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Commentary on The Capital Markets- Category [Health Reform]
2017-03-22 05:00 by Karl Denninger
in Health Reform , 10700 references
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I had an "interesting" debate on Twitter last night with someone who is involved in the health insurance game in some way and apparently has cancer patients as clients.  He is a strong shill for (supporter of) the "Obamacare Repeal/Replace" process by his own admission.

The debate was plenty fun and decent right up until I pointed out that on the math the Federal Government spent $1,417 billion last fiscal year on Medicare and Medicaid, up from $380 billion in 1998, which incidentally was 37% of all federal spending last year -- and it's accelerating at ~8-9% a year as it has been for the last several decades (with some notable outlying years.)

At this rate it will cross $2,000 billion, or more than half (by a good margin) of the current federal budget within 5 years.  That will blow a $600 billion additional annual deficit hole in the budget into a rising rate environment which the government will not be able to finance.

That's math, not politics.

For this I was told I was a conspiracy nut and belonged on Infowars.  Never mind that every one of my figures came from the Treasury itself in the form of its official published balance sheet.  If that's tinfoil.....

Yeah.

Following my assertion that the AHCA does zero to address cost, which he admitted is correct, and that if we do not address cost and thus drop that $1,417 billion precipitously the government's budget will be destroyed and thus collapse on the clear evidence and trends published by our government's own Treasury Department he declared that he was storming off and blocking me -- and did exactly that.

So what do we have here?  When I bring up arithmetic and facts that are published by our own government along with the published growth rates and what that will inevitably lead to, pointing out that there is exactly one way to stop what is otherwise inevitable predicated on the laws of mathematics I get called a conspiracy nut?

30 year trends in data published by our own government is a conspiracy?  A statement that we cannot finance another $600 billion a year rising to somewhere around $2.5 trillion a year within five more in a rising rate environment is open to question?

REALLY?

Or is the truth that the light came on in his head -- he is shilling for a bill that is an outrageous and open fraud upon the public since it will not address cost (which he admits) but will further advance the collapse of our federal government's ability to fund itself, and thus operate!

It's a hell of a lot easier to just slam the door than take on the math and either find an error in it (in which case you win) or admit you're wrong and change your position, especially after you've been lobbying lawmakers, eh?

If you're wondering why despite my repeated public statements (including right here, again) that I'm willing to show up in DC (or anywhere else for that matter) and have this debate in public, under oath if the body sponsoring same would like it that way and hash it all out there have been no takers among the political class you now know why.  Most of those in the political class do know what the math shows -- they're simply intentionally sticking their fingers in their ears and repeating "na-na-na-na-na-na" because the minute they stop the entire charade they've been running on health care comes crashing down around them.

It's damn hard to continue supporting stupid once you admit it's stupid and won't work - so the entire game is to refuse to have the debate at all in an effort to prevent being tagged with the label "financial rapist" by everyone around you.

Here's a bit of history -- all fact, not conjecture.  The insurance and medical industry was in the beginning stages of collapse in 2008.  Annuities are funny things; you promise to pay X, you take in Y, you invest it with a return of Z in a bond ladder and the books balance.  You hope.

You get in a lot of trouble when the promise to pay X ends up as X+ and the return Z doesn't materialize.  You can get in lethal trouble that way, in fact, and quite easily.  This is how the pension systems in our states, cities and private instances have blown up, and most of it has come from health care.

Then there are all the pigs at the trough in health care itself.  See, while health care counts toward GDP, and is nearly 20% of it today (up from about 3% 30ish years ago) most of it doesn't produce anything.  Not one car, one house, one television set.  Oh sure, it might allow someone to keep making those things -- maybe -- but at what cost?  Yes, there are exceptions, but most of those exceptions (e.g. childbirth) are actually quite cheap in percentage terms.

The ugly part is that much medical care is actually negative to GDP.  Why?  Consider the drug addict who mainlines opiates and destroys his heart valves. "Fixing" it costs upward of $500,000, all said and done. Will that person ever produce more value than that with their remaining life?  Definitely not if they keep using drugs; they'll die.  The sad reality is that most of them do exactly that.

How about the Type II diabetic that winds up running through a quarter-million bucks in drugs, amputations, dialysis, blindness and death because they won't change their food intake and stop eating carbohydrates?  How far does he or she go before the ability to produce is destroyed, at which point they're on disability and go from producing something to a net consumer of everyone else's production?  By the way that specific instance when you add it all up nets out to somewhere around $400 billion a year for Medicare and Medicaid now!  That's crazy on any objective basis; you could literally give everyone in the country -- man, woman and child $1,000 a year instead with money left over -- or adequately feed everyone who is hungry in sub-Saharan Africa (all ~230 million of them!) with a lot of money left over.

I'm not going to talk ethics regarding the two examples above in this post because that's a thorny discussion indeed!  But you can't escape the mathematical outcome that results from allowing these people to impose their costs on everyone else.  There are plenty of people in the lower and middle economic strata -- in fact, most -- who can easily wind up being a net negative to GDP and the problem becomes much worse when medical costs ramp by a factor of six compared against GDP and not all of the conditions in question come as the result of voluntary lifestyle choices.

But in all cases you eventually run out of people who can and will pay when exponential cost expansion occurs, especially when at the same time you ramp cost the income base you rely on to pay taxes to fund it is being destroyed one drug addict or Type II diabetes sufferer at a time.

Always.

Starting in the 1990s and early 2000s and everyone in the industry, never mind anyone running a company (like me) knew this was coming.  The so-called "High Risk Pools" were collapsing.  That's a fact, and it was cited as one of the reasons we had to pass the PPACA - to put a stop to their collapse by forcing everyone into paying for those who were very sick or nearly dead!  The stories of people who were unable to get into those pools at all due to lack of funding were well-circulated and the crimp put on treatments paid for by them were both well-documented and publicized -- again, due to lack of funds.

I wrote article after article on this in the 2009 timeframe with the facts and figures from our own government and those making similar claims.  The PPACA was basically a bailout of the medical industry engineered to force a more-level slam of the cost on everyone in the country.

But... it failed.  It failed because nothing was done about the actual problem and costs continued to ramp.  The PPACA managed to get a lower spend in Medicare and Medicaid for one year (and a modestly-better increase in the two bordering it) but spending then returned to its previous trend!  The negative GDP problem got worse rather than better in aggregate and moved even further up the income scale on an individual basis.  The government tried to finance that through even more deficit spending but doing so just destroyed productivity and tax receipts.

That's the funny thing about cost-shifting -- it can never solve a cost problem.  It just moves the problem somewhere else.  Where it moved it was on the back of productivity and tax receipts, both of which have been horrifyingly bad since the 2008 crash.  Last fiscal year tax receipts rose by less than 1% despite all the new taxes in the PPACA and higher rates generally while productivity improvements have all but disappeared.

The AHCA cannot resolve this problem because it intentionally refuses to address the driver of the problem in the first instance.  Returning to "High Risk Pools" is idiotic because those very pools were on the verge of collapse prior to the PPACA and were a big part of why Obamacare was written and passed!  The insurance and medical lobbies wrote the PPACA to get rid of those problems and pools, or so they thought.

They tried denying math but failed because the laws of mathematics are not suggestions. You can't get rid of a cost by making someone else pay it; you simply move it and eventually it comes back and bites you.

The answer to the problem cannot lie in "more insurance" or "restructuring" health insurance and let me remind you that my debate "partner" admitted the AHCA will do nothing to address the total cost of health care.  It just moves money around, something I noted back when it was first released (and much to the detriment of state budgets.)

The answer to the problem is, and can only be, a return of the medical industry to its historical 3-4% of GDP.

How?

Enforce the damn law -- specifically, 15 USC and State Consumer Protection laws.

You need just one simple requirement to be enforced against every medical provider of any kind: Everyone must post a price and everyone pays the same price; any sort of hiding, collusion, cost-shifting or similar is met with indictments, prosecution and prison for consumer fraud and racketeering along with violations of the Sherman, Clayton and Robinson-Patman acts.

What your insurance covers instantly becomes between you and the insurance company; the provider of service has nothing to do with it.  I remind you that insurance companies are not immune from anti-trust when they "negotiate" with providers and that this is a matter of settled law; they tried to run the claim they were immune under McCarran-Ferguson in the 1970s and lost at the US Supreme Court.

Forcing published pricing and charging everyone the same price for the same service or product of like kind and quantity, disconnecting it from alleged "insurance" using existing law, will force competition into the market immediately.

Medical costs will instantly drop like a stone.  How much?  Let me point out that from one "direct concierge care" site we have some examples of what market prices for common services and drugs look like - $4 for an A1c test, $3.13 for a CBC (complete blood count), $7 for a PSA screen, $275 for an MRI (damn close to what you can buy it for in Japan - cash, of course), $37 for an X-ray and $167 for a CAT scan.  On drugs how about $1.98 for 90 Prozac pills, or $1.44 for 30 Prilosecs? This place claims these offers are "at their cost" with your "membership"; note that they are not selling at a loss and the maker/operator of same is still making a profit!  Why would you fork over a "co-pay" of $10 or $20 when you can pay $1.50 for your prescription in cash?

Why would you need "health insurance" to cover routine medical care and prescriptions if you could buy services and drugs at prices like that -- or at a 20% markup from them with a bunch of competitors in a given area?

We can have that sort of pricing for medical care today, right now, right here, everywhere in the country: Enforce the damned law today and that's the pricing we will have for medical services and drugs TOMORROW.

Let me make this clear for you because we have proof of what the outcome will be: The known pricing we will obtain if we were to do this is, for most treatments and drugs, 80 to 90% LESS than paid today.  In fact most of the drugs listed on that concierge site are 10-20% of your copay under existing so-called "insurance" and so are the imaging and lab prices!

We do, however, need some legislation as well.  Specifically, we need to repeal the reimportation ban on pharmaceuticals, and we need to add to Robinson-Patman inclusion of international sales.  That will force "best price" everywhere and pharmaceutical costs will fall like a rock here in the United States.  Oh, those other nations?  They'll get to pay their ratable share of the development of drugs -- and it'll be about damn time.

In terms of legislation it's pretty easy -- you can see some ideas here and here.

Note the dates.

If we fail to address cost in this manner then it matters not whether the AHCA passes.  I hope it doesn't, simply because bad laws are worse than no laws, and I'm not vindictive.

You see, if they pass it they own it -- and everything that comes after it as a result.

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2017-03-14 12:40 by Karl Denninger
in Health Reform , 2571 references
[Comments enabled]  

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.

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So it's out..... well, at least sort-of-out.

And let me point out a few things about this bill, at least as far as I can determine from reading and cross-referencing it:

  • Idoes not repeal the "penalty."  It instead moves it to the back end; if you don't have insurance (by choice) and then buy it, you get hammered with a 30% penalty for a year.  For most people that's far more than the ACA penalty for not having insurance -- it could easily be $3,000 or more!  This is outright fraud on the part of the GOP which said it was repealing the penalty.  Paul Ryan, Donald Trump and the rest are all ****ing liars.

  • Medicaid expansion is essentially ended and cost-pickup for the states is capped to CPI-U's medical expenditures inflation index on a forward basis.  This will detonate State budgets within about 10 years as the current spend is expanding at ~9% a year but the CPI-U index is less than half that.

  • It does not repeal the prohibition on discrimination in price (or denial) for pre-existing conditions, but it does increase the multiplier for age to 5 (from 3.)

  • IT IS NOT A REPEAL OF THE ACA -- not even close.  The vast majority of the ACA remains intact.  The "mandate" is gone but the penalty remains, just shifted to the back side and for many will be far worse than the penalty would have been.  The restriction on what plans you can sell is gone, subsidies are cut, indexed only to age and paid to HSAs instead of directly to insurers. It does repeal many of the "add-on" taxes that paid for the program previously as well.

Repeal and replace? More like bend over, grab your ankles and bite down on a big stick so you don't chomp your tongue off.

When it comes to the media and their "lead-in" to the bill you have pieces like this, which sound awfully good when you read them until you realize there's exactly zero being said about the how.

Remember, it's who, what, when, where, why and how (sometimes stated as "with what?")

These are the 5 Ws (and one H, or sometimes 6 Ws) that form the basis of journalism.

Well?

Where's the examination of that last one: How?

Not in that oped and not in the "new bill" either IN WHICH THERE IS NOT ONE WORD ABOUT ANTI-TRUST, COLLUSION, OR ANY OF THE OTHER PRACTICES THAT MAKE MEDICAL CARE SO DAMNED EXPENSIVE, NEVER MIND THAT MANY OF THESE PRACTICES AND COLLUSIVE ACTS WERE RULED ILLEGAL IN 1979 BY THE SUPREME COURT YET THOSE LAWS ARE NOT ENFORCED AND THE COLLUDING PARTIES ARE NOT INDICTED, PROSECUTED OR BROKEN UP.

As an example you have laments like this from a physician:

Republicans ran on a platform of repealing and replacing a failing ObamaCare system. 

Democrats touted ObamaCare as an overwhelming success.  Neither party has really addressed the issues surrounding the law—patients are experiencing higher costs, diminished access and poorer quality care.

....

I have seen my patients go without medicines, miss important preventative care milestones and struggle to find access to high quality care. Copayments continue to increase—deductibles are rising (more than $12,000 in some cases) to the point where an average family simply cannot utilize insurance except in catastrophic circumstances.

There's a hell of a screed in that article but as I read it what kept going through my head is that this is a physician who's complaining that Washington has failed to fix this and that, lawmakers are putting "their own interests" ahead of the public and so on.  Complaint after complaint after complaint leveled against both political parties.

But nowhere in that article is found any discussion about the how -- that is, how is this individual physician prevented from putting a stop to that crap for his customers right damn now!

In other words how is it that he can't charge $100/hour (a quite-reasonable wage, all things considered -- that would be $200,000 for 50, 5-day-a-week 40 hour weeks of work in a year with 2 weeks off) in cash for his patients and given that most patients actually see said doctor for about 15 to 30 minutes per visit you then get to explain why someone who has a $12,000 deductible shouldn't just pay $50 for 30 minutes of said doctor's time with said physician seeing said person under his terms (and none of the nonsense being complained about.)

Is the problem that you can't just pay the $50 because said doctor has been prohibited from holding out his hand for you to stuff a Grant into it?  What law prevents him from doing that?  Why is that all of these "escalating costs" and "administrators" have resulted in actual physicians kneeling before Zod instead of them telling everyone trying to mandate that crap to stick it up their ass?

In short did someone make the current model something he's forced into rather than chooses and if so who did it with what law(s) (specifically) and why is doing so legal especially when every doctor in a given area has the same "problem"?  If there's no competition due to collusive behavior in a place where competition would obviously make someone richer at the other competitor's expense then you have a very solid case that felony violation of the law is taking place among all those who are doing the colluding!  If extortion (that is, some sort of threat) is involved then it's even worse.  I remind you that in 1979 insurance companies and pharmacies tried to claim that their collusion was exempt from anti-trust law and lost at the Supreme Court.

There are only two possibilities: This physician is part of the scam voluntarily or he is being forced involuntarily.  He's either a protagonist and thus willingly engaged in the offense or he's a victim of it.

Which is it and why isn't that the center of the a whole lot of journalistic attention?

You know.... the old "How" question that is supposed to be central to journalism?

Start asking that question and you will find yourself in two places at once.  The first is here, where we can remove $400 billion a year from the federal budget alone by cutting the crap on just one disease -- by putting sufferers of same first and prescribing health instead of expensive drugs that do not resolve anything.  The second is found in making The Surgery Center of Oklahoma the model for all medical practice exactly as it is for a car repair shop; that is, mandatory posting of prices and charging of the same price for the same product or service to all who come in the door for same.

Neither Democrat or Republican members of Congress will do either, and neither will Trump -- and journalists will not poke at why physicians have not revolted en-masse and destroyed this demonic system from within by simply putting out their hand and demanding a Grant to see them for 30 minutes of their time, ending the rampjob on the front end, at the local medical office, with finality while demonstrating that obtaining medical advice need not bankrupt you or be complicated.

As a result of all these actors serving those who are colluding to jack up the price by a factor of five to ten over what it should be for medical care in this country and the complete unwillingness of both Congress and the press to call those parties out and put a stop to it the federal budget is on a path to implosion along with all of the pension systems in the United States within the current President's term.

In 2009 I gave you a fairly simple "how" in these very pages, and have followed through with far more since, including more-complex ideas, all centered on the rule of law -- specifically, law that has existed for more than 100 years and does apply to health care.

You might want to go back and read that piece again. Then read this one.

Make sure you note the dates on both....

As for Trump, Price and the GOP?

smiley

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2017-03-04 06:00 by Karl Denninger
in Health Reform , 502 references
[Comments enabled]  

The byline on this article is misleading -- probably because of where it's published.

Salim Yusuf says new evidence fails to support many major diet recommendations.

There is no such "new evidence."

Yusuf presented evidence that many of the most significant and impactful nutrition recommendations regarding dietary fats, salt, carbohydrates, and even vegetables are not supported by evidence.

There was never evidence to support those "recommendations"; there was industry gaming, there was outright fraud (the "7 nations study") and there was and still is lobbying by various organizations.

The results from PURE will likely add fuel to the ongoing fiery debate over carbohydrates and fats. Yusuf displayed data showing that the incidence of cardiovascular disease in the PURE population increases as carbohydrate intake (as a percentage of total calories) rises.

....

"We actually found that increasing fats was protective," he said. Low consumption of total fat was associated with increased risk.

In other words exactly backward from what has been promoted by your doctor.

These "guidelines" and "recommendations" have killed millions of Americans.  They have led to more than half of all adults being overweight or obese.  They have caused millions of cases of Type II diabetes and uncountable human suffering.

Do not believe for a second that any of this is or ever has been a "mistake." These are alleged experts; doctors and nutritionists.  How do we know they're full of crap -- either on purpose or via gross negligence? Basic physiology tells us how carbohydrates are processed in the human body.  Learning the basic physiology of humans is part of becoming a doctor or nutritionist and it's not an optional part either. In short these are people who claim to be experts, who as part of their "degrees" must, by definition, learn the basic facts of physiology and yet they then go on to set recommendations that make utterly no sense unless they are intentionally ignoring what they learned.

These people are directly responsible for roughly $400 billion a year in federal spending and countless more through private health plans, virtually all of which can not only be avoided in the future but stopped right now.

There has not been one bit of accountability applied to any of them.

The "recommendations" did not come about as a result of honest mistake they were made on the basis of economic desire by the lobbying parties and require, in order to be made, intentional denial of basic physiological facts. These "recommendations" have in turn inured to the benefit of physicians, drug companies and hospitals who have made trillions of dollars off the disease, suffering and death in the population following those recommendations cause.

These **********s are just like a "fire department" full of firemen who commit mass-arson and then demand huge amounts of money to put out the fires they set, refusing to pay the bill to restore or replace the smoldering ruins they created, and they manage to dodge prosecution for killing the people who die in said fires, all by claiming to be those who do good for society.

Not only should all of the wealth these individuals and corporations stole via this fraud be confiscated every one of those individuals who has been involved in or profited from this scam need to be indicted, tried and sentenced for each human case of disease or death they caused -- and since mass-homicide is often a death penalty offense, it should be considered.

I argue we ought to being back the gallows and carry out those sentences in public.

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2017-03-02 06:00 by Karl Denninger
in Health Reform , 686 references
[Comments enabled]  

I can cut approximately 25% off Medicare right now without jailing one person, without breaking one monopoly, without doing one single thing to the actual health providers -- although all of those things should and in fact must happen.

In the private sector I can have a similar, but smaller (percentage-wise) impact.  Ditto for Medicaid.  The budget impact of this change would be roughly -$400 billion annually, which is wildly better than any projected "growth" addition (it would add to more than $4 trillion over 10 years.)

You simply have to allow me to make the following policy change with regards to one disease -- Diabetes:

  • For those with Type II diabetes we will provide unlimited metformin (cheap, off-patent generic medicine that costs pennies a day) to anyone with the disease.

  • We will provide no other care of any sort for Type II.  You want or "need" it, pay cash or die.  Period.

  • We will also make changes to how we deal with Type I diabetics' insulin requirements, as detailed below, that will cut said requirements dramatically.

Now before you scream in horror that I'm a monster, listen up.

Instead of medicine and, inexorably, amputations, dialysis, hospitalization and death we're going to prescribe a lifestyle of eating no more than 50g of carbs a day, all in green vegetables high in vitamin C (e.g. broccoli, brussels sprouts, etc.)

Caloric intake is to otherwise be 70% saturated (animal) fat and 20% protein.  Sugars, grains and starches, including but not limited to "white" foods (pasta, potatoes, breads, etc) are all prohibited.  Zero-calorie / zero-carb spices and condiments are unrestricted, of course.

In short you eat (and don't eat) what's described in this post, less the fruits (since they are all fairly high-glycemic and the vitamin C requirement is taken care of.)

For most Type II diabetics eating this way will reduce their need for other drugs, including insulin, to a literal zero and since their blood sugar will normalize their need for many-times-a-day testing will also disappear, getting rid of both the pain of sticking one's finger repeatedly and the cost.

For those who it doesn't the metformin is there to help.

We will also accommodate all actual, documented exceptions -- that is, those people for whom this lifestyle change legitimately doesn't work.

Those who claim "it doesn't work" will be locked in an isolation ward where they will be fed that diet for two weeks (with no access of any sort to any other source of sustenance) and be able to prove that for them, individually, it doesn't work.  If they're right then they will get whatever medication or other intervention is necessary provided they keep to the lifestyle change.  But if that empirical test shows that it does work (and it will for virtually everyone) then their ass will be discharged, the fact that they refuse to change what they eat will be noted in their chart and further complaints of "impossibility" will be ignored.

Type I diabetics will find their insulin requirement cut to a tiny fraction of what it is now and again those who claim "it doesn't work" will be subjected to the same empirical, isolation ward test -- with the allocated and paid for insulin amount (and/or other intervention measures) set by the results of said test.

If you are insulin-compromised but choose not to eat this way -- if you cheat, if you want those Doritos, potatoes, pasta, breads, cereals, sugars and similar, then have at it -- but you will get no medical care paid for by any insurance, by Medicare, Medicaid or otherwise.  You may buy whatever you want with your own money but there will be zero further support from the government or anyone else.

When diabetes causes gangrene in your feet you can use your own chainsaw to cut them off and your belt can be used as a tourniquet until you can sew the gaping flesh shut with your own hands.  When it causes blindness you cannot collect disability because you intentionally caused your own disabled state.  When it causes kidney failure you can pay for the dialysis yourself or die.  When the complications from all of the above kill you, tough crap.

If you're Type I your reimbursable amount of insulin under Medicaid, Medicare or private insurance will be limited to that which is required by a 50g/day carb load comprised of all low-glycemic green vegetables -- and not one unit more.  If you want to eat carbs or load up with excess protein (which gets turned into glucose in the body!) you pay for both the carbs and/or protein and the insulin.  Again, if you argue that the provision for what your coverage provides is too low or it's "unsafe" for your personal metabolic situation you get to do two weeks in said isolation ward and prove it. The results will go in your chart as irrefutable and individual evidence as to your actual requirements.

Not everyone is the same -- but the exceptions must be proved empirically, not just by what you claim.

It's simple, really: If you consume no carbohydrates of note and no fast carbs at all, along with little or no excess protein you need very little insulin.  If you have damaged your endocrine system so badly that you actually need injected insulin as a Type II diabetic then you will need a tiny fraction of what you use now and you can pay cash for it.

If you haven't, and most Type II diabetics haven't you will need no "advanced" medication at all and most Type II diabetics will need no medication of any sort as their blood glucose will immediately return to the normal range.

At the same time you will lose the extra weight if you have it, your blood pressure (if it's high) will probably come down and the odds of you needing any other sort of medical intervention -- all of which are a consequence of something bad going wrong with you such as a heart attack, stroke, blindness, kidney failure and similar -- will go through the floor.

If you're Type II over time your endocrine system might heal.  Or it might not.

But whether it does or doesn't isn't the point, nor is it the goal.

The point is that we're blowing over $200 billion a year in Medicare alone because people who are diabetic will not stop eating ****ing bread, pasta and potatoes while demanding that we pay for their pig-headed, self-destructive behavior!

That's not a disease it's a choice and by God we have to stop doing that crap right damn now.

Will Price and Trump mandate this?

You know good and ******n well neither will mandate any such change so **** them both.

Our current medical scam "system" is nothing more than feeding addicts -- sugar and carb addicts -- and then providing support for continuing addiction despite the fact that we know it is killing those who are addicted and have already had that addiction do severe harm to their bodies while stealing roughly four hundred billion dollars a year from everyone in the country.

We are, effectively, feeding crack addicts government-sponsored crack and forcing the public to pay for both the crack and the harm to the body that it does.

It's time to cut that crap out and indict, try and hang those who demand that it continue.

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