“Almost half of people on Medicare, 31 million Americans, are now enrolled in a Medicare Advantage plan, nearly double the share of 10 years ago. It is widely assumed that Medicare Advantage will cover a majority of the program’s beneficiaries within the next few years.”
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“Medicare Advantage allows private insurers to offer their own plans that provide Medicare benefits as well as some additional perks not available in the original program. The secret to the program’s success is simplicity. Traditional Medicare is a fragmented program; Part A covers hospital care and Part B covers outpatient services. Patients must enroll in a separate Part D plan for prescription drug coverage that is administered by private insurers. Most people also purchase supplemental coverage, extra insurance that helps reduce their out-of-pocket costs.
Medicare Advantage, also known as Part C, combines those benefits into one insurance plan that also includes an annual limit on out-of-pocket costs, something that does not technically exists in regular Medicare.
But the benefits to patients seem to come at a cost to taxpayers. Though the health insurance industry disputes these findings, MedPAC, the independent committee tasked with overseeing Medicare on Congress’s behalf, found Medicare Advantage plans cost the federal government more money per patient than the original program would have if those same people had stuck with the traditional benefits.
Private companies are also making healthy margins on their Medicare business.”
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“Medicare Advantage enrollees are more likely to report trouble affording health care than people on traditional Medicare. Some of the behavior by Medicare Advantage plans, such as using AI to decide when to stop covering services for their enrollees, may be becoming more common in the private sector but is still unheard of for public programs.
The trade-off the United States seems to be making is accepting more administrative bloat and more stringent provision of benefits in exchange for a more navigable Medicare plan. The trade-off is one other countries have made as they designed universal health care programs. (A similar trend is underway in Medicaid.)
But as concern grows about Medicare facing a potential financial cliff, and evidence mounts about the costs of Medicare Advantage, the risks of the trade-off are becoming clearer. Medicare is no longer what it used to be: Once the epitome of government-run health insurance, its benefits are on the verge of being primarily funneled through private companies. Any attempts to change the program will have to wrestle with that reality.”
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“In traditional Medicare, for example, patients can go to any doctor or hospital that accepts Medicare; Medicare Advantage has more limited provider networks, and patients can be on the hook for higher costs if they are treated at an out-of-network doctor or hospital.
The federal government pays Medicare Advantage plans a flat rate for the expected cost of covering their particular customers and the insurers are required to adhere to certain rules about benefits and costs. But companies still have flexibility about how to run their plans and have a financial incentive to limit expenses. The less money they spend, the more they get to keep for themselves.
Still, customers will vote with their feet and, after slower-than-expected initial uptake, Medicare Advantage is now growing so quickly that it will soon be the dominant form of Medicare.”
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“The premiums people pay for a Medicare Advantage plan can be significantly lower than the combined cost of supplemental coverage and a Part D plan — less than $50 compared to more than $200 on average, per Terry and Muhlestein — with the added benefit of having only a single insurance card. According to a 2022 Commonwealth Fund survey, the additional benefits offered by Medicare Advantage plans (such as dental or vision) and the limits on out-of-pocket costs were the most common reasons seniors gave for choosing the alternative over the original program.”
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“Medicare Advantage patients are less likely to receive medical care at the highest-rated facilities for their particular needs, compared to people with traditional Medicare, a reflection of more restrictive provider networks.”
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“A report from federal investigators published in April 2022 found that tens of thousands of Medicare Advantage customers were denied coverage for services they should have been entitled to. A significant number of prior authorization denials (13 percent) and payment denials (19 percent) reviewed by the investigators were for services that should have been covered by the program but were not.”
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“According to MedPac, since 2004, Medicare has always paid more to Medicare Advantage plans for the cost of covering their customers than the program would have spent if the same beneficiaries had instead been enrolled in traditional Medicare. Some years, the private plans were receiving a nearly 20 percent markup compared to the original benefit structure.”
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“The growth of Medicare Advantage is contributing to the financial crunch. Those plans receive funding based on the type of service provided to their customer, which means money for hospital care comes from Part A. Annual Part A payments to Medicare Advantage plans are expected to increase from about $176 billion in 2022 to $336 billion by 2030.
With revived concerns over Medicare’s solvency and evidence of excess spending in Medicare Advantage, policymakers are starting to look at making changes to the program. But that won’t be easy.”
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“States have outsourced much of the administration of Medicaid to managed care plans. Countries like the Netherlands have set up health systems that use private insurers, operating under strict government oversight, to provide insurance benefits to their citizens. Giving people more choice and a more streamlined experience can have its benefits, as evidenced by the popularity of Medicare Advantage in the US.
But asking private actors, with profit motivations, to administer government benefits to which people are supposed to be entitled brings risks. People are more likely to have trouble affording health care and their claims are more likely to be denied; that is true in places like the Netherlands, compared to other countries with more direct government administration, and that is true of Medicare Advantage when compared to the traditional Medicare program.”
“Food companies say their price increases merely reflect how much their costs have gone up due to “inflationary pressures,” like higher labor costs, transportation delays, and capacity issues, or the higher price of grains and animal feed. Yet inflation in 2022 outpaced the rise in wages in most industries, and the prices of many agricultural commodities have come down.
The eyebrow-raising spikes at the grocery store can only partly be blamed on manufacturers’ higher costs. The inflation narrative offers the perfect jumping-off point for companies to raise prices, and major food manufacturers are taking advantage of the moment to boost their profits.
The proof? Look at just how rich companies have gotten since the start of the pandemic.”
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““Corporate profits have hit their highest level ever, and corporate profit margins — how much they’re making on each unit that they’re selling — have hit the highest level in 70 years,” said Chris Becker, senior economist at the Groundwork Collaborative, a progressive economic advocacy organization.”
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“Why are corporate profits so high at a time when regular people feel increasingly strapped? Because a small number of players have gobbled up most of the food chain. Cargill and just three other agribusiness companies control about 70 percent of the world’s agriculture market, according to Oxfam. Brands like PepsiCo, Nestle, Mondelez, and Conagra produce and market the vast majority of the offerings found in US grocery stores.
“We look at the supermarket shelf, and we might be buying tea, cereal, whatever it might be, and we think, ‘Oh, I’ve got a real offer of choice here on the product I want to buy,’” Ahmed, of Oxfam, told Vox. “Frankly, it’s an illusion of choice, because so many of those products are actually owned by the same company.”
Grocery retailers, too, have become increasingly consolidated.”
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“Evan Wasner, a University of Massachusetts-Amherst economist who authored a recent paper on companies’ price-setting power with economist Isabella Weber, said that companies tend to raise prices when they think they won’t see a huge backlash — like when everyone else is hiking prices, too. “In a sense, economy-wide cost increases act as a kind of coordinating mechanism which allows firms competing with one another for market share to safely raise prices together,” said Wasner.”
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“Market dominance makes the supply chain more brittle, too, because it means there are just a few vulnerable points for failure. Last year’s baby formula shortage is an example of how dangerous the results can be. Just two US companies control about 80 percent of the market, which meant that when one manufacturing plant shut down, the entire nation struggled to buy baby formula.
Becker blames the vulnerable state of supply chains in part on market deregulation over the last several decades, which has enabled companies to cut corners. In the 1980s, the growing popularity of “just-in-time” inventory systems, where companies order just the amount of inventory needed right now without a buffer, allowed companies to become more efficient. That has meant lower prices for consumers, usually, and higher profits for companies — until a crisis hits, and suddenly there are shortages and supply bottlenecks.”
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“Transcripts of corporations’ recent earnings calls illuminate that they’re well aware of their power right now. Groundwork has been collecting highlights from corporate earnings calls on its website. “They’re saying a lot about cost increases and supply shocks, but they’re also saying it doesn’t matter,” said Becker. “We do have these higher costs that we’re paying, but we have so much pricing power, we’re so capable of passing all these prices on to consumers, that it doesn’t matter.””
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“Becker echoed that the current economic orthodoxy on how to fix inflation — to rein in Americans’ ability to spend money by attempting to raise unemployment levels — should be questioned.
“I would say that we have this really toxic narrative out there that the only way we can get inflation under control is to throw a bunch of people out of work,” said Becker. “Larry Summers recently claimed that we would need 10 percent unemployment [for one year], which is about 11 million jobs lost, to get inflation under control.”
“We’re going to try to solve a cost-of-living crisis by making people poor or losing their jobs? I think that’s crazy,” he continued.
What will break the cycle of not just inflation, but of consumers having to pay ever-higher prices for essential goods while the world’s food producers become richer? Experts offered several potential solutions. One is stronger antitrust laws and improved enforcement of preventing and breaking up monopolies. Anti-price gouging laws are another tool in the arsenal. Oxfam, for one, has been a vocal advocate of a windfall profits tax on food corporations. “It’s a tax on those corporations which are raising prices substantially in excess of costs,” Ahmed explained. The fact that it would raise tax revenue is great. But “fundamentally, it reins in companies’ monopoly power and disincentives corporate greed.” Other countries already have similar measures in place. Spain expects to raise about $6.39 billion from its windfall tax on energy companies and banks.
“Corporations are really making profits on the backs of consumers and households,” said Becker. “Let’s tax those windfall profits — and let’s do something with that money.
“There’s nothing that really stops corporations right now from just doing whatever they want.””
“Hypersonic weapons, or vehicles and missiles that travel faster than Mach 5, or five times the speed of sound, aren’t new; the US has been developing and testing these weapons since the 1950s. But there’s been relatively little USinvestment in these systems
“Vermont is one of at least three states seeking to strengthen its laws against paramilitary activity. At the same time, Idaho — a state with a long history of anti-government militia activity — is seeking to overturn its sole, unenforced law banning militias. The pending legislation represents two very different responses to what federal authorities say is a growing threat of domestic terrorism: Incidents of domestic terrorism, which includes violent militia, increased 357 percent from 2013 to 2021, according to a February report from the Government Accountability Office. The new laws could shape where militias operate, and what they feel emboldened to do, in the years to come.”
“Nathaniel Rakich: Joe Biden is racing toward the political center. First, reports surfaced that his administration may resume detaining immigrant families who cross the border illegally. Then he came out in favor of blocking a Washington, D.C., law that would have reduced the penalties for certain crimes. Finally, he approved a massive new oil drilling project in Alaska that’s ardently opposed by environmentalists. So today we’re asking the question that a lot of progressive Democrats are asking themselves too: What’s the deal with Biden’s move to the center?
I can’t read Biden’s mind, but I suspect he’s doing this to improve his chances in the 2024 election. Biden hasn’t yet officially announced his reelection campaign, but moves like this leave little doubt that he’s running again. His approval rating is around 44 percent, according to FiveThirtyEight’s average. So he’s got to put in the reps to pump those numbers up.”
“Gang violence has killed more than 530 Haitians this year and 187 in the past two weeks alone, as the security and political situation in the Caribbean nation continues to devolve. Decades of corrupt leadership and weakened democratic institutions — supported by the United States — have brought a state of terror and lawlessness to Haiti without an achievable political solution or even an end to the violence in sight.
The violence, concentrated in Haiti’s capital, Port-au-Prince, and the surrounding areas, is caused by political and economic factors including the decimation of the country’s largest economic driver, agriculture, and subsequent urban migration, small arms proliferation, and a political class willing to weaponize Haiti’s struggles to cling to power. The person nominally in charge of the country, acting Prime Minister and President Ariel Henry, lacks a true mandate to power and has proven incapable of managing the chaos, instead proposing to deploy the country’s young and fragile military to maintain order.”
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“Violence by groups and gangs connected to the state is not new in Haiti, but a number of factors have contributed to the gangs’ power at the present moment. Political leaders as far back as François “Papa Doc” Duvalier, Haiti’s populist elected leader-turned-dictator from 1957 through 1971, have formed and utilized armed groups external to national security forces for protection or to enforce their own agendas and self-interest, according to an October report from the Global Initiative against Transnational Organized Crime.
The present gangs are primarily affiliated with two groups, G-Pep and G9, which fight for control of Port-au-Prince. An estimated 60 percent of the capital is under the control of these groups, which terrorize civilians not only with threats of murder, but also abduction for ransom, extortion, and sexual violence, often at random.”
“Human error and track defects are two of the biggest causes of derailments, for example. In cases involving hazardous chemicals, equipment failures have also played a role in the past. These issues, broadly, may be compounded by staffing cuts railroads have made in recent years and their resistance to more costly equipment upgrades.”
“US policy isn’t solely to blame for the adverse conditions in Mexico that may have contributed to the tragedy at the migrant detention center. As a result of Trump-era policies that have largely continued under the Biden administration, there are now more migrants than ever waiting in Mexican border cities to enter the US as a result of policies pursued by the Trump and Biden administrations. As of late December, there were a record estimated 20,000 migrants waiting in Juárez alone.
But Michelle Mittelstadt, a spokesperson for the Migration Policy Institute, a nonpartisan think tank, said the Mexican government can invest more in expanding its capacity to accommodate migrant populations that include families and unaccompanied children.”
“Michigan repealed an 11-year-old law that weakened unions’ power in the workplace. Known as a “right-to-work” law, this type of legislation has been around since at least 1943, and Michigan is now one of only a handful of states to ever repeal it.
When Michigan’s law passed in 2012, the state was firmly in Republican hands. The party held control of the governorship, state Senate and House, after riding the Tea Party wave to power. Conversely, this repeal comes a few short months after the Democratic Party — which has long allied with unions — scored their own trifecta for the first time in roughly four decades. Meanwhile, in 2022, unions reached their highest popularity since 1965. In the repeal of right-to-work, though, partisanship could play just as much of a role as love of unions does.
Because every worker covered by a union contract receives its benefits, private-sector unions are often allowed to collect fees from those employees regardless of whether they join the union. But the 1947 Taft-Hartley Act allowed states to pass laws — branded “right-to-work” laws — that would end that practice, and a flurry of states did indeed pass them.
The primary effect of the laws is to weaken unions in the states where they’re passed. Because workers can gain the benefits of unionization without paying for them, it creates a classic “free-rider” economic problem. Why pay union dues if you get the benefits anyway? As a result, unions often have fewer resources to organize and bargain with.”
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“Proponents of right-to-work laws have long held that decreasing unions’ power in a state will entice employers and lead to more jobs, and that the benefits of added employment lift people out of poverty and increase job satisfaction. “There’s well-known stories about especially Southern states saying, ‘Well, we’re gonna give you a bunch of subsidies to support your investment, and also we’ll make sure there’s going to be no union,’” said Thomas Lemieux, an economist at the University of British Columbia who has studied the recent wave of right-to-work laws. However, studies suggest that that hasn’t led to wage growth or greater worker protections in those states. A common criticism about many studies showing the benefits of right-to-work laws is that they fail to control for all of the other factors that might lead to economic and job growth. “It’s certainly fair to have a debate about what are the costs and benefits of unionization,” Lemieux said.
Lemieux said that the jobs created tend not to include the benefits that unionized jobs bring, because the workers have little bargaining power. In states like Michigan, income inequality has increased as union density has declined; this appears to be because the presence of unions tends to lower the number of households at the top and bottom of the income scale. The presence of unions may also signal support for, and provides organizing around, other state policies that benefit workers, said David Kemper, the senior state policy coordinator at the Economic Policy Institute, a left-leaning think tank that supports unions. In general, right-to-work states scored lower on a number of issues, from wages to workplace safety conditions to political participation, according to a report by Illinois Economic Policy Institute.2 and the Project for Middle Class Renewal at the University of Illinois Urbana-Champaign.”
“the core violation here is, basically, that the Trump Organization logged hush money repayments improperly. The more small-scale charges like this after a long investigation seem, the more they suggest prosecutors landed on them because they tried to make a bigger case that didn’t pan out.
Does it resemble previous prosecutions? In some ways yes, in some ways no. Business records charges are common in the Manhattan district attorney’s office. The New York Times called this charge “the bread and butter” of the office’s white-collar practice, pointing out that during Bragg’s tenure of a little over a year, 29 individuals and companies were charged with such offenses before Trump. “The charge of creating false financial records is constantly brought,” Agnifilo and Eisen write.
Still, there is some dispute about how the charge is being applied in this case. Fordham law professor Jed Shugerman points out that these false records were just internal company documents, and that Bragg has not yet specifically alleged they were used to deceive anyone. Shugerman asked whether there’s ever been a conviction in such a case. Various former prosecutors in the Manhattan DA’s office have argued that they can and did file such charges based on internal documents, but it’s unclear whether the legality of that theory has been directly tested in court.”