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2018-06-11 07:01 by Karl Denninger
in Health Reform , 310 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 , 243 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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2017-11-01 12:14 by Karl Denninger
in Health Reform , 501 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!

QUIT ****ING WORKING AT $20,000 A YEAR OF INCOME, FIGURE OUT HOW TO MAKE YOUR LIFE FIT IN THAT EARNINGS LEVEL AND YOU WILL NOT ONLY PAY BASICALLY ZERO FEDERAL TAX (OTHER THAN EMPLOYMENT TAXES, OF COURSE) AND YOU WILL GET CLOSE TO $10,000 OF "HEALTH INSURANCE" WITH A ZERO-DEDUCTIBLE PLAN  FOR UNDER $200 A YEAR.

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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**** you Mr. President and your "Executive Order."

Double-**** you Rand Paul.

There is no "reform" in your Executive Order; selling insurance across state lines and allowing "skinny" plans does nothing to address cost.

You could, via Executive Order, direct the FTC to go after medical providers of all stripes for refusing to publish prices, declaring such an action to be a deceptive practice and thus in violation of Federal Law and Regulation.  Every single business we deal with daily, with the exception of health care, posts prices and thus allows us to shop before we buy.  It is only health care that lacks this essential element of a market and in any other line of work such would have long-ago led to enforcement actions and even indictments.

You could, via Executive Order, direct Jeff Sessions to enforce 15 USC Chapter 1 against all medical firms as regard disparate pricing based on one's insurance status, a clearly-extortionate and illegal act under 100+ year old law which forbids any collusive act intended to limit competition and/or fix prices.  Said law has been challenged twice by the insurance industry all the way up to the United States Supreme Court with the first such challenge in 1979 (Group Life & Health .v. Royal Drug, 440 US 205) claiming an exemption for health insurance providers under McCarran-Ferguson.  THEY LOST.  I have repeatedly heard from myriad "lawmakers" that health insurance and medical providers are exempt from anti-trust; this is a bald lie given that there are two cases which went to the United States Supreme Court and were lost after attempting to assert exactly this claim.  What's even more outrageous is that after the second loss the State of California wrote a section into their BPR code (similar to the federal CFRs) that explicitly exempts health providers from the effects of that US Supreme Court decision yet it is a fact that no state regulator or legislature can exempt someone from a federal law.  That such a claim continues to be made by lawmakers, including Matt Gaetz just recently here in a Town Hall meeting in Florida, is an outrage and a deliberate fraud upon the public in which you are not only complicit you are the chief fraud enabler and promoter.

You, Mr. President, had not one but two items in your platform when running for President that addressed these issues, with one of them requiring the publication of prices.  As soon as you were elected that provision disappeared and has never been seen or heard since.

You're a damned liar Mr. President, and watching you at the dias this morning I want to ****ing puke at the crap you are running on the American people with the full support of Rand Paul, who likewise wants to screw Americans by extending anti-trust protection to all medical providers.  He has in fact repeatedly tried to pass such a provision which would make legal that which currently is not, and which has been ruled illegal twice at the US Supreme Court but which your Administration, just like the previous ones, refuse to enforce.

The actions of this industry are illegal and between them medical firms steal over $3 trillion a year from Americans, enough for each and every American family to afford the payment on a middle-class house.

**** you Mr. President, **** you Rand Paul, and **** you Congress.  

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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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