Neoliberalism – Informed Comment https://www.juancole.com Thoughts on the Middle East, History and Religion Sat, 21 Sep 2024 03:38:58 +0000 en-US hourly 1 https://wordpress.org/?v=5.8.10 The American Dream isn’t Dead; but it’s on Life Support https://www.juancole.com/2024/09/american-dream-support.html Sat, 21 Sep 2024 04:15:50 +0000 https://www.juancole.com/?p=220628 Portland, Or. (Special to Informed Comment; Feature) – In the run-up to the 2024 Presidential election, the concept of the American Dream has become more central than ever to our national discourse. Many Americans simply ask, “What happened to it?” In my new book, The Hidden History of the American Dream: The Demise of the Middle Class and How to Rescue Our Future, I address the systematic erosion of the middle class that has taken place over the past four decades — a decline brought about by deliberate economic policies designed to enrich the wealthy at the expense of working people.

For much of our history, the American Dream was defined by a strong, thriving middle class. The ability to buy a home, raise a family, and retire comfortably was once within reach for the average American. From the time of Alexander Hamilton, who advocated for tariffs and protectionist policies to nurture American manufacturing, to the post-World War II boom, we saw how government action could create conditions for middle-class prosperity.

As I explore in my book, the middle class peaked during the post-war period, when policies like high unionization rates, affordable education, and government investment in infrastructure supported widespread economic mobility. By 1980, two-thirds of Americans were classified as middle class. But that all started to unravel with Ronald Reagan’s election.

Reagan’s presidency marked the beginning of a seismic shift in American economic policy, driven by neoliberal principles that favored deregulation, tax cuts for the rich, and the weakening of labor unions. His administration’s assault on unions, beginning with the firing of air traffic controllers in 1981, sent a clear message to corporate America: workers’ bargaining power would no longer be protected. This was followed by free trade agreements and policies encouraging the outsourcing of millions of good-paying, unionized manufacturing jobs. The consequences have been devastating. Over the last 40 years, we’ve seen the hollowing out of the middle class and an unprecedented concentration of wealth at the top.

This economic shift didn’t just come from Republicans — Democrats like Bill Clinton embraced many of these neoliberal policies as well, mainly through trade agreements like NAFTA. These agreements promised prosperity but led to the decimation of our industrial base and the rise of low-wage service jobs. Today, the wealthiest 1% of Americans hold a disproportionate amount of wealth, while working-class families struggle to make ends meet.


Thom Hartmann, The Hidden History of the American Dream: The Demise of the Middle Class—and How to Rescue Our Future. Click here to buy.

The election of Donald Trump in 2016 brought many of these issues to the forefront. Trump’s populist rhetoric tapped into the deep dissatisfaction many working-class Americans felt after decades of being ignored by both parties. He criticized free trade, imposed tariffs, and promised to return jobs to America. While I acknowledge that Trump’s critique of neoliberalism resonated with many voters, his execution was deeply flawed. His tariffs on Chinese goods were haphazard, and they backfired without a comprehensive plan to rebuild American manufacturing. Instead of restoring the middle class, his policies further enriched corporate interests while forcing the federal government to bail out farmers and other industries hurt by the tariffs.

As I argue in The Hidden History of the American Dream, the real solution lies in returning to the progressive values that once defined the Democratic Party. We need to look back to Franklin D. Roosevelt’s policies and the New Deal, which created the most prosperous middle class in world history. By investing in infrastructure, implementing progressive taxation, and protecting workers’ rights, FDR’s administration built an economy that worked for everyone, not just the wealthy elite.

Today, we find ourselves at a crossroads. We must commit to a comprehensive industrial policy revitalizing American manufacturing to rebuild the American Dream. I advocate for reintroducing tariffs and other protectionist measures, not as punitive measures against foreign nations but as a way to incentivize domestic production. Unlike Trump’s tariffs, which were politically motivated and poorly executed, we need a strategic, long-term approach that ensures economic stability while rebuilding our industrial base.

In addition to tariffs, we need a return to Keynesian economics, where the government actively ensures economic fairness. President Biden has quietly implemented policies, such as the Inflation Reduction Act and efforts to break up monopolies. These are steps in the right direction, but more needs to be done to reverse the damage wrought by neoliberalism over the past four decades.

Healthcare, education, and housing must be treated as public goods, not commodities to be exploited by profit-driven corporations. Our housing market, for example, has been overrun by speculators who treat homes as financial assets rather than places where people live. We need policies that make housing affordable and accessible to all Americans, not just the wealthy few. Similarly, the privatization of education and healthcare has left millions of Americans in debt and without access to essential services. Progressive taxation, along with increased public investment in these areas, can help create a more equitable society where everyone has the opportunity to succeed.

The American Dream isn’t dead—but it’s on life support. To revive it, we must reject neoliberalism’s failed policies and embrace a new economic vision rooted in fairness, opportunity, and shared prosperity. This election season allows us to set the country on a new path, one where the middle class can thrive once again. It’s time to take action and reclaim the American Dream for future generations.

Learn more about the Hidden History Series.

]]> Why Are Any of Us Paying for the Scam That is Medicare Advantage? https://www.juancole.com/2024/06/paying-medicare-advantage.html Wed, 05 Jun 2024 04:02:13 +0000 https://www.juancole.com/?p=218911 By Thom Hartmann | –

These plans are private health insurance provided by private corporations, who are then fully reimbursed by the Medicare trust fund regardless of how much their customers use their insurance.

( Commondreams.org) – They’re competing unfairly with Medicare, and you and I are paying for it. It’s obscene.

When former U.S. President George W. Bush and congressional Republicans (and a handful of bought-off Democrats) created Medicare Advantage in 2003, it was the fulfillment of half of Bush’s goal of privatizing Social Security and Medicare, dating all the way back to his unsuccessful run for Congress in 1978 and a main theme of his second term in office.

Medicare Advantage is not Medicare. These plans are private health insurance provided by private corporations, who are then fully reimbursed by the Medicare trust fund regardless of how much their customers use their insurance. Thus, the more they can screw their customers and us taxpayers by withholding healthcare, the more money they make.

These giant insurance companies ripped off our tax dollars last year to the tune of an estimated $140 billion over and above what it would’ve caused us if people had simply been on real Medicare.

With real Medicare, if your doctor says you need a test, procedure, scan, or any other medical intervention you simply get it done and real Medicare pays the bill. No muss, no fuss, no permission needed. Real Medicare always pays, and if they think something’s not kosher, they follow up after the payment’s been made so as not to slow down the delivery of your healthcare.

With Medicare Advantage, however, you’re subject to “pre-clearance,” meaning that the insurance company inserts itself between you and your doctor: You can’t get the medical help you need until or unless the insurance company pre-clears you for payment.

These companies thus make much of their profit by routinely denying claims—1.5 million, or 18% of all claims, were turned down in one year alone—leaving Advantage policy holders with the horrible choice of not getting the tests or procedures they need or paying for them out-of-pocket.

Given this, you’d think that most people would stay as far away from these private Medicare Advantage plans as they could. But Congress also authorized these plans to compete unfairly with real Medicare by offering things real Medicare can’t (yet). These include free or discounted dental, hearing, eyeglasses, gym memberships, groceries, rides to the doctor, and even cash rebates.

You and I pay for those freebies, but that’s only half of the horror story.

This year, as Matthew Cunningham-Cook pointed out in Wendell Potter’s brilliant Healthcare Un-covered Substack newsletter this week, we’re ponying up an additional $64 billion to give to these private insurance companies to reimburse them for the freebies they relentlessly advertise on television, online, and in print.

And here’s the most obscene part of the whole thing: The companies won’t tell the government how much of that $64 billion they’ve actually spent. They just take the money and say, “Thank you very much.” And then, presumably, throw a few extra million into the pockets of each of their already very-well-paid senior executives.


Photo by Online Marketing on Unsplash

For example, the former CEO of the nation’s largest Medicare Advantage provider, UnitedHealth, walked away with over a billion dollars in total compensation. With a “B.” One guy. His successor made off with over a half-billion dollars in pay and stock.

Good work if you can get it: All you need do is buy off a hundred or so members of Congress, courtesy of Clarence Thomas’ tie-breaking vote on Citizens United, and threaten the rest with massive advertising campaigns for their opponents if they try to stop you.

Project 2025 and candidate Trump both promise to end real Medicare “immediately” if Trump or when another Republican becomes president.

And while the companies refuse to tell us how much of the $64 billion that we’re throwing at them this year to offer “free” dental, etc. is actually used, what we do know is that most of that money is not going to pay for the freebies they advertise. As Cunningham-Cook noted, in one study only 11% of Advantage policyholders who’d signed up with plans offering dental care used that benefit.

Another study showed over-the-counter-drug freebies were used only a third of the time, leaving $5 billion in the insurance companies’ money bins just for that goodie. A later study found that at least a quarter of all Advantage policyholders failed to use any of the freebies they’d been offered when they signed up.

That’s an enormous amount of what the industry calls “breakage;” benefits offered but not used. Billions of dollars left over every month. And, used or not, you and I sure paid for them.

In my book The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich, I lay out the story of this scam and how badly so many American seniors—and all American taxpayers, regardless of age—get ripped off by it.

When he was president, Donald Trump substantially expanded Medicare Advantage, calling real Medicare “socialism.” Project 2025 and candidate Trump both promise to end real Medicare “immediately” if Trump or when another Republican becomes president.

These giant insurance companies ripped off our tax dollars last year to the tune of an estimated $140 billion over and above what it would’ve caused us if people had simply been on real Medicare, according to a report from Physicians for a National Health Program (PNHP). If there was no Medicare Advantage scam bleeding off all that cash to pay for executives’ private jets, real Medicare could be expanded to cover dental, vision, and hearing and even end the need for Medigap plans.

But for now, the privatization gravy train continues to roll along. The insurance giants use some of that money to buy legislators and some of it for expensive advertising to dupe seniors into joining their programs. The company (Benefytt) that hires Joe Namath to pitch Medicare Advantage, for example, was recently hit with huge fines by the Federal Trade Commission for deceptive advertising.

The FTC news release laid it out:

“Benefytt pocketed millions selling sham insurance to seniors and other consumers looking for health coverage,” said Samuel Levine, director of the FTC’s Bureau of Consumer Protection. “The company is being ordered to pay $100 million, and we’re holding its executives accountable for this fraud.”

And what was it that the Federal Trade Commission called “sham insurance”? Medicare Advantage. Nonetheless, the Centers for Medicare Services continues to let Benefytt and Namath market these products: Welcome to the power of organized money.

And it’s huge organized money. Medicare Advantage plans are massive cash cows for the companies that run them. As Cigna prepares for a merger, for example, they’re being forced to sell off their Medicare Advantage division: It’s scheduled to go for $3.7 billion. Nobody pays that kind of money unless they expect enormous returns.

Traditional Medicare has been serving Americans well since 1965: it’s one of the most efficient single-payer systems to fund healthcare that’s ever been devised. But nobody was making a buck off it, so nobody could share those profits with greedy politicians. Enter Medicare Advantage, courtesy of George W. Bush and the GOP.

While several bills have been offered in Congress to do something about this—including Reps. Mark Pocan’s (D-Wis.) and Ro Khanna’s (D-Calif.) Save Medicare Act that would end these companies’ ability to use the word “Medicare” in their policy names and advertising—the amounts of money sloshing around D.C. in the healthcare space now are almost unfathomable.

So far this year, according to opensecrets.org, the insurance industry has spent $45,173,132 showering gifts and persuasion on our federal lawmakers to keep their obscene profits flowing.

It’s all one more example of how five corrupt Republicans on the U.S. Supreme Court legalizing political bribery with Citizens Unitedhave screwed average Americans and made a handful of industry executives and investors fabulously rich.

Thus, here we are, handing billions of dollars a month to insurance industry executives so they can buy new Swiss chalets, private jets, and luxury yachts. And compete—unfairly—with Medicare itself, driving LBJ’s most proud achievement into debt and crisis.

Enough is enough. Let your members of Congress know it’s beyond time to fix the court and Medicare, so scams like Medicare Advantage can no longer rip off America’s seniors while making industry executives richer than Midas.

 

]]> Who will Tell the Story of Regional Climate Disasters when the News Desert Swallows all Local Newspapers? https://www.juancole.com/2024/05/regional-disasters-newspapers.html Mon, 13 May 2024 04:02:51 +0000 https://www.juancole.com/?p=218528 By

( Tomdispatch.com When wildfires began erupting in the Texas Panhandle in February, Laurie Ezzell Brown, the editor and publisher of the Canadian Record, was in Houston on a panel discussing ways in which losing local newspapers represents a danger to democracy. Running the once-a-week Record from the Panhandle town of Canadian, she certainly knew something about the rise of “news deserts” in this country. While she was meeting with other journalists concerned about disappearing local newspapers, Brown kept an eye on reports about ignitions sparking wildfires west of her town and posted updates from afar so that her readers would remain informed.

“Those fires never stay in the next county,” Brown said grimly. And indeed, as the flames galloped through fallow fields and approached her hometown, she began a desperate drive back to Canadian with a friend. In and out of cell coverage, traveling through black-ash smoke, she saw distinctly apocalyptic scenes of torched trees and powerlines dangling from still-burning poles. As she went, she posted every scrap of information she could get for the scattered and distraught readers of her paper. How else would they know about the houses that were being torched ever closer to their own homes?

In the days that followed, as that historic nightmare of a blaze just grew and grew, finally burning through more than a million acres of the Texas Panhandle, Brown continued to keep Canadian Record readers informed about crucial matters like how to apply for financial assistance, where to take fire debris, and when the next embattled town meeting would be held. It was part of what she’s been doing since 1993: keeping an eye on Canadian’s Hemphill County commissioners, investigating economic salvation schemes, and posting high school sports scores as well as local obituaries.

“There’s no one else to do this and people need to know what’s happening. It’s what I do. It’s what I’ve always done,” she told me.

It’s what I do, too. Like Canadian, my adopted hometown of Greenville in Plumas County, California, was hit by a climate-driven wildfire in 2021 that devastated 800 homes and left the downtown smoldering on its Gold Rush-era dirt foundations. Two years into rebuilding, the only local online publication announced that it was shuttering. So, I set aside my freelance journalism career, joined a team of like-minded citizens, and launched The Plumas Sun.

Like Brown and hundreds of journalists across the country, we’re reporting from the intersection of news deserts and climate disasters. As floods, fires, and tornadoes surge, and daily as well as weekly publications collapse, local journalism maintains an all-too-slender lifeline in devastated rural communities like mine. Local journalists remain after the Klieg lights go dark and the national media flee our mud-strewn, burned-out Main Streets. We continue to report as our friends and neighbors face the challenge of rebuilding (or not).

Somehow, along with flattened towns and shattered lives, disaster sometimes even breeds innovation. Among the ruins left by walls of water and towering flames, bootstrapped publications like mine do their best to keep the news alive in communities now struggling just to survive.

Nowhere Will Be Spared

If there’s one overarching message from the Fifth National Climate Assessment, released in November 2023, it’s that, in this era of climate change, nowhere will be spared disaster. As the burning of fossil fuels warms the world ever more radically, conditions are created that only exacerbate a Pandora’s box of extreme weather events. Scientists predict more intense hurricanes and the storm surges they generate, more frequent and intense wildfires throughout the calendar year, an elevated risk for flooding, and so much else in the new era of global warming.

Still, as the climate scientists report, the impacts of such disasters aren’t landing equitably. Blacks, Indigenous Americans, and other people of color are bearing the brunt of them along with the rural poor. They are “disproportionately exposed to environmental risks and have fewer resources to address them,” as the assessment puts it.

For Laurie Ezzell Brown and her newspaper, that bureaucratese translates all too simply into hardship. The town of Canadian, perched on the high plains near the Oklahoma border, had suffered an economic hit to both its ranching and its oil and gas industries even before the panhandle fires. The Canadian Record was struggling. Launched in 1893, the weekly newspaper that Brown now owns spent half its life in her family’s hands. Ben and Nancy Ezzell, her parents, became its publishers in 1947. Brown took over in 1993. In March 2023, 30 years later, unable to find a buyer for it, she suspended publication of the Canadian Record.

Buy the Book

It didn’t go well. Brown, who has lived in Canadian most of her life, got an earful. And she took it personally. “I had to see all these people who I’d let down every day. And hear them tell me how much they missed the paper, how much they needed it, how they didn’t know what was going on. I guess it just got to me.” She and a skeleton staff are, however, maintaining an online version of the paper while she continues to hunt for a buyer.

It’s a tough sell. After all, most disaster-struck rural towns are already on the economic edge. Lacking the resources that might shield them from some of the impacts, they now face the Herculean task of rebuilding from scratch with scratch. After a town is demolished, said Mary Henkel Judson, editor of the Port Aransas South Jetty, people leave and many simply never come back.

Judson faced disaster in 2017 when Hurricane Harvey blew the roofs off homes and tore businesses from their foundations in that island community off the Texas coast near Corpus Christi. Compared to Canadian, Port Aransas is affluent. The South Jetty enjoys the support of second-home owners and tourists, many of them birders visiting the island’s five sites on the Great Texas Birding Trail. So Port Aransas did rebuild.

It’s a simple fact that the majority of the newspapers that have folded nationwide are in economically disadvantaged areas. In Texas, they are also in the least populous areas, Judson said. Canadian is among them. When businesses are struggling to make ends meet, paying for advertising is an expense that can be postponed. That makes it rough on publications like the Canadian Record.

“Laurie Brown is one of the best journalists in the world as far as I’m concerned. And one of the hardest-working. That community knows what she does for them and supports her as best they can, but it’s tough,” Judson told me.

She knows what can happen without a newspaper — and not just in times of disaster. City councils, school boards, and special government districts meet regularly. Most elected officials are honorable, she adds, “but you’re looking at the opportunity for corruption to raise its ugly head. You put a kid in a candy store when nobody’s watching and things happen.”

Teaching Disaster Communities to Do Journalism

Local reporters and paper owners like Brown and Judson are now an increasingly vanishing breed. Since 2005, in fact, 2,900 American newspapers, mainly smaller weeklies and local dailies, have ceased publication, according to the State of Local News Project 2023 (produced by researchers at Northwestern University’s Medill School). One-third of them were in small counties. Today 195 of those mostly rural counties have no local newspaper at all or any other source of local news. An additional 1,387 counties have only one local news source.

As in so many other economic sectors, the trend is toward consolidation. Fewer and fewer corporations now own more and more publications. Brown describes it as “gobbling up all the newspapers, spitting them out, and firing the real writers.” The result leaves nearly 200 communities without a reliable source of information for everything from political scams to cribbage tournaments. And there’s more bad news ahead. Based on the higher-than-average poverty rates and the population size of those mostly rural counties, the 2023 report determined that an additional 33 communities are at elevated risk of losing their sole remaining source of news.

When Lyndsey Gilpin started Southerly in 2016, her goal was to fill a growing gap in reporting in Southern states. She was particularly interested in providing a regional outlet to cover environmental justice and climate issues. The decline in newspapers in the rural South is worse than anywhere else in the country. After all, 108 counties were already without a local newspaper in 2020. Yes, reporters from the national media sometimes “parachute” in to cover special events like fierce storms or raging tornadoes, but they tend to leave as quickly as they come.

Gilpin wanted to cover climate and energy issues in a more consistent way. Local news institutions are trusted sources of information in a community, often the only source. “We wanted to build deeper relationships with local news outlets, residents and community members who were living this day to day and doing the work to get information out,” she told me.

Southerly’s inaugural year coincided with a startling series of natural disasters. The United States suffered 15 devastating weather and climate events, each causing at least a billion dollars in damage, the second-highest number ever recorded. The South, in particular, was hit with tornadoes, wildfires, hurricanes, and three different major floods. Over the next five years, Southerly became increasingly focused on just such climate disasters.

Gilpin soon discovered personally what the assessment scientists asserted in their 2023 document: Disasters do not inflict damage equally. And adding insult to literal injury, the most ill-equipped communities when it comes to climate disasters are almost always ones without newspapers. “Folks were already struggling and now they don’t know where to turn, who to talk to,” she said. “That leaves a huge, huge hole for industries or politicians or other players to feed them misinformation or accidentally give inaccurate information.”

In response to the growing prevalence of climate-driven disasters, Southerly began developing tools that would help communities do their own disaster coverage. Gilpin built templates that outlined how to apply for aid and navigate paperwork, processes that are nearly the same for hurricanes, floods, or fires. “We morphed into a place that could train people to learn how to do journalism — to do storytelling in more creative ways,” she told me.

As those journalists began to focus on recovery efforts in places repeatedly hit by hurricanes like southern Louisiana, they reported on the effects of such disasters ranging from the disabling of the voting process to damaging disruptions in education. They also tracked disparities in disaster funding by neighborhood, economic class, and race.

As Gilpin put it to me: “The way journalism can do the most good is by making sure people are equipped to do that work. By understanding the process, they can feel confident about knowing what’s happening around them.”

Sadly, however, Southerly ended operations in May 2023, thanks to a lack of funding and fundraising exhaustion. As Gilpin summarized the situation: “The nicest way I can put it is the nonprofit journalism world is difficult. It’s not fair that all the money goes to a few places and not to other places.”

Covering Recovery

Even as the larger newspaper world is suffering blow after blow, the situation could be changing if ever so slightly for local papers. Growing public attention to America’s news deserts has, in recent years, been attracting at least some philanthropic funding. Press Forward and the American Journalism Project are among the efforts to rebuild local news platforms. The State of Local News Report celebrates 17 new local outlets at least five years old and identifies 164 others that are just getting started. All are providing their communities with reporting essential to democracy while searching for stable, sustainable business models.

It was certainly not the lure of foundation funding that gave life to The Plumas Sun. The driver was utter fear of living without a newspaper in a community in the throes of disaster recovery. The local century-old newspaper in my area, The Feather River Bulletin, had folded early in the Covid pandemic, even though it continued to maintain an online presence until July 2023. When it announced it was shutting down, shock reverberated through the small mountain towns in California’s northern Sierra Nevada where I live.

We had already lost so much: Our timber-dependent economy was declining and the spread of Covid had only exacerbated our isolation. But the most profound blow was the devastating 2021 Dixie fire, a climate-change-induced nightmare that scorched an area of the West the size of Rhode Island. It quite literally incinerated most of my town of Greenville and three other local communities. Nearly a million acres of the conifer forests that had once drawn so many of us to this rural outpost were reduced to charred specters. Now, we were losing the only source of local news that had kept us from feeling utterly disconnected from the rest of America and one another during such traumatic times.

The Plumas Sun was conceived in that hapless moment. One urgent phone call led to another until we had mustered a core team of seven with the skills to mount an online news publication. Just days before we launched it, we still didn’t have a name for it.

The two-year mark after a disaster event is a pivotal moment for community recovery, says Sue Weber, an ex-nun who served as coordinator of the Dixie Fire Collaborative, formed after that fire as a voice for the community. State and federal money starts to disappear. Victims begin to move on. That’s when local newspapers play a critical role in keeping places like Greenville invigorated and part of the rebuilding process. “For communities,” Weber told me, “it’s all about where we go from here. Nobody else is paying attention.”

Disaster trauma often shows up in ways that seem unrelated to the torching of entire towns. In the first months of covering county government, The Plumas Sun reported on a sheriff’s dispatcher charged with embezzling from a needy children’s Christmas fund and a county official filing a hostile work environment complaint against the district attorney. It has also posted news on local community suppers and library book giveaways, while offering kudos to people around the county doing extraordinary work. And, of course, obituaries.

“Connecting people is healing,” Weber points out. “Newspapers do that, too.”

Laurie Brown and Canadian are still in the early trauma stage in the scorched Texas Panhandle. Whether her Canadian Record or The Plumas Sun or any of the startups nurtured by Southerly survive depends not just on the whims of funding but on the grit and guts of local reporters. Brown, who is living on Social Security, shows no signs of quitting, despite all too many misgivings about the future.

“I’ve seen good things that didn’t happen because they weren’t encouraged. I’ve seen bad things that didn’t happen because they were exposed,” she says. “And I just keep thinking, you know, you can make a difference. And that still seems worth doing to me.”

Copyright 2024 Jane Braxton Little

]]> Tax Day: The America I wish my Taxes paid for https://www.juancole.com/2024/04/america-wish-taxes.html Sun, 14 Apr 2024 04:02:07 +0000 https://www.juancole.com/?p=217997 Greenfield, Mass. (Special to Informed Comment) – In June 2023 Amanda Jones, an African American who had recently given birth to her second daughter Miranda, died from pregnancy-related causes.  Her state, Georgia, ranks among the least safe states in the country for women to give birth; and the vast majority of women who die during and after pregnancy are poor and disproportionately African American.  Though Amanda and her partner worked, they did not have health insurance and she was only eligible for Medicaid coverage for up to 12 months after the birth of her child, none for prenatal care and none after 12 months.  The majority of the nearly 26 million uninsured people are low-income families with at least one worker, with no health care coverage through their job and who cannot afford the high cost of private insurance.  Further, millions of Americans are losing Medicaid coverage as some states restrict eligibility that was expanded during the Covid pandemic.  All the while, corporate healthcare capitalists are raking in record profits – the largest gaining $41 billion in profits in 2022.   

I want my taxes to help fund universal health care for everyone in our country.  All but 43 countries offer free healthcare or access to health care for at least 90% of their citizens.  Why cannot we, the world’s wealthiest nation for over 60 years, divorce ourselves from corporate capitalist healthcare?

What of other social and economic issues as we near Tax Day?  Take poverty:  140 million people – 40% of US people – are poor or near poor, defined as one emergency away from economic ruin, according to the Poor People’s Campaign. The “140 million” are people of every race, ethnicity, age, faith, sex and sexual orientation, while poverty is highest among Black, Latino and Indigenous peoples due to systemic racism. More women than men are poor due to systemic sexism.  The pay gap between women and men – 21.8% on average – has persisted for 30 years, an injustice that deteriorates our democracy. 

I want my federal and state taxes to lift people out of poverty and end inequality in income. It can be done. Cities are leading the way in raising minimum wage; and they outpace the best states, while the federal minimum wage languishes at a despicable $7.25 per hour

 These 10 Cities have the Highest Minimum Wage in the U.S.

  • Tukwila, Washington: $20.29.
  • Seattle, Washington: $19.97.
  • SeaTac, Washington: $19.71.
  • West Hollywood, California: $19.08.
  • Mountain View, California: $18.75.
  • Emeryville, California: $18.67.
  • Sunnyvale, California: $18.55.
  • Denver, Colorado: $18.29.

Today, the highest minimum wages, by state and Washington, D.C., are in D.C., ($17), Washington ($16.28), California ($16), Connecticut ($15.69) and New Jersey ($15.13).  New York has raised its minimum hourly wage in New York City and its suburbs to $16. 

But we need to do better: A livable wage in Connecticut, that is, an hourly wage that enables a single adult to pay for necessities, including housing, food, utilities, transportation and health care, would be $24.13.  Overall, most single Americans need to earn at least $20/hour to pay their bills, given cost of living where they live.   More than 1/3 fall short. 

I want my federal and state tax money used to raise minimum wage to a livable wage in the name of economic justice for everyone.

PBS NewsHour Video: “Families slip back into poverty after pandemic-era child tax credit expires”

In 2023, the Department of Defense (aka the Department of War) was allocated $816.7 billion dollars in our national budget, while failing to pass its sixth straight audit.  US war spending in 2023 dwarfs that of other countries, totaling more than the next ten highest military budgets combined.  Since October 7, the gunboat-diplomacy Biden administration has approved over 100 weapons sales to the government of Israel, an average of 1 every 36 hours.

I want my tax money to “beat swords into plowshares” by supplanting masculinist militarism with intelligent, committed, unrelenting diplomacy that lifts our country above our abject ranking of 131 least peaceful country out of 163 countries on the Global Peace Index.

Our arduous path back from flawed to healthy democracy will only be through engaged citizens, activist organizations and unions in cities and some states not shackled in the stranglehold of anti-abortion, anti-immigrant, Trumpian, and extreme religious right politics, nor held hostage by their weapons manufacturers.

  • “Voters inCalifornia, Vermont and Michigan in November 2023 adopted amendments to enshrine abortion protections into their respective state constitutions.” More states are expected to advance similar measures, because constitutional protections are considered the most ironclad and are very difficult to amend.
  • In February 2024 the city of Flint Michigan recently approved a universal cash program for babies, called Rx Kids, that provides new mothers $1,500 and $500 monthly for their child’s first year.
  • The same month, Detroit became the largest U.S. city so far to pass a “Move the Money” resolution, following the lead of neighboring city Hamtramck, Michigan. The measure, approved unanimously by the City Council, calls on the U.S. Congress and the president to shift public money away from the military to fund social services.
  • In June 2023 the US Conference of Mayors unanimously passed a resolution “Calling for Urgent Action to Avoid Nuclear War, Resolve the Ukraine Conflict, Lower Tensions with China, and Redirect Military Spending to Meet Human Needs.”
  • In March 2024 the New York State Appellate Court ruled unanimously to affirm Kingston, New York’s Rent Guidelines Board mandating 15% rent reduction, given the scarcity of rental units and tenant organizing for housing justice.
  • More than 100 US cities, including Chicago and Seattle, have passed resolutions on the genocidal Israel-Gaza war with most calling for a permanent ceasefire, exchange of Israeli hostages and Palestinian political prisoners and free flow of aid to the Gazan people.

I want my taxes to be used for our true national security: lifting people out of poverty, hunger and homelessness; providing universal health care; ensuring affordable housing for everyone needing it, assuring a livable wage, ending violence against women, affirming that Black Lives Matter, and fostering peace.

 

 

 

]]> Republicans Plan to wage Class Warfare on Working People https://www.juancole.com/2024/04/republicans-warfare-working.html Wed, 10 Apr 2024 04:02:50 +0000 https://www.juancole.com/?p=217963 ( Tomdispatch.com) – Recently, you may have noticed that the hot weather is getting ever hotter. Every year the United States swelters under warmer temperatures and longer periods of sustained heat. In fact, each of the last nine months — May 2023 through February 2024 — set a world record for heat. As I’m writing this, March still has a couple of days to go, but likely as not, it, too, will set a record.

Such heat poses increasing health hazards for many groups: the old, the very young, those of us who don’t have access to air conditioning. One group, however, is at particular risk: people whose jobs require lengthy exposure to heat. Numbers from the Bureau of Labor Statistics show that about 40 workers died of heat exposure between 2011 and 2021, although, as CNN reports, that’s probably a significant undercount. In February 2024, responding to this growing threat, a coalition of 10 state attorneys general petitioned the federal Occupational Safety and Health Administration (OSHA) to implement “a nationwide extreme heat emergency standard” to protect workers from the kinds of dangers that last year killed, among others, construction workers, farm workers, factory workers, and at least one employee who was laboring in an unairconditioned area of a warehouse in Memphis, Tennessee.

Facing the threat of overweening government interference from OSHA or state regulators, two brave Republican-run state governments have stepped in to protect employers from just such dangerous oversight. Florida and Texas have both passed laws prohibiting localities from mandating protections like rest breaks for, or even having to provide drinking water to, workers in extreme heat situations. Seriously, Florida and Texas have made it illegal for local cities to protect their workers from the direct effects of climate change. Apparently, being “woke” includes an absurd desire not to see workers die of heat exhaustion.

And those state laws are very much in keeping with the plans that the national right-wing has for workers, should the wholly-owned Trump subsidiary that is today’s Republican Party take control of the federal government this November.

We’ve Got a Plan for That!

It’s not exactly news that conservatives, who present themselves as the friends of working people, often support policies that threaten not only workers’ livelihoods, but their very lives. This fall, as we face the most consequential elections of my lifetime (all 71 years of it), rights that working people once upon a time fought and died for — the eight-hour day, a legal minimum wage, protections against child labor — are, in effect, back on the ballot. The people preparing for a second Trump presidency aren’t hiding their intentions either. Anyone can discover them, for instance, in the Heritage Foundation’s well-publicized Project 2025 Mandate for Leadership, a “presidential transition” plan that any future Trump administration is expected to put into operation.

Buy the Book

As I’ve written before, the New York Times’s Carlos Lozada did us a favor by working his way through all 887 pages of that tome of future planning. Lacking his stamina, I opted for a deep dive into a single chapter of it focused on the “Department of Labor and Related Agencies.” Its modest 35 pages offer a plan to thoroughly dismantle more than a century of workers’ achievements in the struggle for both dignity and simple on-the-job survival.

First Up: Stop Discriminating Against Discriminators

I’m sure you won’t be shocked to learn that the opening salvo of that chapter is an attack on federal measures to reduce employment discrimination based on race or sex. Its author, Jonathan Berry of the Federalist Society, served in Donald Trump’s Department of Labor (DOL). He begins his list of “needed reforms” with a call to “Reverse the DEI Revolution in Labor Policy.” “Under the Obama and Biden Administrations,” Berry explains, “labor policy was yet another target of the Diversity, Equity, and Inclusion (DEI) revolution” under which “every aspect of labor policy became a vehicle with which to advance race, sex, and other classifications and discriminate against conservative and religious viewpoints on these subjects and others, including pro-life views.”

You may wonder what it means to advance “classifications” or why that’s even a problem. Berry addresses this question in his second “necessary” reform, a call to “Eliminate Racial Classifications and Critical Race Theory Trainings.” Those two targets for elimination would seem to carry very different weight. After all, “Critical Race Theory,” or CRT, is right-wing code for the view that structural barriers exist preventing African Americans and other people of color from enjoying the full rights of citizens or residents. It’s unclear that such “trainings” even occur at the Labor Department, under CRT or any other label, so their “elimination” would, in fact, have little impact on workers.

On the other hand, the elimination of “racial classifications” would be consequential for many working people, as Berry makes clear. “The Biden Administration,” he complains, “has pushed ‘racial equity’ in every area of our national life, including in employment, and has condoned the use of racial classifications and racial preferences under the guise of DEI and critical race theory, which categorizes individuals as oppressors and victims based on race.” Pushing racial equity in employment? The horror!

Berry’s characterization of CRT is, in fact, the opposite of what critical race theory seeks to achieve. This theoretical approach to the problem of racism does not categorize individuals at all, but instead describes structures — like corporate hiring practices based on friendship networks — that can disadvantage groups of people of a particular race. In fact, CRT describes self-sustaining systems that do not need individual oppressors to continue (mal)functioning.

The solution to the problem of discrimination in employment in Project 2025’s view is to deny the existence of race (or sex, or sexual orientation) as a factor in the lives of people in this country. It’s simple enough: if there’s no race, then there’s no racial discrimination. Problem solved.

And to ensure that it remains solved, Project 2025 would prohibit the Equal Economic Opportunity Commission, or EEOC, from collecting employment data based on race. The mere existence of such “data can then be used to support a charge of discrimination under a disparate impact theory. This could lead to racial quotas to remedy alleged race discrimination.” In other words, if you can’t demonstrate racial discrimination in employment (because you’re enjoined from collecting data on the subject), then there’s no racial discrimination to remedy. Case closed, right?

By outlawing such data collection, a Republican administration guided by Project 2025 would make it almost impossible to demonstrate the existence of racial disparity in the hiring, retention, promotion, or termination of employees.

Right-wingers in my state of California tried something similar in 2003 with Ballot Proposition 54, known as the Racial Privacy Initiative. In addition to employment data, Prop. 54 would have outlawed collecting racial data about public education and, no less crucially, about policing. As a result, Prop. 54 would have made it almost impossible for civil rights organizations to address the danger of “driving while Black” — the disproportionate likelihood that Black people will be the subject of traffic stops with the attendant risk of police violence or even death. Voters soundly defeated Prop. 54 by a vote of 64% to 36% and, yes, racial discrimination still exists in California, but at least we have access to the data to prove it.

There is, however, one group of people Project 2025 would emphatically protect from discrimination: employers who, because of their “conservative and religious viewpoints… including pro-life views,” want the right to discriminate against women and LGBTQ people. “The President,” writes Berry, “should make clear via executive order that religious employers are free to run their businesses according to their religious beliefs, general nondiscrimination laws notwithstanding.” Of course, Congress already made it clear that, under Title VII of the Religious Freedom Restoration Act of 1993, “religious” employers are free to ignore anti-discrimination laws when it suits them.

But Wait, There’s More

Not content with gutting anti-discrimination protections, Project 2025 would also seek to rescind rights secured under the Fair Labor Standards Act, or FLSA, which workers have enjoyed for many decades. Originally passed in 1938, the FLSA “establishes minimum wage, overtime pay, recordkeeping, and child labor standards affecting full-time and part-time workers in the private sector and in Federal, State, and local governments,” according to the Department of Labor.

Perhaps because the federal minimum hourly wage has remained stuck at $7.25 for a decade and a half, Project 2025 doesn’t launch the typical conservative attack on the very concept of such a wage. It does, however, go after overtime pay (generally time-and-a-half for more than 40 hours of work a week), by proposing that employers be allowed to average time worked over a longer period. This would supposedly be a boon for workers, granting them the “flexibility” to labor fewer than 40 hours one week and more than 40 the next, without an employer having to pay overtime compensation for that second week. What such a change would actually do, of course, is give an employer the power to require overtime work during a crunch period while reducing hours at other times, thereby avoiding paying overtime often or at all.

Another supposedly family-friendly proposal would allow workers to choose to take their overtime compensation as paid time off, rather than in dollars and cents. Certainly, any change that would reduce workloads sounds enticing. But as the Pew Research Center reports, more than 40% of workers can’t afford to, and don’t, take all their paid time off now, so this measure could function as yet one more way to reduce the overtime costs of employers.

In contrast to the Heritage Foundation’s scheme, Senator Bernie Sanders has proposed a genuinely family-friendly workload reduction plan: a gradual diminution of the standard work week from 40 to 32 hours at the same pay. Such proposals have been around (and ridiculed) for decades, but this one is finally receiving serious consideration in places like the New York Times.

In deference to the supposedly fierce spirit of “worker independence,” Project 2025 would also like to see many more workers classified not as employees at all but as independent contractors. And what would such workers gain from that “independence”? Well, as a start, freedom from those pesky minimum wage and overtime compensation regulations, not to speak of the loss of protections like disability insurance. And they’d be “free” to pay the whole tab (15.3% of their income) for their Social Security and Medicare taxes, unlike genuine employees, whose employers pick up half the cost.

Young people, too, would acquire more “independence” thanks to Project 2025 — at least if what they want to do is work in more dangerous jobs where they are presently banned. As Berry explains:

“Some young adults show an interest in inherently dangerous jobs. Current rules forbid many young people, even if their family is running the business, from working in such jobs. This results in worker shortages in dangerous fields and often discourages otherwise interested young workers from trying the more dangerous job.”

The operative word here is “adults.” In fact, no laws presently exclude adults from hazardous work based on age. What Berry is talking about is allowing adolescents to perform such labor. Duvan Tomás Pérez, for instance, was a 16-year-old who showed just such an “interest” in an inherently dangerous job: working at a poultry plant in Mississippi, where he died in an industrial accident. The middle schooler, a Guatemalan immigrant who had lived in the United States for six years, was employed illegally by the Mar-Jac Poultry company. If there are “worker shortages in dangerous fields,” it’s because adults don’t want to take the risks. The solution is to make the work less dangerous for everyone, not to hire children to do it.

We’re Gonna Roll the Union Over

Mind you, much to the displeasure of Project 2025 types, this country is experiencing a renaissance of union organizing. Companies that long thought they could avoid unionization, from Amazon to Starbucks, are now the subject of such drives. In my own world of higher education, new unions are popping up and established ones are demonstrating renewed vigor in both private and public universities. As the bumper-sticker puts it, unions are “the folks who brought you the weekend.” They’re the reason we have laws on wages and hours, not to speak of on-the-job protections. So, it should be no surprise that Project 2025 wants to reduce the power of unions in a number of ways, including:

  • Amending the National Labor Relations Act to allow “Employee Involvement Organizations” to supplant unions. Such “worker-management councils” are presently forbidden for good reason. They replace real unions that have the power to bargain for wages and working conditions with toothless pseudo-unions.
  • Ending the use of “card-checks” and requiring elections to certify union representation. At the moment, the law still permits a union to present signed union-support cards from employees to the National Labor Relations Board and the employer. If both entities agree, the union wins legal recognition. The proposed change would make it significantly harder for unions to get certified, especially because cards can be collected without the employer’s knowledge, whereas a public election with a long lead time gives the employer ample scope for anti-union organizing activities, both legal and otherwise.
  • Allowing individual states to opt out of labor protections granted under the Fair Labor Standards Act and the National Labor Relations Act.

The measures covered here are, believe it or not, just the highlights of that labor chapter of Project 2025. If put into practice, they would be an historically unprecedented dream come true for employers, and a genuine nightmare for working people.

Meanwhile, at the Trumpified and right-wing-dominated Supreme Court, there are signs that some justices are interested in entertaining a case brought by Elon Musk’s SpaceX that could abolish the National Labor Relations Board (NLRB), the federal entity that adjudicates most labor disputes involving federal law. Without the NLRB, legal protections for workers, especially organizing or organized workers, would lose most of their bite. Despite the court’s claim to pay no attention to public opinion, its justices would certainly take note of a resounding defeat of Donald Trump, the Republicans, and Project 2025 at the polls.

A New “Contract on America?”

The last time the right wing was this organized was probably back in 1994, when Newt Gingrich published his “Contract with America.” Some of us were so appalled by its contents that we referred to it as a plan for a gangster hit, a “Contract on America.”

This year, they’re back with a vengeance. All of which is to say that if you work for a living, or if you know and love people who do, there’s a lot on the line in this year’s election. We can’t sit this one out.

Copyright 2024 Rebecca Gordon

Via Tomdispatch.com

]]> Could Trump win again? Roots of MAGA Paranoia and the Politics of Fear https://www.juancole.com/2024/03/could-paranoia-politics.html Mon, 18 Mar 2024 04:15:54 +0000 https://www.juancole.com/?p=217596 Brooklyn, NY (Special to Informed Comment; featured) – The cover of my The Politics of Fear: The Peculiar Persistence of American Paranoia features a photograph of a bearded, fur-clad man with a horned helmet, tattoos and face paint. On January 6, 2021, Jacob Anthony Chansley, aka the Q Shaman, stood at the House Speakers’ dais in the US Capitol building and led a prayer, in which he thanked the “divine, omniscient, omnipotent creator God” for allowing his fellow patriots and him “to send a message to all the tyrants, the communists and the globalists that this is our nation, not theirs.”

Chansley has written two books and produced a dozen or so videos about his political ideas; in October, 2023 he filed paperwork to run for Congress in Arizona’s Eighth District. Though he didn’t follow through and mount an actual campaign, had he run and won he likely wouldn’t have been the most extreme member of the House. And Donald Trump, whom Chanley and his fellow Q travelers believed was God’s anointed, is very much a contender for the highest office in the land.   

Chansley’s red-pill moment came, he says, when he discovered the writings of the arch conspiracy theorist Milton William Cooper, who was inspired in his turn by The Protocols of the Elders of Zion, the notorious forgery that purported to expose an ancient Jewish plot to destroy the Christian nations. As Chansley’s thinking evolved, he went on to embrace eco-fascism, anti-vax activism, Christian nationalism, New Age religiosity, and Libertarianism—a stew that is sometimes called “conspirituality.” I’ve written hundreds of thousands of words about the deep roots of paranoid conspiracy theory in American history, but if you want to know what they come down to, his prayer sums it up succinctly. It’s about how “they” are taking what is rightfully “ours.”

Who “they” are has changed over the centuries, but what’s “ours” has always been the privileges that white Christian men believed was their birthright, but for too many, seemed to be slipping away. In colonial times, “they” were agents of the Pope. In the 1790s and the 1820s they were atheistic members of the Illuminati and the Masons. By the mid-19th century, the enemy was the Irish and other Catholic immigrants who were competing for jobs. The fight over slavery spawned a host of rival conspiracy theories. During the post-Civil War era, which saw the failure of Reconstruction and the rise of vast economic inequalities, the focus shifted to English and Jewish bankers and the demonetization of silver. A few decades later, Jewish anarchists and reds and integrationists were also in the crosshairs. QAnon, the first conspiracy theory to be born on social media, takes bits and pieces from its predecessors, mixes and matches them with medieval blood libels and Gnostic apocalypticism, and gamifies it all by inviting believers to participate in its world-building. Donald Trump, in their telling, is secretly battling the elite cabal of pedophile cannibals who control the Deep State.

Whether they make you laugh or cry, those theories wouldn’t be as viral and sticky as they are if their believers weren’t experiencing real stresses—and if the horrible things they accuse their enemies of doing, everything from cannibalism to pedophilia and mass murder, weren’t behaviors that really do exist. Of course, Jews as a category don’t ritually torture and murder Christian babies, but human babies of all varieties—including Jewish ones—have been horrifically abused. More than 13,000 children have been killed by a largely Jewish army in Gaza in just the last several months.


The Politics of Fear: The Peculiar Persistence of American Paranoia by Arthur Goldwag (Penguin Random House). Click here to buy.

And is it altogether delusional to imagine, as QAnon believers do, that elites get away with child abuse? The Comet Ping Pong pizza parlor might not have had a sex dungeon, as the proponents of the Pizzagate theory claimed, but Jeffrey Epstein certainly kept a harem of underaged women and had a circle of socially and politically connected friends that included billionaires, geniuses, and royalty. Epstein’s story—everything from the mysterious sources of his wealth to his odd connection to Trump’s attorney general (William Barr’s father was the headmaster of the Dalton School when it hired him as a teacher in 1974), and his mysterious suicide in jail in 2019—could have leaped fully formed from the head of an antisemitic conspiracy theorist, like Athena from the head of Zeus, but it was all true.

Trump’s voters’ feelings of dispossession are not that far off the mark either, as a host of not-so-fun facts about economic inequality make clear. A 2017 study found that the richest three Americans (none of them Jewish) controlled more wealth than the bottom 50 percent of the nation. The total real wealth held by the richest families in the United States tripled between 1989 and 2019, according to a 2022 Congressional Budget Office report, while average earners’ gains were negligible. The ten richest people in the world, nine of them Americans, doubled their wealth during the pandemic.

Our great national myth—that America is a crucible of equality, tolerance, and boundless economic opportunity—has never been our national reality. Though right-wing populism sees the world through a lens that is distorted by irrational hatreds, it nonetheless lands on a painful truth: that unregulated capitalism is brutal and unfair. Right wing conspiracists displace the blame for its crimes onto outsiders; progressives recognize that for all its very real gestures towards equity, justice, and universal opportunity, our constitutional order was erected on a rickety scaffolding of race supremacism, religious bigotry, involuntary servitude, and land theft and compromised by them from the very beginning.

Trump’s white male voters’ intuition that the system is rigged against them is more-or-less correct, even if the privileges their fathers were born to were undeserved, and their prescriptions to rejigger the fix in their favor could not be more pernicious. The fact that so many economic left-behinds look to Trump as their champion may be perplexing, but no one can doubt that they need one.

Whether Trump wins or loses this fall, the challenge for the center, the left, and even fair-minded members of the moderate right, is to create a reality-based narrative that can compete with Trump’s and Chansley’s—and that has reparation rather than retribution at its core.  

 

]]> ‘Hell No!’: Trump Allies’ Plan to Privatize Medicare Draws Alarm and Outrage https://www.juancole.com/2024/02/privatize-medicare-outrage.html Sat, 10 Feb 2024 05:02:20 +0000 https://www.juancole.com/?p=217013 ]]> We Deserve Medicare for All, But What We Get Is Medicare for Wall Street https://www.juancole.com/2024/01/deserve-medicare-street.html Sat, 06 Jan 2024 05:02:46 +0000 https://www.juancole.com/?p=216368 By Les Leopold | –

Creating a sane healthcare system will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

( Commondreams.org ) – The United States health care system—more costly than any on earth—will become ever more so as Wall Street increasingly extracts money from it.

Private equity funds own approximately 9% of all private hospitals and 30% of all proprietary for-profit hospitals, including 34% that serve rural populations. They’ve also bought up nursing homes and doctors’ practices and are investing more year by year. The net impact? Medical costs to the government and to patients have gone up while patients have suffered more adverse medical results, according to two current studies.

The Journal of the American Medical Association (JAMA) recently published a paper which found:

Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line–associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections.

This should not come as a surprise. Private equity firms in general operate as follows: They raise funds from investors to purchase enterprises using as much borrowed money as possible. That debt does not fall on the private equity firm or its investors, however. Instead, all of it is placed on the books of the purchased entity. If a private equity firm borrows money and buys up a nursing home or hospital chain, the debt goes on the books of these healthcare facilities in what is called a leveraged buyout.

To service the debt, the enterprise’s management, directed by their private equity ownership, must reduce costs, and increase its cash flow. The first and easiest way to reduce costs is by reducing the number of staff and by decreasing services. Of course, the quality of care then suffers. Meanwhile, the private equity firm charges the company fees in order to secure its own profits.

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in.

An even larger study of private equity and health was completed this summer and published in the British Medical Journal (BMJ). After reviewing 1,778 studies it concluded that after private equity firms purchased healthcare facilities, health outcomes deteriorated, costs to patients or payers increased, and overall quality declined.


Photo by Towfiqu barbhuiya on Unsplash

One former executive at a private equity firm that owns an assisted-living facility near Boulder, Colorado, candidly described why the firm was refusing to hire and retain high-quality caregivers: “Their position was: We are trying to increase our profitability. Care is an ancillary part of the conversation.”

Medicare Advantage Creates Wall Street Advantages

Congress passed the Medicare Advantage program in 2003. Its proponents claimed it would encourage competition and greater efficiency in the provision of health insurance for seniors. At the time, privatization was all the rage as the Democratic and Republican parties competed to please Wall Street donors. It was argued that Medicare, which was actually much more efficient than private insurance companies, needed the iron fist of profit-making to improve its services. These new private plans were permitted to compete with Medicare Part C (Medigap) supplemental insurance.

In 2007, 19% of Medicare recipients enrolled in Medicare Advantage plans. By 2023 enrollment had risen to 51%. These heavily marketed plans are attractive because many don’t charge additional monthly premiums, and they often include dental, vision, and hearing coverage, which Medicare does not. And in some plans, other perks get thrown in, like gym memberships and preloaded over-the-counter debit cards for use in pharmacies for health items.

How is it possible for Medical Advantage to do all this and still make a profit?

According to a report by the Physicians for a National Health Program, it’s very simple—they overcharge the government, that is we, the taxpayers, “by a minimum of $88 billion per year.” The report says it could be as much as $140 billion.

In addition to inflating their bills to the government, these HMO plans don’t pay doctors outside of their networks, deny or slow needed coverage to patients, and delay legitimate payments. As Dr. Kenneth Williams, CEO of Alliance HealthCare, said of Medicare Advantage plans, “They don’t want to reimburse for anything — deny, deny, deny. They are taking over Medicare and they are taking advantage of elderly patients.”

Enter Hedge Funds

With so much taxpayer money sloshing around in the system, hedge funds also are cashing in. They have bought large quantities of stock in the healthcare companies that are milking the government through their Medicare Advantage programs. They then insist that these healthcare companies initiate stock buybacks, inflating the price of their stock and the financial return to the hedge funds. Stock buybacks are a simple way to transfer corporate money to the largest stock-sellers.

(A stock buyback is when a corporation repurchases its own stock. The stock price invariably goes up because the company’s earnings are spread over a smaller number of shares. Until they were deregulated in 1982, stock buybacks were essentially outlawed because they were considered a form of stock price manipulation.)

United Healthcare, for example, is the largest player in the Medicare Advantage market, accounting for 29% of all enrollments in 2023. It also has handsomely rewarded its hedge fund stock-sellers to the tune of $45 billion in stock buybacks since 2007, with a third of that coming since March 2020. Cigna, another big Medicare Advantage player, just announced a $10 billion stock buyback.

These repurchases are also extremely lucrative for United Healthcare’s top executives, who receive most of their compensation through stock incentives. CEO Andrew Witty, for example, hauled in $20.9 million in 2022 compensation, of which $16.4 million came from stock and stock option awards.

Those of us fighting for Medicare for All have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks.

A look at the pharmaceutical industry shows where all this is heading. Between 2012 and 2021, fourteen of the largest publicly traded pharmaceutical companies spent $747 billion on stock buybacks and dividends, more than the $660 billion they spent on research and development, according to a report by economists William Lazonick and Öner Tulum. Little wonder that drug prices are astronomically high in the U.S.

And so, the gravy train is loaded and rolling, delivering our tax dollars via Medicare Advantage reimbursements to companies like United Healthcare and Big Pharma, which pass it on to Wall Street private equity firms and hedge funds.

It’s Not Just Healthcare

In researching my book, Wall Street’s War on Workers, we found that private equity firms and hedge funds are undermining the working class through leveraged buyouts and stock buybacks. When private equity moves in, mass layoffs (just like healthcare staff cuts and shortages) almost always follow so that the companies can service their debt and private equity can extract profits. When hedge funds insist on stock repurchases, mass layoffs are used to free up cash in order to buy back their shares. As a result, between 1996 and today, we estimate that more than 30 million workers have gone through mass layoffs.

Meanwhile, stock buybacks have metastasized throughout the economy. In 1982, before deregulation, only about 2% of all corporate profits went to stock buybacks. Today, it is nearly 70%.

Those of us fighting for Medicare for All, therefore, have much in common with every worker who is losing his or her job as a result of leveraged buyouts and stock buybacks. Every fight to stop a mass layoff is a fight against the same Wall Street forces that are attacking Medicare and trying to privatize it. Creating a sane healthcare system, therefore, will depend on building a massive common movement to free our economy from Wall Street’s wealth extraction.

To take the wind out of Medicare Advantage and Wall Street’s rapacious sail through our healthcare system, we don’t need more studies. It’s time to outlaw leveraged buyouts and stock buybacks.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.
]]> How a Big Pharma Company Stalled a Potentially Lifesaving Vaccine in Pursuit of Bigger Profits https://www.juancole.com/2023/11/company-potentially-lifesaving.html Sat, 04 Nov 2023 04:06:31 +0000 https://www.juancole.com/?p=215151 By Anna Maria Barry-Jester | –

( ProPublica) – Ever since he was a medical student, Dr. Neil Martinson has confronted the horrors of tuberculosis, the world’s oldest and deadliest pandemic. For more than 30 years, patients have streamed into the South African clinics where he has worked — migrant workers, malnourished children and pregnant women with HIV — coughing up blood. Some were so emaciated, he could see their ribs. They’d breathed in the contagious bacteria from a cough on a crowded bus or in the homes of loved ones who didn’t know they had TB. Once infected, their best option was to spend months swallowing pills that often carried terrible side effects. Many died.

So, when Martinson joined a call in April 2018, he was anxious for the verdict about a tuberculosis vaccine he’d helped test on hundreds of people.

The results blew him away: The shot prevented over half of those infected from getting sick; it was the biggest TB vaccine breakthrough in a century. He hung up, excited, and waited for the next step, a trial that would determine whether the shot was safe and effective enough to sell.

Weeks passed. Then months.

More than five years after the call, he’s still waiting, because the company that owns the vaccine decided to prioritize far more lucrative business.

Pharmaceutical giant GSK pulled back on its global public health work and leaned into serving the world’s most-profitable market, the United States, which CEO Emma Walmsley recently called its “top priority.” As the London-based company turned away from its vaccine for TB, a disease that kills 1.6 million mostly poor people each year, it went all in on a vaccine against shingles, a viral infection that comes with a painful rash. It afflicts mostly older people who, in the U.S., are largely covered by government insurance.

Importantly, the shingles vaccine shared a key ingredient with the TB shot, a component that enhanced the effectiveness of both but was in limited supply.

From a business standpoint, GSK’s decision made sense. Shingrix would become what the company calls a “crown jewel,” raking in more than $14 billion since 2018.

But the ability of a corporation to allow a potentially lifesaving vaccine to languish lays bare the distressing reality of public health vaccine creation. With limited resources, governments have long seen no other option but to team with Big Pharma to develop vaccines for global scourges. But after the governments pump taxpayer money and resources into the efforts, the companies get control of the products, locking up ownership and prioritizing their own gain.

That’s what GSK did with the TB vaccine. Decades ago, the U.S. Army brought in GSK to work on a malaria vaccine and helped develop the ingredient that would prove game-changing for the company. It was an adjuvant, a substance that primed the body’s immune system to successfully respond to a vaccine for malaria — and, the company would come to learn, a variety of other ailments.

GSK patented the adjuvant and took control of the supply of the ingredients in it. It accepted government and nonprofit funding to develop a TB vaccine using the adjuvant. But even though it isn’t carrying the vaccine to the finish line, it isn’t letting go of it entirely either, keeping a tight grip on that valuable ingredient.

As TB continued to rage around the globe, it took nearly two years for GSK to finalize an agreement with the nonprofit Bill & Melinda Gates Medical Research Institute, or Gates MRI, to continue to develop the vaccine. While the Gates organization agreed to pay to keep up the research, GSK reserved the right to sell the shot in wealthy countries.

The trial that will determine whether the vaccine is approved won’t begin until 2024, and isn’t expected to end until at least 2028. “We just can’t operate like that for a disease that is this urgent,” said Thomas Scriba, a South African scientist and TB expert who also worked on the study.

GSK pushes back against the premise that the company delayed the development of the TB vaccine and says it remains dedicated to researching diseases that plague underserved communities. “Any suggestion that our commitment to continued investment in global health has reduced, is fundamentally untrue,” Dr. Thomas Breuer, the company’s chief global health officer, wrote in a statement.

The company told ProPublica that it cannot do everything, and it now sees its role in global health as doing early development of products and then handing off the final clinical trials and manufacturing to others. It also said that a vaccine for TB is radically different from the company’s other vaccines because it can’t be sold at scale in wealthy countries.

Though a good TB vaccine would be used by tens of millions of people, it has, in the parlance of industry, “no market,” because those who buy it are mostly nonprofits and countries that can’t afford to spend much. It’s not that a TB vaccine couldn’t be profitable. It’s that it would never be as profitable as a product like the shingles vaccine that can be sold in the U.S. or Western Europe.

Experts say the story of GSK’s TB vaccine, and its roller coaster of hope and disappointment, highlights a broken system, which has for too long prioritized the needs of corporations over those of the sick and poor.

“We don’t ask for a fair deal from our pharma partners,” said Mike Frick, a director of the tuberculosis program at Treatment Action Group and a global expert on the TB vaccine pipeline. “We let them set the terms, but we don’t ask them to pick up the check. And I just find it frankly a little humiliating.”

Steven Reed, a co-inventor of the TB vaccine, brought his idea to GSK decades ago, believing that working with a pharmaceutical giant was essential to getting the shots to people who desperately needed them. He’s disillusioned that this hasn’t happened and now says that Big Pharma is not the path to saving lives with vaccines in much of the world. “You get a big company to take it forward? Bullshit,” he said. “That model is gone. It’s failed. It’s dead. We have to create a new one.”

Gaining Control

In the early 1980s, the U.S. Army was desperate for a way to keep troops safe from the parasite that causes malaria. Military scientists had some promising ideas but wanted to find a company that could help them develop and manufacture the antigen, the piece of a vaccine that triggers an immune response. They called on SmithKline Beckman, now part of GSK, which had a plant outside of Philadelphia committed to the exact type of antigen technology they were researching.

For the company’s part, working with the Army gave it access to new science and, importantly, the ability to conduct specialized research. The Army had laboratories for animal testing and ran clinical trial sites around the world. It’s also generally easier to get experimental products through regulatory approval when working with the government, and Army scientists were willing to be infected with malaria and run the first tests of the vaccine on themselves.

Col. Carl Alving, then an investigator at the Walter Reed Army Institute of Research, said he was the first person known to be injected with an ingredient called MPL, an adjuvant added to the vaccine. Today, we know that adjuvants are key to many modern vaccines. But at the time, only one adjuvant, alum, had ever been approved for use. Alving published promising results, showing that MPL boosted the shot’s success in the body.

Company scientists took note and began adding MPL to other ingredients. If one adjuvant was good, maybe two adjuvants together, stimulating different parts of the immune system, might be even better.


Image by Arek Socha from Pixabay

It was an exciting development, bringing the multiple adjuvants together, Alving said in an interview. But then he learned that the company scientists had filed a patent for the combinations in Europe, which put limits on what he and his colleagues could do with MPL. “The Army felt perhaps a little frustrated by that because we had introduced Glaxo to the field.”

Still, the Army wanted the malaria vaccine. Military personnel started comparing the adjuvant combinations on rhesus monkeys at an Army facility in Thailand and ran clinical trials that tested the most promising pairs in humans and devised dosing strategies.

The Army found that one of the combinations came out on top: MPL and an extract from the bark of a tree that grows in Chile. The bark extract was already used in veterinary vaccines, but a scientist at one of the world’s first biotech companies had recently discovered you could purify it into a material that makes it safe enough for use in humans.

Alving said that at the time, he didn’t patent the work he and his colleagues were doing or demand an exclusive license for MPL. “It’s a question of the Army being the Army, which is not a company,” Alving said. (This was actually the second time the government failed to secure its rights over MPL. Decades earlier, the ingredient was discovered and formulated by scientists working for the Department of Veterans Affairs and a National Institutes of Health lab in Montana. One of the scientists, frustrated that his bosses in Bethesda, Maryland, wouldn’t let him test the product in humans, quit and formed a company, taking the research with him. Though his company initially said it thought MPL was in the public domain and couldn’t be patented, he did manage to patent it.)

Experts say drug development in the U.S. is littered with such missed opportunities, which allow private companies to seize control of and profit off work done by publicly funded researchers. Governments, they say, need to be more aggressive about keeping such work in the public domain. Alving has since done just that, recently receiving his 30th patent owned by the military.

It’s an open secret in the pharmaceutical world that companies participate in global health research because it’s where they get to try out new technologies that can be applied to other, more lucrative diseases.

At an investor presentation in 2016, a GSK executive used the malaria vaccine example to explain the benefit of such work. “Of those of you who think this is just philanthropy, it is not,” Luc Debruyne, then president of vaccines at GSK, told the group. He explained that it was through the malaria work that the company invented the adjuvant that is now in its blockbuster shingles vaccine. And, he explained, vaccines are high-volume products that make a steady stream of money over time. “So doing good business, innovating and doing well for the world absolutely can get married.”

As the Army’s research on the combination of MPL and the bark extract evolved — and its market potential became clear — GSK moved to vacuum up the companies that owned the building blocks to the adjuvant.

In 2005, it bought the company that owned the rights to MPL for $300 million. In 2012, it struck a deal for the rights to a lion’s share of the supply of the Chilean tree bark extract.

The company was now in full control of the adjuvant.

Picking a Winner

GSK eagerly began to test its new adjuvant on a number of diseases — hepatitis, Lyme, HIV, influenza.

Steven Reed, a microbiologist and immunologist, had come to the company in 1994 with an idea for a tuberculosis vaccine. An estimated 2 billion people are infected with TB globally, but it’s mainly those with weakened immune systems who fall ill. A century-old vaccine called BCG protects young children, but immunity wanes over time, and that vaccine does little to shield people from the most common type of infection in the lungs.

Reed had just the background and resources to attempt a breakthrough: An adjunct professor at Cornell University’s medical school, he also ran a nonprofit research organization that worked on infectious diseases and had co-founded a biotech company to create and market products.

He and his colleagues were building a library of the proteins that make up the mycobacterium that causes TB. He also had access to a blood bank in Brazil, where TB was more prevalent, that he could screen the proteins against to determine which generated an immune response that prevented people from getting sick.

At the time Reed pitched the vaccine, the company’s decision over whether to take him up was made by researchers, said Michel De Wilde, a former vice president of research and development at the company that partnered with Reed and later became part of GSK. Today, across the industry, finance units play a much stronger role in deciding what a company works on, he said.

GSK signed on, asking Reed to add the company’s promising new adjuvant to his idea for a TB vaccine.

Reed and his colleagues used more than $2 million in federal money to conduct trials from 1995 to 2005. GSK also invested, but NIH money and resources were the key, Reed said. As the vaccine progressed into testing, the Bill & Melinda Gates Foundation pitched in, as did the governments of the United Kingdom, the Netherlands and Australia, among others.

Amid all that, in 2003, GSK started testing the adjuvant in its shingles vaccine, according to annual reports, but at a much faster speed. With TB, it performed a small proof-of-concept study to justify moving to a larger one. There’s no evidence it did so with shingles. By 2010, GSK’s shingles vaccine was in final trials; in 2017, the FDA approved it for use.

To employees and industry insiders, GSK was making its priorities clear. The company built a vaccine research facility in Rockville, Maryland, to be closer to the NIH and the Food and Drug Administration; at the same time, it was retreating from TB and other global public health projects, according to former employees of the vaccine division.

All the while, the adjuvant was limited. GSK struggled to ramp up production of MPL, according to former employees there; it relies on a cumbersome manufacturing process. And it wasn’t clear whether there was sufficient supply of the Chilean tree that is essential to both vaccines.

After researchers learned of the TB vaccine’s successful proof-of-concept results in 2018, GSK said nothing about what was next.

“You would have thought people would have said: ‘Oh shit, this is doable. Let’s double down, let’s quadruple down,’” said Dr. Tom Evans, former president and CEO of Aeras, a nonprofit that led and paid for half of the proof-of-concept study. “But that didn’t happen.”

Scriba, who was involved in the study in South Africa, said he never imagined that GSK wouldn’t continue the research. “To be honest it never occurred to us that they wouldn’t. The people we worked with at GSK were the TB team. They were passionate about TB,” Scriba said. “It’s extremely frustrating.”

But Reed said that when the shingles vaccine was approved, he had a gut feeling that GSK would abandon the tuberculosis work.

“The company that dropped it used similar technology to make billions of dollars on shingles, which doesn’t kill anyone,” Reed said.

Those in the field grew so concerned about the fate of the TB vaccine that the World Health Organization convened a series of meetings in 2019.

Breuer, then chief medical officer for GSK’s vaccine division, explained that the pharmaceutical giant was willing to hand off the vaccine to an organization or company that would cover the cost of future development, licensing, manufacturing and liability. If the next trial went well, they could sell the vaccine in the “developing world,” with GSK retaining the sales rights in wealthier countries.

GSK would, however, retain control of the adjuvant, Breuer said. And the company only had enough for its other vaccines, so whoever took over the TB vaccine’s development would need to pay GSK to ramp up production, which Breuer estimated would cost around $200 million.

Dr. Julio Croda was director of communicable diseases for Brazil at the time and attended the meeting. He said he was authorized to spend significant government funds on a tuberculosis vaccine trial but needed assurances that GSK would transfer technology and intellectual property if governments paid for its development. “But in the end of the meeting, we didn’t have an agreement,” he said.

Dr. Glenda Gray, a leading HIV vaccine expert who attended the meeting on behalf of South Africa, said she wasn’t able to get a straight answer about the availability of the adjuvant.

The year after the WHO meeting, after what a Gates representative described as “a lot of negotiation,” GSK licensed the vaccine to Gates MRI, a nonprofit created by the Gates Foundation to develop drugs and vaccines for global health issues that for-profit companies won’t tackle.

GSK told ProPublica that it did not receive upfront fees or royalties as part of the arrangement, but that Gates MRI paid it a small incentive to invest in the company’s global health endeavors. GSK and Gates MRI declined to comment on the amount.

Gates MRI tax documents show a payment designated as “royalties, license fees, and similar amounts that allow the organization to use intellectual property such as patents and copyrights” the year the agreement was finalized. Among available tax documents, that is the only year the organization has made a payment in that category.

The amount: $10 million.

An Uncertain Future

In June of this year, the Gates Foundation and the Wellcome Trust announced they were pledging $550 million to fund the phase 3 trial that will finally show whether the vaccine works. They’ve selected trial locations and are currently testing it on a smaller subset of patients, those with HIV.

Jeremy Farrar, chief scientist at the WHO, said he’s more optimistic than he’s ever been in his career that we’ll have a new TB vaccine this decade.

Gates MRI and GSK declined to say who had the rights to sell the vaccine in which countries, but Gates MRI said it will “work with partners to ensure the vaccine is accessible for people living in high TB-burden lower- and middle-income countries,” and GSK acknowledged that its rights extend to South America and Eastern Europe, two regions with significant pockets of TB.

As expected, Gates MRI will be reliant on GSK to supply the adjuvant, which concerns vaccine hopefuls because of the lack of transparency surrounding its availability. One of the key ingredients, the bark extract, comes from a tree whose harvest and export has been controlled by the Chilean government since the 1970s because of overexploitation. A megadrought and forest fires continue to threaten native forests today. The main exporter of the bark says it has resolved previous bottlenecks, and GSK said it is working on a synthetic version as part of its long-term plan.

In response to questions about why it retained control of the adjuvant, GSK said it was complicated to make, would not be economical to produce in more than one place, and was a very important component in many of the company’s vaccines, so it wasn’t willing to share the know-how.

The adjuvant is only growing in value to the company, as it adds yet another lucrative vaccine to its portfolio that requires it. In May, the FDA approved a GSK vaccine for the respiratory virus known as RSV. Analysts project that the shot will bring in $4 billion annually at its peak. GSK continues to study the adjuvant in additional vaccines.

GSK strongly insists that it has enough of the adjuvant to fulfill its forecasted needs for the RSV, shingles, malaria and TB vaccines through 2035.

The company and Gates MRI said their agreement includes enough adjuvant for research and the initial supply of the TB vaccine, if it is approved. The organizations declined, however, to specify how many people could be vaccinated. GSK also said it was willing to supply more adjuvant after that, but further negotiations would be necessary and Gates MRI would likely need to pay to increase adjuvant manufacturing capacity. For its part, Gates MRI said it is evaluating several strategies to ensure longer term supply.

Several experts said that Gates MRI should test other adjuvants with the vaccine’s antigen. That includes Farrar, who said it would be “very wise” to start looking for a new adjuvant. He is one of the few people who has seen the agreement between Gates MRI and GSK as a result of his previous role as director of the Wellcome Trust. Farrar is now helping to lead a new TB Vaccine Accelerator Council at the WHO and said he believes one of the group’s roles would be to find solutions to any future problems with the adjuvant.

Gates MRI declined to answer when asked if it was considering testing other adjuvants with the vaccine’s antigen. GSK, along with several other scientists and regulators that ProPublica spoke with, expressed that using a new adjuvant would require redoing all of the long and expensive clinical trials.

U.S. government officials, meanwhile, are working to identify adjuvants that aren’t already tied up by major pharmaceutical companies.

For a corporation, the primary concern is “what is this adjuvant doing for my bottom line,” said Wolfgang Leitner, who began his career working at Walter Reed Army Institute of Research on the malaria vaccine as a consultant for GSK. Now the chief of the innate immunity section at the National Institute of Allergy and Infectious Diseases, his job is to encourage the development of new adjuvants and to make sure that researchers have access to ones that aren’t tightly controlled by individual companies.

The WHO has also been helping to build a global network of vaccine manufacturers who can develop and supply vaccines to less wealthy countries outside of the shadow of Big Pharma; it is using a technology debuted during the COVID-19 pandemic called mRNA, which deploys snippets of genetic code to trigger an immune response. Reed, an inventor of GSK’s TB vaccine, co-founded the company at the center of that effort, Afrigen, after growing concerned about the fate of the vaccine he made for GSK.

Reed helped create a second TB vaccine, which Afrigen has the rights to manufacture for sale in Africa. But that vaccine has yet to start a proof-of-concept trial.

Over the past five years, an average of just $120 million a year has been spent on all TB vaccine research globally, including money from governments, pharmaceutical companies and philanthropic organizations, according to annual surveys conducted by the Treatment Action Group. For perspective, the U.S. alone spent more than $2 billion developing COVID-19 vaccines from 2020 to 2022. At a special UN meeting on tuberculosis in 2018, the nations of the world pledged to ensure $3 billion was spent on TB vaccine research and development over the next five years. Just 20% of that was handed out.

While that mRNA hub holds promise, it will be years before an mRNA TB vaccine enters a proof-of-concept trial, according to people involved. The pharmaceutical companies that made successful COVID-19 vaccines have refused to share the technology and manufacturing techniques that make mRNA vaccines work. One company, Moderna, has said it won’t enforce its patents on mRNA vaccines Afrigen creates for COVID-19, but it’s not clear what it’ll do if Afrigen applies those techniques to a disease like TB. (Paul Sagan, board chairman of ProPublica, is a member of Moderna’s board.)

To date, the GSK tuberculosis vaccine — which does not use mRNA technology — is the only one that meets a set of characteristics the WHO believes are necessary for a viable TB vaccine.

The phase 3 trial is set to begin early next year. In the time between the two trials, approximately 9 million people will have died from TB.

ProPublica

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