The Market Ticker
Commentary on The Capital Markets- Category [Health Reform]
Logging in or registering will improve your experience here
Main Navigation
MUST-READ Selection(s):
Cut The Crap - NOW

Display list of topics

Sarah's Resources You Should See
Sarah's Blog Buy Sarah's Pictures
Full-Text Search & Archives

Legal Disclaimer

The content on this site is provided without any warranty, express or implied. All opinions expressed on this site are those of the author and may contain errors or omissions.


The author may have a position in any company or security mentioned herein. Actions you undertake as a consequence of any analysis, opinion or advertisement on this site are your sole responsibility.

Market charts, when present, used with permission of TD Ameritrade/ThinkOrSwim Inc. Neither TD Ameritrade or ThinkOrSwim have reviewed, approved or disapproved any content herein.

The Market Ticker content may be sent unmodified to lawmakers via print or electronic means or excerpted online for non-commercial purposes provided full attribution is given and the original article source is linked to. Please contact Karl Denninger for reprint permission in other media, to republish full articles, or for any commercial use (which includes any site where advertising is displayed.)

Submissions or tips on matters of economic or political interest may be sent "over the transom" to The Editor at any time. To be considered for publication your submission must include full and correct contact information and be related to an economic or political matter of the day. All submissions become the property of The Market Ticker.

Considering sending spam? Read this first.

2019-02-04 09:00 by Karl Denninger
in Health Reform , 323 references
[Comments enabled]  

There's something especially evil about people who trade on something other than logic and facts.

"Medicare-for-all’s" advocates promise a health care system that's free at the point of service – no co-pays, no deductibles, no coinsurance.

They tend to be less upfront about how they'd pay for it. Independent estimates from both the right and the left peg "Medicare-for-all’s” cost at about $32 trillion over 10 years. Doubling what the federal government takes in individual and corporate income tax revenue wouldn't be enough to cover that tab.

That's assuming “Medicare-for-all” is able to implement its financing strategy. The bill proposes reimbursing doctors and hospitals at Medicare's current rates, which are 40 percent below what private insurance pays.

Left out of this is the fact that CMS (which runs Medicare) is required to pay at a level that is profitable -- that is, which covers the actual cost of said care, plus a reasonable profit.

So why does "private insurance" pay more?

Simple: Racketeering and extortion.

Medicare isn't immune to it either, but it's the 900lb Gorilla in the Health Care room and nobody is talking about it.

Indeed, not even the so-called "moderate voices" are talking about where the real issue lies. Instead they want to subsidize even more screwing and worse, more invasive and personal data taken from you and then abused to hose you even more.

Why?  Because there's a hell of a lot of money thrown around in the United States every year -- about 4 trillion dollars, to be exact -- as a consequence of this fraudulent and illegal enterprise.

Doing anything about that would cause the price to shrink back to about 20% of what it is now and that would result in a hell of a lot of people being out of work.

For every doctor or nurse hired in the "medical and health insurance" field there are roughly 10 people hired that never provider a single second of care to a single person.  They "code" procedures, as one example, and handle the myriad garbage-can of records and billing involved.

Contrast this with your local grocery store or WalMart.  Every item in both has a price on it, marked clearly.  Paying is a matter of, well, paying, and everyone pays the same price for the same thing.  Someone takes money or runs a credit card, and off you go.  There are no extra people trying to figure out whether they can "upcode" a procedure and turn a $100 bill into a $500 one for the exact same thing, which is what a huge percentage of these parasitic "medical field employees" do all day.

I remind you that it is a felony to attempt to monopolize or price-fix.  The law doesn't require "higher prices" as the outcome, although in the medical field you certainly have them -- in spades.  You merely need to try to be guilty, and everyone involved is equally liable under the law.

Well, so says the law.  But there is no enforcement -- ever -- against anyone in this field.

This is why you have a $50,000 bill for a snake bite where antivenom is billed out at $10,000 per dose or more; the very same vial of anti-venom is $100 a few dozen miles away in Mexico.  Not the same formula -- the very same vial, made in the same factory.  It's why you can get on a plane and fly to India and get Sovaldi, the cure for Hepatitis C that costs $80,000 here in the United States for under $1,000 cash.  It's why insulin that costs a few bucks over in Europe and can be had at any pharmacy costs $200/vial here in the United States.  It is why an MRI that costs a literal $100 in Japan is $2,000 here in the US.

The entire design of the US medical system is fraud.  It is the only business in America where you don't have to quote a price and can screw someone based on how they pay to the tune of 10 or even 100:1 or more after the fact.  This forms the basis of extortion by the entire medical system to attempt to force you to buy "insurance", lest you be billed 10 or 100 times as much for the very same thing.

And by the way, that alleged "insurance" isn't actually insurance; the very name and how that industry operates is a massive, felony-level fraud too.  Insurance is something you buy that spreads risk of an event that is unlikely and hasn't happened yet.  If the bad thing happens then you stop paying premiums and the company pays you.  So-called "health insurance" is nothing of the sort; if you have it and get cancer, for example, you should never have to pay another dime in premium yet every bit of treatment for said cancer should be covered. Further it is fraud to buy insurance against something that already happened and everyone involved in procuring same is guilty of that felony act of fraud (including the "insurance company" if they knowingly allow it) because you are, by doing so, forcing others who buy the same alleged "insurance" to pay your bill.  What is sold as "health insurance" is actually a racketeering enterprise that actively conspires to fix health-care prices and conceal them from you, forcing you to use certain providers of a given good or service over others (or even to use one good or service rather than another) lest you not be "covered" and which invariably contains gag clauses in the "contracts" with providers that prohibit them, or anyone else, from disclosing actual costs and prices.  All of this is not only illegal the industry has twice tried to claim exemptions from anti-trust laws bearing on same, both cases went all the way to the Supreme Court and they lost both times.

Michigan, a few decades ago, enacted "no fault" auto insurance in an attempt to stop the "lawsuit lottery" whenever there was a car accident.  It did that, mostly.  It didn't take long, however, for the extortion and fraud-laced medical system to figure out that since nobody ever goes to prison for committing felony crimes through medical billing and screwing that they could charge three times as much or more for repairing the injuries in an auto accident compared against the same injury sustained while walking your dog on the sidewalk.

That's not a joke folks -- it is reality, right here and now, and is why car insurance (which you allegedly "must have" to own a car) is so damned expensive in Michigan.  Drivers there don't wreck more-often than they do anywhere else but Michigan's "no fault" law along with a flat refusal by both state and federal law enforcement to throw people in prison for their daily extortion and felony anti-trust festival has allowed the medical and insurance "industries" to screw blind the residents of said state.

The sad reality is that the last 30+ years demonstrates that absent the people of this nation rising up in protest and taking to the streets, either in a general strike or worse this is not going to change because law enforcement doesn't give a crap about you and in fact they love their "free", taxpayer-covered medical care both while working and in retirement.  That you get hosed out of the money to pay for it makes them smile and rather than toss handcuffs on everyone involved in this crap they eat donuts and become diabetic, which you are then forced to pay for.

Say hello to Amerikka and people like Sally advocating in public that you take it harder, deeper and without a reach-around, demanding that you smile the entire time.

View this entry with comments (opens new window)

2019-01-20 11:00 by Karl Denninger
in Health Reform , 206 references
[Comments enabled]  

This is the sort of article that should never be published.

As insulin continues to become more and more expensive, many people with diabetes who require it can’t afford it and find they have to ration its use. Tragically, news reports say some people have even died because they’ve reduced their expensive insulin dose to save money.

The doctor lays out the price increases -- lock-step increases at that -- among the three major insulin producers.

There has been no "great new thing" in insulin.  There have only been lock-step, monopolist price increases.

This is illegal and has been for more than 100 years.

It's not a "little illegal" either; it's felony illegal.

So where are the cops and handcuffs?

As I have also pointed out in the article The Low-Hanging Fruit we could cut the demand for insulin dramatically, along with virtually all the other bad things that happen to Type II diabetics, by eliminating their glucose intolerance.  We can do that today.  We can do it without any drugs.  Doing so would cut federal medical spending by more than $400 billion a year.

We simply need to stop treating adults as infants and cease coddling their personal insanity.

Most Type II diabetics can reduce their insulin and drug need to zero, or nearly so, by eliminating carbs from their diets.  The cost of doing so is zero.  The benefit of doing so is that they're no longer diabetic.  Instead of insisting that people who have a zero-cost way to not be sick take that path we coddle them and spend hundreds of billions a year and in addition overlook outrageously illegal conduct by multiple firms that screw both taxpayers and common citizens alike.

This can end today.

Right here, right now.

We need no new laws or regulations.  We merely need to enforce existing law, specifically 15 USC Chapter 1.

If it doesn't then the people need to demand that it does -- and enforce that demand -- by any means necessary.

This isn't just about millions of American lives -- which is plenty of reason to do so all on its own.

It is about the literal destruction of our economy, federal and state budgets and government if it is not undertaken now.

View this entry with comments (opens new window)

2018-06-11 07:01 by Karl Denninger
in Health Reform , 309 references
[Comments enabled]  

Well well Justice Roberts, I am writing your obituary right here and now, and should you precede me I'll publish it too, even if it costs me a lot of money to do it.

"Justice Roberts was single-handedly responsible for the destruction of the American Government via its Treasury via his idiotic and legally-infirm contortions in ruling the Affordable Care Act was in fact a tax, rather than a constitutionally impermissible command."

As I wrote at the time Roberts destroyed what little was left of the Supreme Court's legitimacy, putting the final nail into a coffin built since Wickard .v. Filburn.  He justified this in his opinion through what is really called by any means possible I shall torture the law to save it, in that he cited a claim that the Courts are required that any fair means of interpretation exists that leaves a law intact the courts are required to find it.

Of course there was no such "fair means" which he also set forth in his own opinion, stating clearly that the statute reads as a command to buy insurance ("enter into a regulated activity") and that the Constitution prohibits that.

Indeed the Congressional record on the drafting and debate makes clear (if you bother to read it, which Roberts clearly did and then intentionally ignored it, which I also pointed out in a further article) that Congress knew they could not draft the PPACA as a tax because direct taxation on other than strict capitation is unconstitutional.

In other words the US Government can assess a $10 per person tax, per person, but they may not condition the amount of the tax or its imposition on anything other than being a person.  The 16th Amendment makes legal the imposition of taxes on income.  Indeed multiple other attempts to impose such a tax without a Constitutional Amendment had been previously struck as unconstitutional, so there's not only a legislative record but a judicial one as well.

Roberts didn't care.  I've often mused if someone has a video of him buggering a little boy and used it get him to write that "opinion."

But what Roberts didn't have, because he couldn't, is the ability to time travel.  And when Congress passed the TCJA reducing the penalty for not having coverage to zero starting January 1st of next year they destroyed the Constitutionality of both guaranteed issue and community rating, since both were by the Congressional record inextricably tied to the imposition of the penalty and thus are non-severable, as is specifically stated in the Congressional record.

Without the penalty there is no tax since the inherent property of a tax is that it raises revenue.  That's now gone and it was the sole pillar on which the Roberts court decision rested.

The problem is that the rest of the law isn't inseverable and the way law works is that except where severance is specifically declared inapplicable it applies unless the result would be nonsense.

That the result of non-severance will bankrupt you does not enter in the analysis.

Thus the brief referenced herein argues that both community rating and guaranteed issue are Constitutionally infirm and thus void come January 1st.  This is a winning argument, and if there is anything approaching a justice who can actually read it wins by declaratory judgment since the precedent to judge it by is in the original opinion and as a result there is no legal ground to cover in presentation of a case or argument before the court!

But once you do that both Treasury and private industry are irrevocably and instantly ****ed.

Without community rating and guaranteed issue anyone with a pre-existing condition who becomes unemployed becomes permanently unemployable as they are uninsurable without destroying the business they go to work for.  Further, they can't engage in entrepreneurial activity either because there is no possible way for them to buy health insurance.  And finally, since the cost of that care has more than doubled since this problem was allegedly "addressed" by Obamacare they have no other option available.

I have often written about the utter necessity of getting rid of the medical monopolies as a political imperative, and for individuals to do everything in their power to get off the medical teat, which for most people means you damn well better not not be overweight or obese, you better have normal blood sugar which means no damned carbs to any material extent in your diet and it certainly means that intentional high-risk behavior like butt****ing, IV drug use or drinking to excess is an instant economic death sentence.

Of course what has occurred in the decade since Obama came to office and Pelosi and her pals rammed through their "vision" is that all of that has gone downhill in statistical terms for America.  There are more obese and abnormal-insulin and blood-sugar level people in this country than ever before, including a shocking number of teens for whom such was unheard of as recently as 30 years ago.  There has been an explosion of IV drug use including heroin and fentanyl.  And we have removed not just legal strictures but have mandated "tolerance and acceptance" under the law for extraordinarily-high risk social behaviors and in no small part covered that up with expensive, lifetime drug regimes that are utterly dependent on public financing to remain "affordable" for the vast majority of people.

The social issues are real but the cost issues exist only because neither Congress nor any State or Federal executive will take their justice departments and prosecute, throwing in jail, the medical monopolists.  Instead they kowtow to their lobbying, whining and claims of "necessity" to continue the trend of taking medical expense from 4% of GDP to nearly 20% today and beyond into the future.

Well, now the scheme is about to blow up in everyone's face.  As of January 1st those who are healthy do not need to participate and most will not.  I won't.  The "donut hole" where $25,000 - $50,000 in income has an effective tax rate of more than 80% everywhere (and close to 100% in high-tax states) is gone if you simply stick up the middle finger.

But without some means of forcing transfer payments from "someone" (the taxpayer across the entire population) to fork up $900 a month for someone like me, who needs zero routine and chronic medical care so that someone else can run up $5,000 a month prescription drug bills the latter's bill becomes unfundable.

Mr. Roberts will burn in Hell for this, as had he not tortured the Constitution in 2012 Congress would have been forced to deal with the medical monopolists and so would have Obama's administration, saving the US Government and taxpayer several trillion dollars.  You'd also be able to pay cash for virtually any medical situation, save an immediate crisis for which (if you chose to do so) reasonably-priced insurance would be available.  We're talking $100 a month or less here folks, because even the "really awful" stuff would cost one fifth of what it does now.

But all that money has now been stolen and it's gone, while the nuclear fiscal bomb left behind by Robert's outrageous twisting of reality on the back of Obama and Pelosi's intentional set of actions is now about to detonate in his, and everyone else's, face.


View this entry with comments (opens new window)

2018-06-07 07:00 by Karl Denninger
in Health Reform , 241 references
[Comments enabled]  

Here it comes folks, in two reports -- one from the Medicare trustees, and the other from Social Security.

Let's start with the easy one: Social Security.

The "fear" is that it will be unable to pay full benefits (because it will have run out of bonds that are there as a buffer) in 2034.  This is predicated on a few things, so let's list them:

  • Income levels will not generally lift.  Oh really?  More to the point, neither will the cap-out point (where you stop paying every year.)  But the latter does lift every year (it's gone up a lot since I was running MCSNet) and the former is a rather-pessimistic view of the world.  It's one that might prove correct, but it's still quite pessimistic.

  • Disability has actually improved due to fewer people going on the rolls.  Gee, how many were disabled and how many didn't want to work?  Funny how people who were and are disabled suddenly become not disabled as the economy improves.  That's fraud folks, but nobody cares.  You should, because the money being stolen is yours.

  • Through 2039 (five years beyond the projected depletion date) expenditure goes up.  However, the system was designed for this; that's why it holds Treasuries and built a huge surplus while the boomers were working.  Granted, the "surplus" was immediately spent but it was replaced by Treasury bonds, which can and are being (right now) sold.  The Fed, Congress and Obama intentionally destroyed the actuarial health of the system; the current yield on a blended basis is only 3% which is about half of what it should be for a ladder of bonds of appropriate duration.  This is not small potatoes when you're talking about a couple of trillion dollars! I want to know where the handcuffs are for Congress and the entire Federal Reserve plus all of the administrations back to the 2000 tech wreck who have all deliberately suppressed yields and continue to do so today.  But for that the retirement program would probably be sound on an actuarial basis.  Note that had interest been at normal levels the difference last year would have been roughly $80 billion, along with the years prior back to 2008 and on a forward basis.  $80 billion a year is real money, especially over a few decades and in fact it's probably enough to make it through the "bump" when the boomers die!  Too bad America has forgotten what a pitchfork and torch is.

  • Note that Social Security is fairly easy to "fix."  First, we can stop tampering with rates on a forward basis.  Second, we can (and probably have to) lift either the cap on wages at a faster rate (or once on a step-function basis), modestly increase the FICA tax, or some blend of both.  A less than 3% increase in the FICA rate (both halves; you pay both even though you don't see both directly) is roughly where the line is, assuming wages do not lift faster than inflation (payouts.)  If they do some or all of that will disappear; the reason is that Social Security is a progressive system; that is, your first dollar of earnings (taxable) get you more benefit when you retire than higher earnings dollars do.  So if people shift toward the higher end (before the cap-out, at which you neither pay or get more) then the deficiency closes.

The bad news is found in Medicare.

Medicare goes bust in eight years and there is no rational revenue-raising way to fix it.

For most of us who are not 75+ it will not be there unless the medical monopolists are jailed, hung or both right now.

Yes, after trial and conviction (I still believe in due process) but if we don't do it, and I remind you there is 100+ year old law that is more than sufficient to go after this issue right here and now everyone in this nation is absolutely and irrevocably ****ed if they need medical care and are over 65 just eight years from today.


There is no payroll tax adjustment that can plausibly be passed and fix this.  Medicare was designed for a medical system that consumed four percent of GDP.  Today it's nearly 20%, or five times as much.  Cost-shifting from Medicare and Medicaid is already is screwing the rest of the public blind; there is little or no more of that which can be possibly foisted off on working people.


Well, it not only hasn't been stopped the scamming has accelerated and unless the government puts a stop to all of the scams now within the next few years you are going to get reamed up the chute. 

This is no longer a "distant" threat.  It now will occur prior to the end of the next Presidential term, and any acceleration in the deficit in these programs, which will happen instantly when there is a recession, will likely bring forward that date by three to four years immediately rendering the problem both instant and catastrophic.

I have published several articles on real fixes for these issues.  One can be found here, and it's a good place to start.

We either demand it as a nation and back that demand up with whatever we need to in order to make it happen or this nation, it's economy, and our government are all gone inside of the next ten years.

Politicians will not act until and unless we, the people force them to do so.  They only care about the next election and being able to "retire" into some lobbying position at five times their government salary.

You either get off your ass now and force your government to hold the entire medical system to account under anti-trust law or you had better make damn sure you don't need medical care of any sort -- no prescription drugs, no doctors and no hospitals -- and are willing to either get on a plane (if you can) for treatment or die should that change for you.

View this entry with comments (opens new window)

2017-11-01 12:14 by Karl Denninger
in Health Reform , 501 references
[Comments enabled]  

Ok, so I have the APTC for a single person who has reduced income to right near $20,000 a year for 2018.

In Florida it is now $760/month, or $9,120 a year.

This is wildly up from $446 for last year; in fact it's up 70%.

This means I can now have a Silver plan for about $15/month, as opposed to a very low-level Bronze plan for under a buck.  I can also choose virtually all the Bronze plans for zero (since the cost is lower than the APTC), but that would be insane since I'd be leaving a huge amount of your money on the table.

The actuarial value of a "Silver" plan is wildly better than any of the Bronze plans.

There is one "gotcha", which is hospitalization co-insurance that does exist on the Silver plan but not on the Bronze.  But the Silver plan in question has a zero deductible, so even with 20% "coinsurance" you'd have to run a hell of a bill to lose that bet especially considering that you get the insurance-company racketeering-deduction price.

Folks, you have to be flat-out nuts to work harder and run into the subsidy phase-out, especially if you have a spouse, even if you do need routine medical services since you can now buy zero-deductible Silver plans for less than the cost of a burger-and-beer in your local pub!


No, you probably can't do this in high-cost-of-living areas without living in a slum.  Yes, you can make it work perfectly-well in lower-cost-of-living areas and be perfectly fine.  I'm doing it and you can too.  Yes, it means you have to change your lifestyle but I'll be double-******ned if I'm going to go out and earn a six-figure income and then have government thieves not only tax more than half of it away (which they will) but then double-monkey-**** me by extracting approximately $10,000 in after tax money in addition from me for "insurance" that, unless I have some sort of medical catastrophe in the next 12 months in fact provides zero value to me.

View this entry with comments (opens new window)