Health

Let’s lay out the parameters for a bill, a fairly-modest update to my two previous missives on this point here and here (note the dates) and which can be easily turned into formal legislative language:

  • All providers must post, in their offices and on a public web site without any requirement to sign in or otherwise identify oneself to access it, a full and complete price list which shall apply to every person.  This instantly allows customers to compare pricing between providers for services and products in the medical realm.
  • 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.  The current system of an “explanation of benefits” that often features a “negotiated discount” of some 90% is nothing other than an extortion racket and is arguably felonious — threatening to bankrupt someone if they don’t buy your “insurance” through a threat to charge them ten times as much certainly appears to be a criminal enterprise and, given that more than one entity is involved, looks like it meets the definition of Racketeering.  Insurance coverage may well cover some, part or none of a given bill, and nothing prevents an insurer from telling you in advance of your visit how much they will pay (if anything) for a given procedure or drug.  Indeed you should demand that information from them and use it as part of choosing where to obtain treatment but the bill still has to be rendered to you, you have to be the one to file the claim and everyone must pay the same price to the same provider for the same kind and quantity of product or service.
  • For a bill to be valid and collectible it must be affirmatively consented to in writing, with a disclosure of the actual price to be charged from the above schedule for each item to be provided whether good or service, prior to the service being performed or the good furnished, subject only to the emergency exception below.  A bill that is increased, has items added to it after consent is obtained, which contains any open-ended promise to pay without an actual price listed for each service or good prior to customer consent or is issued with no consent at all is deemed fraudulent and void. This instantly stops “drive-by” doctor charges in hospitals as just one example.  It also prevents charging $20 for an aspirin; nobody would tolerate being billed by the square for toilet paper in a hotel!  Hospitals will of course squawk that they cannot operate like this as they “can’t” figure out what is required until after-the-fact but that’s false; nothing prevents them from advertising “Appendectomy: $2,000” and that being the soup-to-nuts price.  In fact that’s exactly what the Surgery Center of Oklahoma does today so quite-clearly it both can and does work.  In addition this change will permanently and immediately put a stop to the ridiculous practice of defensive medicine (read below for the explanation.)  You would never accept a gas station that only displays the cost of your gasoline after you pumped it and varied that price based on who your car insurance was bought from or a grocery store that had no prices posted at all and only gave you a total after your groceries were taken out of the store and the transaction could not be refused.

  • No event caused by or a consequence of treatment can be billed to the customer.  This instantly aligns the interest of the customer in not having such an adverse complication (e.g. MRSA, etc) with the medical provider.  As it stands right now hospitals actually have an incentive for you to have a complication since they make more money if you do.  If you call me to fix your roof and I drop my ladder causing it to crash through your picture window I get to pay for the glass I broke through my ineptness.  The same must apply to medical providers.  For those who claim hospitals and similar can’t adopt such a model I point to the OKC surgery center, which does exactly this — and has a lower complication rate (gee, I wonder why when they have to eat it if they cause it….)

  • All true emergency patients, defined as those who are unable by medical circumstance to choose where their treatment is to take place and require immediate medical intervention to either stabilize their condition, prevent severe permanent impairment or death (e.g. transported by an ambulance, unconscious with no person with medical power of attorney at-hand, having a heart attack in the ER, etc) must receive the same price for the same service as a person who consents to said service.  For a bill to be valid for a true emergency documentation must be maintained and presented showing that the customer was unable, due to exigent circumstances at the time they presented to the provider, to provide consent prior to services being rendered.  Any medical provider who attempts to bill any service or product above that price to a person in exigent circumstances forfeits 100% of their invoice and is guilty of consumer fraud.  Note that this does not prohibit a hospital from having a published price list that charges more for services rendered through their Emergency department so long as those who walk in, are conscious and able to consent gets the exact same price as someone who is unconscious and flat on a gurney.  If you demand that an A/C repairman or plumber come out now at 3:00 AM he most-certainly can charge you more than if you call and ask him to show up during normal business hours!
  • All medical records are the property of, and shall be delivered to, the customer at the time of service in human readable form (a PDF provided on common consumer computer media such as a “flash stick” shall comply with this requirement.)  Any coding or other symbols on said chart must include a key to same in English delivered at the same time.  No separate charge may be made for the provision of a contemporary record of a medical visit or treatment other than a reasonable charge for physical media if the customer does not have same with him or her.  The obvious way to do this is for the customer to bring a flash drive to which the human-readable chart is written.  If the customer doesn’t have one the office can certainly maintain a small supply of $10 flash drives and charge the $10 to their bill.
  • Auxiliary services (e.g. medical or dental Xrays, lab testing, etc) may not be required to be purchased at the point of use.  If you wish to buy your tests from the lab down the street (which also must post a price) that’s up to you.  If you wish to have your bitewings taken at the imaging center across town, that’s up to you.  The dentist or doctor cannot require that you buy those services from them; they must compete for them like everyone else.
  • All anti-trust and consumer protection laws shall be enforced against all medically-related firms and any claimed exemptions for health-related firms in relationship to same are hereby deemed void; for private actions all such violations proved up in court are entitled to treble damages plus a $50,000 statutory civil penalty per impacted person.  If the government won’t bring these charges (and we know they won’t since despite not one but two US Supreme Court cases here and here making clear anti-trust laws apply to medical providers of all stripes not one charge has been leveled against any of the medical firms) let’s make it damn attractive for individual private suits by making the price of losing such a suit for a medical provider ruinously expensive (and lucrative for the attorneys bringing them!)
  • Any test or diagnostic that carries no exposure to drugs or radiation, nor is invasive beyond a blood draw, may be purchased without doctor order or prescription.  If you want an A1c or CBC you thus need nobody’s permission to have one.  Same for an MRI.  For those tests and procedures in which exposure to drugs or radiation are involved, or are invasive (e.g. internal biopsies, etc) requiring some sort of chain of evidence of need due to that risk is reasonable.  But for most diagnostics this is demonstrably not true.  There is a clean argument to be made that for young, outwardly healthy adults a metabolic panel and CBC might actually be more useful in catching incipient serious disease than an annual physical which typically is nothing more than 5 minutes of observation and no checking of metabolic parameters beyond blood pressure and pulse rate!  The former can be had for $10 while the latter is often a $100+ charge.  Let the people and evidence show which is superior on a cost:benefit basis; after all it’s my ass on the line from my decision not yours.
  • Wholesale drug pricing in the United States must be on a “most-favored nation” basis.  The impact of this would be to force a level price across all nations for drugs produced by any pharmaceutical company marketing both in the US and anywhere else in the world.  Violations, including attempts to “offshore” via subsidiaries to evade this requirement are deemed criminal and civil acts.  The civil penalty shall be 300% of the difference paid to the customer who got screwed, and another 300% for each instance of a prescription filled at an inflated price paid as a fine to the government.  This would drive drug prices down by at least half in the United States and for many drugs by 90% or more.  It would instantly and permanently end, for example, the practice of charging someone $100,000 for scorpion antivenom in Arizona when the same drug from the same company is $200 for the same quantity 40 miles to the south and across the Mexican border.  Since all prices must be posted at the retail consumer level for both goods and services controlling the drug pricing problem at a wholesale level is both simpler and sufficient since competition will already exist at the retail pharmacy level.
  • No government funded program or government billed invoice will be paid for medical treatment where a lifestyle change will provide a substantially equivalent or superior benefit that the customer refuses to implement.  The poster child for this is Type II diabetes, where cessation of eating carbohydrates and PUFA oils, with the exception of moderate amounts of whole green vegetables (such as broccoli) will immediately, in nearly all sufferers, return their blood sugar to near normal or normal levels.  The government currently spends about 25% of Medicare and Medicaid dollars on this one condition alone and virtually all of it is spent on people who can make this lifestyle change with that outcome but refuse.  If you’re one of the few exceptions and it doesn’t work in your case you have the burden of proof.  Nobody has the right to light their own house on fire on purpose and then claim FEMA benefits for same.  This one change alone will cut somewhere between $350 and $400 billion a year out of Federal Spending and, if implemented by private health plans as well, likely at least as much in the private sector.  That’s more than three quarters of a trillion dollars a year that is literally flushed down the toilet due to people being pigheaded and refusing to do things that would not only save the money but also save their limbs, eyesight and ultimately their life.
  • Health insurance companies must sell true insurance to sell any health-related policy at all.  A true insurance policy is defined as one that (1) does not cover any condition you have received treatment for over the last 24 months (in other words, p != 1.0), (2) if an adverse event does occur your obligation to pay any further premium ends with regard to coverage for that event and all consequences thereof while the company is required to pay reasonable costs of treatment until and unless the condition has been resolved without limitation on the necessary amount or duration of said payments and (3) does cover, with a selection of deductibles available to the buyer, all accidental injuries and truly life-threatening emergency medical events.  Medical underwriting is permitted for such catastrophic policies but once undertaken is transferable to a new company without a new round of underwriting provided no interruption in coverage of more than 60 days occurs.  Such a policy may exclude intentional acts (e.g. acute drug overdose by other than non-consensual consumption), perhaps with an exclusionary period (such as that for suicide on life insurance.)  A common policy of this sort with the above reforms would cover things such as heart attack, cancer, liver failure by other than alcoholism, rare diseases and similar and would be very inexpensive.  For a young person of normal weight the cost of such a policy might be $100 a year.  For a 50 year old, maybe $300 a year.  If you’re overweight or obese (or worse, have a high A1c) then it’s going to be considerably more-expensive because your risk of heart attack, for example, would be much higher.  Ditto if you’re a smoker.  To protect against fraudulent misconduct by insurance companies with regard to rescission of policies after an event, which used to be quite common, the only grounds for rescission is evidence that you actually underwent medical treatment for the condition that is medically proved as the underlying cause of the claim or fraud in the application (e.g. claiming to be a non-smoker when in fact you are.)  The two-year “no treatment” period balances sufficient protection against anything that (1) is degenerative and emergent and (2) would otherwise lead to a claimable event against the abuse of rescission against the possibility of a customer attempting to rip off the insurance company (and thus all the other policy holders) by buying a catastrophic policy after a serious event has become evident to them.
  • All health insurance providers selling true insurance, in whole or part, must provide within their “true insurance” the ability to “replace like with like.”  This is the premise of insurance, subject to policy limits.  If you wreck your car you’re not entitled to a new car, but rather either (1) repair of the one you wrecked to “as before the wreck” condition or (2) its current value in money.  To the extent reasonably possible health insurance for “true insurance” events (as above) must therefore cover the provision of services and goods to return “like for like” within the area where you are at the time the event occurs, or to where you are involuntarily transported in the event you are incapacitated.

  • Medicare becomes just another insurance provider.  There is no “special” Medicare-accepting doctor list; it is simply an insurance plan and one that does not pay for routine physician visits and similar but rather covers unexpected insurable expenses.  In other words Medicare Part “A” will continue as-is along with Part “D”, but Medicare Part “B” will be deleted.  Since Medicare was sold to the public as an “80/20” plan (the customer bears 20% of the cost of care) this change represents no violation of that promise.  In addition Seniors can still buy “Medicare Advantage” plans should they wish that covers all medical costs (with possible deductibles and co-pays) as is currently the case.
  • Medicaid is repealed entirely. No, we’re not leaving the poor out in the cold.  See the next point; the poor will in fact obtain better care than they have now as they will have full access to the entire body of physicians, hospitals and facilities.
  • For those who have no means to pay and find themselves with a need for medical attention the following provisions shall apply:
    1. EMTALA is hereby repealed.
    2. The provisions of this section, bearing on those who cannot pay for medical services, shall apply only to US Citizens and lawful permanent residents. This instantly puts a stop to the “uncompensated care” problem for illegals and the “come here pregnant and poop out a kid” expense issue as well.  No medical provider shall have any liability, whether civil or criminal, for their refusal to provide care for which they are unable to secure payment when furnished to other than lawful permanent residents or Citizens.  Other nations that wish to negotiate a billback provision for their citizens in order to insure that payment is secured may, of course, do so but under no circumstance shall a person who is not a citizen or permanent resident obligate any provider to provide services without payment, nor may they avail themselves of the backup payment provisions of this section, nor does any cause of action in favor of any person arise in equity or law for a provider’s refusal to provide care to a person who is not a citizen or permanent resident without sufficient guarantee of payment for medical goods and services.
    3. For those with true emergencies (as defined above) and who are lawful permanent residents or citizens and thus can identify themselves as such who are unable to pay the treating hospital/ER shall bill the US Treasury for the lawful charges incurred under the above framework and shall be paid within 30 days.  All provisions of the above shall apply for what constitutes a lawful and payable bill and shall be provided to the customer at the time of service along with the fact that same has been forwarded to the US Treasury for payment.
    4. For those with non-emergency conditions who are (1) US Citizens or (2) lawful permanent residents and who assert they are unable to pay the medical provider shall bill the US Treasury for the lawful charges incurred under the above framework and shall be paid within 30 days with the provision that government billing shall not be available for any condition, drug, device or treatment for which a lifestyle modification that the consumer refuses to make will alleviate any or all of said expense and need for medical goods or services.  Again, all provisions of the above shall apply for what constitutes a lawful and payable bill and shall be provided to the customer at the time of the service being provided.  Treasury shall provide a means of rapid verification of citizenship or permanent resident status for the use of medical providers, with access to same restricted for this exclusive purpose so as to allow validation of such claims at the time of service (if we can have a background check call-in number for gun sales we can certainly verify citizenship status for those who claim to be indigent and in need of medical care!)
    5. Said charges under (3) and (4) will, when submitted to Treasury, result in an invoice being sent to the taxpayer in question and may be settled within 90 days of submission at no penalty.  This allows a person who temporarily cannot pay or who is misidentified as not having a means of payment (whether insurance-based or otherwise) to make payment directly to the US Treasury without risk of an adverse tax action.  If said bill(s) are not paid in full within 90 days then they become a tax lien subject to collection exclusively from any or all of (a) refundable tax credits, which may be garnished at up to 100%, (b) tax refunds, which may be garnished at up to 100%, (c) other entitlement checks excluding Social Security retirement which may be garnished at a rate of no more than 25% (e.g. social security disability, general assistance, etc) and (d) windfall amounts in cash or property that cumulatively exceed $10,000 in a rolling 12 month period from any source (e.g. inheritances, lottery winnings, gifts, etc.) that may be garnished for payment up to their full amount.  Statutory interest at 110% of the current 1-year Treasury bill rate, with the rate adjusted on the last business day of each calendar quarter, shall be applied on any remaining balance until paid in full. This will be vastly cheaper than Medicaid — about 10% of what is spent today, in fact, and a good part of it will be recoverable over time.
    6. At death if a tax lien exists for unpaid medical bills it shall be treated as any other tax lien for the purpose of claim against the decedent’s estate except that in the case of a married couple with a surviving spouse who’s marriage pre-dates the medical expenses in question any such claim shall not be recoverable during the surviving spouse’s remaining life but rather shall become a claim against said surviving spouse’s estate at the time of their death.  Remarriage, creation of a trust or other estate-planning vehicle after the event(s) giving rise to the medical tax lien shall not modify or defray this liability and may not be used to shield the assets of the surviving spouse from an existing claim.
    7. Any provider of service that falsifies billing under this section, bills at inflated prices or otherwise violates the provisions of this law in regard to any bill submitted to the US Treasury for payment shall be deemed guilty of a criminal felony for which the punishment shall be the forfeiture of three times the billed amount and each individual who has caused such an invoice to be issued, transmitted or otherwise participated in same shall be subject to a fine of not less than $1,000 nor more than $10,000 and imprisonment of not less than 2 and not more than 5 years.  Each fraudulent invoice shall constitute a separate and distinct offense, all penalties shall be consecutive and additive, and liability for same shall be joint and several.
    8. Misrepresentation of citizenship or permanent resident status for the purpose of obtaining health care to be billed to the Treasury shall be deemed a criminal felony punishable by not less than one and no more than ten years imprisonment and a civil penalty of three times the amount of the charges incurred.  Upon conviction said individual shall also be immediately deported and suffer permanent exclusion from the United States; said penalties may not be decreased or waived irrespective of other circumstances.
  • ALL provisions of the PPACA and other public health related laws contrary to the above, whether in law, CFR, Internal Revenue Code or otherwise are declared contrary to public policy, void and unenforceable, and all State Laws and Regulations contrary to same are preempted, void and unenforceable since medical care inherently involves commodities that travel in interstate commerce and thus the sale of such goods and services fall under the Commerce Clause to the US Constitution.  Rather than go through and strike them all (which of course Congress could do) that one sentence will take care of it until the necessary clean-up can be performed on a chapter-by-chapter basis.  Yes, this means the taxes, mandates and similar — all gone.

Now let’s look at what you could expect under such a system.

Let me first note that such changes would drop Medicare expenses in the budget by at least 75%.  Again, 25% comes off from changing how we handle Type II diabetes alone; these are not “pie in the sky” numbers.  This results in a near-complete deletion of the federal budget deficit on an instant and permanent forward basis and as a result everyone in the country becomes richer every year because their purchasing power of money stops going down and starts going up.  It also will materially increase access to doctors, clinics and similar by Medicare customers since there is no longer any discrimination between who does and doesn’t take the program — Medicare is simply an insurance payer just as any private program is, and will list its payable amounts for care just as will any private party insurance does.  This also leaves the Medicare Advantage programs, for those who decide they like that program better, fully intact.  For those Seniors who have medical expenses that exceed what Medicare will pay they will wind up with a tax lien just as will any other citizen.

If you’re unable to pay or accrue medical expenses in your Senior years (or otherwise) that wind up being paid by Treasury then when you die they go “poof” (Treasury eats them) to the extent that your estate is unable to pay them off as ordinary debt prior to distribution through probate (will) or trust.  If you’re married then your spouse cannot be punished for said debt during their life should they survive you despite some (or all) of your assets being titled in common, but your joint assets cannot be shielded when the surviving spouse dies against your medical claims nor can you marry after incurring such expenses as a means to prevent recovery from your assets.  This prevents “serial marriage” or late trust-creation gaming of the system yet also protects a surviving spouse, which will be particularly important for poor couples and will prevent some of the nastiest situations that occasionally arise today (where long-married couples are essentially compelled to divorce for economic reasons due to medical expenses and collection efforts.)

Medicaid goes away entirely on a formal basis however poor people actually acquire superior access to health care. The amount spent by Treasury would drop by at least 80% instantly.  A fair amount of the remainder would be, in future years, recoverable as some people leave the ranks of the poor and if and when they do their accumulated medical debt would be recovered over time.

This bill stops the detonation of all of the state public pension fund budgets — a catastrophe that has been driving property tax increases and threatens to destroy all of the state budgetary systems.  That all ends in one day.

It deletes all state Medicaid spending immediately (the states may choose to use said funds,or some part of them, to pay for low-income clinics and similar for residents in their states, much as County Health Departments do today in the States.)

It makes bilking the government by submitting false or inflated bills to the Treasury severe criminal offense.  The poor and disabled are the least able to press their own claims and fraud is rife in both Medicare and Medicaid today.  This puts real teeth in the anti-fraud provisions for those individuals who, most of the time, cannot reasonably bring their own suits.  It also protects the poor and disabled from improper tax liens while at the same time recovers from them the cost of their care should their financial situation improve in the future.

One of the often-repeated claims is that much testing today is undertaken for the purpose of “defensive medicine” in the form of preventing malpractice lawsuits (or at least making them harder to win.)  Forcing the doctor ordering said tests to present a price to the customer and obtaining their consent before the test is done ends this instantly.  If the customer refuses to consent to spending the money on some diagnostic then the result of doing so is on him or her.

“Poof” goes the defensive medicine problem in a puff of smoke because the customer made the choice rather than the doctor!  Physicians often claim we need “tort reform” and that they order tests by the bucket-full as a means to defray lawsuit risk. Various advocates, for their part, want to outlaw bringing such suits.  The problem with so-called “tort reform” is that sometimes lawsuits are appropriate — the classic example is when the doctor amputates the healthy foot or hand leaving the diseased one attached!  The best, easiest and most-equitable reform when it comes to the “tort lottery” game played today is to replace the current “order 10 tests” paradigm with informed consent and shift consent along with the cost and potential benefit analysis to the customer.  If the doc says “I want you to take a CT scan because I suspect X and it costs $200” and I say “No” because I don’t want to spend the $200 then if it turns out that the bad thing would have been discovered by the CT I cannot sue because I was offered but refused the test!  Customers need to become the decision point, not doctors; they must be presented both the cost of such procedures along with the expected benefits — including the odds of either proving up or refuting a possible diagnosis.  My ass, my choice, my expenditure, my risk.  That permanently resolves the entire tort lottery problem yet leaves the legal system intact for the outrageous cases where consumers should have redress in the courts.

Now on to some personal examples of expected financial outcomes.

First, let’s compare against an Obamacare policy that contains a high deductible for a reasonably-healthy, 40 year old person.  That person is today charged approximately $400 a month and the policy has a $5,000 deductible.

This means they pay $4,800 a year for exactly nothing and if they use any health services at all there is no coverage until $5,000 in additional funds are expended, at which point the insurance covers 80% up to the “cap” (typically $7,000 or $8,000.)

Under this system that customer would (voluntarily) pay $300 for a catastrophic policy.  Since they are nominally healthy they might decide to have an annual physical (at a cost of $150)  If they remained healthy they would spend nothing more through the year on medical care.

Their cost of health care would go from $4,800 a year today to $450 for a reduction in cost of 93.7%.

Now let’s take the person who is nominally ill.  Their current expense, assuming they consume $5,000 of medical care under the current insurance system is $9,800 a year — $4,800 for the “insurance” and $5,000 for the deductible.

What do they pay under this system?  $300 for their catastrophic policy which does not cover their existing conditions but does cover an accident or new catastrophe not caused by their existing circumstance and all of their current treatment at a discount of 80-90% of today’s pricing.

How much medical care can you buy for $9,500?  Well, you can buy one of many operations at the Surgery Center of Oklahoma, should you require one (and not many people need more than one in a year!)  You can buy a hell of a lot of pharmaceuticals when they’re sold at outside-US prices, which they would be immediately — in other words divide current drug prices by anywhere from 5 to 20 or more.  Monthly “specialty” visits to the doctor to monitor your condition would run you $700 over the entire year.

Do you really think you’d spend more than $9,500?  Probably not, and you might spend a hell of a lot less.

In fact, in many cases you might spend 80% less depending on exactly what’s wrong with you.  Further, if you go from “ill” to “well” during that year your expense immediately stops since the $400 a month otherwise extracted from you is gone.

A poor person would enjoy dramatically improved access to care over what we have today since there would be no “Medicaid provider lists.”  They could access any physician or other treatment option that was medically indicated and there would be no discriminatory pricing for or against, nor any discrimination in access.  Both access and outcomes would improve dramatically for poor people while cost to the government would be dramatically slashed.

How about the person “covered” through their employment, which is most of the population?  Your employer would see thousands of dollars a year in cost reduction, and even more in his liability insurance premiums would disappear.  For the average family of four the premiums covered by your employer are likely close to $10,000 a year.  That is salary that you will receive.  

To put this in perspective the average family makes some $50,000 a year. That “average” family would see an immediate 20% increase in spendable income; roughly $10,000 each and every year forevermore into the future.  That’s huge; there is no other way to have such a large impact on consumer income and wealth in this country on an aggregate basis than this.

Let’s assume that “average family” has a kid during the year — a routine, uncomplicated pregnancy.  Today that’s about $10,000 worth of expense, but if you have “good insurance” you don’t see any of it directly.  The cost of having that child as a matter of routine vaginal childbirth would drop to about $1,000.  You’d get $10,000 more in salary and spend $1,000 of it; the other $9,000 would be yours.  If something goes wrong then your $200 catastrophic policy would cover it, perhaps with a $3,000 deductible.  You’d spend $1,000 for the routine part of the birth, $3,000 on deductible, the cat policy would cover the rest of the emergency and you’d be $6,000 net positive — with a complex childbirth in the mix.

Now let’s assume under this system you’re nominally well and have a heart attack.  What do you pay?  The $300 you paid for the catastrophic policy, and perhaps a $2,000 deductible.  The bypass you need to resolve the problem is $10,700 instead of over $100,000 because the local hospital has to compete with places like the Surgery Center, and that’s what they charge.  If they don’t then they sell exactly zero bypass surgeries to anyone who isn’t having a heart attack right now, and they’re not going to give up the income. They’ll compete because the alternative is that they have almost no business at all, never mind that you will probably choose to have the $10,000 procedure before you have the heart attack (saving you from the risk of dying during the heart attack outright!)

Ok, who gets hurt?

1. The lobbyists.  They lose big.  In fact virtually all of them wind up out of business entirely.

2. The administrators who aren’t needed and are very expensive.  Many, maybe most, get fired.  The hospital becomes a place full of doctors and nurses but damn few administrators since now their cost can’t be shoved off on others — it’s overhead, and is subject to competition from the hospital across town or in the next town over.  Not only does this reduce employee cost at said hospital dramatically it also reduces the space the hospital uses for overhead which makes their per-person cost for actual procedures go down further since a larger percentage of their space goes to actually treating customers.  Yes, those former administrators will lose their jobs.  The good news is that the economy will expand due to greatly improved cost structures, so there will be new jobs in other fields available to them.

3. The drug reps.  Gee, what happens when you can’t be a pusher any more and have to price on a level basis?  The rest of the world’s prices go up some (there’s many billions of “them”) while ours fall like a stone (because there are only 330 million of “us”)!  That’s math; take the amount of revenue necessary to make the drug and a profit and divide by the number of users; there’s the price.  Guess what — forcing the US consumer to pay for the development cost of drugs used worldwide ends in a day.  This costs us hundreds of billions of dollars a year today.

4. Anyone who refuses to change their lifestyle and instead demands everyone else cover their willful acts.  That’s a tough nut to swallow, but it must be swallowed.  If you can control a condition for zero cost you have no right to demand someone else pay tens of thousands of dollars a year to you every single year because you refuse.  There are millions of Americans who do exactly that costing upwards of $350 billion every year just between Medicare and Medicaid and every penny of that expense must end right now.

That’s a good start.

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.  You can find myriad examples of what competitive prices look like for health services and products if you bother to look around, even in the United States, and since we know what those prices look like what I laid out up above isn’t a fantasy-land dream — it’s a reality we can have right now and forevermore into the future.

To do it we must demand that the politicians put a stop to the scam and back that demand up with whatever political and economic action is necessary until and unless they do so.

Perhaps we should all start showing up at town hall and campaign events with a simple plastic spork and wave ’em in the air from start to finish.  They’re obviously not weapons but the message ought to be pretty clear when it comes to what the people might, at the point the economic and political system collapses due to all the fraud and theft the political class is enabling through medical scams, choose to eat first.

Story courtesy of Market Ticker.

Thanks to dishonest messaging on the part of house leadership there is a lot of confusion as to what exactly is at the core of the problems the conservative movement has with #RINOcare (also known as #SWAMPcare, or #RYANcare). House leadership will reference the amendment as a repeal, for example, when the Ryan legislation is actually an amendment and not a repeal.

They also claim it will improve the quality of care, lower costs, get rid of Obamacare taxes and remove socialist style subsidies. That’s not the real world on the issue, however, and reality paints a much different picture.

Texas Policy Institute has a fantastic document out the puts the top ten concerns in simple, easy to understand bullet points.

The following list tells you everything you need to know about the Obamacare amendment that will likely see a vote on Thursday.

1. Doesn’t Improve Care. Obamacare expanded the federal bureaucracy at the expense of quality care. Tax dollars were taken from providers and used to pay administrators, consultants, lobbyists, insurers, and regulators. The House bill does nothing to change that dynamic.

2. Raises Insurance Premiums. The Congressional Budget Office believes that the bill will raise insurance premiums by 15-20 percent on average in the next two years, with even higher spikes in some areas. Americans care most about lowering health costs and making coverage affordable—yet the bill falls short on that count, retaining all but one of Obamacare’s costly mandated benefits and insurance regulations.

3. Doesn’t Repeal Obamacare. Lost in the question of whether or not the bill’s replacement provisions represent “Obamacare Lite” is the fact that the bill as currently drafted represents “Repeal Lite”—when compared not only to full repeal, but even to the 2015 reconciliation bill that passed both houses of Congress. The bill retains all but one of Obamacare’s benefit mandates, some of its taxes, and keeps Medicaid expansion to the able-bodied in perpetuity.

4. Expands Obamacare. Rather than repealing all of the law, the House Republican bill instead expands Obamacare’s subsidy regime—extending it to millions of individuals off of insurance Exchanges for 2018 and 2019—and revises the subsidy regime for 2019. Some conservatives may question the need to “fix” Obamacare, when House Republicans’ legislation should revolve around repealing Obamacare.

5. Creates New Entitlement. Beginning in 2020, the bill creates an entirely new entitlement—advanceable, refundable tax credits—replacing Obamacare’s form of subsidized health insurance with another.

6. Fiscal Gimmicks? Under the bill, the transition from the Obamacare subsidy regime to the new system of tax credits, and a reformed Medicaid program, will take place beginning in January 2020—a presidential election year. If Congress or the Administration delay or abandon the transition due to political blowback, the cost of the House bill will soar.

7. Permanent Bailout Fund for Insurers? While failing to repeal Obamacare’s risk corridors and reinsurance bailouts, the bill also creates a new “Patient and State Stability Fund,” designed to provide most of its $100 billion in grants to subsidize health insurers. Some conservatives may question whether this grant program will end in 2026 as scheduled under the bill, or whether health insurers instead will make claims on Washington for federal bailouts to the tune of billions of dollars annually.

8. Federally Controlled, Not Patient-Centered. Notwithstanding some important structural changes to Medicaid that respect states, the House bill claims to be patient-centered but still denies a 60-year old the ability to opt out of paying for maternity benefits. Supporters of the House bill talk about giving more flexibility to states, but leave all the federal insurance mandates in place.

9. Perpetuates Medicaid Expansion. The House Republican bill allows states to keep their Medicaid expansion to the able-bodied in perpetuity—a major change compared to the 2015 repeal bill. CBO concluded that many states will in fact keep their expansions, diverting funds from covering the most vulnerable to expand Medicaid to able-bodied adults. Moreover, the House bill maintains Obamacare’s enhanced Medicaid match for nearly three years, encouraging expansion states to sign up more able-bodied adults between now and January 2020 to receive additional federal funding.

10. Inadequate Verification. By relying on Obamacare’s system of verifying eligibility for the new tax credit entitlement, the bill requires verification of citizenship but not identity—continuing Obamacare’s problems of fraudulent applicants obtaining subsidies. In addition, some conservatives may be concerned that even these inadequate verification provisions could be stripped due to procedural concerns in the Senate.

Paul Ryan and his leadership team have drawn their line in the sand. It’s a done deal for them. They will betray the American electorate on Obamacare and we all know it.

Their amendment of Obamacare is not a repeal. And their replacement is pretty much more of the same. Big government controlled, taxpayer subsidized healthcare.

It’s what they want. And if the House Freedom Caucus doesn’t stop them, it’s what they’ll get. The rest of us be damned.

So now the only question is… will the House Freedom Caucus join GOP leadership in approving this betrayal? We’re just two days from finding out what that answer will be.

According to reports out today it appears the Freedom Caucus may stand with the American people. A Communications Director for the conservative group says “the amendments offered by Republican leadership do little to address the serious concerns of House conservatives.” She went on to say “at this time, the bill does not have the votes to pass.”

“At this time.”

So according to the House Freedom Caucus if the vote were held today #RINOcare would be dead on arrival. But the vote isn’t today. It’s currently set for Thursday.

And we have a difficult time believing Paul Ryan would allow a vote to hit the floor if the votes to pass the amendment of Obamacare are not there. Yet the vote is still on, so what’s really going on here?

Americans have come to expect Paul Ryan to go back on his word. He’s now infamous for this act. He’s John Boehner 2.0 when it comes to double speak. We know what Paul Ryan is and we know what he isn’t.

But the House Freedom Caucus, on the other hand, is supposed to be different. They’re supposed to be the warriors. They’re supposed to be the heroes.

And now we’re just two days away from finding out where they stand. Will they fight on behalf of those they promised to fight for? Or will they cave and betray us all?

Now only time will tell. But during the next 48 hours we highly recommend all Americans consider joining the movement to stop #RINOcare. If you haven’t already done so, please consider taking part in Grassfire’s massive fax campaign to pressure the GOP to stand with us.

This legislation must be stopped.

Where is the discussion of facts when it comes to health care?

Why do we keep talking about the cost of “health insurance” when that’s a symptom and not the problem?

Why do we keep talking about “subsidies” (tax credits, etc)?

If you’re coughing incessantly because you have lung cancer do you simply take a cough suppressant and call that a “fix” when you stop coughing for a while?

That entire line of discussion, which is the only discussion being held politically and in the news, is a fraud.

Why?

Two reasons: First, “health insurance” is not insurance to the extent it covers an event that is either certain to happen or has already happened. Insurance is a thing you buy to cover a possible future event you cannot pay for yourself.  It is less expensive than the event will be only because the probability is less than 1.0 — that is, the event is unlikely.  If the event is either certain or worse, has already happened then the probability is 1.0 and the cost of “insurance” against such an event is always more than simply paying for it in cash because the insurance company has costs it must cover or it will go out of business.

Let me repeat that just in case you missed it: The cost of insuring against a bad event is directly and mathematically determinable by the cost and probability of said event.

Second, due to the above mathematical fact if you wish to decrease the amount “insurance” costs there is only one way to do it: You must decrease the cost of the event, the probability of the event or both.

This is arithmetic, not politics and anyone arguing otherwise needs to be indicted, tried, convicted and imprisoned for their intentional act of fraud upon the public because that’s exactly what they’re doing — defrauding you.

I don’t care if they’re pundits, media personalities, Congresspeople or the President — and I remind you that The President is well aware of how insurance actually works since he’s been a Real Estate developer and operator for decades.

Now let’s address the only two means by which we can lower health insurance costs.  And lower them we can — by 90% or so, and quickly too — in fact, within months.

First, insurance must be actual insurance.  In other words it must only cover events for which p < 1.0.  By definition those are events that are neither certain to happen (e.g. routine, every-day visits to a doctor) or have already happened (e.g. pre-existing conditions.)

While you might be able to buy fire insurance on your house if it’s on fire (or you are in the process of setting it on fire!) the cost of that insurance will always be more than the fire damage to said house because the probability is 1.0 and the company has to cover its cost and make a profit or it goes out of business.  It is therefore always cheaper to simply pay cash for the fire damage than to buy said “insurance” and this is true irrespective of what you’re “insuring” — including health.

Again, this is math, not politics.

Second, we must address both “p” (probability) and “c” (COST.)

We must address “p” (probability) because it will directly and grossly reduce the cost of insurance since it is a multiplier to cost.  Reducing “p” by 10% directly reduces cost of insurance by 10% all other things being equal.

We must address “c” (cost) because that not only reduces the cost of insurance (but on a smaller basis than “p” since it’s multiplied by the fraction of risk) for the person who has already had the bad thing happen to them medically it enables them to pay directly for the treatment required. I remind you that paying directly is always going to be cheaper than running that same payment through an “insurance” company (typically by about 10-20%) because said company has costs that have to be covered.

Let’s take “p” on first.  An utterly enormous amount of health expense occurs because people choose to be overweight or obese.  As noted in a previous Ticker the American Diabetes Association claims $250 billion a year is spent by Medicare alone due to both the disease and its effects.  Best guess is that another $150 billion is spent by Medicaid (which they don’t specify.)  This is for one disease and essentially all of that money doesn’t have to be spent.  It is spent because people choose to consume foods that promote and exacerbate the condition rather than reduce or even eliminate its effects.  The cost of changing what you put in the pie hole, medically, is of course zero.  Therefore for each person who is diabetic (Type II) and makes said lifestyle change resulting in either the control or elimination of the harm to their body from same we eliminate all of the health spending by said person on said disorder!

There are myriad other diseases and disorders associated with being obese and overweight.  Hip and knee damage, eventually leading to (expensive) replacement surgeries, for one.  Heart attacks and strokes (many caused by high blood pressure that, again, is often a result of being overweight) for another.  These are all avoidable costs and if we wish to address the cost of health care reducing “p”, the probability of bad events, is a key item.

It is absolutely true that personal choice is a huge factor here and the government does not have the right to tell you how or what to eat.  However, you do not have the right to demand that someone other than yourself pay for the consequences of your personal decisions.

It is therefore perfectly reasonable to put in place a protocol that says if you are overweight or obese and diabetic then the lifestyle change in terms of what you put in the pie hole that has a near-100% record of reducing or eliminating your need for drugs and medical procedures and has a cost of zero will be the only option offered under said publicly-funded programs until and unless you prove, by individually-shown test, that it doesn’t work in the case of your particular metabolic makeup.

Doing this for one disease alone would cut roughly $400 billion off the federal budget this year and every year thereafter and would cost the patient exactly zero on top of it.

Can we extend this demand to private health care policies by force?  No, but we can certainly allow companies to multiply their pricing by the change in “p” that not following such a lifestyle, if you’re overweight or obese, comes with.  Since this one disease is such a huge component of said spending my best guess is that the surcharge for refusal would likely be 25% or more and if you’re already diabetic then it can (and should) be an immediate disqualifier for any coverage of any consequential event whatsoever unless you prove, by individual test, that the lifestyle change outlined above doesn’t result in control of your condition.

Second, we must break all the monopolies in the medical system.  There are in fact simple ways to do this, requiring no new laws, which I’ve outlined before going way back in time.

If you force price transparency by treating any health provider who refuses to do so, or who tries to bill on a discriminatory basis as committing a criminal act under existing consumer protection and anti-trust laws (at both the State and Federal levels) you will instantly and permanently remove all so-called “network” games, break the monopoly pricing games played by the health industry and as a result competition will cause prices to fall like a stone.

It’s worthless to even attempt to argue that this “can’t” or “won’t” work because we know it does.  The Surgery Center of Oklahoma does exactly this right here, right now, today and their pricing with the monopolist-laced chain of supplies for drugs and surgical devices still undercuts “traditional” hospital prices by 80%.  For example a cardiac bypass is $10,700 — cash, all-in, one-price and if there’s a complication taking care of that is included.

Can you come up with $10 large to save your life if you need it?  Almost-certainly, even if you’re poor.  Yes, it would be a lot of money for someone without material means, but remember — we’re talking about a price that’s anywhere from 1/10th to 1/5th of what that same procedure costs in a “traditional” hospital setting and you’re choosing between that and death.

Don’t tell me it can’t be done and wouldn’t result in these sorts of cost reductions because it is being done right now, right here, today and has resulted in these cost reductions — even with a huge part of the medical scamjob monopolist games still embedded in their pricing because they can’t get away from the drug monster in their ORs at present.  In other words their pricing is high (probably by 20% or so) compared to what it would be if we stopped all of the monopolist games.

Here’s the bottom line folks — if you think “health insurance” costs too much you’re being misled.  The problem isn’t health insurance it’s the cost of health care.  The solution to the problem is to first require firms to offer true insurance (that is, does not cover events where p = 1.0) then require all providers to post prices and charge everyone the same amount.

Next, using existing law you then indict and prosecute all violations of 15 USC Ch 1; the health insurance and related industries already tried to claim exemption in a case that went to the Supreme Court in 1979 and they lost.  It is therefore simply a matter of political willpower to get out the handcuffs and start issuing indictments.  That will further collapse prices since now providers will be forced to compete for business.

To put numbers on this we’re talking about “health insurance” for catastrophic events being something that costs the average person well under $100 a month and for virtually everyone they would pay only a few hundred dollars more a year in direct, uninsured cost.

With the cost of care collapsed to 1/5th of what it is now for the truly indigent we can certainly afford to help — but for nearly everyone we won’t need to, because even those of modest means can afford to pay cash at a price 1/5th of what is charged in the United States today.

The obvious question is “Why won’t Donald Trump or Congress take this position, since it’s clear on the math that it will solve the problem permanently and at the same time nearly eliminate both the Federal budget deficit and all State and Private Pension budget problems at the same time?”

The answer is quite simple: Doing so will cause an immediate and deep recession as the health industry collapses from ~19% of domestic output back to its historical level of about 3-4%.

Said recession won’t last very long because that money will get redeployed in other areas of the economy but until it does the impact on GDP will be severe, immediate and deep — and both Congress and Trump know it.

Oh, and it will put a whole bunch of lobbyists out of business too.

Published courtesy of Market Ticker

#RINOcare = Repeal in Name Only

Incredible. Absolutely astonishing.

After years and years of full, clean repeals, years of campaign promises and no past mention of “repeal and replace” in campaign literature, Paul Ryan somehow thinks we’re all going to buy into the snake oil he’s peddling. This is exactly what they promised, he claims. This is precisely what we all voted for, according to Ryan and his leadership looters.

No, it isn’t. Not even close. It’s not even in the same universe.

In this post we’re not going to dive into the nitty gritty details. Those are out there and you all know what they mean. Here’s we’re going to expose Ryan’s misdirections and lies for exactly what they are.

We’re going to look at the following:

  • Repeal & Replace
  • Repeal Only Can’t Pass
  • 3 Phased Approach
  • Access

REPEAL AND REPLACE

The first lie is exposed directly in the very beginning of the legislation Ryan proposed early last week. You don’t have to be a policy wonk or legal mind to read it for exactly what it is.

Last word there. Amended.

This is not a repeal bill. It’s an amendment of the Affordable Healthcare Act. That isn’t my word. It isn’t a word I use because I don’t like the bill. It’s a word the authors put in because the bill is, in fact, an amendment of Obamacare.

So any Congressman or Senator who references this legislation as a repeal is flat out lying. This is no repeal and no matter how brilliantly they twist words the fact remains. There is no repeal.

REPEAL ONLY CAN’T PASS

This too is a lie. Repeal only absolutely can pass the Senate because it can be done with a simple majority.

This can be done through a budget resolution using reconciliation. In such a process bills cannot be filibustered. Meaning, Republicans would only need 50 votes plus Pence to fully repeal Obamacare.

Of course, Republicans would then need to use the two year phase out time to work on a replacement bill, but that is the way it should work if they truly intend to keep to their promise of full repeal.

Which leads me to the next point.

3 PHASE APPROACH

This is possibly one of the worst lies of them all. Paul Ryan and the rest of his ilk in Washington claim Americans can be fully relieved of the pains of Obamacare in the third phase of what they’re up to. We simply need to trust them on this amendment that does virtually nothing to address the problems. Then a repeal comes through the budget process and we’re supposed to believe 60 Senators will pass a bill we all like.

That’s bull.

Here’s the problem. And it exposes the lie out front.

Ryan claims that if a clean repeal is passed now then a proper replacement won’t be able to be passed because Democrats in the Senate will filibuster anything that isn’t remotely close to Obamacare. A replacement that would require 60 votes.

But, you see, that exact same hurdle exists in phase 3 of his current plan. It’s delusional to accept that Dems won’t play ball on a stand alone replacement following a clean repeal but they will magically vote to pass a bill with everything we want now if we just pass RINOcare first.

Ryan knows full well that if RINOcare passes now, the real repeal and replace we all want and need will never see the light of day in a suggested phase 3.

It. Will. Not. Happen. 

He knows it won’t happen. And he knows that he’ll then be able to blame Democrats and pivot to the campaign lie that hey… we can’t do it with our current majority so we need voters to give us 60 Republicans in the Senate and then we can get this done.

Where have we heard that before?

Ryan can repeal Obamacare right now. He needs a simple majority. He needs the votes that already voted for a clean repeal that Obama wouldn’t sign. The votes are there, have been there for years and are on record as being there.

A full, clean repeal can pass. As it should. And then traditional debate can begin on a replacement bill. The ball will then be in the court of Democrats and Republicans will be the referees. Will Democrats sit on their hands and refuse to play? Perhaps. But that will be on them. If they don’t want to get behind a replacement bill that is their problem, not ours.

The fact that Ryan won’t push for what should be the obvious solutions leads us to believe there is something more nefarious at work here. His campaign donors, to be specific.

Because it’s not a matter of whether or not it’s possible. It’s a matter of whether or not he wants it to happen.

ACCESS

Last but not least is a little pet peeve of mine. We all have come to expect Democrats to twist words, giving them ludicrous meaning and redefining them all together. But we’re in a new dawn when Republicans deploy the same dirty tactics.

Access means you can access, right?

When you log into your checking account, you access your balance. When you unlock your front door you can access the interior of your home. When you walk into any pharmacy in America you can “access” birth control.

Access = the ability, right, or permission to approach, enter, speak with, oruse; admittance:

I’m sick of hearing Republicans claim government is needed to ensure Americans have access to health insurance. In a free-market insurance system there isn’t a single American who is prohibited from accessing healthcare.

If we accept that because someone can’t afford healthcare that they do not have access to it, we can make the same argument that someone who doesn’t want to work doesn’t have access to money.

I heard not one but THREE Republicans over the weekend, on national media, claiming they must work to ensure access to healthcare.

Umm… what? We need government to ensure we have access to something that, thanks to government many people do not currently have access to?

Seriously, there are now counties in America that will soon not have a single healthcare plan available thanks to Obamacare. Meaning, government literally removed the ability to access healthcare.

Before government got its filthy fingers in the middle of it all every American did have access to healthcare. The idea that government is needed to guarantee access is hogwash.

What they really mean is that government needs to ensure that other people have access to your money so they can purchase healthcare plans without earning it on their own. Now whether or not government should have that role is another debate. But let’s not pretend this is something it isn’t.

Republicans are slowly but surely becoming Democrats. Same legislation. Same lies. Same tactics. Same plays on words.

Americans were already under the impression we have a single party system that utilizes two party organizations. But if Ryan is successful in shoving through this betrayal, that unity will be sealed forever. A done deal.

Don’t believe the lies, folks.

This RINOcare amendment is nasty. It does nothing to repeal Obamacare and if it passes, we’re stuck with government healthcare that will collapse under its own weight and there will be nothing anyone can do about it.

And we all know what that will lead to with no alternative in the matter.

Single payer.

We know this and they know it. And if they pass this we have to assume this is the outcome they ultimately plan for.

If you haven’t already done so I highly recommend you read our earlier story about Paul Ryan’s Obamacare 2.0 to get a rundown on the bill and what it does in its current form. You can read the bill (American Healthcare Act) by clicking here.

One of the most prominent narratives Ryan’s PR branch is spreading is that his Obamacare 2.0 repeals the mandate in the ACA. This is a PR battle they hope to win on a technicality. Because technically speaking there wasn’t a mandate in the ACA (Original Obamacare) and there isn’t one in Ryan’s AHA (Obamacare 2.0).

But realistically speaking, there is a hefty financial penalty written into both.

In Obamacare you could choose not to carry coverage. But in doing so you would be penalized with a tax. This is where it was labeled a mandate.

So if in Obamacare the mandate was supported by a financial penalty, which is the case, then the same can be said for Paul Ryan’s Obamacare 2.0.

What AHA does is remove the direct tax penalty and puts the penalty on the backend in a different form. Yes, you can choose not to carry coverage. If you’re a healthy 27 year old with no need for expensive premiums, for example, you can opt to not carry coverage. But in such a scenario the only way to avoid a financial penalty is to never again purchase health insurance.

What the AHA does is it levels a penalty of 30% of monthly premiums paid directly to insurance companies the day you decide to begin carrying coverage. So if on your 30th birthday you decide it’s a good idea to obtain health insurance and your premium is, say, $400 a month, the monthly penalty would be $120. Or $1,440 for the first year of newly acquired coverage.

In both scenarios you can choose not to carry coverage. But in both scenarios there is a financial penalty for doing so. Unless, of course, you never have health insurance for the remainder of your life.

What more needs to be said?

In Bangalore, India, heart surgeons perform daily state-of-the-art heart surgery on adults and children at an average cost of $1,800. For the record, that’s about 2% of the $90,000 that the average heart surgery costs in the United States. And when it comes to the quality of the heart surgery, the patient outcomes are among the best in the world.

Why?

Simple: There is no financialization.  

You can’t make someone else pay for your medical treatment in India.

Most families in India have no health insurance, and often need to borrow the money to pay for surgery.

And there are no guarantees on the debt either: You can’t exactly repossess a heart operation!

Quality?  Better than in the United States.

How about drugs?  Let’s talk insulin:

The medication had identical action to what’s sold in the U.S. And its preloaded syringes, with a sophisticated calibrating mechanism, were more accurate in dose than any I’ve seen. What was most remarkable was the price — less than 10% of what it costs Americans with diabetes today. The combination of massive scale and appropriate pricing accounted for the 10-fold difference.

What’s missing from this article?

Any mention of the fact that the only reason drug prices haven’t dropped like a stone is that it’s illegal to import that Insulin here to the United States.  Were it not Novartis and the other insulin makers here wouldn’t sell a single dose at 10x the price, especially when their dosing systems are inferior.

I’ve often said that the total cost of medical care would drop by 85% if we simply enforced the law, specifically 15 USC Chapter 1, against all medically-related firms — including pharma, hospitals, device makers and doctors.

This article is evidence that I’m being conservative and the actual drop might even exceed 90%.

Of course to do that you need to take all the monopolists — which means damn near all of the doctors, hospital administrators, drug company executives, “pharmacy benefit managers” and more out back and…

Indict them.

If we don’t, and if we keep doing what we’ve been doing then eventually those who are condemned might just decide to take some of them out back and do something a less-lawful than indicting them.

Will Trump do anything about this?

Based on the best evidence available to date, NO.

Don’t bet your first nickel on him doing a damn thing about any of this, despite it being very clear that mere restoration of a competitive market would make “health insurance” entirely unnecessary for essentially everyone in the United States.

Pfizer has already said they have no intention of altering their pricing model after the recent pharma meeting. Why should they until and unless their entire executive office gets indicted on many-thousands of counts of federal felonies under 15 USC?

In the meantime if you need treatment for something serious — get on a plane.

If you currently have, or are on the path toward a chronic condition that requires continuing medical assessment and treatment if it’s possible to stop or reverse that you had better or you’re going to be bankrupted, dead or both.

And if you’re already past the point of being able to do anything about it?  Make peace with God.

Until and unless Trump does start indicting this entire segment of the economy (or he makes clear that if they don’t cut the crap right now he will, and if challenged, he does) he is not your friend, he will not stop the detonation of this nation’s finances nor your financial and personal destruction and yet it is entirely within his power to do both right now, without Congressional involvement since the laws necessary to do so already exist.

Trump may be my President just as he is yours if you live in the United States, but any President who has the power of the Executive to put a stop to this crap under existing law and fails to do so, when it constitutes nearly one dollar in five spent in America today and 37% of last year’s federal spending is a five-alarm dickhead, irrespective of what other policies he may or may not implement.  That refusal literally kills hundreds of thousands of Americans a year and financially ruins millions more — far more than any terrorist or even war has managed to claim.

And that’s a fact.

This is truly ugly stuff folks.

This is the “Obamacare” repeal and replace option that is being peddled in the Senate.

I’ve read it.

Let me summarize:

  • For states that wish to keep Obamacare, they can.
  • For states that do not wish to keep Obamacare, they can “opt out.”
  • The underlying “replacement” is a ROTH HSA, which is the same basic mechanism of a ROTH IRA except that spending is restricted to “authorized” health care services (including health insurance.)  All other withdrawals are subject to tax (10%) penalties (much like unauthorized withdrawals from a traditional IRA.)  The primary change from existing HSA law is that the existing structure is an adjunct to a health insurance policy. This legislation allows the HSA to fund a health insurance policy.
  • States that opt out can create their own standards for what constitutes a “legitimate” health insurance plan.  This means that plans which are more or less-restrictive than Obamacare policies are authorized in such states and count.  So if you don’t want a policy that covers pregnancy, for example, you don’t have to buy one.  If you object to contraception, provided your state allows it, you can buy a policy that doesn’t cover that.  And so on.  Note that none of this would ban a company from offering a coverage and states could require whatever they want.
  • For states that opt out if you fail to maintain continuous coverage you can be penalized, including being denied entirely due to medical underwriting and it imposes a mandatory penalty (tax) to be paid to Treasury for your refusal to buy a policy if you come back in the future, even if you are healthy.  If you maintain continual coverage, however, you cannot be denied nor medically underwritten.  This changes the Obamacare requirement by effectively closing the “wait until get very sick, then apply” game but includes a cute [screw] you” for those people who opt out, then decide to come back but are not trying to game the system by buying only when sick.  In many ways this is worse than the “individual mandate” in that the penalty is on the back end and is not imposed only on those who game the system.
  • For states that opt out they can default you into a ROTH HSA, which may or may not obtain a subsidy.  You can opt out but you will have to do so explicitly.

  • Subsidies are deposited directly into consumer HSAs, not to the state general funds (or otherwise) and are adjusted for local conditions (as is the case for existing PPACA subsidies, and in a very similar manner.)
  • Subsidies phase out for MAGI over $90,000 for individuals, and $150,000 for joint returns.  Married-filing-separate has a ZERO subsidy — if you’re married, you must file joint to get subsidies.  This is a large increase in subsidy phase-out income levels and means that basically anyone in a state that opts out of Obamacare will have full subsidies available up to MAGI $90k.  Note that MAGI includes tax-exempt interest and similar income; this is potentially very important for those with substantial non-wage income (as is the case for Obamacare now.)

  • Imposes a $25,000 penalty per-instance on medical providers who attempt to bill out-of-network charges in emergency circumstances only.  However, it does not bar the practice or impose any criminal penalty for this act of financial rape, which means that the effect of this provision is that you’ll still get raped and the hospital will add $25,000 to the amount so as to pay the fine with it!  If you think this means the “out of network” emergency problem will get worse YOU ARE RIGHT, IT WILL GET WORSE AND IN A VERY, VERY SEVERE WAY FOR MODEST ISSUES.  $25,000 isn’t much additional screwing on a $500,000 bill.  It is a very large additional screwing on a $20,000 bill!  Forcing a victim to pay for his or her own screwing is not only cruel it ought to be considered a capital offense.
  • Allegedly “requires” providers to post prices in a way the HHS Secretary directs.  However, there is no penalty for failure to do so, nor is there any penalty for refusing to honor a quoted price.

There are other technical changes, such as specifying that paying a fee for concierge care (e.g. flat fee per month for access, etc) is a legitimate HSA expense, along with specifying limitations and parameters for the ROTH HSAs (which generally appear to be reasonable.)

There is exactly zero in this bill that addresses:

  • The cost of medical care.  Nowhere is there a penalty for failure to disclose prices or to actually bill at the claimed price.  There is no requirement that “what you post as a price is what everyone pays”, there is no sanction on the provider for failure to quote a true price, to bill at the quoted price, or if they discriminate for or against any particular person.  The “requirement” to post prices is a dead letter as it carries zero penalty.
  • For out-of-network emergencies the bill imposes a $25,000 fine on the provider if they bill materially above either Medicare or “Usual and Customary” prices.  However, nothing prevents the facility from actually issuing or collecting that outrageously-escalated billing — such is not deemed an unlawful practice and is not barred, in any way restricted nor is any criminal penalty imposed.  This means that the existing problem of out-of-network emergency care, say if you have a heart attack while in another state, will actually be made worse as the facility will be able to simply add the $25,000 fine to the financial assrape that they are already imposing on you.   The bill also does nothing about the (very common) practice of an out-of-network person appearing in your room when you are in-network and then billing you for an out-of-network event. The “fine”, which you will be forced to pay, only applies to emergency circumstances.  If you’ve been admitted and are stable and Mr. Out-of-Network Doc sticks his head in your room you’re still [screwed].

  • The bill does not eliminate the penalty for not having insurance.  In fact it makes it worse than Obamacare in many instances.  It contains no income exemptions for not having insurance (Obamacare does) and a new set of “screw you” provisions.  Specifically, if you’re young, healthy and poor but making it on your own and choose to opt out of buying insurance you will pay no penalty at that time.  But, if and when you decide to buy health insurance in the future you will get penalized on the back end statutorily, even if you are still healthy at the time (in other words you didn’t game the system, you just refused to buy something you didn’t need!)  For people who are both healthy and in the lower income strata (think young people folks) this will be a rude surprise that will go right up their poop chute when they decide a few years down the road to get married and start a family — right about the time that buying insurance as a preventative act makes sense.

  • The bill is completely silent on the rank violations of existing anti-trust law found in 15 USC; specifically, Sherman, Clayton and Robinson-Patman.  An earlier revision (2015) of this text at least attempted to clarify some aspects of Mccarran-Ferguson which bears on insurance companies — this one is silent on the same matter.  Specifically there is nothing barring collusion between providers, price-fixing (whether overt or otherwise), differential billing based on your wealth, form of payment or for that matter whether you have red hair and other similar abuses, all of which are the very form and function of the existing medical financial rape-room circus served upon the American public.

As such this bill, proffered as a “replacement” for Obamacare, might well fit this description:

This is a Congressionally-imposed financial******room that in many ways is worse than the existing Obamacare system, and has no material positive changes evident with one exception: It increases the MAGI (substantially) that a person or couple may earn without losing their giveaway.

It does nothing to decrease costs, it contains no penalties that bar the imposition of excessive charges for out-of-network emergency services (or any other out-of-network charge which you might not be able to refuse or even know occurred until after the fact); a provider fined for trying to bill you said excessive charge can simply add that to your bill and thus force you to pay their fine, and it contains hidden back-door taxes imposed on anyone who tries to opt out of the insurance and medical scam entirely, even if they are healthy the entire time and thus did not either intend to or actually game the system.

Story courtesy of Market Ticker.

A few hours after taking the oath of office on Friday, President Donald Trump signed an executive order that directs federal agencies to use their authority to relieve individuals, businesses, state governments, and others from the economic burdens of the “Affordable” Care Act.

This move may even include the hugely unpopular mandate (ahem, extortion) that requires most Americans to purchase insurance.

Section 1 of the order reads:

It is the policy of my Administration to seek the prompt repeal of the Patient Protection and Affordable Care Act (Public Law 111-148), as amended (the “Act”). In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with law to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market.

During his campaign, Trump promised to dismantle the ACA should he be elected, and it appears he is going to do what he can to keep that promise.

It is important to understand, though, that this executive order does not actually repeal Obamacare: only Congress can repeal the law. But, the order effectively tells the federal government to take as much leeway as possible to “ease the burdens” on individuals, states, and the health industry.

Judge Andrew Napolitano called the executive order “truly revolutionary”:

Judge Napolitano said that Trump is telling government agencies to proceed with the expectation that the law will be repealed soon, especially with regard to tax penalties.

It’s about time.

Story courtesy of The Daily Sheeple.

Isn’t it this all oddly convenient for Barack Obama? He spends eight years dismantling our constitution, working with powerful people like Paul Ryan to get his corrupt, dangerous agenda funded then rides off into the sun as the rest of us have to deal with the consequences.

Come January Barack Obama will leave the White House. His signature piece of legislation, the Affordable Healthcare Act, did get fully funded by the Republican controlled Congress. And that single piece of legislation will immediately begin to crush the American economy and healthcare system almost the day he leaves office.

Indeed, nationwide Obamacare average rates are set to surge by a whopping 22%.

CNN has more.

Obamacare premiums are set to skyrocket an average of 22% for the benchmark silver plan in 2017, according to a government report released Monday.

The price hike is the latest blow to Obamacare. Insurers are raising prices and downsizing their presence on the exchanges as they try to stem losses from sicker-than-anticipated customers. Enrollment for 2017 will be closely watched since insurers want to see younger and healthier consumers enroll.

The benchmark silver plan — upon which federal subsidies are based — will cost an average of $296 a month next year. That figure is based on prices for a 27-year-old enrollee in the 39 states that use the federal healthcare.gov exchange, plus the four states and Washington D.C. that have their own exchanges.

Sadly, those who get off with a 22% increase will be considered the fortunate Americans. Because many states are going to see rates surge by percentages that are difficult to even fathom.

For example, the following rate hikes have been approved for some insurers and exchanges.

  • Colorado, Florida & Ohio = Just under 20% increase
  • Connecticut, Georgia, Indiana, Kentucky, Maine & Maryland = 20% to 29% increase
  • Alabama, Delaware, Hawaii, Kansas, Mississippi & Texas = 30% to 49% increase
  • Arizona, Illinois, Montana, Oklahoma, Pennsylvania & Tennessee = 50% to 92% increase
  • New Mexico = 93% increase

Granted, these are only “approved” rate hikes and aren’t guaranteed increases. But does anyone honestly believe these rates won’t increases to these approved new rates?

Absolutely nothing affordable about this at all.

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