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Commentary on The Capital Markets- Category [Health Reform]

Riiiight.

The practice increases revenue for physicians and other health care workers at a time when insurers are cutting down reimbursement for many services. The surprise charges can be especially significant because, as in Mr. Drier’s case, they may involve out-of-network providers who bill 20 to 40 times the usual local rates and often collect the full amount, or a substantial portion.

20 to 40 times the usual and customary local rates?

Who authorized that?  Nobody!

So what is it when you're basically flat on your ass unable to consent and someone rams you for 20 times the usual price?

How is that not a violation -- a felony violation at that -- of general consumer protection statutes, and that's being kind?

“This has gotten really bad, and it’s wrong,” said James J. Donelon, the Republican insurance commissioner of Louisiana. “But when you try to address it as a policy maker, you run into a hornet’s nest of financial interests.”

How about this?  We start locking people up for this crap and take their Porsche and Mansion and sell it off, along with their yacht and vacation home?

"But they're doctors!" will be the refrain.  No, they're thieves and extortionists, and they, along with everyone that enables this crap, from the hospital administrators on down, ought to be in prison with them.

You want to know why you need "medical insurance"?  That's the reason.  This is a manufactured racket that were there to be any sort of abiding of the law would not exist.  There is an entire industry that only exists because of these ripoffs and the amount of money involved is immense; over $2 trillion a year is spent on medical care and a huge part of it is stolen or extorted through these schemes.

Patricia Kaufman’s bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition.

$250,000 to sew someone up?  Really?

How does anyone make the argument that this entire system isn't an extortion racket from top to bottom when the listed sort of prices in this article show up?  $115,000 for a $6,000 procedure?  $18,000 for $700 worth of work?

“You can cut fees, but institutions find ways” to make the money back, he said. “There’s been a mushrooming industry of mandatory consultants for services that neither doctors nor patients want.”

C'mon folks -- that sort of thing is organized and by any reasonable definition it's Racketeering.

This isn't something to "push back" against, it's something to prosecute and throw all of these *******s in prison, hitting them with both the statutory maximum fines and treble damages, starting with the hospital administrators and physicians doing it.

ALL OF THEM.

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Yikes....

In a separate room, they had their own duplicate machine, but not connected to anything. This was their “practice” machine. Before using Amgen’s machine, they’d first take me into the other room and have me try various levels of sharp inhalations that were somewhat less than my maximum. My whispered instructions were to try a little harder, then try a little less, until I was able to consistently give just the poor enough “before” measurement Amgen wanted, followed by an “after” measurement that showed just the right amount of improvement. I’d then go back to the “real” computer and blow just exactly the desired counterfeit data into Amgen’s system.

Oh boy.... and no, that's not the whole thing.

Basically, this entire "trial" was a scam.  The guy wasn't on the drug that was being compared against, the "testing" was rigged and so was the reporting.

Isolated incident?  Who knows.

If "statistical significant results" are shown marketing approval will generally follow.

So what happens when the drug either doesn't work or isn't any better than what it is being tested against, but the data is falsified?

How much money is made and how many people get hurt -- or killed?

And how often does this happen?

Still comfortable with our medical system eh?  You mean you really believe that after ripping people off wholesale for 20+ years via acts that in any other line of business would get you tossed in the slammer for price fixing, monopolization, even extortion -- you think drug trials are all on the up-and-up eh?

Well you better read that link then.

In full.

Yeah, I know it's an allegation.  But this one could truly be a "you bet your life" deal.

Think about it.

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Today I wish to outline one of the examples of said false paradigms from one Casey Mulligan on the ACA and its economic impact.

You wouldn't know it if you just took a cursory look at his article coming from my general perspective -- that is, Casey argued the ACA (Brosurance, Obamacare, whatever you prefer to call it) has no possibility of actually being of net benefit.  The problem is that Mr. Mulligan does so by thoroughly and intentionally ignoring the root cause of trouble in the health system.

For example:

The Affordable Care Act attempts to help low- and middle-income families avoid some of the tough sacrifices that would be necessary to purchase health insurance without assistance. But no program can change the fundamental reality that society itself has to make sacrifices in order to deliver health care to more people. Workers and therefore production have to be taken away from other industries to beef up health care, or the workforce itself has to get bigger, or somehow people have to work more productively.

Although the ACA helps specific populations by giving them a bigger slice of the economic pie, the law diminishes the pie itself. It reduces the amount that Americans work, and it makes their work less productive. This slows growth in both personal income and gross domestic product.

True, but insufficient, and intentionally so.

The root of his argument appears to be this:

All of this, and much more, exacerbates the societal problem that the economy cannot expand its health sector without giving up something else of value.

Ah, but there is an intentional refusal to consider whether said "expansion" is real or whether it the vast majority of it was artificially engineered to rip people off.

And since this guy is a professor of economics he knows good and damn well what I'm about to point out -- that is, I argue he's intentionally ignoring that side of the debate to push a political point.

Let's presume there are two loaves of bread.  Both contain the exact same ingredients, were baked at the same temperature for the same time, and contain (after scientific testing to confirm it) the same number of calories and those calories are of the same composition.  That is, they are functionally, visually and perceptibly identical.

One is priced in the marketplace at $1.  The other is priced in the marketplace at $10.

How many will sell for $10?

Zero, or close enough to zero to be indistinguishable from zero.

This prediction, of course, rests on one presumption: The consumer is not prevented from buying for $1, the manufacturer is not prevented from selling for $1, and the manufacturer of the $10 loaf is prevented from lying about his $1 competitor (say, for example, by alleging that the $1 loaf contains rat poison.)

Now which has a greater "impact" on GDP?  The bread selling for $1 or that selling for $10?

Hmmm... since GDP is stated in nominal dollars.....

Mr. Mulligan knows this, incidentally, since it's one of the first things you learn when you begin to study economics.  As a professor this certainly hasn't been lost on him -- he has simply and intentionally refused to talk about it.

Further, if we want to increase the "amount" of bread we must shift much more of GDP if each loaf sells for $10 than if it sells for $1.

This means that Mr. Mulligan's entire premise is false, because the presence of that intentional distortion dwarfs any other consideration when it comes to the amount of health care society wishes to consume.

I'll go further.

The reason Mr. Mulligan refuses to consider these blatant, in-your-face distortions that are widely reported in the media (e.g. $9,000 charges to bandage a finger, $60,000 for two $100 vials of scorpion anti-venom, $10,000 charges for "trauma activation" that never happened and similar) is that were he to do so then the entire premise of his argument would evaporate as there would be no need for health insurance at all and that entire industry would vanish -- as would it's "contribution" to GDP!

At the same time, incidentally, so would vanish more than a quarter of all Federal spending (Medicare and Medicaid alone were $1.13 trillion last fiscal) and all Federal deficits -- indeed, we would run a large surplus.  This would in turn eliminate the new issuance of Treasury debt and that would halt and reverse the destruction in purchasing power (that is, monetary depreciation) that such issuance mathematically causes.

So why are we talking about the ACA at all instead of talking about the behavior of the participants in a so-called "market" that is in fact riddled with actions that, by the black letter of 15 USC Section 1 (Sherman and Clayton Acts) ought to be felonies and, were they to be treated as said felonies the "market need" for "health insurance", the ACA, and more than a quarter of all Federal spending along with all of our Federal deficit and long-term unfunded liabilities, both federally at the state levels, never mind Detroit's bankruptcy, would instantly vanish?

Shoving nonsense in front of the public is of course anyone's right to do and Mr. Mulligan has apparently just published such a book.  But this sort of obfuscation of the underlying issue is outrageous and insulting -- and that's being polite.

We will never, ever solve what's broken in our government's funding model, say much less that of the States and Local governments, until and unless we take on where the actual problem arises from and stomp on it like a cockroach.

And yes, we have to do that even though it would result in an immediate short-term dislocation in GDP.

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2014-09-08 22:21 by Karl Denninger
in Health Reform , 209 references
 

So you still think doctors are the good guys in the medical racket?

Well, then consider this -- it's just one word that makes the difference between legal and illegal....

After Ms. Mallory forwarded his query to BlueWave's Messrs. Johnson and Dent, Mr. Johnson emailed: "Fyi To all I want to refocus that this is an ph fee not a draw fee. One word makes it legal the other illegal."

It's not what you do, it's what you say.

If you say one thing, it's legal.  If you say another, it's not.

I thought it what you did that made something legal or not rather than that you called it?

Oh, what is "it" in this case?

A medical testing lab that, according to some allegations, has been paying kickbacks to doctors for using it.

You decide whether the described amount was for "postage and handling" or whether it was (irrespective of how worded) for referring the test to them -- and pay close attention how much was "reimbursed" for said "p&h" and whether that reasonably corresponds with, well, actual postage and handling.

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It isn't often that three bogons show up in quick succession, but we've got it here from the so-called paper of record of the scam machine known as Wall Street.

First, let's deal with the so-called Obamacare Escalator.

On Wednesday the actuaries at Health and Human Services released their new annual projected measurement of national health expenditures for last year and through 2023. Spending in 2013 grew at a relatively low rate in historical terms for the fifth consecutive year below 4%, though at 3.6% it still outpaced real economic growth. They expect the rate to climb to 5.6% in 2014 and continue rising by 6% a year on average through the decade.

Health spending as a share of the economy rose to 17.2% in 2013 from 16.2% in 2007 and will hit 19.3% in 2023, assuming that GDP grows as smartly as the auditors project. In other words, health care will soak up nearly one of every five U.S. dollars instead of one of six. Taxpayers will finance 48% of that spending a decade out, up from 41% in 2007. Thank you, Peter Orszag

So let me see if I get this right.

Health care spending as a share of the economy will go to 20% within the next 10 years.  It's bad because that will hit the Federal Budget.  But it would be "good" if it didn't, and instead skull****ed everyone in America who isn't Michael Jordan or Bill Gates within an inch of their lives?

The mental gymnastics required to get there are beyond ridiculous.  Oh, and guess what -- they even try to justify it:

Medical spending is valuable to the extent Americans are buying longer and healthier lives and financing innovation in treatments and therapies.

Really?

Would spending on gas be "valuable" if the fuel was $30/gallon to the extent you could get to work using it?

Well, maybe.  But shouldn't we instead be asking why it's $30/gallon instead of $3 when the only reason it's $30 is the monopoly protections that the government provided for in the form of specifically enabling price-fixing of various sorts?

How do we know this?  We know it because hospitals claim it's perfectly reasonable to charge $9,000 to bandage a finger and $60,000 for two $100 vials of scorpion antivenom that can be purchased over the counter a couple hundred miles to the south.  We also know this to be true because a common test that can be purchased for $20 is charged out at $10,000 by some hospitals.

It is in fact laws that make criminal the sale and possession of said anti-venom without a valid license from a cartel-controlled group that enable said $60,000 price, just as it is laws that make a crime your attempt to have such a test done for $20 on yourself without a valid prescription by a member of that very same cartel.

Those acts -- restraint of trade where market power exists -- are supposed to be felonies according to The Sherman and Clayton Acts.  They in fact result in prices that are thousands of percent higher than the market price for said commodities and services.  It is in fact these acts that leads to an entire industry being required for most people and having a reason to exist in the first place (that is, the medical "insurance" business), a situation that is facially a close analogue to a mafia protection racket.

Then there's this ditty on Disillusioned Doctors....

This economic interaction fostered a better physician-patient relationship. Unfortunately this is lost in U.S. health care, where third-party payment dominates and physician allegiance is divided between trying to take good care of patients while adhering to demands of government agencies and insurance companies which pay the bills.

You know what happens when you allow yourself to be used as a pawn akin to a drug mule for a cartel?

You get ****ed, that's what.

Doctors really thought they could be a part of the above crap, actively participate in ****ing their customers out of trillions of dollars at the behest of and for these other actors and come out ahead in the long run?

Oh sure, it worked great for a while.  Being a doctor used to be a solid middle-class profession.  Then it turned into one that got you a Porsche and a mansion when you began robbing people.  That was a carrot -- the stick is that you weren't going to be able to keep any of it long term because you were cooperating with and enabling the devil.

And finally, if that's not enough, you have this on $20,000 bruises:

I was proud to see the health-care system working, to see academic medicine working, and most of all to see my son run as fast as he could out of the ER two hours later.

Then the bill arrived, and you know where this is going: $20,000. Our insurance had already paid $17,000, and we owed $3,000 out-of-pocket. What for? Among the items listed on the printout was a $10,000 charge for a "trauma team activation." This made me want to give consumers some very simple tips on how to fight their health-care bills, so here goes:

The rest of the article is a bunch of arm-waving about how he got rid of the bogus $10,000 charge.

Bogus, I say, because no such activation of said trauma team occurred and if it had it would have been in direct violation of published regulations.

He finishes with (after getting the bogus $10k charge removed) "be graceful in victory and realize you got lucky."

Uh, no.

You see, billing someone for a thing when you didn't do it has a name -- F.R.A.U.D.

When that is systemic, that is, intentional and widespread instead of an occasional "mistake" how do you argue against a position that you're operating a criminal enterprise.

And that means that everyone involved would be engaged in the felony known as Racketeering, which in turn means treble damages, huge fines and prison time for everyone involved from the Hospital Administrator on down to the doctors and clerks who were fully aware that they billed out for services they didn't perform.

All in my opinion, of course, since that would be the outcome if we lived in a world where there was actual Equal Protection of the Law.

I will remind you that we're supposed to live in that world because our Constitution via the 14th Amendment says:

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

So there is supposed to be one law for everyone.  So says Amendment 14.

You and I go to prison when we rip people off for 10 large, especially when we do it daily on a systemic basis.

So here's my position on all of this:

If the hospital, doctors, billing clerks and administrators don't have to obey the law why should those people expect anyone else to obey the law in their dealings with them?

You want to know how we get Mad Max in this country?  Keep playing this game long enough, keep making excuses for what ought to be hard-time felonies, and eventually you'll***** off the public enough to find out.

I'm not looking forward to that day and if you have any common sense you're not either.

Cut the crap and stop making excuses.

Now.

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