Has U.S. Democracy Been Trumped?

[barmar]

The polls have shown the American people to like the ACA but to not like Obamacare, which would be funny if not such a serious issue about the power of propaganda to misinform and lead astray.

Doesn't this point the way to a reasonable solution? Create a new healthcare system that's 95% the same as ACA, but tell the people that it's a big change from Obamacare. This would be far more truthful than most of Trump's tweets, it will make the public very happy, but will not do much damage to the status quo.

[barmar]

Here's the dumb-ass thing tweeted this morning:

 

 

As president of the US, Trump has easy access to any information he wants, and of course only 9 of those 122 were released during Obama's administration, 113 under Bush's administration. And you'd have to be pretty far out of the loop not to realize that the original tweet was way off base. And yet, there it is.

The problem is that many of his misinformed pronouncements sound plausible, and the people who share his worldview aren't going to go looking for confirmation.

 

Like when he said he got the biggest Electoral College win since Reagan. I consider myself reasonably well informed, but off the top of my head I couldn't have refuted it. Luckily every media outlet immediately checked it, and pointed out that it was smaller than most of the wins since then.

 

I know that Obama spent his entire tenure talking about closing Guantanamo, but he wasn't successful at that. But I wouldn't consider it unlikely that he managed to get many of the detainees released. So I wouldn't rush to fact-check Trump's statement about it, it seems like the kind of thing that could easily be true.

 

He's a snake oil salesman. They spout just the BS that their audience wants to believe, so naturally they'll believe it.

[ldrews]

A solution cannot be found in partisan rancor and grandstanding. Why not use the ACA backbone and work to make it better? The polls have shown the American people to like the ACA but to not like Obamacare, which would be funny if not such a serious issue about the power of propaganda to misinform and lead astray. If the Republicans in Congress keep calling for repeal of Obamacare - not the ACA - then they are being disingenuous and relying on inaccurate poll answers to justify their actions.

 

OK, specifically, how do we make it work better? Let's move away from vacuous generalizations and get real. Given the current political climate (Republicans in control of House and Senate, Republicans fractured, President is a populist), specifically what improvements should we make and how do we get them passed into law? (I am not smart enough to have the answers but you seem to be)

[Winstonm]

OK, specifically, how do we make it work better? Let's move away from vacuous generalizations and get real. Given the current political climate (Republicans in control of House and Senate, Republicans fractured, President is a populist), specifically what improvements should we make and how do we get them passed into law? (I am not smart enough to have the answers but you seem to be)

 

You hit the key point. There won't be a bipartisan bill because the polarization is too great and there is no more statesmanship in Congress - and that is because ideologues have moved the Republican Party too far right, forcing an equalizing response from Democrats. There may be a bill eventually and it may be passed. If so, millions will lose coverage.

[Winstonm]

Doesn't this point the way to a reasonable solution? Create a new healthcare system that's 95% the same as ACA, but tell the people that it's a big change from Obamacare. This would be far more truthful than most of Trump's tweets, it will make the public very happy, but will not do much damage to the status quo.

 

It does, but with the Tea Party and libertarians so entrenched now any solution that utilizes the government for support likely has no chance of passing. The Republicans are going to have to live with the mess they created by opposing rather than offering real solutions.

[billw55]

The USA needs to swallow its pride and give up the myth of exceptionalism. We aren't automatically better at everything than every other country just because we are the USA. Universal health care is one thing we are worse at. Many developed nations provide care for everyone - poor, elderly, very sick - at substantially lower cost per capita, and with better health outcomes overall. Let's learn to do it their way.

[jogs]

The USA needs to swallow its pride and give up the myth of exceptionalism. We aren't automatically better at everything than every other country just because we are the USA. Universal health care is one thing we are worse at. Many developed nations provide care for everyone - poor, elderly, very sick - at substantially lower cost per capita, and with better health outcomes overall. Let's learn to do it their way.

Health insurance is only good when someone else pays the bulk of your monthly premium. That's employer based health insurance. Medicare is subsidized by whose under 65.

The individual health insurance is paid 100% by the individual. Bad for individuals.

For those without health insurance there needs to be a bold new plan not tried by any other country. If the insurance industry hates the plan then it is probably a good plan for individuals.

Freeze out insurance companies. Eliminate redundant paperwork. Medical computer chips. No need to fill out a multi pages of health info every time you see a new provider. Stop the gouging. No mal-practice lawsuits allowed. That just jacks up the cost for everyone else.

Put the uninsured on medicaid while we figure how to solve this. But not free medicaid. Consumers get access to the network. But they have to pay.

[Winstonm]

The USA needs to swallow its pride and give up the myth of exceptionalism. We aren't automatically better at everything than every other country just because we are the USA. Universal health care is one thing we are worse at. Many developed nations provide care for everyone - poor, elderly, very sick - at substantially lower cost per capita, and with better health outcomes overall. Let's learn to do it their way.

 

Thank you.

[kenberg]

OK, specifically, how do we make it work better? Let's move away from vacuous generalizations and get real. Given the current political climate (Republicans in control of House and Senate, Republicans fractured, President is a populist), specifically what improvements should we make and how do we get them passed into law? (I am not smart enough to have the answers but you seem to be)

 

I happily confess to similar limitations on providing a solution. I will try, and this is tough enough, to look a little at where we are and where we seem to be heading. Nothing I say will be brilliant, probably not even original.

 

Charles Lane expresses part of this nicely;

Heretofore, the health-care debate was a contest between Republicans, who were bent on repealing "every word of Obamacare," and Democrats, who defended it. Now it's an argument about whose subsidized-regulated-individual-market-plus-some-Medicaid thingy works better.

Indeed. We seem to have accepted that we are going to do something along the lines of the ACA.

 

Now let's look at what it is. The injunction to "Read the bill" is fair enough, as long as we are not required to read every word of the damned thing. Here is a "Cliff's notes" version:

 

summary

 

Ok, I will try to see how this hits me. Being over 60, I was struck by the fact that I get a 4K tax credit while those in their 20s get only 2K. This seemed inverted from what I would expect. But then I see that insurers ge to charge me five times what they charge younger people for the same plan. So maybe I need the extra tax credit! But wait! Would I ever gt the same plan? For example, I am pretty sure Becky no longer feels the need for maternity care coverage. I haven't asked, but I think that is so. More seriously, I have Medicare. Can I apply this tax credit to my Medicare premiums? I also have a supplement to Medicare from Blue Cross Blue Shield. Someone in their 20s does not have such a supplemental plan to Medicare, since they are not on Medicare.

 

The above is just a start on trying to figure out what it all means. I would say more but I have to go. I am being fitted for a hearing aid today. Medicare does not cover hearing aids. BCBS gives an allowance of something like $2800. I'll take it. I have no idea if the this new plan would cover it.

 

 

Anyway, I think Charles Lane makes a good point (which of course has occurred to others as well). We are going to do something where the gov is heavily involved in our health care. That seems to be a settled matter.

[helene_t]

The USA needs to swallow its pride and give up the myth of exceptionalism. We aren't automatically better at everything than every other country just because we are the USA. Universal health care is one thing we are worse at. Many developed nations provide care for everyone - poor, elderly, very sick - at substantially lower cost per capita, and with better health outcomes overall. Let's learn to do it their way.

Yes.

 

However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:

 

- Get rid of malpractice lawsuits. If the doctor out of extreme neglect kills someone or causes permanent disability, report it to the police. Otherwise it's just bad luck. You can get his license revoked or maybe even get him in prisson if he's a really bad guy but your personal gain will be small. And if you report him just for failure to administer a treatment or test that in retrospect could have saved you then sorry, you are wasting everybody's time.

 

- Get rid of doctor-shopping. You have a single GP who knows you and if he's on holidays you just wait till he's back if it's not urgent. And I mean URGENT, not just "urgent".

 

- Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care.

 

- 60-70% paycut for doctors. OK, they save on malpractice insurance so they keep a liveable net income.

 

- Get rid of second opinion except if you are happy to pay for it yourself. Same with all diagnostic tests that don't have a clear indication.

 

- Every "condition" that was discovered by one of those ridicolous "general health checks" is given very low priority. They are usually false positives. Not much better than "my astrologist told me I might have cancer".

 

- No antibiotics unless a serious bacterial infection has been diagnosed. This applies to farm animals also.

 

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

 

- Drug expenses are reimbursed at the price of the cheapest generics unless a patented drug has been scientifically proven not just to be better but to be so much better that it is worth the cost. This means that at current prescription practice, you will often suffer some 90% co-payment so patients will have to put pressure on their doctors to prescribe something that is covered. Obviously guidelines will have to be written for this so patients don't have to ask for it.

 

- Medical school is free to attend. This actually saves money since doctors won't have justification for demanding ridicolous salaries. More doctors will graduate, creating negative pressure on salaries.

 

I wish you good luck.

[Al_U_Card]

So, the consensus is that the Trump health plan is nonsense, unworkable, etc. The current ACA is imploding, premiums are soaring, deductables are soaring, insurance companies are abandoning, etc.

 

So what is your solution? Or are we to just sit on the sidelines and complain?

How about:

The guv sets prices based on.inspection and study of a broad spectrum of service providers. If everyone is obliged to pay into (like an income tax with payroll tax part too) then a sliding scale of how much you pay of the "list price" is used based on age and/or contributions to the "system". Thus, in my case I have almost never made use of the medical system so I would pay a smaller pro-rata amount than someone who was in poorer health. Supplementary private insurance would be available as well according to need. Younger people could use actuarial values to price-in their contributions (like term vs whole life insurance) of the cost to them.

[jogs]

How about:

The guv sets prices based on.inspection and study of a broad spectrum of service providers.

The gov't shouldn't set prices. Just have price transparency by service providers. Let the public decide if they wish to pay more for 'better' providers.

[Winstonm]

Yes.

 

However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:

 

- Get rid of malpractice lawsuits. If the doctor out of extreme neglect kills someone or causes permanent disability, report it to the police. Otherwise it's just bad luck. You can get his license revoked or maybe even get him in prisson if he's a really bad guy but your personal gain will be small. And if you report him just for failure to administer a treatment or test that in retrospect could have saved you then sorry, you are wasting everybody's time.

 

- Get rid of doctor-shopping. You have a single GP who knows you and if he's on holidays you just wait till he's back if it's not urgent. And I mean URGENT, not just "urgent".

 

- Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care.

 

- 60-70% paycut for doctors. OK, they save on malpractice insurance so they keep a liveable net income.

 

- Get rid of second opinion except if you are happy to pay for it yourself. Same with all diagnostic tests that don't have a clear indication.

 

- Every "condition" that was discovered by one of those ridicolous "general health checks" is given very low priority. They are usually false positives. Not much better than "my astrologist told me I might have cancer".

 

- No antibiotics unless a serious bacterial infection has been diagnosed. This applies to farm animals also.

 

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

 

- Drug expenses are reimbursed at the price of the cheapest generics unless a patented drug has been scientifically proven not just to be better but to be so much better that it is worth the cost. This means that at current prescription practice, you will often suffer some 90% co-payment so patients will have to put pressure on their doctors to prescribe something that is covered. Obviously guidelines will have to be written for this so patients don't have to ask for it.

 

- Medical school is free to attend. This actually saves money since doctors won't have justification for demanding ridicolous salaries. More doctors will graduate, creating negative pressure on salaries.

 

I wish you good luck.

 

This sounds SO Paul Ryan. :P

[Zelandakh]

If America wants to keep an insurance-based multi-payer system, and all evidence suggests that is the case, then reading about the oldest healthcare system in the world might be of interest. Naturally that is completely off the chart for Republicans though, being government-led (over 3/4 of costs) and obligatory (most cannot opt out of the statutory Krankenkasse system). Another system of interest would be in Australia, although even here the government pays for 2/3 of the costs. Perhaps an amalgamation of the two, taking Germany's customer focus and range of choice and merging it with Australia's stronger private options, would be possible but the simple truth is that if America really wants to get a hold of healthcare it has to involve the government stepping in and controlling the majority of it. Allowing the private sector free range is just a recipe for disaster in this field.

[jogs]

Politicians wants an insurance-based system. About 20% of Americans have no access to this healthcare. These Americans are mostly the poor. Would not be able to afford any system designed by politicians. The poor want the most healthcare the public is willing to give them( with their tax dollars).

[kenberg]

Yes.

 

However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:

 

- Get rid of malpractice lawsuits. If the doctor out of extreme neglect kills someone or causes permanent disability, report it to the police. Otherwise it's just bad luck. You can get his license revoked or maybe even get him in prisson if he's a really bad guy but your personal gain will be small. And if you report him just for failure to administer a treatment or test that in retrospect could have saved you then sorry, you are wasting everybody's time.

 

- Get rid of doctor-shopping. You have a single GP who knows you and if he's on holidays you just wait till he's back if it's not urgent. And I mean URGENT, not just "urgent".

 

- Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care.

 

- 60-70% paycut for doctors. OK, they save on malpractice insurance so they keep a liveable net income.

 

- Get rid of second opinion except if you are happy to pay for it yourself. Same with all diagnostic tests that don't have a clear indication.

 

- Every "condition" that was discovered by one of those ridicolous "general health checks" is given very low priority. They are usually false positives. Not much better than "my astrologist told me I might have cancer".

 

- No antibiotics unless a serious bacterial infection has been diagnosed. This applies to farm animals also.

 

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

 

- Drug expenses are reimbursed at the price of the cheapest generics unless a patented drug has been scientifically proven not just to be better but to be so much better that it is worth the cost. This means that at current prescription practice, you will often suffer some 90% co-payment so patients will have to put pressure on their doctors to prescribe something that is covered. Obviously guidelines will have to be written for this so patients don't have to ask for it.

 

- Medical school is free to attend. This actually saves money since doctors won't have justification for demanding ridicolous salaries. More doctors will graduate, creating negative pressure on salaries.

 

I wish you good luck.

 

This is so stunning to me that I honestly am not sure if you are being ironic or you really mean it. Most of it I object to. A couple of things I find totally unacceptable:

 

1. "Get rid of doctor-shopping."

If I do not like my doctor I will get a new one. Having lived for quite a while I have encountered doctors who needs to find a new profession. This goes way back to when I was an undergrad in the 1950s and got free medical care on campus. I was a healthy youngster but even so it was immediately apparent that not all doctors are created equal. Any plan that prevents me from seeking out someone I prefer would have my strong opposition. It's not easy to make me into a single issue voter, but this might do it.

 

2, "Get rid of malpractice lawsuits. " No. I take some pride in having gone through my 78 years without suing anyone or being sued. But that is me personally. We did attempt, unsuccessfully, to sue a doctor for something involving Becky. The main objective was to present him as the incompetent boob that he was.

 

3. "Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care." This maybe sounds good, but it isn't. The problem is that often you do not know how urgent something is until you are seen by the specialist. I'll mention one experience along these lines. A few years back I had a TIA, also known as a mini-stroke. A few weeks later I had symptoms similar to what had preceded the earlier TIA. Becky drove me into the emergency room, I walked up to the desk and said "I hope I am wasting your time". I explained, she understood, I was admitted, thankfully I was wasting their time, I was ok. But at the time I walked in I did not know that I was ok. If we wait until it is clear, that may be too late. Or at least it might be a lot more expensive if we are looking at the bottom line. Of course if I croak it would save a bundle.

 

I also am not big on cutting doctor's salaries. I'll let them speak to that, but if a guy saves my life I am not against giving him some money. Even quite a bit of money.

 

Short version: If what you describe is the European version of medical care I want no part of it.

 

But biking instead of driving appeals to me. I have biked a lot in my life but the roads around here are such that biking on them definitely reduces a person's life expectancy.

 

I mention these things because indeed this is a political hot potato. Part of what has to be done is to understand what people feel strongly about, and I believe I am in the (in the U.S.) majority in what I say here.

[jogs]

 

 

3. "Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care." This maybe sounds good, but it isn't. The problem is that often you do not know how urgent something is until you are seen by the specialist. I'll mention one experience along these lines. A few years back I had a TIA, also known as a mini-stroke. A few weeks later I had symptoms similar to what had preceded the earlier TIA. Becky drove me into the emergency room, I walked up to the desk and said "I hope I am wasting your time". I explained, she understood, I was admitted, thankfully I was wasting their time, I was ok. But at the time I walked in I did not know that I was ok. If we wait until it is clear, that may be too late. Or at least it might be a lot more expensive if we are looking at the bottom line. Of course if I croak it would save a bundle.

 

 

I favor the single payer/free market model. Long queue if you want someone else to pay. No waiting when you pay with your own money, whatever the market will bare. Steve Jobs paid his liver transplant doctor the taxes and utilities on the doctor's house for two years.

[kenberg]

I favor the single payer/free market model. Long queue if you want someone else to pay. No waiting when you pay with your own money, whatever the market will bare. Steve Jobs paid his liver transplant doctor the taxes and utilities on the doctor's house for two years.

 

We might agree, at least sort of. I have long felt that there is a limit to how much my family should pay to keep me alive, and if there is a limit to what they should pay then clearly there is a limit to what the tax payer should be expected to do.

 

But it depends a bit on the situation. And the problem is that sometimes the situation is not clear.

 

I favor helping people in need. On the other hand, I find the system works pretty well for me as it is right now and I don't want someone (Dem. or Rep. or Trump, whatever he is) screwing it up with some badly thought out changes.

[barmar]

I favor the single payer/free market model. Long queue if you want someone else to pay. No waiting when you pay with your own money, whatever the market will bare. Steve Jobs paid his liver transplant doctor the taxes and utilities on the doctor's house for two years.

The problem with a 2-tier system like this is that many of the best doctors will abandon the public health system and go into "concierge" practice, treating the rich people who are willing to pay more.

 

Capitalism means you get what you pay for, and free things are worth every penny you spend.

[cherdano]

The problem with a 2-tier system like this is that many of the best doctors will abandon the public health system and go into "concierge" practice, treating the rich people who are willing to pay more.

I think the bigger problems is with doctors who (as jogs suggests) take both public and privat patients. Taking public patients means that they are in charge of public resources - making judgement calls on who needs a surgery most urgently, etc. Taking private patients means you can bribe them, sorry, in a private consultations they may become more aware of this particular patient's urgency.

[jogs]

2, "Get rid of malpractice lawsuits. " No. I take some pride in having gone through my 78 years without suing anyone or being sued. But that is me personally. We did attempt, unsuccessfully, to sue a doctor for something involving Becky. The main objective was to present him as the incompetent boob that he was.

 

I wave my right to sue. Give me the inexpensive healthcare, no insurance companies and no lawyers.

$100 a month with medicare. If you wish to retain your right to sue, you should pay $1,000 a month premiums into medicare.

 

If the doctor is incompetent, decertify him. But give the plaintiffs and lawyers nothing.

[jogs]

What you want is from the progressive agenda, not from Donald Trump. Why continue to support a con man? I mean, it's O.K. to be conned. We are all susceptible. It is not O.K. to stay conned.

I don't agree any progressive agenda. On healthcare both democrats and republicans got it wrong. If the GOP plan isn't hated by health insurance CEO's, it is not an improvement over Obamacare.

Since I don't need to be re-elected to any office, I can offer my plan which would anger many. On a temp basis, all uninsured can join medicaid. Only it's not free. They will be billed. The young and healthy should be pleased. They will have access to healthcare. And only when they need it.

This doesn't solve the problem with older unhealthy Americans without health insurance. I'm amazed how old looking and unhealthy Americans who are 20 years younger than I are. Republicans can repeal Obamacare with no replacement. Put them into medicaid(and bill them for use) til republicans can agree on a workable plan. Not optimistic. Who will come forward and agree to foot the bill for the poor who are sickly?

[helene_t]

This is so stunning to me that I honestly am not sure if you are being ironic or you really mean it.

Well, I mean it in the sense that if (I say IF) you want Scandinavian-level cost-efficiency then you basically have to go for this. I may have exaggerated a bit but then again, there were a couple of things I forgot (like: get rid of poverty, get rid of unhealthy (poor) living space in inner cities, and get rid of pharma lobbyists).

 

Of course you may have different priorities.

 

As for waiting lists, I agree with you. The problem is, apparently, that without the price incitement to keep down demand there has to be a different mechanism to avoid overconsumption. But there must be a better way. There are countries like OZ and France that have reasonably short waiting lists but it comes with a price tag. I think Denmark has managed to get most of the waiting lists down to more or less acceptable lengths, though.

 

As for doctor-shopping, of course you should be allowed to switch doctors but what is not a good idea is to keep switching all the time. Of course every patient is different. If you only see a doctor once every several years it doesn't matter.

 

As for malpractice lawsuits I really would encourage you to reconsider your position. Malpractice lawsuits may work in particular cases but overall their impact on health care quality is almost certainly negative. Have your heard about the book "Complications"? https://books.google.co.uk/books/about/Complications.html?id=8dkuoAz9-WMC&redir_esc=y

[kenberg]

Well, I mean it in the sense that if (I say IF) you want Scandinavian-level cost-efficiency then you basically have to go for this. I may have exaggerated a bit but then again, there were a couple of things I forgot (like: get rid of poverty, get rid of unhealthy (poor) living space in inner cities, and get rid of pharma lobbyists).

 

Of course you may have different priorities.

 

As for waiting lists, I agree with you. The problem is, apparently, that without the price incitement to keep down demand there has to be a different mechanism to avoid overconsumption. But there must be a better way. There are countries like OZ and France that have reasonably short waiting lists but it comes with a price tag. I think Denmark has managed to get most of the waiting lists down to more or less acceptable lengths, though.

 

As for doctor-shopping, of course you should be allowed to switch doctors but what is not a good idea is to keep switching all the time. Of course every patient is different. If you only see a doctor once every several years it doesn't matter.

 

As for malpractice lawsuits I really would encourage you to reconsider your position. Malpractice lawsuits may work in particular cases but overall their impact on health care quality is almost certainly negative. Have your heard about the book "Complications"? https://books.google...WMC&redir_esc=y

Maybe all three of these could be grouped under the general problem of people behaving badly. I don't doubt that lawsuits are a serious problem and not just for lawyers. There have been various times, no details come immediately to mod, where I have felt like saying to a doctor or some other professional, "Relax, I am not the suing kind". But some are.

And I have no idea why anyone would hop from doc to doc. We moved eleven years or so ago, I got a new doc, I would not recommend him to a cat. I got a new one who left for parts unknown, then the next guy I am still with, for maybe eight years.

It's like anything else, some products/services are better than others. But if a person is never satisfied then the problem is probably with them .

 

There can be little amusements. Back during my TIA days I was getting many tests. At one of them the woman about to administer it said "I am not certain Medicare will pay for this but they will if you feel dizzy. I ask you sir, do you feel dizzy?". Well the whole business was very confusing and no doubt causing some dizziness. "Oh yes, I feel dizzy". I have always been good at pop quizzes. The TIA had produced dizziness and beyond, so I have a clear conscience about that one.

[ldrews]

How about:

The guv sets prices based on.inspection and study of a broad spectrum of service providers. If everyone is obliged to pay into (like an income tax with payroll tax part too) then a sliding scale of how much you pay of the "list price" is used based on age and/or contributions to the "system". Thus, in my case I have almost never made use of the medical system so I would pay a smaller pro-rata amount than someone who was in poorer health. Supplementary private insurance would be available as well according to need. Younger people could use actuarial values to price-in their contributions (like term vs whole life insurance) of the cost to them.

 

It seems like anytime you put the government in charge of regulating an industry, the industry immediately starts trying to "capture" the regulators with bribes, campaign contributions, entertainment junkets, etc. The industry is usually successful. Look at banking, insurance, education.

 

And everyone tries to game the system: the regulated companies, the clients and patients, everyone. Each individual and company trying to change or move the the laws/regulations in their favor, or find loopholes to give them some advantage.

 

Expecting everyone to behave themselves and cooperate for mutual benefit seems naive given our history.