The End of Obamacare

To read Robert Pear, longtime health-care policy reporter for The New York Times, over the last year is to know that Obama's signature achievement, the Affordable Care Act (ACA), also known as Obamacare, is in real trouble. I'm not sure if the Gray Lady's shift from booster to skeptic happened last year or the year before, but the conversion is now fully upon us. Paul Krugman, who for many years would devote at least one column per week to the wonders of Obamacare, has largely gone silent on the issue.

For a good overview of why the ACA is headed for the dustbin read "Obamacare: The Neoliberal Model Comes Home to Roost in the United States—If We Let It," by Howard Waitzkin and Ida Hellander, which appeared in the May issue of Monthly Review. In a nutshell, the Affordable Care Act is not affordable. There is no way to control costs. Premiums, deductibles and co-pays are all on the rise, and the increases in costs are not sustainable.

Pear's story in yesterday's paper, "Obama Offers Ways to Improve His Health Care Law," dealt with the lengthy, academic apologia for the ACA penned by Obama and which appears online in the Journal of the American Medical Association. "United States Health Care Reform: Progress to Date and Next Steps," was too long for me to ingest. But the conclusion from the abstract reads as follows:

Conclusions and Relevance Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges.

My coworker asked me incredulously yesterday after seeing the story online, "Can you believe Obama is backing public option now?" Pear shares her incredulity:

White House officials said that Mr. Obama’s purpose in writing the article was to start a discussion and suggest a direction for elected officials and future policy makers, but that he would not be offering detailed new legislative proposals to carry out his ideas. 

Based on his experience in the last few years, Mr. Obama said, Congress should establish “a public plan to compete alongside private insurers in areas of the country where competition is limited.” 

Most of the country has benefited from competition in the marketplaces, and 88 percent of the people who have enrolled live in counties where at least three insurers offer plans, Mr. Obama said. But, he said, the remaining 12 percent are in areas with only one or two insurers. 

Jason Furman, the chairman of Mr. Obama’s Council of Economic Advisers, said, “A public option would be one way to make sure that there was competition everywhere.” 

In the debate on health care in 2009 and 2010, Mr. Obama said he supported the idea of a public option, but he did not always insist on it, and the administration sent mixed signals about how important it was.

Besides the expansion of Medicaid, the key component of Obamacare is the provision of federal subsidies for people to purchase insurance in the online marketplaces:

The online exchanges will be a viable source of coverage “for decades to come,” Mr. Obama said, but “further adjustments and recalibrations will likely be needed.” 

Of the 11 million people with marketplace coverage, 85 percent receive tax credits that, on average, cover nearly three-fourths of their premium costs. But for some, said Kristie Canegallo, a deputy chief of staff at the White House, the “tax credits aren’t big enough.”

Obama is whistling past the graveyard on this one, as Carl Hulse reports in "How an Arcane Spending Fight Could Alter the Federal Balance of Power." The Obama administration has been funding the health insurance subsidies without Congressional authorization: "The final word may come in federal court, where a district judge has already found the spending to be unconstitutional. The administration is appealing that decision."

The administration is likely to lose. Even with the premium subsidies, health insurance is too expensive for most because of the high deductibles and co-insurance. Without the subsidies the online marketplace collapses. All that will remain of Obamacare is the Medicaid expansion for those states that opted in.

Follow Up on the Zacarias Moussaoui Bombshell Connecting Saudi Arabia to 9/11

It is encouraging to see The New York Times follow up Scott Shane's "Moussaoui Calls Saudi Princes Patrons of Al Qaeda" with two additional stories today.

Yesterday I monitored Google News to see how much play the Moussaoui bombshell was getting. The answer was not that much. The big news at the top of the page was on the fatal Metro-North Railroad accident in New York and Islamic State's immolation of a caged Jordanian fighter pilot, First Lt. Moaz al-Kasasbeh. I was prepared for the Moussaoui story to be a one-off.

Unfortunately one of the two stories today -- "Pre-9/11 Ties Haunt Saudis as New Accusations Surface," by Ben Hubbard and Scott Shane -- is a pitiful effort by the Gray Lady to walk back, or at least muddy, Shane's original report. I say pitiful because it is constructed out of quotes from establishment academics (Princeton's Bernard Haykel and Texas A & M Bush School of Government's Gregory Gause III, whose universities are likely endowed by Saudi money), Saudi royalty and former U.S. ambassador to Saudi Arabia Charles Freeman all casting doubt on the veracity of Moussaoui's claim that key members of the Saudi royal family with critical positions in the Kingdom backed the 9/11 attacks.

Where is an outline of the case against Saudi Arabia that the families of the 9/11 victims are pursuing? That is what should be addressed in this follow up because it is civil suit that has not be reported on extensively. We get plenty of stories about Jewish families going after Hamas and Iran in civil court for backing terrorism but very little about the great white whale of international jihad, the Kingdom of Saudi Arabia.

The gist of the Hubbard and Shane walk back is that, yes, the Saudis supported the mujahedeen in Afghanistan, along with the U.S. government, and these mujahedeen morphed into Al Qaeda, But the Saudis cut their ties with Al Qaeda.

For a sample of the quality of the walk back there is this quote from Princeton's Haykel:

By 1994, when Osama bin Laden was stripped of his Saudi citizenship and banned from the kingdom, the Qaeda founder was “writing nonstop against the Saudi regime with the idea of toppling it,” said Bernard Haykel, professor of Near Eastern studies at Princeton. “That the Saudis would knowingly support a movement that sought to destroy them makes no sense to me.”

I guess a prestigious perch at an Ivy League university blinds an intellectual like Haykel to the possibility that Saudis might support Al Qaeda with the understanding that its targets will be first and foremost the "Far Enemy."

In any case, Hubbard and Shane have a tough pull on their hands. Piles of evidence point to the Saudis. Everyone knows it, accepts it as an existential reality. The story even acknowledges a continuation of the pattern today with Saudis funding fighters in Libya and Syria:

. . . American officials have praised the Saudi government for cracking down on militants inside the kingdom and for acting to stop terrorist financing by Saudi citizens. But the kingdom has continued to support militant groups other than Al Qaeda and armed tribes that it sees as advancing its policies in Libya, Syria and elsewhere. And at home, the kingdom’s traditional religious establishment promotes and enforces a strict interpretation of Islam.

The point of the Hubbard and Shane walk back is to muddy the waters, float the narrative that Saudi support for Al Qaeda was a historical artifact that preceded 9/11 (even though there is a paragraph in the piece built around a quote from Ambassador Freeman that states the Saudis didn't seriously change their thinking on Al Qaeda until 2003 when there were Qaeda-linked bombings in the Kingdom) as well as cast doubt on Zacarias Moussaoui.

The second story today on the Saudi connection to 9/11 is by the reliable Carl Hulse ("Claims Against Saudis Cast New Light on Secret Pages of 9/11 Report") and focuses on the long, strange history of the national security classification of the 28 pages classified 13 years ago obviously finger the Saudis as the funding source for the 9/11 attacks -- former Florida Senator Bob Graham has said as much. And Obama has promised family members of 9/11 victims that he will release section 4, but he never has. The reason? Pressure for some sort of action against the House of Saud would be hard to resist. Why not some fianancial sanctions? We have plenty levied against Iran and Iran didn't attack us on 9/11.

Another reason is that the U.S. doesn't want to stop funding for jihad as this has replaced the Cold War as the primary rationale for its globe-straddling militarism. As one of plaintiffs in the civil suit against the Saudis explains:

WASHINGTON — A still-classified section of the investigation by congressional intelligence committees into the Sept. 11, 2001, attacks has taken on an almost mythic quality over the past 13 years — 28 pages that examine crucial support given the hijackers and that by all accounts implicate prominent Saudis in financing terrorism. 

Now new claims by Zacarias Moussaoui, a convicted former member of Al Qaeda, that he had high-level contact with officials of the Saudi Arabian government in the prelude to Sept. 11 have brought renewed attention to the inquiry’s withheld findings, which lawmakers and relatives of those killed in the attacks have tried unsuccessfully to declassify. 

“I think it is the right thing to do,” said Representative Stephen F. Lynch, Democrat of Massachusetts and an author of a bipartisan resolution encouraging President Obama to declassify the section. “Let’s put it out there.”

White House officials say the administration has undertaken a review on whether to release the pages but has no timetable for when they might be made public.

Mr. Lynch and his allies have been joined by former Senator Bob Graham of Florida, who as chairman of the Senate Intelligence Committee was a leader of the inquiry. He has called for the release of the report’s Part 4, which dealt with Saudi Arabia, since President George W. Bush ordered it classified when the rest of the report was released in December 2002.

Mr. Graham has repeatedly said it shows that Saudi Arabia was complicit in the Sept. 11 attacks. “The 28 pages primarily relate to who financed 9/11, and they point a very strong finger at Saudi Arabia as being the principal financier,” Mr. Graham said last month as he pressed for the pages to be made public.

Relatives of those killed on Sept. 11 as well as plaintiffs in a federal lawsuit against Saudi Arabia have also demanded that the pages be made public, seeing them as the vital link that they believe connects an important ally of the United States to the deadly attacks. They say the pages, Part 4 of the report, could also help in determining the source of current funding for terrorist activities.

“If we stop funding of terrorism and hold those people accountable, wouldn’t it make a dent in the financing of terrorism today?” asked William Doyle, whose son, Joseph, was killed in the World Trade Center. Mr. Doyle said that President Obama personally assured him after the death of Osama bin Laden that he would declassify that section of the report.

Proponents of releasing Part 4, titled “Finding, Discussion and Narrative Regarding Certain National Security Matters,” have suggested that the Bush and Obama administrations have held it back for fear of alienating an influential military and economic partner rather than for any national security consideration.

I don't see how section 4 can remain classified now. To keep it classified with a presidential campaign fast approaching would require a great deal of political capital, something the Democrats don't have. I would imagine what will happen is that there will be more attacks on Moussaoui, more muddying and prevarication in the prestige press, high profile senators will eventually stand on their hind legs and voice support for their paymasters in the Kingdom, and Obama will grudgingly release the 28-pages, possibly at date designated after the 2016 election, in a highly redacted form.

***CORRECTION***

Originally I said that the 28 classified pages are part of the 9/11 Commission Report. That is incorrect. The 28 classified pages are part of the "Joint Inquiry into Intelligence Community Activities before and after the Terrorist Attacks of September 11, 2001," which Senator Bob Graham co-chaired.