The Poverty Industrial Complex

(film reel spooling) - There's people getting rich off this graph.

(soft music) What we're looking at here is the number of Americans that don't make enough money for basic survival. So like a family of four, two parents, two kids, living off of $31,000 a year or less. That's considered poverty in the United States and there's millions of people who live with that kind of income. The U.S. government spends about a trillion dollars every year helping these people meet their basic needs. In recent decades, a lot of that money has been flowing through a middleman, private corporations who are supposed to be more efficient in administering this money.

- So welfare is big business. And of course, that's the irony of this whole thing, that there's so much money to be made from poverty.

(pensive music) - Now this is not easy stuff to understand. We're talking about government welfare programs and bureaucracy. Sometimes they're intentionally hard to understand and these corporations don't really want to be known by anyone. But if you start to dig, which we've been doing, and you look deep enough into this, you start to see what all of this actually looks like, who's actually getting rich, what the incentives are within this system, where the loopholes are, and whether or not this is actually benefiting the people that it's designed to benefit. So in this video, I'm gonna show you who gets rich off the poor. And I'm just gonna do a few case studies that demonstrate how this works. I'll be making a list of examples here going from what I see is the least egregious abuse of this system to the most. I am bracing myself to get sued or intimidated by the companies that I'm calling out in this video because that's how a lot of these powerful shadowy companies work. So as always, every assertion in this video is rigorously fact-checked and in my sources. Lawyers, go check that first before you send me your cease and desist order. Thank you. And with that, let's look at who gets rich off the poor.

Let's go back to this graph one last time and just zoom back to the 1950s where you can see that the poverty rate was double what it is today. It's like 22%. This was really bad. And it led to the president at the time declaring war.

- And this administration today, here and now, declares unconditional war on poverty in America. We shall not rest until that war is won.

- So, "A War on Poverty" by Lyndon B. Johnson in 1964. This is what that war looked like. This big line. This is social spending as a share of GDP. You can see this is where he gives this speech, right here, this flat line. Social spending just skyrockets right after. The government spends tons of money for this war on poverty. That money goes towards programs like Medicare and Medicaid, food stamps, public education, which is why you see this big dip. 22%, all the way down to 12, 13%. And for a time, all this spending worked. Poverty declined 30% in five years. But eventually, progress slowed. The government kept spending and people got tired of it. The economy wasn't doing well and people were tired of subsidizing these welfare programs. And that's where this guy comes in.

- My friends, some years ago, the federal government declared war on poverty and poverty won.

- This is where things start to get a little bit murky. So we needed help. We got it from Ann Kim, who is an expert, who literally wrote the book on this history and the modern day poverty economy and sat down with us to talk through this history and how it works today.

- Remember during the 1980s, we had this, well, no, you don't remember the 1980s. (laughs) Well, during the 1980s, there was really this mythologization, if that's a word, of the CEO. At the same time, the government spending was ballooning. Economic times were not that great. So Americans were not feeling particularly generous about funding social services programs. And so the CEOs were really kind of held up on a pedestal as the ones who are going to make government just as efficient as they made their own companies.

- Poverty is a big business here in the United States and the government is making decisions right now that will affect millions of people. And yet what I've been finding is it's hard to keep up on all of this, how this stuff is being reported and what is trustworthy and factual. Lately, Medicaid portals have been shutting down in all 50 states, thanks to a Trump administration funding freeze. This could result in millions of Americans, low-income Americans, going without care. This is huge and it's not really being reported on. And when there's no accountability, bad policies can go unchecked. I'm saying all of this because it has to do with the sponsor of today's video who is more important than ever, in my opinion. Thank you, Ground News, for sponsoring our video and for existing in this important time for journalism. Ground News has become my preferred news platform because it's this app and website that allows me to see way deeper into today's headlines, to see the full picture, not just one version of it. And it does this by pulling tens of thousands of headlines and sources from around the world and aggregating them in one place. With Ground News, you can compare and uncover the political bias, the reliability, and most importantly, see who owns the sources reporting on the news that you're reading. There's often some big institution or country behind some of these news outlets. Ground News is gaining notoriety for their work. They were recently recognized by the Nobel Peace Center for their impact on media literacy. Since we're talking about Medicare and welfare programs, let me show you how this actually works with an example. Like this Medicaid shutdown news. You'll often see one-sided coverage, like left-leaning outlets focus on Trump's direct role, calling it a policy failure. Right-leaning outlets, they either downplay it as a technical issue or don't cover it at all. You can see all of these framings in just one feed, in one place. As I've been using Ground News more and more, I've noticed patterns in my own behavior, in my own biases. Ground News has been surfacing stories that I'm not likely to read or that are not being covered here in this blind spot feature. It highlights stories like the Medicaid story that are disproportionately covered by one side or stuff that I'm less likely to look at because of my own political bias. I've relied on Ground News for a more balanced, nuanced, deeper view of the news, now for a long time. This is real transparency that allows me to be a more critical news consumer. I'm not just informed, I feel like I'm ahead of the narratives, I see them from a bird's-eye view. Ground News is completely subscriber-funded, doesn't rely on corporate influences to decide what you see. And if you wanna join the platform, you can get 40% off the Vantage Plan, which has all of these features I talked about today. You'll get 40% off if you use my link or scan the QR code, ground.news/johnnyharris is the link. It comes out to be like five bucks a month for this, which to me is an affordable price to be better informed and to have a more critical view of the news you're consuming. So sign up now, ground.news/johnnyharris. Thanks, Ground News, for sponsoring today's video and for existing.

Okay, back to our list of who gets rich off the poor. So it's the 1980s, Reagan wants to rein in all of this spending. He's also afraid that Americans are becoming too reliant on the welfare system. So he kicks off a bunch of changes that over time would lead to a fundamental shift in delivering income support to low-income populations.

- They wanted to privatize Medicaid, Medicare, prisons, air traffic control.

- This privatization of government spending started under Reagan, but it continued into the future administrations, especially under Bill Clinton, who helped expand it. And the fundamental shift looks like this. We're gonna be using a graphic like this, not only for right now, but for the future cases of how this works today. Taxpayers give money to the government. The government used to give money to citizens in need directly. But after these reforms, the money would start to be distributed to the states. The states would then hire for-profit companies to do the complicated work of distributing this money to eligible people in need. They would be responsible for making sure that no one's abusing the system, determining who's eligible and who's not. And the thinking here was that the government is much less efficient than private companies. And that is true in most cases. And that if we apply business and the free market and profit motives to welfare, that the for-profit companies would make this more efficient, less government spending, less waste, and less over-reliance on the welfare system. And the big part of all of this is that there would be more requirement for people to be looking for a job or be working in order to qualify for benefits. And who would verify that applicants are actually working? These for-profit companies. And so this is how our welfare system works today in a very kind of American way. It is administered by private companies that you've never heard about, who are given lots of money from the government to dole it out to people in need.

- So Reagan started this privatization train, and it was really President Bill Clinton who not only hopped on board that train, but got it accelerating to his destination, which was total privatization of a lot of social services in America.

- Okay, so that's the context here. It's been 45 years since this big experiment began of privatizing our welfare system. I've always wondered, like, did this work? So that's sort of been the curiosity at the heart of this story. Is government more efficient? Are we saving money? Is this helping vulnerable populations in a more efficient way? The answer is, in some cases, yes. Like, there have been positive outcomes of outsourcing to contractors within the welfare system and public spending. A good example of that is food stamps that used to come in these paper coupons, but now are delivered electronically on a debit card. This is more secure, it's more efficient. It ensures that people use these for food. There are a lot of instances where private companies have made government spending more efficient, but the purpose of this video is to shine a light on the many instances where private companies have gotten really rich off of this system in a way that has not benefited the most vulnerable and needy people in our country, the poor, the elderly, children in need, the disabled.

So finally, the reason you clicked on this video, let's draw up this list of who gets rich off the poor. And for that, I'm gonna need to look at all these papers, so we need more space. Let's go to the big table. All right.

Okay, so the first one on our list is slightly adjacent to the privatization of welfare, but it follows the same incentives and dynamics. And it has to do with taxes. One of the ways that the government subsidizes the lives of lower income people is through a tax credit. So when you file your taxes, you show that you've been working, you've made money, but you didn't make that much money, and therefore you qualify for an earned income tax credit. If you have kids, it goes up and it kind of maxes out at around $7,000. This is a very simple thing. In a lot of countries, you like check a box and you get this refund or this subsidy to your life. But in the United States, it looks like this. This is a 45-page instruction manual about all the specifics on the earned income credit, something that should be so simple and that is a key way of helping lower income people live their lives. The tax code here in the United States is deathly complicated, intentionally designed to be so to make certain companies rich. And this is one way that works. I have a lot of feelings about this. I made a whole video on "The New York Times" about this very thing, but I didn't focus on this aspect of it. Because it's so complicated, low-income people who qualify for this credit don't wanna fill it out themselves. And so they go to a tax preparer. Enter this guy. Well, not this guy specifically, but a guy like this representing a company like this. Liberty Tax is one of many tax preparation companies that advertise to low-income people to come in so that they can prepare their taxes and get them in on the earned income tax credit. But we now know they do so using some pretty shady means. There's a lawsuit. Lawsuit, lawsuit, lawsuit. District of Columbia versus Liberty Tax Service. Liberty Tax was recently sued for luring low-income people by saying that they will prepare their taxes for them only to deceive these customers by secretly skimming extra money off the top of their tax refund, which remember includes the earned income tax credit that is meant to subsidize their lives. Liberty Tax also gives out loans to people saying that they can pay them back once they get their tax refund.

- But what that really has done is create a market for high-interest cash products like refund anticipation loans or refund anticipation checks, which are basically just payday loans that are secured by the refund. And so this predatory industry has grown to take advantage of the complexity of an incredibly important benefit that a lot of poor people count on every year.

- These loans would often come with high interest rates and unexpected fees. In fact, the pricing in all of this has been kind of a black box, allowing Liberty Tax to take advantage of low-income Americans trying to get in on the benefit that they are entitled to because of this tax credit.

Okay, and this is where I have to come clean. I worked for this company. Not for very long and not in any high position. I was one of these Statue of Liberty guys. One winter, I was home from university waiting for a security clearance for an internship at NATO, and I needed money. And so I found this job being the Statue of Liberty holding this sign. I didn't know what the sign said, okay? But it probably said something like, "Need money today? Apply for a $500 to $6,250 easy advance." In other words, I was probably a part of luring desperate people in to get a bad loan or to have their tax refund skimmed by this corporation. I had no idea, and I'm sorry. Liberty is just one of many corporations who has gotten in on these schemes, targeting low-income people to try to get in on their tax credits. And to me, this is actually a failure of our tax system. For this segment of the population, this should be a very easy thing like it is in every other country. A box on a free government website that you can fill out in five minutes. But instead, we've got a privatized corporate middleman who is making all of this money off the poor.

Okay, number two, housing. So here in the US, instead of building big public housing complexes like they do in some countries and like we used to do, the privatized version of the American government gives vouchers to low-income people and allows them to go choose a house. And the government will basically pay for a portion of their rent. This is called Section 8 housing. And there are landlords that specialize in renting to Section 8 tenants, getting this government subsidy voucher that goes to pay for the rent. But what you find is that some of these landlords jack up their prices because they know the government will pay for it. Like here in DC, an apartment that should cost $1,600 a month the landlord might charge almost $1,000 more, like $2,500 a month, well above the market price. Knowing that the government who has poor oversight over this program won't pick up on this and will subsidize that inflated price. Now I'm not just making this up, those are real numbers from an investigation here in DC by the Washington Post who found that the DC government is overpaying thousands of apartments to the tune of a million dollars every month here in little DC. But this is happening all over the country. Enriching landlords while depleting the assisted housing fund, all while distorting the market. Like this is not free market, this is a totally distorted thing.

Number three on our list is corporate middlemen, which is kind of a big section. I'll try to work through it fairly concisely, but it's kind of the biggest one here. This is where a lot of people get really rich off the poor. Remember from our history section just a few moments ago that Ronald Reagan shook up the welfare system by instead of giving money directly to people in need, instead giving it to the states who would then give it to a corporate middleman who would then distribute it. And that corporate middleman also had to kind of determine the eligibility of people, making sure they're working or they're looking for a job. And all of that is a lot of work and these corporations were the ones to be doing it.

- So these are the folks who are getting government contracts to act as government in running welfare programs. They're basically agents of the government. They are mercenaries for the public sector. They're making huge decisions that benefit the everyday lives of low-income people. One of these companies, for instance, was a company called Maximus, which is one of the largest welfare services providers today. They had revenues of about $88 million in 1995. And just a few years later, their revenues were already up to $500 million. And today they're a $4.9 billion business.

- Now this was exactly the point for Reagan and his reformers. These corporate middlemen were supposed to be much more efficient in administering this government money. And indeed, they are for-profit companies and they operate much more efficiently than the government itself, cutting costs and looking for ways to do things more efficiently. But let's remember, this is not like a normal corporation like McDonald's that is selling a product to a customer that can go somewhere else. Let's see what happens.

(pensive music) A few years ago, Maximus took over Tennessee's health insurance program, state-run health insurance program. It's called Medicaid. And what you saw is that many children and elderly people very quickly were booted out of the program. They were found ineligible. There was a 23% increase in the number of uninsured children in the state. That's more than any other state at the time, 2018. It took me a while to get my head around this. Like why would a for-profit company want to kick children and old people off of the state health insurance program? I'll explain in just a sec, but let's look at one more example. In 2016, Maximus took over the Medicaid program in Kansas. And soon thereafter, applicants started to see huge delays in their applications. Backlogs started to build up, which remember what we're talking about here. This isn't abstract. This is vulnerable people, in this case, mostly elderly people, not being able to access their basic health needs for weeks and sometimes months because their application was pending for a very long time, meaning Maximus was working on it, but presumably very slowly. And that's because children and low-income people and elderly people are not Maximus' customer. They do not have an incentive to serve those people, partly 'cause those people can't go anywhere else. Those people think that they're interacting with the government. They don't know who Maximus is. And mostly because their main job is to get more government contracts and then to cut costs so that they can capture as much of that government contract as profit. So in this case, what that means is cutting staff, making it as cheap as possible to process these applications. This answers my question about why a company like Maximus would want to get people off the rolls, to deem them ineligible for these benefits, because it's cheaper for them. They are motivated to find people who do not qualify and to pare down their list so they have fewer people to work on, which is less cost for them. So yes, there is cost-cutting and efficiency that's happening here, but it happens to be at the expense of vulnerable, needy people who the government is trying to give money to. Now, actually, I don't blame Maximus very much for this. I don't think they're bad people. I think they provide a very useful service in most cases. We should expect a corporation to behave like this. The definition of a for-profit corporation is someone who does everything in their power to make money for their company. That is their job. So without proper oversight and competition and regulation and performance review, these corporations should be expected to minimize the resources they have to put into it, processing applications and administering benefits. And another point of fairness here, if you look at the financials of Maximus, they're not some crazy profitable company. Yes, they bring in billions of dollars. They've captured a huge amount of this government services market. Their gross profit margin is 20%, which seems like a lot, but if you actually look at their net profit margin, which is kind of their more typical profit margin, it's like 3%. That's a pretty poor performance for a company. They're not insanely profitable. The CEO did make $7.3 million last year in full compensation and they did spend over a million dollars in lobbying and funding elections. My point here is corporate middlemen who administer welfare are not robber barons and they're not running some corrupt scheme, but they are for-profit corporations who will cut costs where they can. And if they're not held accountable for doing that, the people who suffer are the people who are already vulnerable and needy in our country, which is what all these programs are meant to help.

- Because they're one of only a handful of companies that are in this business, you can get away with a lot of behaviors that may not fly in a more competitive marketplace.

I remember interacting with these companies. I didn't know I was interacting with them until I started reporting the story, but when my son was like one and a half, he was diagnosed with autism and we started to look around for services, realized our insurance didn't cover anything, so we went to Medicaid and we qualified. And my wife has spent hours and hours on the phone with what I now know was a corporate middleman trying to work through these applications and processes. And it was mind numbingly complicated and difficult and the wait times were so long and the paperwork and the hoops that we had to jump through. And I remember feeling a lot of anger at the inefficiency of the government. The government has no incentive to perform because we're not their customer. What I realize now is that I was dealing with a corporation. I was not the customer, Iz was not the customer, my son, Henry, who needed services was not the customer. And in fact, complicated forms and more wait times and process is actually more business for these corporate middlemen. They have an incentive to sell more paperwork to all of us. To me, that is a distortion of what Ronald Reagan dreamt about of corporations swooping in and making our government more efficient.

Okay, that's corporate middlemen. Let's move on to number four. Medicaid dentists. Now, I've had some positive experiences with Medicaid. When I was a freshly married in my young 20s university student with no insurance and we had our first baby, I got hit with a $10,000 bill from the hospital and freaked out and went to the billing department at the hospital and they told me about this magical thing called Medicaid for someone like me who was very low income at the time. And lucky for me, whoever the benefits contractor in Utah was handled it very well and it really saved my bacon. But if you look at all sides of Medicaid, you start to see entire industries that exist to take advantage of the Medicaid system. A good example of this is dentistry.

- It's created an enormous business opportunity for some dentists who see that they can make a living treating exclusively Medicaid patients.

- Unlike regular private insurance, Medicaid doesn't reimburse very much for dental procedures. So because of that, a lot of dentists don't take Medicaid as an insurance. And on the other side, there are some dentists that only take Medicaid. They specialize in appealing to patients who qualify for Medicaid, getting them in and doing as many procedures as possible to get in on those Medicaid benefits. And once again, if we're talking rational corporate behavior and incentives, these offices will often target lower income or disabled or elderly patients who are less likely to advocate for themselves and against medically unnecessary procedures.

- So inevitably what's happened over time is that this market has turned into a very exploitative one where dentists have been prosecuted for charging for procedures that didn't exist or procedures that were completely unnecessary. For instance, there was a dentist in North Carolina who was prosecuted for having performed 17 root canals on a three-year-old toddler.

- And it's not just one bad apple in North Carolina. This is a lawsuit where the US government settled with a company called Kool Smiles and they are a Medicaid specific dental franchise who had to pay close to $24 million because an investigation found that they were performing dental operations that were not medically necessary. They were taking advantage of poor patients in order to get more money from Medicaid. According to the lawsuit, they performed tooth extractions, gave out stainless steel crowns, did root canals on babies that did not need them. Like there are multiple things really wrong with this. Obviously, exploiting a government system to deplete the Medicaid fund is one aspect, but performing like dental surgeries on people, root canals on babies for money is a level of greed and corporate exploitation that I cannot really get my head around. But again, in a world where companies will maximize profits, this is to be expected if the incentive structure is set up that way.

Let's get to number five, which is similar to the dental clinics, but it has to do with kidneys. Here in the US, lower income people are disproportionately plagued with kidney failure, a disease where your kidneys fail and your blood can't be cleaned by your kidneys. So you need a machine called a dialysis machine to clean your blood for you. Luckily, since the '70s, the United States now heavily subsidizes people who need dialysis for their kidneys. And dialysis is meant to be a temporary intervention while you wait for a kidney transplant. There's always a long waiting list for a kidney transplant, so you're on dialysis until you can get a transplant, which increases your chances of living. It is a wonderful thing that the government subsidizes this because it saves a lot of lives. But inevitably, here comes the exploitation.

- Overnight, it instantly created an industry opportunity to offer dialysis because now the government was going to pay for it.

- One of these companies is called DaVita. I think they're the largest dialysis center company in the United States. And because of this set of incentives, we can start to piece together how they would behave.

- And the thing again about dialysis is like Medicaid dentistry, it's a volume business. The government pays dialysis centers per treatment. And last year, it was about $380 per treatment. So it is unfortunately in the interest of dialysis companies that run dialysis centers to keep those machines occupied as many hours of the day as they can to cycle through as many patients as they can because an empty dialysis machine is $380 that they're not making.

- Okay, so a company making sure that their machines are being used at full capacity is actually, there's nothing inherently wrong with that. That is a company just using its resources efficiently, administering a life-saving treatment. But that's kind of just the beginning. What you see in these for-profit dialysis centers is less staff to help with the treatment and you see higher death rates. And this is where it becomes so clear where the failure is. You see 17% fewer referrals for kidney transplant. Meaning these people who are on a temporary dialysis intervention who are supposed to be waiting for a kidney transplant are kept on the machines longer because a for-profit company makes money the longer they're in the chair. So why would they refer them to get a kidney transplant when they make more money keeping them on the dialysis treatment? If someone gets a transplant, that is a lost customer.

- Unfortunately, it's an option that's being denied a lot of people because it's in the financial interest of dialysis centers to keep someone in dialysis rather than quote, "Losing them to transplant."

- Now, DaVita has paid like a billion dollars in settlements and for some of this behavior, including $350 million they had to pay after being sued by the US government for paying doctors to go out to recruit people to come to their dialysis centers so that they could corner the market in certain areas. They had to pay another $450 million because they were found billing the government for medicine that they had received and just thrown out and charged the government anyway so that they could get reimbursed. All of this, once again, further draining the money that is allocated by our government to help people in need.

And finally, number six, the last on our list, the one I'm deeming the most egregious because it has to do with children and not just any children, the most vulnerable children in our society, specifically children who have been removed from their family because of abuse, abandonment, or death, foster children. If a foster child loses a parent or is physically or mentally disabled, the federal government entitles them to around $700 a month to subsidize their lives. This is one that goes straight from the federal government, from the Social Security Fund, straight to these children, or at least it should. But here comes the corporate middlemen once again. States will often hire corporate middlemen like Maximus, who is in fact a part of this, to look through the databases of foster children to identify which of those children qualify for this benefit, meaning which of these children have a dead parent or are physically or mentally disabled. And then to go through the process of diverting that money away from the children and into state coffers. The state says they're doing this to help supplement the foster care program in their state to help boost their budget. But what feels very icky about this to me is that it creates, once again, a business opportunity for a for-profit company who is incentivized to scour these databases looking for children who qualify for this benefit to divert the money away from them and towards the state. And Maximus gets paid a fee to do this. They're incentivized to do this as a service for the state, to look through these databases and look for children who qualify. There's one NPR report from a while back that reports that the corporate middleman Maximus, who we've talked about at length here and who I will probably get sued by, would get $1,600 per child that they found who qualified for this benefit. Remember, a child whose parents are dead or who has a physical or mental disability who's entitled to around $700 a month to supplement their very difficult life. If Maximus finds that child and diverts that money into state coffers, Maximus gets paid $1,600. That was in Alaska. Oh, but it's still going on. In 2018, Washington State worked with Maximus to get $6.89 million of foster children's money. Wisconsin got $4.13 million from their foster children, thanks again to the services of Maximus. Illinois, $18.7 million from foster children. Illinois didn't work with Maximus in this case, but another similar corporate middleman called Diversified Services Network to do the same thing. None of these companies want to be known or spoken out loud. They just sort of operate as like a proxy for the government. They just, this is what they do. This money is being diverted from going directly to the foster children to going into the statewide foster care program. So it still is benefiting those children indirectly, but it feels wrong to me because this money was intended to benefit them directly. These are the most vulnerable children in our society. This money is entitled to go to them.

(paper rustling) Okay, so that was kind of awful. I learned a lot about how the welfare system works and what privatization means. I also learned that there are situations where this makes a lot of sense. I didn't go into the full evaluation of privatization versus not. I don't think that was the scope of this video. What I've been trying to do here is look at places where in our vast welfare system, profit-seeking corporations have found ways to exploit that system to make money at the expense of vulnerable populations that are entitled to that money, who we, the taxpayer, pay to help supplement their life so that they can have a better life.

Now, what can we do about this? Is this just totally hopeless? The answer is no.

- How do we fix the situation? Well, you know, there's an old saying that the first rule of holes is to stop digging. And in this case, the first rule would be to stop privatization. The industry has kind of grown under the radar, unchecked, unmonitored for decades now. And we don't know how big the problem is and we can't tackle it unless we get some sense of how much money is going to this, the amount of drag that the government is experiencing from the poverty sector. And I think that's the first step, one of the first steps to take.

- I believe that there's a version of privatized contractors administering public services and welfare that is responsible and actually works for serving the vulnerable populations it's intended to. To do that, it will require much more oversight and regulation that takes into account all of these incentives, that treats corporations like adults who are going to find whatever loophole they can in whatever system to make money and closes those loopholes. Also, if we're gonna call this privatization, we need competition, real competition, not these near monopoly, massive companies that kind of own entire sectors of public spending. And in all of this, I think we should reevaluate how much profit should play a role in these companies incentives. California is also working on a profit cap, specifically for the dialysis centers, making it so that they don't even have the ability to profit as much as they do. Now, unsurprisingly, this was fought tooth and nail with over a hundred million dollars from dialysis centers and the Proposition 8 was shot down. But it's a great policy recommendation and it begs the question, how much profit should a corporation that is administering public welfare be entitled to? But ultimately, none of this will change unless the customer demands more. And the customer in this case is the government. If the government does not measure and demand better performance, these companies will not do better. The government seems to not be demanding a lot of change on the whole. There's a trend towards more and more privatization in things like Medicaid and other benefits. Our belief in the market has allowed us to be blind to some of these failures. And my worry is as we continue to privatize without plugging some of these gaps, without fixing some of these loopholes, we are enabling these companies to exploit those loopholes. And as we've seen, they will do it. They will find ways to continue to get rich off the poor.

(pensive music)