Guest Post: How To Cut America's Healthcare Spending By 50%

Tyler Durden's picture

Submitted by Charles Hugh Smith from Of Two Minds

How To Cut America's Healthcare Spending By 50%

The current sickcare system is financially unsustainable. Physician correspondent "Ishabaka" proposes practical ways we could cut costs by 50% while improving care.

Since sickcare is fiscally and demographically unsustainable, it will eventually be replaced by something that is sustainable. Our only choice is to either let the current system collapse and then start pondering sustainable alternatives, or begin an honest discussion of sustainable alternatives before sickcare implodes in insolvency.

In the spirit of openly discussing a variety of sustainable, systemic healthcare options, we present this essay by correspondent "Ishabaka" M.D. on how to cut our current (18% of GDP) healthcare spending by 50%. Ishabaka received training in Canada, so he has direct knowledge of the Canadian system from the inside. Having spent decades as a primary-care and emergency room physician in the U.S., he also has deep knowledge of the U.S. sickcare system from the point of view of a care provider to under-served (i.e. uninsured) Americans.

Here is Ishabaka's essay:

Some time ago I told you how I could cut health care costs in half and provide every American with the healthcare they need (not necessarily the healthcare they want!). Here goes. Some of my points might seem drastic, but we are facing a drastic problem.

 

1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens and H1B visa holders ) which will be paid for by an immediate TAX INCREASE.

 

2. Like Canada, this will cover all doctor's office, E.R., clinic, hospital etc. visits. Unlike Canada (the biggest mistake Canada made), there WILL BE co-pays for routine office visits and visits to the E.R. that are NOT serious emergencies.

 

Here is why Canada's no co-pay system is wrong. A family physician friend of mine in London, Ontario had a family in her practice. The little girl got an ear ache, with a low-grade fever on a Saturday. The mother took her to an E.R. and got an antibiotic prescription. On Sunday the girl was feeling better with no fever, but the mother took her to a walk in clinic "Just to make sure everything was all right". The doctor said "Yes". On Monday the mother took her daughter, who was now feeling fine, to my friend's practice "Just to make sure the other doctors knew what they were doing". The ear infection was cured.

 

That was two totally unnecessarily visits the Canadian tax payers paid for, and the first visit should have been to the walk-in clinic, which is much cheaper than the E.R.

 

Co-pays have to be meaningful - not too much to dissuade patients from necessary care, but enough to make them think. That should apply to all aspects of healthcare.

 

Let me give you another example - right now, where I live, a basic ambulance ride (no drugs or treatments) is about $500. I have had a patient come in by ambulance for a TOOTHACHE. The paramedics should be able to say "No" and not worry about being sued.

 

3. Like Britain, every person will choose a primary care provider, who will provide their primary care. Referral to a specialist will require a request for consultation from the primary care doctor. In the U.S., there are no restrictions on seeing specialists who charge twice as much or more than a primary care doctor. I saw a guy who went to an ear nose and throat doctor to have his ear wax cleaned - a procedure any nurse can do!

 

4. Immediate tort reform. Not quite sure of the details, but I estimate that probably 50% of the tests done in the U.S. are to C.Y.A. against malpractice suits, and are medically unnecessary. What would probably be best would be a no-fault system. You are injured by the health care system, you are compensated a REASONABLE amount for your injuries, regardless of who was or wasn't at fault. You aren't really injured, you get nothing. This could be handled by arbitration panels which would take the lawyers out of the system.

 

Right now, it takes on average $50,000 to defend a doctor against a frivolous lawsuit - the doctor wins, but still $50,000 is down the drain. On the other hand I was involved in a suit where a patient died due to real negligence on the part of two doctors and the family lost the lawsuit and got nothing. This would cut malpractice premiums by at least 1/2 and drastically reduce the amount of testing.

 

5. We spend WAY TOO MUCH money on end of life care. We have to get together as a society and decide what we will and will not provide for end of life patients, and that doesn't just mean cancer patients, it also applies to end of life heart failure patients, emphysema patients, etc.

 

For example, a reputable study in The New England Journal of Medicine showed 0% survival from treatment of cardiac arrest on kidney failure patients on dialysis. Zero. I have had to do numerous "codes" on kidney failure patients on dialysis - they all died. A code costs thousands of dollars. The first code I ever ran was on a 38 year-old accountant having an acute heart attack. In the old days (1960's) I would have simply pronounced him dead. He lived, and was FINE, no brain damage from loss of oxygen, walked out of the hospital a week later and went back to work. That was money well spent. We don't have infinite money. We need to get the most bang for the buck.

 

The $90,000 chemo drug that extended terminal prostate cancer patients' lives by 6 months should NOT have been paid for by taxpayers' money. Patients who want it should have to pay for it themselves.

 

6. We have GOT to get the gold-bricks off disability and workmen's comp. If we did, we could put the truly disabled and injured-on-the-job folks in suites in the Ritz Carlton with 24 hour nursing and rehab care! It is mind boggling to see how many gold-bricks there are.

 

I really liked the system in Ontario, Canada. Any primary care doctor could certify a patient as disabled or off work for up to two months. After that, the patients had to be seen by a panel of specialists paid by the government. They had NO INCENTIVE to either certify the patients as disabled/unable to work or not. To make these specialists truly independent they should be salaried - and the government CANNOT fire them except for the reasons that would cause them to lose their license (sex with a patient, drug addiction, etc.).

 

7. All advertising immediately banned. We go back to the 70's. No doctor, hospital, clinic, drug company, can advertise to patients. Period.

 

8. All new drugs have to be compared to existing drugs (if there is a similar existing drug). ONLY if they prove superior to existing drugs should the FDA approve them. Every time a new drug is invented, all the other pharma companies copy it, change a molecule or two, and then study it compared to PLACEBO. We end up with 20 drugs that do the same thing. It's ridiculous.

 

9. Get rid of fraud and abuse - for real. This means doctors AND patients. You get caught committing health care fraud you pay in fines THREE TIMES what you stole, and spend a minimum of ONE YEAR IN JAIL OR PRISON. This is crucial - fraudsters MUST be made to do time.

 

Everybody's charges get audited by an independent panel. You charge for patients you didn't see, or wheelchairs you never provided to patients - you go to jail. It must be recognized that nobody is perfect, mistakes happen. A doctor accidentally charges for a patient they didn't see once in five years is not fraud - it's a mistake.

 

In the same way, patients caught "doctor shopping" for narcotics and selling them pay three times what they made and go to jail for a year. Same for patients selling blood pressure pills (this is a big racket for Medicaid patients) - doctors are usually suspicious of healthy looking patients seeking narcotics, but see a Medicaid patient who is on expensive blood pressure pills, says they ran out and can't contact their doctor - they will usually get a prescription. You can make a nice income on welfare doing this.

 

10. Eliminate health insurance companies, except for people who want to buy extraordinary coverage like for the $90,000 prostate cancer drugs. Do like we did in Ontario - fee for service with the fees paid by taxpayers via a Department of Health, the fees negotiated annually by either state or national medical associations.

 

11. Electronic medical records THAT WORK. Right now we are in the "pre-internet" era of EMR. There are a thousand different ones, they are very expensive, doctors pay the full amount, and NONE OF THEM CAN TALK TO EACH OTHER. I worked for a long time in an ER in Florida in an area where elderly people from the north came to winter. They would get sick all the time and come in not knowing their allergies, meds, or medical history. It was a nightmare. If I hear "I'm on a little white pill for blood pressure" one more time I may scream!

 

With a national standard EMR I could find everything I needed to know with a few mouse clicks. It will be a disaster if this info is stolen or hacked, so the punishment must be severe - TEN YEARS in prison WITHOUT PAROLE, and a hefty fine. No excuses. Set up something with Interpol and the UN so this applies to all countries. And, since EMRs would benefit patients, doctors, and the entire country, doctors and hospitals pay half, the government pays the other half.

 

12. Get rid of the bad docs/nurses/hospitals/ etc. I'll just speak for the docs here - there are two kinds of bad docs - ones who are bad usually due to lack of knowledge or drugs/alcohol but WANT to be good, and those who are bad and don't care. The second ones are immediately banned from healthcare for life. The first group gets extensive education/rehab, whatever they need. Then close monitoring. In my experience, most of them will turn out to be good docs. A few won't, and get banned from healthcare for life.

 

13. Finally, immediately outlaw high fructose corn syrup and foods made with trans fats. We know they are poisonous. Again, minimum one year prison for the CEO and board of directors of any company that violates this law, whether it's a mom and pop shop or Kellogs or McDonalds.

 

That's it, except for a few tweaks. Fifty percent cheaper, everyone gets what they need.

Thank you, Ishabaka. Here is a story Ishabaka sent recently that highlights the consequences of fast-food on human health:

This is an article from the July 2, 2012 issue of Circulation, the journal of The American Heart Association. It shows how frequency of eating fast food per week increases the risk of heart attack - up to 80% if eaten four or more times per week! This is a highly respected medical journal, not some crackpot website.

Western-Style Fast Food Intake and Cardio-Metabolic Risk in an Eastern (Asian) Country.

Conclusion: "Western-style fast food intake is associated with increased risk of developing type 2 diabetes and of chronic heart disease (CHD) mortality in an eastern (Asian) population."

 

* * *

And this from Zero Hedge - want to live to 100? Here's how:

The Centenarian Diet
Via: TermLifeInsurance.org

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lasvegaspersona's picture

since new drugs cost a billion dollars to bring to market your solution of a 5 year wait would result in higher drug prices or fewer new drugs brought to market.

midtowng's picture

to put it into perspective, all I am asking is a return to the situation before 1994.

honestann's picture

Patents are utterly unethical.  Period.  There INHERENTLY CANNOT BE justification to prohibit any human being from applying his understanding of reality, no matter how he obtained that understanding (other than sneaking into a top secret lab and stealing it).  Once a product is on the market, there cannot be an ethical way to stop others from applying knowledge they gained by studying reality, including their product.  Just because someone mails a patent application 2 days, 2 weeks, 2 months or 2 years before someone else CANNOT ethically reduce or eliminate the right of every human being to apply everything they know.

As an aside (if you're about to complain), everyone who creates a product has free access and free use of ALL knowledge and ALL inventions that came before.  So don't cry big alligator tears for all those poor starving inventors.  And as a disclaimer, for most of my life I've been a full-time self-employed inventor.  So I say this even though it may well work against my personal interest (though in my view, honesty is more valuable than artificially enhanced profits).

As an aside, copyright is different.  That is simply a voluntary agreement between the author/seller of a book and the buyer, in which the buyer agrees not to make copies --- but does not agree he won't lend the book to others.

The FACT is, doctors are prevented from giving a great many very effective natural herbs to their patients due to laws, regulations and knowledge the artificial drug companies will trash their careers unless they prescribe their [mostly but not always] vastly inferior poisons.

Matt's picture

How would you promote investment in research and developement in a patent-free world? Would all research have to be publicly funded?

You want to make a better widget, so you spend $100 million on research, then you make 100 million widgets at a cost of $1 a piece, so your total per-unit cost is $2.

I take your design and I make 100 million widgets at $1 per piece cost, and I sell them for $1.50 per widget, less than your cost per unit. My widget is identical to yours, since I just copied it exactly. Now you go bankrupt and I make all the money.

honestann's picture

How do I promote research and development?  Are you serious?  Did you not read that I've spent my entire life performing research and development on my own dime?  And without resorting to fraudulant mechanisms to prevent competitors from competing with the products I developed?

You mention an absurdly limited portion of a complete situation, then pretend what you mention is the entirety of reality.  The fact is, reality and human behavior (if unconstrained) are enormously rich and dynamic.  In an "anything goes" environment, the quantity, quality and variety of innovation would absolutely blow your mind.  Without the manipulations imposed by government and made possible FOR THE BENEFIT OF LARGE CORPORATIONS by government, most humans would be living elsewhere in this solar system by now, and possibly on our way beyond this solar system.  And our lives would be fabulously better in unlimited ways.

That anyone today can even IMAGINE giving extra powers to large corprations (to limit and thwart competition) somehow furthers innovation... is stunning.  It shows how narrow human minds can be.

I am sure you believe what you're saying, but please take a look at your comment and consider how many other elements come into play in innovation.  Just to start, to take the simplest and most obvious fact, consider this.  If you put something new on the market, it takes time for others to develop, manufacture and introduce their product on the market.  By that time, since you have the most experience with your field/product (your "new invention"), you can often be ready to introduce your "next generation" offering, keeping you in the lead.  Furthermore, you are already recognized as the leader in whatever new field or market you created, and will retain a significant following simply because of that fact (your loyal customers will not abandon you, if you treated them well).

Who do you think can tie up "little guys" in patent court if they wish, on TOTALLY bogus claims?  That's right --- the big guys.  It doesn't even matter if they know they have no case... they will slow you down, suck all your money from product development to lawyers, and eventually drain you dry.  ANY legal structure, whether patents or otherwise, assures innovation is KILLED or SLOWED.  And that's a fact.

If you want to live the good life in a clean, comfortable futuristic world... leave everyone ALONE.  Stop giving the predators mechanisms to stop us, slow us down, thwart us, drain our resources.

However, all the above should be irrelevant.  It is utterly and inherently unethical and immoral to prevent a human being from applying his knowledge to support his life.  Think about what you are actually saying!  Your mind is your core, crucial, fundamental tool.  Your mind is what tells your hands, feet and limbs what to do, how to produce, how to survive, how to live.  To claim that you or anyone else (including a pack of predators DBA "government" or some large "corporation") has any right to PREVENT any individual from living his life by THE central, fundamental means of survival (exercizing his mind, and acting upon it), is advocacy of absolute, complete, utter slavery and totalitarianism.  To say a human cannot "see, understand, produce" and then enjoy/benefit-from the consequences of his thought and action is a most VILE EVIL.  On the face of it.

Anyone who claims that "arriving at the patent office 5 minutes later", or "having your patent application randomly be lower on the stack of incoming mail" somehow creates anything remotely like a legitimate, justifiable excuse to DESTROY YOU, is absurd.  And yes, it is quite possible you will be destroyed.  A great many inventors invest "everything" to develop and introduce their gizmo.  By preventing them from taking advantage of what they've invented and developed, you are destroying [some of] them, and definitely greatly harming them.  And why?  Because someone else was also working on a similar advancement or device?  That is some reason to destroy one and give exclusivity to the other?  Do you really believe such nonsense when you sit down and think carefully about the issue?  Really?  I certainly hope not.

The fact is, patents cannot be ethical for the reasons I mentioned.  The fact that patents also greatly hold back human advancement is interesting and perhaps important, but the real issue is simple.  People have a 100% right to observe reality, reflect on the nature of reality, invent new configurations of reality that have beneficial properties or aspects, and take actions to produce products based upon that most natural of all human activities --- productive activity.

PS:  I won't even mention the cases I know about personally where large corporations have the government unilaterally "loose" or "close" or "abandon" patent applications made by small fry.  What you do by supporting patents is to assure predators rule earth forever.

Matt's picture

Is your solution to the problem of copycats, that if you keep your knowledge secret long enough, you can bring your product to market before a competitor, so you can recoup your R&D costs?

It seems to me that a large part of your complaint with patents have more to do with corruption within a central authority than with allowing the inventor a reasonable head-start on bringing his product to market. 

Perhaps intellectual property should be registered in a more open and public manner. I don't believe any intellectual property rights, patent or copyright, should be allowed to be someone's exclusive right indefinitly; after a reasonable amount of time, most intellectual property should become commonly available for anyone to use.

By submitting online, all submissions can have a Universal Timecode Stamp, to prevent selective shuffling to favor one application over another.

honestann's picture

No.  I refuse to quibble about HOW we mistreat people or HOW we behave in unethical manners.  I said what I meant to say, which is that every human being has an inherent right to operate his brain and move his limbs in productive ways... and is attached to the goods he produced by the nature of reality - in this case causality as applied to human actions.

It simply CANNOT be legitimate for ANY human being to stop ANY human being from having or applying knowledge, performing productive actions, and trading goods he produces with others.

THERE CAN NOT BE ANY LEGITIMATE BARRIERS TO HUMAN KNOWEDGE OR PRODUCTION.

The very nature of a modern productive human being is observation, thought, knowledge and taking productive actions.  To STOP someone is to attempt to KILL them, even if they don't die every time (due to savings or charity or other factors).  The way humans survive is to COMPREHEND REALITY and PRODUCE.  It simply CANNOT be ethical or legitimate to insert ANY barriers in this process.  I'd say "especially something as arbitrary as who happened to have an idea first", but that too is philosophically, ethically and factually irrelevant.

And it does not matter whether the scumbag trying to impede productive action by others supposedly works for some fictitious entity like a "central authority" or "corporation", or is simply a thug.

As a practical matter, if you make a product that has value, in almost every possible case the only thing competition can do is reduce the price you can charge to reach a certain level of business.  Your products do not become "valueless" just because someone else introduces a product.  And yes, of course you can keep your product development secret if you wish.  Sometimes that is wise, and sometimes you get more bang for your buck by pre-announcing the getting some percentage of buyers to hold onto their pennies and wait until your product becomes available.  That's your choice.

Every single supposed justification for patents is utterly bogus and disingenuous.

Catullus's picture

So higher taxes, more middlemen, more misguided drug regulation, one payor that can't seem to manage a post office, no advertising of what drugs do, ban foods that someone thinks are unhealthy overall with no regard for the individual, co-pays (which are going to turn into scheduling payments that doctors will require, and is itself a pricing mechanism which the left thinks is so evil), and get rid of "bad" doctors which will undoubtably be a terrible measurement based medicine that will be easily rigged.

Yeah, I can't understand why so many Americans say no to this.

How about you make it easier for Americans to save money to purchase the goods and services they want when they want them? Oh, but this may be a major expense that needs to be accounted for? Maybe, just maybe, people will take that into consideration as they live their own lives.

Gromit's picture

Just decide how much we as a society can afford for our healthcare then spend it sensibly.

Dr. Acula's picture

How about I decide how to spend my own money and the socialist masterminds can go jump off a cliff

 

Gromit's picture

It is society's interests to offer BASIC healthcare to everyone who needs it. As much as it can reasonably afford. And pay for it through general taxation.

If you want additional health care of your personal choosing  of course you can buy it yourself.

honestann's picture

If it is in your interest to provide basic healthcare to others, you may do so.

If it is in others interest to provide basic healthcare to others, they may do so.

It is NEVER in my interest to FORCE OTHERS to do anything.

It is NEVER in my interest to be FORCED to do anything.

Get all predatory ideas OUT OF YOUR FREAKING HEAD.

francis_sawyer's picture

Here's francis_sawyer plan to cut healthcare spending:

~~~

1. END ALL FOREIGN WARS ~ let gasoline prices rise, thereby incentivizing human ingenuity to morph towards more physical means to accomplish work

2. END BIG PHARMA ~ thereby getting people OFF the drug treadmill that is the foundation of poor health (or, at minimum, exacerbates it)

3. Fucking dismantle MONSANTO

4. END THE FED ~ who are the facilitators of all of the above

5. BUY LOCAL ~ support your local farmers

~~~

That's just a rough sketch... Add-ons are welcome... 

honestann's picture

Good list.  I wish more people would put your #3 on their list, and understood how horrific the consequences of that company will become in the coming years and decades.  And I do mean horrific.

I would add: end all fictions, including:

predators DBA government
predators DBA corporations
predators DBA central banks

Once stripped of the cover of those fictions, we can treat predators as predators treat others.

Hype Alert's picture

Central planning extraordinaire with the only thing even close to free market restraint would be the co-pays.

belogical's picture

we defintely need to cut medical expenses, but if you chopped the healthcare budgets by even one percent the system would crash. Look around the large hospital admins are up to their eyes in property and debt.

We need a slow transition with things like price disclosure when ever possible and claw backs on iatrogenic heathcare costs, to keep drug companies and doc's honest.

Many hospitals have ventured into alternative care and it works, but it is never instigated because the hospitals can't charge enough. We need effect care to have increases in price, sound silly, but if you get paid less for fixing people you won't do it long

dugorama's picture

health care for H1B but not green cards?  most H1B workers immediately begin applying for green cards... this is the modern form of indentured servitude. I think we should end the H1B visa program with our persistent double digit real unemployment.  why do we need to import new workers?  but anyway, I'm actually in favor of medical care for everyone sharing my water, air and space.  I hardly want outbreaks of disease coming from the kitchen help and tomato pickers just because I have some righteous indignation about their presence on American soil.  If you're human and you're here, we treat your communicable disease.  It's a matter of public health, not "fairness" or "border control".

Bicycle Repairman's picture

I'll congratulate the author presenting a solution that is more thoughtful than  Obamacare, which is a joke.

I do have a lot of criticisms, however and I'll give two.

1.  We need deregulation and free market reform applied to this sector.  Single payer does nothing in this regard.

2.  Medical misadventure (as the British say) is one of the leading causes of death in the US.  A no fault system does nothing to change this situation.  A good health care system must have risk management as a cornerstone.  Bad doctors need to be removed.  Profits must not be placed above safety.

Dr. Acula's picture

>I'll congratulate the author presenting a solution that is more thoughtful

No, it is thoroughly immoral and misguided.

It's immoral because he's advocating theft (tax increase) and assaults against liberty (like banning advertising - an integral part of the market).

It's misguided because his solution isn't subject to market disciplines. He suggests nice-sounding ideas like "With a national standard EMR I could find everything I needed to know with a few mouse clicks", but he isn't willing to sustain the financial losses if such an investment proves to be wasteful.

 

Bicycle Repairman's picture

We mostly agree on the real solution, I suspect.  He did a better job than Obamacare.  A low hurdle to be sure.

icanhasbailout's picture

This article is an illustration of why doctors aren't the best people to implement a health care system. Concepts like "regulatory capture" escape them entirely - even though they damn well should be aware of it and how it's basically impossible to escape it as long as that power is in the hands of a government.

Dr. Acula's picture

>This article is an illustration of why doctors aren't the best people to implement a health care system.

The best person to implement a socialist health care system is a mobster.

Because it boils down to pointing guns at people to get them to transfer property and perform services in ways that they wouldn't choose.

 

paint it red call it hell's picture

Healthcare is not expensive, it is the domestic purchasing power of the dollar that has suffered . Healthcare costs only reflect the actual rate of domestic dollar devaluation the dollar suffered over the last 30 years. The economic distortion attributable to the "strong dollar policy" and its affects in foreign produced goods manufactured at slave wages in third world economies.  Healthcare is one thing that could not be outsourced to foreign producers making it the one accurate gauge of devaluation of the dollar.. A caesarian section hospital billing was $1500 in 1980, it is presently on the insurance pay schedule at about 17,000$. What changed the procedure, the staffing required, the facilities, the expertise?  Gasolene has increased by a factor of 3 since 1980 while the Caesarian section went up over 10 fold. NO, the value of the dollar changed along with the reduced value of basically frozen domestic wages.

 Socialized health care is not the solution to health care costs, it is the bill of goods presently being sold as a solution to a prior bill of goods that was thoroughly sold, "King Dollar" as Kudlow would say.

Count de Money's picture

There is absolutely no price transpanrency in health care and that's part of the problem.

Most people don't even know what their care costs because they don't have to pay it. Either the government or an insurance company pays. There is a "list" price and then there's the price the hospital and doctor will accept. The latter is often a small fraction of the former.

honestann's picture

I watched this happen, so I know it is true.  I was with a wife and husband when they picked up the EXACT same prescription (same medication, same quantity, same dose) at the pharmacy.  The wife had insurance, and her copay was $35.  The husband had no insurance, and the full price was $15.

Anyone who buys conventional health insurance in the USSA is completely off their rocker stupid.

I do, however, consider high-deductable "catastrophic care" insurance to be "plausible" on the surface.  But I don't have it, so it too might be bogus in some not inherently obvious ways.

lasvegaspersona's picture

utter bullshit

in the USA Medicare system and by extension MOST insurances pay specialists and primary care doc close to the exact amount!!!!!!

If a primary care doc does a level 4 service and a specialist does the same service level they are both paid for that service level.

I stopped reding after that 100% error.

I'll go back and mine for more smelly nuggets now that I have alerted you to the the fact that this guy is guessing at best. I have practiced in the USA for 40 plus years, what this guy says was NEVER true (maybe before Medicare (1965)). OH yeah a huge tax in the first paragraph too....this guy is just another lib who has all the answers for what to do with your money. get real....there are solutions that involve more patient control of the health care dollar but I doubt this guy could ever find them.

Totentänzerlied's picture

I love it when the health nuts come out of the woodwork, from your mouths to god's ear, assholes. Show me a double-blind peer-reviewed study of your magical cure-all diet with a sample size of at least 2,000 people tracked over 5 years, no self-report bullshit, control for all ingested substances including supplements, chewing gum, tap water, and air, and then we'll talk about how your soya is the miracle food that will let you reach 100 (because longevity is all that matters, right? Especially in a country with already top-heavy demographics which will only become more so in the next 30 years, nope living longer is the prime directive, even if at's the expense of your kids, grandkids, and great-grandkids, fucking scum).

Yes, give us different laws to replace the new laws which replaced the old laws which replaced the older laws. That should work nicely.

alien-IQ's picture

Luck of the genetic lottery is the only certainty of good health.

Some people can eat anything and everything in sight and not gain a pound. Others can't even look at a picture of a steak without putting on 5 pounds. It is what it is.

honestann's picture

Grains of truth, but not true.

Sentence #1:  Great genes is very helpful, but does not eliminate accidents and "outliers".  Therefore, please at least remove the word "certainty".

Sentence #2:  True, but omits the fact that people CAN, and some DO, control their diet to match their genetics and proclivities.

NEOSERF's picture

Some problems as people have noted but by and large he is correct.  Would add that anyone with a net liquid wealth of $1M or more is not allowed in Medicare.  Same with Senators.  Governments can be helpful to set standards and in the case of EMR, it would be good for someone to step in pick a winner and be done with it...all these competing systems add up to nothing but a country full of databases inaccessible to everyone else.  End of life care has to be addressed.  If you have the money to pour into staying alive in the last few years of your life, those in your immediate family are the only ones that will benefit.  Give a $50K inflation adjusted threshold after 80 year old limit and the rest is up to you,your heirs and your reverse mortgage company.

Count de Money's picture

OK, I'll just make my assets illiquid. Like put them into real estate.

You come up with a system, I'll figure out how to game it.

i love cholas's picture

Funny how all the fat ass states are the ones who oppose socialized healthcare and probably the ones sucking the system dry.

Catullus's picture

You know what would be awesome, if we could create insurance where we didn't have to cover unhealthy fat people. Oh wait, we did. But those are now "preexisting conditions" that have to be covered.

MJ's picture

"1. Immediately introduce national healthcare for all Americans ( and ONLY American citizens and H1B visa holders ) which will be paid for by an immediate TAX INCREASE."

FRAT.  That's where I stopped reading. 

"Give me (him, her, it, ect.) more power and we can do better."  Heard it before.  I'll pass, thanks.

FedBunny's picture

Perhaps there was a day when any nurse could remove impacted earwax, but there is no way on Earth that I would let some teenager just off the plane from the Phillipines near my ears. The removal of impacted earwax is a delicate procedure that can cause permanent deafness if done improperly. Moreover, hearing loss may not be due to earwax accumulation alone, so follow-up testing may be required. Charles Hugh Smith is a drug-addled old hippie who proffers dangerous advice. If your hearing is impaired for any reason and safe home procedures do not work, the prudent thing to do is see a specialist, they exist for a reason.

alien-IQ's picture

Wouldn't cutting health care spending by 50% also cut health care profits by at least that much?

I'm not saying that's a bad thing...I'm just saying...it's a thing.

haskelslocal's picture

All sounds great but.. What about number 10?

10. Eliminate health insurance companies.....

I Just read that Aetna, the third-biggest U.S. health plan, agreed to buy Coventry Health Care for about $5.6 billion to increase its share of government business in Medicaid/Medicare.

Talk about TBTF.

These posts are great ideas perhaps but it seems, so sadly, just an illusion of truth.

Eat well my friends.

Lore's picture

"9. Get rid of fraud and abuse - for real."

That's so sweet.

honestann's picture

Right.  I suppose we'll get predators DBA government to take care of that, right?  Oh, wait!  They are the ones who sponsor most fraud and abuse --- for real.

You're right.  That's so sweet... as in "mercury-laced high-fructose corn syrup" sweet.

diogeneslaertius's picture

IVE GOT SOMETHING TO SAY:

ITS BETTER TO BURN OUT THAN TO FADE AWAY!

 

(happy halloween ladies)

diogeneslaertius's picture

dont eat poison? but 2+2=5... i dont even...

diogeneslaertius's picture

immediately introduce not eating and living in poison (food, ideas, or otherwise)

Piranhanoia's picture

Isn't it predictable when someone trying to help another person is burned for their compassion and intelligence.  Beat up the guy trying to save your life.  That will work out well.

Dr. Acula's picture

>someone trying to help

The offered "help" includes "increasing taxes", a euphemism for threatening to shoot people or put them in cages for not coughing up protection money. And there are like 99 more "helpful" ideas.

No thanks.

Maybe he can let the free market test some of his ideas (at least the non-violent ones). If they are "helpful", then he'll reap financial profits. But without facing market disciplines, we'll never know.

 

SmoothCoolSmoke's picture

So why does a hip replacement cost $40 K in the USA and $10 K in a state of the art Singapore hospital, work performed by a US trained doctor?  Why, you free-market freaks?  Why?  One more question....why?

Dr. Acula's picture

Sorry, I don't know the answer. I don't know enough about that business.

Maybe you can answer, why does a bottle of water cost $1 in grocery store and $5 in a restaurant and $100 in the desert?

And why do these even questions matter? If you don't want something, don't pay for it. If you can't sell something, lower your price or give up.

 

Matt's picture

Is it a world-renowned clinic that only does hip replacements? You can make more profit with lower margins, higher volumes if you specialize in specific treatments and actively advertise worldwide for your services. Just my guess.

They may also have greater protection against malpractise suits there (cheaper insurance, lower limits on the maximum you can be awarded, etc).

They may also have US trained doctors, and lots of locally trained nurses and technicians that make much lower wages. 

Dr. Gonzo's picture

...But we can't outlaw  the poisonous food making everyone sick because this is America and it's a free country and the people are all free and allowed to put whatever they want into their bodies...Oh wait. Nevermind.  

JR's picture

It is unethical and disingenuous to use the issue of Medicare as a government dependency program or soaring healthcare costs and implications of America as the welfare state without the accompanying truth of illegal immigration, the Obama giveaways and the incredible burden that immigration places on the system.

Art Cashin (On the New Normal's New Populism: 165 Million as State Dependents?) and Smith both leave out the incredible impact of illegal immigration and the legal immigration of a welfare class on the American system, regardless the criminality of the current healthcare industry; these people are legal welfare; they are brought in as welfare and immediately given supplemental government support of all kinds, creating a tremendous burden on Medicare/Medicaid and healthcare costs, HUD and housing, SNAP and IRS child credits, transportation and roads, education and schools, crime and prisons, wages and standard of living…

People need to understand that the non-producer sector of society is growing unbelievably due to immigration, not only to the yearly entry of millions into the country, but also due to higher immigrant births than the US average, flooding the healthcare/welfare system and the school population, school lunch programs and the need for language classes…

It’s time to stop making these points, that “the majority uses its voting power to demand government services from taxpayers” while attempting to tweak healthcare costs, without recognizing this elephant in the room. Why are Cashin and Smith avoiding this major catalyst to America’s dependency status, never even mentioning that one of the biggest burdens that producers in America have is the increased immigration of a welfare-dependent lower class brought in through open borders – of Mexican women with their children entering the United States to go directly onto welfare?

And, now, Obama has a program whereby illegal entrants don’t even need pretend to be legal – pay a few bucks and you’re in.

They have one attractive feature to the welfare-state promoters, of course: they vote Democrat.

Dr. Acula's picture

>People need to understand that the non-producer sector of society is growing unbelievably due to immigration, not only to the yearly entry of millions into the country, but also due to higher immigrant births than the US average, flooding the healthcare/welfare system and the school population, school lunch programs and the need for language classes…

Most of the immigrants I know work their asses off, flooding the economy with cheap produce and cheap services like landscaping.

And if they are helping to collapse the socialist programs, then I hope even more immigrants come.