Time To Wake Up
The Market Ticker - Commentary on The Capital Markets
2017-03-20 09:09 by Karl Denninger
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Time To Wake Up
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Let's face it -- Ryan and Trump are not going to do anything to actually address the health care mess.

Health care is not about "coverage" or "insurance."  It's about price.

Therefore any discussion about "coverage", "insurance" or similar is an intentional deception until and unless price has been addressed.

The facts are that the federal government spent $1,417 billion dollars last fiscal year between Medicare and Medicaid.  In 1998 the federal government spent $379.95 billion dollars on the same programs.  That approaches a quadrupling of said spending over that time period, and an increase from 23% to 37% of the total. If you believe the bleating from hospitals and doctors about how Medicare and Medicaid "don't cover their costs" then private spending must have gone up at an even-faster rate than spending by the government.

The facts are that we spend twice as much as a percentage of GDP (and per-person, roughly) as virtually the entire industrialized world -- and nearly all of those nations have socialized systems.

Let me remind you that socialism always loses to capitalism, and the reason it loses is simple: There is no profit motive in a socialist system and therefore there is never an incentive to pound your competitor down the street over the head with a Clue-by-4 in the form of price.

Technology is responsible, in the main, for what is called productivity growth.  That's a very simple thing when you get all the wonky economist talk out of it: Productivity growth means doing more while expending less, whether the "less" is money, labor, time or material cost.

If you want to boil it down to what used to be MCSNet's slogan, it's this:

Better, faster, cheaper.

The usual chestnut adds "pick any two", but ours finished with "you don't have to choose."

Only true competition produces you don't have to choose.  Without it technology is a horrifying thing because it can be -- and will be -- used to obscure facts and screw you.

We live in a nation of alleged laws.  Our government has a duty to enforce those laws, and in the context of Health Care that means prosecuting all those entities that collude or screw consumers.  The very existence of an "Explanation of Benefits" statement that shows a "price" of $10,000, a "negotiated discount" of 80% and then some tiny amount you're expected to pay is proof of collusive action that is intended to and does screw you and, I'd argue, Racketeering.

Why?  Because you were never given a price or any way to negotiate it before you had the procedure.  Your "discount" is based on what insurance you have and is concealed from you until after you have already incurred the expense, which is an effective agent of extortion ("either buy this good insurance or get hosed with a smaller discount or no discount at all!")  It is further an attempt to force a tied sale for something that, absent the collusion, you might not have wanted to buy at all (in this case health "insurance.")  And finally without pricing being in the open and level you're either being discriminated against or for and that discrimination is based on what you did or didn't buy from a third party.

Then there are those who openly keep some of whatever "discount" they "negotiated", such as "pharmacy benefit managers."  The classic example is that you have a $20 co-pay for a prescription but you can buy the drug without any insurance at all for $10!  Not only is the pharmacist not required to post a cash price (so you know this before you pull out the insurance card) in many cases he's forbidden by contract to tell you.  Every time you fill such a prescription you get screwed out of $10 simply because you told them you had insurance!

How could you choose which station to pull into for gasoline if none of them ever posted a price and the pump didn't tell you how much it was until after the gas was in your tank?  Worse, what if you had to tell the gas station pump which car insurance you had before it would give you a price after you filled your tank?  How badly would you get screwed on the highway if that was the case?  What if there were no prices on the grocery store shelf -- just a barcode that looked it up but the register never displayed anything except a final total when you pressed "all done"?

What if after you pressed "all done" and were presented a price, having told the grocery store which homeowners insurance company you had they kicked back 5% of your bill to a firm employed by the insurance company -- all because they claimed they gave you a "special deal"?  The "special", of course, was that you paid double for your groceries over claiming you had no insurance at all.

You know the answer to this question -- you'd get reamed every single day.

Here's the other thing you also know: If a grocery store or gas station owner tried that sort of stunt nobody would shop there; they would go down the street.  If they got together so everyone did the same thing they'd all be in jail in an afternoon.

Please explain to me why the doctors aren't all in jail?  Why isn't the hospital administrator in jail?  Why isn't the pharmacist and the owner of the pharmacy in jail?  Why isn't the insurance executive in jail?  Why do not those who work in any of these fields and gain their income by screwing you blind find themselves with nobody who will even sit in the same pew with them in church, say much less find themselves in the graybar motel for the rest of their lives -- with all their material wealth confiscated to provide some restitution to the millions of people they screw blind every single year?

Folks, either this stops -- right now -- or we lose the country.  It's that simple.

On a personal level if you have recently been given some very bad news -- that you are now considered to have a chronic condition that's weight or metabolic disorder-related, or you're overweight (or just plain old fat) and thus clearly at risk for this to happen even if it hasn't yet there are things you can do beyond getting pissed off at the scam (which clearly you won't do, or this would have been addressed by now.) 

You can start by reading here.

And then, you might click here, which will give you (in reverse chronological order) the publicly-available articles I've penned on personal health and are marked as exempt from expiring.

And finally, if you are willing to get off your ass and start demanding that people face the music for what are quite-clear violations of 100+ year old law, you might try reading these articles -- which are (mostly) focused on policy, as opposed to personal health.

But we already know the truth on that last point, don't we?

Nobody, statistically-speaking, is going to do anything beyond possibly reading a bit, and for that reason you better do the first two -- right here, right now, today.

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User Info Time To Wake Up in forum [Market-Ticker]
Keenan
Posts: 239
Incept: 2013-01-11

Western PA
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Karl, as you written, meaningful action requires numbers. I'm in the process of organizing a group of sufficient size to have a meeting with our congressional rep to address medical monopolies in violation of 15 US Code. Preferably in-person but may have to settle for a conference call, given the recent instances of rancorous "town halls".

Thanks for restoring access to your essays for enlightening those still in ignorance.
Tickerguy
Posts: 148161
Incept: 2007-06-26
A True American Patriot!
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I did not restore access; the available Tickers are the ones that I had originally marked "exempt" from rolling off. There are somewhere in the neighborhood of 10,000 Tickers in total, and only a few have been marked "exempt" over time.

The "1 month and it expires" policy I put in place over a year ago has not been modified, and there are no plans to do so at the present time.

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Winding it down.

Keenan
Posts: 239
Incept: 2013-01-11

Western PA
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I understand and thanks for clarifying for me and the Forum.
Mooreupp
Posts: 434
Incept: 2007-10-31

Ohio
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Keenan,
How are you going about organizing a group? I would like to try something similar here, but not sure even how to really go about it. Even with friends and family I feel I have trouble talking to on these things.

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The Constitution is the law. It is not, and was never meant to be a "living document."
Keenan
Posts: 239
Incept: 2013-01-11

Western PA
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Mooreupp:

Start in your neighborhood. Get to know your neighbors well enough and you can talk with them about critical issues such as this. Our host has provided the materials in the Tickers mentioned in this post. Use the ideas but make the words your own, to create your own presentation to persuade others to action.

Once you get one or two people sufficiently convinced that they will advocate for it just as you did, then you can start planning group action. It's a process of building relationships, one convincing just two more, then combining efforts for common purpose.


I've also put a couple of the local talk radio hosts onto Karl's thinking and they've been intrigued enough to have him on air to present his arguments on their call in programs. As you may have seen, our host is quite effective in articulating his thinking and these two radio talkers have had him on multiple occasions. Another way to open up minds to the logic of the message.
Flappingeagle
Posts: 2551
Incept: 2011-04-14

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Well, I'm 4 plus weeks into Keto eating and its so far so good. I haven't stepped on the scale in two weeks, all I know is that I feel better and that I've taken up my belt one hole and I'm close to a second.

The aspect that I'm working on now is cutting some additional protein out of my diet, that is still a little high.

Flap

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Here are my predictions for everyone to see:
S&P 500 at 320, DOW at 2200, Gold $300/oz, and Corn $2/bu.
No sign that housing, equities, or farmland are in a bubble- Yellen 11/14/13
Trying to leave the Rat Race to the rats...
Flappingeagle
Posts: 2551
Incept: 2011-04-14

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Back to the subject of the original post.

Prices are the most important thing in an economy, they transmit volumes of information to the economy's participants. There's only one reason to obfuscate prices...

Flap

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Here are my predictions for everyone to see:
S&P 500 at 320, DOW at 2200, Gold $300/oz, and Corn $2/bu.
No sign that housing, equities, or farmland are in a bubble- Yellen 11/14/13
Trying to leave the Rat Race to the rats...
Als
Posts: 501
Incept: 2010-03-12

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Here is the way to make it work and drastically drop the cost of routine care, lab work and prescriptions.

For Brent Long and his family, paying for healthcare is now like paying a cellphone bill. Since they joined Black Bag Family Healthcare in Johnson City, Tennessee, about two years ago, the family has paid about $150 a month to belong to the practice.

Long joined around the time he was shifting his insurance to a high-deductible health plan. There were two reasons he decided to switch and start paying for all six members of his family to get direct primary care: the cost-effectiveness of not having to deal with copays or urgent-care visits, and the fact that it could easily fit his family's busy lifestyle that doesn't jibe with spending hours in waiting rooms.

Included in that monthly fee are basic checkups, same-day or next-day appointments, and a big boon to patients the ability to obtain medications and lab tests at or near wholesale prices.

Direct primary care also comes with near-constant access to a doctor talking via FaceTime while the family is on vacation, or taking an emergency trip to the office to get stitches after a bad fall on a Saturday night. Because direct primary care doesn't take insurance, there are no copays and no costs beyond the monthly fee.

http://www.businessinsider.com/direct-pr....
Tickerguy
Posts: 148161
Incept: 2007-06-26
A True American Patriot!
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Except that's $1,800/year. Does a family that is nominally well use anywhere NEAR that amount of health care in a year? Not a ****ing prayer in hell.

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Winding it down.
Hstella
Posts: 670
Incept: 2009-08-18

Colorado
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The pitiful thing is that my husband and I pay almost $700 in HMO "health insurance" per month. I've never seen a doctor on that plan. There is no way that we would use that kind of money in such a fashion if it weren't for the "bezzle".
Tickergroupie
Posts: 618
Incept: 2010-03-24

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Health care is being turned into an extra-curricular activity.
You bought the membership so you have to go, right?
Like a season pass to a tourist attraction.

If it ain't broke, don't let 'em fix ya!
Smacktle
Posts: 1800
Incept: 2009-01-20

Texas
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What happens when the doc goes on vacation on a cruise somewhere?

I'd make him go play golf with me or go fishing with me, just in case I have an injury.

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The faults of the burglar are the qualities of the financier.
- George Bernard Shaw
Tickerguy
Posts: 148161
Incept: 2007-06-26
A True American Patriot!
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I think we should just eat him.

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Winding it down.
Mannfm11
Posts: 5336
Incept: 2009-02-28

DFW, Tx
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Maybe it is time to end the agony and let the whole pile of crap in DC fall apart. The 60 vote bull**** locked in the crooks. Government mandated insurance, including tax shelter needs to end. I'm starting to believe we could throw out the entire Congress and replace it with 535 35 year olds with 8th grade educations and no political philosophy and come out light years ahead. The Democratic Party is full of moron crooks and the Republicans are merely crooks. The philosophy of the Democratic Party has no resemblance to the constraints of the Constitution and is closer to a totalitarian state. My opinion is the central government in DC needs to go away, before it destroys the economic wellbeing of 99% of the population.

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The only function of economic forecasting is to make astrology look respectable.---John Kenneth Galbraith
Tat668
Posts: 2776
Incept: 2007-09-08
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"I think we should just eat him"

You meant with a fork?

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"This marks the beginning of the end."- Barack Obama 2-26-09
Steph4liberty
Posts: 2348
Incept: 2010-10-22

Raleigh, NC
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Tat668 wrote..
"I think we should just eat him" You meant with a fork?


Yes, topped with a low carb barbecue sauce.

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"Man will never be free until the last Banker is strangled with the entrails of the last Politician" - unknown

"This isn't a market anymore, it's a computer game." - Drench
Hstella
Posts: 670
Incept: 2009-08-18

Colorado
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One situation where I would support a monthly membership deal for medicine is in the type of situation where very sick people go on a medically supervised ketogenic diet (something similar to Dr. Nally's practice). When people are on a multitude of drugs that they have to be weaned off of, and you have to work through compliance issues (what do you mean I can't have orange juice?), and the population you treat has autoimmune issues, severe heart disease and the like as a baseline, you need a lot of visits, guidance, and tests. I can't believe the number of people who are on 10ish meds. They take meds to counteract the side effects of other meds.
Wis/min
Posts: 5887
Incept: 2009-08-14
A True American Patriot!
On the border
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Sure is getting bright in here.

The hope of daylight or nearing the end?
Nickdanger
Posts: 613
Incept: 2011-06-12

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I heard Loren Spivack on a local radio talk show this morning that was talking about the healthcare issue and basically said the same things Karl has been talking about for the last several years. What a breath of fresh air! The radio host, who is actually pretty good, was very interested and in tune with what he had to say about insurance and the cost of procedures. Host was already familiar with the Surgery Center of Oklahoma, and has talked about it at length on his show. This talk show has a large listening audience, so it may hopefully get some traction. Spivack is going to be in town for a 2-evening seminar next week so I will go check out what all he has to say.

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Grammar: the difference between knowing your **** and knowing you're ****.
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