Nonprofit Hospitals Get $60 Billion in Annual Tax Breaks in Order to Aid the Poor, but Often Use High-Pressure Opaque Tactics to Collect Full Payment

(p. A1) Nonprofit hospitals must have financial-assistance policies for needy patients, under federal requirements tied to an estimated $60 billion in annual tax breaks.

They often make that aid hard to get. Hospitals put up obstacles, delay checking eligibility and sometimes press for payments that aren’t refunded even if a patient eventually gets qualified for assistance.

That is according to a Wall Street Journal analysis of thousands of nonprofit hospital policies in filings to the Internal Revenue Service and posted by hospitals, as well as thousands of pages of internal documents from government hospitals obtained through public-record requests and the experiences of dozens of advocates and patients who have (p. A9) applied for aid.

. . .

An earlier Journal analysis of Medicare filings highlighted how little of nonprofit hospitals’ billions in revenue goes toward financial help for low-income patients. The new analysis uncovered the barriers many hospitals place in the way of patients who should qualify for assistance—even under the hospitals’ own criteria.

Under tax laws, nonprofit hospitals are set up to function as charities benefiting their communities. Government facilities, whose policies the Journal also looked at, are also intended to serve the public, though they aren’t subject to all the same IRS requirements as private nonprofits. The Journal found that many of these hospitals act like for-profit businesses in their efforts to get paid, even by those who can’t afford it.

. . .

Separate from the analysis of nonprofit hospitals’ IRS documents, the Journal also obtained internal documents on patient-billing procedures from large state and local government hospitals, including academic medical centers, through public-records requests. These hospitals share a similar mission with private nonprofits to serve communities.

The thousands of pages of procedures, scripts and other training material for hospital staff give an inside look at how some hospitals routinely push patients toward payment, including through installment plans that may come with interest. The guidelines often play down or don’t raise the option of financial assistance. Adding to the pressure, these tactics are often deployed before the patient gets care.

In a document titled “Collections Scripting for Non-Emergent Visits,” used by Georgia-based Augusta University Health System, staffers are supposed to start by requesting the entire amount due from the patient, saying, “How would you like to take care of that today?”

For the full story, see:

Anna Wilde Mathews, Andrea Fuller and Melanie Evans. “Some Hospitals Skimp on Aid.” The Wall Street Journal (Friday, Nov. 18, 2022): A1 & A9.

(Note: ellipses added.)

(Note: the online version of the story has the date November 17, 2022, and has the title “Hospitals Often Don’t Help Needy Patients, Even Those Who Qualify.”)

“Woke” Bankman-Fried’s FTX Played “Dumb Game” of Virtue Signaling

(p. A17) There was a time when people engaged in doing good addressed problems that, so to speak, you could get your arms around, such as improving school performance, providing potable water or preventing malaria. But at some point, the impulse to do good transformed into a combination of moral tendentiousness and grandiosity.

. . .

. . ., inside the Bankman-Fried fairy tale rests a smaller tipping point, which suggests his generation senses that their preachy elders may have led them down a moral garden path.

In an exchange with Mr. Bankman-Fried, a writer for Vox asserts, “You were really good at talking about ethics.” He replied that “I had to be” because of “this dumb game we woke westerners play where we say all the right shibboleths and so everyone likes us.”

He is describing what has come to be known in our time as virtue signaling, . . .

For the full commentary, see:

Daniel Henninger. “WONDER LAND; The Moral Vanity of FTX.” The Wall Street Journal (Thursday, December 1, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 30, 2022, and has the title “WONDER LAND; The Moral Vanity of Sam Bankman-Fried.”)

Due to Xi’s Communists, China’s “Depressed” Tech Entrepreneurs Spend “Their Time Hiking, Golfing and Drinking”

(p. B1) For decades, China’s business class had an unspoken contract with the Communist Party: Let us make money and we’ll turn a blind eye to how you use your power.

Like most Chinese people, they bought into the party’s argument that its one-party rule provides more efficient governance.

Now, the tacit agreement that entrepreneurs had come to count on is dissolving in front of their eyes.

. . .

(p. B5) “Under the leadership of this dictator, our great country is falling into an abyss,” said a hardware tech executive in Shenzhen. “But you can’t do anything about it. It pains and depresses me.”

Despite many conversations over the years, we never talked about politics. I was surprised when he called after the party congress to talk about his “political depression.” He said he used to be very nationalistic, believing that the Chinese were among the smartest and hardest-working people in the world. Now, he and many of his friends spend most of their time hiking, golfing and drinking. “We’re too depressed to work,” he said.

Until a year ago, his start-up was doing so well that he was planning to take it public. Then he lost a big chunk of his revenues, and his new hires sat idly with nothing to do when cities were locked down under the “zero-Covid” rules. He said now he had no choice but to lay off more than 100 people, sell his business and move his family to North America.

“Since the dark night has descended,” he said, “I’ll deal with it the dark night way.”

The tech entrepreneur from Beijing who texted me after the party congress recounted a chilling experience. In May, when there were rumors that Beijing could be locked down, he felt he could not tell his employees to leave work early and stock up on groceries. He was worried that he could be reported for spreading rumors — something that had gotten people detained by the police. He told them only that they should feel free to leave early if they had things to take care of.

This successful businessman is now applying to emigrate to a European country and the United States.

Just like many ordinary Chinese people, the executives I spoke to said they were horrified by the video of Hu Jintao, Mr. Xi’s predecessor as China’s top leader, being abruptly led out of the closing ceremony of the party congress. They did not accept the official government explanation that Mr. Hu had to leave early because of health issues.

If Mr. Xi could remove his predecessor like that, several of them said, he could do anything to anyone.

A well-connected investor in Beijing said his friends who were entrepreneurs now realized they could no longer remain indifferent to politics. At social gatherings, they have started discussing which countries to seek passports from, and how to move their assets offshore. At social gatherings, hosts are asking friends to surrender their phones to be kept in a separate place for fear of surveillance.

For the full commentary, see:

Li Yuan. “Xi Is Scaring Away China’s Business Elite.” The New York Times (Tuesday, November 8, 2022): B1 & B5.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date November 7, 2022, and has the title “China’s Business Elite See the Country That Let Them Thrive Slipping Away.”)

U.S. Elites Win Short-Term Profits from Pleasing the Chinese Communist Party

(p. C9) “Red-Handed: How American Elites Get Rich Helping China Win,” by Peter Schweizer, is an eye-opening book that highlights a legacy of entanglement that senior U.S. government officials have had with the Chinese Communist Party, or CCP, over the last couple of decades.  . . .  . . .–the entanglement between our officials and those of China’s ruling party has led to the trading of our collective security for the short-term high of profit.

For the full review, see:

Mike Garcia. “12 Months of Reading; Mike Garcia.” The Wall Street Journal (Saturday, Dec. 10, 2021): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date December 8, 2022, and has the title “Who Read What in 2022: Political and Business Leaders.”)

The book praised by Mike Garcia is:

Schweizer, Peter. Red-Handed: How American Elites Get Rich Helping China Win. New York: Harper, 2022.

Corrupt and Bankrupt FTX Got Higher ESG Rating for “Leadership and Governance” Than Exxon Mobil

(p. A14) Crypto dark knight Sam Bankman-Fried may have deceived investors, customers and various journalists and politicians. But now the FTX founder is at least telling the truth about a few things. Lo, he says that environmental, social and governance (ESG) investing is a fraud, and so was his progressive public posturing.

. . .

“Problems were brewing. Larger than I realized,” he tweeted. “In the future, I’m going to care less about the dumb, contentless, ‘good actor’ framework,” he added. “What matters is what you do—is *actually* doing good or bad, not just *talking* about doing good or *using ESG language*.”

Mr. Bankman-Fried is also acknowledging that he genuflected to regulators and Democratic lawmakers to win political protection. ESG ratings company Truvalue Labs even gave FTX a higher score on “leadership and governance” than Exxon Mobil, though the crypto exchange had only three directors on its board.

For the full editorial, see:

The Editorial Board. “Sam Bankman-Fried, ESG Truth-Teller.” The Wall Street Journal (Friday, Nov. 18, 2022): A14.

(Note: ellipsis added.)

(Note: the online version of the editorial has the date November 17, 2022, and has the title “Sam Bankman-Fried Becomes an ESG Truth-Teller.”)

An Economist with “Enough Steel” to Cut “the Tentacles of Restrictive Government Regulation”

(p. A9) When Elizabeth Bailey was appointed in 1977 as the first woman to serve on the Civil Aeronautics Board, or CAB, she saw her job as freeing the airline industry “from the tentacles of restrictive government regulation.”

During a confirmation hearing, Sen. Ted Stevens of Alaska asked Dr. Bailey, a Republican with a Ph.D. in economics, whether she had “enough steel” for the task.

“I hope so,” she said. “I’m tougher than I look.”

The Airline Deregulation Act of 1978, approved by Congress with strong bipartisan support, led to abolition of the CAB at the end of 1984 and freed airlines to set fares without government permission. During her six years on the board, Dr. Bailey proved one of the most ardent advocates for swift deregulation, a process that reduced fares, increased choice and doomed inefficient airlines.

. . .

One summer, she accepted an offer to join a group studying regulatory issues at Bell Labs. She gave a presentation on regulatory distortions to a panel of economic advisers to AT&T, including William Baumol and Alfred Kahn.

Dr. Baumol helped her gain admission to Princeton as a doctoral candidate in economics. She delved into business-competition issues and received her Ph.D. in 1972.

Those studies prepared her to oversee economic research at Bell Labs and advise AT&T on its impending breakup by regulatory authorities. “We said, ‘Look, if the government is going to bust you up, there are some ways that are going to be a lot less costly and a lot more efficient than others,’ ” she recalled.

Dr. Kahn, later chairman of the CAB, became her mentor and ally at the agency, where she rose to vice chairman.

For the full obituary, see:

James R. Hagerty. “Economist Helped Free Airlines From Red Tape.” The Wall Street Journal (Saturday, Sept. 3, 2022): A9.

(Note: ellipsis added.)

(Note: the online version of the obituary has the date September 1, 2022, and has the title “Elizabeth Bailey Helped Free Airlines to Cut Fares.”)

Initially Socialist Israeli Kibbutzim Gradually Embraced Entrepreneurial Capitalism

(p. C4) Today, in a break with . . . [its] communal past, Ms. Barnea’s kibbutz is farming for profit, and its main cash crop is medical marijuana. She recently retired from managing the greenhouse that grows the drug.

The shift at Kibbutz Beit HaEmek is just the latest sign of how much Israel’s kibbutzim are changing, as both Israel and the kibbutz movement move away from their socialist roots to become more entrepreneurial and profit-driven.

“We have to survive,” said Ms. Barnea, now 64, walking around the greenhouse as the smell of marijuana wafted past.

. . .

Facing a bleak financial future, young people abandoned the kibbutzim in the 1990s. Meanwhile, Israel’s vibrant technology sector took off, providing an additional pull away from the communes.

To reverse the exodus, Israel’s kibbutzim dismantled much of their socialist model. In 1995, Kibbutz Merom HaGolan became the first to go through a so-called privatization process, paying members salaries on a scale.

Today, most kibbutzim have undergone some form of privatization. Many members now earn salaries outside the kibbutz but pay taxes for the community’s upkeep. New members can take out mortgages with banks and buy land on the kibbutz for their homes.

. . .

Only about 40 kibbutzim still share resources and give equal allowances as envisioned in the original model. Most of these communities had created successful businesses that helped them maintain the communal way of living.

One such community is Kibbutz Sdot Yam, on Israel’s central coast between Tel Aviv and Haifa. In the 1980s, the kibbutz opened a factory that constructed quartz surfaces for tables and floors. Despite that venture’s success, the kibbutz is now considering whether to allow members—most of whom work outside the community—to earn their own salaries, rather than sharing them with the commune, said Doron Stansill, a 47-year-old member.

For the full essay, see:

Rory Jones. “The Kibbutz in a Capitalist Israel.” The Wall Street Journal (Saturday, Oct. 14, 2017 ): C4.

(Note: ellipses added.)

(Note: the online version of the essay has the date Oct. 13, 2017 , and has the title “The Kibbutz Movement Adapts to a Capitalist Israel.”)

Forest Service Banned Private Logging to Thin Forests; Then Started an Uncontrolled “Controlled” Fire to Thin Same Forests

(p. A11) SEATTLE — In a high-altitude landscape parched by drought, U.S. Forest Service crews took advantage of some stable weather in eastern Oregon this month and prepared to burn off some thick underbrush and shrubbery at the edge of the Blue Mountains, part of an expanding strategy to remove forest fuel that can turn fires into conflagrations.

The target was a 300-acre tract of woodlands in the Malheur National Forest, adjacent to a private cattle ranch. But the controlled fire that the crew set on the afternoon of Oct. 19 [2022] jumped a containment line and charred through a portion of the nearby ranch. Two sisters from the family-owned Windy Point Cattle Company made their way through the smoke-filled landscape for a furious confrontation with the Forest Service’s “burn boss,” Ricky Snodgrass, and then dialed 911.

What happened next, federal officials say, was highly unusual in the modern history of the Forest Service and its programs for managing federal lands across the country. The Grant County sheriff arrived on scene, placed Mr. Snodgrass in handcuffs and sent him to jail.

. . .

With climate change driving an increase in the size, frequency and ferocity of wildfires, the Forest Service adopted a plan this year to step up those prescribed burns, and also more aggressively thin forest stands with strategic logging programs.

. . .

The Forest Service’s operations in this part of Oregon have long been the subject of contention in Grant County, where the U.S. government manages some 60 percent of the land.

Locals have long stewed over federal land management policies, including logging restrictions that have contributed to declines in timber production and the shuttering of the region’s sawmills.

For the full story, see:

Mike Baker. “A Strategy to Protect Forests Reopens Old Wounds in Oregon.” The New York Times (Saturday, October 29, 2022): A11.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the story has the date Oct. 28, 2022, and has the title “Prescribed Burns Are Encouraged. Why Was a Federal Employee Arrested for One?”)

Senate Cedes Sovereignty on Air Conditioning HFC Regulation

(p. A17) WASHINGTON — The Senate voted on Wednesday to approve an international climate treaty for the first time in 30 years, agreeing in a rare bipartisan deal to phase out of the use of planet-warming industrial chemicals commonly found in refrigerators and air-conditioners.

. . .

Many American manufacturers had a business incentive to support the amendment. Under the pact, nations that do not ratify the amendment will have restricted access to expanding international markets starting in 2033.

Some Republicans from states with many chemical manufacturers supported the Kigali deal.

. . .

Americans for Prosperity, a political action committee founded by the billionaire Koch brothers, sent a letter to lawmakers last week saying that ratifying the Kigali Amendment would be an “abdication of U.S. sovereignty over environmental regulation” to the United Nations. The group also argued it would raise the price of air-conditioning, refrigeration and industrial cooling for American consumers.

For the full story, see:

Lisa Friedman and Coral Davenport. “Senate Ratifies Global Pact to Curb HFCs, Used in Cooling.” The New York Times (Thursday, September 22, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the story has the date Sept. 21, 2022, and has the title “Senate Ratifies Pact to Curb a Broad Category of Potent Greenhouse Gases.” Where there is a minor difference between the online and print versions, the passages quoted above follow the online version.)

California $113 Billion Bullet Train “Is a Case Study” in How Boondoggle Infrastructure Grows “Too Big to Fail”

(p. A1) LOS ANGELES — Building the nation’s first bullet train, which would connect Los Angeles and San Francisco, was always going to be a formidable technical challenge, pushing through the steep mountains and treacherous seismic faults of Southern California with a series of long tunnels and towering viaducts.

But the design for the nation’s most ambitious infrastructure project was never based on the easiest or most direct route. Instead, the train’s path out of Los Angeles was diverted across a second mountain range to the rapidly growing suburbs of the Mojave Desert — a route whose most salient advantage appeared to be that it ran through the district of a powerful Los Angeles county supervisor.

The dogleg through the desert was only one of several times over the years when the project fell victim to political forces that have added billions of dollars in costs and called into question whether the project can ever be finished.

Now, as the nation embarks on a historic, $1 trillion infrastructure building spree, the tortured effort to build the country’s first high-speed rail system is a case study in how ambitious public works projects can become perilously encumbered by political compromise, unrealistic cost estimates, flawed engineering and a determination to persist on projects that have become, like the crippled financial institutions of 2008, too big to fail.

. . .

Political compromises, the records show, produced difficult and costly routes through the state’s farm belt. They routed the train across a geologically complex mountain pass in the Bay Area. And they dictated that construction would begin in the center of the state, in the agricultural heartland, not at either of the urban ends where tens of millions of potential riders live.

The pros and cons of these routing choices have been debated for years. Only now, though, is it be-(p. A15)coming apparent how costly the political choices have been. Collectively, they turned a project that might have been built more quickly and cheaply into a behemoth so expensive that, without a major new source of funding, there is little chance it can ever reach its original goal of connecting California’s two biggest metropolitan areas in two hours and 40 minutes.

When California voters first approved a bond issue for the project in 2008, the rail line was to be completed by 2020, and its cost seemed astronomical at the time — $33 billion — but it was still considered worthwhile as an alternative to the state’s endless web of freeways and the carbon emissions generated in one of the nation’s busiest air corridors.

Fourteen years later, construction is now underway on part of a 171-mile “starter” line connecting a few cities in the middle of California, which has been promised for 2030. But few expect it to make that goal.

Meanwhile, costs have continued to escalate. When the California High-Speed Rail Authority issued its new 2022 draft business plan in February, it estimated an ultimate cost as high as $105 billion. Less than three months later, the “final plan” raised the estimate to $113 billion.

The rail authority said it has accelerated the pace of construction on the starter system, but at the current spending rate of $1.8 million a day, according to projections widely used by engineers and project managers, the train could not be completed in this century.

For the full story, see:

Ralph Vartabedian. “Costs Soaring As Bullet Train Goes Nowhere.” The New York Times (Monday, October 10, 2022): A1 & A15.

(Note: ellipsis added.)

(Note: the online version of the story has the date Oct. 9, 2022, and has the title “How California’s Bullet Train Went Off the Rails.”)

Non-Partisan Congressional Budget Office Estimates Cost of Biden Student Loan Forgiveness at $400 Billion

(p. A1) WASHINGTON — President Biden’s plan to erase significant amounts of student loan debt for tens of millions of Americans could cost about $400 billion, the nonpartisan Congressional Budget Office said in a report Monday [Sept. 26, 2022], making it one of the costliest programs in the president’s agenda.

The C.B.O. said the price tag might rise even higher because of Mr. Biden’s decision to extend a pause on federal student loan repayments through the end of the year, which could end up costing some $20 billion. The report gauged the cost over a period of 30 years, though the bulk of the effects to the economy would be felt over the next decade.

. . .

. . . , critics have accused the Biden administration of hiding the plan’s true cost.

Marc Goldwein, the senior vice president for the Committee for a Responsible Federal Budget, said that the C.B.O. score did not take into account a significant part of (p. A13) the administration’s loan relief program: a plan to reduce payments for future borrowers who go on to earn low incomes after college, which outside analysts say could host hundreds of billions of dollars more.

“You’re basically buying a very expensive lottery ticket,” Mr. Goldwein said. “When you’re taking out the loan, you’re going to have no idea of how much you’re going to be paying back.”
Monday’s report, issued by a nonpolitical budget scorekeeper, is one of several attempts to estimate the total cost of the program, which Mr. Biden enacted using executive action rather than legislation.

For the full story, see:

Katie Rogers and Jim Tankersley. “Cost of Erasing Students’ Debt Will Be Steep.” The New York Times (Tuesday, September 27, 2022): A1 & A13.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date Sept. 26, 2022, and has the title ‘White House Student Loan Forgiveness Could Cost About $400 Billion.”)