If you owned a product or service that everyone needed whether they wanted it or not, you could easily dictate all the conditions under which that product or service would be offered to the public. If your ownership of this necessary product/service occurred in a culture and business environment where the maximization of private profit was the driving force, there would be practically no limit to how much you would provide this product for and under what terms. We would hope that there would be massive consumer protest if your monopoly position was abused to what your customers considered intolerable levels. If these intolerable conditions were reached only some kind of intervention on the part of a cumulatively larger force than the monopolizing owner’s  could restore some kind of reasonableness to the market.  This is precisely the situation in the American economy and it is not for any frivolous reason that our economic system is called monopoly, corporate capitalism. People can protest this label as much as they want but no amount of protestation can change historic reality. If we set the not so arbitrary date of 1790 as the date from which the United States began to function as a State and economic system very similar to the one we have today we can see that this drive for monopoly, cartelizing of economic power and collusive activity got under way very early in the in the history of our Republic.  Barely 100 years into the game the Sherman (Anti-Trust) Act had to be passed to essentially maintain social order and to prevent further egregious monopoly behavior on the part of large business concerns.  Since the passage of that act the history of American business has largely been and attempt to control the monopoly behavior of large business concerns on the part of whatever countervailing forces were available in any period of time. In 1914, the Clayton Act was passed to regulate abuses that large business concerns engaged when finding areas for rapacious economic behavior that were not “covered” by the Sherman Act. 22 years later the Robinson-Patman Act was passed because business buccaneers still found ways around legislation. A thesis maintained by some social scientists is the thesis which states that the natural development of large business enterprises in a private property, private profit maximization economic system is the one that naturally leads to cartelization and collusive activity. More recently some political scientists who promote the idea of “democracy inversion” state this move to cartelization by necessity leads to Fascism, which is the ultimate collusion of State and large business concerns for mutual sustenance and benefit. The mechanics of just how this system develops would be a rich area for some enterprising social/political scientist to investigate.  The whole system could be summarized by the description that the big get bigger, the smaller get eaten, and  in our economic system the big need to continue getting bigger. Fascism cannot be contained within national boundaries.  National boundaries are too limiting for forces which need to get bigger and control more and more.  Obviously this is not something we can look into in this piece.  However, let’s look and see whether there is some evidence to support the statements made above.  Clearly, what we don’t have to look into is whether this is the economic milieu in which Obummer Care has to function. Where else could it function?

Prior to the Savings and Loan crisis of the late eighties it wouldn’t be an exaggeration to say that there were thousands of banks of various sizes operating in practically  every community is America.  Since that crisis, smaller banks could not compete with larger entities and their assets we absorbed by bigger banks. This process continued without abatement well up to the financial meltdown of 2008. Since 2009 over 1400 banks which by now were no longer “smaller banks”  were swallowed up until today where there are only six “to large to fail” banks left which control over 90% of all United States banking activity and control 67% of all financial assets.

When Obummer Care was being drafted by whomever it was drafted by do you think hundreds of insurance companies each had their say on what provisions would be  put into the legislation.  How would this be even be practically doable?  Will we ever find out just how many and which insurance companies had input into this bill.  Given the nature of American monopoly capitalism, would the viability of smaller insurance companies have been of even minimum concern?  On the so called Obummer insurance exchange it turns out that in over 500 of the economically  weakest counties in 15 States only ONE insurance company is offering policies that “meet up” with required Obummer Care guidelines.  The notion that the American consumer can go into a competitive free market place and choose the plan that best meets their needs is a ludicrous howl that only the most bamboozled and uninformed consumer could possibly believe. Especially when this line is reeled out by an Administration that has been nothing but disastrous for small to medium size businesses.  Unfortunately, this kind of uninformed consumer accounts for the great majority of American consumers whether they be Obama idiots or not.

This move towards the concentration of power and wealth extends to all sectors of the American economy.  There are no exceptions.  In 1995 there were close to a hundred companies that produced prepared foods that were considered health foods.  These were all by and large brands that were held in good esteem by many Obummer supporting idiots. In 2005 only 15 of these companies remained.  The rest were absorbed by mega corporations like Nestlè, Coca Cola, Pepsi, and ConAgra, all ironically companies that are strong opponents of GMO labeling.  How many Obummer idiots are aware of this. Once a monopoly cartel situation is established, the consumer is the ultimate big time loser.  This fate will be the inevitable fate of Obummer Care recipients which will soon be everyone in the United States.

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The economic size of the pharmaceutical industry is already a significant indicator of the influence the pharmaceutical industry wields in health care delivery in the United States.  In order to more fully appreciate the influence of the pharmaceutical industry we need to look at the role this industry plays in American health care.  We already saw that the health care already accounts for easily US$3 trillion of annual GDP. We saw that this figure was roughly four times the size of the GDP of the Netherlands.  At least 40 % of every health care dollar spent in the United States is spent on mental health services.  Does anyone who has any familiarity with the delivery of mental health services in the United States have any difficulty with the statement that health care delivery is largely a drug dispensing activity?  Nearly 70% of Big Pharma profits are derived specifically from the sale of psychotropic drugs. This is a fancy way of saying Big Pharma derives 70 % of its profits on drug sales from mental health drugs.

Every prescription for mental health drugs that is reimbursed by the insurance industry or that goes through any kind of government statistical measuring purposes is governed by a thick volume of over a thousand pages called the Diagnostic and Statistical Manual of Mental Disorders. It is a publication of the  American Psychiatric Association which many people maintain is just a branch of Big Pharma. There is no reason to even entertain this claim in order to show the preponderant influence of Big Pharma in mental health care and, thus by extension of at least 40% of all health care dollars spent. The other 60%, of profits from the sale of drugs, of course, comes from the sale of other categories of drugs many of which are very controversial as to their efficacy and unwanted and most of the times not sufficiently studied side effects.  The controversies surrounding psychiatric drugs far exceed the controversies surrounding the “other drugs”. Some professionals  consider the entire pharmaceutical industry to be nothing but one big area of controversy.  We don’t need to go that far in our misgivings.

When the DSM first came out in the early 1950’s it listed 34 diagnosable mental disorders. Today in its latest fifth edition it lists 374.  All these disorders are behavioral clusters determined by a committee of psychiatrists. There is not one physiological test to determine the presence of any of these disorders, however, for nearly all of them psychiatric medication can be prescribed. And more often than not are prescribed.  There are more than  150,000 of new mental health diagnoses made every year. This equivalent to 420 new diagnoses made every day.  The U.S. has the largest population in the world in both absolute and relative numbers of patients on prescribed medications. The numbers of patients on prescribed mental health medication is three times more in absolute and relative numbers than Germany, the U.S.’s nearest “competitor.”  There are over 3,000 deaths a year, as determined by the FDA, attributed to unforeseen effects of properly prescribed psychiatric medications.  This is equivalent to having 12 9/11’s every year.  Children over five years of age is the fastest growing demographic for the prescription of mental health drugs. There is a new diagnostic category for the prescription of mental health drugs. The 0-3 year old cohort. One could go on and on listing mind boggling statistics on the prevalence and influence of psychiatric drugs in the American mental health care field.  There are currently 54 million people in the United States who are taking prescribed SSRI anti-depressant drugs. Growing the sales of mental health care drugs is a major industry endeavor of Big Pharma.  Pages of evidence can be provided to solidly back up this claim. To appreciate the giant influence Big Pharma has in American mental health it is necessary to be reminded of two salient facts.  Big Pharma was going to withhold support of Obummer Care and lobby against its passage unless two conditions were met: the inclusion and expansion of mental health services had to be a major part of Obummer Care, and the issue of government negotiation with Big Pharma to determine an equitable market price of dugs was not even allowed to be a topic of negotiation. Any attempt by anyone for any reason to bring this issue up was promised to be an immediate deal breaker.  The Obummer Administration,of course, played ball.  The most important thing to keep in mind is that Big Pharma has targeted psychotropic medications as its major growth market.  Obummer Care will guarantee millions of new customers every year; from the newly born to people in nursing homes. It is also helpful to keep in mind that once one starts taking psychotropic drugs it is notoriously difficult and dangerous to wean oneself from them even with close medical supervision.  The long term effects of these drugs simply have not been studied.

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If we named the four constituents, if you will, in health care we would obviously list the recipients of health care, the people, the primary providers of this health care, the doctors and nurses, the regulators of this health care, the government, the insurance companies, and the pharmaceutical companies.  This seems clearly obvious and no one would contest the this listing of players.  People will more than likely start having problems if I had said that of these four players the government and the people are minor players at best and have very little to say on how health care is delivered in America. If I said that between the insurers and the pharmaceutical industry, the pharmaceutical industry had the most influence on health care delivery in America many people would protest and claim this an outlandish statement. If I said that the largest influence of all, the shadow influence exercising power over all the other players, that controls the whole industry was a cartel of private international banks, well, 90% of you would claim this is just delirious paranoid thinking not supported whatsoever by reality based facts.  Though it would not necessarily be that easy, I am confident that a case could credibly be made to substantiate this statement. The attempt to do so would clearly be beyond the scope of this piece because it would entail an analysis of factors that go much beyond health care and we would have to delve into a fairly basic but still relative detailed breakdown of the entire financial structure of our so called economy. However, I hope to be able to make a credible case here that Big Pharma is, by far, the largest mover in determining how health care is delivered in the United States.

We do this by first making some verifiable statements. First I must qualify this verification by published figures by saying it depends on what sources one goes to get one’s figures.  If one goes to enough sources one can average and compare the reported data and come up with a figure that is more or less consistent with other reported figures and could thusly be determined to be not wholly un reliable. On this basis the total annual revenues of the United States pharmaceutical industry surpasses $US 300 billion.  This is about equivalent to the GDP of Denmark and about equal to the United States real estate business which is tied with the pharmaceutical business in amount of revenues among U.S.industries.  Of course, real estate is a very broad term and eventually when one says real estate one has to practically equate it with the banking industry and we again quickly get beyond the scope of this piece. The petroleum industry has revenues well in excess of US$ 300 billion annually but the petroleum business is not involved in health care in any significant way.  The medical insurance industry may come close to the revenue figures of the pharmaceutical industry but it is hard to find reported figures- The pharmaceutical industry is reported to have the highest profit margins on revenues of all U.S. businesses. The industry itself reports an ROI of 10% and some financial analysts claim that a figure of 19 % would be more representative.  This is quite an impressive number considering that most U.S. businesses have a ROI of about 2-3 %.   This gives the pharmaceutical industry a lot of cash to throw around for influence peddling and a truly enormous amount if one considers that influence peddling as a budget item may very well come out of expenses/liabilities and not profits.  This is a consideration also way beyond the scope of this piece. We must also bear in mind that an industry or business in our economy enjoys this kind of profitability for two predominant reasons. One, the industry enjoys a significant design/technology advantage over its competitors, or two, it is a cartel that enjoys significant protection and subsidies not enjoyed by its competitors.  There is only one source of protection and subsidies in the American economy and these emoluments are bought by lobbying dollars.

 We usually think of the attack industry has spending the most money on lobbying or influence peddling. This turns out not to be the case. Big Pharma spends nearly three times more on lobbying that the entire military industrial complex. Of course, there are many reasons for this, the main one being that the attack industry hardly has to convince anyone to throw money its way. A strong attack sector is an indisputable given in our permanent war economy.  However, it may take some effort to convince doctors and all of us that we need all them pills.

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Since 26,000 pages of legislation do in fact exist, isn’t it reasonable that one asks some questions on what some of the implications of having such a voluminous act are and to also inquire if the implications arrived at can go beyond the level of pure conjecture?  Is it safe to say that no one nucleus of experts could have written 26,000 pages of legislation and that it would be logical to assume that a it involved a large agglomeration of groups of experts working over a considerable time frame.  No one group could possibly hold any meaningful grasp of the totality of 26,000 pages of legislation in any coherent way. Would it be reasonable assume that each group had a competent grasp of only that portion of the legislation to which they were assigned responsibility or in which they had expertise? However, there had to be a coordinator and liaison person between the working groups and the Administration who could be relied upon to report back on questions and requests for details that were inevitably ound to come up.. After all, this was ostensibly a part of “legislative” process and some form of accountability, however spurious, had to be present.  What if somebody had the audacity to ask for details of the “done deal” Well, there was such a liaison person, Liz Powell, a lawyer and Senior Vice President of one of the larger medical insurance companies. Who knows who appointed her to this position, how she was appointed, what her exact function as a liaison person was, or how she was to perform this function. Only two things are really known about Liz Fowler.  One, she came from the insurance industry and two, returned to a very lucrative position in the insurance industry immediately after Obummer Care became law.

A principle feature of Obummer Care is its sheer complexity and skillful opacity. A lot of things can be hidden in 26,000 pages of legislation and as time goes on many unpleasant surprises will be popping out of its 26,000 pages to surprise everyone.  Just one of these myriad surprises that most people don’t know about is a reference to Federal legislation that was passed in 1993 that dealt with a provision of Medicaid called the “estate recovery provision”.  Prior to Obummer Care this provision had very little impact, if any, on the beneficiaries of Medicaid recipients as they were all indigent patients with no assets.  This situation has changed significantly since the near total collapse of the economy since 2008.  It is important to keep in mind that more than 30% of Obummer Care enrollees are newly qualified Medicaid Patients under the new qualifying guidelines of Obummer Care. The percentage of future enrollees to Obummer Care will increasingly be Medicaid enrollees as economic conditions the financial condition of the average American are bound to continue to worsen. What is the significance of increasing Medicaid rolls besides the fact that these new enrollees will be further overburdening a system already severely strained.  Many of these patients in heavily populated States like California whose medical system is already under heavy strain are finding that although they have insurance “on the books”, there are no facilities they can go to where they can receive medical care. The real significance of this increase in new enrollees into Medicaid, in contrast to past enrollees, is that these new enrollees have some assets. Take a person who finds himself in the most exposed and vulnerable segment of the population under Obummer care, those in the age 50 to 65 cohort. Say this person had some savings and some assets in his home. He lost the job that enabled him to accumulate these modest assets in the first place.Now his prospects of finding employment again at a similar level of income prior to his last job  or finding any employment at all are slim to none.  There are millions of people in this situation. This person now becomes one the millions of “newly qualified “ Medicaid enrollees under Obummer Care. We could also consider current beneficiaries of Medicare who due to changes in the economy and very likely austerity cuts to  Medicare  will also have to drop down to becoming a Medicaid beneficiary.  Let’s say that these “newly qualified “ beneficiaries are even able to access medical care through their new qualifications.  Under the “estate recovery provisions” whatever expenses that were disbursed by the government on health care can be recovered through the “estate recovery provision”  through a government seizure of any and all personal assets. This provision also assures that assets cannot be protected by transfer of title or through  probate to family or relatives.  A person can be financially ruined by being an indigent who received medical care from the government.  Who do you think these “recovered assets” are going to go to?  To meaningfully answer this question would put us in the realm of “conspiracy theory” that is so obvious that tolabel it conspiracy theory becomes ridiculous. Isn’t it beyond irony that a health care reform bill that was touted to be a great gift to the American people who were increasingly finding adequate health care to be either unaffordable or unavailable now could find themselves in financial ruin by a “gift” that was negotiated behind closed doors by the medical care industry racketeers and a fraudulent President. This is Obama’s great gift to the American people.

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A fact that would clearly show that it could not have been the Heritage Foundation that wrote the actual legislation for Obummer Care would be to ask some very obvious questions. Considering that the legislation in its entirety consists of about 26,000 pages, one could easily ask how many man hours would it take to coherently write 26,000 pages of legislation? For the sake of illustration, 26,000 pages is very conservatively about 75 350 page three ring binders. Anyone who has worked with three ring binders knows a 350 page three ring binder is a pretty thick binder.  How many man hours would it take to write 75 of these. An examination of a personnel list of the Heritage Foundation shows that they have a policy staff of about 70 experts of one sort or another.  These people surely have other things to occupy their professional time with than the colossal tedium of drafting 26,000 pages of legislation. Another consideration much more significant than coming up with some speculative time number that it would take to draft 26,000 words of legislation, would be to ask how many staff at the Heritage Foundation would have sufficient detailed knowledge of all the intricacies  of the health care business sufficient to draft 26,000 pages of implementation guidelines and enforcement regulations that would guarantee a profitable bottom line.  Clearly Obama didn’t draft 26,000 pages of legislation and clearly it wasn’t anyone in Congress or any Congressional Committee who wrote  the act.  Didn’t Nancy Pelosi say they needed to pass the Act so we could see what was in it.  Surely this was one of the most comic Congressional announcements of the Obama years. Doesn’t a mind boggling question come to mind now?  Isn’t it one of the major functions of Congress according to the Constitution to draft and pass legislation? Isn’t Obummer Care touted to be one of the major legislative acts of modern times? So, does this mean a major piece of legislation was passed and Congress was hardly involved in its drafting.  All this begs the rhetorical question that if it wasn’t the Hertitage Foundation, Obama ( not permitted by the Constitution, of course ), or Congress who drafted the legislation, who did? Who are the ONLY people who had the time, resources, staff, and detailed knowledge to draft 26,000 pages of implementation and enforcement regulations that produce a guaranteed profitable bottom line? Doesn’t this question beg any number of other alarming questions?  Even for a power block that had the time, staff, resources, and expertise, it would still be a major, gargantuan effort to draft 26,000 pages of coherent legislation.  Would it be reasonable to state that Obummer Care was a done deal long before Obama ran for President?  Isn’t the United States health care system the only health care system in the industrial world that is clearly stated to be profit motivated.  In this kind of economic system do people who enjoy monopoly profits readily and voluntarily give them up for the public good?  Has this ever happened in our economic history?

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There is one aspect of Obummer Care that got quite a lot of play in what could kindly be considered the conservative alternative media but didn’t get hardly any, if any play at all,  in the mainstream media. This aspect is the sheer size of the text of the legislation that makes up Obummer Care. While the bill was being drafted and before it formally passed in March, 2014 statements as to its length that were being bandied about ran anywhere from 2000 to 3000 pages. Granted this 1000 page difference is by far not insignificant. A lot of legislation can be covered in 1000 pages. However, I will try to show it does not really matter what the actual length of the bill is because there is a comparative order of magnitude involved that makes the exact number of pages irrelevant. In any regard, since the bill is now official, it is included in its entirety in the Federal Register. Obummer Care consists of two parts. The Patient Protection and Affordable Care Act and the Health Care and Education and Reconciliation Act. Just the first part is 1909 pages long. Therefore the estimates of the “conservative” alternative media were not that overblown and exaggerated by any means.  It is an interesting fact to know that the 1909 pages of the “main body” of the bill are on three column per page small font size pages. This for me would already be a fact from which I could raise a lot of questions that no one, in my reading, at least, has raised.. Last year for the purposes of this piece I arrived at a figure of 2700 pages of no column regular size font as being a reasonable estimate for the text length of this legislation. It is now revealed by the Federal Register that I was not too far off.  Again, the exact number of pages is irrelevant. What is relevant are the questions that can be reasonably raised about the sheer size of this bill.  Raising questions about anything having to do with Obama or anything associated with him is the last thing any of Obama’s benighted supporters do.

Even the most fervid supporter of Obummer Care doesn’t have any major problems with the very prevalent idea that Obummer Care was  “written” by the Heritage Foundation.  If we remember the fact that the original 1989 Heritage Foundation monograph was 140 pages long, isn’t it reasonable to ask who wrote the remaining 2560 pages of Obummer Care. We reasonably concluded that the Heritage Foundation monograph was a general ideological statement and summary of the principles of a politically acceptable  health care program that coincided with Republican Part ideology. I will support this conclusion below.  Of course, it is possible that the monograph could also have included broad policy guidelines for the implementation of this newly proposed health care program.  Would the 2560 page difference between Obummer Care and the Heritage Foundation monograph simply be a continuation of the tenets of Republican Party ideology? If it were, it would probably be considered a major work of political philosophy.  This is hardly what the purpose of legislation is, is it?  Wouldn’t it be much more reasonable to conclude that the remaining 2560 pages cover policy details for the implementation of Obummer Care.  Would it take 2560 pages to outline policy and implementation details that are intended to be for the benefit of the beneficiaries of this great gift to the American people, Obummer Care.  This notion becomes outlandish when one considers that the entire Canadian universal health care plan was covered in 13 pages.  Just the Table of Contents of Obummer Care is more than 13 pages long.  These questions become even more pertinent when one considers that for every word of the Obummer Care Act, 30 additional words of addenda and enforcement regulations were written.  This means that these addenda comprise nearly 12 million words or 20,000 pages!  Pictures of this over seven foot high stack of paper were widely disseminated on the Internet at the time of the drafting of Obummer Care. Now, to whose benefit would it be to include 20,000 pages of detailed enforcement regulations?  Do the American people need to be benefited by 20,000 pages of ENFORCEMENT regulations.  What other modern industrial country has a health care law that is nearly 3000 pages long and which is further buttressed by 20,000 pages of enforcement regulations. Why has no one asked this question?  I am going to give you this great gift and to make sure you really enjoy it I am going to write 20,000 pages of rules and regulations to make sure that you do enjoy it, or else.  I am doing all this because I have your best interests at heart. The sheer size of Obummer Care just begs the question of who are the real beneficiaries of this “health care reform”.


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No Brains Needed

Does it really take a brain to figure any of this stuff out.  Tell me if I am oversimplifying or erring in my observations. The Democrats have been governing for six years now.  The following is what has transpired during this time in no particular order:

Despite the constant spinning of the numbers the economy continues to stagnate for the average citizen.

No one can really say who the “average citizen” is anymore.

The concentration of wealth and the disparity in income levels continues unabated.

Dirty oil continues to flow through “KXL equivalents” regardless of the political theater spinning around KXL.

TPP/TAP and the assault on national sovereignty continue to be aggressively pushed.

The Federal Reserve continues to act in complete secret autonomy.

Despite rapidly growing citizen protest the practice of fracking expands.

The prospect of permanent war in the Middle East is now almost a certainty.

The outsourcing of military activities using both domestic contractors and foreign proxies continues.

All the questions as to the legality and morality of drone murder continue.

The relationship with Israel will not change and the real national security threat this relationship constitutes will continue.

Bail outs and bail ins of Wall Street banks will continue.

The derivative market and the clear threat it is to a stable financial system continues to grow and remains unregulated.

The resurrection of the Cold War will grow unabated.

Military expansion throughout the globe will continue.

Nothing will continue to be done about climate change.

The assault on Social Security and Medicare will continue.

The assault on public education will continue.

Budget cuts in important social areas will continue.

What is left of the manufacturing sector of the economy will continue to get gutted.

Pervasive domestic surveillance and the violation of Constitutional rights will continue.

This list can easily be expanded. The above should work adequately for the illustration of my point which was it doesn’t take any brains to figure this stuff out.  It doesn’t matter why the situation I as it is. Any argument in this direction is futile and serves no purpose. It is sufficient to notice that this is simply the way things are. It is futile to argue why simply because we all know even with the trouncing the Democrats got during the mid-terms nothing is going to change.  Everyone knows this.  Even if the Republicans win in 2016 nothing  will change.  It is futile also to argue if the Republicans are any different from the Democrats. Fundamentally? Any differences that may exist are simply elements of style required to play in the Grand Circus of the Two Ring One Ring Circus of the Terminally Absurd.  How can I make such a statement?  Well, I just told you. You know in your no brain of no brains that nothing fundamentally will change.  Don’t forget to vote.  It’s important.

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