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2018-08-08 07:00 by Karl Denninger
in Health Reform , 158 references
[Comments enabled]  

I rarely agree with Newt, but he's right on this point.

Many in the GOP are hoping this success will help them get re-elected in November. Some consultants I’ve spoken with seem to think it will inoculate Republican candidates against most all Democratic attacks.

They are mostly right, except for one area – health care. 

No doubt, Republicans should be proud of the enormous success of the economy. But the economy won’t reach its full potential and the GOP will not win big in the 2018 elections unless Republicans deal with the cost of health care in America.

There is only one way to do that: Government must enforce 100+ year old existing law that makes illegal the collusive and discriminatory behavior that virtually all health-related businesses engage in.

Meanwhile you have allegedly "free health care for all" politicians lying to constituents and promising health executives they'll "play nice" with their monopolist profit system.

Note that it's not illegal to lobby a politician.  But the fact that you have and do when the discussion includes a debate about price-fixing and bid-rigging, which is what we're talking about in this case, is hard evidence of intentional conduct when it comes to violations of 15 USC Chapter 1 and all of those discussions can and should be subpoenaed and used against said industry as they are not privileged communications.

A lobbyist is not a priest and their conversations didn't take place in a confessional.  Quite the opposite.

There are solutions to these problems; we could start here, for instance, which I have often written about.  Politicians and the media have refused to take this issue up with any sort of honest examination for one simple reason: If you do it the stock market blows up immediately as a huge percentage of the economy (about 20% right now) is "health care", a monstrous number of people are "employed" in do-nothing, never-one-second-of-care positions yet make high wages, and if you put a stop to this theft most of them will lose their jobs.

What's missed is that while the adjustment in the economy to returning health care to 3% of GDP or thereabouts would be brutal for those who are currently abusing the American public it would also be short, would likely be complete within 12-18 months (much like 1920/21) and when finished it would usher in a golden age for America where our business and government costs would drop precipitously, stoking our competitiveness in a way not seen since the end of WWII when everyone else's manufacturing capacity had been laid waste.

Newt's warning is not just about winning elections, however -- although he fails to note that.  It's also about the fact that if this garbage is not stopped it will destroy the federal budget within the next decade and, along with it, civil society.  The CBO has been warning of this for more than 20 years, as have I.

That's a function of math and as a result it has nothing to do with partisan politics.  It is simply a function of whether this nation is going to continue as a going concern at all.

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2018-08-07 07:20 by Karl Denninger
in Health Reform , 222 references
[Comments enabled]  

Right, because CMS couldn't require that hospitals charge everyone the same price to get either Medicare and Medicaid....

Hospitals will be required to post online a list of their standard charges under a rule finalized Thursday by the Trump administration.

While hospitals are already required to make this information public on request, the Centers for Medicare and Medicaid Services (CMS) said the new rule would require the info be posted online to "encourage price transparency" and improve "public accessibility."

Which of course tells you exactly zero about what you will pay.

Now if CMS actually required non-discrimination and public prices, easily accessible then we'd be somewhere useful.

But instead they do something that sounds good but in fact does nothing, because your heart attack, while allegedly the same "standard price" as the next guy's, is in fact billed at $500,000 while his is billed at $50,000.

Try running a gas station where you post a $3.00/gal price but one person pays $3 and the next pays $1.40 based on who you bought your car insurance from and see how long you remain in business before you're tossed in prison, especially when you and all the other gas stations in town collude in both limiting the number of gas stations and fixing prices.

It's still full of fraud and not one damn thing has changed in that regard with this alleged "rule."

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2018-07-16 08:50 by Karl Denninger
in Health Reform , 138 references
[Comments enabled]  

There comes a point where you must conclude that Donald Trump never meant a word he said about breaking the medical monopolies -- or fixing the underlying problem with health care in the United States, which has nothing to do with insurance and everything to do with cost.

He could have directed Jeff Sessions to go after the entire industry under 100+ year old existing law, 15 USC, which make a criminal felony any attempt to monopolize trade, fix prices or restrain competition.

He could tell Congress to send to his desk a bill removing all constraints on "reimportation" or any drug that is FDA approved, irrespective of the source nation -- and that he won't sign anything else from Congress until that appears on his desk.

But he hasn't done anything of the sort.  He likes to take credit for Pfizer's "rollback" of intended price hikes, but reality is that this tiny little concession in the grand scheme of things means zippity do-da, while the screwing goes on daily in both hospitals and the pharmacy.

The simple reality is that nearly everyone would not need "health insurance" for anything other than major catastrophic events if this crap was stopped.  A routine childbirth would cost under $1,000.  Insulin would cost less than a pack of cigarettes.  Virtually all medical treatment could be bought for cash by all but the poorest Americans.

Look at this record -- drugs that have been off-patent for decades, approved in 1950 and available for under $10 around the world -- but $38,892 here.

Or try insulin.  Over less than 20 years it has gone up in price by about 700%.  Is it a different drug?  No.  It's the same drug.  Is insulin new, novel or under patent?  No.  Why did this happen?  Because there are basically two formulations and the companies have raised prices in lock-step since the second was introduced with an ever-increasing scale over the last few years.

This is black-letter illegal and yet there has not been one indictment leveled but there has been billions stolen from Type 1 diabetics who have exactly zero choice on buying said drug.

If the government will not do their ****ing job and stop this then the FDA must be abolished by whatever means are necessary along with every law and regulation pertaining to same.  In this world of the Internet where anyone with a cellphone can research whether some compound has been studied, what it's properties and risks are, and decide for themselves to take the risk (or not) of consuming same for some condition if the government is going to do nothing more than enforce and enhance a racket that screws everyone out of billions then the enablers of that racket must be destroyed and the racket torn down.

There are already existing laws sufficient to do so.  We need no new ones.

But if we cannot expect actual faithful enforcement and execution of the laws from our government then we need a new government.

Trump promised to fix this and he lied.  Either crap or get off the pot Donald.

It's that simple.

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2017-11-01 12:14 by Karl Denninger
in Health Reform , 500 references
[Comments enabled]  

Ok, so I have the APTC for a single person who has reduced income to right near $20,000 a year for 2018.

In Florida it is now $760/month, or $9,120 a year.

This is wildly up from $446 for last year; in fact it's up 70%.

This means I can now have a Silver plan for about $15/month, as opposed to a very low-level Bronze plan for under a buck.  I can also choose virtually all the Bronze plans for zero (since the cost is lower than the APTC), but that would be insane since I'd be leaving a huge amount of your money on the table.

The actuarial value of a "Silver" plan is wildly better than any of the Bronze plans.

There is one "gotcha", which is hospitalization co-insurance that does exist on the Silver plan but not on the Bronze.  But the Silver plan in question has a zero deductible, so even with 20% "coinsurance" you'd have to run a hell of a bill to lose that bet especially considering that you get the insurance-company racketeering-deduction price.

Folks, you have to be flat-out nuts to work harder and run into the subsidy phase-out, especially if you have a spouse, even if you do need routine medical services since you can now buy zero-deductible Silver plans for less than the cost of a burger-and-beer in your local pub!

QUIT ****ING WORKING AT $20,000 A YEAR OF INCOME, FIGURE OUT HOW TO MAKE YOUR LIFE FIT IN THAT EARNINGS LEVEL AND YOU WILL NOT ONLY PAY BASICALLY ZERO FEDERAL TAX (OTHER THAN EMPLOYMENT TAXES, OF COURSE) AND YOU WILL GET CLOSE TO $10,000 OF "HEALTH INSURANCE" WITH A ZERO-DEDUCTIBLE PLAN  FOR UNDER $200 A YEAR.

No, you probably can't do this in high-cost-of-living areas without living in a slum.  Yes, you can make it work perfectly-well in lower-cost-of-living areas and be perfectly fine.  I'm doing it and you can too.  Yes, it means you have to change your lifestyle but I'll be double-******ned if I'm going to go out and earn a six-figure income and then have government thieves not only tax more than half of it away (which they will) but then double-monkey-**** me by extracting approximately $10,000 in after tax money in addition from me for "insurance" that, unless I have some sort of medical catastrophe in the next 12 months in fact provides zero value to me.

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Here it is:

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

That's it.

One sentence.

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

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

It ends the "Chargemaster" ripoff game.

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

It ends the $500,000 cancer treatment.

It ends all of that, immediately and instantly.

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

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

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

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

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

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

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

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

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

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