Finally Friday Reads: Let’s talk Kleptocracy!!
“Felon of the Year!” John Buss, @johnbuss.bsky.social
Good Day, Sky Dancers!
The Golden Age of Self-Dealing is about upon us! This year, we’ve had all kinds of new descriptions to assign the type of government the dumbest among us will usher in on Jan 20th. We’re in a polycrisis that will be managed by the least qualified and skilled among us; a kakistocracy. We will be governed by the least fit, the most incompetent, and the proven corrupt. I spent a lot of time in my doctoral program studying Corporate Governance. However, we, the People, are much more than mere stockholders in our government. The powers invested in our Federal Government could lead to more serious crimes than even the worst things committed by companies like Enron. Corporations can not print that universally accepted thing called government-backed currency. They cannot declare war and make and break treaties and alliances. That’s probably the biggest responsibility. But our health, happiness, justice, and liberty are at stake. Are we really that expendable to them?
Much of what’s being discussed right now is dismantling agencies that have been vested with the responsibility to ensure many things businesses do won’t kill us or bilk us. So, what will likely happen if we are left to the wolves of Wall Street with no oversight? What about putting the conspiracy crowd in charge of guarding our public health or our safety when we fly, drive, or use any form of transportation? What about letting anyone with the financial ability to set up shop call themselves a university, a daycare, or any other form of school? Should we leave children to the likes of the folks who tell pollsters they don’t think Arabic numbers should be taught in school? The overlords will ship off their kids to the top boarding schools in the country while everyone else gets stuck with whatever the undereducated in their community will scream about. It’s a pretty depressing future.
So, I’m not even sure where to start, but how about with RFK Jr, the one with the worm that ate his brain, and the television and web-based Snake Oil Salesman, Mehmet Oz. A USA Today headline blares this bit of happy news. “Dr. Mehmet Oz had up to $33 million in companies doing business with agency he’d run.” I don’t care if it’s in a blind trust; he knows if he owns it. Erin Mansfield has the analysis.
President-elect Donald Trump’s pick to be the top health insurance regulator in the country, Dr. Mehmet Oz, has invested in companies that do business with the agency he would run.
Oz, Trump’s choice to run Medicare, Medicaid and the insurance marketplace under the Affordable Care Act, owned up to $33.7 million stock in these companies when he filed a financial disclosure during his unsuccessful 2022 campaign for Senate in Pennsylvania.
The TV talk show host owned between $280,000 and $600,000 in UnitedHealth Group and between $50,000 and $100,000 in CVS Health, which both provide health insurance plans under Medicare Advantage.
He also owned between $5.8 million and $26.7 million in Amazon and between $1.6 million and $6.3 million in Microsoft, two major technology providers for the Centers for Medicare and Medicare Services, the agency he would run.
Accountable.US, a left-leaning group that compiled some of the research, said it reviewed filings with the Securities and Exchange Commission and was unable to find evidence that Oz sold stocks in Amazon or Microsoft since the 2022 filing.
“All nominees and appointees will comply with the ethical obligations of their respective agencies,” Brian Hughes, a spokesperson for the Trump-Vance transition, said in a statement to USA TODAY when asked if Oz still owns these stocks.
Oz will be required to fill out the same form after his official nomination as administrator for the Centers for Medicare and Medicaid Services.
Oz in 2020 said the federal government should allow all Americans to purchase coverage through Medicare Advantage, a program in which private insurance sell Medicare-regulated plans to seniors and people with disabilities.
In 2022, Oz owned stock in the parent company of UnitedHealthcare, which covered 29% of Medicare Advantage patients in 2024, according to the health care organization KFF, formerly known as the Kaiser Family Foundation. CVS Health covers another 12%.
I won’t give you my usual microeconomics lectures on monopoly, but for all that shouting about free markets these billionaires do, they sure love themselves markets that are so concentrated that you can count the number of providers with one hand. This year’s study from this 2024 report by the US Government Accountability Office will give you the willies. Oh, and DOGE is after that Federal Agency, along with others. Just to make it short, these markets are dysfunctional. The producer side of the equation has too much power in the market. In this case, it’s literally the power of life and death. And, it’s made based on whether they hit their profit goals for their stockholders. Businesses only make money by cutting costs because doing anything inventive is hard. You know what that leads to. “Private Health Insurance: Market Concentration Generally Increased from 2011 through 2022.GAO-25-107194.”
Several companies may be selling health insurance in a given market, but, as we previously reported, most people usually enroll with one of a small number of insurers. Known as market concentration, this can result in fewer choices of insurers and higher premiums due to less competition in the market.
Market concentration generally increased from 2011 through 2022, with three or fewer insurers holding at least 80% of the market share for the individual and employer group markets in at least 35 states. However, the markets for individuals became slightly less concentrated from 2020 to 2022.
In November 2022, GAO reported that, from 2011 through 2020, enrollment in private health insurance plans was concentrated, meaning a small number of issuers of those plans enrolled most of the people in a given market (GAO-23-105672). Specifically, GAO considered a market concentrated in a state if three or fewer issuers held at least 80 percent of the market share of enrollment. For this report, GAO examined the individual (coverage primarily sold to individuals who lack access to group coverage), small-group (coverage offered by small employers), and large-group (coverage offered by large employers) health insurance markets from 2011 through 2022 and found that concentration generally increased. Specifically:
The overall individual market became more concentrated from 2011 through 2022. Concentration in this market peaked in 2019 and became slightly less concentrated through 2022.
The small-group market became more concentrated from 2011 through 2022, but the rate of increase slowed more recently.
The large-group market remained concentrated with only slight increases from 2011 through 2022 (see figure).
Companies do not merge for the purpose of cost efficiencies. They merge because they think they will own more of the market and have more market power. This concentration will lead to much higher profits and less for everyone else. I can spend an entire semester showing how broken concentrated markets are and that they desperately need supervision. But that serves everyone but the guys at the top, so these studies are written, empirical evidence is provided by nerds like me and think tanks, and nothing gets done policy-wise.
In the case of this market, people die for the illusion that all markets set free of oversight magically function on their own. That’s a philosophical hypothesis that tests wrong over and over. Few markets meet the critical structure that makes them efficient by leaving them alone. Most of those are wholesale commodities markets and not complex markets like those that try to find a price for financial contracts that tend to be very specific and unique, involve middlemen and market confusion, and can’t find a price with just interaction between buyer and seller.
I ran across this Blue Sky thread by billionaire Mark Cuban. He gets it. There’s more of this thread here. I can tell you anecdotally what it took me to get out of the Mutual of Omaha provide providers, which was basically Catholic Management sending patients to Catholic hospitals when I had my high-risk pregnancy. I basically told my ex, who was one of these ghoulish cost cutters for that company, that he better get them to pay for me delivering at Methodist or that I would go there to deliver, and he could fricking pay for it for the rest of his natural born days.
He got the person in charge to send me to Methodist since it was the only hospital with a neonatologist at the time. He was a nice Jewish OB/GYN who later was in charge of Doctor Daughter’s residency. Methodist Hospital obviously cared if their patients lived while having a complicated pregnancy. You might notice that the way I got this treatment was to send an AVP of the company to twist their arm. I remember that one of my friends doing his rotation in OB/GYN watched a patient at Creighton Medical Center get a lecture from a Priest brought in by her doctor on why she should carry her pregnancy to term despite the condition the baby had was a brain undeveloped so badly that it was spilling out from a lack of skull. There was no chance of survival, but there was a lot of risk to the mother. I was not about to go through that. I was a happy little Methodist then, and that’s where I wanted to deliver my youngest. The C-section went fine, and we both went home, although I did drive myself to the emergency room 10 weeks before she was due to hemorrhaging.
All this leads to Mark Cuban. Leave these decisions to Doctors. not cost-cutting paper pushers like my MBA ex-husband.
If you want to understand why healthcare pricing is horrific, the first thing to know is that our system puts 100% of the credit risk for deductibles, copays and co-insurance on hospitals and doctors. That's insane. We have turned them into Sub Prime Lenders 🧵
When they can't collect payment, they raise prices to make up that loss. Plus they need to have all the administration of a mortgage loan servicer to try to collect those amounts. Which of course also puts people who can't afford the cost, in medical debt, which often leads to bankruptcy
Then there are insurance companies. The crazy thing is that for more than 50m people,those covered by self insured entities,ins comps don't actually provide insurance. They act as Care Authorizers and payment processors. Can the care occur and how much will be paid.
Their primary role is to make sure that there is not fraud by providers (think overuse of operations to inflate revenue , or services not covered by the plan the user is covered by and/or determine if care is "medically necessary "
That authorization process is one we should not be asking ins comps to do. That role should be performed by INDEPENDENT TPAs. With zero economic incentive to approve or deny. The first step is for self insured entities to use 3rd party TPAs and move away from insurance companies for this service
If they do this, they can use the insurance companies for their networks and software. But better yet, I think direct contracting is the future. For my employees, we are direct contracting with providers. We are stipulating that there will be no pre authorizations. We will trust the provider
Imagine that! He says to trust the Doctors, not the guys making money off the ill.
So, I am staying with the theme of Health Care because BB alerted me to this while preparing to write this post. JJ couldn’t believe they would actually do this to us. This headline is horrifying! It’s from Reuters. “Trump to discuss ending childhood vaccination programs with RFK Jr.” This is what happens when idiots vote for supposed “businessmen.” WTF do either of these men know about vaccines?
Trump says could get rid of some vaccinations “if I think it’s dangerous”
Kennedy is known for anti-vaccine stance, linked to debunked autism claims
Experts warn ending vaccine programs could lead to disease outbreaks, deaths
U.S. President-elect Donald Trump in an interview published on Thursday said he will be talking to Robert F. Kennedy Jr., his nominee to run the Department of Health and Human Services, about ending childhood vaccination programs.
When asked if he would sign off if Kennedy decided to end childhood vaccinations programs, Trump told Time magazine, “we’re going to have a big discussion. The autism rate is at a level that nobody ever believed possible. If you look at things that are happening, there’s something causing it.”
When asked if the discussion could result in his administration getting rid of some vaccinations, Trump said: “It could if I think it’s dangerous, if I think they are not beneficial, but I don’t think it’s going to be very controversial in the end.
Asked in the Nov. 25 interview if he thinks childhood autism is linked to vaccines, Trump said: “No, I’m going to be listening to Bobby,” referring to Kennedy. Trump said he had a lot of respect for Kennedy and his views on vaccinations.
Can you hear me screaming all the way from the Mississippi River way down yonder in New Orleans? And this is the headline that did it to me from The Guardian. “RFK Jr key adviser petitioned regulators to revoke approval of polio vaccine. Aaron Siri is helping Trump’s health secretary pick to select top jobs despite long history of attacking vaccines.” I wonder what Mitch McConnell might say if he could.
A key legal adviser to Robert Kennedy Jr, Donald Trump’s pick for health secretary, is at the center of efforts to push federal drug regulators to revoke approval for the polio and hepatitis B vaccines and block distribution of 13 other critical vaccines.
Aaron Siri, a lawyer who has been helping Kennedy select top health administrators as part of the Trump transition process, is deeply embedded in longstanding efforts to force the US Food and Drug Administration (FDA) to withdraw a raft of vaccines that have saved the lives and health of millions of Americans.
Siri has been sitting alongside Kennedy in interviews in which they have asked candidates for top health jobs where they stand on vaccines, the New York Times reported on Friday.
Kennedy, a leading vaccine sceptic, has insisted he has no plans to revoke vaccines should he be confirmed by the US Senate for the health secretary position. But his close ties with Siri are raising concerns about the incoming Trump administration’s intentions, given the lawyer’s intimate involvement in the anti-vaccine movement.
Siri works closely with the Informed Consent Action Network (Ican), a “medical freedom” non-profit founded by Del Bigtree, whose has long waged war on vaccines including as producer of the anti-vaccination documentary, Vaxxed. The New York Times report noted that Siri filed the 2022 petition calling for the FDA to revoke approval for the polio vaccine on behalf of ICAN.
Poliovirus, the cause of a disease that used to be one of the most feared by Americans, has been eliminated from the country by the US through polio vaccines. The federal Centers for Disease Control and Prevention notes that the best way to avoid its return and keep people safe is through vaccination.
Siri has not only been involved in lawsuits calling for the withdrawal or suspension of the polio and hepatitis B vaccines, but he has also petitioned the FDA to “pause distribution” of 13 other vaccines, according to the Times.
Trump said this week that Kennedy may investigate vaccines for a supposed link with autism. The remark to NBC suggests that his pick for health secretary may run with the conspiracy theory that there is a connection between childhood vaccinations and autism that has been thoroughly debunked yet is repeatedly peddled by Kennedy.
Kennedy’s spokesperson, Katie Miller, confirmed to the Times that Siri has been advising Kennedy but said his vaccine petitions had not been discussed.
“Mr Kennedy has long said that he wants transparency in vaccines and to give people choice,” she said.
When you have a savior complex, you think nothing will get you. There are a lot of those types up for Cabinet jobs. Kari Lake is about to become the Voice of America. I’ve already dubbed her Lady Haw-Haw after an American NAZI sympathizer who was a propagandist on the radio during World War 2. NPR has a lot to say about that. “Trump says Kari Lake will lead Voice of America. He attacked it during his first term.” Our taxes are funding MAGA propaganda here.
President-elect Donald Trump says Kari Lake, a local television news anchor-turned-MAGA politician, will lead the federally funded broadcaster Voice of America.
If successful, the move would put a loyalist at the helm of a news outlet that Trump sought to bring to heel under his appointee during the final year of his first term. Trump officials sought to strip the network and its parent agency of their independence during his first term, including actions later found to be illegal and in one case, unconstitutional.
But Trump doesn’t have the authority to unilaterally install Lake; the hire is dependent on a bipartisan board beneath the chief executive of its parent agency.
Voice of America (VOA), which is funded by Congress, operates in nearly 50 languages and reaches an estimated 354 million people weekly across the globe. It is part of the U.S. Agency for Global Media, the government agency that oversees all non-military, U.S. international broadcasting.
Trump said Wednesday on Truth Social that Lake will be appointed by and work closely with the incoming head of that agency, “who I will announce soon.”
A free press is central to VOA’s mission: It aims to bring unfettered reporting to places that do not have it, and show political debate and dissent in the U.S. even when that reflects critically on the administration in power.
Trump’s White House took the unprecedented step in spring 2020 of openly attacking VOA in public statements over its perceived failures to explicitly blame the Chinese government for the pandemic.
On Wednesday, Trump wrote that Lake and his as-yet-unnamed agency leader will “ensure that the American values of Freedom and Liberty are broadcast around the World FAIRLY and ACCURATELY, unlike the lies spread by the Fake News Media.”
I’d say it’s highly likely that Tulsi Gabbard will be more than willing to provide material for those broadcasts. I’m sure Putin will oblige. The latest outrage, for me, anyway, is that all the Trump TechBros are funding his inauguration with millions of dollars, and Presidential Reject Incontinentia Buttocks is inviting all the favorite despots from the world over. This is from CNN. “Xi’s RSVP is a snub to Trump, but the inauguration invite is still a big deal.”
Getting Xi to fly across the world would be an enormous coup for the president-elect — a fact that would make it politically unfeasible for the Chinese leader. Such a visit would put the Chinese president in the position of paying homage to Trump and American might — which would conflict with his vision for China’s assumption of a rightful role as a preeminent global power. At the inaugural ceremony, Xi would be forced to sit and listen to Trump without having any control over what the new president might say while lacking a right of reply. Xi’s presence would also be seen as endorsing a democratic transfer of power — anathema for an autocrat in a one-party state obsessed with crushing individual expression.
Still, even without a favorable response, Trump’s invitation to Xi marks a significant development that sheds light on the president-elect’s confidence and ambition as he wields power ahead of his second term. CNN’s team covering Trump reported that he’s also been asking other world leaders if they want to come to the inauguration — in a break with convention.
This is a reminder of Trump’s fondness for foreign policy by grand gesture and his willingness to trample diplomatic codes with his unpredictable approach. The Xi invitation also shows that Trump believes that the force of his personality alone can be a decisive factor in forging diplomatic breakthroughs. He’s far from the only president to pursue this approach — which rarely works since hostile US adversaries make hardnosed choices on national interest rather than vibes.
Then, when will his cult figure this one out about his lie about being able to bring prices down, which he just admitted he can’t do?
Wake me up when this is all over.
What’s on your reading and blogging list today?
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