Author Archives: dave

The Medicaid Solution: End It, Don’t Mend It!

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Dave Kingsley

Why Do We Have Character Tests for Medicaid Eligibility and Not for Any Other Government Subsidized Healthcare?

     Medicaid is a $trillion-dollar program that has become a cash cow for the likes of UnitedHealth, Centene, Molina, Aetna, and Humana.  At the same time, it has always been a badge of shame for the lowest income Americans needing care.  Rules, regulations, and government oversight of the program are applied in the harshest of ways to poor people needing healthcare but not to the corporations responsible for widespread fraud and abuse.

   Unlike major corporations funneling $billions in undeserved compensation to executives and generous returns to investors, Americans needing healthcare but too poor to qualify for other federally subsidized programs must prove to a state government that they are poor enough and of good enough character to get Medicaid.  The stigma and harshness heaped on applicants and beneficiaries varies from state to state.  For instance, the pious, holier-than-thou, Christian governor of Arkansas has been on a crusade to ferret out people in her state who, in her view, are unworthy of life saving medical care.

Who Deserves Quality Medical Care – or Any Medical Care for that Matter?

    The concept of the “deserving poor” versus the “undeserving poor” has been integral in societal assistance for the economically unfortunate from the very beginning of North American colonization.  Poverty has always been and still is considered a character flaw.  It was just last week that I heard Mehmet Oz – the new overlord of Medicare and Medicaid – pontificate about – as he put it – “Abled bodied men,” who should not get Medicaid benefits if they are not suitably employed.

    Most ordinary, non-superrich, Americans probably can’t conceive of the $trillions in government benefits handed to the wealthiest among us without a scintilla of concern about character.  Think about a young, unemployed, able-bodied male who inherits $30 million from his parents.  He will pay no taxes on that inordinate sum of money that he can use for his pleasure – and for concierge medicine.  Maybe he is of good character, looking for work or contributing as best he can to society.  Conversely, he may be into jet setting and partying without any intention of doing anything positive for society.  However, the medical profession won’t consider any of that if he needs medical care.

    The legislature in the State of Kansas, near where I live and do a considerable amount of work, refuses to expand the Medicaid program under the Affordable Care Act.  Cross-wearing Christians in the state legislature believe that it’s some kind of a sin for the government to help poor people. They don’t give second thought to the massive subsidization of agri-corporations, tax write-downs for the oil and gas industry, etc.  They don’t seem to be concerned about the millions of acres of corn subsidized by the federal government at 50 cents per bushel while rich farmers and agri-corps irrigate it with water from the people’s Ogallala Aquifer, which is being depleted by such craziness.

    There are countless instances of government benefits provided without concern for the worthiness of the beneficiaries.  I grew up with farmers who loved the Soil Bank because they could let land lie fallow and collect a payment from the government.  These farmers, with few exceptions, thought then and think now that welfare in the form of assistance to poor mothers for food, clothing and shelter is despicable. 

Medicaid is an Inferior Healthcare Program Conceived by Southern Segregationists in the 1960s.

    Medicaid is the handiwork of post-Reconstructionist Southern Democrats.  Their sole purpose was to keep black people from getting medical care.[1]  They were able to engineer and codify into law a unique American concept known as “indigent medical care.”  The 1960 Kerr-Mills Act, ensured that the U.S. would have second-class medicine for the “needy” or “indigent,” and that state governments would have dominance over it.

    Senators and Congressmen from the former Confederate States left the Democratic Party in the 1970s.  Their political heirs in the current Republican dominated legislature and executive branch are now in the process of passing legislation that will further tilt the U.S. tax system in favor of the wealthy.  They are attempting to enhance corporate and superrich tax advantages on the back of people needing medical care – medical care that the least fortunate amongst us can only get from Medicaid.

    For obvious reasons, it has always been easy to politically bully poor people and, of course, poor black people are easiest of all to bully. We should also remember that the Southern States are not the only racist states.  Furthermore, Medicaid in any state will be a second-class medical care program with inordinate amounts of fraud on the part of the companies contracting to provide services. Nevertheless, had there been no history of slavery, Jim Crow, and the ongoing institutional racism they have wrought, the U.S. healthcare system would look a lot more like our peer countries in Asia and Europe (where everyone has equal access to one national, medical care program).

It is Time to Get Honest and Give Everyone Equitable Access to Quality Medical Care

    Medicaid is a disgraceful medical charade with roots in the incomprehensible cruelty of slavery and its aftermath.  There is of course what critical race theory dubs intersectionality – white-, Hispanic-, Asian-, Native-poor people are caught up in it also.  The results are these: poor black men will have 12 years less life to live than rich white men, the life expectancy of whites with a high school education or less has gone into reverse, black men die of cancer at a rate double any other demographic group, patients in hospitals on Medicaid are sicker, cost more, and stay longer than patients on any other payer system – just to list a few of the consequences of healthcare discrimination.

    There has never been a time in American history when the rich lived longer with better health.  On the other hand, there has never been a time when the bottom half of wealth holders and earners experienced a declining life expectancy and worse health outcomes compared to the fortunate upper classes.

    The right wing and the medical industry are using a clever tactic by keeping us all bogged down in a fight over tweaking, improving, expanding a system that will never be anything other than means-tested, welfare medicine.  Poor people’s medicine is and always will be inherently poor medicine.  As long as the program exists, there will be an immoral distinction between the worthy and unworthy in the U.S. medical care system. 

    My question to the medical profession is this: “How do you square medical ethics with denial of care because a person can’t afford to pay or because some bureaucrat deems them unworthy?”  I’m not berating individual doctors – I’m asking the medical profession, “Where in the hell have you been?”  There are many good physicians that are in the fight to change the corrupt, discriminatory medical system.  But this very powerful profession itself has a shameful track record in standing up for the human dignity of all people needing medical assistance.

End it! Don’t Mend It!

    So, I say, the only solution to this American healthcare disgrace called Medicaid is “End it! Don’t Mend it.” Give everyone equal access to equitable healthcare.  Fighting over nuances in a program unworthy of the fight keeps a white, college educated, advocacy enterprise going and ensures that the system itself won’t change.  I see verbal assaults on bad nursing home chains, and on private equity in the hospital/nursing home industry, and other such ongoing battles as nothing more than a futile game of whack a mole that will be never ending. I’ve been playing that game. And I’m tired of it.  The nursing home industry is fine with the game as is every other sector of the healthcare industry feasting off of government largesse like we could hardly imagine a half century ago. 

[1] My interest in Medicaid research has been on systems analysis rather than the litany of bad acts by bad providers such as is the tenor of Mary Adelaide Mendelson’s wonderful and productive work Tender Loving Greed, which is a classic in the study of fraud and abuse in the nursing home industry.  Systems research is focused on how systems originate, develop over time, and are politically maintained.  The concept of “sensitive dependence on initial conditions” is critical for understanding why poor and African Americans are treated differently – and inequitably – in the healthcare system (See for instance, Walter Buckley, Sociology & Modern Systems Theory). For the best validation of the racist roots of Medicaid, see: Jill Quadagno, One Nation Uninsured: Why the U.S. Has No National Health Insurance; Gerard W. Byouchuk, National Health Insurance in the United States & Canada; and, Robert & Rosemary Stevens, Welfare Medicine in America: A Case Study of Medicaid.

Do You Know Where the Taxes You Pay for Medicaid Are Going?

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Dave Kingsley

A Medicaid Disgrace:  Nursing Home Companies Make Big Bucks Off of Poor Peoples’ Medical Care

    Medicaid expenditures by Federal and State governments are approaching $1 trillion per year. All of it has been privatized with hundreds of billions of public dollars funneled into the nursing home industry alone.  That’s unfortunate because tax paying Americans pay dearly for privatized government services.  While healthcare accounts for about one-fifth of U.S. GDP, peer countries spend half to one-third of that amount on much fairer and more effective government-administered healthcare systems.

    It is important that we expose the excessive extraction of government funds from Medicaid by private companies and some nonprofit entities engaged in Medicaid contracting with states.  Corporations such as Centene, UnitedHealth, Aetna, Humana and Molina have captured the bulk of primary, preventative, and acute care Medicaid contracts.  They have an incentive to deny care and control their networks to keep their costs low. In upcoming posts, I will cover that facet of Medicaid.

    Nursing home Medicaid contracting involves a conglomeration of LLCs, Real Estate Investment Trusts, Public Corporations, sole proprietorships, nonprofits, and private equity owned chains. It is a big industry with net patient revenue of approximately $200 billion.  This does not include earnings from real estate, dietary services, labor contracting, and other services sold by parent/holding companies to the nearly 15,000 nursing home facilities in the U.S.  For instance, in 2022, the total cost of dietary services noted as expenses in cost reports totaled $12 billion. This is a money maker because parent companies buy in bulk, negotiate a favorable deal, and charge their facilities – the state contracting entities – full price.

If You Have Seen One Nursing Home Chain, You Have Seen One Nursing Home Chain. 

    The nursing home industry is comprised of diverse legal, and financial structures run by a variety of characters and investing entities.  Some of the characters have become quite notorious for accumulating great wealth while providing appalling care.  A couple of the better-known investor/owners with unsavory reputations are Ephram Lahasky and Forrest Preston.  Lahasky’s name appears in our research on ownership all over the United States.  He’s been denied a license to operate by the state of Vermont and has been sued by the Attorney General of New York.  Preston is the sole owner of one of the largest chains in the U.S. – The Life Care Centers of America. Both of these guys continue to run substandard nursing homes unabated. There are plenty others that are somewhat less noticeable but just as bad or worse.

    Infamous operators aside, documents available regarding publicly listed companies provide the best insight into the industry’s extraction of taxpayers’ dollars that could otherwise be applied to decent and humane care as opposed to the warehousing care that is pervasive in the highly profitable nursing home business. There are financial advantages to companies listed on a stock exchange.  Capital is available from investors through the sale of stock.  If the stock price increases, so does the availability of capital for expansion, return to shareholders, and executive compensation. 

In the right business, stock becomes attractive, appreciates, and provides a nice return.  The nursing home business is the right business because taxpayers guarantee revenue and ensure robust net incomes that are shielded from ordinary business cycles and economic crises such as caused by the COVID pandemic.

The Ensign Group: $4.2 Billion in Medicaid & Medicare Nursing Home Business Per Year

    The Ensign Group is one of the largest nursing home chains in the U.S. It is listed on the NASDAQ. The advantage of publicly listed companies to the taxpayers is transparency.  Public companies are required to file financial statements with the Securities & Exchange Commission.   CMS data and financial reports submitted to the SEC by the Ensign Group suggests that outstanding returns do not equate with high quality care.

As information from Ensign’s latest SEC 10K and Proxy Statements and data from the CMS ProviderInfo file suggests, this $4.2 billion corporation is making a handsome return on very poor-quality service. CMS Nursing Home Care Compare rates facilities on a scale of 1 to 5 with 1 being the lowest on a variety of factors such as nursing hours of care per resident day, turnover, patient care overall, and so forth. Of the 268 Ensign affiliated facilities in the July 2024 ProviderInfo file, 22% were rated 1 and 32% were rated 2 – only 1.5% were rated 5. So, over half of this company’s facilities are rated at the bottom in quality while their investors and executives are richly rewarded.

In view of Ensign’s appallingly low performance on care ratings, let’s look at the following financial data they reported to the SEC: (1) return on shareholder value, (2) stock repurchase, (3) cash on the balance sheet, (4) executive pay, and (5) net cash provided by operating activities. It is important to keep in mind that approximately half of the 56 million shares of stock are owned by three asset management firms BlackRock, Vanguard, and State Street.

$100 Invested in Ensign in 2019 was worth $296 at the end of 2024.

The Ensign Groups 10K touts the company’s cumulative stockholder return from 2019 through 2024 per $100 invested in 2019. The chart below indicates that Ensigns outperformed the NASDAQ Composite and peer companies. A $100 dollar in 2019 was worth $296.63 in 2024.

Stock buybacks drain money from production/service and raises the price of stock.

Ensign noted in its financial report that it invested $20,000,000 in a stock buyback in 2024. Stock buybacks raise the price of the stock and enrich shareholders and executives. Money that could be reinvested in business operations and improved care is extracted for the purpose of rewarding investors. Investors have indeed been quite positive toward Ensign stock. When the market tanked in November of 2021 due to COVID and the Federal Reserve’s monetary tightening, Ensign stock was selling at $75 per share. Today it is trading at over $140 per share.

Don’t believe industry propaganda – nursing homes are not “running on a thin margin.”

Ensign’s 2024 cash flow statement notes net cash from operating activities of $324 million. Their balance sheet indicates cash and cash equivalents of close to a half billion dollars ($464,598 million).

Executives are richly rewarded for impressive financial performance and disgraceful performance on their contract with taxpayers. Five top executives’ compensation totaled $110 million over 3 years.

As the table below demonstrates, the compensation of Ensign’s five corporate executives totaled nearly $110 million over the past three years. It is notable that actual salary for all of the top executives/officers are less than $1 million while their total compensation ranges from $4 to over $11 million per year. Corporations receive a tax advantage for keeping executive salary below $1 million and putting the bulk on stock awards, stock options, bonuses, and perks. Therefore executives have an incentive to keep costs (services) low and poor while increasing shareholder value.

Summary

Data pertaining to one large nursing home chain only scratches the surface of the financial reality of privatized, government sponsored, healthcare in America. The initial purpose of Medicaid was to keep states in control of government funded medical care for poor people. Throughout the 1940s, 50s, and 60s, bigoted Southern Democrats had outsized legislative power to block a single payer, universal healthcare system managed by the federal government. Their goal was to keep African Americans in an inferior position. They were able in the 1940s to include a segregation clause in the Hill-Burton Hospital Survey & Construction program and block President Truman’s plan for single-payer, universal medical care.

After Truman’s fight for equitable healthcare along the lines of programs adopted by European governments and countries with advancing economies in Asia, the Democrats gave up and went along with a “Rube Goldberg” government healthcare system designed to discriminate against black Americans and enhance the power of states over the federal government in the realm of medical care. Consequently, American government sponsored medicine became divided along race and class lines. That did not stop venal politicians from pouring increasing amounts of taxpayer dollars into Medicaid and turning it into a cash cow for their corporate patrons.

Note: The Ensign Groups 10K and Proxy Statements can be found here: The Ensign Group, Inc. – Financials – SEC Filings. The CMS ProviderInfo file is available on the CMS website or through a request to dkingsley@tallgrasseconomics.org.

MEDICAID:  AN AMERICAN MEDICAL CARE DISGRACE

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Dave Kingsley

Everyone But the Totally Uninsured Receives Government Subsidized Medical Care. Only the Poor are Stigmatized

    Practically all medical care in the U.S. is subsidized by federal and state governments – mostly by the federal government.  The taxes to pay for these subsidies are collected from workers’ paychecks, sales taxes on what they buy, and property taxes that are paid by homeowners or added into rent/lease payments. And yet, it is only Medicaid, a medical care program for the poor, that is stigmatized. But the poor pay taxes too. Indeed, a disproportionate share of taxes.

    The biggest tax subsidy is awarded to companies providing health insurance for their employees.  When companies can write down their federal income taxes, they are actually getting money from the government – they are legally allowed to keep money that they owe the government.  That is why these “breaks” are called tax expenditures.

    Indeed, the $251 billion in tax write downs for corporations providing health insurance is the largest tax expenditure by far.[1] Furthermore, this deduction is a transfer of wealth from lower income Americans (who earn their employee benefits) to wealthier classes who increase their assets from equities and compensation in the healthcare industry.  In costing labor, employers trade benefits for wages.  In fact, in many negotiations in which I was on the negotiating team, we often settled wage disputes by offering to “sweeten the health insurance package.”

    The poor pay more than their fair share of taxes that keep governments running.  In the U.S. taxes on capital have been continuously reduced while at the same time taxes on consumption and labor have increased. This puts the heaviest burden on the lowest income groups and  lightens higher income groups’ tax load.  Nevertheless, Medicaid recipients are treated like freeloaders and “lesser thans” while everyone receiving other forms of subsidized healthcare are considered solid, upstanding Americans by politicians blaming poor people and the elderly for budget deficits.

“What We Do unto the Least of These”

    Capitalist America as it has evolved can be harsh and unforgiving for the unfortunate, which could be any of us.  With job loss, we can find ourselves struggling to keep a roof over our head and food on the table.  At the very least we could lose our health insurance.  The Affordable Care Act is not affordable for the unemployed.  If you live in a state that has not expanded Medicaid, i.e., has not made residents with incomes below 120% of poverty eligible for Medicaid, you must have children and be in extreme poverty to qualify.  If not, you will not be eligible for any healthcare program.

    Let’s say a person lives in a state that has expanded Medicaid.  And let’s say that person lives in a so-called “red state” like Arkansas or Missouri.  The governors and legislators of those states will humiliate them and create administrative barriers to establishing eligibility for no other reason than they assume they are a cheater until they prove otherwise.  These legislatures are dominated by pious Christians who despise poor people despite their prophet’s admonishment “what you do unto the least of these; you do unto me.”  It is easy to bully poor people for the purpose of impressing constituents with bravado about controlling wasteful spending.

    The poor are despised by right-wing politicians and a large portion of Christian America. Certainly, we don’t see the powerful Christian Church Industry – otherwise known as “faith based” institutions – closing ranks to take up the cause of their less fortunate brethren. Their prophet did that but for the most part they seem reticent about exerting their influence.

Transfer of Wealth from the Poor to the Wealthy

    Conservatives claim that poverty in the U.S. is far lower than officially measured by the federal government due to transfer in the form of welfare such as Medicaid, child tax credits, and the Earned Income Tax Credit.  There are several problems with the conservative wealth transfer argument. First, the poor struggle day-to-day to survive due to paltry benefits and continued threats of loss of those benefits and actual loss due to administrative complexities that are hard to navigate in a hostile political environment. 

    Second, transfers to the poorest of the poor are paltry compared to the transfers to the upper classes in the form of such mechanisms as capital gains write downs, untaxed cash flow, earnings on unrealized gains, and investments in tax free municipal bonds – to name a few “loopholes” for the rich. The hypocrisy of politicians claiming to save “we the people” money by bullying poor people on Medicaid is palpable in legislatures these days.  Congresswoman Vicki Hartzler of Missouri is a wealthy owner of an Agri Corp that receives hundreds of thousands of dollars in undeserved federal farm subsidies.  Nevertheless, she is a loud voice for clamping down on benefits for the voiceless, the powerless, and the defenseless who need those benefits for their health and often for their very survival.

WATCH FOR UPCOMING BLOG POSTS:

“Lucrative Medicaid Funded Nursing Home Care”

“Finding the Roots of Medicaid in the History of Slavery & Jim Crow”

“Corporate Medical Care Benefits:  The Privatization of Medicaid”

“The Poor as a Government Healthcare Class:  A Uniquely American Idea”

“The Injustice of the ‘120% of Poverty Gap’ in States That Have Not Expanded Medicaid”

[1] Tax Expenditures | U.S. Department of the Treasury.  Other big tax expenditures include the mortgage interest deduction, and a variety of corporate real estate write downs, including depreciation.  There is no doubt that the tax codes are a major factor in the maldistribution of wealth.

MESSAGE TO THE GOVERNMENT HATERS:

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YOUR FREEDOM, HEALTH & WELFARE DEPEND ON RESPECT FOR THE U.S. CONSTITUTION AND A GOVERNMENT THAT WILL ENFORCE IT

By:

Dave Kingsley

Without Government You are Without Protection from Self-Serving Corporations, Techno-Plutocrats like Musk, and Fascists.

    Thanks to both major political parties, a phony government hating movement has been able to fester and eventually capture the levers of power in the United States. Indeed, hating government is fashionable these days. A shallow, faddish, libertarian political philosophy – unleashed by a doltish President in 1980 – has become de regueur. 

     A public distracted by trash entertainment has been moved by corporate media’s penchant for disseminating misinformation (e.g., Social Security has created a huge budget problem) as well as political propaganda (e.g., asylum seeking immigrants are a threat) to put a self-serving oligarchy in control.  A very potent government hating, financier-industrialist led political apparatus has incrementally managed to engage major “news” outlets and political parties in furtherance of their economic interests at the expense of the freedom, welfare, and health of the very people who voted their candidate into office. 

    Blaming Social Security, Medicare, programs for poor people, economic equity/DEI, and the like is a scurrilous but effective mantra for promoting a “government bad, corporation good” narrative.  Ronald Reagan instilled that incantation in the body politic throughout his eight years as president with little opposition from the Democrats.  By the time the next Democrat ascended to the Presidency in 1992, the Democratic Party – now the “New Democrats” – were on board with the Reaganism and Ayn Randism that had taken hold.  President Clinton said that the “era of big government is over.”  What he meant was that poor people needed some tough love and that cutting safety net benefits and Social Security would be one way to carry that out.  Enough Democrats were all in on that to change grants-in-aid to block grants that would allow state governments to humiliate and abuse poor people.

    The Clinton Administration – with prodding from the venomous Newt Gingrich – did cut Social Security through a devious, back-door means.  Conservative economists were put in charge of a commission – the Boskin Commission – that promoted and eventually won the day for recalculating the SS cost of living increases, which dampened the increases in monthly payments to beneficiaries.  Along with both parties’ support of Reagan in pushing back eligibility for full benefits by two years – a massive cut – the statistically invalid reconfiguration of COLA increases insured that life would be harder for the majority of SS beneficiaries.

    The next Democratic President, Barack Obama, tried to give away massive cuts to Social Security and Medicare but was rebuffed by the Republicans who thought he wasn’t giving quite enough away.  Or perhaps they really thought that the Democrats could sell it as some kind of victory.  So, the feckless and weak Democrats, garnering little respect from the masses, blamed Jill Stein for their loss in 2016, which is rather silly when you think about it.

 Radical Government Haters and the Reductio Ad Absurdum

    Now the government haters are in control and taking government hating to its logical conclusion.  Sociopathic, narcissistic billionaires have been handed the right to dismantle the portion of our federal government that protects us from them and the fascists beholden to them. The real power now resides with super-rich techno-plutocrats such as Thiel, Bezos, Musk, and others who are in control of the entire digital communications infrastructure and, in cooperation with government, are sucking up information without regard to 4th Amendments rights against search and seizure. It was their data capabilities that allowed them to hand the last election to Trump.

    Industrial behemoths such as UnitedHealth, Exxon, CVS, Walmart, Chevron, Monsanto/Bayer, and others now have an opening to achieve extreme deregulation, monopolistic market power (price fixing), excessively low to no taxes, and the right pollute our air, water, food, and building/manufacturing materials with toxic chemicals conducive to poor health and a shorter life expectancy.

    Because of theocratic fascists of the Baptist, Catholic, and the “get down, holy rolling fundamentalist, government hating” varieties, the 1st Amendment separations of church and state provision of the constitution is in tatters.  Attacks on 1st Amendment freedom of speech rights have intensified in the form of public policy (e.g., attacks on media outlets and journalists by Trump).  Members of Congress who speak out are threatened and harassed. The few courageous House and Senate members who do speak out are sort of hanging out there alone.  For instance, Congressman Eric Swalwell and his family have been going through hell while so many of his fellow Democrats stay in hiding and maintain a low profile.

    Overwhelmingly, the elected representatives in both parties are cowards willing to slink into hiding rather than incur the wrath of a psychopathic President.  Senate Minority Leader Schumer maintains that the Democrats can just wait for Trump to sink and the public polls to turn against him.  Unfortunately, most Democrats have been relying on opinion polls for decades rather than standing up for what they believe.

It Will Get Worse Unless We Can Change the Democratic Party

    Life expectancy will continue to move backwards as the plutocratic wrecking crew continues to disassemble the government and protections we rely on for a healthier life and environment.  The people in power now care about only this: money and power.  To the people running the U.S. today, the masses are merely fodder to be manipulated and fleeced. Those government services for which the middle and lower income strata pay disproportionately will be taken away for the purpose of enriching the rich.

A Letter from Hakeem Jeffries Makes Me Ask This:  “Has the Democratic Party Leadership Learned Nothing?”

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Dave Kingsley

    Yesterday, a mass mailing from Democratic House Leader Hakeem Jeffries arrived in my mailbox.  It was actually an appeal for money, which seems to be the main activity of the Democratic Party these days.  This is the first paragraph verbatim:

“The American people deserve leaders who set aside partisanship and focus on bipartisan solutions.  House Democrats are committed to working with the other side of the aisle to make life better for hardworking middle-class families.  At the same time we will push back against their extremism whenever necessary.”

    Just how delusional can a Democratic Party leader be?  Since 1980 and the right-wing revolutionary regime of Ronald Reagan, bipartisanship has meant “Democrats rolling over.” Pushing back has meant “making some noise and then caving in to Republican demands.”  Let’s take the massive 1983 bipartisan cuts in Social Security as an example.  As a result of the Establishment’s stewing and fretting over funding the coming retirement of the Baby Boomer generation, eligibility was pushed back two years.  There appeared to be no consideration of raising the cap and making the affluent classes pay a little more.  That was the result of a recommendation from the “bipartisan” Greenspan Commission and an accommodative bipartisan vote in Congress.

    Perhaps one could find a little bit of bipartisanship and Democratic Party pushback on extremism in the early days of the Reagan Revolution.  But these days we are not talking about extremism of the Reagan variety.  Over the past 45 years, extremism has evolved into a current regime of fascists, and neo-Nazi sympathizers intent on bringing back second-class citizenship for women, people of color, and gay people. They are also intentionally heaping cruelty on transgender, poor, and asylum-seeking immigrants.  We are talking about a typically sadistic, fascist movement rife with anti-Semitism.

    We now have in America a proclaimed dictatorship in league with the regimes of Pinochet, Franco, Salazar, and Mussolini.  It appears that their leader thinks that Hitler had some good ideas.  Of course, Washington Democrats along with their pals in the mainstream media aren’t pushing the current Republican’s self-anointed dictator to specify exactly what those ideas are.

    Until recently, Republicans at least had a modicum of respect for the U.S. Constitution.  But in January of 2021, an insurrectionist mob attacked the U.S. Capitol.  Members of law enforcement were injured and some died as a result of the violence heaped on them.  I watched in horror as goons wearing t-shirts with “Six Million Was Not Enough,” “Camp Auschwitz” and the like broke windows, assaulted police offices, and set up a gallows for the execution of Vice President Pence who refused to override the election results.

    Eventually, many were convicted and held accountable.  But now the U.S. dictator wannabe with support of his Republic sycophants in Congress have given them a pardon.  These are the same leaders who have a rubber stamp Supreme Court that will back their destruction of all facets of federal government designed to protect and improve the lot of “we the people.”  Project 2025 is designed for the betterment of the extremely wealthy.  It will not end well for everyone else.

    Where exactly does Congressman Jeffries see an opportunity for bipartisanship?  This is a fanatical Republican Party that denied President Obama his constitutional right to select a Supreme Court Justice. 

    One give away regarding the state of the Democratic Party at the top these days is Leader Jeffries statement that the party wants to “make life better for hardworking middle-class families.”  That’s laudable.  However, life has become unbearable for low-income families in America.  The Republicans are intent on slashing Medicaid, SNAP, and other programs barely keeping a large part of the U.S. population alive.

    All of this will not end well for anyone in the U.S. except billionaires who can always seek refuge in more comfortable surroundings located far from the boundaries of the United States.  If the Democratic Party continues its mealy-mouthed nonsense about bipartisanship and fails to operate (fight) from clearly stated principles, they will continue to sink and take the rest of us with them.

RELIANT HEALTH CARE MANAGEMENT LLC: THE WORST NURSING HOME CHAIN IN AMERICA

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Dave Kingsley

The data analytics system we have developed at the Center for Health Information & Policy (CHIP) – our nonprofit research organization – gives us the capability to drill into our extensive data on the nearly 15,000 skilled nursing and long term care facilities in the U.S. We feel confident that we have identified the bottom of the bottom dwellers and need to bring them to the attention of other professionals and the public. We are curious about why a chain like the one described in this post is allowed to operate with impunity.

RELIANT HEALTH CARE, LLC: AN EXTREMELY LOW PERFORMING MISSOURI NURSING HOME CHAIN

    Reliant Care Management, LLC owns 21 Medicare & Medicaid funded skilled nursing  facilities in the State of Missouri – four are in the Kansas City Metropolitan Area.  In our work across the United States in cities, counties, states, and regions, we have not encountered a chain with  lower federal ratings on quality of care. In this alert, we will lay out the case for a high level of concern among families, ministers, social workers and others who might have an occasion to find a skilled nursing facility for a loved one or a client.

LOOK FOR THE RED HAND

    The Center for Medicare & Medicaid Services as the federal regulatory agency for Medicare and Medicaid funded skilled nursing has a complicated rating system for each facility that ranges from l for low performing facilities to 5 for high performing facilities.  Facilities with a rating plus a red hand have incidents that present a danger to patients.  It is rare for a chain of even a few facilities to have more than one red hand.  Nevertheless, of the 21 Reliant facilities 9 have a red hand (see table below).

    Red hands are signs of poor quality of care.  In addition to incidents that place patients in immediate jeopardy, ongoing neglect often occurs due to a lack of adequate staffing.  Nursing staffing is measured by the number of nursing hours per resident day (HPRD).  The current average of the 14,516 skilled nursing facilities in our data file is 3.8 (3 hours & 48 minutes) HPRD for RN, LPN, and CNA staffing – which most experts agree is far too low.  Nevertheless, nursing homes with an HPRD of 2 or less are quite rare – only 7 tenths of 1 percent or 103 out of 14,516 facilities.

    As the table below illustrates, the hours per resident day column indicates that Reliant facilities are extremely understaffed (“HOURS” was somehow deleted from the column – it should be “HOURS PER RESIDENT DAY”).  Indeed, HPRDs in the low 2s and 1s for an entire chain is appalling.

*According to CMS, a Special Focus Facility has, “More problems than other nursing homes (about twice the average number of deficiencies),” More serious problems than other nursing homes,” and “A pattern of serious problems that have persisted over a long period of time.”

**Special Focus Candidates:” Not quite bad enough to be a Special Focus Facility yet but moving in that direction. It is truly phenomenal to see a chain of this size with one SFF and two SFF candidates.

THE NURSING HOME CLASS DIVIDE AND THE RELIANT BUSINESS MODEL

    If you’ve seen one nursing home, you’ve seen one nursing home.  If you’ve seen one nursing home chain, you’ve seen one nursing home chain.  If you’ve seen one state nursing home system, you’ve seen one state nursing home system.  Nevertheless, similarities in patterns and practices can be seen in the SKN/LTC system.  For instance, some chains accept Medicare but not Medicaid, some accept Medicaid and Medicare, some have very little Medicaid while others have mostly Medicaid as a payor.  The amount of contract labor used, and the price paid for it varies from chain to chain and so forth.

    With 90 percent of its bed days reimbursed by Medicaid, Reliant has an extremely high number of patients who are in long-term care and too poor to pay out of pocket.  The company runs mostly large facilities (120-250 beds) and a small proportion of small facilities (approximately 60 beds). Bed size varies between and within chains.  However, the pattern we see is this:  the larger facilities in number of beds tend to be in poorer neighborhoods and serve a disproportionate number of Medicaid patients.  We have also noticed that these “big” facilities with mostly Medicaid bed days tend to be rated lower in CMS Nursing Home Care Compare quality measurement system.

Some Significant Reliant Financial Information:

  • Average bed size of 113.5 (versus 90 nationwide but Reliant has a mix of a few small and very large facilities).
  • Patient revenue: $161.6 million
  • Net operating income: $3.3 million
  • Payments to Home Office & Wholly Owned Subsidiaries:  $28.8 million
  • Reliant owned businesses supplying goods and services: management, therapy, pharmaceuticals, medical supplies, laundry subsidiaries (real estate side of the business is unknown at this time due to a lack of information)
  • All therapy services are contracted out to Reliant owned therapy subsidiary
  • Reduced labor costs through extreme low staffing and below average wages

WHO OWNS RELIANT CARE MANAGEMENT, LLC AND WHAT ARE OFFICIALS AND AUTHORITIES DOING ABOUT THIS CHAIN?

    According to CMS ownership records, Reliant is owned by one individual – Mr. Rick DeStefane (see, e.g.: Find Healthcare Providers: Compare Care Near You | Medicare).  Information (perhaps PR and propaganda) about Mr. DeStefane can be found on the Reliant website (Rick DeStefane | Reliant Care Management, LLC | St. Louis).  We cannot be a judge of Mr. DeStefane’s character.  We can only ask why his SKN/LTC facilities are rated lower than even some of the most scurrilous chains we have analyzed.

    We would also ask Mr. DeStefane to show the taxpaying public Reliant’s consolidated financial reports, e.g. income statement, balance sheet, and cash flow statement.  We have no idea the extent of personal wealth accruing to Mr. DeStefane and his family’s assets but we believe that the public has the right to know.  Our federal and state governments have failed the public by allowing nursing home providers to hide their finances. 

    What are Missouri and federal legislators and regulators planning to do about Reliant? Are they even tuned into the ratings discussed in this bulletin? What are local politicians, health departments, ministerial alliances, and other individuals and organizations with an obligation to protect the vulnerable aging and disabled populations with a need for institutional nursing care doing about Reliant?  Certainly, it is not OK to allow nursing homes this bad to operate below the radar.

     THE PRESIDENT & UNENLIGHTENED APPROACHES TO ELDERHOOD.  HOW DID IT COME TO THIS?

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    By:

    Dave Kingsley

        As Americans, we are instilled with the idea that we are the most enlightened and advanced society on the planet.  That may be true in some matters, but when it comes to biological aging it is patently false.  I’m not saying that most of the other societies of the World are more enlightened in the understanding and treatment of serious physical decline in the later stages of life, but we need to take a hard look at what we do in our families, nursing homes, politics, and other institutions.

        Let’s take the current imbroglio involving President Biden as a case study in how aging people and the people who surround them create a seriously dysfunctional and hurtful situation – indeed a heartbreaking situation that is resulting in humiliation to a man and his family because of past and ongoing family, media, and political irresponsibility.

        The biology of aging cannot be ignored – should not be ignored. This is especially true when the symptoms of clinical frailty are glaringly obvious as they have been with President Biden for the past two years.  I was aghast at noticeable changes in his appearance, movement, and speech.  I watched him closely on television and looked at video of his speeches in 2020.  The changes were palpable. 

        Cruel, agist jokes and snide remarks on late night television and in conversations I was having seemed to be on the increase.  The President ignored what so many people could see but couldn’t understand, or at least they couldn’t understand how to discuss it and deal with it appropriately.  The people around the President out of ignorance or venal political motivation rationalized, denied, or repressed the obvious when they had a duty to confront the president responsibly and compassionately.  All the political elites in the President’s circle had a responsibility to do the same thing.  It shouldn’t take a whole lot of brilliance to know when to consult geriatricians and neuroscientists.

        Unfortunately, politics in the United States have become increasingly characterized by delusion, narcissism, and self-interest over the public interest. Politicians are far too often deluded and overcome with narcissism.  The attitude is “what’s in it for me politically?” not “what’s my duty to the country?” I write this with the New York Times sitting on my desk with an above the fold headline: “Top Democrats Swallow Fears and Back Biden.”  Senate Majority Leader Schumer is quoted as saying, “I’m with Joe.” Congressman James Clyburn stated, “We are ridin with Biden.”

        This is despicable behavior on the part of two of the most powerful leaders in the Democratic party.  It is also an example of how congress is failing the American people.

        The president of a business corporation, a nonprofit, or a university would be asked to retire under the same set of circumstances – probably privately and compassionately.  Indeed, a few years ago the Chancellor of the University of Kansas was asked to step down because of confusion and lapses of memory due to aging.

        But the President’s top advisors and the First Lady are doubling down on their irresponsible claims that he can run a grueling race for President and serve our country for the next four years and a half years.  He cannot do that.  He won’t be fit to take office and carry out one of the most important jobs on the planet.  To say otherwise is sheer folly and dangerous.

        What we are seeing is sad and tragic.  It should never have come to this.  No doubt, the President’s opponent is a dangerous man leading a dangerous movement.  That is a primary issue in this looney political race.  But the American people deserve better than what is currently shoved down their throat on both sides.  Ordinary people can see what is happening.  The danger is that they might not show up to vote and a man will be elected who will do so much damage that the country will never be the same – in a negative way.

    Supreme Court Decision in Loper Bright Enterprises v. Raimondo:  A Blow to Americans’ Health & Our Democracy as We Know It.

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    By:

    Dave Kingsley

    Free Rein for the Increasingly Powerful Insurance Industry in the Increasingly Privatized Medicare & Medicaid Programs

        Make no mistake about it, the Supreme Court this week in Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce [1] handed over supreme power to the corporations of America.  These decisions didn’t just weaken federal agencies, they gutted them. OSHA, CMS, EPA, NLRB and other major regulatory agencies have been incrementally weakened for decades through legislation and raw political power. These cases are the coup de grace for our mortally wounded regulatory agencies.

        In the massive healthcare sector of our economy – funded mostly by taxpayers – major corporations will now be able to ride roughshod over the rights and needs of beneficiaries who have paid for and earned qualification for benefits.  For instance, UnitedHealth, which has exploded to the top of the Fortune 500 in a mere two decades and other insurance behemoths can continue their takeover of Medicare and Medicaid, reduce care, increase cash flow, and ignore attempts by HHS to rein them in.

        Any attempt at regulation by CMS will be challenged in court.  It is likely that regulators will lose.  No matter how rational, technical and scientific the agencies’ arguments are, the Supreme Court will have the final say.  Although nine justices on the court do not have the expertise, the resources, or the time to make appropriate decisions that congress and the courts have historically left to qualified experts in agencies, this Supreme Court will hand down decisions based on the majority’s perverse right-wing, religious ideology.   As Justice Kagan wrote in her dissent:

        “Its justification comes down, in the end, to this: Courts must have more say over regula­tion—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding prec­edent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The major­ity disdains restraint, and grasps for power.”

        Make no mistake about it, that power will be exercised on behalf of UnitedHealth, CVS, Cigna, Molina, the Ensign Group and any other corporation wanting relief from government oversight.  We are already seeing this in the American Healthcare Association’s judge shopping suit against CMS for regulations requiring adequate staffing in nursing homes (through their Texas affiliate).

    The Philosophy and Structure of the U.S. Constitution Provides Ultimate Power to the People – not to the Biggest Corporations & Six Ideologues on the Supreme Court.

        The people pay the taxes to fund government healthcare and elect representatives to enact and implement programs such as Medicaid and Medicare.  And I believe we the people still have the power – if we are willing to exercise it. Last week I was speaking to the National Association of Attorney’s General/Medicaid Fraud Control Units Association in San Diego.  My evaluation of the nursing home industry is not complimentary to say the least. At the end of my talk, I was asked what could be done about the scurrilousness of this industry.  My answer to that is first things first: expose them. Expose them to the media, expose them to legislators, expose them to colleagues, friends, and neighbors.  The American Healthcare Association (AHCA) and LeadingAge perpetually lie and propagandize about finance.  In my view, the pushback on their claims about low nets and thin margins needs to be stepped up. 

        Anyone can see the income statement, cash flow statement, and balance sheet of the Ensign Group – it is public.  Attorney General Jame’s suit in New York exposes a cabal of investors who are not required to disclose their consolidated financial statements.  The Ensign Group has over $500 million setting on their balance sheet – that is double what they had a couple of years ago.[2] The New York AG’s suit against Comprehensive at Orleans indicates cash extraction of 22% on $86.4 million in revenue over approximately three years.[3]

        Does anyone seriously doubt that these examples are exceptions in the whole scheme of things?  They are not.  We have plenty of other evidence to undermine the lies of AHCA and LA.  We need to put that in the face of legislators.  Organize, organize, organize, and relentlessly shove information at Senators and Congresspersons.  No doubt, the majority on the Supreme Court will do what we know they will do.  It will be ugly.  But they need public support to remain legitimate and survive as a credible juristic institution.  If the court continues down its current path, the citizens will eventually change the court.

    [1] 22-451_7m58.pdf (supremecourt.gov)

    [2] See their 2024 10K filing with the S.E.C. here: https://investor.ensigngroup.net/financials/sec-filings/default.aspx

    [3] https://ag.ny.gov/press-release/2022/attorney-general-james-sues-orleans-county-nursing-home-years-fraud-and-resident

    The Choice between a Humane Health Care System or an Industrialized Medical System for the Benefit of Shareholders & Executives: What would the People Choose?

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    By:

    Dave Kingsley

        Elites sneer at the idea that people in general are intelligent enough to make good decisions in democratic elections. This is a disgusting and ill-informed attitude mostly aimed at the middle- and lower-income classes. But historical evidence indicates that people en masse are not as dumb as the self-anointed educated class and the mainstream media would have us believe. 

        Hubris and ignorance on the part of political elites and the intelligentsia have led pollster charlatans, journalists, bureaucrats, and politicians to assume that public opinion is little more than clueless folderol, rife with nonsensical conspiracy theories.  In so many ways, the “people” are viewed by the affluent and college educated classes and opinion influencers in the media as “lesser thans” and “lower types.”

        Machiavelli knew better. As he wrote in Discourses on Livy, “But as for prudence and stability, I say that the people are more prudent, more stable, and better judges than a prince. And not without reason is the voice of the people compared to that of God, for popular opinion has been seen to predict things in such a marvelous way that it is as if some occult power[virtu] enables it to foresee the evil and the good that may befall it.”[1]

        Harry Truman knew better. Among other issues, he ran on the principle of universal, single payor health care and won. Elites, pollsters, and journalists predicted that he would lose in a landslide.   We didn’t get the health care – thanks to the bigotry of Southern Democrats – but we got the people’s opinion about government’s role in medicine for the masses. There is no evidence that it has changed.[2] 

        Women fighting for reproductive rights know better and are winning ballot measures to enshrine those rights in state constitutions across the U.S. Extremist conservative legislators are consistently trying to undermine the efforts of citizens for a “right of choice” through anti-democratic legislative maneuvers.

        In Missouri, where I live and where the Republican majority in the legislature has gone extremist right-wing bonkers, Medicaid expansion was passed by “the people” through a referendum.  Ballot measures on reproductive rights and a minimum wage will be on the ballot in November and will likely pass.

        Oracles from left-to-center-to-right elitist political ingroups were shocked when voters from so-called “red states” voted to enshrine reproductive rights of women in state constitutions.  The media – all the media from right to left – would have you believe that we are a “divided nation.”  We aren’t. But that story is good fodder for television and newspapers.  The truth is most Americans share the same values and want the same things from government.  The broad middle (the overwhelming majority) of the voting public can best be described as ambivalent with some conservative views and some liberal views – mostly commonsensical views.

        I will stipulate that a pathological, narcissistic-sadistic fascist was able to win the electoral college and become president – but like every other Republican since George H.W. Bush he didn’t win the popular vote. He lost by an even wider margin in 2020.  Furthermore, many counties in states like Pennsylvania that Barack Obama won in 2012 by an overwhelming margin flipped to Trump by a wide margin in 2016.  I believe there is an explanation for that – which is ignored by the media and political intelligentsia.

    In this Age of Show Business, the Role of Media is to Entertain You – Not Inform You.

        No doubt, in a country with a population of 334 million people (231 million are 18 and older) [3] and 161.42[4] million registered voters, an unstable tyrant can round up tens of millions of ardent, true believer followers. Given the spread of mental illness, fractured egos, instability, financial stress, and other psychologically damaging stresses of toxic capitalism, it should come as no surprise that a demagogue could and would come along and with the help of the MSM drive the electoral process into nonsense and chaos. 

        This should be even less surprising when the demagogue’s persona is the creation of NBC, which is owned by Comcast, one of the most powerful corporations in the oligopolistic media industry. It was, therefore, the mainstream media that led a significant mass of busy stressed-out people into believing that Trump was a kick ass, savvy businessman who could and would straighten things out and lessen their pain.  For years, he was a corporate created caricature foisted onto unwitting and economically hurting television viewers looking for escape. 

        Since 2015 when Trump descended on the escalator in Trump Tower – and after setting up Mexican immigrants as America’s enemy – the media has feasted on his burlesque politics.  Nothing attracts attention like dangerous cartoonish politicians with slapstickish, outrageous performances.  For nearly a decade, Trump has been a prop for feeding the much needed noisy, shallow product on cable channels, morning talk-entertainment shows, and nightly news. Although we “have nothing to fear but fear itself,” fear plus titillation keeps people tuned in.  The corporate need to enhance and protect shareholder value enhances the value of all Trump all the time on cable political entertainment channels such as CNN, FOX, and MSNBC plus all of the NBC, CBS, ABC, and FOX Sunday talk shows.

        The media is responsible for Trump – not public stupidity.  The media has a vested interest in keeping him going.  The public does not. 

    Venal Media & Political Forces with Dangerous, Self Interest Designs Have Hijacked Political Narratives through Propaganda, Chutzpah, and Manipulation

        As we have learned from history, industrialists, media, and other powerful institutions (think religion) with the intent to install a strong man and a fascist movement in power for their own benefit, have the capability to misinform the public about real conditions and move them to participate in their own destruction. Once falsehoods are instilled in desperate and unwitting citizens, it is very difficult to tear them down.   

        As the American people are subjected to another round of election time insanity, the MSM is at it again – minimizing the severe pathologies and dangers of Trump and magnifying real and imagined negatives of President Biden.  In their stressful, busy attempts at survival, ordinary people naturally and unconsciously process signals – memes and narratives sometimes subtle, sometimes not so subtle.  It is to the benefit of media corporations to create and maintain an appearance of normality and a “horse race” so that their customers don’t lose interest.  As former President Obama said last week “behavior that used to be disqualifying is now normal.”

    Let “We the People” have Honest Information – not Propaganda – and then Let Us Decide

        U.S. leadership values have dragged mass culture downhill since the post World War II robust and optimistic middle-class and Golden Age of Capitalism (circa 1945-1975). Since that time, the former Republican Party has degenerated into a full-blown fascist movement – a phenomenon filtered out of MSM narratives. It is dangerous for the media to ignore the resilience of fascism [5] and concentration of wealth and power in mammoth corporations and super-rich individuals/families.

        The fascists have clearly laid out their agenda. The MAGA Project 2025 will take the American people to a place where an overwhelming majority does not want to go.  It is a blueprint for dismantling the administrative state, stacking the courts, white supremacist rule, repression of dissent, and oppression of the middle and lower classes.  The healthcare program is misogynistic, religiously fundamentalist, and identitarian.[6]

        None of the theocratically fascist program offered to the American people by the fanatics of a movement that could gain control of government in a few months would pass muster in a referendum on healthcare or any of the other scary elements of Project 2025.  The cruelty of the current healthcare system would become cruel in spades.  I believe that the media should be less sanguine about rising fascism for the sake of appeasing shareholders and provide truth instead of pablum to consumers of television and print publications. 

        Furthermore, the Democratic Party should stop its political poll idolatry and naïve idealism about “working across the aisle” and wage a more robust fight.  The overwhelming majority of the American people can see through all of this political theatre and are disgusted.  Why don’t we just have a national referendum on what the people want?

    [1] Niccolo Machiavelli (2003) The Prince and Other Writings.  New York:  Barnes & Noble Books, 182.

    [2] David McCullough (1992) Truman. New York: Simon & Schuster, p. 532. It is widely believed by historians and social scientists that the American Medical Association blocked Truman’s single-payer, universal, healthcare program by convincing the American people that it was a slippery slope into socialism.  That’s false.  Southern Democrats killed Truman’s proposal for a national health insurance program that would look like the “Medicare for All” proposals devised by progressive Democrats.  The Democrats with a majority in Congress could have passed Truman’s plan and the AMA could not have stopped it.  However, Senators and Congressmen from the former Confederate States had to power to block any legislation that would threaten the racial hierarchy and plantation capitalism of the South.  When it came to healthcare, he American people in general did not share the Jim Crow agenda of the Southern Delegation. 

    [3] National Population by Characteristics: 2020-2023 (census.gov)

    [4] Number of registered voters U.S. 2022 | Statista

    [5] The Allies defeated Hitler and  Mussolini, but fascism has been quite robust and is now more potent than ever. Consider the strength of Marine LePen’s National Front in France and the results of the recent EU elections.  See also: Richard Wolin (2004) The Seduction of Unreason:  The Intellectual Romance with Fascism from Nietzsche to Postmodernism.  Princeton, N.J.: Princeton University Press.

    [6] Project 2025 – Wikipedia:

    “Project 2025 accuses the Biden administration of undermining the traditional nuclear family and wants to reform the Department of Health and Human Services (DHHS) so that this household structure is promoted.[18] According to Project 2025, state governments should have the authority impose stricter work requirements for beneficiaries of Medicaid,[23] the federal government should promote the Medicare Advantage program, which consists of private insurance plans,[56]: 464–65  federal healthcare providers should deny gender-affirming care to transgender people, and eliminate insurance coverage of the morning-after-pill Ella required by the Affordable Care Act of 2010 (Obamacare).[18] Project 2025’s healthcare plan would also remove Medicare‘s ability to negotiate drug prices.[18]

    Project 2025 aims at dramatically reforming the National Institutes of Health (NIH) by making it easier to fire employees and to remove DEI programs. Conservatives consider the NIH to be corrupt and politically biased.[15]

    Project 2025 accuses social media networks—directly naming Facebook, Instagram, Twitter, and TikTok—of jeopardizing the mental health and social ties of young Americans by creating a form of addiction. “Federal policy cannot allow this to continue,” it states.”[56]: 5–6 

    If We Forget Our COVID Pandemic History, We Will be Forced to Relive it.

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    By:

    Dave Kingsley

    The COVID Tragedy Was System Failure that Didn’t Need to Happen

        The U.S. health care system, which includes preventative and public health, is complex and dynamic. Unfortunately, this necessary and critical system for the good of the public interest has been declining into catastrophic failure mode for at least two decades. We struggled to manage and survive a systemic collapse of the economy along with medical systems due to an inept response to a deadly pandemic during 2020 and 2021.

        Because private interests had taken precedence over the health needs of the public, approximately 2000 nursing home patients and employees had died of COVID by April of 2022.[1] They are victims of industry greed and neglect, government deregulation, and venal, corrupt, and indifferent politicians.  Given the lack of Trump Administration concern and preparation and given what happened in the Senate Intelligence Committee discussed below, it should come as no surprise that dangerous and destructive conspiracy theories abound. How easy it is to see why government failure has inflamed cynicism among such a widespread number of Americans.

        The previous administration, bureaucrats, and legislators knew that the probability of a plague was high but did not have the capacity to respond when it did happen. Successful response to a rapidly moving scourge requires: (1) a plan, (2) a strategy, (3) adequate equipment/supplies, (4) technology (5) trained personnel, and (6) and competent, honest leadership willing to implement the plan.

        The consequence of a blasé attitude on the part of government in January of 2020 was devastating. There was no plan, no strategy, adequate personal protective gear, enough ventilators, bed capacity and other equipment and supplies needed in a pandemic. 

        The question is why? Public health and infectious disease experts had been warning for decades that pandemics would grow more severe and more frequent (In 1993, global public health expert Laurie Garrett warned us of that in The Coming Plague). Indeed, since the 1980s, we have seen HIV, H1N1, SARS, and Ebola outbreaks spread across the planet. It is not as if there have not been dire health scares in our past that could have informed us of the critical need for preparedness in the future.

    Who Knew What and When Did they Know it?

        The CIA was aware of something serious going on in China in December of 2019. The Chinese economy was practically brought to a halt and serious isolation practices were implemented as only an authoritarian government can implement population control. The disease quickly spread to other Asian countries. Singapore, South Korea, Taiwan, and Japan implemented extensive organized and effective prevention efforts. Singapore, South Korea, and Taiwan had prior experience with the SARS epidemic and undertook impressive campaigns to keep the outbreak from overwhelming their medical systems. They succeeded.

      Why were administration officials in the United States so sanguine about a novel virus that prompted massive public health efforts in China and other Asian nations? Even after it was known that a case of COVID had been discovered in a Washington state nursing home, the U.S. government remained unconcerned. Or did it?

        Former Senator Richard Burr, Chair of the Senate Intelligence Committee, was a leading legislative figure in the development of a national plan to thwart pandemics. He was not a neophyte in public health policy. Nevertheless, having been present at a “closed door” COVID19 briefing presented by the Trump Administration National Security Council on January 24th of 2020, he announced to the public that the virus would be contained and that grave worries about a pandemic weren’t justified.  

        By late February, Senator Burr had dumped stock worth between $628,000 and $1.7 million.. Intelligence Committee Members Feinstein, Loeffler, Purdue, Inhofe, and Johnson also unloaded a considerable amount of stock.[2]  The public was not immediately aware of these financial transactions.  The contents of the briefing have never been disclosed to the public. In a search of the Senate Intelligence Committee website, no evidence could be found that a meeting regarding COVID 19 was held.[3]

        Journalists uncovered an audio recording of Senator Richard Burr, Republican chair of the Senate Intelligence Committee, telling some donors in a private meeting that the coming pandemic could be as serious as the global flu pandemic of 1918. He was not at all as laid back and buoyant as he was in public at that time. The donor meeting occurred on February 27th.[4] 

         At the time Senator Burr was not expressing the same alarm in public he imparted to his close political allies, the President of the United States declared at a South Carolina rally on February 28th – one day after Burr’s ominous statements caught on audio – that the corona virus was a Democratic Party hoax.

        Throughout February and most of the month of March, Trump and his powerful propaganda machine consisting of Fox News, an assortment of well-funded and well-organized Christian nationalist organizations, and most of the Republican Party repeated the corona virus hoax lie. A phalanx of right-wing virus deniers, conspiracy theorists, and Fox bloviators were egged on by the president who at best was recognizing that the disease did exist, but claimed that it was primarily China’s problem and wouldn’t amount to much in the U.S.

    Minimizing by the CDC, NIH, HHS, and the FDA at Senate Health, Education, Labor, & Pensions Committee Hearing

        On March 3rd, Trump Administration officials responsible for pandemic preparedness, presented their views on potential threats to public health from the COVID19 outbreak at an open hearing held by the Senate Health, Education, Labor, & Pensions Committee. Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response, HHS stated that, “The potential global public health threat posed by this virus is high, but right now, the immediate risk to most Americans is low. The greater risk is for people who have recently traveled to an affected country or been exposed to someone with COVID19.”

        After the SARS epidemic, Asian countries developed pandemic guidelines for nursing homes. The nursing home industry and HHS/CMS were totally indifferent to the steps taken by countries affected by SARS to prepare for the eventuality of another plague.[5]

    Will Our Government Fail Us the Next Time?

        Over a million Americans died during the raging Covid19 pandemic. Nursing homes have been disproportionally affected. Over four years after the outbreak, two major nursing home commissions have avoided direct confrontation with the industry and CMS over lack of preparation prior to COVID and misfeasance and nonfeasance during the Pandemic. Little to no attention has been devoted to the issue of responsibility. As has become a normal response to serious negligence and consequent damage to the public by industry and government inaction, no entities or persons have been held accountable.

        The behavior of U.S. Senators privy to information not available to the public and acting on that information in their interests and to the detriment of the public is disgusting. It is in fact criminal. A flurry of activity by the DOJ, SEC, and Senate Ethics Committee was initiated and then dropped.  No one was held accountable. The government failed the American people, Senators behaved criminally, responsible parties escaped accountability, and the country moved on.

        It is delusional to believe that another scourge is not likely.  Advocates need to begin asking questions about protocols in nursing homes, stockpiling of personal protective equipment, and responsibility of the industry for preparation and administration of facilities during a pandemic.  We are dealing with an industry in which shareholders have intrinsic value and patients have instrumental value. Investors’ mission is to maximize cash flow.  To do that, they will naturally minimize care.  That is immoral and medically unethical.

    [1] Over 200,000 Residents and Staff in Long-Term Care Facilities Have Died From COVID-19 | KFF

    [2] The Senator Who Dumped His Stocks Before the Coronavirus Crash Has Asked Ethics Officials for a “Complete Review” — ProPublica.  Senator Feinstein sold stock worth $7 million dollars.

    [3] https://www.intelligence.senate.gov/, “HEARINGS” tab.  I checked this URL in the Spring of 2020 and could not find any information about the hearing.

    [4] The audio of the Senator warning his wealthy supporters about the coming plague can be heard at https://media.crooksandliars.com/2020/03/44593.mp3_standard.mp3. 

    [5] (2) Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect (researchgate.net); see also: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00062-4/fulltext