Why Health Care Is So Expensive In The U.S.A.

[shintao]

When I look at the World Health Organization findings (WARNING: THEY CONTAIN VERY FEW FACTS, AND LIBERALS IGNORE THOSE), I see a giant, reeking pile of dog turds, otherwise known as "propaganda". But then, I - apparently unlike you - am capable of actually researching and getting to the reality of things, rather than just swallowing whatever the media feeds me.

The only levels on which the US has comparable or worse healthcare to the third world, according to your precious WHO report (which I highly doubt you have ever actually read yourself), is in its lack of widespread socialism. In those areas that actually MATTER to sane, intelligent people and to the real issues of healthcare - such as survival rates from cancer, since you mention it - the US ranks extremely high. I for one am not going to lose sleep about our "abysmal" distribution of socialism. How about you?

Meanwhile, why don't you answer the questions? What third-world countries have YOU personally visited, and which ones do YOU go to for healthcare?

You must be into anal care, because you are making an ass of yourself here. I can assume if you haven't personally taken it up the ass, you have no right to debate gay issues. He didn't say he had been there, and he wouldn't need to have been there to discuss intelligently on the subject. Go bake some biscuits & STFU.

Well, we all know how much I value YOUR opinion. If you have nothing to contribute to the conversation besides telling me the "horrible" news that someone I wouldn't piss on if he were on fire doesn't like what I say (Oh, NOOOO!!!), may I suggest you go do whatever it is you do for fun (please keep it to yourself) and shut the fuck up?

If I want to hear from you, rest assured, I'll wave a Snausage over your nose.

So far all you have is con-turds trailing your bullshit on this thread, no facts from all that research you claim to have done. If you have something to say, say it. By the way, I won't be using a sausage to wave over your lips.

 

[Mr Objective]

When I look at the World Health Organization findings (WARNING: THEY CONTAIN VERY FEW FACTS, AND LIBERALS IGNORE THOSE), I see a giant, reeking pile of dog turds, otherwise known as "propaganda". But then, I - apparently unlike you - am capable of actually researching and getting to the reality of things, rather than just swallowing whatever the media feeds me.

The only levels on which the US has comparable or worse healthcare to the third world, according to your precious WHO report (which I highly doubt you have ever actually read yourself), is in its lack of widespread socialism. In those areas that actually MATTER to sane, intelligent people and to the real issues of healthcare - such as survival rates from cancer, since you mention it - the US ranks extremely high. I for one am not going to lose sleep about our "abysmal" distribution of socialism. How about you?

Meanwhile, why don't you answer the questions? What third-world countries have YOU personally visited, and which ones do YOU go to for healthcare?

I have read it many times.

My personal visits would be anecdotal and for you to even ask that in the face of well researched data by unbiased experts tells me that you hate facts and truth and spin like a Fox News Nazi.

And still I wait for answers in vain, receiving only lame dodges.

Who are these "unbiased experts" with "well-researched data"? I KNOW you're not talking about the World Health Organization. Even YOU cannot possibly be THAT pig-stupid and willfully gullible.

So let's talk about some facts, rather than "Oh, I've read it all, and done it all, and I'm JUST too weary to bother talking about it", which only a newbie like you would try around here.

1) How was the US's ranking of 37 arrived at? What were the determining factors? (You should know this, since you "have read it many times".)

2) How were the criteria weighted? Which ones counted for a larger part of the score?

3) How did the United States rank on each of the individual criterion?

4) How much does the vaunted WHO take into account differences in culture and lifestyle and the effect they can have on many of their criteria?

I know the answers to all of these questions, because I've not only read WHO's catbox liner of a report, I've also researched it. How about you? Think you can grow a pair and answer a question for once, nancyboy?

POST THE WHO REPORT AND PICK IT APART. UNTIL THEN, STOP LYING.

The reason you are asking me to is because you know I don't have enough posts to post links but I can still expose you lies and dirty tricks. If we were in the same I'm probably beat the crap out of you fat boy.

 

[auditor0007]

Doctors can charge what they charge because the people paying the bill are not the ones receiving the service.

Health care in America costs more because your health care dollar has to not only put fancy cars in the driveways of a doctor and an anesthesiologist for the OUTSTANDING way they took care of your boo-boo, but those same health care dollars are also responsible for putting something nice in the garages of 5 to 7 insurance executives for the OUTSTANDING ways they collected your premiums and denied your claim.

Agreed. But it doesn't have to be that way. Insurance is a lot like really expensive credit. It's probably a good idea to have access to some in case you really need it. But it's foolish to use for everyday expenses. People are finally starting to realize that too much insurance is too expensive and doesn't pay off. And we're looking for better alternatives.

The insurance industry has seen the writing on the wall. They know the gig is up, and that's why they've finally acquiesced to phony 'reform'. What they're really doing is seeking a 'partnership' with government - essentially using the state to 'mandate' themselves perpetual customers. It's truly sickening.

What the insurance companies have done is forced higher deductibles on most of us, so that we are paying for everyday care out of pocket. The problem is that it still isn't competitive because the way the system is set up, the insurance companies are still setting the rates. If you have insurance and your treatment/care falls under your deductible, you pay the negotiated price that is set between your insurance company and the providers they are contracted with. What should happen is that you should be able to purchase a policy that covers only major medical or only covers expenses over a certain amount per year. Then any treatment prior to that, you search out the most affordable provider based on competitive rates, not negotiated rates between your insurance company and their network of providers.

The other big problem has to do with overhead. With new technologies coming out all the time, every provider thinks they have to have it so they can be competitive. The problem is that many of these new technologies are only used for a limited number of patients. So all the providers determine their profit margin for a certain piece of equipment based on very few users. And guess what? The cost becomes astronomical, but the insurance companies agree to cover it by raising premiums.

There are so many problems with our current system, it's hard to know where to even begin. But one thing is certain, having insurance companies calling all the shots is not working.

 

[dblack]

What the insurance companies have done is forced higher deductibles on most of us, so that we are paying for everyday care out of pocket. The problem is that it still isn't competitive because the way the system is set up, the insurance companies are still setting the rates. If you have insurance and your treatment/care falls under your deductible, you pay the negotiated price that is set between your insurance company and the providers they are contracted with. What should happen is that you should be able to purchase a policy that covers only major medical or only covers expenses over a certain amount per year. Then any treatment prior to that, you search out the most affordable provider based on competitive rates, not negotiated rates between your insurance company and their network of providers.

Good points. The negotiated rates stuff is bullshit, and a good example of how insurance is mutilating the health care market. The other reason there's no competition amongst doctors is because insurance nullifies demand for lower prices for those covered. Imagine what would happen in any other industry if most transactions were paid via insurance - prices would sky rocket.

Insurance only ever makes sense as a hedge against risk. It should be something that we very rarely 'use'. If it isn't, if insurance becomes the defacto way to finance a regular service, the market melts down - which is what we're seeing now in health care. This is why I don't understand those who think single payer will solve everything. All that would do is consolidate all the insurance companies into one. The 'corporate greed' problem might go away, but the basic dynamic will remain, and the health care market will continue to suffer in the same ways.

The other big problem has to do with overhead. With new technologies coming out all the time, every provider thinks they have to have it so they can be competitive. The problem is that many of these new technologies are only used for a limited number of patients. So all the providers determine their profit margin for a certain piece of equipment based on very few users. And guess what? The cost becomes astronomical, but the insurance companies agree to cover it by raising premiums.

Exactly. Insurance turns the incentive structure upside down - to the point that the competitive impulse produces higher prices rather than lower. As long as most patients are 'covered', there's no incentive to compete on price. And that's exactly where we want doctor's competing.

There are so many problems with our current system, it's hard to know where to even begin. But one thing is certain, having insurance companies calling all the shots is not working.

I just wish I could get people to understand that that's exactly what things like the ACA are all about - letting the insurance companies continue to call the shots. I'm not suggesting we just 'do nothing', but it would be better than what Congress has passed. If we did do nothing, the insurance industry would collapse. As consumers, we simply can't afford to pay spiraling premiums indefinitely. When that happens, when people and businesses start dropping their insurance plans out of sheer necessity, health care prices will come tumbling back down.

The problem is, that would be a relatively long and painful way for the market to self-correct. We (as in the government) could do some things to help it along, primarily by removing all the policies that have pushed us all into the group insurance madness in the first place. To soften the transition, we could help out the people on the fringes (the poor and the elderly) by giving tax credits for health care (NOT health insurance). We could remove the tax policies that have engineered health insurance as principle perk of employment. We could remove those health insurance regulations that exist primarily to protect insurance companies from innovative competitors.

 

[AVG-JOE]

Agreed. But it doesn't have to be that way. Insurance is a lot like really expensive credit. It's probably a good idea to have access to some in case you really need it. But it's foolish to use for everyday expenses. People are finally starting to realize that too much insurance is too expensive and doesn't pay off. And we're looking for better alternatives.

The insurance industry has seen the writing on the wall. They know the gig is up, and that's why they've finally acquiesced to phony 'reform'. What they're really doing is seeking a 'partnership' with government - essentially using the state to 'mandate' themselves perpetual customers. It's truly sickening.

I would LOVE to be dumping my $310 per month into Medicare and have them pick up 80% of my health care expenditures. If I'm responsible for 20%, I won't go screaming to the ER for every hang nail and if Medicare picks up 80% of a truly bad day I won't end up homeless AND sick.

Not to mention that when I'm 65, and start seeing a doc more regularly, I won't feel so guilty about hitting up that tax-payer supported program for my 80%.

The idea that you would develop hangnail problems if the public was paying your way is preposterous. I have a 100% health care from the VA, and the last place I want to be is sitting in a clinic or ER for any treatment. I think the idea is mythical, drempt up by some of those insurance CEOs we are raving about. Surely you have more to do than have a finger up your ass and being told to cough.

Be careful the next time you drive... if you miss a turn like you missed my point, you're going to hurt yourself or someone else.

 

[AVG-JOE]

When I look at the World Health Organization findings (WARNING: THEY CONTAIN VERY FEW FACTS, AND LIBERALS IGNORE THOSE), I see a giant, reeking pile of dog turds, otherwise known as "propaganda". But then, I - apparently unlike you - am capable of actually researching and getting to the reality of things, rather than just swallowing whatever the media feeds me.

The only levels on which the US has comparable or worse healthcare to the third world, according to your precious WHO report (which I highly doubt you have ever actually read yourself), is in its lack of widespread socialism. In those areas that actually MATTER to sane, intelligent people and to the real issues of healthcare - such as survival rates from cancer, since you mention it - the US ranks extremely high. I for one am not going to lose sleep about our "abysmal" distribution of socialism. How about you?

Meanwhile, why don't you answer the questions? What third-world countries have YOU personally visited, and which ones do YOU go to for healthcare?

You must be into anal care, because you are making an ass of yourself here. I can assume if you haven't personally taken it up the ass, you have no right to debate gay issues. He didn't say he had been there, and he wouldn't need to have been there to discuss intelligently on the subject. Go bake some biscuits & STFU.

Well, we all know how much I value YOUR opinion. If you have nothing to contribute to the conversation besides telling me the "horrible" news that someone I wouldn't piss on if he were on fire doesn't like what I say (Oh, NOOOO!!!), may I suggest you go do whatever it is you do for fun (please keep it to yourself) and shut the fuck up?

If I want to hear from you, rest assured, I'll wave a Snausage over your nose.

Snausage?!?

Google Search: What the FUCK is a "Snausage"?!?



Ahhhhhhhhhhh... Snausage!!!

[ame=http://www.youtube.com/watch?v=M95_PhCYDEw]YouTube - ‪Snausages dog treat commercial‬‏[/ame]


I love living in the 21st century!

 

[AVG-JOE]

You must be into anal care, because you are making an ass of yourself here. I can assume if you haven't personally taken it up the ass, you have no right to debate gay issues. He didn't say he had been there, and he wouldn't need to have been there to discuss intelligently on the subject. Go bake some biscuits & STFU.

Well, we all know how much I value YOUR opinion. If you have nothing to contribute to the conversation besides telling me the "horrible" news that someone I wouldn't piss on if he were on fire doesn't like what I say (Oh, NOOOO!!!), may I suggest you go do whatever it is you do for fun (please keep it to yourself) and shut the fuck up?

If I want to hear from you, rest assured, I'll wave a Snausage over your nose.

So far all you have is con-turds trailing your bullshit on this thread, no facts from all that research you claim to have done. If you have something to say, say it. By the way, I won't be using a sausage to wave over your lips.

Would you two mind getting a room at Manifolds Sand-box Hotel and Flame Zone Emporium and let the grown-ups talk here?

 

[AVG-JOE]

Doctors can charge what they charge because the people paying the bill are not the ones receiving the service.

Health care in America costs more because your health care dollar has to not only put fancy cars in the driveways of a doctor and an anesthesiologist for the OUTSTANDING way they took care of your boo-boo, but those same health care dollars are also responsible for putting something nice in the garages of 5 to 7 insurance executives for the OUTSTANDING ways they collected your premiums and denied your claim.

Agreed. But it doesn't have to be that way. Insurance is a lot like really expensive credit. It's probably a good idea to have access to some in case you really need it. But it's foolish to use for everyday expenses. People are finally starting to realize that too much insurance is too expensive and doesn't pay off. And we're looking for better alternatives.

The insurance industry has seen the writing on the wall. They know the gig is up, and that's why they've finally acquiesced to phony 'reform'. What they're really doing is seeking a 'partnership' with government - essentially using the state to 'mandate' themselves perpetual customers. It's truly sickening.

What the insurance companies have done is forced higher deductibles on most of us, so that we are paying for everyday care out of pocket. The problem is that it still isn't competitive because the way the system is set up, the insurance companies are still setting the rates. If you have insurance and your treatment/care falls under your deductible, you pay the negotiated price that is set between your insurance company and the providers they are contracted with. What should happen is that you should be able to purchase a policy that covers only major medical or only covers expenses over a certain amount per year. Then any treatment prior to that, you search out the most affordable provider based on competitive rates, not negotiated rates between your insurance company and their network of providers.

The other big problem has to do with overhead. With new technologies coming out all the time, every provider thinks they have to have it so they can be competitive. The problem is that many of these new technologies are only used for a limited number of patients. So all the providers determine their profit margin for a certain piece of equipment based on very few users. And guess what? The cost becomes astronomical, but the insurance companies agree to cover it by raising premiums.

There are so many problems with our current system, it's hard to know where to even begin. But one thing is certain, having insurance companies calling all the shots is not working.

 

[editec]

Its a FOR-profit system.

Ergo, it will increase prices whenever and whereever it can.

 

[AVG-JOE]

What the insurance companies have done is forced higher deductibles on most of us, so that we are paying for everyday care out of pocket. The problem is that it still isn't competitive because the way the system is set up, the insurance companies are still setting the rates. If you have insurance and your treatment/care falls under your deductible, you pay the negotiated price that is set between your insurance company and the providers they are contracted with. What should happen is that you should be able to purchase a policy that covers only major medical or only covers expenses over a certain amount per year. Then any treatment prior to that, you search out the most affordable provider based on competitive rates, not negotiated rates between your insurance company and their network of providers.

Good points. The negotiated rates stuff is bullshit, and a good example of how insurance is mutilating the health care market. The other reason there's no competition amongst doctors is because insurance nullifies demand for lower prices for those covered. Imagine what would happen in any other industry if most transactions were paid via insurance - prices would sky rocket.

Insurance only ever makes sense as a hedge against risk. It should be something that we very rarely 'use'. If it isn't, if insurance becomes the defacto way to finance a regular service, the market melts down - which is what we're seeing now in health care. This is why I don't understand those who think single payer will solve everything. All that would do is consolidate all the insurance companies into one. The 'corporate greed' problem might go away, but the basic dynamic will remain, and the health care market will continue to suffer in the same ways.

The other big problem has to do with overhead. With new technologies coming out all the time, every provider thinks they have to have it so they can be competitive. The problem is that many of these new technologies are only used for a limited number of patients. So all the providers determine their profit margin for a certain piece of equipment based on very few users. And guess what? The cost becomes astronomical, but the insurance companies agree to cover it by raising premiums.

Exactly. Insurance turns the incentive structure upside down - to the point that the competitive impulse produces higher prices rather than lower. As long as most patients are 'covered', there's no incentive to compete on price. And that's exactly where we want doctor's competing.

There are so many problems with our current system, it's hard to know where to even begin. But one thing is certain, having insurance companies calling all the shots is not working.

I just wish I could get people to understand that that's exactly what things like the ACA are all about - letting the insurance companies continue to call the shots. I'm not suggesting we just 'do nothing', but it would be better than what Congress has passed. If we did do nothing, the insurance industry would collapse. As consumers, we simply can't afford to pay spiraling premiums indefinitely. When that happens, when people and businesses start dropping their insurance plans out of sheer necessity, health care prices will come tumbling back down.

The problem is, that would be a relatively long and painful way for the market to self-correct. We (as in the government) could do some things to help it along, primarily by removing all the policies that have pushed us all into the group insurance madness in the first place. To soften the transition, we could help out the people on the fringes (the poor and the elderly) by giving tax credits for health care (NOT health insurance). We could remove the tax policies that have engineered health insurance as principle perk of employment. We could remove those health insurance regulations that exist primarily to protect insurance companies from innovative competitors.

The problem is that 2/3 of the increases are covered by our employers and the resulting lack of wage advancement is much easier to foist on us than an actual price increase in a competitive insurance market.

Can you imagine the pain-in-the-ass driving would be if 2/3 of your car insurance was an 'employee benefit'? Would GEICO continue to be running commercials touting their product over Progressive and Farmers? My guess is no. They'd start taking employers out to lunch and striking 'deals' to screw us.

 

[rdean]

For one thing, countries can get together and purchase American drug in bulk. Republicans, working on the behalf of the drug companies during the Bush Administration, made it illegal for HMOs or states to purchase drugs in bulk. That make the cost of medicine skyrocket from pennies to dollars.

It's not like it's a secret. It happened less than 10 years ago.

 

[AVG-JOE]

For one thing, countries can get together and purchase American drug in bulk. Republicans, working on the behalf of the drug companies during the Bush Administration, made it illegal for HMOs or states to purchase drugs in bulk. That make the cost of medicine skyrocket from pennies to dollars.

It's not like it's a secret. It happened less than 10 years ago.

Good point. Bluntly partisan when BOTH sides are equally guilty of nursing on the Drug Industry tit, but a good point.

 

[dblack]

Can you imagine the pain-in-the-ass driving would be if 2/3 of your car insurance was an 'employee benefit'? Would GEICO continue to be running commercials touting their product over Progressive and Farmers? My guess is no. They'd start taking employers out to lunch and striking 'deals' to screw us.

Likewise, could you imagine what would happen to automobile maintenance prices if state regulation required that oil changes and tune-ups be covered by insurance?

 

[AVG-JOE]

Can you imagine the pain-in-the-ass driving would be if 2/3 of your car insurance was an 'employee benefit'? Would GEICO continue to be running commercials touting their product over Progressive and Farmers? My guess is no. They'd start taking employers out to lunch and striking 'deals' to screw us.

Likewise, could you imagine what would happen to automobile maintenance prices if state regulation required that oil changes and tune-ups be covered by insurance?

Careful dblack, you never know who reads these boards! Don't be giving the terrorists good ideas, Bro'.

 

[Mr Natural]

Health care is expensive because we're a very unhealthy society.

Obesity, lack of exercise, bad diets, and stressful jobs all take their toll.

 

[auditor0007]

What the insurance companies have done is forced higher deductibles on most of us, so that we are paying for everyday care out of pocket. The problem is that it still isn't competitive because the way the system is set up, the insurance companies are still setting the rates. If you have insurance and your treatment/care falls under your deductible, you pay the negotiated price that is set between your insurance company and the providers they are contracted with. What should happen is that you should be able to purchase a policy that covers only major medical or only covers expenses over a certain amount per year. Then any treatment prior to that, you search out the most affordable provider based on competitive rates, not negotiated rates between your insurance company and their network of providers.

Good points. The negotiated rates stuff is bullshit, and a good example of how insurance is mutilating the health care market. The other reason there's no competition amongst doctors is because insurance nullifies demand for lower prices for those covered. Imagine what would happen in any other industry if most transactions were paid via insurance - prices would sky rocket.

Insurance only ever makes sense as a hedge against risk. It should be something that we very rarely 'use'. If it isn't, if insurance becomes the defacto way to finance a regular service, the market melts down - which is what we're seeing now in health care. This is why I don't understand those who think single payer will solve everything. All that would do is consolidate all the insurance companies into one. The 'corporate greed' problem might go away, but the basic dynamic will remain, and the health care market will continue to suffer in the same ways.



Exactly. Insurance turns the incentive structure upside down - to the point that the competitive impulse produces higher prices rather than lower. As long as most patients are 'covered', there's no incentive to compete on price. And that's exactly where we want doctor's competing.

There are so many problems with our current system, it's hard to know where to even begin. But one thing is certain, having insurance companies calling all the shots is not working.

I just wish I could get people to understand that that's exactly what things like the ACA are all about - letting the insurance companies continue to call the shots. I'm not suggesting we just 'do nothing', but it would be better than what Congress has passed. If we did do nothing, the insurance industry would collapse. As consumers, we simply can't afford to pay spiraling premiums indefinitely. When that happens, when people and businesses start dropping their insurance plans out of sheer necessity, health care prices will come tumbling back down.

The problem is, that would be a relatively long and painful way for the market to self-correct. We (as in the government) could do some things to help it along, primarily by removing all the policies that have pushed us all into the group insurance madness in the first place. To soften the transition, we could help out the people on the fringes (the poor and the elderly) by giving tax credits for health care (NOT health insurance). We could remove the tax policies that have engineered health insurance as principle perk of employment. We could remove those health insurance regulations that exist primarily to protect insurance companies from innovative competitors.

The problem is that 2/3 of the increases are covered by our employers and the resulting lack of wage advancement is much easier to foist on us than an actual price increase in a competitive insurance market.

Can you imagine the pain-in-the-ass driving would be if 2/3 of your car insurance was an 'employee benefit'? Would GEICO continue to be running commercials touting their product over Progressive and Farmers? My guess is no. They'd start taking employers out to lunch and striking 'deals' to screw us.

As I have said in the past and continue to say, if we just could get health insurance out of the hands of employers, prices would come crashing down. Most people have no clue how much their health insurance costs. If they had to pay it all out of their own pocket, can you imagine what would happen?

 

[clanthar]

graft

 

[clanthar]

corruption

 

[Cecilie1200]

I have read it many times.

My personal visits would be anecdotal and for you to even ask that in the face of well researched data by unbiased experts tells me that you hate facts and truth and spin like a Fox News Nazi.

And still I wait for answers in vain, receiving only lame dodges.

Who are these "unbiased experts" with "well-researched data"? I KNOW you're not talking about the World Health Organization. Even YOU cannot possibly be THAT pig-stupid and willfully gullible.

So let's talk about some facts, rather than "Oh, I've read it all, and done it all, and I'm JUST too weary to bother talking about it", which only a newbie like you would try around here.

1) How was the US's ranking of 37 arrived at? What were the determining factors? (You should know this, since you "have read it many times".)

2) How were the criteria weighted? Which ones counted for a larger part of the score?

3) How did the United States rank on each of the individual criterion?

4) How much does the vaunted WHO take into account differences in culture and lifestyle and the effect they can have on many of their criteria?

I know the answers to all of these questions, because I've not only read WHO's catbox liner of a report, I've also researched it. How about you? Think you can grow a pair and answer a question for once, nancyboy?

POST THE WHO REPORT AND PICK IT APART. UNTIL THEN, STOP LYING.

The reason you are asking me to is because you know I don't have enough posts to post links but I can still expose you lies and dirty tricks. If we were in the same I'm probably beat the crap out of you fat boy.

Yeah, I'm going to post the entire, 6-chapter, 1.73 Mb report right here. Even if I could, why would I bother posting the entire report for a screeching, fucktard newbie who can't be bothered to answer a single question about anything, but sure as hell feels able to come in here shooting off his mouth with STATEMENTS - oh, MY, yes - about how the United States has third-world health care. Can't give me any proof, other than to cite a report he's "read many times", but can't answer any questions about until I "post the report" for him.

Fuck you, newbie. Strike fucking two, wanna go for a shutout of "I'm loudmouthed moron, ignore me please"? Because we can sure do it.

Anyone with any brainpower (in other words, not you) can see that I already picked the fucking report apart with the questions I asked. Maybe even you, with your two lonely brain cells huddling together for warmth, can see it, and THAT'S why you're too chickenshit to answer the questions.

Come on, poltroon. Answer the fucking questions. YOU want to cite WHO as your source, so answer the questions and prove you've even read the report. Otherwise, I've picked it AND you apart, and you can go ahead and crawl away with your tail between your legs.

No one's asking you to link anything. Just man up and answer the questions, you coward.

 

[uscitizen]

We need to streamline the healthcare paperwork so more medicaid/medicare fraud can happen. And less of a paper trail to prove malpractice.