Vivek Ramaswamy

Growing fury over the power big business has over ordinary Americans’ lives

by

Heather Cox Richardson | Letters from an American

Heather Cox Richardson

Dec 5, 2024

Yesterday a gunman assassinated the chief executive officer of UnitedHealthcare, Brian Thompson, as he arrived at a meeting of investors in New York City. While authorities are still investigating, officials have released the information that the casings of the bullets that killed Thompson bore the words “deny,” “defend,” “depose,” all words associated with companies’ denial of health insurance, taken from the longer phrases “deny the claim,” “defend the lawsuit,” “depose the patient.”

While those clues could simply be a red herring, posters on social media have cheered what they seem to see as revenge against an abusive system in which people’s lives are at the mercy of executives who prioritize profits.

Health insurance companies have long been under scrutiny for their practices. For the past two years, ProPublica has run a long series exploring the different ways in which companies have developed systems to deny healthcare coverage to their policyholders.

UnitedHealthcare has been no exception either to such practices or to scrutiny. Its parent group UnitedHealth has a market valuation of $560 billion and was the eighth largest corporation in the world last year as measured by revenue. This year, UnitedHealthcare—Thompson’s unit—is expected to bring in $280 billion in revenue.

UnitedHealth is embroiled in a number of lawsuits. Andrew Stanton of Newsweek reported that on November 14, 2023, families of two now-deceased patients sued UnitedHealthcare over denial of coverage for Medicare Advantage patients for nursing home stays prescribed by their doctors. Medicare Advantage is the private insurance alternative to Medicare that receives a flat fee from the Centers for Medicare and Medicaid Services. It’s an enormously profitable industry, and UnitedHealth controls almost a third of it.

The lawsuit alleges that UnitedHealthcare uses artificial intelligence to deny claims from Medicare Advantage policyholders. The lawsuit claims that the company knowingly uses an algorithm that makes errors 90% of the time because it also knows that only about 0.2% of policy holders will appeal the decision to deny their claims. Last month the Senate Permanent Subcommittee on Investigations hammered UnitedHealth for dramatic increases in their denial rates for post-acute care between 2019 and 2022 as it switched to AI authorizations.

On the same day as the shooting, Anthem Blue Cross Blue Shield insurance covering Connecticut, New York, and Missouri announced it would cover anesthesia during surgery or procedures only for a specific time period in order to make insurance more affordable by reducing overbilling.

After an outcry both from anesthesiologists and the public, the company today retracted its policy change, saying it had never intended to avoid “medically necessary anesthesia,” but meant simply to “clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.” Their explanation might have calmed the news cycle, but its suggestion that the insurance officials rather than doctors should determine what anesthesia is appropriate for a patient during surgery echoed the argument in the UnitedHealthcare lawsuit.

Thompson’s murder seems to be a cultural moment in which popular fury over the power big business has over ordinary Americans’ lives exploded. Maureen Tkacik of The American Prospect noted, “Only about 50 million customers of America’s reigning medical monopoly might have a motive to exact revenge upon the UnitedHealthcare CEO.” The shooter, whose actual motive remains unknown, is fast becoming a folk hero.

Social media has exploded with users writing things like “[t]his claim for sympathy has been denied”; songs featuring the words “deny, “defend,” and “depose”; and recorded commentary condemning the healthcare insurance industry. UnitedHealth Group posted its sadness about Thompson’s death on Facebook yesterday about 1:00 p.m.; 36 hours later the post had 65,000 laughing emojis under it.

Security expert Charlie Carroll expressed surprise to Josh Fiallo of the Daily Beast that Thompson did not have a security detail. “We’re living in a world where people are extremely disgruntled,” Carroll said. “When people lose trust in the system, you start seeing more kidnappings and assassinations because they feel like they have to take matters into their own hands.”

In the wake of the shooting, UnitedHealthcare and several other insurance companies took down from their websites the names and photographs of their officials.

Billionaires Elon Musk and Vivek Ramaswamy were on Capitol Hill today where they met with lawmakers to explain their vision for the Department of Government Efficiency, the group designed to cut the U.S. budget. Neither they nor the lawmakers shared much with the press, although Fox Business played a video of Representative Ralph Norman (R-SC) saying that “nothing is sacrosanct,” and “they’re going to put everything on the table,” including Social Security, Medicare, and Medicaid.

Representative Tom Tiffany (R-WI) told Just The News that cuts to the budget “don’t have to be just the discretionary spending. We can get at some of the mandatory spending also…food stamps, some of those things.” He continued: “There may be more bang for the buck in terms of growing our economy…making regulatory changes, get the impediments out of the way, let those job creators and entrepreneurs really be able to go to work.”

In view of today’s news about healthcare, it’s probably worth remembering that Musk has called for the elimination of the Consumer Financial Protection Bureau, and that Project 2025 has called for making Medicare Advantage—the privatized Medicare in which UnitedHealth specializes—the default enrollment option for Medicare. This would essentially privatize Medicare for the 66 million people who use it, but since Medicare Advantage costs taxpayers about 6% more than Medicare, this would not create the savings Musk is supposed to be finding.

Andrew Perez of Rolling Stone reported today that election financial disclosures filed yesterday revealed that Elon Musk was the secret funder of the “RBG PAC,” a Super PAC created just before the election that claimed Trump had the same position on abortion as the late Supreme Court justice Ruth Bader Ginsberg. Although Trump has bragged about overturning the 1973 Roe v. Wade decision recognizing the constitutional right to abortion and the 2024 Republican platform supported the far-right idea of “fetal personhood”—which would apply all the rights protected by the Fourteenth Amendment from the moment a human egg is fertilized—the RBG PAC ran ads promising that Trump would not support a national abortion ban.

Ginsburg’s granddaughter called the comparison of Trump and her grandmother “nothing short of appalling.”

The super PAC was created so late that it avoided disclosure before November 5. It was funded by Musk with an injection of $20.5 million.

Bridget Bowman, Ben Kamisar, and Scott Bland of NBC News reported tonight that Musk spent at least $250 million to get Trump elected. In addition to the $20.5 million to the RBG PAC, he put $238 million into the America PAC. Musk also supported Trump through free advertising and commentary on his social media platform X.

Today provided a snapshot of American society that echoed a similar moment on January 6, 1872, when Edward D. Stokes shot railroad baron James Fisk Jr. as he descended the staircase of New York’s Grand Central Hotel. The quarrel was over Fisk’s mistress, Josie, who had taken up with the handsome Stokes, but the murder instantly provoked a popular condemnation of the ties between big business and government.

Fisk was a rich, flamboyant, and unscrupulous man-about-town, who was deeply entwined both with railroad barons like Jay Gould, Daniel Drew, and Cornelius Vanderbilt and with New York’s Tammany Hall political machine and its infamous leader, William Marcy Tweed. Tweed made sure the laws benefited the railroads and, the papers noted, snuck into the hotel to say goodbye to his friend in the hours it took for him to perish.

After the Civil War, most Americans applauded the nation’s businessmen for the support their growing industries had provided to the Union, but by 1872 the enormous fortunes the railroad men had amassed had tarnished their reputation. At the same time, big operators were starting to squeeze smaller enterprises out of business in order to control the markets, and popular anger simmered over their increasing control of the economy.

Stokes’s shooting was the event that sparked a popular rebellion. Newspapers covered every minute of the event and Fisk’s demise, while sensational books about the murder rolled off the presses.

Together, they redefined late nineteenth-century industrialists, with one painting Fisk as a representative businessman who with just “an hour’s effort,” could “gather into his clutches a score of millions of other people’s property, impoverish a thousand wealthy men, or derange the values and the traffic of a vast empire.”

Both those covering the murder and those reading about it rejoiced in Fisk’s misfortune.

Very few undocumented immigrants and very little illegal fentanyl come into the U.S. from Canada

by

Heather Cox Richardson | Letters from an American

Heather Cox Richardson

Nov 26, 2024

Today presented a good example of the difference between governance by social media and governance by policy.

Although incoming presidents traditionally stay out of the way of the administration currently in office, last night, Trump announced on his social media site that he intends to impose a 25% tariff on all products coming into the U.S. from Mexico and Canada “until such time as Drugs, in particular Fentanyl, and all Illegal Aliens stop this Invasion of our Country!” Trump claimed that they could solve the problem “easily” and that until they do, “it is time for them to pay a very big price!”

In a separate post, he held China to account for fentanyl and said he would impose a 10% tariff on all Chinese products on top of the tariffs already levied on those goods. “Thank you for your attention to this matter,” he added.

In fact, since 2023 there has been a drop of 14.5% in deaths from drug overdose, the first such decrease since the epidemic began, and border patrol apprehensions of people crossing the southern border illegally have fallen to the lowest number since August 2020, in the midst of the pandemic. In any case, a study by the libertarian Cato Institute shows that from 2019 to 2024, more than 80% of the people caught with fentanyl at ports of entry—where the vast majority of fentanyl is seized—were U.S. citizens.

Very few undocumented immigrants and very little illegal fentanyl come into the U.S. from Canada.

Washington Post economics reporter Catherine Rampell noted that Mexico and Canada are the biggest trading partners of the United States. Mexico sends cars, machinery, electrical equipment, and beer to the U.S., along with about $19 billion worth of fruits and vegetables. About half of U.S. fresh fruit imports come from Mexico, including about two thirds of our fresh tomatoes and about 90% of our avocados.

Transferring that production to the U.S. would be difficult, especially since about half of the 2 million agricultural workers in the U.S. are undocumented and Trump has vowed to deport them all. Rampell points out as well that Project 2025 calls for getting rid of the visa system that gives legal status to agricultural workers. U.S. farm industry groups have asked Trump to spare the agricultural sector, which contributed about $1.5 trillion to the U.S. gross domestic product in 2023, from his mass deportations.

Canada exports a wide range of products to the U.S., including significant amounts of oil. Rampell quotes GasBuddy’s head of petroleum analysis, Patrick De Haan, as saying that a 25% tax on Canadian crude oil would increase gas prices in the Midwest and the Rockies by 25 cents to 75 cents a gallon, costing U.S. consumers about $6 billion to $10 billion more per year.

Canada is also the source of about a quarter of the lumber builders use in the U.S., as well as other home building materials. Tariffs would raise prices there, too, while construction is another industry that will be crushed by Trump’s threatened deportations. According to NPR’s Julian Aguilar, in 2022, nearly 60% of the more than half a million construction workers in Texas were undocumented.

Construction company officials are begging Trump to leave their workers alone. Deporting them “would devastate our industry, we wouldn’t finish our highways, we wouldn’t finish our schools,” the chief executive officer of a major Houston-based construction company told Aguilar. “Housing would disappear. I think they’d lose half their labor.”

Former trade negotiator under George W. Bush John Veroneau said Trump’s plans would violate U.S. trade agreements, including the United States–Mexico–Canada Agreement (USMCA) that replaced the 1994 North American Free Trade Agreement that Trump killed. The USMCA was negotiated during Trump’s own first term, and although it was based on NAFTA, he praised it as “the fairest, most balanced, and beneficial trade agreement we have ever signed into law. It’s the best agreement we’ve ever made.”

Trump apologists immediately began to assure investors that he really didn’t mean it. Hedge fund manager Bill Ackman posted that Trump wouldn’t impose the tariffs if “Mexico and Canada stop the flow of illegal immigrants and fentanyl into the U.S.” Trump’s threat simply meant that Trump “is going to use tariffs as a weapon to achieve economic and political outcomes which are in the best interest of America,” Ackman wrote.

Iowa Republican lawmaker Senator Chuck Grassley, who represents a farm state that was badly burned by Trump’s tariffs in his first term, told reporters that he sees the tariff threats as a “negotiating tool.”

Foreign leaders had no choice but to respond. Mexican president Claudia Sheinbaum issued an open letter to Trump pointing out that Mexico has developed a comprehensive immigration system that has reduced border encounters by 75% since December 2023, and that the U.S. CBP One program has ended the “caravans” he talks about. She noted that it is imperative for the U.S. and Mexico jointly to “arrive at another model of labor mobility that is necessary for your country and to address the causes that lead families to leave their places of origin out of necessity.”

She noted that the fentanyl problem in the U.S. is a public health problem and that Mexican authorities have this year “seized tons of different types of drugs, 10,340 weapons, and arrested 15,640 people for violence related to drug trafficking,” and added that “70% of the illegal weapons seized from criminals in Mexico come from your country.” She also suggested that Mexico would retaliate with tariffs of its own if the U.S. imposed tariffs on Mexico.

Canadian prime minister Justin Trudeau did not go that far but talked to Trump shortly after the social media post. The U.S. is Canada’s biggest trading partner, and a 25% tariff would devastate its economy. The premier of Alberta, Danielle Smith, seemed to try to keep her province’s oil out of the line of fire by agreeing with Trump that the Canadian government should work with him and adding, “The vast majority of Alberta’s energy exports to the US are delivered through secure and safe pipelines which do not in any way contribute to these illegal activities at the border.”

Trudeau has called an emergency meeting with Canada’s provincial premiers tomorrow to discuss the threat.

Spokesperson for the Chinese embassy in Washington Liu Pengyu simply said: “No one will win a trade war or a tariff war” and “the idea of China knowingly allowing fentanyl precursors to flow into the United States runs completely counter to facts and reality.”

In contrast to Trump’s sudden social media posts that threaten global trade and caused a frenzy today, President Joe Biden this evening announced that, after months of negotiations, Israel and Lebanon have agreed to a ceasefire brokered by the U.S. and France, to take effect at 4:00 a.m. local time on Wednesday. “This is designed to be a permanent cessation of hostilities,” Biden said.

Lebanon’s Iran-backed Hezbollah attacked Israel shortly after Hamas’s attack of October 7, 2023. Fighting on the border between Israel and Lebanon has turned 300,000 Lebanese people and 70,000 Israelis into refugees, with Israel bombing southern Lebanon to destroy Hezbollah’s tunnel system and killing its leaders. According to the Lebanese Ministry of Public Health, Israeli attacks have killed more than 3,000 people and injured more than 13,000, while CBS News reports that about 90 Israeli soldiers and nearly 50 Israeli civilians have been killed in the fighting. Under the agreement, Israel’s forces currently occupying southern Lebanon will withdraw over the next 60 days as Lebanon’s army moves in. Hezbollah will be kept from rebuilding.

According to Laura Rozen in her newsletter Diplomatic, before the agreement went into effect, Israel increased its airstrikes in Beirut and Tyre.

When he announced the deal, Biden pushed again for a ceasefire in Gaza, whose people, he said, “have been through hell. Their…world is absolutely shattered.” Biden called again for Hamas to release the more than 100 hostages it still holds and to negotiate a ceasefire. Biden said the U.S. will “make another push with Turkey, Egypt, Qatar, Israel, and others to achieve a ceasefire in Gaza with the hostages released and the end to the war without Hamas in power.”

Today’s announcement, Biden said, brings closer the realization of his vision for a peaceful Middle East where both Israel and a Palestinian state are established and recognized, a plan he tried to push before October 7 by linking Saudi Arabia’s normalization of relations with Israel to a Palestinian state. Biden has argued that such a deal is key to Israel’s long-term security, and today he pressed Israel to “be bold in turning tactical gains against Iran and its proxies into a coherent strategy that secures Israel’s long-term…safety and advances a broader peace and prosperity in the region.”

“I believe this agenda remains possible,” Biden said. “And in my remaining time in office, I will work tirelessly to advance this vision of—for an integrated, secure, and prosperous region, all of which…strengthens America’s national security.”

“Today’s announcement is a critical step in advancing that vision,” Biden said. “It reminds us that peace is possible.”

Trump launching “a hostile takeover” of the American government with Project 2025

by

Heather Cox Richardson | Letters from an American

Heather Cox Richardson

Nov 20, 2024

Remember how American voters so hated Project 2025, the playbook for a second Trump term written by the Heritage Foundation and other right-wing institutions, that Trump said he had nothing to do with it, and then one of its key architects, Russell Vought, told undercover filmmakers that Trump was only running away from the project as political cover? 

It appears Vought was right and the story that Trump had nothing to do with Project 2025 was, indeed, just political cover. Ed O’Keefe and Major Garrett of CBS News reported today that two sources close to the Trump transition team have told them that they expect Trump to name Vought to lead the Office of Management and Budget (OMB). 

Vought wrote the section of Project 2025 that covers the presidency, calling for “aggressive use of the vast powers of the executive branch” to “bend or break the bureaucracy to the presidential will” and identifying the OMB as the means of enforcing the president’s agenda. Vought was Trump’s OMB director during the end of his first term and tried to remove the civil service protections that have been in place since 1883 to protect federal workers from being fired for political reasons. That plan, known as Schedule F, would have affected about 88% of the federal workforce. 

One of the first things Biden did when he took office was to rescind Trump’s executive order making that shift.

Like that earlier attempt, Project 2025 leans heavily on the idea that “personnel is policy,” and that idea illuminates the choices the Trump team is making. Trump has refused to sign the official documents required by the 2022 Presidential Transition Act. Those documents mandate ethics commitments and require the incoming president to disclose private donations. They also limit those donations. Without the paperwork, Trump appointees cannot start the process of getting security clearances through the Federal Bureau of Investigation; the team says it is planning to do its own vetting of its candidates instead.  

Claiming they have a mandate, Trump’s people have said they are launching “a hostile takeover” of the American government “on behalf of the American people.” But as voting numbers continue to come in, Trump’s majority has fallen below 50% of voters, meaning that more voters chose someone else than chose Trump on November 5. These results are far from being in “mandate” territory.

The U.S. Constitution charges Congress with writing the laws under which the American people live, and the president with taking “care that the laws be faithfully executed.” Since 1933, Congress has created an extensive system of agencies that regulate business and provide a basic social safety net. Congress will say, for example, that the U.S. needs an agency to protect the environment (like the Environmental Protection Agency, established under Republican president Richard M. Nixon), appropriate money for it, oversee its leadership, and then trust those leaders to hire the personnel necessary to carry out its mission. 

Regulations and social welfare programs and the agencies that provide them are broadly popular—think how hard it has been for members to get rid of Social Security, for example—so Congress trims at the edges rather than abolishing them. As the U.S. budget has grown, they often bear the brunt of accusations that the government spends too much, although what has really caused the budget to operate deeply in the red is the tax cuts for the wealthy put into place by Presidents George W. Bush and Donald Trump.  

Right-wing leaders who want to continue cutting regulations and taxes are newly empowered by Trump’s victory in the 2024 election, and they are turning to a quirk of the government to enable them to work around Congress. 

Since the first administration of President George Washington, agencies created by Congress have lived in the Executive Branch. If, as Vought and others argue, the president is the absolute authority in that branch, Trump can do whatever he wants with those agencies and the civil servants—the bureaucrats—who run them.  

In an op-ed in the Wall Street Journal today, billionaires Elon Musk and Vivek Ramaswamy laid out their plans for cutting the U.S. government. Neither of them has ever held elected office, but they see that as an advantage, not a downside: “We are entrepreneurs, not politicians,” they write. “We will serve as outside volunteers, not federal officials or employees.” Trump has named them to the “Department of Government Efficiency,” or DOGE. Despite the “department” name, DOGE is not an official government agency—which would require ethics disclosures—but rather an advisory panel. 

Their op-ed begins by redefining congressional authority to create agencies to suggest that agencies are illegitimate. “Most government enforcement decisions and discretionary expenditures aren’t made by the democratically elected president or even his political appointees,” they write, “but by millions of unelected, unappointed civil servants within government agencies who view themselves as immune from firing thanks to civil-service protections.” This, they say, “imposes massive direct and indirect costs on taxpayers.” 

“Thankfully,” they continue, “we have a historic opportunity to solve the problem. On Nov. 5, voters decisively elected Donald Trump with a mandate for sweeping change, and they deserve to get it.”

While “politicians” have “abetted” an “entrenched and ever-growing bureaucracy,” they write, they will work with the OMB to identify regulations that, they claim, Trump can issue an executive order to stop enforcing. “This would liberate individuals and businesses from illicit regulations never passed by Congress and stimulate the U.S. economy,” they write. Should Trump want to cut things that Congress wants to fund, they claim that Trump will simply refuse to spend those appropriations, challenging the 1974 Impoundment Control Act that declared such withholding illegal. 

Musk and Ramaswamy reiterated their support for cutting programs that are not currently authorized, although budget experts note that such a lapse is a tool to permit adjustments to programs Congress has, in fact, authorized and have also pointed out that one of the top items on that list is health care for veterans. Cuts to all these programs will naturally mean extensive cuts to the federal workforce. 

“With a decisive electoral mandate and a 6–3 conservative majority on the Supreme Court,” they write, “DOGE has a historic opportunity for structural reductions in the federal government. We are prepared for the onslaught from entrenched interests in Washington. We expect to prevail. Now is the moment for decisive action.” 

They conclude by asserting that “[t]here is no better birthday gift to our nation on its 250th anniversary than to deliver a federal government that would make our Founders proud,” which is one heck of a conclusion to a blueprint for taking the power of American lawmaking from the Congress, where the Framers put it, and delivering it into the hands of an extraordinarily powerful president acting on the advice of two unelected billionaires, one of whom wasn’t born in the United States.  

In the vein of getting rid of regulations, today the chief executive of Delta Air Lines said he expected the Trump administration would be a “breath of fresh air” after the Biden administration’s consumer-protection laws that he called government “overreach.” 

Meanwhile, in Washington, the Senate has been confirming President Joe Biden’s judicial nominees, with the absence of Republican senators making the confirmations easier.