Monthly Archives: October 2019

Another Black Eye For Indiana

A reader of this blog recently sent me a research report from Ball State. In this study, the author, Michael Hicks, confirms conclusions reached by other solid researchers.

One such conclusion: sick people in Indiana are being fleeced by hospitals that are supposedly “nonprofit.”

Hicks began by admitting his preconceptions:

Several weeks ago, a concerned citizen sent me a financial summary of Indiana’s not-for-profit hospitals. He asked that I look into the issue of excessive profits by these systems. I was skeptical that the issue would be relevant. Profits are critical to an economy; they serve as a guide to pricing and investment decisions and reward the men and women who create value. The demonization of profits is a sure sign of unformed thought. Moreover, not-for-profit hospitals have explicitly chosen to forgo profits as part of their operations, so I doubted the financial summary would reveal anything important. I was mistaken.

What he found shocked him–and should shock us.

It turns out the not-for-profit hospital industry and their network of clinics is the single most profitable industry in Indiana. These profits are so large that when accumulated, they account for roughly 9 percent of the state’s total economy. As of 2017, this industry had accrued more than $27 billion, yes billion. Yet, the not-for-profit industry in Indiana pays virtually no taxes and invests almost none of those profits locally. That money is invested in Wall Street, not Main Street. However, they do charge Hoosiers a premium to access healthcare.

The numbers come from a Rand Corporation study conducted earlier this year that found  hospitals in Indiana charging among the highest prices in the nation. Hicks noted that he had confirmed Rand’s data, and had compared the results with with the lack of competition in each healthcare market.

In places where there is little competition, such as Fort Wayne, consumers pay more than twice the cost for a typical medical treatment as they do in places with the most competition. This is how these hospitals accrued excess profits that are roughly 12 times larger than the entire state of Indiana’s Rainy Day Fund.

Hicks says that Hoosiers pay $819 more per person per year than the average American, and attributes that premium to the growth of monopoly power among the state’s not-for-profit hospitals.  And he provides examples.

Parkview Hospital is the most blatant example. In one recent year, Parkview Hospital in Wabash earned a 48 percent profit rate. By comparison, Walmart, which also has a store in Wabash, had a profit rate of 3.12 percent that year. Parkview Hospital’s profit absorbed a full 4.1 percent of the county’s GDP (gross domestic product).

Using data from a ProPublica investigative website, I found IU Ball Memorial Hospital enjoyed a lavish 23.8 percent profits in that year. This was more than $100 million, or a full 2.5 percent of the county’s GDP. Despite this, the president of IU/BMH recently begged the city of Muncie to subsidize new luxury apartments so his doctors could live downtown. That subsidy will cost Muncie Community Schools more than $2 million, which just so happens to be about two days of profits at the not-for-profit IU Ball Memorial Hospital. There are literally dozens of other outrageous examples reflecting an appalling lack of governance at not-for-profit hospitals.

This situation is particularly hurtful for local governments that are already reeling from Mitch Daniels’ politically-brilliant and governmentally-destructive constitutionalization of  property tax caps. As Hicks rightfully notes,

Local governments are also victims. The most profitable industry in our state pays no property tax and no income tax, but overcharges schools, city and county governments for healthcare.

Hicks ends his article with a warning to profiteering organizations–it can’t go on like this for much longer. As he says, it’s an open invitation to plaintiffs attorneys and politicians alike.

To place this in historical context, the profit rates at Indiana’s not-for-profit hospitals are larger than anything the Gilded Age robber barons were able to secure. In this observation is a final lesson. In the process of vetting this study with several colleagues, I shared it with one lifetime Republican and veteran of two GOP administrations. His response was simply that this is the single best argument for Warren/Sanders healthcare reform he had ever seen. He is not wrong, and that alone should prompt quick legislative, regulatory and legal action.

I wouldn’t bet on it.

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Subsidizing Our Own Destruction

That biblical admonition about “love of money” being the root of all evil continues to be pertinent.

We are now experiencing the initial effects of climate change–effects that scientists have warned about for many years–and sane people know that much worse is to come. Yet rather than directing resources to measures that will ameliorate it, governments all over the globe are continuing to subsidize behaviors that are known to make the problem worse.

The public is providing more than $1m per minute in global farm subsidies, much of which is driving the climate crisis and destruction of wildlife, according to a new report.

Just 1% of the $700bn (£560bn) a year given to farmers is used to benefit the environment, the analysis found. Much of the total instead promotes high-emission cattle production, forest destruction and pollution from the overuse of fertiliser.

The security of humanity is at risk without reform to these subsidies, a big reduction in meat eating in rich nations and other damaging uses of land, the report says. But redirecting the subsidies to storing carbon in soil, producing healthier food, cutting waste and growing trees is a huge opportunity, it says.

The report rejects the idea that subsidies are needed to supply cheap food. It found that the cost of the damage currently caused by agriculture is greater than the value of the food produced. New assessments in the report found producing healthy, sustainable food would actually cut food prices, as the condition of the land improves.

To add insult to injury, in the U.S., those subsidies disproportionately fatten the wallets of big corporate farming operations–not the small family farms urban folks envision when the subject is raised.

Nor is our pell-mell race toward self-destruction limited to farming. When I was researching my most recent book, I was astonished by the enormity of the subsidies of fossil fuels. Despite the fact that climate change is already affecting America’s weather, increasing the urgency of efforts to reduce carbon emissions and increase the development and use of clean energy sources, the United States spends billions of dollars a year subsidizing fossil fuels. The International Monetary Fund estimates that the United States has spent more subsidizing fossil fuels in recent years than it has on defense spending. The IMF found that when indirect subsidies for coal, oil and gas were factored in, subsidies reached $649 billion in 2015, a year when Pentagon spending was $559 billion.

Most inexplicable of all is the fact that that amount includes 2.5 billion per year specifically earmarked for searching out new fossil fuel resources.

Oil Change International calculates that permanent tax breaks to the US fossil fuel industry are seven times larger than those for renewable energy. Several of those fossil fuel subsidies make it profitable to extract resources that it would not otherwise be cost-effective to extract.  Energy experts tell us that, at current prices, the production of nearly half of all U.S. oil would not be economically viable, but for federal and state subsidies.

The Obama administration had proposed to eliminate 60% of federal fossil fuel industry subsidies, but–surprise!– that proposal went nowhere.

During the 2015-2016 election cycle oil, gas, and coal companies spent $354 million in campaign contributions and lobbying. The industry received $29.4 billion in federal subsidies in total over those same years – reaping a 8,200% return on investment.

It is difficult to argue with the conclusion of the OCI report: “Removing these highly inefficient [fossil fuel] subsidies – which waste billions of dollars propping up an industry incompatible with safe climate limits – should be the first priority of fiscally responsible climate, energy, and tax reform policies.”

Our first priority should be the election of lawmakers who will not be seduced by “love of money” and who will work to save the planet for our children and grandchildren.

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Toleration

I’m a big fan of John Locke (of Enlightenment “Two Treatises on Government” fame). (Yes, I’m a nerd.) Although he wasn’t the only philosopher of his time to think in terms of a social contract, he was arguably the most consequential; his approach to the role of government had an enormous influence on the Founders who crafted America’s constitution. So when I came across this article about a previously unknown text of his, I was fascinated.

A “once in a generation” discovery of a centuries-old manuscript by John Locke shows the great English philosopher making his earliest arguments for religious toleration, with the scholar who unearthed it calling the document “the origin and catalyst for momentous and foundational ideas of western liberal democracy”.

Dated to 1667-8, the manuscript titled “Reasons for tolerateing Papists equally with others”, was previously unknown to academia. It had been owned by the descendants of one of Locke’s friends until the 1920s, when it was sold at auction to a book dealer. From there, it went into private collections until it was donated to St John’s College, Annapolis, in the latter half of the 20th century. It lay unstudied in archives until Locke scholar JC Walmsley noticed a reference to it in a 1928 book dealer’s catalogue, and raised an eyebrow: Locke, a hugely influential Enlightenment thinker, was not known to have extended his arguments for religious tolerance to Catholics.

Because tolerance of Catholics (or, in Catholic countries, tolerance of Protestants) was pretty much unthinkable at the time he wrote, attributing such sentiments to Locke seemed an unlikely stretch, so scholars put the newly discovered manuscript through a number of tests in order to determine whether it was, indeed, Locke’s.

It was.

“Locke is supposed to have never tolerated Catholics,” said Walmsley. “All his published work suggested that he would never even consider this as a possibility. This manuscript shows him taking an initial position that’s startling for him and for thinkers of his time – next to no one suggested this at this point. It shows him to be much more tolerant in certain respects than was ever previously supposed.”

Locke, who died in 1704, is known for his Two Treatises on Government, which which became a foundational text for modern western democracy. His other hugely influential texts included the Essay Concerning Human Understanding, which provided philosophical grounds for the scientific revolution, and A Letter Concerning Toleration, which influenced James Madison’s thinking on the separation of church and state in his work on the US constitution.

The newly-discovered document was written before A Letter Concerning Toleration, and adds to our understanding of Locke’s approach to what we now call “nondiscrimination.” As America’s religious and racial diversity explodes, the growth of “toleration”–or more properly, civic equality and inclusion–becomes an ever more critical element of a functioning polis.

Joseph Macfarland, dean of St John’s College, said it was “an unexpected pleasure to find that we are in possession of a manuscript by Locke himself on a question so critical to American political life and to liberal democracy generally”.

Calling the question critical is an understatement. We either overcome our innate tribalism and learn to live amicably together, or this experiment we call America is over.

The 2020 election provides us with a stark choice: We can re-elect Trump and validate various degrees of intolerance of anyone who isn’t a white Christian male, or we can reject the politics of hate and division and embrace “toleration.”

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Peter Wehner Explains The Inexplicable

Like most Americans today, I occupy a bubble. My friends, family, colleagues and neighbors all tend to see political reality largely the way I see it.

So I was taken aback–floored, really–by a conversation I had during a weekend visit to New Buffalo, Michigan. Our daughter and son-in-law had treated us to the visit and a tour of the 1932 World Fair’s “Homes of the Future” sponsored by Indiana Landmarks. We were staying in a lovely Bed and Breakfast, and while I was getting coffee, I chatted with a guest who turned out to be from Carmel, a suburb of Indianapolis.

What began as a cordial exchange devolved when he mentioned that he “loved” President Trump. (I’m sorry to report that I didn’t bite my tongue; I suggested he’d been drinking the Kool-Aid, and he stomped off.)

This encounter bothered me immensely. Here was a person who was obviously comfortable financially, who didn’t look like someone who ignored the news, or was mentally incapacitated. Why would he “love” this pathetic excuse for a human?

My husband’s theory was that Trump justifies the guy’s probable racism, but the exchange was still rankling when I read Peter Wehner’s column in Monday’s New York Times, titled “What’s the Matter with Republicans?”

One might hope that some of the party’s elected officials would forcefully condemn the president on the grounds that there is now demonstrable evidence that he had crossed an ethical line and abused his power in ways even beyond what he had done previously, which was problematic enough.

But things are very different today than they were in the summer of ’74. Mr. Trump was on to something when he famously said, during the 2016 campaign, “I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters, O.K.? It’s, like, incredible.” What most people took to be hyperbole turned out to be closer to reality.

Wehner–who was formerly a staunch  Republican–then asked the same question I had asked: why? What would account for continued fealty to someone who is not only a demonstrably unfit President, but a truly repulsive human being with what Wehner accurately describes as “a mobster’s mentality”?

Why, then, are so many Republicans yet again circling the Trump wagon rather than taking this opportunity to denounce what the president did and declare some independence from him by doing so? Why has Mr. Trump, an ethical wreck of a man both before and after he reached the White House, earned such fealty from Republicans?

Wehner says it isn’t policy, and I agree.

Understanding the close compact between Mr. Trump and the Republican Party starts with acknowledging the false hope many establishment Republicans placed in the shady real estate mogul as he rose to power. They misdiagnosed the individual they were dealing with, assuming that Mr. Trump would “grow in office” and that they, the “adults in the room,” would be able to control and contain him. At the outset of this unholy alliance, they were convinced they would change Mr. Trump more than Mr. Trump would change them. But the transformation turned out to be in them, not him.

Wehner acknowledges that politicians’ self-interest is threatened by the loyalty of the GOP base to Trump. But what accounts for the devotion of that base–of people like the man I had encountered?

As a conservative-leaning clinical psychologist I know explained to me, when new experiences don’t fit into an existing schema — Mr. Trump becoming the leader of the party that insisted on the necessity of good character in the Oval Office when Bill Clinton was president, for example — cognitive accommodation occurs.

When the accommodation involves compromising one’s sense of integrity, the tensions are reduced when others join in the effort. This creates a powerful sense of cohesion, harmony and group think. The greater the compromise, the more fierce the justification for it — and the greater the need to denounce those who call them out for their compromise. “In response,” this person said to me, “an ‘us versus them’ mentality emerges, sometimes quite viciously.”

“What used to be a sense of belonging,” I was told, “devolves into primitive tribalism, absolute adherence to the leader over adherence to a code of ethics.”…

As the psychologist I spoke to put it to me, many Republicans “are nearly unrecognizable versions of themselves pre-Trump. At this stage it’s less about defending Trump; they are defending their own defense of Trump.”

“At this point,” this person went on, “condemnation of Trump is condemnation of themselves. They’ve let too much go by to try and assert moral high ground now. Calling out another is one thing; calling out yourself is quite another.”

And then there’s that shared racism….

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The Fight Is Never Over

When I first began this blog, one of the issues I frequently addressed was gay rights. LGBTQ folks still faced formidable barriers to equality; same-sex marriage was a pipe dream, with DOMA at the federal level and so-called “mini-DOMAs” in many states.  Activists were fighting “Don’t Ask, Don’t tell” and working to include protection against discrimination on the basis of sexual orientation and gender identity in state civil rights statutes.

In Indiana, civil rights organizations and major businesses managed to defeat an effort to place a ban on same-sex marriage in the state’s constitution, but we still lack those “four little words”–sexual identity and gender identity–in our civil rights law.  Unless you live in an Indiana city with an inclusive human rights ordinance, it is still perfectly legal here to fire someone for being gay. We also remain one of only five states without an inclusive hate crimes law.

Even in states like Indiana, though, LGBTQ folks have benefitted from the truly dramatic shift in public opinion that has occurred over the past couple of decades. As homophobia ebbed–it certainly hasn’t disappeared, but it has greatly diminished–this blog focused on other issues.

Attacks on LGBTQ citizens may have diminished, but as young folks like to say, “haters gotta hate.” As an article in the Guardian recently illustrated, there is plenty of room for homophobia among the numerous bigotries exhibited by our accidental President and those who support him.

The Trump administration has attacked LGBT rights in healthcare, employment, housing, education, commerce, the military, prisons and sports.

These efforts, it turns out, were just the beginning.

The president’s anti-LGBT agenda could soon gain significant momentum at the US Supreme Court, where Trump’s Department of Justice (DoJ) is pushing to make it legal to fire people for being gay or transgender. The move would fundamentally reverse civil rights for millions of people, LGBT leaders say, and raises fears that LGBT people may lose the minimal protections and resources they have won in past years.

“This is a critical point in history,” said Alesdair Ittelson, the law and policy director at interACT: Advocates for Intersex Youth. “The outcome of this case is going to have a tremendous impact on everyone.”

During the Obama administration, the LGBTQ community won significant victories:  repeal of “don’t ask, don’t tell,” new protections under the Affordable Care Act, an anti-discrimination executive order and expanded recognition of trans rights, among other things. Those victories are now under attack.

Since taking office, the Trump administration has sought to reverse healthcare protections for trans people, moved to ban trans people from serving in the military, eliminated rules protecting trans students and pushed to allow businesses to turn away gay and trans customers if they seek a religious exemption.

Last month, the Trump justice department made its most aggressive anti-gay legal argument to date, urging the supreme court to rule that gay employees are not protected under a longstanding act that prohibits “sex discrimination”. The DoJ filed briefs related to three supreme court cases to be heard together on 8 October – two involving gay men fired from their jobs, and a third involving a woman terminated by her employer after she came out as trans.

The courts have repeatedly held that gay people are covered by Title VII of the Civil Rights Act. Before Trump, the federal government agreed. But William Barr’s Department of Justice is now arguing that sexual orientation and gender identity are excluded under Title VII because “sex” means only whether people are “biologically male or female.”

Before Trump, the Justice Department pursued justice. Before Trump, judicial nominees elevated to the federal bench were vetted for legal competence, not for fidelity to radical “conservative” (actually fundamentalist Christian) ideology.

Before Trump, even our worst Presidents weren’t rabid White Nationalists, Islamophobes, homophobes, anti-Semites and proud and loud racists.

But that was then, and now is now.

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