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2018-07-16 08:50 by Karl Denninger
in Health Reform , 90 references
[Comments enabled]  

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

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

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

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

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

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

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

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

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

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

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

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

It's that simple.

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I've written much on the health scams -- especially pricing.

10x or even 100x as much for a drug here in America as in Canada, France, England, Spain, anywhere else -- all made by the same company.

10x as much paid by one person for the same procedure as someone else.

3-4x as much for an MRI in Michigan if you need it due to a car accident as opposed to falling while walking your dog.

A local hospital here that has been repeatedly accused of gouging people for 200, 300% or more the price of the same procedure performed in a hospital 15 miles south in the same county.  This, incidentally, is the closest hospital to a county jail -- recently our county commission claimed that six-figures worth of medical care for two people detained there -- along with medical costs for their employees, many of whom live near that hospital -- as justification for an 11% property tax hike.

All of this is contrary to 100+ year old felony anti-trust law in the United States, which makes criminally illegal any attempt to fix prices or restrain trade (15 USC Chapter 1.)


Now let me add to this.

There are a fair number of individuals who have intentionally, through their own hand, destroyed their own health.  They then successfully go on disability.  Once being on disability they are entitled to Medicare, even if not yet 65.

These individuals then can, and do, often run up six figure or more medical bills which occur entirely because of their own lifestyle choices. 

I am talking about people who literally drink or drug themselves to death and the slow destruction that occurs lands them in the hospital repeatedly with life-threatening conditions, from congestive heart failure to cirrhosis, liver cancer, sepsis and similar.

They have no money to pay for any of this and it all gets billed back to the taxpayer with the damage continuing to mount both personally and in medical bills for which they are not responsible in any way as a direct result of their refusal to make any lifestyle change -- including ceasing their extreme consumption of alcohol and/or drugs.

We are told we must be "compassionate" and yet this "compassion" comes with forced payment by others at extortionate pricing for whatever it is they might need on any given day.

There are those who claim this isn't all that frequent.  Oh yes it is; never mind that at a half-million a crack 2,000 such people nationally wind up running a billion dollar tab.  May I remind you that last year somewhere between 40,000 and 60,000 people killed themselves with opioids and most of them managed to do a lot of damage and run up a hell of a bill first?

Does anyone honestly think this isn't a $50 billion a year problem -- that would be 10,000 such people nationwide.

Of course it is.  Indeed that's probably a low estimate.

Now add to this Type II diabetes, most of which is directly caused by insane consumption levels of carbohydrates and sugars and which, for 90+% of the people involved, can be either completely mitigated or substantially alleviated by simply stopping that, exactly as someone who is trashing their body through excessive alcohol consumption can stop accumulating more damage by ceasing the consumption of booze.

Again, when you begin to suffer the severe consequences of Type II diabetes, such as blindness, amputations and similar you also become unemployable, you thus qualify for disability and Medicare.

At that point you can mass 500lbs and yet are not responsible for a single nickel of your medical bills, which will inevitably total well into six figures by the time they get done cutting off both your feet and you go through dialysis (the final stage) and die, all of which is quite miserable to boot.  The cost of this is well into the hundreds of billions every single year.

We cannot, in a free society, tell people they cannot drink or eat lots of carbs and metabolically destroy themselves.  Freedom includes the freedom to kill oneself, whether immediately or via slow destruction and lifestyle choice.  We can argue morality and such all we wish but in the end only a fascist government can prevent someone from undertaking such lifestyle decisions.

But it is indeed another form of fascism to force others to pay for these choices and those of us who do so must refuse to do so including enforcing that refusal by any means necessary.

In addition, we must refuse to allow rampant price-fixing, extortion and monopolist felony conduct, all of which is illegal at a criminal level under 100+ year old law, to continue onward and enforce that refusal as well by any means necessary.

In a nation with a Rule of Law those means are quite simple, since law enforcement and judicial process at local, state and federal levels are all sufficient, since these acts are crimes, to put a stop to it.  Every State has an anti-trust law similar to the Federal laws on the same subject they can apply to commerce within their borders -- including medical care, never mind licensing processes at both state and local levels that can be conditioned on non-discriminatory conduct.

In a nation without the Rule of Law it is inevitable that you will eventually have a Civil War if you do not resolve this problem because as these acts of extraction and extortion continue in the name of "profits" and "stock market support" the inevitable point is reached where the majority of the population is unable to retain anything approaching a reasonable standard of living.  When, not if, this occurs -- and it already has occurred in the United States today -- it is merely a matter of time before some material percentage of those permanently suppressed by these scams and schemes decide that if they are going to die destitute, demoralized and destroyed by such policies, corporations and individuals they will make damn sure as many others as possible go to Hell with them.

We are not far from that happening folks and once it does there is no way backMedicare goes broke in under 8 eight years and that assumes no recessions, which never is the case.

When the next recession occurs that timeline will be shortened, through a lack of tax receipts, to an essential zero.

We either act to fix this problem now before that occurs or it isn't going to make a damn bit of difference who you vote for.

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2018-06-20 09:09 by Karl Denninger
in Health Reform , 176 references
[Comments enabled]  

Oh please.

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

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

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

Never mind the reality put forward here:

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

Oh really?  Argument by assertion me thinks.

Where is the evidence?

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

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

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

Again, how?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You're welcome.

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

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

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

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

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

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

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

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


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

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Here it is:

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

That's it.

One sentence.

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

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

It ends the "Chargemaster" ripoff game.

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

It ends the $500,000 cancer treatment.

It ends all of that, immediately and instantly.

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

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

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

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

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

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

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

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

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

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