Donald Trump and US politics

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Cut The Crap, Trump
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That goes for the rest of the so-called "analysts" as well.

Everyone is entitled to their opinion.

You are not entitled to your own made-up claims which you present as fact.

Again, the facts:

Last year the Federal Government spent $1,417 billion dollars out of $3,854 billion, or 37% of every dollar it spent, on Medicare and Medicaid. This was a 9.3% increase over last year's expenditure of $1,296,731 (million), all-in.

But inside this figure are even-more damning numbers.

Payments to the health care trust funds were up 13.4% (!)

Spending on CHIP, the plan for poor kids, rose last year by an astounding 56%. While the total spent was only $14.3 billion that rate of rise is utterly astronomical by anyone's measure.

Don't believe for a second that administrative expenses are under control, which is a claim often made for Medicare and Medicaid: They were up 32% last year for the primary hospital insurance trust fund. No, that's not a misprint.

Hospital benefit payments for Medicare? Up 8.4% -- the bright spot, believe it or not.

Medicare Part "D" (drugs)? Sit down: Up 26.2% to a total of $95.2 billion.

Folks, at this rate of change within the next four years Medicare and Medicaid will consume just over $2,000 billion a year, or $2 trillion -- an increase of $600 billion a year in spending.

No, it won't rise to consume that amount.

If it is attempted, and absent actual resolution that will be attempted, the federal budget and economy will detonate.

No, "bidding for drugs", as Trump said, will not fix the problem. Last year Medicare Part "D" (drugs) spent $95.2 billion. Yes, that was up 26% from the previous year, but the fact of the matter is that even if you cut that acceleration rate to zero the rest of the $1,417 billion would continue to accelerate, with hospital payments up by 8.4% last year.

You have to put a stop to all of the medical pricing games, the collusion and the rank violations of long-existing law found in the Sherman, Clayton and Robinson-Patman acts.

You cannot simply "negotiate" on the government side. I remind you that outside of prescription drugs the federal government already mandates "reimbursement rates" for medical procedures including hospital charges on both the Medicare and Medicaid programs and yet that spending went up 8.4% last year anyway.

8.4% is wildly beyond even the most-optimistic view of economic expansion under a Trump administration -- and those optimistic views are unlikely to be met. Some improvement is likely due to tax and regulatory reform but there is no way it's going to eclipse an 8.4% acceleration in spending.

Further, any attempt to do so on the "government" side for Medicare and Medicaid without forcing the private-sector side to adhere to the very same set of laws will simply cause the medical firms to shift the expense to those not on the government dole.

That's probably you.

If Trump does that then you get butt*****d. If Price manages to get balance billing into Medicare (which he has formerly advocated for and in fact tried to get passed!) then every Senior will get butt*****d and as they get older and sicker, after being forced into Medicare, they will all have their entire net worth stolen.

If Medicaid is block-granted to the states then the states will have a fixed pile of money "given" to them but the mandate for Medicaid will continue and with a ~9% acceleration in cost not matched by the block grant every single state budget will detonate within five to ten years.

Medical spending is approximately 19% of total GDP today and 37% of federal spending last fiscal year.

The only solution to the problem is to take the ~$3.5 trillion "medical industry" and make it a $1 trillion a year industry by enforcing the Sherman, Clayton and Robinson-Patman acts against each and every actor in same.

Robinson-Patman, for example, states that any commodity (physical, standardized good) that travels in interstate or international commerce cannot have discriminatory pricing applied to it between buyers of like kind and quantity. This quite-clearly applies to drugs and supplies used in medical care.

Whether you have "health insurance" does not change who the actual buyer of said drug is -- the actual consumer is you. It is therefore quite-clear that to charge one person $20 for a month's supply of a drug and someone else $500 for the same one-month supply is an obvious and blatant violation.

So-called patient assistance programs are also rank violations of Robinson-Patman.

Those programs, which are often-cited by pharama companies, discriminate against some people and for others based on their income and insurance status for a buyer of like kind and quantity of a commodity -- in this case a drug. Try charging one person $3,000 for a car and the next person $30,000 based on their car insurance company and/or income and see how long you stay out of prison. Ditto if you were to try to charge a poor person $20 to change the oil in their car and the next person, who has a $100,000 income, $200.

Likewise, Sherman and Clayton make collusive practices of any sort that intend to or do lessen competitive pressure illegal. The refusal to post a price, refusal to honor a claimed price or discriminating between consumers based on their health insurance carrier or status is quite-clearly intended to prevent meaningful shopping -- competition -- between providers of medical services (such as hospital services.)

To those who claim there is an exemption in these laws for such goods and services I challenge you to provide a citation to the law you claim exists. Mccarran-Ferguson is not a valid example of same as regards drugs, incidentally, as that has already been litigated at the US Supreme Court and it was found that "pharmacy agreements" (to fix prices and charge differential rates based on "insurance") are not "the business of insurance."

Never mind that Mccarran-Ferguson provides no shield from state anti-trust statutes (only federal) and in fact the law explicit allows for said state laws by deferring to same!

We don't need new laws -- we need vigorous enforcement of existing, 100+ year old law.

Folks, it is this issue that Trump either must address now, in the first 100 days, or the rest doesn't matter.

If you're a Trump supporter then you need to be 100% on board with this and make damn sure he is held accountable to it because if he doesn't address this specific issue in this specific fashion then the rest of his agenda literally does not matter. The federal budget will collapse and attempts to stave it off will at best buy a couple of years while forcing said collapse down on the states as well.

Again, there is no "halfway" measure that will work. The only answer is to break up all of the medical monopolies and enforce all of federal (and state) anti-trust, anti-competitive and deceptive practice laws against every medical provider, whether it be a drug company, a pharmacy, a hospital, a practice, diagnostic centers and even individual doctors.

We either do this and return health care to a $1 trillion a year industry from a $3.5+ trillion industry or this nation dies fiscally, and if you currently suffer from a chronic condition that requires ongoing medical care or pharmaceuticals there is a good chance you will die physically as well.

This is not politics.

It's math.

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鬼殺し wrote:

Anyway. There you go. No jokes, no fake news, no alternative facts. Just part of my story, which may be a little less awesome than that title over there might indicate...

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Head_Less wrote:

Those type of health system are not working on high population countries.

I am french, Such health care program worked from the 60 to the 80.
We gained 20 millions habitants and now the country is in deficit and they are cutting every health programs nowadays.

There is no way a country like the US with 300+ millions hab would function like that without bankrupting after 1 year of free healthcare.

Wait Australia get 60+ millions people and you will see your hospital bills going up 5000%.

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Xavderion wrote:

Shit I'd kill for $1k a year health care cost. I live in socialist Germany and pay $7k a year because I'm self-employed.

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Xavderion wrote:

Shit I'd kill for $1k a year health care cost. I live in socialist Germany and pay $7k a year because I'm self-employed.