Wednesday, August 2, 2017

A Blacklisted Film and the New Cold War


















August 2, 2017












Special Report: As Congress still swoons over the anti-Kremlin Magnitsky narrative, Western political and media leaders refuse to let their people view a documentary that debunks the fable, reports Robert Parry.



By Robert Parry



Why is the U.S. mainstream media so frightened of a documentary that debunks the beloved story of how “lawyer” Sergei Magnitsky uncovered massive Russian government corruption and died as a result? If the documentary is as flawed as its critics claim, why won’t they let it be shown to the American public, then lay out its supposed errors, and use it as a case study of how such fakery works?

Instead we – in the land of the free, home of the brave – are protected from seeing this documentary produced by filmmaker Andrei Nekrasov who was known as a fierce critic of Russian President Vladimir Putin but who in this instance found the West’s widely accepted Magnitsky storyline to be a fraud.

Instead, last week, Senate Judiciary Committee members sat in rapt attention as hedge-fund operator William Browder wowed them with a reprise of his Magnitsky tale and suggested that people who have challenged the narrative and those who dared air the documentary one time at Washington’s Newseum last year should be prosecuted for violating the Foreign Agent Registration Act (FARA).

It appears that Official Washington’s anti-Russia hysteria has reached such proportions that old-time notions about hearing both sides of a story or testing out truth in the marketplace of ideas must be cast aside. The new political/media paradigm is to shield the American people from information that contradicts the prevailing narratives, all the better to get them to line up behind Those Who Know Best.

Nekrasov’s powerful deconstruction of the Magnitsky myth – and the film’s subsequent blacklisting throughout the “free world” – recall other instances in which the West’s propaganda lines don’t stand up to scrutiny, so censorship and ad hominem attacks become the weapons of choice to defend “perception management” narratives in geopolitical hot spots such as Iraq (2002-03), Libya (2011), Syria (2011 to the present), and Ukraine (2013 to the present).

But the Magnitsky myth has a special place as the seminal fabrication of the dangerous New Cold War between the nuclear-armed West and nuclear-armed Russia.

In the United States, Russia-bashing in The New York Times and other “liberal media” also has merged with the visceral hatred of President Trump, causing all normal journalistic standards to be jettisoned.

A Call for Prosecutions

Browder, the American-born co-founder of Hermitage Capital Management who is now a British citizen, raised the stakes even more when he testified that the people involved in arranging a one-time showing of Nekrasov’s documentary, “The Magnitsky Act: Behind the Scenes,” at the Newseum should be held accountable under FARA, which has penalties ranging up to five years in prison.

Browder testified: “As part of [Russian lawyer Natalie] Veselnitskaya’s lobbying, a former Wall Street Journal reporter, Chris Cooper of the Potomac Group, was hired to organize the Washington, D.C.-based premiere of a fake documentary about Sergei Magnitsky and myself. This was one the best examples of Putin’s propaganda.

“They hired Howard Schweitzer of Cozzen O’Connor Public Strategies and former Congressman Ronald Dellums to lobby members of Congress on Capitol Hill to repeal the Magnitsky Act and to remove Sergei’s name from the Global Magnitsky bill. On June 13, 2016, they funded a major event at the Newseum to show their fake documentary, inviting representatives of Congress and the State Department to attend.

“While they were conducting these operations in Washington, D.C., at no time did they indicate that they were acting on behalf of Russian government interests, nor did they file disclosures under the Foreign Agent Registration Act. United States law is very explicit that those acting on behalf of foreign governments and their interests must register under FARA so that there is transparency about their interests and their motives.

“Since none of these people registered, my firm wrote to the Department of Justice in July 2016 and presented the facts. I hope that my story will help you understand the methods of Russian operatives in Washington and how they use U.S. enablers to achieve major foreign policy goals without disclosing those interests.”

Browder’s Version

While he loosely accused a number of Americans of felonies, Browder continued to claim that Magnitsky was a crusading “lawyer” who uncovered a $230 million tax-fraud scheme carried out ostensibly by Browder’s companies but, which, according to Browder’s account, was really engineered by corrupt Russian police officers who then arrested Magnitsky and later were responsible for his death in a Russian jail.

Browder’s narrative has received a credulous hearing by Western politicians and media already inclined to think the worst of Putin’s Russia and willing to treat Browder’s claims as true without serious examination. However, beyond the self-serving nature of Browder’s tale, there are many holes in the story, including whether Magnitsky was really a principled lawyer or instead a complicit accountant.

According to Browder’s own biographical description of Magnitsky, he received his education at the Plekhanov Institute in Moscow, a reference to Plekhanov Russian University of Economics, a school for finance and business, not a law school.

Nevertheless, the West’s mainstream media – relying on the word of Browder – has accepted Magnitsky’s standing as a “lawyer,” which apparently fits better in the narrative of Magnitsky as a crusading corruption fighter rather than a potential co-conspirator with Browder in a complex fraud, as the Russian government has alleged.

Browder’s mother also has described her son as an accountant, although telling Nekrasov in the documentary “he wasn’t just an accountant; he was interested in lots of things.” In the film, the “lawyer” claim is also disputed by a female co-worker who knew Magnitsky well. “He wasn’t a lawyer,” she said.

In other words, on this high-profile claim repeated by Browder again and again, it appears that presenting Magnitsky as a “lawyer” is a convenient falsehood that buttresses the Magnitsky myth, which Browder constructed after Magnitsky’s death from heart failure while in pre-trial detention.

But the Magnitsky myth took off in 2012 when Browder sold his tale to neocon Senators Ben Cardin, D-Maryland, and John McCain, R-Arizona, who threw their political weight behind a bipartisan drive in Congress leading to the passage of the Magnitsky sanctions act, the opening shot in the New Cold War.

A Planned Docudrama

Browder’s dramatic story also attracted the attention of Russian filmmaker Andrei Nekrasov, a well-known critic of Putin from previous films. Nekrasov set out to produce a docudrama that would share Browder’s good-vs.-evil narrative to a wider public.

Nekrasov devotes the first half hour of the film to allowing Browder to give his Magnitsky account illustrated by scenes from Nekrasov’s planned docudrama. In other words, the viewer gets to see a highly sympathetic portrayal of Browder and Magnitsky as supposedly corrupt Russian authorities bring charges of tax fraud against them.

However, Nekrasov’s documentary project takes an unexpected turn when his research turns up numerous contradictions to Browder’s storyline, which begins to look more and more like a corporate cover story. For instance, Magnitsky’s mother blames the negligence of prison doctors for her son’s death rather than a beating by prison guards as Browder had pitched to Western audiences.

Nekrasov also discovered that a woman who had worked in Browder’s company blew the whistle before Magnitsky talked to police and that Magnitsky’s original interview with authorities was as a suspect, not a whistleblower. Also contradicting Browder’s claims, Nekrasov notes that Magnitsky doesn’t even mention the names of the police officers in a key statement to authorities.

When one of the Browder-accused police officers, Pavel Karpov, filed a libel suit against Browder in London, the case was dismissed on technical grounds because Karpov had no reputation in Great Britain to slander. But the judge seemed sympathetic to the substance of Karpov’s complaint.

Browder claimed vindication before adding an ironic protest given his successful campaign to prevent Americans and Europeans from seeing Nekrasov’s documentary.

“These people tried to shut us up; they tried to stifle our freedom of expression,” Browder complained. “[Karpov] had the audacity to come here and sue us, paying high-priced libel lawyers to come and terrorize us in the U.K.”

The ‘Kremlin Stooge’ Slur

A pro-Browder account published at the Daily Beast on July 25 – attacking Nekrasov and his documentary – is entitled “How an Anti-Putin Filmmaker Became a Kremlin Stooge,” a common slur used in the West to discredit and silence anyone who dares question today’s Russia-hating groupthink.

The article by Katie Zavadski accuses Nekrasov of being in the tank for the Kremlin and declares that “The movie is so flattering to the Russian narrative that Pavel Karpov — one of the police officers accused of being responsible for Magnitsky’s death — plays himself.”

But that’s not true. In fact, there is a scene in the documentary in which Nekrasov invites the actor who plays Karpov in the docudrama segment to sit in on an interview with the real Karpov. There’s even a clumsy moment when the actor and police officer bump into a microphone as they shake hands, but Zavadski’s falsehood would not be apparent unless you had somehow gotten access to the documentary, which has been effectively banned in the West.

In the documentary, Karpov, the police officer, accuses Browder of lying about him and specifically contests the claim that he (Karpov) used his supposedly ill-gotten gains to buy an expensive apartment in Moscow. Karpov came to the interview with documents showing that the flat was pre-paid in 2004-05, well before the alleged hijacking of Browder’s firms.

Karpov added wistfully that he had to sell the apartment to pay for his failed legal challenge in London, which he said he undertook in an effort to clear his name. “Honor costs a lot sometimes,” the police officer said.

Karpov also explained that the investigations of Browder’s tax fraud started well before the Magnitsky controversy, with an examination of a Browder company in 2004.

“Once we opened the investigation, a campaign in defense of an investor started,” Karpov said. “Having made billions here, Browder forgot to tell how he did it. So it suits him to pose as a victim. … Browder and company are lying blatantly and constantly.”

However, since virtually no one in the West has seen this interview, you can’t make your own judgment as to whether Karpov is credible or not.

A Painful Recognition

Yet, in reviewing the case documents and noting Browder’s inaccurate claims about the chronology, Nekrasov finds his own doubts growing. He discovers that European officials simply accepted Browder’s translations of Russian documents, rather than checking them independently. A similar lack of skepticism prevailed in the United States.

In other words, a kind of trans-Atlantic groupthink took shape with clear political benefits for those who went along and almost no one willing to risk the accusation of being a “Kremlin stooge” by showing doubt.

As the documentary proceeds, Browder starts avoiding Nekrasov and his more pointed questions. Finally, Nekrasov hesitantly confronts the hedge-fund executive at a party for Browder’s book, Red Notice, about the Magnitsky case.

The easygoing Browder of the early part of the documentary — as he lays out his seamless narrative without challenge — is gone; instead, a defensive and angry Browder appears.

“It’s bullshit,” Browder says when told that his presentations of the documents are false.

But Nekrasov continues to find more contradictions and discrepancies. He discovers evidence that Browder’s web site eliminated an earlier chronology that showed that in April 2008, a 70-year-old woman named Rimma Starova, who had served as a figurehead executive for Browder’s companies, reported the theft of state funds.

Nekrasov then shows how Browder’s narrative was changed to introduce Magnitsky as the whistleblower months later, although he was then described as an “analyst,” not yet a “lawyer.”

As Browder’s story continues to unravel, the evidence suggests that Magnitsky was an accountant implicated in manipulating the books, not a crusading lawyer risking everything for the truth.

A Heated Confrontation

In the documentary, Nekrasov struggles with what to do next, given Browder’s financial and political clout. Finally securing another interview, Nekrasov confronts Browder with the core contradictions of his story. Incensed, the hedge-fund executive rises up and threatens the filmmaker.

“I’d be very careful going out and trying to do a whole sort of thing about Sergei [Magnitsky] not being the whistleblower, it won’t do well for your credibility on this show,” Browder said. “This is sort of the subtle FSB version,” suggesting that Nekrasov was just fronting for the Russian intelligence service.

In the pro-Browder account published at the Daily Beast on July 25, Browder described how he put down Nekrasov by telling him, “it sounds like you’re part of the FSB. … Those are FSB questions.”

But that phrasing is not what he actually says in the documentary, raising further questions about whether the Daily Beast reporter actually watched the film or simply accepted Browder’s account of it. (I posed that question to the Daily Beast’s Katie Zavadski by email, but have not gotten a reply.)

The documentary also includes devastating scenes from depositions of a sullen and uncooperative Browder and a U.S. government investigator, who acknowledges relying on Browder’s narrative and documents in a related case against Russian businesses.

In an April 15, 2015 deposition of Browder, he, in turn, describes relying on reports from journalists to “connect the dots,” including the Organized Crime and Corruption Reporting Project (OCCRP), which is funded by the U.S. government and financial speculator George Soros. Browder said the reporters “worked with our team.”

While taking money from the U.S. Agency for International Development and Soros, the OCCRP also targeted Ukraine’s elected President Viktor Yanukovych with accusations of corruption prior to the Feb. 22, 2014 coup that ousted Yanukovych, an overthrow that was supported by the U.S. State Department and escalated the New Cold War with Russia.

OCCRP played a key role, too, in the so-called Panama Papers, purloined documents from a Panamanian law firm that were used to develop attack lines against Russian President Vladimir Putin although his name never appeared in the documents.

After examining the money-movement charts published by OCCRP about the Magnitsky case, Nekrasov notes that the figures don’t add up and wonders how journalists could “peddle these wooly maths.” He also observed that OCCRP’s Panama Papers linkage of Magnitsky’s $230 million fraud and payments to an ally of Putin made no sense because the dates of the Panama Papers transactions preceded the dates of the alleged Magnitsky fraud.

The Power of Myth

Nekrasov suggests that the power of Browder’s convoluted story rested, in part, on a Hollywood perception of Moscow as a place where evil Russians lurk around every corner and any allegation against “corrupt” officials is believed. The Magnitsky tale “was like a film script about Russia written for the Western audience,” Nekrasov says.

But the Browder’s narrative also served a strong geopolitical interest to demonize Russia at the dawn of the New Cold War.

In the documentary’s conclusion, Nekrasov sums up what he had discovered: “A murdered hero as an alibi for living suspects.” He then ponders the danger to democracy: “So do we allow graft and greed to hide behind a political sermon? Will democracy survive if human rights — its moral high ground — is used to protect selfish interests?”

But Americans and Europeans are being spared the discomfort of having to answer that question or to question their representatives about the failure to skeptically examine this case that has pushed the planet on a course toward a possible nuclear war.

Instead, the mainstream Western media has hurled insults at Nekrasov even as his documentary is blocked from any significant public viewing.

Despite Browder’s professed concern about the London libel case that he claimed was an attempt “to stifle our freedom of expression,” he has sicced his lawyers on anyone who might be thinking about showing Nekrasov’s documentary to the public.

The documentary was set for a premiere at the European Parliament in Brussels in April 2016, but at the last moment – faced with Browder’s legal threats – the parliamentarians pulled the plug. Nekrasov encountered similar resistance in the United States. There were hopes to show the documentary to members of Congress but the offer was rebuffed. Instead a room was rented at the Newseum near Capitol Hill.

Browder’s lawyers then tried to strong arm the Newseum, but its officials responded that they were only renting out a room and that they had allowed other controversial presentations in the past.

“We’re not going to allow them not to show the film,” said Scott Williams, the Newseum’s chief operating officer. “We often have people renting for events that other people would love not to have happen.”

In an article about the controversy in June 2016, The New York Times added that “A screening at the Newseum is especially controversial because it could attract lawmakers or their aides.”

One-Time Showing

So, Nekrasov’s documentary got a one-time showing with a follow-up discussion moderated by journalist Seymour Hersh. However, except for that audience, the public of the United States and Europe has been essentially shielded from the documentary’s discoveries, all the better for the Magnitsky myth to retain its power as a seminal propaganda moment of the New Cold War.

After the Newseum presentation, a Washington Post editorial branded Nekrasov’s documentary Russian “agit-prop” and sought to discredit Nekrasov without addressing his many documented examples of Browder’s misrepresenting both big and small facts in the case.

Instead, the Post accused Nekrasov of using “facts highly selectively” and insinuated that he was merely a pawn in the Kremlin’s “campaign to discredit Mr. Browder and the Magnitsky Act.”

Like the recent Daily Beast story, which falsely claimed that Nekrasov let the Russian police officer Karpov play himself, the Post misrepresented the structure of the film by noting that it mixed fictional scenes with real-life interviews and action, a point that was technically true but willfully misleading because the fictional scenes were from Nekrasov’s original idea for a docudrama that he shows as part of explaining his evolution from a believer in Browder’s self-exculpatory story to a skeptic.

But the Post’s deception – like the Daily Beast’s falsehood – is something that almost no American would realize because almost no one has gotten to see the film.

The Post’s editorial gloated: “The film won’t grab a wide audience, but it offers yet another example of the Kremlin’s increasingly sophisticated efforts to spread its illiberal values and mind-set abroad. In the European Parliament and on French and German television networks, showings were put off recently after questions were raised about the accuracy of the film, including by Magnitsky’s family.

“We don’t worry that Mr. Nekrasov’s film was screened here, in an open society. But it is important that such slick spin be fully exposed for its twisted story and sly deceptions.”

The Post’s arrogant editorial had the feel of something you might read in a totalitarian society where the public only hears about dissent when the Official Organs of the State denounce some almost unknown person for saying something that almost no one heard.

It is also unlikely that Americans and Europeans will get a chance to view this blacklisted documentary in the future. In an email exchange, the film’s Norwegian producer Torstein Grude told me that “We have been unsuccessful in releasing the film to TV so far. ZDF/Arte [a major European network] pulled it from transmission a few days before it was supposed to be aired and the other broadcasters seem scared as a result. Netflix has declined to take it. …

“The film has no other release at the moment. Distributors are scared by Browder’s legal threats. All involved financiers, distributors, producers received thick stacks of legal documents (300+ pages) threatening lawsuits should the film be released.” [Grude sent me a special password so I could view the documentary on Vimeo.]

The blackout continues even though the Magnitsky issue and Nekrasov’s documentary have become elements in the recent controversy over a meeting between a Russian lawyer and Donald Trump Jr. [See Consortiumnews.com’s “How Russia-gate Met the Magnitsky Myth.”]

So much for the West’s vaunted belief in freedom of expression and the democratic goal of encouraging freewheeling debates about issues of great public importance. And, so much for the Post’s empty rhetoric about our “open society.”




























ACLU to Coal CEO Suing John Oliver: 'You Can't Sue People for Being Mean to You'











https://www.ecowatch.com/john-oliver-bob-murray-2468261760.html


The American Civil Liberties Union of West Virginia filed a shade-filled brief Tuesday supporting HBO's John Oliver in his legal battle with a coal executive.
Murray Energy and CEO Robert Murray filed a defamation suit against Oliver and HBO earlier this summer, claiming a June 18 segment was a "false" attack on the industry and on Murray, and later sought a gag order from the late-night host.
"Bob Murray thinks John Oliver was mean to him, and he doesn't want him to be mean again," the ACLU's Jamie Lynn Crofts wrote in the brief. "While that is sad for Bob Murray, it is unconstitutional for a court to order such relief."





https://www.youtube.com/watch?v=aw6RsUhw1Q8























Border Police officer fires sponge round at Palestinian, then hits him with a gun, 10 March 2017










https://www.youtube.com/watch?v=E7vRpQ8-6KU










































What the US "Health Care Reform" Debate Did Not Address













Posted by Roy M. Poses MD











It looks like the bizarre process in the US Senate ostensibly to "repeal and replace Obamacare" (aka the Affordable Care Act, or ACA) may be ending, at least for now.  I can only hope that further discussion of health care reform will let sanity prevail, and start to address the major issues that have led to the massive dysfunction of US health care, but were not discussed during the latest kerfuffle (and not even discussed much in the real debate that preceded the introduction of the ACA.)


On Health Care Renewal we have discussed some of the issues that have received much less attention than the Senate process and the push by the Trump administration to get rid of Obamacare.  I submit the country needs to revisit these issues (and in some cases face them for the first time).


Health Care Dysfunction


Despite some protestations to the contrary (e.g., here), the US health care system has been plagued by dysfunction.  According to a recent Commonwealth Fund study, the US was ranked 11 out of 11 in health care quality, but 1 out of 11 in costs.  Traditionally, health care reform has targeted ongoing problems in the cost, accessibility and quality of health care.  The ACA notably seems to have improved access, but hardly addressed cost or quality.


Early on we noticed a number of factors that seemed enable increasing dysfunction, but were not much discussed.  These factors notably distorted how medical and health care decisions were made, leading to overuse of excessively expensive tests and treatments that provided minimal or no benefits to outweight their harms.


Threats to the Integrity of the Clinical Evidence Base


Evidence-based medicine advocates making decisions for individual patients based on critical review of the best evidence from clinical research to make decisions that will provide patients with the most benefits and the least harms.  However, the clinical evidence has been increasingly affected by manipulation of research studies, including aspects of their design, implementation, and analysis.  Such manipulation may benefit research sponsors, now often corporations who seek to sell products like drugs and devices and health care services.  Manipulation may be more likely when research is done by for-profit contract research organizastions (CROs) which may get more busines when they can produce results to fit the sponors' interests. When research manipulation failed to produce results to sponsors' liking, research studies could simply be suppressed or hidden.  The distorted research that was thus selectively produced was further enhanced by biased research dissemination, including ghost-written articles ghost-managed by for-profit medical education and communications companies (MECCs). Furthermore, manipulation and suppression of clinical research may be facilitated by health care professionals and academics conflicted by financial ties to research sponsors.  Clinical decision making based on evidence delibrately biased to favor particular products or services is liable to distortion, and the overuse of products and services that are excessively expensive, useless, and/or harmful.


Deceptive Marketing


The distorted evidence base was an ingredient that proved useful in deceptive marketing of health care products and services. Stealth marketing campaigns became ultimate examples of decpetive marketing.  Deceptive marketing was further enabled by the use of health care professionals paid as marketers by health care corporations, but disguised as unbiased key opinion leaders, another example of the perils of deliberate generation of  conflicts of interest affecting health care professionals and academics.  These extensive deceptive marketing efforts likely have induced again the overuse of products and services that are excessively expensive, useless, and/or harmful.


Distortion of Health Care Regulation Policy Making


Similarly, promotion of health policies that allowed overheated selling of overpriced and over-hyped health care products and services included various deceptive public relations practices, including orchestrated stealth health policy advocacy campaigns.  Third party strategies used patient advocacy organizations and medical societies that had institutional conflicts of interest due to their funding from companies selling health care products and services, or to the influence of conflicted leaders and board members.  Some deceptive public relations campaigns were extreme enough to be characterized as propaganda or disinformation.  


Furthermore, companies selling health care products and services further enhanced their positions through regulatory capture, that is, through their excessive influence on government regulators and law enforcement.  Their efforts to skew policy were additionally enabled by the revolving door, a species of conflict of interest in which people freely transitioned between health care corporate and government leadership positions.



Bad Leadership and Governance


A major factor driving various distortions of medical and health care policy making which could have increased costs, decreased access, and threaten quality was bad leadership and governance of the organizations involved.


Health care leadership was often ill-informed.  More and more people leading non-profit, for-profit and government have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research. One could view recent legislative efforts to "repeal and replace Obamacare," which largely shut out the input of health care professionals and health policy experts as a giant example of apparently deliberately ill-informed leadership.  Obviously health care and health policy decisions made by ill-informed people are likely to have detrimental effects on patients' and the public's health.


Health care leaders often were unfamiliar with, unsympathetic to, or frankly hostile to their organizations' health care mission, and/or health care professionals' values.  The most recent example we have posted was a hospital CEO who allegedly over-ruled medical leadership to hire a surgeon despite reports that his patients died more frequently than expected, gamed reports of clinic utilization, and associated with organized crime (look here).


Health care leaders were driven by perverse incentives that prioritized financial goals over patient care.  Executives may received millions of dollars despite reports of poor clinical results or unethical behavior.  We have seen executives get raises after their companies made huge legal settlements of allegations of kickbacks or fraud.  The hospital executive mentioned above was receiving $1.7 million a year, plus perks like a car and driver.  Obviously, providing incentives that disregard patients' and public health outcomes and unethical behavior can induce decisions that lead to excess costs, insufficient access, and poor health care quality.


Health care leaders often had their own conflicts of interest.  For example, leaders of academic medicine frequently had financial relationships with corporations that sold health care products or services. In one study, approximately 60% of academic department chairs had such conflicts.  These included being consultants, paid key opinion leaders (as noted above), or even serving as corporate executives or members of boards of directors (e.g., see our first post on this phenomenon in 2006 here, and this article documenting the frequency of such conflicts.)   The latter conflict of interest is particularly concerning because directors of for-profit corporations are supposed to have unyielding loyalty to the interests of the corporation and its stockholders, although they are frequently accused of acting mainly as cronies of the top hired executives (see here and here).  Leaders who have such conflicts might be biased in favor of their corporate benefactors' interests even when they conflicted with their institutions' missions. 


Moreover, we have found numerous examples of frank corruption of health care leadership.  Some have resulted in legal cases involving charges of bribery, kickbacks, or fraud.  Some have resulted in criminal convictions, albeit usually of corporate entities, not individuals.  One would hardly expect corrupt leadership to put patients' and the public's health ahead of the leaders' ongoing enrichment.


Health care leaders in the private sector (non-profit or for-profit) are supposed to operate under the governance of boards of trustees or boards of directors.  However, these boards may be populated by the leaders' cronies, and fellow corporate executives, but often not by people who primarily represent the interests of patients or the public at large.  Such governance has proven to be opaque, fail to be accountable to patients and the public, and sometimes conflicted (e.g., non-profit trustees who are executives of for-profit health care corporations).  Such governance would be unlikely to restrain bad decision making driven by bad leadership. 


Over-Arching Trends


Finally, bad health care leadership and governance has been enabled by series of over-arching trends.



Health care increasingly dominated by ever larger and more powerful organizations.  Such concentration of
power may be facilitated by uninformed regulatory changes, and regulatory capture by private interests.  Concentration of power in industries outside of health care, which may culminate in the formation of oligopolies and even monopolies, historically has led to increased prices and hurt consumers and workers.  Concentration of power may well be a major factor in rising health care costs, and declining access and health care quality.


Abandonment of Health Care as a Calling



A US Supreme Court decision was interpreted to mean that medical societies could no longer regulate the ethics of their members, leading to the abandonment of traditional prohibitions on the commercial practice of medicine.  Until 1980, the US American Medical Association had  ruled that the practice of medicine should not be "commercialized, nor treated as a commodity in trade."  After then, it ceased trying to maintain this prohibition. Doctors were pushed to be businesspeople, and to give making money the same priority as upholding their oaths.  See posts  here and here.


Meanwhile, hospitals and other organizations that provide medical care are increasingly run as for-profit organizations.  The physicians and other health care professionals they hire are thus providing care as corporate employees, resulting in the rise of the corporate physician.  These health care professionals may befurther torn between their oaths, and the dictates of their corporate managers.  When corporate imperatives to increase revenue prevail, no matter what, the outcome is likely to be worse patient care, higher costs, less access, and worse outcomes.


Perverse Incentives Put Money Ahead of Patients, Education and Research


We have extensively discussed the perverse incentives that seem to rule the leaders of health care. Financial incentives may be large enough to make leaders of health care organizations rich.  Even leaders of non-profit organizations such as academic medical centers and the parent universities of medical schools often make many millions of dollars a year in the US.  Incentives often prioritize financial results over patient care.  Some seem to originate from the shareholder value dogma promoted in business school, which de facto translates into putting current revenue ahead of all other considerations, including patient care, education and research (look here).   Health care leaders may become "value extractors" who put revenue, and the positive incentives they receive from enhancing revenue, ahead of all else (look here).  This may be a leading cause of mission-hostile management.


Cult of Leadership


Top leaders of health care organizations, be they non-profits or at least publicly held for-profit companies, used to be considered hired managers beholden to the organizations' mission, its board, and its various constituencies.  However, such leaders, particularly CEOs, tend now to be regarded as  exalted beings, blessed with brilliance, if not true "visionaries," deserving of ever increasing pay whatever their organizations' performance.  This pheonomenon has been termed "CEO disease" (see this post).  Afflicted leaders tend to be protected from reality by their sycophantic subordinates, and thus to believe their own propaganda.  Leaders in these bubbles tend to make bad decisions, and put their self-interest ahead of patients' and the public's health.    


Leadership of health care organizations by managers with no background in actual health care, public health, or biomedical science has been promoted by the doctrine of managerialism which holds that general management training is sufficient for leaders of  all organizations, regardless of their knowledge of the organizations' fundamental mission.  Ill-informed management may result from leaders who have no background or training in actual health care.  Managers lacking understanding of or sympathy towards health care professionals' values may be more likely to practice mission-hostile management.


Impunity Enabling Corrupt Leadership


Leaders of health care organizations increasingly have conflicts of interest, as noted above. Such conflicts may be risk factors for actual corruption (as defined by Transpaency International, the abuse of entrusted power for private gain).   Also as noted above, we have found numerous examples of frank corruption of health care leadership.  Some have resulted in legal cases involving charges of bribery, kickbacks, or fraud.  Some have resulted in criminal convictions, usually of corporate entities.  Corrupt leadership obviously can distort, if not ruin decision making, and channel large sums of money into private pockets. 


In the US, nearly all cases involving corruption in large health care organizations are resolved by legal settlements.  Such settlements may include fines paid by the corporations, but not by any individuals.  Such fines are usually small compared to the revenue generated by the corrupt behavior, and may be regarded as costs of doing business.  Sometimes the organizations have to sign deferred prosecution or corporate integrity agreements.  The former were originally meant to give young, non-violent first offenders a second chance (look here).  However, in most instances in which corruption became public, are no negative consequences ensue for the leaders of the organizations on whose watch corrupt behavior occurred, or who may have enabled, authorized, or directed the behaviors.  Since no individuals suffer negative consequences, the deterrent effect of such settlements on future corrupt behavior is likely to be nil. 


Taboos



When we started Health Care Renewal, such issues as suppression and manipulation of research, and health care professionals' conflicts of interests rarely appeared in the media or in medical and health care scholarly literature.  While these issues are now more often publicly discussed, most of the other topics listed above still rarely appear in the media or scholarly literature, and certainly seem to appear much less frequently than their importance would warrant.  For example, a survey by Transparency International showed that 43% of US resondents thought that American health care is corrupt.  It was covered by this blog, but not by any major US media outlet or medical or health care journal.  We have termed the failure of such issues to create any echoes of public discussion the anechoic effect.


Public discussion of the issues above might discomfit those who personally profit from the status quo in health care.  As we noted above, the people who profit the most, those involved in the leadership and governance of health care organizations and their cronies, also have considerable power to damp down any public discussion that might cause them displeasure. In particular, we have seen how those who attempt to blow the whistle on what really causes health care dysfunction may be persecuted.  But, if we cannot even discuss what is really wrong with health care, how are we going to fix it?


Real Health Care Reform


After the ACA became law, we noted that while it had some worthwhile provisions, it hardly addressed the concerns we had been raising to that point. Nonetheless, these deficiences were hardly raised by any of those advocating "repeal and replace."


Now that perhaps more sober heads a are prevailing, maybe it is time to consider some of the real causes of health care dysfunction that true health care reform needs to address, no matter how much that distresses those who currently most personally profit from the status quo.





















Oliver Stone et al. on the irrational dismissal of Russia








https://www.youtube.com/watch?list=PLZNV4DrfcAmFC9o6HXPjNvKaqrDlSXz7X&v=TEJ5DXO4MsI