Category Archives: Health Disease

Obamacare = O’boondoggle

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Everything has a consequence and there are many attached to Obamacare, many not in the mainstream knowledge base. Jobs and innovation in the United States is the latest victim of the law. The Supreme Court will decide the fate of the law under the King vs. Burwell case at the end of the month. A description of the case is found here. There are some key facts on the case that need to be known as noted here. Additional destructive consequences still loom in the future.

ObamaCare’s Anti-Innovation Effect

by Scott W. Atlas

Of the many unintended consequences of the Affordable Care Act, perhaps the least noticed is its threat to innovation. Although most discussions center on the law’s more immediate effects on hiring, insurance rates and access to doctors and care, attention should also be paid to its impact on U.S. research and development and health-care technology.

The overwhelming majority of the world’s health-care innovation occurs in the U.S. This includes ground-breaking drug treatments, surgical procedures, medical devices, patents, diagnostics and much more. Most of the funding for that innovation—about 71% of U.S. R&D investment—comes from private industry. A recent R&D Magazine survey of industry leaders in 63 countries ranked the U.S. No. 1 in the world for health-care innovation.

But that environment is changing. According to R&D Magazine and the research firm Battelle, growth of R&D spending in the U.S. from 2012 to 2014 averaged just 2.1%, down from an average of 6% over the previous 15 years. In that same 15-year period, Malaysia, Thailand, Singapore, South Korea, India and the European Union saw faster R&D spending growth than the U.S. China’s grew on average 22% per year.

The recent slowdown in R&D spending in the U.S. is in part caused by weak economic growth since the 2008 financial crisis. But the economy’s weakness itself has been exacerbated by the negative impact of new taxes and regulations under ObamaCare. According to Congressional Budget Office estimates, the new health-care law will levy more than $500 billion in new taxes over its first 10 years to help pay for insurance subsidies and Medicaid expansion. These new taxes include significant levies on key health-care industries, such as manufacturers of medical devices and drugs, and their investors.

As a result, small and large U.S. health-care technology companies are moving R&D centers and jobs overseas. The CEO of one of the largest health-care companies in America recently told me that the device tax his company paid last year exceeded his company’s entire R&D budget. Already a long list of companies—including Boston Scientific , Stryker and Cook Medical—have announced job cuts and plans to open new centers for R&D, manufacturing and clinical trials overseas.

The bureaucrats at the Food and Drug Administration are also hindering medical-technology and drug development. According to a 2010 survey of more than 200 medical-device companies by medical professor and entrepreneur Josh Makower and his colleagues at Stanford University, delays of approvals for new medical devices are now far longer in the U.S. than in many other developed countries. In the European Union—not exactly known for cutting through red tape—it takes on average seven months to gain approval for low- to moderate-risk devices. In the U.S., FDA approval for similar devices takes on average 31 months.

The 2011 PricewaterhouseCoopers Medical Technology Innovation Scorecard found that “the gap between innovation leaders and emerging economies is rapidly narrowing.” And that “although the United States will hold its lead, the country will continue to lose ground during the next decade.” It goes on to say that “China, India, and Brazil will experience the strongest gains during the next 10 years.”

Since the signing of the Affordable Care Act in 2010, private-equity investment in new U.S. health-care startups has also diminished. Annual capital investment has decreased to $41 billion in 2013 from $61 billion in 2011, according to quarterly reports by the accounting and audit firm McGladrey LLP. Similarly, the Silicon Valley-based law firm Wilson Sonsini Goodrich & Rosati reported in its semiannual Life Sciences Reports decreases from the first half of 2010 through the second half of 2013 in deal closings and capital raised for startups in biopharmaceuticals, medical devices and equipment, and diagnostics, with only a slight uptick in health-information systems investment.

Meanwhile, many of the best and brightest who come to the U.S. to study science, technology, engineering and math—the STEM subjects that are so crucial to innovation—are choosing to return to their home countries upon graduation. In 2008, a survey conducted by Vivek Wadhwa and his team of researchers at Duke, Harvard and the University of California found that only 6% of Indian, 10% of Chinese and 15% of European students expected to make America their permanent home. Much of this is Congress’s fault. Lawmakers have been slow to increase limits on H-1B visas for high-skill foreign workers. Pressure has been brought to bear on Congress to take action, but it may be too late for an increase in the visas to have much effect in health care, given the decline in R&D spending that would make use of their talents.

What can be done to reverse these damaging trends? First, strip back the heavy tax burdens that currently inhibit innovation, starting with repealing the Affordable Care Act’s $29 billion medical-device excise tax and the $80 billion tax on brand-name drugs. Change the tax code to add incentives for investment in early-stage medical technology and life-science companies, as well as for philanthropic gifts to academic institutions that promote tech entrepreneurs.

And finally, simplify processes for new device and drug approvals, so that the FDA becomes a favorable rather than an obstructionist environment for these life-saving and cost-saving discoveries. It’s a tall order, especially in today’s Washington. But America’s health—and wealth—depend on it.

*** Obama’s ‘King v. Burwell’ Speech Displayed The Very Ideological Fervor That Led Him To Break The Law

In a case called King v. Burwell, the Supreme Court will soon decide whether it agrees with two lower courts that President Obama is breaking the law by subjecting 57 million employers and individuals to illegal taxes, and spending the illegal proceeds to hide the cost of HealthCare.gov coverage from 6.5 million enrollees. Today the president delivered a speech designed to cow the Supremes into turning a blind eye to the law. Instead, he offered what for some is the missing piece of the King v. Burwell puzzle. He displayed the very ideological fervor that leads powerful people to break the rules.

“We have an obligation to put ourselves in our neighbor’s shoes, and to see the common humanity in each other,” the president said. Yet the president of the United States has an even more important obligation to “take Care that the Laws be faithfully executed.”  It’s right there in Article II, Section 3 of the U.S. Constitution, which President Obama swore to uphold. King v. Burwell is about his failure to meet that obligation.

 

U.S. Healthcare, a Manufactured Crisis

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Is Our Healthcare Crisis Man-Made?

by: Juliette Fildes

The media would have us believe that the healthcare crisis is us something that mysteriously arose out of a number of factors, including periods of economic crisis and an ever-growing deficit, yet what if the crisis was actually manufactured?

Americans are forced to buy insurance that doesn’t really protect them against their greatest health risks at all. There are many factors that reveal that insurance companies are favored, as are the pharmaceutical and medical industries. In the past, charity hospitals existed to attend to medical emergencies but over the past few decades, federal law has ensured that Americans can no longer receive unfunded care.

Healthcare should be about protecting the consumer, but as long as the medical industry is permitted to charge whatever price they deem fit for a procedure, there is little chance that Americans will pay the significantly lower prices paid by patients in other countries.

We must fight for the establishment of affordable alternatives to current hospitals and clinics; without a free market, it will be difficult for the situation to change for the better. Read about how the man-made health care crisis came about and discover how we can put an end to it.    

Understanding U.S. Healthcare Costs

Infographic provided by Calculators.org

Further Reading

 

A Federalized/Globalized Red Cross Fails

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NYT: Greater Port-au-Prince is pocked with buildings that are half-standing, half-collapsed, including the National Palace, which one cynical aid worker described as “the beggar’s stump,” an enduring symbol of Haiti’s need for help.

Nobody knows exactly how many are living inside such wreckage. A study for the United States Agency for International Development estimated that 65 percent of condemned properties had been reinhabited as of last year. And a yearlong building inspection tagged about 80,000 houses red: beyond repair.

The Red Cross has a long stellar reputation in countless missions and locations but when governments have a hand in operations, failure is common.

There are fundamental national and global services provided by the Red Cross and those operations are well oiled machines where great work is delivered, yet when the Red Cross is tasked to go outside their lane for services such as building houses, the machine breaks down.

Several years ago, there was a devastating earthquake in Haiti. Charity organizations worldwide stepped up in humanitarian aid to the small country yet today, conditions are essentially no better.

How the Red Cross Raised Half a Billion Dollars for Haiti ­and Built Six Homes

Even as the group has publicly celebrated its work, insider accounts detail a string of failures

The neighborhood of Campeche sprawls up a steep hillside in Haiti’s capital city, Port-au-Prince. Goats rustle in trash that goes forever uncollected. Children kick a deflated volleyball in a dusty lot below a wall with a hand-painted logo of the American Red Cross.

In late 2011, the Red Cross launched a multimillion-dollar project to transform the desperately poor area, which was hit hard by the earthquake that struck Haiti the year before. The main focus of the project — called LAMIKA, an acronym in Creole for “A Better Life in My Neighborhood” — was building hundreds of permanent homes.

Today, not one home has been built in Campeche. Many residents live in shacks made of rusty sheet metal, without access to drinkable water, electricity or basic sanitation. When it rains, their homes flood and residents bail out mud and water.

The Red Cross received an outpouring of donations after the quake, nearly half a billion dollars.

The group has publicly celebrated its work. But in fact, the Red Cross has repeatedly failed on the ground in Haiti. Confidential memos, emails from worried top officers, and accounts of a dozen frustrated and disappointed insiders show the charity has broken promises, squandered donations, and made dubious claims of success.

The Red Cross says it has provided homes to more than 130,000 people. But the actual number of permanent homes the group has built in all of Haiti: six.

After the earthquake, Red Cross CEO Gail McGovern unveiled ambitious plans to “develop brand-new communities.” None has ever been built.

Aid organizations from around the world have struggled after the earthquake in Haiti, the Western Hemisphere’s poorest country. But ProPublica and NPR’s investigation shows that many of the Red Cross’s failings in Haiti are of its own making. They are also part of a larger pattern in which the organization has botched delivery of aid after disasters such as Superstorm Sandy. Despite its difficulties, the Red Cross remains the charity of choice for ordinary Americans and corporations alike after natural disasters.

One issue that has hindered the Red Cross’ work in Haiti is an overreliance on foreigners who could not speak French or Creole, current and former employees say.

In a blistering 2011 memo, the then-director of the Haiti program, Judith St. Fort, wrote that the group was failing in Haiti and that senior managers had made “very disturbing” remarks disparaging Haitian employees. St. Fort, who is Haitian American, wrote that the comments included, “he is the only hard working one among them” and “the ones that we have hired are not strong so we probably should not pay close attention to Haitian CVs.”

The Red Cross won’t disclose details of how it has spent the hundreds of millions of dollars donated for Haiti. But our reporting shows that less money reached those in need than the Red Cross has said.

Lacking the expertise to mount its own projects, the Red Cross ended up giving much of the money to other groups to do the work. Those groups took out a piece of every dollar to cover overhead and management. Even on the projects done by others, the Red Cross had its own significant expenses – in one case, adding up to a third of the project’s budget.

In statements, the Red Cross cited the challenges all groups have faced in post-quake Haiti, including the country’s dysfunctional land title system.

“Like many humanitarian organizations responding in Haiti, the American Red Cross met complications in relation to government coordination delays, disputes over land ownership, delays at Haitian customs, challenges finding qualified staff who were in short supply and high demand, and the cholera outbreak, among other challenges,” the charity said.

When the earthquake struck Haiti in January 2010, the Red Cross was facing a crisis of its own. McGovern had become chief executive just 18 months earlier, inheriting a deficit and an organization that had faced scandals after 9/11 and Katrina.

The group said it responded quickly to internal concerns, including hiring an expert to train staff on cultural competency after St. Fort’s memo. While the group won’t provide a breakdown of its projects, the Red Cross said it has done more than 100. The projects include repairing 4,000 homes, giving several thousand families temporary shelters, donating $44 million for food after the earthquake, and helping fund the construction of a hospital.

“Millions of Haitians are safer, healthier, more resilient, and better prepared for future disasters thanks to generous donations to the American Red Cross,” McGovern wrote in a recent report marking the fifth anniversary of the earthquake.

In other promotional materials, the Red Cross said it has helped “more than 4.5 million” individual Haitians “get back on their feet.”

It has not provided details to back up the claim. And Jean-Max Bellerive, Haiti’s prime minister at the time of the earthquake, doubts the figure, pointing out the country’s entire population is only about 10 million.

“No, no,” Bellerive said of the Red Cross’ claim, “it’s not possible.” When the earthquake struck Haiti in January 2010, the Red Cross was facing a crisis of its own. McGovern had become chief executive just 18 months earlier, inheriting a deficit and an organization that had faced scandals after 9/11 and Katrina.

Inside the Red Cross, the Haiti disaster was seen as “a spectacular fundraising opportunity,” recalled one former official who helped organize the effort. Michelle Obama, the NFL and a long list of celebrities appealed for donations to the group.

The Red Cross kept soliciting money well after it had enough for the emergency relief that is the group’s stock in trade. Doctors Without Borders, in contrast, stopped fundraising off the earthquake after it decided it had enough money. The donations to the Red Cross helped the group erase its more-than $100 million deficit.

The Red Cross ultimately raised far more than any other charity.

A year after the quake, McGovern announced that the Red Cross would use the donations to make a lasting impact in Haiti.

We asked the Red Cross to show us around its projects in Haiti so we could see the results of its work. It declined. So earlier this year we went to Campeche to see one of the group’s signature projects for ourselves.

Street vendors in the dusty neighborhood immediately pointed us to Jean Jean Flaubert, the head of a community group that the Red Cross set up as a local sounding board.

Sitting with us in their sparse one-room office, Flaubert and his colleagues grew angry talking about the Red Cross. They pointed to the lack of progress in the neighborhood and the healthy salaries paid to expatriate aid workers.

“What the Red Cross told us is that they are coming here to change Campeche. Totally change it,” said Flaubert. “Now I do not understand the change that they are talking about. I think the Red Cross is working for themselves.”

The Red Cross’ initial plan said the focus would be building homes — an internal proposal put the number at 700. Each would have finished floors, toilets, showers, even rainwater collection systems. The houses were supposed to be finished in January 2013.

None of that ever happened. Carline Noailles, who was the project’s manager in Washington, said it was endlessly delayed because the Red Cross “didn’t have the know-how.”

Another former official who worked on the Campeche project said, “Everything takes four times as long because it would be micromanaged from DC, and they had no development experience.”

Shown an English-language press release from the Red Cross website, Flaubert was stunned to learn of the project’s $24 million budget — and that it is due to end next year.

“Not only is [the Red Cross] not doing it,” Flaubert said, “now I’m learning that the Red Cross is leaving next year. I don’t understand that.” (The Red Cross says it did tell community leaders about the end date. It also accused us of “creating ill will in the community which may give rise to a security incident.”)

The project has since been reshaped and downscaled. A road is being built. Some existing homes have received earthquake reinforcement and a few schools are being repaired. Some solar street lights have been installed, though many broke and residents say others are unreliable.

The group’s most recent press release on the project cites achievements such as training school children in disaster response.

The Red Cross said it has to scale back its housing plans because it couldn’t acquire the rights to land. No homes will be built.

Other Red Cross infrastructure projects also fizzled.

In January 2011, McGovern announced a $30 million partnership with the U.S. Agency for International Development, or USAID. The agency would build roads and other infrastructure in at least two locations where the Red Cross would build new homes.

But it took more than two and a half years, until August 2013, for the Red Cross just to sign an agreement with USAID on the program, and even that was for only one site. The program was ultimately canceled because of a land dispute.

A Government Accountability Office report attributed the severe delays to problems “in securing land title and because of turnover in Red Cross leadership” in its Haiti program.

Other groups also ran into trouble with land titles and other issues. But they also ultimately built 9,000 homes compared to the Red Cross’ six.

Asked about the Red Cross’ housing projects in Haiti, David Meltzer, the group’s general counsel and chief international officer, said changing conditions forced changes in plans. “If we had said, ‘All we’re going to do is build new homes,’ we’d still be looking for land,” he said.

The USAID project’s collapse left the Red Cross grasping for ways to spend money earmarked for it.

“Any ideas on how to spend the rest of this?? (Besides the wonderful helicopter idea?),” McGovern wrote to Meltzer in a November 2013 email obtained by ProPublica and NPR. “Can we fund Conrad’s hospital? Or more to PiH[Partners in Health]? Any more shelter projects?” Read much more here.

 

Hillary Fails with Myanmar, 1000’s Coming Here

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Both Hillary Clinton and Barack Obama have visited Burma (Myanmar), Hillary in 2011 and Barack in 2014. Clearly, this country is not a diplomatic achievement for either of them.

The U.S. has not had any contact or relations with Myanmar in 50 years.

The promise of a free and democratic Myanmar is rapidly receding as sectarian violence escalates and the government backslides on a number of past reforms. That’s causing genuine alarm on Capitol Hill among lawmakers from both parties. The House Foreign Affairs Committee unanimously passed a resolution this week calling on Myanmar’s government to respect the human rights of all minority groups in the country and end the persecution of the Rohingya people, an essentially stateless and largely Muslim ethnic group that has been singled out by both Rakhine Buddhists and the government of Myanmar.

“As the government of Burma transitions from decades-long military rule to a civilian government, it is important to hold them accountable for persistent human rights abuses,” New York Congressman Eliot Engel, the most senior Democrat on the House panel, said Tuesday.
What happens in Myanmar has implications for Clinton as she prepares for a potential presidential bid for the White House in 2016. Until now, the Myanmar portfolio has been widely viewed as the “one clear-cut triumph” of her tenure as secretary of state — a tenure in danger of being viewed as underwhelming and overly cautious when compared to that of her successor, John Kerry, who has taken on the Gordian knot of the Mideast peace process.

Now, as the civilian regime that replaced Myanmar’s military junta embraces increasingly brutal tactics against Muslim minority populations, the jewel in the crown of Clinton’s tenure risks vanishing into thin air. “Things have gone from bad to worse,” said Tom Andrews, president of United to End Genocide, a group that monitors violence between Buddhists and Muslims in the country.

Since Oct. 1, the U.S. has resettled more than 1,000 Rohingya

(WASHINGTON) — The United States is willing to take in Rohingya refugees as part of international efforts to cope with Southeast Asia’s stranded boat people, the State Department said Wednesday.

Spokeswoman Marie Harf said that the U.S. is prepared to take a leading role in any multicountry effort, organized by the United Nations refugee agency, to resettle the most vulnerable refugees.

BANGKOK (AP) — The decision by Indonesia and Malaysia to give temporary shelter to thousands of migrants stranded at sea appears to have defused a potential Southeast Asian humanitarian catastrophe, but the root causes of the crisis remain. Here’s a look at still-unanswered questions surrounding the Rohingya Muslim migrants who are persecuted at home in Myanmar and have found scant welcome anywhere else.
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A FIRST STEP, BUT WHAT’S NEXT?
The Indonesian-Malaysian offer to shelter migrants for up to a year was hailed as a breakthrough, and marks a major reversal after navies from the two countries and Thailand pushed boatloads of desperate migrants away. But it is just the first of many steps needed to solve the crisis. Groups such as the International Organization of Migration say time is running out for vessels still at sea and call for countries to urgently launch operations to find and rescue drifting boats believed to be crammed with people in need of food, water and medical treatment.
HOW MANY MIGRANTS ARE THERE?
Nobody knows, but the U.N. refugee agency UNHCR estimated as of Thursday that more than 3,000 could still be at sea.
“Having said that, there could be more that we don’t know about,” Bangkok-based UNHCR spokeswoman Vivian Tan said.
When the crisis first came to international attention early this month, aid agencies estimated 6,000 or more migrants were abandoned on boats after a regional crackdown on human trafficking prompted smugglers to flee. Since then more than 3,000 ethnic Rohingya Muslims and Bangladeshis have landed in Indonesia, Malaysia and Thailand.
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HOW MANY BOATS ARE AT SEA?
This is another mystery. Malaysian Prime Minister Najib Razak tweeted Thursday that he had ordered the navy and coast guard to comb the sea to look for stranded migrants, becoming the first country to announce it will actively search for refugees instead of waiting for them to wash up on the region’s shores. Navy chief Abdul Aziz Jaafar said it has deployed four vessels, and three helicopters and three other vessels are on standby. Thailand and Indonesia have not announced any similar operations to search their sections of the Andaman Sea. The countries have also expressed concerns that offering temporary shelter could encourage an exodus of even more refugees.
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WHAT HAPPENS IN A YEAR?
Malaysia and Indonesia have made clear that their offer to house migrants is temporary. Both said their hospitality expires in one year. It is unclear what happens after that. Indonesian Vice President Jusuf Kalla said his government is ready to shelter Rohingya refugees who fled Myanmar, while Bangladeshis would be sent back home. “A year is (the) maximum,” he said. “There should be international cooperation.” Malaysia has set the same time limit, saying in a joint statement that the international community must take responsibility for repatriating or resettling the migrants in third countries within that period.
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“THE ROOT CAUSE” AND THE R-WORD
Southeast Asian governments say the key to solving the migrant crisis is addressing the “the root cause” — which is code for Myanmar. The Rohingya Muslim minority has been boarding rickety boats to escape Myanmar for years due to state-sanctioned discrimination in the predominantly Buddhist country where they are openly despised. They are denied citizenship, have limited access to education and medical care and cannot practice their religion freely. The Rohingya have faced repeated outbreaks of violence, the latest of which have been occurring since 2012, with hundreds killed and 140,000 displaced. So they try to flee abroad, most hoping to reach Muslim-majority Malaysia in search of jobs and security. Myanmar has said it does not want to be blamed for the problem but agreed Thursday to join regional talks on the crisis to be held in Bangkok next week. Observers are eager to see how the countries will discuss the issue, given the Myanmar government’s distaste for the word “Rohingya,” which is taboo in Myanmar, where they are referred to as Bengalis — migrants from neighboring Bangladesh — even though many have lived in Myanmar for generations.

The Buzzwords are Refugee and Asylum

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UN pushes for migrants to be called refugees

In part: SAN JOSE, Costa Rica (AP) — United Nations officials are pushing for many of the Central Americans fleeing to the U.S. to be treated as refugees displaced by armed conflict, a designation meant to increase pressure on the United States and Mexico to accept tens of thousands of people currently ineligible for asylum.

Officials with the U.N. High Commissioner for Refugees say they hope to see movement toward a regional agreement on that status Thursday when migration and interior department representatives from the U.S., Mexico, and Central America meet in Nicaragua. The group will discuss updating a 30-year-old declaration regarding the obligations that nations have to aid refugees.

Sure there are thousands and in some cases millions that have fled their home country over brutal regimes, civil wars, disease, lack of economic opportunity and to perhaps incite attacks and terrorism in other countries.

U.N. Calls on Western Nations to Shelter Syrian Refugees

With Syria’s neighbors increasingly shutting their borders to refugees and thousands trying to cross the Mediterranean Sea in search of safety, the war in Syria is creating the worst global refugee crisis in decades, putting new pressure on the United States and other Western countries to open their doors — and in turn, prompting domestic political backlash.

Not since the wave of people who fled Southeast Asia after the war in Vietnam have the world’s industrialized countries been under such intense pressure to share the burden of taking in refugees, experts say. Nor has the task of offering sanctuary been so politically fraught.

The United States is scheduled to take in its largest group of Syrian refugees to date — up to 2,000 by the fall of this year, compared with a total of about 700 since the civil war in Syria began four years ago, according to the State Department.

Here is a disturbing fact, the work that the United Nations High Commissioner for Refugees division does for refugees and asylees does NOT collaborate with U.S. agencies as they claim, unless it is on an exceptional basis. They maintain a database of applications and fingerprints that is not integrated or actually shared for background checks.

UNHCR seeks to contribute to informed decision-making and public debate by providing accurate, relevant and up-to-date statistics. As such, the Statistical Online Population Database provides data and trends on the “Population of concern to UNHCR”: refugees, asylum-seekers, returned refugees, internally displaced persons (IDPs) protected/assisted by UNHCR, returned IDPs, stateless persons, and others of concern to UNHCR, in more than 180 countries.

In a single electronic platform, UNHCR’s Statistical Online Population Database is bringing together for analysis and comparison standardized data on UNHCR’s population of concern at country, regional, and global levels.

The database is work-in-progress and will be updated on an ongoing basis. Currently, data up to 31 December 2012 can be downloaded from the Statistical Online Population Database. Some of the statistics contained in the Statistical Online Population Database, in particular the ones for 2012 should be considered provisional and subject to change. Some data in the database may differ from statistics published previously due to retroactive changes or the inclusion of previously unavailable data.

 

‘All data refer to the number of individuals with the exception of asylum-seekers in the United States of America, where figures are available only for the number of cases (which may include several individuals) submitted to the United States Department of Homeland Security (DHS). However, applications submitted to the Executive Office of Immigration Review (EOIR) of the United States department of Justice are recorded as individuals.’

‘A combination of armed conflict, deterioration of security or humanitarian situation and human rights concerns in a number of countries – notably the Syrian Arab Republic – have been among the main reasons for the sharp increase in the number of asylum-seekers registered among the main reasons for the sharp increase in the number of asylum-seekers registered among industrialized countries during 2014.’  Full document here. (It is a must read).

Sample application for asylum:

Note the cost of security weakness and lack of full collaboration:

Fifteen of the 19 hijackers were Saudi nationals. There were significant security weaknesses in the Saudi government’s issuance of Saudi passports in the period when the visas to the hijackers were issued. Two of the Saudi 9/11 hijackers may have obtained their passports legitimately or illegitimately with the help of a family member who worked in the passport office.