Review: The Poverty Industry

One of my clients recently recommended that I read Professor Daniel Hatcher‘s The Poverty Industry. So I did. Now I understand why my client was so adamant that I read the book, and with the same urgency, I recommend that you do the same.

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Hatcher addresses the “poverty industry,” akin to the military industrial complex of which President Eisenhower warned. But it’s worse than that:

In 2011, the defense industry spent in excess of $134 million on government lobbying efforts. Impressive. But the healthcare industry spent almost four times that amount – more than half a billion dollars, including a significant focus on lobbying related to government healthcare problems for the poor. The defense industry also spent almost $24 million in 2011 on campaign contributions, but the healthcare industry multiplied that amount by almost eleven. In fact, campaign contributions made only on behalf of hospitals and nursing homes were about equal to all the campaign contributions made on behalf of the entire defense industry.

Not many Americans are aware of the extent to which private interests are intimately involved in healthcare aspects of what Hatcher refers to as “fiscal federalism.” Most of us believe that the federal government provides money to states, and permits states to deliver those funds to vulnerable populations in a manner most meaningful to the particular circumstances of those populations. But private contractors are interjected into this relationship, creating the iron triangle and the worrisome statistics noted above.

Contractors like MAXIMUS and PCG (the Public Consulting Group) operate internationally, helping governments’ take advantage of financial opportunities. What opportunities that we talking about? Taking Social Security benefits from children in the foster care system.  Taking Medicaid payments for nursing home care, and applying them to state general fund coffers or other projects that have absolutely no linkage to care of the elderly. (By the way, such contractors are often also hired by the federal government for audit activities, creating a scenario in which they are responsible for checking off on their own behavior.)

One of the examples Hatcher shares in the book hits close to home. The Marion County Health & Hospital Corporation in Indianapolis began buying for-profit nursing homes throughout Indiana. It then contracted with American Senior Communities to manage them. Owning the nursing homes permitted the claiming of more federal dollars, which would presumably be used to increase the quality of care nursing home residents were receiving. (Note that Indiana rates abysmally in regard to the quality of care experienced by nursing home residents.) In fact, the Indiana General Assembly passed a bill that would require any additional federal dollars to be spent on nursing homes. However, Governor Frank O’Bannon vetoed the bill, allowing the federal dollars to be routed elsewhere. Ultimately, they were used to fund Eskenazi Hospital. Quality of care in Indiana’s nursing homes is still deplorable.

The Poverty Industry describes numerous other examples of private companies – often with shareholders to keep in mind – working with the government to take advantage of those to whom the money was intended. It is a great eye-opener, and is likely to disturb you like no other non-fiction book on the market. I strongly recommend that everyone read this and then look into how their own state manages public benefits coming from the federal government.

Review: The Smear

I’ve read a bunch of books since my last review, but none of them lent themselves to a review on this website. This afternoon, I finished reading Sharyl Attkisson’s The Smear: How Shady Political Operatives and Fake News Control What You See, What You Think, and How You Vote. (Yes, long title, long book. But one worth reading.) Anyone who is concerned with the declining state of American media – which should, presumably, be everyone – should read this book for a behind-the-scenes account of transactional journalism, super PACs, and the smear.

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Attkisson is an Emmy award-winning journalist, frustrated with how the media has become a unit of propaganda. One day, a couple of congressional staffers approached  her with dirt on their opponent. Attkisson was a disgusted:

I let the thought swirl around in my head. These men are being paid tax dollars to supposedly serve the public interest working for a member of Congress. Instead, they are using time on the clock to smear political enemies.

But this is the status quo in contemporary Washington, D.C.

Working with friendly journalists isn’t the only tactic used by those wanting to discredit an enemy.  The Internet is also a powerful propaganda tool. Attkisson describes a tactic known as “astroturfing,” which allows PR firms, nonprofits, and anyone else to sway public opinion anonymously online. Entities can create hundreds of anonymous online profiles to make it appear that there is grassroots support when none truly exists.

Perhaps most disturbingly, Attkisson documents how Democrats attempted an astroturfing campaign against “fake news.” At the time, Media Matters and President Obama were proclaiming citizens were deeply concerned about the onslaught of fake news, and that something must be done about it. Both Obama and Media Matters trainees called for websites, including Google and Facebook, to curate news. The problems? The American public is not calling out for the First Amendment to be restricted; surveys do not support that fake news is one of the biggest concerns of the American electorate. Media matters and Obama are overselling the threat of fake media, as perceived by Americans at large. The second concern is that, to solve the “threat” of fake media, Obama and Media Matters are calling upon Google, Facebook, and other companies to curate news. Such a “solution” leads to serious concerns about censorship and protection of the First Amendment. (Although Democrats’ plans fizzled when Trump co-opted the term “fake media,” it is still deeply worrisome that Google and Facebook may curate news to the advantage of a singular ideology.)

My biggest critique of this book is that it focuses almost exclusively on the 2016 election. I realize Attkisson is a political reporter, but it would be interesting to see how the smear affects those outside of politics, if at all.Anyway, if you are a propagandist in the making, are a journalist, or have an interest in learning about how the powerful are trying to manipulate you, check out The Smear.

Review: Devil’s Bargain

Not long ago, I quickly finished Joshua Green‘s Devil’s Bargain: Steve Bannon, Donald Trump, and the Storming of the Presidency. I actually read it after Bannon left the White House; I never really understood the controversy over his entry or exit in the Trump Administration, and bought the book in order to provide insight. To an extent, the book was helpful, but only insofar as providing the typical left-of-center perspective dished out via the mainstream media.

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Green’s initial description of Bannon is “as a colorful version of a recognizable Washington character type: the political grifter seeking to profit from the latest trend.” He is also repeatedly portrayed as slovenly, apparently having only recently decided to “swap[] the cargo shorts for cargo pants and toss[] a blazer over his many layers of shirting.” His motto? “Honey badger don’t give a shit.”

Much more interesting than Green’s perspectives on Bannon are those regarding Trump. Reportedly, Trump is incredibly superstitious, going so far as to throw salt over his shoulder during meals. Apparently Corey Lewandowski and Trump had a falling out as Lewandowski believed that, because Trump treated him as a son, he could act like one. Not the case. Green also writes that Governor Chris Christie also irked Trump, repeatedly attempting to ingratiate himself with the family and refusing to respect Trump’s personal space.

Gossip about individual quirks aside (and Green does make a point of noting that his writing is extensively sourced), the book speculates that Trump became serious about running for president after he was humiliated at the White House Correspondents’ Dinner by President Obama and Seth Meyers. He did run, and when Paul Manafort’s efforts to mold Trump into a more conventional candidate began tanking the campaign, the Mercer family encouraged Trump to bring Bannon on board.

The book discusses Bannon’s background, both personally and professionally, but never really explains why he is so incredibly disliked, aside from his efforts to have the Clintons discredited. Although Green appears to dislike populism, in general, he never offers policy arguments to illustrate why Bannon’s platforms are wrong or inappropriate. While I did learn gossipy tidbits mentioned above, Devil’s Bargain falls flat when it comes to anything more than that.

Review: The Vanishing American Adult

I didn’t read Senator Ben Sasse‘s The Vanishing American Adult: Our Coming-of-Age Crisis and How to Rebuild a Culture of Self-Reliance when it initially came out because I was put off by the title. Do we really need another anti-millennial book? And is anyone truly self-reliant in contemporary culture? Moreover, I was reluctant to read yet another politician dictating policy solutions when he has little grasp on those upon whom he is prescribing policy. Indeed, I only picked up the book at the recommendation of my friend, T.K. Small. I’m glad T.K. recommended the book and have since learned not to judge a book by its title (or it’s author’s profession)!

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What first impressed me about Sasse was his writing itself. I was not expecting syntax and diction that were pleasant to read; I suppose a stereotype Nebraskans as boring farmers, but Sasse’s style is entertaining. Moreover, it is based in fact; he uses a fine balance of academic literature and personal anecdote to convey information in a well-paced manner.

And, although the beginning of the book does discuss how millennial Americans fail to meet many of the standards of their forbearers, Sasse does not blame millennials for these shortcomings. Rather, he takes the reader through an interesting history of the American education system and the goals of social reformers like John Dewey. As immigrants arrived from various backgrounds and jobs became harder to get, school was a good place to stick new arrivals and provide a standardized baseline. However, education transitioned from the classical toward the pragmatic. More time was continually devoted to the classroom, taking students away from family, the community, and jobs. Learning became a passive endeavor.

Dewey’s student ultimately has no soul. The only thing that matters, in the end, is man’s relation to his society. The societal here and now is the all in all. The goal is expressly not the full flowering of the individual, but rather ‘all education preceded by the participation of the individual in the social consciousness of the race.’

Certainly, other factors contribute to the lack of well-roundedness with which today’s young adults must grapple, but the mere fact that so much of one’s youth is spent in the classroom contributes significantly to the problem.

In the second, and largest, part of the book, Sasse offers concrete ideas for helping youth grow into adulthood. Importantly, none of the five proposals is a policy idea, but instead direct action that parents can take to enrich the lives of their children. He proposes: ensuring that young people spend time with those of a range of ages and experiences; arranging for youth to work; diminishing consumption of material goods; traveling; and sharing great works of literature with young people. Sasse uses his own family’s practices as examples for instituting the above ideas, but also recognizes that implementation will look different for every family. For example, he notes that one need not travel far in order to try one’s hand at navigating, managing a new environment, and participating in new experiences.

I’ve already noted that I was impressed with the book, and believe others would learn from its pages. In particular, I would recommend this book to parents and those who have children in their lives, including aunts, uncles, and mentors.

Review: Dangerous

I really hesitated before purchasing Milo Yiannopoulos DangerousI was afraid of the controversy that reading the book in public might entail. One of my work colleagues and I discussed Milo and his movement after the riot that followed him at Berkeley. Before hearing about the massive damage left in his wake, I had never heard of him, nor read his Breitbart columns. Shortly after the Berkeley incident, Milo made the news again, resigning from Breitbart after allegations that he supported pedophilia. So, you can imagine why I was leery.

It turns out that Milo relishes the spotlight, referring to himself as a “dangerous faggot” and adopting the drag persona Ivana Wall. His book describes the role he’s created for himself, eagerly pushing boundaries and challenging liberals who try to suppress the free speech of himself and others. Milo promises readers that he is a “good troll,” only using “a certain level of disregard for other people’s feelings” when “reasoned argument and polite entreaty have failed.

Nonetheless, in Dangerous, Milo is occasionally downright mean for no apparent purpose, other than getting himself put squarely back in the limelight. Milo regularly complains about “ugly women” and “fat people,” yet claims he only trolls “deserving targets,” including “the disabled.” What did people with disabilities ever do to get on Milo’s bad side? I find his attitude toward people with disabilities particularly ironic given that Milo claims HIV/AIDS is still a problem worthy of attention, particularly amongst the gay male population. Funny that, when the Americans with Disabilities Act was being passed, disability advocates fought tenaciously to get HIV/AIDS recognized as a disability within the Act’s protection.

The surprising thing is that Milo actually has many astute points. Particularly in regard to social media censorship and the millennial generation’s engagement in the political sphere, Milo has many thoughts worthy of discussion. Because I actually learned something from Dangerous – something interesting, I promise, completely aside from name-calling – I feel compelled to recommend that others give the book a chance. At the same time, I understand if and why you don’t. Fortunately, you have to freedom to expose yourself to Milo. (I’m sure he’d get a kick out of it!)

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Review: An American Sickness

You know by now that I love reading and sharing information that I learn from a good book. Elisabeth Rosenthal‘s An American Sickness: How Healthcare Became Big Business and How You Can Take It Back is truly one of the most interesting books I’ve read all year! Especially now, as Senators discuss repealing and/or amending the Affordable Care Act, read this book!!!

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Rosenthal, a former journalist and physician, begins by thoroughly describing how the medical-industrial complex takes advantage of patients and legal loopholes. She devotes a chapter each to the ills of insurers, hospitals, physicians, pharmaceutical companies, medical device companies, ancillary service providers, billing and coding contractors, medical researchers, conglomerations, and patient complacency. The facts presented are fascinating: for example, “[t]he average hospital cost per day in the United States was $4,300 in 2013,” more than triple “the cost in Australia and about ten times the cost in Spain”!

The concept that irked me the most is “venture philanthropy.” Of it, Rosenthal writes:

The problem is that many charitable foundations no longer see themselves as funders of research for knowledge propelled by donor dollars to cure a disease, but instead as inventors in new treatments.

When insulin was developed in the 1920s, researchers did not stand by patent protection to reap income, but instead shared their knowledge with the community. When the March of Dimes helped fund vaccination research, it did not bill children or their families for inoculation. Now, medical charities are investing money in research. Because any successful discovery will likely result in royalties to the charity shareholder, the charity has no financial incentive to advocate for the cost of that discovery to be accessible to those served by the charity. Talk about conflict of interest!

Rosenthal devotes the second portion of the book to offering both systemic reform, as well as individualized, methods to save money on medical treatment. Again, this section was disturbing, given that neither Republicans nor Democrats are proposing many of the reforms proposed by Rosenthal. Although concepts like tort reform have been initiated in states like Indiana, contemporary federal reform efforts appear completely off the mark.

Last, but most certainly not least, the end of the book contains multiple appendices patients can use to arm themselves in price negotiation. Although options for comparison shopping for medical procedures are limited, Rosenthal provides links to those options that are available. She also includes template letters patients can use when objecting to healthcare charges.

This book contains good stuff, all around. I’ve been bugging my coworkers about it all week long, eager to share stories about how we are all getting ripped off. This book, however, is not a ripoff, but a real gem for the bookshelf!

Review: Life, Liberty & the Defense of Dignity

Leon Kass Life, Liberty & the Defense of Dignity: The Challenge for Bioethics is an oldie, but a goodie. The premier bioethicist explains the philosophy of dignity, and describes how various technological advances, including cloning and progress toward immortality, threaten dignity and humanity itself.

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The book is heavy stuff. In addition to the gravity of the subject matter, Kass dives into Kantian ethics, etymology, and the philosophy of science. Perhaps this will deter the casual reader, but those interested in the subject should appreciate the thorough eloquence of the author.

The main challenges Kass addresses include: the origins of procreation, genetic therapy, cloning, the sale of organs, the so-called “right to die,” the quest for immortality, and the nature of biology. Throughout, Kass argues in favor of restraint and respect for human nature.

I was particularly intrigued by those  passages of the book in which Kass opines on the nature of humanity itself, writing that the corporeal nature of our situation should not be discounted.

The point is crucial, and stands apart from the text that teaches that: everything high about human life – thinking, judging, loving, willing, acting – depends absolutely on everything low – metabolism, digestion, respiration, circulation, excretion. In the case of human beings, “divinity” needs blood – or “mere” life – to sustain itself. And because of what it holds up, human blood – that is, human life – deserves special respect, beyond that which is owed to life as such; the low ceases to be the low.

If the above quote gets you thinking, I highly recommend reading the remainder of Kass’ book! Indeed, given the attention on healthcare as of late, Kass’ theories are all the more timely and deserving of contemplation.