With Ebola Raging in Africa, Why Risk Bringing It Here?

Incredibly, even the Ebola scare became political no sooner than it arrived in Dallas. Republicans began arguing for travel bans, Democrats for open borders,
the President hesitant.

“I don’t have a philosophical objection necessarily to a travel ban if that is the thing that will keep the American people safe”, said Obama, but experts have told him that a travel ban is less effective than the measures “we are currently instituting”: educating hospital personnel across the country and temperature checks at five airports through which all travelers from the three afflicted West African nations must now pass.

That didn’t ensnare a doctor working with Médecins Sans Frontières (MSF) who had no symptoms when he returned from West Africa but who checked himself into New York’s Bellevue Hospital days later when he ran a fever and was diagnosed with Ebola. When a second MSF healthcare worker named Kaci Hickox landed at Kennedy and, agitated by being detained for six hours showed a slightly elevated temperature, three governors — Chris Christie of New Jersey, Andrew Cuomo of New York and Pat Quinn of Illinois — made the colossal blunder of declaring that all returning personnel from the region who had had any contact with Ebola patients would be quarantined for 21 days, a decision made with no contact with the White House or federal health officials. Christie jailed Hickox in a tent at a Newark hospital with a port-a-potty, no television, no books. Her captors even wanted to take away her cell phone.

The medical community reacted immediately against an extraordinarily ill-considered policy that was guaranteed to end the flow of medical volunteers to fight contagion in Africa if they face mandatory quarantine every time they return for a break. The governors walked back their edict and Hickox was released to go home to Maine. Christie denied he had reversed his policy, as if we had imagined him announcing the 21-day plan, and tried to lie his way out of his debacle saying “she was running a high fever and was symptomatic” which was not the case. Hickox is suing.

separation

It will seem that we are now arguing against ourselves when we now say that fruit bats cannot cross the Atlantic to bring us Ebola, so why not impose travel restrictions to severely limit the disease from coming into the U.S. in the first place. There has been panicky reaction to the specter of Ebola from the public as well as from governors — Oklahoma kids pointlessly kept home from school because a few had been on that cruise ship where they had no contact with a self-quarantined Dallas lab technician who showed no symptoms, for example — but it is not a panicky response to ask why leave our doors open to everyone from the afflicted countries so we can treat Ebola here, when public health officials say it is essential that we take every measure to defeat the epidemic there?

disagreements

The arguments against a travel ban suffer from confusion. It would make the epidemic worse, is said continuously but unconvincingly. Wouldn’t it impede getting needed aid into the afflicted countries? Well no, because a ban would only prevent people from coming out. How would medical personnel, crucially needed in those countries, come and go if there were a travel ban? They would be exempted from the ban, of course. The free movement of medical personnel, who need of course to be monitored, who of course need to be quarantined if they then present symptoms, is the obvious exception if we are to enlist them in the fight.

But the Center for Disease Control’s (CDC) director Thomas Frieden and others have said the ban won’t work because people will simply detour through other countries. Even if that were an effective method for the few to defeat the system, the many — currently upwards of 150 arriving daily at U.S. airports from the stricken countries — would be blocked.

It is vacuous even to suggest that end-runs would be a problem. No matter what route people take they are identified by their passports, as well as passport stamps or customs’ online data that indicate where they have just been. And an outright ban is the wrong word. The U.S. can simply closely restrict the issuance of visas until the disease is defeated.

Another argument is the damage it will do to the frail economies of the West African countries.

The danger is that if other nations followed an American ban with bans of their own, economies in West Africa would be crippled. That could only reduce the ability of those nations to fight the epidemic, and make it even more likely the disease would spread through porous borders to other African nations and beyond.

says a New York Times editorial. But no one is waiting to see what America does; 14 African nations have banned residents of Liberia, Sierra Leone and Guinea from entering their countries, and 14 other African countries have enacted travel restrictions.

The economies of the stricken countries will be wrecked anyway. “Schools have shut down, elections have been postponed, mining and logging companies have withdrawn, farmers have abandoned their fields”, says this Times piece from two days earlier. There are 10 times fewer burial teams than are needed for lack of the willing, and there are threats of strikes by health workers and gravediggers in Sierra Leone. Helene Cooper, a Times correspondent and native of Liberia who was recently there, said on Andrea Mitchell’s cable news show that while there is progress — increased education, signs in the street advising people, public chlorine washes — there is “no question that Ebola has hit Liberia, Sierra Leone and Guinea very hard…so many businesses have now pulled out of Liberia, so much investment has started to come out…so when you see the flight of capital and resources, that’s a big deal”.

Tragic, but it renders inconsequential the harm a travel “ban” would do to their economies. And worse is to come. The World Health Organization predicts 10,000 cases a week of this devastating disease by December. Make that up to 1.4 million West Africans that could be infected by the end of January, according to the CDC’s estimates. Economic restoration of these countries will have to wait until the contagion is overcome.

pacification

Those geometrically progressing numbers should tell us that in the coming months there will be a steadily increasing likelihood that someone among the 150-a-day arriving passengers will be carrying the virus.

Yet, Ebola is an “unlikely candidate for epidemic status” says an editorial at BloombergBusinessweek because it can only be contracted by contact between the bodily fluids of the ill and our soft tissues, such as eyes and mouth. Why, measles is easier to catch, we’re reminded.

Compared to this blithe reassurance, the reality of top to bottom hazmat suits and the gutting of all the seats and carpeting of the aircraft that took one of the Dallas nurses to Cleveland makes for a glaring contradiction. The edit makes no mention that the measles fatality rate before vaccines was 0.0129%; the fatality rate for Ebola is from 50% to 90%.

A travel ban is a terrible idea, the editorial continues, because it could disrupt trade. And besides, “people want to travel to see family and friends, visit places, work, or invest. We think all that is worth the price of somewhat increased risks of illness.”

virulence

Texas Congressman and doctor, Michael Burgess, gave us a sense of how wishful were those musings on Andrea Mitchell’s news program:

“The CDC was telling us to prepare for this virus the same way we might prepare to take care of a patient with hepatitis A. [Ebola] is different. The viral load, the disease burden in a patient who is near the end of the struggle with this disease, it’s unlike anything anyone has ever seen before. The virus may not be airborne but it can be everywhere in the room because there’s just so darn much of it in a patient who is unfortunately at the end of the clinical course.”

If that is somehow not persuasive,

A patient in the throes of Ebola can have 10 billion viral particles in a fifth of a teaspoon of blood — far more than the 50,000 to 100,000 particles seen in an untreated patient with the AIDS virus. Even the skin of an Ebola patient can be crawling with the virus.

That was Dr. Bruce Ribner, a physician involved in the care of Ebola patients treated at Emory University Hospital in Atlanta. This is what the President, who has the authority to restrict travel under the 2005 Pandemic Plan, is potentially allowing to enter the United States.

ebola exceptionalism?

The three besieged countries in West Africa have weak health infrastructures that quickly were overtaken by the disease, whereas the United States has one of the best health systems in the world, goes the argument. True enough, when there are only a few cases that need to be isolated and controlled. But with only four facilities equipped to handle highly infectious diseases — Emory alongside CDC in Atlanta, NIH in Bethesda, and hospitals in Omaha and Missoula — and the expectation that future cases are best transferred to these sites, we are less prepared than claimed should cases suddenly multiply and these facilities become overwhelmed. The fallback is presumed to be the larger regional hospitals to which patients would be transferred. But that brings up the question of how transferred?

The only aircraft in the U.S. that are adapted for sealing off the cargo of an infectious patient are two Gulfstreams owned by government contractor Phoenix Air. A third is being outfitted. A VP of Phoenix cautions in a Times article that
Branden Camp/European Pressphoto Agency
transport is “the easy part…It is a nasty, nasty disease and ultracontagious”. “Decontaminating an aircraft once the patient is dropped off is the hard part…an elaborate 24-hour process of treatment with chemicals and the removal and burning of seatbelts, lights and anything else that might have come into contact with the sick passenger”. An added concern: there may be a problem of finding pilots willing to fly Ebola patients, as is occurring with a French company comparable to Phoenix. They will fly only “dry patients”, patients who are not bleeding, vomiting and are free of diarrhea. The general director of that company says he knows only two pilots in all of Europe who will fly Ebola evacuation missions.

Why bring this up? To make the point that in a general outbreak, there will be too many patients to transfer elsewhere. They will need to be treated at local hospitals wherever the disease turns up. Note some of the local reactions at Emory in Atlanta where only three medical personnel brought in from West Africa were treated. The county threatened to cut the sewer system off if the hospital flushed medical waste, trash companies insisted that all takeaway be sterilized, couriers would not drive blood samples to testing labs, and the staff could not even get pizza outfits to deliver.

If in this day of increasing threat from drug-defying pathogens — such as SARS, MRSA, KPC — if we do not prepare with thorough training and upgrading of facilities to gain the confidence of medical personnel, a wildfire of contagion could lead to a break in their willingness to serve.

All of which argues that the deliberate gamble of an open door policy is unwise. Contemplating the possibility of outbreak and what needs to be done to prepare is not panic; it is precaution. Rham Emanuel’s nostrum of “never let a serious crisis go to waste” is not the right prescription in this case. With Ebola we must not, as usual, find ourselves deciding after a calamity to do a better job. We cannot always stop a disease at the border but we can slow it down in order to give this country the opportunity to organize against a medical emergency.

It’s Because Obama Didn’t Attend Intel Briefings, Right?

ISIS Is Obama’s Fault for Not Leaving Troops Behind, Right?

If We Don’t Stop Global Warming, You’re Not Going to Like Plan B

If we don’t take immediate and concerted action to slash fossil fuel emissions, we face “high to very high risk of severe, widespread, and irreversible impacts globally” from climate change, according to a leaked draft of a report by the U.N. Intergovernmental Panel on Climate Change (IPCC).

But in this country, there is no possibility for the all-encompassing energy
policy that is needed to confront the threat. The Obama administration has raised auto fuel efficiency standards and is moving to restrict power plant emissions, but Republicans and those Democrats who hail from coal-producing states call the plan a “war on coal” and will sue to keep them belching pollution. The American public is largely indifferent. Constant naysaying in the partisan media has persuaded 1 of 4 Americans that global warming is a hoax or of little concern, says an April Gallup poll; only 39% are “concerned believers”; the rest had mixed views.

But even those who disbelieve should spend a few moments to think about what will happen if they turn out to be wrong and nothing is done sufficient enough to reverse global warming. What sort of world will we live in when, too late, we need to take desperate measures?

Clusters of scientists around the globe are dealing with the question of what we would have to do. Expecting that mankind will go on heedlessly extracting and burning ever greater quantities of fossil fuels, they follow a different path from the usual climate scientist. Their fear is that the planet may tip beyond a point of no return and experience a climate emergency for which we had better have a Plan B. To that end most are exploring ways to affect the climate itself. The umbrella term for their hypothetical solutions is geo-engineering.

the search for solutions

One camp favors capturing carbon dioxide. Increasing plant life is of course a well-known antidote, especially planting the more rapidly-growing genetically-modified trees developed by the lumber industry. But plant matter releases its CO2 when it dies, so we would only be borrowing time. There’s capture and burial of carbon dioxide by emitting industries, but industry can’t be counted on to adopt this costly technology.

So one solution engineers propose is “direct air capture” that sets up
arrays of fans to pull air through filters to capture CO2 for burial. A variant of this idea would use plastic mesh sheets to trap CO2 from the wind that would then be doused with sodium carbonate, yielding harmless baking soda.

But few see these as adequate to the global task. An oft-mentioned method puts nature to work. It would fertilize vast stretches of the oceans with iron dust. Blooms of plankton algae would sprout to suck carbon dioxide from the air in order to grow by photosynthesis. When the algae dies, the assumption is that it would sink to the bottom rather than release its CO2 into the atmosphere. Done widely enough to make a difference, however, the worry is that it would change the chemical composition of the oceans with unknown consequences for marine ecosystems.

We endanger ecosystems now. In desperate times consequences will be ignored.

Instead (or as well), what about increasing pollution in the atmosphere to block the sun’s rays from reaching Earth? This is probably the most
widely advanced solution. The trade off would be hazy days in place of sunny days, and reddish sunsets like the skies “Blade Runner” anticipated (the 1982 film that, eerily, was set in 2019, almost upon us). This method would pump sulfur compounds into the stratosphere above where rains would wash them out, so they would sink only slowly back to Earth. Never mind our long campaign to scrub from power plant emissions the sulfur that caused smog and acid rain. If warming gets out of hand, smogging the planet now becomes desirable .

The sulfate particles that form would reflect sunlight back into space. We know that works from past volcanic eruptions. It was called “the year without a summer”, with July frosts on New England farms, after Indonesia’s Mount Tambora blew in 1815. And after the Philippines’ Mount
Pinatubo in the Philippines in 1991
before it blew
Pinatubo exploded in 1991, the earth’s temperature fell by a full Fahrenheit degree across three years from the sulfuric acid haze that winds carried around the world.

We would need to reflect back just 1.1% of the sun’s energy — still a huge amount — to counteract all of the temperature rise forecast by mid-century. This calls for spraying 10 million tons of sulfate particles into the upper atmosphere every year. A fleet of portly, specially-designed aircraft carrying 10 tons each trip for release at 65,000 to 80,000 feet (burning high sulfur content fuel while at it) could manage the job in 100,000 flights a year.

Bill Gates invested in a company that would do it differently: sun-blocking sulfur dioxide particles would be pumped from the ground through a 19-mile long hose suspended by helium balloons.

A setback is that these estimates have since been weakened in more recent IPCC findings that say that aerosols such as sulfates have less of a cooling effect. And there is the question of what reduced sunlight will do to agricultural output. Temperature forcing could also disrupt weather patterns, such as the Indian monsoons that a billion people rely on for water.

Would working with clouds be better? Different groups from Edinburgh to Texas have signed onto this approach. The belief is that clouds could be made whiter, and therefore more reflective of sunlight, by spraying them with sea water. The moisture in clouds would condense around the salt to make shiny droplets. The calculation is that some 1,500 specially designed ships would be needed to drag turbines to make the electricity to power pumps that would spray 1.4 billion tons of ocean water a year into the skies.

Far more radical is a scheme to emulate the little-known phenomenon that oxygen leaks into space at the poles. It is impelled to do so by Earth’s magnetic fields. A Swedish scientist, with support from Univ. of California-Berkeley, postulates that lasers could ionize molecules of carbon dioxide and radio waves could be tuned to spiral them out the same magnetic funnel, to be lost forever in space.

Another polar remedy deals with the problem of polar ice melting more rapidly than predicted. It would lock the ice caps in place. This would not slow warming, but would retard the feared rise of the oceans from the conversion of ice to sea water. The cause of the rapid calving of glaciers is melt water that gets under them and acts as a lubricant to speed their journey to the sea. The notion is to arrest movement by freezing the melt water with liquid nitrogen at key points.

Every answer to the looming problem is the subject of serious scientific inquiry, but before considering the ethics and politics of geo-engineering, we’ll leave you with this one. A professor at the University of Arizona says that if we were to build 20 mile-long electromagnetic guns, so powerful that they could shoot Frisbee-like ceramic disks into static orbit at the gravitational midpoint between Earth and Sun, and if were to fire 800,000 such disks every five minutes for ten years — day, night, weekends, holidays — into the same spot, we would create a shield to bring about an annual solar eclipse of a size enough, apparently, to cool the planet.

moral hazard

Geo-engineering is done on the quiet. Partly, it is taboo for being scary; people don’t want to think that it could come to this as the only recourse. But the greater concern by climate change believers is that climate change skeptics will see geo-engineered solutions as exculpatory substitutes for doing nothing. If there is technology in the wings, why leave hydrocarbons in the ground, why spend on alternative fuels, why change our lifestyles when these magical rescues await?

But they don’t. All would need proving, and the scientists behind these projects urge that we embark on small-scale testing of these many propositions to see what works or doesn’t, to see whether harmful side effects come about from poking at the clouds or the oceans. It becomes all the more urgent to stage trial experiments as we go ever onward with business-as-usual fossil fuel burning. We would at least know which glass to break, which extinguisher to grab, when the climate emergency alarm goes off.

reality

With that dutiful and sensible recommendation having been said, how would the world’s nations ever come to an agreement in the use of any of these weapons? Who would get to decide? How, for example, would Russia or Canada go along with a plan to make their countries colder again, taking away their tantalizing prospect of a rosy global warming future? These techniques are meant to affect the whole planet. Some look surprisingly cheap. What happens when a single nation acts on its own — a Bangladesh refusing to accept disastrous flooding — and unleashes some climate altering fix to its own problem to the detriment of everyone else? We will have devised a new reason for war.

But there is a still larger reason that geo-engineering looks to be a delusion. Few think of it as a permanent solution. Rather, it is thought of as buying breathing room while the world weans itself gradually of fossil fuels and converts to renewables. Sounds good, but here’s the rub. All the while during the decades in which geo-engineering is deployed to hold down the global temperature during that transition to green energy, we will have continued to pump CO2 into the atmosphere where it will be suspended for as long as a hundred years before settling to earth. When the day comes that we stop spraying sulfates or sea water or powdered iron, vastly more CO2 than ever will be in the atmosphere, lying in wait. When geo-engineering stops, its heat-trapping greenhouse effect will burst forth. Temperatures would zoom to the same levels we are predicting for that future time as if geo-engineering had never been used.

It’s grim enough to make a warming skeptic set aside doubts and join the fight against global warming as the safer bet.

The Affordable Care Act, One Year Later

By October 1 the exchanges of the Affordable Care Act (ACA) have been operating for a year, following their disastrous debut, which prompts an assessment how the furiously controversial health insurance program is doing. The reckoning? There’s seismic rumbling subsurface, but what was once expected to be the biggest issue in the coming election is instead hardly mentioned. A recent Kaiser Family Foundation poll found that only 3% of Republicans and 2% of Democrats thought Obamacare was the biggest problem facing the nation. Immigration, the economy and now the “network of death”, as President Obama calls it, have surged to the lead.

scorecard

More than 8 million signed up during the enrollment period that ran to the end of March. The administration said in mid-September that 7.3 million had paid their premiums and were still enrolled. In July the Commonwealth Fund reported a drop of 9.5 million uninsureds; their figure includes those who registered for Medicaid.

It has been unclear how many already had insurance deemed inadequate and had to convert to plans meeting the ACA’s minima, versus how many previously uninsured were brought into the fold for the first time, but in July the Kaiser Family Foundation reported that 57% of its enrollees had no previous insurance.

An estimated 13 million more will need to enroll in the coming period that runs from mid-November to mid-February 2015 if the administration is to meet its targets.

Medicaid mIA

Considering that the foundational motive was to deal with the rising tide of 50 million Americans who had no coverage, there is a long way to go. The biggest setback was the Supreme Court’s decision that the administration lacked the constitutional right to require the states to expand Medicaid. Even though the federal government will pick up the entire tab for the first two years and 90% of the cost thereafter, 23 states have not taken up the offer. Partly, they are worried about funding even that future 10%, but 20 of those states have Republican governors and their refusal is an ideological protest against Obamacare which harms an estimated five million of their citizens.

An Urban Institute survey found that the number of households without insurance has declined by 6.1% in states that agreed to Medicaid expansion versus only a 1.7% drop in states that turned it down.

year two

Only now is it beginning to emerge by how much the cost of insurance will rise or fall in the coming enrollment period. Inevitably, those most ill and who were denied insurance before the Affordable Care Act were quick to take advantage of the law’s prohibition against insurers turning them away owing to their pre-existing illness. Of enrollees who sought treatment in the first quarter of this year, 27% had serious health issues compared to 16% before Obamacare took effect. “It’s even worse than what we thought”, said the chief actuary for Blue Cross Blue Shield of North Carolina. The counterbalance of enough of the healthy young demographic signing up, with their premium payments effectively paying for the care of the older and sicker, has not matched hope.

What this will do to rates is too complicated to guess at from outside the field; this Bloomberg outline of what insurers must consider in setting prices makes that clear. So far, the heralds telling us of coming costs are largely partisan, with those on the left reporting instances of lower charges and those on the right saying “new premiums and deductibles are much higher”, leaving us with not much to go on. These same right-left disparities are neatly matched in popularity samplings. Media on the left quoted that same Commonwealth Fund survey, saying that even 74% of Republicans are happy with their new coverage, whereas a June Fox News poll said 38% were “glad the healthcare law passed” against 55% who “wish it had never passed”.

Effect on employers

One of the worst defects of the ACA law is the rule that employers with 50 or more employees working more than 30 hours a week must offer to pay for their health insurance. Adding a 50th employee suddenly triggers the sizeable cost for all 49 preceding employees. If not fixed — and we have a Congress that would prefer to leave flaws in place to help bring down the healthcare law — the rigid barrier will cause employers to either avoid expansion or, more likely, reduce employee working hours to part-time jobs of less than 30 hours a week at tremendous damage to families’ incomes in addition to introducing scheduling chaos into their lives.

The President unilaterally waived the rule that employers must offer insurance, first giving special exemptions to a host of large companies in response to their pleadings, and then postponing by two years the requirement altogether. Small businesses had said they weren’t ready (four years since passage of the law in 2009 was not enough?).

The delay was welcomed by Republicans — the Party would like the employer mandate repealed altogether — but they then made this Obama manipulation (one of several) of a law passed by Congress the centerpiece of a suit against the President that Speaker John Boehner persuaded the House to approve.

Low-wage companies that offer coverage are finding that employees who have never availed themselves of the benefit are now signing up. Walmart’s insurance cost have risen, for example, because employees who held off joining the company plan because of the $18 payroll deduction every two weeks, now realize they must have insurance under the new law.

what pays for this?

Of the 7.3 million still in the program some 85% receive some level of subsidy. That such a high percentage is eligible makes it apparent that affordability is what had caused people to run the risk of having no insurance, not just inattention or avoidance of an unwelcome expense. The subsidy declines as income increases but it is substantial enough for the “vast majority” to pay $100 or less a month and 46% to pay less than $50 a month. That leads conservatives to despair that “Obamacare turns out to be just another subsidy program”, as columnist Holman Jenkins at The Wall Street Journal says. He writes:

In economics, you can’t subsidize everybody but we’re trying: 50 million Americans get help from Medicare, 65 million from Medicaid, nine million from the Department of Veterans Affairs, seven million (and counting) from ObamaCare, and a whopping 149 million from the giant tax handout for employer-provided health insurance.

That last point refers to what equates to tax free income that employees get when companies pay for their health insurance. It has become a whopping big number; the average annual premium for a family plan is now $16,834 a year.

Some of Jenkins’ anger is misdirected. What makes health insurance so unaffordable, what makes subsidies unavoidable, is the staggering cost of healthcare, which would be a better target at which to direct anger. Yet no action is taken against the astonishing fraud of hospital charges and the stratospheric prices of drugs that pharmaceutical companies charge to Americans so as to charge far less in other countries.

To spur people to buy insurance, but also to partly cover some of the cost of the subsidies, those who fail to buy into the program are to be fined. Roughly $100 billion over the next decade was to come from those penalties and from employers who fail to offer insurance. Yet nearly 90% of the of the nation’s 30 million uninsured won’t pay a penalty says a Wall Street Journal report. They will qualify for one of 14 exemptions that excuse those who say they suffered from domestic violence, are members of a Native American tribe, or of certain religious sects, have incurred property damage from fire or flood, received an electricity shutoff notice, faced eviction, experienced a death in the family or even the mystifying “experienced another hardship obtaining health insurance”. There’s lots of room for cheating here. The exemptions leave only 4 million who are expected to be fined.

Where imposed, the penalties phase in at too low a level to make buying insurance the better monetary option. At the threshold above which a person or family is not eligible for Medicaid and must buy insurance, what the Supreme Court has called a “tax” is only $95, or 1% of household income, whichever is greater. It rises to $695 per adult or 2.5% of family income by 2016, with a cap of $2,085 per family. Originally, the fines were to have been as high as $3,800 a year, but former Sen. Max Baucus (D-Mt), who chaired the Senate finance committee “whittled” them down in the hopes of gaining Republican votes, but not a single Republican voted for the ACA.

Another outflow of federal funds will be payments to insurers via what is referred to as the “risk corridor”. Until it sunsets in 2017, insurers are guaranteed by the government against loss arising from, say, having to accept a disproportionate number of sick people onto their roles or setting premium prices too low to cover their cost. The administration had declared that this would be “revenue neutral”, that it would not cost extra taxpayer dollars, although we are left wondering where the money will come from. And what will prevent insurers from slashing rates to gain market share, secure in the knowledge that their losses will be eradicated by the federal government, which is to say, a taxpayer-funded bailout?

Dr. No

Another looming threat is a shortage of doctors, especially primary care physicians. Editorialists on the right have repeatedly warned us of long waits for appointments that we can expect by pointing to countries that have single payer systems, which is where they believe Obamacare is headed. Their foreboding reeks of self-interest, however. What they complain about is that, thanks to the Affordable Care Act, a huge underclass will finally have access to medical help that they could never afford. The opinionators are upset at having to have to share their doctors.

Repeal and replace

A favorite Republican meme even shared by Democrats is that “ObamaCare top to bottom was poor judgment”, as expressed recently by Peggy Noonan, former Reagan speechwrite and columnist at the Journal. “It shouldn’t have been the central domestic effort of his presidency, that should have been the economy and jobs”. Setting aside Obama’s $858 billion stimulus to resurrect the economy, had he focused on and somehow improved the economy, we would still have the broken U.S. healthcare system that left 50 million and counting with no protection from the uinsurmountable costs of healthcare in this country. It’s a little like the aphorism “give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime”. Good economies come and go irrespective of who is president, whereas Obama chose to put in place something that will last (if allowed to).

But if Republicans gain control of the Senate, won’t they move forward on those 50-or-so House votes to repeal the Affordable Care Act? The author of a lengthy
article in the New York Times Magazine over the summer about the reform movement in the Republican Party pointed out, as have others, that Obama’s plan, which expands healthcare coverage through the marketplace of private insurers, was “hatched from a conservative policy suggestion that originated in 1989 from the Heritage Foundation”, a well to the right think tank, and writes that “Every reformer I talked to acknowledged that the principle of universal coverage is here to stay”.

ISIS Is Obama’s Fault for Not Leaving Troops in Iraq, Right?

In their zeal to blame the President for everything gone wrong, politicians and pundits on the right count on Americans’ diminished memories as time passes. They have discovered that no one challenges their blaming Obama for the rise of ISIS because he did not leave troops behind in Iraq. So media on the right has made it ritual simply to say that Obama’s hurriedly pulling out our troops led to ISIS, and its endless repetition on outlets such as Fox News is how propaganda becomes perceived truth.

You’d never know that the withdrawal had been agreed to three years earlier from New York Times columnist David Brooks, who just said on the PBS NewsHour,

“the drawdown of troops was too fast, one of the biggest mistakes of the Obama presidency was to draw down the troops too fast.”

You wouldn’t know that Iraq chose to push us out if you read Jonah Goldberg at the National Review, who wrote, “Obama chose to pull troops out of Iraq as quickly as possible”.

You wouldn’t know when that magazine’s editor Rich Lowry said Obama is a commander-in-chief with “a history of all but walking away from his military commitments” and on “Meet the Press” said that he “abandoned the war in Iraq”, that ending the U.S. troop presence in Iraq was “an overwhelmingly popular demand among Iraqis”, as reported at the time.

Bill Kristol, one of the original and unreconstructed neocons wrote an editorial in his Weekly Standard magazine titled “We Were Right to Fight in Iraq” that said Obama

“removed all U.S. troops from Iraq at the end of 2011” and “threw away hard-earned gains” with “this disastrous policy of withdrawal and retreat”.

You never know that the
departure was the complete withdrawal of U.S. forces — all 40,000 troops by the end of 2011 — was an agreement signed by George W. Bush in his last year in office.

A common phrase we hear from the blame throwers on the right is that Obama should have “tried harder” to negotiate keeping troops in Iraq when the time came. Never mind that we had fought to turn Iraq into a democracy, not a U.S. territory, a sovereign country with a parliament that got to decide such matters for itself. Iraq Prime Minister Nuri al-Maliki was unwilling to risk a confrontation with Shi’ite cleric Moqtada al-Sadr, who controlled the largest bloc of parliament. U.S. troops remaining on Iraqi soil? The al-Sadr faction would have none of it. But surely the al-Sadr brigades that fought against and killed our troops would have been swayed by a sophomoric good old college try by Obama.

In making that try, Obama would have had to undo the “status of forces agreement” (SOFA) in an entirely hostile environment. We may have got rid of a dictator, but by trying to rule their country we had broken it and caused a bloody insurgency in which 4,500 Americans died, but what mattered more to Iraqis were the as many as half a million of their lives lost and two million displaced. They wanted us gone.

As example of the willful amnesia deployed to place blame on Obama, Andrew Card, White House Chief of Staff under Bush, lied on Fox’s “America’s Newsroom” last June that “not having a status of forces agreement in Iraq is a horrible problem that President Obama is facing, and he created that problem”. Dick Cheney also forgot who agreed to the troop removal. A Wall Street Journal piece says he thinks Republicans should scrutinize the withdrawal of U.S. troops under Obama.

But nothing tops the shameful attempt to deflect blame away from himself than narcissist Paul Bremer days ago saying,

“ISIS is the creation that happened after we pulled all of our troops out in 2011. That is the key mistake that was made by this administration”.

That leaves one gasping for air. Bremer was the disastrous choice of George W. Bush to head the occupation government, the Coalition Provisional Authority, as its chief executive. He infamously made the worst decision of the war by disbanding the army shortly after the invasion, sending home
several hundred thousand troops without paychecks but with their weapons who would form the insurgency, and several of them now showing up leading ISIS units. If you want to pick someone who set the stage for ISIS, it would be Bremer.

But the big lie about leaving troops behind is they were meant not for combat but only to train Iraq’s security forces. Iraq certainly would not have then allowed combat troops to remain. And never mind that a contingent as small as the 3,000 Obama finally proposed would be adequate to combat the estimated 30,000 ISIS fighters. But the chorus blaming Obama for not leaving that token force behind can’t pretend to be saying anything else.

protecting the troops

All of the claims that Obama “should have tried harder” bury the most inconvenient fact of all: Iraq was unwilling to grant to U.S. troops immunity from prosecution. It would have been out of the question to accede to Iraq’s demand that our military (in their country to help them, we might add) be subject to their laws. Imagine a soldier accused of a crime, whether real or trumped up by Iraqi elements wishing us gone, that leads to incarceration in an Iraqi prison, trial in an Iraqi court, and a conceivable death sentence. Imagine an agreement that left our troops open to that. Imagine media that dodges these facts in order to blame Obama for not leaving troops behind, which is what the right wing media did.

“Keep in mind, that wasn’t a decision made by me”, the President has said. “That was a decision made by the Iraqi government”.

Max Boot, a contributing editor at the conservative Weekly Standard, knows better but tried a different tack in a Council of Foreign Relations article. He says the breakdown was the result of the Obama administration’s insistence that immunity be ratified by the Iraqi parliament, an impossible hurdle. Why was that? Bush hadn’t demanded that ratification in the 2008 SOFA, he argues. But we had 150,000 troops in Iraq at the time. When a trooper stepped out of line, the U.S. military dealt with its own; our force of arms denied Iraq any prospect of prosecuting our troops. One could say that the Bush administration was shortsighted for its failure to look ahead to when the troop count would wind down to small numbers without immunity protection. The Obama administration, in contrast, anticipated how vulnerable 10,000 or 3,000 would be to an agreement signed only by an Iraqi leader of the moment and not made into law by the country’s parliament.

Last fall along came Leon Panetta, first Obama’s CIA director, then secretary of defense, with a memoir in which he says he advocated for a residual force to remain in Iraq “but the President’s team at the White House pushed back”. The redoubtable ABC reporter Martha Raddatz, who has been to Iraq 21 times, has said the Obama administration originally “wanted 10,000 troops to remain in Iraq— not combat troops, but military advisers, special operations forces, to watch the counter-terrorism effort”. That number was reduced to 3,000 in the hope that the smaller contingent would break the logjam with the Iraqis.

Panetta wrote, “To this day, I believe that a small U.S. troop presence in Iraq could have effectively advised the Iraqi military on how to deal with al-Qaeda’s resurgence”. He was saying that the same Iraqi military that has turned and run after the U.S. devoted the better part of a decade and billions of dollars to train would, in his view, performed entirely differently against ISIS had we “advised” them some more.

None of the commentariat choose to remember al-Maliki himself saying, “When the Americans asked for immunity, the Iraqi side answered that it was not possible”, nor do they mention the headlines then that said “Immunity issue scuttled U.S. troop deal”.

Rather than listen to Panetta blame shifting, why not ask someone who had actual war fighting experience in Iraq — and in Anbar Province? Charlie Rose had this conversation with Gen. David Petraeus,

Rose: As you know, there are people in the political world who will say “if the U.S. had left troops in Iraq, we would not be watching the rise of ISIS”.

Petraeus: Well look, I supported leaving troops, as a number did around the situation room table, indeed the President, if we could have gotten…
Rose: But would leaving troops have led to impeding the rise of ISIS?
Petraeus: It’s arguable, I’d like to have tested the proposition, but it is by no means certain. There were other agreements made at the time with President Obama’s support that were not consummated and required no boots on the ground, no uniforms but would have helped him enormously; even those were not allowed to be brought to bear. I was involved in that so there is no guarantee that having them on the ground would have changed everything.

Oct 6 2014 | Posted in Defense | Read More »