Don’t Believe the Propaganda: The Nursing Home Industry is Doing Very Well – Even in a Down Market

By:

Dave Kingsley

Stocks Have Been Dropping Rapidly Since the End of November – But Not in the Nursing Home Business. Why?

The nursing home industry has a well-funded, highly effective, lobbying-propaganda arm that has been effective in convincing the public that providers are not paid enough to provide decent, medically ethical care. That is a lie. The evidence is overwhelming that the industry’s hardship pleas are merely a propaganda effort at squeezing ever more money out of the taxpayers without providing a correlative improvement in care.

The stock market is one of the many sources of evidence supporting my claim that the nursing home industry is doing just fine during these economic uncertain times. Although the the Dow, S&P, and NASDAQ have dropped precipitously since the end of November, stock prices of the major players in the nursing home industry have held their own or have made major upward swings. For instance, the Ensign Group stock increased by nearly 10% during the same period that the DOW fell 7%, the S&P dropped 10%, and the NASDAQ declined by 17%.

The stability (see discussion of volatility below) and steady upward trend of stock overall in the public-funded long-term care/skilled nursing business suggests that the industry is not subject to the vicissitudes of the overall “market economy.” That is indeed the case because it is an industry that is not part of a market economy. The corporations in the nursing home industry listed on a public exchange are not capitalist enterprises. They are a growing part of the U.S. economy that is a partnership between government and corporations in which corporations have steadily gained the upper hand over government.

The characteristics of the government-corporation partnership – otherwise known as corporatism or statism – is guaranteed revenue, a restricted market, i.e. no competitive market in which prices are negotiated. Nursing home corporations are reimbursed for their costs plus adjustments for inflation. Furthermore, the underlying source of revenue is derived from commercial real estate, i.e., the facilities in which patients are maintained with minimal care.

The power of the industry over its government partner has allowed for financial machinations and accounting maneuvers that hide a significant portion of gains in revenue, operating margins, and, most importantly, cash flow from facilities to parent corporations. States are responsible for auditing cost reports submitted by facilities for the purpose of determining daily Medicare and Medicaid reimbursement rates. The auditing and financial oversight of cost reports are weak – allowing extremely flawed cost reports to pass audit review.

The lucrative nature of commercial real estate with a generous government guarantee of producing revenue plus a stable stream of government funds into medical services have not gone unnoticed by institutional investors such as BlackRock and Vanguard. The overwhelming voting shares in nursing home industry corporations are owned by these asset managers. Hence, pension funds, college endowments, and other large pools of capital have been invested in multi-billion dollar corporations that are setting the trends in long-term/skilled nursing care in the U.S.

Volatility is a Big Deal in the Markets: It Tells Us a Lot About the Past & Future of a Company.

Stocks have been mostly trending down in the past few months due to supply chain crisis, oil price fluctuations, conflict in the Ukraine, inflation hysteria, and uncertainties related to COVID. The market has also been highly volatile, which means stock prices are swinging widely in price. I won’t go into great detail about the technical aspects of volatility. Suffice it to say that a volatility of 1 means that the stock doesn’t move up and down much but a volatility of 0 means it never fluctuates – a theoretical situation that doesn’t happen.

Stock may trend up over time but it will tick down and up on the way up. If it swings widely that suggests that it is far more speculative and traders are buying and selling it at a rather rapid pace. For instance, stocks listed on the NASDAQ with recent IPOs tend to be more volatile because they tend to be risky tech stocks back by venture capitalists willing to take a chance on the next big thing.

Stock of a corporation with a guaranteed market in which competition is restricted and earnings are robust will increase over time with only minor day-to-day fluctuations. That is what is noticeable about the stock in corporations comprising the nursing home industry. Not all of its members have increased their stock price over the past few months, but even the few that have lost ground have not seen the kind of downward swings seen across the board on the Dow, S&P, and NASDAQ.

A “Nursing Home” License is a Valuable Asset: States Are Failing to Leverage Licenses in Securing Reputable Providers & High-Quality Care

By:

Dave Kingsley

What’s A Nursing Home License Worth?

    What is a nursing home license worth to a corporation or group of investors pooling their money to buy facilities?  It’s of enormous value. Without a license granted by a state, nursing home real estate – the primary purpose of an investment in the business – is worthless.  The value of these intangible assets are noted on nursing home corporation balance sheets as “Right-of-Use-Assets.”  For instance, Brookdale Senior Living noted $788 million of “Operating lease right-of-use assets” in 2020 and $1.2 billion in 2019.  The Ensign Group noted $1.0 billion in both 2020 and 2019 on its balance sheet as “Right-of-Use Assets.”

    A limited number of licenses are available, which enhances their value.  We can expect a modest decrease in the number of long-term care facilities and number of beds across the United States.  More emphasis on keeping individuals at home and out of institutions has gained some traction.  Any downward trend in institutionalization of patients on a long-term basis will increase the value of licenses merely because of supply and demand.

State Agencies Responsible for Licensing Are Handing Out Valuable State Assets Without Adequate Expectations of Transparency, Responsibility, & Quality of Services from Recipients

    Although industry lobbyists constantly and consistently claim that providers are struggling financially due to inadequate Medicaid reimbursement, they have never presented objective (audited) financial data to support their hardship pleas.  Conversely, an abundance of evidence is available from required Security & Exchange Commission reports that executives, board members, and major shareholders are being abundantly rewarded.

    It is time for the public to insist that high paid industry lobbyists such as former Governor Mark Parkinson of Kansas either cease their incessant misinformation about the financial hardship of providers or provide audited financial data that contradicts publicly available financial information.  Contrary to the effective, well-funded, industry narrative and political strategy, overwhelming evidence suggests that investors are becoming fabulously rich from land and buildings, the value of which is based mostly on taxpayer funded “poor people’s medicine,” i.e., Medicaid.  A variety of complicated sections of the U.S. tax codes further add to cash flow from government funds into the pockets of investors. Not the least of these tax advantages is depreciation appearing on corporate financial statements (there are many others, but that’s a subject for a future blog post).

    It is my contention that states are not leveraging the value of their licenses on behalf of federal and state taxpayers.  Indeed, over the past few decades, major industries such as real estate, finance, insurance, skilled nursing/long-term care have captured legislatures at the federal and state level through generous political contributions and an army of lobbyists. Therefore, state regulators tend to take a very laisse faire approach to oversight. Due diligence in the issuance of licenses is lax and revocation of licenses for negligent care is rare.

Will Long-term Care Investor Ephram Lahasky Be Granted Licenses to Operate Diversicare Facilities in Kansas? It Is Time for Advocates to Put Legislators, the Governor, and State Agencies on Notice:  We are Watching!

    Diversicare Inc. is one of the rather small number of publicly listed nursing home chains.  For the most part, it is a “failed company” due to poor management.  This corporation was on the brink of bankruptcy until generous federal and state COVID subsidies breathed new life into it.  Entering the COVID pandemic in 2020, the company’s stock was trading at about $1.60.  By Spring of 2021, the stock was trading around $3.50 per share.  A couple of weeks ago, I noticed that Diversicare shares had shot up about 250% in one day.

    An investor by the name of Ephram Lahasky had offered to buy the company for $10.00 per share.  According to media reports, Lahasky has a record of running substandard nursing homes. He is not welcome to buy long-term care facilities in states where his past surfaces.  A Lexis/Nexis search uncovered a host of suspect activities and federal investigations pertaining to Lahasky owned facilities (see for instance, Sean D. Hamill, “Lawsuit: Nursing Home Reported False Data: Owners Also Own Brighton Rehabilitation and Wellness Center In Beaver County,” Pittsburgh Post-Gazette, August 27, 2020 Thursday).

     We must insure that Lahasky is thoroughly vetted by the Kansas Department of Aging & Disability Services before licenses are granted to him for the six Diversicare facilities now licensed to operate in Kansas.  According to the following section of Kansas statutes, it would be illegal for the current licenses to be merely transferred to a new owner of the property:

39-928. Issuance of license, when; inspections and investigations; reports; time license effective; nontransferable; display; contents of license.

Each license shall be issued only for the premises and persons named in the application and shall not be transferable or assignable. It shall be posted in a conspicuous place in the adult care home. If the annual report is not so filed and annual fee is not paid, such license is automatically canceled. Any license granted under the provisions of this act shall state the type of facility for which license is granted, number of residents for which granted, the person or persons to whom granted, the date and such additional information and special limitations as are deemed advisable by the licensing agency.

History: L. 1961, ch. 231, § 6; L. 1972, ch. 171, § 5; L. 1980, ch. 182, § 11; L. 1989, ch. 126, § 1;

Public officials have a fiduciary responsibility to citizens when they award rights to their states’ valuable resources.  A license to operate a long-term care facility infuses more value into real estate than taxpayers realize. Investors benefitting from a state-granted license owe taxpayers quality services equal to the financial rewards they will reap.

WARNING! The Mainstream Media is Writing COVID-related Deaths in U.S. Nursing Homes Out of History.

By:

Dave Kingsley

If you visit your local Barnes & Noble store, you will find three new arrivals chronicling the COVID-19 scourge:

Washington Post journalists Yasmeen Abutaleb & Damian Paletta: Nightmare Scenario:  Inside the Trump Administration’s Response to the Pandemic that Changed History (New York:  HarperCollins).

Freelance writer John Sternfeld (Introduction by New York Times Columnist Timothy Egan): Unprepared: America in the Time of Cornovirus (New York: Bloomsbury Publishing).

New Yorker staff writer Lawrence Wright: Plague Year: America: America in the Time of COVID (New York:  Alfred Knopf).

This post is not a full-fledged review of these books.  I have read them and find them disturbing because of what they don’t say.  I’m warning the “less physically abled” people of America needing skilled nursing and long-term care that they are being disappeared from history.  That puts those people we dehumanize as “frail” and “disabled” out of sight and out of mind, which puts them at great risk.

Authors of these books have ignored the estimated 140 to 200 thousand mostly unnecessary deaths and suffering of patients and their families due to dereliction of the nursing home industry and government regulatory agencies.  Their focus is on Washington, D.C., inside the beltway politics and the Trump Administration’s handling of the pandemic (sans nursing home related issues). 

It is not surprising that Timothy Egan’s introduction to Sternfeld’s book ignores the “nursing home tragedy” altogether.  He has, in the past, demonstrated hostility toward the “elderly.” In an NYT column he claimed that “pill popping seniors” were robbing younger generations.  He was referring to the cost of Medicare, which he failed to recognize is paid for by the beneficiaries through a payroll tax and out of pocket expenses. I remember this column so well because I was in Washington circa 2012 on many occasions lobbying to stop cuts in Medicare and Social Security.  NYT columnists like David Brooks and Timothy Egan were accusing the aging population of selfishness merely because of their audacity to fight for the benefits they had worked hard to earn.

The Silence of Professional and Advocacy Groups is Deafening

COVID-19 resulted in a horrendous failure of care and protection for the institutionalized less abled among us, i.e., those individuals institutionalized in the so-called “nursing home system.”  Not only were government agencies and corporations charged with the care of millions of patients in skilled nursing and long-term care facilities derelict, but professional organizations comprised of physicians, gerontologists, and advocacy groups such as the AARP were reticent and vacuous in speaking out about the preventable mass fatalities occurring in these government-funded and regulated institutions during 2020 – and remain so to this very day.

How elites and paid professionals and the organizations in which they are employed react to the massive loss of life in SKN/LTC facilities will greatly impact the public attitude toward the value of Americans with physical barriers preventing their full independence and participation in society.  Ignoring the unnecessary loss of life in the institutions ostensibly designed for humane care will send a strong signal about what we can expect in the years ahead.

Another Conversation with Charlene Harrington

We welcome back Charlene Harrington for another conversation. In this session, Dr. Harrington updates us on some alarming statistics and related details regarding the impact of Covid in nursing homes throughout America. She informs us that there are currently approximately 3.1 million residents in these facilities, of which 1.3 million became infected. We also learn that Scandinavian countries are thirty years ahead of America with their methods of caring for their elder populations.

Lydia Nunez is Joining Us as A Blogger on Disability Issues

Lydia Nunez is a Knowledgeable & Experienced Colleague Who Has Joined Us to Provide Her Perspective on Assisted Living, Long-term Care, & Issues Pertaining to Americans with Disabilities. We’re Delighted to Have Her on the Tallgrass Economics team. Lydia’s bio is on the “Meet the Bloggers” page. Today her testimony to the Senate Finance Committee is posted.

The Ensign Group, America’s Biggest Nursing Home Corporation, Had a Banner Year in 2020

The American Health Care Association’s Well-Funded PR Machine Is Promoting a False Narrative.  The Ensign Group’s 10-K Debunks the Industry “Hardship Claim.”

The AHCA – the long-term care industry’s lobbying arm – has a perpetual propaganda machine which incessantly cranks out a hardship narrative.  By operating mostly behind a veil of secrecy, the industry has been able to convince the public and legislators that profitability is so meager that firms are barely making it and, consequently, are on the verge of exiting the business.

Let’s consider the industry’s narrative in the context of what we are learning from publicly listed firms required to file financial statements with the Securities & Exchange Commission (available to the public).   I will begin a series of posts with the consolidated financial statement of The Ensign Group, one of the handful of publicly listed long-term care corporations.  I consider the Ensign Group to be the largest skilled nursing corporation with over 300 stand-alone nursing homes.

Other companies owning and operating skilled nursing facilities have larger annual revenues, but they are Real Estate Investment Trusts with a diverse portfolio in the broader senior housing realm. The Ensign Group owns and operates facilities in buildings it also owns.  For this reason, I’m claiming that it is the “biggest” skilled nursing corporation.

2020: A Banner Year For The Ensign Group

On a February 4th conference call, The Ensign Group reported the following:

  • Earnings per share of $3.06, an increase of 86.6% over the prior year.

  • Revenues of $2.4 billion, an increase of 18% over the prior year.

  • Net income of $174.6 million, an increase of 74.8% over the prior year.  This is “GAAP net income.”  GAAP is Generally Accepted Accounting Principles.  This measure of net income will be significantly lower than non-GAAP measures, a fact with which I don’t need to bother readers.

  • Liquidity, which is of great importance to shareholders, remains strong with $236.6 million in cash and equivalents on hand, and $340 million of available capacity under its line-of-credit facility.

  • The company returned approximately $150 million relief funds provided under the CARES Act.  Given the company’s strong financial condition, it’s interesting that a corporation as large and in solid financial condition would have received these grants in the first instance.

Financial Engineering through Patient Arbitrage

As we unravel the finances of the long-term care industry during the COVID-19 pandemic, we need to access all data pertaining to corporate patient mix.  Furthermore, it’s well-known that patient care reimbursed by Medicare is much higher than reimbursement from Medicaid. Also, premiums are paid for patients with COVID.

 Although there is plenty of evidence that Medicaid is profitable, providers will manipulate their business in favor of Medicare patients.  I call this “patient arbitrage.”  Given that protecting and enhancing shareholder value is the primary objective of long-term care corporations, no one should be surprised by the practice of seeking higher reimbursement patients.

By perusing The Ensign Group financial statements and promotional material, I surmise, reading between the lines, that the pressure on management at each facility to maximize revenue is rather intense. Here is a quote from the February 4th Conference Call:

Port noted that as evidence of the medical communities’ confidence in their local operations’ clinical capabilities, the Company saw a marked improvement in patient volumes, especially with high acuity and skilled patients with a 7.2% and 10.8% increase in Medicare census and 6.2% and 5.7% in managed care census, sequentially from second quarter to third quarter and third quarter to fourth quarter for same store and transitioning portfolio, respectively.

This improvement in our admissions trends not only gives us great confidence that we can continue to perform well as the pandemic stubbornly persists in many of our largest markets, but it also gives us confidence that we are in an excellent position to see occupancies normalize to pre-pandemic levels even while the pandemic continues to impact us and our patients. Because we have been working arm in arm with our hospital and managed care partners during this pandemic to care for both COVID-19 positive and negative patients with complex medical needs, our operations have solidified the critical role they play in the post-acute care continuum as an essential and cost-effective setting for highly complex patients.

Don’t Cry for Long-Term Care Corporations: Demand Accountability!

Most restaurants, movie theatres, and other small businesses in your community could only hope to have the government provided revenue stream as that provided to long-term care corporations throughout 2020 while the COVID scourge killed at least 200,000 people in their care.  As the pandemic is brought under control, it is important to demand answers from our political representatives.  What did providers do for patients and families versus shareholders?  Why were nursing home systems in countries throughout Asia, Australia, New Zealand, and other parts of the world able to keep death in long-term care facilities so much lower than the United States? If our government is not presented with these and other questions along with a demand for answers, patients in nursing homes will remain vulnerable to the next pandemic.

The Media is Promoting a Dangerous & False Narrative by Claiming that the Nursing Home Industry is Struggling Financially

By:

Dave Kingsley

Here is a message to the media:  high net worth individuals and their financial managers do not invest in long-term care because it is a poor investment.  Furthermore, corporations will not continue in a line of business that is a losing proposition for their shareholders.  Nevertheless, journalists keep writing articles in which they promote a false narrative concocted by the long-term care industry and spread by the American Health Care Association. I call it the “nursing home industry hardship narrative.”

An egregious example of this false narrative appeared in the Kansas City Star recently.  Writing about the assistance requested from the National Guard by long-term care facilities, Star journalist Sydney Hoover said this: “Nursing homes in Kansas have long struggled financially, with many unable to pay competitive wages, or even basic utility bills.” The article went on to say that the “pandemic has exacerbated those difficulties, as the cost of personal protective equipment increases and staff shortages grow.” (“Kansas nursing home officials push for staffing aid – and calling out National Guard,” https://www.kansascity.com/news/coronavirus/article248477490.html).

This article cited no empirical evidence or any credible research that supports this typical industry “hardship narrative.”  I have been researching Kansas nursing home ownership for years – probably to an extent no one else has – and the only evidence of bankrupt and insolvent facilities pertains to chains taken over by private equity firms or white-collar criminals and looted.  Conversely, plenty of evidence exists to suggest that the long-term care business is an attractive investment.

It is incumbent upon agency employees, the media, and advocates to debunk the industry’s hardship pleas.  The evidence is not difficult to find.  Publicly listed companies are required to file quarterly and annual financial reports with the Securities & Exchange Commission. They are also required to file a “proxy report” on an annual basis, which includes executives’ and board of director’s compensation.

The largest long-term care facility owners are real estate investment trusts.  Welltower is the dominant REIT long-term care corporation in revenue (Over $5 billion in 2019).  It’s 2020 proxy report indicates that CEO compensation was $17 million in 2019.  Board member compensation ranged from $250,000 to $350,000. 

The Ensign Group – not an REIT – is one of the largest long-term care corporations in number of facilities.  Its 2020 revenue has increased quarter over quarter.  Like most of the other publicly listed corporations, the Ensign Group has had robust earnings, has paid dividends, and has not drawn down its rather impressive stash of cash. These companies are sitting on $billions in cash and equivalents and are not overly debt ridden.  Like the rest of corporations listed on a stock exchange, the value of Welltower, Ventas, Ensign Group shares tanked in March but have since recovered to near prior highs.

The 10-Q reports for these publicly listed long-term care corporations also indicate that they have been receiving a considerable amount of COVID relief from the federal government through the CARES Act.  For example, the VENTAS 3rd Quarter 10-Q states that the corporation applied for $35 million under Phase II of the Provider Relief Fund.  They further stated that “HHS recently announced a new $20 billion Phase III General Distribution allowance.”   

There seems to be little doubt that these highly subsidized corporations will land solidly on their feet as the pandemic is brought under control.  It is interesting to note the following statement by VENTAS regarding its liquidity during the COVID pandemic:

Since the start of COVID-19 pandemic, we have taken precautionary steps to increase liquidity and preserve financial flexibility in light of the resulting uncertainty.  See ‘Management’s Discussion and Analysis of Financial Condition and Result of Operations, Liquidity and Capital Resources; Recent Capital Conservation Actions.”  As of November 5, 2020, we had approximately $3.2 billion in liquidity, including availability under our revolving credit facility and cash and cash equivalents on hand, with no borrowings outstanding under our commercial paper program and negligible near-term debt maturing (Form 10-Q, page 9).

Fourth quarter 10-Qs, 2020 annual reports, and proxy statements will be issued early in February. At that time, we will have a clear picture of the financial condition of the publicly listed “players” in long-term care.  We will be analyzing those and reporting on the finances of the major providers in the industry.  These reports are hundreds of pages of financial information. Writing about them is a daunting task.  However, we will take small bites for posting on Tallgrass Economics Finance & Politics.

Our detailed analyses of long-term care provider finances will be uploaded to a new website – The New Economics & Politics of Aging at http://neweconomicsofaging.org/. If we do not begin to push back on industry propaganda, the future of long-term care looks bleak for patients and families.  The victimhood bestowed upon long-term care corporations during the COVID-19 pandemic will, if left unchallenged, strengthen their position with the public, politicians, and agencies charged with regulating them. Conversely, it will weaken the hand of advocates, the public, and families as they attempt to transform the current long-term care system from a business for extracting federal and state dollars at the expense of care into a truly humane system that values the lives of the elderly and disabled.

The “Nursing Home” System has Failed Patients and Employees. Now Operators are Calling on the National Guard for Help

By

Dave Kingsley

Will we Just Bail Out the Industry & Move On?

Because it was a white wash, I have been critical of the CMS Commission on COVID in Nursing Homes. On September 16, 2020, the Trump Administration issued a press release with the title “Independent Nursing Home COVID-19 Commission Findings Validate Unprecedented Federal Response.” Probably another 100,000 patients will have died in long-term care institutions between that “big lie” (typical of autocratic regimes) and when the pandemic is under control.

Although the report shamefully let CMS, state agencies, and the industry off the hook for dereliction of their duties, the claim that it validated the federal response was blatant propaganda. I’m dismayed that I haven’t heard that from the advocates, scholars, lobbyists, and industry representatives who served on the commission.

Here’s the truth: staffing in many facilities has deteriorated to the point that the industry is calling for help from the National Guard. Apparently, they are receiving that help because nurses and other employees are leaving to work in hospitals and clinics. In addition to receiving an unknown amount of payroll protection assistance under the CARES Act and other supplemental payments, owners now want the National Guard to pick up slack in their workforce (see Sydney Hoover, “Kansas Nursing Home Officials Push for Staffing Aid” https://www.kansascity.com/new/coronavirus/article248477490.html). Apparently this military assistance has already been provided in some areas such as San Diego.

If that is what is required to save as many lives as possible, I’m all for it. However, I will keep agitating for a reckoning when the pandemic is under control. I want to know how much extraction of federal and state funds has taken place for the sake of investors and at the expense of saving lives. The best we can do in determining that is look at the financial statements of for-profit enterprises or the 990s of the non-profits. If facilities are owned by non-public corporations, we will not be able to see what was reasonably extracted. However, publicly held corporations will soon be submitting their 10-K reports to the Securities & Exchange Commission.

I will be going through those 10-Ks as soon as they are available. If they reflect what we have seen in quarterly reports for the past year, then we need to ask why so many people died while executives, board members and shareholders gave up very little – if anything. We need to ask why some of the biggest owners sat on a pile of cash and continued to do business as if there were no pandemic.

What we have seen is euthanasia by neglect during the past year. If we do not hold the responsible parties in government and industry accountable, we will see even less regard for human life in long-term care institutions in the future. The industry will be further emboldened to deny treatment for the benefit of high net worth individuals who see long-term care as a good place to park their wealth and keep it from the IRS.

More People are Agreeing that Greed is “Not Good.” What they are Missing is that the Greedy have become Increasingly Clever.

By

Dave Kingsley

Greed is No Longer Acceptable, but That’s Not the Whole Story

In his latest book, Evil Geniuses, Kurt Andersen suggests that the “greed is good era,” kicked off by the likes of Ronald Reagan, Milton Friedman, Ayn Rand, and Ivan Boesky, has run its course.  Andersen covers old territory that many progressive writers have been discussing ad infinitum, ad nauseum for decades, e.g., “the Powell Memo,” the rise of Chicago School free market economic orthodoxy, so on and so forth.

Perhaps greed is no longer de rigueur, but that does not really matter to a small number of Americans who have amassed incomprehensible economic and political power.  That power is centered in the economic sector known as “FIRE:” finance, insurance, and real estate, or, metaphorically speaking, Wall Street.  Indeed, finance now dominates the U.S. economic system.

The goal of financiers and the super-rich is to protect the wealth they have accumulated during the past few hyper-capitalistic decades following the ascendance of Ronald Reagan and Margaret Thatcher. Given the economic injustice Reagan-Thatcher neo-liberalism has wrought and shifting attitudes toward a just and fair economy, the greedy have turned to deceptive and clever political networks within the Washington, D.C. beltway.  As I will demonstrate in a series of blog posts, these networks have been successful in coopting advocacy and professional organizations.

501(c)4 and 501(c)3 organizations such as the Better Medicare Alliance, The Third Way, the Committee for a Responsible Feder Budget, the Concord Coalition, and others are particularly aimed at either privatizing Medicare or reducing Social Security and Medicare benefits. The financing of these lobbying groups can be traced to the late billionaire, private equity mogul, Peter G. Petersen.  The thirty board members of the Third Way – a Democratic Party “think tank” – are practically all financiers.

Better Medicare Alliance

The Better Medicare Alliance was initiated and funded by the insurance industry. This “think tank,” and front group for the insurance industry has a mission of privatizing Medicare through Medicare Advantage. With congressional cooperation, the insurance industry has been successful in shifting Medicare beneficiaries away from traditional Medicare and into Medicare Advantage.  Approximately one-third of all beneficiaries are now in MA. If this movement achieves its goal of killing traditional Medicare, the insurance industry will have achieved immense power over what will soon be a trillion-dollar health care program for the elderly.

The image of the BMA has been concocted to convince the public that it is an advocate for elders and the betterment of their cherished federal health care program.  That is a lie.  But a large number of professional and advocacy group have signed on as allies (https://www.bettermedicarealliance.org/our-allies/).  These allies – too numerous to mention in this post – range from insurance businesses to Area Agencies on Aging, Leading Age, nurses associations, and professional medical organizations.

We Know What Greed Has Wrought, but We Don’t Know How Entrenched it has Become.

In the past few years, a spate of books about the throes of hyper-capitalism have appeared in the popular press. The best among these are The Finance Curse by Nicholas Shaxson and Transaction Man by Nicholas Lemann.  Andersen’s book adds nothing to these and many others.

What all of these excellent writers have failed to see is this:  greed has spread its tentacles throughout the political system in a shadowy network that is rewarding congresspersons with post-career jobs as executive directors of think tanks and on corporate boards.  These so-called “think tanks” are highly influential behind the scenes and are called on by legislators for testimony in congressional testimony and consultation on legislation.  They are the go-to organizations when the press is looking for “expert opinion” on issues and legislation.

The growing elderly population of the U.S. must not ignore these powerful interest groups working against their best interests.  Hence, many future blog posts on Tallgrass Economics, Finance, & Politics will be focused on predatory activities by FIRE interests within the Washington, D.C. Beltway.

Republicans, Trump, and Examples of Conservatism’s Economic and Political Inconsistencies

By:

Max Skidmore

If an objective observer from outside were looking at America’s political economy for the first time just after the 2020 elections, several astonishing inconsistencies would be immediately apparent. In the presidential election, many supporters of the incumbent – the loser Donald Trump – had first voted for him in 2016 because they believed he was a “good businessman.” Yet under his presidency the economy was failing, his incompetence as a leader was manifest, and conditions under a pandemic literally were lethal, the worst in the world, because he had no idea how to deal with the emergency, nor did it even appear to concern him.

Mr. Trump had, in fact, never demonstrated skill at business; on the contrary, he consistently had failed. Having lost money in businesses, he shifted his attention to television where he appeared on a successful “reality” show, which provided him with a substantial income. In any case, the qualities required to run a business are far different from those needed to guide a government that exists not to profit from, but to benefit, the people.

Apart from Trump, voters often explained their support for Republicans because they believed Republican leadership would bring a strong economy. Yet in administration after administration, the business climate had been better when Democrats were in power, than it was under Republicans. The Republican reputation as better for the economy does not hold up under examination.

Republicans have come to claim that taxes inhibit the economy, and that tax reductions pay for themselves by increasing business activity. President Bill Clinton signed tax increases into law in spite of dire predictions that they would damage the economy, but the economy afterward improved at an astonishing level. His successor, George W. Bush, on the other hand, signed into law huge tax reductions, and what followed was the greatest economic catastrophe since the Great Depression. In other words, basic Republican assumptions are wrong. This does not mean that tax policies are good or bad, but that they do not routinely have the effects that Republicans claim for them. A cursory glance at the actual record makes that clear.

Although Republicans long stressed patriotism and love of country, they recently exposed their party’s thirst for power at the expense of America’s fundamental interests. In response to clear revelations of massive foreign interference in American elections, they tend to deny it, or shrug it off as unimportant if it happens under Republicans. At the same time, they generate fantasy scenarios to charge Democrats as “un-American,” and beholden to foreign powers. Many of the Republicans’ prominent office holders supported Donald Trump as he illegally sought to pressure Republican state officials to “find” nonexistent Trump votes and reverse the results of democratic elections, hoping to retain him in power by overturning the will of the voters. 

The most shocking example of “conservative” contradictions took place on the 6th of January 2021, when Congress was scheduled to count the electoral vote totals that the states submitted. Donald Trump, still president despite considerable loss of the election, incited his followers to engage in a coup, to storm and take over the Capitol, keeping him in power despite his clear loss.

They did so in massive numbers, vandalizing the seat of national government, stealing items, and taking “selfies” in some of the most presumably secure places in the House and Senate chambers, and offices of the members. They were cleared out, gently, as many observers noted. This was in sharp contrast to the manner in which authorities dealt with civil-rights protests, when peaceful demonstrators were gassed, beaten, and sometimes killed. Quotations from some Capitol Police expressed astonishment, because  they had anticipated no trouble. Conservatives, they thought, did not engage in violence. Even the most cursory examination reveals that political violence in modern America almost always comes from the right¾from white nationalist, neo-Nazi, and other racist groups¾not the left.

Some authorities deny that the riot was actually a coup, because it was too disorganized. That is nonsense. The attempt was to take over the government. Some of the rioters had even constructed a gallows on the grounds of the Capitol, reportedly having planned to kidnap officeholders, conduct mock trials, and then hold public executions. The fact that they were incompetent and failed does not in any way mean that they had not attempted a government takeover¾which by definition was an attempted coup. All the while, Trump still the sitting president, was reported as having enjoyed the spectacle.

This was sufficiently outrageous that a few of Trump’s previously ardent supporters broke with him, and called for his removal, Nevertheless, his most fervent core of support remained, even though the actions violated what they had professed to be their principles. The fact that they had become supporters of Trump, personally (Heil Trump!), and not supporters of whatever principles they purported to profess, is demonstrated that the Republican National Convention, when it re-nominated Trump in 2020 for a second term, for the first time ever, did not even see fit to produce a party platform, merely expressing fealty to their cult leader.

As with deficits, when Republicans are in power, they create huge shortfalls flowing from, among other things, great tax cuts for the wealthy. Yet when Democrats are in power, Republicans become deficit hawks, masquerade as “fiscally responsible,”  and seek to impose austerity in order to block Democratic programs that would help the people. Witness the fervent Republican opposition to “Obamacare,” and the numerous Republican attempts to sabotage the program and keep it from functioning optimally.  

These are merely a few of the plethora of inconsistencies that would be apparent to our outside observer. Perhaps the most glaring of all, and the most irrational from a policy standpoint (as opposed to that of raw power), is the  conservative Republican reaction to Social Security. That warrants an article of its own.