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2023-03-25 07:00 by Karl Denninger
in Health Reform , 863 references
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Who's got the nuts to put this on the table in the upcoming elections for CMS and HHS?

No cure, no pay.

Not less pay, no pay.

How different would the last three years have been if Trump had stood up in March of 2020 and given this speech:

We have a novel virus circulating in our nation and indeed the world.  We understand little of it at the present time, but this is America, the land of innovation, and I'm convinced we have the capacity to understand what this virus is doing and how to stop it from being lethal.

We will not learn that in a day, and there are no certainties in life.  We are all mortal, myself included.  But, what we know from history, both here and elsewhere, is that incentives matter and driven men and women will find answers.  We have set foot on the moon and conquered atomic power for peaceful generation of electricity despite both appearing, at first glance, to be impossible.

But since incentives must never make failure profitable under the Emergency Authorities delegated to myself in the event of a public health emergency I am issuing the following constraints:

  • No medical provider will be paid by the Federal Government, and no private insurance concern that is regulated and authorized under federal jurisdiction, including but not limited to PPACA, otherwise known as Obamacare, VA and similar entities, for failure to reach a successful conclusion of a Covid-19 case.  Success means you leave medical care under your own power in essentially the same condition before you were stricken by this infection.  Death is the most-obvious failure -- but not the only one. Death within one year after infection from a covid-related cause, as but one example, is a presumptive failure.  CMS, the VA and all auditing agencies under Obamacare will be directed to examine all such events under which payment is made.

  • The Federal Government will act with all of its authority to facilitate the use by the medical arts of any and all available medical interventions applied to or upon willing patients to prevent, lessen or treat this disease, subject to the above.  No State government, licensing board or other entity shall interfere with the clinical judgment of a physician or other entity in this regard, provided that informed consent is obtained from the person with the illness.

  • The Federal Government will require, and all medical providers shall document via electronic means, which was introduced as a requirement for charting with the PPACA, all such contacts, all interventions, treatments or preventatives that are applied, and the resulting outcomes.  That data, de-identified, will be placed into a public-facing database that is searchable by any member of the public, including but not limited of course to clinicians, hospitals, doctors, nurses and laypeople.  Any attempt to obstruct, delay or otherwise tamper with this data flow and access shall be treated as computer tampering under existing United States federal law and prosecuted.  We trust that the people of this nation, the finest on the planet, will be able to sift through that which works, that which does not, and make decisions on an ever-refined basis until the risk of this novel virus fades.  I call upon Congress to mandate this on a permanent basis and will veto every bill that comes across my desk until it is passed.  We have the capacity to empower everyone, from the lowliest service industry worker up the line, to evaluate and choose countermeasures and treatments for all manner of disease and disorder.  We can do this and we will do this -- right now for this virus, and forevermore for every medical malady that befalls humankind in this nation.

  • For the duration of this public health emergency any countermeasure in the form of a drug that currently requires a prescription and is desired to be used by a member of the public for his or her own personal use shall be made available over the counter at all licensed pharmacies.  This shall not be construed to permit the dispensation of opioids, their analogs, or other scheduled drugs that have substantial addictive capacity, such as methamphetamine analogs used for ADHD and similar.  Pharmacists shall check for drug interactions or known contra-indications should a member of the public desire such a drug and warn against any known interactions or cautions but may not refuse to dispense the drug.  A pharmacist who so dispenses an amount suitable for personal use is immune from all sanction, civil or criminal, for so doing and the outcome of such use and shall label all such dispensations as "at personal risk" conspicuously on the bottle.  Any pharmacist refusing to dispense, or any corporate entity refusing to so permit shall be personally, severably and corporately liable for manslaughter should the person seeking that drug subsequently die from Covid-19.  

Finally, no party in this nation shall violate your Constitutional right to free assembly, engage in interstate travel, worship or commerce -- not now, and not ever in the face of this or any other disease, disorder or virus.  The Department of Justice will bring immediate prosecution against any and all actors who attempt to do so and place all such persons under immediate arrest.  This does not prohibit a state or local health authority from enforcing a quarantine upon an actually-ill and contagious individual but no person shall be deemed guilty by association or inference in that regard and any intent or attempt at mass-declarations are hereby deemed void and whatever federal force is necessary to prevent that from occurring will be used.  We will vigorously enforce the law against all corporate and State actors who take any action whatsoever in violation of the Constitutional Rights of the citizens of this nation, without exception.  There shall be no forced medical treatment in this nation -- not now and not ever.  This is not Nazi Germany and never shall be.  If you have the absolute right to engage in risky personal sexual practices that could kill you, and the Supreme Court has found that indeed you do, then you have the right to refuse any medical treatment or prophylaxis; if other persons are threatened by your mere presence as a result of your decision to refuse or accept some medical intervention they have every right to take the protective measures they deem fit for their person but have no right to force it upon you.  If a prophylaxis will protect you then it will protect those who choose it, and those who do not are free to make that decision just as we allow people to consume any amount of alcohol they wish even though we know that in excess it is dangerous and even lethal.  In a free society individuals make these decisions and accept the consequences.  This is America, that is the precept on which it was founded, and for as long as I am President that principle shall be upheld and enforced with every authority at my command.

America is the finest nation this planet has ever known.  I took an oath to defend and protect the Constitution from all enemies, foreign or domestic; that oath was neither a suggestion or mere political theater.  May God bless America for as long as we respect the foundational principles of our great nation, and for as long as I hold this office I shall do exactly that.

Trump was no man and unfit to be President.  He was a scared mouse believing that a virus was an evil cat about to eat him and everyone else.  That was false, known false within weeks as soon as Diamond Princess occurred and not a thing has changed since.

That speech above, perhaps with a declaration that if we found that another nation was the source due to malfeasance or worse they would be held fully accountable for the final toll of cost in both treasure and money, is what a person who is fit to be President would have delivered.

Trump's failure to do so cost over one million American lives, most of which should not have been lost.  Biden's failure to correct this course publicly before the election and immediately upon taking the office confirms he is no more fit than Trump and equally liable. 

This may have been speculation in March of 2020 but no longer is; it is all now known to be fact.  While retrospection cannot change the past it must guide our future and any person who wishes to sit in the left seat of this nation from the election of 2024 forward must deliver this speech's equivalent right here, right now.

Where is the candidate that will deliver this speech and demand it be backed with force of law, not just a threat to do so by Executive Order, down the road?  Were this to be policy there would be no market for "cancer treatments" that don't actually cure cancer.  You'd have to find answers to whatever is going on or you don't get paid.

The doctor who puts you on Statins and then 10 years later we find no change in all-cause mortality would have all of the funds paid by any PPACA or government program (e.g. Medicaid, Medicare, etc.) clawed back along with all the funds paid for the drugs.  No cure, no pay.

Is "Ozempic" the answer to obesity?  I don't know -- but if it isn't, and the all-cause rate of death does not go down in people using it for "weight loss" the same thing happens.  No cure, no pay.

Can you choose to do it anyway?  Sure!  You most-certainly can; this is a free country.

But if there is no cure, then no subsidized, socialized and forced payment scheme will fork up a single nickel, and during the period of time when something new is going on that we do not understand very well, such as Covid, the people choose -- not the government, not the hospitals, not the doctors and not the pharmacists.  Those who try to prevent you from choosing take personal criminal liability if you are prohibited that choice and then die.  If a threat to your person is in fact lethal then you have every right to make the decision as to which countermeasures you will use and which you will not in a free nation.

You choose, and you accept the consequences since, in the end, all such consequences are always personal.

No?  You won't stand up here and now and enforce all of the above?

Then we deserve to fail as a nation, and fail we shall.

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2019-07-01 07:00 by Karl Denninger
in Health Reform , 304 references
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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 goddamned 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.


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 , 322 references
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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 fucked.

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 buttfucking, 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.


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2018-06-07 07:00 by Karl Denninger
in Health Reform , 340 references
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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 fucked if they need medical care and are over 65 just eight years from today.


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.


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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2017-11-01 12:14 by Karl Denninger
in Health Reform , 511 references
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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-goddamned 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-fuck 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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