Picked up by Instapundit

https://pjmedia.com/instapundit/264300/

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I want to see teeth flying as someone is beaten with a cast iron dildo hidden in a sock.

Saw that -- and an indexing problem that came from when I brought over the forum to the cloud was responsible for the terrible performance earlier this morning.

The indexing problem has been fixed...

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Karl leaves out the single most contentious issue, pre-existing genetic conditions with massive costs. Some severe hemophiliacs use $750,000 of factor per year to keep relatively healthy. Obamacare has made this a major issue and it MUST be addressed. Most solutions proposed build on a convoluted system. I suggest that we simplify by defining the problem by identifying critical nodes and addressing them first. Healthcare today is essentially (not absolutely) a zero-sum game. Prior to Obamacare, a hemophiliac could either join a big enough company with a good group plan or drop into medical indigence and go on Medicaid. As a result, too many productive persons were forced to be dependent on government unnecessarily. That's wasteful. I'll post my idea in a future reply.

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Karl leaves out the single most contentious issue, pre-existing genetic conditions with massive costs.

No, I don't.

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Prior to Obamacare, a hemophiliac could either join a big enough company with a good group plan or drop into medical indigence and go on Medicaid. As a result, too many productive persons were forced to be dependent on government unnecessarily. That's wasteful. I'll post my idea in a future reply.

This is ABSOLUTELY not necessary given the reform I have proposed and in fact WILL result in said person being prosecuted if they try the former -- as it should.

INTENTIONALLY joining a "good group plan" (e.g. going to work for someone with same) is THEFT of the wages from everyone else in that company. Such an action ought to be met with immediate criminal felony indictment.

Please go read the original article again. That issue IS addressed. If you claim not be specific because I have a VERY short fuse for people who run claims that bald lies around here.

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Karl,

Please cite the location or locations where you address pre-existing NON-LIFESTYLE conditions. Hemophilia is inherited from the X chromosome of either parent. There is no choice involved. Lifestyle is not an issue in this disease. It is not yet curable although there are promising gene therapies on the horizon. Hemophiliacs are not slackers seeking a free ride.

Are you suggesting that all severe hemophiliacs must drop into medical indigence by virtue of a condition which they inherited? Does your proposal cover them if they are upfront about the reality of their condition as soon as they or their parents become aware of it? Some "severes" are diagnosed months after birth.

You got banhammered because you were warned and kept trying to wave an aborted fetus around in rhetorical terms. I will not stand for that shit and I will make an example out of you, since you did it in public.

It is clear that:

1. There is NO just answer in cost-shifting a $750,000 per year cost to others. Going to work for someone with such a condition to get on their "group" plan is GROSS THEFT from everyone else who works there; if the place employs 1,000 people you're proposing to STEAL $750 per worker, per year, FOREVER plus administrative expenses -- and they don't get a vote. Worse, the employer is COMPELLED to conspire with the applicant AND CONCEAL THE CONDITION and its expense to the existing staff. Such a condition a LITERAL $37 million dollar theft from others, assuming the person lives to a mere 50 years old! You have the BALLS to demand that others pay that? In doing so you argue that ANY LESSER cost condition must ALSO be covered in full. WE DO NOT HAVE THE MONEY AND CANNOT RAISE IT.

2. The ONLY way to solve this problem that can actually WORK is to provide a PROFIT incentive for people to beat each other over the head until someone figures out how to make that affordable -- which means to whack SEVERAL zeros off the cost. If it's $7,500, he might be able to pay it. At $750,000, not a prayer in Hell. Only TECHNOLOGICAL ADVANCEMENT will bring that cost reduction by a factor of 100 -- if it can be done at all. It MIGHT be impossible.

This sort of situation is flatly outside of the purview of any ordinary view of a "social contract." There simply are things we CAN do technically but are not OBLIGATED to do -- they're just flatly impossible to provide on demand to everyone who wants or needs them. By breaking the medical monopolies and demanding "America first" pricing for pharmaceuticals we MIGHT get a breakthrough that makes this sort of event affordable, or we might not. But what is certain is that we CAN'T provide everyone who might need it $750,000 worth of medical treatment every year for LIFE.

You claim that it's unreasonable to drop into medical indigence. I claim that it's FAR WORSE to BANKRUPT an employer, putting EVERYONE in the firm out of work or steal thousands per person who works for said firm AT GUNPOINT, which is what you propose. The bill outline proposed provides a safety net. Yes, it results in the person in question winding up with a MONSTROUS tax liability they'll never pay, and when they die it will die with them. But in the meantime they have an incentive to get together with others and people in the medical field to FIND ANSWERS, instead of the system we have now which simply shoves off the $750,000 ON OTHER PEOPLE at gunpoint, with a LITERAL gun up their nose, destroys employers and puts EVERYONE in the place out of work and ultimately winds up with EVERYONE who comes into professional contact with this person that applies somewhere on food stamps and public assistance while yet another business is rendered to ash.

I am not going to play the "flying carcass of the aborted baby" game here with you or anyone else. It's an argument that has no place in THIS debate on public policy.

Yes, there's a public policy debate to be had on this but it needs to be HONEST and FORTHRIGHT: Do you have the right to demand tens of millions of dollars from other people because you had a misfortune of genetics?

THAT is the debate you raised and it's NOT one of health care and its delivery.

GET OUT.

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In far too many people's minds you automatically lose your argument - regardless of the logic and reality of the position - if somebody can get you to say that poor helpless little bobby might die.

FAR FAR FAR too many people.

Political correctness won a long time ago. I wonder how many people have to die due to that?

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It's justifiably immoral to deal morally with an immoral entity.

Festina lente.

Very much in agreement, at least from a first pass read. Your post is very dense with information. Could you perhaps post a summary with the top five or so points condensed into a one screen read?

Short attention spans require "sound bytes". That's just the way it is these days.

Karl, I re-read this one just now, and upon reflection think it is the smartest and most focused Ticker I have ever read. Here you have covered more bases than I ever would have imagined, and I think it is just about right.

Now, Sir, how to get it into circulation? I must admit that I do not know the answer to that question. But I do know math pretty well (having been educated in the public-government schools in Huntsville, Alabama, during the '60s, coming up to the Apollo 11 Moon Landing on July 20, 1969).

Many, far too many, are too stupid, or too unfocused, or whatever, ever to understand what you wrote here back on 30 March. I'm not, and I certainly hope a whole lot of others are not that-stupid.

So, there's the question: How do we get these ideas into circulation???? ???? ????

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TANSTAAFL

How to get these ideas into circulation??

How about a Karl Denninger TED TALK??

Overall I think this is an excellent start for a realistic, free-market plan. It's interesting that I have not seen anything like this elsewhere, probably because most people don't have the guts or sheer bullheadedness necessary to put it together. I remember you from decades ago on the Internet Access Provider list and you definitely haven't changed :).

Even though I don't always appreciate your harsh style, I have to admit that you are the only person I know of who has actually tried to come up with a realistic, workable solution to our health care issues. So much appreciation to you for doing this.

I don't think enough diabetes sufferers have the iron willpower that you do to successfully execute the lifestyle changes you refer to. As someone with that disease, I have personally made an effort and honestly come up short. If Congress cannot come up with an Obamacare-elimination compromise I see no way it would ever come up with a compromise that did not allow the millions of diabetes sufferers to get some form of continued care.

What would happen if you ran the numbers of your plan without that specific vindictive feature? I would expect you to still get numbers far superior to any previously existing plausible plan. I think it would help your plan if you could include a "halfway but better" plan allowing diabetes sufferers treatment and see where you would expect it to take people. I would think that if you got diabetes patients on a plan with the low cost features you advocate, it would not be that expensive to treat them and your plan would still function much better than any other idea currently proposed.

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I don't think enough diabetes sufferers have the iron willpower that you do to successfully execute the lifestyle changes you refer to. As someone with that disease, I have personally made an effort and honestly come up short. If Congress cannot come up with an Obamacare-elimination compromise I see no way it would ever come up with a compromise that did not allow the millions of diabetes sufferers to get some form of continued care.

That which you intentionally do, once informed, is not "suffering." It's choice.

Are you REALLY telling me that cookies, breads and donuts are more important than having your feet or eyesight?

Because that's really what we're talking about here.

And by the way, I eat this way now. Voluntarily, since while I was never diabetic I was surely odds-on to be headed that way just as are MOST Americans.

It's not "iron willpower", it's choice. And by the way, it's tasty too -- FAR MORE SO than the cookies and donuts are.

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What would happen if you ran the numbers of your plan without that specific vindictive feature?

It's not vindictive; it's factual.

There is nothing vindictive about telling someone that they cannot bill someone else for a personal decision to take the most expensive and least effective choice available when it comes to a particular disorder, along with intentionally exacerbating the condition on top of it.

If you're Type II diabetic you can change the progression of the disease any time you want. You can't reverse the cut-off foot or the kidney dialysis you ALREADY NEED but you can CERTAINLY prevent the foot from needing to be cut off NEXT YEAR or the dialysis you WILL need if you keep eating the fast carbs.

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I would think that if you got diabetes patients on a plan with the low cost features you advocate, it would not be that expensive to treat them and your plan would still function much better than any other idea currently proposed.

This is a disease that is nearly 100% controllable for life without much if any medication. Without it there is no such thing as "reasonable control" for life; it is progressive, it gets more expensive over time and it ultimately kills you either directly or indirectly.

It's also roughly ONE QUARTER of the federal Medicare+Medicaid expense -- for just ONE disorder!

Yes, it would be cheaper without the monopolist bullshit. But if it's $100 billion instead of $400 billion the fact remains that there is a difference between a disease you have contracted (whether through fault of your own or not) and cannot do anything about (e.g. HIV, Lupus, etc) and a disorder that you can stop the progression of at any point in time.

On what planet do you get to choose the MOST expensive option and send someone ELSE the bill? It is EXACTLY this paradigm that has led us to where we are.

Your response is in fact why there's no progress and never will be until it all blows up and then you will DIE for lack of treatment because there's no fucking money to pay for it -- not yours or anyone else's.

Your insistence that you MUST eat those fast carbs and bill someone else for ever-more expensive drugs that over time inevitably lose their ability to control the condition BECAUSE YOU REFUSE TO STOP MAKING IT WORSE is THE reason why we are where we are with "health care" in this country.

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I don't think enough diabetes sufferers have the iron willpower that you do to successfully execute the lifestyle changes you refer to.

Karl already said it well in his post, but it can be summed up so much more simply:

Here are your choices:

1) Pay for the meds out of your own pocket.

2) Die.

3) Decide your life is more important than that donut.

Pretty simple, IMO.

BTW, I went low carb primarily to support my SO. I don't miss the donuts.

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It's justifiably immoral to deal morally with an immoral entity.

Festina lente.

The "caused by or consequence of" will need some work. Some consequences are the natural outcome of treatment. Some cancer treatments cause permanent hearing loss. The use of steroids can cause diabetes. Most severe burns result in infection.

You need to discriminate between natural complications that occur in a high percentage of patients receiving treatment, and preventable complications that are not commonly expected. What that threshold is is better set by professionals than laymen.

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The "caused by or consequence of" will need some work. Some consequences are the natural outcome of treatment. Some cancer treatments cause permanent hearing loss. The use of steroids can cause diabetes. Most severe burns result in infection.

Most severe burns result in infection as a result of the burn.

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You need to discriminate between natural complications that occur in a high percentage of patients receiving treatment,

Oh no I don't.

If someone accepts a treatment (e.g. for cancer) and one of the listed, disclosed and appropriately consented to, with full knowledge of the risks side effects is diabetes or hearing loss, then there's no issue. One can ALWAYS consent to a side effect, PROVIDED they are given full and fair disclosure.

However, if you tell someone that statins will reduce their risk of death by cardiovascular incident, DO NOT DISCLOSE THAT THE MEDIAN SURVIVAL ADVANTAGE IS FOUR DAYS, and they get DIABETES as a result of taking it, YOU OUGHT TO BE BBQ'D, SLATHERED IN SAUCE AND EATEN since your "disclosure" was a LIE.

If you manage to give someone MRSA in a hospital then you should NOT be able to bill them for the treatment of that secondary infection which they acquired while in your care, and in what you represented was a sterile operating theater with proper infectious agent control. Obviously it wasn't.

The BEST and FASTEST way to reduce the incidence of hospital-acquired infections and similar horseshit is to align the interests of the customer and the hospital. If the hospital has to treat said secondary condition THAT WOULD NOT HAVE OCCURRED AT ALL BUT FOR THEIR "TREATMENT" then they will for the FIRST TIME have an incentive to NOT let that happen.

Right now the incentive is FOR it to happen since they BILL YOU for the disease or condition THEY CAUSED.

That should be felonious assault -- at minimum.

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Can this can be done at the State level?

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Preparing to go Hunting.

Yes.

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All customers must be billed for actual charges at the same price on a direct basis at the time the service or product is rendered to them. This immediately and permanently decouples "insurance" from the provision of care.

This is what I stress to people I debate with about the state of healthcare in our country. They think lack of insurance is the problem, while I maintain that insurance IS the problem.

Thank you for all the work you put into this blog post. Your arguments are irrefutable, in my opinion. With your permission I want to pass this on to everyone I can.

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"The purpose of life is not to be happy. It is to be useful,
to be honorable, to be compassionate, to have it make some
difference that you have lived and lived well."
~Ralph Waldo

Of course.

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Karl--

You are the man.

I'm printing this out and taking my right for redress to city council on Monday and reading it verbatim.

Then, I will send it verbatim to all members of the VA general assembly on Tuesday.

On Wednesday, I will send it to the congressassholes and senatorial fucks.

If no one will listen, we are very close to, if not there, to using up all our boxes.

Thanks for what you do, man.

I hope to meet you one day, catch a few fish for dinner, and enjoy a good beer and/or whiskey/scotch.

Low carb is the word. Thanks!

Riverrat

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A motion to adjourn and go fishing is always in order.
--me channeling Heinlein

I'm in.

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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.

Just read and finished An American Sickness ... How healthcare became big business and how you can take it back by Elisabeth Rosenthal (Editor of Kaiser Health News). Explains how/why we got into this mess and why it is so difficult for the average Joe to even begin to tackle it. Highly recommend.

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It is death which gives meaning to life.

This story . . . in case you missed it (from the NYTimes)

https://www.nytimes.com/2019/12/07/opini....

@Cbracket - The only answer to this, given that the government refuses to prosecute, will come when the people decide to take things into their own hands -- and it may need to become truly medieval, as I doubt they'll believe anything less.

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Trojan Trump: Hey, get me this Karl on the horn. I want to buy his idea he just posted.

Reince: (Rolls eyes) What for?

Trojan Trump: I want to buy his idea he just posted, and have Ivanka present it as her idea to counter this Nepotism story.

Reince: You'll interfere with the existing extortion and racketeering we have in place, and you'll save the country from financial ruin if you go this route.

Trojan Trump: I want my face chiseled on Mount Rushmore with my family beside me, you know, like a really really big family portrait. Really huge family portrait. We'll flatten the side of the mountain, and wipe Washington, Teddy and those other guys off. It'll be just my family on there, and well rename it Mount Trumpmore.

I can do this. I am the President. I'll prove I am not a Diabolical Narcissist with my family on Mount Trumpmore.
https://www.congdonandcoleman.com/
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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.