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Commentary on The Capital Markets- Category [Health Reform]
2017-02-20 06:00 by Karl Denninger
in Health Reform , 722 references
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It seems some of the state AGs might be reading my postings.......

But now generic drug executives can expect to face tougher legal repercussions, as evidenced by two federal court lawsuits filed late last year—one in November brought by Eatontown, N.J.-based Heritage Pharmaceuticals Inc. against two of its former executives, Jeffrey Glazer and Jason Malek, using the Racketeer Influenced and Corrupt Organizations Act (RICO), and one in December that 20 states have filed against six companies, including Heritage, after a major antitrust investigation by the state of Connecticut.

Racketeering and Anti-Trust eh?  Gee, that's a good start.

Now go after the hospitals and diagnostic centers and you'll really make progress.

Let me give you a hint: It takes 30 seconds to find a bill from a hospital that has a 90% discount for a certain "insurance."

There's extortion ("buy this insurance or be bankrupted if you need our services") and incidentally an illegally-tied sale (anti-trust again) -- and probably Racketeering there too, since the hospitals are all doing basically the same thing and if you can find a couple of people who are "in on it", well....

This crap has been illegal for over 100 years and yet nobody has been willing to bring charges and suits.

Until now, and at the state level. 

WHERE IS THE DEPARTMENT OF JUSTICE, Mr. PRESIDENT?

Do it and you get your face on Mt. Rushmore.
Don't do it and you have a failed presidency.

(Yes, I'm aware of the short term economic impact from doing it -- and it won't be pretty.  However, that won't last long, and the intermediate impact will be growth rates we haven't seen since right after WWII.)

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It seems some of you folks think that Trump "somehow" said he was going to help you with drug costs (a component of medical care, but only about 15% of the problem.)

In fact there are some bloggers out there who are trying to find something "good" in the "news conference" yesterday on that point, and the meeting with the pharma folks.

Then of course there's the fact that Trump made a Supreme Court nominee announcement yesterday, completely blacking out any further debate or discussion over the pharma meeting, sending Trump's supporters into a frenzy of knob-slobbering while his opponents immediately went into a full-on temper-tantrum meltdown -- including Senators who had voted for him to be confirmed to the Court of Appeals about 10 years prior.  (I note for the record that such was done on a voice vote -- there were in fact zero Senators opposed to him in 2006 and as such no roll call was necessary!)

If you think the timing of these events was coincidence your IQ is smaller than my shoe size; distracting people from something important with an event that the announcer knows will steal all the oxygen out of the news cycle is a time-honored act by all political animals, and Trump is no different in that regard.

But just in case you missed the real news of the day here is what Bloomberg reported yesterday on the pharma meeting:

Drug company executives were also heartened by Trump’s promises of lower taxes, quicker regulatory approval, and help defending them against foreign countries that are able to charge less because American consumers pay more.

Got it?

Pfizer almost-immediately said they were not going to alter their pricing model or intentions as well, confirming this statement and got no pushback from Trump on same.

Pfizer's stock yesterday? Up. (They did announce earnings yesterday, which may muddle this for them.)

Merck?  Up.

Valeant? Up.

Roche? Way up.  (They have earnings this morning, so there may have been a leak.)

Novartis? Up.

Celgene? Up.

Detecting a pattern here yet?

I remind you that actually addressing these issues requires no new laws as 15 USC Chapter 1 is perfectly adequate, and that McCarran-Ferguson was attempted to be used to defend price collusion between pharmacies, drug companies and insurance firms in the 1970s, went to the US Supreme Court and the insurance and drug companies lost.

Held: The Pharmacy Agreements are not the "business of insurance" within the meaning of § 2(b). Pp. 440 U. S. 211-233.

(a) Section 2(b) exempts the "business of insurance," not the "business of insurers." Pp. 440 U. S. 210-211.

(b) A primary element of an insurance contract is the underwriting or spreading of risk, SEC v. Variable Annuity Life Ins. Co., 359 U. S. 65, but that element is not involved in the Pharmacy Agreements, which are merely arrangements for the purchase of goods and services by Blue Shield, enabling it to effect cost savings. Pp. 440 U. S. 211-215.

Being a United States Supreme Court decision that case is entitled to stare decisis, the principle in the law that what is decided, is decided.  In other words Mccarran-Ferguson, a law which does exempt insurance companies from most anti-trust regulation provided they are regulated by the states, does not extend to an "arrangement" for purchase of goods and services by said insurers.

THIS ISSUE WAS DECIDED IN OUR COURTS MORE THAN 30 YEARS AGO AND YET TRUMP HAS NOT SHOWN ONE INDICATION THAT HE INTENDS TO ENFORCE THE LAW IN THIS REGARD, JUST AS BARACK OBAMA REFUSED TO, BUSH REFUSED TO, CLINTON REFUSED TO AND BUSH BEFORE HIM REFUSED TO.

IF YOU WISH TO CLAIM THAT SUBSEQUENT LAW HAS PROVIDED RELIEF FROM THIS RULING TO MAKE THE ACTS OF THESE PARTIES LAWFUL THEN SHOW ME EXACTLY WHERE IT IS AND WHEN IT WAS PASSED.

Until you do your mandate and that of the mainstream press is in fact to show me and the rest of the nation where the first mandate of the Executive -- to enforce the law -- is occurring or even being contemplated when it comes to the financial raperoom that is our current US medical and pharmaceutical system -- a system that was challenged, went to the Supreme Court and was ruled unlawful as the claimed exemption does not exist.

You can't, I argue, because it is my considered position that no such evidence exists.

To those who are currently believing Trump is going to 'help' when it comes to medical care, Obamacare and the rapejob that is being done to you when it comes to the issue of cost of medical care in the United States let me point out that if you don't get your mouth off Trump's schwantz right now you're going to quickly discover that all you did was put spit on it so he and all the fine executives at Merck, Pfizer, Roache, Novartis, Celgene, hospital administrators, diagnostic centers, doctor's offices and others can shove it further up your ass.

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I've repeatedly, over some 30 years time, heard that there's "some law" that exempts health care from anti-trust when the discussion turns to the topic of price-fixing, collusion, differential billing for commodities of like kind and quantity and similar.  Every time I hear this claim I respond the same way: "Show me the law."

Nobody ever has.

And I haven't asked just once or twice.  I've asked dozens of times since the 1990s.  I've asked politicians.  I've asked lawyers.  I've asked political candidates.  I've asked policy "wonks" of various flavors. Gary Johnson got asked (Lib candidate for President) in person a number of years back in his suite during the Libertarian convention in Orlando.  Yet not one of the people I've asked has ever replied with a title, chapter and section of US code that provides such an exemption.

As just one of many examples I heard this claim during the campaign from a (Democrat) candidate for the US House when I asked him whether he would demand that the executive enforce anti-trust law against all medical providers and suppliers.  He said he'd call me with a cite to the law when I responded that with all due respect the exemption he claimed did not exist at a meet-and-greet in a room full of Libertarians.  He never did call me.  (He lost the election, incidentally.) 

I'm utterly convinced that's because the oft-claimed exemption doesn't exist.  I'm in fact quite sure of it, because I can actually read the US Code -- it's public, of course, and the sections that could bear on this matter are reasonable in size (that is, I can and have read through them in a day or two.)

Never mind the contravening evidence too - like this case from 1979 that went to the Supreme Court which ruled that Mccarran-Ferguson does not protect insurance companies against anti-trust claims related to drug "discounts" on collusive actions.  In other words the insurance company took the case to the Supreme Court and lost, which is damn good evidence that (1) anti-trust does apply to health care broadly including the criminal provisions in the Sherman and Clayton Acts and (2) health insurance firms and providers are not exempt to the extent they collude to restrain trade or fix prices.

It is thus my considered position that the reason the law isn't enforced isn't because it doesn't apply -- it isn't enforced because the Executive voluntarily chooses to refuse to enforce it in collusion with Congress and the States and has done so for 30+ years despite the evidence being clear that the law -- a law that carries both ruinous civil and felony criminal penalties -- is being violated on a daily, continuing basis by the entirety of the so-called "health system."

Nonetheless this line of crap continues to be put forward.

Well, you can stop with that nonsense now, because Rand Paul has just announced intent to file a bill (which has a bill number, but the text is not public as of the date of this post) that explicitly exempts Health Care providers from anti-trust.

Anti-Trust Reform for Healthcare

  • Provides an exemption from Federal antitrust laws for health care professionals engaged in negotiations with a health plan regarding the terms of a contract under which the professionals provide health care items or services.

  • This section applies only to health care professionals excluded from the National Labor Relations Act. It would also not apply to contracts or care provided under Medicare, Medicaid, SCHIP, the FEHBP, or the IHS as well as medical and dental care provided to members of the uniformed services and veterans.

Isn't that special?

Rand Paul understands full well that the law prohibits what the entire health system does on a daily basis right here and now.  He is thus proposing to make that financial rape-room, which includes apparent violations of both civil and criminal conduct under 15 USC Chapter 1, explicitly legal on an ongoing, forward basis for everyone who is not covered by the government.

In other words for anyone with private health care or health insurance the conduct that is engaged in every single day by virtually every single health provider, hospital, administrator, drug company and other firm -- colluding to fix prices, restrain competition, differential billing of people for like kind and quantity, effective extortion in that if you have no "preferred insurance" you can and will be billed at ten times or more what is paid by someone who has same and more, all of which appears to be, on the plain text of 15 USC Chapter 1 a violation of that 100+ year law and much of which carries 10 year criminal felony imprisonment penalties along with ruinous fines of up to $100 million per occurrence will be made explicitly legal.

And by the way, if you're wondering why Medicare, Medicaid, SCHIP, FEHBP and other government-run entities are "not included" it's because the Government itself is already exempt from 15 USC (federal anti-trust law) and always has been.

You want proof that there is currently no such exemption when it comes to private insurance and uninsured patients and that the law has been intentionally ignored and not prosecuted for the last 30+ years, there's the best evidence currently available.

Rand would have no reason to include such a provision if it already existed somewhere else in the law.  He'd simply cite said exemption -- or cite something that provides partial protection and extend it.

It is therefore evident that at the present time, and for the previous 30+ years, there has been no such exemption in the law and it certainly appears clear you have been screwed for the previous 30+ years by conduct that the government has refused to prosecute.  In fact there is case law going all the way to the Supreme Court that makes clear that 15 USC does apply to health-related firms, as is cited above.

Rand Paul ought to be kicked out of the Senate.  Unfortunately it's not illegal for sitting Congresspeople to conspire to restrain trade (Congress and the government itself is, in fact explicitly exempt from anti-trust) or his ass ought to be under indictment for explicitly conspiring to restrain trade himself.

But what Rand has now done, whether he realizes it or not, is to expose that the entire ramp in health care cost over the last 30 years has been driven by this conduct already prohibited by 100+ year old law and that both sides of the aisle have refused, over that same 30 years, to enforce same.

The only answer to what is otherwise inevitably coming -- the destruction of our economy and government -- requires that the law be enforced against all medically-related firms right now.  If it is the cost of care will collapse by as much as 85% and thus so will the cost of medical insurance, making the entire argument over "Obamacare" moot since everyone will be able to pay cash for routine events and buy inexpensive catastrophic insurance against rare, but possible catastrophes.

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2017-01-24 12:41 by Karl Denninger
in Health Reform , 5524 references
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This is truly ugly stuff folks.

This is the "Obamacare" repeal and replace option that is being peddled in the Senate.

I've read it.

Let me summarize:

  • For states that wish to keep Obamacare, they can.

  • For states that do not wish to keep Obamacare, they can "opt out."

  • The underlying "replacement" is a ROTH HSA, which is the same basic mechanism of a ROTH IRA except that spending is restricted to "authorized" health care services (including health insurance.)  All other withdrawals are subject to tax (10%) penalties (much like unauthorized withdrawals from a traditional IRA.)  The primary change from existing HSA law is that the existing structure is an adjunct to a health insurance policy. This legislation allows the HSA to fund a health insurance policy.

  • States that opt out can create their own standards for what constitutes a "legitimate" health insurance plan.  This means that plans which are more or less-restrictive than Obamacare policies are authorized in such states and count.  So if you don't want a policy that covers pregnancy, for example, you don't have to buy one.  If you object to contraception, provided your state allows it, you can buy a policy that doesn't cover that.  And so on.  Note that none of this would ban a company from offering a coverage and states could require whatever they want.

  • For states that opt out if you fail to maintain continuous coverage you can be penalized, including being denied entirely due to medical underwriting and it imposes a mandatory penalty (tax) to be paid to Treasury for your refusal to buy a policy if you come back in the future, even if you are healthy.  If you maintain continual coverage, however, you cannot be denied nor medically underwritten.  This changes the Obamacare requirement by effectively closing the "wait until get very sick, then apply" game but includes a cute "**** you" for those people who opt out, then decide to come back but are not trying to game the system by buying only when sick.  In many ways this is worse than the "individual mandate" in that the penalty is on the back end and is not imposed only on those who game the system.

  • For states that opt out they can default you into a ROTH HSA, which may or may not obtain a subsidy.  You can opt out but you will have to do so explicitly.

  • Subsidies are deposited directly into consumer HSAs, not to the state general funds (or otherwise) and are adjusted for local conditions (as is the case for existing PPACA subsidies, and in a very similar manner.)

  • Subsidies phase out for MAGI over $90,000 for individuals, and $150,000 for joint returns.  Married-filing-separate has a ZERO subsidy -- if you're married, you must file joint to get subsidies.  This is a large increase in subsidy phase-out income levels and means that basically anyone in a state that opts out of Obamacare will have full subsidies available up to MAGI $90k.  Note that MAGI includes tax-exempt interest and similar income; this is potentially very important for those with substantial non-wage income (as is the case for Obamacare now.)

  • Imposes a $25,000 penalty per-instance on medical providers who attempt to bill out-of-network charges in emergency circumstances only.  However, it does not bar the practice or impose any criminal penalty for this act of financial rape, which means that the effect of this provision is that you'll still get raped and the hospital will add $25,000 to the******amount so as to pay the fine with it!  If you think this means the "out of network" emergency problem will get worse YOU ARE RIGHT, IT WILL GET WORSE AND IN A VERY, VERY SEVERE WAY FOR MODEST ISSUES.  $25,000 isn't much additional screwing on a $500,000 bill.  It is a very large additional screwing on a $20,000 bill!  Forcing a victim to pay for his or her own screwing is not only cruel it ought to be considered a capital offense.

  • Allegedly "requires" providers to post prices in a way the HHS Secretary directs.  However, there is no penalty for failure to do so, nor is there any penalty for refusing to honor a quoted price.

There are other technical changes, such as specifying that paying a fee for concierge care (e.g. flat fee per month for access, etc) is a legitimate HSA expense, along with specifying limitations and parameters for the ROTH HSAs (which generally appear to be reasonable.)

There is exactly zero in this bill that addresses:

  • The cost of medical care.  Nowhere is there a penalty for failure to disclose prices or to actually bill at the claimed price.  There is no requirement that "what you post as a price is what everyone pays", there is no sanction on the provider for failure to quote a true price, to bill at the quoted price, or if they discriminate for or against any particular person.  The "requirement" to post prices is a dead letter as it carries zero penalty.

  • For out-of-network emergencies the bill imposes a $25,000 fine on the provider if they bill materially above either Medicare or "Usual and Customary" prices.  However, nothing prevents the facility from actually issuing or collecting that outrageously-escalated billing -- such is not deemed an unlawful practice and is not barred, in any way restricted nor is any criminal penalty imposed.  This means that the existing problem of out-of-network emergency care, say if you have a heart attack while in another state, will actually be made worse as the facility will be able to simply add the $25,000 fine to the financial assrape that they are already imposing on you.   The bill also does nothing about the (very common) practice of an out-of-network person appearing in your room when you are in-network and then billing you for an out-of-network event. The "fine", which you will be forced to pay, only applies to emergency circumstances.  If you've been admitted and are stable and Mr. Out-of-Network Doc sticks his head in your room you're still ****ed.

  • The bill does not eliminate the penalty for not having insurance.  In fact it makes it worse than Obamacare in many instances.  It contains no income exemptions for not having insurance (Obamacare does) and a new set of "screw you" provisions.  Specifically, if you're young, healthy and poor but making it on your own and choose to opt out of buying insurance you will pay no penalty at that time.  But, if and when you decide to buy health insurance in the future you will get penalized on the back end statutorily, even if you are still healthy at the time (in other words you didn't game the system, you just refused to buy something you didn't need!)  For people who are both healthy and in the lower income strata (think young people folks) this will be a rude surprise that will go right up their poop chute when they decide a few years down the road to get married and start a family -- right about the time that buying insurance as a preventative act makes sense.

  • The bill is completely silent on the rank violations of existing anti-trust law found in 15 USC; specifically, Sherman, Clayton and Robinson-Patman.  An earlier revision (2015) of this text at least attempted to clarify some aspects of Mccarran-Ferguson which bears on insurance companies -- this one is silent on the same matter.  Specifically there is nothing barring collusion between providers, price-fixing (whether overt or otherwise), differential billing based on your wealth, form of payment or for that matter whether you have red hair and other similar abuses, all of which are the very form and function of the existing medical financial rape-room circus served upon the American public.

As such this bill, proffered as a "replacement" for Obamacare, might well fit this description:

This is a Congressionally-imposed financial******room that in many ways is worse than the existing Obamacare system, and has no material positive changes evident with one exception: It increases the MAGI (substantially) that a person or couple may earn without losing their giveaway.

It does nothing to decrease costs, it contains no penalties that bar the imposition of excessive charges for out-of-network emergency services (or any other out-of-network charge which you might not be able to refuse or even know occurred until after the fact); a provider fined for trying to bill you said excessive charge can simply add that to your bill and thus force you to pay their fine, and it contains hidden back-door taxes imposed on anyone who tries to opt out of the insurance and medical scam entirely, even if they are healthy the entire time and thus did not either intend to or actually game the system.

**** you Mr. Cassidy, **** you Ms. Collins, Mrs. Capito and Mr. Isakson, **** you Mitch McConnell and the entire remaining leadership in the Senate and House and finally, **** you Donald Trump.

Oh by the way, **** you Larry Kudlow, who is once again talking "free markets" on CNBS as an "unofficial" Trump carnival barker while in fact the GOP and Donald Trump are protecting monopolists even further and screwing you even harder.

smiley

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Yes, you're going to die.

We all will die.

We have some choice as to how and where, but not the final outcome.  That's known in advance.

We have heard for decades about how "terrible" this part of medical care this or that might be.  That administrative overhead has grown here, there, and everywhere.  That cost is going up due to this, that or whatever.

The latest screamfest is about MACRA and claims that it will "destroy" Medicare doctor choice.  Like so many claims before it this one centers on trying to get you buy into the idea that all these "great plans" are really about pushing Grandma, in a wheelchair, down the stairs -- or off the cliff, as Democrats have repeatedly charged.

But nobody wants to talk about the truth.

The truth is that technology drives productivity, and productivity drives down cost.  It does so every time that the market is allowed to work. It is why you can buy a $35 computer today, right now, that is the size of a credit card, can run your house, browse the web or do all sorts of things that a computer costing a million dollars 40 years ago could not.

Oh, and did I mention that it requires less electricity than one 25 watt light bulb, where the former model 40 years ago required industrial power (and the power bill to match) along with forced air conditioning under a raised floor lest it literally melt down from its own heat.

You'd think medical care is exempt from this, but that's only because you live here in the United States.

Let's just take one example.  MRIs have been revolutionary in many areas of medicine.  By allowing imaging of soft tissue that was formerly impossible, along with having zero radiological exposure (that is, no risk of causing cancer or other problems as with an X-ray, CT scan or similar) they have brought precise diagnosis of maladies that formerly were nothing more than a guess.

But.... here in the United States they're expensive.  If you have allegedly "good" health insurance you might not think so, but in fact they are.  An MRI scan costs from $1,000 to $3,000 or so in the United States, and whether you pay it out of pocket or it is billed to some "insurance company" and thus is hidden in cost from you, that's what they cost.

We have US companies that make the machines used for those scans.  We also have doctors trained to read them, which is inherently part of it.  And, to hear the medical folks talk, they tell you these machines are expensive, trained radiologists are expensive, and, well, that's what it costs.

They're lying, they're bilking you, and they all ought to be in prison.

Every.

Single.

One.

See, there is this little nation called Japan.  Japan is also a first-world nation.  Japan also has firms that make MRI machines. Japan has doctors, including trained radiologists.  And in Japan, you can walk into a clinic and get your MRI done for somewhere between $100-160.  In cash.

In the 1980s, when the first MRIs for clinical use were approved and entered service, scans were expensive everywhere, including Japan.  But over the last 30 years the price there crashed, as happens whenever the advancement of technology and productivity intersects with the market and unlawful, felonious interference is absent.

But wait, we're told -- that 10x, 20x, 30x price here in the United States is reasonable and necessary.

Sure it is -- if you support being bilked, price-fixing, intentionally buying up competitors and either shutting them down or raising their prices, "affiliating" all the centers with hospitals (at even higher prices) and more.

And all of this, I remind you, is illegal.  Not "a little" illegal either: Felony illegal.

So says 15 USC Chapter 1.

Said law is more than 100 years old.  It bans, under felony criminal penalty and ruinous fines, any act that restraints trade, forms monopolies, price-fixes and similar.  Trusts in restraint of import trade (e.g. prescription drugs) are also illegal, albeit at a misdemeanor level (15 USC Ch 1, §8)

We keep asking the wrong questions, and we do it because the media and political parties intentionally ask the wrong questions so as to keep us from asking the right ones.

The right question is: "Why do we need a thing called 'insurance' that is not actually insurance, and why aren't those who sell an intentionally falsely-labeled product or service all rotting in prison?"

You see, insurance is a thing you buy to cover your expense if an unlikely but ruinous event happens.  Medical care in the general sense is not unlikely.  Cancer might be unlikely, but prescription meds, a checkup or treatment for an existing condition are not "unlikely"; they are not only likely in the case of something you already suffer from they're guaranteed!

You cannot buy insurance on your house if it is already on fire.

Why can you buy "insurance" on your medical state to treat diabetes if you are already diabetic?

And finally, if you buy insurance on your house, and it burns down, you never pay another nickel in premium (on that house) -- now the insurance company pays you.  But get sick and watch what happens -- not only must you keep paying but when your "annual insurance birthday" comes along the price can change, and so can the services, and you must pay whatever the new price is or they stop paying your already existing claim for the event that already happened.

Hmmmm....

I've been writing on this since The Market Ticker began publication and in fact have been advocating on this point since the 1990s when I ran my Internet company -- the trajectory, where it was headed, when it was going to happen and the outcome was easily projected even then.  The number of "mainstream media" folks who want to have myself or others who have brought this up with facts and figures on the air, and the number of serious political discussions or debates on the topic over those last 25+ years?

Zero.

The real discussion, which nobody wants you to ask, is why that MRI is $1,000 instead of $98 like it is in Japan?  You see, the $98 you could pay out of your pocket, and in fact with most "insurance" the $1,000 MRI scan still costs you more than $98!

What does that mean?

Simple: If there was no medical scam in the first place you wouldn't need or want today's version of "medical insurance" and thus you would never buy it.  You would instead be able to and would pay in cash.

There would never have been a "need" for Obamacare, there would have never been an outcry over health insurance, Medicare and Medicaid would not be 37% of federal spending, there would be no federal budget deficit, most of the Federal Debt would not exist and in fact there would be a multi-hundred-billion a year budget surplus, your spending power would be going up by about 2% a year instead of down by 8+%there would be no impending pension crisis nor would cities have gone bankrupt and more.

What you might buy, and companies would offer, is true insurance.  But since the cost of treating things such as cancer would also come down in cost by 80%, 90% or more the cost of insurance against those unlikely but expensive events would be reasonable to purchase.  You'd probably pay a couple hundred bucks for it -- yearly -- which is affordable for basically everybody.  And it you got sick?  The company would pay to "fix" it and you would not need to pay any more for the actual insurance against the event that already happened.  You might choose to continue to pay for possible future illnesses or injuries -- or you might not.  But irrespective of that choice your treatment for the already-occurred event would be covered.

How does it happen in this country, if it is to ever happen?

Prosecution.

Not new laws, not new regulations, not more hand-waving by Democrats, Republicans or anyone else.

Prosecution under laws that are over 100 years old, exist now, could have been enforced 30 years ago, 20 years ago, 10 years ago, 5 years ago, 2 years ago, 1 year ago, yesterday, today and tomorrow.

Laws that neither political party will enforce.

Laws that neither a Republican or Democrat White House, which I remind you is where the power to enforce laws rests (in the Executive) has ever in the history of this insane mess enforced.

Laws that no State Attorney General, despite there being laws on most state law books banning these practices as well, along with general consumer protection laws that prohibit deceptive practices (and performing a service without discussing price first certainly would fit that description) has ever enforced.

Laws that, I remind you, neither Trump or Hillary has spent one minute discussing in this Presidential Campaign despite it being within either of their power, if elected, to direct their Attorney General to investigate, bring to Grand Juries and prosecute the rampant, outrageous and clear violation of these laws.

Would there be losers if this was to happen?

There sure would.  Anyone who says otherwise is crazy.

There would be a lot of out-of-work lobbyists, for one.

There would be a material increase in the cost of prescription drugs in other nations because level pricing would force same.  But while their prices would go up, perhaps by a lot, ours would collapse by 70% or more.  Why?  It's arithmetic -- there are 330 million of us and about 1000 million in the OECD world of them, plus another ~300+ million in the "developing" world with a middle class or better income.  We've been paying their bill for decades and the day we stop there is one pool with level pricing for all. Assuming no change in total revenue their prices rise by quite a bit but ours collapse by 70% or more -- in many cases that drop would be 80-90%.

There would be an immediate recession, and a deep one at that, as Health Care went from 19% of the US economy (where it is today) back to about 4%, where it was 30-40 years ago.  However, at the same time that would increase business productivity tremendously, reallocate those funds to production, businesses would flock to the newly-competitive United States and ultimately, within a year or two, we'd win big on both productivity and GDP.   But make no mistake -- there would be losers, and in the short term there would be economic pain, especially for those in the health care sector today.  Indeed, if you're a health "administrator" I hope you can do something else, since your numbers have grown by over a factor of 30 in the last 40 years and none of those additional administrators would still have jobs.

If you have or develop a rare or "orphan" disease you might be screwed.  Let's not mince words on this -- there are certainly things we can do technologically but we cannot afford to do for everyone, or even nearly anyone.  While you will be able to buy insurance against those calamities many people will not, just as many do not buy flood insurance now despite it being cheap if you're in a "no special risk" zone.  If you get flooded without flood insurance, or get an orphan disease without having insurance against it, you're going to be screwed.  And?  Life is a series of risks, some of which you can control and some of which you cannot.  You can insure against whatever you wish but you must not be allowed to take your choices and make them someone else's obligation.  That is how we got to where we are now, in short, and if we fix this that will end.

What if we don't fix it?

Then we all -- this entire nation -- economically die within the next few years. Not at some point in the reasonably-distant future, and not just a possibility either.

IT IS, IN FACT, A MATHEMATICAL CERTAINTY.

That's the choice folks, and if you choose not to decide -- if you choose to remain silent -- you are choosing economic if not personal, and painful, death.

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