Robert @trip3980 - Twitter Profile

2 days ago

@mara_065 I think we should also put these people into prison because they are grooming our children. What sexual behavior is early on in childhood? It’s literally a sex religion that they’re teaching our children

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Robert

@trip3980

2 days ago

@helenckh medal of honor?

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@trip3980

17 days ago

https://t.co/GWSbh3lGKE

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@trip3980

20 days ago

https://t.co/ZP8XCSTSzZ

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@trip3980

23 days ago

The September 9 Treasury buyback does not change Medicaid or Medicare counseling coverage. Treasury already runs buybacks. This one raises the cap on certain long-end liquidity operations to improve market function. It is debt management, not a clinical-funding switch. That distinction matters because official messaging from @POTUS and @WhiteHouse often treats the fiscal problem as waste, fraud, and overspending. Those are real. They are not the whole machine. A lot of finance commentary still says America is addicted to spending. That is incomplete. The United States is also addicted to bureaucracy. We do not just buy too much care. We buy an enormous process that sits between the Treasury and the actual service. A Medicaid counseling session can look like government paying a clinician. The real path can run through federal rules, state Medicaid, an MCO, credentialing, eligibility, prior auth, diagnosis codes, treatment-plan documentation, claims, denials, resubmissions, audits, and compliance. CMS has put prior authorization around 13 hours per provider per week. Comparative hospital research put U.S. hospital administration near 25% of hospital spending versus about 12% in Canada and Scotland. Commonwealth Fund analysis has put insurance administration plus provider-side administration at roughly 30% of excess U.S. health spending versus peer countries. Some of that control is necessary. Fraud exists. Safety standards exist. Less process can mean less oversight and more leakage. That is why governments keep adding red tape. The American problem is when the cost of verifying, coding, reviewing, denying, appealing, and auditing starts to rival the value of the care being controlled. That is a bureaucratic spiral, not only a debt spiral. It is not unique to healthcare. Tax compliance is the same shape. Businesses hire accountants, specialists, and lawyers because the rules move — often through administrative interpretation, not a clean statute — and getting it wrong can wreck the firm. A few thousand dollars a year in experts is not “stimulus.” It is private time and money spent decoding the state. Scale that across accounting, legal work, credentialing, and court process and a large industry exists to navigate government rather than produce goods or care. Other countries are not bureaucratically weightless, and some tolerate informal workarounds the U.S. would not accept. Purchasing-power differences also explain part of a cheap dental bill overseas. What they often do not do is build this much paid machinery around every ordinary transaction. If @POTUS wants cheaper government without shrinking needed care, the test is simple: 1. A dollar of clinical labor 2. A dollar of necessary fraud and safety control 3. A dollar of low-yield process created by a fragmented financing architecture Treasury refinancing can cheapen borrowing. It cannot fix number 3. Cutting Medicaid rates, tightening auth, and driving clinicians off public insurance can “save” money by shrinking access, then shift the cost into ER, disability, jail, and family collapse. That is reactive budgeting. Medicaid counseling is more exposed than Medicare counseling because Medicaid runs through states. Watch Alaska rates, authorization rules, MCO contracts, federal matching legislation, and the Medicare Physician Fee Schedule. Those will show a real reimbursement threat earlier than bond operations will. The fiscal risk is not only that government spends. It is that a large share of the money never becomes treatment.

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