The Health Care Morass

Franken on medical bankruptcies

2009-10-22T12:48:00.000-07:00

Health care discussion panel

2009-10-20T11:19:00.000-07:00

The University of Alaska Fairbanks Student Pre-Medical Society will host a free public panel discussion on health care reform and how it could affect Alaskans Sunday, Oct. 25, from 4-6 p.m. at the Davis Concert Hall on the UAF campus.

"The UAF pre-med society's goal is to offer the public useful information and discussion on health care reform in understandable language," said Nick Bajada, public relations officer for the society and an undergraduate in UAF's biomedical program.

Panelists include Richard Seifert, a UAF professor and member of the Fairbanks Memorial Hospital Foundation Board; state Sen. Joe Paskvan, vice chairman of the Senate Health, Education and Social Services Committee; Melanie Arthur, UAF assistant professor of sociology; Mike Powers, Fairbanks Memorial Hospital CEO and fellow of the American College of Healthcare Executives; state Rep. John Coghill, member of the Health, Education and Social Services Committee and the HESS finance subcommittee; Lloyd Hilling, Tanana Valley Campus economics instructor; and Dr. Mark Simon, medical director of Golden Heart Emergency Physicians.

The event is free and the public is encouraged to attend. Seating is limited.

CONTACT: Nick Bajada, UAF Pre-Medical Society public relations officer, nickbajada@gmail.com. Marie Gilbert, Institute of Arctic Biology information officer, at 907-474-7412 or megilbert@alaska.edu

Health care reform is real

2009-09-28T17:37:00.000-07:00

This month's Dose of Reality concerns the way the American public pays for health care:

[I]t is important to remember that the public always pays, and in fact, it is the only payer of the cost of health care. Many decades ago, the members of the public mostly paid for health care in only one way: by direct payment to health care providers using cash if they could, or chickens and pigs if they could not.

Then during World War II especially, the public begin to pay more of its medical bills by funneling money through insurance companies…But now that is changing as the system is being reforming in an underhanded, backdoor fashion. Leading the reform is the for-profit health insurance industry, and by doing so the industry is slowly putting itself out of business. The steps the industry is now taking to retain profitability are forcing the American public to funnel an increasing proportion of its health care expenditure through other, more efficient pipelines, namely direct payments to medical providers and payments to them through government channels.

In other words, the insurance companies are making it so onerous to pay premiums and co-pays and deductibles that their customers are simply dropping insurance altogether—which means the companies get nothing from them.

Two Town Meetings on Health Care

2009-09-28T11:50:00.000-07:00

Alaska’s two senators have now held town meetings on Health Care in Fairbanks, Senator Murkowski on August 13, and Senator Begich on September 26. The contrast between the two hosts and their events was striking.

Based on their comments, questions, and levels of applause to statements, I concluded that the 500-member crowd attending the Murkowski town meeting was largely right-leaning Republican, with the majority having an anti-Obama, anti-government attitude that biased them against increased government involvement in health care. This group also showed a substantial presence at Senator Begich’s town meeting hosting about 300, but probably were outnumbered by persons of less conservative bent who were in favor of greater government involvement in the form of establishing a public health insurance option and greater regulation of the health care insurance and pharmaceutical industries.

Perhaps most striking was the difference in approach and performance of the two hosts. Senator Murkowski stated at the outset that she was against more government involvement in health care. That statement not only made the majority of the audience happy, it set the tone of the entire meeting: generally negative toward any substantial health care reform. Senator Murkowski responded to questions and comments in ways that built on the fears of those in the audience and promoted what I took to be her own personal views. Although she proclaimed that she wanted input from all quarters, it was quite obvious to me that she was not receptive of any new information.

Thinking back on that town meeting after attending Senator Begich’s later one, I was struck by Senator Murkowski’s comparative lack of knowledge about health care issues and apparent willingness to ignore factual information on the topic. To me, this was best illustrated when someone asked if Senator Murkowski knew of even a single country where universal health care was successful. Ignoring the well-known fact that universal health care is successfully operating in every modern country except for the United States, the good senator walked slowly across the stage, shoulders hunched, head shaking and eyes downcast as though seeking inspiration from the floorboards as she replied, “No, I can’t.” Oh come on, Senator, I thought to myself, you are not that ignorant, you know better than that and are just being disingenuous.

By contrast, Senator Begich displayed an impressive breadth of knowledge about and understanding of health care issues. He too had made an opening statement. Unlike Murkowski’s negative opening, Begich’s contained positive assertions regarding desirable goals of health care reform. Some of them were little more than motherhood statements, but at least they were positive in nature. I did not agree with some of Begich’s views—for example, he stated that he was against having a government-operated single-payer health system—but he did at least display an attitude of guarded openness toward the proposal of a public option insurance program.

He used a question on that issue to suggest that perhaps a better option might be to allow everyone to buy into the Federal Employees Health Benefits Insurance program enjoyed by members of Congress and all other federal employees and retirees.

I hope Senator Begich was aware that he was making quite a radical proposal because in this program the government (using funds supplied by the taxpayers) picks up 75 percent of the premium cost. Now that is serious government involvement in health care! At least financially, it is about three-fourths the way to a single-payer health care system. To complete the process the next logical step will be to eliminate the useless middleman: the health insurance industry.

Desperate measures for desperate times

2009-09-16T17:20:00.000-07:00

We're Number 37

2009-09-16T17:07:00.000-07:00

Public meeing on health care with Senator Begich

2009-09-09T10:25:00.000-07:00

Senator Begich will be holding a forum in Fairbanks, from 11:30 a.m. to 1 p.m. Sept. 26, at Friends Community Church, 1485 30th Avenue. Begich has held open discussions/question-and-answer town hall meetings in Anchorage and Juneau; according to the Anchorage Daily News, they've been beyond "lively" and have gone into outright rudeness.

Begich said he's interested in what people have to say about health care reform, but is growing tired of the lies, myths and fear tactics.

"Now the media are talking about the 'swift-boating' of health reform over the recess," Begich told the Anchorage Chamber of Commerce in a lunchtime speech. He said he's seeing evidence of a political smear campaign in television ads.

Health reform protesters have been hijacking town hall meetings around the country. There's controversy over whether the dissent is real and grassroots, or a sophisticated attack intended to bring down President Obama and the health reforms he seeks.

The point of having a forum like this is to allow the public an opportunity to a) express their opinions, and b) ask questions of—and receive answers from—their representatives in government. That means that when a person is asking their question, everyone else in the audience should let them, and let them hear the answer. It's pretty basic courtesy, but some people just don't want anybody else to have their say.

Let's hope that Fairbanksans will behave like grownups, willing to let every questioner speak, and let Senator Begich answer.

Alaska's Congressional delegation and health care reform

2009-08-17T14:43:00.000-07:00

The July Dose of Reality tackles the stance of our US senators and representative on health care reform. Davis sums up their approach: "According to its own statements, Alaska’s Congressional delegation hopes to kill meaningful health care reform this year." First, the Republicans:

We have not heard much from Representative Don Young on this issue, but Senator Lisa Murkowski has clearly stated her opposition to the public insurance option in an article appearing June 24, 2009, in the Fairbanks Daily News-Miner. First, she presents a tirade against Medicare and Medicaid, playing very loose with factual information both about these programs and the changes to them being proposed by the Democrats in Congress. Then she closes with the false charges that the establishment of a public insurance option would deny the public with choice of doctors, “and leave crucial health care decisions in the hands of government bureaucrats.” Actually, a public insurance option would increase the choice of doctors over what we have now.

And then our lone Democrat, a Blue Dog:

Senator Begich clearly stated his opposition to establishing universal health care in an opinion piece published by the Fairbanks Daily News-Miner on June 12, 2009. His telling statement: “If Congress gets it right, Americans happy with their health insurance and medical care will keep what they have, while everyone will have access to affordable, quality care.” In his article, Senator Begich pointedly ignored the major issue of the moment, that of instigating a program of public health insurance.

Sarah Palin on Health Care

2009-08-13T10:22:00.000-07:00

Sarah Palin’s recent Facebook statement (Associated Press, Aug. 8, 2009) in which she called President Obama’s health plan “downright evil” suggests that she did Alaska a big favor by abdicating the governorship last month. Anyone capable of intentionally publishing such a ridiculous and obviously untrue claim lacks the ethics and moral fiber to hold any public office from dogcatcher on up, never mind one as important as the governorship of Alaska.

When Palin broke her contract (sworn to on the Bible) with the Alaska voters who put her in office, I figured that she had in mind reverting back to a public communications career as in the years of yore. As an ex-governor, she now could aspire to the role of a respected journalist and commentator on world and national affairs whose clever insights, penetrating analyses and profound judgments would earn her respect far and wide. Admittedly, this aspiration could be a little bold for a logically challenged person who sometimes found it difficult to assemble words into a meaningful sentence and who even sometimes was unable to determine when the end of that sentence had come. So was this a hopeless idea? Not in America, absolutely not!

Let’s face it, Palin knew she could easily do it. Despite various psychological weaknesses, she knew she had some nice counterbalancing physiological assets, including a pretty face, a seductively crooked smile and a hell of a wink. The key to success here was merely to pick the right audience to speak to, one to which her physical assets would hold strong appeal and to which her cerebral weaknesses would not matter squat. In other words, Palin needed an audience that liked things simple—not just simple, flat out either black or white—an audience that would suck up to the kind of emotional appeals Palin enjoyed presenting. She did not need to be speaking to that portion of the public that preferred factual information over emotional arguments. Unfortunately for her, there were a lot of people in America like that, maybe even half the population. So forget them; this would not be the audience ex-governor Palin should try to cater to, but this group’s very nature gave a hint as to the direction she go. Best to plant a sharp right heel and do a quick one-eighty away from them. Of course! Now right there in front of her was a ready-made audience already shepherded together by that great Republican leader Rush Limbaugh. This was the audience to go for. Heck yes, Sarah would be a perfect Rush Limbaugh in Lipstick.

Sarah knew that her appeal to this ultraconservative audience was already proven by her recent campaign effort with John McCain to help elect Barack Obama president of the United States. She had come out of it with maybe three-quarter million supporters (more than the entire population of Alaska) and a lucrative book contract. Pondering the issue, Sarah Palin could see that although Rush Limbaugh was the acknowledged spokesman for that group he might not continue to be. “He’s OK on talk radio but he’s an ugly ole cuss, and I betcha I can do better than him on TV, and God would want me to,” Sarah must have thought as she reached her decision to shoot for the position of hostess of the Sarah Palin TV Show or whatever the network might want to call it.

Oh it was going to be so easy, ‘cause it didn’t matter what you would say as hostess of this production. All she would have to do was do as Rush does: pick a topic, any topic involving President Obama, put on a crooked knowing smile and a sneer in the voice and make fun of Obama’s action.

Rush was good. Like just the other day on his program Sarah had heard him say that Obama was going to use several million dollars of the stimulus funds to hire people to clean up and improve the toilets in the national parks. Snickering and scoffing at this huge and pernicious waste of taxpayer funds, Ole Rush made the concept resonate across the airways as another vicious government attempt to takeover our guaranteed 2nd Amendment rights to choose or own methods and manners of bodily waste disposal in the national parks. About the time Limbaugh finished his tirade, a female caller came on air to gush, “Oh thank you, Rush, for telling it to us like it is.” Now that was Sarah Palin’s kind of woman.

Shoot, even if none of the networks wanted to shell out big bucks for her to host a TV talk show, there were plenty of other ways to rally the clueless masses. Twittering was good; 140 characters was just about right to detail any idea that she could think up. They might call her tweets “Quitter’s-Twitters,” and those missives could strike to the hearts of millions who would applaud her abandonment of the Alaska governorship. And then there was Facebook and plenty of Obamamania fumbles to attack on it. Hey, just the stupid idea of reforming health care should get plenty of mileage. “It’s evil, evil, evil,” she could say repeatedly. “We’ve got to stop Obama from trying to take our doctors and guns away. You betcha, folks, now is the time to get our country back. Evil, evil, evil.”

It really would not matter how it all worked out. Sarah was now rich and famous and also free of those nasty ethical constraints some people thought should be imposed on those serving in public office. She now could say anything she wanted, and hundreds of thousands of Americans already thought anything she said was virtually the word of God. If it really went well, those thousands would turn into millions, and if so she might consider letting Rush Limbaugh serve as her running mate in the next election.

So what about the "death panels" we've got now, Sarah?

2009-08-12T14:16:00.000-07:00

Mike Madden of Salon asks this question with his recent article, "The 'Death Panels' Are Already Here":

Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty.

Consider that, and then this news release: "New Poll Shows Canadians Overwhelmingly Support Public Health Care: Group says advocates of private system are out of touch with most Canadians".

Kucinich amendment passes committee

2009-07-22T11:44:00.000-07:00

As pointed out in The Beat, single-payer health care came to Canada province by province. Dennis Kucinich(D-Ohio) has successfully introduced an important amendment to America's Affordable Health Choices Act, H.R. 3200:

By a 25-19 vote, the House Committee on Education and Labor on Friday approved an amendment to the House's health-care reform bill allowing states to create single-payer health care systems if they so choose.

Democracy Now! has a extensive interview with Kucinich about this amendment and health care reform.

Comedy team in health care reform

2009-06-30T10:32:00.000-07:00

Neil's newest Dose of Reality treats the recent hearings on health care reform in the Senate:

As we watch the Senate Committee on Finance grapple with the task of how to reduce the cost of health care in the United States it is easy to get the impression that we are watching a remake of the old movie, Abbott and Costello Meet the Invisible Man, a comedy horror film from 1951. The plot in the new version is thin; centering on the old-timey burlesque gag in which the players have a problem that they stumble around trying solve, not realizing that the solution—which as the watching audience is well aware—is obvious. That solution is virtually staring the Abbott and Costello company in the face, but of course these comics cannot see it, and they take humorously extreme measures to avoid looking in the right direction.

Replacing Abbott and Costello as lead comics in this modern-day version of that film are Senate Finance Committee chairman Max Baucus (D-Montana) and his straight man Chuck Grassley (R-Iowa). The part of The Invisible Man is played by the proposal for single-payer health care, best embodied at the moment by HR 676, introduced into Congress last year and gaining increasing public support. The remainder of the cast is comprised of the other twenty-one members of the Senate committee and their staffs. Experts all, the cast excellently parodies how we in the public think our elected officials should represent our interests.

As well illustrated in an interview with reporter Mike Dennison on Democracy Now!, Baucus and Grassley are heavily funded by the health and health insurance industries, and have not been interested in a full discussion of health care reform options.

Single-payer health care teach-in at UAF

2009-06-16T21:07:00.000-07:00

Addendum 6/30/09: this teach in was postponed and will be rescheduled.

Neil Davis is a guest speaker at a teach-in on single-payer health care systems to be held at the University of Alaska Fairbanks campus, Saturday, June 27, from 1 to 5 pm at the Boyd Berry Auditorium in the Reichardt Building (the Natural Sciences Facility).

In the midst of the health care reform debate, single-payer health care, although a system successfully used in many industrialized countries, including Australia, Canada, and Taiwan, is not even being considered by Congress. Why? Is it a viable option? How does this system work? What advantages does it have over our own? What disadvantages? How does it compare to our own system, or that of countries like Belgium, France, Germany, Great Britain, Japan, New Zealand, or the Netherlands? Explore these questions and others at this event.

Talk of Alaska

2009-06-08T15:00:00.000-07:00

I will be on Steve Heimel's APRN "Talk of Alaska" program airing at 10:00 am tomorow, Tuesday, June 9. We will be talking about the progress of health care reform.

Addendum 6/9/09: a link to the broadcast is available at the Talk of Alaska website. Senator Hollis French (D-Anchorage) was Steve Heimel's other guest.

Community Perspective by Richard Seifert on universal health care

2009-06-06T20:32:00.000-07:00

Rich Seifert's piece in the Fairbanks Daily News-Miner today has provoked quite a lot of comment on the merits (or perceived lack therof) of a single-payer universal health care system. He writes this:

Davis ultimately compares our system to those of other industrialized nations, making a compelling case for a publicly financed system of single-payer national health insurance.

All the members of the Fairbanks Memorial Hospital Foundation have a copy of this book, and I hope they have all read it. It is hard to do so and not come to the conclusion that the U.S. desperately needs a universal, publicly financed health care system. What’s more though, is that we as a nation also need to totally eliminate the insurance industry’s hold on our payer system.

The comments are very interesting, ranging from the irate to the very thoughtful and informative with supporting links and references. "Stakeholder" has found some very intriguing testimony by Dr. Linda Peeno to the US House subcommittee on Health and Environment.

Davis to participate in the 3rd Alaska Book Festival

2009-06-03T10:26:00.000-07:00

The 2009 Alaska Book Festival will be held in Fairbanks on June 11, 12, and 13, with the theme "Historically Alaska." Neil Davis will be available during the general author book signings on Friday the 12th and Saturday the 13th (4 to 6 pm each day at the Exhibit Hall at Pioneer Park) . He will also be on a panel discussion from 10 to 11:30 am on Saturday, "Writing, Publishing, and Marketing Your Book," in the theatre at Pioneer Park.

A cartoonist's view of the health care reform hoo-hah

2009-05-20T15:15:00.000-07:00

Peter Dunlap-Shohl, former editorial cartoonist for the Anchorage Daily News, has a new blog on health care issues and reform: Gurney to the Dark Side. Check it out: he takes a grim subject and puts a bit of much-needed levity into it while skewering the absurdities of our current health care system with that pen of his.

An example that Alaska should not follow

2009-05-18T17:55:00.000-07:00

In the May Dose of Reality, Neil Davis examines the results of the Massachusetts Health Reform Law of 2006. In short, the reform has failed.

There is of course a reason for the failure. The framers of the Massachusetts legislation refused to address head-on the major problem with American health care: the control exerted upon it by the private for-profit health insurance industry. They did not just ignore the problem, they exacerbated it by giving the industry even more power than it had before to dictate to many more Massachusetts residents who gets health care and how much.

Davis warns that this may be relevant to Alaskans' health care future because

Despite the failure of the Massachusetts health insurance reform, Alaska may find itself led down the same garden path to higher health care costs and decreasing access to health care. An attempt to push the state in that unfortunate direction was made in the 2008 legislative session by the introduction of SB 160. The sponsors emphasized that the bill was patterned after the Massachusetts legislation enacted earlier. Senate Bill 160 failed to pass the senate, but Senators Hollis French and Johnny Ellis, both Democrats, resurrected it as SB 61 (short-titled Mandatory Universal Health Insurance) during the just-concluded 2009 session. Although SB 61 went through several hearings, it was in committee when the session ended and is still alive for consideration during the next legislative session.

A comparison of single-payer and multi-payer systems

2009-05-15T17:42:00.000-07:00

The United States uses a multi-payer, for-profit health care system, with some elements that are not for profit, such as Medicare. Our system is administered privately, and operates from a market-based view, i.e., that health care is a commodity. Canada, on the other hand, uses a single-payer system that, while still for-profit, is administered publicly, and operates from the assumption that health care is a right. Our system is financially out of control, and incredibly wasteful and complex. Canada's is fairly simple, and far less expensive. Not only that, Canada's system is rated as better by the World Health Organization than is ours.

The recent hearings in Congress on possible reform measures, headed by Senator Max Baucus, have one striking feature: proponents of instituting a single-payer system in the US have not been invited to participate. Thus, protestors, representing organizations such as the California Nurses Association and Physicians for a National Health Care Program, have taken to interrupting the proceedings to make their point.

Below are two graphic representations of just why our system is so expensive and Canada's is so much cheaper, and yet still outperforms ours. These are taken from Neil Davis' book.

Pharmaceutical industry perturbed by the Drug Savings and Choice Act

2009-04-19T14:51:00.001-07:00

In the April Dose of Reality, Neil Davis shows how the pharmaceutical industry, which is not happy about the provisions in the Medicare Prescription Drug Savings and Choice Act of 2009, is, in effect, a giant marketing machine, but not really an industry devoted to finding new drugs to cure illness. (You read that right.)

It is the most profitable of all industries in the United States, with profits equaling 25 percent of sales. Big Oil isn’t even close.…

In 2000, drug company expenditures for marketing and administration amounted to 36 percent of sales income, but only 14 percent of income went to research and development. Thus, the expenditure for marketing and administration was two and a half times that for drug research and development.

Also, of seventy-eight drugs approved by the Food and Drug Administration (FDA) in 2002, only seventeen contained new active ingredients, and only seven were classified by FDA as improvements over older drugs. Not one of these improved products came from a major drug company.

So, going by the numbers, the truth is that big pharmaceutical companies are primarily marketing machines. Their high profits and large marketing costs are the true reasons that the public has to pay such high prices for pharmaceuticals. It is not due to the need to cover the cost of developing new drugs.

The health care reform war starts

2009-04-18T18:38:00.000-07:00

And the first sally, according to Neil Davis, is the Medicare Prescription Drug Savings and Choice Act of 2009 (HR 684 and S 330).

I am hoping that President Obama and the Democrat-controlled Congress will get behind the serious reform proposed by HR 676… this bill calls for a total overhaul of the system by taking health care out of the marketplace.…But the early signs are that the Democrats in Congress and President Obama are not willing to make a frontal attack on health care reform.

Instead, Davis says, they are hoping to set up a government operated program that would deal with only one small part of the health care picture: negotiating drug prices for Medicare. A step in the right direction, but only one smal step--still, one that would save perhaps $40 billion annually!

More in the March Dose of Reality.

April author events in Fairbanks

2009-04-02T20:22:00.000-07:00

April 4: talk at the meeting of the UAF Society of Pre-med Students, 6 pm

April 28: IDEA Curriculum Fair, Westmark Hotel & Convention Center, 11 to 1

Neil Davis on Sleep in Saturdays with Matt Want

2009-03-05T21:51:00.000-08:00

Matt Want hosts a local talk show on 660-KFAR on Saturday mornings from 10 to 11 am, choosing a different topic each week. This Saturday's topic is the US health care system and Neil Davis has been invited to be on the show. You can call in with questions or ask for advice; the phone number is 907.458.8255 (458-TALK).

(Cross-posted on The Ester Republic blog)

Insuring the Uninsurable

2009-03-05T21:50:00.000-08:00

In February's Dose of Reality, Davis looks at the some 60,000 Alaskans who are refused health insurance by the for-profit industry and the alternative they are provided by the state: health insurance so expensive that almost no one has purchased it:

The cheapest ACHIA policy is a PPO plan with a deductible of $15,000 and maximum out-of-pocket expense of $25,000. A person twenty-five years old can buy this policy for $1,848 per year, but it costs a sixty-year-old person $6,384. Each of those persons is at risk for another $25,000, the out-of-pocket maximum, and each will have to pay the $15,000 deductible before receiving any benefit whatsoever from the policy. Thus the twenty-five-year-old will pay out only $1,848 for health care if he needs no health care during the year (all money goes to policy premiums) but at worst he might have to pay out another $25,000 for the health care he needs before the policy covers all costs thereafter. Thus, his worst-case expenses are $26,848 per year.

How many 25-year-olds can afford $15,000 in deductibles?

The Health Care Reform War Opens

2009-02-19T12:48:00.000-08:00

Democrats fired the opening shot of the Health Care Reform War in January with the introduction of a bill to allow Medicare to negotiate prescription drug prices with the pharmaceutical industry. Introduced in both the House and Senate, the Medicare Prescription Drug Savings and Choice Act of 2009 (H. R. 684) negates provisions of the Bush administration’s Medicare Prescription Drug Improvement and Modernization Act of 2003 that prevented such negotiations.

If the bill becomes law, Medicare will have the same power to negotiate as the Veterans Administration. That organization is able to buy pharmaceuticals for little over half what the Medicare D insurers pay. Consequently it is expected that major savings will accrue to both taxpayers and Medicare beneficiaries, perhaps as much as $40 billion annually.

Very likely, as with the stimulus package legislation just enacted, the passage of this legislation will shape up as a partisan battle. Our Senator Begich surely will vote for it, but the Republicans in Congress probably will stand almost unanimously against passage in order to protect pharmaceutical and insurance industry profits. Alaskans should watch how Senator Murkowski and Representative Young vote on this issue. It is an opportunity for them to display their true colors; are they on the side of the taxpaying public, or are they on the side of the for-profit insurance and pharmaceutical industries? There is no in-between on this one.