The FRAUD that is “Our Democracy”: Conservative/Right-Wing/Capitalist Governor Enacts Marxist-Authored, Truly Socialist Legislation…Redistribution of Wealth that DECIMATES THE WORKING CLASS

By: Eric

Voter, you are a lost soul and a dreamer if you have any faith that voting actually dictates policy in America. The whole entire thing is very fake and gay.

This really happened. In a historically left-leaning, liberal state known for electing democrats, vox populi elected a republican for governor. This governor had a political career as a staunch conservative, a business career in the cut-throat upper echelon of capitalism known as private equity. The governor passed into law the nation’s first state-subsidized health care mandate (at the state level, before ObamaCare took effect at the federal level). The bill, known as RomneyCare, was authored by a self-described Marxist, a man who shares credit in the creation of what is known as the Democratic Socialists of America (yes that DSA). The bill provided comprehensive health insurance (at no cost) to the low/no-income class. Health insurance carriers now provided coverage to these recipients – yet the health insurance carriers still had to maintain their revenue streams (to run profitable business operations). In order to do so, the health insurance costs to the working class skyrocketed stratospherically. Finally, special caveats written into the bill that required the costs of behavioral health care (therapy, substance abuse treatment) be included in all insurance plans. And by enabling this caveat, the private equity firm the governor co-founded, which owned investments in substance abuse treatment centers, profited enormously through both a dramatic surge in revenues earned by the substance abuse treatment centers and through the eventual sale of the investment – with a monstrous capital gain earned on that liquidation.

Politics in America is nothing more than bombastic orchestrated hyperbole – truly – the consequences of our dystopian post-truth fact-checked democracy: ordinary working people that vote get fucked.

Mitt Romney:

His grandfather was a locally-based politician, his father served in Nixon’s cabinet. Prerequisites met – political legacy. This man went to elite schools like Harvard and earned a JD/MBA. He found cut-throat white collar success in the private equity realm. He entered into politics. He is a right-wing conservative Republican. Very religious. A devout Mormon. He ran for governor in a left-leaning state. “Taxachusetts” it’s called, with excessive sales & use, excise, payroll and real estate taxes – in aggregate – compared with other states.

He won the election. A Republican governor in Ted Kennedy’s state. His name is Mitt Romney. He is the quintessential Republican. He was a bona fide conservative of that time; platform with built in expectations for::

  • Bolstering capitalism
  • Tax cuts (one would assume)
  • Smaller government (slash spending)
  • Laissez faire old school conservative politics (right?)

The conservative governor – a conservative right-wing, republican – and the bullshit that entails – and yet: he onboarded a Marxist (a fellow Harvard man who is one of the original Democratic Socialists of America) to concoct policy that once passed, it has significantly altered the economic framework of Massachusetts, then the country over – for he authorized the enactment of state subsidized health insurance in Massachusetts.

It was dubbed “RomneyCare.” – aka the test-run for ObamaCare – the Affordable Care Act.

The Marxist John McDonough (author of RomneyCare):

The RINO passed what truly was the most economically far-left, economically radical, socialist piece of policy in the modern era of Massachusetts.

McDonough is a former chair of the Boston local of Democratic Socialists Organizing Committee, (since 1982, known as Democratic Socialists of America), the U.S.’s largest Marxist organization. He is a Harvard graduate, like Romney.

D.S.A. has used this gradual approach for decades, setting up numerous front groups and using subservient labor unions and secret supporters in state legislatures and the U.S. Congress to put forward several versions “single” payer legislation.It was only with the election of President Barack Obama in 2008, however, that D.S.A.’s long held dreams began to be realized at the Federal level.

Exploring RomneyCare:

The policy dubbed RomneyCare, was the first “universal healthcare” mandate passed in the United States. So in Massachusetts, radical changes came to the economic lanscape, which had and has had, extremely unfavorable circumstances for the working class that receives health insurance as part of their compensation from their employer. These are the pillars of the RomneyCare:

  1. For all individuals that can afford health insurance, it is now law they must have health insurance. The method to substantiate the level of income is determined via an individual’s annual income tax return.
  2. For individuals that cannot afford health insurance – low-income, which is determined using the Federal Poverty Level guidelines, individuals in this tier will receive comprehensive health insurance at the expense of the state.
  3. For businesses of 10+ employees, the employer must offer health insurance as part of the basic compensation package for employees.

Working Class – Financial Torpedo:

Premium and Co-pays: The impact was quite staggering. First of all, for the working class that already had employer sponsored health insurance, this is where the brunt of the health insurance carriers adjustments to their profitability models hit hardest most. Prior to the enactment of RomneyCare, health insurance was a benefit (in both a figurative and literal sense) for a small portion of one’s salary went towards medical coverage. This coverage extended to include dependants (spouse and children). When one would go for an eye exam, or their child to a pediatrician for an annual physical, or their wife to fill a prescription – copays were the really the only additional cost to having traditional medical insurance coverage. What I mean when I say traditional, I mean essential, critical, non-elective – “doctor’s orders” – medical protocols vital to maintaining health. Copays would range from $5 to $20 per scheduled doctor appointment/medication refill/ER visit/etc. This depended upon both which carrier one had (ie Tufts, Harvard Pilgrim, etc) and the expansiveness of the coverage of the premium paid via employment.

But really, copays were manageable, they were reasonable, it (speaking anecdotally) was fair enough.

Well, once RomneyCare took affect, the premiums materially did not change, nor did co-pays. We were all introduced to the deductible.

Deductible: Premiums still applies, copays still applies but now – before the benefit of paying for the health insurance even takes affect, now a deductible would have to be paid. Simply stated, from $2,000 to $5,000 would be paid out of pocket before coverage from premiums applied. This is how the carriers recovered their costs for having to handle the administration of state-subsidized health insurance plans. This is definitively a socialist redistribution of wealth. Put into affect by a so-called conservative politician.

The pain did not end there.

Penalties for Being Uninsured: RomneyCare provisions also made it mandatory that anyone who could afford health insurance – according to financial affordability metrics penned by the Marxist – would have to pay for it. The reporting method of proof of having paid for health insurance came through a new level of regulatory compliance, enforced by the Massachusetts Department of Revenue. On one’s individual annual income tax return now included mandatory reporting of this health insurance proof. For each month an individual (and their joint-filer and dependants) did not have paid health insurance, the penalty imposed was about $80/month. This penalty, if applicable, would go dollar for dollar to any state refund, or liability payment owed, upon filing.

Carrier Chicanery: Pre-existing conditions. This got complicated, all I can say is that anyone with a pre-existing condition before acquiring health insurance via a carrier would have to crawl through bureaucratic chutes and ladders to have services approved for payment. A fucking nightmare for many. Disenchantment is a great method to remove the motivation to dedicating time and effort to satisfy the bureaucratic protocols.

Businesses of 10+ Employees: small businesses, working class businesses, now had to offer these deductible-plagued health insurance plans to their employees if the company had more than 10 employees. Another financial uppercut, right to the face.

Capitalism for the Win (sale of CRC):

Mitt Romney joined Bain & Company around 1980. He demonstrated his strong abilities for the realm of private equity and was the co-founder of Bain Capital, a dedicated private equity arm of Bain & Company. Private equity is a highly complex economic operation, incorporating a multitude of complex variables, of which my personal professional background affords me the ability to explain this simply.

Bain has typically high net-worth clients. Those clients invest their money into Bain’s investment operations. The investment operations involve acquisitions, mergers, divestitures, etc of various privately held businesses, injecting money into venture capital, placing money in hedge funds, etc. Let us call the resulting ownership in various investment operations holdings.

The holdings are not all pooled into one giant oversight scheme by the holding company, Bain Capital. There are multiple subsidiary operations; limited partnerships, limited liability companies, trusts, etc that portions of the holdings are funneled into and managed. We can call the subsidiaries pools.

One holding, which was carved up from ownership perspective into various pools, was a company called CRC Health. Bain Capital agreed to acquire the CRC Health Group for about $720 million, in late 2005. CRC Health owned and operated various substance abuse treatment centers, rehabs, clinics, etc – including operations in Massachusetts. With the passing of RomneyCare, many people with access to the state-subsidized health insurance – which provided coverage for behavioral health and substance abuse treatment, as mandated by the Marxist author – now could enter into various levels of treatment for substance abuse disorders – and it is all covered by the state.

CRC saw it’s profit margins dramatically rise while under the ownership of Bain, which made it a highly attractive holding that could be liquidated for a killing – in terms of a net gain on the sale of CRC.

Bain ultimately sold CRC in 2015 for $1.2 billion. Remember, they purchased it in 2005 for $720 million. The $400 million gain is quite substantial, not to mention the annual net income earned from owning the business operations of this particular holding. Those annual net incomes fed the pools. Very lucrative.

Lucrative and also very suspicious. The man that is the co-founder of the very beneficiary of this nature of business Bain undertakes, passes legislation that handsomely benefits the profitability of the holding – for people in need of the service provided by CRC (substance abuse treatment) – now have seamless access and mobility to utilize the service. First Massachusetts has RomneyCare – then ObamaCare passes nationwide – with the same provisions regarding coverage of substance abuse treatment.

Ironically, Romney lost to Obama in the 2012 presidential election. Romney’s campaign had an odd time conveying Romney being the man responsible for RomneyCare, the leftist socialist policy – to the nation of conservative, right-wing republican voters. And swing voters.

Oh yeah – the Marxist McDonough is credited with authoring ObamaCare too.

No Solutions to Problems in Rules-Based Democracy:

Romney’s legacy as governor is antithetical to the structure of the political ideology shared with those that voted him in …his loyalties were to the private equity circle, to the major donors to his campaigns, to the promised donors of his eventual presidential bid.

Marxist types scored a victory in the fact Romney’s RomneyCare was an actual implementation of a system to accomplish the redistribution of wealth. First in Massachusetts – adapted nationwide via ObamaCare.

So voter? How does this make you feel? Do you believe your vote, your milquetoast ideology, your owning the libs, or shaming the MAGA-pedes – does anything beneficial to your comfortable struggle come about?

No – it doesn’t.

Mitt Romney.

Not only does he shit on your head ….you’re expected to say thanks for the hat.

Physicians And The Vaccine Tyranny – Open Letter From A Physician

I find myself in the position that I must use an alias for fear of reprisal. Those days may be quickly coming to an end, as hospitals are denying requests for vaccine exemptions with impunity. I will likely soon be out the door, with nothing to lose. Even if I survive this round, if the “pandemic” continues, it won’t be long before I am shelved like a can of spam.

Doctors need to be called out. From early in the pandemic, it was like a mass hypnosis or forgetfulness of everything we had learned in medical school. Immune system knowledge was shelved and replaced by government dictates. The thought of early outpatient treatment with “off label” drugs that could modulate the immune system was forbidden. We essentially told patients that they had to go home and wait until they were sick enough to be hospitalized, then treatment would begin. Imagine telling all diabetics that there is no metformin, Glucophage, or insulin. Would we really wait until patients are in diabetic ketoacidosis, and then treat them only at the hospital? It is medical malfeasance of a grand scale.

We physicians gave up our training and our reasonable medical thought process. The reasons are multiple. First, it was the easy way out. Second, many of us are employed and feared reprisal. Third, despite what the public thinks, we physicians are not bold leaders, we tend to be sheep, and are afraid of having an entire institution ostracize us or our colleagues to think us crazy.

As we got to the point of vaccine rollout, doctors were not using the scientific method, questioning and challenging prevailing hypotheses. They kept their heads down, closed clinics, converted to telemedicine, and pushed only the jab.

I had conversations with doctors who are supposed experts in virology and immunology denying the lasting immunity of natural infection. Conversations about natural immunity:

“I have antibodies.”

“But they will wane.”

“But I have memory cells.”

Dumbfounded look.

Really, are these the leaders we want?

Other conversations about the safety of vaccines:

“The vaccine is safe.”

“No, we would have shut down any trial in the past after even 100 deaths.”

“This is more serious.”

“But the survival rate is about 99.6%.”

“Its killing people.”

“So is the vaccine”

“You can’t believe VAERS.”

“It was set up to help protect the public, and if anything, it is underreporting side effects.”

“You’re a conspiracy theorist.”

Or conversations about early treatment

“You must get the vaccine, it is the only “proven” treatment, there are no other treatments.”

“Really, ivermectin has eradicated COVID in India, parts of Mexico, Japan….”

“It is a horse dewormer.”

“It won a Nobel Prize in medicine, is a WHO essential drug, and has been around for decades with a great safety profile.”

“No, only the vaccine works.”

“But it is failing”

          “You are a denier and a conspiracy theorist.”

          “Sigh….”

Lately it has been all about getting 100% of the population jabbed. For what reason? I am not sure, and some of the more detailed and investigated theories scare me. I shudder to think. But last year’s heroes are being labeled selfish and villainous for not getting the vaccine. Hospital systems have abandoned their community’s health and ignore early successful outpatient treatment in favor of huge government subsidies for inpatient and ICU treatment. The success of these treatments was not great, but that is another article. Now we have the same

hospital systems turning their backs on their own employees. Basically, health providers have a choice, get shot, or get fired. How does that help? Both vaxxed and unvaxxed can spread virus, so it doesn’t help anyone. It only helps the hospital to get more government money by meeting quotas.

I, for one, will remember that when we faced real crisis, the hospitals and many physicians chose money and profit over their own community’s best interest. Perhaps it is time for groups of physicians to get back to running their own health-care clinics and hospitals. We used to have a code of ethics. We used to put patients first. Not anymore.

As for physicians, those who are blindly following the government edicts are culpable in a moral atrocity. Bullying and deriding patients who chose to refrain from this still experimental therapy is an abomination. (You will say it isn’t experimental anymore, to which I would say that just because the government broke its own rules regarding approval, doesn’t make it legal or right). Patients have sincere beliefs for making their choice. Respect their thoughts. Do you yell as much at smokers, drinkers, fornicators, drug abusers, etc? No, I think not. I think you chose to fit in because it gives you a sense of righteousness.

And going so far as to encourage vaccination in children and pregnant women is crazy. There is blood on the hands of any physician who does this. With children, there is no benefit to the vaccine, only harm. They would serve themselves and society better with natural immunity. The vaccine hasn’t been studied on women and their babies. It is pregnancy category X (unknown) but being pushed wholesale on these poor women without proper studies. Shame on you, doctors who are doing this. I certainly have lots to answer for when I meet my maker, but this is on another level.

I beg physicians to get back to basics, remember all the epidemiology and immunology that bored us to tears in school. Investigate the real literature and take a stand. Society needs us to do this. Even if you have been vaccinated, help those who are fighting for their lives. Stand up against this forced vaccine tyranny. Support those who have legitimate reasons for declining the jab. If you don’t stand up now, who will stand up for you when you are faced with your choice of yet another booster or your job.

Blaise Edwards, M.D.

Economic Incentives for Administrative Simplification • JAMA Network

Source: JAMA

Administrative complexity in the US health system has been identified as the source of enormous spending and potential cost savings.1 In a new report, Sahni and colleagues2 provided a detailed evaluation of administrative cost-savings opportunities, including an estimated $175 billion that could be addressed without new laws or regulatory changes.

Health care is complicated because complexity is profitable. In the US health care system, payers, health systems, physicians, other clinicians, drug companies, pharmacies, and pharmacy benefit managers all earn more revenue because of administrative complexity. Moreover, unlike virtually any other sector of the economy, except higher education, health care can raise prices annually faster than inflation.3 This means that revenues, margins, and profits can all improve without addressing administrative efficiency. In most other sectors, organizations can only improve margins if they improve labor productivity or simplify administration.4

That administrative spending is greater in health care than other service industries is not new. Of the $3.8 trillion spent in 2019, an estimated $935 billion was on administrative spending.1 This percentage, approximately 25%, has been roughly constant for more than a decade.5 This Viewpoint explores the misaligned incentives that have made it difficult to make progress in reducing administrative spending and suggests potential changes necessary for administrative simplification to occur.

The Economic Incentives of High Administrative Spending

First, the current health care administrative system is the natural byproduct of economic forces rewarding payers, health systems, physicians, other clinicians, drug companies, pharmacies, and pharmacy benefit managers to maximize their profits. For example, payers profit from administrative complexity, using prior authorization and claims processes to reduce medical costs and designing custom benefit designs to achieve a specific premium price. Health systems profit from administrative complexity such as through opaque pricing, differential prices based on insurance coverage, and coding or risk adjustment activities to increase revenue.

The way health care services in the US are most often reimbursed with the fee-for-service payment system fuels this wasteful administrative give-and-take between payers and health entities. For instance, health care organizations are motivated to spend money on more sophisticated billing strategies to capture more revenue from payers, and payers are motivated to spend money on sophisticated review strategies to avoid paying claims to health care organizations and clinicians. These equal and opposite forces increase each year while canceling each other out and creating no aggregate value. While organizations innovate to improve the productivity of these billing or claims review activities, productivity improvements generally drive more activity rather than reduce total expense. For example, as offshore labor made medical claim reviews and denial appeals less expensive, payers have used this approach to review more claims, and health care organizations and clinicians have appealed claim denials more frequently. At times, the same business-process-outsourcing firm may provide services (such as call centers) for payers as well as services (such as call centers) for health care organizations.

Second, regulators (such as state departments of insurance and the Centers for Medicare & Medicaid Services) add administrative complexity as they act to protect patients from harm, ensure access and fairness, and protect public health. To achieve these goals, regulators collect data and quality metrics, formalize appeal and grievance processes, monitor payment accuracy, and conduct audits. Even regulations that require insurers to spend 85% of premiums on medical care—intended to cap administrative costs plus profits at 15%—decrease insurers’ incentive to reduce medical expenses, which in turn weakens the incentive for health care organizations to reduce their administrative costs.

Third, the US health care market structure blocks attempts to standardize. Payers are governed and organized at the state and county levels, whereas many health systems are primarily local organizations with concentrated market power in a single medical service area. Health plans need local health systems to join their networks to create marketable insurance products and do not have much leverage to force health care centers and clinicians to adopt processes or technologies that could lower administrative spending.

Aligning Technology With Economic Incentives to Help Lower Administrative Costs

Against these challenges, health care organizations are applying new technologies like remote process automation and artificial intelligence to address administrative processes and costs. Remote process automation is an approach for automating recurring processes, and because it is inexpensive to set up, it could be applied to many different processes. A common use is to manage prior authorization requests across many different payers. Artificial intelligence is also frequently deployed against complex administrative processes because it can iteratively solve problems and “learn.” A common administrative use for artificial intelligence is to assist with coding because the software can learn from payment and denial experiences that codes maximize revenue. Still, these technologies are ultimately workarounds, automating how the structural complexity is handled but not simplifying health care.

Although both artificial intelligence and remote process automation technologies have received much attention, another approach for addressing administrative complexity involves building technology-enabled customer service organizations. For example, in Medicare Advantage, some companies like Humana are offering one-stop patient “navigator” service functions that can handle nearly any question or problem. These approaches attempt to buffer patients, health care centers, and clinicians from insurance benefit design, network, and payment complexity. Even with these approaches, the underlying complexity persists, and the navigator services may increase administrative spending on customer service in exchange for higher satisfaction scores.

Reducing administrative spending will require changes in the regulation of and payment for health care. Actions to limit price increases, perhaps by indexing health care prices to the consumer price index, could also substantially increase motivation to reduce administrative spending. The Center for Medicare and Medicaid Innovation could pursue programs to test all-payer prices, hospital price oversight (such as adopted in Maryland), or Medicare–indexed hospital price caps based on local market dominance to drive margin pressure, motivating health care organizations to manage administrative expenses.6 Another policy lever could be enhanced Federal Trade Commission–Department of Justice enforcement and surveillance of hospital mergers at the local level, which would make it more difficult for health systems to raise prices.

Because incentive alignment is an effective mechanism for large and rapid change, one of the most important actions is to coordinate and accelerate the move away from fee-for-service payment models. Multipayer coordination could create an even stronger incentive. If payers adopt model contracts with the same quality metrics and definitions, data extraction and reporting could be automated. Standard prior authorization lists mandated electronic prior authorizations, and standardized payment denial and appeal protocols could all enable technology to automate these labor-intensive processes and reduce cost and complexity. Another cost-saving approach would be to reduce from 1400 the number of quality metrics reported.7

Conclusions

The US health care system is complicated but can be made simpler. To achieve this goal, the most important contributing factor is to make simpler, less expensive administration a profit imperative. All payers need to be enlisted in support of standardization around payment models, payment rules, and reporting metrics. Additionally, policies that limit price increases to the rate of inflation could create the profit margin pressures that have led to ongoing labor productivity and administrative simplification in other sectors.

Article Information
Corresponding Author: Bob Kocher, MD, Venrock, 3340 Hillview Ave, Palo Alto, CA 94304 (bkocher@venrock.com).

Published Online: October 20, 2021. doi:10.1001/jama.2021.18292

Conflict of Interest Disclosures: Dr Kocher reported being a partner at Venrock, which invests in technology and health care companies including Devoted Health, and serving on the boards of Devoted Health, Premera Blue Cross, and several other companies. Mr Chigurupati reported being an employee of and holding stock options in Devoted Health.

References

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  2. Sahni NR, Mishra P, Carrus B, Cutler DM. Administrative Simplification: How to Save a Quarter-Trillion Dollars in US Healthcare. McKinsey & Company. October 20, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/administrative-simplifaction-how-to-save-a-quarter-trillion-dollars-in-US-healthcare
  3. Perry MJ. Chart of the day…or century? Carpe Diem AEI blog. January 14, 2020. Accessed August 27, 2021. https://www.aei.org/carpe-diem/chart-of-the-day-or-century-3/
  4. Kocher R, Sahni NR. Rethinking health care labor. N Engl J Med. 2011;365(15):1370-1372. doi:10.1056/NEJMp1109649
  5. Angrisano C, Farrel D, Kocher R, Laboissier M, Parker S. Accounting for the cost of health care in the United States. McKinsey Global Institute. Published January 1, 2007. Accessed August 27, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/accounting-for-the-cost-of-health-care-in-the-united-states
  6. Kocher RP, Shah S, Navathe AS. Overcoming the market dominance of hospitals. JAMA. 2021;325(10):929-930. doi:10.1001/jama.2021.0079
  7. Wilensky G. The need to simplify measuring quality in health care. JAMA. 2018;319(23):2369-2370. doi:10.1001/jama.2018.6858