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Hospitals Gone Wild

9780812996951_custom-6db90c2bec0ca63a130734bf860ac91414ff28bb-s1200-c15New Orleans         There’s one thing that Paul Kiel, reporter for ProPublica.org, Steven Brill, author of the new book, America’s Bitter Pill:  Money, Politics and Backroom Deals and the Fight to Fix Our Broken Healthcare System, Senator Charles Grassley, Republican from Iowa, and I can all agree on about healthcare, and that’s the simple fact that hospitals have gone wild, which was the subject of Wade’sWorld on KABF/88.3 FM recently.

Kiel has been all over the story of Heartland Hospital in St. Joseph, Missouri, famous as a staging area for exploration of the West during the Lewis-and-Clark Expedition, and not a lot since, and their practices of dunning patients and sending them over the financial cliff, despite their supposedly nonprofit and completely tax exempt status.  Over the last few years they have put some 6000 of their patients in collection procedures that involved wage garnishment collecting about $3 million a year from the process.   Heartland has a debt collector of course, but that’s a for-profit subsidiary owned by the nonprofit hospital, so not exactly arms’ length.  Kiel noted that 100 of them were Walmart workers, which gives you a pretty good grasp of how little they make.  The judges there charge 9% interest on the bills, so it’s almost a lifetime sentence.  Kiel noted one case that we talked about where a fellow had to go into the emergency room at Heartland and ended up with a $15000 bill.  He makes about $40,000 for a family of four and ended up with his wages garnished.   Now several years later he’s paid $50,000 in lost wages for that $15,000 bill, and it’s not over yet.  Today he still owes about $26000!  And, he’s not alone.  This story is common for them and common all over the country.

New rules may or may not stop this practice.  Steven Brill, a veteran investigative reporter as well and now a bestselling author with America’s Bitter Pill, made the point firmly saying that the rules mandating that hospitals earn their tax exempt status by actually providing some charity care and forbearance was one of the few provisions in the Affordable Care Act that “actually reduced costs.”  Brill was adamant as well that the Obama Administration had drug their feet on this regulation causing harm to tens of thousands who have been pushed and bullied unnecessarily on their bills or forced into bankruptcy because of the bureaucratic delays in writing the regulations.  As Brill told Wade’s World, he could have written the regs himself in “two hours” in 2010 when the bill passed mandating them, rather than later as the rule goes into effect in 2016.

In talking to Kiel, he shared the fact that even with the 2016 dateline, hospitals better clean up their act.  Senator Charles Grassley in reaction to his story sent a letter to Heartland asking them to account for themselves, which was sure to get a response, and did, as Heartland indicated it would immediately review its procedures.  Grassley has been on the case tracking tax exempt abuse of hospitals and others for a decade and now with the Republicans in control of the Senate is going to have more weapons in his arsenal, so no matter how we might disagree with him on hundreds of other issues, he’s a champion on this score.

Both Kiel and Brill pointed out that hospitals have seen this rule coming with its attendant review of their tax exempt status for years now since Obamacare passed, so they don’t have any excuses for not having cleaned up their act.  It could be that they, and their lobbyists, have been trying to get some last big paydays by squeezing the last pennies out of lower income families with their predatory billing and collection practices.

Hospitals gone wild may not be completely tamed, but they better sober up and get off the beach or they aren’t going to like the stories, videos, and actions forcing them to get right with their patients and communities or suffer the consequences.

Heartland Regional Medical Center, now known as Mosaic Life Care, seizes more money from patients than any other hospital in Missouri.

Heartland Regional Medical Center, now known as Mosaic Life Care, seizes more money from patients than any other hospital in Missouri.

Facebook Rules the World According to Facebook

FACEBOOK_IPO_914259fNew Orleans    There’s nothing so juicy in the world of the billionaires, high flyers, and masters of the universe for the rest of us peons and hoi polloi as when they overstep the boundaries of even standard arrogance.  Not long ago Comcast and its chief lobbyist and bully boy, David Cohen, did so in a lengthy scold which gave everyone a sense of how they would wield their power as a full-on monopoly if the President and the FCC allowed it.   The head of Uber, the ridesharing service and frequent lawbreaker, does so routinely to the degree they are getting pushed out of countries and having to do the “walk of shame” in a number of European cities.  Now on the eve of the big whoops annual winter blowout in Davos, Switzerland, the Facebook folk led by their chief operating officer, Sheryl Sandberg, have leaned into a mess as they claim they are responsible for $227 billion in global economic impact and 4.5 million jobs last year or, as the Wall Street Journal reports, “roughly the gross domestic product of Portugal.”  To risk a pun, even on its face, Facebook must have known this was preposterous.

They bought and paid for the study making such wild claims from the consulting firm Deloitte.  They paid for a high number in assessing their own performance, so not surprisingly they got it, most of which was based on inflating the economic worth of each “like” on Facebook.  Deloitte said that they “looked at how many people responded to events on Facebook and multiplied the estimated number of attendees by the average cost of a pub visit, then added an estimate of the ancillary economic benefits of the gatherings.”  Wow, that just takes the breath way.  Obviously, the Deloitte folks don’t actually use Facebook.  There seems to be no discount value applied to the number of people who might “like” something and then never come back to the site again, which Facebook’s own analytics very accurately document.  The percentages are often infinitely low.  Furthermore on events the discount rate, as any organizer could have told them, can run up to 90% since many will “like” the event or say they will attend just to be supportive, even if it is in a foreign country for crying out loud.  That’s the way Facebook works.  I don’t want to even imagine what Deloitte thinks a so-called “pub visit” costs but given how they did this study, I have a feeling they have spent a lot of time in pubs!

Sandberg and the Facebook self-promo folks who claimed in her statement that they were doing all of this because of a “genuine desire…to understand the economic impact” they were having, and of course increase the ad dollars they could harvest by puffing themselves up.  She thought the fake study might “help influence policies in favor of the tech industry.”   This must be a modern version of Facebook hoping that we all will start saying “what’s good for Facebook is good for the world,” just like the old saying about “what’s good for GM is good for America” went.

Not surprisingly real economists are having a field day of fun with the study.  One from Stanford in the Silicon Valley playpen was plain spoken saying, “The results are meaningless.  Facebook is an effect, not a cause, of the growth of Internet access and use.”  Another said they didn’t create “nearly as many jobs as the report suggests” and that the “study’s calculations” were “bad reasoning.”

The manager of Deloitte’s study cited a European survey saying that 16% of those asked said they “couldn’t live without social media.”  I guess since Facebook claims so much of the world’s economy and employment is coming from their website, we should be glad they are not taking credit for preventing 16% of all Europeans from committing suicide as well.

Anytime you’re ready, Facebookers, take foot out of your mouth and leave “voodoo economics” to the politicians.

Jindal “No Go!”

Governor Jindal Speaks to Members of Henry Jackson Society in London

Governor Jindal Speaks to Members of Henry Jackson Society in London

New Orleans    It’s not often that almost everyone agrees on something throughout the land and perhaps the globe, but Louisiana’s Governor Bobby Jindal, formerly a Republican presidential hopeful, has truly succeeded in bringing everyone together.  He did so with his crazy, controversial remarks to a conservative group in London named after former Senator Henry Jackson from Washington State.  While there he went on at some length about the fact that there were “no go” zones in cities in Britain, France, and elsewhere that non-Muslims and even the police didn’t go that were functionally ruled by sharia law.

When he left Louisiana, he claimed he was on his way to Europe to drum up business for the state.  Hopefully when he’s talking to corporations over there he will mention that he is on the downside of his last term in office and can’t run again, so it may be safe for them to come to the Bayou State without embarrassment.  Definitely, his sudden notoriety will make it clear that they should wait until he’s gone from the governor’s mansion and the coast is clear.

Fox News jumped on the bandwagon with some of its commentators also parroting the “no go” line.  They have quickly apologized four times on the air and retracted every last line of their remarks. The Mayor of Paris has announced that she is going to sue Fox News for slander, and why not.

In Louisiana, where few agree on anything, both newspapers in New Orleans the daily Advocate and the every once in a while Times-Picayune led with editorials making it clear that Jindal’s hate speech didn’t speak for Louisiana.  They were both embarrassed and horrified by his remarks. The last time they agreed so strenuously was in their assessment that Hurricane Katrina was in fact a bad thing!

It’s easy to understand Jindal’s predicament. He thinks he should be president. Fortunately no one else does. The last poll among Republicans had him in the 2 or 3% range in terms of support and recognition. Jindal’s strategy has been to pretty much leave Louisiana alone, it being Louisiana I can’t say “high and dry,” which is somewhat a good thing, and try to carve out some notice for himself on the far right. He’s willing to go speak to right wing groups and church gatherings that no other candidate will touch.  He’s organizing a prayer thing that seems like it’s a path to perdition itself from the way folks are running away from it. The budget in Louisiana is fabricated on oil and gas revenues so any claims Jindal might have had about finances in the state are long gone and all of his tricks with the numbers are going to haunt the rest of his term and whoever is elected along with the citizens of the state for years.

Jindal’s reaction to all of this? Well, he’s doubled down by releasing a 1700 word press statement in Baton Rouge restating the so-called “evidence” of his “no go” remarks.

I think the only place there is really a “no go” rule is that Jindal is no longer welcome in Europe, especially the United Kingdom and France again.  It seems it won’t be long before Louisiana is also a “no go” spot for Jindal as well.

Is “American Sniper” an Anti-War Movie?

fb_shareNew Orleans   The papers are buzzing about the surprising opening weekend success of Clint Eastwood’s latest movie, “American Sniper,” starring Bradley Cooper, who was also nominated for an Academy Award for his performance.Hollywood is scratching its head as if they had found a new audience in the South and the West for war movies.  Quelle shock!

According to the Wall Street Journal eight of the top ten markets for the movie were in the South or Midwest including San Antonio, Oklahoma City, Houston, Nashville, and Albuquerque.  The movie did $105.3 million in business in the US and Canada over the four-day Martin Luther King holiday weekend.  “Sniper” enjoyed the “largest opening ever for a drama or R-rated film and more than doubled the prior record for Martin Luther King Day weekend.”

So what’s up?  Was this just a situation where the yahoos, vets, and necks drove the box office in a red meat, blood curdling frenzy?

We went to see the movie in Chalmette, a working class community downriver from New Orleans, and the theater was packed for a Sunday night flick with most in the audience probably not having a day off for King Day.  The movie was riveting, action-packed, and well-acted.  There was no applause, but virtually no one left their seats until after the credits ran showing real life footage with pictures of Chris Kyle and his wife and the funeral cortege traveling the Dallas interstate and passing crowds of people on the way to a military funeral in Texas Stadium in Arlington, home of the NFL Dallas Cowboys.

Is this the kind of response to the film that should worry progressives and lead them to ask questions about how bloodthirsty we are becoming as a country? My answer would be “no.”

“Sniper” is a movie without any real vocal or visible politics.  In fact one of Kyle’s team questions whether the war is worth it and whether or not we should be in Iraq during their 2nd or 3rd tour together, and dies later.  His own brother leaves him head scratching when he runs into him on his 4th tour expressing plainly his disgust for the war in four letter terms.  For Kyle, reportedly American’s deadliest sniper ever with almost 200 confirmed kills, this is his “job” and his patriotic responsibility to his country, but even more so the movie is clear that it’s personal and about protecting his fellow soldiers and community.  In the movie’s metaphor he’s the “sheepdog” protecting the sheep. The movie makes it obvious the soldiers are untrained and unprepared for this war and clueless and trusting about any big picture. War is hell here, and any viewer can’t mistake that it is blind luck and fickle fortune that allows any of the soldiers to live from day to day, including Kyle, despite his SEAL training and marksmanship.

To the degree that veterans are flocking to the movie and giving it thumbs up as they leave and saying that Eastwood “got it right” in his depictions of Iraq and the war, any sober minded viewer can only conclude that this may be one of the more powerful anti-war movies ever made.  The toll on the battlefield is no more intense than the adjustment on the home front.  The struggle in the field is almost less than the fight later in the VA hospitals.

The moral of the movie seems to me: it’s all right for all of us to love America, but war is crazy, deadly, and permanently wounding.

Global Inequality is Increasing Dangerously

yacht-landscape-billion-oxfamNew Orleans        Rev. Martin Luther King’s last campaign was about poor people and human rights, taking another step down the road from civil rights.  It’s no surprise that Oxfam International, even though based in the United Kingdom, chose the day set aside to celebrate King’s legacy as the day to release a report on the soaring increases in global inequality just in recent years.

Their report is hard to ignore when you look at the figures alone:

In 2014, the richest 1% of people in the world owned 48% of global wealth, leaving just 52% to be shared between the other 99% of adults on the planet.  Almost all of that 52% is owned by those included in the richest 20%, leaving just 5.5% for the remaining 80% of people in the world. If this trend continues of an increasing wealth share to the richest, the top 1% will have more wealth than the remaining 99% of people in just two years… with the wealth share of the top 1% exceeding 50% by 2016.

Rising inequality is not like climate change where you can wonder what the world might look like in 20, 30, 50, or 100 years.  This is happening right this second last year, this year, and next year and demands action.

As startling, we can almost put faces and names on this problem since so few now have so incredibly much:

The wealth of these 80 individuals [at the top of the Forbes list] is now the same as that owned by the bottom 50% of the global population, such that 3.5 billion people share between them the same amount of wealth as that of these extremely wealthy 80 people.5 As the wealth of everyone else has not been increasing at the same rate as that for the top 80, the share of total wealth owned by this group has increased and the gap between the very rich and everyone else has also been increasing. As a result, the number of billionaires who have the same amount of wealth as that of the bottom half of the planet has declined rapidly over the past five years. In 2010, it took 388 billionaires to equal the wealth of the bottom half of the world’s population; by 2014, the figure had fallen to just 80 billionaires

Oxfam’s report is a little different though because it involves more than wringing their hands about the grossness of the inequality.  They bell the cat by pointing out that much of the concentration of wealth is coming in the finance, insurance, health, and pharmaceutical sectors and is correlated directly with not just the amount these industries are over compensating their owners and executives, but also the amount they are investing in lobbying.  Almost $1 billion was spent by the financial industry between lobbying and direct election contributions in the last year.  Healthcare and drugs spent $500 million in lobbying last year.  Oh, yeah, all of that is in the United States, where so much of the wealth is concentrated, but even in the EU the Oxfam count is $150 million euros and $50 million by finance and health respectively.

If you follow the money and want to decrease inequality, it’s hard to ignore the Oxfam argument.  The chicken and the egg question is straightforward in their report.  Curtail the ability of the these industries and the rich to buy special treatment and favors through lobbying and politics, and we might have a chance to finally start narrowing the inequality gap here and abroad between the very, very, very rich and the poor and poorer, which is pretty much the rest of us.

Post-Ferguson: It’s Not the Tactics, It’s the Troops

713Highway Blocked

Boston highway blocking

New Orleans     Historians, celebrities, names in the news, and old warriors of the civil rights movements are being put in the uncomfortable position of being asked by the press as so-called opinion leaders to comment on everything from the movie, Selma, to the tactics of protestors in the post-Ferguson moment of pushback and leap forward for more racial equality and rights.  A lot of the talk seems fuddy-duddy and old fashion as too many try to both line up with the drive to end injustice but shrink from the tactics, often seeming to channel school marms and old aunts.

Street blocking has been a favorite tactic of current protestors with dramatic impact.  In Oakland several weeks ago the interstate along the east Bay was blocked for hours attracting wild publicity.  More recently several dozen protestors chained themselves to 1200 pound concrete barrels and blocked a highway coming into Boston for hours there as well.  There are reports of “speaking truth to power” actions where protestors interrupt lunches in restaurants with largely white clientele to demand that they deal with the issues.

All of this invariably leads to the general wet noodling by outsiders that adopt the standard line that they agree with the goals, but abhor the tactics.

David J. Garrow, the award winning and great historian of the civil rights movement is a good example of a less than helpful tendency to scold and deprecate.  Saying to the Times:

 

…the impromptu protests that had erupted in recent months were not comparable to the strategies used by civil rights groups of the 1960s, which had clear goals such as winning the right to vote or the right to eat at a segregated lunch counter. “You could call it rebellious, or you could call it irrational,” Mr. Garrow said of the new waves of protests. “There has not been a rational analysis in how does A and B advance your policy change X and Y?” Mr. Garrow compared the protesters to those of Occupy Wall Street. “Occupy had a staying power of, what, six months?” Mr. Garrow said. “Three years later, is there any remaining footprint from Occupy? Not that I’m aware of.”

 

Even Rev. Al Sharpton, who knows something about protesting, took some shots by saying of the protests,

 

“I think some of them are absolutely what we need,” he said. Of others, he said: “I think some of them are hustling the media, they have no real following, no real intent, and they may not be around in four months.”

Rev. Sharpton knows something about working the media, and part of the tactical dilemma faced by today’s civil rights protestors, just as by others 50 years ago, is how to get enough attention to convert the protest to pressure.

From an organizing perspective the tactics don’t seem problematic to me.  The fact that the actions are small and broadcast a limited base is what worries me.  You can’t make change without troops, and putting lots of people in motion, and the choice of tactics in some of the more dramatic actions has been more about a vanguard leading, than building a movement for change.  A movement for change can’t crystallize around folks watching YouTube videos of other people engaging risk and taking action.  Unless this generation of organizers and activists starts assembling tactics that allow broad engagement and participation, the naysayer army is always mobilized and will drown them out and beat them down.  If we look small, we quickly become irrelevant.  Organizers can’t allow that to happen on campaigns of this importance.