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2018-04-20 07:00 by Karl Denninger
in Health Reform , 153 references
[Comments enabled]  

Pick one folks.

Those are the only two options.

The "entitlement" game is back on, of course.  But let's toss something else into the mix while we're at it -- the that that it has now been admitted that actually curing people is not, and never will be, the goal of our "medical scam, er, system."

The translation: if you develop a new drug that cures people rapidly, then patients will not need to take the drug on an ongoing basis, and that limits the amount of money a company can make.

The analyst asks: "Is curing patients a sustainable business model?"

The "problem" appears to be particularly great if the disorder in question is a transmittable disease. 


Their introduction (Sovaldi, was a landmark event -- for two reasons. First, they provided a near-certain cure for hepatitis C in 12 weeks. Fantastic! Second, they were among the first of a series of drugs to be priced at exorbitant levels. When Harvoni was introduced, a 12-week course in the U.S. cost $94,500. Interestingly, in India, the same 12-week course of treatment cost only $900. (I assume that the company was still making a profit on its sales in India.)

Was this outrageous pricing good enough for Goldman Sachs? Apparently not.

Therefore we cannot actually cure any transmissible, but chronic, condition.  If you do then there are no new patients and no more money.  Q.E.D. that won't be the model that is pursued.

It gets even worse when it comes to cancer:

Over the last five years, cancer research has seen the “greatest advances,” including a new approach to treating the complex disease as a “chronic disease,” instead of trying to cure it.

“We have seen the greatest advances in cancer medicine in the last five years with drugs targeting the immune system moving into the clinic and showing remarkable response rates with quite a few different malignancies,” Lisa Coussens, Ph.D., Chair of the Department of Cell, Developmental & Cancer Biology, said to Fox News at the American Association for Cancer Research annual conference.

However, the response rates do not indicate that medical doctors and scientists are getting closer to a cure – or if that is still the goal.

“With regards to a cure for that, it’s really not a realistic goal. I don’t know if cancer is a disease that can be cured. I think for most of us, the goal is management where we think about cancer like other chronic disease,” Dr. Coussens said. “50 years ago diabetes was a death sentence, now it is a chronic disease that is managed.”

Of course that "management" means ever-present cash flows for the rest of the person's life.

And pay attention to this specific statement form the American Cancer Society:

“Cancer isn’t always a one-time event. Cancer can be closely watched and treated, but sometimes it never completely goes away. It can be a chronic (ongoing) illness, much like diabetes or heart disease,” the website says.

Uh huh.

You mean like diabetes, specifically Type II diabetes, right?

Type II diabetes has a near-zero cost means of containment if not reversal, available but nobody is out there in the mainstream advocating it.  It's simply this: Stop eating carbohydrates except for green vegetables.

It works in nearly everyone who does it and it costs nothing.

But the medical system refuses to put this out there and so does the government as the primary means of addressing that condition.  As I pointed out quite some time ago in The Low-Hanging Fruit this one condition is responsible for about 25% of all Medicare spending -- and a likely similar amount off Medicaid.

Last year the Federal Government spent $1,443 billion on those two programs.  The states spent an additional $204 billion on Medicaid matching payments (their "share" of the total in 2016; I do not have 2017 numbers available yet.)  That totals approximately $1,600 billion dollars; getting rid of $400 billion of that overnight would make an enormous different in the federal budget deficit (in fact it would wipe out two thirds of last year's deficit entirely!) without disadvantaging one person -- in fact their health would improve and morbidity in the form of blindness, amputations and disability would massively decrease.

But literally nobody has, since I published that article over a year ago, picked up that ball and attempted to run with it at either the state or federal levels.  Nobody -- and I do mean nobody -- in any of the government roles involved will do anything to tamper with the over one and a half trillion dollars a year that the medical scam imposes in cost on the public even though it is not just a monetary cost it is also a human suffering cost that these policies promote and enhance.

This crap has gotten so brazen that now even Goldman Sachs and the American Cancer Society are willing to come straight out and state, in public, that the model of "medicine" is not to actually cure or fully mitigate diseases and conditions any more -- it is, rather, to develop drugs and therapies that have the exact same profile of consumption as an addictive drug in that the person in question becomes compelled to spend on same forever.

We already have such drugs -- they're called opioids and the drug industry makes billions selling them.  The problem is that they have both a tolerance response and a lethal dose; perpetual, life-long use thus has a high probability of the two curves intersecting at which point the person taking the drugs dies and doesn't buy any more of them.

But if you can find a way to effectively compel someone to take expensive drugs for cancer or diabetes forever, without that "coffin corner" problem then you can effectively "addict" them without the "side effect" of their eventual accidental suicide.


The people promoting and practicing this need to be exposed for who and what they are and then put into a plastic chipper -- feet first.  We must put a stop to this, right here and now.  The option to defer that choice no longer exists; we have state pension fund shortfalls driven to a large degree by these ruinous policies and "expenses" that have exactly nothing to do with the best option available for people at large but rather are intentionally designed to screw the public out of trillions of dollars a year and keep them sick.

The entire business model of so-called "medicine" in this country is a scam.  We can collapse that business model and expense by 80% almost overnight starting with The Low Hanging Fruit and moving on from there to a few simple legislative and law enforcement changes.

We either do it -- and do it now -- or the United States will fiscally collapse as the ever-spiraling higher percentage of GDP consumed by these rapacious bastards will overtake government and private revenue at both a state and federal level.  There are real proposals available to do so, starting here and here.

There is no "entitlement problem" with Social Security.  The entire problem lies in the medical system and its business model which must be changed using existing Anti-Trust law along with voiding all special protections they have gotten passed, such as preventing cross-border drug price arbitrage.  If we do not begin to execute on this now the point of no return on both the state and federal side will be reached and that will be the end of our ability to deal with this other than by government fiscal collapse, massive civil unrest or even civil war.

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2018-04-15 13:10 by Karl Denninger
in Health Reform , 189 references
[Comments enabled]  

This is utterly insane -- that a so-called "newspaper" can publish this sort of factual lie and not immediately be bent over the table and, well, you know -- is outrageous.

A group of distinguished economists from the Hoover Institution, a public-policy think tank at Stanford University, identifies a serious problem. The federal budget deficit is on track to exceed $1 trillion next year and get worse over time. Eventually, ever-rising debt and deficits will cause interest rates to rise, and the portion of tax revenue needed to service the growing debt will take an increasing toll on the ability of government to provide for its citizens and to respond to recessions and emergencies.

..... (goes on to talk about the claim that this is mostly about entitlement spending growth)

Entitlement programs support older Americans and those with low incomes or disabilities. Program costs are growing largely because of the aging of the population. This demographic problem is faced by almost all advanced economies and cannot be solved by a vague call to cut “entitlements” — terminology that dehumanizes the value of these programs to millions of Americans.

And there you go with the lie right there.

This is what happens when you allow very wealthy people who got that way by cheating anti-trust law for a couple of decades to enter the world of so-called 'news' and distort the truth on purpose.

Their first weapon is to lie.  The second is to label anyone who tries to oppose their position on anything by calling them names and attribute to them an intent to "de-humanize" people.

The truthwhich is trivially discernible from simply looking at the budget and as-spent in the Monthly Treasury Statements over time is that indeed it is specifically the explosion in spending in Medicare, Medicaid and SSDI (the portion of Social Security that is "disability") that is responsible for the entire problem.

SSDI is a particularly-insidious issue in that any sort of dispassionate analysis reveals two facts that nobody will take on honestly: (1) Disability recipients go up massively during recessions and (2) once on disability nearly nobody ever leaves the program.

The problem is that there is no plausible organic explanation why people "more often" become actually disabled during recessions.  Instead "disability" becomes a replacement for unemployment compensation either up front or when the checks run out; that is, those people aren't actually disabled as the program allegedly requires.

In other words, to be blunt, these "explosions" of alleged disability are fraud.

But the other two problem areas -- Medicare and Medicaid -- are real.  And here again is the claim:

Program costs are growing largely because of the aging of the population.

That is a lie and it is a knowing one.

Medicare is for old people (aging of the population.)  Medicaid is for poor people who are neither on disability (if you are you get Medicare irrespective of age) or 65 (old.)

Yet the Medicaid spend has been increasing at nearly the same rate as Medicare.

If the ramp in these costs was largely due to the aging of the population the entire problem would be focused on Medicare.  It's not, that's trivially discernible by looking at the MTS over the last few decades' time and all of these so-called "distinguished" people know that.

They're lying.

They're lying to protect medical monopolists who are breaking 100+ year old anti-trust law on a daily basis and, in addition, who have lobbied for explicit protections from some of those laws -- such as making it a crime for you to cross a border and fill a suitcase with prescription drugs you can buy from the same factory but at 1/10th or even 1/100th of the price here in the US and then return to sell said drugs -- which would instantly collapse the price here.

What's worse is that the Washington Post, owned by Jeff Bezos, is basically shilling for the company that Jeff Bezos runs (Amazon) that wishes to insert itself into the medical monopolist game and siphon off a few trillion more for itself.  In other words the owner of the so-called "newspaper" is chuckling while his publishing property runs interference for and lies about the bankruptcy of America and our federal budget so he can personally steal a few hundred more billion dollars while the rest of us watch the nation literally burn its fiscal house to the ground.

There are fixes for this problem that I've published on repeatedly.  I wrote on them in Leverage.  I've been raising Hell about this since the 1990s.  And there are specific proposals to be found right here, in these pages.  You can start here and here, for two examples.

Nobody on either side of the aisle wants to take this on because they're all being bribed by both the so-called "jobs" created through this theft and scam along with direct lobbying.

When will the people of this nation hold to account those who have been and are screwing you blind on a daily basis?

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No, really?

Public Citizen’s Health Research Group today released an updated report cataloging all major financial settlements that the pharmaceutical industry has been forced to sign with federal and state governments from 1991 through 2017 for illegal activities.

The report shows a dramatic decrease since 2013 in both the total amount paid and the average penalty. Additionally, it found that state governments have virtually stopped prosecuting pharmaceutical manufacturers on their own initiative and with their own resources.

The companies paid fines for law-breaking such as marketing drugs for unproven uses and paying kickbacks to doctors.

Not only are fines just a cost of doing business but the amounts and number of such prosecutions are decreasing dramatically, while the behavior has not gone down -- it's gone up!  Indeed, the criminal financial penalties have dropped by 90%.

Any why not keep doing it?

We all know robbing banks is illegal.  Let's assume that instead of throwing bank robbers in prison we instead made them pay back just 5% of what they stole.

You wouldn't be able to actually get to a teller in the bank unless you were willing to wait for the five bank robbers in line in front of you to finish their "jobs"!

This is so blatantly obvious it's disgusting, yet nobody -- and I do mean nobody -- cares.

The problem is that eventually the people will care, and some subset of them, even if a very small subset, will start taking their own idea of "justice" to said individuals and those who protected them.  There is little or nothing the government can do if and when a group of citizens, or even just a few individual citizens, decide to spend their remaining life all at once obtaining redress for what the government refuses to prosecute, despite it being illegal conduct.

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2017-11-01 12:14 by Karl Denninger
in Health Reform , 499 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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