Flu season strikes early and, in some places, hard

NEW YORK (AP) — From the Rocky Mountains to New England, hospitals are swamped with people with flu symptoms. Some medical centers are turning away visitors or making them wear face masks, and one Pennsylvania hospital set up a tent outside its ER to deal with the feverish patients.

Flu season in the U.S. has struck early and, in many places, hard.

While flu normally doesn't blanket the country until late January or February, it is already widespread in more than 40 states, with about 30 of them reporting some major hot spots. On Thursday, health officials blamed the flu for the deaths of 20 children so far.

Whether this will be considered a bad season by the time it has run its course in the spring remains to be seen.

"Those of us with gray hair have seen worse," said Dr. William Schaffner, a flu expert at Vanderbilt University in Nashville.

The evidence so far points to a moderate season, Schaffner and others say. It looks bad in part because last year was unusually mild and because the main strain of influenza circulating this year tends to make people sicker and really lay them low.

David Smythe of New York City saw it happen to his 50-year-old girlfriend, who has been knocked out for about two weeks. "She's been in bed. She can't even get up," he said.

Also, the flu's early arrival coincided with spikes in a variety of other viruses, including a childhood malady that mimics flu and a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." So what people are calling the flu may, in fact, be something else.

"There may be more of an overlap than we normally see," said Dr. Joseph Bresee, who tracks the flu for the Centers for Disease Control and Prevention.

Most people don't undergo lab tests to confirm flu, and the symptoms are so similar that it can be hard to distinguish flu from other viruses, or even a cold. Over the holidays, 250 people were sickened at a Mormon missionary training center in Utah, but the culprit turned out to be a norovirus, not the flu.

Flu is a major contributor, though, to what's going on.

"I'd say 75 percent," said Dr. Dan Surdam, head of the emergency department at Cheyenne Regional Medical Center, Wyoming's largest hospital. The 17-bed emergency room saw its busiest day ever last week, with 166 visitors.

The early onslaught has resulted in a spike in hospitalizations. To deal with the influx and protect other patients from getting sick, hospitals are restricting visits from children, requiring family members to wear masks and banning anyone with flu symptoms from maternity wards.

One hospital in Allentown, Pa., set up a tent this week for a steady stream of patients with flu symptoms. But so far "what we're seeing is a typical flu season," said Terry Burger, director of infection control and prevention for the hospital, Lehigh Valley Hospital-Cedar Crest.

On Wednesday, Boston declared a public health emergency, with the city's hospitals counting about 1,500 emergency room visits since December by people with flu-like symptoms.

All the flu activity has led some to question whether this year's flu shot is working. While health officials are still analyzing the vaccine, early indications are that it's about 60 percent effective, which is in line with what's been seen in other years.

The vaccine is reformulated each year, based on experts' best guess of which strains of the virus will predominate. This year's vaccine is well-matched to what's going around. The government estimates that between a third and half of Americans have gotten the vaccine.

In New York City, 57-year-old Judith Quinones skipped getting a flu shot this season and suffered her worst case of flu-like illness in years. She was laid up for nearly a month with fever and body aches. "I just couldn't function," she said.

But her daughter got the vaccine. "And she got sick twice," Quinones said.

Europe is also suffering an early flu season, though a milder strain predominates there. Flu reports are up, too, in China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo. Britain has seen a surge in cases of norovirus.

On average, about 24,000 Americans die each flu season, according to the CDC. That's an estimate — the agency does not keep a running tally of adult flu deaths each year, only for children. Some state health departments do keep count, and they've reported dozens of flu deaths so far.

Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications.

Most people with flu have a mild illness and can help themselves and protect others by staying home and resting. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms.

Flu vaccinations are recommended for everyone 6 months or older. Of the 20 children killed by the flu this season, only two were fully vaccinated.

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AP Medical Writer Maria Cheng in London contributed to this report.

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Online:

CDC flu: http://www.cdc.gov/flu/index.htm

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String of bombings kill 101, injure 200 in Pakistan

QUETTA, Pakistan (Reuters) - At least 101 people were killed in bombings in two Pakistani cities on Thursday in one of the country's bloodiest days in recent years, officials said, with most casualties caused by sectarian attacks in Quetta.

The bombings underscored the myriad threats Pakistani security forces face from homegrown Sunni extremist groups, the Taliban insurgency in the northwest and the less well-known Baloch insurgency in the southwest.

On Thursday evening, two coordinated explosions killed at least 69 people and injured more than 100 in Quetta, the provincial capital of Balochistan, said Deputy Inspector of Police Hamid Shakil.

The first attack, in a crowded snooker hall, was a suicide bombing, local residents said. About ten minutes later, a car bomb exploded, they said. Five policemen and a cameraman were among the dead from that blast.

The attacks happened in a predominately Shia neighborhood and banned sectarian group Lashkar-e-Jhangvi claimed responsibility. The extremist Sunni group targets Shias, who make up about 20 percent of Pakistani's population.

Targeted killings and bombings of Shia communities are common in Pakistan, and rights groups say hundreds of Shia were killed last year. Militant groups in Balochistan frequently bomb or shoot Shia passengers on buses travelling to neighboring Iran.

The killers are rarely caught and some Shia activists say militants work alongside elements of Pakistan's security forces, who see them as a potential bulwark against neighboring India.

Many Pakistanis fear their nation could become the site of a regional power struggle between Saudi Arabia, source of funding for Sunni extremist groups, and Iran, which is largely Shia.

But sectarian tensions are not the only source of violence.

The United Baloch Army claimed responsibility for a blast in Quetta's market earlier in the day. It killed 11 people and injured more than 40, mostly vegetable sellers and secondhand clothes dealers, police officer Zubair Mehmood said. A child was also killed.

The group is one of several fighting for independence for Balochistan, an arid, impoverished region with substantial gas, copper and gold reserves, which constitutes just under half of Pakistan's territory and is home to about 8 million of the country's population of 180 million.

SWAT BOMBING

In another incident Thursday, 21 were killed and more than 60 injured in a bombing when people gathered to hear a religious leader speak in Mingora, the largest city in the northwestern province of Swat, police and officials at the Saidu Sharif hospital said.

"The death toll may rise as some of the injured are in critical condition and we are receiving more and more injured people," said Dr. Niaz Mohammad.

It has been more than two years since a militant attack has claimed that many lives in Swat.

The mountainous region, formerly a tourist destination, has been administered by the Pakistani army since their 2009 offensive drove out Taliban militants who had taken control.

But Talibans retain the ability to attack in Swat and shot schoolgirl campaigner Malala Yousufzai in Mingora last October.

A Taliban spokesman said they were not responsible for Thursday's bombing.

(Additional reporting by Jibran Ahmad in Peshawar, Pakistan; Writing by Katharine Houreld; Editing by Mark Heinrich and Jason Webb)

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Captain blames faulty brakes, motor for NY ferry accident

NEW YORK: The captain of a packed ferry that crashed into a New York City pier injuring 74 people blamed malfunctioning brakes and a faulty motor for the accident, US investigators said Thursday.

"As the boat was coming in, the captain found that the reverse thrust was not operating as anticipated," said Robert Sumwalt of the National Transportation Safety Board, which is investigating the accident.

The captain said there was also a problem with the motor on the vessel, telling investigators that at some point "both diesel engines shut off," while he steered it toward the pier, Sumwalt told reporters.

There were 326 passengers and five crew on board the ferry at the time of Wednesday's mishap.

The accident took place during the morning rush hour at Pier 11 in lower Manhattan's East River, not far from Wall Street. The ferry was arriving from New Jersey.

Sumwalt said the captain, who is 36 years old, has 12 years of experience as a ferryboat captain and tested negative for alchohol use, as did the entire crew. Results of drug testing have yet to be completed, he said.

Some witnesses reported that the ferry, the Seastreak Wall Street, was going too quickly as it approached the pier.

Weather conditions were good at the time of the accident, with hardly any wind and good visibility.

Dozens of ferries bring thousands of commuters from New Jersey or Brooklyn to Manhattan every day, but accidents are rare.

The most serious mishap, in October 2003, killed 11 people and injured 70 others when a Staten Island ferry slammed into a pier at full speed.

- AFP/ck

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Border truce violations almost doubled last year

NEW DELHI: Ceasefire violations, which are now threatening to derail the India-Pakistan peace process, were not long ago, besides being fewer, a very organized affair, with both sides following the rules of the game.

As per what had evolved into an informal protocol over the years, each side would warn the other about their firing intent by raising a red flag, and would never fire directly on posts in front. Timings were predictable too, often once a month and definitely on important occasions like January 26 or August 14-15, during a cricket match or when a high-profile foreign dignitary visited India. That was until mid-2012, when the Indo-Pak tensions along the Line of Control picked pace and raced to a new level.

The firings then became more frequent, the warning flags were not raised. Fire would even be directed on the posts across. And both sides engaged occasionally in "aggressive cross-border actions". Statistics speak for themselves — in 2010, there were 57 violations, in 2011 there were 61. But in 2012, the figure virtually doubled to 117. In the first 10 days of this year, there have already been at least four violations.

"There has been an increase in ceasefire violations. There been an increase in infiltration attempts. In 2012, there was an overall increase over 2011. That is a fact. And that is something we are dealing with, both ourselves and with the Pakistani authorities," national security advisor Shivshankar Menon said on Thursday.

While terrorist infiltrations have always been significantly higher along the LoC in the Kashmir Valley, it is particularly along the stretch from south of Uri to north of Rajouri in the Jammu region that most ceasefire violations have taken place. Other than for these violations, the ceasefire between the two countries along the borders since November 2003 has been largely holding well.

A senior source in the security establishment said there have been occasional flare-ups in the region, but no serious attention seems to have been paid to them by both New Delhi and Islamabad. And it peaked on January 8, with the beheading of an Indian soldier that is now threatening the tense diplomatic engagement between the two sides.

Sources said there could be several reasons why the ceasefire was being breached in this particular area which includes the Mendhar sector. On the Poonch side, Indian forces occupy dominant positions while in Mendhar sector, where the two soldiers were brutally killed, the Pakistan army enjoys more dominant positions. This mismatch could be one of the triggers.

The other trigger involves the efforts to help terrorists to infiltrate into J&K. The Pakistan army regularly provides firing cover for them to come in. Inputs have also spoken of changing trends in infiltration, including many happening in winter.

Traditionally, winter months were infiltration-free because of the heavy snowfall and bad weather. But that is not the case any longer. In light of the latest flare-up, many seasoned hands in the establishment are calling for political leadership to pay closer attention to the local dynamics at play in the Uri/Mendhar sectors.

The Army assessment is that while 2011 witnessed only 52 "successful" infiltrations, the number jumped to 121 in 2012. Infiltration attempts have steadily risen since the departure of General Pervez Musharraf. Apart from the lull after the 26/11 terror attacks, Indian sources have noted a steady rise in the attempt by Pakistanis to push terrorists into Jammu & Kashmir.

These were also the years when due to the rising violence, terrorism and military action on the western flank, Pakistan moved a large number of its forces from the east to the west to deal with the war in Afghanistan and in the border regions.

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Hero Teacher Talks Shooter into Dropping Gun

A California high school teacher is being hailed a hero for talking a 16-year-old shooter into putting down his gun and turning himself in after opening fire on a classroom and wounding another student, police said.

The student victim was taken to a nearby hospital and remains in critical but stable condition, Kern County Sheriff Donny Youngblood told reporters on Thursday.

The teacher, whose name has not yet been officially released by authorities, helped evacuate nearly two dozen students out a door at Taft Union High School in Taft, Calif., while calmly engaging the young gunman, who is a student at Taft Union, in conversation.

Chris McCullah/The Californian/ZUMA

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The teacher and a campus supervisor, who responded to the gunfire and arrived at the classroom, helped convince the teenager to stop shooting.

"They talked him into putting the shotgun down," Youngblood said.

The shooting began around 9 a.m. in the school's science building and sheriff's deputies were on the scene within one minute of the call. An armed security guard who is typically at the school was not on campus because he had been snowed in, the sheriff said.

Two other students received minor injuries: One reported hearing loss and the other fell over a table. The teacher was shot with a pellet, but refused medical treatment, according to police.

The school's 900 students were evacuated from the building and many of them were met by parents within minutes of the first 911 calls.

Today's shooting comes less than month after 20-year-old Adam Lanza opened fire on an elementary school in Newtown, Conn. killing 20 children and six adults.

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Retooling Pap test to spot more kinds of cancer

WASHINGTON (AP) — For years, doctors have lamented that there's no Pap test for deadly ovarian cancer. Wednesday, scientists reported encouraging signs that one day, there might be.

Researchers are trying to retool the Pap, a test for cervical cancer that millions of women get, so that it could spot early signs of other gynecologic cancers, too.

How? It turns out that cells can flake off of tumors in the ovaries or the lining of the uterus, and float down to rest in the cervix, where Pap tests are performed. These cells are too rare to recognize under the microscope. But researchers from Johns Hopkins University used some sophisticated DNA testing on the Pap samples to uncover the evidence — gene mutations that show cancer is present.

In a pilot study, they analyzed Pap smears from 46 women who already were diagnosed with either ovarian or endometrial cancer. The new technique found all the endometrial cancers and 41 percent of the ovarian tumors, the team reported Wednesday in the journal Science Translational Medicine.

This is very early-stage research, and women shouldn't expect any change in their routine Paps. It will take years of additional testing to prove if the so-called PapGene technique really could work as a screening tool, used to spot cancer in women who thought they were healthy.

"Now the hard work begins," said Hopkins oncologist Dr. Luis Diaz, whose team is collecting hundreds of additional Pap samples for more study and is exploring ways to enhance the detection of ovarian cancer.

But if it ultimately pans out, "the neat part about this is, the patient won't feel anything different," and the Pap wouldn't be performed differently, Diaz added. The extra work would come in a lab.

The gene-based technique marks a new approach toward cancer screening, and specialists are watching closely.

"This is very encouraging, and it shows great potential," said American Cancer Society genetics expert Michael Melner.

"We are a long way from being able to see any impact on our patients," cautioned Dr. Shannon Westin of the University of Texas MD Anderson Cancer Center. She reviewed the research in an accompanying editorial, and said the ovarian cancer detection would need improvement if the test is to work.

But she noted that ovarian cancer has poor survival rates because it's rarely caught early. "If this screening test could identify ovarian cancer at an early stage, there would be a profound impact on patient outcomes and mortality," Westin said.

More than 22,000 U.S. women are diagnosed with ovarian cancer each year, and more than 15,000 die. Symptoms such as pain and bloating seldom are obvious until the cancer is more advanced, and numerous attempts at screening tests have failed.

Endometrial cancer affects about 47,000 women a year, and kills about 8,000. There is no screening test for it either, but most women are diagnosed early because of postmenopausal bleeding.

The Hopkins research piggybacks on one of the most successful cancer screening tools, the Pap, and a newer technology used along with it. With a standard Pap, a little brush scrapes off cells from the cervix, which are stored in a vial to examine for signs of cervical cancer. Today, many women's Paps undergo an additional DNA-based test to see if they harbor the HPV virus, which can spur cervical cancer.

So the Hopkins team, funded largely by cancer advocacy groups, decided to look for DNA evidence of other gynecologic tumors. It developed a method to rapidly screen the Pap samples for those mutations using standard genetics equipment that Diaz said wouldn't add much to the cost of a Pap-plus-HPV test. He said the technique could detect both early-stage and more advanced tumors. Importantly, tests of Paps from 14 healthy women turned up no false alarms.

The endometrial cancers may have been easier to find because cells from those tumors don't have as far to travel as ovarian cancer cells, Diaz said. Researchers will study whether inserting the Pap brush deeper, testing during different times of the menstrual cycle, or other factors might improve detection of ovarian cancer.

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Venezuela's top court endorses Chavez inauguration delay

CARACAS (Reuters) - Venezuela's top court endorsed the postponement of Hugo Chavez's inauguration this week and ruled on Wednesday that the cancer-stricken president and his deputy would continue in their roles, despite a cacophony of opposition complaints.

Critics had argued the 58-year-old's absence from his own swearing-in ceremony on January 10 meant a caretaker president must be appointed. Chavez has not been seen in public nor heard from in almost a month following surgery in Cuba.

"Right now we cannot say when, how or where the president will be sworn in," Supreme Court Chief Judge Luisa Morales told a news conference.

"As president re-elect there is no interruption of performance of duties ... The inauguration can be carried out at a later date before the Supreme Court."

The decision opens the door in theory for Chavez to remain in office for weeks or months more from a Cuban hospital bed - though there is no evidence he is even conscious.

It leaves the South American country in the hands of Vice President Nicolas Maduro, as de facto leader of the government.

The opposition say that is a brazen violation of the constitution, and that Maduro should leave office on Thursday when the current presidential term had been due to expire.

They say National Assembly boss Diosdado Cabello, another powerful Chavez ally, should take over the running of the country while new elections would be organized within 30 days.

Maduro would be the ruling Socialist Party's candidate.

Government leaders insist Chavez, 58, is fulfilling his duties as head of state, even though official medical bulletins say he suffered complications after the surgery, including a severe lung infection, and has had trouble breathing.

His resignation or death would transform politics in the OPEC nation, where he is revered by poor supporters thankful for his social largesse, but denounced by opponents as a dictator.

RALLY PLANNED FOR THURSDAY

Opposition leader Henrique Capriles, who lost a presidential election to Chavez in October, said the Supreme Court had become politicized under the socialist leader's administration.

"The tribunal gave an interpretation (of the constitution) in order to solve a problem that the government has," Capriles told a news conference.

Moody's Investors Service warned on Wednesday that Venezuela's sovereign credit rating, already at junk status, faces short-term risks over any political transition.

Prices of Venezuela's widely traded bonds have soared lately on Chavez's health woes, but dipped this week as investors' expectations of a quick government change apparently faded.

The president has undergone four operations, as well as weeks of chemotherapy and radiation treatment, since being diagnosed with an undisclosed type of cancer in his pelvic area in June 2011.

He looked to have staged a remarkable recovery from the illness last year, winning a new six-year term at a hard-fought election in October. But within weeks of his victory he had to return to Havana for more treatment.

The government has called for a huge rally outside the Miraflores presidential palace in Caracas on Thursday, and allied leaders such as Uruguay's Jose Mujica, Bolivia's Evo Morales and Nicaragua's Daniel Ortega have said they will visit - despite Chavez's absence.

Argentine President Cristina Fernandez, a close friend, has announced plans to visit Chavez in Cuba on Friday.

The unprecedented silence by Chavez, who is well known for his hours-long rambling speeches, has convinced many Venezuelans that his 14 years in power may be coming to an end.

Unlike after his previous operations in Cuba, no photographs have been published of him recuperating, and social media in Venezuela is buzzing with rumors he is on life support.

Cabello, the pugnacious head of the National Assembly, has repeatedly ruled out taking over as caretaker president to order a new presidential election, saying Chavez remains in charge.

"Tomorrow we will all go to the Miraflores palace," he told a televised Socialist Party meeting on Wednesday. "The people will be invested as president. We are all Chavez!"

(Additional reporting by Marianna Parraga, Diego Ore and Enrique Andres Pretel; Editing by Andrew Cawthorne and Eric Walsh)

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EU leaders want UK in union, but not treaty change

LONDON: European leaders on Wednesday stressed the importance of keeping Britain in the EU, but said they opposed treaty changes demanded by Prime Minister David Cameron.

"Britain is an essential part of the EU," Irish Prime Minister Enda Kenny said during a conference in Dublin marking the beginning of his country's six-month presidency of the bloc.

"Great Britain has great value and is a very important member of the EU," added EU President Herman Van Rompuy.

The two leaders highlighted the importance of the union for British businesses, saying that it was essential for them that Britain remained a full and active member.

A majority of Britons favour severing all ties with the union, according to polls, and Cameron is expected to deliver a speech within the next few days spelling out his views on the country's relationship with Brussels.

He insisted last year that he supported Britain's membership, but that he wanted to negotiate a "new agreement" which would allow it to opt out of certain directives.

Kenny and Van Rompuy both repeated their opposition to any treaty changes.

"I don't see a reopening of the treaties, I don't see an issue in treaty change for any individual countries," said the Irish prime minister.

Irish Deputy Prime Minister Eamon Gilmore stressed that the top concern of European citizens, "whether from Liverpool or Limerick", was unemployment.

Van Rompuy reiterated that it would be possible to change the treaties after the 2014 European elections, but added that he strongly supported deeper EU integration as opposed to an "a la carte" union.

He pointed out that there was already scope for increasing EU partnership.

"We don't need, at this stage, a treaty change," he said. "We can deliver for a deeper EU within the treaties."

- AFP/jc

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Born of rape, left alone and bereft

BHUBANESWAR/AHMEDABAD: He's just four and is lost and bewildered. Not only is Raghav in a new school in a strange place, he's away from the fond gaze of his doting grandparents. For no fault of his.

In 2007, his mother Meera was raped in Khaprakhol area of Balangir in Orissa. Distraught and depressed, she approached local NGO Kalyan when she was two-months pregnant. "We counselled her and convinced her not to go for an abortion," says Meenakshi Purohit of Kalyan.

But life has been a constant struggle since. Her son was refused admission in school when the teachers discovered that he was born of rape. Later, Meera got him admitted to a school unfamiliar with her status. But for that, she had to leave the security of her parents' home and shift to another place. She's now finding it difficult to earn a living. What's worse, the accused is still absconding.

Meera's story is the story of countless rape victims left to fend for themselves and their children in a cruel and uncaring world. In Orissa alone, there are at least a dozen children in recent times born out of rapes who lead a hand-to-mouth existence in the absence of family or government support.

In Deogarh district, a 14-year-old disabled girl raped by a 70-year-old is jeered by everyone. After she gave birth in July, she's been living with her parents. But her father, a daily wage labourer, can't support her. "She has visited several government offices for help but no one cares," says a local.

There are also cases of parents deserting their raped daughters. A minor who was raped in Balangir is now working in a beauty parlour and fends for her three-year-old daughter after her parents wanted nothing to do with her. Besides the cold indifference of families, there is the insensitivity of authorities.

A Class IV dropout in Kuchinda who conceived after being raped by a neighbour has got little help despite the then state commission for women chairperson Jyoti Panigrahi discussing her rehabilitation with district authorities.

"A rape victim, even if she is not pregnant, is entitled to be rehabilitated under the Criminal Injuries Relief and Rehabilitation Boards scheme. Each victim gets Rs 2 lakh compensation. Collectors should ensure its implementation," says Panigrahi.

But there has been hope and rehabilitation for some. In contrast to these bleak cases, the Patan gang-rape victim in Gujarat has got her life back on the rails. The victim, 23, teaches in a school in rural Gujarat. After a tiring day at work, she heads home to a loving husband who runs a mobile repair shop and a baby boy who makes her run around in circles.

Her amazing comeback story is an example of how rape victims should be treated. After being sexually assaulted by six teachers at Patan Primary Teacher's Training College (PTC) in 2008, she used to hallucinate about monster gurus despite being ensconced in the safety of a home run by an NGO. She would be held, comforted and told that it was all over.

She was lucky. The boy in love with her also proposed marriage. "His proposal in 2010 was something I felt would never happen to me. Even my in-laws treat me like a daughter," she says. Despite post-traumatic stress for months, she passed her studies with distinction and got a government job. She's now at peace. "I wish the outrage over rape allows people to open their hearts and accept rape victims as wives and daughter-in-laws," she says plaintively.

(Some names changed to protect identity)

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White House Won't Rule Out $1 Trillion Coin

(United States Mint/Wikimedia Commons)

White House Press Secretary Jay Carney today flatly ruled out any negotiations with Congress over raising the debt ceiling, but there’s one odd-ball solution he would not rule out:  minting trillion dollars coins to pay off the debt.

“There is no Plan B. There is no backup plan. There is Congress’s responsibility to pay the bills of the United States,” White House Press Secretary Jay Carney told reporters at the daily White House briefing.

READ: $1-Trillion Coins: The Ultimate Debt Ceiling End-Around?

Asked if the administration would rule out minting trillion dollars coins if Congress fails to act, Carney deflected saying “you could speculate about a lot of things.”

“Nothing needs to come to these kinds of… speculative notions about how to deal with a problem that is easily resolved by Congress doing its job, very simply,” he added.

Pressed further on why they won’t offer a clear yes-or-no answer to the question, Carney referred questions to the Treasury Department.

“I answered it thoroughly,” he later joked. “And I have no coins in my pocket.”

Some have suggested the President could invoke the 14^th Amendment to the Constitution – which states, “the validity of the public debt of the United States … shall not be questioned” – and ignore the debt ceiling altogether.  On that question, Carney has offered a straight answer:  the 14 Amendment does not apply to the debt ceiling.

“We just don’t believe that it provides the authority that some believe it does,” Carney said.

The trillion-dollar-coin idea has been floated by, among others, an economist at the American Enterprise Institute.

Here’s our full Q and A:

KARL: I heard you unequivocally rule out using the 14th Amendment on the debt ceiling. I heard you unequivocally rule out negotiating with Congress. But you did not rule out this trillion-dollar coin idea. So can I ask you just a yes-or-no question? Does the White House rule out the idea of minting trillion-dollar coins as a way of dealing with the debt ceiling?

CARNEY: I would refer you to Treasury for the specifics of this question. I can tell you that the president does not believe that there is a backup plan or a plan B or an off-ramp. The only viable option here is Congress to fulfill its — that Congress fulfills its responsibility and ensures that the United States of America pays its bills, as it has always paid its bills throughout its history.

KARL: But why have we ruled out the 14th Amendment and not ruled out the trillion-dollar coin idea?

CARNEY: Again, I can tell you that there are no back-up plans. There are no plan B’s. I’d refer you to the Treasury.

–

KARL: Jay, the speaker of the House has made it perfectly clear that he is willing to increase the debt ceiling, but the principle is for every dollar the debt ceiling is increased, a dollar of spending must be cut. Given that you’re saying that the White House will not negotiate on raising the debt ceiling, are you willing to accept that principle from the speaker, a dollar in cuts for every dollar increase?

MR. CARNEY: I think the president’s been very clear that his absolute principle is that we need to reduce our deficit in a balanced way that does not shift all the burden, through cuts exclusively, on senior citizens, on families who have disabled children, on families who are trying to send their kids to school. That’s just unacceptable.

You know, one of the things we learned in the process that we just went through late in — late last year is that when it comes to specificity, we never saw any specificity from Republicans in terms of how exactly they would achieve the kind of sweeping cuts that they say they want and out of whose — you know, from whom would they demand that payment.

And what the president has been very clear about is he will not negotiate on Congress’ responsibility to pay its bills. He will negotiate and is willing to compromise, as he has demonstrated repeatedly, when it comes to moving forward in a balanced way to reduce our deficit. We have to deal with the sequester. We have to deal with a variety of budgetary and economic and fiscal challenges.

But he will not negotiate over the debt ceiling. And the threat itself is a problem, as we saw in the summer of 2011. The binary choice that Republicans seem to want to present to the American public is either we gut Medicare and Social Security or we tank the global economy. I’m not a communications director for the speaker of the House or the Senate minority leader, but I would think selling that would be very hard.

KARL: But help me understand how this works. You say you will not negotiate on this issue. They’ve put out a principle, so they produce something — and they say they will — that cuts a dollar for every dollar increase. And you’re saying you won’t negotiate on that?

MR. CARNEY: Have you seen that?

KARL: Well, this is what they say they are going to go forward.

MR. CARNEY: Well, I mean, you know –

KARL: So either –

MR. CARNEY: — words are not actions, and there has been, at — to this date, very little specificity, you know, since we — since the Ryan plan, which itself was lacking in specifics. And if their — if their position is we’re going to voucherize Medicare or tank the global economy, they should say so. That is unacceptable to the American people. It’s certainly unacceptable to the president.

Look, here’s the thing. Congress has the authority to authorize money, right, not the president. Congress racked up these bills. Congress has to pay these bills. We are very interested in a discussion and negotiation about getting our fiscal house in order. This president has already signed into law over $2 trillion in deficit reduction. He is eager to do more in a balanced way.

But it is not appropriate to — in this president’s view — to say that if I don’t get what I want, I’m not going to raise the debt limit. That is basically saying, I will abandon the history of the United States maintaining the full faith and credit of its currency and its — and its treasury by refusing to pay bills because I didn’t get what I want politically.

And that’s just not acceptable to the president.

KARL:  I’m not sure I understand how that works — you’re not going to negotiate at all? –

MR. CARNEY: We’re not going to negotiate. Congress has a — if Congress wants to give the president the responsibility to raise the debt ceiling, he would take it, as we saw when — in 2010 or — I forget, there have been so many of these confrontations — in — when — in 2011 when the so-called McConnell plan was adopted, you know. But they assigned themselves this responsibility. They need to be — the fact that they, you know, assigned it to them is something that they have to deal with. They assigned it to themselves, they need to act, and they need to, without drama or delay, raise the debt ceiling. We still have — there is plenty of opportunity outside of threatening the full faith and credit of the United States to debate fundamental differences over our economic and fiscal policy proposals, but it is not wise to do that around raising the debt ceiling, not wise to do it around the simple principle that we, the United States of America, pay our debts.

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