November 11, 2013

International Countertrade With A Social Purpose


Global trader with a social cause in the making
By Melvin J. Howard

Circumstance has away of preparing you for life without you knowing it. For example when I was in College I got a job that was arranged by my alumni department head. It was working for a major defense contractor in their countertrade division. Little did I know at the time it would play a major roll in my life now? Countertrade is a term used for parallel business transactions, linking sellers and buyers in reciprocal commitments, which usually lie outside the realm of typical monetary trade. Some of the common forms of countertrade transactions include barter, counterpurchase, compensation, buyback, clearing arrangements, offset and switch trading. More than 10% of world trade today involves some form of countertrade.The World Trade Organization estimates that 15% or $8.43 billion  of the $5.62 trillion in international trade is conducted on a non-cash basis.

My mentor was a great teacher he was a Vice President of the defence firm I was working for. I was learning first hand how to do world trade not in the classroom but on the front lines. He took me under his wings and taught me the most basic and the most complicated forms of Trade.  Offsets–an umbrella term for a broad range of industrial and commercial compensation practices required of foreign suppliers under primarily government agency of state-owned enterprise acquisitions–were made a common requirement for the procurement of either military (e.g., fighter aircraft) or high-cost civilian hardware (e.g., commercial aircraft). Both defense and non-military offsets may entail overseas co-production of the procured item, as well as other economically beneficial transfers to the importing country that are not related to the original export. To assist their exporters some industrialized country governments also promoted countertrade under government agreements. For example, the French Ministry of Agriculture signed in 1989 an agreement with the USSR Council of Ministers which provided for exchanges of Soviet commodities for French agricultural and food processing equipment and technologies. Other Western governments, such as those of the United States, Canada, Belgium, Holland, the United Kingdom, and Italy, established special countertrade service units within public agencies to provide countertrade-related advisory assistance to their exporters. The French Government has supported instead the formation of a separate countertrade assistance entity in the private sector. The Swedish Government was until 1990 a major stockholder, through interests by the Swedish Investment Bank, in a private sector company involved in countertrade. Now with trade agreements like NAFTA in 1994, which integrate regional trade, based on free market principles some countertrade has abated somewhat.

International countertrade practices are now increasingly associated with bidding on major defense and non-military government procurement contracts and with project financing–a contract-based, off-balance-sheet finance technique whereby revenues generated from the output of the financed project are directly allocated to service outstanding debt and principal. A variation of the countertrade buy-back contract which links foreign contractors’ repayments to the output products of the production capacity they supplied, project financing relies instead mainly on contractual recourse to the project’s revenue streams. (According to the World Bank, developing countries are now spending around $200 billion a year on new infrastructure investment, one-fifth of their total investment.) High procurement costs and tighter budgets have prompted many emerging country governments in the 1990s to issue new civilian offset regulations (e.g., United Arab Emirates, Kuwait). Civil offset requirements, therefore, are increasingly acquiring a financing rationale in these markets. In a global environment of budgetary constraints, the ability of suppliers to meet offset requirements and/or to provide their clients with financial packages that can best those of competing bidders is a major competitive edge.

International trade in medical services will become increasingly more important. For ensuring quality, well-known medical facilities are likely to invest (commercial presence) in countries. Likely to be the destination of “consumption abroad” mode. Likely to be the supplier of patients mainly due to “poor quality” of medical care rather than the cost of care. International migration of foreign medical graduates will likely to be associated with commercial presence rather than traditional migration. New migration pattern will further encourage adoption of consumption abroad approach for reducing overall healthcare cost in both developed and low-income developing countries. Further expansion of consumption abroad will discourage purchase of expensive health insurance plans. In high medical care cost countries; international trade in health services will encourage purchase of catastrophic insurance plans. Health expenditure in the world in 2005 was about $4.8 trillion ($60 trillion was the global income) $4.0 trillion in OECD countries,  $800 billion in the remaining 160 countries of the world. Globalization has increased trading in health care services. Cost of international communication, travel has declined. Time lag has declined significantly and for electronic transfer of information, it has become almost zero (origin to destination). Cost of obtaining services of similar quality varies significantly among developing countries as well as between developing and developed countries of the world. There are types of medical care services that are extremely time sensitive. Waiting will rapidly reduce the benefit of treatment.

 The benefit function declines rapidly. If the time lag between the onset of the condition and reservation benefit level is shorter than the time needed to travel to a country, the service will be demanded locally. Worldwide, 1.3 billion people do not have access to effective and affordable health care. Low- and middle-income countries bear 93% of the world's disease burden, yet account for only 18% of world income and 11% of global health spending. What governance structures are necessary to encourage the right mix of public and private health care provision? What regulatory framework is needed to induce businesses to provide insurance, provision and finance for health in poor countries? How can the fruits of medical knowledge and technologies be shared among rich and poor countries without destroying incentives to generate more knowledge? What forms of international cooperation are conducive to the finance of health systems in developing countries? What international institutions are required to make health care for the poor an attractive opportunity for business? One thing is clear groups or individuals who think health care is static or promote the status-quo are sticking their heads in the sand. Recent economic conditions highlight the need for new sources of capital to be brought to bear on social problems.

At the heart of the social enterprise movement is the ongoing challenge of accessing investment capital for socially responsible purposes.  Acquiring start-up capital is a common issue for many nonprofits. It's exacerbated by federal tax laws that restrict nonprofits from accessing traditional forms of equity, such as venture capital and, sometimes, commercial debt. For the most part, nonprofits must rely on private foundation grants, government support, and, for some, earned income such as fees for services. To subsidize their earned income, some nonprofits have set up separate social enterprise business sidelines. The for-profit sector faces its own challenges in funding charitable activities because federal tax laws generally restrict private business entities from accessing foundation grants and government assistance. In addition, for-profit investors expect market-rate returns and maximized profits. Their expectations don't align well with social mission-focused entities, which need "patient capital" and typically have slower, more modest growth.

There is a growing body of thought that new business models and possibly new tax incentives or structures are needed to effectively bridge the "sector" gap. These new models would eliminate the need for social entrepreneurs to either choose between the for-profit and nonprofit business models or create and manage both. One such model, could be a form of business that blends attributes of nonprofit and for-profit organizations in order to promote investment in socially responsible objectives. “It’s time we utilize innovative ways to stimulate the economy and create jobs we need to spur the growth of socially responsible business by simplifying partnerships between nonprofit foundations and for-profit investors. Hybrid financial tools can generate a vast pool of investment funds needed to develop companies dedicated to the public good.

There are major lessons learned from the global greed era we are leaving behind to a new era which creates an opportunity for the investment of private capital to further social purposes.

November 04, 2013


The Washington Award Program has chosen Melvin J Howard Foundation, Inc for the 2013 Washington Awards in the Non-Profit Organizations classification.

September 05, 2013

Mental Health Of Success On The Couch

Paying That Price For Success

By Melvin J. Howard

The first rule of paying the price is a very important rule, and, indeed, possibly covers most of the subject matter. Before you make any formal resolutions whatsoever, make certain that you genuinely desire to carry it out. Let there be no doubt that the end you have in view is so desirable or advantageous that it will outweigh all desires and advantages or all other ends that are likely to have to be foregone or abandoned in order to attain it. In short, be sure you are willing to pay the price. This rule is the corner-stone this is of great importance. There is a price for everything for doing and not doing. Paying the price is characteristic and a passionate desire to succeed, a desire so strong and overbearing that it amounts to a demand, and that, in the strictly economic sense to which I means willingness to pay the price

The price is first of all singleness of purpose and concentration of effort. Nearly all of us, at school, have thought that we should someday like to be President of the United States. But not all of us have made it a point to study the lives of past presidents to see how they did it. Not all of us have taken a law course with that special insight like constitutional law. Not all of us have refused tempting commercial opportunities for certain poverty and struggle for a time to gain an end in which the mathematical chances were ridiculously and overwhelmingly against us. Not all of us have kept desperately fanning the embers of dissatisfaction, fanning them into a constant white-hot flame. With most of us the early fire dies; the embers fade and grow cool. We reach as high a level as we ever seriously hope to reach. We have spasms of dissatisfaction with our position in the world, but not sufficient dissatisfaction to make us work our way out of the rut to a higher position. We have moments of longing for the mountain tops, but not enough longing to make us willing to give up something for them. Strolling in the valleys is so much more pleasant than climbing.

And singleness of purpose demands more sacrifices than mere industry. It involves giving up all pleasures that interfere with it. They may be quite innocent pleasures, their sole offense being that they occupy time. It involves making oneself narrow; one cannot be a success in any one line if one dissipates one’s energies in a number of activities—unless, of course, one be a versatile genius whose energies overflow, like Benjamin Franklin, Leonardo da Vinci, or Goethe—and such instances are so rare that they may be ignored. Let there be no mistake. I do not mean to discourage efforts to become a Success. I mean merely to indicate that the goal has a price. I want you merely to ask yourself whether you are willing to pay that price; to ask yourself candidly how far you want to go and how much you are willing to pay; for if you do not ask yourself now, before you make your Success resolutions, you are likely to ask yourself later on. 

As you see obstacles and disappointments pile up, you are apt to begin wondering whether the game is worth the pain. And if you decide to give up then, you will have broken your early resolution, with all the undermining of self-confidence and faith in your will which that involves. 

Once you have made your decision, having coldly decided that is what you want and that you are willing to pay the price, your decision is forever beyond dispute. You should never ask yourself again whether the other course is possible; whether it is really worth while staying home to study for a specified number of evenings each week; whether a man who has resolved to stop drinking can really do so suddenly without blowing to pieces; whether a man in a moderate position, without so many responsibilities and burdens on his shoulders, doesn’t really get just as much enjoyment out of life as the Success. Can I do it a person that comes from Hoboken anywhere can actually accomplish what he sets out to do. Those questions are forever closed; you have asked them before and have decided them. You will know that thoughts determine action, and to control your actions you will begin by controlling your thoughts. You will vivify all the advantages that will come from carrying out your resolution. You will paint them in glowing colors.

You will dwell on them constantly. The disadvantages you will ignore. They are disadvantages only to fools; a wise man does not think them so. Concentrate on the positive side; avoid the negative at all costs friends, family anyone that would dampen your spirit. Picture yourself already a success. I have come across many people in my life that want the easy life the glamorous life the rich life. But they are never willing to pay the price. Each successful person knows what I am talking about they have paid the price. What looks to the outside world of easy success is an illusion the price these individuals paid could be number of things that we will never know about. 

August 08, 2013

Medical Debt And Your Credit Score

Medical Credit Score
Til Debt Do Us Part #3

By Melvin J. Howard
Do ever wonder why you have a low credit score or why you never seem to qualify for the lowest interest rates on home, car, or other loans, the problem may be medical debt. This is true even if you paid an overdue medical bill. The Federal Reserve has shown that more than half of all collection accounts that negatively impact credit reports are medical debt. This is a result of the fact that health care costs are on the rise and tens of millions are uninsured. But it is also because medical debt is treated differently from other kinds of debt. Private health insurance reimbursement is incredibly cumbersome. Different benefits are often covered by different companies and at different rates, leading to a lengthy, circuitous billing process that often leaves patients holding the bag. If you have ever received a medical bill that you didn’t understand or that you thought your insurance was supposed to cover, you have been caught up in this system. If you have ever received a letter from a health care provider stamped with the notice “This Is Not A Bill,” or if you have signed a form at a doctor’s office promising to pay anything your insurance fails to cover, you have been an unwitting victim in the tangled web of medical billing, an industry that thrives on patient and health care provider confusion.
One study found that nearly one-third of respondents let a medical bill go to a collection agency because they did not understand the bill or explanation of benefits statement. Another study estimated 14 million American adults said that a medical bill was sent to a collection agency because of a billing mistake.
Confusion keeps the medical collections industry turning. It’s hard not to think that billing “mistakes” may not be mistakes at all but part of an intentional strategy to keep patients in the dark and in the red. In addition to patient confusion, medical debt is more likely to end up in collection because hospitals routinely sell medical debt to debt collectors after 60-90 days of nonpayment, far less than the customary 180 days for other kinds of debt. Health care providers rarely report paid medical bills to the credit reporting agencies. So, even if you are billed in error, your health care provider may send your bill to a collection agency before you can dispute the charge. Once in default, a medical debt stays on a credit report for up to 7 years, even if you pay the bill. Research by the Commonwealth Fund shows that, in 2010, 9.2 million people wound up in default on a medical bill because of a billing mistake.
These mistakes have serious consequences. A single paid medical bill can lower a consumer credit score by as many as 80 points. That means you will pay a higher interest rate for almost anything else you want to buy on credit, including a home or a car. The fact that a relatively small medical bill can end up costing thousands in interest charges down the line demonstrates the obscene power of the credit rating agencies. No other companies have more power over the American consumer than the top three credit reporting agencies, Equifax, TransUnion, and Experian.
If patients are powerless, so are many health care providers. It’s important to note that your doctor may be just as confused as you are. Talk to any health care worker around the country, and they tell you that they are as frustrated as patients when it comes to medical billing. Why do insurance companies and ratings agencies have so much power over our lives? Why do we live in such perpetual confusion?
The Medical Debt Relief Act attempts to prohibit credit reporting agencies from listing medical debts on credit scores. Yet, even this minor reform has little chance of passing because the credit rating agencies and insurance companies are a powerful lobby in Washington. And even if the MDRA were to make it through the Senate, it only applies to paid medical bills. Indeed, the evidence actually indicates that if we don't act things will get worse for patients and debtors before they get better. FICO has begun developing a special ratings system to rank potential patients on how likely they are to pay their medical bills. Like having a barcode tattooed on your forehead, we could be looking at a brave new world in which your credit rating determines not only whether you can obtain a credit card but whether you receive medical care when you get sick.

August 03, 2013

Nonprofits are losing out to Privatizers that has got to stop forthwith

After years of welfare reform there is evidence that privatization has been successful, not for the people who were supposed to be moved out of poverty, but for corporate profiteers.

By Melvin J. Howard
An unintended consequence of welfare “reform” has been the transformation of the nonprofit sector particularly the better-funded national organizations from community assets to market-based competitors. The traditional distinction between nonprofits investing in people and communities, and for-profit entities that make money for their owners, is becoming blurred. In some areas, for-profits and nonprofits are now in direct competition; in others, they are creating partnerships to secure government contracts. In the Harvard Business Review, William P. Ryan, a Cambridge, Massachusetts-based consultant to foundations and nonprofit organizations, looks at the changing landscape for nonprofits forged by government willingness to contract with for-profit corporations to administer government services. Ryan points out: “By playing in the new marketplace, nonprofits will be forced to reconfigure their operations and organizations in ways that could compromise their missions. The danger,” writes Ryan, “is that in their struggle to become more viable competitors in the short term, nonprofit organizations will be forced to compromise the very assets that made them so vital to society in the first place.”

One of the most insidious consequences of the San Francisco County’s welfare-to-work program is that local nonprofits and private businesses are able to “steal jobs from low-wage workers, for whom these jobs no longer exist.” This short sighted pitting of low-wage workers against welfare workers threatens to create a new group of unemployed workers, who may find themselves applying for welfare benefits.

To compete in the marketplace, nonprofits are adapting to its new realities in a myriad of ways, “from subcontracting to partnership to outright conversion to for-profit status,” writes Ryan. He points to the YWCA of Greater Milwaukee, which although “large and sophisticated by any nonprofit standard…could not go it alone.” In order to deal with the “demand of a comprehensive, $40 million welfare-to-work contract, it created a for-profit limited liability corporation [called YW Works], with two for-profit partners.”
In addition to unleashing predatory corporate forces, and the ongoing transformation of nonprofit organizations into high stakes competitors for government contracts, the Personal Responsibility and Work Reconciliation Act of 1996 contains the first enactment of a concept known as “charitable choice.” Far from expanding anyone’s choices, “charitable choice” mandates that state and local governments include religious organizations in their pool of bidders for service-delivery contracts.

On the face of it, this is nothing new. As Cathlin Siobhan Baker, Co-Director of the Employment Project, explains, for years religious organizations have received government funding for emergency food programs, child care, youth programs, and the like. However, they were expressly prohibited from religious proselytizing. Now, Baker writes: “Gone are the prohibitions regarding government funding of pervasively sectarian organizations. Churches and other religious congregations that provide welfare services on behalf of the government can display religious symbols, use religious language, and use religious criteria in hiring and firing employees.”

President George W. Bush has been a big-time supporter of charitable choice and faith-based initiatives. If his faith-based initiative, announced to great fanfare in late January, ever gets back on track, it will allow for a bunch of social services to come under the control of faith-based organizations. During the presidential campaign, Bush repeatedly called for “armies of compassion” fielded by “faith-based organizations, charities and community groups” to help aid America’s poor and needy. In a USA Today opinion piece he laid out his plan for taking “the next bold step in welfare reform,” proposing $80 billion over 10 years in tax incentives to “help our nation’s most heroic armies of compassion.” He also proposed a federal initiative to “support community and faith-based groups that fortify marriage and champion the role of fathers.”

Welfare is no longer a question of poverty or the economic inequities in our society. Charitable choice frames the debate within such time-honored moral hodgepodge as the proverbial “epidemic of out-of-wedlock births,” or the “lack of personal responsibility”—behaviors that conservatives claim, contribute to the general moral breakdown of our society.

Since 1996, responsibility for welfare services has shifted from the federal government to the states and the states have contracted many services out to for-profit corporations and non-profit organizations. Under President Bush’s faith-based initiative, religious organizations have become a major player in the service provider mix. However, in addition to the bevy of objections raised by liberals and conservatives that have stalled the implementation of Bush’s faith-based plan, many people of faith do not believe that they can shoulder such a burden.

In Religion-Sponsored Social Service Providers: The Not-So-Independent Sector, independent researchers Jim Castelli and John McCarthy of Pennsylvania State University, conclude that it is mistaken to believe that faith communities can take on the burden of expanding their provision of social services as a substitute for government efforts. “Not only is there no infrastructure at the national, state, or local levels to administer programs and large amounts of funding, but such expansion would require faith communities to wholly change their funding priorities in order to build their capacity.”

Privatization as the engine powering welfare reform was supposed to replace federal and state bureaucracies with streamlined, cost-effective corporate service providers. Privatizers believed that private companies would administer welfare regulations more stringently and accurately, deliver services more efficiently, and focus on only those who really deserved benefits. Saving the taxpayers money was another appealing promise. Companies competing for contracts assured states that they would dramatically reduce the welfare rolls.

Has the privatization of welfare delivered on its promises? Have private companies and enterprising nonprofits transformed the old welfare system with the outcome of long-term employment with decent pay for former welfare recipients? Max Sawicky, economist at the Washington, DC-based Economic Policy Institute, is troubled by the fact that the so-called “success [of welfare privatization] was announced before the results are in.”

In a 1997 speech, Lawrence W. Reed, President of the conservative Midland, Michigan-based Mackinac Center for Public Policy, touted privatization as the wave of the future: “The superiority of [privatization]…is now approaching the status of undisputed, conventional wisdom: the private sector exacts a toll from the inefficient for their poor performance, compels the service provider or asset owner to concern himself with the wishes of customers, and spurs a dynamic, never-ending pursuit of excellence - all without any of the political baggage that haunts the public sector as elements of its very nature.”

·         While welfare privatization has delivered drastic reductions in caseloads and welfare rolls, it has not moved recipients from the “underclass” to the working class. Privatization is not efficiently delivering job training and support services to those who need them.

·         The financial bonuses privatizers receive for reducing caseloads create an incentive to terminate clients’ benefits, not to assist them in climbing out of poverty.

·         As in the case of Curtis and Associates, staff working for private companies often have neither the credentials nor the training to handle their caseloads. Consequently, clients do not receive services they need, and to which they are entitled, such as childcare, transportation subsidies and medical care.
·         As Wisconsin, New York, and Texas have learned to their chagrin, companies like Maximus and Lockheed Martin blithely spend public money from other jurisdictions to wine, dine, and pay off decision-makers in the pursuit of new contracts.

·         The states and local governments that contract with corporations for welfare services have not instituted any form of systematic oversight. Because information about large private contractors is not centralized, it is not unusual for a company in hot water one place to pick up new contracts at the same time in another state—or in another county in the same state. Ultimately, for-profit corporations are accountable to their shareholders, not to the communities they are hired to serve.

Spurred by revelations of Maximus’s questionable activities, Milwaukee-area Democratic Congress- people Jerry Kleczka and Tom Barrett, are hoping the federal General Accounting Office will fully investigate the practices of private companies hired to manage welfare services. As we move closer to welfare reauthorization, the GAO needs to vigorously take on the Congresspeople’s request. In the meantime, corporations will continue prospecting for gold among the poor.                                      

July 21, 2013

Medicaid and Medicare Poverty and Wealth the money train

There is money to be made off the poor:
Til debt do us part #2
By Melvin J. Howard

In 2007, MAXIMUS agreed to pay $30.5 million to resolve an investigation by the U.S. Department of Justice (DOJ) into False Claims Act allegations.  In a deferred-prosecution agreement, the company admitted responsibility for causing the District of Columbia to request Medicaid reimbursement as if the city‘s foster care agency provided reimbursable services to every single foster child when, as Maximus then well knew, that was not true. The DOJ described the settlement as demonstrating strong commitment to vigorously pursuing those companies that defraud the Medicaid program. However, both before and during the course of the litigation, MAXIMUS was almost inextricably linked to federal and state government agencies through contracts to provide services in Medicaid, Medicare, and other aid programs. Thus, the available sanction of exclusion from continued participation in federal aid programs was explicitly avoided as part of the settlement. Within two months of the settlement regarding allegedly fraudulent Medicaid claims, MAXIMUS won a five-year contract with the state of New York to provide Medicaid fraud-consulting services talk about the fox watching over the hen house. Within three months, the District of Columbia extended the same Medicaid revenue maximization contract with MAXIMUS that resulted in the alleged false claims. From the time of the settlement through the end of 2008, MAXIMUS entered into or extended contracts related to Medicaid or Medicare worth more than $240 million, including millions of dollars in contracts directly with the Centers for Medicare and Medicaid Services (CMS) the federal agency to which the allegedly fraudulent claims had been submitted. Then, one year after the DOJ settled its possible claims against MAXIMUS, the company won a contract to insert its services within the DOJ itself, to provide investigative and analytical support, consulting, technical services, financial management, and case-related professional support during the investigation and prosecution of criminal cases.

In addition to tax and debt instruments for raising revenue, intergovernmental grants are a primary tool for different levels of government to carry out their respective roles, and thus are a key application of fiscal federalism theory. In the United States, intergovernmental grants typically take the form of federal grant-in-aid programs, such aid programs has been to devolve more discretion and control to the states and local governments. The grant programs generally fall into three categories: matching programs such as Medicaid and Title IV-E Foster Care where state spending is required at a certain percentage match to receive additional federal funds; block grants like the current welfare cash assistance program (Temporary Aid to Needy Families, or TANF), which require states to maintain a certain level of state spending to receive the full federal block grant; and programs that are fully funded by the federal government but administered by the states, such as the Food Stamps Program.

Total federal spending on two of the largest matching grant programs, Medicaid and Title IV-E Foster Care, is projected to reach almost $320 billion in 2014. The programs are frequently targeted for contractor operational and consulting services and have been the subject of increased federal scrutiny into revenue maximization strategies. The programs provide an excellent example of intended fiscal federalism structure and the transformative effects that occur as the poverty industry‘s relationships with both the state and federal governments continue to grow. Numerous private companies have not only recognized the money to be made from poverty programs, but have concentrated on that niche as the core of their business offerings. With a mission of helping Government Serve the People, MAXIMUS provides operational and consulting services for almost all aspects of government health and human services programs. The poverty industry thrives on bad times. While many companies‘stocks were diving, MAXIMUS announced increased cash dividends to its shareholders. MAXIMUS also noted in its 2008 fourth quarter earnings call that there are more unemployed people and they look for job opportunities, and that plays right into the sweet spot for our welfare to work programs.

The depth and scope of the poverty industry‘s role in federal grant-in-aid programs and funds is striking, spurred in part by lobbying efforts, campaign contributions, and a revolving door of personnel between private industry and government leadership. The poverty–industrial complex has grown to the point where seemingly any task regardless of possible conflicts or limitations regarding inherently governmental functions can be contracted out.


A few years before former Illinois Governor Rod Blagojevich faced impeachment for allegedly trying to sell a U.S. Senate seat, he faced media scrutiny for his dealings with MAXIMUS. In 2005, The Chicago Sun Times reported on possible links between the company‘s receipt of state contracts and campaign contributions to Governor Blagojevich made by MAXIMUS and the company‘s lobbyists. According to the paper, MAXIMUS initially contracted with the state to develop a new plan to maximize federal aid dollars, and the company was then ―handed a waiver from state contracting rules by Blagojevich‘s administration so it [could] bid on the lucrative contract proposal it helped the state develop. The company had apparently given Blagojevich‘s political fund $25,500, and the company‘s lobbying firm—which employed the governor‘s former congressional chief of staff—donated another $80,300 to the governor.

Such scrutiny then reached to the west coast. According to the Los Angeles Times, when MAXIMUS faced the risk of losing a $32 million welfare-to-work contract with Los Angeles County, the company reacted by outspending its competitor on lobbying efforts by eight to one. The county‘s Department of Public Social Services concluded another company‘s bid was better, and a review panel and the auditor–controller upheld the decision on appeal. But after MAXIMUS spent $200,000 in lobbying fees and thousands more in campaign contributions, the paper explains, Los Angeles‘s five county supervisors voted to ignore the year-long review process and re-bid the contract to give MAXIMUS another chance.

Revolving Door

In addition to the influence of money and lobbying, there is a continuous flow of leadership between the ranks of government agencies and private contractors involved in federal grant-in-aid programs. While Governor of Wisconsin, Tommy Thompson was on the national forefront of the charge to privatize welfare and other poverty programs and he took his championship of privatization to the national stage as Secretary of the U.S. Department of Health and Human Services. When he left his federal post, Thompson was rewarded with multiple positions in the private sector. Simultaneously, Thompson joined Deloitte Consulting, leading the firm‘s Center for Health Solutions; became a partner with Akin Gump Strauss Hauer & Feld LLP, where he focused on developing solutions for clients in the health care industry, as well as for companies doing business in the public sector; joined former U.S. House Majority Leader Richard Gephardt as a member of the board of directors for Centene Corporation, a company that provides Medicaid managed care services in several states; became the board chairman of Logistics Health Incorporated and joined the boards of directors of several private companies in the healthcare field.

As states increasingly view federal grant-in-aid funds as a source of general revenue rather than a means to enhance program services. Once the bipartisan pick for Commerce Secretary in the Obama Administration, U.S. Senator Judd Gregg has since become a critic of the Administration‘s increased spending on federal aid programs to address the economic downturn and budget difficulties faced by states. However, when Senator Gregg was governor of New Hampshire and faced a growing state budget deficit, he initiated a process of claiming additional federal Medicaid matching funds, but with no additional net outlay of state funds. Then, rather than using the additional funds for Medicaid-related services, Gregg created a new general revenue line item in his state budget called ―Medicaid Enhancement Revenue. Gregg converted additional federal Medicaid payments into general use rather than using the federal dollars for Medicaid programs and services. The strategy led to such an increase in federal funds that the new general revenue line item accounted for 28% of New Hampshire‘s total general fund revenue in 1994.Gregg balanced the state‘s budget—indeed, to the point of a surplus by converting federal funds intended to aid the poor into general state revenue.

July 20, 2013

The Medical Debt Market

Til Debt Do Us Part #1
By Melvin J. Howard

Over the next few entries I will be writing about the medical debt industry. I have a unique vantage point in commenting about this issue because of my background in health finance and a unique perspective of living with different healthcare systems. America is one if the only country that have such a market. Today, virtually every single American is one really bad day from financial ruin. Did you know that the vast majority of people that go bankrupt due to medical bills actually have health insurance?  Meanwhile, there are a significant number of people that are becoming fabulously wealthy off of this system.  Our “health care industry” has turned large numbers of individuals and company executives into multi-millionaires. The healthcare industry in the United States has been so corrupt and so greedy for so long that we don't even know what a legitimate medical system even looks like anymore something has got to change. People without insurance must privately finance health care. Less well understood, however, is that medical debt is not only a problem for those without coverage. One in five adults who are privately insured struggles to pay medical bills. Even more scandalous is the fact that Americans are paying more for weaker coverage (“Shorter Lives”). According to the Commonwealth Fund, the cost of insurance has outpaced wage increases for the last ten years. Employers are shifting these costs to employees and their families. Premiums increased 62% from 2003 to 2011. For at least ten million Americans, deductibles are so high that their insurance plans are little more than illusions, providing a false sense of security in hard times. The cost of health care has also risen faster than inflation. As a result, over the last few years, families have had little choice but to accept lower wages to hold on to benefits that, in the case of a serious illness or accident, may not protect them from financial disaster.

Almost every American is affected by medical debt. 

The healthcare industry is designed to benefit a few at the expense of the rest. Debtors and non-debtors alike are forced to pay out-of- pocket for everything from basic care to life-saving operations. The minute you walk into a doctor’s office or a hospital where you get ready to open your wallet to make an upfront payment called a co-pay, before seeing a doctor. The costs can start piling up from there, even if you have insurance. If you have a serious illness or accident, it’s unlikely that your insurance will cover all or even most of the care you need. What insurance doesn't pay, you’re responsible for remember that document you singed in the doctor’s office? Predictably, medical debt discriminates along familiar lines. According the Commonwealth Fund. Among the working-age population, 39% of women have medical bill problems, compared with just 25% of men. More than half of working-age African Americans (52%) report medical bill problems, in contrast with 34% of Hispanics and 28% of whites. 

Although medical debt affects some more than others, it cuts across lines of class, race, and gender. In fact, rates of medical indebtedness are comparable for people with and without insurance (“Consequences”). Insurance companies make a profit by denying claims. Private health insurance is akin to a life raft with holes in it. It simply sinks when you most need it. Americans spent $300 billion on out-of-pocket costs in 2010; a figure over and above the cost of health insurance premiums.Who is paying the price for our profit- based system? It may be obvious that low-income people pay a higher percentage of their income for health care. But the young are also at a high risk for incurring medical debt. This is because those from the ages of 19 to 29 are more likely to lack health insurance than older Americans. Many low-wage employers that hire young adults do not provide coverage, and since the 2008 financial crisis, new college graduates have disproportionately high rates of unemployment and underemployment. Through a toxic combination of college loans, medical debt, and a recession caused by banks, many people’s financial lives are ruined before they are even out of their twenties.

The link between medical debt and bankruptcy also shatters the myth of personal responsibility that makes many of us feel as if we are to blame if we can’t afford basic needs. According to a report in the American Journal of Medicine, most people who declare bankruptcy as a result of medical debt had insurance at the time they incurred the debt. Furthermore, the majority of medical debtors who declared bankruptcy attended college, owned their own home, and had middle-class jobs. They did everything “right,” yet they were still financially devastated when a member of their family got sick or had an accident.

If you have ever needed medical care but didn't have insurance, you most likely went to a public hospital or clinic. There are approximately 1,131 public hospitals in the US. These institutions, which serve 75% more uninsured patients than their private counterparts, are a vital resource for low-income and uninsured patients. Yet, public hospitals are disappearing. Like public schools, they have been swept up in a wave of privatization. The madness extends beyond the walls of the hospital. In 2012, the Minnesota Attorney General began an investigation of Accretive Health, one the largest medical debt collection firms in the country. Documents reveal that debt collectors were allowed into hospitals where they were indistinguishable from regular hospital staff. According to the New York Times, such collectors routinely demand [that patients] pay outstanding bills and may discourage them from seeking emergency care at all.” This is a violation of a federal law requiring hospitals to provide care to anyone who needs it.


June 17, 2013



By Melvin J. Howard

Einstein’s “E=Mc2” everybody has heard of this famous equation there are few others that are just as important but why does E=Mc2 stick out. Because the equation connects intangibility and tangibility by making them equivalent, it joins them as one. Energy, Mass and the speed of light that brings them together. Energy is everywhere and energy makes things happen and every object has mass. In 1905 Einstein did some of his best work what was Einstein’s reason for his quest after a Grand Unification Theory? Would it be fair to conclude that he hoped to better the living conditions of mankind? Did he want to cast light on a new view of Economics? Whether Einstein actually wanted to apply his thinking to Economics is beside the point. We can see in his search the desire to provide a path for such an inquiry. The economy as I observed are the laws of nature at work in the formulas governing the behavior of energy and mass a method for understanding the universe. Let’s see if we can bring energy mass and economics into the same expression of thought.

George Bernard Shaw once penned, “If all economists were laid end to end, they would not reach a conclusion.” Shaw was frustrated because Economics is so difficult to understand. The study of human relations is called sociology. However, even though a study of Economics can involve mathematics, it is not a discipline bound up in numbers. William L. Anderson writes in the February 2002 issue of The Free Market: “Modern Economics fails at the very heart of analysis, that being the attempt to make Economics into a branch of mathematics instead of a systematic way of examining human action.” Economics is about human beings and how they relate to each other. It is about people in social groupings.

At the heart of the study of society is Economics, the study of how we meet the needs of each other. The aim of Economics is to create conditions that allow people to prosper. Today’s physicists have not erected an altar of stone to the God they seek. They have, however, opened themselves with honest vulnerability to that God by seeking the “Grand Unification Theory.” Their microscopic study into Quantum Physics and their macroscopic discoveries involving space-time have driven them to the edge of their ability to discover. On this cliff overlooking a clear understanding of as much of the universe as it is ours to analyze, they have let it be known that they seek the great unifying principle. The Unknown — they declare — must become known. They admit, in the words of Silvan S. Schweber, “.. the difficulty is only that the exact application of these laws [of physics] leads to equations much too complicated to be soluble. Does that speak to human intelligence recognizing it cannot grasp the full implications of the infinite? Yet, if the infinite is infinite, then He is also within the finite. His imprint should be visible to us, if not the extent of His presence and influence.

If science ever recognizes a “Grand Unification Law,” that law must be inter-disciplinary. It must not be limited to cosmology, chemistry, astronomy or mathematics. Further, it cannot be content with ignoring pre-Big-Bang considerations. Why is Quantum theory so important because it touches every part of our lives? From the moment you wake up to the moment you go to bed Quantum is happening. As scientists gained the technology to measure with greater precision, strange phenomena was observed. The birth of quantum physics is attributed to Max Planck's 1900 paper on blackbody radiation. Development of the field was done by Max Planck, Albert Einstein, Niels Bohr, Werner Heisenberg, Erwin Schrodinger, and many others. Ironically, Albert Einstein had serious theoretical issues with quantum mechanics and tried for many years to disprove or modify it. What's Special About Quantum Physics? In the realm of quantum physics, observing something actually influences the physical processes taking place. Light waves act like particles and particles act like waves (called wave particle duality). Matter can go from one spot to another without moving through the intervening space (called quantum tunnelling). Information moves instantly across vast distances. In fact, in quantum mechanics we discover that the entire universe is actually a series of probabilities. One of the most exciting discoveries of quantum physics is the realization that our thoughts affect the world around us. In the quantum realm--far smaller than protons and neutrons--quantum scientists have conducted numerous experiments with the smallest particles known.

In these quantum physics studies, it was discovered that the thoughts and expectations of the experimenter were actually causing the experiment's outcome! For instance, if the experimenter thought the particle would spin a certain way, it would! Scientists witnessed that a person's thoughts were actually causing the reaction of matter--at the quantum physics level.

The implications of this and other quantum physics studies has lead quantum scientists to understand that we have a direct effect on the world around us--our thoughts are affecting the physical world in which we live. In fact, they are discovering that the power of thought literally creates your world. I must admit for years I was lost in the mechanical world not open to thought. Just doing what everybody else was doing or as having the same thoughts as the people before me. Now I know life is about probabilities and possibilities. Probabilities are determined by variables for example if you toss a coin you have a 50% probability that you would get heads or tails. But if you take in to account the force at which you tossed the coin. Let’s not forget wind speed the direction you are standing and so forth would give you more of a chance of predictability. I am saying in essence if you knew all the variables that would affect the outcome you could predict with certainty 100% probability. Not only in economics but in real world life situations so open you mind to the possibilities do not limit yourself to old beliefs. Wealth is a state of mind to be picked up and pulled apart and studied. Thought is very important I am not just talking about surface thoughts. I am talking about deep inner core thoughts about your life and the interactions with it. You should remember just by you being born you have set a ripple effect in the world you have caused it to change in one form or another. Just like in the movie The Matrix when Morpheus is talking to Neo. This is your last chance after this there is no turning back. You take the blue pill, the story ends; you wake up in your bed and believe what you want to believe. You take the red pill you stay in wonderland. And I show you how deep the rabbit hole goes. Neo takes the red pill, discovers that his entire life and the lives of everyone he has ever known have been an illusion. What pill do you want to take I took the red and can never go back.

March 17, 2013



By Melvin J. Howard

This post will serve as background of an announcement I will be making shortly in regarding the subject matter on international trade and our NAFTA case and how one company’s gross misconduct demonstrates a reckless disregard of U.S. constitutional rights and the rule of law. And the continuous violation of American citizen’s protected rights both at home and abroad. Private institutions that are less accountable than governments and whose interests do not align with profitability targets are designed to co-opt the application of power on behalf of the public. What was once the only domain of a sovereign nation now belongs to multi-national corporations? But first let’s go back in time and see how companies got these broad powers and protective rights that were reserved for people in the first place. It was an individual named John Marshall the first Secretary of State who was appointed Chief Justice of the U.S. Supreme Court in1801by then President John Adams little did Adams know what his appointee would unleash. However later in 1819, Marshall participated in a decision that would dramatically alter the balance of power between corporations and the governments that created them. The origins of the case The Trustees of Dartmouth College v. Woodward can be traced back to the founding of what became Dartmouth College in 1754. By 1815, two sides were issuing inflammatory and contentious pamphlets, and the trustees ultimately decided to remove the founder Reverend Eleazor Wheelock and elect a replacement. In response, Wheelock went to the New Hampshire legislature and got them to pass a series of laws revoking Dartmouth's corporate charter and putting the school under public control. The trustees ignored the law and continued operation of the school as before. This triggered passage of yet another act by the legislature, making it illegal to serve as a trustee or officer of the college without an appointment by the legislature. The trustees appealed to the Supreme Court. On March 10, 1818, Congressman Daniel Webster a Dartmouth alumnus and future senator, secretary of state, and presidential candidate, presented arguments on behalf of the college and the original trustees. Webster had gone a step further then anyone thought. He used the idea of property rights to limit a state's influence over a corporation once it had been brought into existence. This would open the door to the gradual accumulation of other rights and prerogatives by corporate "fictional persons" that had only recently been won by real people. As we all know by now, the concept of property rights, which was originally developed to preserve an individual's rights to property, would as a direct result of this decision be used to grant individual rights to entities that were themselves a form of property.

It was ironic, hypocritical and somewhat of a insult of all involved that while these early advances were being made on the road to granting individual rights to "fictional persons," which were in fact forms of property, real people were still being bought and sold as property with fewer protections than corporations. Webster closed his case by arguing that the actions of the New Hampshire legislature in undoing the original charter violated constitutional provisions against taking away property without due process.
When the Court announced its decision, the Chief Justice began by stating that "the American people have said, in the constitution of the United States, that 'no State shall pass any bill of attainder, ex post facto law, or law impairing an obligation of contracts." He asserted that "it can require no argument to prove" that a contract existed in this case. 

The private donations of funds with future authority vested in the trustees made Dartmouth a private corporation whose rights were protected by the Constitution despite the holding of the New Hampshire court. He then defined what a corporation is:

A corporation is an artificial being, invisible, intangible, and existing only in contemplation of law. Being the mere creature of law, it possesses only those properties which the charter of its creation confers upon it among the most important are immortality, and, if the expression may be allowed, individuality; properties, by which a: perpetual succession of many persons are considered as the same, and may act as a single individual. They enable a corporation to manage its own affairs, and to hold property without the perplexing intricacies, the hazardous and end-less necessity, of perpetual conveyances for the purposes of transmitting it from hand to hand. By these means, a perpetual succession of individuals are capable of acting for the promotion of the particular object like one immortal being. But this being does not share in the civil government of the country, unless that be the purpose for which it was created. Its immortality no more confers on it political power, or a political character, than immortality would confer such power or character on a natural person. It is no more a State instrument, than a natural person exercising the same powers would be.

Restoring Civil Rights to human-beings not corporations

While this definition is famous, it contains a big big flaw. It fails to recognize the connection between economic and political power. It fails to note that an entity that is granted immortality has the ability to accumulate more means and thus influence than a mortal human being. Further, it fails to recognize that the decision of which it was a part would later be used to open the door to future Supreme Court decisions that would grant additional "individual" rights to these "artificial beings" that would allow them to use that economic power specifically for political purposes. Furthermore, the corporation in question was an institution of higher learning, not a profit-seeking company. The decision and its subsequent interpretations seem to gloss too quickly over this fact, ignoring the critical role a corporation's mission plays in determining its value to society and consequently how it should be treated under the law. U.S. states were rattled by the Dartmouth decision and tried for a number of years to work around it by either limiting the duration of charters or obligating companies to have a public purpose. But gradually they began to change their laws in ways that ultimately gave even greater latitude to companies. In 1830, Massachusetts passed an act decreeing that corporations did not need a public purpose in order to achieve limited liability status. Seven years later Connecticut created what would be a popular model when it enabled firms in almost all areas of business to incorporate without a special legislative act. This signaled the beginning of a competition among the states to offer ever more business friendly laws. New York was an early leader in this sweepstakes, then New Jersey; ultimately Delaware was viewed as so welcoming that today more than 50 percent of publicly traded corporations are incorporated in that state. This competition for investment, of course, presaged a similar competition that would be created among nation-states for the investment of multinational corporations. While some might assert that states have the upper hand because they can issue and enforce laws, states' power is not absolute if in so doing they damage themselves economically (which in turn damages their leaders politically).

Further, while Dartmouth offered corporations the protections of property and contract laws pertaining to their charters, subsequent Supreme Court cases have enabled companies to obtain additional rights that had previously been thought to be available only to actual flesh-and- blood people. In 1886, in the case of Santa Clara County v. Southern Pacific Railroad, the Court declared without argument that the Fourteenth Amendment of the U.S. Constitution, which guarantees equal protection of the laws (and was originally intended to provide protection for actual human beings denied such protection), applied to corporations. In 1890, it used this principle to start a series of rulings over the next fifty years that were used to strike down economic and often anti-corporate regulations under the Fourteenth Amendment's doctrine of substantive due process. Fifth Amendment due process and Fourth Amendment protections against unreasonable searches were added in 1893 and 1906 respectively. And then, in the 1970s, the pace picked up and some really remarkable bending of the law took place to empower the private sector in ways that would have been unimaginable to those who once saw property rights as a tool by which to empower individuals.

Writing seventy years after the initial passage of the Fourteenth Amendment, the U.S Supreme Court justice Hugo Black lamented the fact that of all the cases to which it was applied, "less than one-half of one percent invoked it in protection of the Negro race, and more than 50 percent asked that its benefits be extended to corporations." Given that the amendment was passed after the Civil War to correct the grotesque ways the law had been used to deprive African Americans of their liberties and fundamental rights, Black's shock was easy to understand. It is quite clear that corporations were never the amendment's intended subject. The language of the amendment speaks of protections for "all persons born or naturalized in the United States." It asserts that no state can deprive such people of "life, liberty or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws," While Justice Marshall had noted that historically the law had viewed corporations as "artificial" beings, in the tradition of English law.

Of the ten amendments that make up the Bill of Rights, corporations have successfully asserted the applicability of five to win protections for themselves. These include the First Amendment right to free speech, the Fourth Amendment freedom from unreasonable searches and seizures; the Fifth Amendment prohibition against takings and double jeopardy (despite the fact that the amendment clearly refers to natural persons); and the Sixth and Seventh Amendment rights to jury trials in criminal and civil matters, respectively. This sort of high-paid alliance on behalf of the interests of business illustrates yet another way in which the scales of justice are balanced somewhat differently when it comes to corporate citizens rather than mere individuals with much more limited means. This result in an uneven application of the laws or more protections for those who can afford to assert them, then the law is once again being used as a tool to advance the interest of the few in ways that reasonable critics may see as antithetical to at least its asserted purpose within "just" societies.

Other cases show similar creativity in the use of constitutional protections to push back against federal power and advance corporate interests. Certainly, the assertion of such a right seems to be at odds with the original concept of the corporation as an entity created exclusively to advance public interests.
The Fifth Amendment protects against double jeopardy by stating that no person shall "be subject for the same offense to be twice put in jeopardy of life or limb." Nonetheless, even though a 1906 ruling asserted that corporations do not enjoy constitutional protections against self-incrimination, a 1962 case and 1977 case both asserted that companies could not be retried in cases that had previously been settled by direct verdicts. As for the Fifth Amendment guarantee that "life, liberty or property" cannot be taken by the state "without due process of law.

The majority of American businesses want nothing to do with crony capitalism and corporate rights. As in Theodore Roosevelt's day, this cause is neither partisan nor divided between racial lines. There is a strong need to contain the government-created and -subsidized transnational corporations that wield such much power over American lives and communities. Clearly, there is no reason to stay on the sidelines while these stateless corporations violate the rights that were clearly meant for human-beings. We frequently hear of the emphasis in constitutional interpretation on the intent of the framers of the Constitution. We ought not to forget, however, how often and how actively Americans have updated the Constitution by using the amendment process as a basic tool of democracy. In the end, it is the American people who are the ultimate interpreters of our Constitution, and it is we who decide how to fulfill the framers' vision of equality, freedom, and justice for all. If original intent is the guideline, we can take comfort in two key facts. The framers intended the Bill of Rights to protect the liberties of human beings, not corporations. And the framers intended that Americans take responsibility for amending the Constitution when necessary to strengthen self-government and protect our liberties.  

The Corporation Reformed  

In this global era, of self-interested companies and cross border transactions, when it is combined with the need to co-opt and bend state laws to their need, in the pursuit of enhancing shareholder value. This leads them to enter into illegal and unethical behavior that goes unquestioned. Corporations are not just accountable only to shareholders. Why should we not expect that those who accept the government created privilege of incorporation balance that privilege with good standards for the livelihood of employees, our economy, and the health of the environment and of the communities in which they do business? And why should we allow multibillion-dollar global corporations to take shelter in the corporate law. At some point should not the size and complexity of a corporation warrant a federal charter rather than a state charter from the most corporate-friendly state that transnationals can find (or can pressure)? Why shouldn't all Americans decide what standards we expect from global corporations that choose to do business in the U.S. Why should the corporate status be perpetual, without some ability of the people to evaluate whether the corporation has complied with the law and served the public interest as intended? In America, we are free, or should be, to answer these questions in the democratic way we can debate and then vote to make whatever answers best serve the country. The rules of corporations come from us if we do not like how the corporate rules are working out, we need to change them. At least two principles should guide corporate law reform to restore balance between large corporations and human beings and our government. First, incorporation is a privilege. Second, transnational corporations should not be able to use the corporate law of a single state, without proper national corporate standards and safeguards.

Incorporation Is a Privilege

Corporate law is a public matter, not a private one. Corporate law defines parameters of corporate conduct and shapes our world, our families, and our communities in profound ways. We cannot afford to leave it to multi-billion dollar transnational corporations to decide what they think corporate duties and responsibilities should be. Corporate and Constitutional law may seem boring, but we need to care about these laws as much as we care about any other laws or issue, from the environment to the economy, from healthy communities to strong families, from energy to foreign policy and war. The consequences these laws, for better or worse have as big an impact on those issues and others than any other laws, and perhaps more. Global companies should not be able to cloak themselves in the American flag when it needs U.S. funds. But drop the flag when it comes to moving earnings back home.