Whitcomb: CVS-Aetna; Pedestrian Bridge; Pour in More Pollution? O Jerusalem
Monday, December 11, 2017
“Boston doesn’t change for anyone, really. It’s kind of the point of Boston — that it doesn’t change.”
-- Richard Bradley, author of Harvard Rules, to The Boston Globe, about Stanford, not Harvard, now seen as America’s premier university.
“With Trump’s enthusiastic blessing, they {the Republicans} devised a bill that was more solicitous of their donors than their voters, and that only modestly addressed the central socioeconomic challenge of our time — the nexus of wage stagnation, family breakdown and falling birthrates, which will eventually undo conservatism if conservatives cannot take it as seriously as they do the animal spirits of the investor class.’’
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-- Conservative columnist Ross Douthat, in The New York Times
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Besides senior executives and other Aetna shareholders, who would benefit most from CVS’s $69 billion acquisition of Aetna?
Well, the new behemoth’s pharmacy benefit management operation might use its even greater bargaining power with drug makers to negotiate down the extreme, indeed extortive, cost of so many prescription drugs in such a way as to benefit consumers. But I doubt it. It’s more likely that they’ll keep the savings to benefit CVS-Aetna senior executives and other shareholders and consumers will see little if any benefit from that.
Indeed, if the merger drives competitors out of business, CVS might, in the fullness of time and pricing power, increase other prices for its captive customer base a lot. But with giant insurer UnitedHealth Group also getting into the big-time clinic business, too, maybe that might not happen.
Anyway, much good can come from this combination.
The merger is part of CVS’s plan to turn itself into a much-wider-service health-care provider, building on its rapidly expanding chain of Minute Clinics. There, nurse practitioners, physician assistants and regular nurses are joining with pharmacists to offer many services that you’d once have to go to a doctor’s office or hospital to get, at very high cost. After all, U.S. physicians are highest paid in the world, co-payments are jumping, etc. A brief visit to a hospital emergency room shows that far too many patients go to that very expensive venue for problems that could better be addressed in a, well, Minute Clinic. The aging of the population, and thus a flood of sicker people, especially raises the potential of Minute Clinic-like health-care retailers to slow surging health-care costs, or some of them anyway.
Indeed, whatever happens with drug prices at the likes of CVS-Aetna, consumers can save time, and thus money, by using a facility that will offer many primary-care services beyond pills, such as medical tests, physical exams and medical consultations, as well as food and other products. Life can be frantic. One-stop shopping is very attractive. At the least, these centers might help you cut down on transportation costs.
Getting your health insurance from the same organization where you get much of your health care may also make your life easier. For one thing, the sharing of patient data between the insurance side and the provider (CVS) may facilitate better care, especially for those with such chronic ailments as heart disease. But, yes, it will also make your personal data more vulnerable to computer hacking from crooks domestic or foreign (especially the Russians and Chinese)….
But again, much depends on whether the merger ends up squashing CVS-Atena competitors so much that the behemoth can jack up prices, including for insurance. Many patients may find themselves trapped in expensive “health-care hubs.’’ Always remember that most companies care far more about their senior executives and other shareholders than anyone else.
And the CVS-Aetna deal is more bad news for hospitals and physician groups: The new entity will probably drain away many of their patients.
Unless executives of the new outfit decide they really want the glamour of a big city headquarters and move it to, say, New York or Boston (remember Fleet Financial Group leaving Providence for Boston?), the merger is good news for Rhode Island, both psychologically (having such an even bigger company based here) and in the new employees that CVS-Aetna would presumably need to hire here for additional administrative, marketing and other headquarters-related work.
But don’t bet the farm on CVS keeping its headquarters in Woonsocket. Increasingly, those working at corporate headquarters, especially younger up-and-coming employees, and the executive suite, like to be in a dynamic city instead of some suburban-style office park.
So Providence’s Financial District, once an important banking center, might eventually host CVS-Aetna headquarters. Given that Aetna is a financial company that would be fitting. And the Rhode Island School of Design’s army of graphic and other designers would be next door; a few blocks away would be the Brown Medical School. Both very handy for a consumer health-care chain. There’s been chatter lately that toy-and-entertainment giant Hasbro might consider moving its headquarters to downtown Providence. Wouldn't it be nice if this old city once again became a major corporate headquarters town?
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The GOP tax bills (as of the middle of last week) singled out “Blue (Democratic) States’’ for special punishment by, among other things, eliminating deductions for state income taxes, as well as for property taxes over $10,000. Blue States, which are generally richer than Red States, have higher taxes than Red ones because they usually have more and better public services. (That is one reason they’re richer.) An effect of the GOP bills would be to raise taxes on Blue State people in order to subsidize tax breaks for some favored folks in Republican “Red States.’’
Last week, as the complaints mounted from the relatively few Republican congresspeople from Blue States, Senate Majority Leader Mitch McConnell suggested that the GOP might let people choose whether to deduct state income taxes up to $10,000 or property taxes up to that amount.
Blue State residents have long been big net federal tax-revenue donors to Red States. The people of New York, Massachusetts, etc., pay a lot so that Red States that refuse to cover the cost of some services with state and local taxes have much of such expenses in effect covered by federal income taxes.
Indeed, Red States tend to have high poverty rates and very low taxes on the wealthy. Thus they receive disproportionately large shares of federal dollars for such things as Food Stamps.
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One of the arguments for cutting taxes for the rich is the obvious one that most rich people (but not all --there are some delightful tax shelters) pay a lot of taxes. But that’s mostly because they have never done better, at least since the Roaring Twenties. And that, in turn, is partly because the people at the top of corporate America pay themselves ever more astronomical amounts, even as they suppress the wage increases of the employees below them. Even more important: Federal tax policy that has long favored money made from investments over wage and salary income, along with record corporate profits, have also helped the rich become so much richer.
A stunning example of how this can work is the news that Aetna CEO Mark Bertolini will get a $500 million payoff if, as seems very likely, CVS completes the acquisition of the giant insurer. You could run a lot of clinics and employ a lot of nurses with $500 million. The winner-take-all society indeed!
From 1978 to 2016, CEO pay rose by 937 percent, while the average worker’s pay has crept up 11.2 percent. Meanwhile, top marginal federal income-tax rates are much lower now than in 1978, when they were far too high. They were raised a bit in the Obama administration, but stayed far, far below 1978 levels, but are about to be cut again by a Republican Congress and White House determined to put more money into their own and their donors’ pockets. Quite rational!
Income inequality has been widening for years, but you ain’t seen nothing yet….
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People love looking at water. So it was heartening that the long-delayed pedestrian bridge across the Providence River to connect College Hill and the Fox Point neighborhoods and downtown is finally being built. This will make the area that much more inviting and encourage more walking and less driving in the area. And it will be yet another way to knit together the academic/research activities that are downtown with those up the hill.
The more Providence in particular and Rhode Island, in general, can take advantage of its water views, the better. That means spiffing up its bridges and building some new ones, too, and more ferry service.
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A slightly weird story on page one of the Dec. 7 Providence Journal, “Fishermen: Bay Cleanup might be doing harm,’’ reported on a couple of lobstermen suggesting that Narragansett Bay was too clean these days – specifically that the decline in “nutrients’’ as a result of better wastewater treatment was reducing the numbers of flounder, lobsters and some other species. The notion is that we need more nitrogen runoff.
Hmm… Yes, some species are up and some down. The numbers of different species vary over time with water temperature, pollution, overfishing and other factors. And there are plenty of species in the Bay, such as tautog and menhaden, that seem to be doing well. Perhaps a less polluted Bay means that there’s less nitrogen at the bottom and thus less phytoplankton, a decrease that might be bad for some fish species. But the decline in nitrogen runoff and other pollution has been very good for species who swim near the surface. And of course, as The Journal story reminds fishermen, there was much less nitrogen runoff before the Industrial Revolution and suburban sprawl development than there is now! The Bay was teeming with life then.
Lobstermen from across the southern New England coast are complaining that lobster catches are plunging as the water temperature rises with global warming. It’s probably the crucial factor in the decline in Narragansett Bay.
In any case, most of us would prefer a cleaner Bay, even if it means fewer lobsters.
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News that Jay Leno has bought a mansion on Ocean Avenue in Newport called Seafair for $12 million to $14 million reminds me of the enduring appeal of the city. It continues to attract a wide range of celebrities from around the world.
And that’s despite the obvious fact that Newport is far from a perfect resort town. It has plenty of grittiness. It has very rich people and very poor ones. It has its share of rowdy sailors and bar-goers, as well as high-end museums and other cultural treasures. Newport hosts the intellectual center of the Navy -- the U.S. Naval War College – and a fine collection of ethnic neighborhoods. It has among the most exclusive private clubs in America (e.g. , Bailey’s Beach and the Reading Room), and a nice selection of working-class pubs. It has some spectacular shoreline and some decrepit housing.
When I worked in France and told people that I had moved from Providence, Rhode Island, many French people told me they had never heard of it. But just about everyone had heard of Newport. We’re so lucky to have such an interesting city.
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Trump foreign-policy matters:
The central challenge of Robert Mueller’s investigation of Trump and his gang may be to prove that the president and/or his associates directly offered Putin help in ending U.S. sanctions imposed for Russia’s seizure of Crimea and its attack on eastern Ukraine in return for helping to get Trump elected. Which would be treason.
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Trump’s decision to have the U.S. recognize Jerusalem as the capital of Israel is meant to especially appeal to Evangelicals, who, despite his own behavior, are a key part of his base. The rich entrepreneurs of America’s religion racket (Pat Robertson, et al.) love the idea. The decision also pleases some, but far from all, members of the Jewish community. Sheldon Adelson, the casino operator and big Trump donor, is one of them.
Of course, Jerusalem (which I have visited) is, in fact, the capital of Israel, whose government is run from that city. The refusal of most of the world to officially accept that has something to do with anti-Semitism, as well as with the desire to please an Arab world that dwarfs tiny Israel.
The president’s relentless denunciations of North Korea, Iran and ISIS are a useful diversion from the fact that America’s biggest threats by far are Russia and China. He has always been gentle with the Kremlin even as Putin continues to oversee a massive cyberwar against us and to militarily threaten our NATO allies in eastern Europe. And Trump has become gentle with the regime of Chinese dictator Xi Jinping even as China continues to aggressively expand in the South China Sea, to threaten Taiwan and to refuse to do much to restrain its bloodthirsty ally North Korea. Indeed, Trump’s sucking up to tyrants has been quite a show.
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I’ve met Joe Trillo a couple of times. He’s perfectly pleasant in person. My biggest beef with him is that he’s been such a loud and enthusiastic supporter of Donald Trump despite the latter’s easily researchable and decades-long history of corruption. Fine if Mr. Trillo hates the Clintons, but…!
Still, perhaps I’m being too harsh. If you want the comfort of a strong, or at least loud, leader who you think shares your view of the world, you’ll happily avert your gaze from many unsightly scenes. The wishful thinkers who follow demagogues will always be with us. Indeed, they’re often a majority.
Now Mr. Trillo says he’ll run for governor as an independent. That may drain enough votes away from the Tea Party branch of the GOP to re-elect Gina Raimondo, which you’d think that Joe would not want to do. But then in what will probably be another crazy election year, former Gov. Lincoln Chafee may run against Ms. Raimondo in the Democratic primary and, given the leftward lurch of the party, could even win. Oh, for the days of Eisenhower Republicans and Truman Democrats!
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So much for freedom of association. Harvard has approved a rule barring students who are members of single-sex clubs (basically meaning fraternities, sororities and “final clubs”) from leading officially approved campus organizations or serving as captains of Harvard sports teams. Further, the school won’t recommend such students for such major scholarships as the Rhodes. Nanny State goes to college. Social engineering 101.
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A study by First Round Capital, a venture-capital firm, says that only 17 percent of tech startups have put in place a formal strategy to promote diversity and inclusion. So what? Well, maybe these firms are spending all their time trying to survive, and, as they say, “go to scale’’! Maybe they don’t have enough money to hire harassment and/or diversity consultants.
The study also looks at the sexual-harassment mess. It's pathetic that society, culture or whatever has declined so much that we have to have formal guidelines on how to act appropriately when in fact most people should know almost intuitively at least how not to act. Maybe it’s the decline of parenting. To read the report, please hit this link:
The obsession among many Democrats with “diversity’’ for its own sake and their appeals to racial and sexual identity are major reasons they keep losing elections. When they escape their obsession and start appealing to the middle class without reference to individuals’ sexual or racial identities but with broad appeals for socio-economic “fairness’’ they’ll start winning again.
After all, most polls show Democratic positions on, for instance, health care, taxes, Social Security, fixing infrastructure, etc., are more popular than Republican ones. Get competent people to run for office who share broad centrist or center-left principles and don’t recruit them on the basis of their skin color and sexual preference. That’s a turnoff for many Americans.
Appealing to voters on the basis of their race and sexual identity devalues the complexity of human individuality and is profoundly condescending.
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“As political scientist Jacob T. Levy pointed out at the Niskanen Center blog, in his brief presidential tenure Trump has already ‘defied, ignored, or shredded the whole previous system of norms about avoiding financial conflicts of interest and the use of public office for private enrichment.’
“Trump has openly signaled that his Washington hotel and Palm Beach club {Mar-a-Lago}, where he doubled the fee to $200,000 after his election, thereby putting an explicit dollar value on presidential access, are political souks. ‘He has, in short, drawn a very clear map to foreign interests about how to enrich him and his family and how to gain direct access to him in the process,’ Levy wrote.’’
-- Francis Wilkinson, writing in Bloomberg News. SEE HERE:
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