Facts On Health Care
The Market Ticker - Commentary on The Capital Markets
2017-03-26 10:45 by Karl Denninger
in Editorial , 4427 references Ignore this thread
Facts On Health Care
 

Friday afternoon the Republicans "pulled" the AHCA without a vote.

This is the common way that the party in power makes sure you never get a recorded answer these days as to who opposes and who supports some piece of legislation: If there is no majority to pass it, they never vote at all.

If you think about it for a bit you'll realize that's the exact antithesis of representative government.  Representative government not only "works" when it passes something it works when it fails to pass something too, and the list of elected officials who did and did not support something that fails to pass is just as important and maybe more-so than those who supported (or not) passed legislation.

But, now you simply have claims -- not votes.  And remember folks, claims are not votes; if they had been (according to the polls) we'd have President Hillary right now.

Now let's talk about health care and "health insurance." 

Let us remember that insurance is simply a math problem.  That is, insurance is always and everywhere simply the expression of the formula [sum(p * c) + cost(operation of insurance company]

p = probability of having to pay a claim on a specific event
c = cost of the event

And of course "sum" is the sum of all the "p * c" components that exist for all the things you bought the insurance against.

Given this fact I will now demolish a number of lies that you've been told.

Health insurance should cover routine and expected events.  Nonsense.  If p = 1.0 then it is always cheaper to simply pay cash because [cost(operation of the insurance company)] is never zero.  For something where p = 1.0 for all, or nearly all of the population you should never buy insurance for same since p * c = c!  Again, just in case you missed it: Putting such an expense through an insurance company will never cost less money; it is always cheaper to pay cash.  The only reason to force such expected and certain events through any third party is to hide the cost from you and remove competitive pressure so that someone can jack up the price or collude with others to do so on a grand scale (which is illegal under 100+ year old law in 15 USC, by the way) and steal your money.  Period.

Obamacare is so expensive because men -- and women who have gone through menopause -- have to buy insurance that includes maternity care.  There are dozens of variations of this claim run by politicians and "policy wonks" on the TeeVee; they simply change the condition and population to suit their audience.  It's maternity when they're talking to men and senior women, it's prostate cancer when in a room full of 20 year old women, it's IVF or abortion when talking to a bunch of evangelicals. This is a lie because "p" for such an event for such a person being spoken to at the time is (obviously) zero.

Zero times anything is zero.

So what is the purpose of requiring such "mandatory benefits"?  Simple: It reduces "p" over the entire population of people with policies.  But since the total of those "p * c" computations is the sum of all of them for each individual the purpose of such mandates is to force you to pay for someone else's treatment for a condition you cannot possibly suffer.

To put it more simply: It's theft from those who can't have that condition occur and it's intentional obfuscation of the cost of said insurance for those who can.  In short it's a lie told to the entire population; the exact substance of the lie depends on whether you're in the "can happen" or "can't happen" group but in each and every case whenever someone is forced to buy a policy that covers an event that cannot occur both the can and cannot groups are being lied to and one of them is being robbed.

This lie is intended to and acts to shut down any discussion of the real problem: Why is "c" so damned high?

Obamacare is so expensive because the "high risk" people are in the same pool as everyone else; the AHCA would "fix this" by putting back in place High Risk Pools and insurance costs would drop substantially for health people.  True, as far as it goes.  But there's a problem: The ACA, or Obamacare if you prefer, was written and passed because those High Risk Pools were collapsing!  They were collapsing because by definition everyone in them had "p = 1.0" for something; they had cancer, diabetes, HIV or some other serious and usually-chronic condition that had already happened.

When you get down to it for someone with a p=1.0 problem the cheapest way for them to be treated for that condition is to pay cash for it.  The more hands the money goes through the more you spend in total.  This is obvious to anyone who thinks about it for more than 20 or 30 seconds because nobody works for free.  If you put the money through an insurance company with thousands of employees and big buildings all over the place then the total cost of such care goes up because the insurance company has to pay all of its employees and make a profit (no matter how tiny) or it is no longer in business!  It would be far cheaper to simply stroke a check from Treasury instead of going through all sorts of convoluted arm-waving and cost-shifting such as Obamacare "subsidies" and insurance company mandates.

Here's the problem with simply stroking the check: As soon as you get rid of all the layers of obfuscation the cost is immediately exposed to everyone.  I've already mentioned the lie told to both the people with the (possible) condition and not above when it comes to cost, so I'll focus here on a second lie: Let me remind you that right now the Treasury of the United States (that's everyone in the country, since we're all allegedly responsible for the debt and deficits accrued) spends $350-400 billion a year between Medicare and Medicaid on health services for people with just one condition: Diabetes.  We can reduce that to nearly zero (that is, cut Medicare + Medicaid expense by roughly 25% instantly) by refusing to pay anything from public funds for those people who refuse to undertake a lifestyle change in the form of what they eat that has a proved track record of reducing the need for drugs to treat the far more-common form of that condition (Type II) to near-zero and at the same time dramatically reduces all of the complications (blindness, amputations, kidney disease and dialysis, etc) as well for both forms of the disease.  In fact for most Type II diabetics making this change eliminates the condition entirely.  Note that I did not say "cure" because if you go back to what you were doing you'll almost-certainly see the condition (poor blood sugar control) immediately come back -- but eliminating the condition eliminates all of the cost to the health system.

Remember, as I pointed out up above, that a big part of why Obamacare was written and passed was that the "High Risk Pools" were expanding in cost at an explosive rate.  The states did not have the money to continue funding them and many people with some of these conditions were dying before they could get into the pools and thus access treatment due to delays in enrollment driven by lack of funds.  So the lie here was twofold: Political debate on the cost of such treatments was refused as it was for everyone else up above and at the same time the fact that many of these conditions are not only due to voluntary action (e.g. IV drug abuse, unprotected anal sex or eating things once overweight that are known to exacerbate these conditions) in some cases, specifically those related to diabetes, the condition and its medical costs will disappear if the person in question changes what they eat -- in other words, they make a lifestyle change.  In other words not only are we all having our money taken to pay for the voluntary decisions of others who "made a big mistake" (which is perhaps defensible on the grounds of compassion) we are also having our money stolen to pay for the ongoing voluntarily decisions of others who refuse to change and, if they did change, would see the condition and thus its cost disappear entirely.  That is not compassion, it's pig-headed theft.

In short in order to prevent discussion of both the cost of said treatments and the role that voluntary actions of the sufferers, both causative and continuing have on the expenditure of funds politicians drove the spending through "health insurance" firms and thus made it even more expensive simply due to the middle man being present.

If there was little or nothing we could do about cost then we might all be able to stop here and, at least, take the insurance company costs out of the picture for those with p = 1.0 for some medical problem.  But that's simply not true, which is why the larger lie, and the one that I listed first, is run on everyone instead of simply focusing on those with already-existing medical problems.

Why would you need health insurance if this pricing was commonplace for the following routine medical things -- and remember to extend these representative samples to everything else in the medical field:

  • MRI: $275
  • CT scan: $167
  • X-Ray: $37
  • Mammogram: $142
  • Ultrasound (pregnancy-related primarily, I suspect): $94
  • A1c test (common for diabetics): $4
  • CBC (complete blood count; common for a lot of diagnostics): $3.13
  • Metabolic panel (common diagnostic as well): $3.50
  • PSA screening (common for men over 50): $7
  • 3-Panel cholesterol (the cheap and common one): $3.94
  • Tetanus booster: $20
  • 90 Prozacs: $1.98
  • 30 Prilosecs: $1.44
  • 30 Plavix (blood thinner; newer generation of Warfarin): $2.76
  • 90 Zocors (which I'd argue you probably ought not take at all!): $2.16

These are not fantasy prices -- they're real.  They're what you could have today, or darn close to them if we had a conversation about competitive markets in medicine.  I didn't pull these numbers out of my ass; they're on a "concierge" site for a "direct care" practice in Michigan and none of them are being provided at a loss.

Think about what you spend on "health insurance" today; whether you pay for it directly or you "get it" through employment.  If you get it through your job then every penny of what your employer spends is money you could instead have in salary.  Multiply the monthly amount your employer spends on health insurance for you by 12 and that's money you should receive in cash but don't because it's stolen and given to an industry that then charges you five to ten times the above through the so-called "insurance."  In fact for most medications your co-pay is larger, often by ten times, the above prices!

Would you rather pay a $10 or $20 co-pay for that Plavix prescription or would you rather pay $2.76 cash?

If the answer is "cash" then can you please explain why you would then pay for said "coverage" at all?

So why are these medical procedures, drugs and similar so expensive now for most people?  Why are you basically extorted into buying "insurance" either through your employer or directly?  Why is now the law to run these charges through a company that has to make a profit and thus is guaranteed to drive up cost?

Simple: It prevents us from all having the two political discussions up above -- why are we being ripped off to the tune of 1,000%, that is 10x what we we ought to be paying for virtually everything health-care related and why should we pay anything for someone else's decision to continue a lifestyle choice that results in the expenditure of hundreds of thousands of dollars after they get the condition when they can change that lifestyle choice and eliminate not only the condition but nearly all of its expense?

We know that the pricing above, or similar to it, can exist for everyone in the United States right now.  We know this because it does exist in the United States, right now.

We also know that health insurance companies and providers of health-related products and services are not immune from Anti-Trust law (15 USC Chapter 1.)  We know this because that case went to the US Supreme Court in 1979 and the insurers and those conspiring with them lost.  Specifically, it was ruled that "volume pricing" arrangements and similar were not "the business of insurance" and thus not entitled to protection from anti-trust enforcement under McCarran-Ferguson. We therefore know factually that the failure to bring said cases at the State and Federal levels from 1979 to today has been a political decision, not a matter of "not having" laws that could be applied.  In other words both State and Federal law enforcement and the executive branches of government in both places have intentionally refused to enforce the law and by doing so have become willing partners in you being robbed out of $9 of $10, approximately, spent on health care.

We know that if the cost of health care came down by 90% almost everyone could and would simply pay cash for all routine expenses.  Having a baby.  Vaccinations. Annual checkups. An MRI for a sports injury. A CT scan for something serious that's suspected in your chest or head.

We know that if the cost of health care came down by 90% true insurance for serious catastrophes like cancer, a serious injury or a heart attack would cost pennies compared to what it costs today.  If the cost of cancer treatment was $10,000 instead of $100,000+, and it would be if we locked up the monopolists that refused to stop playing their game of obfuscation and cost-shifting the cost of such insurance would be a fraction of what you spend today to insure your $10,000 automobile!  After all, it's more-likely in a given year that you'll wreck your car than get cancer!

We also know that there would be circumstances under which costs would remain very high; "orphan" conditions are the prime example, simply because the number of sufferers is low and thus spreading the development cost of treatments becomes problematic.  A condition that has 10,000 sufferers in the United States at any given time, for example, has a risk (probability) of 0.003% across the population.  If the cost of treating that condition is $500,000 (because it costs billions to develop the drug and there are only 10,000 customers for it) then for $15 (plus a profit for the insurance company) you could buy insurance against that condition for life.  Would you buy such "rare disease" insurance if, say, the "blended" cost was about $50/year to cover all such conditions?  Some people would not, but if we had the political discussion on this point and decided that the choices were "buy the insurance personally, pay cash if it happens to you without it or suffer the consequences including your death for which there will be zero funds spent other than through private, consensual charity" would that not be a better system than we have today?  It sure as hell would be a cheaper one and nearly everyone would fork up the $50!  Hell, make that $50 something that is akin to the "Presidential Election Fund" checkbox on your 1040 except that it's an opt-out rather than an opt-in if you'd like; $50 for single or HOH, $100 for married and an additional $50 for each dependent.  I'm ok with the mildly-coercive nature of that, considering the potential consequence of choosing "no."

We can surmise that the reason for the above political refusal to have this discussion is due to both lobbying and the fact that should the law be enforced Health Care would drop from its present ~19% of GDP to 3% (it's historical figure prior to the monopolists pulling this crap starting in the 1970s and 80s) almost immediately.  That would be a rough reduction of 15% in GDP which, I remind you, exceeds the 10% drop that economists call "a Depression."  It would not last long because all of the money currently spent through this scam that no longer was would be freed up to produce other goods and services in the economy and the impact on reduction of cost for businesses would be immediate and immense.  Further, the salary increases that would result from the embedded "health insurance" expense in an employee being removed (allowing it to be paid directly to you) would lead to a huge increase in consumer consumption in other areas.  But make no mistake -- there would be losers: Lobbyists, overpriced or overstaffed administrators in health care and similar, and during the adjustment period GDP would indeed fall before rebounding.  Find the politician that is willing to accept this without being forced -- good luck.

Finally, let me remind you that these are not particularly-new ideas.  I've been talking about them since the 1990s when I was the CEO of MCSNet.  I've been writing on them since The Market Ticker began publication.  There are two simple legislative agenda items here and here (note the dates of publication), never mind the entire section in Leverage, that would immediately address virtually all of the above.

I have had a standing offer out to several current House Leadership members since 2011 and to several Senate staffers since not long after to come to DC at my expense to testify before an open committee hearing on the math in this regard and resolution of these issues.

There have been no takers in the last six years.

Among political commentators on "the right" the following have also refused to take this on:

  • Hannity
  • Rush
  • Mark Levin
  • Glenn Beck
  • Michael Savage
  • Bill OReilly
  • Hewitt
  • Michelle Malkin
  • Laura Ingraham
  • Neal Boortz
  • Ann Coulter
  • Tucker Carlson
  • Judge Napolitano (despite the obvious nexus to law in 15 USC)
  • Judge Jeanine (despite the obvious nexus to law in 15 USC)

Oh, and this is not a complete list; it's just a list of people who, off the top of my head, have said zero despite, in many cases, my direct prodding.  I will note that among the left there have no takers either; I simply don't have anywhere near as complete a list of them (there are far more left-leaning political commentators than right-leaning!)

So folks, when you get down to it, it's up to you.

You can look at the AHCA being pulled as "just another thing" and decide to ignore it.

You can try to ignore this too if you want, but it's truly stupid to do so:

That's from the US Treasury's own published MTS taken from September of each year (close of the US Government fiscal year) back to 1998.  It is instructive to note that the blue line is an exponential series, and is expanding at about 8-9% a year, far beyond any rational projection for economic growth.  It is also instructive to note that it is a mathematical fact that any two exponential expansion curves, where one is growing faster than the other, will eventually cause the destruction of the slower-growing one if the faster relies on the slower to pay for it.  That's arithmetic and was the reason that I projected in the 1990s that this trend would bankrupt the United States.

Finally, it is worth noting that Obamacare, for all of its disruption and 2,000+ pages of obfuscation and horsecrap, managed to produce exactly one year of lower Medicare and Medicaid expenditures after which the former trend resumed almost-entirely unchanged.  For those who claim it's all about people getting "older" that is the final lie I would like to demolish; the trend from FY 1998 to 2016 excluding the one-year decrease was 8.35% (all-in) and 8.64% (Medicaid), respectively.  That is, Medicaid (poor people) spending expanded at a slightly-faster rate than Medicare (old people).

We either act on all of this as a nation now or it destroys the economy, it destroys the markets and it destroys both state and federal budgets.

My offer to both government and political commentators whether in the list above or not and irrespective of their political bent remains open: I will be happy to appear by voice, by video or in person to debate and discuss the facts in this regard.

If there's anyone willing to take it on, that is.

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Oliver1655
Posts: 88
Incept: 2012-08-02

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To everybody on this forum.....
Lets share/send this Ticker to all those listed up above and to anyone else you think might possibly help. Lets get someone/anyone to begin this conversation and get the facts out. We need to build a tidal wave of interest and awareness on this issue.
Tickerguy
Posts: 148437
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An aside for those who want to take a cheap shot at the "90%" target.

I don't think it's off-base at all. Here's why:

1. I can get 25% out of Medicare and Medicaid without touching one price (and explain how in the above and the link from it.) The spend privately on the same condition is likely in the same magnitude area, but it's much harder to get an accurate number on it.

2. "Administrators" and similar have expanded in the medical system at a rate some six times that of doctors and nurses. Exposed to competition exactly ZERO of those jobs will exist in that form. That's a HUGE amount of (1) salary and (2) operating expense in the form of office space, phones, computers and similar that will simply disappear. While the nurse may make more than the mid-level administrator and the doctor makes more than most of them they're out numbered 5 or 6:1! Simply put a huge percentage of spend (and thus price) has exactly ZERO to do with providing any care to anyone -- at all -- and in a competitive system most if not all of that will go away entirely.

3. There are plenty of examples of 90% savings now in places like the Oklahoma Surgery Center over traditional hospital care -- oh, and OKC includes possible complications in the price where hospitals never do.

4. There is no INCENTIVE to reduce complications (and thus cost) in hospitals since they get to bill for them. At OKC reducing complications is VERY important since every complication comes out of their pocket! Which do you think does a better job of both reducing cost AND providing better care? What percentage of cost goes to "complications" that the existing model rewards instead of punishes? If we drop the complication rate by 50% by making it impossible to charge for same (and I bet it would be easily that much) all of that spend disappears.

5. "Drive by" consults in hospitals have a 100% reduction immediately since they can't take place or be billed except by open and blatant fraud. They all disappear the day the model changes.

6. I listed a large variety of 90% or BETTER price reductions. Incidentally that metabolic panel is frequently billed out at over $100 and it's not a unique example by any stretch. The recurring financial******that occurs for people taking prescriptions is especially galling with co-pays often 10 or 20x the cash price of the drug, and pharamacists are prevented BY CONTRACT from telling you that you're getting screwed.

7. The "concierge" places are STILL grossly over-charging. Why? Because they're selling defense against getting raped by high co-pays and deductibles instead of a service, basically. The average healthy person sees a doc once a year for 15 minutes for an annual physical -- maybe. How many people use $500 worth of that sort of professional service in a year on a cash basis? Very few. While there is no 90% to be had there, I bet there certainly is 40-50% with a widely-competitive market (in other words, EVERYONE has to post a price and honor it for everyone.) Now instead of one or two concierge places EVERY doctor office has to compete for customers and price is a part of it. Suddenly any "extras" that don't actually contribute to operational efficiency and results are going to disappear -- FAST.

8. 19% -> 3% (of GDP) is an 85% reduction. Spitting distance.

Since the 3% is a known historical FACT that in fact was durable over a long period of time it's damn hard to argue that it isn't in the ballpark. The other 5% is easy to account for -- it's called productivity growth, otherwise known as technological advancement.

It reduces cost everywhere competition occurs. It always has, and always will. It is blocked intentionally by those who wish to steal, but absent such intentional blockage and collusion by government to make it occur, it's VERY reliable and is why you now have 55" 4k TVs for under $1,000 where 20 years ago a 50" 3-tube 1080i set cost $8,000 and had a volume and power requirement 20x the TV of today. Never mind the computer in your pocket which ran you $500 that cost a million dollars or more for equivalent CPU capability in the 1990s.

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Winding it down.

Aztrader
Posts: 7750
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Scottsdale, AZ
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Have you checked this bill out? Someone is actually talking the talk:

https://www.congress.gov/bill/115th-cong....
Tickerguy
Posts: 148437
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Except that McCarran-Ferguson already does not apply to the acts contemplated in the bill as it was ruled so in 1979 by the US Supreme Court.

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Winding it down.
Lunatic_fringe
Posts: 9358
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Location: Terra Firma
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Even if nobody backs it, your plan will happen one way or another. Ether it's implemented by people who see a quick ripping off of the band aid as the best way or mathematics will force it implementation which will probably be a lot worse for everyone.

Sooner or later though...
Capcon
Posts: 20
Incept: 2016-04-11

Tulsa
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Another great article on the current sad state of our health care fiasco! Just got back from spring break in Spain where socialized health care is only 9% of Spain's GDP. After being gone a week, my wife and I were suddenly VERY aware of the amount of obese people walking around in the US airports compared to Madrid and Barcelona. It takes being gone, and then coming back to it to really open your eyes.
The question on my mind, is how to bring Karl's insights to the attention of our local newspapers. I believe that all politics are to some extent "local" , and all political animals are only really beholden to their local constituents. The local newspapers are probably still the best venue for influencing local politicos.
(IMHO) While a regular reader of market-ticker.org "gets" it, casual readers, or those directed here by a link to a specific article, probably are not going to be swayed after a single visit. What is needed is a concise version of Karl's "greatest hits" on health insurance, that is reproducible in print media format, and is geared toward the reading comprehension and attentiveness of the average public. I would be willing to donate to a fund that would pay to place this as an "oped" in the wsj or similar paper which is read "locally" virtually everywhere in the US.
Tickerguy
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Here's another thought: Is the "routine" medical exam (absent some specific complaint you wish to discuss) worth anything at all?

Take the healthy young man or sexually-inactive (or monogamous and happily so) woman. Does a "routine physical" actually uncover anything, statistically-speaking? Or is it a waste of time and money?

Do we actually know that a $4 A1c and $3 metabolic panel would not be more effective in catching early-process disease than a $50, $100 or $200 office visit -- during which those tests are NOT routinely ordered, incidentally.

If medical records and trends are yours (you own them, you control them, period -- because you pay for said procedures out of your pocket and they're damn cheap) would that model be more or less-likely to catch something ugly before it gets you? I've seen zero evidence that the current way do this actually WORKS, statistically speaking. But it sure as hell is expensive.

Why do you need a "prescription" (doctor's order) to have any non-destructive, non-invasive test performed? Why can't you walk into a place and plunk down $2-4 for a metabolic panel or A1c? There's no risk from the procedure! Likewise for an MRI. You buy, you own the data produced. Period. There's an argument against this for anything involving radiation or drug exposure, of course -- but not for non-invasive, non-exposure related testing such as any sort of bodily-fluid test or, for that matter, MRI.

Speaking of radiation exposure, you know that X-ray in the list up there? Why are dental bite-wings materially more? The current technology is entirely-electronic, involves something like 1/100th of the rad exposure it used to and the "imaging device", being electronic, basically never wears out and requires no processing unlike film. In fact the rad exposure has sunk SO low that exposure rules no longer require the hygienist to wear a lead lab coat over their parts while taking them even though they still do hundreds of them a year. So why can't you buy your DENTAL series every year or whenever from a walk-in place on the corner and take the images with you, presenting to your dentist when he or she cleans your teeth? Gee, that would be cheaper (by a lot, given the above price), no? Uh huh. Maybe there'd only be one of those places within a half-hour's or hour's drive -- so would you drive an hour both ways to save $100? I would.

Can't cut costs 90% eh? BULL!

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Winding it down.
Jymm
Posts: 413
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Wisconsin
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That no so called political "Conservative commentators" have taken you up on your offer is no surprise. They are all shills for the Republican party, which seems unable to even get out of their own way. Eight years of Obamacare and they have no clue as to how to fix health care. They are still working on "health insurance", which will always, no matter what bills they pass, equal costs plus operating expenses. Cost going up equals insurance premiums going up. Not all that hard to understand, unless you are a congressman, senator or political commentator.
Zigmont
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Incept: 2017-03-26

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Hey Karl, thanks for all you do trying to inform people on this subject, just so you and your readers know Laura Ingraham has brought this subject up, earlier this month on Fox and Friends, I don't think they even understood what she was talking about, also this month she interviewed none other then HSS secretary Tom Price on her radio show, she asked about USC 15, antitrust, McCarran-Ferguson, collusion, calling the hospital for a price of a colonoscopy and getting no price, Price just stuttered with well, uh, yeah, well were looking at all those things, she also had Rand Paul on her show and asked about USC 15, he didn't even address it, just babbled about his great plan, if anyone is interested in her interview with Price its in her archives, March 7th, thanks again Karl, we need all the talk show people bringing this up.
Tickerguy
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Rand is trying to make it LEGAL!

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Winding it down.
Themortgagedude
Posts: 10244
Incept: 2007-12-17

saint louis
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So what if it's not 90% KD. Say it's only 53% or 48% savings. Everything still remains true in what you write here. And I think it's remarkably easy to make the case that it's at least half. I'm guessing it would be about 80% because you'd still have some graft and people would be so happy paying 20% of the prior amount they wouldn't even complain.

Oh wait - of course they wouldn't because they don't now.

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I think its time we ask ourselves if we still know the freedoms that our founding fathers intended for us. Ronald Reagan 1964
Als
Posts: 504
Incept: 2010-03-12

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This one got me, Tetanus booster: $20.

Last year I got up dated after 28 years, and was floored when the nurse rolled in and had me sign a waver that said if the insurance company didn't cover the TDap shot I would be billed $158. Are you kidding me? I knew my insurance would cover the vaccination since my Dr. is part of the same medical group my health insurance comes from but still.

I have to agree on the revolving door of PCP's. I walked out last year with a clean bill of health, and my Dr says I'll see you in six months. Try again lady I'll see you sometime in 2020. I never saw a PCP in 37 years and when I finally did they said I was in perfect health. Why would anyone want to see their Dr. once a year if they are not dealing with a medical issue? I feel every three to five years is often enough to stop in for a check up if you have never had an ongoing medical problem.

My Dentist offers a 10% discount for cash and my Vet offers a 5% discount for cash.
Themortgagedude
Posts: 10244
Incept: 2007-12-17

saint louis
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http://www.oftwominds.com/blogmar17/sick....

CHS take on the health care system

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I think its time we ask ourselves if we still know the freedoms that our founding fathers intended for us. Ronald Reagan 1964
Sean
Posts: 2883
Incept: 2009-04-21

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Quote:
my Vet offers a 5% discount for cash.


they have pet insurance???!!???

AND PEOPLE ACTUALLY PAY FOR IT!!




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GEN 5:32,GEN 7:6, 6/17/1689, 6/17/1789, 10/13/1917, 10/13/2017 (???)
Steve98765
Posts: 5
Incept: 2015-09-10

Detroit, MI
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I wonder if the reason that those political commentators wont touch this topic is that they get a lot of ad revenue from big phama
Dennisglover
Posts: 586
Incept: 2012-12-05

Huntsville, AL
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Al, the same kind of thing happened with me a couple of months ago. Some kind of foot problem resulted in me "dropping the toe" on every step, accompanied by annoying numbness in much of the lower leg and foot.

Orthopedist said she could see nothing wrong, but see this guy and get that thing.

Neurologist gave me the "shock the frog test" (long form), which was charming, to say the least. He says the nerve response and signaling from mid-spine downward on that side is just about better than perfect for a 65-year old, and etc. He also says to use the AFO (ankle foot "orthotic", the brace).

I go to get fitted for the brace, and that's fine, but the foot is working better already. At the fitting there's what I consider an odd exchange with Mr. Brace. He says he's got the prescription order ready, but I've got to agree to pay $260 myself, and "insurance" will be billed $1126, and if they deny any of it I get to pay it.

I tell him that's fine (Blue Cross/Blue Shield of Alabama has never denied anything they've been charged on my account), and it all seems well.

I wore the orthotic 13 days, and my physical therapist (who I consider to be an actual medical professional and a practitioner of the healing arts) told me to try getting around for a day without the brace. I haven't used it since then.

But the very strange thing was that someone, anyone, had discussed actual cost at any time during the process. That was practically surreal.

(Actual diagnosis: You have let that leg forget how to walk, so retrain it. That was the actual answer. Now that I have an awareness of what the exterior tibialis muscle is doing it's very much better.)

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TANSTAAFL
Bhami
Posts: 56
Incept: 2009-03-12

Salt Lake City, UT
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In fairness to Hannity, he has in fact recently and repeatedly described the concierge practice of Dr. Josh Umbehr, who charges the low prices similar to what Karl describes. http://www.hannity.com/articles/shows-47....
Fedwatcher
Posts: 1945
Incept: 2009-04-07

Southern California
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As long time readers of this blog, we all know the problems and the possible solutions.

However, we also know that politicians are blocking all possible solutions.

Both Democrats and Republicans are digging in their collective heels to block any possible solution.

Thus, the 'Crash and Burn' will come.


Winding it down.
Fedwatcher
Posts: 1945
Incept: 2009-04-07

Southern California
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PS:

I in no way am endorsing Trump's or Ryan's plan by my comment above, as they both stink to high heaven.

Politicians NEVER admit their mistakes, thus they cannot enforce existing anti-trust law nor existing laws against restraint of trade. This is in their DNA and why we need extreme TERM LIMITS.



Winding it down.
Dilbs
Posts: 70
Incept: 2011-04-19

Maryland
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I have the hardest time wrapping my head around the outright refusal to even talk about the root cause as you present it. I just don't get it since it is crystal clear. I have heard callers to radio shows get immediately shut down when getting even close to approaching the topic. The skeptic in me says it is because too many people are part of the system. It just pisses me off.

One point, when I put a straight edge to the chart, OCare didn't buy anything. It was a speed bump that was erased with acceleration. One way or another it all blows up soon. I would prefer it to be orderly, but it appears it won't be.
Tickerguy
Posts: 148437
Incept: 2007-06-26
A True American Patriot!
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Correct.

The other interesting thing is that Medicaid is EXTREMELY sensitive to recessions. It's not supposed to be, but it is. But the ugly is that smoothed Medicaid is actually growing slightly faster than Medicare, yet the common excuse everyone in the political class uses for the reason we are seeing such a crazy spend acceleration is "people are getting older and sicker."

Uh, maybe sicker, but not older -- or Medicare expansion would VASTLY outstrip Medicaid, and it doesn't.


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Winding it down.
Dilbs
Posts: 70
Incept: 2011-04-19

Maryland
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The fun, thought provoking, question that I pose is: Two customers are procuring the same service. One has insurance. The other is paying cash. The insurance customer requires significant additional labor in order to get payment. What service or value does the insurance company perform to the provider that results in a 80% discount over the cash customer? There is no right answer. Usually, I get a dumbstruck stare. Sometimes the answer will be that the insurance company negotiates for a better rate; I counter that the question is not answered. I guess I should say that there is a right answer, the providers and insurance companies are colluding to price fix against the consumer. Stupid me thought this was illegal.
Aztrader
Posts: 7750
Incept: 2007-09-10

Scottsdale, AZ
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Medicaid should be turned into a catastrophic care insurance and stop the countless millions going to the doctor or hospital for nothing illnesses. Take away that free 100% coverage and see how many people run to the doctor. Give them the same $5000 deductible the rest of us have and watch the dollars used shrink dramatically. These entitlements are killing us and forcing hard working Americans to pay more to support people that don't contribute. Trump is not going to run for a second term, so he needs to go balls to the wall and do what is necessary to fix things.
Nickdanger
Posts: 617
Incept: 2011-06-12

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Not only should Medicaid be turned into a catastrophic care benefit, folks on Medicaid should not be able to go the hospital emergency room for every little sniffle and sore throat. I was with my elderly aunt in the ER a few months ago, and it's amazing the number of people clogging up the works with non-emergency visits. I overheard the receptionist tell one of them that there was a 12-hour wait, probably to discourage them because evidently they can't turn them away. It wasn't working...

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Grammar: the difference between knowing your **** and knowing you're ****.
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