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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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