Relevant and even prescient commentary on news, politics and the economy.

Back To School

In an earlier post, My Education In Going to College, I commented:

what was done most recently by some wonderfully-over-funded people in an effort to get their children into a Tier one school certainly did not have to happen in the manner it did. They could have just approached school authorities and with a “Thornton Mellon’s” (Back to School’s – Rodney Dangerfield) audacity, offered to pay full ride and make a sizeable donation to the school. Maybe I am wrong; but, I do not know of many schools who would turn down a half a $million donation or so and a student who is willing to pay full price at the same time. Schools are short of funding. I am pretty sure this is going on today with little being said about the donations. Perhaps, others here would disagree with me?

It appears my comment is more correct than wishful thinking as detailed in The Atlantic’s “Elite Colleges Constantly Tell Low-Income Students That They Do Not Belong.”

The Atlantic article explores Anthony Jack’s “The Privileged Poor” and gets into the detail of the prevailing wealth at top-tier schools. For instance, it is no secret, many of the students come from elite origins. For example:

“Led by the Harvard economist Raj Chetty a team of researchers found students coming from families in the top 1 percent of household incomes (those who make more than $630,000 a year) are 77 times more likely to be admitted to and attend an Ivy League school than students coming from families who make less than $30,000 a year.” I do not consider this to be a new discovery. Most people go to where they can and to what they can afford. And many end up at for-profits with a hope of achieving some type of equivalency and a chance to succeed.

“The study found that 38 elite colleges have more students who come from families in the top 1 percent than students who come from the bottom 60 percent or families making less than $65,000 a year.” Granted those 1 percenters are not the “real” rich in income as the 1 tenth of 1 percent comprising 115,000 households but, they do have enough money available to influence a school. They do count in the scheme of influencing outcomes.

14% of all the students at the elite colleges such as Stanford, Princeton, or Columbia come from the bottom half of the US income distribution. Before I go on, the author (Jack) details what he identifies as the privileged-poor and the doubly-disadvantaged. Privileged poor students come from low-income backgrounds and more than likely attended wealthy private high schools which gives them familiarity with and an acquired access to the social and cultural capital making people successful at elite universities. In other words, they know the ropes and how to get about. Doubly disadvantaged students arrive at these top institutions from neighborhood public schools many of which are overcrowded and underfunded. These students have excelled, however they are ill-equipped and lack the sociocultural tools necessary to understand the nuances of how these elite colleges operate. The doubly disadvantaged lack the social capital many students the 77-percenters and the privileged poor, the faculty, and the administrators have taken for granted. There are few mentors, councilors, or whatever you want to call them to guide them.

The advantage of the 77-percenters have is in the exposure to better schools, neighborhoods, and economics. For all intents and purposes their parents buy their way into the elite schools through private-school tuition, test prep, donations to colleges, and a myriad of other advantages which opened doors and prepared them to compete. They also rarely experience the same level of skepticism as to whether they have ‘earned’ their place as would those who enter the elite schools as a privileged poor of doubly disadvantaged.

Back to the controversy . . . rather than buy their way into the university with full price tuition and “Thorton Mellon-like” donations, these parents tried a cheaper route to getting their children admitted. Historically, the elite have used wealth to get their kids into top colleges via legal and widely recognized means—legacy, athletic admissions favoring the wealthy, and the use of test preparation to gain an advantage. Some followed the route of Thornton Mellon from “Back To School” and made or offered some nice donations meant to influence the school regardless of whether it paid for a new School of Business building or a revamped sports field.

The parents caught up in the illegal bribery opted instead for a different scheme of conspiracy and bribes. These bribes were cheaper than a building, less costly than paying for years of student preparation, going to sports games and having your child coached, and personally guiding and working with your children. Many were the vacations we took focused around soccer tournaments and many were the meetings we had with teachers and colleges.

Upfront here is the deal; a $million plus full tuition or meet me tonight at such and such place for $500,000 and full tuition. The only difference is how the bribe is made as the thumb is still on the admissions scale of yea or nay.

What is the difference? A bribe is a bribe and while one is illegal, I would say both face a test of morality.

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My Education in Going to College

As I explained in a conversation, what was done most recently by some wonderfully-over-funded people in an effort to get their children into a Tier one school certainly did not have to happen in the manner it did. They could have just approached school authorities and with a “Mellon’s” (Back to School’s – Rodney Dangerfield) audacity and offered to pay full ride and make a sizeable donation to the school. Maybe I am wrong; but, I do not know of many schools who would turn down a half a $million donation or so and a student who is willing to pay full price at the same time. Schools are short of funding. I am pretty sure this is going on today with little being said about the donations. Perhaps, others here would disagree with me?

Unfortunately, I was never so well-funded to initiate a back door funding approach such as what we are reading about today. My field of endeavor being Purchasing, Logistics, Distribution, and other similar disciplines did not command the type of salary to allow me to even hint at $hundreds of thousands or even $tens of thousands. In my field, we did not have the respect and admiration the reported actors had in their fields and accumulate such money. I was also caught in the 10 year economic cycle and one year spent time gaffing up trees and cutting them down. As Rodney would say; “Where does one go to get some respect around here?” It kept my family in one place and it paid the bills.

The Boston Globe’s Jeff Jacoby tells us what his mother said to him while a sophomore in high school; “If you want to go to college, you’d better get a scholarship.” I never had such a discussion with my parents other than my dad telling me not to do what he did. At 19 I was in the military, got out at 22, and married this pretty woman from NYC who in the beginning made more money as a Paralegal than I did with a college education. It paid the bills until such time as I caught up.

Suddenly I had responsibility for more than just myself. So I picked out a small Lasallian Catholic college, used my VA bennies and the state grant to pay for it, and finished up in three years. Never thought of Northwestern or University of Chicago as neither were in the cards and my parents would not have understood it much less pay for either. As a good Baptist I chose a Jesuit University over a Vincentian University for my Masters. Going to school at night then seemed to drag on forever. It was years later when I found out the high school and colleges I attended were pretty good schools. Each year, I donate a few hundred and get invited to various functions which I do not attend. I do not know anyone at these schools other than the Deans.

As advice to my own children, I suggested they go to where the money was. If they offered you grants and scholarships, they wanted you. If all they could conjure up was a subsidized Stafford loan at $3,000/year for a $30,000/year education, they were telling you something. Thank the school for their time and move on to the next one. In the end, it worked and we were also able to finagle a few more $thousand yearly at some pretty good small colleges for each. They do well for themselves and have paid their school loans.

As I sit here in my Levi jeans and ratty-looking Jesuit University sweat shirt writing this, I find myself agreeing with Jacoby and confirming what I already know; “No one needs to attend an elite university to get a decent education or to make a success of their lives, just as no one needs to wear a Dolce and Gabbana sweater to keep warm or drive a Ferrari Enzo to get from here to there.

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PFAS Contamination, the New Flint at Military Bases and Again in Michigan

In parts of Livingston and Oakland counties, the people have been warned not to eat the fish from the Huron River and Kent, Strawberry, Zukey, Gallagher, Loon, Whitewood, Base Line and Portage lakes as well as Hubbell Pond due to the fish being contaminated with PFAS and similar chemicals coming from industries. In 2016, Michigan started to tell people about the impact of PFAS and how dangerous the PFAS and PFOAs are.

PFAS/PFOA are part of a class of man-made chemicals used in many industrial and consumer products to make the products resist heat, stains, water, and grease. Product Examples include: Teflon® cookware, waterproofing fabric and coating on fast food wrappers.

Former Army reservist Spc. Mark Favors, his relatives, and family have lived around Fort Carson and Peterson Air Force Base for years drinking and bathing-in base and off-base water for years. The level of PFAS and PFOA on base around Peterson Air Force Base has been established at 79 to 88,400 parts per trillion on-base wells and 79 to 7,910 parts per trillion in public and private drinking wells off base.

It was not until the EPA published its 70 parts per trillion guidelines did the DOD claim it began to understand how harmful exposure could be and voluntarily took action. Spc. Mark Favors does not buy the excuse. The issue has been explored in-depth by the Colorado Springs Gazette, which produced a timeline dating back to the first concerns about the foam used to fight fires in 1962. Fort Carson stopped using the firefighting foam in 1991 stating, “Firefighting operations that use AFFF must be replaced with nonhazardous substitutes.”

In Michigan, it will take a Flint-sized emergency before it begins to take aggressive action with businesses dumping contaminated water in company drainage pipes going to water reclamation plants. Then too, Livingston County is the richest in income in the state and is also 96% white, an advantage the county has over the City of Flint.

Fifty year old Mark Favors can count at least 16 relatives from around the area who have been diagnosed with cancer; 10 have died. Six of those relatives have died since 2012, including his father at age 69 and two cousins, ages 38 and 54.

“In my family alone, we have had five kidney cancer deaths,” Favors said. “And those people only lived in the contaminated area.”

Many of Favors’ relatives lived near Peterson Air Force Base, where scores of both on-base and off-base water sources have tested significantly above the Environmental Protection Agency’s recommended exposure of 70 parts per trillion of perfluorooctane sulfonate (PFAS) or perfluorooctanoic acid (PFOA). The compounds were part of the military’s firefighting foam until just last year. The same compounds in the foam have been linked to cancers and also developmental delays for fetuses and infants.

In a recent March 6, 2019 House subcommittee hearing, Mark Favors was among those in attendance as the subcommittee was questioning the actions of the Environmental Protection Agency and Department of Defense representatives over the decades long use of PFAS, the failure to regulate it’s usage, provide adequate protection from its usage, and monitor the safe disposal to prevent contamination of ground water and the environment. Knowing its dangers, a reasonable person would have found an alternative to its usage as demonstrated by Fort Carson in 1991. Obvious, some elements of the military were not of that mind.

With a large degree of politeness, House Oversight and Reform subcommittee on the environment chairman Rep. Harley Rouda, D-CA commented:

“To put it charitably, it is unclear why DoD feels justified in passing the buck to the EPA, particularly in light of the evidence suggesting DoD’s awareness of the toxicity of the chemicals since the early 1980s.”

If stationed at a military bases (and who has not been for some period of time?), this is a big issue as many of us were using the water supplied to us at places such as Camp Lejeune where we were drinking and showering in water contaminated with chemicals such as benzene. For those who were at Camp Lejeune for at least 30 days, there is now a list of disorders which the VHA will accept as being attributed to exposure to base water. Some of us have disorders on that list and some of us do not. There are many other military sites where former military and civilian personnel have complained of disorders and illness which they believe is attributed to the bases they were stationed during their enlistment or working as civilians.

In Michigan, there is a site where you can get an idea of how bad the issue is in and around your community. All known PFAS sites in Michigan and check your own area (at the bottom you scroll to find your county and township/community).

Many knowledgeable sources believe the 70 parts per trillion is still too high.

by run75441 (Bill H)

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Brooklyn Heights, NY

Click on the picture to get a great, detailed view of these magnificent and architecturally significant structures. Claude Scales’s Photo of the day: there is a lot of Brooklyn Heights literary history in this photo.

The poet W.H. Auden lived in the top floor apartment of the brownstone row house at One Montague Terrace, nearest the corner of Montague Street and Montague Terrace, in the winter of 1940-41 when he wrote his “New Year Letter.” If you go to the right two doors, to 5 Montague Terrace, you find the house where Thomas Wolfe (not to be confused with the recently deceased Tom Wolfe) worked on his novel “Of Time and the River.” On the left of the photo, the building with the cylindrical tower and turreted top is where the playwright Arthur Miller and his first wife, Mary Slattery, lived during the early years of their marriage, and where he began work on his first Broadway play, “The Man Who Had All the Luck”. — in New York, New York.

Love the buildings and maybe because I worked on a few similar to them using rope or cable suspended scaffolds and ladders in downtown or near downtown Chicago. Harvard attorney Claude Scales is the photo-artist-author of this snapshot and commentary stolen from Facebook. I know him from when I would comment at Slate Magazine (along with JackD) when it was a cool place to be. Editor Moira Redmond (not to be confused with the English actress) described the Best of The Fray site, “the place I would tell the other editors to go to if you wanted to find out what Americans were actually thinking.”

Hope you enjoy . . .

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Light Sentence

“Legal observers were surprised by the relatively light, 47-month sentence received Thursday by President Trump’s former campaign chairman Paul Manafort, who was convicted in August on charges of tax and bank fraud.

The 69-year-old, who appeared in the court in Virginia in a wheelchair and pleaded for compassion, could have been sentenced to up to 24 years in federal prison.

With time served, Thursday’s sentence means Manafort could spend a little more than three years behind bars for this case.

NBC News and MSNBC legal analyst Glenn Kirschner: ‘As a former prosecutor, I’m embarrassed. As an American, I’m upset … I am just as disappointed with Judge Ellis. It’s an outrage and it’s disrespectful of the American people.'”

I have been in level 4, 2, and 1 prisons. I used to chase prisoners a long time ago. None of these prisons are a walk in the park. The prison up in Pugsley, Michigan was a level 1 and one of the most dangerous ones in the state as they transferred a bunch of long timers there who did not give a . . . . . you know what I mean. For this peace of garbage ‘Manafort’ it has to be a huge let down having to associate with the lesser human beings who will be making fun of him. Lets see what the next sentencing brings. If they run it consecutively and it goes over 10 years, he will go to a Level 4.

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Pentagon to Tap Leftover Military Pay Funding

“The Pentagon is planning to tap $1 billion in leftover funds from military pay and pension accounts to help President Donald Trump pay for his long-sought border wall, a top Senate Democrat said Thursday.

Sen. Dick Durbin, D-IL ‘It’s coming out of military pay and pensions. $1 billion. That’s the plan.

The funds are available because Army recruitment is down and a voluntary early military retirement program is being underutilized.’

The development comes as Pentagon officials are seeking to minimize the amount of wall money that would come from military construction projects that are so cherished by lawmakers.

‘Imagine the Democrats making that proposal — that for whatever our project is, we’re going to cut military pay and pensions.'”

Gee, did anyone ever think of tossing this into the VHA funding since the VA now has to pay for the Choice program which Trump said he will not fund.

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The Lost People . . .

Over heard in the Comments Section:

EMichael: “I do love the term ‘Goober Safari’”.

“I am as tired as anyone else is at the seemingly endless Goober safaris into those benighted precincts of Americans who helped hand us El Caudillo del Mar-a-Lago as our president*. I am even more tired of being told that the prescription for getting rid of this guy is to romance the daylights out of the unreconstructed ignorami who voted for him in the first place.

So imagine my complete lack of surprise when The New York Times sent yet another expedition out into the hinter-boondocks to see what the plaid-cap and camo set is thinking these days.

‘But, listening to strategists and voters in a critical state for Democrats, the midterms feel like a long time ago. Instead, there are widespread worries that the momentum in Pennsylvania, and in other key Rust Belt states, could screech to a halt if the issues in the 2020 presidential primaries and the party’s eventual nominee stray too far left for the region’s many centrist voters. “The more we have presidential candidates or newly elected congresspeople talking about the Green New Deal, talking about ‘Medicare for all,’ talking about socialism, the more that plays into the Trump campaign’s hands,” said Ed Rendell, a former Pennsylvania governor and national Democratic chairman.’

Jesus H. Christ in a wax museum, have we not heard enough from Ed Fcking Rendell? No presidential candidate—except Donald Trump—is “talking about socialism.” The Green New Deal and Medicare For All are new policy proposals growing from policy positions and philosophies held by Democrats for at least 40 years.

Both are “a Yuengling order for a Pennsylvanian right now,” said Ryan Costello, a former Republican congressman from suburban Philadelphia. That is, someone as familiar as the beer brewed in Pottsville. Mr. Costello said that by nominating a progressive in 2020 — he named Mr. Sanders and Elizabeth Warren — the general election would become a referendum on far-left policies rather than the president.

“The whiplash on the left right now, it’s almost like they didn’t learn the lesson of why they were successful in 2018,” Mr. Costello said.

One of the reasons “they” were successful, of course, was that people like Costello ran like rabbits away from their congressional seats because they saw what was coming at them. So, sure, let’s make certain that Democrats listen to the likes of him. And, of course, there is that stubborn Economic Anxiety in some of these areas that just won’t go away.

We had eight years of nothing,” said Diane Pappert, 75, a retired school guard, referring to President Barack Obama, “and this guy’s trying to clean up everybody’s mess.” Her daughter Angie Hughes, 55, a nurse, had cast the first vote of her life for Mr. Trump. She said she would never vote for a Democrat because she believed that the party favored generous welfare benefits. “When you see people who have three, four, five children to different fathers, they have no plans of ever going to work,” she said.

and then there is . . .

Lou Iezzi, 68, who still works at an auto garage he opened at 19, had voted Democratic for decades before casting a ballot for Mr. Trump. He liked the way he sounded as if he were on the next barstool, and Mr. Iezzi chuckled approvingly recalling Mr. Trump’s dismissive remarks about the newscaster Megyn Kelly in 2015 that were widely interpreted as referring to menstruation. Mr. Iezzi could vote for a Democrat in 2020 if the nominee “sounds like he’s talking honestly,” he said. His choice of the male pronoun was deliberate: “I just can’t see a woman running this country.”

Whadda guy! Buy him a Yuengling. But, for the love of god, don’t tailor a single policy position toward gaining his support. He’s hopelessly lost.”

These People Are Lost. Democrats Shouldn’t Bother Chasing Them., Charles P. Pierce, Esquire Magazine

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Who Beats Out Sanders Other Than Biden?

A Hill-HarrisX poll released Tuesday found that 25 percent of Democrats said they would back Michelle Obama in the party primary over nine other declared or potential candidates, including Sens. Bernie Sanders (I-Vt.), Kamala Harris (D-Calif.), Elizabeth Warren (D-Mass.), and former Rep. Beto O’Rourke (D-Texas). 5% error in Democrat only questioned.

Cited reasons for her being a top choice? She is mostly an unknown, never a candidate, never been on a ballot, avoided a candidate’s public scrutiny, always seems nice, etc. People love her for who she has been, what she has said, and what she exemplifies. There is nothing bad about her. The closest to her, Biden is a real trip and has been in the pocket of Delaware Bankers forever. He personally sponsored bills which have created much of the student loan debt issues today and he comes right out and says it is the student’s fault. The old “I got mine, now you get yours” routine. Biden is as bad as the Bush’s for politics and being beholden.

Hell, I would vote for Michelle.

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Again, Healthcare Cost Drivers Pharma, Doctors, and Hospitals

This should come as no surprise as I have written on the topic of Healthcare Costs and Its Drivers before. In particular, the overriding statistic from an earlier post was 50% of the increase in healthcare costs was due solely to price increases between 1996 and 2013 (JAMA, Factors Associated With . . . . Adjusting for inflation, “annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased from $1.2 trillion to $2.1 trillion or $933.5 billion between 1996 and 2013.” This was broken down into 5 fundamental factors contributing to rising healthcare costs.

– Increased US population size was associated with a 23.1% increase or $269.5 billion

– An aging population was associated with an 11.6% increase or $135.7 billion
– Changes in disease prevalence or incidence (inpatient, outpatient, ED) resulted in spending reductions of 2.4% or $28.2 billion
– Changes in service utilization (inpatient, dental) were not associated with a statistically significant change in spending
– Changes in service price and intensity were associated with a 50.0% increase or $583.5 billion.

Five fundamental factors (Population size, Population aging, Disease prevalence or incidence, Service Utilization, and Service Pricing) were collectively associated with a $933.5 billion increase in annual US health care spending between 1996 through 2013. Represented pictorially, stated objectively, and categorized numerically, I can not make it any more obvious.

Some Explanation

The change in disease prevalence or incidence was associated with a spending reduction of 2.4%, or $28.2 billion while the change in service utilization did not result in a statistically significant change in spending. Said another way, these two factors had little or no impact on the rising cost of healthcare.

The increased healthcare costs from 1996 to 2013 were largely related to Healthcare Service Price and Intensity and secondarily impacted by Population Growth and Population Aging in order of impact. The bar chart reflects all of the impact in changes.

So the aging tsunami of baby boomers has not hit yet and population growth has not greatly impacted the results of this study. In patient stays at hospitals are down as well as out patient use of facilities. The big issue is the change in pricing for inpatient hospital stays and pharmaceuticals. Hospital/clinic consolidations leads to the former even though insurance has been fighting for a reduction in stays. Pharmaceutical has instituted new pricing strategies which we have all read about in the news. Old drugs such as Humalog, Viovo, and the infamous Epipens as well as others are now more expensive. This study points to pricing for pharma and service as the issues.

An example?

There is a tendency to challenge the lifestyle practices of people who indulge in too much. One factor did come out in the increased cost of healthcare. The increase in annual diabetes spending between 1996 and 2013 was $64.4 billion of which $44.4 billion of this increase was pharmaceutical spending. Said another way, two-thirds of the increase in treating diabetes was due simply to the increased pricing of pharmaceutical companies.

And yes, there should be time spent on changing habits where it can be changed and providing the means to do so. However, in 1996 Eli Lilly’s Humalog was $21 per vial. By 2017, the price increased to $275 (700%) for a vial which equates to a one-month supply.

Why has the cost of Humalog increased? “The truth is the improvements in new formularies of old versions which are marginally different, and the clinical benefits of them over the older drugs have been zero.” Just like slapping “new and improved” on the labels of food products with a change of ingredients (which qualifies under USDA and FDA labeling regs)., pharmaceuticals can play the same game and they do.

As the article (“Eli Lilly Raised U.S. Prices Of Diabetes Drug 700 Percent Over 20 Years”) explains, “most patients do not pay the full cost/price of a drug up front and absorb their portion of the cost via an increase in monthly healthcare premiums.” This leads to pharmaceutical companies charging as much as the U.S. insurance companies will let them. Both parties profiting from increased prices. Perhaps Alex Azar the Secretary of Healthcare can explain it better as he was an officer of Eli Lilly when Humalog began its ascend?

Another Study via Health Affairs

A shorter time period extending one year longer than the Jama study, the Health Affairs study supports what is being said in the JAMA study. According to data from the Henry J. Kaiser Family Foundation, total health spending on the privately insured in the United States increased in real terms by nearly 20 percent from 2007 to 2014.

A more recent study funded by the Commonwealth Fund and published by Health Affairs examined other costs impacting healthcare. Commonwealth Fund supported researchers recently analyzed hospital and physician prices for inpatient and hospital-based outpatient services as well as for four high-volume services: cesarean section, vaginal delivery, hospital-based outpatient colonoscopy, and knee replacement. Its findings were as follows:

– From 2007 to 2014, hospital-prices for inpatient care grew 42 percent compared to 18 percent for physician-prices for inpatient hospital care
– For hospital-based outpatient care, hospital-prices rose 25 percent compared to 6 percent for physician-prices
– There was no difference in results between hospitals directly employing physicians and indirectly employing physicians
– Hospital prices accounted for over 60 percent of the total price of hospital-based care.
– Hospital prices accounted for most of the cost of the four high-volume services included in the study. The hospital component ranged from 61 percent for vaginal deliveries to 84 percent for knee replacements.

Sound familiar? The JAMA study looked at both in and out patient costs/prices associated with hospital services and said they were up. The Health Affairs study looks at in patient services for four high volume inpatient services stating they have increased significantly from 2007 to 2014.

What the Health Affairs study Showed

The Health Affairs study also presents a comparison of hospital pricing growth rates as compared to physician pricing growth rates. The study is only a few weeks old and I am surprised I am able to access as much information as I have. While Health Affairs admits the study is a start and more work differentiating other aspects must be done, the study suggests there are significant growth in the bargaining leverage of hospitals as compared to physicians.

If you recall Rusty “Tom” and I engaged in a number of different conversations on healthcare with one of them being hospital consolidations (2013). It is a power grab, as Rusty pointed out, for more market segment and pricing control with those having name-recognition gaining the most. Maggie Mahar also referenced the same issue.

In my own commentary On the Horizon After Obamacare (2014): As it stands and even with its faults, the ACA is a viable solution to many of the issues faced by the uninsured and under-insured; but in itself, it only addresses the delivery-half of the healthcare problem. The other half of the problem rests with the industry delivering the healthcare and the control of pricing through the inherent monopolistic power coming and pushing the industry into greater integration of delivery. As Longman and Hewitt posit,

“the message from Department of Health and Human Services stresses the vast savings possible through a less ‘fragmented and integrated’ health care delivery system. With this vision in mind, HHS officials have been encouraging health care providers to merge into so-called accountable care organizations, or ACOs”; “while on the other side of the Mall, ‘pronouncements from the FTC are about the need to counter the record numbers of hospitals and doctors’ practices merging and using their resulting monopoly power to drive up prices.”

Two different messages from government, greater efficiencies in healthcare through consolidations as ACOs versus monopolistic pricing control in healthcare by large hospital and pharmaceutical corporations an unintended result. There is large amounts of inefficiencies, waste, and rent-taking in healthcare as well as in Medicare which is touted as the go-to by politicians and advocates of it. Lets not make a similar mistake, the creation of any forthcoming healthcare system must first address the costs of healthcare and then the delivery of it not ignoring the quality of the product and its outcome after treatment. Again Maggie Mahar was big on promoting this result emanating from any new system.

While Physician fees grew at a compounded annual rate of 6% for baby deliveries and 1% for office visits between 2003 and 2010, hospitals fees during a similar period grew at 17%.

A measurement of the competitiveness of a hospital within a certain area of the country is done utilizing the Herfindahl-Hirschman Index (HHI). It has been used to measure competition in and around cities. The results of the HHI revealed an increase in the concentration of hospitals from mergers and acquisitions, going from moderately concentrated in 1990 with an HHI numeric of 1570, to more concentrated in 2009 with a HHI of 2500, and with some cities purely monopolistic at 10,000.

Rigorous action by the FTC would certainly go a long way in improving compositeness; however, the FTC has been purposely understaffed by cutting its funding. In place at the FTC is a staff 22 lawyers and economists to monitor a $3 trillion healthcare industry. It is too understaffed to take on such a large industry which would overwhelm it with legalese and paper. Maybe in the next election will bring forth the right person to take on healthcare.

Resources

Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14, Zack Cooper, Stuart Craig, Martin Gaynor, Nir J. Harish, Harlan M. Krumholz, and John Van Reenen, HealthAffairs, February 2019

Hospital Care Prices Rose Faster Than the Cost of Physician Services, Zack Cooper, February, 2019

After Obamacare Phillip Longman and Paul S. Hewitt, Washington Monthly, January – February 2014

by run75441 (Bill H)

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WaPo Sued for $250 million

This is really, really Rich . . .

Nick Sandmann, high school junior who faced off with Native American elder Nathan Phillips on the Lincoln Memorial steps is suing WaPo for $250 million. It is “only the beginning said attorneys Lin Wood and Todd McMurtry, on their firm’s website, noting that it was the ‘first lawsuit’ on Sandmann’s behalf.”

The Nathan Phillips MAGA smirker “video went viral in January as multiple groups collided after Sandmann attended the Right to Life March and Phillips attended the Indigenous People’s March, two separate events. Sandmann did not give way upon Phillp’s approach at the Lincoln Memorial.

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