Brass knuckles capitalism at work in America's overpriced heath care system

“Social responsibility is a fundamentally subversive doctrine” in a free society, and have said that in such a society, “there is one and only one social responsibility of business–to use it resources and engage in activities designed to increase its profits so long as it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud.” ― Nobel Prize laureate Milton Friedman, The Ethics of Competition and Other Essays, 1969

“When the rules of the capitalism game exclude only unfree competition, deception and fraud, and businesses buy the legal definitions of unfree competition, deception and fraud from our corrupted pay-to-play system of politics and government, one should expect little to no concern for social responsibility from businesses. What little concern there may be amounts to a public relations propaganda problem. Such problems are almost always addressed by (1) deceiving, distracting and/or confusing the public as much as possible, and/or (2) buying more effective social responsibility-subverting laws from government.” ― Blogger Germaine, Dissident Politics blog post, 2024  

The NYT reports (not paywalled for 30 days) about a quiet, obscure little data analytics company, MultiPlan. MultiPlan is shifting unknown billions of dollars in health care costs from insurers to consumers. The lead example is a woman who used an out of network doctor to treat a serious infection. Insurance paid the doctor $5,449.27 and billed the woman more than $100,000. That was based on a “fair and independent analysis” as MultiPlan and the insurance companies define the concepts of fair, independent and analysis. That amounts to a fig leaf over a very nasty thing to look at.

Insurers Reap Hidden Fees by Slashing Payments. 

You May Get the Bill.

A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.

The answer is a little-known data analytics firm called MultiPlan. It works with UnitedHealthcare, Cigna, Aetna and other big insurers to decide how much so-called out-of-network medical providers should be paid. It promises to help contain medical costs using fair and independent analysis.

But a New York Times investigation, based on interviews and confidential documents, shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee.

But when employees see a provider outside the network, as Ms. Lawson did, many insurance companies consult with MultiPlan, which typically recommends that the employer pay less than the provider billed. The difference between the bill and the sum actually paid amounts to a savings for the employer. But, The Times found, it means big money for MultiPlan and the insurer, since both companies often charge the employer a percentage of the savings as a processing fee.

Can you see the incentive to shift

costs to the consumer?

Note the sentence in the NYT article: It promises to help contain medical costs using fair and independent analysis. Think about that a moment. How does shifting already outrageously high medical costs from insurance companies and health care providers to powerless consumers contain medical costs? It doesn’t. Instead, it incentivizes increasing costs by shifting costs to consumers who cannot do anything about it because health care is usually a necessity, not an option. It is exactly like requiring all drivers to have car insurance. All the power is with the insurance companies. That power incentivizes them to squeeze every possible penny out of every consumer.  

The point of this post is to again point out that brass knuckles private sector capitalism, including health care, mostly operates with one and only one moral imperative, profit lust. There are some exceptions, but that generally tends to be in smaller businesses. Incentives that increase profit are effective, regardless of harm or cost to consumers. The more risk and cost that gets shifted to consumers, the higher the profit. Nowhere in this does the strange concept of social responsibility or conscience come into play for brass knuckles capitalists. 

With brass knuckles capitalism, the concept of social responsibility exists only as an evil thing to be minimized as much as possible. Only when government regulates for the benefit of consumers does social responsibility have some effect.

Another Middle East war front opens?; The hopelessness of the Republican Party

Israel bombed part of the Iranian embassy in Damascus, Syria. The consular building, whatever that is, was leveled, but the main embassy remains intact. Experts expect that Iran will pick a place and time retaliate in kind. That could lead to the US getting into some kind of a proxy or otherwise war with Russia somewhere in the Middle East. The AP reported:

Israel has grown increasingly impatient with the daily exchanges of fire with Hezbollah, which have escalated in recent days, and warned of the possibility of a full-fledged war. Iranian-backed Houthi rebels in Yemen have also been launching long-range missiles toward Israel, including on Monday.

While Iran’s consular building was leveled in the attack, according to Syria’s state news agency, its main embassy building remained intact. Still, the Iranian ambassador’s residence was inside the consular building.

Iran’s ambassador, Hossein Akbari, vowed revenge for the strike “at the same magnitude and harshness.”

Hamas and Islamic Jihad — another Palestinian militant group backed by Iran — accused Israel of seeking to widen the conflict in Gaza.

Experts said there was no doubt that Iran would retaliate. The strike in Syria was a “major escalation,” Charles Lister, a Syria expert at the Middle East Institute in Washington, said on the social media platform X.

Another source commented: Is Israel's plan to draw the US into a war with Iran? -- Iranian leaders will feel heavy pressure to respond forcefully. The extent of that pressure can be appreciated by imagining if the roles were reversed. If Iran had bombed an embassy of Israel or the United States, a violent and lethal response would be not just expected but demanded by politicians and publics alike. .... Speaking a day after the attack, Iranian Supreme Leader Ali Khamenei vowed revenge and said “Israel will be punished.” The Iranian representative at the United Nations Security Council asserted Iran’s right to a “decisive response to such reprehensible acts.”

Maybe it is time to move the nuclear Armageddon clock ahead a few seconds. The nuclear Armageddon experts opine: 

It is still 90 seconds to midnight -- 2024 Doomsday Clock Statement 

The war in Ukraine and the widespread and growing reliance on nuclear weapons increase the risk of nuclear escalation. China, Russia, and the United States are all spending huge sums to expand or modernize their nuclear arsenals, adding to the ever-present danger of nuclear war through mistake or miscalculation. .... And the war in Gaza between Israel and Hamas has the potential to escalate into a wider Middle Eastern conflict that could pose unpredictable threats, regionally and globally.

If the US had forced Israel and the Palestinians into a peace agreement decades ago, we very likely would not be in this mess today. But here we are, like it or not.

Fire the Democratic and Republican Parties!

_________________________________________________________________

_________________________________________________________________

It is time to squarely face what has been clear for at least the last 7 years. Most of the GOP leadership is staunchly authoritarian, corrupt and completely morally rotted. (Most of the rank and file supports it all, so what does that make them? Patriots?) Nearly all of the pro-democracy, pro-facts Repub elites that were left in 2017 have either been RINO hunted out of power, radicalized into authoritarianism, or left the party.

A WaPo article (not paywalled off) about Russian influence on GOP elites exemplifies the hopelessness: 

When a top Republican says Russian propaganda has infected the GOP

House Foreign Affairs Committee Chairman Michael McCaul is the latest to point out such a problem in his party

[In 2019] former Trump national security aide Fiona Hill made an extraordinary plea. Seated in front of congressional Republicans, she implored them not to spread Russian propaganda.

“In the course of this investigation, I would ask that you please not promote politically driven falsehoods that so clearly advance Russian interests,” she told them. She was referring to comments they had made during her earlier deposition breathing life into a baseless, Trump-backed suggestion that Ukraine, rather than Russia, interfered in the 2016 U.S. election.

“These fictions are harmful even if they’re deployed for purely domestic political purposes,” she added.

Republicans on the [first Trump impeachment inquiry] committee blanched at the suggestion that they had served as conduits for Russian misinformation, but Hill refused to back down.

Five years later, Republicans are starting to grapple more publicly with the idea that this kind of thing is happening in their ranks.

The most striking example came this week. In an interview with Puck News’s Julia Ioffe, Rep. Michael McCaul (R-Tex.) — none other than the GOP chairman of the House Foreign Affairs Committee — flat-out said that Russian propaganda had “infected a good chunk of my party’s base.”

McCaul suggested conservative media was to blame.

“There are some more nighttime entertainment shows that seem to spin, like, I see the Russian propaganda in some of it — and it’s almost identical [to what they’re saying on Russian state television] — on our airwaves,” McCaul said.

He also cited “these people that read various conspiracy-theory outlets that are just not accurate, and they actually model Russian propaganda.” 

Former congresswoman Liz Cheney (R-Wyo.) said there is now “a Putin wing of the Republican Party.”

In 2022, Sen. Mitt Romney (R-Utah) called the pro-Putin sentiments in some corners of his party “almost treasonous,” while allowing that perhaps his fellow Republicans were just attention-seekers.  

What may be the most famous example: when House GOP leaders in 2016 privately joked about Trump being compromised by Russia, as later reported by The Washington Post.

The day after The Post broke the news that the Russians had hacked the Democratic National Committee, then-House Majority Leader Kevin McCarthy (R-Calif.) quipped that perhaps Russia had gotten Democrats’ opposition research about Trump.

“There’s two people, I think, Putin pays,” McCarthy added, “[Rep. Dana] Rohrabacher and Trump.” (Rohrabacher was an openly pro-Russian Republican from California.)

Then-House Speaker Paul D. Ryan (R-Wis.) quickly tried to steer the conversation in another direction and urged people to be discreet. [Yeah, God forbid House Republicans are honest with the American people, fools and dupes that they are -- Hey Speaker Ryan! Thank you for your service  /s]

Mitt exemplifies infantile, crackpot reasoning: “Almost treasonous?” Really? One can only wonder what Mitt considers to be actually treasonous. Just attention-seeking by elected politicians knowingly spouting Russian anti-American propaganda is not treasonous? They have no moral responsibility to at least try to speak truth? That reasoning is roughly the same saying that idiots who shoot off lots of fireworks in a tinder-dry forest on a very windy day are almost arsonists. The level of reasoning that most GOP elites usually bring to the table is grade-school level drivel.**

The dreadful reality: After all this time and all the lies, bile and hate that has come from GOP elites, it is not likely that they will back away from Russian lies and made-up conspiracy theories. They just have too much invested in staying the course, like many or most stay the course with the stolen 2020 election lie. The odds of the Republican elites changing course and being honest with the public in the next year seems to be low, maybe a 0.1% chance (1 in 1,000).  

** Grade-school level drivel arguably is the norm, not the exception. From the book Democracy for Realists: Why Elections do not Produce Responsive Governments:

“. . . . the typical citizen drops down to a lower level of mental performance as soon as he enters the political field. He argues and analyzes in a way which he would readily recognize as infantile within the sphere of his real interests. . . . cherished ideas and judgments we bring to politics are stereotypes and simplifications with little room for adjustment as the facts change. . . . . the real environment is altogether too big, too complex, and too fleeting for direct acquaintance. We are not equipped to deal with so much subtlety, so much variety, so many permutations and combinations. Although we have to act in that environment, we have to reconstruct it on a simpler model before we can manage it.”

GOP elites have that infantile analyzing and arguing thing down pat. Good job GOP elites, you cynical, lying, morally rotted pieces of authoritarian crap! You too Mitt. 

Nancy Pelosi & 39 House Dems urge Biden to stop arming Israel until conditions are met

 The NYT writes:

Forty House Democrats including Representative Nancy Pelosi, the former speaker, sent a letter on Friday to Mr. Biden and Secretary of State Antony J. Blinken expressing displeasure with their approach to Israel. The group called on the Biden administration to deny Israel weapons pending an independent investigation into how Israel's airstrikes killing 7 humanitarian aid workers last week happened, and tie any new aid to conditions “to ensure it is used in compliance with U.S. and international law.”

The letter reads, in part:

"Given the horrifying facts on the ground, we are also greatly concerned by your recent decision to authorize an arms transfer to Israel, which reportedly includes 1,800 MK-84 2,000-pound bombs, 500 MK-82 500-pound bombs, and 25 F-35A fighter jets.6 The MK-84 2000-pound bombs have been linked to multiple mass casualty events in Gaza and are capable of killing or wounding people more than 1,000 feet away. We are also concerned by recent reports that the administration is considering authorizing another $18 billion arms transfer to include dozens of F-15 aircraft.7 

In light of the recent strike against aid workers and the ever-worsening humanitarian crisis, we believe it is unjustifiable to approve these weapons transfers. We again strongly urge you to withhold any offensive weapons transfers until the investigation into the airstrike is concluded and, if it is found this strike violated U.S. or international law, those responsible are held accountable. And we again urge you to ensure that any future military assistance to Israel, including already authorized transfers, is subject to conditions to ensure it is used in compliance with U.S. and international law." 

It is important that the letter specifies that suspending and conditioning military assistance must include "already authorized transfers." As discussed below, and in a long NYT article published today, the funding of this war has been anything but transparent. Much of the military assistance has not been approved by the current Congress, but rather has been sent under a $38 billion aid agreement from the Obama-era. The reps in the letter are referring to that and other "pre-approved" spending, such as that discussed in this WaPo article on Biden's "quiet transfers" of money and weapons to Israel approved long ago in 2008. He "quietly transferred" those weapons and money 2 weeks ago without notifying lawmakers in Congress, even as tensions about funding the war were already beginning to mount.

 -------------------------------------------------------------------------------------

The humanitarian workers killed by Israel were Australian, British, Palestinian, Polish and a dual citizen of the United States and Canada.  The leaders and citizens of those countries have expressed outrage, causing what appears to be a reappraisal of Biden's policy of unconditional aid in the US. 

Several top Senators-- including staunch Biden ally and friend, Chris Coons, are no calling on Biden to condition aid to Israel. Sarah Sidner on CNN asked Coons if it was time to stop relying only on "carrots" and start using "sticks" to leverage any further aid to Israel. Coons replied:

"I think we're at that point...If Prime Minister Benjamin Netanyahu were to were to order the IDF into Rafa at scale, if they were to drop thousand pound bombs and send in a battalion to go after Hamas make no provision for civilians and humanitarian aid, then I would vote to condition aid to Israel. I've never been here before. I've been a strong supporter of Israel the whole time I've served in congress...[B]ut the tactics by which the current PM is making decisions don't reflect the best interests of Israel or the United States." (CNN News Central with Sarah Sidner, April 4, 2024)

Biden called Netanyahu on Thursday.  He stopped short of conditioning military aid. However, he issued a stark warning to Israeli Prime Minister Benjamin Netanyahu that future U.S. support for Israel's Gaza war depends on the swift implementation of new steps to protect civilians and aid workers. Though this is still only talk and not a policy change, Netanyahu-- after the call-- announced that Israel would open Gaza aid routes, including the Erez crossing. Israel depends on the US desperately right now, not vice versa. If tougher talk from Biden led to a promise like that, imagine what real diplomacy (using leverage as we do with other countries) might achieve. We've seen the carrots AND sticks approach work to achieve US ends in Israel under Reagan (the bombing of Lebanon in 1982 was stopped) and Bush I (who was able to pressure Israel using leverage in 90s). At the time, a younger Biden raised his voice objecting vehemently to Bush's approach at an AIPAC dinner. But Bush 1 laid the groundwork for what would become Oslo Accords, while Biden's approach of "never disagreeing with Israel publicly" has only led to the current impasse. He should revise his playbook if he wants the results he now says he wants, namely, an end to what he calls the "over the top" and "indiscriminate" killing of civilians, and immediate help for thousands and thousands of starving Gazans. 

______________________________________________ 

Meanwhile, as the tone of many Democrats in office has changed after Israel killed American and European aid workers, so has that of mainstream media here. So, I'll end this update by linking to a NY Times piece which describes in some detail just how non-transparent the funding of this war has been to date. The NYT explains processes by which  President Biden sends arms to Israel under an Obama-era $38 billion aid agreement that runs until 2026. Israel’s purchases include the types of bombs dropped in Gaza. The following is an excerpt.

The NYT writes:

"The process of arms delivery to Israel is opaque, and the pipeline for weapons to the country is long. The United States has sent tens of thousands of weapons to the country since the Oct. 7 killings by Hamas attackers, but many were approved by Congress and the State Department long ago and funded with money mandated by the Obama-era agreement, known as a memorandum of understanding.

“At any given time, delivery on these sales is constantly taking place,” said Dana Stroul, who recently departed as the Pentagon’s top official for Middle East affairs.

"Mr. Biden has the power to limit any foreign arms deliveries, even ones previously approved by Congress. Far from cutting off Israel, however, he is pushing a request he made shortly after the Oct. 7 attacks for $14 billion in additional arms aid to the country and U.S. military operations in the Middle East. The money has been stalled in Congress amid disputes over Ukraine aid and U.S. border security and faces growing Democratic concern. "

News bits: Self-interest politics; Corrupted, partisan Republican judges; Lying to judges

By now we all know that some politicians are purely self-interested and could not care less about most anything else. The Hill reports about a nice example of this exceptionally disgusting form of moral rot: 

Former President Trump’s growing criticism of Israel’s war against Hamas in Gaza signals a glaring break from GOP talking points backing Israel’s right to self-defense. Trump allies played down the importance of his interview with Israeli reporters last week, saying his staunch support of Israel would continue in a potential second term.

John Bolton, who served for 17 months as Trump’s White House national security adviser, told The Hill the former president’s stance on Israel will largely depend on the environment he inherits and on what would best serve his own interests.

“At bottom, Trump doesn’t have a national security policy,” Bolton said, calling the former president’s approach “ad hoc.” “He sees things primarily through the prism of, ‘Does this benefit Donald Trump?’”

____________________________________________________________

____________________________________________________________

The Texas Tribune reports: 

Texas Supreme Court justice implies Democrats will cheat in 2024 election

Texas Supreme Court Justice John Devine is facing new questions about his impartiality after a clip went viral this week in which he implied that Democrats plan to cheat against presumptive Republican presidential nominee Donald Trump in the 2024 election.

“Do you really think the Democrats are going to roll over and let Trump be president again?” Devine asked in a keynote speech at the Texas Tea Party Republican Women’s 2023 Christmas event. “You think they’re just going to go away, all of a sudden find Jesus and [there will] be an honest election? I don’t think so.”  

But election disputes weren’t the only hot-button issues on which Devine opined that night. Throughout his 40-minute speech, he blasted legal challenges to Texas’ abortion laws as a “mockery of God,” and invoked apocalyptic language when discussing Democrats — saying his judgeship gave him a “front-row seat to the end of the world.”  

“Our culture is dying before our very eyes,” he said. “The church seems to be weakened and not know what to do. We have a corrupted government. On a federal level, we’re run by a criminal enterprise. … None of you are going to escape this. And so I would implore you to get closer to the Lord. I would implore you to prepare. I would implore you to bring other people on board.”

This exemplifies the extremist theocratic Christian Sharia thinking that motivates guides beliefs of elite radical Christian nationalist authoritarians.

____________________________________________________________

____________________________________________________________

America's radical right authoritarian wealth & power movement has no limits on its shocking public contempt for the rule of law when the law is inconvenient. ProPublica reports about a recent incident of lawyers lying to judges by withholding important relevant information:

Trump’s Lawyers Told the Court That No One Would Give Him a Bond. Then He Got a Lifeline, but They Didn’t Tell the Judges.

An appeals court reduced Trump’s bond by more than 60% after his attorneys claimed it was a “practical impossibility” to pay the full amount. Their failure to disclose a proposal from a billionaire financier may have violated ethics rules.

But before the judges ruled, the impossible became possible: A billionaire lender approached Trump about providing a bond for the full amount.

The lawyers never filed paperwork alerting the appeals court. That failure may have violated ethics rules, legal experts say.

It is discouraging that by withholding important financial information that DJT merely “may have violated” ethics rules. The rule of law is often or usually feeble to non-existent for elites.* It is always a matter of may have, might, could be, a possibility, etc. Situations are rare where something is concrete in the eyes of the law dealing with elites like DJT.

* For example, DJT obstructed justice at least four times during the Mueller investigation. That became public knowledge on April 18, 2019. But so far, there has been no prosecution of those felonies. That is an undeniable example of the rule of law being literally non-existent for an elite. Ethics rules always seem to have ways for elites to weasel out and get away with whatever they want.

Merrick Garland ‘the Worthless’

I've been calling for his firing since May 2021

Obstruction of justice analysis based on evidence

in the Mueller report