Saturday, May 5, 2012

How big is that supermoon anyway?

Robert Michael / AFP - Getty Images

A nearly full moon rises behind the cross of the Frauenkirche in the German city of Dresden in May 4.

Tonight's "supermoon" is the biggest and brightest full moon of the year, due to the fact that the moon is near the closest point in its orbital path around Earth. But just how much bigger and brighter does it look? That's a tricky question.

Most reports say the moon looks 14 percent bigger than usual, which is close to the truth but isn't quite right. They also say it's 30 percent brighter than usual, which isn't right, either. James Garvin, chief scientist at NASA's Goddard Space Flight Center, ran the numbers to come up with an explanation that seems to make the most sense.

First of all, it's important to note that the moon itself is not getting significantly bigger or smaller. There's a scientific debate over whether the moon is slowly shrinking or spreading out. But in either case, the change isn't noticeable on human time scales.

The difference in the moon's apparent size is basically a function of how close it is to Earth in its elliptical orbit. That orbit isn't changing on human time scales, either. It just so happens that tonight, the moon is coming closest to Earth at the same time that it's going full. Because the moon and the sun are precisely opposite each other, relative to Earth, tonight's ocean tides may be a bit higher than typical — but again, the effect is nowhere near big enough to worry about.

So how noticeable is the visual effect? Here what Garvin told me in an email today:
  • "The biggest predictable effect on the brightness of the full moon is how close the moon is to Earth.  With everything else the same, a full moon is about 30 percent brighter when the moon is closest to Earth in its orbit (called perigee) compared to a full moon when the moon is farthest from Earth in its orbit (called apogee).  Today’s full moon is at perigee."
  • "Also, when the moon is high in the sky (as it is now), we are closer to the moon by approximately the radius of Earth compared to when the moon is on the horizon. (Note: Earth’s radius is about 6,371 kilometers)."
  • "Since the distance from the center of Earth to the center of the moon is on average about 384,403 kilometers, the radius of the earth is about 6,371 kilometers, and brightness changes as the square of the distance, being closer to the moon by about the radius of the earth increases the brightness of the full moon by about 3 percent."  
  • "Thus the present supermoon is, at maximum, only about 9 to 10 percent larger in an angular (appearance) sense than a typical full moon and is also brighter (by a few percent), making it appear 'super.'"
"Meanwhile, our intrepid Lunar Reconnaissance Orbiter continues its remarkable mapping of our nearest celestial neighbor, coming up (in June) on its three-year anniversary of being in lunar orbit with its amazing array of 7 instruments," Garvin added.  "As of now, the data returned from LRO (over 300 trillion bytes) is larger than all of the rest of the data acquired for planets in the solar system combined (except for Earth, of course)."

Which just goes to show that every day is a "super moon" day for the Lunar Reconnaissance Orbiter and its science team. Check out NASA's Web site for more wisdom from James Garvin.

A NASA video explains the science behind the "supermoon."

Geoff Chester, an astronomer at the U.S. Naval Observatory, says the moon appears 14 percent larger in angular size when it's at the closest point in its orbit, compared with its appearance when it's farthest away from Earth. That's not 14 percent larger than average. That's 14 percent larger than the minimum apparent size.

"You'd be very hard-pressed to detect that with the unaided eye," Chester told The Associated Press. Seasoned skywatchers, however, say they can definitely tell the difference. Can you? Take a look at the moon tonight — before, during or after the moment of maximum fullness at 11:35 p.m. ET — and tell us what you see.

Update for 6:45 p.m. ET: Bad Astronomy's Phil Plait observes that the moon's angular size is roughly equivalent to that of a dime as seen from 6 feet away. You can bet I'll have a dime taped onto a south-facing window tonight to make the observations. Also, tonight's supermoon will be a little less super than last year's supermoon, because the moon is about 240 miles farther away at peak fullness than it was in March 2011. For what it's worth, next year's supermoon will be imperceptibly smaller than this year's. I wonder if there'll be perceptibly less hype.
More about the supermoon:

'Supermoon' rises around the world

Dimitri Messinis / AP

The full moon rises behind the Temple of Poseidon in Cape Sounion, southeast of Athens, Greece, while tourists watch on May 5. Saturday's event is a "supermoon," the closest and therefore the biggest and brightest full moon of the year.


Tonight's "supermoon" is the biggest and brightest full moon of the year, due to the fact that the moon is near the closest point in its orbital path around Earth. But just how much bigger and brighter does it look? That's a tricky question.

Most reports say the moon looks 14 percent bigger than usual, which is close to the truth but isn't quite right. They also say it's 30 percent brighter than usual, which isn't right, either.

James Garvin, chief scientist at NASA's Goddard Space Flight Center, ran the numbers to come up with an explanation that seems to make the most sense.
Read more about Garvin's explanation.
-- Reported by's Alan Boyle

Ralph Lauer / Zuma Press

A supermoon rises over neon hotel signs on Highway 80 in Ft. Worth, Texas.

Mark Blinch / Reuters

The moon rises over the skyline in Toronto, Canada, May 5.

Wilfredo Lee / AP

People fish from a jetty as the moon rises over the Atlantic Ocean, May 5, near Bal Harbour, Fla.

Asmaa Waguih / Reuters

A full moon is seen behind the minaret of Mohamed Ali mosque, in Islamic Cairo, Egypt, May 5.

Republicans ‘green with envy’ over Obama’s foreign-policy record

WASHINGTON— From Wednesday's Globe and Mail

Four years ago, who would have guessed Barack Obama’s most tangible and possibly enduring successes as President would stem from his role as Commander-in-Chief?
Because he has a good story to tell about his foreign-policy achievements, and cannot tout his economic record in quite the same way, Mr. Obama is making the most of it.

U.S. President Barack Obama greets U.S. soldiers at Bagram Air Base, north of Kabul, on Wednesday. - U.S. President Barack Obama greets U.S. soldiers at Bagram Air Base, north of Kabul, on Wednesday. | Doug Mills/NYT
U.S. President Barack Obama greets U.S. soldiers at Bagram Air Base, north of Kabul, on Wednesday.
On the first anniversary of the raid that killed Osama bin Laden, the President swooped into Afghanistan on the pretext of having reached a deal to stick by the Afghans but also end America’s military entanglement there.
But Mr. Obama’s dramatic Tuesday night speech to Americans from a U.S. military base in Afghanistan was also meant to persuade voters that he has aced his responsibilities as Commander-in-Chief – and rub his foreign-policy successes in Republican faces.
It was election-year stagecraft at its finest.
In 2008, Mr. Obama campaigned like a peacenik and was derided as hopelessly na├»ve about foreign policy – first by Hillary Clinton, his rival for the Democratic nomination, and then by John McCain, the onetime prisoner-of-war and that year’s GOP nominee.
Yet, foreign policy is the one sphere in which Mr. Obama has exceeded expectations in office. His Nobel Peace Prize notwithstanding, he has shown himself to be a cool-headed – and, if necessary, ruthless – practitioner of realpolitik and proved the naysayers wrong.
Who could blame him for taking a victory lap or three?
“In a typical election year, foreign policy is a strong point for the Republican Party and the Republican candidate,” noted University of Akron political science professor David Cohen. “This is an odd year in that the Democratic candidate has the advantage.”
The risk facing Mr. Obama one year after Mr. Bin Laden’s demise – a milestone the President marked with an unprecedented interview from the White House Situation Room that NBC will broadcast Wednesday night – is that his swagger will backfire.
The underperforming economy remains the top concern of American voters and Mr. Obama’s self-congratulatory remarks this week about his successes on the foreign front may only remind many electors of how he has fallen short in domestic affairs.
A new Obama campaign ad that asks whether presumptive Republican nominee Mitt Romney would have had the stomach to authorize the Navy Seal operation that bagged Mr. Bin Laden, has also exposed the President to charges of politicizing national security.
A year ago, in a midnight address from the White House, Mr. Obama hailed the elimination of the world’s most notorious terrorist as a collective accomplishment.
But if the White House made only modest hay of the achievement then, it appears to be more than making up for it now. Many pundits see the switch as the handiwork of the Obama re-election campaign’s chief strategist, David Axelrod.
It has left Republicans exasperated and struggling to regain their foreign policy spurs.
“I’ve had the great honour of serving in the company of heroes. And, you know the thing about heroes, they don’t brag,” Senator McCain retorted on Monday.
Mr. Romney shot back at the President on Tuesday, telling CBS This Morning that “any thinking American would have ordered” the raid on Mr. bin Laden’s compound in Pakistan. “I would have taken exactly the same decision,” he said.
Americans have every right to question that. The Obama campaign ad, featuring former president Bill Clinton, recalls Mr. Romney’s 2007 criticism of Mr. Obama for saying he would act without Pakistan’s approval to strike at al-Qaeda targets in that country.
Mr. Romney has further been haunted by his comments back then that the fixation with capturing Mr. bin Laden was misplaced. “It’s not worth moving heaven and earth, spending billions of dollars, just to catch one person.”
Former George W. Bush acolytes have attacked the Obama administration for failing to give credit to their ex-boss. They say the Bush administration’s “enhanced interrogation techniques” on terrorist leaders held at the Guantanamo Bay led them to cough up vital information that helped U.S. intelligence officers find Mr. bin Laden.
That debate is largely lost on the American voters. All they know is that Guantanamo Bay is still open, in spite of Mr. Obama’s vow to close it within a year of taking office, and that 9/11 mastermind Khalid Sheikh Mohammed will face a military tribunal there, in spite of Mr. Obama’s vow to try terrorists in civilian courts in the United States.
Republican suggestions that Mr. Obama is somehow soft on terrorism just do not fly.
Nor does Mr. Romney’s charge that the President has spent his first term “apologizing for America” abroad and cozying up to Russia, “our No. 1 geopolitical foe.”
Mr. Obama seems so self-assured in his conduct of foreign policy that he can afford to mock his GOP rival, telling a Sunday fundraiser: “I didn’t know we were back in 1975.”
A foreign policy crisis – involving Iran, Syria or China – could test the President before Americans vote in November. And a positive result is by no means guaranteed.
But for now, Mr. Obama has made Americans grateful and his rivals green with envy.
“There is a lot of faux outrage by Republicans about the Obama campaign [exploiting] the Bin Laden killing,” Prof. Cohen said. “It is an event worth bragging about.”

Smart Steps on Natural Gas

Since taking office, President Obama has supported an all-out, all-of-the-above strategy that develops every available source of American energy. A strategy that’s cleaner, cheaper, and full of new jobs.

As part of that effort, the Administration has focused on expanding production of natural gas. After all, we have a supply of natural gas that can last America nearly 100 years. And this Administration will continue to take steps to develop this energy resource in a way that can help fuel our economy and, according to industry experts, support more than 600,000 jobs by the end of the decade.

Last year, U.S. natural gas production grew by more than 7 percent in 2011 – the largest year-over-year volumetric increase in history – and easily eclipsed the previous production record set in 1973. As we produce more of this resource in the years ahead, its potential to power everything from our trucks to our factories only grows, while at the same time reducing our dependence on foreign oil.

At the same time, it’s imperative that we develop our natural gas resources in a safe and responsible way. For the Administration, this is a top priority.

So today – following through on a promise that the President made in his State of the Union address – the Department of Interior (DOI) has proposed a rule that will require companies to publicly disclose the chemicals used in hydraulic fracturing operations on public and Indian trust lands.

This is a sensible, common sense step that incorporates feedback from the public, industry, tribal representatives, and other key stakeholders and aligns with standards already in place in certain states. Currently, there is no specific requirement for operators to disclose these chemicals on federal, tribal and Indian trust lands, where approximately 90 percent of the wells drilled use hydraulic fracturing to increase oil and gas production. Accordingly, this proposed rule will modernize our management of well stimulation activities to ensure that fracturing operations conducted on public and Indian lands follow industry best practices.

Separately, the EPA announced today new draft permitting guidance for using diesel fuel in oil and gas hydraulic fracturing. This guidance is designed to improve compliance with the Safe Drinking Water Act requirements and strengthen environmental protections consistent with existing law.

These steps build on a series of recent actions to promote prudent natural gas development in the United States. Just last month, the President issued an Executive Order to create a new Interagency Working Group to Support Safe and Responsible Development of Unconventional Domestic Natural Gas Resources, which will coordinate the efforts of federal agencies responsible for overseeing domestic natural gas development.

Moving forward, we will take full advantage of our natural gas resources, while giving American families and communities the confidence that natural and cultural resources, air and water quality, and public health and safety will not be compromised.

Heather Zichal is Deputy Assistant to the President for Energy and Climate Change

Weekly Address: A New Chapter in Afghanistan

After signing an agreement that details our future relationship with Afghanistan, President Obama explains that we must now focus on the type of nation our troops return home to, and calls on Congress to take the money we are no longer spending at war, use half of it to pay down our debt, and use the other half to rebuild America.

Alleged Sept. 11 planners disrupt arraignment at Guantanamo hearing

Janet Hamlin / AP

In this sketch reviewed by the U.S. Department of Defense, Khalid Sheikh Mohammed reads a document in court on Saturday.

Updated at 2:20 p.m. ET: GUANTANAMO BAY NAVAL BASE, Cuba -- Accused Sept. 11 mastermind Khaled Sheikh Mohammed and his co-defendants defied a military judge Saturday, refusing to answer his questions and one of them silently got up and started praying as the long awaited arraignment of the terror suspects got off to a rocky start in a military courtroom in Guantanamo.
Mohammed -- dressed in a white turban and robe -- sat silently, taking off his headphones when Judge James Pohl first addressed him. "One cannot refuse to participate and frustrate the proceedings," a clearly irritated Pohl snapped.
"The reason he's not putting the earphones in his ears is because of the torture that was done to him," his lawyer, David Nevin, told the judge. 
Ramzi Binalshibh, another alleged 9/11 plotter, at one point disrupted the court by standing up and shouting -- first in Arabic and then in English --  that "the era of Gadhafi is over but it continues at this camp. Maybe you aren't going to see me anymore ... there are threats we have seen at this camp. Maybe they will kill us and say we have committed suicide."
When Pohl ordered him to sit down, saying such issues could be raised later, Binalshibh shot back: "The time to discuss these things is now, not tomorrow."
While families of the 9/11 victims watched in the courtroom, and on closed circuit television at seven sites in the United States, the  dispute - and other protests by the defendants and their lawyers--  appeared to initially tie up the proceedings  in knots.
Binalshibh earlier brought the court to a halt when he stood up and then dropped to his knees in prayer.

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NBC's Michael Isikoff reports from Guantanamo on the disruptions .

Yet another defendant, Walid bin Attash, sat in court in restraints -- apparently because of a dispute with guards -- and his lawyer said he couldn't participate because his client was "in pain." The restraints were later removed.
With his long flowing beard, Mohammed was a striking presence in the courtroom. But his refusal to utter a word -- despite repeated entreaties by the judge -- stood in stark contrast to previous court appearances where he has chanted Koranic verses, denounced  the United States, and taken credit for the terror attacks.

At left, a 2003 photo obtained by the Associated Press shows Khalid Sheikh Mohammed, the alleged Sept. 11 attacks mastermind, shortly after his capture. At right, a photo downloaded from purports to show Mohammed in 2009.
When the defendants declined to wear their headsets so they could listen to translations of the judge's questions, Pohl ordered a translator to repeat them out loud in Arabic. And he plowed ahead, asking each of the defendants detailed questions about their knowledge of the lawyers who had been appointed to represent them and whether they accepted them. None of the defendants responded and refused to even look at the judge.
During a break, the defendants could be seen leaning back in their seats, laughing, smiling and chatting among themselves -- apparently pleased with their ability to frustrate the judge.
The lawyers did their part, raising repeated objections. Cheryl Borman, a lawyer for Attash and dressed in a muslim hajib, objected to the attire of women members of the prosecution team, several of whom were dressed in military skirts with their legs showing.
"There are issues of cultural sensitivity here," she said. "I am suggesting the prosecution team make decisions of appropriate dress of their female colleagues so that our clients are not forced to look (at them) for fear of commiting a sin under their faith."
Nevin, Mohammed's lawyer, asked Pohl to force prosecutors to identify the men sitting in the back of the courtroom. "Given what Mr. Mohammed has been through with unknown, shadowy people it will affect his ability to proceed," Nevin said. The men were later ID'd as paralegals and FBI agents.
The tactics appeared designed to highlight objections their lawyers have raised to the fairness of the proceedings before a military commission.
In recent days, defense lawyers have filed motions objecting to rules that allow military guards to inspect the mail they send their clients, a lack of translators, and orders that make anything their clients as "presumptively classified."
The Obama administration had previously sought to try the suspects in federal court in New York City -- a move that stirred up a storm of political opposition. Since then, the case has been moved back to military court here at Guantanamo and some of the family members that gathered here this week said they are anxious to see the suspects brought to justice.

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An online article purportedly written by al-Qaida members includes instructions on how to set fires in Montana. NBC's Brian Williams reports.

"I'm from Brooklyn and you know what, you face your, you face your fight," said Eddie Bracken, whose sister Lucy was killed in the World Trade Towers.
He said he wanted to see Mohammed and his co-defendants in the courtroom. "I want to see him eye to eye. That's the man that killed my sister -- him and the other cohorts or whatever you want to call them."

It was the first public appearance by the five men in more than three years.
Mohammed, a Pakistani citizen who grew up in Kuwait and attended college in Greensboro, N.C., was joined by four co-defendants:
  • Binalshibh, a Yemeni -- allegedly chosen to be a hijacker but couldn't get a U.S. visa and ended up providing assistance such as finding flight schools;
  • Attash, also from Yemen, allegedly ran an al-Qaida training camp in Afghanistan and researched flight simulators and timetables;
  • Mustafa Ahmad al-Hawsawi, a Saudi accused of helping the hijackers with money, Western clothing, traveler's checks and credit cards;
  • Ali Abd al-Aziz Ali, a Pakistani national and nephew of KSM, allegedly provided money to the hijackers. 
Like Mohammed, Binalshibh also earlier told the court he was proud of the attacks in New York, Washington and Shanksville, Pa.
Defendants before military commissions typically do not enter a plea during arraignment. Lawyers for the men said they were prohibited by secrecy rules from disclosing the intentions of their clients.

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Rachel Maddow points out that while fear and a lack of confidence in the American Justice system has forced terror trials like the upcoming trial of Khalid Sheikh Mohammed to be held at Guantanamo, prosecutors were able to conduct a successful terror conviction in a Brooklyn court without any of the dire consequences warned of by alarmists.

But Jim Harrington, Binalshibh's civilian lawyer, didn't expect any of the defendants to plead guilty, The Associated Press reported.
And attorney James Connell, who represents al-Aziz Ali, told reporters at the base that the arraignment is "only the beginning of a trial that will take years to complete, followed by years of appellate review."
"I can't imagine any scenario where this thing gets wrapped up in six months," he added.
Also in court Saturday were six 9/11 family members who won a lottery to attend the proceedings. Others were watching on closed-circuit video at military bases in New York City and the eastern U.S.
Cliff and Christina Russell traveled from New York to honor the memory of Cliff's younger brother, Stephen, a firefighter killed responding to the attacks, AP reported.
Cliff Russell said he hopes the tribunal will end with the death penalty for Mohammed and his co-defendants. "I'm not looking forward to ending someone else's life and taking satisfaction in it," he said. "but it's the most disgusting, hateful, awful thing I ever could think of if you think about what was perpetrated."
The Associated Press contributed to this report.

The Washington Post's Overly-Credulous Take on Boehner

On Sunday, The Washington Post published a long, blow-by-blow of last summer’s negotiations between Barack Obama and John Boehner over a $4 trillion deficit deal. The take-away from the piece is that Obama had a chance at a deal involving $800 billion in tax increases and trillions in spending cuts (including cuts to sacred programs like Medicare and Social Security), but that he got cold feet and backed away. By the time his feet warmed up again, the opportunity for a deal had passed.

Most of what I think about the piece, and what we learn from it about the Boehner-Obama negotiation, Jon Chait has already said, and probably better than I could. But I’d just add a couple quick points based on reporting I did for my recent book covering the same territory.
First, like Chait, I find the premise of the Post piece off-base. The context you need for understanding the negotiation is that House Republicans were simply never going to accept anything that had the slightest whiff of a tax increase. Period. That means, whatever the temperature of Obama’s feet at any given moment, there was no deal to make. The whole narrative about cold feet is, in fact, only of interest insofar as it gave Boehner cover to walk away while pretending he would have done a deal. It doesn’t change the non-viability of the deal itself.

To see this, you need to back up a few weeks from the action in the Post piece to May and June of 2011. That’s when Vice President Joe Biden and Obama’s top economic aides—Tim Geithner, Jack Lew, and Gene Sperling—were negotiating with Eric Cantor and Jon Kyl, the second-ranking Republicans in the House and Senate respectively, to lay the groundwork for the Obama-Boehner talks. And what you see in the Biden episode is GOP resistance to even broaching the subject of tax hikes, much less actually agreeing to them. As I write in the book:
The third group at the negotiating table was a four-man detachment of congressional Democrats, who would have to sell their colleagues in the House and Senate on whatever deal emerged. These were men acutely aware of the backlash any Democratic representative or senator would court by even contemplating Medicare cuts. As the conversation drifted in this direction, they became adamant that it was time to discuss tax increases. “Medicare beneficiaries have a median income of $23,000 a year,” one of the Democrats told Cantor and Kyl. “Why should we be engaged in a conversation asking them to pay more unless you’re talking about closing corporate tax loopholes and special breaks for corporate jets?”
At this, Cantor and Kyl became visibly flustered, according to several observers. They groused that it would be far more productive to stay focused on the spending cuts all sides could support, at least in theory, rather than get bogged down talking tax increases, which the Republicans opposed. Their strategy, the Democrats eventually concluded, was to resist tax increases and simply pocket whatever spending cuts everyone in the room would accept.
“Let me get this right,” Kyl finally said to Lew and Sperling as the discussion became tense. “You’re saying there are Medicare savings you think would be good policy. But you won’t do them unless we agree to raise taxes?” Lew and Sperling looked back at him stone-faced and simply said: “Yes.” A few days later, on June 23, Cantor and Kyl withdrew from the negotiations.
Given that Cantor and Kyl had left the Biden talks because Democrats’ insisted on tax increases as part of any deal, it’s hard to see how Obama failed to seize a deal involving tax increases, since they were never going to be forthcoming. Or, put differently, to the extent Obama made a mistake in his negotiation with Boehner, it wasn’t, as the Post suggests, that he lost his nerve in the face of an acceptable offer. It was that he assumed there was something to negotiate over, when in fact the entire exercise had already been shown to be futile.

The Post really only offers one real data point to rebut this, but it’s highly suspect. The paper says there was a chance that Republicans would have accepted $800 billion in revenue if the revenue arose from an obscure form of budgetary magic—Chait calls it “imaginary” revenue. Here’s the relevant portion of the piece:
Much of the $800 billion would have to come from overhauling the tax code—not from higher tax rates. The Republicans believed lower rates and a simpler code would generate new revenue by discouraging cheating and spurring economic growth. If the White House would agree to count that money, the Republican leaders said, then they might have a deal.
[W]hen Boehner brought up economic growth, arguing that his caucus would not accept tax increases under any other terms, the Republicans saw Geithner as receptive, Jackson said. “It was literally one of the last things discussed when they came in on that Sunday. And Geithner said, ‘Yes, we accept that,’ ” Jackson recalled. “We viewed it as a breakthrough.”
But, as the piece points out, Geithner and several other administration officials deny that the imaginary $800 billion would have been remotely acceptable. And there’s good reason to believe them. I spoke with several people involved in the negotiation for my book, and each one of them understood that even doing a deal with $800 billion in real revenue would be incredibly controversial among Democrats—many hands were wrung over this when the parameters of the negotiation became clear. There was simply no way they would have expected to sell $800 billion in imaginary revenue to their own party. It was a complete impossibility, and they understood it as such. The only reason for not shooting it down was the hope that they could eventually turn the dross into gold. (As I say, it was delusional hope, but it was the hope nonetheless).

The Post goes on to report that, once the negotiations fell apart for the last time, Obama attempted to restart them by accepting this approach. “[T]he president tried to put the original framework back in play,” the authors write, explaining that he asked an aide to get Boehner on the phone and tell him “I’ll take your last offer.” But Boehner balked, saying, “[W]e don’t have time to reopen these negotiations.”

Chait reads this to mean that Obama was making a final, abject capitulation—settling for an imaginary $800 billion in revenue in exchange for trillions in spending cuts, when even a real $800 billion would have been insultingly meager. But I don’t think that’s what actually happened, or even what the Post is necessarily saying happened. If you parse these lines closely, Obama seemed to be accepting a framework in which Republicans would agree to an $800 billion figure, which the White House hoped would be real and the GOP hoped would be imaginary. That would have been the subject of the negotiation Boehner said there wasn’t time to reopen. And, on that point at least, Boehner was right. Given the Republican hostility to any bona fide revenue, the two sides could have negotiated ad infinitum without reaching a deal. 

That’s really all you need to know about what went down.

Obama’s evolution: Behind the failed ‘grand bargain’ on the debt

By Peter Wallsten, and , Published: March 17

President Obama had just arrived home, walking across Lafayette Square after attending Sunday services with his family at St. John’s Church. In the West Wing, Obama ducked into the spacious office of his chief of staff, where he found his negotiating team huddled with two leading Republicans and a passel of aides.

To the outside world, it looked like a do-nothing summer Sunday, a disturbingly quiet reminder of government dysfunction. The prevailing theme on the weekly political talk shows was things falling apart. In two weeks, the government would be unable to pay its bills. Where were the administration and congressional leaders who might work out a compromise to avert the looming disaster? No meetings were taking place at the White House that day, one network host said.

The reality was quite different. Around 11 a.m. July 17, John A. Boehner, the House speaker, and Eric Cantor, the majority leader, had slipped through a side entrance, out of view from the bank of television cameras stationed near the front gate off Pennsylvania Avenue. The on-and-off secret negotiations were on again. They had resumed with a Friday meeting at the Capitol. And they seemed to be going so well by the time Obama returned from church that he invited Boehner and Cantor into the Oval Office to talk, just the three of them.

The sermon the president had heard that morning was a stirring Old Testament account of Jacob dreaming of a ladder that stretched to heaven. Sometimes, the pastor had said, “the best adventures occur when we venture into unmarked terrain.” Obama was in a similar frame of mind. Against the vehement advice of many Democrats, including some of his own advisers, Obama was pursuing a compromise with his ideological opponents, a “grand bargain” that would move into unmarked territory, beyond partisan divides, pushing both parties to places they did not want to go. Now might be the moment.

Months later, that moment and the tense, ultimately unsuccessful ones that followed have become a critical issue in Obama’s reelection campaign as the president and his Republican critics lay out competing narratives about his stewardship of the economy and the United States’ fiscal health.

Republicans say those days offer clear evidence that the president is fiscally reckless and determined to tax his way out of the nation’s mounting deficit and debt problems. A Washington Post-ABC News poll this month illustrates Obama’s lingering vulnerability: Only about a third of Americans approve of his handling of the deficit.

From the White House point of view, those few days show a politically selfless president willing to rise above the partisan fray and make difficult choices for the good of the country — if only obstinate Republicans would meet him halfway.

On that Sunday in July, Boehner, the old-school pol from Ohio, seemed willing to hash it out. He had met in private with the president and his aides many times. Their sessions were so sensitive — especially for the speaker, who was dealing with a House teeming with tea party rebels — that Obama’s aides were under strict orders to “protect Boehner” and not talk about his private entreaties. Obama liked Boehner; they got along well during the private sessions and a round of golf. But there was doubt in the White House as to whether the speaker could bring his party along. He “probably could not deliver a pizza,” was one administration aide’s skeptical assessment.

Cantor, a Virginian, was more closely aligned with the tea party wing. The fact that he was there, and had been involved since Friday, however reluctantly, was taken by the White House as an encouraging sign.

The conversation during that brief gathering inside the Oval Office did nothing to dampen the optimism. When the trio emerged and returned to the roomful of aides, Obama appeared upbeat.

“I want a deal,” he said.

The aides put down their muffins and BlackBerrys and snapped to attention.

Secrecy would be essential as the details came together, the president told everyone. He spoke openly with Boehner about how the two sides might sell the emerging plan to their respective parties, an imposing task from either end.

“How soon can we get this drafted?” the president asked, according to notes taken during the meeting by a top Republican staff member. When Obama left, the negotiations rushed forward, staffers on both sides now energized by the prospect of a deal.

Three days later, the grand bargain was cold and dead.

What happened? Obama and his advisers have cast the collapse of the talks as a Republican failure. Boehner, unable to deliver, stepped away from the deal, simple as that.

But interviews with most of the central players in those talks — some of whom were granted anonymity to speak about the secret negotiations — as well as a review of meeting notes, e-mails and the negotiating proposals that changed hands, offer a more complicated picture of the collapse. Obama, nervous about how to defend the emerging agreement to his own Democratic base, upped the ante in a way that made it more difficult for Boehner — already facing long odds — to sell it to his party. Eventually, the president tried to put the original framework back in play, but by then it was too late.

The moment of making history had passed.

The actions of Obama and his staff during that period in the summer reflect the grand ambitions and the shortcomings of the president’s first term.

A president who promised to bring the country together, who confidently presented himself as the transformational figure able to make that happen, now had his chance. But, like earlier policy battles, the debt ceiling negotiations revealed a divided figure, a man who remained aloof from a Congress where he once served and that he now needed. He was caught between his own aspirations for historical significance and his inherent political caution. And he was unable to bridge a political divide that had only grown wider since he took office with a promise to change the ways of Washington, underscoring the gulf between the way he campaigned and the way he had governed.

In the end, that brief effort, described by White House officials as the most intense and consequential of Obama’s presidency, not only illuminated pitfalls in the road he had taken during the previous three years but also directed him down a different, harder-edged, more overtly partisan path that is now defining his reelection campaign.

The meeting that crucial Sunday took place in the office of William M. Daley, the White House chief of staff. Among those in the room were Treasury Secretary Timothy F. Geithner , perhaps Obama’s most influential Cabinet member; Rob Nabors, the legislative liaison; and Jacob J. Lew, then the budget director. Lew had already made the rounds on the Sunday talk shows, saying that Obama was waiting for a negotiating partner to develop a plan to avert the looming fiscal calamity. He betrayed no hint that those elusive partners were coming to the White House that very day.

Lew’s comment referred to the collapse of secret talks a week earlier. Boehner had broken them off after word leaked that tax hikes were on the table. His caucus would not stand for them.

The tea party conservatives, who dominated the group of new House Republicans that gave the GOP a majority in the 2010 elections, were hellbent on preventing Obama from raising the legal limit on government borrowing — known as the debt ceilingwithout deep spending cuts and a radical restructuring of expensive health and retirement programs. While its members had elevated Boehner to the speaker’s office, the tea party caucus, critical of Obama’s political agenda and elected to stop it, also proved to be Boehner’s biggest political challenge.

Their voice in the House leadership was Cantor, who also aspired to be speaker and had uneasy relations with Boehner. Publicly, Cantor was insistent that the House would never approve higher taxes. But the White House took his presence now alongside Boehner as a sign that the rift within the GOP had perhaps been patched and that talks could begin again in earnest. “We thought, ‘Okay, this is different,’ ” Daley recalled. “There was a perception from our end that, because Cantor was in the room, the people who blew up the first discussion may be able to be mollified.”

Cantor and Boehner brought their top aides, including Barry Jackson, the speaker’s chief of staff, who had worked in George W. Bush’s White House. When they reached Daley’s office, the Republicans were handed a four-page document that made changes, typed in red, to an offer Boehner had made two days earlier, during a secret meeting at the Capitol.

A lot of red ink, the Republicans thought. But the major elements of a bargain seemed to be falling into place: $1.2 trillion in agency cuts, smaller cost-of-living increases for Social Security recipients, nearly $250 billion in Medicare savings achieved in part by raising the eligibility age. And $800 billion in new taxes.

In Boehner’s offer Friday night, the taxes came with strings attached. The Republicans wanted Obama
  1. to give up plans to raise the tax rate paid by the wealthiest Americans, now set at 35 percent. Instead, they wanted that rate to go down. 
  2. They also wanted to preserve low rates for investment income — one of the biggest perks for the wealthy in the tax code — 
  3. and establish a blanket exemption from U.S. taxes for corporate profits earned overseas.
  4. Another key caveat: Much of the $800 billion would have to come from overhauling the tax code — not from higher tax rates. The 
  5. Republicans believed lower rates and a simpler code would generate new revenue by discouraging cheating and spurring economic growth. 
  6. If the White House would agree to count that money, the Republican leaders said, then they might have a deal.

That last condition was a problem. For years, Democrats have mocked the Republican argument that tax cuts pay for themselves by boosting the economy, an assertion for which evidence is scant. Many independent budget experts say the effect, if it exists, would be almost impossible to measure and useless in crafting a budget. Fiscal “snake oil,” some Democrats say.

So there were issues to work out that Sunday but also reason for optimism. In its counter proposal, the White House appeared to accept the $800 billion tax offer and a lower top rate. The administration rejected the exemption for overseas profits, but Geithner told the Republicans, they said, that he could get most of the way there.

And when Boehner brought up economic growth, arguing that his caucus would not accept tax increases under any other terms, the Republicans saw Geithner as receptive, Jackson said. “It was literally one of the last things discussed when they came in on that Sunday. And Geithner said, ‘Yes, we accept that,’ ” Jackson recalled. “We viewed it as a breakthrough.”

On this point, the two sides are in dispute. Geithner and other administration officials say it never happened. They strenuously deny agreeing to count revenue from economic growth, a process known as “dynamic scoring.”
Treasury spokeswoman Jenni LeCompte said the Republicans “were kidding themselves” if they thought the White House would concede that point. “That’s always been a total non-starter for Secretary Geithner and this administration and always will be,” she said.
Whatever the case, by the time Obama returned to the room with Boehner and Cantor after their half-hour Oval Office chat, the focus was on defending their compromise more than debating it. The president looked at the Republicans and wondered how each side could sell the plan when key components — such as taxeswould need to be explained in ways that would attract liberals and conservatives alike.

“Everybody was saying the right thing,” Daley recalled. “Nobody was saying, ‘If you don’t take this then the deal’s over,’ even though there were real differences. We walked away feeling that we were 80 percent there. But no doubt about it, like any negotiation, the final 20 percent is always the most difficult.”

Jackson said the speaker and his aides felt they had reached a general understanding with Obama and the White House. “Everybody felt really upbeat,” Boehner’s top aide recalled. “They were in nervous territory, as were we. But we walked out of there thinking this was coming together, and we had the outlines.”

That afternoon, the Republican team reconvened at the Capitol, pleased with the morning’s progress. They agreed to drop several key demands.

They would accept fewer cuts in a category of spending that includes federal worker benefits. And they would drop the demands on investment income and overseas corporate profits.

Another major concession: Their offer had proposed boosting the debt ceiling just high enough to see the Treasury through March, which would become the new deadline for Congress to approve the more difficult cuts to entitlement programs and to overhaul the tax code. The White House vehemently opposed that approach. Obama did not want to have this debate again in an election year. The White House wanted a “trigger” that would automatically raise taxes on the wealthy and cut health spending, an idea the Republicans opposed. For now, Boehner and Cantor agreed to give up their demand for a short-term debt-limit increase. But talks on the trigger would have to continue.

“Further discussion necessary to finalize,” Boehner aide Brett Loper wrote in the GOP counteroffer he e-mailed to the White House.

Loper hit the send button at 6:55 p.m. Sunday. Nabors replied immediately.
Thanks, Obama’s legislative liaison wrote. We’ll get right to work.

The next morning at the White House, top aides circulated Boehner’s latest offer throughout the West Wing. They met repeatedly in Daley’s office, scouring budget tables and Democratic vote sheets. By mid-afternoon, they told the Republicans that they were about to take a plan to the president for his approval.

A senior administration official said the White House team recognized that the two offers were coalescing and that the time for a decision was at hand. People asked themselves, the official said: Is this something we can sell? Is this a deal we can live with?

At the Capitol, the Republicans waited. Shortly after 6 p.m., Daley called Boehner’s office and said an update was on the way. None came, and four hours later, Jackson told his staff to go home. The White House, he said, was continuing to “massage their counter on all sections.”
The next morning, Nabors called Jackson with an ominous question: Have you heard about the Gang of Six?

Nabors was using the Beltway shorthand for a group of senators — conservatives and liberals — who had been working for months on a long-range deficit-reduction plan based on recommendations from a fiscal commission Obama appointed the previous year.

The group included
Sen. Richard J. Durbin (D-Ill.), a close ally of the White House, and
Sen. Saxby Chambliss (R-Ga.), one of Boehner’s dearest friends. Another participant,
 Sen. Tom Coburn (R-Okla.), was close to Obama and Boehner. The senators said they kept Boehner and administration officials informed about their work. They said the White House had been pressing them for months to put something out, believing that getting a few Republicans to sign on to any tax increase would build momentum.

“The fact that we had Republicans willing to discuss revenue was a breakthrough,” Durbin said. “That’s why [the White House] thought it might help move the conversation forward in the House.”

The Gang of Six was unable to seal its own deal. But that morning — a Tuesday — they finally revealed their work at a closed-door briefing for 64 fellow senators. Coming at that moment, it had an unintended effect.

Desperate to resolve the debt-limit deadlock, senators enthusiastically and publicly latched on to the proposal, which included more taxes and stronger protections for the poor and elderly than the still-secret Obama-Boehner framework. Dozens of senators emerged from the briefing praising the group’s work, including Republicans such as Lamar Alexander (Tenn.), then the third-ranking member of his party’s leadership team. The Gang of Six had “come to a bipartisan agreement,” Alexander told reporters, “and I support it.”

At the White House, Obama showed equal enthusiasm. He made a rare appearance in the White House pressroom, surprising reporters who had been awaiting the regular briefing from press secretary Jay Carney. As Carney stood to the side, the president hailed the plan as “broadly consistent with what we’ve been working on here in the White House and with the presentations that I have made to the leadership when they have come over here.”

In private, however, he and his aides were alarmed. The emerging deal with Boehner looked timid by comparison.

“The Democratic leaders already thought we were idiot negotiators,” Daley said. “So I called Barry [Jackson] and said, ‘What are we going to do here? How are we going to sell Democrats to take $800 billion when Republican senators have signed on to” nearly $2 trillion?

Daley added,“I don’t think it was a mis-characterization on our part to say we’d be beat up miserably by Democrats who thought we got out-negotiated.”

In lauding the plan quickly, Obama hoped to harness the enthusiasm for it on behalf of his own talks. But his appearance that day caused more problems by increasing suspicions among conservatives about the group’s framework — and boosting their distrust of any bipartisan dealmaking.

Coburn, a staunch conservative and the only member of his party who openly acknowledged the need for higher taxes to balance the budget, had developed a close personal bond with Obama dating to their shared opposition to federal budget earmarks when both were senators. But Coburn was “shocked,” he said later, when he saw Obama’s remarks that day on television. His effusive praise for the Gang of Six, Coburn believed, was a tactical mistake that revealed Obama’s inexperience in the ways of Washington. It signaled to skittish conservatives that a tax hike was on the way.

Obama’s announcement, Coburn said in an interview, “absolutely killed anything we were doing with the Republicans.”

That afternoon, with concern mounting in the West Wing, Nabors called Boehner’s office with a message from the president: He still wants a deal.

Obama had empowered the aide who knew the Hill best to try to pull it out. Shortly before 7 that evening, he sent a new proposal that, Republicans said they were told, had not been vetted by other senior advisers at the White House. It was his own pitch, underscored by its title: “Deficit Reduction Package — Nabors Draft.”

His plan backed away from earlier positions on taxes in a number of ways, including
  • pushing the top rate below 35 percent. But there was a deal-breaker for the Republicans — 
  • a demand for additional tax increases to match proposed cuts to Medicare and Medicaid. 
  • To keep the health-care cuts, a critical component of the deal for the GOP, 
  • Republicans would have to swallow about $400 billion more in tax hikes — a 50 percent jump from the figure that had been under discussion.

Inside the White House, the offer reflected the new political reality shaped by the Gang of Six. In light of that farther-reaching proposal, White House officials worried that the deal under discussion with Boehner would meet resistance, particularly among Obama’s Democratic supporters. Higher taxes explicitly targeted toward the wealthy offered an element of fairness, in the White House view, and a way to sweeten any deal for the Democratic base.
Obama aides said the new offer also reflected their frustration at what they described as an unrelenting effort by the GOP to cut safety-net programs. “They say: ‘You moved the goal posts. You derailed this entire thing,’ ” said a senior administration official. “But it was simply a recognition of what they were demanding.”

The official said the Republicans wanted “game changers” on Medicare and Social Security; they said they needed an “Obama scalp.”

“We said, ‘Look, guys, in a world in which the Gang of Six just came out today, if you’re doing all those things, a fair and balanced approach involves more revenue,’ ” the official said. “At the time, nobody in the room, neither us nor them, thought that anybody was moving the goal posts.”

The Republicans describe it differently. The news from the White House, they say, was a “tough blow” to Boehner, who saw the push for additional taxes as tantamount to Obama violating a “gentleman’s agreement” on the broad outlines of a plan for which the speaker was already taking heat from some in his ranks.

By Wednesday morning, as the Obama and Boehner sides gathered again in the Oval Office, the optimism of Sunday had disintegrated. Vice President Biden, a skeptic of restarting talks with Boehner after the first round collapsed, was there. There appeared to be a very different president in attendance, as well.

Excited and upbeat three days earlier, Obama now was stern and lecturing. According to notes taken by GOP aides, he opened by complaining about Boehner’s demand for $200 billion in Medicaid cuts, a persistent point of contention. Then he began to talk about taxes, saying the Gang of Six “makes things more complicated.” The White House would need more tax revenue or smaller health-care cuts.

Boehner opened by expressing continued support for a big deal. But he told Obama that Republicans could not sign off on $1.2 trillion in new taxes. “I cannot go there,” he said. Nor could he sell $800 billion in tax increases without cuts to federal health programs, the biggest drivers of future borrowing.

Annoyed, Obama invoked Boehner’s personal friendship with Chambliss, a member of the Gang of Six, warning that Democrats would never support the package under discussion when “your friend Saxby” and other Republicans were willing to stomach as much as $2 trillion in new taxes. Negotiations deteriorated from there.

Boehner said Republicans could accept automatic repeal of the top-end Bush tax cuts as an enforcement trigger only if that were balanced by automatic repeal of a key piece of Obama’s signature health-care law, the individual mandate. Here in the president’s own office, Boehner used the most derisive terminology of conservative critics, calling it “Obamacare.”

Obama laughed. Then he joked that maybe the trigger should be his own removal from office. 

Biden deadpanned: Republicans might just go for that.

On Thursday morning, aides to Boehner and Cantor gathered again at the White House. During a two-hour meeting, the two sides hashed over minute details of a deal, never actually killing the president’s request for additional tax revenue.

Later that day, Obama called Boehner. The two spoke as if an agreement was still possible.
“We’re close,” Obama said. “Call me back.”

That night, Obama prepared his party’s congressional leaders. He warned Senate Majority Leader Harry M. Reid (D-Nev.) and House Minority Leader Nancy Pelosi (D-Calif.) that he might return to the position under discussion the previous Sunday — that is, cuts to Social Security, Medicare and Medicaid in exchange for just $800 billion in tax increases.

Would they support him?

The Democratic leaders “kind of gulped” when they heard the details, Daley recalled.

By this time, Obama had become the face of the bitter debt-ceiling talks and his poll numbers were dropping. His allies on Capitol Hill cringed at his predicament but also at what he was asking them to do.

Dan Pfeiffer, the White House communications director, recalled that the president and his team felt the weight of the global economy “on our shoulders.”

“Is there political benefit to coming to a big budget deal with John Boehner? Sure,” Pfeiffer said. “But every other political and message imperative was thrown out the door to prevent a disaster and do the right thing for the country. That’s why we were willing to do things we wouldn’t normally do.”

Reluctantly, Reid and Pelosi agreed to do their best to support the plan.

Boehner, meanwhile, had gone dark.

The House speaker did not return Obama’s call until 5:30 p.m. the next day, a Friday, when he told the president that he was again breaking off the talks. The two men staged dueling news conferences.

Obama said angrily that he had been “left at the altar” again.
Boehner said dealing with the White House was “like dealing with a bowl of Jell-o.”

“There was an agreement with the White House for $800 billion in revenue,” Boehner told reporters. “It was the president who walked away from this agreement.”

Two day later, July 24, one week after the Sunday morning meeting that sparked such optimism, the president found himself trying to turn back the clock.

Working late into the evening, Obama asked someone to get Boehner on the phone. His message: I’ll take your last offer.

“Mr. President,” Boehner answered, “we don’t have time to reopen these negotiations.”

White House officials said this week that the offer is still on the table.

The following night, Obama delivered a prime-time address from the East Room to update Americans on the status of the talks. He left no doubt about whom he intended to blame for the failure of the grand bargain.

The only reason a deal is not on its way to becoming law, he said, “is because a significant number of Republicans in Congress are insisting on a different approacha cuts-only approach — an approach that doesn’t ask the wealthiest Americans or biggest corporations to contribute anything at all.”

In the following days, congressional leaders and Obama worked out a bare-minimum agreement to lift the government’s borrowing limit just enough to get past the election.

The tough choices on deficit reduction were handed to a special House-Senate “super committee,” and if that group failed to secure legislation by the end of 2011, then the deal required $1.2 trillion in automatic, across-the-board cuts to agencies, including the Pentagon.

Although Obama had denounced “kick the can down the road” deals as a candidate in 2008, he was now adjusting to the realities of his office. The agreement was at least a tactical victory. 

He used it to wash his hands of Washington’s dysfunction, presenting himself as a
well-intentioned man unable to secure a fair deal, because of the capital’s enduring partisanship.

But White House advisers conceded that the collapse of the debt talks was a disaster from a policy perspective and, at least in the short term, from a political one. For the first time, Standard & Poor’s, the credit rating agency, downgraded U.S. debt. Polls showed that the public blamed Obama as well as congressional Republicans, with approval ratings for both reaching new lows.

In mid-August, Obama escaped for a week of golf and relaxation with his family on Martha’s Vineyard. He reviewed his strategy, concluding that it was time for a dramatic shift in approach. With the debt-ceiling debate over, he would focus more fully on jobs, the chief concern of most Americans, including his Democratic base.

At the White House, economic advisers who had devoted so much time to meeting with House Republicans now turned their attention to drafting the American Jobs Act, a package that would extend a temporary payroll tax holiday, provide fresh money for roads and bridges — and set up a new confrontation with Republicans.

“You say you’re the party of tax cuts? Well then, prove you’ll fight just as hard for tax cuts for middle-class families as you do for oil companies and the most affluent Americans,” Obama said to thunderous applause at a Labor Day speech in Detroit. “We’re going to see if congressional Republicans will put country before party.”

Suddenly, the same Democrats who had accused Obama of meekness in negotiating with the GOP were praising his aggressive new tone. What happened during those days in July when the grand bargain was almost reached, but not quite, had changed him. He no longer seemed divided.
His goal now was unequivocal: to win a second term.

Health care laws leave hospitals overwhelmed by 'permanent patients'

By Kate Snow, Janet Klein and Dustin Stephens
Rock Center

For Barbara Latasiewicz, home was a hospital room.  The Poland native, who had cleaned homes in the Chicago area for 20 years, suffered a stroke while on the job in September 2009.  An ambulance took her to Adventist La Grange Memorial Hospital in Illinois.

"I was thinking that after a few days, that I'm just gonna get better," Latasiewicz told NBC’s Kate Snow through a translator in an interview airing April 25 at 9pm/8 c on Rock Center with Brian Williams.

Latasiewicz suffered paralysis on one side of her body, but eventually became well enough to leave the hospital.  However, more than two years later, the 62-year-old was still in the hospital.

“She hasn’t needed to be in this acute facility for a long time,” said Richard Carroll, the hospital’s chief medical officer.

When asked about Latasiewicz’s more than two year stay at the hospital he oversees, Carroll said, “That’s really a function of how our health care system is working right now, which is it’s not working very well at all, particularly in cases like this.”

Carroll said that Latasiewicz belonged in a skilled nursing facility where she would receive a more appropriate rehabilitation, but she had no way to pay. Latasiewicz had no insurance and was an undocumented resident with no access to government safety-net programs like Medicaid.  Without payment, no facility would take her.

NBC News
Barbara Latasiewicz

The end result? Latasiewicz stayed at La Grange.  Her care cost the hospital $1.4 million.  A skilled nursing facility would have been a fraction of the cost.

An NBC News investigation discovered that cases like Latasiewicz’s are not unusual, but the result of current health care policies and guidelines.  They are known as “permanent patients” and are hidden in plain sight in hospital rooms across the country.  That’s because under federal law, hospitals must treat any patient who needs emergency medical attention even if they have no way to pay.  Nursing and rehab facilities are not required by law to do so.  At the same time, hospitals cannot discharge a patient without a plan in place for his or her ongoing care.  The result is patients stuck in the hospital in need of long-term care but with nowhere to go, large medical bills, and no way to pay – a cost that is usually covered at the hospital’s expense.

“It would be cheaper to take these patients and send them to the Ritz Carlton,” said Harvard University School of Public Health Professor Ashish Jha.  “They could get room service all day, and that would be cheaper.”

Jha estimates there are tens of thousands of these patients stuck in the hospital with no clear place to go.  Some stay an extra week, some months, and some like Latasiewicz even years.  NBC News spoke with officials at dozens of hospitals across the country who confirmed housing patients who didn’t need to be there for extended periods.

Many patients are stuck because they have no money or insurance to pay for long-term care.
Other patients may have insurance, but their medical needs are too complex for most skilled nursing facilities to accept.  Then there are those in limbo at the hospital waiting sometimes for months to qualify for Medicaid.  Once they’re approved, Medicaid will cover the nursing or rehab facility they need.

A spokesperson for the American Health Care Association which represents skilled nursing facilities says that the industry works with hospitals to find facilities for such hard-to-place patients.

According to data from the National Inpatient Sample database at the Agency for Healthcare Research and Quality, the problem of permanent patients appears to be on the rise.  From 2005 to 2009, the last years for which data was available, uninsured hospital patients with no access to Medicare or Medicaid in need of long term care increased 20 percent.

NBC News
Garrick Amato

“Most of them are Americans,” Jha said. “And if they get hit by a bus, they get sick, they’re in this situation.”

Garrick Amato, 59, arrived at Banner Heart Hospital in Mesa, Ariz., after suffering a heart attack.  A few days later, he was ready to leave the hospital for a rehab facility.  However, Amato, who said he worked part-time at a local discount store, had no health insurance and no way to pay for his rehab.

“I guess no nursing home will take me cause I don’t have insurance,” Amato said.
Furthermore, as a single adult without dependent children, he did not qualify for Medicaid in Arizona. Amato spent most of March and much of April at the hospital.  Banner Hospital eventually found charity care for him that placed him in a skilled nursing facility where he belonged.

Other patients linger in hospitals despite their best efforts to find charity care.  Fatima Khydarova, a professor from Uzbekistan, has been at Maimonides Medical Center in Brooklyn, N.Y., for more than two years.  Khydarova arrived there after suffering an incapacitating stroke while visiting her grandchildren in New York.  While Khydarova will never walk or talk again, doctors say she does not need to be in a hospital.

NBC News
Fatima Khydarova

“In a perfect world she should be either at home with her family caring for her or in a nursing home,” Maimonides CEO and President Pamela Brier said.

Khydarova’s grandchildren said that they cannot take care of their grandmother at their mother’s small apartment and at the same time make a living to support all of them.

“I’m working, I’m working.” said granddaughter Nigina Abdullaeva who works at a doctor’s office.

Dr. Jha of Harvard University says that the costs for treating permanent patients are passed on to other consumers through higher medical bills and insurance premiums.

“The bottom line is we’re all paying for it,” Jha said.

To mitigate the cost of these patients, some hospitals have paid out of their own funds to move them to skilled nursing facilities.  Once there, the hospital could pay for their care for the rest of their lives.

“Hospitals don't want to widely advertise that they will pay for your care elsewhere,” Jha said. “But in select situations, they look, and they realize, instead of spending tens of thousands of dollars to keep the patient in the hospital, it's probably cheaper for them to send them somewhere else.”

Back in Illinois, case workers at La Grange Hospital also struggled for years to find a more appropriate medical facility for Latasiewicz.  They eventually found one, but it was in her native Poland.

Wiping tears away from her eyes, Latasiewicz told Kate Snow through a translator that she did not want to leave.  Latasiewicz lived in the United States for 20 years and has a son and grandchildren living nearby.  However, her son, Peter Latasiewicz, said he could not take his mother into the small apartment he shares with his children and another family.

“I wouldn’t be able to provide as much help and support and care for her,” Peter Latasiewicz said, “she’s got a lot of medical conditions where she requires 24/7 care.”

The hospital eventually went to court for permission to send Barbara to the medical facility in Poland.

The hospital won and on March 1, Latasiewicz boarded a flight back to her native Poland.

In Brooklyn, Khydarova, the professor from Uzbekistan, remains at Maimonides and the hospital is still working hard to find a solution for her family

“She’s going to stay in the hospital unless we can find a spot for her,” CEO Brier said, “She could stay here potentially for the rest of her life.”