Friday, December 10, 2021

Neoliberalism coddles bad nursing homes in comforting secrecy

Neoliberalisma political approach that favors free-market capitalism, deregulation, and reduction in government spending; neoliberalism is a political development of capitalism and a political and economic ideology that seeks to (i) maximize the freedom of the market by removing barriers to the private accumulation of wealth, and (ii) become a power over and above the state directed to the ends of profit without government interference; neoliberalism opposes regulation over which it has no control; the controlling ethic of capitalism is prudence which leads to wealth, but the ethic of neoliberalism is the accumulation of wealth for its own sake which leads to political power; neoliberalism, as the de facto only available political and economic option has had catastrophic effects on society and the environment 


The effects of the neoliberal influence on the Democratic and Republican Parties is usually manifest as deregulation of commerce and wealth with a concomitant flow of power from government and its ability to protect and serve public interests. Power flows to special interests and owners of wealth who gain advantage and use it over the public and public interests to their own benefit. Secrecy is a necessary and major aid in the power shift. Special interests and neoliberal politicians deny that this power shift happens, but they are liars. As we all know, an ignorant public is more compliant and profitable than an informed public. --- Germaine, 2021


Politicians love opacity and secrecy. So do lobbyists. So do courts. Businesses too. Obviously, fine citizens like tax cheats, embezzlers and drug dealers really like lots of secrecy. Everyone with things to hide loves secrecy. That runs the gamut from hiding merely embarrassing boo-boos to hiding shockingly illegal, cruel and/or lethal activities. That is why non-disclosure agreements are the norm in many or most businesses. That is why many or most consumer products and services come with a demand that disputes be settled by arbitration in secret. That is why most major lawsuits that settle before a court decides a case in public are settlements that demand secrecy of the terms. Usually the defendant demands secrecy from the plaintiff.

And it's always the same game: Those with power demand secrecy. Those without power, like the public interest and consumers, are forced to accept secrecy to the advantage of those with power over them. That is how neoliberalism works for people and interests in power, usually (always?) to the detriment of the public and its interest.

All that wonderful neoliberal secrecy allows the crooks, liars, and thugs an opportunity to downplay and lie about what they did, how bad it was and exactly who was responsible. The stench of plausible deniability for the bad guys is overpowering. The public is left free to decide what, if anything it wants to believe. Facts just cannot get in the way of forming false beliefs based on lies because the public remains ignorant of the truth. 



A New York Times article, How Nursing Homes’ Worst Offenses Are Hidden From the Public, provides a wonderful example of of what neoliberal government often produces. The NYT writes:
In Arizona, a nursing home resident was sexually assaulted in the dining room.

In Minnesota, a woman caught Covid-19 after workers moved a coughing resident into her room.

And in Texas, a woman with dementia was found in her nursing home’s parking lot, lying in a pool of blood.

State inspectors determined that all three homes had endangered residents and violated federal regulations. Yet the federal government didn’t report the incidents to the public or factor them into its influential ratings system. The homes kept their glowing grades.

A New York Times investigation found that at least 2,700 similarly dangerous incidents were also not factored into the rating system run by the federal Centers for Medicare and Medicaid Services, or C.M.S., which is designed to give people reliable information to evaluate the safety and quality of thousands of nursing homes.

Many of the incidents were uncovered by state inspectors and verified by their supervisors, but quashed during a secretive appeals process, according to a review of thousands of pages of inspection reports and nursing home appeals, which The Times obtained via public-records requests. Others were omitted from the C.M.S. ratings website because of what regulators describe as a technical glitch.

The Times this year has documented a series of problems with Medicare’s ratings system. Much of the data that powers the system is wrong and often makes nursing homes seem cleaner and safer than they are. The rating system also obscures how many residents are receiving powerful antipsychotic drugs.

On the rare occasions when inspectors issue severe citations, nursing homes can fight them through an appeals process that operates almost entirely in secret. If nursing homes don’t get the desired outcome via the informal review, they can appeal to a special federal court inside the executive branch. That process, too, is hidden from the public.

Even when the citations are upheld by this federal court, some never make their way onto the Medicare website, known as Care Compare. In November, for example, the court sustained a major punishment against Life Care Center of Kirkland, Wash. — the nursing home that faced the first coronavirus outbreak in the United States — yet the citation is absent from the Medicare site. The facility has a five-star rating.

The pattern gives nursing homes a powerful incentive to pursue every available appeal. Even if they lose, the process eats up time and reduces the odds of damaging information ever becoming public.

“There is every advantage to the facility not to have an opinion issued for as long as they could possibly delay, and there’s no advantage to the public for that to occur,” said Richard Routman, a lawyer who represented the federal government in nursing home appeals until 2014.

“Once I realized that people wouldn’t see cases that are on appeal, I thought, why would anybody ever look at this again?”  
Representatives of the nursing home industry say it is only fair that they be allowed to appeal citations before they are made public, especially since many end up getting overturned or downgraded. But The Times found that the appeals process can be one-sided, excluding patients and their families.  
There’s big money at stake. Because of the weight that people place on the star ratings, researchers have found a connection between better inspection results and greater profits. The Times analyzed nursing homes’ financial statements from 2019 and found that four- and five-star facilities were much more profitable than lower-rated facilities. (For-profit companies own about 70 percent of all U.S. nursing homes.) 
For decades, federal watchdog agencies have criticized state inspectors for taking a light touch with the nursing homes they oversee.  
Inspectors rarely deem problems to be serious enough to harm homes’ star ratings. From 2017 to 2019, The Times found, inspectors wrote up more than 2,000 five-star facilities at least once for not following basic infection-control precautions, like having employees regularly wash their hands.

At 40 other five-star homes, inspectors determined that sexual abuse did not constitute actual harm or put residents in immediate jeopardy.  
“I feel sometimes the things I cite don’t mean anything because it gets tossed out at the state level or they determine it not to be as severe,” an unnamed inspector said in a 2013 survey conducted by the Center for Medicare Advocacy, a consumer rights group. “Sometimes it makes you wonder why we spin our wheels on a problem.”

One can clearly see the influence and power of economic incentives to do bad things when they are shrouded in secrecy. If the public never hears about bad things and no significant penalties attach, the bad stuff effectively did not happen. There is every reason to keep doing bad things that help make money, even if people are harmed or killed in the process. Power and wealth are the only moral values inherent in neoliberalism. Human and environmental destruction and death are not major factors in the profit equation unless government steps in and gives those those things major weight.


Ranking existential threats
Unwarranted secrecy and neoliberalism arguably are existential threats to liberal democracy, the rule of law, modern civilization via wealth inequality and maybe even the existence of the human species on Earth. Unwarranted secrecy is necessary for subversion of democracy and the rule of law. 

A ranking of threats to global democracy and the rule of law should help at least some to put this in context.
1. Nuclear war
2. Corruption and subversion of government by special interests
3. Unwarranted secrecy
4. Dark free speech and social media disinformation
5. Political polarization
6. Authoritarianism, neoliberalism and Christian theocracy
7. Wealth inequality (an aspect of American authoritarianism, neoliberalism and Christian theocracy)
8. Environmental damage (also an aspect)
9. Weak public education
10. Overpopulation
 
There is overlap among at least some of these things. Note that unwarranted secrecy is usually a major component of corruption and subversion of government by special interests, dark free speech and political polarization. This ranking just intended to give a general idea of how secrecy might fit into an existential threat assessment. Opinions on this will vary. For example, some or most conservatives might put the BML movement, critical race theory, the Democratic party and/or socialism/communism on the top 10 list of threats.


Questions: 
1. Why does the government allow secrecy to protect nursing homes, neoliberalism, fairness to nursing homes, and/or something else, or is secrecy not a significant factor here?

2. Is it more likely than not that unwarranted secrecy is a significant existential threat to democracy and the rule of law?

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