Obama strategy doesn’t add up

By CHARLES KRAUTHAMMER   Friday, April 24, 2009
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— Unified theory of Obamaism, final installment:

In the service of his ultimate mission—the leveling of social inequalities—President Obama offers a tripartite social democratic agenda: nationalized health care, federalized education (ultimately guaranteed through college) and a cash-cow carbon tax (or its equivalent) to subsidize the other two.

Problem is, the math doesn’t add up. Not even a carbon tax would pay for Obama’s vastly expanded welfare state. Nor will Midwest Democrats stand for a tax that would devastate their already crumbling region.

What is obviously required is entitlement reform, meaning Social Security and Medicare/Medicaid. That’s where the real money is—trillions saved that could not only fund hugely expensive health and education programs but also restore budgetary balance.

Except that Obama has offered no real entitlement reform. His universal health care proposal would increase costs by perhaps $1 trillion. Medicare/Medicaid reform is supposed to decrease costs.

Obama’s own budget projections show staggering budget deficits going out to 2019. If he knows his social agenda is going to drown us in debt, what’s he up to?

He has an idea. But he dare not speak of it yet. He has only hinted. When asked in his March 24 news conference about the huge debt he’s incurring, Obama spoke vaguely of “additional adjustments” that will be unfolding in future budgets.

Rarely have two more anodyne words carried such import. “Additional adjustments” equals major cuts in Social Security and Medicare/Medicaid.

Social Security is relatively easy. A bipartisan commission (like the 1983 Alan Greenspan commission) recommends some combination of means testing for richer people, increasing the retirement age, and a technical change in the inflation measure (indexing benefits to prices instead of wages). The proposal is brought to Congress for a no-amendment up-or-down vote. Done.

The hard part is Medicare and Medicaid. In an aging population, how do you keep them from blowing up the budget? There is only one answer: rationing.

Why do you think the stimulus package pours $1.1 billion into medical “comparative effectiveness research”? It is the perfect setup for rationing. Once you establish what is “best practice” for expensive operations, medical tests and aggressive therapies, you’ve laid the premise for funding some and denying others.

It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective—and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures such as hip replacements.

Rationing is not quite as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by myriad similar criteria.

The more acute thinkers on the left can see rationing coming, provoking Slate blogger Mickey Kaus to warn of the political danger.

“Isn’t it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: ‘Our plan will deny you unnecessary treatments!’ … Is that really why the middle class will sign on to a revolutionary multitrillion-dollar shift in spending—so the government can decide their life or health ‘is not worth the price’?”

My own preference is for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment. But if you believe that health care is a public good to be guaranteed by the state, then a single-payer system is the next best alternative. Unfortunately, it is fiscally unsustainable without rationing.

Social Security used to be the third rail of American politics. Not anymore. Health care rationing is taking its place—which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow.

Taken as a whole, Obama’s social democratic agenda is breathtaking. And the rollout has thus far been brilliant. It follows Kaus’ advice to “give pandering a chance” and adheres to the Democratic tradition of being the party that gives things away, while leaving the green-eyeshade stinginess to those heartless Republicans.

It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.

Charles Krauthammer is a columnist for the Washington Post. His e-mail address is letters@charleskrauthammer.com.

reader COMMENTS
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(61)
RUSerious
Apr 26, 2009 at 8:40 p.m.
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andre-linoge: "You are wrong. End of conversation."
I suppose that's kind of what we all think, no matter which side we are on, or we wouldn't be leaving comments. So doesn't it kind of "go without saying"?

pharm
Apr 26, 2009 at 5:43 p.m.
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andre, you asked me to provide data after I said it was my opinion. I asked the same of you. The use of common sense backs my opinion. Bush never would have even tried to invade without 9-11 to arouse the public. As for the government doing things, were Democrats in charge when those things I listed took place? I was a little off about the soldiers that were sent to Vietnam in 1955, they were not allowed to shoot until 1959, under Eisenhower. The Vietnam Veterans Memorial does say the starting date for our participation in the war was 11-1-1955.

pharm
Apr 26, 2009 at 3:28 p.m.
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andre, where is your data that the invasion would have taken place without 9-11. Use common sense. The first "soldiers" were sent to Vietnam in 1955. Absolutely the government can do anything it wants to unless it is specifically prohibited by the Constitution. Does it say we can buy Alaska, or Louisiana, or make Hawaii a state? Does it say the government will give land to the railroads to expand west? Does it say we can take land from the Native Americans, and send them to reservations? The government does things all the time not mentioned in the Constitution.

pharm
Apr 26, 2009 at 1:18 p.m.
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andre, on another matter, the Vietnam Veterans Memorial dates the start of that war as 11-1-1955, under a Republican president. I believe you referenced this on another posting, attributing it to Kennedy`s administration. Not to start an argument, just to be informative.

pharm
Apr 26, 2009 at 1:15 p.m.
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andre, show me where it says the government can`t do it if it wants to.

pharm
Apr 26, 2009 at 1:12 p.m.
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andre, there were no compelling reasons to go to Iraq except the passions of 9-11. All the reasons of the administration were not true, as IAEA, and the CIA themselves said before the invasion. Why didn`t most of our allies go with us, because there was no reason to invade?

usaret
Apr 26, 2009 at 12:51 p.m.
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Zoom. I agree with you that we have to remember our history otherwise we will repeat the mistakes of yesterday. But it is a shame that both of our political parties believe that history should only be used to benefit one sides view. Bring up a point that refutes what they say or do and immediately it is history that has no bearing on today. Bring up a point that substanciates it, then history should be remembered. What happened 5, 10, 50 or a 100 yrs ago may not necessarily have complete revilence to today, but it is history and should not be forgotten just because it doesn't support the political point of view you believe it should.

pharm
Apr 26, 2009 at 12:16 p.m.
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RetiredAirForce, in a country that is the richest in the world, supposedly having some of the best health care, we shouldn`t be 43 rd in infant mortality no matter what. We are because of the uninsured, underinsured. They don`t go for pre-natal care, even regular check ups because they can`t afford it.Your website wanted me to sign up and I don`t like that, so I didn`t see their figures. I do know that cancers account for about 7% of all deaths in the world in a year. Heart disease, stroke are one and two. That would be a good idea, put doctors on a salary so they don`t order redundant tests to raise income. That saves many times the money of tort reform. Did you know the doctors at the Mayo Clinic are salaried? Depending on where you live, you could already be getting rationing. Sections of the country, even different hospitals/doctors approach health problems differently. Some are much more aggressive in treatments, and some are not. I just had a friend die six months after being diagnosed with cancer. They went after it with everything they could, but he was gone in those six months. If they had done nothing, he would have been gone anyway. He told me those last few months of radiation and chemo were the worst of his life, and if he had to do it over again he wouldn`t. $67,000 of medical bills for nothing, he would have preferred to be "rationed!"

pharm
Apr 26, 2009 at 11:56 a.m.
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andre, if you really think that with the "facts" provided by the administration we would have invaded if 9-11 hadn`t occurred, you are deluding yourself. Stop and think about it, there was opposition even after 9-11.

darwin1
Apr 26, 2009 at 11:02 a.m.
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First, what exactly does an HMO do? It rations care. Second, we already have nationalized health care. They are called emergency rooms and bankruptcy. Either way you pay. Third we already have rationed care based on wealth. For example, Paris Hilton gets to inherit a large fortune tax free, behave irresponsibly, and be assured she will get the base care her unearned money can buy.

RAF defends your freedom to end up destitute or dead waiting in an emergency room for non-rationed care. (What is triage if not rationing?).

RetiredAirForce
Apr 26, 2009 at 9:59 a.m.
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I agree tort reform is a great place to start. As far as the 11 billion dollar figure of savings being paltry; that would hire 44,000 more doctors and pay them $250,000 per year...the figure is huge!

RetiredAirForce
Apr 26, 2009 at 9:50 a.m.
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"Sure, there are tradeoffs, some rationing, but that has not been proven to raise death rates, on the contrary, they are the same as ours."
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This is not true, a perfect example is cancer survival rates http://www.medscape.com/viewarticle/5617...

RetiredAirForce
Apr 26, 2009 at 9:43 a.m.
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"Infant mortality rank of 43"
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I love when this one is brought up. In a country legalized abortions you want to talk about infant mortality rates? The average rate for infant mortality in the world is 40 deaths for every 1000 live births. Our country is 6, the lowest number (best rating) is just over 2 per 1000, the worst with over 180 per 1000. It is also interesting to note that in this country many women have decided to wait until later in life to have children which increases the mortality rate as well as the use of fertility drugs and other methods that cause multiple births. Many of the countries that by virtue of the numbers game are ahead of the US (lower rate) do not have these as issues.

pharm
Apr 26, 2009 at 8:31 a.m.
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Yes, they deteriorate. If any useful WMD`s had been found the administration would have touted them as a sign they were right to invade. Just as they tortured to try and find a link between Iraq and Al Qaida, that doesn`t exist, to justify the war. This is an article about SS and health care, but the first post goes to the writers credibility, that is how talking about the past began. Does he know more about these subjects than the invasion, or as others have charged liberals, is he a "conservative right-wing hack?" As for health care, in this country we pay more for that than we do for food, and what do we get? Infant mortality rank of 43 in industrialized nations, 50 million with no health care, a cost growth rate that is 2% higher than inflation. We are not looking for free care, that is not feasible, but other countries have shown you can cover everybody for much less than it is costing us now. Sure, there are tradeoffs, some rationing, but that has not been proven to raise death rates, on the contrary, they are the same as ours. We will see what treatments really are effective, not just used because they are there, and discard others. A big part of the cost is physicians ordering unnecessary tests because they don`t know for sure which are the most effective, and are afraid of malpractice. We can have some tort reform to help solve that, but even that only shaves one half of a percent($11.5 billion) from our total health care bill of $2.3 trillion(2007).

RetiredAirForce
Apr 26, 2009 at 3:22 a.m.
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"The only WMD`s that were found were old and useless, probably forgotten."
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Yes because as a WMD is older it is no longer a threat?

RetiredAirForce
Apr 26, 2009 at 2:50 a.m.
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“My point is that you consider anyone wanting Universal Health Care for everyone left wing socialism except for someone like you.”
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First, I do not have universal health care. I have a earned benefit that I still pay for annually, I pay much out of pocket, plus I pay for additional insurance because my benefit is not all encompassing. Second, yes I think a government run system of health care is a bad thing for this country; the current VA system is a perfect example. Again, I am not sure what my personal healthcare use/needs/cost or my view has to do with any comments I have made on this thread for you to determine I think those that want it are socialist. If all this was in reference to my comment following darwin1’s comment; I just took his last line and exchanged 2 words to show the absurdity of the comment.

casey
Apr 26, 2009 at 1:58 a.m.
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I'm entitled to medicare at the age of 50? Thats news to the vast majority of working people! My point is that you consider anyone wanting Universal Health Care for everyone left wing socialism except for someone like you.

RetiredAirForce
Apr 26, 2009 at 1:47 a.m.
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Casey I forgot to add...that I too have not stopped working, the plan is not even close enough to live on; I would qualify for food stamps if I did.

RetiredAirForce
Apr 26, 2009 at 1:44 a.m.
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casey, the health care you speak of is not very different from Medicaid or Medicare which you and the rest of Americans’ are already entitled too. The coverage is not completely “free”, there are many co-pays, limiting factors involving going out of group area for coverage results in complete out of pocket exposure. More to the point I am not sure what my health coverage good/bad has to do with anything in this thread---that was the point of the e-mail.

Zoom
Apr 26, 2009 at 1:31 a.m.
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usaret, all I can say is, if we don't learn from history, we are doomed to repeat it. Oh, how I long for the days when the worst mistake our President made was lying about sex with an intern.

casey
Apr 26, 2009 at 12:29 a.m.
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RetiredAirForce. The reason I asked about full retirement (which you answered in an email as at least 20 years)is you have many of the things you rail against. When my wife loses her job next year due to plant shut down we will lose our health insurance. National Health Care is a ugly debate and could have many problems and abuses as Medicare does. I applaud your military service and do not begrudge the benefits you may have earned. But many of us have served America well also and are being told tough luck. I have worked hard since I was a teenager and have well over a decade before I reach Social Security and Medicare and so does my wife. I have my own small business and cannot afford health insurance. I could try and get a job with benefits but my back is shot as are my rotor cuffs. I have repetitive hand injuries that are not treatable and my knee has been hurting. Would you hire me? Yet after 40 years in the labor pool it's tough luck. I'm not looking to quit working and I hope when I hit 66 I can keep working but I would like health care. People like me aren't bums but we are the same people who worked and paid taxes to provide you with the benefits you receive. Don't we deserve the same?

usaret
Apr 25, 2009 at 11:16 p.m.
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The subject is SS and health and 3/4th's of the comments live in the pass on the Iraq war. Wow, no wonder nothing ever gets resolved in this country. You don't want to solve you want to continue your tirade's against the previous administration. So, let's just drop everything else, bring on the investigation and let the chips fall where they may. Do you really want both parties dirty laundry hanging out to dry? Do you really want the rest of the world to watch us self-destruct? But this must be the way to win back the respect of the world that if you want to be honest, we've never ever really had in the first place. They see us only as a bank and if we stand up for our selves, they are afraid the money will stop flowing their way. So, please make up your minds, continue on the road to self-destruction or on the road to recovery.

Zoom
Apr 25, 2009 at 11 p.m.
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Packerfan1, please explain how gasing Kurds was a threat to the U.S.

casey
Apr 25, 2009 at 10:42 p.m.
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RetiredAirForce do you have a full military retirement?

pharm
Apr 25, 2009 at 9:52 p.m.
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If they had found any you can be sure they would have shouted it from the highest mountain. The only WMD`s that were found were old and useless, probably forgotten. When did they gas the Kurds, in the 80`s? They probably got the gas from us, we were kissing Saddam`s butt back then.

Packerfan1
Apr 25, 2009 at 9:41 p.m.
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Pharm,
what killed all the kurds, I think they gased them, I think that can be called wepons of mass destruction.

pharm
Apr 25, 2009 at 8:53 p.m.
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andre, with 100% certainty we would not have invaded if 9-11 hadn`t happened. My opinion. There was no immediate threat to the US, we would not have invaded. Did Kennedy have to do anything, no, the threat worked. Would he have, who knows. All we, as the public, saw was the crap they presented us with before Iraq, along with deliberate exaggerations, omissions, and outright lies. Even after 9-11 only a few countries backed our invasion, instead of the 70 or so that were with us during the first Iraq war, a pretty good indication of the lack of proof for action.

RetiredAirForce
Apr 25, 2009 at 7:38 p.m.
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darwin1 is just another left wing repeating the same incompetent garbage.

darwin1
Apr 25, 2009 at 5:29 p.m.
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In this the day 96 DAB(Days After Bush). I think we should change the calendar to 0 to celebrate the first year out of the Bush Presidency.

Mr Kraut is deluded. We already have health care rationing. The rich get whatever they want and the middle class and poor take what the private sector will allow us to take. The idea that we shouldn't use the most effective treatments was tried before but was defeated because back surgeons opposed it. Back surgery isn't as effective as doing nothing, but if you don't cut people you don't get paid. Say for example, there is a drug that is is 1/3 the price of the best drug but 75% as effective shouldn't we try that drug first. Exercise and weight loss are some of the best treatments for diabetes, obesity, arthritis and back pain, so we shouldn't try them first because that would be rationing?

Here is a Special Report from the Economist on Health Care.
http://www.economist.com/specialreports/...

The right always cries about class warfare while they are making sure the Paris Hilton's of this world get their inheritance and capital gains tax free. Kraut is just another right wing repeating the same incompetent garbage.

Seabee
Apr 25, 2009 at 4:56 p.m.
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I wonder how long a politician will wait for his/her rationed healthcare?

Zoom
Apr 25, 2009 at 4:55 p.m.
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"...and was more concerned about being perceived as weak by Iran..."

corrected.

pharm
Apr 25, 2009 at 4:39 p.m.
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andre, one question for you; if 9-11 hadn`t happened, and passions been raised, would Bush have gotten the OK to invade Iraq? I`m sure what the answer is.

Zoom
Apr 25, 2009 at 4:30 p.m.
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"Why did Saddam keep the inspectors from inspecting?"

Saddam didn't want Iran to know he didn't have WMD's. He didn't really believe the U.S. had the will to invade, and was more concerned about being perceived as weak by Iraq, his next door neighbor. This info came from Saddam himself, not some armchair quarterback.

Kleej
Apr 25, 2009 at 4:14 p.m.
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In regards to the title of this article I have one word: DUH!

pharm
Apr 25, 2009 at 3:48 p.m.
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Canada and UK do have some rationing, but even with that their death rates for cancer are the same as ours.

pharm
Apr 25, 2009 at 3:47 p.m.
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andre, the Bush administration massaged the intelligence to meet their goal of invasion, including a report written by a student passed off as"intelligence." The CIA and FBI told the administration not to use the supposed intelligence about aluminum tubes and uranium, they used it anyway. Iraq had no way to deliver WMD`s here even if they had them. As for the Pelosi thing, I don`t know what that is supposed to prove. That she was told we were thinking of using torture is undisputed, that she was never told it was used is undisputed so far. She was not to talk about it for security reasons. What is your point? As for a pre-emptive strike, show me the reasons, and they better be more than what Bush used or the answer is no.

pharm
Apr 25, 2009 at 1:23 p.m.
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andre, The IAEA reported to the UN 12 days before we invaded that there were deteriorating production capabilities, no new nuclear facilities, no attempts to buy uranium, the aluminum tubes could only be used for rockets, as Iraq stated. All of Mr. Bush`s reasons to go to war were shot down, and we went anyway. So a pre-emptive strike to stop what? There was nothing to stop.

janesvillean
Apr 25, 2009 at 12:56 p.m.
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I don't think anyone is really in disagreement about the doctrine of preventive war per se. People are in disagreement about preventive war based on a lie.

pharm
Apr 25, 2009 at 12:35 p.m.
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The only problem with that theory is that the IAEA stated categorically that no enrichment facilities were rebuilt before we invaded.

RetiredAirForce
Apr 25, 2009 at 12:12 a.m.
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the yellow cake was found by the inspectors well before the war started. They knew where it was, and knew Saddam didn’t have the means to use it.
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The stock pile was discovered after the first gulf war. Your assumption the IAEA knew Saddam didn’t have the means to use it was the reason behind the inspection process; attempted at every opportunity to thwart. If the IAEA really believed he did not have the means to use it why did they want it tracked? Why did Saddam keep the inspectors from inspecting? The purpose was simple; the remaining “low-level” (that was not put through isotopic dilution) yellow cake was placed in marked barrels and tracked because the IAEA believed that if Saddam had rebuilt the centrifuges it would then gain access to fissile material. The problem from November 1992 to the end of Saddam’s regime was not if he the material it was where it was all located and had he enriched any. The resulted findings after the war; it was not all were it was believed to be….but what do I know, I am still waiting for a pony.

pharm
Apr 24, 2009 at 5:13 p.m.
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RetiredAirforce, you know the yellow cake was found by the inspectors well before the war started. They knew where it was, and knew Saddam didn`t have the means to use it.

janesvillean
Apr 24, 2009 at 3:08 p.m.
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RetiredAirForce, keep on believing. Maybe someday you'll get a pony.

RetiredAirForce
Apr 24, 2009 at 12:08 p.m.
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Yep no credibility. In less than one month they were already recovering yellow cake...http://www.time.com/time/world/article/0,8599,454441,00.html?iid=fb_share

janesvillean
Apr 24, 2009 at 9:34 a.m.
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"Hans Blix had five months to find weapons. He found nothing. We’ve had five weeks. Come back to me in five months. If we haven’t found any, we will have a credibility problem." -- Charles Krauthammer, April 22, 2003
http://www.aei.org/events/filter.,eventI...

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