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2019-01-10 08:20 by Karl Denninger
in Health Reform , 184 references Ignore this thread
Yet More BeeESS!
[Comments enabled]

What's this nonsense?

Our current health care system is based on a fee-for-service (FFS) reimbursement model that rewards doctors for providing more treatments than necessary because payment is dependent on the quantity, not quality, of care.

Each time you visit the doctor’s office, consult a specialist, or stay in a hospital, you pay for every single test, treatment, or procedure, even though some of these services may be unnecessary.

These unnecessary tests and treatments have accounted for $200 billion annually and have been found to actually harm patients. That’s because the FFS system is volume-based, not necessarily value-based. Therefore, any increases in the volume of care equal increases in medical errors.

The article goes on to put forward a fundamental fact of the current health system in the US, which I've pointed out multiple times over the last 10+ years in this column: The system has incentives in it to not improve infection control and to actually give you complications because they can bill you for it.  Provided said can be considered an "accident" or "just part of the risk" you can't sue them (since it's not "malpractice") and you will get the bill.

One of the items cited in that article is blood-based infections that arise from central line insertions; a fairly common procedure.  The article points out that all of these infections are avoidable and that following a specific and reasonable checklist on said procedure has been shown to reduce the incidence of such infections to statistically zero.  Yet that hasn't happened on a national, mandatory basis.

Why not?

Because if you do get such an infection they bill you for the treatment and thus hospitals do not improve their standards because they make more money by not doing so.

If that happens to kill or severely injure you - tough crap for you.

But despite the (honest) accounting here there is not one word about the root cause of the problem with the medical system in the United States -- monopolist and other feloniously illegal practices that violate not just 15 USC Chapter 1 but also both federal and state deceptive practice (that is, consumer fraud) laws.

It is generally illegal to intentionally deceive someone by omission or commission in regard to any form of transaction where value is received.  The person with superior information and a claim of expertise generally has a common-law duty to disclose.  Two idiots transacting are perfectly free to do stupid things without liability but if you take advantage of an idiot while in a knowing superior position you can and should be hammered for it.

Yet neither state or federal law enforcement has gone after any of these *******s despite the laws on the books -- in some cases, specifically in the case of 15 USC Chapter 1 which outlines felony criminal violations of law, that have been valid for more than 100 years!

We overpay not a little but a crazy amount for medical care in the United States -- by five hundred percent on average and in many cases by thousands or even tens of thousands of percent.  In addition we spend upwards of a quarter trillion dollars a year catering to people's insatiable desire to stuff fast carbs down their pie hole and literally kill themselves instead of telling them to cut that crap out or get nothing.  If they did cut that out not only would we not need to spend the money all the bad things that later come to them, such as having your foot cut off or going blind wouldn't happen.

There are plenty of people who think this doesn't apply to them -- in fact, nearly everyone thinks it doesn't.  The less-well-off are on Medicaid, and think it doesn't apply to them.  The older are on Medicare, and think it doesn't apply to them.  The working middle class have employer paid health "insurance" and think it doesn't apply to them either.

They're all wrong.

If you're on Medicaid and reach 55 every dollar Medicaid spends on you can and will be clawed back from your estate when you die.  If you happen to live in one of the more "progressive" states that has capitated Medicaid plans you're not safe from this even if you use ZERO medical services since "capitated" plans assign you a fixed amount of liability irrespective of how much service you use.  This is typically in the $400-500/month range which means if you go from 55-65 (when you qualify for Medicare) in such a state there is a hidden lien on your estate for $60,000!  When you die the state will steal that from whatever's left, if there's that much left.  Got kids?  What do they think of this?

On Medicare?  That's nice.  By 2024 it runs out of reserves and by law cannot spend more than it takes in via taxes and has in reserves.  What percentage of current Medicare spending is paid in via taxes?  About 26%.  What do you think is going to happen when three quarters of what Medicare spends now becomes unfunded?  Under current law that cannot be spent at all; either a change in the law that will instantly blow up the budget deficit by close to three-quarters of a trillion dollars a year will have to be passed or 75% of all current benefits will disappear.  You can scream all you want about "I paid in and I'm owed it" but if the latter law change is attempted the odds of it instantly detonating the financial markets and spiking interest rates is very real.

On private insurance via your employer?  That's nice.  By 2024 when Medicare blows what do you think happens if the government or medical system tries to cost-shift Medicare and Medicaid onto private plans?  Your employer either drops coverage and you have zero or goes out of business trying to pay the 200%+ premium increase and you now have both zero coverage and no job.  May I remind you that while COBRA allows you to buy into whatever plan exists when you lose your job you have to pay the full price in cash and the reason you lost the coverage if your employer blew up is that those costs were something they couldn't pay!  Got $2,000+ a month for your family health insurance when that happens?  I hope so because that's what it costs now and it will be worse -- far worse -- in 2024.

What leads you to believe you won't get hosed by this America?  You will, no matter which of the above three buckets you're in, and the vast majority of Americans are in one of the three above categories.  It is a certainty that if we don't stop this crap everyone in those three buckets above is utterly and completely screwed.

All of this can be fixed and most of it doesn't even require new law.  It just requires enforcing existing law.

There are answers, in short.  I've outlined a potential legislative and policy path; a large part of it requires no new law, and the law it does require is relatively modest.  It would stop the scams immediately and in the process collapse prices by 80% for medical procedures, drugs and devices.  It would render Medicare and Medicaid virtually unnecessary, along with all but catastrophic insurance.  Said catastrophic insurance would drop in cost to the point that it would be a few hundred dollars per year, easily affordable for nearly everyone.

We're out of time on this folks -- the politicians need to hear loudly and clearly that the above proposal, or something virtually identical to it, is not only a requirement to keep their jobs in two years if they don't do it right here and now and as a result the fiscal situation in the nation goes down the toilet both they and all in the medical profession are going to be the first people held to account for the resulting collapse and death that will result -- and since at that point all resemblance of civility will be gone any expectation that such holding to account will have anything to do with what today is considered civilized norms and behavior has a high probability of going right out the window.

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Posts: 398
Incept: 2017-06-26

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Another good article, but nobody in Washington is going to do anything except promise more Marxist healthcare. And when the collapse happens the new face of healthcare, Alexandria Ocasio-Cortez, will just blame "the rich".

Get ready for more capitated everything! By that I mean get ready for more taxes, taxes, taxes, fees, fees, fees rght up your ass --- middle class.
Kellyf
Posts: 14
Incept: 2011-06-11

ONTARIO, CANADA
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My Canadian friend just spent one night in a Georgia hospital. She did not purchase travel insurance before leaving Canada. She asked for an itemized bill so she could submit it to our Ontario Hospitalization Insurance Plan. (OHIP)
They will pay an amount based on same service she would have had in Canada.
No way would they give her the breakdown of services she needs for home.
Aztrader
Posts: 8179
Incept: 2007-09-10

Scottsdale, AZ
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I had first hand experience with all this BS when I had an accident in mid 2017. My left hand was damaged in a bike accident and I needed the tendon repaired and skin grafts. After the initial surgeries to clean and prep the wound, they fixed the tendon and did the graft. The tendon didn't hold and I had the feeling they knew it wouldn't hold. In surgery 5, they went in and fixed it again, when in fact they should have done a transplant. I asked the surgeon several times before the first surgery if the tendon was still good and couldn't get a straight answer from him, so I went along with fixing it. That one broke too and I was really getting frustrated that these clowns didn't know what they were doing. After the 6th surgery, I went in because I thought I felt a stitch break and was right when they pulled the bandage. I small hole was where the stitch broke and I wanted it fixed. A substitute doctor was in the office and told the nurse to fill it with cotton and it will heal on it's own. I told him that the stitch needed replacing and he just walked out. The next day I saw my regular surgeon for an evaluation and told him that I was there the day before and what happened. When he pulled the bandage, there was a hole the size of a quarter where the stitch was. I would literally see my tendon moving within the hole and the doctor couldn't believe I had no pain. When he saw the hole, he completely freaked and told the nurse to arrange an emergency surgery that afternoon. He even told me to pick the hospital that was most convenient for me which they never do. I could see the fear in this guys eyes of possible sepsis and he wanted to get it fixed. Now he wanted to do a transplant and explained the procedure and it happened that night. What was really unusual was that the wound healed at three times the rate of the previous surgeries. My therapist even commented on this and never saw a wound seal that fast.
That made me wonder if they have procedures to speed up healing, but only use it in major emergencies...Like a possible lawsuit.
This was in October of 2017 and once January 1, 2018 came around and I found that a new deductible started, I never heard from these guys again. I could no longer see the therapist unless I wanted to pay the $85 co-pay on my policy per visit plus the $800 a month in premiums. I completely believe that a least a couple of these surgeries could have been avoided if the doctor had spent more time explaining things. I in fact completely agree with the article that they do as little to fix the problem so you have to keep coming back.

The math worked out like this: I pay $9600 a year in premiums, had a $5600 deductible to reach full coverage. It didn't include all the bandages and other BS I had to deal with while recovering. This is with a real policy that Obamacare destroyed due to their insane coverage requirements. How many people can fork out this kind of cash for an emergency like this?
Spence
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Aztrader wrote..
That made me wonder if they have procedures to speed up healing, but only use it in major emergencies...Like a possible lawsuit.


There is an expensive membrane they can apply made of human placental tissue that dramatically speeds healing. Might be what they used.

https://www.livescience.com/53563-human-....
Niti
Posts: 660
Incept: 2008-03-20

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Aztrader,

"That made me wonder if they have procedures to speed up healing..."

Yes there is!

Found it for ya....

"Alan Russell: The potential of regenerative medicine"

https://www.youtube.com/watch?v=tijEl8I3....




Tripseven
Posts: 111
Incept: 2012-04-26

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"There areplentyof people who think this doesn't apply to them --"

My veteran father on Tricare that ate and drank himself into the grave, and thought it didn't apply to him.

A fun little healthcare analogy:
https://www.libertarianism.org/building-....

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Please God, take it all away...we don't deserve what we have!

"I find medicine is the best of all trades, because whether you do any good or not, you still get your money." -Moliere "A Physician in Spite of Himself" 1664
Gmh
Posts: 49
Incept: 2008-10-05

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"How many people can fork out this kind of cash for an emergency like this?"

They can't, for much longer.

I'm no expert, but the way I see it is the decline will become expedited with an attempt at fully socialized medicine (if the Dems gain control of the Presidency and both Houses of Congress), health care rationing (except for the rich and powerful), then gradual (or not so gradual) collapse.

We can either take our medicine NOW, as Karl has argued, take a difficult (but hopefully brief) economic hit and rebuild our system, or we can continue to delay and face a guaranteed complete collapse of our health care system, our economy, and our country.
Jack_crabb
Posts: 5654
Incept: 2010-06-25

Peoples' Republik of Maryland
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My money, sadly, is on the latter, Gmh.

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Molon Labe
Where is Henry Bowman when you need him?
How many are willing to pledge this? We mutually pledge to each other our Lives, our Fortunes, and our Sacred Honor
Wa9jml
Posts: 302
Incept: 2017-04-29

DeKalb, Illinois
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The Federal Reserve has found out that most families would have to sell some of their belongings, or go into debt to meet a $400 emergency. I suspect that this is the main reason why people forego medical care, because they cannot afford to meet their deductible on ObamaCare policies. The parasites don't care because they get everything for "free", but not for much longer, I suspect. The whole rotten system is imploding.
Aztrader
Posts: 8179
Incept: 2007-09-10

Scottsdale, AZ
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The sad thing is that you have to come to a blog like this to get any real information. Google, FB and Apple are blocking the truth. No media won't cover it because it exposes the ACA for the crap it is. This cloud over the truth is getting darker every day. Today we saw the talking heads waiting for the Fed minutes to save their market. Everyone is getting more and more desperate for someone else to save them. The end is near.
Kareninca
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"In addition we spend upwards of a quarter trillion dollars a year catering to people's insatiable desire to stuff fast carbs down their pie hole and literally kill themselves instead of telling them to cut that crap out or get nothing. If they did cut that out not only would we not need to spend the money all the bad things that later come to them, such as having your foot cut off or going blind wouldn't happen."

Getting a foot cut off or going blind sounds wonderful compared with what is happening to my 56 y.o. brother. He has stage three cirrhosis of the liver due to obesity (not due to drinking). He has a 50 percent chance of surviving two years; a 30-40 percent chance of surviving five years, given that he already has ascites (abdominal fluids). He does have a hepatologist now, who is the head of a department that has a transplant center. So maybe they'll find him a liver. I would offer (you can donate part of your liver), but the donor needs to be bigger than or comparable to the recipient in size, and he is 6'2" and weighs 355 pounds and I am 5'4" and weigh 136 pounds. Also I am 55 y.o. and that is the typical cut-off for age, although some centers will go up to age 60 for donors. If you donate you will never be able to buy life insurance again, and never be able to buy health insurance again on a real market; it is major surgery.

He has good health insurance (for now) through his wife's work (she is a schoolteacher)(his health insurance as a college professor is actually not great it turns out). That would cover the surgery. But then there is the $3,000/month cost of the anti-rejection drugs, for the rest of your life. Insurance often doesn't cover that. We can afford it as a family - my mom has money, I have money (my brother and sister in law earn a lot but are broke naturally), at least as things are now. But when Medicare goes south, as Karl is saying, it will pull the other systems down with it. Maybe we could take him to India; you can get a transplant there for 60k; you have to bring your own donor, but I bet they wouldn't object to using my liver; what's it to them.
Mannfm11
Posts: 5461
Incept: 2009-02-28

DFW, Tx
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Well, we know Medicare is the left wing success story. How many Americans know it is this close to zero? This is a pretty good slice of salary over 40 years of work, when you can't get a dime paid before 65, unless you are on disability. Then, you still have to pay a premium and deductible and copay.

One question is this the reason there is a sudden scream from the left to have Medicare for all? Are they in a panic to shift the cost of Medicare to younger people thru more tax and more premiums to cover up what appears to be failure of epic proportions? How would socialism look to people, if a life funded plan blew to bits?

I wrote on my blog today, about the current impasse over the wall. Trump is claiming emergency and the idiots ask where. The damn thing has been an emergency for 20 years. It has merely spread out. Like 10 tons of **** spread around 100 acres with 10 ton loads coming daily. The politicians have been talking like they are together on this issue until time comes to do something. I think it is a partisan talking point issue to sell the 2 parties and neither has any intention of solving it. The government is loaded with such issues consisting of wars, trade policies, health care and so on. Of course we have the budget issue. I guess that's why so many women are showing up, as no one has balls in either of these houses.

I see these people speak. We could take the names of people attending a 100,000 capacity football crowd and draw 435 out of the drum for the house every 2 years and 33 for the Senate and not do worse than those that are elected. The Junior Senator from CA couldn't run an animal shelter. Ditto either from NY. These 2 states have a combined 60 million people.

The left wants government health care. Their programs screwed the system up to start. The system is a racket. If 5% of your lifetime income plus premium, deductible and copays can't pay health care for the rest of ones life, discounted, then something is wrong. For every person who drags on and on, there is one, like my Dad, who laid down and didn't wake up. Dad had a hospitalization for cellulitis and to the best of my knowledge, never tapped the system otherwise.

Democrats keep talking about this issue, like everything is okay and it's free. The truth is, if they get their way, I suspect it is going to impact the economic lives of people who rarely would use the system to the point many will get sick out of economic stress. Who gives a **** about health care, if it enslaves you? I don't believe there is 2 cents of difference between what they are pushing and peonage, that we are permanently contracted to labor for an industry without compensation and cannot ever pay our bills. Private and public peonage are against the law.

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The only function of economic forecasting is to make astrology look respectable.---John Kenneth Galbraith
Dennisglover
Posts: 1075
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Huntsville, AL
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I was 13 years old in 1965, the year the Medicare hearings and debates were held, and were widely reported in newspapers and on radio and television. Well do I remember thinking that the whole thing was part of an elaborate deceit whose end was to destroy the economy and the republic. At that time my state (Alabama) had two democrat senators (Sparkman and Hill, I believe), and an even split between democrat and republican congressmen (in my district it was Robert Jones-D)--every one of the congressmen voted in lock-step against passage of those Social Security amendments (which I found exceedingly odd); both senators voted "Yea".

But all the "old" people around me were pretty ecstatic that all of their health care was going to be "FREE" from then on. (Not really, granny.)

A couple of years ago I read every word of the 1935 Social Security testimony and debates. Might as well call it the "pie in the sky" act.

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TANSTAAFL
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