Tuesday, May 10, 2016


Ever heard of “Helicopter Money?” No? Ok the skinny on this is the TARP and then the QEs. TARP stands for Troubled Asset Relief Program and QE (I,II,III, IV) all denote Quantitative Easing or in other words Printing Money to devalue it. (Total TARP + QEs since 2009 = $4.5 Trillion (4 followed by 12 zeros). These monetary mechanisms are designed to bring Liquidity to an illiquid market. Liquidity is implied as a means for the banks to have the money to loan to people and companies to make the business cycle function. Oh but a tiny bit of wrinkle sets in when the QEs start flying…the banks use the free money (since the interest rates were/are down to ZERO or 0%) to shore up their own balance sheets so they can survive a “Run on the bank” in case the plebeians decide to withdraw their savings, which have been leveraged to gain big gains for the banks in risky derivative markets (enter Lehman Brothers with $600 Billion assets declaring bankruptcy in September 2008) The net result of all these machinations at the Federal Reserve to prevent “pain and suffering” to other financial institutions and to the gentry was to blow up the balloon to its popping point from it’s sub-sub popping point. You see, currently, given these ballooning opportunities, the more the experts in Davos delay the inevitable of paying the piper, the more they postpone from what could have been a sustainable downturn with pain into a collapse the likes never seen. No, not even the 1929 depression will match this one.

On equal footing is the top-down machination of the healthcare policy makers headed by some geniuses who have begun helicoptering mandates akin to the QEs. The QEs in Medicine are no different. They have used a single point of reference (Costs) as their ends and used their personal genius means (like Mr. Gruber) to come up with a complex series of unintelligible verbiage to confuse and obfuscate the basic reasoning beneath; reduce cost at whatever the cost (notwithstanding patient’s real care). The demographics are changing as aging population in the US continues to grow. Controlling costs via simple-mindedness fails to realize the issues of tomorrow.

How do these mandates and policies effect medicine. Well, they are no different than the monetary QEs. They bloat the policy ledger creating a widespread net of regulatory reasonings to entrap an individual - patient and physician. Acronyms abound; PCORI, SGR, APM, MACRA, PQRS, etc. that have little do with the health of any individual but more to do with the flawed reasonings of a few. Let me throw in for gratuitous reasons the good ol' 5-6 PhD Quants of the 1998 who nearly took down the world economy with their asymmetric exploitation shenanigans. These same Quant incarnations are working hard with their statistical models in medicine today. Just Saying!

The reasonings fit perfectly well from the middling manager’s point of view since they reward larger and larger benefits to the intermediation between the two parties involved in healthcare (patient and physician). If you have doubts consider that the average CEO of healthcare industry makes $11.7 million in annual salary. The average Insurance agency makes $1-2 Billion (with a B as in 1 followed by 9 zeros) annually in revenue and a handsome bonus to its managers and the patients get denial for services and the patient gets denial of services for cost reasons arbitrarily created and physicians gets an annual cut in their reimbursements.

Therein lies the network of cables that push and pull within the net to warp the landscape of healthcare similar, I might say to what is going on in the financial sector, the FED and its bank-comforting policies that ultimately lead to the detriment to the working class.

Meanwhile both in the financial and the healthcare sectors there is a constant barrage of media reports of the blame game. The finger points and moves on to the next target as the distractions keep the citizenry occupied. “Yes,” the media and the spokespersons claim, “the Regulatory bodies are doing a yeoman’s work to preserve and protect the innocent citizen.” All this as the ground beneath is shifting, poised for a tectonic upheavel.

Helicoptering money and ideas is an old game, “keep the gentry happy and the bourgeois distracted,” practiced by evil pseudo-scientists whose weightless thoughts are all about the self and their cronies. We know money works for a while and similarly ideas manufactured in the marbled silos handed down as mandates work for the same duration until the citizenry reaches a breaking point and then all hell breaks loose, when “Let them eat cake” does not suffice.

One finally asks the question, “How will it end?”

The answer is not a happy one.

“There’s a special providence in the fall of a sparrow. If it be now, 'tis not to come; if it be not to come, it will be now; if it be not now, yet it will come. The readiness is all.” - Shakespeare

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