Finally Friday Reads: Deadly Dysfunction
Posted: December 5, 2025 | Author: dakinikat | Filed under: #We are so Fucked, Breaking News, Corruption and Criminal Insanity, Foreign Affairs, GOP Crimes Against Humanity, ICE Immigration and Customs Enforcement, ICE raids, New Orleans, Venezuela | Tags: @johnbuss.bsky.social John Buss, anti-vaccination twits, Attacks on Venezuala, No Quarter, RFK Jr Weirdo, The Media SUCKS | 12 Comments
“I’m not sure, but that Cabinet Meeting may have been the most entertaining one yet. Two hours of trump fighting off sleep, like the toddler he obviously is, while his minions heaped praise upon his barely coherent body.” John Buss, @repeat1968
Good Day, Sky Dancers!
And, hello again from Occupied New Orleans. We’ve had cold rainy weather for quite some time. Perhaps it will wash aways some of the dirty ICE terrorizing the city. The stories get more horrific and we’re barely into the first week of it. The complete idiocy with which this administration operates is ruining the country and a lot of it brings unnecessary death. I only wish we had a Congress that would function the way it was designed and a much better press. Let’s dig in while my tea is still hot.
The latest maneuvering of RFK jr’s death panels is once more directed to childhood vacinations. Where are all these supposedly pro-life people when something other than a fertilized egg is involved. No one cares about actually breathing children? This is from the Washington Post. “CDC panel makes most sweeping revision to child vaccine schedule under RFK Jr.. The panel voted to eliminate a long-standing recommendation for every newborn to receive a hepatitis B shot, excluding those born to mothers testing negative.”
An influential vaccine advisory panel on Friday voted to lift a long-standing recommendation that all newborns receive a vaccine for hepatitis B, marking the most significant change to the childhood immunization schedule under Health Secretary Robert F. Kennedy Jr.
The Advisory Committee on Immunization Practices approved the change despite fierce objections from medical groups who said the recommendation had proved a successful public health strategy, nearly eradicating the dangerous virus among U.S. children.
The committee voted 8-3 to eliminate a recommendation, dating to 1991, for every child to receive a first dose of a hepatitis B vaccine shortly after birth. The panel said the newborn shot is no longer necessary for babies born to mothers who test negative for the virus. They suggested parents of those children delay the first dose for at least two months and consult with their doctors about whether or when to begin administering the three-dose series.
Supporters of the change said the universal recommendation regardless of risk was overly broad and undermined informed choice. Retsef Levi, an ACIP panelist who voted to change the language, said he believes the intention is to push parents to consider whether they want to give another vaccine to their child.
“It’s actually suggesting a fundamental change in their approach to this vaccine and maybe more broadly,” said Levi, a professor of operations management at MIT.
The recommendation from the group of outside government advisers goes to the acting director of the Centers for Disease Control and Prevention for final approval.
Medical experts have argued that it’s important to vaccinate all newborns for hepatitis B, even if their mothers test negative, because babies are at risk of infection if their mothers receive a false negative or become infected after testing. Some of the dissenting panel members pushed back on the change — one called the revised guidance on hepatitis B unconscionable, while another said the move was rooted in “baseless skepticism.”
“We will see hepatitis B infections come back,” said panelist Cody Meissner, a professor of pediatrics at the Geisel School of Medicine at Dartmouth. “The vaccine is so effective, it does not make sense in my mind to change the immunization schedule.”
Select lawmakers were around yesterday for a hearing about the lastest, criminal act by our country against Venezuelan boats. The stories offered up by the Department of War were quite different than the story told by the film. This is from CNN. “Exclusive: Survivors clinging to capsized boat didn’t radio for backup, admiral overseeing double-tap strike tells lawmakers.”
The two men killed as they floated holding onto their capsized boat in a secondary strike against a suspected drug vessel in early September did not appear to have radio or other communications devices, the top military official overseeing the strike told lawmakers on Thursday, according to three sources with direct knowledge of his congressional briefings.
As far back as September, defense officials have been quietly pushing back on criticism that killing the two survivors amounted to a war crime by arguing, in part, that they were legitimate targets because they appeared to be radioing for help or backup — reinforcements that, if they had received it, could have theoretically allowed them to continue to traffic the drugs aboard their sinking ship.
Defense officials made that claim in at least one briefing in September for congressional staff, according to a source familiar with the session, and several media outlets cited officials repeating that justification in the last week.
But Thursday, Adm. Frank “Mitch” Bradley acknowledged that the two survivors of the military’s initial strike were in no position to make a distress call in his briefings to lawmakers. Bradley was in charge of Joint Special Operations Command at the time of the strike and was the top military officer directing the attack.
The initial hit on the vessel, believed to be carrying cocaine, killed nine people immediately and split the boat in half, capsizing it and sending a massive smoke plume into the sky, the sources who viewed the video as part of the briefings said. Part of the surveillance video was a zoomed-in, higher-definition view of the two survivors clinging to a still-floating, capsized portion, they said.
For a little under an hour — 41 minutes, according to a separate US official — Bradley and the rest of the US military command center discussed what to do as they watched the men struggle to overturn what was left of their boat, the sources said
During that time, Bradley also consulted with the uniformed lawyer on duty during the operation, he told lawmakers, according to two of the sources. The JAG officer, or judge advocate general officer, assessed it would be legal to move forward with a second strike, the sources added.
Ultimately, Bradley told lawmakers, he ordered a second strike to destroy the remains of the vessel, killing the two survivors, on the grounds that it appeared that part of the vessel remained afloat because it still held cocaine, according to one of the sources. The survivors could hypothetically have floated to safety, been rescued, and carried on with trafficking the drugs, the logic went.
Another boat was targeted by the Pentagon in the Pacific. This is from The Guardian. “Pentagon announces it has killed four men in another boat strike in Pacific. Strike comes amid congressional turmoil over legality of US attacks on suspected drug smugglers.”
The Pentagon announced on Thursday that the US military had conducted another deadly strike on a boat suspected of carrying illegal narcotics, killing four men in the eastern Pacific, as questions mount over the legality of the attacks.
Video of the new strike was posted on social media by the US southern command, based in Florida, with a statement saying that, at the direction of Pete Hegseth, the defense secretary, “Joint Task Force Southern Spear conducted a lethal kinetic strike on a vessel in international waters operated by a Designated Terrorist Organization”.
“Intelligence confirmed that the vessel was carrying illicit narcotics and transiting along a known narco-trafficking route in the Eastern Pacific. Four male narco-terrorists aboard the vessel were killed,” the statement added.
The footage showed a large explosion suddenly overtaking a small boat as it moved through the water, followed by an image of a vessel in flames and dark smoke streaming overhead.
It is the 22nd strike the US military has carried out against boats in the Caribbean Sea and eastern Pacific Ocean, bringing the death toll of the campaign to at least 87 people since September, when the strikes began.
U.S Foreign and Military policy has become so incoherent, illegal, dangerous, and likely leaked to our country’s traditional enemies, that our European partners no longer trust us. This link was shared to me by BB this morning and comes from The Economist. “Donald Trump’s bleak, incoherent foreign-policy strategy. Allies may panic; despots will cheer.”
YOU MIGHT think that in Trumpworld a new National Security Strategy (NSS) would not count for all that much. John Bolton, a national security adviser in Donald Trump’s first term, frequently laments that his boss had no strategy at all. Instead, the president worked by impulse—and without the encumbrance of too many briefings. From one day to the next, he veered in opposing directions.
Despite that, the new NSS matters. Released, weirdly, in the dead of night on December 4th/5th, it will be pored over by soldiers, diplomats and advisers in America and around the world. It is the latest and fullest statement of what “America First” means in foreign policy. It sets the terms for a soon-expected review of military power, and lays out the priorities for all those trying to interpret the president’s wishes. And, for many of its readers, it will be profoundly alarming.
For the most part, the new NSS rejects the decades-old insight that a common set of values are what cement America’s alliances. It declares that it is “not grounded in traditional, political ideology” but is motivated by “what works for America”. Instead, it embraces what it calls “flexible realism”. That means being “pragmatic without being ‘pragmatist’, realistic without being ‘realist’, principled without being ‘idealistic’, muscular without being ‘hawkish’, and restrained without being ‘dovish’.”
If that sounds like a dog’s breakfast, that is because it is. Shorn of the enlightened values that have long anchored foreign policy, America First becomes a naked assertion of power that owes more to the 19th century than the world that America built after the second world war. And that leads to a document riven by contradictions.
In some parts of the world, in particular in Asia, Mr Trump expects countries to behave as willing allies. In most others they are to submit meekly to America’s economic and military will. In one place the NSS rejects the interventionist idea of urging countries to adopt “democratic or other social change that differs widely from their traditions and histories”. That suits Russia, China and the monarchies of the Middle East. Yet in Europe, where MAGA worries about wokeism, migration and the dominance of liberal values, the NSS bluntly declares that “our goal should be to help Europe correct its current trajectory.”
When the NSS applies this formula to the world, region by region, the full consequences of this shift start to become clear.
Nowhere is this more evident than in the section covering the western hemisphere. “We want to ensure that the western hemisphere remains reasonably stable and well-governed enough to prevent and discourage mass migration to the United States,” it reads. Governments in the Americas will be enlisted to control migration and curb drug flows. They are expected to grant America control of key assets, resources and strategic locations, or at least a veto over “hostile foreign” ownership of them—a clear warning to refuse Chinese investments that offer a sway over ports or such assets as the Panama Canal. Where law enforcement has failed to halt drug smuggling, America will use armed forces, the NSS warns.
This swaggering right of intervention is called a “Trump Corollary” to the Monroe Doctrine. That is a deliberate tribute to the “Roosevelt Corollary”, President Theodore Roosevelt’s assertion of gendarme-like enforcement rights over the western hemisphere in 1904.
All this seems sure to provoke angry recollections of high-handed American interventions in the region in the 20th century, from military invasions and blockades to CIA-backed coups or security pacts that saw America arming and training autocracies guilty of extra-judicial murders and torture in the cold war. With its talk of conditioning aid and trade on co-operation from Latin American governments, the NSS signals a belief that resentment will not stop Latin Americans from doing as they are told.
In Asia, by contrast, allies will read the NSS with a mixture of immediate relief and long-term gloom. The passages on Taiwan could have been worse. The nightmare scenario for such allies as Japan, the Philippines and South Korea would have involved an NSS declaring that the fate of the democratically ruled island of Taiwan is not an existential interest for America.
Instead, the NSS restates America’s position that it “does not support any unilateral change to the status quo in the Taiwan Strait”. True, there is nothing about Taiwan’s importance as a friendly, pro-Western democracy whose people overwhelmingly oppose coming under rule by China. But the strategy does make a cold-eyed realist case for Taiwan’s importance as a usefully-located redoubt in the middle of the “First Island Chain” that runs from Japan through Taiwan to the Philippines, penning in China’s navies and air forces. In addition, the NSS nods to Taiwan’s importance as the largest source of advanced semiconductors.
Accordingly, America will sustain forces capable of deterring any attempt to take Taiwan or to control the sea lanes near that island, or in the South China Sea. Asian allies must also spend much more on their own defences and grant America more access to their ports and bases. In short, the NSS demands that Asian countries risk China’s wrath by helping America contain Chinese ambitions in the Indo-Pacific. But there is not a word of criticism for China’s (or indeed Russia’s) expansionist ambitions or their desire to overthrow the post-1945 legal and multilateral order.
The NSS spares its sharpest barbs for Europe. The old world, it says, is undergoing a profound crisis, and this is not so much about economic decline or military weakness as it is about the loss of national identity, leading to the “stark prospect of civilisational erasure”.
Warning that “it is more than plausible that within a few decades at the latest, certain NATO members will become majority non-European,” the NSS warns that “it is an open question whether they will view their place in the world, or their alliance with the United States, in the same way as those who signed the NATO charter.” In other words, immigrants will corrupt the values of the societies they move to—a shocking assertion from a country that is itself built on immigration.
The NSS’s prescriptions for Europe flow from this assertion of Judeo-Christian nationalism. The NSS calls for “unapologetic celebrations of European nations’ individual character and history”, encouraging the revival promoted by “patriotic European parties”. That is a reference to the populist right, including National Rally in France, Reform UK in Britain and Alternative for Germany, which the vice-president, J.D. Vance, embraced earlier this year when he spoke at a conference in Munich. If that is the Trump administration’s programme, how are the centrist governments in Europe, who see these parties as a grave threat, supposed to treat America as an ally?
When the NSS applies this rationale to Ukraine, it draws some devastating conclusions. Suggesting that most Europeans want peace even if it means surrendering to Vladimir Putin, and asserting that their governments are standing in the way, the strategy calls for a rapid end to the war in order to prevent escalation. It says that America should curb the sense in Europe that Russia is a threat and warns that NATO cannot be “a perpetually expanding alliance”. Alarmingly, it has nothing to say about the repeated aggression and hostility of Vladimir Putin, the Russian president. To much of Europe, this sort of appeasement will only serve to set up the next conflict.
“In everything we do, we are putting America First,” reads the letter from Mr Trump to the American people that opens the NSS. But it is the preceding sentence that will be read by allies with gloom, and with glee by China and Russia, for it is hopelessly at odds with reality: “America is strong and respected again—and because of that, we are making peace all over the world.” Alas, that claim comes from an administration that is indeed feared, resented and obsessed over, but one that is less respected or trusted than any American government in decades.
If that doesn’t give you geopolitical goosebumps, I don’t know what will. Meanwhile, we’ve been experiencing press coverage that’s not providing us the information we need. This article is from The Nation. “A New Roosevelt Institute Report Confronts the Roots of Our Media Crisis—and Calls for Breaking Up Corporate Media.” Today’s journalism crisis wasn’t inevitable, but it’s time to free journalism from the straitjacket of turning a democratic obligation into a profit-maximizing business model.” Concentration in this market is dumbing up America big time. This story is reported by Bilal Baydoun, Shahrzad Shams, and Victor Pickard
The desire to attack and ultimately control the media is a through line of modern authoritarian governance across the globe. President Donald Trump’s reign as the defining political figure of the last decade has demonstrated how quickly that tactic can take hold here. In courtrooms, agencies, and White House briefings, Trump and his allies have sought to punish and delegitimize journalists. In the second Trump term, the bully pulpit has been turned into a battering ram, with open or implied threats to withhold the broadcast licenses or block the media mergers of insufficiently loyal companies. But a singular focus on state meddling has, ironically, obfuscated how authoritarians come to wield such great power over the media system in the first place, and why a free press must be protected from both state and commercial coercion.
What we’re experiencing now is a dangerous convergence of the two.
The truth is that the administration’s threats have rippled across a media ecosystem buckling under the weight of commercial pressures—pressures that existed long before that fateful golden escalator ride more than a decade ago. It’s these longstanding commercial imperatives that Trump knows how to weaponize to manipulate media institutions. He understands that newsrooms accountable first and foremost to investors will sell out their accountability function to survive. Likewise, media conglomerates pursuing mergers cannot afford to anger the administration holding the regulatory pen. When journalism is trapped inside a commercial straitjacket, it can’t fight back.
In our oligarchic age, where billionaires can decide which fledgling outlets live or die for pennies on the dollar and even themselves command powerful roles in government, the line between state-run media and state-aligned media through private means becomes vanishingly thin. A press dependent on the whims of the ultra-wealthy cannot claim meaningful independence from the political forces its owners serve. And even though our Constitution protects the press for democratic reasons, our policy regime assumes that news organizations should behave like profit-maximizing firms.
How did we get here? As we show in our new Roosevelt Institute report, today’s media crisis wasn’t inevitable, but the consequence of policymakers embracing a corporate libertarian approach to media policy. This framework treats our information ecosystem as an ordinary market, rather than vital democratic infrastructure, resulting in a media system riddled with structural deficits. The result is a media environment that’s vulnerable to pressure from every direction, from the White House to the C-Suite.
The consequences of this policy failure have been catastrophic. Newsrooms have been gutted as advertising revenue collapsed. Local papers have closed or been absorbed by vulture capitalists whose short-term incentives are fundamentally at odds with journalism’s public mission. More than 1,000 counties now lack the equivalent of a single full-time journalist; the number of journalists per 100,000 residents has fallen 75 percent since the early 2000s. Platforms dominate news distribution, leaving publishers dependent on algorithmic systems designed to maximize engagement rather than inform the public. A handful of billionaires can bend the flow of information with the proverbial push of a button, and conglomerates continue conglomerating: Just earlier today, after a major bidding war, Netflix beat out Paramount Skydance and Comcast in a deal to acquire Warner Bros. Discovery, resulting in a merger that will further concentrate cultural and informational power in fewer hands.
Today, most Americans, and even many policymakers, take these developments and the system that led to them for granted. As the late media scholar Robert McChesney argued, media policy has been rendered invisible, designed behind closed doors in the public’s name, but without the public’s consent—placing core questions related to our information ecosystem outside the purview of democratic contestation. This invisibility has given cover to a set of neoliberal assumptions that define the boundaries of what’s possible, empowering a small set of wealthy private actors to decide, for the rest of us, what our media system looks like, and whose interests it serves.
Such invisibility obscures how our media system’s design—and the many problems ailing it—is the result of policy decisions. Over the course of decades, policymakers diluted the meaning of the media’s public interest responsibilities, refashioning them into something more akin to consumer preferences. At the same time, the media market faced a series of re-regulatory structural moves that shifted power away from the public and into the hands of corporate actors. And well before Trump dismantled the CPB, Congress resisted meaningful public media investment. All these developments were in turn legitimized by a First Amendment media jurisprudence that prioritizes unbridled commercial speech over the public’s “right to know.” Combined, these constraints created a media system that treats commercial imperatives as natural law, and democratic obligations as optional.
I’ve probably over shared most of the excerpts and it will take you some time to get through them all. BB also wrote yesterday on the many ways our country is run by idiots with an angend American’s do not approve of and in a way that is beyond incompetent. Any of us in cities Occupied by the National Guard and Ice have horrors stories that sound more like NAZI Germany than your backyard. They have no incentive stop and they’re even ignoring court orders. This article is the view point of my home city by the BBC. “New Orleans residents in fear as immigration crackdown descends on their city.” The BBC’s North American Correspondent, Tom Bateman, is here and reports the story.
Two labourers stand on the roof of a house in Kenner, outside New Orleans, as US Border Patrol agents clamber up a ladder, getting closer.
As the agents move in, trying to arrest them, the men step to the roof’s edge, poised in an apparent act of resistance – but it’s too high to jump.
On the ground in the mostly Latino neighbourhood, an officer trains his weapon towards the rooftop while a sniper moves into position. Now, neighbours, activists, and crews of local press are gathering at the scene, watching in bewilderment: US President Trump’s new front line on immigration enforcement has just arrived.
It is day one of “Catahoula Crunch”, as the Department of Homeland Security (DHS) has labelled its operation, taking its name from an American leopard dog known for being well-muscled, powerful and territorial.
“These people came to work today to provide for their families and themselves,” said Zoe Higgins, an activist documenting the Border Patrol operation in New Orleans.
“That they could just be abducted, removed from all stability – I can’t imagine how terrifying that is,” she said, shortly after the agents coaxed the men down and detained them.
According to DHS, its agents were conducting immigration enforcement this week when “several illegal aliens climbed on the roof of a residential home and refused to comply with agent commands”.
An “illegal alien” was arrested, DHS officials told the BBC, but they did not answer questions about the immigration status of the labourers involved, nor whether agents had a warrant to access the property.
None of this sounds lawful. I’m not a Constitutional lawyer, but I do know that everyone deserves their day in court. Disappearing people is criminal.
So, I’m going off today to see my doctor for just a normal check up. But my body tells me every day that it’s not coping well with any of this. I usually can drop my blood pressure by meditating. My skills are no longer up to this fight or fly response I feel continually. I just put my birth certificate in my purse. I still doing my whistle brigade thing. This country is not going doing on my watch. This city and every one in it is not going to be given the No Quarter treatment here; especially when they’re not really a threat to any of us in any way.
What’s on your Reading. Action and Blogging list today?
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Finally Friday Reads: Let’s talk Kleptocracy!!
Posted: December 13, 2024 | Author: dakinikat | Filed under: kakistocracy, kleptocracy, self dealing | Tags: @johnbuss.bsky.social, @repeat1968. John Buss, anti-vaccination twits, Dr Mehmet Oz Weirdo, Kar Lake Weirdo, RFK Jr Weirdo, Self Dealing Trump Cabinet, Self[, Trump Cabinet = Rape Gang, Trump Cabinet Weirdos, Voice of Trump | 6 Comments
“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:
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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.
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The small-group market became more concentrated from 2011 through 2022, but the rate of increase slowed more recently.
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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?
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Trump says could get rid of some vaccinations “if I think it’s dangerous”
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Kennedy is known for anti-vaccine stance, linked to debunked autism claims
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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.
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