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Is Trump for the wealthy or for the rest of us?

Trump’s administration is substantially characterized by aggrandizement—particularly the concentration of wealth and power among ultra-wealthy elites. While the administration employs populist messaging that resonates with working-class frustrations, the actual policy implementation and outcomes reveal a systematic pattern of upward wealth redistribution that contradicts the stated goal of revitalizing middle America.

The Oligarchic Structure

The most visible indicator of prioritized aggrandizement is the composition of Trump’s administration itself. The cabinet represents the wealthiest in U.S. history, with a collective net worth of $460 billion and over a dozen billionaires serving in senior positions. This includes prominent figures like Elon Musk, who has gained unprecedented influence over government through his leadership of the “Department of Government Efficiency,” and tech billionaires Mark Zuckerberg and Jeff Bezos who have achieved prominence in Trump’s orbit. Political scientists have characterized this arrangement as demonstrating executive aggrandizement operating at three interrelated levels: establishing presidential supremacy within the executive branch, making the executive branch dominant over other government institutions, and weakening societal constraints on executive power.^[1]^[2]^[3]

Tax Policy: Wealth Concentration Disguised as Middle Class Relief

Trump’s tax policies exemplify the gap between populist rhetoric and oligarchic reality. During his first term, the Tax Cuts and Jobs Act (TCJA) of 2017—promoted as relief for working families—disproportionately benefited wealthy Americans. Analysis by the Tax Policy Center revealed that 83% of the law’s benefits accrued to the top 1% of earners, with middle-income households experiencing minimal tax relief. By 2027, the benefits of that law will be entirely to the wealthy, as middle-class provisions were temporary while corporate tax cuts were permanent.^[4]^[5]

The disparity becomes more stark when examining specific dollar amounts. The Center on Budget and Policy Priorities calculated that the richest 1% of Americans saw their taxes reduced by an average of $61,090 under the TCJA, while the poorest 20% received only $70 in tax relief. In percentage terms, the after-tax income of the richest 5% increased by approximately 3%, while the poorest 20% saw their after-tax income grow by just 0.4%.^[6]

Trump’s 2025 tax legislation continues this pattern. The top 0.1% receive an average tax break exceeding $300,000, while the lowest-income households actually see their taxes increase. Simultaneously, the administration pursues massive spending cuts to public programs like Medicaid and food assistance that millions of families depend upon for basic security.^[2]

Tariffs: A Regressive Tax on Working People

Trump’s tariff policies, framed as bringing manufacturing jobs home and protecting American workers, function as a consumption tax that disproportionately harms the middle and working classes. A Yale Budget Lab analysis found that Trump’s tariff regime could push an additional 875,000 Americans into poverty by 2026, including 375,000 children. The Institute on Taxation and Economic Policy estimated that the poorest 20% of Americans will experience a 4.8% average tax increase due to tariffs, while the richest 5% will see only a 1.2% tax reduction.^[7]^[6]

This regressive impact occurs because lower-income households spend a significantly larger proportion of their income on consumer goods, food, and basic necessities—categories heavily impacted by tariffs on Chinese, Mexican, and Canadian imports. Wealthy Americans, with substantial savings and investments, remain largely insulated from tariff-driven inflation.^[7]^[6]

Conflicts of Interest and Personal Enrichment

Beyond policy outcomes, Trump’s personal business dealings reveal aggrandizement as a governing principle. Trump has failed to divest from his business interests, creating extensive conflicts of interest as president. His administration records show systematic patterns of self-dealing: Trump visits his properties hundreds of times while taxpayers fund Secret Service protection; foreign governments and special interests hold lavish events at Trump properties to gain access and influence; and Trump uses his presidential platform to continuously promote his hotels, golf courses, and resorts.^[8]

More egregiously, specific instances document direct personal enrichment from presidential power: Trump pardoned the founder of Binance after the company engaged in business talks with the Trump family and boosted their crypto venture; he launched a memecoin ($TRUMP) days before inauguration while the SEC declined to regulate it; he opened a new golf course in Scotland subsidized by American taxpayers; and he held White House events exclusively for major holders of his memecoin, effectively auctioning presidential access.^[8]

Rhetorical Populism Versus Actual Policy Outcomes

The disconnect between Trump’s populist messaging and oligarchic governance is fundamental. Trump framed his presidency around channeling “middle class pain” into political action, claiming that globalist elites had abandoned workers. Yet his actual policies systematically transfer resources from the middle and working classes to ultra-wealthy elites and mega-corporations.^[9]^[2]

Political scientists have documented this pattern comprehensively. A 2015 study by Princeton’s Martin Gilens and Northwestern’s Benjamin Page analyzing 1,800 policy proposals over 30 years found that America functions as a functional oligarchy where political outcomes overwhelmingly favor wealthy people and corporations while ordinary citizens’ influence is “at a near-zero level”. Trump’s administration represents this oligarchic tendency made explicitly visible, with billionaires openly wielding executive power and shaping policy to benefit their own interests.^[3]

Long-Term Middle Class Deterioration

The broader context reveals that middle class expansion has been deteriorating across decades, independent of Trump’s policies—but Trump’s administration actively accelerates this decline rather than reversing it. The middle class share of national income declined from over 60% in 1970 to just 43% by 2022. Young men today earn less than their fathers did at the same age, reversing the post-WWII upward mobility that defined the American Dream. Production workers and white men without college degrees, core Trump supporters, experienced a dramatic loss of status relative to college-educated workers across the globotics shock era (globalization plus automation).^[9]

Rather than implementing policies to reverse this structural decline, Trump’s administration pursues strategies that exacerbate it: cutting social safety nets, reducing corporate regulation to favor monopolies, pursuing consumption taxes (tariffs) that burden working families most heavily, and maintaining tax structures that allow billionaires to pay lower effective rates than teachers and retail workers.^[10]^[11]^[2]^[6]

Conclusion

The Trump administration is fundamentally characterized by aggrandizement—the concentration of wealth, power, and decision-making authority among ultra-wealthy elites operating within a framework of oligarchic governance. While populist rhetoric promises middle class restoration and protection from globalist elites, actual policy implementation systematically transfers resources upward, weakens institutional checks on executive power, and constrains the economic mobility and opportunity of working and middle-class Americans. The administration’s composition of billionaire cabinet members, its self-dealing business conflicts, and its regressive economic policies collectively indicate that aggrandizement—not middle class expansion—represents the administration’s defining characteristic.

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https://www.sciencespo.fr/en/news/trump-2-0-the-rise-of-an-anti-elite-elite-in-us-politics/

Tags: donald-trump, history, news, politics, trump

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America First Agenda: The rest of the story

11 Nov

Do you remember Paul Harvey (1918–2009), an iconic American radio broadcaster who created and hosted “The Rest of the Story,” a distinctive program featuring forgotten true stories about famous people and events, with key details revealed at the conclusion?

The “America First” Agenda: Background and Economic Impacts

The “America First” agenda represents a set of economic and policy priorities championed by the Trump administration, beginning in 2017 and continuing into 2025. This framework emphasizes tax cuts, deregulation, energy dominance, immigration restrictions, and trade protectionism as mechanisms to boost American economic prosperity and worker wages.

Background on the America First Agenda

The America First approach grew out of Trump’s campaign platform and was implemented through several major legislative and executive actions. The cornerstone fiscal policy was the Tax Cuts and Jobs Act (TCJA) of 2017, which reduced corporate tax rates from 35% to 21%, modified individual income tax brackets, expanded business deductions (particularly the Section 199A pass-through deduction set at 20%), and eliminated the Affordable Care Act’s individual mandate penalty.^[1]^[2]^[3]

The 2025 version of the America First agenda has extended and expanded these core tax provisions, making the TCJA tax cuts permanent and further reducing corporate rates and expanding pass-through deductions. The agenda prioritizes other objectives including border security, energy production expansion, reduction of federal spending, and elimination of regulations deemed burdensome.^[4]

Impact on Income and Wages

Initial Period (2017-2019)

During the first Trump administration, the administration and its supporters cited rapid income growth. According to the Heritage Foundation and Republican data, median household income rose by approximately $5,003 between January 2017 and mid-2019. The Ways and Means Committee reported that real wages grew 4.9% in 2018-2019, the fastest two-year growth in 20 years, with workers in the lowest income decile seeing approximately 50% higher wage growth than those in the highest decile.^[5]^[6]^[7]

However, independent analysis tells a more nuanced story. The Congressional Budget Office and Tax Policy Center found that while all income groups saw tax reductions initially in 2019, the distribution was unequal. The bottom quintile (those earning less than $25,000) received an average tax cut of $50 or 0.3% of after-tax income, while those in the 95th to 99th income percentile received approximately $12,000 or 3.5% of after-tax income.^[8]^[1]

Longer-Term Trends and Current Analysis

Critical analysis suggests that income gains for lower and middle-income workers were temporary and driven largely by unusually tight labor markets rather than sustained structural improvements. A 2024 analysis by The Conversation found that the 2017 tax cuts made income inequality worse and disproportionately harmed Black Americans, with the bottom 90% of wage earners seeing no real wage gains when corporate tax cuts and stock market wealth were considered.^[9]

Recent research from Yale’s Budget Lab indicates that 2025 tariffs imposed as part of the broader America First trade policy have created significant headwinds. All 2025 tariffs combined increase consumer prices by approximately 2.3% in the short run, representing an average loss of $3,800 per household in purchasing power, with bottom-income households losing $1,700 annually. This directly erodes any earlier wage gains, particularly for lower-income Americans.^[10]

Impact on Taxes by Income Level

2017 Tax Cuts Implementation

The TCJA’s distributional effects varied significantly by income level. At passage in 2019, taxpayers earned up to $25,000 saw their federal tax rate fall by 0.4 percentage points—the smallest reduction. The top 1% saw their effective tax rates drop by approximately 0.8 percentage points, while the most dramatic benefits went to those earning $307,900 to $732,000, whose rates fell by 3.1 percentage points.^[11]^[8]

2025 Tax Policy and the Extended TCJA

The recent extension of TCJA provisions into 2025 continues this pattern of unequal benefits. According to the Institute on Taxation and Economic Policy, extending the TCJA will raise taxes on the poorest 40% of Americans and barely cut them for the middle 20%, while the richest 1% benefit more than the bottom 80% combined in 2026.^[12]

Specifically, the bottom income quintile (those making $28,600 or less annually) will receive an average tax cut of approximately $110, while those in the second quintile ($28,600-$55,100) receive about $510. In stark contrast, the top 1% (making over $914,900) will receive average tax cuts of $80,680 annually. The new pass-through deduction increased from 20% to 23%, overwhelmingly benefiting wealthy business owners, with White taxpayers receiving substantially larger benefits than Black and Hispanic taxpayers despite comparable population percentages.^[13]^[12]

Looking forward to 2027, when many TCJA provisions are set to expire, the Tax Policy Center estimates that 50% of taxpayers will face tax increases, with the lowest-income quintile experiencing an average tax increase of about $200 and the middle quintile seeing little change, while top earners continue to receive cuts.^[8]

Impact on Health Insurance Costs

ACA Individual Mandate Repeal

One of the most consequential health care impacts of the America First agenda was the elimination of the Affordable Care Act’s individual mandate penalty through the TCJA. This provision had immediate and substantial effects on health insurance costs, particularly for lower-income Americans.^[1]

The Congressional Budget Office estimated that repealing the individual mandate would result in 13 million fewer people with health insurance by 2027. The mandate repeal increased non-group market premiums by approximately 10%, as younger and healthier individuals—who faced no financial incentive to maintain coverage—dropped out of the insurance pool, leaving a sicker, more expensive risk pool.^[14]^[1]

Income-Level Disparities in Health Insurance Impacts

The impact of the mandate repeal fell most heavily on lower-income Americans. Research demonstrates that the individual mandate had its strongest positive effect on insurance enrollment among lower-income populations, with effects diminishing as income increased. When the mandate was repealed, lower-income individuals were more likely to forgo coverage, particularly those earning between 138% and 400% of the federal poverty level, who lacked access to either free Medicaid or heavily subsidized marketplace plans.^[15]^[16]

The Congressional Budget Office estimated that eliminating the individual mandate would reduce government spending on healthcare subsidies for lower-income persons by up to $338 billion ($415 billion in 2024 dollars) during 2018-2027, primarily through reduced insurance marketplace participation among lower-income households. By 2021, the CBO estimated that 7 million additional people had become uninsured compared to if the mandate had remained in place.^[1]

Current 2025 Health Insurance Costs

In 2025, average monthly premiums on the ACA Marketplace range from approximately $380 for Bronze plans to over $510 for Gold plans, representing about a 7% increase from 2024 due to rising medical and prescription costs. However, enhanced subsidies under the Inflation Reduction Act have helped offset premium increases for lower-income enrollees making below 400% of federal poverty level.^[17]

Broader Economic Inequality Effects

The America First agenda’s tax and spending policies have demonstrably increased wealth and income inequality. During 2017-2019, the bottom 50% of households saw a 40% increase in real net worth, but this masked a widening gap. By 2024-2025, analysis shows that the benefits to lower-income Americans proved temporary, with gains concentrated among wealthy shareholders and business owners.^[18]^[12]^[9]

The 2025 tariff implementation—a core America First policy—creates additional regressive impacts. Working-class families at the bottom of the income distribution face annual losses of $1,700 from tariffs alone, compared to average losses of $3,800 across all households.^[10]

Summary

The America First agenda has produced starkly unequal economic outcomes across income levels. While temporarily boosting median wages during 2017-2019 through labor market tightness, the underlying tax structure and current 2025 implementation continue to concentrate benefits among the wealthy while imposing net costs on lower- and middle-income Americans. Health insurance costs have risen for lower-income populations due to the individual mandate repeal, while tax policy extends through 2025 benefits disproportionately to top earners and corporations. The inflationary effects of 2025 tariffs further erode purchasing power for lower-income households, suggesting the agenda’s core promise of broad-based prosperity remains unrealized for most Americans outside the top income quintiles.

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Tags: donald-trump, economy, news, politics, trump

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Continuing Resolutions: admission of failure

5 Oct

Continuing resolutions have become the de facto federal budget process rather than the emergency measures they were designed to be. This represents a fundamental departure from the 1974 Congressional Budget Act’s vision of orderly, deliberative appropriations that could respond to changing national needs and priorities.

The 93.6% reliance rate on temporary funding measures since FY1977 indicates systematic institutional failure transcending party control or political circumstances. Both unified and divided governments have proven equally incapable of executing basic constitutional responsibilities for federal funding.

Path Forward

The data demonstrates that neither unified nor divided government provides a reliable path to functional appropriations. The three successful divided government years (FY1989, FY1995, FY1997) suggest that bipartisan cooperation, while difficult to achieve, may be more conducive to completing appropriations than partisan unity.

Fundamental budget process reforms appear necessary to restore congressional capacity for timely, responsive federal funding. The current system’s 8.2% success rate over nearly five decades represents a level of institutional dysfunction that threatens effective governance regardless of which party holds power.

The federal government’s chronic dependence on continuing resolutions reflects deeper institutional challenges that transcend partisan politics, requiring structural reforms to restore Congress’s constitutional appropriations authority and enable responsive governance in an era of complex national challenges.

Looking at the three presidents who achieved successful appropriations funding (Carter, George H.W. Bush, and Clinton), several common characteristics emerge:

Pragmatic, Non-Ideological Leadership Style

All three presidents were known for pragmatic governance over rigid ideology:

Jimmy Carter was a technocrat who approached problems analytically rather than through partisan lens, though he initially struggled with congressional relations
George H.W. Bush was famously described as prioritizing governing competence over conservative ideology, willing to compromise on issues like tax increases
Bill Clinton built his political brand as a “New Democrat” focused on centrist, pragmatic solutions that could attract bipartisan support

Pre-Polarization Era Leadership

All successful appropriations occurred between 1977-1997, before the extreme polarization that has characterized American politics since the late 1990s. This was an era when:

Cross-party personal relationships were still common in Washington
Compromise was viewed as governing competence rather than weakness
Institutional norms around congressional cooperation were stronger

Experience Working with Opposition

Three of the four successful years (FY1989, FY1995, FY1997) occurred under divided government, suggesting these presidents were particularly skilled at bipartisan negotiation:

Bush 41 had extensive Washington experience as Vice President, CIA Director, and House member, giving him deep relationships across party lines
Clinton demonstrated remarkable ability to work with the Republican Congress after 1994, achieving major bipartisan legislation

Governor Background

Two of the three presidents (Carter and Clinton) were former governors who brought state-level executive experience to Washington. Governors are often more accustomed to working with divided legislatures and finding practical solutions to funding challenges, as state governments typically cannot run deficits like the federal government.

Notable Absence: No Modern Presidents

No president since 1997 has achieved successful appropriations, despite the presidency being held by Bush 43, Obama, Trump, and Biden across various party configurations. This suggests the common characteristic may be the pre-2000 political environment rather than individual presidential traits.

The most significant common characteristic appears to be that all three governed during an era when institutional norms favored compromise and bipartisan problem-solving over partisan warfare—an environment that has not existed in modern American politics since the late 1990s.

The current administration is an extreme example of opposite of what’s needed.

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Tags: donald-trump, history, news, politics, trump

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The sleeping elephant in the room.

24 Aug

The world continues to experience unprecedented warming, with 2025 on track to be among the hottest years on record despite the waning influence of the strong El Niño event that drove 2024’s record temperatures.

Current Temperature Trends

2025 is virtually certain to rank as the second or third warmest year on record, with global temperatures approximately 1.4°C above pre-industrial levels. While unlikely to exceed 2024’s record, the year has maintained exceptionally high temperatures, with January setting a new monthly record and subsequent months consistently ranking in the top three warmest for their respective periods.

The rate of human-induced warming has accelerated to 0.27°C per decade over 2015-2024, the fastest rate in recorded history. This represents a significant increase from 0.2°C per decade observed in the 1970s, demonstrating that climate change is not only continuing but intensifying.

Atmospheric Carbon Concentrations

Carbon dioxide levels reached a new record high of 422.8 ppm in 2024, with the largest single-year increase ever recorded at 3.75 ppm. By May 2025, monthly CO2 concentrations peaked at 430.5 ppm. This surge was driven by continued fossil fuel emissions combined with reduced natural carbon absorption due to wildfires, droughts, and high temperatures associated with El Niño conditions.

Global carbon emissions from fossil fuels hit 41.6 billion tonnes in 2024, continuing an upward trajectory with no signs of the peak that scientists say is urgently needed. Despite some recent decreases in monthly emissions, the overall trend remains deeply concerning.

Critical Climate Indicators

Carbon Budget Depletion

The remaining carbon budget to limit warming to 1.5°C will be exhausted in approximately three years if emissions continue at 2024 levels. This represents a dramatic shrinking of the window for avoiding the most severe climate impacts.

Sea Level Rise Acceleration

Sea levels are rising at 3.31 mm per year, more than double the rate observed in the early 20th century. The acceleration is driven by both thermal expansion of warming oceans and accelerating ice loss from major ice sheets.

Greenland is losing ice at a rate of 265 billion tonnes annually, while Antarctica loses 134 billion tonnes per year. Research published in 2025 suggests that even limiting warming to 1.5°C may be insufficient to prevent catastrophic ice sheet collapse and multi-meter sea level rise over coming centuries.

Arctic Changes

Arctic sea ice reached its lowest winter maximum extent on record in March 2025, continuing a long-term decline pattern where all ten smallest winter extents have occurred since 2007. The ice is also becoming thinner and more fragile, fundamentally altering Arctic ecosystems and shipping possibilities.

Climate Tipping Points

New research indicates a 62% probability of triggering multiple climate tipping points under current policy trajectories. These include potential collapse of major ice sheets, Amazon rainforest dieback, permafrost thaw, and disruption of ocean circulation patterns. However, rapid emissions reductions could significantly reduce these risks.

Temperature Projections

The World Meteorological Organization projects an 86% chance that at least one year between 2025-2029 will exceed 1.5°C above pre-industrial levels, and a 70% chance that the five-year average will exceed 1.5°C. While this represents temporary breaches rather than the sustained warming threshold referenced in the Paris Agreement, it signals that the world is rapidly approaching this critical benchmark.

Extreme Weather Impacts

2025 has already witnessed severe climate impacts globally. The year began with devastating extreme weather events that have killed over 1,800 people in Europe alone due to heatwaves. Record-breaking temperatures have affected regions from the Arctic Circle to tropical zones, while extreme precipitation events have caused deadly flooding across multiple continents.

The Path Forward

Despite these alarming trends, scientists emphasize that rapid decarbonization could still significantly reduce future risks. Research shows that achieving net-zero emissions could halve warming rates over the next two decades. However, this requires unprecedented global action, as current policies remain insufficient to prevent dangerous climate change.

The latest science makes clear that while the 1.5°C target is becoming increasingly difficult to achieve, every fraction of a degree matters for reducing the severity of climate impacts. The next few years represent a critical window for implementing the transformational changes needed to safeguard the planet’s climate system.

Tags: climate, climate-change, environment, global-warming, sustainability

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AI in Healthcare

19 Jul

Two articles to help healthcare consumers understand how artificial intelligence is impacting the healthcare you receive.

The first one explains how insurance companies use AI to control the services you receive through prior authorization and denials of care. The second one provides you with an AI resource to appeal denials of of care and, in many cases, get the appropriate care approved.

Prior authorization is a process used by health insurance companies that requires health care providers to obtain advance approval from the insurer before a specific medical service, treatment, procedure, or prescription drug will be covered for payment . This means your doctor or provider must get the health plan’s permission before you receive certain medical care or medications, except in emergencies .

The main purposes of prior authorization are:

Controlling costs for the insurance company
Ensuring medical necessity, safety, and cost-effectiveness of the requested care
Sometimes, verifying that less expensive or safer alternatives have been tried first .

This process is also referred to by names like preauthorization, preapproval, or precertification.

“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” said AMA President Bruce A.Scot, MD. Your physician should be able to make medical decisions with their patients without interference from unregulated and unsupervised AI technology.

This article describes how insurance companies use AI to limit the care you receive:
https://theconversation.com/how-artificial-intelligence-controls-your-health-insurance-coverage-253602

If prior authorization is not obtained, the insurer may refuse to pay for the service or medication, leaving the patient responsible for the cost . The responsibility for requesting prior authorization typically falls on the provider, who must submit documentation to justify the request .

Prior authorization can lead to delays in care, and approximately a quarter of these requests are initially denied; however, denials can often be appealed and overturned. Marketplace plans under the Affordable Care Act denied 19% of in-network claims in 2023, the most recent year for which data is available. Fewer than 1% of consumers appealed the denials, the research found, but when they appealed, over half the denials — 56% — were upheld.

This article gives you an AI tool that is effective in reversing denials of services that you need:
https://www.nbcnews.com/news/us-news/ai-helping-patients-fight-insurance-company-denials-wild-rcna219008

Claimable, a private company, is a pioneering healthcare technology company founded in 2024 that leverages artificial intelligence to help patients overturn unjust health insurance claim denials. The company launched its AI-powered appeals platform on October 2, 2024, marking a significant milestone in making healthcare appeals more accessible and effective for patients nationwide. This gives you the power of AI to overturn denials of care.

Tags: health, health-insurance, healthcare, insurance, news

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What is hypocrisy?

7 Jul

In this morning’s press conference, Ted Cruz said: “Please pray right now for everyone in the Hill Country, especially Camp Mystic.”

It is also true that Ted Cruz, like the majority of Republicans in the Senate voted a few days ago to pass H.R.1 the Big Beautiful budget reconciliation bill.

Here are some of the real provisions of the bill:

slashes FEMA’s core discretionary budget by nearly $10 billion by 2026
massive cuts to Medicaid totaling approximately $863 billion over 10 years
The Congressional Budget Office estimates that nearly 12 million people will lose health insurance by 2034 as a result of these Medicaid changes
reduces SNAP funding by approximately $295 billion over 10 years
An estimated 5.3 million families could lose at least $25 in SNAP benefits monthly, with an average loss of $146 per month

Beyond Medicaid, the bill affects other healthcare programs:

Eliminates enhanced premium tax credits for ACA marketplace plans, affecting over 22 million people
Reduces Medicare access for low-income beneficiaries through cuts to Medicare Savings Programs
Threatens rural hospital funding with over 300 rural hospitals potentially facing service reductions or closures

The Congressional Budget Office estimates that approximately 17 million Americans will lose health insurance as a direct result of the bill’s provisions8. The American Hospital Association condemned the legislation, stating it represents “nearly $1 trillion in Medicaid cuts” that will result in “irreparable harm to our health care system”

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How artificial intelligence controls your health insurance coverage

21 Jun

Health insurers increasingly use artificial intelligence (AI) algorithms to determine which medical treatments and services will be covered, particularly through prior authorization, where AI evaluates whether a treatment is “medically necessary”. Insurers claim AI enables faster, safer, and more cost-effective decisions, potentially reducing unnecessary care. However, there are significant concerns about transparency, fairness, and patient impact.

A key issue is the opacity of these AI systems—insurers do not disclose how their algorithms function, making it difficult for patients and providers to understand or challenge decisions. When coverage is denied, patients face limited options: appeal (a process rarely pursued due to its complexity and cost), accept an alternative treatment, or pay out-of-pocket, often unaffordable. Evidence suggests that AI-driven denials can delay or block access to necessary care, sometimes with insurers financially benefiting if appeals outlast a patient’s prognosis. In other words, the patient dies during the appeals procedure.

There are also several equity concerns: people with chronic illnesses, minorities, and LGBTQ+ individuals are disproportionately affected by denials, and the use of AI may worsen these disparities. Regulatory bodies and lawmakers are beginning to address these issues, but the lack of knowledge about the algorithm and accountability remains a pressing problem for patient rights and health equity.

You can read a more detailed story here.

This is not a new concern: read a JAMA article from March 2024.

What can you do? – Join in the fight to create universal health care for everyone. Some helpful links:

One Payer States

Health Care for All Washington

Let me know your thoughts in the comments.

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50,000 people suddenly lost healthcare insurance!

19 Jun

On June 17, 2025, this OP ED in the Seattle Times: “Patients hurt most by Aetna-UW Medicine contract failure” describes how 50,000 people suddenly lost their healthcare insurance coverage, and they had no recourse. Read the story here:
https://www.seattletimes.com/opinion/patients-hurt-most-by-aetna-uw-medicine-contract-failure/

The Aetna-UW Medicine contract failure brings out the basic flaws in our current healthcare system, where profit motives and employment-based coverage create unnecessary barriers to care and disrupt critical provider-patient relationships. A universal healthcare system that is publicly funded but privately delivered would eliminate these disruptions and maintain the benefits of private healthcare delivery.

By ensuring all providers are “in-network,” decoupling coverage from employment, reducing administrative waste, and enhancing transparency, such a system would address the core deficiencies and improve access to care. Until we fix it, the current healthcare system will continue to degrade healthcare by placing profit considerations above patient needs. A universal system would reorient healthcare around its fundamental purpose: ensuring everyone has access to the care they need, when they need it, without financial barriers or network disruptions.

In 2021 through Senate Bill 5399, the Universal Health Care Commission (UHCC) was set up to prepare Washington for universal coverage. In 2024 the results of three critical studies to develop infrastructure, unify the healthcare system, and meet federal waiver requirements projected savings ranging from $738 million to $12 billion annually while expanding benefits like vision, dental, and mental health services.

Every reader should urge their Washington legislator to tell the UHCC to publish their design for a universal healthcare system for all Washingtonians.

Find your legislator here: https://app.leg.wa.gov/districtfinder

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I helped create Medicare Advantage. Here’s why I believe it needs reform.

17 Jun

An Architect of MA Speaks Out – In an op-ed published by The Hill on Sunday, former Republican Rep. Jim Greenwood of Pennsylvania — who helped write the Medicare Modernization Act that created Medicare Advantage — said plainly: “The program no longer lives up to [its] promise. I never imagined that Medicare Advantage would become a vehicle for such waste and abuse. It’s time to fix it.”

Read Jim Greenwood’s own words here.

Republicans Turn Against Medicare Advantage: A Growing Conservative Revolt

Republican leaders are increasingly criticizing Medicare Advantage (MA), marking a significant shift from traditional bipartisan support for the privatized Medicare program that now covers more than half of all beneficiaries.

Leading Conservative Voices

Former Republican Representative Jim Greenwood of Pennsylvania, who helped create the Medicare Modernization Act establishing Medicare Advantage, publicly declared that “the program no longer lives up to [its] promise.” Greenwood acknowledged that what was intended to drive innovation through private competition has been overtaken by “a handful of massive insurers who are gaming the rules for profit.”

Two Republican physicians in Congress, Representatives Greg Murphy of North Carolina and John Joyce of Pennsylvania, co-chairs of the GOP Doctors’ Caucus, wrote that “profit-driven insurance companies have destroyed [Medicare Advantage’s] model.” They specifically criticized insurers for using prior authorization to delay or deny necessary care and for “upcoding” – exaggerating patient illness severity to collect more taxpayer dollars.

Financial Impact

Medicare Advantage now costs taxpayers 22% more per beneficiary than traditional Medicare, according to the Medicare Payment Advisory Commission (MedPAC), resulting in $83 billion in overpayments to private insurers last year alone. This represents a dramatic departure from the program’s original cost-saving promise.

Industry Accountability

Conservative advocacy leader Phil Kerpen warned that Medicare Advantage is “becoming increasingly costly and unstable,” pointing to the Department of Justice’s criminal investigation into UnitedHealth as evidence of systemic problems1. He called for stronger disclosure rules, better plan comparison tools, and serious action against prior authorization abuse.

Political Implications

This Republican criticism represents a crack in the insurance industry’s protective wall of bipartisan political support, potentially opening the door for meaningful Medicare Advantage reforms that the insurance lobby has successfully fought for years.

What can you do? – Join in the fight to create universal health care for everyone. Some helpful links:

One Payer States

Health Care for All Washington

Tags: healthcare, medicare, medicare-advantage, news, politics

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How the hunt for profit can harm cancer patients

4 Jun

Cancer Drug Costs: High Prices, Modest Benefits

A new Bloomberg investigation reveals the troubling reality behind America’s $200 billion cancer drug industry, where pharmaceutical companies are generating massive profits from treatments that often fail to extend patients’ lives.

Exorbitant Costs Without Survival Benefits

Cancer drugs have reached staggering price points, with medications like Pfizer’s Ibrance costing $214,000 annually despite never being proven to prolong women’s lives ^[1]. The median initial price of new cancer drugs has quadrupled after inflation since the early 2000s to approximately $25,000 per month, while the average survival improvement is only about three months ^[1].

Flawed FDA Approval Process

The Food and Drug Administration has expedited approvals based on “progression-free survival” – a measure of tumor growth that doesn’t necessarily correlate with extended life ^[1]. Fewer than half of cancer drugs approved since 2000 have ever demonstrated survival benefits, yet they remain on the market generating billions in revenue ^[1]. In the past decade alone, drugmakers earned over $50 billion from cancer drugs showing no survival benefit ^[1].

Devastating Healthcare Costs

Medicare spending on oncology drugs more than doubled to $53.9 billion in just four years ending in 2020 ^[1]. This explosive growth places enormous strain on the healthcare system and forces difficult coverage decisions that ultimately affect patient access to care.

Industry Regulatory Capture

Pharmaceutical companies have gained significant influence over the regulatory process by funding nearly half of the FDA’s $7 billion annual budget through user fees ^[1]. They also financially support patient advocacy groups, creating a network that promotes faster drug approvals with reduced scrutiny.

Broken Promise to Patients

Despite the proliferation of new treatments, overall cancer survival rates have shown minimal improvement ^[1]. Patients and families often assume newly approved drugs are “fantastic,” creating false hope when many offer little to no meaningful benefit while imposing substantial financial and physical burdens through toxic side effects ^[1].

You can read the full Bloomberg article by clicking the link below:

https://www.bloomberg.com/graphics/2025-cancer-treatment-costs/

For an interactive description of the overall landscape of cancer in the US review this report published Dec 2024 by the National Institute for Health Care Management (NIHCM) – a nonprofit, nonpartisan organization dedicated to transforming health care through evidence and collaboration.

https://nihcm.org/publications/insights-on-cancer-rates-costs-and-strategies

What can you do? Advocate for a universal healthcare solution to end the scramble for profit in healthcare. Join in the fight to create a better healthcare system:
1. Health Care For All Washington – https://www.hcfawa.org
2. One Payer States – https://www.onepayerstates.org/

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What can you do? Advocate for a universal healthcare solution to end the scramble for profit in healthcare. Join in the fight to create a better healthcare system:
1. Health Care For All Washington – https://www.hcfawa.org
2. One Payer States – https://www.onepayerstates.org/

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Current Temperature Trends

Atmospheric Carbon Concentrations

Critical Climate Indicators

Carbon Budget Depletion

Sea Level Rise Acceleration

Arctic Changes

Climate Tipping Points

Temperature Projections

Extreme Weather Impacts

The Path Forward

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Industry Accountability

Political Implications

What can you do? Advocate for a universal healthcare solution to end the scramble for profit in healthcare. Join in the fight to create a better healthcare system: 1. Health Care For All Washington – https://www.hcfawa.org2. One Payer States – https://www.onepayerstates.org/

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What can you do? Advocate for a universal healthcare solution to end the scramble for profit in healthcare. Join in the fight to create a better healthcare system:
1. Health Care For All Washington – https://www.hcfawa.org
2. One Payer States – https://www.onepayerstates.org/