Tuesday, November 27, 2018

The Butthurt, It Burns

I see we've garnered a response at WRSA from Deninger to what I posted Sunday.
I'm sure he's blogged it himself, but I don't put replies on page A39, or reflex banhammer everyone who disagrees with me, even here, so here you go:

"Well, the amusing part of the “rebuttal” that has been spewed all over DOZENS of websites now (identical text, so can we call it spam?) is that it’s nonsense. Why do I suspect the author is likely someone who could find themselves on the wrong end of things should the government suddenly decide the law matters once again? 
First, the claim that hospitals don’t bill people for their own errors of both execution and judgement? Horsecrap. Illegal, yes, fraud sure, but why does anyone care? They’re sure as hell not afraid of being indicted. Who went to jail for all the fraud prior to the 08 blowup in housing when it all came apart? Nobody. Who has gone to jail for the DAILY violations of 15 USC Chapter 1 which, I remind you, the medscam and insurance firms TWICE went to the USSC claiming exemptions from (under McCarren-Ferguson) and lost BOTH cases? Nobody, ever, period. Those two runs at the USSC happened in the 70s and early 80s and yet here we are nearly FORTY years later and not ONE criminal prosecution under said laws have been brought that I can find a record of. Not ONE. If you think I’m talking out my butt on this or speaking from conjecture you’re wrong — I’ve seen it first-hand in my own family and it nearly killed one of them (she subsequently managed to do herself with booze, but that’s a story for another time.) Fact is they never should have gotten the scalpel out of the cabinet in the first place given the reality of said person’s condition at the time but you can’t bill the government — or the next poor sop who comes through the door on a stretcher — a half-million bucks when things go *predictably* sideways if you say “no.” 
The math IS what it is. Medicare WAS sound from an actuarial point of view with medical care at 4% of GDP. Social Security is NOT going to collapse — unless they keep raiding the OAS fund for the “D” (disability) scammers, but even then it’s reasonably matched given the tax rate charged, the progressive nature of the benefits and the designed buffering to handle the “pig-in-python” issues with periodic baby booms (and busts.) Oh, and the actual drain on the budget in terms of percentage spend by Social Security starts decreasing (since the boomers start dying) in just a few years. Again, not just by my numbers — by the CBOs as well. 
Medicare, on the other hand, last year spent MORE than Social Security but has a tax rate of less than ONE QUARTER that of FICA. If you think that’ll work out…. no it won’t, and you can’t fix it with a tax increase NOW because of the 30+ years of malfeasance. That’s the math. 
The POLITICS side is that there is utterly no reason other than fraud, felony and scam that medical care is nearly 20% of GDP. It *WAS* 4% and must go back there, NOW — or the entire med system as we know it will collapse, likely taking with it federal, state and local budgets. If you think the government can *add* $1.5 trillion a year to the *existing* deficit run rate in 2024 to keep the scam going you’re flatly out of your mind — and that’s the projected requirement. Right here and now, today, it’s $800 billion — each and every year forward 
Exponents are a bitch when you’re on the wrong end of them. 
In the 1990s I started raising hell about this when I was running my Internet company because the trend was clear as was the exponential progression. To the person above who said I predicted the end date was before the end of Trump’s FIRST term, I challenge you to provide the quote. My original projection in the early 1990s was “30 or so years hence” and being off a couple of years on a 30 year timeline is, in my opinion, pretty damn good when you control ZERO of the variables involved. Further, the article in question isn’t citing “my” guesses on dates at this point IT IS CITING THE CMS TRUSTEES DATE OF EXHAUSTION — which just happens to be approximately in the same place (gee, they can do math too?) 
What I *did* say when Trump was elected (and have continued to) was that markets *never* let you actually hit the wall and that the point at which they throw up and force an issue that is apparent and on the horizon cannot be determined in advance. That is why it has to be fixed NOW — because the odds are quite high that indeed it WILL be before the end of Trump’s first term, not on the math but because the markets will call “BS!” on the entire charade and down it will all come on our heads. 
There ARE solutions. My original article linked to this, which provides one workable path forward. Of course nobody wants to debate that because then all the scams disappear. Fancy that. https://market-ticker.org/akcs-www?post=231949" - KD

Look Karl, stand up and let the clue here smack you in the head:

Are you right that Medicare et al are going tits up in a few years?
Abso-fucking-lutely, to a metaphysical certainty.
You and 5000 other economists can't all be wrong.

The problem is, you want to save that, because you see that impending smoking hole as a bug.
I see it as a feature.
I argued not so much as a speck against that economic premise.

As I explained at WRSA, my quibble wasn't and isn't with your economic math, but with your gross medical ignorance on things outside your lane.
(You may have noticed I don't offer bona fide and bonded investment advice or hypertechnical economic analysis here, for the same reasons.)

Do hospitals commit fraud? I'm sure sometimes they do.
If they do it to you, sue them. That's what makes a horse race.
The point is that suggesting that they can legally commit fraud is nonsensical in the abstract.
No matter how many people commit murder, it doesn't disprove the point that it's against the law. IANAL, but I'm pretty sure that noting something is against the law is the textbook definition of illegal.

The bigger problem is you pointing to imaginary cost savings at surgical centers; having some wee experience in that line, I offered alternative evidence to better judge your counter-factual assertions. You also made recockulous claims that they're more circumspect than hospitals, and tried casting aspersions and some apples-to-pineapples sleight of hand to try to sell that pantload.

Now, I admit, I'm sorry you fucked up that bit of hand-waving, but it's your act, and it's not my fault you couldn't quite pull the rabbit out of the hat.

I'm sorry you have a relative who had a bad medical outcome once; show us on the doll where Big Medicine touched you.

I make no secret of the fact that I make my living within that employment category. (And I've been a patient a time or two myself.)
I don't sell ads or do anything else to suggest any other stream of income.
But having a paltry quarter-century or so of experience at it, and no small amount of horse sense, I don't suffer fools or interlopers gladly. I do treasure them, for the ceaseless bounty they provide me at work, in providing a steady stream of screw-ups that pay my bills, keep a roof over my head, and put food in my refrigerator. But that fiduciary relationship doesn't compromise the medical care I provide, the license I earned to do it, nor require me to patronize and tolerate their bullshit when they think they can tell a one-sided version of "what happened".

In medicalese, we call that a high index of suspicion.
Like cops and lawyers, I assume a non-zero percentage of my clientele routinely lies to me.
Because they do. And because I was born on a Tuesday, but not last Tuesday.

So look mate, you stepped on your dick, because you don't know dick about my biz.
No harm intended in my reply, but that approach on your part isn't going to fly.
Either learn whereof you speak, or skip the parts beyond your ken. And don't get raw with me for pointing out your jangly bits under your cleats. Let alone all but accuse me of criminal conduct because of the industry I work in. That's bush league ad hominem, at the kindest.

You want to save Medicare?
Hey, great. ROWYBS.
Write your congressweasel.
Let me know how that works out for ya. I hear Miss Alzheimer's 2018, Nancy Pelosi, is going to be in charge of that circus next month; that should really help things, doncha think?

I'm waiting for the crash and explosion to follow.
What cannot continue, won't.
It's going to hurt, but therapeutically, much like surgeons cut you to fix you.
The short answer is, government can't dictate the price of something, whether it's oil, medical care, or Big Macs, without shitting in the well, and screwing things up for everyone.
Evidence for that from my side of the argument is everything they've ever touched, forever.
You think differently? It's a free country. Saddle up, Don Quixote; that windmill isn't going anywhere, and you should catch up to it any second. Show it who's boss.

And if you think a surgical center is a better choice, go there. Best wishes.
Sometimes, maybe even a lot of times, some of them even pull off what they do.
But there are trade-offs involved, as always. And please, don't try to tar hospitals at the same time, or think you can gloss over the cons of one care modality while harping on the ad brochure pros exclusively. It's a wee bit more complicated than that in real life, which is why I have to make sure people understand both sides before gaining their informed consent. Sticking your fingers in your ears may work for your peace of mind, but I chose to let people know the things you don't know you don't know. Sorry if that left a mark. No, really.

But hey, maybe cast about, and seek out some subject-matter expertise and insight, from someone, when you're out of your depth, or writing from personal pain, instead of as a dispassionate scribe. I can get fact-free hacktivist yellow journalism from 5000 newspapers, magazines, TV and radio stations; your blog doing that is just the 5001st guy to yell "I am Spartacus!"

Be different: post facts, or at least opinion based on documentable evidence. When you do that, everyone wins. Or so I've been lead to believe.

And my response wasn't "spam".
The word you were grasping for was expertise.
And if my "rebuttal" (which was only aimed at that part of your article, the medical mythos, not the economic part) got posted "dozens" of other places, I'd say, in full self-interested response, that maybe it's because I'm a better proponent of my position than you are of yours.

Or perhaps just better at expressing it. (There's writing software available, man; just saying.)

Either way, you work the financial side of the street, and I'll work the medical side of the street, and both our audiences will be better off when we talk about what we know about.

Because I think we can both agree, I piss more vinegar and crap bigger snark than you do.
I'm not saying it's a superpower, but it is what it is.

You're a big boy. You write your own blog, and post it where literally billions of people can see it. Learn to deal with it if you get off in the weeds. Probably starting with growing skin just a bit thicker.

Best Wishes.


JR said...


I always love your rebuttals and then the subsequent rebuttal to the butthurt response to your rebuttal.

TiredPoorHuddled Masses said...

4 out of 5 doctors recommend Aesop brand Butt Hurt Cream. Guaranteed to cool and soothe. Aesop: We know Assholes.

TiredPoorHuddled Masses said...

When will people learn? ;)

Anonymous said...

Well stated!

As someone who's been on the receiving side of a few medical errors, you know who I blame? Nobody. Doctors aren't perfect. If they were we'd all live forever. You know who I credit for being alive? Doctors, who saved my life on a few occasions. It all evens out.

You know who I blame for the cost explosion of medical care everywhere, and this new triage system we're all in now? (That wait for hip replacement is already here in some urban areas - I had to wait a week for an emergency gallbladder procedure - doctor shortages are REAL). I blame the government for trying to impose costs, and I blame the whole system for making sure people don't want to BECOME doctors anymore, which is causing this shortage.

Hell, my own mother retired early because she couldn't spend enough time on quality care for patients anymore - the S****r system makes sure everyone is overbooked and on a tight timeline, and doctors had best bend over and rush, because that umbrella system is the only way they can practice now.

I watch old shows and hear stories from older relatives about "house calls" and "private rooms" and all of that - that was before LBJ. Quality of care has gone down,, costs have gone up, the only people who COULD be responsible for that are bureaucrats getting in the way, because doctors and nurses are typically not that retarded.

Beautiful rejoinder to that guy. I hope he uses some of that cream.

Anonymous said...

KD writes: To the person above who said I predicted the end date was before the end of Trump's FIRST term, I challenge you to provide the quote.

This was the quote I remembered. Titled "The CERTAIN Destruction Of Our Nation*", https://market-ticker.org/akcs-www?post=231561 written at 2016-10-15 06:00, highlighting and bold in original:

We will _not_ manage to get through the next 10 years at this rate and in fact will not get through the next President's term.

2016-10-15 was before Election Day on November 8, so "next President" refers to Hillary or Trump. https://en.wikipedia.org/wiki/United_States_presidential_election,_2016_timeline

I read "get through" as meaning spending tradeoffs made within the existing federal budget which were qualitatively different from what has happened since 1985. A thwarting of government will. An embarrassing admission of planning failure, that things cannot go on as they have. For example, huge military airplane or ship development programs put on hold.

Anonymous said...

I am Aesop


My Dad had two strokes, TIA's they call it. (2) Doctors said it was because stuff was cutting loose in his brain. I along with my sisters researched it and were skeptical. Pushed for Dr. #3. Before he could speak I told him what we had been told my the other two. He screamed, "Who told you that!" I said, the other two doctors. He asked. "Here!" Yep. He said BS. "This is because like 25% pf all people he has a flap in his heart which over time has collected particles. As the body/heart ages the flap gets weaker thus releasing these particles up to the brain". Boom, had my Doctor. Pissed! Of course, but did we sue the Hospital, No. But I damn well made sure they knew who the two moonbats were. Guess what? They moved on with little notes in their files. Not perfect, but that's the way it is. Imperfect.

Anonymous said...

Public relations agents for the patriot movement said there were 1,000 persons on the line of scrimmage at the Bundy standoff, but the photo showed 100. After this 10X lie went unchallenged, I concluded the patriot political party was willing to lie just as much as the mainstream political parties. None of their promises or projections could be trusted.

Exaggeration is a straw man fallacy. It is consciously knowing the argument fails, so lying to make a different argument which wins. You won't win the trust of the remnant if you exaggerate doom in the hopes of motivating the masses. The oceans will rise 20 feet in 100 years! Sure, right, put a later date on your doomsday sign. In the long-term, it is extremely difficult to snatch a win out of the mouth of an exaggeration lie.

Chris said...

As someone who's been on the receiving side of a few medical errors, you know who I blame? Nobody. Doctors aren't perfect. If they were we'd all live forever. You know who I credit for being alive? Doctors, who saved my life on a few occasions. It all evens out.

Yeah, I really do agree. Absolutely. God have I had some fantastic Drs. and nurses and dentists, you know, the dentists are just as important for healthcare as Drs. People in Mexico and Guatemala have perfect teeth. ALL of them. You can afford dental care there.

BUT, I have also fallen prey to evil Drs. I started having really bad seizures from a head injury 14 years earlier (Complex, Partial/Complex) or what used to be called Grand Mal which is a shitty word for something so complex.
I couldn't work once the seizures started, so I was under Patient Assistance.
Between the Dr. and them, working together, they did their very best to make sure I couldn't ever get at least one med until the day I ran out. Trust me, when you have seizures at a level that can kill you, this is not a fun week! When one company opened a pharmacy in Texas to ship directly to the patients, they tried to force me to send it to them instead. Wanted to keep terrorizing me. Oddly, same crap in Del Rio, Texas. You have no idea how many times they lied to me about faxing the med prescriptions to the company. I called in the waiting room, no fax. Asked the nurse when she came out. Oh yeah we already faxed it. Then they called in a verbal, which has to be followed by a fax with the prescription. The company called me. Somehow the prescription didn't have a patient name! But they did basically win when they actually managed to cut me off my medications for another condition that is eventually fatal. I had to flee for my life to Washington State.

So yeah, most medical staff is OK, even when things go wrong. We all make mistakes.

But being terrorized and then trying to kill me. Nope, I can't forgive that.
I would sue, but in Texas, sometimes people have accidents. Since the last clinic was on the Mexican border, an accident would be pretty likely. Sucks.

Anonymous said...

I totally understand. I'm sorry to hear about your circumstances, but there is a bright side - you're not in the sweltering Texas summers anymore? No, I know, if you'd have preferred to stay in Texas I wish that could have happened for you, but I do try to look for bright sides. Personally I'd love to move to Washington State just to escape the summers here in CA at this point, but jobs and family, you know.

Beastly of your doctors there, though. I have encountered a couple of monster doctors in my lifetime of dealing with them also. In terms of humanity, they're pretty much the dregs. Luckily they've always been in the minority for me, most medical staff are outstanding as you said.

william williams said...

I'm retired MD, with 40 years of hospital experience, and two comments:

95% of doctors are conscientious, hard-working folk, doing their (imperfect) best. 5% or so are unethical creeps, and will lie, cheat and steal if the opportunity arises.

The "best and brightest" candidates these days are increasingly NOT becoming medical doctors. There will always be a small number of talented superdocs, but for many young people, the reward of becoming a merely competent medical practitioner is just not worth the required time and effort. So, look for overall practitioner quality to decline over the coming years. Alas....

waepnedmann said...

I had a good doctor.
When Obamacare was instituted he announced his plans for retirement.
He now teaches and works as a volunteer a day or two a week at a clinic.
I had a PA for awhile that was so terrified of the government due to linking her getting paid to her patient's cholesterol improvement numbers that she was thinking about closing down her office.
I now have a great doc after being on a five-year waiting list.
He told me if he had to do it all over again he would not become an MD.
The paperwork and .gov requirements have him working nights and weekends.
But, you never feel rushed. You have the feeling that you are his only patient.
I cannot say enough good things about him.
As william williams said,"Alas..."