The Health Insurance Business

Insurance is not a product but a financial service. Unlike others, the selling point of insurance is risk. People buy insurance because they want to get compensation in case something bad happens such as an accident, a natural calamity, or a serious illness. Companies like to sell insurance because they receive monthly payments beforehand in the form of premiums. They take the risk that bad things don’t happen frequently. Even if they do, only a small portion of the insurance pool requires compensation, which will give them enough profit margin to survive. In fact, the profit margins are big. The health insurance industry in America made a combined profit of over $13 billion in 2016, up 46% from the previous year.

What makes health insurance a viable business? Most importantly, the market must be big to cover millions of people with diverse health conditions spread out across the land. It won’t work if only senior or sick people buy health insurance. All buyers must recognize the fact that those in good health subsidize those in bad health, usually the young subsidizing the old. In return, when the young get sick or older, they will be taken care of if they are contributing to the insurance pool. Thus health insurance is basically a long-term social service providing a safety net for everybody. This raises the question if the government should take over health insurance as a single payer for all health services. In most developed countries, their governments have already monopolized health care where private insurers are permitted to operate at the periphery covering enhanced services or special conditions.

In America, health insurance still rests in private hands. The reason is that most American companies have long been providing health insurance to their employees through private insurers. When a citizen reaches the age 65 or above, he/she is automatically insured under Medicare provided by the federal government. Since 2014, Obamacare has been enacted to subsidize those aged under 65 who are self-employed or unemployed for the purchase of private health insurance if their incomes fall below the poverty level. By early 2017, Obamacare has expanded to cover more than 11 million people out of 56 million uninsured due to rising premiums. In addition, local governments at the state, county or city levels provide some forms of subsidy to low-income families through public hospitals or special services. Thus in America, private health insurance applies to the majority of the people under 65 years and above the poverty level, that is, the majority of the middle class. When premiums rise rapidly, the middle class will be increasingly squeezed.

What is the biggest danger to private health insurance? Premium inflation is the one. When premiums rise too fast, the young and healthy tend to drop out because they will take the chance of not getting seriously ill. This leaves the insurance pool with older and sicker people, which forces the insurers to raise premiums further to reduce their risks, which in turns causes more dropouts. The result is a continuous death spiral until the premiums become too high for any middle-income person to afford. Then the time will be ripe for the government to take over, or some radical disruption such as a revolution. This is what has been happening in America since the 1990’s. What is the cause? The insurance companies are too greedy without the common sense that they are digging their own graves. When premiums keep rising, the other parts of the health care industry such as the pharmaceutical companies and the hospitals will begin raising their prices, too. All of them are able to raise prices by bribing legislators to relax the regulations.

Before the passage of Obamacare, there was a big discussion about whether the federal government should tax, subsidize, and force everybody to buy health insurance to prevent the insurance pool from shrinking. The issue was settled in June 2015 by the US Supreme Court which ruled that it was legal to do so. However, it left the loophole that private insurers could still continue to raise premiums while receiving government subsidies. So it set into motion a runaway health care inflation that cannot be sustained by government subsidies except price controls on the private health care industry.

The American scene is complicated by the power of the health care industry with huge resources to bribe politicians and legislators to act in their favor. The health insurers can get away with continuously raising premiums, offering less coverage, restricting access for people with “pre-existing conditions”, increasing “deductibles”, and employing other kinds of dirty tricks. It is almost impossible to clamp down on prices. Politicians like to advocate increasing competition by freeing the marketplace via deregulation. This will only worsen the situation because there is no free market for health care in America where only a few big companies collude and dominate. Right now, the people being squeezed most are the middle-income self-employed under 65. Those employed by companies are not immune. Although their companies are bulk buyers of health insurance with the ability to get a better deal from the insurers, they find that their employer-provided health plans are getting smaller in coverage and higher in “deductibles”. It has taken more than 30 years to come to this sorry state. The worst is yet to come for the end is not in sight unless the government imposes price control rather than subsidizing for the short-term benefit of those in need.

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Believing in Evolution

Being a Catholic, I have no problem believing in evolution because this scientific theory offers plenty of insights. Unlike many religious people, I don’t take the Bible literally, especially the Old Testament. As a general rule, words invented by humans cannot describe in full all the truths, particularly subtle and complex ones like evolution. There is an ancient Chinese saying that if you believe without questioning what you read from books, you may as well go without any books at all. We must think critically about what we read and see. That’s how people find enlightenment. The negative attitude toward evolution is not new. It has something to do with the following three factors — psychology, religion, and complicated scientific knowledge.

First, how can we accept that humans descended from an ancestral branch of apes? Harder still, how can we accept that all living things originate from a single cell at the beginning? This thinking definitely conflicts with our egos since we think humans are the highest form of life. Well, all we need is an open mind. Why not take a look at something important about life that is based on scientific evidence? Never mind our egos that tend to get us into trouble. The fact that humans have come this far demonstrates our great success in evolution history. However, we must also pay attention to the countless success stories of other species around us. Despite being illiterate, are apes smart enough to survive the hostile environment in their own styles? Despite possessing no tools, are vegetables smart enough to photosynthesize for survival besides providing for human consumption? Despite being single cells, are microbes smart enough to populate everywhere even within our bodies? The fact that all life forms (not just us) continue to thrive in this diverse and complex ecosystem is a great reason to celebrate, not denigrate.

Second, the curious human mind never stops looking for answers. When an answer is found, it provides closure and peace of mind. How can we find answers to the greatest mysteries such as the origins of life and of the universe? Here, religions rightfully come into play. The Bible snd other scriptures provide the ultimate elegant answer — the omnipotent Creator. As for the atheists, they will also find the ultimate answer even more elegant that everything in the universe is a result of pure chance. We don’t need scientific evidence that is hard to understand. We just want closure and peace of mind, which are perfectly fine. Then what about the Creator’s plan for humankind? It varies depending on which religion you belong to. The religious answers to the Creator’s plan are simple like fairy tales but fail to provide closure. We are still asking God why so many humans in the world are suffering, and why does evil triumph over good in so many cases.

Third, science is a very complex discipline, but you need not fully understand it to appreciate its usefulness. If you possess a smart phone, access the Internet while flying or employ GPS while driving, to deny scientific evidence is a sinful betrayal of truth and reality. Every scientist will tell you that they only know a very small fraction of truth because science is always work in progress. Scientists learn and correct their mistakes along the way everyday. The science of evolution has now grown to encompass not only biology but also many other disciplines such as Physics, Chemistry, Cosmology, Geology, Ecology, Paleontology and Anthropology. There has not been a single piece of evidence suggesting that evolution is false or contradictory to logic. Instead, more and more evidence point to the wonder and complexity of evolution.

In spite of all the advanced tools, science cannot answer the question about the existence of the Creator. That is not the job of the scientists, but of the clergy in order to fulfill the human desire for closure. The scientists can never provide closure regarding the origins of life and the universe, because one question inevitably leads to another as to what was the first being or condition to give rise to all the physical laws and other things. They find that the answer involves more and more complexity — an infinite wonder worthy of continued research. This wonder is the Creator’s plan if we really want closure.

The science of evolution describes how the Creator’s plan evolves as revealed by continuous scientific discoveries without usurping the religious doctrine about the existence of the Creator. In so doing, evolution provides a fuller yet complex answer to the simple religious doctrine about the Creator’s plan. Therefore we see that religion proclaims the omnipotent Creator while evolution confirms the omnipotence of His complex plan. The two are complementary. Why do we have to treat them as conflicting? The science of evolution gradually reveals the Creator’s plan like peeling an onion. It gives us great insights into the process of life instead of simple closure. In addition, it points the direction to how we are able to save the world.

Evolution, nature and ecology are almost synonymous. There seems to be a goal for all living things — to adapt, survive and reproduce. These essential capabilities are all built-in and passed down from one generation to the next. Evolution does not discriminate between species, resulting in a huge diversity of both animals and plants to form a well-balanced ecosystem. This balance is dynamic rather than static. Many species including humans evolve faster than others. Many species become extinct because they fail to adapt fast enough. This natural balance may be disrupted by some major external disturbances like an asteroid impacting the earth like the one ending the dinosaurs and many other species. However, a different balance will be restored eventually reflecting the high adaptability of the surviving species.

We should recognize that all living things are passively responding to the changes in their environments, with the exception of humans. In this technological age, an external disturbance may comprise not only an asteroid, but also disastrous human acts such as nuclear holocaust, overfishing, environmental pollution, and climate change due to excessive man-made carbon dioxide. It is difficult to predict how living things will adapt and evolve in these conditions. Nevertheless there is scientific consensus that after an extinction event for humans, the creatures ruling the earth will likely be the most adaptable cockroaches and other insects. If you find this really hurts your ego, better engage yourself in promoting peace and protecting the environment from man-made disasters.

In conclusion, I believe in evolution because it helps me understand all those things important for human survival and wellbeing. It does not conflict with my religious belief. It only helps me find a way to contribute positively to the Creator’s plan, which despite omnipotent and benevolent, allows human freedom to destroy the earth.

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Some Political Jokes

Based on journalists’ reports and other published materials, I have assembled the following jokes for your enjoyment. The contents are half real and half fiction. I wrote the fiction part by creating an imaginary context whose purpose is to give you a good laugh rather than providing extra information.

Bill Clinton’s Astute Observations
Why he won in 1992: “It’s the economy, stupid!”
Why Hillary lost in 2016: “It’s the angry crowds, stupid!”
Why Al Gore lost in 2000: “It’s Monica, stupid!”

“Corporations Are People!”
Shorty after his re-election in 2012, President Obama invited his opponent Mitt Romney for lunch featuring hamburgers especially prepared by the White House chefs. The butler in the next room heard Romney saying out loud, “Hamburgers are people, too!” There they started debating again.

Move Over Darling
According to his biographers, President Lyndon Johnson liked to make his secretaries work through the night in the office. When they got tired, the sofas were there for them to lay down for a nap. One night Johnson came in and squeezed himself into the sofa where a secretary was resting.
“Move over! It’s your President,“ he commanded.

World’s Most Honest Politician
Winston Churchill had the strange habit of coming out of his bathroom totally naked (indecent exposure if you will). One evening a maid went into his bedroom to tidy things up for the night. She was shocked when Churchill suddenly appeared in a state of nature.
“Now you know that your Prime Minister has nothing to hide,” Churchill calmly reassured her.

World’s Smartest Tax Accountant
President Trump was advised to claim $59 million tax deduction for the total loss of 59 cruise missiles he ordered to be fired into Syria.

Pre-Existing Conditions
Members of the US Congress know that they will be denied coverage if they vote to privatize their own health insurance provided by the government. The reason is that they all share the same pre-existing condition — Their crooked eyes are permanently fixated on the ugly money donors, a condition that is impossible to cure.

What Makes Us Special
Many Americans don’t understand why we are not embraced as liberators when we fight a war on foreign soil. In WWII England which was our staunchest ally, an American soldier recalled what an Englishman said to him, “You are over-paid, over-sexed and over here.”

A Truth Not So Subtle
Senator Hayakawa from California often dozed off while the US Senate was in session. A reporter asked Senator Edward Kennedy to confirm the rumor because their seats were next to each other.
“I never saw Senator Hayakawa, I only saw his pillow,” replied Kennedy.

Voting Fraud
Somewhere in America, voting fraud is said to be rampant. To prevent it, the following regulations are written down for strict enforcement:
No persons may enjoy the pleasure of voting more than once on election day.
No children may vote.
Homeless or illiterate persons must write down their addresses.
Poor persons may pay a discount price of $1 for the voting forms.
Dead persons are not allowed to vote.

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The 2016 US Election

Winners and losers are only separated by a thin line. Many people have crossed that line, some more than once. Thomas Edison once said, ”I have not failed. I’ve just found 10,000 ways that won’t work.” Most people don’t have the luxury to recover after failing so many times, but the point is, learn from your own mistakes.

The failure of Hillary Clinton in the 2016 election was a shock to many. How could she have lost to Donald Trump, an inexperienced egomaniac with a penchant for insulting people? Truth is, Hillary had failed to learn her lessons. The first lesson was losing to Barack Obama in the 2008 primary election (Why was she a worse campaigner than he, a novice after all?). The second one was a big challenge from Bernie Sanders in the 2016 primary (Why did so many young people flock to an old man who repeated the same real issues like a recorder?). The third one was an ineffective presidential campaign mostly focusing on Trump’s negatives (Why couldn’t she be more positive than Trump who ran an under-funded campaign based on hate?). Her vulnerabilities were obvious but she had not learned from them. Neither had the Democratic Party she represented.

Recently, Hillary admitted that she had made some mistakes, with no further elaboration of what they were. However, she immediately turned to blaming former FBI Director James Comey, Russian hacking and Wikileaks. Granted that all those were true, their impacts were only partial. Hillary will not learn if she does not honestly examine her own mistakes.

Hillary supporters like to say that America is not ready for a woman president. No! Americans are ready for anything new. They have already voted and re-elected a black president. On the other hand, they have rejected Sarah Palin because she showed amazing ignorance in world affairs. Americans are ready for a woman who can connect with the people, not just any woman. Hillary has failed miserably in showing understanding and connecting. Her supporters say she did not really lose to Trump because she won the national popular votes (albeit coming mostly from California and New York). Remember, the name of the game is the electoral vote. What matters is the popular votes being counted within each state, not across the whole country. Thus the candidate must win state after state in order to accumulate 271 electoral votes required for the presidency.

The Democratic Party should accept the responsibility that they had nominated a candidate who could not connect well with the people. If they cannot field a better candidate next time, we can look forward to another failure in 2020. The Democratic party bureaucracy deserves a shake up, too. Some of its leaders are over seventy years old. It needs to cultivate young blood and new visions. This by no means implies any virtues for the Republican Party. The GOP has gone berserk for many years. It has degenerated from the Party of Lincoln to the Party of No. Desperate for victory, the GOP has allowed itself to be hijacked by Trump, who is not a true Republican but has beaten all the Republican candidates in the nominating process.

What is Hillary’s political vulnerability? Her baggage is only part of the problem because Trump has his own baggage, too. It all boils down to her poor emotional connection with the voters, which is what an election is all about. If you think that her emails and her enemies did her in, how do you explain Trump’s popularity based on ego and unjust scapegoating of immigrants and foreign competitors for America’s woes? Did Trump create any enemies? Trump’s temperament led him to offend so many people that his insults did not seem to matter. In short, the American voters deserved a better candidate than any of those two in the 2016 election. In the absence of a third candidate, they tended to pick the firebrand whom the people could wrongly but easily connect.

Hillary’s careful manners and scripted conversations didn’t offend, but they betrayed a sense of aloofness and inauthenticity that gave people little emotional reason to vote for her. Neither did she inspire voters on the good things she had done and offer a better future for the country. Just compare their campaign slogans of “Make America great again!” and “I’m with her!”. Which one do you think conveyed a better message? Hillary’s slogan made people think that it was her turn to be president. No! Americans wouldn’t accept that kind of privilege or entitlement. She had to earn it every time she went out to campaign, not by qualification or seniority, but by her ability to whip up the crowd.

It has been reported that Bill Clinton was not happy with her campaign. He advised that Hillary should pay more attention to the millions of angry workers being hurt by stagnant wages, factories moving overseas, crushing health care costs, ballooning student loans, and government dysfunction in Washington. The advice fell on deaf ears. Hillary simply continued to hammer on Trump’s bad temperament and insisted that he was unfit for the presidency. She seldom stressed what she would do to make life better for the millions of disenchanted voters. As a consequence, she lost three important “blue” states: Pennsylvania by 71,000 votes, Michigan by 22,000, and Wisconsin by 11,000.

Hillary could have been president had she carried those three states even after losing Florida and Ohio, which were really tossups. She blamed her enemies causing her to lose those three states. In fact, she was complacent and did not campaign hard enough over there, thus allowing Trump to move in through the back door. Trump offered many crazy campaign promises that would not work, but he managed to connect with the angry voters. Based on Trump’s snafu, many experts predicted that Hillary would win a landslide across the country in many states. It did not happen due to her continuous hammering on Trump’s negatives that many people already knew. She should have inspired the voters by telling them why she wanted to be president, and how she planned to change things for the better. In short, her campaign lacked a positive inspirational message that could stir up the crowd. She failed to follow up on what Michelle Obama wisely said, “If they go low, we go high.”

Now America winds up with a president who has an unstable temperament which is unfit for the office. This is unfortunate but real. The whole world has to wait and see what will come out of this in the next four years, maybe eight. God please help us!

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Lost in Translation

A young man from China arrived in San Francisco during the Gold Rush. He knew very little English but was eager to adopt a convenient English name for a new life. His friend had advised to use Sam Ding, which was simple, easy to pronounce, and sounded more or less like his Chinese name.

During that era, many immigrants did not have travel documents for various reasons. Ding was one of them. The US immigration staff would meet them at the port of entry to do screening and registration.

An officer had just finished registering Antonio Fuentes, the man waiting in front. He then turned to Ding and asked for his name.
“Sam Ding”, Ding tried to pronounce as accurately as he could.
“Okay! Same thing”, the officer acknowledged.
He then wrote down “Antonio Fuentes, Jr.” on the form.

The Chinese immigrant came out of registration with a fancy name. Instead of Sam Ding, he wound up with one that he could not even pronounce!

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Answering the Herbalist’s Call

I was born in 1950 into an herbalist family in Guangzhou, Southern China. We moved to South Vietnam because my father got a contract as a Chinese herbalist in the Cantonese Hospital in Cholon, the sprawling Chinatown adjacent to Saigon (Now Ho Chi Minh City).

After completing his contract with the hospital, my father decided to stay in Cholon and opened an herb shop of his own just two blocks away from home. Living next door was Grandma on Mom’s side. She was a midwife operating a small 10-bed maternity ward. We felt like having two homes which were connected through a backdoor.

We maintained a home office catering to many clients who came at odd hours. Since my father never said no to his clients, the rest of the family helped out when a client came unexpectedly (We had no phone and no advance-booking tradition). During the flu season when the workday typically started at 6 AM and ended at midnight, the whole family was mobilized including the kids. Among the four siblings of two boys and two girls, I ranked second, and was the most willing helper because I found the job more interesting than school work.

I often wondered how Dad could remember all the herbs being used. Dad showed me the classical herbal dictionary where about 1000 herbs were listed and described. “Try to learn five a day and you’ll be done before the year’s over.” So this became my goal before turning a teenager. It took me about an hour to read and remember five herbs. I was also encouraged to spend time at the shop to look at, feel, smell and taste them. I was surprised they did not taste as terrible as the tea brewed from an herbal mixture. Several months later, I was proud to show that I could identify most of our inventory even if blindfolded.

Learning the herbs is only the first step. The art of Chinese medicine involves putting together the right mixture of herbs that reinforce rather than conflict with each other in order to bring about a cure for a particular illness of a particular person. It is always custom-made according to the condition of the patient.

Dad taught me not to be lazy intellectually. By that he meant not to copy blindly from the many “ancient secret formulas” floating around, and not to take the words of those “wise men” for granted. A good herbalist should draw his own conclusion based on knowledge and experience, tempered by logic and empirical evidence. The only criterion of a good herbal prescription is its cost-effectiveness, not where it is copied from.

As time went by, I found myself often sitting next to my father to observe how he interfaced with each individual client employing the cardinal rule of “Look, feel, ask and pulse read”. We kept a record of the client’s condition for each visit and the corresponding herbal mixture being formulated. Gradually, I could understand the reasoning and subtleties in the process of writing an herbal prescription.

While Dad graduated from the Guangzhou Herbal College, my training involved apprenticing with him, which was an acceptable alternative for entering the herbal profession. Since we owned and managed the business, my herbal education was a 24/7 immersion because it was actually our livelihood around which most activities revolved.

As the Vietnam war began to escalate, we moved to Hong Kong in 1964 where most of our relatives had long settled. In 1968, I left for college in America to study Physics, a subject I had scored high in the public certificate exam and my teachers said I was good at. However, I ended up with a B.A. in Economics (Berkeley) that I really liked. This was followed by 6 years of work in Hong Kong in the economic consultancy profession, capped by an M.A. in International Relations (Chicago) in 1978. The following year, my family immigrated to America where I first worked as a technician in Silicon Valley, then as an engineer after obtaining an M.S. in Engineering (Stanford) in 1989. During those years, while my father carried on his herbal profession uninterrupted, my herbal training turned into a hobby due to the demands of a full-time job, higher education, and raising a family of four after getting married in 1979.

In 1993, something unexpected happened. My company went through a massive layoff, a victim of the personal computer revolution. I suddenly discovered the potential of partnering with my father in the herbal business. We opened an herb shop called Herbs & Tea in San Jose. Since we were the only duos operating the business, it became a 24/7 immersion just like the good old days, except that the clients might phone beforehand for a consultation and would not come during odd hours anymore.

I find it very satisfying for being able to help my clients solve their health problems. In the process, we also become friends. After all these years, I have finally heard my calling and settled in the profession I truly love. It may seem like a long wild detour, but I think fate has brought my career back in a great circle to where I originally began as a little boy.

Although my father wished that I would follow in his footsteps, he never insisted upon it because he wanted to see me develop my other potentials. On the day we opened the herb shop in San Jose, Dad was so happy that he was moved to tears. He said we were finally in full control of our own business and destiny. He also said that in this profession, you could never retire if your clients still wanted to see you. Dad passed away in 2006, one year after seeing his last client at the age of 96. I guess this is also my fate because I am still professionally active although having retired officially since 2015.

Posted in Funny/Personal, Health Care, Inspiration | 1 Comment

World’s Biggest Middlemen

In everyday life, we try to eliminate the middleman in order to cut cost and foster closer relationship between producer and consumer. How successful are we doing that? I can see four areas where the middleman seems indispensable despite all the scandals and damages they’ve done. They are the so-called too-big-to-fail entities that need urgent reforms.


Since ancient times, humans prefer to worship God through an agent such as a village elder, a priest or an organized church through established rituals. Have we thought about seeking hope, comfort and salvation directly from God? Does God really prescribe that we must go through an agent? Being a Catholic since young age, I began to ponder this question only recently. I guess I’ll never find an answer unless through divine enlightenment.

Internet Platforms

The Internet has produced many big companies that bring large numbers of consumers and producers together through their versatile website platforms. Their success owes to the great services they provide in terms of choice, efficiency and lower price. Examples are Amazon, Uber and Airbnb. They are fast evolving and growing with plenty of things to learn and unexpected problems to solve.

Another group of companies establish the social networks that bring people together by facilitating the sharing of interests and experiences. Ironically, the dating websites have successfully revived the ancient role of the matchmaker that seemed dying in this modern age. Examples are Facebook, LinkedIn and Match.

Banking and Finance

We trust the banks by depositing our hard-earned money with them. We also trust the government to bail them out or take over responsibility when a bank fails. We never care what the banks do with our money which they use to make loans to other people, hopefully producing a profit. On the other hand, we scream when the government uses taxpayers’ money to bail them out when they fail. We tend to forget it was the big banks’ subprime-mortgage fiasco that precipitated the great recession in late 2008 from which we are still recovering almost ten years later.

The stock market represents another big middleman for sellers and buyers of financial instruments called stocks, shares and mutual funds. Since luck plays a significant part in stock trading for the average consumer (so-called small investor) who has no leverage in a bidding auction system, Wall Street operates more or less like a traditional gambling house under the heavy influence of big players and the seducing investment analytics they produce. The stock market is the best place where the strong legally eat the weak and get away with it by blaming the capitalist market and the economy.

A third big middleman operates in the insurance business. As customers, we pay regular premiums, and trust the insurance companies to compensate for our losses in case we die (life insurance) or suffer from an accident (fire, flood, earthquake and auto insurance). Again, we never care how they make use of the premiums we’ve paid because we assume they invest wisely. In any case, Warren Buffett has said that insurance is a good business where the insurers receive the money first before paying out any. When the insurer pays compensation, it mostly wins because in reality only a small percentage of the insured get into accidents or die. The laws of statistics favor them. The insurance business is based on the principle that the majority subsidizes the small minority, thus allowing the insurer to pocket the profit as a middleman. The only condition is that the insurance market must be big. It won’t work if only several thousand people buy insurance.

Health Care

Health care insurance has become the norm in industrialized countries as a health maintenance program rather than an accident-compensation program. Where universal health care is practiced, the government runs the health insurance as a single payer. On the other hand, people in developing countries pay for their own health care on a piecemeal basis when they get sick. Strangely speaking, with all the medical technology available, health care is much more expensive for the average person in industrialized countries than in developing countries, especially in the United States where there is no universal health insurance. What are the causes? They can be summed up in two words, corruption and lack of competition.

The situation is very complicated in the United States where relentless health care inflation has priced out tens of millions of citizens. I will discuss this further in another post.

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