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.
Make no Mistake about It, Project 2025 is Powerful, it is Well-Funded, and it is Religiously Extremist, Misogynistic, and White Supremacist.
Last August, this headline appeared in the Washington Times: “Recruiting is underway for Trump-like ‘wrecking ball’ to shrink government and fire federal workers”[1]The wrecking ball to which the article was referring is a cadre of extremist right-wing individuals who will, if Trump wins in November, see to it that their allies staff his administration. The powerful, anti-Democratic Heritage Foundation has initiated a movement dubbed “Project 2025,” – a network of Christian Nationalist, states’ rights’, anti-choice, school censorship, and anti-constitution organizations steeped in religious zealotry and as far out on the right of the political spectrum as any movement in U.S. history.
The Heritage Foundation is claiming that 100 organization on the hard right have signed onto their project in preparation for ending U.S. Constitutional government as we know it.[2] They are intent on scrapping the form of federalism intended by the framers and accepted by the American people as it has evolved since 1789. The list of organizations signing on includes Moms for Liberty, Turning Point USA, Hillsdale College, Liberty University, Susan B. Anthony Pro Life America, Dr. James Dobson Family Institute, Family Research Council, and other reactionary groups.
Most people who pay attention to politics have heard of at least one or more of these fanatical groups. Adherents of the Moms for Liberty have been running around censoring books in school libraries. They are allied with DeSantis’s project to undermine public education and replace it with a revisionist, false history and toxic religious indoctrination. Turning Point USA was formed and led by Charlie Kirk a rabid disseminator of disinformation and supporter of Donald Trump and his tripe about stolen elections, insurrectionists as patriots & hostages, and other dangerous nonsense. He has successfully organized chapters on at least 400 college campuses.
These types of anti-American organizations have moved from the unthinkable to the normal in the past few decades. Even more diabolical and violent groups are lurking in the shadows of this cabal. The violent, neo-Nazi Proud Boys and other Hitler sympathizing white male organizations are operating on the perimeter of the movement and tolerated at meetings of CPAC and Turning Point USA.[3]
Project 2025 is in Sync with the Ultra Conservative, Six Member Supreme Court Majority and the Republican Party
The current six-member majority on the U.S. Supreme court is acting not as jurists but rather as idealogues with sympathies for the dominant and dogmatic religious leaders of the Republican Party and a very mentally disturbed Donald Trump. Mainstream legal scholars are horrified by their actions and are speaking out about it[4] – to no avail. Not only is the overtly ideological majority on the court signaling that they will seriously weaken federal agencies,[5] they are expressing a considerable amount of sympathy for reducing women to second class status,[6] and interfering with privacy rights of gay and heterosexual married couples.[7]
It also appears that the S.C. majority has piled weight on the scales of justice for Donald Trump who is attempting to forestall his criminal trials by claiming total immunity for anything he did as president. This is an absurd claim rejected by a unanimous three judge panel of U.S. Court of Appeals for the District of Columbia Circuit. Nevertheless, the S.C. decided to hear the case and help stall justice for the American people who need a decision prior to the November 4th election.
Rarely in U.S history has the Supreme Court issued rulings that retract previously granted liberties. However, this court is intent on remaking law to reflect their favoritism toward a fundamentalist Christian theocracy with concentrated power in the hands of ultra-conservative white males.
What Project 2025 Means for the Elders of America
Like other vulnerable groups in American society, the elderly are falling prey to economic predators. This is consistently becoming a bigger problem, but it is happening without adequate federal regulation. This is particularly the case for elders institutionalized in “nursing homes.” Lax oversight of the nursing home industry prior to 2020 and the spread of COVID led to 2000 patient and 200 employee deaths. This was preventable and shouldn’t have happened. Nevertheless, the media, white-washing commissions, government agencies, and the legal system have displayed no propensity to hold the industry accountable for its neglect.
While the scourge was killing and isolating nursing home patients, the right-wing media and politicians and pundits appearing on their networks were claiming that masking, isolating, and preventative behaviors in general weren’t necessary because as Bill O’Reilly mused on Fox News: “The [U.S. death] projections that you just mentioned are down to 60,000, I don’t think it will be that high. 13,000 dead now in the USA. Many people who are dying, both here and around the world, were on their last legs anyway.”[8]
O’Reilly’s attitude reflects a far wider viewpoint about the value of older Americans than our government and politicians would care to admit – even beyond the confines of the radical right. However, the strength of an underlying theological dominionist[9], government-hating religiosity – combined with grievances against liberal, women, gay, ethnic, transgender, and other non-white male outgroups – does not bode well for programs such as Social Security, Medicare, and humane care for frail elders. Crazy religious views of the extreme right have incorporated a glorification of private corporations and privatization of government services. This is an outgrowth of their hatred of liberal programs from the New Deal forward and the political liberalism that era implies.
Summary
Religious fanatics want to run America. They have made significant inroads in doing just that (think school vouchers). The Christian extremist alliance with violent, neo-Nazi organizations is even more disturbing. Under the influence of the Heritage Foundation for the past fifty years and now its Project 2025, this coterie is infecting the mainstream of U.S. political discourse and jelling into a real threat to our constitutional form of government.
Coverage of right-wing fanaticism by the mainstream media has been problematic. The Heritage Foundation was formed by wealthy individuals on the far right in the 1970s. At the time, it was considered too radical for the normal American politically centered zeitgeist. By the 1980s, representatives of the organization were invited as guests on moderate news outlets such as PBS News Hour and it became a go to entity for print media seeking what they believed to be normal conservative views.
The MSM tends to engage in a misguided form of “fair and balanced” coverage of political groups with the chutzpa to push unthinkable views hard enough and long enough to become accepted into the Washington, D.C. establishment. The undeserved respect these entities receive inside the D.C. beltway – including by the press – creates a form of induced ambiguity in mass communication and voters’ thought processes. The real danger and odious facets of the Heritage Foundation and Project 2025 are minimized in leading new outlets out of respect for their success in becoming part of the normal political establishment.
I’m worried about the level of energy exerted by moderates in pushing back on the well-organized and aggressive organizations constituting Project 2025. Furthermore, there should be vocal opposition to the media myth about a “divided country” as if there are two equally legitimate sides in U.S. politics. In truth, American political views can be characterized as a broad, ambivalent middle with loud minorities on the fringes. The loudest and most effective fringe voice these days is on the right. Is it even fringe any longer?
[7] In Dobbs v. Jackson, Clarence Thomas expressed interest in overturning the right to contraceptives – a right granted in Griswold v. Connecticut, 381 U.S. 479 (1965) – and the right of gay people to marry, which was accorded in Obergefell v. Hodges, 576 U.S. 644 (2015).
[9] Along with misogyny and white supremacy, Dominionism is one of the more perverse political philosophies driving the Christian Nationalist movement. Proponents of this weird and dangerous philosophy are increasingly successful in persuading the Republican Party to seriously consider and adopt their ideas. Dominion theology includes a belief in a Christian nation ruled on biblical tenets – whatever those may be. Many of the opponents of imaginary “woke education” would replace it with false teaching about the framers’ intent, which they claim was to create a “Christian Nation.”
