Governors Fall Away in G.O.P. Opposition to More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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Sign of a Comeback: U.S. Carmakers Are Hiring

Tony Dejak/Associated Press

Joseph R. Hinrichs, head of Ford's Americas region, with a two-liter EcoBoost engine at the Cleveland plant.

DETROIT — A few years ago, American automakers cut tens of thousands of jobs and shut dozens of factories simply to survive.

But since the recession ended and General Motors and Chrysler began to recover with the help of hefty government bailouts and bankruptcy filings, all three Detroit car companies including Ford Motor Company have achieved one of the unlikeliest comebacks among industries devastated during the financial crisis.

Now steadily rising auto sales and two-tier wage concessions from labor have spurred a wave of new manufacturing investments and hiring by the three Detroit automakers in the United States. The latest development occurred on Thursday, when Ford said it was adding 450 jobs and expanding what had been a beleaguered engine plant in Ohio to feed the growing demand for more fuel-efficient cars and S.U.V.’s in the American market.

Ford, the nation’s second-largest automaker after G.M., said it would spend $200 million to renovate its Cleveland engine plant to produce small, turbocharged engines used in its top-selling models. Ford plans to centralize production of its two-liter EcoBoost engine — used in popular models like the Fusion sedan and Explorer S.U.V. — at the Cleveland facility by the end of next year.

Its move to expand production in the United States is yet another tangible sign of recovery among the Detroit auto companies. Industrywide sales in the United States are expected to top 15 million vehicles this year after sinking beneath 11 million in 2009.

Last month, G.M. announced plans to invest $600 million in its assembly plant in Kansas City, Kan., one of the company’s oldest factories in the country. And Chrysler, the smallest of the Detroit car companies, is adding a third shift of workers to its Jeep plant in Detroit.

The biggest factor in the market’s revival has been the need by consumers to replace aging, gas-guzzling models. “Pent-up demand and widespread access to credit are keeping up the sales momentum,” said Jessica Caldwell, an analyst with the auto research site Edmunds.com.

And Joseph R. Hinrichs, the head of Ford’s Americas region, explained in an interview that the company’s Ohio revival plan was “all based on increased demand.”

“We’re putting the capacity here because that’s where we need it most,” he said.

Yet even though Ford is enjoying a resurgence in the United States, it is racing to reduce costs in its troubled European division. The workers in Spain who were building the small EcoBoost engines that have been shipped to America will be moved to an assembly plant that is taking on work from a plant to be closed in Belgium.

While Ford survived the industry’s financial crisis without government help, it still cut thousands of jobs and shuttered several factories to reduce costs and bring production more in line with shrinking sales.

But now, the burst of showroom business has prompted automakers to increase output at remaining plants. In Ford’s case, the company added about 8,000 salaried and hourly jobs last year, and has said it plans to hire about 2,200 white-collar workers in 2013. Ford is also moving some vehicle production from Mexico to a Michigan plant, where it will add 1,200 jobs.

The investment in Cleveland is indicative of how Ford and other carmakers have trimmed domestic labor costs and improved productivity since the recession. Just a few years ago, the company was forced to consolidate two engine plants into one in northern Ohio, and close a major component operation. “No question we have been through a lot in northern Ohio,” Mr. Hinrichs said. “But now our North American business is very competitive with the best in the world.”

Mr. Hinrichs said that a new local agreement with the United Automobile Workers union in Cleveland paved the way for the expansion. Currently the plant employs about 1,300 workers.

The Detroit companies are also benefiting from their ability to hire lower-paid, entry-level workers as part of their national contract with the U.A.W. Many of the 450 new workers at the Cleveland plant will start at $16 an hour, compared to about $28 for veteran union members, and some of the new engine plant workers could include employees from other Ohio plants.

“With our competitive labor agreements, we can bring business back to the U.S. from Spain and Mexico,” Mr. Hinrichs said.

Employment still falls far short of levels in the 1990s, when cheap gas and the popularity of S.U.V.’s led to big profits in Detroit.

The auto manufacturing sector employed 1.1 million people in the United States as recently as 1999, according to a recent study by the Center for Automotive Research in Ann Arbor, Mich. About one-third of those jobs were in the final assembly of vehicles, and the balance in the production of auto parts.

Employment dropped as low as 560,000 in 2009. Since then, about 90,000 jobs have been added, the report said.

This article has been revised to reflect the following correction:

Correction: February 21, 2013

Because of an editing error, an earlier version of this article gave a false impression of sales among the Detroit auto companies. Overall auto sales in the United States are expected to top 15 million this year, not sales among the Detroit automakers.

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Police Detective in Pistorius Case Faces Attempted Murder Charges

PRETORIA, South Africa — In a remarkable twist in the case of Oscar Pistorius, the double amputee track star accused of murdering his girlfriend, the South African police said on Thursday that the officer leading the investigation against the athlete is himself facing seven criminal charges of attempted murder.

The disclosure seemed to present one more setback for the prosecution and to deepen questions surrounding the detective, Hilton Botha. When the bail hearing resumed on Thursday — Mr. Pistorius’s fourth court appearance since the killing on Feb. 14 — the chief prosecutor, Gerrie Nel, began by explaining the events relating to his lead witness and the charges of attempted murder. “The case was originally dropped but now it has been reinstated,” Mr. Nel said.

Mr. Botha was not in court at the time and the Pistorius hearing was briefly adjourned while court officers went to find him. Under cross-examination on Wednesday, the detective was forced to concede that he could not rule out Mr. Pistorius’s own version of events based on the existing evidence, apparently undermining the prosecution’s account. While the prosecution has accused Mr. Pistorius, 26, of the premeditated murder of his girlfriend Reeva Steenkamp, 29, a week ago, the track star himself said he opened fire thinking there was an intruder in his home in a gated community and had no intention of killing her.

But the case has continued to take a toll on his global reputation as an emblem of athletic prowess and of triumph over adversity. On Thursday, the Nike company became the latest corporate sponsor to suspend ties with him. “We believe Oscar Pistorius should be afforded due process and we will continue to monitor the situation closely,” the company said in a statement on its Web site. In Pretoria, in a development that seemed as bewildering as it was sensational on Thursday, Police Brig. Neville Malila said that Mr. Botha is himself set to appear in court in May facing attempted murder charges relating to an incident in October 2011, when Mr. Botha and two other police officers were accused of firing at a minivan carrying seven people.

The case had initially been dropped. News of its reinstatement at the insistence of the state prosecutor r emerged hours after Mr. Botha appeared as the lead police witness in the prosecution’s attempt to prevent Mr. Pistorius from securing bail.

“Botha and two other policemen allegedly tried to stop a minibus taxi with seven people. They fired shots," Brigadier Malila told Reuters.

“We were informed yesterday that the charges will be reinstated,” he said. “At this stage, there are no plans to take him off the Pistorius case.”

South African news reports said the officers at the time were pursuing a man accused of murdering and dismembering a woman before putting the body parts into a drain.

Prosecutors said initially on Thursday that they were unaware of the charges when they called Detective Botha as their lead witness in the argument over bail on Wednesday.

But Medupe Simasiku, a spokesman for the National Prosecuting Authority, said “the decision to reinstate was taken on Feb. 4, way before the issue of Pistorius” or the shooting death of Ms. Steenkamp “came to light.”

“It’s completely unrelated to this trial,” the spokesman told Reuters.

Mr. Botha was quoted in South African news reports as denying claims that he was drunk during the alleged shooting in 2011. He said he and other officers had opened fire on the wheels of the minivan without causing injuries and he was convinced that the case had been withdrawn.

Calling the timing of the reinstated charges “totally weird,” Bulewa Makeke, a spokeswoman for the National Prosecuting Authority, told The Associated Press that Mr. Botha should be replaced but the final decision depends on the police, not the prosecutors.

Mr. Pistorius returned to court on Thursday for further arguments about whether he should be granted bail in a case that has riveted South Africa and fascinated a wider audience, reflecting Mr. Pistorius’s status as one of the world’s most renowned athletes, whose distinctive carbon-fiber running blades have given him the nickname Blade Runner.

On Wednesday, what was supposed to be a simple bail hearing took on the proportions of a full-blown trial, with sharp questions from the presiding magistrate, Desmond Nair, and a withering cross-examination that left Detective Botha grasping for answers that did not contradict his earlier testimony.

Initially, Detective Botha explained how preliminary ballistic evidence supported the prosecution’s assertion that Mr. Pistorius had been wearing prosthetic legs when he shot at a bathroom door early on Feb. 14. Ms. Steenkamp, a model and law school graduate, was hiding behind it at the time.

Mr. Pistorius said in an affidavit read to the court on Tuesday that he had hobbled over from his bed on his stumps and had felt extremely vulnerable to a possible intruder as a result.

But when questioned by Barry Roux, Mr. Pistorius’s lawyer, Detective Botha was forced to acknowledge sloppy police work, and he eventually conceded that he could not rule out Mr. Pistorius’s version of events based on the existing evidence. Mr. Roux accused the prosecution of selectively taking “every piece of evidence” and trying “to extract the most possibly negative connotation and present it to the court.”

Lydia Polgreen reported from Pretoria, South Africa, and Alan Cowell from London.

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Prosecutors: Detective should be dropped from case

PRETORIA, South Africa (AP) — South Africa's National Prosecuting Authority acknowledged that the timing of attempted murder charges against a police detective leading the investigation into Oscar Pistorius is "totally weird" and that he should dropped from the case against the world-famous athlete.

Bulewa Makeke, spokeswoman for the NPA, said Thursday that detective Hilton Botha should be replaced, but that it's a decision for police and not prosecutors.

Police said Thursday that Botha, who gave testimony Wednesday opposing Pistorius' application for bail, faces attempted murder charges in connection with a 2011 shooting incident.

Police said Botha and two other police officers had fired at a minibus and will appear in court in May to face seven counts of attempted murder.

Pistorius is charged with premeditated murder in the Valentine's Day shooting of his girlfriend.

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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The Trade: A Revolving Door in Washington With Spin, but Less Visibility

Obsess all you’d like about President Obama’s nomination of Mary Jo White to head the Securities and Exchange Commission. Who heads the agency is vital, but important fights in Washington are happening in quiet rooms, away from the media gaze.

After a widely praised stint as a tough United States attorney, Ms. White spent the last decade serving so many large banks and investment houses that by the time she finishes recusing herself from regulatory matters, she may be down to overseeing First Wauwatosa Securities.

Ms. White maintains she can run the S.E.C. without fear or favor. But the focus shouldn’t be limited to whether she can be effective. For lobbyists, the real targets are regulators and staff members for lawmakers.

Ms. White, at least, will have to sit for Congressional testimony, answer occasional questions from the media and fill out disclosure forms. Staff members, however, work in untroubled anonymity for the most part. So, while everyone knows there’s a revolving door — so naïve to even bring it up! — few realize just how fluidly it spins.

Take what happened late last month as Washington geared up for more fights about the taxing, spending and the deficit. The Senate majority leader, Harry Reid, Democrat of Nevada, decided to bolster his staff’s expertise on taxes.

So on Jan. 25, Mr. Reid’s office announced that he had appointed Cathy Koch as chief adviser to the majority leader for tax and economic policy. The news release lists Ms. Koch’s admirable and formidable experience in the public sector. “Prior to joining Senator Reid’s office,” the release says, “Koch served as tax chief at the Senate Finance Committee.”

It’s funny, though. The notice left something out. Because immediately before joining Mr. Reid’s office, Ms. Koch wasn’t in government. She was working for a large corporation.

Not just any corporation, but quite possibly the most influential company in America, and one that arguably stands to lose the most if there were any serious tax reform that closed corporate loopholes. Ms. Koch arrives at the senator’s office by way of General Electric.

Yes, General Electric, the company that paid almost no taxes in 2010. Just as the tax reform debate is heating up, Mr. Reid has put in place a person who is extraordinarily positioned to torpedo any tax reform that might draw a dollar out of G.E. — and, by extension, any big corporation.

Omitting her last job from the announcement must have merely been an oversight. By the way, no rules prevent Ms. Koch from meeting with G.E. or working on issues that would affect the company.

The senator’s office, which declined to make Ms. Koch available for an interview, says that she will support the majority leader in his efforts to close corporate tax loopholes. His office said in a statement that the senator considered her knowledge of the private sector to be an asset and that she complied with “all relevant Senate ethics rules and disclosures.”

In a statement, the senator’s spokesman said, “The impulse in some quarters to reflexively cast suspicion on private sector experience is part of what makes qualified individuals reluctant to enter public service.”

Over in bank regulatory land, meanwhile, January was playing out like a Beltway remake of “Freaky Friday.”

Julie Williams, chief counsel for the Office of the Comptroller of the Currency and a major friend of the banks for years, had been recently shown the door by Thomas J. Curry, the new head of the regulator. Banking reform advocates took that to be an omen that a new era might be dawning at the agency, which has often been a handmaiden to large banks.

Ms. Williams, of course, landed on her feet. She’s now at the Promontory Financial Group, a classic Washington creature that is a private sector mirror image of a regulatory body. Promontory is the Shadow O.C.C. The firm was founded by a former head of the agency, Eugene A. Ludwig, and if you were to walk down the halls swinging a copy of the Volcker Rule, you would be sure to hit a former O.C.C. official. Promontory says only about 5 percent of its employees come from the O.C.C., but concedes that more than a quarter are former regulators.

Promontory, as the firm explains on its Web site, “excels at helping financial companies grapple with and resolve critical issues, particularly those with a regulatory dimension.” But it plays for the other team, too, by helping the O.C.C. put into effect regulatory reviews. The dreary normality of this is a Washington scandal in the Michael Kinsley sense: a perfectly legal one.

Promontory, which demurred on a request to talk with Ms. Williams, has a different view. The firm doesn’t lobby or help in litigation. It argues that after banks stop fighting regulators and lobbying against rules, then they come to Promontory to figure out how to fix their problems and comply.

“We are known in the industry as the tough-love doctors,” said Mr. Ludwig, the chief executive of Promontory. “I am deeply committed to financial stability, and the only way to have stability is to do the right thing in both the spirit and letter of the law.”

Hmm. Remember the Independent Foreclosure Review, the program that the O.C.C. and other federal bank regulators trumpeted as the largest effort to compensate victims of big banks’ foreclosure abuses? As my colleague at ProPublica, Paul Kiel, detailed last year, that review involved consultants like Promontory essentially letting banks decide who was victimized. How well did that work? So well that the regulators had to scuttle the program because it hadn’t given one red cent to homeowners but somehow, I don’t know how, managed to send more than $1.5 billion to consultants — including Promontory.

Promontory maintains that it complied with the conditions set out by the O.C.C. And the review was replaced by a settlement, which the regulators say will compensate victims — though the average payout is small beer.

Who, exactly, makes the rules at the O.C.C.? I mentioned “Freaky Friday.” That’s because at the agency, Ms. Williams is being replaced by Amy Friend. And where is Ms. Friend coming from? Wait for it … Promontory. In March, maybe they’ll do the switcheroo back.

The O.C.C. didn’t make Ms. Friend available but said that her “talent, integrity and commitment to public service are beyond reproach” and would be subject to the rule requiring her to recuse herself for a year on matters specifically relating to her former employer.

I spoke with people who said she was a smart and dedicated public servant, an expert on the Dodd-Frank Act who can help complete the scandalously long list of unfinished rules and expedite its adoption.

“Amy Friend is absolutely rowing in the right direction,” said a Senate staff member who worked on efforts to push for stronger financial regulation.

Let’s hope so.

But people also described Ms. Friend as pragmatic. In Washington, that’s the ultimate compliment. Sadly, that has come to mean someone who seeks compromise and never pushes for an overhaul when a quarter-measure will do.

Washington today resembles something like the end of “Animal Farm.” People move from one side of the table to the other and up and down the Acela corridor with ease. An outsider looking at a negotiating table would glance from lobbyist to staff member, from colleague to former colleague, from pig to man and from man to pig and find it impossible to say which is which.

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India Ink: Cameron Calls Colonial-Era Massacre in India 'Shameful'

NEW DELHI – Britain’s prime minister laid a wreath at the site of a notorious 1919 massacre that cost the lives of hundreds of Indians and has long been seen as one of the British Empire’s most shameful episodes.

David Cameron was the first serving prime minister to voice regret about the Jallianwala Bagh massacre in Amritsar, although Queen Elizabeth made a similar appearance in 1997 that at the time caused an outpouring of pained reflections about India’s colonial history under Britain. Mr. Cameron’s trip, perhaps because it is his third one here, or because Britain’s role in India has become relatively less important, has caused far less comment and consternation.

“This was a deeply shameful event in British history – one that Winston Churchill rightly described at that time as monstrous,” Mr. Cameron wrote in the visitor’s notebook at the pink granite memorial.

Like the queen before him, Mr. Cameron did not offer a full apology, a fact that was duly noted by Indian media. Britain’s colonial history is so replete with regrettable episodes that officials have quietly worried that an apology for one episode might lead to an outpouring of demands for similar apologies all over the world.

In 1919, Brig. Reginald Dyer, a British officer administering martial law, ordered 50 soldiers to open fire on a crowd of about 10,000 unarmed Indians protesting a postwar extension of World War 1 detention laws. A British inquiry concluded that 379 people were killed and 1,100 wounded, but an Indian inquiry estimated that 1,000 died.

Fortunately for Mr. Cameron, Prince Philip was not on this trip. When Queen Elizabeth visited the Amritsar memorial in 1997, the queen’s royal consort was overheard griping that the memorial’s official signage “vastly exaggerated” the death toll, a fact that he said he had learned from Brigadier Dyer’s son when the two men were cadets in the Royal Navy before World War II.

The nearly sacrilegious remark touched off a storm of commentary, little of it beneficial to the visitors. The Amritsar massacre is seen by many Indian historians as a crucial moment in the country’s struggle for independence.

Mr. Cameron’s trip is intended to bolster the two countries’ business and trade ties and perhaps strengthen his support among 1.5 million British voters of Indian descent. On Tuesday, Indian Prime Minister Manmohan Singh asked for Mr. Cameron’s assistance in the increasingly embarrassing bribery investigation into India’s purchase of 12 AgustaWestland helicopters made at a plant in Britain.

AgustaWestland’s parent company, Finmeccanica, is based in Italy, and the company’s chairman and chief executive, Giuseppe Orsi, was arrested recently on corruption and fraud charges after investigators charged that Finmeccanica had engaged in an elaborate scheme to bribe Indian generals to win the contract, charges that at least one of the top generals has firmly denied. The case has become a black eye for Mr. Singh’s governing coalition.

While stressing that Finmeccanica is “an Italian company,” Mr. Cameron promised to “respond to any request for information.”

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Police oppose bail for Pistorius

PRETORIA, South Africa (AP) — Killing suspect Oscar Pistorius is a flight risk and should not be granted bail, South African police argued in court Wednesday.

Pistorius is charged with premeditated murder for the Valentine's Day shooting death of girlfriend Reeva Steenkamp with a 9 mm pistol.

Pistorius asserted in a court affidavit Tuesday that the shooting was accidental and he thought the model was an intruder in his home.

Police officer Hilton Botha said in the star athlete's bail hearing Wednesday that Pistorius illegally possessed .38-caliber ammunition in a safe in his bedroom. The policeman testified that Pistorius did not have a license for a .38-caliber weapon and consequently possession of that ammunition was illegal.

The detective said that all Pistorius would say after the shooting was "he thought it was a burglar."

In an additional revelation Wednesday, police said they found two boxes of testosterone and needles in the Pistorius' bedroom.

Pistorius' defense lawyer, Barry Roux, said the substance found in the bedroom was a "herbal remedy" not a steroid and not a banned substance.

Prosecutor Gerrie Nel said police are not saying that Pistorius used the substance, simply that it was found in his bedroom.

Pistorius became the first Paralympian runner to compete at the Olympic Games in London last year.

Pistorius, 26, has insisted he shot the 29-year-old Steenkamp by mistake, fearing there was an intruder in his gated and guarded luxury complex in the capital, Pretoria.

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Well: No Consensus on Plantar Fasciitis

Phys Ed

Gretchen Reynolds on the science of fitness.

There are more charismatic-sounding sports injuries than plantar fasciitis, like tennis elbow, runner’s knee and turf toe. But there aren’t many that are more common. The condition, characterized by stabbing pain in the heel or arch, sidelines up to 10 percent of all runners, as well as countless soccer, baseball, football and basketball players, golfers, walkers and others from both the recreational and professional ranks. The Lakers star Kobe Bryant, the quarterback Eli Manning, the Olympic marathon runner Ryan Hall and the presidential candidate Mitt Romney all have been stricken.

But while plantar fasciitis is democratic in its epidemiology, its underlying cause remains surprisingly enigmatic. In fact, the mysteries of plantar fasciitis underscore how little is understood, medically, about overuse sports injuries in general and why, as a result, they remain so insidiously difficult to treat.

Experts do agree that plantar fasciitis is, essentially, an irritation of the plantar fascia, a long, skinny rope of tissue that runs along the bottom of the foot, attaching the heel bone to the toes and forming your foot’s arch. When that tissue becomes irritated, you develop pain deep within the heel. The pain is usually most pronounced first thing in the morning, since the fascia tightens while you sleep.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

It was thought that by running or otherwise repetitively pounding their heels against the ground, people strained the plantar fascia, and the body responded with a complex cascade of inflammatory biochemical processes that resulted in extra blood and fluids flowing to the injury site, as well as enhanced pain sensitivity.

But instead of lasting only a few days and then fading, as acute inflammation usually does, the process can become chronic and create its own problems, causing tissue damage and continuing pain.

This progression is also what experts believed was happening when people developed chronic Achilles tendon pain, tennis elbow or other lingering, overuse injuries.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.

“Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

Instead, plantar fasciitis more likely is caused by degeneration or weakening of the tissue. This process probably begins with small tears that occur during activity and that, in normal circumstances, the body simply repairs, strengthening the tissue as it does. That is the point of exercise training.

But sometimes, for unknown reasons, this ongoing tissue damage overwhelms the body’s capacity to respond. The small tears don’t heal. They accumulate. The tissue begins subtly to degenerate, even to shred. It hurts.

By and large, most sports medicine experts now believe that this is how we develop other overuse injuries, like tennis elbow or Achilles tendinopathy, which used to be called tendinitis. The suffix “itis” means inflammation. But since the injury isn’t thought to involve chronic inflammation, its name has changed.

This has not yet happened with plantar fasciitis, and may not, given what a mouthful fasciopathy would be.

The evolving medical opinions about plantar fasciitis matter, beyond nomenclature, though, because treatments depend on causes. At the moment, many physicians rely on injections of cortisone, a steroid that is both a pain reliever and anti-inflammatory, to treat plantar fasciitis. And cortisone shots do reduce the soreness. In a study published last year in BMJ, patients who received cortisone injections reported less heel pain after four months than those whose shots had contained a placebo saline solution.

But whether those benefits will last is unknown, especially if plantar fasciitis is, indeed, degenerative. In studies with people suffering from tennis elbow, another injury that is now considered degenerative, cortisone shots actually slowed tissue healing.

We need similar studies in people with plantar fasciitis, Dr. Khan said. “They have not been done.”

Thankfully, most people who develop plantar fasciitis will recover within a few months without injections or other invasive treatments, Dr. Philbin said, if they simply back off their running mileage somewhat or otherwise rest the foot and stretch the affected tissues. Stretching the plantar fascia, as well as the Achilles tendon, which also attaches to the heel bone, and the hamstring muscles seems to result in less strain on the fascia during activity, meaning less ongoing trauma and, eventually, time for the body to catch up with repairs.

To ensure that you are stretching correctly, Dr. Philbin suggests consulting a physical therapist, after, of course, visiting a sports medicine doctor for a diagnosis. Not all heel or arch pain is plantar fasciitis. And comfort yourself if you do have the condition with the knowledge that Kobe Bryant, Eli Manning and Ryan Hall have all returned to competition and Mr. Romney still runs.

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Nestlé Pulls 2 Products in Horse Meat Scandal

LONDON — First centered on Britain and Ireland, the scandal over beef products adulterated with horse meat escalated across continental Europe on Tuesday after Nestlé, one of the world’s best-known food companies, said it was removing pasta meals from store shelves in Italy and Spain.

Before the announcement late Monday, the crisis had already spread, with perhaps a dozen countries caught up in product recalls, but the involvement of Nestlé marks another significant act in a fast-moving drama which is forcing Europeans to question the contents of their meals.

Nestlé, which is based in Switzerland, said it had increased testing after the discoveries of horse meat in British foods and found “traces” of horse DNA in two products made with beef supplied by a German company named as H.J. Schypke.

The levels were above the 1 percent threshold used by the British Food Standards Agency  as an indicator of adulteration in testing being conducted by Britain’s food industry and therefore the products would be withdrawn, Nestlé said in a statement.

“There is no food safety issue, but the mislabeling of products means they fail to meet the very high standards consumers expect from us,” Nestlé added.

Two chilled pasta products, Buitoni Beef Ravioli and Beef Tortellini are being taken off supermarket shelves in Italy and Spain immediately. Meanwhile, Lasagnes à la Bolognaise Gourmandes, a frozen meat product made for the catering trade in France, will also be withdrawn and replaced with product made from 100 percent beef.

Nestlé knows only too well the importance of its brand image, having once been the object of a boycott after being embroiled in a controversy over the marketing of baby milk in developing countries.

Although the current horse meat crisis has been seen mainly as an issue of fraud and mislabeling it emerged last week that a powerful equine painkiller, phenylbutazone – or bute – may have entered the food chain.

Eight horses slaughtered for food in Britain tested positive for the drug. Six of those carcasses had already been exported to France for use in human food.

In Britain, food manufacturers have embarked on a huge program of tests of food to try to stem a crisis of confidence in products originating in a long and bewilderingly complex supply  chain.

Last Friday, the British Food Standards Agency released the results of 2,501 tests conducted on beef products by the British food industry, of which 29 contained more than 1 percent horse meat.

But, just as that information was released, it emerged separately that food intended for school meals had also contained horse meat and a blame game has erupted between politicians and supermarket bosses over where responsibility ultimately lies.

The European Union has also announced an increase in food testing though there are growing calls for more regulation at a European level. Though tough traceability rules for fresh beef products were introduced after the crisis over mad cow disease more than a decade ago, a similar regime is not in place for processed food.

“What has been discovered in recent days is large-scale fraud,”  said Richard Seeber, the coordinator for the center-right group  in the Environment, Public Health and Food Safety Committee of the European Parliament. “This is a clear breach of current European food labeling rules. This is why the first thing we need is more controls and better enforcement of the existing rules.”

Glenis Willmott, the leader of the British Labour Party’s members of the European Parliament, said that the response of the E.U.’s executive, the European Commission, had been totally inadequate.

“The horse meat scandal should result in a Europe-wide comprehensive legislation on ‘origin labeling’ for all meat in processed foods, and a better E.U. enforcement procedure,” Ms. Willmott said.

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