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Commentary on The Capital Markets- Category [Health Reform]
2017-07-20 07:00 by Karl Denninger
in Health Reform , 507 references
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There is no greater scam in the world today than the blatant and outrageous lies told to everyone from school age onward over the last 40+ years when it comes to diet, exercise, health and various risk factors associated with same.  The root of the scam goes back even further, but it really became evident with the so-called "food pyramid" which emphasized refined starches (breads and "white vegetables") and claimed that fats were bad for you and should be limited.

Then, the scam evolved.  Only saturated fats were bad, so it was claimed.  The rest weren't so bad.  And of course what we all heard was to eat more "natural", meaning vegetables -- mostly.

We were also told that weight was all about calorie balance.  In .vs. out, thus the exhortation to exercise -- to increase the "out" and to restrict calories, in order to decrease the "in."

This may sound easy and is demonstrably, if you can stuff someone in a lab, it might actually appear to work.

But it doesn't work out in the real world -- ever.

It doesn't work because the advice on what to eat was all a lie and the people who ran it knew it was a lie -- especially for people with any sort of metabolic derangement.  Of course before there were insulin and drugs if you became diabetic you had two choices: Stop eating carbohydrates or die from the effects of the disease -- and probably quite quickly too.

Then we developed some drugs.  And when we did, suddenly we allegedly "forgot" that metabolic derangement could be very effectively treated without a single dose of pharmaceuticals.  We were told to believe that taking the drug made it all ok.

But it didn't.  We knew this early on because the number of people with Type II diabetes, heart disease and obesity continued to increase.  The doctors all claimed this was because "nobody took their advice", but that belies the point: Either the advice was wrong or it was impossible, psychologically, physiologically or both, to comply with.

It doesn't matter which of the two possibilities is true, by the way.  A "mandate" to do something that most people will fail at due to either physiological or psychological factors is no mandate at all unless there is no alternative that doesn't have the same problem.

Of course the facts are that there is an alternative -- the same one we knew about 100 years ago.

And now, here comes the evidence -- that not only was the advice wrong the people pushing it knew it was wrong because they tampered with the data.

For instance, there are 44 randomised controlled trials (RCTs) of drug or dietary interventions to lower LDL-C in the primary and secondary prevention literature, which show no benefit on mortality[8]. Most of these trials did not reduce CVD events and several reported substantial harm. Yet, these studies have not received much publicity. Furthermore, the ACCELERATE trial, a recent well-conducted double-blind randomised controlled trial, demonstrated no discernible reduction in CVD events or mortality, despite a 130% increase in high-density lipoprotein cholesterol (HDL-C) and a 37% drop in LDL-C. The result dumbfounded many experts, sparking renewed scepticism about the veracity of the cholesterol hypothesis[8].

In other words the drugs do reduce cholesterol but don't reduce either heart attacks or rates of death!

That is, they don't work to produce the claimed outcome -- better health.

What's worse is that even when you look at trials the drug industry sponsored for "secondary prevention" (in other words, you already had a heart attack before starting Statins) showed that the median life expectancy increase was....... four days.

Now tell me folks -- would you agree to take a drug after a heart attack if (1) you knew it would cost you some amount of money -- any amount of money -- and (2) that the expected improvement in your survival time was four days if you took it every day for several years?

No, you would not -- and you know it.

Yet not only the drug industry but your doctor have made billions of dollars selling you these drugs without telling you that the expected improvement in your life is four whole ****ing days.

Knowingly failing to disclose a material fact that would have changed your decision had you known it for the purpose of making a profit at your expense has a name: FRAUD.  It is not a mistake, it is a crime.

The paper says:

There is an ethical and moral imperative that the true benefits and potential harms of these drugs are discussed to protect patients from unnecessary anxiety, manipulation, and iatrogenic complications.

Actually there is a legal requirement to disclose these facts, not just a moral and ethical imperative.  It is a criminal event (fraud) to fail to disclose material facts that you are aware of, that disadvantage the person who you withhold the information from and from which you profit.

There is of course a moral and ethical requirement here as well but this is a matter of law, and black-letter law at that.  It is not a close argument, it is not a split decision.  It is black letter, especially when the underlying claim is that taking a particular drug will reduce your risk of a life-ending event and that claim is knowingly false.

Then paper then goes on to talk about another aspect of this, and includes the 20% of obese people who are allegedly "metabolically healthy."  Hmmm.... maybe.  But do we know or are we guessing?  Remember that as a matter of routine most people are not screened for actual insulin resistance.  Indeed I'm aware of no physician that does so nor any practice that claims it's something that should be done.  Yes, your A1c will be tested if there is a reason to suspect trouble and you might also be asked to take an OGTT but while failing either certainly means you're metabolically compromised to in that you're symptomatic for diabetes passing either or both does not mean your insulin levels are normal!

So how many people really are "metabolically healthy and obese"?  We don't know, but I bet it's not 20% -- especially if you're obese for decades.

Then the paper goes on to make another point, which I've repeatedly brought up -- Omega 3:6 balance.  It's impossible to have a decent Omega 3:6 balance if you eat vegetable oils in any material quantity.

So where does this leave us?

Right about..... here.

Or, if you want more detail on the food side, you can try this.

But while you're at it, cut the **** America.  This scam is pervasive, it's international and it is killing people by the millions along with asset-stripping the population to the tune of a few hundred billion a year in the United States alone.

The referenced paper makes clear that this is not function of a mistake it's an intentional lie and that makes it a fraud.

It further is a major contributing factor to the health cost explosion and thus the detonation of State and Federal finances, which if we do not stop it will destroy the country.

Either we as a people demand that this crap stop and everyone involved be both asset-stripped to their underwear and thrown in prison or it literally does not matter what else we do from a finance, budget and government perspective.  And that's no bull.

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2017-07-11 08:46 by Karl Denninger
in Health Reform , 395 references
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Uh, yeah, sure we can't.

Go read that folks.

Now contemplate this: This law is completely unnecessary because the health industry has twice gone all the way to the Supreme Court to try to defend their abuses, once citing McCarran-Ferguson (in the late 1970s and early 1980s) and lost both times.

I've cited these decisions multiple times on this page.

Yet not only will the Federal and State governments not enforce the existing law The Senate has refused to take up this act which passed by near-unanimous consent in the House.

The entirety of how the US Health System operates today is in rank violation of 100+ year old law, as I have repeatedly pointed out in these pages.

Not only will the government not enforce existing law a few-sentence bill to make clear that such enforcement must take place can't even get a hearing in the Senate.

The entirety of our government, from the President down, must either stop this crap and enforce the law against the medical scam machine that currently consumes through its machinations one dollar in five spent in the economy, causing price to collapse and its share of the economy to return to something more-akin to historical levels or both State and Federal government funding will collapse as the exponential expansion that has taken place cannot continue forward as it is mathematically impossible for it to do so.

If you don't understand how and why this problem will soon consume our nation entirely then go read my several-year old article on lilies.  You might wake up.

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2017-07-09 06:55 by Karl Denninger
in Health Reform , 425 references
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This is just flat-out ridiculous:

As Paul explains in his letter, “While I appreciate the inclusion of Small Business Health Plans in the BCRA, I believe improvements could be made to expand upon this provision to allow for greater freedom for individuals and small businesses to pool together for the purpose of obtaining health insurance coverage.”

Under the BCRA, self-employed people could participate in small business health insurance plans, but Paul wants “the language [to] be changed to allow any individual, including self-employed individuals, to form associations for the purpose of purchasing group health insurance.”

Basically what Rand wants is two-fold, although this OpEd only focuses on one of the two points.

This focus is on the ability for any group of people to get together and "form an association" to buy health insurance.

Think about this one folks.  It sounds like a good idea -- your church, your civic organization, your local chamber of commerce, your homeowner's association or scout troop could get together and form an association "for the purpose of buying health insurance", then negotiate with various insurance companies exactly like a business does.

What could possibly be wrong with that, you ask?

Simple: It does exactly nothing to address the cost issues in health care.

Not.

One.

Thing.

The other part of Rand's "proposal" is to allow insurance companies that sell "Obamacare" compliant policies to also sell policies that are not "Obamacare compliant" as they wish.  He alleges this will "bring down cost."

Of course it will -- because it will include fewer covered services and/or have limits on payments.

Again: This does exactly nothing to address the cost issues in health care.

If you want to address cost issues you cannot do so via "insurance", since the cost of insuring something is simply a mathematical function of "p * c + (profit)", where p = probability of the bad thing and c = the cost of the bad thing.

Since nobody works for free as soon as p = 1.0 for any subset of the included risks, that is, anything is included that either has happened or will happen then it is always more expensive to cover that via an "insurance company" than to simply pay cash in any sort of free market economy because nobody works for free.

The only way that can not be true is if there is racketeering and price-fixing involved in the so-called "market" and those acts are illegal under 100+ year old Federal law.

We still have exactly zero attention being paid to the root of the problem.

Let me give you just one small example: You wind up in the hospital and think you're covered because you are at a facility "in network", and further you (or a loved one) was able to call and get it "approved."

Unknown to you a doctor sticks his head in your room and says "hi" every day you're there.  He's not on your insurance company's "list".  You get billed for his "services", which might be nothing more than a 30 second look at your chart daily, to the tune of hundreds or thousands of dollars.  At no time were you informed of this in advance and given the opportunity to refuse his "services."

NOTE THAT THE HOSPITAL HAS EXPLICITLY ALLOWED THIS PERSON IN THEIR BUILDING AND GAVE THEM ACCESS TO YOUR ROOM.

That is, everyone involved conspired to intentionally******you financially by billing you for "services" you neither consented to nor could you have reasonably foreseen would be provided in advance and thus it is not possible to argue you gave informed consent.

What if you called the A/C repairman because your unit wasn't working correctly, and he comes out and tells you that he can fix it, but the parts are $200 and the labor is $150.  The good news is that when you bought the unit it had a 10 year warranty on parts and 50% for labor.  You think this isn't so bad -- you'll be back in business for $75.00.  You give consent and he starts working.

Then, while he's working, another guy shows up and takes a look at the gauges on the AC unit.  He mutters something to the other guy, or writes something down, gets back in his truck and disappears.  You later get a bill not for the $75 you agreed to but for $325, with $250 of it being from the guy who is "out of network".

When did you give meaningful consent to that?  Never.

When could you have given reasonable consent to that?  Never.

If an A/C repairman tried that crap the state would prosecute him under consumer protection statutes that forbid this sort of garbage as an unfair and deceptive practice.  He would not only be put out of business and forced to refund your money he might be jailed.

If all the AC repairmen in the area got together and set up a system to do this sort of thing or allow to happen on a systematic basis via "accrediting" those people they'd all get prosecuted under 15 USC Chapter 1 for price-fixing and illegally tied sales of products or services you did not consent to or ask for.

If they then went further and decided that if you didn't buy their favored brands of Air Conditioners they'd charge you five times as much for a service call every last one of those firms would be prosecuted under felony violations of 15 USC Chapter 1 (the Sherman Act) and would probably face prosecution under federal Racketeering law as well since their scheme is quite-clearly an act of extortion!

Now find me one "conventional" hospital that doesn't operate this way.

Just one.

I'm waiting......

Fix this by simply enforcing the damned law and the cost of medical care drops like a stone.  With it so does the cost of insurance -- for things that haven't happened yet.  For things that have happened the price becomes reasonable and able to be paid in cash or financed by most people.  For those who really can't pay we can figure something out -- but if the price is 1/10th of what it is now, the number of those truly unable to pay will approach zero on a statistical basis and for those who can't pay the cost will be 1/10th of what it is now as well.

We could stop a huge amount of the extortion game played with so-called "health insurance" by passing a one-sentence bill.  You can read it right here.  After passing it insurance companies would have to offer real value instead of threatening you with 10x the charge for not buying, and further, since Medicare prohibits the sort of "drive by" game entirely outlined above ("balance billing") that blatantly and outrageously unlawful practice would instantly cease.

Having done that we can then do this, which will fix the rest of the system -- and most of it is simply a matter of enforcing existing, 100+ year old law that has twice been found applicable at the US Supreme Court.

Any lawmaker who dances around these facts is simply trying to find a way to screw you further, harder and drier -- leaving me to ask "Why do the people put up with a Congress and President that are literally financially raping them daily instead of running them all out of town -- NOW."

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2017-07-06 08:00 by Karl Denninger
in Health Reform , 474 references
[Comments enabled]  

This is getting closer to the mark, but they still won't use the magic words...

About a year ago, I wrote a story about a family that went to the emergency room, had a Band-Aid put on their 1-year-old daughter’s finger, and then were billed $629 for the encounter. Since then, I’ve gotten countless letters describing other outlandish medical bills. These include:

  • A $2,237 bill for liquid stitches and a bandage. This emergency room visit lasted from about 11:30 pm until 1 am, so the hospital billed for two days spent there.
  • A $900 bill for four stitches in the emergency room
  • A $1,000 bill for a pneumonia vaccination delivered in a health care clinic

The list goes on and on. These sky-high prices are what make health care policy a vexing exercise for legislators on both sides of the aisle. Because our prices are so high and the federal government has a limited budget, the architects of the Affordable Care Act settled on expanding access to largely high-deductible health plans. The Republican plans would drive those deductibles even higher, leaving consumers on the hook to cover the pricey services.

Right.

Now how do you justify any of that?

You can't.  Nor can you justify MRIs that are 2, 3, 5 or even 10x or more what is charged in other industrial nations.

But they are.

Then you have this:

Blue Cross and Blue Shield of Minnesota claims that the state’s largest pediatric hospital has refused to accept payment reductions recently adopted by more than 10 other medical centers.

Children’s Minnesota counters that a proposed 33 percent cut to Medicaid rates — one of the biggest sources of revenue for the hospital — would be “catastrophic” and force painful service reductions.

Catastrophic eh?

How many administrators of all sorts -- that is, anyone who never provides any actual care to a person -- have been added by the hospital system over the last 10 years compared with physicians and nurses?

Who makes decisions on what overhead is acceptable?  What can be billed to other people?

In a market system competition does that.

If you try to add 10 administrators for every doctor someone else does cash-only and adds zero administrators.

They don't need 'em, since they only take money.  Their bills are 1/5th yours.  You go out of business.

What kept MCSNet from hiring all sorts of administrative staff?  Exactly that.  If I had tried it my competitors would have pounded me into the dust.  Same with other people who were reasonably called "overhead."

Who stuffed racks with modem servers and cards?  I did.  Why?  Because it didn't need to be done all that often and hiring someone competent to do it when I didn't have a full-time requirement for them would have meant that I would have added a $50,000 salary to the cost side of my ledger but only gotten $3,000 or $5,000 worth of billable value out of him or her.  The rest?  Someone would have had to eat it, and in a competitive market you get tattoed if you make those sorts of decisions.

So you don't.

You analyze every job, every position, every person.  You figure out what you have to have, and what you don't.  You make your decisions and then the market either rewards you for those choices or punishes you.

But in health care we get none of that.

You can't get a price.

You can't negotiate.

You get hospital systems running whine-n-cry ads claiming children will be harmed if they don't get their way.

Imagine what the reaction would have been if I argued that kids would be harmed because I couldn't charge $10/month more for my Internet service.  I would have been laughed out of town.

Folks, this leads to problems like this -- 99% of bills for more than $3,000 going unpaid because they can't be paid.  They can't be paid because you were first charged $12,000 a year for worthless "insurance" on top of which you had to meet a $7,000 "deductible"!

You're already broke, so where you gonna get that sort of money?  $19,000 in a year is approaching 40% of gross (pre-tax!) income for a lot of families.  You can't pay it, so you don't.  You never meet the deductible because you can't pay the charges.  And thus you wasted $12,000 for exactly nothing.

But someone got the $12,000.  And those someones are all over the place.  They're the doctors.  They're the hospital employees most of whom never provide a single second of care to a single person during their career.  Those people were hired at a rate ten times that of doctors and nurses, who actually provide care to people, yet they get paid just like the doctor does.

All of this is enabled by a system that, I argue, is a racket wildly and outrageously in violation of 100+ year old law -- specifically 15 United States Code, Chapter 1, along with state consumer-protection statues which broadly define any scheme to deceive someone as to the price for a given product or service as a criminal act.

Never mind Robinson-Patman which makes illegal discriminatory pricing that reduces competition between buyers of like kind and quantity of goods.  You know, things like stents, drugs, artificial hips, syringes and other common medical supplies?  Yes, those; essentially all of which flow over state lines and thus are subject to federal law since they flow in Interstate commerce.

Has there been one attempt to address any of this by either the State or Federal Government?

Nope.

Not one.

Never mind that this one-sentence bill would stop 90% of the extortion game with insurance companies.

Why?

Because they couldn't force you to buy overpriced insurance of dubious value by having a hospital threaten to charge you 10x as much money if you refuse to purchase that tied product. Instead you'd be charged Medicare's price, which would instantly force insurance companies and providers to quote prices and provide value for the money spent instead of literally shoving a gun up your nose and threatening you with bankruptcy if you refuse to fork over $12,000 for nothing at all in return.

It's not like there aren't answers folks.

What's missing is your demand, along with enforcement via all legal and available means that those answers are taken up, debated and passed into law.

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2017-04-04 09:16 by Karl Denninger
in Health Reform , 713 references
[Comments enabled]  

Let's talk about the implementation of my model bill that I recently posted to reform health care on a permanent basis.

It's fairly easy to envision timelines based on complexity.  Simply put, most of this isn't complex because providers have price lists now -- you just can't see them.  So with that said, let's look at an example and assume The Bill was passed and signed somewhere around 30 September -- or the close of the fiscal year.

What's next?  The following timeline appears to be reasonable.

Beginning immediately on signature with implementation required on or before 1/1/2018:

  • CMS (Centers for Medicare and Medicaid Services; the existing federal agency) would be required to spin up the interface for Treasury to verify whether someone who presents credentials as a US citizen or lawful permanent resident is, in fact, a citizen or lawful permanent resident.  Treasury already has this via the Social Security Administration, since they have the records of all issued Social Security numbers and addresses from tax filings.  In fact you can get at this right now (for yourself) via http://ssa.gov.  CMS also already has an electronic interface system for all medical providers who are registered in order to submit Medicare or Medicaid billing; ergo, the infrastructure is already in place along with access credentials.  Medical providers who wish to avail themselves of the ability to bill Treasury for indigent patients would have to register, but the number of providers currently not registered is a tiny minority of the whole.

  • CMS begins publication of Medicare reimbursement rates for all procedures, drugs and devices.  CMS already has developed and maintains this information so this is simply a publication of existing data and can be done very quickly.  The list may be updated annually as is now the case however with Medicare being a reimbursement source but not a direct billing source as of 1/1/2019 fair notice to all non-Advantage Medicare recipients so they can start shopping providers and services is necessary. (Medicare Advantage customers will have this data from the Medicare Advantage company they select and it may well be different between different Medicare Advantage providers.)

  • Providers must put together their price lists.  They have three months to do so; failure to have and post one as of 1/1/2018 means you're closed!

On 1/1/2018:

  • Providers must post their prices and on demand honor them, along with affirmative consent requirements.  A customer may present him or herself on January 1st 2018 and request the published price.  If they do so then binding, fixed-price treatment per the price schedule and treatment consent rules in the bill must be honored.  Note that all such binding prices must include any consequential events or complications (e.g. those caused by the treatment or the facility in question.)

  • No event caused by a provider or treatment may be billed to the customer.  Alignment of the customer's interest in NOT having an MRSA infection, for example, with the provider's interest in reducing their cost must take place on an expedited basis.

  • "Most favored" nation pricing for drugs begins.  No exceptions, no apologies.  Drug prices drop like a stone.

  • Open testing begins.  If you wish to purchase a test or other diagnostic without invasive exposure beyond a blood draw and not bearing radiation or similar exposure, you may -- for cash and without a prescription or doctor's order.  Since all medical providers must have posted prices on 1/1/2018 you have a list of prices available to you and places to shop from.

  • Auxiliary services must be open.  You can buy said test wherever you want and bring the results to your doctor for consultation or treatment, without limitation.

  • A 365 day period begins during which medical providers may continue to maintain records and coding, but they must also provide human-readable records at the point of service to the consumer.  Since there is basically no medical office in the nation that doesn't have PCs or similar this is trivially done; 3 months is more than enough time to put in place the policy to provide records at the time of treatment to the consumer.

  • CMS and Treasury continue their tax processing and billing integration work with a start date of 365 days hence, or 1/1/2019.  This will be necessary to deal with EMTALA repeal and related from the bill.

  • A 180 day notification period begins during which lifestyle modification is mandatory for those with existing conditions on public medical assistance in order to receive Treasury Billing (and potential medical debt forgiveness at death due to their indigence.)  This specifically applies to Type II diabetes suffers on publicly-funded health programs, although the list of conditions will likely expand.  Those who claim that cessation of eating carbs and PUFAs are not sufficient to bring their blood glucose either under control or materially improve their condition may challenge the individual applicability to them during this time, and must prove same via isolation test (which will likely take less than 48 hours!) with them bearing the cost of the testing in cash if they lose.  Since nearly all of these people either have or should have home instrumentation (e.g. a blood glucose meter), and those who don't can certainly buy one for a few dollars at any drug store including such outlets as WalMart over the counter, they ought to have damn good evidence before attempting to claim an exemption.  These people will also know in advance, or easily be able to determine, if they're going to get caught if they try claiming an exemption and are lying.

  • A 180 day period begins during which Health Insurance companies are required to put together true insurance offerings as required under the Bill to continue selling any health-related policy with effect beyond 12/31/2018.  Since state regulators typically require some notice period (usually six months) this means they must submit same by 6/30/2018.

On 7/1/2018:

  • Medicare and Medicaid recipients with diabetes who have not made the lifestyle adjustments required are cut off from further government funded or transferred billing for their condition until and unless they make the required lifestyle change for at least six months.  They had six months warning and ability.  For the last six months of 2018 the Federal Government, during the remainder of the transition, will see approximately $200 billion in reduced spending. 20% of the adults in the United States have had their pants fall off.

  • Health insurance companies must have posted to the states their catastrophic plan pricing and coverage, along with whatever other offerings they wish to make for the 2019 calendar year.

  • All providers who intend to bill indigent customers must be registered with CMS to provide CMS with sufficient time to process any pending applications and resolve questions prior to 1/1/2019.

On 1/1/2019:

  • Level pricing and quote-before-service (and the procedures for exigent circumstances) for all customers is mandatory.

  • Centralized medical record and coding requirements end and all customers must receive their medical records at the point of service.  The AMA's monopoly on coding revenue (which, IMHO, should have resulted in them being indicted years ago) ends.

  • EMTALA repeal is effective; illegal immigrants no longer can access emergency services at the public's expense.

  • Medicaid repeal is effective at both State and Federal levels; all Medicaid spending ends.

  • Medicare Part "B" repeal is effective.  For "HMO" or "PPO" style coverage post this date Seniors can buy Medicare Advantage policies as they do now but they are not compelled to do so (as they are now.)

  • PPACA repeal is effective; all Obamacare policies, taxes and tax credits end.

  • US Code and CFR amendments to remove the PPACA, Medicaid, and Medicare Part "B" components become effective.

  • Lifestyle requirements continue.  Again, this specifically applies to Type II diabetes where a zero-cost lifestyle change simply comprised of what one eats is sufficient to reduce or eliminate drug and procedure requirements along with the degenerative effects of the condition.

  • All citizens or permanent residents who assert inability to pay a provider now have their bills submitted to Treasury for payment within 30 days.  The customer can choose any provider but the price charged must be level as for anyone else.  Providers who have more than 50% of their customers submitting invoices to Treasury on an annual dollar-billed basis are subject to audit for charges being reasonable and non-collusive (see below.)  The 60 day "no fault cure" policy begins for those who have bills submitted to Treasury due to a claim of inability to pay and tax liens begin to accrue on March 3rd, 2019.

  • For those on Medicare CMS continues to provide the payment rates it will cover to the public for Parts A and D but the customer must submit claim for payment and is responsible for the difference should the price charged be higher than the reimbursement amount.  Medicare customers thus now have an incentive to shop and no restriction on which provider they use for services.  For Medicare customers not using an "Advantage" plan Medicare Part "B" ends both as to the premium collected and benefit disbursed since Part "B" has been deleted.  For Seniors who find themselves unable to afford the portion of payment they must make even with Medicare's typical 80/20 split due to indigence they may assert that indigence just as can a former Medicaid customer and as such low-income Seniors are protected to a much greater extent than is currently the case with Medicare since they enjoy 100% access to all medical providers -- a huge increase in choice compared to today and they have access to the same billing deferral via Treasury that former Medicaid consumers have.

  • For former Medicaid consumers they may assert indigence and thus may access any medical provider as may anyone else who can pay cash.  This is a massive improvement in their access to health services over today as many providers today refuse Medicaid patients (other than via the ER!), but it comes with a tax lien that, should their economic circumstances improve in the future or should they have refundable tax credits, they will be expected to pay.  As a result former Medicaid recipients will, for the first time, have an incentive to both shop and consume medical services wisely.  Many former Medicaid consumers will choose to pay cash, especially for drugs, since a large variety of drugs will be available at monthly costs similar to that of a cup of coffee from McDonalds, but for services where they cannot afford to pay directly the safety net will be available via the Treasury.

  • Private and corporate-funded catastrophic plans, along with any new "PPO" type plans, take effect.  
    With price transparency and no billing obfuscation or "hiding" insurance costs drop like a stone.  Typical "catastrophic" coverage will be available for a few hundred dollars a year.

  • Direct and hidden billing of insurance companies of all sorts, along with "explanation of benefits" nonsense and the implied extortion attendant with same ends.  The customer is billed at a level price as with all other customers for the same good or service; whatever insurance they may have, whether it covers the service(s) provided and how much it will cover is between only the customer and the insurance company.  Collusive behavior, hidden pricing, performance of procedures without prior consent (except in exigent circumstance) and price-fixing disappears entirely.

  • For the first time in 30 years real competition breaks out in the medical field -- not just on price but also on quality of service.  With cost and outcomes exposed customers will be able to research and choose just as they choose a cellphone or automobile today.
  • Non-citizens/non-green-card holders have no right to treatment of any sort nor does any provider have liability for refusal to provide it without payment.  Non-citizens and non-green-card holders (visitors, illegal immigrants, etc) may purchase services and products for cash should they be willing and able to do so.

  • State CON laws and similar are all pre-empted.

  • Mandatory enforcement of 15 USC and the civil rights of action for individual consumers against medical providers for price-fixing, collusion and similar offenses begins.  Note that providers who collude or attempt to defraud Treasury and allegedly low-income customers claiming indigence (who really aren't) are subject to mandatory prosecution and punishment under the Bill.

And.... it's done.

The medical scam has ended.

There are no more Federal Deficits; in fact, we run a perpetual budget surplus and begin paying down the national debt.

Your standard of living starts going up every year even without a raise by about 1% each and every year instead of going down as it does today.

We no longer pay for illegal immigrant medical care at all from public funds.

You get a price that is the same as everyone else for the same good or service in the medical field just as you do at the grocery store, the gas station and the local restaurant.  The outrageous price discrimination (sometimes as much as 10, 20 or even 100x or more) served up on some people -- discrimination that usually bankrupts the consumer in question -- ends permanently.

You know exactly how much you will be billed for a medical procedure, drug or device before you choose to undergo that procedure or accept the treatment.  Your insurance company, if you have one, will have to make available what they will pay and the hospital, doctor or pharmacist must tell you what they will charge.  You will thus know what the total cost to you will be -- before you sign a consent form or have a procedure done.

If you get an infection from a hospital you cannot be billed for the drugs and time to treat that which they gave you due to their incompetence.  That risk and cost is finally on them, which will drive innovation and greater care to prevent such infections that harm and even kill Americans today.

If you can't pay you will still be treated and can still choose your doctor, but you will be responsible to cover the (much more-reasonable) bill if you become able to pay it in the future.  This will permanently put an end to the practice of poor people using the ER like a doctor's office since this sort of abuse will no longer be advantageous compared against going to a regular physician.

Drug prices fall in the United States by at least half (and more likely by 80% or more on an average basis) and for those with chronic diseases that have been sucking down drugs and procedures while refusing to make simple, zero-cost lifestyle changes they finally have a strong incentive to both do so and have their health improve materially at the same time.

There will be no more $300,000 snake bites, $150,000 scorpion stings and $1,000-per-stitch fees that get lumped on you without any way to prevent them when something bad and random happens.  Any medical provider who tries it will find their bill void and they will be prosecuted for fraud.

Obesity and diabetes incidence falls dramatically since it is now strongly in everyone's best interest to practice simple changes in their lifestyle.  An epidemic has broken out -- of people having their pants fall off.  It's a good epidemic and America is noted and lauded as being the first nation to have reversed the increasing rate of obesity and Type II diabetes.

The nation becomes far more productive as the cost of employing someone drops by a solid 15% and America becomes the place to put a multi-national business.  In short labor expense drops tremendously and productivity soars.

If you're not a currently-overpaid administrator you get a raise; for a typical median family it will be about 10% immediately as your employer's cost of having you on staff will drop by at least that amount.  For the average family of four you will see, net of your medical expenses, roughly $7,000 richer in cash spending power after tax each and every year.

Those who are currently-overpaid administrators in health care will find jobs in other sectors.  It may take a while but it will happen, as the economy comes roaring back with the newfound efficiency and productivity improvement from deleting the fraud currently consuming almost one dollar in five.

State and local pensions and budgets stabilize and, over time, taxes come down at the state and local level as the levies put in place to try to stay ahead of the pension destruction are no longer necessary.  Specifically, property taxes decrease materially which will cause both the cost of owning a house and rents to decline.

Your car insurance gets cheaper as your liability policy, much of which covers medical expenses coming from accidents where you are at fault, along with uninsured motorist coverage, will decrease dramatically in cost.

Federal Spending will contract to something similar to this -- and I note that this chart presents a pessimistic estimate. We would almost-certainly do better than what is depicted here and, I remind you, both Seniors and indigent citizens would receive better care and more choice than they have now.

And we prevent this -- our federal debt -- from blowing up in our face as the CBO currently predicts -- an event that, if it occurs, will destroy the nation just a few years from now.

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