Tag Archives: American capitalism

Republican Salami Tactics Undermine Our Democracy

In Eastern Europe after WWII the Soviets consolidated power by undermining countries monarchies and fledgling democracies by subverting elections, the judiciary, police authorities and political parties. This strategy was termed salami tactics—undermining by a thousand cuts.

We are now facing a similar Republican/Trumpian strategy. They are literally taking apart our elections, Judiciary and soon our political structure with a thousand cuts. And sadly the Supreme Court seems a key part of this undoing.

This article from Slate explained salami tactics in 2019……its even worse now. Call it what you like our Democracy is threatened and maybe by this point finished as we know it.

Medicynical Note: Our republican friends are attempting to subvert the election process in states in which they control the legislatures; they are gerrymandering beyond all previous such actions; inhibiting the vote in areas where the opposition resides; not recognizing the validity of fully validated elections (they lost by millions) and are openly supporting violent insurrection. It’s happening now in the U.S.

The Price of Ignorance: American Healthcare Costs

Procuring and paying for healthcare in the U.S. is an exercise more opaque and yes, potentially even more expensive than buying a new car. Ever try and get a firm price for healthcare services? You’ll find that no one can give a total price and guarantee that’s what you’ll be charged.

We have a system of revenue generation not healthcare. Your doctor in modern America is an employee and has little to no control over his office. And doctor’s fees it turns out are only a small part of the total cost.

Adding insult to injury our non-system of healthcare is set up to charge the neediest the most.…..unless they are fortunate enough to have insurance of some type (Obamacare policies, Medicare, Medicaid or private coverage). In the wealthiest (maybe) country on earth we have a system of health care revenue that charges those with the least, the most.

Medicynical Note: I’m an elderly retired M.D. and am well covered by insurance. This year so far my Medicare/Medicare Advantage policy was billed $5,954 for services. Because they have agreements with providers they paid only $2,210.34 for the services with me paying a very modest $10/visit co-pay. Not a bad deal if you have the coverage.

If I were one of the un-insured the providers would charge the entire $5,954……ironically or perhaps by design charging those least able to pay, the most. It’s really an absurd way of paying for health care and is the only such faux health care system/revenue generation system in the industrialized world.

Health care costs in the U.S> are among the leading causes of bankruptcy. Such bankruptcies are unknown in other parts of the world.

The $153,000 Snake Bite and America’s Decline

The paradox of American capitalism is that we say it works best when there is a “free market” with competition.  But as we have seen time and again the goal of business, even in healthcare, is obtain monopoly status (i.e. eliminate competition) for your “product” and then gouge your customers–a great business plan, no?

This was brought home by the Washington Post article reporting a snake bite for which medical costs were $153,000.

The bulk of his hospital bill—$83,000 of it— is due to pharmacy charges. Specifically, charges for the antivenin used to treat the bite. KGTV reports that Fassler depleted the antivenin supplies at two local hospitals during his five-day visit. Nobody expects antivenin to be cheap. But $83,000?

There’s currently only one commercially-available antivenin for treating venomous snakebites in the U.S. — CroFab, manufactured by U.K.-based BTG plc. And with a stable market of 7,000 to 8,000 snakebite victims per year and no competitors, business is pretty good.

and

BTG has fought aggressively to keep competitors off the market. A competing product, Anavip, just received FDA approval this year and likely won’t be on the market until late 2018. This lack of competition is one reason why snakebite treatments rack up such huge hospital bills — $55,000. $89,000. $143,000. In May of this year, a snakebit Missouri man died after refusing to seek medical care, saying he couldn’t afford the bill.

Excessive costs  are nothing new to anyone with a serious illness.     New cancer drugs for example start at $100,000/year for the drug alone, whether they work or not.  As a matter of fact most don’t work at all for the majority of patients treated with them.

This article was almost immediately followed in my browser by the brief statistical review of the 12 economic signs that the U.S. is on the decline published in Fortune magazine  based on the academic article Is the U.S. Still the best Country in the World? Think Again by Hershey Friedman and Sarah Hertz.  Interestingly the thesis of the article is not that the U.S. has too many regulations but rather that unfettered capitalism really really does not work.

“Capitalism has been amazingly successful,” write Friedman and co-author Sarah Hertz of Empire State College. But it has grown so unfettered, predatory, so exclusionary, it’s become, in effect, crony capitalism. Now places like Qatar and Romania, “countries you wouldn’t expect to be, are doing better than us,” said Friedman.

Read the article for the 12 signs but consider that whether it’s incomes, poverty levels, internet speeds, education, health, or prison population the U.S. lags other countries in the world.  Hardly the position for a world leader.

Medicynical Note:  I would posit that the snakebite anecdote is the concrete example of the second article’s thesis.  Our costs lead the world (yes that is one area we are world leader) and that in turn affects access, quality and yes the economic well being of citizens.  The U.S. continues to lead the world in bankruptcy from health care costs–a category of bankruptcy unknown in other countries.

Even more damning is that patients almost never know the cost of a  health care service AND providers (hospitals and practitioners) have little certainty  as to what they will actually be paid for the service rendered.  And yes adding to the insanity,  people billed directly, those without insurance and least able to pay, are billed more, much more, for the same services.  That’s true predatory capitalism!