A One-Sentence Bill To Force The Health-Care Issue
The Market Ticker - Commentary on The Capital Markets
2017-06-23 11:35 by Karl Denninger
in Health Reform , 6139 references Ignore this thread
A One-Sentence Bill To Force The Health-Care Issue
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Here it is:

"Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof."

That's it.

One sentence.

If you want to add a penalty clause with it I propose the following:

"Any bill rendered to a person in excess of said amounts shall (1) be deemed void, with all services and goods provided as a gift without charge or taxable consequence to said consumer but not deductible by said physician or facility from any income or occupational tax and (2) is immediately due to the customer in the exact amount presented as liquidated damages for the fraud so-attempted."

It ends the "Chargemaster" ripoff game.

It ends the $150,000 snake bite or the $80,000 scorpion sting.

It ends the $500,000 cancer treatment.

It ends all of that, immediately and instantly.

I remind you that Medicare is required to set pay rates by law at a level that in fact are profitable -- that is, above cost by a modest amount -- for everything it covers.  Further, those pay rates are audited regularly to prove that they in fact are above cost.

Does this solve every problem?  No, and in fact that would leave alone the existing monopolistic pricing systems that many medical providers, whether they be drug makers, device makers, service providers or otherwise have in place.  It would do exactly nothing to get rid of the 10 paper pushers hired for every doctor or nurse, none of whom ever provide one second of care to an actual person through their entire time of employment.

But it would instantly end walking into an emergency room and getting hammered with a $50,000 bill for something that Medicare will pay $5,000 for.

I remind you that even quite poor people can manage to come up with $5,000 in a life-threatening emergency.  Sure, they might wind up paying 25% interest on the credit card, they might have to stop smoking their $5 pack/day cigs, and it might take them three or five years to pay it off, but they can probably do it.

It's not an answer to the problems the mediscam imposes on society, but it would sure as hell bring down costs for people instantly and permanently, and would make the decision to not carry insurance one that people could opt for while having a rational shot at paying cash -- at least for those in the middle class or better, for whom a $5,000 surprise would be bad, but bearable.

More to the point with the crazy deductibles today the $5,000 would actually buy care and eviscerate the insurance ripoff at the same time, because today you get to pay the $5,000 plus another $10k/year in "premiums" -- for exactly nothing.

This matters because most of the argument for so-called "health insurance" is actually about extortion -- either buy the product or be ruined with charges that are 5, 10 or even 100x what someone who has bought the product will pay.

Ending that will force health insurance companies to actually provide a product that is affordable and provides a reasonable set of benefits -- or people can simply stick up the finger and pay cash.

Pass that, which should take no more than 30 seconds to introduce and put on the floor of both the House and Senate and then we can debate this as a permanent solution.

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Analog
Posts: 1423
Incept: 2010-12-29

arkansas ozarks
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There you go, Karl, nicely done.

When i went on Medicare i was astonished how quickly providers get paid, and how little compared to my prior lush employer's 'self funded' plan.

Yes there's a structure already in place that makes all those paper pushers superfluous.

The insurance/med/pharma complex has captured the legislature though.

How everybody doesn't see that is astounding to me. Paul Krugman has brainwashed the yuppies, they think government is a good thing.

I mentioned it at breakfast on an Amtrak dining car with two other guys, one a financial planner type Krugman fan and the other a businessman. The finance guy was unaware of the term, the businessman explained it to him..

The finance guy recommended i read Krugman, I recommended he read "Leverage" .

a.

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Vernonb
Posts: 1817
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East of Sheol
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I hope the 'or else' forces racketeering charges, business snd personal property forfeiture, and 50 year minimum prison sentences of hard labor w/o possibilty of parole. These people should die in prison and their families put into the street.

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"Mass intelligence does not mean intelligent masses."
Tickerguy
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Oh that one's simple - the bill is void. 100%, period, the end.

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Winding it down.
Penguinzee
Posts: 356
Incept: 2010-06-13

Tampa Bay, FL
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throwing this out there-last I remember, each insurance company had its own claims forms that had to be filled out their way (part of the problem with all these admin people multiplying like rabbits...) What if everyone was forced to use the SAME FORM for processing claims-no variations, all the same coding, something that pretty much everyone could understand. I'd lay odds that would knock down the admin side of a hospital or practice by half, and nearly as much for the insurance companies. Win-Win for everyone but those redundant admin people...

If this is already being done, please disregard this post...

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Aztrader
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Scottsdale, AZ
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Absolutely. I am waiting for backup claims and will use this as my defense.
Vernonb
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East of Sheol
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Quote:
The bill is void


Good start. But you know these asses will resort to harassment in and out of legal system. The only good cockroach is dead cockroach. Do it once and its all over. None of this let's try this again to see what we can get away with doing.


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"Mass intelligence does not mean intelligent masses."
Tickerguy
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I'm perfectly ok with making the Public Service Announcement on this include a bag of charcoal and a big container of molasses-based BBQ sauce, with the clear implication that those two items will be used to COOK AND EAT any physician, pharmacy or hospital administrator that tries to bill otherwise.

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Tickerguy
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Ok, I added an (optional) penalty clause. That ought to be nasty enough.

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Oldno7
Posts: 2582
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RECALL STATE USA
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Karl you are starting to sound like a politician which might be a good thing. First offer a plan to fix the problem and then offer an alternate temporary solution to get them started in the right direction. I LIKE IT!

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IT'S THE SPENDING STUPID The US must become less a government of men, and more a government of LAW.When people lose everything and have nothing left to lose they lose it -Gerald Celente
Orionrising
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hmm that appears to be something that could be adapted at the state or even local level....
Tickerguy
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Quote:
hmm that appears to be something that could be adapted at the state or even local level....

Yep -- and enforced there too.

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Psmcd
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slc ut
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Karl, aside from the feeling I'm living in the twilight zone,I hope your one sentence bill proposal will ring the bell with my reasonably intelligent, logical friends, though I won't bet on it. Appears there's some exception when it comes to medical racketeering.

Personal note: my wife, as a pedestrian, was a hit and run victim in the parking lot at our neighborhood park 4/2/17. 5 days in hospital, 2 - 5+ hour surgeries for broken femur and both legs broken. Excellent trauma ortho but, on follow-up appointment we arrive, they remove the temp casts and apply walking boots though she could not walk. One month plus later we get the explanation of benefits from insurance and the doctor's bill. $495 each boot allowable against the $5k deductible. Calling to pay I tell the nice lady in my experience doctors are not permitted to profit from excess DME billing and told her we were not informed wife would need these boots we could buy for $170 each. Nice lady said she would reduce each to "$125 self pay" amount but doctor was allowed to bill whatever insurance would allow. Short for long story - ask for "self pay" amount.

Further personal note; we recently learned hit and run driver was physician/surgeon with privileges at both hospitals where wife was taken. Only 100k auto ins and no significant assets. Health insurance wants the 100k auto insurance as reimbursement. PI attorney withdrew for lack of funds. We'll continue through the rabbit hole to the twilight zone.


"Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof."
Tickerguy
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I would send said surgeon a bottle of the finest BBQ sauce you can find.

See if he figures it out.

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Tsherry
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Spokane WA
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>>I would send said surgeon a bottle of the finest BBQ sauce you can find.>>

I'd follow the SOB around with a full size, trailer mounted wood chipper.
Malaclypse
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Quote:
throwing this out there-last I remember, each insurance company had its own claims forms that had to be filled out their way (part of the problem with all these admin people multiplying like rabbits...) What if everyone was forced to use the SAME FORM for processing claims-no variations, all the same coding, something that pretty much everyone could understand. I'd lay odds that would knock down the admin side of a hospital or practice by half, and nearly as much for the insurance companies. Win-Win for everyone but those redundant admin people


Not far enough. Providers and insurers need to be left too impotent to resist market forces and competitive pricing. As of now they have all the power in pricing. The only good thing is all they can do is bankrupt us, no cement shoes or crowbars to our kneecaps.

It's been mentioned here before, but always remember that insurers are dealing with limited profit margins. My understanding is that's what the state regulators who have to approve premium increases are there for. Limited margin means the only way to increase their bottom line is to increase their cost. One uniform billing form should reduce hospital admin costs, but insurers won't like it. Where there's a will there's a way, and I'm confident they'd find a way to make their costs go up.
Tickerguy
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Correct -- insurers are typically limited to a 10% operating margin by state insurance law.

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Orionrising
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yep sooo to make more money insurance companies can A) compete in a fairly saturated market on price... or allow medical costs to increase.... ooopps
Tickerguy
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More like "force medical costs to increase"

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Aracoma
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Tuscaloosa, Alabama
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Its a start.....

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Midwest City doctor charged in overdose deaths of five patients
by Kyle Schwab Published: June 23, 2017 12:14 PM CDT Updated: June 23, 2017 7:18 PM CDT

http://newsok.com/article/5553968

A Midwest City doctor was charged Friday in the overdose deaths of five patients, accused in a murder case of unlawfully prescribing excessive amounts of prescription drugs to the victims.

Regan Ganoung Nichols, 57, is charged in Oklahoma County District Court with five counts of second-degree murder. Nichols, an osteopathic physician, is accused of prescribing controlled dangerous substances to patients without a legitimate medical need and in quantities and circumstances that disregarded human life.

She has been banned from prescribing drugs since 2015.

(snip rest)
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Jays
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Quote:
Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof.


Why include the words "while uninsured"? Shouldn't everyone, including those with insurance, get the same price?
Tickerguy
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Yes, they should, but here's the rub -- today, they don't.

Not only don't they but insured people often pay FAR MORE than Medicare patients do.

When it comes to physical commodities that's not legal if it has a substantial impact on competition, and forcing tied sales via extortion is one of the things prohibited under anti-trust law.

This ends that instantly.

It will immediately force "health insurance" companies to offer actual policies that have actual value in them for the people who buy, since the extortion element will INSTANTLY disappear.

A person who can choose to NOT buy insurance and simply pay the Medicare reimbursement out of pocket has just capped what an insurance company can steal from you. They CAN'T "negotiate" a price OVER Medicare's and then lard it up with 20% G&A costs PLUS their 10% operating profit (as allowed by regulators) since nobody will buy that product!

This one-sentence law will NOT fix the larded up system by itself, but it WILL bring instant price transparency, since the Medicare reimbursement codebook is NOT proprietary, and thus you now have a point of negotiation as a consumer.

It also brings, to a large degree, the medical system (as it relates to GOODS anyway) within the boundaries of Robinson-Patman -- which says that buyers of LIKE KIND AND QUANTITY cannot be discriminated against where market power exists -- that is, where the effect is to substantially lessen competition.

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Mannfm11
Posts: 5379
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DFW, Tx
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I haven't read much of this bill, but I think I understand it will force medicaid onto the states. One would only hope the states would push antitrust against the hospitals.

That said, this idea of Karl's would be about all we would need in a reform bill. They wouldn't even need to repeal Obamacare, except the penalties, only adjust the subsidies for the massive reduction in price.

Everyone should go to mises.org and read or listen to Albert Jay Nock's "Out Enemy the State". People will never understand government until they understand that government isn't your friend. There is a hospital in every Congressional district in the United States. Want to bet every Congressman in America isn't on the hospitals payroll in some form? The same holds true for insurance. You can bet SEIU or whatever that union is, doesn't put up big money. All would take a major hit, if we adopted Karl's idea. So would the cost of running for office. Of course, we would hear from all angles about the millions that would die from affordable health care, as the pill pushers own home media.

The $150k snake bite isn't a story. The chiropractor I see, her father was bitten by a copperhead. Bill was $200k. The anti venum is evidently only available on Mars.

When my mother was diagnosed with leukemia, I saw her Medicare bills. For those that have not looked at one, they show the amount billed and the amount paid. There is a wide gulf between some of the charges, like for installing a port to administer drugs. Mom could have paid the cost of treatment at the Medicare price and not suffered much, as she was not poor. The made up price would have been a large setback.

They can spend half a year investigating a made up story about Trump and the Russians hacking the election? We should have an investigation into the medical racket and the buying of Congress. I have a cousin, who lives in Austin and worked for a medical device maker. She was bitching about the NRA lobbying Congress, so I looked up what the NRA spent. Then I looked up the medical industry. One device maker spent something like 5 time what the NRA spent. I never heard another word out of her about the NRA.

I retweeted your link on Twitter. I also copied and pasted another tweet. People are so afraid of paying that they are willing to be looted through the back door. The mafia couldn't have designed a better system of extortion, if you gave them 100 years. We are being robbed at the point of a gun without the robbers facing penalties for the crime. Some people beg for free health care. There isn't any free, as we know and they will get cheap and lousy under socialized medicine. But, under the swamp system, we might only get lousy.


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Ckaminski
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Mass-Hole!
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Quote:
I have a cousin, who lives in Austin and worked for a medical device maker. She was bitching about the NRA lobbying Congress,


A Texan, bitching about the NRA? Must be from California...
Nevertoolate
Posts: 1322
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A True American Patriot!
San Antonio de Bexar de runover with illegals, Texas
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Austin is the 3rd coast. Full of liberals. The real problem is that they are ass deep from a Laredo-San Antonio-Houston line. Add in DFW and Austin and there's a bunch of them. In 5-10 years Texas will turn blue unless something major happens. There will be a state income tax and unless they wake up, Illinois south in 50 years. Thank goodness I will have been digested several times by worms when that happens.

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Democracy is a conversation between 2 wolves & a sheep discussing what's for dinner. A Constitutional Republic is found when the sheep pulls out a gun & makes clear that his 2nd Amendment Right will be exercised should the wolves attempt to hold such a "vote."-KD 9-29-15
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