You’ll Never Fix the Problems Until You Fix the System
Institutions and government systems are like algorithms. No matter what you put into them, you will get the same function applied. Think of an algorithm like a microwave. Its function is to heat things up. Whatever you put in, it will come out hotter. You can change any settings you want, but you will never get a colder drink out of your microwave.
Identifying the Function of a System
You know the function of a system by what it repeatedly produces. What does our current government system produce? Waste, debt, inflation, low wages, government dependence, failing education, isolation, unaffordable housing, crime, addiction, unhealthy citizens, and division. Most of us want to believe these problems are unintended consequences of poorly devised policy and not intended outcomes. It’s time to stop and ask the age-old question, “Qui Bono?” Who benefits? Waste benefits donors and the politically connected who pocket that money. Inflation benefits the government, making paying back its debts easier. Low wages benefit big corporations, who save on labor costs. Government dependence benefits politicians who can count on people to vote for their benefits. Failing education makes the population easier to control. Isolation keeps people from organizing. High housing costs benefit private equity groups that are buying up the residential market. Crime and addiction benefit companies that run prisons and rehabilitation centers like revolving doors. Unhealthy citizens benefit pharmaceutical manufacturers. Division keeps voters voting for the lesser of two evils. If a problem persists and you encounter resistance to solving it, there’s probably a special interest that profits from the status quo.
If We Agree, Why Can’t We Change It
Most Americans agree on the problems, just not the solutions. The left generally sees big corporations as untrustworthy, while the right is suspicious of big government. What is becoming clear is that they are one and the same. As a fun exercise, go to any government agency and look through its list of top employees. In their biographies, you’ll see that many came straight from the companies they are meant to regulate. While you’re at it, go see where the former heads of agencies work now. When you’re done, look up former senators and congresspeople. How many boards of directors do they sit on today? How many are now lobbyists? How many current representatives are married to lobbyists or have a child who works as a lobbyist? These legal sins are equally prevalent in both of the major parties.
Voters in America are waking up. There is a growing consensus that we can’t keep going down the road we’re on. The question is whether we can overcome the artificial divisions to work on meaningful change. Will we come together, stop the name-calling and start listening to each other or will we let our isolation and frustration turn to nihilism? Do we want to work together to solve our problems or are we so frustrated that we just want to burn it all down?
Whether it’s demands from the far left to end capitalism or from the right to slash whole departments of the federal government, these are admissions that our current system is failing. The two-party system is broken. The parties themselves have become massive machines that set election rules and gerrymander districts in their favor. They have entire departments for collecting large donations from big companies and wealthy donors.
Elon Musk Vs Robert Kennedy Jr.
Elon Musk thought that by being one of those donors, he could go into the government with DODGE to find the waste and fraud and that the party he paid so much to support would take his suggestions and make cuts. He found out that, after all his sacrifices and hard work, Congress wasn’t interested in cutting the gravy train for their special interests. It’s a hard lesson that many voters have already learned.
What made Robert Kennedy Jr.’s campaign so inspiring is that he was offering solutions to fix the system. He exposed hidden webs of influence and pointed out the institutional corruption. He offered hope that the institutions could be cleaned out and government systems reset to their intended functions, serving the people. Instead of eliminating HHS and its corrupted umbrella agencies, he set out a path to remove conflicts of interest and corporate nepotism, which is quietly being instituted today. Since taking office as HHS secretary, he has taken on pharmaceutical interests by firing conflicted members of the vaccine approval board, changing funding focus to searching for causes of health issues instead of testing and development of drugs for corporations, and removing financial conflicts of interest in medical journals.
We need to focus on the lynch pins of corruption that have perverted our institutions. If we can follow Bobby’s lead, weed out conflicts of interest, and set in place safeguards to keep them out, we can rebuild our institutions instead of tearing them down. It is tempting to just overthrow the old, but we need to remember the difference between the American and French Revolutions. Our founders started a revolution with a plan for the replacement of a tyrannical government. The jingoists started a revolution with a desire to tear down the nobility. Our country created the world’s first democratic republic. The French were left with public beheadings and a dictator, Napoleon, who sought war with half of Europe after he cleared the protestors from the streets with cannons. If you want to start a revolution, you need a plan to build something, not one to tear things down.
Where Do We Begin
It starts with identifying the problem. The main problems are centralized power, lack of transparency, and lack of accountability that pervert our institutions. We see it in every one of our systems, from education to medicine, to agriculture, to the judicial system, our housing market, and our elections. For more on how to fix our election systems, see our blog on overhauling Pennsylvania’s election code. In future blogs, we will investigate the details of the agricultural, judicial, and education systems, as well as programs to address crime, addiction, and the housing crisis. For now, let’s take a look at our medical institutions. The problems we find in our medical establishment are illustrative of problems we face in all of our government systems, the hidden consolidation of power and control into a small number of hands with no accountability until the function of the system no longer resembles its original purpose.
Medical Freedom For Doctors
To understand just how consolidated our medical systems are, let’s walk through the process of becoming a doctor in America. To begin, a student must attend a medical school. Despite the appearance of choices, all medical schools have the same curriculum controlled by the same association. In his book, Blind Spots, FDA Director Dr. Marty Makary points out, "It’s called the Association of American Medical College, a company discovered to have give half a million dollars to a dark money group in 2018.” In his opinion, "Because American medical education is controlled by a slow, political, distracted, and centralized authority, medical schools propagate outdated groupthink.”
After completing medical school, doctors need to complete a residency with a hospital that is likely owned by a university, an insurance company, a private equity group, or a large nonprofit. The universities depend on NIH grants for research funding. The upper echelon of the NIH, until recently, all had financial conflicts of interest and close-knit relationships with big pharmaceutical companies. Professors at these universities publish or perish, and getting published in a medical journal means getting approval for your research article from the editorial board that takes money from big pharmaceutical companies and the anonymous peer reviewers who also have conflicts of interest.
After residency, a doctor can start their own practice, but this requires financial investment that is hard for an individual to obtain, but much easier for a corporation or private equity firm that has access to the bond market. For this reason, many small practices have closed, and the doctors have gone to work for large hospital systems. The large hospitals use management services organizations (MSOs) that require doctors to sign nondisclosure agreements as well as non-compete agreements and set policies for how care is provided. This means doctors must follow prescribed policy rather than making decisions based on experience or judgment. If they deviate from policy, they could lose their jobs, would be sued if they talked about it, and are forbidden from working elsewhere until their non-compete expires.
They also face losing their board certification. Medical boards that provide certification are equally compromised. Dr. Makary points out in his book Blind Spots, "In 2023, a few of the most powerful medical societies in the US made an unprecedented move to support government actions to silence opposing medical voices. The American Academy of Pediatrics, the American Medical Association, and other medical societies filed an amicus brief with the Supreme Court on behalf of the government supporting government censorship of health information, including opinions expressed by physicians."
From the beginning of their education, American doctors are trained to follow the rules of the system or face expulsion from their profession. As we fight for medical freedom for patients, we must first address the system that eliminates any freedom for doctors. How can a patient have the right to choose if the doctor they are seeing does not?
Mergers and Acquisitions
Consolidation also leads to lower quality care and scarcity. The trend of mergers and acquisitions in the healthcare space is alarming. Over 80% of doctors now work for large companies, five insurance companies control over half of the market and, with vertical integration, they also own their entire supply chain down to the doctor’s offices and ambulance companies. Private equity and financial firms are also buying up healthcare providers and hospitals, leading to higher costs and reduced access.
Private equity firms in Pennsylvania have bankrupted and closed multiple hospitals. The story of Crozer in Delaware County is illustrative of how private equity firms consolidate practices, shut down services to save money, sell the real estate of the hospital then lease it back at exorbitant rates to siphon the equity out of the system, then declare bankruptcy, close the hospital’s doors, sell it and walk away with the profits. Consolidation in companies that manage prescriptions for insurance companies, called pharmacy benefit managers (PBMs), has had similar consequences, driving small pharmacies out of business. The bankruptcy of Rite-Aid was in part due to unfair practices by competitors that own their own PBMs. Hospitals obtain their supplies through group purchasing organizations (GPOs). Congress gave GPOs permission to receive rebates from manufacturers and drug makers with the intent that they would pass the savings on to hospitals. At first, they did, as they consolidated the market by underbidding their competitors. Once they eliminated competition, they drove costs up, even offering hospital administrations kickbacks in exchange for overpriced goods.
The big five insurance companies have increased their profits by engaging in vertical integration. They have each purchased the companies in their supply chain. The image below (from Drug Channels Institute) shows how each of them now own their own PBM, GPO, and doctor’s offices. The medical system from top to bottom is controlled by small groups of people whose interests have nothing to do with health.*
How to Take on the System
While many have expressed impatience and disappointment with Kennedy for not moving faster, we need to appreciate his line of attack. He is working within his authority to break up the hidden power by removing pharmaceutical company influence from advisory boards and medical journals. He needs help from Congress and Trump’s antitrust division at the Department of Justice to break up the monopolies of the big five insurance companies. We should keep pressure on Congress and the administration to act, but as Elon found, solutions are not likely to come from Washington.
The hope to fix our broken medical system is already coming from the states. Oregon recently passed a bill to prevent MSOs from setting policies for physicians, Arkansas passed a bill to prohibit the same company from owning a pharmacy and a PBM, Ohio and Kentucky have taken over pharmacy benefit management eliminating PBMs for state funded programs like Medicaid, and Pennsylvania passed a bill restricting unfair practices of PBMs which goes into effect next year. We need to copy other states efforts to create more competition in Pennsylvania’s healthcare systems.
We The People Welcome Another Challenger to the Duopoly
Elon Musk fell into the trap that many voters find themselves in by focusing on Washington DC. He dove headlong into the swamp, thinking he could enact quick top-down solutions to fix problems without first fixing the system that created them. Now, he seeks to start a new party nationally without first creating state parties for support.
While we agree with many of the platform items of his new America Party, we offer Elon this caution if he is serious about working to create a better future. Like all lasting reforms, the change has to come from the bottom up. The fight has to begin in the states. Policy initiatives are great, but without addressing the source of the problems, policies will act as small band-aids until special interests find a way around them. If you want to change the policies, you have to change the system first.
*As part of our June 26th bimonthly meeting, we had a detailed workshop on monopoly in medicine. Members can access recordings on the members only portion of the website.