Why Are There Disparities In Health Care? Because It’s Free.
The latest issue of Health Affairs is devoted to racial and ethnic disparities in the consumption of health care. Naturally, they found some. Why are they there?
Let’s consider another necessity: food. Suppose you get a Double Quarter Pounder with cheese and a large order of fries, my favorite fast food indulgence when I put all considerations about healthy eating aside. Do you think your burger would have less cheese if you were a black customer? Would your fries be less crispy if you were Hispanic? Would the meat would be less juicy if you earned a poverty level wage?
The answer to these questions is obvious. Just about anybody in America can have the same fast food dinner anyone else in America is having — usually with very little inconvenience. If there is any disparity in this market, it is due solely to individual preference and choice.
So what makes health care different? I am happy to report that increasingly, it isn’t different. MinuteClinics, RediClinics and other walk-in establishments around the country offer standardized services that are comparable to the market for cheeseburgers and fries. In fact, almost one of every five people who got a flu shot last year got it at a supermarket or a drugstore. At a walk-in clinic, your flu shot costs the same as my flu shot. Your allergy prescription is just as inexpensive and just as accessible as mine. If there is any difference between us it is solely due to differences in needs and preferences. Nothing more.
The Failure of Orthodox Health Policy. So what’s the problem? Almost the entire health policy community is dead set against having medical care delivered in this way. The orthodox view is that (a) markets should be systematically suppressed, (b) medical care should be completely free at the point of consumption and (c) availability should be rationed by waiting and other non-price mechanisms.
Yet wherever the orthodox approach has been followed, disparities are rampant. The Inuit and the Cree in Canada, the Maori in New Zealand, Aborigines in Australia — all have less access to care and worse health outcomes than the majority white populations of those countries. (See the summary in Lives at Risk.)
For the United States, a policy brief on health disparities, produced by the Agency for Healthcare Research and Quality, appears in Health Affairs. Chris Fleming summarizes the report this way:
[B]lacks, American Indians, and Alaska Natives received worse care than whites for about 40 percent of the agency’s list of core measures (which include such criteria as whether women receive timely mammography screenings and whether heart attack patients receive recommended hospital care).
Hispanics or Latinos, meanwhile, received worse care than non-Hispanic whites for about 60 percent of core measures. The agency said the situation was improving, but very slowly. And as for minorities’ access to health care—defined as the ability to obtain care when and where they needed it—about 60 percent of the agency’s core measures did not show any improvement, and 40 percent were getting worse, the agency reported.
Bad as all this appears, the situation here is not worse than it is in other countries. As we have pointed out before, our health care system is probably more egalitarian than most other developed countries, including Canada and Britain.
Disparities Around the World. In the last half century, no country in the world has been more dedicated to the goal of equal access to care than Britain and no country has made a greater empirical effort to monitor its progress in achieving that goal. As we pointed out in Lives at Risk, when the British National Health Service (NHS) was established in 1948:
Aneurin Bevan, father of the NHS, declared that “everyone should be treated alike in the matter of medical care.” The Beveridge Report, the blueprint for the NHS, promised “a health service providing full preventive and curative treatment of every kind for every citizen without exceptions.” The British Medical Journal predicted in 1942 that the NHS would be “a 100 percent service for 100 percent of the population.” The goal of NHS founders was to eliminate inequalities in health care based on age, sex, occupation, geographical location and—most importantly—income and social class.
So how well did it all turn out?
[M]ore than thirty years into the program (in the 1980s), an official task force (the Black Report) found little evidence that access to health care was any more equal than when the NHS was started. Almost twenty years later, a second task force (the Acheson Report) found evidence that access had become less equal in the years between the two studies.
Across a range of indices, NHS performance figures have consistently shown widening gaps between the best-performing and worst-performing hospitals and health authorities, as well as vastly different survival rates for different types of illness, depending on where patients live. The problem of unequal access is so well known in Britain that the press refers to the NHS as a “postcode lottery” in which a person’s chances for timely, high-quality treatment depend on the neighborhood or “postcode” in which he or she lives. “Generally speaking, the poorer you are and the more socially deprived your area, the worse your care and access is likely to be,” says The Guardian, a staunch defender of socialized medicine. Scholarly studies of the issue have come to similar conclusions.
So what is it the British are missing? Three things.
First, the price system is the most equalizing institution ever produced by mankind. A largely unfettered price system is why you and I have roughly the same access, for the same price, to a flu shot at just about any CVS pharmacy. It is why we also have roughly the same access, at the same price, to a Quarter Pounder with cheese at any McDonald’s restaurant.
Second, the British made no attempt to understand the economics of non-price rationing. Third, they made no attempt to understand the economics of discrimination.
The Economics of Non-Price Rationing. As we have previously noted here and here, the major barrier to care in the United States is not price. The most important barriers to care in this country are the same as they are in other developed countries. They are non-price barriers. These include, for example: How long does it take me to make a doctor’s appointment by phone? How long do I have to wait before I can see the doctor? How long does it take to get to and from the doctor’s office? How long do I have to wait once I arrive at the doctor’s office?
Not only are non-price barriers the most important obstacles to care, higher-income, better-educated people find it easier to overcome them than lower-income, less-educated people. In other words, rationing by waiting and other forms of non-price rationing make inequalities worse, not better.
If we want to make health care more accessible — especially to vulnerable populations — we should focus on how to remove, or lessen the impact of, these non-price barriers. Of course the most straightforward way is to substitute rationing by price for rationing by waiting.
This is essentially the way the Food Stamp program works. Instead of making food free (or selling it far below-market prices), we allow the market to determine prices and empower low-income families with Food Stamps (which you can think of as a food vouchers).
The Economics of Discrimination. Thanks to the path-breaking work of University of Chicago economist, Gary Becker, we know a great deal about how institutions affect racial and ethnic discrimination as well as discrimination based on age, sex and other individual attributes.
In a free labor market, employers are able to discriminate at will in their hiring practices. But if the market as a whole is discriminating, each employer who discriminates will be financially penalized for doing so. Suppose that white workers are earning $20 an hour for a certain type of job and equally productive black workers are receiving $15. Then any employer who hires a white worker rather than a black, must pay an extra $5 an hour to satisfy his prejudices. Alternatively, a firm that hires only black workers would have labor costs that are 25% lower than those who hire only white workers.
The market not only punishes those who discriminate, beyond some level discriminating firms cannot survive.
At the time of Becker’s original research on this question, I believe he estimated that white workers were getting a 15% wage premium because of the racial preferences of employers (or the racial prejudices they perceive to be held by co-workers or consumers). I don’t keep up with the literature on labor economics, but I would be surprised if the differential is anywhere near that figure today. For sex discrimination, my understanding is that rigorous studies have never found that the market as a whole discriminates against women. Readers can correct me in the comment section if I’m wrong.
[What about the claim that women earn only 87 cents for every dollar men earn? That difference is explained by differences in hours worked, different occupational choices, etc. There is no industry where women earn 87% of what men earn for doing exactly the same work.]
In a nonmarket environment, things are different. If prices are not free to clear the market, then excess demand or excess supply must be cleared in some other way. In general, if people with a scarce resource are not free to discriminate based on price, they will discriminate by some other means. This is why non-price rationing tends to be especially harmful to minorities.
Without looking at any empirical data, economic theory alone predicts that if minimum wage laws and other labor market restrictions create a labor surplus, the black unemployment rate will be greater than the white unemployment rate. If policies that promote first-dollar coverage create a shortage of medical care, economic theory alone would predict that unmet needs will be greater among black patients than among whites.
If the demand for medical care exceeds the supply, for example, providers can discriminate based on racial, ethnic or sexual preferences and not pay a price for doing so. That may be one reason for the statistics given above. It may also help explain why more than half of all patients waiting for an organ transplant are members of a racial or ethnic minority.
There are disparities in health care for the same reason there are disparities in health literacy, differences in seeking medical care and differences in lifestyle behaviors. The notion that everyone should act the same flies in the face of free will and the rights of people to pursue happiness in their own way.
Disparities are often blamed on our health care system and even blamed on doctors’ biases. Disparities are rarely blamed on patient behaviors, which is probably the source of much of the difference.
There will be always be disparities as long as there are differences in patients and differences in how patients take care of themselves. Some disparities could be the result of factors beyond our control. For instance there is evidence that some ethnic minorities deliver low birth weight babies at rates higher than whites even when controlling for income and prenatal care. This is possibly genetic — yet people want to blame the health care system for differences in outcomes that defy treatment.
Good post. The Health Affairs article completely ignores basic economics. No wonder they can’t figure out how to solve the problem.
Excellent post.
John, excellent analysis.
A “food stamps” debit card is really cash. I like to avoid the use of the word voucher, since it is too ofetn not cash but only for something specific, such as for HMO insurance premiums in Massachusetts–a place where the state in fact seeks to fix the price. The MA voucher is not cash–they are different. Thanks, Bob
So very true. The problem however, is that we have not had true free market healthcare since before Medicare- before the rapid advances in medical technology with the corresponding increases in longevity and survival rates. Our healthcare system suffers from a paradox of medical supplies and technology operating in a free market (albeit, rapidly eroding) and administration and delivery of healthcare operating under government’s thumb. We are stuck inside the box of what is–a healthcare system shackled to increasing government regulation, untethered from market indicators and a victim of its own success. This has resulted in people unable to imagine and even negating the possibility of actually paying for their health services like they do for all other products and services and an insurance model just like that in car, home and life insurance.
Healthcare suffers from a lack of vision, creativity and entrepreneurship because over half of it is repressed by government. There’s no reason to believe that healthcare cannot operate like the markets for food, clothing, housing (and even FUNERALS, for heaven’s sake), etc. where a wide range of products and services are available at all price ranges and consumers find satisfaction in buying the best they can afford where the individual or family gets to determine their own cost benefit of whatever medical service/intervention they pursue or don’t pursue.
This is an interesting issue that I’ve never seen explained as well anywhere else.
I looked at the article descriptions in the Health Affairs link you provided (haven’t read the whole issue). I was dumbfounded that not one article was about the vast “disparity” of the Latino population in securing insurance coverage. This is the great unmentionable in health policy circles. Yet the rates of non-insurance in the states is almost perfectly correlated with the size of their Latino population. It is far and away the biggest driver of this issue. But because no one is willing to talk about it, none of the remedies address the cause.
I believe Latinos, especially recent immigrants, do not understand this uniquely American way of financing health care. Clark Havighurst has written about how American health insurance is aimed largely at the needs of the upper middle class (those who determine what the benefits should be, etc.)
Texas has actually done a pretty good job of addressing this population through the direct delivery of services.
Agree with Brian, great explanation.
There are a great number of complex variables that result in disparities in health care, and efforts should be made to reduce the impact of all of them. Perhaps the easiest measure would be to reduce financial barriers that result in disparities by providing first dollar coverage for everyone.
Central planning would also be important to ensure adequate health care facilities in low-income regions – areas that do not tend to be attractive to private providers of health care services.
Perhaps the biggest challenge would be to reverse trickle-up economics so that every household can maintain a decent standard of living, as much as is humanly possible.
I think John is on to something here.
If white and non-white Americans get the same Big Macs in the free market place, they would get the same CABG’s in a free market place.
I am assuming here that anyone who can afford to pay for a Big Mac can also afford to pay for a CABG out of pocket.
Lest someone on this blog — e.g., Don McCanne — argues that it isn’t so in the real world, let me tell you that I am an economist and thus entitled to make assumptions. Our whole professeion depends on it.
Uwe
Okay, Uwe, as an economist, how do you explain the almost total immunity of medical technology to supply and demand and product life cycle on medical pricing. Take CABG, for example. I’m not sure how much it costs right now but I’ll just say $100,000 from admission to discharge and 90 days post op. Of that cost, the surgeon’s fee is about the only part of the cost that has decreased while hospital costs, bypass equipment, anesthesia drugs, OR equipment have all outpaced inflation while the number of CABGs has markedly increased over the last 30 years.
This is what I’m referring to as being “stuck in the box”. The typical supporter of socialized medical care dismisses the possibility that medical procedures and technologies would respond to the same market and economic indices as other high tech industries if pricing was not artificially pumped up by government and third party payer and supply was allowed to respond to demand.
Our healthcare system has never had a chance to operate in a free market system and therefore defies basic economic principles that would have otherwise allowed healthcare to be produced and consumed like other consumer goods and services i.e. CABG should be on the same price/volume index as a computers, electronics, cell phones and of course, as LASIK surgery.
I’ve already heard all the liberal arguments–medical care is not voluntary and therefore, does not abide by normal market behavior. 1) much of healthcare is elective –at least non-emergent and 2) we have not had any evidence of medical care operating without government involvement since the advent of medical high tech—(except now in Thailand, India, etc. and the results to lowering costs are impressive).
We have evidence that healthcare can operate in a free market on the Canadian border where hospitals and physicians offer their services for cash at often lower rates than current Medicare or health insurance reimbursements and Canadians line up for the privilege.
Additional reasons for disparities are:
1) Newcomers tend to create whole communities away from the core city, so are not where the healthcare emerged earlier.
2) Newsomers and disadvantaged earlier arrivals tend not to put enough members through training in the health professions to have them return to give care in their original communities,
3) Health professionals of other cultures tend not to want to live in these single-ethnicity communities, nor do they know the language and culture, (second and third generation residents tend to show no difference in access to care, if they live in the mainstream culture.)
4) Newcomers tend to be frightened by the “packag-ing”of Western healthcare–the multi-story clinics, the massive hospital buildings, the tall Caucasians in their white coats.
5) And they are afraid of giving their right names or of coming to the attention of any government agency.
6) They may associate a medical problem with old age, not an illness that can be cured. (Diabetes–blindness)
7) They may not understand that early identification and treatment can save their lives. Latina women who are first generation tend to go to a doctor for a breast lump an average of 18 months after discovering it. (I once saw a breast on the camera table in a pathologist’s office that had a flower-shaped cancer the size of a camelia. He said: “She just thought it would go away.”)
To talk about disparities as though this was a new topic is just a high school level discussion. For decades great strides have been taken to reduce the obvious causes of these cultural differences. For an excellent example, look at the Texas Diabetes Institute in San Antonio: housed in a closed hospital, has trained dozens of Compradoras to get out the word, has reformulated recipes in family-owned ethnic recipes, has set up training programs for whole families affected by Diabetes, and many more programs. Efforts like these are at work all over the country. They will go far. But sometimes I get the feeling that our good liberal friends, like Uwe, think that all these real world conditions can be overcome by a process of blaming and fiddling with payment methods.
As to the concentration of ethnic minorities on waiting lists for organs, it is well to remember basic medical principles and the sociology of organ donation: Obtaining a DNA/tissue/blood match with a minority patient is difficult when the majority of donors are Caucasian.
John–there should be a different discussion going on–how to further disseminate primary care and a ‘distance medicine’ capability to wherever people live, backed up by a regional medical center’s oversight and ability to recruit and direct health manpower. The main event is not the hospital–it is ambulatory care of all types, including retail.
Policy people should get a life.
Hi to all…
Wanda J. Jones
President
New Century Healthcare Institute
@Prof. Reihardt: Meat consumption in previously poor countries is rising dramatically as incomes increase. Meat is very cheap in the U.S., but that is because of a competitive market. (And I don’t eat hamburgers for ethical reasons. I wouldn’t do very well in Texas.)
Automobiles, kitchen appliances, et cetera, have all become more available because they were allocated according to the price system. Real prices dropped. Imagine if, instead of allowing Henry Ford to innovate a lower cost way to produce cars and sell them for prices that his own employees could afford, the government of the day had decided that cars were too important to be left to market forces. Instead the government would determine how to allocate them fairly.
I suppose one way to do this would be to make automobiles an employer-based, group benefit, regulated by non-discrimination rules that attempted to insure that the CEO and the receptionist drove the same car.
Would that have resulted in the century of innovation and price reductions we’ve seen in automobiles? Surely not.
With respect to non-price rationing of health services. If the government’s policies result in reduced supply, it’s pretty clear that the competition on the demand side will be won by the best connected people.
I know people in Toronto who enrol their kids in private school because their children will be classmates with the children of the limited number of specialists with admitting privileges at the city’s limited number of hospitals. So, if and when you need the city’s best cardiologist, you don’t get an appointment with Dr. Smith, but with “Jane’s mom.
@John Graham–re making cars an employee benefit.
Please, don’t give Congress any ideas. If the individual mandate survives a court challenge, it can require us all to start buying Chevy Volts or make an individual responsibility for planet damage payment.
This will be necessary because not everyone a) pays for the damage he is doing to the planet, b)everyone in the US needs a car at some point in his life and cars are too expensive, and c) there are car disparities and they vary by race.
@ Uwe Reinhardt
I thought ecnomists were supposed to be able to think abstractly. Do I have to walk through every single medical service and show there is an alternative to nonprice rationing in each case? It appears so.
Okay, let’s take CABGs. One way to allocate them is to make them free and deter access with various forms of nonprice rationing. This is how other countries do it, and it appears to be really bad if you are poor or if you are a racial or ethnic minority.
The other way is to empower patients, make them legitimate consumers and invite providers to compete for their patronage. What I call the casualty model of insurance and what others call reference pricing or value based purchasing gives the patient purchasing power, but leaves the market free to determine prices and realize the benefits of competition.
QED
@ Devon Herrick, Buster, Hoads and Bo Geist
I agree
@ Greg Scandlen
You are correct. I believe Hispanics have twice the uninsurance rate as non-Hispanics at every level of income.
@ Don NcCanne
First dollar coverage is not the solution. It is the problem. Most people in most countries have first dollar coveage and it does not guarantee access to care. In fact, it impedes access to care.
@ wanda j. jones
I don’t disagree with you list. But what is missing is the role of markets. What markets do best is discover and meet people’s needs — if they are allowed to do so.
@John Graham and Linda Gorman
Right on the mark, as usual.
Excellent explanation of how market suppression and subsidies lead to poor service and artificial pricing. I have to take issue with the assertion that “many have first-dollar coverage”. Did I read that right? Does he mean here in the US? Most people I know have had to go to a high-deductible HSA style plan, even those with employer supported insurance. Having to satisfy an $8-10,000 family deductible is anything but first dollar coverage.
Our esteemed Professor’s sarcasm had a bit of truth in it, but he missed where the market place comes in. He figures, sarcastically of course, that anyone who could afford a Big Mac could certainly afford to pay for the CABG out of pocket. That is the way non businessman might think. Lesson #1: Businessmen buy insurance so many of our presently unemployed for the price of 1 Big Mac per day can buy health insurance to pay for a big chunk of the bill and still have money left over to buy a few Big Macs. Lesson #2: Amortization.
@Jay W–Here are some numbers on coverage and deductible amounts. I think that they show that it is accurate to say that first dollar coverage is closer to the norm than the exception.
Almost everyone on Medicaid has what amounts to first dollar coverage as copays, if they exist, generally top out at $5.00. In 2009, about 47.5 million people, 15.6 percent of the population, was covered by Medicaid.
Medicare enrollment was about 45.6 million.
About 200.1 million people were privately insured in 2009. The 2011 the Kaiser/HRET survey estimates that 31 percent of employees enrolled in an employer group health plan had deductibles of $1,000 or more for single coverage. This includes HSA and HRA.
Of people with general annual deductibles, the average is $675 for people in HMOs, and $1,908 for people in plans with high deductibles and savings options.
AHIP estimates that 11.4 million people had HSA/HDHP plans in 2011. Of those, 2.4 million were in the individual market. Bigger businesses opted for HRAs as they get to keep any balance in the savings account when the employee leaves.
John,
I beg to differ.It is impossible to equate a big mac to healthcare. They are entirely at the opposite extremes of the problem that health care posits. No two people with the same age, same symptoms, same blood work findings and same x-ray reports could have very different problems. Big macs are always the same regardless of where they are prepared. There are many reasons for the inequities that exist, and unfortunately are directly related to the ability to have good medicine provided that is affordable, that the face to face to the physician or physician extender is handicapped by the time constraint, the fee structure, and the social necessities to spend enough time with the patient to have him/her understand the charge to the patient, to make much needed directions to solve the problem. Yes, there are inequities but little different in concept of equating a big mac to a steak dinned at the Palm.
You take another tenuous step in wondering how this can happen and I will try to give you my opinion. We have a system that is broken beyond repair, that will put quality at the top of the list and personal wealth at the end. Can this be done? It can be but the changes that of necessity rewriting the mission and vision that must be goal number one. In today’s world, the best doctors are the ones that take care of the sickest patients.
John..
Comment from a colleague.
On the short-term, I’m pessimistic about real reform in healthcare. Obama is a conciliating, compromising, cautious, centrist; or maybe, because of his inexperience, he consorted with too many of that ilk rather than with the angels of real “change.” Without the following in place, I think that only a tickling up of the unaffordable, exclusionary status quo is possible, discussion of which leaves me uninterested:
1. Per capita for primary care in lieu of fee-for-service
2. Salary specialists and surgeons who are willing to become hospital employees; and hospitals….? Ah, hah!
3. UK was, so far as I am aware, the only nation to adopt full-scale regionalization of institutional resources on a population basis by means of the NHS. Scotland included the teaching hospitals whereas England left them as entities apart. Hence, the Scots were able to deploy high level skills to upgrade, nay, innovate geriatric services (including LongTerm Care) and upgrade psych and mental retardation services. I left the UK for two years in India in 1967, which I think was the zenith of the Scottish health services. Then a mixture of social mediciner shennigans and Thatcherism (one couldn’t possibly conceive that physicians would work hard or well without strengthening financial gain) made matters more complicated with little public or professional benefit – but with an enormous growth of administrators (recruited from military retirees, in part) as governors extraordinary.
Yes, it’s the only way to really bring cost-effectiveness. But even in the UK it was hard to reduce cottage hospitals or convert them to LTCare.
Over here, I don’t think there’s any likelihood. In Connecticut, I have observed that every little hospital (with ER, ICU, and imaging machinery – but not the staffing or skills -for heart attacks, trauma, etc.) will fight to financial exhaustion – or until well-oiled amalgamation – rather than concede. Our redundancy of surgeons, imaging, etc. etc. is dangerous to the public’s health as to our solvency. But change it all, I doubt. The vested interests are really too powerful, nourished paradoxically on public funding, from the nursing home industry by Medicare/Medicaid to the surgical and procedural specialties by Medicare.
I have a pessimistic view, however, also for the long-term. It is the fanciful delusion of wealthy societies and their elites that they always have so many options, so many bites at whatever fruit, endless open opportunities if this or that incremental change doesn’t work out as anticipated. I don’t believe that. Somewhat like warfare, the opportunity must be taken or lost, if not for ever, lost for decades. Our perplexed and depleted society can’t raise the spirit or imagination or energy for real change. I do, do hope I’m wrong but am unlikely to be around for disproof of my prognostications.
I should say that patient care and its entirely local organization and teaching kept my morale up. I exercised an ethical opportunism towards the hard-money fiscal systems so poorly designed (because deliberately designed around providor profit). But I was increasingly aware that such efforts, as Ray and Stan Ingman used to tell me, were ‘counter cultural.’ So I didn’t expect them to last much beyond my involvement, nor did they.
fyi…
As a Brit I take issue with the way our health care system is portrayed. The implication is that the NHS discriminates on race because the health of deprived areas is worse or perhaps due to racism by NHS staff. Where are the academic studies that show any statistical link between UK health care *provision* and race?
This article is also a bit confused by the term “postcode lottery”. The “postcode lottery” is a reference to some variations in the provision of *specific* treatments for specific illnesses/diseases/cancers with geography. It is not about the overall money spent on care. Differences of treatment by geography are because local health authorities, to a limited extent, have been given powers to prioritize where they direct some of their funding. There is also a variation by country within the UK (England, Wales, Scotland, Northern Ireland) because the Governments/Assemblies of each can prioritize their tax spending on certain areas e.g. prescription charges. There is an overall provision of care that is still there regardless of geography.
The article is correct that the measured health of a population does vary with deprivation. In the *UK* this is primarily due to the *causes* of poor health.
It should also be noted that the UK doesn’t just have an NHS. We also have a private sector health care system with private consultants and private hospitals. It is perfectly possible to pay for your health care if that is what you want to do.
US coverage of the UK health system, on all sides of your debate, often appears to be wrong or hugely simplistic. In general, it also seems to ignore the cultural and social differences between the UK and US. Also, don’t give the impression that everything The Guardian (or any of our other newspapers) says is true or even logical.
Just in case I haven’t been clear, I am _not_ advocating here that the US has an NHS (or doesn’t have one). What you decide about your nation’s health care system is your own business not mine. I’m am merely complaining about the (mis)representation of our situation by *all* sides of the US debate.
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Or we could let 51% of the populaton tax the rest of us into oviblion and kill the goose that laid the golden egg. You’ve probably seen the stats, but the bottom 50% pay roughly zero income taxes. They pay FICA, but if we could turn that Ponzi scheme into individual savings accounts then that wouldn’t be a tax, it would be savings. And the money wouldn’t be there for the 1% or the 99% to manipulate. Charity is donating your money, not that of other people.Do you seriously think the gov’t will do a better overall job than the free market?
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