Saturday, October 5, 2019
Corporate Journalists Push Tax Attack on Medicare for All
JULIE HOLLAR
OCTOBER 2, 2019
https://fair.org/home/corporate-journalists-push-tax-attack-on-medicare-for-all/?awt_l=7pV2m&awt_m=h2A2nc7fg0OI_TQ
Most people really like the idea of Medicare for All. So it will take a concerted effort to persuade them they actually don’t like it—and corporate media are more than happy to pitch in.
Bloomberg‘s Sahil Kapur reported (9/23/19) that centrist think tank Third Way commissioned an August poll on how to turn people off of Medicare for All, and one of the strongest tactics turned out to be emphasizing what the plan would cost taxpayers. Lo and behold, the tax line has become a central focus of media coverage of Medicare for All.
It’s not the first poll to try out different arguments on Medicare for All; the Kaiser Family Foundation put out a poll in January (1/23/19) that gave people varying bits of information about the program to see how such knowledge changed their view of it. When simply asked if they favored a national healthcare plan, people gave Medicare for All a +14 net favorability rating. When told it would “require most Americans to pay more in taxes,” that plummeted to -23. On the other hand, when told it would “eliminate all health insurance premiums and reduce out-of-pocket health care costs for most Americans,” Medicare for All’s favorability rating soared to +37.
Obviously, messaging matters. Sure, people don’t like taxes—but ultimately most people care very little whether their personal financial obligation for healthcare is paid to the government or to a private insurer; what they care about is how much they’re paying. For most people—and for poor and middle-class people in particular—those total costs should go down under Medicare for All. The responsible thing to do, from the journalist’s perspective, would be to clarify what people would be paying overall for their healthcare under different candidates’ plans, not to cherry pick half the equation.
But that would assume a responsible media.
Journalists wielding the Kaiser poll often reported only the parts that included the negative messaging. In the Washington Post (8/14/19) , for example, Sean Sullivan quoted only the finding about higher taxes causing reduced support. He followed with a counter from Sanders’ camp, that “it would be more than offset by savings they would achieve from not having to pay healthcare premiums and other associated costs”—but then why not provide the relevant finding from the poll that that information caused an even larger increase in support?
When Bernie Sanders appeared on ABC‘s This Week on June 30, George Stephanopoulos presented him with the Kaiser poll’s finding about the information that reduced support for Medicare for All, including higher taxes and eliminating private insurance, conveniently ignoring the information that increases support. “So it appears you’re pushing something people say they don’t want,” Stephanopoulos concluded.
When Sanders explained the missing information—that when you tell Americans that their benefits would be expanded and their costs would go down, support increases—Stephanopoulos was obstinate:
But as you know, for a lot of Democrats, the question is how you get there. And it’s true. You tell people you’re going to raise their taxes, support goes down. You tell people that they can’t have private health insurance, support goes down. And that’s led to some of your opponents to say, yeah, how about Medicare for everyone who wants it, and if it works, if this public option works, then the private health insurance are going to wither away anyway.
Sanders replied:
If I said to you, George, let’s say you’re self-employed and you’re spending $15,000 or $20,000 a year out of pocket expenses, premiums and so forth. And I said, George, you’re going to pay $7,000, $8,000 more in taxes, but you’re not going to have to pay your premiums. You’re probably going to say, where can I sign up? People are going to spend less on Medicare for All.
Stephanopoulos, apparently trying to be tough, gave a nonsensical final reply:
I’ll tell you what I might say, senator. I might say, senator, those taxes are going to be certain. Those taxes are coming no matter what, with the hope that your program is going to work.
Actually, if Stephanopoulos were being honest, he would admit that as someone who makes $15 million or more a year, he’s one of the few people whose taxes would likely go up more than his premiums would go down.
Stephanopoulos stuck with the tax question when he was given the opportunity to ask healthcare questions in the ABC-hosted debate (9/12/19):
Senator Warren, let me take that to you, particularly on what Senator Biden was saying there about healthcare. He has actually praised Bernie Sanders for being candid about his healthcare plan…about the fact that middle-class taxes are going to go up and most of private insurance is going to be eliminated. Will you make that same admission?
Stephanopoulos kept that conversation going for four more of the debate’s 15 healthcare questions.
Sanders has spelled out his answer on taxes many times, but some journalists just can’t let it go. For instance, take this statement he made to CNN‘s Jake Tapper (7/28/19):In the CNN debate (7/30/19), too, the journalist moderators raised the specter of taxes, asking Warren whether she was ” ‘with Bernie’ on Medicare for All when it comes to raising taxes on middle-class Americans to pay for it?”—and sticking with the question for the next four prompts.
I do believe that, in a progressive way, people will have to pay taxes. The wealthy will obviously pay the lion’s share of those taxes. But at the end of the day, the vast majority of the American people will pay substantially less for the healthcare that they now receive, because we’re going to do away with hundreds of billions of dollars of administrative waste. We’re going to do away with the incredible profiteering of the insurance companies and the drug companies. So people will be paying, in some cases, more in taxes, but, overall, because they’re not going to pay premiums, deductibles, co-payments, they will be paying less for their healthcare.
Pretty clear, right? Not to Tapper, who hung on to the taxation frame:
So, is Vice President Biden correct that anybody who says Medicare for all is going to happen, but we’re not going to raise taxes on anybody or on the middle class is a fantasy world?
Sanders tried to explain again:
Well, obviously, healthcare is not free. Right now, we pay it for through premiums and out-of-pocket expenses. In Canada, it’s paid through taxes. We will have to do that.
Tapper (estimated income: $4 million) just kept going:
A senior aide to former Vice President Biden is laying out his campaign’s debate strategy in a new memo that they issued this weekend. This strategist writes—quote—”He’s going to draw contrasts where there are policy disagreements in the field, like on healthcare. Booker, Gillibrand, Harris and Warren all have signed on to Bernie Sanders’ Medicare for all plan, which means higher taxes on the middle class. That’s a nonstarter for Joe Biden.”
It’s unclear how Tapper thought Sanders could answer the same question yet another way.
CNN‘s Erin Burnett went into a similar spin cycle two weeks earlier (7/15/19), urging Biden spokesperson Symone Sanders (with remarkable alacrity and specificity) to make a tax-based attack on Bernie Sanders’ healthcare plan:
As a general idea, Symone, a lot of people like the idea of Medicare for All, right? And that’s in part because it sort of rings like it’s free, Medicare for All, right? But it is not free. It has an estimated price tag of $3 trillion a year. People who are on Medicare could pay huge amounts of money out of pocket for things like cancer drugs, which almost certainly means payroll tax, income tax increases, right? It is not free, but it sounds that way to a lot of people. How can you explain that to Democratic-based voters that Medicare for All may sound good but doesn’t really come out that way?
After Symone Sanders tried to talk about Biden’s own healthcare proposal instead of attacking Medicare for All, Burnett (who makes an estimated $3 million a year) held on tight: “Are you trying to explain to voters that Medicare for All is not free, right? It comes at immense cost. You’re trying to come up with another option.”
After still more resistance, Burnett replied: “I get what you’re saying. You want to talk about yours and not theirs. But the reason I’m pushing so hard on this is that [Medicare for All] is popular.”
Jim Kessler, Third Way’s executive vice president for policy, told Bloomberg‘s Kapur (9/23/19) that their poll shows that “Trump is deeply underwater on healthcare and the only lifeline that could pull him to shore is Medicare for All.”
Actually, Trump’s lifeline is not Medicare for All, which—as Burnett and the rest know—is quite popular. It’s Kessler and the corporate journalists who are doing their survey-informed best to sink that popular, life-saving plan.
Joe Biden’s son listed as director at China-backed equity firm, government filings show
Former US vice-president Joe Biden’s son is listed as a director of a state-backed equity fund in China, official government filings show
Pictures of Hunter Biden have been removed from the website of BHR Equity Investment Fund Management Company, but role is unchanged
Cissy Zhou
Amanda Lee
Published: 6:45 am, 5 Oct, 2019
https://www.scmp.com/economy/china-economy/article/3031632/joe-bidens-son-listed-director-china-backed-equity-firm
Hunter Biden, the son of former United States vice-president Joe Biden, is listed as a director of a state-backed equity fund in China, but public records do not appear to support claims by US President Donald Trump that he used his father’s connections to secure Chinese capital for his investments.
Trump on Thursday called on
China to investigate Biden, now a leading Democratic presidential candidate, and his son, alleging the younger Biden used his position of influence to secure US$1.5 billion in funding from the government-owned Bank of China for a private equity firm he was involved in and made millions in the process.
Filings in China’s National Enterprise Credit Information Publicity System database show that Hunter Biden is listed as a director of BHR Equity Investment Fund Management Company, a company incorporated in December 2013 with registered capital of 30 million yuan, or about US$4 million at the current exchange rate.
The private equity firm reshuffled its board of directors on September 18, according to filings, but the younger Biden’s role at the company remained unchanged. All pictures of Hunter have been removed from the BHR website.
In October 2017, Hunter spent about US$420,000 for a 10 per cent stake in BHR, according to a report in The New York Times, when his father had left office.
According to filings, the newspaper report matches an equity structure change reported on the registry on October 23, when BHR’s former shareholder Rosemont Seneca Bohai ceased to become a shareholder and gave way to Ulysses Diversified and Skaneateles LLC.
Bohai Industrial Investment Fund Management, which is backed by Bank of China, and Ample Harvest Finance, a Shanghai-based private equity firm linked with Chinese investment company Harvest, remained the two largest shareholders. The companies paid 9 million yuan (US$1.2 million) for a 30 per cent equity stake.
Thornton Group paid 3 million yuan (US$420,000) for 10 per cent stake, and a Shanghai company controlled by Jonathan Li, or Li Xiangsheng, also controls a 10 per cent stake, according to the government records.
Hunter became involved with the company through Devon Archer, an American businessman, according to comments made by BHR chief executive Li in the 21st Century Business Herald in 2014.
Li told the paper that he was a friend of Archer and asked him to introduce potential partners while in New York in 2012. “One day, after visiting five or six top private equity firms, Archer, Li and another executive went into a pub in Manhattan. While they were having cigar and relaxing, Archer suddenly offered to Li, ‘hey, do not you think I am the right partner for you?’” the paper reported.
Li said he chose Archer to become a partner because of his “deep” ties to US politics, including Biden’s son, according to the report.
The details match a New Yorker magazine profile of Hunter in July, according to which the younger Biden and Archer talked with the Chinese private equity investor about partnering to raise funds in China, as well as other business opportunities.
Hunter and Archer co-founded Rosemont Seneca, along with Christopher Heinz, the stepson of former Secretary of State John Kerry.
Archer is now embroiled in controversy after Trump tweeted a photograph of him golfing with the elder Biden and his son, labelling the businessman a “Ukraine gas exec” in an apparent bid to highlight his business ties with the Bidens and Ukraine.
Trump is facing impeachment proceedings over allegations he asked the Ukrainian president for help in investigating his political rivals.
Trump has accused Beijing of paying “billions of dollars” in “payoffs” to the Bidens in exchange for beneficial trade treatment.
The US president has said “when Biden’s son walks out of China with $1.5 billion in a fund, and the biggest funds in the world can’t get money out of China, and he’s there for one quick meeting and he flies in on Air Force Two, I think that’s a horrible thing.”
BHR did not reply to phone calls or emails and its corporate office in Beijing was closed to visitors on Friday.
The company is facing challenges investing overseas after Beijing imposed draconian controls on outbound investments in 2016. Its website shows its latest deal was on April 20, 2017.
Additional reporting by Sarah Zheng and Zhou Xin
Whistle-blower Reveals Flawed Construction at North Dakota Gas Plants Where Massive Spill Was Downplayed
By Justin Nobel • Tuesday, October 1, 2019
https://www.desmogblog.com/2019/10/01/whistle-blower-lehto-oneok-north-dakota-gas-plants-spill?utm_source=desmog%20newsletter
Two North Dakota gas processing plants in the heart of the Bakken oil fields have shown signs of an eroded safety culture and startling construction problems, according to Paul Lehto, a 54-year-old former gas plant operator who has come out as a whistle-blower. He described worrisome conditions at the Lonesome Creek plant, in Alexander, and the Garden Creek plant, in Watford City, where DeSmog recently revealed one of the largest oil and gas industry spills in U.S. history had occurred. Both plants process natural gas brought via pipeline from Bakken wells and are run by the Oklahoma-based oil and gas service company, ONEOK Partners.
“The safety culture is embarrassing,” said Lehto, who has described to DeSmog the discovery of dozens of loose bolts along critical sections of piping, and other improperly set equipment, deficiencies he attributes to the frenzied rush of the oil boom that has dominated the state’s landscape and economy. “North Dakota is basically a Petrostate,” said Lehto, who worked at the two plants between 2015 and 2016. “There is regulatory capture, and sure that happens in other areas, but nowhere is it more extreme than in North Dakota.”
“The reason I am coming forward is that while I didn’t think ONEOK was doing their job, I still trusted the state to regulate and do its job,” said Lehto. “But in reading what the state’s response was to the condensate spill, I have lost all confidence that the state is acting as a legitimate regulator.”
Furthermore, a trove of documents received by DeSmog from the North Dakota Department of Environmental Quality (DEQ) under a public records request has revealed that despite state regulators listing the Garden Creek spill as just 10 gallons from 2015 to 2019, an intense multi-year cleanup operation was underway to remove the spilled natural gas condensate from the grounds of the plant. According to a cleanup document, the ground well beneath the plant became saturated with condensate, so much so that even 18 feet down, a “pure gasoline-like odor” was detected.
Also, groundwater at one monitoring well registered the carcinogen benzene at levels nearly 2,000 times that required by the state health department.
DeSmog has also received new information to indicate that the Garden Creek spill, whose size continues to be downplayed in statements to the media by DEQ officials, was indeed officially estimated at 11 million gallons. This puts the release, in terms of gallons spilled, on par with the infamous 1989 Exxon Valdez oil spill in Alaska and secures Garden Creek a spot as one of the largest industry spills in U.S. history. ONEOK has not received any fines from North Dakota regulators for the spill.
“Eleven million gallons just barely underground but steadily evaporating, and lots of benzene which is really nasty stuff,” said Lehto, who says ONEOK never officially informed him about the spill. “It’s like working on a health time bomb, we are the guinea pigs for the largest condensate spill in U.S. history. I am glad I got out but feel sorry for workers still there.”
ONEOK spokesperson Brad Borror rejected the idea that workers are at risk. “We have performed assessments and sampling for our employees and contractors, including soil vapor analysis and indoor and outdoor air monitoring at the facility,” he said.
Ripples in the Wake of DeSmog’s Spill Reporting
The spill, initially reported by DeSmog on August 19, has since been reported in papers across the nation and in every major North Dakota city, and the incident has jostled the state’s typically pro-industry politics. “Oil patch spills and leaks need thorough investigations and timely inspections,” stated an editorial in the Bismarck Tribune in September. “Our present course is to moral bankruptcy.”
A spokesperson for Republican Governor Doug Burgum told DeSmog, “The Governor supports ongoing efforts…to provide unified spill reporting with an increased frequency of report updates in an easily accessible format online.” The spokesperson said the governor also supported “current efforts by the DEQ to review all open spill cases to ensure they are updated with the latest available information.”
But for many North Dakotans, rattled by the runaway industry, these efforts are not nearly enough. “The citizens of North Dakota have a right to accurate information on spills,” Sarah Vogel, a former North Dakota Agriculture Commissioner and assistant attorney general, told DeSmog. “We need to know why workers at the Garden Creek plant reported that only 10 gallons had spilled, and why did the state publish that number and keep publishing that number?”
“It is against the law in North Dakota to knowingly report false information to the state, and to make false state records,” Vogel added. “Weak and vague promises by the Governor, the Attorney General, the Health Department, or the Mineral Resource Division of the Industrial Commission that they will now seek further ‘transparency’ will no longer suffice. We need state and federal law enforcement authorities to do their jobs.”
When asked if the U.S. Environmental Protection Agency’s (EPA) Criminal Enforcement division is investigating the spill, an EPA spokesperson told DeSmog, “EPA does not comment on ongoing or potential criminal investigations.”
Working at Garden Creek, ‘Just Like Homer Simpson’
Paul Lehto traveled to western North Dakota from Michigan in 2014 looking for work and says within hours of arriving in boomtown Watford City he had found a job working as a shift manager at Cash Wise Foods, a local grocery. In April 2015, ONEOK hired him to train as an operator at the Garden Creek Plant. The gas condensate spill was discovered in July that year.
Lehto says working as an operator at Garden Creek was “just like Homer Simpson running a nuclear power plant…you are sitting in front of a bank of computers being able to optimize the amount of propane, ethane, and butane you are getting out as product.” These fossil fuels are used as feedstocks to produce plastics and petrochemicals, among other things.
One of Lehto’s tasks was to inspect the grounds twice a shift, often with an instrument called a “sniffer” that detects volatile organic compounds, which the EPA says are “of concern” as air pollutants, and other hydrocarbon emissions.
“Everywhere I looked I would get readings, sometimes so hot the equipment would actually shut down,” said Lehto, whose Personal Protective Equipment, or PPE, included a fire-resistant uniform, hard hat, steel toe boots, safety glasses, and earplugs but no mask or respirator. “The Garden Creek facility was literally sitting on a lake of spilled condensate.”
Borror with ONEOK put it differently. “The air monitoring assessments have not indicated a need for our plant-based employees and contractors to wear additional PPE, such as respiratory equipment,” he said. “The condensate release occurred in the subsurface soil and remains in the subsurface until it’s recovered using a robust combination of systems.”
How Big Was the Spill, Really?
Just how big that lake of spilled condensate was has been an issue of contention. In August, ONEOK told the Associated Press the numbers quoted in a document DeSmog received from a different whistle-blower were “hypothetical assumptions” and pointed out the report was done by a consultant. This statement was repeated in papers across the country, acting to question the validity of the 11-million-gallon spill figure.
But Lehto pointed out to DeSmog that “11,000,000 is a ONEOK number, not a contractor pulling figures out of thin air.” He cited the document DeSmog initially revealed, which reads, “an ORM estimate of approximately 11 million gallons released.”
“ORM is not a term of art but rather a direct reference to the legal name ONEOK operates under in the Bakken,” Lehto told DeSmog. The acronym, in fact, stands for ONEOK Rockies Midstream. “ORM is one of the ways we referred to ONEOK, and ONEOK Rockies Midstream was the name on my paychecks,” said Lehto.
Furthermore, Lehto says that computers at the Garden Creek plant constantly record pressure on incoming and outgoing pipes and should have recorded data that would enable the operators, or investigators, to figure out exactly how big the spill was.
“The whole idea that they can’t come up with a scientific number is just bullshit, an estimate is usually what you have to deal with in situations like this,” said Lehto. “I mean this is their income, it is in their business interest to know how much was spilled.”
When asked if the discrepancies in spill reporting were grounds for criminal action, Chicago-based energy attorney Paul Neilan told DeSmog, “If you have records at this site that show you are cleaning up hundreds of thousands of gallons and at the same time you are reporting only 10 gallons, that kind of imbalance shows somebody knew something and didn’t want to tell someone else about it.”
Borror, the ONEOK spokesperson, contested that the spill could be measured or even reasonably estimated. “When a liquid is released underground, there are limits to how precisely anyone can estimate the quantity released,” he said. “The estimating challenge is even greater when the release is more a result of seepage rather than a rupture, occurring at too slow of a rate to be detected. Additionally, we don’t know when the release began.”
On September 4, DeSmog informed the North Dakota DEQ that the publication was writing a follow-up on the Garden Creek spill, but the agency has not responded to a new set of questions.
The publicly available DEQ report for the Garden Creek spill received only one update between September 2015 and July 2019, but has been updated 12 times since DeSmog published its August 19 article on the spill. On September 6, a state inspector visited the site and noted that, “As of August 30, 2019, the amount of condensate recovered is estimated at 862,735 gallons.”
Working at Lonesome Creek, a Plague of Loose Bolts
At the Lonesome Creek plant, Lehto began as an operator in the fall of 2015. On April 27, 2016 he was using a sniffer to check for leaks along a series of tanks called slug catchers that are used to draw water and other liquids out of the gas stream when he noticed a leak. The cause, upon inspection, was a set of loose bolts. When Lehto checked other bolts on piping in this area he realized that all of them were loose, dozens in total.
“Every single bolt that I looked at was loose and some could be moved with fingers, which is astonishing since a light bump could trigger a catastrophic pressurized release,” said Lehto.
Many pipes at gas processing plants in North Dakota are covered with insulation to protect against cold during the harsh winters. Typically, when a plant is being constructed, pipes are put in and bolts are set; then, what is known as a “torque team” comes in to firmly tighten down all bolts before the insulation is installed. Lehto suspects that in the rush to get the plant online and product flowing, the critical stage of tightening the bolts was missed.
When asked if loose bolts could have been the cause of the “hairline crack” that ONEOK says triggered the Garden Creek spill, Lehto replied, “Yes, a hairline crack would be one thing that could happen when bolts are not torqued down properly, so it is a good hypothesis.”
Lehto conveyed the loose bolt problem to various ONEOK managers, and filed an internal form meant to convey safety problems on this issue, called a “near miss” form. But he says the general response was dismissive, and the beginning of a trend in which safety issues he spotted were ignored. Eventually he quit, notifying employers in a July 23, 2016 email.
“ONEOK makes remarkably strong statements and claims about safety,” wrote Lehto. “All I’ve attempted to do is follow that, but…I have the unmistakable impression these efforts were quite annoying or bothersome to some others, even as everyone of course says safety is a good thing.”
“Every ONEOK employee is expected to report safety concerns to their supervisor so that issues can be appropriately addressed,” ONEOK spokesperson Borror told DeSmog. “We have a robust system for reporting safety concerns as outlined in ONEOK’s Environmental, Safety and Health Commitment, Code of Business Conduct and Ethics and Whistleblower Policy.”
Lehto said ONEOK policies may look good on paper but are not closely followed. In the resignation letter, he stated that ONEOK employees “scolded” him for finding leaks, something he believed as plant operator it was his job to do. “I always assumed ONEOK wanted to know,” he wrote, “so I worked hard to find issues.” He says that in the time period he was at the plant, other than the series of loose bolts associated with the leak he found by the slug catchers, the dozens of other loose bolts he discovered were never tightened.
“I quit,” Lehto explained to DeSmog, “because I couldn’t work at ONEOK and be honest.”
The Industrialisation of Healthcare/Therapy
Alan Rowan
http://www.thelacanianreviews.com
In June of this year many people in the UK were either shocked or bewildered to hear both the American Ambassador to the UK, and then the US President Donald Trump on his state visit there, state; that any new trade agreement between the US and the UK would require that the National Health Service (NHS) was “on the table”.
In other words, that the public health provision currently supplied by the NHS to the citizens of the UK, who pay for these services through taxes, would be opened up as a market, allowing private and for-profit American companies to bid to provide health services to the UK public in place of the direct “public provision” of healthcare (i.e. via the Government’s Department of Health).
In the UK most people consider the NHS to be one of the great political achievements of the post Second World War era whereby all UK citizens were seen to have an equal right to healthcare, that, moreover, is free at the point of delivery.
There was thus nothing short of a “public outcry” in response to this demand, with most British politicians joining-in, including the then Prime Minister, Theresa May, who stated that Britain would never agree to such a stipulation being imposed as a condition of future “trade talks”.
This then led to a retraction from President Trump who stated that future “trade talks” would not be dependent on this condition being met.
To understand why all of this happened is to appreciate, firstly, the extent to which healthcare has been “industrialised”, and thus has become of prime interest to for-profit capital investment. And secondly, to appreciate the extent to which political agendas, especially in the so-called “developed economies”, have become infused with, embody and promote capitalist ideology in the form of neo-liberalism and the so-called “free market”.
That this ideology extracts an ever-increasing cost from the citizens of those countries where it is dominant is without doubt and evident in the recent “bank bailouts” and related “austerity programmes” that have affected many Western nations.
It is also evident in healthcare.
For example, the US spends not only more of its GDP than the UK on healthcare but when private payments are added to this, the amount spent on healthcare is roughly 130% more per capita compared to the UK - while failing to deliver either universal cover or better healthcare outcomes (e.g. the percentage of Americans without health cover in 2018 was 15.5%, or around 30 million people, which is down from the 44 million figure before the Affordable Care Act was introduced – though the latter is now being rolled back under the Trump Administration).
That healthcare has become “big business” is intimately tied to the way it has, over time, become industrialised - meaning being able to be supplied in measurable and costed procedures that allow for-profit margins to be calculated and achieved.
Of course this does not cover all of healthcare and Governments and Charities thus remain the dominant providers when it comes to complex and unpredictable healthcare provision – areas where costs can spiral and measuring outcomes remains inherently difficult (e.g. treating patients with multiple and/or inter-acting conditions).
In other words “big business” typically “picks off” those areas of healthcare it can provide on a for-profit basis leaving the rest to be directly funded by the public sector.
To take some examples from the UK, where about 10% of the NHS budget is spent on private provision (approximately 13 billion per year) one sees that residential care is an area of choice for such companies who now supply most of the forensic hospital beds in the UK and also almost all care-home beds.
Discreet medical procedures are also highly desirable with over 30% of hip replacements in the UK now being supplied privately.
Turning now to the world of mental health/therapy one can take the case of a leading provider of mental health care in the US to better understand the appeal of such markets.
Universal Health Services (UHS)[1], a “Fortune 500” company, has over 250 in-patient (hospitals) and 16 outpatient “behavioural health care” facilities in the US. Like many companies in this sector its return on investment (profit) is approximately 20% per annum - this high level of profit-taking being the norm with large healthcare providers.
Here a first, and perhaps obvious point to make is that in labelling its provision as “behavioural health care”, and thus eliminating terms such as “psychiatric” or “mental health” from its lexicon, one encounters a significant linguistic swoop, one aimed at, one can surmise, avoiding the complexities of treating the subject in favour of all treatment being about “behavioural adaptation”.
Some other illustratives facts about this - not-atypical - corporation are the following:
Management is highly rewarded. For example, the CEO in 2018 received a salary of $1.6 million but a total compensation package worth $23.5 million (see: www1.salary.com) a sum of money that is beyond comparison to public service pay.
Company turnover is currently around $10 billion per year – generating $1 billion of cash profit per year. This, in Marxian terms, is surplus-value (profit) seeking surplus-value.
Given the above point company expansion follows logically, and taking here the UK as an example, has led to the following acquisitions: in 2014 Cygnet Health Care (743 beds – mostly forensic), in 2015 Alpha Hospitals Holdings (350 beds – mostly “secure rehabilitation”), and in 2018 The Darshell Group (288 beds – mostly learning difficulties and autism provision).
While the step from providing in-patient treatment to the world of therapy might seem an inherently difficult one to take, it is nevertheless actively being achieved.
Central to this, and again using the UK as an example, is the introduction of a data driven and performance management approach to therapy.
In the UK the main vehicle for this has been the “Improving Access to Psychological Therapies” (IAPT) initiative, introduced in 2008 with the aim of increasing the availability of evidenced-based therapy - based on an economic evaluation of benefit carried out by Lord Layard on behalf of the Government (i.e. in terms of decreasing sickness days and related payments to working age adults).
In practice such therapy is invariably short-term and CBT based, with standardised questionnaires used to control access to and evaluate the services provided.
At one level much of this no doubt seems reasonable (e.g. increasing access to therapy).
However it is only by going beyond this “mask of rationality” that one can grasp how a process of “industrialisation” lies at the heart of this approach.
Here the work of Dr Elizabeth Cotton, an academic at Middlesex University, who also runs a blog (www.survivingwork.org) targeted at supporting healthcare workers, provides an insightful, if somewhat tongue-in-cheek, commentary on how this is achieved, which I have adapted, as follows:
Downgrade the service provided by standardization,
manualisation and digitalization of available treatments and
marginalise those that cannot easily fit into this framework
Collect performance data that acts as a “evidence base” for a downgraded model of sub-therapy
Sell it to the public as a value-for-money service
Enforce performance management based on numerical targets (e.g. number of patients seen) and standardised measures of recovery that are difficult to challenge
Downgrade the jobs of those who provide treatment by employing more “healthcare workers” and fewer professionals
Silence any dissent from both those accessing and those delivering services via a range of sanctions and/or rules
Open the healthcare door to digital providers and platforms
Two final point can now be made.
Firstly, it is important to underline that for all this to happen the health service must already be a managed system, meaning one wherein decision-making power lies firmly in the hands of management and where professional influence has been downgraded.
Secondly, and in my opinion, the “psy professions” in the UK sleepwalked into this development in healthcare (I was working in NHS at the time) and thus, and obviously, the challenge we now face is to be more awake!
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