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2017-04-23 08:20 by Karl Denninger
in Health Reform , 229 references
[Comments enabled]  

Note the nostrum here....

One of Donald Trump’s few universally welcomed campaign promises was to do something about the prices of pharmaceutical drugs. Most Americans recognize that prices are too high, and are bothered by the rise of pharmaceutical price gouging.....

The key power is found in the “import relief” law — an important yet unused provision of the Medicare Modernization Act of 2003 that empowers the Food and Drug Administration to allow drug imports whenever they are deemed safe and capable of saving Americans money. The savings in the price-gouging cases would be significant. Daraprim, the antiparasitic drug whose price was raised by Mr. Shkreli to nearly $750 per pill, sells for a little more than $2 overseas. The cancer drug Cosmegen is priced at $1,400 or more per injection here, as opposed to about $20 to $30 overseas.

The remedy is simple: The government can create a means for pharmacies to get supplies from trusted nations overseas at much lower prices.

In other words Trump has the ability to administratively put a stop to the drug-price rape.

But let me point out that while this article is informative and points out a means by which Trump can irrespective of Congressional interference put a stop to the scam in one area of the medical system it ignores -- intentionally -- a much-larger and more-powerful hammer that every President has had available to them for the last 30 years and yet has refused to use.

The Executive has the power and duty to enforce the law.  15 USC Chapter 1, which is where The Sherman, Clayton and Robinson-Patman acts reside, is an extremely powerful body of law bearing on exactly the sort of conduct the entire medical system engages in daily.

Why is that body of law far more-powerful than any threat to legislate?  Because those laws not only provide for ruinously-large fines they include prison time for the executives involved and since they already exist they cannot be blocked by Congressional inaction.

Fines are something that we know businesses simply incorporate into their cost of business and thus ignore.  Witness Wells Fargo, which got caught breaking the law by adding on services that customers never ordered.  That's a serious violation of consumer protection statutes and yet nobody went to prison.  In fact nobody was even indicted in that regard, but the company was fined.  Did it matter?  Not really.  Sure, a few people lost their jobs including some executives but the fact of the matter is that measured objectively the company was unharmed and the people who were involved got away with what amounted to robbery by deception.

Why will this article go unanswered?  It's rather simple, really: If you simply enforce the law then you would cause health care spending to contract from it's near-20% of GDP down to something approaching its historical average, which was 3%.

Let's assume that we get 4%.  That's a 15%, roughly, contraction in GDP!

At the same time a whole lot of people who currently are employed but provide not one single minute of actual care to an actual person would either see their salaries drop precipitously or lose their job entirely.  Here's looking at you, medical coders, although certainly that's not the beginning or end of it.

And what do we call that sort of economic contraction, even though it would be short-lived and soon reallocated into other areas of the economy?

A Depression.

I remind you the formal economic definition of "Depression" is a 10% decline in GDP from top to bottom.  We would hit that metric in about an hour after the law began being enforced.

The challenge before both the Executive and the people, along with Congress, is that the path we are on not only is unsustainable (which has been pointed out by many, myself included, for decades) with regard to this spending we are out of time to deal with it.  Like most areas of unsustainable things government's inertia and lack of desire to do something that might (in this case, will) upset asset prices is to kick the can or simply ignore the problem entirely.

That's popular but when the wall comes into view around the last corner if you still have your foot mashed on the accelerator with spending growth around 9% when tax receipts are flat to actually down you are asking for a crack-up of devastating impact.

The obvious bleating is that all these levered hospitals (nearly all of them; you don't think they paid cash for all those nice glistening buildings, do you?) will go bankrupt.  My answer is so what?

Do you really think there will be no doctors and no hospitals?

No, what will happen is that that nice empty hospital that goes bankrupt and shuts down is still sitting there with perfectly-functional operating rooms and beds.  Someone will come along and buy it at 10 cents on the dollar.  A week, or a month later, if the sign read Frobozz Hospital the word "Frobozz" will be gone but the "Hospital" part will be lit up and there will be doctors performing procedures and nurses caring for customers.

With the facility being bought for ten cents on the dollar and 95% of the administrators fired said hospital will operate at a fifth of the former cost, and thus price.  With the law being enforced you'll have a nice price list on the Internet and that hospital will have to compete for business, which it will do quite well at with its much-lower cost structure.

The hospital across town or across the county that didn't go bankrupt will have to figure out how to gets its cost structure down to where that one is or it will go bankrupt too.

Is that bad?  No, it's good!

See, if that one goes bankrupt then the same process happens again.  Once again someone will buy the bankrupt facility for pennies on the dollar and shortly there will again be doctors and nurses -- but not many administrators -- providing care to customers.

This is how markets are supposed to work and it is how they do work when you put a stop to the illegal monopolist and price-fixing games.

I love a good bankruptcy sale.  Buying things at pennies on the dollar with the blessing of judicial oversight in such a process, or just before a forced-eviction is about to happen (because someone didn't pay the rent!) is an awesome competitive thing.  It drives down price and drives up quality for the dollar paid.  It powers innovation.  It powers productivity which is defined as doing more with less.

And it brings down price for customers which is good for everyone except the monopolists.

Its a process that plays out in markets every single day when the government actually enforces anti-monopoly laws and throws handcuffs on colluders, forcing their outrageous mob-like behavior to bet met with well-deserved criminal sanction.

And best of all, despite all the lobbying dollars spent in Congress there is exactly zero Congress can do to stop it since the laws required to bring about these changes are already on the books, have already been challenged and found valid all the way to the US Supreme Court and thus merely need to be enforced.

So Mr. President, as with the last several Presidents, I ask you once again:

Are you going to enforce the law and demand real reform of the payment system for medicine, which I remind you is required by your oath of office, or are you going to continue to allow the medical industry to financially gang***** the American people on a daily basis until it bankrupts not only all of America but the government as well and define yourself, along with the entire body of federal and state law enforcement, as a Racketeer unworthy of anything more than a blob of spit aimed at your shoes?

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2017-04-22 17:03 by Karl Denninger
in Editorial , 740 references
[Comments enabled]  

Let's cut the crap, shall we?

This is scientific fact. It is a record of history showing temperatures and CO2 levels.  You will note that there is no correlation between temperature and CO2 level.  In fact, there appears to be an inverse correlation in many (but not all) instances.

I remind you that the basic truth of science when it comes to correlation and causation is as follows:

1. Correlation can never prove causation.  It can only suggest that it might be true.

2. The inverse of correlation, however, strongly indicates that causation is absent if it occurs just once.

Well, it has been inverted when we're talking about CO2 and temperature -- and far more often than once.

In the Precambrian era CO2 concentrations fell quite a bit while temperatures rose.  In the Silurian period, same.  In the Carboniferous period, again.  At the end of the Jurasic period, again temperatures went up while CO2 levels fell.  Finally, at the exit of the Jurasic period CO2 went up while temperature slowly fell; we believe that happened due to a large asteroid impact (which would make sense as to the step function) but the continued fall in temperatures does not correlate with a further rise in CO2 -- until the exit of the Paleocene epoch.

There was a correlated rise in the Miocene epoch.  But then we saw changes in temperature -- both up and down -- with a nearly-constant CO2 concentration.

Is there scientific evidence that CO2 levels cause global temperature change?  No.  The science says otherwise absent specific and detailed means of disproving why that correlation has been so-often not only absent but inverted.

Is it likely that CO2 levels cause "forcing" of climate change?  No.  Not only is there no correlation history that supports such a belief CO2 is 0.05% of the atmosphere, roughly.  Only a small fraction of all CO2 is man-made; the rest occurs naturally from respiration of animals, decay of organic material, volcanic activity and combustion not initiated by man.  In addition the oceans contain a monstrous amount of CO2 encapsulated in carbonates; this is a buffering reaction and anyone who has studied chemistry at all knows that the equilibrium point is driven by temperature, not the other way around.  Therefore the argument must not be over whether CO2 is involved but whether the small fraction of CO2 that man controls is the causative factor.  There simply is no science to support a claim that it is and plenty of evidence that CO2 is either reactive to temperature or may even be inversely correlated over sufficient time scales for the effect to show up.

It is a scientific fact that in the last ~100,000 years or so we've lived in a generally warming climate cycle and yet human-emitted CO2 has only been on the scene in material quantity for the last couple hundred years.  There have been little excursions in temperature the other way during this cycle; the Maunder Minimum is of note and they were bad news for humans.  You might want to keep that in mind because colder temperatures kill people faster and with greater certainty than hotter ones, specifically by damaging crop yields.

For those who argue that sea level rise is a horrifyingly bad outcome I will point to the Timber Holes; in the current cycle sea level has risen some four hundred feet.  This location, roughly 15 miles offshore Destin, is in about 110' of water today and I have personally dove it to spearfish.  It's a limestone bottom pock-marked with old holes where trees once stood but have long rotted away.  Well, when sea level was 400' lower than it is today it's not hard to figure out why trees were there given this set of facts.  Incidentally there's a drowned spring off Tampa in a couple hundred feet of water that still flows as well.  It used to flow onto dry land.  I've not dove that one; it's a monster dive due to its depth, especially inward beyond the rim and is a long run offshore as well.  I will note for the record that the current sea level rise is measured in inches while the historical, current-period rise has been measured in hundreds of feet.  If the current trend is continuing arguing over inches while hundreds of feet are in play is stupid.  In short if you think that cycle has materially further to run in your lifetime or that of your children (not in times measured in thousands of years) you damn well better get away from anywhere that's less than a few dozen to a couple hundred feet above sea level because there sure as hell were no SUVs 100,000 years ago!

Is the earth getting warming?  Yes, by a small amount.  For how much longer?  I don't know; in geological terms it's anyone's guess. We can assume that the current Quaternary period environment will persist, but we don't know it will persist.  If it stops persisting, incidentally, it will probably not be determinable for a hell of a long time -- tens of thousands if not hundreds of thousands or more years into the future.  We'll all be long dead and so will our children, grandchildren and many generations yet to come.

In human life terms is the cycle about to end?  Probably not, but that doesn't mean much since small fluctuations over the last half-million years or so -- 2 degrees Celsius or thereabouts -- have been pretty common and some of them have come very rapidly.

Are the odds that the next excursion will be down greater than up?  The history of the Quaternary period says probably, but it's a bad bet simply because over short period of time the bet's bad no matter which way you take it.  If the excursion is down it will kill a hell of a lot more people than some more warming will; we need only look to the last couple of those excursions for examples.  While we have far better agricultural technology today we also have a hell of a lot more people on this rock relying on same.  A 10% global casualty rate from a Maunder-minimum type of event is not at all unreasonable to expect.

Now let's look at the other evidence.

1. The "climate models" have thus far all been wrong. They all predicted both far greater temperature and sea level rises than have occurred.  Wrong is wrong, end of discussion.

2. The data has been tampered with.  That's not conjecture or belief it's fact.  It was admitted to and when the source code break-in happened a few years ago I trivially found the "adjustments" they put into the code.  That was intentional tampering, not an accident, and removing it removes the so-called "hockey stick."

3. The prediction of more and more-violent Atlantic hurricanes has been falsified.  We were all told in the time of Ivan, Katrina and Wilma that we were in for those sorts of storms and even more-violent ones in the years to come.  Well, it's been 11 years since a major hurricane hit the United States anywhere.  Hermine hit Florida last year but it was a Cat 1 -- hardly anything to get excited about and an utterly routine event.  During the early 2000s Cat 1s were about as common as cats around here to the point that I didn't bother doing much more than taking in the lawn furniture when one was approaching.

4. The 1880s were the most-violent decade for the United States in terms of hurricane impacts; 25 hit the nation.  How many SUVs were in use in the 1880s?  Since 2010 there have been six hurricane impacts; for comparison the decade of the 2000-2009 recorded 19.  We are way behind the so-called prognosticators of doom.

5. The prediction of more and more-violent Tornadoes in the US has also been falsified.  There has been no statistical increase and in fact of F3+ storms (the worst) there was much more activity in the 1950s and 60s than now, with several real doozy years -- two of which recorded over 100 of these extremely-violent storms.  By comparison 2012, 2013 and 2014 clocked in under 30.  While 2011 was a bad year for tornadoes it was hardly unprecedented -- 1973 recorded nearly as many.  Again, there's no particular trend despite the claim that we would see more and more-violent storms of this nature as well.

6. The claims of "more and more-serious drought" sounded pretty good out in California right up until this winter when it snowed like a bitch.  So much for that.  We'll see if that's a one-off or not in the coming years.

In short all these claims have just been plain old-fashioned wrong.

Now let's look at the other side.

We've massively improved the number of people on this planet and roughly tripled life-expectancy -- almost-exactly correlated with the industrial extraction and consumption of carbon-based fuels.  Would you like to give both of those up in exchange for, perhaps, a bit less warming but no fewer storms and a sea level that is continuing to rise?

Hmmmm.....

Oh, and let's assume that the sea level does continue to rise.  Would you like to have the energy resources to move people and build barriers and employ other mitigating technologies when that occurs?  Or would you like to give up those resources?

Without carbon-based energy there would be no trucks bringing food to stores.  There would be no commercial agriculture; commercial fertilizer production requires natural gas as a feedstock and modern agricultural machinery runs on carbon-based fuels. Half the planet would not be alive because the people could not be fed without it.  Life expectancy would be 20% or more reduced from what it is now for those who remain.  When storms hit there would be no trucks to bring relief supplies including food and water -- thousands of people would die from thirst and disease caused by the inability to quickly repair power and water-processing infrastructure.  Instead we count the dead after tornadoes and hurricanes on our fingers.  I remind you that it wasn't that long ago -- before our efficient use of carbon-based fuels -- that we added several zeros to those counts.

So, on this "Earth Day" what do we have?

We have a bunch of screaming harpies that ignore actual science and lie for political purposes, but they sure as hell expect all the comforts of modern life -- a life that is inexorably powered by carbon-based fuels, directly and indirectly, like it or not.

Take away those fuels and there is no food in the grocery store, your car doesn't run, your Tesla can't be charged, your air conditioner doesn't work and neither does your furnace.  Your lights work a couple of hours a day -- maybe.  Your life expectancy is cut by 20 years or more because the first time you have an emergency there is no ambulance to come get you nor any advanced operating theater to fix the holes in you after some horrible accident.  Disease is far more-prevalent than today and spreads like wildfire among any populated area since sanitation to modern standards is impossible.  The very chlorine dioxide that keeps your drinking water safe is impossible to manufacture as it relies on methanol and sulfuric acid, both chemicals that require modern industrial processes to produce safely and in volume and the precursor (sodium chlorate) requires electrolysis of salt under controlled conditions.  (PS: The emergency oxygen generator in an airliner that powers those drop-down masks, which incidentally requires carbon-based fuel to fly, also requires this material.)

Oh, and on the evidence the temperature will probably continue to go up a bit for a while, as will the sea level.  Exactly when will the present cycle end and at what temperature rise?  I have no idea, but end it will, probably after I'm long dead -- although it's always possible we get a major sunspot minimum in the next 5, 10 or 20 years and if we do things could get quite sporty -- on the cold side.

If you're dumb enough to be one of those marchers or "protesters" today then you have either a vacuum or granite between your ears.  In either case you're stupid, dangerous or both -- and deserve to reap the consequences of your demands.

May that outcome visit you and not to the rest of us who actually believe in science.

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2017-04-22 11:41 by Karl Denninger
in Corruption , 247 references
[Comments enabled]  

You want to talk about gender bias?

Ok, let's talk about gender bias.  Specifically, let's talk about Elizabeth Holmes, the "wonderkind" who founded Theranos.

I wish to point out a few inconvenient facts:

First, had "she" been a black male the company would have never gotten even a first-round venture kick say much less the hundreds of millions it did get.  In other words she traded on her white womanly state and leveraged it -- and that's discrimination.  Sure, it was the sort that got her a benefit instead of a blackball but let's not forget that for everyone who gets hosed by discrimination someone else profits from it.  And profit she did.  Either neither is wrong or both are.

Second, the company was quite clearly misrepresenting -- intentionally -- a material number of facts related to their scientific claims.  These cannot be excused as errors.  That might have been a colorable excuse early on but it isn't any more.  Not only do we now know the company was aware of the inability to reproduce its claimed results (by itself enough to falsify their claimed technology) we also now have discovered that the company apparently used a shell company it owned to buy commercial lab gear and fake results for potential investors.

There's no mistake here assuming the allegations are correct: That's fraud, and apparently this information comes from unsealed depositions of former Theranos employees and directors, which means that it appears that their CEO knew the firm was gaming results and intentionally hid that fact from the board, along with others in the firm.

Finally there's Arizona -- in which the firm agreed to reimburse state residents for all of the testing done by the company of its residents between 2013 and 2016 -- some $4.6 million worth.  In other words the company essentially agreed that the "services" it provided had no value whatsoever.  Now how does that square with them not being aware that their claims were false?  You tell me.

If I tried something like this I'd be in handcuffs so fast my head would spin around.  But I'm a white male.  Elizabeth is a white female, and was much-lauded as an entrepreneurial genius.

Really?

The record seems to suggest something else entirely, and yet as far as I know there have been exactly zero criminal indictments handed up against anyone within the smoking crater of what once was Theranos, especially Holmes.

Now maybe you can simply say but nobody goes to jail if they're a big CEO and you'd be right thus far except...... Theranos wasn't a big or even a public company.  It was an upstart that made a lot of puffy claims, all of which now appear to have gone up in smoke.

So the next you bleat at me about gender discrimination and glass ceilings you're going to get served a giant mug full of shut-the-****-up in reply.

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2017-04-22 05:00 by Karl Denninger
in Macro Factors , 114 references
[Comments enabled]  

Have a look; this is a nice "gaze from 20,000'" with a lot of opinions:

"Medical cost inflation and the incentives to both remain ill and not work. Specifically, PPACA has driven a lot of it, as has expansion of SSDI. Not only does this destroy productivity directly it does so indirectly by driving deficit spending, which destroys the value of one's earnings. Last year that destruction was approximately 7% on a monetary basis just from Federal Debt expansion alone."

Much more at the link.... both my view and that of and others.

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2017-04-21 05:00 by Karl Denninger
in Editorial , 202 references
[Comments enabled]  

You have to love The Atlantic and their "slant" on alleged "news":

Brick-and-mortar retail is having a meltdown, and economists are starting to see the effects in the job market.

Overall retail employment has fallen every month this year. Department stores, including Macy’s and JC Penney, have shed nearly 100,000 jobs since October—more than the total number of coal miners or steel workers currently employed in the U.S. Even America’s richest areas are getting hit: Employment in New York City clothing stores has fallen three years in a row, the longest period of decline on record, going back to the early 1990s.

Of course the lamentation is that unlike the coal industry (or manufacturing) there's been no political promise (empty or otherwise) to do something about this one.

Well, yeah.

Why does this shock you?

Who owns a major mainstream media outlet?  That's not the same guy who runs Amazon, is it?

And of course The Atlantic tries to make it appear that there's a racism element to it too: Manufacturing is, of course, "white men" while retail is not so-concentrated, ergo, they're all sexist and racist bastards in the medial the DC and that's why they won't report on the job loss.

But the decline of clothing-store jobs has something in common with the demise of manufacturing and mining jobs, too. They are both victims of the familiar forces of globalization and technology, which have conspired to make clothes cheaper and accessible online. 

Really?  This just started recently?  How long ago did all the textile jobs leave South Carolina?

Hmmmm....

And of course they try to claim that the losses are offset by distribution center employment.  Maybe, but there's a critical difference: You can't really replace a clerk in a store with a robot, or at least not very effectively.  But Amazon can and is mightily trying to replace employees with robotic systems -- and that will continue.  In other words the distribution center "jobs" are mostly temporary, even if "temporary" means "good for a year or three."

And, of course, The Atlantic pulls out the standard nostrums of socialism: "Universal" health care not tied to a company, etc.  I note most particularly that there is not one word about the ridiculous proliferation of monopolist behavior in that industry without which there'd be no need for "insurance" in virtually every instance at all.

But no!  We can't have that.  We can't have The Rule of Law and we can't do things that, well, make prices cheaper when it comes to those areas of pain that everyone is taking these days -- including displaced retail workers.

It is much harder to say the truth: Technology and trade make America richer as a country, but the winnings are distributed unevenly, and it’s the responsibility of government to improve the distribution without making everybody poorer in the process.

Technology maybe, trade frequently not.  Trade frequently takes the winnings and gives them to the Chinese and Mexicans.

Now exactly how is the government supposed to "improve the distribution" when it's no longer here?

Unless, of course, they're suggesting that we start using all that military hardware we have laying around.

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