is no longer an abstract possibility but a growing likelihood. We do not have much time left.

Chalmers Johnson is the author of three linked books on the crises of American imperialism and militarism. They are Blowback (2000), The Sorrows of Empire (2004), and Nemesis: The Last Days of the American Republic (2006). All are available in paperback from Metropolitan Books.

Obama's Missed Opportunity

Obama's Missed Opportunity

by Stephen Zunes

Democratic presidential nominee Barack Obama missed a number of key opportunities during the presidential foreign policy debate on September 26 to challenge the dangerous and reckless foreign policies of Republican nominee John McCain.

Obama did remind viewers that he strongly opposed the invasion of Iraq. He pointed out that the invasion created a tragic situation in that country that McCain - who vociferously supported the invasion and defends his decision to this day - now claims he's better qualified to redress. Yet, in what was perhaps his most stunning failure of the evening, the Democratic nominee effectively conceded McCain's claim that President George W. Bush's "troop surge" in Iraq - long advocated by the Republican nominee and opposed by Obama - brought about the dramatic reduction of violence in that country in recent months.

In reality, a shift in the alignment of internal Iraqi forces and the tragic de facto partitioning of Baghdad into sectarian enclaves contributed more to lowering the death toll, and the current relative equilibrium is probably temporary. The decision by certain Sunni tribal militias that had battled U.S. forces to turn their weapons against al-Qaeda-related extremists took place before the announcement of the surge, and militant opposition leader Muqtada al-Sadr's unilateral ceasefire resulted from internal Shia politics rather than any U.S. actions.

Nor did Obama raise questions over McCain's assertion that Iraq, as a result of the U.S. invasion and occupation, was well on its way to becoming a "stable ally." McCain's claims of stability are questionable. There's an ongoing conflict between the two groups that the United States depends on to maintain stability - the Shia-led government and the Sunni militias of the Awakening Council. In addition, there are ongoing attacks by Sunni extremists and a continuing risk that the radical Shia Mahdi Army will once again end its ceasefire.

Nor should the United States consider the Iraqi government an "ally," given that the two largest parties in the ruling coalition have historically allied themselves with Iran. During Saddam's rule, Iran recognized the largest party now in government, the Supreme Iraqi Islamic Council (then known as the Supreme Council for the Islamic Revolution in Iraq), as Iraq's government-in-exile, and the Iranian Revolutionary Guard organized and trained the Council's militia - known as the Badr Corps - which fought on Iran's side during the Iran-Iraq War. The Iraqi government identifies far more with the ruling Iranian clerics and other Shia movements than with the United States or with America's traditional Middle Eastern allies. For example, Iraqi Prime Minister Nouri al-Maliki strongly sided with Hezbollah in the 2006 conflict with Israel.

Falsehoods Unchallenged

A glaring failure of Obama's during the debate was his unwillingness to counter some of McCain's demonstrably false statements. On no less than three occasions during the debate, for instance, the Republican nominee claimed that Iranian president Mahmoud Ahmadinejad had threatened to "wipe Israel off the map." In reality, Ahmadinejad never said that. That idiom does not even exist in the Persian language. The Iranian president was quoting the late Ayatollah Khomeini from more than 20 years earlier when, in a statement largely ignored at the time, he said that "the regime occupying Jerusalem should vanish from the pages of time." While certainly an extreme and deplorable statement, the actual quote's emphasis on the Israeli "regime" rather than the country itself and its use of an intransitive makes the statement far less threatening than McCain made it sound.

McCain even claimed that Ahmadinejad "is now in New York, talking about the extermination of the state of Israel, of wiping Israel off the map." In reality, in response to a reporter's question while in New York to attend the opening of this year's UN General Assembly session, Ahmadinejad used the analogy of the Soviet Union disappearing from the map. In other words, as with his previous clarifications that McCain deliberately ignored, the Iranian president was calling for Israel's dissolution as a state, not the country's physical destruction. McCain, however, unchallenged by Obama, was trying to make Iran appear to be a greater and more imminent threat than it actually is.

When McCain criticized Obama for his refusal to support the Kyl-Lieberman amendment, which urged the Bush administration to designate Iran's Revolutionary Guards as a "terrorist organization," Obama conceded that he indeed believed they were "a terrorist organization. I've consistently said so." Ironically, even the Bush administration has been unwilling to designate the entire Iranian Revolutionary Guard as a terrorist group, which they correctly recognized as an irresponsibly sweeping characterization of the largest branch of Iran's armed forces. Despite congressional pressure, the Bush administration only designated the al-Quds Force - a sub-unit of the Revolutionary Guards that has indeed engaged in terrorist operations, but doesn't always operate with the full knowledge and consent of the leadership of the Revolutionary Guards or even Iran's central government - as a terrorist group.

In another falsehood during the debate, McCain defended his support for Pervez Musharraf's dictatorship in Pakistan by insisting that "there was a failed state in Pakistan when Musharraf came to power. Everybody who was around then, and had been there and knew about it, knew that it was a failed state." While the democratically elected civilian government of Nawaz Sharif was certainly corrupt and inept in many respects at the time Musharraf staged his 1999 coup, Pakistan didn't fit the usual definition of a "failed state." This term is generally reserved for countries experiencing a near-total collapse of order and central authority, such as Somalia, Afghanistan, and such West African countries as Liberia and Sierra Leone during the 1990s. Again, Obama failed to call McCain on this rewriting of history.

Other Misleading Statements Unchallenged

Obama even failed to challenge McCain's statement that "the Russians are preventing significant action in the United Nations Security Council" against Iran's ongoing refusal to abide my edicts of the International Atomic Energy Agency. In fact, the Russian government agreed to support a U.S.-sponsored resolution that very day, which included the toughest language to date, to force Iran to abide by legally binding Security Council edicts.

McCain then launched into his proposal for the formation of what he referred to as a "league of democracies" to bypass the UN system due to the alleged failure of the Security Council to enforce its resolutions, such as those targeting Iran's nuclear program. In response, Obama could have pointed out that the United States has blocked enforcement of UN Security Council Resolution 1172, which calls on India and Pakistan to eliminate their nuclear arsenals and their long-range missiles. Or that the United States has blocked enforcement of UN Security Council Resolution 487, which calls on Israel to place its nuclear facilities under the trusteeship of the International Atomic Energy Agency. Or that the United States has blocked the Security Council from adopting a resolution calling for a nuclear weapons-free zone for the entire Middle East. Or that, over the past 40 years, the United States has vetoed more Security Council resolutions than Russia and all other members of the UN Security Council combined. But Obama failed to do so.

Obama also failed to challenge McCain's dubious statement that "Iranians are putting the most lethal IEDs into Iraq which are killing young Americans" and that "there are special groups in Iran coming into Iraq and are being trained in Iran." Despite repeated claims to this effect by both McCain and the Bush administration, they haven't put forward any credible evidence to support them. Obama also failed to point out that the vast majority of U.S. casualties in Iraq have come from attacks by anti-Iranian Sunni groups, and that the political movements in Iran most closely allied with Iraq are part of the U.S.-backed government. Nor did he remind listeners that McCain had earlier made the ludicrous claim that the Iranians were bringing al-Qaeda forces into Iran for training and sending them back into Iraq to kill Americans, something that McCain himself eventually acknowledged was false.

When the Republican nominee characterized Georgian leader Mikheil Saakashvili as a "great young president," Obama could have pointed out that Saakashvili's disastrous decision to launch a massive assault against South Ossetia prompted the devastating Russian attacks on his country. Doing so would have enabled Obama to defend himself from McCain's criticism during the debate that Obama was wrong to have initially appealed to both sides "to show restraint" and that he should have instead placed all the blame on the Russian side for their illegitimate and disproportionate counter-attack. Obama could also have noted that Saakashvili responded to antigovernment protests within the Georgian capital of Tbilisi late last year with severe repression, shutting down independent media and detaining opposition leaders. Human Rights Watch criticized Saakashvili's government for using "excessive" force against protesters and the International Crisis Group warned of growing authoritarianism in the country. Obama might have then been able to ask McCain what makes Saakashvili so "great" in his eyes and why McCain retains as his chief foreign policy advisor someone who served as the leading paid lobbyist for Saakashvili's government.

Hawkishness Unchallenged

The hawkish approach of both Obama in particular and the Democratic party overall hampered his ability to more effectively challenge McCain during the debate on several key issues. For example, Obama couldn't challenge McCain's calls for increasing Bush's already bloated military budget since Obama and the Democratic platform also calls for increasing the military budget. Most Americans are unaware that the United States, at less than 4% of the world's population, accounts for approximately half of the world's military spending. Military-related spending already accounts for a full 54% of the discretionary U.S. federal budget. Indeed, the only criticism during the debate regarding excessive Pentagon spending came from McCain, who challenged the waste caused by the cost-plus formula regularly awarded to military contractors.

When McCain insisted that the United States pursue a highly provocative policy of bringing Georgia into NATO, thereby risking embroiling the United States in the complex armed ethnic conflicts of the volatile Caucasus region, Obama largely agreed with the Republican nominee. He said that the United States should insist that Georgia be able to join NATO and that NATO "should have a membership action plan immediately to start bringing them in."

Obama couldn't challenge McCain's call to send more troops to Afghanistan because Obama himself has called for increasing U.S. troop strength in that country. To his credit, Obama has called for holding the Afghan government to greater accountability, curbing the poppy trade, and dealing more forcefully with Pakistan, which has provided support and sanctuary for Taliban fighters. Yet the reality on the ground in Afghanistan contradicts the shared assumption of the two candidates that additional forces would stabilize that country. The U.S.-led war has worsened the security situation and the American bombing of civilian areas has led to a popular backlash that has strengthened the Taliban.

Flawed Logic Unchallenged

Obama also failed to fully challenge McCain's flawed logic on several points, such as his claim that Iran's possession of nuclear weapons would pose an "existential threat" to Israel. While nuclear weapons controlled by any state can theoretically be an existential threat to anybody, the Iranians surely recognize that, given Israel's massive nuclear deterrent capability, any such attack would be suicidal. If Iran indeed does have ambitions to acquire nuclear weapons, they would most likely be designed to deter threatened Israeli and American attacks. It's also noteworthy that, while both expressed alarm at a hypothetical Iranian attack on Israel, neither expressed any concern about a far more plausible Israeli attack on Iran.

Similarly, Obama didn't challenge McCain's claim that Iranian possession of nuclear weapons would lead other countries in the region to "feel [a] compelling requirement to acquire nuclear weapons as well." Obama could have pointed out that Israel's procurement of nuclear weapons nearly 40 years ago had not led to any other Middle Eastern countries acquiring nuclear weapons, nor had Pakistan's procurement of nuclear weapons in the 1990s - after India already joined the nuclear club - led additional countries in the region to develop nuclear weapons either. Instead, Obama conceded the point, claiming that a nuclear Iran would indeed "create an environment in which you could set off an arms race in this Middle East."

Obama also gave a surprisingly weak retort to McCain's preposterous claims that meeting with a foreign leader would be "saying they've probably been doing the right thing" and it would "legitimize their illegal behavior." Obama could have pointed out that Bush and other U.S. presidents - as well as McCain himself - have met with foreign leaders who have also engaged in severe repression against their citizens and engaged in illegal behavior.

If Obama expects to defeat John McCain, who indeed has more foreign policy experience, he must be more willing to challenge his opponent's record. McCain is in fact extremely vulnerable in the foreign policy realm. Obama, however, must be more rigorous in pointing out their differences and more effective in challenging McCain's weaknesses.

Stephen Zunes, a senior analyst at Foreign Policy in Focus, is a professor of politics and international studies at the University of San Francsico.