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2018-06-20 09:09 by Karl Denninger
in Health Reform , 126 references
[Comments enabled]  

Oh please.

Medicaid is now the largest health insurance program in the United State, covering about 74 million Americans with low incomes and disabilities, along with participants in the Children’s Health Insurance Program. Medicaid is costing our federal and state governments enormous amounts of money and the costs are growing – rising from $553 billion in the 2016 federal fiscal year to $565 billion in 2017. That’s about $1 out of every $6 spent on health care in the U.S.

And, may I add, this was intentional on the part of Obama -- and Trump too.

What, you say?  Yes, Trump too.  He has done exactly nothing to address this, Siegel's rant notwithstanding.

Never mind the reality put forward here:

Before she joined the Trump administration, Verma was a health policy consultant who worked on Medicaid reform programs in Indiana with then-Governors Mitch Daniels and Mike Pence, as well as in Ohio and Kentucky. Now vice president, Pence knows from firsthand experience that if anyone can tackle the Medicaid challenge, it is Seema Verma.

Oh really?  Argument by assertion me thinks.

Where is the evidence?

The problem is this sort of nostrum is utter and abject nonsense:

In other words, instead of simply cutting Medicaid and other programs for poor people, help poor people work their way out of poverty.

I interviewed Verma for Fox News recently. I was impressed with her vision for ways to enact President Trump’s plan to help able-bodied Medicaid recipients gain skills and self-esteem, and ultimately get off Medicaid. She emphasized that these programs are not simply work programs, but include community service and education and job training options.

Again, how?

Let's face the numbers here folks.  A decent "health insurance" policy for a single person in their "prime years" is over $1,000 a month today.  That's $12,000 a year.  For two people it's double that, then add another five grand per kid for those under 18.

So for a family of four we're talking north of $30,000, each and every year.

Obamacare makes this "tolerable" for single people who make $25,000 a year or less, and about $45,000 for married people filing joint -- by forcing "someone else" (the taxpayer) to pay for it.  The problem is that you can't live on that in the so-called "middle class" virtually anywhere, unless you own your home outright somewhere that's low-cost.  The reason is that rent for a 2 bedroom apartment, along with basic living expenses (food, utilities, renters insurance, transportation, etc) consumes a solid $20/hour, or $24,000 a year, virtually everywhere in the United States today.

It does so because of the imputed taxes in both rent and property ownership, imposed by the states, counties and cities as a direct result of promising to give things to people who didn't pay for them, and those promises never diminish -- even in times when the economy is "good" (like right now, for instance.)

Now add to this the complete phase-out of Obamacare subsidies at about $50,000 a year for a single person, and about $80,000 a year for a married couple.  Then add to that FICA/Medicare and income tax and the second $25,000 earned for a single person, or the band between $45-80k for a married couple, is taxed at an effective rate that in many areas exceeds 80%.

huge percentage of the population, indeed most of the population, by definition cannot get out of that band and start to pull clear of it.  It's simply impossible as their skill level and basic intellectual firepower is not worth enough in the marketplace to do so.  Even if you do manage to break free the drag of that band and it's "take" from you which remains for the income in that band makes your standard of living much worse than it first appears; in essence you make $25-40,000 less than your income appears to be once you cross the phase-out threshold.

For someone who makes $400,000 a year that $25,000 "hole" is around 6%, and not all that material.  For someone who makes $100,000 a year the hole is 25% and enormous!  For someone who makes just over the phase-out the hole is utterly ruinous and prevents them from getting into the middle-class entirely -- PERMANENTLY.

There is no fix for this other than to collapse the entire medical scam.  To get people "out of poverty" and fix this problem you have to jail all of the medical providers, insurance companies, hospital executives and pharmaceutical company executivesor credibly threaten to do so and thus force the collapse of all of the monopoly pricing models.

Specifically, the US must have "most-favored" nation pricing on all pharma products and surgical supplies, without exception.

All prices must be posted and everyone must pay the same price for the same thing.

All instances of collusion, price restraint and other monopolist behavior must be met with prison sentences, in every single case -- not fines which can be passed on to the consumer.

Jail has to be the consequence for such behavior -- EVERY SINGLE TIME.

If this is not done then eventually you will wind up with a feral environment -- a literal civil war -- or worse, as you cannot put the entire median and below earnings-capable population into permanent poverty by design when it's impossible to pay for that in perpetuity without those people eventually deciding that they are going to kill their oppressors -- and mobs of this sort tend to be rather indiscriminate in how they target such aggression.

This problem can be fixed, but not the way Siegel says.  The reason is simple: The system has been set up in such a fashion that for the median person in America it is impossible for them to get out of the hole without solving this problem first.

There are answers however, and we can start right here.

That is, if there is anyone left in America willing to demand same, and stand behind that demand with a credible and immediate "or else" should Trump, Congress and the States refuse to immediately act to resolve it.

At the same time, should we take this on and resolve the issue, we permanently and immediately fix both the budget deficit and the "entitlement" explosion, plus the National and State debt issues.

You're welcome.

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2018-06-11 07:01 by Karl Denninger
in Health Reform , 287 references
[Comments enabled]  

Well well Justice Roberts, I am writing your obituary right here and now, and should you precede me I'll publish it too, even if it costs me a lot of money to do it.

"Justice Roberts was single-handedly responsible for the destruction of the American Government via its Treasury via his idiotic and legally-infirm contortions in ruling the Affordable Care Act was in fact a tax, rather than a constitutionally impermissible command."

As I wrote at the time Roberts destroyed what little was left of the Supreme Court's legitimacy, putting the final nail into a coffin built since Wickard .v. Filburn.  He justified this in his opinion through what is really called by any means possible I shall torture the law to save it, in that he cited a claim that the Courts are required that any fair means of interpretation exists that leaves a law intact the courts are required to find it.

Of course there was no such "fair means" which he also set forth in his own opinion, stating clearly that the statute reads as a command to buy insurance ("enter into a regulated activity") and that the Constitution prohibits that.

Indeed the Congressional record on the drafting and debate makes clear (if you bother to read it, which Roberts clearly did and then intentionally ignored it, which I also pointed out in a further article) that Congress knew they could not draft the PPACA as a tax because direct taxation on other than strict capitation is unconstitutional.

In other words the US Government can assess a $10 per person tax, per person, but they may not condition the amount of the tax or its imposition on anything other than being a person.  The 16th Amendment makes legal the imposition of taxes on income.  Indeed multiple other attempts to impose such a tax without a Constitutional Amendment had been previously struck as unconstitutional, so there's not only a legislative record but a judicial one as well.

Roberts didn't care.  I've often mused if someone has a video of him buggering a little boy and used it get him to write that "opinion."

But what Roberts didn't have, because he couldn't, is the ability to time travel.  And when Congress passed the TCJA reducing the penalty for not having coverage to zero starting January 1st of next year they destroyed the Constitutionality of both guaranteed issue and community rating, since both were by the Congressional record inextricably tied to the imposition of the penalty and thus are non-severable, as is specifically stated in the Congressional record.

Without the penalty there is no tax since the inherent property of a tax is that it raises revenue.  That's now gone and it was the sole pillar on which the Roberts court decision rested.

The problem is that the rest of the law isn't inseverable and the way law works is that except where severance is specifically declared inapplicable it applies unless the result would be nonsense.

That the result of non-severance will bankrupt you does not enter in the analysis.

Thus the brief referenced herein argues that both community rating and guaranteed issue are Constitutionally infirm and thus void come January 1st.  This is a winning argument, and if there is anything approaching a justice who can actually read it wins by declaratory judgment since the precedent to judge it by is in the original opinion and as a result there is no legal ground to cover in presentation of a case or argument before the court!

But once you do that both Treasury and private industry are irrevocably and instantly ****ed.

Without community rating and guaranteed issue anyone with a pre-existing condition who becomes unemployed becomes permanently unemployable as they are uninsurable without destroying the business they go to work for.  Further, they can't engage in entrepreneurial activity either because there is no possible way for them to buy health insurance.  And finally, since the cost of that care has more than doubled since this problem was allegedly "addressed" by Obamacare they have no other option available.

I have often written about the utter necessity of getting rid of the medical monopolies as a political imperative, and for individuals to do everything in their power to get off the medical teat, which for most people means you damn well better not not be overweight or obese, you better have normal blood sugar which means no damned carbs to any material extent in your diet and it certainly means that intentional high-risk behavior like butt****ing, IV drug use or drinking to excess is an instant economic death sentence.

Of course what has occurred in the decade since Obama came to office and Pelosi and her pals rammed through their "vision" is that all of that has gone downhill in statistical terms for America.  There are more obese and abnormal-insulin and blood-sugar level people in this country than ever before, including a shocking number of teens for whom such was unheard of as recently as 30 years ago.  There has been an explosion of IV drug use including heroin and fentanyl.  And we have removed not just legal strictures but have mandated "tolerance and acceptance" under the law for extraordinarily-high risk social behaviors and in no small part covered that up with expensive, lifetime drug regimes that are utterly dependent on public financing to remain "affordable" for the vast majority of people.

The social issues are real but the cost issues exist only because neither Congress nor any State or Federal executive will take their justice departments and prosecute, throwing in jail, the medical monopolists.  Instead they kowtow to their lobbying, whining and claims of "necessity" to continue the trend of taking medical expense from 4% of GDP to nearly 20% today and beyond into the future.

Well, now the scheme is about to blow up in everyone's face.  As of January 1st those who are healthy do not need to participate and most will not.  I won't.  The "donut hole" where $25,000 - $50,000 in income has an effective tax rate of more than 80% everywhere (and close to 100% in high-tax states) is gone if you simply stick up the middle finger.

But without some means of forcing transfer payments from "someone" (the taxpayer across the entire population) to fork up $900 a month for someone like me, who needs zero routine and chronic medical care so that someone else can run up $5,000 a month prescription drug bills the latter's bill becomes unfundable.

Mr. Roberts will burn in Hell for this, as had he not tortured the Constitution in 2012 Congress would have been forced to deal with the medical monopolists and so would have Obama's administration, saving the US Government and taxpayer several trillion dollars.  You'd also be able to pay cash for virtually any medical situation, save an immediate crisis for which (if you chose to do so) reasonably-priced insurance would be available.  We're talking $100 a month or less here folks, because even the "really awful" stuff would cost one fifth of what it does now.

But all that money has now been stolen and it's gone, while the nuclear fiscal bomb left behind by Robert's outrageous twisting of reality on the back of Obama and Pelosi's intentional set of actions is now about to detonate in his, and everyone else's, face.

smiley

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2018-06-07 07:00 by Karl Denninger
in Health Reform , 216 references
[Comments enabled]  

Here it comes folks, in two reports -- one from the Medicare trustees, and the other from Social Security.

Let's start with the easy one: Social Security.

The "fear" is that it will be unable to pay full benefits (because it will have run out of bonds that are there as a buffer) in 2034.  This is predicated on a few things, so let's list them:

  • Income levels will not generally lift.  Oh really?  More to the point, neither will the cap-out point (where you stop paying every year.)  But the latter does lift every year (it's gone up a lot since I was running MCSNet) and the former is a rather-pessimistic view of the world.  It's one that might prove correct, but it's still quite pessimistic.

  • Disability has actually improved due to fewer people going on the rolls.  Gee, how many were disabled and how many didn't want to work?  Funny how people who were and are disabled suddenly become not disabled as the economy improves.  That's fraud folks, but nobody cares.  You should, because the money being stolen is yours.

  • Through 2039 (five years beyond the projected depletion date) expenditure goes up.  However, the system was designed for this; that's why it holds Treasuries and built a huge surplus while the boomers were working.  Granted, the "surplus" was immediately spent but it was replaced by Treasury bonds, which can and are being (right now) sold.  The Fed, Congress and Obama intentionally destroyed the actuarial health of the system; the current yield on a blended basis is only 3% which is about half of what it should be for a ladder of bonds of appropriate duration.  This is not small potatoes when you're talking about a couple of trillion dollars! I want to know where the handcuffs are for Congress and the entire Federal Reserve plus all of the administrations back to the 2000 tech wreck who have all deliberately suppressed yields and continue to do so today.  But for that the retirement program would probably be sound on an actuarial basis.  Note that had interest been at normal levels the difference last year would have been roughly $80 billion, along with the years prior back to 2008 and on a forward basis.  $80 billion a year is real money, especially over a few decades and in fact it's probably enough to make it through the "bump" when the boomers die!  Too bad America has forgotten what a pitchfork and torch is.

  • Note that Social Security is fairly easy to "fix."  First, we can stop tampering with rates on a forward basis.  Second, we can (and probably have to) lift either the cap on wages at a faster rate (or once on a step-function basis), modestly increase the FICA tax, or some blend of both.  A less than 3% increase in the FICA rate (both halves; you pay both even though you don't see both directly) is roughly where the line is, assuming wages do not lift faster than inflation (payouts.)  If they do some or all of that will disappear; the reason is that Social Security is a progressive system; that is, your first dollar of earnings (taxable) get you more benefit when you retire than higher earnings dollars do.  So if people shift toward the higher end (before the cap-out, at which you neither pay or get more) then the deficiency closes.

The bad news is found in Medicare.

Medicare goes bust in eight years and there is no rational revenue-raising way to fix it.

For most of us who are not 75+ it will not be there unless the medical monopolists are jailed, hung or both right now.

Yes, after trial and conviction (I still believe in due process) but if we don't do it, and I remind you there is 100+ year old law that is more than sufficient to go after this issue right here and now everyone in this nation is absolutely and irrevocably ****ed if they need medical care and are over 65 just eight years from today.

Period.

There is no payroll tax adjustment that can plausibly be passed and fix this.  Medicare was designed for a medical system that consumed four percent of GDP.  Today it's nearly 20%, or five times as much.  Cost-shifting from Medicare and Medicaid is already is screwing the rest of the public blind; there is little or no more of that which can be possibly foisted off on working people.

THIS IS WHERE THE EMERGENCY IS AND WHY I HAVE RAISED HELL ABOUT IT FOR MORE THAN TWO DECADES CONTINUALLY.  IT IS AND WAS OBVIOUS EVEN IN THE 1990s WHERE THIS WAS GOING TO GO IF NOT STOPPED.

Well, it not only hasn't been stopped the scamming has accelerated and unless the government puts a stop to all of the scams now within the next few years you are going to get reamed up the chute. 

This is no longer a "distant" threat.  It now will occur prior to the end of the next Presidential term, and any acceleration in the deficit in these programs, which will happen instantly when there is a recession, will likely bring forward that date by three to four years immediately rendering the problem both instant and catastrophic.

I have published several articles on real fixes for these issues.  One can be found here, and it's a good place to start.

We either demand it as a nation and back that demand up with whatever we need to in order to make it happen or this nation, it's economy, and our government are all gone inside of the next ten years.

Politicians will not act until and unless we, the people force them to do so.  They only care about the next election and being able to "retire" into some lobbying position at five times their government salary.

You either get off your ass now and force your government to hold the entire medical system to account under anti-trust law or you had better make damn sure you don't need medical care of any sort -- no prescription drugs, no doctors and no hospitals -- and are willing to either get on a plane (if you can) for treatment or die should that change for you.

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Bottom line: Women were lied to, scammed, screwed out of their quality of life and hundreds of billions of dollars over a period of time spanning decades.

One word that scares damn near everyone: Cancer.

And nothing gets women (in particular, although men do get it) going more than breast cancer.

It's not just the fact that it can kill you, but that it frequently also involves cutting off one or both breasts, which has a rather-severe psychological impact associated with it.  Of course the mortality aspect doesn't help things a bit and all of that drives a fear in anyone who suspects or is told they have it to do "everything possible" to prevent it from "getting" them.

But now comes the data, and 70% of women who get it receive no benefit from taking chemo.

Now to be fair the testing required to know if you're in that bucket is pretty new.  But we're talking more than 80,000 women a year who are, today, conned into taking a treatment that has no benefit for them whatsoever.

What it does do, however, every single time is damn near bankrupt you, drive health insurance costs to the moon, in a world of Obamacare it forces men to pay as well for something they have a much lower risk of contracting since companies can't "discriminate" by gender and far worse it always comes with debilitating side effects including having all your hair fall out and life-threatening complications that in some persons include severe infection and critical or even fatal organ damage.

Don't get me started on this ****.  Like damn near everyone I know someone who has dealt with cancer, because it's quite common.  None of the choices one makes when facing their own mortality is easy but it damn sure is easy for the so-called "medical profession" to prescribe something that will destroy the quality of your life for a significant period of time with the  "on-the-come" claim that it will also extend your life.

When that claim to turns out to be bull**** you have been assaulted as certainly as if you had a gun shoved in your face and were shot.  You suffered and you were robbed, and it was for a lie that made those who lied to you billions of dollars.

And you still can't find your ******n pitchfork.

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2018-06-03 11:40 by Karl Denninger
in Health Reform , 327 references
[Comments enabled]  

This is a laughable article.

 

Michael Frank ran his finger down his medical bill, studying the charges and pausing in disbelief. The numbers didn't make sense.

His recovery from a partial hip replacement had been difficult. He'd iced and elevated his leg for weeks. He'd pushed his 49-year-old body, limping and wincing, through more than a dozen physical therapy sessions.

...

But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That's more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofitthat tracks prices.

Fuming, Frank reached for the phone. He couldn't see how NYU Langone could justify these fees. And what was Aetna doing? As his insurer, wasn't its duty to represent him, its "member"? So why had it agreed to pay a grossly inflated rate, one that stuck him with a $7,088 bill for his portion?

Three times the Medicare rate and more than double the estimates others claim they'll do it for.

Nobody seems to understand why eh?

But as Frank eventually discovered, once he'd signed on for surgery, a secretive system of pre-cut deals came into play that had little to do with charging him a reasonable fee.

After Aetna approved the in-network payment of $70,882 (not including the fees of the surgeon and anesthesiologist), Frank's coinsurance required him to pay the hospital 10 percent of the total.

That's called racketeering, by the way.

Why do they do it?

Insurance is a regulated business.  Being a regulated business their margin is fixed by law.

So if you're insurance company would you like to make 10% of $70,000 or 10% of $25,000?

Because either way you can only make 10%!

Yes, it's that simple folks.  And it's not just health insurance either.  The only thing that keeps this from being everywhere is this thing called "competition", such as it exists.

Come talk to me about "competition" after a hurricane in an area where there isn't any because the amount of demand is near-infinite compared with the supply.  Then talk to me about why hurricane insurance is so damned expensive.

It's not the storm.  It's the gouging and bid-rigging that goes on between insurance companies and contractors after events like this, and the person who they try to screw is you if you have a claim.

I haven't been damaged in one of these storms down here but I pay exorbitant premiums (like everyone else) because others have and most of them get hosed.  Someone I know had a major firm try to screw her almost literally blind after one of the storms here and I got involved in it since I knew what was going on and what the law actually required.  She got paid.  Many others did not.

But whether you get paid when you have a claim or not you get hosed on the premiums because these firms have exactly zero incentive to lower prices.

Ever.

And so long as we have no enforcement of the Rule of Law, starting with 15 USC Chapter 1 which makes price-fixing illegal at a felony criminal level, this crap will continue.

The only other alternative is for the people of this nation to find their pitchfork and torch and start using both.

Oh, and CNBC knows damn well what the root of the problem is.  Why don't they talk about it?

Because if they do you might find that pitchfork and torch and the market would instantly crash.

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