Yves here. We’ve written regularly on Eileen Appelbaum and Rosemary Batt’s important investigations into how private equity has taken over more and more of hospital staffing, including of emergency rooms. This in turn has allowed them to override patient efforts to have only in-network doctors assigned to their case, as well as to engage in other practices that greatly inflate patient charges (so-called surprise billing).
The legal fig leaf that allows private equity firms like Blackstone and KKR to play doctor is that their deals are structured so that MD or group of MDs is the nominal owner of the specialty practice, even though the business is stripped of its assets and the operating contracts are widely believed to strip them of any say. The now-notorious incident of Blackstone’s TeamHealth firing whistleblower Dr. Ming Lin confirms who is really in charge.
By Eileen Appelbaum, the Co-Director of the Center for Economic and Policy Research and visiting professor, School of Management, University of Leicester, UK and Rosemary Batt, the Alice Hanson Cook Professor of Women and Work, Cornell University ILR School. Produced by Economy for All, a project of the Independent Media Institute
Doctor Ming Lin is the first emergency room doctor to be fired for going public with his concerns about poor hospital emergency room safety practices and shortages of medical supplies and protective gear for health workers. He won’t be the last.
Like many hospitals in the US, PeaceHealth St. Joseph Medical Center in Bellingham Washington, where Ming Lin worked for the past 17 years as an emergency room doctor, has outsourced the management and staffing of its emergency rooms. So, Lin works on-site at the hospital’s emergency room, but he is employed by a physician staffing firm that runs the emergency room. These staffing firms are often behind the surprise medical bills for emergency room services that patients receive after their insurance company has paid the hospital and doctors, but not the excessive out-of-network charges billed by these outside staffing firms.
About a third of hospital emergency rooms are staffed by doctors on the payrolls of two physician staffing companies—TeamHealth and Envision Health—owned by Wall Street investment firms. Envision Healthcare employs 69,000 healthcare workers nationwide while TeamHealth employs 20,000. Private equity firm Blackstone Group owns TeamHealth, Kravis Kohlberg Roberts (KKR) owns Envision.
Care of the sick is not the mission of these companies; their mission is to make outsized profits for the private equity firms and its investors. Overcharging patients and insurance companies for providing urgent and desperately needed emergency medical care is bad enough. But it is unconscionable to muzzle doctors who speak out to advocate for the health of their patients and co-workers during the global pandemic that is rapidly spreading across the US.
Yet, that is what Blackstone-owned TeamHealth just did. Why would an experienced emergency room doctor be fired in the middle of a pandemic? One clue may be that Blackstone’s CEO, Stephen A. Schwarzman, is part of President Trump’s inner circle. He may not want to risk that relationship by allowing TeamHealth’s doctors to inform the public about Washington’s mishandling of the allocation of supplies and protective gear. The President might conclude that TeamHealth doctors didn’t appreciate him enough, and where would that leave Schwartzman?
PeaceHealth St. Joseph Medical Center may have the distinction of being the first hospital to have a doctor outsourced from a physician staffing firm unceremoniously fired for telling the public the truth. But it won’t be the last. Hospitals are now telling doctors treating coronavirus patients they will be fired if they speak to the press.
The American Academy of Emergency Medicine protested Dr. Lin’s ouster and questioned how TeamHealth is allowed to provide hospital services when the law requires that physician practices must be owned by a licensed medical practitioner. TeamHealth skirts the law by owning all the assets of the physician practices it acquires—the real estate, offices, equipment, supplies, inventory, and even accounts receivable.
On paper, the physician practices are owned by a doctor-led organization that TeamHealth has set up to comply with the law. But what does it mean to own a physician practice if the practice has no assets and no possibility to exist on its own?
The furor over patients hit by surprise medical bills revealed that TeamHealth controls the billing for the doctors it supplies to hospital emergency rooms. The firing of Doctor Ming Lin pulls back the curtain and reveals that TeamHealth controls the doctors as well.
A columnist for The Washington Post and author of the Pulitzer-winning Gulag, Applebaum has been writing about Russia since the 1990s. Her fifth book is a detailed study of Stalin’s 1929 policy of agricultural collectivization, which set off the worst famine in European history. Some five million people died between 1931 and 1933 in the USSR. Of these, roughly three million were Ukrainians, and Applebaum definitively shows that they died due to deliberate government policy. Drawing on newly opened archives and personal accounts not previously translated, Applebaum substantiates the stories that Stalin suppressed Ukrainian uprisings by closing the borders, stopping food shipments, and letting the rebellious peasants starve.
(32 min): wrote about the Ukranianism of American politics with Paul Manafort
Search out far left and far right. They don’t invent, but they do fund.
Question: how do we divide people.
[Stalin] writing in private you know what he
writes to Kaganovich and these other
sidekicks he believes his ideology and
one of the things that’s important about
them about the Bolsheviks is they
believed that Marxism wasn’t just some
kind of theory and it could be money
they believed that it was a science and
it was true and it’s even more common
because it’s science and it’s true and
we define what it is and that means that
whatever we’ve said you know is true and
this is this is how things are going to
be and if it doesn’t work out in reality
the way we thought it was going to then
somebody else is responsible and who’s
responsible saboteurs wreckers kulaks
enemies of the people enemies of the
state you know and I actually believe
now that a lot of the you know a lot of
the violence the kinds kind of cycles of
violence you have in the Soviet Union
1932 and 33 you had the famine a few
years later you had the purges of 1937
and you have cyclical violence and
that’s almost always a response to
policy failure you know it hasn’t worked
the revolution hasn’t brought prosperity
and made us happy there has to be a
reason for it
okay you know let’s find the let’s find
the the parasites who are sucking the
blood of the revolution and get rid of
them and so that was you know and so the
so so your point you know your logical
point okay well look this agricultural
policy hasn’t worked let’s change it
that’s not how they thought you know it
wasn’t let’s change it love wheat you
know it’s not our policy that needs to
change it’s you know
the people in reality that has to adjust
our way of thinking and anyways I said I
Romney’s main complaint in the piece is that Donald Trump is a mercurial and divisive leader. That’s true, of course. But beneath the personal slights, Romney has a policy critique of Trump. He seems genuinely angry that Trump might pull American troops out of the Syrian civil war. Romney doesn’t explain how staying in Syria would benefit America. He doesn’t appear to consider that a relevant question. More policing in the Middle East is always better. We know that. Virtually everyone in Washington agrees.
Corporate tax cuts are also popular in Washington, and Romney is strongly on board with those, too. His piece throws a rare compliment to Trump for cutting the corporate rate a year ago.
That’s not surprising. Romney spent the bulk of his business career at a firm called Bain Capital. Bain Capital all but invented what is now a familiar business strategy:
- Take over an existing company for a short period of time,
- cut costs by firing employees,
- run up the debt,
- extract the wealth, and
- move on, sometimes
- leaving retirees without their earned pensions.
Romney became fantastically rich doing this.
Meanwhile, a remarkable number of the companies are now bankrupt or extinct. This is the private equity model. Our ruling class sees nothing wrong with it. It’s how they run the country.
Mitt Romney refers to unwavering support for a finance-based economy and an internationalist foreign policy as the “mainstream Republican” view. And he’s right about that. For generations, Republicans have considered it their duty to make the world safe for banking, while simultaneously prosecuting ever more foreign wars. Modern Democrats generally support those goals enthusiastically.
There are signs, however, that most people do not support this, and not just in America. In countries around the world — France, Brazil, Sweden, the Philippines, Germany, and many others — voters are suddenly backing candidates and ideas that would have been unimaginable just a decade ago. These are not isolated events. What you’re watching is entire populations revolting against leaders who refuse to improve their lives.
Something like this has been in happening in our country for three years. Donald Trump rode a surge of popular discontent all the way to the White House. Does he understand the political revolution that he harnessed? Can he reverse the economic and cultural trends that are destroying America? Those are open questions.
But they’re less relevant than we think. At some point, Donald Trump will be gone. The rest of us will be gone, too. The country will remain. What kind of country will be it be then? How do we want our grandchildren to live? These are the only questions that matter.
The answer used to be obvious. The overriding goal for America is more prosperity, meaning cheaper consumer goods. But is that still true? Does anyone still believe that cheaper iPhones, or more Amazon deliveries of plastic garbage from China are going to make us happy? They haven’t so far. A lot of Americans are drowning in stuff. And yet drug addiction and suicide are depopulating large parts of the country. Anyone who thinks the health of a nation can be summed up in GDP is an idiot.
The goal for America is both simpler and more elusive than mere prosperity. It’s happiness. There are a lot of ingredients in being happy:
Above all, deep relationships with other people. Those are the things that you want for your children. They’re what our leaders should want for us, and would want if they cared.
But our leaders don’t care. We are ruled by mercenaries who feel no long-term obligation to the people they rule. They’re day traders. Substitute teachers. They’re just passing through. They have no skin in this game, and it shows. They can’t solve our problems. They don’t even bother to understand our problems.
One of the biggest lies our leaders tell us that you can separate economics from everything else that matters. Economics is a topic for public debate. Family and faith and culture, meanwhile, those are personal matters. Both parties believe this.
Members of our educated upper-middle-classes are now the backbone of the Democratic Party who usually describe themselves as fiscally responsible and socially moderate. In other words, functionally libertarian. They don’t care how you live, as long as the bills are paid and the markets function. Somehow, they don’t see a connection between people’s personal lives and the health of our economy, or for that matter, the country’s ability to pay its bills. As far as they’re concerned, these are two totally separate categories.
Social conservatives, meanwhile, come to the debate from the opposite perspective, and yet reach a strikingly similar conclusion. The real problem, you’ll hear them say, is that the American family is collapsing. Nothing can be fixed before we fix that. Yet, like the libertarians they claim to oppose, many social conservatives also consider markets sacrosanct. The idea that families are being crushed by market forces seems never to occur to them. They refuse to consider it. Questioning markets feels like apostasy.
Both sides miss the obvious point: Culture and economics are inseparably intertwined. Certain economic systems allow families to thrive. Thriving families make market economies possible. You can’t separate the two. It used to be possible to deny this. Not anymore. The evidence is now overwhelming. How do we know? Consider the inner cities.
Thirty years ago, conservatives looked at Detroit or Newark and many other places and were horrified by what they saw. Conventional families had all but disappeared in poor neighborhoods. The majority of children were born out of wedlock. Single mothers were the rule. Crime and drugs and disorder became universal.
What caused this nightmare? Liberals didn’t even want to acknowledge the question. They were benefiting from the disaster, in the form of reliable votes. Conservatives, though, had a ready explanation for inner-city dysfunction and it made sense: big government. Decades of badly-designed social programs had driven fathers from the home and created what conservatives called a “culture of poverty” that trapped people in generational decline.
There was truth in this. But it wasn’t the whole story. How do we know? Because virtually the same thing has happened decades later to an entirely different population. In many ways, rural America now looks a lot like Detroit.
This is striking because rural Americans wouldn’t seem to have much in common with anyone from the inner city. These groups have different cultures, different traditions and political beliefs. Usually they have different skin colors. Rural people are white conservatives, mostly.
Yet, the pathologies of modern rural America are familiar to anyone who visited downtown Baltimore in the 1980s: Stunning out of wedlock birthrates. High male unemployment. A terrifying drug epidemic. Two different worlds. Similar outcomes. How did this happen? You’d think our ruling class would be interested in knowing the answer. But mostly they’re not. They don’t have to be interested. It’s easier to import foreign labor to take the place of native-born Americans who are slipping behind.
But Republicans now represent rural voters. They ought to be interested. Here’s a big part of the answer: male wages declined. Manufacturing, a male-dominated industry, all but disappeared over the course of a generation. All that remained in many places were the schools and the hospitals, both traditional employers of women. In many places, women suddenly made more than men.
Now, before you applaud this as a victory for feminism, consider the effects. Study after study has shown that when men make less than women, women generally don’t want to marry them. Maybe they should want to marry them, but they don’t. Over big populations, this causes a drop in marriage, a spike in out-of-wedlock births, and all the familiar disasters that inevitably follow — more drug and alcohol abuse, higher incarceration rates, fewer families formed in the next generation.
This isn’t speculation. This is not propaganda from the evangelicals. It’s social science. We know it’s true. Rich people know it best of all. That’s why they get married before they have kids. That model works. But increasingly, marriage is a luxury only the affluent in America can afford.
And yet, and here’s the bewildering and infuriating part, those very same affluent married people, the ones making virtually all the decisions in our society, are doing pretty much nothing to help the people below them get and stay married. Rich people are happy to fight malaria in Congo. But working to raise men’s wages in Dayton or Detroit? That’s crazy.
This is negligence on a massive scale. Both parties ignore the crisis in marriage. Our mindless cultural leaders act like it’s still 1961, and the biggest problem American families face is that sexism is preventing millions of housewives from becoming investment bankers or Facebook executives.
For our ruling class, more investment banking is always the answer. They teach us it’s more virtuous to devote your life to some soulless corporation than it is to raise your own kids.
Sheryl Sandberg of Facebook wrote an entire book about this. Sandberg explained that our first duty is to shareholders, above our own children. No surprise there. Sandberg herself is one of America’s biggest shareholders. Propaganda like this has made her rich.
What’s remarkable is how the rest of us responded to it. We didn’t question why Sandberg was saying this. We didn’t laugh in her face at the pure absurdity of it. Our corporate media celebrated Sandberg as the leader of a liberation movement. Her book became a bestseller: “Lean In.” As if putting a corporation first is empowerment. It is not. It is bondage. Republicans should say so.
They should also speak out against the ugliest parts of our financial system. Not all commerce is good. Why is it defensible to loan people money they can’t possibly repay? Or charge them interest that impoverishes them? Payday loan outlets in poor neighborhoods collect 400 percent annual interest.
We’re OK with that? We shouldn’t be. Libertarians tell us that’s how markets work — consenting adults making voluntary decisions about how to live their lives. OK. But it’s also disgusting. If you care about America, you ought to oppose the exploitation of Americans, whether it’s happening in the inner city or on Wall Street.
And by the way, if you really loved your fellow Americans, as our leaders should, if it would break your heart to see them high all the time. Which they are. A huge number of our kids, especially our boys, are smoking weed constantly. You may not realize that, because new technology has made it odorless. But it’s everywhere.
And that’s not an accident. Once our leaders understood they could get rich from marijuana, marijuana became ubiquitous. In many places, tax-hungry politicians have legalized or decriminalized it. Former Speaker of the House John Boehner now lobbies for the marijuana industry. His fellow Republicans seem fine with that. “Oh, but it’s better for you than alcohol,” they tell us.
Maybe. Who cares? Talk about missing the point. Try having dinner with a 19-year-old who’s been smoking weed. The life is gone. Passive, flat, trapped in their own heads. Do you want that for your kids? Of course not. Then why are our leaders pushing it on us? You know the reason. Because they don’t care about us.
When you care about people, you do your best to treat them fairly. Our leaders don’t even try. They hand out jobs and contracts and scholarships and slots at prestigious universities based purely on how we look. There’s nothing less fair than that, though our tax code comes close.
Under our current system, an American who works for a salary pays about twice the tax rate as someone who’s living off inherited money and doesn’t work at all. We tax capital at half of what we tax labor. It’s a sweet deal if you work in finance, as many of our rich people do.
In 2010, for example, Mitt Romney made about $22 million dollars in investment income. He paid an effective federal tax rate of 14 percent. For normal upper-middle-class wage earners, the federal tax rate is nearly 40 percent. No wonder Mitt Romney supports the status quo. But for everyone else, it’s infuriating.
Our leaders rarely mention any of this. They tell us our multi-tiered tax code is based on the principles of the free market. Please. It’s based on laws that the Congress passed, laws that companies lobbied for in order to increase their economic advantage. It worked well for those people. They did increase their economic advantage. But for everyone else, it came at a big cost. Unfairness is profoundly divisive. When you favor one child over another, your kids don’t hate you. They hate each other.
That happens in countries, too. It’s happening in ours, probably by design. Divided countries are easier to rule. And nothing divides us like the perception that some people are getting special treatment. In our country, some people definitely are getting special treatment. Republicans should oppose that with everything they have.
What kind of country do you want to live in? A fair country. A decent country. A cohesive country. A country whose leaders don’t accelerate the forces of change purely for their own profit and amusement. A country you might recognize when you’re old.
A country that listens to young people who don’t live in Brooklyn. A country where you can make a solid living outside of the big cities. A country where Lewiston, Maine seems almost as important as the west side of Los Angeles. A country where environmentalism means getting outside and picking up the trash. A clean, orderly, stable country that respects itself. And above all, a country where normal people with an average education who grew up in no place special can get married, and have happy kids, and repeat unto the generations. A country that actually cares about families, the building block of everything.