Showing posts with label health care industry. Show all posts
Showing posts with label health care industry. Show all posts

Monday, January 14, 2013

The four business gangs that run the US

Ross Gittins
The Sydney Morning Herald's Economics Editor


IF YOU'VE ever suspected politics is increasingly being run in the interests of big business, I have news: Jeffrey Sachs, a highly respected economist from Columbia University, agrees with you - at least in respect of the United States.

In his book, The Price of Civilisation, he says the US economy is caught in a feedback loop. ''Corporate wealth translates into political power through campaign financing, corporate lobbying and the revolving door of jobs between government and industry; and political power translates into further wealth through tax cuts, deregulation and sweetheart contracts between government and industry. Wealth begets power, and power begets wealth,'' he says.

Sachs says four key sectors of US business exemplify this feedback loop and the takeover of political power in America by the ''corporatocracy''.

First is the well-known corporate military-industrial complex. ''As [President] Eisenhower famously warned in his farewell address in January 1961, the linkage of the military and private industry created a political power so pervasive that America has been condemned to militarisation, useless wars and fiscal waste on a scale of many tens of trillions of dollars since then,'' he says.

Second is the Wall Street-Washington complex, which has steered the financial system towards control by a few politically powerful Wall Street firms, notably Goldman Sachs, JPMorgan Chase, Citigroup, Morgan Stanley and a handful of other financial firms.

These days, almost every US Treasury secretary - Republican or Democrat - comes from Wall Street and goes back there when his term ends. The close ties between Wall Street and Washington ''paved the way for the 2008 financial crisis and the mega-bailouts that followed, through reckless deregulation followed by an almost complete lack of oversight by government''.

Third is the Big Oil-transport-military complex, which has put the US on the trajectory of heavy oil-imports dependence and a deepening military trap in the Middle East, he says.

''Since the days of John D. Rockefeller and the Standard Oil Trust a century ago, Big Oil has loomed large in American politics and foreign policy. Big Oil teamed up with the automobile industry to steer America away from mass transit and towards gas-guzzling vehicles driving on a nationally financed highway system.''

Big Oil has consistently and successfully fought the intrusion of competition from non-oil energy sources, including nuclear, wind and solar power.

It has been at the side of the Pentagon in making sure that America defends the sea-lanes to the Persian Gulf, in effect ensuring a $US100 billion-plus annual subsidy for a fuel that is otherwise dangerous for national security, Sachs says.

''And Big Oil has played a notorious role in the fight to keep climate change off the US agenda. Exxon-Mobil, Koch Industries and others in the sector have underwritten a generation of anti-scientific propaganda to confuse the American people.''

Fourth is the healthcare industry, America's largest industry, absorbing no less than 17 per cent of US gross domestic product.

''The key to understanding this sector is to note that the government partners with industry to reimburse costs with little systematic oversight and control,'' Sachs says. ''Pharmaceutical firms set sky-high prices protected by patent rights; Medicare [for the aged] and Medicaid [for the poor] and private insurers reimburse doctors and hospitals on a cost-plus basis; and the American Medical Association restricts the supply of new doctors through the control of placements at medical schools.

''The result of this pseudo-market system is sky-high costs, large profits for the private healthcare sector, and no political will to reform.''

Now do you see why the industry put so much effort into persuading America's punters that Obamacare was rank socialism? They didn't succeed in blocking it, but the compromised program doesn't do enough to stop the US being the last rich country in the world without universal healthcare.

It's worth noting that, despite its front-running cost, America's healthcare system doesn't leave Americans with particularly good health - not as good as ours, for instance. This conundrum is easily explained: America has the highest-paid doctors.

Sachs says the main thing to remember about the corporatocracy is that it looks after its own. ''There is absolutely no economic crisis in corporate America.

''Consider the pulse of the corporate sector as opposed to the pulse of the employees working in it: corporate profits in 2010 were at an all-time high, chief executive salaries in 2010 rebounded strongly from the financial crisis, Wall Street compensation in 2010 was at an all-time high, several Wall Street firms paid civil penalties for financial abuses, but no senior banker faced any criminal charges, and there were no adverse regulatory measures that would lead to a loss of profits in finance, health care, military supplies and energy,'' he says.

The 30-year achievement of the corporatocracy has been the creation of America's rich and super-rich classes, he says. And we can now see their tools of trade.

''It began with globalisation, which pushed up capital income while pushing down wages. These changes were magnified by the tax cuts at the top, which left more take-home pay and the ability to accumulate greater wealth through higher net-of-tax returns to saving.''

Chief executives then helped themselves to their own slice of the corporate sector ownership through outlandish awards of stock options by friendly and often handpicked compensation committees, while the Securities and Exchange Commission looked the other way. It's not all that hard to do when both political parties are standing in line to do your bidding, Sachs concludes.

Fortunately, things aren't nearly so bad in Australia. But it will require vigilance to stop them sliding further in that direction.

Saturday, December 8, 2012

The Plutocrats and the Placeholder President

*Sigh* Yes, the Democrats suck just as hard ads the Republicans do. Obama will bend over for the Republicans' bullshit 'the sky is falling' austerity and cut deep gouges out of social security and other important programs even though it's unnecessary. (Hint) just let the Bush tax cuts expire, end the wars, bring the troops home, and cut the military budget. A conventional military is outdated and unneeded in this age of warfare. Problem solved.--jef

+++++++++++

Austerity, Obama-Style
by ROB URIE


In Quentin Tarantino’s movie ‘Jackie Brown’ the illegal arms dealer played by Samuel L. Jackson laughs as he recounts the sales slogan used by the manufacturer of the ‘Tech Nine’ semi-automatic weapon—“the most popular gun in American crime, like they proud of that shit.” Mere weeks after Barack Obama was re-elected, farce is added to tragedy with his supporters complaining that while the Republican proposal to cut Federal government spending and social insurance programs is all bluster and misdirection, their guy (Mr. Obama) has a real plan to do so—like they’re proud of that shit. Thanks just the same folks, but I’ll take the fake plan.

The moment when the New Deal as we knew it became history by bi-partisan consensus was a long time coming. A trans-generational core of inherited wealth and right-wing cranks has been trying to undo the New Deal since Social Security became fact in 1935. Ronald Reagan echoed anti-New Deal cries of ‘socialism,’ first as a paid spokesperson of the AMA (American Medical Association) against the implementation of Medicare and Medicaid, and later through his racist caricature of the ‘welfare queen’ living fat on public largesse. Despite the fact that Social Security is an insurance program paid for by its participants, much the same as private insurance but without the executive looting, the charge has always been of an undeserving public sucking on “a milk cow with 310 million tits.”

Democrats first joined the effort in earnest with Bill Clinton’s plan to partially privatize Social Security. The idea was to let our good friends on Wall Street manage a bit of the money for us, for a fee of course. That proposal faltered when Mr. Clinton was impeached. As was the fashion in European Central Bank circles in 2009, Mr. Obama took up the torch of fiscal austerity of his own initiative by creating his very own deficit commission. This should have come as no surprise to anyone paying attention—Mr. Obama publicly stated his intention to ‘fix’ Social Security, Medicare and Medicaid when he allied himself with the Wall Street friendly ‘Hamilton Project’ in 2006.

(In Between Democrats Clinton and Obama came Republican George W. Bush who also tried to partially privatize Social Security. Mr. Bush quickly retreated when he saw the depth of political opposition to the effort. As the saying goes, it takes a Democrat to gut the New Deal).

For the uninitiated, the Hamilton Project is the demon spawn of the Clintonite contingent of the Democratic Party led by former Treasury Secretary and disgraced Citicorp Board member Robert Rubin. The kindest take on the Wall Street lootocracy populating the organization is that they don’t know how money is created (the U.S. has a fiat currency), making them morons. The less kind take is that their greed has no limits. Whichever is more applicable (neither is mutually exclusive), if one group of Wall Street politicos bears responsibility for the economic catastrophe that an unregulated Wall Street has visited upon the world in recent years, the Hamilton Project is it.

Never one to let the wish list of the entrenched plutocracy go unfulfilled, Barack Obama chose Democrat, inheritance baby and Wall Street ‘welfare queen’ Erskine Bowles, to co-head his (Mr. Obama’s) very own ‘deficit commission.’ Of course Mr. Obama knew nothing of Mr. Bowles experience leading the earlier effort to (partially) privatize Social Security when he appointed him to the position. In his speech welcoming the Hamilton Project into existence (link above), Mr. Obama additionally described himself as an enthusiastic ‘free trader’ committed to globalization. And of current relevance, he ascribed fiscal ‘discipline’ as the proximate cause of the Clinton economic ‘boom,’ deftly ignoring the greatest stock market bubble (as measured by price / earnings ratio—twice that of 1929) in human history.

One could be forgiven for believing that Mr. Obama, or any other placeholder Democrat for that matter, has something of a point regarding ‘entitlement’ spending if his words are the only that are listened to. People in the U.S. are living longer and a strapped citizenry simply cannot afford the lavish promises made in an earlier age of plenty goes the toxic bullshit. By leaving out class divisions this formulation simply furthers the shift in social resources upward from poor to rich. As economist Paul Krugman has effectively argued, the rich are living longer and the working class and poor are not. Additionally, unless those in the ‘gap’ years between the old and new eligibility ages for Medicare simply forgo health care, the change will force them to purchase private health insurance under whatever terms the ‘market’ will bear. But of course, private insurance companies always act in the public interest when people’s backs are to the wall.

At the end of the day this charade is a struggle over social resources. The ‘too-big-to-fail’ guarantee of the banks, which is the only reason why insolvent, predatory Wall Street remains in business, is an entitlement program for connected bankers—for which they pay nothing. The bloated, murderous, military industry that lobbies the U.S. into unnecessary wars for their own benefit and that of corporate welfare receiving multi-national corporations is an entitlement program. And the aforementioned corporate welfare that perpetuates the puffy, gray corporate executives behind the ‘Fix the Debt’ campaign for whom official Washington now apparently works is an entitlement program. So if we want to have a public ‘discussion’ of entitlement spending, by all means let’s do so.

And as far as entitlement programs go, government guarantees and redistribution schemes are only a starting point. As economist Dean Baker has argued, America’s professional class retains monopoly pricing power for their labor through trade restrictions while the working class has been thrown to the wolves. The Federal Reserve has spent upwards of four trillion dollars to entitle the fortunes of the investor class since 2008, returning the already rich to their former wealth. And corporate executives have entitled themselves to robber-baron sized paychecks through the combination of trade policies that have so reduced the fortunes of the working class, tax abatements that have bled the public weal for some forty years, and through the financialization of the economy that has favored, along with Federal Reserve policies, the financial wealth that executives pay themselves with. All of these and more are entitlement programs that have redistributed ever more social wealth from the working class and poor up to the Washington establishment’s beloved plutocrats.

But the trillions of dollars in health care expenditures that we deadbeats intend to sponge off of the blessedly deserving rich is the really big money, right? When Erskine Bowles wakes with night terrors, it is my herniated disk and your gall bladder operation that will sink the country, right? The U.S. pays 30% – 50% more per person than other first world nations for health care that is of substantially lower quality because we have a largely private health care system. Were the system totally public—Medicare for all, we would realize some material proportion of these savings and most likely vastly improve the health of the citizenry. Were the monopoly entitlements of doctors and pharmaceutical companies reduced or eliminated, further cost reductions would be realized. So quickly, who are the main beneficiaries of America’s ‘bloated’ entitlement programs?

As Mr. Obama will offer, his proposals include reducing payments to health care providers and negotiating lower prices for prescription drugs. However, the private health care system in America is the global leader in shifting costs to those with the least social power. Cuts in public payments to private providers have a long history of popping up elsewhere, as health insurer profits will attest. For instance, Mr. Obama’s health care ‘reform’ program, the ACA (Affordable Care Act), requires insurance companies to spend fixed percentages of their revenues providing health care or to rebate the difference to their customers. As corporations constitute the majority of their ‘customers,’ corporations apparently now have an incentive to shop around for health insurers that provide the lowest proportion of health care to their employees to maximize the rebates. (The central business of insurers was already to provide the appearance of coverage without providing actual coverage). And health insurance providers can gain market share, if at lower margins, by doing exactly this. Welcome to America.

Last, any honest discussion of ‘entitlements’ would be to the benefit of America’s poor and working classes. The globetrotting plutocrats behind current ‘discussions’ see working class product as their due. This is the very definition of entitlement. We can either disabuse them of this notion or roll over and play dead. Or better yet, roll over and vote Democrat.

Wednesday, October 17, 2012

America R.I.P.

October 16, 2012 | Paul Craig Roberts
During the second half of the 20th century the United States was an opportunity society. The ladders of upward mobility were plentiful, and the middle class expanded. Incomes rose, and ordinary people were able to achieve old-age security.

In the 21st century the opportunity society has disappeared. Middle class jobs are scarce. Indeed, jobs of any kind are scarce. To stay even with population growth from 2002 through 2011, the economy needed about 14 million new jobs. However, at the end of 2011 there were only 1 million more jobs than in 2002. http://www.bls.gov/webapps/legacy/cesbtab1.htm 
 
Only 426,000 of these jobs are in the private sector. The bulk of the net new jobs consist of waitresses and bartenders and health care and social assistance. According to the Bureau of Labor Statistics, over the 9 years, employment for waitresses and bartenders increased by 1,188,000. Employment in health care and social assistance increased 3,087,000. These two categories accounted for 1,000% of the net private sector job growth.

As for manufacturing jobs, they not only did not grow with the population but declined absolutely. During these nine years, 3.5 million middle class manufacturing jobs were lost. 

Over the entire nine years, only 48,000 new jobs were created for architects and engineers.

In the 21st century the US economy has been able to create only a few new jobs and these are in lowly paid domestic services that cannot be offshored, such as waitresses and bartenders. 

The lack of jobs, especially high value-added, high productivity jobs, is the reason real median household income has declined and the distribution of income has worsened. Without rising real household income, there cannot be a consumer economy. 

In the early years of the 21st century, the Federal Reserve substituted a rise in consumer debt to drive the economy in place of the missing rise in consumer incomes. Low interest rates drove up housing prices, and people refinanced their mortgages and spent the equity. The Federal Reserve kept the economy alive by loading up consumers with debt that housing prices and consumer incomes would soon be unable to support.

When debt and real estate prices reached unsustainable levels, the bubble popped, and the ongoing financial crisis was upon us.

The cause of all of the problems is the offshoring of Americans’ jobs. When jobs are moved offshore, consumers’ careers and incomes, and the GDP and payroll and income tax base associated with those jobs, go with them. When the goods and services produced for American markets by offshored labor are brought into the US to be sold, the trade deficit rises, and downward pressure is put on the dollar, pushing up domestic inflation. (On October 12, statistician John Williams (shadowstats.com) reported that “third-quarter wholesale inflation jumped to an annualized 6.2%.”)

Jobs offshoring is driven by Wall Street, “shareholder advocates,” the threat of takeovers, and by large retailers, such as Walmart. By cutting labor costs, profits go up.It is that simple. However, as a result of sending American jobs to cheap labor countries, US consumer incomes go down. The end result is to destroy the domestic consumer market. What would have been US consumer income growth becomes instead profit growth for US corporations.

Keynesian economists use in their textbooks the example of how the aggregate effect of individual saving could be the opposite of the effect intended by the individuals. Whereas each saver seeks to improve his position by building wealth, in the aggregate saving could exceed investment, resulting in a decline in aggregate demand and a fall in income for all. Offshoring has the same logic. Each corporation can expect to gain more profits from moving US jobs offshore, but the aggregate effect is a fall in American consumer incomes and a reduction in the American consumer market.

I have told this story many times. But policymakers, the media, and economists seem unable to connect the dots.

Jobs offshoring has substantial implications for Social Security and Medicare. The US has the least adequate social safety net of any developed country. The two major components of the US social safety net are Social Security and Medicare for the elderly. Social Security and Medicare are financed by a payroll tax. The combined tax is 15.3% of payrolls. For the past quarter of a century the Social Security portion of the payroll tax has built up a surplus of over $2 trillion. Recently, the Medicare portion began running in the red.

Right-wing Republicans, free market ideologues, and the left-wing have all indoctrinated themselves with incorrect beliefs about Social Security and Medicare. The right-wing claims that a safety net financed with 15.3% of payrolls is a “Ponzi scheme” and an “unfunded liability.” If that is the case, then so are veterans benefits, military pensions, and federal pensions, all of which are financed by the income tax, the basis for the payroll tax. 

The left-wing claims that the rich do not pay high enough payroll taxes, because the income subject to Social Security payroll tax is capped at about $110,000. But the benefits are also capped. Social Security is not supposed to be an income redistribution scheme from rich to poor, and it is not supposed to be a pension system for the rich. The pension paid is supposed to correlate with the pre-retirement income level of the retiree. Those who had higher wages or salaries and consequently paid more in payroll taxes receive a larger Social Security check than those who had lower wages and salaries and paid less payroll taxes, although there is favoritism toward the lower income earners who receive proportionally more in respect to their payroll taxes than higher income earners.

There is no cap on income subject to the Medicare portion of the payroll tax. Moreover, Medicare charges a Medicare Part B premium that is deducted from the Social Security monthly check. In addition, there is a further Part B premium based on retirement age income. For example, someone working beyond retirement age and making $250,000 per year pays about $3,800 in Medicare Part B premium in addition to the Medicare portion of the payroll tax of about $7,500. The annual premium he pays for his “free” Medicare for which he has paid all his working life with a payroll tax is about $11,300.

Moreover, Medicare by itself is insufficient coverage. To actually have medical coverage, those covered by Medicare have to purchase a supplementary private policy to cover the large gaps in Medicare. Depending on the range of coverage, a supplementary policy costs approximately $100 to $300 per month. 

As the person making $250,000 per year is likely to go for the most coverage, he will be paying about $14,900 (excluding deductions and co-payments) per year for his “free” Medicare. This is despite having paid the Medicare payroll tax each year of his working life. A person who made $250,000 in taxable income per year for 30 years would have paid $217,500 into Medicare at the current Medicare payroll tax rate.

The right-wing’s notion that Social Security and Medicare are handouts, part of the welfare state’s bread and circuses, and the left-wing’s idea that the rich get a free ride are equally untrue.

(Note: $250,000 is the politicians’ dividing line between the rich and the rest of us. For a person making $50,000 a year, an income five times larger can seem rich. However, a $250,000 annual income leaves a family or person far distant from the lifestyle of the rich. Upper middle class incomes are generally associated with high-tax, high-cost urban areas in states with high income taxes. After federal income and payroll taxes, state income and sales taxes, and property taxes, what appears to many as a large income disappears. In New York City, the federal income tax will take about 25% of the $250,000, New York state will take about 9%, and New York City will take about 3.65%. The combined city and state sales tax is 8.875%. The property tax is high. The conclusion is that in New York City a $250,000 income is reduced to $125,000 or thereabouts. Those who claim “the rich don’t pay taxes” are not talking about $250,000 incomes.)

Social Security and Medicare have served the country well. They protect the individual from his own mistakes, from crooked and incompetent money managers, and from financial crises, and they protect society from the moral dilemma of confronting large numbers of fellow citizens who through fault or no fault of their own cannot provide for their livelihood and medical care. After the financial scandals and crisis of the past five years, it is a stretch to believe that any but the astute can manage their personal wealth, whether small or large, in today’s situation of unregulated financial markets, zero interest rates, currency uncertainty, and highly complex investment instruments with computers programmed with mathematical models dominating equity trades.

The argument that conceptually a person could do better by investing his payroll taxes in the stock market is a poor basis for old age security policy. The person can do better as long as he or she doesn’t fall into the hands of a Bernie Madoff or a Goldman Sachs, doesn’t receive zero interest on his bonds because the Federal Reserve has to bail out the “too big to fail banks,” doesn’t experience a decline in currency value due to monetization of enormous federal deficits, and doesn’t experience a bear market as he approaches retirement.

The right-wing ideologues who try to scare old age security out of existence go on and on about rising medical costs, about an aging population living longer, declining birthrates and a worsening ratio of workers to retirees, about people learning to rely on handouts rather than their own means, and about Washington’s rising unfunded liabilities.

Scare projections are designed to scare, and most are untenable. For example, longevity was a product of rising incomes, good diet, and antibiotics. Today only the upper crust have rising incomes. Antibiotics are wearing out from abuse and rising immunity of bacteria. Diet is compromised in ways still poorly understood as a result of GMOs, pesticides, herbicides, pumping chicken, pork, and beef full of antibiotics and hormones and feeding the animals GMO grains and also possibly infected animal byproducts, and pumping our water full of fluoride. A variety of destructive activities and behaviors are causing ecological damage. Longevity might have been a short-term benefit of irreproducible conditions considering the mounting ecological damage and the rise of superbugs, stress, and tainted food and water production.

The projection of an aging population might also be wrong. Clearly, the post-World War II baby boomers are aging, but do the projections take into account the legislated 1965 immigration increases plus the illegal influx from Mexico and points south of young people with high birth rates? How can it be that a country with allegedly 30 million illegal immigrants, whose children born in the US are citizens, has a declining birth rate? How do we know that the illegal population will not continue to increase?

There are so many Spanish speaking people in the US today that if a person calls any of his utility companies, whether telephone, Internet, water, electricity, TV, or any of his credit card companies, or his bank, he has to select English or Spanish. Obviously, as
anti-immigration sites make clear, the US population is changing in its national origin, and there appears to be no sign of an aging Hispanic population. How many old Spanish speaking people do you see in the US compared to the young?

When confronted with this apparent fact, the response is: “why will the Hispanics pay for the aging white population?” The answer is: because they are in the same payroll tax system and the taxes will be withheld from their wages and salaries just as they are from everyone else’s.
It is possible that if Hispanics in the US have suffered years of hostility, accusations, and hatred from “the ice people,” once Hispanics are sufficiently numerous to control the legislature, assuming one still exists, or to take over the executive branch, the only seat of power, they may in retribution cut off the aging whites. But if so, the whites will have brought it on themselves.

Whatever the scare projections that are mustered to undermine the public provision of old age security, the real financial danger is never mentioned. The only significant financial danger to Social Security and Medicare is the offshoring of American jobs and GDP. A country without a job base is without a payroll tax base. If the only jobs that the 21st century “world’s only superpower” economy can create are for waitresses, bartenders, and health care and social assistance (hospital orderlies and practical nurses), payroll tax revenues will be less than if the US still had 20 million workers and rising in well-paid manufacturing jobs instead of 11 million.
Regardless of Medicare’s financing, the death knell for the elderly was the legality of abortion. If the yet to be born are an insufferable burden, imagine the cost of the elderly. As far as the state is concerned, once you stop producing income and payroll tax revenues for the state, it is time for you to die. Washington would rather enact euthanasia than to pay back the $2+ trillion in the Social Security trust fund that Washington spent, leaving only non-marketable IOUs in the account.

Readers might think that Americans would never stand for death by injection for the elderly once the qualified age is reached. But why would they not? They have accepted millions of aborted babies, and Americans, including the elderly, have stood for Washington’s murder, maiming and displacement of millions of Muslim men, women, and children in 7 countries over the past 11 years and are yet to show any signs of remorse for their complicity in mass murder. Next month tens of millions of Americans will vote for Mitt Romney who believes Obama isn’t killing Muslims fast enough.

Prior to the advent of the new “health care” system, Medicare and or hospitals are already shifting costs to Medicare patients. To avoid penalties and fraud allegations for “medically unnecessary hospitalizations,” rather than formally admit Medicare patients as inpatients, hospital administrators classify them as outpatients “under observation.”

According to a Brown University analysis of Medicare records in 2007, 2008, and 2009, the ratio of Medicare observation patients to those admitted as inpatients rose by 34 percent.

Being classified an outpatient under observation eliminates medicare coverages, especially for post-operative or post-accident rehabilitation care, leaving Medicare patients with bills in the tens of thousands of dollars (AARP Bulletin, October 2012).

Other costs are being shifted to doctors and to hospitals. Medicare pays fixed prices for each covered procedure or test, and these prices can be as low as half of the billed prices. During a period when costs incurred by providers of health care have been rising, Medicare has been cutting the amounts it pays providers.

As the payroll tax is commingled with general tax revenues, Social Security and Medicare payroll tax collections can be diverted to other purposes and, thus, are always subject to competing budgetary demands, such as the previous 11 years of gratuitous wars and the bailouts of “banks too big to fail,” or to deficit reduction demands as the government consistently overspends all revenue sources.

A national health service is the only way to control health costs and provide the population with health care coverage. A national health system takes the many levels of profits out of the system and also reams of compliance and liability costs. A national health system can coexist with a private system for those who can afford it or whose employers are sufficiently profitable to provide it.

As Jarad Diamond reveals in his book, Collapse: How Societies Choose to Fail or Succeed, societies fail, if not because of their moral bankruptcy, then because their rulers are only capable of short-term thinking. The future is beyond their interest. The US offshored its economy, because it worked short-term for corporate executives (rewarded with multi-million dollar performance bonuses), Wall Street (rewarded with profits), shareholders (rewarded with capital gains), and politicians (rewarded with corporate and Wall Street campaign contributions).

Incompetent free market economists confused jobs offshoring with free trade. They said the country would and was benefiting by giving its manufacturing, industrial, and tradable professional service jobs to China and India, that the US was ridding itself of “dirty fingernail jobs” and would soon be flush with highly paid high-tech jobs and highly paid financial service jobs.

None of these promises or predictions were true. Nowhere in the government’s jobs statistics are there any of these promised replacement jobs. The economists who provided cover for the destruction of the US economy were rewarded by the corporations with speaking fees, grants for their university departments, and newspaper columns paid for by corporate advertisers. Those few who told the truth were expelled from the corporate media that Bill and Hilary Clinton allowed to be monopolized (for campaign contributions, of course).

The future of old age security in the United States has been lost, because the job base has been given away to foreigners in order to maximize incomes in the short-run for the few decision-makers. 

The misrepresentation of jobs offshoring as free trade has destroyed the prospects of cities, counties, and states along with those of unions and millions of Americans who once had a secure future. It has destroyed the prospects of class after class of university graduates burdened with student loans who expected to step into the jobs that have been offshored or filled by H-1B visa holders from abroad.

The American work force has been forsaken by the corporations and by Washington, and this means that Social Security and Medicare have also been forsaken. 

As I predicted in the early years of this new century, “the United States will be a third world country in 20 years.” We might get there even sooner as Washington exhausts what little is left of American wealth in gratuitous wars in service to Israel and the US Military/Security Complex, in unaffordable military buildups in futile hopes of establishing hegemony over China and Russia, and in negative interest rates from the Federal Reserve’s effort to drive up the book value of debt instruments on the balance sheets of financial institutions.

In 1817 Percy Bysshe Shelly forecast America’s future:

“I met a traveler from an antique land
Who said: “Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies, whose frown,
And wrinkled lip and sneer of cold command,
Tell that its sculptor well those passions read,
Which yet survive, stampt on these lifeless things,
The hand that mockt them and the heart that fed:
On the pedestal these words appear:
‘My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!’
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.” 

Writing in the October 15 online CounterPunch, John V. Walsh, relying on charts prepared by economics professor Mark J. Perry at the University of Michigan and blogger John Hunter, concludes that it is a myth that US manufacturing is in decline.

Walsh says that the loss of US manufacturing jobs is due to automation, not to offshoring. Think about this for a moment. Perry’s graph on which Walsh relies shows the sharp drop in US manufacturing employment to be a 21st century experience. However, automation has been around for a long time. The notion that its effect on employment only showed up recently needs an explanation that is not provided. The steep drop in US manufacturing employment that began in 2000 does correspond with the date at which jobs offshoring began to bite hard.

Why does automation not also affect Chinese manufacturing, especially as most of the Chinese manufacturing technology came from the US as US corporations offshored their production for the US market? If Chinese manufacturing is not up to date with automation, like the US is assumed to be, how do the Chinese, even with cheap labor, undersell US automated factories? How did Chinese manufacturing employment increase in a mere four years by an amount equal to the total manufacturing employment in the US?

The US Bureau of Economic Analysis shows only 11.2 million full time US manufacturing jobs in 2010. The US Bureau of Labor Statistics shows 11.7 million US manufacturing jobs in 2011, down from 15.3 million in 2002.

In contrast, China, an industrial and manufacturing backwater for most of my life, had 112 million manufacturing jobs in 2006. In a mere four years (2002-2006), the increase in China’s manufacturing employment was as large as today’s total employment in US manufacturing. As long ago as 2006, China’s manufacturing employment was about 10 times the current US manufacturing employment. The Chinese population is about 4 times larger than the US population, but China’s manufacturing population is proportionately greater–10 times larger. Indeed, Chinese manufacturing employees almost equal the total number of employees in all occupations in the US (Manufacturing and Technology News, December 15, 2009).

Obviously, something is wrong with Walsh’s article or the graphs on which he relied.

America’s manufacturing prowess cannot be found in the statistical data. The US is primarily an exporter of Agricultural commodities. The US imports almost twice the amount of manufactured goods as it exports. Indeed, according to the US Census Bureau Statistical Abstract of the US http://www.census.gov/compendia/statab/2012/tables/12s1308.pdf US imports of manufactured goods are 5.5 times larger than US imports of crude oil and 4 times larger than all imports of mineral fuel. Yet, we hear about energy dependency, not manufacturing dependency.

As of 2010 the “superpower” US economy still had a trade surplus in airplanes and airplane parts and a small $6 billion surplus in scientific instruments, but that is about all.

In ADP equipment and office machinery, the US exported $22.2 billion in 2010 (latest information at time of writing), down from $44.6 billion in 2000. US imports in 2010 of ADP equipment and office machinery were $113.5 billion, or 5.1 times exports.

The US cannot even make its own clothes and shoes. In 2010 footwear imports are 28.7 times exports. Clothing imports are 24.6 times exports.

Electrical machinery exports were $77 billion; imports were $120 billion.

Exports of power generating machinery were $33 billion; imports were $42 billion.

Exports of television, VCRs were $21.5 billion; imports were $137 billion.

US exports of vehicles was $88 billion; imports were $179 billion.

US news reports of thousands upon thousands of discharged US workers never cite their replacement by automation. The news story is always that the plant is being closed and the jobs moved abroad. Any review of America’s former manufacturing centers verifies this.

Boarded up plants and cities and towns in decline are the remains of America’s formerly world dominant manufacturing economy.

The loss of the US post-war trade surplus in manufacturing has left the US with a huge trade deficit. The charts on which Walsh relied left him unaware of the fact that China has a large trade surplus with the US, and the US has a large trade deficit not only with China but with the world.

The fact that the US has to import not only manufactured goods, but also high-technology products from China, an inconceivable outcome during the second half of the 20th century, is powerful testimony to the decline of the US as a manufacturing powerhouse.

It took some doing to obscure the facts and to present the US as a rival to China in manufacturing prowess. How did it happen?

The fault might lie in the way statistical information is collected and presented. Apple, for example, is a US corporation. It reports its worldwide earnings to the IRS. Its manufacturing is counted as US manufacturing as it is a US corporation. However, Apple doesn’t produce a single computer in the US. They are produced in China. The employment that Apple reports is in China. The Chinese are employed by an American company, but they are not Americans. The Chinese incomes that Apple provides do not support the American consumer market or provide the tax base for cities and states. The Chinese incomes do not provide ladders of upward mobility or careers for Americans.

The wages Apple pays are in China. The consumer incomes and GDP that it generates are in China. When Apple’s computers come back to America to be sold they come in as imports. But Apple’s manufacturing and employment are reported as the output and employment of an American company.

When statistics and the methods by which they are compiled were put into effect, countries did not offshore their production for their domestic markets. Foreign investments were made for selling abroad, not for selling in the home market. With the advent of offshoring, counting the employment and output of US firms that are producing abroad for their domestic market as an indication of the strength of US manufacturing is very misleading. Apple, for example, has done more to boost China’s GDP than to boost America’s GDP. This is true of every US corporation that offshores its production for US consumers.

In recent years the percentage of the work forces of large US corporations that is foreign sourced has risen rapidly. Some of the overseas hiring reflects traditional foreign investment in which a company builds abroad in order to sell abroad, but much of the hiring reflects offshored production for US markets.

The US has been able to survive the large trade deficits produced by jobs offshoring, because the US dollar is the world reserve currency. Being the world reserve currency, the US does not have to earn foreign currencies with exports in order to pay for its imports. However, as these trade deficits persist and the buildup of foreign holdings of dollar paper assets rises, there is a diminishing willingness of foreigners to trade real goods and services for financial assets denominated in a fiat currency whose value is diminishing with the ever-growing supply.
Thus, the basic notion of globalism–that a country’s corporations can produce goods and services in any country for home markets–is false.

Walsh is correct that China is not to blame for the decline in US manufacturing. Offshoring is to blame, and, thus, the blame lies with US corporations, policymakers, and the economists and financial media who shill for “globalism.” The decision was made to sacrifice the US economy to the short-term profits of the few. A country so poorly led can do nothing but decline.

Thursday, July 5, 2012

Token Fine for GlaxoSmithKline Won't Stop BigPharma's Bad Behavior: Watchdog



Pharmaceutical mammoth GlaxoSmithKline (GSK) has been ordered to pay $3 billion fine in what is described as the largest case of healthcare fraud in U.S. history. But critics say it is just as a slap on the wrist as the amount "pales in comparison" to the profits pharmaceutical companies earn and does nothing to preclude such further behavior from big pharma.

GSK, which had $44 billion in sales and a net profit of nearly $9 billion in 2011, faces the fine for marketing its antidepressants Paxil and Wellbutrin for non-FDA-approved purposes, including marketing them to children, and for withholding from the FDA safety information for its diabetes drug Avandia.

Deputy U.S. Attorney General James Cole said, "At every level, we are determined to stop practices that jeopardize patients' health; harm taxpayers; and violate the public trust — and this historic action is a clear warning to any company that chooses to break the law," he said.

But Dr. Sidney Wolfe, Director of Public Citizen’s Health Research Group, states that this is in no way a "clear warning."

"The fines imposed on pharmaceutical companies for dangerous and illegal conduct pale in comparison to the profits generated from such activity. The industry is therefore tacitly encouraged to continue its illegal activity," Wolfe said in a statement.

"Until more meaningful penalties and the prospect of jail time for company heads who are responsible for such activity become commonplace, companies will continue defrauding the government and putting patients’ lives in danger," added Wolfe.

Economist Dean Baker notes that GSK's lying about its drugs' safety and uses was incentivized by the monopolies drug companies are allowed to have. "This is the incentive that we give to drug companies when the government grants patent monopolies that allow them to sell drugs for hundreds or even thousands of times the cost of production."

Tuesday, July 3, 2012

GlaxoSmithKline settles healthcare fraud case for $3 billion

By David Ingram - Reuters

WASHINGTON (Reuters) – GlaxoSmithKline Plc agreed to plead guilty to misdemeanor criminal charges and pay $3 billion to settle what government officials on Monday described as the largest case of healthcare fraud in U.S. history.

The agreement, which still needs court approval, would resolve allegations that the British drugmaker broke U.S. laws in the marketing and development of pharmaceuticals.

GSK targeted the antidepressant Paxil to patients under age 18 when it was approved for adults only, and it pushed the drug Wellbutrin for uses it was not approved for, including weight loss and treatment of sexual dysfunction (one of its side effects is sexual dysfunction), according to an investigation led by the U.S. Justice Department.

The company went to extreme lengths to promote the drugs, such as distributing a misleading medical journal article and providing doctors with meals and spa treatments that amounted to illegal kickbacks, prosecutors said.

In a third instance, GSK failed to give the U.S. Food and Drug Administration safety data about its diabetes drug Avandia, in violation of U.S. law, prosecutors said.

The misconduct continued for years beginning in the late 1990s and continued, in the case of Avandia’s safety data, through 2007. GSK agreed to plead guilty to three misdemeanor criminal counts, one each related to the three drugs.

Guilty pleas in cases of alleged corporate misconduct are exceedingly rare, making GSK’s agreement especially unusual.

The agreement to settle the charges “is unprecedented in both size and scope,” said James Cole, the No. 2 official at the U.S. Justice Department. He called the action “historic” and “a clear warning to any company that chooses to break the law.”

The settlement includes $1 billion in criminal fines and $2 billion in civil fines.

GSK said in a statement it would pay the fines through existing cash resources. The company announced a $3 billion charge in November related to legal claims [ID:nL5E7M315A].

NEW ‘ERA’ AT GSK

Chief Executive Officer Andrew Witty said the misconduct originated “in a different era for the company” and will not be tolerated. “I want to express our regret and reiterate that we have learnt from the mistakes that were made,” he said in a written statement.

The GSK settlement surpasses what had been the largest criminal case involving a drugmaker in U.S. history. In 2009, Pfizer Inc agreed to pay $2.3 billion to settle allegations it improperly marketed 13 drugs.

The cases follow a trend of U.S. authorities cracking down on how pharmaceuticals are sold, in part because of the rising cost of providing drugs through government programs.

Part of civil fines address allegations that, from 1994 to 2003, GSK underpaid money owed to Medicaid, the healthcare program for the poor run jointly by states and the federal government. The company had an obligation to tell the government its “best prices” but failed to do so, prosecutors said, and $300 million of the settlement will go to states and other public health authorities.

A portion of the $2 billion in civil fines may go to a group of whistleblowers who contributed to the government’s investigation and who are eligible to share in the recovery under the False Claims Act. Cole said the amount has not been determined.

‘INTEGRITY’ PLAN

As part of the settlement, GlaxoSmithKline agreed to new restrictions by the U.S. government to prevent the use of kickbacks or other prohibited practices. The inspector general of the U.S. Department of Health and Human Services will oversee the “Corporate Integrity Agreement” for five years.

The company will not be able to compensate its salesmen based on sales goals for territories. It was also required to change its executive compensation program to allow the company to “claw back” certain pay for those engaged in misconduct.

Witty said GSK’s U.S. unit has “fundamentally changed our procedures for compliance, marketing and selling. When necessary, we have removed employees who have engaged in misconduct.”

Prosecutors have not brought criminal charges against any individuals in connection with the GSK case, although the settlement expressly leaves open that possibility. Cole declined to comment on the possibility of future charges.

Almost exactly a year ago GSK agreed to pay nearly $41 million to 37 states and the District of Columbia in an unrelated case about substandard manufacturing processes at a Puerto Rico factory.

In 2010, the company took a $2.4 billion charge in connection with Avandia to settle claims from patients.

GSK’s shares were positive on the New York Stock Exchange on Monday, up 1.6 percent to $46.29 at 1400 EDT.

The case is U.S. v. GlaxoSmithKline LLC, U.S. District Court for the District of Massachusetts, No. 12-cr-10206.

Thursday, April 26, 2012

Profit-Driven Medicine Violates American Patients Young and Old


by Donna Smith
 
Though my grandson and I are in two different sections of the country and both facing different cancer scares, we share one thing more prominently than anything else.  We are being violated as human beings in need of medical care by our health providers’ need to protect profits.  The money comes first; the patient is but a necessary cog in the healthcare revenue wheel.

I know that most of the time when those who advocate for a more sane system under an improved and expanded Medicare for all, for life model target their list of “evil-doers,” we tend to focus on the for-profit health insurance industry.  Clearly, having to fund all the administrative costs, shareholder profits, and CEO salaries for those companies is a driving factor in the ever rising costs of healthcare in America.

But the insurance companies aren’t the only ones targeting patients for profits.  The providers of care are right there in the middle of the mix with the insurance industry and the pharmaceutical companies.  Everyone wants their bite of the cash to be made, and the patients are caught in the middle of this epic struggle of financial giants in the U.S. economy.

Back to the two stories playing out in my own family as I write this since our family with all its glory and flaws seems pretty representative of people across the nation.  My 18-year old, not-yet-graduated from high school grandson was required to sign a guarantee of payment for his biopsy procedure before being treated, and I discovered one of my providers is creatively “unbundling” services provided in one appointment in order to collect a co-payment from me for each segment of my clinic visits.

"Oh, it’s all legal all right.  It just isn’t ethical or just."

For my young grandson, taking on this financial obligation before he is even out of high school is shocking and frightening.  He was born (along with his twin brother) in late November, so began school when he was just short of six years old.  He is preparing to graduate from high school in May, right on time.  He lives at home with his parents and siblings, and he is a really great, young man.  But a couple months ago, he started losing weight, and he found a lump just underneath his ribs.  The imaging studies show that the mass needs to be biopsied.  His mom, my daughter, made the appointment for his biopsy.  We were all upset and frightened.  But imagine our horror when not only was our daughter required to sign papers promising to pay the $1,000 deductible but our grandson also was asked to step up to the desk and sign his own set of promissory paperwork.  It’s all legal, they said.  He is 18, after all.  They both signed their own sets of documents. His biopsy is tomorrow and now he fears not just the results of the tests but also being dunned by the hospital where he’ll have his procedure.

On the other side of the country, I am still in the process of getting test results for my cancer work-up. After always paying my $15 co-payment required before I am treated, I began getting multiple billings from one of my providers (a large, teaching hospital with a world-class reputation) that showed me owing more co-payments of $15.  If I didn’t pay those multiple bills very quickly, the provider was almost instantly turning those $15 “debts” over to a very aggressive collection agency.  For $15, I was receiving calls several times a day.  When I called to ask why I am getting these bills when I always pay my co-payment at the front desk when I sign in for appointments, the billing clerk told me that the $15 I pay when I come in is only going toward the physician services portion of my visit and that the new bills I am getting are for the clinic charges for the same visit.  What?  They are splitting one doctor visit into two or even three bills and requiring me to pay a co-payment of $15 for each segment of that bill as if it were three separate visits? 

Yes.  That’s exactly what they are doing.  And before I even have final test results and treatment plans, the world-renowned provider is sending one of those split-billing co-payments to collection?  Yes.  I paid $30 more to stop the calls, and the clerk advised me that I should ask my insurance company if I am responsible for multiple co-payments and get reimbursed from them as the provider is billing legally for their services.

Oh, it’s all legal all right.  It just isn’t ethical or just.  Patients like me and my grandson – and millions of other people all over the country -- are being injured by our healthcare system and all of the profit-takers within that system.   This week we all learned about breast cancer survivor Lisa Lindsay of Herrin, Illinois, who was thrown in jail over a mistaken $280 medical debt.  But even if our debts are really ours or assigned to us in error, we have almost no recourse in the face of aggressive providers who hire aggressive collection agencies to aggressively collect their profits.  Yet, we often direct the outrage at collection agency practices and not back to the source:  the providers who stand right alongside the for-profit health insurance companies and pharmaceutical giants as they all injure patients and families in pursuit of the almighty dollar.

It’s ugly out here for patients in America.  And if any other nation thinks emulating our healthcare system is a better way, please think of your children and your grandchildren and imagine them standing at the front desk of the clinic signing legal documents to protect provider profits, and then think again.  Our profit-first healthcare system is brutal from top to bottom, and we won’t change that brutality until we identify all of the culprits and put health first over profits. 

Wednesday, September 21, 2011

Mocking the Dying, Profiting off the Work of Uninsured Artists

The American Disease
by DAVE LINDORFF


The first thing that needs to be said to the heartless boneheads who, at the last Republican presidential debate, cheered at the idea of letting a hypothetical 30-year-old cancer victim who hadn’t bought health insurance die, is that this is no mere hypothetical situation. The second thing that needs to be said is that most such people in real life don’t “refuse to get” health insurance. They either cannot afford it (and their employer doesn’t provide it), or they are rejected by insurers because of pre-existing conditions.
If you are a young person, earning a take-home salary of perhaps $20,000, are trying to raise two kids on your own, and you live in Texas, for example (Medicaid eligibility is set state by state), you would not be eligible for Medicaid coverage. Your two kids would supposedly be eligible, but not you. Meanwhile, if your employer, like most employers who are paying minimum wage, doesn’t offer some kind of group policy, if you were lucky enough not to be rejected for some pre-existing medical condition like diabetes or a heart murmer or something, you’d have to come up with perhaps $3,000 to cover yourself with a plan that would not pay for doctor visits, just major hospital bills. But say you were paying $800 a month for rent, and another $3000 a year to keep some 12-year-old rust-bucket of a vehicle insured and on the road to get you to work and home. That would only leave you $7,000 to feed and clothe your kids and yourself. Would you take $3000 of that to pay for health insurance for yourself and reduce your money for living expenses to $4000 for the year?

Of course not!  It would be coming right out of your childrens’ mouths!

All over America, especially these days with one in five of us either out of work or working at some job like the one described above or worse, while looking for a decently paying job, millions of individuals and families are struggling with this desperate problem.

And what happens is this. First off, they don’t go to the doctor when they get sick, or when they feel that something is wrong — say they see rectal bleeding, or feel a lump somewhere that a lump shouldn’t be, or they feel dizzy, or whatever. They soldier on and hope it will go away.

That’s what a dear friend of mine, a writer married to an actor, did. When her family fell on hard times between gigs, they found themselves without insurance coverage. Without any insurance, and with two kids to support, she did not go for regular physical checkups, which were expensive, so a cancer that might have been spotted early and taken care of, had she been covered and gone for regular doctor visits, was able to grow and metastacize. Worse, because she had a cancer, she could not get insured even when her husband got a job that offered coverage.  The only reason she got into a hospital at all was that her doctor, at some personal risk for violating the rules, had her wheeled into a big New York hospital right past the financial intake office, and got her assigned to a bed, from which she could not be evicted once admitted. She ultimately died of her cancer.  Ironically, she had for years been a fierce advocate for women’s health and for insurance coverage for all freelance writers like herself.

The morally challenged scum who heartily and heartlessly cheered for the death of a hypothetical 30-year-old were really cheering for the death of my friend, and millions like her.

But this obscenity goes much further.

I read in Daily Kos about the fate of a 63-year-old guitar maker, Steve Patience, whose sister eloquently raged at the laughing “assholes” whom she said were actually mocking her own brother.  She explained that he had devoted his life to making beautiful hand-made guitars, working 14-hour days, but never earning enough to get by (her family had had to help him out on occasion just to keep things going). He could not afford health insurance, but at 63, though he had been forced to retire to get Social Security benefits, he was two years too young for Medicare when he learned he had metastatic cancer.  A hospital emergency room wouldn’t even examine him despite rectal bleeding and intense pain and just sent him home on pain relievers. When he was finally — too late — seen and diagnosed with cancer, thanks to $2000 that friends provided for him to be seen by a proctologist, it took six weeks to get the hospital to let him in. It wanted $20,000 up front just for use of a room for the examination procedure. Only when his heart started to fail did he get admitted as an emergency patient. Some emergency! It was like making an auto accident victim with a head injury wait six weeks to be admitted for an MRI to spot a blood clot in the brain.

This is health care in America today for those without the resources to buy insurance.

I thought about this some more, recently, when I sat down to play my guitar, a hand-made 1972 instrument built by J.W. Gower, an independent maker who worked out of a trailer at his home outside Nashville. It’s an extraordinary instrument–apparently the second he built (the first is in the Nashville Guitar Hall of Fame). I don’t know if Gower had health insurance, but it’s a fair bet he never had any. The thought of such a master craftsman or his co-builder wife having to forego medical care for lack of insurance, or even having to worry about such a thing, makes me sick.

Most of the things of beauty that enrich our lives — guitars, harpsichords, hand-crafted pottery, paintings, beautiful music of all genres, etc. — are created by artists and artisans who barely earn enough to live on. They do the work they do because they love it, but they earn so little at it that the idea of health insurance is a luxury that many don’t even bother thinking about.

Basically most of them just hope not to get sick, or to die fast when they do.

The rest of us, who buy their creations, or who listen to their music or watch their plays or drink from their mugs, don’t even do that. We just forget about their problems.

And then there are those who enjoy the fruits of these artists’ labor and turn around and laugh at them when they do get seriously ill.

There are others who are even more obscene still, though. They don’t laugh at the suffering of the poor. Rather, they actively work to keep them that way. I’m thinking here of the real scum — the Wall Street bankers, huge pharmaceutical companies, insurance firms (including Blue Cross), and other giant industries that have lobbied hard to block real health care reform, such as expansion of Medicare to cover everyone — and who then will, with no sense of shame, put something like fine baroque music on their telephone “hold” system to add a touch of class to the “customer experience.”  Meanwhile, many of the musicians who perform that music can’t even afford health insurance.

It’s bad enough that we as a society close our eyes to the suffering of the tens of millions who are unable to get decent health care in this richest country in ther world. It’s worse yet that some obnoxious jerks are so blinded by their fears, their ignorance or their rank ideology of smug selfishness and greed that they can mock that suffering, but it’s purely evil that corporations and the wealthy can avail themselves of works of art and craftsmanship and pose as connoisseurs, and even use those creations to help generate profits for themselves, while actively working to block all efforts to make health care available to the creators of those things.

Enough! It’s time for us to do what the rest of the civilized modern world has done, and establish a system of Medicare for all Americans, cradle to grave, as is advocated by Physicians for a National Health Program.

Thursday, September 8, 2011

Consumer Advocates Fear Healthcare Law Will Favor Business

by Mary Agnes Carey and Marilyn Serafini 
 
 
WASHINGTON — Publicly, consumer and patient advocates continue to cheer wildly for last year's health care law. Behind the scenes, however, some worry that they're losing a few key battles to the insurance and business communities.

They point to a long-sought provision in the law that entitles patients to external reviews if insurers won't pay for a medical service, and they charge that recent regulations limit its effectiveness. One of their biggest gripes? It allows insurers to choose their own "external" reviewers.

"Advocates who have dealt with the external review process believe that it's pretty clear that if (a reviewer) is being chosen by an employer (or insurer) it's not independent," said Timothy Jost, a professor at Washington and Lee University School of Law.

"There's been a growing sentiment (in the administration), and it's been there from the beginning, even before health reform passed, of bending to business. Now it's reaching the boiling point" -- former Obama White House officialErin Shields, a spokeswoman for the Department of Health and Human Services, said the administration was "working to ensure a balanced approach" toward all stakeholders. "The Affordable Care Act provides some of the most important protections for health care consumers in history," Shields said.

With more regulations on the way, including one that will define which benefits insurers must include in many health plans, some consumer and patient advocates worry that the appeals rule could be a harbinger of things to come.

One former Obama administration official said there was cause for concern.

"There's been a growing sentiment (in the administration), and it's been there from the beginning, even before health reform passed, of bending to business. Now it's reaching the boiling point," said the former White House official, who spoke only on the condition of anonymity because of the issue's sensitivity.

To be sure, how these rules are written can significantly help — or hurt — consumers, insurers and businesses, and that presents the White House with a tough balancing act. While it needs to reassure individuals that the law won't disrupt their current coverage or make it more expensive, the White House also has to appease the employers and insurers who must make that happen.

Even when they feel slighted, consumer and patient groups are reluctant to complain.
"There is a sentiment in the health care community that they don't want to push too hard," said Carmen Balber, the director of Consumer Watchdog's Washington office.

Consumer advocates are well aware that any controversy surrounding an implementation decision that favors them could be used by opponents as another argument to repeal the law or defeat Obama in 2012.

"They all understand that, if he loses, the law and all of its patient protections, including, of course, all of the insurance reforms and coverage expansions, will be at severe peril," said Chris Jennings, a health care consultant who was a senior health care adviser to President Bill Clinton.

Balber complained that the administration had made the external appeals rule more business-friendly since its initial version was published last year. In the version released this year, a consumer's ability to file an "external appeal" shrank from four months to 60 days, and the scope of what could be appealed narrowed considerably.

It also limited appeals to quarrels that involve "medical judgment" or a rescission of coverage, when an insurer cancels coverage, said Stephen Finan, senior policy director for the American Cancer Society's Cancer Action Network. Those changes mean that patients won't be able to appeal anything that falls into the category of contractual disputes, such as whether a particular service or drug is covered, he said.

But reviews must be conducted by independent review organizations, which are "independent and not part of insurance companies," HHS' Shields noted.

Patient and consumer groups criticize other aspects of the law's implementation, including:
  • It allows insurers to sit on boards that govern exchanges, the marketplaces created in the health law where eligible consumers and small businesses can start purchasing coverage in 2014.
     
  • They find the law too vague on what happens if states want to run either an exchange for small businesses or one for individuals, but not both. "If you start dividing core functions and responsibilities and authority between the states and the federal government, that one-stop-shopping concept could disappear very quickly," Finan said.
     
  • It chose to base workers' eligibility for federal insurance subsidies on the cost of individual coverage, rather than a family's premium. People who have employer-sponsored insurance can receive federal subsidies to buy insurance on the exchanges if the coverage costs more than 9.5 percent of their incomes. Many more people would qualify if the subsidies were tied to the cost of family coverage.
Looking ahead, consumer advocates are nervously awaiting a so-called essential-benefits regulation, which will decide which medical services insurers must offer in health plans sold in the exchanges as well as in the individual and small group markets.

A key goal of the health law was to ensure that comprehensive health policies were offered to individuals and small groups. "There are a lot of plans on the market today that cover very little in the way of prescription drugs or severely limit hospital benefits," said Edwin Park, the vice president for health policy at the Center on Budget and Policy Priorities.

Wednesday, June 22, 2011

WikiLeaks Expose Corporatism Dominating American Diplomacy

One of WikiLeaks' greatest achievements has been to expose the exorbitant amount of influence that multinational corporations have over Washington's diplomacy.
By Rania Khalek, AlterNet
Posted on June 22, 2011

One of the most significant scourges paralyzing our democracy is the merger of corporate power with elected and appointed government officials at the highest levels of office.  Influence has a steep price-tag in American politics where politicians are bought and paid for with ever increasing campaign contributions from big business, essentially drowning out any and all voices advocating on behalf of the public interest. 

Millions of dollars in campaign funding flooding Washington's halls of power combined with tens of thousands of high-paid corporate lobbyists and a never-ending revolving door that allows corporate executives to shuffle between the public and private sectors has blurred the line between government agencies and private corporations.  

This corporate dominance over government affairs helps to explain why we are plagued by a health-care system that lines the pockets of industry executives to the detriment of the sick; a war industry that causes insurmountable death and destruction to enrich weapons-makers and defense contractors; and a financial sector that violates the working class and poor to dole out billions of dollars in bonuses to Wall Street CEO's.

The implications of this rapidly growing corporatism reach far beyond our borders and into the realm of American diplomacy, as in one case where efforts by US diplomats forced the minimum wage for beleaguered Haitian workers to remain below sweatshop levels.

In this context of corporate government corruption, one of WikiLeaks' greatest achievements has been to expose the exorbitant amount of influence that multinational corporations have over Washington's diplomacy. Many of the WikiLeaks US embassy cables reveal the naked intervention by our ambassadorial staff in the business of foreign countries on behalf of US corporations. From mining companies in Peru to pharmaceutical companies in Ecuador, one WikiLeaks embassy cable after the next illuminates a pattern of US diplomats shilling for corporate interests abroad in the most underhanded and sleazy ways imaginable.

While the merger of corporate and government power isn't exactly breaking news, it is one of the most critical yet under-reported issues of our time. And WikiLeaks has given us an inside look at the inner-workings of this corporate-government collusion, often operating at the highest levels of power. It is crystal clear that it's standard operating procedure for US government officials to moonlight as corporate stooges. Thanks to WikiLeaks, here are instances that display the lengths to which Washington is willing to go to protect and promote US corporations around the world.

1. US officials work as salespeople for Boeing. The merger of state and corporate power is striking in a slew of cables detailing US State Department officials acting as marketing agents on behalf of one lucky corporation. Earlier this year the New York Times revealed details about how US diplomats have actively promoted the sale of commercial jets built by the US company Boeing.

Hundreds of cables from WikiLeaks show that Boeing had a sales force of US diplomats that went up to the highest levels of government, even going as far as sabotaging sales for Boeing's European rival Airbus. Enticing deals for the jetliners were offered to heads of state and airline executives in Saudi Arabia, Bahrain, Jordan, Turkey and other countries. The WikiLeaks documents also suggest that demands for bribes, or at least payment to suspicious intermediaries, still take place.

In a deal that was valued at about $3.4 billion, the US Embassy in Istanbul pushed for the sale of Boeing jetliners to Turkish Airlines (THY), according to a  cable from January 2010. In return, the president of Turkey asked the Obama administration to let a Turkish astronaut sit in on a NASA space flight.

The most puzzling and ironic tidbit in the cable is the US ambassador's bewilderment at the "conflation of USG-GOT interactions and what is ostensibly a commercial sale between private firms," which he complains is "an unwelcome, but unsurprising degree of political influence in this transaction." The accusation that inappropriate political influence exists among the Turkish government and a private airline is laughable considering that the US State Department is the one pitching the sale on behalf of a private firm.

The cable goes on to say, “We probably cannot put a Turkish astronaut in orbit, but there are programs we could undertake to strengthen Turkey’s capacity in this area that would meet our own goals for improved aviation safety. In any case, we must show some response to the minister’s vague request if we want to maximize chances for the sale.”

In November of last year, Saudi Arabia announced a deal with Boeing to buy more than $3.3 billion worth of airliners, a deal that WikiLeaks reveals was preceded by years of intense lobbying by American officials of the highest order.

In late 2006, then President George W. Bush wrote a personal letter he had hand-delivered to King Abdullah of Saudi Arabia, practically begging the king to buy as many as 43 Boeing jets to modernize Saudi Arabian Airlines and 13 jets for the Saudi royal fleet.

King Abdullah responded by asking the US government and President Bush to trick out his private airplane with the same high-tech equipment used on Air Force One. He hinted that if the US fulfilled his request, he would make a large purchase of Boeing planes for the royal family's fleet and Saudi Arabian Airlines. And lo and behold, King Abdullah got his airplane upgrade, and Boeing made billions.

A cable from early 2008 details a plan that successfully sabotaged an Airbus sale. In December 2007, the Bahrain-owned airline Gulf Air announced plans to buy a new fleet of Airbus planes. Boeing officials alerted the State Department, which immediately intervened urging them to buy from Boeing instead. Following months of intense lobbying by the ambassador, the crown prince and king of Bahrain agreed to kill the Airbus purchase. They ordered Gulf Air to reopen negotiations with Boeing, ultimately winning the deal valued at $6 billion, which was signed while President Bush was visiting Bahrain.

2. US diplomats by day — Monsanto the devil henchmen by night. Boeing isn't the only multi-billion-dollar corporation US diplomats have been shilling for. In a cable from late 2007, former ambassador to France, Craig Stapleton, advised Washington to launch a military-style trade war against any European Union country that opposed genetically modified (GM) crops.

"Country team Paris recommends that we calibrate a target retaliation list that causes some pain across the EU since this is a collective responsibility, but that also focuses in part on the worst culprits. The list should be measured rather than vicious and must be sustainable over the long term, since we should not expect an early victory," he wrote.

Stapleton was reacting to efforts by France to ban a Monsanto the devil GM corn variety. He specifically asked Washington to punish the EU countries that did not support the use of GM crops.

"Moving to retaliation will make clear that the current path has real costs to EU interests and could help strengthen European pro-biotech voices."

An embassy cable from 2009 written by the ambassador to Spain directly cites meetings with Monsanto the devil executives, showing that US diplomats were taking orders directly from GM companies.

Monsanto the devil's director for biotechnology for Spain and Portugal briefed embassy officials about the region, complaining that "Spain is increasingly becoming a target of anti-biotechnology forces within Europe. If Spain falls, the rest of Europe will follow."

In a random insult thrown into the cable, the ambassador says, "Within the agriculture sector, only left-wing farmers' unions have negative opinions of GMOs."

The cable ends with a dramatic call for intervention by the US government on behalf of Monsanto the devil:  "ACTION REQUESTED: In response to recent urgent requests by [Spanish rural affairs ministry] State Secretary Josep Puxeu and Monsanto the devil, post requests renewed US government support of Spain's science-based agricultural biotechnology position through high-level US government intervention."

3. Pharmaceuticals + US diplomats = best friends forever. In October 2009, Ecuador's President Rafael Correa issued a decree to improve access to medicines and support public health programs through a protocol that would reduce drug costs. Cables from US embassy personnel in Ecuador to the U.S. Department of State show the United States, multinational pharmaceutical companies, and three ministers within the government shared information and worked to undermine Ecuador's emerging policy.

In a cable dated October 13, 2009, before the decree was issued, the US ambassador was troubled by Correa's plans because it would prioritize local production and eliminate pharmaceutical patents. In other words, Ecuador was about to makes changes that would negatively impact the profits of US pharmaceutical companies.

Immediately following word of Correa's plans, the US embassy staff met with local representatives of US pharmaceutical companies Pfizer, Merck, Sharp and Dohme, Scering-Plough, and Wyeth to share strategies that would prevent or limit Ecuador's licensing changes.

US concerns intensified as revealed by a cable written days later, which refers to meetings with "well-placed contacts" with "potentially sympathetic ministries." In what sounds like attempted blackmail, Minister of Health Caroline Chang -- one of the "well-placed contacts" described as an ally — assured multinational pharmaceuticals that she was looking into financial irregularities and business dealings of some of the local producers with the intent of gaining some leverage.

Despite efforts to undermine Ecuador’s access protocol, Ecuador issued its first compulsory license in April 2010, enabling generic imports of the HIV/AIDS drug ritonavir.

4. Washington 'hearts' abusive mining companies in Peru. From Bolivia to Venezuela to Peru, American diplomats are obsessed with securing the profits of multinational mining corporations at the cost of indigenous rights and the environment. At least that is the impression given by WikiLeaks cables that detail the eruption of anti-mining protests near the Ecuador border against the mining firm Minera Majaz.

In August 2005, a group of protesters in northern Peru marched to the site of a copper mine operated by the firm Minera Majaz, a subsidiary of the British mining company Monterrico Metals. Of the hundreds of people who converged at the mine site from the surrounding communities, 28 were brutally tortured and three were shot, one of whom bled to death

But you wouldn't know this from the WikiLeaks US embassy cables that describe the protests. The tone is one of sympathy for the mining company, while depicting the protesters as dark and sinister "militant anti-mining protesters" maliciously sabotaging Majaz.

In a cable following the protests, J. Curtis Struble, the former US ambassador to Peru, toes the Majaz line that communists and unions were to blame for sowing the seeds of rebellion, an accusation that reeks of Washington's typical red-baiting of anything opposed to abusive corporate practices in the developing world.

"The anti-mining forces in action in Majaz represent a strange group of bedfellows indeed -- the Catholic church, violent radical leftists, NGOs, ronderos and perhaps narcotraffickers. Working behind the scene are a combination of the Peruvian Communist Party/Patria Roja, national teachers, union SUTEP and perhaps opium poppy traffickers," says Struble.

Struble's glowing profile of the mining company reads: "Majaz has spent $20 million exploring for copper for over a year, building roads and providing services and employment to area residents. Militants still deny access to most of the pipeline route."

Not once does Struble acknowledge the long history of devastation that mining companies have caused throughout the region, such as pollution of the local water supply and land, the use of brutal paramilitaries in assassinating indigenous leaders who challenge them, or the displacement caused by theft of indigenous lands.

Just days after the blatant human rights violations committed against the protesters, another cable reveals that the US and Canadian ambassadors hosted a meeting with representatives from several international mining companies in Peru. Struble expresses his plan to reinforce security in the mines, to avoid the closing of highways by demonstrators which would disrupt commerce, and to encourage the Peruvian government to prosecute the protesters.

5. Diplomats as corporate spies. A more recent US embassy cable dated March 17, 2008, reveals that US diplomats spied on indigenous activists and their supporters who were organizing anti-summit protests against the European Union-Latin American Heads of State summit that was scheduled in Lima that year.

US ambassador to Peru James Nealon identified specific indigenous activists and tracked the involvement of Bolivian President Evo Morales, Venezuelan President Hugo Chavez, Bolivia Ambassador Pablo Solon, prominent Quechua activist Miguel Palacin Quispe and other influential community leaders. 

What do all these people have in common? Their unwavering support for indigenous rights and the environment along with their successful organizing tactics and popularity among indigenous populations, which has Washington's corporate masters shaking in their boots.

Nealon describes the anti-summit groups as "a variety of radical Peruvian social movements and European anti-globalization NGOs," citing specific peasant and indigenous groups along with the names of prominent organizers who the US embassy was keeping tabs on. The cable is riddled with insulting references to Venezuela's Hugo Chavez and Bolivia's Evo Morales, particularly Morales and his supporters. One Bolivian social leader is described as a "pro-Morales ideologue" and another as a "top Evo Morales adviser and anti-free trade and globalization guru."

In almost all of the Peru cables, the US government interprets the enemies of corporate power as being enemies of the United States. As a result, leftist activists and community organizers, particularly those who  threaten corporate profits, are regularly targeted. Unions, environmentalists and indigenous communities that challenge multinationals are consistently regarded with disdain and viewed as hostile villains. The US government's propensity at conflating threats to corporate interests as threats to US interests should alarm anyone who values democracy.

What don't we know about?
Besides getting a good laugh at watching pathetically corrupt diplomats whore themselves out to corporate executives, these cables give us a rare glimpse at American diplomatic subservience to corporate behemoths regardless of the costs to people and the environment.
It appears that the collusion between corporate executives and US diplomats is taking place at an ever accelerating rate around the globe, yet more and more, these shady endeavors are shrouded in secrecy. Transparency and accountability have taken such a devastating blow over the past decade, that whistleblowers and media outlets such as WikiLeaks are the only mechanisms left still capable of shedding light on the consequences of the unbridled corporate influence infecting our government.

With tens of thousands of WikiLeaks embassy cables still waiting to be published, there’s sure to be hundreds if not thousands of episodes involving US corporate and government collusion that have yet to be discovered.