goes after what the 99% has left. Scraping the bottom of the barrel is sure to get ugly.

We need to overhaul providers before we can get universal healthcare. Insurance companies used to be able to rein them in but Obamacare has removed their incentive to police costs. At least that's what they thought going into the exchanges...Had insurance companies maintained this role they would not be dropping out of the exchanges nor have to raise premiums to ridiculous levels. But they were very intent on "hacking" the profit cap by letting providers and drug companies jack up their rates....

Previously I have published a few articles relating to what MFA would not solve, but I won't link to them here.

My understanding of this essay is as follows: there are two co-existent problems both of which have been compound by additional greed and by gross misunderstanding.

The first could be called "Killing the Goose that lays the Golden Egg". This applies to over-borrowing and over-consolidation. The result of these two inter-related aspects is that debt rises much more than is reasonable based on any reasonable projection of future earnings. The American economy has been and is being pillaged by the Oligarch-Insurance-Pharma cabal. Stagnant and actual falling wages have not kept pace even with expected inflation. People are being gouged so hard, it is like getting blood from a turnip (pardon for the mixed metaphors). Regardless of the true number of annual medical bankruptcies, they are significant. These ruin lives, produce depression (leading to drug abuse and suicide) and homelessness (homelessness of course have adverse consequences on the entire housing sector). People, aka consumers of healthcare, are being forced to pay debt service for unwise financial moves, or moves that may be actually fraudulent.

The second lies in the Janus-like medical code/medical billing debacle. ICD-9, the previous diagnostic disease coding standard, which directly affects billing, was relatively simple. ICD-10 was devised as an aid to research. There are 5 codes for Alligator-related injury about which I earlier posted. This is ridiculous. The Purpose was to provide a more accurate research data base so that all types of medical issues, whether congenital, acquired, accidental, iatrogenic, could be separately analyzed for frequency and total budgetary expense. It is clearly unworkable in the clinical setting. The other Janus-face of this over-meticulous coding requirement, is not only abuse of the physician's time taken away from direct patient care but also two unintended consequences. The first is utter confusion as to how properly bill for a procedure, knowing, as all physicians do, that over-coding (i.e., more than the procedure is worth) can lead to civil and criminal penalties. Paradoxically this unnecessary over-complication introduces yet more possibilities for provider fraud. Many codes are iffy and some are downright wrong. Computer programs are unable to evaluate over-coding which involve evaluation of numerous individual unique circumstances. Needless to say, the insurers and government don't care about under-coding because they save money. This accentuates the basic unfairness of the coding system.

Yes, provider fraud is rampant in particular areas, large population ones such as L.A. Patient fraud is also rampant--i.e., faked injuries either under premises liability claims or worker's compensation claims. Next there is the obscene fraud that "Insurance" companies actually provide benefits for health-related problems. To which must be added the even more obscene over-compensation of the higher echelon executives whose decrees make patients jump through interminable hoops, only to have legitimate claims denied. I could go on but enough for now.

Though I must admit that I didn't see it playing out this way.
(pats self on back, wrenches shoulder, goes bankrupt, dies under bridge)

In this case, simple.

The issues are not clearly labeled, which can obscure the oft-repeating patterns. That can make the solution seem complex when it is not. Otherwise, this is another well-structured presentation.

You are describing our unique, ideologically-riddled economic system from which specific control valves and regulators have been removed. It has a steampunk look, but it works well enough if you know its eccentricities and where to kick it.

However, I don't want to talk about the financial sector today.
I want to talk about the health care industry.

Although much of the health care industry operates inside the financial sector (insurance, for example), these can be isolated for discussion-sake. It's much harder to isolate the financial sector (banking) from the economic system. In the real world, it cannot be done.

Next, you describe one of those investment sector bubbles (are there any other kind?) that periodically plague the economic system, in this case the cash flow of health care commodity (parts and labor) expansion investment, not to be conflated with consumer health care debt. This bubble is the ego-debt of merger fever among health care corporations, much of it already extracted in stock buybacks and CEO bonuses. Their shareholders can pay for their greed and inability to perform. They can also take a haircut on any bankruptcies.

You talk about greed as if it was an occasional variable rather that the pillar upon which this nation and its system of government was founded. Greed is what inspired predatory capitalism, the lifeblood of our economy. It is greed that decides what parts of the Federal government to privatize and how much the government (taxpayers) will be forced to "single-pay" the corporations to run the government that they now own. The government also indemnifies them for mismanagement, and picks up the tab on any losses and bankruptcies the new owners incur.

Finally, you close with:

The math doesn't add up. The greed has been too great.
The theft has been too rapacious.
Now the first signs of the inevitable are starting to be seen.

“Companies in the health care sector are starting to lay people off,” said John Burns, CEO of John Burns Real Estate Consulting, an independent research and consulting firm on macro trends, such as the health care and technology sectors, that drive the US housing market… It could be like a Lehman Brothers scenario, where a couple of big health care companies take the economy down,” Burns told The Post

.

When the next recession hits, which will be soon, the bankruptcies will start.

First off, Burns clearly has PTSD from the last recession, and everything looks like a real estate crisis to him. He can be safely dismissed.

We already configure the various components of our economic system to weather business cycles and storms. In 250 years of local banking and 2,500 years of Middle East and Islamic banking, we've seen it all. We can see trouble a long way off. We know where the next bubbles (unsustainable imbalances) are and we know exactly how to regulate them back into a safe range. (With Goldman Sachs embedded at both Treasury and the Federal Reserve, you never really know.) If we decide not to regulate or to de-regulate, we know with great accuracy how a bubble will resolve and how that resolution will affect other economic components. We even know how to adjust other components to hide the bubble, and we know who is going to pick up the tab when the bubble does pop. The system itself is no more complex than a steam engine.

I reject the entire notion of economic surprise.

The only problems the US economic system has come from political ideology and psychological denial. Here, we get into the realms of mental illness and religious obsession. So let's talk about solutions, instead.

The US has only one economic problem. It cannot tell the difference between a private business, a public utility, and a natural resource. The latter two need to be nationalized along with anything else that is too big to fail, especially the large banks.

I say, get it done or burn it down.