Background: Health Care Corruption
As we wrote in August, 2017, Transparency International (TI) defines corruption as
Abuse of entrusted power for private gainIn 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.
The report got little attention. 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 some other places, mainly presumably benighted less developed countries. At best, the corruption in developed countries that gets discussed is at low levels. In the US, frequent examples are the "pill mills" and various cheating of government and private insurance programs by practitioners and patients. Lately these have gotten even more attention as they are decried as a cause of the narcotics (opioids) crisis (e.g., look here). In contrast, historically 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.
We have been posting about this for years at Health Care Renewal, while seeing little progress on this issue.
Health Care Corruption in the Context of a Corrupt Government
Instead, things now only seem to be getting worse, given the increasing evidence that the Trump administration is corrupt at the highest levels. In January, 2018, we first raised the question about how health care corruption could be pursued under a corrupt regime. We noted sources that summarized Trump's. the Trump family's, and the Trump administration's corruption.. These included a website, entitled "Tracking Trump's Conflicts of Interest" published by the Sunlight Foundation, and two articles published in the Washington Monthly in January, 2018. "Commander-in-Thief," categorized Mr Trump's conflicted and corrupt behavior. A Year in Trump Corruption," was a catalog of the most salient cases in these categories in 2017.
In July, 2018, we addressed the Trump regime's corruption again By then, more summaries of Trump et al corruption had appeared. In April, 2018, New York Magazine published "501 Days in Swampland," a time-line of starting just after the 2016 presidential election. In June, 2018, ProPublica reviewed questionable spending amounting to $16.1 million since the beginning of Trump's candidacy for president at Trump properties by the US government, and by Trump's campaign, and by state and local governments. Meanwhile, Public Citizen released a report on money spent at Trump's hospitality properties.
In October, 2018, we summarized the content of the Tracking Corruption and Conflicts of Interest in the Trump Administration from the Global Anti-Corruption Blog. The blog organized corrupt activities within the Trump administration into the following categories:
1. U.S. Government Payments to the Trump Organization
2. Use of the Power of the Presidency to Promote Trump Brands
3. U.S. Government Regulatory and Policy Decisions that Benefit Business Interests of the Trump Family and Senior Advisors
4. Private and Foreign Interests Seeking to Influence the Trump Administration Through Dealings with Trump Businesses
The voluminous 26 page report showed that many examples of corruption by Trump et al were not one-offs, but were long-term activities. For example, every time President Trump travels to on of the properties he owns through the Trump Organization, like the Mar-a-Lago resort in Florida, the US government is obligated to pay the Trump Organization, hence Trump himself for expenses like the Secret Service renting golf carts. Each such payment seems to violate the "domestic emolument clause" of the US Constitution, which prohibits state or US government payments to a President for anything other than his salary. Also, every payment made by a foreign government to the Trump Organization, such as for hotel accomodations or events at Trump Organization properties, appears to violate the "foreign emoluments clause" of the US Constitution, which prohibits payments by a foreign government to the US President.
In April, 2019, we noted more new and updated sources on Trump administration corruption, including Bloomberg's interactive guide, and updated versions of the Global Anti-Corruption Blog's tracker (see above), and the Sunlight Foundation's "Tracking Trump's Conflicts of Interest" project.
Updates on the Corruption of the Trump Administration
The Trump regime continues to spin off a chaotic barrage of news and distractions, making it hard to concentrate on any one topic. Unfortunately, discussion of conflicts of interest and corruption has been muted as news media, the pundit class, and everyone else has scrambled to keep up. Nevertheless, there have been a few recent developments.
Updates of the Sunlight Foundation's "Tracking Trump's Conflicts of Interest"
The Sunlight Foundation's "Tracking Trump's Conflicts of Interest" project is frequently updated, most recently in August, 2019. Posts have appeared generally weekly, with the most recent examples focusing on: White House adviser KellyAnne Conway's alleged violations of the Hatch Act, and the properties owned by Trump's son-in-law Jared Kushner's real estate company (look here); an ongoing lawsuit against the Trump Organization (look here); and the continuing battle to obtain financial disclosures from Trump and the Trump Organization (l.ook here)
New Source: the New CREW Report
CREW is the Citizens for Responsibility and Ethics in Washington, a non-profit watchdog organization formed after the 2016 election. We noted their blog in the April, 2019 update. Now CREW has published a report on Trump's and colleagues' conflicts of interest, headlined: Trump's 2,000 Conflicts of Interest (and Counting).
The document was organized into these chapters:
- Visits to Trump properties by Trump, White House officials, members of Congress, foreign officials, and corporate executives
- Political events and spending at Trump properties
- Blurring the line between the White House and the Trump Organization
- International travel and businesses
The report also included an updated summary of over 2300 of Trump's, Trump's family's, and Trump's business' conflicts of interests and apparent corrupt activities, showing the huge scope of the problem:
The president has visited his properties 362 times at taxpayer expense during his administration, sometimes visiting more than one of them in a single day. In 2019 alone, he has visited his properties 81 times, helping to further establish them as centers of political power. The number of days where President Trump has spent time at a Trump-branded property account for almost a third of the days he’s been president.Thus it appears that the Trump administration functions as a giant marketing operation for Trump and the Trump Organization. Furthermore, elected officials, almost entirely from the Republican party, and appointed administration officials have had significant roles in enriching Trump and the Trump Organization. This appears to be corruption at a breath-taking level unheard of in US history.
One-hundred eleven officials from 65 foreign governments, including 57 foreign countries, have made 137 visits to a Trump property, raising the question of how much foreign money has been spent at Trump’s properties.
Additionally, CREW has recorded 630 visits to Trump properties from at least 250 Trump administration officials. This includes high-level White House staff, members of Trump’s cabinet, and individual agency employees. So far this year, CREW has recorded 198 visits by White House officials. Ivanka Trump—who has an ownership interest in the Trump hotel in D.C.—and her husband Jared Kushner, both senior White House advisors, are the most frequent executive branch officials to visit Trump properties, other than the president himself. Jared has made 28 known visits, while Ivanka has made 23.
Members of Congress have flocked to President Trump’s properties, despite their constitutional oversight responsibility to provide a check on the executive branch as it relates to President Trump’s conflicts of interest. Throughout his two and a half years as president, 90 members of Congress have made 188 visits to a Trump property.
Forty-seven state officials, including 20 Republican governors, have made 64 visits to Trump properties, sometimes resulting in state taxpayer funds being spent there.
President Trump has used the presidency to provide free publicity for his properties, which he still profits from as president. Over the course of his presidency, Trump has tweeted about or mentioned one of his properties on 159 occasions, and White House officials have followed suit: Members of Trump’s White House have mentioned a Trump property 65 times, sometimes in the course of their official duties.
Political groups have hosted 63 events at Trump properties since President Trump took office, selling wealthy donors access to the administration while also enriching the president. Seventeen of these have been for Trump-linked groups, and another six have been hosted by groups linked to Vice President Mike Pence. Trump Victory, the joint fundraising arm of Trump’s 2020 election committee and the RNC, has hosted six events at Trump properties just this year, four of which were attended by the President himself. In all, the RNC and other Republican Party groups have had 28 events at Trump properties.
Twenty Trump administration officials have attended 38 political events at a Trump property, giving wealthy donors who fund spending at the president’s businesses access to top officials to discuss their pet issues while they enrich President Trump personally.
Political groups have spent $5.9 million at Trump properties since President Trump took office. So far this year, political groups have spent $1.1 million at Trump properties. In more than a decade prior to his run for president, Trump’s businesses never received more than $100,000 from political groups in a single year.
The Trump Hotel in Washington, D.C. is the top beneficiary of this political spending. In just over two and a half years, the hotel has raked in $2.4 million in traceable political spending.
Foreign governments and foreign government-linked organizations have hosted 12 events at Trump properties since the president took office. These events have been attended by at least 19 administration officials.
This amazing record should also be considered in light of Trump and family's record of legal and ethical issues prior to the presidency. Despite accusations of ties to organized crime, kickback, fraud, violations of gaming regulations, violations of rules governing non-profit organizations, violations of rules about money laundering, perjury, Trump and his family members often escaped investigation and always escaped any negative consequences, thus demonstrating impunity (look here).
Summary
We now have had continuous reporting for years of massive conflicts of interest and extensive corruption permeating the executive branch of the US government. Nonetheless, this topic has been virtually buried under the flood of chaotic news that emanates from the Trump administration every day.
To underscore what we wrote in October
So the driver of US health care corruption may now be the executive branch of government and its relationship with the Trump family and cronies, trumping even the influence of health care corporate corruption.
That corruption appears to be ongoing, worsening, and remains largely anechoic.
In November, 2017, we noted a report by Transparency International of an international survey of corruption perceptions showing substantial minorities of US respondents thought that US corruption was increasing, and was a particular affliction of the executive and legislative branches of the national government, other government officials, and top business executives. There was virtually no coverage of these results in the US media, just as there was virtually no coverage of a 2013 survey that showed 43% of US respondents believed that US health care was corrupt.
Similarly, despite, or perhaps because of their tremendous scale, the reports about Trump related corruption listed above have generated little discussion. Despite the extensive and ever-increasing list of apparently corrupt acts by the Trump and cronies, grand corruption at the top of US government, with its potential to corrupt not just health care, but the entire country and society, still seems like a taboo topic. The US news media continues to tip-toe around the topic of corruption, in health care, of top health care leaders, and in government, including the top of the US executive branch. As long as such discussion seems taboo, how can we ever address, much less reduce the scourge of corruption? The first step against health care corruption is to be able to say or write the words, health care corruption.
So we welcome any additional attention to health care corruption, or the larger corruption within the US government that is making health care corruption even harder to address.
But even if we can take that step, when the fish is rotting from the head, it makes little sense to try to clean up minor problems halfway towards the tail. Why would a corrupt regime led by a president who is actively benefiting from corruption act to reduce corruption? The only way we can now address health care corruption is to excise the corruption at the heart of our government.
It is now over 30 months since Trump was inaugurated, and there has been no real progress. The fish is still rotting, and so is health care. What will it take to make something happen?
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