For the president, a lesson in limits.

Seven days cannot encapsulate the whole of a presidency, but the past week was a vivid illustration of the arc of President Obama’s first year in office. The main events of the week for the White House — a speech on the Afghanistan war and a jobs summit — provided fresh insights into the limits to Obama’s ambitions and the scale of the risks he has taken on for himself and his party.

Begin with the president’s ambitions. At the opening of his presidency, there was hardly a problem that Obama wasn’t prepared to confront aggressively. The economy? Bailouts for banks and automakers, and a huge stimulus package to short-circuit the recession. Iraq? Set a date for withdrawing promptly. Health care? Go for it immediately, and with primary colors, not pastels. Energy and climate change? Ditto. Afghanistan? Send the brigades long advocated as a candidate.

Some of these were decisions of necessity (the economy). Others reflected campaign promises he could not afford to break (Iraq). Still others represented promises that might have been deferred but were not (health care).

Taken together, they signaled the enormous ambitions that came to define Obama’s conception of his presidency. They also helped to create an increasingly contentious political climate in reaction to that agenda.

Fast-forward to today. Obama’s announcement that he is sending an additional 30,000 troops to Afghanistan represents a major military escalation of that conflict. But it is also an escalation in search of a more limited mission than the one he seemed to have endorsed only months earlier.

To be fair to Obama, he has long believed the key to Afghanistan was a combination of additional resources and scaled-back ambitions. Even as a candidate who said Afghanistan was the central front in the anti-terrorism effort, Obama resisted suggesting that the United States had the capacity to create a Jeffersonian democracy there and clearly did not believe that was possible. Unlike President George W. Bush with Iraq, Obama was thinking then about defining his goals in ways to avoid an open-ended commitment.

The deliberations over the proposal by Gen. Stanley A. McChrystal for 40,000 more troops went on so long in part because Obama was reluctant to sign on to a mission that could last a decade, result in untold casualties, consume a trillion dollars in taxpayers’ money and become a nation-building exercise in a country with no history of wanting to become such a society.

Obama might have decided to send more troops to Afghanistan than he ever thought would be necessary when he was a candidate, but he was still trying to constrain the scope of the investment and tamp down on Bush-era rhetoric of victory and spreading democracy. Whether he can avoid a protracted engagement in Afghanistan remains to be seen, but Obama has tried to signal to the nation, the Afghan government and the Pentagon that he does not intend to be there indefinitely.

A different reality confronts Obama on the economic front. Friday’s jobs report was the best in the past two years, with the unemployment rate dropping unexpectedly from 10.2 percent to 10 percent. It was the latest sign that the stimulus package has had a positive effect. But as Christina Romer, chairman of the Council of Economic Advisers, put it, “The unemployment rate remains unacceptably high.”

Obama’s jobs summit on Thursday and his road trip to Allentown, Pa., on Friday — planned before anyone knew what the jobless report would say — were meant to show his concern to voters who might be angry that Wall Street has been given billions as Main Street struggles. Obama was saying to the country what President George H.W. Bush once said during the recession that lingered into his 1992 reelection campaign: “Message: I care.”

Given the political sensitivity, Obama displayed a sense of urgency at the White House gathering about dealing with joblessness. “I am not interested in taking a wait-and-see approach when it comes to creating jobs,” he said. But he was forced to acknowledge he can do only so much. “We don’t have enough public dollars,” he said, “to fill the hole of private dollars that was created as a consequence of the crisis.

That would be true with any economic downturn the size of the one that hit last year. But the limits of Obama’s ambition on this front are the result of fiscal realities in part of his own making. The amount of money he has spent on economic recovery and that he wants to spend on health care have produced record projections of red ink. To do more, he must scrounge for money and check his appetite.

His advisers say he will probably tap some of the money remaining in the Troubled Assets Relief Program for more job-creating initiatives. That is a sign that dealing with the deficit will continue to take a back seat to the human and political problem of unemployment. But there are limits. The fiscal squeeze has grown acute during his presidency. That will rule decisions for the remainder of his time in office. Passage of a health-care bill will virtually guarantee no room for big initiatives later.Obama has tied his party and his presidency to policies that could make 2010 extremely difficult for the Democrats, and it’s clear that political considerations influenced the Afghanistan debate inside the administration and the renewed focus on jobs.

He sought a middle course on Afghanistan designed to give people on both sides of the debate something to hang onto, even if they were not fully satisfied with it in its entirety. On the economy, the White House was responding to the clamor from congressional Democrats, who worry about heading into the 2010 midterm elections with the unemployment rate still in double digits.
The year began with a mountain of problems facing the president. He attacked them with an expansive sense of the possible. Many of those problems remain to be solved. But if the past week is a guide, Obama is approaching them with a greater appreciation for how far his ambitions can take him and the political costs of trying to do so.

Capitol Briefing: Senate votes to keep Medicare cuts.

I was reading the Washington times magizine and this what I found interesting. The Senate voted Thursday to keep nearly $500 billion in Medicare cuts in its overhaul of the health care system, protecting the bill’s major source of financing against a Republican attack. On a vote of 58 to 42, the Senate rejected a proposal by Sen. John McCain (R-Ariz.) to send the bill back to committee with orders to strip out the cuts, a move that would effectively have killed the measure. Two Democrats — Ben Nelson of Nebraska and Jim Webb of Virginia — voted with all 40 Republicans on the amendment.

The vote was among the first cast on proposed changes to the package, which would spend $848 billion over the next decade to extend coverage to more than 30 million additional people and implement the most dramatic revisions to the nation’s health-care system in more than 40 years. Though debate officially opened on Monday, legislative progress has been hampered by disagreements between the two parties over the terms of debate and the timing of votes. But Senate Majority Leader Harry M. Reid D-Nev. still hopes to hold a vote on final passage before the Senate adjourns for the Christmas holidays, and on Thursday he told senators to plan on working throughout the coming weekend.

The vote on Medicare cuts was the most significant of four votes held Thursday. Republicans argued that the cuts, which would slow the projected increase in Medicare by about 5 percent over the next decade, would decimate the popular program for people over 65 in order to finance an expansion of insurance coverage for younger people. Any cuts to Medicare, they argued, should instead be dedicated to preserving the program, which is scheduled to start running out of money in 2017.

“If we’re going to take money from Grandma’s Medicare, let’s spend it on Medicare,” said Sen. Lamar Alexander (R-Tenn.). Democrats, backed by an array of major senior organizations, including the AARP, argued that the cuts would extend the financial life of Medicare by several years. The cuts would not reduce guaranteed benefits or increase co-payments, they said. And because hospitals and other providers have agreed to absorb the cuts by working more efficiently, Democrats said they would not affect access to medical services.

Cervical cancer screening can wait till 21.

Women can delay having their first Pap test for cervical cancer until they turn 21 and many can wait longer to go back for follow-up screenings, according to new guidelines released Friday by a major medical group.

The American College of Obstetrics and Gynecologists (ACOG) recommended the change after concluding that more frequent testing did not catch significantly more cancers and often resulted in girls and young women experiencing unnecessary stress, anxiety and sometimes harmful treatments because of suspicious growths that would not cause problems.

“We really felt that the downsides of more frequent screening outweighed any benefits,” said Alan G. Waxman, a professor of obstetrics and gynecology at the University of New Mexico who led the revision of the guidelines. “More testing is not always more intelligent testing.”

The change comes amid sharp controversy over new recommendations from a federal task force that women wait until age 50 before they begin having routine mammograms and that women age 50 to 74 scale back to getting the exams routinely every two years.

Officials said the release of two sets of guidelines in the same week was coincidental, but the new cervical cancer screening recommendations could fuel the firestorm over mammograms, an issue that has become embroiled in the debate over health-care reform. The Obama administration distanced itself from the breast exam guidelines announced Monday by a federal task force, saying the panel does not set government policy or determine what services are covered by the government.

White House aides said the political team leading the fight to pass health-care reform first heard about the upcoming report — which the panel approved in March — in the past two weeks, and viewed it as one of many potential headaches that opponents could use to attack the reform efforts.

“There’s something about health reform and guidelines that makes people think they’re telling women to do less screening to save money,” said Cindy Pearson of the National Women’s Health Network, a Washington-based advocacy group. “But we don’t have any concerns that women are being asked to give up something that is helpful. These recommendations are sound,” she said.

Several experts said a backlash against those guidelines could be less likely because of a variety of factors: There is greater scientific agreement about the risks and benefits of cervical cancer testing than mammography, which involves a less common and less politically charged disease; the changes in the recommendations are less dramatic; and the guidelines were issued by a private medical group and not a government-appointed task force, they said.

“I can certainly understand why people are concerned about linking these — it’s clear we’re going to have to carve billions out of the health-care system,” said Thomas Herzog, chairman of gynecologic oncology at Columbia University New York Presbyterian Hospital, speaking on behalf of ACOG. “Where’s the money going to come from? But in this case, if anything, we’re taking money out of our own pockets.”

The American Cancer Society, which has led the opposition to the mammography guidelines issued by the U.S. Preventive Services Task Force, was involved in the discussions leading up to the Pap test guidelines and will consider them in reevaluating its own recommendations, an official said.
“We are persuaded that the guidelines are really consistent with the evidence,” said Robert Smith, the society’s director of cancer screening.

The National Cervical Cancer Coalition, a patient advocacy group, endorsed the recommendations. “The new ACOG practice guidelines appear consistent with where we have seen the science trending,” said Alan Kaye, chairman of the coalition’s board of directors.
Some members of the group, however, were less supportive. “It seems a little bit of a week where women’s health is taking a beating, considering the suggested guideline changes for mammography and all,” Patricia Juirc, 37, a cervical cancer survivor from Mission Viejo, Calif., wrote in an e-mail. “Like they no longer want to be proactive and only see or treat us when we get sick.”

Because cervical cancer is caused by a sexually transmitted virus known as the human papillomavirus (HPV), many medical groups had recommended that women start having annual Pap tests within three years of becoming sexually active. Under the new guidelines, women can wait until they reach age 21 for their first test regardless of when they begin having sex, be screened only every other year until they turn 30 and then start having the test every three years if nothing concerning shows up on three consecutive tests. Those at increased risk, however, should continue to be screened more frequently, the group said.

The recommendations were based on evidence that while HPV is not unusual among sexually active girls and women, and abnormalities caused by the virus are common, those abnormalities often go away on their own and cervical cancer remains rare, especially at the youngest ages. Cervical cancer is also grows relatively slowly, so even if it does occur, waiting to catch it at age 21 would not pose a significant danger, the group concluded.

Deep divisions linger on health care

As the Senate prepares to take up legislation aimed at overhauling the nation’s health-care system, President Obama and the Democrats are still struggling to win the battle for public opinion. A new Washington Post-ABC News poll shows Americans deeply divided over the proposals under consideration and majorities predicting higher costs ahead.

But Republican opponents have done little better in rallying the public opposition to kill the reform effort. Americans continue to support key elements of the legislation, including a mandate that employers provide health insurance to their workers and access to a government-sponsored insurance plan for those people without insurance.

Over the past few months, public opinion has solidified, leaving Obama and the Democrats with the political challenge of enacting one of the most ambitious pieces of domestic legislation in decades in the face of a nation split over the wisdom of doing so. In the new poll, 48 percent say they support the proposed changes; 49 percent are opposed.

With the bill through the House, Senate Democrats are now looking for the votes to enact their version of the legislation and keep the reform effort moving forward. Whatever the outcome of the health-care debate, it will have a powerful influence in shaping the political climate for next year’s midterm elections.

The House bill contains a highly controversial provision prohibiting abortion coverage for those insured under a new public insurance plan as well as those who received federal subsidies to purchase private insurance. In the poll, 61 percent say they support barring coverage for abortions for those receiving public subsidies, but if private funds were used to pay for abortion expenses, the numbers flipped. With segregated private money used to cover abortion procedures, 56 percent say insurance offered to those using government assistance should be able to include such coverage.

, say they have an overall favorable impression of him, and a slim majority continues to see him as “about right” ideologically (four in 10 consider him “too liberal.”

The president, who is on a 10-day visit to Asia, gets his top mark on handling international affairs, and also picks up majority approval on dealing with the threat of terrorism. But Americans are more divided over his performance on other key issues, with nearly even splits in satisfaction with his work on health care, the economy and the situation in Afghanistan. On each of these three issues, intensity runs against the president, with significantly higher numbers expressing “strong” disapproval as strident approval. Obama receives generally negative reviews on his handling of the federal budget deficit, with 53 percent disapproving of his actions on that front.

Obama continues to be lifted by weakness in the opposition. In addition to his double-digit lead over congressional Republicans on health care, the president has a 15-point advantage on handling the nation’s still-struggling economy. More broadly, Democrats continue to have the edge as the party more trusted to deal with the country’s main problems over the next few years and when it comes to being more empathetic and more in tune with people’s values.

But there are also evident signs of an anti-incumbent mood in the new survey, which would disproportionately hurt the majority Democrats next fall should they hold. Most see the country as headed pretty seriously off on the wrong track and half of all Americans say they are inclined to look around for someone new to support for Congress; just 38 percent are inclined to reelect their member of Congress. These numbers are similar to those from November 1993, one year before Republicans took back control of the House and Senate and close to those from May 2006, six months before of independents do not trust.

G.M., Citing Progress, Reports Loss of $1.15 Billion.

General Motors said on Monday that its finances had improved to the point that it could begin repaying its government loans, though it lost nearly $1.15 billion in the third quarter after emerging from bankruptcy in July. G.M. said it increased its cash reserves by $3.3 billion from July 10 to Sept. 30, ending the quarter with $42.6 billion on hand. It plans to make a $1 billion payment to the federal government in December, more than five years before the loans are due, and to make similar quarterly payments after that.

G.M.’s chief executive, Fritz Henderson, said the automaker’s performance showed “some signs of progress and some signs of stability” and a “good, strong liquidity position. Speaking at a news conference at G.M.’s headquarters, Mr. Henderson said the loss was much lower than what it has been and certainly better than our plan going into bankruptcy, but nonetheless, it’s a loss and you can’t be satisfied with it. For the entire third quarter, including the final 10 days of G.M.’s bankruptcy, the company said its revenue was $28 billion, up 21 percent from the second quarter.

Obama Begins First Visit to China.

I was reading this New York times and it’s talks about President Obama arrived here late Sunday on the third leg of his four nation trip to Asia, where he is working to strengthen ties in the region.

After meeting with world leaders in Japan and Singapore, the president is beginning his first visit to China, where he will have a chance to see for himself this country’s spectacular rise. The president and his advisers, including Secretary of State Hillary Rodham Clinton, are expected to discuss a wide range of issues with China’s leaders, including North Korea, terrorism, the environment, human rights and the fragile state of the global economy.

The president is expected to praise Beijing for its efforts to stimulate its economy, aiding a global recovery that is now gathering steam. But he is also expected to press Beijing to allow its currency to appreciate and to speed up market reforms and give American companies greater access to its market, which could bolster American exports and help create jobs in the United States.

The three day visit to China comes after the president traveled to Japan and Singapore, where on Sunday he attended an Asia Pacific economic summit meeting. During those stops, President Obama pledged to forge closer ties with Japan, a longtime ally, and in a speech in Tokyo said that he did not fear China’s rise but welcomed it.

High Costs Weight on Troop Debate for Afghan War.

While President Obama’s decision about sending more troops to Afghanistan is primarily a military one, it also has substantial budget implications that are adding pressure to limit the commitment, senior administration officials say.

The latest internal government estimates place the cost of adding 40,000 American troops and sharply expanding the Afghan security forces, as favored by Gen. Stanley A. McChrystal, the top American and allied commander in Afghanistan, at $40 billion to $54 billion a year, the officials said.

Even if fewer troops are sent, or their mission is modified, the rough formula used by the White House, of about $1 million per soldier per year, appears almost constant.

So even if President Obama opts for a lower troop commitment, Afghanistan’s new costs could wash out the projected $26 billion expected to be saved in 2010 from withdrawing troops from Iraq. And the overall military budget could rise to as much as $734 billion, or 10 percent more than the peak of $667 billion under the Bush administration.

Profit Rises at Wal-Mart but Key Indicator Slips

Wal-Mart, the nation’s largest retailer and a bellwether for the entire industry, posted better-than-expected earnings on Thursday, though sales at stores open at least a year fell slightly amid the tough economy. For the three months ended Oct. 31, Wal-Mart had net income of $3.24 billion, or 84 cents a share, up from $3.14 billion, or 80 cents a share, a year ago. Revenue rose to $99.4 billion from $98.3 billion. Analysts surveyed by Thomson Reuters had expected earnings of 81 cents a share on $99.9 billion

But sales at Wal-Mart stores open at least a year in the United States, a measure of retail health known as same-store sales, fell 0.4 percent, not including the impact of fuel. For the same period a year ago, same-store sales increased 2.5 percent. The company attributed the decline solely to falling prices. In a recorded call, Eduardo Castro-Wright, who oversees Wal-Mart’s United States operations, said the same-store sales results were “driven by price deflation that was well beyond what we had expected, across many food categories, as well as electronics. The food categories hurt most were meat, produce and dairy; Wal-Mart said it does not expect food deflation to abate until the end of the first quarter next year.

As Obama attends Fort Hood memorial, investigation explores motive.

FORT HOOD, Tex. President Obama and first lady Michelle Obama attended a memorial service Tuesday for victims of last week’s rampage at this Army post, honoring the 13 who were killed and meeting with many of the three dozen others who were wounded in the nation’s worst shooting on a military installation.

Obama’s visit came as investigators from the Army, the FBI and the Texas Rangers continued to gather evidence and explore a motive for the attack, in which Army Maj. Nidal M. Hasan allegedly opened fire with two handguns on soldiers being processed for deployment to Iraq and Afghanistan. Thirteen people were killed and 38 injured before civilian police shot Hasan four times, ending the rampage.

Hasan, 39, who is being treated at an Army hospital in San Antonio, was “coherent” during a meeting Monday with defense attorneys, who informed him that his rights as a defendant in the military justice system would be respected, one of the attorneys said.
Hasan is “aware that he’s a suspect, retired Col. John P. Galligan said on CBS’s “The Early Show” Tuesday. “But there were no formal charges that I could discuss with him.”

Investigators tried to interview Hasan on Sunday, but he refused to answer questions and requested a lawyer, U.S. officials said. Galligan, who was hired by Hasan’s family, and Maj. Christopher E. Martin, Fort Hood’s senior defense attorney, met with Hasan for about half an hour at Brooke Army Medical Center. Galligan later questioned whether Hasan could get a fair trial at Fort Hood, the Associated Press reported.

DA Turns On Student In Innocent Project

I was watching the ABC news I was listening about A Northwestern University professor and journalism students who spent three years investigating the case of a man convicted in the 1978 killing of a security guard believe they have evidence that shows prosecutors put the wrong man behind bars. But in the quest to prove his innocence, they may have to defend themselves, too.

Cook County prosecutors have outraged the university and the journalism community by issuing subpoenas to professor David Protess seeking his students’ grades, his syllabus and their private e-mails. Prosecutors claim since the team was made up of students, they may have been under pressure to prove the case to get a good grade.

It’s a first for Protess and his investigative reporting students, who have helped free 11 innocent men from prison, including death row, since 1996. Their work also is credited with prompting then-Gov. George Ryan to empty the state’s death row in 2003, re-igniting a national debate on the death penalty.