When Health Insurers Practice Medicine

2019 was not the best year for me

In the middle of the year, I had to change employers, which meant new health insurance. I have a family member who has some health issues which require expensive medications, so we normally meet our deductible a few months in, finish up our copay a few months after that, and pay nothing at all during the last few  months of the year.

However, in 2019, getting new insurance meant that my deductible reset to zero in the middle of the year, and I had to start paying full price all over again, which cost me thousands of dollars in unanticipated costs. As if that was not bad enough, the new health insurance was not only about twice as costly as the old one.

This new insurer was truly horrible. To save money, they kept refusing to cover the brand-name medications that has been prescribed , and replaced them with cheap generics that were often ineffective. One such medication is Singulair, a Brand-name asthma medication that is seriously expensive. The generic did not work, so I had to pay full price for the brand-name medication. This had never been a problem with the old insurance company, but the new one kept refusing to cover medications that we had been using for years, and generally giving us the run-around. To add insult to injury, they insisted switching to three-month prescriptions in the middle of December, knowing that we would be on a new plan on January 1st. And they wanted $600 for a three -month supply of Singulair. It was cheaper for me to pay out about $250 for a one-month supply of Singulair that was not covered by Insurance at all. As they say in England, “Merry Bleedin’ Christmas”.

On one of the many occasions that I was forced to call them, I was told that several different generic versions were available and that we should try them and find one that works. I am reluctant to do this; my family is not a beta-testing lab for an insurance company looking for ways to save money. If they want us to do their quality assurance testing for them, they should be paying us for the privilege, or at the least, providing us with free samples. For those who believe that generics are just as good as brand-name medications, I recommend that you do some research; at the very least, check out a book called: “Bottle of Lies”

I keep getting phone calls and junk mail informing me about various telemedicine and telehealth services, in which I can get in touch with Doctors and nurses via the telephone or Internet 24/7. While this is a wonderful idea that will become more and more prevalent over time, I am not comforted by the fact that this service is provided, not by healthcare providers, but by my Health Insurance company. In my opinion, this is a conflict of interest, as their primary goal is not to provide better healthcare service (which is not their job; they are an an insurance company, remember?), but to reduce, minimize and eliminate claims.

Bottom line: Health Insurance Companies should not be practicing medicine; they should stick to paying claims.

When “Affordable” ain’t

Before Obamacare became law, my employer offered three plans: HMO, PPO and High Deductible Health Plan (HDHP). I opted for PPO, which had a combined deductible/copay/coinsurance of $1000/year per person.

The year the act became law, HMO and PPO options were taken off the table, and we were offered the option of HDHP, which had a combined deductible/copay/coinsurance of $5000/year per person. They took great care in repeatedly telling us that this decision had nothing to do with Obamacare, but was to do with “the higher costs of health insurance”, while ignoring the fact that the single biggest changes in the the cost of healthcare was the increased costs to health Insurance mandated by the new law.

“Pull the other one, it’s got bells on it”.

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My lady has multiple allergies and several other health issues, which require several expensive (up to $300/month *each*) drugs. Before Obamacare, I had to find $1000/year to pay for these. At about the cost of a high-end cellphone plan, this was annoying, but bearable. Under HDHP, however, I paid the first $2500 of all medical costs – which we usually burned through by March – and then 20% of all subsequent costs until we had spent another $2500, which happened around September. For the last three months of the year, however, all health costs were covered at 100%.

This led to an interesting interlude a few years ago: I was picking up her drugs and when the pharmacist told me that there was no charge, the fellow behind me said “Free drugs? How do I get some of that?“. I riposted with: “Easy. Just spend five thousand dollars“, to which he replied “Forget I asked.”.

So for me, Obamacare translates directly to a four-thousand-dollar-per-year pay cut – and that’s just for her; if I get sick, that’s another five grand I’ll have to find. this is why I flatly refuse to refer to it as the “Affordable Care Act.” I think it’s the height of understatement to say that I’m not a fan.

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Obamacare is not all bad news; two good things came out of it were The removal of coverage limits was a good thing, and Health Insurance companies could now no longer deny coverage on the basis of Pre-existing conditions. However, both of these changes increased the exposure of Insurance Companies, and those costs were passed on to the Customer – Mr. and Mrs. You-and-me. But the biggest insult about Obamacare was the ridiculous Supreme Court decision that effectively made purchasing healthcare mandatory; a mandate that has since been overturned by Executive Order, and rightly so, in my opinion.

The Healthcare system in the USA used to be a perfect example of capitalism in action; It takes about a million dollars and twelve years to train a doctor – about the same as a fighter pilot. Unlike the Air Force, however, the Physicians train themselves at their own expense, so it makes sense that they should set the value of their services. As an aside, this is tempered by the fact that the AMA and licensing authorities effectively conspire to restrict the supply of doctors, which keeps prices high. This seems to be working; there are, for example, plenty of unemployed attorneys, but the unemployment rate of qualified and licensed physicians is effectively zero, and an M.D. is often perceived, rightly or wrongly, as a license to print money.

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The problem with Obamacare is that it attempts to mix the worst of Capitalist and Socialized systems while getting the best of neither, and ends up being less than the less than the sum of its parts. The young were forced to pay for coverage that they did not want, in order to subsidize the unemployed, the itinerant, and the poor. The quasi-free-market Health Exchanges, while a good idea in theory, have not worked out well in practice; prices have spiraled in recent years, and many insurance providers have left the business or gone out of business.

I, for one, would like to see Obamacare repealed. But it will not be until something better is offered. And by “better”, I mean that “nobody loses any coverage that they currently have”, that simply won’t happen. This is in accordance with Prang’s Law of Freebies, which goes as follows:

“Once someone has gotten used to free stuff, they will never voluntarily give it up, and will fight tooth-and-nail to keep it“

One weird trick for weight loss

 

Stop eating like a bloody hippo.

Affordable?

Where ObamaCare went wrong.

The Affordable Care Act — or ObamaCare, as I prefer to call it, giving credit where credit is due — is a wonderful panoply of the entertaining, the frustrating and annoying to me.

• Entertaining, as it is quite amusing watching a bunch of politicians trying to implement socialized medicine and ending up with a curious hodge-podge of Marxism, Capitalism and Corporatism.
• Frustrating, because I have personally experienced the costs of a piece of legislation that was so complicated that we had to pass it to find out what was in it (thanks Nancy!).
• Annoying because I work — indirectly — in the Healthcare industry, and have seen and have had to deal with the direct knock-on effects and consequences that have resulted from the introduction of this legislation.

What they did:

• Insurance for everybody! At some point somebody decided that Health Insurance was a fundamental Human Right, and that we should all have Health Insurance. Pity the 90% of the people on this planet have never heard this.
• That’s an order! The Supreme Court has bought into this flummery to the degree that they ruled that it was a crime to refuse Health Insurance if it was offered to you.
• Expand Medicaid! Free coverage for the poor! Sounds good, but who’s going to pay for this? More on that later.
• Abolish Pre-existing conditions: Depending on who you ask, this was either one of the few good things that came out of the Affordable Care Act or an affront to Free-Market Capitalism. Until now, insurance companies could refuse to insure you if you had a pre-existing condition.
• Abolish annual and lifetime caps. Nobody wants unlimited liability and exposure, and Insurance Companies are no exception. A Heart Transplant costs millions… and nobody wants to pay for that.

Unintended Consequences:

• The words: “If you like your health care plan, you can keep it” will go down in history as one of the great presidential lies of all times, along with “Read my lips, no more taxes“, “I am not a crook“, and “I did not have sex with that woman“.
• The first consequence of Obamacare was that premiums went up significantly. So much so that my employers dropped the HMO and PPO options that they had been offering, leaving only the High-Deductible Health Plan (HDHP) — the cheapest option for them, and the most expensive for those of us who are not young and healthy. The good news is that I now pay about 20% less for health insurance. The bad news is that I am on the hook for the first $10,000 of expenses, Since I have a dependent who has severe allergies and Asthma, I am about $6000 a year worse off than before. Thanks for the pay cut, your Obama-ness.
• Only the largest groups get a good deal: My employers are not a large company, so they get a crappy deal from the Insurance Companies. Big organizations like Federal and State Government, Home Depot and Wal-Mart can use their size to get a better deal.
• Doctors don’t get paid. Under HMO/PPO, the patient pays a Co-Pay. Under HDHP, the entire bill goes to the insurance company where it is “adjusted” and then gets passed on to the customer… who ignores it for several months. Medical bills are now at the back of the line to get paid after just about everything else.
• Insurance companies won’t to answer the phone: “All of our agents are busy at the moment”, “call volume is exceptionally high at the moment”, and “We can’t come to the phone right now” all mean the same thing WE DO NOT HAVE ENOUGH EMPLOYEES.When even your local pharmacist is getting having their time wasted by the IVR run-around, something is rotten in the state of Denmark.

What they should have done:

• Removed or phased out the incentive that enabled employers to offer Health Insurance.
• Added tax breaks for individuals who purchase private health insurance. or added the incentive to private buyers.
• Favorable tax treatment to Health Care Professionals who provide free services.
• Made *all* medical expenses tax-deductible, and abolish that stupid AGI requirement.
• Removed all sweetheart in-network deals for Insurance companies – the original idea behind the HMO was that the insurance companies paid top dollar so that the uninsured could get free or low-cost treatment. This lasted until the Insurance companies realized that there was money left on the table that they could grab.
• Broken the AMA-induced doctor shortage by introducing government-backed training for doctors and/or allowing Nurse Practitioners and Midwives to practice medicine in limited situations without a Doctor present.
• Introduced menu pricing or allowed patients to negotiate prices directly, with governmental oversight in place when this is not possible.
• Reduced our reliance on Employer-provided Health Insurance: Employer Health Insurance first became popular during the Carter years; with a wage freeze in place, employers scrambled for a way to keep their best employees, and this was one of the “perks” that they came up with. There is no definitive reason why Health insurance has to be the province of employers!
• Divided healthcare into acute care (private) and chronic care (public) components, let the private sector handle the former and the Government handle the latter.
• Prohibited conflict-of-interest situations like Insurance companies involving themselves in providing (cheap) medical care.
• Required that Insurance Companies answered the phone. Not sure if there is any practical way to do this.

Of course, none of these things were going to happen, since they all result in a cost to the Government, the Health Insurance companies, or the Doctors.

And we can’t have that now, can we?

Anthem Sings the Blues

I got this message from the good folks at Anthem yesterday:

That’s right, folks, Anthem got hacked.

 Let’s take that apart, shall we?

“Anthem was the target of a very sophisticated external cyber attack.”

I love the wording here – has anyone ever admitted to being the target of a simple external cyber attack?

“These attackers gained unauthorized access to Anthem’s IT system and have obtained personal information from our current and former members such as their names, birthdays, medical IDs/social security numbers, street addresses, email addresses and employment information, including income data.”

Translation: “We just released the identity thief’s treasure chest. Everything you need to open bank accounts, take out loans and generally pretend to be someone else, just ad a fake ID.”

“Based on what we know now, there is no evidence that credit card or medical information, such as claims, test results or diagnostic codes were targeted or compromised.”

It is obvious to me that they were struggling to find some comforting news to tell us, but the fact is that most of Anthem’s customers have Health Insurance through their employers. Since they do not pay Anthem directly, Anthem does not have their credit card details.

As for medical information, most people don’t really care about others knowing what ailments they are suffering from. Indeed, most will happily tell you if you stand still long enough. It is my understanding that HIPAA, the medical confidentiality law of the land, was originally created to prevent Celebrities’ medical secrets from falling into the hands of the press. It obviously works; I didn’t find out that Michael Jackson was bald until after his death.

So… the identity thieves’ wildest dreams have come true, but stuff you don’t really care about is totally secure. It really gives you the warm fuzzies, doesn’t it?

So… what are Anthem going to do?

1. Notify all customers whose details were filched. I haven’t been notified, but I have noticed a surge in the number of calls to my cell phone from numbers I don’t recognize. I made the mistake of answering one, and was greeted by a heavy Indian accent. I pretended I couldn’t hear him, and hello-hello-helloed at him until he hung up. Then I added the number to my reject list. Coincidence? Perhaps… but I doubt it.
2. They are offering “free credit monitoring”. We’ll see what this looks like, but I suspect that this will be the cheapest option on the table. What they should do is offer the customer a paid subscription to an Identity protection service like Lifelock, or offer to pay the fees to lock/block your credit report with the “big three” Credit Reporting agencies. Time will tell.

Moral: If you run a big website, it’s not a matter of if you get hacked, it’s a matter of when.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Where it all went wrong

The Healthcare Disaster in a nutshell

Her Ladyship recently had some routine blood-work done. Here is a rather disturbing excerpt from the bill.

What does this tell us?

1. Insurance has made healthcare stupidly expensive – nearly two grand for a simple blood test? #YaGottaBeKiddinMe
2. Insurance is mandatory – With insurance, the cost is about $125…
3. The uninsured are up the creek without a paddle. …but without insurance, I would be on the hook for the full – ridiculously overpriced – amount.

This is mute testimony to the game that Health Insurance has become: the providers send massively overinflated bills to the Insurance companies, who then cut them down to size using specially-negotiated “sweetheart” deals – while those who have no insurance pay full price.

This is simply not right.

A brief history of Healthcare

Once upon a time, a sick person would go to the local quack, and said quack would prescribe a course of leeches. This went on for quite a while. Many people died as a result of quackery.

Over time, “Leechcraft” became known as “The Healing Arts”, quacks became known as “Doctors”, and hospitals were invented by the church. The process of training Doctors became formalized, and moved from the hospitals to the universities.

And Healthcare got expensive.

Since a stay in the hospital was expensive, the first Health Insurance — “Major Medical”, which insured against the huge expense of an extended stay in hospital — was invented.

And Healthcare got more expensive.

“The Healing Arts” became “The Healthcare Industry”. HMOs were invented, ostensibly “to control the spiraling costs of healthcare” (did it work? You decide). The cost control in HMOs was achieved by giving your Doctor the power to decided whether further treatment was necessary and punishing them for making too many referrals. For those patients who did not want such restrictions, they invented the more flexible (and expensive) PPOs, in which the patient decided what treatment was needed, were invented. Those who could afford it got PPOs, those who couldn’t — also known variously as “The Plebeian Classes” or “The Great Unwashed” — got the leavings.

And Healthcare got more expensive.

We hit hard economic times, and one of the government’s well-meaning but inept responses was to freeze wages. Enterprising employers, looking for ways to incentivize employees without paying them more, introduced Employer-provided Health Insurance, where the employer footed part or all of the cost of health insurance. It soon became so popular that employers who did not offer “Health Benefits” found it difficult to attract staff. Within ten years, Health Benefits were such an integral part of the landscape that it was difficult to imagine a world without it, and it was only a matter of time before otherwise-intelligent people started to believe that Health Insurance was a basic human right.

Even for the uninsured, the vision of employer-provided health insurance was a compelling one; folks with jobs got insurance that paid their healthcare bills, while those without jobs — or those who could not afford insurance — would get free care with the money that was left on the table. A worthy and excellent vision.#And Healthcare got more expensive.

And then came merger-mania. The health Insurance industry was composed of hundreds of companies, some for-profit, some non-profit. As inevitably happens when these two types of businesses compete, the non-profit health insurance firms got acquired by the publicly-owned for-profit ones that were flush with shareholder cash. Over time, the playing field shrunk until there were only a handful of major players left standing.

At the same time, the Health Insurance companies looked at the the money left on the table and decided to grab it for themselves. And so they designed a system where all roads lead to Health Insurance. They introduced a system of Co-pays, Co-insurance and deductibles that passed on the costs to their customers, and created “Networks” of health professionals who were contractually obliged to accept lower payments than they would have liked. As a result, the healers, now doing more work for less money, no longer had the time or resources to give free treatment to the indigent.

And Healthcare got more expensive.#As is often the case when a significant proportion of the population are dispossessed, disenfranchised and disenchanted, the uninsured started looking around for someone with deep pockets to pay their part of the bill. Naturally they turned to the Government, who, having done such a stand-up job with Social Security, Welfare,  and the Post Office, could clearly be trusted to look after the Nation’s health.

And they were not alone: Women pushed for free birth control (presumably so they could slut around at somebody else’s expense) and free abortions (presumably to deal with the “unintended consequences” of said slutting around), and they called it “Reproductive Freedom”.

And there was much rejoicing.

With so many votes on the table, the politicians looked around for a solution. And after several abortive attempts over three decades, they finally came up with a compromise, which one wag described as follows:

…a healthcare plan we are forced to purchase and fined if we don’t, which reportedly covers at least ten million more people without adding a single new doctor, but provides for sixteen thousand new IRS agents, written by a committee whose chairman says he doesn’t understand it, passed by a Congress that didn’t read it but exempted themselves from it, and signed by a president who smokes, with funding administered by a treasury chief who didn’t pay his taxes, for which we will be taxed for four years before any benefits take effect, by a government which has already bankrupted Social Security and Medicare, all to be overseen by a surgeon general who is obese – and financed by a country that’s broke.”

This great compromise, had the following effects and unintended consequences:

• It required employers to offer health insurance to all full-time employees. As a result, many employers who could not afford this had to reduce full-time employees to part-time, and in some cases, to dismiss employees outright.
• To bring more money into the system, it required anyone who had access to Health Insurance whether they wanted it or not. In a landmark case, the Supreme Court actually took unbelievable stance of declaring a Health Insurance premium paid to a private business to be a tax. Those who refuse it will pay fines, and may eventually serve jail time. Time will tell.
• It required Insurers to abolish lifetime caps, mandated free-of-charge preventative care, required coverage of children through college and into adulthood, and made it illegal for insurers to refuse coverage based upon pre-existing conditions. While these are all good things, they add to the costs of insurance, and it came as no surprise that heath insurance costs shot up. What did come as a surprise was that nobody was able to make the connection between the great compromise and the increased insurance costs.
• It required all insurers to provide birth control and abortifactants (aka the “morning-after” pill) to women at no cost. This puts businesses that are ideologically opposed to abortion in a very difficult position, and at least one major employer may have to close down as a result.

In the end, everyone got what they wanted — Health Insurance, Pharmaceutical and Medical Industries got the profits they wanted, women got the free birth control and abortion pills they wanted, and large portions of the Great Unwashed got the free stuff they wanted.

And they all lived happily ever after. Except for the working insured and future generations of taxpayers, who will be presented with the bill.

Fairytale or History lesson? You decide.

Ten simple steps to healthier living

1. Cut out sugar – Nothing has had more impact on my health over the past year than the decision to cut out sodas, sweets, cakes, donuts etc. Watch for “sneaky sugars – even bread has sugar in it. The ugly fact is that sugar is a poison, and it is as addictive as cocaine (which is why so many children won’t eat their vegetables but will happily inhale all the candy that they can lay their grubby little fingers on). This is why I predict that ten years from now we will think of sugar the way we now think of nicotine.
2. Cut back on starches – God may have created the potato, but the devil boiled, mashed, and added a pint of cream and a pound of butter to it. Pasta, rice, breads, all OK in moderation, but the less the better. Remember that your digestive system breaks down starches into sugar molecules.
3. Smaller portions, more of them – Human beings were designed to graze on natural, high fibre foods on a continuous basis. Three high-fat-high-sugar binges a way play merry hell with your blood sugar levels and “stretch” your stomach into expecting bigger meals.
4. Fruits not fruit juices – for me the most stunning revelation was the realization that fruit juices contain more sugar than sodas! Terminate with extreme prejudice. Fruits have the same amount of sugar, but the fiber prevents the digestion of some of the sugar, and slows down absorption of the rest, so you don’t get it all in one hit.
5. Eat Breakfast – A blend of good fats and protein is best. stay away from cereals (mostly starch) and fruit juices (mostly sugar) as they are not “part of this nutritious breakfast”. This is the most-skipped meal in western culture… and the one meal that should not be skipped.
6. Eat out less often – There are three things we should minimize consuming: sugar, fat and salt. Paradoxically, there are three things that taste nice: sugar, fat and salt. Restaurants want you to enjoy their foods, so they will improve the taste any way they can, usually by adding… sugar, fat and salt. Once or twice a month is plenty.
7. Cut back on junk foods – I have not had a hamburger in nearly two years. Wherever possible, I have a grilled chicken sandwich. My heart will thank me later. I would like to thank my doctor for making this possible.
8. Cook real food with real ingredients – Read the labels: If you can’t pronounce the ingredients, or they read like a chemistry lesson, look elsewhere. Oh, and remember that 4 grams of sugar = 1 teaspoon of sugar. So the 39g of sugar in that can of soda comes to almost ten teaspoons of sugar! Ewwwwww….
9. Drink a lot more water – many ailments can be avoided or minimized by drinking plenty of water.
10. Stand up and walk! The human body was designed for walking, running and lying down. Sitting was not in the design spec. Sadly, most of us have sedentary jobs that keep us sitting for long periods of time. And we wonder why we have lower-back problems. Walking is the third-best exercise there is (swimming is the second). While in London recently I typically walked four or five miles a day, with peaks of up to nine. No back pain or knee problems. Back at work, I am lucky to get three. Predictably, aching knees and back pain have returned. Make of that what you will.

Some preach “All things in moderation”, but the fact is that you can survive without “empty calorie” sugars and starches that we were not designed to consume in large quantities. As for me, my weight is down, my belly fat is GONE and my waistline is back to where it was a quarter of a century ago.

Affordable?

Or: The Affordable Care Act, and other Fairytales

I just completed yearly Health Insurance enrollment through my employer. Last year we had three options: HMO, PPO and a High-Deductible Healthcare Plan (HDHP) with a Health Savings Account (HSA). At the time, I went with PPO. This year, they dropped the first two options and left us with the third. They say that this was due to overall cost increases of the other two plans, and had nothing to do with Obamacare. I find this hard to believe, mostly because none of us saw this coming.

	2012	2013
Premium (PPO vs HDHP)	$        4,130	$        2,694
FSA vs HAS	$        2,500	$        6,000
Total	$        6,630	$        8,694

So assuming that next year will be the same as this, healthcare will cost me about 31% more. Gee, thanks Mister President.

This leads to my principal objections to this piece of legislation – the fact that it makes nothing affordable. I am far from alone in this. Everyone I have spoken to, without exception, will be paying significantly more in 2014 than they did in 2013. I have yet to meet anyone who is better off under the ACA.

This is hardly surprising: After all, the ACA mandates that Insurance companies provide more services than they did before. Many of these “features” are hard to dislike, such as:

• Making it impossible for an insurer to deny/terminate coverage due to”pre-existing conditions”
• Removing yearly/lifetime insurance caps
• Free* Birth Control

There are other “improvements”, such as Free* Abortifactants (“morning after” pills) – that are contentious issues (no Dorothy, recreational sex without the fear of pregnancy is *not* a basic human right, however strongly you may “feel” about it). But whatever way you slice it, the cumulative effect of all of these changes will be to raise the overall cost of healthcare, which begs the question “How is this affordable?“

“But Wait, There’s more!” Says ObamaCare. “You will have more choices!” And there are savings, to be had! Not so fast… since I have a good job, I get *nothing* from the government; No help, no discount, nothing. And the options available on the exchanges are very expensive ($680/month and up).

It’s beginning to look a lot like “You on you own, foo!”

But the ACA story does not end there. The worst part is the arrogance and hubris of assuming that the free market can be bound by legislation like this without any adverse consequences. They seem to have forgotten some basic principles:

• Adding more bureaucracy to any process makes it less efficient and more expensive.
• You cannot force private business to operate at a loss.
• You cannot force Doctors to do business with you on *your* terms.
• You cannot force young, healthy people to buy health insurance that they don’t need.
• You cannot force employers to pay more than they are willing for employee health insurance.

Most of us know people who have had their working hours cut to the point where their employers no longer have to offer Health Insurance. Some have lost their jobs entirely. Before blaming the “Eeeevil capitalistic employers”, ask yourself why they are doing this. To put it bluntly, this legislation made Health Insurance too expensive for them — and unlike the Federal Government, they can’t just print money and spend their way out of trouble.

Just as The Internet and Osama Bin Laden are President Clinton’s legacies, and the War On Terror is George Bush’s, ObamaCare will be the enduring legacy of this president. His fortunes, and that of the Democrats who rammed it through over the repeated objections of the Republicans, will be indelibly tied to this initiative. If it works, it will be their greatest shining moment since the New Deal. If it fails, it sill be a millstone around their collective necks for years to come – if not decades.

I believe it will fail. Here’s why: Healthcare is not a human right, and it is not a Governmental duty (one possible exception: chronic disease and serious disability). I know whereof I speak – I know *exactly*what Socialized Healthcare looks like; Britain’s National Health Service is inefficient, top-heavy, strained to breaking point, dangerously incompetent, and expensive enough to bankrupt the national economy of a first-world nation.

The only reason that it works at all is that the Government trains and employs the doctors – and we are trying to do it with doctors who trained themselves at their own considerable investment in time and money. It takes fifteen years and about a million dollars to train a doc. Force them to do business at a loss and they will walk – and then we will complain that there is a “Doctor shortage” and try to fix it by passing new laws.

Good luck with that.