Saturday, February 19, 2011

Libyan & Bahrain move freedom not so easy

Bahrain Protesters Return to Pearl Square

Thousands of protesters flooded back into Bahrain's Pearl Square as the military withdrew Saturday. The withdrawal of the military from the streets was one of the protesters' preconditions for negotiations, but it isn't clear whether it alone will be enough to begin talks.

Ibrahim Sharif, head of an umbrella group of protest factions, said he wants guarantees that protesters won't be attacked. The behavior of the riot police as the military withdrew isn't convincing in that regard: They fired tear gas and beat and detained protesters as they entered the square. Violence has been escalating in Bahrain, with the death toll climbing to six on Friday when soldiers opened fire on protesters during a funeral march for someone killed earlier in the week.

The increasing violence drew a harsher rebuke from President Obama, who said Friday that he "condemns the use of violence by governments against peaceful protesters," and spoke with the king of Bahrain. But it's unclear who exactly in Bahrain is responsible for the violent crackdown. While the king and his son are viewed as modernizers, the king's uncle, the prime minister is in charge of security.

Eighty Four Killed in Libyan Protests

The situation in Libya is becoming increasingly violent. Early Saturday morning, special forces launched a surprise attack against protesters camped out in front of the courthouse in Benghazi.

"They fired tear gas on protesters in tents and cleared the areas after many fled carrying the dead and the injured," one protester said. Human Rights Watch estimates that 84 people have been killed so far.

On Friday, President Muammar Qaddafi tried to appease protesters be announcing that the congress had been suspended indefinitely and many members would be replaced when it resumed. Qaddafi seems to be following Hosni Mubarak's playbook in other ways as well, as the U.S.-based Arbor Networks security company says the country's Internet has been shut down.

Study of Breast Biopsies Finds Surgery Used Too Extensively

Too many women with abnormal mammograms or other breast problems are undergoing surgical biopsies when they should be having needle biopsies, which are safer, less invasive and cheaper, new research shows.

A study in Florida found that 30 percent of the breast biopsies there from 2003 to 2008 were surgical. The rate should be 10 percent or less, according to medical guidelines.

The figures in the rest of the country are likely to be similar to Florida’s, researchers say, which would translate to more than 300,000 women a year having unnecessary surgery, at a cost of hundreds of millions of dollars. Many of these women do not even have cancer: about 80 percent of breast biopsies are benign. For women who do have cancer, a surgical biopsy means two operations instead of one, and may make the cancer surgery more difficult than it would have been if a needle biopsy had been done.

Dr. Stephen R. Grobmyer, the senior author of the Florida study, said he and his colleagues started their research because they kept seeing patients referred from other hospitals who had undergone surgical biopsies (also called open biopsies) when a needle should have been used.

“After a while you keep seeing this, you say something’s going on here,” said Dr. Grobmyer, who is director of the breast cancer program at the University of Florida in Gainesville.

The reason for the overuse of open biopsies is not known. Researchers say the problem may occur because not all doctors keep up with medical advances and guidelines. But they also say that some surgeons keep doing open biopsies because needle biopsies are usually performed by radiologists. The surgeon would have to refer the patient to a radiologist, and lose the biopsy fee.

A surgical biopsy requires an inchlong incision, stitches and sometimes sedation or general anesthesia. It leaves a scar. A needle biopsy requires only numbing with a local anesthetic, uses a tiny incision and no stitches and carries less risk of infection and scarring.

If the abnormality in the breast is too small to be felt and has been detected by a mammogram or other imaging method, the needle biopsy must also be guided by imaging — mammography, ultrasound or M.R.I. — and will often have to be performed by a radiologist. If a lump can be felt, imaging is not needed to guide the needle, and a surgeon can perform it.

“Surgeons really have to let go of the patient when they have an image abnormality,” said Dr. I. Michael Leitman, the chief of general surgery at Beth Israel Medical Center in Manhattan. “They are giving away a potential surgery. But the standards require it. And I’m a surgeon.”

Dr. Grobmyer’s study, published by The American Journal of Surgery, is based on 172,342 biopsies entered into a state database in Florida. It is the largest study of open biopsy rates in the United States, and the first to include patients with and without cancer.

About 1.6 million breast biopsies a year are performed in the United States. But in 2010, only about 261,000 found cancer (207,000 women had invasive breast cancer, and another 54,000 had a condition called ductal carcinoma in situ, in which cancer cells have not invaded the surrounding tissue).

Hospitals charge $5,000 to $6,000 for a needle biopsy, and double that for an open biopsy, according to Dr. Grobmyer’s article. Doctors’ fees for an open biopsy range from $1,500 to $2,500, he said, and $750 to $1,500 for a needle biopsy.

A surgeon who was not part of Dr. Grobmyer’s study said she often encountered patients referred from other hospitals whose open biopsies should have been done with a needle.

“I see it all the time,” said the surgeon, Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan. “People are causing harm and should be held accountable.”

Dr. Melvin J. Silverstein, a breast cancer surgeon at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., and a clinical professor of surgery at the University of Southern California, said it was “outrageous” that 30 percent of breast biopsies were done by surgery.

He said some of the unnecessary procedures were being performed by surgeons who did not want to lose biopsy fees by sending patients to a radiologist.

“I hate to even say that,” Dr. Silverstein said. “But I don’t know how else to explain these numbers.”

A study at Beth Israel Medical Center in Manhattan (Dr. Leitman was an author), published in 2009, found that the rate of open breast biopsies in 2007 varied with the type of surgeon.

Breast surgeons employed by the hospital and involved in teaching had a 10 percent rate. Breast surgeons in private practice who operated at Beth Israel had a 35 percent rate. Among general surgeons, who do not specialize in breast surgery (some who were on staff at the hospital and some who were not), the rate was 37 percent. All the doctors earn biopsy fees, so they all had the same incentive.

The lead author of the study, Dr. Susan K. Boolbol, chief of breast surgery at Beth Israel, said the difference could be explained, in part, by training. She said the academic breast surgeons on the hospital staff were more likely than the others to keep up with new developments in the field and to work closely with radiologists. As for the idea that the motivation was money, she said, “A huge part of me doesn’t want to believe it’s true.”

She said that when she asked surgeons in the study why they were doing open biopsies, many said patients wanted them. “My comeback was, ‘Do you think you had an inherent bias in the way you explained it?’ ” In the past seven years, she said she had only one patient choose an open biopsy over a needle biopsy.

Dr. Boolbol says some patients fear that sticking a needle into a cancer will cause it to spread, and she spends a lot of time explaining that it is not true. She said that open biopsy rates declined among surgeons at Beth Israel who were told about her study’s findings, but newcomers still tended to have higher rates.

“This is a constant education process for surgeons,” she said.

One way for hospitals to stop excess open biopsies is to ban them, Dr. Silverstein said, unless they are truly necessary, as in uncommon cases in which a needle cannot reach the spot.

“We made a rule,” he said. “If it can be done with a needle, it has to be. We embarrass you if you do an open biopsy. We bring you before a tumor board to explain.”

Dr. Silverstein says that when he lectures and asks how many surgeons in the audience perform open biopsies, no hands go up. “Nobody will admit it,” he said.

He said there is more to be gained by taking his message straight to the patients. He and other doctors say that any woman who is told that she needs a surgical biopsy should ask why, and consider a second opinion.

“Maybe we have to get patients to say, ‘This guy took a big chunk out of me and I didn’t even have cancer, and now I’m deformed,’ ” Dr. Silverstein said. “Who just overthrew Mubarak? The people. This is exactly the same thing.”


House passes $60B in spending cuts

More a battering ram than a budget, a giant government-wide spending bill passed the House early Saturday morning, packing $60 billion in Republican spending cuts together with scores of legislative riders to impede President Barack Obama in carrying out his policies.

Final passage came on a 235-189 vote shortly before dawn, capping an all-night session and marathon week during which literally hundreds of amendments were debated.

The open process — and largely civil tone — represent a victory for Speaker John Boehner (R-Ohio). But by moving so far right to appease his large freshman class, Boehner picked up no Democratic votes and sacrificed what many saw as his best shot of scoring a quick win in the Senate at the expense of Obama.

Instead, Senate Democrats will be more united now and Majority Leader Harry Reid (D-Nev.) stronger after Saturday’s margins. And the real question becomes: can Reid, Boehner and Obama pick their way through the coming weeks without falling into a government shutdown?

Since Oct. 1, agencies have been funded under a series of continuing resolutions or CR’s, the latest of which is due to expire Mar. 4. Washington is already electric with speculation of a shutdown and today’s circumstances are more dangerous than the crisis in 1995 when Republicans had also just taken over the House.

Unlike 1995, the nation is at war, with U.S. troops in the field in Afghanistan and Iraq. This profoundly raises the symbolism of any shutdown even as the political distance between Obama and the new Republican-tea party majority is far greater than what existed between then President Bill Clinton and the so-called Republican Revolution in 1995.

So much of 1995 was dominated by the outsized personality of then-Speaker Newt Gingrich who fancied himself a modern Cromwell leading Parliament against the king. By comparison the bill now reflects a more genuine upheaval, springing from the Republican ranks and demanding far more dramatic spending cuts than anything attempted so early in 1995.

The $60 billion in reductions are concentrated in the last six months of this fiscal year and represent a 14 percent cut that will severely impact Obama’s agenda at home and abroad. Foreign aid and State Department operations would be cut as much as $10 billion from Obama’s latest request. Pell Grants for low income college students are reduced, and School Turnaround Grants cut by almost two-thirds.

The Environmental Protection Agency lost $2.7 billion from its current appropriations. The Commodity Futures Trading Commission, charged with major new responsibilities under Wall Street reforms, would get a third of the funding Obama wants. And the new Republican majority would block not just federal regulators but Obama’s signature achievement thus far: healthcare reform.

Indeed, the final day of House floor debate Friday showed that a large faction in the Republican conference still wants $22 billion more in reductions than the bill provides.

“The American people are ahead of us. They are asking us to go one step forward…to be bold,” said Rep. Joe Walsh (R-Ill.), one of 147 Republicans, including House Budget Committee Chairman Paul Ryan (R-Wis.), who supported the cuts. And the amendment only failed because of concerted opposition by top GOP leaders and the House Appropriations Committee.

Among the three Republicans who voted against the bill — Reps. Walter Jones of North Carolina, Jeff Flake of Arizona, and John Campbell of California — Flake and Campbell were both part of this group seeking more cuts.

For its part, the Appropriations leadership is not wedded entirely to the final package either.

“I don’t think the chairman of the full committee likes the CR very much. If he did he wouldn’t have been required to write it three times,” joked Rep. Steven LaTourette (R-Ohio) in the closing debate. And many on the committee believe that its initial bill, making $32 billion in cuts, was a far more realistic target given the makeup of the Senate.

As lawmakers go home for their Presidents Day recess, the next seven days could prove pivotal in shaping public opinion — and how GOP moderates respond — in relation to the expansive House bill.

What began as a straight-forward budget-cutting exercise is now a ledger bulging with provisions that touch on everything from Western lands management to Florida water quality rules, Internet regulations, a new consumer product safety data bank, and emissions standards for the cement industry.

West Virginia coal interests and East Coast fishermen won relief in the post-midnight amendments Saturday, even as the powerful ethanol lobby suffered twin setbacks. And in their eagerness to cut off legal fees for environmental lawyers, Western Republicans may have inadvertently cut off veterans and the elderly as well — a potential minefield for their colleagues.

As the marathon session stretched into early Saturday morning, a half-dozen members were asleep in the Speaker's Lobby off the House floor. Other lawmakers walked around bleary eyed, asking each other "Are we done yet." When Majority Leader Eric Cantor (R-Va.) announced at 2:15 a.m. that the voting would end in another hour, members on both sides of the aisle cheered loudly.

In fact, it was closer to two more hours.

Boehner has been content to let this process evolve, but there will come a point soon when the speaker will have to weigh in more heavily. His critics see him as a weak leader, running to stay ahead of his troops. But others find a cleverness in his approach: steering this movement to Obama’s doorstep and from it capturing a certain energy himself, almost like those William Holden roles where a jaded character finds new purpose and comes alive in the end.

When Congress returns Feb. 28, the first challenge will be for Boehner to steer through the House a short-term extension of current spending to avert any shutdown Mar. 4.

In the war of nerves now, Minority Leader Nancy Pelosi (D-Cal.) late Friday offered her own clean extension to Mar. 31 to put pressure on the speaker. But he has already signaled that he will want to use the same exercise to begin to ratchet down spending — to put pressure on the Senate to act and appease his own right.

This is a third big difference from 1995: Republicans don’t control the Senate. And the tea party movement — so steeped in the Constitution — must come to terms with that side of the bargain: no one election can decide the direction of American government.

“The last election is not determinative, the Founding Fathers wanted it that way,” Rep. Barney Frank (D-Mass.) told POLITICO. “This is part of the Constitution. It takes three election cycles to impact all of American government.”

Behind all the politics, what’s most clear is how far all sides—including Obama himself—have moved away from the president’s initial 2011 budget announced a year ago this month.

That blueprint assumed about $1.128 trillion for discretionary appropriations—minus overseas contingency funds for Iraq and Afghanistan. The Senate Appropriations Committee first cut this substantially as part of a bipartisan 2011 omnibus spending bill, which never got to a floor vote after the elections. Last week Appropriations Chairman Daniel Inouye (D-Hawaii) went a step further, telling his clerks to begin marking an alternative to the House CR that would total about $1.087 trillion, a hard freeze at 2010 funding levels.

That’s about $60 billion higher than the House’s initial target, $1.028 trillion, even after adjustments for added spending cuts made on the floor. But it also means that Democrats have already conceded about $41 billion in reductions from what Obama first asked for—or almost half way to the Republican campaign goal of cutting $100 billion from the president’s 2011 budget.

So much is optics, and Reid wasted no time Saturday making this point in a statement from his office.

“By bringing $41 billion in cuts to the table, nearly half of the House Republican proposal, Democrats are demonstrating a good faith effort to reduce the deficit and prevent a government shut down,” Reid said. “ It's time for Republicans to do the same.”
© 2011 Capitol News

So where are the right wing wacko that BO hates Israel? - Obama Vetoes U.N. on Israel

Under pressure from Israel and Congress, the Obama administration issued its first veto on the U.N. Security Council in order to prevent the committee to issue a resolution condemning Israeli settlements in Palestinian territories.

All other 14 members of the council backed the measure, as well as the Palestinian Liberation Organization. It's a tricky time for the U.S. to protect Israel, as the move stands to pit Arab sentiment against the U.S. at a time when mass protests are rocking the region.

Susan Rice, Obama's ambassador to the U.N., says the veto was issued because it would have complicated peace talks between Palestine and Israel, "hardening" each side's position.

Read it at BBC

U.S.-Taliban Talks by Steve Coll

August 22, 1998, Mullah Omar, the emir of Taliban-ruled Afghanistan, made a cold call to the State Department. The United States had just lobbed cruise missiles at Al Qaeda camps in his nation. Omar got a mid-level diplomat on the line and spoke calmly.
He suggested that Congress force President Bill Clinton to resign. He said that American military strikes “would be counter-productive,” and would “spark more, not less, terrorist attacks,” according to a declassified record of the call. “Omar emphasized that this was his best advice,” the record adds.

That was the first and last time that Omar spoke to an American government official, as far as is known. Before September 11th, some of his deputies had occasionally spoken with U.S. diplomats, but afterward the United States rejected direct talks with Taliban leaders, on the ground that they were as much to blame for terrorism as Al Qaeda was.
Last year, however, as the U.S.-led Afghan ground war passed its ninth anniversary, and Mullah Omar remained in hiding, presumably in Pakistan, a small number of officials in the Obama Administration—among them the late Richard Holbrooke, the special representative for Afghanistan and Pakistan—argued that it was time to try talking to the Taliban again.

Holbrooke’s final diplomatic achievement, it turns out, was to see this advice accepted. The Obama Administration has entered into direct, secret talks with senior Afghan Taliban leaders, several people briefed about the talks told me last week.
The discussions are continuing; they are of an exploratory nature and do not yet amount to a peace negotiation. That may take some time: the first secret talks between the United States and representatives of North Vietnam took place in 1968; the Paris Peace Accords, intended to end direct U.S. military involvement in the war, were not agreed on until 1973.

When asked for comment on the talks, a White House spokesman said that the remarks that Secretary of State Hillary Clinton made last Friday at the Asia Society offered a “thorough representation of the U.S. position.” Clinton had tough words for the Taliban, saying that they were confronted with a choice between political compromise and ostracism as “an enemy of the international community.” She added, “I know that reconciling with an adversary that can be as brutal as the Taliban sounds distasteful, even unimaginable.
And diplomacy would be easy if we only had to talk to our friends. But that is not how one makes peace. President Reagan understood that when he sat down with the Soviets. And Richard Holbrooke made this his life’s work. He negotiated face to face with Milosevic and ended a war.”

Mullah Omar is not a participant in the preliminary talks. He does not attend even secret meetings of underground Taliban leadership councils in Pakistani safe houses. When he does speak, he does so obliquely, via cassette tapes. One purpose of the talks initiated by the Obama Administration, therefore, is to assess which figures in the Taliban’s leadership, if any, might be willing to engage in formal Afghan peace negotiations, and under what conditions.

Obama’s war advisers previously made it clear that the Afghan President, Hamid Karzai, must lead any high-level peace or “reconciliation” process involving Taliban leaders, and, since 2008, Karzai has carried out sporadic talks with current and former Taliban, occasionally aided by Saudi Arabia, but to no end. Last summer, the Afghan government’s attempts produced a farcical con, when a man posed as a senior Taliban leader and fleeced his handlers for cash. The recent American talks are intended to prime more successful and durable negotiations led by Karzai. The United States would play a supporting role in these negotiations, and might join them to discuss the status of Taliban prisoners in U.S. custody or the future of international forces in Afghanistan.
For the United States, the overarching goal of such negotiations would be to persuade at least some important Taliban leaders to break with Al Qaeda, leave the battlefield, and participate in Afghan electoral politics, without touching off violence by anti-Taliban groups or gutting the rights enjoyed by minorities and women.

Although the Taliban’s record is nothing like Al Qaeda’s, they have aided international terrorism; in 2000, for example, they facilitated the escape of the murderous hijackers of an Indian Airlines passenger plane. As Hillary Clinton indicated, the morality of talking to them at all, given their history of violence and repression, is debated within the Administration, as it is within the Afghan government. But in both countries there is also hope for an honorable path to end the war.

The pursuit of peace, however, can be just as risky as the prosecution of war. If mismanaged, full-blown Afghan peace talks might ignite a civil war along ethnic lines. (The Taliban draw their support from Afghanistan’s Pashtuns; the most vehement anti-Taliban militias are non-Pashtun.) Also, the Taliban and their historical benefactors in Pakistan, the Inter-Services Intelligence Directorate, the spy agency directed by the Pakistani military, have an almost unblemished record of overreaching in Afghan affairs, by funding and arming client militias, and there is no reason to think that their habits would change if serious negotiations unfolded.
And, even under the best of circumstances, an Afghan peace process would most likely mirror the present character of the war: a slow, complicated, and deathly grind, atomized and menaced by interference from neighboring governments—not just Pakistan’s but also those of Iran, India, Russia, Uzbekistan, and China.

The Taliban today are diverse and fractured. Some old-school leaders, who served in Mullah Omar’s cabinet or as governors during the nineteen-nineties, belong to a council known as the Quetta Shura, named for the Pakistani city in which many Taliban have enjoyed sanctuary since 2001. This is the group whose members are thought to be most ready to consider coming in from the cold. Other factions, such as the Haqqani network, based in North Waziristan, which has long-standing ties to the I.S.I., are regarded as more malicious and more susceptible to Pakistan’s control. Inside Afghanistan, young Taliban commanders fight locally and often viciously, oblivious of international diplomacy. Yalta this is not.

Nonetheless, the Obama Administration has understandably concluded that the status quo is untenable. The war has devolved into a strategic stalemate: urban Afghan populations enjoy reasonable security, millions of schoolgirls are back in class, Al Qaeda cannot operate, and the Taliban cannot return to power, yet in the provinces ethnic militias and criminal gangs still husband weapons, cadge international funds, and exploit the weak. Neither the United States nor the Taliban can achieve its stated aims by arms alone, and the Administration lacks a sure way to preserve the gains made while reducing its military presence, as it must, for fiscal, political, and many other reasons.

If giving peace talks a chance can decrease the violence and shrink the Afghan battlefield by twenty or even ten per cent, President Obama will have calculated correctly: even a partly successful negotiation might help create political conditions that favor the reduction of American forces to a more sustainable level. A Taliban-endorsed ceasefire, to build confidence around long-term talks supported by many international governments, might also be conceivable.

Last spring, in Kabul, several former Taliban leaders told me that some exiled senior Taliban in Pakistan wanted the United States to leave Afghanistan but, at the same time, they preferred to talk with the Americans directly about the country’s future, both to escape I.S.I. manipulation and because they regarded Karzai as a weak puppet. As long as the Obama Administration refused to join in the talks, progress would be impossible, they told me. “It’s just the Americans,” Mullah Abdul Salam Zaeef, the Taliban’s former ambassador to Pakistan, said. “They are not ready to make positive progress.”

At that point, Defense Secretary Robert Gates and military commanders, such as Admiral Michael Mullen, the Chairman of the Joint Chiefs of Staff, argued that Obama’s “surge” of troops needed more time to inflict morale-sapping damage on the Taliban; their theory was that Taliban leaders would take peace talks seriously only when they felt sufficiently battered. Last year, American-led forces killed or captured scores of mid-level Taliban commanders. General David Petraeus said recently that counterinsurgency efforts in the Taliban strongholds of Helmand and Kandahar provinces had pushed the guerrillas back. It was these perceived military gains that influenced the Administration’s decision to enter into direct talks.

Confidentiality has its place in statecraft, and if Afghanistan’s war is to be resolved it will require some quiet dealmaking, but there is something unsavory about secret talks as a mechanism for drawing the Taliban into politics. Afghanistan has suffered heavily enough from the covert designs of outside powers. Negotiations with the Taliban must eventually be transparent, so that the Afghans themselves can examine them. And more than a deal with Taliban leaders will be called for. American efforts to calm the violence will succeed only if they are part of a broader strategy in Afghanistan and South Asia, one that gives priority to economic development, energy links, water, and regional peacemaking, including in the conflict between India and Pakistan.

It is past time for the United States to shift some of its capacity for risk-taking in the war off the battlefield and into diplomacy aimed at reinforcing Afghan political unity, neutrality, civil rights, and social cohesion. The recent talks are nevertheless a constructive step. For too long, American political strategy in Afghanistan has been subordinate to military and intelligence operations. Thinking and learning through principled discussions with an enemy is an opportunity, not a trap

The New Yorker

House Votes to Cut $60 Billion, Setting Up Budget Clash

WASHINGTON — The House voted early Saturday to slash more than $60 billion from the federal budget over the next seven months, showing how powerfully the grass-roots, antispending fervor of the November elections is driving the new Republican majority’s efforts to shrink the size and scope of government.

The vote, in favor of deep reductions in domestic programs, foreign aid and even some military projects, put the two parties on a path to a quick succession of showdowns over the deficit and the nation’s accumulated and growing debt. The debate has been made all the more bitter by long-simmering political feuds over health care, energy, social policy and a fundamental divide over the proper role of government.

The vote, 235 to 189, was a victory for the large, boisterous class of fiscally conservative Republican freshmen that is fiercely determined to change the ways of Washington and that forced party leaders to pursue far bigger cuts than originally planned.

With Congress on a weeklong Presidents’ Day recess, lawmakers will return with just four days to agree on a temporary extension of the stop-gap measure now financing the government. The Democratic-controlled Senate has signaled that it will not consider anything approaching the scale of cuts approved by the House, setting up a standoff that each side has warned could lead to a shutdown of the federal government early next month.

The vote was also the opening salvo in what is likely to be a long, bitter clash of philosophical ideas about fiscal policy on Capitol Hill, in statehouses around the country and in the 2012 presidential campaign, as Republicans repudiate the liberal, Keynesian strategies the Obama administration has relied on to navigate through the worst economic downturn since the Great Depression.

In Washington, the fight in the weeks ahead will focus on paying for government operations through the end of the fiscal year on Sept. 30, and the need within the next few months to raise the federal debt ceiling. But the push by Republicans for spending cuts and new austerity is already shaking state capitals, including Madison, Wis., and Columbus, Ohio, where labor unions have begun protesting efforts to reduce benefits and weaken their collective bargaining rights.

The House approved its spending measure in the predawn darkness on Saturday after four days and nights of free-wheeling floor debate — a veritable ultra-marathon of legislating in which hundreds of amendments were put forward. Republican leaders lost votes on some of those amendments, in what they said was a testament to their commitment to allow a more open legislative process than their recent predecessors.

Republicans seemed to grow more excited as the final vote neared shortly after 4:30 a.m.

“We have a mandate from the American people to cut spending,” declared Representative Judy Biggert, Republican of Illinois.

Immediately after the vote, the House speaker, John A. Boehner of Ohio, said in a statement, “This week, for the first time in many years, the people’s House was allowed to work its will — and the result was one of the largest spending cuts in American history.” Mr. Boehner added, “We will not stop here in our efforts to cut spending, not when we’re broke and Washington’s spending binge is making it harder to create jobs.”

Just three Republicans opposed the bill, while all 186 Democrats present voted against it. The Republicans who opposed the spending package were Representatives John Campbell of California and Jeff Flake of Arizona, both of whom had advocated for even bigger reductions, and Representative Walter B. Jones of North Carolina, who often disagrees with his party.

The Republicans’ plan would quickly impose sharp spending reductions in nearly every area of government. But Republicans will not have long to bask in the glory of their win, and their bill has virtually no chance of becoming law in its current form. President Obama and Senate Democrats say the cuts would harm the fragile economic recovery, and the White House had threatened to veto the bill even before it was approved. The Democrats say Mr. Obama’s budget proposal, which calls for a five-year freeze in many spending areas, is a more reasonable approach. But Republicans have rejected it as insufficient.

As House Republicans laid down their marker in the spending fight, it went unremarked on by the White House. On Saturday morning, Mr. Obama went to a local community center to be a guest basketball coach, and there was no immediate comment from the administration on the vote.

The stopgap measure now financing the government expires on March 4. And with Congress in recess, party leaders concede that there is not enough time to forge a deal and that a short-term extension will be needed to avert a shutdown of the government.

But with the tone in the House growing more strident over the four days of debate, and politically charged amendments dominating the action on Friday, lawmakers and Washington at large have begun to face the possibility that even a temporary accord will be difficult to achieve.

Mr. Boehner has said he will not agree to a short-term extension without added cuts. Democrats, meanwhile, have not shown any willingness to give ground, apparently betting that Republicans will be held responsible for a shutdown as they were in 1995 in a standoff with the Clinton administration.

The House Democratic leader, Representative Nancy Pelosi of California, late Friday night put forward a temporary extension of the stopgap measure that would maintain expenditures as they are now, generally at 2010 levels, and avert a shutdown through March 31. But Republicans quickly dismissed it.

Democrats, for weeks, have warned that Republicans were risking a shutdown by showing no flexibility in the spending debate.

“Closing our government would mean our men and women in uniform wouldn’t receive their paychecks and veterans would lose critical benefits,” Ms. Pelosi said at a news conference earlier on Friday. “Seniors wouldn’t receive their Social Security checks, and essential functions from food safety inspection to airport security could come to a halt.”

Aides to the Senate Republican leader, Mitch McConnell of Kentucky, sought to play down the possibility of a stalemate that would shutter the government but accused Democrats of rooting for that outcome.

Mr. McConnell, however, showed no willingness to consider Ms. Pelosi’s proposed temporary extension. “Freezing in place the current unsustainable spending levels is simply unacceptable,” he said in a statement.

Even without a government shutdown, there were warnings that the Republican cuts could hobble federal agencies. The Securities and Exchange Commission, for instance, charged with carrying out a sweeping new financial regulation law, will end up with $25 million less than last year, which was before the law was adopted.

In a letter to employees on Thursday, the Social Security Administration warned of potential furloughs “given the potential of reduced Congressional appropriations for the remainder of the fiscal year.”

The cuts even hit some programs that had support among Republican leaders, including an alternate engine for the F-35 Joint Strike Fighter. The House voted to cancel the engine, achieving $450 million in short-term savings.

Up to the end, the Republican Study Committee, a conservative bloc, continued to push for even bigger cuts, putting forward an amendment on Friday to slice $22 billion more. That amendment was defeated, as senior Republicans, including the majority leader, Representative Eric Cantor of Virginia, and veteran members of the Appropriations Committee, teamed with Democrats to hit the brakes.

But flush with enthusiasm on the fourth long day of debate, House Republicans on Friday easily approved amendments to the spending package that would deny government financing for Planned Parenthood, block money for the Democrats’ big health care overhaul and bar new regulation of certain greenhouse gases.

The amendment to deny government funds to Planned Parenthood was put forward by Representative Mike Pence, Republican of Indiana. It was approved by a vote of 240 to 185.

Ms. Pelosi, a supporter of abortion rights, angrily denounced the vote as a camouflaged effort by Republicans to prevent Americans from engaging in family planning, which she said would actually undermine the Republicans’ larger goal by leading to an increase in elective abortions.

At least six amendments were approved to block federal agencies from carrying out the new health care law or crucial components of the law.

For Republican freshmen, however, the health care law offers a potentially sobering lesson about American democracy: after countless hours of drafting and floor debate, the health care bill Mr. Obama signed last year was the one written and approved by the Senate.

In much the same way, the spending measure being debated so feverishly on the House floor has virtually no chance of becoming the law.

Just as the Senate ultimately controlled the health care debate, so too will it control crucial negotiations in the current spending fight. Senate Republicans have said they support the overall goals of their House counterparts but have not committed to making identical cuts, and Democrats have a majority in the chamber.

In an understated reminder of his chamber’s role in the process, Senator Daniel K. Inouye, Democrat of Hawaii and chairman of the Appropriations Committee, issued a statement expressing a desire for compromise.

“It is my sincere hope that all the parties will remain reasonable as we seek to fund the federal government for the remainder of the fiscal year,” he said. “Neither house of Congress is in a position to dictate terms to the other, so I remain hopeful that we will come to a sensible accommodation.”


HAWAII proposal to sell Obama birth certificate dies

HONOLULU - A proposal to sell copies of President Barack Obama's birth records to anyone for $100 is going nowhere in the Hawaii Legislature.

The bill (HB1116) died when it didn't get a hearing before a Friday deadline for bills to advance to their final committees.

House Health Committee Chairman Ryan Yamane said Thursday he won't consider the legislation because he doesn't think it's appropriate to sell private information to the public — even if it's the president's birth documentation.

"We shouldn't take knee-jerk reactions. Just because there are these people who want this information, that doesn't mean we should change our state statute so a private, personal record could be accessible for $100," said Yamane, a Democrat.

Hawaii's privacy laws bar the release of birth records unless the requester is someone with a tangible interest, such as a close family member.

So-called "birthers" claim there's no proof Mr. Obama was born in the United States, and he is therefore ineligible to be president. Many of the skeptics question whether he was actually born in Kenya, his father's home country.

Republican Rep. Kymberly Pine said efforts to reveal President Obama's birth information fuel unfounded suspicions that he wasn't born in Honolulu.

"It's just opening a whole new can of worms again," said Pine, the minority floor leader. "We should just let this die. People have presented as many facts as we can."

Hawaii's former health director said in 2008 and 2009 she verified President Obama's original records. Public notices were published in two local newspapers within days of Mr. Obama's birth at a Honolulu hospital.

The Obama campaign issued a certification of live birth in 2008, an official document from the state showing the president's Aug. 4, 1961, birth date, his birth city and name, and his parents' names and races.

Bill introducer Rep. Rida Cabanilla said she'll drop the issue after she learned that requests to the state for President Obama's birth documents have declined to just a few per week.

"The demand is dying down," said Cabanilla, a Democrat. "If they still got a lot of requests, I could have pushed it more."

Only a handful of people contacted Yamane about the bill, he said. Three or four people from the mainland United States wrote they were skeptical that President Obama was born in the United States, and two people from Hawaii said the government should focus on the economy rather than birthers.

Democratic Gov. Neil Abercrombie, who was a friend of Mr. Obama's parents and knew him as a child, revived the issue in December when he said he wanted to release more of the state's birth information about the president. But he ended the effort in January when the state attorney general told him that privacy laws bar disclosure of an individual's birth documentation without the person's consent.

The bill failed because it had to reach its final committee — the House Finance Committee — by a Friday deadline for all bills requiring more than one public hearing to advance. But it wasn't given a hearing in the House Health Committee, a required step before it could move forward.

It would have run into many obstacles from lawmakers even if it had cleared the House and moved to the Senate.

"Any plan to sell copies of the president's or anyone else's birth records is a non-starter," said Senate Health Committee Chairman Josh Green, a Democrat. "Rights to privacy issues like this are too important to be taken lightly."

Fourteen states allow birth certificates of elected officials or candidates to be made public in some circumstances, according to the National Conference of State Legislatures.

Lawmakers in several states have introduced legislation aimed at making Obama prove his U.S. nationality by birth before he could be placed on those states' ballots. Those states include Arizona, Georgia, Missouri, Nebraska, Connecticut, Oklahoma and Texas.