Researchers: NFL's Seau had brain disease

When he ended his life last year by shooting himself in the chest, Junior Seau had a degenerative brain disease often linked with repeated blows to the head.

Researchers from the National Institutes of Health said Thursday the former NFL star's abnormalities are consistent with chronic traumatic encephalopathy, or CTE.

The hard-hitting linebacker played for 20 NFL seasons with San Diego, Miami and New England before retiring in 2009. He died at age 43 of a self-inflicted gunshot in May, and his family requested the analysis of his brain.

"We saw changes in his behavior and things that didn't add up with him," his ex-wife, Gina, told The Associated Press. "But (CTE) was not something we considered or even were aware of. But pretty immediately (after the suicide) doctors were trying to get their hands on Junior's brain to examine it."

The NIH, based in Bethesda, Md., studied three unidentified brains, one of which was Seau's, and said the findings on Seau were similar to autopsies of people "with exposure to repetitive head injuries."

"It was important to us to get to the bottom of this, the truth," Gina Seau added, "and now that it has been conclusively determined from every expert that he had obviously had CTE, we just hope it is taken more seriously. You can't deny it exists, and it is hard to deny there is a link between head trauma and CTE. There's such strong evidence correlating head trauma and collisions and CTE."

In the final years of his life, Seau had wild behavioral swings, according to Gina and to 23-year-old son, Tyler, along with signs of irrationality, forgetfulness, insomnia and depression.

"He emotionally detached himself and would kind of 'go away' for a little bit," Tyler Seau said. "And then the depression and things like that. It started to progressively get worse."

He hid it well in public, they said, but not when he was with family or close friends.

Seau joins a list of several dozen football players who were found to have CTE. Boston University's center for study of the disease reported last month that 34 former pro players and nine who played only college football suffered from CTE.

The NFL faces lawsuits by thousands of former players who say the league withheld information on the harmful effects of concussions. According to an AP review of 175 lawsuits, 3,818 players have sued. At least 26 Hall of Famer members are among the players who have done so.

The National Football League, in an email to the AP, said: "We appreciate the Seau family's cooperation with the National Institutes of Health. The finding underscores the recognized need for additional research to accelerate a fuller understanding of CTE.

"The NFL, both directly and in partnership with the NIH, Centers for Disease Control and other leading organizations, is committed to supporting a wide range of independent medical and scientific research that will both address CTE and promote the long-term health and safety of athletes at all levels."

NFL teams have given a $30 million research grant to the NIH.

The players' union called the NIH report on Seau "tragic."

"The only way we can improve the safety of players, restore the confidence of our fans and secure the future of our game is to insist on the same quality of medical care, informed consent and ethical standards that we expect for ourselves and for our family members," the NFLPA said in a statement.

"This is why the players have asked for things like independent sideline concussion experts, the certification and credentialing of all professional football medical staff and a fairer workers compensation system in professional football," it said.

Seau is not the first former NFL player who killed himself and later was found to have had CTE. Dave Duerson and Ray Easterling are the others.

Before shooting himself, Duerson, a former Chicago Bears defensive back, left a note asking that his brain be studied for signs of trauma. His family filed a wrongful-death suit against the NFL, claiming the league didn't do enough to prevent or treat the concussions that severely damaged his brain.

Easterling played safety for the Falcons in the 1970s. After his career, he suffered from dementia, depression and insomnia, according to his wife, Mary Ann. He committed suicide last April.

Mary Ann Easterling is among the plaintiffs who have sued the NFL.

Tyler Seau played football through high school and for two years in college. He says he has no symptoms of brain trauma.

"I was not surprised after learning a little about CTE that he had it," Tyler said. "He did play so many years at that level. I was more just kind of angry I didn't do something more and have the awareness to help him more, and now it is too late."

Gina Seau's son Jake, now a high school junior, played football for two seasons but has switched to lacrosse and has been recruited to play at Duke.

"Lacrosse is really his sport and what he is passionate about," she said. "He is a good football player and probably could continue. But especially now watching what his dad went through, he says, 'Why would I risk lacrosse for football?'

"I didn't have to have a discussion with him after we saw what Junior went through."

Her 12-year-old son Hunter has shown no interest in playing football.

"That's fine with me," she said.

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Japan Approves $116 Billion in Emergency Economic Stimulus

TOKYO — The Japanese government approved emergency stimulus spending of more than $100 billion on Friday, part of an aggressive push by Prime Minister Shinzo Abe to kick-start growth in Japan’s long-moribund economy.

Mr. Abe also reiterated pressure on Japan’s central bank to make a firmer commitment to stopping deflation by pumping more money into the economy — a measure the prime minister says is crucial to getting businesses to invest and consumers to spend.

“We will put an end to this shrinking, and aim to build a stronger economy where earnings and incomes can grow,” Mr. Abe told a televised news conference. “For that, the government must first take the initiative to create demand, and boost the entire economy.”

Under the plan, the Japanese government will spend about 10.3 trillion yen (about $116 billion) on public works and disaster mitigation projects, subsidies for companies that invest in new technology and financial aid to small businesses.

The government will seek to raise real economic growth by 2 percentage points and add 600,000 jobs to the economy, Mr. Abe said. The measures announced Friday amount to one of the largest spending plans in Japan’s history, he stressed.

By simply talking about stimulus measures, Mr. Abe, who took office late last month, has already driven down the value of the yen, much to the relief of Japanese exporters whose competitiveness benefits from a weaker currency.

But the government’s promises to spend its way out of economic stagnation also raise concerns over Japan’s public debt, which has already mushroomed to twice the size of its economy and is the largest in the industrialized world.

At the root of Japan’s debt woes was a similar attempt in the 1990s by Mr. Abe’s own Liberal Democratic Party to stimulate economic growth through government spending on extensive public works projects across the country.

Mr. Abe said, however, that the spending this time around would be better focused to bring about growth through investment in innovation. He said the government would also invest in measures that would help mitigate the fall in Japan’s population, by encouraging families to have more children.

“To grow in a sustainable way, we must help create a virtuous cycle where companies actively borrow and invest, and in so doing raise employment and incomes,” Mr. Abe said.

“For that, it is extremely important that we adopt a growth strategy that gives everyone solid hope that the future of the Japanese economy lies in growth.”

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Americans Under 50 Fare Poorly on Health Measures, New Report Says

Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States.

Researchers have known for some time that the United States fares poorly in comparison with other rich countries, a trend established in the 1980s. But most studies have focused on older ages, when the majority of people die.

The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, France, Germany and Spain.

The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including American youths. It went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics.

The panel called the pattern of higher rates of disease and shorter lives “the U.S. health disadvantage,” and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.

“Something fundamental is going wrong,” said Dr. Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University, who led the panel. “This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”

Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50.

The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.

Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said. “The bottom line is that we are not preventing damaging health behaviors,” said Samuel Preston, a demographer and sociologist at the University of Pennsylvania, who was on the panel. “You can blame that on public health officials, or on the health care system. No one understands where responsibility lies.”

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

Americans also had the lowest probability over all of surviving to the age of 50. The report’s second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50.

“We expected to see some bad news and some good news,” Dr. Woolf said. “But the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us.”

There were bright spots. Death rates from cancers that can be detected with tests, like breast cancer, were lower in the United States. Adults had better control over their cholesterol and high blood pressure. And the very oldest Americans — above 75 — tended to outlive their counterparts.

The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.

Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college, Dr. Woolf said. In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.

Still, even the people most likely to be healthy, like college-educated Americans and those with high incomes, fare worse on many health indicators.

The report also explored less conventional explanations. Could cultural factors like individualism and dislike of government interference play a role? Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.    

The United States is a bigger, more heterogeneous society with greater levels of economic inequality, and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. But the panelists point out that this country spends more on health care than any other in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.

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Chinese Officials Pledge to Loosen Controls Over Embattled Newspaper

GUANGZHOU, China — Propaganda officials in the southern province of Guangdong have agreed to loosen some controls over an embattled newspaper whose struggle against censorship has galvanized free-speech advocates across China, according to journalists at the newspaper. But the paper’s weekly Thursday edition went to press late partly because of internal disputes over content, one senior editor said.

The agreement, reached late Tuesday, was part of a compromise in which reporters and editors who had said they would strike continued to work to put out the newspaper, Southern Weekend, also known as Southern Weekly. It is an iconic liberal publication that has regularly challenged Communist Party officials and policies but has come under tighter control in recent years, particularly since the summer.

The publication delay on Thursday was due in part to a disagreement between the newspaper’s leadership and employees over whether to publish an editorial defending the newspaper and letters of support from readers, the senior editor said. The leadership chose not to publish the editorial or the letters in an effort to calm the crisis, he said.

In Beijing, talk of another newsroom in crisis emerged on Wednesday as reporters at Beijing News, a newspaper co-founded by the parent company of Southern Weekend, said propaganda officials forced the newspaper, against the judgment of its publisher and top editors, to run an editorial attacking Southern Weekend. Some journalists broke down in tears in the newsroom, according to various accounts, and the publisher, Dai Zigeng, threatened to resign, but was still in his job Wednesday night.

The deal in Guangzhou, the provincial capital, appeared to bring a tentative peace to a newsroom in turmoil, though journalists said they would have to see whether provincial officials followed through on their promises.

The journalists appeared to back down from their demands that the top provincial propaganda official, Tuo Zhen, leave his post. Newspaper employees have accused Mr. Tuo of putting in place much stricter censorship rules since he began his job in May; in particular, they said, he had a hand in the rewriting of a New Year’s editorial that was supposed to have been a call for enforcement of constitutional rights but that ended up being more of a paean to the current system. It is unclear what role Mr. Tuo played in the changes, which ignited the call last weekend among some journalists to carry out a strike.

Journalists at Southern Weekend said that under rules imposed by Mr. Tuo, propaganda officials regularly reviewed the content of the paper before it went to print and vetted reporting topics proposed by journalists. Those rules are supposed to be abolished under the new agreement.

Zeng Li, a veteran journalist who reviews articles in-house at Southern Weekend to guard against riling the censors, said, “Now things are calming down.”

“To publish a good paper is the hope of both the leaders and the staff,” he added.

Hu Chunhua, the new party chief of Guangdong, China’s most liberal province, helped mediate the settlement, journalists said. The clash over censorship is the first big test for Mr. Hu, 49, who is considered one of the party’s rising stars and a candidate to be the leader of China in a decade.

The battle at Southern Weekend also poses a challenge for the central authorities. Xi Jinping, the new party chief, made a trip to Guangdong late last year to stress the need to open the economy further. Analysts have wondered whether he will also call for greater political freedoms. Mr. Xi has made remarks, though, that underscore the need for China to remain true to its socialist roots.

Central propaganda officials appear to have taken a tough line on the censorship issue by demanding this week that the biggest news Web sites and some important publications print an editorial criticizing Southern Weekend that was originally published by Global Times, a populist newspaper, and widely derided by Chinese journalists. Beijing News ran a truncated version.

One journalist described the scene in the Beijing News office in a blog post: “Some people look sad; some burst into tears; some shout that they are going to quit.”

The post continued: “We don’t want to kneel down, but our knees have been shattered. We are kneeling down this one time while gnashing our teeth.”

Edward Wong reported from Guangzhou, and Jonathan Ansfield from Beijing. Mia Li contributed research from Guangzhou, and Shi Da from Beijing.

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‘Liquipod’ takes smartphone waterproofing on the road

Amid a sea of Ultra-HD TVs, smart washing machines and various other gadgets, waterproofing expert Liquipel took to CES 2013 to make two announcements. The firm, which adds an interior and exterior waterproof nanocoating to cell phones, revealed a new and improved waterproofing material that is even more effective than its first-generation solution. Liquipel also unveiled its new “Liquipod,” a portable machine that can waterproof gadgets anywhere in the world while device owners wait, according to TechCrunch. Previously, Liquipel required customers to ship their handsets to the company’s offices for treatment.

[More from BGR: iPhone 5 now available with unlimited service, no contract on Walmart’s $ 45 Straight Talk plan]

This article was originally published on BGR.com

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Steroids fallout: No BB Hall for Bonds, Clemens

NEW YORK (AP) — No one was elected to the Hall of Fame this year. When voters closed the doors to Barry Bonds, Roger Clemens and Sammy Sosa, they also shut out everybody else.

For only the second time in four decades, baseball writers failed to give any player the 75 percent required for induction to Cooperstown, sending a powerful signal that stars of the Steroids Era will be held to a different standard.

All the awards and accomplishments collected over long careers by Bonds, Clemens and Sosa could not offset suspicions those feats were boosted by performance-enhancing drugs.

Voters also denied entry Wednesday to fellow newcomers Craig Biggio, Mike Piazza and Curt Schilling, along with holdovers Jack Morris, Jeff Bagwell and Lee Smith.

Among the most honored players of their generation, these standouts won't find their images among the 300 bronze plaques on the oak walls in Cooperstown, where — at least for now — the doors appear to be bolted shut on anyone tainted by PEDs.

"After what has been written and said over the last few years I'm not overly surprised," Clemens said in a statement he posted on Twitter.

Bonds, Clemens and Sosa retired after the 2007 season. They were eligible for the Hall for the first time and have up to 14 more years on the writers' ballot.

"Curt Schilling made a good point, everyone was guilty. Either you used PEDs, or you did nothing to stop their use," Hall of Famer Mike Schmidt said in an email to The Associated Press after this year's vote was announced. "This generation got rich. Seems there was a price to pay."

Biggio, 20th on the career list with 3,060 hits, appeared on 68.2 percent of the 569 ballots, the highest total but 39 votes shy. The three newcomers with the highest profiles failed to come close to even majority support, with Clemens at 37.6 percent, Bonds at 36.2 and Sosa at 12.5.

Other top vote-getters were Morris (67.7), Jeff Bagwell (59.6), Piazza (57.8), Tim Raines (52.2), Lee Smith (47.8) and Schilling (38.8).

"I'm kind of glad that nobody got in this year," Hall of Famer Al Kaline said. "I feel honored to be in the Hall of Fame. And I would've felt a little uneasy sitting up there on the stage, listening to some of these new guys talk about how great they were. ... I don't know how great some of these players up for election would've been without drugs. But to me, it's cheating."

At ceremonies in Cooperstown on July 28, the only inductees will be three men who died more than 70 years ago: Yankees owner Jacob Ruppert, umpire Hank O'Day and barehanded catcher Deacon White. They were chosen last month by the 16-member panel considering individuals from the era before integration in 1947.

"It is a dark day," said Jose Canseco, the former AL MVP who was among the first players to admit using steroids. "I think the players should organize some type of lawsuit against major league baseball or the writers. It's ridiculous. Most of these players really have no evidence against them. They've never tested positive or they've cleared themselves like Roger Clemens."

It was the eighth time the BBWAA failed to elect any players. There were four fewer votes than last year and five members submitted blank ballots.

"With 53 percent you can get to the White House, but you can't get to Cooperstown," BBWAA secretary-treasurer Jack O'Connell said. "It's the 75 percent that makes it difficult."

There have been calls for the voting to be taken away from the writers and be given to a more diverse electorate that would include players and broadcasters. The Hall says it is content with the process, which began in 1936.

"It takes time for history to sort itself out, and I'm not surprised we had a shutout today," Hall President Jeff Idelson said. "I wish we had an electee. I will say that, but I'm not surprised given how volatile this era has been in terms of assessing the qualities and the quantities of the statistics and the impact on the game these players have had."

Bonds, baseball's only seven-time Most Valuable Player, hit 762 home runs, including a record 73 in 2001. He was indicted on charges he lied to a grand jury in 2003 when he denied using PEDs but a jury two years ago failed to reach a verdict on three counts he made false statements and convicted him on one obstruction of justice count, finding he gave an evasive answer.

"It is unimaginable that the best player to ever play the game would not be a unanimous first-ballot selection," said Jeff Borris of the Beverly Hills Sports Council, Bonds' longtime agent.

Clemens, the only seven-time Cy Young Award winner, is third in career strikeouts (4,672) and ninth in wins (354). He was acquitted last year on one count of obstruction of Congress, three counts of making false statements to Congress and two counts of perjury, all stemming from his denials of drug use.

"To those who did take the time to look at the facts," Clemens said, "we very much appreciate it."

Sosa, eighth with 609 home runs, was among those who tested positive in MLB's 2003 anonymous survey, The New York Times reported in 2009. He told a congressional committee in 2005 that he never took illegal performance-enhancing drugs.

Since 1961, the only years the writers didn't elect a candidate had been when Yogi Berra topped the 1971 vote by appearing on 67 percent of the ballots cast and when Phil Niekro headed the 1996 ballot at 68 percent — both got in the following years. The other BBWAA elections without a winner were in 1945, 1946, 1950, 1958 and 1960.

Morris will make his final ballot appearance next year, when fellow pitchers Greg Maddux and Tom Glavine are eligible for the first time along with slugger Frank Thomas.

"Next year, I think you'll have a rather large class, and this year, for whatever reasons, you had a couple of guys come really close," Commissioner Bud Selig said at the owners' meetings in Paradise Valley, Ariz. "This is not to be voted to make sure that somebody gets in every year. It's to be voted on to make sure that they're deserving. I respect the writers as well as the Hall itself. This idea that this somehow diminishes the Hall or baseball is just ridiculous in my opinion."

Players' union head Michael Weiner called the vote "unfortunate, if not sad."

"To ignore the historic accomplishments of Barry Bonds and Roger Clemens, for example, is hard to justify. Moreover, to penalize players exonerated in legal proceedings — and others never even implicated — is simply unfair. The Hall of Fame is supposed to be for the best players to have ever played the game. Several such players were denied access to the Hall today. Hopefully this will be rectified by future voting."

The BBWAA election rules say "voting shall be based upon the player's record, playing ability, integrity, sportsmanship, character, and contributions to the team(s) on which the player played."

An Associated Press survey of 112 eligible voters conducted in late November after the ballot was announced indicated Bonds, Clemens and Sosa would fall well short of 50 percent. The big three drew even less support than that as the debate raged over who was Hall worthy.

Voters are writers who have been members of the BBWAA for 10 consecutive years at any point.

BBWAA president Susan Slusser of the San Francisco Chronicle said she didn't vote for Bonds, Clemens or Sosa.

"The evidence for steroid use is too strong," she said.

As for Biggio, "I'm surprised he didn't get in."

Mark McGwire, 10th on the career home run list with 583, received 16.9 percent on his seventh try, down from 19.5 last year. He got 23.7 percent in 2010 — a vote before he admitted using steroids and human growth hormone.

Rafael Palmeiro, among just four players with 500 homers and 3,000 hits along with Hank Aaron, Willie Mays and Eddie Murray, received 8.8 percent in his third try, down from 12.6 percent last year. Palmeiro received a 10-day suspension in 2005 for a positive test for performance-enhancing drugs, claiming it was due to a vitamin vial given to him by teammate Miguel Tejada.

MLB.com's Hal Bodley, the former baseball columnist for USA Today, said Biggio and others paid the price for other players using PEDs.

"They got caught in the undertow of the steroids thing," he said.

Bodley said this BBWAA vote was a "loud and clear" message on the steroids issue. He said he couldn't envision himself voting for stars linked to drugs.

"We've a forgiving society, I know that," he said. "But I have too great a passion for the sport."

NOTES: There were four write-in votes for career hits leader Pete Rose, who never appeared on the ballot because of his lifetime ban that followed an investigation of his gambling while manager of the Cincinnati Reds. ... Two-time NL MVP Dale Murphy received 18.6 percent in his 15th and final appearance. ... At the July 28 ceremonies, the Hall also will honor Lou Gehrig and Rogers Hornsby among a dozen players who never received formal inductions because of restrictions during World War II. ... Piazza has a book due out next month that could change the view of voters before the next election.

___

AP Sports Writers Dan Gelston, Mike Fitzpatrick, John Marshall and Ben Walker contributed to this report.

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Obama’s Pick for Treasury Is Said to Be His Chief of Staff

WASHINGTON — With his choice of Jacob J. Lew to be the secretary of Treasury, President Obama on Thursday will complete the transformation of his economic team from the big-name economists and financial firefighters hired four years ago to budget negotiators ready for the next fiscal fights in Congress.

If confirmed by the Senate, the 57-year-old Mr. Lew — Mr. Obama’s current chief of staff and former budget director — would become the president’s second Treasury secretary, succeeding Timothy F. Geithner, who was the last remaining principal from the original economic team that took office at the height of the global crisis in January 2009.

While the team is changing, so far it is made up entirely of men who have been part of the administration since its first months. Gene B. Sperling, like Mr. Lew a veteran of the Clinton administration, is expected to remain as director of the White House National Economic Council. Alan B. Krueger, a former Treasury economist, continues as chairman of the Council of Economic Advisers and Jeffrey D. Zients, a former business executive, as acting director of the Office of Management and Budget.

That composition gives Mr. Obama a high degree of comfort with his economic advisers, who have experience in the budget struggles that have occupied the administration since Republicans took control of the House two years ago. Those struggles will resume later this month. Yet the continuity also plays into criticism that the president is too insular and insufficiently open to outside voices and fresh eyes in the White House.

Adding to a scarcity of female advisers among Mr. Obama’s top aides, Hilda L. Solis, the secretary of labor for four years, announced on Wednesday that she would be resigning, following the most prominent female Cabinet member, Secretary of State Hillary Rodham Clinton, out of the administration.

Separately, administration officials let it be known on Wednesday that several Cabinet members will remain in their jobs: Kathleen Sebelius, the secretary of health and human services, who is expected to stay through the full adoption of the 2010 health care law in 2014; Eric H. Holder Jr., the attorney general; and Eric K. Shinseki, the secretary of veterans affairs.

If Mr. Lew is confirmed in time, his first test as Treasury secretary could come as soon as next month, when the administration and Congressional Republicans are expected to face off over increasing the nation’s debt ceiling, which is the legal limit on the amount that the government can borrow. Mr. Obama has said he will not negotiate over raising that limit, which was often lifted routinely in the past, but Republican leaders have said they will refuse to support an increase unless he agrees to an equal amount of spending cuts, particularly to entitlement programs like Medicare and Social Security.

Mr. Lew was passed over for Mr. Obama’s economic team four years ago, when Mr. Obama instead chose Lawrence H. Summers, a former Harvard University president and Treasury secretary, as director of the National Economic Council. Mrs. Clinton then hired Mr. Lew at the State Department, and in late 2010 — over the objections of Mrs. Clinton, who had come to rely on Mr. Lew — Mr. Obama made him budget director, the same post Mr. Lew had held late in the Clinton administration.

Mr. Lew in the 1980s was a Democratic adviser to the House speaker then, Thomas P. O’Neill, participating in fiscal talks with the Reagan administration. Mr. Lew is known for his low-key style and organizational skills.

While Mr. Lew has much less experience than Mr. Geithner in international economics and financial markets, he would come to the job with far more expertise in fiscal policy than Mr. Geithner did. That shift in skills reflects the changed times, when emphasis has shifted from a global financial crisis to the budget fights with Republicans in Congress.

The partisan tension suggests that Mr. Lew will be questioned closely by Senate Republicans in confirmation hearings.

But, Republicans have not signaled the kind of opposition they put up to some of Mr. Obama’s other potential nominations.

Mr. Lew’s departure as chief of staff would create a vacancy for what would be Mr. Obama’s fifth White House chief of staff, a turnover rate that is in contrast with the stability atop Treasury the last four years with Mr. Geithner. The leading candidates are said to be Denis McDonough, currently the deputy national security adviser in the White House, and Ronald A. Klain, a former chief of staff to two vice presidents, Joseph R. Biden Jr. and Al Gore.

Before joining the Obama administration, Mr. Lew spent a brief period in the financial sector, at Citigroup, first as managing director of Citi Global Wealth Management and then as chief operating officer of Citigroup Alternative Investments.

By contrast, Mr. Geithner had been president of the New York Federal Reserve Bank, which includes overseeing Wall Street. For the financial industry, Mr. Lew is a largely a blank slate.

“While he can undoubtedly learn the material on the job, we question whether he has sufficient relationships with the banking industry in the U.S. and abroad, which can be critical during a financial crisis,” Brian Gardner, head of Washington research for the investment banking firm Keefe, Bruyette & Woods, wrote to clients on Wednesday.

But Michael Schein, who worked with Mr. Lew at Citigroup and is now head of a nonprofit financial services organization, Accion, countered: “People in the business community like to deal with people in Washington who they can trust. I think Jack already does, and will do, very well with Wall Street and with business leaders because he is a very, very straight shooter.”

Mr. Lew has a reputation as a fiscal progressive who, like Mr. Obama, is eager to protect Medicaid and other antipoverty programs from deep cuts. But advocates for tighter financial regulation of Wall Street question whether he is too conservative.

The question is relevant because major regulations under the 2010 Dodd-Frank law remain to be put into effect in Mr. Obama’s second term.

“He appears to share a Wall Street mentality, particularly when it comes to financial reform,” said Dennis M. Kelleher, the president of Better Markets, a Washington-based nonprofit. “Financial reform is all about making the banking system safer and preventing more taxpayer bailouts.”  

Annie Lowrey contributed reporting.

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Economic Scene: Health Care and Pursuit of Profit Make a Poor Mix

Thirty years ago, Bonnie Svarstad and Chester Bond of the School of Pharmacy at the University of Wisconsin-Madison discovered an interesting pattern in the use of sedatives at nursing homes in the south of the state.

Patients entering church-affiliated nonprofit homes were prescribed drugs roughly as often as those entering profit-making “proprietary” institutions. But patients in proprietary homes received, on average, more than four times the dose of patients at nonprofits.

Writing about his colleagues’ research in his 1988 book “The Nonprofit Economy,” the economist Burton Weisbrod provided a straightforward explanation: “differences in the pursuit of profit.” Sedatives are cheap, Mr. Weisbrod noted. “Less expensive than, say, giving special attention to more active patients who need to be kept busy.”

This behavior was hardly surprising. Hospitals run for profit are also less likely than nonprofit and government-run institutions to offer services like home health care and psychiatric emergency care, which are not as profitable as open-heart surgery.

A shareholder might even applaud the creativity with which profit-seeking institutions go about seeking profit. But the consequences of this pursuit might not be so great for other stakeholders in the system — patients, for instance. One study found that patients’ mortality rates spiked when nonprofit hospitals switched to become profit-making, and their staff levels declined.

These profit-maximizing tactics point to a troubling conflict of interest that goes beyond the private delivery of health care. They raise a broader, more important question: How much should we rely on the private sector to satisfy broad social needs?

From health to pensions to education, the United States relies on private enterprise more than pretty much every other advanced, industrial nation to provide essential social services. The government pays Medicare Advantage plans to deliver health care to aging Americans. It provides a tax break to encourage employers to cover workers under 65.

Businesses devote almost 6 percent of the nation’s economic output to pay for health insurance for their employees. This amounts to nine times similar private spending on health benefits across the Organization for Economic Cooperation and Development, on average. Private plans cover more than a third of pension benefits. The average for 30 countries in the O.E.C.D. is just over one-fifth.

We let the private sector handle tasks other countries would never dream of moving outside the government’s purview. Consider bail bondsmen and their rugged sidekicks, the bounty hunters.

American TV audiences may reminisce fondly about Lee Majors in “The Fall Guy” chasing bad guys in a souped-up GMC truck — a cheap way to get felons to court. People in most other nations see them as an undue commercial intrusion into the criminal justice system that discriminates against the poor.

Our reliance on private enterprise to provide the most essential services stems, in part, from a more narrow understanding of our collective responsibility to provide social goods. Private American health care has stood out for decades among industrial nations, where public universal coverage has long been considered a right of citizenship. But our faith in private solutions also draws on an ingrained belief that big government serves too many disparate objectives and must cater to too many conflicting interests to deliver services fairly and effectively.

Our trust appears undeserved, however. Our track record suggests that handing over responsibility for social goals to private enterprise is providing us with social goods of lower quality, distributed more inequitably and at a higher cost than if government delivered or paid for them directly.

The government’s most expensive housing support program — it will cost about $140 billion this year — is a tax break for individuals to buy homes on the private market.

According to the Tax Policy Center, this break will benefit only 20 percent of mostly well-to-do taxpayers, and most economists agree that it does nothing to further its purported goal of increasing homeownership. Tax breaks for private pensions also mostly benefit the wealthy. And 401(k) plans are riskier and costlier to administer than Social Security.

From the high administrative costs incurred by health insurers to screen out sick patients to the array of expensive treatments prescribed by doctors who earn more money for every treatment they provide, our private health care industry provides perhaps the clearest illustration of how the profit motive can send incentives astray.

By many objective measures, the mostly private American system delivers worse value for money than every other in the developed world. We spend nearly 18 percent of the nation’s economic output on health care and still manage to leave tens of millions of Americans without adequate access to care.

Britain gets universal coverage for 10 percent of gross domestic product. Germany and France for 12 percent. What’s more, our free market for health services produces no better health than the public health care systems in other advanced nations. On some measures — infant mortality, for instance — it does much worse.

In a way, private delivery of health care misleads Americans about the financial burdens they must bear to lead an adequate existence. If they were to consider the additional private spending on health care as a form of tax — an indispensable cost to live a healthy life — the nation’s tax bill would rise to about 31 percent from 25 percent of the nation’s G.D.P. — much closer to the 34 percent average across the O.E.C.D.

A quarter of a century ago, a belief swept across America that we could reduce the ballooning costs of the government’s health care entitlements just by handing over their management to the private sector. Private companies would have a strong incentive to identify and wipe out wasteful treatment. They could encourage healthy lifestyles among beneficiaries, lowering use of costly care. Competition for government contracts would keep the overall price down.

We now know this didn’t work as advertised. Competition wasn’t as robust as hoped. Health maintenance organizations didn’t keep costs in check, and they spent heavily on administration and screening to enroll only the healthiest, most profitable beneficiaries.

One study of Medicare spending found that the program saved no money by relying on H.M.O.’s. Another found that moving Medicaid recipients into H.M.O.’s increased the average cost per beneficiary by 12 percent with no improvement in the quality of care for the poor. Two years ago, President Obama’s health care law cut almost $150 billion from Medicare simply by reducing payments to private plans that provide similar care to plain vanilla Medicare at a higher cost.

Today, again, entitlements are at the center of the national debate. Our elected officials are consumed by slashing a budget deficit that is expected to balloon over coming decades. With both Democrats and Republicans unwilling to raise taxes on the middle class, the discussion is quickly boiling down to how deeply entitlements must be cut.

We may want to broaden the debate. The relevant question is how best we can serve our social needs at the lowest possible cost. One answer is that we have a lot of room to do better. Improving the delivery of social services like health care and pensions may be possible without increasing the burden on American families, simply by removing the profit motive from the equation.

E-mail: eporter@nytimes.com;

Twitter: @portereduardo

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News Analysis: Obama Nominees in Step on Light Footprint

Carolyn Kaster/Associated Press

President Obama named John O. Brennan, right, as his choice for C.I.A. director and chose Chuck Hagel, left, to be his next defense secretary.

WASHINGTON — With the selection of a new national security team deeply suspicious of the wisdom of American military interventions around the world, President Obama appears to have ended, at least for the moment, many of the internal administration debates that played out in the Situation Room over the past four years.

He has sided, without quite saying so, with Vice President Joseph R. Biden Jr.’s view — argued, for the most part, in the confines of the White House — that caution, covert action and a modest American military footprint around the world fit the geopolitical moment. The question is whether that approach will fit the coming challenges of stopping Iran’s nuclear program and the potential collapse of Syria.

Gone for the second term are the powerful personalities, and more hawkish voices, that pressed Mr. Obama to pursue the surge in Afghanistan in 2009, a gamble championed by Secretary of State Hillary Rodham Clinton and Robert M. Gates, the former secretary of defense. Gone from the C.I.A. is the man who urged Mr. Obama to keep troops there longer, David H. Petraeus.

The new team will include two Vietnam veterans, Senator John Kerry and Chuck Hagel, who bear the scars of a war that ended when the president was a teenager, and a counterterrorism chief, John O. Brennan, who helped devise the “light footprint” strategy of limiting American interventions, whenever possible, to drones, cyberattacks and Special Operations forces. All are advocates of those low-cost, low-American-casualty tools, and all have sounded dismissive of attempts to send thousands of troops to rewire foreign nations as wasteful and ill-conceived.

Most important to Mr. Obama and his national security adviser, Tom Donilon, all three are likely to accommodate themselves, in ways their predecessors often did not, to a White House that has insisted on running national security policy from the West Wing.

“One of the characteristics of this administration has been that decision-making has been centered in the White House,” said Dennis B. Ross, a Mideast expert who left the Obama administration a year ago but never wandered far from some of its key debates. “And most second-term administrations don’t change their sociology.”

But if they grab hold of the national security levers after what many predict will be, for Mr. Hagel and Mr. Brennan, bruising confirmation hearings, they will confront problems that may test whether the light footprint carries enough weight.

“Issues 1 and 2 will be cutting the defense budget and confronting Iran,” said Michael Mandelbaum, a political scientist whose 2010 book, “The Frugal Superpower,” dealt with the challenge of trying to manage the world on the cheap. “And then you will have issues like Syria, which test the question of whether you can manage to control a dangerous situation with no boots on the ground — and unless something dramatic changes, there will be no boots.”

Mr. Hagel, who was both a senator and a cellphone entrepreneur, has long been a critic of Pentagon bloat. But others with business experience, like Donald Rumsfeld, have believed they could bring market discipline to one of the country’s most sprawling enterprises, only to discover that killing off unneeded weapons systems has almost nothing to do with business decisions and everything to do with the politics of Congressional districts and campaign funds.

Mr. Obama’s bet was that by appointing a Republican, he will better his chances of overcoming those obstacles. What he discovered even before announcing Mr. Hagel’s appointment is that the former senator burned many bridges with his Republican colleagues, in part with his outspoken opposition to the Iraq war, despite voting in 2002 to authorize military action, and to the 2008 surge when President George W. Bush was still in office.

“If the president thinks Chuck Hagel can get him the Republican votes to downsize the Pentagon,” said one former senior aide to Mr. Bush, who declined to speak on the record, “I think he is in for a very rude surprise.”

Then there is Iran, which will be a test for all three men, for different reasons. Mr. Hagel has been particularly vocal about the dangers of a military confrontation with Tehran. While both Mr. Gates and his successor, Leon E. Panetta, expressed similar concerns at various points in the first term, Mr. Hagel’s view is considerably to the left of Mr. Obama’s. The president has, gradually, endorsed “coercive diplomacy,” telling the American Israel Public Affairs Committee in March, “As I’ve made clear time and again during the course of my presidency, I will not hesitate to use force when it is necessary to defend the United States and its interests.”

But Mr. Hagel has opposed unilateral sanctions and suggested that threatening Iran just closes down opportunities for dialogue.

“The key to coercive diplomacy is that the side you are trying to influence is convinced you are willing to follow through on the threat,” said Mr. Ross, who drafted some of those threats. “The president has been clear, but from others there have been mixed messages.”

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AP Exclusive: Richardson pressing NKorean test ban

PYONGYANG, North Korea (AP) — Former New Mexico Gov. Bill Richardson said Wednesday that his delegation is pressing North Korea to put a moratorium on missile launches and nuclear tests and to allow more cell phones and an open Internet for its citizens.

Richardson told The Associated Press in an exclusive interview in Pyongyang that the group is also asking for fair and humane treatment for an American citizen detained in North Korea.

“The citizens of the DPRK (North Korea) will be better off with more cell phones and an active Internet. Those are the three messages we’ve given to a variety of foreign policy officials, scientists” and government officials, Richardson said.

He is accompanied by Google Executive Chairman Eric Schmidt and Google Ideas think tank Director Jared Cohen on what Richardson has called a private, humanitarian trip. Schmidt, who is the highest-profile U.S. business executive to visit North Korea since leader Kim Jong Un took power a year ago, has not spoken publicly about the reasons behind the journey to North Korea.

The high-profile visit comes just weeks after North Korea launched a long-range rocket to send a satellite into space. Washington has condemned the launch as a banned test of missile technology.

Schmidt, who oversaw Google‘s expansion into a global Internet giant, speaks frequently about the importance of providing people around the world with Internet access and technology. Google now has offices in more than 40 countries, including all three of North Korea’s neighbors: Russia, South Korea and China, another country criticized for systematic Internet censorship.

He and Cohen have collaborated on a book about the Internet’s role in shaping society called “The New Digital Age” that comes out in April.

Using science and technology to build North Korea’s beleaguered economy was the highlight of a New Year’s Day speech by leader Kim Jong Un.

New red banners promoting slogans drawn from Kim’s speech line Pyongyang’s snowy streets, and North Koreans are still cramming to study the lengthy speech. It was the first time in 19 years for North Koreans to hear their leader give a New Year’s Day speech. During the rule of late leader Kim Jong Il, state policy was distributed through North Korea’s three main newspapers.

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Follow AP’s bureau chief for Pyongyang and Seoul at www.twitter.com/newsjean.

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