How to Charge $546 for Six Liters of Saltwater

[Bill Peckham]

The ACA doesn't fund health care! Are you serious Bill?

Just because it doesn't fund 100% of health care does not in any sense diminish the expansion the public sector health care nor the new subsidies on the exchanges nor shunting more from the private sector into the government sponsored exchanges.

In addition, you are overlooking the massive takeover and of the ENTIRE health care system which is NOW controlled by the government. If you cannot understand the socialistic nature of the entire ACA, there is little point in further discussion.

In addition, it is getting tiresome to read your absurd and false insults against me in almost all of your responses. Bill, if you wish to discuss politics, you have stated on many occasion you enjoy that so let's talk politics if you wish. I have not ventured into trading insults against you in response to yours simply because I still respect your friendship and your contributions mentoring me in blogging and introducing me to those in dialysis advocacy.

Saying you self refute is an insult? I think it's an observation - you made a claim: "socialistic approach employed by this administration" meaning the ACA's approach to providing access to health insurance is socialistic. Then you defined your meaning: "public funded healthcare is essentially socialized medicine for a short definition." Is the administration's approach to expanding access to health insurance socialistic? No, because it doesn't use public funds to pay for healthcare. Am I insulting you by pointing this out? The subsidies for the purchase of health insurance put individual buyers on an equal footing with employers who provide coverage and receive tax preferences fo r health insurance. Was the historic practice of allowing tax breaks for providing health insurance through work socialistic? Was that an example of socialistic public funded healthcare? I'd say no and I'd say offering low income subsidies for health insurance is not socialistic, even by your definition.

You make a claim that there has been a " the massive takeover and of the ENTIRE health care system which is NOW controlled by the government", what are you talking about? Controlled in what sense? To engage with this statement at all I have to state that I find it to be wrong. Is that an insult? to disagree? To think a statement you made makes no sense is an insult?

[Hemodoc]

If I remember correctly, the exchanges are called the "Federal Healthcare Insurance Exchanges." Interestingly, they probably won't open on time due to one more delay of this massive law that is truly a train wreck heading down the tracks. Open enrollment is supposed to start on October 1 this year but they still don't have the insurance contracts in place.

You also keep forgetting about the expansion of Medicaid and the tax credits to those who are less than 400% of the federal poverty rates. That by definition is a socialistic program.

In addition, those that have their own private insurance through employers are at great risk of losing that coverage and being forced into the exchanges. Many will be above the 400% threshold but not be able to afford what is offered in the exchanges. The train wreck continues down the tracks.

All people in the US are now required to have or buy health insurance. All are required to submit to the IRS proof of that coverage and face fines if they don't have that proof. This is a huge portion of the US economy that is now under the power and control of the US Federal government.

[Quickfeet]

I'm not commenting on your discussion, but doesn't every government have to have a certain degree of socialism? If the government doesn't control anything wouldn't that be anarchy? The government owns the police dept., fire dept., libraries, etc. So why is the government owning the healthcare system any different than them owning the fire dept.?

I'm sincerely interested in peoples opinion. I'm not a political person and I don't understand where or why the line is drawn. From what I have read, there hasn't ever been a pure capitalist or socialist government.

[rocker]

Sorry Rocker, it appears you don't understand what socialism really is which is probably not surprising since most folks don't understand the concept of socialism.

Some people understand it so little that they can't even provide a definition when asked.

Rocker, simply because the government does not yet own the bricks for all of the health care facilities does not in the least prevent you from understanding how the ACA is moving from a capitistic/individualistic system to a collectivist/government controlled system. The exchanges are paving the way for a single payer system in that all of the private insurers are dictated to on coverage details in large part eliminating competition between the different insurance companies. Competition as you must be aware is one of the hallmarks of capitalism.

Again, unsupported nonsense.  Your entire premise rests on mindreading and clairvoyance - you (and only you) understand what the government intends to do, and you can see the future to know where this leads.

Sorry, I don't believe in psychic powers.

In addition, you are ignoring the impact of ACO's on the current fee for practice, i.e., private practice that has put the final nail in the coffin eliminating this last vestige of capitalism in American medical practice. And yes, it is the ACA that brings this into place:


The Patient Protection and Affordable Care Act (ACA) authorizes the use of Accountable Care
Organizations (ACOs) to improve the safety and quality of care and reduce health care costs in
Medicare. The ACO program – a voluntary program – began on January 1, 2012. This is not a
demonstration project or pilot, it creates a new entity, an ACO that can directly contract with
Medicare. 

You mean, the organization that ensures that Medicare is not reimbursing for snake oil?

Sorry, but I'm in favor of reducing waste and fraud in Medicare.  If you aren't, that's fine. But I don't think a lot of people share your opinion.

[Hemodoc]

Rocker, once again, you don't read what I write. I DID provide a definition, that of Marx which is what I believe is behind the heart of socialistic endeavors. It is a transitional state. Every socialistic state is DIFFERENT since it is in a state of transformation from capitalism to communism, from private ownership to public ownership. (Can you say GM)  In such, yes, the ACA is indeed in every aspect just that since it is transforming the American health care from an individualistic to a collective system, it is transforming the US health care from private control to their goal of a single payer system. Yes, I did indeed give a definition, that from the origin, Marx.

No psychic powers, Harry Reid has openly stated that is the goal. Anyone that looks at the impact that the ACA will have understands it is a transitional law destroying the current employer based system that will evolve into a fully supported government entity at some point. So, not psychic at all my friend. That has always been Obama's objective as well.

http://www.forbes.com/sites/theapothecary/2013/08/10/sen-harry-reid-obamacare-absolutely-a-step-toward-a-single-payer-system/

http://www.youtube.com/watch?v=fpAyan1fXCE

Rocker as far as doc control of health care issues which can only occur when docs are independent is going to be the worst aspect of collectivist health care in the future here in the US. What do I mean? As a practicing internist, I stood in the gap between the bean counters and the patients on more than one occasion. The bean counters by the way were many times over in the government sponsored health systems, not just private insurance. I just documented how the nurses and admin at FMC tried to reduce the dosage on my treatments for cost purposes only and in doing so put forth a "medical" justification that was pure lies.

What stood in the gap for me? My doctor who put a stop to that. Your ignorance that docs are the ONLY effective advocate for patients that can still influence outcomes and treatment choices is evident in your response. When the docs are shackled and silent and impotent to advocate for patients, then my friend, you shall see the real teeth of health care "reform" bared.

Lastly, before the government takeover of health care in the 1960's with LBJ, docs routinely provided care that they did not get paid a red cent and were glad to do it as a part of their professional duties. If you do not understand that this still occurs, I won't bother to educate you on that, but I have indeed mentioned recently the unfunded mandates that my colleagues at Kaiser operated under at great professional risk due to high risk pregnancies in a population with a VERY high rate of lawsuits. So, you are wrong my friend, today, hospitals and doctors across this nation today will see thousands of patients and not get a red cent of reimbursement. Docs in this nation have always taken care of the patient and worried about getting reimbursed later.

That is NOT the way it is in other countries. Go on a cruise to Mexico, get Montezuma's revenge and have to leave in a Mexican port. The first thing the ambulance company will do is ask for your credit card which they will check before boarding you. Then when you get to the hospital, before you are admitted, you WILL have to likewise secure payment BEFORE you are treated. It is NOT that way in this nation my friend, but your hatred and bias against docs is not surprising.

[rocker]

I'm not commenting on your discussion, but doesn't every government have to have a certain degree of socialism? If the government doesn't control anything wouldn't that be anarchy? The government owns the police dept., fire dept., libraries, etc. So why is the government owning the healthcare system any different than them owning the fire dept.?

I'm sincerely interested in peoples opinion. I'm not a political person and I don't understand where or why the line is drawn. From what I have read, there hasn't ever been a pure capitalist or socialist government.

Yes, it is confusing.  Those people yelling about the dangers of socialism never seem to acknowledge the fact that the US government has a very large number of socialist programs.  From fire and police (as you correctly note) to the VA, Medicare, Medicaid, Social Security, and many others.

To be fair, there are a few extremists out there trying to eliminate Social Security and Medicare, and to privatize services like fire and police. But everyone recognizes that that is a hopeless quest.  All Americans love their socialist programs - as long as they feel they can personally benefit from them.

[Hemodoc]

No one yelling Rocker, just simply putting forth historical and political truths. 

You seem to be ignorant of the founding fathers separation of powers between the Feds and the States. Just because a community has fire and police does not make that socialistic. What is your definition of socialism my friend. I believe you are confused on what is socialism and what is simply a community service provided by that community and often done as a VOLUNTARY UNPAID service. That is before unions came into being.

Obama is destroying Medicare so who is the extremist?

Obama is not addressing the Social Security short falls, so who is the extremist?

Most working Americans do not benefit from the multitude of socialistic programs that continue to expand unchecked in our ever growing government and they don't enjoy the tax burden at all.

[Quickfeet]

No one yelling Rocker, just simply putting forth historical and political truths. 

You seem to be ignorant of the founding fathers separation of powers between the Feds and the States. Just because a community has fire and police does not make that socialistic. What is your definition of socialism my friend. I believe you are confused on what is socialism and what is simply a community service provided by that community and often done as a VOLUNTARY UNPAID service. That is before unions came into being.

I used the definition you referenced by Marx(intermediate stage between capitalism and communism). In the city I live, the fire dept. and the police dept. are both controlled and owned by the city government. There is no private community that provides us these services, just the government. It is true that there are some volunteers, but I'm not sure how that would make these institutions capitalists. The volunteers do not own the institution nor do they profit from it. Also there is no competition either, if the fire dept. is called to your house or business you have to pay them what ever they say. In an earlier post you stated, "Competition as you must be aware is one of the hallmarks of capitalism." I'm not aware of any "community" that has a privately funded police dept. or fire dept. Unless you are referring to the Amish.


So you are saying if we simply change health care to a service that is provided by the local community like the fire dept. then it is capitalist? If the communities eliminated privately owned hospitals and then provided community funded hospitals and doctors, then it wouldn't be socialist? Obviously to keep with your argument, the hospital's staff would include plenty of volunteers. Is this what you are saying?

[Hemodoc]

Please explain how a community that comes together, democratically votes and provides for their own protection through police, fire, streets, water and sewer is a political synthesis of progressively going from a capitalistic society to a communist society?

The irony is that now you are arguing that all of these basic services are "socialistic" while Bill and Rocker are alleging the ACA is NOT socialistic. You folks are now opposing each others arguments. So how can fire, police and sewer services be socialistic and the ACA is not?

[rocker]

Please explain how a community that comes together, democratically votes and provides for their own protection through police, fire, streets, water and sewer is a political synthesis of progressively going from a capitalistic society to a communist society?

You're making even less sense now.  Your argument seems to have devolved to "I hate socialism, I like the police and fire department, therefore they are not socialist."

The irony is that now you are arguing that all of these basic services are "socialistic" while Bill and Rocker are alleging the ACA is NOT socialistic. You folks are now opposing each others arguments. So how can fire, police and sewer services be socialistic and the ACA is not?

Because they are different.  This makes as little sense as "how can police and fire be socialistic, but Microsoft is not?"  The exchange consists wholly of private for-profit insurance companies, who pay for services at private doctors and hospitals.  When asked how the ACA represents a "government takeover", your response was that the exchanges had the word "federal" in them.  More nonsense.

Please give me a list of the doctors, hospitals, and insurance companies that will pass from private to government ownership under the ACA.  And spare me the clairvoyance this time.

[Hemodoc]

Rocker, please put forth YOUR definition of socialism.

I have already put forth an example (European socialism) a partial definition of socialized medicine (public funding) and the inherent goal in the definition by Marx (a transitional state between capitalism and communism)

Please put forth you OWN definition for clarification of your views.

Secondly, just because a community has a police force, or a fire dept. does not in any manner tell us what political philosophy underlies their governmental organization. For your information, the first paid police force in America was Philadelphia in 1751. I don't recall that being part of a transition from capitalism to communism since Marx wasn't even born until 1818.

The first fire dept in the US is attributed by some accounts to Ben Franklin in 1736. Are you arguing that Ben Franklin was a Socialist over a hundred years before Marx defined socialism as a transitional state between capitalism and communism? What about all of the founding fathers who served as volunteer fireman in their younger days? Are they socialists as well?

http://en.wikipedia.org/wiki/Union_Fire_Company

These are simply community services that are evidence of advanced and developed civilization and in no manner refutes the underlying capitalism of that day.

However, understanding the socialism is a transitional state between capitalism and communism, yes, absolutely, the ACA is one of the most transitional acts of legislation you could ever find as an example of the Marxist definition of socialism. It is already having a terrible effect on free market businesses here in the US and I have already discussed the huge impact it is having against the last vestiges of private medical practice in the US.

So, your refutations are once again groundless and without any supporting documentation.

[Quickfeet]

Please explain how a community that comes together, democratically votes and provides for their own protection through police, fire, streets, water and sewer

I'm not sure where you live but in the united states we don't as you say, "democratically votes and provides for their own protection through police, fire, streets, water and sewer." We vote for representatives that then make those decisions. These programs are provided by our elected government and financed through the taxes we pay, as I basically said already, but you keep referring to a "community". I stated earlier that it doesn't work like that here. I don't know how things work with the Amish or on Indian reservations, but I'm not asking about them. I'm asking you how a government owned and run organization like the fire dept. is in any way a capitalist organization. I explained exactly how it works here. So I don't understand why you keep referring to a "community". Can you give an example of a community that actually does what you say? If an institution is not capitalist and yet not quite communist, then doesn't that make it, "intermediate stage between capitalism and communism." Which is what you said Marx said was socialism, and you said that Marx understood socialism best.

"you are arguing that all of these basic services are "socialistic"

I haven't made any arguments. I only explained to you how things are done in the city I live and asked you to explain why you think it is capitalist despite your definition of socialism seeming to be a better match. I then gave an example of a way to provide health care under the conditions you said were non-socialist, and asked if that was a correct interpretation of how you saw things. And you haven't responded to that.

Please explain how a community that comes together, democratically votes and provides for their own protection through police, fire, streets, water and sewer is a political synthesis of progressively going from a capitalistic society to a communist society?

when you referenced Marx, you didn't say it had to be a progressive transition. To reiterate, I am asking you how these institutions are capitalistic, so I am very confused as to why you are asking me to prove something when I never claimed they were socialist.

You folks are now opposing each others arguments. So how can fire, police and sewer services be socialistic and the ACA is not?

I stated from the beginning that I wasn't involved in your debate. I simply wanted to know where the line was drawn on what is socialist and what isn't. So far what you have said about the institutions I mentioned does not match with how things are done in the united states.


So just to be clear I'm not debating anything. I have two questions for hemodoc because I don't understand why one thing is socialist and another isn't even though they seem to operate the same way.
First, how is the fire department capitalist? If you could explain why, given how my fire department is operated, it isn't socialistic that would be helpful, but probably unnecessary if you can show that it is capitalistic.
Second, can you explain why having a community provide healthcare for the protection of their fellow American citizens is different from them providing a fire department?

If you are unable to answer these two questions, it's o.k. just say so. I am not try to argue with you and I don't care about the discussion about the "ACA". I am confused why you feel there is a difference but I hope that I will understand once you are able to answer my two questions.

[Hemodoc]

Dear Quickfeet

I went back to your first comment and it had to do more with where is the line drawn defining anarchy. That is an interesting discussion in itself since that was a large part of the American debate at the beginning of our nation. The founding fathers put into place limitations on our Federal government. The first experiment failed because it did not give the Feds enough power under the articles of confederation. The response was the 1789 constitution which still placed limits on government and granted constitutional protections on God give natural rights, but gave the feds enough power to prevent the chaos of the time under the articles of confederation.

Their discussion was about how far do you move the power of government to prevent anarchy which they had in a limited fashion under the articles of confederation but keep it from becoming totalitarian which is the sad history of democracies. In such, they rejected the political organization of democracy which is rule by the majority for that of a constitutional republic, rule by law with three competing spheres of influence.

So while anarchy and how to prevent anarchy and what degree of limited government powers should the Feds have was at the heart of their discussions, simply because a community likewise imposes governmental powers to prevent anarchy and they should does not lend itself to revealing what type of political philosophy the politicians espouse. Pretty much all modern civilizations have some degree of the rule of law. So the discussion on that level is between anarchy and totalitarianism and how much power you grant that government to prevent anarchy.  Unfortunately, governments over time find ways to usurp more and more power.

So, I don't see how a police force or fire dept, etc. is evidence for or against capitalism, socialism or communism. It is simply a basic application of the rule of law to prevent anarchy as you stated in your first comment.

[Quickfeet]

I understand your point about the police being an extension of the rule of law. However, it seems like the fire dept. could just as easily be run by a business for profit which would make it capitalistic, but it is instead run by the government which would be socialist. The same for public library's and other services. I guess I just don't see what the big deal about putting labels on things is about. Shouldn't things really be about what works best not arguing over philosophy.

[Hemodoc]

I understand your point about the police being an extension of the rule of law. However, it seems like the fire dept. could just as easily be run by a business for profit which would make it capitalistic, but it is instead run by the government which would be socialist. The same for public library's and other services. I guess I just don't see what the big deal about putting labels on things is about. Shouldn't things really be about what works best not arguing over philosophy.

I suspect we are pretty much in agreement. The point I was trying to make is that these basic services existed before the world ever heard of socialism. In such, from my point of view, I don't know how these basic services could be used as evidence for or against socialism itself. That is all I was trying to state with the example of Ben Franklin.

Have a great weekend,

God bless,

Peter

[obsidianom]

I have read all the arguments back and forth on this thread. I have all kinds of opinions but instead will just state a few things that came into my head.
1. I am not a big fan of our 'founding fathers" as they didnt recognize women as equals , allowed slavery and had numerous other issues. Also they lived in the 1700s , so their perspective on our life now would be quite speculative. They did their job giving us a framework , but beyond that the rest is history , so to speak.
2. medicine in Canada is lousy. I spent 15 years working up there as a consultant while practicing in the US. . The doctors up there hate it . Waiting times for non emergency procedures and treatments are outragious. I dont want their system.  In our small area we have 3 MRI units while a comparible area in Canada would have none and patients would have to travel to a larger city  and wait. I can get an MRI for any reason for a patient within 1 day here. In Canada it could be 6 months.
3. As a physician who closely moniters billings from my practice (for 25 years) I prefer Medicare over private insurance as I know the rules, I know what I will be paid and what is covered and what is not covered,. Yes it pays less than private insurance, but is easier to deal with.
4. The deductables and copays on private insurances are going up so fast that many patients cant afford to pay for medical care and dont go unless its an emergency. Most group plans I see this year have $2500  or higher deductables and $40 copays for office visits. This really hurts the average patient in my area which is a low income area in Maine. At least my Medicare patients can afford to get medical care as they have virtually no out of pocket costs if they have a Medigap plan. So in my world Medicare works better.
5. Capitalism works in general but in medicine it breaks down often. Drugs/medication is one area of example. The drug companies only want to develop new drugs that are long term maintenance drugs as that is where the maximum profits lie. So we have 4 drugs out now for erectile dysfunction that all work the same and cost a fortune, and many other me too drugs that mimic each other for depression, hypertension , hypercholesterolemia, etc. Meanwhile there has not been a new class of antibiotics in many years and very little research is being done there as antibiotics are only used for relatively short periods . Not enough money to be made on patients backs there. So we have major problems with resistance to older antibiotics and very little research for the future. Capitalism fails in this area.  Drug companies are scoundrals.
Its better to not be able to get it up in the US then to have a bacterial infection. Sex sells , MRSA doesnt.   

[Rerun]

obsidianom,  I love you!  YES, YES and YES!  The media makes it sound like most physicians hate medicare and for a while no docs would accept Medicare patients.  Then I think they realized that "at least they got paid" from Medicare.  I LOVE when I get my EOB on one month of dialysis and the submitted charges are $65K and they get $3k.  What ARE they thinking?  If they put what they WANT they will get it?  It does not cost $65 thousand dollars a month for ME to be on dialysis. 

You know...all I want is TRUTH in BILLING!  Don't lie!

[cattlekid]

Your question: "if they put what they want, will they get it?", highly depends on the insurer.  I was always on private insurance when I was on dialysis, both home and in-center.  My insurance company billed $3500 per treatment ($70,000 per month) and received around $950 per treatment. 

So what does it really cost to provide dialysis?  What Medicare reimburses?  What the provider bills?  Somewhere in between? 

I agree that truth in billing is necessary.  Especially for those who are on the hook for the 20% that their insurer does not cover.  I want to cover my costs, I don't want to be gouged.

obsidianom,  I love you!  YES, YES and YES!  The media makes it sound like most physicians hate medicare and for a while no docs would accept Medicare patients.  Then I think they realized that "at least they got paid" from Medicare.  I LOVE when I get my EOB on one month of dialysis and the submitted charges are $65K and they get $3k.  What ARE they thinking?  If they put what they WANT they will get it?  It does not cost $65 thousand dollars a month for ME to be on dialysis. 

You know...all I want is TRUTH in BILLING!  Don't lie!

[obsidianom]

Your question: "if they put what they want, will they get it?", highly depends on the insurer.  I was always on private insurance when I was on dialysis, both home and in-center.  My insurance company billed $3500 per treatment ($70,000 per month) and received around $950 per treatment. 

So what does it really cost to provide dialysis?  What Medicare reimburses?  What the provider bills?  Somewhere in between? 

I agree that truth in billing is necessary.  Especially for those who are on the hook for the 20% that their insurer does not cover.  I want to cover my costs, I don't want to be gouged.

obsidianom,  I love you!  YES, YES and YES!  The media makes it sound like most physicians hate medicare and for a while no docs would accept Medicare patients.  Then I think they realized that "at least they got paid" from Medicare.  I LOVE when I get my EOB on one month of dialysis and the submitted charges are $65K and they get $3k.  What ARE they thinking?  If they put what they WANT they will get it?  It does not cost $65 thousand dollars a month for ME to be on dialysis. 

You know...all I want is TRUTH in BILLING!  Don't lie!

That is another advantage to medicare. They publish the allowed fees for every procedure . There is no guessing about what you will be billled or the doctor will receive. So if you are paying the 20% copay  you know right upfront what it will be. It doesnt matter what the provider bills, the allowed fee is ALWAYS the same. With private insurance the same company often allows different fees for the same procedure depending on the contract with the group that purchased it . It is a MESS trying to figure it out.

[rocker]

Your question: "if they put what they want, will they get it?", highly depends on the insurer.  I was always on private insurance when I was on dialysis, both home and in-center.  My insurance company billed $3500 per treatment ($70,000 per month) and received around $950 per treatment. 

So what does it really cost to provide dialysis?  What Medicare reimburses?  What the provider bills?  Somewhere in between? 

I agree that truth in billing is necessary.  Especially for those who are on the hook for the 20% that their insurer does not cover.  I want to cover my costs, I don't want to be gouged.

I think the only way to get any sort of comparison is to look at what other countries pay for dialysis, particularly in Europe.  They pay much less money, and have far better outcomes.

There was an article in Time a while back that showed that there is nothing remotely resembling "truth in billing" in the US.  Hospitals literally make up their prices (known as "chargemaster" rates) - as the article that started this shows. No one in the medical industry could say where the prices come from, only that there was "someone" who maintained them.  The Obama administration has taken one small step in this direction by releasing the chargemaster rates for several major operations at a selection of major hospitals.  It was unbelievable - the rates could vary by 500-1000% for hospitals a few blocks away from each other.  There's no rational reason for such a variation.

[Simon Dog]

Docs in this nation have always taken care of the patient and worried about getting reimbursed later.

For emergencies, yes.  Broken bone, heart attack, stroke - immediate treatment followed by payment if possible.

But, docs (via a system of gatekeepers that prevents the doc from personally turning down anyone directly, it's all done by minions) routinely refuse lifesaving treatment unless payment is secured in advance (notice how the insurance card is verified on the way in, not out ... and many docs offices insist on the copay before you are seen).  Try getting a doc to worry about getting paid later it you need to get a melanoma checked out, or have lung cancer and want to schedule a resection.   The big article on medical rates discussed someone showing up at the MD Anderson cancer center in TX for treatment and being made to wait while the staff verified his check would clear.   

[rocker]

Docs in this nation have always taken care of the patient and worried about getting reimbursed later.

For emergencies, yes.  Broken bone, heart attack, stroke - immediate treatment followed by payment if possible.

But, docs (via a system of gatekeepers that prevents the doc from personally turning down anyone directly, it's all done by minions) routinely refuse lifesaving treatment unless payment is secured in advance (notice how the insurance card is verified on the way in, not out ... and many docs offices insist on the copay before you are seen).  Try getting a doc to worry about getting paid later it you need to get a melanoma checked out, or have lung cancer and want to schedule a resection.   The big article on medical rates discussed someone showing up at the MD Anderson cancer center in TX for treatment and being made to wait while the staff verified his check would clear.

And note, that check verification happened after he presented his insurance card - and the financial officer sneered that "We don't take that kind of discount insurance here."

[ianch]

Well this does go some way to help explain why the US pharmaceutical industry keeps trying to block a free trade agreement with NZ.  We have one state drug buying agency for the whole country and we don't pay for markups.  There are some down sides like accessibility, but on balance it works for the majority.    Go Kiwi's