Sunday, November 25, 2018

What Is "Kicking And Screaming, On A Sunday"

h/t Silicon Graybeard

I'll take "How Did Aesop Get Goat-roped Into Posting On A Four Day Weekend" for $1000, Alex.

From SiG:
The impression we get is that we're in a wolves' den of terrible free market forces where providers charge whatever they want and kill off their patients (the two don't seem to go together).  The problem is we aren't in a free market for medical care, with very few exceptions.  We have a bastardized system where the people who pay for the product aren't the ones most affected by it.   Healthcare is paid for by brokers (insurance companies) who skim off a percentage for themselves.  People paying for that insurance pay not just for coverages they want and need, but they pay for many others because lobbyists get congress to mandate all insurance plans cover their favorite expenses; everything from sex change treatments to addiction treatments to other psychological treatments.  Devoted teetotalers are required to pay for addiction treatment coverage.  Families beyond the child bearing years or with no desire or interest in having children pay for maternity coverage. 

Medical costs are scary.  One of the reasons they're so scary are the market distortions we see throughout the medical world. 
I have to believe free market reforms would help immensely, mainly because there's a handful of places where free market principles are already working.  In his usual, bombastic style, Denninger talks about some of this at Market Ticker.
When it comes to surgeries (Hospital Part "A" stuff) may I point to The Surgery Center of Oklahoma which routinely, even when it has to buy supplies and drugs at monopolist prices which are 100-500% or more of a market price, manages to undercut the local hospital in your town by that very same 80% I cited as necessary?  Were they able to buy supplies and drugs at market prices it would likely be 90%.  Oh, and you're one twentieth as likely to acquire an infection in said surgery center as your local hospital because they can't bill you for the cost of fixing their own mistakes and as a result they're far more-careful than your local hospital is.

Deninger, as usual when he gets outside his lane, is an idiot.

Nosocomial (hospital-acquired) infections are not billable to the patient nor the insurer, they are a liability assumed by the hospital/provider that caused them. Any other approach goes by the quaint legal term "fraud".

They've only beaten this into providers' heads for something like a decade or two, which is why doctors and hospitals are death on things like ordering indwelling urinary catheters, which are virtually guaranteed to cause the patient a UTI if left in long enough. It's the same reason leaving sponges or instruments inside people in surgery is an own goal: the doctor and hospital eat the cost of all subsequent care for the sequellae of that little foul-up.

And surgery centers are rightfully regarded both within the biz and outside it as the bounty hunters of the medical world, because they cut costs by cutting corners on patient safety, and hiring itinerant staff moonlighting from other jobs. If anything goes dreadfully wrong, they ship their mistakes to real hospitals to fix. No wonder they can undercut costs, because they've outsourced everything but the procedure itself; God help you if anything goes sideways, because they can't handle that, by design. Accidentally punctured a lung while doing a boob job? Ship 'em to the ER, then the real hospital OR, to sew up that "Oopsie". And no, they don't include that in their annual statement of average procedure costs. Ask me how I know.

Go into a pissy-smelling elder-care lash-up, and realize that's the business model for the surgical center.

There's also the obvious: surgical centers are virtual medical drive-thrus: In and out, same day. People in hospital are there for days and days. Getting an infection isn't from lack of circumspect care (you @$$h*le!), it's from constant exposure to everything and everyone in the building, and the fact that, unlike the surgical center, your only time there isn't in the prep/operating room/recovery areas, but rather in areas open to everyone, and their families, including their coughing uncle and snot-nosed kids, startingin the main lobby. Anyone wants to argue for banning all visitors from hospitals on medical grounds forever except expectant fathers in full surgical scrub, and I'll sign your petition, buy your newsletter, and march in your parade; but let's stop acting like that's the hospital's fault. If we told people there was a "No Visitors" policy, they'd shit kittens, make YouTube videos, and write Congress to "Stop the Nazis!!!".

Deninger has his moments, virtually exclusively on financial items.
If he bothered to learn WTF he was talking about WRT health care, he might rise to the level of only bloviatingly inept, instead of completely ridiculous.

As for the health care market, if you aren't paying for your care out of pocket, you're not the consumer. You're just a guest at the table, exactly like the person who goes to a wedding reception. Your input may be noted, but the person paying the caterer's bill decides what's on the menu.

You haven't had a free market in health care since before nearly anyone reading this was born, i.e. the 1930s. Your first clue should be that you haven't seen a doctor make a house call in 50 years, because no one's paying for that: you don't want to, and the insurance won't cover it. So unless you live in a mansion and pay cash, you don't get that anymore.

SiG is also right about government involvement driving costs up, but barking up the wrong tree if you think the money is what's doing it. That's like trying to figure out how the car is running by sniffing the tailpipe, instead of looking under the hood.

That model is correct for college tuition, (which, IIRC, has been a tenfold increase over GDP growth, not a 4-fold one), but that's because colleges control tuition. The feds just pay it all at full rate, hence the move to make student loans for worthless degrees non-dischargeable through bankruptcy. The feds and colleges would go bankrupt, as they need to.

But with healthcare, the thing driving up costs isn't the availability of government money, it's the availability of "coverage", to a vastly wide Mississippi River of recipients, while forcing providers to accept literal pennies on the dollar in federal compensation.

The average reimbursement for an ER visit to doctors is something like 2¢ per dollar of billed cost, both to the doctor and the hospital.

{Welcome to the other half (besides covering uninsured/homeless/illegal alien patients) of why your Tylenol was billed at $54@. They bill $54, they get $1 from the government, which covers the pill, the pharmacist, the pharmaceutical supply stock, the pharmacy tech, and the nurse.
My average is around $40/hr, so if it takes me one minute to read the order, get the pill, bring it and some water to you, and watch you swallow it, I've already spent 67¢ of that dollar, before we even get to what the pharmacist makes per his/her minute for verifying you weren't allergic to it and that the dosage and form are correct, and the tech for restocking the machine every shift, let alone the cost of the actual pill (1¢-9¢@, unless they expired and we had to throw some out). If the form ordered needed to be changed, because you can't swallow pills, we're already in the hole, financially. And that's just one aspect of the most basic element of care.}

Imagine if the federal government offered hunger insurance that was like Medicare. In return for no premiums from you, the government issues you a card good for a meal. So you go to McDonald's for the Big Mac Combo, and Uncle pays Mickey D's 12¢ for the Big Mac, fries, and drink.

So, you tell me: how long will Ronald and his minions stay in business, before we even get to paying order-taking flunkies $15/hr to screw up a cash register order with pictures of the food where number keys used to go??

This is also why coding is a medical thing, because if I, the doctor, can find a way to charge for every single thing in a Manhattan-phone book sized list of options, I can manage to squeak out a living, after hiring the coding clerk, an accountant, a lawyer, and two people to prepare the invoices in the format of every different insurance company in existence, simply by ringing you up for everything except the golf pencil you used to fill out the seventeen-page health and insurance questionnaire when you walked into my office. (Government forms and payment being the worst offender there.)

This is the point where the Big Mac would be one thing, even with the bun, but the special sauce, lettuce, pickles, and onions would be billed separately.

See if you can figure out why I personally pay for simple services out of pocket, and refuse to carry anything but a catastrophic illness policy. I get the cash price with my PMD, and I get my prescriptions generic on the local pharmacy's low-cost plan, for about $3.33/mo, which is cheaper than my co-pay was with gold-plated Hollywood movie industry Blue Cross.

The government doing the care at all is what fornicated the system up, and pooch-screwed your costs, while simultaneously requiring you to pay for unwanted things mentioned, as part of insurance companies' Faustian bargain with your congressweasels.

Government poisons everything it touches, like it was a wasp with VX venom.
True x1000 with health care.
Write it on your hand in case you forget.

And if you figured out (correctly) that in response for having to virtually give away Big Mac Combos to everyone disabled or over 62 with a government Meal Card, McDonald's would immediately raise the price for the same combo to $300, so that they would not only get their actual $6 from Uncle, but simultaneously screw everyone under 62 by forcing them to pay full freight, I should let you know there's an open supervisory position in the hospital's billing office, and you're over-qualified.

If your rejoinder is that you'd just go to Carl's Jr. or Burger King, be advised that they're on the same program, and for you really snotty ones, Uncle Sam has also made hamburger and condiments prescription items, and banned hamburger buns, home barbeques and George Foreman grills.

That's the medical system you woke up to five minutes after FDR got done screwing with wages and compensation starting during WWII, and then LBJ invented Medicare to troll for more of the senior citizen vote starting in 1966.

Nota bene that Baby Boomers couldn't vote on anything until 1967, at the earliest.

"Greatest Generation" my ass.
Greatest shuck-and-jive con artists, chiselers, and math-impaired gullible goofballs ever burped onto humanity, more like.

Who else would've voted for FDR four effing times?


Bear Claw Chris Lapp said...

Thanks for your insight more valuable than you know. In your opinion would competition across state lines for the insurance help to reduce costs? I have always believed this but do not know for sure.

Aesop said...

It would help somewhat, but you'd mainly have 50 different insurance bureaucracies getting replaced by one monstrous one in D.C.

Deregulate what they offer and where, without multiplying bureaucracy, and simply check the fraud, and you'll get actual market competition, but by definition, any problems you have will instantly end up in federal court, because crossing state lines.

Trading one bureaucrat 3000 miles away for 3000 bureaucrats 1 mile away never works, in either direction it's tried.

A better answer is to make plans cafeteria-style: get what you want, pay for what you take. I'm pretty sure I'm not going to have any babies, need a mammogram, need psychiatric help, or abuse anything, so I'll skip those, thanks.

It's the same way you could get cable bills down to $10/mo.: stop forcing everyone to subsidize channels 12 people watch, and divide the cost of the ones everyone does by X-million subscribers.

MSNBC and Bravo would cost $5k/month, and no one would ever see it, and ESPN would shrink to one channel, maybe two, and actually have to cover sports events instead of talk politics. You wouldn't need ratings, because you'd know how many people were paying for what, by looking at what they ordered. Easy-peasey.

Do that with medical care, and you'd see what people were getting, and the specialty choices of med school grads would sort themselves out, because there'd be a million family practice and internal medicine openings, and the neurosurgeons and cardio-thoracic specialties would have the top 0.1% of surgical residents to pick from. Prostate cancer would get the same attention as breast cancer, because demographics rather than what's the trendy PC shi-shi hot topic would be the deciding vote. HIV/Aids would become the fractional percentage of the national debate it always should have been, and the people driving that bus (figuratively and literally) would become a self-limiting set.

The first revolution in medicine, which is when it became modern, was when statistical analysis drove care decisions.
The second one will be as well.

Health insurance only promotes paying your premiums.
Anything else is of secondary or tertiary importance, if it enters in at all.

Badger said...

Now that you've picked the bones, you deserve to enjoy a nice bowl of turkey soup. Happy 4-day'er, sorta. :)

Eaton Rapids Joe said...

I have a friend who needed a couple of new knees. He is a slumlord and had the skimpiest possible Act-of-God health insurance policy he could find. He went shopping by visiting three medical facilities to get quotes.

They were unable to produce quotes because the software was designed to bill after the fact. They were unable to tell him what they charged for one of the most common surgeries they performed.

Pretty hard to get your arms around costs, even if you wanted to, if you cannot explicitly look at your cost structure. Basically, the accounting side of the business is driving down the freeway by looking in the rearview mirror.

The Gray Man said...

Not only do providers eat the cost of fixing their own mistakes, but surgeons are often only paid for X number of days of follow-up care post-op, oftentimes regardless of how long the patient actually requires follow-up care. And the pay for follow-up care isn't really that much compared to what most people think it would be.

The Gray Man said...

"As for the healthcare market, if you're not paying for your care out of pocket, you're not the consumer."

If you're not the consumer, and obviously you're not the producer, then what would that make you?

The product.

We sure have a lot of "products" in our ER. Half of our patients show up without their damn ID.

Anonymous said...

I live near a "larger" metropolis (<250,000 people) in flyover country. I am under the age of 50 and a disabled veteran (service connected). I have stayed outside the VA health system since 2007 because, as I went through the Pension and Compensation exam, I asked other veterans from Gulf War I who had injuries more severe than mine, "If you could stay inside the VA for treatment or go outside, which would you do?" The answer was ALWAYS "get the HELL OUT!" So, wifey and I decided that I would receive care on the outside.

I recently attended a "town hall" event at my local VA where the muckity-mucks from the next-state-over that administer my VA came in to talk about all the gee-whiz improvements going on and how they are still trying to hire docs and nurses to fill in all the vacancies. They asked the vets in attendance what their concerns were. Three out of 15 vets spoke about their doc writing an Rx for insulin and the pharmacy not being able to fill the Rx because it wasn't on the formulary. I am diabetic (amongst several other afflictions) so I felt good about our decision to stay outside.

Flip side:

I receive MEDICARE disability coverage. I actually read the EOBs that come in the mail periodically. I just had two MRi's, one in October and one in November. Each was billed at about $2,500.00, and MEDICARE wrote off about $2,100.00 of it. By the time I got my actual bill, it was for about $16.00 out-of-pocket.

The docs/hospitals used to get a larger reimbursement from us because my wifey was working so we had ANTHEM insurance and MEDICARE was a supplemental insurance. My wifey died in 2011 of colon cancer at age 44. That left only MEDICARE coverage for me.

I feel a guilty pleasure about all of the above. With my out-of-pocket medical bills being so low, it allows me to pay the electric bill and such relatively easily. (I live my life frugally.) But, I also know that the docs and their associated facilities have to make money or they will fold up their shingles and go away. I ALWAYS shake my head in disbelief when I read my EOB or bill and see how little reimbursement actually makes it to the providers.

Blue Tile Spook

Anonymous said...

Joe Mama, I'm not a slumlord and we have great insurance through my husband's work, but it doesn't cover one of my specialists. I can't get a quote to save my life on a basic cleaning procedure for my ear from my specialist. Seriously. I'll pay whatever it ends up being because I'm not about to shop around, but even with the code that the nurse was nice enough to provide, they couldn't give me a freaking quote. I'm just going to budget my first born child.

Aesop, you'll be happy to hear that at least one Marine in FDRs time refused to vote for FDR, ever. You'd think a farm boy from Georgia would have voted "D", but my grandfather was smarter than that even then. Understanding the dangers of socialism wasn't hard then, and it isn't hard now, but most people have brains made of lint. Grandpa also didn't appreciate FDRs attempted stacking of the Supreme Court.

Anonymous said...

The thing is, the current system is so screwed up the average person is just utterly fed up with every aspect of it. If something isn't done to "fix" things in the eyes of the general public you're going to get government run healthcare. We can talk market forces, numbers, insurance and socialism until we're blue in the face but unless drastic changes are made which makes medical care far less complicated, far less expensive and far less frustrating to deal with for average Joe and Jill Citizen they will end up agreeing to or even demand the government take over the whole damn thing from top to bottom.

They will. I promise you they will.

Your average man on the street is that fed up with the status quo. They're of the mindset that anything is better than what we have now. They'll come to regret it of course but by then it'll be too late.

Aesop said...

"The thing is, the current system is so screwed up the average person is just utterly fed up with every aspect of it. If something isn't done to "fix" things in the eyes of the general public you're going to get government run healthcare."

You're absolutely right.

This is because people are stupid, and most have the mental capacity of a retarded child unless someone holds their feet to the fire.

And that solution is the sort of reasoning that says "Since I'm blind in one eye, I'll stab the other one out to fix it."

And healthcare is expensive because you're getting Cadillac care. Everyone wants champagne on a beer budget.

Once the government gets involved, healthcare becomes a jobs program for government cronies, and you'll get mule piss care on a champagne budget.

But if you think government can run health care, go to the VA.
Then visit the post office, and the DMV.
Finally, go down to the airport, and look at the fat stupid slobs running TSA checkpoints and groping nuns and five-year old girls.
They'll be your doctors and nurse when Uncle runs everything.

Anonymous said...

The funny thing is, you won't have to worry about what the doctor has to say, unless you're an interpreter with a dozen languages under your belt.

Just look to the UK or Canuckistan, or closer like the VA or local hospital, to see that when you're assigned a Doc, you'll get Habib or Okumbe or Consuelo, because a Doc with a witch-doctor degree from Shitholistan is a lot cheaper, and De'ShaundaLamar got the school slot for being almost able to spell it's name.

Better get to know your local veteranarian to get any real treatment, the kind that actually cures problems instead of pushing pills...

Stealth Spaniel said...

My mother's family-including her-never voted FDR. As Uncle Art used to say, he couldn't go to the shXXXer without hearing Roosevelt on the radio. Great Uncle Ted had zero capacity for speeches from the mount: he simply shot the radio all to hell one Sunday evening. It was 1942, so none of the neighbors even blinked with the sound of gunfire. And my mother had to buy her parents a new radio. We need to get back to those days.....
A lot of this asshole-ism cleans itself up once we start cultural cleansing. Drs. Habib, Okumbe, and Consuelo won't be around to distribute their brand of incompetence and ill favor. People need to start taking charge of their own care. I had 2 new knees this year. First thing I did was interview and investigate orthopedic specialists. I did NOT take my chances on Dr. Wazzhole because he doesn't charge a co-pay. I took tours of hospitals after I choose my physician. I looked at their floors, rooms, and broom closets. The result was I got a super, educated +, surgeon; a terrific hospital; and the A Team of nurses. Everyone knew who I was and what I was looking for. You get what you pay for and what you expect. A 3rd world educated doctor will give you 3rd world medicine.

Roy said...

"...he simply shot the radio all to hell one Sunday evening."

That mind picture has made me smile. I'm sure it was worth the cost of a new radio, and I think I would probably like your Great Uncle Ted.

Roy said...

I said this over at Silicon Greybeard's site and I will say it again here...

Aesop, I work in the healthcare industry, and yours is the best and simplest explanation of why these costs are so out of control that I have seen in a while.

And... The "boomers" constantly get blamed for *everything* that happened in the 60's yet only the earliest boomers could even vote during that time. Yeah, I agree with you. Greatest generation, my ass!

Now, the 70's on the other hand... well, let's not go there.

Unknownsailor said...

I got the banhammer over on Denninger's site for daring to disagree with him.

No great loss.

Oldtimer505 said...

It would seem that you have left out one of the larger medical care costs, LIABILITY INSURANCE and the bottom feeders that goes with it. If you are going to include all the other parasitic costs to the system in a generalized way then make a list of the parasites in the order of impact so the folks that want to make an informed decision can do so to the best of their ability.


Tucanae Services said...

"Nota bene that Baby Boomers couldn't vote on anything until 1967, at the earliest."

Thank you. I have for years pointed out that most of what is the Boomer Gen was not politically viable till 1970. One can attribute a lot of ills to my generation but early postwar political agendas is not one of them.

pyrrhus said...

Denninger's main point is that Medicare/Medicaid are costing well over a trillion/yr above tax collections, and that is exploding upward (another benefit of all those nice "immigrants"), with the system going DOA in the mid '20s..And we know that NYC's employee/retiree healthcare program is 100 billion underfunded, and that is just one city. The whole bureaucratic mess is coming down, and rapidly.

Aesop said...


Liability insurance has added nothing whatsoever to health care costs.

It's added volume to health care patient load, and added fraud as a magnet for scamming patients and colluding providers.

That may have driven up your premiums, but it has no primary effect whatsoever on the actual delivery of healthcare, just on the cost of insurance. Frankly, that's their problem, not mine.

Medicare etc., OTOH, has directly impacted costs, by screwing with reimbursement to actual providers, which induces them to jack prices to recover costs.

Aesop said...


Already noted in a reply awaiting posting over at WRSA.

Deninger on economics is generally reliable, and I have no doubt the whole Ponzi house of cards is going to explode, bigly. It was the sloppy nonsense on healthcare per se that pissed me off.

Genesis said...


I've seen more of this than I can count, and posted a long reply on another blog on the same point.

BTW, here's the proposed legislation that would fix it, along with a link at the bottom to what implementation would look like:

Aesop said...

Deck chairs, Karl, and kicking the can.
You can stop a lot of the fraud, even the illegality and anti-market features, maybe even patch it up for another generation.

But the fundamental problem is government paying for care in the first place, and telling people you can get $1 out for paying 20¢ in, because the next guy will pay for you. We're running out of "next guys"; the last Boomer retires in 2030, four years after you expect it to blow apart. Just like Social Security. This is not coincidental.

A Ponzi scheme will always be a Ponzi scheme.

It's one thing to nick people up front for a point or two, and tell them it's to pay for the uninsured and impoverished elderly, and they'll never see it again.

It's another thing when you tell everyone that it'll cover everyone, for any value of everyone, for ever and ever, and the bills will never increase.

Everyone floats the idea of upping the eligibility for SS; how come no one advocates pushing Medicare off until you hit 75?
Because 85% of folks will be dead by then, and everybody can see the ace up your sleeve.

James said...

Aesop,while a side note in the medical fiasco in many ways am putting together IFAK kits for folks for Christmas,they may or may not do it if I push and thus just gonna do it as I actually like these folks and though at times very busy with family ect. they are also at times lazy.I am building out with 2 tourniquets/sets of chest seals and have added a couple of Mylar blankets and a head light if needed.Your repost of the IFAK inspired me to check mine and updated with Cat-7's for less confusion in trying times,I also got a Cat -7 for practice and I WHILE get them to spend time with the stuff/watch the basic videos,and,perhaps inspire em to learn more,either way,hopefully never needed but if they are will buy em some needed time in a emergency.

As for health care have insurance at moment and just too busy to get into it with pols ect.

I will say when my state went interstate competition with car insurance my rates loweredconsiderably,would that work for health care,I have no idea but we need to make some changes.

Will said...

No. Just no. Hospital acquired infections costs of care are not borne by the hospitals in Texas. I dont know about anywhere else but they damn sure are not here. I have considerable experience with the issue and I can tell you that they absolutely bill for such care and expect payment for same. You cannot find a physician who will testify that acquiring MRSA surgery is a violation of the standard of care-without that finding and the threat of a lawsuit based on it hospitals will not willingly shoulder those costs. I say this as a Board Certified Personal Injury Trial Attorney with over 25 years in the field.

Aesop said...

MRSA requires that the patient be tested for colonization beforehand, because 30% of the population carries SA, and 1.5% has asymptomatic MRSA colonization just walking around, before they go to surgery.
Unless they were tested prior to admission, you have no way to know whether that's a factor or not.

So you've cherry-picked your data set before presenting your case.
Nice try, counselor.

By definition, an infection caused by the hospital is the hospital's problem, legally and ethically. You've picked one of the items where that information has to be established.

Either hire better medico-legal consultants, or fully disclose that you knew this before you posted that.

Information to the exact contrary regarding things like CAUTIs is standard of care here, and nationally, per JCAHO, every one of twenty hospitals I've worked in during that same period of time, and every Risk Management lecture ever attended.

Last I checked, Texas was still part of the U.S.
And fraud is still fraud.

Deter Naturalist said...

I, too, got banned by Denninger for daring to point out that his prescription for med service issues (enforce anti-trust and bust the entire cartel) would immediately destroy 20% of the good-paying jobs in the USA and plunge the nation into a deep depression.

With his recent post, he finally agreed with me. I never said this was avoidable; since the bond market low of 1981 the desire for bonds (an intangible asset) made borrowing-and-spending a wealth creation machine: every dollar borrowed and spent created at least a dollar in GDP plus a second dollar, an asset/receivable, went onto the bondholder's balance sheet. What was not to LOVE??!!

Congress spent like a drunken sailor on shore leave in a brothel while holding a no-limit MasterCard. One of the great beneficiaries of this was the Medical Services Cartel, and services (and employment) grew like a metastatic cancer sporting 90 chromosomes. When money floods into a market, demand skyrockets. Employment skyrockets. New ways to "consume" that money skyrocket. A chicken in every pot became two new knees and a prosthetic hip in every senior, and ain't $40k to treat Hep C dandy?

The bond bull market ended two years ago. As interest rates rise (signalling a waning of trust for the face value of an ocean of IOU's) they'll eventually hit a Minksy Moment and bond prices (and the wealth they represent) will collapse. Borrow-to-spend will end, as tax receipts crater.

Hardest hit will be those industries grown entirely addicted to government spending (or other borrowed money.) I forecast that medical services provision will drop by 75% (as will employment in that sector.) Soon will be the best time ever to be healthy (and not need a doctor or drug.)

Deter Naturalist said...

Anyone who thinks thoughtful change will come to this morass is too short for the ride.

Change will come when Medicare/Medicaid collapse, covering indigent care bankrupts one hospital after another and people are forced to find real, market alternatives. Reportedly 80% of Venezuelans are malnourished now, but that means 20% are not.

When hardship arrives in the USA courtesy of the idiotic policies that held sway for a lifetime, those who maintain the ability to pay for medical services will retain access to them. This might be a very small fraction of people, but at least it should be a better system than today's where the productive are being crushed by costs of the unproductive and those with savings are threatened by bankruptcy due to the burden of the indigent getting Cadillac Care.

Rollory said...

Thank you for posting this.

I have, on occasion, repeated Denninger's arguments to various people, because they seemed perfectly believable to me.

I will now stop doing that.

Chris said...

Well, mentioning Texas and healthcare, my dad is a veteran who did healthcare in the Air Force and later was a Medicare/Medicaid surveyor and then did CLIA in Texas.
He didn't fuck around and he happened to be seated in theology class next to the guy who first burned his draft card. My dad served. When stationed at Cocoa Beach in FL, he was part of the team that dealt with the three astronauts who burned alive in the pure oxygen test capsule (pure oxygen! WTF!) There were quite a few others who died the same way that didn't get reported.
OK, self-serving endorsement here. You will like to see some of the unbelievable crap he ran into in rural West Texas
plus of course a little about me and one nightmare I had in healthcare.