MANUFACTURED THEFT: A change in tone!

FRIDAY, JUNE 30, 2017

Conclusion—On C-Span, Rosenthal bails:
Elisabeth Rosenthal's book, An American Sickness, was released on April 10.

One week later, on April 17, Rosenthal taped an hour-long interview for After Words, the weekly C-Span program. She was interviewed by Dr. David Blumenthal, president of the Commonwealth Fund.

As best we can tell, the program aired for the first time on Sunday, May 14; you can watch it here. Due to an editing error, the C-Span site mistakenly suggests that it runs two hours.

As we'll note at the end of this report, Rosenthal adopts a surprisingly narcotized tone at the start of this hour-long program. But near the end of the session, she states some facts which help explain this data set, the one you'll see nowhere else:
Per capita spending, health care, 2015
United States: $9451
Canada: $4608
France: $4407
Japan: $4150
United Kingdom: $4003
Why does a year of health care cost twice as much in this country as it does everywhere else? Our results are no better than theirs!

Why does our health care cost so much? That's a deeply foundational question for our clownish American governance. Near the end of her hour on C-Span, Rosenthal partly explains.

At the start of the exchange in question, Blumenthal tees her up. "You have some pretty striking things to say about hospitals as non-profits," he says. "Could you elaborate on that a little bit?"

"I'm probably going to make a few enemies in business here," Rosenthal says as she starts her reply.

This happens near the 50-minute mark. We're going to guess that she may have lost a few friends, based on what she eventually said.

Rosenthal started her response with a bit of soft soap. She said she hates the fund-raising letters she gets after trips to the hospital.

Eventually, though, she took us where the rubber hits the road. Warning! Information ahead:
ROSENTHAL (4/17/17): What are hospitals doing? Do they feel like charities? Do they feel like they're serving a community? I recommend that everyone look at the 990 tax form of their local hospital. Look how much the executives are paid.

The highest paid executive in most cities is the CEO of the local hospital.
And you know, I don't want anyone going broke on health care. I don't think you have to take a vow of poverty. But I don't think most hospitals need the top twenty administrators paid over a million dollars a year.

And when they say, "Oh, health care is really complicated," my immediate answer is, "Yeah, well the Ford Foundation is really complicated too, and it operates in ninety countries, and the CEO of the Ford Foundation doesn't make nearly as much as the 15th administrator at a local hospital in New Jersey." So I think that's a kind of false narrative.
Ow ow ow ow ow ow ow ow! Is she allowed to say that?

The CEO of the Ford Foundation makes far less money than the fifteenth highest-paid administrator at your local hospital?

Your local hospital may be paying million-dollar salaries to twenty different administrators? Can these claims be true?

We don't know if those claims are true. But that's what Elisabeth Rosenthal said—and when she did, Blumenthal offered no challenge or contradiction.

With those statements, the street-fighting author of the new book, An American Sickness, had returned to the form she displays in her book. Assuming her statements were reasonably accurate, we'd learned about one of the factors which explain the remarkable data we've posted above.

More significantly, we'd been exposed to one of the reasons why we can't provide universal health care in this country. Beyond that, we'd been exposed to one of the reasons why we can't seem to get control of our federal budgets.

We'd been exposed to one of the factors which led the author of An American Sickness to describe our health care system as she does in her book's opening pages—as a "slow-moving heist" performed by an "extractive industry" which exposes patients to "medical extortion."

If you plan to pay salaries like that, you'll have to perform some extortions. According to Rosenthal, the leading extortionist in your community may be that CEO!

For ourselves, we were surprised by what Rosenthal said. We don't think we've ever heard anyone discuss the size of those salaries.

Equally surprising is this:

By apparent common agreement, remarkable facts like those are essentially never discussed by our major news orgs. Despite her fiery progressive views, Rachel Maddow doesn't mention such facts on her corporate "cable news" show, for which she's paid ten million dollars by her corporate owners.

You'll rarely hear such facts discussed in our biggest, most famous newspapers, even when we're all pretending to discuss our American health care.

You won't be exposed to such facts, and you won't be exposed to the data they generate. The New York Times would voluntarily cease to publish before it would show you this:
Per capita spending, health care, 2015
United States: $9451
France: $4407
Five thousand dollars, per person per year, disappears in our health system! You aren't encouraged to know.

How does such group silence work? Twelve years ago, in 2005, Paul Krugman tried to put such data in play in a series of columns in the Times. For one of those columns, click here.

Everyone else ignored what he wrote! The topic is AWOL, missing-in-action from our discussions today.

Decades ago, an explanation was offered for this remarkable type of group silence. Chomsky and Herman referred to this type of systemwide silence as a way of generating "manufactured consent."

What is manufactured consent? The leading authority on the topic offers this capsule account. Note the "self-censorship" function:
Manufacturing Consent: The Political Economy of the Mass Media (1988), by Edward S. Herman and Noam Chomsky, proposes that the mass communication media of the U.S. "are effective and powerful ideological institutions that carry out a system-supportive propaganda function, by reliance on market forces, internalized assumptions, and self-censorship, and without overt coercion", by means of the propaganda model of communication. The title derives from the phrase "the manufacture of consent," employed in the book Public Opinion (1922), by Walter Lippmann (1889–1974).

Chomsky credits the origin of the book to the impetus of Alex Carey, the Australian social psychologist, to whom he and co-author E. S. Herman dedicated the book. Four years after publication, Manufacturing Consent: The Political Economy of the Mass Media was adapted to the cinema as Manufacturing Consent: Noam Chomsky and the Media (1992), a documentary presentation of the propaganda-model of communication, the politics of the mass-communications business, and a biography of Chomsky.
Everybody knows that this theory has to be crazy and nuts. And yet, Krugman's attempt to introduce this topic crashed and burned in 2005. Today, the data we've shown you are relentlessly disappeared, despite their obvious centrality to the endemic failures of our clownish federal governance.

The data set we've posted is an astonishing data set. It's true that our journalists aren't real bright, but even they can surely see the remarkable strangeness of those data, and the relevance of the fact that so much money—$5000 per person per year!—is disappearing (being extracted) from our health care "system."

That said, Rachel would jump off the Golden Gate Bridge before she'd discuss such a topic. Rosenthal, who wrote this "important book," has never appeared on MSNBC, our allegedly liberal cable.

(You've also never seen education expert Diane Ravitch on your liberal channel. A few years back, she became the liberal rage. But despite their fiery progressive views, people like Rachel don't discuss the experiences of black kids in our public schools. Nor do they discuss the looting of our health care "system," which lines the pockets of people like the corporate bosses who own them.)

Everyone can invent his own reasons for the group silence of which we speak. Why don't our major newspapers present and explore those remarkable data?

We can imagine various reasons. But you are never going to see that obvious question discussed.

Chomsky spoke of manufactured consent, attributing it to a form of propaganda. In this case, we'd say the practice leads to manufactured theft.

The theft comes from our health care system. It explains why we, among all developed nations, are still clownishly unable to provide universal health care.

As we close, let's note an unfortunate point. A very potent group dynamic seems to encourage major players to conform to this silence.

Right out of the gate in her new book, Rosenthal breaks all the rules. Using the language of corporate crime, she describes our health care system as a series of extortions and heists.

We were surprised when we purchased her book and encountered this tone. We were surprised because we'd already seen her on that C-Span program.

Near the end of that hour, Rosenthal gets a snootful and talks about hospital salaries. But at the start of that hour-long program, she and Blumenthal seemed to be speaking the clubby language which manufactures consent in this world.

Before three minutes are gone, Blumenthal lets the viewer know that he and Rosenthal share the old school tie from Harvard Medical School. He proceeds to let Rosenthal explain that her new book won't bore the reader with lots of diagrams and charts.

(Or with a single presentation of that data set!)

Finally, near the nine-minute mark, Blumenthal gets to the serious questions. He asks Rosnethal to explain what the basic problem is. What is "the American sickness?" he asks.

The basic problem is "high prices and unaffordable health care," Rosenthal says. "I don't think anyone—Republican, Democrat independent, libertarian—would disagree with that."

It seems to us that she was already putting a shine on the matter. But Blumenthal proceeded to ask what the source of this problem is.

How did we come to have crazy high prices? Amazingly, this is what Rosenthal said, around the ten-minute mark:
BLUMENTHAL: And how did we get to those high prices? What's the diagnosis?

ROSENTHAL: Well, this is where the kind of history of present illness, you know, kind of has to spool itself out. And I think what I realized as I was digging into that is, this is kind of a classic case of, you know, the road to Hell is paved with good intentions.
"This is kind of a classic case of the road to Hell is paved with good intentions?" Before we ever looked at her book, that's what we'd heard her say.

It's very hard to read Rosenthal's book and think that's the story you're hearing. But the C-Span interview goes on at some length in this tapioca vein.

At the 50-minute mark, we finally hear about those seven-figure salaries. Still, we never see the data set which defines the extent of the looting created by the extortions and heists and Rosenthal cites in her book.

"It's nice to be nice," a sage once said. Rosenthal's book isn't "nice." It traffics in a horrible truth, one you won't learn from Rachel or Lawrence or their slippery millionaire pals.

Rosenthal's book isn't "nice" at all. That's why it's going undiscussed. That seems to be why the people we love won't let her new book be important.

24 comments:

  1. Regarding the accuracy of the statement that 15 administrators at a local hospital in NJ earn more than the CEO of the Ford Foundation, it's not true as of 2014 for the one hospital that I reviewed (St. Barnabas in Livingston, NJ, which is one of the bigger hospitals in NJ). It's true that the CEO of St. Barnabas was paid more than the Ford Foundation CEO, but the Ford Foundation CEO's compensation of $900K was more than anyone else at St. Barnabas.

    ReplyDelete
    Replies
    1. The median salary in the US for a CEO in 2017 is $757,000. The quoted hospital CEO is at the 75th percentile. This includes both large and small businesses.

      http://www1.salary.com/Chief-Executive-Officer-salary.html

      Our entire economy is based on looting -- we call it capitalism.

      Is health care as complicated or as important as another industry that pays its CEO a lot? Is it as important as car manufacturing? Is it as important as entertainment or communications or computers?

      Jobs that include a lot of female workers, that provide caring and services instead of products, typically pay a lot less in our economy. We don't value such jobs. But when men enter the picture, they won't work for lower pay. They insist that they be paid as much as their equivalents in private industry. They point out that they could go work for a manufacturing firm and earn much more, so they claim salaries commensurate with the rest of the economy. It doesn't matter to them that they are holding their patients' health hostage in such negotiations. All those female doctors and nurses and administrative staff are supposed to make it balance out by taking less pay, since their helping role is traditional and not much different than what they do at home for no pay at all. But then those nasty women form unions and insist of being paid commensurate with the education and training, their value to the organization. So their salaries increase too. And everyone complains that health care costs money. No matter that it involves round the clock monitoring, or technical expertise, or dedication and skill. It should be cheap, like in nations where health care is subsidized in numerous ways (beginning with free education).

      I agree that it should be provided at government expense. If enough people keep protesting, we may gradually work our way in that direction. But in the meantime, it makes no sense to blame those nasty doctors, nurses, and even administrators for the high costs that are actually a direct result of a capitalist system applied to time-consuming, highly technical, specialized, individualized personal services, provided on demand in most locations. We take this for granted and expect that it should cost around the same as maintaining our cars.

      It is facile to blame a CEO salary for a per-person cost that is double the rest of the world. The difference is systemic and neither Somerby nor Rosenthal seems inclined to grapple with it. They just keep crying that they don't want to pay for it, no doubt at any cost. Because at heart it is a service that at best does nothing more than restore you to the status quo. Why should anyone have to pay for that? That's Somerby's basic complaint.

      Delete
    2. I don't read that as Somerby's complaint. I think that he just wants the media to drive an honest conversation about the issue, which it refuses to do.

      Delete
    3. High executive pay is only one of many (and not the primary) reason for how expensive our awful healthcare system is.

      Please note: I have not criticized nurses' or health care clerical workers' pay. If we had a more efficient system, there would probably be fewer clerical workers employed in our health care system. Maybe if RNs and NPs took on more of the work doctors have traditionally done, they would get paid more. Maybe the fewer number of clerical workers could/would/should be paid more.

      Delete
    4. I'm not disagreeing with you about the substance of the issue. I'm just saying that I don't think Bob would disagree, either. In fact, if I had to bet I'd think Bob would point to insurers as the biggest driver of increased costs.

      But either way, the point is that our media should be having serious discussions about this, but it doesn't seem able or willing to do so.

      Delete
    5. A few days ago CMike commented about a doctor mocking his patient. I hate to tell you this, but most doctors (if not all) feel that their patients routinely sabotage their best efforts to keep them healthy. Why does our society not want to have that discussion? People in other cultures behave differently than Americans do. The differences contribute to the return visits and the decreased success and the worse numbers we obtain for the greater money we spend. They include things like doctor shopping and getting third and fourth opinions when the doctor tells you to do something you don't want to do. They include things like splitting pills because you want to keep smoking and don't have the money to buy both prescriptions and cigarettes.

      My husband visited his primary care physician last week to discuss mobility issues. He offered three times to prescribe a motorized scooter. This, despite his physical therapist telling him that it is use it or lose it and riding around on a scooter would result in him becoming bedridden due to muscle atrophy at a much earlier age. Those scooters are expensive in both $ and health terms, but they look like toys to American patients. But no one wants to talk about this stuff either. It is easier to blame fat cats than to blame ourselves for our collusion in driving up health care costs.

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  2. I still recall the 1971 movie "The Hospital", with a script by Paddy Chayefsky. It convinced me that heading a big city hospital is an incredibly challenging job.

    ReplyDelete
    Replies
    1. You realize that wasn't a documentary, right?

      Delete
  3. It can't be that hard to look at those other countries and discover what they do to keep costs at half or less than what ours are. Part of the answer must be they allow no large role for a parasitic middleman known as the for-profit health insurance industry. Another reason must be that salaries are kept lower. Another must be an "everyone is in" system means that everyone has instant access to preventive care. Anyone else?

    ReplyDelete
  4. Somerby says $5000 per person, per year is being extracted from people by our health care system. That assumes the amounts spent by other countries are a fair baseline of what costs ought to be. Is that necessarily true? Perhaps they are not spending enough in those other countries.

    This amount is per person. Most people do not spend anything like that amount because they are young, healthy and do not need health care services. The bulk of that amount is spent by people at the end of their lives, and by people with chronic illnesses or severe accidents. It no doubt seems like the dollar amount Somerby has cited is a huge figure if you are among the lucky majority who do not use health care much in the course of a year. If you are old or have serious health problems, the amount Somerby quotes is ridiculously low. So, it is easy to feel outrage about his quoted dollar amount, but what do actual health care system users feel? Gratitude?

    Perhaps it would make more sense to compare what people actually pay across cultures, instead of what the system supposedly spends. The latter figures make no sense, because is it actually a health care "cost" if the dollars go into someone's pocket as profit? We have no way of knowing the true costs of our system if they are comingled with profits.

    Is it fair to compare a profit-based system with a semi or fully socialistic or government-based health care system. What are we actually paying toward health care and what goes instead toward maintaining the wages and earnings of those who engage in providing health care as a business venture. Do we want to dismantle that venture and thereby undermine the economy, the livelihood and well-being of the citizens who work in that sector? Is that a worthy goal? Somerby doesn't ask and he doesn't chide anyone else for not asking that question either. Why not?

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  7. @AnonymousJuly 1, 2017 at 10:07 AM: "Is it fair to compare a profit-based system with a semi or fully socialistic or government-based health care system." Well, if you're going to make the claim that a profit based system is guaranteed to produce better results than a system which allows the government to regulate commercial activity, then, yes, it's fair to compare. If you don't make that claim, then maybe not. Here in Thailand, if I go to a doctor's office, it will cost me about $6, plus the cost of any medicine he prescribes, which he makes a profit on by selling it from his own stock. If I go to a hospital it's more problematic, but checking my last bill the doctor's fee was $12 and the nurses salaries and building's overhead are included in that. So much for comparison across cultures.

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