Trump: Yeah, I Mean It
The Market Ticker - Commentary on The Capital Markets
2017-03-15 21:57 by Karl Denninger
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Trump: Yeah, I Mean It
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Look, this is math.

I don't want credit.  I don't care if you never admit you talked with me.

Seriously -- I don't care.  This isn't about glory.

It's about the Republic and its survival.

The arithmetic is clear.  It's irrefutable.  There's no discussion to be had.  It's fact.

I called this in the 1990s when I ran MCSNet.  I called it again in 2011 in Leverage.  I've been raising Hell about it since 2007 on this blog.  It wasn't hard and I claim no special knowledge or insight.  All that was required was reading the MTS and either a $3 calculator or a piece of paper and a pencil.  An act, I remind you, that every CEO does every single month -- that is, reading the financial statements.

Look, I get it.  The political side of dealing with this is hard.  You're going to******off a lot of very powerful and wealthy people.  They're going to get very angry.

The bottom line is this: You have the ability to put a stop to all the medical scams now -- right now -- using existing law.

If you don't then the nation fiscally dies.  Ryan's bill or no bill; doesn't matter.

If you do it then "insurance" is something that 95% of Americans need only for catastrophic events because the cost of medical care will fall by at least 80% and for most items by 90% or more.  Said insurance will be cheap - under $100/month for a family, and about $25-50/month for a single person.

Nobody will need "insurance" for routine events because they will be able to pay cash.

Birth control will cost under $10/month.

Routine labor and delivery will cost under $1,000.

This isn't hyperbole -- it's fact.

We know this is true.

We know because The Surgery Center of Oklahoma performs cardiac bypass surgeries all day long for $10,700, complete, no surprises, no extras including complications that may arise -- done.  $10,700, period.

The hospital across town charges five to ten times as much.

But even the prices at The Surgery Center, nice as they are by comparison, are chock-full of monopolist price fixing. Why? Supplies, devices and equipment are all provided under monopolist, price-fixed schemes for starters.  We know this because the same bypass surgery is about $2,000 in India where there is no such collusion, the doctor was trained in the United States and the supplies and devices are the same as in the US but unlike in the US the suppliers have to compete for business.  The difference is that in India competition reins because there is no hiding the cost, there is no extortion via "explanation of benefit" statements from providers and thus price reflects competitive pressure not only on cost but quality of service between providers.  Not surprisingly the complication rates in India for that surgery are lower than they are here in the United States.

You can find bills for routine childbirth from the 1960s -- including epidural, doctor and nursing charges, charges for care of the baby, three nights in the hospital, soup-to-nuts.  Inflate them by the CPI to today's price.  You wind up right around $1,000.  Routine, vaginal childbirth certainly hasn't changed in the last 40 years in terms of what's required.  The only "change" is that the medical establishment has decided to ramp the price by a factor of ten and screw you out of the money.  It has been able to do so only because there is no competitive option available to you.

In Tokyo, Japan, you can have an MRI done for $200 or less on a walk-in basis -- cash.  How much does an MRI cost here in the US?  You can literally fly to Narita from any major city in the US, take the NEX to Tokyo, have the MRI done and read then get on the NEX again and fly back for less than it costs to have the scan done in the United States.  There is a person on my forum who was just quoted over $5,000 to have said scan done here in the US yet he can fly to Narita round trip and have the scan done for $1,200 -- $1,000 of which is his airfare!

He can fly to Japan four times and have four MRI s done for the cost of one here in the US including four intercontinental airplane rides!  If the price of the scan being 20 times higher here in the US doesn't meet the definition of a scam would you please explain what would?

The entire medical system in this nation is a massive fraud and scam.  It's not a mistake, it's not an error, it's not an aberration it's a scam, it's robbery and everyone involved ought to be in prison.

You're out of time Mr. President.

You either do the right thing with regard to medical care, now, or this nation dies.

We either do the right thing or we let Paul Ryan and his buddies in the Congress, along with the doctors, hospitals and lobbyists and others screw millions of Americans -- a crime for which all of them should be indicted, tried, convicted and hanged.

You choose.

The math is clear.

The facts are clear.

The acts by which these individuals and corporations screw America are illegal. These laws, which include both ruinous civil and felony criminal penalties barring said conduct were passed over 100 years ago and are embodied in 15 United States Code.  They were challenged in the 1970s, the case went to the Supreme Court and the insurance companies and their buddies lost.

It's not a close call.

It's not a matter of opinion.

It's settled law.

You, as President, are able to direct the AG to enforce said 100+ year old law.  In fact, as head of the Executive branch of government, which is responsible for enforcement of the law, it is your job to do so.

Or not.

As Barack Obama didn't.

As Bush didn't.

As Clinton didn't.

As Bush before him didn't.

Four Presidents willfully, intentionally and knowingly refused to enforce 100+ year old law that would have immediately and permanently put a stop to the medical scams and the escalation of cost.

I get it.  This expansion from 3% to 19% of GDP over the last 30ish years has put a half-percent a year on GDP expansion that would not otherwise have taken place.  It has made "growth" look better.  It has wildly expanded the "market cap" of various public companies and their stock prices, including pharmaceutical firms and other health-related conglomerates, along with insurance companies.  It is politically enticing to continue doing it, except for one small problem: 10% expansion annually at 3% of GDP is 0.3% of GDP, a relatively small number both percentage wise and in terms of dollars.  At 19% it's 1.9% of GDP -- a much larger percentage and dollar amount, more than six times as much.

Oh, and this exponential growth, which your predecessors and now you have allowed, is also responsible for more than half of the Federal Debt, all-in, as that same expansion has added to Medicare and Medicaid spending.

I understand that collapsing health care from the current 19% to 3-4% of GDP will produce a huge recession.  It will produce a monstrous movement downward in the stock market.  That freed-up spending will go somewhere else in the economy and the recession produced will be quickly recovered from -- probably like 1920/21, in fact when the entire drop and recovery took less than two years.  The cost of operating a business will drop like a stone; not only will employee costs drop so will any firm's and individual's liability insurance where injury is a risk insured against.  From car insurance to business liability to trucking firms these costs will drop tremendously -- and be reflected in the competitiveness of American business.

This is not a matter of choice any more Mr. President -- other than on time.  We can either do it now, take the adjustment and become the most-competitive place to do business in the Western World or we can keep playing this game right up until our economy and budget collapses -- and collapse it will if you do not put a stop to this crap now.

Last fiscal year the Federal Government spent $1.417 trillion on Medicare and Medicaid, 9.3% more than the $1.297 trillion it spent the previous year. Last year was not an aberration; it was in fact very close to the historical expansion rate from the 1990s forward.  Spending has almost quadrupled on these programs since FY 1998.  Total outlays in 1998 were $1.651 trillion of which Medicare and Medicaid comprised 23%. Last fiscal year 37% of all fiscal expenditures were made on these two programs.  The ACA (Obamacare), for all of its warts, only managed to dampen that rate of expansion in spending for two years, after which it returned to trend.  At this rate of spending expansion within the next four years the government will attempt to spend $2.02 trillion on these two programs combined which will blow an approximately $600 billion additional hole, per year, in the deficit.  That will not be able to be financed since if it you ignore this issue it will be clear that within 10 years the government would try to spend $3.4 trillion per year on the same two programs -- an utter impossibility under any rational expectation for economic expansion.  The impact on private health spending has been even larger on a percentage-of-increase basis due to the blatant cost-shifting that is well-documented in myriad reports and is responsible for a large portion of the stunting of economic progress in America that has occurred over the previous two decades.

We can't keep doing what we've been doing Mr. President.  We cannot continue to allow the monopolists in the medical and health-insurance industries to continue to expand their influence -- and consumption of GDP.  Not for long.  Not for the rest of your first term, and certainly not into the second.  That's the math, like it or not.

Further, that math was either known to you or you would have known if you looked before you ran for President, which means you took the job without any ability to claim "surprise."  Thus, it is not only reasonable to expect you to resolve this problem now, in the present time (particularly given that you have tools as the head of the Executive to do so) it is also quite reasonable for the people to hold you personally to account as President if you don't.

We either admit to what we've been doing and stop the scam or it will overtake the economy and our ability to pay -- both in the government and otherwise, within the next 4-5 years.

We either stop it now or it destroys the economy, asset prices and the nation.

This isn't politics.  It's math.

The facts are what they are.  Demonstrating them is easy and irrefutable.

I'm a (long) day's drive from DC and about the same from Mar-a-Largo.

You name the place and time.

I'll be there -- with the laptop, charts and figures.

I have only one "ask" -- you listen and then act predicated on that which is obvious given the numbers -- politics be damned.

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User Info Trump: Yeah, I Mean It in forum [Market-Ticker]
Enapa
Posts: 1543
Incept: 2008-01-25

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Please Mr. Trump. Just enforce the laws. How do we get him to read this *******n it?
Tsherry
Posts: 781
Incept: 2008-12-09

Spokane WA
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He or his staff have most certainly read it by now, don't you agree?

It's obvious to me that by enforcing the USC 15, Trump is being told that he would destroy the nation, when the exact opposite is the case. He's being told this by the same people who came up with "ryancare" or whatever BS non-repeal of Obamacare is currently floating in the toilet. They are the ones on their knees in front of the law-breakers, and they're not about to bite down on that schlong, are they?

I'd love to see just that one law enforced...no other changes, and sit back and watch the domino effect. Sadly it appears that we'll just watch the country implode instead.
Neoterikos4
Posts: 13
Incept: 2009-03-23

Wash DC
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Two ideas:
1) Social media storm - post links to Karl's best healthcare articles on social media sites. A twitter storm is when a bunch of people start tweeting on the same thing a lot at the same time, with a #hashtag, to get it visible. This includes that, but hit everywhere: twitter, reddit, facebook, snapchat, instagram, etc. (wherever it makes sense - I'm not very familiar with some of these). Ask other people to read the article, and - important - if they agree, to share it everywhere. You must ask them to share the link. Share it with friends, relatives, congressmen, attorney generals, newspeople, and everyone. Post it to @realDonaldTrump on twitter too. (If @realDonaldTrump is getting blasted by thousands of tweets about these articles, he will see them. Same for your congressman, etc.). Get the word out that we are paying more than 5 times what we should for healthcare, that we need our laws enforced, and that we need a free market. #FreeMarketCare #WhereAreTheCops

2) Harder - create a video with these ideas. Share that everywhere. For some people, a video would be a better way of reaching/convincing them than articles.

The first idea is immediately doable by everyone. The more people that would do this, the better. And the more social websites that are hit, the better. Hope the internet picks it up, adds to it, and it snowballs. Don't underestimate the power of social media to reach eyeballs. But you need a big enough start for it to trend and catch. Might be best to storm at the same time, but if that is hard to coordinate, if everyone started posting a lot, it still might work. Thoughts/comments/join me? :-)
Bhakta
Posts: 86
Incept: 2009-12-03

Bangkok, Thailand
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Karl, I had prostate reduction surgery in Thailand last November; I paid cash at the government hospital, full retail price. 4 days, 3 night in the hospital, 2 1/2 hours in the operating room, beautiful private room with a lovely view, TOTAL COST US$532 including medicines to take post operation for two weeks.

Cost at the Oklahoma Surgical Center $4700. Cost at most public hospitals in the USA must be over $20,000.

I am reading you write on this since 2007. I am amazed that it seems no politicians and no major media pick this up.
Themortgagedude
Posts: 10235
Incept: 2007-12-17

saint louis
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You say it has added to gdp. I will argue that with you. To steal money from one person doesn't add to gdp. It's just a wealth transfer.

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I think its time we ask ourselves if we still know the freedoms that our founding fathers intended for us. Ronald Reagan 1964
Themortgagedude
Posts: 10235
Incept: 2007-12-17

saint louis
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It's not a scam. It's well beyond that. I'd call it racketeering.

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I think its time we ask ourselves if we still know the freedoms that our founding fathers intended for us. Ronald Reagan 1964
Tickerguy
Posts: 148205
Incept: 2007-06-26
A True American Patriot!
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Quote:
You say it has added to gdp. I will argue that with you. To steal money from one person doesn't add to gdp. It's just a wealth transfer.

I'm not the one who defines how GDP is counted; in Leverage I argue for an SI-unit based unit of account (e.g. Joules of energy evolved or consumed) because you can't define something in terms of a variant (number of dollars) without algebraically removing that OR you get a meaningless result.

Since the definition of a recession (in economics today) is two consecutive negative GDP prints, and the definition of a Depression is a >10% top-to-bottom GDP excursion it is clear exactly what fixing health care will do in terms of contemporary economics. There's nothing you can do about the collision between what has to happen and what CNBS and the entire cadre of "economists" will call it. It is what it is.

However, what's LIKELY to occur in terms of trajectory is similar or identical to what we had happen in 1920/21 -- which nobody even counts as a Depression (the two were 1873 and the 1930s) despite the fact that 20/21 was both the deepest and fastest decline in GNP (at the time they counted it slightly differently than today.) Why does nobody even TALK about that particular event? Because the recovery was also the fastest and most-energetic ever recorded -- in fact, the greatest year-over-year output gains ever in the history of the nation were notched during that time.

It will not suck for long and we will be FAR better off as a country once we do it but for those who are part of the racketeering now it will suck for certain during the time the realignment is taking place, and the headlines will be SCREAMING "Depression!" as well.

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Winding it down.
Marquiri
Posts: 16
Incept: 2015-02-24

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I have started writing to my congressman (Bill Posey) and Marco Rubio on this topic. No responses yet, and coming up on two weeks since I sent the message. I also sent a message to Sean Hannity, given that he seems to have taken up the health care fight, imploring him to have Karl on the show. I have had issues with Hannity in the past, but he worked as hard as anyone during the last election cycle, and I can't think of many better ways of getting the message out there.
Nickdanger
Posts: 615
Incept: 2011-06-12

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Great presentation on the 3-14 Stocks and Jocks show as usual Karl. It would be nice if the ones that need to hear it would listen...

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Grammar: the difference between knowing your **** and knowing you're ****.
Emac
Posts: 17
Incept: 2012-10-01

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I am 50. Last year I had my first colonoscopy. My doctors office set it up for me. I got a call from the hospital to set up the appt. I asked how much would the procedure cost. She said nothing, as I had met my deductible, $6,500 (wife had shoulder sx) for the year. I asked again how much it would cost. She said she really didnt know, but I would not have to pay anything. I went ahead and had the procedure. A few weeks later I got a bill from the hospital for $430 for a portion the insurance did not cover. The total bill was $5400! I called billing and they said they were sorry but I needed to contact BCBS. I got the run around for several months from BCBS. "We are looking in to it, we will get back to you". I started getting collection letters from the hospital. Here in SC, the hospital can garnish your tax return for unpaid bills!

I told them I wasn't paying and that I would spend far more than $430 fighting it to prove a point. I contacted the SC Insurance commission and filed a detailed complaint. Within 24 hours I had BCBS blowing my phone up trying to apologize for the error. They would cover all the costs and gave me a direct phone number and contact person if I had any more problems.

Being an Orthodontist, I deal with insurance every day and we keep very good records/notes on all conversations with insurance companies. We have called them out several times. They are scum. Most people do not have the resources or knowledge to know how to fight back and would either pay the $430 or get their tax return garnished. It is beyond sickening. It is pure theft and borderline slavery.

I have contacted my state representative several times about healthcare and working on it from the cost side and not the insurance side. All I get is canned responses. I wouldn't be surprised if the hospital system donates to his campaigns.
Zappafan
Posts: 2871
Incept: 2007-11-30

Atlanta
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I read a mind-blowing statistic - something like 50% of all new born babies delivered in GA are being paid for under Medicaid. And we're not unusual - some states are worse. That just goes back to the point that it's all a giant fraud. Using your number of around $1000 for a routine delivery, that means that half this freaking state cannot save up $1000 for a major life event?

It's all a damn ponzi scheme. The states want more Federal money to keep the racket going a while longer. Swampcare won't end Medicaid expansion - it will at best keep it frozen for a few years. Then they'll cave and let it resume, I predict.

It's a corrupt system that increasingly sucks the life out of the rest of the economy. To the point of the poster above, you have to be a shark to deal with the system. Best to stay out of it, if you can.

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Ich bin der Tankendau!
Tickerguy
Posts: 148205
Incept: 2007-06-26
A True American Patriot!
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The problem is that the CURRENT price isn't $1,000 -- it's $8-10k.

The only REASON it's $10,000 is monopolistic behavior for which the actors involved -- all of them, from hospital administrators on down to the nurse in the room -- ought to be in prison.

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Winding it down.
Flamberge
Posts: 3
Incept: 2011-06-30

Colorado
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I have written several times to both Senators in this State and my Congressional Representative too. I have also spoken personally and privately with my Congressional Representative on this topic - on several occasions.

It does not seem to matter. I get canned form letters in response to written requests, and I get polite agreement with no follow-up in response to direct conversations. I do not believe the current politicians are going to fix anything. They seem to be stuffing their pockets just as fast as they can while the getting is still good.

I suppose we will end up doing everything "the hard way".




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Well, it seemed like a good idea at the time...
Smacktle
Posts: 1800
Incept: 2009-01-20

Texas
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I get a chuckle when all these people say they contact their rep and all they get is a canned response. If that's the case then why do you keep voting for them?!

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The faults of the burglar are the qualities of the financier.
- George Bernard Shaw
Ckaminski
Posts: 4005
Incept: 2011-04-08

Mass-Hole!
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Quote:
I suppose we will end up doing everything "the hard way".


There is no suppose.
After 10 years of no results for all the action by all actors, nothing has happened.

Plan accordingly.
Idiom
Posts: 81
Incept: 2015-02-20

New Zealand
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I am on exchange to these united states. Just got a CT scan done for $4000. Its like a ten minute thing.

Fortunately I have Gold racketeering insurance.

Unfortunately for the racket I am a walking pre-existing condition and was just quoted $52K for a follow up surgery. Which would cost <$7k in my home country in cash. Hit my out of pocket max a while ago, so god knows which of you poor schmucks is paying for my larking about.

I swear they just make up a number then add zeroes. I had to try it just to see if it really works. I couldn't believe anything like this would exist in the real world, let alone that anyone would tolerate it.

But hey at least Trump is going to make racketeering insurance affordable right?
Idiom
Posts: 81
Incept: 2015-02-20

New Zealand
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Just checked the Oklahoma Center... that $52k surgery.. $5-7k, same as my home country. Funny that.
Tickerguy
Posts: 148205
Incept: 2007-06-26
A True American Patriot!
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Quote:
I swear they just make up a number then add zeroes. I had to try it just to see if it really works. I couldn't believe anything like this would exist in the real world, let alone that anyone would tolerate it.

What I haven't figured out is why, when people are told "you're ****ed and by the way that'll be $200,000 which we're stealing for the pleasure" they don't say in response to the doc, the hospital dude or the politicians (or all of the above) "Well, I can only die once and you're going first!"

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Winding it down.

Supertruckertom
Posts: 1209
Incept: 2010-11-07

USA
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That day is coming.
You have sounded the warning.
Now it is time to start making lists of the Racketeers and enablers.
Elected Officials are easy to doc.
It is the lobbyists and Corporate CEO'S that really need to feel the pain.
Those slimy bastards are hard to pin down.

When the mobs are in the streets, I want to be able to point them in the right direction.
They will be a good diversion.


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Preparing to go Hunting.
Cecropia
Posts: 61
Incept: 2007-11-02

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Quote:
The only REASON it's $10,000 is monopolistic behavior for which the actors involved -- all of them, from hospital administrators on down to the nurse in the room -- ought to be in prison.

If that's the case, I don't understand why the OK Surgery Center lists (uncomplicated vaginal) birth at a minimum of ~$12k.

I had an uncomplicated vaginal birth within the last year (1 day stay, no anesthesia) and the hospital initially billed about $9k. That number includes newborn services (hearing screening etc).
Tickerguy
Posts: 148205
Incept: 2007-06-26
A True American Patriot!
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Those numbers are insane on all counts.

An uncomplicated vaginal birth hasn't changed materially in a hell of a long time. If you take the actual charge (I have several bills from this timeframe) from the 1960s and inflate them by the CPI-U you wind up with about $1,000.

If you can show me what services and products are provided in such a delivery that make a charge materially higher than that reasonable, I'm willing to listen. Being that I was there for the birth of my daughter I have a pretty good idea exactly how much time the doctor and nurses, etc spent there -- and what was actually done.

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Winding it down.
Vernonb
Posts: 1742
Incept: 2009-06-03

East of Sheol
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Quote:
An uncomplicated vaginal birth hasn't changed materially in a hell of a long time. If you take the actual charge (I have several bills from this timeframe) from the 1960s and inflate them by the CPI-U you wind up with about $1,000.


I was born at home in the 60s and was essentially delivered by my maternal grandmother who was a midwife. The country doctor performed a spinal tap for my mom, put silver nitrate drops into my eyes, provided some post natal services for my mom, and filled out the documentation for the state.

Total cost in a rural area of South Carolina in 1962 - $20.00. (twenty dollars).

Not much has changed with who is doing the real work. What has been added are the middle pig men waiting to literally get their cut of blood money at the moment of birth. Many have made it sound like a form of child abuse in this country with propaganda if a kid is not born in a hospital? They have played the fear factor one again to drive profits.

Obviously if the mother or child is a known high risk it is one thing to need such services but trying to extrapolate such services to every mother and child ("just in case") is intentional theft. It is also been billed as "social equity" in many circles. You are free to do as you want with expenses IMO as long as your actions have no consequences on others. But we no longer have that.

More kids are born outside a hospital on this planet than in hospitals. Nothing like a captive audience for pig men in the medical system.




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"Mass intelligence does not mean intelligent masses."
Cementhead
Posts: 2
Incept: 2015-09-06

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They "meaning all politicians" don't care they are concerned with themselves only. There may be a handful of them that actually want to do good most are only concerned about re-election. nobody is going to do anything. Why when republicans have all three offices they still act like they are not in charge. Democrats would ram anything that they wanted to pass through the congress etc.
Wayiwalk
Posts: 2
Incept: 2016-11-09

New Yersey
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I've started sharing the idea of the need to enforce anti-trust laws to address healthcare costs....did so this morning in reply to a healthcare professional's post on LinkedIn. We'll see how that goes. Since my job is on the edge of an abyss right now, I'm not worried that it is linked to the "real me". Yes, and F*** linked in ( that was just for Karl :-) )
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