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At her birth, on Feb. 28, 1926, she was named Svetlana Stalina, the only daughter and last surviving child of the brutal Soviet tyrant Josef Stalin. After he died in 1953, she took her mother’s last name, Alliluyeva. In 1970, after her defection and an American marriage, she became and remained Lana Peters.

Ms. Peters died of colon cancer on Nov. 22 in Richland County, Wis., the county’s corporation counsel, Benjamin Southwick, said on Monday. She was 85.

Her death, like the last years of her life, occurred away from public view. There were hints of it online and in Richland Center, the Wisconsin town in which she lived, though a local funeral home said to be handling the burial would not confirm the death. A county official in Wisconsin thought she might have died several months ago. Phone calls seeking information from a surviving daughter, Olga Peters, who now goes by the name Chrese Evans, were rebuffed, as were efforts to speak to her in person in Portland, Ore., where she lives and works.

Ms. Peters’s initial prominence came only from being Stalin’s daughter, a distinction that fed public curiosity about her life across three continents and many decades. She said she hated her past and felt like a slave to extraordinary circumstances. Yet she drew on that past, and the infamous Stalin name, in writing two best-selling autobiographies.

Long after fleeing her homeland, she seemed to be still searching for something — sampling religions, from Hinduism to Christian Science, falling in love and constantly moving. Her defection took her from India, through Europe, to the United States. After moving back to Moscow in 1984, and from there to Soviet Georgia, friends told of her going again to America, then to England, then to France, then back to America, then to England again, and on and on. All the while she faded from the public eye.

Ms. Peters was said to have lived in a cabin with no electricity in northern Wisconsin; another time, in a Roman Catholic convent in Switzerland. In 1992, she was reported to be living in a shabby part of West London in a home for elderly people with emotional problems.

“You can’t regret your fate,” Ms. Peters once said, “although I do regret my mother didn’t marry a carpenter.”

‘Little Sparrow’

Her life was worthy of a Russian novel. It began with a loving relationship with Stalin, who had taken the name, meaning “man of steel,” as a young man. (He was born Ioseb Besarionis dze Jughashvili.) Millions died under his brutally repressive rule, but at home he called his daughter “little sparrow,” cuddled and kissed her, showered her with presents, and entertained her with American movies.

She became a celebrity in her country, compared to Shirley Temple in the United States. Thousands of babies were named Svetlana. So was a perfume.

At 18, she was setting the table in a Kremlin dining room when Churchill happened upon her. They had a spirited conversation.

But all was not perfect even then. The darkest moment of her childhood came when her mother, Nadezhda Alliluyeva, Stalin’s second wife, committed suicide in 1932. Svetlana, who was 6, was told that her mother had died of appendicitis. She did not learn the truth for a decade.

In her teenage years, her father was consumed by the war with Germany and grew distant and sometimes abusive. One of her brothers, Yakov, was captured by the Nazis, who offered to exchange him for a German general. Stalin refused, and Yakov was killed.

In her memoirs she told of how Stalin had sent her first love, a Jewish filmmaker, to Siberia for 10 years. She wanted to study literature at Moscow University, but Stalin demanded that she study history. She did. After graduation, again following her father’s wishes, she became a teacher, teaching Soviet literature and the English language. She then worked as a literary translator.

Elizabeth A. Harris and Lee van der Voo contributed reporting.

Now a federal investigation into the Chevrolet Volt could make the pitch for the electric cars that much tougher.

General Motors said on Monday that it would offer free loaner cars to Volt owners worried about the safety of their vehicles, a move that underscored the fragile reputation of automobiles powered primarily by batteries and the growing consternation set off by the federal action. The National Highway Traffic Safety Administration on Friday opened a formal defect investigation into the Volt after two batteries caught fire as part of testing by regulators.

“Our customers’ peace of mind is too important to us for there to be any concern or worry,” Mark L. Reuss, head of G.M.’s North American division, said in announcing the offer of loaner cars. “This technology should inspire confidence and pride, not raise any concern or doubt.”

G.M. executives defended the safety of the Volt’s lithium-ion batteries, and said the loaners were being offered as a gesture of good will — not because of safety concerns.

But the federal investigation represents an unexpected hurdle for the nascent technology. While the electric car market is in its infancy, more models are coming soon. And questions about their safety, whether proved real or otherwise, threaten to puncture the Volt’s aura, auto analysts said.

Even some of the car’s staunchest defenders acknowledged on Monday that questions raised about its safety were unsettling.

“The reality is that it does make me a little uneasy — a little bit, a tiny bit,” said Lyle Dennis, a New York neurologist and early owner who founded the Web site GM-Volt.com.

Electric models represent a fraction of the overall auto market. G.M. has sold 5,300 Volts since introducing the car a year ago — the first plug-in electric vehicle to be mass-marketed by an American carmaker — in late 2010, and the Japanese automaker Nissan has sold 7,200 all-electric Leafs in the first 10 months of this year. The specialty carmaker Tesla has sold about 2,000 electric cars since 2008. A total of 9.5 million new vehicles had been sold in the United States this year through October.

As other automakers plan to begin offering their own electric models next year, G.M. is expecting to substantially increase Volt production. The blitz of new electric cars is partly a response by the industry to substantially higher fuel-economy regulations enacted by the government. Most automakers will need a significant number of electric models in their fleets to achieve the target of 54 miles a gallon in 2025 proposed by the Obama administration.

Until now, the biggest drawbacks to buying an electric vehicle have been practical ones — the limited driving range a battery provides, the need to charge cars overnight and prices that are higher than comparably equipped models powered by traditional engines.

G.M. believed it had an answer to range anxiety with the Volt, which travels under electric power but has a small gas engine that assists the battery on the go. However, some analysts said that the Volt investigation, regardless of its outcome, could cause fuel-conscious consumers to migrate toward the growing number of compact cars and gas-electric hybrids on the market.

“Consumers wary of the new electric vehicle technology have an array of less expensive, fuel-efficient options to choose from,” said Bill Visnic, an analyst with the auto-research Web site Edmunds.com.

The focus of the Volt investigation has been the stability of its battery after an accident. In June, a fire occurred at a storage facility in Wisconsin after the Volt was crash-tested by federal regulators.

Then on Thursday, a Volt battery pack caught fire after being intentionally damaged a week earlier by N.H.T.S.A. officials. The agency has also said that another battery pack emitted smoke and sparks after a similar test.

The agency has said that there was no evidence of fire problems in real-world crashes involving the Volt.

“However, the agency is concerned that damage to the Volt’s batteries as part of the three tests that are explicitly designed to replicate real-world crash scenarios have resulted in fire,” the N.H.T.S.A. said in a statement.

The rechargeable lithium-ion batteries are optimal for energy storage and have been commonly used in consumer electronics. However, the chemistry of the batteries can be volatile when ruptured or overheated. While this is the first time car batteries have raised such concerns, millions of laptop computer batteries, also lithium ion, have been recalled in recent years because of the possibility of fire.

G.M.’s head of global product development, Mary T. Barra, said Monday that consumers were not in danger in the immediate aftermath of a collision. Rather, she said the bigger concern was what happened to the batteries in the days and weeks after an accident.

“We don’t think there is an immediate fire risk,” said Mrs. Barra. “This is a postcrash activity.”

G.M. has sent its engineers to all accidents involving a Volt, she said. None of those incidents — she said there were “very few” — had resulted in a fire.

A pressing issue, Mrs. Barra said, is ensuring that batteries are de-powered by trained service personnel after a collision. “When electrical energy is left in a battery, it’s similar to having gasoline in a tank of a car that has been damaged,” she said.

G.M. is working with federal regulators on the Volt tests.

Until the matter is resolved, G.M. will provide loaners to Volt owners wanting one, Mr. Reuss said. And the company is also contacting all owners “to assure them and reassure them that our cars are safe to drive.”

One analyst said that G.M.’s decision to offer loaner cars was prudent given the level of media attention that the Volt investigation had generated.

“The stakes are very high with a new technology product, and that’s just good customer service,” said Eric Fedewa, an analyst with the research firm IHS Automotive. “The fact is that good news travels slow, and bad news travels extremely fast.”

The same kind of New England pluck and perspicacity is now stoking an unusual battle, 18 years after Ms. Duke’s death, over a plan to create a permanent, minimalist art installation in honor of her legacy on this swath of green that she left behind in a former commercial area near the harbor.

The tenor of the dispute is distinctly Newportian. Many of the combatants have known one another for decades, as did many of their mothers, fathers, grandmothers and grandfathers.

Supporters of the project — which is being designed by Maya Lin and is completely underwritten with private money by some of the city’s wealthiest families — converge at an oceanside cottage on Edith Wharton’s former estate, now home to Marion Oates Charles, known as Oatsie, the president of the Newport Restoration Foundation and a close friend of Ms. Duke’s, who has spearheaded the memorial plan.

The opposition marshals its forces several blocks up gilded Bellevue Avenue, in a rambling Carrère & Hastings mansion that is now home to Laurence S. Cutler, a Harvard-trained architect and former professor, and his wife, Judy Goffman Cutler, an art dealer, who both vehemently oppose the plan — though Mr. Cutler takes pains to point out that “it is all well intentioned, and these are all very good people.”

Despite the air of politesse, the fight has taken on the intensity of a debate over the soul of Newport itself, a city that — largely because of the efforts and example of Ms. Duke — has painstakingly preserved its colonial and Gilded Age heritage over the last four decades and has kept most incursions of contemporary commercial culture and design at bay.

But when Mrs. Charles, who is 92 and a longtime Newporter, began to think about a public tribute to Ms. Duke, who founded and bankrolled the restoration foundation, she said she felt strongly that it should be “something that looked to the future, not to the past.” And so when a foundation staff member suggested Ms. Lin, who is well known for the Vietnam Veterans Memorial in Washington and other public projects that use a mostly spare, abstract visual language, Mrs. Charles enthusiastically sought her out.

The plan that has evolved since Ms. Lin signed on last year would place three low-walled structures around the roughly one-acre space of the square, each to be made from salvaged local stone and intended to evoke the foundations of vanished centuries-old buildings that can still be found in the woods throughout New England. Ms. Lin chose the three foundation outlines — a square and two rectangles — from historical Newport maps from the 18th, 19th and 20th centuries, and said in an interview that they appealed to her as a way to give form to the idea of the “layers upon layers of history” that have shaped Newport.

But in the five months since the $3.5 million project, called the Meeting Room, was first presented to the public, a growing group of opponents — including a preservationist who ran the Newport Restoration Foundation during the years when Ms. Duke was building the square — has denounced it as ersatz history and as the result of a kind of celebrity-artist-shopping that they say the relentlessly pragmatic Ms. Duke would have hated.

The opponents further complain that the foundation-structures will impede recreation, that the stone — which is to serve double duty as the first seating in a park that has never had benches — will be too chilly to sit on through much of the spring and fall, not to mention the winter, and that the low, wall-like forms, instead of serving as gathering places for people, will mostly just gather lots of wind-blown trash.

“It will be like some kind of Disneyland fake in the middle of town, and as a professional, I think it’s not only a bad design but a bad idea,” said Mr. Cutler, who with his wife runs the National Museum of American Illustration, which houses the couple’s extensive collection of work by Norman Rockwell and Maxfield Parrish. (Mrs. Charles sits on the Cutlers’ museum board, now somewhat uncomfortably. “She calls me the rogue of Newport,” Mr. Cutler said.)

In an online poll completed recently by The Newport Daily News, 329 respondents said they wanted the park to remain as it is now, with grass and trees and a few boulders, while 43 said they supported the current plan. (The population of Newport is just under 25,000.) Among the more prominent opponents is Janet Alexander Pell, daughter-in-law of Claiborne Pell, the longtime Rhode Island senator who died in 2009; in a letter to a local weekly, she repeated a shorthand putdown of the project that seems to have gained traction lately that likens the stone foundations to cat litter boxes.

The judge, Jed S. Rakoff of United States District Court in Manhattan, said that he could not determine whether the agency’s settlement with Citigroup was “fair, reasonable, adequate and in the public interest,” as required by law, because the agency had claimed, but had not proved, that Citigroup committed fraud.

As it has in recent cases involving Bank of America, JPMorgan Chase, UBS and others, the agency proposed to settle the case by levying a fine on Citigroup and allowing it to neither admit nor deny the agency’s findings. Such settlements require approval by a federal judge.

While other judges are not obligated to follow Judge Rakoff’s opinion, the 15-page ruling could severely undermine the agency’s enforcement efforts if it eventually blocks the agency from settling cases in which the defendant does not admit the charges.

The agency contends that it must settle most of the cases it brings because it does not have the money or the staff to battle deep-pocketed Wall Street firms in court. Wall Street firms will rarely admit wrongdoing, the agency says, because that can be used against them in investor lawsuits.

The agency in particular, Judge Rakoff argued, “has a duty, inherent in its statutory mission, to see that the truth emerges.” But it is difficult to tell what the agency is getting from this settlement “other than a quick headline.” Even a $285 million settlement, he said, “is pocket change to any entity as large as Citigroup,” and often viewed by Wall Street firms “as a cost of doing business.”

According to the Securities and Exchange Commission, Citigroup stuffed a $1 billion mortgage fund that it sold to investors in 2007 with securities that it believed would fail so that it could bet against its customers and profit when values declined. The fraud, the agency said, was in Citigroup’s falsely telling investors that an independent party was choosing the portfolio’s investments. Citigroup made $160 million from the deal and investors lost $700 million.

Judge Rakoff said the agency settlement policy — “hallowed by history, but not by reason”— creates substantial potential for abuse because “it asks the court to employ its power and assert its authority when it does not know the facts.” That undermines the constitutional separation of powers, he said, by asking the judiciary to rubber-stamp the executive branch’s interpretation of the law.

The agency said that it disagreed with the judge’s ruling but did not say whether it would appeal, or try to refashion the settlement or prepare to begin a trial, as the judge directed, on July 16.

Robert Khuzami, the agency’s director of enforcement, said in a statement that the Citigroup settlement “reasonably reflects the scope of relief that would be obtained after a successful trial,” and that the decision “ignores decades of established practice throughout federal agencies and decisions of the federal courts.”

Citigroup said it also disagreed with Judge Rakoff’s decision, adding that it would fight the charges if the case indeed went to trial.

“We believe the proposed settlement is a fair and reasonable resolution to the S.E.C.’s allegation of negligence, which relates to a five-year-old transaction,” Edward Skyler, a Citigroup spokesman, said in a statement. “We also believe the settlement fully complies with long-established legal standards. In the event the case is tried, we would present substantial factual and legal defenses to the charges.”

In his decision, Judge Rakoff called Citigroup “a recidivist,” or repeat offender, for having previously settled other fraud cases with the agency where it neither admitted nor denied the allegations but agreed never to violate the law in the future.

Citigroup and other repeat offenders can agree to those terms, the judge said, because they know that the commission has not monitored compliance, failing to bring contempt charges for repeat violations in at least 10 years.

“It’s a good story to tell,” she said. That is because Ms. Fitzgerald and 239 schoolmates live on a cruise ship that was converted into student housing after an outbreak of mold shut down two dorms on campus. The closing forced students into hotels miles from campus, and Ms. Fitzgerald, 18, stayed in a Holiday Inn that was a 45-minute drive from campus.

College officials searched for a closer and safer alternative, and on the suggestion of an alumnus, moved the students to the ship, the Sea Voyager. Joseph R. Urgo, the college president, said it made sense to use St. Mary’s River, already a subject of research and a source of recreation for the school, to harbor a dormitory.

“We followed up on what we thought was just a lark,” Mr. Urgo said. “But the more we found out about it, the more we looked into it, the more realistic it became.”

Since the 286-foot Sea Voyager docked last Sunday at a city pier just off campus, it has attracted a stream of curious students and visitors to the waterfront, where it towers over the Maryland Dove, a replica of an 87-foot schooner that brought settlers from Europe in the 17th century. After a series of delays, students moved in last week and will complete the semester aboard the ship while crews clean their dormitories on land.

The decision to move the students a second time during midterm exams drew complaints from students and parents concerned about the effect of the disruption on students’ academic performance.

Mr. Urgo acknowledged that the situation had been taxing for the students, who are freshmen and sophomores.

“The whole idea of a residential college is you don’t have to worry about where you live and where your next meal is coming from. You just study,” Mr. Urgo said. “And this has sort of interrupted that a little bit.”

But many of the displaced students seemed excited about the chance to live on a cruise ship, and some students who had not been affected tried to get rooms on the floating dormitory.

The ship’s gift shop has been converted to an office for residence officials, the ballroom functions as a social lounge, and the pub as a coffee ship.

Ms. Fitzgerald said she had to explain that the ship was not the luxury liner described in some news reports. Space is tight and she has had to send most of her belongings back home.

“It’s not super-extravagant,” she said, “but it works.”

And there are perks. The crew replaces linens and towels twice a week and provides laundry service. Students share a bathroom with their roommates instead of an entire floor of co-eds.

Then, there is the view.

“Oh, my gosh!” said Caitlin Whiteis, 18, a freshman from Olney, Md. The room she shares with Alison Horvat on the second floor overlooks the river. “The sunset is right out of our window, and it’s amazing.”

They are members of a class that another freshman, Katie Hough, has labeled “The Natural Disaster Class of 2015.”

The freshmen rode out Hurricane Irene during orientation and were then confronted by the mold that officials said flourished because of excessive moisture that built up around ventilation pipes in the wake of the storm.

Inconvenience or opportunity, the phenomenon of the floating dormitory will be short-lived. The students move out when the semester ends in December and return to their old dormitories in January.

“I’m not excited to move again,” Ms. Horvat said.

“I’m trying to embrace the fact that I live on a cruise ship.”

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Thinking the plane might crash, Mr. Vos, a 25-year-old grocer, turned on the video camera of his iPhone.

“If the plane did go down and crash,” he recalled later, “maybe my phone would have made it, and it would have been a piece of the puzzle.”

Instead, the flight returned safely to Denver, and his video appeared on CNN, CBS and Fox News.

These days, Mr. Vos is hardly the only traveler having such impulses. With more people carrying devices like camera phones, events both benign and disastrous are being recorded by civilians and finding a wider audience — not just in the news media and online, but also in accident investigations. And while these documents are often a boon to investigators, they can also be a burden.

Videos from bystanders have been particularly useful in investigating the Sept. 16 crash that killed 11 people, including the pilot, at an air show in Reno, Nev., especially since video from plane’s onboard camera was not readable. In the recent past, clues have been found in a tourist’s video of the collision of a helicopter and a private plane over the Hudson River in 2009 and in audio recordings of an airplane crash in Palo Alto, Calif., in 2010.

When an Interstate 35 bridge collapsed in Minneapolis in 2007, killing 13, a photo by a passenger in an airplane flying overhead was invaluable to investigators, said Joseph Kolly, director of research and engineering at the National Transportation Safety Board.

“I had a picture of that bridge before it collapsed,” he said, “so that I could exactly place where each load of aggregate was, each concrete truck, so we could get an accurate picture of the loading of the bridge.”

Yet citizen documentarians are in danger of overwhelming government agencies with all their digital data. Over the last five years, the safety board has seen a 400 percent increase in material coming into its recorder laboratory. Extracting data from hundreds of different kinds of electronic devices that were never intended to be flight data recorders is time-consuming and expensive.

“We have invested a lot of money and effort to develop software to help us reverse-engineer these devices,” Dr. Kolly said.

Alex Talberg, an Australian air safety engineer, knows well how long data recovery can take. When a Royal New Zealand Air Force plane with no flight data recorder crashed in 2010, Mr. Talberg spent six months coaxing data from a badly burned motion sensor. His efforts paid off — the information helped determine what happened.

At a meeting of professional aircraft accident investigators in September, Maj. Adam Cybanski of the Canadian Air Force showed a YouTube video of an F-18 Hornet veering off course and crashing seconds after the pilot ejected from the cockpit. The video was one of three by separate bystanders. Multiple vantage points proved a bonus for investigators, as did a special-effects software program used by movie producers that allowed Major Cybanski to determine the airplane’s course in three dimensions.

“We can measure the altitude at a moment in time because we can see the ground features and we can see the airplane and we can measure distances,” he said.

Even video of an airplane isolated in cloudless sky can be used to discover the position of flight control surfaces, landing gear and the pilot’s position.

Of course, the use of video in investigations precedes the YouTube age. Nearly two decades ago, Robert MacIntosh, chief adviser for international safety affairs at the N.T.S.B., was looking into an accident involving a TACA Airlines Boeing 767 that overran the runway in Guatemala. The biggest clue, he said, came from a passenger who recorded the approach and landing and gave the video to a television station.

What is different now is the sheer number of people who have the ability to record practically anything, anywhere and at any time. At the safety board, the workload has increased fourfold but the staff has not.

The growing desire of air travelers to digitally document their flights may, paradoxically, create new risks. The use of electronic devices during takeoff and landing is prohibited because signals can interfere with flight systems. In the future, investigators say, they may have to more seriously consider whether passenger gadgets played a part in an accident. And if so, Mr. MacIntosh said, the task could be monumental.

“If we have a certain number of passengers and they say, ‘Yeah, we saw my neighbor using a cell,’ we’ve got 50 to 75 cellphones we’ve got to start running checks on,” he said. “Is it expensive and time-consuming? Yeah, but we can’t walk away from it.”

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The news of additional accusations came on a day when Sandusky made his first extended public comments since his arrest, and the resignation of the chief executive of the Second Mile foundation, the charity founded by Sandusky, was made public. They were the latest developments in a case that has led to the ouster of several top university officials, including the football coach, Joe Paterno, and the president, Graham B. Spanier.

In a phone interview with Bob Costas that was broadcast Monday night on “Rock Center,” Sandusky said he was innocent of the charges against him and declared that he was not a pedophile. He did acknowledge, “I shouldn’t have showered with those kids.”

“I could say that I have done some of those things,” he said of the accusations against him. “I have horsed around with kids. I have showered after workouts. I have hugged them and I have touched their legs without intent of sexual contact.”

He added: “I enjoy being around children. I enjoy their enthusiasm. I just have a good time with them.”

For many years, that enthusiasm took public form in his work with the Second Mile, a charity to benefit needy children that Sandusky started in 1977. On Sunday, Jack Raykovitz, the chief executive of the foundation for 28 years, resigned. Raykovitz’s failure to do more to stop Sandusky has been a focal point of criticism.

The Pennsylvania attorney general has said that Sandusky used the Second Mile to prey on young boys and that he met each of the eight boys mentioned in the grand jury report through the foundation.

Raykovitz was reportedly informed by the Penn State athletic director Tim Curley about a 2002 assault in which Sandusky is suspected of raping a young boy in a shower at Penn State’s football facility. Curley also advised Raykovitz that Sandusky was prohibited from bringing children onto the university’s campus from that point.

Sandusky resigned from daily involvement with the Second Mile last fall, saying he wanted to spend more time with his family.

Raykovitz, who is a licensed psychologist, said in a statement last week that Penn State officials had told him only that the graduate assistant who witnessed the attack was “uncomfortable” with seeing a young boy shower with Sandusky. That graduate assistant has since been identified as a current Penn State assistant, Mike McQueary, who has been placed on leave.

“I hope that my resignation brings with it the beginning of that restoration of faith in the community of volunteers and staff that, along with the children and families we serve, are the Second Mile,” Raykovitz said in a statement released by the Second Mile.

In announcing Raykovitz’s resignation, which was accepted Sunday, the Second Mile also said that it would conduct an internal investigation to assess its policies, procedures and processes, and to make recommendations regarding the organization’s future operations.

The vice chairman of the organization, David Woodle, will be in charge of the Second Mile’s day-to day operations.

Raykovitz made $132,923 from the Second Mile during the calendar year that ended Aug. 31, 2010, according to its tax forms.

In addition to the firings of Paterno and Spanier, the scandal led Curley and Gary Schultz, the vice president for finance and business, to step down last week. Both men have been charged with perjury and failure to report to the authorities what they knew about the allegations involving Sandusky, Penn State’s defensive coordinator from 1977 to 1999.

Also Monday, the Big Ten announced that Paterno’s name would be removed from its championship trophy for football. It will now be called the Stagg Championship Trophy, after Amos Alonzo Stagg.

The Second Mile has sought to help needy children across the state through various programs, but its suspected role in the case against Sandusky and its close relationship with the university are now being scrutinized.

The Second Mile also announced that Archer & Greiner, including Lynne M. Abraham, a partner at the firm, would become the organization’s general counsel, replacing Wendell V. Courtney, who resigned last week. Courtney had served as Penn State’s counsel before he said he started representing the Second Mile in 2009.

While none of the suspected incidents involving Sandusky and the eight boys mentioned in the grand jury report had reportedly taken place at Second Mile programs, the organization said, that “does not change the fact that the alleged sexual abuse involved Second Mile program children, nor does it lessen the terrible impact of sexual abuse on its victims.”

Jo Becker reported from Harrisburg, Pa.

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The cause was lymphoma, said his wife, Andy.

Dr. Epstein, a physician and associate director of the Center for Health and the Global Environment at Harvard Medical School, published widely in scientific journals beginning in the early 1990s about what were then some of the less obvious potential effects of excessive carbon dioxide in the atmosphere.

He wrote about ocean warming-spiked algae blooms, and how they might be the source of recent cholera outbreaks, how milder winters and hotter summers favored mosquito breeding in areas where there had been outbreaks of encephalitis, how the same conditions accelerated the growth of ragweed, and how some particulate matter from coal-burning plants was particularly good at carrying pollen and other allergens deep into the lungs, possibly explaining a worldwide asthma epidemic since 1980.

His views provoked arguments. Within the politically contentious climate-change debate, it has been especially hard to prove direct links between climate events and the outbreak of disease.

But Dr. Epstein’s prolific writing and his championing of others’ research broadened the terms of the debate — initially focused on long-term threats facing coastal populations and Arctic polar bears, for instance — to include questions about potentially sudden, unforeseeable public health catastrophes.

Former Vice President Al Gore, who tapped Dr. Epstein as a science adviser in conceiving the slide show about global warming that became the basis of the Academy Award-winning 2006 documentary “An Inconvenient Truth,” praised him not only for his research but also for “his rare ability to communicate the subtleties and complexities of his field.”

“Paul was truly a pioneer in the area of climate change and infectious disease,” Mr. Gore said in an e-mail on Monday.

Dr. Epstein’s initial interest in the field was sparked by observations he made as a volunteer physician in East Africa, beginning in the late 1970s in Mozambique. He saw outbreaks of disease that had not been recorded before — “malaria high up in the mountains of Kenya, tick-borne diseases that were hard to explain,” said his wife, a public health nurse who lived in Mozambique with Dr. Epstein and their two children from 1978 to 1980.

But it was a seminal 1989 article in The New England Journal of Medicine — “Potential Health Effects of Global Climatic and Environmental Changes,” by Dr. Alex Leaf, a Harvard Medical School professor and chief of medicine at Massachusetts General Hospital — that suggested the possibility that those unusual outbreaks among the poorest people in Africa might be related to climate change.

“Dr. Leaf’s article gave us a new insight,” said Dr. Eric Chivian, director of the Center for Health and the Global Environment at Harvard and a longtime friend and colleague of Dr. Epstein.

“We realized our responsibility as physicians was to educate people that climate change was not just about whales, wolves and polar bears,” Dr. Chivian added.

Paul Robert Epstein was born on Nov. 16, 1943, in Manhattan, the older of two children of Nathan Epstein, a physician, and Edith Hillman Boxill, a music therapist. He was a graduate of the Little Red School House, a progressive private school, where his classmates included figures active in the ’60s antiwar movement like Angela Davis and Kathy Boudin. He graduated from Stuyvesant High School, Cornell University and the Albert Einstein College of Medicine.

Besides his wife, he is survived by a son, Benjamin; a daughter, Jesse; and a sister, Emily Duby.

Dr. Epstein worked throughout his life as a primary care physician in poor communities, mainly in Boston, and also did stints of volunteer service in several East African countries.

Soon after attending a United Nations Earth Summit in Rio de Janeiro with Dr. Chivian, where the topic of human disease was barely mentioned, he helped frame the idea for the Harvard Center for Health and the Global Environment, which was established in 1993.

With Dr. Chivian, a professor of clinical psychiatry, he taught a course at Harvard Medical School, “Human Health and Global Environmental Change,” that became a template for similar courses now taught at more than 65 medical and graduate schools around the country, Dr. Chivian said.

In an interview with The New York Times in 1998 about that year’s outbreak of cholera and malaria in South America in the wake of El Niño flooding, and simultaneous outbreaks of cholera, malaria and Rift Valley fever in Africa after heavy rains and flooding, Dr. Epstein made the case for linkage.

“If extreme weather events are part of a changing climate,” he said, “we’ve seen lots of evidence of the profound health effects associated with climate change this year.”

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This week, the House is expected to vote on three appropriations bills with significant cuts to local law enforcement as well as trims to agriculture, community development and other programs.

House Republicans had sought deeper cuts than those reflected in the compromise with Senate Democrats, although many of their priorities are reflected in the bill, including eliminating grants to public transportation agencies to reduce greenhouse gases.

Top lawmakers hope the package of bills will be a vehicle for another short-term spending bill to get the government’s bills paid through mid-December as both chambers cobble together the final bills and try to put to rest the immediate debate over spending for 2012.

Throughout the year, the short-term bills, known as continuing resolutions, have proved a headache for Speaker John A. Boehner, Republican of Ohio, largely because some of the most conservative members of his conference, seeking more cuts, have voted against them. One such impasse nearly led to the shutdown of the government this year.

House Republican leaders are hoping to avoid this with the next set of bills; however, several policy items, specifically a provision reviving higher limits on government-backed mortgage loans, which most House Republicans vehemently oppose, could prove a sticking point.

The discussions among members of the deficit reduction committee reflect the wrangling over spending writ large, and the members’ inability to reach a compromise with less than two weeks to their deadline to present to the full Congress has unnerved lawmakers.

The committee’s 12 members, split among the parties and chambers, continued discussions Monday, sometimes in smaller groups, in the hope of finding a compromise between party positions outlined last week.  Added federal revenue remains the sticking point. Among those searching for a compromise are Senator Max Baucus, Democrat of Montana and chairman of the Senate Finance Committee, and senior House Republicans, including Representative Dave Camp of Michigan, the chairman of the House Ways and Means Committee.  

The Democrats’ latest proposal calls for an initial increase of $350 billion of new revenue over 10 years, to be accompanied by instructions to the tax-writing committees to raise $650 billion more.  Democrats said their down payment included revenue that could be raised from ending tax breaks for oil and gas producers, the horse-racing industry and owners of corporate jets, and from changing the tax treatment of business inventories.

In his weekly briefing with reporters, Representative Eric Cantor of Virginia, the No. 2 House Republican, declined to speculate about the committee’s work, saying only that he has been “kept abreast” of the discussions.

“I’m not going to answer any hypotheticals,” said Mr. Cantor. “What I’m telling you is I am hopeful that they are going to complete their work and make the Nov. 23 deadline.”

If the committee were to reach an agreement, the full Congress would have until Dec. 23 to approve it and send it to the White House. At a fund-raiser on Monday in Hawaii, Mr. Obama suggested that he would stay in Washington over the holidays and skip his family’s annual visit to the state, his childhood home.  

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Video of Mr. Cain’s appearance on Monday before editors and reporters at The Milwaukee Journal Sentinel went viral almost immediately after it was posted online, and drew immediate comparisons to Rick Perry’s recent stumble in a debate when he froze in discussing which federal agencies he would eliminate.

At the interview in Milwaukee, after he was asked his thoughts on Mr. Obama’s handling of Libya, Mr. Cain leaned back and appeared to search for an answer: “O.K., Libya,” he said.

“President Obama supported the uprising, correct?” he said. “President Obama called for the removal of Qaddafi — just want to make sure we’re talking about the same thing before I say ‘Yes, I agree,’ or ‘No, I didn’t agree.’  ”

Mr. Cain said he disagreed with the president’s approach “for the following reasons” — then changed course.

“Nope, that’s a different one,” he said. “I’ve got to go back and see.”

He added: “I’ve got all this stuff twirling around in my head.”

Some analysts have grown sharply critical of Mr. Cain’s foreign policy pronouncements in debates and interviews, saying he shows a basic lack of understanding of critical regions of the world. Mr. Cain himself has sometimes fed into this, and in Monday’s interview he said: “Some people want to say, ‘Well, as president, you’re supposed to know everything.’ No you don’t.”

His comments about Libya came after a string of other provocative remarks about foreign policy and related issues.

Those include a statement published Monday in which Mr. Cain suggested that most American Muslims are extremists; a contradictory answer about waterboarding during a Republican presidential primary debate on Saturday focusing on foreign policy; and his statement that if Al Qaeda or another terrorist group demanded, he would consider authorizing the release of every detainee at Guantánamo Bay in return for the release of one American soldier.

J. D. Gordon, Mr. Cain’s spokesman and national security adviser, said the candidate had not been at his sharpest in Milwaukee because of a lack of sleep amid a long day of traveling.

“We were all going on four hours sleep, so he was tired,” Mr. Gordon said in a telephone interview. “When he got the Libya question, it took him a while to get his bearings on it, but he got the answer right.”

Mr. Gordon said Mr. Cain did repeat several times what he said was the correct answer — that the Obama administration should have done a better job assessing the Libyan opposition to Qaddafi and how it would govern.

Even on this point, though, Mr. Cain seemed to contradict himself at the end of the interview, when he said, “I don’t know that they were or were not assessed.”

Daniel Drezner, a professor of international politics at the Fletcher School at Tufts University, was unforgiving in a post on his blog at foreignpolicy.com.

“There’s a mercy rule in Little League, and I’m applying it here — unless and until Herman Cain surges back in the polls again, or manages to muster something approaching cogency in his foreign policy statements, there’s no point in blogging about him anymore,” Mr. Drezner wrote. “I can only pick on an ignoramus so many times before it feels sadistic.”

Jamie Fly, executive director of the Foreign Policy Initiative, said Mr. Cain’s answer was further argument for additional foreign policy debates by the candidates.

“Past presidents have often been tested very early in their terms,” Mr. Fly said. ”We elect a president solely on an economic rationale at our own peril.”

In the Cain comments about Muslims that were released on Monday, he told GQ magazine he believed that most American Muslims held “extremist views,” explaining that a “Muslim voice” he knows — whom he would not name — told him that was the case.

“I have had one very well-known Muslim voice say to me directly that a majority of Muslims share the extremist views,” Mr. Cain said.

Though the transcript indicates Mr. Cain explicitly said he was talking about Muslims in the United States, Mr. Gordon said Mr. Cain had actually been talking about those in another country. “He doesn’t believe most Muslims in America have extreme views,” Mr. Gordon said.

Mr. Gordon said some other criticisms of Mr. Cain’s foreign policy comments had been unfair.

He also said that Mr. Cain had been spending anywhere from 10 minutes to several hours a day boning up on national security issues, including conversations with some ambassadors, and that he had spoken to the first President Bush and former Secretary of State Henry A. Kissinger.

“It’s frankly just a lot of stuff to know in a little bit of time,” he said.

Michael D. Shear contributed reporting from Washington.

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“There had been discussions about this over the last couple of days,” said Matt Boever, a spokesman for State Senator Mike Flood. “Moving it out of that Sand Hills region is important.”

The proposed pipeline would run from Alberta’s oil sands to the Gulf of Mexico and was slated to pass through the Sand Hills, which includes the Ogallala Aquifer, a vital source of drinking water for the Great Plains.

TransCanada’s offer comes just days after a Nov. 10 announcement by the State Department that it would delay a final decision on the $7 billion project until it had considered other routes through Nebraska.

The Obama administration had been under increasing pressure from environmental groups, as well as citizens and lawmakers in Nebraska, to reroute the pipeline.

“I can confirm the route will be changed and Nebraskans will play an important role in determining the final route,” Alex Pourbaix, TransCanada’s president, Energy and Oil Pipelines, said in a statement Monday, adding that the company would support legislation in Nebraska that would shift the pipeline route.

Still, it is the State Department that will ultimately decide the fate of the huge project, and TransCanada’s offer of flexibility does not change the department’s plans to conduct a fresh environmental review of a new route, a process that will probably take 12 to 18 months and push the final decision into 2013.

The department must factor in broader environmental concerns about the 1,700-mile project and recommendations of other federal agencies to determine if it is in the “national interest.”

“We look forward to working with TransCanada and the Nebraska Legislature,” a department spokesman said Monday.

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It was largely because of Ms. Guerrero — and hundreds of other college students like her across the country — that Mr. Obama assembled a formidable machine that helped him roll to victory in 2008, a triumph that included putting Nevada into the Democratic column for the first time in 12 years.

“We did everything,” she said. “We went canvassing. Phone banking. Cleaning the offices. Taking out my bosses’ dry cleaning. Whatever they needed. It was such an amazing time because we all believed and wanted him to get elected.”

Ms. Guerrero said that she did not blame Mr. Obama for the 13.4 percent unemployment rate that has gripped this state, and that she was still likely to vote for him. But as she looks to graduation this June and her job hunt ahead, the emotion she feels is fear, and she cannot imagine having the time or spirit to work for Mr. Obama.

“I don’t think I could do it anymore,” she said. “That campaign was an amazing experience. But I don’t think I’m in the same mind-set anymore. He hasn’t really addressed the young people, and we helped him to get elected.”

Across this state — and in others where young voters were the fuel of the Obama organization, voting for him two to one over John McCain — the enthusiastic engine of the 2008 campaign has run up against the reality of a deadened job market for college students.

Interviews here and across the country suggest that most of his college supporters of 2008 are still inclined to vote for him. But the Obama ground army of 2008 is hardly ready to jump back into the trenches, potentially depriving Mr. Obama of what had been an important force in his victory.

Mr. Obama’s advisers, while acknowledging the shift, said they were confident that the loss of these workers would be negated by an influx of new students who have turned of voting age since 2008. Mr. Obama’s campaign manager, Jim Messina, said there had been eight million voters ages 18 to 21 registered since the last election, most of whom were Democrats.

“Their brothers and sisters started it, and they are going to finish it,” Mr. Messina said Monday. “They are storming into our office. Our volunteer numbers are up from where we thought they would be.”

Yet even Mr. Obama’s supporters say it seems unlikely that the president — given the difficulties of these past three years and the mood of the electorate of all ages — will ever be able to replicate the youthful energy that became such a defining hallmark of his campaign. In the last election, Sandra Allen hosted a group of fellow Brown University students at her home to call voters in North Carolina and Indiana on Election Day, a common practice in the Obama campaign. Mr. Obama won those states to the shock of Republicans.

Asked if she would be doing similar work for Mr. Obama this time, Ms. Allen responded: “Not now. And I will not be streaking across the main green of any campus with hundreds of thrilled people were he to be re-elected next year.”

Ms. Allen graduated last year and, after surveying the job market, decided to take refuge in graduate school to wait things out. “I’m not optimistic,” she said.

Jason Tieg, 22, a student at Brigham Young University-Idaho, voted for Mr. Obama with great enthusiasm in 2008. But now, struggling to find a part-time job to help him through school, he is not even sure he would do that again. “I got a job in July as a custodian on campus, but I lost it again when they needed to cut down.”

“I don’t know if I’ll support him next year,” he said.

It is hard to find a state that more vividly illustrates the danger to Obama from declining enthusiasm among young voters than Nevada. Few parts of the country have been harder hit by this recession, with stubborn double-digit unemployment, an unending wave of mortgage foreclosures and huge numbers of homeless. And there are few states where young voters were so crucial to Mr. Obama’s victory.

Mark Triola, who was president of Young Democrats of Nevada in 2008, said at the time, the Democratic organization at U.N.L.V. was about three times as big as the Republican organization. By last year, he said, they were about equal, a trend that students there say has not changed this year. (For his part, Mr. Triola graduated in the spring and found a job in the communications industry — “ideally probably not what I was looking for, but I don’t have any room to complain given what’s going on,” he said.)

Ian Lovett contributed reporting from Los Angeles, and Kim Palchikoff from Las Vegas.

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The bishops have expressed increasing exasperation as more states have legalized same-sex marriage, and the Justice Department has refused to go to bat for the Defense of Marriage Act, legislation that established the definition of marriage as between a man and a woman.

“We see in our culture a drive to neuter religion,” Archbishop Timothy M. Dolan of New York, president of the bishops conference, said in a news conference Monday at the bishops’ annual meeting in Baltimore. He added that “well-financed, well-oiled sectors” were trying “to push religion back into the sacristy.”

Archbishop Dolan also came prepared to answer questions about the sexual-abuse scandal at Penn State University, which has reminded so many observers of the Catholic Church’s own abuse scandal. He said that the accusations against a former university football coach were a reminder that sexual abuse is a universal problem that affects most institutions.

“Every time that once again takes over the headlines we once again bow our heads in shame,” the archbishop said. “We know what you’re going through, and you can count on our prayers.”

The bishops are struggling to reclaim the role they played in the 1980s and into the ’90s as a nationally recognized voice on the moral dimension of public policy issues like economic inequality, workers’ rights, immigration and nuclear weapons proliferation. Since then, however, they have reordered their priorities, with abortion and homosexuality eclipsing poverty and economic injustice.

But as the sexual-abuse scandal largely overshadowed their agenda in the last decade, their pronouncements on politics and morality have been met with indifference even by many of their own flock. The bishops issue guidelines for Catholic voters every election season, a document known as “Forming Consciences for Faithful Citizenship,” which is distributed in many parishes. But the bishops were informed at their meeting on Monday that a recent study commissioned by Fordham University in New York found that only 16 percent of Catholics had heard of the document, and only 3 percent had read it.

Nevertheless, the bishops remain a forceful political lobby, powerful enough to nearly derail the president’s health care overhaul two years ago over their concerns about financing for abortion. Last week, the White House, cognizant of the bishops’ increasing ire, invited Archbishop Dolan to a private meeting with President Obama, their second. Archbishop Dolan said they talked about the religious liberty issue, among others.

“I found the president of the United States to be very open to the sensitivities of the Catholic community,” Archbishop Dolan said in the news conference. “I left there feeling a bit more at peace about this issue than when I entered.”

But in an impassioned address to the prelates, Bishop William E. Lori of Bridgeport, Conn., the chairman of the bishops’ newly established committee on religious liberty, said the church would urge priests and laypeople to take up the religious liberty cause. Bishop Lori said that in states like Illinois and Massachusetts, and in the District of Columbia, Catholic agencies that received state financing had been forced to stop offering adoption and foster care services because those states required them to help same-sex couples to adopt, just as they helped heterosexual couples.

Bishop Lori said in his speech, “The services which the Catholic Church and other denominations provide are more crucial than ever, but it is becoming more and more difficult for us to deliver these services in a manner that respects the very faith that impels us to provide them.”

The bishops have also been lobbying the Department of Health and Human Services to expand the religious exemption to the mandate in Mr. Obama’s health care overhaul that requires private insurers to pay for contraception. The exemption, as currently written, would still require Catholic hospitals and universities to cover birth control for most of their employees — which the church says is a violation of its religious freedom.

Some liberal Catholic commentators have criticized the bishops’ priorities, saying they are playing into the culture wars. John Gehring, Catholic outreach coordinator with Faith in Public Life, a liberal religious advocacy group in Washington, said, “The bishops speak in hushed tones when it comes to poverty and economic justice issues, and use a big megaphone when it comes to abortion and religious liberty issues.”

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Speaking at a press conference at the conclusion of the Asia-Pacific Economic Cooperation forum here, Mr. Obama also defended his policies on Iran against assaults from Republican presidential candidates and boasted of those policies’ support among foreign leaders.

By his comments on job creation and deficit reduction, Mr. Obama sought to remain in the fray even as his foreign policy commitments — two trade summits here and in Indonesia, and a visit to Australia in between to announce a security agreement — keep him away from Washington.

Republicans “don’t seem to have that same sense of urgency about needing to put people back to work,” he said, citing their opposition to his $447 billion package of tax cuts and spending for infrastructure projects and state aid to avert teacher layoffs.

Mr. Obama also called for Republicans on the special Congressional committee seeking $1.2 trillion in deficit reductions over 10 years to drop their opposition to raising some revenues from the wealthy — to “bite the bullet and do what needs to be done, because the math won’t change.”

“If you want a balanced approach that doesn’t gut Medicare and Medicaid, doesn’t prevent us from making investments in education and basic science and research,” he said, “then prudent cuts have to be matched up with revenue.” 

Now at an apparent impasse, the committee of six Democrats and six Republicans faces a Nov. 23 deadline — four days after Mr. Obama returns — to reach agreement. If it fails or falls short, automatic spending cuts will take effect in 2013, half of them from military programs, under the law creating the panel that the White House and Congressional leaders agreed to in August.

Republican leaders want to repeal the law’s provision threatening the military reductions if Congress does not act. But Mr. Obama reiterated his opposition, recalling that the August deal provided for the automatic spending cuts — known in budgeting jargon as a sequester — as an incentive for both parties to compromise on alternative ways to reduce projected deficits.

“The whole idea of the sequester was to make sure that both sides felt obligated to move off rigid positions and do what was required to help the country,” Mr. Obama said. He would not say whether he would veto a repeal measure “until I actually see a bill.”

With polls suggesting broad support for the provisions in Mr. Obama’s jobs package, the Republican-controlled House has countered by passing a number of measures it calls jobs bills. Most attack various federal regulations, in keeping with the party’s anti-regulation principles, but economic forecasters say the measures would not spur consumer demand and thus job creation in the short term.

Ignoring the Republican bills, Mr. Obama said, “Do I anticipate that at some point they recognize that doing nothing is not an option?  That’s my hope. And that should be their hope, too, because if they don’t, I think we’ll have a different set of leaders in Congress.”

On the issue of Iran and its suspected efforts to build nuclear weapons, Mr. Obama deflected a question about his inability here to win support from the presidents of China and Russia, Hu Jintao and Dmitri A. Medvedev, for tougher sanctions.

“Because of our diplomacy and our efforts, we have, by far, the strongest sanctions on Iran that we’ve ever seen. And China and Russia were critical to making that happen” in the United Nations, he said.

Mr. Obama met separately with the Chinese and Russian presidents on the sidelines of the trade summit. “All three of us entirely agree on the objective, which is making sure that Iran does not weaponize nuclear power and that we don’t trigger a nuclear arms race in the region,” he said.

The three leaders would consult further in the weeks ahead, he added, “to look at what other options we have available to us” diplomatically.

Administration officials had hoped that China and Russia would soften their resistance to additional sanctions given the recent report from the International Atomic Energy Agency of a “credible” case that Iran has been trying to develop a nuclear weapon.

Mr. Obama refused to respond directly to criticisms from Republican presidential candidates in their latest debate on Saturday — in particular a statement from Mitt Romney, widely considered the Republican most likely to win his party’s nomination, that “if we re-elect Barack Obama, Iran will have a nuclear weapon.”

“I am going to make a practice of not commenting on whatever is said in Republican debates until they’ve got an actual nominee,” Mr. Obama said.

“Now, is this an easy issue?  No,” he added. “Anybody who claims it is is either politicking or doesn’t know what they’re talking about.”

Mr. Obama was asked about another issue raised at the Republicans’ debate — the contention by candidates Herman Cain and Michele Bachmann that “waterboarding” of suspected terrorists is not torture and should be used.

“They’re wrong,” he said.

Aside from the fact that the practice is “contrary to our ideals,” Mr. Obama said, “We don’t need it in order to prosecute the war on terrorism.”

On a topic removed from foreign or domestic policies, Mr. Obama elaborated on comments on Friday in California that the scandal at Pennsylvania State University should prompt a broader national soul-searching.

“For the alleged facts of that case to have taken place and for folks not to immediately say, nothing else matters except making sure those kids are protected, that’s a problem,” he said.

But the problem is “not unique to a college sports environment,” Mr. Obama added.

“All of us, I think, have occasion where we see something that’s wrong, we’ve got to make sure that we step up,” he said. “That’s true in college athletics. That’s true in our government. That’s true everywhere.”

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The professor, Richard H. Fallon Jr., said he would not, and his assessment of what he had been asked to sign was cutting.

“Its argumentation fell within the bounds of what lawyers could permissibly say in a brief,” Professor Fallon wrote in a provocative draft essay that has been circulating in the legal academy. But the brief’s presentation of the historical evidence, he said, “was not nuanced or balanced.”

“A purportedly scholarly book or article that asserted its claims without further qualification,” he wrote, “would attract derision as one-sided if not misleading.”

The health care brief was just an example of a larger problem, Professor Fallon wrote, one of role confusion between scholarship and advocacy. “Many scholars’ briefs are actually not very scholarly,” he wrote.

In major cases, the Supreme Court receives stacks of friend-of-the-court filings, called amicus briefs. It helps for them to have an angle: The justices may be more likely to read a brief from a group of scholars with specialized expertise than one from, say, a trade group. That, along with an understandable desire by some law professors to help shape the law, may explain the explosion in the filing of such briefs.

In the term that ended in June, the Supreme Court decided about 80 cases after briefing and argument. By Professor Fallon’s count, it received 56 briefs from groups of law professors.

In the term that ended in 1986, by contrast, the court decided twice as many cases, but it received only three such briefs.

Barry Friedman, the law professor at New York University who asked Professor Fallon to join the health care brief, said his colleague was “exactly right” as a general matter in his criticism of law professors’ briefs.

“I’m completely in sympathy with the broader argument he develops,” Professor Friedman said. “I get constant requests to write them and to sign them. There is often more attention to the issue than the analysis.”

But that was not the case with the health care brief, Professor Friedman said. “I actually happen to possess great expertise on this subject,” he said. “On his analysis of this particular issue, I think Dick is wrong.”

In his essay, Professor Fallon discussed a second brief he had declined to join. It concerned “a highly complex question of federal jurisdiction over a habeas corpus petition filed by a prison inmate” and was written by Michael C. Dorf, a law professor at Cornell.

Professor Fallon said the brief was in all likelihood “exemplary in all respects.” But he said he would not sign that one, either, on the refreshing ground that he had not done the required reading.

“Of the dozens of Supreme Court decisions to which the brief referred, there were some that I know well, and others I recall only hazily,” he wrote. “The brief also cited at least nine Supreme Court cases that I cannot remember ever having read at all, and 12 lower court decisions that I know I have never read.”

“It seems pertinent,” he added, “that my instinctive sympathy for the asserted position — and thus my impulse to want to sign — had ideologically based foundations.”

In an e-mail, Professor Dorf said that he, too, had long been suspicious that “law professor briefs were attempting to leverage scholarly reputations for political/ideological ends.”

“I prefer not to be asked to sign such briefs, but because I do sign some, I worry that not signing may be taken as disagreement,” he wrote. “Finding it harder than Dick does to say no, I cannot afford to be as scrupulous as he. I admire him on both counts, but I guess I’m just weak.”

Professor Dorf, who did sign the health care brief, set out his standards. He will join briefs for groups of law professors if he trusts their organizer or author, cares about the issue and agrees with “the overall thrust of the argument.”

This entire discussion may be, for want of a better word, academic. There is no particular reason to think that briefs from law professors have much impact.

In an interview in September, Justice John Paul Stevens, who retired last year, said that “normally I didn’t even read amicus briefs.”

“That was one of the tasks I assigned to my law clerks,” he said. “Their job was, if they thought an amicus brief really should be read, they’d pull them out for me and then I’d look at them.”

Justice Antonin Scalia said almost the same thing last month at the Chicago-Kent College of Law, but more colorfully. “I do not read all amicus briefs,” he said, according to notes of the remarks taken by Abdon M. Pallasch of The Chicago Sun-Times. “My law clerks read all amicus briefs.”

“If there’s one that has a hidden truffle in there somewhere,” he said, “they call it to my attention.”

When the United States Court of Appeals for the District of Columbia Circuit upheld the health care law last week, it did not cite the brief that Professors Friedman and Dorf had submitted. But it did cite a scholarly article published in August in The California Law Review — by Professor Fallon.

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For the nation’s health care system, there may be no going back.

No matter what the Supreme Court decides about the constitutionality of the federal law adopted last year, health care in America has changed in ways that will not be easily undone. Provisions already put in place, like tougher oversight of health insurers, the expansion of coverage to one million young adults and more protections for workers with pre-existing conditions are already well cemented and popular.

And a combination of the law and economic pressures has forced major institutions to wrestle with the relentless rise in health care costs.

From Colorado to Maryland, hospitals are scrambling to buy hospitals. Doctors are leaving small private practices. Large insurance companies are becoming more dominant as smaller ones disappear because they cannot stay competitive. States are simplifying decades of Medicaid rules and planning new ways for poor and rich alike to buy policies more easily.

But how to pay for these changes, and what will happen to the 30 million uninsured Americans the law intends to cover, will be up in the air if the mandate at the heart of the law — the requirement that individuals buy health insurance or face a penalty — is struck down.

The election results of 2010 and stiff state opposition to the mandate also complicate the picture. Hospital administrators, insurers and doctors are counting on federal subsidies and coverage expansion that would result in a surge of patients with insurance to offset cuts in government programs that many fear could soon become draconian. Large health systems could then use their newfound clout to demand higher prices from private insurers even as federal and state governments pay less.

Other changes influenced by the legislation may leave some patients and doctors lost in the new land of giants. As medicine moves from a cottage industry to one dominated by large organizations, some patients with insurance will probably find their choices more limited. But their care may be better coordinated, as hospitals, doctors and even insurers join to streamline services.

“The system is transforming itself,” said Charles N. Kahn III, president of the Federation of American Hospitals. “But the success of these changes depends a lot on whether there is sufficient funding.”

Hospital systems are anticipating a major influx of federal funds and patients as a result of the law. In Maryland, for instance, the Johns Hopkins Hospital and Health System recently bought two suburban hospitals and is spending several hundred million dollars on computer systems to link its clinics and hospitals across the state. It has hired hundreds of primary care doctors and nurses, forged partnerships with urgent care clinics and expanded home health service to serve an expected flood of new patients.

“If the law is struck down, health care reform will have to continue one way or another,” said Patricia Brown, president of Johns Hopkins HealthCare.

Across town, Baltimore Medical System, a community health center, expects to expand its medical staff by 50 percent over the next three years to accommodate an anticipated increase in patients to 70,000 from 47,000.

“We are looking for new clinicians on a constant basis,” said Jay Wolvovsky, the system’s chief executive, who said that hiring would stop if the law were overturned and federal funding were in doubt. “We wouldn’t be able to expand and we’d be stuck where we are.”

In states like Texas, the law is deeply unpopular, and the medical association has a “Calendar of Doom” listing the timeline for important provisions of the law and other government rules. Still, changes in delivering medical care are taking hold, including a move away from small doctor practices that were predominant for more than a century.

Texas medicine will never be the same no matter what happens with the law, said Louis J. Goodman, the association’s chief executive, and older doctors blame a cascade of new rules and changes well beyond the new health law. “There’s a feeling among doctors here that government is crushing them,” Mr. Goodman said.

And even though critics say the law does little to reduce the costs of care, its passage touched off myriad efforts to pare widespread waste.

“The interest from the doctor and hospital community has accelerated,” Tom Richards, a senior executive at Cigna, said of efforts to exact savings and improve care.

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“We go to a lot of job fairs,” said Stuart Stevens, a top adviser to Mr. Romney. “You cannot spend a half-hour at a job fair and actually talk to people without having to leave because you’ll start crying.”

Mr. Obama’s campaign team has been gathering film of its own, documenting what Democrats say are Mr. Romney’s shifting positions on an array of issues over the years. The White House, which is already sending aides and allies out to make a case that Mr. Romney has no core or principles other than trying to win office, is ready to unleash the assault at any time. Democrats have already run commercials against Mr. Romney in Iowa and Arizona and could release even more before the primary season begins.

It is still seven weeks until Republican voters start getting their say in choosing from a wide field of candidates. But a stealth general election discussion is already under way, with the White House acting as if Mr. Romney will be the Republican nominee and Mr. Romney, for his own reasons, happy to assume the role and respond with an intense retort of his own.

The Romney campaign drew attention to the intensifying clash on Monday, suggesting that Mr. Obama and Democrats have an “obsession” with Mr. Romney. To amplify their point, they issued a statement that morphed the blue Obama campaign logo into the word “Obsession.”

The candidates themselves engaged in one of their first direct exchanges over the weekend, with Mr. Romney asserting at a debate Saturday that Iran’s progress toward developing a nuclear weapon represented Mr. Obama’s “greatest failing.” Asked to respond on Sunday, Mr. Obama shot back that “anyone who claims” that containing Iran’s ambitions is easy “is either politicking or doesn’t know what they’re talking about.”

The back-and-forth provides an early look at how the two men intend to confront each other. While Mr. Romney relentlessly criticizes Mr. Obama for the sour state of the economy, his attacks are often almost genial in tone — a recognition that many of the independent and moderate voters Mr. Romney hopes to win over like the president personally, but do not necessarily approve of his job in the Oval Office.

“David Axelrod says it’s going to be an M.R.I. for the soul, “ said Mr. Stevens, referring to the way Mr. Obama’s senior political strategist referred to the campaign process. “This will be an M.R.I. of the president’s record.”

By contrast, Mr. Obama and his advisers have signaled that they intend to try and use elements of Mr. Romney’s background against him, particularly his time running Bain Capital. In a strategy that dovetails with the sharpening tenor of the president’s populist message, they are likely to paint Mr. Romney as a plutocrat whose brand of capitalism would hurt the interests of the middle class at a moment when the country is increasingly focused on income inequality.

“Presidential races are, by definition, revealing,” said Mr. Axelrod, who spends more time talking about Mr. Romney than about any other Republican candidate. “You can try and craft your image, but whoever you are, people find out.”

The president and Mr. Romney have little personal history between them.

They had their first brief meeting in 2005 at the Gridiron Club dinner in Washington. They bumped into each other a few times on the campaign trail in 2007, aides said, and Mr. Obama called Mr. Romney when Ann Romney, his wife, was found to have cancer.

But they are now zeroing in on each other, previewing what the 2012 race will look like should Mr. Romney survive what are likely to be further twists in the primary contest. Mr. Romney’s focus on Mr. Obama was on full display at Saturday’s debate in South Carolina, when he took on the president’s approach to Iran, China, Pakistan and, even, the United States’ role in the world.

“We have a president right now who thinks America’s just another nation,” said Mr. Romney, who is testing new lines of attack most anywhere he goes. He has criticized Mr. Obama’s “Where’s Waldo economy,” for example, suggesting that the president has been an absent leader on the biggest issue facing the country, and he characterized the country’s economic condition as the “Obama Great Recession.”

Ashley Parker contributed reporting.

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