7 ms·

Obamacare’s sinking safety net

28 points by mkane848 10y ago

qserpent 10y ago
I don't know anything about the details of this situation. But maybe someone else here does. How is the US so inefficient at healthcare? We spend more per person (or per GDP?) than many (most?) other countries and we get less in return. Where is this money going?
- snuxoll 10y ago
  Administrative fees, paying too many MD's to do work that PA's and NPP's could accomplish if they were allowed to, as well as paying high salaries because our education costs have skyrocketed so we have people leaving school with tens to hundreds of thousands of dollars of debt to enter the medical field. People abusing the emergency room (especially Medicaid members) for the sniffles instead of going to an urgent care or a family practice. Oh, and let's not neglect that hospitals have no choice but to jack up prices to insane rates because insurance companies will just negotiate them down heavily. The whole system is messed up.
  - jjnoakes 10y ago
    If the insurance companies are successfully negotiating the prices down so low, shouldn't they have more money?
    - snuxoll 10y ago
      This part only affects the underinsured. Let's say you have some crazy medical test, like an MRI. It costs roughly $2,000 to run the test (totally random number out of my hat). If a hospital is negotiating a contract with an insurance company, and says "An MRI costs $2,000 here" the insurance company will say "We will pay you $500". So, to make sure they can be correctly compensated by insurance carriers they instead say "An MRI costs $8,000", the insurance company will then say "Okay, we will pay you $3,000". It's total luck to get the correct amount, so you will usually WAY over compensate and end up getting more than you NEED to be reimbursed in return, just to provide a safety net for insurance carriers messing around with you. Under most cases people with amazing low-deductible plans are fine, they pay their $500 deductible for the year plus 20% of the remaining and make off quite well for the procedure. People with high deductible plans (like mine) get screwed, I would end up having to meet my $2,500 deductible and then pay 20% after that (up to my annual out of pocket max, which is $5000). Because hospitals have to play this stupid game with insurance companies, it's rare that you can get charged the "real" price of any procedure or lab time. People without insurance can negotiate extremely discounted rates based on financial need, but if you are underinsured you are stuck with whatever contracted rate the facility has with your insurance company.
      - toomuchtodo 10y ago
        Why don't insurance companies own the vertical and purchase healthcare providers, in order to control costs? It seems like cost controls are the root of the problem.
        snuxoll 10y ago
        Some do, they're called HMO's (Health Management Organizations), Kaiser Permanente being a prominent one. A lot of people don't like having to see a doctor not part of the organization without going through headaches, however, which lead to the prevalence of modern PPO's.
        dragonwriter 10y ago
        > Some do, they're called HMO's (Health Management Organizations), Kaiser Permanente being a prominent one. KP is an HMO, and does own its provider network rather than contracting with providers (for most things, at least), but that's not a defining characteristic of HMOs. Many HMOs have contracted, rather than insurer-owned, provider networks.
        wahern 10y ago
        But the issue is still the same: the network of doctors you can see is very much restricted. And in any event, the way Kaiser is structured (at least in Southern California, where a friend is a Kaiser doctor), the doctors are employed by separate legal entities which contract with the hospitals. So it's kind of a distinction without a difference. HMO implies vertical integration where incentives line-up differently than when providers and insurers are more at arms length. That said, PPOs also have in-network restrictions. They're looser, but PPOs are also often significantly more expensive. In my limited experience, it's not the network restrictions per se, but that people want to continue going to a specific doctor or to a specific hospital. My relative who is a partner at a law firm rails against Obamacare because of the ridiculous premiums her firm has to pay. But they only pay those premiums because she demanded a policy that allowed her to continue seeing the same doctor she's seen for over 20 years. She's smart and almost always votes Democratic; the cognitive dissonance in her rants would be comical if it weren't for the fact that so many people exhibit that kind of thinking. I use Northern California Kaiser and love it. For one thing, it's ridiculously inexpensive, all things considered. And I don't expect the kind of relationship with my doctor portrayed on television. Kaiser is very technologically savvy and data driven. (Though that doesn't mean they used the latest & greatest tech). Their doctors are disciplined to attend to patients efficiently. I've never felt rushed or anything of the sort (even during the 48 hour birth of my son), but neither the doctors nor staff will linger unnecessarily. But because Kaiser works as a holistic entity, some people may feel neglected. Kaiser dis-intermediates you from the doctor and his personal staff. Appointments are booked on the web or via a call center. For illnesses, you first contact the Kaiser nursing call center, where a nurse and on-call doctor will do a preliminary diagnosis over the phone and often even write a prescription. For common injuries like sprains, etc, you might be scheduled to see a doctor at their sports injury center or similar specialized department, which at my medical center is conveniently (and I doubt coincidentally) located across the corridor from the imaging department. Follow-ups with a doctor will often use their electronic messaging system (basically, web mail). I _love_ that aspect of Kaiser because I appreciate the effort that goes into reducing costs and improving outcomes. For people who want to feel coddled by their doctor and his staff, or use them as an outlet for their anxiety, it's probably a nightmare.
  - pravda 10y ago
    >paying high salaries because our education costs have skyrocketed This whole thread is chockablock with fallacies, but let's limit ourselves to this one for now. Education costs are sunk costs. Doctor's salaries have nothing to do with education cost. Doctor's salaries are high because the government restricts the number of doctors. That leads to high salaries for doctors. Supply and demand, not sunk costs. Hint: you've got a bunch more fallacies in your post!
- etendue 10y ago
  It's of course very complex, but three things not always mentioned: Dealing with the insurance companies and their Byzantine billing practices requires hiring additional staff to specifically deal with billing issues, with that cost passed to the patient. Electronic medical records slow down physicians, (fewer patients seen requires billing more for those you do see) and at least the ones I've experienced end up being more expensive than paper records. The insurance companies also are very slow in reimbursements to physicians (sometimes several months behind) which requires billing more to help compensate for the uncertainty. Also, insurance frequently doesn't reimburse enough to cover the actual cost of a procedure, e.g., vaccines.
- glenra 10y ago
  Price competition is mostly illegal due to the way the health industry has been successfully cartelized over the years. The usual benefit of free-market competition is that inefficient providers are allowed to go broke while better ones expand, but the field is so over-regulated that we simply don't allow that to happen. So lots of ridiculous inefficiencies persist. In a more free market, insurance wouldn't be tied to specific states - you could buy insurance from any firm in the nation willing to provide it. Hospitals would be allowed to expand and compete and go out of business like restaurants are - there wouldn't be any "Certificate of Need" process preventing that. Doctors wouldn't be tied to specific states or nations and medical schools wouldn't have their enrollment limited via licensing rules. In short, we have an artificial shortage of both doctors and hospitals which makes healthcare inherently expensive and low-quality compared to what it might otherwise be.
  - HillRat 10y ago
    >In a more free market, insurance wouldn't be tied to specific states - you could buy insurance from any firm in the nation willing to provide it. That's an idea that sounds good but turns out to be a nightmare in practice. You would end up with a classic "race to the bottom" scenario of the sort seen in credit card regulations, corporate tax rates, and employee disability reimbursements -- eventually you would end up with a state that allows such egregiously poor insurance practices that every company would flock there to avoid more onerous regulations. The current system is byzantine and a nightmare to deal with -- I still wake up in the middle of the night with implementation guides scrolling behind my eyelids -- but it's an improvement over a policy that would, in effect, let the payers pick and choose the least-protective regulatory structure.
- rogerbinns 10y ago
  No one has an incentive to fix it. Tour round the various entities that money is spent on, and try to find a single one that is campaigning to reduce their income. (eg doctors, practises, drug makers, equipment manufacturers, health "insurance" companies, hospitals). Any reduced spending is coming out of their pockets - turkeys don't campaign for xmas! So you have a bright idea. You'll open up an excellent well run hospital, using best practises, big picture approaches, and due to all that you'll save everyone money. Of course opening that hospital will take patients away from existing more expensive providers. But it is a free country, and in other commercial sectors that seems like progress. In many states you can't do this by law. You have to show there is unserved "need" and get a certificate of need, including that existing providers are not harmed. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
ozy23378 10y ago
Politico.com :D
hardcandy 10y ago
As a self-employed developer I have an ACA plan and I can tell you first-hand it feels like a total fraud. I pay $300/month but also have a $6k deductible, which means the plan doesn't really pay for anything until I've already spent $6k out of pocket. I have no problem with a $6k or even $20k deductible because I work hard to remain healthy but then my premiums for what is essentially a catastrophic policy should be much lower (around $75/month). Fortunately I can afford the extra amount, but I can see how it would be extremely painful for a family at the median income. My MD friends tell me the economics are based on people who work diligently to improve their health subsidizing people who could care less and actively sabotage themselves (e.g. non-compliant diabetics who eat like crap and don't medicate...not even diabetics as a whole). Unless and until the conversation about personal responsibility starts it seems hopeless. Whatever Obamacare started out trying to be, it has been twisted into something else and badly needs reform.
- pgroves 10y ago
  My story is very similar except my insurance company went out of business yesterday: http://www.chicagotribune.com/business/ct-land-of-lincoln-shutdown-0713-biz-20160712-story.html http://www.chicagotribune.com/business/ct-land-of-lincoln-sh...
- wutbrodo 10y ago
  I had roughly the same plan as you (I'm on a sabbatical). I thought autopay was set up but my second month's payment failed to go through. I was traveling for a few months at the time, and since insurance companies are universally incompetent, they sent me a few letters (and zero emails to the address they had on file) before cancelling my coverage. The nice part is that, since I'm not not eligible to re enroll on the exchanges, the short term insurance plan I have to buy is MUCH cheaper. For the months of July - December, I'm paying around $350 for a catastrophic plan. If I was working the penalty would probably hit me hard but since I'm on vacation, getting dropped out of the exchange has actually saved me quite a bit of money.
- karmajunkie 10y ago
  Just out of curiosity, when did you make the move to self-employment and the individual exchange? I was self-employed for years prior to the advent of the ACA, and my experience was that my premiums were about the same, deductibles were the same or higher, PPOs were out of the question, and I was rolling the dice on whether I could even get coverage for myself or my family because of preexisting conditions. If that market were in place today, getting coverage would be an impossibility for myself and my wife, who is a cancer survivor, leaving us to the high-risk pools where the premiums would be in the 5 figure range annually. Yes, the ACA has some problems, but if the right wing in Congress hadn't been so hell-bent on making it fail to the detriment of all constituents, chances are we'd have something that works a bit better (if still imperfectly.)
noobermin 10y ago
Before the ACA, there were a handful of ways insurers could balance their risk pool. One big tactic was just to avoid covering sick people, filtering out individual customers who appear likely to need lots of expensive medical care. But Obamacare made that type of discrimination illegal: One big selling point of the law was that everyone would be eligible to sign up. Companies that profited off of denying helping people with pre-existing conditions are finding they can't profit anymore? Allow me to play a little ditty on the world's tinniest violin for them. The honest reality is that these costs did exist before, it's just they were paid by the sick in our society by dying, while the health insurance companies skimmed off the cream from the healthy. No free lunch, right? So this cost existed, only by law, it was pushed onto the healthcare companies after the ACA It is quite bad though, as the article details, costs have reached 100% of premiums at least in NC it looks like. That is unsustainable, and since the ACA went ahead with requiring healthcare companies to help pull this off, without something like a public option to cover say the super sick, this isn't good news. All around, this is a bad. But it's not like ACA made it worse, it just made the costs appear somewhere else, and as the article states, absent of any new policy, that cost will shift back to the sick who will have to die again.
- antisthenes 10y ago
  Companies that find they are losing money in individual states should be forced to bite the bullet. I'm still amazed that these companies are allowed to make a profit in the first place. Yes, there will be bad states, but you shouldn't be allowed to just stop offering coverage until you're actually losing money as a company overall.
  - hardcandy 10y ago
    The ACA provided over $2 billion in startup funds for about three dozen non-profit health care co-ops (new insurance companies) who were meant to provide competition, increased choice and lower prices for consumers. Almost all of these co-ops are now bankrupt thanks to a medley of fraud and incompetence. As noted elsewhere in the thread, Land of Lincoln in IL just publicly announced their dissolution today. What happened? Well, it turns out running an insurance company is hard, and in return for doing that hard job, the executives, even of these non-profits, want to be paid a lot of money. In many cases the Government allocated startup funds to politically-connected individuals who sucked it out of the system and into their own pockets. So no, the grass isn't always greener. You can't just slap a ''non-profit'' label on something and expect problems to be fixed. And to the extent you pay executives less money, they will work less, and in the absence of that leadership, systemic future risks start to accumulate. The selfish profit motive is still one of the core values that our society depends upon in order to function the way we expect it to. Gordon Gekko put it one way: ''Greed is Good!''. Milton Friedman another: ''Nirvana is not for this world.'' Not yet, at least.

28 points by mkane848 10y ago

I don't know anything about the details of this situation. But maybe someone else here does. How is the US so inefficient at healthcare? We spend more per person (or per GDP?) than many (most?) other countries and we get less in return. Where is this money going?

snuxoll 10y ago
Administrative fees, paying too many MD's to do work that PA's and NPP's could accomplish if they were allowed to, as well as paying high salaries because our education costs have skyrocketed so we have people leaving school with tens to hundreds of thousands of dollars of debt to enter the medical field. People abusing the emergency room (especially Medicaid members) for the sniffles instead of going to an urgent care or a family practice. Oh, and let's not neglect that hospitals have no choice but to jack up prices to insane rates because insurance companies will just negotiate them down heavily. The whole system is messed up.
- jjnoakes 10y ago
  If the insurance companies are successfully negotiating the prices down so low, shouldn't they have more money?
  - snuxoll 10y ago
    This part only affects the underinsured. Let's say you have some crazy medical test, like an MRI. It costs roughly $2,000 to run the test (totally random number out of my hat). If a hospital is negotiating a contract with an insurance company, and says "An MRI costs $2,000 here" the insurance company will say "We will pay you $500". So, to make sure they can be correctly compensated by insurance carriers they instead say "An MRI costs $8,000", the insurance company will then say "Okay, we will pay you $3,000". It's total luck to get the correct amount, so you will usually WAY over compensate and end up getting more than you NEED to be reimbursed in return, just to provide a safety net for insurance carriers messing around with you. Under most cases people with amazing low-deductible plans are fine, they pay their $500 deductible for the year plus 20% of the remaining and make off quite well for the procedure. People with high deductible plans (like mine) get screwed, I would end up having to meet my $2,500 deductible and then pay 20% after that (up to my annual out of pocket max, which is $5000). Because hospitals have to play this stupid game with insurance companies, it's rare that you can get charged the "real" price of any procedure or lab time. People without insurance can negotiate extremely discounted rates based on financial need, but if you are underinsured you are stuck with whatever contracted rate the facility has with your insurance company.
    - toomuchtodo 10y ago
      Why don't insurance companies own the vertical and purchase healthcare providers, in order to control costs? It seems like cost controls are the root of the problem.
      - snuxoll 10y ago
        Some do, they're called HMO's (Health Management Organizations), Kaiser Permanente being a prominent one. A lot of people don't like having to see a doctor not part of the organization without going through headaches, however, which lead to the prevalence of modern PPO's.
        dragonwriter 10y ago
        > Some do, they're called HMO's (Health Management Organizations), Kaiser Permanente being a prominent one. KP is an HMO, and does own its provider network rather than contracting with providers (for most things, at least), but that's not a defining characteristic of HMOs. Many HMOs have contracted, rather than insurer-owned, provider networks.
        wahern 10y ago
        But the issue is still the same: the network of doctors you can see is very much restricted. And in any event, the way Kaiser is structured (at least in Southern California, where a friend is a Kaiser doctor), the doctors are employed by separate legal entities which contract with the hospitals. So it's kind of a distinction without a difference. HMO implies vertical integration where incentives line-up differently than when providers and insurers are more at arms length. That said, PPOs also have in-network restrictions. They're looser, but PPOs are also often significantly more expensive. In my limited experience, it's not the network restrictions per se, but that people want to continue going to a specific doctor or to a specific hospital. My relative who is a partner at a law firm rails against Obamacare because of the ridiculous premiums her firm has to pay. But they only pay those premiums because she demanded a policy that allowed her to continue seeing the same doctor she's seen for over 20 years. She's smart and almost always votes Democratic; the cognitive dissonance in her rants would be comical if it weren't for the fact that so many people exhibit that kind of thinking. I use Northern California Kaiser and love it. For one thing, it's ridiculously inexpensive, all things considered. And I don't expect the kind of relationship with my doctor portrayed on television. Kaiser is very technologically savvy and data driven. (Though that doesn't mean they used the latest & greatest tech). Their doctors are disciplined to attend to patients efficiently. I've never felt rushed or anything of the sort (even during the 48 hour birth of my son), but neither the doctors nor staff will linger unnecessarily. But because Kaiser works as a holistic entity, some people may feel neglected. Kaiser dis-intermediates you from the doctor and his personal staff. Appointments are booked on the web or via a call center. For illnesses, you first contact the Kaiser nursing call center, where a nurse and on-call doctor will do a preliminary diagnosis over the phone and often even write a prescription. For common injuries like sprains, etc, you might be scheduled to see a doctor at their sports injury center or similar specialized department, which at my medical center is conveniently (and I doubt coincidentally) located across the corridor from the imaging department. Follow-ups with a doctor will often use their electronic messaging system (basically, web mail). I _love_ that aspect of Kaiser because I appreciate the effort that goes into reducing costs and improving outcomes. For people who want to feel coddled by their doctor and his staff, or use them as an outlet for their anxiety, it's probably a nightmare.
- pravda 10y ago
  >paying high salaries because our education costs have skyrocketed This whole thread is chockablock with fallacies, but let's limit ourselves to this one for now. Education costs are sunk costs. Doctor's salaries have nothing to do with education cost. Doctor's salaries are high because the government restricts the number of doctors. That leads to high salaries for doctors. Supply and demand, not sunk costs. Hint: you've got a bunch more fallacies in your post!
etendue 10y ago
It's of course very complex, but three things not always mentioned: Dealing with the insurance companies and their Byzantine billing practices requires hiring additional staff to specifically deal with billing issues, with that cost passed to the patient. Electronic medical records slow down physicians, (fewer patients seen requires billing more for those you do see) and at least the ones I've experienced end up being more expensive than paper records. The insurance companies also are very slow in reimbursements to physicians (sometimes several months behind) which requires billing more to help compensate for the uncertainty. Also, insurance frequently doesn't reimburse enough to cover the actual cost of a procedure, e.g., vaccines.
glenra 10y ago
Price competition is mostly illegal due to the way the health industry has been successfully cartelized over the years. The usual benefit of free-market competition is that inefficient providers are allowed to go broke while better ones expand, but the field is so over-regulated that we simply don't allow that to happen. So lots of ridiculous inefficiencies persist. In a more free market, insurance wouldn't be tied to specific states - you could buy insurance from any firm in the nation willing to provide it. Hospitals would be allowed to expand and compete and go out of business like restaurants are - there wouldn't be any "Certificate of Need" process preventing that. Doctors wouldn't be tied to specific states or nations and medical schools wouldn't have their enrollment limited via licensing rules. In short, we have an artificial shortage of both doctors and hospitals which makes healthcare inherently expensive and low-quality compared to what it might otherwise be.
- HillRat 10y ago
  >In a more free market, insurance wouldn't be tied to specific states - you could buy insurance from any firm in the nation willing to provide it. That's an idea that sounds good but turns out to be a nightmare in practice. You would end up with a classic "race to the bottom" scenario of the sort seen in credit card regulations, corporate tax rates, and employee disability reimbursements -- eventually you would end up with a state that allows such egregiously poor insurance practices that every company would flock there to avoid more onerous regulations. The current system is byzantine and a nightmare to deal with -- I still wake up in the middle of the night with implementation guides scrolling behind my eyelids -- but it's an improvement over a policy that would, in effect, let the payers pick and choose the least-protective regulatory structure.
rogerbinns 10y ago
No one has an incentive to fix it. Tour round the various entities that money is spent on, and try to find a single one that is campaigning to reduce their income. (eg doctors, practises, drug makers, equipment manufacturers, health "insurance" companies, hospitals). Any reduced spending is coming out of their pockets - turkeys don't campaign for xmas! So you have a bright idea. You'll open up an excellent well run hospital, using best practises, big picture approaches, and due to all that you'll save everyone money. Of course opening that hospital will take patients away from existing more expensive providers. But it is a free country, and in other commercial sectors that seems like progress. In many states you can't do this by law. You have to show there is unserved "need" and get a certificate of need, including that existing providers are not harmed. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need

ozy23378 10y ago

Politico.com :D

hardcandy 10y ago

As a self-employed developer I have an ACA plan and I can tell you first-hand it feels like a total fraud. I pay $300/month but also have a $6k deductible, which means the plan doesn't really pay for anything until I've already spent $6k out of pocket. I have no problem with a $6k or even $20k deductible because I work hard to remain healthy but then my premiums for what is essentially a catastrophic policy should be much lower (around $75/month). Fortunately I can afford the extra amount, but I can see how it would be extremely painful for a family at the median income. My MD friends tell me the economics are based on people who work diligently to improve their health subsidizing people who could care less and actively sabotage themselves (e.g. non-compliant diabetics who eat like crap and don't medicate...not even diabetics as a whole). Unless and until the conversation about personal responsibility starts it seems hopeless. Whatever Obamacare started out trying to be, it has been twisted into something else and badly needs reform.

pgroves 10y ago
My story is very similar except my insurance company went out of business yesterday: http://www.chicagotribune.com/business/ct-land-of-lincoln-shutdown-0713-biz-20160712-story.html http://www.chicagotribune.com/business/ct-land-of-lincoln-sh...
wutbrodo 10y ago
I had roughly the same plan as you (I'm on a sabbatical). I thought autopay was set up but my second month's payment failed to go through. I was traveling for a few months at the time, and since insurance companies are universally incompetent, they sent me a few letters (and zero emails to the address they had on file) before cancelling my coverage. The nice part is that, since I'm not not eligible to re enroll on the exchanges, the short term insurance plan I have to buy is MUCH cheaper. For the months of July - December, I'm paying around $350 for a catastrophic plan. If I was working the penalty would probably hit me hard but since I'm on vacation, getting dropped out of the exchange has actually saved me quite a bit of money.
karmajunkie 10y ago
Just out of curiosity, when did you make the move to self-employment and the individual exchange? I was self-employed for years prior to the advent of the ACA, and my experience was that my premiums were about the same, deductibles were the same or higher, PPOs were out of the question, and I was rolling the dice on whether I could even get coverage for myself or my family because of preexisting conditions. If that market were in place today, getting coverage would be an impossibility for myself and my wife, who is a cancer survivor, leaving us to the high-risk pools where the premiums would be in the 5 figure range annually. Yes, the ACA has some problems, but if the right wing in Congress hadn't been so hell-bent on making it fail to the detriment of all constituents, chances are we'd have something that works a bit better (if still imperfectly.)

noobermin 10y ago

Before the ACA, there were a handful of ways insurers could balance their risk pool. One big tactic was just to avoid covering sick people, filtering out individual customers who appear likely to need lots of expensive medical care. But Obamacare made that type of discrimination illegal: One big selling point of the law was that everyone would be eligible to sign up. Companies that profited off of denying helping people with pre-existing conditions are finding they can't profit anymore? Allow me to play a little ditty on the world's tinniest violin for them. The honest reality is that these costs did exist before, it's just they were paid by the sick in our society by dying, while the health insurance companies skimmed off the cream from the healthy. No free lunch, right? So this cost existed, only by law, it was pushed onto the healthcare companies after the ACA It is quite bad though, as the article details, costs have reached 100% of premiums at least in NC it looks like. That is unsustainable, and since the ACA went ahead with requiring healthcare companies to help pull this off, without something like a public option to cover say the super sick, this isn't good news. All around, this is a bad. But it's not like ACA made it worse, it just made the costs appear somewhere else, and as the article states, absent of any new policy, that cost will shift back to the sick who will have to die again.

antisthenes 10y ago
Companies that find they are losing money in individual states should be forced to bite the bullet. I'm still amazed that these companies are allowed to make a profit in the first place. Yes, there will be bad states, but you shouldn't be allowed to just stop offering coverage until you're actually losing money as a company overall.
- hardcandy 10y ago
  The ACA provided over $2 billion in startup funds for about three dozen non-profit health care co-ops (new insurance companies) who were meant to provide competition, increased choice and lower prices for consumers. Almost all of these co-ops are now bankrupt thanks to a medley of fraud and incompetence. As noted elsewhere in the thread, Land of Lincoln in IL just publicly announced their dissolution today. What happened? Well, it turns out running an insurance company is hard, and in return for doing that hard job, the executives, even of these non-profits, want to be paid a lot of money. In many cases the Government allocated startup funds to politically-connected individuals who sucked it out of the system and into their own pockets. So no, the grass isn't always greener. You can't just slap a ''non-profit'' label on something and expect problems to be fixed. And to the extent you pay executives less money, they will work less, and in the absence of that leadership, systemic future risks start to accumulate. The selfish profit motive is still one of the core values that our society depends upon in order to function the way we expect it to. Gordon Gekko put it one way: ''Greed is Good!''. Milton Friedman another: ''Nirvana is not for this world.'' Not yet, at least.