Sunday, 1 July 2018

Growing Health Care and Grand Governmental Corruption - But Still Anechoic After All These Years

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Here we go again.  We have long been concerned about health care corruption as a major cause of health care dysfunction. Our last post on the topic was in January, 2018.


Summary: the Corruption of Health Care Leadership as a Major Cause of Health Care Dysfunction

As we wrote in August, 2017, Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.
the scale of corruption is vast in both rich and poor countries.

Also,
Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruption because they often cannot afford bribes or private health care. But corruption in the richest parts of the world also has its costs.

The report got little attention.  Health care corruption has been nearly a taboo topic in the US, anechoic, presumably because its discussion would offend the people it makes rich and powerful. As suggested by the recent Transparency International report on corruption in the pharmaceutical industry,
However, strong control over key processes combined with huge resources and big profits to be made make the pharmaceutical industry particularly vulnerable to corruption. Pharmaceutical companies have the opportunity to use their influence and resources to exploit weak governance structures and divert policy and institutions away from public health objectives and towards their own profit maximising interests.

Presumably the leaders of other kinds of corrupt organizations can do the same. 

When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects somewhere else, mainly  presumably benighted less developed countries.  At best, the corruption in developed countries that gets discussed is at low levels.  In the US, frequent examples are the "pill mills"  and various cheating of government and private insurance programs by practitioners and patients.  Lately these have gotten even more attention as they are decried as a cause of the narcotics (opioids) crisis (e.g., look here).  In contrast, the US government has been less inclined to address the activities of the leaders of the pharmaceutical companies who have pushed legal narcotics (e.g., see this post). 

However, Health Care Renewal has stressed "grand corruption," or the corruption of health care leaders.  We have noted the continuing impunity of top health care corporate managers.  Health care corporations have allegedly used kickbacks and fraud to enhance their revenue, but at best such corporations have been able to make legal settlements that result in fines that small relative to their  multi-billion revenues without admitting guilt.  Almost never are top corporate managers subject to any negative consequences.

While we at Health Care Renewal have written about this for years, we saw little improvement.  However, in the past few years we began to feel a little more encouraged.  For example, we had long complained that US law enforcement had not been devoting enough effort going after the corruption of the leadership of large health care organizations, thus effectively allowing these leaders' impunity. However, the US Department of Justice during the Obama administration made some modest attempts to decrease such impunity.  One such measure was the formation of a Health Care Corporate Strike Force.

As reported by Law.com,

the strike force was created in the fall of 2015, with five dedicated lawyers working on about a dozen of the most complex corporate fraud cases in the health care space.

Andrew Weissmann, the then-chief of the DOJ’s fraud section, told a health care conference in April 2016 that the section was placing 'a heightened emphasis' on corporate health care fraud investigations. He pointed to the recently established Corporate Fraud Strike Force that he said would focus resources in investigation and prosecution of larger corporate health care law violations, as opposed to smaller groups or individuals.

Unfortunately, that strike force was downsized by the Trump administration as we noted in July, 2017.  Perhaps that could have been viewed as just a minor setback.

However, we noted in May, 2018, that legal actions by the US government against apparently corrupt acts by large US health care organizations seemed to be falling off.  At that point, we found only one significant settlement made this year.  We also found a report by Bloomberg, with the headline, "White-Collar Prosecutions Fall to 20-Year Low Under Trump," on May 25, 2018.

 Increasing Evidence of Corruption in the Trump Administration


We had noted in January that corruption in the US was becoming even more systemic, and worse, it appeared that the administration itself was fundamentally corrupt. We noted sources that summarized Trump's personal, family, and the Trump administration's corruption, a website, entitled "Tracking Trump's Conflicts of Interest" published by the Sunlight Foundation, and two articles published in the Washington Monthly in January, 2018, "Commander-in-Thief," which categorized Mr Trump's conflicted and corrupt behavior.  The second, "A Year in Trump Corruption," was a catalog of the most salient cases in these categories in 2017.

The evidence of corruption has only gotten more substantial since then.

April, 2018: The New York Magazine Timeline

In April, 2018, New York Magazine published "501 Days in Swampland," a time-line of  starting just after the 2016 presidential election.   Its introduction included,
The rewards of government would now be reaped by a single man — and the people would bear the cost.

More than at any time in history, the president of the United States is actively using the power and prestige of his office to line his own pockets: landing loans for his businesses, steering wealthy buyers to his condos, securing cheap foreign labor for his resorts, preserving federal subsidies for his housing projects, easing regulations on his golf courses, licensing his name to overseas projects, even peddling coffee mugs and shot glasses bearing the presidential seal. For Trump, whose business revolves around the marketability of his name, there has proved to be no public policy too big, and no private opportunity too crass, to exploit for personal profit.

The timeline was  organized by mode of malfeasance.  Pages were devoted to how foreign governments and private entities curried favor with Trump by lavish spending at his hotels, golf clubs, and other properties.  More pages were devoted to dubious dealings by Trump's family and friends, and officials in his administration.  Yet more recounted relationships with lobbyists and "petty graft."

Although it was not focused on health care corruption, some of the cases it listed involved health care and public health:

[Under Trump's Hotel in DC - 2017]

7/17 E-cigarette-makers hold their annual conference at the hotel. Ten days later, the FDA announces it will delay federal oversight of e-cigarettes until 2022.

Note that this suggests not just regulatory capture, but the possibility of a quid pro quo bribe.

[Under Officials & Their Pals - 2017]

1/24 During his confirmation as secretary of Health and Human Services, Tom Price fails to disclose an insider deal he got on $520,000 in stock in a biotech company. As secretary, he will be in a position to approve a drug the company has developed.

[2018]


1/31 CDC chief Brenda Fitzgerald is forced to resign over her purchase of stock in one of the world’s largest tobacco companies. She bought the shares a month after taking over the agency tasked with reducing tobacco use.

[Under Lobbyistss & Other Sleaze - 2018]

1/29 Alex Azar, a former lobbyist who worked his way up to the presidency of a drug company, is sworn in as secretary of Health and Human Services. Azar, whose company hiked the price of insulin and other drugs under his watch, is now in charge of making drugs more affordable.

[Under Petty Graft - 2017]

6/2 David Shulkin’s chief of staff falsifies an email to suggest that the VA secretary needed to travel to Europe to receive an award. Shulkin’s 11-day trip with his wife, most of which was devoted to sightseeing, cost taxpayers $122,344.

8/4 HHS Secretary Tom Price takes a private jet at taxpayer expense to St. Simons Island, an exclusive resort where he owns land. The trip, like many of the 26 flights Price took on corporate jets, could have been accomplished with a routine commercial flight.

9/29 HHS Secretary Price is forced to resign over the nearly $1 million in taxpayer money he spent taking military planes and private jets, often to visit family and friends.

This list also included several other examples, not directly health care or public health related, suggesting quid pro quo bribery.  For example, in 2017 at the Trump International Hotel in Washington, DC:

10/4 At its annual board meeting, the National Mining Association is addressed by three Cabinet members: Commerce Secretary Wilbur Ross, Labor Secretary Alexander Acosta, and Energy Secretary Rick Perry. 'Coal is fighting back,' Perry exults over breakfast with the country’s top mining executives. 'Clearly the president wants to revive, not revile, this vital resource.' Five days later, the Trump administration announces the repeal of Obama’s Clean Power Plan, which would have encouraged states to replace coal with wind and solar energy. The plan would have cut climate-warming pollution from coal plants by a third and saved taxpayers and consumers as much as $93 billion a year. The venue for the mining board’s meeting: the Trump International Hotel in Washington, D.C.




So the evidence base of conflicts of interest and outright corruption is becoming more massive, includes cases relevant to health care and public health, and includes examples that seem like outright bribery.


June, 2018: the ProPublica Database of Spending at Trump Properties

In June, 2018, ProPublica reviewed questionable spending amounting to $16.1 million since the beginning of Trump's candidacy for president at Trump properties by the US government, and by Trump's campaign, and by state and local governments.  Its introduction included,

Since Donald Trump declared his candidacy for president in late 2015, at least $16.1 million has poured into Trump Organization-managed and branded hotels, golf courses and restaurants from his campaign, Republican organizations, and government agencies. Because Trump’s business empire is overseen by a trust of which he is the sole beneficiary, he profits from these hotel stays, banquet hall rentals and meals.

Note that

The use of taxpayer dollars at Trump hotels is under scrutiny in a closely watched lawsuit in Maryland federal court. The District of Columbia and the state of Maryland sued Trump, citing a venerable anti-corruption provision of the U.S. Constitution known as the Emoluments Clause. It prohibits any financial gift, or emolument, from benefiting a sitting public official, including the president.

June, 2018: Public Citizen's Corporate Presidency's Hotel Swamplandia

Meanwhile, Public Citizen released a report on money spent at Trump's hospitality properties.  

In its introduction

For those seeking to get on Trump’s good side, it certainly helps to fork over some cash at one of his properties. There simply is no other plausible explanation why so many companies, business groups and foreign governments are spending big money eating, drinking, socializing and sleeping at Trump’s properties around the country. And there’s always the chance that the president himself will show up, as he did in June....

Also,

Trump came to office with the most blatant corrupting conflicts of interest in the history of American politics, so what followed should not be a surprise. By spending money at his properties, corporations and foreign governments are being transparent about their desire to curry favor with the president and influence the Trump administration’s policies.

Information on how much is being spent at Trump properties for political events is available, but remains unknown for the vast majority of spenders at Trump properties. An exception was the Saudi embassy, whose $270,000 in spending at the D.C. hotel was disclosed through a PR firm’s filing with the Justice Department. That said, we were able to document $1.75 million in spending, with more than half coming from the Republican Party.

Examples of spending by health care and public health related organizations included

Allign Technology [medical device company]
American Association of Orthodontists
Curetivity Foundation [supports St Jude Hospital]
National Drug & Alcohol Screening Association
University of Wisconsin
Vapor Technology Association [trade assocation for manufacturers of e-cigarettes]

So it seems that various large health care and public health related organizations are happy to shovel money  into the Trump Organization, and hence into the pocket of the president himself, if doing so can advance their business agendas.


Meanwhile Corruption, Even of a President, Remains a Virtually Taboo Topic

And still, we don't talk about it. 

 As noted above, corruption in health care has always seemed a taboo topic.  In November, 2017, we noted that once again, a report by Transparency International that showed that in an international survey of corruption perceptions, substantial minorities of US respondents thought that US corruption was increasing, and was a particular affliction of the executive and legislative branches of the national government, other government officials, and top business executives.  There was virtually no coverage of these results in the US media, just as there was virtually no coverage of a 2013 survey that showed 43% of US respondents believed that US health care was corrupt.

Similarly, the reports listed above have generated little discussion.  Despite the extensive and ever-increasing list of apparently corrupt acts by the Trump and cronies, grand corruption at the top of US government, with its potential to corrupt not just health care, but the entire country and society, still seems like a taboo topic.  The US news media continues to tip-toe around the topic of corruption, in health care, of top health care leaders, and in government, including the top of the US executive branch.  As long as such discussion seems taboo, how can we ever address, much less reduce the scourge of corruption?  The first step against health care corruption is to be able to say or write the words, health care corruption.


But even if we can take that step, when the fish is rotting from the head, it makes little sense to try to clean up minor problems halfway towards the tail. Why would a corrupt regime led by a president who is actively benefiting from corruption act to reduce corruption? The only way we can now address health care corruption is to excise the corruption at the heart of our government.



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