Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

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Despite New Health Law, Some See Sharp Rise in Premiums

Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.

Bob Chamberlin/Los Angeles Times

Dave Jones, the California insurance commissioner, said some insurance companies could raise rates as much as they did before the law was enacted.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own.

In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013. These rate requests are all the more striking after a 39 percent rise sought by Anthem Blue Cross in 2010 helped give impetus to the law, known as the Affordable Care Act, which was passed the same year and will not be fully in effect until 2014.

 In other states, like Florida and Ohio, insurers have been able to raise rates by at least 20 percent for some policy holders. The rate increases can amount to several hundred dollars a month.

The proposed increases compare with about 4 percent for families with employer-based policies.

Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site, healthcare.gov, along with regulators’ evaluations.

The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability.

New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases.

The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits.

Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted.

“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.

While Mr. Jones has not yet weighed in on the insurers’ most recent requests, he is pushing for a state law that will give him that authority. Without legislative action, the state can only question the basis for the high rates, sometimes resulting in the insurer withdrawing or modifying the proposed rate increase.

The California insurers say they have no choice but to raise premiums if their underlying medical costs have increased. “We need these rates to even come reasonably close to covering the expenses of this population,” said Tom Epstein, a spokesman for Blue Shield of California. The insurer is requesting a range of increases, which average about 12 percent for 2013.

Although rates paid by employers are more closely tracked than rates for individuals and small businesses, policy experts say the law has probably kept at least some rates lower than they otherwise would have been.

“There’s no question that review of rates makes a difference, that it results in lower rates paid by consumers and small businesses,” said Larry Levitt, an executive at the Kaiser Family Foundation, which estimated in an October report that rate review was responsible for lowering premiums for one out of every five filings.

Federal officials say the law has resulted in significant savings. “The health care law includes new tools to hold insurers accountable for premium hikes and give rebates to consumers,” said Brian Cook, a spokesman for Medicare, which is helping to oversee the insurance reforms.

“Insurers have already paid $1.1 billion in rebates, and rate review programs have helped save consumers an additional $1 billion in lower premiums,” he said. If insurers collect premiums and do not spend at least 80 cents out of every dollar on care for their customers, the law requires them to refund the excess.

As a result of the review process, federal officials say, rates were reduced, on average, by nearly three percentage points, according to a report issued last September.

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Michael Cronan, Who Gave TiVo and Kindle Their Names, Dies at 61

Michael Cronan, a San Francisco-based graphic designer and marketing executive who placed his stamp on popular culture when he created the brand names TiVo and Kindle, died on Tuesday in Berkeley, Calif. He was 61.

The cause was colon cancer, said his wife, Karin Hibma, with whom he founded the marketing firm Cronan in the early 1980s.

Mr. Cronan, who studied art in college, had many corporations and cultural institutions as clients, but he was most remembered for the pair of brand names he came up with a decade apart.

In the spring of 1997, he was asked to forge a name and an identity for a new device, a digital video recorder developed by a company called Teleworld that offered more sophisticated television recording choices than the videocassette recorder.

“We reviewed probably 1,600-plus name alternatives, seriously considered over 800 names and presented over 100 strong candidates to the team,” Mr. Cronan told Matt Haughey for his blog PVR (the letters stand for personal video recorder) in 2005.

“We spent the early meetings trying to place a cultural context on the product,” he said. Among the possibilities were Bongo and Lasso, which never got far.

Believing that “we were naming the next TV,” Mr. Cronan recalled, “I thought it should be as close as possible to what people would find familiar, so it must contain T and V.”

“I started looking at letter combinations,” he added, “and pretty quickly settled on TiVo.” (The “Vo” portion, he said, had a connection to the Latin and Italian words for vocal sound and voice.) Then came the search for a mascot that Mr. Cronan hoped “would become as recognizable as the mouse ears are to Disney.” He created a TV-shaped smiley character with the name TiVo inscribed on its face, rabbit ears suggesting an early TV set and large, splayed feet. Teleworld changed its name to TiVo Inc.

When Amazon prepared to introduce its first electronic reader in 2007, it turned to Mr. Cronan, who envisioned imagery reflecting the reading experience as an embryonic but rising technology.

Ms. Hibma said in an interview on Friday that in pondering a brand name, Mr. Cronan “wanted to create something small, humble, with no braggadocio,” while choosing an image that “was about starting something, giving birth to something.” He found the name, she said, by likening use of the new e-reader to “starting a fire.”

Michael Patrick Cronan was born on June 9, 1951, in San Francisco. He studied painting at the California College of Arts and Crafts (now California College of the Arts), where he later taught, and received a degree in art from California State University, Sacramento. He was a founder and past president of the San Francisco branch of AIGA, the professional association for design.

Mr. Cronan and his wife expanded their focus in 1992 to create the Walking Man clothing collection, featuring loose-knit tops and pants. Mr. Cronan also designed a pair of 1999 postage stamps, one commemorating the 50th anniversary of NATO and the other promoting prostate cancer awareness, and painted portraits and watercolors.

In addition to his wife, Mr. Cronan is survived by his sons, Shawn HibmaCronan and Nick Cronan; a brother, Christopher; a sister, Patricia Cronan; and a granddaughter.

For all his devotion to marketing and branding, Mr. Cronan felt that sometimes the demands of commerce went too far, as in the often-changing corporate names attached to sports stadiums and concert halls.

“There was a time in American life where going to a sporting event or a concert was sort of magical, because a lot of these places had these fun names,” he told The Denver Post in 2010. “But these days, with the amount of people craving advertising exposure, the sponsors have found a way to sell everything. They’re selling our nostalgia, and it’s sad.”

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Memo From London: Argentina’s Call for Return of Falkland Islands Causes a Stir

LONDON — They have barely 3,000 inhabitants and far more sheep than people. They are more than 8,700 miles from London. For much of the year, they are bitterly cold and wind-swept, with only open sea and ice between them and Antarctica. President Ronald Reagan, who tussled with Margaret Thatcher over them as he rarely did on any other issue that engaged the two leaders, described them once as “that little ice-cold bunch of land down there.”

But the Falkland Islands, the focus of a short war between Britain and Argentina in 1982, have been in the headlines again recently.

Politicians, newspapers and military leaders in both countries have been back at the barricades making the old arguments about who is the islands’ rightful owner. Their arguments suggest what has long been evident: nothing lasting was settled by the conflict that killed 255 British and 649 Argentine soldiers, sailors and airmen, as well as 3 civilians on the islands.

The British newspaper The Guardian heralded the latest outburst in an editorial on Friday that struck an exhausted note. “Here we go again,” it said, tacitly acknowledging that the paper has been stuck in something of a rut of its own on the issue for years in its calls for a negotiated settlement.

As it was in 1982, few British politicians, and only a minority of mostly left-of-center opinion in Britain, have been ready to deviate from the unyielding stance that Mrs. Thatcher adopted. She sent a British naval task force to recapture the islands after the Argentine military dictatorship of Leopoldo Galtieri dispatched troops to overrun the meager British garrison there.

To many on the British left, there is little to be served by rehashing the old arguments that were set off when President Cristina Fernández de Kirchner of Argentina wrote an open letter to Prime Minister David Cameron of Britain on Thursday. It was published as an advertisement in The Guardian and another left-of-center British daily, The Independent.

The letter appeared on the 180th anniversary of Jan. 3, 1833, when an armed clash between the two nations took place on the islands. The episode has been settled on by Argentina as a watershed moment in a convoluted colonial story that goes back to the 16th century and involves competing claims to sovereignty by Britain, France, Portugal and Spain, which was the colonial power in Argentina until the country gained independence in 1816. In the statement that ran in the British papers, Mrs. Kirchner asserted that “Argentina was forcibly stripped of the Malvinas Islands” — Argentina’s name for the territory — in the murky 1833 episode. The clash involved a British sloop, an outgunned Argentine vessel and an Argentine commander’s submission to a British demand that he remove the remnants of a mutinous Argentine garrison from the islands.

Britain has always rebutted Argentine claims that the people who were expelled included Argentine civilians, and it contends that British sovereignty was established by a much earlier settlement, dating to the mid-18th century.

The Guardian, in its editorial, dismissed this as political window dressing, ultimately irrelevant to the present dispute. Mrs. Kirchner’s letter, it said, had more to do with a populist bid to revive her slumping popularity in Argentina than “anything a British brig-sloop did 180 years ago.” The newspaper added, “Any objective reader of the history of these islands would more likely conclude that this history is mixed, to say the least, and that the rival sovereignty claims are finely balanced.” The editorial urged the two countries to grapple with the issue diplomatically and to aim, initially, for an agreement on sharing in the bounty of fisheries and in recently discovered offshore oil reserves that some economists believe could turn into a 21st-century bonanza for the islands.

Mr. Cameron, though, is having none of it. Within hours of Mrs. Kirchner’s statement, he went before television cameras, saying that the future of the islands would be determined by the Falkland Islanders and that they would make their feelings known in a referendum to be held in March on the islands’ political status.

That was the expedient Britain adopted last year when Mrs. Kirchner campaigned in Argentina, and at the United Nations in New York, for a reopening of the sovereignty issue on the 30th anniversary of the 1982 war.

“As long as they choose to stay with the United Kingdom, they have my 100 percent backing,” Mr. Cameron said.

For the British leader, it is a safe bet. About 70 percent of the islanders are of British descent, and visitors there say there is no more than a scattering of support for an Argentine takeover. Tying the Falklands’ future to the islanders’ choice leaves Britain essentially where it was under Mrs. Thatcher. She remains a revered figure for Mr. Cameron, not only for her conservative stewardship at 10 Downing Street but also for her success in turning the Falklands issue into her second general-election victory, in 1983. It is a precedent unlikely to be lost on the current prime minister as he contemplates the general election he must face in 2015.

If there is a worry for Mr. Cameron, it lies in the possibility that Argentina, with popular passions heightened by Mrs. Kirchner, may make another attempt to seize the islands by force. British military commanders say they consider that highly unlikely, since Argentina’s armed forces have been barely modernized since the military junta there collapsed in the wake of the 1982 conflict, and they lack the power they had then to project air and naval power.

British forces on the islands have been expensively upgraded, with 800 troops, a new military airfield equipped to take heavy transport jets, a squadron of Typhoon fighter-bombers and, at times of tension, a nuclear attack submarine prowling the South Atlantic.

But Britain miscalculated before, in 1982, when Mrs. Thatcher’s government brushed aside diplomatic warnings of an invasion.

“I never, never expected the Argentines to invade the Falklands head-on,” she told an inquiry after the war, according to secret cabinet papers from the period that were released in late December. “It was such a stupid thing to do, as events happened, such a stupid thing even to contemplate doing.”

The papers included another kind of warning. Little noticed among the newly published documents was the last dispatch of Britain’s ambassador to Argentina when the Falklands invasion took place.

The envoy, Anthony Williams, who was never assigned as an ambassador again, argued eloquently that Britain had been wrong to regard the Argentine invasion as “a simple act of brigandage.” He said that although the country had “its share of vandals, hooligans and roughs,” it also had a case that the ambassador suggested could be compared to the seizure of the Suez Canal from its British and French owners in 1956 by President Gamal Abdel Nasser of Egypt.

“If our rightness is not so absolute as it now seems to us, no more is Argentine wrongness,” he said.

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After Fiscal Deal, Tax Code May Be Most Progressive Since 1979

WASHINGTON — With 2013 bringing tax increases on the incomes of a small sliver of the richest Americans, the country’s top earners now face a heavier tax burden than at any time since Jimmy Carter was president.

The last-minute deal struck by the departing 112th Congress raised taxes on a handful of the highest-earning Americans, with about 99.3 percent of households experiencing no change in their income taxes. But the Tax Policy Center estimates that the average family in the top 1 percent will pay a federal tax rate of more than 36 percent this year, up from 28 percent in 2008. That is the highest rate since 1979, at least.

By some measures, the tax code might now be the most progressive in a generation, tax economists said, while noting that every American is paying a lower burden currently than they did then. In fact, the total federal tax rate is still vastly lower for the very rich than it was at any point in the 1940s through 1970s. It has risen from historical lows, but is still closer to those lows than where it was in the postwar decades.

“We made the system more progressive by raising rates at the top and leaving them for everyone else,” said Roberton Williams of the Tax Policy Center, a research group based in Washington. “The offsetting issue is that the rich have gotten a lot richer.”

Indeed, over the last three decades the bulk of pretax income gains have gone to the wealthy — and the higher up on the income scale, the bigger the gains, with billionaires outpacing millionaires who outpaced the merely rich. Economists doubted that the tax increases would do much to reverse that trend.

With the recovery failing to improve incomes for millions of average Americans and the country running trillion-dollar deficits, President Obama made “tax fairness” a centerpiece of his re-election campaign. In the heated negotiations with House Speaker John A. Boehner, that translated into the White House’s insistence on tax increases for the top 2 percent of households and a continuation of tax breaks and cuts for a vast number of taxpayers.

Republicans resisted increasing tax rates and aimed for lower revenue targets, arguing that spending was the budget’s primary problem and that no American should see his or her taxes go up too much in such a sluggish economy. But ultimately they relented, and Congress cut a last-minute deal.

“A central promise of my campaign for president was to change the tax code that was too skewed towards the wealthy at the expense of working middle-class Americans,” Mr. Obama said after Congress reached an agreement.

That deal includes a host of tax increases on the rich. It raises the tax rate to 39.6 percent from 35 percent on income above $400,000 for individuals, and $450,000 for couples. The rate on dividends and capital gains for those same taxpayers was bumped up 5 percentage points, to 20 percent. Congress also reinstated limits on the amount households with more than $300,000 in income can deduct. On top of that, two new surcharges — a 3.8 percent tax on investment income and a 0.9 percent tax on regular income — hit those same wealthy households.

As a result of the taxes added in both the deal and the 2010 health care law, which came into effect this year, taxpayers with $1 million in income and up will pay on average $168,000 more in taxes. Millionaires’ share of the overall federal tax burden will climb to 23 percent from 20 percent.

The result is a tax code that squeezes hundreds of billions of dollars more from the very well off — about $600 billion more over 10 years — while leaving the tax burden on everyone else mostly as it was. And the changes come after 30 years of both Republican and Democratic administrations doing the converse: zeroing out federal income taxes for many poor working families while also reducing the tax burden for households on the higher end of the income scale.

“Back at the end of the Carter and beginning of the Reagan administrations, we had a pretty severe income-tax burden for people at a low level of income. It was actually kind of appalling,” said Alan D. Viard, a tax expert at the American Enterprise Institute, a right-of-center research group in Washington. “Policy makers in both parties realized that was bad policy and started whittling away at it” by expanding credits and tinkering with tax rates.

After those changes and the new law, comparing average tax rates for poor households and wealthy households, 2013 might be the most progressive tax code since 1979. But economists cautioned that measuring progressivity is tricky. “It’s not like there is some scientific measure of progressivity all economists agreed upon,” said Leonard E. Burman, a professor of public affairs at Syracuse University. “People look at different numerical measures and they’ve changed in different ways at different income levels.”

Mr. Viard said that over time the code had become markedly more progressive for the poor compared with the middle class. But it arguably did not become much more progressive for the rich compared with the middle class, or the very rich compared with the rich, in part because of the George W. Bush-era tax cuts on investment income.

An anesthesiologist who earns a $500,000 salary subject to payroll and income taxes might pay a higher tax rate than a hedge fund manager making $1 billion subject mostly to capital-gains taxes, for instance.

Economists are also divided on the ultimate effect of those tax increases on the wealthy to income growth and income inequality in the United States. The recession hit the incomes of the rich hard, but they have snapped back much more strongly than those for middle or low-income workers.

“I’d still rather be really rich, even if I’m getting taxed much more than a low-income person” would be, Mr. Williams of the Tax Policy Center added.

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Scare Amplifies Fears That Clinton’s Work Has Taken Heavy Toll

Pool photo by Brendan Smialowski

Hillary Rodham Clinton with Field Marshal Mohamed Hussein Tantawi in Cairo in July.

WASHINGTON — When Secretary of State Hillary Rodham Clinton fractured her right elbow after slipping in a State Department garage in June 2009, she returned to work in just a few days. Her arm in a sling, she juggled speeches and a trip to India and Thailand with physical therapy, rebuilding a joint held together with wire and pins.

It was vivid evidence of Mrs. Clinton’s indomitable stamina and work ethic — as a first lady, senator, presidential candidate and, for the past four years, the most widely traveled secretary of state in American history.

But after a fall at home in December that caused a concussion, and a subsequent diagnosis of a blood clot in her head, it has taken much longer for Mrs. Clinton to bounce back. She was released from a hospital in New York on Wednesday, accompanied by her daughter, Chelsea, and her husband, former President Bill Clinton. On Thursday, she told colleagues that she hoped to be in the office next week.

Her health scare, though, has reinforced the concerns of friends and colleagues that the years of punishing work and travel have taken a heavy toll. Even among her peers at the highest levels of government, Mrs. Clinton, 65, is renowned for her grueling schedule. Over the past four years, she was on the road for 401 days and spent the equivalent of 87 full days on a plane, according to the State Department’s Web site.

In one 48-hour marathon in 2009 that her aides still talk about, she traveled from talks with Palestinian leaders in Abu Dhabi to a midnight meeting with Prime Minister Benjamin Netanyahu in Jerusalem, then boarded a plane for Morocco, staying up all night to work on other issues, before going straight to a meeting of Arab leaders the next morning.

“So many people who know her have urged me to tell her not to work so hard,” said Melanne S. Verveer, who was Mrs. Clinton’s chief of staff when she was first lady and is now the State Department’s ambassador at large for women’s issues. “Well, that’s not easy to do when you’re Hillary Clinton. She doesn’t spare herself.”

It is not just a matter of duty, Ms. Verveer and others said. Mrs. Clinton genuinely relishes the work, pursuing a brand of personal diplomacy that, she argues, requires her to travel to more places than her predecessors.

While there is no medical evidence that Mrs. Clinton’s clot was caused by her herculean work habits, her cascade of recent health problems, beginning with a stomach virus, has prompted those who know her best to say that she desperately needs a long rest. Her first order of business after leaving the State Department in the coming weeks, they say, should be to take care of herself.

Some even wonder whether this setback will — or should — temper the feverish speculation that she will make another run for the White House in 2016.

“I am amazed at the number of women who come up to me and tell me she must run for president,” said Ellen Chesler, a New York author and a friend of Mrs. Clinton’s. “But perhaps this episode will alter things a bit.”

Given Mrs. Clinton’s enduring status as a role model, Ms. Chesler said women would be watching which path she decides to take, as they plan their own transitions out of the working world.

“Do remember that women of our generation are really the first to have worked through the life cycle in large numbers,” she added. “Many seem to be approaching retirement with dread.”

For now, aides say, Mrs. Clinton’s focus is on wrapping up her work at the State Department. She would like to take part in a town hall-style meeting, thank her staff and sit for some interviews. But first she has to get clearance from her doctors, who are watching her to make sure that the blood thinners they have prescribed for her clot are working.

Speaking to a meeting of a foreign policy advisory board from her home in Chappaqua, N.Y., on Thursday, Mrs. Clinton said she was crossing her fingers and encouraging her doctors to let her return next week. “I’m trying to be a compliant patient,” she said, according to a person who was in the room. “But that does require a certain level of patience, which I’ve had to cultivate over the last three and a half weeks.”

While convalescing, Mrs. Clinton has spoken with President Obama and has held a 30-minute call with Senator John Kerry, Democrat of Massachusetts, whom Mr. Obama nominated as her successor.

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Scare Amplifies Fears That Clinton’s Work Has Taken Heavy Toll

Pool photo by Brendan Smialowski

Hillary Rodham Clinton with Field Marshal Mohamed Hussein Tantawi in Cairo in July.

WASHINGTON — When Secretary of State Hillary Rodham Clinton fractured her right elbow after slipping in a State Department garage in June 2009, she returned to work in just a few days. Her arm in a sling, she juggled speeches and a trip to India and Thailand with physical therapy, rebuilding a joint held together with wire and pins.

It was vivid evidence of Mrs. Clinton’s indomitable stamina and work ethic — as a first lady, senator, presidential candidate and, for the past four years, the most widely traveled secretary of state in American history.

But after a fall at home in December that caused a concussion, and a subsequent diagnosis of a blood clot in her head, it has taken much longer for Mrs. Clinton to bounce back. She was released from a hospital in New York on Wednesday, accompanied by her daughter, Chelsea, and her husband, former President Bill Clinton. On Thursday, she told colleagues that she hoped to be in the office next week.

Her health scare, though, has reinforced the concerns of friends and colleagues that the years of punishing work and travel have taken a heavy toll. Even among her peers at the highest levels of government, Mrs. Clinton, 65, is renowned for her grueling schedule. Over the past four years, she was on the road for 401 days and spent the equivalent of 87 full days on a plane, according to the State Department’s Web site.

In one 48-hour marathon in 2009 that her aides still talk about, she traveled from talks with Palestinian leaders in Abu Dhabi to a midnight meeting with Prime Minister Benjamin Netanyahu in Jerusalem, then boarded a plane for Morocco, staying up all night to work on other issues, before going straight to a meeting of Arab leaders the next morning.

“So many people who know her have urged me to tell her not to work so hard,” said Melanne S. Verveer, who was Mrs. Clinton’s chief of staff when she was first lady and is now the State Department’s ambassador at large for women’s issues. “Well, that’s not easy to do when you’re Hillary Clinton. She doesn’t spare herself.”

It is not just a matter of duty, Ms. Verveer and others said. Mrs. Clinton genuinely relishes the work, pursuing a brand of personal diplomacy that, she argues, requires her to travel to more places than her predecessors.

While there is no medical evidence that Mrs. Clinton’s clot was caused by her herculean work habits, her cascade of recent health problems, beginning with a stomach virus, has prompted those who know her best to say that she desperately needs a long rest. Her first order of business after leaving the State Department in the coming weeks, they say, should be to take care of herself.

Some even wonder whether this setback will — or should — temper the feverish speculation that she will make another run for the White House in 2016.

“I am amazed at the number of women who come up to me and tell me she must run for president,” said Ellen Chesler, a New York author and a friend of Mrs. Clinton’s. “But perhaps this episode will alter things a bit.”

Given Mrs. Clinton’s enduring status as a role model, Ms. Chesler said women would be watching which path she decides to take, as they plan their own transitions out of the working world.

“Do remember that women of our generation are really the first to have worked through the life cycle in large numbers,” she added. “Many seem to be approaching retirement with dread.”

For now, aides say, Mrs. Clinton’s focus is on wrapping up her work at the State Department. She would like to take part in a town hall-style meeting, thank her staff and sit for some interviews. But first she has to get clearance from her doctors, who are watching her to make sure that the blood thinners they have prescribed for her clot are working.

Speaking to a meeting of a foreign policy advisory board from her home in Chappaqua, N.Y., on Thursday, Mrs. Clinton said she was crossing her fingers and encouraging her doctors to let her return next week. “I’m trying to be a compliant patient,” she said, according to a person who was in the room. “But that does require a certain level of patience, which I’ve had to cultivate over the last three and a half weeks.”

While convalescing, Mrs. Clinton has spoken with President Obama and has held a 30-minute call with Senator John Kerry, Democrat of Massachusetts, whom Mr. Obama nominated as her successor.

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Common Sense: Google Finds a Line Between ‘Aggressive’ and ‘Evil’

“Don’t Be Evil,” the founders of Google, Larry Page and Sergey Brin, proclaimed in their 2004 “Owner’s Manual” for prospective investors in the company. Despite widespread cynicism, criticism and even mockery, the company has never backed down on this core premise, reiterating in its most recent list of the “things we know to be true” that “you can make money without doing evil.”

Mladen Antonov/Agence France-Presse — Getty Images

Jon Leibowitz, chairman of the F.T.C., at the announcement of its Google antitrust ruling.

Yet the company has been dogged for years by widespread allegations that it violates its own pledge by manipulating the search results that remain the core of the company and the primary source of its enormous profits.

Google insists that its results have always been “unbiased and objective” and that they are “the best we know how to produce.” But for competitive reasons, it never disclosed the secret algorithms that produce those results, so no one outside the company knew for sure. A growing chorus of complaints from companies like Expedia, Yelp and, especially, Microsoft that Google manipulates the results to favor its interests at the expense of competitors led both the United States government and the European Union to take up the issue. On Thursday, after nearly two years of investigation, the Federal Trade Commission rendered a verdict: Google isn’t evil.

It may have been “aggressive,” as the commission delicately put it. But “regarding the specific allegations that the company biased its search results to hurt competition, the evidence collected to date did not justify legal action by the commission,” said Beth Wilkinson, outside counsel to the F.T.C. “The F.T.C.’s mission is to protect competition, and not individual competitors.”

The decision is “a huge victory for Google,” Randal Picker, a professor of commercial law at the University of Chicago Law School and a specialist in antitrust and intellectual property, told me just after this week’s decision.

It’s also a vindication of the integrity of Google’s search results and the company’s credibility. “There’s never been any evidence that consumers were harmed by Google’s practices, and no evidence that Google ever engaged in any manipulation that violates antitrust law,” said Eric Goldman, a professor of law and director of the High Tech Law Institute at Santa Clara University School of Law.

The decision is also likely to set standards for competition on the Internet for years to come. It’s a blow to competitors like Microsoft, which has been stirring up opposition to Google for years, not to mention newer rivals like Facebook, Apple and Amazon. “The gloves will be off,” Professor Picker predicted. “The F.T.C. has indicated it’s going to be taking a very cautious approach toward regulating competition on the Internet.”

But will the decision ultimately prove to be good for consumers?

The F.T.C. did secure some concessions from Google regarding patent licensing and advertiser options. But to call those a slap on the wrist would be an overstatement.

What mattered most to both Google users and competitors was Google’s search practices, which had never been put under the regulatory microscope to such a degree and which the F.T.C. left untouched.

Google’s search results have evolved significantly from its early, simpler days. When I searched for “flight JFK to LAX” this week, I got three categories of results: paid ads at the top and on the right; a Google-produced chart comparing flight options with the disclaimer, which you need to click on, that “Google may be compensated by these providers”; and so-called organic results below that. The first two organic results were entries for Expedia, a rival to Google’s travel site. But given the layout and size of my screen, none of the organic results were visible unless I scrolled down.

However clearly labeled, the prominence of Google’s own travel results gives pause to some antitrust experts. “Location is important,” Professor Picker said. “No one thinks otherwise. Years ago, it was important for airlines’ reservations systems to be on the first screen. But I’m not sure this is an antitrust problem.”

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Digital Technology Is Making Its Mark in Cuba

Jose Goitia for The New York Times

The director Carlos Lechuga at the International Festival of New Latin American Cinema in Havana.

HAVANA — Sebastián Miló barely had enough money to put gasoline in the aged bus that ferried his crew to the set each day, let alone to pay actors a salary.

But Mr. Miló, a 33-year-old Cuban filmmaker, had a Canon 5D digital camera and a story to tell. So, during one frenetic week in May 2011, he shot “Truckdriver,” a tense 25-minute film about bullying at one of the vaunted rural boarding schools where millions of Cubans used to spend part of their high school education.

“It was something I went through myself, and so did many people I know,” said Mr. Miló, referring to incidents of bullying that dogged him at school and, later, during military service. “The subject struck a chord.”

Mr. Miló is one of hundreds of Cuban filmmakers who, armed with digital technology, are laying the foundations of an independent movie industry outside the state apparatus that has defined Cuban cinema for much of the Castro era — and still, much to the frustration of some filmmakers, controls access to the island’s movie theaters.

Around the country, Cubans are making features, shorts, documentaries and animated works, often with little more than a couple of friends and some inexpensive equipment — and little input from the state-supported Cuban Institute of Cinematic Art and Industry.

Mr. Miló, who received about $10,000 in financing from a Spanish production company, Idunnu Music and Visual Arts, said that the crew and actors worked for next to nothing. “They said they felt strongly about what the film was saying,” he said.

The global boom in digital filmmaking has rippled across Cuba over the past decade, letting filmmakers create their work beyond the oversight of state-financed institutions. Independent movies have become a new means of expression in a country where, despite freedoms and economic reforms introduced by President Raul Castro since 2006, the state still carefully controls national press, television and radio, and access to the Internet is very limited.

While there is no official tally of independent movies, they have gained prominence on the national scene. They dominate the Cuban offerings at the International Festival of New Latin American Cinema in Havana and scored a new level of commercial visibility last year with “Juan of the Dead,” a zombie movie that was released in several countries, including the United States.

“They’re bringing fresh ideas; they’re experimenting,” said Javier Ernesto Alejándrez, 21, a humanities student waiting in line last month to see the independent feature “Pablo,” shown as part of the film festival.

“There’s a lot of creativity, and they are really thinking about stuff,” said Alexandra Halkin, the director of the Americas Media Initiative, a nonprofit group that distributes and promotes Cuban film overseas. “They just need more tools and more space.”

For decades, the film institute was an important tool of the government’s program to educate Cubans and build a national narrative under the Communist system, annually producing dozens of documentaries and features and nurturing acclaimed directors, including Tomás Gutiérrez Alea (known as Titon), Humberto Solás and Fernando Pérez. The institute’s financing plummeted after the Soviet Union collapsed, and it now relies on foreign sources to produce a handful of features each year.

The explosion of independent film has yielded an uneven jumble of movies that draw on genres eschewed by the establishment — like thrillers and horror — and that offer raw depictions or biting satire about the darker side of life on the island.

Miguel Coyula, whose surreal, fragmentary feature “Memories of Overdevelopment” was shown at the Sundance Film Festival in 2010, said that while no specific trend had emerged, there was a greater willingness to tackle riskier and risqué subjects — even Fidel Castro — and document issues not covered by the official press.

Some movies offer a glimmer of a promising new generation, experts and filmmakers say, citing the experimental documentaries of Marcel Beltrán and Armando Capó, which will be included in a program at the Museum of Modern Art in February; Victor Alfonso’s humorous animated shorts about a high school nerd; Carlos Machado Quintela’s feature-length movie “The Swimming Pool,” about a group of physically disabled children and their swimming instructor; and the work of more established practitioners like Mr. Coyula and Esteban Insausti, whose work has been screened at many foreign festivals, including Cannes.

Carlos Lechuga, 29, whose debut feature film, “Melaza” (“Molasses”), tells a story of social degradation in a sugar town whose mill has been shuttered, said that independent movies were nourishing a conversation among Cubans keen to see the hard realities of their lives dealt with on screen.

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U.S. Economy Adds 155,000 Jobs; Jobless Rate Is 7.8%

American employers added 155,000 jobs in December, about apace with job growth over the last year, the Labor Department reported on Friday.

The biggest gains were in health care, food services, construction and manufacturing, and the government sector showed modest job losses, the report said. The unemployment rate was 7.8 percent, the same as in November, whose rate was revised up from 7.7 percent.

“It’s not a home-run report by any stretch, but it’s constructive,” said John Ryding, chief economist at RDQ Economics. “It’s another month of fairly stable, solid, moderate job creation.”

Over the course of 2012, the country added 1.8 million net jobs, despite continued job losses in the government sector and anxiety and uncertainty related to a looming fiscal tightening.

Economists are unsure of what the rest of the year holds for the American job market, but most are forecasting more of the same: hiring fast enough to stay just ahead of population growth, but still too slow to make a sizable dent in the 12.2-million-person backlog of unemployed workers.

A number of encouraging trends in the economy suggest that businesses have good reason to speed up hiring, including the housing recovery, looser credit for small businesses, a rebound in China and pent-up demand for new autos. Friday’s jobs report also showed slightly faster wage growth and longer working hours in December, both of which bode well for hiring.

But Congress’s last-minute deal to raise taxes earlier this week will offset some of these sources of growth, since higher taxes trim how much money consumers have available to spend each week.

“Job creation might firm a little bit, but it’s still looking nothing like the typical recovery year we’ve had in deep recessions in the past,” Mr. Ryding said. “There’s nothing in the deal to do that and nothing in this latest jobs report to suggest that. We’re a long way short of the 300,000 job growth that we need."

The fiscal compromise also renewed for a year the federal government’s emergency unemployment benefits program. That allows workers to continue receiving unemployment benefits for up to 73 weeks, depending on the unemployment rate in the state where they live, and acts as a stimulus to the American economy because unemployment benefits are spent almost immediately.

The extension has proved to be a tremendous relief to the 2 million workers who would have otherwise abruptly lost their benefits this week.

“We woke up on Wednesday morning and saw the news and just said, ‘thank God, thank God, thank God,’ and then went out and went food shopping because we knew we had money coming in,” said Gina Shadis, 56, of Newton, N.J.

Both she and her husband, Stephen, were laid off within the last 14 months from jobs they had held for more than a decade: she from a quality assurance manager position at an environmental testing lab, and he as foreman and senior master technician at an auto dealership. They are now each receiving $548 per week in federal jobless benefits, or about a quarter of their pay at their most recent jobs.

“It has just been such a traumatic time,” she said. “You know you wake up in the morning with shoulders tense and head aching because you didn’t sleep the night before from worrying.”

While Congress’s deal on New Year’s Day brought clarity to tax and unemployment benefits policies, lawmakers have still not settled their disputes about federal spending cuts and the debt ceiling. Economists worry that the lingering uncertainty over these issues could discourage businesses from investing in more workers or equipment.

“We may be seeing the calm before the storm right now,” said Ian Shepherdson, chief economist at Pantheon Macroeconomic Advisors, noting that a recent survey from the National Federation of Independent Business found that alarmingly few small companies plan to hire in the coming months. “Small businesses are wringing their hands in horror at what’s going on in Washington.”

In the meantime, more than six million workers have exhausted their unemployment benefits altogether since the recession began in December 2007, according to the National Employment Law Project, a labor advocacy group.

Millions of workers are sitting on the sidelines and so are not counted in the total tally of unemployed. Some are merely waiting for the job market to improve, and others are trying to invest in skills to appeal to employers who are already hiring.  

“I have a few prospects who say they want me to work for them when I graduate,” said Jordan Douglas, a 24-year-old single mother in Pampa, Tex., who is enrolled in a special program that allows her to receive jobless benefits while attending school full time to become a registered nurse. She gets $792 in benefits every two weeks, a little less than half of what she earned in an administrative position at the nursing home that laid her off last year.

She calculates that her federal jobless benefits will run out the very last week of nursing school.

“This had to have been a sign from God that I had to do this since it all worked out so well,” she said.

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