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More concretely connecting to your ideas: I believe that the federal government tax lien idea, if it could be implemented, would be counter to your aims. It would dilute the market-price signal of medical pricing. I would much rather see communities step in to assist individuals who are unable to succeed in the market.

No it won't because in the implementation section you will see that any provider that bills more than 50% of its dollar volume via Treasury is instantly subject to audit.

You HAVE TO provide some means for the indigent to get care or you'll never get anything other than Single Payer passed. That's reality whether you like it or not. And there ARE places in the country that have EXTREMELY high levels of indigence when it comes to medical care payment ability. To deny that is to deny reality and if you deny reality you go nowhere.

Thus you need both a way to address that AND a way to prevent it from being gamed. If you don't do BOTH then either we fail to fix anything (because the fraud will continue in those areas) OR every provider in those areas closes and now the poor have no care at all. Neither will pass and both WILL be seized upon by the opponents of reform.

The bill fixes both issues; implementation resolves the fraud problem (note that the Bill specifically DEMANDS -- not allows -- prosecution for bilking Treasury and makes same a criminal FELONY with mandatory prison times) so you wind up with plenty of doctors and hospitals in those areas but none of them can screw either customers or the public. None of these folks are going to keep their current crap up when the penalty for doing so is hard federal prison time.

I have no quarrel with efforts at the state level but it has to come with enforcement, not just claims. Note that Rand Paul is trying to get an explicit anti-trust EXEMPTION into federal law for providers AND insurance companies. He has published his framework bill and it includes that explicit provision. He's doing this because he KNOWS there are two USSC cases that have already held that 100+ year old law APPLIES to these firms. The need to focus on the Federal side is extreme because if that provision makes it into federal law the game is irretrievably over due to the Commerce Clause; any attempt to enforce a state mandate will be ruled AGAINST in federal court and since the Statute will EXPLICITLY protect the conduct of the providers they will win all the way up to the USSC.

This fight MUST be at the Federal Level without dilution because a loss of anti-trust prohibitions on this industry will be impossible to rectify EXCEPT by violence, exactly as the 17th Amendment was. The 17th Amendment was a grave mistake, and central to its gravity is that it cannot be repealed since the Senate would have to vote themselves out of a job to do so and that will never happen.

There are, occasionally, "poison pill" laws and amendments that cannot be fixed once enacted EXCEPT through violent revolution. The 17th is one of those and it has had terrible consequences. If we allow an anti-trust exemption for the health industry into the law at the federal level then our children are utterly and absolutely ratfucked as within the next decade Medicare and Medicaid will be spending roughly $3.5 trillion a year -- an impossible amount as that is roughly equal to the ENTIRE current Federal Budget. Long before we get there will economy, markets and government will collapse -- the odds that such collapse will be violent and involve the death of 20% or more of the population of the country approach 100%.

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