“Anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that 'my ignorance is just as good as your knowledge.'” — Isaac Asimov
Honoring Rosa Parks and Denying African Americans The Vote On the Same Day
Feb. 27, 2013 On the same day that The state Capitol erected a statue to the civil rights movement icon Rosa Parks that would not give up her seat on a bus in the 1960′s, a Supreme Court judge called Voters Rights Act a “racial entitlements” to black voters.
It was an affront to Civil Rights, it was a disgraceful display of racism and stained the highest court of justice in the land in a country that stands for democracy, it shows the tipping point of the incredible discrimination taking place in the voting process in America.
1. Routine Care, Unforgettable Bills When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.
Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.
Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.
About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”
Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”
Claudia Susana for TIME
Sean Recchi Diagnosed with non-Hodgkin’s lymphoma at age 42. Total cost, in advance, for Sean’s treatment plan and initial doses of chemotherapy: $83,900. Charges for blood and lab tests amounted to more than $15,000; with Medicare, they would have cost a few hundred dollars
The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.
The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.
Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.
Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE” charge of $36.00 appeared, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done on Recchi amounted to more than $15,000. Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.
On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.
When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”
The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1
The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”
DePinho’s salary is nearly two and a half times the $750,000 paid to Francisco Cigarroa, the chancellor of entire University of Texas system, of which MD Anderson is a part. This pay structure is emblematic of American medical economics and is reflected on campuses across the U.S., where the president of a hospital or hospital system associated with a university — whether it’s Texas, Stanford, Duke or Yale — is invariably paid much more than the person in charge of the university.
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Photograph by Nick Veasey for TIME
Gauze Pads: $77 Charge for each of four boxes of sterile gauze pads, as itemized in a $348,000 bill following a patient’s diagnosis of lung cancer
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.
The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.
Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.
According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.
The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care. America’s largest city may be commonly thought of as the world’s financial-services capital, but of New York’s 18 largest private employers, eight are hospitals and four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.
The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.
When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses.
1. Here and elsewhere I define operating profit as the hospital’s excess of revenue over expenses, plus the amount it lists on its tax return for depreciation of assets—because depreciation is an accounting expense, not a cash expense. John Gunn, chief operating officer of Memorial Sloan-Kettering Cancer Center, calls this the “fairest way” of judging a hospital’s financial performance
The original version of this article misidentified William Powers Jr., the president of the University of Texas system, as the head of the entire system. That is in fact Francisco Cigarroa, the chancellor of the University of Texas
Sen. Lindsey Graham: Sacrifice Obamacare To Avoid Sequester
To avoid a March 1 sequester, Sen. Lindsey Graham (R-S.C.) suggested on Fox News Sunday that Congress save money by cutting the Affordable Care Act instead.
“Here’s my belief: Let’s take Obamacare and put it on the table,” he said. “People are leaving the private sector because their companies can’t afford to offer Obamacare. If you want to look at ways to find $1.2 trillion in savings over the next decade, let’s look at Obamacare. Let’s don’t destroy the military and just cut blindly across the board.”
The White House recently released a fact sheet detailing the devastating effect a sequester could have on the economy if Congress fails to pass spending cuts by March 1, including a reduction in loan guarantees to small businesses by $900 million. The blame, Fox News anchor Chris Wallace pointed out on Sunday, would likely fall on Republicans, who are digging in their heels to protect tax cuts.
Graham said the blame should fall on President Obama, who “came up with the idea of sequestration.”
“The president promised this wouldn’t happen,” Graham said. “He’s the commander in chief, and on his watch we’re going to begin to unravel the finest military in the history of the world at the time we need it most.”
WHEN Stevie Wonder crooned “I just called to say ‘I love you’,” he was bang on when it comes to men and women in their sexual prime. Were the ballad sung by a post-menopausal matron, though, the person at the other end of the line would probably be her daughter—and the conversation would revolve around grandchildren. That, at least, is the picture which emerges from a study published in Scientific Reports by Robin Dunbar, of Oxford University, and his colleagues.
Evolutionary psychologists like Dr Dunbar are interested in how investment in close relationships differs between the sexes. Dr Dunbar, indeed, has just published a book on the phenomenon of sexual love, analysed from a scientific point of view (see article). These differences reflect distinct strategies that have evolved to maximise reproductive success across a lifetime. One prediction that makes intuitive sense, but which has been difficult to nail down empirically, is that when women hit the reproductive wall of the menopause they funnel their remaining energy into bolstering their children’s—especially their daughters’—odds of producing viable offspring. (Sons spend less time minding their progeny than their spouses do.)
The main obstacle to testing the grandmother hypothesis, as it has come to be known, is that most studies have involved small numbers of people, making it hard to draw sweeping conclusions. Dr Dunbar leapt this hurdle by tapping a trove of 2 billion anonymised telephone calls and 500,000 text messages between customers of an unnamed European mobile-phone operator over the course of seven months. After eliminating those for which age and sex data were unavailable, they identified the people each subscriber contacted most often. Frequency of contact is a good proxy for emotional closeness, so this yielded a list of 1.2m “best friends”, and 800,000 “second-best friends”.
For any given age, the researchers then calculated the average sex of men’s and women’s phone pals. They did this by adding 1 every time the friend was a man and subtracting 1 every time it was a woman, and dividing the result by the number of friends for the age/sex group in question. If every person in the sample had a male best friend, the average-sex index would be 1; if all the best friends were women, it would be -1. An equal number of male and female best friends would mean the index came out at precisely zero.
Between the ages of 20 and 40 men and women behaved similarly (see chart). Both tended to have best friends of the opposite sex. The proclivity was slightly more pronounced among ladies, whose best-friend sex index peaked in their late 20s at 0.46 (equivalent to roughly three male best friends for every female one in the sample) and stayed more or less the same throughout their 30s. Men reached a maximum of -0.41 a bit later and remained there for less time. In both cases, these best friends tended also to be of a similar age, suggesting they were actually sexual mates. Second-best friends, meanwhile, were typically of the same sex—chums, in other words.
Things change markedly, though, as people enter middle age. For men, the best-friend sex index falls steadily from its peak until it levels off at the age of 50 or so, while remaining skewed towards females for the rest of their lives. However, any sexual bias for second-best friends more or less disappears when men reach their 40s, consistent with the hypothesis that these “friends” are by then no longer chums, but children (who are about as likely to be male as female) and that fathers do not favour those of any one sex.
Among women, by contrast, the best-friend sex index plummets around the time menopause strikes. By the age of 55, it actually turns negative, in favour of other females who are, tellingly, about half their age. At around that time, women’s second-best friends are increasingly men from their own generation. Older women, it appears, do indeed invest more time in furthering their daughters’ welfare—and reproductive success—and less in nurturing relationships with their husbands, no doubt to the latter’s chagrin. Strong evidence, then, for the grandmother hypothesis. And possibly an explanation for men’s mid-life crisis.
After every flight, UPS pilots fill out a form, called a ‘gripe sheet,’ which tells mechanics about problems with the aircraft.
The mechanics correct the problems, document their repairs on the form, and then pilots review the gripe sheets before the next flight.
Never let it be said that ground crews lack a sense of humor. Here are some actual maintenance complaints submitted by UPS pilots (marked with a P) and the solutions recorded (marked with an S) by maintenance engineers.
By the way, UPS is the only major airline that has never, ever, had an accident…
P: Left inside main tire almost needs replacement.
S: Almost replaced left inside main tire.
P: Test flight OK, except auto-land very rough.
S: Auto-land not installed on this aircraft.
P: Something loose in cockpit
S: Something tightened in cockpit
P: Dead bugs on windshield.
S: Live bugs on back-order.
P: Autopilot in altitude-hold mode produces a 200 feet per minute descent
S: Cannot reproduce problem on ground.
P: Evidence of leak on right main landing gear.
S: Evidence removed.
P: DME volume unbelievably loud.
S: DME volume set to more believable level.
P: Friction locks cause throttle levers to stick.
S: That’s what friction locks are for.
P: IFF inoperative in OFF mode.
S: IFF always inoperative in OFF mode.
P: Suspected crack in windshield.
S: Suspect you’re right.
P: Number 3 engine missing.
S: Engine found on right wing after brief search
P: Aircraft handles funny. (I love this one!)
S: Aircraft warned to straighten up, fly right and be serious.
P: Target radar hums.
S: Reprogrammed target radar with lyrics.
P: Mouse in cockpit.
S: Cat installed.
And the best one for last
P: Noise coming from under instrument panel. Sounds like a midget pounding on something with a hammer.
S: Took hammer away from the midget
Lawrence E. Braxton
7100 Pirates Cove Road, #1100
Las Vegas, NV 89145
“I am dedicating the majority of my wealth to improving education. It is the key to the survival of the human race. We have to plan for our collective future –- and the first step begins with the social, emotional, and intellectual tools we provide to our children. As humans, our greatest tool for survival is our ability to think and to adapt – as educators, storytellers, and communicators our responsibility is to continue to do so.” George Lucas, 2010.
President Obama has said that his public campaign against Republicans is not producing results.
President Obama’s political team is fanning out across the country in pursuit of an ambitious goal: raising $50 million to convert his re-election campaign into a powerhouse national advocacy network, a sum that would rank the new group as one of Washington’s biggest lobbying operations.
But the rebooted campaign, known as Organizing for Action, has plunged the president and his aides into a campaign finance limbo with few clear rules, ample potential for influence-peddling, and no real precedent in national politics.
In private meetings and phone calls, Mr. Obama’s aides have made clear that the new organization will rely heavily on a small number of deep-pocketed donors, not unlike the “super PACs” whose influence on political campaigns Mr. Obama once deplored.
At least half of the group’s budget will come from a select group of donors who will each contribute or raise $500,000 or more, according to donors and strategists involved in the effort.
Unlike a presidential campaign, Organizing for Action has been set up as a tax-exempt “social welfare group.” That means it is not bound by federal contribution limits, laws that bar White House officials from soliciting contributions, or the stringent reporting requirements for campaigns. In their place, the new group will self-regulate.
Officials said it would voluntarily disclose the names of large donors every few months and would not ask administration personnel to solicit money, though Obama aides will probably appear at some events.
The money will pay for salaries, rent and advertising, and will also be used to maintain the expensive voter database and technological infrastructure that knits together Mr. Obama’s 2 million volunteers, 17 million e-mail subscribers and 22 million Twitter followers.
The goal is to harness those resources in support of Mr. Obama’s second-term policy priorities, including efforts to curb gun violence and climate change and overhaul immigration procedures. Those efforts began Friday, when thousands of Obama supporters were deployed through more than 80 Congressional districts around the country to rally outside lawmakers’ offices, hold vigils and bombard Congress with e-mails and phone calls urging members to support stricter background checks for gun buyers.
Suzanne DeChillo/The New York Times
Advocates of efforts to curb violence, a priority of President Obama, in Manhattan on Friday.
“There are wins we can have on guns and immigration,” Jon Carson, the group’s new executive director, told prospective donors on a conference call on Wednesday, according to people who participated. “We have to change the conventional wisdom on those issues.”
But those contributions will also translate into access, according to donors courted by the president’s aides. Next month, Organizing for Action will hold a “founders summit” at a hotel near the White House, where donors paying $50,000 each will mingle with Mr. Obama’s former campaign manager, Jim Messina, and Mr. Carson, who previously led the White House Office of Public Engagement.
Giving or raising $500,000 or more puts donors on a national advisory board for Mr. Obama’s group and the privilege of attending quarterly meetings with the president, along with other meetings at the White House. Moreover, the new cash demands on Mr. Obama’s top donors and bundlers come as many of them are angling for appointments to administration jobs or ambassadorships.
“It just smells,” said Bob Edgar, the president of Common Cause, which advocates tighter regulation of campaign money. “The president is setting a very bad model setting up this organization.”
Mr. Obama’s new organization has drawn rebukes in recent days from watchdog groups, which view it as another step away from the tighter campaign regulation Mr. Obama once championed. Over the past two years, he has reversed course on several campaign finance issues, by blessing a super PAC created by former aides and accepting large corporate contributions for his second inauguration.
Many traditional advocacy organizations, including the Sierra Club and the National Rifle Association, are set up as social welfare groups, or 501(c)(4)’s in tax parlance. But unlike those groups, Organizing for Action appears to be an extension of the administration, stocked with alumni of Mr. Obama’s White House and campaign teams and devoted solely to the president’s second-term agenda.
Robert K. Kelner, a Republican election lawyer who works with other outside groups, said the arrangement “presents a rather simple loophole in the otherwise incredibly complex web of government ethics regulations that are intended to insulate government officials from outside influence.”
The closest precedents for Organizing for Action exist at the state level. In New Jersey, a 501(c)(4) called the Committee for Our Children’s Future, set up by friends of Gov. Chris Christie, has run hundreds of thousands of dollars’ worth of advertising praising Mr. Christie’s proposals.
In New York, Gov. Andrew M. Cuomo encouraged the formation of a nonprofit group, the Committee to Save New York, that is run by business leaders allied with him, and it has raised millions of dollars from corporations, private sector unions, and individuals. The group supported Mr. Cuomo’s agenda — but it also thrust him into controversy when The New York Times revealed that gambling interests poured $2 million into the group as Mr. Cuomo was developing a proposal to expand casino gambling.
Organizing for Action said it would accept unlimited personal and corporate contributions, but no money from political action committees, lobbyists or foreign citizens. Officials said they would focus — for now — on grass-roots organizing, amplified by Internet advertising. Friday’s “day of action” involved half a million dollars’ worth of targeted Internet ads and events in Florida, Maine, Pennsylvania and California, among other states.
“O.F.A.’s first day of action was about bringing the issue of closing background-check loopholes into communities across the country that feel very strongly about supporting the president’s plan to reduce gun violence,” said Katie Hogan, a spokeswoman for the group.
Organizing for Action has also promised to steer clear of electoral politics, unlike the politically active nonprofit groups like the right-leaning Crossroads Grassroots Policy Strategies and Americans for Prosperity. Such groups spent hundreds of millions of dollars on advertising during the recent election campaign season, ostensibly for issue advocacy, spurring a wave of lawsuits, ethics complaints from campaign watchdogs and criticism from Mr. Obama himself.
But the distinction between campaigning and issue advocacy may be hard for Organizing for Action to maintain in the prelude to the 2014 elections, especially if it continues its emphasis on pressing lawmakers on delicate issues like immigration and guns.
In Wednesday’s conference call, Mr. Carson said the group hoped to form partnerships with other 501(c)(4) groups on the left, including America Votes, which was at the center of Democratic efforts to defeat President George W. Bush in 2004 and now serves as a coordinator for progressive advocacy organizations. He also said Organizing for Action wanted to be a counterweight to grass-roots organizations on the right, like the N.R.A., according to people who took part in the call.
There should be “as much of a price to pay if you tick off the gun violence people” as there is for angering the N.R.A., Mr. Carson said, according to those people. “Let’s build an organization that means that Republicans are embarrassed to have climate change deniers running for office.”