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2019-11-17 15:44 by Karl Denninger
in Health Reform , 363 references Ignore this thread
See, I Told You So: FORCE THIS OR DIE AMERICA
[Comments enabled]

Gee, someone else figured it out?

As the Democratic presidential candidates argue about “Medicare for All” versus a “public option,” two simple policy changes could slash U.S. health-care costs by 75% while increasing access and improving the quality of care.

These policies have been proven to work by ingenious companies like Whole Foods and innovative governments like the state of Indiana and Singapore. If they were rolled out nationally, the United States would save $2.4 trillion per year across individuals, businesses, and the government.

What was my number?  80% or more.  And that's without screwing a single person.

The first policy—price tags—is a necessary prerequisite for competition and efficiency. Under our current system, it’s nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing. Patients have no way to comparison shop for procedures covered by insurance, and providers are under little pressure to lower costs.

....

Price tags also insure that everybody pays the same amount. We currently have a health-care system in which providers charge patients wildly different prices depending on their insurance. That injustice will end if we insist on legally mandated price tags and require that every patient be charged the same price.

It's not "injustice" -- it's too many felonies to list, all of which carry hard prison time for everyone involved.

It's extortion to threaten, whether by implication or statement, that unless you buy health insurance you'll be billed 10x as much for the same thing.  Yet that happens all the time.  It also constitutes an illegal tied sale (forcing you to buy another product or service, in this case health insurance, you don't want or you will be disadvantaged) -- this too is unlawful under anti-trust law.

In addition it implicates 15 USC Chapter 1, which carries a 10 year prison term, in that it is clearly an attempt to restrain trade -- how do you have competition when you can't get a price?

15 USC has been on the books for more than a century.  The medical industry has twice tried to get an exemption through the courts and lost both times.

As a side benefit, we will also see massively lower administrative costs. They are currently extremely high because once a doctor submits a bill to an insurance company, the insurance company works hard to deny or discount the claim. Thus begins a hideously costly and drawn-out negotiation that eventually yields the dollar amount that the doctor will get reimbursed. If you have price tags for every procedure and require that every patient be charged the same price, all of that bickering and chicanery goes away. As does the need for gargantuan bureaucracies to process claims.

This is why the politicians refuse to address this and the cops won't arrest.

We have added roughly 400,000 people a year since the crash to the "health care" sector in employment.  Yet a look at the statistics for doctors, nurses and other direct care-givers shows that doctors have barely moved in number and nurses, while they've increased, have only gone up by a few.

All told roughly ninety percent of the "employment" adds in this sector since the crash in 2008 never provide a single second of care to a single person and this did not start in 2008 either; it's been going on for at least the last two decades.

If you put a stop to the scam nearly all of those people instantly lose their jobs.  We're talking about roughly 15% of the economy that instantaneously evaporates.

Now it won't stay gone for long; with much lower costs the resulting economy progress that will follow will set records for years and those people will be hired to do something else.

But the immediate effect of doing this will be a 15% contraction in GDP and the loss of millions of jobs on an immediate basis; the papers will scream "Depression!" (because from the perspective of a classical economic basis it is) and the political blowback in the short term will be extreme.

The second policy—deductible security—pairs an insurance policy that has an annual deductible with a health savings account (HSA) that the policy’s sponsor funds each year with an amount equal to the annual deductible.

There's no need to do that but its an OK adjunct.  Why not?  Because I've got a better answer to that, although HSAs, as they already exist, are certainly a good thing and can be an effective part of the answer.

Oh, and before you say it won't work?

We know this to be true because while price tags and deductible security were invented in the United States, only one country has had the good sense to roll them out nationwide. By doing so, Singapore is able to deliver universal coverage and the best health outcomes in the world while spending 77% less per capita than the United States and about 60% less per capita than the United Kingdom, Canada, Japan, and other advanced industrial economies.

Note that Canada, Japan and the other economies are all socialist systems in whole or part.

I hope that politicians on both sides of the aisle will get behind these proven solutions. Washington should not be a place where good ideas go to die.

They will not unless the only alternative, as expressed by the people, is a gallows being erected on the National Mall or worse.

I've been tracking this trajectory since the 1990s when I was buying health insurance for my staff at MCSNet.  It was glaringly obvious what was going to happen, and I started raising Hell about it.  Nobody gave a wet crap.  Nobody has since.  Despite serving on the EC of the Florida Libertarian Party not one time did I manage to get that into the party platform nor did I manage to get one candidate to run on such a platform.  In my time before or since exactly zero politicians of either major party have done so.

Matt Gaetz (R-FL-01) lied to my face and that of a room full of Seniors at a town hall meeting here about a year ago, claiming that the Health Industry was exempt from 15 USC.  When challenged with the two USSC decisions that say otherwise he promised to get back to me and never did.  He is a liar and a fraud, just as are the rest of the politicians.

Leverage, my book which was published in 2011, pointed out all of these facts and numbers.

Since then I've published a whole series of articles on Health Reform, many of which remain available.  You can get the reverse-chronology reading list right here.

specific legislative proposal to solve the problem can be found here; it contains a link at the end that goes to a second article that describes how implementation would look.  It resolves all of these scams.  Part of it can be done by Executive Order or simply by starting to prosecute providers, insurers and drug companies under 100+ year old criminal felony law.  The rest needs Congress.

Oh by the way doing this eliminates the entire Federal Deficit and the government runs a surplus.

I'm not kidding -- it really does and it really will; that's the math.

So why won't the politicians take this on?

Simple: If you do it nearly all of those 4 million people employed robbing the public lose their jobs and the stock prices of the firms who have made all their money ripping people off, never mind all the billionaires who have done so in the medical and drug industry lose much or even all of their value.

I remind you that Obama claimed he was going to fix this.  He lied.  Trump had three bullet points on his campaign web page that, in effect, would implement most of this.  I said during the election season that I didn't believe a word of it as it all sounded good but lacked the sort of detailed exposition that indicated he really meant it and had studied it.  All three points disappeared on the night of the election as soon as it was called for him; his recent "proposal" has no teeth in that it carries a trivial $300 fine for non-compliance.  He's a known serial liar when it comes to this issue as is every single GOP member in the House and Senate.  The Democrats, for their part, want to enlarge their control over this part of the economy even more than exists now.  When they can't pay for it, which will occur within the next five years, the government will collapse or if you actually need health care you will be left out in the cold to die

I suppose the Democrats consider that "reasonably safe" in that someone ill enough that they'll expire without their "health care" probably is too sick to be able to mount a revolt, never mind that "one nut at a time", which is exactly how the press will present it to you, just gets themselves either arrested or dead.

Again, from the above:

The immediate effect of doing this will be a 15% contraction in GDP and the loss of millions of jobs on an immediate basis; the papers will scream "Depression!" (because from the perspective of a classical economic basis it is) and the political blowback in the short term will be extreme.

Thus the only way this will happen is if the people of this nation as a whole, not a few "nuts", make clear that not implementing this change is worse.

What's worse than losing your job to a politician?

Only one thing: Losing your head.

Thus the people of this nation must make clear as a whole, not a handful nor a fringe group, that either this policy change is implemented or a literal ejection and replacement of the entire government of this nation by whatever means are necessary, up to and including through the use of force, will occur -- a literal "second act" of 1776.

If the people of this nation will not rise and make that demand as a body politic then it will never happen.  In fact, a number of years ago when I met with Senate staffers to discuss exactly this that was what was communicated to me; they had no intention of doing anything like this from both sides of the aisle and the reason was they knew they'd get voted out of office if they did.

Therefore the only means of obtaining that outcome is for the people of this nation to insist that it happens under penalty of worse than being voted out of office.

You don't have to like logic and where it takes you; I certainly don't like where logic leads in this instance.  But whether I like it or not is immaterial to the facts; it is what it is.

All governments exist only with the consent of the governed.  That is the lesson of 1776 and our Constitution.  This fact is clearly stated, in plain English, in the Declaration of Independence.

Our economy currently has one dollar in five spent on health care and 80%, approximately, of that is stolen through these schemes.

The medical and "health insurance" system in this nation is the largest criminal enterprise and organized racket, extracting more money from more people, than any other in the history of mankind.  It personally costs each and every citizen in this nation, man, woman and child, in excess of $10,000 per year and is expanding at a rate of approximately 8% every year, far beyond economic growth and the ability to pay.

The continued existence of this scam is an existential threat to the United States.

It must be stopped here and now.

Whether it is, or whether we instead all go down the toilet together, is collectively up to you.

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Stee_man
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Price transparency is everything. Then he confuses things by bringing up HSAs. I guess there wasn't enough material for a whole book without that.

Americans are confused because the industry wants it that way. They say, if only trial lawyers would leave us alone. Meanwhile they operate the only service in the world that can get away without quoting prices.

What if you filled your grocery cart, then at checkout the store could decide how much you should pay. It would be a really reasonable number, right? But before you can even get past the door, you are forced to agree to pay what ever they wish to charge. People would scream, but they willingly do that at every health care provider.
Amused
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I dare say 80% of the real 'healthcare' people need or experience is simply pill pushing, and even if you post prices, and try to lay anti-trust enforcement, it won't help because of regulatory capture.

I can't freely shop for drugs and devices without a rent seekint doctor getting is cut.

A simple solution is to return to a pre-CSA model where only certain Narcotics are restricted (I still don't like that but would tolerate it), so people can just get whatever refill they need whenever they need and want it.

Want to see waste in healthcare? It is an otherwise healthy 36 year old woman having to go back and sit at the doctors for an hour, go through the whole process of weighing, blood pressure, shakedown by incompetent staff and a five minute visit from the doctor just to get Zolfoft refilled. Oh wait, this time we want you to also go get blood work done. And of course come back AGAIN for another rent-seeking co-pay.

You multiply this behavior, by every other drug or treatment, most of which should be over the counter (like say... birth control), and you quickly see the other end of the scam.

Now you add the repeal of the CSA to your plans and make it a three part system? Then I believe we would see that 80% collapse of the industry.
Tickerguy
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Except if the doc has to post a price you can find a doc-in-a-box to do it for $25 - and write it for 3 refills.

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Winding it down.

Amused
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I mean seriously, you want to talk extortion?

Let's ask that women what the **** she does when she can't get her Zoloft (which is dirt cheap refilled) because she can't pay the extortion fee of the doctor?

Of the guy with diabetes when he can't pay for the office visit to get his Metformin refilled? Or his insulin? He is otherwise completely healthy, there is no change from a year ago, he is just having a hard time right now.

Or what about the college kid that needs to replace his EpiPen? You are literally going to shake him down, while he is already broke, and deny him his life saving device?

It is ****ing Murder that these things are not over the counter.
Amused
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I'm saying, why the hell should I need a permission slip for a chronic condition? I'm gonna need Zoloft for ever. Kevin is gonna need his EpiPen forever. Mike is gonna need his Insulin or Metformin forever unless his got his way by being a fat slip that didn't watch his sugar.

It is a bloody shakedown. Literally holding a gun to our heard for those three Oliver 'yes may I have another passes'

It is ****ing immoral at any price, be it $5 or $100.
Hot-dog-guy
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Hey guys it kinda occurs to me.

If you won't stand and literally fight the establishment, well, truth is it takes a lot of time off work and in Northern Arizona we got cops and deputies up the ass because we dared raise a fuss.

And preppers though we are, we're starting to run short of basic food stuffs.

See, in between you guys telling us we should revolt and us actually revolting, there's a certain leadership gap.

Make no mistake though, if there's any revolting news it's gonna come from us dirt poor masses. And now we are literally revolting. They cut off our water. We haven't bathed in weeks.

Could you guys maybe consider helping us finance a portable shower just so we don't smell so bad while we're defending your liberty?

Some soap wouldn't hurt a bit.

Check out http://arlallc.org/ for hip news and instructions on how to send us soap.
Doctor.d
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Quote:
Gee, someone else figured it out?


More like someone has been reading your blog!
Redcabin
Posts: 2
Incept: 2019-07-06

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Karl, I believe you but need my hand held. How does an individual fight back on this? As youve pointed out, this is serious upstream swimming. Very powerful people make me nervous. Im just a guy. A guy that just now looked up this recent rotator cuff surgery cost at Surg Center of Oklahoma. Website lists their total cost at $8460 vs the cost for my surgeon at 30k+. The deductible and then 10% my out of pocket was within reach of SCO.

Seems like pointing to this or the cost of foreign surg might make a difference to some. But big numbers, enough to start a big chance? Very unsure if progress even if it means saving murica.
Goforbroke
Posts: 7599
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The tadpole and I are hunkering down.
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Marketwatch? Hmmm ... Seems to me that Mr. Sean Masaki Flynn needs a 24/7 watch so he doesn't have an unforseen accident.

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And yes, I'm not deleting this because despite her appearance to be a new age nutcase, I think this is true ... Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our Light, and not our Darkness, that most frightens us. -- Marianne Williamson
Jal
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"Oh by the way doing this eliminates the entire Federal Deficit and the government runs a surplus."

Can I disagree on this point . "run a surplus" . not in my universe.
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I went to the original article.
https://www.marketwatch.com/story/the-us....
By Sean Masaki Flynn
Published: Nov 9, 2019

There are Conversation(818) at this time.

" .price tagsis a necessary prerequisite for competition and efficiency."

There is price tags in all system and all systems have been written by the very people receiving the money.

My input is that I'll be dead before price tags will cause the price to go down.
Captainkidd
Posts: 1601
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Houston, Texas
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Quote:
It is an otherwise healthy 36 year old woman having to go back and sit at the doctors for an hour, go through the whole process of weighing, blood pressure, shakedown by incompetent staff and a five minute visit from the doctor just to get Zolfoft refilled.


Along those same lines, even though I can pass an eye exam 20/20 with the glasses or contacts I'm wearing, if I decide or have to get another pair, and the scrip is more than 12 months old....NOPE!!!!

Quote:
Except if the doc has to post a price you can find a doc-in-a-box to do it for $25 - and write it for 3 refills.


I've been using this exact tactic for about 4 years now for the times I absolutely have to go to a doctor. $35 office visit, and scrip written with refills as needed. GoodRx coupon fills 90% of them for less than my copay through work provided "Insurance".

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A lawyer with a briefcase can steal more than a thousand men with guns. --Mario Puzo

It is well enough that people of the nation do not understand our banking and monetary system, for if they did, I believe there would be a revolution before tomorrow morning. -- Henry Ford
Hot-dog-guy
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To get back in the convo, I see that you guys are talking about your choppers. Your perly-whites.

I don't know how to put this gently but for some reason our pumpkin chompers were designed for a species that didn't live much longer than 45 years.

A more proximal lesson I learned as a kid is we just get dentures.

Perhaps oddly, a toothless grin indicates age and maturity to me. It's the opposite of perfect teeth, perfect boobs, perfect liposuction, perfect perfection. We get old, we get wise, our hair turns grey, our teeth fall out and we all start looking like Karl Denninger. And then young men ask us for advice.

Our advice better damn well be better than "get your teeth fixed".

My latest young man house guest is just about to get his cert in HVAC. He scores in the 95th percentile in every test and he doesn't even study.

Naturally his most important interest in the universe is getting laid. And he's worried about his teeth. He's got girls jumping out of closets to be with him.

How do I keep him on task? It's easy. I threaten him daily with violence. I'm done with shilly shallying, son, if you don't produce and perform in this house, I'm not gonna yell at you, I WILL ****ING KILL YOU AND THEY WILL NEVER FIND YOUR BODY.

He seems to have taken this to heart. He listens to every word I say. He sleeps on my couch because he says "it feels more like home".

This feels more like home to you kid? I'm just trying to imagine what this kid went through before me.

AFAIC, I'm pretty proud to have a son. Always wanted one of those. I got a good one. World's loss is my gain. I get to put the blessing on him that my dad did for me. Which I'd recite right now but it doesn't translate well from Lennappe to English. It was a stupid language anyway.

Tickerguy
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******nit I'm out of CLP smiley

Not toothless yet. But eventually... yeah.

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Winding it down.

Hot-dog-guy
Posts: 163
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<blockquote class="forum">Karl, I believe you but need my hand held.</blockquote>

Long time readers have the popcorn machine heated up on standby.

You got one chance at this Ace. Don't blow it.
Amused
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> Except if the doc has to post a price you can find a doc-in-a-box to do it for $25 - and write it for 3 refills.

Tickerguy: it's not that I disagree that some competition will help, far from it, I've long advocated if we are gonna play this Open Borders Globalism game, we need to shove it down that throats of some sacred Industry, Healthcare and Legal.

Legal theory is basically the same for any Common Law country, regardless of if you are a Barrister in London, Sydney or DC, (some of the case law precedence is different, and the Constitutional law differs from parliamentary systems), but for most Defense and Torts the legal concepts are the same.

So I say, **** em, You can pass the Bar Exam? I am Oprah.
You get a Green Card.

You a neurosurgeon from elsewhere in Oceania or the EU? Can you pass the Board Exam?
You get a Green Card.

If we want to drive prices down, it shouldn't just be because some border jumper did it to the kid who could have made his summer money picking cabbage and carrots or computer programers and architects being pushed out by global competition.

Make the Bastards Eat Globalism and let the Free Market do its thing.
Asimov
Posts: 112685
Incept: 2007-08-26

East Tennessee
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Amused: You've said something like that before.

The doctor and nurse wages aren't the issue. They're small to the point of irrelevance in comparison to everything else.

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

Festina lente.
Tickerguy
Posts: 160437
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@Hot-dog-guy - one dude just ends up dead or in jail. Or five dudes. Pass. Y'all got about two or three months then, well, I'm done.

I just don't see this nation giving a ****. So I'm gonna go hike, ski and drink and when my time comes, take the walk.

**** it.

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Winding it down.
Tickerguy
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@Asimov - yep. Horse, water...

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Winding it down.
Amused
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Asimov: it's not that I disagree about the other areas of bloat, far from it. I think Tickerguy is 100% correct about the bloating of the 'support staff', the paper pushers doing the coding, claim filing, etc, and the issues of price transparency and market forces are clearly a problem.

My disagreement is that that is the totality of the problem. I see it as 66% of the problem, and the other 33% being the Rent-Seeking Regulatory Capture.

Market forces can drive down the costs of the middleman. My argument has whole been **** the middle-man.

If I use an app to test my vision at home I should just be able to buy a set of glasses or contacts, no prescription.

If I need Metformin or Insulin or Testosterone or Estrogen or Birth Control, or an EpiPen, in a Free Society I should just be able to ****ing buy them.

There is an entire third part the argument missing, which frankly did not exist before the Controlled Substances Act was passed, and anything and everything required a permission slip to buy.

That is not freedom. Do I agree that all of Tickerguy's proposals would work? Certainly.

Do I see them happening? No. No more so than I see Regulatory Capture going away. But if it could, it would have a lot of the same effect because most of us would just tell the Medical Cartel to **** off and die and never go to the doctor again if we could just buy our **** like you would be able to in a truly Free Society.
Hot-dog-guy
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Karl, all jokes aside. I was willing and ready to follow Aaron Russo into battle. In fact that was my specific task. Hands on hard and dirty street activism.

THE ****ER UP AND DIED ON US and perhaps worse, he ordered us to support Ron Paul with everything we had in us. That blunted our keen edge. It wasn't the best strategic move.

You were there Teabagger. You know. We had EXPLOSIVE energy and dedication.

I'd follow you now iffn you lead. People need leaders now more than ever. I bet I'd be one of 25 readers that would organize as YOUR MILITIA. I trust you. I trusted Aaron for the same reason. He had caring and compassion from the engine room to the flying bridge, he cared about every single one of us, he knew the names of our kids. He'd call and get my female and he's day "Hi Susan sweetness how are you darling?"

You know that we know that you know you owe us nothing. Not one of us can blame you if you want to bust out your remaining joints to busting powder. Smartest guy in the room. Who are we to say how you spend your remaining days.

I am gonna tell you that it's gonna hurt. It's gonna hurt us bad in terms of lost opportunities, it's gonna hurt in terms of the limited leadership we can offer and let's really face this.

Aaron Russo fought as hard as he could to be our front man and he died trying to insure an inheritance for all of us. He'd be here right now if he could.

You say you wanna go surf the waves.

Boss, and I have secretly always wanted to call you boss so this might be my only chance.

Boss, if you step away from us, are you sure you aren't gonna always be looking over your shoulder?

Regret is the worst bitch in the whole world boss. Don't let it happen to you.

I leave you with the same words I had for Aaron when he fired me. I said you can't fire me boss, I'm a volunteer.


Click
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I'm totally for -15% GDP and unemploying hundreds of thousands of middle and lower class workers employed by the Marxist healthcare system. I'll watch as not just "hundreds of thousands lose their healthcare jobs", but millions do. A "depression" would totally wreck the "consumer economy". And this next depression won't be just any ol' depression. The consequences of taking a machete to the Marxist healthcare system and cutting out the cancer would put the entire system into shock and undoubtedly kill the entire Marxist economy. Yeah, I can see it all now. I can smell it, too.

The American Empire is built on malinvestment. FDR and his Marxist "Brain Trust" laid the foundation for what The American Empire is today, viz., an Orwellian Super State. The Keynesian credit and money junkies have been addicted to "stimulus" ever since the last Great Depression. And right now the American Empire is on monetary crack. The Empire won't survive the withdrawal. Ever hear of a "crack-up boom"?

The Mother****er of all crack-up booms is on the way. And so is civil war. Personally, I have to problem with anybody who with a machete in one hand and meat axe in the other slashes and chops up all of the Kafkaesque bureaucrats entirely out of the healthcare system. I say let the doctors on their own organize a totally free-market healthcare system. And let the insurance companies compete 100% laissez-faire.....

....But of course you know this means WAR!

Fine. Bring it on. The next great depression. Civil War2. The Mother****er of all Crack-up Booms. It's coming sooner or later, anyway, so "go ahead and make my day". Put the Marxists out of work...
Click
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"two or three months then, well, I'm done".

I don't blame you!, Karl, one bit for not grinding out one article after the other anymore. Writting articles at such a high level is really hard work. I for one, hope that you don't discontinue writting altogether, but only cut back to once a week or once a month.

I hunt, fish, hike, snowshoe and campout, yet I can still stay connected to the Internet from the top of a mountain.... Anybody can. Whatever you decide. Good luck.
Tickerguy
Posts: 160437
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@Hot-dog-guy -- you're missing the point, I suspect. Probably on accident.

Yeah, we could do that. We'd get nothing out of it. We'd all be dead, or in prison, and the impact would be zero. Black bastard (my cat) would miss me.

Google Joseph Stack. Impact -- zero. He's dead, and that's it.

I'm not nuts. There are plenty of people around me who are, but I'm not. I've spent the last 20 year here in a nice place. I'm moving, mostly because I'm just tired of being here. No other real reason. I can live where it's 1/3rd cheaper, and I like it more. That's enough reason to do it, so I'm gonna do it. And most of the people who I don't really like all that much -- I'm not telling 'em where I'm going. I'd rather be alone. I sort of like it, to be honest.

WHEN, not if, it all goes to **** I really don't give a ****. If I run out of money or health, and either might happen, I'll go take a walk in the woods.

Would I lead something? Sure. But not a rag-tag band of fugitives. We'll all be dead, nothing will change, and when I get to Hell, and I'm sure I'm going, I want it to be worth it, or not at all.

So let me know when the American public gives a ****. IMHO, they never will. When and if nuclear hellfire rains down we all have it coming and we deserve it in this nation. I'd dump my jizz in Schiff's eye sockets but only if it would make a difference, because otherwise the sentence for doing it, and I'd willfully accept that without complaint, isn't worth it.

And today, it won't make a difference.

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Winding it down.

Austin
Posts: 85
Incept: 2008-10-22

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you should get Steven Crowder going on this [ he loves your present system it seems ] or Joe Rogan
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