"I didn't say it would be easy. I just said it would be the truth."
Thursday, May 5, 2016
Politics/The Economy: “Dawn In America?”
“Dawn In America?”
by Karl Denninger
"I didn't say it would be easy. I just said it would be the truth."
"I didn't say it would be easy. I just said it would be the truth."
“Is that the sun I see this morning? It might be. Look folks, I don't trust Trump. Then again I don't trust politicians generally, no matter who they are, simply because they have a proven record of lying and yet while their lies are never punished ours are turned into felonies whenever those they empower are asking the questions- including themselves!
So here's the challenge before us: As I've pointed out repeatedly in these pages since 2009 when the health care debate came into the forefront of American politics, and turned into Obamacare, we have only two choices fiscally as a nation:
1. Enforce the law against hospitals, doctors, pharmaceutical firms and those running clinics and diagnostic centers.
2. Our nation will be fiscally and, in all probability politically destroyed.
This is not hyperbole. It is arithmetic. Arguing over other matters when it comes to our political system, until this is addressed, is stupid and serves only to protect those who are robbing you blind- literally. Anyone denying arithmetic is not only a fool they're both a tyrant and a thief.
Let's think this one through. In 1940, entitlement payments, which include everything from disability payments to Social Security to Medicare, amounted to just over 20% of annual government spending in the United States. Today, entitlement spending has swelled to nearly 70% of the annual federal budget. Things are about to get a whole lot more complicated. The 20-year baby boom that took place after World War II is now beginning to result in a retiree boom. For context, Druckenmiller points out that in 2030, the average age of an American citizen will be older than the average age of a resident of Florida today. This demographic trend is going to create an entitlement spending catastrophe. It doesn't have to, and the root of it isn't "entitlement spending", in the main.
Social Security is funded by a "one in 8" tax, basically. That is, about one dollar of every $8 you earn up to a given cap is confiscated before you ever see it. You think it's half that, but it's not because the other half is paid "by your employer" and this fiction is maintained so you don't revolt. However, your offered wage is reduced by that amount- guaranteed.
So let's assume that we have a 2.5:1 ratio as is put forward. That sounds horrifying, except that it's a temporary problem (it lasts 20 years, roughly), and then everyone involved in "causing" it is dead. Further, there will be some that will "file late" for Social Security in an attempt to get more- a strategy that only works if you live a very long time in terms of total funds, and lose their bet because they will die before the break-even is reached. In fact, actuaries don't care if you make this bet because they know that on balance while some will win, some will also lose and it will all even out.
No, the problem here is not the "one in 7.5" tax for Social Security. It is the one in 34 rate assessed for Medicare. To put not too fine a point on it, Medicare and Medicaid (combined) are roughly double the outlay of Social Security and yet they are funded at a rate of less than 1/4 that of Social Security via taxation. Further, Social Security outlays are indexed to alleged inflation, which is intentionally machined to show smaller than real figures, and thus there is a built in depression of Social Security obligations in real terms, especially over long (20, 30, 40+ year) timeframes.
Social Security itself is unlikely to go broke. If it does "run out of money" 30 years hence there will be some reduction in benefits, but remember that even a 1% inflation "miss" against reality over 30 years turns into a 35% reduction in real expense. In other words the "you'll only get 70% of your promised amounts" out of Social Security claims are probably dead wrong; you'll get the entire amount but it will be short in purchasing power by 30%. The disability fund is another matter; that's bankrupt now and politicians have been stealing from the retirement fund for a while to cover it up.
On the other hand Medicare and Medicaid spending is going up at a radical rate compared to inflation, government-stated or not. How bad is this? Fiscal Year 2005, for example, spent a total of $652 billion. Fiscal Year 2015 spent a total of $1,297 billion, or close to a clean double in 10 years.
This was not mostly-centered in Medicare- that is, retirees. Medicaid went from $182 billion to $349 billion, damn close to a double standing alone. In other words it was across-the-board in all age groups served. That's a 7.2% growth rate which far exceeds alleged inflation- inflation allegedly was up 20% over the same 10 years, or an annual rate of about 1.8%. In other words that segment of the economy as spent by the government went up at a rate four times that of general prices.
Need I remind you what happens any time two exponential growth curves have a different growth rate? Go look at my book "Leverage;" there's a damn good reason that this is covered in the front of the book because if you don't understand and deal with it nothing else matters. This, and only this, is the cause of all of the federal debt expansion, pension fund problems both private and public and the detonation that will occur in the federal budget and forward liabilities unless it is stopped and reversed.
Note carefully that we spend as a nation roughly double as a percentage of GDP what other developed, G20 nations spend on health care- and virtually all of those other nations have socialized medical systems. Socialism is always less-efficient than capitalism because there is no reward for innovation in a socialist system; you cannot take market share from someone else since market share is not a function of market success or failure. This, in turn, means we're definitely overpaying by more than twice for medical care; we are in fact probably overpaying by as much as 80% across-the-board.
It is not hard at all to find examples of people being billed 10 or even 100x a price in another nation for a given thing. It is cheaper for me to fly to Narita, Japan, round-trip, and have an MRI done there by more than 50% than the average amount charged for the same scan here in the United States. While you can in some cases get that scan done for a few hundred bucks here they're all $200 or so in Japan, and most people grossly overpay here in the US. Why? Because of various practices that all amount to consumer deception, extortion, price-fixing or all of the above- all acts that are supposed to be crimes.
Let's say you go to the ER "in-network" on your alleged health insurance. While there some doctor sees you. He isn't in your network and you get a bill for hundreds or thousands from him. The hospital administrator should be imprisoned for allowing this along with the doctor who did it; you neither consented to such a bill nor in many cases had any ability to refuse, but the administrator could have required that said doctor be "in network" to be there or if not that he take the same reimbursement rate as if he was. He didn't and thus they both took advantage of your "in extremis" situation to bilk you. That's supposed to be illegal as a matter of general consumer protection yet not one person has gone to prison for it- ever- that I can find a record of.
Drug companies set prices by nation based on various things, including GDP and what they think their drug is "worth" in terms of your life or health. It's illegal to restrain trade (15 USC, Sherman, Clayton and Robinson-Patman) yet that's exactly what they do, with the help of the Federal Government, in that if you get on a plane and buy a suitcase full of some drug at a much cheaper price to try to bring it back and both make a profit while dropping the cost here in the United States it is you rather than they who will go to prison.
It is virtually impossible to get a binding quote on a procedure from nearly all medical facilities in advance. The notable exception are places like The Surgery Center of Oklahoma, which posts "all-in" prices. I note that said prices are typically one third to one fifth of what is charged in hospitals that don't post prices, including hospitals in the same general area of the country. Gee, I wonder why, and then one wonders why there haven't been thousands of criminal indictments and lawsuits alleging racketeering and extortion filed against the administrators and doctors in all the other hospitals.
To those who claim to be "conservative" yet who have failed to act on this matter for the last three decades: You're liars, thieves, tyrants and unfit to be citizens of this nation- you most-certainly are not conservative. Deliberately subverting the rule of law, whether done by action or intentional inaction, disqualifies you on all counts.
To those who claim to be "evangelicals" or "Christians" yet who have failed to act on this matter for the last three decades: You are not Christian; no person who is can permit the sort of ravenous theft and fraud that has driven the expansion of this racket to nearly a full 20% of our economy. You are Satanists to an individual and that's a fact. Either repent here and now or own and be proud of your serpent behavior. (Mr. Denninger's opinions do not necessarily reflect my own. I may or may not agree with his characterizations, but we do NOT indulge in "religious" debate or controversy here. - CP)
The laws in question are very clear. 15 USC (collectively), otherwise known as the Sherman, Clayton and Robinson-Patman acts declare that attempting to restrain trade or fix prices is felonious at a federal level. Further laws at the state level typically declare that it is a criminal act to, through any means, deceive people as to the cost of a good or service or bill them at a rate exceeding that quoted without their affirmative and prior consent.
There are other laws that also bear on this matter, including laws prohibiting extortion (the obtaining of something, particularly money, through threats or force) which facially appear to be violated thousands of times on a daily basis by the medical and insurance industries. Then there are laws that prohibit discriminatory pricing; the usual means of getting around this is to claim that the "chargemaster" price is the actual price but that then turns the so-called "negotiated price" on your EOB from the insurance company into a kickback to the insurance firm which is also prohibited in many cases and in those where it's not that's taxable income to the insurance company as debt forgiveness yet they have never been prosecuted for the outrageous level of tax evasion- to the tune of over a trillion dollars of undeclared and untaxed income a year- that such a scheme involves.
Hillary Clinton, should she win the Presidency, will not only refuse to address this problem she'll make it worse. We know this because she, along with her husband Bill, tried to cram down our throat what is now Obamacare when Bill was in office- an attempt to take a set of facially unlawful acts by an industry and compel compliance through the use of government force.
Trump has hinted at dismantling this scheme, but he hasn't come out with a full-throated intent to do so. He needs to, and he needs to do it now, explaining why it has to happen and what will come if we both do and don't take that path.
If we stop this right now the Federal Government would immediately and permanently run a roughly $400 billion a year surplus. In other words your purchasing power would go up rather than down every year and the federal debt would slowly be retired at a rate of about a trillion dollars every three years. To be clear, doing it will not be painless. There will be an industry that is turned on its head and, for a short time, a nasty recession. We must accept this, because in doing so we will take roughly 15% of the cost structure out of not only your personal life but also that of every business in America.
This will not end drug R&D in the United States or anywhere else. It will cause prices to go up elsewhere in the world, in some cases by a lot, but it will also cause them to come down here in America by as much as 85%. It will render paying cash for medical care, even fairly complex care, practical for most Americans. For those events where it is not it will turn the cost of insurance into a bill similar to that which is paid for homeowners insurance on a modest home- a reasonable and routine expense, since with the cost of care coming down by 85% so will the cost of insurance similarly fall.
It will permanently resolve not only the Federal Deficit and, over 30 or so years, the entirety of the federal debt, it will also permanently resolve the financial problems our state and local governments face- threats that if not addressed will cause property and other taxes to rise to unpayable levels for most Americans. By replacing the federal deficit with a 30-year unbroken records of surpluses it will also take the current ~2% loss of real purchasing power that you have suffered every year for the last 30 and turn it into a 2% compounded annual gain over the same amount of time. You may not get a raise but you don't need one when you are gaining 2% in real purchasing power each and every year; over 30 years this will almost double your real buying power without a single penny of increase in your wages.
And finally the dramatic reduction in business cost will mean that firms will flock to both manufacture here and run their offices and administrative functions in the United States, freed from what is currently certain fiscal disaster that any reasonably-competent CEO can and has foreseen and thus is trying, in today's business climate, to avoid.
Will Trump do any of the above? Maybe. Or maybe not. But unlike the other candidates he has hinted at it, and he knows where the problem is, because he's lived with it through the 1990s forward, as have I. As a former CEO myself this was the issue I identified while running MCSNet that was guaranteed to destroy my company financially given sufficient time if it was not addressed.
Competitive pressures are always present in any business; they're a function of the market and part of the job is navigating them. Arithmetic is not something you can navigate; you must face it and, if you cannot convince the political powers that be to change the underlying facts that lead to these disasters you have no choice but to move as much of your operations as possible away from the jurisdictions where these disasters will take place, lest your company be destroyed.
We have a choice in this country and the time to choose is now. In 2009 my best estimate was that we had 10 years left before the fiscal pressures reached the point of doing critical and possibly irreversible damage. It is now 2016, and that means we have less than four years remaining. We should be drawing up lists of people to be indicted and imprisoned. After just the first few were served this entire edifice would collapse in upon itself and prices would fall like a stone. We either act now or we fail to act at all, and our decision determines whether the light that I see this morning is in fact the dawn of a new and better day... or an oncoming train."