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Ginnie
Posts: 2
Incept: 2017-04-03

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Mr. Denninger is the first voice I've found whose fix for healthcare is exactly what I've been saying to everyone who'll stand still long enough to hear. Pricing transparency and the same price for everyone along with freedom of choice. Medical care used to be affordable for the vast majority of people. I track the pricing craziness to when co-pays and HMO's started which allowed the true billing cost to be hidden.

I'm old enough to remember paying for a doctor's visit on the way out of the doctor's office (and knowing the price before I made the appointment). And then paying the total cost at the pharmacy if I had a prescription filled. I also remember calling different doctor's offices and pharmacies to check prices because there were differences. That meant the cost of office visits and drugs had to be low enough for most people to afford to write a check. That went a long way toward keeping prices sensible. My 80/20 plan with a deductible then required I submit paperwork with the bills and wait for reimbursement. Some antibiotics were so cheap I didn't even bother.

I have a son with an autoimmune disorder - the drug that keeps him in good health costs $4500 every 6 weeks. Most people think that means I'm all in for single-payer but I'm adamantly opposed. I've read the internet enough to know that the rosy stories from Europe are more fairy tale than truth. The best care for my son would be under a system with price transparency, no cost shifting that makes the drug $4500 in the U.S. and much cheaper elsewhere. I also want choice because that's how I find the really good doctors who can diagnose and treat with the best mix of reward vs. risk. I've been in enough doctor's offices to know the range of competence among MD's is vast. I had no idea that a mom with an internet connection could be more knowledgeable about drugs and treatments than practicing MDs but sadly I've found it to be all too common.

Fear is what's holding this country back from torches and pitchforks. People think they'll die without their little, pricey pill when what they really need is to lose 20 pounds and go for a walk. Or, in my son's case, without insurance they'll be unable to afford the drug that gives them a quality life. Nobody is asking why things cost what they cost even when they see they've just been billed $20 for an aspirin.

This country is in a dreadful mess and most people advocate making it worse. We need to hand people their lives back and tell them to wise up and start making their own decisions. I'm dismayed by how many people don't want to do that.
Joeykins
Posts: 4
Incept: 2017-04-03

Columbus, OH
Banned
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I used to read the ticker regularly some years back. I've recently come back, curious to know how you are processing current events. I think that the topic on which you're now spending most of your energy is critical. On the whole, I agree with the vast majority of your commentary. I have some reservations that seem important to me. But rather than launch into points of contention (if ever I do), I wanted to share something that could be valuable. Are you aware of this pending (and contested law) in my home state of Ohio?

http://thehealthcareblog.com/blog/2017/0....

This is aiming at a central tenants of your proposals: price transparency. It's interesting how it is being lobbied against.
Tickerguy
Posts: 148437
Incept: 2007-06-26
A True American Patriot!
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Why doesn't Jim ask where the anti-trust charges are out of the Ohio AG?

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Winding it down.
Thorvold
Posts: 181
Incept: 2013-09-12

NY
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"I am curious who came up with this medical billing system - a mobster in the Federal prison system or the mobsters elected to congress?" Vernonb

The Rosenthal NYT article details coding history. Legitimate coding to track disease evolved over time to this:

"Individual doctors have complained bitterly about the increasing complexity of coding and the expensive necessity of hiring their own professional coders and billers or paying a billing consultant. But they have received little support from the medical establishment, which has largely ignored the protests. And perhaps for good reason: The American Medical Association owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the associations biggest single source of income."
Tickerguy
Posts: 148437
Incept: 2007-06-26
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And when the Architects tried this sort of crap the government sued them under Anti-Trust and forced them to cut that crap out.

Where is the ENFORCEMENT against the AMA? If there isn't going to be any then at what point will the torches and pitchforks come out?

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Vernonb
Posts: 1759
Incept: 2009-06-03

East of Sheol
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Quote:
The American Medical Association owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the associations biggest single source of income."

Good God. The largest medical political lobby in the country (AMA) owns the rights to the codes and are enforcing a monopoly because they had laws passed prohibiting other system. Now what few INDIVIDUALS are getting rich from this system at the top of the fraud/monopoly pyramid?

It's past the time for pitchforks, fire, and a firing squad.

http://www.anh-usa.org/who-does-the-amer....

Of course there is no published list for the PUBLIC to easily verify the billing for when some obscure code shows up. It's just more ways to hide the fraud. You have to register on the AMA website to get it I am told.

Thanks Thorvold


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"Mass intelligence does not mean intelligent masses."
Tickerguy
Posts: 148437
Incept: 2007-06-26
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BTW, if you think my "enforce 15 USC against everyone involved" was an accident.. no, it was not.

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Lobo
Posts: 366
Incept: 2013-12-25

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A recent Gallup survey gives an interesting perspective on the issues of greatest concern based on household income. http://www.gallup.com/poll/207521/worry-....

Summarizing the top issues for the three income categories:
Less than $30k
1. Hunger/Homelessness (67%)
2. Crime/Violence (65%)
3. Healthcare (62%)

$30k to $74.9k
1. Healthcare (60%)
2. Economy (54%)
3. Crime/Violence (52%)

$75k+
1. Healthcare (49%)
2. Budget deficit (46%)
3. Economy (44%)

There are several interesting things that can be pulled from the results. First, Trinityalpsgal, I note that healthcare is in the top 3 for all income groups, so any document explaining Karl's bill will hit that concern. Second, any explanation that shows how households will end up with more money due to the drop in costs will address the number 1 concern for the under $30k households. The economy would suffer short term, but the end result would be much better. (Would it be possible to tie up the Fed and stuff them in a closet for a couple years to keep them from "managing" the economy during that time?)

About the only thing that the bill wouldn't directly address is crime/violence. Short term, that, too, would probably get worse.

Changing topics, I went looking for more glucose test strips on Amazon and couldn't find them for my meter (True Result). A little internet searching revealed that the meter had been discontinued due to inaccuracy. Any recommendations for a new meter?

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Village Idiot
Tickerguy
Posts: 148437
Incept: 2007-06-26
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I have the ReliON Ultima which has individually wrapped strips. Good for the person who isn't diabetic and this uses them more rarely.

All the meters that have strips in a "bottle" have the same basic issue - the reagents start to decay with exposure to air. This impacts accuracy over time, possibly severely. If you're diabetic and using 3-5+ of them a day, no big deal as the bottle is gone in a couple of weeks. If, on the other hand, you use it once every few MONTHS, well....

Thus you want individually-wrapped strips so they're sealed until use.

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Winding it down.

Lobo
Posts: 366
Incept: 2013-12-25

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Dennisglover, I'll help. Not too good with written communication any more (you don't use it, you lose it), but I'll give it a shot.

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Village Idiot
Tickerguy
Posts: 148437
Incept: 2007-06-26
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Updated to require publication of outcomes and complication rates.

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Trinityalpsgal
Posts: 25
Incept: 2017-03-30

Weaverville, CA
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Interesting how this subject is bringing more newcomers to the site.

@Ginnie - Yes, fear is driving us off the cliff. It is a convenient weapon of choice for our masters who do not want us to find our Way. Personal responsibility is our weapon of choice - it will take us far on the road ahead. Of course ditto for a 20 lb. weight loss and a walk!

@DennisGlover - I will join you.

@Lobo - the survey confirms what we know to be true. Everyone is impacted! Happy to work with you and Dennis.
Dennisglover
Posts: 586
Incept: 2012-12-05

Huntsville, AL
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All right, Susan Marie and Dave (Trinityalpsgal and Lobo), here we go, then. I am honored and gratified that you have responded. Once again, as I reflected on November 9, 2017, I say, "We have got a chance now, and we didn't have it before. It's time to pick up the plow and not lay it down. Let's Roll!"

That's my first observation. The first question comes next: What's the best way to communicate? I think that we should avoid social media (which I don't use) and "free email" accounts. If the inter-user email on here works, I'd say I trust Karl's security sense more than I do just about anyone's. If that doesn't work, then I could set up a small number of emails on my domain, which is now paid for until mid-2019, and would gladly do so. Of course, my email service is in fact "in the cloud", hosted in Phoenix on a shared server farm, and that could be less than the best, but I prefer not to pay for a dedicated server, so there it is, for good or for ill.

So, what say you? My email address is simply dennis@dennisglover.com, and I can set up a filter to segregate your mail from the general flow of stuff I get every day; that's easy. Please voice your concerns at your convenience. We need to trust each other if we're going to be saying things that make sense and telling each other where we're going blindly and stupidly wrong (believe me, I can do that!), and if we're going to be encouraging each other, too.

You might read some or all of my existing blog posts (few as they are), at https://dennisglover.com/wordpress/ and try to figure out how my mind "operates". I have 17 published and 21 in draft. There is a way to grant collaboration-type access to verified email addresses, and if you wish to join me in collaborating on the piece I started on April 1, "The Bezzle Has Been Bizzle", maybe we could follow through with that. Please tell me what you think, about any idea I might offer! Don't hold anything back; I'm not so big a fellow as I used to be (thanks to HFLCMP, Karl, a stubbornness that leaves doubt as to that attributed to the lowly but amazing mule, and a lot of encouragement), but I'm plenty old.

You two have kindly offered, so I can only reply in like fashion, and do say that to have that kind of affirmation is indeed a very good thing. So let's carry it forward, please, and with all needed haste. If you're "aboard" the Good Ship Lollypop, then let's a-weigh some anchor and get under sail or steam!

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TANSTAAFL
Dennisglover
Posts: 586
Incept: 2012-12-05

Huntsville, AL
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Ginnie/Jaye,

You write with an impassioned voice borne of experience, observation, reflection, and decision. Those are the ways we learn to know, and to grow, and they're the ways to make a "still, small voice" heard. We must listen and attend to the opposition's voice, simply so that we know and understand that to which we are opposed.

You, in your very first post here, have struck a chord, and I'll bet it's not only in me. (I'm a musician, among other things, so chords are kind of important.) I think you have proven, by speaking, that you are ready to speak, and I thank you for the forthrightness and honesty. Whatever you do, keep on doing it!

Trinityalpsgal (Susan Marie) and Lobo have offered to join me in the battle, and I'm no natural leader, but I welcome their offer, and will go to the mat on account of it. I sense that you are ready to "let it all hang out", and wish so to do. You are welcome to join in, as well.

I remember a fellow named Todd Beamer, who on September 11, 2001, uttered two immortal words aboard a hijacked airplane over a field in Western Pennsylvania. The result only accelerated the assured death of all aboard, but possibly prevented many more deaths further to the East.

Those words were, "Let's roll."

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TANSTAAFL
Keenan
Posts: 247
Incept: 2013-01-11

Western PA
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Dennisglover:

We can use something succinct, like this graphic to make the point:
https://pbs.twimg.com/media/C8QUFzFVwAEy....

Wonder what that hip would cost in India given their $1800
price for cardiac surgery as described by Robert Pearl, MD here:
https://www.usatoday.com/story/opinion/2....

Might he be an advocate to get KD's ideas into the national conversation ?
https://mobile.twitter.com/i/nojs_router....


Trinityalpsgal
Posts: 25
Incept: 2017-03-30

Weaverville, CA
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@DennisGlover
@LOBO

Moving our discussion off line for initial organization. Will email Dennis here shortly.

@Keenan - yes on visuals. We will have it all consistently branded and cross-referenced so Advocates can clearly find their source.


Tickerguy
Posts: 148437
Incept: 2007-06-26
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Implementation ticker is up.

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Joeykins
Posts: 4
Incept: 2017-04-03

Columbus, OH
Banned
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Quote:
Why doesn't Jim ask where the anti-trust charges are out of the Ohio AG?


I don't personally know Jim, so I guess that I can't say. If I get involved in this issue, I may ask him. I also wonder if you're interested in getting involved in more local efforts such as this. More to follow on that...

I appreciate your reasoning that many health industry practices appear to violate the logical interpretation of existing laws. However, my non-professional take on law is that custom establishes law as much or more than logical reasoning. A law that fails to be established, whether generally or in a specific setting (such as is the case in the current matter), ceases to be law. One approach: we can address the situation by reviving the previous law. Another approach: I think that it is reasonable to proceed with establishing new laws that more specifically address issues that have been neglected by previous laws (whether in their logical formation or their enforcement).

On the matter of my question to whether you would get involved in a state issue such as Ohio's pending law: my perception is that you appear fixated on solving issues on a national level. And I get it. These are national issues. Yet you also appear to share my skepticism that the federal government is too corrupt and dysfunctional to act on any real solutions.

So there is a practical consideration. Maybe state governments are more amenable to creating and enforcing common-sense laws. Or more local: municipalities or even non-government community movements could act effectively. Imagine if a community joined together to pressure their doctors to quote prices prior to services. Could that serve as a model to be replicated elsewhere on a grass-roots level?

I intend to play a small role in this kind of grass-roots effort. As background: a doctor recently recommend some ENT procedures for my daughter. He played the victim that his group's out-patient surgical facility recently dropped out of network. He further quoted some (ultimately bogus) numbers about hospital surgical costs to pressure me to pay cash to his group's facility. You can imagine the hoops that I had to jump through to learn that the estimated out-of-pocket cost of his facility would be $5000. For him to do the surgery at a hospital: $1400. I found a physician who can do the procedure at an out-patient facility that remains in network. Cost: $400.

I plan to return to this doctor and tell him that I hold him accountable for his role in these troubles. He is NOT a victim. I accept that solutions do go beyond just his efforts. But I hold him responsible to work to fix his practice. Of course, he has irrevocably lost my business...

Karl, I also believe that there are ethical considerations to promoting changes from more local level. The federal government WILL do us harm far beyond what I've seen you envision. To accept the false premise that solutions MUST be imposed at the national level is to fail to check the destructive mechanisms that the United States and other world governments are wont to take to cover up the deleveraging that we all know MUST happen.

I hope that my local versus national prompting isn't too far off topic. I do respect the work that you do. At the risk of going even more off topic and taking kind of a philosophical approach, I believe that it comes down to enforcing market mechanisms at macro levels (national, global) while recovering more socialistic attitudes within our communities. More concretely connecting to your ideas: I believe that the federal government tax lien idea, if it could be implemented, would be counter to your aims. It would dilute the market-price signal of medical pricing. I would much rather see communities step in to assist individuals who are unable to succeed in the market.

Again, I love the thinking and passion that you put to these issues. I don't mean to be presumptuous to suggest a change to the focus of your message. I'll continue to be an interested reader if you retain the same message and focus that you've been on.
Tickerguy
Posts: 148437
Incept: 2007-06-26
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Quote:
More concretely connecting to your ideas: I believe that the federal government tax lien idea, if it could be implemented, would be counter to your aims. It would dilute the market-price signal of medical pricing. I would much rather see communities step in to assist individuals who are unable to succeed in the market.

No it won't because in the implementation section you will see that any provider that bills more than 50% of its dollar volume via Treasury is instantly subject to audit.

You HAVE TO provide some means for the indigent to get care or you'll never get anything other than Single Payer passed. That's reality whether you like it or not. And there ARE places in the country that have EXTREMELY high levels of indigence when it comes to medical care payment ability. To deny that is to deny reality and if you deny reality you go nowhere.

Thus you need both a way to address that AND a way to prevent it from being gamed. If you don't do BOTH then either we fail to fix anything (because the fraud will continue in those areas) OR every provider in those areas closes and now the poor have no care at all. Neither will pass and both WILL be seized upon by the opponents of reform.

The bill fixes both issues; implementation resolves the fraud problem (note that the Bill specifically DEMANDS -- not allows -- prosecution for bilking Treasury and makes same a criminal FELONY with mandatory prison times) so you wind up with plenty of doctors and hospitals in those areas but none of them can screw either customers or the public. None of these folks are going to keep their current crap up when the penalty for doing so is hard federal prison time.

I have no quarrel with efforts at the state level but it has to come with enforcement, not just claims. Note that Rand Paul is trying to get an explicit anti-trust EXEMPTION into federal law for providers AND insurance companies. He has published his framework bill and it includes that explicit provision. He's doing this because he KNOWS there are two USSC cases that have already held that 100+ year old law APPLIES to these firms. The need to focus on the Federal side is extreme because if that provision makes it into federal law the game is irretrievably over due to the Commerce Clause; any attempt to enforce a state mandate will be ruled AGAINST in federal court and since the Statute will EXPLICITLY protect the conduct of the providers they will win all the way up to the USSC.

This fight MUST be at the Federal Level without dilution because a loss of anti-trust prohibitions on this industry will be impossible to rectify EXCEPT by violence, exactly as the 17th Amendment was. The 17th Amendment was a grave mistake, and central to its gravity is that it cannot be repealed since the Senate would have to vote themselves out of a job to do so and that will never happen.

There are, occasionally, "poison pill" laws and amendments that cannot be fixed once enacted EXCEPT through violent revolution. The 17th is one of those and it has had terrible consequences. If we allow an anti-trust exemption for the health industry into the law at the federal level then our children are utterly and absolutely rat****ed as within the next decade Medicare and Medicaid will be spending roughly $3.5 trillion a year -- an impossible amount as that is roughly equal to the ENTIRE current Federal Budget. Long before we get there will economy, markets and government will collapse -- the odds that such collapse will be violent and involve the death of 20% or more of the population of the country approach 100%.

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Joeykins
Posts: 4
Incept: 2017-04-03

Columbus, OH
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Quote:
No it won't because in the implementation section you will see that any provider that bills more than 50% of its dollar volume via Treasury is instantly subject to audit.

You're suggesting a bureaucratic function to enforce "fair" prices. While it would certainly serve to police egregious cases of fraud, I doubt that you could move me from the opinion that it would provide a kind of subsidy that would tend to increase prices. I get that it is your concession to the critical problem of how to care for the indigent. I acknowledge that there are choices to be made among imperfect solutions. Rather than forecast the impact of any particular solution, allow me to propose some other approaches:

1. Directly address issues of the source of poverty. Most solutions are reactive. There are things to do to improve the lot of the poor, many of which are done to some extent. A neglected topic is to understand and fix why so much wealth is diverted to the financial sector. This category, in my opinion, is the most fruitful long-term. As interesting as it could be, I'm sure we can agree that it's no quick fix.

2. Encourage informal institutions to care for the indigent. Again, this is certainly not a quick fix. If we don't actually care about the poor, this approach results in some of them dying. In the long-run, it would be the cheapest if we survive the resulting class wars. (I'm speaking tongue-in-cheek; in the long-run I really do wish that we could move this direction.)

3. If a top-down government mandate must be made, how about this: back-stop funding is to be provided by the smallest government entity possible. Cities and municipalities must demonstrate financial inability to provide the back-stop before appealing to counties. Counties must do the same before appealing to states. And you get the same deal with states appealing to the federal government.

#3 could be effectively accomplished by restructuring Medicaid to require states to adopt this bottom-up approach in order to receive any funding at all. States that prefer to do a state-level top-down back-stop or no back-stop at all, of course, could simply fail to qualify for federal funding. However they're established, I believe that institutions will be more effective to control costs and needs when they are as close as possible to the people that they serve.

Regarding some of the considerations to why you insist that solutions must be imposed at the federal level, I need to continue to educate myself and will listen. I don't doubt that there are points at which the federal government must cooperate and/or acquiesce to achieve fully consistent solutions. But I still believe that the best solutions come from the bottom-up. Fortunately, there is nothing to stop me from putting my efforts into those local solutions while you continue your voice aimed at the top.
Tickerguy
Posts: 148437
Incept: 2007-06-26
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Quote:
You're suggesting a bureaucratic function to enforce "fair" prices. While it would certainly serve to police egregious cases of fraud, I doubt that you could move me from the opinion that it would provide a kind of subsidy that would tend to increase prices.

I'm about to run out of patience because you are demonstrating what has gotten a few hundred people banned over a decade of writing here: Intentionally ignoring the text in the post in question, claiming it doesn't exist by omission.

Well, it DOES exist. It exists in multiple forms:

Quote:
Any medical provider who attempts to bill any service or product above that price to a person in exigent circumstances forfeits 100% of their invoice and is guilty of consumer fraud.

Quote:
All anti-trust and consumer protection laws shall be enforced against all medically-related firms and any claimed exemptions for health-related firms in relationship to same are hereby deemed void; for private actions all such violations proved up in court are entitled to treble damages plus a $50,000 statutory civil penalty per impacted person.

and finally
Quote:
7. Any provider of service that falsifies billing under this section, bills at inflated prices or otherwise violates the provisions of this law in regard to any bill submitted to the US Treasury for payment shall be deemed guilty of a criminal felony for which the punishment shall be the forfeiture of three times the billed amount and each individual who has caused such an invoice to be issued, transmitted or otherwise participated in same shall be subject to a fine of not less than $1,000 nor more than $10,000 and imprisonment of not less than 2 and not more than 5 years. Each fraudulent invoice shall constitute a separate and distinct offense, all penalties shall be consecutive and additive, and liability for same shall be joint and several.

Between these three clauses what you claim will happen simply won't. Why? Because the civil remedy for PRIVATE actions makes it so lucrative in the civil litigation area that anyone who gets ****ed like this AND IS POOR will (from their point of view) win the lottery. Not only do they get THREE TIMES the inflated bill they ALSO get $50 large.

This guarantees there will be plenty of attorneys willing to take such cases on contingency, and even with them collecting the customary 20% for doing so the person who is poor and has this done to them will gain anywhere from $30,000 to $100k+ simply because some doctor or clinic did that.

In short it won't happen and there will be no "bureaucratic" solution required - the market and private civil litigation threat will take care of it.

This site always entertains legitimate and honest debate. Dishonest tactics reliably lead to immediate and irrevocable ban-hammer use. You may consider this fair warning and I expect either an honest and debate-based rebuttal to those THREE anti-fraud provisions OR a blanket retraction of your claims.

You choose.

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Susanjbear
Posts: 777
Incept: 2010-06-10

Salt Lake City, Utah
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Printing this out and mailing to certain persons.

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Susan
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