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2018-12-13 07:55 by Karl Denninger
in Health Reform , 238 references
[Comments enabled]  

No, really, you mean the law really does apply?

Executives at more than a dozen generic-drug companies had a form of shorthand to describe how they conducted business, insider lingo worked out over steak dinners, cocktail receptions and rounds of golf.

The “sandbox,” according to investigators, was the market for generic prescription drugs, where everyone was expected to play nice.

“Fair share” described dividing up the sales pie to ensure that each company reaped continued profits. “Trashing the market” was used when a competitor ignored these unwritten rules and sold drugs for less than agreed-upon prices.

15 USC Chapter 1.

Which has been completely ignored by the Federal Government and its prosecutors now, when it comes to the medical industry generally, for 30+ years.

This, despite the fact that the industry twice, in concert with the insurance business, tried to claim exemptions.  Both of those cases went all the way to the Supreme Court and the medical and insurance industries lost both cases.

So the law does apply, and has been tested.

Doesn't matter.  The drug makers don't care.  They have broken the law with impunity.  And why not?  Nobody goes to prison.

If you think this is just about generic drugs, you're dead flat wrong.  It applies to everything in the medical industry.  The very premise of being unable to get a price as a customer while the very same hospital has negotiated a price with an insurance firm is in essence the definition of anti-trust.  Predatory, collusive behavior intended to prevent you from shopping -- that is, exercising competition.  15 USC Chapter 1 says that sort of behavior is a criminal felony.  Well?

Screwing people who can't negotiate violates all manner of anti-gouging laws that exist on the books in most states as well.  Those laws may have as their predicate natural disasters but few of them actually require that; most require only duress, which is why the motel has to post a sign on the back of the door with the "rack rate" and they can't bill you 10x that, or refuse to give you a price, before you sleep on the bed.  Never mind the implied covenant of fair dealing that is in all contracts and cannot be waived.

None of this stuff is hard to fix.  Enforce existing law and it all gets fixed.  Is it really that difficult?


So why are the states going after this?  Likely because Medicaid comes with an unfunded mandate they have to cover, and it's hurting them.  Finally.

Does the federal government care?  Obviously not, but they damn well should since Medicare alone spent over $1 trillion last fiscal year -- and likely paid close to 500% what they should have.

Yes, you read that right.

But heh, if you won't charge people and actually throw them in prison why shouldn't they break the law, even if the behavior in question has been a felony for the last 100+ years?

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2018-12-02 08:20 by Karl Denninger
in Health Reform , 200 references
[Comments enabled]  

Simply put what we're dealing with here is not "Conservatism" at all: It is instead the promotion of violent, at-gunpoint thuggery in which refusal means death by withdrawal of that which you allegedly need to survive.

A coalition of 55 conservative groups has written a letter calling on the Trump administration to withdraw a proposal to lower drug prices, warning of creating "price controls."

The letter from the groups represents a break between President Trump and conservative allies over the drug pricing proposal unveiled in October, which departs from the traditional Republican position on drug prices.

The letter warns that the administration's proposal "imports foreign price controls into the U.S."

It was signed by leaders of prominent conservative groups such as Americans for Tax Reform, FreedomWorks and the American Conservative Union.

These 55 groups are Racketeers.  They promote not transparency, price discovery and a free market but rather monopolistic control over people's lives.

Technological advancement always makes something of equivalent kind and quantity cheaper.  It is the power behind GDP advancement in the form of what is called productivity.

And in every place where you do not find it in America today and for the last 30 years you will find at-gunpoint command economic features that share one common thread: They're illegal under 100+ year old anti-trust law.

Where that won't do industries have actually gone and gotten special exemptions.  The drug industry, however, does not have one -- except in one place, which is in the prohibition of "reimportation" of drugs.

Let's be clear what we're talking about here: The purchase of a substance that is properly and honestly labeled, is deemed safe and effective by our government, by someone who happens to be across an arbitrary line on a map and who then desires to transport and sell it.

In other words legislated market controls which is exactly what these "55" claim to be against.

Further, there is the example of a Naloxone similar drug in an "auto injector" for opioid overdoses that was jacked up by some 600% in price but only for some people -- those with insurance.  This too is illegal under Robinson-Patman which says that for a physical item that travels in interstate commerce (so the Federal Government has jurisdiction) pricing differentials between buyers of like kind and quantity, where the intent is to lessen or dissuade competition, are illegal.

Well?  Where is the indictment?

Let's be clear: This must stop.  It is already illegal under 100+ year old law.  These "55" organizations are in fact advocating for continued criminal activity and should be named and indicted as co-conspirators.

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2018-11-23 07:00 by Karl Denninger
in Health Reform , 339 references
[Comments enabled]  

The entire "health industry" needs to be destroyed.

Not "reformed" -- there is no reform possible -- destroyed.

Everyone involved at the executive level must go to prison and, if the government won't do it, well..... use your imagination.

Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.

The article goes on to point out that not only are insurers and the companies that make these machines getting "telemetry" on your individual use data they're screwing you blind on the price of consumables too because you have "insurance."

Of course said "insurance" usually comes with a deductible, which means for many people you get screwed out of the whole difference in cost simply for having the "insurance."

And they spy on you -- the data from which, I'm sure, will "never" be misused -- right?

If this isn't racketeering, never mind a blatant anti-trust violation may I ask what is?

Oh, and no, health insurance companies are not immune from 15 USC under McCarran-Ferguson.  They twice went to the USSC -- all the way there -- with that argument in the 1970s and lost both times.

So where are the damned cops?

Where is the FBI?

Where is the AG -- federal and all 50 States'?

Why is it that this sort of behavior, which is endemic across the health "industry", hasn't resulted in prosecutions, prison, and if the government won't do it why don't the people find their damned pitchfork and torch?

What sort of stupid is America filled with these days that allows this crap to go on?

May I remind you that you're being hosed all-in to the tune of 500% on health care, generally, over what free market prices?

Think I'm kidding?  Go over to the Surgery Center of Oklahoma and price a procedure (they'll give you a price.)  Now call your local hospital for the identical procedure.  If you can get a price you'll find it it's typically 500% higher -- and in some cases worse.

Oh by the way the Surgery Center has a hospital-acquired infection rate 1/20th -- that's not a misprint -- of most hospitals.  Why?  Because as a "one price, everyone pays the same, cash on the barrel" provider if they give you an infection they have to eat it instead of billing you for it.  This means they're a lot more careful than the hospital is.

While we're at it can I bother you with the fact that roughly 200,000 Americans a year die -- the third leading cause -- as a result of errors committed by medical providers, and the reason that number is so high is that they get paid whether the results are good, bad -- or if they literally kill you.

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2018-06-07 07:00 by Karl Denninger
in Health Reform , 236 references
[Comments enabled]  

Here it comes folks, in two reports -- one from the Medicare trustees, and the other from Social Security.

Let's start with the easy one: Social Security.

The "fear" is that it will be unable to pay full benefits (because it will have run out of bonds that are there as a buffer) in 2034.  This is predicated on a few things, so let's list them:

  • Income levels will not generally lift.  Oh really?  More to the point, neither will the cap-out point (where you stop paying every year.)  But the latter does lift every year (it's gone up a lot since I was running MCSNet) and the former is a rather-pessimistic view of the world.  It's one that might prove correct, but it's still quite pessimistic.

  • Disability has actually improved due to fewer people going on the rolls.  Gee, how many were disabled and how many didn't want to work?  Funny how people who were and are disabled suddenly become not disabled as the economy improves.  That's fraud folks, but nobody cares.  You should, because the money being stolen is yours.

  • Through 2039 (five years beyond the projected depletion date) expenditure goes up.  However, the system was designed for this; that's why it holds Treasuries and built a huge surplus while the boomers were working.  Granted, the "surplus" was immediately spent but it was replaced by Treasury bonds, which can and are being (right now) sold.  The Fed, Congress and Obama intentionally destroyed the actuarial health of the system; the current yield on a blended basis is only 3% which is about half of what it should be for a ladder of bonds of appropriate duration.  This is not small potatoes when you're talking about a couple of trillion dollars! I want to know where the handcuffs are for Congress and the entire Federal Reserve plus all of the administrations back to the 2000 tech wreck who have all deliberately suppressed yields and continue to do so today.  But for that the retirement program would probably be sound on an actuarial basis.  Note that had interest been at normal levels the difference last year would have been roughly $80 billion, along with the years prior back to 2008 and on a forward basis.  $80 billion a year is real money, especially over a few decades and in fact it's probably enough to make it through the "bump" when the boomers die!  Too bad America has forgotten what a pitchfork and torch is.

  • Note that Social Security is fairly easy to "fix."  First, we can stop tampering with rates on a forward basis.  Second, we can (and probably have to) lift either the cap on wages at a faster rate (or once on a step-function basis), modestly increase the FICA tax, or some blend of both.  A less than 3% increase in the FICA rate (both halves; you pay both even though you don't see both directly) is roughly where the line is, assuming wages do not lift faster than inflation (payouts.)  If they do some or all of that will disappear; the reason is that Social Security is a progressive system; that is, your first dollar of earnings (taxable) get you more benefit when you retire than higher earnings dollars do.  So if people shift toward the higher end (before the cap-out, at which you neither pay or get more) then the deficiency closes.

The bad news is found in Medicare.

Medicare goes bust in eight years and there is no rational revenue-raising way to fix it.

For most of us who are not 75+ it will not be there unless the medical monopolists are jailed, hung or both right now.

Yes, after trial and conviction (I still believe in due process) but if we don't do it, and I remind you there is 100+ year old law that is more than sufficient to go after this issue right here and now everyone in this nation is absolutely and irrevocably ****ed if they need medical care and are over 65 just eight years from today.


There is no payroll tax adjustment that can plausibly be passed and fix this.  Medicare was designed for a medical system that consumed four percent of GDP.  Today it's nearly 20%, or five times as much.  Cost-shifting from Medicare and Medicaid is already is screwing the rest of the public blind; there is little or no more of that which can be possibly foisted off on working people.


Well, it not only hasn't been stopped the scamming has accelerated and unless the government puts a stop to all of the scams now within the next few years you are going to get reamed up the chute. 

This is no longer a "distant" threat.  It now will occur prior to the end of the next Presidential term, and any acceleration in the deficit in these programs, which will happen instantly when there is a recession, will likely bring forward that date by three to four years immediately rendering the problem both instant and catastrophic.

I have published several articles on real fixes for these issues.  One can be found here, and it's a good place to start.

We either demand it as a nation and back that demand up with whatever we need to in order to make it happen or this nation, it's economy, and our government are all gone inside of the next ten years.

Politicians will not act until and unless we, the people force them to do so.  They only care about the next election and being able to "retire" into some lobbying position at five times their government salary.

You either get off your ass now and force your government to hold the entire medical system to account under anti-trust law or you had better make damn sure you don't need medical care of any sort -- no prescription drugs, no doctors and no hospitals -- and are willing to either get on a plane (if you can) for treatment or die should that change for you.

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2017-11-01 12:14 by Karl Denninger
in Health Reform , 501 references
[Comments enabled]  

Ok, so I have the APTC for a single person who has reduced income to right near $20,000 a year for 2018.

In Florida it is now $760/month, or $9,120 a year.

This is wildly up from $446 for last year; in fact it's up 70%.

This means I can now have a Silver plan for about $15/month, as opposed to a very low-level Bronze plan for under a buck.  I can also choose virtually all the Bronze plans for zero (since the cost is lower than the APTC), but that would be insane since I'd be leaving a huge amount of your money on the table.

The actuarial value of a "Silver" plan is wildly better than any of the Bronze plans.

There is one "gotcha", which is hospitalization co-insurance that does exist on the Silver plan but not on the Bronze.  But the Silver plan in question has a zero deductible, so even with 20% "coinsurance" you'd have to run a hell of a bill to lose that bet especially considering that you get the insurance-company racketeering-deduction price.

Folks, you have to be flat-out nuts to work harder and run into the subsidy phase-out, especially if you have a spouse, even if you do need routine medical services since you can now buy zero-deductible Silver plans for less than the cost of a burger-and-beer in your local pub!


No, you probably can't do this in high-cost-of-living areas without living in a slum.  Yes, you can make it work perfectly-well in lower-cost-of-living areas and be perfectly fine.  I'm doing it and you can too.  Yes, it means you have to change your lifestyle but I'll be double-******ned if I'm going to go out and earn a six-figure income and then have government thieves not only tax more than half of it away (which they will) but then double-monkey-**** me by extracting approximately $10,000 in after tax money in addition from me for "insurance" that, unless I have some sort of medical catastrophe in the next 12 months in fact provides zero value to me.

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