You Do the Math

In an earlier post, Hell-o, Old Fart, I commented on his article, American Winter clearly defines what poverty looks like, and reflected on my experience in Detroit. 

This morning, I read  an article in The Tennessean*. I was struck by the statistics -- 

"Of the 935,317 public school students in the state in 2012, nearly 60 percent were considered economically disadvantaged." 

-- and the comment that followed: " Studies show that children who come from poverty tend to be less prepared for the rigors of school."

Flashback to the Rotary Club luncheon in my earlier post and the (paraphrased) comments of Dr. Eddie Green, then interim Superintendent of Detroit Public Schools: 

“On any given day in the City of Detroit, no education takes place. A child coming to school, his last meal, lunch the day before, is thinking about lunch, not math or reading. Many of our children arrive at school on Monday morning, their last meal was lunch the previous Friday. They are not prepared to learn. 

“ On any given day in the City of Detroit, no education takes place. Children come to school in winter without coats. Their bodies shiver a good portion of the morning until the warmth settles in. Before the last bell rings, those same bodies again shiver, in anticipation of the trip home.

“On any given day in the City of Detroit, no education takes place. When squad cars fill the street corners adjacent to their school while a drug bust takes place, the school is in lockdown. No learning takes place.”

In Detroit at that time, 1996, the Detroit Public School system had almost 160,000 students, with 40% drop out rates before ninth grade. 

In 2013, the numbers in The Tennessean tell me that, Today, in Tennessee, over 550,000 students are at risk due to poor performance that can be directly attributed to poverty, a condition in which hunger is but one of many symptoms. 

Ms. Giordano’s article raises many questions. Among them, 

• What are the future prospects for a state when it puts so little value on the well-being of its children? Can we put a number on that? 
• What are the future prospects for a state where legislators proudly announce they support cutting funding of vital services like SNAP programs (Supplemental Nutrition Assistance Program), literally guaranteeing their state's children will go hungry? Can we put a number on that?
• What are the future prospects for a state when, knowing how poverty impacts performance, its political leadership attacks teachers , citing them as the cause, and takes actions to drive them from their schools and to discourage future teachers from considering Tennessee as the place to teach?

I won't ask you for a specific number. Suffice it to say, the amount would be staggering. I will, however, point to some statistics that reflect the outcomes of such myopic policies over time:

The United States is:

16th out of 23 countries in literacy proficiency

21st in numeracy proficiency

14th in problem solving in technology-rich environments **

NUMBER ONE in Prison Population and Incarceration Rates ***

                         Adolescent Birth Rate****

Until voters (YOU) realize that their (YOUR) current legislators are part of the problem, the attacks on the poor, on women, infants and children, on teachers and on the elderly will continue. It is time for voters (YOU) to learn -- and to act in their (YOUR) own best interests, for their (YOUR) better futures and for a better future for their (YOUR) state.

*Tennessee schools see hunger in eyes of many students

Every district has pockets of poverty http://www.tennessean.com/article20131104/WILLIAMSON/311040024                      Maria Giordano mgiordano@tennessean.com 

** http://www.insidehighered.com/news/2013/10/08/us-adults-rank-below-average-global-survey-basic-education-skills#ixzz2jh2h5WHv 

*** http://www.savethechildrenweb.org/SOWM-2013/#/58/ 

All the above stats are attributable to poverty. All of them are outcomes of benign neglect. All of them are also correlate with the despicable actions of politicians.

Thank you, Karen Pickering

Thank you, Karen Pickering, for your contribution to the Guardian.
http://www.theguardian.com/commentisfree/2013/nov/12/australia-america-inequality-guns-healthcare?CMP=ema_565#start-of-comments

The views you express from your vantage point are in keeping with the views that many Americans hold as well. Currently, we are suffering from a disease confined for the most part by geography, political affiliation and values. This disease was first seen decades ago by a group of very attuned Republicans who, over thirty or more years, consciously and with intent nurtured its development (read American Theocracy by Kevin Phillips).


Much has been taken out of our systems to ensure that over time ignorance would abound and the leadership of exalted figures would prevail, at all levels of government and within such seemingly obscure groups as boards of education. These innocuous groups are rewriting the text books for millions of children, altering history and science to fit their dogma.


To this day, we spend more than five times what China spends on military and more than the next 16 nations combined, all of whom are allies or bit players. (http://jmalgeri.blogspot.com/2013/10/so-many-complexes.html)

We spend less on our children than those same nations who, like China, India, and even Kenya are increasing spending to grow and nurture the health, education and overall well-being of their children. They see their actions as INVESTING in the future.

Corruption is rampant here, with politicians shills for corporations, working for their personal benefit at the expense of the nation's future. It is time again for Americans to say "enough is enough" and take our country back. We have a history of doing that, and it is once again time we reassert our rights.

The Light is Better Over Here

There’s a story about a fellow leaving a bar late at night. As he walks through the parking lot to his car, he sees a guy on all fours, moving first one way, then another, his hands moving from spot to spot in front of him.

“You all right?, “ he asks, “Something wrong?”

“Yeah”, the guy replies, “I lost my car keys.”

“Maybe I can help. Where’d you drop them?”

The guy points toward an area yards away from where they are. “Over there,”he says.

“Then why are you crawling around over here/”, the man asks.

“The light’s better over here.

That, my friends, is a metaphor for the Republican approach to cutting the budget.

The problem really is over there, some distance away. In the budget game, it’s  a decade or more away. Social Security is not bankrupt. And any problems with it long term are easily dealt with, if action is planned and taken sensibly. Medicare is in trouble, long term, but cutting its benefits is undermining the contract we made with our citizens, present and future.

These programs are labeled ‘entitlements’ as if entitlements is a pejorative term, They are entitlements – because the people who had monies taken out of their paychecks for decades did that so they would have the services they need when they need them. They paid for them – they’re entitled.

Even if there was need for financial adjustments, there is plenty of money to go around. If we cut waste. Now, let’s see if we can agree on where the waste is – what’s wasteful and what’s not.

Let’s look at defense spending. We’re coming off the second of two wars that cost lots of money and made lots of money – for a few Lockheed Martin, BAE Systems, Pratt & Whitney,  Halliburton, the list goes on.

It cost lives as well, hundreds of thousands of lives (over 8,000 US military, over 601,000 violent deaths for just the first three years in Iraq alone)  . It brought us an entirely new and HUMUNGOUS security infrastructure, threatened our privacy rights and militarized local and state police forces and national guards.

Our $700 BILLION defense budget is coming down, to just over $500 BILLION, still more than the TOTAL combined budgets the next 16 nations, most of whom are our allies, and some six times China’s budget.

Further, what it’s buying us is more military equipment, arms we’ll never use because the nature of warfare has changed, and that equipment is obsolete.

Let’s talk another time about Government programs that can be cut deeply and sensibly, were it not for the fact that the companies involved are major contributors to our legislators.

The best way to make sure we’re looking at ALL options is simply to look at the Cabinet posts:

Agriculture

Commerce

Defense

Education

Energy

Health and Human Services

Homeland Security

Housing and Urban Development

Interior

Labor

State

Transportation

Treasury

Veterans Affairs

Attorney General

Hell-o, Old Fart: A post to http://musingsofanoldfart.wordpress.com

Hell-o, Old Fart,

I just found your blogs as I was googling The Power of Habits and came across your post. Since then, I have been reading your other posts, heading toward the most recent. When I am caught up with the current posts, I’ll go back to the first one I found and backtrack. Seems like a plan.

I just finished reading your post, American Winter clearly defines what poverty looks like. I feel the need to commence a dialogue with you starting with it as the basis. Other posts will inevitably follow, as you are a terrific writer with compelling insights, and the thought of dialoguing with you is delightful.

I live in Tennessee, where the most uncaring among us all seem to work in the same industry: politics. With child poverty over 20%  statewide and near 50% poverty in pockets like Memphis, one would think that elected officials would be working overtime to resolve the issue, if only for the horrific long-term trends it portends. Instead, they cry out for cuts in vital programs and the need for austerity.

Study after study points out the link between poverty and poor performance in school. Study after study link poor performance in reading in third grade to school dropout rates and further correlates to the increase in prison populations. Yet, the budget takes priority. 

in the late ‘90s, Dr. Eddie Green, interim Superintendent of Detroit Public Schools,  spoke to an audience of well-to-do Rotarians in adjacent Troy, MI. He began by saying (I paraphrase here), “On any given day in the City of Detroit, no education takes place. A child coming to school, his last meal, lunch the day before, is thinking about lunch, not math or reading. Many of our children arrive at school on Monday morning, their last meal was lunch the previous Friday. They are not prepared to learn. 

“ On any given day in the City of Detroit, no education takes place. Children come to school in winter without coats. Their bodies shiver a good portion of the morning until the warmth settles in. Before the last bell rings, those same bodies again shiver, in anticipation of the trip home.

“On any given day in the City of Detroit, no education takes place. When squad cars fill the street corners adjacent to their school while a drug bust takes place, the school is in lockdown. No earning takes place.”

In 2013, in cities and towns across the nation, no learning takes place, for many of the same reasons and more. To them we add mass shootings.

Poverty kills. It kills bodies, minds and spirits. What it doesn’t kill it damages beyond repair. When the numbers of poor reach the tipping point, where barely adequate social nets no longer hold together, the people perish. Fortunately for many, they do so out of sight. Statistics on a page.

To Your Health! Dump the LDLs, Drop Pounds, enjoy life!

In February, I had a procedure to place four stents in my arteries. In June, I went for a check up with my internal medicine doctor and told him about the stents. He referred me to a lipid specialist. Long story short, the specialist drew blood samples and sent them to a lab that specializes in measuring lipids.

Three weeks later, I returned for a consult to review the numbers. I had a fair number of measurements in the red and yellow categories, high and intermediate risk ranges respectively. In the high range was LDL-P, which is explained better by others.*  As he explained it, there are two concerns with lipids; the number, which in my case was1842;    and size. For that, he asked me to imagine I was opening a kitchen wall cabinet door and lipids were falling out like balls. If the balls are like basketballs, it’s fine. Mine, he said, we golf ball size and they are the ones that cause plaque build up.

He recommended Niaspan, a slow acting version of niacin. Regular niacin, he told me, causes a severe flush on the skin, like a sunburn, so people don’t like to take it. Niaspan  doesn’t have that effect, or when it does, it’s tolerable.

I returned just under five months later for a repeat blood test and follow up. All the red and yellow  indicators were now green. The LDL-P score, 887, well in the desired range of <1000.  

Two things had happened in the intervening months. First, I read the book, Wheat Belly, which details the deleterious affects of wheat on the human body. The author, William Davis, MD, spells everything out in detail (if you’re interested, buy the book or get it from your library), with separate chapters for wheat and cardio, wheat and diabetes, etc. In my case, I went right to the cardio and discovered that the way wheat is processed by the liver, it generates tiny LDLs. That was one terrific piece of information.

Wheat, he said,  is in everything. It’s in bread, of course, and in cake (aargh! I love chocolate cake). It’s also in frosting -- and in processed foods of all types. Manufacturers like it because it’s an appetite stimulant. I didn’t know that.

Second, I found out how much Niaspan costs, over $200/month. That’s a deal breaker! To get my niacin at a reasonable cost, I went to Costco and bought 150 count bottle of over-the-counter SLO_Niacin for around $10. I take one in the a.m. and another at night. Let’s see that’s 2.5 months worth in a bottle. Over the five months, that’s two bottles (around $20) instead of five fills (over $1,000). I take the pills with food and a baby aspirin, and rarely do I experience the flushing. When I do, it’s tolerable and short lived.

Consider reading the book if you have any of the following issues. A chapter on each is in the book:

Wheat and Obesity

Wheat and Celiac Disease

Wheat and Insulin Resistance

Wheat and the Aging Process

Wheat and Heart Disease

Wheat and the Brain

Wheat’s Destructive Effect on the Skin

Buy the book new, Buy it used, Buy it on Kindle -- or borrow it from your local library.

http://www.amazon.com/dp/1609614798

* http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-vi  Scroll down to #8.

So Many Complexes

“Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all in any true sense. Under the clouds of war, it is humanity hanging on a cross of iron.” ― Dwight D. Eisenhower 

President Eisenhower's original draft included Congress but he felt he had spent so much of his energy fighting the military that he didn't have the wherewithal to take on congress, too. 

I use this photo to drive home the magnitude of our expenditures on things military. Here's another way to look at things from a current perspective: http://world-defece-review.blogspot.com/2013/01/top-10-largest-air-forces-2013.html 

Nation TOTAL AIRCRAFT: TOTAL HELICOPTERS:

1) US AIR FORCE                           15293                   6665

2) RUSSIAN AIR FORCE              4274                   1426

3) CHINA                                         2743                       96

4) INDIAN AIR FORCE                1962                     559

5) IRAN AIR FORCE                     1858                     800

6)NORTH KOREA                         1667                     237

7)PAKISTAN AIR FORCE            1531                     589

8)TURKISH AIR FORCE             1512                     570

9) UNITED KINGDOM (UK)         1412                     367

10) JAPAN                                      1252                     258

No country is a threat to us. We are a threat to MANY. That’s just wrong!

Of the top 10 largest air powers, we rank number one, with TOTAL AIRCRAFT:15293, TOTAL HELICOPTERS:6665; China has 2743 AIRCRAFT and 96 HELICOPTERS. Of the other nine, 7 are our Allies (maybe not friends, but allies). 

Look also at the number of countries whose air forces use US MADE planes, many of them sold/given to them on credit to keep our military-industrial complex (MIC) going. 

Let’s put our military spending in perspective. We’re spending some $700 million/year on defense. That's $2,222 for every man, woman and child (assuming 315M population). 

We spend 13% less (only $1943 for every man, woman and child) on K-12 education. Does it make sense to you that we spend more per person to 'defend' each American than we do to educate them? Especially when we have no 'enemy' with war capacities anywhere near our own, and where the combined forces of ourselves and our allies dwarfs any other possible combination? 

We are spending money on equipment that will fill more desert sands without EVER having flown a combat mission -- at the expense of our children and their futures.

Post Script:

President Eisenhower cited the Military-Industrial-Complex. I have given this a lot of thought as I work on my documentary on the scam of prescription drugs. I am looking at the Pharmacy-Congressional complex (they rigged Medicare Part D). 

There's also the Agri-congressional complex, the healthcare-congressional complex, the insurance-congressional complex, the education-congressional complex, the Big Oil-congressional complex, the transportation-congressional complex, the list goes on. After I complete this documentary, I will tackle yet another congressional complex. Have a preference? Let me know.

Because They Can

Observations: Because They Can

As fledgling businesses grow to behemoths, their understanding of the world changes. Their world view evolves. They come to realize that, over time, they become immune from the normal mores of society. They realize that they can do things that lesser corporations could never do. Soon they take bold, brash and often illegal, immoral and amoral steps -- because they can.

Goldman Sachs’ CEO Lloyd Blankfein reportedly believes he’s just a banker ‘doing God’s work’ as he ravages the global financial system. Goldman influenced the writing of a letter giving financial speculators the right to deal in commodities. The result was, in 2008, when the global harvest of wheat was the highest in history, speculators drove the price of wheat futures so high there were food riots in over thirty impoverished nations. They did that because they could.

After the 2008 market collapse, as people across the nation were furloughed from their jobs, and financial institutions were supported by bailouts, Goldman Sachs and others handed out million dollar bonuses -- because they could. All the while, politicians and the media were decrying the earnings and pensions of teachers, and canceling union contracts, also because they could. Valid contracts in one industry,

illegitimate in another. Go figure.

Governments do the same. The Bush administration waged war because they could. The NSA spies on the world because they can, and they bring along their collaborators, experts in communications, social media, and the traditional media as well. Now they all do things because they can.

Look at the US budget and you’ll find plenty of collaborators: Lockheed Martin, Northrop Grumman, Boeing at the top. Dick Cheney’s former company, Halliburton, and construction, engineering contractor Bechtel don’t even make the top 20 list.

Look at the media corporations and the way they support the military industrial complex. Interviews on media news center on ‘experts’, those special people who know all about the myriad relationships in conflicting nations like Syria. They easily and confidently espouse the many reasons for US intervention in Syria while failing to disclose that they are board members of the major contractors that benefit from such conflicts.

http://public-accountability.org/2013/10/conflicts-of-interest-in-the-syria-debate/

In healthcare, the immoral and devious actions of PBMs (Pharmacy Benefit Management companies) are finally surfacing, and not enjoying the scrutiny. For a couple decades, these pariahs of prescriptions have hidden their financial wizardry from their corporate clients, to the tune of Billions per year and growing. How is it that industry leader Express Scripts profits have grown from $250 million a decade ago to $1.8 billion on the 12 months ended in June*.?

PBMs negotiated with the government for, and received, “an amendment requiring the government to keep the PBM’s incentives and spreads confidential.”* How could they do that? Size matters. Money Matters. Both buy influence. Why did they do that? Because they can. It is only when Americans finally take notice, and then take action will we be able to say ’You can’t.”

*

http://money.cnn.com/2013/10/10/news/companies/pbm-pharma-management.pr.fortune/index.html

Enter Name Here

Congressman Chuck Fleischmann sent out his own youtube.com video to explain the national debt and the need for fiscal responsibility: 
https://www.youtube.com/watch?feature=player_embedded&v=oDVg9DQUalg

In just under two minutes he made this point:
2/3 of the budget is based on mandatory spending programs, and that’s way too much. The government should run the budget like good Americans run theirs. 
Oddly enough, 2/3 of the average household budget is mandatory as well*:

Major Household Expenses              Share (%) of income
Housing                                                    34.1
Transportation                                          17.6
Food                                                           5.4
Insurance & Pensions                                10.8
Medical expenses                                       5.7
Total                                                        73.6

The numbers don’t include income tax payments, payment on high-interest debts, car loans or home equity loans. Note that only 1%, more or less, goes to personal care, tobacco and alcohol and, sadly only 0.2% goes to reading. 

Some expenditures are investments, like education costs. We should talk about education, too. Chuck did not mention that. Nor did he mention that if he cuts SNAP programs, the ones that feed women, infants and children, he is then sending children to school ill-prepared to learn because they’re hungry, and hungry kids get distracted by that. He also cuts Head Start, the program with a track record of achievement.

Chuck did not mention that there is a direct relationship between poverty and poor performance in school. With 23% of the nation’s children living in poverty (27% in his district), I wonder if he sees the connection between hunger, poor academic performance, drop out rates, incarceration rates, the cost of, for lack of a better word, caring for the incarcerated. 

I wonder if he sees a link between poverty and hospital costs, most notably in overtaxed emergency rooms (in those hospitals the cuts have not yet been forced to close).

He might have overlooked that among the largest budget items are defense expenditures, Now, to be fair, some of that is coming down as we extricate ourselves from two disastrous and very expensive, not to say meaningless and fruitless, wars. The new budget reflects our new peaceful environment yet still spends over four times what China spends on its military, and more than the next 15 nations spend combined – who, by the way, are our allies.

Certainly he did not consider that our 3,000 plus fighter planes are more than a match for any other nation’s, and that we’re still building more at $29-57 MILLION per plane. Or, that the US military has recently graduated more drone pilots than fighter pilots. He is silent about the number of tanks we’re building that will never see battle because massive ground scale wars have become obsolete. He has said nothing about the generals' openly stating they don't want them. Strange, isn't it?

I ask you, my fellow American, “Do you see something wrong with spending over $35,000/year to keep a body in prison while spending only a fraction of that for their education, nurturing of body, mind and spirit while they're young?

Did Chuck tell you, ‘cause he didn’t tell me, that the trends of the major nations, third world nations among them, is toward the nurturing, growth and development of their children. Did he tell you that by 2020, China and India will have more college graduates with STEM degrees than the US has people? I guess he hasn’t.

Before you lend this guy an ear, understand that he is not your friend; he is not working for you; and, he will continue to not work for you. His future is aligned with people who are not you. You’d better find one who is for you and work like the dickens to get her into office.

Joe Malgeri
Citizen
jmalgeri@gmail.com

I posted this also to my blog: jmalgeri@blogspot.com


Oddly enough, you could use this article as a template. Remove Chuck Fleischmann’s name, enter your own Congressman’s, and be pretty sure that what is written will apply.

*Source:
http://budgeting.thenest.com/average-american-household-budget-4385.html

Weird Dream

Weird Dream

Seems strange, really. To awaken in the midst of a dialogue with someone, a woman for sure, whose visage one cannot make out, who is dressed quite formally as she sits across from me at a small round table -- wrought iron, I think, with a glass top, 

And I’m sharing with her my thoughts about Prince William and his grandmother of all things. She is British herself I think, by her demeanor, and her interest is piqued by the topic, as expressed by an outsider.

She listens intently, though taken aback somewhat, much as I was when I realized it was I speaking. But it seemed natural to share this observation, and comfortable I was doing it.

Elizabeth, the eldest and very much her father’s daughter has been Queen so long it seems like she has never not been. In my monologue,I muse about Prince William and his good fortune at having been the son of Diana, a rare gift to the English people and about her gift to him (and, of course, Harry). 

I admire the queen for being the Queen, for accepting her lot in life and fulfilling her role in the context of her nation and her society. It was never easy, yet she did it with ease, and when she couldn’t be at ease with it, she strove to deal with it by acting in ways that seemed to her the proper ways a queen should act. She was never, I went on, a person with her own identity playing a role, fulfilling duties. Queen Elizabeth is her role and it is who she is -- no separation.

William, on the other hand is William, the boy who became a man with a strong sense of self, a reflection of his own humanity, separate from the roles he now fulfills and those destiny has laid out for him. William is William first, and then Prince, and both identities are comfortable to him. He fulfills his role with aplomb and enjoys it immensely. He is open and caring, he shares of himself with the radiance of his mother. 

His grandmother is her role and she lives it every moment of her life, controlled as it seems by working every waking moment to anticipate what the personage should do next and then do it, to be what she should be, what the role demands.

Whomever was seated across from me as I rambled, listened quietly, taking in my words and giving them a respectful hearing, non-judgmentally in a British sort of way, non committal, poised without emotion. I think I may never know her true thoughts but I know she has them, and she holds them firmly. She also holds them to herself. As for my thoughts, I am amazed to have had them at all.

Radical Republicans Have No Idea

To the members of the US House of Representatives who voted for the shutdown:

You have no idea the harm you have done, the long-term damage you have wreaked upon your nation.

You were the bullies on the playground, so filled with testosterone that you convinced yourselves you could take over the school and overpower the principal. You spoke only to yourselves to the exclusion of all others and came to believe your own bullshit. How stupid you proved yourselves to be.

Not so, you say? Well, consider this. United States allies from the majority of the world nations are talking – to each other. “Look out,” they’re saying. The nation is imploding, collapsing under its own weight, under the burden of its own hubris and ignorance.

“There are no leaders there – not any more. The ones that might have been, like John McCain, can only apologize for their peers. There are only self serving egotists, feeding at the public trough – at the expense of their own people. It was like this in Rome. It was like this in every collapsing hegemony.

“While we quietly invest in our own people, in infrastructure, strive to improve our education systems and to create opportunities for our children, their infrastructures are collapsing around them. They have taken so much money out of their system for the benefit of the few that they now have to privatize what remains. They openly and gleefully wage wars on their women, infants and children. They would wage a more active war against the elderly if there were fewer and they didn’t need the votes.

“Look how they spend their money – on war materiel. They spend more on their military than all of us combined – and for what? Where can they use it. We are all friends here, by and large. They blind sided Libya but Syria is mush wiser, and they have friends. Iran is softening, making efforts to join the community again. How many missiles do we really need for North Korea?

“As we watch from a distance, they continue to build more fighter jets they’ll never need, more tanks that will never see a battlefield, all to enrich the war machinery. They ignore the fact that the last junior officer to engage an enemy in battle is now an aging general nearing retirement, preparing for new career as a lobbyist. They fail to acknowledge that they now graduate more drone operators than fighter pilots.

“They don’t understand that the last great war for them was won in 1945 and that every one since has come at too great a cost to be called victory. They fail to acknowledge that while they once fought for a cause, they now only wage war as predators.

“After conducting silent wars of economic aggression against Central and South America, and after supporting Asian and Middle Eastern despots, what’s left?

“What’s left but to militarize their internal police forces and national guards to defend themselves against their own. What’s left but to spy on everyone, friends and foe alike, their own citizens as well.

“Careful, my friends. We must ask ourselves, is it time to look elsewhere for leadership? Is it time for an alternative currency to replace the dollar? We must craft a plan to divest ourselves of the trillions we have invested in their treasuries for ‘full faith and credit’ carries less significance for us than it once did. We must prepare to withstand the tsunami as the giant collapses into the sea.

“The leaders among the 545 are too few to overcome the avarice and greed of the fascist elite, the billionaire overlords, the few mega corporations that control everything: the food supplies, the energy resources, healthcare, the media, and the military. Most of them are part of the system, including five of the judiciary. Let us look to each other, for their end is near. It is part of the cycle of life.”

You may deny this, Republicans like Cantor and Ryan, Gohmert and Cruz. Fair enough. History will prove it out. You did not cause the decline. The cracks have been appearing for years. What you did, however was to fracture the nation, to show the world what our institutions have become, to expose us to the light. Ill winds are blowing stronger because of you.

PBMs -- Scorpions and Dogs

In January of the year 2000, the Henry J. Kaiser Family Foundation issued a report titled: The Role of PBMs in Managing Drug Costs: Implications for a Medicare Drug Benefit.  It is one of those special reports in that it is clear, fair and balanced in its presentation. Some thirteen years later, it is good to reflect back on what it said and to analyze the current state of PBMs and their impact on healthcare management, both for efficiency and cost. The results, by and large are abysmal for the nation, while wildly profitable for the largest providers.

I draw your attention to the goal espoused in the opening pages of the report:

The intent behind proposals to use PBMs is to apply private sector best practice techniques to a publicly funded benefit.

In a nutshell that is a euphemism for applying devious, underhanded tactics to charge customers as much as possible just shy of having the client revolt.

PBMs are not servants to their clients. They are corporate pariahs whose goals are profit maximization at the customers’ expense.

To that end, PBM contracts essentially prohibit clients from knowing any more than the PBM thinks they should know. In most cases, this means the client should know that his costs went up again this year, as they have in years past, without asking for an in-depth explanation. In other words, “Trust us.”

It is possible that the acronym PBM was chosen to simplify the words Pharmacy Benefit Manager. It is also possible that this title and the acronym were chosen because the terms Shell Game and Smoke and Mirrors, while more accurately reflecting what publicly traded PBMs do, were already taken.

While PBMs smile and talk softly, the wording of the contracts belies their true purpose. Think of it as the dog (customer) and the scorpion (PBM), together on one side of the river. The scorpion says ever so gently, “The river is moving way too fast and I fear I can’t get across on my own. Can you take me there on your back?”

“But you’re a scorpion. Your venom is fatal. Why would I do that?”

“I promise I won’t sting you. Look, I only ask for safe passage to the other side. That’s all. Trust me.”

Safely ensconced atop the dog’s head and just barely above the waves, the scorpion watches as the shore comes ever closer. Within yards of landfall, his pincer penetrates the dogs skull and, immediately, his paws cease their strokes.

“Why did you do that?,” the dogs asks plaintively, as his body starts to roll with the waves. “Now we’re both going to die.”

“Yes, replies the passenger. I’m a scorpion. It’s what I do.”

PBMs might also stand for Pariahs… you provide the rest.

Not All PBMs Are Alike

The most pernicious PBMs are large, publicly traded corporations that have as their mission to maximize profits for their shareholders – no matter what, no matter how. The top three control between them some 80% of the market and spend millions each year on lobbyists and PR firms in Washington to give them access to legislators with the goal of solidifying their grip on contracts like Medicare.  Americans must take note and beware of these giants because they go beyond feasting at the trough, to gorging themselves lavishly and without remorse on our tax dollars.

Having said that, there are among the hundreds of smaller PBMs, those points of light who have as their mission to provide management services transparently and in the spirit of fiduciaries. It is to these PBMs we should look for management services, because their missions are more consistent with the needs of their clients – to provide good service at a fair price, transparently. They openly state that they seek fiduciary relationships, whereby they serve their customers in every way and openly share each element of their charges to back up their claims.

These PBMs, true servants all, offer every service that the Wall Street listed counterparts without hidden fees, inflated prices and without holding back rebates.

To be clear, here is a comparison of the two models of PBMS:

How PBMs charge for their services

                                                Wall Street Listed                        Smaller, Independent

Admin fees            Very low, may waive them                        Prefer a per member

to get the pharma business             per month fee that a customer can budget                                   

Data Selling                             Make a bundle selling information            Do not sell Data         

                                                to large insurance companies. Data

mining is big business but an

imposition on doctors’ privacy

Spread *                                  The add-on charge for prescription            Do not Spread. In fact

Drugs can range from pennies to            they show the client

Tens of dollars per prescription             exactly what they

filled. Passed on directly to the            paid the just there’s

client for pressing a key.            no doubt.

                                   

Discounts                                Call many discounts by other                Pass along all names

names to keep from passing                         discount

them along.                                               

Delayed Price Changes            Price increases are passed along            Do Not Delay

                                                to the client immediately but they

                                                defer paying them to enhance the

                                                spread

Others yet to be discovered

* Business Owners/CEOs  How would you feel if you discovered you were charged $120 for filling an employee’s prescription when the PBM managing your benefit program paid $30 to buy it? Check your wallets.

How to Be Sure Which PBM You Have

Read the contract and all its fine print. Large PBMs never hide what they’re doing, In fact, they’re quite up front about it. It’s all spelled out in great detail. They tell you there is no fiduciary relationship and they define transparency differently than you or I might.  They key is that it’s not what they say but, rather, how they say it. Most contracts are so well written, it’s hard to discern the truth in what they’re doing.

The best PBM will spell out what they charge, how they charge and, most importantly, what they DON”T charge for or pass through quietly, under the radar.

What is this costing me – Right Now  -- This Minute?

That’s a perfectly good question. After all, if you’re going to go through a rigorous analysis, three should be a good return for the effort. From my research, I find that if a company counts up all the prescriptions it paid for in a year (or a quarter), and multiplies that number by five, it can safely assume the resulting total is a fair estimate. So, for example, if a company with 250 employees on a plan fill 20,000 scripts/period, the savings conservatively accrue to over $100,000 for that period.

Impact on Profits

For simplicity’s sake, let’s assume a company works on a 5 per cent profit margin. That $100,000 savings to the bottom line is the same as a sales increase of $2 MILLION. You do the math. Imagine if, in these hard economic times, your margins are only 2.5%.You decide if it’s worth your time to look.

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/the-role-of-pbms-in-managing-drug-costs-implications-for-a-medicare-drug-benefit.pdf  

Amigos

En un momento, un grupo de voluntarios llamada Remote Access Medical (RAM) trajo médica, dental y de la vista a las zonas remotas de los países del tercer mundo como Guyana y Haití. Hoy, el sesenta por ciento de su trabajo está en el tercer país más nuevo del mundo - los Estados Unidos de América. Proporcionan servicios a los condados y ciudades remotas alejadas como Los Angeles, California y Knoxville, Tennessee.

En cualquier fin de semana, los voluntarios médicos, dentistas y optometristas servirán unos tres mil estadounidenses. Lamentablemente, al final de su fin de semana, ya que cierran las puertas, cientos más se quedarán en pie, no se ha cumplido.

Imagine un país donde los políticos están tan llenos de sí mismos que no tienen tiempo para el 30% de sus conciudadanos que han caído en tiempos difíciles. Imagínese las personas que ganan millones de su gobierno, pero censuran a sus hermanos y hermanas, mujeres y niños de cuidado de la salud, educaciones trabajo o incluso una comida caliente. Hay algo mal aquí. Visita

www.ramusa.org y ver el video.

¿Líder del Mundo Libre? No lo creo.

Graciás por leer.

Joe Malgeri


At one time, a group of volunteers called Remote Access Medical (RAM) brought medical, dental and vision care to remote areas of third world nations like Guyana and Haiti. Today, sixty percent of their work is in the newest third world country -- the United States of America. They provide services to remote counties and remote cities like Los Angeles, California and Knoxville, Tennessee.

On any given weekend, volunteer doctors, dentists and optometrists will serve some three thousand Americans. Sadly, at the end of their weekend, as they close the doors, hundreds more will be left standing, unserved.

Imagine a country where the politicians are so full of themselves that they have no time for the 30% of their fellow citizens who have fallen on hard times. Imagine people who make millions off their government but decry their brothers and sisters, women and children health care, educations jobs or even a warm meal. There is something wrong here.  Visit www.ramusa.org and watch the video.



Leader of the Free World? I don't think so.


Thanks for reading.  Joe Malgeri