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2018-12-13 07:55 by Karl Denninger
in Health Reform , 252 references
[Comments enabled]  

No, really, you mean the law really does apply?

Executives at more than a dozen generic-drug companies had a form of shorthand to describe how they conducted business, insider lingo worked out over steak dinners, cocktail receptions and rounds of golf.

The “sandbox,” according to investigators, was the market for generic prescription drugs, where everyone was expected to play nice.

“Fair share” described dividing up the sales pie to ensure that each company reaped continued profits. “Trashing the market” was used when a competitor ignored these unwritten rules and sold drugs for less than agreed-upon prices.

15 USC Chapter 1.

Which has been completely ignored by the Federal Government and its prosecutors now, when it comes to the medical industry generally, for 30+ years.

This, despite the fact that the industry twice, in concert with the insurance business, tried to claim exemptions.  Both of those cases went all the way to the Supreme Court and the medical and insurance industries lost both cases.

So the law does apply, and has been tested.

Doesn't matter.  The drug makers don't care.  They have broken the law with impunity.  And why not?  Nobody goes to prison.

If you think this is just about generic drugs, you're dead flat wrong.  It applies to everything in the medical industry.  The very premise of being unable to get a price as a customer while the very same hospital has negotiated a price with an insurance firm is in essence the definition of anti-trust.  Predatory, collusive behavior intended to prevent you from shopping -- that is, exercising competition.  15 USC Chapter 1 says that sort of behavior is a criminal felony.  Well?

Screwing people who can't negotiate violates all manner of anti-gouging laws that exist on the books in most states as well.  Those laws may have as their predicate natural disasters but few of them actually require that; most require only duress, which is why the motel has to post a sign on the back of the door with the "rack rate" and they can't bill you 10x that, or refuse to give you a price, before you sleep on the bed.  Never mind the implied covenant of fair dealing that is in all contracts and cannot be waived.

None of this stuff is hard to fix.  Enforce existing law and it all gets fixed.  Is it really that difficult?

No.

So why are the states going after this?  Likely because Medicaid comes with an unfunded mandate they have to cover, and it's hurting them.  Finally.

Does the federal government care?  Obviously not, but they damn well should since Medicare alone spent over $1 trillion last fiscal year -- and likely paid close to 500% what they should have.

Yes, you read that right.

But heh, if you won't charge people and actually throw them in prison why shouldn't they break the law, even if the behavior in question has been a felony for the last 100+ years?

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2018-12-02 08:20 by Karl Denninger
in Health Reform , 200 references
[Comments enabled]  

Simply put what we're dealing with here is not "Conservatism" at all: It is instead the promotion of violent, at-gunpoint thuggery in which refusal means death by withdrawal of that which you allegedly need to survive.

A coalition of 55 conservative groups has written a letter calling on the Trump administration to withdraw a proposal to lower drug prices, warning of creating "price controls."

The letter from the groups represents a break between President Trump and conservative allies over the drug pricing proposal unveiled in October, which departs from the traditional Republican position on drug prices.

The letter warns that the administration's proposal "imports foreign price controls into the U.S."

It was signed by leaders of prominent conservative groups such as Americans for Tax Reform, FreedomWorks and the American Conservative Union.

These 55 groups are Racketeers.  They promote not transparency, price discovery and a free market but rather monopolistic control over people's lives.

Technological advancement always makes something of equivalent kind and quantity cheaper.  It is the power behind GDP advancement in the form of what is called productivity.

And in every place where you do not find it in America today and for the last 30 years you will find at-gunpoint command economic features that share one common thread: They're illegal under 100+ year old anti-trust law.

Where that won't do industries have actually gone and gotten special exemptions.  The drug industry, however, does not have one -- except in one place, which is in the prohibition of "reimportation" of drugs.

Let's be clear what we're talking about here: The purchase of a substance that is properly and honestly labeled, is deemed safe and effective by our government, by someone who happens to be across an arbitrary line on a map and who then desires to transport and sell it.

In other words legislated market controls which is exactly what these "55" claim to be against.

Further, there is the example of a Naloxone similar drug in an "auto injector" for opioid overdoses that was jacked up by some 600% in price but only for some people -- those with insurance.  This too is illegal under Robinson-Patman which says that for a physical item that travels in interstate commerce (so the Federal Government has jurisdiction) pricing differentials between buyers of like kind and quantity, where the intent is to lessen or dissuade competition, are illegal.

Well?  Where is the indictment?

Let's be clear: This must stop.  It is already illegal under 100+ year old law.  These "55" organizations are in fact advocating for continued criminal activity and should be named and indicted as co-conspirators.

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2018-11-23 07:00 by Karl Denninger
in Health Reform , 339 references
[Comments enabled]  

The entire "health industry" needs to be destroyed.

Not "reformed" -- there is no reform possible -- destroyed.

Everyone involved at the executive level must go to prison and, if the government won't do it, well..... use your imagination.

Millions of sleep apnea patients rely on CPAP breathing machines to get a good night’s rest. Health insurers use a variety of tactics, including surveillance, to make patients bear the costs. Experts say it’s part of the insurance industry playbook.

The article goes on to point out that not only are insurers and the companies that make these machines getting "telemetry" on your individual use data they're screwing you blind on the price of consumables too because you have "insurance."

Of course said "insurance" usually comes with a deductible, which means for many people you get screwed out of the whole difference in cost simply for having the "insurance."

And they spy on you -- the data from which, I'm sure, will "never" be misused -- right?

If this isn't racketeering, never mind a blatant anti-trust violation may I ask what is?

Oh, and no, health insurance companies are not immune from 15 USC under McCarran-Ferguson.  They twice went to the USSC -- all the way there -- with that argument in the 1970s and lost both times.

So where are the damned cops?

Where is the FBI?

Where is the AG -- federal and all 50 States'?

Why is it that this sort of behavior, which is endemic across the health "industry", hasn't resulted in prosecutions, prison, and if the government won't do it why don't the people find their damned pitchfork and torch?

What sort of stupid is America filled with these days that allows this crap to go on?

May I remind you that you're being hosed all-in to the tune of 500% on health care, generally, over what free market prices?

Think I'm kidding?  Go over to the Surgery Center of Oklahoma and price a procedure (they'll give you a price.)  Now call your local hospital for the identical procedure.  If you can get a price you'll find it it's typically 500% higher -- and in some cases worse.

Oh by the way the Surgery Center has a hospital-acquired infection rate 1/20th -- that's not a misprint -- of most hospitals.  Why?  Because as a "one price, everyone pays the same, cash on the barrel" provider if they give you an infection they have to eat it instead of billing you for it.  This means they're a lot more careful than the hospital is.

While we're at it can I bother you with the fact that roughly 200,000 Americans a year die -- the third leading cause -- as a result of errors committed by medical providers, and the reason that number is so high is that they get paid whether the results are good, bad -- or if they literally kill you.

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2018-06-11 07:01 by Karl Denninger
in Health Reform , 301 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 , 236 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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