My favorite clusterfuck!

http://kunstler.com/clusterfuck-nation/r....

@Tickerguy:

Nice kitty!

Hi Karl, new registrant, first time poster. My father who passed a bit before his time used to read your blog regularly and subscribe to your news letter. He was a CPA, a very smart guy and fairly conservative politically so as much as I loved and respected him we didn't always see eye to eye on matters. We had some fun debates. I miss him. He and I were different people from different generations who lived different lives with greatly varying experiences. He used to forward me a lot of your posts which I enjoyed.

I just finished reading through your last several posts on Healthcare reform and the ACA etc. and I must say your analysis is extremely insightful and intelligent. I just read your last post on how to fix the system and I could get onboard with 99% of your recommendations, but there is one huge glaring, inescapable error that I am surprised you missed:

As you astutely noted at the end of your post, "The problem isn't that health care is "expensive." The problem is that it's a rip-off and is laced through with fraud, theft and arguably even racketeering from top to bottom." Very accurate observation indeed, and I would agree the healthcare industry is chock full of greedy criminals. Insurance and pharma CEOs being among the very worst. I cut and pasted your list of policy prescriptions into MicroSoft Word and your post was approximately 7500 words and 24 pages long. In the absence of a massive, beastly federal agency created to enforce your manifesto who exactly is going to make the criminal mafia profiteering from our healthcare industry comply with the new law of the land? Assuming you could get your common-sense, clean-up-the-healthcare-racket bill passed and a huge new federal agency to enforce your bill created, then what? How do you stop the lobbyists and Pharma billionaires from buying Congress and judges then suborning the new agency, and eventually wrecking it from the inside before the public is ready to abolish said agency for being ineffective and corrupt? I mean that is the business party playbook from the last 30 years, no?

I propose something much more simple and likely to succeed instead- Medicare for All, everybody in, nobody out. Seven simple words. The entirety of my idea. Remove the profit motive and remove the temptation for humans to extort plunder when given the opportunity to withhold life saving services. Deliver healthcare to Americans as a basic human right and a public utility like every other civilized nation on earth, fixing the out of control cost problem while providing every man, woman and child with a universal, non-means tested benefit. I know, I know. It's socialism. But seriously what's not to like? The Norwegians and the Swiss are stinking socialists- can't we at least deliver universal healthcare for the same cost that they do? Their healthcare costs are half of ours here and beer cost something like twelve dollars a pint there! America is at least as good as Norway right?

You're a very wise and smart man Mr. Denninger. Take off the idealogical strait-jacket. Our health insurance system is a classic free-market failure. I have been doing my banking with a non-profit credit union for two decades now and so far I haven't seen any other dangerous signs of communist creep in my life. We can have socialized medicine in the United States and still be a capitalist democracy. However, I'm not sure we can stay a capitalist democracy without single payer healthcare. As you have pointed out, our current "free-market" healthcare system is set to bankrupt the county very soon without radical reform.

Quote:

I cut and pasted your list of policy prescriptions into MicroSoft Word and your post was approximately 7500 words and 24 pages long. In the absence of a massive, beastly federal agency created to enforce your manifesto who exactly is going to make the criminal mafia profiteering from our healthcare industry comply with the new law of the land?

There are actually just a handful of bullet points (I counted 17.) The rest of the text is EXPLANATION -- the WHY to go with the WHAT.

Quote:

I propose something much more simple and likely to succeed instead- Medicare for All, everybody in, nobody out. Seven simple words. The entirety of my idea. Remove the profit motive and remove the temptation for humans to extort plunder when given the opportunity to withhold life saving services. Deliver healthcare to Americans as a basic human right and a public utility like every other civilized nation on earth, fixing the out of control cost problem while providing every man, woman and child with a universal, non-means tested benefit. I know, I know. It's socialism. But seriously what's not to like?

That you can't pay for it.

This is your problem with that idea:



The EXPONENTIAL expansion of expense EVERY YEAR has led to this.



That is all CAUSED by Medicare and Medicaid (first graph.) Every bit of it. That's the math.

That same program you wish to shove everyone into is what's blowing up the government budget and will destroy the finances of the nation. That has to stop yet your "proposal" is to make it incalculably worse.

Try to extend that train wreck to everyone and the entire government comes down. Do nothing and leave the system as it is and it comes down in 5 to 10 years. Try "Medicare for everyone" as you propose and my best guess is that it'll be about 3 years.

Then you'll get nothing. Or worse, the people who really need it will get nothing. Millions will die, and most of them will die horribly.

And if the nation fractures over it? You'll probably die; if not from the lack of health care, from your neighbor who decides to eat you.

Yes, it's that serious, yes, this is that real, and yes, this is where the current system -- driven by Medicare and Medicaid at a federal budget level -- is going.

Adding to that isn't political suicide it's LITERAL suicide.

This isn't ideology or politics.

It's MATH.

PS: NHS in England (socialist) is in serious financial trouble. So are the others. In addition, if you want to know how they've gotten away with it until now you need only contemplate drugs like Sovaldi that are 200-1,000% more expensive here than there. Level price enforcement, which is one of my bullet points, will instantaneously blow up their little socialist game -- which has only been able to "work" as long as it has because we in the USA have been paying their bill. Socialism is especially nice when you shove the cost off on someone who doesn't live in your country. It fails miserably when that blows up in your face. Go ask the USSR about how it all worked out for them.

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Trinityalpsgal wrote..

My favorite clusterfuck!

http://kunstler.com/clusterfuck-nation/q....]

Kunstler is hitting on some of Karl's points. He was on Tucker Carlson a couple weeks ago. Maybe he could be a conduit to get Karl on Tucker?

From the article:

Quote:

The US Senate needs to set up an equivalent of the Pecora Commission to thoroughly expose the cost racketeering in medicine, enable the prosecution of the people driving it, and propose a Single Payer remedy for flushing it away. The Department of Justice can certainly apply the RICO anti-racketeering statutes against the big health care conglomerates and their executives personally. I dont know why it has not done so already except for the obvious conclusion that our elected officials have been fully complicit in the medical rackets, which is surely the case of new Secretary of Health and Human Services, Tom Price, a former surgeon and congressman who trafficked in medical stocks during his years representing his suburban Atlanta district. A new commission could bypass this unprincipled clown altogether.

Earlier in the article he says the alternative to single payer is small clinics without all the technology, but I think that is not correct. It would be more like Karl is proposing.

Single Payer will not work. Without price transparency and competition Single Payer will simply squeeze the budget until they draw a list of all the things that go wrong with the human body, put a price to treat all of them (of which they'll know item by item since they're paying the whole bill), order them by prevalence (most votes wins, right?) and when the money runs out they draw a line there.

Fall under the line? You're fucked.

Completely, utterly, 100% fucked.

That's what single-payer will do, and the line will move UP every year, because at 8% compound growth in cost it has to or the government literally fails to finance itself and collapses.

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I agree with the concerns about excessively high obstacles for becoming a qualified doctor, and about the impossibility in many situations of determining what is wrong with someone and predicting how much work will be required to fix the actual problems, not all of which can be known without a lot of further work and attempts at treatment.

I support Karl's approach to insisting on proper self care regarding eating fewer carbs for all those who face type 2 diabetes and similar problems.

Preventative health is vastly better and cheaper than trying to mend the damage caused by avoidable behavior. Preventative health in terms of education, food regulations and insistence on self-care as part of medical care should go much further:

Everyone in the West should reduce their sodium (salt) intake and increase their potassium intake, including by use of supplements such as water-solutions of the almost tasteless potassium gluconate. This is because the excessively high sodium to potassium ratio which pretty much everyone in the West consumes is proven to cause hypertension, heart disease and stroke:

http://advances.nutrition.org/content/5/....
https://www.goodreads.com/book/show/1120986.The_High_Blood_Pressure_Solution

Increasing potassium levels may also reduce anxiety and improve mental health. Refs at: http://woman.thenest.com/can-low-potassi.... .

Anyone who smokes (tobacco or cannabis) shouldn't, for numerous obvious physical and mental health reasons.

Alcohol is a carcinogenic depressant. Anyone who drinks it regularly is setting themselves up for long-term depression problems, as well as increased risk of breast, colon and other cancers. It is a major factor in road injuries and deaths.

Most people use alcohol, cannabis and tobacco to reduce anxiety. Surely there's enough things in modern life to make us anxious. While it is true that a certain level of anxiety is natural and desirable, there is a huge, systemic, unrecognised (and actively denied) problem in that most people use caffeine every day of their adult (and sometimes adolescent) lives. This is a sleep disruptor, drives tiredness (and so road accidents), drives restless legs syndrome (immediate reduction and longer term increase of symptoms), drives road rage, aggression, domestic violence and probably war-making decisions by politicians.

So anyone seeking therapy or drugs for anxiety problems, especially PTSD, OCD or anything resembling borderline personality disorder, should be required to reduce and eliminate their caffeine consumption (and go easy on the dark chocolate).

Almost everyone needs vitamin D supplements, since the only way to get enough is via regular UV-B exposure which also drives skin cancer. Vit D is vital for good mood, reducing cancer and numerous other aspects of health. https://www.vitamindcouncil.org/ It is an extremely inexpensive supplement (see 50,000IU capsules, one every two weeks or so). This is especially important for people with dark or black skin, and for pregnant women, since low vit D is arguably a significant cause of autism and perhaps schizophrenia: http://www.abc.net.au/news/2016-12-14/au.... https://www.scientificamerican.com/artic....

Most people need more exercise and would benefit from ingesting more omega 3 essential fatty acids (fish and algal oils).

Most people get too little light (especially blue light) in the day, and too much (via computer/phone screens and artificial lighting) in the evening.

People with serious mental health problems and/or proclivity to violence need to be institutionalised before they harm and/or kill or maim themselves or someone else, not just after.

Here in Australia, the government prevents smoking in most public places and requires cigarette packets to have no trademarks and to be covered by dull colors, health warnings and gruesome images. The result is an impressive drop in smoking, including among young people, which translates in to a huge decrease in long-term ill-health and death.

In Victoria, the last commercial road traffic accident insurer withdrew some decades ago, leaving just the government insurer (insurance is part of vehicle registration). They soon figured it was cheaper and better to educate the public into reducing traffic accidents than to continue to pay out for medical care and lifelong support of the seriously injured. The result (despite increases in population and modern cars having poor visibility due to excessively thick A-pillars) is an extraordinary reduction in the road toll, from 1061 in the 1970s to 291. We have much better road signage and signals than those I have seen in the South of the USA, all due to government investment.

All this could be done in the USA. If it is not, then the epidemic of ill-health will continue, no matter how the economics of health care are improved.

This will require a reversal of the long tradition of the government not being involved in people's lives. The current pattern of ill-health and rapacious health-care has brought this extraordinary nation to its knees - and results directly from governments avoiding investing in preventative health care, while allowing the private sector to exploit the population due to insufficient regulation and government involvement. (There are problems with the nanny state too - that's another discussion.)

I must apologize for dropping the f***bombs this afternoon. They were corrected after releasing my post - and then they reappeared. Now they seem to be everywhere!

Honestly, we will have more credibility in our communications if we keep it clean and insert our ***'s. The potential for getting Karl the wide-scale visibility he has earned diminishes with the lack of personal responsibility on the language front. This site used to be full of it... and somewhere along the line it changed. I don't want to drag us down. Small things matter.

We are a passionate bunch of f***ers! Eh?!

******************************************************************************

Am completely OFF of the Single Payer bandwagon. Karl's presentation of the numbers/math make it so. No going back.

@JerryDenim. Great story - and your connection to this blog through your Dad. May LOVE Be with You as you honor his memory...and what a great post you gave us that does just that! Your Dad must be proud. Do keep in mind that Karl's math makes a clear case for the sustainability of Social Security (yeah) AND for keeping the promise of Medicare (Parts A and D). The elimination of Part B plus Medicaid seems harsh on the surface but is an important destination. The numbers do not lie. Extremely lower prices for care will change everything. Published prices/price transparency is the key. Providers must step up or they will fail. Choice is the opportunity.

@Spence: Small clinics have a place in the mix. So do alternative providers. Here in rural Northern CA options are limited. People learn to do more with less. If I wanna pay my local cannabis oil supplier for services or head down to UC Davis or SanFran then that is my choice. The power in this Plan is that Consumers rule!

And by the way, the Planned Parenthood model works for dispensing quality healthcare - clinic style - at affordable prices. Made my first visit to PP in the late 70's. Have returned many times since. You get quality care from mostly FEMALE doctors. Imagine getting treated by someone who understands and who specializes in female anatomy. For some of us, that is what really matters. Anyway thought I would throw that one in the mix.

@TickerGuy: great charts.

A look at just one slice of the medical monopolist pie - PBMs

snip:
"Over the past 30 years, PBMs have evolved from paper-pushers to significant controllers of the drug pricing system, a black box understood by almost no one. Lack of transparency, unjustifiable fees, and massive market consolidations have made PBMs among the most profitable corporations youve never heard about.

Americans pay the highest health-care prices in the world, including the highest for drugs, medical devices, and other health-care services and products. Our fragmented system produces many opportunities for excessive charges. But one lesser-known reason for those high prices is the stranglehold that a few giant intermediaries have secured over distribution. The antitrust laws are supposed to provide protection against just this kind of concentrated economic power. But in one area after another in todays economy, federal antitrust authorities and the courts have failed to intervene. In this case, PBMs are sucking money out of the health-care systemand our walletswith hardly any public awareness of what they are doing."

PBMs have been party to the opioid addiction crisis:

"An investigation by Stat News found that Purdue Pharma, makers of OxyContin, paid off PBMs to keep prescriptions flowing for their product, over the howls of a state employee health plan in West Virginia. In exchange for rebates, PBMs kept OxyContin on their formulary with low co-pays, and without requiring prior authorization from the health plan to dispense the drug. Over-prescribing of OxyContin laid the groundwork for a crisis that killed more than 20,000 Americans in 2015.


They were making a profit on peoples addiction, which is fricking criminal, says consultant Susan Hayes. Rubbing their hands with glee that people are becoming addicted to opioids. I cant believe it."

http://prospect.org/article/hidden-monop....

"The car dealer doesn't know exactly what he faces when the customer comes in with bad brakes either. He prices the procedure at a price that allows him to make money on an average basis. On any particular car he may make more, less or even lose money, but on average he's ok. That's what a flat-rate book does. "Replace rear brakes: $400.""
Two problems with this simile.
1. The human body and it's physiological mechanisms are vastly more complicated than a brake job.
2. As one poster already pointed out sometimes you don't know what you have to fix until you start trying to fix it. Now in a brake job the maximum risk the shop takes is limited to the entire brake system. Say a five to six multiple of the repair cost. In medicine the maximum risk under this scenario is thousands fold for expensive specialty or rehabilitative treatment or even chemotherapy. Basically now the doctor has to take out insurance to cover his downside risk of catastrophic losses, not just malpractice. You are asking the doctors to self insure, but they are doctors not insurance companies. You have now created another insurance product and you still haven't gotten rid of the first one. What if the patient dies during the procedure? Shortly there after? They do. This was not "the expected outcome" but it happens. Are you going to ask the doctor to cover the burial cost? Replacement of lost wages? Your proposal now requires the doctor to take a life insurance policy out on the patient.
I am not a surgeon but I have tremendous respect for what their training, devotion and work entails. Do you want a doctor or a mechanic when you are ill?
Carl's treatise on this issue is the best yet. The healthcare discussion is really one about how to take a service industry that has been granted/earned a level of monopoly and make it competitive when it doesn't want to be competitive. Right now the insurance companies are the levered players not the doctors. If you socialize it, and that's what we are doing now by choking regulation and wealth redistribution in the form of a multi tiered charge structures, you will not have doctors because they wont be able to pay back their $300,000 loans. And it's not just the doctors and the health insurance companies. Americans are over utilizers compared to the rest of the world. We are soft, fat and unhappy. Very complex problem. But if you don't have good doctors you have nothing. Communism proved that.

Looks like I created an opportunity to clarify a few things re: Planned Parenthood.....

You can pay cash for services rendered. You can pay more than what is required. Those of us who can afford it do.

Government "funding" of PP comes through Medicaid reimbursements. It is not directly funded with a line item on the Gov't. budget. Since funding would be ending with Karl's plan to end Medicaid, then PP would need to attract more full-price clients, find more generous Donors, and apply a sliding scale to pricing so that everyone pays according to what they can afford.

The quality of service at PP is excellent.

Remember with Karl's Plan - we are all personally responsible for our well-being and have a stake in the program.

Karl wrote..

because at 8% compound growth in cost it has to or the government literally fails to finance itself and collapses.

Which clearly explains why the federal government is looking at the serious possibility of "furlough" based on "sequestration" late in April. Tomorrow is April 1. "Sequestration" is, in fact, the "Law of the Land" (and isn't it "funny" how that term resonates from time to time in certain hearts fond of it for their purposes?).

One guy I know, a GS-14 "General Engineer", is fond of saying that IT'S THE LAW, that the NATIONAL DEBT WILL BE PAID. He's never answered my question, "What happens when the national debt has grown too large ever to be paid?"

Here's what I know. I'm a contractor employee supporting an Army (DoD) program. Today the task order I worked under expired, and one other contractor and I went home on furlough until April 24 (probably). Precisely what happened? Who knows? I expect it was something like my employer (prime contractor) and the other employer (subcontractor) had a perfect TO replacement contract ready more than two weeks ago. Someone in the government imagined a comma was out of place, or someone didn't follow a full stop with two spaces, or some such silliness, and the entire process was sent back "to the very beginning".

Is this going to hurt me? No, it will not. It will not hurt the other guy, either. What? It's going to be a problem that I get to stay home from work for three weeks, and I'm not responsible for the absence? That I can take some naps (I like afternoon naps when the sun is warm and the breeze cool)? That I can go to a buddy's place in the country and blast off a thousand rounds of ammunition on a nice afternoon?

Yeah, THAT is going to hurt me. I don't get paid? Guess what? If government workers have to do a "furlough", they have without exception been paid for all "furlough" periods in my living experience. (This anecdote is based on a former enlisted US Marine, who then got an appointment to West Point, graduated in 1976, and did an Army career, finishing as an O-5; I'll never distrust that man.)

So, I'd guess they won't be hurt in any realistic sense, either. (Sure, they might get another frown line or two from "poor-mouthing" their situation. Wah.)

"These aren't the 'droids you're looking for. There's nothing here to see. Move along."

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TANSTAAFL

@Susan Marie, I read the Kunstler article and very much enjoyed it. That blog is in my bookmarks/favorites now. And it led me to a couple of other places that were quite interesting, as well.

Thanks!

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TANSTAAFL

Quote:

I know, I know. It's socialism. But seriously what's not to like?

Yeah, what's not to like about North Korea, Venezuela or Cuba. Life is just so great in those countries, is it not? Yeah, even Sweden, Norway, Canada, Japan...ask yourself why they are trying presently to dump their Communist healthcare systems and return to privatized systems. IT IS BECAUSE THE COMMUNIST SYSTEM HAS BROKE THEM. NO FREAKING MONEY TO SUPPORT IT BECAUSE THERE IS NO MONEY AFTER IT ALL HAS BEEN STOLEN.

What's not to like about England citizens yelling across the pond to us on the internet to "not give up our guns. We made a huge mistake." Communism was supposed to be great.

What's not to like about waiting in line for 6 months to a year for hip replacement surgery or bypass in any Communist run country?

What's not to like about your chances being higher to die than live while waiting in line for a life saving organ transplant surgery or cancer treatment?

What's not to like about death panels in a COMMUNIST SYSTEM ordering doctors to refuse treatment IN YOUR FACE and MURDER YOUR RELATIVE.

You obviously were not taught Colonial history by your COMMUNIST PROFESSORS or whoever you allowed to brainwash you, because if you had, you would know the Colonists tried Communism when they first landed and half died the first year BECAUSE COMMUNISM DOES NOT WORK. Centuries of evidence all around the world prove it, but the 20th Century Communists are better trained and know how to make it work, RIGHT?

If Communism worked, than how come we are knocking at the door of financial ruin?

If COMMUNISM worked, then how come Detroit was destroyed when Democrats implemented it?

If COMMUNISM worked, then how come all cities were Democrats implemented it were destroyed and are BANKRUPT?

Socialism is not Socialism.

SOCIALISM IS COMMUNISM.

Communism DID NOT CREATE the USA, the largest economy in the world. A moral society and a free market created the largest economic engine in the history of the world. Small government and a free capitalistic markets work when COMMUNISTS are kept at bay from bringing their corruption, lawlessness and tyranny.

You want free things? Well then you are free to go. Go to whatever Communist country you want, and dont let the door hit you.

And one last thing, Lets cut the BOOLSHIT. You never agreed with 99% of what Karl said or you would not be suggesting we turn to full blown COMMUNISM. And yes, it's full blown Communism, because COMMUNISTS never stop at just one thing...the 535 TRAITORS in Congress ARE YOUR PROOF.

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When Revolution comes to America, I want to shoot these sumbitches with Black Powder so they know Im not blowing smoke up their backsides.

Quote:

"The car dealer doesn't know exactly what he faces when the customer comes in with bad brakes either. He prices the procedure at a price that allows him to make money on an average basis. On any particular car he may make more, less or even lose money, but on average he's ok. That's what a flat-rate book does. "Replace rear brakes: $400.""
Two problems with this simile.
1. The human body and it's physiological mechanisms are vastly more complicated than a brake job.

That's true. Now how many nice old ladies come into the auto shop and say "It's making a noise and I don't know what it is. Fix it."

Lots. And the way this USED to be handled was that the old lady got fucked. The car went on the rack and when it was done, well, she got the bill. And maybe it was fair, but often it was not. Maybe the ball joints weren't really bad or maybe the shop owner just saw $$$ in her eyes.

The media got onto it and starting doing exposes. They found some little old ladies, gave them a car with a KNOWN problem that a master mechanic had already diagnosed and had them go to the shop with it. They came back with bills for 5 or 10x that much and a lot of work done that wasn't needed. Repeatedly and reliably.

The laws changed. The car dealers all said they'd go out of business if the law changed because "cars are complex and when someone doesn't know what's wrong we can't possibly know if it's a minor thing that's loose or the engine's bad and needs to be replaced."

All that's gone now. Guess what? They dealt with it. What's wrong with a diagnostic charge, then presenting the customer with what's wrong and the cost to fix it?

Nothing. Except you don't like that model in medicine, because you can't assrape the customer any more. If you have to quote prices and give the customer a diagnosis and cost then you still get to charge for the diagnosis but now the customer chooses what to do and where. He or she decides that procedure may need to be done but guess what -- the doc or hospital across town will do it for less. This nasty thing called COMPETITION comes into the game, and the better doctor fucks up less often too.

That means he EATS FEWER OF HIS OWN MISTAKES, as does the hospital that does a better job of controlling infection and other errors -- like giving you the wrong drug, or the wrong dose. Quality in execution makes for more efficiency and, as a result, LOWER COST. That's reflected in PRICE. The better doctor wins -- he gets more business and he keeps more of what he makes. The poorer doctor LOSES -- and ultimately, maybe he sweeps floors.

That's GOOD, not bad. But boy, you don't like it.

Neither did the crooked car repair shops.

Tough shit. Either stop this crap voluntarily or the system will collapse and you'll get nothing. Worse, the people might eat you since you caused it, if they figure it out.

Quote:

2. As one poster already pointed out sometimes you don't know what you have to fix until you start trying to fix it. Now in a brake job the maximum risk the shop takes is limited to the entire brake system. Say a five to six multiple of the repair cost. In medicine the maximum risk under this scenario is thousands fold for expensive specialty or rehabilitative treatment or even chemotherapy. Basically now the doctor has to take out insurance to cover his downside risk of catastrophic losses, not just malpractice.

Oh bullshit.

Look, there's nothing wrong with separating diagnostics (cheap) from fixes (maybe really expensive.) But again, you don't want to do it.

Why not? That's pretty simple to figure out -- if you have to separate the diagnostics from the fixes then the customer gets to choose. Not only does he or she choose what to do (which means it's on him or her instead of you if he chooses "no") but it ALSO means you get stuck with the cost of being wrong -- which might be REAL BIG, since you can't hide the wrong any more. For the good doctors -- the ones who can actually nail a diagnosis -- this is a great thing. They figure out how to diagnose at a lower cost, and they win big by getting more business. The customer wins by saving money on that part of it. The customer then picks where and by whom they wish to fix it, if it's fixable at all, and if there's a menu of possible treatment options they get to pick that too. Their choice, their cost and, even better, they get the responsibility for the outcome if they pick choice #1 over #2.

See, medicine isn't an exact science. That's why you call it "practicing" -- which I'm sure you know. Well, you're practicing on me! Since I have to live with both the successes and the fuckups when you practice, and you specifically deny that you can control outcomes then I insist that you provide me with your "best guess" AND the price to fix whatever you find BEFORE YOU DO IT. I also want to know how many times you've done this before and what the outcomes were -- how often were you right, how often wrong, and what sort of success record do you have in correcting it.

Since it's MY ass and not yours on the line I want to think about it -- not only to evaluate your record of accuracy and success, but your quoted price. I want to compare that with the clinic across town, on the other side of the state, or, for that matter, in India! And then I'm going to choose. My choice, my money, MY ASS.

If you're good at what you do then you don't fear this sort of thing. You're one of the docs who will win. But if you suck, well, you fear this greatly. Your failures will be exposed. Your record of failure will be on the table and you won't be able to hide it any more. And you soon won't be a doctor -- not because you get sued out of existence, but because you won't have any customers.

Well, guess what -- either do things this way or the system collapses. How much do you make when there's no government backing of the money at all because it can't fund itself, interest rates are 20% for 1 year money and nobody has any to pay you wish?

Quote:

You are asking the doctors to self insure, but they are doctors not insurance companies. You have now created another insurance product and you still haven't gotten rid of the first one. What if the patient dies during the procedure? Shortly there after? They do. This was not "the expected outcome" but it happens. Are you going to ask the doctor to cover the burial cost? Replacement of lost wages? Your proposal now requires the doctor to take a life insurance policy out on the patient.

Horseshit top to bottom. You didn't read the ENTIRE SECTION on defensive medicine stoppage. Why? Was that intentional? I'll take the retraction and apology now, that is if you'd like to hang around here beyond, oh, maybe noon today.

What's worse is that all this was laid out in the original post and you intentionally ignored all of it. The fact that separating diagnostics from fixes will become necessary. That exposing data to the customer on the success rate will both drive down cost and favor the better physician -- he'll have a cheaper cost of operation AND a better success rate, and thus will gain customers while the poor physician will lose them and either have to up his game or go out of business. Further, putting the decision and cost for treatment options in front of the customer BEFORE the work is done means the person who's ass is on the line will be the one making the decision as a matter of informed consent instead of being treated as a rube who knows nothing and simply is expected to pay whatever bill is presented AFTER THE FACT, whether that was the best option available to him or her or not.

Quote:

I am not a surgeon but I have tremendous respect for what their training, devotion and work entails. Do you want a doctor or a mechanic when you are ill?
Carl's treatise on this issue is the best yet. The healthcare discussion is really one about how to take a service industry that has been granted/earned a level of monopoly and make it competitive when it doesn't want to be competitive. Right now the insurance companies are the levered players not the doctors. If you socialize it, and that's what we are doing now by choking regulation and wealth redistribution in the form of a multi tiered charge structures, you will not have doctors because they wont be able to pay back their $300,000 loans. And it's not just the doctors and the health insurance companies. Americans are over utilizers compared to the rest of the world. We are soft, fat and unhappy. Very complex problem. But if you don't have good doctors you have nothing. Communism proved that.

Why's it cost $300,000 to be a doctor? Do you really think that's anything close to a reasonable cost to learn the trade? What if you suck? Are you still entitled to the $300,000?

How come it didn't cost $300,000 (in today's money) in the 1960s to become a doctor? Did the human genome magically change to something 100x more complex? Or did you just start fucking people in the ass, starting with an entitled mentality drilled into your head in medical school?

You sound an awful lot like the snowflake that takes out $150,000 in debt to learn....... painting. Or.... sociology. And then, of course, they're ENTITLED to a job that pays that amount. Nobody ever expects them to justify their decision to do something stupid, nor their willful and intentional support (by attending and agreeing to pay!) for a racketeering enterprise at said "college". Nobody ever expects said "student" to ask "what the hell do you think you're doing charging that sort of money for this educational experience, and how do you think it's ever going to get paid back -- without me extorting someone else?"

No, there's no responsibility there! You're all Marcus Welby!

Horsecrap.

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I've advocated for health service and medicinal price and fee disclosure on this site in the past. This policy attacks the core problem of "healthcare" in this country: price inflation. Disclosure contributes to fixing several problems; provides instant transparency, stokes competition (in theory), immediately resolves questionable business practices by the "medical billing" industry, should (in theory) make the insurance claims process more streamlined, it's a simple and honest policy to implement that doesn't involve any trickery or "rob Paul to pay Pete" processes, and likely would result in other tangible benefits. I strongly believe, without experience or data to backup my position, that this is the first and necessary step to resolving the health care problem in this country.

#knowitall #rant

The ACA required 2,000+ pages and the KD Act would need less than 20. It's so much simpler when you're not trying to legalize a racket.

Oh am I gonna rip you to pieces on this...... pay attention folks because this is the sort of crap that Single Payer will FORCE you into.

Rwhittle wrote..

I agree with the concerns about excessively high obstacles for becoming a qualified doctor, and about the impossibility in many situations of determining what is wrong with someone and predicting how much work will be required to fix the actual problems, not all of which can be known without a lot of further work and attempts at treatment.

I support Karl's approach to insisting on proper self care regarding eating fewer carbs for all those who face type 2 diabetes and similar problems.

Insisting? Nowhere did I insist. I simply said "You cannot suck off the public teat IF you refuse to do the right thing, and the right thing WOULD resolve the problem you have."

BIG difference. Not only are you free to do so if you can pay for the cost on your own but the "no public tit" constraint is based on SCIENCE. Indeed, the constraint has a further check and balance on it in that if you insist that the science is bollocks for your particular metabolic make-up (and it might be, although it's unlikely) you have the right to prove it and if you're right then you can continue to access said public help, should you need it.

YOUR view is entirely different. "Do this or else", and the or else has no appeal process and no science required, as you amply demonstrate below.

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Preventative health is vastly better and cheaper than trying to mend the damage caused by avoidable behavior. Preventative health in terms of education, food regulations and insistence on self-care as part of medical care should go much further:

And here we go with the mandates -- enforced by law, of course.

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Everyone in the West should reduce their sodium (salt) intake and increase their potassium intake, including by use of supplements such as water-solutions of the almost tasteless potassium gluconate. This is because the excessively high sodium to potassium ratio which pretty much everyone in the West consumes is proven to cause hypertension, heart disease and stroke:

http://advances.nutrition.org/content/5/....
https://www.goodreads.com/book/show/1120986.The_High_Blood_Pressure_Solution

Increasing potassium levels may also reduce anxiety and improve mental health. Refs at: http://woman.thenest.com/can-low-potassi.... .

The best part of mandates is when they're lies. Like these, for example. See, with a few exceptions (there ARE a few people who are very sensitive to sodium) salt is of no harm to you at all and in fact is GOOD. It's quite hard to get a proper sodium:potassium balance and maintain it if you are intentionally evading sodium intake, and by the way, low potassium can kill you by disrupting your heart rhythm!

So now we start measuring people's sodium levels and if they're "too high", even if you're not hypertensive, "no health care for you!"

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Anyone who smokes (tobacco or cannabis) shouldn't, for numerous obvious physical and mental health reasons.

No argument with smoking being bad. What if I eat cannabis? Oh, by the way, while smoking weed isn't good for you (smoking is bad always) do you know anyone who can actually smoke 20 "Class A" joints in a day and still walk? No, you don't, so do we talk relative harm or absolute? If absolute, what if I spend an evening after hiking in front of a campfire (during which I will inevitably inhale some smoke)? If you can detect evidence of that in my body, do I get thrown out of the doctor's office?

YES, UNDER A SOCIALIST SYSTEM.

Let's keep going.

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Alcohol is a carcinogenic depressant. Anyone who drinks it regularly is setting themselves up for long-term depression problems, as well as increased risk of breast, colon and other cancers. It is a major factor in road injuries and deaths.

That's a half-lie. Alcohol in moderate amounts is actually protective in some cases. Is it bad if you overuse it? It sure is; it's VERY bad if you overuse it. And by the way, road injuries and deaths are ACUTE reflections of overuse of alcohol. I'm sure you're aware that the NTSB here in the US (and probably where you are) calls any accident where ANY amount of alcohol is detected an "alcohol-involved" wreck -- even if the person who had it detected was (1) well below legal limits and (2) PROVED NOT TO BE AT FAULT (e.g. hit from behind while stopped at a light.) This has the effect of GROSSLY overstating the problem, but, of course, that's all in the state's interest -- right?

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Most people use alcohol, cannabis and tobacco to reduce anxiety. Surely there's enough things in modern life to make us anxious. While it is true that a certain level of anxiety is natural and desirable, there is a huge, systemic, unrecognised (and actively denied) problem in that most people use caffeine every day of their adult (and sometimes adolescent) lives. This is a sleep disruptor, drives tiredness (and so road accidents), drives restless legs syndrome (immediate reduction and longer term increase of symptoms), drives road rage, aggression, domestic violence and probably war-making decisions by politicians.

Oh, here we go. Now we can call the beer I will drink this afternoon (since I just PR'd a 5k race this morning) "causative" of restless legs, aggression, depression (gee, we both sides here -- pick one!) and even WAR MAKING.

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So anyone seeking therapy or drugs for anxiety problems, especially PTSD, OCD or anything resembling borderline personality disorder, should be required to reduce and eliminate their caffeine consumption (and go easy on the dark chocolate).

REQUIRED again eh? Or? Hmmmm....

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Almost everyone needs vitamin D supplements, since the only way to get enough is via regular UV-B exposure which also drives skin cancer. Vit D is vital for good mood, reducing cancer and numerous other aspects of health. https://www.vitamindcouncil.org/ It is an extremely inexpensive supplement (see 50,000IU capsules, one every two weeks or so). This is especially important for people with dark or black skin, and for pregnant women, since low vit D is arguably a significant cause of autism and perhaps schizophrenia: http://www.abc.net.au/news/2016-12-14/au.... https://www.scientificamerican.com/artic....

TAKE THIS DRUG "OR ELSE".

BTW the science is REAL shaky on the "take a supplement to reduce cancer risk."

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Most people need more exercise and would benefit from ingesting more omega 3 essential fatty acids (fish and algal oils).

Most people get too little light (especially blue light) in the day, and too much (via computer/phone screens and artificial lighting) in the evening.

People with serious mental health problems and/or proclivity to violence need to be institutionalised before they harm and/or kill or maim themselves or someone else, not just after.

You're mentally ill. You believe you have the right to institutionalize (jail) people who YOU believe might harm someone else. That they choose to do things that might be less than optimal for THEMSELVES in YOUR view means they get to go to prison.

I call that sort of thing projection and mental illness. I think I'll lock your ass up for it, and if you resist, I'll kill you.

Are you ok with this?

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Here in Australia, the government prevents smoking in most public places and requires cigarette packets to have no trademarks and to be covered by dull colors, health warnings and gruesome images. The result is an impressive drop in smoking, including among young people, which translates in to a huge decrease in long-term ill-health and death.

In Victoria, the last commercial road traffic accident insurer withdrew some decades ago, leaving just the government insurer (insurance is part of vehicle registration). They soon figured it was cheaper and better to educate the public into reducing traffic accidents than to continue to pay out for medical care and lifelong support of the seriously injured. The result (despite increases in population and modern cars having poor visibility due to excessively thick A-pillars) is an extraordinary reduction in the road toll, from 1061 in the 1970s to 291. We have much better road signage and signals than those I have seen in the South of the USA, all due to government investment.

All this could be done in the USA. If it is not, then the epidemic of ill-health will continue, no matter how the economics of health care are improved.

Ah, so Government gets to choose what is "ill health" and what is not.

How's that working out, may I ask? After all, how did PUFAs and cheap carbs come to be? Why, at the urging of government!

But you're sure they'll fix it. Uh huh. Sure they will.

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This will require a reversal of the long tradition of the government not being involved in people's lives. The current pattern of ill-health and rapacious health-care has brought this extraordinary nation to its knees - and results directly from governments avoiding investing in preventative health care, while allowing the private sector to exploit the population due to insufficient regulation and government involvement. (There are problems with the nanny state too - that's another discussion.)

Uh huh. "Insufficient regulation and government involvement" eh?

Let's see.... food pyramid anyone? War on (saturated) fat anyone? Both GOVERNMENT PROGRAMS and both lies. Both based on provable metabolic falsehoods, and both arguably responsible for a large part of the obesity and diabetes epidemic.

No, correcting that can't be done the way you want, for one simple reason: Government hasn't been held accountable for its past lies, and won't be either ABSENT A VIOLENT REVOLUTION. Who's going to go to jail for telling people to eat few saturated fats and lots of PUFAs, which are biochemically PROVED to improve insulin sensitivity in adipose (fat) cells while damaging insulin sensitivity in muscle? Now add lots of glucose via fast, easily-digested carbs to the mix and you have actually CREATED the conditions that, if maintained over years, have a very high probability of CAUSING heart disease, diabetes and obesity -- all at once.

Then of course you'll tell us, as the government, to simply "eat less and exercise more" when the facts are that a mile of running burns about 100 calories and a pound of body mass is about 3,300. This means you need to run a 50k ULTRA to burn ONE pound. Clearly, you cannot outrun your fork, and if you poison the metabolic demand ("hunger") control center that every human has, well, you're going to get fat absent EXTRAORDINARY willpower that almost nobody will be able to maintain.

Now if I saw every single surgeon general marched off to the gallows from the last 50 years in the United States, all the doctors marched off with them to hang, the drug company executives and nutritionists -- yeah, then I might think government could solve this and provide an answer. I might even think the coercive nature of your ideas could work.

But that hasn't happened, and until and unless it does all your position will do is kill people -- and lots of them.

Unfortunately none of them will be the fine government folks responsible for all the mortality and morbidity they caused.

Unless, of course, the people decide to use the lampposts around town for their best and highest purpose. And, if such a program was forced onto the people, that would be exactly the sort of response that any logical individual would consider. Fortunately for government officials there are few logical individuals -- in our country and, apparently, in yours.

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See, medicine isn't an exact science. That's why you call it "practicing" -- which I'm sure you know. Well, you're practicing on me! Since I have to live with both the successes and the fuckups when you practice, and you specifically deny that you can control outcomes then I insist that you provide me with your "best guess" AND the price to fix whatever you find BEFORE YOU DO IT. I also want to know how many times you've done this before and what the outcomes were -- how often were you right, how often wrong, and what sort of success record do you have in correcting it.

Reminds me of one of the few times I've had to be taken into surgery. The administrative paper pushers always seem to show up right after the sodium pentathol injection right before I am being wheeled into surgery to sign "consent" papers.

They wanted to claim it was simply to "give permission" to treat me. I'd already done that when I came to the hospital on my own for a scheduled surgery with my doctor. What these papers did was essentially give them the ability to perform a damned exploratory on me at the doctor's discretion to 'fix' anything else that might be wrong while they were in there. Of course I'd be responsible for any additional costs incurred.

You bring a car into a shop now they are going to only fix something for which you contracted. If they see something else they will call you to advise and get permission if you want it fixed. You will then get a separate quote for that repair.

I had a conniption right there on the gurney. It soon became apparent the barbiturates didn't have enough time to render me into the needed sheep-like stupor. I told her "hell no. You will ONLY treat me for things that were discussed or for items causing my current issues and nothing more." She then wanted to scare me by telling me how much more expensive it would be if they had to open me up again. I told her that it will then be MY decision want it? That's really what they did not like.

I wrote in big letters across all forms you will ONLY treat me for what was originally contracted and scheduled and nothing else. They would then not be able to deny my warning. I also marked out a few lines and initialed. She then got the papers back on my terms. No one at the hospital ever said anything else. I'm sure they knew the consequences if this was to wind up in a courtroom.

I wonder how many people couldn't fight the drugs enough or even care about what they were signing? The fact they would bring such things to a patient after PURPOSEFULLY drugging him IMO makes the entire contract null and void.

This demonstrates the "capture" system and the criminal intent of medicine today!

Then there was the issue of an anesthesiologist wanting to perform a spinal block to deliver more drugs while I would also be under general anesthesia. When I inquired why that was needed they gave the same BS -"well sometimes it is needed to stop pain if the general does not work." Yes I've heard of people being conscious and unable to move while experiencing pain under anesthesia but it is so very rare. This is simply more scare tactics.

I told her I had no problems in the past and saw no advantages - only potential risks as infection and nerve injury to my spine. Of course the forms attempted to excuse them from any liability in the process. The forms essentially reduced me to the status of a lab rat.

The spinal block was not performed and I had no issues with the general anesthesia.

The fact is much of modern 'medicine' does not like an informed patient or anyone that thinks they have the right to control decisions that affect their own body. Nothing strikes more fear in these frauds than patients making their own decisions because in the end it puts an end to the scam.

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"Mass intelligence does not mean intelligent masses."

"You didn't read the ENTIRE SECTION on defensive medicine stoppage."
You are right, I didn't. Arguement accepted. Apology offered.

"What's wrong with a diagnostic charge....Nothing."
Agreed. Your model has to accommodate multiple diagnostic charges over time though. It's not efficient to order the whole universe of testing possible for each first presentation. First round of tests may surprise you and take you in a different direction. Furthermore, disease manifests itself differently over time so your labs can change over time. Autoimmune diseases in particular can take months to pin down. Even then they continue to change. Additionally, some procedures are both diagnostic and therapeutic at the same time. What is also true is that doctors by and large don't own the labs and imaging centers. Other corporations and hospital centers do. They set the prices for much of the diagnostic side. Stark regulations rightly limit the ability to self refer. Currently when I order a CT scan the patient is given a choice where to pursue it. I don't set those prices and the entities that do suffer from the same smoke and mirrors pricing we are fighting against. As a doc I can only charge for my component of the aggregate service. On the therapeutic side we have the same challenges. Multiple parties with their own charge structures. We could do away with Stark and let mega healthcare corporations own everything but then i think we have decreased competition.

"Except you don't like that model in medicine, because you can't assrape the customer any more."
I'm on your side Carl. As your post is a direct reply to my comments and you refer to the model of medicine afterwards I have to assume "you" means me personally. As you have never been my patient you are not in a position to judge how I treat patients.

"How come it didn't cost $300,000 (in today's money) in the 1960s to become a doctor?
Good question. Financialization, federal student loan programs?

"Did the human genome magically change to something 100x more complex?
The human genome did not change significantly. But advances in medicine have increased the complexity significantly.

"Or did you just start fucking people in the ass, starting with an entitled mentality drilled into your head in medical school?"....."You sound an awful lot like the snowflake that takes out $150,000 in debt to learn....... painting. Or.... sociology."

Again, I'm on your side Carl.
And no I did not start fucking people up the ass...with an entitled mentality. I'm no slowfake either. I calculated the risk reward of the cost of my training and borrowed only what I had to. I worked while I was in graduate school to minimize debt. I worked six and seven day weeks for the first ten years after graduation to pay off my and my wife's student loans. I have no debt, I could "leave the system" tomorrow as you have described but I have chosen to keep working because it's what I love to do. Inspite of all the regulation and BS. I've haven't practiced "defensive medicine" and I've personally seen to it that patients who choose to come to me get the most efficient care possible. I've watched docs in my area make more money because they over test, over prescribe, and do unecessary surgery. Everything you've riled against. I've waited for the insurance companies or the feds crack down on this stuff but they haven't. I nievely thought the insurance companies would eventually recognize my and others efficiency on everyone's behalf but it never happened. So like you, I am blessed with a large following of people who see value in the service I deliver.

You are right, I didn't read the whole "bill." But my post was in good faith, attempted constructive criticism, and I kept it to a discussion of the model.

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I've waited for the insurance companies or the feds crack down on this stuff but they haven't. I nievely thought the insurance companies would eventually recognize my and others efficiency on everyone's behalf but it never happened. So like you, I am blessed with a large following of people who see value in the service I deliver.

What led you to believe an insurance company, a REGULATED FIRM with a fixed profit margin (by the regulator) has any interest OR EVER WOULD in seeing costs go down?

If you make 10%, and that's all you can make, then how can you make revenue go up? There's only one way and it's not rocket science.

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You are right, I didn't read the whole "bill." But my post was in good faith, attempted constructive criticism, and I kept it to a discussion of the model.

Fair enough, but if you don't read the whole thing including the "why" side then you can't have an informed opinion on what the outcomes would be.

That's kind of like sticking the car on the rack and getting blanket consent, isn't it?

Or, rather like sticking a blanket consent form (with no price!) under a customer's nose AFTER you've given them pharmacologically-active drugs and are about to wheel them into the OR.

Gee, that never happens, right? Oh wait -- it happens EVERY SINGLE FUCKING TIME in today's hospitals. How do I know? I've SEEN IT when my Mom had surgery a couple of years back and I went absolutely APESHIT as while she's of perfectly-sound mind NORMALLY after you stick an IV full of drugs in her it's an entirely different matter.

Everyone of those people ought to be brought up on charges as such an act is a per-se violation of the customer's rights and is in fact exactly identically ethically AND LEGALLY to stuffing a roofie in a girl's drink and then claiming she consented to sex.

Oh, by the way, it's Karl with a "K", and it's not like every article posted doesn't have a byline with my full name on it. Oh wait, they do.

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Here in Australia, the government prevents smoking in most public places and requires cigarette packets to have no trademarks and to be covered by dull colors, health warnings and gruesome images. The result is an impressive drop in smoking, including among young people, which translates in to a huge decrease in long-term ill-health and death......................... [ad naseum]

Once again we have people that desire the totalitarian jack boots of the nanny state. What these people are actually objecting too is behaving like responsible adults. That's one thing Karl's plan does and it needs to be done. Just like the banks that keep the profits but gamble with public's money these miscreants want to do as they please but feel they should not be held responsible when their actions harm other people - financially or otherwise.

One is free to do as he pleases until he begins to ACTUALLY harm others. Once you encroach onto the personal boundaries of others you deserve to be beaten back with all available fury and punishments.

Government sponsored healthcare for the most part is one of the issues. People do not wish to act like responsible adults and feel they can do as they please. If a lifestyle and diet change fixes the problem - then it is SOLELY your problem. I don't care if it's diet, unprotected sex, or popping out kids - you are responsible for your actions.

Once people start bearing the true and TOTAL burden for their 'sins' against their bodies (and minds) maybe then will they grow up and start being responsible. You can't MAKE anyone responsible but you sure as hell can make them bear the full burden and consequences of their actions! Once again this is to what many of these people are actually objecting!

It is time to stop coddling immoral beasts intent on the destruction of everything around them. This is irresponsible consumerism where your fellow human being is forced to pay the bills.

And if these people then refuse to be responsible? Natural selection can THEN work its magic without governmental interference. In the end it will produce a stronger, healthier, and more moral society.

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"Mass intelligence does not mean intelligent masses."

Got it. Thank you Karl.
MW

where do you see insurance actually trying to save money on medical costs? you don't really.

Does bluecross have cruise ships sitting outside the 12 mile limit of coastal cities with a hospital suite to provide all non emergency care to their plan members after a brief helicopter or cutter ride? does any other providers?

I can guarantee you that would be far cheaper than paying for room nights in billion dollar hospitals which are generally located on the most valuable real estate on the planet...

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Does bluecross have cruise ships sitting outside the 12 mile limit of coastal cities with a hospital suite to provide all non emergency care to their plan members after a brief helicopter or cutter ride? does any other providers?

For a non-emergency coronary bypass why aren't they buying you a ticket and a 2-week stay in a luxury hotel in India?

Not only would that be five percent of the cost of the same operation here in the United States the complication rate is LOWER than it is here.

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Rwhittle wrote..

Anyone who smokes (tobacco or cannabis) shouldn't, for numerous obvious physical and mental health reasons.

Most people use alcohol, cannabis and tobacco to reduce anxiety. Surely there's enough things in modern life to make us anxious. While it is true that a certain level of anxiety is natural and desirable, there is a huge, systemic, unrecognised (and actively denied) problem in that most people use caffeine every day of their adult (and sometimes adolescent) lives. This is a sleep disruptor, drives tiredness (and so road accidents), drives restless legs syndrome (immediate reduction and longer term increase of symptoms), drives road rage, aggression, domestic violence and probably war-making decisions by politicians.

Im going to take issue with these statements regarding cannabis consumption. First, I do agree that SMOKING cannabis is detrimental to health due to ingestion of combustion byproducts. However, the consumption of cannabis by vaporizing or ingesting the plant via edibles or oils has shown to be beneficial for pain control and PTSD issues, among many other ailments. There are various studies and anecdotal reports regarding the use of cannabis to reduce, or in some cases completely eliminate, the use of opioids and the dangerous anti-depressants that the allopathic doctors want to get you on for life. I sincerely believe this is why the medical/pharmaceutical cartel throws such a great sum of money lobbying against legalization. Im disgusted that this reefer madness mentality still exists, and that folks still blindly believe these myths.

There is no way cannabis should be lumped into the category of opioids, and even alcohol. Please educate yourself about the medicinal qualities of cannabis before stating such generalizations. A great place to start is www.fuckcombustion.com.

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-- I'm in the control group

-- In life, it's important to know when to stop arguing with people and simply let them be wrong.