The Market Ticker
Commentary on The Capital Markets- Category [Health Reform]

I'm serious, although obviously he can only run for one of them.

How?

It's not hard: Take on the health care issue and destroy both the existing Republican and Democrat "platforms".

Here's how Mr. Trump.

Today health care in the United States costs 500%, approximately, that of the same technology purchased elsewhere in the first world.  There are places where the "offset" is only 200% but virtually nowhere that it runs the other way.  It is literally possible in many parts of the United States to buy a plane ticket to Narita, Japan, have an MRI done and read there and then fly back home for less than you will be charged for the same exam in your town.

The 900lb Gorilla in the room that nobody talks about is that health plans under Obamacare, Medicare and most private insurance, with a notable exception found in certain "Cadillac" plans that are all now heavily taxed under Obamacare, along with all Medicare recipients, leave the patient with a typical 20% "co-pay" plus in the case of private insurance a hefty deductible that typically runs to $5,000 per person, per year before a single penny is covered.

Here's the reason this matters: 

If you fix this problem then the consumer still pays 20% as they do now but that is the entire bill which means they do not need to buy "Health insurance" at all except for a low-cost policy against sudden and catastrophic events such as a heart attack or serious accident.  Such a policy would only cost a few hundred dollars a year and for those who are truly indigent it could be provided at little cost to the government.

Now let's start with what this means to the various parts of the electorate:

1. The working middle class.  These people typically get their medical insurance from their employer and most of the cost is hidden from them.  However, it is not "gone"; it is in fact part of the total employee cost and thus when salaries are set that cost is deducted from the salary offered!  Getting rid of this parasitic cost means that salaries actually seen by the middle class will rise by an immediate and permanent amount since that cost will disappear.  For the average middle-class ($50,000 a year) worker this will be about a 20%, or $10,000 a year, raise.

2. The working poor.  These people are typically on Medicaid or are buying subsidized "Obamacare" policies.  The problem is that if you're buying an Obamacare policy with subsidies and in this class you can't afford to actually use it since the deductible on these plans tends to be as much as $5,000 or more -- which you don't have.  These people will see a massive improvement in their access to actual care since they will be able to afford to use said care, and can replace their "Obamacare" subsidized policy with an unsubsidized catastrophic gap policy.

3. Retired people.  These people are all on Medicare; either traditional or Medicare Advantage.  All are paying a monthly premium that will go away; some will choose to buy said catastrophic coverage (which will be less expensive than the monthly premium by roughly about half) and their out-of-pocket will remain about the same.

4. The top 10%.  While these people will see a decrease in their costs of the same amount that the working middle class, it means less to them because as income rises the percentage in take-home pay falls.  Nonetheless an extra $10,000 a year is an extra $10,000 a year, and these people will be able to spend that on discretionary purchases.

Now let's talk about the impact on the Federal Budget.

First, the magnitude of the problem: Last fiscal year Medicare and Medicaid spent $1,187 billion in total.  Of that $301 billion was for Medicaid (administered by the states, but spent by the Federal Government.)

80% of that Medicaid expense, and a similar percentage of Medicare expense, will disappear from the budget.  This amounts to an immediate and permanent reduction in the federal budget of about $900 - $1,000 billion a year -- or roughly $10 trillion over the next decade.

This will not only wipe out the entire federal deficit it will result in a permanent and sizable budget surplus and, over the next decade, cut the federal debt in half.  That in turn will improve purchasing power through the economy through the reduction of outstanding dollars that are presently being issued by the government.

Further, it will make Obamacare unnecessary and thus trivially able to be repealed -- and there will be no need for a replacement.

And finally, it will improve access to actual care for everyone -- across the board.

How would Donald Trump, President, accomplish this?

We already know exactly how to do it and we know it will work too.

ENFORCE EXISTING CONSUMER PROTECTION AND ANTI-MONOPOLY LAWS IN THE MEDICAL INDUSTRY.

In short:

1. Prosecute all attempts to price-fix, collude and otherwise monopolize this segment of the market (15 USC .et.al.) The abuse of market power is endemic; simply look at The Surgery Center of Oklahoma for an example of how a legitimate surgical practice can operate and indict any who do not similarly post binding prices prior to providing services.  Donald Trump has brought up cross-county and state shopping for insurance but that is just a tiny piece of the price-fixing that goes on today in the medical industry.  Stop it all and prices for services and commodity goods will collapse by 70-90% immediately.

2. Enforce consumer protection statutes that require a binding price to be posted, agreed to and honored before services are provided except in exigent circumstance (e.g. you're unconscious) in which case the services may not be charged at greater than that billed to a conscious, consenting individual.  Treat violations as criminal matters resulting in felony charges against hospital administrators, doctors and pharmacists who engage in same with treble damage civil racketeering suits available to consumers who the medical industry attempts to screw. You cannot engage in a contract to fix someone's roof, air conditioner or car in this country without quoting a price first.  It should be no different for the medical industry.

3. Demand that the "first sale" doctrine be enforced worldwide.  This will instantly break the pharmaceutical pricing games by allowing anyone to purchase drugs anywhere in the world and then sell them into the market for a price of their own choosing.  If you prosecute all firms and their executives who attempt to limit distribution or sales to prevent this then prices find their natural level and the outrageous distortions currently found in certain drugs disappear overnight.  For example, the modern treatments for Hepatitis C cost $90,000 for a course of treatment here in the United States but less than $1,000 in other nations.  It is the same drug made in the same factory and yet only through blatantly outrageous constraints that such a pricing disparity can be maintained.

The only reason this issue is "hard" is due to the lobbyists and vested interests in our government.  That an anti-venom costs $60,000 here in the US for a course of treatment but literally $200-300 in Mexico a few dozen miles away is an outrage.  These abuses, all of which are easily stopped but for those lobbyists and the outright purchase of our government by the medical and insurance industry are why we have a federal budget deficit, our nation is going broke and despite having the highest cost of medical care in the developed world our health outcomes suck.

None of the other candidates in the last several election cycles, including third party candidates, have taken this on.

Trump can and if he does he wins in a landslide with wide support from both Democrat and Republican voters.

More-importantly than winning the Presidency, however, resolving this issue will also fix the financial cancer that is eating our government and economy alive.

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Yet another "see, I told you so"....

An important new medical study finds that chemotherapy does not extend life for end-stage, terminal cancer patients. What's more, those who received chemotherapy treatment near the end of their disease had a worse quality of life than those who didn't.

Got that one?

If you have a terminal cancer diagnosis -- that is, you have a metastatic or otherwise inoperable cancer chemo not only fails to extend your life it damages the quality of life in the time you have left.

Why would anyone go through such a regime?  

Simple: You're offered false hope and those pushing said false hope make a hell of a lot of money if they can con you into damaging or destroying your enjoyment of the time you have left.

Nobody wants to face the fact that we're all mortal and we will die some day of something.  When that death comes quickly and without warning there's little opportunity for anyone to play on our fears.  But all too often you find out a few weeks or months before the end comes that the reaper is on the way, and then the medical machinery goes to work selling you false hope and carefully-couched misleading statistical claims.

I wrote several articles when Provenge was originally developed by Dendreon and faced review.  The clinical data showed that it had a median improvement of time-to-live of about 4 months and cost roughly $100,000.  Note that there was zero evidence that it produced a durable remission; that is, that the drug actually reversed the progress the cancer was making -- it simply slowed it down somewhat, but at horrific cost.

Dendreon went as high as $57.67 on this hype machine before collapsing with the firm filing Chapter 11 with the wreckage being acquired.  Why?  Simple: There was no cost-benefit analysis that favored the drug under any reasonable circumstance except when you could force others (e.g. Medicare) to pay for it.

This was obvious at the inception of approval and the expected pricing, but nobody picked up on it.  And while Dendreon blew up the fact remains that huge parts of our medical industry run on this same crap on a daily basis, and nowhere is it more-evident than when it comes to metastatic cancer of virtually every sort.

Will this finding change the debate?  It ought to -- but you can bet the drug pushers will line up the usual arguments on the other side; "you're trying to kill Grandma!" being one of the most-common.

No, folks, I'm not trying to kill Grandma.  Rather, when it is evident that Grandma is going to die I would prefer that she have the facts in front of her on a clean basis without hype or misrepresentation because the time she has remaining is unlikely to be materially extended by these drugs, but the misery of those last months will be increased if she chooses to take them, while the drug companies, doctors and hospitals will be materially enriched at the same time.

Monster (n):

1. Making money by increasing human misery in the last weeks and months of a person's life by peddling false hope and intentionally misleading claims, all for the purpose of selling high-priced drugs at an obscene profit.

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As I've repeatedly reported, yep...

Oklahoma City has become a medical tourist destination, according to an industry expert, leading the charge for a different method of healthcare delivery, specifically one that embraces the principles and fundamentals of the free market.

Dr. Keith Smith is a local physician who believes in a free market healthcare system. He is a strong advocate for transparent pricing.

“Oklahoma City has become a major medical tourist destination because of entrepreneurial physicians committed to quality and value,” said Dr. Smith. “People have been flying in all over the country and outside to get their care in Oklahoma.”

I've profiled The Surgery Center of Oklahoma several times on this page for it's embrace of the free market and price transparency.

As a consumer I'm allegedly protected by a wide body of law at both state and federal levels that is supposed to prohibit back-room deals to restrain trade and boost prices through obfuscation, lies, and simple refusal to quote a price.  I'm also supposed to be protected by Federal Law against monopolistic practices no matter who is involved in creating and maintaining them.

Both of these bodies of law are filled with strong civil and criminal penalties for violators -- but to my knowledge these laws are simply never investigated, say much less enforced, when it comes to medical providers, pharmaceutical and insurance companies.  Yet if I was to have attempted any of what is done literally daily in this "industry" when I ran my ISP I'd probably still be rotting in a "PMITA" federal prison.

Note the prices posted on the above page.  That's an "all-in" quoted price.  Now try to get one from your local hospital, in writing, on the same terms.

The blanket refusal of most providers to do so should be more than sufficient to trigger investigation and prosecution under the consumer protection laws of the states, say much less federal racketeering and price-fixing statutes, given that prices actually charged and funds collected vary wildly (by as much as 5x or more!) for the exact same procedure performed for the same indications.

But.... it isn't and won't be until we demand that it is, backed up with whatever means of enforcement by we, the people, is necessary.

Until that day comes (and it may never given how willing it appears Americans are to be financially sexed without calling it "rape") this may be the best and most-reasonable option available unless you're willing to get on a plane and go overseas.

PS: If you can get a price you'll note that the prices on that page are within the ability of most people to afford, even if with difficulty.  You'll also note that most hospitals will try to bill you at 3, 5 or even 10x or more those posted prices -- for the exact same procedure.

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