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The Wrongologist

Geopolitics, Power and Political Economy

Monday Wake Up Call – June 15, 2020

The Daily Escape:

Bright Angel Trail, in the middle foreground, Grand Canyon NP – photo by glowrocks

The chickens are coming home to roost. Michael Flor was originally the longest-hospitalized COVID-19 patient. Somehow, he survived. He came close enough to death that a night-shift nurse held a phone to his ear while his wife and kids said their final goodbyes.

Today, he’s recovering at home in West Seattle, WA. That’s the good news. The bad news is that he just got the bill. From the Seattle Times:

“The total tab for his bout with the coronavirus:…$1,122,501.04, to be exact. All in one bill that’s more like a book because it runs to 181 pages.”

More from the Seattle Times:

“…the charge for his room in the intensive care unit was billed at $9,736 per day. Due to the contagious nature of the virus, the room was sealed and could only be entered by medical workers wearing plastic suits and headgear. For 42 days he was in this isolation chamber, for a total charged cost of $408,912.

He also was on a mechanical ventilator for 29 days, with the use of the machine billed at $2,835 per day, for a total of $82,215. About a quarter of the bill is drug costs.”

Those charges don’t include the two weeks of recuperating he did in a rehabilitation facility.

Since Flor has Medicare, it is unclear how much he will actually have to pay out of pocket. Further, since Congress set aside more than $100 billion to help hospitals and insurance companies defray the costs of the pandemic, it’s possible that Mr. Flor may not have to pay even the out-of-pocket charges normally billed by his Medicare Advantage policy, but that remains to be seen.

The insurance industry has estimated treatment costs of COVID-19 could top $500 billion, so unless Congress steps up with more money, co-pays for COVID will soon become injurious.

One outcome of the pandemic may be that America takes a closer look at universal health insurance. There are many detractors in Congress, but the sticker shock that so many families will see from COVID-19 cases may restart the discussion. Medicare for all could work: A single payer with a set system of prices would be good for employers and employees alike.

It will be hard. Universal health insurance is such a tough problem to solve that only 31 out of 32 developed nations have managed to do it.

A second issue for today is the killing of Rayshard Brooks in Atlanta over the weekend. From the Atlanta Journal-Constitution:

“Officers were called to the restaurant after receiving a complaint about a man asleep in his vehicle, which forced other customers to go around his car to get their food at the window. The man, Atlanta resident Rayshard Brooks, was given a field sobriety test, which he reportedly failed…”

Brooks grabbed a cop’s Taser. More:

“…surveillance footage from the Wendy’s appeared to show Brooks turn toward the police and attempt to fire the Taser as he ran away. That’s when the officer chasing Brooks pulled out his gun and shot him…”

Tasers are a form of de-escalation instead of using firearms. The Taser momentarily incapacitates, but ultimately doesn’t threaten life. So shouldn’t it follow that if a suspect steals a cop’s Taser and threatens to use it, the cop can’t just shoot him dead since he’s being threatened by an ultimately harmless weapon?

The cops had his car, it’s likely they knew where he lived. They could have picked him up at any time. Instead, they killed him. The police tried to do something, the suspect resisted, and in the heat of the moment, the cop escalated to show that he’s in charge. It was a terrible reason to kill someone.

Time to wake up America! We have both out-of-control policing and out-of-control capitalism harming our society. To help you wake up, listen to Sly and the Family Stone’s 1969 song, “Everyday People”. This is Playing for Change again, along with Turnaround Arts students. Trust Wrongo and watch:

Sample Lyric:

Sometimes I’m right and I can be wrong
My own beliefs are in my song
The butcher, the banker, the drummer and then
Makes no difference what group I’m in
I am everyday people, yeah, yeah

And different strokes for different folks
And so on and so on and scooby dooby doo-bee
Ooh, sha sha
We got to live together
I am no better and neither are you
We are the same whatever we do

Of course there was racism back in 1968, but the musicians were preaching integration. Despite the racism back then, people were optimistic. Compare that to today.

Those who read the Wrongologist in email can view the video here.

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World’s Most Expensive Health Care System Can’t Provide Minimum PPE

The Daily Escape:

Tim Hunter, BSN, in Brooklyn, NY – April 2020 photo by Tim Hunter

Tim Hunter, an acquaintance from the world of show dogs, is a nurse living in Buffalo, NY. In early April, he accepted a traveling nurse assignment at Kingsbrook Jewish Memorial’s ICU in Brooklyn, NY to help out on the front lines of the COVID-19 fight. Tim posts on his experiences, and he graciously agreed to share this dispatch from earlier this week:

“Wednesday May 6th starts Nurse’s Week 2020

The last time we worked, we were informed that we will, moving forward, only be getting our body suits and can no longer get a disposable gown to put over the suit. Big freaking deal right? Wrong. What does this mean? This means we will enter rooms “protected” but after leaving a room we will be tracking COVID all over the unit. Nurses are buying spray alcohol to try and kill whatever lands on the suit so we don’t risk getting each other sick. Or do you take off the suit in between care? Absolutely not. What if you need to intervene right away? There’s no time to get it on.

People who have no relevant education or experience are protesting having to sit at home, while we watch people who have been intubated for weeks struggle, while we’re standing in patient’s rooms and intervening we’re looking at posters of patient’s family, of these people who are dancing at their daughter’s wedding and giving their grandson a piggy back ride. People that were once fine and people that should be able to still be doing those things.

We drive to work in dead silence because we have no idea what we’re in for. Maybe it will be a super typical hospital shift, or maybe it will be the worst night you’ve ever worked.

We’re watching people get tracheostomies after weeks of intubation in hopes that MAYBE someday they’ll be okay enough to have their life back. We’re drying patient’s tears when they wake up from their sedation and they’re terrified!

We’re watching people who we were once hopeful would maybe get off of the vent sustain lung injuries from not being able to handle the pressures of mechanical ventilation any longer.
We listen to family members cry because they don’t know if they will ever see their loved one again, and they mourn that they’re going through this alone.

We see patients grabbing our hands begging us not to leave rooms because they’re lonely, and scared.

We walk past tractor trailer trucks full of dead bodies on our way in and out of work every night. Because there is no way to manage, no morgue can keep up with the amount of people dying. Even now with the “down swing”.

And the end of a shift we feel like our head is in a vice grip, and literally crave a breath of actual fresh air after rebreathing CO2 all night.

We wake up in the middle of the night with a panic because of a headache or any symptom and literally fret over that one time we did compressions or were a part of an intubation, because of how high risk those events are.

You know what nurses want for nurses week?
To know they’re safe, to know that in AMERICA that we can be afforded a shitty disposable gown to help protect ourselves from sitting in a virus. To not become so neurotic that our hands are completely raw from washing them so much. We want you to have enough respect for human life to not make stupid decisions. We want you to pay attention to science and not stupid conspiracy theories.

We don’t want to be called heroes, we don’t want shitty pizza, or signs. We want to be safe, well-staffed, and to not feel like every day we’re risking our own well-being.

Returning to the bedside has been the most amazing thing I’ve ever done, but after this I will go back to my job with an insurance company. While people that actually deserve your accolades keep fighting this.

So think this status is for attention, likes, call it fear mongering or whatever. But really it’s just so maybe for a second you’ll take this seriously. I have 33 days left in my contract to keep fighting with these people, and I honestly hope that things are headed back towards normal when I drive home. But with all of the small gatherings that pop up on social media that you’ve convinced yourself are fine, masses of people standing outside of a damn Dairy Queen, and seeing all the people in streets ignoring social distancing measures, it’s honestly unlikely.

Happy Nurses Week though…”

#EndRant

This is the state of American health care in 2020. Tim, thanks for your bravery and insight.

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Monday Wake Up Call – April 6, 2020

The Daily Escape:

Texas bluebonnets, Round Rock, TX – 2018 photo by dried_fruit

Here are the latest national numbers (which will be out of date by the time you read them). From The COVID Tracking Project: (as of 4/4)

  • Number of daily cases: 305,755, up 33,767 or +12.4% vs. April 3
  • Rate of case increase: 12.4% vs. 13.75% on 4/3 and 15% average for the past week
  • Number of deaths: Total 8,314, up 1,352 vs. April 3
  • Rate of deaths increase 4/4 vs 4/3: 19.4% % vs. 20.4% on 4/3
  • Daily number of tests 4/4 vs. 4/3: 1,623,807, up 226,945 over 4/3
  • Rate of increase in tests: +16.2% vs. previous day

The rates of growth in cases and deaths have begun to slow. In the past week, they are in a decelerating trend, declining by about 1%/day. Testing is growing, which is a very good thing.

Just when you think you can’t get any more cynical about America’s response to the pandemic, we tumble to the fact that about a third of hospital emergency rooms are now staffed by doctors on the payrolls of two physician staffing companies, TeamHealth and Envision Health. They are owned by two Wall Street private equity firms. Envision Healthcare employs 69,000 healthcare workers nationwide while TeamHealth employs 20,000. Private equity firm Blackstone Group owns TeamHealth; Kravis Kohlberg Roberts (KKR) owns Envision. Private equity is the term for a large unregulated pool of money run by financiers who use that money to invest in, lend to, and/or buy companies and restructure them.

Wrongo began hearing that despite the urgent pleas from hospitals on the front lines of the COVOID-19 outbreak, nurses and doctors were being taken off schedules in nearby places once “elective” procedures were suspended, as they are at many hospitals and clinics. That means the associated revenues were lost, or at the very least, postponed.

Here’s a report from Yahoo Finance:

“KKR & Co.-backed Envision, which carries over $7 billion of debt amassed through one of the biggest leveraged buyouts in recent years, reported steep drops at its care facilities. In just two weeks, it suffered declines of 65% to 75% in business at its 168 open ambulatory surgical centers, compared to the same period last year, the company said in a private report to investors. About 90 centers are closed.”

Private equity has taken over more and more of hospital staffing, including emergency departments. The legal fig leaf that allows private equity firms like Blackstone and KKR to play doctor is that their deals are structured so that an individual MD or group of MDs is the nominal owner of the specialty practice, even though the business is stripped of its assets. The practices’ operating contracts are widely believed to strip the MDs of any say in management.

Care of the sick is not the mission of these companies; their mission is to make profits for the private equity firms and its investors. In 2018, Paladin Healthcare, an entity owned by private equity baron Joel Freedman, bought Philadelphia’s Hahnemann University Hospital. This hospital served the poor, and Freedman closed it down so he could use the land to build luxury apartments.

When the city recently asked to use the empty hospital as part of its solution for the Coronavirus pandemic, Freedman demanded $1M/month in rent. Overcharging patients and insurance companies for providing urgent and desperately needed emergency medical care is bad enough. But holding a city hostage?

In another example, STAT reports on another private equity firm: (emphasis by Wrongo)

“Alteon Health, which employs about 1,700 emergency medicine doctors and other physicians who staff hospital emergency rooms across the country, announced it would suspend paid time off, matching contributions to employees’ 401(K) retirement accounts, and discretionary bonuses in response to the pandemic…The company also said it would reduce some clinicians’ hours to the minimum required to maintain health insurance coverage, and that it would convert some salaried employees to hourly status for “maximum staffing flexibility.”

NY’s Governor Cuomo and others are pleading to have doctors come out of retirement, and here we have skilled doctors who have the training and are being asked to work fewer hours? All of the Republican talk about “choice” and “markets” in healthcare is just self-serving BS that benefits their buddies.

Time to wake up America!

Why do private equity firms continue to benefit from the “carried interest” tax loophole? Shouldn’t they shoulder their part of the financial grief the pandemic is causing to our country?

To help you wake up, here is John Lennon’s 1970 song, “Isolation”. It appeared on John Lennon/Plastic Ono Band. It has a whole new meaning in today’s context:

Sample Lyric:

We’re afraid of everyone,

Afraid of the sun.

Isolation

The sun will never disappear,

But the world may not have many years.

Isolation.

Those who read the Wrongologist in email can view the video here. 

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Buffett: Focus on Lower Health Care Costs, Not Corporate Taxes

The Daily Escape:

Ribbon Chapel, Onomichi Japan – photo by Koji Fujii

Andrew Ross Sorkin wrote about Warren Buffet and the Berkshire Hathaway annual meeting in Omaha. Thousands of people attend these meetings, which are known as “Woodstock for capitalists.” Sorkin reports that Buffet made this comment:

The tax system is not crippling our business around the world.

Sorkin said that Mr. Buffett, was blunt and pointed, implicitly rebuking his fellow chief executives, who have been lobbying the Trump administration and Washington lawmakers to lower corporate taxes. Buffett said that those who have been single-focused on seeking relief from their tax bills would be smart to shift their attention to health care costs, which are growing and swallowing evermore corporate profits. The Kaiser Family Foundation reports that 49% of Americans, about 156 million, are insured by their employer. More from Sorkin:

The need for corporate tax relief has become the lodestar of the corner office, with CEOs rhapsodizing  over President Trump’s plan to try to stimulate growth by cutting tax rates for businesses.

But as Mr. Buffett pointed out, these chief executives are missing the bigger issue: As a percentage of our GDP, the cost of maintaining our American health care system is rising at an alarming rate. And Corporate America pays a big (and growing) chunk of that bill.

Buffett wasn’t talking about the cost of health insurance, which is a fraction of the total cost of health care. He suggests that today’s corporate tax rates are a distraction, not a true impediment to growth:

If you go back to 1960 or thereabouts, corporate taxes were about 4% of GDP…And now, they’re about 2 % of GDP.

While tax rates have fallen as a share of gross domestic product, health care costs ballooned:

About 50 years ago, health care was 5% of GDP, and now it’s about 17%.

Buffett is a smart guy. He raises an argument for focusing on the underlying costs of our health care system, something that goes far beyond the debate around the Affordable Care Act, or what will replace it. Buffett says that our global competitiveness has fallen largely because our businesses were paying far more for health care — a tax by another name — than those in other countries.

As Buffett said: (brackets by the Wrongologist)

When American business talks about [corporate taxes] strangling our competitiveness, or that sort of thing, they’re talking about something that as a percentage of GDP has gone down…While medical costs, which are borne to a great extent by business, have swelled.

Here are the facts:

  • In 1960, corporate taxes in the US were about 4% of GDP. The percentage fell steadily, reaching a bottom in 1983 before rising slightly over the last few decades. Today, it is 1.9%.
  • In the meantime, health care costs as a percent of GDP have skyrocketed. Today our health care costs are 17.1% of GDP, up from 13.1% in 1995.
  • Germany’s cost is 11.3%, up from 9.4% during the same period. Japan’s is 10.2%, up from 6.6%. Britain’s health care costs are 9.1% of GDP, up from 6.7% percent in 1995.

That makes our health care cost disadvantage far greater than our tax differential. It harms American companies in particular, since they bear such a large share of those costs, which firms in our competitor countries do not. US Corporations spend $12,591 on average for coverage of a family of four, up 54% since 2005, according to a study by the Kaiser Family Foundation.

But Congress avoids the issue, and CEOs don’t talk about it. A final quote from Warren:

It’s very tough for political parties to attack it…it’s basically a political subject…

In fact, Buffett’s partner, Charlie Munger, is the rare Republican (Buffett is a Democrat) who has advocated for a single-payer health care system. Under his plan, the US would enact a sort of universal type of coverage for all citizens — perhaps along the lines of the Medicaid system.

Which brings Wrongo to his final point: Medicaid expansion is the one part of Obamacare that can be said unequivocally to work. It’s a single payer program funded by the Federal government. So it’s bitterly ironic that the Republican’s reaction to Obamacare is to assault and roll back an existing Federal program, from LBJ days.

Of course, kicking poor people who benefit from Medicaid will always be popular with Republicans. So, Republicans, by making Medicaid worse, will try to restore their natural order of things.

Lazy, uninformed voters = Lazy, uninformed legislators = Lazy, uninformed policy.

It’s that simple.

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Saturday Soother – January 14, 2017

You may have noticed that the Wrongologist has not posted a column since Monday. Life intervened, as we began a to-the-studs kitchen renovation this week. Think about it, no kitchen in January in the Northeast. It’s like camping, but you sleep in your own bed, and use your own shower.

This week, the Trumpathon marched forward, with each day giving us something unique to consider, to react to with disbelief as our Overlord moves to fully take the reins of power.

The commonly accepted story is that the Russians hacked Podesta and the DNC, and that might have helped Trump defeat Clinton. Then there is the “Dossier” of possibly incriminating info that the Russians may, or may not, have on Trump. The story could be false or true, and there is no solid evidence either way.

Trump’s plan to place his business in “trust” is ridiculous, but he has no plan to abide by the spirit of a blind trust, and he’s exempt from the rules for other public servants, so deal with it.

The Democrats didn’t lose to the Republicans because of a Russian conspiracy, but because they didn’t do a good job of governing, for two reasons: First, the economy hasn’t recovered for quite a few Americans. Second, Obama’s record on foreign policy is at best, mixed and is possibly a failure.

Despite his success with Obamacare, we should remember that insurance coverage is not health care. Consider that the US mortality rate is going up. And there is still considerable economic uncertainty: Elevate’s Center for the New Middle Class looked at how much money in the form of an unexpected expense would be a crisis for ordinary Americans. Their study asked 502 nonprime (credit score below 700) and 525 prime Americans (credit score of 700 or above) how they could handle an unexpected expense. They found that:

A bill becomes a crisis for nonprime Americans at $1,400. For Primes, it’s $2,900…

160 million Americans come under the nonprime category, according to the study. That’s half of our population who would have difficulty paying for a trip to the emergency room with a broken arm. Two-thirds of Americans would struggle to cover a $1000 emergency expense. Half of Americans find it hard to pay over $100 a month for health insurance, while the average price nationally in 2017 for a bronze plan is $311 per month for a 30-year-old nonsmoker who does not qualify for subsidies. That means without subsidies, half of America is at serious risk of being uninsured under repeal and replace.

This speaks to our uneven economic recovery better than any average wage or unemployment statistics.

In short, Democrats lost to a very flawed person because they (Dems) ran the country badly for people like those in this study, and those people are upset.

If that didn’t bring you down far enough, there are just six days until the inauguration.

Wow, with all this going on, we need something to help us relax. Today’s soother is Samuel Barber’s “Knoxville: Summer of 1915“, with soprano Dawn Upshaw and the Orchestra of St. Luke’s. Barber was a 20th century American composer, perhaps our best. He was twice awarded the Pulitzer Prize for Music.

He wrote this piece in 1947, based on a prose poem by James Agee. Agee would later use the poem as a preamble to his Pulitzer Prize-winning book, A Death in the Family, published posthumously in 1957. Agee was also the screenwriter for the movie, the African Queen. Here is Knoxville: Summer of 1915:

While this feels operatic, the lyrics are in English. Here is a sample:

It has become that time of evening when people sit on their porches, rocking gently and talking gently and watching the street…People go by; things go by. A horse, drawing a buggy, breaking his hollow iron music on the asphalt; a loud auto; a quiet auto; people in pairs, not in a hurry, scuffling, switching their weight of aestival body, talking casually, the taste hovering over them of vanilla, strawberry, pasteboard and starched milk, the image upon them of lovers and horsemen, squared with clowns in hueless amber.

“Aestival” means of, or occurring in the summer.

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American Exceptionalism Doesn’t Include Your Healthcare

The Republican’s effort to repeal and (maybe) replace the Affordable Care Act (ACA) began today. From NPR:

Opening punches were thrown in what one top Democrat today called “the first big fight” of the new congressional year — the promise by President-elect Donald Trump and GOP lawmakers to repeal and replace the Affordable Care Act.

The Obamacare debate is political and ideological, and it obscures a hard truth about healthcare in America. Historically, we spend more money than any other country on healthcare.

In the late 1990s, the US spent roughly 13% of its GDP on healthcare, compared to about a 9.5% average for all high income countries. However, the difference has steadily increased. Last year, as the ACA continued to roll out, healthcare costs hit 17.5% of GDP, the highest ever. That’s $9,695 per person.

We spend over $3 trillion on healthcare annually, and that rate of spending is expected to accelerate over the next decade. With all the debate about Obamacare, and what should replace it if it is repealed, we are ignoring what healthcare costs in the US, relative to other high income countries. It may surprise you that America doesn’t have better care than other high income countries, if we compare life expectancy to per capita health expenditures:

Source: Visual Capitalist

Americans spend more money, but do not receive similar results to other countries using the basic metric of life expectancy. The chart shows that the divergence started before 1980, and it widens all the way to 2014. While the 2015 statistics are not plotted on this chart, but we know that the healthcare expense in 2015 was 17.5% of GDP, so the divergence is likely to continue to widen.

The conclusion is that while our healthcare spending is considerably higher than in other high income countries, it’s also relatively less effective. If America spent more money and got the same results, we might say that our system is unique, but it produces similar outcomes, so let’s keep it the way it is.

But in fact, Americans on average live shorter lives than people in other high income countries. In fact, life expectancy went down in 2015:

The overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer’s disease, respiratory disease, kidney disease and diabetes. More Americans also died from unintentional injuries and suicide.

We have a broken political system, one that cannot deal with the root cause of our expensive healthcare, or the fact that our healthcare system simply doesn’t produce the results that others can.

Despite the talk by Republicans about Obamacare being socialized medicine, our system is private, with the exception of the health insurance provided by Medicare and Medicaid. Our insurance companies are private, our physicians and providers are private.

By some estimates, the private multi-payer system in the US adds $0.38 for every dollar spent to cover the profits and the discreet management organizations that exist in our multi-payer system. The problem is that there is so much money (over $1 trillion) going to the private players, that they will fight like hell to keep the system as it is.

And they have the lobbying funds available to fight to keep the status quo. Thus, we will continue to deal with excessive costs regardless of no Obamacare, or some jury-rigged GOP Obamacare replacement.

In our Exceptional system, the fact is that even though you pay for health insurance, you are not the actual customer. When you go to the doctor or to the hospital, you are not the actual customer. The Insurance companies are the true customers of the doctors and the hospitals, and for the insurance companies, their shareholders are the true customers.

And before you question the statistics, saying for example, that the US counts infant deaths differently than they do in other countries, the infant death rate in the US is about 0.5% of births, and with about 4 million births in the US that translates into about 20,000 infant deaths. If you remove 20,000 people assigning them a life span of zero, in a country of 320 million people, the overall average life expectancy rises by only 1.81 days (43.4 hours). That is the statistical life span increase assuming we had zero infant deaths. (Please check Wrongo’s math).

Higher infant death rates have virtually no effect on the results shown on the chart.

Remember: Whomever is getting that extra $1 Trillion dollars every year has a trillion reasons why they should keep getting it.

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