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Commentary on The Capital Markets- Category [Health Reform]

There are times that I spit my espresso on the monitor and keyboard; it wipes off the monitor but frequently winds up costing me a new keyboard.  This article, when I read it, got close.

We fling open the doors of America’s emergency departments to help those who can’t afford health care.  We have legislated this protection: No person can be turned away for financial reasons.  This is very compassionate, and represents the higher angels of our culture.  Alas, it also is emblematic of the stupider demons of government.  You see, the ER demonstrates the inverted priorities of American society.

Oh really?  Let's see your argument...

In the ER, expensive tattoos abound.  Piercing is ubiquitous.  Almost every adult and child has a smartphone, it seems.  All too many spend the duration of their ER visit glaring at the screen of said phone; barely looking up at the physician who is attempting to engage them in meaningful conversation about the reason they came for care.

And your ER is full of expensive toys and ridiculous cost models because?

See, the two are linked, aren't they?  You call this a "higher angel" but I argue that it's demonic.

It's demonic because that which you can "charge someone else for" provides a gross incentive for people to consume without consideration.  If booze was free how much would many people drink?  If steak was free how many ribeyes would you have?  I know my answer: I'd eat 'em every single day -- and probably two of them, for breakfast and dinner.

Of course I eat low-carb.

What prevents me from doing that?  I have to pay for the steaks.

Dental care? It is regularly ignored because, in the words of my patients, “I don’t have dental insurance.” Guess what. Neither do I, and I pay a lot for insurance. Dental care has typically been a cash business. That’s why dentists, crafty guys and gals that they are, spend their time mucking around the human mouth. Floss and toothpaste? Seems a bit excessive compared to a nice new tattoo.

Oh?  Or is the truth that people do floss and brush but (1) there is a huge genetic component, particularly related to gum disease and the rate of building of plaque and tartar (now being recognized as real, but formerly not) and (2) calling your customers liars is not conducive to repeat business.

As for more than the routine when it comes to dental care it's gotten damned expensive, except for cosmetics, which have come down quite a bit over the years.  Why?  For the same reason the rest of medical care has -- cost-shifting and monopoly protections granted by government to the industry.  Doubt me?  Go hop a plane and fly to Japan to have your major dental work done.  Bring cash, but about a quarter of it compared to what you'll be charged here.  Japan is not a third-world country either and even quite-serious dental work, such as root canals and crowns, are not "high tech" procedures -- they're things we've known how to do for decades.

A woman told me, recently, that her daughter (at birth) had a minor congenital abnormality that required daily application of a cream. “And I had to spend $200 of my own money!” She was aghast.

Why did it cost $200 a month (which incidentally is over $2,000 a year) instead of $20?  Again: Monopoly protections, which are supposed to be federal offenses and land you in the pokey for a decade along with getting you fined a million smackers -- for each instance.

We can’t keep this up.  We’ve created a monstrosity of entitlement.  I care for the poor; I love the poor and have always tried my best to help those in genuine need.  Those truly hurting.

But when cosmetics, vices and electronics are considered reasonable expenditures while the rest of us pay for necessities like prescriptions (or over the counter Tylenol and Motrin as I’m often asked to prescribe for Medicaid), then we are entering the death spiral.

Quit ripping people off and I'll listen to you.  You can talk to me about this when it costs $100 for 15 minutes of your time to stitch up my finger or foot instead of $5,000; $400 an hour is pretty good money, and commensurate with your training and experience, and is about what your time is worth on the free market (for an example again, go try for the same care in Japan or other first-world nation ex-United States.)  $20,000 is outrageous and trying to bill me for that after-the-fact without fair and full disclosure (say much less an opportunity to negotiate beforehand) is theft and extortion, both of which are supposed to be felonies.

Until then go **** a duck Edwin, and you better pray you don't need computer or networking help, because I have a special hourly rate just for you -- it's $20,000, you see, payable in advance -- and in cash.

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Heh heh heh....

More than a dozen states plan to cancel health care policies not in compliance with ObamaCare in the coming weeks, affecting thousands of people just before the midterm elections.

"It looks like several hundred thousand people across the country will receive notices in the coming days and weeks," said Jim Capretta of the Ethics and Public Policy Center.

The policies are being canceled because states that initially granted a reprieve at the request of President Obama are no longer willing to do so.

There's good news and bad news.

The good news is that if you were one of the idiots who bought into the "reporting" that claimed Americans "like" Obamacare, and are pleasantly surprised at the "improvement" or "lack of harm" it has done to them, you're about to get lots of stimulation of your prostate, and that may be a pleasant surprise.

For most, however,including the 50% of the population that doesn't have a prostate, I suspect you'll instead call it rape.

That, of course, is the bad news.


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Here it comes....

NEW YORK –  Wal-Mart Stores Inc. plans to eliminate health insurance coverage for most of its part-time U.S. employees in a move aimed at controlling rising health care costs of the nation's largest private employer.

Starting Jan. 1, Wal-Mart told The Associated Press that it will no longer offer health insurance to employees who work less than an average of 30 hours a week. The move, which would affect 30,000 employees, follows similar decisions by Target, Home Depot and others to eliminate health insurance benefits for part-time employees.

Big surprise -- not!

In fact, this was exactly what I expected -- and here's the problem with that position -- Obamacare means someone is going to pay that bill, and either way it's the employee. 

That is, the choice not to pay it (and not have it) is now gone; ergo, the economic impact is at best a cost shift and (unfortunately, and at the margin) a cost increase for consumers, which means less disposable income to spend everywhere - including at WalMart.

On the margin this is a small change.  But it's all those small changes over time that wind up being a big change in the health of an economy, and for the most part Obamacare's impact has been delayed (but not removed) by all the unlawful "executive decision" delays, whether they be the employer mandate or otherwise.

Delayed impact, however, does not mean evaded.  It simply means delayed, and in this case the important factor is that it's delayed until after the election.

Obama could have pushed hard for an end to the monopoly and price-fixing ways within our medical system in 2009 and actually accomplished something.  The legal framework to end that crap already exists.  Instead he got on his knees and paid tribute with political fellatio aimed at the entire medical and insurance industry, and you, dear citizen, are being lined up to pay for it.

So lube up America and assume the position, because here it comes again.

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Ah, those subsidies....

A federal judge in Oklahoma ruled that those receiving Obamacare through the federal insurance exchange aren’t eligible for subsidies for their health-care coverage. 

The Affordable Care Act explicitly states that those who purchase insurance on “an exchange established by the State” are eligible for subsidies for their coverage, but challengers say that language does not include those covered by Obamacare’s federal exchange. 

That's because it doesn't.

The intent of the legislation was to "coerce" states into offering exchanges.  Some said "nuts", and the Feds then turned around and "interpreted" the statute to neuter what was intended to be a means of coercion but which had failed.

That's illegal -- period.

But nobody cares today about the law.  Nobody has cared about the law when it suits them for decades.  The lawless nature of our own government has reached the point of absurdity, and so the IRS simply "interpreted" the law to mean what they wanted it to mean.

Well, this judge said no.

We shall see how this all plays out as the various challenges work their way through the system; ultimately this likely will go back to the Supreme Court, where I suspect the black-robed bastards will again rule that The Constitution is a dead letter, effectively challenging both the States and The People to decide whether to sit for yet more lawlessness or finally stand up to both the black-robed brigands and the Feds generally and say this far you have come but not one inch more forward shall you move.

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An OpEd from the WSJ and then a series of letters went on to raise hell about the anti-vaccination movement in California and elsewhere.

Some of the explanation may be reasonable -- modern Americans, for example, have never seen polio and the suffering it causes.  Therefore the claims are, to most Americans, abstract -- they've never seen the price.

But there's another undercurrent here that is part and parcel of this story, and one that nobody wants to talk about.  That's the conflation between vaccinations that have little or no downside risk compared to the upside benefit, and for which the protected event is one that has no connection to personal choice, and ones that either violate that premise or where the protection is conferred against chosen behavior.

There are places where, if you travel, you're either strongly recommended to or required as a condition of your visa to have received certain vaccinations.  Why not enforce all of those here in America?  That's easy -- there is no such thing as a drug without risk, and if the benefit is small enough (that is, the risk of exposure is small enough) then the balance is not strongly toward the "you should get this" side.

Then there are those vaccinations such as Gardisil that are of dubious value and bear only on consensual conduct.  Gardisil allegedly protects against HPV, which in women can cause cervical cancer (men don't have a cervix, of course.)  However, to be sexually exposed you must (of course) have sex, and second the vaccine does not provide anywhere close to complete protection.  That in turn may lead you to engage in more risky behavior than you might otherwise, and actually wind up working backwards for that reason.  And there are direct risks -- specifically, there is a small but present risk of Guillain-Barre syndrome, an auto-immune disorder that is extremely nasty (it can kill, by the way) and, while rare, has as one of its possible triggering events the administration of this vaccine.

Texas tried to force administration of Gardisil upon school children and there are allegations that improper conflicts of interest and financial ties were behind the attempt.  This sort of incident does not help in the general case, and can lead people to conclude that the entire process is corrupt.  To the extent that this results in parents refusing other vaccinations, such as MMR, it's outrageous -- but the blame for that should be laid at the feet of people like Governor Perry!

Then there is the "herd immunity" argument -- that because some kids (and adults) are unable, for medical reasons, to take vaccines you owe them a duty to do so.  That's utter nonsense.  You owe nobody any such duty, period.  That those people are the unfortunate victims of a disease such as cancer that renders them unable to seek protection on their own from a virulent thing in the common environment doesn't obligate you to take risk on their behalf.  Your risk should be taken on your behalf, and it's important that we stop trying to play this damned nanny game; if you can't make the argument for vaccination on the merits of your health (as the one taking the needle stick) then the argument has failed in its essence.

Indeed, the essence of that argument, if you wish to follow it, comes directly with a demand to close the border immediately and deport all illegal immigrants instantly on detection.  Why?  Because very few if any have all of the vaccinations that are common in America.  You can talk to me about "my" duty (or that of my offspring) with regards to you (as opposed to the direct benefit to her) when the border is closed and every single illegal is immediately deported without delay, as they form a much higher transmission risk vector than anyone in America ever will be simply because we have fewer reservoirs of these diseases in our population in the first place.

Finally, there is another part of this debate that nobody wants to have, but we all should: Scientific fraud is almost never punished in any meaningful way.

As just one example the so-called study that allegedly tied thimersol in vaccines to autism was found to be bogus and was retracted.  The authors faced no consequence of materiality.  The climate-scare people who intentionally doctored tree-ring data by selecting the side of the tree they took their bores from so as to show "higher temperatures" (when the other sides showed no such thing -- it was entirely natural variability) faced no material consequence for their intentional deception.  Those who have falsified data in medical trials have never, to my knowledge, been indicted for what amounts to outright fraud upon the public, so-called "scientists" that rig various other experiments (remember the "exploding fuel tank" tests that were in fact conducted with a lit firework-style device on the outside of the tank?) don't go to jail and, for that matter, neither does anyone else involved in these fiascos.

Remember, we're talking about someone's kid here.  The damage to scientific credibility over the years has been immense, and nowhere is it more-evident than in the medical realm.  Cholesterol and fat in the diet .vs. eating lots of fast carbohydrates, anyone?

If we're going to have an honest debate on this topic we need to cut the crap across the board.  All vaccines are not so simple as to say "You should (or must) have them all."  There are those that clearly fall into this category, such as MMR and Polio; the personal consequences (to the person who doesn't have them) are severe if the disease is contracted, and the risks are small.

But beyond those there are many others where the argument is far less-clear.  Chicken pox and Gardisil are two of them in this category, with the latter being of particular concern and worthy of ridicule as a "required" vaccination because the route of exposure to the allegedly-protected-against disease is found only in either consensual sexual conduct or sexual assault (a felony.)  Neither of those is anywhere close to completely effective in providing protection either; for most of the other common vaccines such as MMR and Polio the conferred protection is very close to 100%.

Parents and others deserve honest information and this begins with criminal prosecution for cooked data presented to sway public policy as the open and notorious fraud that it is; we cannot expect people to behave simply "as demanded" when the record shows that many of those demands are in fact driven by corruption rather than scientific reality.

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