"When you have foreign keys, you refer to related identities with an identifier."
"What this results in is having to manipulate the ORM to get a database identifier by manually flushing the cache or doing a partial commit to get the actual database identifier."
This(and the sentences before it) basically saying if you have if you have a foreign key you have to first save the main object to get it's id. Id doesn't have to be responsibility of the database. In fact, I'd argue an identifier is an application layer concern. Orm could still solve this problem by simply cascading, or you can use one of the identity strategies that don't rely on database assigning it. You can generate them in either application layer or orm layer through identity generators.