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2017-08-14 06:15 by Karl Denninger
in Health Reform , 478 references
[Comments enabled]  

This column demands a response, so here you go.

There is nothing more we can do here. We tried everything else, and now it's time to do the right thing (ed: Single Payer). It's the American way.

Well, let's see. I count three lies in three sentences, four if you call "Single Payer" the American Way.

Let's start with the first: There is nothing we can do here.  Sure there is.  We could start with my one sentence extortion-stopping bill.  We could then follow up with the linked bill outline from that article, which you can read here.  That has a link to the implementation of same, and what it would look like -- read that too.

None of this has been tried, so to say that there is "nothing more we can do here", or "we tried everything else" is a flat-out lie.

It is in fact worse than a lie; it's a knowing fraud put together by someone who advocates for and sells "medicine as a business", of course, with a focus on, in her own words, "obtain(ing) better reimbursement" (read: "more moolah!")

But let's rewind that article and go back to the start, with the claim that we have a $3 trillion annual "healthcare pot" to spend.  That's a lie too.  You see, the Federal Government runs huge deficits.  That is, we don't have a $3 trillion annual "pot" of money because we're borrowing a huge percentage of it.  This is akin to saying that if you make $30,000 a year, but spend $50,000 because you charge up the credit cards by $20 large your "pot" to spend is $50,000.

No, it isn't.  It's $30,000.  You can for a while spend the $50, but not forever.  In the case of the government the form of "not forever" doesn't come the same way it does for you.  When you try this you eventually get a declined back at the store on your plastic.

When governments do it they destroy productivity in the economy and cap GDP expansion.  We have done this serially for 30 years and it has now caught up with us, which is why we haven't had an actual "recovery" since the 2008 crash, being capped off under 2% GDP.

What has happened since the 1970s is that medical spending has gone from ~5% of GDP to almost 20%, a four-fold increase in percentage terms.

What's just as bad, however, is that the much-vaunted "Medicare" and "Medicaid" (single-payer, basically) that this chick likes to argue for has seen a roughly 9% compounded rate of increase in spend for the last 30 years.

Obamacare managed to buy one year of decreased spending -- exactly one.

On this trajectory the Federal Government will try to spend $2 trillion dollars a year by the time Trump's first term ends, nearly $600 billion more each year than it spends now.

May I remind you that $600 billion is approximately the size of the entire defense budget?

There is utterly no possible way to do that.

I remind you again: Medicare and Medicaid are single-payer.

The author also tries to present military procurement as a "success model."  Oh really?  Exactly how much over budget and behind schedule was the new Ford aircraft carrier?  Let me count that up for you -- it's over $2.4 billion above the "accepted bid cost" and the carrier was roughly 18 months behind schedule for completion as well; it was supposed to be finished in September of 2015!  Worse, while it's currently in the water and running on its own power it won't actually be operational until at least 2020.

Would you like to talk about something much more-pedestrian yet essential to the military?  How about pistols?  The military recently decided to have a "competition" for the next-generation military sidearm.  That ought to be quite simple; there are literally hundreds of sidearms currently available in the marketplace.  Let them compete, pick one, negotiate a volume discount, done.  Let me remind you that in the context of the military a sidearm isn't a primary weapon, unlike a police force. In the military a sidearm is a last-ditch, everything has gone to hell piece of equipment with its best and highest use being to fight your way to a weapon that is both longer and more-powerful. Yet police departments perform this task all the time, I remind you, for their duty (primary and "most important") weapons and it works perfectly-well for them.

But, you see, that's not what the military did.  Go look that one up for yourself as it's enough to make you want to throw up.  What the military wound up with was a bespoke variant of an existing design at materially increased cost.

We run our entire government this way -- and this is the model for health care we should adopt?

If you think that perhaps the states or cities can do better may I direct you to a bathroom in New York, in a public park.  It's a public restroom.  It has stalls, urinals, sinks.  It's not especially large and might be able to accommodate a dozen people doing their business at once.  It cost $2 million dollars and took several years to build.  In the same neighborhood you can buy an entire house for under $700,000 and a new one can be built in six months, more or less.

Again, this is the model you wish to apply to health care?

The math presented is reasonably clear -- $3 trillion and change divided by 330 million people is about 10 large a person, annually.  The problem is that this is two to three times the cost per-person in all other developed nations and essentially all of those are socialist medical systems -- that is, single payer.

I think American medicine is the best in the whole world. Not because it's expensive and not due to the corrupt ways in which it's being financed, but in spite of these things.

Oh, so we're back to what people think?  See, when you can't argue facts (because they say you're full of crap) you argue feelings and this of course leaves you open to charge anyone who disagrees with bigotry and, if you're a woman, you can claim sexism as well.

Arithmetic and statistics, of course, don't care about your feelings or what you think.

The facts are that we spend 2-3x as much per-person on health care as any other developed nation and yet we're nowhere near the top of the list among developed nations on any of the objective measures of success in health outcomes: Mortality, morbidity, longevity, infant deaths, obesity, diabetes, high blood pressure, coronary disease, strokes and more.

More to the point we have 100+ years of history in economic outcomes comparing socialism .vs. capitalism across the world.  There has never been a case where socialism has "won" on an objective basis -- real GDP growth per capita, technological advancement, objective measures of personal wealth, economic upward mobility and more.

No matter what objective metric you care to use as a yardstick socialist systems consistently and persistently underperform.

What's worse is that there are myriad cases in which socialist societies have literally collapsed upon themselves leading to violence, civil unrest, coups, and even civil war.

What "single payer" boils down to, in short, is attempting to protect the medical scam.

And yes, it's a scam.

I can cite specific Medicaid issues in this regard, and some Medicare ones as well.  They're outrageous.  We're talking about situations where people are cut up to fix something ignoring severe, even life-threatening co-morbidity problems that could be at least in part alleviated first.  Not doing so means greatly increasing the risk of severely-extended hospital convalescence for which the hospital gets paid, of course.  Never mind the fact that this "decision path" also comes with a materially-increased risk of the person in question dying.  And finally, if you alleviated those co-morbidity issues the original operation might not have been required at all and that would mean they make far less money.

The medical industry doesn't want to talk about this sort of thing just like they don't want to talk about what they do now when it comes to billing in general, which is bilk you.  And I do mean bilk.  I have here in my hand a hernia repair bill sent to me by someone who had the procedure recently done.  It's roughly $20,000, of which the "insurance company" paid $3,500 and the customer paid $150.

Note that if said "customer" had a $6,000 deductible they would have paid the entire $6,000 which is close to double what the insurance company actually paid.  This, despite the fact that the customer got the exact same surgery and exact same result.  The only difference was whether he elected to pay for a "catastrophic" plan or not.

This pretty-much fits the description of extortion to a "T".  The message is clear: Buy a low-cost insurance plan for a catastrophic event and for a non-catastrophic but still serious event you will be billed double or more.

Incidentally extortion is illegal -- at least it's supposed to be.  Further, refusing to quote a price and other similar games are illegal under long-standing consumer protection laws, and colluding to fix prices is a felony under 100+ year old law (15 USC Chapter 1.)

Exactly how many prosecutions are brought over this?  Zero.

Or shall we talk about the two recent lawsuits brought against pharmacy chains (of which there are now only a handful, and thus there is effective monopoly power) alleging that people with insurance are paying more than a cash customer for medications?  Those allegations look pretty solid, seeing as they're easily backed up.  Exactly what justification can you raise for someone to pay $23 after they buy "insurance" when a cash customer can walk in and buy the exact same medication for $10?  I remind you that Robinson-Patman, part of that 100 year old 15 USC Chapter 1 law, makes illegal the charging of differential prices for physical goods that travel in interstate commerce (that would be basically all drugs), where it tends to reduce or destroy competition, between customers of like kind and quantity.

You want to put this all under "single payer"?  Where is the evidence that any of the above would be helped by doing so?  And as for the claim that "we've tried everything else" would you please point out when and where your definition of everything else involved enforcing existing, 100+ year old law -- when it's quite clear that doing so would collapse cost by at least 50% and probably something more like 70-80%!

Then there is the plethora of evidence that morbidity and mortality is intentionally stoked by Medicare and Medicaid existing in the first place.

Leaving aside the financial impact we are talking about people being screwed physically and perhaps dying unnecessarily as a consequence, all so the medical scam machine can make an even more-obscene profit.

Now you might actually get me on board if we had "tried everything else" first.

But we haven't and any such assertion, as I noted, isn't just a mistake -- it's a lie.

Right at the top of this article are two links.  They take you to a one-sentence bill that would instantly stop the extortion game played on people who have high-deductible insurance plans by requiring that a person who either has no insurance or is underinsured for the event (e.g. they have a deductible to satisfy) is not billed more than a person on Medicare is billed for the exact same procedure.

This instantly ends the medical extortion and cost-shifting game.

The second link restores competition by (1) forcing the posting of prices and agreement, when possible, to actual charges before they are incurred, (2) enforces 100+ year old law that does apply to the medical industry across-the-board, (3) aligns the interest of customers and providers in stopping infections transmitted by poor procedure or "mistakes" in clinical practice by refusing to allow said firms to bill you for that which they do to you as a result of said failures, (4) enforces "most-favored nation" status for the US on drugs, devices and supplies, preventing US consumers from being forced to fund the entire world's medical system at gunpoint, (5) allows anyone to obtain any non-invasive and non-dangerous diagnostic on their own, for cash, without a doctor's order should they so choose, (6) requires the provision of medical records in readable form to you at the time of service, and confirms your sole ownership of same, (7) ends, permanently, the provision of government-funded care to illegal invaders in this nation and (8) for the indigent dramatically increases both their options for medical care and drives down cost by enforcing anti-trust law, thereby bringing competition into the game for everyone.

If we try all of that and fail with it then I might be open to debate about single-payer.  But we won't fail if we do that.  What we will do is take that $3 trillion current spend and cut it to $1 trillion.  This will not only permanently fix the budget deficit it will make America the place in the industrialized world to start and operate a business on a cost-competitive basis.

But until all that happens any such statement that we've tried everything else is simply a bald-faced, self-interested lie by those who have ripped off Americans for more than 30 years, all of whom should be staring down an indictment right here and now.

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2017-08-13 09:31 by Karl Denninger
in Editorial , 774 references
[Comments enabled]  

Folks, this one's pretty simple:

1. You have the right to free speech.  That happens to not only include but is explicitly present in the Bill of Rights to protect disgusting, outrageous speech.  Why?  Because nobody ever tries to censor the other kind.  I remind you that the KKK has for decades marched in Skokie, IL -- a Jewish community.

2. You do not have the right to respond to speech, no matter how outrageous or disgusting, with violence.  Period.

If you do not both accept and embrace #1 and #2 then we no longer have a Constitutional Republic.

You will rue the day America is no longer a Constitutional Republic, no matter if you think you're on the "correct" side of the argument or not.  The day our government fails to prosecute violence directed at someone for mere speech, irrespective of how outrageous said speech may be is in fact the bright-line test as to whether our Constitutional Republic still exists.

Let's see what Jeff Sessions actually does.

As for those demanding that the President intimate that the government should, or might, suppress free speech?  I'll buy you a one-way ticket to North Korea; you'll fit right in and can watch the off-time sunshine that appears to be headed for a rendezvous with Fatman.

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Oh what have I often said....

"That we would be sitting around watching holograms and Netflix would be an "old" invention. When it first came out it had decent movies on it. Now it has movies that I didn’t know existed and movies that just aren’t that interesting to me. They really lowered the quality so of course that meant Hulu was my backup. 

smiley

Psst.... don't look at their free cash flow; into deteriorating user perception that could be real trouble...

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2017-08-11 12:55 by Karl Denninger
in Foreign Policy , 278 references
[Comments enabled]  

How about a bit of analysis, eh?

First, Russia's Lavrov has apparently said that a nuclear armed North Korea is unacceptable.  Well, fancy that.  It would have been nice if you gave a **** ten years ago, or five, eh?

Then there's China.  Let us not forget that in order to execute any foreign transaction someone has to intermediate the money coming back into the country.  That someone has been one of a handful of Chinese banks, and may I remind you that all banks are licensed by the nation in which they operate.  Therefore China has been able to enforce all previous sanctions against North Korea and has willfully refused to.

Now China says that it "will not" interfere if North Korea attacks US interests first.  But China made no such promise if we attack to "change the regime."  In fact it claims it will "prevent" us from doing so (sure it will..... how?)

What's the significance of this bluster from China?  It reinforces China's refusal to adhere to the previous and present UN resolutions and punish those organizations that intentionally violate same, including those very same banks.

This belies the ultimate problem on the Korean peninsula: China most-definitely does not want a unified Korea under a representative republican form of government.  In fact it actively fears that happening since said nation would not be able to be controlled and could become hostile on a trade basis to China.  In fact, it probably would become hostile to same at least in some degree and worse, if it demonstrated success it would add to the risk of political instability in China itself.

So here we are.  China and Russia have sat on their hands or worse, actively aided and funded North Korea for 20+ years while it (1) built a reactor, (2) produced bomb material from said reactor, (3) assembled said bomb and (4) tested said bombs.  They also sat back while the nation developed missiles of increasing ranges, up to and now including, it appears, ICBMs.

Finally they also sat back while North Korea shrunk the size of said bombs so that they will now fit on a missile.

There are four, roughly, steps to producing a nuclear-tipped missile.

1. Make a nuclear bomb.
2. Make a missile that will go as far as you wish to shoot it.
3. Miniaturize said bomb so it will fit on the top of said missile, and the missile can lift it.
4. Figure out the ablative and stability technology so said missile's warhead survives reentry.

The only piece still in question now for North Korea is #4; the last test of their missile appeared to show the nose section breaking up on reentry.  But the Norks know why it broke up and I presume they will figure out what they did wrong stability and ablative-wise, and fix it -- quickly.

Cut the crap, folks.  China in particular is why the North Koreans are within spitting distance of an ICBM-deliverable nuclear bomb, an ability we must presume they now either have or are one test-fired missile away from confirming they have.  They need only splash one successful re-entry to demonstrate that they have accomplished all four of the above steps and China is directly and politically responsible for this state of affairs.

I don't care if you like it or not, whether it's politically uncomfortable or not, these are facts.

Barry Obama sat on the throne for eight years and did exactly nothing to China or anyone else for that matter in putting a stop to the progression of steps #1-4.  Neither did Boosh before him.  In fact all the way back to Bill Clinton there has been zero policing and plenty of evidence that North Korea was openly cheating on every "deal" they made that allegedly prevented them from getting a bomb -- and the technology to deliver it.

In each and every one of these instances of cheating China was directly and explicitly involved in enabling said cheating and the fund flows necessary to accomplish it.  Rather than go after and punish China for their part in these actions we instead bestowed ever-more-favored access to our markets and allowed China to steal US firms' intellectual property for the same 25+ year period.

I remind you that it was back in 1993 that North Korea got caught by the IAEA during routine inspections -- it was fairly clear to them that plutonium was being diverted, which is pretty easy to catch as the numbers of various isotopes produced by a reactor are pretty-well determined by physics, and when they don't all add up, well, you're hiding something.  In other words we've sat on this problem, and the Chinese have actively obstructed attempts to strangle the Norks nuclear program, for roughly 25 years!

Let's leave aside whether all the other folks who have acquired nuclear weapons should have been allowed to do so, or whether anyone should have them at all.  We can debate that all day long but it won't change a thing on the ground.  It is a fact that there are plenty of nations that do have nukes and it's also a fact that the genie is out of the bottle in that regard.  The process isn't all that hard to master given today's technology and more-importantly the world has never successfully stuffed the genie back in said bottle in any nation that has acquired said weapons, declared and tested or otherwise.  There is exactly zero reason to believe, as a result, that we can "de-nuclearize" North Korea successfully and this means that they have nuclear bombs, they either have or will have nuclear ICBMs, and we now argue only over the government that has or will have control over same.

That is the entire scope of the debate at this point in time folks -- we can hold people accountable, including Clinton, Bush and Obama along with both Russia and China now or later, but doing so (or not) will not change this fact.

Further, if you stick your head up your ass and refuse to accept this as fact then you are begging to glow in the dark and eventually someone is going to do exactly that.

So here we are.  We know that if there is an attack on North Korea then Seoul will come under immediate artillary bombardment by the North Koreans; they have dug into the mountains just north of the DMZ thousands of field pieces.  We cannot take them out before they lay waste a large part of South Korea -- basically anything within 30-40 miles of the DMZ is within range of their conventional artillery.  North Korea could also attempt to infiltrate the South and fight a guerrilla war; we know of a number of tunnels under the DMZ and we must assume there are dozens or even hundreds of others we don't know about.  Finally, they might have solved the reentry problem or worse, could take one of their diesel-electric subs, which are extremely quiet and difficult for us to detect even with our superior technology and sail it, with a big old-fashioned nuclear bomb and a suicide-willing crew, right up into someone's harbor and set it off.  While we might catch such an incursion before it happens the odds of success are actually quite good for such an attempt.  I put our ability to actively police and catch such an attempt at less than 1 in 2; active sonar is easily detected well beyond its useful range and said sub captain can then go somewhere else.  Absent active sonar a D/E sub is quiet enough to sneak in with a good probability of success and the Norks have several such subs.

Yes, we would utterly paste North Korea if any of that happened, but do not mistake winning for winning "cheaply."  It would not be cheap at all, either in lives or economic cost and there is a very real chance they get at least one nuclear bomb off on someone before we can kill enough of their command and control to stop it.

But at the same time do not make the error of thinking that China or Russia have done a ******n thing to stop the progression of this threat.  They have not, and what's worse is that said obstruction continues to this day, meaning that as things stand right now if you do not accept a nuclear-armed North Korea you have no choice but to hit them before they perfect that last step, and with China openly declaring that such a strike would cause them to "stop it" one must assume that we now have the situation of an immovable object .vs. an irresistible force.

This is not good at all since either someone has to change their mind as to what is acceptable or we wind up with open warfare, and quite-possibly war involving China on a direct basis.

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2017-08-11 08:43 by Karl Denninger
in Social Issues , 490 references
[Comments enabled]  

So it is offensive and not ok to speak the truth.

The engineer in question who penned the piece probably knew the odds were high that he'd get canned.  Nonetheless, having read the entire thing, it's not only correct on an ideological basis (conservatives are considered persona-non-grata in many environments) it's also scientifically accurate.

“To suggest a group of our colleagues have traits that make them less biologically suited to that work is offensive and not OK,” part of the CEO's note, entitled “Our words matter,” reportedly read.

That's not what the piece said, so obviously lying is now part of Google's "words" that "matter."

What the piece pointed out were some pretty-basic facts and how they might influence personal choice when it comes to fields of employment.

For example, it is a biological fact that men are biologically disposable.  The old saw about a man's minimum contribution to creating a new life being over in 20 seconds, while for a woman it inevitably requires at least nine months isn't sexism it's science.  Science isn't "offensive", it just is.

Now let's project that onto the workplace.  Let's assume that the collective decision is made by a company to engage in a project that is expected to take more than a year and for which the primary engineering talent is going to be asked to work 60+ hour weeks for the duration every single week.

Never been there, you say?  I have -- multiple times -- in my professional career.  Let me note that in none of those instances was the "request" a surprise; in fact in all cases I took the job knowing that was the "ask".  In the last case since I was founding the company I knew exactly what the expectations were going to be.

Could I also have, during the same 2-year period, become a father?  Yes.

Could a woman also, during the same 2-year period, become a mother?  No.

That's not sexism it's scientific fact.  It would have been physically impossible to both meet the requirements of the job and bear a child; even with an extremely aggressive (short) time off to actually have the kid, and zero complications it would have been physically impossible to perform the tasks put before me.

This doesn't mean that a woman cannot choose not to have kids at any given point in time.  But I will also point out that the period of time in most people's lives where they can do the "burn the candle on both ends and not wind up in the morgue doing it" game is in the key ~22-35 time frame -- exactly when most people would possibly like to start or add to families.

So if just half of women in the workforce decide that they'd like to have kids then they would not take jobs that had these demands.  That right there explains why you have one in five, roughly, women in hard-driving engineering areas -- and that makes the assumption that only half of all women would like to bear children!  In fact I suspect the percentage is much higher than 50%.

The outcome is not due to discrimination it's due to individual choice and both men and women have the right to make said choice.

Of course today we can and do turn this "problem" (that is, the choice someone makes) into sexism against men by demanding that no company ever place such a schedule before its engineering staff, and we can do it quite-effectively by mandating various policies such as paid parental leave whether equally available to both genders or not and other similar political decisions.

But if we do so then we cripple those firms that would otherwise be able to embark on such a project and succeed because we make that endeavor illegal to undertake.

This is, incidentally, exactly what the fired engineer was talking about.

When people speak of "high pressure" jobs most folks who have never done that sort of work have no idea what the hell they're referring to.  I do -- basically my entire professional career consisted of doing exactly those sorts of jobs under that sort of pressure.  It'll probably kill me some day; I'm sure I clocked off some years on my longevity by making that choice.

Make no mistake folks -- it was a choice, it was willingly made, and I do not regret it.

Can women make that choice?  Of course.  But by doing so they preclude other choices, such as having a family during that period of time.  That's science, not sexism.  A man can create a family under those conditions.  Maybe he won't choose to and maybe he shouldn't choose to, but he can, where a woman simply cannot.  It's virtually a biological impossibility and it has been a flat legal impossibility for decades.

To state as a matter of "corporate principle" that there are no biological and scientific differences between the sexes that bear on their representation in various parts of the workforce is a lie.  To state that one will not accept those differences that exist is to reduce the potential of said collective firm to the lowest common denominator of capacity of either sex in all respects because instead of forming groups within a company to utilize the strengths of each sex you instead demand that the inability expressed by any employee in the company become that to which all must conform.

This is exactly the argument that people like Sheryl Sandberg of Face****er likes to make and her argument has nothing to do with equality but is rather intended to cripple any firm that could challenge Facebook by making it impossible for them to do what Facebook previously did -- which involved requiring that sort of work schedule and output by its engineers!

Sheryl, in other words, wishes to mandate under threat of being shot that any potential competitor be crippled so as to not be able to take Facebook on.  For this she should be tried and imprisoned, along with the rest of Facebook management, under 100+ year old law that forbids monopolistic practices such as this (15 USC Ch 1.)

That's what Google allegedly "supports" but just like Sheryl Google's "support" has zero to do with "justice"; it is entirely-focused on suppressing competition.

It's also what the grievance industry and social justice warriors want, support and demand.  But at the same time they refuse to prosecute their war against those firms that built themselves up using and today live by the above scientific fact or even worse, just plain discriminate and yet give lip-service and pander to their bull****.  Take a look around the boardrooms and top executive positions at various competitively-successful firms and may I note that most board members in most firms are old enough that further child-bearing is not at issue.  Boeing anyone -- right in the middle of SJW heaven in Seattle.   How many women?  Two.  How about Amazon? Google itself?  Gee, the bastion of this screamfest has what percentage of women on the board -- and zero, I might add, in the top four officer positions!  How many officers on Netflix's board are women?

Now tell me again all about the SJW demands and why those four firms along with all the rest are given "exemption certificates".......

Guess what?  You can demand all you want, you can even get that infantile screaming turned into law in the United States but you can't force the rest of the world to put up with your bull**** and it won't.

Adopting such positions as a company is in fact how you lose in a competitive world.

Adopting such positions as a nation is how you get buried competitively on a global scale. 

There are plenty of people, myself included, who will not start a company under these conditions.  Had they existed in 1993 I would not have founded MCSNet.  Until and unless they go away that's a final decision on my part and, I argue, the only logical decision for any person in the US to make.  No more business ventures in this environment -- period. The SJW folks can stuff it.

Those are facts folks, and we as a nation must choose.  We must choose to either die competitively as a result of these "social justice" ****heads or we must, while respecting their right to speak, say "no" to them, shun them, refuse to play their game and in fact destroy them and their attempted strong-arm garbage exactly as they seek to destroy everyone else through their puerile and outrageous denial of facts.

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