Obamacare in the supreme ct

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+ 1 Explanate

And Midpack, I also agree with you 100% There are numerous issues contributing to the problem.

Many countries enjoying a better standard of living than the US, higher wages etc. (where things cost a lot, like here) have been successful in developing affordable health care plans for themselves. Most of these people are very pleased with their health care in the studies conducted, and most important, they can sleep at night.

Of course all of them have abandoned the previous Health Care For Profit insurance companies. Those that still use them work on a purely administrative bases for stated service fees and still compete to a limited degree for business, with guidelines set up by the government.

In other countries they have been turned into only providers for supplemental policies for those who can afford it, wishing to purchase additional plans, but the basic coverage comes from the government.

Some, like England, have abandoned most all privately run health hospitals and organizations, though there are some privately run ones you can access if you choose to purchase a supplemental policy there as well, that gives you some additional privileges, but it is my understanding that few do so, as most are very satisfied with the HSA.

As stated, their system is the most controlled, as the government owns pretty much all the hospitals, pays their doctors not only a set salary, but a bonus plan for their successes which can increase their income substantially (more than double it in some cases) when they are successful in doing things like getting their patients to stop smoking, getting their patients cholesterol level down, getting their patients to lose weight etc, etc.. Physicians are not able to profit from expensive tests, MRI's etc. or even operations I believe. There increase in pay comes from their success rate in controlling and curing their patients and most importantly preventative medicine. They have lots of incentive to do a good job.

They (the government) progressively pursue preventative medicine by heavy marketing and easy availability to keep people healthy. All the drugs are bought by the government at greatly reduced cost, and the cost for any prescription to an individual is always $6.00

In our current Democratic system, most politicians are heavily influenced by whoever gets them (pays into their campaign) and keeps them in office or promises a good job afterwards. As well as their own party basically threatening them that if they stray from the fold and vote other than told, there will be serious consequences and they can kiss any future support goodby. This formula hardly makes for good representation for us.

It seems the only way we have ever been able to get congress to do something is just like Obama advised in his campaign when asked a question at one of his rallies. "Make Me".
I think that was very telling of the reality of politics today.

As long as the pharmaceutical companies, the AMA's , and large insurance companies are successful in convincing 1/2 the public that change to our current system is a bad thing, we will never be able to make it right. I think of Lincoln's famous statement, “A house divided against itself cannot stand.”

I also love this one too by Lincoln by the way, “These capitalists generally act harmoniously and in concert, to fleece the people”

So if we can't count on congress to make things right on their own, then it is left to us to yell loud enough and in big enough numbers to make them do it. Are we always doomed to be divided by ideological diversity?

I can't help think that on the issue of health care, we could have cross over. I know that even though I consider myself to lean mostly left, I do not agree with my representative parties in all matters.

Sometimes I see merit in a more conservative mindset of the issue. Sometimes I see solutions that can pull ideas together from both sides.

The question is: Are there enough flexible and rational people out there who can put their party aside and look at issues independently for themselves. It appears to me, you tend to think not.

I think the key here is education. Too many people don't really know all the alternatives we have available. They don't know what the rest of the world has done, and sometimes cling to the idea that American exceptional-ism trumps all, and rejects looking at things outside our borders in any global capacity. I don't know the percentages, but I do know that an uninformed decision is usually a bad decision. I WANT TO RUN FOR OFFICE. GIVE ME MY YOUTH BACK!
 
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Well if you say you want free-market health care, then you are saying health care businesses have every right to maximize profits or price at what the market will bear -- though a lot of providers have non-profit status, which may confer some tax advantages.

Of course, some would say this is a dysfunctional market because there isn't transparency and consumers aren't able to shop around, either because they don't have the opportunity or they don't have the knowledge. If you need emergency surgery, you're not going to have the chance to price-compare. Plus the insurance payment scheme may have introduced price distortions into the market.
 
If you need emergency surgery, you're not going to have the chance to price-compare. Plus the insurance payment scheme may have introduced price distortions into the market.
It's very useful to distinguish between two things:
1) Establishing an open (though regulated) market in health insurance
2) Establishing an open (though regulated) market in health care (procedures, medicines, etc)

Both are important, but in my opinion #1 is more important, and in some ways it can encompass #2. If people have good information on the various health insurance plans available to them (costs, customer satisfaction, wait times, any "extra" benefits above the standard package, any standardized information on outcomes for various procedures, etc) then they can make an "umbrella" choice that leaves the issue of controlling costs and assuring customer satisfaction to the insurance companies (it's all baked into the cost and quality info available to the consumer). When I buy a car, I do my research on available models, find out what they cost, see if present customers are happy and if the manufacturer has designed a good car, then I make a choice. I don't fret with trying to find the best value for every individual part and then ask Toyota to substitute a different type of engine so I can save money. It comes as a package.

Assuring that accurate information on health insurance packages (standardized information on costs, satisfaction, outcomes, etc) is available might be a valid function for the government in this whole process. They'll do a terrible job of presenting the info, but that can be done much better by private companies (compare doing your taxes using the official IRS "help" and using TurboTax.) There would be fantastic web sites/decision engines by KFF and others within a week to help folks pick the best insurance plan based on their needs, but the government probably needs to drive the collection of information from insurers/customers.

Now, there's a place for price transparency in medical care and "shopping around" as a means to help cut costs. I'd like to see the costs of various procedures because I have to make a co-pay. Insurers can make this a selling point: "all our approved providers are required to tell you in advance what their services cost--the actual cost that you'll pay and what will be paid by your insurance. You can also go to our web site and see what various procedures cost from those who are enrolled in our system". A policy like that would be more likely to get my business.
 
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Have you looked at a recent insurance prospectus lately. You'll be real hard pressed to find a lot of the detail in it. After recently experiencing this, I had to call and go up several levels to talk with someone who was willing to furnish me with "the real deal", and that sure did take a long time to get accomplished. I spent a lot of time (thank goodness I'm retired) on the phone listening to people tell me all that I need to know was stated in their brochure they had already sent me or on line at blah blah blah.com By not accepting their answers- I was subjected to being passed on to number 2 to be told the same thing, #3, and then finally #4 who fessed up to the fact, and agreed to send me the "complete" book that would answer all my questions.

Now how many of the average souls out there will question authority or perhaps for lack of a better word "less worldly" know enough to do what you and I might do. Is it ok for them to be screwed because they didn't know enough not to question what that brochure they were sent did not say?

A lot of policies written today are hardly worth the paper they are written on and some families after years of paying on it, get a big surprise when someone gets sick and needs it.

Maybe you are just referring to when the 2014 policies roll around (if they ever do)

IMHO health care should be elevated to a higher level that includes a level of protectionism for everyone (smart and not so smart) and every possible measure taken to safeguard the less sophisticated. And that all policies put on the market in the future contain a certain minimum level of protectionism that is reasonable to preserve life if you get sick (without losing your home and everything you own). From there, your on your own as to how much you want to spend.

I also hope our government will insure that all policies and prospectuses contain all the information in VERY understandable terms for everyone.

But choosing the policy, I think is the least of our problems for the future (hopefully). Like many here have posted above we have more serious problems to figure out in health care, like cost containment, how to achieve affordable availability- doctor shortages (primary care) -elimination (for real) of insurance company abuses and ultimately how to make it available for everyone rich and poor
 
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Have you looked at a recent insurance prospectus lately. You'll be real hard pressed to find a lot of the detail in it. After recently experiencing this, I had to call and go up several levels to talk with someone who was willing to furnish me with "the real deal", and that sure did take a long time to get accomplished. I spent a lot of time (thank goodness I'm retired) on the phone listening to people tell me all that I need to know was stated in their brochure they had already sent me or on line at blah blah blah.com By not accepting their answers- I was subjected to being passed on to number 2 to be told the same thing, #3, and then finally #4 who fessed up to the fact, and agreed to send me the "complete" book that would answer all my questions.

Now how many of the average souls out there will question authority or perhaps for lack of a better word "less worldly" know enough to do what you and I might do. Is it ok for them to be screwed because they didn't know enough not to question what that brochure they were sent did not say?

Actually, I think it is a mute point, as selecting the best insurance policy today, does little to really address the BIG problems at hand in that department. Smarter people will usually always make better buying decisions, and the uninformed will always make the worst.

The only question I pose to you on that subject is: Is it ok to say, you deserve what you get when it comes to health care. You didn't ask enough questions or read all the small print when you signed. Sorry, your screwed.

Don't you think it vitally important to protect people who generally don't make life's best decisions when it comes to an issue like health care? Shouldn't at least health care be elevated to a higher level that includes a level of protectionism for everyone (smart and no so smart)?

Like many here have posted above we have more serious problems to figure out in health care, like cost containment, affordable availability, doctor shortages (primary care) insurance company abuses, how to make it available for everyone rich and poor, and as this tread first started out, the role it plays with your wages, and it's effect on business.
Good post. I recently went to a Medicare Advantage sales seminar put on by GHC here in Seattle. Judging by their questions the attendess were all well educated and curious about their opportunities. The presenter was excellent, very well organized, and I think completely out front. Yet I needed to go to 2 of these seminars to feel that I had much of a grip on the details, and I feel sure that if I joined I would be discovering things I had understood incompletely for several years at least.

A person needs time to do this kind of thing, and interest and imo the willingness to keep coming at things from different angles and watch for inconsistancies, hesitancy, body language and then ask ask ask until you get contract type disclosure.

With some things, like annuities, we can just say, no, not going to play. But health insurance, what choice do we have?

It should not be this complicated.

Ha
 
If we use the available information tools to facilitate the presentation of information, we'll get an efficient marketplace in health insurance. As I mentioned, I think government can have a role in this, but if experience is any guide, private entities/nonprofits, etc will take the lead and do a better job of making the information easily understood by potential customers. If the "answer" is more company brochures and sales pitches, we've probably screwed up.

Remember that sellers of products make higher profits when markets are inefficient. They are not interested in efficient markets, because efficient markets drive down margins. And we're not talking about toasters here--health insurance is a complicated product. But I'm not ready to say that people are just too stupid to make good choices.
But choosing the policy, I think is the least of our problems for the future (hopefully). Like many here have posted above we have more serious problems to figure out in health care, like cost containment, how to achieve affordable availability- doctor shortages (primary care) -elimination (for real) of insurance company abuses and ultimately how to make it available for everyone rich and poor
An efficient (regulated) market in health insurance is key to solving the medical cost problem, the focus on treatment rather than "health and wellness," the inefficient distribution of health care resources, and many other sub-problems. Just as efficient competition between suppliers brings us the best products and services at the best prices in every other aspect of our lives.
 
YOu think the lay person is going to be able to make informed choices about medical options?

Hard enough to figure out the insurance provisions.
 
YOu think the lay person is going to be able to make informed choices about medical options?

Hard enough to figure out the insurance provisions.
Right. Too stupid by far.

When did "adult" lose it's meaning?

If people are too ignorant to choose their own medical procedures, how can we possibly trust them to properly choose their own spouse? I can assure you much more grief and human suffering has been caused by an ill-advised selection of a mate than by poor choices regarding medical care. Where's the government assistance when we really need it?
 
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Because making medical decisions require special knowledge.

If you're going to eschew doctor's advice to "shop around" do you really want to compare what you can glean from the Internet vs. the training a doctor has acquired, not just in med school but throughout his career?

There are just some things on which most lay people have to rely on experts.
 
eschew doctor's advice to "shop around"

Would "shopping around" include seeking second opinions? You're saying that when I "eschewed" a specialist's decision and sought advise from another doc and did some reading on my own, I was wrong to do so?
 
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No because you'd still be relying on a doctor.

The whole idea of a transparent marketplace assumes almost equal knowledge between buyer and seller about all the choices in the marketplace./

You can't compare shop medical choices like you would compare cars to buy.
 
You can't compare shop medical choices like you would compare cars to buy.

Sorry, but for non-emergency procedures, I find out all I can about my choices, the various pros and cons, risks with and without the procedure, experience level of the provider and the facility doing the procedure, etc. This includes, but is not limited to, consulting with alternative providers.
 
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The whole idea of a transparent marketplace assumes almost equal knowledge between buyer and seller about all the choices in the marketplace./

You can't compare shop medical choices like you would compare cars to buy.

This is 2011. We are swimming in information (which, though not the same as knowledge, is better than ignorance). If the doc told you that you had xxx disease, what would you do? You'd do what nearly everyone does--you'd scurry back home, open up Google and find out about it. And you'd find out about treatments. You wouldn't become a microbiologist, but you'd quickly learn about what is typically done to treat the disease. You might even learn something that changes your opinion of the doc's proposed treatment plan.

Anyway, you've swung into the "comparison shopping for a kidney transplant" mode. As I mentioned earlier (post 81), the better place for market forces to have an impact on cost is for people to comparison shop between insurance providers--these insurance providers will then be under pressure to please customers and contain costs. When provided with the information in a clear way, people can understand what "customer satisfaction" ratings mean, what "average wait time" means, etc. If they've got a favorite doc they can see which insurance plans he accepts, etc.
 
SamClem,

IMHO you may be a little out of touch in 2011 in the doctor category at least. You don't shop for a doctor any more (especially primary care) You hope and pray you can find one who will take you. Secondly, unless you are without insurance, you do not shop for prices for procedures. And as for having doctors tell you upfront what something cost, this does not happen unless you are the negotiator, and you never are unless you carry no insurance at all. If that is the case, the only thing you find out is the price will be negotiated up for doctor, not down for you. That's just gravy money for them. (I want to preface this by saying I do believe there are a small percentage of humanitarian doctors out there that don't fall into this category. Some even volunteer their services for free, so my hats off to them, and I offer a sincere Thank You. I'd give you a real big hug if I could) Anyway back to the subject matter.

This shortage of doctors in this country, not only primary care (though admittedly that's the worst- psychiatry second I believe) is causing the opposite to happen (theory of supply and demand) So until that problem is addressed and fixed (which in my opinion can only be fixed with government help and intervention) we will find letting the free market solve this problem inapplicable. As you realize, the end users don't negotiate and control the costs. It's the middle man that controls the costs (insurance companies or government) And yes, your proposal of the "free market" solving the cost issues is true to a point, provided we had an abundance of doctors and medical providers who were competing for the same business.

Right now we have a very strong uptick in doctors refusing to take anymore Medicare patients. I pleaded with my primary care doctor to take my mother as a patient , and was refused on several occasions (I always go back a 2nd or 3rd time) . Now whether the actual approved Medicare payment is too low for them to make a decent living, or it's more I have enough patients to chose from, I'll take the new patient who will be more profitable, I can't say with absolute certainty. But if it is because they (the doctors) have better choices, then the free market is only working for him, not for the public. If it is because they are truly not paid enough, then we need to look at that. And not necessarily by just throwing more money at it. There are ways to do that with also getting something back.

Then there's the #1 reason for preventing Early Retirement. How many people have we heard say, if it were not for the high cost of health insurance, I would be able to retire now.

As stated before, it is a very complex problem with many interwoven causes and effects. We have to un-weave these problems, one by one to be able to come up with a truly sensible solution and fix.

Lets look at shopping for policies. Only people young enough and healthy enough really get much shopping leverage. If you are say 60, or even 30 and have some pesky "condition", your leverage in the market becomes very thin. And yes, as mentioned in an earlier post, some "less sophisticated" people who buy insurance on the open market can be screwed badly by a number of unsavory companies out there very willing to take their monthly check, but not deliver when the time comes.

Here's where we differ SamClem. I elevate this category on government involvement and assistance above all other issues. It is (in my eyes) an area that needs to be closely monitored by our government for the protection of it's people. (all people) We are talking life and death here, not buying a lemon of a car. Hey, wait a minute, we have Lemon laws protecting people in that department don't we? Hmmm, I wonder which one is more important?

We need to figure out things like: how do we get more young people to go into the medical field. Maybe we have to help them pay for their medical school, and maybe enter into a contract with them to excuse X amount of dollars owed on their loans for every year they practice as a primary care physician before entering their chosen specialty field. What else is keeping them out. Can we come up with a workable plan to fix it? Where ever a problem lies, there is always a solution. We may not hit the mark the first time round, but we are bound to if we don't give up.

Personally, I'm unaffected (at least for the moment) I'm already past 65, and I've got mine, as they say. But I care about all those coming behind me, and see real problems for them, so I don't want to sit on my rump and do nothing. I think we have a crises looming out there and sooner or later, if nothing is done, it will effect everyone. The old Ostrich thing is not going to work forever.

I am a eternal optimist, so I can not accept it is not doable. Complicated yes, but always doable.
 
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I'm surprised when people tell me that they can't find a doctor who accepts new Medicare patients because the government rates are too low, but these same people believe the government will be able to impose price caps in the larger health care system and it won't result in a doctor shortage. Sometimes you even hear it in the same paragraph, or read it in the same post.

How did price caps work for gasoline in 1973-was there plenty of gas at low prices, or were cars wrapped around the block waiting to buy their 5 gallon limt? Does rent control lead to an increase in the availability of apartments, or to a decrease in availability? Price caps that "work" always result in artificial scarcity. There is a tried and true mechanism for matching the quantity of a good or service to the demand, and it doesn't involve a government pricing board. If we want more of a particular thing (good medical care, important new drugs and treatments, etc) the best we can do is let people buy it freely. And the best way to assure that their purchasing decisions reflect their true priorities is to let them, as much as possible, use their own resources to make the purchases. We may decide to tax people to help pay for the health insurance policies of the poor, but the more they are allowed to participate in paying the cost, the more judicious will be their decisionmaking.
 
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They said doctors would flee Canada when they went single-payer. In fact the AMA went up there and tried scare tactics.

Canada still has doctors.
 
the more they are allowed to participate in paying the cost, the more judicious will be their decisionmaking.

That's pretty radical samclem! Whatever happened to that "giving according to their ability and receiving according to their need" talk?
 
They said doctors would flee Canada when they went single-payer. In fact the AMA went up there and tried scare tactics.

Canada still has doctors.

+1

Yes, and the man(Tommy Douglas) who was ultimately responsible for actually getting universal health care started there is hailed as Canada's most respected and admired heroes (I think they have a national holiday in his honor now, but I am not certain) and voted the greatest Canadian of all time by it's citizens.

"In 2004, the Canadian Broadcasting Corporation held a national contest to determine the greatest Canadian of all time - the person who had the most profound impact on the nation. Tommy Douglas, that humble preacher who hailed from Falkirk, was declared the winner. He bested Marathon of Hope runner Terry Fox and former prime minister Pierre Elliot Trudeau"

Tommy Douglas: Hero of the common Canadian - Arts - Scotsman.com
 
+1

Yes, and the man(Tommy Douglas) who was ultimately responsible for actually getting universal health care started there is hailed as Canada's most respected and admired heroes (I think they have a national holiday in his honor now, but I am not certain) and voted the greatest Canadian of all time by it's citizens.
At 46% less than the US private system, I can understand that.
 

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Well, you know facts don't matter.

The idea that there are just some things that should not be run for profit, is just hard for some people to get their head around. I think you can learn a lot on these forums. They can be a very good source of information worth sharing and discussing with one another. It has made me on more than one occasion, think twice about something when reading other peoples thoughts.

Embracing some form of universal health care, from everything I have read and know has never changed a free market society into anything but continuing free market society.

We will be forced to look hard at this issue again, whether it is when the Supreme Court gives it's ruling, or down the road further. But we will be forced to look at it - probably many times again.
 
You don't shop for a doctor any more (especially primary care) .
Right. You're talking about 2011. The world where you have one insurance provider (chosen by your employer, or it's Medicare if you are over 65). Now imagine a world where you are choosing your insurer based on price and quality. You've got money in your hand--some of it yours, some or all of it from Uncle Sam through the subsidies. Insurers want your business, and you have information at hand. Do you think the insurers are going to compete to get enough doctors so they'll get customers to buy policies (the doctor availability/waiting time, etc info will be readily available to prospective customers). That's much better than the present world where insurers work to please major employers, not the actual users of the medical care. Where doctors are relegated to piecework at a government rate that is so low that they can only keep their practice afloat by seeing 8 patients per hour.

I elevate this category on government involvement and assistance above all other issues. It is (in my eyes) an area that needs to be closely monitored by our government for the protection of it's people.
We agree on the importance of the topic. We differ greatly in our faith in centralized command and control measures to get the job done as effectively as market forces will. The continued existence of faith in government entities to efficiently allocate resources is contrary to nearly every observable indicator. And yet it goes on.
 
Sorry SamClem, I'm having a hard time processing the first part of your post. Maybe because it's getting late, and my brain is fried (I'll read it again in the morning) Only thing I can say for certain right now, is you appear to have zero faith in the government in most any capacity, so considering any form of government involvement in a health care plan, is not doable for you. That's fine. I respect your opinion.

I just don't see that the health care free market has been working so good for us lately in it's current form. Of course I agree that competition and more companies competing for the same dollar, is a good cost containment in the free market. Problem as you implied consolidation moves on, and big companies are allowed to swallow little companies, until like you say we only have 4 or 5 left. Maybe eventually only two. That is always bad for the consumer.

That's all the more reason to take health care out of the competitive market. One big fish, buying for everyone. Get rid of the middle man. We don't need em. Certainly not for extracting profits anyway from the money pool.
That gives the big fish a lot of negotiating power, to lower costs. Say what you want about Medicare, the government has done pretty good at squeezing there, and has a lot of happy customer to prove it. And as far health care meeting future needs, a lot of squeezing needs to be done. What if we could take that 15-25% loss ratio and give a good chunk of it to our primary care doctors.

Most other countries came to this conclusion a long time ago.

I think there is always sufficient fault to hurl at private industry as well as government, and both have been bad in one way or another. I would just for the sake of enlightenment prefer to discuss what might work. And I just don't see any evidence of the current scenario working in the future for us. There was a time it did, but that time has passed. Technology has moved on and a new day has come. So I guess for the time being, as the saying goes, we will just have to agree to disagree.
 
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That's pretty radical samclem! Whatever happened to that "giving according to their ability and receiving according to their need" talk?
Where is this generation's Milton Friedman? Somebody needs to be blasting the clay pigeons that get tossed up as valid ways to increase supply and reduce prices.
- Increasing demand (introducing more customers) increases prices, at least until supply catches up.
- Artificially capping the price of a good or service reduces supply and creates shortages
- Anything provided "free" will be subject to tremendous waste. Pricing mechanisms only work when consumers make choices involving the marginal utility of that dollar in their hand.

http://www.youtube.com/watch?v=MJgbc8ojYUg
 
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Where is this generation's Milton Friedman? Somebody needs to be blasting the clay pigeons that get tossed up as valid ways to increase supply and reduce prices.
- Increasing demand (introducing more customers) increases prices, at least until supply catches up.
- Artificially reducing prices (with caps) reduces supply and creates shortages
- Anything provided "free" will be subject to tremendous waste. Pricing mechanisms only work when consumers make choices involving the marginal utility of that dollar in their hand.


I agree with everything said there. Except I think health care should leave the free market place. Medicare (as an example of the free aspect) is abused by some, cause it doesn't cost anything to see a doctor or specialist. Very easy to pick up the phone and make an appointment when it's free. Would save a lot of money if a co-pay was enacted. As I said, there are many modifications to be made across the board that are needed.

See, SamClem. I can agree with you too.
 
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Except I think health care should leave the free market place.
It can't leave the free market place because it's not in the free marketplace now. And neither is medical insurance (which is a different issue). Government involvement and the tremendous distortions caused by this involvement (e.g. encouragement of employer-provided medical insurance, etc) have been a primary cause of the problems we've got now.

See, SamClem. I can agree with you too.
Great minds --well, you know.

Here's the great Milton Friedman addressing a Mayo clinic audience on the impact of government involvement on US medical care. Presented in 1978, it's amazing how things have continued along the trendlines he anticipated, though he does not pay enough attention to the problems inherent in private insurance underwriting. It's a 6 part series, approx 10 minutes each, so I'd advise anyone against starting it unless this is of burning interest.

 
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