Popular Flood Insurance Law Is Target of Both Political Parties

From The New York Times:

A major flood insurance bill was a rarity when it passed what is widely derided as a do-nothing Congress in 2012, but a year and a half later, there is now an enthusiastic bipartisan effort to gut it.

This week the Senate is expected to approve a measure that would block, repeal or delay many of the key provisions of the Biggert-Waters Flood Insurance Reform Act, which was sponsored by Representative Judy Biggert, an Illinois Republican, and Representative Maxine Waters, a California Democrat.

Tucked into broader transportation legislation, the bill had enthusiastic support across the political spectrum, from liberal environmentalists to fiscal conservatives.

But Ms. Waters is now leading an effort in the House to gut the legislation she sponsored. And this week, the Senate is expected to pass a measure that would stymie the law, an effort that has support from across the political spectrum, from prominent liberals like Senator Elizabeth Warren, Democrat of Massachusetts, to conservatives like Senator Marco Rubio, Republican of Florida.

 

What happened?

 

It appears to be another Washington story of unintended consequences, and a warning, environmentalists say, of the rising costs of climate change. Most important, the bill may be a preview of the fights to come over who will pay those costs.

 

The Biggert-Waters measure sought to reform the nation’s nearly bankrupt flood insurance program, ending federal subsidies for insuring buildings in flood-prone coastal areas. Over the past decade, the cost to taxpayers of insuring those properties has soared, as payouts for damage from Hurricanes Katrina, Irene, Isaac and Sandy sent the program $24 billion into debt.

 

The aim of the measure was to shift the financial risk of insuring flood-prone properties from taxpayers to the private market. Homeowners, rather than taxpayers, would shoulder the true cost of building in flood zones.

 

Deficit hawks liked the idea because it would curb a rapidly rising source of government spending. Environmentalists liked the bill because they said it would reflect the true cost of climate change, which scientists say is ushering in an era of rising sea levels and more damaging extreme weather, including more flooding.

 

But a year after the law passed, coastal homeowners received new flood insurance bills that were two, three, even 10 times higher than before.

 

In Beach Haven West, N.J., for example, Diane Mazzuca, a furniture showroom designer, had been paying $595 annually for flood insurance on her $90,000 home. After Biggert-Waters ended federal flood insurance subsidies last June, she got an updated bill — for $4,492.

“Our house never flooded before Sandy,” Ms. Mazzuca said. “The new insurance statement said we were in the storm surge line.”

 

Ms. Mazzuca is still struggling with her insurance company over payments to repair damage to her home from Sandy, and cannot pay the costs on her own, or the new insurance rates.

 

“I’m going to have to walk away from my house and my life savings,” she said.

 

Ms. Mazzuca has plenty of company. The insurance rate increases hit many of the 5.5 million coastal home and business owners covered under the National Flood Insurance Program, and came as the Federal Emergency Management Agency, which runs the program, was updating flood maps and placing thousands of homes inside flood zones for the first time. Last summer and fall, homeowners near coasts, rivers and wetlands saw their insurance rates soar and their property values plummet.

 

The homeowners’ frustration erupted into a grass-roots lobbying campaign to roll back the Biggert-Waters act, and lawmakers in Washington quickly got the message.

 

“Never in our wildest dreams did we think the premium increases would be what they appear to be today,” Ms. Waters said.

 

Similarly, in Louisiana, where hurricanes and flooding have devastated coastal residents and the new insurance rates were viewed as a further affront, Senator Mary L. Landrieu, a Democrat who faces a tough re-election fight this fall, paid close attention to angry constituents.

Ms. Landrieu teamed with Senator Robert Menendez, Democrat of New Jersey, and Senator Johnny Isakson, Republican of Georgia, to sponsor a bill that would delay most insurance rate increases by four years.

 

“The Biggert-Waters bill is not going to save the flood insurance program. It’s going to collapse it,” Ms. Landrieu said. Supporters of her effort to delay Biggert-Waters say that the spike in flood insurance rates will drive homeowners out of coastal zones altogether.

 

But budget watchdogs, insurance groups and environmentalists are fighting the effort. They say that while the original Biggert-Waters law was imperfect, the effort to delay it would bankrupt the program and leave coastal property owners more vulnerable to future damages, and that taxpayers would be forced to pay the bill.

 

On Monday, the White House released a statement criticizing the effort to gut the law, saying it would further erode the financial position of the national flood insurance program, and that it would reduce the government’s ability to pay future claims. But the administration did not threaten a veto.

 

The Senate bill is expected to pass on Wednesday or Thursday, after which it will head to the Republican-controlled House.

 

Although the effort there is being led by Ms. Waters, she already has more than 180 co-sponsors from both parties, and House Speaker John A. Boehner, Republican of Ohio, indicated that G.O.P. leadership may consider the effort.

Earmarks Survive In All but Name - Congress banned money for pet projects, but lawmakers remain eager to prove they can still bring home the bacon.

From The Wall Street Journal:

Congress three years ago banned earmarks—money for pet projects that had become synonymous with wasteful spending. But the spending bill that became law this month shows that lawmakers remain eager to prove to voters that they can still bring home the bacon.

As they traveled their districts during last week's congressional recess, legislators nationwide touted local benefits in the $1.012 trillion spending bill.

Kansas lawmakers spotlighted the money for a research facility and military-base expansion. For Georgia, the spending bill expedited a Savannah port-dredging project. For Arkansas, there was money to keep an Air National Guard base in business.

 

The bill, the first comprehensive spending measure in more than two years, has given lawmakers their best opportunity in some time to show their constituents they can direct federal spending and policy benefits to home districts.

 

"This wasn't just a lucky kind of thing," Sen. Mark Pryor (D., Ark.) told a local TV station about the military funding. "This is from me working with the Pentagon, working with the administration and House and Senate Democrats and Republicans to try to get this done."

 

Members of the House and Senate appropriations committees said the local projects in the bill did not violate Congress's ban on earmarking, the process that had channeled money to favored projects and companies, often sidestepping any competitive process of ranking proposed projects. Most of the approved projects had been requested by the administration or subjected to competitive review.

 

Both the House and Senate passed rules banning earmarks by early 2011. Amid a tea party-fueled push to restrain federal spending, many lawmakers had come to argue that these projects were wasteful spending that advanced narrow political interests.

 

"The name 'earmark' has become poisonous, but the idea of being able to address specific needs is not," said Rep. Tom Cole (R., Okla.), senior member of the House Appropriations Committee. "It's something to talk about when you go home."

 

Sen. Jerry Moran (R., Kan.) voted for the spending bill and claimed credit for two tranches of money destined for his home state—$404 million for a facility at Kansas State University to study animal disease and $219 million to expand an Air Force base in Wichita.

 

The new spending bill contains projects and provisions that could give ammunition to both sides in a number of Senate races.

 

Both Sen. Mary Landrieu (D., La.) and the leading Republican candidate in her fight for re-election in 2014, Rep. Bill Cassidy (R., La.), have claimed credit for a provision to delay for one year a planned increase in flood-insurance premiums. Both voted for the bill.

 

Rep. Jack Kingston (R., Ga.), who is running in a crowded GOP primary field for a Senate seat, faced a particularly ticklish dilemma. As a senior member of the House Appropriations Committee, he was well positioned to shape the bill. He used that influence to advance a provision to expedite federal funding of a huge infrastructure project crucial to Georgia, the dredging of Savannah harbor.

 

It was a coup, but Mr. Kingston voted against the bill on grounds that it spent too much overall. He was the only member of the appropriations committee to vote against the measure, a move that colleagues attributed to him facing a primary slate of Republicans competing to establish themselves as the most conservative candidate.

 

In Arkansas, Mr. Pryor's GOP opponent, Rep. Tom Cotton, voted against the spending bill, in part because be believed it cost too much. But Mr. Pryor—a senior member of the Senate Appropriations Committee—has been touting the many provisions the bill included to benefit the state.

Estate recovery: Little-known aspect of Medicaid now causing people to avoid coverage

From The Washington Post:

Add this to the scary but improbable things people are hearing could happen because of the new federal health-care law: After you die, the state could come after your house.

The concern arises from a long-standing but little-known aspect of Medicaid, the state-federal program that provides health coverage to millions of low-income Americans. In certain cases, a state can recoup its medical costs by putting a claim on a deceased person’s assets.

Asset recovery predates the health-care law, but the legislation makes it apply to a larger pool of people.

About half of the states took an option to expand Medicaid to anyone who makes up to 138 percent of the poverty level, or $15,900 for an individual. That includes childless adults and people with significant assets besides a home, who previously had been excluded in most states.

In 1993, concerned about rising Medicaid costs, Congress made it mandatory for states to try to recover money from the estates of people who used Medicaid for long-term care, which can cost taxpayers hundreds of thousands of dollars per person.

Advocates are pressing the Obama administration to specify that new Medicaid recipients nationally should not be subject to asset recovery.

Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said, “We recognize [the] importance of this issue and will provide states with additional guidance in this area soon.”

Part of the issue is that people who qualify for expanded Medicaid do not have the option of choosing instead to get a tax subsidy to buy private coverage on the marketplaces. In the states expanding Medicaid, the subsidies are available only to those who make more than the Medicaid income cutoff.

That means that someone just under that threshold could be subject to asset recovery, while someone who earns slightly more — up to 400 percent of the poverty level, or $45,960 for an individual — could get a federal subsidy to buy private coverage on the marketplaces, with no strings attached.

Other options are to buy insurance without a subsidy outside the marketplaces, or to be uninsured.

This will make the talking heads today: GOP congressman’s book: ‘The wife is to voluntarily submit’ to her husband

From The Washington Post:

A Republican member of Congress says in a recently released book that a wife is to "voluntarily submit" to her husband, but that it doesn't make her inferior to him.

Rep. Steve Pearce's (R-N.M.) memoir, "Just Fly the Plane, Stupid!" was released last month. Its publication -- and his acknowledgment in the book of the controversial nature of the submission debate -- come as the Republican Party reevaluates how it talks to and about women.

In the book, Pearce recounts his rise to owning an oil-field service company and winning election to Congress. In the book, the Vietnam War veteran says that both the military chain of command and the family unit need a structure in which everyone plays his or her role.

He said that, in his family's experience, this meant that his wife, Cynthia, would submit to him and he would lead.

"The wife is to voluntarily submit, just as the husband is to lovingly lead and sacrifice," he writes, citing the Bible. "The husband’s part is to show up during the times of deep stress, take the leadership role and be accountable for the outcome, blaming no one else."

Pearce, who is Baptist, emphasizes repeatedly in the chapter that submission doesn't mean inferiority but rather that husbands and wives play different roles. He also says it doesn't mean his wife doesn't have a say in major decisions.

"The wife’s submission is not a matter of superior versus inferior; rather, it is self-imposed as a matter of obedience to the Lord and of love for her husband," he writes.

Pearce recognizes in the book that he's delving into controversial territory. He recounts the time his wife broached the subject of submission with him, saying he cringed at the conversation.

"The principle is among the most controversial of all directives coming from the Bible. Critics abound, both Christian and non-Christian," he writes, adding: "Many of my friends dealt with the directive by ignoring it..."

In the Bible, the book of Ephesians says wives should "submit to their husbands in everything" (according to the New International Version). Pearce's book doesn't quote this verse, but it does criticize men who use this passage in order to "bully their wives and families." He says that "authoritarian control is not given to the husband."

Democrats in recent years have repeatedly attacked Republicans for their views on and comments about women's issues, particularly when it comes controversial comments made by GOP candidates. Mitt Romney suffered from one of the biggest so-called "gender gaps" in recent history in the 2012 election -- an election in which two GOP Senate candidates might have cost their party a seat because of comments about rape and pregnancy.

Since that election, GOP leaders have sought to coach their members on how to be more sensitive when talking about women's issues.

During the 2008 presidential campaign, the political left attacked a statement similar to Pearce's from former Arkansas governor Mike Huckabee (R). It was revealed at the time that Huckabee had signed on to a 1998 Southern Baptist Convention statement that a wife should "submit herself graciously to the servant leadership of her husband."

Pearce is a back-bench member of Congress from southern New Mexico's 2nd congressional district, but he formerly served as an assistant GOP whip.

He has served two separate stints in Congress since he was first elected in 2002. He also ran for Senate in both 2002 and 2008, losing the latter race to now-Sen. Tom Udall (D-N.M.).

In recent years, Pearce has distanced himself from GOP leadership, becoming one of the few GOP House members to vote against John Boehner for speaker. He has since said it was his most popular vote ever.

Update 5:25 p.m.: A Pearce spokesman is out with a statement accusing the Post of "falsely and inaccurately" mischaracterizing Pearce's book.

"This was a piece of either sloppy journalism or wilful intent to deceive," the spokesman said. "The words clearly written show that Pearce believes the phrase 'submission' is widely misunderstood in society and criticizes those who distort the bible to justify male dominance."

The statement does not make clear what Pearce's office believes is inaccurate.

The spokesman also accuses the post of "refusing" to use a number of quotes that add context to the congressman's words. One of the supposedly refused passages -- "But a close study of the Bible shows that authoritarian control is not given to the husband" -- is, in fact, quoted above.

Target Cuts Health Coverage for Part-Time Workers - Retailer Points to Insurance Options Available Through Public Exchanges

From The Wall Street Journal:

Target Corp. on Tuesday said it will stop offering health coverage for part-time employees, citing insurance options available through public exchanges.

Target said the health-insurance marketplaces, spurred by President Barack Obama's Affordable Care Act, could provide options its part-time workers may prefer.

"By offering them insurance, we could actually disqualify many of them from being eligible for newly available subsidies that could reduce their overall health insurance expense," Target said.

The health law requires large companies to offer coverage to employees working 30 hours a week or more, from 2015, or pay a penalty starting at $2,000 per worker. The law also requires most individuals this year to have coverage, or pay a penalty, and many big employers have been bracing for higher costs as employees who previously turned down participation in the company health plan now sign up for it.

Retailers, along with restaurant and hospitality companies, are bracing from some of the biggest cost increases under the new insurance mandates due to their sizable workforces.

Several other big employers have already said they are paring back the benefits they offered that aren't required by the law to try to keep their benefits spending in check. In August, United Parcel Service Inc.  said it was cutting off coverage for workers' spouses who had access to insurance through their own employers.

The online health insurance exchanges allow individuals to compare health plans and apply for tax credits toward the cost of their coverage. People can get tax credits on a sliding scale if they fall within certain income brackets--between $11,490 and $45,960 for a single person — but only if they don't have access to insurance through their employer that costs 9.5% or less of their wages.

Some employers have also sought to trim workers' hours to minimize the number for whom they have to provide coverage or pay a penalty. In its statement, Target said it wouldn't be limiting hours for workers as a result of the change and its workers that average at least 32 hours a week will be eligible for comprehensive health insurance coverage. 

Republicans Widen Push to Pick Up Senate Seats - President's Sagging Approval Ratings Expand Map of Competitive Races

From The Wall Street Journal:

President Barack Obama's sagging approval ratings and the rocky health-law rollout are expanding the map of competitive Senate races this year, giving Republicans new hope of capturing seats in states that the president carried in 2012.

The GOP already had a strong opportunity to pick up a net six seats to win a Senate majority. Democrats have to defend many more seats than Republicans, including in seven states that Mr. Obama lost in 2012. Now, polls show tighter-than-expected races for Democratic-held seats in Colorado, Iowa and Michigan, while a formidable Republican is challenging the Democratic incumbent in Virginia and another is weighing a bid in New Hampshire. In 2012, Mr. Obama won all five of those states.

With Election Day more than nine months away, the question is whether this marks a low ebb for Mr. Obama and his party, or a lasting trend.

"I'd be more worried if I were a Democrat than if I was a Republican," said Stuart Rothenberg, editor of the nonpartisan Rothenberg Political Report, which tracks congressional elections. "The Republicans' prospects in the existing targets are improving because of the president's approval ratings, and they are continuing to put other races on the board."

A Democratic lead of better than six percentage points in which party voters think should control Congress has collapsed since the glitch-plagued health-law rollout in October, leaving the parties at parity, according to an aggregate of polls by Real Clear Politics.

Adding weight to the Democratic burden: Midterm elections are historically unkind to the parties of sitting presidents, particularly in their second terms. And voter demographics should favor Republicans because the electorate in midterms tends to be older and whiter than in presidential-election years.

Senate Fails to Advance Bill Extending Benefits for Long-Term Unemployed

From The Wall Street Journal:

Efforts to reach a bipartisan deal extending emergency jobless benefits for the long-term unemployed collapsed in the Senate on Tuesday, ending at least for now a push by Democrats to revive a program that started during the financial crisis.

The law that expired in December dates from the financial crisis and provided federal aid to supplement the 26 weeks of unemployment benefits provided by most states, giving up to 47 weeks of additional payments. The latest proposals from both Democrats and Republicans would scale that back to a maximum of 31 weeks.

The benefits lapse could cause the unemployment rate to drop, if some unemployed people no longer are motivated to keep applying for jobs—a requirement to receive the jobless benefits. That would shrink the labor force, the total field of people that are out of work but actively seeking employment. Some analysts have predicted the loss of benefits could also cause some people to take jobs even if the work pays less than the job seekers want.

Reid’s Uncompromising Power Play in Senate Rankles Republicans - With his strong-armed change to the filibuster rule and an iron-fisted control of the Senate floor, Senator Harry Reid has engaged in the greatest consolidation of congressional power since Newt Gingrich ruled the House, unleashing a bitterness that may derail efforts to extend unemployment insurance

From The New York Times:

With his strong-armed change to the filibuster rule and an iron-fisted control of the Senate floor, Senator Harry Reid has engaged in the greatest consolidation of congressional power since Newt Gingrich ruled the House, unleashing a bitterness that may derail efforts to extend unemployment insurance.

Mr. Reid of Nevada, the majority leader, on Thursday dismissed all proposed Republican amendments to the unemployment extension, even those drafted by Republicans who had handed Democrats a victory on Tuesday by voting to take up the bill.

“We get nowhere with dueling amendments,” Mr. Reid declared.

A Republican effort to try to reopen the amendment process failed on a party-line vote, 42 to 54, setting up a showdown next week that is likely to end in the bill’s demise, Democrats conceded.

To Democrats, it was a typical Reid show of force in the face of unfair Republican amendments. To Republicans, it was only the latest — and one of the boldest — slaps in the face.

“I’m just kind of fed up,” said Senator Lisa Murkowski of Alaska, a moderate Republican who has increasingly become a key vote for Democratic legislation. “He’s a leader. Why is he not leading this Senate? Why is he choosing to ignore the fact that he has a minority party that he needs to work with, that actually has some decent ideas? Why is he bringing down the institution of the Senate?”

Mr. Reid’s brutish style matters beyond the marbled chamber of the Senate. Senate legislation has increasingly turned into a battle over amendments and Mr. Reid’s uncompromising control over the process. The six Republicans who voted to take up the unemployment bill on Tuesday expected at least to be allowed votes on their amendments to shape the legislation.

Instead, Mr. Reid dismissed all Republican proposals as unacceptable and then proposed his own new unemployment deal. Under it, benefits would be extended until mid-November of this year, and paid for largely by extending a 2 percent cut to Medicare health providers in 2024. Republicans were outraged, and an obscure procedural fight is likely to leave up to three million out-of-work Americans without benefits.

“We need to be able to have votes on behalf of our states,” said Senator Kelly Ayotte, Republican of New Hampshire, who was denied a vote on her amendment to pay for the extension by requiring applicants for the child tax credit to have Social Security numbers, a proposal Mr. Reid declared an attack on children. “I don’t know what the issue is, unless you are afraid it will pass.”

Ms. Murkowski said that she was unlikely to support the bill.

The unemployment bill is only the most recent example of legislation that has become stuck in a procedural quagmire, affecting senators in both parties. A long-awaited showdown between two Democratic senators, Kirsten E. Gillibrand of New York and Claire McCaskill of Missouri, over the military’s approach to sexual assault fizzled late last year when they were denied any votes on an annual military policy bill that usually is shaped over weeks on the Senate floor. A bipartisan bill on Iran sanctions has yet to receive floor consideration. And Democrats, eager to replace a tax on medical devices that helps pay for the Affordable Care Act, have been denied a vote.

“I would like to take one of the bipartisan bills and allow for a more open amendment process,” said Senator Amy Klobuchar, Democrat of Minnesota and a primary sponsor of the medical device tax repeal. “I think that would be a good way to do it and more forward.”

For their part, Republicans have received all of four amendment votes since mid-July.

Rankled by the Republican criticism, Mr. Reid said in an interview that Republicans refused to agree to any reasonable limit on amendments despite his overtures.

“So we get nothing done, which is their goal anyway,” Mr. Reid said.

U.S. Needs a Role in the New Mideast - The Regional Transformation Launched by the Arab Spring Calls Compels America to Rethink its Stake: "The three most consequential states in the Middle East today—Turkey, Iran and Israel—all are non-Arabs."

Gerald Seib writes in The Wall Street Journal:

It's becoming clear the Arab Spring didn't merely shake up the ossified power structure of the Middle East. It launched a total transformation of the region—one that has reduced American influence and ultimately will compel the U.S. to rethink its stake in an area that for half a century was assumed to be central to its global interests.

Syria's civil war is bleeding into Lebanon and Iraq, weakening the governments of both and setting off parallel fights between armed Sunni and Shiite groups. Egypt's military government is growing more authoritarian and beyond the reach of American influence. Libya has gone from being a bizarre but ultimately stable nation run by a single mercurial figure to a state beyond anyone's control. Yemen is a playground for Islamic extremists. Persian Gulf monarchies are stable but frightened.

 

All this represents a virtual collapse of the Arab world's power structure. As Aaron David Miller, a longtime State Department Middle East aide and now a vice president at the Wilson Center, notes: "The three most consequential states in the Middle East today—Turkey, Iran and Israel—all are non-Arabs."

This amounts to an earthquake in a region that for decades was kept stable because of rule by secular Arab strongmen in Egypt, Iraq, Libya, Yemen, Syria and Tunisia. Some were America's friends, some were America's foes, some vacillated between the two, but all provided a stability that translated into a safe flow of oil.

In theory, all this should represent good news for the U.S. The ouster of Iraq's Saddam Hussein and Libya's Moammar Gadhafi, and the threat to the rule of Bashar al-Assad in Syria represent the weakening of what had been for many years a kind of axis of Arab anti-Americanism. But nothing is that simple in the Middle East, and three problems are making the changes troublesome for Washington:

• The collapse of the Arab power structure has opened the door for expanded influence by Iran—a legacy of the Iraq war. It rid the world of Saddam Hussein but made the region safer for Iran next door.

• The departure of Arab autocrats hasn't paved the way for the rise of secular democracy, at least not yet. Instead it has opened the path for Islamic extremists that the autocrats had long suppressed.

• As is becoming increasingly clear in Syria, Lebanon and Iraq, the earthquake shook loose underlying tensions between Sunni and Shiite Muslims. Saddam Hussein in Iraq and the Assad family's regime in Syria helped keep these tensions in check for everybody. No more. Increasingly, Saudi Arabia is bankrolling the region's Sunni factions and Iran is giving aid to the Shiite ones, creating an unhealthy kind of broad sectarian proxy struggle.

These changed dynamics should be calling forth a serious national debate about America's interests in the Middle East in a new era of lowered dependence on Middle East oil, continued risk of Islamic-extremist terrorism and exhaustion with military interventions in the region. Current debates over the wisdom of a nuclear deal with Iran and intervention in Syria are complicated by the simple lack of national consensus on America's broader interests these days. 

 

For now, the U.S. seems to have limited ability or interest in affecting the trend lines. But the perception the U.S. can steer events in the region—a perception that always was a bit exaggerated—is fading.

 

A lot of American influence stemmed from the belief that the U.S. could, and just might, intervene militarily to realign the balance of power in the region. After the exhaustion borne of more than a decade of fighting in Iraq and Afghanistan, and in the wake of a conscious decision not to intervene to help rebels in Syria's civil war, that idea simply isn't taken as seriously.

 

More than that, it isn't clear the American public cares all that much. The U.S. is producing more of its own energy, Washington's friends in Israel seem secure and the memory of terrorist attacks is fading.

 

Unfortunately, that's shortsighted. The U.S. has a deep interest in the health of a global economy that still depends on Middle East oil. The dangers of Islamic extremism actually are on the rise rather than the decline. And now there is the real danger of a destabilizing regional nuclear arms race in coming decades set off by Iran.

 

Americans have a stake, like it or not. "Let's be clear," says Mr. Miller. "We're trapped in a region we can't fix or leave."

Once upon a time, starting a national discussion about all this would have been the job of the Senate Foreign Relations Committee. Perhaps it can be again.

The group that got health reform passed is declaring victory and going home

From The Washington Post:

It’s hard to remember now, as the Affordable Care Act’s biggest programs come into effect, but many central decisions regarding Obamacare’s structure were made before anyone expected Barack Obama to be president. By the time he was a serious contender, Obama, Hillary Rodham Clinton and John Edwards had all coalesced around strikingly similar health plans that would, in broad outline, become Obamacare.

This prehistory was essential to health reform’s passage. Key constituencies that advocated for health reform negotiated compromises well before a bill even existed. And a grass-roots campaign was prepared to move health reform center-stage within Democratic congressional districts across the country. Before President Obama took office, congressional leaders and House and Senate staffers were drafting specific legislative language.

Health Care for America Now (HCAN) played a central role in leading that effort. HCAN brought together a wide array of organizations, from AFSCME, AFL-CIO and SEIU to the NAACP, MoveOn, ACORN, the Center for American Progress, the National Council of La Raza, Campaign for America’s Future and more. Even George Soros played a part.

As national campaign manager and chief executive, Richard Kirsch played a key role in founding HCAN. His 2012 book, "Fighting for Our Health: The Epic Battle to Make Health Care a Right in the United States," is an essential reference regarding the grass-roots advocacy behind health reform.

HCAN officially closed up shop on Dec. 31, 2013. I caught up with Kirsch to discuss HCAN’s contributions, as well as to discuss the accomplishments and the many missteps in the passage of health reform. In our conversation, Kirsch expressed pride in health reform. He also wasn’t shy about criticizing Obama, Sen. Max Baucus and others regarding various strategic missteps and the demise of the public option. Below is an edited transcript of our conversation.

HP (Harold Pollack): So much of your story might be called the prehistory of health reform, which did so much to shape what became the Affordable Care Act. People like to use terms such as ObamaCare. Yet if we had had President Hillary Clinton instead, I wonder how different the final product would actually have been.

RK: There’s no reason to think it would be fundamentally different. A lot of work was done before the 2008 election really got into gear to get the major Democratic candidates aligned in support of the same health policy solutions. As a result, the three leading Democratic candidates -- John Edwards as well as Hillary Clinton and Barack Obama -- were all supporting almost the same proposal, which was in effect the Massachusetts law, with a public option added to it.

I think President Hillary Clinton would’ve come in with a similar proposal and faced a similar political climate, with a very hostile opposition. After all, we saw the tremendous opposition to her husband from the right. Many of the same people who hate Obama have lots of reasons to hate the Clintons, too. So I don’t think we would have seen a very different contour to the political fight. She may not have made some of the concessions that Obama made preemptively, which made it harder to win good policy, but it’s hard to know. It wouldn’t have been that different.

On the substance, ACA is a very conservative law. It increases the role of the insurance industry. Many of the ACA’s real current problems -- as opposed to problems conjured up by the right -- such as excessive deductibles, are prominent because these policies are the insurance companies’ favorite mode of operating. The new law relies on individual responsibility to purchase often-subsidized coverage through the new marketplaces, which nationally and in most states are lightly regulated. Conservatives in a different era would’ve said, “This is a real compromise.

HP: To connect back to your book, single-payer folks would respond to your description by saying: “Well, a single-payer system would have an obviously social insurance structure. We would avoid all this nonsense with the exchanges, all the layers of complexity barnacled onto our crazy system.” These advocates might ask: “Wouldn’t we have a better system if we had a single payer? Why didn’t HCAN and its friends push for that?”

RK: What’s the expression: “If wishes were horses, beggars would ride?”

Yes -- if we could wave a magic wand and design a rational health-care system that would control costs while providing much better access, we wouldn’t design our current one. The ACA was the best that we could get through the American political system. The fact that we failed in every previous instance in the past 100 years reflects the reality that there hadn’t been a reform designed to deal with the realities of American politics, and there hadn’t been a broad-based movement built effectively for the country to pass this reform. That was the contribution that HCAN made.

The two things came together in passing the ACA. The legislation was carefully constructed to engage, instead of alienating, the biggest interest groups, which have huge amounts of money that could effectively be used to kill health reform. Both because of their lobbying clout and their ability to use paid media to scare the public. These interest groups were neutralized enough, in some cases even mildly supportive. Then we built a whole grass-roots movement to overcome the opposition.

Yes, there are much better ways to run our health-care system. The question is now that we have the ACA in place, will the conservatives’ nightmare be realized? That nightmare is that ACA really does turn, over time, into something much broader, more collective, more affordable, and that government does a better job of controlling costs by confronting private interests. That’s going to be the battle for the next few decades.

The biggest problems with the law are around affordability. The way the law is structured, coverage is still not affordable for many people. And again, people’s experiences of the law will be around affordability. So people will be glad to get coverage, but they will also live with high deductible-coverage and premiums that may still be difficult to pay.

In the legislative campaign, our biggest issues with the bill concerned affordability. A lot of the cost to people was made much worse by the president’s unfortunate (to put it nicely) decision to spend less on subsidizing people because he wanted to get the cost of the subsidies under the magic 1-trillion-dollar figure.

But doing so didn’t change the debate at all; Republicans still called it a “trillion-dollar program.” But it did mean lower subsidies for people, higher premiums, higher deductibles. It has resulted in making insurance less affordable, making the plan less popular. It’s going to shape a lot of the contours of the upcoming debate in the next few years of how we make the program work better.

HP: Going back over the political history of ACA, it’s hard to fairly distinguish genuine strategic missteps from losses that simply reflected a tough negotiation. When you need 60 votes, it’s easy to end up negotiating with yourself because you’re thinking how Senators 57, 58, 59 and 60 are going to perceive the fiscal discipline of this new law. In the wake of some of the rollout challenges, many people are saying that the president needs to rethink his approach.
 
Many of these calls are effectively saying, “You need to reach out to the political center more and to be more ideologically moderate.” Your book argues that some of the president’s biggest strategic mistakes were quite the opposite: He moved too quickly in the direction of the political center. In fairness, he bet his presidency on ACA. Its passage was a very close thing. Before this thing was done, he was going to have to make some very painful concessions to Ben Nelson, Kent Conrad, and Max Baucus under any scenario … .

RK: Absolutely. I’m not so critical of the fact that they had to make compromises. It’s the fact they made them much too soon. The reality was that they were relying on 60 Democrats and not relying on Republicans. It became pretty clear by the summer of 2009 that Baucus was being led down the primrose path by Chuck Grassley. Grassley was making all sorts of public statements that he wasn’t really going to reach a deal on this. Yet Baucus kept trying and trying.

You have to look at Baucus and Obama together on this. Jim Messina, who was one of the top people working for Obama and his deputy chief of staff, had been Baucus’s chief of staff. They kept making concessions when it was clear the Republicans weren’t going to support it. Even when it was crystal clear -- and they gave up on getting Republican support - -they didn’t go back and present a better bill. They might have said, “Well, we’re going to write the bill that we want and then we’ll make compromises to get 60 Democrats.” Instead, they kept all the things they added to appeal to Republicans that hadn’t worked. So they were unnecessarily negotiating with themselves. Then, at the end in December, when they had to get it through the Senate, they had to negotiate with the Joe Liebermans and the Ben Nelsons and had to make concessions. Had they not made all these concessions earlier, they would’ve started it with a stronger bill … . The conservative Democrats could only ask for so much. The final bill would have been stronger.

By making these preemptive concessions to appease Republicans, Baucus and Obama put themselves in a much weaker position from a policy point of view and eventually from a political popularity point of view, as well. That’s the thing I want to emphasize: It’s not just a political game. At HCAN we kept asking: how is it going to affect real people’s lives? We were looking for legislation that people would find the most affordable and giving them the best opportunity to gain access to good health care. That’s what our mission was.

We always wanted to ask: What does the best legislation look like? And we’ll make political concessions when we need to in order to get something passed. It’s a different lens than was largely held inside Washington. For me it was an unwise concession to say we’re going to spend less than a trillion dollars. The ACA was still attacked as a trillion-dollar plan when it was $960 billion. It would have been attacked in the same way had it cost another $100 or $200 billion, which would have made coverage more affordable. The ACA would have faced the same attack, but now we wouldn’t be facing the proliferation of so many plans with overly expensive premiums. That really is what creates the long-term problem.

HP: That $900 billion figure also encouraged another original sin of ACA: back-loading of so many key provisions. One floated proposal would have allowed states to start Medicaid and the new exchanges whenever they wanted. So the blue states could have started when they were ready. Especially as we’re in the middle of a devastating recession, front-loading would have added some economic stimulus, too. Had a couple of states started early, we might also have received greater forewarning about some of the implementation and software issues …

Then there was the public option. From a progressive perspective, what happened was doubly sad. The public option didn’t make it into the final bill. And it wasn’t bargained away to get anything in return. It seems like it was just left on the table. Part of the political challenge for Democrats was that people on the left were very excited about the public option.

HP: At one point in your book, you asked someone in the White House, “What’s the inside/outside game?” This person basically responded, “There is no outside game.” Watching from a distance in 2009 and early 2010, I always got the feeling that the White House didn’t quite know how to strike the right balance here. They faced practical challenges of negotiating inside deals to get this done. By the way, I think the president’s progressive base understood that. People had watched the Clinton effort fail. They knew that some deals needed to be cut. President Obama had a tremendous amount of good will from liberals and the left coming on his historic election. For all this, there was tremendous uneasiness in Washington about what would happen to ACA if all of these somewhat uncontrollable outside groups who were operating alongside a delicate set of negotiations.

How would it work if grass-roots activists — including many who had been quite active in the Obama campaign — pursued a populist campaign against the insurance companies at the very moment politicians were in the room with the insurers negotiating the myriad practicalities of health reform. One end result was a de facto demobilization of outside voices out of a fear these might have complicated the inside game.

RK: This was a huge misunderstanding by the Obama folks about power and political dynamics, just a fundamental miscalculation and blindness that was really destructive. The president’s personality is to be conciliatory. Until the summer of 2011 and the grand bargain collapsed, he always wanted to be conciliatory. He also had people like Rahm Emanuel and Jim Messina in the White House who wanted to totally control everything and did not want any on the left pushing them. But power works differently. They would have been in a much stronger position if they could say, “We’re being pushed really, really, really hard from the left, and so this is the best we can do.” And then cut final deals when they had to.

Look at the difference in approach between Ronald Reagan and Barack Obama. Reagan did not compromise publicly. He staunchly stood up for his conservative ideals publicly. But finally he made a lot of deals. He made a lot of concessions. People now point out that a lot of what Reagan agreed to was further left than where Republicans are now on taxes and other things. But when Reagan made those deals, his base ultimately forgave him. They saw he was out there as a champion and said, “Well, this must be the best he can do.” But because Obama was constantly undercutting his own rhetoric, he lost credibility with his base.

HP: Your comments make me wonder how different the Obama presidency would’ve been had Republicans not made the basic strategic decision before he was even inaugurated that their best political play was implacable opposition. He really had hoped for a presidency in which he could identify and generate a greater degree of bipartisan consensus. I believe, for example, he would have been delighted to negotiate over the malpractice issue, if Republicans were at all interested.

There was one unintended consequence of this process. Moderate and conservative Democrats in the end came to own ACA in a very serious way. It’s striking after Scott Brown’s election that people like Conrad and Baucus did what had to be done to enact ACA, because it really was their bill.

RK: Indeed it is.

Another thing that empowered many politicians in the process — here I mean the president and the speaker and pretty much most the entire Democratic leadership and many Democratic members -- was a compelling sense of history. They really did believe that they were doing something historic and of vital importance to the country and to their constituents. It was reinforced by all the constituents they met, the personal stories they heard at our events at at others. It’s easy to be cynical about politicians, but what I saw over and over again was really a heartfelt commitment, sense of destiny, a sense of history.

HP: I think we should close with the future of the public option. Do you believe the public option will reappear? If it has a future, how do you think it may come back given the current political landscape?

RK: The most sensible approach would be to extend Medicare to people under 65, to make Medicare another choice in effect for people who are shopping within the exchanges. Medicare is already in place. It would need some changes, but I think you’re going to see more and more people saying, “Well, let’s just look at that as an option.”

We need to see big changes in the ACA, like expanding Medicare, within the context of the question of how do people in the 21^st-century American economy support themselves and their families.

Stagnant wages, health care that has high deductibles, retirement plans which if they exist at all are subject to market whims, the high cost of higher education -- these challenges are all interrelated.

Are we going to actually see an opportunity for a movement that advocates for an economy that once again tries to work for everybody as opposed as the few at the top? It’s in that context that we’ll see positive changes with the ACA: It could be a Medicare expansion. It could be just much bigger subsidies. It could be much more active purchasing, which involves states really negotiating and pushing insurance companies for lower rates and makes plans more affordable.

In terms of health-care prices, how much more are we going to see the need to actually control what we pay for health care? That’s the biggest problem with health care. We pay much higher prices for doctors, hospitals, drugs, medical equipment than other countries. We don’t use more health care than most places. We actually have lower use of drugs and doctors in hospitals than most of our competitors. We just pay much more for it.

Can Obama raise his job approval ratings enough for a political recovery?

Chris Cillizza writes in The Washington Post:

Here’s a surprisingly complex question: Can President Obama actually recover, politically speaking? And, if so, what does that “recovery” look like?

The president is mired in the worst extended polling dip of his five years in office, dragged down by a series of scandals (National Security Agency spying, IRS) and fumbles (the rollout of HealthCare.gov).

Gallup’s month-by-month breakdown of Obama’s 2013 job approval numbers shows a steady decline from 52 percent approval in January to 41 percent by December. The Washington Post-ABC News poll pegged Obama’s job approval rating at 55 percent in January 2013; he ended the year with just 43 percent of Americans approving of the job he was doing as president.

Obama is now far closer to the approval trajectory of George W. Bush during his second term than that of either Bill Clinton or Ronald Reagan. Pew Research Center data show that a year into their second terms, Reagan’s approval stood at 62 percent, while Clinton’s was 58 percent. Obama was at 41 percent as of November 2013, more on par with Bush’s 36 percent in November 2005.

“I don’t think it’s possible to get to Reagan or Clinton levels from where Obama is now, especially since there are more problems looming for Obamacare,” said Glen Bolger, a partner at the Republican polling firm Public Opinion Strategies. “However, to get back to the low 50s, the president needs to rally with independent voters. Betting on that happening, however, is like betting on Andy Reid in the playoffs — not advisable!”

Digging into the numbers largely bears out Bolger’s assessment. The 12-point drop in Obama’s approval rating from January 2013 to December 2013 is not attributable to Republicans (17 percent approved in January, 13 percent in December), but rather to a precipitous drop among independents (down 14 points) and, interestingly, Democrats (down 15 points).

The dip among Democrats explains why Obama has of late focused on economic inequality (unemployment insurance, minimum wage increase, etc.) in his speeches and policy proposals. Those moves are aimed at rallying the Democratic base and, with it, Obama’s approval numbers.

But, his standing among independents and Republicans speaks to the broader difficulties for Obama in “recovering” to Clinton or Reagan territory in his second term.

Among Republicans, Obama’s disastrous year had remarkably little impact on how they regarded him. (The decline from 17 percent approval to 13 percent approval is statistically insignificant.) Given that, it’s reasonable to conclude that nothing will move the Obama number among Republicans — in much the same way that by this time of Bush’s second term, he had lost Democrats completely. If one in five (or less) self-identified Republicans approves of the job he is doing, it’s virtually impossible for Obama’s numbers to ever come close to Clinton/Reagan range.

Then there is the independent problem. There’s little doubt that the debacle that was the rollout of the health-care Web site — and the resultant negative news coverage — damaged Obama among unaffiliated voters.

“The president is being weighed down by one issue, his health-care law,” Democratic pollster Fred Yang told the Wall Street Journal. “It’s probably fair to say that as goes health care, so goes the Obama presidency for the next year.”

The issue for Obama in Yang’s statement is that opinions about the health-care law have remained remarkably stable (and negative) for the last several years. With a single exception in September 2012, support for the law has been in the low-40s/high-30s percentage range since spring of 2010, according to monthly tracking polls conducted by the Kaiser Family Foundation. That consistency suggests that moving independents (or anyone else) off of their position on the law is an extremely difficult task.

(Worth noting: Many Democrats argue that independent voters are increasingly Republicans as GOPers disaffected with the tea party wing move to the unaffiliated ranks, skewing what “independent” numbers really mean. That said, among “pure” independents, who lean to neither party, just 25 percent carried a favorable view of the health-care law while 52 percent had an unfavorable opinion in the December Kaiser tracking poll.)

Add it all up, and you can conclude two things: 1) Obama’s best (only?) strategy to move the needle on his approval numbers in the near term is to rally Democrats, and 2) even if that rallying happens, he will still find himself well short of the lofty ratings enjoyed by Reagan and Clinton in their second terms.

In the longer term, Republican pollster Jon Lerner argues that the best chance for an Obama approval surge is actually a GOP victory. “It will only happen if the Republicans take over the Senate in 2014, and Obama moves to the center in 2015-16, including accepting some changes to Obamacare,” Lerner argued. “In his second term, Clinton made deals with the GOP-controlled Congress. In his second term, Reagan made deals with Gorbachev.”

Who votes?

Dan Balz writes in The Washington Post:

Women are now more likely to vote than men. And the gap between black and white participation has narrowed significantly. In the most recent election, blacks voted at higher rates than whites in some states.

During a time of rising income inequality, wealthier and better-educated people continue to vote “at substantially higher rates” than poorer, less-educated people. That gap existed 40 years ago and still does.

Politicians and others have looked for ways to make it easier to vote. New laws that allow people to register on Election Day are one example. Those changes have had a positive, if modest, impact on the percent of eligible voters who actually cast ballots, the authors conclude, enough to change the outcome in a close election.

But they haven’t changed the imbalance in participation rates among wealthier vs. poorer Americans, nor have they affected the degree to which politicians have sought to address income inequality. The problem has gotten worse as voter participation rates have increased.

Another conclusion is that eligible voters are more likely to cast ballots if they see a difference among the candidates. “If citizens see no differences in what candidates are offering, then, there really is very little reason to show up at the polls,” according to the authors.

Senate Discord Drains Power of Finance Chief - While all the committees have surrendered influence in recent years, the Finance Committee had typically been considered above all others since its creation in the early 1800s.

From The New York Times:

After the Reagan landslide of 1980 swept Bob Dole into the chairmanship of the Senate Finance Committee, Mr. Dole was not sure how to break the news to Russell B. Long, the Louisiana Democrat who had presided over the panel with unquestioned authority for 15 years.       

“Who is going to tell Russell?” asked an anxious Mr. Dole.
      

That the incoming chairman of the Finance Committee was nervous about approaching the deposed head speaks volumes about the power vested in that position and the men who have held it.

      

The imminent departure of Max Baucus, Democrat of Montana, from both the Senate and the committee has put a new focus on the panel and the chairmanship, which has declined in stature and influence compared with the vital role it played in the Senate almost from the beginning. Without a shift in the power structure of the Senate, it appears likely the next committee leader will have only a fraction of the clout of those in the past.

      

In addition to Mr. Russell, the esteemed chairmanship was the domain of such Senate forces as Lloyd Bentsen of Texas, Daniel Patrick Moynihan of New York, Mr. Dole of Kansas and Bob Packwood of Oregon (before his fall in a sexual misconduct scandal). Many other prominent Senate figures also held the gavel over the centuries.

      

The committee handles all tax and revenue legislation, trade and tariffs; oversees Social Security and Medicare; and vets crucial nominations like the top jobs at the Departments of Treasury and Health and Human Services.

      

When President Lyndon B. Johnson yearned to cut taxes in 1964, he knew he could not succeed without tirelessly wooing Senator Harry Byrd of Virginia, the Democrat who held the Finance Committee job for a decade before Mr. Long.

      

“As powerful as Lyndon Johnson was, he was powerful because he knew how to play the committee chairs,” said Richard A. Baker, a former Senate historian.

      

Mr. Baker says he sees power ebbing from the Finance Committee because of a consolidation of control in the offices of the floor leaders. That is where most of the main decisions on policy and legislative priorities are made these days — in suites on the second floor of the Capitol rather than in the committee rooms of the Senate office buildings.

      

“It has been a gradual accretion through the ’80s and ’90s in the direction of the floor leader,” said Mr. Baker, a co-author of the book “The American Senate: An Insider’s History.”

      

While all the committees have surrendered influence in recent years, the Finance Committee had typically been considered above all others since its creation in the early 1800s.

      

“The Finance Committee is second to none in the Senate in terms of the legislative responsibilities entrusted to it,” declared a 1981 history of the committee commissioned by Mr. Dole when he became chairman.

      

When a special committee led by Senator John F. Kennedy was formed in 1959 to select five outstanding senators through history, all five — Henry Clay, Daniel Webster, John C. Calhoun, Robert M. La Follette Sr. and Robert A. Taft — had served on the committee and Webster, Clay and Calhoun were chairmen.

      

The committee has traditionally been viewed as a microcosm of the Senate, with the notion that a measure that could clear the Finance Committee with a bipartisan majority stood a solid chance of success in the Senate because members of the panel were representative of the whole Senate.

      

The committee also had a deep history of working in a bipartisan fashion to push its major legislation. But with the decline of the spirit of bipartisanship and trust between members of the Senate, some of the power of the Finance Committee and its chairman has dissipated with it.

      

“You have an eclectic mix of people on the committee who have become less and less bipartisan,” said Tom Daschle, the former Democratic Senate leader, who also served on the committee. “The environment is so different regardless of leadership.”

      

As control of the Senate — and of the committee leadership — has shifted between parties, the power of the chairman has diminished. Senate Republicans have put a six-year limit on how long a member can serve as chairman of a single committee.

 

Senator Ron Wyden, the policy-driven Oregon Democrat who is in line to become chairman, has tried the bipartisan route in the past. He first wrote a bipartisan tax overhaul with Senator Judd Gregg, Republican of New Hampshire, and then with Senator Dan Coats, Republican of Indiana, after Mr. Gregg left the Senate. The plan has gotten little traction but stands to get more attention now.

 

Mr. Wyden was burned by his reach across the aisle when he joined Representative Paul D. Ryan of Wisconsin in promoting a major Medicare overhaul. Republicans, in defending Mr. Ryan’s privatization plan after he became their vice-presidential candidate in 2012, often cited Mr. Wyden’s support, forcing Mr. Wyden to back away from it.

      

Mr. Baucus also drew criticism for working too closely with Republicans on both taxes and social policy. Fellow Democrats thought Mr. Baucus ceded too much and was being used by Republicans to stall health care legislation. The law ended up drawing no Republican support despite Mr. Baucus’s determined overtures even though Republicans had originated some of the central policy ideas.

      

Still, a seat on the Finance Committee remains a sought-after post and the chairmanship a coveted slot even in a Senate environment that limits its reach.

      

“It is the most powerful and most important committee, but it is the most powerful and most important committee in a dysfunctional Senate,” said Lawrence O’Donnell, an MSNBC host and political analyst who served as the committee’s staff director for two years when Mr. Moynihan was chairman.

      

“Every job in the Senate is less enviable,” he said. “The best job you can have in the Senate is chairmanship of the Finance Committee, but it is the worst version of the job that has existed in my life.”

      

At least Mr. Wyden does not have to worry about breaking any news to Mr. Baucus, whose nomination as ambassador to China is likely to cause him to leave before his term expires.

      

Mr. Dole, in a later speech, said he never worked up the nerve to inform Mr. Long. And he recounted that when the committee voted for the first time after his takeover, he steeled himself for his inaugural vote as the man in charge.

      

Instead, when the clerk called, “Mr. Chairman,” Mr. Long voted aye before Mr. Dole could speak. Such was the power of the Finance Committee chairman, even when he was the ex-chairman.

Power Vacuum in Middle East Lifts Militants - Behind much of it is the bitter rivalry of two great oil powers, Iran and Saudi Arabia, whose rulers — claiming to represent Shiite and Sunni Islam, respectively — cynically deploy a sectarian agenda that makes almost any sort of accommodation a heresy.

From The New York Times:

The images of recent days have an eerie familiarity, as if the horrors of the past decade were being played back: masked gunmen recapturing the Iraqi cities of Falluja and Ramadi, where so many American soldiers died fighting them. Car bombs exploding amid the elegance of downtown Beirut. The charnel house of Syria’s worsening civil war.     
 
But for all its echoes, the bloodshed that has engulfed Iraq, Lebanon and Syria in the past two weeks exposes something new and destabilizing: the emergence of a post-American Middle East in which no broker has the power, or the will, to contain the region’s sectarian hatreds.
      

Amid this vacuum, fanatical Islamists have flourished in both Iraq and Syria under the banner of Al Qaeda, as the two countries’ conflicts amplify each other and foster ever-deeper radicalism. Behind much of it is the bitter rivalry of two great oil powers, Iran and Saudi Arabia, whose rulers — claiming to represent Shiite and Sunni Islam, respectively — cynically deploy a sectarian agenda that makes almost any sort of accommodation a heresy.

      

“I think we are witnessing a turning point, and it could be one of the worst in all our history,” said Elias Khoury, a Lebanese novelist and critic who lived through his own country’s 15-year civil war. “The West is not there, and we are in the hands of two regional powers, the Saudis and Iranians, each of which is fanatical in its own way. I don’t see how they can reach any entente, any rational solution.”

 

The drumbeat of violence in recent weeks threatens to bring back the worst of the Iraqi civil war that the United States touched off with an invasion and then spent billions of dollars and thousands of soldiers’ lives to overcome.

      

With the possible withdrawal of American forces in Afghanistan looming later this year, many fear that an insurgency will unravel that country, too, leaving another American nation-building effort in ashes.

      

The Obama administration defends its record of engagement in the region, pointing to its efforts to resolve the Iranian nuclear crisis and the Palestinian dispute, but acknowledges that there are limits. “It’s not in America’s interests to have troops in the middle of every conflict in the Middle East, or to be permanently involved in open-ended wars in the Middle East,” Benjamin J. Rhodes, a White House deputy national security adviser, said in an email on Saturday.

      

For the first time since the American troop withdrawal of 2011, fighters from a Qaeda affiliate have recaptured Iraqi territory. In the past few days they have seized parts of the two biggest cities in Anbar Province, where the government, which the fighters revile as a tool of Shiite Iran, struggles to maintain a semblance of authority.

      

Lebanon has seen two deadly car bombs, including one that killed a senior political figure and American ally.

      

In Syria, the tempo of violence has increased, with hundreds of civilians killed by bombs dropped indiscriminately on houses and markets.

      

Linking all this mayhem is an increasingly naked appeal to the atavistic loyalties of clan and sect. Foreign powers’ imposing agendas on the region, and the police-state tactics of Arab despots, had never allowed communities to work out their long-simmering enmities. But these divides, largely benign during times of peace, have grown steadily more toxic since the Iranian revolution of 1979. The events of recent years have accelerated the trend, as foreign invasions and the recent round of Arab uprisings left the state weak, borders blurred, and people resorting to older loyalties for safety.

 

Arab leaders are moving more aggressively to fill the vacuum left by the United States and other Western powers as they line up by sect and perceived interest. The Saudi government’s pledge last week of $3 billion to the Lebanese Army is a strikingly bold bid to reassert influence in a country where Iran has long played a dominant proxy role through Hezbollah, the Shiite movement it finances and arms.

      

That Saudi pledge came just after the assassination of Mohamad B. Chatah, a prominent political figure allied with the Saudis, in a downtown car bombing that is widely believed to have been the work of the Syrian government or its Iranian or Lebanese allies, who are all fighting on the same side in the civil war.

      

Iran and Saudi Arabia have increased their efforts to arm and recruit fighters in the civil war in Syria, which top officials in both countries portray as an existential struggle. Sunni Muslims from Egypt, Libya, Tunisia, Saudi Arabia and elsewhere have joined the rebels, many fighting alongside affiliates of Al Qaeda. And Shiites from Bahrain, Lebanon, Yemen and even Africa are fighting with pro-government militias, fearing that a defeat for Bashar al-Assad, Syria’s president, would endanger their Shiite brethren everywhere.

 

“Everyone fighting in Syria is fighting for his own purpose, not only to protect Bashar al-Assad and his regime,” said an Iraqi Shiite fighter who gave his name as Abu Karrar. He spoke near the Shiite shrine of Sayida Zeinab near Damascus, where hundreds of Shiite fighters from around the region, including trained Hezbollah commandos, have streamed to defend a symbol of their faith.

 

Some Shiite fighters are trained in Iran or Lebanon before being sent to Syria, and many receive salaries and free room and board, paid for by donations from Shiite communities outside of Syria, Abu Karrar said.

      

Although the Saudi government waged a bitter struggle with Al Qaeda on its own soil a decade ago, the kingdom now supports Islamist rebels in Syria who often fight alongside Qaeda groups like the Nusra Front. The Saudis say they have little choice: having lobbied unsuccessfully for a decisive American intervention in Syria, they believe they must now back whoever can help them defeat Mr. Assad’s forces and his Iranian allies.

      

For all the attention paid to Syria over the past three years, Iraq’s slow disintegration also offers a vivid glimpse of the region’s bloody sectarian dynamic. In March 2012, Anthony Blinken, who is now President Obama’s deputy national security adviser, gave a speech echoing the White House’s rosy view of Iraq’s prospects after the withdrawal of American forces.

      

Iraq, Mr. Blinken said, was “less violent, more democratic and more prosperous” than “at any time in recent history.”

      

But the Iraqi prime minister, Nuri Kamal al-Maliki, was already pursuing an aggressive campaign against Sunni political figures that infuriated Iraq’s Sunni minority. Those sectarian policies and the absence of American ground and air forces gave Al Qaeda in Iraq, a local Sunni insurgency that had become a spent force, a golden opportunity to rebuild its reputation as a champion of the Sunnis both in Iraq and in neighboring Syria. Violence in Iraq grew steadily over the following year.

      

Rebranding itself as the Islamic State in Iraq and Syria, or ISIS, the group seized territory in rebel-held parts of Syria, where it now aspires to erase the border between the two countries and carve out a haven for its transnational, jihadist project. Sending 30 to 40 suicide bombers a month to Iraq from Syria, it has mounted a campaign of violence that has led to the deaths of more than 8,000 Iraqis this year, according to the United Nations, the highest level of violence there since 2008.

      

In recent days, after ISIS fighters rode into the cities of Falluja and Ramadi, they fought gun battles with Sunni tribal fighters backed by the Iraqi government, illustrating that the battle lines in the Middle East are about far more than just sect. Yet the tribal fighters see the government as the lesser of two evils, and their loyalty is likely to be temporary and conditional.

      

As the United States rushed weapons to Mr. Maliki’s government late last year to help him fight off the jihadis, some analysts said American officials had not pushed the Iraqi prime minister hard enough to be more inclusive. “Maliki has done everything he could to deepen the sectarian divide over the past year and a half, and he still enjoys unconditional American support,” said Peter Harling, a senior analyst at the International Crisis Group. “The pretext is always the same: They don’t want to rock the boat. How is this not rocking the boat?”

      

The worsening violence in Iraq and Syria has spread into Lebanon, where a local Qaeda affiliate conducted a suicide bombing of the Iranian Embassy in Beirut in November, in an attack meant as revenge for Iran’s support of Mr. Assad.

      

More bombings followed, including one in a Hezbollah stronghold on Thursday, one day after the authorities announced the arrest of a senior Saudi-born Qaeda leader.

      

“All these countries are suffering the consequences of a state that’s no longer sovereign,” said Paul Salem, vice president of the Middle East Institute in Washington. “On the sectarian question, much depends on the Saudi-Iranian rivalry. Will these two powers accommodate each other or continue to wage proxy war?”

      

For the fighters on the ground, that question comes far too late. Amjad al-Ahmed, a Shiite fighter with a pro-government militia, said by phone from the Syrian city of Homs, “There is no such thing as coexistence between us and the Sunnis because they are killing my people here and in Lebanon.”