States Decline to Set Up Exchanges for Insurance

WASHINGTON — Georgia, Ohio and Wisconsin joined more than a dozen other states on Friday in saying they would not establish health insurance exchanges, while a handful of other states said they would take advantage of an extra month allowed by the Obama administration to make decisions.

The exchanges — online markets where consumers can shop for private insurance subsidized by the federal government — are a centerpiece of President Obama’s health care law.

The administration has been urging states to set up exchanges, as Congress intended. The federal government will create and run exchanges in any state that is unable or unwilling to do so.

Mr. Obama and his health secretary, Kathleen Sebelius, have promised to give states flexibility in carrying out the new health care law and running the exchanges. However, Republican governors said they had not been allowed much latitude to date.

Gov. John R. Kasich of Ohio, a Republican, said Friday that his state “will not run an Obamacare health exchange, but will instead leave that to the federal government to do.”

“Based on the information we have,” Mr. Kasich said, “states do not have any flexibility to build and manage exchanges in ways that respond to unique needs of their citizens.”

Gov. Scott Walker of Wisconsin, another Republican opposed to the health care law, said, “From a philosophical standpoint, I prefer state-run over federal on any day on any subject.” But under the law, Mr. Walker said, “Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents.”

For decades, under governors of both parties, Wisconsin has been a national leader in the regulation of insurance.

Caroline F. Pearson, who tracks state developments at Avalere Health, a consulting company in Washington, said it appeared that about 18 states would choose to run their own exchanges, while 10 to 12 would seek partnerships with the federal government, and 18 to 20 would have federal exchanges.

Friday was to be the deadline for states to declare their intentions. But Ms. Sebelius said Thursday night that she was extending the deadline to Dec. 14. In any event, she must decide by Jan. 1 whether states are able to run their own exchanges.

Americans are supposed to be able to start shopping for insurance through exchanges in October 2013. By January 2014, most Americans will be required to have health insurance under the law.

Obama administration officials said they would be ready to run the federal exchanges, but they have not provided any information about their plans or their progress.

Gov. Rick Scott of Florida, a Republican, asked Friday for a meeting with Ms. Sebelius to discuss plans for an exchange. He said he was still analyzing his options, but had not seen evidence that an exchange would lower health costs for Floridians.

Gov. Nathan Deal of Georgia, a Republican, said his state would not establish an exchange. He expressed concern about what he described as “the one-size-fits-all approach and high federal burden imposed on states.”

Other Republican governors, including Jan Brewer of Arizona, C. L. Otter of Idaho, Terry E. Branstad of Iowa, Chris Christie of New Jersey, Tom Corbett of Pennsylvania and Bill Haslam of Tennessee, said they would use the extra time to seek more answers from Washington and feedback from constituents.

In a letter to Ms. Sebelius, Mr. Branstad said his state wanted to create its own exchange, but needed much more information. He included a list of 50 questions and said that unless they were answered, Iowa might have no choice but to opt for a federal exchange.

Many of the questions were about the costs of building and running an exchange. Mr. Otter said he would consult leaders of the Idaho Legislature and make a decision by the new deadline. An advisory committee appointed by Mr. Otter recommended last month that Idaho create its own exchange. But, Mr. Otter said, “I don’t want us buying a pig in a poke.”

Gov. Bev Perdue of North Carolina, a Democrat, said her state intended to join the federal government in establishing a hybrid form of exchange. Ms. Perdue will soon be succeeded by Pat McCrory, a Republican, who will decide what role the state should play.

Heather H. Howard, a lecturer at Princeton University who provides technical help to states as director of the State Health Reform Assistance Network, said the guidance provided by the Obama administration was sufficient for states to make decisions. States like California, Maryland and Washington have made great strides in developing exchanges, she said.

Ms. Howard said that governors might try to use the extra time to negotiate. “They’re feeling their oats and testing the limits of what leverage they have,” she said.

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States Decline to Set Up Exchanges for Insurance

WASHINGTON — Georgia, Ohio and Wisconsin joined more than a dozen other states on Friday in saying they would not establish health insurance exchanges, while a handful of other states said they would take advantage of an extra month allowed by the Obama administration to make decisions.

The exchanges — online markets where consumers can shop for private insurance subsidized by the federal government — are a centerpiece of President Obama’s health care law.

The administration has been urging states to set up exchanges, as Congress intended. The federal government will create and run exchanges in any state that is unable or unwilling to do so.

Mr. Obama and his health secretary, Kathleen Sebelius, have promised to give states flexibility in carrying out the new health care law and running the exchanges. However, Republican governors said they had not been allowed much latitude to date.

Gov. John R. Kasich of Ohio, a Republican, said Friday that his state “will not run an Obamacare health exchange, but will instead leave that to the federal government to do.”

“Based on the information we have,” Mr. Kasich said, “states do not have any flexibility to build and manage exchanges in ways that respond to unique needs of their citizens.”

Gov. Scott Walker of Wisconsin, another Republican opposed to the health care law, said, “From a philosophical standpoint, I prefer state-run over federal on any day on any subject.” But under the law, Mr. Walker said, “Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents.”

For decades, under governors of both parties, Wisconsin has been a national leader in the regulation of insurance.

Caroline F. Pearson, who tracks state developments at Avalere Health, a consulting company in Washington, said it appeared that about 18 states would choose to run their own exchanges, while 10 to 12 would seek partnerships with the federal government, and 18 to 20 would have federal exchanges.

Friday was to be the deadline for states to declare their intentions. But Ms. Sebelius said Thursday night that she was extending the deadline to Dec. 14. In any event, she must decide by Jan. 1 whether states are able to run their own exchanges.

Americans are supposed to be able to start shopping for insurance through exchanges in October 2013. By January 2014, most Americans will be required to have health insurance under the law.

Obama administration officials said they would be ready to run the federal exchanges, but they have not provided any information about their plans or their progress.

Gov. Rick Scott of Florida, a Republican, asked Friday for a meeting with Ms. Sebelius to discuss plans for an exchange. He said he was still analyzing his options, but had not seen evidence that an exchange would lower health costs for Floridians.

Gov. Nathan Deal of Georgia, a Republican, said his state would not establish an exchange. He expressed concern about what he described as “the one-size-fits-all approach and high federal burden imposed on states.”

Other Republican governors, including Jan Brewer of Arizona, C. L. Otter of Idaho, Terry E. Branstad of Iowa, Chris Christie of New Jersey, Tom Corbett of Pennsylvania and Bill Haslam of Tennessee, said they would use the extra time to seek more answers from Washington and feedback from constituents.

In a letter to Ms. Sebelius, Mr. Branstad said his state wanted to create its own exchange, but needed much more information. He included a list of 50 questions and said that unless they were answered, Iowa might have no choice but to opt for a federal exchange.

Many of the questions were about the costs of building and running an exchange. Mr. Otter said he would consult leaders of the Idaho Legislature and make a decision by the new deadline. An advisory committee appointed by Mr. Otter recommended last month that Idaho create its own exchange. But, Mr. Otter said, “I don’t want us buying a pig in a poke.”

Gov. Bev Perdue of North Carolina, a Democrat, said her state intended to join the federal government in establishing a hybrid form of exchange. Ms. Perdue will soon be succeeded by Pat McCrory, a Republican, who will decide what role the state should play.

Heather H. Howard, a lecturer at Princeton University who provides technical help to states as director of the State Health Reform Assistance Network, said the guidance provided by the Obama administration was sufficient for states to make decisions. States like California, Maryland and Washington have made great strides in developing exchanges, she said.

Ms. Howard said that governors might try to use the extra time to negotiate. “They’re feeling their oats and testing the limits of what leverage they have,” she said.

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Shortcuts: The Meaning in a Drawer Full of Old Family Snapshots

Eric Thayer/Reuters

A resident found photos as she sifted the debris of a house destroyed by Hurricane Sandy in Union Beach, N.J.

I WASN’T going to write about Hurricane Sandy. I was going to write about the changing nature of photographs and our relationship to them in this digital age.

Doug Mills/The New York Times

Picture-taking is now mainly digital, making prints of photos uncommon.

But as I began my research, I came across a Facebook page where lost photos from the storm were posted. Called “Union Beach — Photos and Misplaced Items,” the page shows photos of newborns and birthday parties, weddings and family gatherings.

Starting the morning after the storm devastated her community of Union Beach, N.J., Jeanette Van Houten and her niece have collected over a thousand photos and some photo albums. She is making it her mission to scan and post to Facebook as many as possible, including those turned into the fire department, police station and borough hall.

In addition, she was handed a drawerful of over a thousand family photos that must have been wrenched from a dresser.

About 60 photos have been claimed so far, and some professionals have offered to restore damaged photos free.

“These photos were passed down through families and they survived Sandy, even if the structures they were in didn’t,” Ms. Van Houten said. “They tell our story.”

With the Facebook page, Ms. Van Houten uses newer technology to help people reconnect with their old-fashioned snapshots. And seeing the photographs of mundane scenes and milestones on Facebook, along with the grateful comments from people who got back a bit of their lives, reminded me of both the fragility and strength of photos and their continuing importance in our lives. Judith Dupré, author of “Monuments: America’s History in Art and Memory” (Random House, 2007), and other books, teaches a class at her local library in Mamaroneck, N.Y., called “Stories from My Life,” for older residents. They use photos and stories to write about their lives.

“They bring in a basketful of photos,” Ms. Dupré said. “Each one of these photos contains a story — they’re like a key that opens the door to a life.”

And a printed photo “is a different species than a digital photo,” she said. “I don’t think anyone’s figured out the place of digital photos in terms of memory keeping.”

When an elderly aunt of hers died and left behind lots of photographs, Ms. Dupré said the family took them to the memorial service.

“We had a table and people could select and take what they wanted,” she said. “It was a very moving part of the memorial.”

Of course, even prints can lose their meaning and poignancy through the generations.

And in some cases, as with Hurricane Sandy, photos may be safer in cyberspace than in an album on a bookshelf — as long as you remember to upload them to a site like Flickr, Shutterfly, Snapfish or countless other photo sites available. (And make sure you know how long a site will keep your photos. Some, for example, require you to show some activity at least once a year.) That way, if you lose your hard drive, you don’t lose your photos.

But Ms. Dupré said she worried that photos that existed only online somewhere might die with the photographer.

“I don’t even know what my parents have in terms of digital photography,” she said. She said she put the password to her photos safely away with her will and other documents, so her children can access them.

Now I’m not trying to say that the old-fashioned way is the only way. Photography has constantly evolved. The Brownie camera, first sold by Kodak for $1 in 1900, radicalized photography by making it available to just about everyone.

But, and I know this largely a generational thing, I can’t help but wonder about the ubiquity of the cellphone photo. As Ms. Dupré said, “The infinite number of digital photos that can be taken has devalued the single image and made one-of-a-kind prints that much more precious.”

E-mail: shortcuts@nytimes.com

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Israel Sticks to Tough Approach in Conflict With Hamas

TEL AVIV — With rockets landing on the outskirts of Tel Aviv and Jerusalem on Friday and the Egyptian prime minister making a solidarity visit to Gaza, the accelerating conflict between Israel and Hamas — reminiscent in many ways of so many previous battles — has the makings of a new kind of Israeli-Palestinian face-off.

The combination of longer-range and far deadlier rockets in the hands of more radicalized Palestinians, the arrival in Gaza and Sinai from North Africa of other militants pressuring Hamas to fight more, and the growing tide of anti-Israel fury in a region where authoritarian rulers have been replaced by Islamists means that Israel is engaging in this conflict with a different set of challenges.

The Middle East of 2012 is not what it was in late 2008, the last time Israel mounted a military invasion to reduce the rocket threat from Gaza. Many analysts and diplomats outside Israel say the country today needs a different approach to Hamas and the Palestinians based more on acknowledging historic grievances and shifting alliances.

“As long as the crime of dispossession and refugeehood that was committed against the Palestinian people in 1947-48 is not redressed through a peaceful and just negotiation that satisfies the legitimate rights of both sides, we will continue to see enhancements in both the determination and the capabilities of Palestinian fighters — as has been the case since the 1930s, in fact,” Rami G. Khouri, a professor at the American University of Beirut, wrote in an online column. “Only stupid or ideologically maniacal Zionists fail to come to terms with this fact.”

But the government in Israel and the vast majority of its people have drawn a very different conclusion. Their dangerous neighborhood is growing still more dangerous, they agree. That means not concessions, but being tougher in pursuit of deterrence, and abandoning illusions that a Jewish state will ever be broadly accepted here.

“There is a theory, which I believe, that Hamas doesn’t want a peaceful solution and only wants to keep the conflict going forever until somehow in their dream they will have all of Israel,” Eitan Ben Eliyahu, a former leader of the Israeli Air Force, said in a telephone briefing. “There is a good chance we will go into Gaza on the ground again.”

What is striking in listening to the Israelis discuss their predicament is how similar the debate sounds to so many previous ones, despite the changed geopolitical circumstances. In most minds here, the changes do not demand a new strategy, simply a redoubled old one.

The operative metaphor is often described as “cutting the grass,” meaning a task that must be performed regularly and has no end. There is no solution to security challenges, officials here say, only delays and deterrence. That is why the idea of one day attacking Iranian nuclear facilities, even though such an attack would set the nuclear program back only two years, is widely discussed as a reasonable option. That is why frequent raids in the West Bank and surveillance flights over Lebanon never stop.

And that is why this week’s operation in Gaza is widely viewed as having been inevitable, another painful but necessary maintenance operation that, officials here say, will doubtless not be the last.

There are also those who believe that the regional upheavals are improving Israel’s ability to carry out deterrence. One retired general who remains close to the military and who spoke on the condition of anonymity said that with Syria torn apart by civil war, Hezbollah in Lebanon discredited because of its support for the Syrian government, and Egypt so weakened economically, Israel should not worry about anything but protecting its civilians.

“Should we let our civilians be bombed because the Arab world is in trouble?” he asked.

So much was happening elsewhere in the region — the Egyptian and Libyan revolutions, the Syrian civil war, dramatic changes in Yemen and elections in Tunisia — that a few rockets a day that sent tens of thousands of Israeli civilians into bomb shelters drew little attention. But in the Israeli view, the necessity of a Gaza operation has been growing steadily throughout the Arab Spring turmoil.

In 2009, after the Israeli invasion pushed Hamas back and killed about 1,400 people in Gaza, 200 rockets hit Israel. The same was true in 2010. But last year the number rose to 600, and before this week the number this year was 700, according to the Israeli military. The problem went beyond rockets to mines planted near the border aimed at Israeli military jeeps and the digging of explosive-filled tunnels.

“In 2008 we managed to minimize rocket fire from Gaza significantly,” said Lt. Col. Avital Leibovich, a military spokeswoman. “We started that year with 100 rockets a week and ended it with two a week. We were able to give people in our south two to three years. But the grass has grown, and other things have as well. Different jihadist ideologies have found their way into Gaza, including quite a few terrorist organizations. More weapons have come in, including the Fajr-5, which is Iranian made and can hit Tel Aviv. That puts nearly our entire population in range. So we reached a point where we cannot act with restraint any longer.”

Gazans see events in a very different light. The problem, they say, comes from Israel: Israeli drones fill the Gazan skies, Israeli gunboats strafe their waters, Palestinian militants are shot at from the air, and the Gaza border areas are declared off limits by Israel with the risk of death from Israeli gunfire.

But there is little dissent in Israel about the Gaza policy. This week leaders of the leftist opposition praised the assassination of Ahmed al-Jabari, the Hamas military commander, on Wednesday. He is viewed here as the equivalent of Osama bin Laden. The operation could go on for many days before there is any real dissent.

The question here, nonetheless, is whether the changed regional circumstances will make it harder to “cut the grass” in Gaza this time and get out. A former top official who was actively involved in the last Gaza war and who spoke on the condition of anonymity said it looked to him as if Hamas would not back down as easily this time.

“They will not stop until enough Israelis are killed or injured to create a sense of equality or balance,” he said. “If a rocket falls in the middle of Tel Aviv, that will be a major success. But this government will go back at them hard. I don’t see this ending in the next day or two.”

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In BP Indictments, U.S. Shifts to Hold Individuals Accountable

HOUSTON — Donald J. Vidrine and Robert Kaluza were the two BP supervisors on board the Deepwater Horizon rig who made the last critical decisions before it exploded. David Rainey was a celebrated BP deepwater explorer who testified to members of Congress about how many barrels of oil were spewing daily in the offshore disaster.

Mr. Vidrine, 65, of Lafayette, La., and Mr. Kaluza, 62, of Henderson, Nev., were indicted on Thursday on manslaughter charges in the deaths of 11 fellow workers; Mr. Rainey, 58, of Houston, was accused of making false estimates and charged with obstruction of Congress. They are the faces of a renewed effort by the Justice Department to hold executives accountable for their actions. While their lawyers said the men were scapegoats, Attorney General Eric H. Holder Jr. said at a news conference, “I hope that this sends a clear message to those who would engage in this kind of reckless and wanton conduct.”

The defense lawyers were adamant that their clients would contest the charges, and prosecutors said that the federal investigations were continuing.

Legal scholars said that by charging individuals, the government was signaling a return to the practice of prosecuting officers and managers, and not just their companies, in industrial accidents, which was more common in the 1980s and 1990s.

“If senior managers cut corners, or if they make decisions that put people in harm’s way, then the criminal law is appropriate,” said Jane Barrett, a University of Maryland law professor and former federal prosecutor.

She noted that it was unusual for the Justice Department to prosecute individual corporate officers in recent years, including in the 2005 BP Texas City refinery explosion that killed 15 workers, where only the company was fined.

BP said on Thursday it would pay $4.5 billion in fines and other payments, and the corporation pleaded guilty to 14 criminal charges in connection with spill. The $1.26 billion in criminal fines was the highest since Pfizer in 2009 paid $1.3 billion for illegally marketing an arthritis medication.

The crew was drilling 5,000 feet under the sea floor 41 miles off the Louisiana coast in April 2010 when they lost control of the well during its completion. They tested the pressure of the well, but misinterpreted the test results and underestimated the pressure exerted by the flow of oil or gas up the well. Had the results been properly interpreted, operations would have ceased.

Mr. Vidrine and Mr. Kaluza were negligent in their reading of the kicks of gas popping up from the well that should have suggested that the Deepwater Horizon crew was fast losing control of the ill-fated Macondo well, according to their indictment, and they failed to act or even communicate with their superiors. “Despite these ongoing, glaring indications on the drill pipe that the well was not secure, defendants Kaluza and Vidrine again failed to phone engineers onshore to alert them to the problem, and failed to investigate any further,” the indictment said.

The indictment said they neglected to account for abnormal pressure test results on the well that indicated problems, accepting “illogical” explanations from members of the crew, which caused the “blowout of the well to later occur.”

In a statement, Mr. Kaluza’s lawyers said: “No one should take any satisfaction in this indictment of an innocent man. This is not justice.”

Bob Habans, a lawyer for Mr. Vidrine, called the charges “a miscarriage of justice.”

“We cannot begin to explain or understand the misguided effort of the United States attorney and the Department of Justice to blame Don Vidrine and Bob Kaluza, the other well site leader, for this terrible tragedy.”

Several government and independent reports over the last two years have pointed to sloppy cement jobs in completing the well or the poor design of the well itself as major reasons for the spill. But none of the three was indicted in connection with those problems.

Mr. Rainey was a far more senior executive, one who was known around Houston and the oil world as perhaps the most knowledgeable authority on Gulf oil and gas deposits. According to his indictment, Mr. Rainey obstructed Congressional inquiries and made false statements by underestimating the flow rate to 5,000 barrels a day even as millions were gushing into the Gulf.

Campbell Robertson contributed reporting.

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Change Rattles Leading Health-Funding Agency

Major changes erupted at one of the world’s leading health-funding agencies Thursday as it hired a new director, dismissed the inspector general who had clashed with a previous director and announced a new approach to making grants.

Alex Wong/Getty Images

Dr. Mark Dybul, who led the President's Emergency Plan for AIDS Relief, in 2007.

Dr. Mark Dybul, the Bush administration’s global AIDS czar who was abruptly dismissed when President Obama took office, was named the new executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Dr. Dybul, who was selected over candidates from Canada, Britain and France, was backed by the United States, which donates about a third of the fund’s budget, and by Bill Gates, who helped the fund through a cash crisis earlier this year.

He is respected by many AIDS activists in the United States, though there is some lingering controversy about his time in the Bush administration related to abstinence policies and anti-prostitution pledges imposed by conservative lawmakers as well as concerning strict licensing requirements for generic drugs.

The fund, which is based in Geneva and has given away more than $20 billion since its founding in 2002, has been in crisis for more than a year. Some donors shied away after widely publicized corruption scandals, while others, notably Mr. Gates, said the scandals were exaggerated and increased donations.

Its last executive director, Dr. Michel Kazatchkine, quit in January after the day-to-day management duties of his job were given to a Brazilian banker, Gabriel Jaramillo, who was charged with cutting expenses.

By some accounts, 40 percent of the employees soon left, although Seth Faison, a fund spokesman, said the total number of employees declined by only 8 percent. The fund also dismissed its inspector general, John Parsons, on Thursday, citing unsatisfactory work.

Mr. Parsons and Dr. Kazatchkine had privately clashed. Mr. Parsons’s teams aggressively pursued theft and fraud, and found it in Mali, Mauritania and elsewhere. But the total amount stolen — $10 million to $20 million — was relatively small, and aides to Dr. Kazatchkine said the fund cut off those countries and sought to retrieve the money. The aides claimed that Mr. Parsons, who reported only to the board, went to news outlets and left the impression that the fund was covering up rampant theft.

The fuss scared off some donor countries that were already looking for excuses to cut back on foreign aid because of the global economic crisis.

Mr. Parsons did not return messages left for him Thursday.

Dr. Dybul’s appointment was welcomed by the United Nations AIDS program, the Bill and Melinda Gates Foundation, the Elizabeth Glaser Pediatric AIDS Foundation, Malaria No More and Results.org, an anti-poverty lobbying group. By contrast, Jamie Love, an American advocate for cheaper AIDS drugs who works in Washington and Geneva, said he expected Dr. Dybul “to protect drug companies.”

The fund also announced a new application process, which it said would be faster and focus more on the hardest-hit countries rather than all 150 that received some help in the past.

In an interview, Dr. Dybul said he felt the fund was “on a strong forward trajectory” after changes were put in place in the last year by Mr. Jaramillo, and now would focus on “hard-nosed implementation of value for money.”

Both the President’s Emergency Plan for AIDS Relief and the fund spend billions, but in different ways.

The fund supports projects proposed by national health ministers and then hires local auditors to make sure the money is not wasted or stolen. Pepfar usually gives grants to American nonprofit groups or medical schools and lets them form partnerships with hospitals or charities in the affected countries.

The conventional wisdom is that the Global Fund’s model is more likely to win the cooperation of government officials but more vulnerable to corruption — and also spends less on salaries and travel for American overseers.

Dr. Kazatchkine said he did not expect Dr. Dybul to “Pepfarize” the Global Fund.

“I hope that, after a year of turbulence, the fund finds the serenity needed to move forward again,” he said.

Read More..

Change Rattles Leading Health-Funding Agency

Major changes erupted at one of the world’s leading health-funding agencies Thursday as it hired a new director, dismissed the inspector general who had clashed with a previous director and announced a new approach to making grants.

Alex Wong/Getty Images

Dr. Mark Dybul, who led the President's Emergency Plan for AIDS Relief, in 2007.

Dr. Mark Dybul, the Bush administration’s global AIDS czar who was abruptly dismissed when President Obama took office, was named the new executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Dr. Dybul, who was selected over candidates from Canada, Britain and France, was backed by the United States, which donates about a third of the fund’s budget, and by Bill Gates, who helped the fund through a cash crisis earlier this year.

He is respected by many AIDS activists in the United States, though there is some lingering controversy about his time in the Bush administration related to abstinence policies and anti-prostitution pledges imposed by conservative lawmakers as well as concerning strict licensing requirements for generic drugs.

The fund, which is based in Geneva and has given away more than $20 billion since its founding in 2002, has been in crisis for more than a year. Some donors shied away after widely publicized corruption scandals, while others, notably Mr. Gates, said the scandals were exaggerated and increased donations.

Its last executive director, Dr. Michel Kazatchkine, quit in January after the day-to-day management duties of his job were given to a Brazilian banker, Gabriel Jaramillo, who was charged with cutting expenses.

By some accounts, 40 percent of the employees soon left, although Seth Faison, a fund spokesman, said the total number of employees declined by only 8 percent. The fund also dismissed its inspector general, John Parsons, on Thursday, citing unsatisfactory work.

Mr. Parsons and Dr. Kazatchkine had privately clashed. Mr. Parsons’s teams aggressively pursued theft and fraud, and found it in Mali, Mauritania and elsewhere. But the total amount stolen — $10 million to $20 million — was relatively small, and aides to Dr. Kazatchkine said the fund cut off those countries and sought to retrieve the money. The aides claimed that Mr. Parsons, who reported only to the board, went to news outlets and left the impression that the fund was covering up rampant theft.

The fuss scared off some donor countries that were already looking for excuses to cut back on foreign aid because of the global economic crisis.

Mr. Parsons did not return messages left for him Thursday.

Dr. Dybul’s appointment was welcomed by the United Nations AIDS program, the Bill and Melinda Gates Foundation, the Elizabeth Glaser Pediatric AIDS Foundation, Malaria No More and Results.org, an anti-poverty lobbying group. By contrast, Jamie Love, an American advocate for cheaper AIDS drugs who works in Washington and Geneva, said he expected Dr. Dybul “to protect drug companies.”

The fund also announced a new application process, which it said would be faster and focus more on the hardest-hit countries rather than all 150 that received some help in the past.

In an interview, Dr. Dybul said he felt the fund was “on a strong forward trajectory” after changes were put in place in the last year by Mr. Jaramillo, and now would focus on “hard-nosed implementation of value for money.”

Both the President’s Emergency Plan for AIDS Relief and the fund spend billions, but in different ways.

The fund supports projects proposed by national health ministers and then hires local auditors to make sure the money is not wasted or stolen. Pepfar usually gives grants to American nonprofit groups or medical schools and lets them form partnerships with hospitals or charities in the affected countries.

The conventional wisdom is that the Global Fund’s model is more likely to win the cooperation of government officials but more vulnerable to corruption — and also spends less on salaries and travel for American overseers.

Dr. Kazatchkine said he did not expect Dr. Dybul to “Pepfarize” the Global Fund.

“I hope that, after a year of turbulence, the fund finds the serenity needed to move forward again,” he said.

Read More..

Critic’s Notebook: Nintendo’s Wii U, With New Touch-Screen Controller

Ubisoft

A scene from Ubisoft’s ZombiU, one of the games available to play on Nintendo’s Wii U console, to be released on Sunday.

The Wii U is Nintendo’s capitulation to the screen, the tyrant of the digital age. As the follow-up to the original Wii — the nearly 100-million-selling, get-off-your-couch console that upended the video game industry six years ago — the Wii U does not deliver the sensation that its predecessor unleashed, the sense that something new had been wrought upon this earth. It was not always routine for grandparents and grandchildren to gather in front of the television to wield plastic sticks and pretend to bowl.

Instead, the Wii U feels like an accommodation to the new mode of living that Apple’s iPhone and iPad have introduced. That lifestyle was evoked by a New Yorker cover this summer that featured family members posing for a beach vacation snapshot while engrossed in their personal devices.

The Wii U, which is to be released on Sunday, works with the motion-control remotes you probably already own from the original Wii, and it plays most of the original games. What’s new — beyond high-definition graphics and some Internet-enabled features that won’t be turned on until Sunday — is the Wii U GamePad, a roughly 10-by-5-inch touch-screen controller. With a six-inch display surrounded by thumbsticks, buttons and triggers, the GamePad is the offspring of an iPad Mini and a traditional video game controller.

In its marketing buildup to the Wii U introduction, Nintendo emphasized the benefits of two-screen gaming, particularly competitions in which the player with the GamePad sees something different from what the other players watch on the television. In so doing, Nintendo played down a simpler concept, one more easily understood by casual players and Apple fans: the touch screen.

By merging touch-screen gaming with a video game system that is designed to live next to your TV set rather than be carried around in your pocket or purse, Nintendo is not merely acceding to the cultural tide. It is also trying — valiantly, perhaps quixotically — to stem it. After creating a world in which we are no longer bowling alone (because we are all Wii-bowling together), Nintendo is seeking to invent a new way for us to commune with our screens. The company’s hope is that the Wii U will bring families together in their living rooms for touch-screen gaming rather than leave them isolated with their tablets and smartphones.

Touch has always been a part of gaming, of course, because the physical interaction between player and device is central to the medium. But in recent years the growing complexity of the standard controller has become an obstacle for new players who did not grow up adapting to each iteration: the shift from one button to two buttons to four, or from one joystick to a directional pad to two thumbsticks and a directional pad — not to mention triggers and bumpers and start and select buttons. Easy, right?

Simplicity was a large part of the broad appeal of the first Wii, and though playing with the Wii U is not quite as uncomplicated as standing up and waving your arms around, the touch screen is straightforward compared with the controllers used with an Xbox 360 or a PlayStation 3. Selecting songs in Sing Party, a karaoke game published by Nintendo, is done by swiping through tiles on the GamePad’s touch screen and then tapping the song you want. The same goes for Ubisoft’s Just Dance 4, with the added wrinkle that a player can use the touch screen to choose dance moves, midsong, for the other players to perform.

In Balloon Trip Breeze, one of the mini-games bundled on the Nintendo Land anthology that comes with the $350 Wii U deluxe edition, the player uses a stylus to make quick swipes — familiar to anyone who has played Angry Birds or Fruit Ninja — to make a character pop balloons on the television. In Takamaru’s Ninja Castle, another Nintendo Land game, similar swipes hurl martial arts stars at cartoonish cutouts. In Pikmin Adventure, from the same disc, enemies are defeated by tapping on them as they appear on the GamePad screen. In Yoshi’s Fruit Cart players scrawl a path on the touch screen and then watch a character follow it on television.

The touch screen also allows the GamePad to morph swiftly into a TV remote control; you can adjust the volume on your set or quickly check the score of a football game without reaching for a separate device. And if you like what you see on cable, or if you want to allow someone else to watch TV in the same room, you can switch from playing a game of New Super Mario Bros. U on television to watching it unfold on your GamePad.

As that last trick indicates, the GamePad is more than just a touch screen, and Nintendo Land provides a sketch of other possibilities. The camera inside the GamePad is used in the game Octopus Dance to project the player’s genuine, human face onto the television, a merger of the virtual with the corporeal that goes by the name “augmented reality.”

Lightly blowing into the GamePad’s microphone in Donkey Kong’s Crash Course turns a windmill that moves a cart skyward. The GamePad can be used as a viewfinder in Metroid Blast and the Legend of Zelda: Battle Quest to target enemies for destruction. And in some other Nintendo Land games, characters can be moved by turning or tilting or lifting the GamePad into the air, another technique borrowed from mobile and tablet gaming.

Equally promising, if not more so, are the possibilities the GamePad presents for intensive, single-player gaming. In Ubisoft’s ZombiU, the GamePad transforms, if not eliminates, some of the metaphors gamers are accustomed to: The map is no longer a tiny icon in the lower-right corner of your television, nor a menu that must be reached by punching a sequence of buttons. It is something you hold in your hands and look down at, something that draws your attention away from the world (of zombies) around you.

Your inventory — the items you carry — also becomes less abstract as you peer into your GamePad to see what’s in your backpack and then physically move, say, a pistol into your hand by sliding it with your finger into an open slot. Similarly, digging through lockers, file cabinets and suitcases in the game world becomes closer to a genuine interaction.

Then again, when the first Wii console felt new, as with Microsoft’s Kinect more recently, many decreed that motion controls would be swiftly and widely integrated into long, narrative games. Surely the intuitive interface of Wii Sports would be merged with storytelling ambition. By and large, that didn’t happen. So, spoiler alert: I have no idea what the Wii U augurs, or whether it will permanently alter how we play, alone or together.

But it’s a pretty nice present.

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Israel and Hamas Step Up Air Attacks in Gaza Clash

Wissam Nassar for The New York Times

The Gaza City funeral on Thursday of Ahmed al-Jabari, the Hamas military commander, killed in an Israeli attack. More Photos »

KIRYAT MALACHI, Israel — Israel and Hamas brushed aside international calls for restraint on Thursday and escalated their lethal conflict over Gaza, where Palestinian militants launched hundreds of rockets into Israeli territory, targeting Tel Aviv for the first time, and Israel intensified its aerial assaults and sent armored vehicles rumbling toward the Gaza border for a possible invasion.

Defense Minister Ehud Barak of Israel, expressing outrage over a pair of long-range Palestinian rockets that whizzed toward Tel Aviv and set off the first air-raid warning in the Israeli metropolis since it was threatened by Iraqi Scuds in the Persian Gulf war of 1991, said, “There will be a price for that escalation that the other side will have to pay.”

He authorized the call-up of 30,000 army reservists if needed, another sign that Israel was preparing to invade Gaza for the second time in four years to crush what it considers an unacceptable security threat from smuggled rockets amassed by Hamas, the militant Islamist group that governs the isolated coastal enclave and does not recognize Israel’s right to exist.

It was not clear whether the show of Israeli force on the ground in fact portended an invasion or was meant as more of an intimidation tactic to further pressure Hamas leaders, who had all been forced into hiding on Wednesday after the Israelis killed the group’s military chief, Ahmed al-Jabari, in a pinpoint aerial bombing. But Prime Minister Benjamin Netanyahu of Israel said he was prepared to “take whatever action is necessary.”

Tel Aviv was not hit on Thursday. One rocket crashed into the sea off its coast and another apparently fell, the ability of militants 40 miles away to fire those weapons at the city of 400,000 underscored, in the Israeli government’s view, the justification for the intensive aerial assaults on hundreds of suspected rocket storage sites and other targets in Gaza.

Health officials in Gaza said at least 19 people, including five children and a pregnant teenager, had been killed over two days of nearly nonstop aerial attacks by Israel, and dozens had been wounded. Three Israelis were killed on Thursday in Kiryat Malachi, this small southern Israeli town, when a rocket fired from Gaza struck their apartment house.

In a sign of solidarity with Hamas as well as a diplomatic move to ease the crisis, President Mohamed Morsi of Egypt ordered his prime minister to lead a delegation to Gaza on Friday. In another diplomatic signal, Ban Ki-moon, the United Nations secretary general, also planned to visit Jerusalem, Cairo and Ramallah, the West Bank headquarters of the Palestinian Authority, in coming days.

In Washington, Obama administration officials said they had asked friendly Arab countries with ties to Hamas, which the United States and Israel regard as a terrorist group, to use their influence to seek a way to defuse the hostilities. At the same time, however, a State Department spokesman, Mark C. Toner, reiterated to reporters the American position that Israel had a right to defend itself from the rocket fire and that the “onus was on Hamas” to stop it.

The Pentagon said late Thursday that Defense Secretary Leon E. Panetta spoke to Mr. Barak this week about Israeli operations in and around Gaza and condemned the violence carried out by Hamas and other groups against Israel.

There was no sign that either side was prepared, at least not yet, to restore the uneasy truce that was forged the last time the Israelis invaded Gaza in the winter of 2008-9, a three-week war that left 1,400 Palestinians dead and drew widespread international condemnation.

Denunciations of Israel for what critics called a renewal of its aggressive and disproportionate attacks spread quickly on the second day of the aerial assaults. The biggest criticism came from the 120-nation Nonaligned Movement, the largest bloc at the United Nations. In a statement released by Iran, which holds the group’s rotating presidency and is one of Israel’s most ardent foes, the group said: “Israel, the occupying power, is, once more, escalating its military campaign against the Palestinian people, particularly in the Gaza Strip.” The group made no mention of the Palestinian rocket fire aimed at Israel but condemned “this act of aggression by the Israelis and their resort to force against the defenseless people” and demanded “decisive action by the U.N. Security Council.”

Isabel Kershner reported from Kiryat Malachi, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Alan Cowell from Paris and Elisabeth Bumiller from Bangkok.

Isabel Kershner reported from Kiryat Malachi, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Rina Castelnuovo from Kiryat Malachi, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem, Alan Cowell from Paris and Elisabeth Bumiller from Bangkok.

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Obama Meets C.E.O.’s as Fiscal Reckoning Nears

Luke Sharrett for The New York Times

Ursula M. Burns, chief of Xerox, said the president discussed few specifics of a potential agreement but emphasized that “we cannot go over the fiscal cliff.”

WASHINGTON — President Obama extended an olive branch to business leaders Wednesday, seeking their support as he prepared to negotiate with Congressional Republicans over the fiscal impasse in Washington.

If Congress and the president cannot reach a deal to reduce the deficit by January, more than $600 billion in tax increases and spending cuts will go into effect immediately — a prospect many chief executives and others warn could tip the economy back into recession.

Even so, Mr. Obama has some fence-mending to do before he can count on any serious backing from the business community.

“The president brought up that he hadn’t always had the best relationship with business, and he didn’t think he deserved that, but he understood that’s where things were and wanted it to be better,” said David M. Cote, chief executive of Honeywell. He was one of a dozen corporate leaders invited to meet Mr. Obama at the White House for 90 minutes Wednesday afternoon, after the president’s first news conference since the election.

While Mr. Obama did not present a detailed plan at Wednesday’s meeting or reveal what he would propose in terms of new corporate taxes, he strongly reiterated that he would not allow tax cuts for the middle class to expire. The president, according to attendees and aides, said he was committed to a balanced approach of reductions in entitlements and other government spending and increases in revenue.

With time running out, many people expect the president and Republican leaders in Congress to come up with a short-term compromise that prevents the full slate of tax increases and spending cuts from hitting in January. That would give both sides more time to come up with a far-reaching deal on entitlement spending, even as they work on a broad tax overhaul later next year.

One corporate official briefed on the meeting said that the chief executives came away with a sense that Mr. Obama was poised to present a more formal proposal in the next few days, but that he did not press them for support on particular policies. “It was more of a back and forth,” he said.

The chief executives from some of the country’s biggest and best-known companies, including Procter & Gamble and I.B.M., were not unified on everything, according to one who was interviewed after the meeting.

Many of the executives who described the meeting would speak only on condition of anonymity.

The outreach to business comes as both the White House and corporate America maneuver ahead of the year-end deadline, as well as the beginning of Mr. Obama’s second term. Many executives were put off by what they saw as antibusiness rhetoric coming from the White House in his first term, and many also oppose tax increases on the rich that Mr. Obama favors but would hit them personally.

Both sides have plenty to gain from a better relationship. Business leaders want to buffer their image after the recession and the financial crisis, while Mr. Obama would gain valuable leverage if he could persuade even a few chief executives to come out in favor of higher taxes on people with incomes over $250,000.

Lloyd C. Blankfein, chief executive of Goldman Sachs, publicly endorsed higher tax rates in an opinion article published in The Wall Street Journal on Wednesday.

“I believe that tax increases, especially for the wealthiest, are appropriate, but only if they are joined by serious cuts in discretionary spending and entitlements,” he wrote.

While Mr. Blankfein and other Wall Street leaders have been speaking out about the dangers of the fiscal impasse, only one executive from the financial services industry, Kenneth I. Chenault of American Express, was at Wednesday’s meeting.

Afterward, the corporate leaders seemed pleased with the tone of the meeting but cautious about the prospect of finding common ground with the White House on the budget choices facing Congress and the president.

“I’d say everybody came away feeling pretty good about the whole discussion,” Mr. Cote said. “Now, all of us are C.E.O.’s, so we’ve learned not to confuse words with results. And that’s what we still need to see.”

Ursula M. Burns, chief executive of Xerox, who was also at the meeting, said afterward that it was clear that “we’re going to have to work through some sticking points.” But while “we didn’t get into too many specifics,” she said, it was also made clear that “we cannot go over the fiscal cliff.”

Ms. Burns’s comments about the potentially dire consequences of the fiscal impasse echoed those of other chief executives, including many in the Business Roundtable, which began an ad campaign Tuesday calling on lawmakers to resolve the issue quickly. The Campaign to Fix the Debt, a new group with a $40 million budget and the support of many Fortune 500 chiefs, began its own ad campaign on Monday.

Michael T. Duke, chief executive of Wal-Mart Stores, warned in a statement after the meeting that “before the end of the year, Washington needs to find an agreement to avoid the fiscal cliff.” He said Walmart customers “are working hard to adapt to the ‘new normal,’ but their confidence is still very fragile. They are shopping for Christmas now, and they don’t need uncertainty over a tax increase.”

 

Helene Cooper reported from Washington and Nelson D. Schwartz from New York. Jackie Calmes contributed reporting from Washington.

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