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Gee, someone else figured it out?

As the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

What was my number?  80% or more.  And that's without screwing a single person.

The first policy—price tags—is a necessary prerequisite for competition and efficiency. Under our current system, it’s nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing. Patients have no way to comparison shop for procedures covered by insurance, and providers are under little pressure to lower costs.

....

Price tags also insure that everybody pays the same amount. We currently have a health-care system in which providers charge patients wildly different prices depending on their insurance. That injustice will end if we insist on legally mandated price tags and require that every patient be charged the same price.

It's not "injustice" -- it's too many felonies to list, all of which carry hard prison time for everyone involved.

It's extortion to threaten, whether by implication or statement, that unless you buy health insurance you'll be billed 10x as much for the same thing.  Yet that happens all the time.  It also constitutes an illegal tied sale (forcing you to buy another product or service, in this case health insurance, you don't want or you will be disadvantaged) -- this too is unlawful under anti-trust law.

In addition it implicates 15 USC Chapter 1, which carries a 10 year prison term, in that it is clearly an attempt to restrain trade -- how do you have competition when you can't get a price?

15 USC has been on the books for more than a century.  The medical industry has twice tried to get an exemption through the courts and lost both times.

As a side benefit, we will also see massively lower administrative costs. They are currently extremely high because once a doctor submits a bill to an insurance company, the insurance company works hard to deny or discount the claim. Thus begins a hideously costly and drawn-out negotiation that eventually yields the dollar amount that the doctor will get reimbursed. If you have price tags for every procedure and require that every patient be charged the same price, all of that bickering and chicanery goes away. As does the need for gargantuan bureaucracies to process claims.

This is why the politicians refuse to address this and the cops won't arrest.

We have added roughly 400,000 people a year since the crash to the "health care" sector in employment.  Yet a look at the statistics for doctors, nurses and other direct care-givers shows that doctors have barely moved in number and nurses, while they've increased, have only gone up by a few.

All told roughly ninety percent of the "employment" adds in this sector since the crash in 2008 never provide a single second of care to a single person and this did not start in 2008 either; it's been going on for at least the last two decades.

If you put a stop to the scam nearly all of those people instantly lose their jobs.  We're talking about roughly 15% of the economy that instantaneously evaporates.

Now it won't stay gone for long; with much lower costs the resulting economy progress that will follow will set records for years and those people will be hired to do something else.

But the immediate effect of doing this will be a 15% contraction in GDP and the loss of millions of jobs on an immediate basis; the papers will scream "Depression!" (because from the perspective of a classical economic basis it is) and the political blowback in the short term will be extreme.

The second policy—deductible security—pairs an insurance policy that has an annual deductible with a health savings account (HSA) that the policy’s sponsor funds each year with an amount equal to the annual deductible.

There's no need to do that but its an OK adjunct.  Why not?  Because I've got a better answer to that, although HSAs, as they already exist, are certainly a good thing and can be an effective part of the answer.

Oh, and before you say it won't work?

We know this to be true because while price tags and deductible security were invented in the United States, only one country has had the good sense to roll them out nationwide. By doing so, Singapore is able to deliver universal coverage and the best health outcomes in the world while spending 77% less per capita than the United States and about 60% less per capita than the United Kingdom, Canada, Japan, and other advanced industrial economies.

Note that Canada, Japan and the other economies are all socialist systems in whole or part.

I hope that politicians on both sides of the aisle will get behind these proven solutions. Washington should not be a place where good ideas go to die.

They will not unless the only alternative, as expressed by the people, is a gallows being erected on the National Mall or worse.

I've been tracking this trajectory since the 1990s when I was buying health insurance for my staff at MCSNet.  It was glaringly obvious what was going to happen, and I started raising Hell about it.  Nobody gave a wet crap.  Nobody has since.  Despite serving on the EC of the Florida Libertarian Party not one time did I manage to get that into the party platform nor did I manage to get one candidate to run on such a platform.  In my time before or since exactly zero politicians of either major party have done so.

Matt Gaetz (R-FL-01) lied to my face and that of a room full of Seniors at a town hall meeting here about a year ago, claiming that the Health Industry was exempt from 15 USC.  When challenged with the two USSC decisions that say otherwise he promised to get back to me and never did.  He is a liar and a fraud, just as are the rest of the politicians.

Leverage, my book which was published in 2011, pointed out all of these facts and numbers.

Since then I've published a whole series of articles on Health Reform, many of which remain available.  You can get the reverse-chronology reading list right here.

specific legislative proposal to solve the problem can be found here; it contains a link at the end that goes to a second article that describes how implementation would look.  It resolves all of these scams.  Part of it can be done by Executive Order or simply by starting to prosecute providers, insurers and drug companies under 100+ year old criminal felony law.  The rest needs Congress.

Oh by the way doing this eliminates the entire Federal Deficit and the government runs a surplus.

I'm not kidding -- it really does and it really will; that's the math.

So why won't the politicians take this on?

Simple: If you do it nearly all of those 4 million people employed robbing the public lose their jobs and the stock prices of the firms who have made all their money ripping people off, never mind all the billionaires who have done so in the medical and drug industry lose much or even all of their value.

I remind you that Obama claimed he was going to fix this.  He lied.  Trump had three bullet points on his campaign web page that, in effect, would implement most of this.  I said during the election season that I didn't believe a word of it as it all sounded good but lacked the sort of detailed exposition that indicated he really meant it and had studied it.  All three points disappeared on the night of the election as soon as it was called for him; his recent "proposal" has no teeth in that it carries a trivial $300 fine for non-compliance.  He's a known serial liar when it comes to this issue as is every single GOP member in the House and Senate.  The Democrats, for their part, want to enlarge their control over this part of the economy even more than exists now.  When they can't pay for it, which will occur within the next five years, the government will collapse or if you actually need health care you will be left out in the cold to die

I suppose the Democrats consider that "reasonably safe" in that someone ill enough that they'll expire without their "health care" probably is too sick to be able to mount a revolt, never mind that "one nut at a time", which is exactly how the press will present it to you, just gets themselves either arrested or dead.

Again, from the above:

The immediate effect of doing this will be a 15% contraction in GDP and the loss of millions of jobs on an immediate basis; the papers will scream "Depression!" (because from the perspective of a classical economic basis it is) and the political blowback in the short term will be extreme.

Thus the only way this will happen is if the people of this nation as a whole, not a few "nuts", make clear that not implementing this change is worse.

What's worse than losing your job to a politician?

Only one thing: Losing your head.

Thus the people of this nation must make clear as a whole, not a handful nor a fringe group, that either this policy change is implemented or a literal ejection and replacement of the entire government of this nation by whatever means are necessary, up to and including through the use of force, will occur -- a literal "second act" of 1776.

If the people of this nation will not rise and make that demand as a body politic then it will never happen.  In fact, a number of years ago when I met with Senate staffers to discuss exactly this that was what was communicated to me; they had no intention of doing anything like this from both sides of the aisle and the reason was they knew they'd get voted out of office if they did.

Therefore the only means of obtaining that outcome is for the people of this nation to insist that it happens under penalty of worse than being voted out of office.

You don't have to like logic and where it takes you; I certainly don't like where logic leads in this instance.  But whether I like it or not is immaterial to the facts; it is what it is.

All governments exist only with the consent of the governed.  That is the lesson of 1776 and our Constitution.  This fact is clearly stated, in plain English, in the Declaration of Independence.

Our economy currently has one dollar in five spent on health care and 80%, approximately, of that is stolen through these schemes.

The medical and "health insurance" system in this nation is the largest criminal enterprise and organized racket, extracting more money from more people, than any other in the history of mankind.  It personally costs each and every citizen in this nation, man, woman and child, in excess of $10,000 per year and is expanding at a rate of approximately 8% every year, far beyond economic growth and the ability to pay.

The continued existence of this scam is an existential threat to the United States.

It must be stopped here and now.

Whether it is, or whether we instead all go down the toilet together, is collectively up to you.

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2019-11-16 09:23 by Karl Denninger
in Health Reform , 119 references
[Comments enabled]  

You'd be forgiven (maybe) if you didn't pay any attention to the Presser that the President gave on health pricing transparency, given that it wasn't impeachment-related.

Breathless CNN didn't cover it.  Neither did Fox with any sort of density.  CSPAN did, however.  I (mostly) listened to it in my car and had read the published proposal a bit earlier.

You'd be forgiven for thinking that there's a grenade in there that will definitely be stuffed up your ass with the pin pulled.  After all, the health care ETF was up two percent plus yesterday into the maw of this announcement, the exact opposite of what would happen if prices are going to actually come down.

So let's talk about it a bit.

The rules changewhich is sure to run into an immediate lawsuit or 50 by the industry, would allegedly do the following things:

  • Finalize a rule that has been in the pipe for roughly a year now that will require hospitals to show their negotiated prices between insurers and themselves to patients starting in 2021.  What is not clear is whether you'll be able to see all negotiated prices (that is, you'll know that your insurance company pays X, Medicare pays Y, Medicaid pays Z, and the other insurance companies pay A, B, C, D and E) or whether you'll have to know both your insurance carrier and plan code to get anything.  Further, it's not at all clear whether you (or anyone else) will be able to grab the entire bag of data and sift it.  Only a "yes" to both of those will allow you to actually shop.

  • Second, add a rule that will require insurance companies to show you "expected" out of pocket costs before you have a procedure done.  This is a new one and is subject to 60 days of public comment; it has no announced implementation date as of yet.  Most insurance companies will give you this already if you ask (and you damn well should) but the problem with it is that "expected" doesn't mean "binding", even in a "binding estimate" (e.g. subject to 10% variance, etc) format.

The truth of any law is always in the punishment section.  That is, a "law" that has no "or else" is not a law at all; it is a suggestion no matter whether or not it is in the Statute Books.  For a prime example of this look at the Federal Reserve Act which states that the Federal Reserve's mandate is for stable prices.  Well, stable means unchanging and yet Fed Chair after Fed Chair dutifully trots up to the dais and gives testimony to Congress in which he or she states their intent to violate said law, and touts their record in doing so -- that is, they both tout and proclaim their intent to target 2% inflation and have a near-perfect record of actually exceeding 2% over the longer term (the actual record says it's about 3% on a long-term basis, and that's if you believe the so-called CPI!)

How many of said Fed Chairs have gone to prison?  Zero.  Why?  Because there is no or else in the Statute and thus nobody has to enforce it -- and nobody does.  After all, making the stock market go up is more important than following the law, right?

Well, right up until you get a grenade stuffed down your throat it is.

What's the penalty here?  $300/day.  Garbage, in other words, and that assumes anyone actually brings a case to collect it, which for $300/day isn't worth it.  How many hospitals would simply add the $109,000 a year in "fines" to your bill on a ratable basis and shove that up your ass instead of complying?

Probably all of them.

Note also what was missing: No threat to enforce 15 USC Chapter 1, which already exists, has twice been challenged to the Supreme Court for health-care firms and both times the health and insurance industry lost.  In other words we already know that 15 USC Chapter 1, which provides for one hundred million dollar fines for corporations per instance and ten years in prison for all persons involved, applies to this conduct.

Now enforcing that not only requires no comment period it almost-certainly couldn't be successfully challenged legally either since the precedent has already been set all the way to the Supreme Court and, while I certainly expect the medical industry would try to appeal all the way up (after all, the alternative is to quit screwing you up the ass and the related firm's stock prices would collapse) they'd almost-certainly lose since to do otherwise the Supremes would have to overturn not just one but two prior precedents.  That's unlikely enough to be in the realm of fantasy-land nonsense.

So why did Trump do this?  For the same reason he listed three almost-identical items on his 2016 campaign web page, all three of which disappeared on the night of the election: He is a lying piece of **** and is trying to use this for the 2020 election campaign

Proof I'm right?  The Health Care ETF was up over 2% yesterday right into the maw of, and during this announcement.

There is a fix for all of this and it's right here.  Note that exactly zero of that was found in these "proposals" -- not even the you must post a price and everyone pays the same price rule, which incidentally applies to every single item at WalMart and every gallon of gas at the corner station.  Gee, it's so complicated -- NOT!

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2019-11-10 07:00 by Karl Denninger
in Health Reform , 229 references
[Comments enabled]  

This pair of thieves -- the adults -- ought to be in prison.

Right now.

They are stealing from you and I.  They demand to do so at gunpoint.

Trikafta took three decades to develop. Scientists first isolated the genetic defect that causes cystic fibrosis in 1989. Vertex, which developed the treatment, has set a high price tag for Trikafta, at $311,000. But a treatment that can extend life expectancy for cystic fibrosis patients by decades, while also improving the quality of life for my daughter and patients like her, is still worthwhile even at that price.

It's not $311,000 once, it's $311,000 per year, forever.

I assure you that neither she or her daughter have that kind of money.  Her daughter is five.  If she lives to 80 she will steal $23 million dollars from others in order to live to 80 and have this medication.  Of course that's pie-in-the-sky bull****; there are no long-term studies on any of these molecules, and while a 10-20% improvement in airflow into the lungs is very impressive whether that's permanent and what other bad things may come are both undetermined.

But let's assume the best, for the moment.

The bottom line remains simple: Nobody has the right to steal $23 million from anyone, ever, period, and those who do deserve prison, the gallows -- or both.

Those who try to steal $23 by force often discover, quite lawfully, that the answer to such a demand is "bang."

So why do we tolerate someone trying to steal $23 million by parading around cute children as their weapons that are shoved in your face.

Don't get me wrong -- I feel very badly for anyone with a chronic disease like this and there are, sometimes "treatments" developed.  We don't know what the long-term side effects are of them because they haven't been around long enough to know, but that they produce benefit right now isn't the question.

The question is whether the current model of medicine, which institutionalizes extortion and theft at gunpoint from others such that your health "insurance" costs $10,000+ a year can be defended or whether those who advocate for that level of theft from you, especially when they use cute children as props for their schemes, should be free to roam among us or ought to be charged with felony child abuse and locked up -- or simply told "No" or perhaps something even more-forceful -- like "**** you."

There are answers to these problems that don't involve such types of theft but notice how none of the cute children paraders are interested in those.  That's because they're thieves and don't give a wet crap about how they get what they want, just like any other thief.

One of those potential solutions is to publicly fund this sort of research instead of allowing people to do what they do now, which is to piggyback on NIH (publicly-funded) primary studies and then steal all the money from when they refine that primary work forward.

Global pharmaceutical R&D spending was roughly $200 billion last year.  Drugs discovered for one benefit all with the same condition, no matter where they live.  Therefore there is utterly no reason for the United States to spend one penny more than our ratable portion of this based on our population, since, we are all told, there is no person who is worth more than another.

We are about 5% of global population; 5% of $200 billion is $10 billion.

Fine.  Fund that out of the Federal Budget; it's about 2/3rds of 1% of Medicare and Medicaid spending today.

Every other nation is then expected to kick in their piece.  If they don't, no drugs for them -- at all.  This isn't a negotiation; fork it up or get nothing, ever, period, and we'll enforce that at gunpoint if we have to.  We spend $700 billion a year buying weapons, delivery systems and people -- you either pay your share or we'll blow up any attempt to circumvent the blackballing of your nation's access to pharmaceuticals.

The exchange on this is that by paying your fair share of R&D based on population there are no patents on pharmaceuticals anywhere in the world; all molecules are publicly published as are the trial results, anyone can make them and sell them, anyone can cross-ship them between nations as they wish, and now we have competition so the price falls to that of reproduction plus a modest profit around 10% since R&D has been publicly paid for and there is no reason to set prices like this.

I know, you'll claim I'm a communist.

Nope.

I simply refuse to let this evil bitch and her husband steal $23 million from Americans so the ****ing Chinese and Indians, along with damn near everyone else can have the ******n drug for nearly free, exactly as occurred with Sovaldi.

I'm willing to go to war over this right now and you should be too because if this crap is not stopped by 2024 the Federal Government's budget will collapse -- and that's a fact.

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2019-07-01 07:00 by Karl Denninger
in Health Reform , 291 references
[Comments enabled]  

Watch this one folks.

$400 vials of insulin.

$25 for the very same vial in Canada.

CNN points out that the manufacturers, of which there are three, intentionally do not enter competing lines of business and thus there is no competition between providers.

On purpose.

Intentionally divvying up markets like this is a felony.  It has been a felony since the late 1800s -- more than 100 years.  The Sherman and Clayton acts, known as 15 USC Chapter 1, declare such practices or any attempt to engage in them federal criminal offenses carrying 10 years in prison for each person so-involved.

The number of criminal prosecutions in the medical and drug sector over these obvious, blatant criminal acts number zero.

The media calls this "greedy" as do "activists."

They do not call it what it is under more than 100 year old law: Felonious.

They do not ask: Where are the ******ned handcuffs and why aren't the executives in prison?

They do not call for prison terms -- right now.

They ignore, as do the activists, the clear statement of law found in 15 USC Chapter 1.

There is no "hard" problem here to solve.

You need only jail a few executives and all of this bullcrap will stop across the medical industry instantly.

Well?

If the government will not do its job then why do you sit back and whine and run "human interest" stories instead of storming the Halls of Congress and State AG offices, along with demanding that both the FBI and State Cops raid these firms and arrest all of the executives inside, shuttering the buildings and chaining the doors closed until this blatant and obvious lawless behavior stops?

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2018-06-11 07:01 by Karl Denninger
in Health Reform , 317 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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