Sunday, August 13, 2017

Can We Challenge Health Care Corruption Under Morally Failed Government Leadership?

Introduction: Health Care Corruption

An important theme of Health Care Renewal has been health care corruption as a cause of health care dysfunction.

Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In 2006, TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.
the scale of corruption is vast in both rich and poor countries.

Also,
Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruption because they often cannot afford bribes or private health care. But corruption in the richest parts of the world also has its costs.

Yet the report did not get much attention and health care corruption has been nearly a taboo topic in the US, anechoic, presumably because its discussion would offend the people it makes rich and powerful. As suggested by the recent Transparency International report on corruption in the pharmaceutical industry,
However, strong control over key processes combined with huge resources and big profits to be made make the pharmaceutical industry particularly vulnerable to corruption. Pharmaceutical companies have the opportunity to use their influence and resources to exploit weak governance structures and divert policy and institutions away from public health objectives and towards their own profit maximising interests.
Presumably the leaders of other kinds of corrupt organizations can do the same. 

When health care corruption is discussed in English speaking developed countries, it is almost always in terms of a problem that affects somewhere else, mainly benighted less developed countries.  At best, the corruption that gets discussed is low level.  In the US, frequent examples are the "pill mills"  and various cheats of government and private insurance programs by practitioners and patients that lately have been decried as a cause of the narcotics crisis (e.g., look here).  (In contrast, the US government has been less inclined to address the activities of the leaders of the pharmaceutical companies who have pushed legal narcotics (e.g., see this post). 

However, Health Care Renewal has stressed "grand corruption," or the corruption of health care leaders.  We have noted the continuing impunity of top health care corporate managers.  Health care corporations have allegedly used kickbacks and fraud to enhance their revenue, but at best such corporations have been able to make legal settlements that result in fines that small relative to their  multi-billion revenues without admitting guilt.  Almost never are top corporate managers subject to any negative consequences.

Because a few individual cases suggested discussion of health care corruption has recently become less taboo (look at this post from June, 2017), we thought we were making a little progress.  On the other hand, we worried that little progress would be made under an administration that is being increasingly identified with corruption and impunity itself?

You ain't seen nothing yet.


Nazis and Ku Klux Klan March, Deaths and Injuries Ensue, the President Equivocates

Worse, how could we function under a government led by the morally corrupt?  Yet in the last few days, this is the specter we face. 

The events in the US triggering this fear are well known.  A public demonstration by the "alt-right" protesting the planned removal of a statue of a Confederate general from a park in Charlottesville, Virginia, was populated by people carrying overtly Nazi, Ku Klux Clan and Confederate flags, chanting racist and anti-Semitic slogans.  The demonstrators clashed with counter-demonstrators.



A car driven by a demonstrator plowed into the crowd of counter-demonstrators, killing one and seriously injuring many.



Numerous US politicians, from the left and right, condemned the the attack as a terrorist act, perpetrated by open followers of Naziism and the KKK. (Look here for representative coverage.)

Yet the US President so far has refused to personally utter the words "Nazi," "Ku Klux Klan," "racist," "anti-Semitic," "terrorism," or anything similar about this attack.



Instead, he blamed some hypothetical "many sides."  Meanwhile, David Duke, the former leader of the Ku Klux Klan, had saluted President Trump during the rally:



After Mr Trump made the vague remarks above, Duke responded:

So, after decades of White Americans being targeted for discriminated & anti-White hatred, we come together as a people, and you attack us? https://t.co/Rkfs7O2Ykr — David Duke (@DrDavidDuke) August 12, 2017

I would recommend you take a good look in the mirror & remember it was White Americans who put you in the presidency, not radical leftists. https://t.co/Rkfs7O2Ykr — David Duke (@DrDavidDuke) August 12, 2017 
 Can Progress Be Made Under Morally Failed Leadership?

On the other hand, an op-ed by Michael Gerson in the Washington Post noted:

Ultimately this was not merely the failure of rhetoric or context, but of moral judgment. The president could not bring himself initially to directly acknowledge the victims or distinguish between the instigators and the dead. He could not focus on the provocations of the side marching under a Nazi flag.

Furthermore,

If great words can heal and inspire, base words can corrupt.



Sen. Orrin G. Hatch (R-Utah) tweeted:

We should call evil by its name. My brother didn’t give his life fighting Hitler for Nazi ideas to go unchallenged here at home.

Then there was Will Bunch in the Philadelphia Inquirer, who entitled his op-ed:

Trump's shameful moral void on Charlottesville leaves America without a leader

And the Guardian's editorial entitled:

Donald Trump and racism: a moral failure that shames America

Last Words 

Is it still possible to meaningfully address health care corruption in a land whose leader is so corrupt, a "moral failure," unable to "call evil by its name?" Maybe not until that leader is no longer in office. We will find out, but may not be able to survive a long wait.  

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