Fuck you Mr. President and your "Executive Order."

Double-fuck you Rand Paul.

There is no "reform" in your Executive Order; selling insurance across state lines and allowing "skinny" plans does nothing to address cost.

You could, via Executive Order, direct the FTC to go after medical providers of all stripes for refusing to publish prices, declaring such an action to be a deceptive practice and thus in violation of Federal Law and Regulation.  Every single business we deal with daily, with the exception of health care, posts prices and thus allows us to shop before we buy.  It is only health care that lacks this essential element of a market and in any other line of work such would have long-ago led to enforcement actions and even indictments.

You could, via Executive Order, direct Jeff Sessions to enforce 15 USC Chapter 1 against all medical firms as regard disparate pricing based on one's insurance status, a clearly-extortionate and illegal act under 100+ year old law which forbids any collusive act intended to limit competition and/or fix prices.  Said law has been challenged twice by the insurance industry all the way up to the United States Supreme Court with the first such challenge in 1979 (Group Life & Health .v. Royal Drug, 440 US 205) claiming an exemption for health insurance providers under McCarran-Ferguson.  THEY LOST.  I have repeatedly heard from myriad "lawmakers" that health insurance and medical providers are exempt from anti-trust; this is a bald lie given that there are two cases which went to the United States Supreme Court and were lost after attempting to assert exactly this claim.  What's even more outrageous is that after the second loss the State of California wrote a section into their BPR code (similar to the federal CFRs) that explicitly exempts health providers from the effects of that US Supreme Court decision yet it is a fact that no state regulator or legislature can exempt someone from a federal law.  That such a claim continues to be made by lawmakers, including Matt Gaetz just recently here in a Town Hall meeting in Florida, is an outrage and a deliberate fraud upon the public in which you are not only complicit you are the chief fraud enabler and promoter.

You, Mr. President, had not one but two items in your platform when running for President that addressed these issues, with one of them requiring the publication of prices.  As soon as you were elected that provision disappeared and has never been seen or heard since.

You're a damned liar Mr. President, and watching you at the dias this morning I want to fucking puke at the crap you are running on the American people with the full support of Rand Paul, who likewise wants to screw Americans by extending anti-trust protection to all medical providers.  He has in fact repeatedly tried to pass such a provision which would make legal that which currently is not, and which has been ruled illegal twice at the US Supreme Court but which your Administration, just like the previous ones, refuse to enforce.

The actions of this industry are illegal and between them medical firms steal over $3 trillion a year from Americans, enough for each and every American family to afford the payment on a middle-class house.

Fuck you Mr. President, fuck you Rand Paul, and fuck you Congress.  

Here it is:

"Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof."

That's it.

One sentence.

If you want to add a penalty clause with it I propose the following:

"Any bill rendered to a person in excess of said amounts shall (1) be deemed void, with all services and goods provided as a gift without charge or taxable consequence to said consumer but not deductible by said physician or facility from any income or occupational tax and (2) is immediately due to the customer in the exact amount presented as liquidated damages for the fraud so-attempted."

It ends the "Chargemaster" ripoff game.

It ends the $150,000 snake bite or the $80,000 scorpion sting.

It ends the $500,000 cancer treatment.

It ends all of that, immediately and instantly.

I remind you that Medicare is required to set pay rates by law at a level that in fact are profitable -- that is, above cost by a modest amount -- for everything it covers.  Further, those pay rates are audited regularly to prove that they in fact are above cost.

Does this solve every problem?  No, and in fact that would leave alone the existing monopolistic pricing systems that many medical providers, whether they be drug makers, device makers, service providers or otherwise have in place.  It would do exactly nothing to get rid of the 10 paper pushers hired for every doctor or nurse, none of whom ever provide one second of care to an actual person through their entire time of employment.

But it would instantly end walking into an emergency room and getting hammered with a $50,000 bill for something that Medicare will pay $5,000 for.

I remind you that even quite poor people can manage to come up with $5,000 in a life-threatening emergency.  Sure, they might wind up paying 25% interest on the credit card, they might have to stop smoking their $5 pack/day cigs, and it might take them three or five years to pay it off, but they can probably do it.

It's not an answer to the problems the mediscam imposes on society, but it would sure as hell bring down costs for people instantly and permanently, and would make the decision to not carry insurance one that people could opt for while having a rational shot at paying cash -- at least for those in the middle class or better, for whom a $5,000 surprise would be bad, but bearable.

More to the point with the crazy deductibles today the $5,000 would actually buy care and eviscerate the insurance ripoff at the same time, because today you get to pay the $5,000 plus another $10k/year in "premiums" -- for exactly nothing.

This matters because most of the argument for so-called "health insurance" is actually about extortion -- either buy the product or be ruined with charges that are 5, 10 or even 100x what someone who has bought the product will pay.

Ending that will force health insurance companies to actually provide a product that is affordable and provides a reasonable set of benefits -- or people can simply stick up the finger and pay cash.

Pass that, which should take no more than 30 seconds to introduce and put on the floor of both the House and Senate and then we can debate this as a permanent solution.

Let's talk about the implementation of my model bill that I recently posted to reform health care on a permanent basis.

It's fairly easy to envision timelines based on complexity.  Simply put, most of this isn't complex because providers have price lists now -- you just can't see them.  So with that said, let's look at an example and assume The Bill was passed and signed somewhere around 30 September -- or the close of the fiscal year.

What's next?  The following timeline appears to be reasonable.

Beginning immediately on signature with implementation required on or before 1/1/2018:

• CMS (Centers for Medicare and Medicaid Services; the existing federal agency) would be required to spin up the interface for Treasury to verify whether someone who presents credentials as a US citizen or lawful permanent resident is, in fact, a citizen or lawful permanent resident.  Treasury already has this via the Social Security Administration, since they have the records of all issued Social Security numbers and addresses from tax filings.  In fact you can get at this right now (for yourself) via http://ssa.gov.  CMS also already has an electronic interface system for all medical providers who are registered in order to submit Medicare or Medicaid billing; ergo, the infrastructure is already in place along with access credentials.  Medical providers who wish to avail themselves of the ability to bill Treasury for indigent patients would have to register, but the number of providers currently not registered is a tiny minority of the whole.
  
  
• CMS begins publication of Medicare reimbursement rates for all procedures, drugs and devices.  CMS already has developed and maintains this information so this is simply a publication of existing data and can be done very quickly.  The list may be updated annually as is now the case however with Medicare being a reimbursement source but not a direct billing source as of 1/1/2019 fair notice to all non-Advantage Medicare recipients so they can start shopping providers and services is necessary. (Medicare Advantage customers will have this data from the Medicare Advantage company they select and it may well be different between different Medicare Advantage providers.)
  
  
• Providers must put together their price lists.  They have three months to do so; failure to have and post one as of 1/1/2018 means you're closed!

On 1/1/2018:

• Providers must post their prices and on demand honor them, along with affirmative consent requirements.  A customer may present him or herself on January 1st 2018 and request the published price.  If they do so then binding, fixed-price treatment per the price schedule and treatment consent rules in the bill must be honored.  Note that all such binding prices must include any consequential events or complications (e.g. those caused by the treatment or the facility in question.)
  
  
• No event caused by a provider or treatment may be billed to the customer.  Alignment of the customer's interest in NOT having an MRSA infection, for example, with the provider's interest in reducing their cost must take place on an expedited basis.
  
  
• "Most favored" nation pricing for drugs begins.  No exceptions, no apologies.  Drug prices drop like a stone.
  
  
• Open testing begins.  If you wish to purchase a test or other diagnostic without invasive exposure beyond a blood draw and not bearing radiation or similar exposure, you may -- for cash and without a prescription or doctor's order.  Since all medical providers must have posted prices on 1/1/2018 you have a list of prices available to you and places to shop from.
  
  
• Auxiliary services must be open.  You can buy said test wherever you want and bring the results to your doctor for consultation or treatment, without limitation.
  
  
• A 365 day period begins during which medical providers may continue to maintain records and coding, but they must also provide human-readable records at the point of service to the consumer.  Since there is basically no medical office in the nation that doesn't have PCs or similar this is trivially done; 3 months is more than enough time to put in place the policy to provide records at the time of treatment to the consumer.
  
  
• CMS and Treasury continue their tax processing and billing integration work with a start date of 365 days hence, or 1/1/2019.  This will be necessary to deal with EMTALA repeal and related from the bill.
  
  
• A 180 day notification period begins during which lifestyle modification is mandatory for those with existing conditions on public medical assistance in order to receive Treasury Billing (and potential medical debt forgiveness at death due to their indigence.)  This specifically applies to Type II diabetes suffers on publicly-funded health programs, although the list of conditions will likely expand.  Those who claim that cessation of eating carbs and PUFAs are not sufficient to bring their blood glucose either under control or materially improve their condition may challenge the individual applicability to them during this time, and must prove same via isolation test (which will likely take less than 48 hours!) with them bearing the cost of the testing in cash if they lose.  Since nearly all of these people either have or should have home instrumentation (e.g. a blood glucose meter), and those who don't can certainly buy one for a few dollars at any drug store including such outlets as WalMart over the counter, they ought to have damn good evidence before attempting to claim an exemption.  These people will also know in advance, or easily be able to determine, if they're going to get caught if they try claiming an exemption and are lying.
  
  
• A 180 day period begins during which Health Insurance companies are required to put together true insurance offerings as required under the Bill to continue selling any health-related policy with effect beyond 12/31/2018.  Since state regulators typically require some notice period (usually six months) this means they must submit same by 6/30/2018.

On 7/1/2018:

• Medicare and Medicaid recipients with diabetes who have not made the lifestyle adjustments required are cut off from further government funded or transferred billing for their condition until and unless they make the required lifestyle change for at least six months.  They had six months warning and ability.  For the last six months of 2018 the Federal Government, during the remainder of the transition, will see approximately $200 billion in reduced spending. 20% of the adults in the United States have had their pants fall off.
  
  
• Health insurance companies must have posted to the states their catastrophic plan pricing and coverage, along with whatever other offerings they wish to make for the 2019 calendar year.
  
  
• All providers who intend to bill indigent customers must be registered with CMS to provide CMS with sufficient time to process any pending applications and resolve questions prior to 1/1/2019.

On 1/1/2019:

• Level pricing and quote-before-service (and the procedures for exigent circumstances) for all customers is mandatory.
  
  
• Centralized medical record and coding requirements end and all customers must receive their medical records at the point of service.  The AMA's monopoly on coding revenue (which, IMHO, should have resulted in them being indicted years ago) ends.
  
  
• EMTALA repeal is effective; illegal immigrants no longer can access emergency services at the public's expense.
  
  
• Medicaid repeal is effective at both State and Federal levels; all Medicaid spending ends.
  
  
• Medicare Part "B" repeal is effective.  For "HMO" or "PPO" style coverage post this date Seniors can buy Medicare Advantage policies as they do now but they are not compelled to do so (as they are now.)
  
  
• PPACA repeal is effective; all Obamacare policies, taxes and tax credits end.
  
  
• US Code and CFR amendments to remove the PPACA, Medicaid, and Medicare Part "B" components become effective.
  
  
• Lifestyle requirements continue.  Again, this specifically applies to Type II diabetes where a zero-cost lifestyle change simply comprised of what one eats is sufficient to reduce or eliminate drug and procedure requirements along with the degenerative effects of the condition.
  
  
• All citizens or permanent residents who assert inability to pay a provider now have their bills submitted to Treasury for payment within 30 days.  The customer can choose any provider but the price charged must be level as for anyone else.  Providers who have more than 50% of their customers submitting invoices to Treasury on an annual dollar-billed basis are subject to audit for charges being reasonable and non-collusive (see below.)  The 60 day "no fault cure" policy begins for those who have bills submitted to Treasury due to a claim of inability to pay and tax liens begin to accrue on March 3rd, 2019.
  
  
• For those on Medicare CMS continues to provide the payment rates it will cover to the public for Parts A and D but the customer must submit claim for payment and is responsible for the difference should the price charged be higher than the reimbursement amount.  Medicare customers thus now have an incentive to shop and no restriction on which provider they use for services.  For Medicare customers not using an "Advantage" plan Medicare Part "B" ends both as to the premium collected and benefit disbursed since Part "B" has been deleted.  For Seniors who find themselves unable to afford the portion of payment they must make even with Medicare's typical 80/20 split due to indigence they may assert that indigence just as can a former Medicaid customer and as such low-income Seniors are protected to a much greater extent than is currently the case with Medicare since they enjoy 100% access to all medical providers -- a huge increase in choice compared to today and they have access to the same billing deferral via Treasury that former Medicaid consumers have.
  
  
• For former Medicaid consumers they may assert indigence and thus may access any medical provider as may anyone else who can pay cash.  This is a massive improvement in their access to health services over today as many providers today refuse Medicaid patients (other than via the ER!), but it comes with a tax lien that, should their economic circumstances improve in the future or should they have refundable tax credits, they will be expected to pay.  As a result former Medicaid recipients will, for the first time, have an incentive to both shop and consume medical services wisely.  Many former Medicaid consumers will choose to pay cash, especially for drugs, since a large variety of drugs will be available at monthly costs similar to that of a cup of coffee from McDonalds, but for services where they cannot afford to pay directly the safety net will be available via the Treasury.
  
  
• Private and corporate-funded catastrophic plans, along with any new "PPO" type plans, take effect.  
  With price transparency and no billing obfuscation or "hiding" insurance costs drop like a stone.  Typical "catastrophic" coverage will be available for a few hundred dollars a year.
  
  
• Direct and hidden billing of insurance companies of all sorts, along with "explanation of benefits" nonsense and the implied extortion attendant with same ends.  The customer is billed at a level price as with all other customers for the same good or service; whatever insurance they may have, whether it covers the service(s) provided and how much it will cover is between only the customer and the insurance company.  Collusive behavior, hidden pricing, performance of procedures without prior consent (except in exigent circumstance) and price-fixing disappears entirely.
  
  
• For the first time in 30 years real competition breaks out in the medical field -- not just on price but also on quality of service.  With cost and outcomes exposed customers will be able to research and choose just as they choose a cellphone or automobile today.

• Non-citizens/non-green-card holders have no right to treatment of any sort nor does any provider have liability for refusal to provide it without payment.  Non-citizens and non-green-card holders (visitors, illegal immigrants, etc) may purchase services and products for cash should they be willing and able to do so.
  
  
• State CON laws and similar are all pre-empted.
  
  
• Mandatory enforcement of 15 USC and the civil rights of action for individual consumers against medical providers for price-fixing, collusion and similar offenses begins.  Note that providers who collude or attempt to defraud Treasury and allegedly low-income customers claiming indigence (who really aren't) are subject to mandatory prosecution and punishment under the Bill.

And.... it's done.

The medical scam has ended.

There are no more Federal Deficits; in fact, we run a perpetual budget surplus and begin paying down the national debt.

Your standard of living starts going up every year even without a raise by about 1% each and every year instead of going down as it does today.

We no longer pay for illegal immigrant medical care at all from public funds.

You get a price that is the same as everyone else for the same good or service in the medical field just as you do at the grocery store, the gas station and the local restaurant.  The outrageous price discrimination (sometimes as much as 10, 20 or even 100x or more) served up on some people -- discrimination that usually bankrupts the consumer in question -- ends permanently.

You know exactly how much you will be billed for a medical procedure, drug or device before you choose to undergo that procedure or accept the treatment.  Your insurance company, if you have one, will have to make available what they will pay and the hospital, doctor or pharmacist must tell you what they will charge.  You will thus know what the total cost to you will be -- before you sign a consent form or have a procedure done.

If you get an infection from a hospital you cannot be billed for the drugs and time to treat that which they gave you due to their incompetence.  That risk and cost is finally on them, which will drive innovation and greater care to prevent such infections that harm and even kill Americans today.

If you can't pay you will still be treated and can still choose your doctor, but you will be responsible to cover the (much more-reasonable) bill if you become able to pay it in the future.  This will permanently put an end to the practice of poor people using the ER like a doctor's office since this sort of abuse will no longer be advantageous compared against going to a regular physician.

Drug prices fall in the United States by at least half (and more likely by 80% or more on an average basis) and for those with chronic diseases that have been sucking down drugs and procedures while refusing to make simple, zero-cost lifestyle changes they finally have a strong incentive to both do so and have their health improve materially at the same time.

There will be no more $300,000 snake bites, $150,000 scorpion stings and $1,000-per-stitch fees that get lumped on you without any way to prevent them when something bad and random happens.  Any medical provider who tries it will find their bill void and they will be prosecuted for fraud.

Obesity and diabetes incidence falls dramatically since it is now strongly in everyone's best interest to practice simple changes in their lifestyle.  An epidemic has broken out -- of people having their pants fall off.  It's a good epidemic and America is noted and lauded as being the first nation to have reversed the increasing rate of obesity and Type II diabetes.

The nation becomes far more productive as the cost of employing someone drops by a solid 15% and America becomes the place to put a multi-national business.  In short labor expense drops tremendously and productivity soars.

If you're not a currently-overpaid administrator you get a raise; for a typical median family it will be about 10% immediately as your employer's cost of having you on staff will drop by at least that amount.  For the average family of four you will see, net of your medical expenses, roughly $7,000 richer in cash spending power after tax each and every year.

Those who are currently-overpaid administrators in health care will find jobs in other sectors.  It may take a while but it will happen, as the economy comes roaring back with the newfound efficiency and productivity improvement from deleting the fraud currently consuming almost one dollar in five.

State and local pensions and budgets stabilize and, over time, taxes come down at the state and local level as the levies put in place to try to stay ahead of the pension destruction are no longer necessary.  Specifically, property taxes decrease materially which will cause both the cost of owning a house and rents to decline.

Your car insurance gets cheaper as your liability policy, much of which covers medical expenses coming from accidents where you are at fault, along with uninsured motorist coverage, will decrease dramatically in cost.

Federal Spending will contract to something similar to this -- and I note that this chart presents a pessimistic estimate. We would almost-certainly do better than what is depicted here and, I remind you, both Seniors and indigent citizens would receive better care and more choice than they have now.

And we prevent this -- our federal debt -- from blowing up in our face as the CBO currently predicts -- an event that, if it occurs, will destroy the nation just a few years from now.

Let's lay out the parameters for a bill, a fairly-modest update to my two previous missives on this point here and here (note the dates) and which can be easily turned into formal legislative language:

• All providers must post, in their offices and on a public web site without any requirement to sign in or otherwise identify oneself to access it, a full and complete price list which shall apply to every person.  This instantly allows customers to compare pricing between providers for services and products in the medical realm.
  
  
• All customers must be billed for actual charges at the same price on a direct basis at the time the service or product is rendered to them.  This immediately and permanently decouples "insurance" from the provision of care.  The current system of an "explanation of benefits" that often features a "negotiated discount" of some 90% is nothing other than an extortion racket and is arguably felonious -- threatening to bankrupt someone if they don't buy your "insurance" through a threat to charge them ten times as much certainly appears to be a criminal enterprise and, given that more than one entity is involved, looks like it meets the definition of Racketeering.  Insurance coverage may well cover some, part or none of a given bill, and nothing prevents an insurer from telling you in advance of your visit how much they will pay (if anything) for a given procedure or drug.  Indeed you should demand that information from them and use it as part of choosing where to obtain treatment but the bill still has to be rendered to you, you have to be the one to file the claim and everyone must pay the same price to the same provider for the same kind and quantity of product or service.

• For a bill to be valid and collectible it must be affirmatively consented to in writing, with a disclosure of the actual price to be charged from the above schedule for each item to be provided whether good or service, prior to the service being performed or the good furnished, subject only to the emergency exception below.  A bill that is increased, has items added to it after consent is obtained, which contains any open-ended promise to pay without an actual price listed for each service or good prior to customer consent or is issued with no consent at all (including having a customer sign a consent form while under the influence of drugs the facility gave them as occurs in virtually every instance today while you're being wheeled into the OR) is deemed fraudulent and void. This instantly stops "drive-by" doctor charges in hospitals as just one example.  It also prevents charging $20 for an aspirin; nobody would tolerate being billed by the square for toilet paper in a hotel!  Hospitals will of course squawk that they cannot operate like this as they "can't" figure out what is required until after-the-fact but that's false; nothing prevents them from advertising "Appendectomy: $2,000" and that being the soup-to-nuts price.  In fact that's exactly what the Surgery Center of Oklahoma does today so quite-clearly it both can and does work.  In addition this change will permanently and immediately put a stop to the ridiculous practice of defensive medicine (read below for the explanation.)  You would never accept a gas station that only displays the cost of your gasoline after you pumped it and varied that price based on who your car insurance was bought from or a grocery store that had no prices posted at all and only gave you a total after your groceries were taken out of the store and the transaction could not be refused.
  
  
• No event caused by or a consequence of treatment, can be billed to the customer.  This instantly aligns the interest of the customer in not having such an adverse complication (e.g. MRSA, etc) with the medical provider.  As it stands right now hospitals actually have an incentive for you to have a complication since they make more money if you do.  If you call me to fix your roof and I drop my ladder causing it to crash through your picture window I get to pay for the glass I broke through my ineptness.  The same must apply to medical providers.  For those who claim hospitals and similar can't adopt such a model I point to the OKC surgery center, which does exactly this -- and has a lower complication rate (gee, I wonder why when they have to eat it if they cause it....)  The exception: A unavoidable and pure-chance side effect of a treatment or medication that (1) is less harmful than the disease or condition treated, (2) fairly and objectively disclosed in comparison to the original risk of the condition being treated and (3) thereby consented to with informed consent.  In other words you can't give informed consent to an MRSA infection acquired in a hospital but you can give informed consent to the risk of taking a drug, if and only if you are in fact provided the truth about the treatment and it's scientifically-documented risks and rewards.  Note that if those scientific facts are later proved to be bogus you have a cause of action against everyone so-involved in deceiving you.
  
  
• All true emergency patients, defined as those who are unable by medical circumstance to choose where their treatment is to take place and require immediate medical intervention to either stabilize their condition, prevent severe permanent impairment or death (e.g. transported by an ambulance, unconscious with no person with medical power of attorney at-hand, having a heart attack in the ER, etc) must receive the same price for the same service as a person who consents to said service.  For a bill to be valid for a true emergency documentation must be maintained and presented showing that the customer was unable, due to exigent circumstances at the time they presented to the provider, to provide consent prior to services being rendered.  Any medical provider who attempts to bill any service or product above that price to a person in exigent circumstances forfeits 100% of their invoice and is guilty of consumer fraud.  Note that this does not prohibit a hospital from having a published price list that charges more for services rendered through their Emergency department, those that are provided at 3:00 AM, etc. so long as those who walk in, are conscious and able to consent get the exact same price as someone who is unconscious and flat on a gurney.  If you demand that an A/C repairman or plumber come out now at 3:00 AM he most-certainly can charge you more than if you call and ask him to show up during normal business hours!
  
  
• All medical records are the property of, and shall be delivered to, the customer at the time of service in human readable form (a PDF provided on common consumer computer media such as a "flash stick" shall comply with this requirement.)  Any coding or other symbols on said chart must include a key to same in English delivered at the same time.  No separate charge may be made for the provision of a contemporary record of a medical visit or treatment other than a reasonable charge for physical media if the customer does not have same with him or her.  The obvious way to do this is for the customer to bring a flash drive to which the human-readable chart is written.  If the customer doesn't have one the office can certainly maintain a small supply of $10 flash drives and charge the $10 to their bill.
  
  
• All surgical providers of any sort must publish de-identified procedure counts and account for all complications and outcomes, updated no less often than monthly. Consumers must be able to shop not only on price, but also on outcomes.  Because outcome odds do vary with the seriousness of the presented case providers may classify severity as well provided it can be done in an objective way.  Complications must be broken down as to type (specifically identifying any that are not due to presentation but rather the facility via infection or error), severity of injury (including death) and additional time and/or drugs and procedures to resolve on a ratable scale commensurate with the original prognosis.
  
  
• Auxiliary services (e.g. medical or dental Xrays, lab testing, etc) may not be required to be purchased at the point of use.  If you wish to buy your tests from the lab down the street (which also must post a price) that's up to you.  If you wish to have your bitewings taken at the imaging center across town, that's up to you.  The dentist or doctor cannot require that you buy those services from them; they must compete for them like everyone else.
  
  
• All anti-trust and consumer protection laws shall be enforced against all medically-related firms and any claimed exemptions for health-related firms in relationship to same are hereby deemed void; for private actions all such violations proved up in court are entitled to treble damages plus a $50,000 statutory civil penalty per impacted person.  If the government won't bring these charges (and we know they won't since despite not one but two US Supreme Court cases here and here making clear anti-trust laws apply to medical providers of all stripes not one charge has been leveled against any of the medical firms) let's make it damn attractive for individual private suits by making the price of losing such a suit for a medical provider ruinously expensive (and lucrative for the attorneys bringing them!)
  
  
• Any test or diagnostic that carries no exposure to drugs or radiation, nor is invasive beyond a blood draw, may be purchased without doctor order or prescription.  If you want an A1c or CBC you thus need nobody's permission to have one.  Same for an MRI.  For those tests and procedures in which exposure to drugs or radiation are involved, or are invasive (e.g. internal biopsies, etc) requiring some sort of chain of evidence of need due to that risk is reasonable.  But for most diagnostics this is demonstrably not true.  There is a clean argument to be made that for young, outwardly healthy adults a metabolic panel and CBC might actually be more useful in catching incipient serious disease than an annual physical which typically is nothing more than 5 minutes of observation and no checking of metabolic parameters beyond blood pressure and pulse rate!  The former can be had for $10 while the latter is often a $100+ charge.  Let the people and evidence show which is superior on a cost:benefit basis; after all it's my ass on the line from my decision not yours.
  
  
• Wholesale drug pricing in the United States must be on a "most-favored nation" basis.  The impact of this would be to force a level price across all nations for drugs produced by any pharmaceutical company marketing both in the US and anywhere else in the world.  Violations, including attempts to "offshore" via subsidiaries to evade this requirement are deemed criminal and civil acts.  The civil penalty shall be 300% of the difference paid to the customer who got screwed, and another 300% for each instance of a prescription filled at an inflated price paid as a fine to the government.  This would drive drug prices down by at least half in the United States and for many drugs by 90% or more.  It would instantly and permanently end, for example, the practice of charging someone $100,000 for scorpion antivenom in Arizona when the same drug from the same company is $200 for the same quantity 40 miles to the south and across the Mexican border.  Since all prices must be posted at the retail consumer level for both goods and services controlling the drug pricing problem at a wholesale level is both simpler and sufficient since competition will already exist at the retail pharmacy level.
  
  
• No government funded program or government billed invoice will be paid for medical treatment where a lifestyle change will provide a substantially equivalent or superior benefit that the customer refuses to implement.  The poster child for this is Type II diabetes, where cessation of eating carbohydrates and PUFA oils, with the exception of moderate amounts of whole green vegetables (such as broccoli) will immediately, in nearly all sufferers, return their blood sugar to near normal or normal levels.  The government currently spends about 25% of Medicare and Medicaid dollars on this one condition alone and virtually all of it is spent on people who can make this lifestyle change with that outcome but refuse.  If you're one of the few exceptions and it doesn't work in your case you have the burden of proof.  Nobody has the right to light their own house on fire on purpose and then claim FEMA benefits for same.  This one change alone will cut somewhere between $350 and $400 billion a year out of Federal Spending and, if implemented by private health plans as well, likely at least as much in the private sector.  That's more than three quarters of a trillion dollars a year that is literally flushed down the toilet due to people being pigheaded and refusing to do things that would not only save the money but also save their limbs, eyesight and ultimately their life.
  
  
• Health insurance companies must sell true insurance to sell any health-related policy at all.  A true insurance policy is defined as one that (1) does not cover any condition you have received treatment for over the last 24 months (in other words, p != 1.0), (2) if an adverse event does occur your obligation to pay any further premium ends with regard to coverage for that event and all consequences thereof while the company is required to pay reasonable costs of treatment until and unless the condition has been resolved without limitation on the necessary amount or duration of said payments and (3) does cover, with a selection of deductibles available to the buyer, all accidental injuries and truly life-threatening emergency medical events (yes, this means the "exceptions" medical insurance firms write into policies for victims of crimes or terrorism will be unlawful and unenforceable.)  Medical underwriting is permitted for such catastrophic policies but once undertaken is transferable to a new company without a new round of underwriting provided no interruption in coverage of more than 60 days occurs.  Such a policy may exclude intentional acts (e.g. acute drug overdose by other than non-consensual consumption), perhaps with an exclusionary period (such as that for suicide on life insurance.)  A common policy of this sort with the above reforms would cover things such as heart attack, cancer, liver failure by other than alcoholism, rare diseases and similar and would be very inexpensive.  For a young person of normal weight the cost of such a policy might be $100 a year.  For a 50 year old, maybe $300 a year.  If you're overweight or obese (or worse, have a high A1c) then it's going to be considerably more-expensive because your risk of heart attack, for example, would be much higher.  Ditto if you're a smoker.  To protect against fraudulent misconduct by insurance companies with regard to rescission of policies after an event, which used to be quite common, the only grounds for rescission is evidence that you actually underwent medical treatment for the condition that is medically proved as the underlying cause of the claim or fraud in the application (e.g. claiming to be a non-smoker when in fact you are.)  The two-year "no treatment" period balances sufficient protection against anything that (1) is degenerative and emergent and (2) would otherwise lead to a claimable event against the abuse of rescission against the possibility of a customer attempting to rip off the insurance company (and thus all the other policy holders) by buying a catastrophic policy after a serious event has become evident to them.
  
  
• All health insurance providers selling true insurance, in whole or part, must provide within their "true insurance" the ability to "replace like with like."  This is the premise of insurance, subject to policy limits.  If you wreck your car you're not entitled to a new car, but rather either (1) repair of the one you wrecked to "as before the wreck" condition or (2) its current value in money.  To the extent reasonably possible health insurance for "true insurance" events (as above) must therefore cover the provision of services and goods to return "like for like" within the area where you are at the time the event occurs, or to where you are involuntarily transported in the event you are incapacitated.
  
  
• Medicare becomes just another insurance provider.  There is no "special" Medicare-accepting doctor list; it is simply an insurance plan and one that does not pay for routine physician visits and similar but rather covers unexpected insurable expenses.  In other words Medicare Part "A" will continue as-is along with Part "D", but Medicare Part "B" will be deleted.  Since Medicare was sold to the public as an "80/20" plan (the customer bears 20% of the cost of care) this change represents no violation of that promise.  In addition Seniors can still buy "Medicare Advantage" plans should they wish that covers all medical costs (with possible deductibles and co-pays) as is currently the case.
  
  
• Medicaid is repealed entirely. No, we're not leaving the poor out in the cold.  See the next point; the poor will in fact obtain better care than they have now as they will have full access to the entire body of physicians, hospitals and facilities.

• For those who have no means to pay and find themselves with a need for medical attention the following provisions shall apply:
  1. EMTALA is hereby repealed.
  2. The provisions of this section, bearing on those who cannot pay for medical services, shall apply only to US Citizens and lawful permanent residents. This instantly puts a stop to the "uncompensated care" problem for illegals and the "come here pregnant and poop out a kid" expense issue as well.  No medical provider shall have any liability, whether civil or criminal, for their refusal to provide care for which they are unable to secure payment when furnished to other than lawful permanent residents or Citizens.  Other nations that wish to negotiate a billback provision for their citizens in order to insure that payment is secured may, of course, do so but under no circumstance shall a person who is not a citizen or permanent resident obligate any provider to provide services without payment, nor may they avail themselves of the backup payment provisions of this section, nor does any cause of action in favor of any person arise in equity or law for a provider's refusal to provide care to a person who is not a citizen or permanent resident without sufficient guarantee of payment for medical goods and services.
  3. For those with true emergencies (as defined above) and who are lawful permanent residents or citizens and thus can identify themselves as such but are unable to pay the treating hospital/ER shall bill the US Treasury for the lawful charges incurred under the above framework and shall be paid within 30 days.  All provisions of the above shall apply for what constitutes a lawful and payable bill and shall be provided to the customer at the time of service along with the fact that same has been forwarded to the US Treasury for payment.
  4. For those with non-emergency conditions who are (1) US Citizens or (2) lawful permanent residents and who assert they are unable to pay the medical provider shall bill the US Treasury for the lawful charges incurred under the above framework and shall be paid within 30 days with the provision that government billing shall not be available for any condition, drug, device or treatment for which a lifestyle modification that the consumer refuses to make will alleviate any or all of said expense and need for medical goods or services.  Again, all provisions of the above shall apply for what constitutes a lawful and payable bill and shall be provided to the customer at the time of the service being provided.  Treasury shall provide a means of rapid verification of citizenship or permanent resident status for the use of medical providers, with access to same restricted for this exclusive purpose so as to allow validation of such claims at the time of service (if we can have a background check call-in number for gun sales we can certainly verify citizenship status for those who claim to be indigent and in need of medical care!)
  5. Said charges under (3) and (4) will, when submitted to Treasury, result in an invoice being sent to the taxpayer in question and may be settled within 90 days of submission at no penalty.  This allows a person who temporarily cannot pay or who is misidentified as not having a means of payment (whether insurance-based or otherwise) to make payment directly to the US Treasury without risk of an adverse tax action.  If said bill(s) are not paid in full within 90 days then they become a tax lien subject to collection exclusively from any or all of (a) refundable tax credits, which may be garnished at up to 100%, (b) tax refunds, which may be garnished at up to 100%, (c) other entitlement checks excluding Social Security retirement which may be garnished at a rate of no more than 25% (e.g. social security disability, general assistance, etc) and (d) windfall amounts in cash or property that cumulatively exceed $10,000 in a rolling 12 month period from any source (e.g. inheritances, lottery winnings, gifts, etc.) that may be garnished for payment up to their full amount.  Statutory interest at 110% of the current 1-year Treasury bill rate, with the rate adjusted on the last business day of each calendar quarter, shall be applied on any remaining balance until paid in full. This will be vastly cheaper than Medicaid -- about 10% of what is spent today, in fact, and a good part of it will be recoverable over time.
  6. At death if a tax lien exists for unpaid medical bills it shall be treated as any other tax lien for the purpose of claim against the decedent's estate except that in the case of a married couple with a surviving spouse who's marriage pre-dates the medical expenses in question any such claim shall not be recoverable during the surviving spouse's remaining life but rather shall become a claim against said surviving spouse's estate at the time of their death.  Remarriage, creation of a trust or other estate-planning vehicle after the event(s) giving rise to the medical tax lien shall not modify or defray this liability and may not be used to shield the assets of the surviving spouse from an existing claim.
  7. Any provider of service that falsifies billing under this section, bills at inflated prices or otherwise violates the provisions of this law in regard to any bill submitted to the US Treasury for payment shall be deemed guilty of a criminal felony for which the punishment shall be the forfeiture of three times the billed amount and each individual who has caused such an invoice to be issued, transmitted or otherwise participated in same shall be subject to a fine of not less than $1,000 nor more than $10,000 and imprisonment of not less than 2 and not more than 5 years.  Each fraudulent invoice shall constitute a separate and distinct offense, all penalties shall be consecutive and additive, and liability for same shall be joint and several.
  8. Misrepresentation of citizenship or permanent resident status for the purpose of obtaining health care to be billed to the Treasury shall be deemed a criminal felony punishable by not less than one and no more than ten years imprisonment and a civil penalty of three times the amount of the charges incurred.  Upon conviction said individual shall also be immediately deported and suffer permanent exclusion from the United States; said penalties may not be decreased or waived irrespective of other circumstances.
  
  
• ALL provisions of the PPACA and other public health related laws contrary to the above, whether in law, CFR, Internal Revenue Code or otherwise are declared contrary to public policy, void and unenforceable, and all State Laws and Regulations contrary to same are preempted, void and unenforceable since medical care inherently involves commodities that travel in interstate commerce and thus the sale of such goods and services fall under the Commerce Clause to the US Constitution.  Rather than go through and strike them all (which of course Congress could do) that one sentence will take care of it until the necessary clean-up can be performed on a chapter-by-chapter basis.  Yes, this means the taxes, mandates and similar -- all gone.

Now let's look at what you could expect under such a system.

Let me first note that such changes would drop Medicare expenses in the budget by at least 75%.  Again, 25% comes off from changing how we handle Type II diabetes alone; these are not "pie in the sky" numbers.  This results in a complete deletion of the federal budget deficit on an instant and permanent forward basis and as a result everyone in the country becomes richer every year because their purchasing power of money stops going down and starts going up.  

The CBO is out with their latest estimate on the detonation of our federal budget, and it's not pretty. They point out what I've said repeatedly on the budget and "entitlements": Social Security is not the problem and in fact will start declining in share of the budget in 2028; politicians speaking of "entitlements" lumping Social Security in with Medicare and Medicaid are lying.  The entire problem is in medical spending and if current trends are not reversed -- not just "adjusted" over time -- will destroy the federal budget and economy.  We will not get to 2037 before it happens either; in fact, if we do not act we'll be lucky to get through the next four years as the markets will figure out that neither political party will take this issue on and resolve it.  Simply put we must solve this problem and we must do it now.

If we don't this is what the federal government will try to do with debt

That will fail because it must; infinite exponential expansion of debt is impossible to sustain and will result in a fiscal crisis.  Since this is being entirely driven by health care spending the only means to avoid collapse of the government will be forced rationing or even collapse of both Medicare and Medicaid -- an immediate disaster for everyone dependent on them.

We must act now to stop this, and the above plan (or something substantially identical to it) is the only workable means to do so.

Let's take some pessimistic estimates of the result from enacting this set of changes -- that Medicare spending will go down by half and Medicaid by 60%.  These are in fact very pessimistic, since a 25% reduction is simply from policy change rather than cost control.  What does that do to the budget even if that's all we get?

Total spending goes from $3.85 trillion to $2.92 trillion in an afternoon.

In other words we go from a $587 billion dollar budget deficit last year (on "official" terms) to a $342 billion surplus; that is, from a 15.24% deficit (as a percentage of the budget) to an 11.70% surplus!  This change in spending and the surplus is maintained forevermore into the future -- in short this change ends, permanently, the federal budget deficit.

At least as importantly for you, as a consumer, we take the destruction of purchasing power of your money caused by deficit spending and permanently reverse that.  Over time this will eliminate the federal debt -- without cutting any discretionary (or military) spending.

Let me add to this: I have, since The Market Ticker began publication, said that Social Security is not going to blow up; the entire problem is in health care.  Lawmakers and candidates love to either scare Grandma by saying their opponent will "cut" Social Security or threaten that we must address "entitlements" in which they include Social Security. Here's proof from the CBO that I'm right and they're lying: Social Security does not materially increase in budget load over the next 30 years, and more to the point it starts declining in impact ten years from now as the Boomers begin to pass on!

Fixing Health Care prevents the destruction of the Federal Budget and prevents you from losing access to medical care -- especially if you're a Senior Citizen or poor.  If we do not pass this bill or something substantially identical to it and you are either a Senior Citizen or poor within the next five to ten years you will face forced rationing of your health care or the government will collapse.

This bill will materially increase access to doctors, clinics and similar by Medicare customers since there is no longer any discrimination between who does and doesn't take the program -- Medicare is simply an insurance payer just as any private program is, and will list its payable amounts for care just as will any private party insurance does.  This also leaves the Medicare Advantage programs, for those who decide they like that program better, fully intact.  For those Seniors who have medical expenses that exceed what Medicare will pay they will wind up with a tax lien just as will any other citizen.

This bill will make customer choice not just a function of price but also of outcomes.  Today there is no accurate way for a person seeking a procedure to compare the success rate between various providers of a given procedure.  This must be fixed immediately if we are to have true competition as some doctors are outstanding, some are excellent, many are average and some are poor.  There is literally no way for a customer today to know, other than by anecdote, which category a physician falls into.

The bill will also destroy PBMs and the outrageous extraction of funds they commit by forcing price transparency and decoupling price from "insurance."  You will be able to call or go online to look up drug prices from any pharmacy and they will in turn have to honor the same price for all retail buyers.  Competition will return at the retail level and the practice of "gagging" pharmacists, which is arguably illegal as it is done for anti-competitive purposes, will end immediately.

If you're unable to pay or accrue medical expenses in your Senior years (or otherwise) that wind up being paid by Treasury then when you die they go "poof" (Treasury eats them) to the extent that your estate is unable to pay them off as ordinary debt prior to distribution through probate (will) or trust.  If you're married then your spouse cannot be punished for said debt during their life should they survive you despite some (or all) of your assets being titled in common, but your joint assets cannot be shielded when the surviving spouse dies against your medical claims nor can you marry after incurring such expenses as a means to prevent recovery from your assets.  This prevents "serial marriage" or late trust-creation gaming of the system yet also protects a surviving spouse, which will be particularly important for poor couples and will prevent some of the nastiest situations that occasionally arise today (where long-married couples are essentially compelled to divorce for economic reasons due to medical expenses and collection efforts.)

Medicaid goes away entirely on a formal basis however poor people actually acquire superior access to health care. The amount spent by Treasury would drop by at least 80% instantly.  A fair amount of the remainder would be, in future years, recoverable as some people leave the ranks of the poor and if and when they do their accumulated medical debt would be recovered over time.

This bill stops the detonation of all of the state public pension fund budgets -- a catastrophe that has been driving property tax increases and threatens to destroy all of the state budgetary systems.  That all ends in one day.

It deletes all state Medicaid spending immediately (the states may choose to use said funds,or some part of them, to pay for low-income clinics and similar for residents in their states, much as County Health Departments do today in the States.)

It makes bilking the government by submitting false or inflated bills to the Treasury a severe criminal offense.  The poor and disabled are the least able to press their own claims and fraud is rife in both Medicare and Medicaid today.  This puts real teeth in the anti-fraud provisions for those individuals who, most of the time, cannot reasonably bring their own suits.  It also protects the poor and disabled from improper tax liens while at the same time recovers from them the cost of their care should their financial situation improve in the future.

An often-repeated claim is that medicine is "highly variable"; the person who presents to the hospital or ER has an unknown expectation for complications and follow-up requirements.  But this is true for car repair as well. I remind you that it was not that long ago (if you're old enough you remember) that the practice in car repair was to put your car on the rack, get a blanket authorization, rip it apart and tell you what the bill was when they were done.  This often led to vehicles being literally held hostage and outrageous bills that nobody would have agreed to in advance.  That was made illegal and during the debate over these laws all the car dealers and repair shops said they "couldn't" accurately estimate and would go out business if forced to do so.  They lied; the dealers are still there but the racketeering they used to engage in and the rabid screwing the consumer used to take is gone. Car dealers dealt with this by introducing a "flat rate" book.  The "flat rate" for repairing your front brakes is $400.  This includes a set of pads and rotors and the labor to install them along with a margin for expected and possible complications; the dealer has no idea what sort of condition the vehicle is in other than that it needs brakes when he takes it into the shop.  The flat rate book gives him the expected time to perform the procedure including a margin for possible complications.  In some cases the dealer will take less time to fix the car and in some cases more. That doesn't matter; what does matter is that on average that's what it will take with a reasonable profit for the dealer, and in addition the dealer typically adds a "shop charge" that is a flat 10% of his repair price for small and hard-to-itemize things like shop towels, grease and similar.  If he gets it done faster and cheaper, he wins.  If he runs into complications, he loses.  The book gets released with each new model and can be updated as actual service history is fed back to the manufacturer.

The "must post a price" model, incidentally, does not mean that providers cannot differentiate between customers who have objectively-measurable differences in presentation.  For example a provider could charge 25% more for someone who is morbidly obese but must do so for everyone who is, and must post that up front on their price list.  There may well be a higher complication rate for such a person in that practice's history.  If a provider is willing to come in at 3:00 AM to take care of something urgent but wants to charge double to do so rather than waiting until the morning they can, provided they disclose it up front in their price list.  Likewise, perhaps some practice has a lot of available appointments in the afternoon and wishes to offer a 10% discount for appointments between 1-4 PM.  No problem.  Competition once again comes into play; if some provider figures out how to get rid of the additional complication rate caused by said obesity they can then undercut the other guys on price and gain that business.  If one provider is more skilled than another and thus has a lower complication rate they can undercut their competitors which is good for everyone except the lesser-skilled provider.  Who do you want practicing their medicine on you -- the better guy or the lesser one?  This is how progress is made folks.  It's also why the shop charge to change an alternator in one make and model of car is different than the same job done on a different make and model; one may have easy access from the top, the other does not.

Likewise insurance companies employ a whole bunch of actuaries for the purpose of figuring out the odds of a given thing happening and what it will cost if it does.  To do this they analyze previous events.  After this change in law hospitals will be no different; the hospital has access to fine-grained data on all of its previous procedures done, for example, to perform a coronary artery bypass.  It knows on average how many sutures must be laid, how many scalpels are used, how many units of blood get consumed, what drugs and in what amounts are consumed, how many hours in the operating theater and so on.  It knows that X% of the operations go without a hitch, Y% have some minor complication and Z% are a disaster requiring other major interventions because of unforeseen complications -- some of which are avoidable (e.g. infections acquired in the hospital) and some of which are not.  From all of this data the hospital can compute an average and that's the price they set.   Just like the car dealer does not know if your car has frozen bolts that will have to be chiseled off in order to change your brakes or a caliper that will have to be swapped out because when it is reset it starts leaking fluid the hospital does not know all of the possible complications that may arise from a procedure when you are admitted.  By mandating a quoted pricing model competition comes into the game and the hospital now has an incentive to find ways to reduce the complication rate and waste.  The complication rate is very important to you as a customer since avoidable complications (e.g. MRSA infections) are severe consequences that you suffer and a good part of the time it happens because they screwed up.  It is utterly essential if we are to improve the quality of care that the incentives align for the provider and customer in this regard and if the hospital across town (or across the state!) can reduce the infection rate, for example, that also reduces its average cost for a given procedure and thus said provider can offer a cheaper price.  That's called innovation or, if you prefer, productivity enhancement and it is the driver for progress in your quality of life both personally and economically.

One of the often-repeated claims is that much testing today is undertaken for the purpose of "defensive medicine" in the form of preventing malpractice lawsuits (or at least making them harder to win.)  Forcing the doctor ordering said tests to present a price to the customer and obtaining their consent before the test is done ends this instantly.  If the customer refuses to consent to spending the money on some diagnostic then the result of doing so is on him or her.

"Poof" goes the defensive medicine problem in a puff of smoke because the customer made the choice rather than the doctor!  Physicians often claim we need "tort reform" and that they order tests by the bucket-full as a means to defray lawsuit risk. Various advocates, for their part, want to outlaw bringing such suits.  The problem with so-called "tort reform" is that sometimes lawsuits are appropriate -- the classic example is when the doctor amputates the healthy foot or hand leaving the diseased one attached!  The best, easiest and most-equitable reform when it comes to the "tort lottery" game played today is to replace the current "order 10 tests" paradigm with informed consent and shift consent along with the cost and potential benefit analysis to the customer.  If the doc says "I want you to take a CT scan because I suspect X and it costs $200" and I say "No" because I don't want to spend the $200 then if it turns out that the bad thing would have been discovered by the CT I cannot sue because I was offered but refused the test!  Customers need to become the decision point, not doctors; they must be presented both the cost of such procedures along with the expected benefits -- including the odds of either proving up or refuting a possible diagnosis.  My ass, my choice, my expenditure, my risk.  That permanently resolves the entire tort lottery problem yet leaves the legal system intact for the outrageous cases where consumers should have redress in the courts.

Now on to some personal examples of expected financial outcomes.

First, let's compare against an Obamacare policy that contains a high deductible for a reasonably-healthy, 40 year old person.  That person is today charged approximately $400 a month and the policy has a $5,000 deductible.

This means they pay $4,800 a year for exactly nothing and if they use any health services at all there is no coverage until $5,000 in additional funds are expended, at which point the insurance covers 80% up to the "cap" (typically $7,000 or $8,000.)

Under this system that customer would (voluntarily) pay $300 for a catastrophic policy.  Since they are nominally healthy they might decide to have an annual physical (at a cost of $150)  If they remained healthy they would spend nothing more through the year on medical care.

Their cost of health care would go from $4,800 a year today to $450 for a reduction in cost of 93.7%.

Now let's take the person who is nominally ill.  Their current expense, assuming they consume $5,000 of medical care under the current insurance system is $9,800 a year -- $4,800 for the "insurance" and $5,000 for the deductible.

What do they pay under this system?  $300 for their catastrophic policy which does not cover their existing conditions but does cover an accident or new catastrophe not caused by their existing circumstance and all of their current treatment at a discount of 80-90% of today's pricing.

How much medical care can you buy for $9,500?  Well, you can buy one of many operations at the Surgery Center of Oklahoma, should you require one (and not many people need more than one in a year!)  You can buy a hell of a lot of pharmaceuticals when they're sold at outside-US prices, which they would be immediately -- in other words divide current drug prices by anywhere from 5 to 20 or more.  Monthly "specialty" visits to the doctor to monitor your condition would run you $700 over the entire year.

Do you really think you'd spend more than $9,500?  Probably not, and you might spend a hell of a lot less.

In fact, in many cases you might spend 80% less depending on exactly what's wrong with you.  Further, if you go from "ill" to "well" during that year your expense immediately stops since the $400 a month otherwise extracted from you is gone.

A poor person would enjoy dramatically improved access to care over what we have today since there would be no "Medicaid provider lists."  They could access any physician or other treatment option that was medically indicated and there would be no discriminatory pricing for or against, nor any discrimination in access.  Both access and outcomes would improve dramatically for poor people while cost to the government would be dramatically slashed.

How about the person "covered" through their employment, which is most of the population?  Your employer would see thousands of dollars a year in cost reduction, and even more in his liability insurance premiums would disappear.  For the average family of four the premiums covered by your employer are likely close to $10,000 a year.  That is salary that you will receive.  

To put this in perspective the average family makes some $50,000 a year. That "average" family would see an immediate 20% increase in spendable income; roughly $10,000 each and every year forevermore into the future.  That's huge; there is no other way to have such a large impact on consumer income and wealth in this country on an aggregate basis than this.

Let's assume that "average family" has a kid during the year -- a routine, uncomplicated pregnancy.  Today that's about $10,000 worth of expense, but if you have "good insurance" you don't see any of it directly.  The cost of having that child as a matter of routine vaginal childbirth would drop to about $1,000.  You'd get $10,000 more in salary and spend $1,000 of it; the other $9,000 would be yours.  If something goes wrong then your $200 catastrophic policy would cover it, perhaps with a $3,000 deductible.  You'd spend $1,000 for the routine part of the birth, $3,000 on deductible, the cat policy would cover the rest of the emergency and you'd be $6,000 net positive -- with a complex childbirth in the mix.

Now let's assume under this system you're nominally well and have a heart attack.  What do you pay?  The $300 you paid for the catastrophic policy, and perhaps a $2,000 deductible.  The bypass you need to resolve the problem is $10,700 instead of over $100,000 because the local hospital has to compete with places like the Surgery Center, and that's what they charge.  If they don't then they sell exactly zero bypass surgeries to anyone who isn't having a heart attack right now, and they're not going to give up the income. They'll compete because the alternative is that they have almost no business at all, never mind that you will probably choose to have the $10,000 procedure before you have the heart attack (saving you from the risk of dying during the heart attack outright!)

Ok, who gets hurt?

1. The lobbyists.  They lose big.  In fact virtually all of them wind up out of business entirely.

2. The administrators who aren't needed and are very expensive.  Many, maybe most, get fired.  The hospital becomes a place full of doctors and nurses but damn few administrators since now their cost can't be shoved off on others -- it's overhead, and is subject to competition from the hospital across town or in the next town over.  Not only does this reduce employee cost at said hospital dramatically it also reduces the space the hospital uses for overhead which makes their per-person cost for actual procedures go down further since a larger percentage of their space goes to actually treating customers.  Yes, those former administrators will lose their jobs.  The good news is that the economy will expand due to greatly improved cost structures, so there will be new jobs in other fields available to them.

3. The drug reps.  Gee, what happens when you can't be a pusher any more and have to price on a level basis?  The rest of the world's prices go up some (there's many billions of "them") while ours fall like a stone (because there are only 330 million of "us")!  That's math; take the amount of revenue necessary to make the drug and a profit and divide by the number of users; there's the price.  Guess what -- forcing the US consumer to pay for the development cost of drugs used worldwide ends in a day.  This costs us hundreds of billions of dollars a year today.

4. The PBMs.  All gone.  These organizations are all quite-arguably committing unlawful acts on a daily basis in any event under 15 USC Chapter 1; using market power to restrain trade and fix prices is per-se illegal.  These firms appear to be nothing more than a racket -- and one that was tested in 1979 at the US Supreme Court with the drug firms losing their appeal.

5. Anyone who refuses to change their lifestyle and instead demands everyone else cover their willful acts.  That's a tough nut to swallow, but it must be swallowed.  If you can control a condition for zero cost you have no right to demand someone else pay tens of thousands of dollars a year to you every single year because you refuse.  There are millions of Americans who do exactly that costing upwards of $350 billion every year just between Medicare and Medicaid and every penny of that expense must end right now.

That's a good start.

The problem isn't that health care is "expensive."  The problem is that it's a rip-off and is laced through with fraud, theft and arguably even racketeering from top to bottom.  You can find myriad examples of what competitive prices look like for health services and products if you bother to look around, even in the United States, and since we know what those prices look like what I laid out up above isn't a fantasy-land dream -- it's a reality we can have right now and forevermore into the future.

To do it we must demand that the politicians put a stop to the scam and back that demand up with whatever political and economic action is necessary until and unless they do so.

Perhaps we should all start showing up at town hall and campaign events with a simple plastic spork and wave 'em in the air from start to finish.  They're obviously not weapons but the message ought to be pretty clear when it comes to what the people might, at the point the economic and political system collapses due to all the fraud and theft the political class is enabling through medical scams, choose to eat first.

What will implementation look like?  Read here.

Where is the discussion of facts when it comes to health care?

Why do we keep talking about the cost of "health insurance" when that's a symptom and not the problem?

Why do we keep talking about "subsidies" (tax credits, etc)?

If you're coughing incessantly because you have lung cancer do you simply take a cough suppressant and call that a "fix" when you stop coughing for a while?

That entire line of discussion, which is the only discussion being held politically and in the news, is a fraud.

Why?

Two reasons: First, "health insurance" is not insurance to the extent it covers an event that is either certain to happen or has already happened. Insurance is a thing you buy to cover a possible future event you cannot pay for yourself.  It is less expensive than the event will be only because the probability is less than 1.0 -- that is, the event is unlikely.  If the event is either certain or worse, has already happened then the probability is 1.0 and the cost of "insurance" against such an event is always more than simply paying for it in cash because the insurance company has costs it must cover or it will go out of business.

Let me repeat that just in case you missed it: The cost of insuring against a bad event is directly and mathematically determinable by the cost and probability of said event.

Second, due to the above mathematical fact if you wish to decrease the amount "insurance" costs there is only one way to do it: You must decrease the cost of the event, the probability of the event or both.

This is arithmetic, not politics and anyone arguing otherwise needs to be indicted, tried, convicted and imprisoned for their intentional act of fraud upon the public because that's exactly what they're doing -- defrauding you.

I don't care if they're pundits, media personalities, Congresspeople or the President -- and I remind you that The President is well aware of how insurance actually works since he's been a Real Estate developer and operator for decades.

Now let's address the only two means by which we can lower health insurance costs.  And lower them we can -- by 90% or so, and quickly too -- in fact, within months.

First, insurance must be actual insurance.  In other words it must only cover events for which p < 1.0.  By definition those are events that are neither certain to happen (e.g. routine, every-day visits to a doctor) or have already happened (e.g. pre-existing conditions.)

While you might be able to buy fire insurance on your house if it's on fire (or you are in the process of setting it on fire!) the cost of that insurance will always be more than the fire damage to said house because the probability is 1.0 and the company has to cover its cost and make a profit or it goes out of business.  It is therefore always cheaper to simply pay cash for the fire damage than to buy said "insurance" and this is true irrespective of what you're "insuring" -- including health.

Again, this is math, not politics.

Second, we must address both "p" (probability) and "c" (COST.)

We must address "p" (probability) because it will directly and grossly reduce the cost of insurance since it is a multiplier to cost.  Reducing "p" by 10% directly reduces cost of insurance by 10% all other things being equal.

We must address "c" (cost) because that not only reduces the cost of insurance (but on a smaller basis than "p" since it's multiplied by the fraction of risk) for the person who has already had the bad thing happen to them medically it enables them to pay directly for the treatment required. I remind you that paying directly is always going to be cheaper than running that same payment through an "insurance" company (typically by about 10-20%) because said company has costs that have to be covered.

Let's take "p" on first.  An utterly enormous amount of health expense occurs because people choose to be overweight or obese.  As noted in a previous Ticker the American Diabetes Association claims $250 billion a year is spent by Medicare alone due to both the disease and its effects.  Best guess is that another $150 billion is spent by Medicaid (which they don't specify.)  This is for one disease and essentially all of that money doesn't have to be spent.  It is spent because people choose to consume foods that promote and exacerbate the condition rather than reduce or even eliminate its effects.  The cost of changing what you put in the pie hole, medically, is of course zero.  Therefore for each person who is diabetic (Type II) and makes said lifestyle change resulting in either the control or elimination of the harm to their body from same we eliminate all of the health spending by said person on said disorder!

There are myriad other diseases and disorders associated with being obese and overweight.  Hip and knee damage, eventually leading to (expensive) replacement surgeries, for one.  Heart attacks and strokes (many caused by high blood pressure that, again, is often a result of being overweight) for another.  These are all avoidable costs and if we wish to address the cost of health care reducing "p", the probability of bad events, is a key item.

It is absolutely true that personal choice is a huge factor here and the government does not have the right to tell you how or what to eat.  However, you do not have the right to demand that someone other than yourself pay for the consequences of your personal decisions.

It is therefore perfectly reasonable to put in place a protocol that says if you are overweight or obese and diabetic then the lifestyle change in terms of what you put in the pie hole that has a near-100% record of reducing or eliminating your need for drugs and medical procedures and has a cost of zero will be the only option offered under said publicly-funded programs until and unless you prove, by individually-shown test, that it doesn't work in the case of your particular metabolic makeup.

Doing this for one disease alone would cut roughly $400 billion off the federal budget this year and every year thereafter and would cost the patient exactly zero on top of it.

Can we extend this demand to private health care policies by force?  No, but we can certainly allow companies to multiply their pricing by the change in "p" that not following such a lifestyle, if you're overweight or obese, comes with.  Since this one disease is such a huge component of said spending my best guess is that the surcharge for refusal would likely be 25% or more and if you're already diabetic then it can (and should) be an immediate disqualifier for any coverage of any consequential event whatsoever unless you prove, by individual test, that the lifestyle change outlined above doesn't result in control of your condition.

Second, we must break all the monopolies in the medical system.  There are in fact simple ways to do this, requiring no new laws, which I've outlined before going way back in time.

If you force price transparency by treating any health provider who refuses to do so, or who tries to bill on a discriminatory basis as committing a criminal act under existing consumer protection and anti-trust laws (at both the State and Federal levels) you will instantly and permanently remove all so-called "network" games, break the monopoly pricing games played by the health industry and as a result competition will cause prices to fall like a stone.

It's worthless to even attempt to argue that this "can't" or "won't" work because we know it does.  The Surgery Center of Oklahoma does exactly this right here, right now, today and their pricing with the monopolist-laced chain of supplies for drugs and surgical devices still undercuts "traditional" hospital prices by 80%.  For example a cardiac bypass is $10,700 -- cash, all-in, one-price and if there's a complication taking care of that is included.

Can you come up with $10 large to save your life if you need it?  Almost-certainly, even if you're poor.  Yes, it would be a lot of money for someone without material means, but remember -- we're talking about a price that's anywhere from 1/10th to 1/5th of what that same procedure costs in a "traditional" hospital setting and you're choosing between that and death.

Don't tell me it can't be done and wouldn't result in these sorts of cost reductions because it is being done right now, right here, today and has resulted in these cost reductions -- even with a huge part of the medical scamjob monopolist games still embedded in their pricing because they can't get away from the drug monster in their ORs at present.  In other words their pricing is high (probably by 20% or so) compared to what it would be if we stopped all of the monopolist games.

Here's the bottom line folks -- if you think "health insurance" costs too much you're being misled.  The problem isn't health insurance it's the cost of health care.  The solution to the problem is to first require firms to offer true insurance (that is, does not cover events where p = 1.0) then require all providers to post prices and charge everyone the same amount.

Next, using existing law you then indict and prosecute all violations of 15 USC Ch 1; the health insurance and related industries already tried to claim exemption in a case that went to the Supreme Court in 1979 and they lost.  It is therefore simply a matter of political willpower to get out the handcuffs and start issuing indictments.  That will further collapse prices since now providers will be forced to compete for business.

To put numbers on this we're talking about "health insurance" for catastrophic events being something that costs the average person well under $100 a month and for virtually everyone they would pay only a few hundred dollars more a year in direct, uninsured cost.

With the cost of care collapsed to 1/5th of what it is now for the truly indigent we can certainly afford to help -- but for nearly everyone we won't need to, because even those of modest means can afford to pay cash at a price 1/5th of what is charged in the United States today.

The obvious question is "Why won't Donald Trump or Congress take this position, since it's clear on the math that it will solve the problem permanently and at the same time nearly eliminate both the Federal budget deficit and all State and Private Pension budget problems at the same time?"

The answer is quite simple: Doing so will cause an immediate and deep recession as the health industry collapses from ~19% of domestic output back to its historical level of about 3-4%.

Said recession won't last very long because that money will get redeployed in other areas of the economy but until it does the impact on GDP will be severe, immediate and deep -- and both Congress and Trump know it.

Oh, and it will put a whole bunch of lobbyists out of business too.