How Many Atrocities Will It Take?

How Many Will It Take? | The Hon­est Cour­te­san

Why America’s Healthcare (Sickcare) System Is Broken and Unfixable

He looks to be right: Oba­macare is the begin­ning of the end. Check it out.

Why America’s Health­care (Sick­care) Sys­tem Is Bro­ken and Unfix­able
// Max Keiser

Here’s a two-word sum­mary of why the Amer­i­can health­care sys­tem is fun­da­men­tally bro­ken and can­not be fixed with pol­icy tweaks: per­verse incentives.

If you type sick­care in the cus­tom search box on this site, you get 10+ pages of arti­cles. I have cov­ered healthcare/sickcare in depth for many years. I have many cor­re­spon­dents within the sec­tor (doc­tors and nurses), and have paid the unsub­si­dized costs of insur­ance as an employer or as a self-employed worker for 30+ years.

Here are two charts and three sto­ries of many I’ve pub­lished over the years:

Oba­maCare: The Neu­tron Bomb That Will Dec­i­mate the U.S. Econ­omy (Novem­ber 21, 2013)

Greed + Car­tels = U.S. Sickcare/ObamaCare (Feb­ru­ary 13, 2014)

Oba­macare is a Cat­a­stro­phe That Can­not Be Fixed (Decem­ber 6, 2013)

The unsub­si­dized cost of Oba­macare for two 60-year old healthy adults ($23,244 annu­ally) for an infe­rior plan to what we had before exceeds the cost of rent or a mort­gage for the major­ity of Amer­i­cans. Please pon­der this for a moment: buy­ing health­care insur­ance under Oba­macare costs as much or more as buy­ing a house.

Here’s a two-word sum­mary of why the Amer­i­can health­care sys­tem is fun­da­men­tally bro­ken and can­not be fixed with pol­icy tweaks: per­verse incen­tives.Physi­cian Ishabaka pro­vides a telling exam­ple of how per­verse incen­tives oper­ate beneath the sur­face of what patients (and clue­less politi­cos) see:

Today I saw a 16 year old boy who weighed 310 pounds – the wave of the future – will have type II dia­betes by his 20′s, prob­a­bly have at least one leg ampu­tated by his 40′s.I got home – and there was a fax in my fax machine. It was from a med­ical device com­pany, pro­mot­ing their new machine which is used to test for periph­eral auto­nomic neu­ropa­thy (a dis­ease of the nerves). There was NO MENTION of how this device would help patients.

What WAS men­tioned was that insur­ance and Medicare pay for this test, and that no pre-authorization is required. It was stated the aver­age Medicare reim­burse­ment is $200. The “C.P.T. code” – the code doc­tors use for billing insur­ance – for the test was included, and a state­ment that the device would return its ini­tial cost within 3 months was included – also a state­ment that the test takes THREE MINUTES.

Now, $200 for three min­utes work is pretty sweet. In all of med­i­cine “doing things” pays more than “think­ing”. That’s why sur­geons on aver­age earn twice or more the income of pri­mary care doc­tors. Surgery isn’t hard – if you can do car­pen­try, you can do surgery. The think­ing is the hard part – but it doesn’t pay.

Now – here’s the crux of the mat­ter – periph­eral auto­nomic neu­ropa­thy is very com­mon in dia­betic patients – and we are hav­ing an explo­sion in the pop­u­la­tion of peo­ple with dia­betes. There­fore there are a LOT of patients with periph­eral auto­nomic neu­ropa­thy, and a lot more com­ing down the pipe. See­ing an estab­lished dia­betic patient, going over their blood sugar results, other tests, dia­betes med­ica­tions, diet, and exer­cise takes 15 – 20 min­utes and pays FAR LESS than $200 – but actu­ally HELPS patients. This ben­e­fit has been sci­en­tif­i­cally proven.

As a gen­eral rule, med­ical tests should only be done if they are likely to HELP a patient – either due to the fact that they may guide treat­ment, or give the patient use­ful infor­ma­tion – an exam­ple might be a test that shows a patient has incur­able can­cer with a life expectancy of three months (I have had to tell a guy this at least once, based on the results of my phys­i­cal exam­i­na­tion, which sug­gested can­cer, and a CT scan, which revealed that the can­cer orig­i­nated in the pan­creas, and had spread to the liver) the infor­ma­tion doesn’t affect the patient’s treat­ment, but does help him arrange his life – i.e. that he should make sure his will is up to date, say good­bye to fam­ily and friends, etc.

Here is the deal – for 99.9% of dia­bet­ics there is NO TREATMENT for periph­eral auto­nomic neu­ropa­thy, and NO BENEFIT for the patient to know if they have it or not. In other words, almost all the time – this test is com­pletely and utterly use­less. There are a small amount of dia­betic patients with seri­ous, treat­able periph­eral auto­nomic neu­ropa­thy – but in them, the diag­no­sis is best made by phys­i­cal exam­i­na­tion and symp­toms – not by this test.

So there you have it – a worth­less test that appar­ently Medicare and other health insur­ances WILL pay for, that I could use on a whole bunch of patients to make a LOT of money, in very lit­tle time.

In fact, Medicare pays about $50 – $60 for the estab­lished dia­betic patient visit I ref­er­enced ear­lier – or about one quar­ter what I’d make from doing this worth­less test. Not only could I test all my dia­betic patients – if they tested neg­a­tive, I could re-test them at yearly inter­vals, keep mak­ing my $200 a pop, all for no ben­e­fit what­ever to my patients.

I thought this was the most crys­tal clear exam­ple of mal-investment in the health care field I’ve come across in some time. The fax is in my re-cycling bin, wait­ing to be picked up by the city today. I’m not buy­ing one of the test­ing machines. Oh well – I’ll never own an Porsche Turbo – and I love fast cars!

In con­clu­sion – there are plenty of doc­tors who jump at this kind of profit-making oppor­tu­nity – I know sev­eral. One in par­tic­u­lar does an echocar­dio­gram on EVERY SINGLE patient he admits to the hos­pi­tal – he gets paid to read the results of the echocar­dio­gram – which takes lit­tle time, and is very lucra­tive. An echocar­dio­gram CAN be a very use­ful test in patients with cer­tain heart con­di­tions, or in who cer­tain heart con­di­tions are sus­pected (can con­firm or refute the clin­i­cal sus­pi­cion – which can dra­mat­i­cally change the patient’s treat­ment) – but an echocar­dio­gram on EVERY patient is a rip-off, plain and simple.

I don’t know how he gets away with it, but he does – he’s a mul­ti­mil­lion­aire. I’m not. Some­times I won­der who is the smarter doctor.

Mean­while, else­where in the world, equiv­a­lent care is afford­able. Since the advanced, devel­oped nations of Tai­wan and Japan both pro­vide care for one-third of what the U.S. spends per per­son, we already know that fully 65% of what we spend on sick­care is waste, fraud, defen­sive med­i­cine (i.e. med­ically worth­less tests given to stave off future law­suits), prof­i­teer­ing, rack­e­teer­ing and paper-shuffling.

Con­sider this report from cor­re­spon­dent Barry P.:

I’ve been vis­it­ing the Philip­pines and came down with an ear infec­tion. I tried to allow my immune sys­tem do the work, but after 3 days of no improve­ment my wife dragged me to the hos­pi­tal, Makati Med­ical Cen­ter (MMC). MMC is one of two-or-three hos­pi­tals that the well-to-do go to when the need arises. Just as mod­ern as the aver­age US city-hospital. I have no health insur­ance in The Philippines.The doc­tor spoke excel­lent Eng­lish. The tools and tech­nique used was pretty much as I expected (hav­ing had a his­tory of ear infec­tions in life). The US dol­lar cash price (after the exchange rate) I paid was $18.44 for the office visit and $30.54 for one weeks worth antibi­otics, a vial of ear drops, and five pills for pain (as needed). A week later, I’m OK; no infec­tion, no pain.

So for less than $50, the amount around the “US-sickcare” co-pay, I’m done.

Let that sink in.

The US med­ical car­tel has a racket, eh? But we know that.

I have direct expe­ri­ence of sim­i­lar costs in Thai­land and China for care that was as good or bet­ter than in the U.S. (i.e. min­i­mal wait­ing and paper­work, care­givers were polite, care was effi­cient, test machines of the exact same type and brand as in the U.S., etc.).

Cor­re­spon­dent M. sub­mit­ted this report on the change in U.S. health­care from a non-profit community-based hos­pi­tal sys­tem to a cen­tral­ized profit machine:

I reviewed this same topic with 3 dif­fer­ent MD prac­ti­tion­ers in recent months and ALL said the same thing!… namely, that med­ical care tran­si­tioned from local com­mu­nity MD non-profit run, into psy­chopath MBA profit run (at the hos­pi­tal level) start­ing in the 1970s. They empha­sized or gave exam­ples of how the effec­tive local non-profit MD run com­mu­nity hos­pi­tal was taken over by for profit MBAism, typ­i­cally with huge buy­outs of the pre­vi­ous MD non-profit oper­a­tors. Med­ical care became just another avenue for sys­tem wide rack­e­teer­ing via tran­si­tion from local to larger sys­tem (i.e. rack­e­teer­ing).The solu­tion as you say: return to local community.

Large-scale rack­ets like sick­care can­not sur­vive with­out a Cen­tral State that col­lects taxes and fun­nels the pro­ceeds to the rack­e­teers, who of course have bought polit­i­cal influ­ence with their plun­dered prof­its. This is a self-reinforcing sys­tem that can­not be reformed in any mean­ing­ful way. It will bank­rupt the nation and then we’ll have a chance to start over with an afford­able, effi­cient, fair sys­tem that is focused on pre­ven­tion and health rather than prof­it­ing from dis­ease, fraud and lawsuits.


Early Days of Music Videos

I love Dionne Warwick’s early work, espe­cially Walk on By. But I’ve never seen this until today. While Ricky Nel­son is often cred­ited with mak­ing the first music videos, Trav­el­ing Man, seen on the Nel­son fam­ily TV show, this has got to be a close competitor.

I’m struck by the weird­ness of the con­cept for this video as it relates to the song. Shot in Paris, Eif­fel Tower in the back­ground, on the roof of some build­ing or pos­si­bly on the bed of some kind of mono­rail sys­tem (tracks seen in fore­ground), War­wick strolls through a group of vogue-ing young white male Parisians, appar­ently walk­ing on by them, even though the song is about a male she loves walk­ing on by her, ignor­ing her, in order to save her more pain of their break up.

Dionne sports a ragged look­ing un-processed ‘do and idly fon­dles what appears to be a mon­key doll. Here stark, buck-toothed beauty is promi­nent in this black-and-white production.

A now-primitive arti­fact of another world.

Netanyahu knew it was done & by whom

From day two.…

Netanyahu’s Bad Faith: From Gag orders to War as Bread and Cir­cuses
// Informed Com­ment

By Car­lyn Meyer

In a stun­ning rev­e­la­tion pub­lished by the Jew­ish daily news mag­a­zine, For­ward, JJ Gold­berg uncov­ers an almost patho­log­i­cal new low for PM Netanyahu’s decep­tive ‘bait and switch’ style of polit­i­cal war­fare. Gold­berg reports that Israeli intel­li­gence con­cluded the three Israeli Yeshiva stu­dents killed by Pales­tin­ian gun­men were slain within hours of being kid­napped. Yet, Netanyahu issued a gag order that pre­vented gov­ern­ment offi­cials and jour­nal­ists who were privy to the knees from report­ing it.

Gold­berg writes:

“The ini­tial evi­dence was the record­ing of vic­tim Gil-ad Shaer’s des­per­ate cell­phone call to Moked 100, Israel’s 911. When the tape reached the secu­rity ser­vices the next morn­ing — neglected for hours by Moked 100 staff — the teen was heard whis­per­ing “They’ve kid­napped me” (“hatfu oti”) fol­lowed by shouts of “Heads down,” then gun­fire, two groans, more shots, then singing in Ara­bic. That evening searchers found the kid­nap­pers’ aban­doned, torched Hyundai, with eight bul­let holes and the boys’ DNA. There was no doubt.”

In addi­tion, Netanyahu and oth­ers in the Israeli gov­ern­ment knew from the begin­ning that the killings were car­ried out by a rogue Hamas-affiliated group from Hebron and was not ordered by Hamas lead­er­ship. The per­pe­tra­tors even­tu­ally arrested were widely known to have taken other actions on their own in order to embar­rass or dis­credit Hamas.

The entire nar­ra­tive that Netanyahu has spun since this tragic kid­nap­ping was first uncov­ered is false. Not only did the PM uncon­di­tion­ally charge Hamas for the kid­nap­pings, he also set in motion weeks of house-to-house searches, depor­ta­tions and over 800 arrests of Pales­tini­ans, all under the pre­tense of look­ing for the killers and the fake assump­tion that the three teenagers were still alive.

When non-Hamas mil­i­tants launched rock­ets into south­ern Israel in response to the raids and arrests, Israel bore down harder, even­tu­ally bomb­ing Gaza, draw­ing Hamas into the con­flict and launch­ing “Oper­a­tion Edge”.

Pun­dits in both the US and Israel are fond of claim­ing that nei­ther Hamas nor Israel will ben­e­fit from the cur­rent fight­ing, espe­cially if Israel launches a ground war. In truth, hun­dreds of Pales­tini­ans have been killed or injured in ser­vice to the nar­row polit­i­cal inter­ests of a Prime Min­is­ter skilled at cov­er­ing up his own weak lead­er­ship through dra­matic dis­plays of polit­i­cal and mil­i­tary pyrotechnics.

Netanyahu abdi­cated his respon­si­bil­ity to defuse an explo­sive sit­u­a­tion. He could have done so by iden­ti­fy­ing key sus­pects and declar­ing, hard as that would be, that the three boys were mur­dered soon after being kid­napped. Instead of car­ry­ing out an inves­ti­ga­tion of killings by patho­log­i­cal extrem­ists, Netanyahu treated the kid­nap­ping as an act of war. Pales­tin­ian civil­ians are pay­ing the price.

Car­lyn Meyer, for­mer edi­tor of the blog Read Between the Lines writes on pol­i­tics from her home in Chicago.


Related video added by Juan Cole:

The­Re­al­News: “Israeli Gov­ern­ment and Press Knew Teenagers Were Dead For Weeks”


Why Is the Left Slice of the Democrats Getting Crushed?

If there is to be a counter to the drift towards rad­i­cal inequal­ity, it will not come from insti­tu­tional DC-based pro­gres­sives as long as these osten­si­bly groups sup­port the pol­i­tics of nothingness.

Why Is the Left Slice of the Democ­rats Get­ting Crushed?