Why should insurance companies be able to get lower rates through negotiation?
It's called the free market. If you have buying power, you can negotiate better pricing. This is not specific to insurance!
I'm not arguing that it *should* be this way, but that it *is* this way, in the U.S. system.
Note that, in an insurance system, it is rational to charge uninsured patients a higher price because a higher percentage of those bills will never be paid. However, for the same reason, patients *can* often negotiate lower prices based on immediate payment. Even after you've gotten a bill, you can go to a hospital and say, "I don't have the cash to pay this bill, but if you'll agree to take $XXX as a settlement in full, I'll borrow the money against my house." My understanding is that most medical creditors will go for it. You'd want to be sure that they payment *was* a settlement in full; one way of doing this is an endorsement condition on the check (with an accompanying letter).
IMO, the flaw in the current thinking about medical care, insurance, and drugs is that the consumption of these things is negotiable. It isn't. For example, if your TV stops working, you go shopping for a new one. If you don't like the price of plasma TV's, you can wait for a sale, decide to buy a cheaper CRT set, or just stop watching TV altogether. You can't do this with medical problems; going without treatment is not on the negotiating table.
Well, it is. You can "go without treatment" from one provider in two ways. One is simply to go without treatment, which you may not consider an option, but some people do (and you may have treatment modality options).... and the other is to seek treatment from a *different* provider. Because you have choices, you have a certain market power. In this case, for example, if it is not an immediate emergency, you could go to careentree.com, sign up for a medical plan which makes you a part of the PHCS network. You could then present your Foresight TPA card, which you would get (and you can get a number without waiting for the mail), and you'd then be getting insurance company prices....
Or you could negotiate pricing in advance, with *prepayment*.
At least, it isn't for someone like me who wants to continue living. Likewise, trying a cheaper treatment or operation isn't always an option, either. In my case, the only treatment for kidney cancer was to cut the malignant thing out and throw it away. Fortunately, the other kidney functions well and is not cancerous (FYI, kidney cancer is fairly common, but it is very rare for both kidneys to be cancerous).
Anyways, back to the issue of medical costs. The law of supply and demand doesn't really apply in the usual way. To recap the law of supply and demand: 1) The supplier is willing to sell more units at marginally higher prices, 2) the buyer is willing to buy more units at marginally lower prices, therefore 3) there is an ideal point where the selling and buying prices meet which will result in optimized unit volume sales and maximized profit for the seller. This is Economics 101. The problem with all the talking heads' theories about the way to manage health care is that they all seem to think that the law of supply and demand applies to everything. As I stated before, it doesn't apply in the usual way to medical care. You will consume as much medical care as you need, at any price (up to your maximum ability to pay), or you will die. What kind of choice is that?
Supply and demand *does* apply to medical care. It just doesn't apply in the simplistic way described.
As to negotiating rates, here is why it's a fallacy: the number of any given procedures or treatments is going to be fairly constant in a given time period. After all, there is a given number of people in a fiscal year who are going to need a nephrectomy (that's medical lingo for the surgical removal of a kidney). So, if the numbers of different types of operations in a fiscal year can be predicted fairly accurately, based on past years' data, the total costs of performing these operations can be predicted also.
Yes, I'd think so.
So, just take that, tack on a modest profit if it's a for-profit hospital (2-7% maybe), and charge the result for it. No negotiations would be necessary or possible. And EVERYONE pays that amount - no sweetheart deals for insurance companies.
One little problem with this model. Some people won't have the money? And hospitals are often legally required to treat anyway. Insured patients are different from non-insured patients because the former's bills *do* get paid, with a much higher frequency.
Because if the insurance companies get sweetheart deals and get to pay BELOW the actual cost, then those who are not represented by lobbyists have to make up the difference by paying ABOVE actual cost.
Yes. The answer? *GET TOGETHER!!!*
Otherwise you are reduced to what is essentially begging the government to interfere. Problem is, the government is *also* influenced by money from special interests. Actually, "the uninsured", as a group, have more money than any of the special interests, *but they are not organized.* They are not organized together to obtain medical services as a group, and they are not organized politically.
I, for one, don't like the idea of being forced into indirectly giving my hard-earned money to some huge insurance company who has no financial obligation to me, and will just take that money and buy lobbyists to lobby further against my interests. Hey, that sounds like what's going on right now!
Negotiating lower prices is a service. You *can* do it yourself (I've gotten doctors, for example, to agree to substantially lower prices based on immediate payment), but you could also buy the service. That's what Care Entree does. PHCS is a network which serves what the name implies, Private Health Care Systems. The customers of PHCS are insurance companies and large companies which are self-insured, i.e., they provide a health plan to employees *without* having an insurance company involved (or perhaps they fund routine care and have some insurance for catastrophic care). What Care Entree did was to realize that they could sell this service to individuals. You can go to the web site to look into the details. We heard about it because someone selling it was on National Public Radio.
Now, ultimately we went with insurance, i.e., high-deductible catastrophic care insurance, which, it happens, also makes an insured a member of the same network, PHCS. PHCS is good because most practitioners accept it.
Politically, the best answer to this problem, in my view, is the same answer that I offer to a whole host of problems, the common element being the necessity for large numbers of people to organize. Classic organizational forms work to a certain degree (obviously), but they suffer from some serious shortcomings. Direct democracy, when the organization reaches a certain size, suffers from a huge organizational overhead, i.e., there is a great cost to the members in terms of the time it takes to participate. Oligarchical structures (which means structures where the organization is controlled by a relatively small group; members or customers do not directly control it) can be efficient -- which is why they are so common -- but they have or develop their own special interests.
What I propose is a hybrid; it could be called "direct democracy with delegable proxies allowed." In such an organization, any voting member may vote on any issue being decided, *but* may also designate a proxy. If the member does not vote, but the proxy does vote, the member's vote is added to that of the proxy. If the proxy does not vote, but has designated a proxy who *does* vote, then the original member's vote and the member's proxy's vote are added to the voting proxy's vote.
One more feature is implicit in the system. A "meeting" -- which could be face-to-face, or virtual, perhaps conducted through a mailing list -- may set rules for active participation; and one such rule could be that to "speak" at the meeting, one must be holding a certain minimum number of direct or delegated proxies.
I describe this to people frequently; a *few* people get it immediately. Most, however, make assumptions about what such an organization would do, missing implications of the features described.
Note that I've proposed such a structure for the Protel Users Association -- but I've had no time recently to take the next organizational steps....
The hospital can also RUIN your credit rating if you don't pay or don't pay in full. I like having a good credit rating. Non-payment is not an option, because I did sign an agreement stating that I would pay. I wasn't educated at Enron U. - it's a matter of personal integrity with me that I honor such agreements. I did manage to be somewhat savvy about what I agreed to. I made them strike out clauses where leins could be put on my estate in the event of my death. And also made them not require another person to financially guarantee payment in the event I couldn't or wouldn't pay. So basically, they only got paid if I survived the surgery and they did a good job (I wouldn't have felt obligated to pay if malpractice occurred)! That's the way it should be.
Such an agreement is made within the context of a social system that includes features like bankruptcy. Bankruptcy is, essentially, a system which by law *cancels* agreements to pay, subject to the rules. Any contract will (as it should) be interpreted within the law of the jurisdiction in which the contract is to be performed. Yes, you agreed to pay. But if it turns out that you can't pay, the law says that you don't have to, and you do not have to spend the rest of your life with a burden of unpayable debt.
What I'd suggest for someone in your position would vary a bit with the state in which one lives. Being uninsured is somewhat of an option; but if there is any mutual insurance available, it should theoretically be priced correctly. (However, the devil is in the details.) (With mutual insurance, insurance company profits are distributed to the insured as a dividend; that dividend is considered a reduction of the cost of insurance and would typically not be taxed.)
Or one can buy the kind of insurance we bought. My wife is not willing to go without insurance....
BUT, if one does not have insurance, definitely it would be a good idea to join something like Care Entree. The cost is not great. In your case, it might have saved you many times over its cost.
> Hospital bills also *commonly* contain overcharges of various kinds.
Yet another symptom of morally bankrupt medical economics.
When you get an insurance company involved (or a service company as used by an insurance company), you are essentially hiring someone else to go over the bills with a fine-tooth comb....
> Then, if one of us gets seriously ill, we'd switch immediately to an HMO. > No delay. Expensive, yes, but better than paying high medical bills.
CAUTION: Are you sure you can do this? Even though Massachussettes may not have an eligibility waiting period, you still may not be able to get a preexisting condition covered. Make sure you know EXACTLY how that law works. In Florida, the eligibility period is 12 months.
Yes, I checked. Quite carefully. Massachusetts is a guaranteed-issue state. This is one reason why insurance is so expensive here! If you are insured, you may switch insurance companies without any waiting period. If you are uninsured, the waiting period depends on how many months you have been without insurance. I think the maximum is a year.
> In another state, one could buy catastrophic care insurance and set up a > tax-deductible Medical Savings Account. We can't do that in Massachusetts > because it turns out that the insurance which would qualify for the tax > deduction at the federal level will not meet Mass. law for insurance. I.e., > it can't be sold here.... that's also insane....
How about when you travel? How does it work then? You will be outside of your "plan area", right?
No. There is no "plan area." Try these links: http://www.phcs.com/aboutus/index.html this one tells you what PHCS is. http://www.geoaccess.com/phcs/po/ this will put you into a provider search engine.
The chances are good that your personal physician already accepts PHCS.
You said it yourself - it's insane! Why the hell does this corporatized, institutionalized, self-propagating insanity continue to exist and escalate? It certainly doesn't serve the public interest.
I would disagree. It does serve the public interest to a certain degree; however, it is fairly obvious to me that the public interest could be much better served. But until the "public" is intelligently organized, there is a counter-incentive for any politician who might otherwise attempt to serve the public interest. That is that he or she will immediately attract the ire of special interests, and special interests tend to be organized, i.e., they have money to spend for political purpose, whereas there is little organization of the "public interest." So such politicians may very well, as the result of their efforts, lose the next election. Most of them simply won't go there. Instead, if they mean well -- I think most do --, they will still be very careful not to offend the special interests.
> sold by the National Association of the Self-Employed. Note that these > associations are closely related to the insurance companies, they are a bit > of a scam, but they also do sell real insurance (and provide certain other > services). Apparently, the Alliance is settling a class-action lawsuit > that, among other things, established clearly that, no, you don't have to > pay Association dues in order to get the insurance. (We weren't told that....)
Wow, that sounds like a company that I would really want to trust with my life...NOT!
The insurance company is real, and apparently legitimate. They really do connect us with PHCS (that's worth about $60 per month). And they really do process claims.
If we were not in Massachusetts, we'd have many more insurance options, but there are very few companies licensed here. Midwest National is licensed, and so is MegaLife (which is actually an associated company, but sold by the NASE).
The sales techniques were only slightly sleazy, actually. I don't know that we were told that we *had* to pay association dues in order to get the insurance (the dues aren't much, really, compared to the insurance), but I don't think we were told that we didn't have to.... In other words, I can't say that the salesman lied to me. We had competing bids from the NASE and the Alliance. The programs offered by the two associations (and thus by the two related insurance companies) were different....
You aren't trusting your life to the salesman, nor to the insurance company. These are not HMOs, you make your own treatment decisions; because most providers are in-plan -- at least in our area -- really the only major concern should be the financial stability of the insurance company. These companies have been around for a long time....
There *are* phony insurance scams out there, so buyer beware. Not only should you read the fine print in the contracts, you should also make sure that any insurance company you use is licensed in your state. If they are licensed, that might mean something. You can also do searches for a company on the internet; some states also maintain complaint records. Note that high-deductible insurance may be subject to a certain level of complaints from customers who did not realize what "high deductible" meant!
Our treatment options are much more flexible now than they were with our Health New England HMO, which is considered a good HMO. As an HMO, HNE required that we get a referral before we go to any specialist. We can now simply go to any doctor. If we go to an out-of-plan doctor, it might not count toward our deductible, but the consequence of that is usually small, since we don't expect to exceed the deductible except rarely. (If they are only charging $350 per month for the insurance, obviously they don't expect to be paying a lot of large claims....) Essentially, if we go out-of-plan, we won't get the negotiated prices; but nothing prevents us from doing our own negotiation....
> The insurance, as I mentioned, is $10,000 deductible, and it does have a > 20% copay after $10,000, and it does have a fairly low benefit limit (I > forget how much, but it might be $100,000), but this would mean that a > large hospital bill of, say, $50,000 -- after rebilling, Mr. Bagget's bill > would have been quite a bit less than that -- would have cost us $18,000. > Not a pleasant experience, to be sure, but the kind of money that can be > borrowed if necessary. Since we are saving $12,000 per year on insurance, > we would be, really, only out $6,000 more than we'd have been by buying > that generous insurance. And I've never had *any* hospital bills for > myself. Of course, I'm getting older....
Well, I never had any hospital bills either, until my kidney cancer. There was no reason to expect it, because I don't engage in any of the known risk factors (smoking, drug use, working in toxic environments, etc.).
Being alive is a risk factor.... and the U.S. is a toxic environment, unless you spend all your time in a remote area....
I did manage to get the hospital, urologists, imaging, and anesthetists to put me on monthly payment plans. I did get a discount from the anesthetists for early payment, and it was a whopper discount: 40%.
Bingo. The fact is that you *might* have been able to negotiate an even larger discount, it is hard to tell. Discounts of 80% are not unheard of. But 40% is pretty good. Care Entree advertises that they can get you discounts of 15% to 50% and sometimes more. I've heard of discounts that were *much* more, but my guess is that this is not terribly common. Care Entree, on their business page mentions discounts as high as 80%.
http://www.careentree.com/bizgroups.asp
They must not get paid in full very often, so they automatically take less if they get it NOW.
Didn't I say that?
You might be able to go to the other providers and negotiate something similar. The fact is that if they are rational business people, they will take *some* discount for immediate payment. And the reality of the medical business is that immediate payment is worth a *lot*. After all, you are a cancer survivor, and there is a certain risk that you won't survive to complete those payments.... Hopefully, this will not be a reality for you, but the business people at the hospital would be concerned about the statistical risk....
I paid off the urologists and imaging according to schedule, and paid the hosptal ($19K) according to schedule for about a year, and then paid the remainder in a lump sum just to get that last monkey off my back and get a tax deduction for last year. I'm not rich, but I am fortunate that I could afford to do that. You may ask "Ivan, if you could afford pay off your medical bills early, what the hell are you bitching about?"
I think you that you have every right to complain about paying full price for any of it. You may have done about right with the anesthetists.
I can't help but feel sorry for the people who can't afford medical care. I myself was worried for a while that I might not be able to afford it, and my potential for affording it is much better than most people in the U.S. How much more they will have to worry! Something must change; the current system is broken. I heard on the news last week that medical insurance rates went up 28% last year.
When we were living in California, we had the Kaiser Permanente HMO. We were paying I think about $300 per month, for myself and my wife. We moved to Massachusetts and our payment with Health New England became about $500 per month. Then we adopted Lucia, the rates went up, our payment became about $800 per month. Then, next year, the rate went up to $1300 per month. We thought $800 was bad.... So I did some frantic research. Among other things, I found out that our old insurance would not actually be cancelled unless our payment was about 25 days late. We bought the new insurance to start on the expiration date of the old, but it turned out that the salesman had been wrong about how fast it could be issued, it was issued a few days later. But by that time, of course, we knew there were no claims in the uninsured period.... Had there been a serious problem, we'd have simply paid the HNE payment....
Now, we are saving something like $12,000 per year by not having regular low copay insurance. That will pay for a lot of doctor visits! It would even pay for some major care. Note that our deductible, though high, is still less than what we are saving. After the deductible, we have a 20% copay. Essentially, our medical bills would have to reach about $20,000 per year before we'd have lost any money by switching from the old insurance
This fact has not escaped the notice of our dear representatives in Washington, who have thoughtfully provided for Medical Savings Accounts. Essentially, you buy a qualifying high-deductible insurance policy, then you can put money, a certain amount per year, I think it is the insurance deductible, into an MSA. The MSA contribution is tax-deductible, and so is at least part of the insurance payment if you are self-employed. Such a plan typically involves a cash savings every month over low-deductible insurance, yet, in fact, in the combined plan, you have the money set aside to pay the deductible. *But if you don't spend the deductible, you have an account that can accumulated earnings, tax-free. Withdrawals for medical expenses are always tax-free, and you have absolute freedom in determining how the money is spent, i.e., you want to go to a chiropractor, go to a chiropractor. As long as the expense would be recognized as a medical expense for tax purposes, the withdrawals are tax-free. And then there are other ways to get the money out of the account free of tax, or one simply pays the tax on it....
But I can't set up such a plan in Massachusetts, because of the peculiarities of Massachusetts law. Essentially, any insurance that meets the requirements of the federal tax law for "qualifying insurance" does not meet the requirements of Mass law for insurance. Can't get there from here.... I have not been able to figure out why -- and, in fact, I don't know the exact details of why it won't work here -- I just know that I ran into a brick wall when I tried to find qualifying insurance. There are national companies that sell it, and *they* told me, "not in Massachusetts."
And the total number of uninsured Americans rose to 49 million (from 45 million a year earlier, I think). I don't know the current Census figures, so I just going to assume a U.S. population of 300 million. A reduction of insured from 256 to 251 million is about a 2% drop. A 2% drop in insured population for a 28% increase in insurance rates. I bet these supply and demand curves are non-linear. My prediction: if this trend continues, in a few years these curves will cross. Once the insured population drops at a percentage rate faster than the increase in insurance premiums, the medical profession will go into tailspin, going down in flames. Now, didn't I say earlier that medical care doesn't follow the law of supply and demand in the usual way? By that, I meant it doesn't follow the "textbook" examples, which are reasonably linear supply and demand curves. With medical, we have a demand curve that stays fairly flat even as the price curve trends up exponentially.
The cause of this, by the way, was insurance, which insulated patients from health care costs. If you are paying a flat rate per year for insurance, and it doesn't cost you any more to go to the doctor an extra time, why not go? If your doctor suggests doing an expensive test, why not do it? Why bother doing all the research and getting a second opinion, if it is not going to cost you a penny.
Obviously, some efforts have been made to bring this monster under control. Insurance companies instituted copays; however, the copay is typically a fixed amount per service, so it does not provide enough incentive to really control costs; it only eliminates a certain level of frivolous care.
HMOs can control costs by making care decisions. You know how popular that is! But, obviously, some kind of restraint is necessary if the system is not to collapse.
But at some point it becomes impossible to scrape together any more money to pay, and the demand curve abruptly turns down. This happens rather quickly. Insurance companies respond to their shrinking customer base by raising rates on the remainder. Which causes even more people to drop their insurance, which causes another rate increase...and so on. We know this as an unstable feedback loop. I think this is what is going to happen in the medical industry.
Going to happen? It *is* happening. The real question is how painful it has to get before enough people get exercised to make it a must-solve political issue. I find the media strangely silent about it. Our insurance went through the roof, and I saw few comments in the media. The full story is not being told. A tax refund of a few hundred dollars, big story! An insurance increase of $6,000 per year, not a whisper.
We are told that to pay for a single-payer system, taxes would have to increase. Well, yes, I'm sure. TANSTAAFL. But those who argue against such a system simply are playing on the idea that Tax Increase = Very Bad Thing. If the tax increase is counterbalanced by greater reductions in expenses, Very Good Thing.
> In California, we had Kaiser insurance, which was *very* affordable, and > the service was good. Kaiser used to be in Massachusetts, but the heavy > regulation, it seems, forced them out. So I don't feel terribly guilty > about working the system! I'd vote in a flash for a single-payer system.....
If by single-payer, you mean like what Canada has, I'm with you on that. The problem is, *we* don't get to vote on it. Our elected Congress members do. And they don't see the urgency of it, because they get their health care from the U.S. government.
The is a politically powerful argument, but I don't think it is the reason. The reason is that the money is elsewhere.
As to your comment that "we don't get to vote on it," this is what I mean when I say that the U.S. (and most "democratic" countries, maybe all) don't have a truly democratic system. As conservatives used to point out, this is a republic, not a democracy.
The *system* is defective. This insurance problem is merely one symptom of that.
Winston Churchill said that "democracy is the worst form of government, ... except for all the others." I'm sure it got a laugh, it still does. However, it presumes that democracy has actually been tried. From my point of view, it hasn't.
What we have is essentially a constitutional monarchy, with a provision that the monarch is periodically elected, by an archaic process that has more than once resulted in the winner having fewer votes than a loser. Some of the writers of our Constitution wanted to make Washington king. The compromise was that he *was* made king, with some restrictions on his powers, and for a term.
Corporations aren't run this way. Corporations *hire* a chief executive, and they can fire him or her at will. Public stock corporations are essentially democracies of money, with each share having a vote. The rules often effectively dilute the power of shareholders, but that was not the original intent, it is just what happened as corporations got very large, with many shareholders. The existing management found ways to improve its own security; for example, companies helpfully provide shareholders with proxy forms, just sign them and send them in. By doing that, you are giving your voting power to persons chosen by the existing management. If you don't know and personally trust those people, it would be better to send in no proxy at all!
The structures I'm working on use proxy representation in an attempt to address the difficulties of direct democracy; I think that corporations allowed proxy voting for pretty much the same reasons. I address the problem of scale by allowing proxies to be delegable. This allows you to designate someone you know -- or can come to know -- as your proxy, without requiring that you pick someone at a high level. Essentially, high-level proxies would be picked by people who personally knew them -- presumably by working with them in the organization. Some organizations might even restrict the number of direct proxies that could be held by an individual, to a manageable number. For various reasons, a proxy-holder should be accessible to direct communication from any person who has given him or her their direct proxy. This is not necessarily the case with a delegated proxy....
This could be called a utopian scheme; however, the scale is not nearly as ambitious as a true utopian scheme. Essentially, this is only a small modification of existing organizational methods. The immediate plan is simply to develop the technique (or "technology," as I tend to call it) both by discussing it and by applying it as circumstances arise. I'd propose it for *any* new organization that involves -- or could involve -- a significant number of members. However, along with that plan there is an expectation that once people *experience* what I'm now calling "free associations," they will never again be satisfied with less.
A free association allows individual participation to the degree that an individual cares to devote, all the way from almost no participation, and very low attention paid, to moderate participation, i.e., discussing issues of interest in small or sometimes large groups, to full participation, which could be a full-time job. The key participation, made by all active members, would be the selection of a proxy. That is an act of trust. It is revocable at any time; and the organizational activities of the proxy would be visible to the member.
Free associations also, as I'd conceive them, would accumulate very little property. I've taken a hint from Alcoholics Anonymous in this.... With little property, there is little to fight over. If you don't like what the association is doing, form your own! The association would not collect dues beyond a bare minimum, probably just enough to maintain the membership records and operating structure (which would not be much). If it wants to undertake a large project (such as electing a desired candidate to public office), it would simply advise its members to contribute *individually*. It might even have accounts set up that would make it easy to do so. In such a way, it would be able to go around most of the campaign financing legislation, since the contributions would be individual, made directly to a candidate (or for other purpose). This is essentially what MoveOn.org has done, the difference is that MoveOn.org is what I've called an oligarchical organization, that is, it is controlled by a few people. They happen to represent the views of a larger group, which is why they have the power they have, but they have not -- to my knowledge -- turned that power over to the larger group.
Free associations would not, in general, attempt to change existing social structures, at least not at first. Instead, they would be like a nerve network, added on top of older communication structures (as nervous systems did not replace the older chemical messaging systems used in living organisms).
A better deal than you and I can get privately.
Yes. So why not simply allow individuals to join that system? It already exists, it would be simple.... But you'd hear the screaming from insurance companies clear around the world....
And *we* cannot sue our HMO's if they deny us necessary treatment.
Right. You do have, however, arbitration rights. Lawsuits are an inefficient method of resolving disputes; essentially, they involve high overhead. Of course, whenever you try to lower those costs, here come another special interest group, the trial lawyers.
Most of these special interest groups *do* serve the public interest in some way or other, but each of them has, shall we say, a conflict of interest. And politicians also have a conflict of interest: if they work for the public interest, they lose the support *they need* from the special interests.
To solve this problem, the *public* needs to be organized, to balance the power of the special interests. Seems fairly obvious to me! But *how* is the public organized? So far, all the efforts I have seen suffer from the same problems inherent in the typical organizational forms. Very, very few people are looking at the *system*. And many of those who *are* looking are looking from a point of view that is essentially trying to pin the tail on the donkey, to find out who the bad guys are so we can throw them out, never noticing that this accomplishes very little, any improvement is short-lived and temporary. This is because the *system* is the problem, not the persons who happen to be placed in positions of authority from time to time.
And *we* aren't rich enough to afford more lobbyists than the HMOs.
This is not correct. *We* have *much* more money, more resources, than *they* do. But *they* are organized and *we* are not. The only way in which *we* are organized is through the defective mechanisms that I've described, and these mechanisms, quite rightly, are not trusted. The cynicism is astronomical. People basically pinch their noses and vote. (I'm not implying that politicians are bad people, rotten to the core, they aren't, but the system can make them appear so even when they aren't.) The choice is often, "which
Yes, it's not enough to have a lobby, you must have the biggest, most well funded lobby. After all, if you are lobbying Congress in opposition to some other lobby, unless you have more resources than your opposition does, you've wasted your money, because the opposing lobby will win.
As long as power is in the hands of *elected* officials, rather than *selected* ones, this will be true. So, in the meantime, we need, indeed, to have the "biggest, most well-funded lobby." Why not? We have, in fact, more disposable income than any special interest group. Much more. Every special interest group represents a small fraction of society. Even *the poor* have more money *if they were organized.* That's a big IF. But I think it is possible.
All the money, all the resources of those special interest groups comes from *us*. And most of what we give them goes for the services that they provide to us, only a fraction of it is available for purposes like lobbying. Mr. Gates has a lot of money, right? But it comes from the purchase of software from his company, for the most part. What percentage of your income has gone to that software? That ought to give you an idea, if you are typical, of how much of the economy Mr. Gates could possibly control if somehow he could keep all of that as profit.... But, of course, much less than that is profit. He has tremendous wealth because he is making a relatively modest profit on a huge gross. But that gross is dwarfed by *our* gross....
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