Storm Clouds Over US Healthcare…

Storm Clouds Over US Healthcare…

Medical debt is a leading cause of bankruptcy in the United States.

- Overwhelmed by Medical Bills, and Finding Help on TikTok – NY Times

In a mad world, only the mad are sane.  

- Kurosawa

By JM Hamilton 1-26-2020

The battle lines are clearly drawn in the ongoing US healthcare fight, and at stake, trillions in annual revenue for an industry that syphons off nearly 20% of US GDP.

On one side of the war, we have:

·      Healthcare insurers (an industry well on its way to becoming a cartel, if it’s not already there);

·      Hospital chains (that rarely compete);

·      Big Pharma (thanks to patents -granted by gov- essentially monopolies);

·      Pharmacy benefit managers (PBMs… the blackhole of the entire healthcare scam);

·      Doctors (the holy of holies, in terms of special interest groups – who, after all, doesn’t love their doctor);

·      Consolidated pharmacy chains;

·      Predatory Private Equity is increasingly penetrating this industry & is well known for shock & awe billing;

·      Battalions of attorneys and lobbyist (who represent this multitrillion dollar leviathan); and of course, supporting this unholy alliance;

·      The United States Federal & State governments.

On the other side of the battle royal, stands alone:

·      The US consumer and your family.

This is no mere David and Goliath story…  at stake for America are the very lives of our citizens.  The life expectancy of Americans – unlike other Western democracies – is in decline.  Those other Western democracies, with increasing life expectancies, all have some form of universal care, with strict controls over any private sector involvement.  At stake for the US economy is trillions - in opportunity costs - sucked up by the healthcare industry that could be spent in other areas of the economy.  The healthcare storm speaks to the very priorities the United States elite hold dear: profits before the health of the nation’s children & families.

In a profits first society, it’s no surprise that healthcare debt is the number one cause of US bankruptcy.  The vampires who run the healthcare cartels & monopolies like to frame this as a “choice" argument… after all, we don’t want the state to takeover healthcare, because that would eliminate choice.  

But the reality on the ground is Americans, all too often, have one of two options:  one, forego care and die; or two, seek treatment and enter abject poverty and bankruptcy.  That’s one hell of a choice… perhaps some alternative K-Street lobbyist, or advisory firm, can create another lie for the healthcare industry?

At the heart of the US healthcare catastrophe, we have the classic case of capitalism’s & neoliberalism’s very failure; and more to the point, cartels and monopolies – authorized by the state – that often refuse to compete and have been granted the ability to charge whatever they want w/out sanction and little or no oversight.  When it comes to aforementioned healthcare industry, the various entities like to cast blame at one another for ever increasing costs. The drug cartel, frequently & often, likes to blame healthcare insurers and PBMs.  While the healthcare insurers and PBMs blame the ultra-greedy Big Pharma companies. And even though both entities, healthcare insurers & Big Pharma, seemingly, can’t control one another, they both hold incredible power over the US government, particularly the best legislative bodies money can buy.

There’s also the issue of dual systems, and redundancies on top of redundancies: with private insurance and public insurance (Medicare & Medicaid) systems.  The result: doctors spending more time on paperwork and arguing with insurance carriers than they spend with patients.

To top it all off: healthcare insurers and pharmacy benefit managers – despite the finger pointing engaged in w/ Big Pharma – have every incentive to see drug, doctor, and hospital prices escalate.  Call it a perverse incentive…  as medical costs grow, so do premiums (and so do the insurers’/PBMs’ profit markups and administrative loads). Higher medical costs translate into higher premiums, also translates into higher actuarial reserves, and presumably higher investment income (here, Fed and central bank actions - in regards interest rate suppression - may have driven healthcare premiums higher, as well).  And if the premium cannot be fully passed onto the US employer/employee… well, there’s always higher co-pays, deductibles, and annual deductibles, etc., etc.  (This abortion of a healthcare system also makes it far more difficult for US businesses and labor to compete in the global market, since our developed & emerging market competitors aren't dealing w/ a failed US healthcare model.)

Either way, the insurance carriers and PBMs (sometimes carriers own the PBM) mysteriously hit their profit goals, and C-Suite brass hit their targets, bonuses are paid, stock buybacks ensue, and Wall St receives its dividends and stock appreciation.  

See, the current US healthcare system makes the 1% very happy.  Everyone else can go die.  

And speaking of Wall St., superimposed across the US healthcare price gouging dynamic are the usual suspects:  M&A, industry consolidation, stock buybacks, financial engineering, vertical integration, free money furnished to the elite - for financial engineering & buyouts - courtesy of the Fed, and of course, evil incarnate: private equity.

So how to weather this perfect healthcare storm, and more importantly make US healthcare affordable for all… first, eliminate the middlemen, who have for decades failed to contain and control costs (which, last I heard, is the alleged social benefit of capitalism).  Of course, the middlemen are healthcare insurers and the pharmacy benefit managers.  These businesses - healthcare insurers & pharmacy benefit managers - are along for the ride in absorbing the astronomical annual mark ups of Big Pharma, doctors, and hospitals.  The end result: greater economy, & family, crippling insurance premiums. Pharmacy benefit managers and their nontransparent formulas, by which drug costs are allocated (and long known for kickbacks and other financial shenanigans), really need the boot.

By removing the middlemen, the American consumer loses an expensive cost center and a layer of superfluous overhead.  

That’s step one… step two is put the US government to work for the American people, instead of the criminal enterprise that is today’s healthcare industry.  This means freeing the Federal government – as is done in other Western democracies – to negotiate drug and healthcare costs directly with Big Pharma, doctors, and hospitals.   

Heh, if Big Pharma and hospitals want to run cartels and monopolies – that is, up until now, w/out checks and balances against price fixing & gouging – then they need to be, thoroughly: regulated; profit taking needs to be strictly monitored & subject to caps and a windfall profits tax; and in the case of Big Pharma, especially, a predetermined percentage of revenue – not profits but revenue – needs to be allocated to R&D.  All this will curtail the financial engineering, surrounding an industry, that only benefits the 1%.

With the middlemen eliminated, and w/ the government working for the consumer and the public – instead of cartels & monopolies – healthcare as a percentage of GDP should fall into line w/ that enjoyed by other Western democracies.  Thanks to improving technologies and AI, costs should travel down, not up.  The US also spends absurd sums on end-of-life care, vis a vis our peers... this bloodletting must cease.

At the end of the day, the current US healthcare system is sick and to use another metaphor, a dead man walking.  It’s time to euthanize the apex predators, and redundancies in the US healthcare system, and operate the industry as a public good for the benefit of the citizenry, in lieu of as a profit-making venture for an elite few.  The handful of bottom feeders at the top of the healthcare scheme - ride the storm and - prey upon the weak, the infirm, the mentally challenged, the desperate and the dying.

Americans are dying so robber barons, per the usual, can loot, pillage and rape the US citizenry, from the cradle to the grave. The business model of today’s US healthcare system is for patients to go deep into debt, not only so that they can pay for their initial medical care but pay and continue to pay (as interest & fees on medical debt accrue). 

It’s time for the US government to stop working for the financial & medical aristocracy and go to work for the American people.

Copyright JM Hamilton Publishing 2020

The End of the Innocence, Reprise

The End of the Innocence, Reprise

When "happily ever after" fails
And we've been poisoned by these fairy tales
The lawyers dwell on small details
Since daddy had to fly

O' beautiful, for spacious skies
But now those skies are threatening
They're beating plowshares into swords

For this tired old man that we elected king

Armchair warriors often fail
And we've been poisoned by these fairy tales
The lawyers clean up all details

Since daddy had to lie

-       The End of the Innocence, Don Henley

"Iraq, was the worst decision, going into the Middle East was the worst decision ever made in the history of our country ... We're not leaving unless they pay us back for it," he said of the joint air base.

-       Trump warns he may hit Iraq with sanctions, doubles down on Iran threat – Axios

By JM Hamilton (1-11-2020)

Pelosi is winning, and indirectly, showing how US foreign policy is conducted, via the president.

Despite Trump’s frequent pronouncements that impeachment will make him stronger for 2020 and rally his base, the POTUS has arguably come unglued.  Witness Trump’s assassination of a key foreign head of state, General Qasem Soleimani.  

Assassinating foreign heads of state is illegal, even by US standards (which increasingly is a very low moral bar, from which to conduct foreign policy).  But since Trump, and his GOP lackeys, believes he’s above the law – whether making up various stories in regards withholding Ukrainian foreign aid, or coming up with assorted rationalizations to justify the killing of Iran’s premier general – this latest attempt, by the administration, to distract from the president’s criminal conduct and impeachment headache, could actually land the US in WW3.

The president’s latest screwup demonstrates how far the House Speaker has dug underneath Trump’s exceptionally thin skin – not only w/ the impeachment hearings but subsequently, by exhibiting zero rush to release the articles to a gerrymandered Senate.  Trump’s ego demands redemption, and the Senate will kowtow.  Hence, aggravated & angered, it’s no accident that the narcissist-in-chief would roll out the Clinton playbook and start up a war w/ Iran (in a now all too familiar Wag the Dog strategy).  War w/ Iran, apparently, is what the president has been aiming for, since he tore up the Iranian nuclear agreement (and launched provocation after provocation upon the Iranian government and its people).  Talk about the apogee of folly: the Iranian people were rebelling against their government; now, thanks to Trump, they’ve rallied around the religious dictatorship.  

Despite Trump doing everything possible to bait Iran into war, we must not forget the fact that some of Israel’s top military leaders (as well as US Generals) supported the Iranian Nuclear agreement, negotiated by the Obama administration.  The logic being, anything that keeps nukes out of the hands of yet another Middle East actor is a good thing.  (Don’t get me wrong, JMH abhors any theocracy, especially the Christian fundamentalist Taliban that has successfully dictated US social mores, since the nation’s founding.)  

Trump, however, actually acted like (not unlike Obama), and said, he got it in 2016, when he called for an end to failed Middle East nation building.  Many will remember, Trump ran on pulling US troops out of the Middle East money pit.  Now that the American people are looking at one final year, w/in his first term, the POTUS has reneged on his foreign policy (FP) promises.  

Moreover, in the chaos that is Trump’s FP there is a constant theme.  That theme is in protecting the assets & interests of commercial enterprise in the Middle East, and around the globe: namely, Big Oil, the MIC, multinationals/donor class, and assorted despots & foreign governments.  As such Trump has done a complete reversal on his FP campaign pledges and doubled down on the deep state (the DOD, MIC, and intelligence/surveillance services - both domestic & foreign), which he used to decry, seemingly, on a daily basis.  

That America was founded upon rebelling against the very colonialism/empire/imperialism/state sponsored monopoly (see East India Trading Company and the Boston Tea Party) for which, Trump now stands...  appears completely lost on this president, his political base, & generations of proceeding presidents.  In short, America was initially formed to fight empire and imperialism’s inherent tyranny.  And yet, for decades, the US has become the very empire - with colonial and imperialist designs & machinations - that our forefathers rebelled against.

Trump, however, is just another in a long line of presidents, who lied to (or misled) the American people in order to drag them, yet again, into another bloodbath war.

·      Johnson – Gulf of Tonkin;

·      Bush deux – Iraq & WMD; 

·      Bush deux, again – Launching into endless war & nation building w/in Afghanistan, when the US should have held OBL, Pakistan, & the Saudis accountable for 9-11;

·      Obama – Waffling eight ways to Sunday on Syria, only to suck the US into another martial quagmire (while failing to hold those responsible for the formation of ISIS/ISIL, the US included, accountable).

Now, as Iran heats up, Trump can join the pantheon of presidents who dragged this country into war, or perpetuated existing wars they vowed to end, by telling lies and more lies.  To wit, and apparently the latest whopper, General Qasem Soleimani posed an “imminent threat” to the US.  Apparently, a lie so egregious that the government won’t release its findings – and justification for the assassination - to the American people, let alone the US Congress.  

Such irony that the Evangelical POTUS, who claims God is on his side, has forgotten some of the basic and most fundamental tenets of the Bible, like:

·      Thou shall not kill (including extra judicial killings & drone strikes, making the US government de facto judge, jury, and executioner);   

·      Thou shall not covet thy neighbor’s property (note, the Bible offers no caveats - or riders - for Iraqi and Iranian oil); 

·      And of course, the most famous of all, the Golden Rule: Love thy neighbor as thyself (last checked, the book makes no provision that this rule only applies for ultra-wealthy GOP campaign donors, who bow down to the president and stay at Trump resorts).  Then again, when has Trump used the Bible for anything else other than a political prop?

The reality is Trump is just continuing the US foreign policy that’s been in place, since WW2 (and yes, in no few instances, prior to the mid twentieth century…  see Manifest Destiny).  That is, the perpetuation of a bankrupting empire that threatens any nonwhite – resource rich – nation.  Resource rich nations (often referred to has EM or emerging markets) that don’t have the good fortune to possess nukes, & are nonwhite, are clearly under threat.  Twenty-first century colonialism defined.

When’s the last time the US attacked an Anglo-Saxon nation?  

When’s the last time the US attacked and occupied a nation with nukes?

If you want to see a fire breathing/earth scorching reason for nuclear proliferation, look no further than the US empire & FP.  

This was made abundantly clear when Trump told the Iraqi government to pound sand, when the Iraqi parliament ordered the US military out, in the wake of the Iranian general’s assassination on Iraqi soil.  So much for the falsehood and pretense that the US is a benevolent actor on the world stage, aiming only to spread peace, love, and understanding (and perhaps, a little bit of democracy along the way).

With that act, Trump ripped the benign mask off the bankrupt/festering visage that is the US empire…  and a US FP that serves exclusively, plutocrats, multinationals, & foreign governments.  Notice, the American people don’t even make the list, but the safety of same – the illusion of danger is created by nonstop fearmongering – is used to rationalize nearly ever US FP evil under the sun, from the aforementioned lies to extrajudicial drone killings.

It, the empire, was never about spreading democracy; it was never about decency or romanticized American virtues.  But rather, US foreign policy, since WW2, has been, predominately, all about the money.  Even the canard, often used during the height of the Cold War, that the US was just trying to contain communism, globally --- and more specific to today’s topic, in the 1950s, when the CIA overthrew Iran’s nascent democracy for oil & profits --- increasingly has the aroma of raw fertilizer. 

In regards FP, the US keeps doing stupid things, but this is what happens to bankrupt (fiscally & morally) empires.  History repeats.  Despite the many gifts handed to America by the Goddess above, we keep electing leaders, who perpetuate old fears, prejudices, myths about American exceptionalism, and the continued need for some 800 military bases around the globe (while nearly 20% of America’s children live in poverty).  Talk about a misplacement of priorities, blood stained hands, and $6.4 trillion added to the national debt… the US FP policy establishment should do themselves, America, & the world a favor, and march themselves to the Hague (and therein, await trial).  

We can thank Speaker Pelosi – perhaps by design or unintentionally - for driving Trump to such a manic state, that the president finally revealed the nation’s darkest FP secret.  Our heroic women & men, who serve, really are being abused - as security & speed bumps - by a global oligarchy …  a kleptocracy with delusions & hubris surrounding the need to maintain & perpetuate a fading US empire (in a vain attempt to control global markets).

If a money sucking empire & imperialism - and endless collateral damage - doesn’t make readers sick to their stomach, then perhaps we should all check to see if we have a pulse.

Copyright JM Hamilton Publishing 2020