The legacy of Obamacare: A five percent increase in heart patient deaths

15 November 2017

When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet  murder it remains. (Friedrich Engels, The Condition of the Working Class in England, 1845)

* * *

A US government program supposedly devised both to improve medical care and cut costs has, predictably, succeeded in the latter while undermining the former. Research published Sunday in JAMA Cardiology (Journal of the American Medical Association) shows that an initiative introduced five years ago under the Affordable Care Act (ACA) to induce hospitals to reduce Medicare readmissions for heart patients has resulted in an increase in mortality rates among those studied.

Under the ACA’s Hospital Readmissions Reduction Program (HRRP), hospitals were penalized financially when heart failure patients were readmitted within a month. While the program has succeeded in reducing the number of 30-day readmissions, the number of patients who died within a year rose by 5 percentage points. According to one of the study’s senior authors, these findings could account for an additional 5,000 to 10,000 deaths annually across the US due directly to the program.

For the American ruling elite, HRRP and other schemes devised by bureaucrats at the Centers for Medicare and Medicaid Services (CMS) are part of an agenda that is as deliberate as it is ruthless: Men and women in the US are living too long into old age and measures must be taken to cut costs associated with their medical care and shorten their life expectancy. This is the deadly price that must be paid to prop up a society that is one of the most socially unequal both in terms of income and the delivery of health care.

The statistics do not lie. Study researchers analyzed 115,245 patients at 416 hospitals in the American Heart Association’s Get With the Guidelines-Heart Failure registry from January 2006 to December 2014. They examined readmission and death rates before and after the program began in 2012.

* Readmission rates within one month fell from 20 percent before HRRP penalties to 18.4 percent after HRRP (down 1.6 percent). Mortality rates, however, rose by almost the same rate, from 7.2 percent before HRRP to 8.6 percent after (up 1.4 percent).

* Statistics for readmission and mortality within one year were even more damning. Readmission within one year fell by only about 1 percent, from 57.2 percent before HRRP to 56.3 percent after. But the mortality rate within one year rose from 31.3 percent before HRRP to 36.3 percent after—a shocking 5 percent increase. These figures show that there is a direct correlation between implementation of the Obamacare policy and preventable deaths.

HRRP penalizes hospitals up to 3 percent of every Medicare dollar for “excessive” repeat hospital stays. That is 15 times more than the 0.2 percent penalty levied against hospitals with high mortality rates. In other words, while hospitals with higher rates of mortality face a minimal fine, hospitals are being substantially penalized for failure to comply with a program that is resulting in increased deaths.

Compounding the misery, financial penalties from HRRP have been shown to fall disproportionately on academic medical centers and “safety-net” hospitals where “higher readmission rates are associated with the higher case-mix complexity and lower socioeconomic status,” according to the study, i.e., those treating poorer and sicker patients. In such settings, hospitals are incentivized to “game” the system by delaying admissions, increasing observation stays or shifting inpatient-type care to emergency departments, to the detriment of patient welfare.

The US mortality rate rose in 2015 in the first year-over-year increase since 2005, with life expectancy falling between 2014 and 2015 from 85.8 years to 85.6 years for men, and from 87.8 years to 87.6 years for women. According to the Centers for Disease Control and Prevention, this decline was due to an increase in eight of the 10 leading causes of death in the US, including heart disease, stroke, Alzheimer’s disease and suicide.

With heart disease rising, there is no other way to interpret the penalties imposed by the ACA for early readmission of heart patients than a deliberate effort to see more men and women die. US corporations are already reaping a grim dividend from this downward trend, with at least 12 major corporations reporting this summer that they have reduced their estimates for how much they could owe in pension and other retirement obligations by a combined $9.7 billion due to shorter life spans.

It is fitting that the health care overhaul known as Obamacare was the instigator of HRRP, an irrefutable demonstration that the ACA was the first major volley in the bipartisan drive to restrict access to affordable health care and sharply reduce the length of workers’ lives.

As the World Socialist Web Site explained as early at 2009, the Obama administration’s health care “reform” established a framework for the insurers, the corporations and the government to drastically reduce the health benefits available to low- and middle-income individuals and families. The aim is to limit the amount that the government must pay out for health care and Social Security payments, as well as what corporations must pay in pensions and other retirement benefits.

Health care in the Obamacare era has nothing in common with quality, near-universal health care, as Obama initially pledged. It is based entirely on the for-profit health care system in America, including the insurance companies, giant hospitals, health care chains and pharmaceutical companies. Any repeal of the ACA—and its replacement with “Trumpcare” or any other legislation—will maintain the class-based delivery of health care and undoubtedly worsen it for the majority of Americans.

The empirical proof provided by research published in JAMA Cardiology that an ACA program has predictably caused increased deaths should serve as a stark warning to the working class. This Obamacare program is of a piece with the bipartisan attack on jobs and living standards, the attack on immigrants and democratic rights, and the drive to war.

This assault will inevitably provoke enormous social opposition among workers and young people. This opposition must be channeled into the fight for a progressive overhaul of the health care system that takes as its starting point an end to privately owned health care corporations and medicine-for-profit and the establishment of socialized medicine, democratically administered by a workers’ government, providing free, high-quality health care for all.

Kate Randall

http://www.wsws.org/en/articles/2017/11/15/pers-n15.html

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Chomsky: Imagine a World Without Neoliberals Privatizing Everything in Sight

NEWS & POLITICS
A proposal for a progressive social and economic order for the United States.

Noam Chomsky.
Photo Credit: screenshot via Democracy Now!

This is the first part of a wide-ranging interview with world-renowned public intellectuals Noam Chomsky and Robert Pollin. The next installment will appear on October 24.

Not long after taking office, it became evident that Donald Trump had engaged in fraudulent populism during his campaign. His promise to “Make America Great Again” has been exposed as a lie, as the Trump administration has been busy extending US military power, exacerbating inequality, reverting to the old era of unregulated banking practices, pushing for more fuel fossil drilling and stripping environmental regulations.

In the Trump era, what would an authentically populist, progressive political agenda look like? What would a progressive US look like with regard to jobs, the environment, finance capital and the standard of living? What would it look like in terms of education and health care, justice and equality? In an exclusive interview with C.J. Polychroniou for Truthout, world-renowned public intellectuals Noam Chomsky and Robert Pollin tackle these issues. Noam Chomsky is professor emeritus of linguistics at MIT and laureate professor in the department of linguistics at the University of Arizona. Robert Pollin is distinguished professor of economics and co-director of the Political Economy Research Institute at the University of Massachusetts at Amherst. Their views lay the foundation for a visionary — yet eminently realistic — progressive social and economic order for the United States.

C.J. Polychroniou: Noam, the rise of Donald Trump has unleashed a rather unprecedented wave of social resistance in the US. Do you think the conditions are ripe for a mass progressive/socialist movement in this country that can begin to reframe the major policy issues affecting the majority of people, and perhaps even challenge and potentially change the fundamental structures of the US political economy?

Noam Chomsky: There is indeed a wave of social resistance, more significant than in the recent past — though I’d hesitate about calling it “unprecedented.” Nevertheless, we cannot overlook the fact that in the domain of policy formation and implementation, the right is ascendant, in fact some of its harshest and most destructive elements [are rising].

Nor should we overlook a crucial fact that has been evident for some time: The figure in charge, though often ridiculed, has succeeded brilliantly in his goal of occupying media and public attention while mobilizing a very loyal popular base — and one with sinister features, sometimes smacking of totalitarianism, including adoration of The Leader. That goes beyond the core of loyal Trump supporters…. [A majority of Republicans] favor shutting down or at least fining the press if it presents “biased” or “false news” — terms that mean information rejected by The Leader, so we learn from polls showing that by overwhelming margins, Republicans not only believe Trump far more than the hated mainstream media, but even far more than their own media organ, the extreme right Fox news. And half of Republicans would back postponing the 2020 election if Trump calls for it.

It is also worth bearing in mind that among a significant part of his worshipful base, Trump is regarded as a “wavering moderate” who cannot be fully trusted to hold fast to the true faith of fierce White Christian identity politics. A recent illustration is the primary victory of the incredible Roy Moore in Alabama despite Trump’s opposition. (“Mr. President, I love you but you are wrong,” as the banners read). The victory of this Bible-thumping fanatic has led senior party strategists to [conclude] “that the conservative base now loathes its leaders in Washington the same way it detested President Barack Obama” — referring to leaders who are already so far right that one needs a powerful telescope to locate them at the outer fringe of any tolerable political spectrum.

The potential power of the ultra-right attack on the far right is [illustrated] by the fact that Moore spent about $200,000, in contrast to his Trump-backed opponent, the merely far-right Luther Strange, who received more than $10 million from the national GOP and other far-right sources. The ultra-right is spearheaded by Steve Bannon, one of the most dangerous figures in the shiver-inducing array that has come to the fore in recent years. It has the huge financial support of the Mercer family, along with ample media outreach through Breitbart news, talk radio and the rest of the toxic bubble in which loyalists trap themselves.

In the most powerful state in history, the current Republican Party is ominous enough. What is not far on the horizon is even more menacing.

Much has been said about how Trump has pulled the cork out of the bottle and legitimized neo-Nazism, rabid white supremacy, misogyny and other pathologies that had been festering beneath the surface. But it goes much beyond even that.

I do not want to suggest that adoration of the Dear Leader is something new in American politics, or confined to the vulgar masses. The veneration of Reagan that has been diligently fostered has some of the same character, in intellectual circles as well. Thus, in publications of the conservative Hoover Institution at Stanford University, we learn that Reagan’s “spirit seems to stride the country, watching us like a warm and friendly ghost.” Lucky us, protected from harm by a demi-god.

Whether by design, or simply inertia, the Republican wrecking ball has been following a two-level strategy. Trump keeps the spotlight on himself with one act after another, assuming (correctly) that yesterday’s antics will be swept aside by today’s. And at the same time, often beneath the radar, the “respectable” Republican establishment chips away at government programs that might be of benefit to the general population, but not to their constituency of extreme wealth and corporate power. They are systematically pursuing what Financial Times economic correspondent Martin Wolf calls “pluto-populism,” a doctrine that imposes “policies that benefit plutocrats, justified by populist rhetoric.” An amalgam that has registered unpleasant successes in the past as well.

Meanwhile, the Democrats and centrist media help out by focusing their energy and attention on whether someone in the Trump team talked to Russians, or [whether] the Russians tried to influence our “pristine” elections — though at most in a way that is undetectable in comparison with the impact of campaign funding, let alone other inducements that are the prerogative of extreme wealth and corporate power and are hardly without impact.

The Russian saboteurs of democracy seem to be everywhere. There was great anxiety about Russian intervention in the recent German elections, perhaps contributing to the frightening surge of support for the right-wing nationalist, if not neo-fascist, “Alternative for Germany” [AfD]. AfD did indeed have outside help, it turns out, but not from the insidious Putin. “The Russian meddling that German state security had been anticipating apparently never materialized,” according to Bloomberg News. “Instead, the foreign influence came from America.” More specifically, from Harris Media, whose clients include Marine Le Pen’s National Front in France, Benjamin Netanyahu in Israel, and our own Donald Trump. With the valuable assistance of the Berlin office of Facebook, which created a population model and provided the needed data, Harris’s experts micro-targeted Germans in categories deemed susceptible to AfD’s message — with some success, it appears. The firm is now planning to move on to coming European races, it has announced.

Nevertheless, all is not bleak by any means. The most spectacular feature of the 2016 elections was not the election of a billionaire who spent almost as much as his lavishly-funded opponent and enjoyed fervent media backing. Far more striking was the remarkable success of the Sanders campaign, breaking with over a century of mostly bought elections. The campaign relied on small contributions and had no media support, to put it mildly. Though lacking any of the trappings that yield electoral success in our semi-plutocracy, Sanders probably would have won the Democratic Party nomination, perhaps the presidency, if it hadn’t been for the machinations of party managers. His popularity undimmed, he is now a leading voice for progressive measures and is amassing considerable support for his moderate social democratic proposals, reminiscent of the New Deal — proposals that would not have surprised President Eisenhower, but are considered practically revolutionary today as both parties have shifted well to the right [with] Republicans virtually off the spectrum of normal parliamentary politics.

Offshoots of the Sanders campaign are doing valuable work on many issues, including electoral politics at the local and state level, which had been pretty much abandoned to the Republican right, particularly during the Obama years, to very harmful effect. There is also extensive and effective mobilization against racist and white supremacist pathologies, often spearheaded by the dynamic Black Lives Matter movement. Defying Trumpian and general Republican denialism, a powerful popular environmental movement is working hard to address the existential crisis of global warming. These, along with significant efforts on other fronts, face very difficult barriers, which can and must be overcome.

Bob, it is clear by now that Trump has no plan for creating new jobs, and even his reckless stance toward the environment will have no effect on the creation of new jobs. What would a progressive policy for job creation look like that will also take into account concerns about the environment and climate change?

Robert Pollin: A centerpiece for any kind of progressive social and economic program needs to be full employment with decent wages and working conditions. The reasons are straightforward, starting with money. Does someone in your family have a job and, if so, how much does it pay? For the overwhelming majority of the world’s population, how one answers these two questions determines, more than anything else, what one’s living standard will be. But beyond just money, your job is also crucial for establishing your sense of security and self-worth, your health and safety, your ability to raise a family, and your chances to participate in the life of your community.

How do we get to full employment, and how do we stay there? For any economy, there are two basic factors determining how many jobs are available at any given time. The first is the overall level of activity — with GDP as a rough, if inadequate measure of overall activity — and the second is what share of GDP goes to hiring people into jobs. In terms of our current situation, after the Great Recession hit in full in 2008, US GDP has grown at an anemic average rate of 1.3 percent per year, as opposed to the historic average rate from 1950 until 2007 of 3.3 percent. If the economy had grown over the past decade at something even approaching the historic average rate, the economy would have produced more than enough jobs to employ all 13 million people who are currently either unemployed or underemployed by the official government statistics, plus the nearly 9 million people who have dropped out of the labor force since 2007.

In terms of focusing on activities where job creation is strong, let’s consider two important sets of economic sectors. First, spending $1 million on education will generate a total of about 26 jobs within the US economy, more than double the 11 jobs that would be created by spending the same $1 million on the US military. Similarly, spending $1 million on investments in renewable energy and energy efficiency will create over 16 jobs within the US, while spending the same $1 million on our existing fossil fuel infrastructure will generate about 5.3 jobs — i.e. building a green economy in the US generates roughly three times more jobs per dollar than maintaining our fossil fuel dependency. So full employment policies should focus on accelerating economic growth and on changing our priorities for growth — as two critical examples, to expand educational opportunities across the board and to build a green economy, while contracting both the military and the fossil fuel economy.

A full employment program also obviously needs to focus on the conditions of work, starting with wages. The most straightforward measure of what neoliberal capitalism has meant for the US working class is that the average wage for non-supervisory workers in 2016 was about 4 percent lower than in 1973. This is while average labor productivity — the amount each worker produces over the course of a year — has more than doubled over this same 43-year period. All of the gains from productivity doubling under neoliberalism have therefore been pocketed by either supervisory workers, or even more so, by business owners and corporate shareholders seeing their profits rise. The only solution here is to fight to increase worker bargaining power. We need stronger unions and worker protections, including a $15 federal minimum wage. Such initiatives need to be combined with policies to expand the overall number of job opportunities out there. A fundamental premise of neoliberalism from day one has been to dismantle labor protections. We are seeing an especially aggressive variant of this approach today under the so-called “centrist” policies of the new French President Emmanuel Macron.

What about climate change and jobs? A view that has long been touted, most vociferously by Trump over the last two years, is that policies to protect the environment and to fight climate change are bad for jobs and therefore need to be junked. But this claim is simply false. In fact, as the evidence I have cited above shows, building a green economy is good for jobs overall, much better than maintaining our existing fossil-fuel based energy infrastructure, which also happens to be the single most significant force driving the planet toward ecological disaster.

It is true that building a green economy will not be good for everyone’s jobs. Notably, people working in the fossil fuel industry will face major job losses. The communities in which these jobs are concentrated will also face significant losses. But the solution here is straightforward: Just Transition policies for the workers, families and communities who will be hurt as the coal, oil and natural gas industries necessarily contract to zero over roughly the next 30 years. Working with Jeannette Wicks-Lim, Heidi Garrett-Peltier and Brian Callaci at [the Political Economy Research Institute], and in conjunction with labor, environmental and community groups in both the states of New York and Washington, we have developed what I think are quite reasonable and workable Just Transition programs. They include solid pension protections, re-employment guarantees, as well as retraining and relocation support for individual workers, and community-support initiatives for impacted communities.

The single most important factor that makes all such initiatives workable is that the total number of affected workers is relatively small. For example, in the whole United States today, there are a total of about 65,000 people employed directly in the coal industry. This represents less than 0.05 percent of the 147 million people employed in the US. Considered within the context of the overall US economy, it would only require a minimum level of commitment to provide a just transition to these workers as well as their families and communities.

Finally, I think it is important to address one of the major positions on climate stabilization that has been advanced in recent years on the left, which is to oppose economic growth altogether, or to support “de-growth.” The concerns of de-growth proponents — that economic growth under neoliberal capitalism is both grossly unjust and ecologically unsustainable — are real. But de-growth is not a viable solution. Consider a very simple example — that under a de-growth program, global GDP contracts by 10 percent. This level of GDP contraction would be five times larger than what occurred at the lowest point of the 2007-09 Great Recession, when the unemployment rate more than doubled in the United States. But even still, this 10 percent contraction in global GDP would have the effect, on its own, of reducing carbon dioxide (CO2) emissions by precisely 10 percent. At a minimum, we would still need to cut emissions by another 30 percent within 15 years, and another 80 percent within 30 years to have even a fighting chance of stabilizing the climate. As such, the only viable climate stabilization program is to invest massively in clean renewable and high energy efficiency systems so that clean energy completely supplants our existing fossil-fuel dependent system within the next 30 years, and to enact comparable transformations in agricultural production processes.

The “masters of the universe” have made a huge comeback since the last financial crisis, and while Trump’s big-capital-friendly policies are going to make the rich get richer, they could also spark the next financial crisis. So, Bob, what type of progressive policies can and should be enforced to contain the destructive tendencies of finance capital?

Pollin: The classic book Manias, Panics, and Crashes by the late MIT economist Charles Kindleberger makes clear that, throughout the history of capitalism, unregulated financial markets have persistently produced instability and crises. The only deviation from this long-term pattern occurred in the first 30 years after World War II, roughly from 1946-1975. The reason US and global financial markets were much more stable over this 30-year period is that the markets were heavily regulated then, through the Glass-Steagall regulatory system in the US, and the Bretton Woods system globally. These regulatory systems were enacted only in response to the disastrous Great Depression of the 1930s, which began with the 1929 Wall Street crash and which then brought global capitalism to its knees.

Of course, the big Wall Street players always hated being regulated and fought persistently, first to evade the regulations and then to dismantle them. They were largely successful through the 1980s and 1990s. But the full, official demise of the 1930s regulatory system came only in 1999, under the Democratic President Bill Clinton. At the time, virtually all leading mainstream economists — including liberals, such as Larry Summers, who was Treasury Secretary when Glass-Steagall was repealed — argued that financial regulations were an unnecessary vestige of the bygone 1930s. All kinds of fancy papers were written “demonstrating” that the big players on Wall Street are very smart people who know what’s best for themselves and everyone else — and therefore, didn’t need government regulators telling them what they could or could not do. It then took less than eight years for hyper-speculation on Wall Street to once again bring global capitalism to its knees. The only thing that saved capitalism in 2008-09 from a repeat of the 1930s Great Depression was the unprecedented government interventions to prop up the system, and the equally massive bail out of Wall Street.

By 2010, the US Congress and President Obama enacted a new set of financial regulations, the Dodd-Frank system. Overall, Dodd-Frank amount to a fairly weak set of measures aiming to dampen hyper-speculation on Wall Street. A large part of the problem is that Dodd-Frank included many opportunities for Wall Street players to delay enactment of laws they didn’t like and for clever lawyers to figure out ways to evade the ones on the books. That said, the Trump administration, led on economic policy matters by two former Goldman Sachs executives, is committed to dismantling Dodd-Frank altogether, and allowing Wall Street to once again operate free of any significant regulatory constraints. I have little doubt that, free of regulations, the already ongoing trend of rising speculation — with, for example, the stock market already at a historic high — will once again accelerate.

What is needed to build something like a financial system that is both stable and supports a full-employment, ecologically sustainable growth framework? A major problem over time with the old Glass-Steagall system was that there were large differences in the degree to which, for example, commercial banks, investment banks, stock brokerages, insurance companies and mortgage lenders were regulated, thereby inviting clever financial engineers to invent ways to exploit these differences. An effective regulatory system today should therefore be guided by a few basic premises that can be applied flexibly but also universally. The regulations need to apply across the board, regardless of whether you call your business a bank, an insurance company, a hedge fund, a private equity fund, a vulture fund, or some other term that most of us haven’t yet heard about.

One measure for promoting both stability and fairness across financial market segments is a small sales tax on all financial transactions — what has come to be known as a Robin Hood Tax. This tax would raise the costs of short-term speculative trading and therefore discourage speculation. At the same time, the tax will not discourage “patient” investors who intend to hold their assets for longer time periods, since, unlike the speculators, they will be trading infrequently. A bill called the Inclusive Prosperity Act was first introduced into the House of Representatives by Rep. Keith Ellison in 2012 and then in the Senate by Bernie Sanders in 2015, [and] is exactly the type of measure that is needed here.

Another important initiative would be to implement what are called asset-based reserve requirements. These are regulations that require financial institutions to maintain a supply of cash as a reserve fund in proportion to the other, riskier assets they hold in their portfolios. Such requirements can serve both to discourage financial market investors from holding an excessive amount of risky assets, and as a cash cushion for the investors to draw upon when market downturns occur.

This policy instrument can also be used to push financial institutions to channel credit to projects that advance social welfare, for example, promoting investments in renewable energy and energy efficiency. The policy could stipulate that, say, at least 5 percent of banks’ loan portfolios should be channeled to into clean-energy investments. If the banks fail to reach this 5 percent quota of loans for clean energy, they would then be required to hold this same amount of their total assets in cash.

Finally, both in the US and throughout the world, there needs to be a growing presence of public development banks. These banks would make loans based on social welfare criteria — including advancing a full-employment, climate-stabilization agenda — as opposed to scouring the globe for the largest profit opportunities regardless of social costs…. Public development banks have always played a central role in supporting the successful economic development paths in the East Asian economies.

Editor’s note: This interview has been lightly edited for length and clarity.

Copyright, Truthout. Reprinted with permission.

 

 

C.J. Polychroniou is a regular contributor to Truthout as well as a member of Truthout’s Public Intellectual Project. He is the author of several books, and his articles have appeared in a variety of publications.

https://www.alternet.org/news-amp-politics/chomsky-imagine-world-without-neoliberals-privatizing-everything-sight?akid=16283.265072.yNcENf&rd=1&src=newsletter1084478&t=6

Slain US special forces troops on apparent assassination mission in Niger

By Bill Van Auken
25 October 2017

Three weeks after four US special forces soldiers were killed in a firefight in the landlocked West African nation of Niger, information has surfaced indicating that the American troops and their Nigerien counterparts were involved in a “capture-kill” mission aimed at the leader of a local Islamist militia operating on the Niger-Mali border.

The White House and the Pentagon has provided only a trickle of information about the abortive October 4 operation. The incident came to the public eye largely because of President Donald Trump’s initial failure to say anything about the largest loss of US military personnel since he took office, along with his subsequent lies about contacting families of slain troops and his shameful public confrontation with the widow of Sgt. La David Johnson, one of the four Green Berets killed in Niger, over a callous condolence call.

Marine Gen. Joseph Dunford, the chairman of the Joint Chiefs of Staff, told reporters Monday that the Green Berets had been engaged in a “simple reconnaissance mission,” and described the overall purpose of deploying some 1,000 US special operations troops in Niger as a “train, advise and assist mission” to support the Nigerien security forces.

It appears that Dunford’s comments were deliberately misleading on both counts.

NBC News Tuesday cited “multiple US officials” as recounting that the US detachment of 12 US special forces troops and 30 Nigerien soldiers had been on what was effectively an assassination mission, aimed at killing a senior leader of a local Islamist militia.

NBC reported: “One theory, said an official with direct knowledge of the military’s investigation, is that the soldiers were gathering information about the target, and, after learning his whereabouts, decided to pursue him. A big question would then be whether the unit got authorization, and whether the risks were assessed.”

It added that the ill-fated Niger mission was conducted under the mantle of Operation Juniper Shield, a program begun under the Obama administration and continued under Trump, which is directed at using US military force to “disrupt or neutralize” organizations deemed connected to Al Qaeda and the Islamic State across the Sahel region of central west Africa.

This military intervention is being conducted in coordination with the French military, which is waging an even more intense neocolonial operation in neighboring Mali. Both countries have mounted a campaign against an insurgent group known as Al-Mourabitoun, which has been active throughout the region. Last January, Al-Mourabitoun took responsibility for a suicide bombing against a military base in the city of Gao in Mali, killing 77. Previous attacks have targeted foreigners in Ivory Coast and Burkina Faso, while in 2013 the group seized a gas facility in Algeria, leading to a confrontation in which all 39 of its hostages were killed.

According to the sources cited by NBC, the Green Beret team involved in the October 4 firefight, officially known as Operational Detachment Alpha or ODA, was involved in an “intelligence-directed operation,” which included a meeting with an individual purported to have information on the whereabouts of an Islamist militant known as Abnan Abu Walid al-Sahraoui, who is believed to be the leader of at least one section of Al-Mourabitoun.

While the precise way in which the ambush that led to the deaths of the four US special forces troops remains shrouded in mystery, military sources have suggested that the unit was set up by hostile elements of the local population, who either led them into a trap or gave away their location to the Islamist insurgents.

Leading members of the US Senate and House—including Democratic Senate minority leader Chuck Schumer and Republican Senators John McCain (chairman of the Senate Armed Services Committee) and Lindsey Graham—have claimed to have been kept in the dark by the Pentagon on the escalating US intervention in the region and expressed surprise that up to 1,000 US special forces troops are deployed in Niger and on its borders.

A closed-door hearing has been scheduled for Thursday in which two senior Pentagon officials will deliver a classified briefing to the Senate Armed Services panel. The session was scheduled after McCain threatened to subpoena the administration for more information on the Niger operation.

In reality, the steadily escalating US military intervention in Africa has been a fairly open secret, provoking disquiet only after the October 4 debacle.

In February 2013, the Obama White House announced that the first 100 US troops were being sent into Niger, with hundreds more to follow. At the time, it was revealed that Washington had signed an agreement with the Niger government allowing the US military to set up a drone base on the country’s territory, creating the conditions for spreading the Obama administration’s remote-control assassination spree throughout the region.

That base is now under construction in the city of Agadez, where the US is preparing major facilities to house and launch MQ-9 hunter-killer drones.

Last Friday, the Washington Post reported that the Pentagon is instituting a “status-based targeting” system in Niger allowing its troops to hunt down and employ lethal force against suspected members of Islamist insurgent groups “even if that person does not pose an immediate threat.” This appears to be what was involved in the abortive mission that claimed four US soldiers’ lives on October 4.

The employment of such assassination squads, along with drone killings and similar methods, will serve only to intensify civil war conditions throughout the region, providing the pretext for even greater US intervention.

Indeed, the principal source of the present conflict lies in the 2011 US-NATO war to topple Colonel Muammar Gaddafi in Libya, which shattered the tenuous equilibrium that Gaddafi had maintained among the Tuareg and other tribal groups in Niger and elsewhere in the Sahel. The rise of Islamist groups was directly tied to the utilization of Al Qaeda elements by Washington and its allies as proxy ground forces in the war for regime change that ended with Gaddafi’s lynching and the decimation of Libyan society. In the aftermath of the Libyan government’s fall, its arms stockpiles found their way into the hands of Islamist groups throughout the region.

In the midst of the roiling controversy over the troop deaths in Niger and Trump’s response, there has been a steadily escalating drumbeat from Democratic politicians and the media for Congress to debate the ongoing US military interventions and pass a new Authorization for the Use of Military Force (AUMF).

This found fresh expression Tuesday in a piece in the Washington Post by the ostensibly liberal columnist Eugene Robinson, who wrote: “Congress needs to do more than investigate the deaths. It needs to authorize this conflict—or shut it down.”

Robinson went on to describe the cabal of generals—Kelly, Mattis and McMaster—that largely controls the White House and the Trump administration’s foreign policy as “the last line of defense between our great nation and the abyss.”

At the same time, however, he suggested that this military domination of the administration made it all the more important for Congress to “reclaim its war-making powers” by passing a new AUMF.

Such columns reflect the increasing nervousness within ruling circles that the ugly controversy over Niger has lifted the lid on both the ever-expanding global military operations of the Pentagon and the increasingly open turn toward military control of the government at home. Any new AUMF passed by Congress, which long ago gave up even the pretense of defending its constitutional powers, will only provide a legislative fig leaf to facilitate this process.

http://www.wsws.org/en/articles/2017/10/25/nige-o25.html

Behind the opioid crisis: Republicans and Obama cleared the way for corporate murder

By Patrick Martin
16 October 2017

Leading Republican and Democratic members of Congress and top Obama administration officials collaborated to shut down efforts by the Drug Enforcement Administration (DEA) to stem the flow of prescription opioids that have killed 200,000 Americans over the past two decades, according to a devastating exposure published Sunday by the Washington Post and broadcast Sunday night on the CBS news magazine “60 Minutes.”

The joint investigation by the Post and “60 Minutes” made use of extensive whistleblower revelations by former officials of the DEA, which has the main responsibility for halting the flow of illegal narcotics, including prescription drugs like oxycodone and hydrocodone diverted into the black market.

Three major companies, all in the top 20 of the Fortune 500 and hugely profitable, dominate the distribution of these opioids: McKesson, Cardinal Health, and AmerisourceBergen, with combined revenues of more than $450 billion. McKesson chairman and CEO John Hammergren has the largest pension fund of any US corporate boss, a $160 million personal nest egg.

These gigantic revenues and huge personal fortunes were accumulated by means of what can only be termed a massive social crime: the flooding of impoverished working-class neighborhoods with high volumes of opioids, narcotics that were being prescribed in vast quantities by doctors and pharmacists and illegal “pain centers” and “pill mills” that were a constant presence in the affected areas.

The consequences have been felt in a historic reversal in the long-term rise of life expectancy in the United States. For middle-aged whites, particularly those living in rural areas, life expectancy is declining and death rates soaring, in large part because of the impact of opioid abuse and addiction.

Appalachia is a center of the opioid crisis. The figures presented in the Post/”60 Minutes” report are staggering—and damning. To Mingo County, West Virginia, an impoverished former mining area on the state border with Kentucky, population 25,000, the mid-sized Ohio-based drug distributor Miami-Luken shipped 11 million doses of oxycodone and hydrocodone in a five-year period: enough to give two pills a week to every man, woman and child in the county.

In the county seat, Williamson, population 2,938, Miami-Luken shipped 258,000 hydrocodone pills in one month to a single pharmacy. The city of Williamson has filed suit against the company and other drug distributors, charging them with deliberately flooding the city with pain pills to supply the black market. A document filed in the suit charges, “Like sharks circling their prey, multi-billion dollar companies descended upon Appalachia for the sole purpose of profiting off of the prescription drug-fueled feeding frenzy.”

Post reporters Scott Higham and Lenny Bernstein and “Sixty Minutes” reporter Bill Whitaker conducted dozens of interviews for their exposé, but the principal whistleblower is Joseph T. Rannazzisi, who headed the DEA’s Office of Diversion Control for a decade until he was forced out in 2015.

The Office of Diversion Control oversees the flow of prescription drugs produced by the major US pharmaceutical companies and shipped to hospitals and pharmacies and other prescribers by distributors, including the big three. By targeting unusually large and unexplained sales—for example, several Walgreen’s pharmacies in Florida sold more than one million opioid pills in a year, compared to a nationwide average of 74,000—the DEA unit could force companies to pay substantial fines.

These big three and smaller distributors paid more than $400 million in fines over the last decade as the result of the DEA, but this is a pittance compared to their gross revenues during that same period, well over $5 trillion. One former DEA official told the Post this sum simply represented “a cost of doing business.”

A more serious problem for the industry was the issuance of “freeze” orders, in which the DEA could use its authority to order a distributor to halt a shipment if there is “imminent danger” to the community. According to Rannazzisi, there was increasing resistance from top-level DEA officials, from 2011 on, to approving such “freeze” orders against opioid distributors. During this period, the drug distributors hired 46 DEA officials either directly or through law firms or lobbying groups representing them.

In 2014, industry lobbyists produced a bill, written by a former DEA lawyer, and introduced by Republican Representative Tom Marino, that substantially raised the threshold of proof for a DEA order to halt a shipment. Instead of “imminent danger,” such an order required proof of “a substantial likelihood of an immediate threat,” a standard so strict that, once adopted, there were no further DEA orders to halt drug distribution.

Marino’s bill was initially blocked by DEA opposition, but it was reintroduced with Democratic cosponsors and passed the House of Representatives by a voice vote, without opposition, in April 2015. In October 2015, Rannazzisi was pushed into retirement at the DEA, after previously being removed as head of the Office of Diversion Control by means of heavy pressure from congressional Republicans on the Obama Justice Department. In March 2016, the Senate passed a modified version of the Marino bill, and the House accepted the changes the following month. The DEA was now handcuffed, and the drug distributors could proceed without any concern about federal oversight.

As Rannazzisi told “60 Minutes”: “The drug industry—the manufacturers, wholesalers, distributors and chain drugstores—have an influence over Congress that has never been seen before. And these people came in with their influence and their money and got a whole statute changed because they didn’t like it.”

The protection of the giant drug distribution companies—amid a nationwide epidemic of drug overdose deaths caused by the products they were distributing—was a bipartisan affair. Congressional Democrats cosponsored the legislation, and a former top Clinton administration official, Jamie Gorelick, was a lead attorney and lobbyist for the distributors. Attorney General Loretta Lynch approved the legislation, and President Obama signed it into law, with the White House issuing a one-page press release to mark the occasion.

None of those involved, including Lynch and Obama, would comment to the Post or “60 Minutes.” According to the Post, “The DEA and Justice Department have denied or delayed more than a dozen requests filed by The Post and ‘60 Minutes’ under the Freedom of Information Act for public records that might shed additional light on the matter,” indicating that the Trump administration is continuing the stonewalling tactics begun under Obama.

When a “60 Minutes” camera crew came to Marino’s office, his aides called Capitol Hill police to have them removed.

Trump has rewarded the darling of the drug distributors, Representative Marino, by nominating him last month to become the next White House “drug czar,” in charge of coordinating federal efforts against the opioid crisis. Representative Marsha Blackburn of Tennessee, the main cosponsor of the bill, is now favored to be the Republican nominee for US Senate in Tennessee in 2018. Both representatives come from districts ravaged by the opioid crisis. According to the Post account, 106 people have died in Lycoming County, Pennsylvania, the largest in Marino’s district, since he first introduced his anti-enforcement legislation.

The following exchange from the “60 Minutes” program sums up the reality of corporate domination of American life, and the catastrophic impact on working people:

BILL WHITAKER: You know the implication of what you’re saying, that these big companies knew that they were pumping drugs into American communities that were killing people.

JOE RANNAZZISI: That’s not an implication, that’s a fact. That’s exactly what they did.

… These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.

http://www.wsws.org/en/articles/2017/10/16/drug-o16.html

More than 52 million Americans live in economically distressed communities

By Sandy English
28 September 2017

A new analysis of Census data shows that the so-called economic recovery under the Obama administration was an unmitigated catastrophe for the 20 percent of the American population that live in the poorest areas of the United States and that gains of jobs and income have gone overwhelming to the top 20 percent richest areas.

The 2017 Distressed Communities Report,” published by the Economic Innovation Group (EIG), analyzes the census data for 2011-2015 for people living in each of the nearly 7,500 American zip codes according to several criteria.

The EIG’s Distressed Communities Index (DCI) considers the percentage of the population without a high school diploma, the percentage of housing vacancies, the percentage of adults working, the percentage of the population in poverty, the median income ratio (the percentage of median income that a zip code has for its state), the change in employment from 2011 to 2015, and the change in the number of businesses in the same period.

The report divides the findings for zip codes into five quintiles based on these indicators, rated from worst- to best-performing: distressed, at risk, mid-tier, comfortable, and prosperous.

The results show that distressed communities—52.3 million people or 17 percent of the American population—experienced an average 6 percent drop in the number of adults working and a 6.3 percent average drop in the number of business establishments.

“Far from achieving even anemic growth from 2011 to 2015,” the report notes, “distressed communities instead experienced what amounts to a deep ongoing recession.”

Further, “fully one third of the approximately 44 million Americans receiving SNAP (Supplemental Nutrition Assistance Program or food stamps) and other cash public assistance benefits (such as Temporary Assistance for Needy Families (TANF)) live in distressed communities.” The report notes that most distressed communities have seen zero net job growth since 2000.

Residents in these zip codes are five times more likely to die than those in prosperous zip codes. Deaths from cancer, pregnancy complications, suicide, and violence are even higher. “Mental and substance abuse disorders are 64 percent higher in distressed counties than prosperous ones, with major clusters in Appalachia and Native American communities where rates exceed four or five times the national average,” the report continues.

One other important and alarming fact which the report highlights is that over a third of the distressed zip codes contain so-called “brownfield” sites—areas which are polluted or contaminated in some way. Not only do these have impacts on real estate and business development, they present a whole array of health hazards to the very poorest Americans.

Distressed communities can be found all over the United States but are concentrated in the South: 43 percent of Mississippi’s zip codes are distressed, followed by Alabama, West Virginia, Arkansas and Louisiana. According to the report, [the South] “is home to a staggering 52 percent of all Americans living in distressed zip codes—far above its 37.5 percent share of the country’s total population.”

After this, the Southwest and Great Lakes region have the largest share. In the Northeast, most distressed communities tend to be found in urban areas and in the South, primarily in rural areas.

The biggest cities with the largest numbers of distressed zip codes are Cleveland, Ohio, Newark, New Jersey, Buffalo, New York, Detroit, Michigan and Toledo, Ohio. Mid-sized cities with the highest number of distressed zip codes include Youngstown, Ohio, Trenton, New Jersey, Camden, New Jersey, Gary, Indiana, Hartford, Connecticut and Flint, Michigan.

Urban counties with the highest number of distressed zip codes include Cook County in Illinois, with Chicago at its center, Los Angeles County in California, Harris County in Texas, with Houston at its center, and Wayne County in Michigan, encompassing Detroit. Most of these urban areas were once industrial centers and home to the industrial working class.

Zip codes that have a majority of minorities living in them are more than twice as likely to be distressed as zip codes that are majority white. “In total,” the report notes, “45 percent of the country’s majority-minority zip codes are distressed and only 7 percent of them are prosperous.” At the same time there are numerous distressed communities that are almost completely white. A quarter of the total distressed population is under 18.

The report found that the economic benefits of the recovery after the 2008 recessions have gone to the top quintile of zip codes, where the wealthier layers of the population live, including not only the very rich but also the upper middle class.

These areas, which the DCI terms prosperous, and make up roughly 85 million Americans or 27 percent of the US population, have for the most part the economic wherewithal to finance higher levels of education, have the lowest housing vacancy, highest percentage of working adults, and have had the lion’s share of job and business expansion.

“The job growth rate in the top quintile was 2.6 times higher than nationally from 2011 to 2015, and business establishments proliferated three times faster than they did at the national level,” the report notes. “Prosperous zip codes stand worlds apart from their distressed counterparts, seemingly insulated from many of the challenges with which other communities must grapple. The poverty rate is more than 20 points lower in the average prosperous community than it is in the average distressed one.”

The report makes much less of an analysis of the other three, middle quintiles, the at risk, mid-tier, and comfortable categories, but it does note some factors that address the overall trends nation-wide. “A remarkably small proportion of places fuel national increases in jobs and businesses in today’s economy. High growth in these local economic powerhouses buoys national numbers while obscuring stagnant or declining economic activity in other parts of the country.”

One of the more telling aspects of the report is that extreme poverty in the US is presided over by both capitalist parties: Democratic and Republic politicians have equal numbers of distressed communities in their constituencies. Democrats, in fact, “represent six of the 10 most distressed congressional districts.”

Another observation from the voting data, and one of the few that looks at conditions beyond the bottom and top quintiles, is worth quoting in full:

“President Trump accumulated a 3.5 million vote lead in counties that fell into the bottom three quintiles of well-being (equivalent to 9.4 percent of all votes cast in these counties). A vast array of factors determined voting patterns in the 2016 election, but it stands that the ‘continuity’ candidate performed better in the places benefiting most from the status quo, while the ‘change’ candidate performed better in the places one would expect to find more dissatisfaction.”

Broader figures and the historical view of wealth distribution in the US—that one percent of the population control 40 percent of the wealth or the decades-long decline in the percentage of the national income that goes to the working class—are not brought out in the report but the data add to a complete picture of social conditions across the United States, the character and geographical distribution of social and economic conditions in a country of more than 320 million.

The portrait provided by the EIG report is not simply one of increasing misery and poverty for the bottom 20 percent, and not only one in which only a minority of Americans are achieving anything like “prosperity,” but of growing and explosive dissent among tens of millions.

It exposes as a bare-faced lie the claim that President Obama made at the end of his second term, that “things have never been better” in America.

http://www.wsws.org/en/articles/2017/09/28/pove-s28.html

Killing: The American Way

A napalm strike during the Vietnam War. (manhahi / CC BY 2.0)

One of the most hyped “events” of American television, “The Vietnam War,” has started on the PBS network. The directors are Ken Burns and Lynn Novick. Acclaimed for his documentaries on the Civil War, the Great Depression and the history of jazz, Burns says of his Vietnam films, “They will inspire our country to begin to talk and think about the Vietnam War in an entirely new way.”

In a society often bereft of historical memory and in thrall to the propaganda of its “exceptionalism,” Burns’ “entirely new” Vietnam War is presented as “epic, historic work.” Its lavish advertising campaign promotes its biggest backer, Bank of America, which in 1971 was burned down by students in Santa Barbara, California, as a symbol of the hated war in Vietnam.

Burns says he is grateful to “the entire Bank of America family,” which “has long supported our country’s veterans.” Bank of America was a corporate prop to an invasion that killed perhaps as many as 4 million Vietnamese and ravaged and poisoned a once-bountiful land. More than 58,000 American soldiers were killed, and around the same number are estimated to have taken their own lives.

I watched the first episode in New York. It leaves you in no doubt of its intentions right from the start. The narrator says the war “was begun in good faith by decent people out of fateful misunderstandings, American overconfidence and Cold War misunderstandings.”

The dishonesty of this statement is not surprising. The cynical fabrication of “false flags” that led to the invasion of Vietnam is a matter of record—the Gulf of Tonkin “incident” in 1964, which Burns promotes as true, was just one. The lies litter a multitude of official documents, notably the Pentagon Papers, which the great whistleblower Daniel Ellsberg released in 1971.

There was no good faith. The faith was rotten and cancerous. For me—as it must be for many Americans—it is difficult to watch the film’s jumble of “red peril” maps, unexplained interviewees, ineptly cut archive and maudlin American battlefield sequences.

In the series’ press release in Britain—the BBC will show it—there is no mention of Vietnamese dead, only Americans. “We are all searching for some meaning in this terrible tragedy,” Novick is quoted as saying. How very post-modern.

All this will be familiar to those who have observed how the American media and popular culture behemoth has revised and served up the great crime of the second half of the twentieth century—from “The Green Berets” and “The Deer Hunter” to “Rambo”—and, in so doing, has legitimized subsequent wars of aggression. The revisionism never stops, and the blood never dries. The invader is pitied and purged of guilt, while “searching for some meaning in this terrible tragedy.” Cue Bob Dylan: “Oh, where have you been, my blue-eyed son?”

I thought about the “decency” and “good faith” when recalling my own first experiences as a young reporter in Vietnam: watching hypnotically as the skin fell off Napalmed peasant children like old parchment, and the ladders of bombs that left trees petrified and festooned with human flesh. General William Westmoreland, the American commander, referred to people as “termites.”

In the early 1970s, I went to Quang Ngai province, where in the village of My Lai, between 347 and 500 men, women and infants were murdered by American troops (Burns prefers “killings”). At the time, this was presented as an aberration: an “American tragedy” (Newsweek ). In this one province, it was estimated that 50,000 people had been slaughtered during the era of American “free fire zones.” Mass homicide. This was not news.

To the north, in Quang Tri province, more bombs were dropped than in all of Germany during the Second World War. Since 1975, unexploded ordnance has caused more than 40,000 deaths in mostly “South Vietnam,” the country America claimed to “save” and, with France, conceived as a singularly imperial ruse.

The “meaning” of the Vietnam war is no different from the meaning of the genocidal campaign against the Native Americans, the colonial massacres in the Philippines, the atomic bombings of Japan, the leveling of every city in North Korea. The aim was described by Colonel Edward Lansdale, the famous CIA man on whom Graham Greene based his central character in “The Quiet American.”

Quoting Robert Taber’s “The War of the Flea,” Lansdale said, “There is only one means of defeating an insurgent people who will not surrender, and that is extermination. There is only one way to control a territory that harbors resistance, and that is to turn it into a desert.”

Nothing has changed. When Donald Trump addressed the United Nations on Sept. 19—a body established to spare humanity the “scourge of war”—he declared he was “ready, willing and able” to “totally destroy” North Korea and its 25 million people. His audience gasped, but Trump’s language was not unusual.

His rival for the presidency, Hillary Clinton, had boasted she was prepared to “totally obliterate” Iran, a nation of more than 80 million people. This is the American Way; only the euphemisms are missing now.

Returning to the U.S., I am struck by the silence and the absence of an opposition—on the streets, in journalism and the arts, as if dissent once tolerated in the “mainstream” has regressed to a dissidence: a metaphoric underground.

There is plenty of sound and fury at Trump the odious one, the “fascist,” but almost none at Trump the symptom and caricature of an enduring system of conquest and extremism.

Where are the ghosts of the great anti-war demonstrations that took over Washington in the 1970s? Where is the equivalent of the Freeze Movement that filled the streets of Manhattan in the 1980s, demanding that President Reagan withdraw battlefield nuclear weapons from Europe?

The sheer energy and moral persistence of these great movements largely succeeded; by 1987 Reagan had negotiated with Mikhail Gorbachev an Intermediate-Range Nuclear Forces Treaty (INF) that effectively ended the Cold War.

Today, according to secret NATO documents obtained by the German newspaper, Süddeutsche Zeitung, this vital treaty is likely to be abandoned as “nuclear targeting planning is increased.” The German Foreign Minister Sigmar Gabriel has warned against “repeating the worst mistakes of the Cold War. … All the good treaties on disarmament and arms control from Gorbachev and Reagan are in acute peril. Europe is threatened again with becoming a military training ground for nuclear weapons. We must raise our voice against this.”

But not in America. The thousands who turned out for Senator Bernie Sanders’ “revolution” in last year’s presidential campaign are collectively mute on these dangers. That most of America’s violence across the world has been perpetrated not by Republicans, or mutants like Trump, but by liberal Democrats, remains a taboo.

Barack Obama provided the apotheosis, with seven simultaneous wars, a presidential record, including the destruction of Libya as a modern state. Obama’s overthrow of Ukraine’s elected government has had the desired effect: the massing of American-led NATO forces on Russia’s western borderland through which the Nazis invaded in 1941.

Obama’s “pivot to Asia” in 2011 signaled the transfer of the majority of America’s naval and air forces to Asia and the Pacific for no purpose other than to confront and provoke China. The Nobel Peace Laureate’s worldwide campaign of assassinations is arguably the most extensive campaign of terrorism since 9/11.

What is known in the U.S. as “the left” has effectively allied with the darkest recesses of institutional power, notably the Pentagon and the CIA, to see off a peace deal between Trump and Vladimir Putin and to reinstate Russia as an enemy, on the basis of no evidence of its alleged interference in the 2016 presidential election.

The true scandal is the insidious assumption of power by sinister war-making vested interests for which no American voted. The rapid ascendancy of the Pentagon and the surveillance agencies under Obama represented an historic shift of power in Washington. Daniel Ellsberg rightly called it a coup. The three generals running Trump are its witness.

All of this fails to penetrate those “liberal brains pickled in the formaldehyde of identity politics,” as Luciana Bohne noted memorably. Commodified and market-tested, “diversity” is the new liberal brand, not the class people serve regardless of their gender and skin color: not the responsibility of all to stop a barbaric war to end all wars.

“How did it fucking come to this?” says Michael Moore in his Broadway show, “Terms of My Surrender,” a vaudeville for the disaffected set against a backdrop of Trump as Big Brother.

I admired Moore’s film, “Roger & Me,” about the economic and social devastation of his hometown of Flint, Michigan, and “Sicko,” his investigation into the corruption of health care in America.

The night I saw his show, his happy-clappy audience cheered his reassurance that “we are the majority!” and calls to “impeach Trump, a liar and a fascist!” His message seemed to be that had you held your nose and voted for Hillary Clinton, life would be predictable again.

He may be right. Instead of merely abusing the world, as Trump does, the Great Obliterator might have attacked Iran and lobbed missiles at Putin, whom she likened to Hitler: a particular profanity given the 27 million Russians who died in Hitler’s invasion.

“Listen up,” said Moore, “putting aside what our governments do, Americans are really loved by the world!”

There was a silence.

John Pilger, an Australian who lives in the United Kingdom, is a prize-winning journalist and documentary filmmaker. His website is johnpilger.com.

The Reichstag Fire Next Time

The coming crackdown

When each day brings more news than we are used to seeing in a week, and the kind of news that only the most catastrophic imagination can accommodate, we find ourselves talking about the Reichstag fire. Time feels both accelerated and slowed down, and so we imagine that we have been talking about the fire for years. It is the new president’s new clothes: invisible, yet always present in our perception of him.

The Reichstag fire, it goes almost without saying, will be a terrorist attack, and it will mark our sudden, obvious, and irreversible descent into autocracy. Here is what it looks like: On a sunny morning you turn on the television as you make coffee, or the speaker in your shower streams the news, or the radio comes on when you turn the ignition key in your car. The voices of the newscasters are familiar, but their pitch is altered, and they speak with a peculiar haste. Something horrible has happened—it is not yet clear what—and thousands are dead, and more are expected to die. You hear the word “terror.” You feel it.

Illustrations by Lincoln Agnew. Source photographs: Adolf Hitler © Hulton Archive/Getty Images; crowd saluting Hitler © Visual Studies Workshop/Getty Images

You reach for your cell phone, but the circuits are busy, and will be for hours—it will take you the rest of the day to check in with your loved ones. They are safe, but changed. And so are you. So are all of us. Tragedy has cast its shadow over every space where you encounter strangers: the subway, your child’s school, your lunch spot. People are quieter, less frivolous, yet they are not subdued. They share a sense of purpose that is greater than their fear. They are experiencing something they’d only read about: War has come to their land. Everyone is a patriot now.

You used to scoff at that word, or argue that dissent was the highest form of patriotism. But now you find that the word expresses what you are. Now is not the moment for dissent. A couple of public intellectuals insist that it is, and you feel embarrassed for them. They quickly fade from the scene, and this serves to underscore an unprecedented sort of unity.

Nowhere is this unity more evident than in Washington. Bills are passed unanimously. These laws give new powers to the president and his security apparatus. The president, unpopular and widely considered incompetent before the attack, now steps up to direct the war effort. His demeanor—which some used to deride as primitive—is well suited for this new black-and-white era. His administration institutes sweeping surveillance to ferret out enemies at home, and wages one war and then another abroad.

American public life is profoundly transformed. The press becomes uncritical of the government. There is no outright censorship; correspondents are part of the effort now, as they were during the Second World War. American casualties pile up, the foreign carnage is enormous and unmeasured, but there is scant domestic resistance. Only at the margins of politics and the media do some people question the usefulness and legality of the war effort.

The government pushes the limits further, cutting off access to the judiciary for those deemed the enemy. The president is no longer unpopular, and he can impose his will on Washington and the country. The country is in a forever war, a state of exception that has taken away many American freedoms, some of which were ceded voluntarily.

That is what we talk about when we talk about the Reichstag fire, and it has already happened. Like sad versions of the characters in The Wizard of Oz, who set off in search of traits they already possess, we are living in fear of an event that will catapult us into a terrifying future, when the event has already occurred—and has given us our terrifying present.

The actual fire in the Reichstag—the German parliament building—burned on the evening of February 27, 1933. Adolf Hitler had been appointed chancellor four weeks earlier, and already he had begun placing restrictions on the press and expanding the powers of the police. Yet it is the fire, rather than Hitler’s toxic first steps, that is remembered as the event after which things were never the same, in Germany or in the world.

Hitler capitalized on the fire by taking an uncompromising militant stand: “There will be no mercy now. Anyone standing in our way will be cut down.” This, in turn, probably boosted his popularity, paving the way for a victory for the Nazi Party in parliamentary elections a week later.

Hitler immediately began cracking down on the political opposition. The day after the fire, the government issued a decree allowing the police to detain people without charges, on the grounds of prevention. Activists were rounded up by his paramilitary forces, the SA and the SS, and placed in camps. Less than a month later, the parliament passed an “enabling act,” creating rule by decree and establishing a state of emergency that lasted as long as the Nazis were in power.

Anschluss—the annexation of Austria—was still five years away, and the start of the Second World War six and a half, but the Reichstag fire was used to create a state of exception, as Carl Schmitt, Hitler’s favorite legal scholar, called it. In Schmitt’s terms, a state of exception arises when an emergency, a singular event, shakes up the accepted order of things. This is when the sovereign steps forward and institutes new, extralegal rules. The emergency enables a quantum leap: The sovereign has to have enough power to declare a state of exception, and then by that declaration he acquires far great­er, unchecked power. That is what makes the change irreversible, and the state of exception permanent.

Every galvanizing event of the past eighty years has been compared to the Reichstag fire. On December 1, 1934, Sergei Kirov, the head of the Communist Party in Leningrad, was murdered by a lone gunman. The killer, Leonid Nikolaev, was arrested and executed, but the assassination is remembered as the pretext for creating a state of exception in Russia. Show trials and mass arrests followed, swelling the gulag with people accused of being traitors, spies, and terrorist plotters. To handle the volume, the Kremlin created troikas—three-person panels that doled out a sentence without reviewing the case, much less hearing from the defense.

More recently, Vladimir Putin has relied on a succession of catastrophic events to create irreversible exceptions. In 1999, a series of apartment bombings in Moscow and cities in southern Russia killed hundreds. This allowed Putin to proclaim that he could summarily execute those deemed “terrorists” and became a pretext for a new war in Chechnya. In 2002, the three-day siege of a Moscow theater served as a demonstration of the principle of summary execution: Russian law enforcement pumped the theater full of sleeping gas, entered the building, and shot the hostage-takers as they lay unconscious. The Kremlin also used the theater siege as a pretext to ban the already cowed media from covering anti-terrorist operations. Two years later, more than three hundred people, most of them children, died following an attack at a school in Beslan, in southern Russia. Putin used this catastrophic event to cancel the elections of local governors, effectively abolishing the country’s federal structure.

The thinking that transforms tragedy into crackdown is not foreign to the United States. During the crisis that followed the Alien and Sedition Acts at the turn of the nineteenth century, the ruling Federalists and the opposition Republicans accused each other of treason and a fatal lack of vigilance, of being Jacobin puppets. The courts, stacked with Federalist appointees, wasted no time shutting down opposition newspapers.

Half a century later, Abraham Lincoln suspended habeas corpus, the right not to be imprisoned without civilian judicial review. He did this to be able to indefinitely hold rebels whom he judged a danger to the Union—but whom, he said, “the courts, acting on ordinary rules, would discharge.” It wasn’t until 1866 that the Supreme Court ruled the practice unconstitutional.

By the next major war, the First World War, speech perceived as critical of or detrimental to the American war effort was punished with prison sentences as long as ten years. Historian Geoffrey Stone has called Woodrow Wilson’s Sedition Act of 1918 “the most repressive legislation in American history.” Thousands of people were arrested—many without a warrant—and 249 anarchist and communist activists were deported to Soviet Russia. It wasn’t until later that Supreme Court Justices Oliver Wendell Holmes Jr. and Louis Brandeis started on a dissenting streak that ultimately restored and clarified free-speech protections.

The Second World War brought another presidential assault on the Constitution: the internment of more than a hundred thousand Americans of Japanese descent. Then came the ­McCarthy era, when the government took up spying on the enemy within and accusations of treason, whether or not they were supported by evidence, ruined life after life. The next generation of Americans lived through the secrecy, deceit, and paranoia of the Vietnam War years, which culminated in a president who had his opponents prosecuted and wiretapped. For Americans in the twentieth century a state of exception came close to being the rule.

Not all the periods of exception are remembered as repressive: In State of Exception, the Italian philosopher Giorgio Agamben notes that Franklin Roosevelt invoked emergency powers for the passage of the New Deal in 1933, arguing that economic catastrophe warranted “broad Executive power to wage war against the emergency, as great as the power that would be given to me if we were in fact invaded by a foreign foe.” Writing in 2005, Agamben drew a narrative line from the state of exception in Europe following the First World War to that in America following 9/11.

As long as war is raging, political consensus supports the crackdowns. Legal scholar Stephen Holmes calls this wisdom “the intuitive claim that grave emergencies require discretionary authority to act outside and against inherited rules and standard operating procedures.” There is no proof that such a response is effective—and there is even copious evidence that it leads to abuse of power and damage to society—but the temptation to both seize and cede power in the face of fear proves irresistible time after time.

Source photographs: Donald Trump © JB Lacroix/WireImage; Vladimir Putin © Mikhail Svetlov/Getty Images; Barack Obama © Ron Sachs-Pool/Getty Images; George W. Bush © Luke Frazza/AFP/Getty Images; protest © Creative Touch Imaging Ltd./NurPhoto/Getty Images; drone © Erik Simonsen/Getty Images

The war that began in 2001 is unlike other wars: The enemy is not a nation or an army but a tactic, one that has existed for millennia. This war cannot be won, because a tactic cannot be eradicated. A war that cannot be won cannot end, and so it has not. Nor have the liberties surrendered by Americans in response to 9/11 been restored. Under President Obama, the war on terror morphed into the more grammatically sensible war on terrorism. The Patriot Act became the Freedom Act. The use of torture appears to have been largely discontinued, but the camp at Guantánamo Bay continues its shameful existence—with a reduced number of inmates, though numbers are never a good measure of liberty. Millions of Americans who voted in the last election have lived with the war on terror for as long as they can remember.

In his farewell address in Chicago, Obama could claim only that he had “worked to put the fight against terrorism on a firmer legal footing. That’s why we’ve ended torture, worked to close Gitmo, reformed our laws governing surveillance to protect privacy and civil liberties. That’s why I reject discrimination against Muslim Americans,” he said, interrupted by cheers before continuing, “who are just as patriotic as we are.” Over the course of more than fifteen years, the essential premise—that the United States is at war, and that the Other in this war is Muslims—has remained unchanged. Trump claims that Muslim Americans celebrated 9/11, while Obama says that they are just as patriotic as we are; that they are not us is one of the few things the two men agree on.

The current state of exception rests in part on the national state of emergency, which George W. Bush declared three days after the September 11 attacks, which he renewed every year of his presidency, and which Obama also renewed every September of his. The president’s ability to impose and renew a state of emergency is technically limited by the 1976 National Emergencies Act, which requires Congress to vote on the state of emergency within six months of the day it is imposed. But such a vote has never occurred—even though the act has been invoked at least fifty-three times. In practice, the president wields unilateral power over emergencies.

The National Emergencies Act can be invoked for disasters beyond an actual war—Obama declared a national emergency in anticipation of the swine flu epidemic in 2009—but it invariably represents both an outsized reaction to a perceived threat and a journey outside what we maintain is normal national and social conduct. At any given time in the past decade, roughly thirty simulta­neous states of emergency have been in effect. Dozens of executive orders, and numerous other directives and regulations, have stemmed from these states of emergency—all of them creating powers that would be impossible in the increasingly illusory normal state of things. A state of emergency allows the president to unilaterally seize control of the media, food supplies, and commercial vessels, for instance. The fact that Bush and Obama did not utilize some of the more extreme possibilities of the state of emergency testifies only to their restraint, not to the legal limitations. At the same time, we know less and less about the powers the government has exercised; since 2001, an ever-increasing number of these emergency powers have been classified.

The state of exception also rests on the Authorization for Use of Military Force, which was passed by Congress three days after the attacks in 2001. It gives the president sweeping power to

use all necessary and appropriate force against those nations, organizations, or persons he determines planned, authorized, committed, or aided the terrorist attacks that occurred on September 11, 2001, or harbored such organizations or persons, in order to prevent any future acts of international terrorism against the United States by such nations, organizations, or persons.

The law, passed with a single dissenting vote, remains in force as the nation enters its fourth post-9/11 presidential term.

Today, when it is said that a terrorist attack is sure to happen, it is assumed that the attack will be carried out in the name of the Islamic State. The premise of inevitability is notable—one would think that such acts of terror occurred in the United States on a regular basis. Since September 11, 2001, however, there have been eleven attacks ostensibly driven by jihadist ideology; they have claimed a total of ninety-five lives. “The death toll has been quite similar to other forms of political—and even non-political—violence Americans face today,” a recent report from the New America foundation summarized. The report referred only to domestic terrorism and mass shooting incidents, but many more Americans have died at the hands of the state: In the first four months of this year, the use of deadly force by police claimed three times as many lives. These killings, extrajudicial by definition, are a symptom of the state of exception, which has turned the police into a military force. As a nation we insist on being united in fear of the one-in-millions chance of a particular kind of violence. That we seem so certain of the outlines of the Reichstag fire to come reveals the fact that it has already occurred.

Among the victims of the sixteen-year-old state of exception are hundreds of individuals identified, prosecuted, and sentenced under emergency rules. Since the war on terror began, the United States has prosecuted an average of forty terrorism cases per year, about half of them on the basis of informant operations. Convictions that result from such cases—and convictions result almost without fail, usually as the result of a plea bargain—fetch higher sentences because of something known as the terrorism adjustment in federal sentencing guidelines. The adjustment went into effect following the World Trade Center bombing of 1993 but was used most widely after 9/11. This was a law passed by Congress, yet it created an exceptional category of crime that could not be addressed by normal law. One example is the prosecution of two Iraqi refugees who were tried in Bowling Green, Kentucky, for allegedly intending to help insurgent fighters battling U.S. forces back home. The men were convicted of terrorism, even though the accusation against them—that they aided fighters confronting an army—doesn’t fit standard definitions of terrorism. They were sentenced to life in prison, in the case of a man arrested at the age of twenty-three, and forty years behind bars, for the one who cooperated with the prosecution. This was the case that Trump aide Kellyanne Conway presumably had in mind when she conjured the memory of the Bowling Green Massacre—something that never happened but, according to the logic the country has applied over the past decade and a half, could have happened.

A key characteristic of the most frightening regimes of the past hundred years is mobilization. This is what distinguishes the merely authoritarian regimes from the totalitarian ones. Authoritarians prefer their subjects passive, tending to their private lives while the authoritarian and his cronies amass wealth and power. The totalitarian wants people out in the square; he craves their adulation and devotion, their willingness to fight and die for him. Mobilization was just as important an element of Hitler’s 1933 consolidation of power as his crackdown. Victory rallies, national holidays, and parades demonstrated, even forced, the unity of a nation. In Germans into Nazis, historian Peter Fritzsche makes no mention of the Reichstag fire but devotes a chapter to the May Day parade of 1933, a daylong, citywide spectacle “carefully choreographed to .?.?. demonstrate the national sense of purpose that was now said to animate the German people.”

To totalitarianism watchers, Trump’s campaign rallies, which segued into his victory rallies, including his “America First” inauguration, have looked familiar and perhaps more worrisome than an imaginary future fire. To historians of the twenty-first century, however, they will likely look like logical steps from the years of war rhetoric that preceded them, not quantum leaps. A nation can be mobilized only if it knows its enemy and believes in its own peril.

It is not clear how many Germans attended that May Day parade because the spirit moved them and how many were compelled by fear or force. Four and a half decades later, in “The Power of the Powerless,” the Czech dissident Václav Havel described an individual who “lives within a lie,” the lie of the official ideology, without consciously accepting or rejecting it. Totalitarianism robs a person of the very ability to form an opinion.

Fear has a way of catapulting citizens into the inside of a lie. Following the apartment-building bombings of 1999, Russians huddled together, forming neighborhood patrols, eyeing strangers and neighbors alike with suspicion, and then threw their support behind the recently appointed prime minister, Vladimir Putin. In one of his first public statements, the unknown, gray little politician promised to hunt down terrorists and “rub them out in the outhouse,” rhetorically trampling the foundations of the justice system.

Americans, too, have finely honed instincts for banding together in the face of an attack. Within hours of the September 11 attacks, 150 members of Congress gathered on the Capitol steps and sang “God Bless America.” Some of them held hands. The strongest country on the planet was making a spectacle of fear and resolve. The following day, a train traveling between Boston and New York was stopped because passengers had been alarmed by the presence of a Sikh man; he was removed. Two days later, enabling legislation—bills on war powers and the state of emergency—were passed.

Trump does not have to declare war—this has already been done—or even proffer an assessment of the danger. But he has already shown that he can deftly use the coercive power of the state of being at war—this is, possibly, the only political tool of which the president has instinctive mastery. During his first address to a joint session of Congress, Trump orchestrated more than two minutes of applause for the widow of a fallen Navy SEAL. It was 125 seconds of naked cynicism that left no one in the audience any choice but to stand and applaud. The following day Breit­bart falsely claimed that several top Democrats had refused to do so. This was a preview of the coercion by national unity that we talk about when we talk about the Reichs­tag fire, but it was also reminiscent of the early weeks and months following 9/11, when Bill Maher and Susan Sontag were shamed for breaking rhetorical ranks.

In Russia, it took many years for Putin to consolidate power, and it wasn’t until 2012 that his regime assumed its current retro-totalitarian character. Over the years, the use of terrorist attacks to justify successive crackdowns has grown familiar and gradually transformed the country’s thinking. The lack of logical connections between events and their ostensible consequences, along with the general degradation of the judicial system and law enforcement, eroded all trust in the government—to the extent that every time a terrorist attack occurred, many Russians assumed that the government, no matter what it said, was behind it. When a bomb went off in the St. Petersburg Metro in April, killing fourteen people, journalists and Russia watchers instantly assumed that the Kremlin had organized the attack in order to detract attention from or to stifle emergent anti-corruption protests.

Over the years many Russians, including me, have come to believe that the apartment-building bombings in Moscow and elsewhere were organized and carried out by the FSB, the intelligence agency, in order to shore up Putin’s power grab. There has never been a transparent and satisfying investigation of the blasts, but the available evidence stacks up in favor of this theory.

When we talk about the Reichstag fire, we speak not only about an event that precipitates a state of exception and launches coercive national mobilization but also of a conspiracy. Many Germans were certain that the Reichs­tag fire was set by the Nazis themselves. So much evidence supported this theory that for decades after the Second World War a Nazi conspiracy was the historians’ consensus. During the same period, it was generally accepted that the Kirov murder was a secret-police assassination. But when all the available information on the Kirov murder was excavated in the late 1980s and early 1990s, there was no proof to back up the conspiracy theory: It is now believed that Kirov was killed by his assistant’s jealous husband. In the 1960s, reporting cast doubt on the theory that the Nazis burned down the Reichstag, but in the 1990s, a new wave of evidence suggested they may have been involved after all. Historians continue to debate the issue. (A young Dutch Communist was apprehended at the scene, tried, and sentenced to death by beheading.) It is certainly too early to exonerate Putin and the FSB for the apartment bombings, but the Russian autocrat may eventually be proved to have simply seized an opportunity, as he has done many times since. For now, though, we do not know enough, and this paucity of information, too, is one of the signs of an autocracy.

Autocracies thrive on and engender fear, ignorance, and—their combined product—conspiracy theory. Writing in his diary in January 1934, the linguist Victor Klemperer assessed a genre of joke. “Conversations in heaven are popular. The best one: Hitler to Moses: But you can tell me in confidence, Herr Moses. Is it not true that you set the bush on fire yourself?” The joke shows Hitler and the satirist sharing a conspiratorial worldview: The person telling the joke believes that the führer set the Reichs­tag fire and also that Hitler sees the world through the lens of his own deception. Everyone is both a conspirator and a conspiracy theorist.

The September 11 attacks, like all unimaginable events, spawned conspiracy theories. Trutherism spread far and wide; its younger cousin, birtherism, grabbed hold of a smaller but more vocal constituency. By the time Trump was elected president, America was living through an epidemic of conspiracy thinking. Some were convinced that Hillary Clinton ran a child-sex ring from a pizza shop in Washington; others that every recently dead Russian man was connected to Trump’s election victory. No one now seems to believe that most things are what they seem: usually, a mess.

When we talk about the Reichs­tag fire, we talk about the consequences of a catastrophic event. But in our case, these consequences—a legal state of exception, a sense of living under siege, popular mobilization, and an epidemic of conspiracy thinking—are already in place. Indeed, they are the preconditions of our current predicament. Trump used the conspiracy thinking and the siege mentality to get himself elected. Once president, he used the state of exception to begin lobbing missiles, dropping bombs—nothing less than the so-called Mother of All Bombs. Mobilization, the popular sense of being together in constant battle, ensured that Trump’s first forays into war looked good on TV. At the same time, Trump overestimated the power given to him by the siege mentality. When he attempted to ban Muslims from entering the United States, for example, he encountered great popular and institutional resistance.

Here lies our best hope for reversing the effects of the next Reichs­tag fire: American civil society is strong—far stronger, paradoxically, than it was before the election. And something remains of what Hannah Arendt observed in a letter from 1946:

People here feel themselves responsible for public life to an extent I have never seen in any European country. For example, when all Americans of Japanese descent were locked up willy-nilly in concentration camps at the beginning of the war, a genuine storm of protest that can still be felt today went through the country.

What struck Arendt was the spontaneous and active expression of solidarity on the part of ordinary Americans who “declared that if something like that could happen, they no longer felt safe themselves.”

The comparison to contemporary protests may not be entirely straightforward. Leading arguments rested on the impossibility of religious discrimination; popular protest relied on a general sense of injustice and the rational argument that banning the entry of people from seven majority-Muslim countries would do little to protect Americans from terrorism. But by pointing to the ineffectiveness of the proposed ban, some of these arguments unwittingly reinforced the idea that Americans can make themselves safer by shutting out some part of the world.

Most recent protests share a fundamental flaw: They project the assumption that things were fine until America inexplicably elected Trump. The women’s marches, the immigrants’ marches, the scientists’ marches, the protests in defense of the Affordable Care Act and freedom of speech, and the earliest of the protests, which simply expressed outraged disbelief at the results of the election, all serve the purpose of staking out the current norms and vowing to defend them. It’s hard to argue with the urge; all indications are that the current norms are far preferable to the reality of the near and distant future. Yet most of the protests live within a lie—the fiction that the threats of the Trump presidency are not only grave but also new. His war against the national press is a grotesque blowup of many years’ worth of growing regimentation of access, concentration of power, and government opacity. Trump’s war on immigrants builds on the mass deportations of the Obama years, which were themselves built on the siege mentality of the Bush years. Trump’s casual bomb-throwing is enabled by the forever war begun nearly sixteen years ago.

To confront the threat we face, it is not enough to advance the rational argument that an American has a lesser chance of dying in a terrorist attack carried out by a refugee than of being struck by lightning. Nor is it enough to focus on the grave injustice of tarnishing immigrants as potential criminals and Muslim refugees as potential terrorists. It is most certainly not enough to revel in the beauty, intelligence, and wit of the many people who have come out to protest Trump’s attacks on humanity and its planet. There is, in fact, no room for self-congratulation in the actions we need to take.

To be worthy of the lofty name “resistance,” the opposition to Trump must aim to break the country’s post-9/11 trajectory. It must question the very premise of the war on terror, challenge the very fact of a perpetual state of emergency, and confront not only the Trump presidency but the legacy of the Bush and Obama Administrations. Organizations such as the A.C.L.U. have been doing this for years. The Trump presidency has not only, paradoxically, brought the group millions of dollars, it has also, potentially, rallied millions of people to the cause. Now is the time to stop waiting for the Reichs­tag fire and start battling the consequences of the one we already had—Trump and the legal and public conditions that are enabling his presidency.