Can Someone Actually Be Responsible? – The Health Care Blog

By MATTHEW HOLT

I used to be having a combat on Twitter this week and it hit me. America 2024 is Japan 1989. 

The subject of the combat was right-wing VC Peter Thiel. In 2001 he put a ton of Paypal inventory allegedly price lower than $2,000 right into a Roth IRA. The Roth IRA was designed in order that working stiffs might put submit tax money into an IRA, develop it slowly and take out cash tax-free. (For conventional IRAs you set in pre-tax cash and get taxed once you take it out). You could have learn the story in ProPublica. Magically Thiel earned much less that yr than the max allowable revenue restrict (round $100K) to contribute to a Roth IRA, and magically that inventory was inside weeks price rather more after which, later, lots of of thousands and thousands extra. Since then Thiel has invested these Paypal returns in Fb, Palantir and rather more, and that Roth IRA has billions of {dollars} in it that may by no means be taxed.

My twitter adversary was saying that Thiel obeyed the regulation. I doubt it, however that’s not likely the purpose. When the Roth was launched it wasn’t meant to be a loophole that Silicon Valley sorts might use to cover billions from tax. However neither my twitter “good friend” nor Peter Thiel wish to take duty or pay their justifiable share.

Japan in 1989 was rich and profitable and heading off a speculative cliff which it’s since taken 3 many years to dig out of. There have been quite a few academics pointing this out, however essentially the most attention-grabbing evaluation was The Enigma of Japanese Power written by a Dutch journalist named Karel van Wolferen. Right here’s a abstract from wikipedia with my emphasis added

Van Wolferen creates a picture of a state the place an advanced political-corporate relationship retards progress, and the place the residents forgo the social rights loved in different developed nations out of a collective concern of international domination….Japanese energy is described as being held by a unfastened group of unaccountable elites who function behind the scenes. As a result of this energy is loosely held, those that wield it escape duty for the results when issues go improper as there’s nobody who will be held accountable.

In Thiel’s case a collective community of tax accountants, junk philosophers, and bought politicians like JD Vance make sure that nobody must be accountable. Finally Thiel doesn’t really feel liable for paying what he owes. After all the exposure of Trump’s tax cheating exhibits that he doesn’t both. And many individuals discover this OK.

In the meantime I got into it a little with Jeff Goldsmith on last week’s THCB Gang about why hospitals are nonetheless paid per transaction when it could be a lot better for them to be paid some form of international funds for the companies they supply and for medical doctors to be paid a wage to train their finest judgment moderately than be tempted into offering care simply because they receives a commission for it. Each COVID and the current Change Healthcare outage put well being care suppliers in a horrible scenario financially as a result of they depend upon being paid fee-for-service by way of claims for particular person transactions. Did the management of America’s hospitals and medical doctors come out asking for a change to the system? No, they simply received a authorities hand out and begged for a return to plain working process. Nobody can rationally take a look at how we pay for well being care in America and say “give us extra of the identical” however there’s no management to vary it in any respect.

Speaking about lack of management, Amber Thurman died in Piedmont Henry Hospital as a result of no-one on the medical crew was prepared to give her the D&C that she desperately needed. They have been fearful of going to jail below Georgia’s draconian anti-abortion regulation. There are numerous, many responsible events right here.

Not one of the medical doctors or medical employees stood up and stated, “that is the proper factor”. Trump openly appointed unqualified Supreme Courtroom judges as a result of he knew, and Leonard Leo informed him, that they have been going to overturn Roe. The Georgia legislature and governor knew what they have been doing after they handed their abortion laws. 

Nevertheless it appears to me that Piedmont CEO Kevin Brown has an enormous duty. His bio says that since he turned CEO 11 years in the past he “delivered to Piedmont a tradition of stewardship that’s now ingrained into the day by day operations”.  Though he knew that Roe was prone to be overturned, there was apparently no stewardship, coverage or directive that the medical employees might flip to. Ought to Brown be accountable? Ought to he be prosecuted for involuntary manslaughter in Amber Thurman’s case? Would your view be modified in case you knew that he gets paid $4m a year to supposedly be accountable and make the massive choices? I’ve Googled laborious and have seen nothing from Piedmont or Brown about this case. Once more, not even seen, not to mention accountable. 

The opposite large information not too long ago, no less than for these of us who care about interoperability, is Epic being sued by startup Particle for denying it access to data. However strip away the rhetoric, the conduct alleged within the lawsuit is simply what you’d anticipate from a giant bully monopoly–put the little man in a troublesome place, go to their purchasers and make them a suggestion they will’t refuse. Particularly Epic went to a Particle consumer referred to as XCures and stated “good enterprise you bought there, you wouldn’t need it to go away in case you preserve utilizing Particle when we’ve got an answer for you as an alternative”. XCures appeared to be a happy client which then canceled its Particle contract. I think this can be the primary of many incidents that might end in a big FTC investigation into Epic. 

However that’s not the center of the  drawback. As they tell us at HIMSS every year, principally everyone seems to be on Epic and no main system is changing them anytime quickly. In truth they’re including large regional techniques (UPMC, Northwell, Intermountain) and there’s principally nobody left for them to promote to. Epic’s wise answer would have been to tug a Invoice Gates in 1997 and provides Steve Jobs/Particle, some cash and an onramp onto their system, in trade for agreed clear conduct. Possibly Epic was fearful about turning Apple 1997 into Apple 2015 however I’m positive they might have managed that danger, and I’m positive Microsoft made an enormous return on its $150m put into Apple.

As a substitute Epic is appearing prefer it’s nonetheless the weak begin up Judy Faulkner launched in a kitchen. In the meantime, all of the hospitals its know-how operates have been appearing for years as if their solely duty is to extend their reserves and days of money readily available, whereas paying their executives like aid pitchers.

My urged answer is to nationalize Epic and its supplier prospects, as they’re all principally monopoly utilities sucking on the teet of the taxpayer, extracting huge worth from their native economies, and giving little or no in the way in which of innovation or common/charity care again. (Jeff Goldsmith doesn’t agree with me however he’s improper!). In any case, in my homeland of the UK Thatcher and her successors privatized the water utilities within the Eighties & Nineteen Nineties, and now the executives & shareholders are rich, the sewer  infrastructure is broken due to lack of investment, and the rivers and beaches are flooded with shit. We’re shifting in direction of that in well being care right here on account of a non-discussed “want” to maintain 100 hospital techniques and their executives within the prime 0.1% of richest People. I’m positive Kevin Brown and lots of of his government colleagues at Piedmont are amongst them.

I settle for that is America and that’s unlikely nevertheless it’s what we should always do. 

We would not need to go there if anybody would rise up and be accountable. However nobody will take duty for something, and apparently the buck by no means stops.

Matthew Holt is the writer of THCB