The Triumvirate Running America Is Not Who You Think

 With more than $23 trillion in assets under their collective management, the Big Three investment managers – BlackRock, Vanguard and State Street – are undisputed financial heavyweights.  State Street has more assets under management than the entire annual gross domestic product of Germany. And together, they’ve become known for imposing a woke political agenda on corporate America.

The Big Three have heavily invested in America’s banks. At some of them, BlackRock and Vanguard hold more than 10% of the voting stock. State Street also holds substantial amounts of shares of many banks. That’s important because, under the Change in Bank Control Act, companies are prohibited from acquiring “control” of a bank unless certain federal regulators approve beforehand. Federal regulators long ago adopted regulations that rebuttably presume “control” when a firm holds more than 10% of the voting stock of a publicly held company.

Jonathan McKernan, a Republican on the FDIC’s board of directors, recently called for enhanced monitoring of the Big Three, and for temporarily prohibiting further investments by the investment manager behemoths in FDIC-regulated banks in excess of 10%. Democrat board member Rohit Chopra appears to be on board as well.

The bipartisan duo has it right. These investment managers have used voting power that they should have never been permitted to wield. Instead of using it solely for the benefit of their customers, they anointed themselves rogue, unaccountable emperors whose woke whims at banks could include choking off credit and denying banking services to businesses they politically disfavor, including oil companies, firearms manufacturers, payday lenders and other businesses not to their personal liking.  The corrupting influence of their undeserved power should and can at long last be curbed in the case of banks.

The FDIC was weaponized during the Obama administration’s “Operation Choke Point” to actively discourage banks from serving clients with business classifications at ideological odds with the White House. After the operation’s discovery, it collapsed under the weight of legal action. But today, the acquisition of controlling blocks of bank stock by proudly woke investment managers raises the specter of a return to Operation Choke Point by different means.

Despite the prohibition on controlling interests above 10%, the giant managers do indeed own shares in excess of the 10% threshold. They’re being allowed to skate by regulators who give them a free pass on the condition that the companies signal their intent to retain a “passive” posture. In other words, it’s alright for them to hold a stake greater than 10% if they refrain from using that controlling interest to push an agenda. But, considering that they are exceptionally well-known for “forcing behaviors” like their arbitrary ESG standards, their assertion that they have been acting with passivity is completely self-serving.

Regulators seldom, if ever, enforce or even look into such flaunting of the rules. Among other things, government bank examiners should critically interrogate senior bank executives as to whether they’ve had any communication from shareholders BlackRock, Vanguard or State Street.

At a minimum, in the case of publicly held companies, share acquisitions above the 10% threshold should trigger the regulatory approval process, and investment managers would be expressly prohibited from pursuing such an acquisition in the event that the regulator denies the application.

Not only should the reform be implemented by the FDIC (which generally regulates smaller, often rural, community banks); but it should be adopted by other bank regulators, such as the Office of the Comptroller of the Currency (the primary regulator of all national banks) and the Federal Reserve Board (the primary regulator of companies that control banks).

For all practical purposes, the Big Three have a controlling influence over the American economy and are not held to account for their potentially despotic control. For its part, BlackRock has reportedly and self-servingly been asserting that existing arrangements with the FDIC are working and no changes regarding oversight are necessary. It would be hard to point to more compelling evidence that “business as usual” is not working and that a drastic shake-up is urgently needed.

Jerry Loeser is a retired bank regulatory lawyer who, over a 50-year career, counseled the Federal Reserve Board, major banks, and prominent law firms.

https://www.realclearpolicy.com/articles/2024/04/29/the_triumvirate_running_america_is_not_who_you_think_1028114.html

US SET TO REGRESS FROM MODERNITY

 Liberals denounce Donald Trump as a would-be tyrant, but the fact is that he ruled less by executive order than any other recent president. It is Joe Biden who has discarded the Constitution and imposed a blizzard of illegal or probably-illegal regulations on the rest of us.

Lately, they have been coming so furiously that it is hard to keep up with them. The Wall Street Journal’s editorial board caught up with just one set, relating to power plants. The intent of the regulations is to set our economy and our material well-being back by as much as a century:

On Thursday the Environmental Protection Agency proposed its latest doozy—rules that will effectively force coal plants to shut down while banning new natural-gas plants.
***
Barack Obama’s regulation spurred a wave of coal plant closures. Now President Biden is trying to finish the job by tightening mercury, wastewater and ash disposal standards. EPA is also replacing the Obama Clean Power Plan that the Supreme Court struck down with a rule requiring that coal plants and new gas-fired plants adopt costly and unproven carbon-capture technology by 2032.

The Supreme Court held that Obama’s Clean Power Plan was illegal; Biden’s version likely will meet the same fate. But the damage done in the meantime will be incalculable.

Section 111 of the Clean Air Act says the EPA can regulate pollutants from stationary sources through the “best system of emission reduction” that is “adequately demonstrated.” Carbon capture is neither the best nor adequately demonstrated. As of last year, only one commercial-scale coal plant in the world used carbon capture, and no gas-fired plants did.

Existing carbon capture technology will badly degrade our ability to produce electricity:

Because carbon capture uses 20% to 25% of the electricity generated by a power plant, less will be available to the grid. That means more generators will be needed to provide the same amount of power. But new gas-fired plants won’t be built because the technology will make them uneconomic. Talk about a catch-22.

Another problem: CO2 must be stored underground in certain geologic formations, largely in the upper Midwest and Gulf Coast. Permitting new wells for CO2 injections can take six years. Pipelines to transport CO2 can take even longer. Green groups oppose pipelines for CO2 as they do for oil and natural gas.

All of this regulatory uncertainty will discourage the development of new gas-fired plants even as coal plants that currently generate about 16% of the country’s power are forced to retire.

So the federal government is forcing us to produce less electricity. Meanwhile, the demand for electricity is growing:

All of this will hit while demand for power is surging amid new manufacturing needs and an artificial intelligence boom. Texas’s grid operator this week raised its forecast for demand growth for 2030 by 40,000 megawatts compared to last year’s forecast. That’s about seven times the power that New York City uses at any given time.

Texas power demand will nearly double over the next six years owing to data centers, manufacturing plants, crypto mining and the electrification of oil and gas equipment.

We are on a collision course with disaster. And to what end? These new rules will do no good whatsoever, except for those who are on the Democratic Party’s “green” gravy train. They will get many billions of dollars, if not trillions, at the American people’s expense.

By the way, EPA plans to unveil soon another rule to reduce CO2 emissions from existing gas-fired plants, so some of them may also have to shut down. Meantime, China has added about 200 gigawatts of coal power over the last five years—about as much as the entire U.S. coal fleet. The Biden fossil-fuel onslaught will have no effect on global temperatures.

Biden’s purpose is not to benefit the climate, it is to benefit the vast “green” grift that is one of the Democratic Party’s main constituencies. The greens, but also Communist China. China controls the market for solar panels and wind turbines, and it also controls the raw materials that are necessary to produce solar panels, wind turbines, electric vehicles and the hypothetical batteries that are the magical solution to the fact that weather-dependent sources of energy can never fuel an economy–a primitive economy, let alone a modern one.

Why is Biden destroying our electrical grid and dragging the United States back into the 19th century, to the immense benefit of the Chinese Communist Party? Occam’s Razor suggests that he is doing it on purpose. Even Joe Biden isn’t dumb enough to fail to understand where these policies are leading. I don’t know whether it is sheer, malicious anti-Americanism, or whether the millions of dollars that Biden and his family have gotten from China have made him the Manchurian Candidate. But, one way or another, the disastrous consequences of the Biden administration’s energy policies are obvious to anyone who pays attention.

Including, even, Slow Joe.

https://www.powerlineblog.com/archives/2024/04/us-set-to-regress-from-modernity.php

California State Lawmaker Introduces Bill To Ban Excessive Homework

 by Eric Lundrum via American Greatness,

A state lawmaker in California has introduced legislation that would severely restrict a teacher’s ability to hand out homework assignments to students that are deemed to be too much.

As reported by Breitbart, State Assemblywoman Pilar Schiavo (D-Calif.) introduced AB 2999, formally known as The Healthy Homework Act, in February.

The bill would mandate public school officials to “develop, adopt, and update” their policies regarding homework “at least once every five years.”

The bill would also require schools to take into account research which allegedly shows the physical and mental health impacts of homework.

“I think this is going to make a huge impact for the students,” said Schiavo.

“The times have changed and our homework policies don’t always change with the times, so we need to make sure we are addressing issues that are effective and also don’t harm kids.”

Schiavo was partially influenced by the fact that her sixth-grade daughter, Sofia, hates homework; she described homework as “exhausting” and “overwhelming.”

“It’s depressing that my whole day, from when I wake up to when I go to bed, is nearly all taken up with schoolwork,” said Sofia.

Several alleged “experts” have agreed with Schiavo’s view that homework largely needs to be banned. Harris Cooper, professor of Psychology and Neuroscience at Duke University, claimed that “there is a limit to how much kids can benefit from home study,” and that students should have no more than 10 minutes of homework per day.

A recent survey by Stanford University found that, of over 300,000 student respondents, 45% said that homework was their top source of stress.

“If it’s such a source of stress for kids, and we know taking stress off kids’ plates will make a difference in their mental health, this is something that can practically impact kids’ mental health overnight,” Schiavo continued.

https://www.zerohedge.com/political/california-state-lawmaker-introduces-bill-ban-excessive-homework

Pfizer, Genmab get full FDA approval for cervical-cancer drug

Pfizer and Genmab on Monday said they had received full approval from U.S. regulators for their treatment for certain forms of cervical cancer.

The companies' drug Tivdak had previously been granted accelerated approval by the U.S. Food and Drug Administration, which allows quicker approval for drugs addressing a serious unmet need. The FDA's full approval covers Tivdak in the treatment of recurrent or metastatic cervical cancer.

Danish biotechnology company Genmab and Pfizer-owned Seagen codeveloped Tivdak under a cost- and profit-sharing agreement.

Tivdak has had accelerated approval from the FDA for cervical-cancer treatment since 2021.

Genmab (GMAB) and Pfizer (PFE) said Monday that the antibody-drug conjugate had been approved to treat patients who have disease progression on or after chemotherapy, meaning it is a second-line treatment.

The approval was based on results from a Phase 3 trial of Tivdak, which met its primary endpoint of overall survival as well as its secondary endpoints, the companies said.

https://www.morningstar.com/news/marketwatch/20240429181/pfizer-genmab-get-full-fda-approval-for-cervical-cancer-drug

Brain function of older adults 'catching up with younger generations', finds study

 According to research by Nottingham Trent University, the brain function of older generations is improving, with the gap between old and young healthy adults lessening.

The three-part study reviewed evidence from 60 independent research papers regarding cognition in older and younger adults to explore trends and determine whether age differences are changing over time.

It also examined the results of a study by lead researcher Dr. Stephen Badham, Associate Professor in Psychology at NTU's School of Social Sciences, which assessed and compared the cognitive abilities of more than 1,000 older and younger adults at different points in time. The research is published in the journal Developmental Review.

Cognition relates to how the brain processes information and can be linked to education, physical activity, and diet quality. It is also a factor in diagnosing age-related diseases such as dementia.

The studies in the review examined the cognition of older adults over time, particularly comparing earlier born adults with later born adults. The research also explored whether an age-related reduction in brain function is changing over time by analyzing historic studies that compared young and older adults.

Some of the factors measured included verbal fluency, for example the ability to list words within a category; memory, such as delayed recall, delayed recognition, immediate memory and working memory; and cognitive speed.

The evidence points overall to improving and higher cognitive performance among older adults with eighty three of the measures used (68%) across the studies showing better performance in later cohorts of older adults than earlier cohorts, only six (5%) showed the reverse.

In contrast, findings show that that young adults' cognition remained relatively flat across time—closing the gap between generations.

The findings were linked to ongoing improvements in education, health care, nutrition and access to more mentally stimulating, digital environments, which might have previously applied mainly to younger adults.

Associate Professor Stephen Badham said, "Much existing research shows that IQ has been improving globally throughout the 20th century. This means that later-born generations are more cognitively able than those born earlier.

"However, there is growing evidence that time-based increases in IQ are leveling off, such that in the most recent couple of decades, young adults are no more cognitively able than those born shortly beforehand.

"As a result, the current data show that young adult advantages in cognition relative to older adults, such as memory ability and speed of processing, are now getting smaller over time. This means that when we compare young and older adults today, the gap is smaller than it was in the past.

"Therefore, the decline an individual might expect to experience as they become older is smaller than originally thought. In other words, we can expect to be more cognitively able than our grandparents were when we reach their age.

"Finally, as older adults are performing better in general than previous generations, it may be necessary to revise definitions of dementia that depend on an individuals' expected level of ability. This is because dementia is defined as cognitive ability that is below normal and the current results suggest that as healthy older adults become more cognitively able, we may need to revise our definition of normal when diagnosing dementia."

More information: Stephen P. Badham, The older population is more cognitively able than in the past and age-related deficits in cognition are diminishing over time, Developmental Review (2024). DOI: 10.1016/j.dr.2024.101124

https://medicalxpress.com/news/2024-04-brain-function-older-adults-younger.html

Health insurer cartels are liberals’ backdoor to government-run healthcare

 UnitedHealth Group, the nation’s largest health insurance and services corporation for nine years in a row, could soon become the world’s first trillion-dollar healthcare company. Ironically, the fact that UnitedHealth, along with a small handful of massive corporate health services cartels, now controls much of the U.S. healthcare system suits most liberal politicians in Washington just fine.

As odd as it sounds, this is likely those politicians’ new plan B for “Medicare for all.” Democrats have figured out how both to control and manipulate these soon-too-big-to-fail corporations to achieve their policy and political goals. Furthermore, this plan allows liberals a means to avoid blame when the entire system collapses: What better time to offer government-run healthcare as the only viable option?

The new reality is that many of the same progressive leaders who once claimed to loathe big health insurance companies are now discreetly allowing a few selected companies to monopolize the system. What else would explain the near silence of anti-corporate crusaders such as Sen. Bernie Sanders (I-VT), Rep. Alexandria Ocasio-Cortez (D-NY), and Sen. Amy Klobuchar (D-MN) as these massive corporations expand control over a vast array of health services and entitlement programs, such as Medicare and Medicaid, while the prices of premiums and patients’ out-of-pocket expenses simultaneously skyrocket?

Moreover, this explains the lack of antitrust outrage over mass industry consolidation and acquisitions of wholly owned business subsidiaries, which consist of massive pharmacy benefit management companies, specialty pharmacy operations, primary and urgent care practices, surgical centers, home health giants, health IT services, and more. UnitedHealth alone employs or is affiliated with nearly 10% of physicians in America and even operates a Federal Deposit Insurance Corporation-insured bank.

Both Democratic politicians and the healthcare mega-companies benefit from this arrangement, trading favors and diverting revenues in the process. Often, this is done at the direct expense of patients and critical health programs.

Such behavior was on full display with the passage of President Joe Biden’s laughably named Inflation Reduction Act. Under the guise of lowering Medicare drug prices through government price control measures, Democrats were able to raid $280 billion in so-called “savings” from the seniors’ health program to fund unrelated spending priorities such as electric vehicle tax credits. In tandem, big insurers now receive a financial windfall in the form of large subsidies on expanded Obamacare policies and the prospect of lower government-set prices on medicines they are forced to cover.

Unsurprisingly, the Inflation Reduction Act’s special interest handouts were distributed immediately, while most of the drug pricing provisions promised to those in Medicare received delayed implementation schedules of two to five years. It is no wonder that nearly two years after the passage of the bill, polls show over 80% of older people have either seen their insurer-imposed costs — premiums, copays, deductibles, etc. — and prescription drug prices stay the same or go up, not down. Meanwhile, UnitedHealth and other health conglomerates have seen record-setting revenues.

Playing head cheerleader for the Democrats’ Inflation Reduction Act was none other than the AARP. While many people know it for its soft-feeling TV ads and direct mail touting itself as a seniors’ advocate, the AARP has quietly been paid well over $7 billion dollars over the last decade via UnitedHealth alone through a lucrative financial partnership with the giant corporation. In fact, AARP spent over $60 million to help pass the Inflation Reduction Act.

Many of the other biggest healthcare challenges that are devastating patients and families, such as skyrocketing premiums, have received a notable lack of action on the part of Democratic leaders and the AARP. Reforms to prohibit PBMs from pocketing large drug pricing meant for patients, allowed under a legal exemption from anti-corruption kickback laws that was extended under the Inflation Reduction Act, were stalled. Democrats have also shown little interest in trying to pull back billions in alleged overcharges to Medicare, investigate insurer denials of medical care for seniors, or investigate the massive consolidation taking place within the health services industries.

Democratic leaders in Washington know precisely what they are doing, and powerful health conglomerates such as UnitedHealth and proxies such as AARP are all too happy to oblige them. It is time for voters, patients, and families to recognize why they are doing so and stand up against them before it is too late.

David Safavian is executive vice president and general counsel at the Conservative Political Action Coalition. Andrew Langer is director of the CPAC Foundation’s Center for Regulatory Freedom.

https://www.washingtonexaminer.com/opinion/beltway-confidential/2979546/health-insurer-cartels-backdoor-government-run-healthcare/

Primary Care Shortage Reshaping How Patients Seek Care

 By February of 2022, Ella, a 25-year-old behavioral interventionist in Colorado Springs, Colorado, was sick with strep-like symptoms for the third time in 3 months. She didn't bother to call her doctor

The first two times she had strep throat, she'd tried to schedule an appointment with her newest primary care doctor but couldn't get in. They only had available appointments 5 and even 10 days out, but she'd already had symptoms for 3 days.

Until she graduated college, Ella had only known easy-access primary care. Her childhood family doctor and the nurse practitioners at her college clinic knew her. They anticipated her yearly allergies and knew about her predisposition for strep throat. Appointments were easy to schedule, and providers responded to her messages. But since entering the workforce and leaving her parent's insurance, the kind of primary care she'd come to rely on was nearly impossible to find.

"I went to urgent care, and that became my primary care," she told Medscape Medical News.

Patients Can't Get Appointments

Primary care is in crisis. A growing number of Americans, like Ella, can't access care when they need it. According to a 2024 report, 29% of adults and 14% of children don't have a regular source of care. Those looking for a new primary care provider face extensive research and 6- to 9-month waits for a new patient appointment — if they can get in at all.

But even those with a primary care provider face long wait times: Days to weeks for a sick visit and months for a wellness checkup. Over one third of Medicare beneficiaries wait more than a month to see a doctor. Accessing primary care is more difficult than access to surgery, physical therapy, or rehabilitative care, according to a survey of Medicare beneficiaries by the Commonwealth Fund.

"Shortages tend to be in rural and urban underserved areas, but now, you're hearing about primary care shortages in Boston, which is a mecca of healthcare," said Ann Greiner, president and CEO of the Primary Care Coalition.

While retail clinics, urgent care, and telehealth help close the gap in acute needs, they miss one of primary care's most critical benefits: A doctor who knows you. There's strong evidence that ongoing treatment from a primary care physician (PCP) who knows your history, family, and context results in better long-term outcomes and fewer hospitalizations and emergency room visits.

If patients continue to find it too hard to break into primary care or set up an appointment, experts are concerned that they'll stop pursuing primary care altogether.

Doctors' Hands Are Tied

"I want to highlight that this is not an issue of primary care doctors not wanting to be accessible," said Lisa Rotenstein, MD, MBA, a PCP and medical director of Ambulatory Quality and Safety at the University of California San Francisco Health. "These access issues are symptoms of the design of primary care in the United States."

Across the United States, there's a dearth of family medicine doctors, pediatricians, and internists. And without significantly more primary care providers, there's simply no way for all Americans to get optimal primary care. The Health Resources and Services administration estimates a current shortage of 13,000 primary care providers. And that shortage will skyrocket to 68,000 by 2036 as the number of Americans needing care balloons and existing PCPs retire with too few trainees to fill their shoes.

The American Association of Medical Colleges predicts a slightly lower shortage in 2036 — between 20,000 and 40,000 primary care physicians — only if more residency positions are funded nationwide.

However, even with more positions, medical trainees see little incentive to pursue primary care. Young doctors are avoiding primary care because of the pressures, Rotenstein said. There's incredible pressure to get reimbursement for primary care doctors. And the added administrative burden makes "the work life of these specialties not really manageable," she said.

Continued Shortages of PCPs

"We know there's a documented pajama time," Greiner said. For every 1 hour spent with a patient, primary care must spend nearly 2 additional hours on electronic health records and desk work, according to a study by the American Medical Association. Even with all those additional hours devoted to getting paid, primary care doctors make an average of $103,000 less annually compared with their counterparts in surgery and oncology.

It's not an attractive combination for a new doctor with medical debt. This year, Greiner said that residency positions in internal medicine and pediatrics went unfilled. Of those trainees who do go into a primary care specialty, many won't last. Only half of primary care residents practice in primary care 3-5 years later. The rest choose to subspecialize or become hospitalists.

These untenable demands on a primary care provider don't go unnoticed by patients. In Ella's attempts to invest in a new primary care relationship, she often doesn't feel heard and can tell the doctor is rushed. "[Urgent care is] probably not the best care because they don't know me, but it does seem like they are able to listen to me better," Ella said.

Patients Want to Invest in Primary Care

Primary care should work like putting money in a bank account, Rotenstein said. Young patients invest in the relationship and reap the benefits of a doctor who knows them later in life when they need more complex care. But if seeing a doctor is so difficult, many young people may stop investing in their PCP relationship.

"One thing…that I worry about in this kind of situation where patients really have to put in a lot of work to get the care they need is in inequities of care," Rotenstein said. "We know some of our patients are more able to undertake that work."

Alternatively, the primary care shortage could be reshaping how patients seek care. A 2023 study showed the proportion of primary care preventative visits increased over 20 years. Policies under the Affordable Care Act were the driving force. But it's also true that sick visits are being diverted to urgent care.

Ella told Medscape Medical News she doesn't even consider primary care for sick visits at this point, "I can't wait 5 days or a week and a half. Unless I have bigger issues, like I need tests, I'm not even going to go to primary care." It's possible that other patients also see primary care as a place for testing and wellness checks and leave sick visits to retail and urgent care.

The Road Ahead

There's no single fix for primary care, but experts agree that the fee-for-service model is a core issue for the specialty. In a 2021 report, the National Association of Engineering and Medicine said that primary care reform needs to include higher reimbursement rates for primary care and that US primary care should be restructured so that payers "pay primary care teams to care for people, not doctors to deliver services."

In the current model, the doctor-patient clinic time is the only income-generating part of a primary care practice. A better model would consider the communication, administration, teams, and support doctors have to fund to provide the best primary care.

"We need to change how we pay and how much we pay, so [primary care doctors] are properly incentivized to build out a team to provide the comprehensive care you need," Greiner said.

In the meantime, primary care doctors are adapting. Some drop down to part-time to account for the additional administrative workload. Others are transitioning to concierge services to offer the quality of care they want while getting the income they need. Still, others specialize their practice, offering primary care to a subset of the population, like older adults.

Employers are also looking to improve care access for their employees, hiring in-house doctors to provide primary care onsite. Greiner recently met with a group of chief medical officers from major companies to discuss expanding primary care access via the workplace.

The efforts to adapt amid a broken system are admirable, Rotenstein said. And whatever a PCP has to do to keep practicing in primary care is laudable. The only problem with these adaptations is they largely limit a doctor's patient pool and, therefore, limit access, she said. More significant reforms that adequately reimburse primary care and incentivize new doctors are still needed.

As for Ella, she got married. Her wife is in the military, so now she has Tricare, which comes with a more streamlined process to access primary care. However, doctor shortages are just as evident in that system. The couple called to schedule new patient appointments after their recent move to Virginia. The first available ones were 6 weeks out.

https://www.medscape.com/viewarticle/primary-care-shortage-reshaping-how-patients-seek-care-2024a100089i