Everything Is Broken

Mission Statement

1. Hospitals. Non-profit hospitals were granted tax exemption on the condition that they treat patients who could not pay. In 1969 the IRS dropped that condition and replaced it with a vague "community benefit" standard under which, in the IRS's own words, "an explicit level of charity care is no longer required." The result: in 2021 nonprofit hospitals received $37.4 billion in tax benefits and provided $15.2 billion in charity care. A Johns Hopkins study found that in 2018 nonprofit hospitals as a group spent 2.3 percent of total expenses on charity care; a separate study of 2011-2018 put the value of their exemption at 4.3 percent of total expenses. (This report, using IRS filings for fiscal years 2024-2025, finds a median of 1.23 percent for systems over $1 billion.) Every one of them reports these numbers to the IRS each year, and the IRS told the Government Accountability Office in 2020 that it had not revoked a single hospital's exemption for insufficient community benefit in the previous ten years. These institutions no longer serve the public. They serve themselves, and the IRS subsidizes it.
2. Regulators. Federal and state regulatory agencies, once the envy of the world, have been captured by the industries they regulate. The FAA let Boeing certify its own 737 MAX. Two-thirds of the FDA's budget for reviewing human drugs now comes from fees paid by the drug companies themselves. The job has shifted from protecting consumers and competition to protecting the largest corporations, the ones that can pay the most to lobbyists.
3. Corporations. For most of the postwar era, American companies ran pensions, funded research labs like Bell Labs and Xerox PARC, and paid CEOs 21 times what a typical worker made. That model is gone. The dominant one now is extraction: private equity stripped Sears, Toys R Us, and Red Lobster and left the shells. Boeing spent more than $40 billion on stock buybacks in the six years before the MAX crashes. In 2024, CEOs made 281 times the typical worker, and they are paid in stock, so they manage the share price, not the company, and take as much as they can as fast as they can.
4. Media. Trust in the news media is at a record low. In 2025, 28 percent of Americans said they trust it, down from nearly 70 percent in the 1970s. Audiences have split into separate information worlds, each with its own outlets, and no major news organization is trusted across the country anymore. Whatever you think of the cause, the institution that was supposed to give the country a shared set of facts no longer does.
5. Congress. Congress has passed all of its spending bills on time four times in fifty years, and not once since 1996. It now governs by continuing resolution and shutdown deadline. As of April 2026, 10 percent of Americans approve of the job it is doing. The branch the Constitution put first barely legislates.
6. Checks on the Presidency. The separation of powers held for two centuries. It is now eroding, and both parties did the eroding. Under Bush, the government claimed the power to hold American citizens indefinitely without trial, and did it to Jose Padilla and Yaser Hamdi (Rumsfeld v. Padilla, 542 U.S. 426 (2004); Hamdi v. Rumsfeld, 542 U.S. 507 (2004)). Under Obama, it claimed the power to kill an American citizen without trial, and did it to Anwar al-Awlaki in 2011. Under Trump the Supreme Court granted presidents broad immunity for official acts (Trump v. United States, 603 U.S. 593 (2024)), and the White House now fires heads of independent agencies, withholds funds Congress appropriated, and imposes tariffs by emergency declaration. Each president keeps what the last one took, and neither Congress nor the courts take it back.
7. Credit rating agencies. Until the 1970s, investors paid for credit ratings, so the agencies worked for the people relying on them. Then Moody's, S&P, and Fitch switched to charging the issuers of the debt they rate. The result arrived in 2008, when they rated the mortgage securities that caused the crisis AAA. Nothing about that arrangement has changed. The same three firms still grade the debt, and the issuers still pay them.
8. Civic life. The institutions that held ordinary American life together are emptying out. In 1937, 73 percent of Americans belonged to a church, synagogue, or mosque, and the number stayed near 70 percent for six decades. In 2020 it fell below half for the first time, to 47 percent. In 1983, one in five workers belonged to a union. Today it is one in ten, and in the private sector one in seventeen. These institutions were not captured. People left them, because they stopped delivering.