Also related: Memory Hole: Why the Nation Doesn't Need Massachusetts Health Care
That's why our costs are so high.
"Much is given by hospitals, more is asked; Nonprofits reaping more in tax breaks than they report in charity work. Some say that must change" by Scott Allen and Marcella Bombardieri, Globe Staff | May 31, 2009
Another special report that went down said Memory Hole.
In 1817, hospitals served patients too poor to afford a doctor's house call, so the wealthy had little incentive to support them.
We have gone backwards, Bay State?
To cut costs, the Legislature ordered prison inmates to quarry the gray granite blocks that went into Massachusetts General Hospital's walls.
Sigh. The more I find out about my lovely "liberal" home the more heartbroken I am. This is nothing like the myth I was fed and grew up with about Massachushitts.
Today, glass-and-steel medical towers dwarf that first building, a campus befitting the flagship hospital of Massachusetts' largest healthcare company. But one thing at Mass. General remains much as it was in the 19th century: The hospital, like most in Massachusetts, is taxed as a nonprofit charity - which means it's hardly taxed at all.
Nonprofit hospitals are popular institutions, especially in Boston, home to seven major tax-exempt teaching hospitals that attract billions in federal research grants and patients from around the world.
So tax dollars are supporting care for elites while you get no kickback, taxpayers.
Mass. General's parent, Partners HealthCare, is not only the state's number one private employer, but one of its most successful companies, with an investment portfolio valued at more than $4 billion.
And they are charging us THREE TIMES the amount for HEALTH CARE!
However, as hospitals have prospered and grown, so too has the value of the breaks on state, federal, sales, and property taxes they enjoy as charities.
I do need to see a doctor because the anger in the belly is here again!
And that fact has triggered a growing debate, among policy makers and politicians, about whether the public is still getting its money's worth from an exemption that dates to the 19th century and was created to encourage hospitals to treat the poor.
Where is the debate? The answer to the public is no, of course. Always is when it comes to what government and industry do for you.
Today, in fact, the value of tax exemption far exceeds the amount the state's leading hospitals spend on free care for the poor and other community benefits they report annually to the attorney general, a Globe review has found.
You are getting took again, citizens and taxpayers!
What's more, hospital spending on free care is declining because of the state's 2006 healthcare reforms.
Sigh.
Today, hospitals typically spend about 1 percent of expenses on free medical care, as measured by the attorney general, half of what they spent before reform made insurance available to many more low-income people.
The gap between tax benefits and charity care varies widely among hospitals. The gap is widest at the most prosperous hospital companies.
You know where that money is going, huh? Is bulging pockets of tax loot an illness?
And some less profitable institutions actually spend more on charity than they save on taxes....
Determining how much charity is enough has been difficult because no one - not even the Internal Revenue Service - had calculated how much hospitals save from not paying taxes.
Maybe they better start: Money Monday: The Power of the IRS
With the help of authorities in nonprofit healthcare and management, this report aims to fill that gap.
The tax break numbers are large.
The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available.
Did you get a state discount on your loan -- if you could get one -- 'murkn?
More than half of that goes to two large and growing companies, Partners and Children's Hospital. Overall, the 10 hospital companies' tax breaks and other benefits were worth $264 million more than the value of the "community benefits" - care for the poor and other charity work - they reported to the state attorney general that year.
The rewards of tax-exempt status have helped to keep some of these hospitals on solid fiscal footing; five of the top 10 are expanding. But as governments face yawning budget deficits and state leaders question whether they can continue to afford healthcare reform, some officials are asking whether the most affluent hospitals should do more either in the form of payments to government in place of taxes or increased charity work.
Yup, YOUR NATIONAL MODEL, AmeriKa!!!!!
US Senator Charles Grassley of Iowa, the senior Republican on the Finance Committee, believes federal regulations may be needed to ensure that nonprofit hospitals are required to do more charity work than their profit-making peers.
"I want the IRS to go back and establish a difference so we can have the expectation that if you're a nonprofit and you get these [tax] benefits, you ought to serve the public adequately," Grassley told the Globe.
State Inspector General Gregory W. Sullivan thinks the issue needs examining at the state level, as well.
"There comes a point where the value of the tax break becomes so large that the question is whether it's justified," said Sullivan, who has made controlling healthcare costs one of his main issues. "The time is right for the Commonwealth of Massachusetts to objectively and comprehensively examine the total tax breaks that are being provided to nonprofits in healthcare versus the community benefits."
I'm so sick of official BS, I really am.
Oh, yeah, never saw another word.
Grassley and Sullivan have company in thinking that it's time for a thoughtful look at the public responsibilities of charity hospitals in the 21st century. Ever since the creation of government-funded programs to pay for medical treatment of the poor and the elderly in the 1960s, taxpayers have assumed the primary burden of paying for care of indigent patients, undercutting the historic justification for exempting hospitals from taxation.
So RON PAUL is RIGHT about government care after all.
Meanwhile, the hospital business has exploded, especially for elite teaching hospitals, which increasingly have been expanding into the suburbs. The value of Partners' property and investments, for example, more than doubled from 2001 to 2007, and the company is now in the midst of the costliest expansion program in state history. Partners reported making $119 million from the operations of its hospitals in 2008, a modest increase over 2007, but the profits were more than offset by heavy losses in the stock market.
Don't worry, they made that up at the end of this year.
Neither Sullivan nor any other influential figure in Massachusetts is calling for an end to the hospitals' tax exemption, but it is revealing to examine what it would mean if the state's 61 charity hospitals were run by for-profit companies.
And they never did. That is why this was a one-day wonder, 'eh, Globe?
All their growth over the last decade would have yielded government revenue as well.
That means YOU would have RECEIVED HELP and a LESSENING of the BURDEN, taxpayers. But, no.
The hospitals would have paid increasing state sales taxes as they purchased ever-greater volumes of supplies, more city taxes as they expanded, more state and federal income taxes as they generated large surpluses through much of the last decade. Instead, they pay none of these taxes aside from modest lump sum payments to local governments in place of property taxes.
Cash-strapped governments are eager to get more help from affluent tax-exempt organizations, especially in Boston where governments and nonprofit hospitals and schools own half the land....
On Beacon Hill, meanwhile, State Representative Michael J. Moran, a Democrat from Allston-Brighton, has 16 cosponsors for a bill that would allow cities and towns to collect up to 25 percent of the property tax bill from nonprofits of all kinds. However, his is not among the major tax proposals now under debate in the Legislature.
"Not one of us wants to hurt the soup kitchen or the homeless shelter, but when I see stories about billions and billions being amassed by nonprofits and properties being bought all over the place, that's not what people think of when they think of charities," explained Moran.
You SEE WHAT is GOING ON with your "charities," readers.
You know, CHARITY BEGINS at HOME, America!!
I mean, LOOK at where the $$$$ is GOING!!!
To estimate the value of tax exemption, the Globe assembled detailed financial data on the leading nonprofit hospitals from company filings, state reports, and municipal property records. Then, with the aid of Harvard School of Public Health management professor Nancy Kane and Tom McLaughlin, a nationally recognized authority on nonprofit management, the Globe calculated what the hospital companies would have paid in taxes in 2007, if they had not enjoyed exempt status.
Without the exemption, the 10 leading hospital companies would have paid about:
*********************
In addition, the hospitals greatly benefited from their eligibility, as nonprofit charities, to receive tax-deductible gifts. Collectively, they received more than $500 million in gifts in 2007, from donors who were able to reduce their federal income taxes by $100 million to $150 million by deducting their contributions.
Time to SCRAP the INCOME TAX COMPLETELY!!!
AmeriKans are TAXED WAY TOO MUCH for WASTE, THEFT, FRAUD, and TYRANNY!!!!
The benefits of tax exemption aren't spread evenly. Three companies - Tufts Medical Center, UMass Memorial Health Care (owner of UMass Memorial Medical Center in Worcester) and Boston Medical Center - reported spending more on community benefits than the value of their tax breaks as estimated by the Globe.
Is that why BMC is suing the state for underpayment?
Two others, Baystate Health (owner of Baystate Medical Center in Springfield) and Caritas Christi Health Care, received just slightly more in tax benefits than they paid in community benefits.
Not like we don't deserve it, but....
The other five - Partners, Children's, Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, and Lahey Clinic - accounted for 75 percent of the tax breaks. Together, the five saved more than twice as much from tax exemption as they reported in charity work to the attorney general.
Yeah, I'm not feeling guilty at all.
These are, necessarily, estimates. Tax law is complex and nonprofit hospitals would, like other businesses, adjust their finances to minimize taxes if they were not tax-exempt.
So you are f***ed, Bay State.
But most of the hospitals agreed that the Globe's figures, and the means used to calculate them, are reasonable and close to their own internal estimates. All 10 companies received detailed briefings on the Globe's findings, and eight offered no objection.
The main objections to the estimates came from the two hospital companies that benefit the most from tax-exempt status.
Partners HealthCare received at least $271 million in tax breaks and savings from low-interest state financing in 2007. That's twice as much as any other hospital company, the Globe estimated. Moreover, the value of Partners' benefit from exemption nearly tripled from 2001 to 2007.
The second-biggest beneficiary of such tax breaks, Children's Hospital, has seen its savings from tax exemption more than quadruple during the same period - to $131 million - as profits grew, the Globe review found. Like Partners, Children's is pushing ahead with major expansion during the recession, though scaled back somewhat from pre-recession plans.
I need the health care because I'm feeling sick.
Partners executives said the Globe estimate of tax savings was incorrect, though they declined to say whether the figures were too high or too low despite repeated requests for clarification. Company officials would say only that they disagreed with the Globe numbers on four of the five major taxes.
Children's officials put the value of their tax exemption at $41.9 million - less than one-third of the Globe estimate - mainly because Children's doesn't count taxes on the income of its parent company, which handles the hospital's fund-raising, real estate deals, and drug royalties, and manages the hospital's $2 billion endowment fund.
Why are hospitals involved in all that crap?
The parent company, which is also nonprofit, reported $241 million in net income in 2007. Only about 20 percent of that income was turned over to the hospital with the rest invested in stocks and other financial instruments.
Children's officials say the parent company's earnings should not be considered profit, but as a reserve fund for difficult times such as the present recession....
However, others say Children's parent company should be included in any analysis of the company's savings from tax exemption, since the parent generates an enormous surplus of revenue that a private company would be taxed on....
Whatever objections hospitals have raised in the details, the trend lines are clear: The value of tax exemption to hospitals has risen rapidly over the last decade even as hospital spending on free care has dropped fast in recent years - down 20 percent at the top 10 hospital companies in 2008 alone.
That's a sensitive subject for hospitals, many of which have earned a reputation for charitable works, and on a large scale. Massachusetts nonprofit hospitals provide more than $500 million in free care and other charity that they voluntarily report to the attorney general each year. No hospital spends more than Partners, which provides services ranging from jobs and scholarships for East Boston High School students to funding community health centers around the city. The Boston Business Journal ranked Partners the fifth-largest charity in the metropolitan area in 2007 measured by the cash gifts it makes to a host of local agencies.
After they tripled-charged us for same services. Nice guys.
"They are our de facto human services department here," said Jay Ash, Chelsea's city manager. "I'd be lost without them."
We are lost with 'em!
However, the combined value of Partners' charitable work in 2007, $151.4 million, is $120 million less than the value of Partners' tax breaks and interest discounts, as calculated by the Globe. That's a big swing from 2001, when Partners reported spending more on community benefits than it got back in tax breaks.
So they get the exemption and breaks, make a good first impression, and then lot, loot, loot!
Children's Hospital also runs a highly regarded charity program, but its cost is $96 million less than the Globe's estimate of savings from not paying taxes.
Nonprofit hospital officials say the attorney general's charity reporting system is too narrow and that they should get credit for other good deeds such as seeking cures for disease and treating low-income patients who are covered by government insurance that does not pay them the full cost of their services. Virtually every hospital contacted by the Globe pointed to some combination of activities that could be called "community benefits" and that added up to more than their tax breaks.
Using a new community benefits reporting form developed by the IRS, Partners listed $817 million in community benefits, more than triple the amount the company saves in tax benefits. Similarly, Children's Hospital estimated its community benefits at $79 million, more than twice the amount tallied by the attorney general.
However, the IRS reporting system is intended more as a broad survey of hospitals' activities rather than a rigorous accounting of how hospitals justify their tax exemption. The IRS allows hospitals to count some big-ticket categories of "charity" without taking into consideration the financial benefit they get in return.
Partners, for example, contends that it lost $135 million on scientific research in 2007 under the IRS reporting system. But that does not take into account a $207 million royalty payment the company received for research that led to the development of an arthritis drug, Enbrel....
Massachusetts made history in 2006 when Governor Mitt Romney signed healthcare reform into law, but not just because it became the first state to mandate that almost every citizen have insurance.
Unconstitutional, but who cares about a piece of paper?
In vastly reducing the ranks of the uninsured, the measure also marked a historic shift of responsibility for medical care of the poor.
Partners, the leading industry player in crafting the law, spent $400,000 over two years lobbying for healthcare reform, an effort led by John Sasso, the former adviser to John F. Kerry and Michael Dukakis known for his extraordinary clout on Beacon Hill.
Interesting: The Perils of One-Party Politics: Massachusetts' Democracy
Yeah, that's Massachushitts democracy for you.
In the end, Partners' chairman, Jack Connors, rescued the faltering plan from collapse, showing up to inspire House Speaker Salvatore F. DiMasi with a videotape of comedian John Belushi making his stand in the frat house classic, "Animal House."
"Nothing is over till I say it is over," Connors jokingly told DiMasi, echoing Belushi's most famous line.
I'm glad that s*** stain is gone. Except another s*** stain took his place.
Connors was right: Partners and other reform advocates prevailed, and the landmark bill became law.
What a surprise.
Reform benefited hospitals in two ways. First, it mandated raises in what the state pays hospitals to care for low-income patients covered by Medicaid. Second, by insuring 432,000 more people, the law reduced the number of uninsured patients who come to the ER with no way to pay the bill.
In the first two years, the state spent more than $550 million extra on health programs and the federal government put in $330 million, according to an estimate the state calculated at the request of the Globe. Hospitals, meanwhile, reaped over $450 million: about $230 million in higher Medicaid payments and more than $220 million in reduced charity care expenses, according to a Globe analysis of data from the attorney general's office. Partners alone received at least $30 million more in Medicaid payments - though it says it still lost big money on the program - and saved $81 million on free care.
Hospital advocates say the new money was imperative for the financial well-being of these vital institutions, and they point out that hospitals will not do as well in 2009, because of state budget cuts.
As healthcare reform was crafted and then implemented, no one asked the hospitals to provide more charity work to offset the free care savings....
Partners' spending on free care and community benefits reported to the attorney general has fallen 20 percent since it peaked in 2006....
The patient, Dennis Grady, 61, had a steady job and private medical insurance when he underwent a triple coronary bypass operation last year. Since then, his pay has been slashed, and his insurance has lapsed....
Grady's most recent visit was one of the more than 2,100 made yearly to the clinic by patients whose care in 2008 cost $250,000 - costs absorbed by Vanguard Health Systems of Tennessee, the for-profit company that owns St. Vincent. In addition, the hospital provides nearly $1 million a year in free care to uninsured people who come to St. Vincent itself.
Massachusetts activists tried to prevent for-profit companies from acquiring hospitals here in the first place, fearing they would usher in a heartless brand of medicine.
Today, healthcare officials who work with both types of hospital say the fears were overblown. St. Vincent, for example, spends about as much of its budget on charity as nonprofit hospitals such as Lahey - in addition to paying $2.3 million in sales taxes and property taxes to Worcester. No surprise then that when St. Vincent's former owner put the hospital up for sale in 2004, Worcester officials insisted that the next buyer be another tax-paying company.
Oh, TENNESSEE SHOWING US how it is DONE, huh?
See: Boston Globe Omissions: Hiding Health Care Failure
I wish we would LISTEN TO THEM once in a while, but you know that Yankee arrogance and superiority complex!
The rationale for generous tax breaks has eroded in recent years as investor-owned companies have shown that hospitals can be run as profitable businesses.
And THAT is what is WRONG with your ENTIRE HEALTH SYSTEM, America!
Today, 15 percent of US hospitals are owned by tax-paying, for-profit companies, including four in Massachusetts.
The "non-profit charities" making billions should be doing the same.
At the same time, as nonprofit hospitals have been increasingly run like businesses, the successful ones have adopted practices similar to those of for-profit companies, aggressively expanding into the markets of other hospitals and using their clout to charge higher prices for their services. The Partners-owned hospitals, and Children's, have, as the Globe reported last fall, used their market power to demand and win dramatically higher payments from insurance companies for treatment of their members.
Oh, the AWARD-WINNING REPORT is only VAGUELY REFERRED to here? WTF?
And there is your RESERVE FUND!
And some hospital corporations have diversified, moving into other businesses aside from the care of hospitalized patients.
"Without a scorecard, it is sometimes difficult to tell the difference between the for-profit and the not-for-profit," Lois Lerner, chief analyst of nonprofit organizations for the IRS, said in February. Lerner released a survey showing that many nonprofit hospitals pay their chief executives more than $1 million a year. At least 13 Massachusetts hospital executives made that much in 2007, the latest year for which data are widely available. Several compensation specialists said salaries at for-profit hospitals are generally comparable to nonprofits, although stock options can make the jobs more lucrative....
(Blog editor just throws hands up in air)
Nonprofit hospitals and their allies bristle at the assertion that they behave too much like for-profit companies, noting that studies have shown that nonprofit hospitals are more likely to offer unprofitable services such as psychiatric care or intensive care units for burn patients.
With healthcare costs expected to reach 18 percent of the national economy this year by some estimates, governments are reasserting their role in supervising nonprofit hospitals. The IRS is increasing scrutiny of nonprofit hospitals after decades in which the agency admits it seldom pressured them to do more.
And with healthcare reform at the top of the agenda in Washington, tax exemption for hospitals is already getting a second look. At a discussion hosted by the Senate Finance Committee earlier this month, Grassley pointed out that universal insurance on a national level would reduce the need for free care, as it has in Massachusetts....
I agree with that!
--more--"
See: No Choice But Single Payer
Yeah, that's not what we have.
Also see:
- The Massachusetts Model: Working Or Not?
- The Massachusetts Model: Going Out of Business
- The Massachusetts Model: Crazy Coverage
- The Massachusetts Model: Immigrant Insult
- The Massachusetts Model: Profit and the Paycheck
- The Massachusetts Model: Doctors' Diet
- The Massachusetts Model: By the Numbers
- The Massachusetts Model: Treasurer's Assessment
- The Massachusetts Model: Care-Keeping Costs
- The Massachusetts Model: Mass. Hospitality
- The Massachusetts Model: Lessons Learned
- The Massachusetts Model: Non-Compliant Complacency
- The Massachusetts Model: Office Visit
- The Massachusetts Model: Student Shakedown
- The Massachusetts Model: Medicaid Mess
- The Massachusetts Model: Destroying Small Business
- The Massachusetts Model: Upset Stomach
- The Massachusetts Model: Poor Hospitals Shortchanged By State
- The Massachusetts Model: Partners' Profits
- The Massachusetts Model: Padding Insurer Profits
- The Massachusetts Model: What to Expect
Oh, and meet one of the looters, I mean, million-dollar executives:
"Partners' leader questioned on outside ties" by Stephen Kurkjian, Globe Correspondent | May 31, 2009
Jack Connors....
when the private interests of its board of trustees - a constellation of Boston's power elite - intersect with the interests of the company, as they steadily have, he has ultimate authority over which business entanglements must be disclosed to government officials who regulate nonprofit organizations like Partners....
Connors and top Partners officials defended the decision not to publicly disclose Connors's potential conflicts, saying that because Partners did not directly contract with either of Connors's firms there were no conflicts to report. Connors also defended his right to be an entrepreneur in the healthcare business while also chairing Partners' board, and strongly denied ever using his position for personal or financial advantage.
That's what guilty people say.
The larger company, M/C Communications, grew to become the biggest commercial provider of continuing education to physicians in the decade between its inception in 1994 and when Connors sold it in 2004. It profited hugely from an exclusive commercial relationship it maintained with Harvard Medical School, whose faculty teach at seminars the company holds. Partners' signature institutions, Massachusetts General Hospital and Brigham and Women's Hospital, are major teaching affiliates of Harvard Medical School.
In addition, M/C Communications benefited financially from millions of dollars in sponsorship revenue paid it from major pharmaceutical firms eager to play to this professional audience. The role of pharmaceutical firms has been controversial in the medical profession and inside Harvard Medical School. Critics contend it calls into question the school's traditional standard of offering independent, unbiased medical education; others in the continuing medical education business say such fears are unwarranted or overblown....
See: MSM Monitor Going Through Menopause
I'll never trust a medical journal or the medical authorities ever again.
Connors made a name for himself as an executive with Hill, Holliday, Connors, Cosmopulos, the Boston advertising company that he helped found and guided throughout a long career. Less well known is that he made most of his fortune from M/C Communications, which he sold to Bain Capital for $450 million in 2004.
The sale was the largest of a private healthcare-related company in Massachusetts that year, according to TM Capital Corp., an investment banking company. Connors, who led an investor group that bought the firm outright for $13 million in 2000, made about $250 million from its sale.
Three former members of the Partners board told the Globe they should have been asked to decide whether Connors's ownership needed to be reported to the Internal Revenue Service and the state attorney general's office. The former board members declined to be quoted by name.
Other specialists agreed with the former board members' concerns.
W. Michael Hoffman, executive director of the Center for Business Ethics at Bentley University and a specialist in corporate conflicts of interest, said, "People are going to think that the trustees have either a laissez-faire or old-boy network attitude toward conflicts of interest," Hoffman said. "And Partners can only lose with that attitude out there."
Doesn't seem to have effected them at all.
Although a 2007 study by the Center for Healthcare Governance, an affiliate of the American Hospital Association, recommended that healthcare nonprofits ideally should prohibit board members from having financial ties to the company, nine of the Partners' 16 trustees in 2007 were executives for firms that do business with Partners, according to documents filed with the attorney general's office. The boards that oversee other major teaching hospitals in Boston had relatively fewer members with such conflicts, state records show.
And that corrupt hulk has driven up our health care costs.
"The Partners board is entirely volunteer, and composed primarily of individuals who are trustees of our hospitals and as well as physicians," Partners spokesman Rich Copp said in an e-mail to the Globe. "They are civic and business leaders of consequence. As you know, they do not make purchasing decisions for the organization, and we manage potential conflicts through our disclosure process."
That explains the slimy looting.
Connors brushed aside the notion that a perceived conflict could undermine trust in Partners' board members....
Arrogance.
M/C Communications is not the only for-profit healthcare-related venture that Connors has owned during his Partners chairmanship. After his 2004 windfall, he founded a company that helps elderly patients readjust to life at home after a hospitalization.
That company, Dovetail Health, has - Connors acknowledged - solicited business from hospitals owned by Partners. And Connors confirmed that after Dovetail executives failed to convince Blue Cross Blue Shield of Massachusetts to contract with the firm, he personally spoke to the giant insurer's president, Cleve L. Killingsworth, on Dovetail's behalf. Partners and Blue Cross Blue Shield regularly negotiate over $2.5 billion worth of medical business a year.
But no conflict-of-interest and he wouldn't medal, blah, blah, blah!
Looks like you are going to need your own inflated health care, Jack!
Connors acknowledged in an interview that it might have appeared "inappropriate" to some for him to pitch Killingsworth. But he said the conversation stemmed from a shared belief that new ways must be found to reduce frequent return trips of elderly patients to the hospital. More recently, however, he said he does not believe his approach to Killingsworth was inappropriate.
Arrogance.
Partners executives said, in an unsigned e-mail response, that because no deal was ever been struck between Dovetail and Blue Cross, it saw no violation of the company's conflict-of-interest policy.
While Connors was and is an active player at Dovetail, he describes himself as a passive investor during his years of ownership of M/C....
Which isn't to say he didn't realize how important the Harvard tie had been to M/C's success. Shortly after the 2004 sale of the company to Bain Capital, Connors made that clear with a $5 million contribution to the school....
--more--"Is this what you want for health reform, America?
And look at the small fry:
"1 charged with hospital embezzlement" by Megan Woolhouse, Globe Staff | January 28, 2010
A South Shore Hospital administrator and coordinator for its Dare to Care program was charged yesterday with embezzling $222,000 from the Weymouth hospital, according to the US attorney’s office.
--more--"Don't worry; White House will get them!
"White House wants insurer to justify hike" by Associated Press | February 9, 2010
WASHINGTON - The Obama administration asked California’s largest for-profit health insurer yesterday to justify plans to increase premiums by as much as 39 percent, a move that could affect about 800,000 customers.
In a letter to the president of
