Concussion Liability Issues Could Stretch Beyond N.F.L.

Paul Kitagaki Jr./The Sacramento Bee, via Associated Press

Insurers could raise premiums with a higher risk of lawsuits for concussions, like the one 49ers quarterback Alex Smith sustained a month ago.

As the N.F.L. confronts a raft of lawsuits brought by thousands of former players who accuse the league of hiding information about the dangers of concussions, a less visible battle that may have a more widespread effect in the sport is unfolding between the league and 32 of its current and former insurers.

The dispute revolves around how much money, if any, the insurers are obliged to pay for the league’s mounting legal bills and the hundreds of millions of dollars in potential damages that might stem from the cases brought by the retired players.

Regardless of how it is resolved, the dispute could hurt teams, leagues and schools at all levels if insurers raise premiums to compensate for the increased risk of lawsuits from the families of people who play hockey, lacrosse and other contact sports.

The N.F.L., which generates about $9 billion a year, may be equipped to handle these legal challenges. But colleges, high schools and club teams may be forced to consider severe measures in the face of liability issues, like raising fees to offset higher premiums; capping potential damages; and requiring players to sign away their right to sue coaches and schools. Some schools and leagues may even shut down teams because the expense and legal risk are too high.

“Insurers will be tightening up their own coverage and make sports more expensive,” said Robert Boland, who teaches sports law at New York University. “It could make the sustainability of certain sports a real issue.”

The N.F.L. contends that the insurers, some of whom wrote policies in the 1960s, have a duty to defend the league, which has paid them millions of dollars in premiums. The question for the N.F.L. is not whether the insurers are required to help the league, but rather what percent of the league’s expenses each insurer is obliged to cover.

The 32 insurance companies have varying arguments against the league. Some wrote policies for a limited number of years and contend their obligations should also be limited. Others contend they wrote policies for the N.F.L.’s marketing arm — for licensing disputes, for example — not the league itself.

A few of the companies went bankrupt or merged with rivals. Some insurers wrote primary policies that covered up to the first $1 million of claims; the rest insured obligations in excess of that amount.

Creating a formula for how to apportion liability will in some cases depend on the broader case between the league and its players now in federal court in Pennsylvania. If the N.F.L. persuades the judge to dismiss the case, the league will be left trying to recoup its legal costs from the insurers. If the judge allows the players’ case to proceed, the definitions of when, how and whether a player’s concussions led to his illness will become critical in shaping the insurers’ exposure, and could take years to sort out.

“This is baby step 1 in the process for everyone figuring how deep in the soup they are,” said Christopher Fusco, a lawyer who has worked on similar insurance cases but is not involved in the N.F.L. litigation. “Baby step 2 will be to figure out the facts.”

Fusco and other lawyers said the facts would largely come from the underlying suit between the league and the more than 3,000 retired players, including determining when the players sustained the head trauma and their injuries. This will probably be a long process because many of the retired players in the underlying suit, some of whom are now having memory loss, played decades ago, when concussions were often undiagnosed or not recorded.

Many of the insurance companies named in the suits declined to comment, citing the continuing litigation. The N.F.L. also did not comment.

The two-tiered battle between the league and its former players and insurers echoes the litigation stemming from asbestos claims because both cases center on long-tail claims, or injuries that could take years to manifest themselves.

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Daily Stock Market Activity

Wall Street traded sharply higher Tuesday after unexpectedly cheery data out of Europe and as the Federal Reserve was set to begin its two-day policy meeting.

The Standard & Poor’s 500-stock index added 1 percent in morning trading, while the Dow Jones industrial average rose 0.9 percent and the Nasdaq composite index was up 1.5 percent.

The stock market has entered a traditionally quiet period heading into the end of the year, with thinner trading volumes and fewer large fluctuations likely.

Though the pace of talks quickened in Washington to avert impending tax increases and spending cuts, senior politicians on both sides cautioned that an agreement on all the outstanding issues remained uncertain.

The lack of progress in negotiations about the “fiscal cliff” has kept investors from making aggressive bets in recent weeks, though most expect a deal will eventually be reached.

In Germany, analyst and investor sentiment rose sharply in December, entering positive territory for the first time since May, a leading survey showed. The data helped drive European shares higher. The DAX in Frankfurt was up 0.6 percent in afternoon trading, while the FTSE 100 in London gained 0.2 percent.

“We’ve been getting a lot of the beginning of our day from seeing what Europe has been doing, and I think that’s going to hold true today,” said Kim Caughey Forrest, senior equity research analyst at Fort Pitt Capital Group in Pittsburgh.

The Fed began its two-day Federal Open Market Committee meeting on Tuesday. The central bank was expected to announce a new round of Treasury securities purchases on Wednesday, according to a Reuters survey of analysts. The program would replace its so-called Operation Twist stimulus effort, which expires at the end of the year.

The Treasury Department sold its remaining stake in the American International Group, bringing an end to a government ownership role about four years after a $182 billion bailout. A.I.G.'s shares were up 4 percent in morning trading.

Two firms raised their price targets for Urban Outfitters, sending the retailer’s shares up 6 percent.

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Latin music star Jenni Rivera believed dead in plane crash

Fans of Mexican-American singing star Jenni Rivera held a vigil Sunday night in Lynwood

MEXICO CITY — Mexican American singer Jenni Rivera, the "diva de la banda" whose commanding voice burst through the limits of regional Latin music and made her a cross-border sensation and the queen of a business empire, was believed to have died Sunday when the small jet carrying her and members of her entourage crashed in mountainous terrain.

Rivera, a native of Long Beach, was 43. Mexico's ministry of transportation did not confirm her death outright, but it said that she had been aboard the plane and that no one had survived the crash. Six others, including two pilots, also were on board.

"Everything suggests, with the evidence that's been found, that it was the airplane that the singer Jenni Rivera was traveling in," said Gerardo Ruiz Esparza, Mexico's secretary of communications and transportation. Of the crash site, Ruiz said: "Everything is destroyed. Nothing is recognizable."

Word of the accident ricocheted around the entertainment industry, with performer after performer expressing shock and grief. Fans gathered outside Rivera's four-acre estate in Encino.

"She was the Diana Ross of Mexican music," said Gustavo Lopez, an executive vice president at Universal Music Latin Entertainment, an umbrella group that includes Rivera's label. Lopez called Rivera "larger than life" and said that based on ticket sales, she was by far the top-grossing female artist in Mexico.

"Remember her with your heart the way she was," her father, Don Pedro Rivera, told reporters in Spanish on Sunday evening. "She never looked back. She was a beautiful person with the whole world."

Rivera had performed a concert in Monterrey, Mexico, on Saturday night — her standard fare of knee-buckling power ballads, pop-infused interpretations of traditional banda music and dizzying rhinestone costume changes.

At a news conference after the show, Rivera appeared happy and tranquil, pausing at one point to take a call on her cellphone that turned out to be a wrong number. She fielded questions about struggles in her personal life, including her recent separation from husband Esteban Loaiza, a professional baseball player.

"I can't focus on the negative," she said in Spanish. "Because that will defeat you. That will destroy you.... The number of times I have fallen down is the number of times I have gotten up."

Hours later, shortly after 3 a.m., Rivera is believed to have boarded a Learjet 25, which took off under clear skies. The jet headed south, toward Toluca, west of Mexico City; there, Rivera had been scheduled to tape the television show "La Voz" — Mexico's version of "The Voice" — on which she was a judge.

The plane, built in 1969 and registered to a Las Vegas talent management firm, reached 11,000 feet. But 10 minutes and 62 miles into the flight, air traffic controllers lost contact with its pilots, according to Mexican authorities. The jet crashed outside Iturbide, a remote city that straddles one of the few roads bisecting Mexico's Sierra de Arteaga national park.

Wreckage was scattered across several football fields' worth of terrain. An investigation into the cause of the crash was underway, and attempts to identify the remains of the victims had begun.

Rivera, a mother of five and grandmother of two, was believed to have been traveling with her publicist Arturo Rivera, who was not related to her, as well as with her lawyer, hairstylist and makeup artist; reports of their names were not consistent. Their identities were not confirmed by authorities. The pilots were identified as Miguel Perez and Alejandro Torres.

In the world of regional Latin music — norteño, cumbia and ranchera are among the popular niches — Rivera was practically royalty.

Her father was a noted singer of the Mexican storytelling ballads known as corridos. In the 1980s he launched the record label Cintas Acuario. It began as a swap-meet booth and grew into an influential and taste-making independent outfit, fueling the careers of artists such as the late Chalino Sanchez. Jenni Rivera's four brothers were associated with the music industry; her brother Lupillo, in particular, is a huge star in his own right.

Born on July 2, 1969, Rivera initially showed little inclination to join the family business. She worked for a time in real estate. But after a pregnancy and a divorce, she went to work for her father's record label and found her voice, literally and figuratively.

She released her first studio album in 2003, when she was 34.

Her path had not been easy, but rather than running from it, she wrote it into her music — domestic violence; struggles with weight; raising her children alone, or "sin capitan," without a captain. She was known for marathon live shows that left audiences exhilarated and exhausted; by the fifth hour of one recent performance, she was drinking straight from a tequila bottle and launching into a cover of "I Will Survive."

In a witty and sometimes baffling stew of Spanish and English, she sang about her three husbands, about drug traffickers, in tribute to her father, in tribute to her gynecologist.

She became, in a most unlikely way, a feminist hero among Latin women in Mexico and the United States and a powerful player in a genre of music dominated by men and machismo. Regional Mexican music styles had long been seen as limiting to artists, but Rivera shrugged off the labels and brought traditional-laced music — some of which sounded perilously close to polka — to a massive pop audience.

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Springsteen, Lady Gaga join Stones concert in NJ

NEW YORK (AP) — Bruce Springsteen, Lady Gaga and The Black Keys will join the Rolling Stones on Saturday for the final concert marking the band’s 50th anniversary.

The concert will be held at the Prudential Center in Newark, N.J.

The band said Monday the concert will be telecast live on pay-per-view.

The Stones have played in London and New York on their “50 and Counting” tour. They will also play in Newark on Thursday.

The Stones will perform Wednesday at the “12-12-12″ concert at Madison Square Garden in New York City to raise money for victims of Superstorm Sandy.

___

Online:

http://www.rollingstones.com/

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A Breakthrough Against Leukemia Using Altered T-Cells

PHILIPSBURG, Pa. — Emma Whitehead has been bounding around the house lately, practicing somersaults and rugby-style tumbles that make her parents wince.

It is hard to believe, but last spring Emma, then 6, was near death from leukemia. She had relapsed twice after chemotherapy, and doctors had run out of options.

Desperate to save her, her parents sought an experimental treatment at the Children’s Hospital of Philadelphia, one that had never before been tried in a child, or in anyone with the type of leukemia Emma had. The experiment, in April, used a disabled form of the virus that causes AIDS to reprogram Emma’s immune system genetically to kill cancer cells.

The treatment very nearly killed her. But she emerged from it cancer-free, and about seven months later is still in complete remission. She is the first child and one of the first humans ever in whom new techniques have achieved a long-sought goal — giving a patient’s own immune system the lasting ability to fight cancer.

Emma had been ill with acute lymphoblastic leukemia since 2010, when she was 5, said her parents, Kari and Tom. She is their only child.

She is among just a dozen patients with advanced leukemia to have received the experimental treatment, which was developed at the University of Pennsylvania. Similar approaches are also being tried at other centers, including the National Cancer Institute and Memorial Sloan-Kettering Cancer Center in New York.

“Our goal is to have a cure, but we can’t say that word,” said Dr. Carl June, who leads the research team at the University of Pennsylvania. He hopes the new treatment will eventually replace bone-marrow transplantation, an even more arduous, risky and expensive procedure that is now the last hope when other treatments fail in leukemia and related diseases.

Three adults with chronic leukemia treated at the University of Pennsylvania have also had complete remissions, with no signs of disease; two of them have been well for more than two years, said Dr. David Porter. Four adults improved but did not have full remissions, and one was treated too recently to evaluate. A child improved and then relapsed. In two adults, the treatment did not work at all. The Pennsylvania researchers were presenting their results on Sunday and Monday in Atlanta at a meeting of the American Society of Hematology.

Despite the mixed results, cancer experts not involved with the research say it has tremendous promise, because even in this early phase of testing it has worked in seemingly hopeless cases. “I think this is a major breakthrough,” said Dr. Ivan Borrello, a cancer expert and associate professor of medicine at the Johns Hopkins University School of Medicine.

Dr. John Wagner, the director of pediatric blood and marrow transplantation at the University of Minnesota, called the Pennsylvania results “phenomenal” and said they were “what we’ve all been working and hoping for but not seeing to this extent.”

A major drug company, Novartis, is betting on the Pennsylvania team and has committed $20 million to building a research center on the university’s campus to bring the treatment to market.

Hervé Hoppenot, the president of Novartis Oncology, called the research “fantastic” and said it had the potential — if the early results held up — to revolutionize the treatment of leukemia and related blood cancers. Researchers say the same approach, reprogramming the patient’s immune system, may also eventually be used against tumors like breast and prostate cancer.

To perform the treatment, doctors remove millions of the patient’s T-cells — a type of white blood cell — and insert new genes that enable the T-cells to kill cancer cells. The technique employs a disabled form of H.I.V. because it is very good at carrying genetic material into T-cells. The new genes program the T-cells to attack B-cells, a normal part of the immune system that turn malignant in leukemia.

The altered T-cells — called chimeric antigen receptor cells — are then dripped back into the patient’s veins, and if all goes well they multiply and start destroying the cancer.

The T-cells home in on a protein called CD-19 that is found on the surface of most B-cells, whether they are healthy or malignant.

A sign that the treatment is working is that the patient becomes terribly ill, with raging fevers and chills — a reaction that oncologists call “shake and bake,” Dr. June said. Its medical name is cytokine-release syndrome, or cytokine storm, referring to the natural chemicals that pour out of cells in the immune system as they are being activated, causing fevers and other symptoms. The storm can also flood the lungs and cause perilous drops in blood pressure — effects that nearly killed Emma.

Steroids sometimes ease the reaction, but they did not help Emma. Her temperature hit 105. She wound up on a ventilator, unconscious and swollen almost beyond recognition, surrounded by friends and family who had come to say goodbye.

But at the 11th hour, a battery of blood tests gave the researchers a clue as to what might help save Emma: her level of one of the cytokines, interleukin-6 or IL-6, had shot up a thousandfold. Doctors had never seen such a spike before and thought it might be what was making her so sick.

Dr. June knew that a drug could lower IL-6 — his daughter takes it for rheumatoid arthritis. It had never been used for a crisis like Emma’s, but there was little to lose. Her oncologist, Dr. Stephan A. Grupp, ordered the drug. The response, he said, was “amazing.”

Within hours, Emma began to stabilize. She woke up a week later, on May 2, the day she turned 7; the intensive-care staff sang “Happy Birthday.”

Since then, the research team has used the same drug, tocilizumab, in several other patients.

In patients with lasting remissions after the treatment, the altered T-cells persist in the bloodstream, though in smaller numbers than when they were fighting the disease. Some patients have had the cells for years.

Dr. Michel Sadelain, who conducts similar studies at the Sloan-Kettering Institute, said: “These T-cells are living drugs. With a pill, you take it, it’s eliminated from your body and you have to take it again.” But T-cells, he said, “could potentially be given only once, maybe only once or twice or three times.”

The Pennsylvania researchers said they were surprised to find any big drug company interested in their work, because a new batch of T-cells must be created for each patient — a far cry from the familiar commercial strategy of developing products like Viagra or cholesterol medicines, in which millions of people take the same drug.

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Bloomberg Weighs Making a Run for Financial Times

Not long ago, The Financial Times would have been the crown jewel of any media company, instantly conferring prestige and influence on its owner. Now, given the likely bidders, one of the world’s most respected and distinctive financial newspapers could end up as a trophy to help sell more computer terminals.

Chris Ratcliffe/Bloomberg News, via Getty Images

Like most newspapers, The Financial Times is struggling with an industrywide decline in print advertising revenue.

Pearson, via Agence France-Presse — Getty Images

John Fallon, who is to succeed Marjorie Scardino as chief of Pearson in January, does not share her fondness for print.

Michael R. Bloomberg is weighing the wisdom of buying The Financial Times Group, which includes the paper and a half interest in The Economist, according to three people close to Mr. Bloomberg who spoke on the condition of anonymity to divulge private conversations.

Mr. Bloomberg has long adored The Economist, and his affinity for The Financial Times, at least as a reader, has deepened lately. Its bisque-colored pages, once rarely seen in the thick stack of newspapers Mr. Bloomberg carries under his arm all day, have become a mainstay. Friends say he favors its generally short, punchy and to-the-point articles, which match his temperament.

In October, Mr. Bloomberg visited the London headquarters of The Financial Times, a few blocks away from Bloomberg L.P.’s giant new London complex, which is still under construction. When an editor asked if he would buy the paper, Mr. Bloomberg replied, “I buy it every day.”

He has spoken openly with friends and aides about the potential benefits and pitfalls of making such a costly acquisition in an industry he admires deeply as a reader but sneers at as a businessman, these same people said. And he has recently taken to rattling off circulation figures and “penetration” rates for the paper.

“It’s the only paper I’d buy,” he has said to one associate. “Why should I buy it?” he has asked another.

His ambivalence speaks to the troubles facing the newspaper business, and to the complex motivations of the mayor himself. Drawn to power and prominence, Mr. Bloomberg is wrestling with his affection for the paper as its potential publisher and his wariness of an investment that could mar his company’s reputation for achieving outsize profits. Pearson, the parent company of The Financial Times Group, does not break out separate financial results for the paper, but analysts estimate that it loses money. A spokesman for the mayor declined to comment on his conversations about the paper.

For Thomson Reuters, the other likely bidder, the calculation is somewhat different. Unlike Mr. Bloomberg, who started his financial information company in 1982, James C. Smith, president and chief executive of Thomson Reuters, came up through Thomson’s regional newspapers and has ink in his veins. A replica of an old-fashioned printing press is on display in his corner office overlooking Times Square.

But the company has been hurt financially after its newest desktop terminal product struggled to catch on. In the first nine months of 2012, the company reported revenue of $9.88 billion, a 3 percent decrease from the period a year earlier. A company spokesman declined to comment.

The Financial Times could expand the Thomson Reuters brand and give its reporters additional exposure since, unlike Bloomberg, which bought Businessweek in 2009, the company does not own a regular magazine. Thomson Reuters, partly a British company, and The Financial Times also have large footprints in Asia.

But first, the paper needs to be put on the block. Pearson is about to lose two of its top executives, raising speculation the paper could be for sale. Analysts value The Financial Times Group at about $1.2 billion, well within the reach of Bloomberg L.P., which in 2011 had revenue of $7.6 billion, and Thomson Reuters, which posted revenue of $13.8 billion.

The paper has a successful digital strategy, and analysts have said that its strict online pay wall is considered a financial success. But like most newspapers, it is struggling in an industrywide decline in print advertising revenue. In the three months ending Oct. 1, the paper’s total paid circulation exceeded 600,000, more than half of which was from digital subscriptions. In its most recent earnings report, Pearson said it expected profit to decline because of a sluggish advertising market and “the shift from print to digital.”

Marjorie Scardino, Pearson’s longtime chief executive, who once said the paper would be sold “over my dead body,” is departing on Dec. 31. Rona Fairhead, chief executive of The Financial Times Group, will leave at the end of April. Both executives had championed the print businesses. A successor to Ms. Fairhead has yet to be named, though one person close to the company pointed to John Ridding, the chief executive of the paper.

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Chavez to have more cancer surgery in Cuba

CARACAS, Venezuela—

Venezuelan President Hugo Chavez is heading back to Cuba on Sunday for more surgery for cancer, announcing on television that the illness has returned after two previous operations, chemotherapy and radiation treatment.

Chavez acknowledged the seriousness of his situation in an address Saturday night, saying for the first time that if he suffers complications Vice President Nicolas Maduro should take his place as Venezuela's leader and continue his socialist movement.

"There are risks. Who can deny it?" Chavez said, seated at the presidential palace beside Maduro and other aides.

"In any circumstance, we should guarantee the advance of the Bolivarian Revolution," Chavez said.

Outside medical experts said that based on Chavez's account of his condition, he is facing a very difficult fight against an aggressive type of cancer.

The president, who just returned from Cuba early Friday, said tests had found a return of "some malignant cells" in the same area where tumors were previously removed.

Chavez, who has yet to be sworn in for his new term after winning re-election on Oct. 7, said he would return to Havana on Sunday and would undergo the operation in the coming days.

Chavez's quick trip home appeared aimed at sending a clear directive to his inner circle that Maduro is his chosen successor. He called for his allies to pull together, saying: "Unity, unity, unity."

Chavez said his doctors had recommended he have the surgery right away, but that he had told them he wanted to return to Venezuela first.

"I want to go there. I need to go to Venezuela," Chavez recalled telling his doctors. "And what I came for was this," he said, seated below a portrait of independence hero Simon Bolivar, the inspiration of his Bolivarian Revolution movement.

Chavez named Maduro, his longtime foreign minister, as his choice for vice president three days after winning re-election. Maduro, a burly former bus driver, has shown unflagging loyalty and become a leading spokesman for Venezuela's socialist leader in recent years.

The vice president's expression was solemn as Chavez said that Maduro should become president if any complication were to prevent him from finishing his current term, which concludes in early January. Chavez said that if new elections are held, his movement's candidate should be Maduro.

"In that scenario, which under the constitution would require presidential elections to be held again, you all elect Nicolas Maduro as president," Chavez said. "I ask that of you from my heart."

Chavez held a small blue copy of the constitution in his hands and waved it. The Venezuelan constitution says that if a president-elect dies before taking office, a new election should be held within 30 days and that in the meantime the president of the National Assembly is to be in charge of the government.

While he spoke, Chavez was flanked by both Maduro and National Assembly President Diosdado Cabello.

Chavez is scheduled to be sworn in for a new six-year term Jan. 10, and he called his relapse a "new battle."

This will be his third operation to remove cancerous tissue in about a year and a half.

The 58-year-old president first underwent surgery for an unspecified type of pelvic cancer in Cuba in June 2011, after an operation for a pelvic abscess earlier in the month found the cancer. He had another cancer surgery last February after a tumor appeared in the same area. He has also undergone chemotherapy and radiation treatments.

Chavez said tests immediately after his re-election win had shown no sign of cancer. But he said he had swelling and pain, which he thought was due to "the effort of the campaign and the radiation therapy treatment."

"It's a very sensitive area, so we started to pay a lot of attention to that," he said, adding that he had reduced his public appearances.

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Comedian Katt Williams arrested near Sacramento

SACRAMENTO, Calif. (AP) — Comedian Katt Williams has been arrested in northern California on a felony warrant related to a police chase.

The Sacramento Bee reports (http://bit.ly/UNq5QW ) that Williams was arrested Friday night in Dunnigan, about 25 miles north of Sacramento, by Yolo County deputies.

The paper says he was released from the county jail Saturday after posting bail.

The sheriff’s department confirmed Williams’ arrest late Saturday, but staffers on duty didn’t have details. A spokesman for the comedian didn’t immediately return a call and email.

The California Highway Patrol says Williams fled officers on a three-wheeled motorcycle on Nov. 25 after being spotted driving on a downtown Sacramento sidewalk.

The CHP said Williams was asked to stop and refused, leading to the pursuit.

The CHP says Williams nearly hit five people during the chase, which police ended for safety reasons.

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New Taxes to Take Effect to Fund Health Care Law

WASHINGTON — For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.

The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.

Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.

To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.

The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.

Ruth M. Wimer, a tax lawyer at McDermott Will & Emery, said the taxes came with “a shockingly inequitable marriage penalty.” If a single man and a single woman each earn $200,000, she said, neither would owe any additional Medicare payroll tax. But, she said, if they are married, they would owe $1,350. The extra tax is 0.9 percent of their earnings over the $250,000 threshold.

Since the creation of Social Security in the 1930s, payroll taxes have been levied on the wages of each worker as an individual. The new Medicare payroll is different. It will be imposed on the combined earnings of a married couple.

Employers are required to withhold Social Security and Medicare payroll taxes from wages paid to employees. But employers do not necessarily know how much a worker’s spouse earns and may not withhold enough to cover a couple’s Medicare tax liability. Indeed, the new rules say employers may disregard a spouse’s earnings in calculating how much to withhold.

Workers may thus owe more than the amounts withheld by their employers and may have to make up the difference when they file tax returns in April 2014. If they expect to owe additional tax, the government says, they should make estimated tax payments, starting in April 2013, or ask their employers to increase the amount withheld from each paycheck.

In the Affordable Care Act, the new tax on investment income is called an “unearned income Medicare contribution.” However, the law does not provide for the money to be deposited in a specific trust fund. It is added to the government’s general tax revenues and can be used for education, law enforcement, farm subsidies or other purposes.

Donald B. Marron Jr., the director of the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, said the burden of this tax would be borne by the most affluent taxpayers, with about 85 percent of the revenue coming from 1 percent of taxpayers. By contrast, the biggest potential beneficiaries of the law include people with modest incomes who will receive Medicaid coverage or federal subsidies to buy private insurance.

Wealthy people and their tax advisers are already looking for ways to minimize the impact of the investment tax — for example, by selling stocks and bonds this year to avoid the higher tax rates in 2013.

The new 3.8 percent tax applies to the net investment income of certain high-income taxpayers, those with modified adjusted gross incomes above $200,000 for single taxpayers and $250,000 for couples filing jointly.

David J. Kautter, the director of the Kogod Tax Center at American University, offered this example. In 2013, John earns $160,000, and his wife, Jane, earns $200,000. They have some investments, earn $5,000 in dividends and sell some long-held stock for a gain of $40,000, so their investment income is $45,000. They owe 3.8 percent of that amount, or $1,710, in the new investment tax. And they owe $990 in additional payroll tax.

The new tax on unearned income would come on top of other tax increases that might occur automatically next year if President Obama and Congress cannot reach an agreement in talks on the federal deficit and debt. If Congress does nothing, the tax rate on long-term capital gains, now 15 percent, will rise to 20 percent in January. Dividends will be treated as ordinary income and taxed at a maximum rate of 39.6 percent, up from the current 15 percent rate for most dividends.

Under another provision of the health care law, consumers may find it more difficult to obtain a tax break for medical expenses.

Taxpayers now can take an itemized deduction for unreimbursed medical expenses, to the extent that they exceed 7.5 percent of adjusted gross income. The health care law will increase the threshold for most taxpayers to 10 percent next year. The increase is delayed to 2017 for people 65 and older.

In addition, workers face a new $2,500 limit on the amount they can contribute to flexible spending accounts used to pay medical expenses. Such accounts can benefit workers by allowing them to pay out-of-pocket expenses with pretax money.

Taken together, this provision and the change in the medical expense deduction are expected to raise more than $40 billion of revenue over 10 years.

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Changes to Agriculture Highlight Cuba’s Problems

HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.

“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”

The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.

President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”

No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”

Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.

“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”

A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.

In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.

“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.

Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.

But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.

The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.

Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.

But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.

Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.

“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”

For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.

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