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Gutting the Health Care Plan: The Scorpion and the Congress
Will serious health reform meet the fate of the scorpion and the turtle? In that fable, the scorpion pleads with the turtle to carry him across a river. The turtle resists, fearing the scorpion's sting, but the scorpion reassures him that he'd do nothing so foolish, since both would drown if he did. Finally the turtle agrees. Halfway across, the scorpion betrays his promise with a lethal sting. As the turtle begins to drown, he asks why he took both their lives. "It's just who I am," the scorpion replies.
I fear we're about to get stung again. When people look back at the failure of the Clinton-era health care initiative, they point, accurately, to an opaque process that produced a baroque Rube Goldberg mess that satisfied no one. That happened even before the insurance industry went on the attack with their Harry and Louise ads. But another missing element parallels our current challenge-appeasement of the insurance companies as the plan's centerpiece, and the inevitability that these same interests will betray us again.
The Clintons assumed the insurance companies were too powerful to confront, so the plan had to go along with them. But once they assumed any bill had to get the companies' approval, no plan could work, because it had to build in ways for the companies to maintain their profit margins and the immensely wasteful overhead they spend on advertising, processing claims, and turning down as many sick people as they can. Their approach also creates corollary wastes, like the third of the expenses of the average medical office that go toward dealing with insurance company paperwork.
Our health care crisis is so dire that the simple single-payer approach, as in Canada, should be at least seriously debated. Compared with us, most Canadians are satisfied with their system, in contrast with a recent US poll where 49 percent said our health system needed fundamental changes and 38 percent said it should be completely rebuilt. Canadians get a full choice of doctors (unlike in the US, where households have to switch doctors when employers change their insurance or insurance companies change their preferred provider lists). Tommy Douglas, the Canadian New Democratic Party leader who pushed through national health care in the mid-60s (replacing a system like ours), was recently voted Greatest Canadian in a recent contest, beating hockey star Wayne Gretzky and Prime Minister Pierre Trudeau.
Even if single payer isn't politically achievable yet, there's no reason to take it off the table from the beginning. Doing so means most Americans never get to hear the contrast in cost savings, in allocation ease, in impact on ordinary citizens and their health outcomes. They never get to hear the story that might allow them to overcome current fears about losing the health care they have, being unable to see their preferred doctor, or being condemned to the Purgatory of endless waiting. Maybe we've been so conditioned that we can't quite get the support for a full-fledged switch. A recent Kaiser Foundation poll still gives single-payer a narrow 49 to 47 percent majority, vs 67 percent for including a fully competitive public option, and maybe that isn't enough. But at least we need to tell the story, so the probably inevitable compromise works down from full public coverage, as opposed to considering options that gut even the option of serious public coverage entirely.
Instead, because we've accepted the premise that the private insurance companies have to be included, we're now starting to consider including a public option only if it includes poison pills that will doom it to fail, like requiring it be triggered by a set of exceedingly unlikely circumstances deferred to the indefinite future. Or requiring it to play by rules so onerous that it can't achieve its straightforward cost savings. Or turning it over to the states, so Big Pharma and Big Insurance interests can simply, as Robert Reich warns, "buy off legislators and officials as they've been doing for years."
But why assume that the insurance companies are our friends? Why appease them at all? It's not as if they've played a helpful role in our current system. Rather, they've gamed it in every possible way, leaving our country with the highest health care costs in the world and worst health outcomes of any advanced industrial country. While they've made promises to cut costs, their promises are only that (like the scorpion's), and they're already lobbying with everything they have to gut any seriously competitive public option. Add in examples like former HCA/Columbia CEO Rick Scott. after his company paid a $1.7 billion fine (the largest in US history) for defrauding Medicare, Medicaid, and the program that serves our armed forces, he is now organizing attacks on any public program (hiring the PR firm that coordinated the "Swift Boat" attacks on John Kerry). We need to challenge the insurance companies, not appease them. There's no evidence that suggests they're constructive players, or are likely to do anything except defend their own parochial interest.
The insurance companies and other major financial interests are talking a good line of late. They have no choice if they don't want to be cut out of the game. But ultimately, they are who they are, and their behavior reflects this. It makes no sense to embrace a partner who you know will ultimately betray you.
Maybe the public private mix is the best compromise we can get at the moment. But we must raise our voices now to demand a full debate on the other alternatives, like single payer, and then if necessary settle for something that gives a public option a chance, under equitable rules, to see how it plays out in efficiency, service, and cost. Trusting the insurance companies and stacking the deck to guarantee that private options will prevail merely assures we continue our dysfunctional system until its human and financial costs drown us all.
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52 Comments so far
Show AllThe devil is in the details. How much would the public option cost? Would it end up being a pool for the poor and high risk? (Public transit in lot of US cities just came to mind) Would it actually be a semi-privatized system like medicare has become?
And worse yet, one doesn't need to be a genius to imagine numerous ways the public "option" can be sabotaged by the private insurance corporations - leading to a propaganda coup that condemns universal public healthcare from consideration forever.
Better nothing at all and let the whole system collapse. Then we might get enough people in the streets for single payer, or better yet, a British/French style system.
Insurance, pharma, AMA and their ilk are dedicating boatloads of money to assure that any public component to US "health care reform" is limited to a token program that is doomed to fail, thereby making them look good and making the Obama Regime look good.
Unfortunately, many of the groups (all of them underfunded)advocating a combined private/public system are not following the most basic principles of negotiating...when facing a well funded opponent, you need to demand a dollar if you hope to end up with a nickle.
Unless you are demanding single-payer in this debate, you have no hope of ending up with anything other than a 100% insurance/pharma/AMA endorsed program that will cost you more and deliver less than the existing system.
Given the current trend of the debate, yunzer is correct...as bad as the existing system is, it is not as bad as what the 2009 legislation is likely to produce.
Coretta Scott King said that when the bus boycott leaders realized Birmingham's white power brokers were going to cede nothing, the boycotters would be foolish to spend their energies on anything less than a total victory of all civi rights. We need to demand the only rational program, single payer.
Yunzer--
You're quite right to query the details, because there are droves of well-meaning people touting a "public option" without any clue about what that might be. Most seem to imagine it would be some kind of Medicare clone that would be so attractive that it would wipe out the private insurers. Well . . . guess again. It's likely to be a clone of the private insurers with a phony "public" branding designed to gull the credulous while achieving it's real objective: keeping most of the system in the hands of the rapacious private insurers.
The first inkling of the details of the public option came about a month ago from the repugnant Chuck Schumer, who devised the scheme at the behest of the equally repugnant Max Baucus. Here are the devilish details, according to The New York Times:
"The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:
¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.
¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.
¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.
¶To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market."
In other words, a guaranteed-to-fail farce that would replicate all the worst features of private insurance and offer none of the cost-savings or coverage expansion of the single risk pool of true single payer.
It's time for progressives to stop being played for fools by the K-street sharpies who are trying to put lipstick on this pig of a private system. The only real reform is single payer--anything else will be a sham and a scam.
Go to one of the following sites to find out what you can do:
www.singlepayer.org
http://www.healthcare-now.org
http://www.1payer.net/
To bone up on the issues, go to the FAQ at
www.pnhp.org
thank-you for confirming my suspicions. So, what I see is this:
1. Few doctors will accept the public option - the insurance companies will probably even threaten to refuse to do business with any doctor that takes public option patients.
2. Because the public option must be self-sustaining and will likely consist of a limited pool of high risk patients who can't get insurance elsewere, it premiums and benefits will be higher than even the extremely inefficient, buereaucratic private insurance.
3. if it pays more than Medicare, it will further degrade the utility of medicare - maybe even lead to it's demise.
This "public option" looks like it could not only be unhelpful, it could be a positively bad thing. Time to oppose the whole mess. Better the system collapse completely on it's contradictions that a helathcare plan that just prolons the urrent system.
"Better nothing at all and let the whole system collapse."
You've got a very good point here: it sometimes takes a raging fever for a disease to run its course. Which brings to mind...
Does anyone remember the propaganda themes of the old Soviet Union?
They forecast the ultimate demise of the West resulting from the inherent greed and corruption of unregulated capitalism that, in turn, would promote the increasing oppression of the workers.
We laughed. Couldn't happen here.
The Soviets got and held control of their people until, because they believed their own nonsense, the whole system collapsed.
And isn't all that starting to feel familiar?
Meanwhile, we can adapt our coping style to include a few gems of Russian wisdom:
> "Cheer up! Life is becoming very difficult but, fortunately, shorter!"
> Moscow Motto: "Tough shitzky, komrade!"
Snoop, they had another joke, "We pretend to work and they pretend to pay us". Not applicable in our case because while they pretend to pay us, we work our asses off.
When the people fear their government there is tyranny,
when the government fears the people there is liberty.
~ Thomas Jefferson
Brilliant analogy!!!! Capitalism is the scorpion, and the U.S., with everything seemingly falling apart, is having a hard time recognizing this fact.
With the health care issue, the ruling capitalists say it is all or nothing, refusing to recognize the reality that some things are best not privatized. The capitalists sense they are holding their finger in the dike.
The people need to be better informed on a mass scale to offset the irrational fear of limited socialism. However, a better informed society has been the critical need all along with so many our nations problems. Being the last bastions of community, it is time our churches and universities lift their heads out of the sand.
Don't count on universities to lift their heads out of the sand...they will do anything to maintain the flow of corporate research funds and other corporate largesse that they depend on for survival.
If US schools and universities had done a better job of teaching critical thinking to students, fewer Americans would be falling for the Madison Avenue advertising (actually brainwashing) that politicians, insurance companies, drug companies and other corporations repeatedly employ with great success in hoodwinking American consumers and voters.
If US schools and universities had done a better job of teaching critical thinking to students,.....
35 years ago I came to the conclusion that American students at least at the college level should be required to take LOGIC. IMO, it should be "a requirement for graduation from High School".
Critical thinking will be the first step in the coming Revolution - but I guess that that is an optimistic view. More likely, USAers will continue to accept anything the corporations throw at them.
Ray, I certainly agree with you, but don't you think that the present economic collapse and never ending war will prompt some of the great minds in higher education to question their Rip Van Winkle nap over the past 30 years?
Watch very carefully what is happening in Washington regarding the "Health Plan." Do not be surprised or disappointed, We now live in a culture of chaos run by big corporations finding anyway the can to shovel money into their coffers by tricking, and telling lies to the public.
laffingbear, you stated a profound truth: We now live in a culture of chaos run by big corporations.
It's very hard to see what to do about it. They control the flow of information, our educational system. For all I know they're putting soma in our water supply. People are acting like battered spouses in an abusive relationship, taking the abuse and hoping things will get better. They won't. They will just get worse.
When the people fear their government there is tyranny,
when the government fears the people there is liberty.
~ Thomas Jefferson
After all is said and done, I fully expect a really bad outcome and worse to have it sold to us as a victory no less. That the Obama admin. will allow this is now obvious. All we need do is look @ how they are treating the banksters and it's obvious little has really changed in DC. The BIG CORPS. and the Barons that run them own our Federal Gov't and most of the State Gov'ts as well. ONLY $$ talks in these places anymore and BS walks. All any of us have is BS. Unless , we can put together a 5 mil . person march on DC to demand Single payer were going to get BIG CORP. Vampire care that we are FORCED by law to buy or else.
Yes, yes, yes, a five million person march on Washigton. DC
AW SHUT UP ! Obama's doing a great job of putting forth a compromise. All you stupid Naderites can't quit crying and wetting your panties, can you ?
Heckuva job, Obie!
Go wash your stinking underwear, get rid of your porn collection, leave your basement, and get a life, you pathetic psychotic.
I see you are irritated. Try the more convincing facts.
Another problem in your thinking. Obama is waiting for you and me to gather enough support for single payer. He is on tape (YouTube) saying he supports single payer and that all we had to do was win Congress and the White House. If you really support him, tell him we want the cost-effective national health program he advocated for before the campaign. I campaigned for him and voted for him. Now is the time to let him know we have his back when he supports people over the health care profiteers.
Oregoncharles
"Maybe the public private mix is the best compromise we can get at the moment."
This is BS. This moment is our moment. Once it's gone, it's gone! Do not listen to anyone who advocates backing down. Turn 'em off.
David Brower - one of the greatest environmentalist of the 20th century - said:
"Whenever we compromised, we lost."
So don't compromise. Why? Because any corporate run healthcare system is WRONG. Keep pushing, don't let these smarmy politicians and their minions and punditry talk you into accepting some industry run scam. We are being softened up for that right now.
Keep calling your reps and don't forget to call Baucus to tell him he's a fraud and you're going to make sure every one knows it. Yeah, I know, that's not polite. It also isn't polite to tell the American people that single-payer is not politically an option. Tell him there is a movement to sabotage any industry run system. People are talking about tearing up their healthcare policies, etc.
Healthcare is in our arena right now. They know it. So, DEMAND, DEMAND, DEMAND. Do not say, "Oh well, maybe the industry run scam is the best we can get right now." Like this Loeb guy is doing. He probably doesn't even realize what he's doing. Americans are so used to being used and abused, they can't imagine what a demand would look like.
America, get tough or get run over. There's no other way to deal with this empire's last desperate gasps. It will always involve hurting people. They don't care. I've experienced it myself. They really don't care.
As it is now, single payer is not discussed openly and honestly in the MSM. The only way forward is to keep pushing until Americans have been reasonably educated on its benefits - and whatever pitfalls there are, to be fair. Once that is accomplished, it's a no brainer.
We can get it if we really try. But we can't give one inch!
They're trying to soften us up and it just might NOT work this time.
SINGLE PAYER IS THE ONLY ANSWER - Everybody in, nobody out. Single Payer will save money. We cannot afford a Wall Street Insurance System any longer. It costs too much in money and lives. 18,000 deaths per year !!! Come on people, who are the real terrorists - the ones who did 9/11 and killed 3000, or the ones who continue to kill 3000 every 60 days.
SINGLE PAYER BY ANY MEANS NECESSARY.
Single payer means raising taxes and we can't afford it. More tax cuts are coming along the way so you'll have plenty to be able to afford an insurance provider so stop being a panty-wetting crybaby begging for single payer.
Tax cuts don't help pay for insurance bills. Most of the tax cuts were for the top 1% wealthy and thanks to lack of public funding, there's less of a clean environment as a result. The dirtier the environment, the more the healthcare costs rise and no amount of tax cutting will cover for it. In fact, it will make matters worse. Why should we pay taxes so that government will spoonfeed private insurance industries who are nothing but ripoffs?
But you wouldn't have to pay the health "insurance" companies.
Maybe the cost of single payer taxes would be less than the costs imposed by the health "insurance" companies.
I think the cost of single-payer taxes would be less than the costs imposed by the health "insurance" companies.
Hey, troll--you're an ignoramus and a bore.
Get a life, you pathetic nematode.
You would clearly be surprised if you looked behind the curtain. The "taxes" are already being paid, they are just not being called "taxes". They come under the names of : premiums, co-pays, deductibles, auto and house insurance injury lines, local/state/federal employee benefits, credit card interest on medical bill payments, higher prices for goods and services to pay for employees' benefits, lower pay because of negotiating pay for insurance, profits to pharmaceutical price-gougers, charity giving to neighbors who lost their insurance when they got sick... and don't forget the cost of losing your job when ill and thereby losing your insurance. Then there is the cost of going bankrupt for medical bills (70% of bankruptcies by the latest research) and of course the other disaster, losing your house. The whole set-up is a shakedown for the 30% that the for-profit health care insurance and HMO industries snatch out of the patient/health care provider relationship. Elected officials allow this.
We pay more for health care here than anyplace in the world. The price is the gold standard yet we get the shaft. The countries where health care is paid through taxes -- the honest type -- have their health care seamlessly when they need it, paid for by the gigantic risk pool. Oddly enough, the typical industrialized country not only has universal national health care plans, they also have tax-subsidized university education so their citizens are not paying off debt and accumulated interest for decades after graduation. Young men and women don't have to be wealthy to afford medical school. The average tax payer actually gets to save money for homes and long government-guaranteed vacations.
Your name calling is not helpful to gaining insight into how you are being duped. I hope you do some fact finding.
Bumper stickers?
Single Payer will save money
Health Insurance kills
Great bumper stickers. Who will print them and where can we get them??????
Blame Big Pharma and Big Insurance for providing the bribes, but blame the politicians much, much more for taking them.
Olympia Snowe of Maine is the latest "scorpian" in the debate.
Last week, she blew the "public option" out of the water by recommending:
1. We keep the public option on the table
2. But first, we give private insurance the chance to change their ways - moving towards reduced costs and universal coverage.
3. If they don't change their ways, the public option will be introduced.
4. Private insurance should be given several years to prove themselves before the public option is introduced.
Perhaps after the next presidential election ?
Snowe, single-handedly has taken the public option off today's table - along with any universal option
1. Corrupted senators and representatives can tell their constituents that they support the public option
2. In several years - we will revisit the health care debate - not to debate the entire system, but to debate the public option only.
How far down the list will that be ??
Snowe has given big insurance and big pharma a way out of the debate.
They can now support the public option, knowing it will not be introduced for several years - if ever.
There should be a special place in hell reserved for Senator Olympia Snowe.....
Sioux Rose
Interesting side note: Hillary Clinton is a Scorpio/Scorpion, and that is the rising sign of Mr. Obama. Sometimes metaphors go deeper than surface appearances suggest.
There are some that decry the damage that would be done if the health "insurance" companies lost most of their business.
Tens of millions of people over the years have had to cope with their livelihoods disappearing overnight - nearly always they were the poor slobs (like those who were struggling to make a living pumping gas or tossing pancakes at roadside joints when Eisenhower's interstate came along and by-passed them). These people were put out of work by the government.
There is no special reason why the health insurance companies should remain in business, nor should thay receive any special compensation.
Bingo. These leeches have been sucking the blood of our nation for way too long.
I noted some time ago that, as far as I know, concern for the prospects of continued employment for employees of iron lung and orthotics manufacturers was not raised as a justification for suppressing the development and distribution of the Salk vaccine.
· Yr Obd't Servant
So true. What's more, the basically ethical employees in their midst will get trained for new jobs which will allow them to sleep at night. The politicians doing those alarm odes to the insurance companies are simply wondering where they will get campaign donations when their buddies go into another line of business.
We have gone 180 degrees from the 1980s, when Reagan talked about getting the government off our backs. Now we're trying to get the corporations off our backs.
"Now we're trying to get the corporations off our backs."
I dunno. There are backwards people who would still blindly suggest that corporations are "GOD" and should be "worshipped". Worse, these same people would gleefully sabotage small businesses and even ethical corporations while blindly defending the big, bad, and ugly.
Single Payer is possible and the best solution.
Keep advocating single payer. Let everyone know why it's the best solution.
Health insurance companies are financial companies, they provide no health care. The insurance companies do restrict your choice of doctor, deny or limit the amount of health care your receive. As financial companies they have a fiduciary duty to their share holders to manage resources so that they earn the maximum profit. Their revenues come solely from premiums their customers pay. Increasing premiums or reducing the amount of health care dispensed is the ONLY way insurance companies can maximizes profits.
Single payer is non-profit health insurance. It will allow you to choose your doctor. Single payer will not deny you coverage.
An apropos quote:
“First they ignore you, then they laugh at you, then they fight you, then you win.”
Mahatma Gandhi
Correct.
The trend of health care in the U.S. is that it will be outsourced overseas. It has already started and in its infancy stages now. Initially it is being promoted for elective surgery. Google medical tourism and outsourcing health care to educate yourself. Below are a couple excerpts of articles to get started. In my opinion, the insurance companies will do only what is required to buy them the time needed to strengthen this new business model. Of course, none of the risks or down sides are addressed in these articles. Fasten your seat belts everyone!
"The Future of Health Care: Outsourcing the Patient"
http://www.portfolio.com/views/columns/dual-perspectives/2009/03/03/Outsourcing-the-Patient
“UnitedHealth, which has over 70 million Americans under its care, has already moved to make Bumrungrad International hospital in Bangkok "in network." When Aetna, with 37 million members, bought the overseas insurer Goodhealth Worldwide last year, Aetna's CEO explained the move by saying that globalized surgery is "an important emerging trend." The company has already started a pilot program to send patients abroad for hip and knee replacements.”
http://online.wsj.com/article/SB122933146963306435.html
• DECEMBER 15, 2008, 8:39 A.M. ET
Outsourcing Health Care to India
The costs will be picked up by Serigraph's insurer, Anthem Blue Cross and Blue Shield. Employees will receive travel and concierge help, including free plane tickets for patient and companion, plus post-operative care upon return to the U.S. There will be no co-payments.
It's a trial program, but the economic benefits aren't in doubt: A cardiac bypass can cost about $100,000 in a U.S. private hospital. Apollo says it can do the procedure -- and accommodate a companion -- for a tenth of the cost.”
Obama's rising sign is not Scorpio - it is Aquarius - Scorpio rising was an incorrect guess
by certain astrologer's before his birth certificate was made public.
I'm for single payer - and I am not ruling out Obama - Aquarius can bring on change and
start a revolution.
And - all Scorpios are not bad.
Sioux Rose
Miller: I didn't see the chart changed with a different birth time. The published one I saw had Scorpio rising. There was nothing said about Scorpio being bad, either; the point was an analogy to the scorpion.
The Insurance Vampires are the Scorpion's Sting.
How does Cuba provide world class health care to it's people in spite of America's best efforts to assassinate Castro and strangle their economy? It can be done easily and cheaply.
A caring government would insist that their citizens had regular health check ups rather than 'insurance' payments to nonfunctional corporate monsters. A caring government would insist that all their citizens get medicines in bulk at the lowest noninflated costs. A caring government ensures that greedy corporations do not poison their citizens. Our corrupt congress has been killing us and our children for decades. It's time for reciprocity to take hold. How many bribes can congress take with their hands cut off? How many bribes can a disemboweled Insurance executive give? Reciprocity Now!
Universal Single Payer Health Care Now!
Two small adjustments.
1. Nationalize the pharmacuetical industry. sorry ass*****.
Or, produce the same drugs. For the national good, for nothing.
2. Make it a National priority to mint 100,000 new doctors within 10 years. Pay their tuitions for community work after schooling is finished.
lottsa docs, price of surgery anasthesia et al would plummet
lotta meds, that is most of it.
and the insurance co mf's? those b's could get in line.
"Instead, because we've accepted the premise that the private insurance companies have to be included..."
What you mean "WE, Kemosabe?
_I_ don't accept that we have to include the insurance companies at all. In fact THEY ARE THE PROBLEM.
The insurance companies have had over 30 years to fix health care, and every time they've been given yet _another_ chance, the costs have skyrocketed.
I just got a response from Senator Jeff Merkley saying that _if_ it makes it to the Senate floor, he will vote for Single-payer. But he doesn't indicate that he'll work very hard to get it to the floor. Ron Wyden thinks we "want what Congress has" and wants to offer us a shopping list of insurance options ... no governemt option at all. He's refusing to listen to the majority of his constituents.
This is not the time - in my opinion - to push something other than what the president wants, which is CHOICES INCLUDING A PUBLIC OPTION. The reason why Clinton never got universal health care was, among other things, that despite overwhelming Democratic majorities in both Houses of Congress (until 1995) every bloody congressperson thought HE or SHE had a better idea. So full was the congress of "better ideas" that we never got universal health care.
THE PERFECT IS THE ENEMY OF THE GOOD.
Just work as hard as you can for a PUBLIC OPTION. When people find that the public option works better than private insurance - which they undoubtedly will - guess what we'll have? SINGLE PAYER. Why do you think the insurance companies fight the public option tooth
and nail - because they recognize that sooner rather than later everybody will choose the public option. Fact is that Obama is just a tad smarter than the rest of you - that's why HE is president and not you - and he knows that a public option will be hard enough to get through that weak-kneed congress - but single payer will never make it. So, just trust his better understanding of politics - whenever you'll have a chance to confront the opposition, just ask: What's wrong with CHOICE? Choice means freedom to choose - you got something against freedom? That's the FREE MARKET at work.
What can the opposition say against giving people a choice? Don't you understand the strategy? The opposition loses a lot of traction when WE can say: hey, if you like what you've got YOU KEEP IT. There is NO coercion. The free market is at work!!
Sincerely,
Francoise