April, 2019, Update: How to Challenge Health Care Corruption Under a Corrupt Regime?

In these last few weeks, the US news has been dominated by the release of a redacted verion of the Mueller report which included extensive evidence of questionable behavior by President Trump, his campaign, and various Trump associates.  This week, an editorial in Mother Jones suggested:

The Russia scandal was never, in the main, about whether the president would be prosecuted for a crime. It was, and is, about a bigger issue: A wealthy politician who hoped to profit from pandering to a foreign autocrat put his own financial interests above those of his country, who abetted a foreign attack, and who lied about it to those he swore to serve.

There is a word for this, but it’s not collusion. It’s corruption.

The editorial suggested that journalists have not done an adequate job pursuing the underlying “rot” in the US government and the Trump administration:

And rather than laying off investigating it, as too many are suggesting now, journalism needs to back up and look at the whole thing.

It seems to be a great idea, but in fact, some journalists, scholars, bloggers, etc have been looking at corruption for a long time, including health care corruption, and corruption in the US government.  The problem, however, is that much of the discussion of corruption has been anechoic.

Background: Health Care Corruption

As we wrote in August, 2017, Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report
on health care corruption, which asserted that corruption is widespread
throughout the world, serious, and causes severe harm to patients and
society.

the scale of corruption is vast in both rich and poor countries.

Also,

Corruption might mean the difference between life and death for
those in need of urgent care. It is invariably the poor in society who
are affected most by corruption because they often cannot afford bribes
or private health care. But corruption in the richest parts of the world
also has its costs.

The report got little attention.  Health care corruption
has been nearly a taboo topic in the US, anechoic, presumably because its discussion would offend the people it makes rich and powerful. As suggested by the recent Transparency International report on corruption in the pharmaceutical industry,

However, strong control over key processes combined with huge resources
and big profits to be made make the pharmaceutical industry particularly
vulnerable to corruption. Pharmaceutical companies have the
opportunity to use their influence and resources to exploit weak
governance structures and divert policy and institutions away from
public health
objectives and towards their own profit maximising interests.

Presumably the leaders of other kinds of corrupt organizations can do the same. 

When health care corruption
is discussed in English speaking developed countries, it is almost
always in terms of a problem that affects some other places, mainly 
presumably benighted less developed
countries.  At best, the corruption in developed countries that gets
discussed is at low levels. 
In the US, frequent examples are the “pill mills”  and various cheating
of
government and private insurance programs by practitioners and
patients.  Lately these have gotten even more attention as they are
decried as a cause of the narcotics (opioids) crisis (e.g., look here).  In contrast, the US government has been less inclined to address the
activities of the leaders of the pharmaceutical companies who have
pushed legal narcotics (e.g., see this post). 

However, Health Care Renewal has stressed “grand corruption,” or the
corruption of health care leaders.  We have noted the continuing impunity of top health care corporate managers.  Health care corporations have allegedly used kickbacks and fraud to enhance their revenue, but at best such corporations have been able to make legal settlements
that result in fines that small relative to their  multi-billion
revenues without admitting guilt.  Almost never are top corporate
managers subject to any negative consequences.

We have been posting about this for years at Health Care Renewal, while seeing little progress on this issue.

Health Care Corruption in the Context of a Corrupt Government

Instead, things now only seem to be getting worse, given the increasing evidence that
the Trump administration is corrupt at the highest levels.   In January,
2018, we first raised the question about how health care corruption could be pursued under a corrupt regime.  We noted sources that
summarized Trump’s. the Trump family’s, and the Trump administration’s
corruption..  These included a website, entitled “Tracking Trump’s Conflicts of Interest” published by the Sunlight Foundation, and two articles published in the Washington Monthly in January, 2018. “Commander-in-Thief,” categorized Mr Trump’s conflicted and corrupt behavior.  A Year in Trump Corruption,” was a catalog of the most salient cases in these categories in 2017.

In July, 2018, we addressed the Trump regime’s corruption again  By then, more summaries of Trump et al corruption had appeared.   In April, 2018, New York Magazine published “501 Days in Swampland,” a time-line of  starting just after the 2016 presidential election. In June, 2018, ProPublica reviewed
questionable spending amounting to $16.1 million since the beginning of
Trump’s candidacy for president at Trump properties by the US
government, and by Trump’s campaign, and by state and local governments. Meanwhile, Public Citizen released a report on money spent at Trump’s hospitality properties.

In October, 2018, we summarized the content of the voluminous Tracking Corruption and Conflicts of Interest in the Trump Administration summary appearing in the Global Anti-Corruption Blog. The blog organized corrupt activities within the Trump administration into the following categories:

1. U.S. Government Payments to the Trump Organization

2. Use of the Power of the Presidency to Promote Trump Brands

3. U.S. Government Regulatory and Policy Decisions that Benefit Business Interests of the Trump Family and Senior Advisors

4. Private and Foreign Interests Seeking to Influence the Trump Administration Through Dealings with Trump Businesses

Not only was the report voluminous, the October version of the report requiring 26 pages to print, it suggested that many examples of corruption by Trump et al were not one-offs, but were long-term activities.  For example, every time President Trump travels to on of the properties he owns through the Trump Organization, for example, has Mar-a-Lago resort in Florida, the US government is obligated to pay Trump himself through that organization for various expenses, e.g., the Secret Service renting golf carts at Mar-a-Lago.  Each time that happens it seems to violate the “domestic emolument clause” of the US Constitution, which prohibits state or US government payments to a President for anything other than his salary.  Also, foreign governments and corporations seeking to promote specific government policies in their self-interest, similarly seeking favorable regulations, or other seeking to influence government actions in their favor are making periodic payments to the Trump Organization, such as buying accomodations or paying for events at Trump properties.  When foreign governments do so, that appears to violate the “foreign emoluments clause” of  the US Constitution, which prohibits payments by a foreign government to the US President.

Updates on the Corruption of the US Government

New Source: Bloomberg’s “Tracking the Trump Team’s Conflicts and Scandals”

Bloomberg produced an interactive guide, most recently updated in March, 2019, and divided into sections on individual members of the team, including Trump and his family, Trump appointees, and associates and outside advisers.

New Source: the Citizens for Responsible Ethics in Washington’s Blog

CREW is a non-profit organization whose goal is “to reduce the influence of money in politics and help foster a government that is ethical and accountable.”It produces a blog with very frequent posts that center on conflicts of interest and corruption affecting Trump and associates.  For example, recent posts included: “IRS Commissioner Charged with Releasing Trump Tax Returns Profits from Trump-Branded Property” and “Turkish Interest Group Event Kicks Off at Trump Hotel, with Government Sponsors.”

New Source: Zach Everson’s 1100 Pennsylvania Avenue

Threre are so many instances of violations of the foreign and domestic emoluments clause occurring just at the Trump Organization hotel in Washington, DC that there is now a blog and newsletter dedicated to essentially daily reporting about them.

Updates of the Global AntiCorruption Blog’s “Tracking Corruption and Conflicts of Interest in the Trump Administration”

Since October, the report has been updated nearly monthly .  These updates suggest new variations on these corrupt themes, for example: November, 2018, Interior Secretary Ryan Zinke’s “shady property development deal;”January, 2019, questions of illegal actions by Trump’s inaugural committee;
March, 2019, possible special treatment by the Government Services Administration of the Trump Organization’s flagship Trump International Hotel in Washington, DC; and April, 2019, how Trump-connected lobbyists are directing clients to book rooms at that hotel.

Updates of the Sunlight Foundation’s “Tracking Trump’s Conflicts of Interest”

At the same time, the Sunlight Foundation’s “Tracking Trump’s Conflicts of Interest” project is also frequently updated.  Note that its main webpage includes links to weekly reports about relevant issues.  For example, the most recent is ” This
Week in Conflicts: Redacted Mueller Report Released, Undisclosed Cash
Flow from Inaugural Ball and Mueller Explains Why His Family Left
Trump’s Golf Club

Discussion

Since October, the evidence of pervasive conflicts of interest and outright corruption affecting President Trump, his family, the Trump Organization, and his administration continues to mount.  The totality of the array of unethical and probably illegal activities has become mind numbing.  To underscore what we wrote in October

So the driver of US health care corruption may now be the executive
branch of government and its relationship with the Trump family and
cronies, trumping even the influence of health care corporate
corruption.

That corruption appears to be ongoing, getting worse not better, and is not receiving adequate notice.

In November, 2017, we noted that another report by
Transparency International that showed that in an international survey
of corruption perceptions, substantial minorities of US respondents
thought that US corruption was increasing, and was a particular
affliction of the executive and legislative branches of the national
government, other government officials, and top business executives. 
There was virtually no coverage of these results in the US media, just
as there was virtually no coverage of a 2013 survey that showed 43% of US respondents believed that US health care was corrupt.

Similarly, despite, or perhaps because of their tremendous scale, the reports about Trump related corruption listed above have generated little discussion. 
Despite the extensive and ever-increasing list of apparently corrupt
acts by the Trump and cronies, grand corruption at the top of US
government, with its potential to corrupt not just health care, but the
entire country and society, still seems like a taboo topic.  The US news
media continues to tip-toe around the topic of corruption, in health
care, of top health care leaders, and in government, including the top
of the US executive branch.  As long as such discussion seems taboo, how
can we ever address, much less reduce the scourge of corruption?  The
first step against health care
corruption is to be able to say or write the words, health care
corruption.

So we welcome any additional attention to health care corruption, or the larger corruption within the US government that is making health care corruption even harder to address. We thus specifically welcome Mother Jones’ added emphasis on this topic.

But even if we can take that step, when the fish is rotting from the
head, it makes little sense to try to clean up minor problems halfway
towards the tail. Why would a corrupt regime led by a president who is
actively benefiting from corruption act to reduce corruption?
The only way we can now address health care corruption is to excise the
corruption at the heart of our government.

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