Income inequality among Americans has been a major subject of debate for a decade, and ever more so with leftwing extremists now dominating the ranks of Democratic presidential aspirants. So, let’s get the basic facts and issues straight.
A salient claim in this area comes from the French economist Thomas Piketty in his 2014 book, Capital in the Twenty-first Century, a 700-page tome. His starting point is that the rate of return on capital investment is generally significantly greater than the growth rate of a market economy (or, r>>g). This is generally uncontested.
So, Piketty concludes that the rich, whose incomes derive greatly from their ownership of capital, will get ever greatly richer. On the other hand, the middle and lower classes, whose incomes derive mainly from their labor, will see those incomes increase only at the growth rate of the economy. Hence, they will fall ever farther behind the upper-income people.
If that were the full story, why didn’t income inequality spiral up long ago? In part, it’s because taxes burden upper classes very disproportionately and government transfer payments (mainly welfare, food stamps and health-care subsidies) are concentrated on the lower classes. Piketty’s comparisons are based on pre-tax income, not including transfer payments, as are almost all the data advanced by those obsessing about income inequality.
These folks also fail to adjust for declining household size in recent decades when they allege falsely that middle and lower family income levels have not increased. And Piketty’s analysis overlooks that the wealthy usually divide their estates among charities and various heirs and other folks when they pass it on, thus counteracting the fast growth of family incomes based on capital.
But the important point is that taxes and transfer payments have continued to grow relative to our economy. So, they now overwhelm every other factor, as shown by recent research by Phil Gramm, former economics professor and chairman of the Senate Banking Committee; and John F. Early, twice assistant commissioner at the federal Bureau of Labor Statistics.
When we consider family incomes after taxes and public and private transfer payments, the story is very different from that based on the pre-tax and -transfers data. That’s because 80 percent of all taxes are paid by the top two income quintiles (that is, the top 40 percent) and 70 percent of all transfer payments are received by the bottom two quintiles. Aggregate taxes paid and transfers received by the middle quintile are almost exactly equal.
The average bottom-quintile household earns $4,908 annually while the average top-quintile household earns $295,904, or 60 times as much. But when we consider the $45,993 additional income the lowest-quintile homes get from public and private transfer payments, less taxes they pay, their average incomes rise to $50,901. For the top quintile, the net of taxes and transfers is a reduction of $100,998, leaving them with $194,906.
So, the real ratio between the top and bottom quintiles is only 3.8 times, not 60 times.
And government and the private sector shift enough net income to the lowest quintile to raise their net income to middle-class levels at $50,901.
So, is a 3.8:1 ratio fair and reasonable?
One important fact is that income mobility is higher in America than in most other countries.
Also, 50 years of increasing transfer payments and rising and progressive taxes have had another effect. When the War on Poverty transfers began in 1967, nearly 70 percent of bottom quintile prime-working-age adults were employed. Today, that figure is only 36 percent. For all the top three quintiles, however, labor-force participation has increased.
Ultimately, though, the question depends on what fairness is, as much as it does on data. Progressives, populists and class warriors erroneously claim it means equal outcomes for everyone. They forget that in market systems income flows to people roughly in proportion to the value they deliver to others – that is, proportionately to their contribution to human wellbeing and the public interest. Not so for systems that politically allocate resources.
Finally, recent research shows that three-quarters of the high incomes made by entrepreneurs flows from their own “human capital” contributions, not from the financial capital they employ. So, yes, 3.8:1 seems quite fair.
Stock photos of “healthcare workers” who attend patients—physicians are no longer distinguishable—usually feature a stethoscope draped around the neck.
But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence, and the rubber tubes by sophisticated electronic gizmos costing at least ten times as much as the humble stethoscope.
High tech is wonderful and increasingly capable, but if the stethoscope is dying, so is the art of clinical medicine.
The proper use of the stethoscope requires the doctor to touch, listen to the patient, and spend some time with a living person, not a computer. Patient and physician must cooperate: “Stop breathing,” “Take a big deep breath,” “Lean forward,” and so on.
It may be true, as Dr. James Thomas said, that graduates in internal medicine and emergency medicine miss as many as half of murmurs using a stethoscope. There are several reasons for this. One is not taking enough time to listen in a quiet room, and failing to perform the special maneuvers required to bring out an otherwise inaudible murmur (lean forward and exhale fully, turn onto your left side, squat then stand up, etc.).
The other is inadequate training. There are excellent recordings of heart sounds and murmurs, which of course would take time away from the time-devouring electronic medical record or “systems-based” medicine. And a recording is not the same thing as a live patient. Much of today’s teaching in physical diagnosis may be by “patient instructors”—paid actors pretending to be patients, who are evaluating the students as the students examine them. Rounds may be in a conference room, focused on the electronic record, instead of at the bedside.
In the old days, all the members of the team got to examine a real patient who had an interesting finding, with the patient’s permission and under the supervision of an attending physician. It seemed to me that patients usually enjoyed being the center of attention and the star of the show, and hearing the professor discuss their case. We learned how to help patients to sit up, and about hairy chests, layers of extra insulation, noisy lung sounds, shortness of breath, and other impediments to an easy examination.
The stethoscope is not just for heart murmurs. It’s for finding subtleties in careful, slow measurement of the blood pressure. It’s for extra or abnormal heart sounds. One can sometimes hear evidence of vascular problems inside the skull, or in the arteries supplying the brain, kidneys, or limbs. Or signs of intestinal obstruction. One can check to make sure a breathing tube is in the right place.
I don’t know of any bedside technologic wonders for examining the lungs. The stethoscope can detect sensitive signs of heart failure, pneumonia, fluid in the chest, collapsed lung, or airway obstruction. One can listen frequently to monitor changes in the patient’s status—much more efficiently than bringing the portable x-ray machine around.
The stethoscope works even when the power is off, the batteries are dead, the computer is down, or some circuit in the ultrasound device is malfunctioning. It works in facilities too poor to have the latest technology, or with patients who can’t afford to pay for a more expensive examination.
The stethoscope has tremendous capabilities in trained hands. Patients might want to evaluate whether they have a clinician who knows how to use it or is just carrying around a prop or status symbol. If you have symptoms suggestive of a heart or lung problem, does the doctor listen to all the lung fields—upper, mid, and lower, front and back? To at least four places for heart sounds? Are you asked to cough, say “e,” whisper something, take deep breaths or slow quiet ones, or do other maneuvers if something in the history or examination suggests a possible problem? Is the tv off, and are visitors asked to be quiet?
Everybody including doctors loves fancy technology. But before we toss out the old reliable tools, backed by two centuries of experience, how about some serious comparative studies like those the proponents of evidence-based medicine constantly demand?
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views are her own. This is an edited version of her column that originally appeared in pennypress.com. Reprinted with permission.
Apparently, AT&T bought CNN thinking it was some kind of an entertainment outlet.
It is, but only to those of us who understand that Ted Turner’s creation has devolved into something which no longer resembles, in any way, journalism.
How bad is CNN’s coverage of the President?
Well, depending on who you choose to believe, studies from Harvard to the Media Research Center place the ratio of positive to negative coverage between 91% negative to 93%. Every media analyst agrees. CNN’s coverage is so biased that it can hardly be called coverage.
And it seems to be cheerfully brought to you by the American Telephone and Telegraph Company. At 208 S. Akard Street in Dallas, Texas. CEO Randall Stephenson and Chief operating Officer John Stankey.
When these guys bought Directv, I was a fan. When they brought out Directv Now (Now ATT TV Now) as a streaming service I was and still am a fan. When they bought Warner Media, I was OK with that.
I figured that CNN was already so screwed up, it had only one way to go—up. I was wrong.
I was against the Justice Department’s antitrust action. Still am.
That said, who knew that the two executives I listed above (along with their emails) were closet liberals?
My suspicion still is that they’re not. What they, are, I think, is scared to death—like the dog which caught the car. They have no idea what to do. Owning HBO is one thing. You can always disavow Bill Maher.
But a news outlet? That involves editorial judgment and CNN already had less than none. It needs grown-ups to instill some discipline. Stephenson and Stankey are supposed to be those adults. Only nobody told them. They were too busy getting Hollywood elite sweet nothings blown up their skirts.
On one hand, they don’t want to make the left mad. After all, the left controls show biz—right? On the other hand, they really don’t want to have to choose up sides against a President who could easily be re-elected. Much of their communications business is heavily regulated. And, just to make things interesting, an activist management company, Elliott Management, took a $3.2-billion position in AT&T and wants change as well as seats on the Board.
So, wouldn’t the smart money be to make those clowns in Atlanta actually run a news outlet as opposed to taking virtually every opportunity to tilt to the radical left?
Apparently, Mr. Stephenson’s testicles were there when he bought into the entertainment business, but seem to have softened when it comes to making tough decisions regarding the content of his acquisitions which could ultimately send his share price plummeting.
Here’s a hint as to how another executive has handled it.
Apple’s Tim Cook—hardly a Trump fan—has kept an open channel to the President even though he supported Trump’s 2016 opponent.
That makes sense, considering their common interests, especially where it comes to China, trade and intellectual property.
Do you really think Trump would refuse Stephenson’s call?
As long as his company is channeling Nancy Pelosi, it is probably a difficult call to have.
But if Stephenson and Stankey could say, with straight faces, that they are aiming to make CNN a “just the facts” news outlet, you can bet Trump would take that call.
It’s high time the folks on Akard Street in Dallas started worrying about their shareholder value. They could fix CNN in two weeks. Nobody is asking that they try and duplicate Fox. Just be fair. If they don’t, and 63,000,000 Trump voters take offense, well, they don’t make fallout shelters deep enough to protect them from the economic consequences.
What are the main social, political and economic problems we face today?
I think they fall into two groups, economic-political and cultural.
The economic-political issues are the continuing and still growing over-reach of government, both domestically and in international affairs. Domestically, this means excess spending, taxing and borrowing by government at all levels since about 1960 – an excess that keeps growing every decade. These fiscal problems are enabled to some extent by the federal monetary policy of printing excess dollars and thus inflating the currency.
It also includes the ever-growing excess in regulation of all kinds – health, safety, environmental and economic. Plus government expansion into ever more sectors of the economy as a direct provider of services that would better be served by private markets.
The growing regulatory and intervention excess together make up the bulk of the modern administrative state; combined with excess government spending, it depresses economic growth. Slowing economic growth means people on average are less well-off than they would be without these excesses. That is, government excess diminishes aggregate human wellbeing – and also fairness.
Thus, from the 1960s to the Great Recession, we had real per-person growth in incomes of about 2 to 2.5 percent per year. During that time, the growing government excess was offset by favorable trends in population growth, labor force participation, debt both public and private, foreign trade and international economic growth. These trends are somewhat organic, but also greatly influenced by public policy.
In this century, all those favorable trends have reversed or slowed, and growth in government spending, regulation, etc. has continued. So, for the last decade, our per-person income growth has been less than half of what we all grew up with.
Per person real growth at 2 to 2.5 percent per year means that incomes, wealth and overall wellbeing double each generation. That’s a recipe for real progress – new medical cures, better diets, living standards of all kinds – and for general human happiness.
Growth at less than half those rates is a recipe for unhappiness, economic stagnation, political polarization and social upheaval such as we’ve seen in recent years. It will continue for as long as we have slow growth. And with continued government excess and the other problems driven by public policy, these problems may last for a long time.
A particular aspect will exacerbate these problems in the future. Generous payouts for social security, Medicare, and pension and benefits systems constitute a transfer of income from young people to older folks. These Ponzi schemes are, like all such schemes, unsustainable. They will breakdown or blow up in the future, damaging many people, families and businesses, and producing more social and political upheaval.
What’s the government excess in foreign affairs?
With the collapse of the Soviet evil empire – which, thank goodness, we helped precipitate – our foreign and intelligence Deep State looked for new adventures to keep its numbers employed and growing. The Deep State is the illegitimate child of the modern administrative state.
Certainly, Islamic-fascism is a major problem, but it doesn’t justify our continuous involvement in war in the Mideast and elsewhere, as favored by the Deep State.
It’s also promoting more strategic responses to our next major international problem, the ever-aggressive Chinese state. However, despite Chinese theft of intellectual property and similar aggressions, a trade war and tariffs are not the answer. They diminish overall human wellbeing here and in China.
Participation trophies, trigger warnings, safe spaces, etc. get more attention than they deserve. But they are the tip of the spear, reflecting a softening of society, a cult celebrating victim status, corrosive identity politics, and a deep sense of entitlement. These, coupled with government over-reach in social and political matters, are leading to an inversion of fundamental historic values and rights such as freedom of speech and religion, due process and the presumption of innocence, and Second Amendment self-defense.
What to do?
First, live a good life as a spouse, parent, friend, neighbor and citizen. Second, stay politically active to leave all our children and heirs a better legacy and life. For their sake, don’t give up.
What if purchasing medical products and services were like buying peanut butter? Grocery stores have several brands and varieties: smooth, chunky, old-fashioned, natural, organic, no added sugar, reduced fat, no-stir, and pre-mixed with jelly with clearly marked prices ranging from $1.75 for the store’s generic brand to $7 for the over-priced Yuppie brand. After carefully examining the labels, our shopper chose a 16-ounce, $5 jar of no-added-sugar peanut butter. She paid the cashier $5 for the peanut butter and went home.
If our shoppers were transported to the universe of medical billing with the $5 jar of peanut butter, the shopper with Medicare would pay $1.00 but her grandchild will be presented with a bill for $4. When the shopper with private health insurance attempts to pay, the cashier becomes unglued. The shopper cannot say whether she met her deductible or has a co-payment, and whether the brand of peanut butter is approved by the network. She really wants the peanut butter so she grabs the generic from the shelf and pays the $1.75. Our privately insured shopper was pleasantly surprised at the generic’s good taste and healthful ingredients, her wallet was happy for the cost savings, and she was glad not to have the middleman hassle.
Comparison shopping is one pillar of bringing sanity to the high cost of medical care, but the opacity of the pricing system for medical costs limits the value of posting list prices to encourage lower costs through shaming, competition, and choice. In addition to research and development, manufacturing, and distribution costs, drug costs are affected by additional layers of middlemen: pharmacy benefit managers (PBMs) and insurers. Using a “trade secret” process, PBMs negotiate discounts and rebates for private and government insurers. The money saved is supposed to go back to the government (taxpayers) or to insurers to lower premiums or otherwise benefit patients. PBMs typically are paid by a percentage of the rebate or discount off the list price. The higher the price, the bigger the rebate. Thus, the rebate system gives an incentive to raise list prices rather than placing the lowest-priced drug on the insurer’s formulary. (This same system is used by Group Purchasing Organizations (GPOs) for hospital product purchases.)
An analysis of the effect of California’s 2-year old drug price transparency law illustrates the complexity of pricing. Despite being compelled to post list prices, pharmaceutical companies raised the list price for wholesalers by a median of 25.8 percent but the data did not indicate the “price” that consumers actually paid. Moreover, with medical services and products the simple What the Market Will Bear (WTMWB) pricing method works because either the medication is essential (e.g., Epi-Pen®), has no alternative, is in short supply, or the medical consumer is not paying directly for the services.
Similarly, publishing hospital the charge description master (“chargemaster”). i.e., the standard industry price does not give consumers enough information to make a rational choice regarding elective medical services. The data necessary to make price comparisons depends on an individual’s circumstances. More relevant than the chargemaster price, a self-pay patient needs to know the lowest possible cash price. A patient with health insurance must know (1) whether the hospital is in the insurance network, (2) the price negotiated between the health care provider and insurer (including Medicare), (3) the amount and method of calculating cost-sharing, (4) the amount Medicare or other insurer will pay for services performed in a physician’s office in contrast to the hospital which tags on a “facility fee.”
Transparency is one tool for lowering costs through choice. As one of many studies on hospital consolidation noted, “The Sky’s the Limit” on prices where there is lack of competition. But the difficulties of achieving useful price transparency must not be a cue for the government to initiate bureaucratic band-aids. As we have seen with Obamacare, forcing insurers to pay more of the costs leads to higher premiums, deductibles, and/or co-pays.
Nor should the government impose price caps. President Nixon’s 1971 wage and price freeze brought product shortages—which we are already facing with certain drugs, including anesthetics and chemotherapy agents. If the government sticks to enforcing anti-trust laws, a competitive market will thrive. The court house door anti-trust settlement by Northern California’s Sutter Health sends a message to big hospital chains to stop using their market share to inflate prices or require insurers to join their networks on an all-or-nothing basis to prevent insurers from negotiating lower prices at individual hospitals.
If we can get to the point of direct exchange of money for goods and services and reserve health insurance for major expenses, we can see costs decrease just as we have seen with the Surgery Center of Oklahoma over the last 10 years.
Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). Her opinions, medical or otherwise, are her own. She is a guest columnist and this is an edited version of her article originally written for pennypress.com, reprinted with permission.
United States Attorney General Bill Barr recently spoke at Notre Dame University. Last week I quoted from the first half of that speech. Today, from the second half. I add no commentary because he says it all so well:
“The call comes for more and more social programs to deal with the wreckage. While we think we are solving problems, we are underwriting them.
“Interestingly, this idea of the State as the alleviator of bad consequences has given rise to a new moral system that goes hand-in-hand with the secularization of society. It can be called the system of “macro-morality.” It is in some ways an inversion of Christian morality.
“Christianity teaches a micro-morality. We transform the world by focusing on our own personal morality and transformation.
“The new secular religion teaches macro-morality. One’s morality is not gauged by their private conduct, but rather on their commitment to political causes and collective action to address social problems.
“This system allows us to not worry so much about the strictures on our private lives, while we find salvation on the picket-line. We can signal our finely-tuned moral sensibilities by demonstrating for this cause or that.
“Something happened recently that crystalized the difference between these moral systems. I was attending Mass at a parish I did not usually go to in Washington, D.C. At the end of the Mass, the Chairman of the Social Justice Committee got up to give his report to the parish. He pointed to the growing homeless problem in D.C. and explained that more mobile soup kitchens were needed to feed them.
“This being a Catholic church, I expected him to call for volunteers to go out and provide this need. Instead, he recounted all the visits that the Committee had made to the D.C. government to lobby for higher taxes and more spending to fund mobile soup kitchen.
“A third phenomenon … is the way law is being used as a battering ram to break down traditional moral values and to establish moral relativism as a new orthodoxy.
“First, either through legislation but more frequently through judicial interpretation, secularists have been continually seeking to eliminate laws that reflect traditional moral norms.
“More recently, we have seen the law used aggressively to force religious people and entities to subscribe to practices and policies that are antithetical to their faith.
“The problem is not that religion is being forced on others. The problem is that irreligion and secular values are being forced on people of faith.
“[M]ilitant secularists today do not have a live and let live spirit – they are not content to leave religious people alone to practice their faith. Instead, they seem to take a delight in compelling people to violate their conscience.
“For example, the last Administration sought to force religious employers, including Catholic religious orders, to violate their sincerely held religious views by funding contraceptive and abortifacient coverage in their health plans.
“This refusal to accommodate the free exercise of religion is relatively recent. Just 25 years ago, there was broad consensus in our society that our laws should accommodate religious belief.
“Ground zero for these attacks on religion are the schools.
“The first front relates to the content of public school curriculum. Many states are adopting curriculum that is incompatible with traditional religious principles according to which parents are attempting to raise their children. They often do so without any opt out for religious families … [or] even warn[ing] parents about the lessons they plan to teach on controversial subjects relating to sexual behavior and relationships.
“A second axis of attack in the realm of education are state policies designed to starve religious schools of generally-available funds and encouraging students to choose secular options. [Cites Montana action based on anti-Catholic Blaine provision in its constitution.]
“A third kind of assault on religious freedom in education have been recent efforts to use state laws to force religious schools to adhere to secular orthodoxy. [Cites suit to force Catholic schools to employ teachers in same-sex marriages.]
“[A]s long as I am Attorney General, the Department of Justice will … fight for the most cherished of our liberties: the freedom to live according to our faith.”
Until last Sunday night, I was still an agnostic World Series fan.
I have had connections with the Kansas City Royals and the Anaheim Angels over the years I have owned radio stations and I grew up between the Cubs and the Cards.
I have absolutely zero connections with either the Washington Nationals or the Houston Astros. When they both got into the series, I looked forward to a “may the best team win” kind of series.
But when the President attended Game 5 in Washington’s taxpayer-built stadium, he was introduced. And booed.
Those self-entitled Washington dumbasses weren’t actually booing the President as much as they were booing the 63,000,000 of us in real America who elected him.
Washington is a town which is packed with people who want things one way. Their way. They don’t want us interrupting their making a fine living at our expense. Even if it comes down to a baseball game.
Now the President took it very well. He wasn’t the first President to be booed and certainly won’t be the last.
But I’m still more than a little bit pissed off.
Not for the disrespect to the office, which I would have resented for any President.
But for the disrespect to America. That America which is called “flyover country” by those who were doing the booing.
Who, exactly, do these idiots think they are? It looked to me like Washington, D.C. giving the rest of America—at least that part west of the Hudson River, East of the LA County line and South of the Cook County line—an upraised middle finger.
Now, if it were simply about baseball, well, where I grew up, you had to choose up sides between the Cubs and the Cards. I could take it. But we all know it’s not. It’s about the swamp. It’s about people who make a lot of money on our backs both in and out of government but almost always with money which comes from the very people they were booing.
These are the people who—like fired FBI Agent Peter Strzok—say things like “Just went to a Southern Virginia Walmart. I could smell the Trump support.” Which he texted on an FBI cell phone, which we paid for, to his illicit lover, FBI lawyer Lisa Page, prior to the 2016 election.
Truth be told, they think that Houston is flyover country. Just another place where you could “smell” the Trump support.
Baseball is thought of as our national pastime. Apparently everywhere but Washington DC, where politics is a blood sport and anything which advances those politics goes. In my media life—which started as a sportswriter—I have only seen umpires booed at a baseball game.
And I would have a hard time enumerating the baseball games I have seen save to say it is a very large number. Into five figures.
It’s just not a sport which lends itself to that sort of behavior.
Which makes what happened enough to want to see the Nationals move—perhaps to Las Vegas. D.C. doesn’t deserve a team.
As this is being written, the Nationals have forced a game seven and the series will be won or lost in Houston.
Understand that the players were not booing the President or us. Baseball players can be traded, sent down to the minors or cut at the whim of a General Manager. Indeed, some Washington players GREW UP in Houston.
That said, the Nationals would perform just as well if not better with Las Vegas or any other city except the swamp emblazoned on their jerseys.
And any more stupidity from the so-called “fans” of the Nationals should tell Major League Baseball that such a move would probably not offend the 63,000,000 people who voted for this President.
The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.
Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.
The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds.
Medicare’s $16.7 billion per year hospice program is fertile ground for the unscrupulous. Hospices are paid a fixed daily sum for each patient enrolled “regardless of the services provided.” One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice. A recent Office of Inspector General (OIG) report revealed that in 2012 hospices billed Medicare more than $250 million for services to patients in long-term care or assisted-living residences who did not require hospice care, costing four times more than the appropriate level of care. Even worse, the OIG found that the quality of care suffered in 31 percent of programs. The bureaucratic morass allows the perpetrators to pocket the fixed fee and skimp on the services.
Further, the government cannot keep track of its program dollars. According to another OIG audit, in 2009, Medicare Prescription Drug program paid $33.6 million and hospice patients paid $3.8 million for medications that should have been included in the hospice daily fee. Even after discovering the snafu, the problem got exponentially worse. In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.
Physicians know what patients want and are acting on it. Free from the restraints of government “healthcare” programs, the physician-led, price-transparent, direct-pay Surgery Center of Oklahoma performs some surgeries for less than the copays of some insurance policies. Direct Primary Care physicians provide 24/7 access and basic labs for as little as $50 per month with at-cost medications and low-priced x-rays.
The corporate private sector has learned a thing or two from innovative physicians. Care Accelerator is Sam’s Club’s version of “affordable [medical care] options with transparent pricing.” To offer relief from high out-of-pocket costs, $50 (individual) to $240 per year (families) buys access to lab screening for diabetes and heart disease, free generic drugs, telehealth, and up to a 30 percent discount on vision, dental, and other ancillary services. Additionally, Walmart is training its own employees for jobs in the health sector and ideally to staff Walmart’s own medical services. For their employees, Apple has “health care built around you” with its AC Wellness that offers office and home visits; Amazon launched its Amazon Care telemedicine services.
Given the outrageous price of drugs—largely due to the pharmacy benefit manager middlemen—Good Rx discount coupons are just what the doctor ordered. Good Rx is free to the consumer and makes money from advertisements on the website and referral fees. One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.
Congress claims it plans a full-frontal attack on the high cost of medical care (with the same results as the war on poverty and drugs?). Frankly, we are better off with Congress engrossed in its impeachment clown show and keeping its nose out of our medical business.
Dr. Singleton is a guest columnist. Her opinions are her own. Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. This is an edited version of her column that originally appeared on pennypress.com. Reprinted with permission.
United States Attorney General Bill Barr recently addressed some important issues at the University of Notre Dame. Excerpts follow (edited for space).
From the Founding Era onward, there was strong consensus about the centrality of religious liberty in the United States.
The imperative of protecting religious freedom was not just a nod in the direction of piety. It reflects the Framers’ belief that religion was indispensable to sustaining our free system of government.
They crafted a magnificent charter of freedom – the United States Constitution – which provides for limited government, while leaving “the People” broadly at liberty to pursue our lives both as individuals and through free associations.
This quantum leap in liberty has been the mainspring of unprecedented human progress, not only for Americans, but for people around the world.
In the 20th century, our form of free society has faced a severe test.
Men are subject to powerful passions and appetites, and, if unrestrained, are capable of ruthlessly riding roughshod over their neighbors and the community at large.
No society can exist without some means for restraining individual rapacity.
But, if you rely on the coercive power of government to impose restraints, this will inevitably lead to a government that is too controlling, and you will end up with no liberty, just tyranny.
So, the Founders decided to take a gamble. They called it a great experiment.
They would leave “the People” broad liberty, limit the coercive power of government, and place their trust in self-discipline and the virtue of the American people.
[I]n the Framers’ view, free government was only suitable and sustainable for a religious people.
Modern secularists dismiss this idea of morality as other-worldly superstition imposed by a kill-joy clergy. In fact, Judeo-Christian moral standards are the ultimate utilitarian rules for human conduct.
They reflect the rules that are best for man, not in the by and by, but in the here and now.
I think we all recognize that over the past 50 years religion has been under increasing attack.
On the other hand, we see the growing ascendency of secularism and the doctrine of moral relativism.
By any honest assessment, the consequences of this moral upheaval have been grim.
Virtually every measure of social pathology continues to gain ground.
Along with the wreckage of the family, we are seeing record levels of depression and mental illness, dispirited young people, soaring suicide rates, increasing numbers of angry and alienated young males, an increase in sense less violence, and a deadly drug epidemic.
[T]he campaign to destroy the traditional moral order has brought with it immense suffering, wreckage, and misery. And yet, the forces of secularism, ignoring these tragic results, press on with even greater militancy.
First is the force, fervor, and comprehensiveness of the assault on religion we are experiencing today. This is not decay: it is organized destruction. Secularists, and their allies among the “progressives,” have marshaled all the force of mass communications, popular culture, the entertainment industry, and academia in an unremitting assault on religion and traditional values.
These instruments are used not only to affirmatively promote secular orthodoxy, but also to drown out and silence opposing voices, and to attack viciously and hold up to ridicule any dissenters.
One of the ironies … is that the secular project has itself become a religion, pursued with religious fervor. It is taking on the trappings of a religion, including inquisitions and excommunication.
But today – in the face of all the increasing pathologies – instead of addressing the underlying cause, we have the State in the role of alleviator of bad consequences. We call on the State to mitigate the social costs of personal misconduct and irresponsibility.
So, the reaction to growing illegitimacy is not sexual responsibility, but abortion.
The reaction to drug addiction is safe injection sites.
The solution to the breakdown of the family is for the State to set itself up as the ersatz husband for single mothers and the ersatz father to their children.
The call comes for more and more social programs to deal with the wreckage. While we think we are solving problems, we are underwriting them.
More next week.
My father was a big shot in the worlds of engineering and education.
He retired as the Dean of the College of Engineering at Bradley University after a years long career, producing hundreds of engineers for companies like Caterpillar. One of those young engineers was NOT me.
If I had come to his office one day, when I was still in college, and told my father that Caterpillar had hired me for (this was the 70s) say a mere $20,000 a month in an unspecified position with unspecified responsibilities he would have come unglued.
He would NOT have been proud and congratulated me.
He would have rightfully called the Chairman at Caterpillar (in those days, his friend William L. Naumann), demand I be fired and would never have allowed such a conflict of interest to take place. (I actually had to fight him over the $200 a month job of running the University’s radio station and he ultimately did have me fired after two years.)
Contrast that with former Vice President Joe Biden.
His son, Hunter, is a drug addict who got himself kicked out of the Navy. Serious skillset there.
His father basically had a few responsibilities as Vice President. In addition to staying alive in the event of the President’s untimely demise, two of those were representing President Obama’s policies in China and the Ukraine.
After he got kicked out of the United States Navy, Hunter hitched a ride to China on Air Force Two and a few days after they returned, Hunter’s private equity company got a BILLION dollar “investment” from China’s government.
Imagine that. Coincidence?
Doubtful. But to listen to the former Vice President, sonny boy didn’t do anything wrong—like he intimated the Trump children have. There is, however, a difference. The Trump children were in business long before their father ran for President.
Does Joe really want to take the position that someone who is a businessman CANNOT serve in public office?
You see, Donald Trump is the first President we have had in many years who is NOT part of the political club. Who is so wealthy he cannot be bought, despite the ridiculous claims by people that, somehow, he has become enriched by becoming President. However much the media hates him, it would be very hard for a President as vilified as he to actually increase his net worth while in office.
And his inability to be bought is just another reason he is vilified by people and institutions which would love to buy him.
How is it that a clown like Joe Biden could use his position to make his son wealthy and look the media in the eye and say that nothing was done wrong? That during his tenure there was no corruption?
That’s the very swamp which Trump is in the process of draining. People expect this crap in DC, just as they used to expect the mob to control Chicago, New York and Las Vegas.
Biden would have you believe that he’s an honest man in Washington—that Donald Trump is corrupt. That using his position as Vice President to enrich his son never happened. And, if it did, well, that’s how things work in big time politics.
The truth can be divined in a quote from a video of Biden talking to the Council on Foreign Relations about a Ukrainian prosecutor who apparently was getting a little too close to Sonny Boy. “I said we’re not going to give you the billion dollars. They said ‘you can’t do that, you have no authority, you’re not the president. I said if the prosecutor’s not fired, you’re not getting the money. Well, son of a bitch, he got fired."
(Editor's note: This quote is taken from a one hour video of Biden (and others) discussing Biden's efforts on behalf of the Obama administration to pressure Ukraine into prosecuting corruption and firing prosecutor Viktor Shokin, who was universally recognized by diplomats and officials as an ineffective prosecutor who refused to go after corrupt politicians. Shokin's office was also investigating Burisma, a company that Biden's son Hunter, was a board of director member. Shokin was later fired and replaced by another prosecutor. Therefor, many are pushing an idea that, Joe Biden pressured Ukraine to fire the prosecutor in order to protect his son who must have done something illegal while he was on the board of directors of this company. The above quote is used as "proof." The first problem with this is that Biden's quote is taken completely out of context and if you watch the full hour video, which is much more interesting than you would expect it to be, it speaks for itself. The second problem is that, if you read about the actual Burisma investigation it dealt with Ukraine's Ministry of Ecology, which allegedly granted special permits, that may or may not have been illegal, to Burisma between 2010 and 2012. Hunter Biden did not join the company until 2014. But, because the investigation was still on going when he joined the company it is factually accurate to say that Hunter Biden was on the board of directors while the company was being investigated by Shokin's office. But, as you can see, it would be impossible for Hunter Biden to have anything to do with the investigation since he wasn't even involved in the company until multiple years after the fact. Finally, the reason Shokin was actually fired was because he refused to go after corrupt politicians. He was replaced by a prosecutor who was known to go after corrupt politicians. So, while it is all true that Hunter Biden raised $1.5 billion with China's state bank by having his fater, who was Vice President at the time and was in China on a state vist, introduce him to some very wealthy Chinese folks, which is a bit shady. There is clearly nothing going on with the no story of the Burisma / Hunter Biden investigation as it was about an issue that was two to four years before Hunter joined the company.)