#ill be taking applications in the mcdonalds parking lot

[if-mirrormine]

Why? Just why?

I told myself I already have too many ROs I can't get out of my head, and that I might just be headed for some kind of 40-step program to stop adding to this RO list so maybe some semblance of control over my feelings might return to me. I told myself NO MORE.

*Grayson enters the chat*

My heart:

😍

i think the best part about romancing grayson is that not no matter how much you may simp for him, he will forever and always be the bigger simp😌

[sanhatation]

ri’s thicc 2017 reflection post !

its still quite a few hours away from 2018 for me but i just wanted to take this time to reflect on my absolutely Lovely 2017!!! yay time 2 get sappy as i word vomit and overshare about my year on tumblr.com !!!!

thank you loads to all of my LOVELY followers !!!!!!!!! yall are the cutest, make my day on the daily ! i wish you the best 2018 that the world can offer !!! stay healthy, take time for yourself, love yourself, love others, and be kind! 💓💓

this Riley Rant here, is gonna be here for me than anything. like a Fat journal entry !! and i am an Oversharer so here she goes [jeopardy music]

to begin, i have met and befriended so many amazing people on here this year and WOW!!!!!! lovely and supportive and talented, beautiful aroha friends??? it doesnt get better than that!!!!! i would attempt to tag all of u but yall know who u are ;)) im endlessly grateful to those of you who have really made being on here worth it. heck ya sometimes im like “why do i even spend time on here” but then!!!! idk sunny comes swingin in with just a heart full of love or sara comes swingin in with her eggs or marian comes swingin in with her rare pairs or j comes swingin in with her baking posts and thats not even HALF of it !!!!! seriously.....love you guys tons.

to my friends who i have had the pleasure of remaining your friend this year and getting closer to u !! i love you. i really dont know how yall handle me especially 2015/2016 me?? a MESS! yall are the REALEST. again, yall know who u are ;)) i hope we can continue to talk and have fun in 2018, i wish yall the best. 

and lastly....heres a THICC shoutout to my six shining stars. 

as for me as an individual, 2017 was a freaking Whack year. it was incredible....dare i say, iconic. and now its time for.....RILEY’S 2017 HIGHLIGHTS !!!!!! (also includes: the sucky parts bc even those allowed me to grow !)

- man, did 2017 start out pretty rough when my country decided it was a good idea to elect a freakin cheeto for president. however! i had the lovely opportunity to attend the women’s march at my capital the day before inauguration !! and it was powerful!!!! truly an experience ill treasure forever!

- binch....thank u Winter Dream for my whole life. tbh i wont forget sobbing at my best friend’s house when it dropped. thank u Miss Again Dance Practice. thank u Miss You & Me MV. thank u Miss Cotton Candy Choreography. thank u. 

- ah.....when some pinhead started that tr*mp chanting at a basketball game lol! so iconic that we made the new york times! gotta love that....

- OMG !!! HOW TO SUCCEED !!!! an absolutely amazing experience. granted, the male lead was a Snake, but i had a blast. Rosemary will forever be close to my heart and ill always cry a little when i hear Brotherhood of Man or Paris Original !! such an awesome opportunity. i learned a frick ton about myself as a performer. i improved a ton in acting and dancing, and also came to learn that i am very good at receiving instructions and memorizing lines quickly. i learned that i need to work on some of my facial expressions and i also learned some of my habits ! i miss u Queenie H2$ :’’)

- had my first tap dance performance ever??? i really enjoyed learning tap, and i hope to pick it back up in the future !!!!

- BIIIIIINCCH i had the opportunity to visit my sister in korea!!!!!!! wow.....truly the BEST week of my entire year, maybe even LIFE! i went to the dog cafe, the sheep cafe, mcountdown, the lunar festival kick off, gwanghwamun palace, dongdaemun, shopped a ton around hongdae, ate food by the han river, visited namsan tower (but not without getting lost), hit the noraebang TWICE, walked into a private Fantagio board meeting, ate delicious chicken on a STIIICK, ran in the rain, ordered delivery mcdonalds, had the BEST fried chicken, met a bunch of monks, was led around dongdaemun by a very old korean man, SAW EUNWOO AND DOYEON AND RECEIVED MUCH LOVE AND NEARLY DIED, hit the convenience store literally every day, snuck out, GOT A WAVE FROM KEY :((( , bought Winter Dream and lots of skin care products and lots of cute clothes, had the clearest skin ive ever had in my life, went to a buddhist temple, witnessed a drunk man fall into the splits inbetween the ground and the subway, ran up and down 1000 subway stairs, fell in love with a man named Peanut, drank too much banana and strawberry milk, sobbed my face off at the festival as korean grandmas bowed to me, tried tons of new foods (including the nastiest bowl of cheese ramyun ive ever had in my life), bought lots of socks, rode an airplane for......like 40 hours in total? literally the best week of my Life

- had my junior vocal recital ! it was a cute girl. i felt my acting had really improved since sophomore voice recital !! 

- had prom on my 17th birthday and had a jolly good time !!! my mom made my dress and i felt like a Stunner

- dream pt. 01...she rly is that Bad Bih. best era. miss her loads. none of us ever deserved her. 

- les mis !!!!!! two whole weeks.....another Best Time. i learned so much, made so many lifetime friends, had a blast, sang my heart out.....such a freaking good time. i miss her

- got to spend the ENTIRE summer with momo!!!!!!!!!!! literally the ENTIRE!!!!! and what did we do? hit the park, watched lemonade mouth and fantastic beasts and starstruck and that random unicorn movie, made the Best slime, made that ICONIC weki meki video, laughed a ton, cried a ton, stayed up all night for the sunrise, stayed later for the sunset & thunderstorm, walked home in the pouring rain & lightning (IT IS VERY WET), went to the beach, met many dogs, got me hairs cut, befriended that Cat, and went to a painting class

- cabin week !!!!!!!!!!! whatta lovely time

- my brother’s wedding !!!! honestly? my best outfit of the year... had a bangin time. his wife is truly a cutie and i love her tons!

- there was that Mess in august and i still feel sorry to those who felt hurt because of it. i learned a lot about how things especially on the internet can be easily misunderstood and misinterpreted, so u gotta be EXTRA careful with your words ! 

- through that i also came to accept that u cant get everyone to understand or like u, and tbh that is okay for now. all we can do when we make mistakes is try to understand & learn, apologize, and try to better ourselves. and sometimes even when u do that, u still may not be liked. and thats okay. as long as you are trying your best and recognize mistakes, its all good. 

-skinny dipped at girls time wow what a freaking TIME

- woah dude i dropped out of my arts school lmao!!! the BIGGEST change in my life since 2014.;..wow! i dont even have the words to say how much stress was lifted off of me and i love senior yr !!!!

- momo came to CT!!!!!! 

- seeing svt live !!!!! but tbh the best part was seeing momo, “I LOVE A MAN WHO CAN SEW”, “I!!!!!!!!!! LOVE!!!!!!!!!!!!!!!! JIHOON!!!!!!!!!!!!!!!!!”, “IM UNDERAGE”, and when Mo BLASTED to that other line

- LAKE COMPOUNCE LMAOOOOO I LOVE JIHOON PT2!!!!

- my mom, sister, and i took an eight week painting class! i finished two paintings and learned a ton!! honestly a good time

- dream pt. 02.....shes that other Bad Bih....absolutely adore her

- i also learned that its okay to cut people off who are toxic. especially if you have already informed them that they make u feel bad, they are not worth trying to please or keep around. take care of yourself. similarly, its okay to block people, and you dont owe them an explanation

- MADI CAME HOME !!!!!!!!!!!!!!!!! my other half...missed her so much :(((

- riley’s calligraphy christmas !!!!! was so much fun and i loved people’s reactions and i loved learning arohas favorite astro lyrics !!!

- ah...............one of the hardest weeks of my whole life. the pain still lingers, and i know itll hit me again like a boulder the next time we see only four of my angels standing on stage. for four months, i was worried sick about another member, and i even knew he was hurting, that his mental illness was real. my heart aches and there is a piece of it missing, but it will never be replaced. i know you are much happier now, jjong. i love you. 

- and also because of that, i have been able to think a lot about how i live my life. thoughts like ‘am i watching out for my family and friends enough?’ ‘am i listening enough?’ ‘is this funny comment worth it?’ ‘am i happy?’ im trying to be better. to not take things for granted, to only be kind, to always be there for those i love, for those who love me. and i will try my hardest to not complain about small or petty inconveniences. to try harder to be optimistic. 

- christmas was with my whole family for the first time in five years ;;; she was such a cute girl!

and now on to the next act !!!! its called RILEY’S NEW YEARS RESOLUTIONS !!!!!!!!!! 

1. lets start with the basic stuff that im 99% not gonna pull through on: keep ur room clean. keep everywhere u go clean, it makes mom upset. eat better, u know there is other foods in this house besides peanut butter and pepperoni and popcorn. 

2. send out at least one Lovely Ask per day. i made this goal sometime over the summer, and i did it for a few months until i started to forget ;; its not that hard, u just gotta remember to do it !! 

3. sis.....quit Procrastinating.......GET ur FREAKING application done...do ur homework the night before lmao! call who u need to !!! write those thank u cards!!!! go get them scholarships!!!! enter that graphic design contest lmao!!! just DO IT!!!!!!!!!!!! time is wasting

4. just be happy 

[aramkrikorian-blog]

10-9-2018

waking up. tired. rain. rain on the boots. the boots are torn. shoes. are wet. leather shoes. uncomfortable shoes. comfortable shoes. the daily walk. walking in uncomfortable shoes. ears clogged. not sick. ears jammed up. sticking fingers into ears with toilet paper when in the bathroom. library. salvation army. need to take a piss. need to take a shit. bathrooms. looking for bathrooms. embarassed. look like shit. haven’t showered in a bit. lighters are dead. no flame for cigarettes. the rain. it ruins the cigarette shorts i collect off the ground. talking to myself. not really. lots of people doing real life following. they want me to participate in interactive games with the audience. im not a star. im not taylor swift. she shouldn’t do politics yet. she doesn’t know what she’s talking about. democrats. republicans. green party. lame . parties. people. birthdays. rain. dogs. leashes. masters. slaves. negative conditioning. positive associations. flashbacks. larissa. lory. jessica. ashkhen. hasmig. who and what happened and where am i. did the babies really get aborted. are people messing with my mind. the information. is it true. not true. ears clogged. i can barely hear sarcastic remarks. god is watching over it all. proverbs. Better to live in a desert than with a quarrelsome and nagging wife. peacock in the desert. seattle. pike street. pike market. prospect park. GAR cemetary. ducks. weird tattoo store. weird tattoo aesthetic. cornish college. security guards. smoking cigarettes. asking for cigarettes. not comfortable. SEATAC. orcas. the oceans. pier 70. pier 66. starbucks. starbucks reserve. st james church. gospel mission. millinair club. tweakers. not that many. many or not. not known. know nobody. alone. thoughts. suicide. Virginia Mason hospital. lutheran church. food. food under the bridge. housing help. library on 4th street. newspapers. news. 90 minutes of internet time. homeless resource guide. backpack stolen. all work gone. no more work to look over. wanted a house on frontenac. didn’t get it. went to ferrari dealership - you say you’re a gangsta but you never popped nothing. you’re a real wanksta. songs. curses. nirvana. cause i’ve found god - rethinking what i said about kurt cobain. he is dangerously not well in Lithium. sounds llike the psychiatrists put pills in him and he blew his brains out or heroine or the pain of his wife... she breaks mirrors. weird flashbacks. lorys brother was administerered lithium wh en i was administered seroquel. psychopharma DEATH TOLL. bodies keep stacking. kurt cobain. lithium. lake washington blvd - curt cobains house. i didn’t know. i did a free navigation of the city. i felt things, bro. now i regret what i said about kurt cobain. lady was wearing a nirvana song list tshirt. bruce lee and brandon lee’s graves. crows. bible... scarecrows. 3-6 mafia lord infamous used to call me scaRECROW what is this... where am i. same motifs. same symbols. used by different people at different times. 1 big symbolic soup. trying to make sense of it. untangle it. which came first the word crow or pigeon. beautiful pigeons. appearance of pigeons in ones timeline over time. typing in the library. ‘the kind of kind guy that won’t take no for an answer’ - wanting to buy a house on frontenanc and give it to brent and tim ... tim gave me an umbrella. brent hooked it up with cigarettes - lighter. they were good guys. lyft people circling around. feel guilt and shame resentment everywhere. saved by the dell poster. PRIVATE PROPERTY everywhere - including the seattle sports stadium ... safeco field? seahawks lose to larams - kendrick lamar. lemurians of mt shasta. greyhound... buses. the animals. a great dane takes a fat piss on 700 7th ave...  the courthouse night, doing a speech. finding weed on ground smoking it. speaking at the school ... getting more weed. fed a larabar. ara. ara gets funding again in march. rosenstein is out? cohen is out? melania is in africa - visits a former slave in ghana. beautiful work. thank you mr and mrs trump. kushner? scooby dooby doo. airbnb ... valuations. memories. pains. people. upgrades and promotions. growth. new ideas. scholarships. college. essays. schools. making sure the kids are going to be safe. at least putting a line on the older ones and going to go back and ensure the road is well paved for the younger ones. newspaper room 6th floor. bathrooms on floor 7 of library also on floor 1... and maybe on 3 and 4.. .but not sure. haven’t been higher than floor 7 as far as i recall. lady in front of library - obese with lighter and cigarette - i ask her for a light she says “why are you chasing me?” - not a question. it is a question. it is something inside of a question. an accusation. a false accusation. a controversial, extremely controversial false accusation. it implies more. profile equivalent of a stalker. im not a stalker. a chaser. but i will become one if she wants me to. if the shoe fits ill wear it. or ill just wear it once and throw it away anyway. copy and paste this text and put it into a text to speech application and just listen to it ... let me know if it sounds good. borrow phrases from it. let it brainwash you. because it’s all real. really really really really real. kim and kanye. blessings. armenians. what the heck. little children in library walking around... happy looking. global warming. will it kill all the little children that look so innocent to my eye. and to my eye the world looks ok. but to the instruments... they’re reading something else. that’s how gas kills doesn’t it... it didn’t smell. it just killed. mount olympia. sculpture garden at the pier has a lot of gardners but a lot more dog shit. its impossible to sit in the grass. there was SO MUCH dog shit there. mcdonalds sued for a million dollars. dont do it. all these ridiculous articles on Medium. i joined medium but i cant even press a button to write. ridiculous. double daniels. daniel lives here. so does erin treg. ill try to not mention too many names i guess. maybe they can comment on posts and take them out. fuck ilya golub. fuck olga. fuck all those people. nikolai and m8s and ara and etc etc. let them live their lives but these are weenie people. someone should keep a permanent weenie hat on their heads. stop stuffing dicks into everyones head aram. stop it. note to self. exercise more discipline in the language that i use. lockwood... he was an author who blew his braINS OUT. but he was typing like an animal in the family garage. he released a book. i wish one day i can get back to literature reading again. i miss pynchon. i miss delillo. did they write any new books. are they still alive? im going to check google right now and trust the answer. dellilo alive. i heard roth died. 5-22-2018. wow . the number 22. number of hebrew characters in the alphabet. the number of arab league countries. 22 is a heptagonal number. which means 7 sided polygon number. who knows what that means. its just important. who knows. philip roth died on 5 - 22 - 2018. wow. i miss his work. american paradise or something or portnoy’s complaint. who was that guy. i remember being in oregon 4 years ago and digging deep into literature. is my brother dead? did shant eat a heroine shot? people on the bus were saying weird things. is my father dead? i don’t even know. i remember jolie writing things on the wall. like prophecy that turned into reality. maybe the whole thing was a joke. the name. keith. she used names. she said things. JR JR JR> what is JR.. it’s on the inside of larissa lip . who knows. maybe real or not. nick. wtf. heroine. fresno. people talking to me. gangs this that. greatful dead family. where are we. what is this. acid. meth. heroine. crack brillo pads. what is all this. what happened. where is everyone. dope shooters. not a lot of people left around - “ Cage The Elephant - Shake Me Down - YouTube “ urban dictionary. JR> some caring guy. larissa’s boyfriend. hope they’re still together. been talking out loud to her. sometimes i feel her. saw a lookalike of Lory. or i actually saw lory. maybe when larissa and i were in santa cruz.. we were being watched and played for fools. she kept saying she saw nicole. the aramark logo. the mark from seattle. the people out there. here. chris while. erin triggie. daniel ex of jessica. who knows what people do. say. where am i. what has happened to me. how am i homeless. what is this. what happened to me. i used to be an OG. lol. what am i now. can i even handle it. unlikely candidate. why do people even half respect me. what is going on. scholarships. colleges. high school kids applying for colleges. stanford early application this year is november 1... and the regular is january 2. i remember 2004 applying for fafsa and all that. scholarships. this that. getting accepted. man. SAT scores are still going. its insane how out of touch you get despite trying hardest to stay in touch. eventually the kids evict you themselves. couple library rats tried to trade me bluetooth headset for some molly in front of library and for some crystal. i said no to both. i saw mad guy tweaking dancing fuckin hard at millionair club today - i looked at him and said “brother i love you so i dont want to see you here, like this, ok?” - where is HOMIE RESCUE TEAM - what are we going to do? should we just laugh at this guy. should we just let him die off. should we kill him? what do you think? i have to read news... china and america. usa. and china. and korea. and russia. and some games and calm down and 110 billion dollar pump into USA. turkey and saudi arabia ... and pushing and shoving and ghana and america visits and angola 500 million president running to london who knows... where are we.. like flies buzzing around on The Blue Marble. what happened to sitting at home and enjoying one another in peace. where is my wife. why do i call her my wife. im forgiving people. im rescuing people. im saying im going to quit cigarettes. people look so shady. they look so protective over their assets. ive lost more than i think or know or can count or i dont know whats going on. 

i wanted a ferrari 812 a portofino i saw was pretty i like the color rosso and i wanted a 488 spider and a home on frontenac and i wanted a powerboat like 70 footer or 77′ and i wanted to go to bahamas or caribbean and have sex with my wife and procreate and have children and relax and sleep and rest and have a home on 18 acres in snoquamish and all that stuff and have a Dodge ram 2500 

just read about Satyrs for the first time. rams and satyrs and greece and dionysus and debauchery and Pan and apollo and challenging gods and losing and winning and secretive & lustful and wanting to fuck and permanent erection (piss boner) - very interesting. 

also very interesting is the PT Barnum effect ... basically .. .have you ever had a boner? have you ever wanted to have sex with many women? have you ever flirted with a woman? h ave you ever challenged someone bigger than your own size (like David?) - who knows. Ram. Aram. Random Access Memory. bighorn ram. it was in a shooting game i played on hunting game on computer a long time ago. 

gods .. shoot downs. being destroyed. FLAYED Alive. the Flaying of Tarsus. hubris. arrogance. humility. cold. hot. 

there is this fucking idiot laughing in the library. this fucking tool idiot. he is in the library and he laughs like a clown. i wish joe pesci were here so he can jam and smash on the guy. but he’s not so if i do it. in front of the cameras. it will pr;obably get me into some sort of toruble. who knows. anyway. 

iris murdoch. philip roth. thomas pynchon. all these people. time passes. pynchon delillo still alive still kicking. 

birth days were the worst days. slowly getting over the doldrums. what is it called. weighing yourself down . idioms. expressions. the power of idioms. lists of idioms. lists of ethnic slurs. lists of sociological terms. lists of profiling terms. lists of lists. endless lists of words and referrents and objects and feelings. 

Jimmy hendrix park seattle. the numbered avenues. Ballard. the draw bridges. the seaplanes. the boeing. the SAM . art museum. the fountains. the trees and parks. the lake washington. the lake union. the puget sound. the alaskan viaduct project. 4 months. all the little pieces of seattle. the 4 seasons. the goldfinch bar. the bars. the loyal inn. mark matthews park. he was a presbyterian minister. here we are. some guy still laughing so i told him to shut up bro that hes fucking annoying. then another guy joins in... he does a little goat laugh. so i fucken do a sheep laugh too. fuck these guys. play whack a mole all day. 

seattle is amazing. minus these idiots in it. can someone genocide them. or get rid of their bodies tonight and feed them to the orcas k25 and k13 ? .. k13 is dead. k25 is getting skinny. 

The latest official count is 77 orcas among the three pods. That reflects the death of K-13, a 45-year old female named Skagit.

the count of orcas is 77 orcas. i wanted a 77 or 70 foot yacht. i wanted to call it Septuagint. there are al ot of 7s in the bible. 

oh Gosh. oh man. david reigned for 7 years 6 months. 76. 67.  6s and 7s. 42s. wow. and 7 male descendants of Saul hung before the lord. 7s. the 7 times 77 forgiveness.. yesterday the sevenfold punishments in leviticus. i like stuff like this alot. 

7 for all mankind - i remember such days. the time is 12:12 Pm on 10/9/2018. 

who knows these things ... the Lord is playing on all tracks concurrently. im less annoyed. i see all these defective personas in one day. i dont know why. but its getting better. people getting chin checked. a lot of people getting tagged. 

the rats are getting smashed on worldwide. Meng. etc etc. interpol. this that. internationally. locally, domestically. the Great Awakenings. when we enter into slumbers and turn into zombies turn into psychic vampires. we need to clean the algae every once in a while or else there’s just bodies and piles of bodies of humans. we dont really care about the dead of the past. we really dont’ give a shit or dedicate any time to remembering or researching the dead of the past. a list of wars by death toll. largest natural disasters by death toll. 

to have faith. to try to pray to God. to say im not here to destroy the catholic church. people say and come up with the worst and weirdest things. if you can only see this writing post you will see i hop around so many places. 

a poison dart frog, a dog, a porcupine, a snake, a cow - i’ve been compared to such animals. after a while all the terms of endearment eventually get to me.. its annoying its not cute. people speak they did the worst things to me and im pretty done for trying to recover. maybe i will maybe i wont maybe someone will kill me or ill magically die.. it wont matter - i see that kurt cobain and bruce and brandon and jimmi hendrix theryre all dead and the stars are all dead the “stars” ... revelation says 

Revelation 6:13 and the stars of the sky fell to the earth, like unripe figs

and the woman and the dragon and the red dragon ... and ir ead revelation and imagined myself as satan last year but i dont think so. i think the others are satan becasue they twisted my brains in and out.. and i cant wait for the rest of revelation to be carried out so that i can witness the end of the world. im very tired of how twisted and disgusting things have become.. im not just angry or wrathful.. i would like to actually see the end of the world... i would like to see Jesus im going to try and be ok until that happens. .. and its so sad that people are just.. .its so sad. 

https://www.biblegateway.com/passage/?search=Revelation+12&version=NKJV

love, 

aram krikorian

[titheguerrero]

Follow the Money: Non-Profit Hospital CEOs Quietly Collect Their Millions While US Health Care Reform Battle Rages

In Washington, DC the health care policy wars continue, with a few Republican senators working behind closed doors on a bill to "repeal and replace" Obamacare, aka the Affordable Care Act, and Democrats decrying their secrecy.  Just as during the era in which Obamacare was enacted, there is constant discusison of how US health care costs continually rise, driving up insurance premiums, and how access to health insurance is continually in peril. However, while the current Republican process to write new legislation seems strikingly opaque, in neither era has there been a frank discussion of why US health care costs are so amazingly high, and disproportionate to our mediocre health care outcomes. In particular, there has hardly been any discussion of just who benefits from the rising costs, and how their growing wealth may impede any real cost-cutting measures. Extreme Compensation for Top Managers of Non-Profit Hospitals An obvious example is the gravity defying pay given to top health care managers, particularly the top managers of non-profit hospital systems. Such systems provide much of the hospital care to Americans, and most have declared their missions to be providing the best possible care to all patients, or words to that effect.  Many explicitly include care of the poor, unfortunate and vulnerable as a major part of their missions.  As non-profit organizations, their devotion of mission provides some rationale to their freedom from responsibility for federal taxes. As we last discussed in detail in May, 2016, we have suggested that the ability of top managers to command ever increasing pay uncorrelated with their organizations' contributions to patients' or the public's health, and often despite major organizational shortcomings indicates fundamental structural problems with US health, and provides perverse incentives for these managers to defend the current system, no matter how bad its dysfunction. In particular, we have written a series of posts about the lack of logical justification for huge executive  compensation by non-profit hospitals and hospital systems.  When journalists inquire why the pay of a particular leader is so high, the leader, his or her public relations spokespeople, or hospital trustees can be relied on to cite the same now hackneyed talking points. As I wrote in 2015,  and in May, 2016, It seems nearly every attempt made to defend the outsize compensation given hospital and health system executives involves the same arguments, thus suggesting they are talking points, possibly crafted as a public relations ploy. We first listed the talking points here, and then provided additional examples of their use. here, here here, here, here, and here, here and here.  They are: - We have to pay competitive rates - We have to pay enough to retain at least competent executives, given how hard it is to be an executive - Our executives are not merely competitive, but brilliant (and have to be to do such a difficult job). Yet as we discussed recently, these talking points are easily debunked.  Additionally, rarely do those who mouth the talking points in support of a particular leader provide any evidence to support their applicability to that leader. But since May, 2016, we have steadily accumulated more stories about million-dollar plus pay for CEOs and other top managers of non-profit hospitals and hospital systems.  The reports may be shorter than they used to be, as journalism comes under economic and other attack, and as more journalistic resources go to cover the current president.  Here are some examples, in chronologic order per the date of the published article, rather telegraphically. Examples of High Executive Pay Boston, Massachusetts area, August, 2016 (Per the Boston Business Journal) Brigham and Women's Hospital CEO Dr Elizabeth Nabel, total compensation $5.5 million in 2014, 20% higher than 2013.  Talking points =  brilliant: "committed to retaining a team of top professionals," per Edward Lawrence, Chair, Partners Board of Trustees Tufts Medical CEO Dr Michael Wagner, $1.1 million, 82% increase. UMass Memorial Medical Center CEO Dr Eric Dickson, $1.6 million, 74% increase, Patrick Muldoon, President UMass Memorial Center's biggest hospital, $1.2 million, 67% increase West New York State, August, 2016 (Per the Buffalo News) Catholic Health System CEO Joseph D McDonald, $1.4 million. Roswell Park Cancer Institute CEO Candace S Johnson, $1 million Kaleida Health CEO Jody L Lomeo, $1 million: Talking points = brilliant "few executives have the required skill set and experience to fill these posts" New Jersey, September, 2016 (Per NJ Advance Media) Top 10 hospital CEOs received total compensation from $1.94 million to $4.7 million New Orleans, Lousisiana, September, 2016 (Per the Times-Picayune) Ochsner Health System former CEO and board chair Dr Patrick Quinlan, $3.3 million in 2014, current CEO and board member Warner Thomas, $1.49 million.  Talking points = competitive rates and brilliant: "we must compete nationally to recruit top talent" Touro Infirmary CEO James Montgomery, $1.3 million Children's Hospital Inc Chief Medical Officer Alan Robson, $1.26 million General talking points = competitive rates: "you're looking to attract hospital executives from Californai or New York where they're paid a lot of money" Gastonia, North Carolina, February, 2017 (Per the Gaston Gazette) CaroMont CEO Doug Luckett, $1.03 million in 2015.  Talking points = retain and brilliant "paying what it takes to ensure they attract and retain top-level talent that can help provide premiums health care" Dayton, Ohio, March, 2017 (Per the Dayton Daily News) Kettering Health System CEO Fred Manchur, $1.65 million in 2015, former president Terri Day, $1.23 million, current president Roy Chew, $1.07 million Premier Health former CEO James Pancoast, $1.42 milllion (excluding retirement payments) in 2015. Talking points = brilliant "you've got one person at the top who's trying to provide oversight, direction, and strategy.  At the same time, health care continues to grow in scope, complexity, regulation, and compliance." York County, Pennsylvania, April, 2017 (Per the York Daily Record) WellSpan Health president Kevin Mosser, $1.6 million in 2014.  Talking points = competitive rates Forrest Brisco, associate professor, Penn State Smeal College of Business, "nonprofit hospitals are competing with for-profit hospitals"; brilliant: "If you are at the top of a health care organization, you're going to have pay that's higher than many members of the organization. The the skill and knowledge to understand and interact with surgeons and physicians can command a high salary" [ed note: which often seems higher than those of some surgeons and physicians, though]; also brilliant: Robert Batory, senior vice-president and chief human resources officer, Wellspan, "Kevin has 24/7 responsibility for Wellspan." Ephrata Community Hospital (WellSpan subsidiary) CEO  and WellSpan Medical Group (WellSpan subisidiary) CEO  "more than $1 million" Winston-Salem, North Carolina, May, 2017 (Per the Winston-Salem Journal) Novant Health Inc CEO Carl Armato, $1.31 million in 2015.  Talking points = retain and brilliant "high compensation levels are necessary to recruit and retain executive to run a 'very complex organization'" Tri-Cities region, Tennessee and Virginia, June, 2017 (Per WJHL) Wellmont Health System CEO Bart Hove, $1.4 million in 2015.  Talking points = competitive rates: Wellmont board of trustees chair Roger Leonard, "we have to compete on a national level and we're competing not just with other non-profits, but we're competing with other for-profits" Mountain States Health Alliance CEO Alan Levine, $1.3 million in 2015. Talking points = competitive rates: HSHA board of trustees chair Barbara Allen, "make sure CEO pay is comparable to similarly sized facilities across the country with similar complexities"; retain and brilliant, "we want to attract the best talent ... and be able to retain him." Connecticut, June, 2017 (Per the Connecticut Post) Yale New Haven Health System CEO Marna Borgstrom, $3.8 million in 2015.  Nine other employees paid over $1 million, including Bridgeport Hospital CEO William Jennings, $1.5 million, Greenwich Hospital CEO Norman Roth, $1.3 million.  Talking points = brilliant: Yale senior vice president of public affairs, "Yale New Haven Health is the largest and most complex health system in the state." Also, a total of 39 people, including the above, received over $1 million in 2016. General talking points = brilliant: "there are a limited number of executives experienced enough to guide a state-of-the-art hospital and growing healthcare system in an increasingly competitive and complex industry"; competitive rates: "pay and benefits for such executives need to be comparable to what they could receive at another leading national hospital system or another industry"      Summary and Conclusions The current inflamed discussion of "Obamacare" and Republican attempts to "repeal and replace" it focuses on the costs of care and how they affect individual patients.  Examples include concerns about health insurance premiums that are or could be unaffordable for the typical person; insurance that fails to cover many costs, and thus may leave patients at risk of bankruptcy due to severe illness; poor people unable to or who might become unable to obtain any insurance, and perhaps any health care.  Yet there is little discussion of what really drives high and ever increasing health care costs (while quality of health care remains mediocre). That may be because those who are benefiting the most from the status quo want to prevent discussion of their role.  There are many such people, but top management of non-profit hospitals provide a ready example.  Their institutions' mission is to provide care to sick patients.  Many such hospitals specifically pledge to provide care to the poor, vulnerable, and disadvantaged.  Non-profit hospitals have no owners or stockholders to whom they owe revenue. Yet these days the top executives of non-profit hospitals receive enough money to become rich. See the examples above.  The justification for such compensation is pretty thin.  Consider the talking points above.  Apparently hospitals are extremely concerned about paying top management enough to recruit and retain them.  Yet there is much less evident concern about paying a lot of money to recruit and retain the health care professionals who actually take care of patients to fulfil the hospitals' mission.  Hospital CEOs are frequently proclaimed to be brilliant, visionaries, or at least incredibly hard workers with very complex jobs.  I wonder if those who make such proclamations have any idea what it takes to be a good physician or a good nurse.  Yet such health care professionals' hard work, long training, devotion to duty, and ability to deal with trying situations and make hard decisions rarely inspire hospitals to shower them with money. Furthermore, hospital CEO compensation is almost never justified in terms of their ability to uphold and advance the fundamental hospital mission, taking care of sick people.  The articles above do not contain any justifications of generous CEO compensation based on hospitals' clinical performance or health care outcomes.  At best, hospital executive pay seems to be justified by the hospitals' financial, not clinical performance. So why do non-profit hospital CEOs get paid enough to become rich?  Apparently, because they can. As we discussed here, there is a strong argument that huge executive compensation is more a function of executives' political influence within the organization than their brilliance or the likelihood they are likely to be fickle and jump ship for even bigger pay.  This influence is partially generated by their control over their institutions' marketers, public relations flacks, and lawyers.  It is partially generated by their control over the make up of the boards of trustees who are supposed to exert governance, especially when these boards are subject to conflicts of interest and  are stacked with hired managers of other organizations. Furthermore, such pay may provide perverse incentives to grow hospital systems to achieve market domination, raise charges, and increase administrative bloat.  As an op-ed in US News and World Report put it about executive pay in general,

But the executive pay decisions made inside corporate boardrooms have an enormous impact in the outside world. Outrageous pay gives top executives an incentive to behave outrageously. To hit the pay jackpot, they'll do most anything. They'll outsource and downsize and make all sorts of reckless decisions that pump up the short-term corporate bottom line at the expense of long-term prosperity and stability.

So I get to recycle my conclusions from many previous posts.... We will not make any progress reducing current health care dysfunction if we cannot have an honest conversation about what causes it and who profits from it.  In a democracy, we depend on journalists and the news media to provide the information needed to inform such a discussion.  When the news media becomes an outlet for  propaganda in support of the status quo, the anechoic effect is magnified, honest discussion is inhibited, and out democracy is further damaged. True health care reform requires publicizing who benefits most from the current dysfunction, and how and why.  But it is painfully obvious that the people who have gotten so rich from the current status quo will use every tool at their disposal, paying for them with the money they have extracted from patients and taxpayers, to defend their position.  It will take grit, persistence, and courage to persevere in the cause of better health for patients and the public.  And for our musical interlude, the beginning of "For the Love of Money," sung by the O'Jays, used in the official intro of season 2 of guess what show?

Article source:Health Care Renewal