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2017-01-24 12:41 by Karl Denninger
in Health Reform , 686 references
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This is truly ugly stuff folks.

This is the "Obamacare" repeal and replace option that is being peddled in the Senate.

I've read it.

Let me summarize:

  • For states that wish to keep Obamacare, they can.

  • For states that do not wish to keep Obamacare, they can "opt out."

  • The underlying "replacement" is a ROTH HSA, which is the same basic mechanism of a ROTH IRA except that spending is restricted to "authorized" health care services (including health insurance.)  All other withdrawals are subject to tax (10%) penalties (much like unauthorized withdrawals from a traditional IRA.)

  • States that opt out can create their own standards for what constitutes a "legitimate" health insurance plan.  This means that plans which are more or less-restrictive than Obamacare policies are authorized in such states and count.  So if you don't want a policy that covers pregnancy, for example, you don't have to buy one.  If you object to contraception, provided your state allows it, you can buy a policy that doesn't cover that.  And so on.  Note that none of this would ban a company from offering a coverage and states could require whatever they want.

  • For states that opt out if you fail to maintain continuous coverage you can be penalized, including being denied entirely due to medical underwriting and it imposes a mandatory penalty (tax) to be paid to Treasury for your refusal to buy a policy if you come back in the future, even if you are healthy.  If you maintain continual coverage, however, you cannot be denied nor medically underwritten.  This changes the Obamacare requirement by effectively closing the "wait until get very sick, then apply" game but includes a cute "**** you" for those people who opt out, then decide to come back but are not trying to game the system by buying only when sick.  In many ways this is worse than the "individual mandate" in that the penalty is on the back end and is not imposed only on those who game the system.

  • For states that opt out they can default you into a ROTH HSA, which may or may not obtain a subsidy.  You can opt out but you will have to do so explicitly.

  • Subsidies are deposited directly into consumer HSAs, not to the state general funds (or otherwise) and are adjusted for local conditions (as is the case for existing PPACA subsidies, and in a very similar manner.)

  • Subsidies phase out for MAGI over $90,000 for individuals, and $150,000 for joint returns.  Married-filing-separate has a ZERO subsidy -- if you're married, you must file joint to get subsidies.  This is a large increase in subsidy phase-out income levels and means that basically anyone in a state that opts out of Obamacare will have full subsidies available up to MAGI $90k.  Note that MAGI includes tax-exempt interest and similar income; this is potentially very important for those with substantial non-wage income (as is the case for Obamacare now.)

  • Imposes a $25,000 penalty per-instance on medical providers who attempt to bill out-of-network charges in emergency circumstances only.  However, it does not bar the practice or impose any criminal penalty for this act of financial rape, which means that the effect of this provision is that you'll still get raped and the hospital will add $25,000 to the******amount so as to pay the fine with it!  If you think this means the "out of network" emergency problem will get worse YOU ARE RIGHT, IT WILL GET WORSE AND IN A VERY, VERY SEVERE WAY FOR MODEST ISSUES.  $25,000 isn't much additional screwing on a $500,000 bill.  It is a very large additional screwing on a $20,000 bill!

  • Allegedly "requires" providers to post prices in a way the HHS Secretary directs.  However, there is no penalty for failure to do so, nor is there any penalty for refusing to honor a quoted price.

There are other technical changes, such as specifying that paying a fee for concierge care (e.g. flat fee per month for access, etc) is a legitimate HSA expense, along with specifying limitations and parameters for the ROTH HSAs (which generally appear to be reasonable.)

There is exactly zero in this bill that addresses:

  • The cost of medical care.  Nowhere is there a penalty for failure to disclose prices or to actually bill at the claimed price.  There is no requirement that "what you post as a price is what everyone pays", there is no sanction on the provider for failure to quote a true price, to bill at the quoted price, or if they discriminate for or against any particular person.  The "requirement" to post prices is a dead letter as it carries zero penalty.

  • For out-of-network emergencies the bill imposes a $25,000 fine on the provider if they bill materially above either Medicare or "Usual and Customary" prices.  However, nothing prevents the facility from actually issuing or collecting that outrageously-escalated billing -- such is not deemed an unlawful practice and is not barred, in any way restricted nor is any criminal penalty imposed.  This means that the existing problem of out-of-network emergency care, say if you have a heart attack while in another state, will actually be made worse as the facility will be able to simply add the $25,000 fine to the financial assrape that they are already imposing on you.   The bill also does nothing about the (very common) practice of an out-of-network person appearing in your room when you are in-network and then billing you for an out-of-network event. The "fine", which you will be forced to pay, only applies to emergency circumstances.  If you've been admitted and are stable and Mr. Out-of-Network Doc sticks his head in your room you're still ****ed.

  • The bill does not eliminate the penalty for not having insurance.  In fact it makes it worse than Obamacare in many instances.  It contains no income exemptions for not having insurance (Obamacare does) and a new set of "screw you" provisions.  Specifically, if you're young, healthy and poor but making it on your own and choose to opt out of buying insurance you will pay no penalty at that time.  But, if and when you decide to buy health insurance in the future you will get penalized on the back end statutorily, even if you are still healthy at the time (in other words you didn't game the system, you just refused to buy something you didn't need!)  For people who are both healthy and in the lower income strata (think young people folks) this will be a rude surprise that will go right up their poop chute when they decide a few years down the road to get married and start a family -- right about the time that buying insurance as a preventative act makes sense.

  • The bill is completely silent on the rank violations of existing anti-trust law found in 15 USC; specifically, Sherman, Clayton and Robinson-Patman.  An earlier revision (2015) of this text at least attempted to clarify some aspects of Mccarran-Ferguson which bears on insurance companies -- this one is silent on the same matter.  Specifically there is nothing barring collusion between providers, price-fixing (whether overt or otherwise), differential billing based on your wealth, form of payment or for that matter whether you have red hair and other similar abuses, all of which are the very form and function of the existing medical financial rape-room circus served upon the American public.

As such this bill, proffered as a "replacement" for Obamacare, might well fit this description:

It is a Congressionally-imposed financial******room that in many ways is worse than the existing Obamacare system, and has no material positive changes evident with one exception: It increases the MAGI (substantially) that a person or couple may earn without losing their giveaway.

It does nothing to decrease costs, it contains no penalties that bar the imposition of excessive charges for out-of-network emergency services (or any other out-of-network charge which you might not be able to refuse or even know occurred until after the fact); a provider fined for trying to bill you said excessive charge can simply add that to your bill and thus force you to pay their fine, and it contains hidden back-door taxes imposed on anyone who tries to opt out of the insurance and medical scam entirely, even if they are healthy the entire time and thus did not either intend to or actually game the system.

**** you Mr. Cassidy, **** you Ms. Collins, Mrs. Capito and Mr. Isakson, **** you Mitch McConnell and the entire remaining leadership in the Senate and House and finally, **** you Donald Trump.

Oh by the way, **** you Larry Kudlow, who is once again talking "free markets" on CNBS as an "unofficial" Trump carnival barker while in fact the GOP and Donald Trump are protecting monopolists even further and screwing you even harder.


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2017-01-23 11:34 by Karl Denninger
in Federal Government , 1169 references
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To those who said that I should "sit and wait" -- or "trust Trump" -- I reply that my distrust, and the indications that were visible in the changes made in the transition web page regarding medical and Obamacare .vs. what was on his campaign site, were both well-placed.

Kellyanne Conway, a counselor to Trump, told NBC News's Sunday Today with Willie Geist, that the health care law that will replace Obamacare will turn Medicaid — a joint state-federal health insurance program for the poor — into a block grant program. The change would mean the federal government would give money to the states to implement Medicaid as they see fit.

"Those who are closest to the people in need will be administering it," Conway said in the interview, which was recorded the Thursday and Sunday. "You really cut out the fraud, waste and abuse, and you get the help directly to them."

I go back to what I have repeatedly pointed out in this regard, most-recently right here:

If Medicaid is block-granted to the states then the states will have a fixed pile of money "given" to them but the mandate for Medicaid will continue and with a ~9% acceleration in cost not matched by the block grant every single state budget will detonate within five to ten years.

and here:

Therefore you have somewhere between three and five years before it all goes to hell.  Trump might buy a year or two with various changes to Health Care, such as block-granting Medicaid.  If he does that, by the way, the result will be a couple of million people who die first, then it will go to Hell.  Vouchers for Medicare will destroy the system entirely, but before they do they will kill millions more who are dependent on continual medical care, all Seniors.

And now we know he intends to do at least the first part of it (Medicaid block grants.)

There has not been one mention, anywhere, about enforcing long-existing law, 15 United States Code, against any portion of the medical industry -- not hospitals, not pharma, not the educational "process" (intentionally expanded in both cost and restricted in supply by the AMA, which is a violation as well) and more.


Folks, all the other stuff sounds great.  Trade reform -- a good idea.  Blowing ISIS to Hell -- a good idea.  Fixing our broken immigration system and enforcing the law in that regard -- a good idea.  A territorial tax system -- an excellent idea (and contrary to all the whiners on this point, it's the same basic system the rest of the world has and it does privilege exports over imports, so shut the **** up eh?)

But -- if the medical monopolies are not broken up and thus the cost of medical care is not collapsed such that the roughly $3.5 trillion "mediscam system" we have today is returned to a $1 trillion component in the economy and its cost continues to decrease while quality and quantity improve over time, as is the case for all technology-enhanced aspects of the economy then the federal and, if pushed down to state level, state budgets will collapse within the next few years.

Even "large" changes that fail to address this underlying fact will not change the outcome.  Exponential expansion is math, not politics, and permanent exponential expansion of anything is mathematically impossible. 

In this case, with the growth rate being approximately 9% over a 30+ year period the end-point that I and a handful of others, including Alan Greenspan, predicted in the 1990s is rapidly approaching.  Obamacare bought just two years worth of deferment of that outcome and was the largest set of single-point changes ever imposed on the medical industry.

There is only one way to put a stop to what is going to occur: Break the monopolies, enforce level pricing for everyone, require publication of all prices so consumers can compare and contrast and indict and imprison any provider, executive or person who refuses to comply with the mandates that flow from these 100+ year old laws.

It must be done now, or not at all, and Trump's administration has now officially said it will be "not at all."

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2017-01-22 09:53 by Karl Denninger
in Editorial , 962 references
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It seems there's a wee bit of "protesting" in the air.

Let me point out that we have this thing called The First Amendment.  It protects your right to speak your mind, and as part of that it also protects freedom of association.

But just as it protects that for you, it protects those same rights for everyone else.

So a bunch of people -- most of them women -- marched.  What the media didn't show you is who organized those marches and what they stand for. Let me give you an example; specifically, in Washington DC according to a tweet that was uncovered by Gateway Pundit (and which the person involved has since deleted):

I suppose you think it's a good idea if you're a woman to, oh, support someone who wants to see Sharia Law in the United States.

I mean, what could possibly be wrong with that?  Other than your daughter having her clitoris cut off by religious mandate, never being able to drive (by law) and having to wear a burka whenever out in public, that is.  Oh, and she can't go out in public without a male escort either.  Never mind that if you turn out to be gay you'll be thrown off a building, stoned or imprisoned and if not, but you are female, well, you can be forcibly married off as a child!

It's not like this woman has tried to hide her views.  She has not; she's posted over 84,000 tweets and a couple of minutes of investigation discloses that what may even be worse than her views on Sharia is that she may be engaged in taqiyya on a mass scale, which means there's utterly no way to know exactly what she stands for and intends at any given point in time.

I will (again) point out that it is impossible to claim to be for equality of the sexes and at the same time be Muslim.  It is a flat-out lie to claim to be for equality for gays and to be a Muslim.  You may be one or the other but you cannot be both, unless you have defined your own version of Islam -- and if you have, then I'd like you to specify exactly which of the 114 Surah in the Qu(ee)ran you have torn out and burned.

I'll stipulate for the record that there almost-certainly are Muslims (in fact there may be a lot of them) that do believe in equality of women, gay rights and similar.  Then again there are Christians (in name) who believe in abortion rights.  But just as many Christians would like to adopt a literal definition of the 10 Commandments along with Leviticus and Deuteronomy as law when it comes to abortion (and gays, for that matter) there is an equivalent position among Muslims when it comes to Sharia.

The fact is that if you have any attraction to or have promoted Sharia law anywhere then you are definitely not for equality for either gays or women because Sharia contains strictures that effectively enslave women and mandate that homosexuality is not only wrong it is to be illegal and punishable by severe sanctions up to and including death.  The same is true for a Christian who promotes Leviticus in the Christian Bible as the predicate upon which law should be enacted and enforced with regard to LGBTQ rights (along with those who practice drudism and other pagan faiths as well!)

So why in the Hell would this woman be involved in such a march?  I'll tell you why: She's terrified of Trump's view on Israel and his long-stated threat to move the US Embassy to Jerusalem.

There's a fair debate to be had on that and if you've read my column for any length of time you know full well that I'm no proponent of how we've conducted foreign policy when it comes to the Middle East. My 2016 Review ticker contains some of my thoughts on the matter, if you're so-inclined to look at them again.  But to co-opt a so-called "woman's march" that is in fact a "dump Trump" protest under false pretense, in this case because you fear what Trump may do for Israel (which I remind you is full of women too) is outrageous.

Now maybe you think this woman being involved in organizing the "march" -- and her duplicity -- is an "aberration."  It's not.

You see, it actually got worse yesterday.

Madonna performed at this "thing" in DC.

What did she say?

"I have thought an awful lot about blowing up the White House," the 58-year-old pop star said, before adding that she "knows this won't change anything."


Oh, this was a "peaceful" march, right?  With "entertainers" who think an awful lot about blowing up the White House?

Look folks, you're free to associate with people like that, just like someone's free to associate with the KKK, if they wish.  You're free to march in an event with such "entertainment" and organized by Sharia-touting people, wherever you did it.  Whether it's in DC, Traverse City, Chicago or elsewhere.  You're free to enjoy "entertainment" that, while on-stage, muses about blowing up the White House.  That's the beauty of the First Amendment -- you are perfectly free to associate with the most-outrageous speech should you so choose, right up to the line of making actual threats or conspiring to take criminal acts.

But I will tell you this: If you did so-march, if you did promote it, if you glowingly talked about it on social media or elsewhere or if you do it in the future I'm going to exercise my First Amendment Rights.

I'm going to tell you to **** off.

With prejudice.

My daughter is not your plaything, nor that of some Sharia Law advocate who would cut off her clitoris and favors a legal system that denies her any sort of human rights at all.

Nor will I have anything to do with events featuring organizers who have advocated for a legal system that imprisons and even executes gay people.

And I want nothing to do with anyone who thinks an awful lot about blowing up the White House, nor will I associate with anyone who believes that going to an event at which such a person is given a microphone and a hell of a lot of speakers and amplifiers to give voice to that opinion is a good idea -- or sticks around once that crap starts coming out of said speakers instead of immediately disavowing the whole thing and erecting their middle finger.

Finally, I want nothing to do with any business, association, non-profit or otherwise that employs or maintains an affiliation with any person who does or did any of the above.

You see, this really isn't about politics.  It's about lack of reason, violence, and thinly-veiled threats.  It's about a bunch of sore losers who could barely contain their desire to blow up the White House because they lost an election.  It's about an organizer of said marches who would impose Sharia Law on everyone in America including the very women marching in the streets who were too damn stupid to spend 30 seconds checking out who was setting up the march in the first place and what they stand for, if she was able to.

You have to be a special brand of idiot as a woman to march under the banner of someone who, if they could, would mandate the cutting off of your own clitoris!

But that's what happened.

I'm thunderstruck to find that there is a larggroup of people in this country who are so blinded by their fury and hatred at losing an election that they would associate with someone that views condemning not only themselves but their daughters and those girls not yet born to sexual and personal slavery as not only acceptable but desirable.

Then as a cherry of additional insult (as if enslaving half the children in the country isn't enough) that event featured "entertainment" who mused about blowing up the President of the United States on stage at the event!

These are people I'm expected to associate with?

They're people I'm going to do business with?

They work at and run businesses that I will voluntarily pay money to in exchange for goods and services?

They're people I'm going to drink beer with?

And they're involved with various other organizations, including non-profits that wish to solicit me for donations and, when I die, bequests?


PS: Let's see if CNN provides the same wall-to-wall, all-day coverage of the March for Life in five days time.  After all, those people were excluded from this "protest", even though they, like these folks, are largely women and claim to be for actual equality of all.  What made them "unwelcome", you see, was that they extend that claim of equality to the unborn.

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2017-01-20 10:59 by Karl Denninger
in Editorial , 2484 references
[Comments enabled]  

It is no longer a matter of words.

The transfer of power, which our nation has undertaken 44 times in succession using votes, words and oaths, has been completed.

You are probably feeling either elated, dismayed, horrifyingly pissed off or ready to commit suicide.

All of that is folly.

During the previous 8 years, which many believed was going to augur in a new age for America of equality and progress for all, you got none of the above.  The national debt, which I remind you only has value because you are willing to go to work in the morning and pay taxes, doubled during those eight years.  In "real" terms (if you believe government statistics -- that is, you don't buy food, fuel, medical care or anything similar) you have a lower income. There are nearly a third more people on food stamps.  Seven million more American live in poverty today than did in 2009.

You may be "thankful" for Obamacare if you couldn't get "insurance" before, but in point of fact you ought to be pissed.  You ought to be pissed off because you shouldn't need health insurance for anything other than a catastrophic event you could not reasonably foresee, such as cancer, and the cost of everything medical, including cancer treatment, should be anywhere from a fifth to a tenth of what it is today.

You may be "thankful" for more college loans but in fact you shouldn't need them at all.  You used to be able to flip pizzas to pay for college, and the reason you can't today is those loans.  Calculus, literature, physics, chemistry, history, political sciences -- these things have not suddenly gotten more-complicated or expensive by a factor of ten.

But no, this is not Obama's fault.  You can blame him for a lot of things, but not these.

That responsibility -- and fault -- is yours.

You cheered on the doubling of the national debt, a load that has added over $30,000 to the amount each of us is allegedly obligated to pay -- including yourself, your children and grandchildren.  You are responsible for that because you not only allowed it, you cheered it on.

You did not demand an end to medical monopolies; you instead said you wanted "insurance". You got Epipens at 1,000% of their price in Europe, insulin rising in price by nearly as much, a rattlesnake bite coming with a bill for $200,000 and more - along with crap "insurance" that, if something serious goes wrong, is still likely to bankrupt, kill you -- or both.  One dollar in five, approximately, spent in our economy goes to this scam today.  You could stand up and demand that everyone involved in this crap go to prison; after the first hospital administrator and pharma exec was indicted prices would collapse by 85% or more in an afternoon and you would no longer need "insurance."  But you didn't do that and still won't -- and thus you got stupidity like this.  You also have brain-stem class idiots making claims in articles such as this one, where clown-faced medical monopolist apologists prattle on about savings of "$7 billion a year" against a cost of $1,400 billion and claim it would be significant.

You did not demand an end to the insanity of educational "loans."  As a result your children are told they need to borrow $100,000 to study in college -- a pure act of robbery of not only the $100,000 but also all of the interest on it that they should have been able to keep with the knowledge they got from their education.  Even if the field they go into pays well enough to cover it you still screwed them out of a house or roughly five middle-class cars when you get right down to it.  In short you ****ed your kids in the ass on purpose, and some of you screwed yourselves at the same time by taking out "PLUS" loans. What's worse is if they take out those loans and then can't find work at a salary sufficient to pay it off (or worse, fail to complete their course of study for any reason at all, their fault or not) then they're really screwed because you also sat still while these loans were made "guaranteed" by the government and unable to be discharged in bankruptcy.  You could have demanded an end to all of that, and a 4-year bachelors degree could have been had for $10,000 all-in.  It still could happen today, if you cut the crap and both made and pressed those demands -- but you didn't do that either and still won't.

But the true sadness isn't over these issues, when you get down to it.  It's over something much more personal.

Ever see WALL-E, the Disney movie?

That's not a dystopian future -- it's we, the people of America right now in the present.  It's Netfux, Facehugger, Twatter, Snaphosed and more, all of which exist because you are exactly as pictured.

Folks, the problem isn't defined by either deplorable or anti-deplorable.

It's us.  It's this, both physically and as a matter of attitude.  I literally do not recognize virtually everyone that I knew just 20 years ago say much less in my youth -- physically, emotionally or mentally.  What's worse is that these people think there's nothing wrong with either their personal physical condition or their mental and emotional state in cheering on not only their own personal destruction but that of their children as well.

As a people half the country cheers today and half drinks in despair.  Yet statistically zero of the people today will demand that the use of leverage -- debt -- to bail people out stop here and now, and that the monopolists who steal from everyone, whether in the medical, educational or other industry all go to jail under long-standing federal law and that these scams end right here, right now, today.

That is all there is folks.  We've been on the path to hit the wall since the 1990s.  I saw it then, recognized it for what it was, and projected out the trend.  The wall then appeared to be around 2020 -- 30 years ago.  Obamacare moved the wall a few years out -- two, more or less, to be exact.

That's all.

Think about it. A 2,000+ page bill that literally re-wrote the book on what was and was not permissible in health care and health insurance managed to buy just two years of delay in what was foreseeable as an utter economic disaster 30 years ago.

But leave aside the economic disaster for something much-more important -- your personal disaster.

If you have not acted to mitigate or eliminate that disaster by now for yourself -- if you see any of yourself in that clip up above -- it may well be too late.  If it's not too late you're damn sure about to run out of time.

Simply put the people of this nation will not demand that Trump and Pence dismantle the medical monopolies and enforce the law.  As a result he won't do it.  Yes, he, Paul Ryan and McConnell will pass their bills, and will almost-certainly repeal Obamacare.  But they will do nothing to address the actual problem -- not in medicine and not in education.  Nor, for that matter, in anything else.

There is no "outrunning" this in the market.  There is only being independent of the medical scamdustry or having a deteriorating quality of life, ending in your death and bankruptcy.

Get your head out of the screen.  Peacefully and lawfully destroy the scamdustries embodied in "businesses" like Facefart, Netfux, Disney and anything associated with the medical mess.  Put the middle finger up more, but not over whether someone is Democrat or Republican, but whether the political class has expanded debt, expanded dependence, expanded the scam -- and that includes, sadly, literally all in the political class.

Could Donald J Trump surprise me?  Yes.  He has the balls to do so.  But then again so did, it appeared, Barack Obama -- and all he did was buy another two years and expand the scam.

If you expect more from Trump yet will not force him to deliver, just as you saw in 2009 when the infamous quote was made "Obama gonna pay my gas and mortgage", then the blame for what will come with mathematical certainty within the next four to five years rests with you.

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2017-01-14 12:55 by Karl Denninger
in Editorial , 6343 references
[Comments enabled]  

This is the reason I'm giving up folks:

A new Rasmussen Reports national telephone and online survey finds that 88% of Likely U.S. Voters say it’s important for Congress and the president to have some sort of replacement program in place if they repeal Obamacare, with 69% who say it's Very Important. Eleven percent (11%) don’t think it’s important for them to have a replacement plan ready, but that includes just three percent (3%) who say it’s Not At All Important. (To see survey question wording, click here.)

Let me start from the beginning when it comes to insurance of any sort.

The cost of insurance is determined by the following arithmetic formula:

$ = p(event) * cost(event) + profit(insurance company)

This is not my opinion it is a mathematical fact.

Those who deny mathematics are idiots, frauds, thieves or all three at once.

Now let's ask a question: If you have just totaled your car what is the price of collision insurance on your car?

p(event) is 1.0 (probability of a collision) since the wreck already happened.

Therefore the price of said insurance will be the cost to replace your (now-totaled) vehicle plus a profit for the insurance company (without which it will not stay in business.)

In other words it is always cheaper in that instance for you to just go buy another car because you are paying the insurance company a profit for no reason at all.

It is usually not all that hard to figure out what the cost of an event is; given enough of a data set it's actually quite easy since an insurance company cares only about the average cost of the event across all of those people it insures of like sort and with like limits.  The hard part is the p(event) piece, and if you get that wrong as an insurance company in the wrong direction you will go bankrupt fast.  For this reason insurance companies pay actuaries quite a lot of money to get as close to the true value of p(event) as is humanly (and, with all the computers we have now, analytically and computationally) possible.

For this reason those who argue for "health insurance" for pre-existing conditions are either ignorant or worse, they are actual thieves who deserve to all be thrown in prison because what they are demanding is the ability to steal from everyone else.

That sounds harsh, and it is.

It's also absolutely true and if you actually adovcate and try to get enacted into law anything that forces such a paradigm on the public then you are personally a liar, a fraud and you deserve to go to prison as well for the crime of being an accessory both before and after the fact to their theft.

There is only one way that such a person, arguing for such a thing, can have a position that makes any sense at all.

He or she must argue for rationality in the cost of the treatment of such a condition.

Further, if such is achieved then "insurance" that covers same would be stupid since you then would simply be paying more for the treatment of said condition with the involvement of said insurance company than if you just paid for it yourself.

Let's take birth control.  Most women want birth control options available to them at least some of the time during their life.  The exceptions are (1) when you're too young to have children, (2) when you're too old to have children (you've gone through menopause), (3) you're not in or contemplating a relationship where having children is possible (e.g. you aren't dating anyone, don't intend to, or are in a lesbian relationship) or (4) if you desire to have children at the present time.  Any other woman would logically want to use some form of birth control.

But by mandating that "health insurance" provide such birth control as a "benefit" we now take p(birth control) and make it  [1 - ([number in options 1-4] / all women)]  If 20% of women are in 1-4 then p = 0.8 (instead of 1.0).  The problem is that you are now stealing from the women in groups 1-4 as you're insisting they pay in part for your birth control.  In addition, and much worse, you now have created an incentive to obfuscate the cost of said birth control and ratchet it up since you only get part of the bill.  That is exactly what has happened -- the cost of birth control in the United States is now five to ten times or more what it would be under capitalism and that 500+% increase is literally being stolen from everyone.

Birth control pills are extremely inexpensive where available over-the-counter -- under $15/month.  They typically cost double that or more here in the United States -- for the same drug.  Depo-Povera, the three-month hormonal birth control "shot", costs about  $1.50/vial wholesale in other nations and yet the "routine" cost for said shot here in the US for those without "insurance" runs around $60!

Are you really telling me that even poor people can't come up with less than $20 a month?

More to the point why isn't Depo-Povera $13.00 for three months, or about $4/month -- a 100% profit margin over wholesale cost for the drug + $10 for the 5 minutes to pay a nurse to stick you with the needle?  That's roughly a third of the cost of birth control pills and yet it requires no daily attention.

Yes, I understand Depo isn't for everyone just as birth control pills aren't.  But the fact remains that they work and are the choice of birth control that millions of women make.  By doing so under the "current system" those millions of women are getting screwed out of billions of dollars and forcibly screwing everyone else at the same time.

What all those arguing for such "mandatory" coverage are saying is that you think the drug companies and doctors should be able to charge your "insurance" $100 for something you can buy for somewhere between $13 and $25!  And guess what -- that makes your "insurance" cost more than the difference if you had just paid cash because $100 is more than $25 and the insurance company has to make money or it will go out of business -- so the price to you, through "insurance", when one includes premium, deductibles and similar, is more than $100.

Fact: Birth control pills, in a capitalist system, should cost less than 50 cents/day.  A Depo shot, in a capitalist system, should easily be able to be delivered for $13, or about 14 cents/day.  Even extremely-poor people can afford 14 cents, and if by some chance there are those who truly cannot we can almost-certainly transparently, through voluntary charity, manage to find that 14 cents in change laying around on the ground to provide it for them.

What's even worse is that since insurance is a regulated business and the states typically set the maximum allowable profit for an insurance company at 10% the only way for an insurance company to make more money is for whatever it "covers" to go up in price.

They thus have every possible financial incentive to get involved in business models that make the cost of medical care go up -- and no financial incentive whatsoever, ever for the cost to go down.

We have the mess we are in today in health care because the American public believes in and demands the mathematically impossible and nobody in the political class is willing to stand up and tell them that what they're demanding is impossible and, if they don't stop, our national economy, markets and all asset classes including all government support and assistance of any sort will be ruined.

Roughly one dollar in five spent today in the United States goes toward health care.  This is double what other developed, industrial nations spend and virtually all of them have socialist health care systems. Capitalism always beats socialism because capitalism adds the motive to undercut your competitor(s) on price along with developing new means of efficiency that lower your cost, allowing you to earn the same margin while charging less money.  It is this motivation that has led to $200 TVs that weight 25% as much, use a fifth of the energy and have four times the resolution of a TV set 20 years ago that cost $800.  It is this motivation that has led to the development of $35 computers the size of a pack of cigarettes that are 200 times faster and have more than 1,000 times the memory of a $2,500 computer sold in the 1980s.  It is this motivation that has led to the development of $50 cellphones you can hold in your hand, have a $30/month "all you can talk" bill and run a week on a charge with 30 minutes of talking a day.  The same capability used to require a device the size of a small briefcase that cost $1,000, it weighed 20 pounds, had a battery that was good for an hour of talk time and cost $2/minute to send or receive a call.

I personally have owned all of the predecessor devices I mention in the above paragraph, and many of you have as well.  Medical care and technology should follow the same cost:benefit curve but it has not.  The reason is not because it is different than anything else.

It has not because the companies in the business of providing that care have colluded, they have fixed prices and they have otherwise employed tactics that have driven up the cost of care by a factor of six in terms of the percentage of our economy devoted to same while our actual health in objective terms lags our western peers over the last 40 years instead of that cost plummeting while quality and results skyrocket just as occurred in every other technologically-focused endeavor.

Why do people steal? Because it is easier to steal than to create -- or innovate.

Why do firms collude and lobby for the ability to use force to rip you off?  Because it is easier to grow your top-line revenue by doing so than to innovate and create, and it also has a more-certain outcome.

Capitalism only works when it actually exists. For an economic system to be capitalism you must have (1) the risk of failure, (2) the pressure of competition and (3) a level playing field in which anyone who wishes to can enter your line of business if they perceive that they can do whatever you do better, faster, cheaper -- or all three.  As soon as you can force someone to buy your product instead of someone else's (or you can prevent them from refusing to buy at all), you can price-fix, you can refuse to provide a price at all before someone is obligated to pay or refuse to honor a price you quote, you can form cartels and discriminate against buyers of like kind and quantity based on some third-party affiliation or status or you can deny potential competing entrants the ability to compete with you and any or all of those acts are not met with prosecution and imprisonment you do not have capitalism -- you have racketeering.

It is for this reason that 15 United States Code exists -- to protect capitalism by making illegal the formation of cartels, price-fixing and similar acts -- in other words, to make cheating and using force to block competing business entrants instead of innovating illegal.

For those ignorant of history 15 United States Code was passed in 1890 because multiple firms, including Standard Oil and Chesapeake & Ohio Fuel, among others, were engaged in the above set of acts and were screwing people who were dependent on their products.  The Clayton Act, passed in 1914, closed several loopholes that certain firms tried to exploit.  Robinson-Patman was passed in 1936 to explicitly outlaw price discrimination against buyers of like kind and quantity of goods.

To those who say that Health Care providers "aren't" engaging in acts that are rank and outrageous violations of 15 United States Code (Sherman, Clayton and Robinson-Patman, respectively) let's take health care and transplant it into the sale of, oh, cars and see if you still agree with your position.

Let's assume that a car dealer decides to sell poor people a Frobozz Max (we'll use a made-up make and model) for $3,000.  He decides to charge rich people $50,000 for the same vehicle.  He posts the $50,000 price as his "chargemaster" price for the car, but some people will get it for a lot less.  To figure out exactly how much you will pay you must tell him what sort of insurance you have and you must also sign a piece of paper allowing him to bill you anything up to and including the $50,000 before you can have the vehicle -- you'll find out how much it is only after you leave the lot.  The "middle class" guy will probably, provided he has the "right" insurance, pay somewhere around $8,000 for that car.  But, if he doesn't, he might get swatted for the entire $50k.

It would be very easy to sell that "model" of car sales to more than half the country -- everyone upper middle class and below -- wouldn't it?  It would be very easy to get elected running on that platform, right?  Here's a middle-class guy who is going to pay $8,000 for $24,000 worth of car!  That's a hell of a deal and only the "rich" will get soaked -- they can afford it, right?  That's exactly the model you have been sold and voted for and then once it was in place the medical industry ramped up the price so that instead of $8,000 you're paying $20,000 and the so-called "market" price is $300k instead of $50k -- but you're still getting "a deal" even as they expanded the "base price" by a factor of six!

But are you really getting a deal as "Joe Average"?

Think for a moment about how long this dealer will stay in business unless he colludes with all the other dealers -- or gets the government to force you to work with this model of car sales and force you to buy said insurance. Unless he does one of those two things someone will open up a car lot next door and sell a comparable vehicle for $25,000!

If both dealers cost of the car is actually $24,000 the first dealer with his differential pricing scheme and ramped-up cost model at six times what it should be will immediately go bankrupt.  Everyone who would be charged more than $25,000 will go to the second dealer and buy his or her car there, paying less.  The only people left at the original dealer's lot will be those who are getting the "poor person's price" which is below his cost.

If he can't make someone else pay the difference for all those "poor people" then he will be out of business in a day.

This is true for any line of work -- including medicine.  That such a billing system exists -- where different people are charged different amounts for the same thing not based on the quantity of their purchase (everyone who needs a given procedure only needs one, right?  Likewise anyone who needs a month's supply of a given drug) but rather based on what sort of "insurance" they have or how rich they are is proof beyond any doubt of collusion, restraint of trade and anti-competitive activity.

It is impossible for such a system to survive for a single day without such acts of illegal collusion or the use of force for the simple reason that if just one non-colluding entity in the market offers the same good or service but doesn't do that sort of thing then everyone who is being forced to pay above cost to subsidize those getting below cost will do business with the non-colluding entity and the party trying to use such a billing model will instantly go bankrupt.

Now let me remind you that all of these acts are against the law.  They are not just civilly against the law -- in many cases they're felonies and carry prison sentences.

If you enforce the law then the cost of health care, all-in, will drop by approximately 85% and that assumes no technological innovations have occurred in the interim 30+ years that would make it even cheaper!  Of course such innovations have occurred -- in medicine as elsewhere.

Let me give you one simple example of this outrageous behavior that is trumpeted in public statements and even advertisements on TV and elsewhere: So-called "patient assistance programs" from drug companies. Robinson-Patman (federal anti-trust law) says the following:

It shall be unlawful for any person engaged in commerce, in the course of such commerce, either directly or indirectly, to discriminate in price between different purchasers of commodities of like grade and quality, where either or any of the purchases involved in such discrimination are in commerce, where such commodities are sold for use, consumption, or resale within the United States or any Territory thereof or the District of Columbia or any insular possession or other place under the jurisdiction of the United States, and where the effect of such discrimination may be substantially to lessen competition or tend to create a monopoly in any line of commerce, or to injure, destroy, or prevent competition with any person who either grants or knowingly receives the benefit of such discrimination, or with customers of either of them: Provided, That nothing herein contained shall prevent differentials which make only due allowance for differences in the cost of manufacture, sale, or delivery resulting from the differing methods or quantities in which such commodities are to such purchasers sold or delivered

It does not say "it's ok to discriminate for someone in pricing if they're poor."  It does not say "you may soak the rich."  It does not say "you can charge $5/gallon for gasoline to someone who has a lot of money, and $1 to someone who does not."

Note that the law does say you can offer a quantity discount, provided that the discount rationally relates to the difference in cost of delivery of X .vs. X+Y.  So if I buy 1,000 of a given thing in a package you can charge me less per item than if I buy 10 of the same thing if the difference in price rationally reflects the difference in packaging and distribution costs.  This is why if I buy 5lbs of coffee from a particular supplier I can be charged $8.50/lb (for green coffee) and if I buy 10-25 lbs the price is $7.95/lb, and so on.

But you cannot charge customer X who needs 30 pills a month $20 and customer Y who also needs 30 pills a month $500 based on their income or the insurance they choose to buy (or not.)

Doing so is black-letter illegal.

For those who say that "insurance companies can do this" no they cannot.  That went up before the United States Supreme Court in 1979 when insurance companies tried to claim that under Mccarran-Ferguson (which allows limited anti-trust immunity to insurance firms -- and is the reason they can have and use things such as the CLUE database in their underwriting) a differential-pricing scheme was exempt from anti-trust law and they lost.

There is only one way to prevent the escalation of cost in the federal budget related to Medicare and Medicaid, not to mention the outrageous pricing decisions such as charging $2,000 for a course of treatment of a drug in one country and $80,000 here in the United States -- and that is to enforce the law and break all of these monopolies.

Every medical provider of any good or service, whether it be a doctor's visit, a drug, a procedure, a device or anything else must be required to have one price that is charged to every person equally, irrespective of how they pay or what sort of insurance (if any) they carry and irrespective of where such a product or service is sold, absent a reasonable difference related to the cost of delivery or manufacture in a given locale.  Such prices for each and every service, procedure, drug, device or anything else must be published and maintained where the public can verify that each person who receives like kind and quantity of same is charged the same price exactly as the local gas station is required to post a price and charge the same to each person who wishes to buy gas.

Any entity that colludes with any other to fix prices must be indicted, prosecuted and imprisoned in accordance with 100+ year old law found in 15 United States Code.

The customer, that is the person seeking care, is then free to compare price and quality of service, along with whatever their "insurance" will cover (if any of it) and decide which facility to utilize.  State anti-gouging statutes must be fully enforced for those instances where someone is unable to decide (e.g. they just got in a car wreck and are unconscious, they are having a heart attack, etc) while various EMS and other services that are caught "steering" people in such circumstances to higher-cost treatment options must be criminally and civilly charged.

Drugs are slightly more-difficult. Unlike the other components of anti-trust law (which explicitly include international commerce) Robinson-Patman could be construed to not apply across national borders.  However, should drug companies wish to continue the practice of differential pricing in different nations they remain exposed under the other elements of Sherman and Clayton until Congress repeals the reimportation ban or extends Robinson-Patman by adding "international" to "interstate", never mind existing case law where book publishers tried to prevent the resale of books bought overseas in the United States (and lost in the USSC.)

It will take about one day if these changes are adopted for the cost of medical care to collapse to a tiny fraction of what it is now.  With that collapse it will be unnecessary and undesirable for you to buy "insurance" against already-existing conditions because it will be cheaper for you to simply pay in cash.  For nearly everything you will be able to pay.

For those possible catastrophic situations that haven't happened yet you will be able to buy reasonably-inexpensive insurance because the product of p(event) + cost(event) + profit will be small enough that the premiums will be affordable to virtually everyone, even those of very modest means.

Finally, for the truly indigent we can certainly keep Medicaid and, since this cost reduction will occur across the board we can also keep the promises made for Medicare both for today's Seniors and tomorrow's.  The cost of those programs will fall like a stone -- a more than 50% immediate reduction is assured, and instead of going up in cost every year as technology and productivity improvement will no longer be able to be stolen by said medical providers (since the price is the price for everyone including those in Medicare and Medicaid!) the cost of these programs will go down every year instead.

This is the only way out folks and it's one we must take now.  It cannot wait, it cannot be done tomorrow, we cannot "repeal and replace" with yet another scheme to try to keep the ponzi-based fraud and felony-laced medical system we have in the United States afloat.

If we do not do this now then the federal budget and all state budgets will collapse within the next 5 years.

Attempts to "negotiate" out of this may be able to buy another couple of years of time, but will not change the outcome.  That's the math, like it or not, and we have repeatedly squandered the opportunity to address the issue when it would have been far less disruptive (in terms of the short-term economic recession that will occur) all the way back to the passing of EMTALA in 1986.

We either do this now, and we demand as citizens that it happen without exception and backed by whatever action(s) are both necessary and possible to enforce that demand with both Donald Trump and Congress, up to and including a full general strike called across the nation, or we lose the financial stability of our federal government, our state governments and our way of life in America.

We are doomed to collapse as a nation because the fact is that you won't do it, your neighbor won't do it and as a result Trump won't do it and Congress definitely won't get behind him in doing it either because the medical and pharma lobbies will be completely destroyed if it happens and they know it.

Yet there is literally no other issue that matters to any material degree if we don't take care of this one -- right here, right now.

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