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yoda634
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Originally Posted by UID=30151 View Post
I didn't say that the government should just distribute wealth evenly, even to people who don't work as hard. Everyone should work more or less equally as hard, but they should be given an equal chance to do so. Right now, that is not the case.

Why should everyone work equally as hard? The lazy have a right to be lazy. Those who have a superior work ethic also have a right to work as hard as they want.

I don't see how anyone has less of a chance to work hard than anyone else. Sure, some people start with less than others, but that's a fact of life, and there's nothing that can really be done about that. Everyone has "a chance" to work hard and make something of themselves though.
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Old 02-25-2008, 07:21 PM yoda634 is offline  
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Why can't it be a voluntary system? If I don't feel like paying for other peoples health care I shouldn't be forced to by our government. Why do those who make the most money be forced to pay for the care of others?

Last edited by BigFuzzyArchon; 02-25-2008 at 10:50 PM..
Old 02-25-2008, 10:49 PM BigFuzzyArchon is offline  
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mathlete
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A 19 year old doesn't know shit about making it in the real world. Stop pretending you do.
Old 02-25-2008, 11:07 PM mathlete is offline  
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Isn't that the result of not enough privatization, i.e. government-imposed restrictions on professional licensing? If those restrictions were lifted and, for example, scores of foreign-trained doctors, nurses, etc. were allowed to setup shop, would it be that easy to exploit shortage with high prices?

Explain to me how a free market works when you have a large amount of asymmetrical information and a very inelastic good...
Old 02-25-2008, 11:13 PM Spacemoose is offline  
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Explain to me how a free market works when you have a large amount of asymmetrical information and a very inelastic good...
By providing the most incentives to acquire information and not be ignorant or inattentive, you solve the problem of asymmetrical information as best as can be done under the circumstances. Any alternative invariably takes those incentives and disincentives away, which ensures that the people will remain stupid and careless about their health. There's just no other way to do it--if you want to put a democratic committee in charge of health care, you end up with the same people on the committee, or selecting the committee, that were stupid and ignorant to run their own lives to begin with. How do you solve that problem?

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A 19 year old doesn't know shit about making it in the real world. Stop pretending you do.
Stop pretending like your condescending reference to the "real world" is anything but guilt for not being strong enough to have and hold convictions.
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Old 02-25-2008, 11:45 PM cromicus is offline  
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By providing the most incentives to acquire information and not be ignorant or inattentive, you solve the problem of asymmetrical information as best as can be done under the circumstances. Any alternative invariably takes those incentives and disincentives away, which ensures that the people will remain stupid and careless about their health. There's just no other way to do it--if you want to put a democratic committee in charge of health care, you end up with the same people on the committee, or selecting the committee, that were stupid and ignorant to run their own lives to begin with. How do you solve that problem?

And yet the empirical evidence seems to show that the country with the most privatized healthcare is also the fattest and most drugged in the world.

You still haven't addressed the inelastic nature of the good itself, and the fact that with a good as inelastic as healthcare you'd expect to see some horrendous rent extractions occurring...and, you're also ignoring the fact that being in ill health frequently has nothing to do with a lifestyle choice.
Old 02-26-2008, 12:26 AM Spacemoose is offline  
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A different perspective:
I'm a med student. I will most likely become a specialist and not a GP.
If I would move to the US, I would probably make 5-10 times as much money.

Being a MD is not about money however. If the students in my university would all choose a different profession, they would all make much more money. And they know it.

Health is an universal right. People who are healthy and have good acces to healthcare, are way more productive. Socialised medicine, a two-tier system, works. I see this every day. The rich can still have private healthcare if they choose so.

Yes, there is bureaucracy. And most doctors complain about it. But while the bureaucracy leads to some wasted time and funds, almost no patient is left behind. There are many problems with the system, but almost none truly failing patients.

I would not want to work in the US. I don't need 3 houses and 4 cars. I wouldn't be able to work in a hospital that is run as a company entirely for profit. I think most doctors have the same view on this. Those who don't have chosen the wrong profession.
Old 02-26-2008, 12:45 AM dovvie is offline  
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Originally Posted by yoda634 View Post
The stories you hear of people being denied payment though covered, and insane rate increases would be a thing of the past if people could, at any time, tell their insurance carrier to fuck off and get a new one. Unfortunately, that's not how the current system works for the vast majority of America.
That's not how it would work even if there were a billion insurance agencies because they don't generate profit by insuring people who are already sick. Once you are sick the cost to insure you goes up, this makes you less desirable an employee because it means you will cost the company's health insurance more and this means if you lose your job you are less likely to get another with coverage. This is why health care provision should be handled by the government. Because lives are more valuable than dollars and sometimes it makes sense for a government to run at a loss where a for profit company it wouldn't.

Insurers don't advertise how healthy they will make sick people, that would cost money.
http://www.washingtonmonthly.com/fea...1.longman.html
Quote:
Why care about quality?

Here's one big reason. As Lawrence P. Casalino, a professor of public health at the University of Chicago, puts it, "The U.S. medical market as presently constituted simply does not provide a strong business case for quality."

Casalino writes from his own experience as a solo practitioner, and on the basis of over 800 interviews he has since conducted with health-care leaders and corporate health care purchasers. While practicing medicine on his own in Half Moon Bay, Calif, Casalino had an idealistic commitment to following emerging best practices in medicine. That meant spending lots of time teaching patients about their diseases, arranging for careful monitoring and follow-up care, and trying to keep track of what prescriptions and procedures various specialists might be ordering.

Yet Casalino quickly found out that he couldn't sustain this commitment to quality, given the rules under which he was operating. Nobody paid him for the extra time he spent with his patients. He might have eased his burden by hiring a nurse to help with all the routine patient education and follow-up care that was keeping him at the office too late. Or he might have teamed up with other providers in the area to invest in computer technology that would allow them to offer the same coordinated care available in veterans hospitals and clinics today. Either step would have improved patient safety and added to the quality of care he was providing. But even had he managed to pull them off, he stood virtually no chance of seeing any financial return on his investment. As a private practice physician, he got paid for treating patients, not for keeping them well or helping them recover faster.

The same problem exists across all health-care markets, and its one main reason in explaining why the VHA has a quality performance record that exceeds that of private-sector providers. Suppose a private managed-care plan follows the VHA example and invests in a computer program to identify diabetics and keep track of whether they are getting appropriate follow-up care. The costs are all upfront, but the benefits may take 20 years to materialize. And by then, unlike in the VHA system, the patient will likely have moved on to some new health-care plan. As the chief financial officer of one health plan told Casalino: "Why should I spend our money to save money for our competitors?"

Or suppose an HMO decides to invest in improving the quality of its diabetic care anyway. Then not only will it risk seeing the return on that investment go to a competitor, but it will also face another danger as well. What happens if word gets out that this HMO is the best place to go if you have diabetes? Then more and more costly diabetic patients will enroll there, requiring more premium increases, while its competitors enjoy a comparatively large supply of low-cost, healthier patients. That's why, Casalino says, you never see a billboard with an HMO advertising how good it is at treating one disease or another. Instead, HMO advertisements generally show only healthy families.

In many realms of health care, no investment in quality goes unpunished. A telling example comes from semi-rural Whatcom County, Wash. There, idealistic health-care providers banded together and worked to bring down rates of heart disease and diabetes in the country. Following best practices from around the country, they organized multi-disciplinary care teams to provide patients with counseling, education, and navigation through the health-care system. The providers developed disease protocols derived from evidence-based medicine. They used information technology to allow specialists to share medical records and to support disease management.

But a problem has emerged. Who will pay for the initiative? It is already greatly improving public health and promises to bring much more business to local pharmacies, as more people are prescribed medications to manage their chronic conditions and will also save Medicare lots of money. But projections show that, between 2001 and 2008, the initiative will cost the local hospital $7.7 million in lost revenue, and reduce the income of the county's medical specialists by $1.6 million. An idealistic commitment to best practices in medicine doesn't pay the bills. Today, the initiative survives only by attracting philanthropic support, and, more recently, a $500,000 grant from Congress.

For health-care providers outside the VHA system, improving quality rarely makes financial sense. Yes, a hospital may have a business case for purchasing the latest, most expensive imaging devices. The machines will help attract lots of highly-credentialed doctors to the hospital who will bring lots of patients with them. The machines will also induce lots of new demand for hospital services by picking up all sorts of so-called "pseudo-diseases." These are obscure, symptomless conditions, like tiny, slow-growing cancers, that patients would never have otherwise become aware of because they would have long since died of something else. If you're a fee-for-service health-care provider, investing in technology that leads to more treatment of pseudo-disease is a financial no-brainer.

But investing in any technology that ultimately serves to reduce hospital admissions, like an electronic medical record system that enables more effective disease management and reduces medical errors, is likely to take money straight from the bottom line. "The business case for safety…remains inadequate…[for] the task," concludes Robert Wachter, M.D., in a recent study for Health Affairs in which he surveyed quality control efforts across the U.S. health-care system.

If health care was like a more pure market, in which customers know the value of what they are buying, a business case for quality might exist more often. But purchasers of health care usually don't know, and often don't care about its quality, and so private health-care providers can't increase their incomes by offering it. To begin with, most people don't buy their own health care; their employers do. Consortiums of large employers may have the staff and the market power necessary to evaluate the quality of health-care plans and to bargain for greater commitments to patient safety and evidence-based medicine. And a few actually do so. But most employers are not equipped for this. Moreover, in these days of rapid turnover and vanishing post-retirement health-care benefits, few employers have any significant financial interest in their workers' long-term health.

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Insurance companies should not be making or influencing treatment decisions. If you get into a wreck, your insurance company doesn't tell the mechanic how he should fix it, they simply pay him to fix it. Mechanics know how to fix cars, insurers don't. Doctors know how to fix people, insurers don't.
Totally agree with you there. That's why I think we need to go single payer/dual tier.

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Again, we pay more because of market stagnation. Lack of competition leads to high prices.
Actually one of the reasons we pay more now is because of the number of insurers and payers in our system already. Because of the number of payers, doctors and hospitals already have to deal with in order to get paid we pay three times more per capita than Canada for health care administration.

http://www.consumeraffairs.com/news04/health_plan.html
Quote:
The authors found that bureaucracy accounts for at least 31 percent of total U.S. health spending compared to 16.7 percent in Canada. They also found that administration has grown far faster in the United States than in Canada.

The potential administrative savings of $286 billion annually under national health insurance could:

1. Offset the cost of covering the uninsured (estimated at $80 billion)
2. Cover all out-of-pocket prescription drugs costs for seniors as well as those under 65 (estimated at $53 billion in 2003)
3. Fund retraining and job placement programs for insurance workers and others who would lose their jobs under NHI (estimated at $20 billion)
4. Make substantial improvements in coverage and quality of care for U.S. consumers who already have insurance

Looked at another way, the potential administrative savings are equivalent to $6,940 for each of the 41.2 million people uninsured in 2001 (the most recent figure available for the uninsured at the time study was carried out), more than enough to pay for health coverage. The study found wide variation among states in the potential administrative savings available per uninsured resident.

Texas, with 4.96 million uninsured (nearly one in four Texans), could save a total of $19.5 billion a year on administration under NHI, which would make available $3,925 per uninsured resident per year.

Massachusetts, which has very high per capita health administrative spending and a relatively low rate of uninsurance, could save a total of $8.6 billion a year, which would make available $16,453 per uninsured person.

California, with 6.7 million uninsured, could save a total of $33.7 billion a year, which would make available $5,016 per uninsured person.
http://www.nchc.org/facts/cost.shtml
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm


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Your "sarcastic riff," though obviously exaggerated, is also a bit off base. Sure, not everyone's going to go out and become a paragon of self-destructive behavior, but it's the minor things that would change. I don't go to a doctor every time I have a cold. I take it easy, get plenty of rest, drink fluids, etc. and wait for it to go away. When I cut myself, I bandage it up, keep it clean, etc. When I get a headache, I take some aspirin and rest. I haven't been to a physician in 10 years, except for things like vaccinations and physicals, and I'm perfectly healthy. Now, if it was free for me to run to a doctor and get prescribed some free medicine everytime I had a cold, or if I could get a doctor to dress all my little cuts and scrapes for free, or if everytime I got a headache I could go get the doctor to make sure it wasn't a brain tumor, I probably would. 300 million people going to the doctor once a month would completely clog the system. Good thing that I (and millions of others) can't afford to go to a doctor for every little matter, and that we have to wait until we actually, truly need a doctor.
The gold standard in this area, the RAND health insurance experiment from yesteryear came to the conclusion that the difference between totally free care and out of pocket care was a couple of doctor visits a year and 0.03 hospitalizations per year.

http://www.rand.org/pubs/research_br...AND_RB9174.pdf

Other problems with this study that seem obvious to me are:

1. early 1970s health care versus now
2. They only gave people insurance for 3-5 years. Not a very long term to test the effects of health care or base decisions about a lifelong universal system on.
3. even with the short timespan there were positive benefits.
4. highly effective treatments were reduced as well as less effective treatments.
5. There was no change in risky behavior
6. RAND on the RAND HIE:
Quote:
Today’s health care environment differs in fundamental ways
from the one in which the HIE took place. The science of
medicine has changed across all dimensions. Managed care
has become more prominent, as has prescription drug use.
Doctors emphasize preventive care to a greater extent and
know more about providing it. Given these and many other
systemic changes, it is impossible to know whether a similar
experiment undertaken today would produce similar results.
7. I don't think they took into account the potential cost savings of preventative care, especially not the myriad of developments since the early 1970s in both preventative care and diagnostic ability. i.e. http://www.rand.org/pubs/research_briefs/RB9169/
8. They offered free care temporarily in a market where that was unknown. I bet if you offered to give people free care today you'd see the same thing, only more pronounced, because of the existing conditions and the greatly increased costs. For a proper test you'd need to see the effect across an entire lifetime or a couple generations where people were used to the idea of a national/universal/"free" system. Otherwise it's a novelty temporary giveaway that almost guarantees higher usage. If you gave a great percentage of the uninsured and underinsured persons today temporary free coverage they'd likely go and get all the things they have been putting off getting looked at because of cost concerns looked at ASAP.

In a real national/universal system people would not put off seeing doctors because of cost concerns and they also likely wouldn't go and see the doctor for every little trivial thing just because it was free because having health care without cost concerns wouldn't be a novel temporary condition for them.
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Old 02-26-2008, 02:39 AM pyramid is offline  
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Originally Posted by wingedbuttmonkey View Post
Such as a strain on supply with increased demand.
It seems to work.

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Yea but the fairness is disproportionate. It is nice that I can afford to pay for 3 families health insurance, but why force me to do it? Instead you should encourage me to donate through lower taxes and donation incentives.
The fairness is not disproportionate if you still have ten times more wealth and income than the three families you provided health care for even after being so unfairly taxed.

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We are near the top in responsiveness. Our accessibility is also very high. Health is another issue but I attribute this more to lifestyle choices than the health system.
People don't just get sick because of personal failings. There's also stress, environmental pollution, genes, diseases, accidents, poor nutrition and hygiene, etc.


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again, thats many small countries vs one big one.

If you look at that list closely we are about in the middle of the countries who have universal health care. Sure a lot are better but they have much smaller populations.
Seems to me that per capita measures of doctors and specialists and hospitals and costs would scale pretty nicely. So comparing per capita costs across modern nations of different population sizes would be a fair comparison.

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If that is true then our current system is so riddled with inefficiencies that a simple restructure could take care of a lot.
Not if we restructure back to the same inefficient system.

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I am not opposed to allowing states fund their own health care initiatives, see above.
Neither am I but I think they all need to do it and not turn this into another "states rights" issue.

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They also have 1/10th our population. And they only have 7 large cities with higher concentrations of their population so they can concentrate on a higher percentage of their population with ease.
Most of our population is concentrated in cities or large metropolitan areas too.

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speaking about how people perceive rights that are violated, not health care
He is speaking about rights being violated by universal health care.

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Second sentence - I believe he is speaking of using the diction of "rights" to force someone to pay for it
Pay the taxes that would pay for universal health care.

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It depends on what you consider working. The trade offs for universal health care do not impress me.
Really, 50% of the costs with better average results doesn't impress?

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The supply and availability of complex procedures are sometimes low which causes the rich to pay additional money they would have otherwise not and the poor to not get the treatment. These are the same procedures that gets uninsured people into financial trouble because they cant afford them. Theres also the issue with where you may go and who you may see. They are more efficient only because they have smaller populations.
The wait times in most places are comparable with here. The wealthy in dual tier nations can choose to pay more for faster service. The poor in our nation who can't afford treatment wait forever to get it, not six months. The poor in UHC nations wait six months and don't end up with a lifetime of debt for their wait. People in UHC nations have plenty of choice about who to see, even Canada. They are not more efficient because of their smaller populations, they are more efficient because of how they provide health care.

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Well then they can do what they want and we will do what we want.
And when we decide we want universal care? Hopefully soon?

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I like how we provide universal health care to Iraq and Afghanistan.
Indeed. Though I think I'd take a run down hospital in Detroit over one in either of those countries at the moment.

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I was going to save this for later because I was having some fun but whatever. I am pro-universal health care. Not to the extent that some people take it. I think the states should manage it and not the federal government. I also think there should remain a private industry for those who wish to take advantage of the perks.
I believe that's pretty much how it works in most nations.

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It would be nice if a state could get private companies to manage everything for them, since public management pretty much sucks.
Then why do public health care systems operate with far less overhead than our private system?

Quote:
I also think we should fund all of this without a single increase in taxes, or by restructuring our shit tax system to something like the 1% tax (where EVERY exchange of money is taxed at 1%). But thats another debate.
I could be for that. I'm for a 1% national sales tax.

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The rich should donate to our health care problem, not be forced to.
That is an unrealistic pipe dream. Lords don't care about serfs, there will always be more. People who believe in social Darwinism are not going to become magically altruistic because their tax burden is reduced. They will still harbor the same prejudices they did before and will be no more interested in the idea of a social contract or the reality that they are not the "rugged individuals" they fancy themselves to be.

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I still don't believe it is a right, just the right thing to do.
I think the only way to make it possible may be to make it a right, including a constitutional amendment to that effect.
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Old 02-26-2008, 03:57 AM pyramid is offline  
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If only the top 33% of earners can actually afford to have life, liberty, and a pursuit of happiness then what good are those so called rights to the majority of the nation? Can you have liberty or a pursuit of happiness without life?
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Old 02-26-2008, 04:45 AM pyramid is offline  
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yoda634
my title sucks i need a new one.
 
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A 19 year old doesn't know shit about making it in the real world. Stop pretending you do.

Excellent argument, douche. You don't know shit about me. Stop pretending you do.

And I find it creepy that you know my age.
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Old 02-26-2008, 08:10 AM yoda634 is offline  
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Originally Posted by pyramid View Post
If only the top 33% of earners can actually afford to have life, liberty, and a pursuit of happiness then what good are those so called rights to the majority of the nation? Can you have liberty or a pursuit of happiness without life?

Actually 84% have it.
Old 02-26-2008, 08:41 AM wingedbuttmonkey is offline  
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Originally Posted by yoda634 View Post
Excellent argument, douche. You don't know shit about me. Stop pretending you do.

And I find it creepy that you know my age.

You listed your birthdate in your profile.

I just find it quite disingenuous when you say things like this:

Quote:
Originally Posted by yoda634 View Post
I don't see how anyone has less of a chance to work hard than anyone else. Sure, some people start with less than others, but that's a fact of life, and there's nothing that can really be done about that. Everyone has "a chance" to work hard and make something of themselves though.

It's a lot harder to "make it" in life than you or even I probably realize.
Old 02-26-2008, 08:55 AM mathlete is offline  
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I wouldn't be able to work in a hospital that is run as a company entirely for profit. I think most doctors have the same view on this. Those who don't have chosen the wrong profession.
Where exactly does it say in the fundamentals of the medical profession that you have to force other people to pay you to practice medicine?
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Old 02-26-2008, 10:28 AM cromicus is offline  
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And yet the empirical evidence seems to show that the country with the most privatized healthcare is also the fattest and most drugged in the world.
I don't think that that is the consequence of too much private health care, but not enough. In fact I think that the indulgent nature of the health care industry in the US and the unhealthy lifestyles of many Americans stem from the same problem, which is too much economic security and complacency. Do you really want to correlate the private heath system with obesity and drugs, or do you just want to rationalize forcing other people to pay for your own incompetence?

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You still haven't addressed the inelastic nature of the good itself, and the fact that with a good as inelastic as healthcare you'd expect to see some horrendous rent extractions occurring...
Yup, which is why you want strictly enforced contacts--when you hire a doctor to advise you as to what your health problems are and what you need to fix them, you aren't paying him to rattle off as many of the most expensive and profitable tests and procedures that he can think of charging you for. Also, rents only exist in a highly regulated market, such as the one that exists now where only a politically-connected class can become doctors even though many others are and could be qualified. Any naturally arising rents that come from inelasticity can't be avoided anyways.

Quote:
and, you're also ignoring the fact that being in ill health frequently has nothing to do with a lifestyle choice.
Of course I'm ignoring that, it's totally irrelevant.
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Old 02-26-2008, 10:35 AM cromicus is offline  
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