Continuing make use of the information found in Pacific Standard Magazine, Nov/Dec, 2015: Among the states, while mental health data has remained sparse overall, some states have made it easier for the mentally ill to restore their gun rights than even the federal law would allow. The New York Times noted that in Virginia some people have regained rights to guns by doing nothing more than writing a letter to the state. There are Virginians who got their rights back just weeks or months after being hospitalized for psychiatric care. What are the numbers of Virginians whose gun ownership rights were restored? Unknown because no agency is responsible for keeping track.

Nonetheless, despite the limitations of the mental health database throughout the country, some gun control advocates still see it as better than nothing. Apparently, for some it is a case of beauty in the eye of the beholder. The status of gun control affecting the mentally ill is well described by Ben Wolfgang, in Gun control debate at standstill despite agreement on restrictions for mentally ill, The Washington Times, October 1, 2015. “Across the country, from statehouses to Capitol Hill to federal courtrooms, the debate over whether students should be able to carry firearms on campus, whether the nation needs to rein in gun rights in the name of public safety and how to keep guns out of the hands of the mentally ill continues with little in the way of progress.” He goes on to describe the frustration felt by those who try to come up with a sensible set of laws to deal with the mentally ill. “In 2013, a coalition of senators tried to enact background check measures in the wake of the massacre at Sandy Hook Elementary School in Connecticut. Although the measure garnered a small level of bipartisan support, it ultimately died amid strong opposition from the National Rifle Association and other groups.

Douglas County Sheriff John Hanlin, who is overseeing the investigation of the Oregon campus shooting, was among those opposing the legislation. He sent a letter to Vice President Joseph R. Biden in 2013 after the Sandy Hook shooting, saying he and his deputies would refuse to enforce new gun control restrictions “offending the constitutional rights of my citizens.”

After Newtown, the NRA rolled out its own plan to post armed guards at the nation’s schools, arguing that a “good guy with a gun” is the only way to stop a deranged shooter bent on killing innocent people. That makes sense, but the idea has gone nowhere. On college campuses, lawsuits are being filed challenging restrictions on carrying guns while others are openly defying laws allowing firearms on campus. Ben Carson, a retired neurosurgeon running for president, said that the focus should be entirely on mental health, not on gun laws. That has gone nowhere as well. For one thing, identifying the mentally unstable and preventing them from buying guns has proved to be a complicated and serious challenge throughout the country. For example, Sen. John Cornyn (Rep. Texas) proposed a bill in Congress to strengthen federal background check systems, strengthening mental health treatment programs to treat the mentally ill, and would require court action before barring gun purchases by veterans declared incompetent by the Veterans Affairs Department thus effectively making it easier for seriously mentally ill people to access guns because states and the VA system are not going to be enthusiastic to go through even more rigmarole related to mental health treatment and veterans rights to have guns (incidentally). On a countrywide scale, the NRA once favored having gun dealers turn over sales records to police and creation of a one-day waiting period between buying a gun and physically taking possession of it—two provisions that the NRA opposes today.
Source: Mother Jones

Another article in Mother Jones discussed the problems facing legislators, law enforcement officers, the courts, and mental health workers to determine which if any mentally ill persons should be allowed to carry a firearm. “The specific disqualifications related to mental health are quite narrow. Under federal law, an individual is prohibited from buying or possessing firearms if they have been “adjudicated as a mental defective” or “committed to a mental institution.” A person is “adjudicated as a mental defective” if a court — or other entity having legal authority to make adjudications — has made a determination that an individual, as a result of mental illness: 1) Is a danger to himself or to others; 2) Lacks the mental capacity to contract or manage his own affairs; 3) Is found insane by a court in a criminal case, or incompetent to stand trial, or not guilty by reason of lack of mental responsibility pursuant to the Uniform Code of Military Justice. A person is “committed to a mental institution” if that person has been involuntarily committed to a mental institution by a court or other lawful authority. This expressly excludes voluntary commitment. If a person falls under one of these two categories, they are prohibited from purchasing and possessing firearms for life — although federal law now allows states to establish procedures for such individuals to restore their right to purchase or possess firearms. Many states have done so at the behest of the National Rifle Association, with questionable results.

“There is no guarantee, however, that a formal record of adjudication or involuntary commitment will find its way into the NICS [National Instant Criminal Background Check System] database. Often disqualifying mental health records go unreported by the states. In Colorado, for example, only about 1% of people who have disqualifying mental health histories have been reported to NICS.

“Another problem is that few Americans suffering from serious mental illness ever come into contact with the “system” or receive treatment for their condition(s). According to the National Alliance on Mental Illness (NAMI), approximately 10% of children and adolescents suffer from mental illnesses. Yet only 20% of this group have been diagnosed and are receiving services. Looking at adults, approximately 1 in 17 live with a serious mental disorder such as schizophrenia, major depression, or bipolar disorder. Yet less than one third receive mental health services.”

In the next blogpost in this series, I will discuss efforts to solve the thorny problems of protecting the public from deranged individuals with guns while still protecting their rights under the constitution.

The mental health issues regarding gun ownership and use are well presented by several authors, and I will quote or paraphrase freely from them to convey their valuable contributions to an even wider audience. In my opinion, the information provided by these authors should be as widely disseminated and as frequently as possible to the general public who are constantly bombarded with the spurious and endlessly repetitive arguments regarding guns from the left and the right.

Joaquin Sapien, writing in, How the NRA Undermined Congress’ Last Push for Gun Control, ProPublica, Jan. 24, 2013, pointed out, “In order to get the support of the NRA, Congress agreed to two concessions that had long been on the agenda of gun rights advocates — concessions that later proved to hamstring the database. The NRA wanted the government to change the way it deemed someone to be “mentally defective,” excluding people, for example, who were no longer under any psychiatric supervision or monitoring. The group also pushed for a way for the mentally ill to regain gun rights if they could prove in court that they’d been rehabilitated. The NRA found allies on both sides of the aisle to champion the concessions.”

The NRA agreed to the support the bill, in exchange for provisions pushing states—as opposed to the federal government–to create gun rights restoration programs, a stance that gave the NRA an opportunity to appear to be supportive of keeping guns out of the hands of truly insane persons, a position they trumpeted. It also gave the NRA and the law makers they control a very convenient loophole to thwart actual implementation, a palatable compromise for the rank and file of the NRA who have bought into the fear of big government taking control of all guns if any gun ownership is compromised in the least.

Since 1968, the law has made its leisurely way through state legislatures and is still not in anything like a majority agreement to make limitations state by state. The effective arguments, largely conveyed behind closed doors, convinced many sympathetic law makers that it would be costly for states to share their data within and without the state’s borders. Sapien explains that, “A state agency would have to monitor the courts, collect the names of people who had been institutionalized, and then send that information to the FBI on a regular basis. So, to help pay for data-sharing, Congress created $375 million in annual federal grants and incentives. But to be eligible for the federal money, the states would have to set-up a gun restoration program approved by the Justice Department. No gun rights restoration program, no money to help pay for sharing data.” And a win-win for the NRA and its heavy-handed concept of who should and who should not own guns (precious few of the latter).

As time as gone on, the federal government has had to resort to try and create legislation to provide both incentives and harsh penalties to force states to put names into the database. For the NRA, the convoluted purpose of that database is eventually to find data that will allow as many people with records of serious mental illness—three months of involuntary hospital confinement for mental illness, for example—to have their rights restored to have gun ownership.

The NRA won even more concessions by the time the proposed legislation reached the Senate. Language was inserted that would allow a person’s application for gun restoration rights to be granted automatically if an agency failed to respond within 365 days of the application and allowed people to have their attorney’s fees reimbursed if they were forced to go to court to restore their rights. That constituted an extremely expensive record keeping and information sharing effort foisted onto already financially strapped states. It came as no surprise to anyone that it was easier for states to let the statute of limitations pass, and applicants gain or regain their gun ownership rights even if they were deemed a danger by their care-givers, neighbors, or local law enforcement. The final bill was signed by President George W. Bush in January, 2008, an action which significantly increased his political (and financial assistance for campaigns) currency with the gun ownership community.

To no one’s great surprise, the NRA called the law “pro-gun legislation” and a victory for gun owners, and to its members, a clarion call for more donations to be certain that the NRA’s good work would continue to be well funded. The sponsors of the bill issued public statements that they support making improvements in the mental health data base; but, as quoted by Sapien, they emphasized that, overall, “we first must ensure our constitutional rights and individual liberties.” (read: the nearly unfettered right to own firearms). The law has serious flaws in implementation—again not unanticipated. Many states do not share all of their mental health records. Actually, as of 2012, only twelve states have cooperated. It is only fair to state that even that poor showing resulted in a huge improvement in the numbers of people whose mental health data became party to the system. Twenty-three states and the District of Columbia have “reported fewer than 100 records. Seventeen states reported fewer than 10 records, and four submitted no data at all…Millions of records identifying seriously mentally ill people and drug abusers as prohibited purchasers are missing from the federal background check database because of lax reporting by state agencies,” Sapien’s research revealed. Others simply can’t afford the expense of gleaning the data from the courts, providing it to the relevant state agency, and then passing it on to the federal government.

Like most such efforts, revealing this type of data is a complicated problem; and it is not fair to blame all states, legislators, and executive branches as being tools of the NRA. Some states cannot because of stiff privacy laws; the influence of the National Association for the Mentally Ill (NAMI) exerts such powerful influence to protect the rights and privacy of mentally ill persons even to the extent of protecting gun ownership rights. A New York Times investigation found that many states have not qualified for federal funding to share their data because they have not as yet established gun rights restoration programs. Ironically, some states have had trouble setting up restoration programs because gun control advocates in those states have protested them.

As strange as it may seem, many states have different interpretations of their understanding about exactly (strict legal parlance) what kind of data must be provided and to whom; and more troublesome overall is the vexing issue of what—precisely—does “mentally ill” and “involuntarily committed” mean in the context of the law and the implications for gun ownership by such persons? That issue will be dealt with in blogpost 3 on the subject.

After every horrendous massacre in the United States and abroad, there is anguish and anger over guns. The violence creates yet another media opportunity to demand the wholesale prohibition of gun sales and ownership and—at the extreme—an outcry for confiscation of firearms. In addition, there is the inevitable response by gun owners and especially by the National Rifle Association to defend gun possession and use by virtually everyone except outright criminals under the argument that the Second Amendment to the Constitution makes gun ownership a right of Americans. In my opinion both responses are spurious because they are largely driven by politics and money. Both the left and the right benefit with each new outrage: The Democrats get to make their stand known to their constituency and thus collect money for elections. The Republicans get the same money and political upsurge, and the NRA brings in another fifty or so million dollars from its panicky pleas to its members for money to safeguard their gun ownership rights. Jabin Botsford, The Washington Post, October 9, 2013 put it succinctly: “There’s a kind of usual order of national business–a grim ritual that’s been established for the hours and days after a mass shooting. After the final death and injury toll are established, an elected official or candidate–usually a Democrat–will call for stricter gun control. Then, another elected official or contender for public office–usually a Republican–will object to efforts to politicize the tragedy. Victims and their family members step forward to tell their harrowing stories and weigh in on one of the two sides mentioned above. Then, it all just goes away until the next mass shooting.”

For purposes of clarification, I am a political middle-of-the-roader independent with almost equal disdain for both of the major parties and their candidates. I am a member of the NRA, a gun owner, and a hunter; and I agree with the right of ownership of guns by private individuals for self-defense and recreational activities including target shooting and hunting. Furthermore, because I hold the opinion that the people in the NRA fold are—in the vast majority—law abiding, thoroughly decent, and well meaning, and well versed in the safe and sane use of firearms, I agree with the NRA that it would be a good idea to have well armed and well vetted citizen volunteers in place to guard our schools, sports events, and any activity where people gather.

On the other hand, I disagree strongly with the NRA over the organization’s stances that almost any weapon should be legal for law-abiding citizens, that it is a good thing that the 1968 gun laws they engineered allow registration of guns only by manufacturers and licensed distributers while allowing private individuals to buy and sell personal weapons largely unfettered which has left open the free-wheeling sales of very dangerous weaponry to very dangerous people, even convicted felons, in the open market provided by flea markets. According to Michael Corcoran, Ph.D., Mental Health Checks When Purchasing a Gun, Source, Mother Jones, “You don’t need to submit to a background check to buy a gun, of course. Currently, Americans can buy firearms through ‘private sales’ in more than 40 states without undergoing any type of screening at all. The law requires background checks only for guns sold by federally licensed firearm dealers (FFLs), allowing those not ‘engaged in the business’ of dealing firearms to do so without conducting background checks or maintaining any records of sale. How do we know who is ‘engaged in the business’? We don’t (the IRS isn’t looking at anyone’s tax returns to find out), at least until guns start turning up at crime scenes and an investigation is opened by law enforcement. One study estimated that private sales account for 40% of all gun sales in the United States.”

Even law enforcement departments take advantage of that loophole. And the NRA was also successful in getting the law administrated by the separate states—an arena where the NRA is able to work its magic to prevent real change in the gun culture of the United States.

The Gun Control Act of 1968 reauthorized and deepened the FDR-era gun control laws. It added a minimum age for gun buyers, required guns to have serial numbers and expanded people barred from owning guns from felons to include the mentally ill and drug addicts. Only federally licensed dealers and collectors could ship guns over state lines. People buying certain kinds of bullets had to show I.D. But the most stringent proposals—a national registry of all guns (which some states had in colonial times) and mandatory licenses for all gun carriers—were not in it. The NRA blocked these measures, because, in the opinion of the NRA that while part of the law “appears unduly restrictive, the measure as a whole appears to be one that the sportsmen of America can live with.”

Finally, I take great exception to the actions of the NRA to facilitate the ownership of guns by mentally ill persons. Oh, yes, I am well aware of the NRA’s lip service to the concept that the mentally ill should not have guns; but then they (the NRA) go about quietly undermining the implementation of the laws with the result that mentally ill people have access to guns. That results in killing sprees by deranged individuals on an all too frequent basis.

I recognize that the killings by the mentally ill are not nearly as frequent as those by religiously or ideologically inspired extremists in the name of their various brands of bigotry. Any set of blogposts I might write would fall on deaf ears should I try to tackle the totality of the American gun issues. So, in this set of blogposts, I will endeavor to make the case for changing the mindset of America to protect us at least from dangerous mentally ill persons.

This blogpost is based in part on material found in Pacific Standard Magazine, Nov/Dec, 2015. We have an educational problem in the United States—actually, multiple problems. One of them is the issue of for profit colleges and universities as an alternative to public schools. The impetus for attendance in for profit schools appears to be inability to get accepted at a college the student can afford. Ten percent of all U.S. students attend for profit schools, and they account for nearly forty-five percent of the students who default on their loans. The average student—the ones lacking rich parents or a sugar-daddy—are caught in an ever worsening grind: debt loans, extra out-of-pocket costs, the need to work balanced against the need to study, the necessity of putting off marriage and having a family, and the difficulty of getting sufficiently high paying jobs after graduation to be able to pay the ongoing interest of the debt. Many will not outlive their interest debt; many others will just walk away with all of the consequences that entails since student loans are not cleared by bankruptcy—non-dischargeable as of 2005.

The federal government comes into the problem in an additional issue: students in for profit schools are suing their colleges and universities in ever increasing numbers alleging that recruitment policies and delivery of promises are unethical, unprofessional, and sometimes frankly illegal. Recruitment is a sales pitch stacked in favor of the school against the student. The school has attorneys, iron-clad contractual requirements, and loose attention to the school’s responsibility to turn out a good educational product at a cost which the traffic can bear—the product being a reasonable expectation of getting a job and being able to pay the costs incurred. Many recruiters become so disenchanted with the process that they report that they feel as if they were in a white-collar criminal enterprise. Some recruiters are in fact encouraged to lie about actual costs and benefits to entice potential students who are finding entrance into publically vetted schools too onerous. For 150 years, for profit schools have been criticized, prosecuted, or shut-down for unfair practices.

Between 1990 and 2010, enrollment in for profit schools increased from 200,000 students to over 2.5 million. The educational industry is big business, and the profits are large enough to capture the attention of very large business corporations. More than half of the enrollees come from families making less than $40,000 a year, the most vulnerable people in our country. Forty percent are Hispanic or Black. Alumni fare poorly. Of those students who started to payback their student loans (as required by contract) in 2011, twenty percent are already in default as of 2015. The median income for this people is just over $20,000 per year. As of 2013, only about thirty percent of those students who entered for profit schools had graduated, and their debts are still accumulating. Only seventeen percent of University of Phoenix students who started in 2008 had graduated after six years of attendance and the necessity to add an additional year or more to their debt load. One of the real problems is that the families and students are desperate to achieve the American goal of obtaining a university degree and are willing to pay whatever it costs to get one. It is difficult for such families to accept that such a dream is not only beyond their reach, but the financial and personal cost may well turn out to be ruinous. The other problem is that the degree may be in a field where there are few or no well-paying jobs, a fact that seems to escape the attention of the colleges and their recruiters.

The injurious climate of the not for profit educational institutions piles societal failure on the already serious problems of high school drop-outs; the numbers of those unfortunate young people amount to seven percent of all young Americans between sixteen and twenty-four years of age. The drop-outs compete with the people who get a flawed education in a capitalism ruled mill for the lowest rung of jobs. And they compete with the people with high school diplomas who fail to obtain a bachelor’s degree (27%). That figure is even worse for people who fail to get a high school diploma but do get a GED (General Educational Development, known by wags as the Good Enough) degree. Only 5% of them go one to earn a bachelor’s. In fact, although 40% of those who pass GED obtain some post-secondary schooling, less than half spend even a year in such efforts. All of them at some time and in some way require assistance from the government, i.e., the already overburdened taxpayers.

The Obama administration is well aware of these problems and is trying to move against the worst offenders, which is proving to be a very considerable up-hill battle. The problem is a tangle of legal, financial, social, definitional, and human problems. One measure is to require compliance by the school with the gainful employment rule for federal assistance to the school, i.e., the institution must produce students whose loan repayment rates are less than twelve percent of their annual income. There are now income-based repayment programs. Federal, state, and local governments, and students and their families, are now instituting multimillion dollar lawsuits against the large for profit educational companies. The outcomes of these and many other educational finance issues will have lasting consequences for our republic. Will our society prosper? Will our economy grow? Will we be able to compete with other countries? Or will we make a long, slow slide into mediocrity?

This blogpost is based on information found in Pacific Standard Magazine for Nov/Dec. 2015. There are 60,000 wild mustangs in the ten western United States; more than a thousand of them are penned up in BLM corrals near Las Vegas. Nationwide, 45,000 mustangs languish in BLM holding corrals.  Those horses are in competition with 18,000 ranchers whose cattle graze on ±750,000 so-called animal units contained on 155 million acres of land, and no one knows how many domestic animals use the land in aggregate because the BLM considers counts to be futile exercises. The ranchers consider the wild horses as introduced pests comparable to feral pigs, and wild burros—useless and costly. They cannot even be eaten; legal slaughter of horses for human consumption has been banned under U.S. law for the better part of a decade. Animal enthusiasts, particularly horse lovers—including a considerable number of westerners—believe that it is emblematic of American freedom that mustangs should be able to run wild and free, much like the cowboys of the old west. Freedom for the ranchers is the right to have, to feed, and to protect their animals—the cows and sheep—from the predation of deer, elk, and now wild horses. The world would be better off without any of them, some farmers and ranchers feel.

In the middle is the United States Bureau of Land Management (BLM), and both sides feel free to appeal to the government to persuade for or against the horses. The issue is a powerful one between conservationists and livestock producers. It is estimated that there were over 2,000,000 wild horses in 1900, and the numbers were reduced to around 17,000 total in 1971 when the government passed laws to keep the wild horses from extinction. The BLM controls ranchers’ use of government owned land by granting allotments of land for defined numbers of domestic animals and taking into account environmental factors such as the numbers of wild animals, the plentitude or scarcity of feed in the grazing area, and climatic factors such as drought or heavy snows which are not entirely predictable. The allotments are a bargain from a business point of view, but the ranchers resent that they are not able to get more land to raise more cattle and sheep because the useless horses have to be factored in.

In Fiscal Year 2014, the BLM was allocated $79.9 million for its rangeland management program. Of that figure, the agency spent $34.3 million (43 percent) on livestock grazing administration.  The other funds covered such activities as weed management, rangeland monitoring (not related to grazing administration), planning, water development, vegetation restoration, and habitat improvement.  In 2014, the BLM collected $12.1 million in grazing fees. The receipts from these annual fees, in accordance with legislative requirements, are shared with state and local governments.

To accommodate the horses, ranchers have to build corrals, thus raising the costs of production while they are not able to pass on all of those additional costs to consumers. Environmentalists and conservationists do not accept the complaints and assertions of the ranchers citing the fact that horses move about as much as do elk and do no more damage than they do. On the contrary, the horse lovers assert, cattle, and especially sheep, cause almost irreparable damage to the land and the ecosystem. Why not just raise cows in feed yards and be done with the nostalgia of riding the range in the old west? The conservationists point out that the grazing land does not belong to the ranchers; they are given the privilege of grazing their stock on land that belongs to all of the people of the country.

What should be done? This question is asked by citizen of the West. I do not know the answer; neither does the BLM. Any decision they make will infuriate large numbers of people, and politicians and bureaucrats are allergic to giving offense. So, the horses stay in limbo; the ranchers and the conservations gnash their teeth; and the federal government dithers as it always does when faced with such questions. Everyone is urged to be patient. At this point in time, that is about all that anyone can do.

The Seattle Stateside Dispatch stated that hundreds of billions of dollars were wasted in fraud including physicians referring patients to their own facilities. The U.S. Government Accounting Office [GAO] reported that, in 2003, there were identified 114 unauthorized entities selling bogus insurance to 15,000 employers which–after massive legal processes–left $252 million in unpaid claims as a result of frauds. It 2005, U.S. sales of counterfeit drugs were $39 billion. Estimated bogus drug sales were $75 billion in 2010, and the cost rises annually. Counterfeit versions are often deficient in the important ingredients, and worse, actually dangerous. Every year those numbers increase at an alarming rate.

There is a mistaken belief that healthcare fraud is a victimless crime. On the contrary, that type of fraud is the second largest white-collar crime in the United States. Everyone in the U.S. is affected. Fraud causes insurance premiums and taxes to rise across the board; victims are put through unnecessary or unsafe procedures; and many become victims of identity theft and find that their insurance information has been used to submit false claims.

Pharmaceutical fraud whistleblowers have exposed a vast amount of pharmaceutical criminal activity. Several hundred pharmaceutical fraud cases covering more than 500 drugs are currently under investigation by the U.S. Department of Justice under the False Claims Act. Settlement of the first sixteen pharmaceutical fraud cases–including kickbacks, Medicaid rebate fraud, and best price violations–brought by whistleblowers has returned over $10 billion to the U.S.. Federal law prohibits the fraud of pharmaceutical kickbacks because it colors the judgment of the physician, i.e. the physician will prescribe a prescription drug based not on what is best for the patient, but based upon what prescription drug product most increases the physician’s bottom line. Other examples of kickbacks include: offering pharmaceutical kickbacks to physicians in the form of phony drug studies–the “research” performed has no legitimate value, and is merely a pretext for payments for referrals; phony speaker fees paid for by honoraria–some pharmaceutical companies have used “honorarium” fees or “speaker” fees for physician marketing. They are ostensibly compensation to physicians for agreeing to speak at a true educational event; phony grants–pharmaceutical sales representatives have been allowed by certain companies to give “grants” to physicians, physician groups, and other healthcare providers, ostensibly for an educational program or research program; phony investigator meetings–in some pharmaceutical companies, investigator meetings are ostensibly called for physicians to talk about potential non-indicated uses of drugs. Sales representatives are allowed and instructed to spend lavishly on all physicians, both the speakers and invitees. It has been typical for investigator meetings to last only two hours, yet pharmaceutical companies paid for the physicians’ airfare, hotel, golf, spa treatments, etc. at luxury hotels around the country; advisory board and other meetings–these meetings are typically for the ostensible purpose of getting input/feedback from physicians on drug performance, how they treat disease states, etc. During advisory board meetings, honoraria, lavish entertainment and expenses for physicians are paid for by the pharmaceutical companies.

Clinical trial fraud is another source of ill-gotten gains for pharmaceutical companies and unscrupulous providers and of unwarranted cost to insurance companies and consumers. Clinical trials sponsored by pharmaceutical companies often do not produce the same results as those conducted by the government and other public entities acting objectively. For example, in an analysis published in the American Journal of Psychiatry, it was found that in every publicly available trial funded by the companies that compared five new antipsychotic drugs against each other, the results of 9 out of 10 studies concluded that the best drug was the one manufactured by the pharmaceutical company sponsoring the study.

GMP [Current Good Manufacturing Practice Guidelines] fraud is a practice that frustrates the scientific process, jeopardizes the integrity of the drug product, and creates fraudulent extra costs along with decreased efficacy and safety of drugs. GMP regulations stem from Congressional concern over the danger that impure and otherwise adulterated drugs may escape detection under a system predicated only on seizure of drugs shown to be in fact adulterated. Violations of the GMP regulations have been the basis for qui tam–False Claims Act–lawsuits. The costly and dangerous violations include: off-label marketing; best price fraud; CME fraud–the use of Continuing Medical Education by pharmaceutical companies as a means to influence and induce physicians improperly to prescribe their products, usually newer and more expensive, but not necessarily better medications–unapproved drugs; long term care pharmacy fraud—fraudulent practices in which drugs are adulterated or repackaged in violation of the False Claims Act; and PBM [Pharmacy Benefit Managers] fraud—illegal relationships between pharmaceutical companies and PBMs violate the False Claims Act.

In the next, and final blogpost in this series, fraud perpetrated against the U.S. federal government—and therefore against We the People—will be examined in greater depth.

Several credible estimates indicate that around 30% of health care is unnecessary…[and] 37% of medical cost is waste, abuse, and fraud. Various estimates indicate that between $67 billion and $234 billion are lost each year to waste, abuse, or fraud. That is somewhere between $184 million and $630 million dollar loss per day; broken down that amounts to $63 billion in physician and clinical spending, $12 billion in dental, $100 billion in facility, and $30 billion in pharmacy claims. Waste–directly or indirectly–results in unnecessary costs to the Medicare and other systems. It comes from duplicates, unbundling, and overuse of services such as unnecessary treatments. Examples include: bundling, unbundling, components billed separately, excessive unit thresholds, billing within global surgery periods, incorrect billing based on medical necessity, keystroke errors, and excessive time increments in psychiatric services billing. Waste is generally not considered to be caused by criminally negligent actions but rather the misuse of resources.

Despite penny pinching which lowers physician reimbursement to the point that many physicians refuse to treat the elderly, Medicare is far from frugal. A non-Medicare recipient with chronic respiratory illness, for example, usually purchases the equipment at retail prices and pays about $100 a month for oxygen tanks with deliveries for three years–about $3,600. However, Medicare rents the equipment and oxygen for 3 years at a cost of around $8,280—a cost borne largely by American tax-payers. The cumulative cost for such equipment was $1.8 billion in 2006. During the same year the system put out $21 billion on pumps for disabled and elderly men to obtain erections. Medicare paid $450 for the equipment which is easily available online for $100. A walking cane can be purchased online for about $11, but Medicare pays $20. $20 million each year in waste comes from the federal Vaccines for Children program by failure to refrigerate the vaccines properly–hundreds of thousands of doses.

Abuse is more serious and involves upcoding and bill splitting. Abusive patterns develop from the fraction of providers who believe that because they provide superior service, have sicker patients, or are unjustly compensated, they are entitled to additional reimbursement. This entitlement–though it may not occur as regularly as patterns found in waste–has the potential for far greater risk of high-dollar losses. Abusive practices include: cosmetic surgeries billed as necessary nonelective repairs, routine overuse of modifiers that exempt claims from editing, and submission of claims for in-network providers using an out-of-network provider ID to increase reimbursement.

Outright criminal fraud–intentional deception or misrepresentation–involves schemes such as: durable medical equipment claims for services and supplies not provided; using stolen patient IDs to submit claims for services never provided; submitting claims with reimbursement checks to be sent to P.O. boxes, commercial mail holding businesses, prisons, etc.; referral rings that send patients to providers who bill for unnecessary services or prescribe unnecessary drug treatments, false claims, and identity theft. The NHCAA [National Healthcare Anti-fraud Association] cites an average of 3% to 10% of the annual $2.5 trillion of healthcare spending is lost due to fraud alone—upwards of $200 billion.  A more in depth look at the problem of healthcare fraud will be presented in Blogpost 3 of this series.

We did not get significant healthcare reform with the PPACA, or as it is pejoratively known by the Republicans—Obamacare. The ideas were generally good ones, but the law was fundamentally hamstrung from the beginning by the twin failures of not being able to gain control of the American Trial Lawyers Association and therefore of malpractice suits which resulted in defensive medicine as usual, and of not gaining any leverage against the financially rapacious big insurance companies; so, healthcare insurance premium costs for the majority of employed people went up very substantially; in many cases the costs tripled.

Politics notwithstanding, we cannot afford or sustain our present nonsystem of healthcare. Healthcare is 17.1% of the GDP and is the most important driving force of the national debt—the total amount of money the U.S. government has borrowed—and the national deficit—which is a measure of any single year’s federal financial shortfall, the difference between what the government takes in from taxes and other revenues, called receipts, and the amount of money it spends, called outlays. The items included in the deficit are considered either on-budget or off-budget, and debt is the accumulation of deficits over the years. Total debt also includes off-budget surpluses. The on-budget deficits require the U.S. Treasury to borrow money to raise cash needed to keep the government operating. It borrows the money by selling securities to the public, also borrows from lending institutions and nations. About 61% of the U.S. national debt is owned by China. The deficit hit a maximum of $1.41 trillion in 2009 during the Great Recession, due to a fall-off in tax revenues and an economic stimulus aimed at jump-starting the economy. It gradually declined somewhat, but still stayed at levels of more than $1 trillion in 2010, 2011 and 2012. The nonpartisan Congressional Budget Office said those years marked the largest budget deficits relative to the size of the economy since 1946. The projected national debt for 2016 will be $20.2 trillion, and the yearly interest required to maintain national solvency is expected to be $227 billion by the end of 2015, more than double to $480 billion by 2019, and more than triple to $722 billion by 2024. Medicare liability alone is $28.1 trillion.  Suffice it, we are in an endless struggle to pay the interest on our debt; we make no effort whatever to pay down the ruinously high principle.

Average annual projected growth of healthcare costs of 6.2 percent per year is projected for 2015 (beginning at~$2.5 trillion) through 2022, largely as a result of the continued implementation of the ACA coverage expansions, faster projected economic growth, the aging of the population, and the end of the sequester. One of the worst aspects of this mountain of healthcare related debt is that a serious proportion of those costs are preventable without degrading the quality of care received by the consumers. In the next blogpost in this series, I will quote from my book, Another Whistleblower. The book is fiction, but I purposefully included a finishing section off nonfiction to let my readers know how real and how serious this particular debt problem is.

My wife and I love to travel, and one of the elements of charm in different countries is the fractured English found in official signs which are usually meant to be helpful to the foreign visitor. Here are some examples we noted as we made our way around the world:

Japan—

Tokyo hotel. Is forbidden to steal hotel towels please. If you are not person to do such a thing is please not to read notis.

Another Japanese hotel. Please to bathe inside the tub.

Another Japanese hotel. You are invited to take advantage of the chambermaid.

Detour sign in Kyoto. Stop. Drive sideways.

In a Tokyo bar. Special cocktails for the ladies with nuts.

In a Tokyo shop. Our nylons cost more than common, but you’ll find they are the best in the long run.

Information booklet about use of air conditioner. Cooles and heates. If you want just condition of warm in your room, please control yourself.

Car rental agency brochure. When passenger of foot heave in sight, tootle the horn. Trumpet him melodiously at first, but if he still obstacles your passage then tootle him with vigor.

Hong Kong—

Supermarket. For your convenience, we recommend courageous, efficient self-service.

Tailor shop. Ladies may have a fit upstairs.

Dentist’s office. Teeth extracted by the latest Methodists.

On the box of a clockwork toy made in Hong Kong. Guaranteed to work throughout its useful life.

Russia—

Lobby of a Moscow hotel across from a Russian Orthodox Monastery. You are welcome to visit the cemetery where famous Russian and Soviet composers, artists, and writers are buried daily except Thursday.

In a Soviet weekly paper. There will be a Moscow Exhibition of Arts by 15,000 Soviet Republic painters and sculptors. These were executed over the past two years.

From a translated Russian chess book. A lot of water has been passed under the bridge since this variation has been played.

On the door of a Moscow hotel room. If this is your first visit to the USSR, you are welcome to it. [couldn’t have agreed more with that sentiment at the time.]

Europe—

Bucharest hotel lobby. The lift is being fixed for the next day. During that time we regret that you will be unbearable.

In a Leipzig elevator. Do not enter the lift backwards, and only when lit up.

In a Belgrade elevator. To move the cabin, push button for wishing floor. If the cabin should enter more persons, each one should press a number of wishing floor. Driving is then going alphabetically by national order.

In a Paris elevator. Please leave your values at the front desk.

In an Athens hotel. Visitors are expected to complain at the office between the hours of 9 and 11 a.m. daily.

In a Yugoslavian hotel. The flattening of underwear with pleasure is the job of the chambermaid.

In an Austrian skiers hotel. Not to perambulate the corridors in the hours of repose in the boots of ascension,

One the menu of a Polish hotel. Salad a firm’s own make; limpid red beet soup with cheesy dumplings in the form of a finger; roasted duck 1et loose; beef rashers beaten up in the country people’s fashion.

In a Rhodes tailor shop. Order your summer suit. Because is big rush we will execute customers in strict rotation.

In an East African newspaper. A new swimming pool is rapidly taking shape since the contractors have thrown in the bulk of their workers.

In a Vienna hotel. In case of fire, do your utmost to alarm the hotel porter.

A Bavarian Black Forest sign. It is strictly forbidden on our Black Forest camping site that people of different sex, for instance, men and women, live together in one tent unless they are married with each other for that purpose.

In a Zurich hotel. Because of the impropriety of entertaining guests of the opposite sex in the bedroom, it is suggested that the lobby be used for this purpose.

In a Swiss mountain inn. Special today—no ice cream.

In a Rome laundry. Ladies, leave your clothes here and spend the afternoon having a good time.

In a Czechoslovakian tourist agency. Take one of our horse-driven city tours. We guarantee no miscarriages.

In the window of a Swedish furrier. Fur coats made for ladies from their own skin.

In a Copenhagen airline ticket office. We take your bags and send them in all directions.

In a Norwegian cocktail lounge. Ladies are requested not to have children in the bar.

In a Budapest zoo. Please do not feed the animals. If you have any suitable food, give it to the guard on duty.

In a doctor’s office in Rome. Specialist in women and other diseases.

Signs on the entrance of a shop in Majorca. English well talking. Here speeching American.

Southeast Asia—

In an advertisement for donkey rides in Thailand. Would you like to ride your own ass?

In a Bangkok temple. It is forbidden to enter a woman even a foreigner if dressed as a man.

Mexico—

In an Acapulco hotel. The manager has personally passed all the water served here.

Average debt levels for public college students have shown a disturbing upward trend during the past ten+ years. According to the College Board, in 2001—when 52% of students borrowed–the debt level per borrower was $10,600; and the debt per bachelor’s degree recipient was $20,500. In 2005, those figures climbed to 55% of students borrowing with a debt level of $12,500, and the debt per bachelor’s degree was then up to $21,800. In 2009, the numbers were: 56%, $13,000, and $23,200. In 2012, the numbers were 57%, $14,300, and $25,000. The national default rate on college loans is 9.1%. At a time when college costs more than ever; and we are facing a $1 trillion student debt bubble, it is entirely reasonable to ask “Is College Even Worth It?”

               The value of the education based on money alone differs with different choices of courses to pursue. Students would do well to make a study of what fields of study are likely to bring long-term success, and which are likely to have been an arcane exercise in futility. However, overall, a college degree is worth the financial cost—above and beyond the human value of learning. Over a forty-year span of work, the average high school graduate earns $800,000, and the average graduate with a bachelor’s degree brings in a cumulative $1.6 million. The debt not withstanding does not negate the value of the college degree–$600,000 offsets the debt load. The earnings advantage of having a college degree over a high school degree alone was two and a half times greater in 2013 than it was in 1965 which underscores the ramping up of competition for jobs and for better paying jobs in today’s job market. The advantage of having a two year associate’s degree was seven percent from then until now.

               When I was growing up, the mantra was that you could not have a decent life without a high school diploma. Now, nearly 35% of young adult Americans (male and female) have bachelor’s degrees. It can now be suggested that achieving financial success in a world of educated people is far more difficult without that competitive degree. The income gap continues widen with the college graduate earning $17,000 more per year than the high school graduate. The hard fact is that the job opportunities for those people with nothing more than a high school degree is becoming increasingly curtailed. In 1965, a college graduate could expect a salary of $38,833, a two year associate’s degree graduate, $33,655, and a high school graduate could expect about $31,384. By 2013, those numbers were $45,500, $30,000, and $28,000. The high school graduate’s outlook is bleak—that income can scarcely support a marginal life for a family of four. The high school drop-out earning minimum wage cannot do so. The consequences for life are significant: more young people with only high school degrees live at home with parents, are reduced to using public transportation, require family, church, or government financial assistance, are unemployed or underemployed, and if employed have dead-end jobs not careers with minimal chance for advancement.

Given the difficult economic times, college graduates are displacing people from jobs usually open to high school graduates. 22% of young people with only high school degrees are living in poverty compared to 6% of those with college degrees. Studies of employment since the recent Great Recession reveal disheartening statistics, even for college graduates, according to a study by the Federal Reserve Board of New York. In 2012, about 44% of graduates were working in jobs that did not require a college degree–a rate that was about what it was in early 1990s. Only 36% of that group were in what the researchers called “good non-college jobs”–those paying around $45,000 a year–down from around half in the 1990s. The share of underemployed recent grads in low-wage–below $25,000–jobs rose from about 15% in 1990 to more than 20% currently. About one-in-five–23%–underemployed recent graduates were working part-time in 2011, up from 15% in 2000. Bad as those statistics are, the outlook for non-graduates is worse. In 1965–when the members of the “Silent Generation” were 25-34 years-old–median earnings for high-school graduates were 81% of those for college graduates; in 2013, among the so-called Millennials, it was 61.5%.

The influx of public money is why tuition is lower at a public university. The real cost of an attendance is subsidized. Money raised from tuition doesn’t need to cover all of a public college’s expenses, such as paying faculty. Meanwhile, private colleges don’t receive funds from state legislatures. They rely heavily on tuition and private contributions. This means tuition rates are generally higher–tuition and fees for a public four-year institution cost $20,823 for the 2011-12 school year, about $8,000 less than private institutions. Debt-wise, private school students were worse off, with about two-thirds of alumnus leaving school nearly $30,000 in debt. Tuition and room and board at private four-year colleges rose by 81%–more than double the inflation rate–between 1993 and 2004. The obverse side of that coin is that financial aid provided by private institutions–even to the upper middle class–has grown more than tuition, by 135% over the same period. Six year graduation rates, according to the Pew Research Center, tend to favor private universities: public, 50.6%; private nonprofit, 59%; but private for-profit, 33.5%.

Prestige is usually higher for attending and graduating from a well-known private institution, but tuition is high—usually higher for a private education–for a good education. If money is no object and prestige is important—go private. If finances are a primary concern, consider all of your alternatives before committing yourself to a decade of debt. The vast majority of experts on educational value (cost v. benefit) favor the public school route as the best bargain and value. For undergraduates, there is little that a private college can offer in the way of curriculum and social life that a public institution cannot; and it is illogical to choose private over public schools on the basis of future benefit v. upfront cost. Post graduate study is a different issue and one that takes a major and careful study before selecting public versus private institutions.